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In the early history of this country, and as late as fifty or perhaps even twenty-five years ago, large tracts of sparsely settled portions of the United States presented conditions in which it was impossible for the thoroughly educated medical man to obtain a just recompense for the time and money necessarily expended in acquiring his medical education, yet these communities required the services of physicians, and it therefore happened that persons with very slight qualifications took up the practice of physic and endeavored to supply the demands of the community that was unable to obtain anything better.
With increase in population, wealth and civilization the people became more discriminating in their choice of doctors, the communication with distant points was more rapid, the advent of railroads made it easier to secure competent medical men, and consequently the poorly qualified doctors have gradually decreased until at present there are few
INGALS EF. THE NECESSITIES OF A MODERN MEDICAL COLLEGE.. JAMA. 1895;XXV(5):173-176. doi:10.1001/jama.1895.02430310001001