during the convalescent stage than lactose. Maltose is contraindicated in the treatment of diarrhea due to the gas bacillus and similar organisms, and is less useful than lactose in the treatment of those caused by the dysentery bacillus.

SOCIETY PROCEEDINGS.

THE EASTERN MEDICAL SOCIETY OF THE CITY OF NEW YORK. Regular Meeting, January 10th, 1913.

EXECUTIVE SESSION.

The Executive Session was devoted largely to the transaction of routine business.

The President, Dr. Joseph Barsky, addressed the Society as follows:

WHITHER ARE WE DRIFTING?

It is customary for the President of the organization in assuming the Chair to make a few remarks which he thinks are of some moment to its members. With your permission, I will adhere to the custom of my predecessors and will put my remarks in the form of a few questions leaving the answers to each individual member.

The question of the present day which is of the utmost importance and upon which all our interest largely centers is that of the economic conditions of our individual members. In other words how can we make both ends meet at the end of the month or year? This is a vital question, one that demands solution and must be solved. It takes precedence over everything else and, unless a just and correct solution is arrived at, it will creep up again and again with disastrous results.

I take it for granted that we are all interested in this problem and are cognizant of the fact that the struggle for existence today is greater than at any other time in the world's history, not that the actual conditions are worse, far be it from that, but that our demands have increased through our intellectual development out of all proportion to our present physical ability to satisfy them; hence the general unrest and complaint.

Now what are we as a body doing to meet these demands? We are fully aware of the fact that this economic question is not confined merely to the members of the medical profession as such, but that it is general and concerns all civilized communities, and we can improve our conditions only by improving the conditions of all.

Are we giving it due consideration? Please remember that we cannot improve our condition as the trade unions improve theirs, namely by increasing their own incomes at the expense of others. If we wish to improve our conditions, we must put our shoulders to the wheel and take our places in the ranks of the coming soldier and battle on an equal footing with him. We must do our utmost in this

strife and never cease until the battle is won and we have attained what is in our belief justice for all. We must give a helping hand to the general movement which has for its aim the physical and moral uplift of society. Are we doing our share of work or are we waiting for the other fellow to do it for us and then share with us the benefits in common? Are we to be merely passive onlookers? Upon your correct answers to these questions depends our well being.

To be sure there are ills which are exclusively medical, so to speak, and a remedy for which could be easily found if we were in real earnest and determined to do so. For instance, take the hospital and dispensary abuses. What are we doing to eradicate these evils? I'll tell you. Committees are appointed to investigate and report. In a short time we get reports substantiating all the charges set forth, and lo and behold, before the ink has had time to dry on the paper, we discover in all our daily newspapers that there is an epidemic of hospitals.

From every part of our fair city we hear this epidemic is spreading like wildfire. Balls, fairs, theatricals, sociables, and card parties are organized to raise funds to establish new hospitals all over the city. I personally know a very charming and charitable young lady who danced herself sick for the benefit of a new hospital, where she assured me that the poor unfortunate sick babies would be better cared for than in the old hospital. I have a grave suspicion that the present epidemic has not originated in the mind of the lay public. As far as I know, children are not crying for hospitals, nor do mothers want them, nor fathers like them. It would be interesting to know how and from where the poor public reIceived this inspiration.

Now we are certain of the evils that the hospitals are creating. We all protest against them. We organize for the purpose of curing these evils and what are we doing? We build more hospitals.

Complete Series, Vol. XIX. No. 2. New Series, Vol. VIII, No. 2.

The principles of medical ethics adopted by the American Medical Association, are recommended for careful perusal by everyone whether or not he is a member of the Association or may already know their substance. In our dealings with each other they inculcate the idea of doing to others as we would have others do to us and always of course in a gentlemanly way. The perfect gentleman has yet to be born. and we who are less than perfect must realize that we constantly tend to do some things we ought not to do and omit others we should have done and that "there is no health or perfection in us." For that reason we must be on constant guard lest we do what would hurt us if done by some one else. In other words the code is an ideal towards which we strive and though we constantly get nearer to it we may never reach it. Let us then be a little charitable to those who are so "unprofessional" as to violate the code in some of its details. For instance, it says that, "when an epidemic prevails, a physician must continue his. labors for the alleviation of suffering people, without regard to the risk to his own health or life or to financial reward." If he should die in this alleged duty and leave a widow and several small children dependent on charity, we doubt very much whether he has done right. The greatest good to the greatest number is a good test in such matters of casuistry and we are

quite sure by that criterion that a man who cares more for his own health and efficiency does far more good to far more patients than he who dies for a few. Besides, charity begins at home. An ideal code does not cause more distress than it relieves. Would it not be wise then to temper this provision of the code a little? Would it not be better to make our ideal a bit more attainable? We strongly approve the rule making it unprofessional conduct to fail to obey the law to report to the authorities any notifiable diseases. The public are now too well educated to object to this course and dismiss a physician who will not save them certain inconveniences by hiding contagious diseases. Fear of losing one's practice may have once been an extenuating circumstance for this misdemeanor, but it is so no longer. Indeed he who needlessly risks public health is liable to suffer. There is, then, no acceptable excuse for failure to keep health authorities promptly informed as to notifiable diseases.

The defect of all codes of medical ethics is that they overlook that medicine is a calling by which we earn a living. Civilization is based on the fact that everyone is doing something to benefit others while he is supporting himself. If anyone attempts to gain subsistence in any way which is not reflexly beneficial to others, he is liable to end up in prison. It is nonsense to claim

that any one of the lawful callings is primarily for the good of the public. Like every other bargain, it is beneficial to both sides, and they all survive because of this mutual benefit. Shoemaking would disappear if shoes were no longer beneficial, and the trade arose because of its necessity. All men cannot make their own shoes or medicines and must pay someone else to do both for them. Our old claim that the profession of healing is the only purely altruistic one, in which the selfish consideration. of making a living does not appear except as an incident, is simply untrue. The physician who does not insist on his fees for keeping patients healthy is as foolish as a shoemaker who will give away shoes for the pleasure of keeping people well shod. Our profession is not then "primarily for the good of the public" to any greater extent than any other trade or profession, and it is high time we throw off the smug hypocrisy which only creates ridicule. Medicine is a mutual affair and cannot exist in a pure healthy state unless it is beneficial to both doctor and patient-neither good being the primary one. Pure altruism is as harmful as pure egoism and we must not pretend to be what we cannot be. There is no question that we have suffered dreadfully by our false position. Millions of people take us at our word and see no wrong in their failure to pay the doctor even if they know his children are suffering for the comforts of life if not its necessities. They really think it his duty to heal them without pay. Our unwise attitude even creates a sort of pauperism as seen in the abuse of dispensaries by people clothed in expensive furs. In this respect our code is far from ideal. It must be modified so that violation of its provisions is more difficult than observance -that is, it must be a practical guide, not

an unattainable ideal. Let us acknowledge that we are trying to support ourselves and families and not primarily the families of other men. Except in emergencies, to which all men respond whether they are doctors or not, let it be distinctly understood that the doctor must be paid for his work-all of it. When the code says this, it will be more respected and less often violated. Let it distinctly state that a man is no more entitled to free medical care than he is to free shoes. If there is any primary purpose of practicing medicine it is the purpose of making a living.

Our dreadful accident record seems to be getting worse instead of better-at least in New York City. We are informed that every day there are about two people killed and six injured in the streets by automobiles, wagons and cars. The whole state outside of the city has fewer injured and less than half the killed, though we are justified in doubting the accuracy of the rural statistics since it is impracticable to get reports of every accident. European papers comment, with something like horror, on the number of people killed and injured by our railroads―probably 30 a day killed on an average and the wounded counted by hundreds. Ninety per cent. of this bloodshed is unnecessary. It has been reported that safety appliances introduced. into the shops of the Pennsylvania Railroad employing 50,000 workmen, have reduced the monthly accidents from 300 to 100. We are quite sure that the remaining hundred can be largely reduced, though we are equally sure that at least ten per cent. of our deaths are due to the foolishness of the workers themselves. Such deaths have always occurred on the farm and in our

nomad and hunting stage of existence. It is nature's way of eliminating old types unfit for new environments. We need not worry over these suicides from stupidity, but we ought to worry a great deal over the ninety who are destroyed through no fault of their own, but through our fault in not compelling employers, including railroads, to adopt safety appliances and methods. In time we may evolve a type of baby which will not run out in the streets in front of cars and wagons, but it will be a very very long time and cost too much in life. Evolution of man has proceeded in the opposite direction of an increasing helplessness in infancy and increasing care by parents. As it is practically impossible, as well as unwholesome, to keep all children housed and off the streets, we must keep vehicles off certain streets and reduce speed. We must do something and do it soon, for at a rough estimate there are now about one million

unnecessary cases of accidents needing surgical care every year—perhaps much more than a million. No wonder we have more doctors per thousand population than any other nation in the world. We need them.

Mr. Lloyd George has scored in the first round of his fight with the medical profession of Great Britain over the Insurance Act, but he has done so only by a series of "foul blows." On Nov. 20th, 1912, the representative meeting of the British Medical Association (the analogue of the House of Delegates, A. M. A.) decided to refuse to render service under the terms of the act. Thereupon district after district throughout the country voted not to "go on the panel," that is, that the members should abstain from enrolling themselves on the list of doctors willing to

serve on the panels opened by the local Insurance Committees. This decision was further confirmed by the representative body on Dec. 21st, by 182 votes to 21. When the time came for closing the first list of "panel doctors," on Dec. 31, 1912, it was found that almost all over the country the lists were hopelessly incomplete, and in several cases did not contain the name of a single doctor. Moreover, it was obvious that the greater part of those who had enrolled were the ne'er-do-wells of the profession, and that most of the better class of general practitioners who had anything of a private practice held aloof on several grounds. Apart altogether from the question of inadequate remuneration, the panel doctor's relations with his patient are interfered with by the control of the local Insurance Committees (lay bodies on which the Friendly Societies have by statute a permanent majority of three-fifths). Secondly, the incidental clerical work of practice-for which since the private practitioner is responsible to no one but himself he can always postpone to a convenient occasion. the resulting loss or inconvenience being entirely his own-becomes a dread responsibility when it is made by statute an obligation to the state and may come into conflict with the demands of practice. Thirdly, the fact that the act requires all service to the insured to be rendered personally and not delegated to assistants may easily make it necessary in busy seasons for the doctor' to leave his private patients to the care of assistants while he devotes himself to his insured "club patients." In this light it would tend to be destructive of the best class of general practice. Finally, the injustice of an absence of any income limit for the insured, save in the case of clerical occupations, whereby many who have always paid

good fees become entitled to compulsory attendance for $1.75 per annum, the attendance including venereal diseases, drunkenness, all except major surgery, miscarriage, etc., hitherto excluded from all contract practice, was bitterly resented. For these and other reasons the great bulk of the better class of general practitioners held aloof and declined service under the act.

Then Mr. Lloyd George struck below the belt. In a speech on Jan. 2nd, before the Advisory Committee to the Insurance Commissioners-the absolute and paramount authority under the act-he detailed the measures that would be adopted to crush down resistance if practitioners still refused to serve on the panel. Where the panel was more or less adequate the Insurance Commissioners he said, would close it against resisting local doctors and invite those doctors already on it to take a sufficient number of assistants to enable them to carry on the work, the panels to remain closed in that area long enough to enable the panel doctors to secure all the practice among the insured from their protesting confrères, or a sufficient number of medical men ["blacklegs"] would be sent to start practice in any area where their services might be required for the insured, the panel being meanwhile closed, as before, to give them the opportunity of making good their footing among the insured and incidentally of establishing a private practice at the expense of their professional brethren. Finally, in districts where no panel could be formed, whole time doctors could be sent on a salary of from $2,500 to $3,500 a year to attend solely to the insured, but with the privilege of engaging in private practice among the families of the insured alone.

In the industrial districts of large cities it was recognized that these autocratic measures would entail not merely serious loss, but absolute ruin, on those at the time in practice there, inasmuch as in such districts anywhere from 75 to 100 per cent, of the patients were found to be now compulsorily insured persons. All over the country, therefore, a stampede ensued, and in district after district the doctors, some on their own account, many more out of consideration for their fellows thus circumstanced, voted to take service, but in most instances expressed in their resolutions their bitter resentment against the unscrupulous and dishonorable tactics employed to enforce service under the act.

Mr. Lloyd George had thus repudiated every promise he had made, and every principle he had laid down when advocating his bill. By the act, every legal practitioner is entitled at any time to go on the panel; yet, to punish those doctors who were not willing to enslave themselves, he would close the panels to them, and give a monopoly to "blackleg" doctors devoid of every vestige of professional honor. By the act, all service must be rendered personally by the panel doctor himself and not by means of assistants; yet Mr. Lloyd George, to gain his own ends, would in certain districts authorize the wholesale employment of assistants, who apparently were not even to be selected by the doctors who employed them, but sent down by the central authority. By Mr. Lloyd George's repeated promise, every insured person was to be "free to go to the doctor of his choice," subject to the latter's acceptance of him as a patient; but his choice is now to be restricted to those who accept Mr. Lloyd