590 



SCIENCE 



[N. S. Vol. XLIV. No. 1139 



France, Germany and Austria, but scandals in 

 medical education exist in America alone. 



He also said : 



If the lowest terms upon which a medical school 

 can exist abroad were applied to America, three 

 fourths of our existing schools would be closed at 

 once. And, let me add, the remaining fourth 

 would be easily and entirely adequate to our need. 



The Carnegie Report was unsparing in 

 its denunciation of dishonesty and dis- 

 paraged incompetence. Whilst frank in 

 criticism of the best institutions, it did not 

 fail to encourage good features whenever 

 and wherever presented. The very criti- 

 cism was constructive. 



The publication of annual reports by the 

 Council on Medical Education of the Amer- 

 ican Medical Association, grading the med- 

 ical schools into several classes, has had a 

 far-reaching effect. 



But it is seen that action was not initiated 

 by the national or state official or govern- 

 mental machinery, but followed all too 

 slowly on the heels of the tremendous effort 

 at professional house-cleaning begun by the 

 American Medical Association. This move- 

 ment was extended by the Association of 

 American Medical Colleges and interna- 

 tionalized on an economic and social basis 

 by the Carnegie Foundation, all three or- 

 ganizations cooperating to bring about the 

 much-needed reforms. 



The Council on Medical Education of the 

 American Medical Association reports an- 

 nually the result of all the license examina- 

 tions conducted in each state by the state 

 boards in tabular form so that the percen- 

 tage mortality from each medical college 

 is shown. This Council and the Associa- 

 tion of American Medical Colleges cooper- 

 ate in the inspection of all colleges, par- 

 ticularly the doubtful ones and both by 

 private helpful suggestion and by public 

 criticism are putting the moribund institu- 

 tions to a painless end and encouraging 

 those for which there is hope as well as 



need. Their work could be done far more 

 efficiently, however, by an official federal 

 board. 



There is an increasing tendency in the 

 middle and western states towards strength- 

 ening state universities which seems inevi- 

 table if education is to be regarded as a 

 state function at all. Medicine as a quasi- 

 public profession, which is becoming every 

 day more important in the social-service 

 machinery of the state, must look to the 

 state for its training, which is now so costly. 



CANADA 



Canada, too, has had and still has her 

 problems in medical education. The Car- 

 negie Report being American born, has not 

 dealt as fully with Canada as with the 

 United States, nor has it ventured so far 

 into criticism, constructive or destructive, 

 as in the case of American institutions. 



The Carnegie Report shows that in 1910 

 there were 6,736 licensed physicians in 

 Canada, her population being 6,945,228, the 

 ratio being 1 to 1,030. The statistics for 

 Canada and Newfoundland for 1912 show 

 a registration of 7,278 physicians, which in 

 1914 was reported as 7,577, the increase 

 being much greater than the population re- 

 quirement. 



The congestion promised to be even 

 greater before the war. To the eight med- 

 ical schools a ninth has been added in 

 Alberta. In 1914 there were 2,001 medical 

 students registered in Canada, whilst in 

 the United States there were 16,502, or 

 only eight times as many, although the 

 population was more than thirteen times as 

 great. 



It is surely time for the public to know 

 what the profession has long felt, namely, 

 that we do not need more but better doc- 

 tors. If Flexner, after careful study of 

 conditions within and without the profes- 

 sion, regarded it as highly overcrowded in 



