SCIENCE.-SUPPLEMENT. 



FRIDAY, AUGUST 13, 18s6. 



MEDICINE IN THE UNITED STATES, AND 

 ITS RELATIONS TO CO-OPERATIVE IN- 

 VESTIGATION.' 



I PROPOSE to call your attention briefly to some 

 points relating to the present condition and future 

 jjrospects of medicine in the United States, and 

 to the direction in which you may reasonably 

 hope and expect from that country in the futiu-e 

 the most useful co-operation in the improvement 

 of medical science and art. I believe that these 

 roust be matters of interest to you, and that I can 

 perhaps make clear certain peculiarities which do 

 not seem to be as generally understood on this 

 side of the Atlantic as it is desnable that they 

 should be to insure sound judgment upon some 

 of the results observed. 



In the first place, permit me to call your atten- 

 tion to the fact that it is hardly possible to make 

 any statements with regard to medicine in, or the 

 medical profession of, the United States as a 

 whole, which shall be definite and at the same 

 time distinctive ; that is, which will not apply 

 almost equally well to medicine and the medical 

 profession in other countries. This is due to the 

 fact that there are great differences in the organ- 

 ization of the profession in different parts of Amer- 

 ica, so that what is true of one state would not be 

 true of another ; what is required as to fitness or 

 qualification to practise in one place is not required 

 in another ; and the country covers so many 

 parallels of latitude and meridians of longitude, 

 making the conditions of life so diverse, and pro- 

 ducing such differences in the prevailing diseases, 

 that a man who is fairly quahfied to practise in 

 one section may be poorly fitted to treat the 

 endemic diseases of another. 



Let us begin by considering some of the things 

 that American physicians complain about ; in 

 other words, some of theii* supposed grievances. 

 One of these is that the profession is overcrowded ; 

 that there are too many doctors, both in esse and 

 in posse, and that this is due to too low a stand- 

 ard of education, and to the want of legal restric- 

 tions as to the qualifications which shall give a 

 man the right to practise. Statistics gathered in 



1 Condensed from tbe annual address in medicine de- 

 livered before the British medical association, Wednes- 

 day, August 11, 188(3, by John S. Billings, surgeon U. ^. A. 



1883,^ showed that in the United States and 

 Canada there were 90,410 j)ersons calling them- 

 selves physicians, being in the proportion of 1 to 

 every 600 of population. In Canada alone, there 

 were 3487 physicians, or 1 to 1112 of popula- 

 tion. If we take the figures of our last census, 

 of 1880, the propoition of physicians reported, is 

 1 to 589 of population, or 17 per 10,000. In Eng- 

 land and Wales, by the census of 1881, the pro- 

 portion of physicians is only 5.8 'per 10,000, but 

 these figures are not properly comparable with 

 those of the United States, because they do not 

 include unregistered persons. If the same classes 

 were included that are counted in the United 

 States report, I presume that the proportion would 

 be about 9 per 10,000, or a Uttle more than half 

 that m the United States. 



In the United State the proportion to the popu- 

 lation of those who call themselves physicians 

 varies greatly in different localities ; thus, in 

 Colorado there are 29.3, in Indiana 25.2, in Ore- 

 gon 24.3, and in Arkansas 23.5 per 10,000; while 

 in New Mexico there are only 6.6, in South Caro- 

 hna 9.2 and in North Carolina 9.7 per 10,000. 



It is not easy to give satisfactory reasons for 

 these differences ; we can only say that they do 

 not depend to any great extent upon local legisla- 

 tion. The proportion of physicians is generally 

 lowest in the southern states lying east of the 

 Mississippi, and highest in those regions where 

 immigration has recently been active. If we 

 compare, by localities, the proportion of physi- 

 cians to the population with that of clergymen and 

 lawyers, we find some curious differences. It seems 

 that the lawyers in the United States number 

 12.7, while in England and Wales they are 6.6 

 per 10,000, but that on the other hand the clergy- 

 men are 14.6 in England and 12.8 in the United 

 States per 10,000 of population. In many in- 

 stances it seems that where the lawyers are most 

 numerous the supply of clergymen is smallest. I 

 believe that a fail- proportion of physicians to 

 population is about 1 per 1000, which is not far 

 from the actual proportion in England, while the 

 true proportion of practising physicians in the 

 United States is about 1 in 750. We must admit, 

 then, that there is at all events no scarcity of 

 physicians in the United States, and, as we have 

 over 80 medical schools at work, besides a fair 

 proportion of medical immigrants, there is no im- 

 mediate danger of any interruption to the supply. 

 2 Illinois state board of health report, 1884. 



