people to their support and so create a false appearance of public demand when you can, if you will work, round up thousands upon thousands whose expressions of approval will soon put a quietus upon any threats of Governors or legislature. Your part of the work can be done as you make your daily rounds. The task is not overly arduous. In place of sobbing and quaking get busy, right in your own community. If you are ready the Committee on Civic and Industrial Relationship and our Legislative Committee will outline the plan that will be statewide in its uniformity.

Let us forget the Governor for the time being. Let us forget the Boss Politician. Let us forget the legislature until it convenes. They will all listen and be eager to have us recognize them in these matters if we start now to educate the people and demonstrate to them what will be their dividends if the principles that we uphold for their welfare are accorded their support and endorsement. Think it over, doctor, but do more than think-work. Do not expect anything unless you work. Stop being the politician's weak-kneed vassal. Crack the whip a few times yourself and he will like you. You have got to exercise the old soup bone, however, if you wish to develop the muscle that will make the whip crack, and that means personal effort. Bring up. the subject at your next county meeting and start training now.

STATE MEDICINE

In requesting the editor of the State Journal to place the Dr. Hugh Cabot-Indiana State Medical Journal controversy before its readers, the Committee on Civic and Industrial Relations are pursuing the course laid down by its members, when they first took up their work some three years ago. The Committee decided that members of the medical fraternity were of age-that it was their right to demand of their officers and committees the fullest information on any subject and on any measure, which might affect their well being-that once the facts were placed before the physician, it was his duty to consider them carefully and then govern his actions accordingly.

With that in view, this Committee, without one dollar of expense to the State or County Societies, placed before the medical fraternity the question of Compulsory Health Insurance. The Committee showed the rank and file that, while admitting that an overwhelming majority of the members. of the medical profession were opposed to

Compulsory Health Insurance, the leaders of the American Medical Association, whom the rank and file had elected to safeguard their interests, were working hand in glove with the American Association for Labor Legislation, the author of the Bills being introduced in various states and the power which was fighting to force their adoption. This Committee also showed that these officials of the A. M. A., not satisfied with aiding and abetting the enemy, had employed the high priest of the Health Insurance Cult, Dr. I. N. Rubinow, to spread the infamous gospel, and the irony of the appointment is shown, when it is known that the funds of the overwhelming majority who were opposed to the scheme were paid to Dr. Rubinow for his work. This Committee has not been able to learn just how much was paid Dr. Rubinow, but the fact that he was paid anything is comment enough. And even the great A. M. A. Journal was dragged into the plan to socialize medicine, and to fight the great majority of its subscribers. It did the bidding of the handful, knowing that the great majority of the rank and file, the men who made it possible, were opposed to Compulsory Health Insurance.

These statements are simply statements of fact. They are made with no personal animus. As individuals, this committee has the highest respect for the gentlemen criticised, but as leaders, it can but point to their own spoken words which condemn them as no word from this committee could. In 1916, when every one was on the ragged edge, not knowing what minute this country might become embroiled in the world war, when physicians were so interested in outside matters that they had utterly forgotten to look after their own welfare, the American Association for Labor Legislation, staged a Compulsory Health Insurance love feast at Cincinnati in December. The shinings lights at this tenth annual meeting were Dr. Alexander Lambert of New York, member of the Council on Health and Public Instruction of the A. M. A., Dr. Frederick R. Green, salaried secretary of the same council, and Dr. Frank Billings of Chicago, Resident Trustee of the A. M. A. That no injustice may be done these leaders of the A. M. A., we quote verbatim from a stenographic report published in the Reports of the Tenth Annual Meeting of the American Association for Labor Legislation, Dec.

1916.

Said Dr. Billings: "I am UNEQUIVOCALLY in favor of Compulsory Insurance and the protection of maternity. That, I

think, must be the attitude of any one who studies the question of illness in its relation to economic conditions. I am in favor of them, too, because our present method of managing the sick poor is about as bad as it can be. To my mind, Health Insurance is going to be one of the best measures of preventative medicine. Such results will not be achieved except by some measure of State supervision, and I know of no State supervision which will equal State Compulsory Insurance. I would like to have Dr. Lambert describe a little better the provisions for an INQUISITORIAL body over all health insurance work. You know and I know that we do not do our work well unless there is some incentive, something to make us do it properly and so I think that in this bill there must be something of that kind." So much for Dr. Billings, Resident Trustee of the A. M. A.

Said Dr. Frederick R. Green (salaried secretary of the Council on Health and Public Instruction, who expressed the opinion to Committee in 1919 that an overwhelming majority of the Merical Profession were against Compulsory Health Inurance, but that if a bill were introduced in Michigan, we should not openly oppose it but rather get a commission appointed to make a survey. This Committee thought this queer advice at the time but in the light of the 1916 speech of Dr. Green, it shows that it was but one angle of the attempt to get Compulsory Health Insurance adopted by some state.)

"I would like to say just a word, not in defense or in apology for, but rather in explanation of the statement that nine out of ten physicians the country over would today, with their present knowledge of the subject, be opposed to Health Insurance. That is because physicians, as a class, are not given to considering abstract social propositions of this sort, and also because this proposed plan of social insurance radically alters the relation of the medical profession to the public. The relation of the physician to the patient has always been an individual one, and the basis of compensation has been payment for individual calls on individual patients. Under Health Insurance, this would be changed into the relation of a collective medical profession towards the public as a collective patient, and the great majority of physicians do not understand this change. While it is probably true that a large per cent of the profession would today vote against the proposition, I do not believe that there is a single member of the medical profession who has given it

careful and at all exhaustive study, who is against it. Through the Journal of the American Medical Association, through the Social Insurance Committee of that association, of which Dr. Lambert is the chairman, which was appointed to study this question, we are endeavoring to get the essential facts and educate physicians as rapidly as possible. It would be most unfortunate in any State to have a bill introduced and to have it, on account of some details or lack of understanding, opposed by physicians, for that would put them in the position of opposing what others feel is a much needed social reform. So all we ask at present is to give us time to educate physicians."

This from Dr. Green, whose salary was being paid by the great majority who were opposed to Compulsory Health Insurance, in 1916 and, if the reader will compare it with the advice given this Committee on Civic and Industrial Relations in 1919, he will have something to think about.

In 1919, this Committee placed the story of Compulsory Health Insurance before the physicians of Michigan and the result was that while Dr. F. R. Green, was telling the Chairman of this Committee that Compulsory Health Insurance would not come up in the House of Delegates at the New Orleans meeting because the Council wanted more time for study, Michigan delegates had joined hands with Indiana, Illinois and New York and were preparing a resolution which would bring a vote in the House of Delegates. The revolutionists carried the day, and by an almost unanimous vote Compulsory Health Insurance was voted down. by the representatives of the rank and file, after five years of intensive education by Dr. Lambert, and Dr. Green of the Council on Health and Public Instruction in its favor.

That is what the leaders of the American Medical Association have done to the rank and file of the Medical profession and out of their own mouths has come the evidence.

With the downfall of Compulsory Health Insurance, the leaders with one accord commenced to condemn Compulsory Health Insurance and to introduce varied brands of State Medicine. Our own Dr. V. C. Vaughan, Sr., introduced his particular brand at the Kalamazoo symposium, where young Dr. Apfelbach of Chicago, one of the debaters, took issue with him. Our leaders had become so accustomed to having what they said taken by the rank and file as the law and gospel that Dr. Vaughn was astonished at the temerity of the young physician who dared criticize what Dr. Vaughn

thought best for the medical fraternity. Dr. Vaughn's substitute for the Health Insurance was a Community Hospital to be built at every cross roads and to be the connecting link between city and farm life. Keep the boys and girls on the farm by the establishment of a community hospital was the refrain. Later the new Dean, Dr. Hugh Cabot, of the Medical School of Michigan University, who had succeeded Dr. Vaughn, came to Detroit and offered as his substitute Community Hospitals, subsidized by the state, manned by the staff of the University and under its direct control. Dr. Cabot very frankly said that the standards of the hospital would be very high and that possibly the local men might find themselves debarred from practice in the hospital, but standards would be kept up at any cost to the individual practitioner. Then Dr. Frank Billings took up the refrain in Chicago and again he was quite sure that he had found the cure for all medical ills. Strange to say, he echoed the call of his University brother, Dr. Cabot, in calling for State Subsidized Community Health Centers. The names varied but in every case the State was to pay and the physician was to be a hired man. "Compulsory Health Insurance" had been killed in New Orleans-but its twin sister "State Medicine" was very much in evidence and again the rank and file were being "educated."

At Boston in 1920, Dr. Billings was a candidate for re-election as resident trustee, the most important place in A. M. A. affairs. Opposed to him, were the veterans of New Orleans who had laid Health Insurance to rest. A copy of the speech made by Dr. Billings in 1916, before quoted, was circulated among the delegates. Dr. Billings asked for the privilege of the floor, and he made a speech in which he told of what he had done for the medical profession-of the many things he had tried to do. He announced that now he was opposed to Compulsory Health Insurance and State Medicine. But he absolutely forgot to tell anything about the 1916 speech in which he announced that he was unequivocally in favor of Compulsory Health Insurance and so must every thinking man be who studied the subject. He forgot to explain why, when he knew that an overwhelming majority of his constituents, the men who had elected him to represent them, he, their chosen leader, had abandoned them and joined hands with the enemy. And this committee have failed to hear of that point's being cleared up by Dr. Billings yet. At the close of the speech, there was presented the first

piece of machine work ever shown outside of a political caucus which has been arranged. The practical politician of medicine, the salaried Health official, was right on the firing line. From the south, Dr. Health Officer, with a voice quivering with tears, resented the insult to a beloved leader -from the east came fiery denunciation of men who dared question the acts of one of the anointed-from the west, sarcastic references to the character of men who would dare oppose a man of the candidate's fortune and medical reputation. The plan was well conceived and beautifully executed. But to the onlooker, it was ludicrous to see men who outside, were avowing their allegiance to "State Medicine," because it meant bread and butter to them, calling on delegates to vote for a candidate who was going sled lengths in repudiating Compulsory Health Insurance and State Medicine. This Public Health Service machine dominated Boston. It refused to permit a common sense definition of "State Medicine" being adopted and it ruled to haul those guilty of lese majesty in circulating the Dr. Billings unequivocal approval speech before the bar of the house and censure them. Could obsequeousness go further? Dr. Billings now is preaching the gospel that Socialized Medicine is dead and the battle scarred veterans in the war against State Medicine would rejoice, were it not for those queer schemes for Community Health Centers paid for by the state and by the state is meant any unit of the state, county, township, village or city.

Whether you call it "Comunity Hospital" or "Community Health Center" or "Community Hospital under University domination," the principle is the same "State Medicine" and write that large, lest ye forget and find yourself in another five-year educational campaign of the Council of Health and Public Instruction.

Call on your delegates to work to have a plain, common sense definition of State Medicine adopted by the Delegates of the A. M. A. meeting in St. Louis. Warn your delegates of the dangers of alliance with salaried health service officials. Bid them reject all the airy persiflage of professional educators and the camouflage of leaders who have not kept the faith and then you will not see a great medical association made the football of players like Dr. Alexander Lambert, Dr. Frank Billings, Dr. Frederick R. Green, Dr. Victor C. Vaughn, Sr. and Dr. Hugh Cabot. You will not see men you have placed in your highest offices representing the American Associa

soft berth provided by federal, state or municipal support.

However, aside from all this discussion of the economic phase of the situation as it affects doctors, there is a far more important matter for consideration and that is the one of the limitations of individual effort. It is quite possible that a few men occupynig soft berths may continue to progress, but for the vast majority there is little initiative, and in the main patients are going to fall into the hoppers of institutions that treat them in a rather impersonal and machine-like way, oftentimes with mediocre services. Aside from this there will be the ever-present political phase of the scheme to be dealt with, and experience shows that those selected for federal, state and municipal positions are not always those who are best qualified, but those who, for one reason or another, are able to control the most influence.

We have no quarrel with those who see fit to furnish free medical and surgical attention to the worthy poor, for that practice is upheld by every member of the medical profession, but the scheme proposed by Dr. Hugh Cabot is unworthy of acceptance as being the best for the people of the state. For the medical profession it eventually will prove annihilation, as private pratcice, except in a few isolated instances, can not exist in the face of that sort of competition.

It strikes us that Michigan has been flirting with several socialistic features, and the Medical Department of the University of Michigan long has been a thorn in the flesh of the medical profession of the state through its tendency to socialize the practice of medicine. Now comes Dr. Hugh Cabot, resplendent with the glamous of a reputation secured in the literary, aristocratic and aesthetic atmosphere of Harvard University, with revolutionary and bolsheviki notions which, as dean of the Medical Department of the University of Michigan, he expects to thrust upon the people of Michigan, whether the want them or not. Perhaps a certain element among the people in Michigan will shout their approval, but what about the members of the medical profession whose throats are being cut in order to furnish greater reputation and power for men like Dr. Cabot? And what about the people who in the end will be the greatest sufferers from from such an impracticable

scheme? As we have said before, if we are going into this socialistic business, why not socialize everything, like they do in Russa, and get the agony of the experience over at once in order to get back to the sane

conduct of affairs at an earlier date? It is as fair to put all vocations under state control as it is to put the medical profession there.

This whole question of state medicine reminds us of what we have said before, and that is that the medical profession has more to fear from members in its own ranks, men who have been placed in high positions very largely through the efforts of their fellow profesional men, who are really the worst offenders in advocating and supporting some of the wild, impractical and socialistic schemes which have as their ultimate end the annihilation of private medical practice. It is time to have an accounting and separate the sheep from the goats. We may have a very high regard for Dr. Hugh Cabot's ability, but we have only condemnation and censure for him in advocating such schemes as he proposes in Michigan, and the quicker the medical profession places its stamp of disapproval upon him when he continues to advocate such socialistic schemes as the one which forms the basis of this discussion, the better it will be for the medical profession in Michigan.

-Indiana Medical Journal, October, 1921.

Editor of the Journal of the Indiana State Medical Association,

406 West Berry St., Fort Wayne, Indiana. My Dear Sir:

Your editorial in the number of October 15th has been brought to my attention. Your reading of a newspaper quotation in which I am alleged to have said certain things is so diametrically opposed to the facts that I make haste to write you on the matter. You have apparently concluded from the newspaper paragraph which I do not recognize, that I am at some time supposed to have advised the admission to the University Hospital of patients who could afford to pay. Now this is precisely the reverse of the position which I have always taken and now take in the matter. The only alteration which has been made in the admission of patients to the University Hospital since my coming here two years ago has been the ruling that patients who can afford to pay a fee shall always be required to do so. I am quite of your opinion that it is improper to use the money of the State for gratuitous service to people not entitled to it and this opinion I have long held and expect to continue to hold. If the University Hospital were to admit patients who could afford to pay, I should be wholly of your opinion. As it does not and as every precaution is taken to avoid this form of pauperism, it appears to me that the criticisms you level at me are not well taken.

My opinions in regard to State Medicine to which you also refer are quite the reverse of those with which you credit me. I have always been opposed to it and my published statements on the subject might readily be obtained. I would refer you to my paper entitled "Compulsory Health Insurance, State Medicine or What" delivered as the Annual Discourse before the Massachusetts Med