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chosen persons who were to follow medicine as a profession. Times have changed. The possibility of raising the standard of physical health is now the problem. Preventive medicine involves the education of the multitude. To accomplish this mass education the services of the medical men must be enlisted. There is his new social responsibility resting upon even those who prefer to pose as therapeutists.
Empirical medicine is slowly being subordinated to the scientific investigation of the fundamental etiology of diseases and accidents. The manifold activities of the physicians place them in the front ranks of social investigators. To determine that long hours of labor is a factor in the production. of chlorotic anemia requires all the
The recent opening of the new annex to the N. Y. Post-Graduate Medical School and Hospital which the newspapers proudly announced cost $900,000 should mark a new era in the very important field of post-graduate study in America. It is unfortunate, but it may truly be said that heretofore we have had no medical teaching for physicians in this country which may be called really great. "Schools" we have had and still have, but the results secured to the profession have been out of all proportion to the immence cost of maintaining the same.
careful scientific acumen and patient endeavor that is deemed necessary for a fascinating experiment in vitro. To appreciate the relation of the industrial and economic factors in the causation, progress, and prognosis of many maladies is a recently acquired duty of the profession.
The Hospital as a Teaching Center.
Professors and instructors have been. for the most part either recent hospital graduates with no experience in teaching, or treadmill practitioners whose active practice alone is much larger than they can well handle, to say nothing of time and energy enough held in reserve
Progress is apparent in medicine as well as in other fields of human endeavor. The physicians are less aloof than in former decades. Physicians are citizens as well as physicians and this interwoven relation knits their interests more closely to the social fabric. In their dual relation their opportunities have increased many fold and their social obligations are unlimited. The doctor is, whether he admits it or not, a public servant, teaching, curing, preventing, but always serving the public.
for the uses and purposes of imparting knowledge. In true American fashion we have dashed along head-foremost with eye on the clock and no time for bothersome details or painful prolonged analyses of cases. To be professor of something or other in an American medical school is far too often an empty title, the holder of which has very little to profess but much to confess. An attractive personality, fine clothes, a handsome touring car, an air of just being driven to death. with success have too often taken the place both of actual knowledge and actual teaching ability. We think it may fairly be said that a good teacher ought to be also something of an investigator; he ought at least to know something of laboratory technique, and of the necessary steps to be taken toward the solution of difficult prob
lems. He ought also to know a great deal more about a great many other things than the mere subject in hand. It is not enough that he stand in the pit of a marbled amphitheatre and shout dialectics at the back row of seats. He should have contributed something to the sum total of human knowledge and in the subject which he professes to know. No mind will thrive and grow merely on a fair acquaintance with the literature of a given specialty; it must go far beyond that into the realm of speculation and experiment and reason. One must have plenty of time for thoughtful consideration and reflection and adequate facilities for the trying out of every new idea.
One cannot help but contrast our teaching and our teachers here in America with that found in the great medical centers of Europe. Not that we need make European education our idol, no, but we may profitably take it for our example. There is such a delightful simplicity about it all-no fuss or feathers, no marble stairways, no bronze, no rattle of therapeutic musketry; the professor is usually a mild-mannered man who walks leisurely into his classroom, takes his place, smiles pleasantly and wishes his hearers "Guten Morgen." Then the lecture begins, continues as long as seems necessary and no effort is made to show a raft of cases. In fact one case may occupy the whole period, but when it is finished nothing is left to be done but the autopsy. Simplicity, thoroness, and scientific accuracy are the watchwords. The professor is always an authority, he has written and demonstrated the value of some drug or physical sign or chemical synthesis, he did not secure his place
entirely thru "pull" but only after his merit had been thoroly established. Moreover, he is given the full amplitude of his own aspirations, and is not ordered by a board of lay directors how to conduct his service and lectures.
In America we are greatly in need. of men who know how to teach, and who care enough about their subjects to sacrifice time and effort and money in order that others may learn it too. Our investigators are usually not teachers, they can be seen only by appointment, and are not inclined to tolerate nuisances in their laboratories in the matter either of beginners or advanced students. They are usually hampered by insufficient funds and often by inadequate equipment. They do the best they can with what they have, and the faults they manifest are largely not their own but part of a generally misdirected institutionalism. One great European teacher on the staff of every large New York hospital would soon revolutionize the entire system of medical teaching in America.
We constantly hear a great hue and cry about lack of money for the hospitals. There is no real lack of money but there is a lack of men, men of large minds unhampered by wires pulled in the direction of this or that so-called benefactor. In some respects we already have too much money and too many hospitals. We need to centralize as much as possible under one roof and let the work be carried on by great departmental divisions each. possessing the advantages of full interdepartmental co-operation. In a city like New York, for instance, there is no need of two special eye and ear hospitals each with a half dozen surgeons and scores of supernumerary
surgeons and young hopefuls. Such an arrangement spoils everybody's chances of accomplishing anything. If both were under one roof, efficiency could be doubled and expenses cut to one third the present amount. Hospitals should be under governmental or municipal contract, but "politicians" should be made to "keep off," and when a sum of money is given to an institution one-third or one-half should be set aside as endowment and the
rest should be used for building and equipment, especially for the latter. There is at present too much architectural extravagance in hospital construction. Simplicity and efficiency should be the motto inscribed over every hospital doorway. We have great hopes that the new Post-Graduate is going to open up a great field for splendid work and keep American physicians on this side of the ocean where they properly belong.
IRVING W. VOORHEES, M. D.
The New York Quarantine Station Should be under Federal Control.
for itself the regulation of all matters affecting aliens until they have been released from immigrant stations. There is an implied Federal responsibility to the aliens. By the rights of exclusion there is a direct responsi bility to the welfare of the nation.
The mere fact that Governor Dix has requested the resignation of Dr. Doty, Health Officer of the Port of New York reveals a weakness of the health machinery of this country. A plan for a National Department of Health is under consideration. If the present Owen's Bill were to be accepted and become law this weakness would still remain. The Quarantine station at the port of New York would still remain part of the spoils of state politics. It is a sad enough spectacle to note that matters of health in small communities are too frequently matters of political favor. It is still more lamentable to find the health of a state jeopardized by political intrigues. That the health of the nation should be put in danger thru lack of adequate control of one of its gates is hardly understandable.
During 1910, 1,041,570 aliens entered into the United States. 786,094 aliens entered thru the port of New York. In other words 15 times as many aliens arrived at New York as from any other port of the United States. Three times as many immigrants entered thru Ellis Island as from all the other portals of entry taken together. This immense work of quarantine involved not alone by the immigration problem but also by the international freight transportation is not in the hands of the officials of the nation that quarantine is designed to protect.
It is perfectly true that about onethird of the immigrants remain within the limits of the State of New York. That, however, does not alter the fact that they are immigrants to the United States and not to New York State. They are to claim the protection of the
Since 1890 New York State has had no power in the regulation of immigration into its territory save for the control of quarantine by the State Health Officer. Since 1907, the Federal government has assumed jurisdiction over the admission of aliens and reserves
of etiology that may be welcomed by some. To reduce all ailments into terms of sex apprehensions or repressions is to magnify the importance of sex beyond the bounds of reason or experience.
The statement that "Chastity before marriage cannot be required of all men because a large number of those who
heeded such advice would undoubtedly develop apprehension neurosis" is a pernicious doctrine. Still more reprehensible is the suggestion that "The young gentleman engaged to a respect able young lady who must not conceive of sin should be taught the dangers of frustrated excitement and should be advised rather to associate with a puella publica."
woman be given medical advice to conduct herself during the period of engagement in the same ignoble and antisocial manner as the false disciple of Freud would prescribe for her fiance? Possibly some plan for certified prostitutes had occurred to this exponent of the value of the puella publica.
The "imaginary horrible consequences" that arise from self control are largely imaginary and therefore are of far less importance than the real horrible consequences that are forced upon the individual and the community by physical debauchery.
Rather keep the occasional suffering individual upon the rack for a time than to make him a dangerous devotee of Venus. The truth of Noeggerath's dictum "Once infected, always infected" has not been disproved. To counsel the risk of infection is opposed to the tenets of conscientious physicians and opposed to the highest functions of the profession. It is doubtful if Freud would sanction such a heinous offense.
Passing by all the moral considerations of these atrocious principles the physical hazards involved stamp them as hostile to the welfare of the race. They are physically immoral in that the advice is not for the protection of the physical health of the patient. Play with fire and lessen erotism is the advice. Tempt Fate and do not attempt to practice self-control. Give rein to your passions and forget your manhood and its responsibilities to society. It is far better for humanity that a small number of men should suffer as individuals from sex repression than that the health of the community should be endangered or sacrificed in the slightest degree thru selfish sex expression.
Forsooth should the psychasthenic
After years of patient endeavor the excellent corps of men of the medical profession under the leadership of Col. Gorgas having made the Panama Canal
The venereal diseases are spent upon the fibre of the race. The unnecessarily blind, the sterile, the defectives, the insane, the paretics, the mutilated women, the suffering men cry out in mute appeal against such a perverted sex hygiene. Indignation, surprise, honest disgust should permeate the profession at the announcement of such a doctrine for the guidance of those suffering souls who look to the medical
advisors for scientific and social intelligence and enlightenment.
zone a most livable place, President. Taft has deemed it safe to admit the irregular practitioners of medical methods. Fortunately the executive