are too small; their purpose is only secondarily educational; friction is liable to arise over efforts to retain patients for teaching purposes; the students remain more or less outsiders.
The modernization of medical education in Chicago requires, then, that two of the three schools in question should greatly strengthen their laboratory instruction, and that all three should strengthen their clinical instruction. The number of students to be provided for is a factor in determining a definite line of procedure. Rush has on its two-year college basis 488 students; Northwestern had in its first-year class, on a very loosely enforced one-year college basis, 66; the inevitable two-year standard will greatly reduce this number. Should the College of Physicians and Surgeons go to the two-year college standard,—an inevitable development if it lives,—it would suffer similarly. It seems fair to estimate, then, that the actual number of medical students in Chicago on a two-year college basis will not be too large to be cared for in a single school adequately equipped with laboratories and hospital. As medical education on the proper basis cannot be attempted outside a university, and as none of the three universities now teaching medicine in Chicago is likely to abandon the field to the others, it is suggested in the interest of efficiency and economy that (1) each of the three universities continue to provide—like the University of Chicago—the instruction of the first two years; (2) all three universities combine to form a clinical department under joint management, the first step towards which would be a concerted effort to procure a proper hospital for the use of third and fourth year men. The sum necessary to procure three such hospitals is so large that it is highly improbable that as separate institutions the schools can acquire separate and adequate clinical departments. Inasmuch as there is no demand for graduates exceeding the capacity of one clinical school, it would be sheer extravagance to equip three on the basis proposed. The Cook County and other hospitals would, on the suggested arrangement, play the part for which they are exactly suited in furnishing illustrative material for advanced students whose discipline had been elsewhere looked to, and in making possible the development of instruction for graduates in all the specialties,—a form of opportunity for which, just for lack of differentiation and organization, our physicians are still forced to go abroad. A great opportunity is thus fairly within the grasp of Chicago: the conditions to its realization are honesty and intelligence on the part of the state authorities, and cooperation between the three great universities of the state. The execution of this plan might set the country at large to thinking on the wisdom and necessity of coördinating our educational enterprises. Everywhere, thus far, our higher education has worn a competitive aspect. Some good has been thus accomplished; but now that local or numerical competition can be replaced by scientific and scholarly competition, to which the entire country and indeed the civilized world are parties, we begin to realize the waste and demoralization due to institutional competition. It is difficult to see how the state of Illinois, which in the interest of public health ought to be a factor in
