The

East

ORGANIZATION OF THE MEDICAL

PROFESSION.

Organization and combination seems to be the spirit which pervades all bodies of whatever nature. Its advantages must be apparent to every one viewed from almost any standpoint.

"United we stand, divided we fall," is more potent as a saying today than ever before. Today only the combined forces of enterprizes and organizations are able to compete with opposing forces. Of all the disorganized or even disrupted bodies taken as a whole is the medical profession, admitted by all, and especially those who go about endeavoring to bring about order, good feeling and cooperation, as is told us by the American medical organizer, Dr. McCormick. His relation of experiences and observations obesrved in other places is very happily woven in to cover possibly similar conditions existing in the community which he is addressing. No more gifted or tactful organizer than he could be readily found. His theme of brotherly love and loyal justice is, though possibly "Eutopian," beautiful and poetic.

So enchanting and catchy is the senti

It

ment that the real issues that we confront daily and that give us worry, are overlooked and passed unsolved. seems to us that a general reformation of a class so large and free of thought and action as is the medical profession, is no less of a herculean task than other attempted reformations with which we are more familiar. If, however, enough peace makers can be found to effect local organizations of county societies an opportunity may be afforded to demonstrate its advantages and thus hold together a larger body than now. Certainly it must be apparent that in later years there seems to have been a growing distrust of each other and of the larger medical bodies, a feeling that they were run in the interests of a few and not the many. This same feeling is manifest in other directions to such an extent that it excites comment, not alone from the medical fraternity, but the laity as well. Active competition with limited avenues for advertising has given rise to the organization of many more medical colleges than conditions require. The reresult is strife and combination become more and more noticable. Business is divided and sought for to such an ex

tent that practices new to the older members of the profession are created much to the dertiment of the dignity of the profession. When we ask our friend who dreams we hope not "irridecently" of things beautiful and spotless for the future profession, he evades and answers not.

We are left to hope with every doctor a member of his county society, thus his state association, and the parent association, the American Medical, that it shall then become possible to acquire all that shall be conducive to happiness and prosperity. Then duplicity, unfairness and dishonorable dealing will not furnish so frequent a topic of conversation. Equality, a cardinal principle in the constitution of our great country, must obtain more largely in the medical profession, a better observation of the "spirit of medical ethics" which can only come through a higher sense of honor. H. C. C.

TO OUR PATRONS.

With this issue the INDEX-LANCET begins its twenty-sixth year. It gives us great pleasure to acknowledge our appreciation of the many expressions of continued confidence in our journal. In the future we will publish a series of signed editorials which will be written by men of prominence in the medical profession and we feel sure this will be appreciated by our readers. Our list of contributors for the year 1905 comprises some of the shining lights in the profession. The policy of the journal has always been to publish original articles on subjects of interest to the general practitioner, avoiding any semblance of a department journal, believing that by so doing we could best serve the professional interests of our readers.

We have studiously avoided accepting advertising contracts from any but relible, trustworthy and ethical pharmaceutical houses, and this policy will be continued. We take this opportunity of thanking the profession as well as our advertising patrons for their support

of our efforts to furnish an ethical medical journal and with their continued assistance we hope to succed even better in the future.

HEALTH DEPARTMENT OF KANSAS CITY AND THE NEW CHARTER.

It may not be known to our readers that a movement is already under headway for the creation of a new city charter for Kansas City, the old one having been found most inadequate for the growing needs of this great Western metropolis.

The marvelous growth which has taken place within the past decade has demonstrated the weakness of the present charter which was framed to govern a small town instead of a city of great proportions as Kansas City has now become. In order to remedy this evil a committee known as the Board of Freeholders, consisting of thirteen representative citizens, were appointed some months ago whose duty was to frame a new charter for Kansas City. In no department of municipal government have the evils of the old charter been made more clear than that which relates to the general public health and sanitation. The Board of Freeholders. being conscious of their lack of scientific knowledge concerning these special subjects invited the physicians of the city to assist them by offering suggestions concerning the various provisions necessary to be embodied in the new charter relating to the government of hospitals, sanitation and the general public health.

Two separate reports were furnished this Freeholder's committee a few days ago which may prove interesting to our readers; we, therefore, publish them in full. One of the reports favors the appointment of two committees; the other report is in favor of but one; who shall have full charge of the entire health department.

The first report reads as follows: "We suggest that two separate departments be created:

"First-Department of public hos

pitals.

"Second Department of public health and of public charities.

"First-We suggest that the hospital department shall be under the charge of a board consisting of five trustees, who shall have charge of the city hospital and all subsidiary hospitals, detention, emergency, contagious, etc., which may be hereafter instituted. These trustees

shall purchase all supplies, make all needful improvements, but may not make any change in the occupancy of the buildings. They shall have charge of all the real estate, however, and of all expenditures and income from the hospipenditures and income from the hospitals. They shall have charge of the admission and discharge of patients, and render an annual report of the condition of the hospital, its inmates, admissions and discharges, and finances.

"These trustees shall be five in number. On the adoption of the charter there shall be nominated by the mayor five members, one to serve five years, one four years, one three years, one two years and one one year, and annually thereafter, in the month of

of

each year, the mayor shall apoint one. citizen at large to be trustee of the city hospital, to serve for a term of five years from the first Monday in

in the year in which he shall be appointed. No member of the city government shall be eligible as trustee. No member of the board of trustees shall receive any pecuniary compensation for his services. Whenever a vacancy shall occur, the vacancy shall be filled in the manner aforesand by the appointment of another trustee, who shall hold office for the unexpired term. The trustees shall be subject to removal from office for cause by a vote of three-fourths of each branch of the city council present and voting thereon.

POWERS OF THE BOARD OF TRUSTEES.

"The board of trustees shall have power to make such rules and regulations relating to the city hospital, its officers and servants, as they may deem expedient, provided that they are not

inconsistent with the provisions of this act, and subject to such limitations and restrictions as the city council may di

rect.

"The board of trustees shall appoint a superintendent with such assistants and subordinate officers as they may deem necessary or expedient, and remove the same and fix their compensations. The amount which may be expended, however, shall not exceed the sum appropriated by the city council for this item of expense, together with earned, given or appropriated for this the income of any moneys which may be purpose. They shall also appoint a visiting and consulting staff of physicians and surgeons, who shall serve without compensation.

"Second-We suggest that the department of public health and of public charities shall be under the management of a board consisting of seven members, the mayor, chief of police and president of the board of public works being exofficio members of the board, the other four members being regularly licensed physicians of the city at the time of their appointment and for at least five years preceding. On the adoption of the charter there shall be nominated by the mayor four members, one to serve four years, one three years, one two years and one one year, and annually thereafter in the month of each year the mayor shall appoint one qualified physician to be a member of the department of public health for a term of four years from the first Monday in in the year in which he shall be appointed. No member of the city government shall be eligible. The appointive members of the board shall serve without compensation. Whenever a vacancy shall occur in said board the vacancy shall be filled by appointment in the manner aforesaid of another member, who shall hold office for the residue of the unexpired term. Members shall be subject to removal for cause by a vote of three-fourths of each branch of the city council present and voting thereon.

HEALTH BOARD'S POWERS. "The board of health and public charities shall control all matters pertaining to the preservation, promotion and protection of the lives and health of the inhabitants of the city. It shall investigate the nature of contagious diseases and take measures to prevent their spread. It shall have charge of the inspection of milk, meat and other foods. It shall have the sanitary supervision of the municipal institutions of the city, including jails, schoolhouses and other public buildings, except hospitals. shall have charge of the disposition of of garbage, offal and other offensive substances and of the dead. It shall provide for the registration of births and deaths. It shall have charge of all city charities except hospitals.

"It shall have power to make such rules and regulations relating to the public health as they may deem necessary or expedient, provided they are not inconsistent with the provisions of this act or subject to such limitations and restrictions as the city council may direct.

"The board of health shall appoint a health commissioner with such assistants and subordinate officers, including a city chemist, bacteriologist, milk inspectors and meat inspectors, as they may deem necessary or expendient, and remove the same and fix their compensations. The amount which may be expended, however, shall not exceed the sum appropriated by the city council for this item of expense, together with the income of any moneys which may be earned, given or appropriated for this purpose.

"The members of the board to serve with out compensation. They to elect one of their number president and adopt such rules and regulations as may be necessary for the government of the board.

"The members of the board shall hold office for six years. Those first elected or appointed under this charter shall so classify themselves by lot that two will go out of office on each even year, one being of each of the two dominant political parties.

"The board shall have the management and control of all municipal hospitals and ambulance service, and of all matters pertaining to the preservation, promotion and protection of the lives and health of the inhabitants of the city.

"It shall have the sanitary supervision of the city and all buildings and institutions, public and private, with power to enforce all health or sanitary ordinances. and regulations.

"We recommend that the said board. shall have power to appoint a superintendent of hospitals, the said superintendent to be a physician in good stand

of at least ten years' experience and five years' residence in the city, and further, that said board be empowered to appoint for the hospitals a visiting staff of physicians and surgeons. We further recommend that the superintendent of hospitals be empowered to appoint a resident staff (or that the resident staff be appointed on competitive examinations).

"We recommend that the said superin

tendent of hospitals be appointed by the board to serve during the pleasure of said board and removed only for good

cause.

"We recommend that the said board have power to appoint a commissioner of health, said commissioner of health to have power, with the approval of the board of health, to appoint an assistant commissioner of health, a bacteriologist, a chemist, milk and food inspector, a chief medical inspector of schools, stores and tenement houses, a superintendent of garbage and such other officers as may be required for the proper administration of his department and as may be authorized by ordinance and approved by the board of health."

This report was signed by the following physicians and surgeons: Dr. Edward W. Schauffler, Dr. Frank Hall, Dr. Jacob Block, Dr. Frank C. Neff, Dr. W. S. Wheeler, Dr. C. Lester Hall and Dr. Scott P. Child. Dr. John M. Langsdale, city physician.

In the discussion the physicians agreed that the trustees in charge of the hospitals should not be physicians because of the discord that might ensue between various schools of medicine seeking to control the clinics. They thought some physicians should be on the health board. and that a veterinary surgeon should be on the board also. It was suggested that chief of police should be a member of the health board because he had charge of 300 sanitary officers.

F. A. Faxon, C. S. Palmer and A. R. Meyer constitute the committee which will prepare the sections relative to hospitals and sanitation.

In order that the profession might the better understand the reasons advocated by the two committees in support of their reports which they submitted to freeholders' meeting, the editor requested the chairmen of the committees to indicate their views of this matter. Both chairmen very kindly prepared a statement which is given below: Dr. John Punton, Editor LANCET:

Dear Sir--In compliance with your request for my views on certain recom

mendations submitted for the new charter, relating to the Health and Hospital department, I submit for your consideration the following:

I am opposed to the creation of two departments, one a hospital department and the other a health department, necessitating the appointment or election of two boards and the appropriation of two separate funds. I am opposed to a board of laymen for the hospital and a board of doctors for the health department. I am opposed to a layman as superintendent of hospitals and I am opposed to the board having "charge of the admission and discharge of patients."

My objections are based on the following reasons:

First-The creation of two departments is objectionable for the reason that the work of the two is so interwoven that it would be impossible to separate it entirely and maintain good service, and should the two departments, one with a board of physicians and the other with a board of laymen, not be in perfect harmony and accord continual clashes would occur, besides oftentimes it would be a difficult matter to determine which department should bear certain expenses. If the "board of health shall investigate the nature of contagious diseases and take measures to prevent their spread," it must be done through the physicians of the health department appointed for this purpose, and it necessarily follows that these physicians must say who shall go to this hospital or that and who shall not; it is agreed that the ambulance service should be under the charge of the hospital department and yet it must be continually subject to the demands of these physicians of the health department. If the health department "shall have charge of all city charities except hospitals" hospitals" it is obvious that the poor sick throughout the city must be looked after by the board of health's district physicians, who must be the judges as to the patients they will treat at their homes and who shall be treated