378 



SCIENCE 



[N. S. Vol. XLIII. No. 1107 



the other hand. Public health oiScers can 

 not do thoroughly effective work if they 

 can not apply remedies to diseased indi- 

 viduals as well as to other sources of danger 

 to the public health. By far the most ef- 

 fective public health service in this coun- 

 try to-day is the United States Public 

 Health Service and here treatment of indi- 

 viduals and treatment of environment are 

 carried on hand in hand. The practising 

 physician can not do effective work for his 

 patients if he does not take an active part 

 in promoting public health measures. 



From the social standpoint two things 

 in the practise of medicine especially 

 need changing. First we need more or- 

 ganization and cooperation of men in dif- 

 ferent lines of work in place of the ex- 

 treme individualism which prevails to-day 

 and is economically so wasteful. Hospitals 

 should be looked to more and more as nat- 

 ural centers where the specialized activities 

 of groups of phj'sicians may be brought 

 into harmonious cooperation and where 

 diagnostic centers for those who can afford 

 to pay, as well as for the poor, may be 

 established and economically run. Hos- 

 pitals of this kind established in rural dis- 

 tricts would do much to make the condi- 

 tions of rural practise more attractive and 

 to overcome the lack of physicians which 

 in some communities is already serious and 

 will become more so with the decrease in 

 the number of physicians brought about by 

 raising of standards of medical education. 

 A greatly reduced number of physicians 

 in this country can serve the needs of the 

 people effectively only through coopera- 

 tion. With cooperation it will be possible 

 to serve the community far more effectively 

 than before. It has been estimated for in- 

 stance that at present in Wisconsin physi- 

 cians attend women in labor in only 40 per 

 cent, of cases, midwives, usually poorly 



trained, in 40 per cent, of cases, and no 

 trained persons in 20 per cent, of cases. 

 With the establishment of more hospitals 

 and the use of automobiles practically all 

 women might be given opportunity to bear 

 children amid good surroundings and 

 under skilled care, with untold good to the 

 public. Rural nurses in connection with 

 the rural hospitals and visiting nurses in 

 connection with the city hospitals add 

 greatly to their effectiveness. 



Besides the need of more effective or- 

 ganization and cooperation there is a need 

 of a reorganization in medical economics. 

 The public should pay for the public serv- 

 ices which physicians perform. The evil 

 of extracting a large amount of service for 

 little or nothing is especially marked in the 

 large cities where young physicians are en- 

 couraged to do a large amount of dispen- 

 sary work for "experience." The Robin 

 Hood method of subsequently making the 

 rich pay fees sufficient to cover the serv- 

 ices rendered the poor is economically 

 wrong. Public service should be paid for 

 by the public to the medical as well as to 

 the legal profession. 



The expenses connected with the early 

 years after graduation as well as the cost 

 in time and money of the long training now 

 demanded of medical students makes it im- 

 perative that we should seek to lessen the 

 cost to the student in every way compat- 

 ible with efficient training. Otherwise we 

 shall limit the profession too much to a re- 

 stricted class of the well-to-do. By mak- 

 ing the relative proportion of the cost of 

 the investment represented by a medical 

 education unduly high to the student we 

 shall encourage him subsequently to be- 

 come commercialized, to forget that the 

 public and teachers are stockholders in the 

 investment and to make his chief aim in 

 practise the greatest possible financial re- 



