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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

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.

Progress is apparent in medicine as well as in other fields of human en

deavor. 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.

The Hospital as a Teaching Center.

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.

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

for the uses and purposes of imparting
knowledge. In true American fash-
ion we have dashed along head-fore-
most with eye on the clock and no time.
for bothersome details or painful pro-
longed analyses of cases.
To be pro-
fessor of something or other in an
American medical school is far too of-
ten 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 in-
vestigator; 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 rest should be used for building and


arrangement spoils everybody's chances of accomplishing anything. If both were under one roof, efficiency could be doubled and expenses cut to

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 hospi

one third the present amount. Hospital doorway. We have great hopes

tals 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

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.


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 responsi Ability to the aliens. By the rights of exclusion there is a direct responsibility to the welfare of the nation.

The New York Quarantine Station 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. 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.

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

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

United States and are to become citizens of the United States. Their freedom from disease is a matter of national concern.

The protection of the interior of this country from epidemic diseases is a function not of New York State but of the Federal Government. The exclusion of Bubonic plague, yellow fever, cholera, leprosy are of equal importance to Minnesota, Texas, Maine, and California. The control

of the quarantine station at New York should be under the federal government. The exclusion of diseases of cattle is recognized as being of importance to the entire area of the United States. With the present drawing together of the confines of this country thru the development of transportation facilities, the health of each part of the nation is the concern of the entire nation.

There are more than thirty ports of entry to this country and all are under Federal control except three, as far as quarantine is concerned. The Public-Health and Marine Service has been a tremendous factor in insuring the general protection of the portals of entry to this land. In its organization under the late Dr. Wyman there was achieved a high standard of work due to the intelligence and excellent training of a very select group of men.

There has been no hampering of their work by politics, commercial interests, or religious affiliations. This organization represents the constructive guardian of the Federal health from attacks of inter-state or inter-national infection. The port of New York should be placed under their control in matters of quarantine instead of merely calling upon the government for assistance when the state Health Officer is short of scientific workers.

Quarantine officers require a large experience. There are few men in any state of the union capable of doing efficient work in this department of public health service. Even political sagacity can not with changing administrations successfully fill this office so as to safe-guard the health of the country or the state. Quarantine work is of special importance and it should receive the recognition that it merits. Let the United States control the exclusion of disease as well as "Persons economically unfit."

The National Department of Health is certain to come after the public intelligence has been raised to the real seeing point. In the meantime the medical profession might well consider whether any Department of Health for this nation will be complete if the quarantine station of the Port of New York is not under the control of the United States.

Freudism on Dangerous Ground.

American Medicine recently published an article on Freud's "Apprehension Neurosis." The opening edThe opening editorial in the same number is a noteworthy one called "What is the matter with the Medical Profession?" If the Freud article is indicative of the view

point of a large part of the profession, which we greatly doubt, the editorial query might well be asked again.

To reduce the causes of all symptoms, from voracious hunger to "vasomotor neurasthenia," to a single unit may be a simplification of the subject

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 respectable 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."

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

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

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Christian Science and Insanity.

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

zone a most livable place, President Taft has deemed it safe to admit the irregular practitioners of medical methods. Fortunately the executive

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