A TRIBUTE TO WILLIAM WILLIAMS KEEN, M. D., Sc. D., Ph. D., LL. D., ON HIS EIGHTY-FIFTH BIRTHDAY. A Great Surgeon and Teacher, A Congenial Colleague and Faithful Friend, an American Soldier and Patriot. BY S. ADOLPHUS KNOPF, M. D. (N. Y. and Paris), New York City. Four score years and five are yours today And yet you are so young, so strong, so hale, Alert in mind and warm in heart. Your life has been an inspiration to both young and old, And so it is to us today. Some sixty years ago you started bravely out To serve your country and your State You did your duty well in that long war Which at the end brought union to our nation And led it on to glory and to peace. To add unto your store of knowledge gained You traveled far and wide in distant lands By skilful use of scalpel and of knife, Could they be here would join with me Because of your great virtues and renown A call went out for all the men, who, Vigorous and strong and in the prime of life, Should come to serve in freedom's holy cause, You, with your four score years upon your head, Feeling you still belonged within this class, Enlisted as a surgeon-soldier once again, Prepared for duty still as if but half your age; Regretful that you were not young enough To join the army of the boys, in khaki or in blue, Who went to Flanders and to France to fight. You helped at home as counselor and guide And proudly wore a soldier's uniform. When not at work to teach or yet to heal, You served the commonwealth And helped wherever help was needed most. Where'er you went you did a young man's work To which you brought the skill of ripened years. No wonder then that honors came to you Which only those can feel who, like yourself, Have loved their fellowmen And faithfully have served them and their God. HEALTH CENTERS: STANDARD IZED STATE MEDICINE AND GROUP ORGANIZATIONS. BY BAYARD HOLMES, M. D., The dissolution of the ancient profession of medicine is surely coming, if not already here, and new combinations and a complete reorganization seem inevitable. It should be the effort of every reflecting physician to take such an account of scientific and social trends as will guide him to the wisest course of conduct in these critical times. There appear to the writer, possibilities of restoring our guild to a position of honor and influence, by redeeming it from the domination into which it has been entrapped. In the evolution of society as well as in the evolution of manufacture, diversion of labor and specialization are conspicuous events. The most of us can look back to the household of our youth, in which the bread, the butter and most of the clothes were made for the family, but now, in middle life, many of us live in flats and eat meals cooked at a common kitchen. If we commit the indiscretion of having a family offspring, the sprig is born on the accouchment table of the hospital, its presenting part is stamped with a serial number, and its finger-print is taken the same as that of a criminal. It is by the economic laws of the division of labor that the spinning wheel, the loom, the bake oven, the laundry and even the cooking stove and the obstetrical chamber have gone from the home or our in-a-door bed and kitchenette flat, if it is to be called a home. It is not at all wonderful, then, that in the practice of medicine much of the factory system has shown itself. The hospital has grown out of its old position as an eleemosynary wrecking yard for human derelicts, with the capacity of one bed to the 5,000 inhabitants, to a rehabilitation and service station in every neighborhood with a capacity ten to twenty times as great. The hospital system is as much a part of civilized society as the waterworks, the sewerage system and the electric and gas plants. It is a public utility, and like all public utilities is bound eventually to be publicly owned and operated, and medical service must undergo action and reaction to impersonal industrialism running on the philosophical single track "out for profit." The patients in the public hospitals and in the eleemosynary dietetic hospitals were given medical attendance by our profession gratis, and the interne service still remains almost gratis. Nursing was initiated a hundred years ago as a semi-religious sister hood, and it was and is in a measure outside the ethics (or lack of ethics) of industrial vocations. The one factor that the physician who is disturbed by medical commercialization and industrialization should bear in mind, is the fact that business, commerce, industry and manufacturing are equally disturbed by the humanizing factors which medicine and the church formerly monopolized. If medical treatment and hospital care have become less humane and more profiteering in their tendencies, commerce and industry, whose votaries worshiped the one idol "Profit", have been obliged to bow down to some symbols of humanity which they at least hang about their economic shrines. Medicine came from an altruistic religious service without economic standing. and dependent on free-will honoraria for its economic necessities, but it has now gone awhoring after profit and power and often succeeded. The Growth of Industrial or Salaried Medicine. There have been many inroads upon the old preserve of medicine as a professional field. Some of them are quite distinctly economic. Take for example socalled industrial medicine-in its simplest form it is the provision made by the larger employer for the medical and surgical treatment of the sicknesses and the injuries of the laborers while in his service. This system has grown thru sick benefits and insurance into a very complicated service which removes a large proportion of the wage earners from the care of the general independent or family physician, and diverts them to the salaried staff of physicians employed for full or part time by the great exploiters of labor. These physicians and the claim agents are literary wage workers and intellectual body servants of the great corporations, and they get their annual, monthly, or weekly stipend from the same window. The physician or surgeon is as economically subservient to the manager or efficiency director as is the barn boss or any manual laborer. He must treat his patients so that the efficiency expert may not find that the company suffers thereby. The suffering or loss of the patient is a secondary consideration. It is hard to serve one in the pay of another. When the insurance of all the employees is placed by a great corporation or by a new organization in one of the many accident insurance companies, the employing corporations wash their hands of all economical, legal and ethical responsibility, but this does not relieve the salaried or contract surgeon and physician of the critical position in which he must treat one person in the pay of his (economic) enemy, and he still finds it hard to serve two masters: one the natural ethical master, the patient, the other his paymaster, be it the patient's employer or his insurance company once removed. But another very significant duty falls upon the salaried medical man, which many of our profession in military service grew to recognize and to hate under the name of paper work. Medical records are of the greatest scientific importance, and it is said that Hippocrates derived from the records of the temples of Esculapius, that professional experience which prepared him to write the first great incunabula of our art. But the temple records and any true medical records are not those on which the insurance department and the claim agents step the hardest. They want records of facts and words wholly outside of medical or scientific interest and utility. Their |