Jeffersonville, with 400, has two; Plainfield, with 841, has three. Other New England states are in the same case. I would appear, then, that over-production on a low basis does not effectually overcome the social or economic obstacles to spontaneous dispersion. Perhaps the salvation of these districts might, under existing circumstances, be better worked out by a different method. A large area would support one good man, where its separate fragments are each unable to support even one poor man. A physician's range, actual and virtual, increases with his competency. A well qualified doctor may perhaps at a central point set up a small hospital, where the seriously ill of the entire district may receive good care. The region is thus better served by one well trained man than it could possibly be even if over-production on a low basis ultimately succeeded in forcing an incompetent into every hamlet of five and twenty souls. This it cannot compel. It cannot keep even the cheap man in a place without a "chance;" it can only demoralize the smaller places which are capable of supporting a better trained man whose energies may also reach out into the more thinly Settled surrounding country. As a last resort, it might conceivedly become the duty of the several states to salary district physicians in thinly settled or remote regions, — surely a sounder policy than the demoralization of the entire profession for the purpose of enticing ill trained men where they will not go.[1] We may safely conclude that our methods of carrying on medical education have resulted in enormous over-production at a low level, and that, whatever the justification in the past, the present situation in town and country alike can be more effectively met by a reduced output of well trained men than by further inflation with an inferior product.
The improvement of medical education cannot therefore be resisted on the ground that it will destroy schools and restrict output: that is precisely what is needed. The illustrations already given in support of this position may be reinforced by further examples from every section of the Union,from Pennsylvania with one doctor for every 636 inhabitants, Maryland with one for every 658, Nebraska with one for every 602, Colorado with one for every 328, Oregon with one for every 646. It is frequently urged that, however applicable to other sections, this argument does not for the present touch the south, where continued tolerance of commercial methods is required by local conditions. Let us briefly consider the point. The section as a whole contains one doctor for every 760 persons. In the year 1908, twelve states[2] showed a gain in population of 858,887. If now we allow in cities one additional physician for every increase of 000, and outside cities an additional one for every increase of 1000 in population,—an ample allowance in any event,—we may in general figure on one more physician for every gain of 1500 in total population. We are not now arguing that a ratio of 1:1500 is correct; we are under no necessity of proving that. Our conten-
