policy which have, in recent times, engaged the attention and elicited the energies of our law-makers, seem to sink into insignificance in comparison with the great and benign proposition here presented. It is my deliberat opinion that the establishment of a bureau of health as an integral part of the nation's executive will prove an effective instrument in promoting the public welfare. It will be the means of unifying efforts in the suppression of dangerous diseases. It will afford opportunity for restraining the effete despotisms of the Old World from adulterating our population with the vicious and degenerate. It will be a means whereby this enlightened and progressive republic may exemplify to the world the true mission of medical science. It will offer another agency for disseminating the truths of scientific discovery; another means of discriminating between that which is permanent and immutable and that which is transitory and accidental in medical achievement. The party, professional or political, which shall succeed in consummating this wise measure will assuredly earn for itself the gratitude and applause of an appreciative nation. The individual citizen who shall materially contribute to the success of this noble, useful plan will be justified in congratulating himself on having realized the lofty aspiration of the patriot, as well as the sublime and pathetic wish of the poet that mortals approach the gods by giving health to men.' His paper received great applause and was referred to the executive committee with instructions to bring it to the attention of the national authorities. What promised to be a very sharp discussion on the advertising columns and the management of the Journal of the American Medical Association was quickly tabled. After passing a resolution similar to that adopted by the American Academy of Medicine, requesting Congress to place surgeons in the navy on an equal footing with those in the Army, which is claimed to be not now the case, the Association adjourned until Wednesday. AMERICAN ACADEMY OF MEDICINE. TWENTIETH ANNUAL MEETING HELD AT BALTIMORE, MAY 4 AND 6, 1895. Dr. James W. Walk of Philadelphia read a paper on The Limits of the Physician's Duty to the Dependent Classes. Specialists have become a necessity. We are not only pathologists and therapeutists but also men and citizens, with the privileges and responsibilities appertaining thereunto; and the added duty because of our special knowledge. The physician should be a teacher of preventive medicine. This duty to the community can be performed without any undue sacrifice of time or labor. Beyond is the wider field of so-called charitable work, nine-tenths of which is rendered to the dependent classes; those burdens of every modern community. In almost all the almshouses, infirmaries and public hospitals maintained by taxation, the medical services are rendered without pay, which is wrong. They are a part of the protec tive system of the community, and the doctor should no more donate his services than the merchant his wares. Many institutions supported by voluntary contributions have developed beyond the real needs of the community. Thus, in Philadelphia, investigation shows that 20 per cent. of the inhabitants receive free medical attendance, and other statistics show that the actual pauper class does not exceed 1 per cent. If this is done for charity, it is a mistaken kindness; if for selfish purposes, it does not accomplish what is desired. Some time ago an examination was made into the professional history of twelve physicians who enjoyed large and lucrative practices; nine had devoted themselves to exclusively private practice from the start. No adequate remedy has been found up to the present. Provident dispensaries, monthly payments, etc., have been tried with little success. If the circumstances of every patient were investigated by competent agencies, as the charity organization societies, the evil would be, to a large degree, prevented. The opposition to this plan comes from the physicians who desire large clinics. Dr. W. L. Estes of South Bethlehem, Pa., read a paper on Hospital Management. The proper conduct of a hospital requires a dual management; that which relates to the patients, their care and cure; and the purely executive or business side. While they are mutually interdependent, it would be possible for the medical board to manage the executive side, but a board of trustees, composed of never so excellent laymen, could not carry on the scientific side. In many instances the board of managers are, practically, responsible to none but themselves and the executive committee usually controls the board, constituting the real power. The oversight of the Board of Charities should be made a real one and a competent accountant should audit the books for the Board of Charity yearly. A physician was more fitted for the position of superintendent and surgeonin-chief could be given to the same person with a steward capable of managing all the details of the care of the hospital. The medical staff usually has not an equal voice in the management of the hospital, which is wrong; it should be equal in power and influence with the Board of Trustees and appointed by the same appointing power. The service of the visiting staff, instead of, as is usually the case, having a term of months should be continuous throughout the year. As this will take more of his time, he should receive some compensation for his services. The purpose of a hospital is, primarily, for the administration of charity. If the undeserving are able to receive help, these are apt to assert themselves and crowd out the really deserving; hospital rivalry is an incentive to this condition. We have too many hospitals, and the effect of the over-supply is to encourage the treatment of those who should not be the recipients of charity. The custom of seeking a hospital for prolonged or serious ailments is increasing, and must enhance the desire to secure hospital appointments, causing them to be accepted, sometimes when the true dignity of the profession would suggest a declination. Dr. Walter L. Pyle of Washington, D. C., read a paper on The Emergency Hospital, with a Plea for Municipal Government. The Emergency Hospital is an institution for the reception of recent cases when immediate medical attention is peremptory, and, to best accomplish this purpose, no other cases should be received. It should be easily accessible, in convenient communcation with a police. station. The emergency room should be kept constantly in readiness for any operative procedure. An "emergency ward" should adjoin this room, and some padded wards for alcoholics, the acutely insane, etc., should also be found on this floor. For the ambulance calls, a system patterned on the fire alarm is preferable. The ambulance should never go out without a surgeon fully equipped, and the ambulance surgeon should be one of the more experienced of the resident force, preferably the first assistant. The chief resident should be a man capable of attending to any case that may be received and he should have abundant and efficient assistance. The administration should belong to the municipal authorities, having an advisory board of physicans and surgeons. In the matter of the support of the hospital, the custody of criminals and the transfer of patients to other hospitals, the emergency past, control by the city is desirable. Then, too, the resident staff, being attachés of the Department of Public Safety, would be of assistance to the court in their official capacity. The question of publicity is one of importance. It should be remembered that the newspapers have rights, among them to have information regarding accidents. At the same time, an exaggerated account of an injury works harm. It would be well for the chief interne to see the reporters and give them the proper information; or to post a bulletin to which they had access. The police reporter's badge should give reporters the right to be admitted; should it be found that he was abusing his privilege a letter to the editor would probably prevent any further abuse. It is better to err on the side of the reporter in furnishing news, at the same time the patients' requests and circumstances should be regarded. Dr. Emma B. Culbertson of Boston read a paper on How to Reform the Dispensary Abuse. Indiscriminate professional charity works harm; first to the patient, whom it pauperizes; second to the physicians, since crowded clinics lead to slovenly work; third to the younger members of the profession, as it deprives them of proper experi ence; fourth to the profession at large, since these acts are misinterpreted by the community and the dignity of the profession is lowered. In the writer's mind, the fault lies chiefly with the profession. Because of the moral reward for services rendered and the philanthropic tradition of the profession, physicians, as a class, have ignored their sociological responsibility; even while the relief of suffering is a reward, no one has a right to receive that reward at the expense of the selfrespect of the sufferer. An endeavor should be made to secure efficient aid to the really needy; preservation of self-respect to those assisted, partial assistance to those in narrow circumstances and exclusion of the unworthy. In accomplishing these objects, fraternal aid and countenance can frequently be given to the younger members of the profession. The sifting out of unsuitable cases gives more time for those treated, and the payment of a small sum by these is helpful to the patient; those who are found to be able to pay a diminished fee can be seen at a private office. It was found at one hospital that those who ought not to have come to the clinics either refused to sign the blanks or never returned. But the fact that the patient simply went to another dispensary along with the additional labor of investigation, which was not given to a special officer as it ought to have been, caused the temporary abandonment of the plan. When it was found that a patient was able to pay even a reduced fee, most of them, by the use of a little tact, were persuaded to visit a physician. Dr. George M. Gould of Philadelphia read a paper on Hospitalism. The Dispensary Disease, or Hospitalism, is a contagious epidemic, ingravescent neurosis of civilization. It attacks three considerable classes; the professional philanthropist, the commercial physician, and the social sponge. Two chief factors enter into its causation; the morbid desire of the lazy charity monger to perform his duties vicariously, and the ambition of certain physicians to "get on regardless." The disease exhibits a somewhat different symptom-complex in each class. affected. 1. In the endowing class, many of whom are placed by death beyond the reach of our criticism; with these, endowments are made without proper stipulation as to their management; this is mournful, because in so many ways their money could be used for the real good of mankind. 2. The layman suffers when once the dispensary disease lays hold on him. He buys medical advice for nothing and pays a high price for it; and when once attacked, the disease fastens itself on him. The commercial medical college aids greatly in disseminating this dis ease. 3. The physican suffers under the influence of the necessity of treating crowds of mingled deserving poor and of undeserv ing sponges; it acts disastrously on his disposition and manners. His patients degenerate into clinical material. Hospitalism leads to the degeneration of the physician to the therapeutical or pathological fiend. He frequently uses his position for private ends and for that alone. Thus we are cruelly, consciously, persistently, committing professional suicide. By our giving the most valuable thing we possess for naught, we are teaching others to place no value on it and our profession is viewed with contempt. No one remedy will accomplish a cure. Let us preach incessantly the truth that indiscriminate charity is unadulteratedly sinful and cruel. MARYLAND Medical Journal. PUBLISHED WEEKLY. TERMS OF SUBSCRIPTION, $3.00 a year, payable in advance, including postage for the United States, Canada and Mexico. Subscriptions may begin with any date. DATE OF PAYMENT.-The date following the subscriber's name on the label shows the time to which payment has been made. Subscribers are earnestly requested to avoid arrearages. CHANGES OF ADDRESS.-When a change of address is ordered, both the old and new address must be given. Notice should be sent a week in advance of the change desired. TO CORRESPONDENTS.-Original articles are solicited from members of the profession throughout the world. Reprints will be furnished in payment of accepted articles if the author's wish is so stated at the time. CORRESPONDENCE upon subjects of general or special interest, prompt intelligence of local matters of interest to the profession, items of news, etc., are respectfully solicited. Marked copies of other publications sent us should bear the notice "marked copy" on wrapper. Address: MARYLAND MEDICAL JOURNAL, WASHINGTON OFFICE: BALTIMORE, MAY 11, 1895. AT the present writing the outlook is for a very successful and enjoyable session of the American Medical Association. American Medical Association. Members and delegates with their families have arrived from all parts of the country, principally from the west, and the opening meeting of the general session in Music Hall showed that a large audience had gathered to hear the addresses of welcome. Like schoolboys on a holiday, many of the members have come determined to enjoy themselves and take a rest, perhaps much needed from hard work. The receptions and banquets attracted a large number and the excursions were very popular. Necessarily there was some friction in the workings of such a large body and sectional strife was bound to show itself. On the whole, however, harmony has been the rule and good work was done. One very pleasant feature was a meeting and banquet of the editors and publishers on Monday night. Men who mould and reflect medical opinions (or think they do) came together and enjoyed an inter change of ideas and dwelt peacefully together until the small hours. The profession as a whole has not been equally represented, those from the western States being in the majority. The visitors seemed to be satisfied with their reception and treatment and after a lapse of so many years were glad to visit Baltimore again. Such meetings do the profession of a city good in stirring them up and infusing new life. *** THE subject for discussion at the State Society's meeting, on typhoid fever in country districts, brought out facts not Typhoid Fever. new, but they were presented in an attractive way and may lead to some good reforms. The question of controlling the waters which supply large cities and towns is an important one and involves much expense. How far an efficient State board of health could trace up cases of typhoid fever in the country and remove the cause is not easy to say. So far, this board has not attempted anything approaching that. In Baltimore an ordinance has been introduced into the City Council, asking that typhoid fever be put on the list of diseases to be reported. Whether cases of this disease will be reported is hard to say, for it is well known that many neglect to report diseases apparently more alarming than this one. If, however, typhoid fever be put on the list of diseases to be reported, the discussion of the State Society will not have been in vain. *** Ir is curious how hard it is to live down a prejudice. It has always been supposed that it is not well for man to be alone Unmarried and this was especially said of Physicians. the physician. The two horns were either that no physician can afford to marry until he has a practice and he cannot get a practice until he marries. It has been supposed that a physician, be he young or old, cannot attend to family practice, particularly where there are young women, unless he is married. Why this is so it is not easy to say. In large cities patients do not always know whether their physician is married or not unless they are rather well acquainted and in many cases where confidence has been gained the unmarried man has shown himself as good as the benedict. The idea may imply that an unmarried man is an immoral man, or some such unjust reason may be assigned, but as a fact it could be with just as much effect reasoned that the unmarried physician is the better man of the two because he can devote his whole time to his profession. Whatever the truth may be it is certainly a fact that when prejudice has been overcome and the unmarried man has once gained the confidence of the family he makes his way as well as his more fortunate colleague. This is one of the many traditions and prejudices that hang around the medical profession and the sooner it is brought out in its proper light the better for all concerned. Too many men rush into matrimony at an early and unripe age because they think it will help to promote their professional advancement and after a few years they have time to repent at leisure. There are many more who commit this act and do not repent because they have chosen wisely, but for the sake of the few who use matrimony as a stepping stone to success, the public should be taught that, all things being equal, the unmarried physician is just as good, just as reliable and just as worthy of confidence as the married man and the mere marrying of an unfit man does not fit him for the confidence of his patients. The single man has for his defence that he has no one to whom he can tell his professional secrets, while the married man may often be tempted to tell his better half in the strictest confidence that Mrs. So-andso is in such and such a condition. Therefore give the devil his due and if a good man is able and worthy he should stand on his own merit whatever other conditions exist. State legislature as may increase the efficiency of that law. The State of Maryland has always had a hard time in dealing with incapable practitioners and it is astonishing how much apathy is exhibited when a bill is introduced into any State or municipal body respecting the public health, except by the opponents of this bill. This has been the fate of the medical law. It was killed at one legislature by men who had private interests at stake and who had influence enough to make a weak governor do what they pleased. Later a law was passed, but no money being appropriated, it was inoperative. Now a fairly good law is on the statute books, but it is said to have some defects and even if it were perfect the prosecuting machinery of the State is in such a condition that those accused of minor offences, such as practicing without a license, are not prosecuted, and thus escape. It would be a just punishment if these law officers who declined to prosecute illegal practitioners were compelled to be one of the patients of these incapable doctors. A public officer may be apathetic or negligent or even criminal as long as he himself is not concerned, but let the affair concern himself personally and then justice is done and that right quickly. This committee needs money to employ agents as other societies do, to obtain evidence and it should be everyone's pleasure to contribute a small sum, not less than two dollars, to help on this work. Academy of Medicine. *** TOO MUCH praise cannot be given to the excellent work of the American Academy of Medicine, which began in a small way but which by its constant demands for the improvement of educational facilities in medical schools and its interest in sociological questions has been the pioneer in several important movements. All the papers with few exceptions were extremely interesting and many were remarkably strong and the discussions were full of life. The Academy is composed of educated men who have no selfish motives and who are very urgent in bringing about the reform for which they have declared themselves. Every physician who is eligible should see that his or her name is brought before this enlightened body to increase its usefulness and efficiency. |