A REVIEW 
OF 
IDEALITY OF MEDICAL SCIENCE. 
A Detailed Plan of Reformation of the 
Practice and Study of Medicine. 
BY 
MAURICE J. BURSTEIN, A. M., M. D., 
NEW YORK. 
REPRINTED EROM 
THE DOCTOR'S WEEKLY, 
New York. 
FRICK IO OEWTS. COPYRIGHTED, 1892, 
BY THE AUTHOR. A REVIEW OF "IDEALITY OF 
MEDICAL SCIENCE." 
A DETAILED PLAN OF REFORMATION OF 
THE PRACTICE AND STUDY OF MEDI- 
CINE, BY MAURICE J. BURSTEIN, A.M., 
m.d. New York. 
It were only natural for me to ex- 
perience much pleasure and gratifi- 
cation that my humble effort, pub- 
lished in the Doctors' Weekly of 
February 6, 1892, entitled "Ideality 
of Medical Science; the evil events 
of the profession, and an available 
device for its reformation," should 
have aroused a more than passing in- 
terest in the medical world. It has 
been reviewed and commented upon 
not only in the leading medical jour- 
nals, but in other journals as well, 
while some have reprinted the entire 
article, so that their readers might 
render an opinion for themselves. 4 
Many communications nave also been 
addressed to me advising and re- 
questing that I issue a supplemen- 
tary article in which I could eluci- 
date more fully the plan suggested 
by me, and to give therein the im- 
portant details and necessary data. 
Believing that a proper solution of 
the evil existing at present would 
give a noble impetus to the medical 
profession as well as to the medical 
science itself, and being assured that 
the majority of medical men are of 
this opinion, I am encouraged to at- 
tempt a more accurate description of 
the plan already proposed in my pre- 
vious article. 
Before doing so, however, I cannot 
overlook two of the many criticisms 
which have been passed upon my 
proposed plan, and this compels me 
to quote an important and essential 
extract from my former article. 
"Let the doctors of each and every 
State form an 'Order' with a grand 
Medical Board (or call it State Medi- 
cal Board, if you like). This Board 
should have its subordinate or county 5 
societies; which, again should subdi- 
vide into districts. Each district 
should have a certain number of phy- 
sicians, according to the density of 
the population. A physician should 
have a certain number of patients 
under his care, or he may be appoint- 
ed by the Grand Medical Board to a 
fixed number of families living in his 
district. Physicians may be subdi- 
vided into three classes, according to 
their standing in the profession; 
regular attending, visiting and con- 
sulting. By this procedure, if in 
some cases a few physicians are 
wanted, as for an operation or con- 
sultation, a certain number of physi- 
cians can 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 hopeless stage." 
"Now as regards the financial bear- 
ing of the question. It would, as al- 
ready said, be difficult or impossible 
to induce people to pay in advance a 
fixed sum of money for future medi- 
cal advice. But a suggestion would 6 
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, according 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 
every one 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 
Education. The people may be 
taxed, either according to their in- 
come, or each and every one alike." 
The editor of the "Twentieth Cen- 
tury" in his criticism does not consider 
the question as a whole, and fails to 
mention the advantages that would 
result from my plan, but he does 
find fault regarding the method of 
taxation, and fears that the medical 7 
profession would be controlled by 
political influences and that the sev- 
eral parties would derive therefrom 
quite an item for election expenses. 
With regard to the method of tax- 
ation, I cannot see what difference it 
would make to a man whether he 
was taxed by his family or consulting 
physician, according to services ren- 
dered, or that he be taxed for medi- 
cal advice in the same manner that 
he is taxed for education. Let Mr. 
P examine his doctor bills and 
he will readily see that during the 
year he expended much more for 
medical, surgical and obstetrical work 
done for himself and his family, than 
he would be required to pay in the 
form of taxes. 
Again the editor's fears that the 
medical body would become a politi- 
cal one, are groundless. I have al- 
ready stated that the doctors them- 
selves should form the organization, 
and the selected board in whose 
hands shall be entrusted the State 
medical affairs, which I call the State 
Medical Council, must be composed 8 
of the best and ablest men in the pro- 
fession. 
The State Medical Council will not 
be subject to political influences. 
Certainly, the council will have to be 
endorsed by the government; but 
they will be selected by the physi- 
cians. 
The legislature once having recog- 
nized in them as a supreme medical 
body composed of the ablest men in 
the profession, would necessarily 
give them the power over everything 
pertaining to the practice of medi- 
cine, or relating to health. The edi- 
tor finally admits that the plan pos- 
sesses some very attractive features. 
The "Medical Record" of April 
9th, says editorially, that I'have "ex- 
aggerated the pains and difficulties 
of medical practice, and that physi- 
cians will always find time to read 
medical journals, particularly the 
"Medical Record." 
"Bad bills, ungrateful patients, 
dangerous cases, large and expensive 
families make life somewhat of a 
trial, but we fancy that there are burdens to be met with in every kind 
of work; and no grand medical 
order could do away with those of 
the physician." 
What the editor of the "Medical 
Record" says may be very true, but 
I scarcely think that it has a particu- 
lar bearing upon the subject, and 
then I regret that he should have 
ventured an opinion after reading 
only a small extract of my article in 
the "Twentieth Century." As a 
matter of fact I not only claim that 
my plan would benefit physicians, 
but I have also endeavored to point 
out the many advantages accruing to 
the people were my proposed reform 
adopted in the medical profession. 
Somehow, I feel that if Dr. Shrady 
had read and considered the article 
in toto, he might have joined many 
others in undoubted approval, or 
have shown himself favorably dis- 
posed toward the plan, as manifested 
in the following extracts. 
The "Medical World" of May, 
1892, says, "We congratulate Dr. 
Burstein, and are glad he has written 
9 such a practical paper. The minds 
of a large portion of our popula- 
tion are just now directed towards 
practical measures of relief. This 
article comes just in time." 
The " Southern Clinic " of April 
says: "We can see the many advan- 
tages that would follow such a course, 
but we fail to see that the doctor has 
suggested the all important idea of 
"how" to organize the profession as 
he suggests. If we could ever in- 
duce the profession to perfect such a 
complete organization as is here 
proposed, we would have no need of 
the help of the State or Government. 
We would be in a position to demand 
and have all we wanted or were en- 
titled to both in the matter of proper 
reward for our services, and in the 
improved teaching facilities." 
The editor of the "Southern Clinic" 
is evidently more anxious to know 
how the profession rather than the 
people would benefit by the proposed 
reform; but consider also the bene- 
fits to be derived by the people, and 
there is no doubt that the honest 
10 11 
physician must join the honest citi- 
zen in demanding such a reform in 
the practice of medicine and the 
study of medical science. 
The reader has perhaps concluded, 
and justly so, that my object is to 
abolish the present "Fee System. " 
The maintenance of the physician 
should not be an outcome of the 
struggle for self-existence, but he 
should be placed in a position inde- 
pendent of that, so that his work and 
his efforts would be prompted by feel- 
ings of morality and humanity. Ev- 
ery one is aware of the evils that are 
likely to follow, and that actually fol- 
low, from the present practice of 
medicine, because the physician is 
directly dependent for his bread and 
butter upon his suffering patient, 
and, therefore, it would be but natural 
were the physician to delay the cure 
as long as possible. The tendency 
of the powerful is to take advantage 
of the weak. The struggle for self ■ 
existence, often compels one to be- 
come mercenary and unscrupulous. 
If a merchant can secure $5 for a 12 
pair of shoes worth only $2, he might 
be considered a good business man. 
A workman would endeavor to get 
from his employer the highest possi- 
ble wages irrespective of the ruin it 
might inflict upon the latter. 
On the other hand, the employer 
would strive to reduce wages as much 
as possible, were he in a position to 
do so, and the sufferings of the work- 
ing man whose existence might be a 
hell on earth, would scarcely effect the 
peace and quiet of the former. 
This is a law of nature, and holds 
good with plants and animals as well 
as with man. If a large tree grows 
in a space surrounded by small plants, 
the nourishment of the latter will be 
absorbed by the roots of the tree, and 
the plants immediately encompassing 
it, will grow thin, small and weak in 
comparison with the same plants 
growing far away from that tree. If 
we look upon the animal world, we 
find that the efforts of the stronger 
are to annihilate the weaker. The 
lion will kill the reindeer, the wolf the 
sheep, the cat the mouse, the spider 13 
the fly, for no other reason than to 
secure the means of existence. The 
same natural law holds true with 
man. The difference, however, be- 
tween man and animals is, that man 
possesses a higher faculty over the 
latter, namely, intelligence; but in 
order to bring the man into such 
state of mind that this natural law 
shall be preponderated cr overbal- 
anced by the intelligence, or what we 
call morality, he must be placed in a 
position of life whereby his efforts foi' 
self existence shall be an incident of 
the principal cause--that of morality, 
but not that the endeavor for self- 
existence shall be the primary mo- 
tive in life. 
The practice of the medical profes- 
sion, must be based upon the princi- 
ples of morality. A slight deviation 
from the maxims of ethics may cost 
a human life. Therefore, the endeav- 
ors of mankind must be to avoid any 
occasion that might influence the 
physician to be impure in his mo- 
tives. This object may only be ac> 
complished when the profession of 14 
medicine shall not be practised sim- 
ply as a business, but that the efforts 
to relieve and cure "the ills that flesh 
is heir to" may be prompted by hu- 
manitarian instincts and love of the 
science itself. 
It is not sufficient, however, to give 
a physician all that he needs and tell 
him to treat patients for the love of 
the science; nor is the solution of this 
problem dependent or consequent to 
the formation of a medical body with 
a Grand Medical Board. But in order 
to realize such a noble idea as pro- 
posed here, we must strive to change 
and revise the study of the medical 
science as well, and endeavor to cre- 
ate an ideal physician who shall be 
fully endowed with the principles of 
morality and the instincts of human- 
ity. The following details would be 
essential in bringing this about. 
Let the physicians of each ward or 
district call a general meeting in a 
suitable locality. The meeting shall 
be called simultaneously with the 
others and the first steps shall be to 
elect delegates for the general State 15 
or City convention. Two delegates 
shall be elected for every hundred 
physicians. The elected delegates 
then shall meet at an appropriate 
place, and their only duty shall be to 
elect a supreme body, or what I call, 
the staff of consulting physicians con- 
stituting the State Medical Council. 
The delegates must certainly exercise 
the greatest care in selecting these 
gentlemen, for as I state further, this 
supreme body is to be a permanent 
one, and any member of it can only 
be expelled when proven to be un- 
skillful or negligent in discharging 
his duties. 
Hence these selected physicians 
must be the most scientific, the most 
skillful men in the profession, and 
must bear the highest reputation as 
to character and love for medical 
science and the public welfare. 
The number of consulting phy- 
sicians to be selected need not be 
determined according to the density 
of population, but let the best men 
remain where they are to be found. 
These gentlemen must either be pro- 16 
fessors of a reputable Medical Col- 
lege, or be able specialists, who have 
served in the capacity of consulting 
physician in a reputable public hos- 
pital for a certain numbers of years. 
These consulting physicians, having 
been duly selected by the profession 
at large, shall thereupon be styled 
and constituted " The State Medical 
Council," with power to have full 
control of all medical affairs within 
the State, in accordance with the 
terms and provisions of a bill to be 
passed by the Legislature, and en- 
titled, " An Act," to reform the study 
and practice of Medicine. 
The State Medical Council having 
been constituted by the Legislature, 
shall at once elect from amongst 
themselves Examining Committees 
of five members for each branch of 
medicine or specialty. The examin- 
ing board shall then issue a notice to 
all physicians within the State, that 
the State Medical Council is prepared 
to examine all applicants who desire 
to become visiting physicians or as I 
call them specialists. These appli- 17 
cants shall have had at least five 
year's practice, and also shall have 
devoted sometime to the study of a 
medical specialty. 
The next step of the State Medical 
Council shall be to erect and con- 
struct public medical offices for which 
purpose a special committee shall be 
■appointed. The State shall be sub- 
divided into Medical Counties; the 
counties into Medical Divisions; these 
into Medical wards and into dis- 
tricts. 
New York County or City, for in- 
stance, could be divided into ten me- 
dical divisions, each division into two 
medical wards; and each ward into 
ten districts. In tenement wards, 
however, more districts might be 
formed than in less populated wards. 
In each district there shall be con- 
structed a public medical office, to 
which ten physicians shall be ap- 
pointed, two whom I call Masters in 
Medicine, or recent graduates, and 
eight regular attending who shall 
wait upon patients calling at the 
office and those lying at home. 18 
One public Hospital shall be con- 
structed for each medical division, 
embracing two medical wards. (So 
the City of New York would then 
have ten Hospitals). The physicians 
allotted to Hospitals shall be ap- 
pointed by the State Medical Council, 
from among the district physicians 
and specialists, residing in that par- 
ticular medical division. 
One of the districts shall be called 
the ward or main district, in which 
there shall be an office, besides the 
physician's office alluded to, for vis- 
iting physicians or specialists. 
There shall be one University of 
Medicine within the State under the 
direct control of the State Medical 
Council. The Council shall appoint 
professors and instructors to the 
University; they shall have entire 
supervision over the Candidates ap- 
plying for admission into the Uni- 
versity; they shall also have the 
supervision over the quizing classes 
as- well as clinical teachings; they 
shall regulate the students' fees and 
the expenses of the University. The 19 
curriculum of studies as well as the 
questions for examination shall be 
fixed and prepared by the State Me- 
dical Council, who shall also examine 
the papers written by the students at 
the final examination. 
A candidate shall not be permitted 
to study medicine unless he produce 
a diploma from a High School oi' 
College of General Science. He 
shall undergo a physical examination 
by regularly appointed medical ex- 
amining physicians who are to deter- 
mine whether he is mentally or 
physically capable of pursuing the 
study of Medicine. The course of 
study shall cover a period of four 
years. 
There shall be four courses of Me- 
dical study; each course to last eight 
months during each consecutive year. 
The course of study shall consist of 
four parts, and the student is to pass 
an examination at the end of each 
year, when he is or is not promoted 
into the next course. The curriculum 
of study may be subdivided as fol- 
lows : 20 
FIRST COURSE FIRST YEAR. 
Anatomy, Physiology, Physics, 
Inorganic Chemistry, Botany and 
Practical Anatomy. 
SECOND COURSE SECOND YEAR. 
Anatomy, Practical Anatomy, Phy- 
siology, Embriology, Organic Chem- 
istry, Histology and Pharmocognosy- 
THIRD COURSE THIRD YEAR. 
Materia Medica, Practice of Medi- 
cine, Principles of Surgery, Obste- 
trics, Gyneacology, Histology, Patho- 
logy, Practical Chemistry, and Phys- 
ical Diagnosis. 
FOURTH COURSE FOURTH YEAR. 
Practice of Medicine, Operative Sur- 
gery, Obstetrics, Operative Gynae- 
cology and Clinical Teachings. 
The student having passed his 
final examination in theory and 
practice of Medicine and Surgery, 
shall receive the degree of Master in 
Medicine.-M. M. 
This, however, shall not entitle him 
to practice, but he is then to serve at 
least one year in a Hospital or Public 21 
Medical Office, under the direct 
supervision of the regular attending 
or visiting physician. 
Having served the required term, 
he may apply to the State Medical 
Council, for the degree of M. D., 
whereupon he shall be examined upon 
practical branches, and he must 
present an original thesis upon any 
subject of Medical Science. Having 
passed a satisfactory examination, he 
sha 1 receive a diploma from the 
State Medical Council, conferring 
upon him the degree of Doctor in 
Medicine. 
The title M. D. shall create him a 
Junior Regular attending Physician, 
and then he may be appointed to a 
district office or Hospital as such. 
Each public medical office, there- 
fore, will have in attendance two 
M.M's, four Junior and four Senior 
regular attending physicians. 
The duties of the assistant physi- 
cians or M.M's. shall be to assist the 
regular attending and visiting phy- 
sicians, to officiate in their absence 
and to attend ambulance calls. Their 22 
salaries shall be fixed at $1,000 per 
annum. The Junior regular attend- 
ing physician shall be under the 
direct supervision of the Senior at- 
tending. They shall hold office hours 
at the district office and attend to 
patients at home. Their salary shall 
be $2,000 per annum The Junior 
physician shall be relieved by the 
Senior regular attending, whose duty 
shall be the same as the Juniors'. To 
become a Senior regular attending, 
the physician must serve in the 
capacity of Junior attending at least 
two years. The salary of the Senior 
regular attending physician shall be 
$3,000 annually. 
After having served in a public 
medical office as Senior regular at- 
tending physician at least three 
years, he may apply for promo- 
tion to the rank of "fellow" phy- 
sician, or what I call Visiting or 
Specialist. To become a Specialist 
he must pass an examination bofore 
the Examining Board of the State 
Medical Council upon a Special 
Branch of Medical Science selected 23 
by him and he must present a thesis 
in his own handwriting upon the 
same subject, the result of his own 
original research and experience. 
Having passed a satisfactory exami- 
nation, he shall receive his degree 
which will entitle him to become 
Junior visiting physician, or Junior 
Specialist, whose salary shall be 
$4,000 annually. 
The Junior Specialist shall serve in 
the Ward Medical Office, at least two 
years, under the direct supervision 
of the Senior Specialist. 
After this term should he prove to 
be able and skillful in his specialty, 
the State Medical Council upon a 
recommendation of the visiting staff 
of his Ward, shall grant him a degree 
of "Senior Fellow," or Senior Specia- 
list, and he shall then be eligible to 
the latter position. The salary of the 
Senior Specialist shall be $5,000 a 
year. 
A vacancy in the State Medical 
Council is not to be filled by appoint- 
ment, but by a regular election of 
the Visiting physicians, and no phy- 24 
sician shall be eligible for member- 
ship of the State Medical Council, 
unless he is at the time a Senior 
Specialist or what I call a Senior 
Fellow. The average salary of the 
members of the State Medical Coun- 
cil, shall be $10,000 per annum, and 
is to be fixed by the State Legisla- 
ture. 
The State Medical Council, besides 
controlling the regulation of medical 
studies, and the practice of the pro- 
fession, shall also have the entire 
charge over the Health Department. 
It shall elect out of its own body, a 
B *ard of Directors, who are to do 
the work of the various bureaus in 
the department. It shall have entire 
charge of Sanitary and Hygienic af- 
fairs in the State. It shall appoint 
inspectors for the various divisions 
of the department, who will be re- 
quired to pass an examination, show- 
ing them to be proficient in their 
special line of work. The State Me- 
dical Council shall also have control 
of the medical division of public 
charities under the head of hospitals 25 
and asylums. They shall appoint phy- 
sicians and nurses and regulate the 
salaries and other expenses. 
There shall be a monthly meeting 
of each Medical Division, embracing 
two wards, in which all physicians 
belonging to the district must partic- 
ipate. These meetings will tend to 
bring forth from the physicians, hints 
and suggestions calculated to benefit 
the profession and the public. 
At these meetings also medical 
papers will be read and discussions 
on scientific subjects held. A monthly 
report respecting the medical work 
done in the district must be presented 
to the staff of visiting physicians. 
The report shall contain: 
i. Number of patients treated in 
hospital of that particular division. 
2. Number of patients treated at 
district offices and at home. 
3. Variety of disease and result of 
treatment. 
4. Number of Child Births. 
5. Number of deaths and causes. 
6. Number of consultations with 
the visiting and consulting staff. 26 
7. Advice as to changes in the 
Medical attendance. 
8. Suggestions regarding Sanita- 
tion and Hygiene. 
9. Report of expenses and salaries 
of the Medical division including all 
districts. 
Four Medical Wards shall consti- 
tute a Medical Quarter. There shall 
be a quartely meeting of the visiting 
staff of the whole Quarter embracing 
fifty Specialists. The business of the 
meeting shall be, besides reading 
scientific papers, to discuss the general 
welfare of the public; to make a 
regular report of the work done in 
each individual ward during the past 
quarter; to advise the State Medical 
Council of the necessary changes re- 
garding sanitation and general public 
health, also of changes in the appoint- 
ment of various classes of physicians; 
to report the financial standing of the 
public institutions and district offices. 
In order to faciliate the work of the 
State Medical Council, the visiting 
physicians of each and every medical 
Quarter shall elect representatives 27 
from amongst themselves, who shall 
participate at the annual meeting of 
the State Medical Council, and who 
shall advise the Council to act upon 
certain medical affairs, which have 
been discussed and passed upon at 
the minor medical meetings. 
Now a glance at the cost of main- 
taining this entire medical body; take 
New York City for example. 
One public medical office would 
require: 
2 Masters in Medicine each $1,000 
per annum, $2,000; 4 Junior Reg. At- 
tending each 2,000 per annum, $8,000; 
4 Senior Reg. Attending each $3,000 
per annum, $12,000. Total $22,000. 
One Medical-Ward (composed often 
districts) would require: 20 Masters 
in Medicine each $1,000 per annum, 
$20,000 ; 40 Junior Reg. Attending 
each $2,000 per annum, $80,000; 40 
Senior Reg. Attending each $3,000 per 
annum, $120,000; 100 district physi- 
cians with a salary of $220,000, and 5 
Junior Specialists each $4,000 per 
annum, $20,000; 5 Senior Specialists 
each $5,000 per annum, $25,000. One 28 
medical ward would then have no 
physicians receiving a salary of $1:65,- 
000. The whole city being composed 
of 20 medical wards would require 
2,200 physicians with a salary of 
$5,300,00°, adding 100 consulting phy- 
sicians (members of the State Med. 
Council) receiving an average salary 
of $10,000 per annum, $1,000,000, 
would make a total of 2,300 physicians 
requiring $6,300,000. 
Expenses for maintaining a district 
medical office: For instruments etc. 
per annum, $1,000; 2 nurses $20 per 
week per annum, $1,000; 1 pharm, $10 
per week per annum, $500; Janitor, 
$10 per week per annum, $500; Re- 
pairs and other expenses, $500. Total 
expenses for a District Medical Office, 
$35,000; 200 offices would make a 
total of $700,000; Add same to the 
salary of $6,300,000, makes a grand 
total of $7,000,000. 
Estimating roughly the population 
of New York City at 1,700,00c, we 
would have about one physician to a 
little over 700 of population. If 
$7.,000,000 be expended for medical 29 
services, it amounts to $4.00 pet- 
capita a year. 
Estimating roughly the rate of 
taxes now imposed upon property in 
the City of New York to be two per 
centum we have about $30,000,000, 
then an additional ^2 per centum 
would amount to about $7,500,000, 
which would cover all the expenses 
for Medical services. A tax payer 
having a property of twelve families 
and paying $200 a year, would then 
pay $50 more making a little over 
$4.00 per month. This would actually 
make 25 cents per month to be raised 
on each tenant for free medical and 
surgical service. This, I think, would 
not be too much for any poor man to 
pay in order to get medical advice 
and treatment gratis, and thus have 
a sanitary adviser, who will preserve 
his health at the minimum cost. 
It now remains for me to enumerate 
the benefits that would result from 
my proposed medical reform, and I 
will for convenience repeat some al- 
ready stated in my former article 
These benefits will not be confined to 30 
the profession or to the people, but 
would work fcr the good of all. 
" People would not need to expend 
so much for medical services as they do 
at present." I have already pointed 
out that if the rate of taxationwere in- 
creased % of one per cent., the ad- 
ditional sum thus raised would be 
more than sufficient to cover all ex- 
penses, and the poor man occupying 
three or four rooms in a tenement 
would only be asked to pay about 
25 cents a month more on his rent 
for which he would receive free medi- 
cal, surgical and obstetrical services, 
and that this would mean to him an 
immense saving there can be no doubt. 
Quackery and the use of fake re- 
medies would be entirely done away 
with. The poor patient visits the 
quack because he need only pay for 
the medicine while the advice is 
thrown in free of charge, while it 
would cost much more to consult a 
reputable physician and pay for the 
medicine besides. Then when it is 
too late the unfortunate sufferer goes 
in alarm to the regular practitioner, 31 
and a life is thus often sacrificed at 
the cost of a few dollars. Under my 
system the poor would receive the 
protection against quacks which they 
so urgently need. 
It would also put an end to the use 
of patent medicines. A chronic suf- 
ferer whose disease might be cured 
or kept in check by regular treatment, 
though at some expense, resorts from 
necessity to some " Sarsaparilla," or 
< Liver Pills," or " Great Blood Puri- 
fier," of some ignorant quack, while 
the disease is continually running its 
course, until the " Great Health Re- 
storer " sends him to his eternal rest 
By taking these medicines he incurs 
no expense, but only endangers his 
condition. Now there can be no 
question that, if at such a time good 
medical treatment could be procured 
free of charge, he would eagerly seek 
the same in preference to taking 
patent medicines. The abolition of 
the " Fee System " is all that is neces- 
sary to save his life. 
The physician would have no cause 
to hope for better times; rivalry and 32 
competition among the physicians 
would be a thing of the past, and 
instead of wasting time to work up a 
practice, the physician being amply 
provided for, would have every reason 
to attend more faithfully to the treat- 
ment of his patients. 
The sanitiary condition of dwel- 
lings and streets would be greatly 
improved. At present a doctor being 
called to a patient, usually is not con- 
cerned with the condition of the pre- 
mises, 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 primary 
cause of the disease. The contagious 
diseases, not having the soil for their 
development would, in all proba- 
bility, become less severe in character, 
and we would never let them spread 
as they do at present. Sometimes a 
physician, being requested to attend 
a contagious disease, " may run the 
risk " of not reporting it to the Health 
Department, because, if he does so, 
he will surely lose his patient-his 
bread and butter. There is no doubt 33 
that as it is he is not encouraged to 
determine out the cause of the dis- 
ease, nor to report its true character. 
He is not expected to see whether there 
is sewer gas in the house or con- 
taminated water, or bad plumbing. 
Were he to report the condition of 
such premises his patient would be 
put to trouble and expense in fulfil- 
ling the requirements of the law. The 
result of neglecting to report is that 
an epidemic often breaks out, and 
many lives are lost. And surely 
the Health Department cannot see 
whether the physician is performing 
his duty-duty which would mean the 
losing of trade. Moreover, if a patient 
dies from such a disease the cause 
of his death is never known to the 
public, and the Board of Health fails 
to give proper sanitary protection. 
The physician may write in his certifi- 
cate of death anything he chooses; 
instead of diphtheria-pneumonia, of 
scarlet fever-heartfailure; of small- 
pox-peritonitis. Who and what are 
to prevent him? He will not report 
the real nature of the disease, as the 34 
patient might have been in a place 
of business, which would consequently 
be closed up by the "Health Depart- 
ment" and the physician hardly cares 
to sacrifice any possible future prac- 
tice among his patient's friends. 
Will the physician be more con- 
scientious in the performance of his 
professional duties than he is at pres- 
ent, or not? A physician at present 
may be called to a serious case of a 
complicated character, so that he is 
not able to make a fair diagnosis of 
the disease, and, consequently, lay out 
the exact treatment. He prescribes 
medicine and directs the patient to 
do this or that, although his orders 
may even prove injurious to the 
patient. Why does the doctor do so? 
First, because he gets his fee and he 
wants to live; second, the people are 
too poor to call in a consulting phy- 
sician; and thirdly, he is afraid to 
propose 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 could never 
gain the advantage over intelligence. 
Now what an advantage would this 
reform be to Medical Science itself? 
Let us compare the study of Medicine 
at present with the method as it is 
proposed here. The majority of the 
present Medical Colleges must adver- 
tise to get students, and the institu- 
tion failing to get a sufficient number, 
lacks the income necessary to keep 
the College running, and consequently 
must suffer in point of facilities of- 
fered to the student in instruction and 
practice. The effect of this is to 
induce the College to take in many 
students and to tnrn out as many 
without regard to qualifications, for 
the purpose of making room for the 
next who are materially more useful 
to the College. The State Medical 
Examination is of little value, for ex- 
perience shows us that any foreign 
physician arriving here, and having 
in his possession a diploma of some 
European University, no matter 
whether he is or is not a graduate of 
a Preliminary School of Science, or 
35 whether he knows the English Lan- 
guage, will be endorsed by the State 
Board of Examiners; and then any 
graduate of any " Pathy " will be 
passed before the Board as long as 
he has a diploma of a College, recog- 
nized within the State. 
What is the use of having six Medi- 
cal Colleges in a City, everyone 
claiming to be the best school and 
possessing the best methods and 
largest facilities and boasting to the 
public of its larger number of students 
and larger graduating classes? This 
is simply in accordance with the great 
spirit of competition which pervades 
all business interests, and for that very 
reason, it is wholly wrong. Far more 
competent physicians could be gra- 
duated by maintaining one University 
in a State, furnished with every pos- 
sible facility for instruction, following 
the best methods of study, and having 
ample means for purposes of labra- 
tory practice and scientific research. 
Now a student after being in a Col- 
lege for three years, receives a degree 
and begins to practise; although he 
36 37 
may be incapable of making a proper 
diagnosis of a disease. His profes- 
sors and others may say, "Never 
mind, he will become a good doctor 
in time"; but alas! becoming a "good 
doctor" at this rate would involve the 
sacrifice of many lives. But if the 
student in the first place must pass 
an examination at the end of each 
year, in order to be promoted into a 
higher course, and continue his study, 
he will become proficient at each step 
before he is allowed to advance to the 
next; and then having gone through a 
thorough course, of four years, and 
having passed his final examination, 
before the State Medical Council, he 
will be compelled to practise medi- 
eine under the direct supervision of 
the general practitioner, until he be- 
comes competent and soon unques- 
tionably develop into a "good doctor" 
without doing injury to innocent suf- 
ferers. Now as soon as a physician 
is graduated, he must devote his ener- 
gies to earning a living, regardless of 
his incompetency to practise. As soon 
as he is done with the College, he is 38 
done with the Medical Science. This 
is certainly the case, except with a few 
well-to-do graduates, who have the 
opportunity through influence to be- 
come hospital physicians, or assistants 
to some lecturer ; but the majority 
of men do not study medicine 
for the sake of the science, but 
for the purpose of making a liv- 
ing. 
In my proposed plan, however, the 
incentive to be advanced from a 
lower to a higher rank, would be one 
of the great events that would cause 
a physician to be studious, to attend 
medical and surgical meetings, etc., 
in order that he might gain fame and 
distinction. To become an attending 
physician, he would have to perse- 
vere in his studies and strive for 
promotion; to become a specialist he 
would have to become thorough in 
some specialty, not so as to win the 
approval of the people, who are in- 
capable of estimating a physician's 
knowledge, skill and ability, but to 
be declared competent by the greatest 
physicians, who know what it is to 39 
be thorough in some special depart- 
ment of medicine. Thus the possi- 
bility of advancement, aside from the 
increased remuneration incidental 
thereto, would make men ambitious 
to study and to devote their lives to 
medical and scientific investigation 
and research. The physician will 
then be aware that inattentiveness 
in his practice, neglect in his studies 
and in medical research, failure to 
attend medical meetings etc., will be 
the causes of his remaining stationary 
and making no progress in his pro- 
fessional career. 
But I have not failed to show 
wherein the people would be bene- 
fited. The idea of being recom- 
mended to this or that doctor, by a 
friend, to be cured of an Ovarian 
Tumor or Urinary Calculus or Tabes 
Dorsalis, because it happened to him 
a lucky case of lancing a Simple Ab- 
sess, whereby the patient got well 
will be out of question 
They will not need to hunt after 
good doctors; there will be none but 
good doctors and they will be pointed 40 
out to the people "by the doctors 
themselves." 
In conclusion, I would say, that a 
formation of a consolidated medical 
body, a regulation of the physician's 
income and time, and a reformation 
in the system of medical study, along 
with a systematic and instructive 
culture of an ideal medical practi- 
tioner, by which order of things we 
would cause the physician to perform 
his duties, not for the sake of self 
existence, but through love of the 
science and mankind, the evil events 
of the profession would be entirely 
eliminated and the principles of 
morality and justice would glow in 
the heart of the physicians, and the 
people, once having placed their con- 
fidence in this principled and con- 
scientious medical and sanitary ad- 
viser, would find that the doctor is 
not a burden to them, but that he is 
to them a real comfort in their pains 
and sufferings, and a consolation in 
their health. 
Colleagues, strive for this noble idea, 
that we shall be triumphant! 
180 Henry St., New York City.