148 



SCIENCE. 



[Vol. VIU., No. 184 



Let us now consider the second head of the 

 complaint, viz., that the standard of education is 

 too low. There is ground for this, considered 

 with reference to some localities, but not for 

 others. I said a moment ago that a man might 

 be fairly qualified for practice in one part of the 

 country and yet find himself at a loss in another. 

 This needs a little explanation, which I can, per- 

 haps, give most easily in connection with a map 

 of the United States (chart i.). This map, which 

 was prepared for a very different purpose, indi- 

 cates by different shades of color, the relative pro- 



struction in the office of his preceptor in Vermont 

 or New Hampshire, supplemented by distant 

 glimpses of a few cases in hospital in Boston or 

 New York, will find himself at a loss at first in 

 dealing with the emergencies of daily practice in 

 Arkansas and Mississippi. He will be subjected 

 to influences which at times are dangerous to one 

 who is not acclimated, and which tend to produce 

 depression of spirits, want of energy, and bad 

 health. He will not have free and constant ac- 

 cess to scientific companionship, nor be stimulated 

 by the influence of learned societies, and he can- 



ChART I. — SHOWING THE DISTRIBUTION OF DEATHS FROM MALARIAL FEVER AS COMPARED WITH DEATHS FROM KNOWN CAUSES. 



portion of deaths reported as due to malarial 

 disease to the total number of deaths in different 

 parts of the country, for the census-year 1879-80. 

 You will note how comparatively light the tint is 

 in the north and north-east, and how dark the 

 shades become in the south and in the valley of 

 the Mississippi, thus indicating the great differ- 

 ences which exist as to the prevalence and deadly 

 effects of the malarial poison in different sections 

 of the country. 



As compared with the north and east, much of 

 this malarious region is a thmly settled country, 

 an almost purely agricultural country, and not a 

 rich country. I need hardly tell you that the 

 physician who has received his chief clinical in- 



not avail himself of the ordinary sources of amuse- 

 ment, education, and rest, such as art galleries, 

 the drama, libraries, and museums, etc., which 

 are found in the large cities. Moreover, the 

 pecuniary reward which the practitioner in many 

 of these places can reasonably hope for is com- 

 paratively small. 



Nor can the inducements for highly educated 

 physicians to settle in thinly settled localities be 

 made sti'onger by any form of penal or restrictive 

 legislation. Any attempt to fix a standard of 

 requirements or qualifications for practice which 

 shall be the same for such rural districts and 

 for the large cities and manufacturing towns, 

 must result in the adoption of what competent 



