Cross Society donated a second cottage which was set aside for children and was the first hospital in Detroit to be used exclusively for tuberculous children.

Until July 1, 1909, Dr. V. C. Vaughan, Jr., was alone in this work, attending all patients at the clinic and at the hospital and making such house calls as were necessary at the homes of the clinic patients. All of this work was done at first without salary and subsequently for a small remuneration because of the great interest in his work and the admirable humanitarian character possessed by Detroit's pioneer tuberculosis expert. Now the duties had grown so manifold that they were beyond the grasp of one man and Dr. Guy H. McFall was appointed as an associate. Until this time the nursing service had been donated by the Visiting Nurse Association, but in 1909 an appropriation was allowed for the appointment of a nurse.

During the year ending June, 1910, 137 patients were admitted to the hospital and 30 cases remained from those admitted previously, making a total of 167 patients cared for during the year. Patients were admitted without any regard as to whether there was hope for their ultimate recovery or not, the only provision being that they could not enter unless there was room for their accommodation. They were classified as follows: Early stage, 35 cases; moderately advanced, 51; advanced, 81. Again quoting Dr. Vaughan's words as to results:

"The results obtained in the case of the early and moderately advanced cases are distinctly encouraging. Thus, out of 48 moderately advanced cases who remained in the hospital for a period above one week in duration, 44 showed material improvement in weight and general condition-a percentage of 90. Moreover out of 36 moderately advanced cases who had left the hospital during the present year, 20 are at present engaged in some form of labor, in other words 55.5 per cent. of the moderately advanced cases who have left the hospital are working and to a certain extent self supporting at present. With regard to the early cases, out of 35 patients remaining in the hospital for periods of one week or over, 32 showed improvements in weight and general condition, a percentage of 91.4. Among 33 early cases discharged from the hospital, 20 have been able to return to their work-a percentage of 78.7. The cases which returned to work after leaving the hospital are carefully followed at the clinic in order to see that they do not retrogress."

THE DIAGNOSTIC CLINIC. During the following year the work continued with an enormous growth-702 patients made 6,020 visits to the clinic as compared with 533

patients who came 2,923 times the year previous. The number of nurses doing tuberculosis work was increased from one to three, and these nurses made 1,614 visits to homes of patients. During the year 249 patients were admitted to the hospital. In April, 1911, Dr. Vaughan inaugurated an extension of the work in what he termed a "Diagnostic Clinic." The regular clinics were being held daily, except Sundays, from 10:00 to 12:00 a. m. The diagnostic clinic was opened daily from 4:00 to 6:00 p. m. and was for the purpose of examining children not known to be tuberculous but of tuberculous parents. Dr. Vaughan's idea in 'choosing this hour was in order to obtain records of any elevation of temperature or acceleration of pulse which will manifest itself, if at all, at this time of the day. Moreover children could attend without interference with their school duties. Special tuberculin tests were employed, when necessary, to arrive at a certain diagnosis.

In a comparatively short time 80 children were examined and among them were discovered 40 children with undoubted tuberculous disease who were apparently in good health and who had manifested no symptoms at the time of examination, although definite physical signs of the disease were present. The importance of the detection of these cases is evident as it brings under observation early closed cases, a large proportion in fact, practically all of which, under proper care and attention, will be completely cured without ever becoming, at any stage, a source of danger to others. This is one of the most important phases of the work ever undertaken and it was due entirely to Dr. Vaughan's watchfulness and ever increasing interest in this subject.

CLINIC WORK ADVANCES.

During the year ending June 30, 1912, the number of beds available at the Board of Health Sanatorium was increased to 75. The work at the clinic further increased, the number of new persons examined during the year being 888, besides which there were 270 patients carried over from the previous year. The most striking fact in connection with the work of the Tuberculosis Clinic now is that so large a number of persons not suffering from the disease present themselves for examination. This is the very result that had been hoped for by Dr. Vaughan and he expressed it in his report of that year: "When you take into consideration both those that were found not tuberculous and those who could be classed as suspicious, we have a little more than half the entire number who presented themselves for examination at our clinic. This means that 264 persons who have been exposed to the disease and who had reason to suspect that they might have contracted it, sought instruction in

how to protect themselves against it and that 182 who had positively suspicious cases of tuberculosis will now become entirely well."

On September 3, 1912, The Nellie Leland School, an open air school for cases of closed tuberculosis, was opened. This school was erected by the Detroit Society for the Study and Prevention of Tuberculosis. The building was paid for by Mr. Frank B. Leland and was situated on ground purchased for the purpose and given rent free by the late Mr. J. L. Hudson. The Detroit Board of Education and the Detroit Board of Health co-operated with the Detroit Society for the Study and Prevention of Tuberculosis in the management of the school. The Society furnished the school and subsequently the provisions for the pupils, the Board of Education furnished the teacher and the Board of Health provided the physician and the nurse. Dr. V. C. Vaughan was the physician chosen by the Board of Health to take charge of this work. The pupils were carefully selected from diagnostic clinic and were admitted by Dr. Vaughan, who visited the school at least once a week to keep track of the physical condition of the children. In a report written at that time, Dr. Vaughan said:

"From a medical standpoint the School has proved a decided success and it is to be hoped that the beneficial results obtained will lead to the establishment of similar institutions in the near future, as at present we find it possible to take care of only a few of the cases which should be provided for in an institution of this sort."

The hope expressed in the above paragraph has been realized as a number of open air schools have been established. The year following the opening of the Nellie Leland School, brought an open air school in connection with the Tuberculosis Sanatorium of the Herman Kiefer Hospital and since then there have been added several open-air rooms or pavilions in connection with a number of the public schools of the city. By July, 1913, the accommodations at the Hospital had increased to eighty-five beds and two additional Tuberculosis clinics had been established, one in the extreme western end of the city and the other in the northeastern section.

At this time my activity as Health Officer ended by resignation, but fortunately for the city, Dr. Vaughan was induced to continue as chief of the Tuberculosis Division of the Board of Health. The work has grown tremendously since thenthe hospital now houses 170 patients and will soon accommodate 35 more, making a total of 205 on the old grounds. On the other hand an appropriation of $1,000,000 is available for a fine, large Tuberculosis Farm, the grounds for which have been purchased near Northville. The number of clinics is growing constantly as is the number of physicians and nurses.

In 1917, Dr. Vaughan entered the Medical Service of the army but previous to that time a pretty romance occurred in connection with For his work in The Department of Health. several years previous to 1914, Miss Elsbeth Hosig was chief nurse of the Tuberculosis Division and as such was brought into daily association with the.chief physician. She was his right hand support, as faithful in the performance of her duties as the doctor himself, deeply interested in his success and congenial as his coworker. It was a natural consequence then perhaps, but a beautiful sequel, that Miss Elsbeth Hosig became Mrs. Victor C. Vaughan, Jr. His faithful and tireless co-worker became his cherished and devoted wife.

AN UNTIMELY END.

Unfortunately the brilliant career of Dr. Vaughan was cut short by his untimely deathJune 4, 1919-when he was about to return from France to his native country, from army service to his life's work. The work of the Detroit Department of Health for the prevention of Tuberculosis will continue to progress, but it must never be forgotten that it will do so because of the solid foundation laid by Dr. V. C. Vaughan, Jr., a foundation so well planned and so carefully set that conditions can not change nor time efface it. His labors in behalf of the Tuberculous poor, painstaking, self-sacrificing, noble, will always remain as an inspiration to those who follow him. His beautiful character will never be forgotten. All honor to his memory!

sis. It emphasizes the fact that in many, if not in all cases, strong etiologic factors are at work in the physiologic domain without minimizing the importance of factors that are psychical. Rather, it brings new proof, of a physical character, of the conception that, in the war neurosis, an initial weakness operative in the psychical field, is essential.

(Arch. of Neurol. & Psych., Oct., 1919, Davis).

What are we as a profession doing in regard to the cancer problem?

We recall a few years ago, yes quite a few years ago, that we had a Cancer Committee. We also remember that that Committee was formed at the instigation of Dr. J. H. Carstens. For some reason or other that Committee was discharged and the work it had begun remains unfinished. It is true that from time to time our attention has been called to the subject by the writings and discussions of Dr. Carstens but there our activity ceases. Why? Is Dr. Carstens alone to carry on, or are we going to rally to his support in the discussion of this subject, the dissemination of public information and the pursuit of a definite plan to combat the inroads that are made by cancer?

We now know that the persistent work of our Anti Tubercular Committees is producing results. The Anti-Tuberculosis movement is accomplishing definite results in lessening the

mortality rate of that increase. The same results can be secured by like effort directed toward the cancer problem.

We ask for volunteers who will consent to bring before our next meeting a definite plan of action. Will you volunteer to act on such a committee?

ORGANIZATION MISNAMED.

For seven years we have been preaching organization, earnestly and sincerely, not as a hobby but as a duty we felt we owed to the profession. We have seen increasing evidence each month, each year, of the need of compact medical organization that means more than payment of dues and occasional attendance at a society meeting. Organization that is constructive, organization that is productive, organization that is protective and organization that is combative for the rights of the profession as a whole and for the individual.

We have observed the complacency with which these "preachings" have been read or ignored. No real attention has been given to the warnings issued and no particular interest has been taken in the future that awaits the profession

a future that is filled with dire potentialities that will sweep aside, break down all that the years have wrought for us as doctors of medicine. We have, as an organization, complacently let the politician, manufacturer, corporation, insurance company, business man, community, county and state governing bodies tell us what we were or were not to do and only on rare occasions have we raised a voice in protest. We have quietly and true, with inward grumbling, acquiesced without making an ef fectual effort to protest or dictate in how so far we were to be dictated to.

If you doubt the last declaration, please tell us what was done to outline the profession's protection when the Compensation Law was enacted and the recent amendment passed to protect the doctor from the dictation of the Board or Insurance Adjusters for medical services? What protest was made when the narcotic tax was increased 300 per cent. for the

permission to scientifically prescribe opium and its derivatives? Who stood idly by while legislators and W. C. T. U.'s made it impossible to secure "undoctored" alcohol unless we filed bonds for which we paid a premium to insurance companies? What was done when an arbitrary ruling was made in regard to our income returns? And so we might continue for ample instances are on record where we have stood idly by and done nothing. And what is more, we seem content to remain in the same state of somnambulism and permit the imposition to continue.

And now there threatens state compulsory health insurance. If that act is adopted when introduced the very foundation of medicine will be invaded. When that time comes, if the physicians do not present a solid front and stand together in their demands for just standards. and adequate remuneration, we will be caught between the two biggest forces in the state and crushed. Medical practice will be so lowered that eventually it will be impossible to practice honestly and live. The two forces are employer and labor-one seeking to keep the cost as low as possible; the other to demand the maximum of medical benefits.

Our salvation will depend upon how well we can organize for collective bargaining. Our only hope lies in organization and the use of that power to control the situation. Do you wonder we are concerned and view with alarm

hazy mists of the past. As we pause to reflect, the memories of a year ago appear to be enveloped in a haziness with indistinct minor details. Scarce can we believe that on November Eleventh, one year ago, the world's war terminated and hostilities ceased.

You who were home recall the frenzied event of American spirit that greeted the first peace headlines and the subsequent days of celebration as well as the silent "Thank God, Its Over," that you breathed when the truth of the news was verified.

You who were "Over There" require no word to recall your hesitating belief and emotion when the word was flashed along that November morning commanding hostilities to cease at eleven o'clock.

To all there will, no doubt, come a reminiscent hour on this November Eleventh, the first since hostilities ceased. And as you engage in your retrospective reflections on that day we make this request:

That as the hour of Eleven strikes on the Eleventh of this month, every doctor in Michigan, no matter where he may be, no matter what he is doing, even in the midst of an operation, pause in his work and in bowed silence pay our reverent tribute to those of our number who made the supreme sacrifice. Our Heroic Doctors kept the faith; we too must keep faith with them. Let other events be forgotten, let other memories fade and die but Doctors of

awake? Not until we do will we be able to

dam back the force that surely threatens to submerge us.

As we headed this editorial, at present as an organization we are misnamed unless we concern ourselves with other problems than those. purely scientific in character. Again we ask --are we awake or awakening? What are you going to do about it?

NOVEMBER ELEVENTH.

The rapid trend of events, the wonderful changes that are being wrought, the busy and crowded hours of the last twelve months have already enshrouded the war days in the first

Michigan forget those of our number who went

forth, as our representatives, but who now sleep on foreign soil. May we never be disloyal to their memory.

MEETING OF THE THIRTEENTH
COUNCILOR DISTRICT.

On the evening of October 7th, we had the pleasure of being present at the meeting of the Thirteenth Councilor District held in the Fayhall Hotel at Cheboygan.

After satisfying the demands of the innerman at an excellent dinner, the attending members, twenty-five in number and representing

Alpena, Alcona, Antrim, Charlevoix, Cheboygan, Emmett and Presque Isle counties, proceeded immediately to the business of the meeting.

Following a short address of welcome by Dr. Tweedale, secretary of the Cheboygan County Society, most enjoyable papers were presented by Dr. Baker, our worthy president of the State Society, Dr. Van Leuven of Petoskey and Dr. Slemons, of the State Health Commission.

One of the most noticeable features of the meeting was the intense interest and spirit manifested by these hustling members of the district in the real matters of organization and the furtherance of their common welfare. Dr. Parks, the Councilor for this district, is indeed fortunate in having the backing that was evidenced at this meeting and although certain parts of the district are not as efficiently organized as they should be, the spirit evinced by the attending members should soon overcome any lack in this direction.

Probably the crowning feature of the meeting, was the remarkable record made by Dr. Tweedale of the Cheboygan County Society, who in less than a month's time, by unstinted effort and application, brought the membership of his society from the disheartening number of two active members to include every physician in his county, registering 100 per cent. in membership for the meeting and attaining a record of which he may well be proud. This shows what can be done if the effort is there and Dr. Tweedale's work should be an incentive to EVERY county society secretary in the state.

We take this opportunity to express our appreciation of the efforts of Dr. Parks and Dr. Tweedale for the success being achieved in the organization of the Thirteenth.

THIRD SURVEY OF HOSPITALS. The third survey of hospitals being made under the auspices of the American Medical Association is now well under way. Through an extensive correspondence and a third questionnaire the Association has collected a mass of information on the subject. Much of this ma

terial has been tabulated and forwarded to comImittees in each state representing the state medical associations. Most of the state committees have arranged definite lines of action and by inspection of the hospitals or by other methods are securing first hand information by which the data collected by the Association is being carefully checked. The immediate end sought is to provide a reliable list of hospitals which are in position to furnish a satisfactory intern training. The investigation is not limited to intern hospitals, however, but will cover all institutions and the data obtained will be useful in any future action which may be taken in classifying hospitals. The work in Michigan is in charge of a committee of which Dr. George L. LeFevre, President, Board of Registration in Medicine, Muskegon, is Chairman, the other three members being Dr. Guy L. Connor, Member, Board of Registration in Medicine, Detroit, Dr. A. M. Hume, Owosso, and Dr. D. Emmett Welsh, Treasurer, Michigan State Medical Society, Grand Rapids. The closer relationship which the hospital now bears to the public in the community which it serves makes it all the more important that the service rendered by it shall be excellent in character.

DIVISION OF FEES.

The law published below was passed by the last legislature and is now effective. This act makes it a punishable offense.to split fees. He who continues to pursue such a course becomes amendable to this law. It is to be urged that those who indulged in the practice will discontinue doing so.

Senate Bill No. 282. File No. 264.
Introduced by Senator Hayes.

State of Michigan

50th Legislature

Regular Session of 1919.

Senate enrolled Act. No. 69.

An act to prohibit the division of fees by physicians and surgeons and to provide a penalty for a violation of the provisions of this act.

The People of the State of Michigan enact: Section 1. It shall be unlawful for any