THE MEDICAL EXAMINER.
PHILADELPHIA, MAY, 1850.
FACTS VS. FIGURES.
Figures, Mr. Editor, are not statistics, nor yet facts, although it
is a very common notion that they are both. They are too often
little better than figures of speech, and like many other such forms
of expression, impose themselves for truths upon the minds of the
unwary. When they stand for definite and ascertained realities,
they form the best possible medium of comparison between different
classes of phenomena or ideas; but when they are only the trans-
lation of an hypothesis, nothing can be more mischievous and de-
ceptive. They become the lion’s skin to the ass concealed within
them, and give a semblance of dignity and strength to things the
weakest and most vulgar.
I was led into these reflections by the curious calculations con-
tained in two portions of your last number, where it is demonstrated
arithmetically, by one writer, that we create annually less Doctors,
by from 20 to 35 per cent., than are demanded, and by another,
that the supply is at least 50 per cent, too small. Here, to be sure,
is a serious discrepancy in the mathematics of the two authorities,
but it is nothing to an omission of which both are guilty. Perhaps
a reluctance to reveal the whole startling truth may have caused a
suppression of this essential element in the calculation. It was sad
enough to think that with all the efforts of the schools from Maine
to California to hurry out half-made, underdone physicians, there
was still a lack of from one-third to one-half of the required number
of these recruits. What would have been the despair of the grind-
ers in these factories had they been told how much further still they
were from the possibility of satisfying the demand for their com-
modity. Their patriotic souls would have sunk within them at the
thought. But even at the risk of renewing their grief, we must
disclose what your too scrupulous statisticians charitably concealed,
for we cannot suppose that it escaped their sagacity.
If, in this year of grace 1850, twenty-five hundred graduates are
required, and only fifteen hundred are created, the manufacture of
doctors is short by one thousand. But the 2500 graduates are re-
quired to supply the demand of this year alone. Whence is the
deficit of preceding years to be made up? If we create a thousand
too few doctors during this year, we made at least nine hundred
too few last year, and so on for previous years; the aggregate of
these deficiencies being added to that of the present year, would
give a total of three to five thousand required in 1851 for equalizing
the supply and demand !
A moment’s reflection will satisfy you, Mr. Editor, that this con-
clusion, absurd as it certainly is, is the legitimate consequence of
the argument stated in your last number; by itself it demonstrates
the foundation of that argument to be unsound. So that the schools
have already good reason to take courage, and rejoice that their
unselfish labors are not quite so inadequate to the object they seem
to have in view, as the articles you published do clearly imply.
But, after all, what ground is there for the assumption out of
which the whole calculation proceeds ? It is simply that in “ the
city and suburbs of Philadelphia,” the number of medical men is
497, and the population within the same limits 350,000. We are
not informed on what authority the estimate is given, and must
consequently regard it as nothing more than a supposition, which
may be true or false, but which certainly offers no proof of a claim
to the former character. Yet it is assumed by the one writer, and
adopted by the other, as if it were an ascertained fact.
The next step in the argument is another assumption: the one
writer considering that there are 31,250 doctors in the United
States, and the other 26,875, the former supposing the hypothetical
ratio of Philadelphia to extend to the whole country, and the latter the
still more gratuitous ratio of one physician to every 800 souls. The
first named gentleman, indeed, attempts to sustain his deduction by
stating that a publishing house in this city has the addresses of more
than 30,000 physicians; but every one must perceive that such a
list can by no possibility be accurate, however well it may answer
for business purposes.
In all of these estimates we see no account taken of the emigra-
tion of physicians to this country from Europe. One writer, to be
sure, alludes to the point, and passes it by with the remark that we
gain by immigration about as many as we lose by emigration!
Why, the graduates or licentiates of British and German colleges
may be counted in this very city by scores, and New York is pretty
well furnished besides with adventurous Frenchmen driven from
their native country by the overcrowding of their profession. WThen
it is known abroad that we need annually a thousand more doctors
than we can make, a very avalanche of greedy and needy medi-
cos will roll upon our quays. Then, if ever, may we take up
Abernethy’s unconscious soliloquy, and exclaim, “ Heaven help
ye, what’s to become of ye all I”
The per centage of deaths, withdrawals from the profession, &c.,
which, according to the articles in question, create an annual
deficit and demand more than equal to what is required by the in-
crease of the population, calculated as it is on the presumed number
of physicians, can have of course no greater validity than this latter,
which in its turn rests on the assumed population, and the assumed
number of physicians in Philadelphia and its suburbs. The old
story, Mr. Editor, of the earth resting on the elephant, the elephant
on the tortoise, and the tortoise upon—what?
Now, I wish distinctly to remark, that it is not my purpose to deny
the numerical statements given above, but only to show that there
is no evidence of their foundation in fact, and to contend that with-
out such a foundation it is unfair to employ them as arguments in
discussing a question which interests the dignity and prosperity of
the medical profession. For if there is no such disparity as that
alleged between the demand and supply of physicians, but, on the
contrary, an actual excess of the latter, the profession as a body
must suffer in every respect by the crowding of its ranks.
There are no figures at present by which this question can be
settled, unless we compare our own with foreign countries. The
only domestic data we have, are the population and the annual
number of graduates. Now, unless it can be shown that there is
something to account for the difference, why should the proportion-
ate number of our graduates exceed that of other civilized coun-
ties—of France, for example? If her population of thirty-five mil-
lions, her colonies, her army of half a million, and her extensive
marine, call for not so many as five hundred physicians annually,
why should our population of twenty-two millions require fifteen
hundred physicians to be made every year, a proportion nearly five
times as great as the other? If these data and conclusions are in-
correct, I shall be heartily glad to have their errors pointed out, but
until then, I shall be constrained to believe that the striking dis-
parity here indicated is of itself a sufficient proof that we already
graduate too many physicians.
But the truth is, Mr. Editor, that we have no need of statistics of
one sort or another to solve this problem perfectly; were it submit-
ted to a jury of practitioners having no interest in the multiplication
of doctors, they would decide it without leaving the box. Every
man of them would feel that his own experience was conclusive in
the matter, and that his hard struggles to earn a livelihood showed
beyond a shadow of doubt, that there are many more practitioners
of medicine than are required. The sentiment is universal in our
large cities, and from the country we hear no complaints of the
paucity of physicians. These facts defy controversy, and are worth
more than all the adverse statistics in creation.
We shall be told, however, that the pressure is not from phy-
sicians, but from quacks, who usurp the place which educated men
should occupy. Very well, extirpate the quacks, and then let us
see how the account stands; but, until that is done, permit me to
say that it makes very little difference whether I starve through a
knave’s impudence, or more genteelly die of inanition through the
successful rivalry of a brother M. D. It really seems, Mr. Editor,
as if one could hardly be in earnest, in using such language as one
of the writers whom you quote. To think of sending forth some
ten scores of graduates with the cheerful information that they are to
make their bread by “ superceding,” not open quacks alone, but
ignorant doctors into the bargain! And how? Are these owls to
be driven to their dens by the light of science? Rather will they
extinguish that light by absorbing all the oil which was counted
upon for keeping it alive. How is it in our largest and most en-
lightened cities ? Why, the very flower of the profession in science,
learning, manners, social position, in everything that commands
respect—these are the very men who daily receive their conge,
and at the bedside where wisdom and conscience and benevolence
sat enshrined in their persons, vulgarity, ignorance and knavery
play their antics, and are caressed by their enlightened patrons. I
should be glad to have the recipe for “superceding” such men.
But it is not forthcoming. It of all things certainly is not—Take:
li Three thousand graduates” fyc., as the author hints. The
working of that prescription would be just the reverse of what is
desirable. It would make quacks; it would multiply them, rather,
for the one in operation now is making them, and that rapidly, as
every one who will open his eyes must see. Men without edu-
cation made students of medicine, and half educated then, learn to
look upon medicine as a trade, and if they cannot drive it profitably
in the regular way, and they cannot, they will become knavish as
a matter of course.
It is of no avail to calculate how many physicians there ought to
be for the whole population, until you ascertain how many of the
latter prefer quackery to medicine ; for in estimating the relation of
supply and demand, every quack represents a physician. But our
statistical friends do not seem to have thought of this. I commend
it to them for the rectification of their arithmetic.
I remain, &c. &c.	Y. Z.