THE HIGH STANDARD OF MEDICAL

EDUCATION TO-DAY

When the appalling status of medical education was revealed by the investigation of 1907, the American Medical Association came down on the one hundred and sixty medical colleges "like the wolf on the fold." As the result of this wholesale housecleaning, there are to-day just eighty medical colleges, half the number of two decades ago.

The medical curriculum of to-day sets a very high standard. Before he is permitted to matriculate, the candidate for the degree of M.D. is required to graduate from high school and obtain the equivalent of two years of college education. The four years of medical instruction that follow contain many crowded hours.

If you happen to visit the wards of a hospital connected with a medical college on a Sunday or holiday, you may see some white-coated young men taking histories and examining patients. They are senior medical students trying to catch up with their overcrowded calendar.

The doctor of to-day is not only far ahead of the old-time country physician in fundamental training; his varied experience during his one or two years of internship gives him a direct contact with disease and the methods of treating it that was altogether impossible during the apprentice period of medical education.

Altogether, the doctor of to-day is head and shoulders above his predecessor of the eighties and nineties. How, then, has it come about that he has lost caste?

THE PASSING OF THE GOATEE

Before the days of diphtheria antitoxin, the kind-hearted physician would sadly tell the parents: "This is diphtheria. I am very much afraid you will lose the child." Then he would sit patiently by, waiting to detach a membrane with his finger, or give whatever simple aid the limited state of medical knowledge of that time permitted. If the case was serious, time meant nothing to him. He would hitch his horse to the lamp-post and send a small boy around to the office to tell the waiting patients that he would arrive

when he got there. Gently he would close the child's eyes after the last gasp, and soothingly assure the stricken mother that God's will cannot be denied.

Let us rehearse the diphtheria drama as it occurs to-day. Baby has a sore throat, and so Doctor Modern is called on the telephone. He arrives in a Ford.

Grandma is shocked by the doctor's appearance. Where, oh, where, is his goatee? Can this smooth-chinned, impudent fellow, who looks more like a bank clerk or an actor in a stock company, profess to be a real doctor?

When the doctor looks at baby's throat, he says: "This looks like diphtheria, but I'll have to take a throat culture to make sure."

Then grandma pipes in: "When I was a girl, the doctors knew their business. They didn't have to poke sticks into a child's mouth to find out what's what."

The antitoxin is given. Then, without any patting of hands, soft soap, or bla-bla, the doctor is off.

The child recovers, thanks to the antitoxin. The parents take the recovery as a matter of course, as one accepts a suit that has been dry-cleaned properly.

One day, the garrulous gossip from the next apartment comes panting into the room with a newspaper item. The heading reads: "Child Dies in Five Minutes after Overdose of Antitoxin."

Antitoxin! That's just what Doctor Modern "experimented with" on baby! Hastily baby is examined and, surely enough, some blotches are found on his skin. Then follows the hurry call for another doctor, and Doctor Modern's monthly statements suffer the ignominious fate of forty per cent of all medical

accounts.

The cold, business-like efficiency of Doctor Modern has failed to impress his clientele. The public demands kind words, soft assurances, and honeyed expressions of comfort; in brief, the personal touch. They want the doctor with the goatee!

Everywhere to-day the conscientious efforts of the physician to cope with disease with the maximum of efficiency and the minimum of bla-bla are met with distrust and suspicion.

An acquaintance of mine in a small town had an attack of appendicitis. The

local physician, quite correctly, advised immediate operation.

"I guess he needs a new car," said the patient. "Well, he's not going to buy it at my expense.

When the physician makes two calls a day, performs laboratory tests for exact diagnosis, or advises a necessary operation, the patient, in many instances, treats him as if he were a salesman. Oftentimes he directly insults the doctor by intimating that the desire for the fee, not the gravity of the illness, is the underlying reason for "all the fuss."

Never before has the medical profession been more efficient, scientific, or idealistic in its aims than to-day. Nevertheless, its reward from the public for this laudable trend is nothing better than general distrust, forty per cent of unpaid bills, and wholesale derelictions to ignorant quacks. The doctor has spoiled the public!

THE ROCKS OF ALTRUISM

It is a maxim of sound business that every concrete improvement in a product must be accompanied by a splurge of "good-will" advertising; otherwise, the purchasing public would be none the wiser.

Good-will advertising is no part of the programme of the medical profession. This body makes very little effort to inform the public of what it is doing for their betterment. Advertising and publicity in general are naturally repugnant to the medical mind; perhaps they should not be, but they are.

Medicine is a science. The men who are responsible for its advancement are interested in a greater knowledge of disease and improved methods of coping with it. Whether or not the public appreciates their efforts seems to make no difference to them.

Good-will cannot be built up by deeds alone. The achievement must be there, but so also must the advertising. Let the manufacturers of the finest grade of hosiery in the country cease advertising for a few years, and they will soon find very little demand indeed for their prod

uct.

The medical profession is tongue-tied with reference to its own achievements. Much of this medical aphasia is unavoid

able. Advertising by individual physicians is, of course, unethical.

The logical answer to this difficulty would be for the profession to disseminate the knowledge of medical achievements to the public press. But here comes the great impasse. Newspaper editors insist that an item of information must have "news value." The medical man insists that it must be strictly accurate, regardless of its "news value." He will not twist the facts one iota in deference to that great editorial god, H. I. (human interest). Hence, many of the authentic accounts of medical advances find their way to the lower strata of the editorial waste-basket.

Lack of salesmanship is another important factor in the decline of the doctor's prestige. The old-time country doctor started his career in direct contact with the sick, not as a scientific man. Therefore his earliest training was in rubbing the cat's fur the right way. What he lacked in scientific training he made up in tact and diplomacy. He was primarily a good salesman.

The modern doctor is the poorest salesman in the world. A man who devotes his entire attention to the control of disease cannot be expected to master the essentials of expression and impression of which the advertising writers speak so glibly.

A very important factor in lowering the doctor's prestige is the deliberate cheapening of his services by the universal trend toward free medical attention. Whatever is free is not appreciated. Water is one of the essentials of life; but who ever thinks of thanking the engineering and public-health authorities for conveying it safely to our spigots?

In the United States 8,000,000 persons a year avail themselves of free medical service. The class of medical attention given at these clinics is usually of a very high order. How, then, can the practising physician expect to receive any respect, when his services are constantly compared with a form that can be received gratis?

THE REMEDY

The remedy must come either from the doctor or the public. If the doctor is to take steps to correct the conditions that have led to the downfall of his prestige, he

must become less business-like and more human, learn less science and more bla-bla, and cater his advice to the whims of grandma rather than to the inflexible dictates of pathology; in short, he must rehabilitate the goatee and all that goes with it.

However, all vital statistics, to say nothing of common sense, prove that the work performed by the doctor of to-day is vastly superior to that of his predecessor with the goatee. Therefore it is manifestly to the interest of the public to retain the cold, calculating, scientific medical man of to-day and reconcile themselves to the loss of his goatee.

The doctor of to-day is a scientific idealist. He thinks of cancer as an extremely interesting problem in pathology, where the layman can see only human

affliction and disaster. Frequently, the physician appears cold and unsympathetic. But his apparent lack of heart is only a mask that he wears for his own protection. A man who must perforce witness a dozen tragedies every day cannot take them all to heart; if he did, his calling would soon become impossible. After all, it is not mushy sentiment in the sick-room but cold, exact science that has increased the span of human life by more than ten years.

To my way of thinking, the public has been spoiled by the too easy-going toleration of the medical profession. The remedy must come from the public; otherwise, medicine will slip back into salesmanship. Appreciation of the modern doctor is much better than depreciation.

HAVE been afflicted for several semesters with a severe pain in the rear of the neck. This arises from clatter I am forced to listen to from the region bordering on 42d Street and Broadway in a prominent Eastern city. It has to do with the moans which indicate that theatrical road shows are a thing of the past.

For the last few years I have been endeavoring, with a skill considered-in other connections-next to uncanny, to book shows in the wonderful Western city of, let us say, Albuquerque, N. M. My results have been remarkable. Remarkable in that after two years I have booked no and no/100 shows in Albuquerque, N. M.

When, as a young man of exuberance should, I have asked why Albuquerque, N. M., has been so slighted, I am informed many things. Among other things I am told that the road-show business in the United States has been practically wiped out because the smaller cities have turned to the worship of new idols-yclept movies, radio, etc. To which I answer with three large snorts and a disgusted sneeze. The truth being, of course, that the smaller cities of the hinterland are starved to the point of anæmia from the lack of legitimate amusement, and are simply convulsed with the desire to pour their money into the Broadway coffers for anything at all that has a set of scenery and two principals who are able to talk the native tongue. Particularly are they anxious to enrich the venturesome gentlemen who bring them a show with music and dancing and pulchritude.

But, say the gentlemen, who in the name of Job can afford to put out a road show, with railroad fares and union rules and equity contracts what they are? VOL. LXXXII.-4

Who can make any money on the road when the company electrician bears in his contract a provision that he must travel in a lower berth? Who can take out a musical show when chorus girls who once were paid ten dollars a week and found will not go out unless they receive seventy-five weekly and a special maid?

The obvious answer to this is that somebody is lopsided and I'm not the party. I say this because there are road shows that continue to make money, and waste no time complaining about it. They go about it a little differently, true enough, but that only goes to prove my point-that what the theatrical profession lacks is a small portion of what they all think they have an abundance of: to wit, brains.

For instance, three years ago the Ruth St. Denis Dancers played matinée and night in Albuquerque. Listen to this very carefully. They grossed $2,771.81 at night and $1,200 at the matinée, a total of $3,971.81 for the day. And this in a punk little theatre seating 888, counting every last rotten balcony seat and every box seat. And still I hear plaints that the road doesn't want legitimate shows any more. Earlier in the year Geraldine Farrar grossed $2,300 for one performance at the same house at lower prices.

But these are not "theatrical" shows. They are sold as concert attractions. It's the one big laugh the regular show people can't seem to appreciate. If St. Denis in a highbrow dancing show in which not a word is spoken can gross $3,971.81 in a town the size of Albuquerque and in a theatre the size of the one we have, what in the name of sense could a real fastmoving musical show with a headliner do?

The St. Denis company had twelve dancers, including Miss St. Denis and Ted Shawn. It also carried a chamber orchestra of four men, a stage carpenter,

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an electrician, and a manager—a total of twenty-three. The Farrar company had sixteen in the cast, a ballet of four and an orchestra of about twenty-an orchestra so large that the bull fiddler did his stuff from the front of one of the lower boxes. This looks like a flock of people to haul around, but Miss Farrar seemed to do it without loss of dignity or need of sacrificing her private car.

I give these figures on the gross receipts because some time ago I saw in a New York theatrical sheet awed words to the effect that Michael Arlen's "These Charming People" played its try-out in Hartford, Conn., to a gross of $2,400, which was considered "such a much" as money goes as to cause imminent swooning on the part of the theatrical wisecrackers, and to bring forth the hilarious witticism that it was a shame Mr. Dillingham hadn't allowed the company to play out the season in Hartford. And all that hullabaloo about $2,400!

New Mexico, you know, is supposed to be broke. And then the wild ribaldry about $2,400 in Hartford. Why, if we ever get a real good year out here we'll have to hold the shows-if we ever get any-in the ball park. We could do that very thing, too, if you come right down to it, but I'll not bother you here with accounts of the world's most wonderful climate.

I can hear my friends sniff at the idea of comparing the St. Denis company of twenty-three with a Broadway musical show. To which I answer that John Philip Sousa played here under my management a year ago, and Sousa carried close to a hundred men-all of them drawing as much every Saturday night as the general run of performers in a musical show. Sousa did $6,100 in Albuquerque in two shows-which should do a little something in the way of providing pocket-money for the march king. I'm told that Sousa netted over $125,ooo the year before. Netted, mind you, after paying $60,000 railroad fares, $20,000 Pullman fares, and $20,000 baggage charges. Of course, Sousa is a household name. You bet he is! He takes good care to see that he continues to be one. In other words, he realizes that New York is after all just one big city

in a nation and that there are millions of people who wouldn't know a New York newspaper from a bag of tripe and who never heard of Billboard or Variety. It takes a whaling big play to get general notice outside of New York. Only a few of them, such as Frank Bacon with "Lightnin'" or "Abie's Irish Rose," ever do it.

If Sousa stayed in New York all year, he'd soon notice the difference in the sticks. A very charming lady from New York tried to convince me last fall that we weren't getting much to hurrah about when Sousa's date here was announced. She said Franko and Goldman in New York had bands of far greater merit. I didn't agree with her in the least, but it made it even more plain to me that New York doesn't really amount to three halfwitted screeches any more with the smaller towns. Mention Goldman or Franko in the same breath with Sousa in any of a thousand American towns and you'll get nothing but smiles for your effort. You won't get violence because nobody will have heard of Franko or Goldman in the first place, and will simply think that you're overcoming an early dumbness and were blossoming forth as something of a wit.

But to get back to the musical-show thing. There are two boys in New York who seem to have awakened from a long sleep. These gentlemen-speak it loudly

are Thompson and Archer, who turned out "Little Jesse James" a few years back. You probably never heard of the show, but you'll remember a song entitled "I Love You" which after its three billionth repetition threatened to nauseate the nation. That was from "Little Jesse James." I didn't see the show but they say that Thompson and Archer battled around until they got somebody to back them with a small chorus of hoofers, a small jazz band in the pit instead of the regular cumbersome theatre orchestra, and a few principals of worth rather than of reputation.

It was a comparatively cheap show to put on, and very little was spent for elaborate hangings or costumes. What they aimed for was speed, cleverness, and humor. I know it only from hearsay, but all tidings reaching my ears are to the