to industry and ultimately paid by the consumer, no matter who makes the choice. Presumably, the workman who has freedom of choice will procure the best medical services available, and no one has ever yet proposed that, in the exercise of his right to choose, the workman shall be debarred from choosing any medical service the employer may provide. The employer, then, who insists that the workman. shall not be given freedom of choice is in the position of contending: (1) that the workman is willing to submit himself knowingly to inferior medical treatment in order to obtain the services of a physician whom he believes is not biased in favor of the employer; (2) that the workman is too stupid to choose the best service even when it is placed before him, or (3) that the service offered by the employer is not the best, but must be forced by law on the unwilling employee. As a matter of fact, to allow injured workmen to choose between the medical service offered by an employer and the medical' service obtainable elsewhere should stimulate a healthy competition for excellence of service in the plant and among competing physicians, and thus result in the maintenance of the highest possible grade of professional services in the community. The right of the employee to choose his own physician can hardly interfere with effective preventive measures on the part of the employer. If the right of the workman to choose his own physician will produce the disastrous consequences sometimes alleged, the very fear of those consequences should serve even as an effective force to compel employers to adopt efficient preventive measures within the precincts of their establishments, and thus to cut down the number of accidents. And this, after all, is the highest ideal to strive for. The fear of the consequences of outside treatment, if they are so grave as has been alleged, should, moreover, serve to stimulate the employer to the improvement of his own medical service so that his employees may be willing to resort to it in preference to seeking outside aid. OPERATION OF LAWS NOT LIMITED ΤΟ FAVORED SPOTS A comparison of the professional efficiency of the physicians in the service of employers to the professional efficiency of physicians not so employed involves many factors difficult of appraisal. Obviously, however, one cannot rightly compare the efficiency of the physician of today, in the service of a large corporation and provided with adequate dispensary and hospital resources, with the efficiency of the average physician of eight or ten years ago in the same community, having no such resources. Neither can the physician of the former class be fairly compared even with the physicians outside the plant who are called on to attend. industrial cases for the limited compensation allowed under the workmen's compensation act; the comparison must be made with the physicians in the same community who would enter industrial service if the law provided adequate remuneration for it. But especially it must be borne in mind that only a small amount of the industrial medical work of the country is done in the hospitals and dispensaries maintained in manufacturing centers by some of our large industrial organizations. The injuries that arise out of industry are being treated in all parts of the country under all possible conditions. The physicians who treat them are ordinarily the physicians who are practicing in the community and who depend on the community for their medical and surgical resources, just as their associates do. To infer that because a physician in a community has been selected by some local manager, or division or camp boss, to treat his injured employees he is or thereby becomes better qualified to do such work than are his associates in the community, would require a considerable stretch of the imagination. The medical profession has no quarrel with the theory on which workmen's compensation acts are based. In so far as such acts conform to that theory and confine themselves to matters necessary to carry it into effect, the medical profession can be depended on to support it as strongly as does any other class in the community. But when such an act operates to shift to the medical profession burdens that the theory requires to be shifted to the consumer, the medical profession complains. And it complains again when any such act unnecessarily authorizes strangers to the professional relation between a physician and a family to step in and compel a member of the family group to go elsewhere for treatment, against the wishes of the family and of the patient. A MEDICAL SURVEY For some months the New York State Journal of Medicine has had a department called "Medical Survey," to which from two to six pages are devoted in each number. In this department data pertaining to the conditions of medical practice, the number and distribution of physicians, medical societies, hospitals, sanitation, nurses, population, etc., etc., for one or more counties in New York are presented each month. The New York State Journal of Medicine is doing a splendid work in making. this survey, and in compiling a permanent record of the information thus secured. which is valuable for present purposes as well as for future use. When it is completed for the whole state, the Medical Society of the State of New York will be in possession of facts that every state medical association should have about conditions in its own state. The survey of Clinton county was printed in December, 1924. It shows that the county has a population of 43,898, about the same as in 1850. There are forty-five physicians in the county, eighteen of whom are in its one city which has a population of 10,909 and is the "natural center" for its own county as well as for large parts of two adjoining counties. In addition to its one community classified as a city, Clinton county has fourteen other "centers" with twenty-seven physicians one physician for every 1,200 inhabitants. Here, as elsewhere, the tendency is for physicians to locate in the centers of population. It is, said, however, that the use of the automobile and greatly improved roads make the services of physicians more available than ever before. In the winter when heavy snows make hard going, some of the physicians use "snowmobiles," conveyances propelled on runners by automobile engines. Clinton county has three hospitals, two in the county seat and one operated by a mining company at the site of its operations for its own employees. One of the two larger hospitals has eighty beds, the other forty. Both have nurse training schools, one with forty-one nurse pupils in training, the other twenty-two. Each has a laboratory, one of which receives $2,000 a year for making examinations for the county board of health. One hospital has an intern, who receives no salary. The total number of hospital beds in the county is 140, about 3.2 beds for each 1,000 of population, but adjoining counties send patients to the Clinton county hospitals so the proportion of beds to the population of the territory served is really much smaller than the above figures indicate. Clinton county has a medical society with thirty-one paid up members-72 per cent. of the physicians in the county-higher than the membership per cent. in other counties surveyed. Two regular meetings are held each year, and joint meetings with societies of neighboring counties are occasionally held. The average attendance is more than 50 per cent. There is a committee to advise with the county board of supervisors in public health matters. The society cooperates actively with the state society in legislation and other important matters. The county seat of Clinton county has a board of health. The health officer conducts a weekly venereal disease clinic; there is a child welfare station with a weekly clinic; tuberculosis clinics, conducted with the cooperation of the staff of a nearby sanatorium; occasional orthopedic clinics are held; there is a "health column" in each of the local papers. The county, outside of its one city, is divided into nineteen health officer districts, served by thirteen health officers. The board of supervisors employs a county nurse. There is a summer camp for undernourished children. An insurance company maintains a nursing service for its policy holders. All of the above data and more are included in the survey of Clinton county. Other county surveys printed in the journal are even more complete. All of them have produced compilations of valuable information that the Medical Society of the State of New York should have and can use to fine advantage. Any state medical society can easily do what is being done in New York state, to its own advantage, to the benefit of its county societies and for the public good. Facts in hand are valuable. A DAY OFF FOR WORK The Michigan State Medical Society is "putting on" a program of graduate work at a central place in each of its councilor districts. This work seems to be greatly appreciated, because in each of the three places where it has been offered the attendance has been good, and fine interest has been shown. The councilor in whose district a clinic is to be held, with the executive secretary of the Michigan State Medical Society, does the necessary preliminary work to insure a good program and a good attendance. The public is advised through the newspapers of the time and the purpose of these clinics; then, too, each physician in the district is sent a card to be hung in his office-where it can be seen and read-as follows: To My Patients: ATTENTION! November 18 is a Special Day of Study in a Clinic for the to be informed upon the newest and best advances in modern medi- (Signed) M.D. There is little doubt but that the public will respond to an appeal of that kind when it knows that its own interest is to be served. A WARNING One Lee Whittaker, claiming to represent the American Medical Association and other organizations, is travelling about the country soliciting subscriptions for publications of the Association and securing money from physicians. On January 19, 1925, he accepted a check from a physician in Newnan, Ga., and immediately collected the money at a local bank, after endorsing the check as "Representative' of the American Medical Association. According to the best information available this man is about 21 years of age, 5 feet 7 inches tall, fair, and has very "winning ways." It is quite probable that "Lee Whittaker" is only one of his names and that when next heard of he will be using another. The American Medical Association has no one in its employ whose name is "Lee Whittaker." Nor does it have any subscription solicitor who is not provided with credentials signed by the Secretary and General Manager of the Association and bearing an impression of its seal. REDUCED RAILROAD RATES FOR ANNUAL SESSION Members of the American Medical Association who attend its annual session at Atlantic City, May 25-29, will secure the benefit of reduced rates established by the passenger associations for that particular event. The so-called "certificate plan" will apply, which means simply this: The member of the Association going to Atlantic City to attend the annual session must pay full fare going and, at the time of purchasing his ticket to Atlantic City must secure from the ticket agent a certificate provided by the railroads. This certificate must be approved by the Secretary of the Association at the Registration Bureau and must be validated by a representative of the railroads who will be available for that purpose. This certificate, when approved and validated, will entitle its holder to secure a ticket to his home at one half the regular fare. Members of the Association accompanied by members of their families will have the benefit of the reduced fares for these, too. Additional information about railroad rates, routes, and details of arrangements at Atlantic City will be found in the Journal under the head "Association News." ANNUAL CONFERENCE OF SECRETARIES OF CONSTITUENT STATE MEDICAL ASSOCIATIONS HELD AT CHICAGO, NOV. 21-22, 1924 (Continued from January, 1925) SPECIAL AND INDEPENDENT LOCAL SOCIETIES—WHY? WALTER F. DONALDSON, M.D. PITTSBURGH I believe that the answer to the existence of special societies is obvious. I take it for granted that special societies exist because there are groups of men in certain communities, not in every county, of course, who are interested in some special phase of the practice of medicine and surgery, and that this group of men of necessity must meet together occasionally to discuss subjects in which they alone are especially interested. In the existence, however, of the independent medical societies I believe we have a problem that concerns every county medical society. I take it for granted that some of them exist because the county medical societies do not meet often enough. Others may exist because county medical societies do not have certain. social features which may be outstanding features of independent medical societies. I believe the blanket answer to the question is that these independent local societies exist because the component county medical societies and the state medical societies have in some way failed to do their full duty. Undoubtedly there are geographic reasons for the existence of certain independent medical societies. In my own state we have two or three such organizations that exist because up and down some line of the railroad are central points in two or three counties at which the men of the various county medical societies concerned can gather, and where they do gather at least once a year, for one large group meeting. In our state we have recognized the need for such meetings, and we have tried to assist through our state organization. In certain independent organizations that have traditions of a good many years' existence, recognizing the necessity for the continued existence of such societies, we have frequently arranged that the councilor for the district should be the chairman; or, if possible, we have the president of the state society invited to be present and preside. Again, we have contributed financially to the support of such meetings. I believe, as I said a moment ago, that the whole thing harks back to a failure of the councilor and of the officers of the state society to do their full duty in a given district. In our society we have our constitution and by-laws so arranged now that we have a censorial district meeting every other year, in the odd year, and a councilor district meeting every other year, in the even year; thus, in each councilor district planning for three meetings in two years, which are in effect group meetings of the various county medical societies concerned. I believe that in such activities lies the answer to the question, "Why do these independent local medical societies exist?" I believe, also, such activities answer the question as to how such societies may be absorbed and controlled by the medical organizations that should control them; namely, the county medical societies and the state medical societies. N. B. VAN ETTEN, M.D. NEW YORK I have been for twenty-five years a member of an independent society in the state of New York, the Greater New York Medical Association, associating physicians from all the boroughs of New York City. One of the reasons for that independent society probably lies in the manner of doing business in the county societies. I have been present at meetings of the county societies when the scientific session didn't begin until about 10 o'clock. You can't get physicians to go out in the evening to discuss for a length of time the business of the medical profession. They ought to, but they won't. They go to medical meetings, because they are interested in matters of scientific interest. In the Greater New York Medical Association, the business takes five minutes. The meetings are called sharply at half-past eight, whether there are a half-dozen people in the room or not. They usually have a curtain-raiser, a short paper, and then the important discussion comes afterward. Those meetings are largely attended. Two hundred and fifty men were at the meeting last Monday night, because they were interested in a particular subject We have a pneumonia meeting every December, which taxes the room to the doors. JOHN B. MORRISON, M.D. NEWARK, N. J. It seems to me that the cause for the continued success of independent societies goes deeper than anything we have heard. In the northern section of New Jersey, ten years ago, we established an Academy of Medicine. After four or five years we were able to build an adequate, not sumptuous, comfortable building, and we made the effort to break down independent societies in that section of the state. Many of us pledged ourselves to give up our membership in independent societies in the hope that we could create in the sections of that society the same amount of interest manifest in the inedependent societies. The county society is a large one, with a membership of 500 or 600. The first meeting was a meeting of registration, at which there was no scientific work. The other four meetings were given up to scientific work. There were 100 or 200 men present. The size of that meeting, it seemed to us, did away with the personal contact, the personal charm, the personal interest that the smaller societies build up and maintain. |