IDEALITY OF MEDICAL SCIENCE. 
THE 
Evil Events of the Profession, 
AND AN AVAILABLE 
Device for its Reformation. 
BY 
MAURICE J. BURSTEIN, A, M., M. I).. 
NEW YORK. 
FROM 
THE DOCTORS WEEKLY, 
(February 6, 1892.) 
96 Fulton Street, New York. New York, April. 18D2. 
To the Editor: 
Dear Sir:- 
Valuable comments and critical discussions o* 
the enclosed pamphlet have appeared lately in Medical and 
other Journals* The idea being worthy of discussion, I 
heartily request yon tn give your opinion upon the sub- 
ject in your paper. I further ask of you that if any cri 
critical review of it should appear in your journal, T 
would be greatly pleased to receive a copy of the number 
containing it. 
Yours Si TIC or e ly , 
M. J. Durstein, M. D. 
180 Henrv St. IDEALITY OF MEDICAL SCIENCE. 
We are now at the end of the nineteenth 
century. The people have already convinced 
themselves that the medical profession is 
not the same thing that it was a few cen- 
turies ago. They now know that the great 
art of medicine is founded on indutiable 
facts, and that it serves as a basis for all other 
scientific studies. The study of physiology 
has cleared up all the cloudy theories in 
medicine, philosophy, and other branches of 
science that have been hypocritically as- 
sumed, previous to its experimental de- 
velopment. We must bear in mind, how- 
ever, that though the advancement of medi- 
cal science is considerably due to our intel- 
lectual powers, its progress is mainly de- 
pendent upon the “practice of the profession 
itself.” The physician is compelled to ob- 
serve his cases carefully; to make memo- 
randa of the good or bad results of a partic- 
ular mode of treatment; to read medical 
works to profit by the wisdom of the past, 
and to observe closely so as to discover new 
methods, and new agents to fight a particu- 
lar disease. By his profession he is 
to support himself and his family, thewSgfyire 
he must endeavor to diagnose his cor- 4 
rectly, and devise the most successful treat- 
ment. 
Whilst a great deal of devoted and unsel- 
fish time, research and investigation is given 
by medical men to the development of the 
Medical Science, how little attention and 
consideration the general public gives to the 
physician himself ! It wants the best fruits, 
and yet gives no heed nor care to the trees 
and the garden. Medical Science is the fruit 
of our intelligence, it is a branch of our in- 
telligence; but the condition of the trees in 
the garden, where we are to cultivate good 
fruits, never comes finto the mind of the 
medical world. Each and every tree must 
struggle, for itself, otherwise it will be 
thrown out of the garden. I think it is 
about time that physicians should begin to 
see where they stand, what work they are 
to do on earth, and whether they are able to 
accomplish this great work. Again, is it 
not now time to see that the great work 
the physician should not be an outcome of 
his struggles in life, but of purely moral and 
scientific origin. We demand of him the 
development of Science; to study medicine; 
to read journals; to join medical societies; 
to pore over countless articles; to go to hos- 
pitals: to see operation; to buy books; to- 
buy periodicals; to buy surgical instruments; 
to examine his patients thoroughly; to make 
a correct diagnosis; to be careful in obstetri- 
cal work; t©» write prescriptions carefully; 5 
to consult his books in all cases of impor- 
tance; to keep his office hours strictly; to 
attend to his patients regularly; to be ready 
for any emergency; to go promptly at 
night, when called; to be charitable; to not 
sue for non-payment of his fees; to keep 
accounts; to support his family; to dress 
himself as a “doctor;” to not keep away 
from society. 
This is too much, entirely too much, for 
the poor physician. He must be rich, he 
must be educated, he must have seventy-two 
hours’ time to accomplish a day's work, and 
even then, it would be almost impossible for 
him to fulfill all these requirements. Now, 
what are the remedies to overcome these 
difficulties? In the first place he should be 
furnished with a salary, and his time of oc- 
cupation should be regulated ; and secondly, 
we should methodize the general study of 
medicine. Let us take the first problem, 
how to regulate the physician’s income and 
his vacation. A proposition was recently 
made by a medical journal, that it would be 
a good plan if the physician, instead of tak- 
ing his fee for each visit, should let people 
come under his care for a sum of $20 yearly 
per family, and, according to the journal, 
the average income for every physician of 
the United States would be about $3,500. 
The plan is theoretically a good one, but 
it could never be carried out, and it would 
lead to still worse results than with our 6 
present “Fee System.” We know that 
a physician must pay for his bread and but' 
ter, as well as any other man; must pay 
rent, pay for clothes, support a family, etc. ? 
so the less popular “M. D,,” not being able 
to get in as many families as would pay for 
all his necessities, would have to take in fam- 
ilies for a much less amount, as is done now 
in some localities of New York City, where 
physicians undertake to treat whole families 
for the sum of $2 to $2.50 per annum, or 
practise under the old “Fee System.” More- 
over, it would seem quite impossible to make 
people pay the doctor a certain sum of 
money in advance for future medical ad- 
vice. Then again, would it be possible for 
the poor workingman, whose wages do not 
exceed $7 or $8 a week, having to support a 
family of six or eight, to pay the doctor the 
sum of $20 in advance? I think that he 
would rather wait until some one of his fam- 
ily should get sick, and, after having con- 
vinced himself of the danger that threatens 
the patient, call in a doctor, or, as it hap- 
pens very often, wait until “God shall help 
him.” On the other hand, would it be equit- 
able that a rich merchant, whose income is 
about $10,000 a year, should be attended by 
a physician for a like sum, namely, for $20 
per annum ? We thus see that the proposed 
plan means ruin to the doctor, and could 
never be carried out by the community. 
But, in my opinion, there is a method by 7 
means of which the regulation of the income 
of the physician could be accomplished, thus 
abolishing the present “Fee System.” It 
could be easily executed, and would enter 
into operation in a very short time provided 
it should be approved by both physician and 
people. 
Let the doctors of each and every State 
form an “Order,” with a grand medical 
board (or call it State Medical Board, if you 
like). This board should have its subordi- 
nate or county societies; which, again 
should subdivide into districts. Each dis- 
trict should have a certain number of physi- 
cians, according to the density of the popula- 
tion. A physician should have a certain num- 
ber of patients under his care, or he may be 
appointed by the Grand Medical Board to a 
fixed number of families living in his dis- 
trict. Physicians may be subdivided into 
three classes, according to their standing in 
the profession; regular attending, visiting, 
and consulting. By this procedure, if in 
some cases a few physicians are wanted, as 
for an operation or consultation, a certain 
number of physicians could be procured. 
In this way only would we be able to give 
the poor man a chance to call in a doctor 
when needed, before he has reached a hope- 
less stage. 
Now, as regards the financial bearing of 
the question. It would, as already said, be 
difficult or impossible to induce people to 8 
pay in advance a fixed sum of money for 
future medical advice. But a suggestion 
would be the following ; Let the Doctor be 
an officer of health, as a policeman is an 
officer to keep order in town, let him be a 
“sanitary teacher.” Every such sanitary 
officer, or teacher, or adviser, should, ac- 
cording to the amount of work he does, be 
paid by the Government of the State a cer- 
tain salary. Say, we have in a city 2,000 
physicians, let the average for everyone be 
$3,500, making $7,000,000 a year which is, 
certainly, a great deal less than the same 
number of physicians earn annually by the 
present “ Fee System.” The money should 
be distributed by the Grand Medical Board, 
as teachers are paid by the Board of Edu- 
cation. The people may be taxed, either 
according to their income, or each and ev- 
ery one alike. 
Having laid out the “ Modus Operandi,” 
let us see the results of our proposed plan. 
1. People would not have to spend so 
much money for medical advice as they do 
at present; the small sum that the Govern- 
ment would disburse would scarcely be ap- 
preciated by them. 
2. Quackery would be entirely extin- 
guished by these proceedings. The patient 
goes to the quack for advice, because he gets 
“the advice together with the medicine,,f 
while it would require much more money to 
consult a physician; and no one can deny 9 
that the “self-made doctor” is guilty of 
murder, when the patient, no longer de- 
pending upon his ‘ ‘spiritualistic” medicines 
fails to be cured by the regular practitioner, 
whose “treatment has probably begun too 
late.” 
3. This would also put an end to the use 
of patent medicines. A person being a 
chronic invalid, whose disease may be of 
such a character that he might be benefited 
by regular treatment, resorts rather to some 
“ Sarsaparilla,” or “ Liver Pills,” or “ Great 
Blood Purifier” of some ignorant quack 
while the disease is continually running its 
course, until the “Great Health Restorer” 
sends him to his eternal rest. By taking 
these medicines he “ avoids the expense of 
a doctor,” and “ it is exactly prepared for his 
illness.” But if, at any time during his pro- 
tracted disease, a regular physician could 
be had free of charge, certainly, he would 
rather seek the latter’s advice than “ help 
himself” by being purged to death from 
some sort of a” Non-Mercurial Liver Pill.” 
The abolishment of the “ Fee System ” is all 
that is necessary to save his life. 
4. The physician would not have to hope 
for better times; he would not try to gain 
the patient’s sympathy mainly for the pur- 
pose of taking him away from his brother 
physician, but, getting his regular salary, he 
would be glad to be occupied in his profes- 
sional work. 10 
5. Sanitation would be brought to a most 
amazing state of improvement. Nowadays 
a doctor, being called to a patient, never 
takes the trouble to see the condition of the 
premises, it is not his business, for there are 
others whose duty it is to inspect the sanitary 
conditions of the house ; although this may 
be the real factor of the disease. The conta- 
gious diseases, not having the soil for their 
development would, in all probability, be- 
come less severe in character, and we would 
never let them spread as they do at present. 
Sometimes a physician, being requested to 
attend a case of a contagious disease, “ may 
run the risk” of not reporting it to the 
Health Department, because, if he do so, he 
will surely lose his patient—his bread and 
butter. There is no doubt that he is not en- 
couraged to find out the cause of the disease, 
to see whether there is sewer gas in the 
house, or contaminated water, or bad plumb- 
ing. In case he should report the condition 
of such premises, his patient would be 
obliged to go to expense and trouble to fulfill 
the requirements of the law. The result is 
that an epidemic breaks out, and many lives 
are lost. Again, is it possible for the Health 
Department to employ so many inspectors 
as would be necessary to look after the pri- 
vate affairs of each and every physician? 
Moreover, if such a patient dies, the cause of 
his death is never known to the public, and 
consequently the laws of the Board of Health 11 
are entirely useless. The physician may 
write in his certificate of death anything he 
chooses ; instead of diphtheria—pheumo- 
nia ; of scarlet fever—heart failure ; of small- 
pox—peritonitis. Who is to prevent him ? 
He will not report the disease, for the patient 
might be taken out of the city, or the latter 
might be in a place of business, which would 
be shut up by the “ Health Department,” so 
he either would lose the patient himself, or 
he might lose future practice among his 
patient’s friends. 
6. Will the physician be more honest in his 
professional services than he is at present, 
■or not? A physician, nowadays, being- 
called to a serious case of a complicated 
character, so that he is not able to make a 
fair diagnosis of the disease, and, conse- 
quently, lay out the exact treatment, will 
prescribe medicine and direct the patient to 
do this or that, although his orders might 
even prove injurious to the patient. Why 
does the doctor do so? Is he an immoral 
man? No, he does so because: firstly, he 
gets his fee—he wants to live : secondly, the 
people are too poor to procure a consulting 
physician ; and thirdly, he is afraid to pro- 
pose a consultation, for the family might 
engage another doctor, who “ does not need 
■any consultations.” But if two or three 
physicians could be had in the same district 
for a particular case, ignorance would never 
gain the advantage over intelligence. 12 
7. What will become of the medical sci- 
ence? There will be more real progress in 
medicine, the advancement more rapid and 
the result will be an incalculable gain to hu- 
manity. We know that the young physician 
beginning his professional career, finds great 
difficulty in making a living. What incen- 
tive has he to devote his time and abilities 
in researches that will be for the good of 
mankind? It seldom happens that physi- 
cians meeting one another, talk about the 
science ; we hear only the usual inquiries 
about “good or bad times.” But, if they 
should have more opportunity of coming into 
contact with each other, if a greater in- 
timacy should exist among them ; certainly, 
they would take greater interest in the ad- 
vancement of the science, and would care 
for the progress of the profession at large. 
There would be an incentive and time to read 
medical works, to attend medical and surgi- 
cal meetings, etc., and all these would be 
mainly due to the fact that the physician 
would not have to suffer physically and 
morally for his slice of bread and butter. 
Having laid out the mode of reformation 
in regard to the regulation of the practice 
of the profession and its results, let us take 
now the second problem : How to method- 
ize the general study of medicine ? As our 
aim is to cultivate a good sanitary and medi- 
cal adviser, who should be provided with a 
salary, and do good to the community, it is 13 
worth while mentioning the conditions and 
problems of our medical schools, and of the 
authorities that create the future ‘ ‘ Counsel- 
ors of Health.” If we will look into the 
system of the study of medicine in our 
American colleges, we will find that it is 
more practical than in any of the European 
universities. But is a physician not suppos- 
ed to be a man of high education ? Is it not 
very important for a doctor to have a pre- 
liminary education before he enters into this 
great study, which is founded on physical 
and chemical observations, constituting the 
greater portion of our knowledge ? Is it not 
necessary for a physician, who is to make a 
correct diagnosis, prognosis and treatment 
of a disease, to be a man of understanding, 
reason and high education? Is there any 
profession in the world that needs so much 
skill in fulfilling its requirements as that of 
the profession of medicine ? Any other pro- 
fessional man, after getting his problem, is 
able to take time for reasoning it out; a 
lawyer, having a case before him, may con- 
sult his books; a clergyman may, before 
delivering his sermon, read it over hundreds 
of times ; but a physician must have every- 
thing in his head ; he must be prepared for 
any emergency that he may happen to be 
called upon to treat! For such a man some- 
thing more is necessary than a couple of 
years’ study in a medical school! How 
many men are graduating from our colleges 14 
who can not even write a prescription cor- 
rectly for the want of the knowledge of 
Latin ; or give the quantities of the consti- 
tuents correctly, for the lack of the know- 
ledge of chemistry. They are only a burden 
to the community. Again, is it proper that 
the popularity of a college should depend on 
the size of the graduating class ? Would it 
not be better to have the medical colleges 
under the control of the Government; to 
have fewer colleges, “one system in medi- 
cine,” competent instructors, that the stu- 
dent should be a graduate of a scientific in- 
stitution, and then confer the degree of 
M. D. only upon those who are worthy ? Is 
it not necessary for every physician to have 
a good hospital experience before he is to be 
allowed to enter into private practice ? 
To sum up, I believe that the regulation 
of the physician's income and time, along 
with a reformed system of study, would 
give a grand and noble impulse to the pro- 
gress of medical science, and then, only 
then, would the people regard the doctor 
with respect and honor, while he, being 
worthy of affection, would fully deserve the 
divine title of “ Counselor of Health.” 
No. ISO Henry St., New York.