AMD

AMERICAN MEDICAL ASSOCIATION BULLETIN

OFFICIAL JOURNAL OF THE HOUSE OF DELEGATES

Published Monthly, except July, August and September, by the American Medical Association, 535 North Dearborn Street, Chicago. Annual Subscription, 50 Cents.

Editor, OLIN WEST, Secretary.

EDITORIAL STAFF

Associate Editor, FREDERICK C. WARNSHUIS, Speaker of the House of Delegates

Entered as second-class matter, July 13, 1920, at the post office at Chicago, Ill., under the Act of Aug. 24, 1912. Acceptance for mailing at special rate of postage provided for in Section 1103, Act of Oct. 3, 1917, authorized Aug. 13, 1920.

THE LARGER PROFESSIONAL SERVICE

DEAN T. V. SMITH, PH.D.

Assistant Professor of Philosophy, University of Chicago

CHICAGO

The fundamental characteristic that usually distinguishes a professional man from a business man on the one side and from an unskilled laborer on the other is the fact that the professional man has found work that he enjoys doing for its own sake. The enjoyment does not spring wholly from the nature of his work, though it is true that he avoids the killing fatigue of the manual laborer and the crushing competition of the business man. More than these, however, is the fact that he mixes with physical exertion a liberal measure of that magic tincture called knowledge. His mind to him his kingdom is. Study has enabled him to look before and after and see not only his job, but to see also how it is related to what other men do and how the sum total of human activity is related to Mother Nature, who smiles on his infancy, indulges his maturity and outwits even the doctor to relieve his dotage. Moreover, he works under the light of distant stars, fulfilling past hopes and foreseeing future judgment on his workmanship. Thus with the poet, he sees life more steadily because he sees it more whole. Though often poor, he largely escapes the distressing insecurity that eats at the heart of the unskilled workman's contentment. Though he must have an eye to business, he largely escapes the restless drive, the constant risks, the dizzy kick-back of financial power, that bulk so large in the lives of ambitious business men.

While, then, the business man seeks to make money and the laboring man seeks to make a living, it remains for the professional man to make a life. Certain it is that today countless professional men illustrate that fine way of living that the philosopher long ago christened the "golden mean": as for money, they suffer neither from too much nor from too little; as for security, they dare not grow complacent, but neither need they fear; as for positive happiness-they have their work!

And this joy in work is the heart of the whole matter. To those who seek profits, "business is business." To those who seek merely a living, "work is Whatever richness and depth experience holds must come to them alike in the margin of life. It is little wonder, then, that our age sets such a feverish pace for leisure hours. Tawdriness on the one side, conspicuous extravagance on the other, mark oftentimes the lives of those who must snatch after work what should come gradually through the day's productive hours. No man will unresistingly forfeit the joy of life. And yet to do present work primarily for the sake of future rewards-whether of profit or of wage-is really to forfeit it. Even to succeed at such a game is to exchange one's birthright for a mess of pottage; to fail at it, with so many of the unskilled poor, is to lose one's birthright for a mess of dotage. And yet, looked at from the point of view of ethical ideals, this is the world in which the professional man lives, but of whose inner tragedy he is not really a part.

How are we of the professions to justify ourselves ethically in living thus on the cream of life while the great majority of our fellows must take the skimmed milk? We cannot argue that our cream does not come off their milk; for after all it is only on the condition that others do the manual labor and run the economic machinery that we are left free to cultivate skill and to pursue knowledge wherever the clues lead. We cannot thank God that we are not as other men, for the God of the Pharisee has led with his client out of the limelight into oblivion. We dare not argue that happiness of a minority must always be purchased at the expense of the many; for after all this is the twentieth century, not the tenth. We can, of course, as we have done in the past, lay on our hearts the obligation of service. We can give generously of the fruits of our cream-fed strength.

Contenting ourselves with small material rewards, we can do something to remedy life's great inequalities by taking huge gifts from the wealthy in order to furnish education at less than cost to the poor; or if we be physicians or lawyers, we can take enormous fees from the rich in order to furnish free service to the indigent. And who can charge that in seeking thus to serve we have not meant well? But who of us can pride himself on the spiritual quality of what we have thus accomplished?

The head and font of our offending is that we have not passed our cream around. The cream of my metaphor is the increment of liberal knowledge that constitutes us professional men. To understand one's work is the more cheerfully to stand under one's responsibilities. To see through what one is doing in all its relations is to spread over many otherwise unpleasant tasks that transforming light that never was on land or sea. Professional men are fundamentally derelict to their deepest duty if they do not let other men perceive what joy activity may bring when it is shot through with insight, and then help other men in similar manner to sanctify their work. For what is it either to cure the body or to improve the business of a man and slight his living soul? To stop the bodily aches of this rational animal without letting his mind become a party to the process is really but to substitute an intellectual insult for an organic pain-an injury of a higher for one of a lower type.

Who has not seen an intellectual crank squander hours explaining his humbuggery to an audience on whom a university professor would not spend a minute for the sake of scientific truths? And who has not seen a medical quack take charts and time to acquaint the humblest patient with knowledge that "ain't so,' when a reputable physician constantly fails to improve a thousand chances to give out knowledge that is so, and is highly important also? The satisfaction that many of us laymen get out of going to quacks is primarily the comfort of being treated like men instead of like incurious animals. One intelligent layman, in impatience with what he calls the intellectual selfishness of physicians, has indeed recently declared that quacks know men but not medicine, physicians medicine but not men.

Of course, one cannot with full justice draw up an indictment against a whole profession. There are physicians and physicians. But it is astonishing how large a number of intelligent laymen today harbor resentment against the medical profession: not because doctors are not good men, almost never because they are thought to be mercenary; but all too generally because they treat their great knowledge as though it belonged to them privately and would be lost if shared with others. The technical language in which they hide their prescriptions is to many but a symbol of indifference or superiority behind which physicians mask truths men need more than they need medicine. Considering the elemental ignorance of men regarding their own bodies and yet the natural wonder and curiosity and solicitude about themselves, one cannot but suspect that if physicians built wisely on the foundation nature has laid for them, the science of medicine could almost in a single generation increase its social utility a hundred fold. Medicine is the finest growing bud of science: in it theory enlightens practice and practice corrects theory. Foreign missionaries use the science of medicine as an opening wedge for the whole of our western culture. And yet in our own land surgeons will perform a tonsillectomy or an appendectomy and leave the patient unenlightened concerning, and even opposed to, evolution, though these vestigial organs are hardly more causally connected with the fact of human evolution than is the whole galaxy of modern sciences on which medical progress depends. A Bryan, whether he succeeds in changing state constitutions or not, can do the future of medicine more harm than a thousand medical quacks. To undermine the confidence of common men in the most fruitful theory of life that man has ever discovered is to strike a taproot blow at science. Doctors, who have by all odds the best psychological approach, must share with educators the joyous burden of letting their patients in on the new ways of thinking that have made, and do yet make, experimentation and research possible.