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AS THEY ARE LISTED BY THE COUNCIL ON MEDICAL EDUCATION OF THE AMERICAN MEDICAL ASSOCIAΓΙΟΝ. CLASS "A PLUS" SCHOOLS GIVE "AN ACCEPTABLE 4-YEAR COURSE"; CLASS "A" SCHOOLS GIVE A 4-YEAR COURSE THAT IS "LACKING IN CERTAIN RESPECTS BUT OTHERWISE ACCEPTABLE"

noticeable. I have a typewritten copy of Dr. Colwell's first inspection report before me. The percentages given the different colleges are admittedly liberal - whenever there was a doubt it was resolved in favor of the college. Yet of the 160 schools inspected only half (81) showed efficiency of 70 per cent. or more, 47 ranked between 50 and 70 per cent., and 32 fell below 50 per cent. in the scale.

From the completion of this first inspection in 1907 dates the beginning of the

increased to 166 by 1904. The graduates of 1880 numbered 3,241 - enough new physicians, in all conscience, even if every one had been a master of the science and art of medicine. By 1894 the number of graduates had reached the high-water mark, with 5,747 obtaining their degrees, and the total attendance of students reached the record-breaking figure of 28,142. Compare these figures with those for the college year 1911-12, after seven years of activity on the part of the Council

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IN THE CLASSIFICATION OF THE AMERICAN MEDICAL ASSOCIATION, CLASS "B" IS COMPOSED OF SCHOOLS THAT "NEED GENERAL IMPROVEMENT TO BE MADE ACCEPTABLE," AND CLASS "C" IS COMPOSED OF SCHOOLS THAT "REQUIRE A COMPLETE REORGANIZATION"

age of training. Medical education, in the profession solidly behind the moveshort, is distinctly on the up-grade. ment for educational reform.

The fruits of the movement for eductional reform began to be apparent when, in 1910, Dr. Colwell presented the results of his second inspection and classification of medical colleges to the Council. This time the classification was published. The time was auspicious, for the Carnegie Foundation for the Advancement of Teaching had just published the report of Mr. Abraham Flexner on his personal

In this report of 1910 to the Council, medical colleges were graded in three classes: "A" including those which were acceptable though not perfect, "B" those which were unsatisfactory in certain particulars but capable of improvement, and "C" those requiring a thorough reorganization to make them satisfactory. There were 72 colleges in class A, 30 in class B, and 31 in class C a decrease in the total

number from 160 to 133 and an increase in the percentage of satisfactory schools. This record showed that 28 medical schools were requiring two years of college work, in addition to a high-school education, as a requirement for admission, and that ten more had come up to the standard set by the Council five years before and were requiring one year of college before entering on the study of medicine-a long step ahead in five years.

And the standards required by the Council for an acceptable medical college are constantly being set higher, yet the third classification, published in April, 1913, shows 24 colleges having a standing of "A plus," 41 in the "A" grade, 24 in the "B" grade and 29 in the "C" gradea total of 118.

After January 1, 1914, no medical college will be included in Class A which does not come up to the standard first set by the Council, requiring of every student a year of work in a college of liberal arts before beginning medical study, in addition to four years of high-school work or its equivalent. In February, 1913, the Association of American Medical Colleges, comprising in its membership practically all the efficient medical schools, adopted the same standard, to become effective on the same date. The preliminary college year must equal the work done in the freshman year in the standard colleges and universities and include chemistry, physics, and biology, and the study of either French or German.

Thirty-two medical colleges now require two years of college work as a requisite for entrance, two more have announced that they will require this in 1914, and two more have announced it for 1915. Twenty-four more colleges have adopted the one-year requirement and 15 more will put it into effect in 1914. Thus, in 75 of the 118 medical colleges now in existence, students graduating as physicians in 1919 or later will be as well equipped to practise as the graduates of only four or five of the very best medical schools were in 1904.

Where there were few full-time, salaried instructors in the medical colleges of 1904, there were in 1912, in 117 medical colleges, 876 full-time teachers, 490 of professional

rank. Only 30 colleges were reported as having no full-time teachers. And these are the colleges that are most rapidly disappearing. The commercial medical colleges, with few exceptions, have vanished completely. Twenty-eight schools that existed in 1904 are extinct and 37 have merged with other colleges, thus building out of several small and inefficient colleges one large and strong one, as in Louisville, where five medical schools have recently been combined into one. Other mergers announced to take place this year will bring the number of medical colleges down to 110 by the end of 1913.

A very interesting phase of this remarkable development in medical education is the extent to which the medical colleges are becoming state institutions. In 27 states medical colleges are now conducted by the state universities, 20 of these giving the full 4-year course and the degree of M. D., and seven a 2-year course without degrees. All but two of these state medical colleges are listed as "A plus" or "A" in the latest classification of the Council, and one of them (of the University of Minnesota) requires a fifth year as a hospital interne before it gives the medical degree to its graduates. Thirteen of these state medical schools now require two years of college work before taking up the 4-year medical course, and the Universities of Georgia and Illinois have announced this requirement to take effect in 1914 and the University of Alabama in 1915. In 15 states there are now no medical colleges except those of the state universities and in another - Alabama-this will be true in 1915.

A particularly gratifying phase of the improvement in the quality of the medical colleges that remain after the poorer ones have been weeded out has been the rapid progress made in the South, where some of the most vigorous objections were raised when the Council first promulgated its plans. The University of Georgia Medical Department, at Augusta, formerly a "proprietary" medical college in everything except its name, has obtained a fund of $45,000 for improvements by public subscriptions, an annual appropriation of $10,000 from the city, has been granted full

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important to the public and the medical
profession, is the unification of state laws
regulating the practice of medicine — or,
at least, the establishment of minimum
requirements to which the laws of every
state shall conform. Much progress has
been made in this direction. The Federa-
tion of State Medical Boards - which
includes nearly all but not quite all
these bodies
these bodies-is coöperating with the
Council in this respect, but conditions of
licensing are still in a very confused state.
Only eleven state licensing boards - those
of North Dakota, Iowa, Minnesota, Colo-
rado, Indiana, South Dakota, Connecticut,

control of the staff of its city's hospital, and its rating in the Council's classification has gone up from "B" to "A." The Medical College of the State of South Carolina, an old institution of such low grade that it formerly had a "C" rating, has raised $76,000 by public subscriptions from the citizens of Charleston, has taken over the control of the city hospital to provide adequate clinical facilities, and has been granted a $10,000 annual appropriation by the state, making it for the first time a genuinely public institution. It now has a "B" rating and gives promise of further improvement in its standards and facilities. In Tennessee twelve medical schools have given place to five, of which three, including one Negro school, have shown remarkable improvement. Alabama, Arkansas, Mississippi, Oklahoma, and South Carolina each now has a single state-controlled medical college. Eight of the Southern medical schools have adopted the higher entrance requirements recommended by the Council and three more will do so next year. "In no section," said the Council on Medical Education in its report to the American Medical Association in June, 1913, "have improvements in medical education been greater than in the Southern States."

With all the advance that has been achieved, tremendous as it is, the Council is still far from satisfied and the medical profession generally is demanding even higher educational standards. The Council has collected statistics which show that of 822 hospitals having 100 or more beds, 279 have no internes, and that 1,054 of 1,363 smaller hospitals have none. The other 852 hospitals provide clinical facilities for and avail themselves of the services of 3,006 young graduate internes - but there are about 1,500 graduates yearly who get no hospital practice and about 1,400 hospitals with 135,000 beds have no internes. To bring the needs of the medical colleges and the opportunities offered by these hospitals together and eventually to establish a requirement on the part of state boards of a hospital interneship as a requisite for license is one of the present aims of the Council.

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Kansas, Utah, Vermont, and Pennsylvania - require more than a high-school education preliminary to the study of medicine as a requisite for license. The six first-named require two years of general college work, the others, one year. In nine states - Arizona, Florida, Georgia, Massachusetts, North Carolina, Oregon, Tennessee, Washington, and Wyoming- and the District of Columbia, the law is silent concerning the educational qualifications, other than medical diplomas, of licensed physicians. In Massachusetts, Tennessee, Colorado, and Oregon, the law does not require physicians to be graduates of medical colleges, and among these states only the board of Colorado has power to refuse a license on the ground of an unsatisfactory diploma. Yet even this condition is an advance from that of Another problem, even more vitally five years ago, when Alabama, Arkansas,

Mississippi, and Rhode Island also admitted non-graduates to the practice of medicine. And in twenty-one states diplomas issued by colleges rated by the Council as in Class "C" are not recognized. There is still much work ahead for the Council on Medical Education, as there is for the Propaganda for Reform and for the Council on Pharmacy and Chemistry. Graduates of a certain Class "C" medical college in Kansas City, for instance, though they cannot be licensed in Missouri, have no trouble in obtaining licenses

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THE AMERICAN "HOME SECRETARY"

THIRD ARTICLE OF

WHO GOVERN THE UNITED STATES

MR. FRANKLIN K. LANE, WHO BRINGS TO THE GREAT TASKS OF THE DEPARTMENT OF THE INTERIOR BOTH GOOD NATURE AND A BOLD AND DIRECT SPIRIT HIS CAREER AS PRINTER, EDITOR, LAWYER, POLITICIAN, AND INTERSTATE COMMERCE COMMISSIONER - WHAT HE INTENDS TO DO

FOR ALASKA AND FOR THE RECLAMATION PROJECTS

BY

BURTON J. HENDRICK

HE whole of Washington clearly feels a sense of gratitude to Mr. Wilson for making Mr. Franklin K. Lane his Secretary

T

of the Interior. The national capital has known Mr. Lane intimately for several years; even the newsboys have learned to love his jovial presence and properly appreciate his traits of mind and character. To the public outside Washington, however, the chairman of the Interstate Commerce Commission has always seemed a somewhat austere and formidable person. He is the "strong," the 'aggressive" man; the "fighter," prepared to throttle the spoilers of the public domain as remorselessly as he has the predatory railroads. His photographs, which usually show Mr. Lane's face in dignified repose, with its quiet and penetrating eyes, its tightly closed lips, and its expansive forehead, sometimes accentuate this idea. The popular mind associates Mr. Lane with

"long and short hauls," railroad rates and rebates, inquisitorial examinations of suspected financiers, recalcitrant witnesses, volumes of dreary statistics, and express company iniquities. He has hitherto had only one point of contact that seemed definitely human: Mr. Lane is mainly responsible for the fact that upper berths are now not so expensive as lower berths.

However, as Washington knows Mr. Lane, his predominant quality is not austerity nor combativeness; it is nothing more complex than superabundant good nature. nature. His greatest gift is the gift of making and retaining friends. This quality sits upon him easily and naturally, as the one law and order of his being; with Mr. Lane, to love his fellow man is merely normal functioning a kind of reflex action. Mr. Lane has lived fortynine years; in that time he has been a printer's devil, a college student, a newspaper reporter, an editor, a lawyer, a

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