Dr. E. J. Emerick: This gentleman had probably half a head of hair when I began treating him. The trouble had been growing worse for sixteen years. I have been of the opinion that in his case the disease is of parasitic nature. The entire scalp was painted with chrysarobin ointment and rubbed in thoroughly for about ten days. The cases cured I regarded as parasitic. The gentleman injured in the wind storm-which case I regard as purely neurotic-was not benefited by any treatment whatever. No hair grows on the patches and no new patches appear. Dr. Timberman read a paper on "COMMERCIALISM IN THE PRACTICE OF MEDICINE.' DISCUSSION. Dr. F. F. Lawrence: Dr. Timberman's paper quotes that the man who scares up the game deserves as much consideration as the man with the gun. That is extremely obnoxious (not as the doctor used it, for he used it as a quotation) for it implies that the family physicani is going through the country seeking patients to send to the specialists like game drivers: This would imply that doctors look upon suffering humanity as prey-an outrageous imputation. Consequently the expression. used by some of the men advocating division of fees is entirely out of place. The patient goes to the family physician for a service and pays him for it. If he recognizes that there is some other member of his profession that can render a safer, more complete, and better service than he can it ought to be not only his duty but pleasure to give the best advice he can. If he is prejudiced by division of fees, if his advice be given upon the ground that he can receive twenty-five per cent. from one man, thirty per cent. from another, and fifty from a third, he will take the largest amount with absolutely no conscience or honor in the matter of advice. This presupposes that doctors-in general practice are conscienceless, a proposition at once unjust, villifying, and to be resented by every man worthy to be called doctor. I do not believe the time will ever come when a man will be justified in advising upon a commercial basis. There are cases in which the assistance rendered deserves renumera *See page 56 this issue. or tion. Should the consulting physician, or the patient renumerate? Should the specialist pay the consulting physician should the family pay? It is not right for the specialist to go down in his pocket and pay the bill which the family or patient should pay. There can be only one honorable course, viz: both the family physician and the specialist do the work honestly, fearlessly, faithfully in the interest of the patient; each make a charge commensurate with his service and the patient's ability to pay for it. The best service possible and no commissions. Dr. E. G. Carpenter: It seems to me that the position of the medical profession is much different than it was half a century ago. There are a number of branches of medicine which are practiced to-day by specialists which were not a part of medicine half a century ago. This is due to the advancement in medicine. Then we knew very little of appendicitis; nothing of the plastic operation as introduced by Sims. There have been advances in gynecology, in ophthalmology, and in other branches of medicine on which medical men have centered their minds and pursued these lines to the utmost end. There is too much of medicine to-day for any one man to absorb; too much for one man to make himself proficient in, yet this is being done much more now than formerly. My observation in the postgraduate schools of New York and in the universities abroad confirms this. General practitioners are trying to make themselves proficient in all branches of medicine. We find general practitioners doing surgical operations so that now the general practitioner has fully as broad a field, if not broader, than hitherto. In every profession there are dishonest men and in the medical profession there are men who are eager for the dollar rather than the interest of their patients; but the conscience of every right-minded physician will tell him that division of fees is not right. When the profession is getting down to such commercialism that the physician's mind is centered more upon the fees obtained than upon the good of the patient it seems to me there is a beginning of a decadency. Dr. E. J. Emerick: I think the rule Dr. Timberman laid down is very good, and speaking from the standpoint of the general practitioner would like to say that I have had little diffi culty with specialists, though I have had frequent occasion to call upon them. If the specialist stops to consider what he would like to have done if he were in the general practitioner's place he will not charge so much that there is nothing left to pay the family doctor. Dr. Timberman: I feel that this subject is one of which some of us are just a little bit afraid. One of my friends asked me why I wanted to bring this matter up at this time, remarking that he was afraid that it might result in professional injury to myself. I replied that I thought the practice had become sufficiently prevalent to justify a paper, and that, so far as injury to myself was concerned, I had no fear. We owe it to our profession to be sufficiently courageous to give expression to honest opinion, and the want of this courage may be as productive of baneful results, almost, as an evil practice itself. I know in a general way that this subject has been discussed in some of our leading medical journals; some time during the last year I read an article by Dr. Frank Lydston of Chicago,-his first article on this subject, as I remember,-his more recent ones I have not read. Articles by authors I have not read, so that I do not know exactly what their position on the subject may be. While I was writing this paper I had my stenographer collect all of the articles on this subject in the "Journal of the American Medical Association," intending to read them, but which I did not do, since I wished to express my unbiased opinion. My paper this evening could not exhaust the subject since it would take too much of the Academy's time. I do not feel that the blame is all on the part of the general practitioner. I think the example referred to in the paper shows that the specialist himself may be as much of a sinner as the other man,—it may be that he is the chief sinner; he certainly is, if by voluntarily offering a percentage of his fees he trains. the general practitioner to expect it. I am frank enough to say that I think there are times when the general practitioner and the specialist may divide; I think it should never be done without the knowledge of the patient. I feel keenly the importance of this matter, because it has been brought home direct to me. Not long ago an optician came to me offering me 50 per cent. of his charges to all pa tients sent to him. Several years ago I heard that the oldest practitioner in the city gave regularly a percentage of his charges to oculists. I went into his place of business and asked him about it, and before he knew what I was going to say, he answered that he did nothing of the kind. I knew then that it was a slander, because I had approached him in such a way as to make him think that I was in there for the purpose of arranging with him in regard to a division of profits. I have always thought well of the man who, simply as a business man, refused to enter into such a combination. How much more should a professional man be free from any such charge! THE SAMUEL GROSS PRIZE.-The essays for the Samuel D. Gross prize of $1,000, to be given for the best original essay not exceeding 150 printed pages on some subject in surgery, pathology, or surgical practice, founded upon original investigation, should be sent to the Philadelphia Academy of Surgeons, care of the College of Physicians, 219 S. 13th St., Philadelphia, on or before October 1, 1901. CONCENTRATION OF MEDICAL LIBRARIES.-A resolution has been introduced before the Cincinnati Library Board, looking toward the concentration of all the medical libraries in the city, namely, those medical works in the Public Library, the library of the City Hospital, and the books in the possession of the Academy of Medicine-a reading room at the Public Library, where they can be properly arranged and catalogued, and placed in charge of a competent attendant. THE COLUMBUS MEDICAL JOURNAL. A MONTHLY MAGAZINE OF MEDICINE AND SURGERY. ISSUED BY THE COLumbus Medical PubLISHING COMPANY JAMES U. BARNHILL, A. M., M. D., EDITOR AND MANAGER, Per annum, in advance, subscription price, including postage .12 cents. Bound volumes. $1 00 1 50 Original articles, scientific and clinical memoranda, correspondence and news items are cordially solicited from the profession. All communications should be addressed to the EDITOR COLUMBUS MEDICAL JOURNAL, 248 East State Street. Remittances are most safely made by bank check or postal money order, drawn to the order of the Editor and Manager. FEBRUARY, 1901. Editorial. DIVISION OF FEES. The physician's vocation is a profession, not a trade. Its rewards should be certain and abundant, untainted with competition or commercialism. Through all the centuries of history, our noble profession has been bound together by a fraternal feeling, which spurns the competitive methods of business. Its highest aim has been to alleviate human suffering, eradicate disease, prolong human life, and not to exact financial equivalents. Not a tithe of the world's debt to the medical profession has been paid, but it is to the glory of the profession that it has withheld nothing that would advance medical science, and has frowned down all attempts at secrecy, combination or competitive methods for the purpose of extorting reward. Freely have the members of the profession given from the laboratory, clinic and the theatre of active practice the most valuable results of observation and study. The best methods have been fully described and illustrated. The best that is known to the profession is given without stint to the public, to boards of health, to the family, to the individual. Hitherto he who would sell his |