802 



SCIENCE 



[N. S. Vol. SLIV. No. 1145 



mands cheaply educated physicians. "With 

 trolley cars and automobiles there are but 

 few in need of medical aid who are so lo- 

 cated that a good physician may not soon 

 reach them, or what is better, that they 

 can not soon be transported to a hospital. A 

 friend who has long practised in a small 

 Montana city recently told me that twenty 

 and more years ago his ride sometimes car- 

 ried him one hundred and twenty-five miles 

 from home. One such visit to a case of 

 pneumonia is unsatisfactory to the doctor 

 and of but little benefit to the sick man. 

 Now, the automobile brings the patient to a 

 well-equipped hospital where several physi- 

 cians may daily consult concerning the case 

 and trained nurses be constantly in attend- 

 ance. 



When I was in medical practise, like the 

 milk man, I made my daily rounds, seeing 

 cases of scarlet fever, diphtheria, some- 

 times smallpox, pneumonia, various ner- 

 vous diseases, attending cases of labor and 

 in short I was a general practitioner. Like 

 others of the kind, I did the best I could for 

 all and I am able to say with some pride 

 that in no case did I carry infection from 

 house to house. However, in order to avoid 

 this I often had to change my clothing and 

 disinfect my person many times in one day. 

 This kind of practise is still largely in 

 vogue, but it is gradually being displaced 

 by hospital treatment in which specialists 

 direct and trained nurses administer. The 

 greatest need of practical medicine to-day 

 is more and better equipped hospitals. 

 With these the specialist and the skilled 

 nurse will multiply and improve. Such 

 hospitals should be supplied with thor- 

 oughly equipped and competently manned 

 diagnostic laboratories which should serve 

 not only curative but preventive medi- 

 cine. Water and milk supplies should be 

 examined daily and visiting nurses under 

 the direction of a competent health officer 



should constantly patrol the community. 

 Adjunct dispensaries which should serve as 

 schools of instruction in baby feeding and 

 care, child welfare, home sanitation and in 

 everything pertaining to healthy living 

 should supplement the community hos- 

 pitals. When in addition to these agencies 

 the people generally can be educated to see 

 the benefits that would follow the periodic 

 thorough examination of all in order to de- 

 tect the first departure from the normal, 

 then medicine will be able to render its 

 highest service to mankind. 



It must be evident that if these hopes are 

 to materialize the practise of medicine must 

 become more and more a state function. 

 That the tendency is in this direction and 

 that this should be encouraged for the pub- 

 lic good are not matters of doubt in my 

 mind. Only a few years ago some of the 

 most eminent men in the profession com- 

 bated earnestly state support of medical 

 education. They claimed that the state had 

 no right to establish and maintain medical 

 schools and that such aid was not fair in 

 competition with the proprietary schools, 

 which at that time educated more than 

 ninety per cent, of the annual recruits to 

 the profession. Now, no one questions 

 either the right or the duty of the state to 

 establish and support medical schools, 

 while the proprietary schools, having 

 proved wholly inadequate and inefficient, 

 have practically ceased to exist. Even the 

 man in the street sees the advantages that 

 have resulted from these changes. To state 

 that a medical school is a proprietary one, 

 in the sense generally understood by that 

 term, immediately condemns it with intelli- 

 gent men. Courts from the lowest to the 

 highest in the land have uniformly held 

 that the state has the right to maintain its 

 own medical school, also to pass upon the 

 merits of other schools both within and 

 without its borders, to set up standards 



