Since its organization the Board has acquired an adjoining farm of 135 acres for the sum of $4,900, which will allow of direct communication with the railroad for the building of a spur track and also permit of sewage disposal construction down and direct to the river without need of acquiring any additional right of way.

The Board has chosen as superintendent of the Colony Dr. Donald L. Ross, who comes from the Staff of Kings Park Hospital for the Insane on Long Island and who has had additional experience at Craig Colony for Epileptics in New York State, where he was for three years first assistant physician. Dr. Ross is already at the Colony, taking care of the property, and advising with the Board as to its future development.

In view of the urgent demands for admission and the absence of proper housing facilities and all such accessories as naturally go with the care and maintenance of the inmates and attendants of an institution such as this, the Board could not see its way clear to open up the institution for the reception of patients until proper means were supplied. Hence the Legislature has been appealed to for funds to the amount of $350,000 for the building and equipment of fireproof structures to accommodate 120 patients (the estimated population for two and one-half years to come), heating, lighting and power plant, kitchen and diningroom, laundry, bakery, storeroom and cold storage plant, laboratory, mortuary, drug room and medical office, sewing room and mattress shop, and an employees' home.

Hearings have already been held before the Humane Institutions and Appropriations Committees, at which your President and your Chairman of the Committee on Public Policy and Legislation have appeared and given the weight of their influence, as representing this Society, toward the granting of the appropriation. The only question which seemed to arise in opposition thereto was as to the quality of material of which the cottages should be built, and we are in hopes that the State will now set an example in this appropriation for fire-proof buildings for public uses. In closing we desire to thank the Society for the confidence it has reposed in delegating such an important

matter to us, and at the same time we congratulate you upon the completion of a work upon which the Society set forth some

ten years ago.

Respectfully submitted,

EDWIN A. Down,

MAX MAILHOUSE,

A. R. DIEFENDORF,

FRANK K. HALLOCK,

Committee.

The Committee was discharged with thanks.

(13) Report of Committee on Contract Practice, by Dr. Seldom B. Overlock (Pomfret).

REPORT OF THE COMMITTEE ON CONTRACT

PRACTICE.

Mr. President and Gentlemen of the House of Delegates:

In making a definition of medical contract certain well established principles of law and precedent must be taken into consideration. A physician has as much right to enter into a contract as any other individual. Any capable person has a right to enter into a contract for his own benefit or advantage, provided always by so doing he does not infringe on the rights and privilege of others or contravene the law of the land.

In a legal sense, every time a physician undertakes a case he enters into a contract. He tacitly agrees to take care for the patient's interests, in so far as that patient's life and health are concerned, to the best of his ability; and the patient agrees to remunerate him for his services. These services include time, effort, and skill.

There have, however, from time to time, arisen in the relations of various members of the medical profession with various classes of individuals, or associations of individuals, special agreements which have come to be grouped under the general term "contract practice."

E*

The attitude of organized medical bodies or associations toward such contract practice should be threefold:

I. To see to it that those engaged therein shall not infringe on the rights of those not thus engaged.

2. To see to it that those engaged uphold the high standards of the medical profession.

3. To see to it that those so engaged give to the persons under their care a service equal in every respect to that given private patients.

Failure of those so engaged in any one of the above points should furnish presumable cause for interference on the part of the organized profession.

With this as preliminary statement, your Committee will define a medical contract as understood in contract practice as follows: A compact entered into by a physician or surgeon on the one part, and some individual or association of individuals on the other part, by which the physician or surgeon agrees to render an indefinite amount of service for a definite and fixed period of time, for a definite and fixed amount in compensation.

Under the above definition contracts may be divided into economic and non-economic, contracts that the laws and business exigencies of the country place beyond the power of medical associations to regulate, and contracts that may be so regulated.

Under the first class are those entered into with the general government of the country, as the army and navy and the marine hospital service, also those entered into with the state as superintendents of its institutions and in caring for its wards and employees. Such contracts are necessary both for economic reasons as well as to secure adequate and systematic medical care for the people who are under public charge. The same or similar reasons prevail in contracts with large corporations like railroads, mines, and insurance companies. It is manifestly necessary for the success of large business enterprises of the above character that they have men in position to attend to their medical affairs who can always be at hand, whose services are at any time available, and at the same time are those qualified by special training and experience in the work required of them.

There are also medical advisers, occupying a position in relation to medical affairs similar to the lawyer in regard to the legal affairs pertaining to the business of the corporation. It would be entirely impossible to distribute this work among all, or any considerable number, of the physicians living in the town or city where such business might be located. In addition, the remuneration from such business bodies to the medical men employed by them is nearly always fairly adequate.

Under the second class appear contracts made with voluntary organizations, commonly known as lodge practice.

From time immemorial, men have been accustomed to associate themselves in bodies for social or fraternal purposes. Originally these organizations were purely fraternal and any aid given to members was purely from brotherly love and a broad charity. Within, comparatively, a few years, there have arisen other forms of these benevolent associations. At first, the lodge carried with it a mutual life insurance for its members; next in order, weekly sick benefits were added, then came free medical attendance for the member or for the member and his family when ill, and finally some of them provide not only free medical attendance to the member when ill but also free burial when dead.

In those lodges which retain simply a mutual life insurance plan and nothing further, a physician is usually appointed to pass upon the physical condition of proposed members, and he is allowed a definite fee for the examination of each candidate. This is a definite amount in compensation for a definite amount of work and is, consequently, a legitimate contract.

When free medical attendance is given by a lodge each member pays an annual fee whether he be ill or not, and if ill, is attended by the lodge physician without further cost to himself beside the annual fee. The condition here is essentially this: the lodge buys the physician's services at wholesale, determining the price for itself, and farms out such services to the members at retail.

The objections to this kind of practice are many and evident. In the first place there is no justification from an economic standpoint for its existence. There is no reason why of two

men living side by side, receiving the same wages, and otherwise in like circumstances, one should receive medical attendance for two dollars per year and the other at a much larger price, simply because the first belonged to a lodge. The whole plan is essentially a bet between the member and the lodge doctor; the member puts up two dollars, or whatever otherwise the annual fee may be, the doctor unlimited services; if the member is not ill the doctor wins two dollars, if the member is ill the doctor is the loser.

A second objection is that it introduces ruinous competition. If one doctor will do it for two dollars, another can be found who will do it for one dollar and a half, or a less sum per annum. In this way the fee is reduced to a ridiculously small amount. No physician for such small fees can or will give good service, damage results to the patient and the community, and opprobrium falls on the medical profession as a result.

Added to this is the tendency to professional degeneration on the part of the doctor who does this kind of work. If this kind of work engage his whole time, he will become simply a hack in the profession. There will be no means of study or incentive to advancement, he will not contribute materially to medical progress. Furthermore, he cannot maintain his own. self-respect to that degree which he might maintain were he working untrammelled by contract.

To the investigator of contract practice it is at once apparent that this is in a process of transition in this state. It is in a stage corresponding to that of the larger cities ten years ago. What the conditions will be in this state eventually cannot be foretold with certainty, but it is fair to assume that it will be the same or similar to that found at present in many other sections of the country. Without exaggeration, it can, in all truth, be said that these conditions in many instances are deplorable.

The second part of the work assigned your committee is to suggest some means for the better enforcement of Sec. 2, Chap. XII of the by-laws of the State Society.

This by-law, as amended in 1908, reads as follows:-"Each county association shall judge of the qualification of its own