THE ORGANIZATION OF THE MINNESOTA STATE MEDICAL ASSOCIATION.

J. N. M'CORMACK, M.D., BOWLING GREEN, KY.

Mr. President and Gentlemen:—I am glad to be the bearer of words of congratulation and encouragement to the profession of this state from the American Medical Association, whose official representative I have the honor to be. Although bearing the commission of that great body, and here by the invitation of yours also, I think it proper to make the claim at the outset that I am here in a purely advisory capacity, to give you the benefit of information and inspiration of such work in my own and other states, and to help you so far as it may be entirely agreeable to you in this work of organization, but in no event to hinder and hamper you in anything. I am an old-fashioned man, a member of an old-fashioned political party, who believes in the right of each state to manage its affairs in its own way, and that applies to medicine as well as to other affairs of government.

The subject of medical organization is such a manysided one, and there are SO many standpoints from which to view it, that I I am always at a loss to know in what particular phase to present it to any particular body of medical men. Our English cousins across the water have always led in this work, and are very much in advance of us at present. Owing to the compactness of their medical population the difficulties that confront us. are not apparent to them, and the influence of the parent society comes more in touch with each individual member of the profession. Much as we seem to have accomplished in this country in the last few years in our methods of education, in medical legislation and work of organization, a bare statement of facts must convince anyone who will heed them that so far, up to the inception of this new movement, the

rank and file of the great profession of this country has never heard what we were doing, and seemed to care as little as they have heard. There are about 120,000 physicians in the United States and its dependencies, and out of that entire number only about 30,000, one in four, have ever been members of any sort of society, county, district, state or national. Think of that for a moment! You who have found it difficult to keep abreast of the times, who live in peace and harmony with your neighbors under the most favorable circumstances, let me say to you that three-fourths of the physicians of this great country of ours who left their colleges to start out in their professional life, animated by the same high hopes and ambitions that inspired you or myself, have not allied themselves with any local organization, and have gradually drifted to that condition of which we all must know, the fate of the physician who loses the influence and the uplifting benefit of the medical societies. This condition of things was forced on my attention as a public official of Kentucky, where I have administered the medical and health laws of my state, a position which I have held continuously for twenty-five years. I found that the more than average man, the more representative men who fill our legislative halls, who occupy judicial positions, look on our profession with distrust, and were inclined to believe, so far as I could learn, even the best of them, that our interest in securing the enforcement of laws that were put on the statute books and to secure other laws, were not unselfish; that we were prompted by motives of selfinterest, and I found in speaking with people on this subject they would say, "If the doctors were like my family phy sician and consulting men I would be willing to vote for anything the medical profession wanted, but they are not. He is the model man of my county, but his neighbors are an entirely different order of men." I find in a little while that this family physician was a very important factor in securing legislation that his influence was all-important in too many instances and in some instances he had destroyed the influence of other medical men in his community in his own. clientele.

I found in the enforcement of the medical laws when the medical official charged with this law undertook to prosecute the offenders of the law, very shortly there developed another factor in the medical profession, and the rivals of these physicians began to whisper into the ears of the profession things that destroyed the effects of the prosecution. Their bitterness was greater very often against the reputable physicians of the community than against this man who was at the bar for trial. I found in the management of smallpox as a state official it became my duty to go to nearly every county in the state, that when the board of health which happened to be in charge at the time the health officer put in force the regulation to protect the health of the community, in a little while the information would go out that it was not smallpox, but it was chicken-pox, or Cuban itch, or African itch, or I under

stand up this way "pancake" itch, which is a new name to me, or anything else but what the officials pronounced it, and it reached the ears of the public that the physicians were too ignorant or had banded themselves together to rob the county. I hope that condition of things does not exist in Minnesota ; I hope that has been remedied by your legislature. I thought they were confined to my own state, but as my observation extended into other states of the union (unless you are different in Minnesota), I found the same conditions existed practically everywhere.

And so, under instruction from my board of health and my state association, and later from the American Medical Association, I began a systematic investigation to ascertain if possible what was the cause of the condition which seemed so unfortunate, because there must be some common cause, and I found after very little investigation that very much of this trouble began in the medical colleges themselves. That very often in the cities where there were two or three or four medical schools, where there was room for but one, the student was surrounded during the formative period of his career by an atmosphere of exaggeration, misrepresentation and falsehood in regard to the faculties of other schools, neither better nor worse than his own. Very often this student whom I am tak

ing as an example, located in a community where there is no local society, and no helping hand is held out to him by those already established, and practically because the reception of young men in this country by the older members of the profession has not, as a rule, been cordial, and as this young man never had one hour's instruction in regard to medical ethics, which we regard so important, because that is almost entirely omitted from the curriculum of our colleges, never had one hour's instruction in regard to business methods in medical practice, and it is scarcely to be wondered at that three-fourths of them, animated by the best purpose, drifted, many of them into unprofessional methods, many of them into quackery, which might easily have been obviated. I hope I am overstating the case in Minnesota, but I have found few places where there were two physicians in a community but what in various ways they would impress the community to our disadvantage and bring our profession into constant reproach, when they really needed each the other's help as no other men on God's green earth need it. But Dr. Jones spent hours every day in misrepresentation of his neighboring physician, in the exaggeration of his faults and mistakes in practice, time which should have been spent in study and research. And Dr. Smith, without waiting to hear anything, was engaged in doing a like duty to Dr. Jones with his patrons. So, in time, that community was divided into two factions, Dr. Smith's friends and Dr. Jones' friends. Lincoln said you could fool some of the people a part of the time, but you could not fool all the people all the time, and when the people come to compare these two physicians, who know more about each other than anybody else could know about them, they will place a low estimate on both of them, and an injustice will be done to both of them, because they are both reputable men and entitled to the confidence of the community, but our profession is brought into reproach as far as these two men are able to do it. I have gone from one end of this country to the other adjusting these difficulties. I understand your profession here in St. Paul, by systematic organization, have almost removed these difficulties, and I con

gratulate you. I have found from one end of this country to another cities with from five to five hundred physicians where rival factions had been created and differences had grown up among them, and the problem differed very little from the problem of petty jealousies between Dr. Jones and Dr. Smith. It was practically the same problem; it was a question of local jealousy, as a rule, between most worthy men. I am trying to make this plain to you, and I will fail in my purpose if I do not do so.

While this evil is so widespread, extending from the Atlantic to the Pacific, and from the Lakes to the Gulf, the trouble is a purely local one between the physicians who are competitors in business. I find the physicians in my state and in other states who come to the meetings of the state societies in different sections are like David and Jonathan, ready to fall on each other's necks, and yet two physicians, competitors, drift apart in the home. If it is suggested to elect a prominent member from a certain city as president of a state association, some members from that city will go to the nominating committee and say: "For the Lord's sake, don't disgrace the profession of our city this year. Take the president from somewhere else. We like him, but it will be a black eye for the profession in our town if he is permitted to hold the office this year." Worthy men, most excellent men, but I have found this local problem between two individuals here, between two individuals there, and between these two factions representing individuals in the large cities, I have found this to be the problem before the whole medical profession. I find that the physicians' wives, who ought to find so much comfort in comparing notes and living in the same community, who ought to have the privilege of intimate communion and association, but I find in a large part of the country and in the cities this condition does not exist, but these two worthy women who ought to have so much comfort from association with each other are drifted apart and held apart from the friendship and association of which both are most worthy.

Now, if I draw a dark picture, it is not because it is a