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SCIENCE 



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



ery, which provides work, pay and author- 

 ity commensurate with the responsibilities 

 which the workers are expected to assume. 

 It means training in the sciences funda- 

 mental to medicine, in diagnosis and in cer- 

 tain branches of sociology, law, economics, 

 engineering, etc., and can not be under- 

 taken in a medical school but in a univer- 

 sity which has full faculties and in a state 

 or province where all public institutions 

 are coordinated and work in cooperation. 



The history of Johns Hopkins Medical 

 School is significant. Medical teaching 

 there grew out of the graduate medical 

 teaching which had developed in the hos- 

 pital. 



Our faces are turned toward public med- 

 icine. If the profession accepts this as in- 

 evitable and also desirable and the public 

 realizes its opportunity and responsibility, 

 the change may be brought about as an evo- 

 lution, rather than as a revolution. In- 

 stead of developing more medical schools 

 to meet a demand which does not exist, so- 

 ciety should unite in strengthening those 

 which have shown a progressive spirit and 

 some realization of the medicine of to-mor- 

 row. The rational evolution of the medical 

 school would be the development at uni- 

 versities which are adequately equipped, of 

 schools of public health in which all of the 

 faculties of the university participate. It 

 simply means the re-grouping of certain 

 existing university departments as a com- 

 mittee under the name of a "School of 

 Public Health." New universities have a 

 particularly good opportunity in the foun- 

 dation of such schools to help orient some 

 of the medical graduates, who have failed 

 in practise to adapt themselves to present 

 conditions. 



Our overcrowded profession has in it 

 many men who would welcome the oppor- 

 tunity to secure freedom from the com- 

 mercial aspects of practise. Many are bet- 

 ter fitted for public service than for private 



practise. Such men could be trained by 

 such a mechanism, for certain phases of 

 public health administration. Others, for 

 their own sake and the sake of humanity 

 should receive further training in the prac- 

 tise of medicine and others should be ex- 

 cluded from the profession for which they 

 are unfitted, or have failed to fit them- 

 selves. It would be some time before all of 

 the present graduates in medicine could be 

 intelligently utilized. When the demand 

 has caught up with the supply and new 

 medical schools are required, they will nat- 

 urally evolve from such graduate schools, 

 in this case of public health, instead of as 

 the Hopkins did from a graduate medical 

 school. Such public health schools would 

 inevitably become more specialized and if 

 private practise, as we have known it, per- 

 sists, it could be logically related to and 

 become the natural outgrowth from such 

 public-health colleges. 



Our profession has to play the part of 

 social pioneer in demonstrating the in- 

 evitability of specialization and the need 

 of cooperation between and coordination of 

 specialists. We have not realized, how- 

 ever, that all of the workers in the medical 

 field do not require and should not receive 

 the same training. The public has long 

 recognized that a short course of three or 

 four months is insufficient for the training 

 of specialists and there is an increasing in- 

 terest within and without the profession in 

 the development of adequate facilities for 

 graduate training of those who desire to 

 enter a particular medical field, i. e., to be- 

 come specialists. If an additional training 

 period of two or three years is required for 

 such a purpose in addition to the six to 

 eight years required now by various med- 

 ical schools and licensing boards, it is clear 

 that great expenditure of time and money 

 is demanded of the would-be specialist and 

 he has a right to expect a fair return on 

 his investment. Will anything less than 



