October 27, 1916] 



SCIENCE 



595 



of acute mental eases preliminary to assign- 

 ment to the state institutions for the in- 

 sane. All of these institutions, including 

 correctional and charitable organizations as 

 well, should be mutually related to each 

 other and to the university, so that the ex- 

 perts of each may be available for all. 



The governmental public-health mech- 

 anism should take advantage of the uni- 

 versity experts in investigational and re- 

 search work for legislative and adminis- 

 trative control. This is applicable also to 

 other departments of the government. 

 The university activities should be limited, 

 however, to teaching, investigation and re- 

 search and should stop short of legislation, 

 administration and police control. 



It seems certain that we can not com- 

 press the training of the physician of to- 

 morrow into less than a four-year high- 

 school course, plus two years of university 

 work which shall include the basic sciences 

 and a modern language, plus two years of 

 medical science, and two years of clinical 

 instruction, followed by a compulsory year 

 in an approved hospital in interne service. 

 Minnesota was the first school in the United 

 States to take this step. At the conclusion 

 of such training, the student should emerge 

 with his arts or science degree and the 

 medical degree. 



We are now confronted with the matter 

 of licensure, the ultimate safeguard which 

 the public should demand for its own pro- 

 tection in addition to the standards of 

 teaching which it enforces in its own pro- 

 vincial or state universities. A federal li- 

 censing board is best. It, like all licensing 

 boards, however, should provide searching 

 practical examinations in addition to writ- 

 ten and oral tests. 



The examination conducted by many of 

 the state medical licensing boards is far- 

 cical in the extreme. The appointments 

 are given all too frequently for political or 

 personal reasons to men who are unfitted 



by natural aptitude, training or tempera- 

 ment for this exacting work. The United 

 States might well take a leaf from Great 

 Britain's book with respect to the conduct 

 of examinations for licensure, whilst the 

 latter might follow, with profit, the ex- 

 ample set by this country in the matter of 

 improvement in medical teaching. 



Such boards should demand, as a mini- 

 mum the amount of training specified 

 above. The constitution of the board is a 

 matter which requires careful thought. In 

 the long run, I am convinced that the re- 

 sponsibility for its personnel should be 

 placed upon the government and not upon 

 the profession. If we are to avoid the pub- 

 lic and private suspicion that the medical 

 profession is a sort of trades union, the 

 appointments should be made by the gov- 

 ernment. If our system of government is 

 sound, this is the logical step. If not, our 

 government needs change and we, as citi- 

 zens, have been neglecting our duty. The 

 prime consideration is that the standards 

 of medical teaching and medical licensure 

 are for the protection of the public and not 

 for the protection of the profession. Li- 

 censing boards must take account of the 

 teaching institutions in their own and other 

 countries, and some governmental, in fact 

 international, clearing-house arrangement 

 be made for the careful inspection and ac- 

 curate report to all the world regarding 

 the facilities, equipment and standards 

 which exist in all countries. A state or 

 province or country can protect itself best 

 from undesirable additions to its medical 

 profession from other communities and 

 other countries by insisting upon one stand- 

 ard for all. 



In view of the present trend towards the 

 socialization of medicine and the increas- 

 ing importance of public health, together 

 with the over-supply of physicians, imme- 

 diate attention should be paid to the train- 

 ing of public-health workers and the devel- 

 opment of adequate public-health machin- 



