more generally and more intimately on the smaller. A knowledge of these purposes is, in a measure, necessary to a proper understanding of the duties of the branch.

The constitution of the Medical Society of the State of New York states that, "The purposes of the society shall be to federate and bring into one compact organization the medical profession of the State of New York; to extend medical knowledge and advance medical science; to elevate the standard of medical education and to secure the enactment and enforcement of just medical laws; to promote friendly intercourse among physicians; to guard and foster the material interests of its members, and to protect them against imposition; and to enlighten and direct public opinion in regard to the great problems of state medicine."

After a study of this clause, it will be seen readily that a dividing of the state into districts and the establishment of bodies of wider scope than the county societies is a virtual necessity.

FUNCTIONS OF DISTRICT SOCIETY

The functions of the district branch society may be said to be three-fold: scientific, economic and social. Its contacts through which its influences are exerted are also three-fold; with the state society, with the county society and with the public. It is from these contacts that the various functions and duties arise and are made possible of accomplishment.

The scientific function is usually to provide papers and demonstrations by men of high scientific attainments who probably could not be induced to appear before a small county gathering. These papers are followed by a general discussion, opened by a local man known in the specialty discussed. În preparing a program care sould be taken in selecting only such subjects as may be of general interest and such men as may be considered to speak with authority. Controversial subjects, dogmatic and self-important speakers, and acrimonious discussion should be avoided. In this way, a harmonious satisfaction with the program is obtained, and the way paved for future good attendance.

The economic function is, perhaps, the most important one and its problems are many sided and far-reaching. Under this head should be classed all matters affecting the welfare of the county society and its individual members; of the profession at large within the district, and of the public.

SUBJECTS FOR DISCUSSION

Among the subjects of interest for study and discussion may be cited:

1. All activities of county societies which because of the contiguity of counties have become more than local problems, such as overlapping legislation and health laws, sanitation and hospital and school problems.

2. All matters which concern the health of the district and also bear relation to that of the state; such as the antidiphtheritic campaign; the antituberculosis work; the conduct of public clinics; industrial medicine, and all problems of preventive medicine.

3. The study of such subjects as may not be classed strictly under the heading of public health but rather under that of public welfare, such as the nursing question, and periodic health examinations.

4. The proper correlation of all work of a public health or welfare character with the health officers and the various welfare organizations. This work is too extensive for the average county society and usually covers more than the local territory.

In all such public health and welfare work, the medical man, both individually and through the channels of organized medicine, must take his place. Times and methods have changed and the physician can no longer maintain a passive attitudę in public affairs. If he allows his prerogative to be usurped and shirks his duty, he throws wide open the door for paternalism and state medicine.

The district branch society, at its meetings or through its officers, should discuss all these problems with the health and welfare bodies and make certain that the work is properly correlated and apportioned and that the practitioner is doing his duty. It is highly important that the public should be educated to the fact that the physician is doing his share in all measures of health, preventive medicine, and public welfare, and that he is working for them and not for himself alone. It is through the medium of the district society that such educational work can be fostered and promulgated. The education along these lines of both physician and public is part and parcel of the district work.

Postgraduate education is being demanded more and more by the profession throughout the rural districts of New York, and here again the district branch can carry on better than can the smaller county society. To bring this work to each separate county would require great sacrifice on the part of the educators and might deter them from giving their services; small audiences would dampen, and have dampened, the ardor and enthusiasm of lecturer and listener, and the expenses incurred would burden the finances of the state society.

A program composed of scientific, civic and economic subjects cannot be put over at an evening meeting and it has been the custom of the districts to hold. all-day meetings, or in some instances to allow the meeting to run into a second day.

THE SOCIAL PHASE

The social function of the society plays a great part in forwarding the success of the meeting. It usually consists of a get-together luncheon or dinner and in some instances of both; of facilities for golfing when held at a country club, as many of our meetings are, and of arrangements for the entertainment of ladies.

Invitations are frequently given to visit and inspect hospitals and institutions, and many members take pleasure in accepting these privileges. For instance, at one of the district branch meetings which I had the pleasure of attending, the morning was spent in such visits; at noon, a luncheon invitation was extended to a number of us by one of the local physicians; the afternoon was given to addresses by the president and secretary of the state society and by the presentation and discussion of papers on health and welfare subjects; the members in attendance were entertained at dinner by the hospital in which the meeting took place, and the evening was concluded with a musical program and a general good time. The following morning was devoted to the scientific program. Nothing can do more to promote good fellowship among the profession, to renew and cement old friendships and to interest members in the work of the state society, than meetings of this character.

It is the opinion of many of the state officers that the branches, which now hold only annual meetings, should be encouraged to hold occasional additional meetings for the discussion of special subjects. It is also their belief that it would be to the advantage of the society if the president of each branch who, by virtue of his office, is a member of the council and in touch with state society affairs and policies, would form his officers and the presidents of the county societies into an executive committee or cabinet by which much of the routine work could be done, and the program seriously thought out. Steps toward the accomplishment of this idea were taken in New York last spring. These conferences were held as luncheon meetings, financed by the state society and attended, by order of the state executive committee, by the executive officer. These conferences, supplemented by a circular letter over the signature of the state president, contributed largely to the increased interest and attendance shown by several of the branches.

THE DUTY OF THE COUNCILOR

The councilor should religiously carry out a system of county society visitations and in this way keep the counties informed as to what is going on in the state society, keep himself in touch with the work and needs of the county and

be thereby the better enabled to report to the house of delegates on the conditions existing among the physicians in his district. Properly reported, a compilation of the eighth district reports would give a comprehensive survey of the profession throughout the whole extent of the state.

The method of financing these meetings should be mentioned. As stated before, the executive committee appropriated funds for the luncheon conferences; there is a constitutional provision appropriating $100 annually to each branch, and the social functions are usually held with the local county society acting as host. In some instances, this latter expense is born by a hospital or institution in which the meetings may be taking place. The notices of the meetings are sent from the offices of the state society.

It has for many years been the custom for the president and the secretary of the New York state society to visit each district branch at its annual meeting, and such visits are now regarded as established, the branches expecting addresses of interest from them. The executive officer, whose duties resemble those of a liason officer, and the executive editor also attend, the former making statistical reports of the meeting to the executive committee, and the latter taking notes for the publication of the transactions of the meeting in the state journal. This publication serves to bring to the notice of the members of the state society the activities of the branches.

DANGERS TO BE AVOIDED

There are several dangers to be avoided at the meetings. The haphazard way of electing officers irrespective of the particular qualifications of the man is, perhaps, the principal one. Frequently, some one has been nominated because he is present, is a good fellow and has many acquaintances; one of these nominates. him, and it is all over, even though he may not wish the office. A good secretary is often chosen president because of his faithful attendance to duties, and valuable services are thus lost to the branch; he becomes a mediocre president, and a year later disappears in the shuffle. Fortunately this habit is losing ground, the candidates now being discussed beforehand. Care should be taken in selecting officers, not to seem to favor any one county society too much. The same care should be taken in selecting places of meeting. The reason for this is evident.

The program may be spoiled if too civic or economic color is given it; there should be a judicious mixture with the scientific, and the discussions of such subjects should not occupy too much time. A reader of a paper on industrial medicine, a health officer presenting his subject or a member of a special committee reading a tentative report may be so wrapped up in his particular subject as to forget that others perhaps are not so deeply interested. A paper of this character should be practical and to the point, giving in as short a time as possible the pith of the matter. Many men read and read, giving many statistics, and do not realize that they are tiring the audiences and hurting their subjects even though the presentation is, from some standpoints, a meritorious one. These faults can and should be remedied by the program committee, and the president should hold readers and discussers to their subject and to their time limit.

A well judged intermingling of science and economics with not too much stress on the latter may avoid the formation of cliques and subsequent dissentions. There still exists a slight difference in the point of view of the practicing physician and that of the salaried physician.

In all dealings and conferences with lay organizations the society should insist on equality of prominence before the public and stand for the rights of the profession. Too often an attempt is made to relegate them to a subordinate position on programs and in the promulgation of literature. All literature should indicate that the work is being done under joint auspices, despite the fact that the lay organization defrays the expenses.

The time and place of the meeting are important. As far as possible, it should be held in an easily accessible location and at a time of the year when the

weather is conducive of a feeling of wanting to get away for a day or two, and when automobile traveling is pleasant.

My experience teaches me that although much has been done of late to perfect the district branch there still remains room for improvement. I have presented the subject not as a finished product but as something from which. others may find meat for thought and discussion.

IMPRESSIONS OF SIX STATE MEDICAL ASSOCIATIONS

MORRIS FISHBEIN, M.D.

CHICAGO

During the past year and a half I have visited some six or seven state medical societies and a few local societies, councilor districts and other organizations. Obviously, I must have gathered in the course of these travels certain random impressions that may be of value to me if not to you.

My visit to any kind of a medical society is primarily a course of instruction for me in what the members of the society are thinking about, the topics in which they are interested, the economic phases of their work, and in any other things that may be of value in reflecting the work of the men in medicine in the Journal of the American Medical Association.

The state societies that I have visited have included Colorado, Minnesota, Maine, Wyoming, Montana and Missouri. The councilor districts have included districts in Wisconsin, Indiana, Ohio, Illinois and Michigan.

As I considered the work that I saw in these societies I became convinced that it would not be fair to compare what I saw in Wyoming with what was observed in Missouri, or to say that the things in Montana should be compared with those in Colorado. Comparisons are odious and bring about invidious distinctions that may hurt somebody's feelings. They would not accomplish the real purpose of this talk, which is to get before you a few ideas that may be of service both to you and to us. This question will be discussed not as it refers to the single state society but by the general topics which may be included in a state society program or meeting.

Such a program would include the papers that are read at the scientific sessions, the clinics that are held in the morning meetings, the entertainment, and the meetings of the Woman's Auxiliary which have seemed to be the chief bane in the life of the secretary; the exhibits, commercial and scientific, that may be associated with such meetings, and finally the public meeting. Recently the public meeting constitutes a not inconsiderable feature of practically all medical gatherings.

SCIENTIFIC PAPERS

In looking over the programs of various state medical societies as they are presented in the medical journals and in the meetings I have attended, I have noticed some outstanding facts. In some societies the secretary or another excutive has obviously carefully planned the program; in other societies the program has been prepared by issuing a warning or an invitation to all of the members of the society that a meeting will be held and that now is the time to get on the program or to stay off. The programs of state medical societies have changed considerably in the last ten or twelve years. The growth of special medical societies in various fields-in bacteriology, pathology, physiology, and all the medical specialties-has made those special societies the place to which a man goes to present an original contribution to scientific medicine. He carries before. a society of his peers, of specialists engaged in the same efforts as concern him, his first announcements of new discoveries in medicine. If he is to appear on a state society program he is likely to present to that society a boiled over piece

of work. That is probably a good thing to do, because it is necessary to disseminate the information further than the original presentation. On the other hand, it is not fair to fill an entire program for a society with boiled over material. Here and there about the United States circulate the "medical barnstormers." Their function is to take a textbook and to hash out of it what is known as a "potboiler," the purpose of the potboiler being to cause certain members of such societies as may be visited to think of the name of the "barnstormer" first in the matter of consultation. This is perhaps rather plain speaking. But as I have journeyed about the medical societies I have found programs again and again marred by the names of these professional medical barnstormers and although the societies may not have been tired of hearing them, it was rather hard for another barnstormer, going from one society to another, to hear the same speech five or six times.

On other programs it has been obvious that certain men were ready to give their names to the secretary for papers. Then when the time came to work up the papers and present them to the society they have felt that almost anything would do. From the titles I have culled a few and thinly disguised them so as not to cause any one great heartburnings.

"The Appearance of Medicine from the Standpoint of the Layman and of Science." "The Random Reflections of an Internist."

"Diabetes."

"Charities."

"Some Interesting Cases."

"Light, Its Energy."

The ultraviolet light is shining here and there, both in the scientific and in the commercial exhibits, and also before the societies. Programs of medical societies are being carefully planted at this time with papers on physical therapy both by commercial minded men connected with the industries and by physicians who are specializing in this field.

The matter of scientific contributions becomes much more serious when the paper as read comes in to the editor of the state society journal or of the Journal of the American Medical Association for consideration for publication. A paper sent in as an official contribution with a title such as "Surgical Operations Above the Neck" constitutes a considerable problem for the editor. The state society editor might well exercise the same type of discrimination in consideration of such papers as we try to exercise here.

The conspicuous point in this connection is the question of developing a program with unity, a program that is, in every sense of the word, instructive. I point to the last program of the Wisconsin State Medical Society, a society that I did not visit, as a program that was carefully planned with a constructive idea in view. I assume the planning from a reading of the program and without having had any conversation with either the secretary or the executive secretary of that society. In that program each of four sessions was given over definitely to the consideration of a single topic. The speakers selected were men who had given attention to the special phases of the topic which they were asked to elucidate, and the men who were to discuss the papers after they were presented were men who had also given special study to their subjects. There was then available to the society a complete consideration of a single subject for each one of those sessions, bringing to light all of the new work that had been done on that subject, and following that an open discussion of value. Such a program is instructive. It represents a thing that is conspicuously absent from the programs of some societies forethought on the part of somebody as to what it is that the society should consider.

The economic and social phases of medicine are left largely in these times to the houses of delegates of the individual state societies. I believe that is an