the readjustment of medical education through further reduction in the number of schools, because the institutions involved are enabled to live on hope for perhaps another decade or more. It is important that our universities realize that medical education is a serious and costly venture; and that they should reject or terminate all connection with a medical school unless prepared to foot its bills and to pitch its instruction on a university plane. In Canada conditions have never become so badly demoralized as in the United States. There the best features of English clinical teaching had never been wholly forgotten. Convalescence from a relatively mild overindulgence in commercial medical schools set in earlier and is more nearly completed.
With the creation of the heterogeneous situation thus bequeathed to us, it is clear that consideration for the public good has had on the whole little to do; nor is it to be expected that this situation will very readily readjust itself in response to public need. A powerful and profitable vested interest tenaciously resists criticism from that point of view; not, of course, openly. It is too obvious that if the sick are to reap the full benefit of recent progress in medicine, a more uniformly arduous and expensive medical education is demanded. But it is speciously argued that improvements thus accomplished will do more harm than good: for whatever makes medical education more difficult and more costly will deplete the profession and thus deprive large numbers of all medical attention whatsoever, in order that a fortunate minority may get the best possible care. It is important to forestall the issue thus raised; otherwise it will crop out at every turn of the following discussion, in the effort to justify the existing situation and to break the force of constructive suggestion. It seems, therefore, necessary to refer briefly at this point to the statistical aspects of medical education in America, so far as they are immediately pertinent to the question of improvement and reform.
The problem is of course practical and not academic. Pending the homogeneous filling up of the whole country, inequalities must be tolerated. Man has been not inaptly differentiated as the animal with "the desire to take medicine."[1] When sick, he craves the comfort of the doctor,—any doctor rather than none at all, and in this he will not be denied. The question is, then, not merely to define the ideal training of the physician; it is just as much, at this particular juncture, to strike the solution that, economic and social factors being what they are, will distribute as widely as possible the best type of physician so distributable. Doubtless the chaos above characterized is in part accounted for by crude conditions that laughed at regular methods of procedure. But this stage of our national existence has gone by. What with widely ramifying railroad and trolley service, improving roads, automobiles, and
- ↑ Osier: Aequanimitas, p. 131.
