in a hospital, or she may be suffering from tuberculosis and told that her case requires rigid isolation in a special hospital. Granting that she may be willing to take the treatment, yet she inquires what is to become of my three children? or who will take charge of my drunken husband while I am in the hospital?

These are samples of what the busy medical practitioner meets in his office dispensary and hospital practice and beautifully illustrate where and how the present medical machinery fails in its greatest good to humanity.

Hence the doctor is at present chiefly concerned with the foregrounds of such cases. But what about the backgrounds?

This refers to their homes, their environment; their social condition and circumstances; their heredity; their employment; their physical, mental and moral handicaps, as well as their ignorance, poverty and excesses of all kinds. It is just here, however, where both the present medical system falls far short in its greatest usefulness to mankind, and where the great moral and religious civic welfare forces fail in their fullest service to the needs of the masses. For the recognition and even treatment of the foregrounds of disease by operation and medicine is not sufficient in itself to relieve or even excuse the greater public religious obligation of effectually administering to the equally urgent social, economic, industrial and moral backgrounds which underlie the origin, spread and continuance of disease.

COMPULSORY OUTDOOR CLINICAL DEPARTMENTS A MODERN NECESSITY.

With the growing appreciation of preventive medicine and the emphasis being placed upon the importance of seeing persons in the incipiency of their disease, as well as their appropriate classification and segregation, it would seem that a well equipped outdoor clinical department or public dispensarv service in connection with our larger general city hospitals under able judicious business and medical control should be made compulsory.

There should also be attached to them in a practical working manner all the combined civic, religious and welfare agencies, and in this way our general hospitals could be made the most effective of all life-saving and health-giving institutions.

When duly and efficiently organized in this manner the hospitals and dispensaries could be made to hit the most serious, modern, medical and social preventive problems at their most vital point in at least four

'ways. First, by determining the root, cause or pathogenic foci of diseases; second, by checking it in its incipiency; third, by keeping the more chronic invalids from lapsing into discouragement; and fourth, by being enabled to minister to the urgent social necessities of the more deserving through non-medical welfare agencies. Unfortunately, the health authorities of many of our cities has so far failed to recognize. these and many other advantages accruing from a well equipped modern outdoor clinical and dispensary department, and, therefore, little provision is now made for the vast number of acute, and chronic as well as so-called walking cases of illness which sadly need attention and which today are for the most part neglected. Moreover, this great omission renders much of the splendid medical and surgical treatment already furnished by the hospital authorities of doubtful utility because of slovenly methods of after care and treatment due often to enforced hospital crowding, and consequent lack of proper care during convalescence, all of which has led to much criticism, dissatisfaction and public distrust of the medical profession by their failing to meet the actual medical and surgical demands of human suffering.

In addition, the apparently extravagant fees now charged for service by our private and even public general hospitals exclude large numbers of the more worthy ciitzens from entering and receiving their superior benefits. So serious is this phase of hospital practice become that the laity are now seeking means of protection in the form of health and hospital insurance, which unconsciously favors the enforcement of medical contract practice now so distasteful to American practitioners, and which is now so prevalent in Europe.

As it exists today a public city dispensary is described as a vast machine for the treatment of hastily observed symptoms in which little or no attempt is made to reach or to cure the deep-seated sources of the diseases, and which may lie far from anything that the doctor can hear or feel or see, beyond indeed his most sensitive thermometer, his perfected microscope, his chemical and bacteriological tests or any other scientific mechanical medical appliance. It may lie deep in the moral character; it may proceed from a deranged family life; it may even be religious, or it may be altogether purely social in origin.

THE NEED OF PRACTICAL MEDICAL ADJUSTMENT TO MODERN NEEDS.

In view of these facts the leading mem

bers of our profession are not only aware of the faulty character of the dispensary and hospital practice, but also realize that the present medical system is both inadequate and grossly deficient to meet modern practical demands. Hence they believe that the entire practice of medicine needs readjusting, or at least moral socializing and even christianizing so that the dispensaries, hospitals and the general practice itself can be made more effectively useful and efficient by acquiring and resuming some of the sacred duties dropped when the church or religion gave them over to private, public and national secular agencies.

It is therefore a part of the Newer Mission of the Doctor and Hospital to bring these highly desirable changes to pass so that the hospitals, dispensaries and even medical practice itself can become better equipped for their greater medical, moral, social, human welfare public duties.

Through popular forms of medical education the public are gradually learning what the medical profession have known for some time, viz., that many diseases are so many crimes to be laid at the door of the community, and that some one is to blame.

Also that the disease is not native with the individual, but the result of a long series of causes which are related to the social, economic, industrial, moral, political and religious problems. Hence to cure one all must be cured. Modern, scientific, preventive medicine is thus found to be intimately bound up with all sorts of new sociological, political, ethical, economic and moral problems, and realizing this the leaders of our profession are awakening to the fact that the former extreme materialism as well as our indifferent moral attitude toward the larger medical needs of the general public must of necessity give place to more correct and polite practical methods of public co-operation. While undoubtedly the technical scientific aspects of medicine and surgery will always be the exclusive province in which the medical practitioner will be expected to perform his greatest service to mankind yet the larger practical humanitarian and moral social welfare side of the practice of medicine cannot afford to be entirely overlooked by the medical pro. fession. Realizing this the attitude of the profession is rapidly undergoing a remarkable change, not only in regard to the more practical humane duties of dispensaries and outdoor clinical departments, but also in the larger practical welfare and social service work of general hospitals.

THE FUNCTION OF A MODERN HOSPITAL.

The real function of a well equipped modern general hospital is, therefore, no longer considered by the leaders of our profession as well as the more enlightened citizens as an exclusive medical monopoly or private concern even when owned and controlled by private interests and which may or may not, have been built solely for convenience to cial reasons. Neither because it bears a subserve interests or even for purely commerreligious name or tagged by some philanthropy does it necessarily represent the great cause of medical science, justice or religion. These are fallacies which no longer bear the scrutiny of modern public medical investigation and must give way to a higher state of efficiency, ethical order and moral system of medical practice.

Moreover, the modern hospital must not be recognized as a great commercial plant where only good paying cases are received and discharged, and where physicians, surgeons, pathologists and specialists are most tempted to engage in envious bitter personal controversies, and haggle over petty differences in diagnosis and methods of treatment as well as the scientific aspects of certain kinds of operation.

Fortunately the leaders of our profession are realizing the futility of all such petty bickerings, as well as the absolute nonsense of the envious jealousy and commercial avarice which attends much of such practice. They also understand its practical, selfish, unethical aspects, and contrary to public belief and popular opinion, are anxious to rid the hospital, dispensary and the general practice itself of such narrow-minded nefarious methods.

Those members of our profession who have its best interest at heart, therefore, believe that independent of its strictly technical, scientific, medical and surgical detail, the work of a modern efficient hospital should include a close study of the social humanitarian side of disease and suffering, and more strict attention paid to the investigation of worthy and unworthy applicants, including their social and moral status as well as other conditions which underlie the pathogenesis, spread and continuance of disease.

Admitting that these are often found to be beyond the province of the science of medicine to change or to even minister (for the disease of poverty, of dependent children, of unemployment, of ignorance, or misfortune and similar social conditions, are not included in the set studies of a medical college curriculum), yet all un

biassed physicians admit that these have a marked bearing as well, as close relation to health as well as the cause and spread of disease.

In order that such social pathogenic factors can be intelligently understood and dealt with humanely they require rigid medical, social, legal, political and religious expert investigation by competent authorities and their appropriate treatment duly prescribed and administered.

The larger welfare work of a modern general hospital and dispensary therefore includes not only its purely scientific medical and surgical work, but also the rigid expert investigation of the social pathogenesis of disease and suffering.

Moreover a modern general hospital is no longer regarded as a dispenser of charity, even though the medical services are free or shorn of all monetary consideration. But its functions are now sufficiently enlarged to include a great and responsible public charge and philanthropic duty by its protection of all the citizens from not only the menace of uncontrolled contagious and loathsome disease, but also the fearful ravages of epidemics. So considered this newer mission of the doctor and hospital becomes a golden link in the great chain of the larger humanitarian social service welfare work now being inaugurated in the larger towns and cities of America for the sole purpose of making the lives of its citizens, and especially those of the underworld, worth living.

In view, however, of its responsible nature and public exacting character the medical staff as well as all other employees, should receive fixed salaries for services rendered, which should be paid out of the city treasury, subject to the Board of Control.

In view of these radical newer changes in the services of the doctor and hospital created by modern public demand and which are admitted as necessary by the leaders of our profession, the question at once arises, How can they be made operative and effective? The answer is: By educating the laity and even the medical profession of their absolute need and just ethical demand for the greater benefit of mankind.

This can only be accomplished by a more united and magnanimous spirit and effort on the part of the medical profession as a whole toward public, social, welfare medical service.

PHYSICIANS AS PUBLIC EDUCATORS.

In this connection too many forget that the relation of the physician and surgeon

to society is not only that of a therapeutist, but he is also a conservator of public health.

Hence the time is at hand when we as a profession must take upon ourselves the fullest function of our mission and become public teachers of preventive medicine.

Of course I am aware that medical education of the masses is now a recognized function of the American Medical Association, but so far this public duty here in Kansas City has not received the favorable recognition and support by the profession it richly deserves.

Many reasons are assigned for this omission, chief of which perhaps is the fact that as a class physicians now render more gratuitous service to the public than any other class of citizens. My observation, however, proves. that much of this is often grudingly and carelessly given, while many claim its virtues undeservedly. Moreover, the deplorable commercialism which prevades our profession is also a cause of such neglect for that which creates no revenue and for which there is no pay other than that of gratitude from an unfortunate public, explains many of the excuses offered in the neglect and condemnation of public preventive medicine.

For instance, a very common method of excuse advances the theory that medical education of the masses is equivalent to self-suicide, which of course to the mercenary doctor means a reduction in volume of business and consequent loss of money. Others claim that the efforts put forth in popular, medical education is absolutely harmful as it contributes to the self-dosing habit. This means that instead of the public going to the doctor for their drugs they will go to the druggist, and he will get the fee which legitimately belongs to the doctor.

Still others assert that such gratuitous public educational work on the part of the medical profession is not appreciated by the general public, and consequently is great loss of time as well as labor in vain.

But the most misleading and subtle of all the excuses offered advances the idea that lecturing to the public on medical topics is a more or less unethical practice, and is indulged in only by those who desire notoriety and free self-advertising, and thus use this method of exploiting themselves and their own wares.

This erroneous pessimistic view, however, has caused much unnecessary alarm and decided opposition on the part of many otherwise good intentioned physicians to this great public medical duty and hindered.

them from engaging in its laudable practice. It has also given rise to a pernicious policy which is still quite prevalent in the medical profession and in its more aggravated form adopts for its slogan the words, "the public be damned," thus excluding the public from all consideration. Fortunately, these excuses are becoming less rampant in the profession, and it is now regarded as a sign of educational, moral weakness in a medical man when he offers such a plea.

To such extremes, however, has this offensive formula been carried in the past by some medical men that the public has not only protected but censured the medical profession in bitterest terms, and have finally resented the slur by not only turning the tables and damning us, but have almost entirely refused to take the medical profession into their fullest confidence as well as declined to recognize more just their ethical standards. Moreover they have legally, morally and socially put those who claim the name of doctor in the same class, believing that all doctors are "tarred with the same brush."

That the medical profession today feels keenly the low public esteem in which it is held beside the disgrace which many of our more unworthy so-called members have heaped upon it, is very clear. Hence our more enlightened and sagacious leaders believe the time is at hand when we as a profession should become more directly related to the general public by studying the larger social preventive medical necessities and ministering to them, not only in their more strictly medical, mechanical aspect, but in their larger, practical educational, scientific and humanitarian, preventive, social welfare relationship.

It is, therefore, one of the essential functions of the newer mission of the doctor and hospital to subserve this great educational cause by regaining, if possible, the lost public esteem and confidence and restore to the medical profession its former valued public prestige by getting into closer direct sympathetic educational touch with the people and entering more deeply into their larger preventive social medical needs and moral welfare interests.

THE NEED OF POPULARIZING SCIENTIFIC MEDICINE.

When preventive medicine is understood arightly, and practically applied, it will be found that primarily it relates to the studies of a medical college curriculum, such as anatomy, physiology, hygiene, sanitation, chemistry, bacteriology, psychology, heredity, eugenics and prophylaxis. More

over the pathogenesis of disease as well as its etiology, pathology, diagnosis and treatment are also closely allied. While all these in large part are purely medical technical studies fit only for the scientific physician and surgeon, yet their fundamental principles must be popularized and the contagious death-dealing character of vice, crime and other social evils must be laid bare to the public before any general, much less special, methods of their prevention will be instituted, and this educational task, I repeat, belongs largely to the medical profession.

As leaders and teachers of public morals and conservators of public health not only the doctor, but also the more intelligent layman must be taught the necessity of recognizing the true significance of heredity and eugenics as well as the need of appropriate legislation regarding marriage of the unfit, such as epileptics, consumptives, syphilitics, confirmed criminals, the feebleminded and the more acute and chronic insane, as well as many other defectives, including their appropriate classification surgical, sterilization and specialized forms of treatment and prevention.

In addition, modern social medical needs of mankind demand certain forms of segregation and rigid classification of the vari ous functional or borderland abnormal mental states known as the psychoneurosis, more especially those found to exist in our public schools and colleges, or roaming at large on the street of the city as well as the more pronounced types of insanity, all of which require improved methods of care, treatment and prevention.

The duty of disseminating this practical knowledge, more especially in its medical preventive aspects, of necessity belongs to the medical profession, and we are criminally culpable when we neglect to ignore such a public obligation.

THE NEED OF SUPPRESSING QUACKERY. Moreover, all forms of medical quackery under any cultism or pathy it may be known should be publicly condemned and the medical profession purged of its many disreputable members and fraudulent fakirs, while the general moral tone and ethical standards of the profession must of necessity be greatly elevated, enlarged and ennobled in order to meet the larger modern medical, social and moral welfare needs of the people.

In this connection we regret to note the favorable encouragement given at the present time to all kinds of medical charlantry by the general public, and even the

clergy, are not free from such vice, as evidenced by their ready willingness to furnish written public and private endorsements of known medical quacks and quack remedies, patent drugs and similar proprietary articles.

Also their constant encouragement of the divorce evil with all its consequent suffering by marrying the known unfit for the price of a fee, which is not only a shame and disgrace to themselves and their sacred calling, but a menace to society, which needs greater emphasis from the legal as well as medical profession, for it not only ignores moral and civil law, but also ecclesiastical as well as medical ethics.

Newly awakened to these various professional human aspects of disease and suffering the modern doctor fully realizes his inadequacy and failure of present methods to meet all such social, moral, legal and medical exigencies. While the existing medical system with its known faulty machinery of dispensary and hospital does not provide remedies for the relief of poverty, ignorance, unemployment, ill-assorted marriages, moral and legal defects and similar underlying pathogenic factors of disease and suffering, yet the modern, progressive doctor does not fail to see new spheres of medical usefulness to mankind in their correction and prevention. Hence, not only the entire practice of medicine, but the whole point of view of the medical profession is at the present time undergoing a remarkable evolution as well as revolution, which has for its keynote the greater medical and surgical efficiency through the instrumentality of a larger social, moral, public, preventive welfare service of both hospital and medical practice, which must of necessity be made sufficiently comprehensive and sagaciously benevolent in its several departments to subserve and relieve the varied ills of humanity.

PREVENTIVE MEDICINE THE GREATEST ASSET TO HEALTH AND HAPPINESS.

All medical authority agree that when the principles underlying the more advanced methods of scientific preventive medicine is duly and efficiently enforced it furnishes the most important asset toward fostering the maintenance of health, longevity and social and moral happiness.

Dull indeed, therefore, as well as sordid must be the medical practitioner as well as citizen who fails to discern, much less sanction, the sacred trend of these more exact, just and discriminating social, moral and medical reforms. Indeed the actual enlightened test of the modern medical prac

titioner depends upon his knowledge and application of these principles in his own practice, while the salubrious character and moral virtue of any city or community is also gauged by the same standard which becomes evident in their lower mortality rates, favorable vital statistics, and greater reduction of vice, crime and pauperism. As a result of these evolutionary medical social movements we therefore discover that the modern well-trained, competent physician and surgeon desires to become not only efficiently prepared in the more strictly technical details of his profession, but also well acquainted with the more practical features of the intricate social, moral, psychologic and even religious pathogenic causes of diseases and their pernicious effects upon the entire human economy, together with the special details of their absolute prevention.

His scientific medical practical knowledge is therefore applied to not only the objective physical clinical foregrounds of disease, but also the equally essential subjective, mental and social details associated with the backgrounds of his patient, thus regarding him as a whole, body, mind and soul.

In its largest therapeutic sense the Newer Mission of the Doctor and Hospital is therefore recognized today to be not so much one of saving persons from the bad effects of disease (this of course is necessary), but the greater medical service to mankind lies in protecting and preserving the health and life of the citizens by the removal and prevention of the ravages of all its known social, psychologic and pathogenic causes, and to this larger and more humane service the medical profession are already committed.

In order that this larger modern social medical welfare propaganda can be made to reach its highest state of efficiency the medical profession as a whole must of necessity become more practically and personally interested in its divine mission and purpose by taking upon themselves the fullest function of their sacred duty to mankind in the manner already outlined. In return for their larger gratuitous public sacrificial service, and work of love for humanity (which we admit is already burdensome to some of our members), the National, State and city governments and public officials, as well as citizens must be taught by us to respect our larger accredited professional rights in a manner heretofore unrecognized, and be more graciously willing in the future to guard and protect our medical, ethical and legal interests in such a way as will appeal