Evening star. [volume] (Washington, D.C.) 1854-1972, 1931-03-08


IA diums of useful information
"A which contained, among pages
devoted to weather predictions,
humorous anecdotes, instructions on
how to subdivide a side of beef and
other valuable data. and paragraph or
so devoted to the subject Of What to
Do Till the Doctor Comes" These pub
locations begin to take on a rather old
fashioned aspect.
The doctor still has to come, however,
and when we want him We want him
more than anything else In the world.
| So we may well ask ourselves, in this
| year of grace, exactly where the doctor
comes from, how he got to be a doctor,
how many patients besides ourselves he
has on his hands and how he differs
from his predecessor of a generation
or two ago, and why. Some of the
| answers to these questions have been
got together by the Committee on the
Costs of Medical Care in tbs course Of
its f1ve-year survey of how much sick
| ness there is in the United States, how
much 1T costs us and what Is being
and can be done about 1t.
It Is a fact, and should be q COM
| forting one, that the United States has
more physicians in proportion to popu-
| lstion than any other country in the
world. The same thing Is probably true
Of dentists and nurses.
100000 Guard Nations Health.
There are, to be exact, taking the
| latest available estimates. l43, 500 ply
sicians, 5000 dentists, 100000 trained
nurses and $4,000 practical nurses.
| These are divisions of the vast army
Of 100000 persons-about one for
every 100 of population-who are occu-
pied in various ways in looking after
our health. Confning ourselves for the
moment to licensed doctors Of medicine
we find some striking and perhaps dis
| turbing facts.
The first OF these is that the number
of physicians has not been increasing
as rapidly as population. In 1900 there
were 173 to every 100000 Of population,
in 1927 only 1875, taking the United
States as whole.
These figures, however, should not
worry us too much, for l26 physicians
today can do their 100000 actual or
prospective patients much more good
than 173 could do in 1900. They are
better trained, for standards of medical
education have vastly improved. They
have many times as many nurses TO
assist them. They have better equip
ment and have more and better equip
ped hospitals to supplement their work.
| There Is less sickness. They use motor
cars instead Of the old-fashioned horse
drawn vehicles and can therefore cover
more ground Their patients, too. use
automobiles, and their ONCE practice
has increased. The very increase Of
population is in part a tribute to their
effectiveness, for it is in part the re-
suit of q diminished death rate.
Distribution Is Uneven.
The uneven distribution of physicians
| does. however, give us something 70
consider. Thus, California has 200 to
every 100000 Of population; New York,
1853; Colorado, 1853; Nevada, 1877; Mary
| land, $50; Missouri. 1853. On the other
hand, Virginia, North Carolina, South
Carolina, Wisconsin, Alabama, Mis-
Montana, Idaho. Wyoming, New Mex
leo, Arizona and Utah all have less
than 100. South Carolina and Idaho
have only II each to the 100, 000-55
below the national average. The ratio
CT nurses and dentists Is roughly in
proportion.
Another factor which ought not to be
overlooked is the tendency of begin
ming physicians to go to the cities
rather than to the rural districts. Their
financial opportunities are theoretically
better there; hospitals are more numer-
Gus and living conditions are more at
| tractive Twenty-Five years ago, one
third of recent medical school grad
yates were settled in communities of
| $4,000 or more; seven years ago, So
per cent were so located. Recently the
National Grange addressed a memorial
to the American Medical Association
with regard to the growing scarcity
of country doctors" The New York
State commissioner of health in 1922
gathered data from rural districts in
80 States which indicated that the
condition Of affairs differs only in
degree, varying from serious to des-
perate."
So much for what we may call the
geography of medicine. We see physi-
clans coming from medical schools
which have been steadily improving
during the past generation. We see the
old-fashioned family doctor lingering
on, especially in the rural communities,
but he is growing older and Is not
being duplicated. His successor Is GER
tainly more scientific, though one
doubts that he knows as much about
human nature or comes into such close
and sympathetic touch with his pres
ent and prospective patients. We see
specialization on the increase, with its
advantages and its new problems. Or
the 143, 400 physicians in active practice
In 1928, 1927 were specialists and
20,712 were interested in, though not
limited to, speciality.
Thus medical services are compli-
Gated not only geographically, but IN
other ways Even in cities the patient
does not always know where to look
and sometimes he pursues long and
roundabout course before he finds the
kind of trea tment he needs.
Services Complicated.
sometimes we NAV feel that we are
as well as equipped with public as
with private agencies for the safe
guarding and restoration of health.
Unhappily this Is not true. We have
made a beginning toward the promot-
ing OF community health. but only
beginning,
twenty-five branches Of the Federal
Government do some kind of medical
work. Federal. State, county and mu-
nicipal hospitals provide 20 per cent OF
all hospital service in the United States.
Thirty mine States maintain diagnostic
laboratories; 20 States control the sale
of drugs: "a States manufacture vac
cines, anti-toXins CT sera.
Every State has health department
which seeks control of communicable
disease, of water supply and the dis
posal of sewage. Especial attention is
being given nowadays to the prevention
and cure of such plaques dor they are
pisgues) as malaria. diphtheria. tuber-
culos.s. typhoid fever, d:arrhea, syphilis
and gonorrhea.
Eut In 1928. In S24 cities with more
than 10000 population only S54 en-
pioyed health officers on a full-tme
basis. OF the ASSOC counties In the |
United States classified as wholly or In |
part rural, only ala had one or more |
health officers on q full-time basis.
County Is Surveyed.
That Is not q picture upon which VIC |
may look with entire pride. even when i
we consider the high quality OF the