Vol. X.

THE MENACE OF THE ANTI-VIVISECTIONISTS. A WARNING.

THE

HE New York Anti-vivisection Society has entered on its annual campaign to persuade legislation at Albany, the purpose of which is to destroy the progress of medical science gained through animal experimentation. This society has always stood for radical measures but has not in the past shown its real intent. It had made a pretence of favoring animal experimentation by qualified and expert persons; but in its outrageous and wholly unjust and really absurd public attack upon the Rockefeller Institute for Medical Research, the falsity of this pretence has been exposed and the true purpose, namely, to abolish all experiments upon animals, has been exhibited. The society has attempted to impose upon the public credulity by means of wilful misrepresentations and the descriptions of commonplace surgical procedures, familiar to every physician and employed in every modern hospital, which have been ignorantly described by a scrub-woman and loudly paraded as cruelty! A year ago this society brought to this country from abroad Miss Lind-af-Hageby, the notorious English champion of anti-vivisectionism, to inflame the American public against the teachings of modern medicine. The medical and lay press promptly exposed the methods employed by Miss Lind and her standing in England and deprived her visit and speeches of all real effect. This year the society is bringing over, for a similar purpose, the Hon. Stephen Coleridge, and will exploit him on the lecture platform and

No. 2

socially, in New York City, Philadelphia, Baltimore and Washington. It is desirable that the medical and lay public should be accurately informed of the manner of person the Hon. Stephen Coleridge is.

He is the honorary secretary of the National Anti-vivisection Society, which stands for the total abolition of vivisection, but until that can be secured he comes for restriction. He, therefore, pretends to be moderate in his demands. Before the Royal Commission he testified that he had never seen an experiment on animals, and never wished or intended to see one, and had never seen an animal after experiment and was wholly unacquainted with the subject from personal knowledge. He stated, further, "that all these experimenters have the greatest contempt for the Act of Parliament. They would deny a breach of the Act just as I would deny a breach of the Motor-car Act. I drive a motorcar, and when I go beyond the speed limit, and a policeman asks me, I say, 'No, I am not going beyond the speed limit.' His conception of what constitutes evidence was revealed in the use of the "Brown Dog" incident, published in the book of Misses Lind and Scharton, through which he was convicted of slander and obliged, by a British jury, to pay Mr. Bayliss the sum of $10,000 and the costs of the trial. This should suffice to show the real standing of the Hon. Stephen Coleridge and with how little authority he speaks, and yet he is described as a fluent and plausible lecturer; so that it will be well to be guarded against him.

The bill to be introduced into the present legislature will, as in the case of its predecessors, demand the so-called "open door," which it is proposed to secure by means of inspection of laboratories by a commission composed of persons chosen from humane societies, so called, and physicians! No misconception should be allowed to be concealed behind the "open door" phrase. The doors of every laboratory are already widely open and admit freely every qualified person; but they are and should continue to remain closed to idle, meddlesome and unfriendly persons, who will seek to find excuses to obstruct and eventually to abolish altogether, the important and delicate work going on there. The work of inspection, were it honorably carried out, would be so difficult and onerous as to be well-nigh an impossible task for even the most gifted, well-informed and highly trained persons, so manifold and varied are the subjects of medical research. It must be remembered, moreover, that no instance of cruelty, alleged to have been perpetrated in a laboratory, has ever been substantiated; and, above all, a warning should be taken from what has just transpired in the case of the attack upon the scientific work of the Rockefeller Institute, which incident shows more clearly than words can describe, what kind of testimony relating to cruelty is acceptable, and gratefully so, to the anti-vivisectionist mind.

Besides the pitfalls and dangers of inspection other equally objectionable features, among them registration and reports, will probably be included in the bill. But enough has been said to show how sinister is the activity of the antivivisectionists. The New York Anti-vivisection Society is also opposed to the germ theory of disease and looks upon vaccination and serum therapy as both useless and injurious. The duty is urged, therefore, upon the individual members of the State Society, to lose no time in acquainting the representatives in the legislature from their districts, of the dangers which are concealed in the anti-vivisectionists' campaign, and thus to preserve the State from committing an egregious blunder the injurious effects of which would be immeasurable. S. F.

THE ECONOMICS OF MEDICINE.

A

N editorial on this subject which appeared in the December issue of the NEW YORK STATE JOURNAL OF MEDICINE has elicited widespread comment. In another part of this number appear several answers to the editor's query, "What is to be Done?" All the replies to this question are practically unanimous in the opinion that the solution of the question depends on organization. If the writers added. another word-loyalty—their answers would be complete remedies, each and all.

There is the difficulty. The plumbers are loyal to one another and to their organization, as

JOURNAL OF MEDICINE

are all the different trades which have solidified themselves into unions. The power of these bodies centers about one fact, the loyalty of the members to their organization and to each other.

When, however, we turn to our own profession, we find ourselves absolutely helpless to contend with the grave evils which confront us. We are unable to bring about a better condition of affairs in the hospitals, which are at present exploiting the profession for the purpose of filling the hospital coffers.

Hospital staffs are subjected to humiliating tyranny to which they bend in abject submission because the members of the staff are not loyal to one another, and they know that they can expect no support from the profession. Should they resign, their places could be filled in an hour by their disloyal brethren. We do not compare favorably with the plumbers. They know the meaning of the word loyalty and the value of the fact. We are like a lot of wolves, ready at a moment's notice to rend one another. Until we change our attitude and learn to be loyal to a principle, loyal to an organization and loyal to one another, no remedy will apply, and we shall continue in our present condition of slavery unable to help ourselves, bound hand and foot in the toils of our own treachery and folly.

and it does sometimes add a wrinkle to the brow

of care when gentlemen get excited because their papers do not appear at once. Softly, all of you, please. Hearken to the policy of the editor. Each of the succeeding numbers of the JOURNAL will be devoted one-half to papers from District Branches and County Societies, one-half to papers from the annual meeting. In this way the editor hopes to be fair to all and escape more or less reproach ful correspondence.

At the same time, do not deny him the privilege of selection. A particular paper may be timely and require early publication, while others sometimes acquire flavor and strength like old wine, by keeping. So also juxtaposition often adds to the value of a paper. Therefore, friends, be patient, if you do not appear in print at once. We are doing the best that can be done under the circumstances and limitations which surround a monthly journal of a limited size. A. T. B.

:

Original Articles.

WHAT CAN WE DO TO IMPROVE THE SITUATION.*

ANNUAL ADDRESS OF THE PRESIDENT.

I

By CHARLES G. STOCKTON, M.D.

N A SENSE the President's annual address is a valedictory as well as a greeting. A greeting because it occurs at the beginning of the annual meeting, and a valedictory because it nearly concludes the term of service.

Once more let me express to you my deep appreciation of the honor which you have bestowed upon me and thank you for the consideration and the co-operation that I have met with on all sides. Since our last meeting there has passed from among us, under circumstances of especial sadness, one who was the devoted friend of the society and the personal friend of most of its members. We shall long remember with loyalty and admiration our former president, Dr. William C. Wey.

The success of the physician has always depended upon his ability to convince people, and the doctor has a following in ratio to the extent of his command of public and private confidence. In these days more than ever we are devoting ourselves to the education of the community, not alone individual members thereof, but society as a whole. An excellent instance of this is seen in the enaction of the pure food law in the face of the opposition of organized interests, for its necessity had been shown not only to Congress, but to the constituencies of the representatives. Another example is seen in the growing willingness of the people to obey quarantine laws. While there is much to be accomplished in the control of epidemics, the situation is steadily improving in proportion as the people are made to understand the necessity and to place confidence in the guidance of professional authority. We may discover a great promise for the future in the fact of the interest shown by the average man in the matter of pure water supply, proper drainage, the control of mosquitoes and other carriers of disease. Such instances as the practice of vaccination and the use of diphtheria antitoxine are so universally accepted that we fail to realize what remarkable illustrations they are of the obedience of the community to the dictates of medical science. In the campaign against tuberculosis. the success has been so marked that we now have comparatively little difficulty in obtaining the consent of the patient to follow that course in life most suited to him; the trouble now lies in providing him with the opportunity.

In the state care of the insane and of the blind, the movement to do away with ophthalmia neonatorum and the gain in the matter of educating defective children stand out among numerous ex

Read before the Medical Society of the State of New York, at Albany, January 25, 1910.

amples of altered public opinion, the outcome of professional education and guidance. Through this teaching function of the profession, with the rise of scientific knowledge and with higher professional ideals, we are achieving the confidence of mankind. We know that this has been the slow outgrowth of centuries of effort and disappointments, but even the most discouraged man in our ranks, when he pauses to reflect, must feel proud of the success which has attended his profession in guiding inankind through the wilderness of mysticism, demonology and other hateful manifestations of ignorance. the profession has seen the result of its educational efforts and the success which has come from telling the truth and insisting upon the wisdom of following it, there has undoubtedly developed a much greater degree of confidence between physician and patient than ever existed before. It is a fact that we are much better able to be truthful with our patients for the reason that we ourselves are not dealing so much in mystery when a man knows a thing he can state it-and the public soon learns when a man is stating a thing that he knows.

Many of us remember the splendid address of the late President Cleveland before the society four years ago dealing with the importance of the physician's taking the patient into his confi

dence. The lesson of that address has not been forgotten and continues to exercise a good effect.

Despondent men sometimes deny it, nevertheless, it is true that we are winning from a re

luctant public a consent to be guided by our judgment. How else explain their consent to submit of an individual from his family, or to increase to serious surgical procedures, to the separation of taxation and large expense in the matter of private and public sanitation?

But we should remember that in proportion to the extent with which we command public confidence we assume a burden of responsibility. It is already so great that but for our training and practice we should hesitate if not retreat. Great as it has been in the past, our responsibility is now swelling into yet larger proportions, and must increase more and more if the world is to be freed from many of the calamities that now afflict it.

Upon review of the question, it would appear that matters no less than the upbuilding of the race, the conservation of the sanity of mankind, in short, the future of civilization are encumbent We bear a weightier burden than is upon us. realized, and it must be said when we take into consideration the waywardness of human nature, the old and the new obstructions, the antagonistic legislation, the lack of sympathy with our motives, and the withdrawal of co-operation, that we carry the load with considerable dignity and with a light-heartedness that holds some promise.

What can we do to improve the situation? That is the inevitable question, the question in

February, 1910

influence of the profession in guiding the public. National, state and municipal governments will cease to be influenced by men who resort to such dishonorable methods in their private business relations. Of what good is the effort to reach an exalted place in the opinion of the world if medicine is to be vitiated by the practice of methods that will discountenance us in the eyes of pure minded men? Those who practice this system defend themselves thus: The surgeons say that they realize that the attending physician receives too little for his service and they feel that it is but just that he should be better recompensed than he is by the patient. Then it is held by the physicians who accept this percentage that they receive no pay for the responsibility which they take in advising an operation, and that for their share in this responsibility they should receive a portion of the fee that ordinarily goes to the surgeon. Some of these men make this defense apparently with sincerity. With due appreciation of the generosity and magnanimity of the surgeons and specialists concerned, and with full consideration of the undoubted fact that many family physicians do take a large part of the responsibility without just compensation, it stands to reason that such a remedy would be destructive of right relations among physicians and honest men and would discountenance us with the public.

We perfectly understand the peculiarly confidential nature of the relations that exist between patient and physician. The law concedes this and protects the principle. Above all things the patient must be able to trust the physician, and the physician cannot afford to weaken this confidence. We must not allow the element of commercialism to sneak in and break this relation, for it certainly is not to the interest of the patient and cannot increase the average professional income. The most that can be accomplished is to attract fees away from their legitimate course and to guide them to the pockets of those who are resorting to a variety of conspiracy. No objection can be raised to legitimate means of obtaining proper fees, but there is the greatest objection to a secret understanding between a specialist and a general practitioner whereby a patient is defrauded and where his vital interest is

placed in jeopardy. For instance, where there arises a question of operation, the patient naturally looks to his family physician to save him, if possible, from the danger, pain, fright and expense of an operation. This faith should not be tampered with. The most fundamental principle of a physician's creed may be said to be: "I will keep faith with my patient." But often our patients do not keep faith with us. That, however, is another matter. Our natural heritage from honorable predecessors has given us a reputation for telling the truth so far as we know it, and sincerity forms the ground work of our legitimate transactions. Can we afford to leave in the

mind of the community the suspicion that for personal gain an attending physician may possibly enter into collusion with a specialist?

The practice of "dichotomy," or fee division, is not new, it existed during the reign of Louis XIV. and was killed by publicity which seriously crippled the practice and at the same time crippled the doctors who followed it. Naturally, this evil has not a wide vogue, but, unfortunately, it has touched some of whom better things should be expected. Should it continue, it is inevitable that it will come to public knowledge and ultimately will be eradicated. Meantime discredit falls upon the profession and unfair competition must be endured by honest men.

The theory of consultation seems in these days to have suffered from a solution of continuity. Consultation and co-operation among physicians should be widely practiced, yet for one reason or another, such is not the case. Sometimes a spirit of narrowness leads to disinclination for consultation, often, doubtless, for the purpose of sparing the patient expense, at other times, it may be, from fear of a confession of weakness, which might lead to dissatisfaction on the part of the patient. The result of this is that the patient not infrequently comes to ask for a consultation, which mortifies the physician and puts him at a disadvantage. At other times, the patient, unknown to the physician, selects his own consultant, which produces an unfortunate situation. The consultant lacks the information which might be acquired from the attending physician whereby the patient is the loser; or, if the consultant happens to be right in making a diagnosis, he may unintentionally injure the family physician in his explanation to the patient. It would seem that we should attempt to foster a greater trust among our patients, and if our conduct be based on a disinterested attempt to reach scientific ground, at the same time eliminating as far as possible personal grounds, we are on the safest course for all concerned. This attitude is becoming the more necessary for the reason that the public is now much better educated regarding medicine and disease than formerly, and a large number of laymen are coming to discriminate between competence and incompetence. In fact it would appear that our troubles would largely dissolve and the complexities become simple if the best interests of the patient were kept constantly in sight, and our fees regulated according to our responsibilities in looking out for those interests.

Some physicians speak resentfully of the smallness of fees as though it were the outcome of a hard edict from a throne. Who makes our fees? Who educates the people as to the value of our services? No one but ourselves. If our fees are too small, we, and we only, are responsible. I can see no way to increase fees but to make them worth more. To paraphrase the words of Horace Greeley, the way to increase fees is to increase