MEDICAL MERCHANDISING OR REDEMPTION, WHICH ?

Twenty-five years ago a few men in the average inland city did all the major surgery, everybody did general practice and the few specialists had practically all their work referred to them by the surgeon and practitioner. In the smaller towns only emergency surgery was done and all major surgery and much of the more serious internal medicine cases went to the city, or the city surgeon and internist went to the case in the smaller town. This was done with the clear, clean, ethical intent of giving the siek the best professional service that could be had. Professional bickerings and green-eyed monsters were not conspicuous. It was more a question of the man being big enough professionally to do the work and receive the meritorious respect of the profession in general. When the patient recovered and returned home the internist or surgeon had made friends in the small town and the family physician had further cemented the relation of reverence then existing between him and his lifelong patrons. The respect and esteem for the medical man was not only sentimentally beautiful, but it stamped him as a man of affairs, to be looked to, in every community.

In the meantime evolutional changes were brewing commercially, politically and among the isms. The people moved up a pace in the dollar race and fellow reverence began drifting down tide. Descriptive adjectives grew in number as the sale letters blushed red with intrinsic hypertrophy. The greater the negative trade value the greater the verbage to ripen the victory of the psychological moment. Per force of the commercial trend the doctor was caught along shore in the eddy of drifting humanized merchandise-that's all he had, human merchandise. All ties of human sentiment and loving adoration for the old doctor had inadvertently floated to the mid stream ridge of high tide. It was sink or swim with the mercantile tide. Thus the medical profession today stands conspicuous in many communities, whole states, as a dealer in human merchandise with the country doctor as a retail merchant, selling to the highest bidder in the cities or to those in country towns where small hospitals have been built for human warehouses and renovating purposes. It's not exacting expert surgical qualifications but what will you pay me for my patient?

From the County, District and State association to the National association, reform lamentations have gone up (emphasis

on UP) and then the lamentors returned home and continue doing business! No one knows how they get the business, of course. No doubt many are sincere, many want to be sincere and also the others, jolly good fellows, who believe in "charity beginning at home," in "laws of self-preservation, in that "possession is nine points in law," "in doing the other fellow before he does you," in that a bird in hand," et cetera, looks like bread and butter in the dollar race of the American people in every livable vocation. How the race started in the unlivable vocation of medicine no one semes to exactly know. Probably some of our leading men could tell. Its safe to say that the local physician did not start it, but when it was started his business sagacity vied with the ambitions of the higher ups who were in the position of having a wild cat by the tail without knowing how to let loose gracefully, preserving the exterior and the business.

In viewing the medical map this merchandising seems to form geographical nidAs a shopping exhibit Kansas City was a thing of beauty till she cleaned some house.

uses.

Her back yard is still unsanitary and the front lawn needs a few high places resodded; but, Mother Jackson County is still on the job. St. Joseph and St. Louis have done some saintly work among their unsaintly brothers. Excepting some areas of functional murmurs, and here and there a little Arythimia, Missouri's heart is in the right place. But Kansas, poor Kansas! For fifteen years she has been gradually but persistently Topeka ized along home rule capitalized inducements. Her stock sale dinners were appetizing in the ex. treme, excepting to those from the effete East for whose ambitious temperatures was prescribed cold grasps, frigid stares and smooth but icy converse. Thus a great and prosperous mutual home rule plant. grew till our own Murphy spoke out in meeting and said he saw a common, insidious and deadly parasite in commission paying and the sale and purchase of patients." He referred to "bartering to the highest bidder," to "traffickers in human lives," to the morally guilty "money changers," to the ostracism of the "pseudo-ethical" as unfit members, to a "membership as a certificate of manhood" and to the principles "of the Golden Rule, the basis of ethics of the medical profession." But as yet the echo of Murphy's voice is only heard in the far distance-out in Kansas. Today Topeka is not Topekaizing everything surgical-out in Kansas. All over the State there are others doing it in towns great

66

and towns small-out in Kansas. There are hospitals that are dreams, nightmares and air castles-out in Kansas. Forty acres grows more surgery to the square foot today than was ever known-out in Kansas. The local hospital to survive must bid in its own else it goes to Topeka -out in Kansas.

Resolution.-Resolved, that the Sedgwick County Medical Society condemns division of fees and that no physician's application for membership be considered who is known to encourage fee division, and that present members who practice or encourage fee division discontinue this practice or resign. This was adopted May 27th, showing this finest bunch of fellows, ever, are thinking-out in Kansas.

The Wichita Beacon of June 4th says: "The Wichita doctors backed up last night. Those who believe in commissions renewed the fight. They were able to wipe from the records of the Sedgwick County Medical Society the former action," showing this still splendid and able bunch of fellows are simply victims of insidiously growing circumstances, demanding defensive action and self-preservation now-out in Kansas.

But this so-called merchandizing will cease. Every one of Wichita's able men will welcome it just as soon as they have the assurance of professional unity over the state. Their single, radical action would so divert their patronage now as to seriously hamper their splendid hospitals. They need concerted action and will eventually get it. This great evil so long developing cannot be wiped out at a single meeting. In time they will, for the good of the cause, get together on "the principles of the Golden Rule, the basis of ethics of the medical profession"-out in Kansas-by legislation, as other states are doing, if there is no other way. Its just a question of time, of working for the right, and praying without ceasing. S.G.B.

Meeting at Savannah.

The St. Joseph-Buchanan-Andrew Co. Medical Society held a meeting and social

T

ssesion at Savannah, Mo., on the evening of May 21. Addresses were made by the mayor and superintendent of schools. Reports on the State meeting were read by Drs. A. L. Gray, W. T. Elam, L. A. Todd and C. R. Woodson. After adjournment an excellent lunch was served, and the members were entertained by some good vocal music.

Damaged Goods.

We are informed that under the auspices of the Sociological Fund of the Medical Review of Reviews, the drama, "Damaged Goods," will be sent en route next season. This had a successful run of several weeks' duration in New York City, where it was witnessed by thousands of people, medical as well as non-medical, and undoubtedly was a strong educational factor in the campaign of sexual education and physiology now being extensively carried on in numerous channels. This medical preachment, for it is strictly speaking not a dramatic production, no doubt will be welcomed by the medical profession when it is produced in Kansas City. It is scheduled to appear here this fall, with the original New York cast of all stars.

The Doctor's Vacation.

The Vanderbilt Hotel, New York City, offers high class service at reasonable rates. The coolest location in New York.

Doctors frequently need a rest during the summer months, why not try a week at Colfax Springs, Iowa. This pretty resort is but 23 miles from Des Moines; has a first-class hotel, with an excellent bath department and mineral waters that cannot be excelled. One visit, doctor, and you'll become a booster" for Colfax.

Doctor, when taking your vacation trip East or North, be sure to include the Thousand Islands in your itinerary. No more beautiful scenery in the world, and a grand boat trip. The Thousand Island House at Alexandria Bay, has a long record of giving satisfaction to its guests. Make your reservations now and avoid disappointment.

The sixty-fourth annual session of the A.M.A. has passed into history, and Minneapolis has achieved the enviable record of entertaining this magnificent body in a manner never surpassed and but seldom ever equalled. The Arrangement Committee, headed by Dr. Frank C. Todd, and his able corps, performed its duties perfectly, leaving nothing to be desired. The group of buildings comprising the great Minne sota State University were utilized to good advantage as the section meeting places, while the Armory Hall served as an ideal exhibit hall and registration bureau. novel feature was the serving of complimentary lunches at various points on the Campus, so that a return to the city during the day was unnecessary.

A

At the opening session Dr. Geo. Edgar Vincent, dean of the State University, made an excellent address. He said that in discharging the pleasant duty of welcoming the American Medical Association he would omit the rhapsodical platitudes characteristic of such occasions, merely assuring the association of the depth of respect and goodwill in which Minneapolis had come to regard the medical profession, largely through the broad-minded efforts of its own physicians to raise the standard of public health and happiness in their community.

He commented on the unity of all science, saying that every section of the association now meeting in the city, every worker in science at human bedsides and in the laboratories of nature and man, were in reality, one in purpose and effort-the discovery of truth for the enlightenment of humanity

and the relief of human conditions.

Mayor Wallace G. Nye extended the hospitality of the city. "Minneapolis wants you to believe that her joy in your coming is unselfish, although she realizes that in spite of the resolution recently passed by your executive body you will be obliged to 'split' some of your hard earned fees with her. And if any of you, unable to tear yourselves away from her charms, become permanent members of our community, she will bid you welcome to her happy family, though with the warning that she will not

decrease her efforts to lessen the demand for members of your noble profession."

Following the mayor the association was given a welcome on behalf of the State through the medium of Governor Eberhart, who told the association that he was pleased to be able to report that the same recent legislature had enacted the best laws, in his opinion, for the protection of public health that could be possibly devised.

Dr. Abraham Jacobi, retiring president, spoke next. "Before vacating my office I have wanted opportunity to express one thought uppermost in my mind, the secretaryship should be made a permanent office. After enjoying the honorable office of president, I say goodby, but only to go back to work in the ranks.

He then introduced Dr. John A. Witherspoon, of Louisville, president-elect. The two men clasped hands amid the applause and cheers of the convention. Venerable and white-haired, retiring President Jacobi sat, and incoming President Witherspoon, with a graceful bow to Dr. Jacobi, paid an eloquent tribute to the elder man. Every man and woman in the Auditorium rose, and handkerchiefs came out of pockets and

hats were waved in air and for several minutes it was a scene like that in a great political convention at the nominating moment.

Dr. Witherspoon dwelt at some length on the successful efforts of the medical profession during the past few years to put the science, art and practice of medicine upon a higher plane than ever. The central theme of his address was the determination of the association to carry to a successful issue its object, so long known to those who have followed its workings, to establish a National board of health looking to the welfare of the nation by co-operation with the state boards of health, through which every state in the Union offers a silent reproach to the mother country of them all.

"The American Medical Association will never rest," said Dr. Witherspoon, "until there sits, side by side with the secretaries of war, agriculture, treasury and other great national departments, in the cabinet of the president, a secretary of health for the United States of America."

SIDE LIGHTS.

Dr. M. M. Carrick, of Dallas, Texas, proclaims Minneapolis as the cleanest city in the United States, and he has travelled "some."

Of course the "natives" told us that the hot weather encountered at Minneapolis was "unusual!"

Most of the Kansas City and St. Joseph men were quartered at the "West," and were much pleased with the service at this splendid hostelry.

Everything in Minneapolis was reasonable, even the taxicab rates were reduced for the visitors. A good pointer for future arrangement committees.

The Chicago Great Western special was a success-with exception of the dining-car service, which in some way became "shortcircuited" and our car missed its supplies. Three case of "White Rock" generously donated by the Water Co. for the "Southwest Special" was the means of making endurable an otherwise hot afternoon.

Mr. Chas T. Hummer, city passenger agent of the C. G. W. R. R. at St. Joseph, was in charge of the Southwest Special" and made his presence felt by many courtesies to the passengers.

We are much gratified to note the election of Dr. Oscar Dowling, of Shreeveport, La., on the A.M.A. Board of Trustees. Dr. Dowling is the chief health officer of Louisiana, and has been doing great work with his health and clean-up crusade.

The newspapers are to be commended for their excellent reports and illustrations, especially the Minneapolis Tribune. This enterprising publication made a made a "tenstrike" by employing local doctors to report for it each day the papers read in each section.

Surgeon-Gen. Blue, U.S. Health Service, said: "A National home for lepers is a necessity." Dr. Blue presented figures showing that leprosy was continuing to spread. He emphasized the importance of humane segregation and of immediate notification when a case of leprosy was discovered.

Too much praise cannot be accorded the profession of Minneapolis for the generous hospitality extended to visitors. Were we to expatiate upon the charms of this city, its splendid men and beautiful women, its magnificent parks and neighboring lakes, even to the extent of one-tenth of our personal appreciation, the space required to print the encomiums would far exceed the

limitations of this magazine, and while the members were busy discussing the excellent program in the sections, the ladies were entertained as they never were before.

Miss Julia C. Lathrop, chief of the children's bureau, Washington, D.C., speaking for the section on diseases of children, explained the work of the bureau. She said that it was a bureau for investigation and report. She described its field as being that of "all matters pertaining to the welfare of children and child life."

Dr. W. D. Haggard, Nashville, Tenn., said: "The first great requirement of the surgeon is his conscience. It should be his constant mentor and the great arbiter of those momentous decisions which come

daily to those who combat disease and death and whose efforts are so far-reaching in the preservation of life and in the science of humanity."

"Mothers, nurse your babies," was the plea of Dr. Abraham Jacobi, retiring president of the American Medical Association, speaking in the Hennepin M. E. Church on "The Care of the Newly Born." Dr. Jacobi made a strong plea for more schools for midwives in this country, saying that he believed money spent in their more thorough instruction would be productive of immediate good results.

Full knowledge of the gynecology of the contracting parties as a prerequisite to entering the married state, and not merely health certificates, will be required when the teachings of eugenics are understood and observed rightly, in the opinion of Dr. W. C. Rucker, assistant surgeon-general in the United States Public Health Service, who spoke from the pulpit of St. Mark's Church on "The Church as a Health Organization."

At the close of the session the council on health and public instruction recommended: That the president call a White House conference on public health in the fall. The creation of a national department of health.

Organization of a national board of medical examiners.

Sending by President Wilson a special messaage to congress on the public health. Making trachoma a reportable disease in all states.

Giving wide publicity to all public health and preventive medical work.

Dr. Harriett Putman, Providence, R .I., brought out these points in her lecture: Infant mortality measures the health, intel