October 27, 1916] 



SCIENCE 



591 



Germany where there was an average of 1 

 physician to each 1,900 of population, he 

 certainly was justified in believing that the 

 United States had reached an unstable con- 

 dition of affairs, since her ratio is 1 to 693, 

 showing nearly three times as much over- 

 crowding as in Germany and nearly twice 

 as much as in Great Britain. Canada, before 

 the war, was more overcrowded than any 

 other country except the United States, her 

 ratio being 1 to 984. As judged by the 

 overwhelmingly large number of registered 

 medical students, she bade fair in the near 

 future to outstrip our neighbor. 



Probably, however, the vast spaces of 

 Canada require and will continue to re- 

 quire more medical men per unit of popula- 

 tion than the older countries, particularly 

 if she is to cure herself of that world-wide 

 infection whose pathognomonic sign is "let 

 the other man produce," and whose final 

 stages are rural atrophy and urban hyper- 

 trophy. 



In adapting supply to demand, the med- 

 ical profession must not only continue to 

 heal and prevent, to practise and to preach, 

 but will be compelled to understand and to 

 help solve those problems which are born 

 of poverty and crime as a consequence of 

 their relations with disease. 



Specialization will be increasingly neces- 

 sary to enable the individual physician to 

 keep up with advance in knowledge. Post- 

 graduate study in a system of continuation 

 schools will be imperative and each state 

 or provincial university will be shirking its 

 duty if it does not cooperate with every 

 other existing local agency in fostering 

 and developing all available facilities. 



With specialization comes inevitable de- 

 mand for cooperation of the specialists and 

 the group system may be expected to re- 

 place individualism. The splendid plan 

 evolved by the Mayos, adapted to various 

 environmental requirements, shorn of weak- 



nesses and moulded on an increasingly pub- 

 lic and decreasingly corporational basis, 

 will spread. Contract work of groups on a 

 public-service basis seems inevitable if the 

 health and well-being of individuals is to 

 be, as it must be, a matter of public con- 

 cern and fundamental to national efficiency. 

 The rural and sparsely settled districts 

 need the best, not the worst, medical serv- 

 ices and can not be ignored. This means 

 increased importance of public medicine 

 and expenditure of the funds of the 

 wealthier districts through governmental 

 administrative channels for their protec- 

 tion against the neglect or disabilities of the 

 poorer districts, just as is now the case in 

 educational expenditures. "We must level 

 up and not down, for we are indeed our 

 brothers' keepers. 



In the great influx of foreign popula- 

 tion which may be expected on the cessation 

 of the war, it is presumed that foreign 

 physicians will also be amongst the new- 

 comers. Rapid transit, ease of communica- 

 tion and all other annihilators of space 

 conspire to make medicine, like commerce, 

 international. 



For these reasons and also because of the 

 lessons to be learned I have ventured to 

 direct your attention to a few of the con- 

 ditions surrounding medical education in 

 certain European countries. 



In the Canadianizing and Americanizing 

 of the millions of people whom we expect 

 to come to us, we must have definite stand- 

 ards and we ourselves must expect changes 

 in our existing standards and ideals, if we 

 are to profit by the best which the new- 

 comers bring us, eliminating our own worst 

 features and placing a prohibitive tariff on 

 theirs. 



Of design, I have stressed the considera- 

 tion of American conditions. The United 

 States had at one time perhaps the worst 

 medical training in the world and also the 



