44 



SCIENCE 



[N. S. Vol. XXXII. Xo. 810 



annual production of doctors from 1900 to 

 1909 was 5,222 ; but last June the number 

 dropped to 4,442. Finally, the total num- 

 ber of medical colleges which reached its 

 maximum — 166* — in 1904 has in the five 

 years since decreased about 10 per cent. 

 Our problem is to calculate how far ten- 

 dencies already observable may be carried 

 without harm. 



We have calcvilated that the south re- 

 quires for the next generation 490 new doc- 

 tors annually, the rest of the country, 

 1,500. We must then provide machinery 

 for the training of about 2,000 graduates 

 in medicine yearly. Eeckoning fatalities 

 of all kinds at ten per cent, per annum, 

 graduating classes of 2,000 imply approxi- 

 mately junior classes of 2,200, sophomore 

 classes of 2,440, freshman classes aggre- 

 gating 2,700 — something over 9,000 stu- 

 dents of medicine. Thirty medical schools, 

 with an average enrollment of 300 and 

 average graduation classes of less than 70, 

 willbe easily equal to the task. As many 

 of these could double both enrollment and 

 output without danger, a provision planned 

 to meet present needs is equally sufScient 

 for our growth for years to come. It will 

 be time to devise more schools when the 

 productive limit of those now suggested 

 shall come in sight. 



For the purpose here in mind, the coun- 

 try may be conceived as divided into sev- 

 eral sections, within each of which, with 

 due regard to what it now contains, med- 

 ical schools enough to satisfy its needs must 

 be provided. Pending the fuller develop- 

 ment of the states west of the Mississippi, 

 the section east will have to relieve them 

 of part of their responsibility. The pro- 

 visional nature of our suggestions is thus 

 obvious; for as the west increases in popu- 

 lation, as its universities grow in number 

 and strength, the balance will right itself: 



' Not including osteopatliic scliools. 



additional schools will be created in the 

 west and south rather than in the north and 

 east. It would of course be unfortunate 

 to over-emphasize the importance of state 

 lines. We shall do well to take advantage 

 of every unmistakably favorable oppor- 

 tunity so long as we keep within the public 

 need; and to encourage the freest possible 

 circulation of students throughout the 

 entire country. 



1. New England represents a fairly 

 homogeneous region, comprising six states, 

 the population of which is increasingly 

 urban. Its population increased, 1908-9, 

 somewhat less than 75,000, i-equiring, on 

 the basis of one doctor to every increase 

 of 1,500 in population, 50 new doctors. 

 About 150 physicians died. Seventy-five 

 men would replace one half of these. In 

 all, 125 new doctors would be needed. To 

 produce this number two schools, one of 

 moderate size and one smaller, readily suf- 

 iice. Fortunately they can be developed 

 without sacrificing any of our criteria. 

 The medical schools of Harvard and Yale 

 are university departments, situated in the 

 midst of ample clinical material, with con- 

 siderable financial backing now and every 

 prospect of more. It is vmwise to divide 

 the Boston field; it is unnecessary to pro- 

 long the life of the clinical departments of 

 Dartmouth, Bowdoin and Vermont. They 

 are not likely soon to possess the financial 

 resources needed to develop adequate cli- 

 nics in their present location ; and the time 

 has passed when even excellent didactic 

 instruction can be regarded as compensa- 

 ting for defective opportunities in obstet- 

 rics, contagious diseases and general medi- 

 cine. The historic position of the schools 

 in question counts little as against changed 

 ideals. Dartmouth and Vermont can, how- 

 ever, offer the work of the first two years 

 with the clinical coloring made feasible by 

 the proximity of a hospital, as is the case 



