to deal with legislation. Legislation regarding medicine should be the particular function of the state medical society and should not be delegated to any auxiliary body.

THE EXHIBITS

The exhibits vary from three exhibits in one state society, which were antiphlogistine, milk of magnesia and an ultraviolet lamp, to an extensive exhibit before another society of many of the great manufacturers of drug products and of physical therapeutic apparatus, of publishers, and of local concerns dealing with medicine, as well as antiphlogistine and milk of magnesia.

The American Medical Association exercises rigid standards as to what goes into the annual exhibit at the American Medical Association's session. Probably the state societies also exercise certain standards which seem to them sufficient. That is, after all, for the individual state society to determine; it must determine whether it wishes to follow the Council on Pharmacy and Chemistry of the American Medical Association absolutely or whether it desires to slide a little on the borders.

The Colorado State Medical Society carries along with its commercial exhibit a scientific exhibit or a historical exhibit on a somewhat smaller scale, of course, than is the scientific exhibit of the American Medical Association. In the one of which I read two years ago and in the one which I saw personally this year, I found a great deal of interest personally. I am sure that all of the members of the society who took the trouble to investigate the exhibit found it worth while. This exhibit again represents the main thing of importance in the operation of an organization: FORESIGHT. The exhibit is planned one year ahead. It is decided that certain phases of medicine or public health education will be elucidated at the next annual session, and the man or the committee in charge of the exhibits lines up men who have given special attention to these matters, secures from them the exhibit material, arranges for a place in which to make the exhibit, and there presents graphically much knowledge that would not otherwise be available. This has seemed to me a function in line with the increasing knowledge of methods of teaching.

A SURVEY FOR THE YEAR 1925 BY THE BUREAU OF LEGAL
MEDICINE AND LEGISLATION

This summary of the medical defense activities of the several constituent associations of the American Medical Association for the year 1925 is based on information furnished by the state associations in response to a questionnaire submitted by the Bureau of Legal Medicine and Legislation. It represents a continuation of the effort to present an annual composite picture of the medical defense situation, with the end in view that a knowledge of the procedures adopted in each state may be available for the guidance of all. Each state association may thereby profit from the experiences of all others, taking advantage of measures that have proved worth while and avoiding methods demonstrated to be inexpedient.

The Bureau of Legal Medicine and Legislation is charged with the responsibility of studying the medical defense activities of the several state associations for the purpose of determining in what way assistance may be given by the American Medical Association. This annual survey is conducted, therefore, for the further purpose of enabling that bureau to give intelligent consideration to the responsibility that has been placed on it.

NATURE OF DEFENSE RENDERED

Forty-one state associations returned the medical defense questionnaires sent. to them. Twenty-three, with a membership of 65,418, offered defense service against malpractice suits in 1925. Eighteen associations which did not furnish defense service in 1925 had a membership of 16,806. Of the eight associations failing to return the questionnaire, all but one furnished defense service in 1924, and no information is available to show that any change was made in 1925. Of the associations which did not defend their members in 1925, three, the District of Columbia, North Carolina and Minnesota, are among those which have entered into agreements with private insurance companies whereby members so desiring can secure protection under group policies. În California, where the state medical association discontinued its defense service in 1924, an organization has been perfected, known as the Medical Society of the State of California, for the primary purpose of assisting members of that society in their defense against unjust malpractice claims. Membership in that society is limited to members of the California Medical Association who have indemnity insurance in some private organization in the sum of at least $5,000. Assuming then, that the seven associations which failed to respond to the 1925 questionnaire and which furnished defense service in 1924, still offered such service in 1925, a total of thirty-four associations,1 with a membership of 73,544, made available defense service in 1925, either by means of defense by the association or by group insurance policies or by the plan adopted in California.

Twenty-one of the twenty-three associations reporting on their medical defense activities for 1925 made such defense available to every member, by virtue of membership in the association. In two, Tennessee and West Virginia, the member to be entitled to the defense service was required to pay an annual fee of $1_in addition to annual dues. Minnesota, listed in 1924 as furnishing defense service, voted in April, 1925, to discontinue defending members. Defense service in fifteen of these associations included the furnishing of expert witnesses in cases defended by the associations or in cases in which the associations cooperated with private indemnity companies in the defense of a member. In four associations no such witnesses were provided.

FINANCING OF SERVICE

Twelve associations met the expense of medical defense by allotments from annual dues. Delaware, Nebraska, Oklahoma, Texas and Virginia allotted $1; Illinois allotted $1.50; Kansas and Michigan allotted $2; Oregon allotted $3; Wyoming allotted $5; Arizona allotted $6; Indiana allotted seventy-five cents. Six associations, Connecticut, Georgia, Iowa, Massachusetts, Missouri and Ohio, met defense expenses from their general funds. Two associations, Tennessee and West Virginia, paid defense expenses out of special funds created by members desiring defense service. In Louisiana, defense expense was paid from a fund accumulated by the allotment in past years of fifty cents from the annual dues of each member of the association.

In the twenty-two associations making the information available and having a total membership of 55,613, the sum of $51,921.98 was expended in 1925 in medical defense. The average per capita cost per member entitled to defense was ninetythree cents as compared with an average per capita cost of $1.10 in 1924. All expenses incident to medical defense were paid by the associations in fourteen states. In two states, Nebraska and Virginia, the state associations paid attorneys' fees only. In Delaware, the association limited its liability in the trial court to $100; in event of an appeal, the amount to be paid by the association was determined by the board of trustees. In Oklahoma and Missouri, attorneys' fees not.

1. Two other associations, Hawaii and Nebraska, with a membership of 131 and 1,227 respectively, acted favorably with respect to group insurance in 1926.

in excess of $100 were paid. West Virginia paid an amount not to exceed $300 for necessary legal services and court costs. In New York, all "ordinary" expenses were paid.

In six states the associations paid expert witnesses only the expenses incurred by them. In Arizona expert witnesses were paid $50 a day plus traveling expenses. In Indiana, Louisiana and Wyoming, such witnesses were paid $10 a day while testifying at home and $30 a day, plus traveling expenses, when testifying elsewhere. In Nebraska, expert witnesses were allowed $10 a day for traveling expenses. In seven states, the associations were not responsible for the expenses of expert witnesses.

In four states, the attorneys handling medical defense for the associations were paid annual retainers. In three states, such attorneys were paid annual retainers, plus a fee for each case actually defended. In twelve states, attorneys were

employed as the need arose.

ORGANIZATION AND PROCEDURE

Special committees to supervise medical defense were appointed or elected in 19 states. In one state, the committee consisted of two members; in ten states, of three; in six states, of five; in one state, of four, and in one state, of six. In three states, defense was supervised by the council and in one state by the executive committee.

Application for defense service in fifteen of the twenty states making the information available had to be presented directly to the state association. In five, the application was first referred to the county society, where an investigation was made into the merits of the case and the application then forwarded to the state association. In either case, whether the application was first presented to the state or to the country organization, the merits of the case were investigated before a decision was reached with respect to the matter of defense. The purpose of defense service by the association is not to prevent a claimant from collecting just compensation for injuries due to the negligent or unskillful treatment, but to save physicians from losses and inconvenience occasioned by malpractice claims and suits instituted without just cause.

VOLUME AND RESULTS OF SERVICE IN 1925 BY STATES

In the twenty-one states making the information available, a total of 543 suits were reported as pending in trial courts at the beginning of the year and 298 were instituted during the year, a total of 841. Of these, seventy-one were withdrawn before verdict, eleven resulted in verdicts for the patients, forty-nine terminated in favor of defendant physicians and 578 were pending, Dec. 31, 1925. information was submitted relative to the status of the remaining 232 suits.

No

A comparison of the figures submitted for 1925 with those submitted for 1924, establishes the fact that during the period covered by this survey fewer suits were instituted against physicians and reported to their respective associations than during the preceeding twelve month period. Reports from twenty states showed that 6.9 suits per thousand members entitled to defense came within the purview of the defense committees in 1924, as compared with 4.9 in 1925, a decrease of two suits per thousand members entitled to the defense service of their respective associations.

ALABAMA

The Medical Association of Alabama does not defend its members against malpractice suits.

ARIZONA

In Arizona, two claims were pending at the beginning of the year, and three were referred during the year. Of these, three were withdrawn by the claimants without suit and two resulted in suits. One suit resulted in a verdict for the

defendant physician and one was pending at the end of the year. In 1924, 9.5 suits per thousand members entitled to defense were filed and reported, as compared with 8.5 suits in 1925. The cost of defense service per member entitled to that service was forty-eight cents in 1924 as compared with ninety-seven cents in 1925. The cost per suit disposed of in 1924 was $133.34; in 1925, $230.

ARKANSAS

The Arkansas Medical Society does not defend its members against malpractice suits.

CALIFORNIA

The California Medical Association does not defend its members against malpractice suits.

COLORADO

The Colorado State Medical Society does not defend its members against malpractice suits.

CONNECTICUT

Twenty-eight claims were pending at the beginning of the year and fourteen referred during the year. Thirty claims were withdrawn by claimants without suit, four were compromised by the association, and two resulted in suits. Seven claims were pending at the end of the year. One suit was pending in trial court at the beginning of the year and one was instituted during the year. No information was given showing what disposition was made of the two suits. In 1924, 3.6 suits per thousand members entitled to defense were instituted and reported as compared with 0.8 suits in 1925. The association reported no expenditures for the year.

DELAWARE

The Delaware State Medical Society reported no claims referred during the year and no expenditures made on behalf of medical defense.

DISTRICT OF COLUMBIA

The Medical Society of the District of Columbia does not defend its members against malpractice suits.

FLORIDA

The Florida State Medical Association does not defend its members against malpractice suits.

GEORGIA

Eighteen claims were handled by the association during the year, seventeen of which were referred during the year covered by this survey. Of these, four were withdrawn and one compromised without suit. Twelve claims resulted in suits being filed and one claim was pending as such at the end of the year. A total of seventeen suits was handled by the association. One was withdrawn and one compromised before verdict, seven resulted in verdicts for defendant physicians and eight were pending in trial courts at the close of the year. In 1924, 11.4 suits per thousand members entitled to defense were instituted and reported as compared with 6.8 suits in 1925. The association in 1924 expended ninety-seven cents per member entitled to defense service, as compared with eighty-three cents in 1925. Each suit disposed of in 1924 cost the association on an average $129.04, compared with $162.26 in 1925.

IDAHO

The Idaho State Medical Association does not defend its members against malpractice suits.

ILLINOIS

No information was submitted relative to the number of claims handled by the association during the year. According to the annual report of the committee