COLLEGES HAVING HIGHER ENTRANCE REQUIREMENTS. The 62 medical schools which are now requiring as a minimum for entrance two years or more of work in a college of liberal aris in addition to a four-year high-school education, or which have announced that standard to take effect in the next one or two years, and the year when the higher requirement was or will be put into effect, are as follows: Alabama.-University of Alabama School of Medicine_ College of Physicians and Surgeons, Los Angeles___ Colorado.-University of Colorado School of Medicine. District of Columbia.-Georgetown University School of Medicine_. Howard University School of Medicine__. Georgia.-Atlanta Medical College--- University of Georgia Medical Department_. Illinois. Hahnemann Medical College, Chicago---. Require ment in force. 1915 1915 1916 1909 1905 1910 1909 1912 1914 1918 1918 1916 1911 1904 1914 1910 1910 State University of Iowa College of Homeopahtic Medicine___. University of Maryland School of Medicine and College of Phy- Massachusetts.-Boston University School of Medicine_. Medical School of Harvard University. University of Michigan Homeopathic Medical School_. University of Missouri School of Medicine__. Nebraska.-University of Nebraska College of Medicine_. New Hampshire.-Dartmouth Medical School____ New York.-Columbia University College of Physicians and Surgeons__ Cornell University Medical College... Syracuse University College of Medicine__. 1918 1916 1900 1909 1916 1907 1918 1918 1910 1912 1909 1910 1910 1908 1918 1910 1918 1914 1917 Wake Forest College School of Medicine__ 1908 North Dakota.-University of North Dakota School of Medicine.. Ohio State University College of Homeopathic Medicine. Jefferson Medical College__. Requirement in force. 1907 1915 1916 1913 1901 1917 1917 1917 University of Pennsylvania School of Medicine_. 1910 1913 1915 South Carolina.-Medical College of the State of South Carolina_ 1916 South Dakota.-University of South Dakota College of Medicine_ 1909 1917 1910 1915 1917 1917 1915 1907 Virginia.-Medical College of Virginia__‒‒‒ University of Virginia Department of Medicine_-_. West Virginia.-West Virginia University School of Medicne_ University of Wisconsin Medical School____. Complete returns show the total registration of students in all medical schools during 1915-16 was 14,022, or 869 less than during the previous session. It is evident that the enrollment of medical students has about reached its lowest ebb, since in the freshman classes there was an increase of 209 over the registration of the previous session-3,582, as compared with 3,373 in 1915. After a few years have been allowed for readjustments under the higher entrance standards, the number of medical students will doubtless return to normal proportions. There were 3,518 graduates in 1916, only 18 less than in the previous year. The higher qualifications of these graduates are indicated by the fact that this year 948, or 26.9 per cent, also obtained degrees in arts or science prior to, or in connection with, their medical course, as compared with 24.3 per cent in 1915 and only 15 per cent in 1910. During the year the Medico-Chirurgical College of Philadelphia was merged with the University of Pennsylvania School of Medicine. as its graduate school of medicine. Two other medical schools-the Georgia College of Eclectic Medicine and Surgery, of Atlanta, and the Southwest School of Medicine and Hospital, of Kansas Citybecame extinct. A new but small medical school was opened at Kansas City, Mo., which is not reported to have the recognition of the Missouri State Board of Health, the licensing body of that State. The total number of medical schools in the United States is now 94, or 2 less than last year. One medical college-the Hahnemann Medi cal College of the Pacific-which was reported last year as having been closed by merger, will continue to exist until 1918, when its last class will have graduated. Of the 94 medical colleges now existing, 67 are rated in Class A by the Council on Medical Education, 15 are in Class B, and 12 are in Class C.1 FINANCES OF MEDICAL SCHOOLS. The total income reported by 82 medical colleges for the session of 1914-15 ranged from $411,570, the highest, to $6,080, the lowest, for colleges teaching all four years of the medical course. The average for each college was $68,277. The income for each college from students' fees ranged from $113,523, the highest, to $500, the lowest, the average being $23,795. Aside from students' fees, the total incomes ranged from $329,221, the highest, to the three colleges which had no income aside from fees. The average income aside from students' fees was $44,482. Included in these figures 34 colleges reported the receipt of a total income from endowments of $1,164,602, or an average of $34,253 for each of the institutions which reported income from this source; 28 colleges reported an income from States or municipalities amounting to $864,285, or an average of $30,868 for each institution. Seventy-eight colleges paid out $2,985,458 in salaries, an average of $38,275 for each of the schools reporting. The highest sum thus expended was $139,430 and the lowest was $3,600. The total expenditure reported by the 82 colleges was $5,432,768, or an average of $66,253 for each institution. For 3 colleges all expenditures were paid from students' fees, and for one of these the expenditures were less than the income. The total enrollment in these 82 medical colleges during the session of 1914-15 was 12,976. The average income received from each student in tuition fees was $150, and the average expenditure for each student was $419. The cost of teaching each student during 1914-15, therefore, was nearly three times greater than the amount he paid in fees.2 ANXIETY BECAUSE OF CHANGES IN MEDICAL EDUCATION. Since the rapid improvement of medical education began-about 12 years ago-alarm has been expressed in some quarters because A pamphlet containing the classified list of medical colleges, and showing in what States diplomas granted by the various colleges are not recognized as an acceptable quali fication for the license to practice medicine, may be obtained by addressing the American Medical Association, 535 North Dearborn Street, Chicago. 2 For a detailed table of medical-college finances for 1914-15, see Jour. Amer. Med. Assoc., Apr. 8, 1916, p. 1115. of some of the results obtained. Certain individuals expressed anxiety lest the marked reduction in the number of medical colleges might lead to a dearth of physicians in the United States. Others noted the increased cost of medical education and the moderately increased charges for tuition and were afraid lest only the "sons of the rich" would be able to secure a medical education. Others were concerned lest the higher standards for admission and the demise of numerous low-standard colleges would take away the opportunities for "the poor boy." Still others laid stress on the thinly populated and rural districts, which they stated were in need of physicians. A few of these statements came from those having no interest in the perpetuation of low-standard medical schools and who were undoubtedly sincere in their expressions of anxiety. As already noted in this report, there are fewer medical colleges, students, and graduates each year than before the campaign for improvement began; the cost of a medical education has indeed been greatly increased; there has been also a moderate increase in the charges for tuition; entrance requirements have been raised; and a number of inferior medical colleges have ceased to exist. It is also probably a fact that rural communities do not have many doctors living in them. A right interpretation of these facts, however, shows there is no cause for alarm. The chief result of the campaign for an improved medical education is that physicians are securing a better medical training, which makes them more able to serve the public in both urban and rural communities. NO DEARTH OF PHYSICIANS. A reduction in the number of medical colleges was expected, since in 1904 this country had more than were needed, and at that time the use of paid solicitors, the shrewd method of advertising commonly employed, and the absence or nonenforcement of entrance requirements naturally resulted in an unusually large enrollment of students. The annual output of physicians was correspondingly large. What was needed was a larger proportion of high-grade and well-equipped medical schools, and this was the result obtained. This was brought about chiefly through the merging of two or more medical schools in numerous instances into single stronger and better equipped institutions. Instead of 28,142 medical students and 5,747 graduates each year, only about 6 per cent of whom were from high-standard colleges, there are now only about half those numbers, but from 75 to 80 per cent of them are in high-standard colleges. The facts are shown in the accompanying table: Quality versus quantity. Although the totals of colleges, students and graduates have been decreased in 11 years, the numbers of high-standard colleges, better-educated students, and better-trained graduates have been increased. 369 2, 652 6. 4 75 Totals from high-standard colleges_. Of the medical colleges which remain the majority have higher and better-enforced entrance requirements; they have stronger staffs of salaried, expert teachers; they have more and better-equipped laboratories, and have more abundant and better-used hospital and dispensary facilities. Physicians coming from these medical schools are better fitted to care for the sick and to do a larger part in the preservation of public health than the average of those graduated under former conditions. Even if the output of physicians were entirely discontinued, there would be no danger of a dearth of physicians for years to come. The country still has an overabundant supply of physicians. There is 1 to every 691 people in the United States, as compared with 1 to every 1,940 in Germany, 1 to every 2,120 in Austria, and 1 to every 2,834 in France; that is, referring to conditions before the war. The need, therefore, is not of larger numbers of medical graduates, but of those who are better qualified to care for the sick and injured, and this result is being obtained. NO DANGER OF A MEDICAL ARISTOCRACY. As already shown in this report, the cost of teaching medicine has been greatly increased during the past 15 years. The larger number of laboratories, equipped with expensive technical apparatus which the modern school must now possess, the score or more of skilled salaried teachers who devote their entire time to teaching and research, and the increased expenses for administration have added tremendously to the cost of conducting a medical school. This cost has advanced from the point at which there were large profits for those owning the medical school to the present situation, where it exceeds the income from students' fees by 280 per cent; nevertheless, during the same period tuition fees have been increased by |