AN OLD AND ACTIVE COUNTY SOCIETY

The present constitution and by-laws of the Medical Society of the County of Kings sets forth its object as "the advancement and spread of medical knowledge, the support of a medical library, the promotion of scientific education, the publication of proceedings and medical papers, and the fulfillment of the duties of a county medical society."

The society was established in 1822 to comply with the state law which permitted the organization of county medical societies for the purpose of regulating the practice of medicine and licensing practitioners. The licentiate, on receiving his license, signed a declaration to honestly, virtuously and chastely conduct himself, and with fidelity and honor do everything in his power for the sick placed in his care.

The development of one hundred years finds the society maintaining the fourth largest library in the United States, housed in a modern fire-proof building, containing in addition to the library space of stackroom for books, a reading room, offices and an auditorium seating 350 people, as well as two meeting rooms, one accomodating about seventy and the other thirty people.

In addition to the regular stated monthly meetings of the society, the auditorium is used for the much talked about Friday afternoon practical clinical lectures twenty times a year. Thus the medical society really holds twenty-eight meetings devoted to scientific medicine. At eight of these meetings the business of the society is a part of the program.

The auditorium and lecture rooms are used by seventeen other medical societies, which hold 123 meetings during the year. Dental and other organizations in the allied fields also use the building of the society, and so the fulfillment of aims and objects is furthered by providing a truly medical center in which are held more than 123 gatherings devoted to the advancement of the health and welfare of the community.

The further fulfillment of its objective is striven for through committee action within and without the confines of the medical profession.

In 1924 the society, through appropriate committee action, participated in preparing the standing orders of the Visiting Nurse Association. In 1922, 1923, 1924 and 1925, the subject of periodic medical examinations of apparently healthy persons was given consideration and resulted in action that has been of national influence in crystallizing thought on method of procedure in this age old service of physician to patient.

In 1925 the nursing problem was considered in its many ramifications, and a preliminary report was issued which has received a cordial reception in nursing, hospital and health circles beyond the confines of the county of Kings which constitutes the borough of Brooklyn of the city of New York.

The hospital and dispensary situation is under constant review and actively participated in by the society. In 1925 the attention of the entire medical profession and the laymen composing hospital boards was focused on this important phase of medical practice through the distribution with the Hospital Council of Brooklyn of a statement of needs and standards in dispensary procedure.1

The participation in community affairs of the Medical Society of the County of Kings is a noteworthy example of the place a medical society can assume in the daily life of the territory it serves. The enumeration of a few of its activities. shows a breadth of scope and broadness of vision that points a lesson for county society action elsewhere. If Kings and a few other county societies can do it all live county societies can do it.

The legislative committée holds an annual dinner at which it entertains all the legislative representatives of the county.

The clinical committee conducts the Friday afternoon practical lectures to which the entire medical profession is invited.

1. Needs and Standards of Outpatient Service, Bull. A. M. A. 20:106 (April) 1925.

The joint committee of the society and the Long Island College Hospital Medical College conducts more than one hundred courses each year in its graduate teaching program.

The public health committee provides a channel of communication with the official and unofficial health agencies and is conducting studies of dispensaries, the

control of syphilis in private practice, the cost of medical care, health examination procedures and the like.

The milk commission is the fourth oldest in the United States and certifies over 5,000,000 quarts a year.

The committee on illegal practice has been responsible in cooperation with the governmental agents in the accomplishment of a considerable improvement in its field.

The joint committee of the medical society and the Brooklyn Chamber of Commerce has studied the heatlh resources of the borough and is considering the advisability of the establishment of a health council for Brooklyn.

These and many other activities mean work for the membership and the expenditure of time and money.

Measured in hours it is obvious that the trustees, council, censors, officers and committeemen spend much of their time, energy and money in making the Medical Society of the County of Kings the vital community asset it is recognized to be. We are informed that during 1925 over 2,000 hours of time was given by the members charged with the conduct of the affairs of the society-time that is known about because of business meetings of committees and the like. No accounting can, of course, be made of "overtime" consumed in work before and after meetings. Brooklyn has a population of more than 2,000,000 and is served by approximately 2,600 physicians, of which number 1,601 are members of the county medical society.

Much of the work accomplished is the result of community support. The society maintains its home, supports a medical library for the public benefit and by its very existence makes possible general community participation in medical It is attracting the required support from the community to provide the many supplementary activities entering into the completely rounded service that a county society can render.

That participation pays appears to be a recognized fact in Brooklyn by both the medical profession and the thinking laymen and lay organizations.

ANNUAL CONFERENCE OF SECRETARIES OF CONSTIT UENT STATE MEDICAL ASSOCIATIONS

HELD AT CHICAGO, NOV. 20-21, 1925

PERIODIC MEDICAL EXAMINATIONS GRADUATE EXTENSION WORK THE PROGRAM OF A

MEDICAL SOCIETY

JOHN E. JENNINGS, M.D.

COUNTY

President of the Medical Society of the County of Kings

BROOKLYN

I know that you do not want to listen to a dissertation on medical education or on periodic health examination, nor do I want to make one. I take it we are all persuaded that the profession needs certain forms of education and that health examinations are, on the whole, a good thing.

What you perhaps expect from me is a report on a story of how the Medical Society of the County of Kings put over health examination with a tremendous roar and how now every man, woman and child in Brooklyn is being examined by their family physician on their birthday, and how this has made Brooklyn so healthy that the doctors have nothing else to do. But that was not what happened at all.

What did occur was this: We made a beginning with the cooperation of the Brooklyn Chamber of Commerce. We had a fine active medical advisory committee. We drew up our own blank in such a way as to seem to us better than previous patterns. We examined 100 physicians and gave them instructions in the technic of the examination; then one of the component parts of the lay committee. with which we were working, lost orientation, became maniacal and the whole

movement stopped. It was necessary to let it rest for about a year before its overheated bearings had cooled, and now we are ready to start and are on our way again.

We found that industry was not willing to underwrite the health survey without access to the record of the individual. We hope it is going to be different now. We found some question on the part of the laity as to the capacity of the average man in general practice to make a reliable health examination and we were asked as a society to guarantee the ability of 1,000 such physicians in our city who would be willing to do this work.

We were brought face to face with the question of the economic value of such an examination and had taken steps to solve that problem. It had been planned to make a drive for the purpose; I do not think we shall advise that again. I am rather persuaded that a slow trickle of oral publicity, directed through the channels reaching women and thus children will prove, in a very few years, the most effective method of publicity.

The problem or rather the task, however, of convincing the public of the value of periodic examinations is, to my mind, less important than that of preparing the physician to make them. I do not believe we have recognized just what this means.

This we have, as I said, undertaken and I expect our next step in advance to proceed along this line.

As to graduate education and the county society, we are singularly fortunately situated in Kings County, for a trial program and the experiment is now well under way.

Let me give you a sketch of our problem.

Long Island, on which Brooklyn stands, is a wedge-shaped tongue of land along the length of which runs the ridge which marks the terminal morraine of the great ice sheet. It is 150 miles long, very fertile, almost entirely free from stone. At the western end it backs against Manhattan Island and New York Bay. The eastern end is a waste of sand dunes-Montauk Point and its lighthouse, and beyond the open sea.

Its western end is a dense city of 3,000,000 inhabitants-Brooklyn and Queens boroughs. Beyond this is a suburban zone of 30 miles and beyond it a gradually thinning rural community whose inhabitants speak the tongue and preserve the traditions of the New Haven Colony, mitigated by an admixture of the sturdy Holland stock which settled the west end of the island. Toward the eastern end a small remnant of the Shinnecock Indians remains.

All this in a space 150 miles long by from 20 to 30 miles wide. We have in miniature, a continent of our own. There are four counties and four county societies on the island; i. e., Kings, Queens, Nassau and Suffolk-Kings, urban; Queens, urban and suburban; Nassau, suburban and rural, and Suffolk, rural.

We are not New York. The great city is back of us but we advance toward the east at the rate of a mile a year with a belief in the future that Texas cannot surpass. We have had a boom for the last ten years and are still booming.

We have a population of a very mixed stock, about one-third native, and we are subject to periodic floods of alien humanity which sweep over us, obliterating ancient landmarks, which presently they apologetically help to restore.

We have our own medical school, the Long Island Medical College, a brave little institution which has been able to meet the requirements of a Class A school while preserving as much as might be of the actual medicine of the pre-Flexnerian era; and we have in our county Society building, for we are fortunate in owning our own building, a good medical library, the fifth in size in the country in fact. We are fairly well supplied with hospitals and dispensaries and, most important of all, our professional brothers have given us the vital support of curiosity, criticism and cooperation in every phase of our undertaking.

The graduate education movement in Kings County began during the presidency of Dr. Frank D. Jennings with a series of practical lectures given at 5 p. m.

on Fridays by men well known in the profession, on subjects of daily useful interest to the man in general practice. They were from the start an immense

success.

Then followed a joint enterprise with the Long Island Medical College. A committee was formed representing the county society and the college. A number of hospitals were willing to cooperate and a series of short courses in practical clinical subjects was offered. This movement has also been successful. It has gone on increasing in value and importance each year. There is much to learn. Some hospitals are not teaching institutions and some are. There is a need for all sorts of variation in such an attempt at growth. I myself am more afraid of over-standardization and of too much authority than I am of freedom.

The actual practice of medicine is a craft and like any other craft must be transmitted from man to man. It does not solicit; it demands an apprenticeship that never ends. It has suffered and gained from its association with the learned, in an academic sense, but it will not much longer tolerate the barren futility of the present undergraduate course.

The hospital must learn to distinguish between the teaching institution and the institution of learning. It is the conversion of our hospital training schools into schools of nursing with its enormous increase of pseudotheory, white uniformed instructors and economic burden that has given us our nursing problem. A very similar dilema in medical training is just around the bend. Too much teaching and too little learning.

Meanwhile we must do the best we can, which has seemed to us in Brooklyn to be to offer to those in the profession who want it such opportunities as our hospitals afford for simple, practical, real clinical learning in the recognition and cure of disease.

We have had some curious experiences. Not a little local criticism has come our way. It has a slightly bitter taste, but it is tonic and might easily become a habit.

We are now planning, in conjunction with the recently activated state committee, Dr. Charles A. Gordon, chairman, who organized and established the work of our own committee, to carry the education movement, as we say, “down the Island." We began last summer and a winter program is under way.

The program of a county medical society: We have started by a vital realization that organized medicine has responsibilities and duties beyond mutual protection and self improvement; that these include a reaction to the present preparation to practice medicine as imposed by law and academic custom, a reaction to the present opportunities for continued improvement and inspiration enjoyed by the practitioner and a reaction to the present hospital and nursing situation.

Are they all they ought to be?

We have realized the enormous force for civic and social sanitation that rests as yet potential in the increasing interest of women in all branches of welfare work. They will come. They are coming to us for advice. How can they best attack their many problems? Shall we tell them that we do not know and that we do not care; that our only interest is in disease in the individual and that we can only see and talk to them, one by one?

Make no mistake, if we do not live up to this call for service we shall be replaced by better and braver men.

We have just begun and we have a long way to go. We would like to see our county society the center of our community in everything that has to do with medicine and its allies, dentistry, pharmacy and nursing-the center of all public health activities, a focus of all honest lay effort for social sanitation-and we have just begun.

We have organized our activities under the direction of committees.

A committee on public health assumes a broad responsibility in all activities that may be grouped under community medicine. The health examination program