THE
MEDICAL EXAMINER,
AND
RECORD OF MEDICAL SCIENCE.
NEW SERIES.—NO. LXIV.—APRIL, 1 8 50.
ORIGINAL COMMUNICATIONS.
On the proportion of Graduates to the Population. By George
Tucker, Esq., formerly Professor of Moral Philosophy in the
University of Virginia.
18 Girard street, March, 16, 1850.
Dear Sir :—My friend Professor Tucker, formerly Profes-
sor of Moral Philosophy and Political Economy in the Univer-
sity of Virginia,—whose attention has been much directed to
statistical subjects, which he has, on many occasions, ably
illustrated,—has sent me the accompanying communication, which
confirms the view recently taken by my friend and colleague
Dr. J. K. Mitchell, in his charge to the graduates of Jefferson
Medical College—that the number of graduates annually sent
from the schools is not yet sufficiently large to meet the demands
of the community. Should you desire to publish it, it is at your
service.	I am my dear sir,
Very truly yours,
Robley Dunglison.
Dr. F. G. Smith, Editor of the Medical Examiner.
13 Girard street, March IG, 1850.
My Dear Sir :—I well recollect that when a committee of the
Medical Association which met at Baltimore, in May, 1848, stated
that the annual number of medical graduates exceeded the demands
of the community, I remarked to you that I had drawn a contrary
inference from the facts stated by the committee themselves; and
your colleague Dr. Mitchell having, in his late charge to the
graduates of Jefferson College, maintained, by a reference to statis-
tical details, that the number annually added to the list of regular
physicians was still far short of the wants of the country, I readily
comply with your request, and state the grounds of my opinion on
a subject on which learned doctors have thus differed. My estimate
will be made for the year 1848.
On the first of June, of that year, the population of the United
States—adding to the ordinary increase a reasonable allowance
for the accessions from the acquired territories of Texas, California
and New Mexico, and an unprecedented number of immigrants
since 1840—was probably not less than 22,000,000. Let us,
however, suppose it to be 21,500,000. With this population,
w’hat is the probable number of physicians ? I have been in the
habit of estimating one for every 800 persons. Dr. Mitchell,
guided by the number in Philadelphia, supposes one for 700 ; but
the proportion is always greater in the cities than in the country.
Taking then the former ratio, the whole number of practising
physicians in the United States is 26,875. On comparing the
number of free white adults in the census of 1830, with that of
1840, and deducting from the latter the intervening gain from
immigration, it would seem that the annual diminution by death
in that class is about 2 per cent. For reasons with which I will
not trouble you, I suppose the proportion of deaths in your pro-
fession to be greater than the average. Let us, however, assume
it to be the same, and the annual reduction from this cause
will be 537.
But the annual addition to the population requires a corres-
pondent addition to the number of physicians. The yearly
increase by natural multiplication appears to be about 2.8 per
cent., which in a population of 21,500,000, amounted in 1848 to
602,000, to which 200,000 may be added for immigration. That
year, indeed, the number of immigrants was considerably larger.
The whole addition to the population being thus 802,000, would
consequently require 1002 physicians.
Further deductions must be made for those who quit the pro-
fession for other occupations, or because they are weary of it ;
for those who have obtained the degree of doctor of medicine but
have never practiced; and for a small number who, having
graduated in two schools, have been reckoned twice. I do not add
to this list, those who practice in foreign countries, since the
number of physicians who migrate to this country is probably
equal to those who leave it. I have no data for estimating this
class of deductions; but Dr. Mitchell reckons it at 2 per cent.,
and you think that estimate not too high. This would take off
537 more, or at 1 per cent. 268.
The additional number of physicians annually required to supply
the wants of the country was then as follows:
From deaths,	537
From increase of population,	1002
From withdrawals, &c., at 2 per cent.,	537
2076
If, however, we reduce the last head to only 1 per cent., the
number would be 1807, so that if the annual number of medical
graduates had not exceeded 1500, as the report of that committee
assumed, we find that after allowing the widest range for possible
error, the annual supply is from 20 to 35 per cent, less than the
annual demand. This deficiency, which has since increased, was
of course supplied from the large class of uneducated and half-
educated practitioners who are still suffered to sport with the
health and lives of the credulous multitude.
With great respect and regard, I am, &c.,
George Tucker.
To Dr. R. Dunglison.