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of hygiene and sanitation but efficient day needs and interests of the people were medical, moral and religious adequate allowed to go more or less by default and means and measures for the treatment and were taken over wholly or in part by public, prevention of all forms of social, physical, private and secular agencies, though there mental and moral distress and suffering. are of course numerous hospitals and
If the function of modern scientific medic schools managed and controlled today by cine aims through its various agencies to various religious orders, yet they are few contribute toward the great righteous cause when compared with their great and growof uplifting humanity and the social better- ing need. ment of mankind by introducing a more Deprived, however, to a large extent of perfect system of hygiene and sanitation its control of education of charity of medias well as improved medical and surgical cine and of government, the church today methods for the treatment and prevention represents according to high ecclesiastical of disease, then certainly we as medical authority, a nearly disembodied soul. men are called upon to study the relation Everyone recognizes the present plight which the modern practice of medicine sus- of the modern church in its helplesstains to such a desirable and worthy public ness to control the results of sin, in the enterprise. Indeed, it is this larger public form of disease and suffering, and it has preventive social aspect of medical practice. even been accused of having lost its actual which constitutes my theme and what may heart and soul. The same truth, however, justly be termed “The Newer Mission of. would seem to apply at least to some extent the Doctor and Hospital."
to prevailing methods in the practice of It is to certain religious, educational, hu- medicine, as we shall see later, for it is an manitarian and scientific features of this open question today by leading medical men newer misison of the doctor which I desire whether the modern practice of medicine is to emphasize in the hope that it may not not deprived of its heart and soul. Every only correct former erroneous inference but physician familiar with the facts understimulate us all to do our part in the stand that no sooner was medicine divorced larger medical redemption of mankind. from its original religious control and intent
and deprived of its christian auspices, than RELIGIOUS ORIGIN OF MEDICINE.
it began to swing rapidly to the opposite exNow in tracing the early history of medic treme from the spiritual to the material. cine one is at once impressed with its ac
MEDICAL MATERIALISM. tual religious origin and purpose. Indeed, its early practice was largely confined to Hence the teaching in the medical schools the priests in their use and observance of became radically materialistic and secular certain sacred rites and religious cere- as well as markedly theoretical and specumonies. Moreover, the early church func- lative. tionaries took sole charge of the social, So universally popular, however, and pereducational, medical and religious needs of sistent was this so-called scientific method the people so that ancient medicine became of study pursued, that until quite a recent correlated as it were with religion itself. period the teaching in our medical schools More especially in connection with the sick and colleges has tended toward an ultra and afflicted did the early church extend its materialistic conception of man and his disspecial humane benefits and even as late as eases. This was also emphasized by the the middle ages hospitals were built in con- misleading use of the term scientific which nection with monasteries for the sole pur- led the former medical student to believe poses of not only receiving and treating the that the minute histology of the cell, the sick and suffering, but where the orphan, microscopic structure of the microbe, and the indigent and dependents of all kinds the material physical pathological process received not only medical care but food, were more essential in diagnosis than the shelter and religious protection.
practical knowledge gained by a thorough Hence, as Dr.Cabot, of Boston, says: “It clinical study of the personal constitution, is not many years ago when the soul of the habits and reaction of the individual to church, its intelligence, its energy and its certain environmental conditions and circreative genius were incarnate in the man- cumstances as expressed in thought, speech aging of schools and colleges, in the heal. and conduct, all of which cannot be fully ing of the sick, in the care of the poor and solved in the pathological or bacteriological in municipal government.'
laboratory or even explained in materalistic Gradually, however, one after another of terms. these religious activities which once kept More especially is this true in that departthe church in close touch with the every ment of medicine which explains the phenomena of mind and mental action or medi- and even morals, and is often responsical psychology and its abnormalities, and ble for lack of appropriate sympathy and which today occupies a most important harsh methods of treatment to the more growing place in practical clinical medicine. unfortunate sick poor in hospitals and dis
Consequently, when the former medical pensaries. Its pernicious hereditary influpractitioner came in contact with the more ence is also expressed in the attitude ascommon nervous affections, and especially sumed by the medical profession as a whole the so-called functional abnormal psycho- toward their clientele, for the sick are no logical processes known today as the psy- longer regarded from their humanitarian choneuroses, or those in which the material standpoint as patients or human beings, physical cause could not be actually demon- but as good
good cases, interesting cases, strated, medical men formerly refused to hard cases and bad cases. Hence their accept the reality of their existence, believ- examination is often conducted with as ing them to be purely imaginary ailments, much personal unconcern and apathy as and therefore gave little attention to their a chemist searches for the unknown in his actual clinical study, much less their appro- test tubes. priate treatment. The continued and per- This is however not always the sign of sistent careless indifference, however, on the disrespect or an intentional slight on the part of the medical profession to recognize part of the doctor, but is largely the result the purely psychic origin of many such of an enforced educational weakness transmorbid conditions, or take cognizance of mitted or acquired by common consent or the potency of mind, both in favoring the custom. production as well as the relief of such ab- Granting that
that the doctor may have normal mental states, undoubtedly gave emancipated himself from such bondage, birth to the origin, rise and popularity of and that in his dealing with the sick and so-called Christian Science, the Emmanuel suffering he is kind, just, conscientious movement and other modern bastard forms and considerate, as many of them are, with of medical practice.
his heart wide open to human distress in Every physician, however, of experience every form, yet he finds today that his today, recognizes that owing to the in- practice is usually so varied, uncertain and creased complexity, strenuosity and excesses incongruous, besides subject to so much incident to modern life the higher centers public criticism and severe commercial and of the nervous system reacts in such a man- often unscrupulous, irregular competition ner as to render many persons abnormally that he, like his friend, the modern business susceptible and vulnerable to various func- man,soon forgets his larger public duties to tional and even organic ailments, both mankind, or a vowed love for his profession, imaginary and real, which may be of primal and therefore becomes absorbed (possibly psychogenetic origin, and which often of necessity) in his own individual financial affect the visceral and other organs of the private affairs, and recognizes that he too body in a very serious manner.
must also make a living. So great, howIt is conservatively estimated that no less ever, are the multitudes of sufferers who than 65 per cent of the ailments which crowd the dispensaries, hospitals and misaffect the American people today are func- sions of our larger cities today as well as tional morbid nervous conditions, in which our offices, that little heed can be given to the primary factors are mental and moral, anything but the outward symptoms or and in which psychotherapy has its special their more urgent objective medical needs. application and wins its greatest victories. Moreover, in order to economize time and
expense routine methods of treatment are MEDICAL SKEPTICISM AND MORAL UNCONCERN.
now carried on in our dispensaries and hosAnother unfortunate result of the former pitals by printed prescriptions and stereoso-called scientific medical materialistic typed directions which are hurriedly handed doctrine which interpreted all forms and out usually by an undergraduate or interne, modes of life as having a purely physical and little opportunity is given to get even origin and purpose, gave birth to almost a glimpse into the actual life, surroundings universal skepticism among the members and circumstances of many of the unforof the medical profession so that atheism tunates who apply for treatment. and agnosticism as well as other forms of infidelity were formerly the commonly ac
FOREGROUNDS AND BACKGROUNDS OF DISEASE. cepted beliefs of medical men, and even A poor woman, for instance, with a matoday its pernicious effects are not entirely lignant tumor may therefore apply to the eradicated. When present it predisposes dispensary or hospital for treatment and be to careless methods of speech, conduct, told she ought to have it surgically removed
in a hospital, or she may be suffering from 'ways. First, by determining the root, tuberculosis and told that her case requires cause or pathogenic foci of diseases; second, rigid isolation in a special hospital. Grant by checking it in its incipiency; third, by ing that she may be willing to take the keeping the more chronic invalids from treatment, yet she inquires what is to be- lapsing into discouragement; and fourth, come of my three children? or who will by being enabled to minister to the urgent take charge of my drunken husband while social necessities of the more deserving I am in the hospital?
through non-medical welfare agencies. UnThese are samples of what the busy med- fortunately, the health authorities of many ical practitioner meets in his office dispen- of our cities has so far failed to recognize sary and hospital practice and beautifully these and many other advantages accruing illustrate where and how the present medi- from a well equipped modern outdoor clinical machinery fails in its greatest good to cal and dispensary department, and, therehumanity.
fore, little provision is now made for the Hence the doctor is at present chiefly con- vast number of acute, and chronic as well cerned with the foregrounds of such cases. as so-called walking cases of illness which But what about the backgrounds?
sadly need attention and which today This refers to their homes, their environ- are for the most part neglected. Morement; their social condition and circum- over, this great omission renders much stances; their heredity; their employment; of the splendid medical and surgical treattheir physical, mental and moral handicaps, ment already furnished by the hospital as well as their ignorance, poverty and ex- authorities of doubtful utility because cesses of all kinds. It is just here, how- of slovenly methods of after care and ever, where both the present medical system treatment due often to enforced hospital falls far short in its greatest usefuluess to crowding, and consequent lack of proper mankind, and where the great moral and care during convalescence, all of which has religious civic welfare forces fail in their led to inuch criticism, dissatisfaction and fullest service to the needs of the masses. public distrust of the medical profession by For the recognition and even treatment of their failing to meet the actual medical and the foregrounds of disease by operation and surgical demands of human suffering. medicine is not sufficient in itself to relieve In addition, the apparently extravagant or even excuse the greater public religious fees now charged for service by our private obligation of effectually administering to and even public general hospitals exclude the equally urgent social, economic, indus- large numbers of the more worthy ciitzens trial and moral backgrounds which under- from entering and receiving their superior lie the origin, spread and continuance of benefits. So serious is this phase of hospidisease.
tal practice become that the laity are now
seeking means of protection in the form of COMPULSORY OUTDOOR CLINICAL DEPARTMENTS
health and hospital insurance, which unA MODERN NECESSITY,
consciously favors the enforcement of mediWith the growing appreciation of pre- cal contract practice now so distasteful to ventive medicine and the emphasis being American practitioners, and which is now placed upon the importance of seeing per- so prevalent in Europe. sons in the incipiency of their disease, as As it exists today a public city dispensary well as their appropriate classification and is described as a vast machine for the treatsegregation, it would seem that a well ment of hastily observed symptoms in equipped outdoor clinical department or which little or no attempt is made to reach public dispensary service in connection or to cure the deep-seated sources of the with our larger general city hospitals under diseases, and which may lie far from anyable judicious business and medical control thing that the doctor can hear or feel or see, should be made compulsory.
beyond indeed his most sensitive therniomThere should also be attached to them in eter, his perfected microscope, his chemical a practical working manner all the com- and bacteriological tests or any other scienbined civic, religious and welfare agencies, tific mechanical medical appliance. It may and in this way our general hospitals could lie deep in the moral character; it may be made the most effective of all life-saving proceed from a deranged family life; it may and health-giving institutions.
even be religious, or it may be altogether When duly and efficiently organized in purely social in origin. this manner the hospitals and dispensaries could be made to hit the most serious,
THE NEED OF PRACTICAL MEDICAL ADJUSTMENT modern, medical and social preventive prob
TO MODERN NEEDS. lems at their most vital point in at least four In view of these facts the leading mem
bers of our profession are not only aware of THE FUNCTION OF A MODERN HOSPITAL. the faulty character of the dispensary and
The real function of a well equipped modhospital practice, but also realize that the
ern general hospital is, therefore, no longer present medical system is both inadequate considered by the leaders of our profession as and grossly deficient to meet modern prac
well as the more enlightened citizens as an tical demands. Hence they believe that exclusive medical monopoly or private con the entire practice of medicine needs readjusting, or at least moral socializing and
cern even when owned and controlled by pri
vate interests and which may or may not, even christianizing so that the dispensaries, have been built solely for convenience to hospitals and the general practice itself
subserve interests or even for purely commercan be made more effectively useful and
cial reasons. Neither because it bears a efficient by acquiring and resuming some of religious name or tagged by some philanthe sacred duties dropped when the church
thropy does it necessarily represent the or religion gave them over to private, great cause of medical science, justice or public and national secular agencies.
religion. These are fallacies which no It is therefore a part of the Newer Mis- longer bear the scrutiny of modern public sion of the Doctor and Hospital to bring medical investigation and must give way these highly desirable changes to pass so
to a higher state of efficiency, ethical order that the hospitals, dispensaries and even
and moral system of medical practice. medical practice itself can become better equipped for their greater medical, moral,
Moreover, the modern hospital must not social, human welfare public duties. be recognized as a great commercial plant
where only good paying cases are received Through popular forms of medical edu- and discharged, and where physicians, surcation the public are gradually learning geons, pathologists and specialists are most what the medical profession have known tempted to engage in envious bitter personal for some time, viz., that many diseases are
controversies, and haggle over petty differso many crimes to be laid at the door of
ences in diagnosis and methods of treatment the community, and that some one is to as well as the scientific aspects of certain blame.
kinds of operation. Also that the disease is not native with Fortunately the leaders of our profession the individual, but the result of a long are realizing the futility of all such petty series of causes which are related to the bickerings, as well as the absolute nonsense social, economic, industrial, moral, political of the envious jealousy and commercial avarand religious problems. Hence to cure one ice which attends much of such practice. all must be cured. Modern, scientific, pre. They also understand its practical, selfish, ventive medicine is thus found to be inti- unethical aspects, and contrary to public bemately bound up with all sorts of new soci- lief and popular opinion, are anxious to rid ological, political, ethical, economic and the hospital, dispensary and the general moral problems, and realizing this the lead- practice itself of such narrow-minded neers of our profession are awakening to the farious methods. fact that the former extreme materialism Those members of our profession who as well as our indifferent moral attitude to- have its best interest at heart, therefore, ward the larger medical needs of the gen- believe that independent of its strictly techeral public must of necessity give place to nical, scientific, medical and surgical demore correct and polite practical methods tail, the work of a modern efficient hospital of public co-operation. While undoubtedly should include a close study of the social the technical scientific aspects of medicine humanitarian side of disease and suffering, and surgery will always be the exclusive and more strict attention paid to the invesprovince in which the medical practitioner tigation of worthy and unworthy appliwill be expected to perform his greatest cants, including their social and moral service to mankind yet the larger practical status as well as other conditions which humanitarian and moral social welfare side underlie the pathogenesis, spread and conof the practice of medicine cannot afford to tinuance of disease. be entirely overlooked by the medical pro. Admitting that these are often found to fession. Realizing this the attitude of the be beyond the province of the science of profession is rapidly undergoing a remark- medicine to change or to even minister (for able change, not only in regard to the more the disease of poverty, of dependent chilpractical humane duties of dispensaries and dren, of unemployment, of ignorance, or outdoor clinical departments, but also in misfortune and similar social conditions, the larger practical welfare and social serv- are not included in the set studies of a ice work of general hospitals.
medical college curriculum), yet all un
biassed physicians admit that these have to society is not only that of a therapeua marked bearing as well, as close relation tist, but he is also a conservator of public to health as well as the cause and spread health. of disease.
Hence the time is at hand when we as a In order that such social pathogenic fac- profession must take upon ourselves the tors can be intelligently understood and fullest function of our mission and become dealt with humanely they require rigid public teachers of preventive medicine. medical, social, legal, political and religi- Of course I am aware that medical educaous expert investigation by competent au- tion of the masses is now a recognized functhorities and their appropriate treatment tion of the American Medical Association, duly prescribed and administered.
but so far this public duty here in Kansas The larger welfare work of a modern City has not received the favorable recoggeneral hospital and dispensary therefore nition and support by the profession it richincludes not only its purely scientific medi- ly deserves. cal and surgical work, but also the rigid Many reasons are assigned for this omisexpert investigation of the social patho- sion,chief of which perhaps is the fact that genesis of disease and suffering.
as a class physicians now render more graMoreover a modern general hospital is no tuitous service to the public than any other longer regarded as a dispenser of charity, class of citizens. My observation, howeven though the medical services are free ever, proves that much of this is often or shorn of all monetary consideration. grudingly and carelessly given, while many But its functions are now sufficiently en- claim its virtues undeservedly.
Moreover, larged to include a great and responsible the deplorable commercialism which prepublic charge and philanthropic duty by vades our profession is also a cause of such its protection of all the citizens from not neglect for that which creates no revenue only the menace of uncontrolled contagious and for which there is no pay other than and loathsome disease, but also the fearful that of gratitude from an unfortunate pubravages of epidemics. So considered this lic, explains many of the excuses offered in newer mission of the doctor and hospital be- the neglect and condemnation of public precomes a golden link in the great chain of ventive medicine. the larger humanitarian social service wel- For instance, a very common method of fare work now being inaugurated in the excuse advances the theory that medical larger towns and cities of America for the education of the masses is equivalent to sole purpose of making the lives of its citi- self-suicide, which of course to the mercenzens, and especially those of the under- ary doctor means a reduction in volume of world, worth living.
business and consequent loss of money. In view, however, of its responsible Others claim that the efforts put forth in nature and public exacting character the popular, medical education is absolutely medical staff as well as all other employees, harmful as it contributes to the self-dosing should receive fixed salaries for services habit. This means that instead of the rendered, which should be paid out of the public going to the doctor for their drugs city treasury, subject to the Board of Con- they will go to the druggist, and he will trol.
get the fee which legitimately belongs to In view of these radical newer changes the doctor. in the services of the doctor and hospital Still others assert that such gratuitous created by modern public demand and which public educational work on the part of the are admitted as necessary by the leaders of medical profession is not appreciated by our profession, the question at once arises, the general public, and consequently is How can they be made operative and effec- great loss of time as well as labor in vain. tive? The answer is: By educating the But the most misleading and subtle of all laity and even the medical profession of the excuses offered advances the idea that their absolute need and just ethical demand lecturing to the public on medical topics is for the greater benefit of mankind.
a more or less unethical practice, and is This can only be accomplished by a more indulged in only by those who desire notounited and magnanimous spirit and effort riety and free self-advertising, and thus use on the part of the medical profession as a this method of exploiting themselves and whole toward public, social, welfare medi- their own wares. cal service.
This erroneous pessimistic view, however,
has caused much unnecessary alarm and PHYSICIANS AS PUBLIC EDUCATORS.
decided opposition on the part of many In this connection too many forget that otherwise good intentioned physicians to the relation of the physician and surgeon this great public medical duty and hindered