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C<jl>yri(jlit Ci. V. fhiih from Uiulcrtvood c'r Uudeitvood, N. Y. 
 Sll«il()\-f il-AKK \l, W. C. GOHGAS, U. S AkMY 
 
MEDICINE AS A PROFESSION 
 
 DANIEL W. WEAVER, M.D. 
 
 PUBLIC HEALTH MEDICAL OFFICER, PENSION EXAMINING SURGEON, MEMBER OP 
 
 THE INTERNATIONAL SCHOOL HYGIENE ASSOCIATION, MEMBER OF 
 
 THE ILLUMINATING ENGINEERING SOCIETY, ETC. 
 
 AND 
 
 E. W. WEAVER, Pd.M. 
 
 VOCATIONAL ADVISER TO THE STUDENTS OP THE BROOKLYN BOYS' HIGH SCHOOL, 
 
 SECRETARY OP THE BROOKLYN VOCATIONAL GUIDANCE ASSOCIATION, 
 
 AUTHOR OF PROFITABLE VOCATIONS FOR BOYS, PROFITABLE 
 
 VOCATIONS FOR GIRLS, ETC. 
 
 NEW YORK AND CHICAGO 
 THE A. S. BARNES COMPANY 
 
IV57 
 
 1 9 17 
 
 Copyright, 1917, bt 
 E. W. WEAVER 
 
 PRESS OF 
 
 THE NEW ERA PRINTING COMPANY 
 
 LANCASTER, PA, 
 
^ 
 
 t 
 
 The final proofs of this book were completed on November 
 
 ^th, IQ17. Shortly after midnight on the 
 
 morning of that day 
 
 Xutber ©berlin XKIleaver 
 
 aged 18 years, 7 months, 24 days, a graduate of the 
 Brooklyn Boys^ High School, 
 
 who had assisted in collecting material for these pages, 
 was sent at the time of the destruction of the U. S. 
 patrol boat Alcedo by a German submarine, to his last 
 sleep in an unmarked grave somewhere in the broad 
 Atlantic far from the quiet churchyard where rest the 
 ten generations of descendants of his German ancestors 
 who took refuge from oppression in the American wild- 
 erness. By his enlistment at the outbreak of the war, 
 he was compelled to decline a prof erred college scholar- 
 ship because, as he expressed it, ''^my obligations to my 
 country must be put before my claims to her bounty y 
 To his memory this book is dedicated and with this 
 dedication the hope is expressed that whether in peaceful 
 pursuits or dangers of war, the coming generations to 
 whom are accorded the generous benefits of our public 
 schools and colleges will give themselves as unselfishly to 
 the service of humanity as did this young man and his 
 twenty associates who sacrificed themselves in their efforts 
 to make the world safer for democracy. 
 
 t 
 
 ^ 
 
INTRODUCTION 
 
 Approximately 250,000 young people are graduated 
 from our secondary schools every year, many of whom 
 have ambitions to take up professional careers. With 
 the increased cost of preparation for such careers, they 
 are called upon to risk much upon a single decision. 
 They are familiar with the status of the physician, the 
 work of the teacher and the rewards of the clergyman. 
 The pay of the teacher and the remuneration of the 
 minister are matters of common knowledge. The ex- 
 pense of preparation for these lines of service is not so 
 great because of the subsidized training facilities and 
 the availability of scholarships. It is not so easy to 
 answer the inquiries of those who are considering the 
 choice of medicine as a profession. 
 
 To find a safe method of handling these inquirers, the 
 writer who had for a number of years been the voca- 
 tional adviser to the students of one of our large sec- 
 ondary schools undertook to enlist a number of former 
 students who had established themselves in this pro- 
 fession to act as volunteer consultants. It was soon 
 found that physicians, like men engaged in other call- 
 ings, in comparing their achievements with the dreams 
 of their youthful days, believed that every man's calling 
 was to be preferred to their own and their pessimism 
 seemed to chill unduly the ardor of the youthful aspi- 
 rants. A collection of the professional records of young 
 men of known abilities was then made and an effort was 
 made to discover some sound principles of vocational 
 guidance from these records. 
 
vi iNTRODUCTIOlSr. 
 
 The greater number of boys who grew up in a large 
 city began their practice in the cities of their own sec- 
 tion. It seemed desirable for purposes of comparison 
 to have an equal number of records of those who had 
 made places for themselves in smaller towns and cities 
 and in other sections of the country. 
 
 I turned to my brother, who, after fifteen years of 
 successful general practice and active identification 
 with a progressive state medical association, of which 
 for a time he had been president, at the time was so- 
 journing in European medical centers for the purpose 
 of study along some special lines in which he was inter- 
 ested. I wanted to know how the early life histories of 
 physicians could most profitably be studied for the pur- 
 poses which I had in mind. He replied that the way to 
 study physicians is to isolate them and to study them 
 the way that they themselves studied germs and mi- 
 crobes, that he had learned more about the hopes and 
 aspirations and the shortcomings of American physi- 
 cians in Europe than he did by associating with them 
 at home, that these men who represented every section 
 of our country talked more freely about themselves and 
 their work in the dining rooms of European caravan- 
 saries than they did with the possible competitors whom 
 they met in their medical societies at home. 
 
 He undertook to collect some material for me and 
 soon became convinced that it was highly desirable that 
 there should be accessible to the young student such a 
 fair statement of the requirements for success as would 
 deter the thoughtless and the poorly endowed from un- 
 dertaking the preparation, and at the same time so 
 alluring as to stimulate promising candidates to exert 
 themselves to make the fullest preparation before enter- 
 
Introduction. vii 
 
 ing upon practice. The outcome of the matter was that 
 in spite of the exactions of a very busy practice to which 
 he returned he undertook the preparation of this book. 
 
 After the manuscript had been prepared copies were 
 submitted to inquiring young men and they were in- 
 vited to personal consultations after reading it so that 
 it might be determined what additions were needed to 
 cover all possible questions which might arise in -their 
 minds. - 
 
 Finally copies of the revised manuscript were sub- 
 mitted to a number of physicians to find out if, in their 
 opinion, the conditions as they existed were properly 
 reflected. In submitting the manuscript to them as- 
 surances were given that any criticisms which they had 
 to make on the subject were not to be given out over 
 their own names, as it was believed that in this way a 
 freer expression of opinion could be secured. 
 
 Some of these critics seemed to think that special 
 references should be made to courses of instruction 
 which they themselves had found to be particularly 
 helpful; others, that references to medical sects should 
 have been omitted; others desired that mention should 
 be made of the fact that appointments to special hos- 
 pitals were particularly desirable and that young grad- 
 uates should be cautioned against accepting appoint- 
 ments to others. Other helpful criticisms were care- 
 fully considered and as far as possible were incorporated 
 in the text in making the final revisions. 
 
 Special acknowledgments are due to Mr. Robert I. 
 Raiman, assistant principal of the Brooklyn Boys' High 
 School, who read all of the final proofs. 
 
 E. W. Weaver. 
 
CONTENTS 
 
 Chapter Page 
 
 I. The Histoky of Medicine 1 
 
 II. The Place of the Physician in So- 
 ciety V 
 
 III. Desirable Native Abilities 12 
 
 IV. The Financial Requikements 21 
 
 V. Financial Eewards 28 
 
 VI. Pkospects 32 
 
 VII. Systems of Medicine 39 
 
 VIII. The Medical Colleges and their 
 
 Requirements for Admission . -. . . 51 
 
 IX. A General Survey of the Field , . . 57 
 
 X. The Army Service 64 
 
 XI. The Naval Service 69 
 
 XII. The Indian Sekvece 77 
 
 XIII. Sanitary Engineering 83 
 
 XIV. The Philippine Seevice 87 
 
 XV. The Federal Public Health Service 90 
 
 XVI. The Public Health Service 96 
 
 XVII. Hospital Service 105 
 
 XVIII. Laboratory Work 112 
 
 XIX. Medical Inspection of Schools 115 
 
 XX. Medical Missions 118 
 
 XXI. Corporation Service 125 
 
 XXII. The Red Cross 129 
 
 XXIII. Research Work 132 
 
 XXIV. Commerce and Medicine 136 
 
 XXV. Specialism 140 
 
 XXVI. Women in Medicine 146 
 
 XXVII. The Future of Medicine 151 
 
 XXVIII. Medical Laws 157 
 
 XXIX. The Code of Medical Ethics 164 
 
 Appendix 187 
 
 ix 
 
CHAPTER I. 
 
 The History of Medicine. 
 
 According to the beliefs of superstitious ages, cruel 
 demons were watching on every side for chances to do 
 injury to man. Gradually tribes of men built up^ elab- 
 orate ceremonies and invented charms to drive off 
 demons, and they arranged sacrifices and scheduled 
 feasts in order to enlist the aid of helpful spirits. The 
 medicine man was their leader in the performance of 
 these ceremonies. If, from the traditions of the tribe 
 and from his own experiences, he learned the demands 
 of the demons well enough, and understood the voices 
 of good spirits so that he could wisely select camping 
 places, know the seasons for making victorious attacks 
 upon enemies, found out how to arrange for success in 
 the annual hunts, discovered what herbs to place in the 
 food of the tribes upon the solemn occasion appointed 
 to stay plagues, he succeeded in extending his influence 
 over his subjects. 
 
 The Mosaic Law gave minute directions for whole- 
 some living. These directions were enforced by the 
 priests. The disciples of ^sculapius were required 
 to record the stories of their cures upon the tablets 
 which were placed on the walls of the shrines erected in 
 honor of this early Greek physician. 
 
 Real progress in medicine, however, begins with Hip- 
 pocrates, a Greek philosopher, who was bom about 460 
 B.C. He was a careful observer and a conscientious 
 
 1 
 
2 Medicine as a Profession". 
 
 student and was much loved and highly honored by his 
 countrymen He knew the effects of many drugs, under- 
 stood the influences of unsanitary surroundings and was 
 able to ascribe many diseases to unwliolesome diet. In- 
 asmuch as the early Greeks opposed the mutilation of 
 human bodies, he knew little about anatomy. His code 
 of ethics has given dignity to the medical profession. 
 Hippocrates observed carefully the progress of disease; 
 Aristotle, who followed him, through his study of the 
 structure of animals made our first known contributions 
 to anatomy, although it is possible that the Egyptian 
 priests who were accustomed to embalm the bodies of 
 the dead knew something of the structure of the human 
 body. 
 
 Galen, from being the physical director to the gladi- 
 ators of an Asiatic town, rose to the important position 
 of physician to the great emperor, Marcus Aurelius. 
 He knew something of anatomy. His recorded observa- 
 tions show that he knew something of hygiene. He 
 recommended gymnastic exercises, the outdoor life and 
 the use of the bath. 
 
 The physicians of the later Eoman Empire were 
 imitators who based their practice upon the writings of 
 Hippocrates and Galen. For want of careful observa- 
 tion and continued investigation, medicine declined and 
 this decline probably led to the first legal regulation of 
 the practice of medicine. Under the laws of the empire, 
 each town had its official physician, w'ho examined and 
 licensed practitioners. After the time of Constantine, 
 hospitals and dispensaries were established. At later 
 periods the monasteries became hospitals. 
 
 In the absence of any strong central government 
 during the several hundred years of confusion, com- 
 
Dr. William Harvey 
 
The History of Medicine. 3 
 
 monly spoken of as the dark ages, little progress was 
 made in the study or the practice of medicine. The 
 Arabs in Spain established the first apothecary shops 
 and through their studies in alchemy accumulated a 
 varied knowledge of remedies. Avicenna, one of their 
 learned men, made a detailed and systematic compilation 
 of the writings of the earlier Greek physicians and of 
 their Arabian successors. During this period, the works 
 of the old masters were taught in the University of Sa- 
 lerno. This university also issued diplomas in medicine 
 to women. In the thirteenth century, we find that 
 Frederick II of Naples decreed that no one should be 
 allowed to practice the healing art until he had received 
 his diploma and had served one year with an experienced 
 doctor. The final examination was intended to test 
 the knowledge of the applicant about the writings of 
 Hippocrates, who had lived sixteen hundred years be- 
 fore, and of Galen, who had been dead over a thousand 
 years. Each candidate, under oath, was required to 
 promise to obey the laws of the state, live a pure life, 
 give his service to the poor, and not to share in the 
 profits of the apothecary. 
 
 Throughout Europe about the time of the discovery 
 of America, the practice of medicine was almost exclu- 
 sively done by the monks and the clergy of the lesser 
 orders. Their religious scruples did not permit them 
 to let blood. Surgery gradually fell to those who had 
 diplomas. These learned men practiced almost exclu- 
 sively among the wealthy, and in addition to the letting 
 of blood for bodily distempers, bandaging their wounds, 
 they shaved their heads. The surgeons of the rich were 
 also their barbers and the barbers of the poor were their 
 surgeons. The common people, also, had their wise 
 
4 Medicine as a Profession'. 
 
 women who attended them in sickness, applied home- 
 made ointments to their wounds, and supplied them with 
 charms to ward off malign influences. 
 
 Strange compounds were prescribed. A remedy for 
 consumption as set forth in an old volume was prepared 
 by taking thriftgrasse, betony, peygrasse, fane, fennel, 
 Christmaswort, and making them into a potion with 
 clear ale. The breath of a donkey was supposed to drive 
 out poison. A bleeding nose was to be cured by slipping 
 a key down the patient's back. For stopping a cough 
 the patient was advised to spit into the mouth of a frog. 
 These foolish prescriptions were to be undertaken in 
 certain phases of the moon. 
 
 When we consider the prevalence of such absurd no- 
 tions and learn of the absence of sanitation in city and in 
 country and read of the filth surrounding military 
 camps, we wonder that the race ever survived. In truth, 
 it was not an unusual thing for plagues to devastate 
 entire countries. In the reign of William and Mary, 
 England was swept by an epidemic of smallpox. The 
 queen herself fell a victim to the scourge. For treat- 
 ment, the patient was given a black powder supposed to 
 have been made from the ashes of burnt toads. During 
 this age bleeding was practiced for every kind of dis- 
 order, either by opening blood vessels or by applying 
 blood-sucking leeches. It is said of one great French 
 doctor, that in his hospital he used 100,000 leeches. 
 
 During these centuries of stupidity, valuable experi- 
 ences were accumulated and the foundations were laid 
 for discoveries which add to the usefulness of the physi- 
 cians of the most remote hamlets of our day. These 
 old-time doctors were taught to follow blindly the tradi- 
 tions which were handed down to them. Their knowl- 
 
The History of Medicine. 5 
 
 edge of the human body was too limited to permit thean 
 to reason intelligently about the causes of disease and 
 the nature and effect of their remedies ; they had no in- 
 struments ; they were ignorant of the common principles 
 of everyday science as we know them and they had never 
 learned the methods of investigating new problems. 
 
 As a new age dawned a period of rapid progress fol- 
 lowed in medicine, as in other departments of knowl- 
 edge, introducing us to a long procession of men of great 
 brilliance. Andreas Vesalius published an elaborate 
 book on anatomy which stimulated the teaching of that 
 subject in all the universities; Montanus of Padua lec- 
 tured to his students at the bedsides of his patients, in 
 which practice he was followed by Sylvius of Holland 
 and the great Boerhaave of Leyden. They taught men 
 how to study the progress of disease, how to learn the 
 effects of disorders by examining the bodies of the dead, 
 and how to apply new discoveries in physics and chem- 
 istry in the art of healing. William Harvey, an English 
 physician, in 1628, published to the world his doctrine 
 of the circulation of the blood. With the invention of 
 the microscope the nature of the tissues of the body was 
 better understood, and after the invention of the stetho- 
 scope by Laennec, a French physician, the diagnosis of 
 diseases of the chest was established upon sound prin- 
 ciples. 
 
 The invention of printing aided in the circulation of 
 these new discoveries and in the wider distribution of 
 the writings of the older investigators and practitioners. 
 Medical schools multiplied. Better equipped men began 
 to interpret anew the experiences of their predecessors 
 and to carry on the search for new remedies. The uses 
 of Peruvian bark were learned from the natives of South 
 
6 Medicine as a Profession". 
 
 America, about 1649, introducing a surer metliod for 
 handling fevers. In 1798, Jenner announced to the 
 world a method for controlling smallpox by vaccination. 
 This list of beacon lights in medicine might be continued 
 at great length but the details of the story of progress 
 belong to the history of medicine and the biographies of 
 its illustrious men. 
 
 With the recognition promptly given to those who 
 have made new discoveries, there has come about that 
 change in attitude which has made of every physician of 
 our day a scientific investigator and has filled our clinics 
 and laboratories with young men eager to add some new 
 contributions to this important science and it has 
 crowded our hospitals with practitioners whose chiefest 
 desire is the perfection of some details of their art. 
 The doctor of to-day is the very prince of professional 
 men. The service which he renders may not be of a 
 higher order than the services which are rendered by 
 men in other professions but his spirit is one of greater 
 and more devoted unselfishness. 
 
 Well were it for the candidate if, before making his 
 final choice, he could take time to read the life histories 
 of some great physicians. If he would succeed, he must 
 remember that he is to enter the ranks of men, many of 
 whom have mastered much of the accumulated inher- 
 itance of this age by long and patient study, and that 
 when he enters upon the practice of his profession he 
 must go before a public which for generations has been 
 accustomed to be ministered to ungrudgingly by those 
 who were moved chiefly by motives other than the tan- 
 gible rewards of their profession. 
 
Edward Jenner^ M.D. 
 
CHAPTER II. 
 
 The Place of the Physician in Society. 
 
 Some persons will seek to enter a calling so as to 
 establish themselves in such a way tliat they may later 
 engage in the larger and fuller relations of life, others 
 take up a vocation in the expectation of making it their 
 exclusive pursuit. Lawyers frequently change from 
 their profession to take up mercantile pursuits, become 
 leaders in corporations or to engage in public service. 
 Men who have been trained for the ministry, too, are 
 found in other walks of life. Ordinarily in every group 
 of professional men about one third of all are over forty- 
 five years of age. Of all the physicians enumerated by 
 the census of 1910, nearly forty per cent, were over this 
 age. This proba;bly means that those who prepare for 
 this profession continue in it and that it is more than 
 likely that they do so because they find in their work 
 the durable satisfactions of life. 
 
 These durable satisfactions for the average man in- 
 clude more than the financial rewards which come to 
 him from his work and it may be well to consider what 
 medical men have achieved outside of their daily occupa- 
 tions. They have been the pioneers in many scientific 
 fields. Ever searching for new remedies, they have 
 studied plants and become our first botanists. Otto 
 Brunfels, a physician of Berne, may be called the father 
 of the botanical sciences. Dr. Benjamin Barton of 
 Philadelphia and Jacob Bigelow, a Boston practitioner, 
 2 7 
 
8 Medicine as a Profession. 
 
 achieved world-wide reputations as botanists before 
 Americans attracted attention in literary fields. Theo- 
 dore Schwann, the son of a German cobbler, became the 
 founder of biology. John and William Hunter, who 
 were in their days the leading physicians of England, 
 were also the leading naturalists. Dr. Joseph Leidy of 
 Philadelphia was a pioneer in zoology. Galvani, who 
 was the first to call attention to' animal electricity, was 
 an Italian physician. Lothar Meyer of Germany and 
 Dr. Berzelius of Sweden made important advances in 
 chemistry, to which science physicians of all ages have 
 made contributions. 
 
 From the very nature of their training we would ex- 
 pect doctors to be students and lovers of books and it is 
 not surprising to find in their ranks the makers of books 
 of popular interest as well as writers of books dealing 
 with professional and scientific subjects. Sir Thomas ^ 
 Browne's Religio Medici has had appreciative readers 
 for nearly three centuries. Dr. William Osier, of our 
 day, writes that it was the reading of this book that de- 
 termined him to become a physician. John Keats wrote 
 verses while serving as an attendant at a London hos- 
 pital. Dr. Oliver Wendell Holmes is more widely known 
 for his contributions to literature than for his lectures 
 to Harvard medical students. Thousands who have been 
 entertained by the delightful stories of S. Weir Mitchell 
 never knew that he was one of the leading physicians of 
 his day, and every school boy has found healthful enter- 
 tainment in the reading of Rab and his Friends by Dr. 
 John Brown. 
 
 The advances in sanitation to which we owe the im- 
 proved living conditions of our cities and the redemption 
 of hitherto uninhabitable portions of the globe have been 
 
Place of the Physician in Society. 9 
 
 made under the leadership of puhlic-spirited medical 
 men. The ventilation of factory buildings, the use of 
 safety devices on dangerous machinery and the pro- 
 tection of workingmen in hazardous occupations has been 
 brought about through the efforts of medical societies. 
 
 In self-f orgetfulness, these men have performed heroic 
 service on the field of battle and too often history has 
 permitted the dashing performances of military leaders 
 to obscure the vs^ork which was done by the medical 
 staffs of the armies in earing for the campaigners and 
 the tireless labors of the surgeons in the wake of retreat- 
 ing armies. Volumes have been written about the com- 
 manding officers of the armies in the wars between 
 Francis I. and Charles Y., while mention is hardly made 
 of the improved methods of treating wounds by Ambroise 
 Pare, the chief surgeon of the French armies. If his- 
 tory were properly written, Alphonse Laveran, who dis- 
 covered the cause of malaria while with the French 
 armies in Algeria, would be accorded as much prom- 
 inence as that which is given to the military leaders of 
 that expedition, and the labors of Walter Eeed and his 
 associates in dealing with typhus and yellow fever dur- 
 ing the Spanish American War would far outshine 
 the heroism of the leader in the charge on San Juan 
 Hill. 
 
 Nor should it be wondered at that those whose work 
 has to do with the mysteries of life and death should have 
 in their ranks persons of great piety and deep religious 
 convictions. Medicine has no nobler pages than those 
 which record the stories of the lives of Dr. Grenfell, the 
 medical missionary to the scattered people along the 
 coast of Labrador, and Dr. David Livingstone, who first 
 penetrated into the interior of darkest Africa. 
 
10 Medicine as a Profession. 
 
 Physicians have been influential in many ways, be- 
 cause of their intimate personal relations, through which 
 they have won the confidences of large numbers of their 
 fellows. As members of boards of trustees of colleges 
 and universities and of educational committees they 
 have been leaders in popular education. They have 
 done more than any other class in establishing hospitals, 
 in promoting prison reform and in improving the meth- 
 ods for caring for the dependent and defective classes. 
 
 The members of the profession have done their share 
 in the fields of politics and government. Vesalius was 
 the confidential adviser of the great emperor, Charles V, 
 not only in matters relating to the health of the royal 
 household but in the affairs of state; Thomas Linacre 
 was not only a physician but a leading statesman of the 
 time of Henry VIII ; Corvisart, the physician to Napo- 
 leon, influenced him in many affairs; Benjamin Push 
 was one of the signers of the Declaration of Independ- 
 ence and was regarded as one of the foremost citizens 
 of Philadelphia and highly honored because of the serv- 
 ices which he rendered during a scourge of yellow fever ; 
 Josiah Bartlett, Lyman Hall, and Oliver Olcott were 
 also signers of the Declaration and later served as gov- 
 ernors of their respective states ; and Matthew Thornton, 
 another signer, rendered important services to the Con- 
 tinental armies during the Revolution and later was a 
 member of congress. 
 
 During recent years the period of preparatory study 
 has been lengthened and professional progress has been 
 so rapid that only by the most careful management of 
 his time and energy has the medical student and the 
 practitioner been able to keep pace with progress and 
 
Place op the Physician in Society. 11 
 
 more and more meclicine lias tended to become the ex- 
 clusive pursuit of the members of the profession. 
 
 This tendency towards exclusiveness of interest seems 
 to make it all the more desirable for the physician to have 
 some avocation to which he can turn for a change or 
 some hobby to carry his mind away from the burden of 
 his daily routine. Many of the older physicians have 
 turned to some secondary pursuits, in which not a few 
 have distinguished themselves. Leopold Auenbrugger, 
 the great Viennese of the eighteenth century, was author 
 of a musical comedy ; Claude Bernard, the noted French 
 physiologist, was writer of plays; Titus Tobler, a Swiss 
 physician of the nineteenth, century, achieved fame 
 as an orientalist. The practitioners of later years have 
 found relief from the burdens of their work in athletics 
 and sports, in collecting, and in country life occupations. ; 
 
 After this brief review, as an introduction to the next i 
 chapter, we may say that he who would succeed in this t 
 time-honored profession must have in him a promise of 
 physical endurance and such a power of close intellectual ' 
 application as will help him to the ready mastery of \ 
 great accumulations of knowledge. He must be well 
 trained to the wise use of his time and his energy and be 
 prepared to deny himself all other ambitions and yet 
 have some other interests sufficiently absorbing to take / 
 his mind from his day's work. 
 
 Reading References. 
 
 The interested student will do well to read the sketches 
 of the men mentioned in these two chapters as they are 
 given in any good encyclopaedia or in biographical dic- 
 tionaries and also a few of the more extended biographies 
 which are listed in the appendix to this book. 
 
 \ 
 
CHAPTER III. 
 
 Desirable Native Abilities. 
 
 In answer to the question — Shall my son prepare for 
 medicine? — a distinguished physician wrote to his 
 friend : *^ There is on earth nothing greater or more beau- 
 tiful than man, and the study of mankind is the most 
 difficult and exalted subject of thought and action. Hu- 
 man development and ambition, human life and ills are 
 all in the highest degree remarkable and touching. But 
 you must bring with you keen eyes and acute ears ; a great 
 gift for observation ; patience, and yet more patience for 
 endless study; a clear critical mind; an iron will 
 strengthened by opposition, but yet a warm and tender 
 heart, comprehending and feeling every sorrow; a rev- 
 erent spirit and austerity that is superior to sensuality, 
 money or eminence; furthermore a decent appearance, 
 polished demeanor, adroit fingers and health of body and 
 soul. All of these you must possess if you would not 
 become either an incompetent or an unhappy physician. 
 You must stagger under the crushing burden of unend- 
 ing knowledge, and yet preserve the light-heartedne'ss 
 of the poet ; you must know all the arts of the charlatan 
 and yet remain an honest man; once for all, medicine 
 must be your creed and your politics, your happiness 
 and your misery. Therefore, advise no one to become a 
 physician. If he still wishes to do so, warn him against 
 it often and earnestly; but if he persists in spite of all, 
 
 12 
 
Desirable Native Abilities. 13 
 
 give him your blessing, if he is worth it, for he will need 
 it." 
 
 This advice is equivalent to saying that no young 
 man should think of entering this profession, and no 
 other profession for that matter, unless he has a sure 
 faith in his abilities to overcome all obstacles which he 
 may find in his way. Surely there is no surer way by 
 which a young man may fortify himself than by placing 
 in order all objections which can be raised against a cer- 
 tain course of action, and by successively proving that 
 none of them is unsurmountable. Unfortunately young 
 men should enter upon their definite preparation for 
 medicine about the age of twenty or before, at which 
 time, the spirit of youth with its vacillations has not 
 always been outgrown. It is not ever best for friends 
 to be too real in the terrorism which they picture to the 
 anibitious youth who comes to them for advice. It may 
 be safe to say that the chances of success in a profession 
 increase with the strength of the call which compels 
 the candidate to enter upon that profession and it may 
 also be said that for those who find their highest satis- 
 faction in social service, medicine supplies a well-defined 
 field of work. 
 
 ^ Here is an extract from a letter written by a medical 
 student in Paris in 1832: "The morning from seven to 
 ten is occupied by a clinic at the hospital ; there are sev- 
 eral clinics; each of them has its advantages. I shall 
 vary my attendance at the different hospitals, but at 
 this moment we are following Piorry at the Salpetriere, 
 two or three miles from our lodgings. From Salpetriere 
 we hurry to La Pitie; we listen to a surgical lecture, 
 reach home in time for breakfast and then to the school 
 of medicine. Lectures, with a private course in anat- 
 
14 Medicine as a Profession. 
 
 omy, fill up the day till four ; after wliicli a private clinic 
 introduces me to some very interesting cases. We dine 
 at five and then again to lectures till eight. 
 
 This letter makes no mention of tl^o time needed to 
 write up notes and to digest lectures and to do reading. 
 Such a routine requires the strong physical constitution 
 of a well-matured individual. It calls for a very tena- 
 cious purpose to carry a student successfully through 
 from four to eight of the best years of his life of the 
 unrenumerative labor of his undergraduate days and it 
 likewise requires equally stern qualities to resist the 
 physically deteriorating and discouraging influences 
 which come in the following years of watchful waiting 
 for patients. Moreover since the physician receives his 
 largest monetary returns from his practice after the 
 ripened judgment of that period of life when most other 
 men are ready to retire we must conclude that a robust 
 constitution is a first essential from a candidate who 
 expects to secure reasonably profitable returns from his 
 investments of time and money in preparing for this 
 profession. 
 
 The growing conviction that the profession makes 
 high requirements, perhaps, accounts for a constantly 
 increasing number of the matriculates of our medical 
 schools who drop out before graduation. This also ex- 
 plains why in the ten years preceding 1914 the number 
 of male students in these schools has decreased 40 per 
 cent.; the number of male graduates, 37 J per cent.; the 
 number of female students decreased 44 per cent.; the 
 number of female graduates, 50 per cent. 
 
 The medical student must detach himself from his 
 own circle in order to give his time to his studies and 
 yet when he would begin his practice he accumulates his 
 
Desirable Native Abilities. 15 
 
 patients by his_ability to enter into the social life of his 
 commnnity; he must be trained in scientific and exact 
 methods and yet be able to meet the frivolous somewhat 
 on their own plane; he must be social and affable, and 
 yet he is forbidden to bring into his social relations any 
 echoes of his daily work; trained in the making a true 
 estimate of men and women and yet blind to the frail- 
 ties of humanity; professionally, firm in dealing with 
 the truth as he sees it and socially ready to be all things 
 to all men. All of which means that he should have had 
 behind him a broad social experience, the lack of which 
 is perhaps one of the heaviest handicaps to the young 
 men from the working classes and the boy from the 
 country with limited social opportunities. Eesidence 
 during his medical course in a social settlement or in a 
 Young Men^s Christian Association home may be recom- 
 mended as a means for supplying an extended social 
 experience. 
 
 A large number of those who make up the army of 
 150,000 American medical men and most of the 3,500 
 recruits who leave the medical colleges every year to 
 take the places of those who drop out of this army have 
 great natural gifts ,and are filled with the true scientific 
 spirit for investigation and for giving to the world the 
 results of their studies which means a great annual flood 
 of medical literature. Ignorance of tried and proven 
 methods of saving from death in any of its varied forms 
 is criminal; so that we must add that it requires great 
 intellectual aptitudes to enable a practitioner to keep 
 squared with himself, to say nothing of his reckoning 
 with the public and his competitors. This means that 
 the young man who would succeed in this profession 
 should be able to accomplish the prescribed school course 
 
16 Medicine as a Profession". 
 
 in much better than the average pace; say finish the 
 high-school course at sixteen and the college course by 
 the time the age of twenty is reached. He should be 
 ready and excellent in his freehand drawing, which 
 means a gift for observation; dexterous in his manual 
 training, which means a facility to adapt means to 
 ends; commendable in his mathematics, which means 
 skill in reasoning; excellent in languages, which signi- 
 fies readiness in extracting information from his profes- 
 sional books later in his career ; absorbed in his sciences, 
 which gives promise of the ability to acquire the essen- 
 tial spirit of his profession. 
 
 The period of physical growth ends with many at 
 twenty and the period of intellectual growth is with some 
 more limited, and such may do well in the routine work 
 of the shop. The business man can crowd a great deal 
 of work into his day, much of which is of a routine char- 
 acter; but that community whose physician has fallen 
 into the routine of beginning every consultation with a 
 diagnosis and ending with a physic will be called upon 
 to lay increased burdens upon those whose duty it is to 
 pray for its living and its dead. 
 
 Let us look into the daily life of a physician* to see 
 just what it calls for in the way of powers of endurance. 
 Just as he is entering upon a good night's rest his tele- 
 phone bell calls him to a remote neighborhood, where in 
 the midst of the surroundings of the poor, frantic par- 
 ents are watching a suffering child. The pulse is feeble. 
 The situation calls for a man with an observant eye 
 which has been trained by long and patient scientific 
 study, to the quick and confident decision which char- 
 acterizes the man accustomed to all the thinking proc- 
 esses, and the resourcefulness which comes from a wide 
 
Desirable "N"ative Abilities. 17 
 
 experience, in order that an operation may be performed 
 under nnfavoraible conditions without trained help, and 
 courage to face the possibility of carrying the malignant 
 diphtheria back to his own children. A brief rest and 
 then his morning office hours with their procession of 
 suffering humanity; the nervous woman who needs 
 mental treatment more than medicine; the woman of 
 careless habits and evil ways who should be treated to 
 the rigors of the law, whose case he can handle because 
 he has had the shrewdness of the detective to discover 
 the causes of ailments which she would conceal from 
 him ; and then the man who would have the doctor falsely 
 certify to physical disabilities, so as to permit him to 
 escape, for a time, deserved punishment by being ex- 
 cused from obeying the edict of a court of law. He is 
 prominent and influential, he beseeches and threatens. 
 The case calls for a high degree of moral rectitude 
 which disregards consequences. 
 
 In his afternoon round of visits, he finds at the bedside 
 of a sufferer from a long-standing disease, a friend who 
 represents to his patient that another physician has 
 treated such cases much more successfully by entirely dif- 
 ferent methods ; the consultation must be carried on with 
 a forgiving spirit into which few other men could readily 
 enter. The afternoon ends with a visit to a hospital for 
 contagious diseases, in which one of his own patients 
 has taken an unfavorable turn. At the end of the long 
 day he must be able to concentrate his mind upon the 
 long history of a stubborn case. He reviews his former 
 judgments of the disturbing causes, recalls to his mind 
 long lists of similar cases, examines into the diet of the 
 patients, analyzes the reports of the nurses, and notes 
 the effects of the prescribed treatment in order to deter- 
 
18 Medicine as a Profession. 
 
 mine what modifications in his methods of handling the 
 case are desirable. 
 
 The day may not be without a call from a fellow prac- 
 titioner for a consultation over a troublesome case, in 
 the handling of which he is sure that his fellow has 
 blundered, yet concerning which he dare not fully ex- 
 press himself without having his motives misconstrued 
 and this calls for Christian forbearance. Then comes 
 a brief rest and the evening office hours. 
 
 Less than in any other line of work requiring a long 
 period of intellectual training will either race or color 
 be a handicap to a physician. In those quarters of our 
 cities inhabited by the descendants of the foreign born 
 there is the same opportunity for those of any given 
 class to win rewards which are relatively equal to those 
 which are open to the native born among their own 
 people. That only 10.8 per cent, of our physicians in 
 this country are foreign born when 20.5 per cent, of the 
 population are foreign born, and that only 2 per cent, 
 of the physicians are colored when 13.6 per cent, of the 
 population is colored is perhaps due to the fact that not 
 so many of these classes can afford the outlay which is 
 needed by those who would prepare for the practice of 
 medicine. 
 
 In 1907 there were 28 registered negro physicians in 
 Philadelphia and 14 in Pittsburgh and in 1912 there 
 were 59 in the former and 28 in the latter city. A negro 
 graduate of the Harvard Medical School who began his 
 practice in Philadelphia in 1869 continued up to his 
 death in 1912, and the first negro woman graduate who 
 began to practice in 1878 is still in practice in that city. 
 
 Though he has a strong constitution to hold himself 
 in readiness for emergencies in each of the twenty-four 
 
Desirable Native Abilities. 19 
 
 hours of the day when others are clamoring to have the 
 working day restricted to eight hours for six days of the 
 week, and though he has physical courage to enter pest 
 houses and lazarettos and the moral courage to refuse 
 to countenance wrong, the intellectual grasp to possess 
 all knowledge and an evergrowing mind, diplomacy and 
 tact and Christian forbearance and social training which 
 will make him welcome in all circles, the physician will 
 not be happy in his work unless he will be proof against 
 envy as he sees inferior men in business overburdened 
 with the possession of those things which appeal to the 
 taste of cultured people and which are denied to him 
 and his, and without jealousy when he sees unworthy 
 men win honors and enjoy the emoluments of high 
 places while he must perforce live his solitary life with 
 an unending succession of human frailties and in- 
 firmities. 
 
 It may be repeated that many of these essential qual- 
 ities are developed by men and women sometime after 
 the age when preparation for this profession should be 
 planned. For those who fail to develop some of these 
 essentials for success after making their preparation 
 there is open that very large field of the business of pro- 
 viding the supplies which are needed in medical work 
 and in which the training given by the medical school 
 will stand in good stead ; then there is that ever-growing 
 field of medical research in which those who are not 
 adapted for general practice may hope to succeed; and 
 that almost untouched field of industrial betterment, for 
 success in which there could be no better preparation 
 than a medical course. Those who later develop a high 
 degree of executive ability will find an attractive field 
 
20 Medicine as a Profession". 
 
 in public health movements and in the management of 
 hospitals and asylums and in public charities. 
 
 In spite of the high requirements it seems that the 
 percentage of failures in the profession is not high. 
 Sir James Paget of London followed the history of a 
 thousand medical students in Great Britain and Ireland. 
 He concludes that 23 of these may be considered to have 
 achieved distinguished success; 66, considerable success; 
 507, fair success; 24, limited success; 41 died before 
 beginning to practice and 87 within twelve years after 
 beginning their careers; 56 failed entirely and 96 aban- 
 doned the profession for other callings. A careful study 
 of biographical dictionaries discovered a very few per- 
 sons who were educated for medicine who took up other 
 callings. A few were found who had entered journalism, 
 one who took up play writing; several who became offi- 
 cers in business corporations and a few who took up 
 social work and several who entered the ministry. With 
 the stricter requirements for admission to the medical 
 colleges the percentage of failures will likely be lessened. 
 
CHAPTEE IV. 
 
 The Financial Eequirements. 
 
 The prudent man who would embark upon a long 
 voyage first takes an account of his resources and tries to 
 estimate the cost of the trip. Young people for whom 
 liberal provisions have been made by self-sacrificing 
 parents and the tax-paying public during the period of 
 their infancy, sometimes expect such subsidies to con- 
 tinue long after they have passed from infancy to man- 
 hood. It is true that our states and the citizens have 
 given liberally towards the encouragement of professional 
 education, but some expenses must be met by the stu- 
 dent and he should at the outset have a fairly definite 
 idea of such expenses and his prospects of meeting them 
 as they become due. 
 
 Dr. Samuel Bard, who left the colonies before the 
 Eevolution in order to get his medical education at the 
 University of Edinburgh, estimated upon his return that 
 his outlay for travelling, living and schooling was nearly 
 a thousand pounds. Although the purchasing value of 
 money has changed since then, yet from four to five 
 thousand dollars comes very near to being the cost of a 
 medical education in this day. 
 
 Thirty-four medical colleges require two or more years 
 of college work before admission and fifty require one 
 full year, so our estimate may well be based upon six 
 years of study after the completion of a high-school 
 course or its equivalent. 
 
 21 
 
22 Medicine as a Peofession". 
 
 We will consider a boy from a town remote from a 
 medical college who would enter upon the study of medi- 
 cine and his brother who will go into skilled trade. 
 The mechanic is not generally accepted in a trade as an 
 apprentice until he is sixteen and in some trades not 
 until he is eighteen years old. By this time the medical 
 student should be ready for college and by the time the 
 mechanic has served his apprenticeship and be ready to 
 earn wages averaging from $750 to $1,000 a year, the 
 medical student will be within one year of graduation. 
 During his apprenticeship the mechanic will possibly 
 earn enough to pay for his own support ; so for the pur- 
 poses of comparison we must add to the expenses of a 
 medical education the cost of living and we will assume 
 that inasmuch as the average length of the term in 
 the medical college is thirty-four weeks, that the medical 
 student during his vacations will be able to earn enough 
 to pay for his clothes and spending money. 
 
 In one fourth of the medical colleges of the country, 
 the total fees are between $600 and $700. In another 
 one third the charges are in excess of this amount, so 
 that we will assume $750 as the total of fees for tuition. 
 For laboratory expenses, text-books, reference books and 
 society dues we must allow $250. Boarding even in 
 mess halls and boarding clubs will likely be more rather 
 than less than $800 for the four years. This brings 
 the cost exclusive of travelling expenses to $1,800. In 
 New York, Boston and Chicago, it is more likely that 
 the cost will be $2,500 for male students and $3,000 
 for those female students who are not able to live in 
 their own homes or with relatives. To this must be 
 added the cost of the time at college before entering 
 upon his medical studies. Young men can usually ex- 
 
The Financial Requirements. 23 
 
 pect to secure free tuition or college scholarships in most 
 of the states, so that the expenses at college will be from 
 $500 to $1,000 for the two years. This will make a total 
 expense of from $2,250 to $4,000 without making any 
 allowance for sickness or failures in promotion. 
 One physician estimated his expenses as follows: 
 
 Tuition $150 
 
 Laboratory expenses 10 
 
 Board and lodging 160 
 
 Text-books 60 
 
 Clothing and incidentals 130 
 
 Traveling expenses 40 
 
 Total $550 
 
 For the four years $2,200 
 
 This total does not include any allowance for the pre- 
 liminary college expenses nor for loss in earnings while 
 attending medical college, and it is based upon living 
 expenses in a city in which expenses are comparatively 
 low. 
 
 An out-of-town student who was graduated from one 
 of the best New York medical colleges in 1914 reported 
 that his entire expenses were as follows : 
 
 For the preparatory year $800.00 
 
 His first year 755.28 
 
 His second year 819.83 
 
 For the third year 1,133.46 
 
 For the fourth year 1,300.00 
 
 A more economical student at the same school re- 
 ported a total expense for the four years at medical col- 
 lege of $1,370 exclusive of living expenses. It has been 
 generally concluded by recent medical gi'aduates who 
 have been interviewed that it is not desirable for the 
 
 3 
 
24 Medicine as a Profession. 
 
 student to attempt to earn anything towards his ex- 
 penses during the time when the colleges are in session. 
 
 A careful study of a number of records has led to the 
 conclusion that the cost of a medical education must be 
 considered as, at the least, $3,000 more than the cost of 
 preparing for a skilled trade. The cost for female stu- 
 dents will be higher, because there are not many free 
 scholarships available in colleges for women and because 
 the income from vacation earnings will likely be less 
 than for male students. 
 
 Some of the very comfortable reformers who believe 
 in regulating all the affairs of men by legislation could 
 find many good arguments for refusing admission to a 
 medical school those who cannot prove at the outset that 
 they have $3,000 in available cash resources, but such 
 would also have excluded from the study of medicine, 
 Leopold Augenbrugger, the son of a poor tavern keeper, 
 who became the physician to the empress, Maria 
 Theresa ; Theodore Schwamm, the fourth of the thirteen 
 children of a poor German cobbler, who is noted as the 
 father of the cell doctrine; Johannes Muller, the son of 
 another German shoemaker who became the foremost 
 physician of Germany in his day; and James Simpson, 
 the youngest of a poor Scotch family of seven who is the 
 father of anesthetics. Perhaps one half of those at 
 present attending medical schools are successfully pur- 
 suing their studies in spite of financial worries. 
 
 It has been the experience of many who borrowed from 
 friends the greater part of the necessary $3,000 and 
 took out life insurance policies for that amount to pro- 
 tect their creditors in case of their death, that by the 
 age of thirty they were enabled to repay their loans with 
 interest, and it may well be considered whether it would 
 
The Financial Eequieements. 25 
 
 not have been as well for them if they had worked and 
 saved for a few years before entering upon medical 
 school^ thus bringing a larger maturity to their studies, 
 incurring smaller obligations and being perhaps as far 
 at the age of thirty as if their educational training had 
 been continuous. 
 
 One ambitious young man who spent the vacations 
 of his college course in selling subscription books secured 
 a position as a district manager with his employers and 
 from this employment he was able to make enough dur- 
 ing his vacations while attending the medical college 
 to provide for all his expenses. At the end of his col- 
 lege course he went back to his college and organized 
 selling squads among the students and directed these 
 squads during his vacations while taking his medical 
 course. 
 
 Another young man graduating out of the same class 
 went into the office of a manufacturer of medical sup- 
 plies expecting to work a few years before going to 
 medical college. His work was so satisfactory that he 
 was soon started on the road as a salesman. He applied 
 himself so energetically to his work that within three 
 years he was able to save enough for his entire medical 
 course. In addition to his earnings he secured an ex- 
 perience which gave him a most helpful outlook over the 
 professional field. 
 
 A physician who has a lucrative practice as a special- 
 ist in nervous diseases, when interviewed, gave this 
 story. As a country boy he drifted to the city to make 
 his fortune. For want of anything else he accepted 
 a place as a waiter in a restaurant, and later secured 
 work in the dining-room of a large hotel. This experi- 
 ence recommended him for a better paying position as 
 
26 Medicine as a Proeession. 
 
 an attendant at a sanitarium in which he was able to 
 earn good wages and save considerable money. The phy- 
 sician in attendance being attracted by the way in which 
 he handled the patients advised him to take up the study 
 of medicine. By the time he was twenty-five he had 
 saved enough money for his medical course and had ad- 
 vanced himself in his studies so as to be able to meet the 
 requirements for admission to the medical school. 
 
 A young man, now thirty years old, who holds a posi- 
 tion in a government laboratory with a $2,750 salary, ex- 
 plained that during college he had specialized in biology 
 and after graduation accepted a position as teacher of the 
 subject in a city high schood, which he held three years, 
 meanwhile doing some of the required medical college 
 work so that he was able to graduate after two years of 
 regular attendance. 
 
 A young colored man who supported himself by work- 
 ing as a waiter in a boarding house while he was taking a 
 special college course in chemistry, worked as an assist- 
 ant in a chemical laboratory for a few years after his 
 graduation from college, saving about half of the money 
 necessary for his medical course and attracting the 
 favorable attention of an employer who volunteered to 
 make him a loan to meet his additional financial needs. 
 
 A young Hebrew who graduated from one of our 
 medical colleges with credit, in 1914, had landed with 
 an older brother in this country at the age of sixteen 
 with a fairly good elementary education. His eyesight 
 was not good, he could not speak the language of a 
 strange land, but he secured admission to a city high 
 school on the strength of his school credentials, and not 
 only maintained creditable standing while attending 
 this school but supported himself by serving a news- 
 
The Financial Eequirements. 27 
 
 paper route mornings and evenings, working from four 
 in the morning to ten in the evening. In addition to 
 paying his share of the modest quarters which the two 
 brothers occupied he paid for two suburban lots on the 
 installment plan. When he was ready to enter the 
 medical college he sold these two lots for $1,200 and 
 with the assurance of support from his brother entered 
 upon his medical course with no special worries about 
 the sources of his income. 
 
 A young woman, who after graduating from high 
 school decided to take up medicine, prepared herself as 
 a stenographer and acquired an experience which recom- 
 mended her for a position as stenographer to the dean 
 of a medical college. While serving in this position 
 she was able to take occasional lecture courses and after 
 she entered the medical school as a regular student 
 she made a considerable part of her expenses by selling 
 typewritten copies of her lecture notes to other students. 
 
 It is usually not difficult for young men and women 
 to obtain remunerative work as attendants at hospitals 
 and sanitariums. This kind of work gives the prospec- 
 tive medical student a chance to test his fitness for the 
 peculiar requirements of the profession and at the same 
 time makes it possible for him to earn something more 
 than he would earn in those occupations which are ordi- 
 narily open to those without any special training. In 
 another chapter there is given a list of such institutions 
 in different parts of the country to which application 
 can be made. 
 
CHAPTEE V. 
 
 Financial Eewaeds. 
 
 The exceptional few, who are impelled to take up this 
 profession because they are endowed with such a rare 
 combination of native talents as to find that the routine 
 of the physician makes to them a special appeal, will be 
 sure to succed and to find the calling so remunerative 
 and satisfying that it would have been a misfortune to 
 them to have permitted themselves to be drawn to any- 
 thing else ; but the average man at the outset will want 
 to know what he may expect in the way of monetary 
 returns from his labors and for the time and money 
 which he is called upon to expend in making his prepa- 
 ration. 
 
 No definite information in regard to the earnings of 
 physicians is available. The Medicol World estimates 
 that in 1902 there were in the United States 100,000 
 physicians whose average income was $1,000 a year; 
 20,000 averaging $2,000; 8,000 making an average of 
 $3,000 ; not over 2,000 reaching the $5,000 a year mark ; 
 only 1,500 averaging $10,000; 200 reaching $20,000; 
 perhaps 100 specialists making $25,000 apiece; and not 
 over 100 who could claim $30,000 or more. 
 
 This would mean average earnings of between $1,000 
 and $1,500, or stated in another way, an average ex- 
 penditure for medical services for each man, woman and 
 child of $2.20 per year, which is perhaps not far wrong. 
 
 Th€^ average salaries of the 374 full and part time 
 
 28 
 
Financial Rewards. 29 
 
 physicians employed by the city of New York in 1912 
 were $1,300. Some of these gave their entire time to the 
 public service and a comparatively few remained in the 
 service for any number of years; four of them after an 
 average service of seventeen years had attained annual 
 salaries of $2,550; seven, averaging fourteen years of 
 service, had attained to averages of $3,000. 
 
 The Bureau of Standards of the same city, after a 
 careful investigation in 1915, recommended the follow- 
 ing schedules of pay for physicians in the municipal 
 service: medical internes in hospitals and institutions 
 with maintenance $240 for the first year and $360 for 
 the second; assistant physicians in institutions with 
 maintenance, from $900 with annual increases of $120 
 to $1,380; senior physicians from $2,520 with annual 
 increases of $240 to $3,480; and for part-time services 
 averaging not less than eighteen hours per week, $1,500 
 with annual increments of $120 to $2,100; medical 
 superintendents and chief physicians, $2,780 to $4,680. 
 
 In 1914 the authorities of Harvard University com- 
 piled from answers to inquiries sent to graduates the 
 following table of average total earnings in law and 
 medicine : 
 
 Years Out of 
 
 ProfCBslonal Law. Medicine. 
 
 School Average Earnings. Average Earnlnga 
 
 1 $664 $623 
 
 2 1,110 909 
 
 3 1,645 1,301 
 
 4 2,150 1,681 
 
 5 2,668 2,005 
 
 6 3,118 2,410 
 
 7 3,909 2,935 
 
 8 4,426 3,227 
 
 9 5,321 3,636 
 
 10 5,325 3,789 
 
30 Medicine as a Peofession". 
 
 This means that those who replied, at the end of their 
 tenth year of graduation, had earned during that year : 
 in law, an average of over $5,000, and in medicine, less 
 than $4,000. From the small number of replies which 
 had been received from the ten year men in law, one 
 may be led to infer that perhaps neither the less suc- 
 cessful law}^ers nor those who had given up law for 
 business answered the inquiries. These tables are more 
 suggestive than informing, since in either case they 
 represent returns only from fractions of the groups 
 studied. 
 
 The average full-time pay of all the male teachers in 
 the high schools of cities having over 250,000 of popu- 
 lation was $1,839 in 1912. While it is true that many 
 persons in the public-school service later take up medi- 
 cine, comparatively few doctors leave their profession 
 to enter teaching, although a change from medical prac- 
 tice to some departments of educational work is quite 
 easy in most of the cities. This means that the practice 
 of medicine brings more satisfying rewards than this 
 other line of public service of which we have definite 
 information regarding the monetary returns and that 
 taking the country as a whole we would expect for the 
 fairly well-established physician, in country districts and 
 villages, net earnings of from $1,000 to $3,000; in the 
 smaller cities, from $1,000 to $2,000; in the larger 
 cities, from $1,500 to $4,000 ; with much larger returns 
 for the unusually successful men. 
 
 Approaching this problem from another side, we note 
 the age distribution of physicians and surgeons, as given 
 in the census, indicates that the proportion of physicians 
 over forty-five years of age is larger than the proportion 
 of such persons in other professions. This means that 
 
Financial Eewards. 31 
 
 a large proportion of those who enter upon the practice 
 of medicine remain in the profession, although from the 
 very nature of the physician's position in society and his 
 opportunity to become acquainted with men of affairs 
 one would think that it would be as easy for him to 
 make profitable business connections as it is for lawyers. 
 
 According to a very careful study made by the Journal 
 of the American Medical Association, the 2,205 physi- 
 cians whose death was noted in the columns of that 
 periodical for 1914 had attained an average age of be- 
 tween sixty and sixty-one years and their average num- 
 ber of years of practice was nearly thirty-four. This 
 means that they eiitered upon practice at about the age 
 of twenty-six, and assuming $3,000 as the cost of their 
 medical education, it would seem that if, during each 
 year of their productive period, they had laid aside $200 
 the principal and the interest on their outlay would have 
 been more than repaid. Taking this amount out of 
 their earnings it is more than likely that the average net 
 earnings of physicians as a class will for this productive 
 period of thirty-four years still be double the net earn- 
 ings of the man who spent about as much time in learn- 
 ing one of the skilled trades and whose productive period 
 is very much shorter. 
 
 It will be claimed that the physician has many ex- 
 penses. Unlike the lawyers most of the physicians have 
 their offices in their own homes. Their travelling ex- 
 penses are much smaller than those of the men engaged 
 in the engineering professions. While it must be con- 
 ceded that the law offers more large prizes than medicine 
 it is doubtful whether any of the scientific professions 
 offer more opportunities for securing unusual financial 
 rewards. 
 
CHAPTER VI. 
 
 Pkospects. 
 
 Certain economists claim that before any man under- 
 takes to invest time and money in securing his special 
 training for any vocation he should make sure that the 
 particular vocation is not overcrowded and that there is 
 a public demand for the services of one more trained man 
 or woman in the field which he is thinking of entering. 
 'On the other hand it must be noted that very few per- 
 sons who prepare themselves for gainful occupations or 
 incur expenses for engaging in producing marketable 
 commodities have any assurance in advance of a demand 
 for their services or a market for their products. 
 
 It is well enough however to try to find out what 
 statistics have to say about the prospects for remunera- 
 tive service in this profession. For the entire United 
 States there were in 1890, 167 physicians and surgeons 
 per each 100,000 of population; in 1900, 174; in 1910, 
 165. For the ten largest cities in the country taken 
 together there were in 1906, 236; and in 1910, 210 
 male and female physicians per 100,000 of population. 
 Compared with 100 or less for most of the European 
 countries, and 142 registered physicians per 100,000 
 for London in 1911, there seem to be indications that 
 the current notion that the field is oversupplied is well 
 founded. This disparity in the number of physicians 
 in different countries may be partially explained by the 
 methods of the census takers of this country, who enroll 
 
 32 
 
Prospects. 33 
 
 every person who reports himself as a physician, as 
 such, without considering whether he is actually en- 
 gaged in practice, or duly licensed and registered. More 
 care has been observed in this respect in the last census. 
 
 In determining whether the number of physicians is 
 greater than the actual needs of the country, several 
 things must be taken into consideration. A careful 
 observer with a large acquaintance among medical men 
 is of the opinion that in this country 20 per cent, of 
 those who graduate never practice medicine; some, be- 
 cause they entered upon their preparation without any 
 appreciation of the real significance of medicine as a 
 career; others, because they early discovered that medi- 
 cine is not a get-rich-quick enterprise if practiced ac- 
 cording to sound ethical standards, nor even an easy 
 way of making a living. Some, even, if they take up 
 other callings retain the title of doctor and are so 
 classed. In determining the chances for success in a 
 given locality, it must be considered that from 10 to 20 
 per cent, of the registered physicians have retired from 
 practice or are among those who while not actively so 
 engaged, minister to the wants of a few families or 
 patients of many years of standing. 
 
 After making due allowance for all these factors, a 
 full consideration of these statistics would seem to force 
 us to the conclusion that on account of the activities of 
 the too numerous medical colleges the number of grad- 
 uates has been in excess of the normal demands ; this is 
 reflected in the decrease of the enrollment in the med- 
 ical colleges in recent years although a part of the de- 
 crease must be attributed to the higher requirements 
 for admission. This tendency is to be noticed in the 
 following table : 
 
34 Medicine as a Profession. 
 
 1880. 1890. 1900. 1910. 1915. 
 
 Number of students in attend- 
 ance upon medical colleges 
 per 100,000 of population... 23 24 33 23 14 
 
 Number of graduates per 100,- 
 
 000 of population 6 7 7 5 3 
 
 The apparent oversupply, as compared with other 
 countries, has been due to the greater freedom which 
 persons of all classes have in taking up this work, and 
 the oversupply had led to such competition for business 
 as to make of our people probably the best served nation 
 in the world in this respect. We may conclude that for 
 the ordinary normal demands of the well-organized and 
 prosperous large city or the smaller city with its con- 
 tiguous country population, a ratio of from 150 to 180 
 per 100,000 of population is not excessive. 
 
 From 1902 to 1912 the average death rate among 
 physicians was 15.93 per 1,000; so that, according to 
 these figures, approximately 2,500 new medical gradu- 
 ates are needed each year to take the places of those who 
 drop out of the ranks on account of death. Considering 
 also the growth of the population and the larger needs 
 of the under-supplied communities as they become more 
 prosperous and considering particularly the increased 
 demand by the industries for the medical supervision of 
 workers and .the rapidly growing movement for organ- 
 ized public-health service we must conclude that the 
 present output of 3,500 medical graduates every year is 
 not excessive. 
 
 By personal interviews with many physicians in sev- 
 eral of our large cities some very conflicting testimony 
 on this point was collected. While the committees of 
 medical societies agree generally that there is an over- 
 
Prospects. 35 
 
 supply of doctors, a study of the progress of young 
 graduates seemed to lead to different conclusions. The 
 explanation seems to lie in the fact that in some of these 
 cities the American elements of the population are not 
 increasing while the number of American physicians is 
 increasing. On the other hand, the rapid increase in 
 some of the foreign elements of the population whose 
 families generally prefer physicians of their own race 
 who understand their own language, habits and customs 
 has contributed to the prosperity of men of particular 
 nationalities who have taken up this profession. 
 
 Turning aside from the statistics of the subject and 
 casting away the offhand opinions of old physicians, 
 who, in common with men in other walks of life, are 
 sure that things with them and in their work are be- 
 coming worse every day, let us examine into some con- 
 crete cases, after the manner of physicians themselves 
 who try to find general truths in particulars. 
 
 Twenty years ago the son of a mechanic consulted 
 his teacher about the advisability of taking up medicine. 
 Tie was referred to the physician of his family and to 
 his teacher's own physician. Both of them advised 
 against it. The young man was of average mental 
 ability, but with a capacity for steadiness and patient 
 plodding. In spite of the advice given him he entered 
 a medical college with what would at this time be con- 
 sidered an inadequate preparation. The college which 
 he entered is one of those which has since been com- 
 pelled to close on account of unfavorable criticisms by 
 an investigating committee. 
 
 The young man settled in a western city with a popu- 
 lation of 200,000 and over 400 physicians; moreover, 
 having no money to keep down expenses he opened a 
 
36 Medicine as a Profession. 
 
 shop in a poorer section of the city. To his former 
 teacher on a recent visit, he deplored the fact that he 
 had not permitted himself to be advised against the 
 profession and gone into business. He was disap- 
 pointed because of what he had not accomplished and 
 allowed himself to be unhappy in his disappointment. 
 
 "Let us look at it in this way/' said his visitor, as 
 they sat in his comfortable study overlooking the city. 
 "How does your success compare with the records of 
 the other fourteen boys who were graduated from the 
 village high school with you?" 
 
 He concluded his review of their several histories, 
 with which he had been fairly well acquainted through 
 his frequent visits to the old home, with the statement 
 that he didn't think that his wife would trade him off 
 for any one of them. 
 
 Within the last year the writer had a visit from one 
 who had been a classmate with him in a country acad- 
 emy. He was a young man who had no means, had 
 enjoyed limited social advantages but had inherited a 
 strong physical constitution and the conviction that he, 
 himself, must be the architect of any fortunes which he 
 could ever hope to enjoy. He entered a medical college 
 with the minimum preparation required by the times 
 and was graduated from a course which later had to be 
 extended upon the demand of the public authorities. 
 He settled in a small eastern town which according to 
 the conclusions of our statistical review was at the time 
 overstocked with medical men. In the course of thirty 
 years he had so gradually grown into a competence that 
 he had not recognized his own financial success. He 
 had lived in comparative comfort, was able to give his 
 
Peospects. 37 
 
 children the best educational and social advantages and 
 to make ample provisions for his own old age. 
 
 The change in the personnel of the medical profession 
 in any locality is well illustrated by the record of a 
 connty of 19,000 population in one of the central states. 
 Twenty years ago there were 28 physicians in active 
 practice; today there are 27 active and 9 retired phy- 
 sicians in the county, while the population remains 
 approximately the same. Only 6 of the physicians who 
 were in practice twenty years ago are so engaged now. 
 Nine of them retired ; two moved away and eleven died. 
 Seventy-six newcomers registered within the twenty 
 years, and only 21 of these are now in practice in the 
 county. The larger number of those who removed 
 could not establish a sustaining practice ; some of these 
 were incompetent physicians who could not have suc- 
 ceeded anywhere, but the others established themselves 
 in other localities. Those who had the patience to grow 
 into a practice, or, in other words, to build into one, suc- 
 ceeded. The schools of medicine, regular, homeopathic, 
 eclectic or osteopathic, are important factors in some 
 localities, and are worthy of consideration as possible 
 factors in determining success, in given locations. 
 
 The action of Congress in placing the army and 
 navy on a war footing will call for such a large number 
 of appointments to the medical service as to influence 
 favorably the prospect of recent medical graduates. 
 
 One of the foremost surgeons in one of our large 
 cities reports that his earnings in his first year were less 
 than $500; the second year, $750; the third, $1,500; 
 reaching in the seventh year to $4,000; upon which, 
 when he announced to his associates that he proposed 
 to take a short time to study and after that to devote 
 
38 Medicine as a Profession. 
 
 himseK to special surgical work, he was advised against 
 doing so by the unanimous voice of his professional 
 friends and yet in less than five years thereafter he had 
 passed annual earnings of $10,000. 
 
 Taking all things into consideration and comparing 
 the prospects in this field with the prospects in other 
 lines of effort in which men are dependent upon the 
 patronage of their fellows for their support, we must 
 conclude that the man who has faith in himself, a will- 
 ingness and the energy to prepare himself by the mas- 
 tery of the best which his time affords, need have little 
 fear of acquiring the durable satisfactions of life in this 
 calling, but he -must do what other men do to win suc- 
 cess : offer his clients a superior service and then educate 
 them to an appreciation of that service. 
 
 The table given in the appendix, showing the number 
 of physicians per 100,000 of population in the several 
 states and cities, may be of value to young physicians as 
 indicating what sections of the country are oversupplied 
 and what parts are undersupplied. 
 
o 
 
 vO 
 
 O 
 
 < 
 
 a 
 
 W 
 Pi 
 
 o 
 
 
 o 
 
 H 
 
 w 
 
 X 
 
CHAPTEE YII. 
 
 Systems of Medicine 
 
 Just as we have parties in politics and sects in reli- 
 gion, we have schools teaching different systems of medi- 
 cine. One of the first questions to be determined in the 
 selection of a medical college in which to prepare for the 
 practice of this profession is the system of medicine 
 upon which the candidate desires to base his medical 
 education. The four principal systems or schools are 
 the so-called regular or allopathic, the homeopathic, the 
 eclectic and the osteopathic. It may be taken for granted 
 that the teachers and practitioners of each of these sev- 
 eral systems are honest and sincere in their belief that 
 their own is the best. 
 
 In the conquest of every extensive field of human 
 knowledge we find like diversities of views and meth- 
 ods. In the development of the flying machine, one 
 experimenter succeeds with a monoplane; he declares 
 that it is the only satisfactory machine ; another achieves 
 wonders with a biplane and another establishes an air- 
 line with a Zeppelin who would fear to trust himself to 
 the smaller machines, which he regards as mere toys. 
 Gradually men combine the best features of each of the 
 several machines or use one or the other according to 
 their needs. So it is in farming ; one man speaks of the 
 profits which he made with diversified crops and another 
 believes that the greatest success comes to him who would 
 specialize in fruit or grain or live stock. One manu- 
 4 39 
 
40 Medicine as a Profession". 
 
 facturer builds up an efficient working machine by using 
 a time basis of paying wages; another, equally success- 
 ful by compensating his men on the basis of piece work, 
 declares that a uniform daily wage would demoralize his 
 force and bankrupt him. Their ignorance of what lies 
 outside of their own experience warps their judgment. 
 A young man who would decide upon taking up some 
 one system of medical practice or another must make 
 due allowances for the prejudices of those whom he 
 consults. 
 
 With the progress of medicine, these several schools 
 have not been slow to appropriate to themselves the best 
 of the others and while it is desirable for a young man, 
 at the outset, to know in general the essential principles 
 of each, yet he will not go far wrong if he assumes that 
 the spirit with which he takes up a system of medicine 
 and the oneness of purpose vrith which he pursues his 
 preparation will mean more to him than the selection 
 of a particular school. 
 
 The theory and philosophy and only the very general 
 differences of the several systems can be enumerated. 
 
 The Regular School. 
 
 The art of healing had made much progress long be- 
 fore the science of medicine had developed. By ex- 
 perience, men learned that certain kinds of treatment 
 and certain medicines were effective, and in the course 
 of time medical men accumulated vast stores of knowl- 
 edge which was carefully handed down from one gen- 
 eration to another and as science advanced the reasons 
 for the effectiveness of their methods became known; 
 but whether the new candidate for the profession studied 
 in the schools or with the men whose offices they entered 
 
Systems of Medicine. 41 
 
 as students, in his education he was chiefly concerned 
 with equipping himself with the traditional knowledge 
 of the profession, and in this way the so-called regular 
 school was developed. 
 
 The impression must not go abroad that all other 
 schools are irregular or unauthorized or unrecognized 
 })y law. In the eyes of the law any duly licensed phy- 
 sician is considered a regular physician. 
 
 The physician of the regular school is the empiric of 
 his profession. He determines upon a treatment or pre- 
 scribes a medicine in a particular case upon the clinical 
 evidence which he has of the value of the special treat- 
 ment or the particular medicine and the results which 
 have been secured by others ; so, if any particular course 
 proves effective in given diseases, the fact is noted and 
 taught, and thereafter others are justified in their own 
 judgment, the opinion of their fellows and in the eyes 
 of the law in using the same in similar cases. This is 
 empirical prescribing and it may be said that no test 
 is so good or so reliable as the test of experience. 
 
 The regular school has fostered the introduction of 
 many therapeutic agents. As a result of the experi- 
 ments in the laboratories a large number of refined, 
 positive and valuable agents have been developed. "We 
 have the antitoxin for diphtheria, another antitoxin for 
 tetanus and some forty serums, vaccines, bacterins, which 
 experience may later approve or reject. 
 
 The regular physician naturally will lay great stress 
 upon the physical diagnosis of disease because, in order 
 that he may be able to assure himself that he is using 
 the traditional treatment, he must be able to diagnose 
 diseases and recognize the description of these diseases 
 as they appear in his treatises; and if, perhaps, the 
 
42 Medicine as a Profession. 
 
 therapeutic or treatment side of the regular practitioner 
 has not kept pace with his ability in physical diagnosis, 
 the advancement even in these lines has been almost 
 revolutionary in the past seventy years. Formerly the 
 doses of medicine were crude and massive; today they 
 are put up in the most palatable vehicles, in sweet syrups, 
 elixirs, sugar-coated pills, tablets, and aseptic, hypo- 
 dermic flasks. The dose is very much smaller and it is 
 seldom that a maximum dose is given upon the old " kill 
 or cure" dosage. 
 
 The practitioner of the old school makes his diagnosis 
 of disease ; selects his treatment according to his experi- 
 ence in similar cases; writes out prescriptions to be 
 filled by the regular pharmacists wherever these are 
 available, and considers the main object of his treatment 
 the restoration of his patient to health and only second- 
 arily the advancement of medical science. 
 
 As a judge allows his decisions in diflBcult cases to 
 be governed by precedents long after social changes have 
 made them obsolete, so the physician oftentimes is 
 tempted to protect himself from criticism in possibly 
 unfavorable results by taking refuge in the traditions 
 of his profession and, moreover, it is generally easier 
 to depend upon precedent in determining a course of 
 action than it is to work out a complicated problem 
 through the slow processes of reasoning. 
 
 The Homeopathic School. 
 
 Society protects itself against anarchy and sudden 
 revolutions by its conservatism. The ranks of the ultra- 
 conservatives are uncomfortable places for the reformers ; 
 therefore the pioneers of progress find it wise to set up 
 independent organizations to promote their views. Such 
 
Systems of Medicine. 43 
 
 independent organizations may die in the course of time 
 or parallel the work of the older ones, displace them or 
 force their views upon them. In medicine these new 
 schools have heen designated as " irregular.'^ The 
 strongest and most influential of these are the practi- 
 tioners of the homeopathic system, which is generally 
 spoken of as the "sugar pill" medicine. 
 
 This nickname originated from the fact th,at in very 
 many instances the homeopathic physician saturated 
 sugar pellets or disks with the medicine which he pre- 
 scribed, merely as a matter of convenience. Today all 
 physicians use pills and tablets, sugared throughout or 
 sugar coated. Then again the small dose of medicine 
 which the homeopathic physician prescribes has been 
 held up to ridicule by the old school for years, yet today 
 the most advanced men of all schools use small doses as 
 compared with the drastic dosing of a half century ago. 
 
 Women are often heard to remark : " We have a home- 
 opathic physician for the children because they take 
 his medicine ; it is not so strong ; but for adults stronger 
 medicine is better." 
 
 The fact that children do get sick, and that about two- 
 thirds of all illness is during infancy and childhood, 
 would be strong argument in favor of the homeopathic 
 system. The parents do want palatable medicine for 
 the children, and this has been the cause of the adoption 
 of a homeopathic system in many homes for the children. 
 
 The children mature and as a rule they continue to 
 favor the family physician of their childhood. Many 
 families have adopted this practice for trivial cases and 
 later finding it effective in serious cases they have been 
 led to adopt it for the adult members as well as for the 
 infants. This is often done without going into the 
 
44 Medicine as a Profession-. 
 
 theory of the practice, or without knowing anything of 
 homeopathy, except that the physicians give palatable 
 medicines in small doses, and cure as promptly as the 
 physicians of other systems. They realize that the 
 danger of over-dosing is minimized. 
 
 The theory upon which a homeopathic physician 
 reasons is this: Nature is reacting against some poison 
 and the fever is an index to its efforts to fight, or throw 
 off, the poison accumulated within the system as a result 
 of the disease. The duty then is to prescribe such reme- 
 dial agents as will assist nature in its own efforts. 
 
 They also regard pain as only a symptom or a warning 
 of the presence of some disturbing factor; and instead 
 of administering an opiate to make the patient uncon- 
 scious of the pain, thereby paralyzing nature in its own 
 efforts at self protection, homeopathy tries, if possible, 
 to remove the cause or to aid nature in its efforts to do so. 
 If it be a foreign body piercing the flesh it is removed 
 mechanically. If it is some offending food within the 
 stomach that causes the pain, the homeopathic physician 
 instead of giving an opiate to paralyze the nervous sys- 
 tem so that the patient may become unconscious of the 
 disturbing element, calls for some remedial measure 
 that will aid nature in eliminating the disturbing factor. 
 
 The homeopathic school tests all its medicines upon 
 healthy human beings before using them upon the sick. 
 Each prover takes the medicine and records the symp- 
 toms that develop in their order of development. All 
 the records of the various provers are taken together and 
 the symptoms experienced by all the provers are recorded 
 as symptoms produced by the medicine. 
 
 Such tests are made of all new remedies before they 
 are added to the armamentarium of the physician. In 
 
Systems of Medicine. 45 
 
 this way all fads and fancies are eliminated. In no 
 field or vocation are fads and fancies so ready to present 
 themselves as in medicine. The cnre-alls are ever with us. 
 
 In the United States about one out of every seven 
 physicians practices homeopathy. This ratio varies in 
 different communities. This school has about 20,000 
 physicians, and nearly all of these are in private prac- 
 tice, hospital and corporation work. 
 
 In the army, navy, marine-hospital and public health 
 service the appointments are made after an examination 
 by a board of surgeons already in the service. These 
 examiners are " regular ^^ physicians and the examina- 
 tion is one conforming to the practice of their own 
 school. So here is a strong argument against the study 
 of homeopathy by any young man who aspires to serve 
 in the army or navy, or for that matter in any govern- 
 ment service in which examination must be taken be- 
 fore a board composed of physicians of the regular 
 school. 
 
 The Eclectic School. 
 
 The Eclectic School is a system of medicine which 
 arose as a protest against the nauseating, heavy dosing 
 with poisonous dinigs of half a century ago. The first 
 N'ational Eclectic Medical Association, organized in 
 1848, proclaimed that "disease was an impairment of 
 life" and not an entity to be removed by violent and 
 pernicious drugs, but rather by a conservative and sup- 
 portive treatment for assisting nature to restore health. 
 The eclectic school has insisted upon giving a small, 
 pleasant, palatable dose, with the object of assisting 
 nature's effort to restore health, instead of giving the 
 massive, poisonous doses composed of concoctions of a 
 number of drugs that too often hindered nature. 
 
46 Medicine as a Profession. 
 
 Then again the eclectics do a great work in the inves- 
 tigation and in the preparation of medicinal agents. 
 The fact that it is possible to obtain such wonderful 
 results with small non-poisonous doses of medicines is 
 in a great measure due to their careful methods of pre- 
 paring them. Many medicines lose their therapeutic 
 properties through careless handling in the crude state 
 and through careless and indifferent methods in the 
 preparation of the tinctures. It is to the credit of the 
 newer schools that the utmost care is taken in the selec- 
 tion of the medicinal plants to be used in the manufac- 
 ture of tinctures, and that all plant tinctures are made 
 of fresh plants, thus retaining all the effective principles 
 of the agent. While the eclectics do use remedies pre- 
 pared mostly from the highly organized vegetable king- 
 dom, yet they do not depend upon them solely. They 
 believe that the curative value of medicines can only be 
 positively demonstrated by actual clinical testing on the 
 sick, and therefore it does not matter whether the medi- 
 cines are derived from the vegetable or mineral kingdoms. 
 
 The eclectic school believes in prescribing remedies 
 upon systemic or specific indications, not for any specific 
 disease. Take, for an illustration, pneumonia. The 
 physician may have several different cases of pneumonia 
 to treat and he may prescribe different remedies in all 
 cases. If the patients would all present similar symp- 
 toms and similar conditions, they would all receive 
 similar remedies; but if different symptoms manifest 
 themselves they would receive different remedies, regard- 
 less of the fact that all are pneumonia cases. The eclec- 
 tics treat patients and not diseases. If a patient has 
 ''a flushed face, bright eyes, contracted pupils, increased 
 heat in the head and a congested headache," no matter 
 
Systems of Medicine. 47 
 
 what the disease with which these symptoms are asso- 
 ciated, whether pneumonia, typhoid fever, la grippe, etc., 
 the same remedy would be selected in each. This makes 
 a safe and simple prescription. 
 
 This school does not look with favor upon the exploi- 
 tation of all kinds of animal serums, which are lauded 
 as "cure-alls'^ for various diseases, for the reason that 
 prescribing upon the specific name of a disease is disap- 
 pointing, and also that the purity of sera cannot at all 
 times be vouched for. 
 
 In private practice the eclectic will find many good 
 openings. He may choose a place where he would like 
 to live, apply himself to his profession, and he will suc- 
 ceed. This is especially true in rural districts. 
 
 Osteopathy. 
 
 This system of treatment or adjustment of the body 
 in the sick has sprung up within the last thirty years. 
 It is based upon the theory that there is a mechanical 
 cause for all ills and diseases. The cause of the disease 
 is a slipping of some vertebrae or bones which impinge 
 upon some spinal nerves, and as a result the nerve func- 
 tion is perverted, resulting in excess or diminution of 
 the blood supply to some organs. 
 
 Abnormal pressure may even cause disease in a remote 
 part of the body through the reflexes or the sympathetic 
 nervous impulse. The osteopath contends that these 
 twists or subluxations need not be large ones in order to 
 cause physical disturbances. The spots of contact are 
 very small, yet cause a great deal of disturbance of the 
 nervous system aside from the local pain. One cannot 
 overestimate the nervous impulse and its influence in the 
 maintenance of metabolism in the human economy. 
 
48 Medicine as a Profession-. 
 
 Every point of the body has nerve filaments which play 
 their part in the whole network of telegraphic lines. 
 The vasomotor nerves practically control the distribu- 
 tion of the blood supply and all voluntary actions, while 
 the sympathetic system controls to a large extent the 
 internal functions. Many physicians believe that a num- 
 ber of diseases, especially neuralgias, are due to pres- 
 sure, or irritation of the nerve affected ; but the method 
 of manipulation of the osteopath for the relief of such 
 pressure is distinctive of the osteopathic system. 
 
 Other schools believe with the osteopath that, after 
 all, nature does all the curing, the only difference being 
 in the means which are used to aid nature. "WTiatever 
 is best in all treatment is that which will aid nature; 
 sometimes, check; sometimes, stimulate, as the case re- 
 quires. The patient does not care a snap for theory, 
 but for results, and the osteopath has given very credit- 
 able results in practice. 
 
 There are about 8,000 practitioners in the United 
 States, and most of them doing well. The school pos- 
 sibly has suffered somewhat by the low standard for- 
 merly set for entrance and the low standards or lack of 
 standards of study, as a result of which a number of 
 incompetent practitioners are credited to the school. 
 Of late years the course of study and general require- 
 ment have been brought up to the standard of other 
 medical colleges, and this has developed skilled modern 
 practitioners who study bacteriology, hygiene, disin- 
 fectants, surgery, obstetrics, etc., in the same thorough 
 way as the students of the regular colleges. 
 
 The cost of tuition and other expenses are about the 
 same as in the preparation for regular practice. 
 
Systems of Medicine. 49 
 
 The osteopathic practitioner is legalized in all the 
 states, except Maine. 
 
 From a business point of view a young man or woman 
 of strong personality can do well in osteopathy. The 
 field is not overcrowded. People are generally feeling 
 kindly towards the system because there has been so 
 much irrational empirical dosing with syrups, elixirs 
 and pills until " they are sick of it.^^ The osteopath has 
 been able to extract a larger fee for treatment than the 
 general practitioner has been able to get in similar cases. 
 
 One might consider here the opposition that a young 
 man may meet in practice. The regular medical pro- 
 fession does not look kindly upon the osteopath, and 
 makes matters unpleasant for the isolated osteopath. 
 This feeling is not so much that they do not recognize 
 the osteopath as a legitimate practitioner, but is due 
 more to the questionable, or, as they call it, " unethical " 
 means used by many osteopaths in advertising. Whether 
 it is right or wrong does not enter into the question, but 
 medical men have a code of ethics which prohibits ad- 
 vertising and which establishes the relations of phy- 
 sicians towards each other. Where the osteopath re- 
 spects the code of ethics of the physician, he, too, is 
 respected and shown the same fellowship. 
 
 Unlicensed Practitioners. 
 
 There are other schools of medical and drugless heal- 
 ing whose promoters, for a sufficient fee, promise to 
 equip any student in a few months with their newly 
 discovered science; and there are those who under the 
 guise of religion profess that by the mere expression of 
 a belief in their peculiar system, the believer may per- 
 form miraculous cures. Eeputable journals carry their 
 
50 Medicine as a Profession. 
 
 alluring advertisements and it is fortunate that the 
 common sense of conservative people has been crystal- 
 ized into laws which make it impossible for any one to 
 become a licensed practitioner who has not taken the 
 prescribed training as described in the next chapter. 
 One contemplating the healing profession as a vocation 
 should select one of the systems that is recognized and 
 legally licensed, and after this decision is made, should 
 select a college with a high standard of efficiency. 
 
CHAPTER YIII. 
 
 The Medical Colleges and theik Eequikements 
 EOK Ad:mission'. 
 
 In planning for a medical edncation, consideration 
 ninst be given to the election of the subjects of study 
 in the high school, the nature of the work which should 
 be done in the oSe or more years of college work and 
 the selection of the medical college. This subject has 
 been carefully studied within the past few years by 
 several committees composed of medical practitioners 
 and teachers of medicine. Prospective students will do 
 well to consider the reports of these investigating bodies, 
 bearing in mind that in order to get the approval of 
 committees on which are found as many conservatives 
 as progressives, such reports usually give the summaries 
 of compromises and not reflections of well-balanced 
 ideals. 
 
 These minimum standards, however, have served the 
 purpose of furnishing a basis for the classification of 
 medical schools. The kind of training that any pro- 
 fessional school can give will depend upon the character 
 of the student body as well as upon the kind of equip- 
 ment and the professional experience and standing of 
 the teachers. Moreover, the graduate of a professional 
 school finds that his initial rating in his profession is 
 made for him by the students who have been graduated 
 from the same school before him. It is good policy, 
 therefore, to attend a school whose graduates are rated 
 
 51 
 
52 Medicine as a Profession. 
 
 high in the profession, and it is safe to assume that the 
 higher the standard of admission for students, the 
 better the grade of instruction in any professional 
 school. 
 
 The best medical schools are rapidly adopting the 
 standards of admission which are prescribed by the 
 Committee on Education of the American Medical Asso- 
 ciation; and it is likely that before another four years 
 have passed, most of the medical colleges will require 
 at least two years of college work in addition to the 
 four years of training in the high school. 
 
 The recommendations referred to require that a stu- 
 dent shall have had a full four years' course of training 
 in an accredited or approved high school or other insti- 
 tution of the same grade, or that he shall present cer- 
 tificates showing that he has passed examinations before 
 a properly authorized examining board, in subjects re- 
 quired in such schools covering at least fourteen units 
 of work, each unit including not less than thirty-six 
 weeks' work of four, or five, forty-minute recitations 
 per week. 
 
 The recommendations referred to prescribe that there 
 shall be seven units which shall be required of all stu- 
 dents and which may be elected from the following: 
 Eeading and Practice of English, 2; Algebra to quad- 
 ratics, 1; Plane Geometry, 1; Elementary French or 
 German, 2; American History or Civics, 1. Two units 
 of Greek or of Latin may be offered in place of the 
 units in modern languages. 
 
 Seven additional units may be selected from the fol- 
 lowing: Intermediate Algebra, -J; Solid Geometry, J; 
 Latin Grammar and Composition, 1 ; Caesar, 1 ; Cicero, 
 1 ; Virgil, 1 ; Nepos, 1 ; Greek Grammar and Composition, 
 
The Medical Colleges. 53 
 
 1 ; Homer, 1 ; Xenophon, 1 ; Intermediate German or 
 French, 1; Elmentary Spanish or Elementary Scandi- 
 navian, 1 ; Greek and Eoman History, 1 ; Medieval and 
 Modern History, 1 ; English History, 1 ; Botany and 
 Zoology, 1; or Biology, 1; Chemistry, 1; Physics, 1; 
 Physiography, -J; Physiology, -J; (no credit shall be 
 given for science courses which do not include labora- 
 tory work;) Agriculture, 1; Drawing, 1; Manual Train- 
 ing, 1 ; Music, 1 ; Domestic Science, 1. 
 
 It will be noted in the table given in the appendix 
 that medical colleges are even now beginning to require 
 one or more years of college work, and that the leading 
 medical colleges are requiring four years of such work. 
 
 The preliminary college year should include for a 
 period of thirty-two weeks 2 recitation or lecture periods 
 and 2 laboratory periods in Physics ; the same in Chem- 
 istry ; 2 recitation periods and 2 laboratory periods or 3 
 recitation periods and 1 laboratory period in Biology; 
 and 3 or 4 recitation periods per week in advanced 
 French or German. 
 
 Work is to be accepted only if taken in a standard 
 college and not as a postgraduate course in a high 
 school. If given as a premedical year in a medical col- 
 lege, it must be up to the standards set by approved 
 colleges. It is advised that a year in a college of 
 dentistry or pharmacy shall not be considered as equiv- 
 alent to a year's work in a standard college, and that no 
 credit shall be given for a course in which a student's 
 record for attendance for the full year is below 80 per 
 cent., but that graduates of regular colleges who have 
 not done the work in these prescribed subjects, may be 
 permitted to have until the opening of the second year 
 in the medical college for removing their conditions. 
 
54 Medicine as a Professioit. 
 
 The standards of the American Medical Association 
 prescribe that a medical college must have at least six 
 professors, giving their entire time to medical work, 
 and an executive officer who has sufficient authority to 
 carry out fair ideals of medical education ; that it has a 
 standard of admission for students equivalent to those 
 given in this chapter; that it offers a full four-years' 
 course of instruction of thirty-two weeks each, and that 
 it requires of the student at least thirty hours of work 
 per week. 
 
 It is also prescribed that the printed course of study 
 should be carefully followed and should include two 
 years of laboratory work under the direction of ex- 
 perienced teachers who are graduates of reputable med- 
 ical schools in properly and fully equipped laboratories 
 in anatomy, histology, embryology, physiology, chem- 
 istry, bacteriology, pathology, pharmacology, thera- 
 peutics and clinical diagnosis ; that there should be two 
 years of clinical work in hospitals and dispensaries with 
 courses in internal medicine, surgery, obstetrics, gyne- 
 cology, laryngology, rhinology, ophthalmology, otology, 
 dermatology, hygiene and medical Jurisprudence. 
 
 It is well for those who are selecting a medical col- 
 lege to study carefully the catalogues of the colleges 
 which they are considering to see whether the college is 
 able to offer them the facilities which this committee 
 considers essential. 
 
 A college should own and control a hospital in which 
 the students may come into contact with patients under 
 the supervision of their teachers, and such a hospital in 
 colleges having a hundred students should have not less 
 than two hundred patients a day; and there should be 
 ample accommodations for treating children's diseases, 
 
The Medical Colleges. 55 
 
 contagious diseases and nervous and mental disorders, 
 and for handling maternity cases, and at least thirty 
 autopsies a year, together with facilities for handling 
 out-patients. 
 
 It is also recommended that an acceptable college 
 should have a fully equipped library, in properly fur- 
 nished quarters, with a librarian in charge, and have a 
 working museum with models and specimens duly 
 classified and labelled; that there should be an ample 
 supply of dissecting material and an experimental labo- 
 ratory with a supply of live animals and adequate facili- 
 ties for housing these animals. 
 
 As one reads over these specifications and notes that 
 mention is made of the importance of having in a med- 
 ical school X-ray -apparatus, stethoscopes, projecto- 
 scopes and supplies of anatomical charts and manikins, 
 he is forced to the assumption that at the time of mak- 
 ing this report there must have been institutions lack- 
 ing in these essentials. This is not surprising when one 
 considers that many medical colleges have been organ- 
 ized by practitioners who hoped that by teaching they 
 could add somewhat to the incomes which they were 
 getting as practitioners. One would expect to find in 
 this report recommendations that a medical college 
 should have a certain minimum number of heads of de- 
 partments whose salaries are large enough to permit 
 them to give all their time to teaching and investiga- 
 tion; and that for professional training in a field which 
 has such an extensive literature as medicine, it should 
 be accepted without mention that a school should not 
 only have a complete library in charge of a trained 
 librarian and that mention should be made of courses 
 of special training in the use of these libraries. 
 5 
 
56 Medicine as a Profession. 
 
 For the guidance of the prospective student, the 
 American Medical Association publishes annually classi- 
 fied lists of medical colleges in which these institutions 
 are rated according to the standing of their faculty mem- 
 bers, their teaching and administrative organizations 
 and the extent and character of their equipment and 
 facilities for practical work. These lists should be con- 
 sulted in selecting a college. 
 
 Success in the acquisition of knowledge and in its 
 organization in the minds of the students for practical 
 work presupposes that the student knows something 
 about the nature of the mind and of the thinking and 
 learning processes, and although professional courses do 
 not usually prescribe anything nor do professional 
 schools generally recommend it, it will increase the prac- 
 tical value of what the attendant gets out of any courses 
 if he first reads or studies, with some care, some of the 
 accessible books bearing upon the laws of mental opera- 
 tions and the principles of the efficient life. A list of 
 these books is given at the end of this chapter. 
 
 Beferences. 
 
 Bennet, E. A. The Human Machine. Doran, 1910. $.75. 
 Colvin, S. S. The Learning Process. Maemillan, 1915. 
 Gulick, L. H. The Efficient Life. Doubleday, 1907. $1.20. 
 Locke, John. An Essay on the Human Understanding. 
 Meumann, E. The Psychology of Learning. Appleton, 
 1913. $2.00. 
 
CHAPTEE IX. 
 
 A Geneeal Sukvey of the Field. 
 
 It has been shown that we have in the entire country 
 about one physician to every six hundred and fifty of 
 the population; in country districts, one to about every 
 two thousand people. Many of these physicians are old 
 and have practically retired ; some are giving their time 
 chiefly to business; others, again, are devoting their 
 time to public service; and many are engaged in re- 
 search work. 
 
 The same motives which lead persons of other trades 
 and professions to crowd into cities, lead medical men 
 to locate in the great centers of population. The phy- 
 sician must go where the people are. Moreover, there 
 are opportunities in the cities which are not found in 
 the country districts ; there are chances for hospital and 
 dispensary work; the better educational and social ad- 
 vantages; the privileges of meeting specialists in the 
 professional organizations; better fees; and opportuni- 
 ties for part-time salaried work. 
 
 The practitioner in the rural communities, on the 
 other hand, does not lose his identity, as too often does 
 his brother in the crowded cities ; he is generally one of 
 the influential members of his community; he com- 
 mands a more permanent clientele and has less competi- 
 tion. He becomes by force of necessity more self-re- 
 liant, and although his fees are smaller his percentage 
 of collections is larger. 
 
 57 
 
58 Medicine as a Peofession. 
 
 The first puzzling problem of the physician who 
 would devote his time to private practice is the selection 
 of a location. Those who follow other trades and pro- 
 fessions may sometimes change their locations to ad- 
 vantage; but the fate of the physician depends in a 
 great measure upon the prosperity of the community 
 with which he first casts his lot^ for it is rarely possible 
 for him to make a change of location without risking 
 considerable loss. 
 
 The student of this problem would suppose that the 
 distribution of the three thousand or more annual grad- 
 uates of our medical schools who expect to enter private 
 practice would be regulated according to some well es- 
 tablished principles. Inquiry was made to learn what 
 instruction was given by the medical colleges to aid their 
 students in this important matter of choosing a loca- 
 tion. It seems that the colleges as a rule overlook this 
 matter of giving instruction in regard to the best meth- 
 ods of marketing the capacities for service which their 
 students developed through the long and expensive years 
 of study. A careful reading of some three hundred 
 answers to a thousand letters of inquiry seemed to indi- 
 cate that the matter of selecting a location has hereto- 
 fore been largely a matter of accident and chance and 
 that the method of trial and error resulted in the aggre- 
 gate in a very large amount of waste. 
 
 One man replied that the final choice between 
 several localities which he had under consideration was 
 determined by a study of the directories of practicing 
 physicians in those places. In one city he noted that 
 half of the names which appeared in the directory for 
 1900 were not in the list for 1910. He concluded that 
 because an unusually large number of those who tried 
 
A General Survey of the Field. 59 
 
 practice in that city abandoned it for some reason or 
 other, the place was to be avoided. Another replied 
 that while debating with himself about the relative 
 advantages of two places he consulted a banker friend 
 who pointed out to him that the figures of the state 
 banking department showed that the average per capita 
 deposits in the saving banks by the people of one of the 
 cities was much larger than in the other and that there- 
 fore it was safe to infer that the first city was more 
 prosperous. Another reported that he was deterred 
 from locating in a manufacturing city when a friend 
 showed him a copy of the census bulletin which indi- 
 cated that the average annual earnings of factory work- 
 ers who formed a very large proportion of those gain- 
 fully employed, was relatively small. Another investi- 
 gated a new industrial city which seemed to be under- 
 supplied with physicians to turn away from it because 
 a very large proportion of the inhabitants were foreign- 
 ers from a country in which the laboring classes had 
 never been educated to make any considerable outlays 
 for medical services and because as a rule these people 
 were clannish and suspicious of those who did not speak 
 their own language. One man reported that by acci- 
 dent a copy of the atlas of the U. S. census had fallen 
 into his hands and that in looking over a map showing 
 the relative value of farm lands for the entire country 
 the thought came to him that a moderate sized town in 
 a good farming country in which a large proportion of 
 the people were retired or living on their investments 
 and in which those who were gainfully employed were 
 engaged chiefly in commercial pursuits would be a good 
 place in which to find a permanent location, he added, 
 however, that "in such places collections are confined 
 
60 Medicine as a Profession. 
 
 almost entirely to the time of the annual pa}Tnent of 
 rents and the settlement days which follow the sale of 
 crops." 
 
 Not a few sharpers seem to be lying in wait for those 
 who are looking for a location. A favorite dodge of 
 real estate promoters in boom towns is to advertise de- 
 sirable openings for physicians when they mean that 
 they have offices to rent to desirable tenants. There are 
 also rumors that there have been physicians who built 
 up records of crowded consultation rooms in order to 
 sell to advantage their practice and office equipments. 
 
 Sooner or later the insistent students of the medical 
 colleges will demand that the faculties undertake an 
 investigation sufficiently extensive to enable them to 
 work out the sound underlying principles with which to 
 make the approach to this problem and that instruc- 
 tion in these matters will form a part of the regular 
 work of the colleges. 
 
 It must also follow sooner or later that all medical 
 schools will follow the example of other professional 
 schools and the more progressive colleges and universi- 
 ties and open for their graduates appointment offices 
 and bureaus of counsel and advice through which trained 
 and experienced men will make available for the use of 
 graduates well indexed and up-to-date information for 
 their guidance so as to minimize the waste of time and 
 energy and discouragement which is incident to the slack 
 period between graduation and full employment as a 
 partial compensation for the lengthening of the period 
 of medical study and preparation, nor is it too much to 
 expect that before long the medical societies will awaken 
 to the fact that it will be to the interests of their mem- 
 
A General Survey of the Field. 61 
 
 bers to aid in a more rational distribution of the newly 
 graduated doctors. 
 
 There are many persons who prefer the routine work 
 of the salaried man in institutions. Appointments of 
 this kind are generally to be had by the young medical 
 graduate ; but the fact that after a few years those who 
 accept salaried appointments leave them to enter private 
 practice, may be taken as evidence that the latter offers 
 the more durable satisfactions. It is well, however, to 
 look over the ever-widening field of salaried positions. 
 
 The Field. 
 
 I. In private practice, city or country. 
 II. In the service of the National Government : 
 The army service. 
 The naval service. 
 
 The marine hospital and public health service. 
 The pension department. 
 The Indian service. 
 The Philippine service. 
 The Canal Zone and coast survey. 
 The pure food division of the department of 
 
 agriculture. 
 III. In state and municipal service: 
 Public health department. 
 In departments of food and drug inspection. 
 In departments of vital statistics. 
 In sanitary work. 
 As milk inspectors and bacteriologists and 
 
 chemists. 
 As lecturers on health topics. 
 In public hospital service. 
 
62 Medicine as a PROFESsioisr. 
 
 In penal institutions. 
 
 In charitable institutions. 
 
 With the state militia. 
 
 As medical school inspectors. 
 
 As supervisors of physical training in schools. 
 IV. In county service: 
 
 As health officers. ■ 
 
 Pension examining surgeons. 
 
 Physicians to the poor. 
 
 Coroners. 
 V. In service of corporations. 
 VI. In research work. 
 VII. In service of fraternal societies. 
 
 Some of these newer fields of work are rapidly being 
 extended. Corporations which employ many men or 
 are engaged in hazardous undertakings employ phy- 
 sicians and surgeons to administer to the injured as 
 promptly as possible in order to minimize the sufferings 
 of their employees; to keep down the cost of maintain- 
 ing the sick and the disabled and to lessen their own 
 liabilities for damages. The railroad and traction com- 
 panies have surgeons at convenient points along their 
 lines, and insurance companies have physicians in all 
 communities in which they do business. Every large 
 steamship has a physician on its staff of regular officers. 
 Fraternal societies employ physicians by the year to 
 wait upon their members, who pay annual dues for this 
 service whether they are sick or well. Large hotels 
 have regular house physicians for their guests, and 
 many of the wealthy families employ physicians by the 
 year to travel with them wherever they go. 
 
 Private sanitariums employ large numbers of young 
 medical graduates, and many experienced physiciaiiS 
 
A Genekal Survey of the Field. 63 
 
 conduct health-building institutions as business enter- 
 prises. Organizations engaged in movements for pro- 
 moting the public welfare employ medical men to pre- 
 sent their several causes to the public, the field of med- 
 ical journalism takes up the time of others, and lately 
 enterprising publishers of daily papers have begun to 
 employ physicians to conduct departments on personal 
 efficiency. 
 
CHAPTEE X. 
 
 The Army Service. 
 
 The medical service of the army is divided into five 
 corps: medical corps, the medical reserve corps, the 
 dental corps, the hospital corps and the nurse corps. 
 
 The medical corps consists of a surgeon general, with 
 the rank of a brigadier general, 14 colonels, 24 lieuten- 
 ants with the rank, pay and allowances of officers of 
 grades corresponding to those in the cavalry service. 
 No person shall be appointed to this service until ex- 
 amined and approved by an army medical board. 
 
 The appointments are made to the junior grade, or 
 grade of first lieutenant ; and after three years of service 
 as lieutenant, one becomes eligible for examination for 
 promotion, to the grade of captain. All further pro- 
 motion to higher grades is by seniority, although the ap- 
 plicant is subjected to examination to determine fitness 
 for advancement. 
 
 A first lieutenant receives $2,000 per annum, or 
 $166.66 monthly. At the end of three years he is pro- 
 moted to a captaincy and receives $2,400 a year. In 
 two years more he receives an increase of ten per cent., 
 making $2,640 or $220 per month. After 10 years' 
 service the pay would be $2,880 annually, or $240 per 
 month. 
 
 The pay attached to the rank of major is $3,000 a 
 year, which, with 10 per cent, added for each five years' 
 service, becomes $3,600 after 10 years, $3,900 after 15 
 
 64 
 
The Akmy Service. 65 
 
 years and $4,000 after 20 years. The monthly pay of 
 lieutenant-colonel, colonel, and brigadier-general is $375, 
 $416.66 and $500 respectively. Officers, in addition to 
 their pay proper, are furnished with a liberal allowance 
 of quarters according to rank, either in kind, or, where 
 no suitable government building is available, by com- 
 mutation; fuel and light are also provided. When 
 travelling on duty an officer receives mileage for the 
 distance travelled, including the distance covered in 
 joining his first station after appointment as first lieu- 
 tenant; the amount allowed is usually sufficient to cover 
 all expenses of journey. On change of assignment he 
 is entitled to cost of transportation of professional books 
 and papers and a reasonable amount of baggage. 
 Mounted officers, including all officers of the medical 
 corps, are provided with forage, stabling and transpor- 
 tation for horses owned and usually kept by them, not 
 exceeding two for all ranks below that of brigadier. 
 Horses and horse equipments are furnished by the gov- 
 ernment for all mounted officers below the grade of 
 major. Groceries and other articles may be purchased 
 from the post commissary at about wholesale prices. 
 Instruments and appliances are liberally supplied for 
 the use of medical officers. Well-selected professional 
 libraries are supplied to each hospital, and standard 
 modern publications on medical and surgical subjects 
 are added from time to time ; current issues of a number 
 of representative medical journals are also furnished for 
 their use. At each military post there is also a labora- 
 tory for those interested in such work ; and medical offi- 
 cers are encouraged to carry on special lines of profes- 
 sional study which appeal to them. 
 
 The Army medical officers are given one month's 
 
66 Medicine as a Profession. 
 
 leave of absence at full pay each year; and if this priv- 
 ilege is not accepted each year, it is allowed to accumu- 
 late for four years, and the four months may be taken 
 in a continuous leave. The medical officer may also 
 have leave of absence by permission beyond this one 
 month, upon half pay. All leaves of absence granted on 
 account of sickness are with full pay. 
 
 Medical officers may be retired at the expiration of 
 forty years' service, or at any time on account of dis- 
 ability incurred in the line of duty. The pay of retired 
 officers is three fourths the amount of the full pay of 
 their rank upon retiring. Officers have also the privi- 
 lege of attending the Army Medical School, wherever 
 practical. 
 
 This school is established especially for the training 
 of the younger men in military surgery, including the 
 transportation of the wounded, first-aid treatment, 
 operative surgery, military sanitation, including instruc- 
 tion in the examination of air, water, food, clothing, 
 the location and sanitation of camps, etc., military med- 
 icine and clinical and sanitary microscopy. 
 
 The officers are detailed from time to time to service 
 at stations, near the principal medical centers of the 
 United States, in order to give them opportunities to 
 attend lectures, clinics, and visit hospitals, attend meet- 
 ings of medical societies, etc., so that they may keep in 
 touch with the most advanced ideas of the time. 
 
 Applicants for first appointment must be between the 
 ages of 22 and 30 at the time of taking the examination, 
 citizens of the United States, and graduates of reputable 
 medical schools. 
 
 The candidates must have had hospital or some prac- 
 tical experience in the practice of medicine. Interne 
 
The Army Service. 
 
 67 
 
 service in some hospital for a year or for a year and a 
 half is the best and most acceptable way to gain the ex- 
 perience. For admission to the army medical corps this 
 is obligatory. 
 
 Besides the examination to test intellectual fitness for 
 the service, the candidate must possess certain physical 
 requirements. 
 
 The physical examination must be thorough. Candi- 
 dates who fall below 64 inches in height will be rejected. 
 Each candidate is also required to certify that he labors 
 under no physical infirmity or disability which would 
 interfere with the efficient discharge of any duty which 
 may be required. Errors of refraction, if vision is not 
 below 20/100 in either eye, are not cause for rejection, 
 provided they are not accompanied by ocular disease 
 and are entirely corrected by appropriate glasses. 
 
 The appended table is given for convenience of refer- 
 ence, and it is expected that the candidate approxi- 
 mates to these measurements. 
 
 The army medical service offers to staff physicians 
 
 Physical Proportions for Height, Weight and Chest 
 
 Measurement. 
 
 Height, 
 Inches. 
 
 Weight, 
 Pounds. 
 
 Chest Measurement. 
 
 At Expiration, 
 
 Mobility. 
 
 
 
 Inches. 
 
 Inches. 
 
 64 
 
 128 
 
 32 
 
 2 
 
 65 
 
 130 
 
 32 
 
 2 
 
 66 
 
 132 
 
 32^ 
 
 2 
 
 67 
 
 134 
 
 33 
 
 2 
 
 68 
 
 141 
 
 33| 
 
 2J 
 
 69 
 
 148 
 
 33^ 
 
 n 
 
 70 
 
 155 
 
 34 
 
 2J 
 
 71 
 
 162 
 
 34.1 
 
 2J 
 
 72 
 
 169 
 
 34^ 
 
 3 
 
 73 
 
 176 
 
 351 
 
 3 
 
68 Medicine as a Peofession. 
 
 and their families many social advantages. The social 
 standings of the members of the staffs and their fam- 
 ilies, whether in camp or in field, are determined by 
 seniority. It is true that associations are necessarily 
 somewhat restricted, and that in some places a good 
 deal of snobbery permeates the atmosphere. 
 
 Post duty becomes more or less of a routine character 
 which is not always favorable to the development of the 
 physician; and since the post physician has no compe- 
 tition, and his patients have little encouragement to 
 appeal from his treatment, there is little to stimulate 
 him to extend his equipment. In times of active war- 
 fare, and on the field of battle he has every chance to 
 develop his resourcefulness. 
 
 The Army Medical Museum and Library in the Sur- 
 geon-General's office contains an interesting collection of 
 anatomical specimens, and nearly 200,000 volumes of 
 medical and surgical literature. This is the largest mod- 
 ern medical library in the world. The museum was pri- 
 marily intended for the medical officers of the army. It 
 was started after the Civil War and was designed to show 
 the effects of gun-shot wounds and their treatment, in 
 order to enable the surgeons of the army to be better 
 prepared for such work in the future emergencies. 
 Both the museum and the library are being continuously 
 enriched by the contribution of specimens and books 
 from physicians and surgeons in private practice. 
 
 To a young man or woman contemplating the study 
 of medicine, who happens to be in Washington, a visit 
 to this collection, which is open from 9 a. m. to 4 p. m. 
 and is free, is profitable, as it shows the extent of the 
 field of medicine and the progress which has been made 
 in surgery. 
 
CHAPTER XI. 
 
 The Naval Service. 
 
 The routine of the doctor attached to the naval train- 
 ing stations is not unlike the work at the army post but 
 when he joins the staff of a battleship he gets a much 
 greater variety of experiences, especially when his ship 
 goes on a long cruise. The senior medical officer of a 
 ship holds a very responsible position; as health officer, 
 he becomes familiar with conditions in the seaboard 
 towns of all climates ; as surgeon, he is called upon to do 
 a great variety of work ; moreover, he is the eye special- 
 ist, the medical exarainer, the food inspector; he is also 
 the dentist, and he has to see that the quarantine regu- 
 lations of all countries where his ship touches are ob- 
 served. 
 
 As the health officer of the ship, the doctor makes daily 
 inspections of cabins, wash rooms, barber shops, gal- 
 leries, pantries and the general cleanliness of the men. 
 Once a week a general inspection is made of the entire 
 ship. He has supervision of the heating and ventila- 
 tion of the seamen's quarters, and the water supplies. 
 
 When the ship casts anchor, he gets in touch with the 
 health officers of the port, learns what diseases are prev- 
 alent, and notifies the commanding officer, so that he 
 may determine what privileges may be accorded to the 
 crew while the ship remains in port. 
 
 He inspects the meats and other foods which are 
 taken on board ship, and plans the rations for the 
 
 69 
 
70 Medicine as a Profession-. 
 
 sailors. He holds himself in readiness for consulta- 
 tions every morning, prescribes medicines and special 
 diets for the sick, and directs special assignments for 
 those who are not able to attend to their regular duties, 
 or requests for them relief when necessary. Ordinary 
 cases of sickness are handled as in private practice, but 
 those who are suffering from serious sickness or chronic 
 ailments may be transferred to hospital ships or to hos- 
 pitals on land. This is done in times of peace as well 
 as in war to preserve the fighting efficiency of the ship. 
 
 A modern war vessel is a veritable machine shop; 
 accidents are likely to occur at any time, so that emer- 
 gency service must always be available for treating broken 
 bones, making amputations, treating injured eyes and 
 performing every kind of operation which is required 
 of a city hospital staff. 
 
 As medical examiner, he passes upon the physical fit- 
 ness of men before they are accepted for service ; gunners 
 and signal men must have their vision frequently ex- 
 amined; divers must be examined before undertaking 
 dangerous work, and the pugilists before entering box- 
 ing bouts. 
 
 These physicians must, therefore, be prepared for 
 ministering to adult men for a great variety of ailments, 
 but they have an advantage over the private practitioner, 
 because, as a rule, they have modern appliances for their 
 work; the hospital equipment is complete, sick quarters 
 are well arranged, operating rooms are modern, testing 
 appliances are adequate and usually the reference libra- 
 ries are comprehensive. 
 
 The service demands complete and accurate records 
 of all disabilities and fatalities, so that the physician re- 
 ceives such a training in the systematic and orderly 
 
The Naval Service. 71 
 
 transaction of the routine of his office as few other prac- 
 titioners get. 
 
 After this brief review of the work which is assigned 
 to the medical officer, it is not surprising to note the 
 high standing which is accorded to him as an officer, and 
 the recognition which is given to him socially, and that 
 his personal accommodations on board ship are as at- 
 tractive as those of the other officials. 
 
 It will also be readily inferred that for such positions 
 of great responsibility men of the highest types are re- 
 quired. To get on smoothly with other officers, a man 
 should have had the advantage of good social training; 
 to win the esteem and hold the respect of representatives 
 of all classes which go to make up the crew of a ship,- 
 the medical officer must be a man of integrity and cour- 
 age ; as the representative of his country among the edu- 
 cated men of other lands, he should have a broad gen- 
 eral culture ; and, moreover, he must be energetic enough 
 to dispatch a great amount of work. 
 
 There are some disadvantages with which these men 
 must contend. Their assignments are frequently 
 changed, they are compelled to sever their home ties. 
 Owing to the routine nature of much of their work, they 
 are not likely to develop those rare traits which make of 
 older family physicians the guides, counsellors and 
 friends of the families of their patients. 
 
 The requirements for admission to the service are 
 given somewhat in detail, because they comprehend 
 what -the best experts consider the physical basis of 
 efficiency. 
 
 For appointment in the medical corps of the navy, 
 the candidate must be a citizen of the United States, 
 and between 21 and 30 years of age. He must be a 
 6 
 
72 Medicine as a Profession". 
 
 graduate of a reputable school of medicine. He must 
 apply for permission to appear before the Board of 
 Medical Examiners. The application must be in the 
 handwriting of the applicant, and must be accompanied 
 by the following : letters or certificates from two or more 
 persons of repute, testifying from personal knowledge 
 to his good habits and moral character; a certificate of 
 citizenship ; certificates of graduation from colleges and 
 medical schools. 
 
 Form of Application. 
 
 191 
 
 Sir: I request permission to be examined for an ap- 
 pointment as assistant surgeon in the Medical Eeserve 
 Corps, with a view to subsequent examination and ap- 
 pointment in the Medical Corps of the United States 
 Navy. 
 
 I was born at , and was 
 
 years of age on the day of 
 
 191. ., and am a citizen of the United States, residing 
 
 in , county of , in 
 
 the State of , and graduated 
 
 from Medical School in 191 . . 
 
 I forward herewith certificates of moral character, 
 habits and citizenship. 
 
 Very respectfully. 
 
 Chief of the Bureau of Navigation, 
 
 Navy Department, Washington, D. C. 
 Via the Surgeon-General, U. S. Navy. 
 
 The physical qualifications of applicants for appoint- 
 ment as officers in the medical corps are decided upon 
 by an examining board consisting of medical officers of 
 
The Naval Service. 73 
 
 the navy. The physical examination of candidates will 
 precede the mental and professional. No one found 
 physically disqualified will be examined further. No 
 material physical defects will he waived in any case for 
 any reason. 
 
 A candidate must declare under oath that he labors 
 under no mental or constitutional disease or weakness, 
 nor under any other imperfection or disability which 
 might interfere with the most efficient discharge of the 
 duties of an officer in any climate. 
 
 Table of physical proportions for height, weight and 
 chest measurement: 
 
 Height, Weight, Chest (mean cir- 
 
 Inches. Pounds. cumf erence) , Inches 
 
 66 132 33-1/2 
 
 67 134 34 
 
 68 141 34-1/2 
 
 69 148 34-3/4 
 
 70 155 35-1/2 
 
 71 162 36 
 
 72 169 36-1/4 
 
 73 176 36-3/4 
 
 It is not necessary that the applicant should conform 
 exactly to the figures in the foregoing table, which is 
 given to show what is regarded as a fair standard of 
 physical proportions. A variation not exceeding 15 
 pounds, not to fall below 132 pounds in weight or 1 
 inch in the mean chest measurement, below the standard 
 given in the table, is admissible when the candidate for 
 appointment is active, has firm muscles, and is evi- 
 dently vigorous and healthy. A chest expansion of less 
 than 2 J inches is a sufficient cause for the rejection of 
 the applicant. 
 
74 Medicine as a Profession". 
 
 Any one of the following conditions will be sufficient 
 to cause rejection: Feeble constitution; poor physique; 
 impaired general health; any disease or deformity, 
 either congenital or acquired, which would impair effi- 
 ciency, such as weak or deranged intellect, cutaneous 
 diseases, parasites of the skin or its appendages, de- 
 formity of the skull, abnormal curvature of the spine, 
 torticollis, inefficiency of joints or limbs, deformity of 
 joints or bones either congenital or the result of disease 
 or injury, epilepsy, or other convulsions, disease of the 
 eye, defective vision, color-blindness, impaired hearing 
 or disease of the ear, chronic nasal catarrh, ozena, polypi, 
 great enlargement of the tonsils, impediment of speech, 
 disease of heart or lungs, enlarged abdominal organs, 
 evidence of sclerosis, tumors, hernia, large varicocele, 
 sarocele, hydrocele, stricture, fistula, hemorrhoids, vari- 
 cose veins, disease of the genito-urinary organs, de- 
 formed or diseased feet; evidences of intemperance or 
 of the morbid use of drugs, loss of many teeth, or teeth 
 generally unsound (teeth properly filled not to be con- 
 sidered unsound). Every applicant must have at least 
 20 sound teeth, and of these not less than 4 opposed in- 
 cisors and 4 opposed molars. 
 
 Acuteness of vision must be as follows : For the med- 
 ical corps, not less than 12/20 for each eye, unaided by 
 glasses, and capable of correction by glasses to 20/20. 
 
 Upon entering the service, a medical officer is assigned 
 to one of the naval hospitals until the following October, 
 when the Naval Medical School, at Washington, opens. 
 He is then transferred to this school for six months of 
 study. One might wonder why this is necessary, when 
 none but graduates from reliable medical colleges are 
 accepted. No medical college can train physicians suffi- 
 
The ISTaval Service. 75 
 
 ciently in the rules, regulations, discipline, customs, 
 uniforms and other matters of detail of the service. 
 The young officer receives pay while attending this 
 Naval Medical College, after which he is assigned to 
 sea duty for 3 years as an assistant surgeon, and after 
 that he is promoted to the rank of passed assistant, 
 which carries with it more salary and more responsi- 
 bility. 
 
 The promotion to the grades of surgeon, medical in- 
 spector, and medical director is governed by seniority, 
 as the vacancies in higher ranks occur. 
 
 A medical officer has the privilege of retiring after 
 thirty years' service, receiving three fourths of the 
 highest salary of the grade in which he served when 
 retired. 
 
 Personnel of Medical Service of U. S. Navy. 
 
 Allowance for 
 Pay. Quarters. 
 
 11 Surgeon-generals $6,000 $1,152 
 
 , 17 Medical directors 5,000 1,008 
 
 14 Medical inspectors 4,500 864 
 
 81 Surgeons 3,300-4,000 720 
 
 158 Passed assistants 2,400-3,120 576 
 
 49 Assistant surgeons 2,000 432 
 
 Naval Hospitals are located as follows: Annapolis, 
 Md. ; Aucon, Panama; Canacao, P. I.; Chelsea, Mass.; 
 Colon, Panama; Great Lakes, South Chicago; Guam, 
 Miarian Island; Las Animas, Cal. ; Mare Island, Cal. ; 
 Narragansett Bay, E. L; Norfolk, Va. ; Pearl Harbor, 
 Hawaii; Pensacola, Fla. ; Philadelphia; Port Eoyal, S. 
 C; Portsmouth, N. H. ; Puget Sound, Wash.; San 
 Juan, Porto Eico; Sitka, Alaska; H. S. S. Eelief ; H. S. 
 S. Solace; Washington, D. C; Yokohama, Japan. 
 
76 Medicine as a Profession. 
 
 The Hospital Ship. 
 
 The hospital ships today are nothing less than float- 
 ing hospitals. The divisions are similar to the hospitals 
 on land; medical wards for the sick, other departments 
 for the surgical cases, and isolation wards for the infec- 
 tious diseases. There are also special rooms for the 
 eye, ear, nose and throat cases, the dispensary for the 
 sick who are not confined to bed, the officers' sick quar- 
 ters, the dental room, the pharmacy. X-ray room, chem- 
 ical and bacteriological laboratories and operating rooms. 
 
 Each of the hospital ships has its commanding officer 
 and crew for navigation, while the hospital is in charge 
 of an executive medical officer who is responsible for 
 the management of the hospital. The medical staff 
 usually consists of six or more medical officers, a dentist 
 and a pharmacist. 
 
 The executive surgeon is supreme in the medical 
 service, and under his supervision some of the most 
 perfect team work is developed. Every medical officer 
 is assigned to a definite duty. He is required to make 
 daily reports. Every evening, consultations are con- 
 ducted to discuss the treatment of cases, the necessity 
 of operation and the methods to be pursued. 
 
 The routine is methodical, and is conducive to the 
 best professional development. The reports must be in 
 detail, and any neglect of duty, or incompetency in 
 service will show in the reports. There is possibly no 
 field of medical service that will develop the resource- 
 fulness of a young physician so satisfactorily as the 
 service on a hospital ship. The ships accompany the 
 war fleets, and the ill on the war vessels are transferred 
 to the hospital ships. 
 
• CHAPTER XII. 
 
 The Indian Service. 
 
 The remnants of the Indian tribes scattered over the 
 western states and territories are the special care of the 
 federal government. The physicians who minister to 
 their needs are salaried employees of the government. 
 The field should be attractive to young men, more espe- 
 cially as it affords experience on sanitary supervision 
 and in preventative measures as well as in medical treat- 
 ment for diseases. 
 
 These men are under the supervision of the Depart- 
 ment of the Interior. The staff comprises: a medical 
 supervisor; 2 assistant supervisors; 6 eye specialists; 7 
 dentists; 108 physicians; 78 contract physicians; 3 
 traveling nurses; 68 regular nurses; 72 field matrons. 
 
 Entrants are selected by civil-service examination. 
 Announcements of these examinations are made in the 
 semi-annual circulars of information, which may be 
 secured by writing to the Civil Service Commission at 
 Washington. 
 
 The annual report of the commission states the num- 
 ber examined, the number passed, and the number ap- 
 pointed each year. From these reports it appears that 
 a large percentage of those who pass the examination 
 secure appointments. 
 
 The entrance salary for medical men for full-time 
 service is from $900 to $1,100 with certain expense 
 allowance. Promotions are made as vacancies occur. 
 
 77 
 
78 Medicine as a Profession-. 
 
 The contract physician is usually a physician who is 
 available in sparsely settled districts where there is not 
 enough practice to require the full time of a physician. 
 These men get about $480 to $500 per year from the 
 government for this part time service. 
 
 These physicians are located on Indian reservations 
 where schools are operated. These stations are the 
 headquarters for the reservation officials, schools and 
 hospitals. The Indians come to the hospitals for treat- 
 ment and in many cases travel fifty or a hundred miles. 
 
 In former times the Indians depended upon their own 
 medicine men. Before the government controlled the 
 Indian tribes, the medicine men were few. As an old 
 Indian chief expressed it: "When the medicine man 
 examined a patient and promised a cure and the patient 
 died, then we killed the medicine man, but today the 
 government does not permit us to do this, and so we 
 have numerous medicine men." 
 
 Today the medicine men are very much in evidence 
 among some tribes, but not more so than "pow-wow'^ 
 doctors among the ignorant whites and the negroes. 
 One even hears of these charm doctors, magnetic healers, 
 with their various mutterings and incantations, in many 
 of the so-called educated white communities. 
 
 The Indian tribes differ as much in their tribal prac- 
 tices and customs and physiognomy, as do the Germans, 
 Italians, Irish and English. Many interesting customs 
 prevail, as for instance, the disposition of the dead. The 
 Navajo Indians burn the house or tent in which the 
 deceased lived, together with the body of the dead. The 
 credit is given the old Mosaic Law for the establishment 
 of the first sanitary code, yet there is found among the 
 most uncivilized Indian tribes a practice of cremation 
 
The Indian Service. 79 
 
 of the dead, and burning of the house and all the belong- 
 ings of the dead — a sanitary measure against the spread 
 of disease. Small-pox epidemics have in many instances 
 nearly wiped out whole tribes, and while the Navajo 
 Indians knew nothing of the bacterial cause of disease, 
 they instituted this effective sanitary practice to prevent 
 its spread. 
 
 The physicians of the Navajos Indian Service respect 
 this traditional practice, and when any Indian is fatally 
 sick in the government reservation hospital, he is moved 
 out of the hospital to a tent or to his home before he 
 dies. No Navajo would ever enter the hospital if to 
 his knowledge any one had died in it. 
 
 Dr. N. F. Canaday, who was in the Indian Service 
 among the Pueblo Indians, says : " The Pueblo Indian 
 was slow to make new friends, but after he accepted the 
 new friendship, he was very loyal. Some of the 
 staunchest friends I ever had were Indians.^' 
 
 The following incident given by Dr. Clarence W. Mul- 
 likin, formerly of the Indian Medical Service, shows 
 how they appreciate the white medicine men. "While 
 stationed at Oraibi, Ariz., a Navajo Indian chief came 
 in one day to consult me concerning the physical condi- 
 tion of his son, who was at that time quite sick. The 
 chief told me that the young man was his eldest son, 
 and he was very anxious that he should live to take his 
 father's place as chief of his particular clan. He told 
 me that he had hired several of the Navajo Indian medi- 
 cine men to treat his boy, and each in his turn had 
 failed to restore the boy's health; but for their service 
 they had taken most of his horses, cattle and sheep ; and 
 now he was a poor man, and his son about to die. The 
 sand painting, the Indian dance, drinking of sacred 
 
80 Medicine as a Peoeession. 
 
 potions and all of the superstitious methods of treat- 
 ment known to the Navajo Indian medicine men had 
 failed; as a last resort he had come to the white medi- 
 cine man for help. 
 
 "In his own language he told how his boy was sud- 
 denly taken sick with a chill and vomiting, and had 
 then developed a high fever which lasted several days. 
 He breathed hard and fast, and coughed up a bloody 
 sputum, and had much pain in his left side. After 
 several days had passed the fever disappeared, but the 
 boy continued to grow weaker and weaker and thinner 
 and thinner, until now after six weeks of sickness he 
 was so weak that he could not lift his arm, and had the 
 appearance of a mass of bones with the skin alone cover- 
 ing them. His left side was bulging so much that it 
 seemed as though it would burst. It was on a Saturday 
 evening that the chief came to talk to me. I told him 
 to go home and I would come the following morning to 
 see what could be done for his sick boy. 
 
 " Early the next morning, after getting together the 
 necessary drugs and surgical supplies which I thought 
 I might need, and in company with a Mexican Indian 
 trader, we began the trip to the chief's camp in a buggy 
 with two strong horses to pull us. We were to go a dis- 
 tance of about fifty miles. About noon we reached the 
 camp. Our patient was, indeed, a sad sight to behold. 
 He had had pneumonia and now had a large collection 
 of pus in his left side. His heart was very weak and 
 beating at the rate of 150 beats per minute. I can see 
 him now as he lay there on the warm desert sand — a 
 mere heap of skin and bones, struggling for his breath, 
 each gasp seemed to be his last. Death apparently was 
 only a few hours distant. 
 
The Indian Service. 81 
 
 "I explained to the chief that there was practically 
 no hope for the boy and in order to help him at all, there 
 would have to be some openings made in his side so that 
 the pns could drain out. His heart was too weak for an 
 anesthetic to be given to relieve pain. This was ex- 
 plained to the boy and he said he would be glad to have 
 the opening made in his side and was willing to suffer 
 the pain, even if it only helped him to die easier; and 
 then, too, he wished so much to live, and if this was a 
 chance for recovery, he wanted to take it. These open- 
 ings were made in his side and most of the pus drained 
 out. The side was irrigated with a solution consisting of a 
 small amount of carbolic acid in boiled water, which I had 
 brought with me. Tubes were placed in the openings 
 to allow further drainage. The young man suffered 
 much pain but stood it bravely. I stayed with him 
 three hours and by the time I left he felt much relieved 
 and breathed easier. 
 
 "Before leaving I gave the chief some medicine for 
 his son and explained how the patient should be cared 
 for. He was also advised to let me know if his son was 
 still alive on the next Saturday; if so, I would return 
 again. On the appointed day I received word that our 
 patient was alive and better. The next day I returned 
 to the chief's camp and found the boy much improved. 
 I again left medicine for him and gave instructions as 
 to how to care for him. Once after this second visit I 
 heard that the boy continued to grow stronger. 
 
 " Several weeks later I left my station at Oraibi and 
 moved to the hospital at Tuba, Arizona, which was more 
 than one hundred miles from the chief's camp. 
 
 "One day while watching a Hopi Indian dance near 
 Tuba, I overheard a Navajo Indian talking to a bunch 
 
82 Medicine as a Profession". 
 
 of Hopi Indians, telling them how his son had been 
 very sick and that the Navajo Indian medicine men 
 had treated him and failed, but had taken most all of 
 his horses, cattle and sheep for their services, and how 
 he finally appealed for help to the white medicine man 
 by whom his boy was cured; I became interested and 
 thought I would walk around to a place where I could 
 .get a view of the speaker's face. 
 
 "At first glance I recognized him. I had no more 
 than gotten my first glance of the chief's face, when he 
 too looked in my direction and at once knew me. He 
 came forward with right arm extended and we clasped 
 hands and as he shook my hand a smile of gratitude 
 came over that stern wTinkled face that I shall never 
 forget. I asked him further about his boy, and he said 
 that he was well and strong and able to ride and lasso 
 horses. He told me that he had heard that I had moved 
 to Tuba, and he had come to express their gratitude for 
 my services. I told him that I appreciated his grati- 
 tude for what I had done, but tried to explain to him 
 that they owed much more gratitude to the people of 
 the United States and their great government who had 
 sent me there to help those Indians who needed the aid 
 of the white medicine man. A puzzled look appeared 
 on his face, and in his own peculiar way he replied: 
 ' You are the only white man who saw my son while he 
 was sick, and now he is well and strong. We are both 
 happy, to you we are grateful.' " 
 
 A list of these Indian Service Stations will be found 
 in the Appendix. 
 
CHAPTER XIII. 
 
 Sanitakt Engineering. 
 
 In the preceding chapter we referred to the work of 
 the medical staff of the Indian reservations. We will 
 dwell at some length upon the more extended work which 
 has been done by the sanitary engineers in the Panama 
 Canal Zone and in the Philippine Islands. Considering 
 the effectiveness of the work in these regions as suggest- 
 ing the possibilities of rendering habitable large areas 
 of the tropics and semi-tropics, one readily sees the 
 almost boundless fields which are open to the medical 
 men of the next generation. 
 
 The Isthmian Canal Commission was organized for 
 the purpose of making the Panama Canal Zone safe for 
 those who were to undertake the construction of the 
 canal. The commission was vested with extensive 
 powers and the strictest kind of laws were formulated 
 for the government of the country. The medical staff 
 numbers sixty-nine physicians. These men receive an 
 entrance salary of $1,800 a year with ample expense 
 allowance. 
 
 The sanitation of the Canal Zone was the most im- 
 portant preliminary work in the building of the canal; 
 it made the long-dreamed-of canal across the isthmus a 
 possibility. The story of the conquest of disease, espe- 
 cially of 3^ellow fever and malaria, reads like a fairy 
 tale. 
 
 The great obstacle in the way of the building of the 
 canal by the French Company was not money, organiza- 
 
 83 
 
84 Medicine as a Profession. 
 
 tion, engineers nor machinery, but a scarcity of men on 
 account of the enormous losses by death. The French 
 Company tried to build the canal through this yellow 
 fever and malarial infected zone — an impossible under- 
 taking, as we now see things. The project was doomed 
 to failure without laborers, and men would not dare to 
 go to work in an atmosphere infested with an enemy 
 that caused the death of 240 per year out of every 1,000 
 of the workmen. The problem of prime importance 
 was how to make the canal zone healthy. 
 
 The Surgeon-General of the United States Army 
 recommended Dr. William C. Gorgas, as the best fitted 
 officer for the head of the Sanitary Commission. Colonel 
 Gorgas was the medical officer who had charge of the 
 crusade against yellow fever in Havana, during the oc- 
 cupancy of Cuba; and under his supervision Havana 
 was freed from yellow fever for the first time in one 
 hundred and forty years. There was nothing miracu- 
 lous in this performance ; it was but a practical applica- 
 tion of scientific discoveries. One of these was the dis- 
 covery of the disseminating cause of yellow fever. It 
 helps us to understand this kind of work to follow those 
 who made this discovery. 
 
 The Surgeon- General of the Army appointed a com- 
 mission, known as the Reed Commission, composed of 
 Drs. Walter Eeed, Jesse W. Lazear, Aristides Agra- 
 monte and James Carroll to study the disease and find 
 its cause. The commission naturally proceeded to 
 prove or disprove the theories which were held regard- 
 ing this disease, and to determine whether it was spread 
 by transmission through air or by infection in the same 
 way as measles, scarlet fever and other communicable 
 diseases are transmitted. In order to test out this 
 
Sanitary Engineering. 85 
 
 source of the disease an experimental camp was con- 
 structed at Havana, which was absolutely insect proof; 
 and the volunteers from among the American soldiers 
 and doctors were housed in the camp for twenty con- 
 secutive nights, sleeping on beds on which yellow fever 
 pjatients had slept. There was no effort made to cleanse 
 the bed linens, but instead of cleansing, the bed linens 
 were intentionally soiled by the vomited matter of yel- 
 low fever patients. The men also donned night clothes 
 which had been worn by persons who died of yellow 
 fever. One hears of many heroic deeds performed by 
 individuals and soldiers in the field, but very few deeds 
 have been more heroic than this test taken by Dr. Eobert 
 P. Cooke, U. S. A., and six privates of the hospital 
 corps. Each one knew of the fatality of yellow fever. 
 None developed the disease. This was conclusive evi- 
 dence that yellow fever was not communicated by direct 
 contact, but by other channels. 
 
 The next clue investigated was one advanced by a 
 Dr. Carlos Finley, of Havana. It was the "mosquito 
 theory.^^ The preliminary investigation showed very 
 strong evidence favorable to this theory, but conclusive 
 evidence was lacking until an actual test was made upon 
 human beings. While there are about seven hundred 
 species of mosquitoes, the evidence pointed to the stego- 
 myia as the species that carried the disease. The com- 
 mission procured eggs of this variety and allowed them 
 to develop in captivity. Upon studying this species of 
 mosquitoes the fact developed that the males were not 
 equipped with a "hypodermic needle" or sucker, and 
 consequently could not carry yellow fever. It also de- 
 veloped that the mosquito for sustenance needs only 
 vegetable juices. A more surprising discovery was made 
 
86 Medicine as a Profession. 
 
 — that while the female stegomyia needs no animal 
 blood for sustenance, she does need it in order to lay 
 eggs. The female did not lay eggs until she sucked 
 some animal blood. This explained why the female 
 alone possessed this biting apparatus. 
 
 The commission allowed the female stegomyia, held 
 in captivity, the privilege of biting yellow fever patients ; 
 and then all was ready for the test. Who were the first 
 volunteers deliberately to allow these mosquitoes to bite 
 them in order to prove or disprove a fanciful theory? 
 Dr. Carroll and Dr. Lazear, two of the commissioners 
 who were conducting the investigation, submitted them- 
 selves. They both developed yellow fever, and Dr. La- 
 zear died within five days from the time he was stricken. 
 " Almost at the beginning of what promised to be a life 
 full of usefulness and good works, and d3dng he added 
 one more name to that imperishable roll of honor to 
 which none others belong than martyrs to the cause of 
 humanity '^ quoting Dr. Reed's words. 
 
 This experiment was repeated with other volunteers, 
 and the mosquito theory was verified. A few heroic 
 lives were sacrificed, but through this sacrifice, Havana 
 and later Panama were ultimately freed of the dreadful 
 scourge, and as a result the Canal was built without the 
 heavy toll of the days of the French Canal Company's 
 operations. 
 
 The United States averaged 39,000 employees on the 
 canal for 10 years, with a death rate of only 14 per 
 1,000. The sanitary commission of the Canal Zone had 
 to destroy all breeding places of the mosquito in order 
 to eradicate the diseases of malaria and yellow fever, 
 as both diseases are disseminated by mosquitoes, though 
 by different species. 
 
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IiiNKkANT Physician at Work in the Philippinks 
 
CHAPTER XIV. 
 
 The Philippine Service. 
 
 When Congress reorganized the government of the 
 Philippine Islands, a special medical service and public- 
 health department was constituted to direct the sanita- 
 tion; control the epidemics; prevent the introduction 
 of plagues; regulate the manufacture and sale of foods 
 and drugs; exercise supervision of water supplies and 
 the building of tenements; to establish, wherever neces- 
 sary, hospitals and asylums and to regulate the practice 
 of medicine. In the continental United States some of 
 the governmental machinery for public-health work is 
 under the control of the national government, part of it 
 is supervised by the state and part by the municipalities, 
 and some by privately supported organizations. The 
 vagaries of our patchwork system can be more readily 
 understood after a consideration of the complete mod- 
 ern system which was created for these islands. 
 
 When the American army of occupation came into the 
 islands, they found malaria, the bubonic plague, typhoid 
 fever, dysentery and cholera everywhere. The great 
 cities were at once transformed. Wholesome artesian 
 water supplies were provided for ; sewerage systems were 
 instituted ; vermin-infested old buildings were removed ; 
 the milk and food supplies were carefully inspected; 
 dance halls and public assemblies were regulated; hos- 
 pitals and free clinics were founded ; medical and train- 
 ing schools for training native physicians and nurses 
 were instituted; and research laboratories for studying 
 climatic conditions and tropical disease were established. 
 
 7 87 
 
88 Medicine as a Profession. 
 
 The duties assigned to the bureau of public health 
 were to include not only those usually imposed upon 
 similar departments in the United States, such as the 
 collection and compilation of vital statistics and the 
 protection of the public from communicable diseases, 
 but also to embrace the distribution of certain charitable 
 f unfls ; the care of the insane ; the supervision of orphans 
 and the aged; the supervision of hospitals, the hygienic 
 and medical care of over 12,000 civilian employees; the 
 administration of the food and drug act; the perform- 
 ance of coroner's duties; the examination of candidates 
 for the public service; the supervision of sanitary and 
 housing regulations and the control of water supplies. 
 
 It will thus be seen that the members of this service 
 must be skilled in administrative work as well as in 
 medical practice; sanitary engineers as well as trained 
 investigators; and that their work is to a much larger 
 extent preventative than curative, than in the American 
 communities, where officials are hampered on all sides 
 by restrictions. Abroad they are in positions to work 
 out gradually such service as progressive medical men 
 have been seeing in their dreams for many years. 
 
 As the islands become more prosperous they will 
 afford, no doubt, fine fields for private practitioners. 
 With a population of over 8,000,000 there are now only 
 620 physicians in the islands, not including the un- 
 trained medical native men. In Bana, with a popula- 
 tion of 39,000, there is only one physician ; in Batanges, 
 with 33,000, only four; in Baybay, with 23,000, only 
 one; in Cadiz, with 20,000, one; Dumaguete, with 15,- 
 000, four; in Calbyog, with 16,000, one; in Caragayra, 
 with 17,000, one; in Tabaco, with 22,000, one; in San 
 Pablo, with 22,600, three ; and in Jaro, with 10,600, two. 
 
The Philippine Service. 89 
 
 With the influx of Europeans and Americans, the 
 development of manufacturing industries and the larger 
 education of the natives there will be a demand for 
 more trained men, not only in these larger cities, but in 
 more remote districts. 
 
 The private practice of medicine is regulated in the 
 same way as in the states, the bureau of health having 
 control of the licensing of physicians. 
 
 Applicants for admission to this service and candi- 
 dates for license to practice in the islands must be grad- 
 uates of reputable medical colleges recognized by the 
 Board of Health. They must pass such examinations 
 as the board directs, which include the subjects usually 
 prescribed by the board of medical examiners of the 
 states, in addition to the medical laws of the islands; 
 candidates, of course, must learn the languages which 
 are spoken in the districts to which they are sent, or 
 which they select for practice. 
 
 The advance guards of modern science, by performing 
 in these remote regions marvelous changes, win such 
 rewards of gratitude and esteem as do the medical men 
 at mission stations, of whom we will treat in another 
 chapter. 
 
 It was in the Philippine Service that one of the 
 American physicians made a discovery in medicine that 
 has been of great service to all mankind — the use of 
 ipecac and its active principle in the cure of dysentery. 
 The investigation which he conducted proved that the 
 disease was due to the amoeba, and that the amoeba 
 could not live in a system thoroughly impregnated with 
 ipecac. It was through the further development of this 
 discovery that, today, dysentery, typhoid fever, pyor- 
 rhea alveolaris, etc., are treated much more intelligently. 
 
CHAPTEE XV. 
 
 The Federal Public Health Service. 
 
 Under the provisions of the constitution of the 
 United States empowering the federal government to 
 regulate the admission of immigrants and to promote 
 the general welfare of the people, from the beginning 
 of our national existence, officers were stationed at the 
 chief points of entry to prevent incoming vessels from 
 landing plague-stricken passengers or members of crews, 
 and gradually, under the supervision of the Department 
 of the Treasury, the United States Public Health Serv- 
 ice has been developed. Few people have any concep- 
 tion of the extensive work which is being carried on by 
 this department, which is just as active in protecting 
 the people of the country as is the army and navy. 
 
 The work of the department is organized under the 
 following divisions: scientific research and sanitation; 
 foreign and insular quarantine and immigration; inter- 
 state quarantine ; sanitary reports and statistics ; marine 
 hospitals and relief; personnell and accounts; miscel- 
 laneous. 
 
 Each of these divisions is in charge of a medical 
 officer who is responsible for its operations to the sur- 
 geon-general of the service. 
 
 The staff of the department at the close of the year 
 ending June 30, 1915, consisted of the following: 
 
 90 
 
The Federal Public Health Service. 91 
 
 Burgeon-general 1 Assistant surgeons 63 
 
 Assistant surgeon-general 1 Acting assistant surg's. . 262 
 
 Senior surgeons 12 Internes 21 
 
 Surgeons 70 Medical inspector 1 
 
 Passed assistant surg 's. 39 Quarantine inspector .... 1 
 Hospital and quarantine nurses and attendants 1,429 
 
 This service must be attractive, because during the 
 year considered there were no resignations from the 
 service, although during the year five officers were 
 placed under "waiting orders" on account of illness, 
 which means that they were relieved from duty on full 
 or half pay. 
 
 The rate of pay is as follows: assistant surgeons re- 
 ceive $2,000; passed assistant surgeons, $2,400; sur- 
 geons, $3,000; senior surgeons, $3,500; and assistant 
 surgeon-generals, $4,000 a year. When quarters are 
 not provided, commutation at the rate of $30, $40 and 
 $50 a month, according to the grade, is allowed. 
 
 After four years' service, assistant surgeons are en- 
 titled to examination for promotion to the grade of 
 passed assistant surgeon. 
 
 All grades receive longevity pay, 10 per cent, in addi- 
 tion to the regular salary for every five years' service 
 up to 40 per cent, after twenty years. 
 
 The tenure of office is permanent. Officers travelling 
 under orders are allowed actual expenses. 
 
 Admission to the service is governed by the following 
 regulations contained in a circular letter which is sent 
 to applicants: 
 
 Boards of commissioned medical officers will be con- 
 vened to meet at the Bureau of Public Health Service, 
 3 B Street, S.E., Washington, D. C, for the purpose of 
 examining candidates for admission to the grade of 
 
92 Medicine as a Profession. 
 
 assistant surgeon on the Public Health Service, when 
 applications for examination at these stations are re- 
 ceived in the Bureau. 
 
 Candidates must be between 23 and 32 years of age, 
 graduates of reputable medical colleges, and must fur- 
 nish testimonials from two responsible persons as to 
 their professional and moral character. Service in hos- 
 pitals for the insane, or experience in the detection of 
 mental diseases will be considered, and credit given in 
 the examination. Candidates must have had one years^ 
 hospital experience or two years' professional work. 
 They must be not less than 5 feet, 4 inches, nor more 
 than 6 feet, 2 inches in height. 
 
 The following is the usual order of the examination : 
 physical, oral, written, clinical. In addition to the 
 physical examination, candidates are required to certify 
 that they believe themselves free from any ailment which 
 would disqualify them for service in any climate, and 
 that they will serve wherever assigned to duty. 
 
 The examinations are chiefly in writing, and begin 
 with a short autobiography of the candidate. The re- 
 mainder of the written exercise consists of examination 
 in the various branches of medicine, surgery and hy- 
 giene. The oral examination includes subjects of pre- 
 liminary education: history, literature and natural 
 sciences. The clinical examination is conducted at a 
 hospital. The examination usually covers a period of 
 about ten days. 
 
 The officers of the medical corps examine the papers of 
 all incoming vessels. The medical officer of all ships 
 upon arriving at a port must state the health condition 
 of the port from which the ship comes as well as the 
 conditions of the ports at which the ship touched during 
 
The Federal Public Health Service. 93 
 
 the voyage, and enumerate any cases of sickness which 
 occurred during the voyage. The medical inspectors 
 may examine all the passengers and crew and require 
 the fumigation of the cargo ; and in suspected cases they 
 may cause the vessel or passengers who were exposed to 
 contagion or infection to be detained in quarantine suffi- 
 ciently long to give any suspected diseases the full 
 period of time to develop. 
 
 The department may also send inspectors to suspected 
 foreign ports to scrutinize cargo, crew and passengers 
 of vessels destined for American ports, to prevent the 
 spread of communicable diseases. 
 
 Officers are stationed as sanitary guards at Santiago, 
 Chile; Callao, Peru; Guayaquil, Ecuador; Eio de 
 Janeiro, Brazil ; La Guaira, Venezuela ; Calcutta, India ; 
 Naples, Italy; Libau, Eussia and in several Cuban and 
 Mexican ports, and in such other foreign ports as 
 deemed necessary. 
 
 One can hardly appreciate the value of the service 
 which the government is rendering to its people through 
 this department. Although Asiatic ports from which 
 vessels sail are often infected with bubonic plague, 
 cholera, smallpox or other diseases, yet these diseases 
 have only on a few occasions been introduced into this 
 country. Several years ago bubonic plague did develop 
 upon the Pacific coast, and but for the persistent, 
 thorough work of these medical officers, the whole coun- 
 try from coast to coast might have been infected. 
 
 This work at the ports of entry is not by any means 
 all the work that is done in disease prevention by this 
 department, but investigations of disease epidemics are 
 carried on continually. During 1914, important inves- 
 tigations of typhoid fever, cholera, plague, smallpox. 
 
94 Medicine as a Profession. 
 
 typhus fever, tuberculosis, trachoma, pellagra, poliomye- 
 litis, malaria, dengue, hookworm disease, water pollu- 
 tions and milk hygiene have been conducted. 
 
 The officer detailed to investigate the disease among 
 the mountain whites in Tennessee, and among the 
 natives of Porto Eico, known as the " lazy " disease, be- 
 cause all the inhabitants afflicted with the disease became 
 lazy, indolent and sleepy, found the cause of the disease 
 to be a hookworm. The officer detailed to this investi- 
 gation also developed a treatment for the cure of these 
 afflicted mountain whites. 
 
 Another officer was detailed to investigate the Eocky 
 Mountain spotted fever, and found the cause to be a 
 microorganism disseminated by a tick. The name of 
 Surgeon T. B. McClintic, who sacrificed his life to the 
 cause of science in order that this fever might be eradi- 
 cated, belongs with those heroes who have given up 
 their lives for the common good of mankind. 
 
 Until recent years, there was possibly no familiar dis- 
 ease that was as little understood by the public and phy- 
 sicians as rabies. The public health service detailed an 
 officer to investigate this disease, its cause, localities and 
 treatment. His report clears up the mysteries of the 
 disease, and will eventually aid in its complete eradica- 
 tion. 
 
 The department maintains a hygienic laboratory 
 where much of the work in connection with these inves- 
 tigations is carried on. In this laboratory the trained 
 men of the service also determine the merits of the new 
 medical discoveries which are announced from time to 
 time, and valuable service has been rendered to the 
 public in exposing frauds. 
 
The Federal Public Health Service. 95 
 
 There are also maintained 22 hospitals on the sea- 
 coasts, lakes and rivers for the care of seamen. During 
 the year closing June 20, 1915, 40,604 seamen were 
 treated at the various stations. Of this number over 
 14,000 were treated in hospitals owned by the govern- 
 ment. The marine hospitals are located at: Mobile, 
 Ala. ; San Francisco, Cal. ; Delaware Break Water ; Key 
 West, Fla. ; Cairo, 111.; Chicago; Evansville, Ind. ; 
 Louisville ; New Orleans ; Portland, Me. ; Boston ; Vine- 
 yard Haven, Mass. ; Baltimore ; St. Louis ; Wilmington, 
 Del.; New York; Memphis; Cape Charles, Va. ; Port 
 Townsend, Wash. 
 
 Assistant surgeons, whether in quarantine stations, 
 marine hospitals, hygiene laboratory or in field service, 
 work under the direction of their superior officers; and 
 they must accustom themselves to such a rigorous sys- 
 tem of routine of work and report as is unknown to the 
 general practitioner. Passed assistant surgeons are 
 more independent, and they may be assigned to special 
 duty in connection with the other departments of the 
 government or in cooperation with the health service of 
 the several states and cities. Whenever they are as- 
 signed to special duty with other branches of the govern- 
 ment, the medical officers are accorded the honor due 
 to officers of the highest rank. 
 
 The rank of surgeon can only be attained by promo- 
 tion as vacancies occur, and then only by seniority. 
 
CHAPTER XVI. 
 
 The Public Health Service. 
 
 Unlike the well-organized, unified public health and 
 medical service of the Philippines, the machinery for 
 doing this work in the States is not always so well co- 
 ordinated. This is because the functions which the 
 state and local governments exercise in these fields have 
 grown from the very insignificant beginnings which date 
 back to the organization of our government, when men 
 acknowledged little collective responsibility for the wel- 
 fare of their fellows. These functions of government 
 deal with the protection of the citizens from infection 
 and contagion, from contaminated food supplies and 
 polluted waters. These functions are exercised by the 
 boards of health of the larger cities within their own 
 areas, and by the state boards of health through local 
 officers in the country districts. The state medical serv- 
 ice generally has to do with ministering to the inmates 
 of state institutions, and the county and city medical 
 service take care of the needs of those in institutions 
 under the jurisdiction of the local governments; while 
 in many states there is a separate medical service for 
 the poor which is administered through the boards for 
 poor relief and charity. 
 
 This work is as yet very unevenly developed and prac- 
 tices vary in the several states. To convey an idea of 
 the operations of these branches of government and to 
 show the large possibilities in this field, a somewhat de- 
 
 96 
 
The Public Health Service. 97 
 
 tailed description is given of the organization and opera- 
 tions of the department of health of the state and city 
 of New York. 
 
 The state paid in 1914, to sanitary, medical and 
 scientific officers connected with the board of health and 
 other departments of the state and county governments 
 and to medical officers of institutions, over half a mil- 
 lion dollars; and in the one single large city of New 
 York the expenditures of the department of health 
 alone were $3,363,767.85. 
 
 The state has a commissioner of public health with an 
 annual salary of $8,000 ; deputy commissioner, at $5,000 
 and an advisory council of eight members, each of whom 
 receives $1,000. 
 
 There is a department of sanitation and hygiene, 
 which passes upon the plans for water supply systems 
 and sewerage systems of cities and villages, investigates 
 complaints of stream pollution, and looks into the causes 
 of t}^hoid fever epidemics. This is in charge of a 
 chief sanitary engineer with a corps of trained assistants 
 who cover the state. 
 
 The department of laboratories and research has 
 charge of the preparation and distribution of antitoxins. 
 Its medical officers and bacteriologists are at the com- 
 mand of the physicians and health officers of the state. 
 
 The division of child hygiene supervises the child 
 welfare agencies of the state and the public and private 
 schools. 
 
 The department of vital statistics collects from the 
 county officers of health, statistics relating to births and 
 deaths. 
 
 The department of publicity and public health educa- 
 tion employs a corps of lecturers, issues bulletins of in- 
 
98 Medicine as a Profession". 
 
 formation for the people and plans and manages exhibits 
 intended to arouse the people to the necessity of sanita- 
 tion and hygiene. 
 
 The division of communicable diseases is constantly 
 on the watch for any outbreaks, and is prepared to check 
 and control the spread of disease, in the same way that 
 a fire department operates or the state militia acts when 
 an enemy threatens the peace and comfort of the people. 
 
 Another department regulates and supervises the 
 operation of cold storage plants and the distribution of 
 food from these places. 
 
 The psychiatric institute and the institute for the 
 investigation of malignant diseases have their own 
 organization of experts and their own laboratories. 
 
 The heads of these several departments are paid 
 $4,000 a year, the assistant directors $3,000, and the 
 members of the scientific forces, whether physicians, 
 bacteriologists, chemists or sanitary experts, are selected 
 by competitive examinations with salaries ranging from 
 $1,200 to $2,500. 
 
 The health officer of the port of New York is a state 
 official who is paid $12,500 a year, and has a deputy at 
 $4,000 and three assistants at $3,000. These men have 
 perhaps the most autocratic power of any officials in our 
 system of government. 
 
 Outside of the department of health the state has a 
 medical adviser to the workingmen's compensation com- 
 mission at $4,000 a year, a medical examiner at $3,000 
 and an assistant at $2,000. 
 
 The superintendents of the state insane asylums re- 
 ceive from $4,800 to $6,000 with maintenance, and the 
 physicians from $1,200 to $2,800. The physicians to 
 the school for the blind and the deaf, the homes for 
 
The Public Health Service. 99 
 
 epileptics and feeble-minded, the houses of detention 
 and the prisons of the state, are designated to act as 
 such from among the practising physicians of the com- 
 munities in which these institutions are located, and 
 they change whenever the political complexion of the 
 state government changes. 
 
 Much of the work of the state department is done 
 through physicians who act as local health officers and 
 who are paid according to the amount of time which 
 they give to this service. The county board of health 
 officers usually act as reporters of conditions to the state 
 board of health, and direct the medical service for the 
 relief of the poor. 
 
 The most completely developed public health systems 
 are found in our large cities. In the city of New York 
 in 1915 the total number of employees of the depart- 
 ment of health was 3,421. Of course, all of these were 
 not medical officers, but a description of the work of this 
 department will show how rapidly this new field for 
 medical men is expanding. 
 
 The commissioner of health, the chief of police and 
 the health officer of the port constitute the board of 
 health. There is also an unpaid medical advisory board, 
 and a board of honorary consultants. The head of the 
 administrative force is the commissioner of health 
 ($8,000), a sanitary superintendent ($7,000), and a 
 secretary to the board of health ($5,000). The force in 
 the office of the secretary handles the correspondence, 
 keeps the records, attends to the purchase and distribu- 
 tion of supplies and audits the accounts of the depart- 
 ment. It is made up of men and women whose train- 
 ing has been along commercial lines. 
 
 The registrar of vital statistics ($5,000) and his 5 
 
100 Medicine as a Profession. 
 
 assistants ($3,000) are medical men. They superin- 
 tend the collection of statistics of births, deaths and mar- 
 riages, issue burial permits and make searches for miss- 
 ing persons. In the department, in addition to a force 
 of 53 clerks, copyists and stenographers, there are four 
 medical clerks ($1,200), and a medical inspector 
 ($1,500). 
 
 The superintendent of the sanitary department in- 
 vestigates complaints about noises which disturb the 
 comfort of people, supervises dangerous trades, has 
 charge of the suppression of mosquitoes and the removal 
 of the bodies of the dead animals. His force consists 
 of five sanitary supervisors ($3,500) and a force of med- 
 ical and sanitary inspectors ($l,200-$2,550). 
 
 The bureau of infectious diseases collects from physi- 
 cians the reports of the appearance of such diseases, 
 issues a daily bulletin showing their location, estab- 
 lishes and enforces the observance of quarantine regula- 
 tions, disinfects premises, disinfects or directs the de- 
 struction of infected goods, attends to the vaccination of 
 patients in public institutions, supervises the tubercular 
 hospitals and camps, and the laboratory for Pasteur 
 treatment. The medical staff consists of a director 
 ($5,000), an assistant director ($4,000), 5 chiefs of 
 divisions ($3,500), 4 borough chiefs, 17 physicians in 
 charge of branch offices and hospitals, 44 medical in- 
 spectors ($1,200 to $3,000), 62 attending physicians 
 ($300 to $600), besides a force of bacteriologists and 
 laboratory assistants. 
 
 The bureau of laboratories attends to the manufac- 
 ture of vaccine virus, antitoxines and other biologic 
 products which are used for the diagnosis, prevention 
 and treatment of diseases. There is a clinical depart- 
 
The Public Health Service. 101 
 
 nient which advises and instructs physicians in the use 
 of these products; a laboratory for the examination of 
 food and milk ; a laboratory which makes bacteriological 
 examinations for other departments and for physicians. 
 The medical staff consists of a director, 7 assistant 
 directors, 25 bacteriologists and 42 laboratory assistants, 
 all of whose pay corresponds with the pay for services 
 of the same kind in other departments. 
 
 The bureau of child hygiene is in charge of a director 
 ($3,000), an assistant director ($2,550) and 5 chiefs of 
 divisions, 5 borough chiefs and 14 supervising inspec- 
 tors. There are 98 school medical inspectors ($1,200- 
 $1,500) : 9 examiners for employment certificates; 7 
 inspectors of child welfare institutions; 18 attendants 
 at clinics for school children; and a large force of non- 
 medical assistants, inspectors and nurses, attendants at 
 milk stations, orderlies, watchmen and cleaners. This 
 department looks after the medical inspection of school 
 children, conducts 55 milk stations for the distribution 
 of properly prepared milk for infants, supervises the 
 midwives, operates clinics for children and controls day 
 nurseries, and issues emplo}Tnent certificates to the chil- 
 dren who leave school. 
 
 The director of the bureau of food inspection makes 
 and enforces the regulations for the manufacture and 
 sale of food products, including milk and beverages, 
 and the sale of drugs and patent medicines. Samples 
 of milk are taken at the dairies and frequently ex- 
 amined, and regulations are made for safeguarding of 
 the milk supplies. Over 4,000 bakeries are regularly 
 visited and inspected, slaughter houses and retail meat 
 markets are also under the jurisdiction of this bureau. 
 
102 Medicine as a Profession. 
 
 The entire force of the department in 1915 was 152, but 
 only a few of the chief officers were medical men. 
 
 There are only three medical men in the staff of the 
 bureau of publicity. During the year 1914, this depart- 
 ment gave lecture courses to medical and food inspectors 
 and to nurses, noonday talks to factory employees, con- 
 ducted an anti-tuberculosis campaign, managed several 
 important health exhibits and distributed over 200 dif- 
 ferent health bulletins. The bureau of hospitals of the 
 department of health conducts three hospitals for con- 
 tagious diseases and one country tuberculosis hospital or 
 camp. While there are over a thousand employees 
 under the jurisdiction of the bureau, the medical staff 
 consists of a director, 26 hospital physicians and a vary- 
 ing number of internes and medical inspectors. The 
 hospital physicians receive from $1,200 to $1,800 and 
 maintenance, and internes $120 a year and maintenance. 
 
 This elaborate organization does not include the entire 
 medical service under the direct control of the city. The 
 independent Bellevue and Allied Hospitals under the 
 direction of a superintendent ($6,000), director of labo- 
 ratories ($5,000), and assistant medical superintendent 
 ($2,500), has 4 attending physicians giving part time 
 service ($1,000), 38 out-patienfs physicians ($600 to 
 $900), and a force of pathologists, radiographers and 
 laboratory assistants. 
 
 There are also four medical examiners for the school 
 department who pass upon the physical qualifications of 
 applicants for appointment to the teaching staff, 25 
 surgeons of the police department ($3,500), and 11 
 visiting physicians to prisons ($1,200-$1,800). The 
 department of charities has a medical superintendent 
 ($6,000). The superintendents of the hospitals under 
 
1 
 
 i 
 
The Public Health Service. 103 
 
 the control of this branch of the city government are 
 paid $4,000, and the physicians from $1,200 to $2,550. 
 
 This elaborate organization has been gradually de- 
 veloped. At present, dental clinics for school children 
 are being tried under the auspices of voluntary organi- 
 zations. If this experimental work proves successful, 
 this work will become one of the functions of the city 
 government. Just in this way the work of the depart- 
 ment of public health has been extended in this city and 
 is now being extended in all leading states and cities. 
 It has fully justified itself not only in this but in Euro- 
 pean countries. The whole movement is a part of the 
 movement for increasing and promoting the economic 
 efficiency of all citizens, and it is a result of the recent 
 discoveries concerning the real causes of infectious and 
 contagious disease. These discoveries have shown that 
 these public health measures must be supported by the 
 citizen, not alone to help his fellow but for his own pro- 
 tection. At present, however, in most of the cities this 
 kind of work, to which the public is committed, is but 
 partially done. In the matter of school medical inspec- 
 tion, it will be readily seen that 98 medical inspectors for 
 the examination of over 900,000 school children is a very 
 small number with which to realize the ideals of the pro- 
 moters of this kind of public service; every day we 
 realize that while the principle of food inspection is a 
 good one, the provisions which have been made for the 
 inspection of retail food stores are wholly inadequate. 
 All this means that this field will be greatly expanded 
 during the coming decades. 
 
 The heads of these public-service departments are 
 usually appointed from among the men who have estab- 
 lished reputations and are specialists in their subjects; 
 8 
 
104 Medicine as a Profession. 
 
 but frequently the appointments are made because of 
 political favoritism. In most of the states and cities the 
 subordinates are selected by civil-service tests which are 
 open alike to men and to women. Young medical men 
 who accept appointments of this kind serve for a limited 
 number of years and then turn to private practice. In 
 the past it has been the custom of these public officials 
 gradually to build up a private practice while holding 
 public appointments. This cannot at present be done 
 so well. The salaries which are paid in the public serv- 
 ice are gradually being increased, and the public is de- 
 manding full service from its employees. 
 
 These salaries are likely to be increased as the demand 
 for trained and experienced men grows. That the sup- 
 ply of such at present is not equal to the demand is 
 proven by the fact that special postgraduate courses for 
 health officers have been established by Harvard Uni- 
 versity, Tulane University and the universities of Penn- 
 sylvania, Michigan and Wisconsin. 
 
 At present the positions in the public medical service 
 which are under civil-service regulation are open to 
 graduates of recognized medical colleges under about 
 the same terms as those under which they enter the ex- 
 aminations for licenses to practice medicine, but for the 
 sake of efficiency the new recruit for these services is 
 gradually shifted to special work and the service itself 
 has opened up many new lines of specialization. 
 
CHAPTER XVII. 
 
 Hospital Service. 
 
 There are nearly 5,000 hospitals, public and private, 
 in the United States, to say nothing of the large num- 
 ber of hospitals which are maintained by corporations 
 for the treatment of their employees. The operations 
 of the hospital staff of the Southern Pacific Railroad 
 for 1914 show a total of 81,525 cases. This great de- 
 velopment of this kind of service in all sections of the 
 country calls for specialists in hospital administration. 
 The general practice of medicine is not such as to give 
 men a chance to develop executive power while getting 
 experience in actual practice; so for this reason the de- 
 mand for men in this service is greater than the supply, 
 and with the continued increase in the number of hos- 
 pitals this is likely to continue. 
 
 The real development of the modern general hospital 
 for the treatment of disease dates back to 1861, when 
 Lister gave to the world the germ cause of wound infec- 
 tion. He proved that wounds, whether accidental or 
 surgical, will heal quickly if kept free from bacterial 
 contamination. Before this discovery all kinds of oint- 
 ments and plasters were applied to wounds; today the 
 applications which are made are intended to destroy or 
 to prevent bacterial growths ; and going upon the prin- 
 ciple that nothing is clean which has not been sterilized, 
 the modern hospital has sprung into existence. Con- 
 ditions have been created under which the patients can 
 
 105 
 
106 Medicine as a Profession. 
 
 be surrounded with that absolute cleanliness which is of 
 prime importance. 
 
 Modern hospitals for the treatment of the sick, as 
 distinguished from asylums and hospitals for defectives 
 and dependents, may be built and supported by public 
 taxation, and have free wards for the treatment of the 
 poor; they may be built by private subscriptions and 
 supported by fixed charges or they may be built partly 
 by subscriptions and partly by public funds and sup- 
 ported by appropriations from the public funds and by 
 fees. 
 
 In the smaller communities the general hospital may 
 admit all kinds of cases and have a surgical and a med- 
 ical department, each of which has its subdivisions for 
 treating special types of cases. In large cities there 
 may be special hospitals with their own rules and regu- 
 lations, which are especially designed to facilitate the 
 handling of particular infirmities. 
 
 The management of hospitals is usually vested in a 
 board of trustees appointed by the governor in the case 
 of state institutions; by the mayor or health board in 
 the case of city institutions ; and in various ways in the 
 case of private or semi-public institutions. These trus- 
 tees have the entire control of the business management, 
 the appointment of the superintendent and, sometimes, 
 the staff of physicians; but recently the tendency has 
 been to give the appointment of subordinates to the 
 superintendent. 
 
 The superintendent, although the executive head, is 
 not expected to render medical service; but he may 
 direct the internes in the treatment of surgical cases in 
 the absence of the chief surgeon. Although the super- 
 intendent of the public hospitals is usually appointed 
 
Hospital Service. 107 
 
 because of his political affiliations, he is rarely disturbed 
 if his party goes out of power while he is in office. An 
 educated public sentiment is beginning to recognize that 
 officials whose value depends upon their experience shall 
 not be removed from positions which they are satisfac- 
 torily filling. 
 
 The successful hospital superintendent is a man of a 
 high type of administrative ability. His medical staff 
 consists of a visiting body of practicing physicians 
 among whom jealousy may develop discords; the house 
 physicians are young physicians who are continually 
 changing and the internes remain hardly long enough to 
 learn the regulations of the institution; the patients 
 come and go ; confiicts may arise between the practicing 
 physicians who bring their patients to the private wards ; 
 and the supervision of nursing requires discipline of the 
 strictest kind. So we have a call here for a physician 
 with medical knowledge and skill sufficiently extended 
 to command the confidence of the best of his profession ; 
 diplomacy and tact to bar all discordant influences; 
 sympathy for the suffering and their friends ; and ability 
 to manage his internal affairs with the strong hand of 
 rigid discipline. 
 
 The internes, who are selected from among the grad- 
 uates of the medical colleges, usually serve for a year. 
 The house physician begins his service as a junior or 
 assistant, and in due time takes the place of the retiring 
 senior. The service is so arranged that the house phy- 
 sicians serve' in turn in the different departments, in 
 order that they may get actual experience in the treat- 
 ment of all kinds of medical and surgical cases. The 
 pay in the hospitals follows generally the schedules given 
 in the preceding chapters. 
 
108 Medicine as a Profession. 
 
 The hospitals for defectives, whether public or pri- 
 vate, require men with special training. The physicians 
 as well as the superintendents are more permanent and 
 give their whole time to the service. The pay is fairly 
 remunerative and the work appeals especially to those 
 who dislike the business side of private practice. The 
 work in the insane hospitals from the medical view- 
 point is very interesting, and it is such as to satisfy 
 the best of altruistic instincts. 
 
 The work in these institutions is more systematic 
 than in general practice or the work of the general hos- 
 pital to which patients continually come. An insane 
 asylum has from four to ten regular physicians for 
 each thousand patients. This gives opportunities for 
 close and careful study of cases, and for keeping careful 
 and systematic records. Ample clinical facilities, labo- 
 ratories and libraries are supplied. 
 
 Upon arrival a patient is kept in the reception wards 
 for examination; and in due time a staff conference 
 classifies him, prescribes his treatment and assigns him 
 to the care of some particular physician. 
 
 In the New York hospitals for the insane, the pay 
 for superintendents is from $4,800 and maintenance to 
 $6,000 in the larger hospitals. The present heads of 
 these institutions in the state average seventeen years 
 of service; the physicians, receiving from $1,200 to 
 $2,800 and maintenance, average very short periods of 
 service, except the women physicians. In 1914 there 
 were 17 receiving from $1,200 to $1,600, and averaging 
 11 years of service. 
 
 It may be interesting to note that as the public has 
 been educated to the wisdom of supporting the unfor- 
 tunate poor insane in public hospitals, there has been a 
 
Hospital Service. 109 
 
 corresponding increase in the number of private hos- 
 pitals and sanitariums for the treatment of the nervous 
 disorders of the members of families in better circum- 
 stances. These hospitals are comparatively small, and 
 the physicians have more general responsibility than 
 in the public hospitals in which the work is more 
 specialized. 
 
 Sanatoriums for the treatment of chronic diseases 
 are becoming more numerous and offer opportunities 
 for physicians. As the public has begun to appreciate 
 the modern hospitals with all conveniences and equip- 
 ments as the best places for the treatment of acute dis- 
 eases, so, too, it is appreciating the modern sanatoriums 
 for handling chronic diseases. The sanatoriums are 
 specialized institutions, and admit only cases of 'the 
 special class for which they are equipped. The climate, 
 location, surrounding and equipment are all selected so 
 as to conduce to the comfort and speedy recovery of the 
 patients. A dry atmosphere, an even temperature, con- 
 tinuous sunshine and pure air are very vital factors in 
 the treatment of tuberculosis; so for this reason the 
 sanatoriums for the treatment of tuberculosis are mostly 
 found in Colorado, New Mexico and Arizona. 
 
 The sanatoriums for the treatment of arthritis, rheu- 
 matism or gouty diseases are usually located at some 
 saline or lithia springs. In this class of cases the 
 climate is immaterial, but the medicinal drinking water 
 is necessary, and the rest of the equipment can be sup- 
 plied. The sanatoriums are therapeutically classified 
 according to the diseases treated, as follows: asthmatic 
 affections; auto-intoxication; anemia and general de- 
 bility; Bright's Disease; catarrhal diseases of the di- 
 
110 Medicine as a Peofession. 
 
 gestive tract ; catarrhal diseases of the nose, throat, ears, 
 respiratory tract; chronic alcoholism; chronic articular 
 rheumatism ; chronic malarial poisoning ; chronic metal- 
 lic poisoning; diabetes mellitus; gouty affections; heart 
 disease; liver and gall duct affections; nervous diseases 
 and neurasthenia; tuberculosis; syphilis; and skin 
 diseases. 
 
 One may readily see the opportunities these institu- 
 tions offer to those who wish to specialize in any one of 
 these lines of internal medicine. This is especially true 
 in the treatment of nervous diseases, because nearly all 
 physicians and the public generally appreciate the fact 
 that to treat nervous or neurasthenic patients success- 
 fully, they must be taken away from their everyday 
 environment ; and for this reason the field of sanatorium 
 practice is promising. The fees obtainable in such a 
 field vary with the institutions. In most cases the 
 sanatoriums have been organized and are managed by 
 physicians as the head of stock companies. The figures 
 showing their net earnings have not been obtainable. 
 
 Many young physicians may be forced to accept posi- 
 tions which will prove immediately remunerative. Ap- 
 pointments to private sanatoriums are not difficult to 
 secure and although the salary may be low, the experi- 
 ence is valuable and comfortable maintenance is as- 
 sured. A list of these privately controlled institutions 
 will be found in the Appendix. 
 
Hospital Service. 
 
 Ill 
 
 Number of Hospitals in 1916. 
 
 Ala..., 
 Ariz.., 
 Ark.., 
 Cal..., 
 Colo.. 
 Conn. 
 Del.... 
 D. C. 
 Fla.... 
 Ga.... 
 Idaho 
 
 111 
 
 Ind... 
 
 la 
 
 Kan.. 
 Ky.... 
 
 La 
 
 Me.... 
 
 Md..., 
 
 Mass. 
 
 Mich. 
 
 Minn 
 
 Miss.. 
 
 Mo.... 
 
 Mont. 
 
 Hos- 
 pitals. 
 
 Private 
 
 Sana- 
 
 toriums. 
 
 7 
 
 64 
 
 51 
 
 9 
 
 62 
 
 18 
 
 422 
 
 109 
 
 95 
 
 17 
 
 90 
 
 22 
 
 13 
 
 1 
 
 70 
 
 1 
 
 42 
 
 16 
 
 98 
 
 31 
 
 57 
 
 3 
 
 240 
 
 40 
 
 72 
 
 22 
 
 183 
 
 18 
 
 116 
 
 11 
 
 99 
 
 14 
 
 63 
 
 8 
 
 48 
 
 6 
 
 123 
 
 20 
 
 242 
 
 48 
 
 226 
 
 28 
 
 227 
 
 23 
 
 35 
 
 13 
 
 207 
 
 34 
 
 76 
 
 2 
 
 Nebr.... 
 
 Nev 
 
 N. H.... 
 N. J.. .. 
 N. Mex 
 N. Y.... 
 
 N. C 
 
 N. Dak. 
 
 O 
 
 Okla 
 
 Ore 
 
 Pa 
 
 R.I 
 
 S. C 
 
 S. Dak.. 
 Tenn. ... 
 
 Tex 
 
 Utah..., 
 
 Vt 
 
 Va 
 
 Wash... 
 W.Va.. 
 
 Wis 
 
 Wy 
 
 Hos- 
 pitals. 
 
 Private 
 Sana- 
 tori urns. 
 
 108 
 
 10 
 
 30 
 
 
 
 56 
 
 5 
 
 77 
 
 17 
 
 21 
 
 13 
 
 611 
 
 86 
 
 94 
 
 28 
 
 57 
 
 2 
 
 341 
 
 34 
 
 51 
 
 21 
 
 85 
 
 19 
 
 468 
 
 46 
 
 52 
 
 2 
 
 46 
 
 7 
 
 47 
 
 3 
 
 101 
 
 15 
 
 113 
 
 78 
 
 32 
 
 3 
 
 25 
 
 5 
 
 119 
 
 15 
 
 165 
 
 21 
 
 58 
 
 8 
 
 109 
 
 
 22 
 
 
CHAPTEE XVIII. 
 
 Laboeatoey Woek. 
 
 The changes which have been made in the practice of 
 medicine by the advances in biology, physics and chem- 
 istry have greatly increased the amount of laboratory 
 work which must be done for the average practicing 
 physician. 
 
 The older physicians neither have the training nor 
 the inclination to do this work for themselves; and in 
 hospital organization, efficiency calls for specialists in 
 this line. These laboratory specialists need not neces- 
 sarily be medical graduates; but in this connection this 
 field deserves consideration because it may prove invit- 
 ing to those medical graduates who find, after having 
 made their preparation, that they have such a repug- 
 nance to morbid humanity that their success in gen- 
 eral practice would be problematical. Moreover it re- 
 quires for patient laboratory work just the careful de- 
 liberate type of mind which some of those possess who 
 shrink from those situations which require ready re- 
 sourcefulness. 
 
 As set forth in a previous chapter, the state and 
 municipal departments of health have their own labo- 
 ratories. The hospitals likewise have their own force 
 of laboratory assistants. There are also research labo- 
 ratories and the commercial establishments in which 
 medical supplies are prepared and tested; and in some 
 
 112 
 
Laboratory Work. 113 
 
 cities specialists establish themselves by doing work for 
 the private physicians. 
 
 Examinations of blood are to be made to determine 
 the presence of evidence of typhoid fever or malaria; 
 mucus from the throat for germs of diphtheria ; sputum 
 for tuberculosis; spinal cords of animals for rabies; 
 drinking water for evidence of pollution; drugs for 
 adulterations; tainted food supplies; and so on through 
 an almost endless series. The water supply companies 
 have their own establishments in which samples of 
 drinking water are being continually tested; and on 
 account of the heavy penalties which are imposed upon 
 the vendors of impure milk, the milk companies in our 
 cities are compelled to employ specialists for examining 
 their supplies. 
 
 This field is particularly inviting to the scientifically 
 trained women ; the associations are good, the surround- 
 ings attractive, and the pay compares favorably with 
 the earnings in those fields usually entered by women. 
 
 Each one of the lines of special laboratory work has 
 its own methods of procedure, and the routine of dif- 
 ferent laboratories doing the same kinds of work may 
 vary greatly. 
 
 The Bureaus of Standards of several cities in which 
 the subject of salaries has been carefully considered 
 have recommended schedules of pay for this service as 
 follows: laboratory assistants, in New York, from $600 
 with annual increases of $120 to $1,200; in Chicago, 
 from $780 with annual increments of $60 to $960; in 
 St. Paul, $600 with annual increases of $60 to $720; 
 in Portland, Ore., from $780 to $1,200; for assistant 
 bacteriologists, in New York, from $1,300 to $2,100; 
 in Chicago, from $1,200 to $1,440; for bacteriologists, 
 
114 Medicine as a Profession". 
 
 in New York, from $2,280 to $3,420 ; in Chicago, from 
 $1,620 to $1,860; in Philadelphia, from $1,000 to 
 $2,000; in Cleveland, from $1,200 to $2,000; in Buffalo, 
 from $2,000 to $2,300. 
 
 Candidates are usually selected from the civil-service 
 lists, and men and women are admitted to the examina- 
 tion on the same terms. It is true that many of the 
 examinations which are given for the purpose of select- 
 ing laboratory assistants can be passed by those who 
 have had a good high-school course, but the chances of 
 such persons for promotion will be very limited. A 
 college course laying stress upon practical work in 
 biology and chemistry, or the laboratory work of the 
 usual medical course, is generally a sufficient prepara- 
 tion for admission to subordinate positions in this serv- 
 ice. Specialization either in college or in laboratory 
 service is needed to qualify for advanced positions. 
 
 Several physicians with wide experience in this kind 
 of work, upon being interviewed, expressed it as their 
 opinion that the precautions are such that those who 
 work in these testing laboratories do not take any 
 special risks by engaging in this kind of work. 
 
ScHoor. Medical Txsi'KCI'ok at \\V)ki< 
 
i 
 
CHAPTER XIX. 
 
 Medical Inspection" of Schools. 
 
 The movement for the medical inspection of school 
 children hardly antedates the beginning of the present 
 century. Like all such movements it has manifested 
 itself in several distinct phases. 
 
 There is the period of argument. In this country the 
 health authorities took the initiative. They argued 
 that since contagious diseases are disseminated in 
 crowded assemblies, the school should be inspected regu- 
 larly in order to exclude children afflicted with con- 
 tagious diseases. 
 
 This was the earliest argument used in favor of 
 medical inspection, and it was a health measure in the 
 interest rather of the public than of the individual. 
 Epidemics in a community paralyze all commercial 
 enterprises. 
 
 Later the scope of the argument for inspection was 
 supplemented by the school authorities who found that 
 many children in the public schools were physically 
 handicapped in their studies; and as the state assumed 
 the responsibility to train the children mentally, it was 
 not unreasonable to assume that the state should safe- 
 guard the children against unfavorable physical con- 
 ditions. 
 
 This period of argument was followed by a period of 
 trial, through which we have passed. As a result we 
 find that several states have passed mandatory laws 
 compelling the local school authorities to make provi- 
 sion for doing this work, and hundreds of cities are 
 
 115 
 
116 Medicine as a Peofession". 
 
 gradually building up medical inspection systems. This 
 will mean that during the coming twenty-five years a 
 very large force of properly trained men and women 
 will be required for this kind of work in this country. 
 The nature and scope of the work will be understood 
 from these regulations, which have been promulgated 
 by the government of Prussia : 
 
 1. School physicians are to be appointed to all the 
 schools of all the communities, large and small, and 
 children without exception shall be subject to medical 
 supervision. 
 
 2. Children must be examined by the physician upon 
 admission to school ; at least once during the school life, 
 and be given a final examination upon leaving school on 
 account of the choice of a profession. 
 
 3. Weak and sickly children are to be continuously 
 superintended. 
 
 4. The school physician shall also have the oversight 
 of the health of the teachers and janitors, and he shall 
 be the expert counsellor of the board of education in all 
 questions of school hygiene ; he shall have a vote in the 
 board of education, and in the teachers' training school 
 he shall be the instructor in physical training and school 
 hygiene. 
 
 In an enterprising school district in a western state, 
 the school physician by energetic measures secured the 
 immunity of the children of a district from diphtheria, 
 while at the same time an epidemic wrought havoc in 
 adjoining districts. The demonstration made it easy 
 for the school boards to secure the necessary support 
 for systematic inspection by salaried physicians. The 
 general results have shown that the progress of many 
 children in their school work is hindered by minor 
 
Medical Inspection of Schools. 117 
 
 physical defects which can readily be remedied. The 
 uniform results of trial in different parts of the country 
 have been such as to justify the contention of the early 
 advocates of medical inspection, and the next step in 
 the movement will be the organization of the work 
 throughout the country. 
 
 In New York city it has been found that the force of 
 approximately 100 physicians and 200 nurses wiU be 
 wholly inadequate to handle the problem. Dr. Cronin, 
 of that city, is of the opinion that there should be one 
 physician and one nurse to each 2,000 pupils. In many 
 of the cities of the country some local physician is paid 
 a small annual salary for examining the children of one 
 or more schools. There are practical reasons why the 
 school physician should be a full-time salaried official 
 who does not combine private practice with school in- 
 spection work. This plan is the general requirement 
 in the English cities and country districts, and if adopted 
 in this country it will open a field which will call for 
 from six to ten thousand medical inspectors of schools. 
 
 The pay for service of this kind varies greatly. In 
 New York city full-time medical inspectors are paid 
 salaries ranging from $1,200 to $3,000 ; in Philadelphia 
 the pay is from $1,400 to $2,400 with a chief inspector 
 at $4,000; in Boston from $800 to $2,850; in Pitts- 
 burgh from $1,200 to $2,400. These schedules will at- 
 tract young men at the beginning of their medical 
 careers, but it is not likely to hold them longer than 
 for a few years. The salary schedule is more likely to 
 prove acceptable to women, and for this and many other 
 obvious reasons this field is sure to become an attractive 
 one to women graduates from the recognized medical 
 colleges. 
 
CHAPTER XX. 
 
 Medical Missions. 
 
 The mission boards or religious denominations send 
 medical missionaries, men and women, to non-Chris- 
 tian countries as advance guards of the physicians of 
 souls. Through these men, who minister to the phys- 
 ical distresses of benighted people, these organizations 
 hope to establish such confidential relations and to con- 
 vey such evidences of good will, that the work of the 
 preacher of righteousness may be made easier and more 
 far reaching. 
 
 As compared with the uncertain results of the crude 
 treatment of unlearned native doctors, the medical mis- 
 sionary's skill in the art of healing is regarded by the 
 ignorant and superstitious people with amazement and 
 wonder, and his reputation soon spreads far and wide; 
 so that both laborers and court dignitaries come to con- 
 sult him. 
 
 It is true that European countries maintain in their 
 colonial possessions, in connection with their official 
 establishments, some trained physicians, but the in- 
 fluence of these men is confined to official stations and 
 military posts; and in many populous districts there are 
 millions who are never benefited by modern scientific 
 medicine until the advent of the medical missionary. 
 
 After their establishment in a given locality, these 
 medical missionaries spend much of their time as itin- 
 erants, thus increasing the area of their influences. In 
 
 118 
 
Medical Missions. 119 
 
 these journeys they are compelled to work with very 
 limited resources in the way of equipment and supplies. 
 This develops resourcefulness ; and, moreover, they must 
 be strategists and diplomats to adjust themselves readily 
 to new situations, and fit into the customs and habits 
 of strange peoples ; consequently this work is exception- 
 ally well designed to develop in a young practitioner all 
 his latent powers, through the unlimited range of ex- 
 perience which it affords. He must have self-reliance, 
 for there are no opportunities for consultation; he must 
 have dauntless courage, because his very successes are 
 likely to be used by the jealous witch doctors to arouse 
 hostility to him. " Surely the strange doctor must dig 
 out the hearts of his patients; else how could he have 
 such tireless energy, and how could he have such super- 
 natural vision, if he did not feast upon the eyes of 
 countless victims ? '^ was circulated about a medical mis- 
 sionary in a remote Chinese village. 
 
 In their home station these missionaries usually have 
 hospitals, connected with which are trained nurses, by 
 whose aid the more difficult cases are treated. 
 
 Even with the facilities provided in the most favored 
 fields, these practitioners are compelled to exercise an 
 independence and self-reliance unknown to their fellows 
 in well-organized communities. Take, for instance, the 
 operation for the removal of cataracts. It is one of 
 the most delicate operations in the field of eye surgery. 
 The highest type of skill is necessary. Experience 
 alone makes for skill in this delicate operation, in which 
 the eye is penetrated from side to side, an open cut 
 made which must be neither too large nor too small to 
 insure a successful termination; and there is no guide 
 except the judgment of the operator as to the size this 
 9 
 
120 Medicine as a Pkofession. 
 
 cut should be. The time to operate, the method of 
 procedure, and many other things that enter in the case, 
 must be decided by the judgment of the operator. The 
 opportunities in this field are rich in India, Egypt, 
 Siam and Arabia. Thousands of cases of blindness due 
 to cataract are found in these countries, and with the 
 exception of the British government medical service in 
 India and Egypt, the afflicted must depend upon the 
 medical missionaries. One medical missionary in India 
 reported over 6,000 cataract operations. 
 
 Today the most noted cataract operator in the world. 
 Colonel Smith, lives in India. He has given to science 
 the results of his experience. He proves that by using 
 a technic and method devised by himself, it is unneces- 
 sary to wait until the so-called "ripening" of the cata- 
 ract takes place ; but that the cases can be operated upon 
 at any time after the vision gets dim, thus saving the 
 patient in many instances a year or two of total blind- 
 ness. 
 
 It must go without saying that the appointing bodies 
 require that candidates for this work shall be conse- 
 crated Christian men and women, and also be fully 
 versed in the science of medicine and skilled in the art 
 of healing. 
 
 The pay of from $500 to $1,500 with professional and 
 living expenses compares not unfavorably in purchasing 
 value with the income-earning power of beginners in 
 private practice at home; but such are the demands 
 upon their sympathies in the foreign field that the 
 purses of few can withstand the financial strain. 
 
 A recent census shows that there are 800 Protestant 
 medical missionaries in charge of 698 hospitals and 979 
 dispensaries, and that they treated in 1914 approxi- 
 
Medical Missions. 121 
 
 mately 10,000,000 patients. This manifestation of de- 
 voted self-sacrifice, on the part of highly trained men, 
 as well as of the generosity of those who provide their 
 support, must prove refreshing to those who turn with 
 horror from the acts of the assumed divinely appointed 
 rulers of European nations, who have in that same year 
 hurled their subjects by the thousands to sure death. 
 
 Nor has this altruism been without reward to its 
 practitioners. Through the studies of missionaries it 
 has been found that the sleeping sickness of Africa 
 could be controlled by the extermination of the fly 
 which spreads it; that quinine is a remedy for fevers; 
 that permanganate of potash is a proper prescription 
 for the bite of the cobra, and so on through a long list. 
 
 Dr. Cyril H. Haas in a small tract used by the Stu- 
 dents' Volunteer Movements, 125 East 27th Street, New 
 York, gives a doctor's reason for going to China : 
 
 " The first of these reasons is because it is the dictate 
 of mere common sense. I do not know of anything 
 which we talked more about in our senior year than 
 where we were going to practice. When I faced the 
 last day of my senior year, I met a man who told me 
 that everything was congested. I went into the city, 
 but was advised that it took an average of ten years for 
 a physician to become self-supporting. I went into the 
 country, and physicians told me that I could do no 
 surgery, because if I attempted it I was liable to make 
 mistakes and my reputation would be gone. Where 
 was a man going to practice ? I saw in the Journal of 
 the American Medical Association that we were pouring 
 out of our medical colleges 4,000 young men every year, 
 and that we only needed a possible 3,000 to fill the 
 vacancies left by those who died. I saw that the Com- 
 
122 Medicine as a Peofession". 
 
 mittee on Medical Education in this country was seri- 
 ously considering the printing of pamphlets to send to 
 high-school boys, urging them not to enter the medical 
 profession, because the great influx of students made it 
 impossible for them to find room in the profession in 
 this country. I think that it is nothing more than 
 common sense for a young physician, at least if he is a 
 Christian, to look to some other country than this for 
 practice. 
 
 "The second factor that urges me to go to another 
 land is common duty. I have many times seen a vision 
 of a city of 150,000 people in the center of Asia, outside 
 of which there is a little hill, and upon that hill there 
 are now going up two buildings, one to be the hospital 
 for women and the other for men; and from that city 
 has come many times within the last few years the 
 urgent plea that I go out there and be one of the phy- 
 sicians in that city where they know nothing of hygiene, 
 nothing of surgery, nothing of asepsis, nothing of the 
 great remedies which we have to alleviate pain ; nothing 
 but squalor, sin, weakness, sickness, uncleanliness. 
 Nothing but common duty urges me to go out there. 
 
 "And the third reason why I go is because of the 
 unique, unmeasured privilege. The grandest moment 
 in my life will be when I stand with my colleagues on 
 that hospital ground and the gates are flung open with 
 the news that the hospital is completed, and the invita- 
 tion goes out to that city : ^ Come in.' I met, some time 
 ago, a Chinese who told me of the necessity of having a 
 Chinese name, and I said, 'Would you christen me?' 
 He wrote out a name in Chinese and I said, ' What does 
 it mean?' He replied with this translation of it, 
 ' American physician, willing to help.' I hope to go out 
 
Medical Missions. 123 
 
 some day as Chen-chou Fu and be an American physi- 
 cian willing to help. I hope to see some day, under the 
 touch of the knife, in the dispensary, at the bedside, 
 the play of the masterful forces of Jesus Christ, as 
 through sympathy and tenderness and unselfish service, 
 his own life may strike deep into the lives of these who 
 know him not. God is going up and down in this great 
 concourse of students, laying his hand upon man after 
 man, medical student after medical student, calling him 
 to be great enough and big enough and loyal enough to 
 go out into this staggering, sorrowing, struggling world 
 and be to it what Christ was, to pity it as Christ pitied 
 it, to love it as Christ loved it, and to serve it with his 
 own sacrificial heart. God calls vsdth loving patience 
 for men to lay their lives alongside of the tremendous 
 immeasurable needs of the non-Christian countries, and 
 to solve the awful problem of human suffering; and as 
 I shall set sail in a little while for that great Empire of 
 China, I want to carry with me from this hour the con- 
 viction that the men here are going to enter into a 
 solemn compact with me to devote their lives, especially 
 the medical students, to the solving of the problem of 
 human suffering in the non-Christian world.^^ 
 
 The members of the Catholic brotherhoods and sister- 
 hoods also support movements of this kind in all parts 
 of the world. 
 
124 
 
 Medicine as a Profession". 
 
 Medical Missionaries of Protestant Churches. 
 
 
 Men. 
 
 Wo- 
 men. 
 
 Hos- 
 pitals. 
 
 Dis- 
 pen- 
 saries. 
 
 Countries. 
 
 Seventh Day Ad- 
 ventist 
 
 American Baptist ... 
 
 Seventh Day Bap- 
 tist 
 
 17 
 
 55 
 
 12 
 
 25 
 
 16 
 
 3 
 3 
 
 9 
 
 3 
 
 40 
 
 102 
 
 14 
 
 13 
 2 
 
 7 
 18 
 
 2 
 2 
 
 12 
 4 
 
 5 
 5 
 
 41 
 38 
 
 7 
 1 
 
 4 
 19 
 
 6 
 
 28 
 
 5 
 
 25 
 
 1 
 
 2 
 
 6 
 
 1 
 45 
 
 80 
 
 7 
 13 
 
 8 
 
 33 
 
 1 
 13 
 
 40 
 
 7 
 
 2 
 2 
 
 15 
 
 3 
 36 
 
 119 
 
 11 
 
 9 
 
 7 
 
 Africa, Asia, South 
 America. 
 
 Philippines, Congo, 
 Burma^ China, South 
 India, Assam, Bengal. 
 
 China, India, Africa. 
 
 Southern Baptist.... 
 
 American Board 
 
 Christian Women's 
 Board 
 
 China, Japan, Africa, 
 Mexico, South Amer- 
 ica. 
 
 Africa, India, China, 
 Philippines, Turkey, 
 Japan, Ceylon. 
 
 Africa, India, West 
 
 Foreign Christian 
 Missionary Society 
 
 Evangelical 
 
 Indies, Mexico, New 
 Zealand. 
 
 China, Tibet, Philip- 
 pines, Africa, Japan. 
 
 China, Japan. 
 
 Alaska, India, Mexico, 
 China, Africa. 
 
 India, Japan, China, 
 Africa, Madagascar. 
 
 India. 
 
 American Friends... 
 Lutheran 
 
 nites 
 
 Methodist 
 
 China, India, Japan, 
 Korea, Africa, Philip- 
 pines. 
 
 India, Mexico, Sudan, 
 
 Presbyterian 
 
 Protestant Episco- 
 nal 
 
 China, Persia, Siam, 
 Japan, Philippines, 
 Africa, Korea, Cuba, 
 Syria, Brazil, Cyprus, 
 Asia Minor. 
 
 Africa, China, Japan, 
 
 Cuba, Brazil. 
 Japan, China, India. 
 China, Japan, Africa. 
 
 Reformed Church... 
 United Brethren 
 
CHAPTER XXI. 
 
 COEPOEATION SeKVICE. 
 
 Railway Service. 
 
 Every one of the railway organizations has its own 
 surgical staff, consisting of a chief surgeon and local 
 assistant snrgeons. 
 
 The chief surgeon's duties are to pass upon all ex- 
 aminations of employees wishing to enter the railway 
 service; to direct the sanitation of the road, disinfect 
 coaches, supervise the drinking water supply, to appoint 
 and dismiss local assistant surgeons, and see to the effi- 
 ciency of the medical service of the road. He passes 
 upon the applications for pension of disabled employees, 
 he assists or advises the legal department in all cases of 
 a medico-legal aspect, such as damage suits for injuries 
 sustained by employees, or others, on the railroad prop- 
 erty. This latter function is a very important one, as 
 thousands of claims for damages are filed against rail- 
 road corporations by persons whose claims are based 
 upon injuries received on railroad property. The chief 
 surgeon in these cases must have physical examinations 
 made of the victim, in order to determine the extent of 
 permanent disability and to be able to advise the legal 
 department. 
 
 The chief surgeon directs the treatment of cases of 
 injury, he instructs the local surgeons how to proceed in 
 emergency work, and in rendering first aid. One must 
 
 125 
 
126 Medicine as a Profession". 
 
 remember that these railroad surgeons do not only 
 render first aid to the injured employees of the system, 
 but also to those of the traveling public who receive 
 injury in railroad accidents. 
 
 On one of the western railroad systems there is a 
 hospital system organized jointly by the corporation 
 and employees. It is very necessary where there are 
 great distances between large cities. The railway com- 
 pany pays for the care of the injured, and for the em- 
 ployees by assessments; in this way sufficient hospital 
 facilities are maintained in sparsely settled communi- 
 ties, providing competent medical service for employees 
 and the traveling public. 
 
 The salaries of the chief surgeons run from $2,500 
 to $6,000, depending somewhat upon the amount of 
 work, and whether part or whole time is taken up by 
 official duties. 
 
 The local railway surgeons who are stationed at all 
 important points, one or more in practically every 
 county, are on the fee-bill basis, and receive payment 
 according to the rates prevailing in their locality. 
 Others in division points are on a straight salary, sub- 
 ject to call of the local railway officials. In nearly all 
 cases the local surgeon gets free transportation for him- 
 self and family, over the lines of the company; and 
 some companies extend this, upon special application, 
 to foreign roads. 
 
 The duties of the local surgeons are outlined in the 
 general instructions, and if the case demands special in- 
 structions, these are given by the chief or division 
 surgeon. 
 
 The railway service should not be considered as a field 
 in itself offering sufficient remuneration for a young 
 
Corporation Service. 127 
 
 man, because no young man can obtain the appoint- 
 ment as chief surgeon. A chief surgeon must be an 
 older, experienced, responsible man. The local appoint- 
 ments, with few exceptions, do not pay enough for full- 
 time work. The work is ideal, though, as a side line to 
 a general practice. Many opportunities arise for one 
 to demonstrate his skill and aptitude in surgery. This 
 work will, besides offering good experience with small 
 compensation, help him to establish himself in private 
 work. The very fact that one is employed by the rail- 
 way corporation as a surgeon gives him prestige. 
 
 Transatlantic steamships also have medical men on 
 their regular staffs. These positions are not unlike 
 the positions which are offered by hospitals to young 
 graduates of medical colleges. The men receive, in ad- 
 dition to their maintenance, small salaries. 
 
 The life-insurance business has developed by leaps 
 and bounds within the last twenty years, and all com- 
 panies must depend upon physicians for the examina- 
 tion of their risks. In each community where a life- 
 insurance company does business, it has a medical ex- 
 aminer. Each company employs its own, and in some 
 communities nearly all physicians are examiners for 
 one or more insurance companies. Other communities 
 have one or two physicians who do all the examining. 
 
 These appointments in themselves are not sufficiently 
 remunerative to be depended on for an income, but they 
 give one prestige and an opportunity for acquaintance 
 that helps in building up a private practice. 
 
 Then there are examinations to be made for the fra- 
 ternal insurance associations, as for the Modern Wood- 
 men, The Foresters, The Eed Men, The Knights of 
 
128 Medicine as a Profession". 
 
 Pythias, etc. These examinations are usually made by 
 physicians who are members of the orders. 
 
 The fees for old-line life-insurance examination are 
 from $3 to $5 ; for fraternal or assessment orders, from 
 $1 to $2. 
 
 The passage of workingmen's compensation laws, 
 under which employers are compelled to pay directly 
 or indirectly for the accident insurance risks of their 
 working men, makes it necessary for practically all 
 manufacturing corporations to retain the service of a 
 physician, who serves them much in the same way as 
 the doctors serve the railroads. 
 
 Many large corporations employ physicians on full 
 time, and this opens a field which young men may well 
 consider. It must be remembered that there are many 
 commercial organizations and industrial concerns which 
 employ a thousand or more people whose efficiency is 
 determined by their physical condition. The managers 
 of these corporations are organizing medical depart- 
 ments for the service not only of the employees, but also 
 of their families very much after the plans of the med- 
 ical departments of the army posts. This field should 
 prove attractive to the young medical graduate. For 
 winning the highest success he should be informed on 
 the methods of welfare work in all of its various aims. 
 
CHAPTEK XXII. 
 
 The Eed Cross. 
 
 It was Jean Henri Dunant who after witnessing the 
 apparently iinnecessary suffering of the wounded on the 
 battle field made such an effective appeal as to lead to 
 the organization of an international association for re- 
 lief with branches in all civilized countries. The banner 
 of the organization was a red cross on a white field. In 
 1881 the American Eed Cross was organized with Miss 
 Clara Barton as its president. For twenty-four years 
 the organization has held itself in readiness to assist in 
 relief measures in every kind of calamity, whether war, 
 or fire, or flood, earthquake or epidemic. In 1905 a 
 reorganization was effected and governmental support 
 was accorded to the American society. Its activities 
 are carried on through many subdivisions of the associa- 
 tion. We are here concerned only with the medical serv- 
 ice. This service supplements the work of the army 
 medical service and the federal health service. 
 
 The Eed Cross base hospital unit is composed of 22 
 physicians, 2 dentists, 50 nurses, 25 volunteer nurses' 
 aids, and 15 civil employes. The base hospitals are 
 under the direction of some parent institution, that is 
 the staff officers of some hospital who select the physi- 
 cians and nurses for this work. During times of peace 
 there is no remuneration to the members of these units, 
 but during times of war they are mustered into service 
 and given commissions and pay according to their re- 
 
 129 
 
130 Medicine as a Peofession". 
 
 spective positions, as colonels, majors, captains or lieu- 
 tenants. Three months after the country entered the 
 European war forty-one of these base hospitals were 
 organized and ready for service. It costs about $75,000 
 to equip one of these hospitals. The experience which 
 — H:hese base hospitals afford is not unlike that which is 
 obtained in the army medical service but those engaged 
 in the Eed Cross work are not exposed to the hazards 
 of those in service on the front battle lines. The hos- 
 pitals are usually located in the rear of the fighting lines. 
 The buildings are of more or less permanent kind and 
 the quarters of the officers are usually comfortable. 
 When these units are mustered into military service, all 
 of the officers, of course, come under military discipline. 
 From the officers in these base hospitals special teams 
 are organized for emergency service in the field. 
 
 Mnety days after diplomatic relations with Germany 
 were severed, forty-two ambulance companies were or- 
 ganized by the Eed Cross for service in the field and the 
 number of these organizations is being ext-ended as rap- 
 idly as funds become available. These ambulance units 
 form relief divisions ready for emergency service on the 
 firing line or in the thickest of the battle to render first 
 aid service to the injured. Each unit is composed of a 
 director, three surgeons, one head nurse, six assistants 
 and a clerk. These units are expected to respond to any 
 emergency calls and their work is most hazardous and 
 strenuous. No more brilliant exploits of daring are 
 recorded in history than those which have been per- 
 formed by the Red Cross ambulance corps in our recent 
 wars. 
 
 It is true that by the Geneva Convention all the 
 signatory powers agreed that in times of war the work 
 
The Eed Cross. 131 
 
 of the Eed Cross should be accorded full protection by 
 the armies of belligerents but with the introduction of 
 long range guns it is practically impossible for the artil- 
 lery men to distinguish between those who are perform- 
 ing these missions of mercy and their enemies and these 
 guarantees of protections come to mean less and less. 
 The expenditures for service in European battle-fields 
 for 1917 will exceed ten millions for the American Red 
 Cross alone. 
 
 The permanent office of the American Eed Cross at 
 Washington is rendering a great national service in hav- 
 ing its enrolled lists of men who are ready to undertake 
 any kind of emergency service which may be called for 
 by any great calamity. Upon short notice they were 
 able to have ready for service in times of such great 
 floods as swept through the Miami Valley and the de- 
 struction of San Francisco their enrolled volunteers 
 from near by localities. 
 
CHAPTER XXIII. 
 
 Eeseakch Woek. 
 
 Dr. Eobert T. Morris has recently expressed the opin- 
 ion that the future advances in medicine will be made 
 by the men who work on salaries and give their undi- 
 vided time and energy to investigation; that so many 
 factors are involved in physiological processes, the 
 process of elimination is so slow, and the continual, 
 patient, watchful attention so necessary, that only the 
 man who devotes his whole energy and time to a sub- 
 ject can hope to master the field of related knowledge 
 sufficiently well to extend our conquests into disputed 
 or little-known areas. 
 
 This has recently been recognized, in the wide accept- 
 ance of the recommendations of medical councils that 
 the professors in medical colleges should be paid salaries 
 sufficiently large so that it would not be necessary for 
 them to combine teaching and practice; that the de- 
 mands of their professorial duties should be so limited 
 that they could command the time for study in their 
 several special fields ; and that the laboratory and library 
 equipments of the acceptable medical college should be 
 increased far beyond what is found at present in the 
 average institution. 
 
 The necessity for setting aside certain men to give 
 their time to the investigation of special problems has 
 also been recognized in the public health service and by 
 the establishment of the Eockefeller Institute at Sixty- 
 
 132 
 
Eesearch Work. 133 
 
 sixth St. and Avenue A, in New York city, which, with 
 its munificent endowment of $4,000,000, is exclusively 
 devoted to medical research. 
 
 Progress has at best been slow when made by men 
 burdened with regular daily tasks, using their odd 
 hours, working in poorly equipped laboratories, with an 
 inadequate command of the existing field of knowledge 
 in the departments in which they were experimenting. 
 
 In previous chapters, reference has been made to the 
 investigation into the causes of yellow fever and other 
 destructive scourges. Physicians daily meet with 
 equally destructive influences, of whose control they are 
 ignorant. 
 
 Of late years, the disease known as infantile paralysis 
 has become epidemic in various parts of the country; 
 even adults have developed the disease in fatal forms. 
 Many who have recovered are partially paralyzed, some 
 permanently. The medical fraternity has been aroused ; 
 men are seeking for the causes of the disease, for the 
 mode of its dissemination, and the possible methods of 
 control. 
 
 In 1909, Landsteiner and Popper produced the disease 
 in monkeys by inoculation, thus proving that the disease 
 could be communicated. Dr. Flexner of the Eockefeller 
 Institute proved that it could be transmitted from 
 monkey to monkey, showing that it was due to an 
 organism that could not only be developed in a living 
 being but transplanted from one to another. While the 
 infectious material could not be isolated, it was found 
 that it could be transmitted; that some animals were 
 immune to it. There is a call for some devoted soul 
 to expose himself while he engages in the search for the 
 
134 Medicine as a Profession". 
 
 disturbing cause and if he succeeds to enroll his name 
 on the world's list of immortals. 
 
 Dr. Alexis Carrell, of the Eockefeller Institute, re- 
 ceived the Nobel prize for his discovery that blood ves- 
 sels could be transplanted and sutured, that sections of 
 veins could be inserted into arteries, that they will heal 
 and function in spite of the fact that the arterial coats 
 are much stronger and firmer than those of the veins. 
 He demonstrated the practical value of his discovery by 
 joining the radial artery of a father's arm to the vein 
 of a five day old child, thus saving the life of the latter 
 through a transfusion of blood. 
 
 By this discovery the old and cumbersome methods 
 of transfusion of blood were displaced. Before these 
 successful experiments, preceded by a long series on 
 lower animals, no surgeon would have sutured these 
 blood vessels together, because of the possible fatal in- 
 troduction of blood clots into the circulation. 
 
 The wonderful possibilities suggested by the experi- 
 ments of Professor Metchnikof, in proving that many of 
 the fatal poisons which shorten human life are generated 
 in the body by the action of bacteria which can be de- 
 stroyed through the introduction of other bacteria, have 
 opened up a new and very fascinating field of experi- 
 ment, through the mastery of which competent authori- 
 ties have predicted that human life can be indefinitely 
 prolonged. 
 
 Just enough is at present known about biochemistry 
 to suggest the possibility of the accurate regulation and 
 control of the chemical composition of fluids of the 
 body, in such a way that methods may be devised as 
 revolutionary as those which have followed the discovery 
 of the properties of radium and the X-ray. 
 
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Eesearch Work. 135 
 
 The progress in physics has suggested the possibility 
 of saving by cold storage processes the healthy organs of 
 persons who have met violent deaths, for transplanting 
 in place of diseased organs in living persons. 
 
 In the field of sanitation, it has been proved that, at 
 an expense of less than $3 per year per inhabitant, it is 
 possible to make the miasmatic regions of the Canal 
 Zone as safe as the most carefully guarded city ; and since 
 the methods for doing this work have been so worked 
 out that they may be adapted to any locality, one ceases 
 to wonder why liberal men should be ready to give large 
 means, and why men of strong intellects should be at- 
 tracted to the narrow confines of the laboratory, to de- 
 vote promising lives to patient study and investigation. 
 It is needless to say that those who are selected to do 
 this work must be men of demonstrated intellectual 
 ability with a capacity for work, and with such a devo- 
 tion to humanity that they will find their reward in 
 their work, rather than in the monetary returns which 
 these positions pay. One of these will discover the real 
 cause of cancer, and develop a cure for it; another will 
 place himself alongside of Jenner by leading the world 
 to a mastery of tuberculosis ; and through the labors of 
 others, one after another of the enemies of humanity 
 which have heretofore baffled science will be controlled. 
 
 10 
 
CHAPTEE XXIV. 
 
 Commerce and Medicine. 
 
 Closely related to the work of the research men in 
 medicine is the work of the preparation and distribu- 
 tion of the curative and remedial agents, whose virtues 
 have been discovered in the research laboratories and 
 tried out in the dispensaries and the hospitals, and the 
 manufacture and sale of medical supplies. After Jen- 
 ner had discovered his treatment for smallpox, through 
 the careless handling of vaccine the treatment was used 
 with only partial success, thus arousing prejudice against 
 it and hindering its use for many years. This has been 
 changed, and the laboratories which supply vaccines, 
 antitoxins, bacterins and tuberculins are now supervised 
 by trained experts. 
 
 Not less than forty biological products are used in 
 medicine today, and each is prepared according to its 
 own special methods. The important factor in the 
 preparation of these products is the maintenance of 
 absolute purity and standard of immunizing power, so 
 that the physician may inoculate the patient without 
 any danger of implanting in him the germs of some 
 other disease. 
 
 There are in this country today twenty-five of these 
 commercial biological laboratories, all of which are regu- 
 larly inspected by officers of the federal goverimient. 
 
 In the preparation of the antitoxin for diphtheria, 
 young healthy horses are rendered immune to the poison. 
 The toxin is obtained by the development of a virulent 
 
 136 
 
Commerce and Medicine. 137 
 
 culture of the diphtheria bacilli "upon the surface of beef 
 bouillon in a flask at a uniform temperature of 65 de- 
 grees Fahr. for one week. The culture is then treated 
 with a 5 per cent, solution of carbolic acid, and after 
 standing for forty-eight hours the solution is filtered. 
 A one-hundredth cubic centimeter is then injected into 
 a 250-gram guinea pig, and if it kills the animal within 
 four days it is considered strong enough to try on the 
 horse. The horse is given an amount of the toxin which 
 would be considered necessary to kill 5,000 guinea pigs 
 of the former weight. At the same time he also re- 
 ceives an injection of 10,000 units of diphtheria anti- 
 toxin. This process is repeated with larger doses of the 
 poison, and in three or four days a repetition of the 
 doses of both the toxin and the antitoxin. After this 
 the animal receives, every five days, an injection of the 
 toxin only, and so the conflict between the virulent 
 germs and their enemies is waged in the circulatory sys- 
 tem of the animal for about six weeks; after which a 
 little blood serum is withdrawn and its resisting power 
 is tested. If its power is high the horse is bled to death 
 under strict conditions of cleanliness, the blood serum is 
 concentrated, refined, standardized and put into care- 
 fully sealed packages for the market. 
 
 It is needless to say that great care must be exercised 
 to see that the animals are sound and healthy, that the 
 stables and surroundings are sanitary and that the labo- 
 ratories and appliances and all the attendants are clean 
 according to the scientific definitions of cleanliness. 
 
 Many men who find, after completing their medical 
 course, that they are lacking in some of the qualities 
 which are needful for success in practice, and that they 
 do not possess the imagination nor the initiative for 
 
138 • Medicine as a Profession. 
 
 success in independent research, may find profitable 
 uses for their training in this interesting and highly 
 important work. The workers in this field are not 
 called upon to submit to the irregular demands which 
 are made upon the time and the energies of a practi- 
 tioner, yet the work is not without its dangers of infec- 
 tion while handling various kinds of bacteria. The 
 salaries range from $1,000 to $2,500. 
 
 The superintendentsi of the laboratories which pre- 
 pare for the trade the pills, powders and tinctures in 
 endless forms and varieties are rather pharmacists and 
 chemists than physicians, and the manufacturers of 
 surgical appliances and supplies are for the most part 
 men who have had a training for business rather than 
 for a profession; but many men of medical education 
 are employed as salesmen to introduce, among physi- 
 cians, these commercial products. 
 
 Not a few physicians in the past, not content with 
 the slow returns from an ethical practice, have thrown 
 their ethical codes to the winds and embarked upon the 
 manufacture and sales of so called patent medicines. 
 In one of our cities this business has developed to large 
 proportions and, according to the reports made to the 
 commercial bureaus, the managers of the houses in this 
 line of business, after deducting their raw materials, 
 salaries and wages and other expenses from the factory 
 value of their manufactured product, had left, in 1909, 
 198 per cent, on their capital invested. In recent years, 
 on account of the rigid supervision, and the refusal of 
 their advertisements by newspapers, there has been some 
 decline in this business. In few of these concerns which 
 were examined did any of the employees receive more 
 than a living salary. It is a mistake for one com- 
 
O 
 
 O 
 
 z 
 
 o 
 
 
Com:merce and Medicine. 139 
 
 mercially inclined to enter medicine with the desire to 
 " get-rich-quick " through quackery. There are so many 
 respectable commercial enterprises that should appeal 
 to such, rather than this questionable trafficking in 
 human lives. 
 
 Biological Laboratories. 
 
 The following biological laboratories were licensed 
 (1916) by the Treasury Department of the federal gov- 
 ernment to manufacture vaccines, serums, toxins, anti- 
 toxins, bacterins, etc.: The Cutter Laboratories, Berke- 
 ley, California; Hygienic Laboratories, State Board of 
 Health, California; American Biological Co., Washing- 
 ton, D. C. ; National Vaccine and Antitoxin Institute, 
 Washington, D. C; Memorial Institute, Chicago; The 
 Abbott Laboratories, Abbott Alkaloidal Co., Chicago; 
 Eli Lilly & Co., Indianapolis ; Swan Myers Co., Indian- 
 apolis; Dr. W. T. McDougall, Kansas City, Kansas; 
 Greeley Laboratories, Boston ; Stafford Biological Labo- 
 ratories, Detroit; Dr. G-. H. Sherman, Detroit; Parke, 
 Davis & Co., Detroit; The Upjohn Co., Kalamazoo, 
 Michigan; St. Louis Pasteur Institute, St. Louis, Mis- 
 souri; Laboratory of Clinical Pathology, Kansas City, 
 Missouri; Bactero-Therapeutic Laboratories, Asheville, 
 North Carolina; E. K. Squibbs & Sons, Eesearch & 
 Biological Laboratories, New Brunswick, New Jersey; 
 New York Pasteur Institute, New York City; Lederle 
 Antitoxin Laboratories, Pearl Eiver, New York; Labo- 
 ratories of Dept. of Health, New York City ; Dr. James 
 McI. Phillips, Columbus, Ohio; Dr. H. M. Alexander 
 & Co., Marietta, Pennsylvania; H. K. Mulford Co., 
 Philadelphia, Pa.; The Slee Laboratories, Swiftwater, 
 Pa. 
 
CHAPTEK XXV. 
 
 Specialism. 
 
 One often hears the school boy say that he is going to 
 be an expert surgeon in response to the question as to 
 what he intends to make of himself. This is really a 
 commendable ambition, but little does the average boy 
 realize what it takes to make his dream come true. To 
 be an expert in any of the special fields of medicine 
 means years of work of preparation and practice. The 
 impression prevails among many prospective students 
 that the only requirement to become a specialist is to 
 comply with the accepted curriculum of a regular med- 
 ical college, and subsequently to add a postgraduate 
 year in the specialty desired. This impression is erro- 
 neous. To become a specialist in medicine one must 
 have a wide experience in a general practice of medicine. 
 He must have a grasp of the whole category of disease, 
 and the effect of disease on the whole body of man, be- 
 fore he is able to analyze in detail the cause of disease 
 of special organs. 
 
 A young graduate who, during his college years, paid 
 especial attention to the eye, called upon his professor, 
 one of the best eye specialists in Philadelphia, and asked 
 him what more he should do to become an eye specialist. 
 The professor told him to go out into general practice 
 for ten years, and then if still ambitious to become an 
 eye specialist, to take a postgraduate course in one of 
 the ophthalmic hospitals in America or in Europe, or in 
 both. This advice was sound. 
 
 140 
 
Specialism. 141 
 
 It takes practice to give experience;, and in order to 
 develop a sound, broad vision of disease and men, one 
 must be in general practice for a number of years. It 
 is true that there are many practicing surgery who have 
 not had such experience, and yet perform some very 
 brilliant operations. They have the technic, the dex- 
 terity, but not the judgment. 
 
 The real surgeon is not the one who is skilful with 
 the knife, alone, but one who is able to decide when not 
 to operate as well as when and how to operate. A first- 
 class surgeon always endeavors to avoid operations. 
 When unavoidable, he operates expeditiously. Unfor- 
 tunately, there are many so-called surgeons who have 
 commercialized the profession, who operate in order to 
 get large fees, regardless of the requirements of the case. 
 Many persons have been subjected to major operations 
 who would have been better off without the operation. 
 This is explained partly because today for conservative 
 medical treatment the fees are comparatively small, 
 while for surgery the fees are large. 
 
 The public sentiment is at the present time swinging 
 backward toward conservatism, while a few years ago 
 many who were in apparent health applied to the sur- 
 geon to be operated upon. Even today the same condi- 
 tion prevails in regard to the tonsil. The faddist has 
 overeducated the public. Many people look upon the 
 scar resulting from a surgical operation with the same 
 degree of pride as the Heidelberg student regards the 
 scar received in an encounter with his fellows. 
 
 The surgeon is entitled to good fees and should re- 
 ceive them for legitimate operations, but at no time 
 should he commercialize his profession. No j'oung man 
 
142 Medicine as a Profession. 
 
 who is attracted to surgery by the pecuniary rewards 
 should become a surgeon. 
 
 Fees are regulated in many respects as are lawyers' 
 fees. They are based upon the risk at stake, the cir- 
 cumstances of the patient, the geographical location, 
 and the reputation of the operator. It is nothing un- 
 usual for operators in New York to receive $2,000 for 
 an appendicitis operation, yet other skilful surgeons 
 perform the same operation for $250. 
 
 The eye specialist is an eye surgeon, and performs 
 all the various surgeries of the eye and its appendages. 
 He, too, collects good fees, especially for the surgery 
 work. The fees for cataract operations run from $100 
 to $1,000; for enucleation from $50 to $500; for ordi- 
 nary office consultations and examinations, from $2 
 to $25. 
 
 The eye specialist, designated as an oculist, is one 
 who treats diseases of the eye and advises the family 
 physician in the treatment of constitutional diseases 
 which are responsible for the eye manifestation. Fre- 
 quently the optician, who fits glasses only, is confused 
 in the minds of people with the oculist. The optician, 
 or optometrist, as he is called in some localities, may fit 
 glasses, but not treat diseases of the eye, nor operate 
 upon the eye; while the oculist may do whatever is 
 necessary. 
 
 The ear specialist is to a great degree a special sur- 
 geon. The largest portion of his work is surgical, and 
 very delicate. The mastoid and labyrinth operations 
 are of the most serious nature, and unless the operator 
 is thoroughly familiar with the anatomy of the ear and 
 adjacent structures, much harm can result. The fees 
 are large. 
 
Specialism. 143 
 
 One may wonder how fields as restricted as ear or eye 
 practice conld demand much study. The ear is small 
 and the student may think there is but little to know 
 about it; but volumes and volumes have been written 
 upon it alone, and while the middle and internal ears 
 are located deep within the bony walls of the skull, there 
 is no part of the human organism as thoroughly under- 
 stood as the ear in its structure, function and treatment. 
 The examination and function tests are so scientific that 
 very seldom is an ear specialist mistaken in his diagnosis. 
 
 The nose specialist treats diseases of the nose and ac- 
 cessory sinuses. The discoveries in medicine in the last 
 few years lead to the fact that much of the general ill 
 health is traceable to infection in these bony cavities of 
 the face. This makes the nose specialist an important 
 factor in medicine. The larger part of the work may 
 be considered as surgical and the fees are proportionately 
 large. Many specialists combine nose, throat and ear 
 practice. The close relationship between throat, ears 
 and nose makes it necessary for each ear specialist to 
 know all about the nose and throat. Many cases of ear 
 troubles are traceable to diseased conditions of the nose. 
 
 One of the fields in surgery, whose importance has 
 only of late years become appreciated as it should be, is 
 the field of orthopedic surgery. One needs only to visit 
 an orthopedic ward in any of the large hospitals and see 
 the various appliances, casts, splints, plasters, braces and 
 exercising appliances used for the relief of the unfor- 
 tunate little ones, and then watch the entrance of the 
 surgeon into the ward to see the radiant smiles of the 
 children who idolize the man who is exercising his skill 
 in his efforts to relieve them. It is wonderful how appre- 
 ciative the patients are. While it is a fact that many of 
 
144 Medicine as a Profession. 
 
 these patients are poor and the returns from a financial 
 point of view are not as large as those from other sur- 
 gical work, yet there is no field of medicine in which the 
 kind, patient, gentle touch of the physician commands 
 such lasting gratitude of society as in orthopedic sur- 
 gery. So far, in this country, in many localities this 
 work is attended to by general practitioners or general 
 surgeons who are often incompetent and cannot render 
 the best service to the patient. The treatment of de- 
 formities is peculiarly a work for the specialist because 
 no two cases are similar. The specialist must be a skil- 
 ful physician, mechanic and surgeon. Much of the 
 work is mechanical adjustment, and each case must be 
 treated individually; the appliances must be changed a 
 little here and there from time to time, and braces must 
 be devised to suit each case. 
 
 Some physicians make children's disease a special 
 practice. One's practice cannot be restricted to the 
 treatment of children exclusively, except in few instances 
 in larger cities ; even then it must be as a consultant to 
 general practitioners. The treatment of children's dis- 
 eases is very similar to the work with adults, because 
 the diseases as a rule are the same as those of adults. 
 So this work is usually taken up by general practitioners 
 who give especial attention to children in connection 
 with their general practice. 
 
 The specialist's practice consists more of consultation 
 work with other physicians than of dealing directly with 
 the public. To command a lucrative special practice 
 one must be able to meet colleagues diplomatically; to 
 differ, if need be, with the diagnosis of the family phy- 
 sician without disturbing the confidence of the family in 
 their physician ; to be thorough, competent, conservative 
 
Specialism. 145 
 
 and polite. He should not resort to rebating or to the 
 granting of a percentage of his fees to the family phy- 
 sician who recommends him. These practices are some- 
 times resorted to by unscrupulous specialists. The prac- 
 tice is vicious because, under such conditions, many 
 physicians recommend specialists, not the most skilful, 
 but from whom they get the largest commission. There 
 are also men who advertise in the daily press as special- 
 ists offering free' consultations and a guarantee cure. 
 No one should consider such a commercialized practice 
 for a moment in choosing a vocation. It is not consid- 
 ered an honorable practice and should be discouraged. 
 The guarantee cannot be enforced if the cure is not 
 made. The money paid cannot be recovered legally on 
 account of so many elements that can enter into a case 
 which cannot be controlled. 
 
CHAPTER XXVI. 
 
 Women in Medicine. 
 
 This is not the place to determine the merits of the 
 arguments on the two sides of the debate between the 
 feminist who claims the whole field of medicine for 
 women by right of prior occupation and natural adapta- 
 tion; and the crusty old specialist who says that the 
 prejudice against women in medicine is probably primal 
 in its origin, and the more generous man who says that 
 women have not been so successful in medicine as they 
 have deserved, because other women do not have a suffi- 
 cient degree of confidence in them. 
 
 Both sides could prove their contentions by quoting 
 these figures from the last census, which show for the 
 entire country. 
 
 Male. Female. 
 
 Physicians and surgeons .... 142,116 9,015 
 
 Trained nurses 5,819 76,508 
 
 Nurses not trained 15,926 110,912 
 
 Total r6^;023 207,312 
 
 In 1900, women comprised 5 per cent, of the whole 
 number of physicians and surgeons, and in 1910, 6 per 
 cent., while the great army of women in the field of 
 trained nursing is almost entirely a development of the 
 twentieth century. It is evident that women are doing 
 their part in caring for the sick and unfortunate. On 
 the other hand it appears that, in the field of medicine 
 
 146 
 
Photo by H. D. Jones from Underwood & Undenvood, N. Y 
 
 Demonstration Before Students 
 Women's Medical College of Pennsylvania 
 
Women" in Medicine. 147 
 
 proper, the number of women students enrolled in the 
 medical colleges in 1904 was 4.3 per cent., and in 1914, 
 3.8 per cent., of all the students enrolled ; and the num- 
 ber of female graduates in medicine was 4 per cent, of 
 the entire number of graduates in 1904, and 3.4 per 
 cent, in 1914. The number of female medical students 
 in attendance upon the medical colleges was 1,129 in 
 1904 and only 631 in 1914. Of these only about 20 
 per cent, were in attendance at the two women's medical 
 colleges, while the larger number attended coeducational 
 institutions. 
 
 An expert in medical education, commenting upon 
 these figures, says: "Now that women are freely ad- 
 mitted to the medical profession, it is clear that they 
 show a decreasing inclination to enter it. More schools 
 are open to them; fewer attend and fewer graduate. 
 True enough, medical schools generally have shrunk; 
 but as the opportunities for women have increased, not 
 decreased, within a year during which entrance require- 
 ments have, so far as they are concerned, not materially 
 altered, their enrollment should have been augmented, 
 if there were any strong demand for women physicians 
 or any strong ungratified desire on the part of women 
 to enter the profession. One or the other of these con- 
 ditions is lacking, perhaps both." 
 
 The president of one of the state medical associations, 
 upon being interviewed, summed up the whole matter 
 somewhat as follows: 
 
 "There are fields of medicine for which women are 
 peculiarly adapted ; the foreign mission field, the school 
 inspection service, especially where the work is with 
 girls, the examination of women factory employees, the 
 personal and social hygiene service of pubKc health 
 
148 Medicine as a Profession. 
 
 work, and the examination of women applicants for life 
 insurance and in the health service of the industrial life- 
 insurance companies. There is no reason why women 
 should not succeed as specialists in the treatment of the 
 eye, ear and nose, in children's disease, and bacteriolog- 
 ical and biological laboratory work. 
 
 " There is an unlimited field in China and India for 
 women physicians who have been trained in western 
 methods. The customs of the countries have established 
 rules whose violation is not excused by even the most 
 extreme forms of suffering. Not only is the progress of 
 the medical missions hindered by this lack of women 
 physicians, but it is gradually becoming possible for 
 them to establish themselves in other connections and 
 with other associations. 
 
 " In the treatment of diseases peculiar to women 
 female practitioners have established lucrative practices. 
 Few persons realize the extent to which cancer of the 
 female reproductive organs prevails. The early symp- 
 toms are of such an intimate nature that women will 
 not discuss them with a male physician. With the ad- 
 vent of the female physician, these early symptoms will 
 be more likely to receive proper treatment. 
 
 "The treatment of nervous disorders which are so 
 often to be traced to discordant, uncongenial and in- 
 compatible social relations, the handling of cases of 
 houses of refuge for wayward women, and the work with 
 women in asylums and hospitals, should make a special 
 appeal to women who are seeking a life career. 
 
 "As preventative medicine becomes more and more 
 emphasized, and the great value of personal hygiene 
 and domestic sanitation becomes more fully recognized, 
 there will be a demand for a much larger number of 
 
Women in Medicine. 149 
 
 women to conduct campaigns of education under the 
 auspices of the public health authorities in congested 
 quarters of our cities and in rural communities. 
 
 "With the inauguration of efficiency campaigns and 
 weKare work by corporations, there will be an increased 
 demand for women with medical training to direct this 
 work for the concerns which employ large numbers of 
 women and girls. Ex-president Roosevelt, in comment- 
 ing upon a section of the factory laws providing for the 
 physical examination of employees, was one of the first 
 to call attention to the need for women to conduct these 
 examinations of female workers. 
 
 " Historically speaking, we may say that it has only 
 been in this country, and during a comparative short 
 space of years, that it has become the accepted custom 
 to call in male physicians in confinement cases, and it 
 seems that women are again entering upon this work, 
 by nature their own. 
 
 " In surgery there are many women who have demon- 
 strated their success in major operations. In the hos- 
 pital connected with the colleges for women, very skilful 
 operations are performed. In the New York hospital, 
 operations for appendicitis have been performed in 
 twelve minutes. One may enter this operating room 
 and observe the surgeons with their heads, nose and 
 lower parts of the face covered, with their operating 
 gowns reaching to their feet, as is customary in all hos- 
 pitals, without any thought that anything out of the 
 ordinary is going on. If there is any difference it is to 
 be noted that perhaps they are more conservative than 
 men; and those familiar with the healing art recognize 
 that in surgery conservatism is a virtue, not a fault." 
 
150 Medicine as a Profession". 
 
 In preceding chapters, reference has been made to 
 the work which women are doing in medical laboratories. 
 
 The natural conservatism of women may explain why 
 larger numbers have not entered this field. The woman 
 who must plan for herself a wage-earning career cannot 
 often command the funds to make the outlay which 
 preparation for medicine demands; nor is she often in 
 a position to regard with equanimity the long years of 
 unremunerative work. Furthermore, on account of the 
 comparative small number of female candidates who 
 apply to the hospital for service, it has been difficult to 
 persuade the hospital authorities to mke those changes 
 which are necessary to provide for a mixed staff of in- 
 ternes and house physicians. 
 
 In conclusion, it may be said that there never was a 
 time when it was so easy for a woman to prepare herself 
 for this field, and when there were fewer obstacles placed 
 in her path. 
 
Laboratory and Operating Room Southern Pacific Hospital, 
 
 San Francisco 
 
CHAPTER XXYII. 
 
 The Future of Medicixe. 
 
 In these days of rapid changes, a young man does 
 not care to make large investments of time and money 
 in preparing for a life work without considering what 
 changes are likely to occur during his active period of 
 life in the particular field under consideration. Of 
 course all prophecy is but speculation and must be ac- 
 cepted as such; and every man is privileged to indulge 
 his own fancies in this direction. 
 
 Through the greater part of the nineteenth century, 
 medical men insisted that the public should regard them 
 as possessing a field of knowledge exclusively their own 
 and that they were endowed with superior wisdom, 
 much of which they tried to conceal in the technical 
 language of the profession; and through the adoption 
 of their own code of ethics they protected the members 
 of their craft from the judgment of the lay public. 
 However, they reserved to themselves the right to deter- 
 mine who should be admitted to their own ranks and 
 under what conditions they should be received. They, 
 however, failed to establish a standard of education by 
 which the general average of practitioners was kept 
 apace with the advances made by their best men. As a 
 result the state stepped in and made laws for the regu- 
 lation of medicine through the special examining boards 
 which were constituted to determine the qualifications 
 of those who desired to enter the profession. 
 
 11 151 
 
152 Medicine as a Peofessioit. 
 
 As knowledge advanced and the social organization 
 became more complex, it became evident that the se- 
 curity of the life of the individual depended as much 
 upon the nature of his environment as upon the knowl- 
 edge and skill of his medical adviser, and that the 
 physician in his individual capacity could not always 
 control his environment; this led up to movements for 
 the purpose of encouraging preventative medicine, sani- 
 tation and such effective organization of medical staffs 
 as to make it possible to bring to bear upon any com- 
 plicated case or any emergency, either for the benefit of 
 the individual or the protection of the public, the best 
 of specialized skill and the whole of that enormously 
 expanded field of knowledge which has long since out- 
 grown the compass of any one man. 
 
 The community for its protection has organized an 
 army and a navy. The members who were serving thQ 
 community in connection with this branch of the gov- 
 ernment must be kept in a fit condition, and it was the 
 part of wisdom to establish a medical corps consisting of 
 salaried members. The sufferings of the poor enlisted 
 the sympathies of a prosperous and enlightened people. 
 Relief was organized as a measure of economy, and to 
 minister to the charges of the state another body of 
 salaried physicians was created. Science advanced and 
 systematic sanitary measures became necessary to secure 
 the results of scientific discoveries. Organization be- 
 came necessary and another body of salaried scientific 
 men, mostly physicians at the outset, was created and 
 thus has the movement grown towards organization for 
 carrying on protective measures on a large scale. 
 
 A canvass of the subject in England, before the out- 
 break of the war, showed that fully one fourth of all the 
 
Kg- 
 
 H 
 
 < 
 
The Future of Medicine. 153 
 
 registered physicians were either employed on full-time 
 salaried positions, or else are performing some paid 
 office in connection with their private practice. Eefer- 
 ence has already been made to the large expenditures 
 which our states and cities are making for maintaining 
 organized work in this field ; and in the absence of defi- 
 nite figures it is safe to say that governmental expenses 
 for public health purposes, sanitary supervision and 
 charitable medical service have doubled within the last 
 ten years. Does this mean the complete socialization of 
 medicine ; that every school district in the country shall 
 have its physician to treat all the people free as it has 
 its teacher to instruct their children, at public expenses ; 
 and that every city shall have its organized staff of spe- 
 cialists and general practitioners supported at the public 
 expense, in the same way that it supports its specialists 
 for fire protection, police protection and instruction? 
 
 On all sides we hear complaints from medical men of 
 the hardships to which they are subjected. There is the 
 burden of carrying with them in the rounds of their 
 general practice the accumulated funds of knowledge, 
 much of which they need only on very rare occasions; 
 there is the isolation which is due to the individual 
 nature of their work; there is the difficulty of keeping 
 up with the latest developments in technical skill; then 
 the business relations between physician and patient and 
 between general practitioner and specialist are far from 
 satisfactory; the separate domains of the public health 
 service and of the private practitioner are but vaguely 
 defined, and the public supervision of private practice 
 is proving to be a source of irritation. 
 
 As the medical graduate becomes imbued more and 
 more with the scientific spirit, which ever seeks for re- 
 
154 Medicine as a Profession". 
 
 suits, little comfort in failure is found in the thought 
 that the traditional methods have been followed in 
 handling a case. There comes dissatisfaction, especially 
 when the physician considers such figures as he receives 
 from the hospitals, which show that the autopsies which 
 are performed on the dead failed to confirm over 70 
 per cent, of the diagnoses. He is forced to the conclu- 
 sion that no one man alone can command for the benefit 
 of a patient, in extraordinary cases, the best which the 
 past has accumulated ; and there comes to him the possi- 
 bility of team work, which will lessen his burdens, en- 
 large his usefulness and increase his efficiency. 
 
 Unfortunately medicine does not generally appeal to 
 the young man with a capacity for organization and 
 leadership as do some of the industrial and commercial 
 fields in which the rewards for this kind of endowment 
 are better known and there is little in the studies of the 
 medical course and less in the routine of the practitioner 
 to develop this special capacity. 
 
 It is true that the hospitals for treating the poor are 
 so organized in our large cities that the patient who 
 comes to them after he is sick or afflicted is turned over 
 to the one man of the staff who handles a specialty, and 
 who has at his command every facility for handling the 
 case, but as a rule these staff physicians are beginners, 
 who handle this work in a routine way, more as a trade 
 than as a profession. On the other hand, a beginning 
 has been made in the organization of private sanita- 
 riums in which there is a staff of high-grade specialists 
 so organized as to bring to bear upon any one case the 
 collective wisdom and skill of the entire body. These, 
 however, reach individuals only during limited periods 
 of the disease and do not succeed in realizing the dreams 
 
The Future of Medicine. 155 
 
 of the general practitioner, who is persuaded that his 
 highest effectiveness comes from caring for individuals 
 rather than from treating morbid humanity. 
 
 Some day there will arise a genius who will map out 
 for himself a community and go to the members and say 
 that he will organize a staff of highly trained men and 
 place them in an establishment in which they will have 
 at their command the best of equipment and for an 
 annual fee will always have at their service and call 
 this fully organized machinery not only for the treat- 
 ment of the sick but to counsel and guard against sick- 
 ness. 
 
 As these words are written there comes to hand the 
 record of the work which is done by the University of 
 California. There it has been shown that by charging 
 the students an annual fee of five dollars for medical 
 service the institution can maintain a self-supporting 
 body of salaried high-grade specialists who are at the 
 command of the students at all times for advice, consul- 
 tation and treatment. At the same time there comes 
 the information that Harvard University, the Univer- 
 sity of Michigan and the University of Wisconsin have 
 set on foot schemes of similar kinds ; and that they are 
 not only placing organized medical faculties at the 
 service of the individual students, but that they are 
 making medical examination, at stated intervals, com- 
 pulsory. 
 
 The unrest in the medical profession, the general dis- 
 satisfaction of a lay public which has in recent years 
 become better and better informed of the larger possi- 
 bilities for a more economical and better medical service, 
 presages a revolution, and the question to be determined 
 is whether that revolution will be worked out by the 
 
156 Medicine as a Profession". 
 
 profession through organization from within, for the 
 wider service and protection of the public, as the life 
 insurance and fire insurance, the lighting of residences 
 has been brought about by organizations which serve the 
 individual for an annual fee; or whether it will be ac- 
 complished by the complete socialization of medicine, 
 so that this service for the entire body of the public will 
 be performed by salaried officials paid out of public 
 funds, in the same way that the public provides the 
 schooling for its children, its police protection, its fire 
 protection, its water supplies and the sewerage of its 
 cities and the lighting of its streets. 
 
 Whether the larger service is worked in one way or 
 the other the tendency will likely be to raise the poor 
 practitioner to a higher standard or eliminate him en- 
 tirely and it will also mean a leveling down by doing 
 away with the large monetary returns to the acknowl- 
 edged leaders in medicine and surgery, but it will result 
 in increasing the general average of income and satis- 
 factions to the men in the profession. It will conduce 
 to more conservatism, by the destruction of the vicious 
 fee-splitting and commission-paying practices, that are 
 indulged in by the unscrupulous and the self-seeking. 
 
CHAPTEE XXYIII. 
 
 Medical Laws. 
 
 The legislative requirements for the practice of medi- 
 cine are interpreted for the several states by their re- 
 spective boards of medical examiners. The standards 
 vary greatly, and while in one state a person may law- 
 fully prescribe for the sick, and operate upon the de- 
 formed, across the boundary in an adjoining state such 
 service may be regarded as a misdemeanor. All these 
 boards of examiners, however, require that the applicant 
 for a certificate must be a person of good character, 
 must possess a diploma from a reputable medical col- 
 lege and must pass examinations in anatomy, physiology, 
 pathology, chemistry, hygiene, surgery, obstetrics and 
 gynecology. In some states there are separate boards 
 to examine the graduates in particular systems of medi- 
 cine, and in states where there is a single board there are 
 usually appointed to this board representatives of the 
 regular, eclectic and homeopathic schools of medicine, 
 and the applicant may request to be examined upon 
 therapeutics and the materia medica by those members 
 who represent his own system or school. 
 
 The boards .of examiners of particular states usually 
 accept certificates which are issued by other states whose 
 standards of requirements are equal to their own; and 
 by addressing a letter of inquiry to the board of medical 
 examiners at the state capitol, applicants can find out 
 whether, at the time, the certificate of examination which 
 
 157 
 
158 Medicine as a Pkoeession. 
 
 they hold from any state is honored by another state. 
 Holders of certificates or licenses to practice in one 
 state are generally expected to pay a fee or tax in order 
 to have their licenses validated for other states; but in 
 most of the states there are special regulations which 
 permit physicians licensed by adjoining states to wait 
 upon patients in nearby counties across the state bound- 
 aries, and they also concede the right to physicians 
 from other states to act as consultants; and allow the 
 regular appointed officers of the army and navy or of 
 railroads to follow their professional work within states 
 in which they do not hold licenses. 
 
 Sections of the medical laws of the state of New 
 York and Pennsylvania are given at some length. The 
 applicant who can meet these requirements can qualify 
 in any state. At the end of the chapter a tabular state- 
 ment is given of the requirements for all of the states. 
 
 In New York the Board of Medical Examiners is 
 constituted by the Eegents of the University of the 
 State of New York, which is the name by which the 
 department of education is known, and this university 
 includes all duly organized schools controlled by the 
 educational officers of the state. 
 
 No persons shall be licensed to practice who have 
 been convicted of a felony; nor shall any person be 
 licensed after 1891 except in accordance with this law. 
 The regents shall admit to the medical examination any 
 person who pays a fee of $25 and submits evidence 
 verified by oath, and satisfactory to the examiners, that 
 he is more than twenty-one years old, is of good moral 
 character, has had, prior to entrance upon the second 
 year of medical study, the academic education which is 
 prescribed by law, and has studied medicine at a school 
 
Medical Laws. 159 
 
 which has been duly registered as satisfactory by the 
 Regents and been in attendance at snch school for a 
 period covering four different calendar years upon 
 courses covering at least seven months of each year. 
 Evidence of five or more years of reputable practice 
 may be accepted as an equivalent for the requirements 
 of the third or fourth years of the medical courses ; and 
 evidence of graduation from a recognized college may 
 be accepted as equivalent to the work of the first of the 
 four years in the medical school. 
 
 Applicants to practice osteopathy shall produce evi- 
 dence that they have studied not less than four years, 
 including courses of not less than seven months each, 
 at a school satisfactory to the Regents. From time to 
 time the board issues circulars of information in which 
 the different schools maintaining satisfactory standards 
 are listed. These circulars can be obtained by address- 
 ing the Board of Regents, Albany, N. Y. 
 
 The law prescribes that the Board of Medical Ex- 
 aminers shall submit to the Regents for their approval, 
 suitable questions for examinations in anatomy, physi- 
 ology, hygiene, sanitation, chemistry, surgery, obstet- 
 rics, gynecology, pathology, including bacteriology and 
 diagnosis. 
 
 Examinations shall be held at four different places 
 in the state, four times annually, and the examination 
 shall be in writing and shall be conducted by examiners 
 appointed by the Regents, who shall deliver the papers 
 to the authorized committees. The papers shall be 
 marked without delay and returned with an official 
 report giving the percentages obtained by each candi- 
 date in each subject. A candidate who fails upon the 
 
160 Medicine as a Profession". 
 
 first examination may have a second trial within six 
 months, without paying an additional fee. 
 
 The Commissioner of Education may at his discre- 
 tion, upon the approval of the Eegents, endorse the 
 license or diploma of a physician from another state 
 provided the applicant has met all the preliminary and 
 professional qualifications for earning a license in this 
 state, has been in reputable practice for a period of ten 
 years, and has reached a position of conceded eminence 
 or authority in the profession. 
 
 Before beginning to practice, the holder of a license 
 shall have the same registered in the office of the clerk 
 of the county where such practice is to be carried on, 
 producing proper evidence that he is the person to 
 whom the license has been issued and that he has com- 
 plied with all the requirements of the laws governing 
 the practice of medicine, that no money except the 
 regular fees has been paid for such license, and that he 
 has not been guilty of any fraud or misrepresentation 
 in securing his credentials. He shall receive a certifi- 
 cate of such registration, for which he shall pay a fee 
 of one dollar. 
 
 A license to practice medicine may be revoked if it is 
 found that the practitioner has been guilty of any fraud 
 or deceit in securing his credentials ; if he is an habitual 
 drunkard or addicted to the use of morphine, opium or 
 cocaine; if he violates any of the laws governing the 
 practice of medicine. 
 
 Nothing in the law shall be so construed as to affect 
 commissioned medical officers serving in the army, the 
 navy or the marine hospital service, while so commis- 
 sioned, or any one while serving on the medical staff of 
 a legally incorporated hospital. 
 
Medical Laws. 161 
 
 The law of 1912 for the state of Pennsylvania is very 
 similar to the law of New York. The Bureau of 
 Medical Education and Licensure is under the jurisdic- 
 tion of the Superintendent of Public Instruction. This 
 Bureau prepares annually a list of medical colleges and 
 schools which are satisfactory to the department, and 
 which require of applicants for a medical degree a 
 satisfactory high-school education, together with one 
 or more years of work in chemistry, biology and phys- 
 ics in an approved college, and maintain graded medical 
 and surgical courses of four years, of not less than 
 thirty-two weks each of not less than thirty-five hours 
 of work, in didactic, laboratory and clinical studies. 
 
 Applicants for the medical examination must furnish 
 satisfactory proof of being twenty-one years of age, of 
 good moral character, not addicted to the intemperate 
 use of alcoholics or narcotic drugs, and that they have 
 complied with the requirements as to preliminary edu- 
 cation and attendance upon a duly authorized and ap- 
 proved medical school, have successfully passed each of 
 the courses prescribed by such school and served as an 
 interne for one year at a hospital having, at least, 
 twenty-five beds for each interne. 
 
 The medical examination shall be in writing, but may 
 be supplemented by oral examinations, by laboratory 
 tests or by bedside examinations. The examinations 
 shall be conducted at such times and places as may be 
 designated by the Bureau, and specially qualified as- 
 sistants may be called in to assist in conducting the 
 examinations. 
 
 The subjects of the examination shall include : anat- 
 omy, physiology, chemistry as applied to medicine, 
 pathology, bacteriology, symptomatology, diagnosis, 
 
162 Medicine as a Peoeession. 
 
 surgery, gynecology and obstetrics. The examination 
 in therapeutics and materia medica is to be conducted 
 by members of the Bureau who are of the same school 
 of medicine as the candidate. The law also provides 
 for partial examinations at the end of the second year 
 of medical study, exempting the applicant who passes 
 any subjects at this examination from, further exami- 
 nation upon those subjects at the final examinations. 
 
 From a table published in the Journal of the Amer- 
 ican Medical Association in its annual state board issue 
 it appears that from 1912 to 1916 inclusive 545 of the 
 4283 graduates who appeared before the state boards 
 for examination failed. During those same years none 
 failed in Idaho, Iowa, Minnesota, Nebraska, New Hamp- 
 shire, Utah, Vermont, Washington, and Idaho. During 
 the same years, 36 per cent, of the applicants were re- 
 jected in Mississippi ; 20 per cent, in New York ; 20 per 
 cent, in South Carolina ; 30 per cent, in Oregon. It ap- 
 pears that in those states reporting large percentages of 
 failures the proportion of failures was greater among 
 the applicants who were graduated from colleges outside 
 of those states than from graduates from colleges in the 
 respective states which seems to indicate that a student 
 is more likely to fulfill all the requirements of a state 
 board in a particular state if he has been graduated from 
 a college located in that state. 
 
 The lack of uniformity of standards is also indicated 
 by the variation of the number of failures by the gradu- 
 ates of the same institutions in different years. Of one 
 leading institution 10 per cent, of the graduates were 
 rejected by the state boards in the years from 1912 to 
 1916 inclusive and only 5 per cent, in the latter year; 
 of another large college 6 per cent, failed in the former 
 
Medical Laws. 163 
 
 period and none in the latter. For all the colleges the 
 percentage of failures was 20J per cent, in 1912 as 
 against 15 per cent, in 1916. This improved result un- 
 doubtedly indicates that standards are becoming more 
 uniform. 
 
 The lack of uniformity of standards has resulted in a 
 movement for the establishment of a federal board for 
 granting licenses which are to be good for the entire 
 country. Such a board has been constituted but at pres- 
 ent it has no official status but it is believed that the 
 several state boards will take steps to validate the licenses 
 issued by this national board. 
 
 The medical laws do not regulate the conduct of a 
 physician after he secures his license to practice, but if 
 it can be proven that he has failed to exercise due dili- 
 gence and care in his duties to his patients he may be 
 held for damages for malpractice, "\\niile it is difficult 
 for a patient to establish before a court claims for dam- 
 ages, suits of this kind are so injurious to a physician 
 that every precaution must be taken to forestall them. 
 There are insurance companies which undertake for an 
 annual fee to afford to practitioners protection against 
 suits of this kind by supplying to their clients at the 
 expense of the company, attorneys for their defense and 
 by paying damages in cases which result unfavorably to 
 the defendant. 
 
 A summary of the medical laws of the several states 
 will be found in the Appendix. 
 
CHAPTER XXIX. 
 
 The Code of Medical Ethics. 
 
 As a final indication of the peculiar position of the 
 physician we give in this closing chapter a summary of 
 professional ethics as set forth in the Hippocratic Oath, 
 which has been subscribed to by physicians for over two 
 thousand years, and as embodied in one of the several 
 approved modern statements of the code of medical 
 ethics. 
 
 The Hippocratic Oath, 
 
 I swear by Apollo, the physician, and ^sculapius, 
 and Health and All Heal and all the Gods and God- 
 desses, that according to my ability and judgment, I 
 will keep this oath and this stipulation; to reckon him 
 who taught me this art equally dear to me as my 
 parents; to share my substance with him and relieve his 
 necessities if required ; to look upon his offspring on the 
 same footing as my own brothers and to teach them this 
 art if they shall wish to learn it, without fee or stipula- 
 tion, and that by precept, lecture, and every other mode 
 of instruction, I will impart a knowledge of the Art to 
 my own sons and those of my teachers, and to disciples 
 bound by a stipulation and oath, according to the law 
 of medicine but to none others; I will follow the sys- 
 tem of regimen which according to my ability and judg- 
 ment, I consider for the benefit of my patients, and ab- 
 staining fpom whatever is deleterious and mischievous, 
 
 164 
 
Hippocrates 
 The Father of Medicine 
 
The Code of Medical Ethics. 165 
 
 I will give no deadly medicine to any one if asked nor 
 suggest any such counsel, but with purity and holiness 
 I will pass my life and practice my art. Into whatever 
 houses I enter I will go into them for the benefit of the 
 sick, and will abstain from every voluntary act of mis- 
 chief and corruption, and further from the seduction of 
 females or males, of freemen and slaves. 
 
 Whatever in connection with my professional prac- 
 tice or not, I see or hear, in the life of men, which ought 
 not be spoken of abroad, I vtdll not dviulge as reckoning 
 that all such should be kept secret. 
 
 While I continue to keep this oath unviolated, may 
 it be granted to me to enjoy life and practice of the Art 
 respected by all men in all times. But should I tres- 
 pass and violate this oath may the reverse be my lot. 
 
 A Modern Code of Ethics. 
 
 The great principles upon which Medical Ethics are 
 based are these : 
 
 The great end and object of the physician's efforts 
 should be "the greatest good to the patient." 
 
 The rule of conduct of physician and patient, and of 
 physicians toward each other should be the Golden Rule: 
 " As ye would that men should do to you, do ye also to 
 them likewise.'' 
 
 The various articles of the code are only special ap- 
 plications of these great principles. 
 
 The physician should hold himself in constant readi- 
 ness to obey the calls of the sick. He should ever bear 
 in mind the sacred character of his calling and the great 
 responsibility which it involves, and should remember 
 that the comfort, the health and the lives of his patients 
 
166 Medicine as a Profession". 
 
 depend upon the skill, attention and faithfulness with 
 which he performs his professional duties. 
 
 The physician, in order that he may be able to ex- 
 ercise his vocation to the best advantage of the patient, 
 should possess his respect and confidence. These must 
 be acquired and retained by faithful attention to his 
 malady, by indulgent tenderness towards the weakness 
 incident to his condition, and by the exercise of a firm 
 but kindly authority. The physician is bound to keep 
 secret whatever he may either hear or observe, while 
 in the discharge of his professional duties, respecting 
 the private affairs of the patient or his family. And 
 this obligation is not limited to the period during which 
 the physician is in attendance on the patient. The 
 patient should be made to feel that he has, in his physi- 
 cian, a friend who will guard his secrets with scrupu- 
 lous honor and fidelity. 
 
 The physician should visit his patient as often as 
 may be necessary to enable him to acquire and keep a 
 full knowledge of the nature, progress, changes and 
 complications of the disease, and to do for the patient 
 the utmost of good that he is able. But he should care- 
 fully avoid making unnecessary visits, lest he render 
 the patient needlessly anxious about his case, or expose 
 himself to the charge of being actuated by mercenary 
 motives. 
 
 The physician should not give expression to gloomy 
 forebodings respecting the patient's disease, nor mag- 
 nify the gravity of the case. Bearing in mind the almost 
 infinite resources of nature, he should be cheerful and 
 hopeful, both in mind and manner. This will enable 
 him the better to exercise his faculties and apply his 
 knowledge for the patient's benefit, and will inspire the 
 
The Code of Medical Ethics. 167 
 
 patient with confidence, courage and fortitude, which 
 are the physician's best moral adjutants. 
 
 But it is the physician's duty to state the true nature 
 and prospects of the case, from time to time, to some 
 judicious friend or relative of the patient, and to keep 
 this person fully informed of its changes and probable 
 issue; and if the patient himself requests the physician 
 to disclose to him the nature and progress of his disease, 
 it is his duty to state tenderly but frankly the whole 
 truth — provided the patient be of sound mind, and 
 strong enough to receive the disclosure without serious 
 injury. The patient has a right to know the truth. If, 
 moreover, facts within the physician's knowledge lead 
 him to believe that it is of great importance, in relation 
 to the patient's affairs, that he should be warned of the 
 approach of death, it is the physician's duty to reveal to 
 the patient's nearest friend, or to the patient himself, 
 the true state of the case, and the importance of timely 
 action. 
 
 Whether the case proceed favorably, or become mani- 
 festly incurable, it is the physician's duty to continue 
 his attendance faithfully and conscientiously as long 
 as the patient may desire it. He is not justified in 
 abandoning a case merely because he supposes it in- 
 curable. 
 
 As the patient has an undoubted right to dismiss his 
 physician for reasons satisfactory to himself, so likewise, 
 the physician may, with equal propriety, decline to at- 
 tend patients, when his self-respect or dignity seem to 
 him to require this step; as, for example, when he per- 
 sistently refuses to comply with his directions. 
 
 In difficult or protracted cases, consultations are ad- 
 visable. They tend to increase the knowledge, energy 
 12 
 
168 Medicine as a Profession. 
 
 and confidence of the physician, and to maintain the 
 courage of the patient. The physician should be ready 
 to act upon any desire which the patient may express 
 for a consultation, even though he may not himself feel 
 the need of it. Nothing is so likely to maintain the 
 patient's confidence as alacrity in this respect. More- 
 over, such a course is but just to him, for he has an in- 
 disputable right to whatever aid or counsel he may think 
 likely to be of service to him. 
 
 The intimate relations into which the physician is 
 brought with his patient give him opportunity to ex- 
 ercise a powerful moral influence over him. This should 
 always be exerted to turn him from a dangerous or 
 vicious course towards a temperate and virtuous life. 
 The physician is sometimes called to assist in practices 
 of questionable propriety, and even of a criminal char- 
 acter. Among these may be mentioned the pretence of 
 disease, in order to evade services demanded by law, 
 as jury or military duty; the concealment of organic 
 disease or of morbid tendencies, in order to secure 
 favorable rates of life insurance, or for deception of 
 other kinds; and especially the procurement of abor- 
 tion when not necessary to save the life of the mother. 
 To all such propositions, the physician should present 
 an inflexible opposition. It is his duty, in an authorita- 
 tive, but friendly manner, to explain and urge the 
 nature, illegality and guilt of the proposed action, and 
 to use every effort to dissuade from it, and to strengthen 
 the patient's virtue and sense of right. The physician 
 should be aware of the frequency of criminal abortion, 
 and of the different methods employed for it, and should 
 take every occasion to warn those who may be tempted 
 to resort to it. In no case should the physician induce 
 
The Code of Medical Ethics. 169 
 
 abortion, or premature labor, without a previous con- 
 sultation with the most experienced practitioners at- 
 tainable, nor without the most clear and imperative 
 reasons. 
 
 Physicians are required, by the nature of their pro- 
 fession, to sacrifice comfort, ease and even health for 
 the sake of their patients. Patients should reflect upon 
 this, and should understand and remember that they 
 have corresponding duties and obligations towards their 
 physicians. 
 
 The patient should select a physician in whose knowl- 
 edge, skill and fidelity he can place implicit confidence ; 
 whose habits of life are regular and temperate, and 
 whose character and demeanor are such that he can re- 
 gard him as a personal friend. He must be able to 
 confide in him freely. And the physician should not be 
 changed for light reasons. A physician thoroughly ac- 
 quainted with the constitutions, temperaments and 
 tendencies of a family, can the more successfully treat 
 the members. 
 
 The patient should always consult his physician as 
 early as possible after he has discovered that he is ill. 
 A disease which is trifling at its onset may grow for- 
 midable through neglect. The physician should be re- 
 garded as a confldential adviser, who, on being early 
 consulted, may prevent a sickness. 
 
 The patient should faithfully and unreservedly state 
 to his physician the cause of his malady, and tell him 
 everything that may have a bearing upon its nature. 
 Since the physician is under the strongest obligations 
 to secrecy, the patients should not allow considerations 
 of delicacy, modesty or pride, to prevent an entirely 
 
170 Medicine as a Profession. 
 
 frank statement of his case, and candid and full replies 
 to interrogatories. 
 
 The patient should implicitly obey his physician's 
 injunctions as regards diet, regimen and medical treat- 
 ment. If he deviates from these directions, he cannot 
 hold the physician to a full responsibility in the case; 
 and, further, by a partial obedience he incurs some per- 
 sonal risk, since, in the treatment of diseases, all parts 
 of the physician's advice are made to harmonize, and 
 each is dependent oh the others and may be unsafe 
 without the coincidence of the others. Moreover, he 
 does the physician an undeserved, and often a serious 
 wrong. If the patient have not sufficient confidence in 
 his physician, and respect for him, to follow his direc- 
 tions, it were better for him frankly to say so, and to 
 employ another in whom he can confide. 
 
 The patient should never allow himself, while under 
 a physician's treatment, to take other medicines than 
 those prescribed by him. He would, by so doing, incur 
 a serious risk of taking medicines that are incompatible 
 with each other. If desirous of trying any other mode 
 of treatment, it would be much better frankly to state 
 the fact to his physician and ask his advice. 
 
 The patient should, if possible, avoid receiving the 
 friendly visits of a physician other than the one under 
 whose charge he is. When he receives such visits, he 
 should avoid conversation on the subject of his disease ; 
 for an accidental observation might give him false im- 
 pressions respecting his disease, or destroy his con- 
 fidence in the treatment he is pursuing. He should 
 never send for a consulting physician without the ex- 
 press consent of his own medical attendant; for physi- 
 cians can act together for the advantage of their patient, 
 
The Code of Medical Ethics. 171 
 
 only when they act harmoniously. Nor should he, by a 
 secret appointment, constrain his medical attendant to 
 meet another physician with whom he might not be 
 willing to consult; but the patient has an undoubted 
 right to have the opinion of any physician whom he 
 may desire, upon his case. His proper course is to re- 
 quest his medical attendant to arrange a consultation, 
 and frankly state his desire for the physician whom he 
 may prefer. If his medical attendant decline the con- 
 sultation, it is then for the patient to determine whether 
 he will insist, and thus dismiss his medical attendant, 
 or whether he will defer to the judgment of his own 
 physician. The patient has a right thus to choose. 
 
 If the patient wishes to dismiss his physician, he 
 should, in justice and in common courtesy, state his 
 reasons, and, if possible, in a friendly manner. To dis- 
 pense with the service of a physician need not, of neces- 
 sity, change the social relations of the parties. 
 
 The patient should, when practicable, send for the 
 physician in the morning, before his usual hour for 
 leaving home. He will, by so doing, secure his earlier 
 attendance, and will enable him the better to apportion 
 his time so as to do justice to all his calls and engage- 
 ments. He should call on his physician during his 
 office hours only, and should avoid disturbing him in 
 hours devoted to meals, rest and sleep. In receiving his 
 physician's visits, he should avoid compelling him to 
 wait, even a few minutes. The aggregate of petty de- 
 tentions, while the patient is making some needless 
 preparation to receive the physician, amounts to a serious 
 waste of valuable time. 
 
 Inasmuch as every member of the medical profession 
 
172 Medicine as a Profession. 
 
 partakes of the honor in which it is held, is entitled to 
 its privileges and immunities, and profits by the scien- 
 tific labors of his predecessors and associates, it is his 
 duty faithfully to endeavor, in his turn, to elevate the 
 position of the profession and, by every honorable ex- 
 ertion, to enrich the science of medicine. 
 
 In no other profession should a higher standard of 
 morality and greater purity of personal character be 
 required. Physicians ought to come up to this standard, 
 and do what they may to exalt it. As the practice of 
 medicine requires the constant exercise of a vigorous 
 and clear understanding, and as the practitioner should 
 be, at all times, ready for emergencies in which the wel- 
 fare and even the life of a fellow creature may de- 
 pend upon his steady hand, acute eye and unclouded 
 brain, it is incumbent upon the physician to be tem- 
 perate in all things. 
 
 The physician should not resort to public advertise- 
 ments, or private cards or handbills, inviting the atten- 
 tion of persons affected by particular disease, or pub- 
 licly offering advice and medicine to the poor, gratis, or 
 promising radical cures. Neither should he publish 
 cases or operations in the daily prints; nor invite lay- 
 men to be present at operations, nor solicit or exhibit 
 certificates of skill and success ; nor perform any similar 
 act. 
 
 It is- equally derogatory tp prof^sional character for 
 a physician to hold a pa^ifm for any nostrum or any 
 surgical instrument or appliance; or to keep secret the 
 nature and composition of any medicine used by him. 
 Such restriction or concealment is inconsistent with 
 the beneficence and liberality which should characterize 
 the medical profession. But it is the duty of the physi- 
 
The Code of Medical Ethics. 173 
 
 cian to avail himself of every opportunity to observe the 
 action and study the properties of new or secret rem- 
 edies, and new processes of preparing medicines, as 
 well as new modes of treating diseases, and to subject 
 them to the analysis of scientific investigation. For the 
 physician should always bear in mind that the great 
 object of his profession is to cure the sick, and that it 
 is not only admissible, but is his solemn duty to inves- 
 tigate, thoroughly and without prejudice, whatever 
 offers any probability of adding to his knowledge of the 
 art and means of curing, and of thus enriching the 
 science of medicine. 
 
 All practitioners of medicine, their wives, and chil- 
 dren while under the parental care, are entitled to the 
 gratuitous services of any one or more of the faculty 
 residing near them. Physicians, when ill, are incom- 
 petent to prescribe for themselves. The natural anxiety 
 and solicitude which they feel for members of their own 
 family when ill, tend to obscure their professional judg- 
 ment and make it difficult to treat them. Under these 
 circumstances, physicians are peculiarly dependent on 
 each other; kind offices and professional aid should al- 
 ways be cheerfully and gratuitously afforded. But visits 
 should not be obtruded, officiously or unasked, upon a 
 sick physician. 
 
 If, however, a physician, in affluent circumstances, 
 request the attendance of a distant professional brother, 
 ■ and offer an honorarium, it is not proper to decline it ; 
 for one should not, even from a kindly motive, impose 
 upon another a pecuniary obligation, which the re- 
 cipient would not wish to incur. 
 
 If a physician is called from any considerable dis- 
 tance, the expense of travel, etc., thereby incurred, 
 
174 Medicine as a Profession. 
 
 should always be paid by the physician receiving the 
 visit, and an honorarium may be tendered if much time 
 is consumed in making the visit. 
 
 Attention to his personal affairs, the pursuit of health 
 and the various contingencies to which the physician is 
 peculiarly exposed, sometimes compel him temporarily 
 to withdraw from his duties to his patients, and request 
 some of his professional brethren to discharge them for 
 him. Compliance with such a request is an act of 
 courtesy which should always be performed with the 
 utmost consideration for the interests and character of 
 the physician relieved. When this is done for a short 
 period only, all the pecuniary obligations for such serv- 
 ices should belong to him. But if a physician neglect 
 his business in quest of amusement and pleasure, he is 
 not entitled to the frequent and long-continued exercise 
 of his fraternal courtesy without conceding to the physi- 
 cian who acts for him the fees accruing from the duties 
 discharged by the latter. 
 
 Obstetrical and surgical cases involve unusual fatigue 
 and responsibility; and it is just that the fees accruing 
 therefrom should belong to the physician who attends 
 them. 
 
 A complete medical education, of which the diploma 
 of a medical college is the formal voucher, furnishes the 
 only presumptive evidence of professional acquirements 
 and abilities. But the annals of the profession contain 
 the names of some who, not having the advantage of a 
 complete medical education, became, nevertheless, 
 through their own exertions and abilities, brilliant 
 scholars and successful practitioners. A practitioner, 
 
The Code of Medical Ethics. 175 
 
 therefore, whatever his credentials may be, who enjoys 
 a good moral and professional standing in the com- 
 munity, should not be excluded from fellowship, nor his 
 aid rejected, when it is desired by the patient in con- 
 sultation. No difference in views on subjects of medical 
 principles or practice should be allowed to influence a 
 physician against consenting to a consultation with a 
 fellow practitioner. The very object of consultation is 
 to bring together those who may, perhaps, differ in their 
 views of the disease and its appropriate treatment, in 
 the hope that from a comparison of different views may 
 be derived a just estimate of the disease and a success- 
 ful course of treatment. 
 
 No test of orthodoxy in medical practice should be 
 applied to limit the freedom of consultation. Medicine 
 is a progressive science. Its history shows that what 
 is heresy in one century may, and probably will be 
 orthodoxy in the next. No greater misfortune can 
 befall the medical profession than the action of an in- 
 fluential association or academy establishing a creed or 
 standard of orthodoxy or ^^ regularity." It will be fatal 
 to freedom and progress in opinion and practice. On 
 the other hand, nothing will stimulate the healthy 
 growth of the profession, both in scientific strength and 
 in the honorable estimation of the public, as the uni- 
 versal and sincere adoption of a platform which shall 
 recognize and guarantee: a truly fraternal good- will 
 and fellowship among all who devote themselves to the 
 care of the sick; a thorough and complete knowledge, 
 however obtained, of all the direct and collateral 
 branches of medical science — as it exists in all sects and 
 schools of medicine — as the essential qualification of a 
 physician; perfect freedom of opinion and practice, as 
 
176 Medicine as a Profession. 
 
 the unquestionable prerogative of the practitioner, who 
 is the sole judge of what is the hest mode of treatment 
 in each case of sickness entrusted to his care. 
 
 The physician may, with propriety, decline to meet 
 a practitioner of whose inimical feelings towards him- 
 self, or of whose general unfairness in consultations he 
 is satisfied. But, in such a case, he should explain to 
 the patient his reasons; and if the patient desire the 
 the opinion of the practitioner objected to, the family 
 physician may withdraw from the case and allow the 
 other to be sent for. But, in justice to the latter, the 
 state of affairs should be explained to him at the time 
 he is requested to visit the patient. 
 
 The utmost punctuality should be observed in the 
 visits of physicians when they are to hold consultations 
 together; this is generally practicable, for society allows 
 the plea of professional engagements to excuse the 
 neglect of all others, and to be a valid reason for the re- 
 linquishment of any present occupation. But, as pro- 
 fessional engagements may sometimes interfere and de- 
 lay one of the parties, the physician who first arrives 
 should wait for his associate a reasonable period of time, 
 after which the consultation should be considered post- 
 poned to a new appointment. If it be the attending 
 physician who is present, he will, of course, see the 
 patient and prescribe ; but if it be the consulting physi- 
 cian, he should retire without seeing the patient, except 
 in cases of emergency, or when he has been called from 
 a considerable distance, in which case he may examine 
 the patient, and give his opinion in writing and under 
 seal, to be delivered to the attending physician. 
 
 In consultations, no rivalry or jealousy should be 
 indulged in. Candor, probity and all due respect should 
 
The Code of Medical Ethics. 177 
 
 be exercised towards the physician in charge of the case. 
 If the consulting physician cannot agree with him 
 respecting the nature and proper treatment of the case, 
 the physician should state this fact to the patient, or 
 his nearest friend, both physicians being present at the 
 time, and should request him to select the one in whom 
 he has most confidence. But, if they agree sufficiently 
 to take joint charge of the case, then the consulting 
 physician must justify and uphold, so far as he can con- 
 scientiously do so, the practice of his associate, and must 
 abstain from any hints, insinuations or actions which 
 might, in any way, impair the confidence which the 
 patient reposes in him, or affect his reputation. He 
 must refrain from any extraordinary attentions or as- 
 siduities, calculated to ingratiate himself in the patient's 
 favor and to supplant his associate. 
 
 In consultations, the attending physician should first 
 put the necessary question to the patient. After this, 
 the consulting physician should make such additional 
 inquiries and examinations as may be needed to satisfy 
 him of the true nature of the case. But he should avoid 
 making a parade of examining the patient more thor- 
 oughly than had been done before ; rather suggesting to 
 the attending physician, where this is possible, to make 
 whatever examinations he desires, than making them 
 himself. Both physicians should then retire to a private 
 room for deliberation. 
 
 In consultations, the attending physician should de- 
 liver his opinion first; then, where there are several 
 consulting physicians, they should express their opin- 
 ions in the order in which they have been called in. 
 Should an irreconcilable diversity of opinion occur, 
 when more than two physicians meet in consultation. 
 
178 Medicine as a Profession". 
 
 the opinion of the majority should be regarded as de- 
 cisive; but, if the number be equal on each side, the de- 
 cision should rest with the attending physician. If two 
 physicians, in consultation, cannot agree, they should 
 call in a third to act as umpire. If this is not prac- 
 ticable, the patient must be requested to select the physi- 
 cian in whom he is most willing to confide. The physi- 
 cian who is left in the minority should, without any ill 
 feeling, retire from the consultation, and from any 
 further participation in the management of the case; 
 and, in justice to the physician thus retiring, the fact 
 of his difference from his associates should, in the pres- 
 ence of all the physicians attending, be explained to the 
 patient, as his reason for withdrawing from the case. 
 
 The attending physician should communicate to the 
 patient or his friends the directions agreed upon in the 
 consultation, as well as any opinon which it may be 
 thought proper to express. But no statement or discus- 
 sion should take place before the patient or his friend, 
 except in the presence of all the physicians attending, 
 and by their common consent. And no opinions or prog- 
 nostications should be delivered, which are not the re- 
 sult of previous deliberation and concurrence. No de- 
 cision arrived at in a consultation is to be regarded as 
 restraining the attending physician from making such 
 variations in the treatment as any subsequent change in 
 the case may demand. But such variation and the rea- 
 sons for it ought to be carefully noted at the time, and 
 detailed at the next meeting in consultation. The same 
 privilege belongs also to the consulting physician, if he 
 is sent for in an emergency when the attending physi- 
 cian is out of the way; and similar explanations must 
 be made by him at the next meeting. 
 
The Code of Medical Ethics. 179 
 
 Sometimes a special consultation is desirable in cases 
 in which the continued attendance of two physicians 
 might be objectionable to the patient. The consulting 
 physician, in such a case, should sedulously avoid all 
 further unsolicited attendance. Such consultation re- 
 quires an extraordinary outlay of time and attention, 
 and at least a double honorarium may be reasonably ex- 
 pected. 
 
 The consulting physician cannot, with propriety, take 
 exclusive charge, at any time, of the patient in whose 
 case he has been called in consultation, without the con- 
 sent of the attending physician, except in cases herein 
 provided for. 
 
 Medicine is a liberal profession and those admitted 
 into its ranks should base their expectations of success 
 upon the extent of their qualifications, not upon in- 
 trigue or artifice. A physician should not allow him- 
 self to feel envious or jealous of a brother practitioner. 
 The distinction which one successful physician wins is 
 shared by the whole profession. Nor should a physician 
 suffer himself to feel ill-will towards another who may 
 come into his neighborhood and appear likely to take a 
 share of the business which he has hitherto enjoyed. 
 Such feelings are inconsistent with the beneficent and 
 liberal nature of the profession. Liberality and true 
 generous fraternity in thought, word and deed, will 
 unite the interests of all the members of the profession, 
 and will so exalt the estimation in which it is held in 
 the community that, confidence being increased, busi- 
 ness will likewise increase ; and to physicians will be ac- 
 corded the position which, of right, should be theirs; 
 that of confidential family advisers in all matters per- 
 
180 Medicine as a Profession. 
 
 taining to the care of the body in health, no less than 
 in sickness. 
 
 The physician, in his intercourse with a patient who 
 is under the care of another practitioner, should observe 
 the strictest caution and reserve. No meddling ques- 
 tions should be asked in any interview for business or 
 friendship, no disingenuous hints thrown out relating 
 to the nature and treatment of his disorder; nor should 
 the patient be allowed to converse upon these topics. No 
 course of conduct should be pursued which might, di- 
 rectly or indirectly, tend to diminish the trust reposed 
 in the physician employed. 
 
 A physician should not take charge of a patient who 
 is, or has recently been, under the charge of another 
 practitioner in the same illness, except in cases of sud- 
 den emergency, or in consultation with the physician 
 previously in attendance, or when the latter has relin- 
 quished the case, or has been regularly notified that his 
 services are no longer required. Under such circum- 
 stances no unjust or illiberal remarks should be made, 
 or insinuations thrown out in relation to the treatment 
 pursued by the previous physician. Nor should the 
 physician permit the patient unreasonably to find fault 
 with his predecessor. For patients often become dis- 
 satisfied with their attendant on account of the mere 
 duration of a case which no degree of professional 
 knowledge or skill could have shortened. 
 
 In cases of accident or sudden emergency, one or 
 more physicians are often sent for by alarmed friends. 
 Courtesy should assign the patient to the first of these 
 that arrives; and he should select from those present 
 such additional assistance as he may deem necessary. 
 But he should also request the family physician (if 
 
The Code of Medical Ethics. 181 
 
 there be one) to be sent for, and, on his arrival, resign 
 the case into his hands. The practitioner of the patient, 
 when he arrives, should take the place of any one called 
 in his absence. "The practitioner of any patient'' 
 is the man whom he has in any way given to under- 
 stand that he regards him as his medical adviser, or 
 who would now be in charge of the case were it not for 
 his absence, sickness or other disability. 
 
 In a sparse population, a physician when visiting a 
 sick person may be desired to see, in an emergency, a 
 neighboring patient, who is under the regular charge of 
 another physician. The conduct to be pursued on such 
 an occasion is : to give advice adapted to present circum- 
 stances; to interfere as little as possible with the gen- 
 eral plan of treatment; to assume no further direction 
 of the case unless it be expressly desired; and, in the 
 latter case, to request an immediate consultation with 
 the practitioner previously employed. 
 
 A wealthy physician should not give advice gratis to 
 the affluent; because his so doing is an injury to his 
 professional brethren. The office of the physician can 
 never be supported as an exclusively beneficent one ; and 
 it is defrauding, in some degree, the common fund, 
 when fees are dispensed with, which might justly be 
 claimed. 
 
 When a physician who has been engaged to attend a 
 case of midwifery is absent and another is sent for, if 
 delivery is accomplished in the absence of the former, 
 the latter is entitled to the fee, but he should resign the 
 patient to the practitioner first engaged. 
 
 Diversity of opinion and opposition of interests may, 
 in the medical, as in other professions, sometimes occa- 
 
182 Medicine as a Peofessioit. 
 
 sion controversy and even contention. When such cases 
 occur and cannot be immediately terminated, they 
 should be referred to the arbitration of a sufficient num- 
 ber of physicians or a court-medical. 
 
 Some general rules should be adopted by the physi- 
 cians in every town or district, relative to pecuniary ac- 
 knowledgments from patients. These should be ad- 
 hered to by physicians as uniformly as circumstances 
 will permit. They serve, likewise, as a standard to which 
 appeal may be taken in cases of doubt or dispute. 
 
 Members of the medical profession have been so uni- 
 formly in the habit of attending, gratuitously, the in- 
 digent sick and, in general, of answering every call 
 promptly, and without a question as to whether they are 
 to receive remuneration therefor, that many persons 
 seem to think they have a right to demand the services 
 of physicians; and do, in fact, call upon them freely, 
 and neglect or refuse to render any pecuniary equiva- 
 lent, although abundantly able to do so. They impose 
 upon one physician, in this way, until they have ex- 
 hausted his patience, and then call upon another; and 
 thus, in the course of a few years, make the circuit of 
 the profession in their neighborhood. It is proper for 
 the physicians of a community to make a list of the names 
 of such individuals, and to demand, before visiting those 
 whose names are on it, adequate security that their 
 honorarium will be paid. 
 
 As good citizens, it is the duty of physicians to be 
 vigilant for the welfare of the community, and to bear 
 their part in sustaining its institutions and burdens. 
 They should be always ready to give counsel to the pub- 
 
The Code of Medical Ethics. 183 
 
 lie, in relation to matters appertaining to their profes- 
 sion; as for example, on subjects of medical police, 
 public hygiene and legal medicine. It is their province 
 to enlighten the public in regard to quarantine regu- 
 lations, the location, arrangement and dietaries of hos- 
 pitals, asylums, schools, prisons and similar institutions ; 
 in relation to the medical police of towns, drainage, ven- 
 tilation, etc., and in regard to measures for the preven- 
 tion of epidemic and contagious disease. And, when 
 pestilence prevails, it is their duty to face the danger, 
 and to continue their labors for the alleviation of suf- 
 fering, and the saving of life, even at the risk of their 
 own lives. 
 
 Physicians should always be ready, when called on 
 by the proper authorities, to enlighten coroners' inquests 
 and courts of justice, on matters strictly medical, such 
 as involve questions relating to insanity, legitimacy, or 
 sudden and violent deaths, and in regard to the various 
 other subjects embraced in the science of medical juris- 
 prudence. But, in these cases, and especially where 
 they are required to make post-mortem examination, it 
 is just and right, in consequence of the time, labor and 
 skill required, and the responsibility and risk they in- 
 cur, that the public should award them more than a 
 mere consulting fee. 
 
 There is no profession, by the members of which 
 eleemosynary services are more freely dispensed than 
 they are by physicians; but justice demands that some 
 limits should be placed to the claims upon such offices 
 at their hands. Poverty, professional brotherhood, the 
 benevolent and scantily remunerated occupation of the 
 individual patient, should always be recognized as pre- 
 senting valid claims for gratuitous services. But neither 
 13 
 
184 Medicine as a Profession. 
 
 institutions endowed by the public or by rich indi- 
 viduals, societies for mutual benefit, for the insurance 
 of lives or for analogous purposes, nor any profession 
 or occupation can be admitted to possess such privilege. 
 Nor can it be justly expected of physicians to furnish 
 certificates of inability to serve on juries, or perform 
 military duty, or to certify to the state of health of 
 parties wishing to insure their lives, obtain pensions or 
 the like, without a pecuniary acknowledgment. But to 
 indigent persons, such professional service should al- 
 ways be cheerfully and freely accorded. 
 
 The benefits accruing to the public, directly and indi- 
 rectly, from the Active and constant labors and benef- 
 icence of the medical profession are so numerous and 
 important that physicians are justly entitled to the ut- 
 most consideration from the community. The public 
 ought, likewise, to entertain a just appreciation of the 
 proper qualification of a practitioner of medicine; to 
 make a due discrimination between true science and the 
 assumption of ignorance and empiricism ; to afford every 
 encouragement and facility for the acquisition of med- 
 ical education, and not to allow the provisions of their 
 statute books or of the prospectus of their chartered 
 institutions to interpose any obstacle to the attainment 
 of the fullest knowledge of every branch of medical 
 science, or, in any way, to restrain the most entire free- 
 dom of thought, investigation and action in matters ap- 
 pertaining to the practice of medicine. 
 
APPENDIX. 
 
BIBLIOGRAPHY. 
 
 Eeadings in the History of Medicine. 
 
 Berdoe, Edw. The Origin and Growth of the Healing Art. 
 Swan, Sonnenschien & Co., London. 1893. 
 
 Booth, Emmons E. History of Osteopathy. Cincinnati. 
 1907. $3. 
 
 King, Wm. H. History of Homeopathy. Lewis Pub. Co., Chi- 
 cago. 1905. 
 
 Macfie, E. C. The Eomance of Modern Medicine. Cassell. 
 1907. $1.75. 
 
 Moon, E. O. The Eelation of Medicine to Philosophy. Long- 
 mans, Green & Co., 1909. $1.50. 
 
 MuMFORD, James G. A Narrative of Medicine in America. 
 Lippincott. 1903. 
 
 OSLER, Wm. The Alabama Student and Other Essays. Oxford 
 Press. 1908. $2. 
 
 Park, Eoswell. An Epitome of the History of Medicine. 
 Davis. 1899. $2. 
 
 Walsh, James J. Lives of Eminent American Physicians of 
 the Nineteenth Century. Fordham University Press. 
 1907. $2. 
 
 Wilder, Alexander. A History of Medicine. Scudder. $3. 
 
 Browne, Sir Thomas. Eeligic Medico. 
 
 OSLER, Wm. ^quanimitas and other Addresses. Blakiston, 
 Philadelphia. 1906. $2.25. 
 
 Adams, J. H. Life of D. Hayes Agnew. F. A. Davis & Co. 
 1892. 
 
 Blakie, Wm. G. David Livingstone. London. 1903. 
 
 Duncan, Norman. Dr. GrenfelPs Parish. Eevell. 1905. $1. 
 
 Kelley, Howard A. Walter Eeed and Yellow Fever. Double- 
 day. 1906. $1.50. 
 
 Lloyd, John. Biographies of Physicians and Surgeons. J. H. 
 Beers & Co. Chicago. 190'8. 
 
 Mears, J. E. Memoir of John Shaw Billings. Philadelphia. 
 1913. 
 
 187 
 
188 Medicine as a Profession". 
 
 Still, A. T. Autobiography of Andrew Taylor Still. 1897. 
 TuCKEE, E. B. Life of S. Weir Mitchell. Boston. 1914. $.50. 
 EoBiNSON, V. Pathfinders in Medicine. N. Y. 1912. $2.50. 
 
 Medical Education. 
 
 Publications of the Council on Medical Education of the Amer- 
 ican Medical Association, 535 N. Dearborn St., 
 Chicago. 
 Educational Statistics of Medical Schools. 10 cents. 
 State Board Examination Statistics. 10 cents. 
 Medical Colleges in U. S. 10 cents. 
 List of Hospitals furnishing Acceptable Internships. 
 
 15 cents. 
 Making a Eight Start. 4 cents. 
 Eeport of Council on Education, American Institute of 
 
 Homeopathy, Ann Arbor, Mich. 
 Wilson, C. D. Working One's Way through College. Mc- 
 
 Clurg. 1912. $1. 
 Blaneienhorn, Heber. First Aid to the Allies. Independent, 
 
 June 23, 1917. 
 Hill, George Griswold. The American Eed Cross. Century, 
 
 New York, May, 1912. 
 Boardman, Mabel T. The Mission of the Eed Cross. Inde- 
 pendent, N. Y., February 9, 1914. 
 
 Systems of Medicine. 
 
 Mack, C. S. Principles of Medicine. W. T. Keener Co., Chi- 
 cago. 1897. $1.25. 
 
 Boericke & Anshutz. Elements of Homeopathic Theory. 
 Boericke, Philadelphia. $1. 
 
 Krauss, James. Principles of Medicine. 419 Boyleston, 
 Boston. 
 
 Scudder's Eclectic Principles of Medicine. Scudder Bros. 
 Cincinnati. 
 
 Stephens, A. F. The Eclectic School in Medicine. 
 
 Army and Navy Medical Service. 
 
 Annual Eeport of the Surgeon-General U. S. Army. 
 U. S. N. Medical Bulletin Quarterly. $1 year. Issued by Bu- 
 reau of Medicine and Surgery U. S. N. 
 
Bibliography. 189 
 
 The Medical Corps of tlie U. S. Navy. Government Printing 
 
 Office. 
 Annual Eeport of Surgeon General U. S. Navy. Government 
 
 Printing Office. 
 Oman, Surgeon. Medical Service on a Battleship. American 
 
 Medical Association Journal, May 16, 1914. Chicago, 
 
 ni. 
 
 Meriwether, W. S. Surgeons of the Fleet. Harper's Weekly, 
 
 May 4, 1912. 
 Dunbar, A. W. Eecent Hospital Construction. Government 
 
 Printing Office. 
 Medical Service of the Navy, Eeference Handbook of Medical 
 
 Science. Wm. Wood & Co., N. Y. 
 
 Public Health Service. 
 
 Eeport of Chief Sanitary Officer of the Canal Zone. Govern- 
 ment Printing Office. 
 
 Eeport of Department of Sanitation. Isthmian Canal Com- 
 mission, Washington, D. C. 
 
 Manual of Civil Service Examination. Civil Service Commis- 
 sion, Washington, D. C. 
 
 History Philippine General Hospital. Philippine Commission, 
 Washington, D. C. 
 
 Eeport of the Philippine Commission. Philippine Commission, 
 Washington, D. C. 
 
 Wyman. Present Organization and Work for the Protection 
 of Health in the United States. Public Health Service. 
 Washington, 1910. 
 
 Doty, A. H. Prevention of Infectious Disease. Appletons. 
 1911. $2.50. 
 
 GrORGAS, W. C. Sanitation of the Panama Canal Zone. Smith- 
 sonian Institute. 1905. 
 
 Annual Eeport of the U. S. Public Health Service. Govern- 
 ment Printing Office. 
 
 Annual Eeport of the Departments of Health of the Several 
 States and Municipalities. 
 
 Allen, W. H. Civics and Health. Ginn. 1909. $1.25. 
 
 BuRGENSTEiN, L., AND Netolitsky. Medical Inspection of 
 Schools abroad. U. S. Bureau of Education. 
 
190 Medicine as a Peofession". 
 
 DiTMAN, N. E. Education and Preventive Medicine. Lemcke. 
 
 1911. $.25. 
 FosTEE, N. K. Oakland, Cal. System of Health Inspection. 
 Godfrey, H. The Health of the City. Houghton. 1910. $1.25. 
 M'Vail, J. C. Prevention of Infectious Disease. MacmiUan. 
 
 1907. $2.75. 
 Nesbitt, O. B. Medical Inspection in Valparaiso, Indiana. 
 Retd, G. Practical Sanitation. Lippincott. $2. 
 Richards, E. H. Cost of Cleanliness. Wiley. 1908. $1. 
 Sedgewick, W. T. Principles of Sanitary Science. MacmiUan. 
 
 1902. $3. 
 Sikes, J. F. Public Health Problems. Scribners. $1.50. 
 Whitelegge, B. a. Hygiene and Public Health. Funk. 1910. 
 
 $1.75. 
 GuLiCK AND Ayres. The Medical Inspection of Schools. 
 
 Survey. 1908. 
 Dresslar, F. B. Medical Inspection of Schools. Bureau of 
 
 Education, Washington, D. C. $.15. 
 Bulletins Nos. 44 and 45. Bureau of Education, Washington, 
 
 D. C. 
 
 Hospital and Laboratory Work. 
 
 Clark, W. B. The Meaning of the Modern Hospital. Long- 
 mans. 1904. $.36. 
 
 Worcester, A., and Atkinson, W. The Small Hospital. 
 Wiley. $1.25. 
 
 U. S. Government Hospital for the Insane. Supt. of Docu- 
 ments, Washington, 1909. $.15. 
 
 White, W. A. Hospitals and Asylums of Europe. Geo. Wash- 
 ington University, Washington. 1908. 
 
 Abbott, A. C. Principles of Bacteriology. Lea. 1909. $2.75. 
 
 DoANE, R. W. Insects and Diseases. Holt. 1910. $1.50. 
 
 Frankland, p. F. Bacteria in Daily Life. Longmans. 1903. 
 $1.75. 
 
 Prudden, T. M. The Story of Bacteria and their Relation to 
 Health. Putnams. 1910. $.75. 
 
 Richmond, H. D. Laboratory Book of Dairy Analysis. Lip- 
 pincott. 1905. $1. 
 
 Savage, W. G. Bacteriological Examinations of Water Sup- 
 plies. Blakiston. 1906. $2.50. 
 
Bibliography. 191 
 
 Faught, F. a. Essentials of Laboratory Diagnosis. F. A. 
 Davis. 1911. $2. 
 
 Medical Missions. 
 
 Chough, John E. Social Christianity in the Orient. Mac- 
 millan. 
 
 Greenfell, W. Y. The Harvest of the Sea. Eevell. $1. 
 
 Keen, W. W. The Services of Missions to Science and Society. 
 Baptist Missionary Society, Boston. 1906. $.10. 
 
 Lowe, J. Medical Missions. Eevell. $1.50. 
 
 Penrose, V. F. Opportunities in the Path of the Great Phy- 
 sician. Presbyterian Board. 1902. $1. 
 
 Stone, Mary. Glimpses of the Heart of China. Eevell. 1911. 
 $.60. 
 
 Williams, Hospital, Pang Chuang, China. American Board. 
 $.30. 
 
 Eeport of Medical Missionary Conference. Battle Creek. 1912. 
 
 Annual Eeports of American Baptist Missionary Society, Bos- 
 ton; Presbyterian Foreign Missionary Society, Philadel- 
 phia; Methodist Foreign Missionary Society, New York. 
 
 Medicine in China. Eeport of the China Medical Commission of 
 the Eockefeller Foundation. 1914. 
 
 Medical Eesearch. 
 
 Carrel, Alexis. Works at the Eockefeller Institute. MeClure. 
 
 Feb., 1909. 
 Flesh that is Immortal. World 's Work. Oct., 1914. 
 Eecent Work of Carrel. Outlook. Jan. 26, 1913. 
 
 Women in Medicine. 
 
 Lamport, Ethel F. Medicine as a Profession for Women. 
 
 In Vol. I of the Woman's Library. London. 1913. 
 Lapinska, M. Women as Doctors: an Historic Eetrospeet. 
 
 Contemporary Magazine. Oct., 1915. 
 Mann, K. The Medical Woman's Handicap. Harper's 
 
 Weekly. Feb. 28, 1901. 
 MORLEY, E. J. Women Workers in Seven Professions. Dutton, 
 
 London. 1914. $2. 
 
192 Medicine as a Peofession. 
 
 MozANS, H. J. Women in Medicine and Surgery. In Women 
 
 in Science. Appleton. 1915. 
 SCHARLIEB, M. Medical Women: their Training and Di£S.eiilties, 
 
 Contemporary Eeview. Nov., 1915. 
 Thompson, W. G-. A. A Great Modern Hospital. Century, 
 
 81: m. 
 Young, Eose. Your D-aughter's Career. Good Housekeeping. 
 
 Aug., 1915. 
 Breakell, M. S. Women as Physicians. Nineteenth Century, 
 
 54: 819. 
 
 The Future of Medicine. 
 
 Cabot, Eichabd C. Better Doctoring for Less Money. Amer- 
 ican Magazine. 
 
 Morris, Eichard T. Doctors Versus Men, 
 
 DODD, F. Lawson a. National Medical Service. London. 
 1911. $.25. 
 
 Macilwane, S. W. Medical Eevolution. London. 1911. $.60. 
 
 Cabot, E. C. Social Service and the Art of Healing. Moffat. 
 1909. $1. 
 
 Physicians in Germany. Scientific American. January 27, 
 1912. 
 
 Medical Practice in Great Britain. Science. September 12, 
 191L 
 
Tables. 
 
 193 
 
 Table Showing Number of Physicians for each 100,000 of 
 Population by States. 
 
 States. 
 
 Number of Male 
 Physicians. 
 
 Number of Fe- 
 male Physicians. 
 
 
 1900. 
 
 1910. 
 
 1900. 
 
 1910. 
 
 Alabama 
 
 116 
 105 
 180 
 
 201 
 260 
 243 
 155 
 151 
 315 
 126 
 120 
 126 
 189 
 204 
 166 
 190 
 165 
 110 
 165 
 170 
 169 
 168 
 109 
 149 
 221 
 141 
 145 
 176 
 195 
 133 
 104 
 177 
 90 
 94 
 192 
 179 
 183 
 154 
 144 
 89 
 115 
 181 
 
 113 
 120 
 119 
 169 
 190 
 204 
 127 
 123 
 349 
 120 
 110 
 116 
 162 
 150 
 140 
 142 
 135 
 123 
 162 
 163 
 161 
 143 
 113 
 107 
 194 
 160 
 154 
 154 
 207 
 107 
 139 
 157 
 87 
 98 
 159 
 152 
 163 
 154 
 127 
 80 
 111 
 167 
 
 1 
 
 12 
 
 3 
 
 3 
 
 40 
 
 32 
 
 14 
 
 4 
 
 20 
 
 4 
 
 2 
 
 9 
 
 17 
 
 8 
 
 12 
 
 13 
 
 4 
 
 2 
 
 9 
 
 7 
 
 27 
 
 11 
 
 11 
 
 1 
 
 9 
 
 7 
 
 12 
 
 15 
 
 15 
 
 9 
 
 3 
 
 12 
 
 1 
 
 5 
 
 10 
 7 
 20 
 9 
 13 
 1 
 6 
 2 
 
 1 
 
 Alaska 
 
 
 
 Arizona 
 
 3 
 
 Arkansas 
 
 3 
 
 California 
 
 31 
 
 Colorado 
 
 22 
 
 Connecticut 
 
 10 
 
 Delaware 
 
 5 
 
 District of Columbia 
 
 31 
 
 Florida 
 
 6 
 
 Georgia 
 
 3 
 
 Idaho 
 
 9 
 
 Illinois 
 
 15 
 
 
 7 
 
 Iowa. 
 
 11 
 
 
 9 
 
 Kentucky 
 
 4 
 
 T • • -^ 
 
 2 
 
 Maine 
 
 11 
 
 
 7 
 
 Massachusetts 
 
 20 
 
 Michigan 
 
 8 
 
 Minnesota 
 
 8 
 
 Mississippi 
 
 2 
 
 Missouri 
 
 10 
 
 Montana 
 
 13 
 
 Nebraska 
 
 10 
 
 New Hampshire 
 
 15 
 
 Nevada 
 
 15 
 
 New Jersey 
 
 8 
 
 New Mexico 
 
 5 
 
 
 15 
 
 North Carolina 
 
 2 
 
 
 4 
 
 Ohio 
 
 9 
 
 Oklahoma 
 
 6 
 
 Oregon 
 
 2 
 
 Pennsylvania 
 
 10 
 
 Rhode Island 
 
 8 
 
 
 2 
 
 South Dakota 
 
 7 
 
 Tennessee 
 
 4 
 
194 
 
 Medicine as a Profession. 
 
 states. 
 
 Number of Male 
 Physicians. 
 
 Number ol Fe- 
 male Physicians. 
 
 
 1900. 
 
 1910. 
 
 1900. 
 
 1910. 
 
 Texas 
 
 191 
 
 97 
 211 
 113 
 172 
 141 
 161 
 153 
 
 125 
 104 
 197 
 180 
 144 
 130 
 111 
 140 
 
 3 
 
 12 
 7 
 2 
 
 12 
 2 
 7 
 
 13 
 
 4 
 
 Utah 
 
 13 
 
 Vermont 
 
 9 
 
 Virginia 
 
 2 
 
 Washington 
 
 13 
 
 West Virginia 
 
 3 
 
 Wisconsin 
 
 6 
 
 Wvoming 
 
 8 
 
 
 
 Table Showing Number of Physicians per 100,000 of 
 Population in the Leading Cities. 
 
 Cities. 
 
 Number of Male 
 
 Number of Fe- 
 
 Physicians. 
 
 male Physicians. 
 
 1900. 
 
 1914. 
 
 1900. 
 
 1914. 
 
 373 
 
 251 
 
 22 
 
 15 
 
 198 
 
 197 
 
 6 
 
 13 
 
 218 
 
 194 
 
 14 
 
 1 
 
 265 
 
 249 
 
 60 
 
 31 
 
 158 
 
 140 
 
 13 
 
 8 
 
 187 
 
 170 
 
 18 
 
 11 
 
 159 
 
 143 
 
 22 
 
 12 
 
 114 
 
 169 
 
 32 
 
 22 
 
 217 
 
 110 
 
 24 
 
 12 
 
 250 
 
 144 
 
 22 
 
 10 
 
 260 
 
 154 
 
 19 
 
 10 
 
 224 
 
 195 
 
 12 
 
 10 
 
 151 
 
 114 
 
 18 
 
 10 
 
 349 
 
 114 
 
 13 
 
 10 
 
 83 
 
 98 
 
 8 
 
 5 
 
 203 
 
 174 
 
 29 
 
 10 
 
 301 
 
 256 
 
 27 
 
 19 
 
 100 
 
 80 
 
 8 
 
 4 
 
 139 
 
 324 
 
 49 
 
 32 
 
 508 
 
 267 
 
 89 
 
 58 
 
 264 
 
 273 
 
 15 
 
 18 
 
 145 
 
 136 
 
 15 
 
 10 
 
 188 
 
 254 
 
 8 
 
 10 
 
 151 
 
 138 
 
 13 
 
 10 
 
 Atlanta 
 
 Albany 
 
 Baltimore 
 
 Boston 
 
 Bridgeport, Conn, 
 
 Buffalo 
 
 Cambridge, Mass 
 
 Chicago 
 
 Cincinnati 
 
 Cleveland 
 
 Columbus, O. . . . , 
 
 Dayton, O 
 
 Denver 
 
 Detroit 
 
 Fall River 
 
 Grand Rapids... 
 Indianapolis .... 
 
 Jersey City 
 
 Kansas City .... 
 Los Angeles .... 
 
 Louisville 
 
 Lowell 
 
 Memphis 
 
 Milwaukee 
 
Tables. 
 
 195 
 
 cities. 
 
 Number of Male 
 Physicians. 
 
 Number of Fe- 
 male Physicians. 
 
 
 1900. 
 
 1914. 
 
 1900. 
 
 1914. 
 
 Minneapolis 
 
 222 
 320 
 196 
 123 
 190 
 330 
 271 
 116 
 101 
 117 
 297 
 176 
 210 
 196 
 233 
 187 
 321 
 138 
 291 
 280 
 242 
 236 
 316 
 
 197 
 273 
 159 
 175 
 138 
 189 
 257 
 115 
 198 
 169 
 241 
 165 
 187 
 166 
 228 
 174 
 210 
 128 
 230 
 200 
 206 
 208 
 300 
 
 54 
 10 
 
 17 
 26 
 14 
 60 
 45 
 7 
 19 
 20 
 63 
 19 
 14 
 25 
 18 
 17 
 51 
 13 
 21 
 25 
 37 
 23 
 12 
 
 24 
 
 Nashville 
 
 18 
 
 New Haven 
 
 13 
 
 New Orleans 
 
 5 
 
 New York 
 
 10 
 
 Oakland 
 
 38 
 
 Omaha 
 
 25 
 
 Paterson 
 
 5 
 
 Philadelphia 
 
 19 
 
 Pittsburg 
 
 9 
 
 Portland 
 
 41 
 
 
 14 
 
 Richmond 
 
 9 
 
 
 18 
 
 St. Louis 
 
 16 
 
 St. Paul 
 
 15 
 
 San Francisco 
 
 34 
 
 
 10 
 
 Seattle 
 
 30 
 
 
 25 
 
 Syracuse 
 
 20 
 
 Toledo 
 
 14 
 
 Washington 
 
 21 
 
 
 
196 
 
 Medicine as a Profession. 
 
 Statistics of Medical Colleges. 
 
 Name and Location of College. 
 
 
 OS 
 
 P 
 
 
 Med. Col., Birmingham, Ala 
 
 University of Ala., Mobile, Ala 
 
 University of Ark., Little Rock 
 
 Col. of Physicians and Surgeons, San 
 Francisco 
 
 Hahnemann Med. Col., San Francisco. 
 
 Leland Stanford Junior Univ. (a), San 
 Francisco . 
 
 University of California, San Francisco 
 
 Col. of Physicians and Surgeons, Los 
 Angeles 
 
 Col. of Osteopathic Physicians and 
 Surgeons, Los Angeles 
 
 Col. of Med. and Surgery, Oakland, 
 Cal 
 
 College of Medical Evangelists, Loma 
 Linda, Cal 
 
 University of Colorado, Boulder, Den- 
 ver 
 
 Yale Medical School, New Haven, 
 Conn 
 
 George Washington University, Wash- 
 ington, D. C 
 
 Georgetown University, Washington, 
 D. C 
 
 Howard University, Washington, D. C 
 
 Atlanta Medical College 
 
 Southern Col. of Med., Atlanta, Ga. . . 
 
 University of Georgia, Augusta, Ga. . , 
 
 Bennett Medical College, Chicago 
 
 Chicago Col. of Med. and Surg., Chi- 
 cago 
 
 Hahnemann Med. Col. and Hospital, 
 Chicago 
 
 Jenner Medical College, Chicago , 
 
 Northwestern University Med. School, 
 Chicago 
 
 Rush Medical College (a), Chicago. . . . 
 
 College of Osteopathy, Chicago 
 
 University of Illinois, Chicago 
 
 R. 
 R. 
 R, 
 
 R, 
 H 
 
 R 
 R. 
 
 R. 
 
 O. 
 
 R, 
 
 R 
 
 R 
 
 R 
 
 R. 
 
 M. 
 M. 
 M. 
 
 M.F, 
 M.F, 
 
 M.F, 
 M.F, 
 
 M.F, 
 
 M.F, 
 
 M. 
 
 M.F 
 
 M. 
 
 M. 
 
 M. 
 
 R. 
 
 M.F. 
 
 R. 
 
 M.F. 
 
 R. 
 
 M. 
 
 R. 
 
 M. 
 
 R. 
 
 M.F. 
 
 R. 
 
 M.F. 
 
 R 
 
 
 H. 
 
 M. 
 
 R. 
 
 M.F. 
 
 R. 
 
 M.F. 
 
 R. 
 
 M. 
 
 0. 
 
 M.F. 
 
 R. 
 
 M.F. 
 
Tables. 
 
 197 
 
 Name and Location of College. 
 
 Indiana University, Indianapolis- 
 Bloomington, Ind 
 
 State University of Iowa, Iowa City, la. 
 
 Still Col. of Osteopathy, Des Moines, 
 la.... 
 
 University of Kansas, Kansas City. . . . 
 
 University of Louisville, Louisville, Ky 
 
 Tulane University School of Med., 
 New Orleans, La 
 
 Medical School of Maine, Portland, Me 
 
 Col. of Physicians and Surgeons, Balti- 
 more, Md 
 
 John Hopkins University, Baltimore, 
 Md... 
 
 University of Maryland, Baltimore, 
 Md 
 
 Boston University, Boston, Mass 
 
 Mass. Col. of Osteopathy, Cambridge, 
 Mass 
 
 College of Physicians and Surg., Bos- 
 ton, Mass 
 
 Harvard Medical School, Boston, Mass 
 
 Tufts College Medical School, Boston, 
 Mass 
 
 Detroit College of Medicine, Detroit, 
 Mich 
 
 University of Michigan, Ann Arbor, 
 Mich 
 
 University of Minnesota (a), Minne- 
 apolis, Minn 
 
 University of Mississippi, Oxford, Miss 
 
 University of Missouri, Columbia, Mo 
 
 Kansas City Hahnemann Med. Col., 
 Kansas City, Mo 
 
 Eclectic Medical University, Kansas 
 City, Mo 
 
 American Medical College, St. Louis, 
 Mo. 
 
 American School of Osteopathy, Kirk- 
 ville. Mo 
 
 
 
 a> 
 
 
 i 
 
 i 
 
 i| 
 
 
 O) 
 
 1 
 
 5l 
 
 •1 ^ 
 
 o s 
 
 O 
 
 O 
 O 
 
 •o 
 
 <! 
 
 
 
 X3 
 
 02 
 
 1^ 
 
 Z 
 
 R. 
 
 M.F. 
 
 2 
 
 4 
 
 R. 
 
 M.F. 
 
 2 
 
 4 
 
 0. 
 
 M.F. 
 
 
 3 
 
 R. 
 
 M. 
 
 2 
 
 4 
 
 R. 
 
 M.F. 
 
 1 
 
 4 
 
 R. 
 
 M.F. 
 
 2 
 
 4 
 
 R. 
 
 M.F. 
 
 1 
 
 4 
 
 R. 
 
 M.F. 
 
 2 
 
 4 
 
 R. 
 
 M.F. 
 
 2 
 
 4 
 
 R. 
 
 M.F. 
 
 1 
 
 4 
 
 H. 
 
 M.F. 
 
 2 
 
 4 
 
 0. 
 
 M.F. 
 
 
 4 
 
 R. 
 
 M. 
 
 
 4 
 
 R. 
 
 M. 
 
 2 
 
 4 
 
 R. 
 
 M.F. 
 
 1 
 
 4 
 
 R. 
 
 M.F. 
 
 1 
 
 4 
 
 H. 
 
 M.F. 
 
 2 
 
 4 
 
 R. 
 
 M.F. 
 
 2 
 
 4 
 
 R. 
 
 M. 
 
 2 
 
 2 
 
 R. 
 
 M.F. 
 
 
 2 
 
 H. 
 
 M.F. 
 
 1 
 
 4 
 
 E. 
 
 M. 
 
 
 4 
 
 R. 
 
 M.F. 
 
 1 
 
 4 
 
 0. 
 
 M.F. 
 
 
 4 
 
 460 
 200 
 
 450 
 300 
 610 
 
 750 
 450 
 
 525 
 
 800 
 
 710 
 535 
 
 600 
 
 410 
 445 
 
 620 
 
 465 
 
 359 
 
 600 
 
 207 
 120 
 
 400 
 550 
 600 
 
198 
 
 Medicine as a Profession. 
 
 Name and Location of College. 
 
 •Si's 
 
 
 
 fee 
 
 .o 
 
 s 
 
 Central Col. of Osteopathy, Kansas 
 City, Mo 
 
 St. Louis Col. of Phys. and Surg., 
 St. Louis, Mo 
 
 Washington University, St. Louis, Mo 
 
 John A. Creighton Med. Col., Omaha, 
 Nebr 
 
 University of Nebraska, Omaha, Nebr 
 
 Cotner Medical College, Omaha, Nebr 
 
 Dartmouth Medical College, Hanover, 
 N. H 
 
 Albany Medical College, Albany, N. Y 
 
 Columbia University, New York City . 
 
 Cornell University Medical Col., New- 
 York City 
 
 rf^rdham J^nivepsi^~$^^vy*¥ortiiCityi , 
 
 Long Island College Hospital, Brook- 
 lyn, N. Y 
 
 New York Homeopathic Med. Col. 
 and Hosp., New York City 
 
 New York Medical Col. and Hosp. for 
 Women, New York City 
 
 University and Belle vue Hosp. Med. 
 Col., New York City 
 
 Syracuse University, Syracuse, N. Y. , 
 
 University of Buffalo, Buffalo, N. Y. . 
 
 Leonard Medical School, Raleigh, N. C. 
 
 University of No. Carolina, Chapel 
 Hill, N. C 
 
 North Carolina Med. Col., Charlotte, 
 N. C 
 
 School of Medicine, Wake Forest, N. C 
 
 University of No. Dakota, University, 
 No. Dak 
 
 Cleveland-Pulte Med. Col., Cleveland, 
 Ohio 
 
 Western Reserve Univ., Cleveland, 
 Ohio 
 
 Eclectic Med. Col., Cincinnati, Ohio. . 
 
 O. 
 
 R. 
 R. 
 
 R. 
 R. 
 E. 
 
 R. 
 R. 
 R. 
 
 R. 
 
 M.F. 
 
 M.F. 
 M. 
 
 M.F. 
 M.F, 
 M.F. 
 
 M. 
 
 M.F. 
 
 M.F. 
 
 M.F. 
 
 -Mr 
 
 2 
 1 
 
 M.F 
 
 M. 
 
 F. 
 
 M. 
 M. 
 M.F. 
 
 M. 
 
 M. 
 
 M.F 
 
 M. 
 
 M.F 
 
 M.F. 
 
 M. 
 M.F 
 
 ■ j^lil' Mijj ' 
 
Tables. 
 
 199 
 
 Name and Location of College. 
 
 Ohio-Miami Med. Col., Cincinnati, 
 
 Ohio 
 
 StarHng-Medical Col., ColumbuR, Ohio 
 Toledo Medical Col., Toledo, Ohio. . . 
 University of Oklahoma, Norman and 
 
 Oklahoma, Okla 
 
 University of Oregon, Portland, Ore. . 
 Hahnemann Med. Col. and Hospital, 
 
 Philadelphia, Pa 
 
 Jefferson Med. Col., Philadelphia, Pa. 
 College of Osteopathy, Philadelphia, 
 
 Pa 
 
 O rf 
 
 Temple University, Philadelphia, Pa.. . 
 
 University of Pennsylvania, Philadel- 
 phia, Pa 
 
 Women's Med. Col. of Pennsylvania, 
 Philadelphia, Pa 
 
 University of Pittsburgh, Pittsburgh, 
 Pa 
 
 Medical College of So. Carolina, 
 Charleston, S. C 
 
 University of So. Dakota, Vermilion, 
 S. Dak 
 
 Lincoln Memorial University, Knox- 
 ville, Tenn 
 
 Meharry Medical College, Nashville, 
 Tenn 
 
 Vanderbilt University, Nashville, Tenn. 
 
 University of Tennessee, Memphis, 
 Tenn 
 
 University of West Tennessee, Mem- 
 phis, Tenn 
 
 Fort Worth School of Medicine, Fort 
 Worth, Tex 
 
 University of Texas, Galveston, Tex. . . 
 
 Baylor University, Dallas, Tex 
 
 Southern Methodist University, Dallas, 
 Tex 
 
 University of Utah, Salt Lake City, 
 Utah 
 
 R. 
 R. 
 R. 
 
 R. 
 R. 
 
 H. 
 R. 
 
 O. 
 R. 
 
 R. 
 
 R. 
 
 R. 
 
 R. 
 
 R. 
 
 R. 
 
 R. 
 R. 
 
 R. 
 
 R. 
 
 R. 
 R. 
 R. 
 
 R. 
 
 R. 
 
 M.F. 
 M.F. 
 M. 
 
 M.F. 
 M.F. 
 
 M. 
 M. 
 
 M.F. 
 M.F. 
 
 M. 
 
 F. 
 
 M. 
 
 M. 
 
 M. 
 
 M.F. 
 
 M.F. 
 M. 
 
 M.F. 
 
 M. 
 
 M. 
 
 M.F. 
 
 M.F. 
 
 M.F. 
 
 M.F. 
 
 
 So 
 
 4 
 
 4 
 4 
 
 4 
 4 
 
 4 
 4 
 
 4 
 4 
 
 4 
 
 4 
 
 4 
 
 4 
 
 2 
 
 4 
 
 4 
 4 
 
 4 
 
 4 
 
 4 
 4 
 4 
 
 4 
 
 2 
 
 600 
 600 
 519 
 
 288 
 605 
 
 720 
 720 
 
 600 
 600 
 
 662 
 
 727 
 
 900 
 
 375 
 
 120 
 
 445 
 
 255 
 625 
 
 525 
 
 230 
 
 460 
 119 
 473 
 
 430 
 
 110 
 
 14 
 
200 
 
 Medicine as a Profession". 
 
 Name and Location of College. 
 
 
 
 « 
 
 
 I 
 
 i 
 
 ♦3 
 
 ll 
 
 
 o 
 o 
 
 1 
 
 a 
 
 < 
 
 « 
 
 CO 
 
 
 ^1 
 
 la 
 
 R. 
 
 M. 
 
 1 
 
 4 
 
 R. 
 
 M. 
 
 2 
 
 4 
 
 R. 
 
 M. 
 
 2 
 
 4 
 
 R. 
 
 M. 
 
 2 
 
 2 
 
 R. 
 
 M.F. 
 
 2 
 
 4 
 
 R. 
 
 M.F. 
 
 2 
 
 4 
 
 R. 
 
 M.F. 
 
 
 4 
 
 University of Vermont (a), Burling- 
 ton, Vt 
 
 Medical College of Virginia, Richmond, 
 Va... 
 
 University of Virginia, Charlottesville, 
 Va... 
 
 West Virginia University, Morgan- 
 town, W. Va 
 
 Marquette University, Milwaukee, Wis. 
 
 University of Wisconsin, Madison, Wis. 
 
 University of the Philippine, Col. of 
 Med. and Surg., Manila, P. I 
 
 585 
 
 686 
 
 560 
 
 100 
 635 
 
 308 
 
 Note, (a) require hospital interneship before granting degree. 
 Schools not listed as to requirement of collegiate work for ad- 
 mission accept certificate of approved high schools. 
 
 A number of schools give a two years' pre-medical course, 
 but complete data is not available. 
 
 Scholarships in Medical Colleges. 
 
 This list was compiled by the Journal of the Amer- 
 ican Medical Association for 1916. 
 
 University of Alabama School of Medicme 66 
 
 Leland Stanford Junior University School of Medicine 3 
 
 University of California Medical School 3 
 
 University of Colorado School of Medicine* 1 
 
 Yale University School of Medicine 2 
 
 Georgetown University School of Medicine 3 
 
 Atlanta Medical College 12 
 
 Hahnemann Medical College and Hospital of Chicago* 6 
 
 Northwestern University Medical School 9 
 
 Rush Medical College, Chicago 6 
 
 University of Illinois College of Medicine* 6 
 
 Indiana University School of Medicine 10 
 
Tables. 201 
 
 Bowdoin Medical School 1 
 
 Johns Hopkins University Medical Department 6 
 
 University of Maryland School of Medicine 6 
 
 Boston University School of Medicine* 20 
 
 Medical School of Harvard University, Boston* 27 
 
 Detroit College of Medicine and Surgery 6 
 
 University of Minnesota Medical School* 1 
 
 University of Missouri School of Medicine 1 
 
 Washington University Medical School 1 
 
 Dartmouth Medical School 2 
 
 Columbia University College of Physicians and Surgeons 64 
 
 New York Medical College and Hospital for Women 2 
 
 Syracuse University College of Medicine 1 
 
 University and Bellevue Hospital Medical College 1 
 
 University of Buffalo Department of Medicine 1 
 
 University of North Carolina School of Medicine 1 
 
 University of Cincinnati College of Medicine 12 
 
 Western Reserve University School of Medicine 1 
 
 University of Oregon Department of Medicine 3 
 
 Hahnemann Medical College and Hospital of Philadelphia 3 
 
 Jefferson Medical College 1 
 
 University of Pennsylvania School of Medicine*t 3 
 
 University of Pittsburgh School of Medicine 2 
 
 Woman's Medical College of Pennsylvania 8 
 
 Medical College of the State of South Carolina 8 
 
 University of Tennessee College of Medicine 1 
 
 Vanderbilt University Medical Department 4 
 
 University of Texas Department of Medicine* 1 
 
 University of "Vermont College of Medicine 9 
 
 Medical College of Virginia 10 
 
 University of Virginia Department of Medicine 2 
 
 ♦ Have loan funds also, 
 
 t Has fifty or more scholarships for graduates of Philadelphia 
 high schools. 
 
202 
 
 Medicine as a Profession. 
 
 TABULAR SUMMARY OF MEDICAL LAWS 
 
 States and Ter- 
 ritories 
 
 Alabama 
 
 Alaska , 
 
 Arizona 
 
 Arkansas 
 
 California 
 
 Colorado 
 
 Connecticut 
 
 Delaware 
 
 District Columbia 
 
 Florida 
 
 Georgia 
 
 Idaho 
 
 Illinois 
 
 Indiana 
 
 Iowa 
 
 Kansas 
 
 Kentucky 
 
 Louisiana 
 
 Maine 
 
 Maryland 
 
 Massachusetts.... 
 
 Michigan 
 
 Minnesota 
 
 Mississippi 
 
 Missouri 
 
 Montana 
 
 Nebraska 
 
 Nevada 
 
 New Hampshire 
 
 New Jersey 
 
 New Mexico 
 
 New York 
 
 North Carolina.. 
 North Dakota ... 
 
 Ohio 
 
 Oklahoma 
 
 Oregon. 
 
 Pennsylvania.... 
 Rhode Island .... 
 South Carolina... 
 South Dakota.... 
 Tennessee 
 
 •2 tf 
 
 Wi fi 
 
 Si n 
 
 P5! 
 
 10 
 
 5(2) 
 7 
 10 
 
 9 
 4 
 5 
 
 7 
 
 10(5) 
 6 
 7 
 6 
 6 
 7 
 7 
 
 (5) 
 
 a I 
 
 (3) (1) 
 7 
 
 (2) 
 
 ti to 
 a) a> 
 
 O 0) 
 
 0-s 
 
 I- a 
 S a> 
 
 > "^ 
 
 v. ^ 
 
 E a 
 
 
 Gov. 
 Gov. 
 Gov. 
 Gov. 
 Gov. 
 
 Gov. 
 
 Gov. 
 Gov. 
 Gov. 
 
 Gov. 
 Gov. 
 Gov. 
 Gov. 
 
 Gov. 
 
 Gov. 
 Gov. 
 Gov. 
 Gov. 
 Gov. 
 Gov. 
 Gov. 
 Gov. 
 Gov. 
 Gov. 
 Gov. 
 Rege. 
 
 Gov. 
 Gov. 
 Gov. 
 
 Gov. 
 Gov. 
 Gov. 
 
 a 
 
 CO 
 
 
 Semi-annually 
 
 Jan., July 
 
 Jan., Apr., July, Oct. 
 
 3 annually 
 
 Jan., Apr., July, Oct. 
 
 July 
 
 Jan., Apr., July, Oct. 
 
 Semi-annually 
 
 May, Oct. 
 
 Apr., Oct. 
 
 Jan., July 
 Jan., July 
 Feb., June, Oct. 
 Semi-annually 
 Semi-annually 
 Mar., July, Nov. 
 
 July 
 
 Oct., June 
 
 Jan., Apr., July, Oct 
 
 Semi-annually 
 
 Apr., Oct. 
 Feb., Aug., Nov. 
 May, Nov. 
 
 June, Oct. 
 
 Jan., Apr., July, Oct. 
 
 Jan., July 
 
 Jan., Apr., July, Oct, 
 
 Semi-annually 
 Jan., Apr., July, Oct. 
 June 
 Quarterly 
 
Tables. 
 
 203 
 
 states and Ter- 
 ritories 
 
 Texas 
 
 Utah 
 
 Verrnont 
 
 Virginia 
 
 Washington.... 
 West Virginia. 
 
 Wisconsin 
 
 Wyoming 
 
 S3 
 
 a 
 
 CO 
 
 b. 
 
 a> 
 
 fl 
 
 a 
 
 ea 
 •A 
 
 W 
 
 o 
 
 ■a 
 u 
 ej 
 O 
 
 fq 
 
 M 
 
 a 
 
 a 
 e 
 
 bfi 
 a> 
 
 o 
 ■a 
 o 
 
 m 
 
 1 
 
 a 
 
 73 
 
 (-1 
 
 a 
 +j 
 
 eJ 
 O. 
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 a 
 
 o 
 W 
 
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 tl 
 
 03 
 
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 02 
 
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 0) 
 
 o3 
 
 IH 
 
 C3 
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 0) 
 
 a 
 
 3 
 
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 a 
 
 c3 
 
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 8 
 
 CO 
 
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 t-l 
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 m 
 
 (U 
 
 *i 
 cS 
 
 (h 
 
 03 
 
 a 
 
 02 
 
 a 
 
 H 
 o 
 
 M 
 
 a 
 
 1-? 
 
 a 
 o 
 t-> 
 o 
 
 d 
 fe s 
 
 OS 
 
 • -"3 
 <- iJ 
 
 o >> 
 
 2a 
 
 a 
 o 
 
 03 
 
 a 
 
 a 
 
 03 
 
 w 
 
 >> 
 
 M 
 
 s 
 
 CO 
 
 a 
 
 o 
 
 a 
 1" 
 
 S 03 
 ^S 
 
 50 
 75 
 
 50 
 50 
 
 25 
 50 
 25 
 
 10 
 9 
 7 
 
 17 
 9 
 
 12 
 8 
 3 
 
 (3) 
 
 (5) 
 
 (3) 
 (3) 
 
 (2) 
 (2) 
 (2) 
 
 (2) 
 (2) 
 
 (2) 
 
 (1) 
 
 6 
 6 
 4 
 
 4 
 
 Gov. 
 Gov. 
 Gov. 
 Gov. 
 Gov. 
 Gov. 
 Gov. 
 
 25 
 25 
 20 
 25 
 25 
 10 
 25 
 25 
 
 Semi-annually 
 Jan., July 
 
 I 
 
 o 
 
 I 
 Is 
 
 Is 
 
 o a 
 <o "3 
 
 M 9 
 
 12 
 
 
 7 
 7 
 3 
 5 
 
 25 
 
 Full data is not available from some states in which the licensing 
 power is vested in boards of health. 
 
A LIST OF INDIAN SEEVICE STATIONS. 
 
 Arizona: Camp Verde, Fort Defiance, Keams, Canon, Leupp, 
 Mohave City, Parker, Phoenix, Sacaton, San Carlos, Supai, 
 Cootsdale, Talklai, Tuba, Valentine, Yuma. 
 
 California: Altmas, Banning, Campo, Covelo, Greenville, 
 Hoopa, Pala Kiverside, San Jacinto, Ysabel. 
 
 Colorado: Ignacia, Navajo, Springs. 
 
 Idaho: Lapwai, Eossfork. 
 
 Iowa: Toledo. 
 
 Kansas: Horton, Lawrence. 
 
 Michigan: Mt. Pleasant. 
 
 Minnesota: Cloquet, Grand Portage, Nett Lake, Onigum, 
 Pipestone, Eed Lake, Tower, White Earth, Browning, Crow 
 Agency, Harlem, Jacko, Lame-Deer, Poplar. 
 
 Nebraska: Genoa, Winnebago. 
 
 Nevada : Fallon, Lovelocks, McDermitt, Moapa, Schurz, Stew- 
 art, Wadsworth. 
 
 New Mexico: Albuquerque, Blackrock, Crownpoint, Dulce, 
 Mescalero, Santa Fe, Shiprock. 
 
 New York: Salamanca. 
 
 North Carolina: Cherokee. 
 
 North Dakota : Belcourt, Bismarck, Elbowoods, Fort Totten, 
 Fort Yates, Wahpeton. 
 
 Oklahoma: Auadarko, Chilocco, Colony, Contomnent, Geary, 
 Hammon, Otoe, Pawhusha, Pawnee, Shawnee, Stroud, White 
 Eagle, Wyandotte. 
 
 Oregon: Chemawa, Klamath Agency, Pendleton, Siletz, 
 Warm Springs. 
 
 Pennsylvania: Carlisle. 
 
 South Dakota: Canton, Cheyenne Agency, Crow Creek, 
 Flaudreau, Greenwood, Pierre, Pine Ridge, Eapid City, Eose- 
 bud, Sisseton. 
 
 Utah: Santa Clara, Whiterocks. 
 
 Washington: Lincoln, Miles P. O., Neah Bay, Simcoe, 
 Tacoma, Tekva, Tulalip. 
 
 Wisconsin: Ashland, Bayfield, Carter, Lac du Flambeau, 
 Neopit, Tom ah, Wittenberg. 
 
 Wyoming : Wind Eiver. 
 
 204 
 
A LIST OF SANITAEIUMS OPEEATED PEI- 
 
 VATELY, HAYING A CAPACITY OF 50 
 
 OE MOEE PATIENTS. 
 
 Hospitals and sanatoriums employ all kinds of help; laborers, 
 stenographers and care takers, male nurses and druggists. 
 Positions are not difficult to secure and the pay is usually better 
 than for similar positions outside. Ambitious persons who are de- 
 sirous to prepare later for medicine may secure valuable experi- 
 ence while they are earning money to pay for their medical edu- 
 cation. Positions in public hospital are usually obtained 
 through civil service examinations. Appointments to the mis- 
 cellaneous service in private institutions are obtained by appli- 
 cation to these institutions. A list of such institutions is given 
 herewith. 
 
 Castle Hot Springs Hotel and Eesort, Hot Springs, Ariz. 
 Desert Inn, Phoenix, Ariz. 
 Tucson-Arizona Sanatorium, Tucson, Ariz. 
 Armstrong Springs Sanatorium, Armstrong, Ark. 
 Eureka Sanatorium, Eureka Springs, Ark. 
 Dale Sanatorium, Texarkana, Ark. 
 
 Arrowhead Hot Springs Health Eesort, Arrowhead Springs, Cal. 
 Gardner Sanatorium, Belmont, Cal. 
 California Sanatorium, Belmont, Cal. 
 Burke Sanatorium, Burke, Cal. 
 Idyllwild Sanatorium, Idyllwild, Cal. 
 San Carlos Sanatorium, La Manda Park, Cal. 
 Livermore Sanatorium, Livermore, Cal. 
 Loma Linda Sanatorium, Loma Linda, Cal. 
 Long Beach Sanatorium, Long Beach, Cal. 
 Pottenger Sanatorium, Monrovia, Cal. 
 Paradise Valley Sanatorium, National City, Cal. 
 Acropolis Sanatorium, Oakland, Cal. 
 Nauheim Sanatorium, Oakland, Cal. 
 Las Eucinas, Lamanda Park, Pasadena, Cal. 
 
 205 
 
206 Medicine as a Peofession. 
 
 Southern California Sanatorium, Lamanda Park, Pasadena, Cal. 
 
 Agnew Sanatorium, San Diego, Cal. 
 
 Adler Sanatorium, San Francisco, Cal. 
 
 O 'Conner Sanatorium, San Jose, Cal. 
 
 St. Helena Sanatorium, Sanatorium, Cal. 
 
 El Eeposo Sanatorium, Sierra Madre, Cal. 
 
 Pasadena Sanatorium, South Pasadena, Cal. 
 
 Clarks Sanatorium, Stockton, Cal. 
 
 Boulder, Colorado Sanatorium, Boulder, Col. 
 
 Glockner Sanatorium, Colorado Springs, Col. 
 
 Star Eanch In-the-Pines Sanatorium, Col. 
 
 Agnes Memorial Sanatorium, Denver, Col. 
 
 Jewish Consumptive Relief Soc. Sanatorium, Edgewater, Col. 
 
 Glenwood Sanatorium, Glenwood, Col. 
 
 Idaho Springs Sanatorium, Idaho Springs, Col. 
 
 Dr. Friend's Sanatorium, Lamar, Col. 
 
 Montcalm Sanatorium, Manitou, Col. 
 
 Modern Woodmen Sanatorium, Woodmen, Col. 
 
 Dr. McFarland's Sanatorium, Greens Farm, Conn. 
 
 Wildwood Sanatorium, Wildwood Farms, Hartford, Conn. 
 
 Dr. Barnes Sanatorium, Stamford, Conn. 
 
 Dr. Givens Sanatorium, Stamford, Conn. 
 
 Gaylord Farm Sanatorium, Wallingford, Conn. 
 
 Westport Sanatorium, Westport, Conn. 
 
 National Odd Fellows Sanatorium, Gainesville, Fla. 
 
 De Sota Sanatorium, Jacksonville, Fla. 
 
 Sanatorium Centro Espanol, Tampa, Fla. 
 
 State Sanatorium for Tuberculosis, Alto, Fla. 
 
 Battle Hill Tuberculosis Sanatorium, Atlanta, Ga. 
 
 Davis-Fischer Sanatorium, Atlanta, Ga. 
 
 Pine Mountain Tuberculosis Sanatorium, Pinedale, Ga. 
 
 Rawlings Sanatorium, Sandersville, Ga. 
 
 Park View Sanatorium, Savannah, Ga. 
 
 Fort Lapwai Indian Sanatorium, Lapwai, Idaho. 
 
 Haley Sanatorium, Champaign, 111. 
 
 Garfield Park Sanatorium, Chicago, 111. 
 
 Parkhurst Sanatorium, Danvers, 111. 
 
 Hinsdale Sanatorium, Hinsdale, 111. 
 
 Oak Lawn Sanatorium, Jacksonville, HI. 
 
List of Sanatoriums. 207 
 
 Edward Sanatorium, Naperville, 111. 
 
 Sulphur Springs Sanatorium, Peoria, 111. 
 
 North Shore Health Eesort, Winnetka, 111. 
 
 Neuronhurst, Indianapolis, Ind. 
 
 Hunter Mineral Springs, Kramer, Ind. 
 
 Mudlavia, Kramer, Ind. 
 
 Brainard Sanatorium, Martinsville, Ind. 
 
 Colonial Sanatorium, Martinsville, Ind. 
 
 Highland Mineral Springs, Martinsville, Ind. 
 
 Hill House Sanatorium, Martinsville, Ind. 
 
 Home Lawn Mineral Springs, Martinsville, Ind. 
 
 Plymouth Sanatorium, Plymouth, Ind. 
 
 Kneipp Sanatorium, Eome City, Ind, 
 
 Grand Hotel and Sanatorium, Colfax, Iowa. 
 
 Victoria Sanatorium, Colfax, Iowa. 
 
 Iowa Sanatorium, Nevad, Iowa. 
 
 Bonner Springs Lodge, Bonner Springs, Kansas. 
 
 Evergreen Place Sanatorium, Leavenworth, Kansas. 
 
 Samaritan Sanatorium, Pittsburg, Kansas. 
 
 Euggles Sanatorium, Stafford, Kansas. 
 
 Kansas Sanatorium, "Wichita, Kansas. 
 
 New Tenwick Sanatorium, Abbeville, Louisiana. 
 
 Baton Eouge Sanatorium, Baton Eouge, Louisiana. 
 
 Dr. Ames Tuberculosis Sanatorium, Shreveport, Louisiana. 
 
 Biedler and Selman Sanatorium, Baltimore, Maryland. 
 
 Eudowood Sanatorium, Baltimore, Maryland. 
 
 St. Agnes Sanatorium, Baltimore, Maryland. 
 
 Laurel Sanatorium, Laurel, Maryland. 
 
 St. Francis Sanatorium, Denville, New Jersey. 
 
 Eiver Lawn Sanatorium, Paterson, New Jersey, 
 
 Brookside Sanatorium, Plainfield, New Jersey. 
 
 Brunswick Home, Amityville, New York, 
 
 Long Island Home, Amityville, New York. 
 
 Louden Hall, Amityville, New York, 
 
 Eiver Crest Sanatorium, Astoria, New York. 
 
 Montefiore Home Country Sanatorium, Bedford, New York, 
 
 Eoss Health Eesort, Brentwood, New York. 
 
 International Sunshine Sanatorium, Brooklyn, New York. 
 
 Day Camp for Consumptives, Buffalo, New York. 
 
208 Medicine as a Pkofession. 
 
 Castile Sanatorium, New York. 
 
 Clifton Springs Sanatorium, Clifton Springs, New York. 
 
 Glenridge Sanatorium, Cranesville, New York. 
 
 Jackson Health Resort, Dansville, New York. 
 
 Gleason Health Eesort, Elmira, New York. 
 
 Sanatorium for Hebrew Children, Far Eockaway, New York. 
 
 St. Joseph's Sanatorium, Forrestburg, New York. 
 
 Sanatorium Gabriels, Gabriels, New York. 
 
 Interpines, Goshen, New York. 
 
 Steuben Sanatorium, Hornell, New York. 
 
 Dr. C. C. Sahler Sanatorium, Kingston, New York. 
 
 Our Lady of Victory Sanatorium, Kingston, New York. 
 
 Adirondack Sanatorium, Lake George, New York. 
 
 Stony Wold Sanatorium, Lake Kushaqua, New York. 
 
 Buckly Sanatorium, Liberty, New York. 
 
 Workmen's Circle Sanatorium, Liberty, New York. 
 
 River Crest Sanatorium, Island City, New York. 
 
 Loomis Sanatorium, Loomis, New York. 
 
 Hudson View Sanatorium, Nyack, New York. 
 
 Glenmary Sanatorium, Owego, New York. 
 
 Lake-Rainbow Sanatorium, Rainbow Lake, New York. 
 
 Graham Sanatorium, Rochester, New York. 
 
 Dr. Strong's Sanatorium, Saratoga Springs, New York. 
 
 Sheldrake Springs Sanatorium, Sheldrake, New York. 
 
 Marshall Sanatorium, Troy, New York. 
 
 Adirondack Cottage Sanatorium, Trudeau (Saranac Lake), 
 
 New York. 
 Glen Springs Sanatorium, Watkins, New York. 
 Winyah Sanatorium, Asheville, North Carolina. 
 Heidelberg Sanatorium, Flat Rock, North Carolina. 
 James Sanatorium, Laurinburg, North Carolina. 
 Broadoaks Sanatorium, Morgantown, North Carolina. 
 White-head-Stokes Sanatorium, Salisbury, North Carolina. 
 Cincinnati Sanatorium, Cincinnati, Ohio. 
 Sawyer Sanatorium, ^Marion, Ohio. 
 Oxford Retreat, Oxford, Ohio. 
 Niles Sanatorium, Urbana, Ohio. 
 Radium Springs, Haines, Oregon. 
 Hot Lake Sanatorium, Hot Lake, Oregon. 
 
List op Sanatoriums. 209 
 
 Lakewood Sanatorium, Lakewood, Oregon. 
 
 Portland Sanatorium, Portland, Oregon. 
 
 Todd Sanatorium, Cambridge Springs, Pennsylvania. 
 
 Philadelphia Jewish Sanatorium, Eagleville, Pennsylvania. 
 
 Markleton Sanatorium, Markleton, Pennsylvania. 
 
 Mercer Sanatorium, Mercer, Pennsylvania. 
 
 East End Sanatorium, Pittsburgh, Pennsylvania. 
 
 Mount St. Michael Sanatorium, Keading, Pennsylvania. 
 
 Fieldmore Sanatorium, Titusville, Pennsylvania. 
 
 Walter Sanatorium, Walters Park, Pennsylvania. 
 
 Grand View Sanatorium, Wernersville, Pennsylvania. 
 
 Sunnyrest Sanatorium, White Haven, Pennsylvania. 
 
 White Haven Sanatorium, White Haven, Pennsylvania. 
 
 Dr. Bate's Sanatorium, Providence, Rhode Island. 
 
 Baker Sanatorium, Charleston, South Carolina. 
 
 Chamberlain Sanatorium, Chamberlain, South Dakota. 
 
 Dr. Hargen's Sanatorium, Hot Springs, South Dakota. 
 
 Dr. Nicholas Sanatorium, Hot Springs, South Dakota. 
 
 Drs. Pettey and Wallace Sanatorium, Memphis, Tenn. 
 
 James Sanatorium, Memphis, Tenn. 
 
 City View Sanatorium, Nashville, Tenn. 
 
 Grand View Sanatorium, Newport, Tenn. 
 
 St. Anthony's Sanatorium, Amarillo, Texas. 
 
 Austin Presbyterian Sanatorium, Austin, Texas. 
 
 Austin Sanatorium, Austin, Texas. 
 
 Spohn Sanatorium, Corpus Christi, Texas. 
 
 Dr. W. H. Caldwell's Sanatorium, Cypress, Texas. 
 
 St. Paul's Sanatorium, Dallas, Texas. 
 
 Doctor Miller Home Sanatorium, Dublin, Texas. 
 
 O'Brien's Surgical Sanatorium, Dublin, Texas. 
 
 Arlington Heights Sanatorium, Fort Worth, Texas. 
 
 Baptist Sanatorium, Houston, Texas. 
 
 The Heights Sanatorium, Houston, Texas. 
 
 Houston Infirmary Sanatorium, Houston, Texas. 
 
 Hot Well Sanatorium, Hubbard, Texas. 
 
 Torbett Sanatorium, Marlin, Texas. 
 
 St. John's Sanatorium, San Angelo, Texas. 
 
 Dr. Moody's Sanatorium, San Antonio, Texas. 
 
 St. Vincents Sanatorium, Sherman, Texas. 
 
210 Medicine as a Peofession". 
 
 Temple Sanatorium, Temple, Texas. 
 
 Providence Sanatorium, Waco, Texas. 
 
 Catawba Sanatorium, Catawba, Virginia. 
 
 Walton Sanatorium, Eichmond, Virginia. 
 
 Westbrook Sanatorium, Eichmond, Virginia. 
 
 Dr. Allen's Sanatorium, Medical Lake, Washington. 
 
 Cliff Lodge Sanatorium, Port Townsend, Washington. 
 
 Point Pleasant, Eaymond, Washington. 
 
 Firland Sanatorium, Seattle, Washington. 
 
 Siloam Sanatorium, Soap Lake, Washington. 
 
 The Sanatorium, Hudson, Wisconsin. 
 
 Pennoyer Sanatorium, Kenosha, W'^isconsin. 
 
 Lake Geneva Sanatorium, Lake Grsneva, Wisconsin. 
 
 Madison Sanatorium, Madison, Wisconsin. 
 
 Eiverside Sanatorium, IMilwaukee, Wisconsin. 
 
 Sacred Heart Sanatorium, Milwaukee, Wisconsin. 
 
 Oconomowoc Health Eesort, Oconomowoc, Wisconsin. 
 
 Sanatorium Waldheim, Oconomowoc, Wisconsin. 
 
 Lakeside Sanatorium, Oshkosh, Wisconsin. 
 
 Waukesha Springs Sanatorium, Waukesha, Wisconsin. 
 
 Milwaukee Sanatorium, Wauwatosa, Wisconsin. 
 
 Washakie Sanatorium, Thermopolis, Wyoming. 
 
 Eocky Mountain Sanatorium, Frank, Alberta. 
 
 Halcyon Hot Springs, Halcyon, British Columbia. 
 
 Homewood Sanatorium, Guelph, Ontario. 
 
 Br. de Blois Sanatorium, Three Eivers, Quebec. 
 
INDEX 
 
 Page 
 
 Abilities, Desirable Native 12 
 Admission to College, Ee- 
 
 quirements for 51 
 
 Aesculapius, Disciples of 1 
 
 Agramonte, Aristides . . 84 
 Animal Electricity, Gal- 
 
 vani 8 
 
 Antitoxins 136 
 
 Apothecary shops, First. 3 
 Application Form, for the 
 
 Navy 72 
 
 Aristotle 2 
 
 Army Service 37, 64 
 
 Allowance 65 
 
 Medical Library 68 
 
 Medical Museum 68 
 
 Pay 64 
 
 Eetirement 66 
 
 Requirements 66 
 
 Auenbrugger, Leopold, 11, 24 
 
 Avicenna 3 
 
 Barton, Benjamin 7 
 
 Bartlett, Josiah 10 
 
 Bernard, Claude 11 
 
 Bibliography 
 
 Future of Medicine . . 192 
 
 History 187 
 
 Hospital and Labora- 
 tory 190 
 
 Medical Education .... 188 
 
 Medical Inspection ... 190 
 
 Medical Missions .... 191 
 
 Medical Research .... 191 
 
 Navy and Army 188 
 
 Page 
 
 Public Health 189 
 
 Systems of Medicine. . 188 
 Women in Medicine . . 191 
 
 Bigelow, Jacob 7 
 
 Biological Laboratories. , 139 
 
 Boerhaave 5 
 
 Brown, John 8 
 
 Brunfels, Otto, botanist. 7 
 
 Canaday, N. F 79 
 
 Canal Zone 83 
 
 Carrel, Alexis 134 
 
 Carroll, James 84, 86 
 
 Childrens ' Diseases .... 144 
 
 Child Hygiene 101 
 
 Code of Ethics 164 
 
 Colleges, Medical 196 
 
 Commerce and Medicine 136 
 
 Consultations 176, 177 
 
 Cooke, Robert P 85, 86 
 
 Corporation Service ..62, 125 
 Duties of a Physician 
 
 as a Citizen 182 
 
 to Fellow Practi- 
 tioner 173, 175 
 
 to Patients 165 
 
 to Self 174 
 
 Earnings during college 
 
 vacation 25 
 
 Earning one's way 
 
 through College ... 26 
 Earnings in medicine 
 
 compared with law . 29 
 
 Ear Specialist 142 
 
 Eclectic School 45 
 
 211 
 
212 
 
 Index. 
 
 Page 
 
 Emergencies 180 
 
 Ethics, a Modern Code . 165 
 Expense, total college . . 23 
 
 Eye Specialist 142 
 
 Federal Public Health 
 
 Service 90 
 
 Fees in medical colleges, 
 
 22, 196 
 
 Field, Survey of 57 
 
 Financial Eewards 28 
 
 Finley, Carlos 85 
 
 Food Inspection 101 
 
 Fraternal Societies .... 62 
 Future of Medicine .... 151 
 
 Galen 2 
 
 Hall, Lyman 10 
 
 Harvey, William 5 
 
 Health Service 
 
 National 90 
 
 State 96 
 
 Municipal 98 
 
 Hippocrates 1 
 
 Hippocrates, Oath of . . 164 
 History of medicine ... 1 
 History of 1,000 medical 
 
 students 20 
 
 Holmes, Oliver Wendell . . 8 
 Homeopathic School .... 42 
 
 Honorarium 173 
 
 Hospital ships 76 
 
 Hospital service 105 
 
 Hospital, number of .... Ill 
 Hunter, John and Wil- 
 liam 8 
 
 Hygienic laboratory .... 94 
 Indian Service stations . 204 
 
 Indian Service 77 
 
 Contract physician . 78 
 Industrial medicine .... 178 
 
 Page 
 Insurance examinations . 128 
 Ipecac, Discovery of use 89 
 
 Jenner 6 
 
 Keats 8 
 
 Laboratories, biological . 139 
 
 Laboratory work 112 
 
 Salaries 113 
 
 Laennec 5 
 
 Laveran, Alphonse 9 
 
 Lazear, Jesse W 84 
 
 Livingston, David 9 
 
 Location, Selection of . . 58 
 
 Lodge Practice 127 
 
 Manufacturing medicines 136 
 
 Marine hospitals 95 
 
 Medical College, scholar- 
 ships 200 
 
 Medical colleges .... 51, 196 
 Medical College Fees. 22, 196 
 Medical Inspection of 
 
 Schools 115 
 
 Medical Laws 157 
 
 New York 158 
 
 Pennsylvania 161 
 
 Summary 202 
 
 Medical Missions . . . 118, 124 
 Medicine, History of . . . 1 
 Medicine, System of ... . 39 
 
 Metchnikof 134 
 
 Missionary, Medical, 118, 124 
 
 Mitchell, S. Weir 8 
 
 Montanus 5 
 
 Muller, Johannes 24 
 
 Mullikin, Clarence W. . . 79 
 
 Naval Service 37, 69 
 
 Naval Service, Admission 71 
 
 Personnel 75 
 
 New York City Public 
 
 Health System 99 
 
Index. 
 
 213 
 
 Page 
 New York State Public 
 
 Health Service 97 
 
 Negro Physicians 18 
 
 Nose Specialist 143 
 
 Nostrums 172 
 
 Number of Physicians, 
 
 32, 193 
 Oath, Hippocratic ...... 164 
 
 Oculist 142 
 
 Olcott, Oliver 10 
 
 Orthopedic surgery .... 143 
 Orthodoxy in medicine . . 175 
 Orders, fraternal, Prac- 
 tice for 127 
 
 Osier, "William 8 
 
 Osteopathic School 47 
 
 Over-crowding, Danger of 
 
 33, 34 
 
 Pare, Ambrose 9 
 
 Patient's duties toward 
 
 Physician 169 
 
 Personnel, Medical Serv- 
 ice of Navy 75 
 
 Personnel, Changes in 
 
 Community 37 
 
 Philippine Service 87 
 
 Philippine Practice .... 88 
 Physician in Society .... 7 
 Physicians ' Opinions of 
 
 Medicine 35 
 
 Physicians, Number 
 
 in Cities 194 
 
 in States 193 
 
 Protestant Medical Mis- 
 sionaries 124 
 
 Prospects 32 
 
 Psychiatric Institute, pay 98 
 Public Health Service . . 96 
 Railway Service 125 
 
 Page 
 
 Red Cross 129 
 
 Base Hospital 129 
 
 Ambulance Corps . . 130 
 
 Reed Commission 84 
 
 Reed, Walter 9 
 
 Recognition of new dis- 
 coveries 6 
 
 Regular School 40 
 
 Religio Medici 8 
 
 Residence at Y. M. C. A. 15 
 
 Research Work 132 
 
 Requirements for admis- 
 sion 21 
 
 Requirements 
 
 for Admission to Col- 
 leges 51 
 
 Financial 21 
 
 for Army 67 
 
 for Navy 73 
 
 Rewards, Financial .... 28 
 Rocky Mountain Spotted 
 
 Fever 94 
 
 Rockefeller Institute, 133, 134 
 
 Rural practice 57 
 
 Rush, Benjamin 10 
 
 Sanatoriums, private . . . 205 
 
 Sanatoriums service ..62, 109 
 
 Sanitary Engineering , . 83 
 
 Canal Zone 83 
 
 Schwann, Theodore .... 8 
 School Physician in New 
 
 York 117 
 
 in Prussia 116 
 
 Scholarships 200 
 
 School, medical Inspec- 
 tion of 115 
 
 Simpson, James 24 
 
 Society, the physician in 7 
 
 Specialism 140 
 
214 
 
 Index. 
 
 ■*^ 
 
 Page 
 
 Stegomyia investigation . 85 
 
 Steamship service 127 
 
 Superintendent, hospital. 106 
 
 Survey of the Field 57 
 
 Sylvius 5 
 
 Systems: 
 
 Eclectic 45 
 
 Homeopathic 42 
 
 Osteopathic 47 
 
 Regular 40 
 
 Tobler, Titus 11 
 
 Under-supplied communi- 
 ties 33 
 
 Unlicensed practitioners . 49 
 
 Pa*:- ui. 
 
 U. S. Public xiealth 
 
 Service 90 
 
 Personnel 91 
 
 Foreign stations . 93 
 
 Hospitals 95 
 
 Pay 91 
 
 Requirements .... 92 
 
 Vaccination, smallpox . . 6 
 
 Vesalius 5 
 
 Women in medicine ...4, 146 
 Workingmen 's Compen- 
 sation Laws 128 
 
 Yellow Fever Commission 84 
 

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