October 27, 1916] 



SCIENCE 



589 



ceiving the same clinical instruction and 

 working with the same ends in view, side 

 by side with students whose premedical 

 equipment, according to his opinion, would 

 not have been too much to expect of an 

 average fifteen-year-old boy. It has seemed 

 strange to all of us, I am sure, why if in 

 the opinion of the British authorities 

 twenty-five years ago, it required a five-year 

 training in medicine to prepare the stu- 

 dents for the responsibilities of practise, 

 it should not now require considerably 

 longer time, on account of the tremen- 

 dous increase in our knowledge of the 

 basic and medical sciences and the clinical 

 branches. 



In 1891, there were 29,555 registered 

 physicians in Great Britain, whose popula- 

 tion at that time was 38,105,975, or a ratio 

 of 1 to 1,289. In 1907 the ratio had be- 

 come 1 to 1,107. Edinburgh showed a ratio 

 of 1 to 489; the Yorkshire ratio was 1 to 

 2,057, if we omit thirty-nine towns of a 

 population of 10,000 or upwards. Of 

 recent years the average annual registra- 

 tion of licensed practitioners showed a de- 

 cline in an attempt to adjust supply to de- 

 mand. Had the medical profession realized 

 earlier that medicine was not a thing apart, 

 but only one of society's implements for 

 its own betterment, on its own initiative it 

 would have prepared in advance a scheme 

 for its social and economic adjustment and 

 the revolution of medicine precipitated 

 some time ago by Lloyd George would have 

 come as an evolution under the direction of 

 medical statesmen. 



In summary, Flexner discusses profes- 

 sional overcrowding in Europe in the fol- 

 lowing words: 



The foregoing discussion appears to warrant the 

 following conclusions: overcrowding of the pro- 

 fession takes place in Germany and Austria on a 

 high, university basis, in England and Scotland on 

 a low, proprietary basis. 



UNITED STATES 



In 1910 the equipments, faculties and 

 facilities for instruction and courses given 

 were reported by the Carnegie Foundation 

 in detail for 148 colleges, with 3,395 pro- 

 fessors, 4,637 other instructors and 22,208 

 students. The Council on Medical Educa- 

 tion of the American Medical Association 

 had already been striving for several years 

 by publicity to make known to the people 

 the conditions within the profession, in 

 order to furnish the basis for correction. 

 Naturally, the general public in the United 

 States, as in other countries, had not inter- 

 ested itself very much in medical matters, 

 from which it had been excluded through 

 mistaken policy on the part of the pro- 

 fession. At the time of the beginning of the 

 council's work there were 164 medical col- 

 leges in the United States and 178 in all 

 the other countries of the world. In Au- 

 gust, 1914, the total number of medical 

 colleges in the United States had been re- 

 duced to 107, through the pressure of pub- 

 licity, whereas the number of medical stu- 

 dents had been reduced from the maximum 

 number in 1904 of 28,142 to 16,502. It 

 was high time that this important work was 

 undertaken, since even yet the number of 

 physicians in the United States seemed to 

 be increasing. The number of registered 

 physicians in 1914 was reported as 142,332 

 and the population as 99,451,000, a ratio of 

 1 to 693. 



At the time the Carnegie Report for the 

 United States and Canada was published, I 

 am convinced that the best undergraduate 

 medical schools in the world were to be 

 found in the United States, as also the 

 worst. Dr. Pritchett, president of the Car- 

 negie Foundation, in one of his comments 

 says: 



Faults of one sort or another may indeed be 

 found in the medical schools of England, Scotland, 



