error.

All of the members of the society should be interested at least to some extent in the problems of social medicine and of economics and of public health generally. If these problems are thrashed out entirely in the house of delegates and only the purely scientific program is sent to the general meeting, it is likely that it will be difficult to get the members behind any movement or attempt at economic reform.

In the American Medical Association, as its annual sessions are constituted, the scientific meetings are devoted to scientific matters. The House of Delegates handles all other matters. The scientific sessions are not used for the presentation of papers on social medicine and on economics. A state society should certainly plan at least one session of an annual meeting in which these problems may be brought directly to the membership. Otherwise the membership will have to gain all of its information by such reading as it cares to do in medical periodicals. If the state society is organized in such form that social medicine is kept out of the general meeting, if the American Medical Association is organized in that manner, and if county societies and councilor districts lean toward the scientific paper primarily, the handling of social medicine and of economic problems will be left entirely to the group of organizers, of politicians and of representatives. The general membership will not be able to keep informed and to recognize its individual duties.

CLINICS AT STATE MEETINGS

The clinics as they have been seen at the state medical societies have seemed to be a valuable feature. I have noticed within the past four or five years an increasing tendency of physicians to go to meetings at which they get clinics. The growth of the postgraduate assemblies, and of the clinical congresses, and the amount of interest expressed in that work must represent clearly an attempt to give to physicians something that they actually want. The increasing popularity of the clinics given at the first day of the meeting of the American Medical Association has caused the Board of Trustees to recommend for the Washington session two days of clinics preceding the opening of the scientific sessions. The way to increase attendance and to hold this interest in the main medical organization of the country is to provide through that organization a certain amount of clinical material.

Of course, the difference between a clinical meeting and a meeting at which papers only are presented is one of psychology. The doctor as well as every one else craves action; he likes to see movement; he likes to see things going on. Papers such as this or the one that preceded it or those that may follow are sometimes good, although sometimes they have the peculiar ability to put the listeners to sleep, whereas a clinic usually keeps a man awake because he sees something moving. The same observation applies to exhibits. If one walks along the aisles one will see the crowd assembled in front of the booth where something is going on, not where there are only charts and flat specimens for study.

At a meeting of one of the societies which I visited, the afternoon was growing dull. About six papers had been read, and one of the members of the society stepped into the anteroom. He had there-by appointment, presumably-a patient. The patient had an unusual lesion of the skin. A number of physicians, first one or two, then three or four, moved out of the main assembly room in which the papers were being presented, and walked into the little side room in which a patient was being presented. In other words, this unofficial clinic with a single patient started in the middle of what was a long scientific program and succeeded in drawing from the main program about half the attendance that was in the hall. It is my interpretation that the men wanted to see something actually in motion.

THE HOUSE OF DELEGATES

In observing a house of delegates-I will speak frankly-one is confronted with movement again. He sees in some the operation of a well oiled machine in which everything moves smoothly, in which every contingency is provided for, in

which the voice rising in the wilderness is quickly hushed. He sees in other state societies the operation of a machine that is running entirely without oil, that clogs up every time something sticks. Obviously in a perfect medical society-that is a medical society as part of a democracy-the action would be something somewhere between these two. Certainly the machine ought to operate in such fashion as to get the business done, but not in such fashion as to grind up the individual member. When a machine operates too well it represents an organization within the organization; it represents a small group in which the secretary undoubtedly has a conspicuous part because he is after all the main portion of the works. When the machine. does not operate at all, it usually fails because the secretary is inefficient and because the society has a presiding officer who may never have presided anywhere previously, and who certainly is not fit to preside on this particular occasion. I have seen many presiding officers in my time and they vary. The American Medical Association avoids the difficulty by selecting a speaker of the House of Delegates, familiar, sometimes, with the rules of order, and when not familiar, quite able to enforce them such as he thinks they are.

Other societies have also attempted to adopt the plan of having a speaker of the house of delegates. I have seen presidents of state societies quite unable to do anything at all. I have seen them refer to the secretary for every possible action on which they might be asked to make a decision. I have seen one president turn to the secretary at least fifty times in a single morning session and say, "What do I do now? What do I do now?" maintaining his face to the audience and out of the corner of his mouth trying to get an idea out of the secretary as to what he ought to do.

One way to avoid these contingencies is to have the secretary and the presiding officer get together at least one week before the session to go over the order of business that will probably come up at the session. The secretary may provide the president with a few notes as to just what he does when the business is presented, as to whether he refers it to a certain committee, as to whether he makes a definite ruling. He may inform him perhaps of a few major points in the rules of order so that he will not constantly be in the position of hitting somebody with the gavel.

I do not believe that all state medical societies should necessarily have a speaker of the house of delegates. The opinion is wholly personal and is based on the fact that the president in some societies has little enough to do anyway and that probably it is a good thing for the president to be forced to sit in the meeting of the house of delegates and to learn the business of the organization as a presiding officer.

I saw reference committees of all types and classifications in the state medical societies whose meetings I attended. I have seen one house of delegates operate with what was known as a committee on committees. Every committee that made a report had that report sent to a committee on committees which looked over the report and made a final report. The house of delegates acted on that final report of the committee on committees. I saw the great power lying within a single committee of this type and I seriously doubt the advisability of a committee on committees.

In another society I saw the same procedure adopted that is followed in the American Medical Association: a reference committee for each type of business brought before the society. That is apparently the ideal method, particularly in these times when medicine may be misrepresented before the public. It is necessary that random reports all sorts of queer ideas and schemes such as may be brought up before the state society-should be referred for consideration before action. In other societies in which there are no reference committees I have seen action adopted in the morning session and reversed in the afternoon session.

The public is taking an interest in scientific medicine. It is entitled to know what is going on. The statements that are made should be safeguarded to represent the actual will of the society before being brought into the open.

The main committee before any house of delegates, at least as I have seen them operate in these visits, is a committee that is sometimes called the committee on public policy and legislation, sometimes the committee on health and public instruction, sometimes the committee on public relations. To this committee are referred all questions having to do with medical legislation, with the SheppardTowner Bill, with education and the press, with publicity for the annual session, with anything concerning the broad general relationships of medicine to the public. It might be well to work out a uniform plan for the creation of a single committee in each society charged with these general functions. These committees operate differently in different groups, although they all consider the same general problems.

In a society that I visited I heard about eight committees called on one after another for reports. The responses were "Our committee was never called together," "We have no report," "Our committee has never met." There was a cluttering of the official program of the meeting with a large mass of inactive material. The committee on conference with the pharmacists, the committee on conference with the masseurs, the committee on conference with the boy scouts were all called on for reports but no reports were available. It should be the duty of the secretary before the calling of a session to anticipate the material to be brought up, to communicate with the man who is supposed to bring up the material, to find out whether the committee will have a report, whether the committee has been at all active. If a committee is not active there is no reason for its continuance and the house of delegates can take action in regard to it.

THE ELECTION OF OFFICERS

The choice of a president is usually involved in the operation of the individual machinery, and the less I say about that the better. In one society I witnessed the election of five vice presidents. When the delegates got down to the fifth the material had dwindled out pretty small. By the time they got to the third, hastily assembled gatherings were meeting in various corners of the room to find some ancient octogenarians on whom the third, fourth and fifth vice presidencies might be conferred. In the new model constitution for state medical societies which the American Medical Association is proposing, I believe there is an attempt to get rid of what might well be called our "superfluous" vice presidents.

Elections in state medical societies are also concerned with the selection of delegates to the American Medical Association. I have heard society after society enter into long debates on the question of a delegate, stating that "the delegate should be elected year after year in order to have continuity of office, in order that he may adequately represent our society in the House of Delegates;" "our society never gets what it goes after because a lot of those delegates come back year after year, know all the machinery, and get anything they want." That is the common trend of the addresses before the delegate is elected. The House of Delegates of the American Medical Association operates efficiently, and the man who proposes to operate in that group ought to be an efficient operator.

THE PUBLIC SESSIONS

The public meetings in the societies which I visited have seemed to me to be a matter of great importance, possibly because I was a speaker in the public meeting. The attendance, perhaps, in spite of the fact just mentioned has in general been good. In a small community as many as 1,400 have attended a public meeting, and in larger communities as few as 600 have appeared at a public meeting. There is something to be said for the manner in which the public meeting is provided with an audience. Here is a task for an expert, a man who knows how to build up interest in a public meeting. Interest in a public meeting can only be built up by proper attention to the press in the community in which the public meeting is to be held, and by proper attention to the regularly established organizations of the city. A notice sent to the Rotary Clubs, Kiwanis Clubs and chambers of commerce, and

proper notices in the newspapers of the community, will bring to the meeting a great many more people than merely a brief announcement in the press some day to the effect that there will be one meeting open to the public when the medical society meets next week.

One of the largest audiences that I have seen brought out for a public meeting regarding medical education of the public was assembled by presenting individual admission tickets to the heads of large industries who were interested in the promulgation of scientific medicine among the public, and asking them to help by getting as many of their employees as possible to attend the meeting. The largest that I saw was in Oklahoma where the superintendent of schools of Tulsa county asked every teacher in the county to attend the meeting. Apparently they all came!

ENTERTAINMENTS

The entertainments vary. I have enjoyed all of them. The annual banquet of the state society is gradually changing for the better. I say this from an observation of some fifteen years of banquets of one kind or another. It is changing for the better largely because of the somewhat relative difficulty of securing liquor and possibly also largely because of the attendance of ladies at the annual banquet. The annual banquets are no longer he-men feasts, where the chest is bared and wild and woolly stories are told for the major portion of the evening. They are rather sane discussions of all of the problems associated with medicine, with general public enlightenment. The annual banquet has become largely civilized! The dances are likewise things of beauty and a joy forever.

THE WOMAN'S AUXILIARY

In practically every state society I visited the first question the secretary asked me was, "What are you going to say to the Women's Auxiliary?" The next was not a question but a direction, "For goodness sake, tell them to lay off." Apparently the women's auxiliary was trying to accomplish something and nobody knew just what or how it should be accomplished; the great fear was that, by its endeavors to accomplish, it would throw something into the machinery. I have gone before such women's auxiliaries as I have had the honor to address and have told them the things that I though a women's auxiliary ought to do. In most instances the women's auxiliaries are trying to do the things that the houses of delegates of the state medical associations tell them to do. They are not trying at present to exceed those powers and most of them are doing things in an intelligent manner.

Many of the women's organizations have been of great service to Hygeia, in building its circulation, in getting it introduced into the schools and in bringing it into contact with the local press so that material from Hygeia is more widely circulated.

Other women's auxiliaries have constituted themselves into smaller committees which got on the programs of all of the women's clubs in their communities and saw to it that the women's clubs were not used by promoters of schemes of economic or medical quackery, for their particular purposes. A few intelligent members of a medical women's auxiliary on the program committee of a federation of women's clubs can stop a lot of foolish discussion about the SheppardTowner Bill, can stop the representatives of Bernard McFadden and of Harter's Defensive Diet League and of a lot of other things from getting on the programs of the women's clubs, and preaching to them the peculiar doctrines that are against the best interests of medicine and of the public.

For the present, those I consider personally to be the main functions of a woman's auxiliary. There are added functions such as have to do with entertainment at the annual sessions and with matters in which women are especially gracious.

I have protested to every women's auxiliary to which I spoke against any attempt to form within the women's auxiliary a separate legislative committee