have been arranged in this way. The fundamental principles of faculty organization are thus sacrificed. Unless combination is to destroy organization, titles must be shaved when schools unite. There must be one professor of medicine, one professor of surgery, etc., to whom others are properly subordinated. What with superabundant 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 administrative 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 country's development actually required more than 3500 physicians annually, that is to say, for a generation or two, at least. Meanwhile, the outline proposed involves no artificial standardization: it concedes a different standard to the south as long as local needs require; it concedes the small town university type where it is clearly of advantage to adhere to it; it varies the general ratio in thinly settled regions; and, finally, it provides a system capable without overstraining of producing twice as many doctors as we suppose the country now to need. In other words, we may be wholly mistaken in our figures without in the least impairing the feasibility of the kind of renovation that has been outlined; and every institution 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 assuredly not be gainsaid. The physician is a social instrument. If there were no disease, there would be no doctors. And as disease has consequences that immediately go beyond the individual specifically affected, society is bound to protect itself against unnecessary spread of loss or danger. It matters not that the making of doctors has been to some extent left to private 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 cannot 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 experience have together established the terms upon which medicine can be most useful. "In the old days," says Metchnikoff,[1] "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 midwives by diploma. In case of nations still 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 progress of obstetrical science." Legislation
- ↑ The Nature of Man (translated by Chalmers), p. 300.
