Within fifteen years or less a distinct cleft appeared; there were on the one side institutions struggling to reproduce the spirit and the effort characteristic of the Johns Hopkins Medical School, and there were on the other side institutions upon which this spirit had made no impression. But soon professional as well as public opinion began to be interested. The eyes of state legislators were opened. Instead of the low standards under which it had previously been possible for both private initiative and state universities to conduct medical education and medical practice, a concerted effort was suddenly made which almost in the twinkling of an eye transformed both; the schools that had learned little or nothing began to shrivel and die away. The states which had formerly licensed illiterates, who had merely listened to didactic lectures, now began to limit the practice of medicine to those who had been properly prepared and properly trained. Within a decade our one hundred and fifty-five medical schools shrank to little more than fifty, and the total resources applied to the conduct of medical schools and hospitals increased from a relatively insignificant sum to hundreds of millions. All this was, in the first place, the result of private effort, private initiative, and private gifts. One individual alone contributed fifty millions of dollars to the general cause of improving medical education and perhaps as much to the creation of an institution for medical research.
A new ideal had been created and realized in Baltimore. It was at first voluntarily taken over in Boston, in New York, in Philadelphia, in Chicago, in St. Louis, in Nashville, in Rochester, and elsewhere. At length the universities maintained by the states realized that they must participate in this same movement. Something very substantial had already been accomplished, to be sure, in Michigan and in Wisconsin under the leadership of a Johns Hopkins graduate, but there was no general movement on the part of the state universities beyond the necessary elevation of the standards of medical practice until in 1922 — only thirteen years ago — the State of Iowa, whose medical school had up to that time been practically worthless, joined a private foundation in raising $5,000,000 for the building of an entirely new medical school and hospital and increased the state support of the medical school and hospital from something like $50,000 a year to a sum exceeding $1,000,000 a year. It was private effort and private money and private devotion and private initiative that in this instance set the pace, and it is this same private effort and private initiative and private devotion and private means that have created, maintained, and elevated the other institutions I have mentioned.
But the story I have just told is something more than a story of private beneficence, for it was, as I have pointed out in passing, unrestrained and unregulated private effort that led to the outrageous conditions which private effort so largely corrected. How did private effort correct its own excesses and abuses? It corrected them by setting an example, by stimulating emulation, and then by governmental action on the part of the several states which incorporated in statutory form standards of efficiency that had been worked out largely by private institutions after the abuses of unrestrained and uncontrolled private institutions had been mercilessly exposed. In reference, therefore, to private beneficence and philanthropy itself, government has a very distinct service to perform, for, as social standards are elevated and refined, laws can be made arid must be made which will place behind the highest types of effort the authority of the state. Our federal form of government fosters emulation and initiative. Thus private effort and public effort are in no wise incompatible. There is no inconsistency between the existence of institutions under private initiative, support, and control and the existence of publicly maintained institutions of the same character and of equal quality. On the contrary, state and private efforts are complementary. Unless private means continue to exist, the role hitherto played in our history by private enterprise in education, in art, and in philanthropy is doomed to shrink in importance and perhaps ultimately to disappear.
A closely parallel example also can be cited. As long ago as 1865, Matthew Arnold — and later others in their capacity of private individuals, though Arnold held office as a school inspector — began a devastating criticism of secondary education in England. Little of a fundamental nature was accomplished by either private or governmental agencies between 1865 and 1895, when Robert (later Sir Robert) Morant entered the Board of Education, as it was then constituted. Morant, who was one of the really great British civil servants, thereupon began an exhaustive and detailed study of the chaotic conditions prevailing in elementary and secondary education in Great Britain. He was a man of the highest ideals and enormous driving power. It is no secret that the revolution in English education which took place between 1895 and 1902, in the face of terrific opposition from both dissenters and churchmen, was due to the skillful parliamentary management of Mr. Balfour, who relied absolutely upon Morant for, the details and the strategy which he evolved in presenting a bill, that transformed elementary and secondary education in Great Britain. In this instance we witness a movement started by private individuals and then taken up by a democratic government which placed all its power behind a far-reaching educational reorganization. To-day elementary and secondary education in Great Britain is admirably conducted by both voluntary and governmental agencies, inspected, supervised, and in part financially sustained by the general government. It would probably be impossible to find a better example of the successful outcome of cooperation between private individuals and government than is exemplified in the great educational reform which will always be associated with the name of Sir Robert Morant and which may well prove to be the most lasting achievement of Mr. Balfour in the sphere of statesmanship.
It is therefore a mistake to view private effort and governmental regulation as opposed to one another. Results are happiest when the two work together, when tolerance, education, and honest publicity prevail. What law can accomplish depends in large measure upon the state of public opinion, which in its turn is very largely the product of individual and cooperative effort. If, for example, law by itself could have enforced conditions against which public opinion ran, the South would have been reconstructed after the Civil War according to the ideas of Thaddeus Stevens. As a matter of fact, after some ten or fifteen years of effort to accomplish by law a result which ran against public opinion in the South, President Hayes withdrew the Federal troops from the states which had been in rebellion, and ever since they have done as they pleased. I should suppose there is no doubt in the mind of any human being that the relations between the two sections of the Union would even to-day be far better and the South would have been far more highly developed if the more generous and magnanimous policy of Lincoln and Johnson had been followed immediately after the close of the Civil War. So, in our own recent experience, no one questions the importance of temperance, and a minority has always believed in the efficacy of prohibition; but there is little doubt that the most disastrous attack upon both temperance and prohibition was made by the passage of the Eighteenth Amendment.