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 showed a gain in population of 358,837. If, now, we allow in cities one additional physician for every increase of 2000, and outside of 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. I am not now arguing that one physician to 1500 persons is the normal or correct ratio; that is a point that need not even be raised. What I contend is that, as such a ratio has proved more than satisfactory elsewhere, it will at least serve for further increase of our population.

A country, in other words, which now has one physician for every 568, will be amply supplied for a generation at least if it produces one additional physician for every 1500 additional persons. On that basis in 1908 the South needed 240 more doctors. In the course of the same year, it is estimated that 500 vacancies in the profession were due to death. If every vacancy thus arising must be filled, conditions will never greatly improve. Let us agree to work toward a more normal adjustment by filling two vacancies due to death with one new physician, once more a decidedly liberal provision. This will prove sufficiently deliberate; it would have called for 250 more doctors by the close of the year. In all, 490 new men would have amply cared

for the increase in population and the vacancies due to death. As a matter of fact, the Southern medical schools turned out in that year 1144 doctors; 78 more Southerners were graduated from the schools of Baltimore and Philadelphia. The grand total would probably reach 1300,-1300 Southern doctors to compete in a field in which one third of the number would find the making of a decent living already difficult! Clearly the South has no cause to be apprehensive in consequence of a reduced output of higher quality. Its requirements in the matter of a fresh supply are not such as to make it necessary to pitch their training low.

The rest of the country may be rapidly surveyed from the same point of view. The total gain in population, outside of the Southern states already considered, was 975,008,- requiring, on the basis of one more doctor for every 1500 more people, 650 doctors. By death, in the course of the year there were in the same area 1730 vacancies. Replacing two vacancies by one doctor, 865 men would have been required; in most sections public interest would be better cared for if the vacancies all remained unfilled for a decade to come. On the most liberal calculation, 1500 graduates would be called for, and 1000 would be better still. There were actually produced in that year, outside the South, 3497, that is, three times as many as the country could possibly assimilate; and this goes on, and has been going on, every year.

It appears then that the country needs fewer and better doctors; and that the way to get them better is to produce fewer. To support all or most present schools at the higher level would be wasteful, even if it were not impracticable; for they cannot be manned. Some day, doubtless, posterity may reestablish a school in some place where we now recommend the

demise of a struggling enterprise. Toward that remote contingency nothing will, however, be gained by prolonging the life of the existent institution.

The statistics just given have never been compiled or studied by the average medical educator. His stout asseveration that 'the country needs more doctors' is based on 'the letters on file in the dean's office,' or on some hazy notion respecting conditions in neighboring states. As to the begging letters: selecting a thinly settled region, I obtained from the dean of the medical department of the University of Minnesota a list of the localities whence requests for a physician have recently come. With few exceptions they represent five states, and judging from these states, the general distribution shows that overproduction prevails in new communities as well as in old ones.

Fifty-nine towns in Minnesota want a doctor, but investigation shows that these 59 towns have already 149 doctors between them! Ten of the 59 are without registered physicians; but of these ten, two are not to be found on the map, while two more are not even mentioned in the Postal Guide; of the other six, four are within easy reach of doctors, and two only, with a combined population of 150 souls, are out of reach of medical assistance. Forty-one places in North Dakota apply; they have already 121 doctors. Twentyone applications come from South Dakota, from towns already having 49 doctors. Seven come from Wisconsin, from places that had 21 physicians before their prayer for more was made. Six come from Iowa, from towns which had 17 doctors at the time of application.

It is manifest that the files of the deans will not invalidate the conclusion which a study of the figures suggests. They are more apt to sustain it, for the requests in question are less

likely to mean 'no doctors' than 'poor doctors,' - a distemper which continued overproduction on the same basis can only aggravate, and which a change to another basis of the same type will

not cure.

As to general conditions, no case has been found in which a single medical educator contended that his own vicinity or state is in need of more doctors; it is always the 'next neighbor.' Thus the District of Columbia, with one doctor for every 262 souls, maintains two medical schools of low grade. 'Do you need more doctors in the District?' I asked one of the deans.

- 'Oh, no, we are making doctors for Maryland, Virginia, and Pennsylvania,' for Maryland, with seven medical schools of its own, and one doctor for every 658 inhabitants; for Virginia, with three medical schools of its own, and one doctor for every 918; for Pennsylvania, with its eight schools, and one doctor for every 636 persons.

With the overproduction thus demonstrated, the commercial treatment of medical education is intimately connected. Low standards give the medical schools access to a large clientèle open to successful exploitation by commercial methods. The crude boy or the jaded clerk who goes into medicine at this level has not been moved by a significant prompting from within; nor has he, as a rule, shown any foresight in the matter of making himself ready. He is more likely to have been caught drifting at a vacant moment by an alluring advertisement or announcement, quite commonly an exaggeration, not infrequently an outright misrepresentation. Indeed, the advertising methods of the commercially successful schools are amazing. One school, for example, offers the bonus of a European trip to any graduate who shall have been in attendance for three years. Not infrequently, advertising

costs more than laboratories. The school catalogues abound in exaggeration, misstatement, and half-truths. A few instances may be cited at random.

The catalogue of the medical department of the University of Buffalo states that 'the dispensary is conducted in a manner unlike that usually seen. . . . Each one will secure unusually thorough training in taking and recording of histories.' There are no dispensary records worthy the name.

The catalogue of Halifax Medical College assures us that 'first-class laboratory accommodation is provided for histology, bacteriology, and practical pathology.' One utterly wretched room is provided for all three.

The catalogue of the medical department of the University of Illinois claims that the University Hospital . . . contains 100 beds, and its clinical advantages are used exclusively for the students of this college.' Over half of these beds are private, and the rest are of but limited use.

In the catalogue of the Western University of London, Ontario, we find under the heading Clinical Instruction: "The Victoria Hospital . . . now contains 250 beds, and is the official hospital of the City of London.' On the average, less than 30 of these beds are available for teaching.

The deans of these institutions occasionally know more about modern advertising than about modern medical teaching. They may be uncertain

about the relation of the clinical laboratory to bedside instruction, but they have calculated to a nicety which 'medium' brings the largest 'return.' Their dispensary records may be in hopeless disorder, but the card-system by which they keep track of possible students is admirable. Such exploitation of medical education, confined to schools that admit students below the level of actual high-school graduation, is strangely inconsistent with the social aspects of medical practice.

The overwhelming predominance of preventive medicine, sanitation, and public health indicates that in modern life the medical profession is an organ differentiated by society for its own highest purposes, not a business to be exploited by individuals according to their own fancy. There would be no vigorous campaigns led by enlightened practitioners against tuberculosis, malaria, and diphtheria, if the commercial point of view were tolerable in practice. And if not in practice, then not in education. The theory of state regulation covers that point. In the act of granting the right to confer degrees, the state vouches for them; through protective boards it seeks still further to safeguard the people. The public interest is then paramount, and when public interest, professional ideals, and sound educational procedure concur in the recommendation of the same policy, the time is surely ripe for decisive action.

ALTHOUGH, probably, from the beginning of time men have pondered upon the nature of thought and the mechanism of the mind, such speculations, while they have remained abstractions, have roused in some of us only a languid interest. Within the last decade, however, step by step and very reluctantly, I have been led to suspect that not only the tranquillity of life, but the coherence of society itself, may hinge upon our ability to modify, more or less radically, our methods of thinking; and, as I tend toward this conclusion, I look at these questions more seriously.

For my purpose I think I may define civilization as being tantamount to centralization, for, however much idealists may dispute that centralization and true civilization have anything in common, they will hardly deny that the massing of population is the salient feature of our age. Furthermore it is an economic axiom that, other things being equal, the cost of administration increases faster than the increase of the human mass to be administered; but if this proposition should be questioned it is easy to prove. Centralized life is relatively costly because of its complexity, and in proportion to its complexity. In 1800, in the United States, a population of 5,308,000 spent $11,308,000, or about $2.14 each, for national purposes. In 1900, according to the Statistical Abstract, the rate per capita had risen to $7.75. That is, a growing density had increased the load which

the Union imposed on each individual three and a half times. At points of high concentration, as in large cities, the increase is greater. When Boston became a city, in 1822, she had a population of 44,000 and a tax-levy of $140,000, or at the rate of about $3.20 per head. Now, with a population of 600,000, the rate approximates $30.

Evidently, to meet this rising expenditure the earning power of the community must be proportionately increased, just as the earning power of any industrial consolidation must be increased, either by larger output or by suppression of waste, to meet the cost of maintaining a complex plant in proportion to its complexity. It follows from this economic law, that, as civilization advances, unless the scientific or inventive qualities which enable men to create wealth, or to suppress waste, gain in at least an equal ratio to the progress of centralization, a centralizing community must perish from inanition if it cannot live by plunder. This I take to have been the fate of Rome. The Romans paid the cost of centralization by robbing others until conquest ceased; then, not being scientific, they could not turn to industry, and, being unable to meet their taxes by agriculture alone, they starved.

To me the evidence is conclusive that a similar catastrophe impended over Europe toward the end of the Middle Ages. At the close of the fifteenth and the beginning of the sixteenth centuries, society appeared to

be sinking under a crushing load; and if the mediæval mind had been as rigid as the Roman mind, I conclude that the subsequent history of the West would have somewhat resembled Roman history. Being more elastic, it responded to the pressure of its environment; and I never tire of contemplating the amazing phenomenon of the sixteenth and seventeenth centuries when men, consciously and deliberately, addressed themselves to the task of artificially creating an intelligence which should be able to despoil nature on a gigantic scale.

After the Liberals had been at work upon their intellectual problem for nearly a generation, Bacon, in his Novum Organum, undertook to present a formula by which the new mind could be produced in bulk. Stated in its simplest terms, he proposed scientific specialization, and the proposition was received as a great and original discovery, although it had been advanced quite as lucidly four hundred years before by the Franciscan friar, Roger Bacon. Apart, however, from Francis Bacon's originality, the fact remains that, during the lifetime of Francis Bacon, society did undertake to set in motion a new energy in the shape of specialized mind, and the correlation of the dates which mark the incubation and the liberation of this energy, and the social revolution which followed upon its liberation, are to me wonderfully suggestive.

Born in 1561, Lord Bacon published his Novum Organum in 1620. Galileo, three years younger, fell into the hands of the Inquisition for maintaining the heresy that the earth moved, and died in 1642 within a year of the birth of Newton. Newton and Leibnitz, who might have been the grandsons of Bacon and Galileo, born

in 1642 and 1646, died respectively in 1727 and 1716, and with them the period of incubation closed. None of these four men had advanced to the point of specialization at which they applied science very readily to the arts. The age of the inventors was to come.

Matthew Boulton, Watt's partner, was born in 1728, Watt himself in 1736, Wedgwood in 1730, and the list might be extended indefinitely. The 'industrial revolution' began when these men reached maturity. It is generally dated from 1760, when the flying shuttle was perfected and coal was successfully applied to smelting. Adam Smith, who expounded the philosophy of the 'industrial revolution' itself, as Bacon had expounded the philosophy of the inductive thought which wrought the revolution, was born in 1723.

Assuming that the year 1760 approximately marks the point when the specialized scientific mind began decisively to predominate in the movement of civilization, there can be no question that, decade by decade, since that epoch, the impulsion given society by the forces set in action by applied science has gathered volume, until now it sweeps before it our laws and institutions, and we seem to be unable to adjust these to the new conditions. Ours is the converse of the Roman predicament. The Romans could conquer and administer, but they could not create wealth fast enough to pay the cost of centralization. We are abundantly inventive and can create wealth, but we cannot control the energy which we liberate. Why we fail is the problem which perplexes me.

I am doubtful whether our apparent lack of intellectual power is due to some inherent and insuperable infirmity of the mind, — in other