Physicians are destined to occupy far more important positions in relation to the public as the evolution of preventive medicine is worked out to its legitimate and ultimate end.

The time is near when physicians, as such, must occupy important places close to the heads of national, state, county and city governments, and the general body of medical men throughout the land must then be prepared to meet upon common ground in support of the new regime.

This somewhat vague outline of what is before us, reduced to particulars, means that in certain governmental affairs pertaining to medical matters, chiefly or solely, the physician is destined to be a more important factor and the professional politician is to be relegated to the rear. To further particularize, it may be said that the progressive movement will be applied extensively to matters of quarantine, immigration, food inspection, public hygiene and sanitation, water supply and sewage disposal in states and nation, and to such public offices and public institutions as may be best administered by highly educated medical men.

In casting about for features of local interest in this connection not a few present themselves for consideration. First let me refer to that abominable relic of the dark ages still officially imposed upon the state of Colorado; a functionary in comparison with whose methods and results those of the immortal Dogberry were brilliant and immaculate indeed, for he was at least sufficiently aware of his limitations to

say to his clerk, "Write me down an ass."

Without making any personal application or individual allusion, I refer to that picturesque, often ignorant and totally incompetent official prescribed for us by our state constitution under the title of "the Coroner."

The coroner's office is, without exception, even as political offices go, the most useless, meddlesome and spectacular bit of political machinery ever invented. The legitimate emolument of the office is insignificant and the place is too commonly filled by some political grafter, who, for purposes of his own or in the interest of his friends, finds it profitable to accept the job. His official investigations chiefly serve to gratify the curiosity of the morbid and to muddle and obscure the facts. When they do not defeat the ends of justice through the more or less direct protection of some favored individual, they do so by making public the evidence against criminals of a certain class, which enables them to successfully meet the charges when at last the case comes to trial. Finally, and after all is said and done and when the elaborate and expensive coroner's function is over and his findings (if he finds anything) are ready for announcement, they are entirely without significance or weight, and the case is forgotten or it goes to the district attorney, the grand jury and the court for serious investigation and solution, regardless of the silly procedure of the high functionary who has already passed upon it with the aid of his six or twelve "good men and true."

In contradistinction to all this elaboration of disingenuous circumlocution for the ostensible detection of crime "by a party or parties unknown," we have only to look upon the excellent system in operation in the state of Massachusetts and elsewhere. That system provides for the appointment of a medical examiner, who shall perform the duties here undertaken by the coroner, but who makes his investigations, including the autopsy, if one be required, collects data for the prosecuting officers and courts, and does it all without undue publicity; and better still, does it with that skill and judgment that education and training for the work enable him to give to it. The results under the medical examiners system are so vastly superior to those attained by the coroners system, wherever and however employed, that there can no longer be a question but the Massachusetts law should be upon the statute books of every state of the Union, that the coroner should be merely an opera bouffe dream, and that his functions should be assigned to some capable, honest, intelligent and trained physician, who could in this capacity bring order out of chaos.

The difficulty in bringing about this change in the state of Colorado, is (as I understand it) that a constitutional amendment would be necessary, as the office of coroner is prescribed by that instrument, but troublesome and expensive as this amendment would be, it is all well worth while if by such action we may be free from the unwieldy and insufficient, justice destroying office, and secure the adoption of that in its

place which has been proved to be all that could be desired. that could be desired. It is not too much to hope that this may be accomplished some day, and it is certainly an end for which this and other medical societies and all medical men should work.

Another local matter that may claim our consideration at this time is the position in which physicians are placed in relation to certain eleemosynary public institutions and public offices.

The average political dispenser of patronage proceeds upon the theory that all those offices that must of necessity be filled by physicians are merely a part and parcel of the spoils belonging to the victors, and that this is true. regardless of the fitness of the incumbent, of the length and faithfulness of his service or of his unselfishness in rendering valuable services without pecuniary compensation.

This abuse of the medical profession as a whole and as individuals, is common in Colorado in state, county and city affairs, and I regret to say is made possible solely and entirely because we tolerate it, and submit to the imposition of the most humiliating indignities.

A notable example of recent date will be recalled by all of you, and as I have never had a place upon the medical staff of the institution in question, never applied for one, and furthermore would not accept one under the existing conditions, I may comment upon it without subjecting myself to the criticism of being a sorehead or of casting longing glances at the sour grapes.

I need scarcely add that I refer to the changes of the past two years in the

medical service of the Arapahoe County Hospital, and when this has been said further particulars are unnecessary, as I believe you are familiar with the details. It is enough to suggest that when it has become possible for a small politico-medical clique to dictate the policy of such an institution in the interest of themselves and their immediate friends, and to the detriment of the institution and those who have long and faithfully served it, the time has come for the great body of self-respecting medical men of this community to take some co-ordinate action for the protection of the interests of the institution and of their own honor and dignity.

Two ethical problems occur to me as worthy of comment, the first having to do with our relations to the victims of the abortionists, and the second with our own relations to the newspapers; both of which bear upon my general topic, our relation to the public.

When we see patients suffering from the effects of criminally induced abortions, what should be our attitude toward them, the individual who may have performed the operation and the public and its officers?

It will be conceded that clean-cut views as to the right and proper course to pursue in such cases are not held by all of us, and I have had to help decide such questions at times when it certainly was not easy to be sure which course was best, but my notions about the matter are undergoing crystalization and I believe my doubts are about set at rest.

First of all, I have concluded that

my first and most important duty—if not my only duty-is to my patient, when I have accepted the responsibilities of her case (which I may refuse to do if I so decide). This is the key to the whole question. The case once accepted, the welfare of the patient is the sole object to be attained by her physician, and with this ever in mind, I shall do all that may be in my power to bring about her recovery, making no inquiry into her antecedent history which may not be necessary for the successful management of the disease, and the protection of my own name and reputation from any connection with the criminal end of the business. Under no circumstances will I ever again make inquiry about or listen to details that do not pertain to these phases of the case, as in my judgment it is no part of the work of a physician to act as a detective and spy upon his patient. He should rather occupy the relation of one to whom privileged communications may be made in the strictest confidence. If the patient or her friends wish to make a statement or complaint to the proper officer they may do so, after which I might add such testimony as my connection connection with the case makes it necessary for me to give, but I shall never report such cases myself, and shall, indeed, take great pains to know nothing that may not be essential to their medical and surgical manage

ment.

The history of such criminal cases as have been reported to the prosecuting officers in this city would commend this course, for I believe but one conviction under such indictment has ever been

procured, and that person escaped punishment. In the past five years there have been numbers of clear, strong cases before our courts without a single conviction.

I have been helped to this conclusion by the following extract from Dr. Flint's Commentaries on the Code of Medical Ethics and Etiquette. He says:

"In respect of the knowledge of criminal acts, the physician is not to play the part of a detective or an informer. Some may consider it a strong assertion that a physician is under an ethical bond of secrecy when, through his professional intercourse, he may have ascertained that his patient is an escaped convict, a thief, a robber, a forger, or even a murderer. No matter how heinous the crime, the wretched criminal has a right to medical services in sickness. Who can tell how important it may be that his health should be restored and his life prolonged by these services, albeit in the light of human judgment it might seem better that he remain prostrated by disease or die? The duty of the physician in such instances relates exclusively to the patient. He would be debarred from medical services were it understood that physicians are to play the part of detectives and informers. It may be said that a distinction should be made as to the nature and degree of crimes

which patients have committed. But where is the line to be drawn? It is not for the physician to exercise a judicial discretion on that point. The ethical rule is without exceptions. Medical men do not always appreciate the binding force of this rule, and disastrous effects sometimes follow its nonobservance. The following recital is in illustration:

"An unfortunate young woman had sought to escape the disgrace of maternity, and is the victim of malpractice. A physician is called to attend her in her extremity. He recognizes the nature of the case and the dangerous condition of the patient. He demands, in the cause of justice, to know the name of the author of her trouble, and of the one who had undertaken a criminal interference. An officer of justice is summoned to receive her testimony. The woman dies. The newspapers give publicity to the case, with all its details. The physician acted from his sense of duty, his object being the punishment of the offenders against the law. As results of his action, the moral effect of the steps taken in behalf of justice may have contributed to the death of the patient, and, at least, it is fair to conclude that the misery of her last hours were thereby increased. She left a dishonored memory; disgrace was

brought upon the relatives of both parties, he being a husband and the father of a family. After all, the surviving offender eluded punishment. This is not a hypothetical case. It is left to the reflections of the reader, with but brief comment. In no point of view was the action of the physician to be justified, although taken with good intentions. Knowledge of the fact of malpractice was essential to a proper appreciation of the case. Further knowledge was not essential, and it was taking an ungenerous and improper advantage to demand it. Compliance with the wishes of the patient, voluntarily and deliberately expressed, could afford the only ground for excuse in the non-observance of secrecy." In our relations to the newspapers we have to deal with a matter that-in my opinion-calls for some modification of the rigid interpretation so long given to the code of medical ethics. The great importance which now attaches to preventive medicine creates the necessity for the education of the people along these lines, so that they may more fully understand the necessity for preventive measures and co-operate with the physicians and the authorities in the elimination of the preventable diseases. To this end and with a due regard to the dignity and merit of the purpose in view, it appears to me that, under certain restrictions, the public prints might with propriety be used, but I particularly desire that it should be understood that I make no excuses or plea for leniency in your judgment of

the adroit medical or surgical newspaper case reporter.

While it might be proper and advantageous for certain topics of general interest and value to the people at large to be explained and elucidated in the public prints by medical writers of ability, solely because such persons are best qualified to discuss them, there can be no similar excuse or warrant for the self advertising of the sensational public case reporter. We are all well aware of the fact that the names of physicians may and do appear in the public prints in connection with the reports of unusual cases, or owing to the official position or high standing of a patient, without such notoriety having been coveted or consented to by the doctor. The utmost care, consideration and deliberation must be exercised in reaching conclusions in regard to the true attitude of one who may be more unfortunate than the rest of us in this particular owing to unavoidable circumstances that make him more liable to such unenviable notoriety, for while few of us have wholly escaped, it will be conceded that those who come most in contact with accident cases and general surgery are more exposed to such notice, yet it is seldom difficult for one who sincerely tries to avoid it to give all the essential details of such cases to the interviewer with a stipulation that his name be not mentioned, a request that rarely will be disregarded. That it is petty and undignified, and often unfair to other physicians and to the patient and his family, to so retail the details of one's cases, ad nauseum, solely for self aggrandizement, will not be