July 8, 1910] 



SCIENCE 



49- 



tion is to destroy organization, titles miist 

 be shaved when schools unite. There must 

 be one professor of medicine, one professor 

 of surgery, etc., to whom others are prop- 

 erly subordinated. "What with superabun- 

 dant professorial appointments, due now 

 to desire to annex another hospital, and 

 again to annexation of another school, 

 faculties have become unmanageably large, 

 viewed either as teaching, research, or ad- 

 ministrative bodies. 



Reduction of our 155 medical schools to 

 31 would deprive of a medical school no 

 section that is now capable of maintaining 

 one. It would threaten no scarcity of 

 physicians until the countrj^'s development 

 actually required more than 3,500 physi- 

 cians annually, that is to say, for a genera- 

 tion or two, at least. Meanwhile, the out- 

 line proposed involves no artificial stan- 

 dardization: it concedes a different stan- 

 dard to the south as long as local needs 

 require; it concedes the small town uni- 

 versity type where it is clearly of advan- 

 tage to adhere to it; it varies the general 

 ratio in thinly settled regions ; and, finally, 

 it provides a system capable without over- 

 straining of producing twice as many doc- 

 tors as we suppose the cotintry now to need. 

 In other words, we may be wholly mistaken 

 in our figures without in the least impair- 

 ing the feasibility of the kind of renovation 

 that has been outlined; and every institu- 

 tion arranged for can be expected to make 

 some useful contribution to knowledge and 

 progress. 



The right of the state to deal with the 

 entire subject in its own interest can as- 

 suredly not be gainsaid. The physician is 

 a social instrument. If there were no dis- 

 ease, there would be no doctors. And as 

 disease has consequences that immediately 

 go beyond the individual specifically af- 

 fected, society is bound to protect itself 

 against unnecessary spread of loss or dan- 



ger. It mattei-s not that the making of 

 doctors has been to some extent left to pri- 

 vate institutions. The state already makes, 

 certain regulations; it can by the same 

 right make others. Practically the medical 

 school is a public service corporation. It is 

 chartered by the state; it utilizes public 

 hospitals on the ground of the social nature 

 of its service. The medical school can not 

 then escape social criticism and regulation.. 

 It was left to itself while society knew no« 

 better. But civilization consists in the 

 legal registration of gains won by science- 

 and experience; and science and experi- 

 ence have together established the terms- 

 upon which medicine can be most useful. 

 "In the old days," says Metchnikoff,'"' 

 "anyone was allowed to practise medicine,, 

 because there was no medical science and 

 nothing was exact. Even at the present: 

 time among less civilized people, any old 

 woman is allowed to be a midwife. Among- 

 more civilized races, differentiation has. 

 taken place and childbirths are attended 

 by women of special training who are mid- 

 wives by diploma. In case of nations stilll 

 more civilized, the trained midwives are- 

 directed by obstetric physicians who have 

 specialized in the conducting of labor.. 

 This high degree of differentiation has. 

 arisen with and has itself aided the prog- 

 ress of obstetrical science." Legislation 

 which should procure for all the advantage 

 of such conditions as is now possible would 

 speedily bring about a reconstruction quite 

 as extensive as that described. 



Such control in the social interest in- 

 evitably encounters the objection that indi- 

 vidualism is thereby impaired. So it is, at 

 that level; so it is intended. The commu- 

 nity through such regulation undertakes to 

 abridge the freedom of particular individ- 

 uals to exploit certain conditions for their 



""The Nature of Man" (translated by Chal- 

 mers), p. 300. 



