governors of fifteen states. It served to draw public attention to the higher aims of the association and to mark a notable step toward the education of the public and of the general practitioner in the care and prevention of insanity and mental deficiency.

The advance of medical science has brought preventive and social medicine to the front and has demonstrated how great a part the physician as an individual and as a member of a united profession is to play in the social movements of our time. There is no more promising field of effort in preventive medicine than the prevention of nervous and mental disease. The modern trend of united professional effort is well shown in the resolutions passed by this association. These men are no longer content to make mere statements of scientific fact; they contemplate action and show that the physician is not merely a scientist, but a philanthropist and a citizen as well.

The resolutions indicate the direction in which the association hopes to influence public opinion. The first recommends custodial care or sterilization for the feeble-minded, the epileptic, and the criminal insane. This places before the medical profession and the public a very important question. Already the experiment of legislation on this subject is being tried and seems likely to be greatly extended in the near future. This movement needs to be guided to a sane conclusion by the medical profession and every physician has the responsibility of preparing himself to help settle the questions involved.

A second resolution calls attention to the danger to the public from intemperance and insanity among railroad employees, and recommends the exclusion from such service of men who drink either on or off duty and suggests an examination from time to time in order to exclude those found to be mentally unfit.

The third important resolution recommends the teaching of eugenics to high school pupils. To this ought to be added some means of reaching the large proportion of the population whose education does not include a high school course. A larger attendance is expected next year, and two years from now it is hoped that the meeting will have an international scope. It is not easy to estimate the importance of these meetings, and while we commend the Chicago Medical Society for its forward step we may suggest that other societies may follow by giving similar prominence to topics on which the public needs information and leadership.

Correspondence

MEDICAL ECONOMICS

CHICAGO, Aug. 15, 1913. To the Editor:-The keynote of medical economics was sounded in the July issue of this JOURNAL by President Whalen. There is no questioning the fact that there are comparatively few physicians, frankly speaking, who honestly get what should be termed a fair living, in keeping with the requirements of a professional life. To earn such a living is also growing more difficult each year, to say nothing of the rise of living expense, so that it is not far-fetched to compare conditions which economically threaten the profession in England with those in America. The outlook bodes ill for us unless the leaders in this country will cease thinking about themselves so much and look more to the welfare of the profession as a whole.

There are very many contributing causes to this economic condition. In all other pursuits for a livelihood, competition has been the main factor in reducing the number of prosperous individuals in their respective callings. In the medical profession, however, competition should be the smallest factor, providing each one in the profession will act as a fractional part of the whole, for the good of the whole. Such, however, is not now and never has been the case, and our leaders are too largely responsible. There is not a student who, when he graduates from a good medical college, is not imbued with the spirit of dignity, honesty and self-sacrifice, which should be the main qualifications of every physician. There is not a graduate of these colleges who does not put on a pedestal of moral idealism the members of his faculty, but when he enters the ranks to earn a livelihood in an upright, dignified manner he soon discovers that very many of the men, whom he held in such high esteem as promoters of the road of ethical practice, do not travel that route themselves, but seek more profitable bypaths along which are to be had for the picking, the cutting of prices, outright stealing of cases, damning brother practitioners, newspaper notoriety, and all the crass commercialisms which the code of ethics taught by them in college denounces in no uncertain terms.

Fortunately, not all our old-time teachers are guilty of all these things. The majority of them are honorable men in many particulars, but somehow the self-importance of certain prominent individuals amongst them leaks into the lay press often enough to make good business for them

selves, no doubt, but to set at naught the ethics they upheld so eloquently in the amphitheater. A few men have striven to control the clinical material of certain medical centers without regard to the effect it would have on the patient, on the profession and on the public at large. In these and other matters selfish ambition and personal and professional jealousy mar the fair figure of medical idealism. Medical education in the recent past must have been worse in Europe than it is to-day in America. If one of our late leading surgeons and pathologists a foreign a foreign graduate in medicine could pay $400 for the privilege of being on the staff of Cook County Hospital, he must have felt within himself that he did not learn sufficient in his medical course across the water.

Only recently a man of great prominence in the medical profession of this city remarked that he would have been glad to pay for the privilege of being on the Cook County Hospital staff at the time he began the practice of medicine, intimating also that doctors ought to be glad to pay now for the privilege of medically serving Cook County for nothing. No one can doubt that this statement was made in absolute sincerity, but what a reflection on the whole profession and on the system of medical education! What effect would such a statement tend to have on the public at large? Surely doctors should pay the people for the privilege of treating them. Furthermore, in all humanity, should Cook County employ physicians to attend its sick who feel themselves incompetent and are willing to pay for the privilege of completing their education by experimenting on poor patients? The county which calls in the doctor without recompensing him is, by the way, not poor. These are all serious questions, and we intend later to write more specifically on each of the factors herein. touched on.

The peculiar attitude which we doctors have assumed and maintained for decades toward this question of the care of the public's sick is illogical and anomalous, and should have, if it has not in fact, had its bad effect on the patient in question. Conscious of the physician's feeling, he should logically conclude that he does not need to pay a doctor, because he is the greatest factor in teaching him his business; indeed, perhaps the patient ought even to receive monetary return for being experimented on. We do not know of any other calling where even for experimental purposes the experimenter does not receive pay for labor and time expended, trying to benefit someone else. There is nowadays almost a house to house canvass for patients by the agents of clinicians look

ing for clinical material; and many a patient in our metropolitan centers has made all arrangements with his physician to have some condition treated for a certain agreed price when the philanthropic (?) clinical agent appeared and he was carried off to "the great medical college" to have his ailment treated free, while the learned professor expounded this wonderful sickness, thus demonstrating to the patient that had he had that ordinary M.D. attend him, he would have been mistreated and robbed, having actually to pay for service. These physicians of prominence are perhaps not aware of the harm they are doing. They serve on hospital staffs, where, in order to help the institution, they accept patients into the wards for the mere price of a bed, and do not try to find out whether they are able to pay a physician's fee. And we affirm without fear of successful contradiction that there are many more patients in hospital clinics to-day who are able to pay more than an ordinary fee than there are patients treated outside of hospitals who pay less than ordinary fees. And all this is done without impressing on the patient that he is receiving something for nothing. The same class of physicians are trying to control the insurance corporations.

There are now in Chicago upward of two hundred thousand employees who are insured against accident, sickness and injury. There are approximately two hundred thousand patients treated in wards of hospitals and dispensaries free of charge, and there are approximately five thousand physicians in Chicago to take care of the balance of the two million people who "sometimes" pay their doctor bills. To figure out the average income of this remaining 1,600,000 people, from whom the doctors must earn their livelihood, is to see how much there might be for each doctor to make honestly out of the practice of medicine and survive in Chicago. And this does not prevail in Chicago alone, but in all medical centers of America. The hospital and insurance evil are even encroaching on the smaller towns so that the country practitioner's income is also being cut. All this certainly has a demoralizing effect on the profession at large. We must live, and in order to live we must have an adequate income. To this end we must get business, and the door of irregular practice stands open, inviting to easy but tainted money. Quackery is on the increase, and right here we wish to state that quack ads to-day, as bad as they are, do not do as much harm as some of the statements made by some of the men whom we idolize, merely because they wish to rush into print without giving the profession a thought.

The effect this has on the people at large is evidenced by public institutions and hospitals run by the so-called philanthropists, at the expense of the physician, because they can always get a physician to work for nothing, whereaas they have to pay their janitor, fireman, cook and social worker, who with the philanthropist receives this quid pro quo. But the physician on the charity staff must do his work or lose the coveted job to the many other fool doctors who are ready to step into it over his professional corpse. And so it comes about that the public has little confidence in the physician's opinion, as evidenced in our farcical expert testimony, and in many expressions that the reporters may get from doctors on any subject for newspaper publication. These evils can be remedied by the profession itself if the individuals who have up to now acted as selfappointed representatives will unite with their fellows for the benefit of the whole profession rather than for their own self-aggrandizement. We should not give out any opinion to the lay press until we have talked it over and reasoned out the effect it would have on the profession as a whole. Then the now self-appointed representatives would have a healthy growth, and their influence would be of lasting value. It is easy to throw stones. Yes, and there are many targets to be hit, and hit hard.

BENJAMIN H. BREAKSTONE, M.D.

32 North State Street.

CONTRACT PRACTICE

CHICAGO, Aug. 15, 1913.

To the Chicago Medical Society, Greeting:I hereby wish to refer to the Chicago Medical Society "a case," which I believe is of such importance to the medical profession in general, that it should not be allowed to rest as a personal matter, pertaining to myself only.

History. I was called, April 25, 1913, by Mr. Louis H. Verick of 3122 Indiana Avenue (called on me in person and took me to 3821 Indiana Avenue) to see his employee, Mike Meyer, who was injured. Patient had emergency (first aid) dressing applied before my call. I was employed by L. H. Verick to treat patient. Had to make surgical dressing to bad scalp wound, also one to right elbow for bad laceration and some maceration of tissues, besides ordering medicine for fever and liniment to other parts of body. I state this because I charged $3 a call for material used and services, and subsequently $2 for office dressings, making a total of $44 for entire amount. Patient being well and discharged cured,

I presented my bill to Mr. Louis H. Verick. I then received a call from an agent of the Standard Accident Insurance Co., 175 W. Jackson Boulevard, and was informed my bill was too high, etc., and they were willing to make a settlement by paying their customary fees of $2 at residence calls and $1 office calls. I told him that I had nothing to do with the insurance company, that my bill was for services to Mr. Louis H. Verick, that in fact I never did allow any company or individual to put a price on my services, etc., and he then told me I would not get any more work from his company. To this I answered that Mr. Verick employed me in this case and as I was not a scab I did not want to prostitute my profession by cheap labor; at this he drew out a typewritten paper containing the names of many physicians. I regret I did not make notes, but I now distinctly remember seeing the names of A. H. and of Dr. H. (they impressed themselves on my mind more than others, for both are classmates of mine) and the agent stated that "all these physicians are doing and have done work for us and our fees are $2 at residence and $1 for office dressings." I ordered the agent out of my office and informed Mr. Verick that I would look to him to pay the bill: after some more time passed by I sent a letter by mail to Mr. Verick, informing him that the bill was overdue and expected payment of same. Mr. Verick informed me he forwarded the same to the company and asked for sufficient time to get a reply. In the meantime Mr. Louis H. Verick never denied nor disputed my bill, and in fact stated he was responsible, only he could not pay it because the insurance company was responsible to him, as he was paying for the insurance of his employees. Only July 25, 1913, the following was handed me by Mr. Verick, which he received from the Standard Accident Insurance Co. (pre

sumably). Letterhead-Henry B. Bale, Adjuster,

Suite 1047, 175 W. Jackson Boulevard; Phone, Wabash 1792.

Louis H. Verick, Esq.,

CHICAGO, July 25, 1913.

3122 Indiana Avenue, Chicago, Ill.

Dear Sir: I have your letter with reference to the bill of Dr. Kercher. We do not propose to pay Dr. Kercher's bill until he reduces it to $35. We have told him this over the telephone, and if he is not satisfied to take that, let him sue for the bill, and we will defend you. We are not going to be held up by him or any other doctor for excessive doctor bills. and that is particularly true when, as a matter of fact, under the compensation act he could not collect anything from you. Dr. Kalliontzis was the first doctor called, and his bill is the only one we ought to pay. We have paid him in full for the first treatment.

Let me suggest this: when Dr. Kercher takes this matter up with you again tell him he must take it up with us, and that it is in our hands entirely. Yours truly, HENRY B. BALE.

Now, to this I told Mr. Verick that I must not take this matter with them, and I am not going to. So it is up to me to either accept $35 or bring suit against Mr. Verick.

Furthermore, in order that a comparison can be made with the treasurer's report, we strongly recommend that the secretary's report of receipts cover the same period as the treasurer's report. Yours very truly,

ERNST & ERNST,

Certified Public Accountants.

REPORT OF EXAMINATION ILLINOIS STATE MEDICAL SOCIETY May 16, 1913

to take interest in this matter.

I ask the Chicago Medical Society to furnish legal services, to sue Mr. Louis H. Verick for the bill, thereby forcing the insurance company to an issue and to make them show that they already own a large number of physicians to whom they dictate prices and parcel out work, or show this insurance company up as arrogant bluffers. Very respectfully,

3144 Indiana Avenue.

JOHN KERCHER, M.D.

AUDITOR'S REPORT ILLINOIS STATE MEDICAL SOCIETY, MAY 16, 1913 August 21, 1913.

Board of Directors,

Illinois State Medical Society.

Gentlemen:-We have completed an examination of the accounts, records and vouchers of the Illinois State Medical Society covering the period from May 16, 1904, to May 16, 1913, inclusive, and have submitted to you a complete detailed report on same.

We can say, however, in substance that we found all funds properly accounted for in accordance with the records.

We have also examined the published reports of both the secretary and treasurer appearing in THE ILLINOIS MEDICAL JOURNAL. We found some errors in these published reports when same were compared with the figures in the books of the Society. These errors are evidently of a clerical nature.

We recommend that the Society, in its published reports each year, should be given complete details of receipts and disbursements. In our opinion the reports in the past have not been in sufficient detail to enable anyone to clearly understand them without access to the records.

Board of Directors, Illinois State Medical Society. Gentlemen:-In accordance with your request we have made an examination of the books of account and records of the Illinois State Medical Society for a

1913, inclusive.

We have used May 16, 1904, as a starting point for our audit, as we found on file a signed certificate from the National Bank of Decatur dated May 16, 1904, to the effect that the balance in the bank to the credit of Everett J. Brown, Treasurer, Illinois State Medical

Society, on that date was $1,127.45, and this balance agreed with the books of the Illinois State Medical Society on the same date.

We were advised that each year the Treasurer's annual report covering the financial transactions for the preceding year was published in the ILLINOIS MEDICAL JOURNAL, but on examination of these JOURNALS we were unable to find any Treasurer's annual report published after the one for the year ending January 1, 1910, until the year 1913. This last report was from January 1, 1913, to May 16, 1913, and accordingly we submit (on page 184) a statement of the cash receipts and disbursements from May 16, 1904, to May 16, 1913, and these figures are based on the Treasurer's reports which have been published.

In the three years from Jan. 1, 1910, to Jan. 1, 1913, for which we could find no reports, we have endeavored to analyze the receipts and disbursements along the same lines that were followed in the preceding published reports.

In our examination of these published reports we found several discrepancies in the totals as compared with the book records, but in most cases the errors appeared to be in the printing of the figures in the reports. The published report for the year ending Jan. 1, 1909, was very meager and differed in its general arrangement and lack of detail from all the preceding reports. This report contained the following:

Balance on hand Jan. 1, 1909..$ 9,859.19

On Jan. 1, 1909, the general fund amounted to $6,058.69, and the balance in the bank to the credit of Medicolegal Defense Committee amounted to $3,799.50, a total of $9,858.19 or a discrepancy of $1.00, as compared with the published report, if we combine the General and Defense funds. All of the other published reports show the General Fund separate from the Medicolegal Defense Committee Fund.

Our audit of the cash transactions was very thorough. The entries in the cash book representing disbursements were verified by an examination of not

only the cancelled bank checks, but also all other invoices or vouchers on file. In most cases there was a cancelled bank check, as well as a voucher, to support the disbursement, but in all cases we were able to locate either one or the other.

We were unable in the time available to verify the cash receipts from advertisements. This could only be done by a comparison of the cash received with the advertisements appearing in THE JOURNAL, and such a verification would require a lengthy examination. Accordingly we have used the book figures for such receipts without independent verification by us.

According to the records the Secretary has turned over the following amounts:

ing to the Secretary's books he turned over to this fund early in June, 1913, the amount of $269.00 which would increase the balance on hand July 1, 1913, to $11,864.93.

According to a certificate from the Farmers' State Bank, Belvidere, Ill., the balance in this fund on July 1, 1913, amounted to $12,042.26, and this increase of $177.33 is possibly interest earned on the savings account.

We call your attention to the large amounts which have been paid by the Medicolegal Defense Committee to Dr. N. H. Moyer, and up to the present writing we have seen no vouchers or invoices of any kind to support these payments. It is our opinion that your vouchers

We have verified these receipts by direct reference to the Secretary's records, although we have not confirmed any of the amounts received by the Secretary by direct correspondence with the party remitting to him.

According to the detailed schedule of cash receipts and disbursements, the balance on hand May 16, 1913, in the General Fund amounted to $5,570.68, and we have reconciled this amount with the balance on hand in the Farmers' State Bank, Belvidere, Ill., on July 1, 1913, as shown by a signed statement received from this bank.

We show a statement of the earnings of "THE JOURNAL" (on page 185), and according to this statement, which is based wholly on the cash receipts and disbursements, the income from advertisements, etc., from May 16, 1904, to May 16, 1913, amounted to $34,900.99, while the expense (exclusive of the salary of Dr. G. W. Kreider) totaled $61,388.20, or a net loss for the nine years of $26,487.21.

On page 185, we show an exhibit of the Medicolegal Defense Committee from September, 1907, to July 9, 1912. On this date the cash on hand amounted to $8,923.15 and we were unable to find any record of the transactions of this committee from that date to Jan. 1, 1913, although we found that the Secretary, according to his records, had turned over to the fund during the period stated the sum of $921.00. After taking this into consideration the balance on hand would amount to $9,844.15 on Jan. 1, 1913. On the same date, however, the present Treasurer starts his published report with a balance on hand of $9,958.93, an increase of $114.78, and this may be interest on the savings account, but we were unable to confirm same, owing to the limited time available for this report.

This published report showed a balance in the Defense Fund on May 16, 1913, of $11,595.93, and accord

DR. H. N. MOYER

ILLINOIS STATE MEDICAL SOCIETY

Board of Directors, Illinois State Medical Society. Gentlemen:-Supplemental to our report of July 22, 1913, on the cash transactions of the Illinois State Medical Society, we submit herewith a statement of the receipts and disbursements of Dr. H. N. Moyer, representing the Defense Fund of the Illinois State Medical Society for the period from Oct. 1, 1906, to June 30, 1913, inclusive.

We have verified the disbursements by comparing them with vouchers submitted to us. There were no vouchers, however, for a number of the disbursements and we append a list of the items we were unable to verify.

The balance of $547.39, as shown on this report, agrees with the balance as shown by the records, but we have not confirmed it by correspondence. Yours very truly,

[SEAL]

ERNST & ERNST, Certified Public Accountants.