profession must be well organized. The medical service must be well organized.

From the viewpoint of the physician the practice of medicine has three aspects, the scientific, the social, the commercial.

It is the glory of our profession that we practice "scientific medicine," that we base our professional work upon scientific facts evolved by the method of inductive philosophy and experimental research. Other methods of practice are necessarily sectarian basing their work upon historic dogmas. This is the opposite of scientific method; it is most unscientific. Scientific medicine says that "one should not teach dogmas, on the contrary, every utterance must, be put to the proof. One should not train disciples but form observers, one must teach and work in the spirit of natural science" (Johannes Orth). This is our declaration This is our declaration of scientific faith.

There was a time when the duty of the physician ended with his personal ministrations to his patient. That day has passed never to return. In addition to these personal ministrations and over and beyond them, the advance of knowledge concerning health and sanitation has placed the doctor in the position of service not only to the individual but to the community as a collection of individuals, to society if you please. More and more will the doctor become a factor in the working out of all those social problems of community life connected with the health and efficiency of society. Tuberculosis, housing, women in industry, infectious disease, intemperance, insanity, eugenics and many others are all social problems which society must solve but each is a medical problem, and none of them will be solved until the way is pointed out by the medical profession. The social duty of the physician therefore has been greatly enlarged so that his responsibility lies not only with the individual but with the community as well. Into this larger field of work for the new humanity our profession is but just entering. The prevention of disease is the highest ideal of the medical profession. This is a social duty and more important than any other function we perform. The time is gone when the medical profession can hold itself aloof from the rest of the community. Doctors must engage in all the activities of modern civic life. In this way only will our profession be able to direct and mold the influences that make for better medical service for poor and rich alike. German physicians have learned this lesson and American physicians are learning it. It is to be regretted that this society is not repre

sented upon our Commerce Club Directory. It is my belief that the best interests of the profession and of the community require such representation year after year.

In order to practice however, and perform these scientific and social functions doctors must live. How to get that living has been the problem of the ages. In days of old, the honorarium was the established custom. In "Journeys in Diverse Places," Ambrose Pare states that he treated M. le. Marquis d. Auret who suffered from a gunshot wound near the knee with fracture of the bone, and that after his patient's recov ery, he made me a handsome present of great value and sent me back with the steward and two pages to my house in Paris." After the honorarium came the system now in vogue by which varying charges are made according to the professional service rendered. These systems have been the natural outgrowth of individualistic practice. But times change and we change with them and now that the practice of medicine has become a social function the state will become the paymaster of the doctor more and more and the individual less and less. In the Journal of the American Medical Association of November 23d, last, under the title "Socializing the British Medical Profession" the following edi torial comments are made in speaking of the so-called Insurance Act: "If we are not mistaken this law marks the beginning of the end of the old system of the individual practice of medicine and of the old relationship between patient and physician, the beginning of a new era, both for society and for physicians. It provides for noth. ing less than an assumption on the part of the government of the responsibility of providing proper medical care for citizens who are financially unable to secure it for themselves." These are startling statements and mean nothing more than an economic revolution for the medical profession. It is a true saying that "the practice of medicine is the noblest of professions and the meanest of trades." There can be no question that the fee system has had a commercializing effect upon the profession, a tendency to make it a trade, to make it a mere means for obtaining a livelihood. But whether it comes from honorarium or fee or government salary, some way will be found to provide a living for the true physician. But it will be a living wage and not a fortune. The practice of medicine is not a vocation suitable for the accumulation of a fortune. It is improper to enter it with this end in view. The rewards are a competency only, the respect of the com

munity and the opportunity for service to humanity.

According to the emphasis which every doctor places upon the scientific, social or commercial aspect of practice he measures up to or falls short of the ideal physician. The first and fundamental necessity for a medical center, is a group of physicians thoroughly imbued with the scientific and social spirit, men who love the work for its own sake and recognize the social responsibility it entails and with whom the commercial equation is subordinate to the other two.

The subdivision of the profession into specialties is a natural and inevitable consequence of the advance in scientific and medical knowledge. It is to be regretted that St. Joseph physicians have not specialized more. To become an efficient organized body capable of good team work this will be necessary and unless it is done we cannot hope to maintain in the future, our status as a medical center. The idea of specialism as the highest type of medical efficiency has very properly become rooted in the mind of the public, and if St. Joseph does not meet this demand for specially trained physicians, the public will go elsewhere to satisfy it. The legitimate specialties are not very numerous and are well represented by the sections of the American Medical Association. I may mention internal medicine, diseases of children, tuberculosis, nervous and mental diseases, general surgery, gynecology with abdominal surgery, obstetrics, orthopedic

surgery,

genito-urinary surgery, rectal surgery. These specialties could be successfully practiced in St. Joseph. I do not think it necessary to mention diseases of the eye, ear, nose and throat, for these specialties are now well established here. But the subdivision of professional work could now be easily made along the lines of the specialties mentioned, with every possible advantage to both doctor and public. It is rapidly becoming easier to build up a practice as a specialist than as a general practitioner, and when once accomplished the service rendered by the physician is more efficient and the remuneration better. subdivision of practice has a good effect upon the profession itself as it makes it possible for cooperation between physicians where formerly existed competition. this way is secured a profession working together instead of at cross purposes, efficient team work, resulting in good for all. Today the practice of medicine consists of cooperation between the various departments of a highly organized profession,

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each department thereof dependent in some wise upon every other department, if the highest results are attained in the application of human knowledge to the relief of human suffering. Whatever local conditions existed in the past to prevent this subdivision have now been dispelled, and a failure to conform to this essential requirement for efficient medical organization will prove suicidal. This principle must be recognized and acted upon by our profession for St. Joseph cannot hope to maintain in the future her standing as a medical center if the profession remains a group of general practitioners only.

Among the agencies of organized medical service that go to make a medical center none stand higher than the clinical and research laboratory.

It is

The debt that medicine owes to general science is tremendous. Before the revival of knowledge on a scientific basis, medicine was little better than a mass of empiricism, dogmatism and mysticism. Progress under such conditions was hopeless and finally came from the outside and not from the inside. It was by the application of the scientific method of experimental research that our profession was placed upon a scientific basis. We should never forget this, for it is only by the continuation of this method that we can hope to progress still further. Unless we use the scientific facts now known to be useful in the prevention and relief of disease we are still unscientific physicians, practicing empiricism. through the medical laboratory that these facts are now made avialable for us in the daily practice of medicine. daily practice of medicine. I am sure that there can be no argument over the statement that our laboratory facilities in St. Joseph are inadequate. The medical profession itself may be ideal, the hospital facilities may be all that is desired and yet our practice still remain unscientific and incomplete without the facilities afforded by a medical laboratory. This is a fundamental necessity, upon which the whole superstructure of scientific practice is built, it matters not whether that practice is in hospital, in home, in city, in town, in country. It is to the credit of this society that it has recognized this fact and appointed a standing Medical Laboratory Committee to promote the enterprise in St. Joseph. Without adequate medical laboratory facilities St. Joseph can never hope to become a medical center. It is the most essential of all the agencies required. One million people are looking to the medical profession of St. Joseph and its tributary country to give to them all the aid known

to medical science. By way of encouragement we should remember that the financing of medical laboratories is much easier of accomplishment than of hospitals. The initial cost is not nearly so great and the administration is simpler and less complicated. A small per cent only of the total investment need be tied up in buildings and equipment. By far the larger part may become endowment, and thus be constantly making the benefits of the laboratory available for the sick.

The two general hospitals now existing, one protestant, one catholic, fully occupy the field of general hospital work and it would seem that the addition of another general hospital working in the same field is not at this time needed. It would act as competitor to those now here and by dividing the work into small portions, weaken the existing institutions. The present in stitutions are general not special hospitals, and should be strengthened in every possible manner, by endowment, by donation, by church support, by professional support, by support of the business men and by the moral support of the entire city. In the building up of a hospital system for any community the general hospital comes first. In this direction our need is to strengthen what we have, rather than to multiply their number. It would seem that St. Joseph protestanism should learn from the mistakes of other communities that is better to concentrate its forces upon one general hospital, and to make it capable of doing the work intended, rather than to create several general hospitals, each one a denominational institution, inadequately equipped, endowed and supported, and therefore incapable of doing the intended work efficiently. These statements apply to general hospitals only and not to special hospitals.

In the field of Special Hospitals there is opportunity for the utilization of all the forces and finances that are likely to be available in the years that are to come. Here there need be no over-lapping but each hospital may be made to fill a useful place in the general hospital scheme of organization.

Our greatest need in medical specialism is that of emphasizing the importance of internal medicine. Internal medicine is the mother, and therefore the greatest of all the specialties. Where it is neglected well balanced well rounded service is impossible. In St. Joseph we have been running toward surgery and internal medicine has rather been pushed into the back-ground. It should be placed in its

position of first importance. We need practitioners who are internists only, who do no surgery at all. We need a special hospital for internal medicine only, or our general hospitals should increase their usefullness by dividing the service into a medical and surgical side, with a medical pavilion separate from the surgical pavilion. The practice of medicine as distinguished from surgery needs to be emphasized in this way. We must get down to this basic principle of medical organization and provide adequate facilities for the development of internal medicine. It is the keystone in the arch of practice that holds together all departments in a completed whole.

Obstetrics is another slighted branch of practice among us. It is certainly a gratifying sign of the times that our presidentelect has established a private maternity hospital and is devoting himself to that branch of practice. He will have the honor of being the first practitioner of our city to establish obstetrics as a distinct specialty in our midst. But this is in the field of private endeavor only. There is need of an endowed public maternity hospital, for those who cannot pay, for those who can pay moderate compensation, for those who can pay a full compensation. Obstet. rics is a surgical specialty and no branch of surgery can be practiced in the home as well as in a hospital equipped for surgical work. Ideally it should not be done in connection with other surgical work of a septic nature such as is necessarily found in general hospitals. Ideally it should not be done in association with hospitals for men for reasons of delicacy and modesty. These reasons are all-powerful, and point the way to the Obstetric Hospital as a separate and special hospital.

These same reasons account for the present day disposition on the part of any community to avail itself of the facilities of obstetric hospitals wherever established. The day is not far distant when every woman, who has the choice, will prefer the obstetric hospital for the place of her confinement. Humanity owes it to her that at such a time she should have the best aid that science can give. Our profession renders no service more sacred than that of attendance upon the birth of the generations of humanity. The influence of such a hospital could be made to reach the homes of the lowliest by the establishment of an out-door department with visiting nurses. What a benediction such a work would be to every child-bearing woman in this community.

A Children's Hospital would fill an unoccupied place, as our medical service is at