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and not of charity. Preventive medicine dreams of a time when there shall be no unnecessary suffering and no premature deaths; when the welfare of the people shall be our highest concern; when humanity and mercy shall replace greed and selfishness; and it dreams that all these things will be accomplished through the wisdom of man. Preventive medicine. dreams of these things, not with the hope that we, individually, may participate in them, but with the joy that we may aid in their coming to those who shall live after us. When young men have visions the dreams of old men come true." P.I.L.

REMINISCENT FEE SPLITLETTES. The often repeated droplet eventually leaves its imprint. The repeated and persistent, sporadically or endemically localized public confession of an existing evil to be abandoned will expectantly be fruitful if the confessor is sincere in purpose, though his past may be retrospectively tinged. Acquired learning fortified and embellished by the benefits of past errors will bring out the best there is in a man; and an argument based on the conviction that past errors continued are unsafe and fatal to the future of the cause is a winning argument.

And so with the accumulative and almost endless verbiage and written criticisms hurled broadcast in the cause of fee-splitting repression. The efforts are insidiously ripening with reward. It is slow, perhaps, but it is coming though some predict it is here to stay, claiming men in high places, serving on important committees, drafting resolutions and laying fundamentals in the open for the evils abolition, while at home they are "sawing wood" and splitting fees with a vengeance under cover.

This may

be true in some instances but not universally. As in other reformations it may be necessary that some irreformables of this generation must pass with the frosts of time because they are mentally and characteristically mal-assimilants, so made by the inherent absence of the Medelian biologic germ-plasm, suggesting the application of eugenics in eventually improving our own medical family.

As opinion evidence we offer these "splitlettes:"

DR. A. L. BLESH, Oklahoma City (1): It had its origin in the time of Pean of Paris. The Medical Society of Paris was compelled to formulate a scale,

(1) President's address, Southwest Medical Association, October, 1912.

"It

considered just to all and quieted it for a time. exists everywhere, no matter how strenuously a locality may deny its existence. According to my observation those protesting most loudly are most guilty, if guilt it is. Moral mentors, standing so upright that they lean backwards, grinding out moral maxims by the bushel, will not tend to clear the situation."

DR. DAVID MYERS, Lawton, Okla. (2): It is evident that Bill Shakespeare had the fee-splitting evil in mind when he wrote, "Oh why rebuke you him that loves you so much." I know not whether other states are afflicted with the fee-splitting parasite but I can vouch for Oklahoma. We have it in a most virulent form. Like all parasitic life it thrives where there is the most filth.

DR. S. S. GLASSCOCK, Kansas City, Kans. (3): This is not a theory; it is a condition, one of the most serious that American physicians have had to deal with, and it is here to stay.

DR. JABEZ N. JACKSON, Kansas City, Mo. (3): This is not simply a matter of secret conversation among the physicians; the people are becoming conversant with the fee-splitting. We should arrive at some solution of the difficulty to preserve the integrity of the profession.

DR. J. F. BINNIE, Kansas City, Mo. (3): The family practitioner ought to receive a dignified fee for service, judgment and diagnosis. He attends Mr. Brown through typhoid, charging $2.00 to $3.00 per visit, making two or three visits daily; attends Mrs. Brown when pregnant and receives a good fee; attends the children through diphtheria and the measles, receiving a yearly "income from the family." Should he receive a big fee for referring a case in the family to a surgeon? He owes it to the confidence reposed in him to refer the case to the best surgeon that can be had!

That some quiet sawing wood" and knotty splitting still exists in some localities is evidenced by some correspondence submitted to the Herald in confidence. For instance:

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Topeka, Kans.

DR. X.

My dear Dr. X. Your letter received. I will not only be glad to serve you in your present case, but also in your future work. I have some delicacy in arranging a division of fees and prefer not to indulge in fee-splitting, therefore, I would suggest that you letting me know of your arrangements with them, fix the fee with your people, a fee they can afford, and you can pay me directly for my services. This would make our work mutual and satisfactory all round and no one could accuse me of giving you a fee, neither could you be accused of accepting a fee from me.

Be sure to call and see me when in the city.
Very truly yours,
Dr.

(2) Medical Herald, page 628, Vol. 31, 1912. (3) Medical Herald, page 632, Vol. 31, 1912.

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The Topeka correspondence is interesting. Dr. X's letter tells much, much that many would prefer to remain untold, yet it is the very evidence that better men are anxious to have made public for the betterment of an existing evil, which, some say, "will not down." The reply to Dr. X is The reply to Dr. X is a remarkable dodging of the question by putting the fee division in the hands of the family physician and placing the surgeon in the position of receiving a fee for the operation only, and having nothing to do with giving any actual fee. We are told this is fast being popularized and enables some to say they split no fees."

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The Kansas City correspondence is a direct confidence reposed and a direct refusal on the fee splitting basis, but with a final assurance that services rendered and time from business" will be cared for." How this is to be done is not revealed, but it is evident that the doctor will not face a split fee accusation, neither will he be sufficient ly unbusinesslike to lose the business. Thus the fee-splitting mysteries continue to entwine and re-entwine till the income tax intricacies assume a simplicity in compari

son.

Other letters from other locations in Kansas, Oklahoma and Missouri, including St. Louis, tell the story of a few direct refusals and many dodges and tumbles and somersaults, with some difficult, but usually safe adjustment in lighting.

(4) The Burning Question," by Dr. H. Gifford, and the discussion shows that Nebraska has finally reduced fee splitting to a legal as well as a medical supervision. The doctor's paper gives these suggestions in his summary:

1st. The passage of rules by state societies and state boards making fee-splitting punishable by expulsion and revocation of the license to practice.

2d. That such rules should specifically prohibit the transmission of funds on any

(4) Western Medical Review, page 552, November, 1913.

patient's account from one M.D. to another. 3d. That such rules should contain a clause making the use of efficient detective work mandatory on the president or some other officer or committee created for the purpose.

4th. That a committee with advisory powers should be appointed to consider and report on the commission evil in general and in particular to devise some practical scheme for the equalization of the fees of general practitioners and specialists, including the establishment of liberal consultation fees, and, where necessary, of traveling fees for the family doctor, in major special cases; and also, if it is thought desirable, an average surgeon's fee bill.

5th. That general practitioners should be urged to use, toward such equalization of fees, the power which they have of practically dictating to the specialist what fee shall be charged in case of patients in moderate or poor circumstance. More opinion "splitlettes:"

DR. MUNROE, Omaha: (4) Nine hundred and ninety-nine men of every one hundred are dominated by the instinct to get, to have, and to hold, and the motive that prompts the physician who wants a "rake off" is the same motive that prompts the one who stands up and fights fee splitting for all he is worth, after he is in the position to catch the plums that come from operations for gross pathological pro

cesses.

DR. MCCONAUGHY, York, Nebr.: Dr. Gifford's question may have been a "burning question," but I think the fire has been quenched by the legislature (of Nebraska).

DR. WELLS, West Point, Nebr.: This "burning question" has a compliment which I think is commendable; in the last year cases diagnosed by me and advice for treatment given, have gone to specialists and my only knowledge of their treatment was a notice in the newspaper of having had treatment or an operation, without my knowledge.

DR. HILDRETH, Lyons, Nebr.: The fact that it was necessary to pass a legislative act is a stigma on the profession. You can not legislate men into doing right if they are determined to do wrong. The men

taking the commissions are a little lower than men giving them.

DR. RYMAN, Benson, Nebr.: A lot of tom-fool lawyers get together to make some sort of a compromise to cover up things, just like they did this. I object to an effort to hunt up and sacrifice some individual who may be caught, an innocent practitioner, caught in some combination that would not look exactly straight under the guise of an examination and which would prejudice him unjustly.

DR. BUTLER, Harvard, Nebr.: I have letters from St. Louis, Kansas City and Des Moines saying: "Doctor, I will operate for the family physician, not for the patient."

DR. A. C. STOKES, Omaha: Detective work is not beneath the dignity of the U. S. Government; it should not be beneath the dignity of the state medical society. We should publish to the world that we are going to settle this question and settle it now. DR. LANGFELT, Omaha: If we have so many angels in this society, all disclaiming fee-splittings,

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DR. W. O. HENRY, Omaha: It seems to have originated in Chicago. Do the older men try in unfair ways to shut out competition and make it difficult or impossible for a young man to get a foothold?

DR. C. P. FALL, Beatrice, Nebr.: This thing was started by Omaha physicians, and they would like to stop it. They built their business in that manner and now feel that they can stand on their reputation by reason of their experience. They are now the active fellows in opposition to fee-splitting.

DR. SWENSON: I grant the speaker's statement that the Omaha physicians started this and that they now wish to abolish it, but I do not believe the reason given is true.

DR. MICK, Omaha: There is no harm in having the facts known. Insinuation has been cast at Omaha surgeons. In their defense I have seen no doctor who said the introducer of this bill ever split

a fee with him.

DR. E. J. CLARK: The very men who have pushed this thing through have offered to split fees with me. Some speakers say they don't do it, but I know they do do it.

DR. SUMMERS, Omaha: I take great pleasure and feel highly honored, now that this law has passed, in telling you that I am the author of it. I would like to see the man who would test its constitutionality. We have plenty of fee-splitting everywhere; they are here today, yesterday and the day before; we all know them. The punishment is ridiculous; $100 fine and the patient's right to recover the full amount of his fees; but the PUBLICITY! Who wants to defend himself in a suit of that kind? It is going to do a great deal of good.

Drop by drop the little drops' imprint is made on the stone. It looks like Nebraska

means business. Would Kansas, Missouri and Oklahoma-and Texas-like an introduction to Dr. Summers, a successful man,

who did not win success on the fee-splitting

route?

PSYCHOTHERAPY.

S.G.B.

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put into practice. Take one phase, psychotherapy, a very old subject dating back to the very dawn of civilization, and recognized every now and then by the great masters of medicine, coming into prominence frequently under some fanciful name, is simply the new discovery of a very old land of practice. In reality it is literally treating the mind as well as the body. It is recognizing the power of the brain over the organism and while giving physical remedies to change the organism it is applying psychical means to the brain to correct that and its disorders.

The Christian Science movement is the last great empirical attempt to show that the mind is superior to the body and to show how far it can be used to correct mental disorders. This is simply one extreme of practice, ignoring everything that is physical, the other extreme is materialistic practice so dominant everywhere, in which the organism is appealed to by drugs and physical measures alone, and the mind is neglected.

Osler said in a recent address, "There are fields of practice in every community and in every town in the country, open for the trained physician if he could only know what they are and how to make use of them." Preventive medicine is one of those fields. The physician who is able to educate his patrons to avoid disease has a far larger field of service than one who waits to have them sick before treating in the old beaten paths, regardless of the them. The colleges as usual, follow along changes and concerned in bacteriology and valuable, are often very impractical. other questions, that while very useful and

principles and practice of psychotherapy. Not a college in America teaches the

and to most medical men it is an unknown region, except a few progressive men who observe the signs of the times, and read the oncoming of the new era.

While surgery is doing magnificent work, already there are indications that its limits are in sight. Bacteriology is a little wider realm and greater researches are yet to come from that field. Electricity, radiography, phototherapy, radium and other new forces that are just coming up the horizon, all indicate a new and larger field, long before the century is past.

Psychotherapy is only a name for mental treatment, not the exclusion of any other measures, but in conjunction with them.

Outside of all theories, speculations and dreams, there is a great land of practice awaiting the capable physician; the physician above the average man of today, with

a larger, clearer insight, is the one who is wanted and will be welcomed and employed constantly, whether he is in a small village or in a crowded city. T.D.C.

WHO KNOWS?

According to Dr. J. Leon Williams of London, quoted authority on anthropology and geology, man as a racial being is at least a half million years old. Dr. Williams is said to possess fifteen skulls of prehistoric men. One of these, by some method unfamiliar to the average reader, is estimated to be 500,000 years old. Folkstone, England, is claimed to have turned up this primordial antique. This being true from an anthropologic and geologic viewpoint does it tend to affirm, deny, modify or reverse the teachings of evolution? A distinctive or differential claim is said to be that the teeth are those of man and not belonging to the anthropoid ape. This would seem to put the ape in bad so far as being the original papa of our present aristocracy, notwithstanding the almost indisputable evidence of inherited character traits as reflected in the varied shadings of our civilized activities.

And thereby seems to hang a tale or tail; did the ape lose a tail and become a man and smoke a pipe, or did man grow a tail and become an ape and quit his pipe? This is a long told tale that still seems to be mixed in the solution of the problem: Who lost or gained a tail? Or, was there an original tail in the beginning, to be lost in the end specie, man, and regained again in the cocoanut forests of Africa, making man the missing link between tails and perverting the tale of theory?

Dr. Williams is quoted as believing that this little cocoanut faced animalcule is our own long lost child and not our daddy.

Would this tale explain how two shakes of a tail made a palm tree forest give up its fruit? It would seem that the tale of historical theory must be rewritten to elucidate the tail of the age and all just because some fellow of 500,000 years ago unwittingly showed his teeth in Folkestone, England, recently. It would seem almost like a predestined fate that such a little thing could so upset the very foundation principle of Darwin's whole life's work, and so utterly route his theories as adopted by world thinkers and Mark Twain! S.G.B.

THE INTERNATIONAL PURITY CONGRESS The seventh annual meeting of this Congress, which occurred at Minneapolis from November 7th to the 12th, deserves notice.

Over eighty persons were registered on the programme to deliver addresses and papers. Nearly 2,000 delegates and visitors were registered.

Evidently the subject has become very prominent. The titles of the papers show the medical side is being recognized and attracting a great deal of attention. Reformers, teachers and clergymen are at present studying these subjects with great enthusiasm. Literally they are furnishing material for more exact studies in the future.

This is one of the subjects which the physician should take up, because he is most competent, by training and acquaintance, with the great principles of sex life, to speak with authority. There is a consciousness abroad everywhere that is growing with more intensity than ever that the diseases which grow out of sexual excesses are increasing, and should be suppressed and treated.

The whole subject is invested with so much theory, speculation and antique conclusions, that a long time must elapse before a correct public sentiment will call for the equal responsibility of both sexes. Men and women should be made accountable and punished alike. The fact that over 1,000,000 prostitutes are registered in this country brings, out the startling fact that at least 5,000,000 or 6,000,000 men are promoters and supporters of this terrible evil.

The time is coming when public sentiment will hold men responsible for this traffic the same as the women, and these great gatherings of enthusiastic men and women will help on that day, when the social evil will come under scientific recognition and be eliminated with the same certainty as typhoid or yellow fever is now. T.D.C.

The Injured Finger.

One of the most human, artistic and appealing pictures we have seen is "The Injured Finger," published by the Surgery Publishing Company of New York. This depicts a representative type of the present day physician treating an injured finger of a street urchin, while his two "pals" are intently and sympathetically watching the operation.

We are sure that you would prize, and your patients and friends would enjoy, this beautiful reproduction, which is so much more natural, more appealing and more human and so different from most of the familiar office and library pictures depicting gruesome scenes. A copy will be sent free to any physician.

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