,,large ,,fees ,,and ,,how ,,to ,,get ,,them --- ,a ,,book ,,for ,,the ,,private ,,use ,,of ,,physicians --- ,,by ,,albert ,v4 ,,harmon1 ,m4,d4 ,,with ,,introductory ,,chapter ,,by ,g4 ,,frank ,,lydston1 ,m4,d4 ,w4 ,j4 ,,jackman1 ,,publisher #aba-abg ,,plymouth ,,court ,,chicago ---------------------------------------- -------------------------------- ,copyright1 #aiaa ,by ,w4 ,j4 ,,jackman ---------------------------------------- -------------------------------- ,,large ,,fees ,,and ,,how ,,to ,,get ,,them ---------------------------------------- -------------------------------- ,,contents ------- ,,chapter ,i4 ,,medicine ,,as ,a ,,business4 ,why ,medicine as #aa ,ordinarily ,followed ,is a ,failure ,from the ,business ,standpoint--,physicians ,themselves ,mainly ,responsible--,queer ,ideas ,about ,philanthropy--,poor ,business ,methods--,tactics that ,pauperize ,one-half the ,patients--,doctors ,easy ,prey for ,sharpers--,evils of ,medical ,colleges--8,charitable0 ,hospitals ,injure ,regular ,practitioners--,free ,clinics and ,dispensaries--,the ,medical 8,tin ,god0--,absurdities of ,ethics--,how ,some ,physicians ,get ,notoriety--,freaks of the ,profession--,things the ,young ,practitioner ,should ,avoid ,,chapter ,,ii4 ,,the ,,physician ,,who ,,succeeds4 ,qualifications #ca for a ,big ,fee-,getting ,practitioner--,the ,kind of ,men ,who ,make ,money in the ,practice of ,medicine--,business ,mistakes in the ,profession--,why ,many ,doctors ,fail--,old-,fashioned ,ideas as to ,set ,fees--,no ,reason ,why ,physicians ,should ,not ,use ,judgment in ,placing a ,monetary ,value on ,their ,services--,prompt ,collection of ,bills an ,important ,item--,attorneys1 ,architects1 and ,other ,professional ,men ,afford ,good ,examples of ,business ,sense--,the ,beard and ,its ,dangers--,necessity for ,scrupulous ,cleanliness--,an ,experience in ,iowa--,reasons ,why ,many ,physicians ,fail--,psychological ,factor an ,important ,one ,,chapter ,,iii4 ,,the ,,bugbear ,,of ,,ethics4 ,intimidation of ,young #dc ,physicians--,overdoing the ,ethical ,proposition--,spying on the ,beginners ,illogical ,advice--,how ,some ,men ,become ,wealthy and ,famous by ,doing the ,very ,things ,they ,denounce in ,others--,clever ,evasions of the ,code--,schemes by ,which ,valuable ,publicity ,is ,obtained--,actual ,incidents ,illustrating ,methods ,prevalent ,among ,physicians ,who ,keep ,themselves ,constantly ,before the ,public--,working the ,newspapers--,employment of ,press ,agents--,how ,they ,get ,free ,write-ups for ,their ,principals--,fine ,work by a ,chicago ,man in ,popularizing a ,new ,treatment--,the ,making of a ,sensation--,newspaper ,story that ,made ,certain ,ethical ,gentlemen ,wealthy--,administration of ,unknown ,preparations by ,high ,apostles of ,ethics ,,chapter ,,iv4 ,,lawful ,,to ,,advertise4 ,publicity ,within ,certain #fa ,lines ,necessary and ,legitimate--,progressive ,physicians ,ignore ,old ,rule--,courts ,uphold ,right of ,doctors to ,make ,their ,qualifications ,known in the ,public ,press--,time ,brings ,radical ,changes--,numerous ,reasons ,why a ,competent ,practitioner ,should ,advertise--,futility of 8,ethical0 ,opposition--,severe ,judicial ,rebuke for ,medical ,society ,leaders ,who ,attempt to ,debar and ,discredit ,men ,who ,advertise--,finding in the ,celebrated ,dr4 ,mc,coy ,case--,indecent and ,obnoxious ,advertising--,the ,proper ,kind--,how to ,obtain ,valuable ,publicity in a ,dignified ,manner ,,chapter ,v4 ,,getting ,,country ,,patients4 ,making ,connection #gc ,with ,prospective ,patients--,again1 the ,intelligent ,use of ,newspapers--,first ,steps to ,be ,taken in the ,location of ,good ,cases--,correspondence an ,important ,feature--,the ,kind of ,letters that ,inspire ,confidence and ,bring ,patients to the ,doctor's ,office--,what a ,physician ,should and ,should ,not ,say in ,his ,correspondence--,specimen ,letters--,the ,danger ,line in ,correspondence--,effect of the ,right ,kind of ,letters--,humoring the ,family ,physician--,getting in ,touch ,with the ,latter--,how to ,make ,him a ,friendly ,co-operator--,arranging for ,country ,trips--,proper ,method of ,procedure--,working on a ,business ,basis--,schedule for ,receiving ,callers--,reception of ,stranger ,doctors--,division of ,fees to ,secure ,their ,support--,treatment of ,country ,patients--,how ,big ,fees ,are ,obtained ,,chapter ,,vi4 ,,reception ,,of ,,office ,,patients4 ,attractive #ic ,quarters the ,first ,essential--,how to ,select and ,furnish ,rooms--,reception of ,strangers on ,arrival--,separation of ,callers--,reception ,room ,attendant an ,important ,factor--,the ,kind that ,wins--,hints on ,treatment of ,callers--,recourse to ,correspondence ,file ,vitally ,essential--,how ,letters ,should ,be ,kept in ,order to ,get the ,necessary ,information ,speedily--,letters ,frequently ,give ,clues as to the ,writer's ,business ,calling and ,financial ,responsibility--,object in ,making ,callers ,wait ,before ,physician ,receives ,them--,how the ,reception ,room ,attendant ,may ,become a ,valuable ,ally--,stenographers ,should ,be ,kept ,out of ,sight ,,chapter ,,vii4 ,,the ,,correspondence ,,file4 ,proper ,handling of #ajc ,correspondence ,one of the ,vital ,essentials to ,success--,life ,blood of the ,specialist's ,practice--,right ,kind of ,correspondence ,clerk an ,indispensable ,ally--,method of ,keeping ,letters on ,file ,so as to ,secure ,best ,results--,sample ,letters that ,bring ,large ,financial ,returns--,methods of a ,competent ,correspondence ,clerk--,how ,he ,makes ,money for ,his ,employer--,tracing the ,financial ,rating of ,strangers--,securing ,names and ,addresses of ,prospective ,patients--,utilization of ,newspaper ,clippings--8,follow-up0 ,systems--,advantage of ,using ,plain ,envelopes in ,writing to ,strangers--,obtaining ,testimonial ,letters from ,patients--,use of ,these ,letters in ,attracting ,new ,comers--,conducting ,correspondence ,with ,people in ,small ,towns--,purpose in ,avoiding ,duplication of ,testimonials ,,chapter ,,viii4 ,,getting ,,at ,,financial ,,status4 ,how to ,ascertain #aai the ,monetary ,resources of ,callers ,who ,appear ,unannounced--,line of ,conversation ,that ,will ,lead ,any ,man to ,unwittingly ,reveal ,his ,financial ,standing--,free ,examinations and ,how ,smart ,specialists ,make of ,them a ,big ,drawing ,card--,bringing a ,caller to the ,point of ,submitting to an ,examination--,means by ,which an ,impression is ,made--,benefit in ,keeping an 8,assistant0 ,within ,handy ,reach--,clinching the ,caller as a ,patient--,avoiding the ,naming of a ,definite ,time for ,treatment--,reasons ,why ,some ,specialists ,fail to ,obtain ,good ,fees--,lack of ,tact in ,getting at a ,caller's ,ability to ,pay a ,reasonable ,fee--,crude ,tactics that ,defeat the ,purpose of the ,physician--,danger in ,too ,much ,haste and ,rash ,promises--,modesty ,properly ,applied the ,great ,winner ,,chapter ,,ix4 ,,deciding ,,upon ,,the ,,fee4 ,value of ,psychological #aca ,influence in ,acting at the ,right ,moment--,just as ,easy to ,get ,big ,fees as ,small ,ones--,experience of a ,young ,physician--,great ,difference in ,patients--,an ,exhibition of 8,gall0--,incubus of the ,old ,dollar-,fee ,system--,when to ,name the ,fee and ,how to ,fix ,upon the ,amount--,what the ,practitioner ,should ,say and ,do in ,order to ,secure ,large ,payments--,how ,reduction ,may ,be ,gracefully ,made ,when a ,patient ,protests ,against the ,amount--,dealing ,with 8,tight ,wads0--,how to ,skilfully ,dangle the ,bait of ,health ,without ,actually ,promising ,results--,taboo on the ,word 8,cure0--,bringing the ,caller ,who ,hesitates ,down to the ,point of ,positive ,action--,system to ,be ,followed in ,deciding ,upon ,amount of ,fee a ,patient ,will ,pay ,,chapter ,x4 ,,getting ,,fees ,,in ,,advance4 ,how the ,money ,may ,be #ada ,secured ,before ,treatment ,is ,started--,undue ,haste1 or ,evident ,desire to ,get the ,cash1 ,bad ,policy--,putting the ,patient's ,mind in ,condition to ,make ,advance ,payment--,a ,successful ,fee ,getter's ,line of ,talk--,creation of ,confidence in the ,physician's ,ability and ,honesty the ,main ,factor--,making ,sure of ,payment ,when ,partial ,credit ,is ,extended--,method of ,drawing ,notes ,that ,are ,readily ,negotiable and ,non-,contestable--,inducing ,patients to ,sign ,iron-,clad ,notes--,when and ,how to ,act--,turning ,checks and ,notes ,into ,cash--,weeding ,out the ,payers and ,non-,payers--,what to ,say ,when a ,patient ,objects to ,signing a ,note--,smart ,man ,easiest to ,deal ,with--,instance in ,which a ,banker ,paid a #b1ejj ,fee ,twice--,how a #aj1jjj ,fee1 ,definitely ,settled ,upon1 ,was ,lost ,,chapter ,,xi4 ,,getting ,,additional ,,fees4 ,patients ,who ,have #aec ,paid ,big ,fees for ,treatment ,almost ,invariably ,good for a ,second ,payment--,lines ,upon ,which ,more ,money ,may ,be ,had--,men of #ej ,years and ,over ,gold ,mines ,when ,they ,have the ,means--,how to ,handle ,them--,dangling the 8,sexual ,vigor0 ,bait in a ,delicate and ,effective ,manner--,suggestions of ,supplementary ,treatments ,that ,bring ,additional ,fees--,arrangements ,with ,occulists1 ,pharmacists1 ,surgeons and ,instrument ,dealers ,that ,add ,materially to the ,physician's ,income--,how ,patients ,are ,induced to ,patronize the ,specialist's ,allies--,secret ,ciphers ,that ,result in ,extravagant ,charges--,division of the ,proceeds--,adventure ,with an ,undertaker--,doctors ,who 8,sponge0 ,upon ,their ,professional ,brethren ,,chapter ,,xii4 ,,proper ,,handling ,,of ,,notes4 ,kind of ,note ,that #aga is ,negotiable and ,easily ,discounted--,manner in ,which ,such a ,note ,should be ,drawn--,defects in ,ordinary ,form of ,promissory ,note--,ease ,with ,which ,payment ,may ,be ,evaded or ,delayed--,difficulties in the ,way of ,enforcing ,collection--,an ,iron-clad ,promise to ,pay ,that ,binds the ,maker--,avoidance of ,litigation and ,attendant ,expense--,what to ,do ,with ,notes ,when ,taken for ,medical ,services--,how to ,dispose of 8,paper0 to ,bankers ,who ,know the ,financial ,responsibility of the ,signers--,successful ,method of a ,chicago ,physician ,who ,handles ,considerable 8,paper0--,the ,collection ,agent ,evil ,,chapter ,,xiii4 ,,prescribing ,,of ,,remedies4 ,why ,physicians #agi ,should ,dispense ,their ,own ,prescriptions--,trouble ,with ,present ,system of ,drug-store ,dispensing--,number of ,drugs ,actually ,required in ,practice ,limited--,duplication of ,prescriptions by ,pharmacists an ,injustice to ,doctors--,proprietary ,medicine ,fakirs--,prescribing ,secret ,formula ,preparations--,how ,many ,practitioners ,are ,hoodwinked--,positive ,injury in ,prescribing ,remedies by ,trade ,names--,violation of ,code in ,using ,preparations ,with ,unknown ,ingredients--,value of ,mystery in the ,administration of ,drugs--,unwise to ,let ,patients ,know ,too ,much ,about ,their ,prescriptions--,why ,all ,remedies ,should ,be ,designated in ,latin--,views of ,dr4 ,osler on ,drug ,prescribing ,,chapter ,,xiv4 ,,medical 8,,steerers0 ,,and ,,their ,,work4 ,method by #ahg ,which ,many ,physicians ,obtain ,patients--,men ,who ,make a ,business of ,directing ,invalids ,where to ,go for ,treatment--,commercial ,diplomats--,their ,style of ,work--,large ,incomes--,how ,sufferers ,are ,approached--,the ,kind of ,talk ,that ,wins the ,confidence of the ,sufferer--,directing the ,victim to a ,physician--,landing the ,patient in the ,doctor's ,office--,the ,steerer's ,commission--,how ,he ,protects ,himself and ,insures ,square ,treatment by the ,doctor--,opportunities for ,obtaining ,patients--,leading ,hotels ,favorite ,places of ,operation--,old ,brace ,faro ,game ,worked in ,new ,form--,women ,steerers and ,their ,methods ,,chapter ,,xv4 ,,what ,,should ,,the ,,physician ,,do8 ,various #aie ,remedies ,proposed for ,existing ,conditions--,too ,many ,doctors in the ,land--,not ,enough ,patients to ,go ,around--,what the ,medical ,colleges ,are ,doing--,over #e1jjj ,doctors ,made ,every ,year in the ,strictly ,ethical ,schools ,alone--,temptations of ,young ,physicians--,what ,men ,like ,dr4 ,evans and ,dr4 ,king ,have to ,say--,prominent ,practitioners ,endorse ,division of ,fees as an ,act of ,justice--,prof4 ,george ,burman ,foster on the ,profession as ,allied to ,business--,no ,reason ,why ,there ,should ,be ,any ,distinction ,between the ,two ,,chapter ,,xvi4 ,,corporation ,,doctors4 ,evils of the ,contract #bjg ,plan--,how ,it ,injures the ,regular ,practitioner and the ,contract ,doctor ,himself--,miserly ,economy by ,corporations--,disastrous ,competition ,among ,physicians--,life ,insurance ,examiners and ,their ,lack of ,business ,sense--,moral as ,well as ,medical ,honesty ,dwarfed by the ,corporation ,system--,contract ,doctors ,expected to ,hide the ,truth to ,retain ,their ,jobs--,beggarly ,salaries ,paid by ,corporations--,practice ,wrongfully ,diverted from ,doctors ,entitled to ,it--,collusion ,between ,corporation ,doctors and ,claim ,agents--,sick and ,injured ,employees ,often ,induced to ,sign ,away ,their ,rights by ,misrepresentation or ,intimidation--,the ,drawbacks of ,promiscuous ,fraternizing ---------------------------------------- -------------------------------- ,,preface ,there are some methods explained in this book which the author does not endorse4 ,they are printed because they are necessary to a thorough understanding of the subject4 ,newspapers publish reports of murders1 but this does not imply endorsement of the crimes4 ,aside from these features there are many things which the practicing physician may read and follow to his advantage4 ,the introductory chapter by ,dr4 ,lydston will be found to be of special interest4 ,,the ,,author4 ---------------------------------------- -------------------------------- ,,chapter ,i ,,medicine ,,as ,a ,,business ,by ,g4 ,frank ,lydston1 ,m4,d4 ,as a general proposition it is safe to assert that the practice of medicine from a business standpoint is a failure4 ,the successful exceptions merely prove the rule4 ,it is also safe to assume that the elements of financial non-success are cumulative in their action--a fact that is easily proved by hospital and dispensary statistics4 ,the practitioner of medicine1 like every man who relies on his own hand and brain for a livelihood1 is entitled to a bit of earth that he and his may call their own1 at least a modest competence1 and a well-earned rest when his sun begins to set and the twilight of his life approaches4 ,how many doctors are in a position to enjoy or even render less awesome their twilight days8 ,as city doctors are all supposed to be rich--at least by the public1 that does all it can to prevent their becoming so--it would be interesting to know what proportion of them1 even in metropolitan medical centers1 own their own homes or have property investments4 ,a far smaller proportion than is just1 ,i fancy4 ,the assertion has been made that the general poverty of the medical profession is due to a lack of appreciation and a contempt for the rights of the medical man on the part of the public at large4 ,this1 however1 is a secondary matter which1 being self-evident1 overshadows the primary cause--the asinine stupidity of the profession itself4 ,as a broad1 general proposition the reputable profession as a whole has about as much sense as the dodo1 and1 unless signs fail1 will1 sooner or later1 meet the fate of that remarkable bird4 ,how the profession can expect the respect and appreciation of the public when it has no respect or appreciation for itself is difficult to conjecture4 ,the public cannot be expected to keep clean the nest of the medical dodo4 ,furthermore1 the public quite rationally values the stupid thing according to its self-appraisement4 ,primarily1 the practice of medicine is supposed to be founded on a mawkish1 blanket-like sentiment of philanthropy1 which is expected to cover both ,god's and the devil's patients--the pauper and the dead-beat--the honest man and the rascal--the rich and poor alike4 ,the doctor is expected to wallow eye-deep in the milk of human kindness1 scattering it broadcast for the benefit of humanity1 but he is in no wise expected to even absorb a little of it1 much less to swallow a gulp or two occasionally for his own benefit4 ,by way of piling ,pelion upon ,ossa1 the public1 having discovered that the doctor sets little value on his own services1 proceeds to eye him with suspicion2 the tradesman is very careful how he trusts doctors4 ,of course the tradesman has his own family physician 8hung up0 for a goodly sum1 but--knowing doctors to be poor business men--the tradesman often cheats them in both the quality and price of goods4 ,it is a great and goodly game that plays from both ends and catches the victim in the middle4 ,the tradesman has one redeeming feature1 however2 he does his best to teach his doctor patrons a lesson4 ,he either sends his goods ,c4,o4,d41 or1 if the doctor be one of the favored ones1 he finds the bill in his mail bright and early on the first of the month4 ,i often think my tradesmen must sit up all night in order to get their bills in bright and early on the first4 ,if not paid by the #aeth1 a collector is usually at the doctor's office to see about it4 ,yet the professional dodo--my apologies to the shade of the 8sure enough0 dodo--will not learn4 ,he goes on and on1 neglecting his accounts1 mainly because he is afraid of offending his patrons and driving them off to some other doctor who isn't so particular2 and the worst of it is1 there are plenty of contemptible fellows who draw their own salaries promptly when due1 or present their bills for goods with frantic haste1 who consider a doctor's bill a flagrant insult4 ,will nothing ever inspire the doctor with courage enough to despise and ignore such contemptible trash8 ,does he prefer the role of a lickspittle to that of an independent and self-reliant man8 ,as illustrations of the value the profession sets on its skill and learning1 the amount of gratuitous work done is striking4 ,our pauper--or pauperized--patrons are divided into several classes1 viz43 #a4 ,the free hospital1 clinic and dispensary class4 ,this is on the increase4 ,according to ,dr4 ,frederick ,holme ,wiggin1 #ea per cent of all cases of sickness in ,new ,york ,city are now classed medically as paupers1 as against #a4e per cent twenty years ago6 ,this is appalling4 ,of these alleged paupers it is safe to say that #ge per cent are able to pay full or at least fairly good fees4 ,why should pauperism be shown so prominently in the matter of medical bills1 as compared with other necessities of life8 ,and why should the profession carry a burden that belongs to the public8 #b4 ,free patients of the private class3 7a7 those who can pay but will not1 i4e41 dead beats1 and swindlers2 7b7 persons whose circumstances are such that the doctor feels in duty bound to render no bills2 7c7 persons who presume upon social acquaintance with the doctor to 8hold him up0 for friendly1 perhaps informal1 consultations4 ,it requires no great mental effort to see the terrible load the profession is carrying--self-inflicted1 and often for fallaciously selfish motives1 it is true1 but none the less heavy4 ,the college and free hospital may be the professional 8old man of the sea10 but so much the worse for the medical ,sinbad4 ,whatever the explanation1 private practice is on a par with dispensary practice with regard to the impositions practiced on the doctor4 ,it is safe to say that1 of the sum total of surgical and medical patients of all kinds and social conditions under treatment in ,chicago at the present time1 over one-half are paupers--honest or dishonest4 ,pay the doctor for the work involved in this wasted and misapplied charity1 and the medical profession would plunge into a sea of prosperity that might swamp it4 ,and it is not only the rank and file of the profession that suffers4 ,ye celebrated professor1 reaching out for glory1 yea1 into infinite space1 clutching frantically at everything in sight1 no matter how profitless--providing the other fellow doesn't get the case--often defeats his own ends4 ,and the great man dies1 and is buried1 and we take up a collection for his widow1 to meet his funeral expenses1 and sell his library--six feet of earth make all men of a size4 ,sic transit gloria mundi4 ,and when1 like dog1 he's had his day1 ,and his poor soul hath passed away1 ,some friendly scribe in tearful mood ,will tell the world how very good ,the dear departed doctor was-- ,and thus win for himself applause4 ,one of the most potent causes of professional poverty is the mania of the doctor for a pretense of well-doing4 ,he exhibits this in many ways4 ,one of the most pernicious is an affectation of contempt for money4 ,this it is that often impels him to delay the rendering of his accounts4 ,oftentimes his patient offers to pay all or part of his bill4 ,with a lordly and opulent wave of his marasmic hand the doctor says1 8,oh1 that's all right2 any time'll do40 ,and the triple-plated medical imbecile goes on his way with a dignified strut that ill befits the aching void in his epigastric region1 and is decidedly out of harmony with the befringed extremities of his trousers4 ,and then the doctor apologizes to himself on the ground of a philanthropy that is but the rankest and most asinine egotism en masque4 ,when will the doctor understand that payment deferred maketh the patient dishonest8 ,when will he consider the necessities of his wife and children as outweighing the feelings of the patient who owes him money8 ,when will he be a man1 and not a time-server and truckler to appearances8 ,he would take the money did he not fear the patient might suspect that his doctor was not prosperous4 ,he wishes the patient to think that the doctor and his family dine with the chameleons1 or are fed by ravens4 ,yet the medical ,elijah waiteth in vain for the manna-bearing birds--they know him for what he is1 a counterfeit prophet who vainly yearns for the flesh-pots of ,egypt--who has a ponderous and all-consuming desire for pabulum1 and a microcephalic capacity for finance4 ,doctors are supposed to be keen judges of human nature4 ,i often think this is absolutely without foundation4 ,defective knowledge in this direction is a very expensive luxury to the medical profession4 ,the confidence man and sharper cannot fool the average doctor into buying a gold brick1 perhaps1 but they can come very near it4 ,the oily-tongued and plausible man with a scheme finds the doctor his easiest prey4 ,the doctor has often hard enough work to wring a few dollars out of his field of labor1 and it might be supposed that it would be difficult to get those dollars away from him1 but no1 it's only too easy4 ,he bites at everything that comes along--he often rises to a bare hook4 ,mining stocks1 irrigation and colonization schemes1 expensive books that he doesn't want1 will never need and couldn't find time to read if he would1 histories of his town or state in which his biography and picture will appear for #ajj--proprietary medicine schemes1 stock in publications of various kinds2 he bites at everything going--he has embonpoint cerebrale4 ,oh1 but the doctor is easy6 ,i have very painful memories4 ,the best investment ,i ever made was when ,i paid a fellow for painting a sign for the door of my consultation room1 reading3 8,notice--,persons with schemes will please keep out4 ,i have some of my own to promote40 ,it is rather a delicate matter1 perhaps1 for a college professor to touch on the evils of medical colleges in their relation to the business aspect of medicine1 but ,i shall nevertheless speak plainly and to the point4 ,while theoretically the better class of medical colleges were founded solely for the advancement of science1 it is none the less true that self-aggrandizement has been the pedestal on which most of our disinterested giants in the teaching arena have stood and are standing4 ,remove the personal selfish interest of college teachers and most of our schools would be compelled to close for lack of instructors4 ,let us be honest with ourselves1 please4 ,not that self-interest is reprehensible--,i hold the contrary4 ,one may teach for salary1 reputation1 the love of teaching1 or a desire for self-improvement1 it matters not1 for if he be of the proper timber he is the right man in the right place4 ,self-interest makes better teachers on the average than philanthropy1 providing the primal material is good4 ,granting that self-interest is the mainspring of the college professor1 is he very 8long-headed0 from a business standpoint8 ,i submit the following propositions as proving that the average college professor defeats his own ends4 #a4 ,he devotes to teaching1 time and labor over and above the exigencies of ordinary practice1 which1 if devoted to cultivating the good-will of the laity1 would be much more profitable4 #b4 ,while cultivating the acquaintance and friendship of the alumni of his own school--a few each year--he alienates from himself the friendship of every alumnus of every rival school1 the instant he begins teaching4 #c4 ,he assists in educating and starting in life young1 active competitors to himself4 #d4 ,he is unreasonably expected to devote a large percentage of his time to the gratuitous relief of medical students and physicians4 ,he may give his time cheerfully1 but he yields up his nerve force just the same4 #e4 ,most college professors are less successful in the long run than the more fortunate ones of the rank and file who have never aspired to teaching honors4 #f4 ,greater demands are made on a professor's purse than if he were in the non-teaching ranks of medicine4 ,he1 more than all others1 is expected to put up a prosperous appearance4 ,the college clinic--especially of the surgical sort--is far-reaching in its detrimental effects on professional prosperity4 ,few or no questions are asked1 and the millionaire is being operated on daily1 side by side with the pauper1 free4 ,and the blame does not always lie with the professor who runs the clinic4 ,general practitioners bring patients to the free clinics every day1 with full cognizance of their ability to pay well4 ,why doctors will persist in thus cheapening surgical art is difficult to conjecture--but they do it just the same4 ,of course1 the college clinic is supposed to be a theater of instruction4 ,often1 however1 it is but a stage on which comedy-dramas are enacted4 ,a brilliant operation that nobody six feet away can see1 and an operator bellowing at his audience like the traditional bull of ,basham--in medical terms that confuse but do not enlighten1 terms that are ,greek to most of the listeners--this is the little comedy-drama that is enacted for students who have eyes but see not2 who have ears but hear not4 ,instruction8 ,bah6 ,take the theatric elements and the plays to the gallery out of some college clinics and there wouldn't be a corporal's guard in attendance4 ,worse than the free clinics are the so-called charitable hospitals4 ,much has been said of dispensary abuses1 but few have had the courage to say anything in adverse criticism of these institutions4 ,while nominally founded to fill 8a long-felt want0--and the number of long-felt wants1 from the hospital standpoint1 is legion--these hospitals are founded on strictly business principles1 save in this respect--the people who found them feed on their innate capacity to get something for nothing4 ,the first thing the founders do is to get a staff of doctors to pull the hospital chestnuts out of the fire4 ,the members of the staff think that the hospital is performing the same duty for them1 and everything is serene4 ,and so the surgeon goes on operating on twenty patients--fifteen of whom are able to pay him a fee--in the hope that one among them all is willing to pay him a fee4 ,exaggeration8 ,well1 ,i cannot swear to the accuracy of the foregoing1 but an eastern surgeon of world-wide fame once told me that for every patient who paid him a fee he operated on nineteen for nothing2 and this man has no public clinic1 either4 ,is it conceivable that the nineteen free patients are all paupers8 ,many of them go to my friend for operation from very long distances4 ,ought the railroads and hospitals to have all the profits8 ,have we not all had similar experiences in a lesser degree8 ,with the development of charitable hospitals far in excess of any legitimate demand1 it has come to pass that surgery is almost a thing unknown in general city practice4 ,even the minor operations have left the general practitioner--to return no more so long as there are free hospitals and dispensaries4 ,where is the emergency surgery1 of which1 in former days1 every practitioner had his share8 ,railroaded off to the 8charity0 hospitals to be cared for gratis4 ,in a recent conversation with a practitioner of thirty years' experience1 ,i said1 8,doctor1 you used to do a great deal of general surgery throughout this section of the city4 ,have the hospitals affected your practice in that direction to any extent80 ,he replied1 8,surgery with me is a thing of the past4 ,even emergency cases are carted off to the nearest hospital4 ,if by chance one does fall into my hands1 it is taken away from me as soon as ,i have done the #8first-aid' work40 ,personally1 ,i see very little use in teaching surgery to the majority of students who intend to practice in our large cities--they will have little use for surgical knowledge4 ,here are three cases in illustration of the way our 8charitable0 hospitals antagonize the business interests of the profession3 #a4--;,a very wealthy farmer engaged me to perform an exceedingly important operation4 ,it was understood that #a1jjj was to be the honorarium4 ,he was afterwards advised to go to a certain 8religious0 hospital1 where he was operated on by an eminent surgeon1 who received nothing for his services4 ,the patient paid #ae a week for hospital accommodation1 and #be a day to his family physician1 who remained with him 8for company40 ,what a harmonious understanding between the patient and his family doctor--and what a 8soft mark0 that surgeon was4 ,i had the pleasure of telling the latter of the gold mine he didn't find1 some time later1 and the shock to his system amply revenged the body surgical4 #b4--;,a patient who was under my care for some weeks and paid me an excellent fee finally divulged the fact that he had meanwhile been living at a certain hospital as an 8out patient10 at an expense of #h a week4 ,he had become dissatisfied with the hospital attention1 he said1 and1 pretending great improvement1 was permitted to get about out-of-doors4 #c4--;,a man on whom ,i operated and who paid me my full fee without argument or question1 came to me directly from one of our large hospitals1 where he had been sojourning for several months4 ,that medical men in hospitals are imposed on is a trite observation4 ,so long1 however1 as it appears to be the doctor's advantage to be on a hospital staff1 plenty of men will be found who will be glad of the chance4 ,as for the injury which the system inflicts on the profession at large1 that is no argument with the individual4 ,human nature operates here as elsewhere4 ,knowing that the system is bad1 we are all anxious to become victims4 ,in recommending the payment of salaries to hospital men1 the ,cleveland ,medical ,journal claimed that such a plan will remedy all the evils incident to the professional side of hospital management4 ,i do not agree in the opinion that the payment of salaries to the staffs of institutions for the care of the sick will alone correct the evils of such institutions4 ,the writer of the aforesaid editorial is incorrect1 also1 when he says that an awakening is at hand4 ,no1 not at hand2 it is coming1 though2 the handwriting is on the wall4 ,when the revolution does come1 this is what will happen3 #a4--;,hospital physicians and surgeons will be paid salaries4 #b4--;,hospitals will take as free patients or patients who pay the hospital alone only such persons as rigid investigation has shown to be indigent4 ,all others will be compelled to pay their medical attendants1 just as in private practice4 #c4--;,certificates of indigency will be required of every free patient1 such certificate being signed by the patient's attending physician--outside of the hospital--and at least two other persons in the community where he or she resides4 #d4--;,general1 and especially country1 practitioners will cease to deceive hospital doctors as to the circumstances of their patients4 ,one medical man should not impose on another4 ,too much trouble1 eh8 ,well1 my friends of the hospital and dispensary--for the same charges should apply to the latter--you must either take your medicine or the revolution will go farther and this is what will happen3 ,the profession at large will boycott every man who runs a college clinic1 and every hospital and dispensary man4 ,it will fight colleges and hospitals to the bitter end4 ,the day is perhaps not far distant when doctors outside of colleges and hospitals will run their private practices on the co-operative plan1 thus dealing a death blow to the free clinic and dispensary4 ,every man of prominence will have his own private clinic and advertise it among his patients4 ,what is fair for twenty or thirty men is fair and ethical for one4 ,each man can have his own hours for the poor2 he can eliminate the unworthy ones1 and1 best of all1 he can refer all his dead-beat patients to his clinic4 ,pride may bring fees from patients to whom honesty is a thing unknown4 ,the private hospital will run most of the public hospitals off the earth4 ,there will be no room for anything but municipal hospitals run squarely and fairly for charity1 and reputable private hospitals run frankly for pecuniary profit1 in which the operation and the attendance fees are the chief factors4 ,such hospitals will benefit1 not hurt1 the profession4 ,one of the most vital flaws in the business sense of the general practitioner is his penchant for hero worship4 ,he hears of the medical tin god from afar1 and burns incense on the altar of his greatness4 ,the great man pats the humble doctor on the back1 calls him a good boy1 and tells him just where to take all his cases4 ,sometimes he offers to divide fees with him4 ,the medical tin god is truly a 8self-made man in love with his maker40 ,he has 8genius stamped upon his brow--writ there by himself40 ,his evolution is interesting4 ,it is history repeating itself3 ,apsethus the ,libyan wished to become a god4 ,despairing of doing so1 he did the next best thing--he made people believe he was a god4 ,he captured a large number of parrots in the ,libyan forests and confined them in cages4 ,day after day he taught them to repeat1 8,apsethus the ,libyan is a god10 over and over again4 ,the parrots' lesson learned1 ,apsethus set them free4 ,they flew far away1 even into ,greece4 ,and people coming to view the strange birds1 heard them say1 8,apsethus the ,libyan is a god2 ,apsethus the ,libyan is a god40 ,and the people cried1 8,apsethus the ,libyan is a god2 let us worship ,apsethus the ,libyan40 ,thus was founded the first post-graduate school4 ,the medical ,apsethus and the deluded parrots of the medical rank and file are here1 and here to stay1 until both are starved out4 ,and the modest general practitioner looks up to the medical tin god and wonders 8upon what meat does this our ,csar feed that he hath grown so great80 ,the meat of industry8 ,perhaps4 ,the meat of prodigious cerebral development8 ,seldom4 ,the meat of opportunity8 ,yea1 yea1 my struggling brother1 8and the devil take the hindmost40 ,but1 more than all1 he hath fed on the meat that the parrots have brought him--,elijah's ravens were not a circumstance to those parrots4 8,in the kingdom of the blind the one-eyed man is king40 ,how long will the general practitioner continue to play parrot to the medical tin god of the charitable hospital the very existence of which is a menace to the best interests of the profession--the profession for which the institution has no charity8 ,in that happy time to be there will be no tin gods4 ,there will be a more equable division of work and every prosperous community will have its up-to-date private hospitals with up-to-date men at the head of them4 ,as for the post-graduate teacher--good or bad--he is already defeating his own ends--he is exciting ambitions in the breasts of his pupils4 ,here and there among them is an embryo ,mc,dowell1 a ,sims1 or a ,battey4 ,the backwoods country produces good1 rich blood and virile brains4 ,and the ,sims1 and ,mc,dowells1 and ,batteys of the future will be found in relatively small places1 doing good work1 and then--good-bye to the tin god and his horn1 8for whosoever bloweth not his own horn1 the same shall not be blown40 ,and in that day the parrot shall evolve into an eagle1 and the hawk had better have an eye to windward4 ,meanwhile1 hurrah for the post-graduate school and its pupils1 and more power to the tin gods4 ,this business handicap is so self-evident that it is hardly necessary to touch on it4 ,we raise the standard of medical education year by year1 yet the mushroom colleges do not go--they are here to stay4 ,if one-half the colleges were wiped out of existence there would still be more than enough to supply the demand for physicians4 ,we have done the best we could to breed competition by manufacturing doctors1 and we are doing all we can to make that competition first class--a queer business proposition in force of the oversupply of doctors4 ,we are unjust1 too1 to the men we educate1 by offering them inducements to enter an already overcrowded profession--but so long as human nature is as it is ,i see no way out of the dilemma4 ,there was once a time when it appeared a goodly thing for the chosen few to get together like the 8three tailors of ,tooley street10 and1 after establishing to their own satisfaction the fact that they were indeed 8the people10 formulated rules for the guidance of the many4 ,these rules were called 8ethics40 ,and the profession has been wrestling with its ethics ever since1 trying to determine what it was all about anyhow4 ,the ethical garment of half a century ago no longer fits--it is frayed and fringed1 and baggy at the knees2 full many a patch has been sewed on it1 in individual attempts to make it fit from year to year1 until it is now1 like the ,irishman's hat1 respectable by age and sentimental association only4 ,and the public1 the ever practical and heartless public1 has also wondered what 'twas all about1 and exhibits little sympathy for a profession which1 while driveling of ethics1 has 8strained at gnats and swallowed camels40 ,who does not remember when all the wiseacres with number eighteen collars and number five hats seriously discussed the relative propriety of 8,specialty0 vs4 8,practice ,limited10 on professional cards8 ,how times have changed4 ,and then came the discussion by a learned society1 of the ethical relations of 8,oculist and ,aurist0 to 8,practice ,limited to ,diseases of the ,eye and ,ear40 ,and it was decided that men who had the former on their cards were not ethical and could not enter that society4 ,ye ,gods6 ,is the fool-killer always on a vacation8 ,must we always see those long ears waving over the top of the ethical fence1 built by the fat hogs to keep all the little pigs out of the clover patch8 ,what is the public to think of a profession that winks its other eye at the man who prints on his cards1 8,diseases of ,women ,only10 but rolls up it eyes like a dying rabbit at the sight of a card reading1 8,diseases of ,men ,only80 ,what has raised the woman with leucorrhea to a more exalted plane than that occupied by a man with prostatorrhea1 does not appear4 ,why so many inconsistencies1 and why such hypocrisy6 ,sir ,astley ,cooper had his own private 8hours for the poor40 ,our ,european brethren print their college and hospital positions and all their titles on their cards4 ,are they less ethical than we8 ,homeopathy is a dead duck over there1 and quackery has a hard row to hoe in ,europe--queer1 isn't it8 ,our system of ethics has not only been hypocritic1 but somewhat confusing4 ,the young man on the threshold of medicine doesn't know 8where he is at40 ,he is confronted by the unwritten law that only celebrated men and quacks may advertise4 ,small fry1 who haven't the ear of the newspapers nor a chance for a college position1 are tacitly ordered to keep their hands off4 ,and the young fellow watches the career of the big man1 who hides every other man's light under his own bushel1 and marvels much4 ,especially does he marvel at the accurate photographs1 life histories and clinical reports of his more fortunate confrres that appear in the newspapers without their knowledge4 ,experiences differ4 ,i haven't yet got around to newspaper clinical reports1 but it has been my fortune to be 8written up0 on several occasions4 ,i do not recall that the newspapers drew on their imaginations for my photograph4 ,i wish ,i might think so1 and that their imaginations were distorted--the result was so uncomplimentary4 ,so far as ,i can learn1 nobody protests against being legitimately represented in the newspapers4 ,why not be honest about it8 ,the hypocrisy of some men is sickening4 ,paying clandestinely for newspaper write-ups is despicable1 yet some of the very men who protest that they 8really don't see how that could have gotten into the papers10 have paid for the advertising in good 8coin of the realm40 ,it is queer that the newspapers should write up the most minute details of the wonderful exploits of some poor fellows1 together with their family histories1 and publish their photographs1 without their knowledge or consent--especially queer when we read in conclusion that 8,professor ,john ,doe is the greatest surgeon that ever lived40 ,why not come out and acknowledge that these are paid for8 ,this would give an equal chance to all1 and especially to young fellows who have money enough to pay for similar things4 ,he who has not the price should not find fault with the fellow who has1 for1 8business is business40 ,meanwhile1 my young friends1 remember that 8big mountains may do what little mountains may not do40 ,when ,koch's tuberculin was yet new1 soon after it escaped1 half-fledged from the laboratory1 only to be captured and made to perform like a trick monkey for the benefit of the laity1 there came a ring at the phone of a prominent daily paper3 8,hello1 is this the ,daily ,bazoo80 8,huh1 huh1 it are40 8,well1 ,i'm ,dr4 ,squirtem ,galls4 ,i wish you would send a reporter over here at once4 ,i want to be interviewed on ,koch's tuberculin40 ,it is said that #be changed hands1 but ,i don't believe it4 ,the gentleman would never advertise--at that rate--8no sir-ree40 ,my informant was once the sporting editor of the ,war ,cry1 and hence unworthy of credence4 ,and what wonderful contributions the newspaper-great-men are making to science6 ,the daily paper is the place to study appendicitis and things4 ,it is not long since ,i learned from a distinguished surgeon friend of mine1 via a daily paper1 that evidence of a blow having been received on the head is an imperative indication for craniectomy1 whether symptoms are present or not4 ,in preference to the clandestine methods now in vogue1 would it not be better for men in authority to write signed articles for the newspapers and intelligently present medical matter to the public8 ,but that wouldn't be ethical1 would it8 ,such topics as 8,advice to ,young ,men10 8,letters to ,young ,wives0 and 8,how to ,keep ,healthy10 must be left to the quacks4 ,we will confine ourselves to the surreptitious blowing of surgical horns and never mind the false notes4 ,meanwhile1 let us stand back and watch the procession of modest men who never advertise--oh1 no6 ,at the head1 with haughty mien1 comes ,professor ,keene ,carver1 preceded by a herald in blood-red garb1 blowing a large brass horn4 ,then comes the 8bearded lady10 whose blonde and breezy whiskers so delight the heart of his swell society clientele4 ,and here comes ,rip ,van ,winkle--a middle-of-the-road 8eclectic10 gathering up his long and weedy beard to keep it from getting tangled up in the scientific barbed wire fence along the route4 ,and here comes another sure-enough 8regular10 evidently a medicine man--so rare nowadays4 ,he is riding in a swell turnout and is on his way to his clinic4 ,how do ,i know that ,professor ,windy ,bowels is a regular8 ,because the gentleman who is riding beside him to his clinic is a reporter on the ,chicago ,daily ,jib-boom4 ,i presume that the suggestion that ,i have made of the advisability of taking the public frankly into our confidence and giving it accurate information so far as its comprehension goes1 by signed articles1 in preference to clandestine advertising and the promulgation of fallacious ideas of medicine and surgery1 will meet with bitter opposition4 ,i nevertheless believe that a better education of the public is the only way to down quackery4 ,the opposition will come chiefly from the surreptitious advertiser1 who sees a prospect of other men getting the advertisement that he believes to be his proprietary right4 ,then there is the tribe of the ,microcephali4 ,the howl of protest will be long and loud from the pews occupied by these far-famed champions of medical orthodoxy4 8,we won't put our discoveries or contributions in the newspapers--not ever40 ,and gazing at their lemur-like front elevations1 we can well believe that they would have no trouble in establishing a 8halibi40 ,apropos of 8discoveries10 it may as well be understood that the public is bound to get the details of them sooner or later1 and1 when the time is ripe1 the matter should be presented to it in a clear and intelligible form--comprehensible to the layman4 ---------------------------------------- -------------------------------- ,,chapter ,,ii ,,the ,,physician ,,who ,,succeeds ,to a great extent ,nature has a commanding influence in the equipment of the successful practicing physician1--the man who actually secures the desired results in his treatment of patients1 builds up and retains a good practice1 and obtains a financial income of respectable proportions4 ,any man of ability1 with the necessary education and training1 may obtain a certain amount of success as a physician and make a modest income--or drag out a miserable existence2 this latter is the most probable4 ,it is a well-established fact that the great majority of physicians are not what the world would call prosperous4 ,this is not because they do not earn enough to secure a competence1 but because they do not get it4 ,the doctor's bill is almost invariably the last one paid4 ,his practice is generally among the middle classes1 people whose intentions are good1 but whose incomes are limited4 ,if there is anything left after the rent1 and grocery and butcher and other bills are paid the doctor will1 perhaps1 get something on account1 but as a rule he doesn't4 ,this is mainly owing to the fact that the average physician is a poor business man2 he does not place an adequate value on his services1 and is slack in looking after collections4 ,if pressed by his wife1 or some friend1 to be more particular in this respect1 his almost invariable reply will be3 8,it would not look well for me to put myself on the same plane with merchants4 ,mine is a profession1 not a trade4 ,besides1 ,i'm in duty bound to do a certain amount of charity work40 ,now charity work is all right in its place4 ,an honest1 upright practitioner will never refuse to respond to a call for his services in deserving cases because the payment of his fee is uncertain1 but this does not obtain to the extent of virtually making paupers of people who are actually able to pay4 ,and yet this is really what happens when a physician conducts his business affairs in a slipshod manner1 and this is what most of them do4 ,there is no excuse or reason for it4 ,but we started in to tell of ,nature's part in the equipment of the successful physician4 ,what is the equipment8 ,the possession of a robust1 healthy physique1 a sunny1 cheerful disposition1 and a fair knowledge of medicine1 and ordinary business ability4 ,all are essential if real success is to be attained1 either in a medical sense1 or in the accumulation of a respectable income4 ,let us take two instances for the purpose of comparison4 ,in one case we have a practitioner with just a fair knowledge of medicine1 but in the possession of all the characteristics mentioned4 ,his very presence in the sick chamber acts as a tonic to the patient4 ,then we have a thin1 undersized1 nervous1 dyspeptic physician2 dissatisfied with himself and the world generally4 ,he is a thorough master in medicine1 and his treatment is more scientific than that of his less learned brother4 ,his presence in the sick chamber1 however1 has anything but a soothing effect on the patient4 ,on the contrary it irritates him1 and the effect of the scientific treatment is nullified4 ,this is not an exaggerated case4 ,there are thousands of just such men in practice4 ,which practitioner is going to have the greatest meed of success8 ,the answer is easy--the one who cheers and encourages his patient by the magnetism of his presence4 ,talk as we may1 suggestion is a powerful factor in the practice of medicine4 ,i do not mean by this that suggestion alone will cure illness 7this statement is made without intention of affronting those who believe in ,christian ,science74 ,but there is ample evidence to the effect that suggestion goes a long ways in making medical treatment effective4 ,it is only the physician whom ,nature has equipped in the manner indicated who can offer the right kind of suggestion and he does it unconsciously4 ,a physician of this kind is bound to become popular1 and popularity begets a large practice and commensurate fees1 provided the practitioner is in the right location1 and has the business acumen to place the proper value on his services4 ,from time immemorial physicians have been imbued with the idea that they must adhere to a set scale of fees4 ,i am speaking now of the average doctor1 the man with a general practice4 ,all patients1 the laborer and the banker1 the wage earner and the millionaire1 are charged the same4 ,in the country districts1 the small towns and cities1 this charge is usually one dollar a visit4 ,in the larger places it is generally two dollars4 ,why should this be so8 ,the architect1 the attorney1 the civil engineer are all professional men in the same way that the physician is4 ,whoever heard of any of them adhering to a set scale of fees in the same way that doctors do8 ,invariably they regulate the charge for their services according to the money value involved1 and the nature of the services required4 ,the man who employs an attorney in litigation where a large money value is at stake naturally expects to pay a much larger fee than the man who employs the same attorney in a minor case4 ,the man who wants plans for a million dollar building pays the architect greatly in excess of the one who builds a one thousand dollar house4 ,the principle is sound and all parties concerned are satisfied4 ,in the eyes of the ,almighty all human lives are of the same value1 and it would be cruelly unjust to attempt to appraise them on a commercial basis4 ,but this should not prevent a physician from grading his fees in proportion to the ability of his patients to pay them4 ,what might seem like a large amount to a wage earner1 would be a mere trifle to one in more affluent circumstances4 ,the lives of both are equally dear to them1 and both are willing to pay the doctor according to their respective ability4 ,custom1 the mother of much folly1 is the only excuse for adhering to the old1 antiquated system4 ,a physician who is called out of bed on a stormy night to answer an emergency call from the home of a coal heaver would not be justified in asking more than the minimum fee4 ,but why should he perform exactly the same service at exactly the same charge for one who is able and willing to pay ten times as much1 or even more8 ,it is not sensible1 it is not fair4 8,but it would be a violation of the code of ethics10 some one may say4 ,bah6 ,the code of ethics be ---- but that's another story which will be told later on in this volume4 ,the plan suggested1 however1 is not a violation of the code of ethics4 ,there is nothing unethical in a physician regulating his fees to please himself1 provided no injustice is done1 and none of his patients is oppressed in this respect4 ,there are certain physicians in the large cities who will not respond to a call for less than #be4 ,there are others who perform the same services for #b4 ,yet both kinds are strictly ethical and are recognized by the medical authorities as such4 ,the reason for this wide difference is that the #be men have used business tact in the practice of their profession1 and elevated themselves to a position where1 by reason of their prominence1 they are justified in naming whatever fees they think they can get4 ,and these fees are almost invariably cash4 ,on the other hand the #b men are timid in a business way2 they hide their light under a bushel as it were1 and consequently lack widespread reputation4 ,their fees remain at #b because they don't ask any more1 and their ledgers are laden with unpaid accounts4 ,there is no reason why a physician should not collect his bills with just as much promptness as a merchant4 ,it is usually his own fault that they go unpaid4 ,statements should be sent out regularly on the first of each month1 and if there is no remittance by the #aeth1 it can be found inconvenient to make any further calls4 ,this1 of course1 is allowing that the patients are able to pay4 ,where real inability to meet the bill exists it becomes a matter for the physician to settle with his own conscience4 ,our medical schools are full of young men who are wasting their time and doing the world at large an absolute injustice by studying medicine4 ,they are doomed to failure before they are well started because ,nature has not endowed them with necessary qualifications for successful practitioners4 ,their instructors realize it1 but the tuition fees are needed for the support of the schools1 and year after year big crops of alleged 8doctors0 are turned out4 ,it might be unfair to refer to them as incompetent1 and yet this is what many of them really are4 ,most of them know medicine theoretically and know it well1 but lack the vital essentials of success4 ,it would be a simple matter of justice to these young men if some plan could be devised for weeding out those who are manifestly unfitted for the practice of medicine before they have wasted their time and money on medical instruction4 ,so long as such a plan is lacking it becomes the duty of the individual to assume this responsibility himself4 ,the mere desire to become a physician should not satisfy the aspirant for medical lore4 ,he should question himself closely as to his fitness4 ,his character may be the best1 his ability to acquire the necessary knowledge unlimited1 but unless ,nature has equipped him as previously outlined1 the most he can hope to attain in the medical profession is mediocrity so far as actually helping the sick1 and obtaining prestige and wealth are concerned4 ,there are men1 it is true1 of high standing in the profession1 who do not possess these qualifications1 but they are few in number and1 as a rule1 are consulting1 rather than practicing physicians4 ,other doctors call upon them for advice because of their recognized skill and learning4 ,they give this advice wisely and well1 but in the sick room would fall far short of obtaining the same results which other men1 more favored by ,nature1 obtain by acting upon the advice they give4 ,time was when the word 8physician10 conveyed the idea of a man with a beard4 ,the two were intimately connected in the public mind4 ,in many parts of the country1 especially in remote districts where modern ideas and knowledge of the germ theory have not penetrated1 this relationship still exists4 ,in such places a full beard is an efficient badge of the doctor's calling1 and is essential in establishing his professional identity among the people4 ,despite the widespread knowledge of the fact that beards are nothing more nor less than nests and hatching beds in which millions of disease germs find shelter1 there are to-day numerous localities in which doctors as well as the laymen cling stubbornly to the belief that a physician without a beard is 8no good40 8,go on1 neighbor1 don't try to fool me4 ,that man's no doctor4 ,how do ,i know8 ,why1 he ain't got no beard40 ,this is no uncommon statement to encounter in rural regions1 and even in some fair-sized towns4 ,even the doctors themselves do not appear to recognize the fact that it is possible to separate their beards from their profession1 and that it would be to the benefit of their patients and the advancement of their own reputations in the end to do so4 ,modern1 well-educated physicians know that many1 in fact nearly all the ordinary ailments1 are of germ origin4 ,they also know1 for instance1 that a patient suffering from typhoid1 or typhus1 or some like disease1 is continually reproducing these germs in immense numbers4 ,for a physician with a full beard to lean over the bedside of such a patient is to invite millions of these germs to invade his beard1 and wherever he goes he carries these germs with him and spreads the disease4 ,it is bad enough when decent precaution is taken as the hair of the head1 the mustache1 and even the clothing itself will harbor too many of the bacilli4 ,but to wear a beard is to greatly increase the accommodations for these undesirable lodgers4 ,in this way the health and lives of thousands of people are daily jeopardized4 ,this is why beards should have no place on the faces of physicians1 and the more highly educated and more progressive the physicians are the fewer will be the beards found among them4 ,another thing is a prime requisite in successful practice and this is the most scrupulous cleanliness4 ,this refers not only to the person and apparel of the physician1 but to the instruments which he handles4 ,some years ago an ,iowa cattleman suffering from a chronic trouble1 came to ,chicago for treatment which was administered hypodermatically4 ,he made fair progress toward recovery1 and finally was in condition to return home where the treatment was continued by his family physician4 ,for a time the reports made by the ,iowa doctor were of a glowing nature4 ,mr4 ---- was getting along nicely1 and the improvement in his condition was nothing short of miraculous4 ,suddenly word came that there was a change for the worse1 and the ,chicago specialist was requested to go to ,iowa and make an investigation4 ,he did so4 ,on arriving in the town nearest the patient's home he first called upon the local physician and together they drove out to see ,mr4 ----4 ,the latter was evidently fast approaching a collapse and the specialist was at a loss to account for the remarkable change4 ,he was assured that his instructions had been closely adhered to1 both the patient and the local doctor agreeing upon this point4 ,finally the specialist said3 8,doctor1 let me see you administer the hypodermatic part of the treatment40 ,the local physician took from his overcoat pocket a hypodermic syringe without case or other protection4 ,this he stuck into the bottle of fluid which constituted the treatment1 and was about to make the injection when the specialist shouted3 8,great heavens1 doctor1 don't do that6 ,let me see that syringe a moment40 ,holding the syringe up to the light the specialist found it extremely dirty on the inside of the glass barrel1 and the needle point covered with lint4 ,calling the local physician into an adjoining room he said3 8,my ,god1 ,doctor1 it's a wonder your patient is not dead4 ,you are poisoning him to death4 ,how long is it since you sterilized this syringe80 8,why1 it was sterilized when ,i got it1 wasn't it80 replied the local ,m4,d4 innocently4 8,yes10 answered the specialist1 8and my instructions were that it should be cleansed with alcohol before and after every injection1 and sterilized in boiling water at least once a week4 ,this has not been done40 ,then and there the visiting physician opened the eyes of his country brother as to the grave importance of utter and absolute cleanliness in all branches of practice1 and especially in the administration of hypodermatic treatments4 ,for nearly ten weeks this doctor had not cleansed the syringe4 ,during all this time he had unconsciously been injecting into the system of his patient the most virulent of poison in the form of the decomposed lymph which remained in the syringe barrel1 as well as such foreign substances as accumulated on the unprotected needle of the syringe4 ,and yet this 8doctor0 was popular and successful in a way1 7in mild cases71 despite his failure to keep up with the progress of modern thought4 ,he was one of the old-fashioned full-bearded type1 ignorant of germs and germ-theory1 and too self-opinionated and set in his way to keep himself posted as to what is going on in the world of medicine4 ,i wish ,i were able to state honestly that1 in the instance here referred to1 the patient recovered1 but he did not4 ,the damage had been done1 and it was too late1 when the specialist was called in1 to overcome it4 ,this is a truthful narrative4 ,it is being duplicated in many instances owing to the ignorance and incapacity of men who1 while possessing diplomas1 are really unfitted for the practice of medicine4 ,it illustrates in a sad1 but forceful way1 the necessity of being 8up to date10 and mixing common sense with the medical lore acquired in the schools4 8,costly thy habit as thy purse can buy10 should be the rule4 ,a physician should never dress flashily1 but he should be garbed well4 ,it creates a good impression4 ,the time and money expended on improving the personal appearance is well invested4 ,patronize a competent tailor4 ,a portly1 well-conditioned man1 well clothed1 and of sunny1 cheerful ways1 will work wonders in the practice of medicine4 ,impressions are created largely by appearances4 ,the man who looks affluent1 who conducts himself in a good-natured1 dignified manner1 will succeed even though he be lacking in a thorough knowledge of his profession4 ,the man who is slouchy and ill-kempt1 and who takes no pains to be pleasant and obliging1 will fail1 no matter how well grounded he may be in the science of medicine4 ,why8 ,because he will repel people instead of attracting them4 ,this same rule holds good in all lines of business1 but it is specially applicable to the practice of medicine4 ---------------------------------------- -------------------------------- ,,chapter ,,iii ,,the ,,bugbear ,,of ,,ethics ,one of the first spooks with which the young practitioner will be confronted is the bugbear of ,ethics--don't overlook the big ,e4 ,it will be in front of him on graduation day1 his preceptor will dangle it before his eyes as he hands him his papers1 and it will be continually bobbing up after he has hung out his shingle4 ,now ethics in its place is a good thing4 ,it is especially essential in the medical profession in which1 without a due regard for the proprieties1 many men would be tempted to go astray4 ,and this temptation is by no means slight at times4 ,but there is such a thing as overdoing the ethical proposition4 ,it becomes monotonously annoying for a man to have his every movement watched and judged from the ethical standpoint by a lot of self-constituted censors4 ,the average physician1 in his bearing toward his younger brother does not ask himself the old question1 8,am ,i my brother's keeper80 ,not at all4 ,on the contrary the worst of it is he assumes an opposite attitude and by his actions asserts 8,i am my brother's keeper40 ,in a way these men assume the right to dog and spy upon the movements of other physicians on the plea that they are doing it for the benefit of the profession--to see that the great ,code of ,ethics is not violated4 ,what they are really after1 nine times out of ten1 is to make sure that the young1 progressive practitioner who has the tact and ability to build up a good-paying practice does not encroach upon their preserves4 ,this is bad enough1 but there is a worse side4 ,in nearly every instance those who howl the loudest about violations of the code1 are gross offenders themselves4 ,this is a bold assertion1 but the proof will be furnished later on4 ,one of the things specially cited as an unpardonable violation of ethics is the courting of newspaper and similar publicity4 8,my dear boy10 one of these old-time offenders will say1 8you must not allow your name to appear so frequently in print4 ,it is undignified and unethical4 ,our profession is one of mighty dignity and responsibility1 and you owe it to yourself and your brother physicians to avoid anything which tends to lower or debase it4 ,i know it is only human to seek notoriety of this kind1 and that it is valuable so far as the mere getting of money goes1 but we must be actuated by higher1 nobler motives40 ,it is practically a certainty--with rare exception--that the man who gives this advice1 is bending every energy1 and using every possible means to secure the same kind of publicity4 ,he knows that fame and wealth come from keeping one's name constantly before the public4 ,in every large city we will find physicians of wealth and fame1 of whose every movement the newspapers seem to have information in advance4 ,how do they get it8 ,let us analyze the conditions4 ,under his professional obligation ,dr4 ,soakum is bound to observe and live up to the code of ethics4 ,he prates loud and often about the beauties of an ethical life1 and the uninitiated might well suppose that his was a model existence in this respect4 ,but1 is it not a trifle strange that whenever ,dr4 ,soakum1 owing to his great skill and fame1 is called out of town to attend some prominent personage in another city the newspapermen know he has been summoned4 ,more than this1 they know where he is going1 whom he is going to see1 and what train he is going on4 ,strange1 is it not8 ,it is no uncommon occurrence to read items like the following in the daily press3 ,dr4 ,soakum1 the distinguished specialist in chronic disorders1 left for ,san ,francisco yesterday1 having been summoned by wire to attend the ,hon4 ,million ,moneybags1 who is seriously ill with chronic nephritis4 ,the patient1 whose disability at this time is of grave import to a number of large business transactions1 has been under the care of a number of famous physicians1 but his great confidence in the skill of ,dr4 ,soakum led to the hasty summoning of the latter4 ,dr4 ,soakum1 who was seen by our reporter just as he was boarding the ,overland limited confirmed the report4 ,he added that the time of his stay was uncertain1 as the case is a most important one1 and may demand his undivided attention for some weeks4 ,during his absence ,dr4 ,soakum's vast practice will be looked after by his associate1 ,dr4 ,bleedum4 ,he added that he was both surprised and annoyed to think the news had leaked out4 ,surprised6 ,annoyed6 ,not on your life4 ,this was only a bit of stage play1 of dramatic action1 on the part of ,dr4 ,soakum4 ,real surprise1 real annoyance and real anger would have resulted only from the failure of the reporter to appear after the careful arrangements which had been made to ensure his attendance4 ,how often have many of us read items like the following in the daily press3 ,at last there is hope for the consumptive4 ,dr4 ,killem1 the eminent specialist1 whose success in the treatment of tuberculosis has aroused wide interest in the medical profession1 has made public the details of his treatment by means of which such wonderful results have been obtained4 8,i would have done this long ago10 said ,dr4 ,killem to a reporter for the ,morning ,howl1 yesterday1 8were it not that ,i desired to be absolutely certain as to the permanent efficacy of the treatment4 ,now that there is no longer room for doubt on this point ,i feel at liberty to act4 8,the essential feature in my method is10---- ,and ,dr4 ,killem goes on to give what he calls a professional statement1 so involved and beclouded with high-sounding terms that the poor reporter makes a sorry mess of this part of his story4 ,strange as it may seem this is just what ,dr4 ,killem wants4 ,he knows his treatment will not stand a scientific analysis by competent men1 and he avoids this by intentionally leading the reporter to misquote4 ,and then it gives him an opportunity to write a letter of protest to the newspaper and thus obtain more publicity4 8,i'm chagrined10 ,dr4 ,killem will say to his professional brethren4 8,that reporter for the ,morning ,howl has made an ass of me1 but ,i suppose there is no redress4 ,i gave him a few1 a very few facts1 out of kindness1 and he has distorted them and made me ridiculous40 ,and all the time ,dr4 ,killem is swelling with pride4 ,he has 8put another one over0 on the press1 and obtained a lot of valuable publicity that he could not have bought outright4 ,besides he would not think of doing such a thing as to pay for advertising--it would be unethical4 ,how do you suppose the newspapers get hold of such items8 ,reporters are a pretty smart lot of men with noses keenly trained on the scent of news4 ,but none of them1 so far as known1 possesses the gift of being able to tell in advance what is going to occur at a given time4 ,smart as they are it would be out of the question for them to know that ,dr4 ,soakum had been called out of town1 or that ,dr4 ,killem had interesting information to impart to the public1 unless they got tips to this effect1 and these tips are just exactly what they get4 ,none of these physicians have press agents4 ,perish the thought4 ,that would be decidedly unethical1 and too clumsily convictive4 ,no siree4 ,they are too smart for that4 ,most of them1 however1 especially those who work the press continually1 have private secretaries4 ,the private secretary work is light1 and is attended to by stenographers and book-keepers1 but the title affords a handy cloak for disguising the press agent4 ,ostensibly engaged as private secretaries the men who fill these positions know full well that their one and only duty is to 8boost0 the professional prowess of their employers2 to keep them constantly before the public4 ,frequently this work is done by men who have no open1 direct connection with the physicians who employ them2 are not even seen around their offices4 ,this is the latest dodge1 and is becoming more and more general4 ,it has one decided advantage in the fact that it is impossible to trace any collusion between the party who gives out the news1 and the party who is benefited by the publication4 ,it also has a further advantage4 ,it enables the physician to put on an air of surprise1 should he be questioned by a brother doctor1 and say3 8,smith4 ,who is he8 ,he is not on my office staff1 and is certainly assuming a lot when he pretends to speak for me40 ,all of these press agents work on the same lines4 ,they know the avidity with which city editors grab for news1 particularly if it concerns prominent people4 ,when the occasion arises they get into communication with some city editor1 generally by phone1 and a conversation something like the following ensues3 8,hello1 that you ,brown8 ,this is ,jones4 ,yes1 the same1 old man4 ,thanks4 ,i've just got onto something that looks like a good tip1 and ,i thought you would like to have it4 ,dr4 ,soakum has been called to ,san ,francisco to attend old ,moneybags1 the trust magnate4 ,if the old chap should die it would raise ,old ,ned in the stock market4 ,i understand that ,soakum goes this afternoon on the ,u4 ,p4 limited4 ,oh1 don't mention it4 ,i'm glad to be able to give you the tip4 ,hope you'll be able to get a story out of it40 ,jones1 the press agent1 does not1 of course1 tell his city editor friend that there's #be in for him 7,jones7 if the story is printed4 ,he's too smart for that4 ,so far as the city editor knows ,jones is simply trying to do him a favor in a news way4 ,the press agent is also smart in another direction--he does not call on the same city editor too often4 ,it might arouse suspicion4 ,in nearly every city of any size there are a number of newspapers4 ,jones works them in rotation1 so far as ,dr4 ,soakum is concerned4 ,first it is the ,morning ,howl1 then the ,daily ,screech1 next the ,evening ,whirl1 and so on4 ,between the ,dr4 ,soakum stories ,jones works in items about other people1 for the modern press agent is an enterprising chap who represents a number of clients all eager for publicity4 ,a good press agent can look after the interests of a physician1 a lawyer1 an actor1 and a promoter at all the same time1 and not overwork himself4 ,it's merely a matter of giving out the right tips in the right way4 ,if the tip looks good the city editor and his staff does the rest4 ,to preserve his standing with the newspaper fraternity ,jones very frequently1 if he is a real live1 first-class press agent1 tips off a bit of actual news1 something in which there is no #be for him1 and which makes the city editors rise up and call him blessed4 ,incidentally it also makes them all the more willing to act upon his next tip1 and this is just what ,jones wants4 ,he is merely sowing seed for the crop he is to reap in the near future4 ,and do reputable physicians countenance this sort of thing8 you may ask4 ,they certainly do2 not all of them1 it is true1 but a big working majority4 ,the large cities are full of physicians of wealth and fame who have been literally boosted into prominence by the newspapers4 ,fancy the effect upon the public when it reads of ,dr4 ,soakum being called to attend so distinguished a citizen as the ,hon4 ,million ,moneybags1 or references to ,dr4 ,killem1 8the eminent authority on tuberculosis40 ,it means a stream of dollars rolling into the pockets of the doctors thus referred to1 and puts them in position to name larger fees4 ,there are times when as a matter of business precaution the press agent resorts to opposite tactics4 ,it would not look well to be lauding ,dr4 ,soakum all the time4 ,so1 having previously laid out the program with the former1 the press agent hunts up another physician who knows how others are prospering through publicity and is not averse to having some of it for himself4 ,the program is explained to ,dr4 ,squills1 and he writes to the newspapers1 bringing to their attention some supposedly important medical subject4 ,it may relate to hygiene1 bad management of hospitals1 unsanitary condition of street cars1 the proper means of stopping the spread of tuberculosis1 anything to attract public attention4 ,city editors1 unless overcrowded with more important matter--and the press agent generally selects the opportune moment--will print this kind of 8stuff0 in full4 ,having printed it about the first thing they will do is to send out reporters to ask the 8eminent ,dr4 ,soakum0 for his opinion on the subject4 ,this is just what ,dr4 ,squills was induced to break into print for4 ,dr4 ,soakum will endorse the latter's letter1 praise it warmly and perhaps bring out some new points which ,squills has purposely overlooked4 ,this gives ,squills a chance to come back with a statement as to the importance of the suggestions made by ,dr4 ,soakum1 and the two old hypocrites thus get a lot more free advertising4 ,all of which means more prominence1 more fame1 and more money4 ,some years ago--about ten at this writing--a new treatment for chronic nervous and mental ailments was introduced4 ,its sponsors were men of high standing in the profession1 instructors in leading medical colleges4 ,that the treatment had great merit is undeniable2 many wonderful results were accomplished with it4 ,it also had great money-making possibilities1 but the promoters did not know how to develop this feature4 ,finally they engaged a press agent--we'll call him ,mr4 ,johnson1 because that is not his name4 ,his terms were #ej a week salary1 and a royalty on the business4 ,for three or four days ,mr4 ,johnson did nothing except post himself as to the scientific features of the treatment and he was soon able to talk more glibly and intelligently about it than the physicians in charge4 ,then one day he said3 8,trot out some of your star cases4 ,i want to look them over40 ,mr4 ,johnson went over the records carefully and selected one which seemed to give promise of producing a big free advertisement4 ,it was that of a well-known1 well-to-do merchant in a neighboring city who a year before had been seized with primary dementia4 ,homicidal tendencies developed and his family1 on the advice of prominent alienists1 placed him in a sanitarium1 the physicians at which1 as well as those called in by the family1 pronounced the case absolutely incurable and hopeless4 ,in time the new treatment was administered4 ,in ninety days the patient was discharged as cured1 returned to his home1 and resumed charge of his business4 ,to this day he is well mentally and physically1 and no one1 unacquainted with his history1 would ever think he had been insane1 and confined as a dangerous lunatic4 ,having satisfied himself as to the accuracy of the story1 ,johnson's next move was to plan out a line of action4 ,the story to be acceptable in a news way1 and carry plausibility with it must come from the patient's home town4 ,it would never do for ,johnson to offer it to the newspapers himself4 ,his connection with it must be carefully concealed4 ,the first thing he did in this direction was to ascertain who handled the correspondence that was sent out to the big dailies from this particular town4 ,he found that it was virtually in the hands of a ,mr4 ,wheeling1 city editor of a local paper4 ,armed with this knowledge ,johnson took a train and went to the town in question--it is only a few miles from ,chicago--timing himself so as to arrive there when ,mr4 ,wheeling had finished his rush work for the day4 ,arriving there he introduced himself to ,wheeling as follows3 8,my name is ,johnson4 ,pardon me for intruding upon you1 but ,i'm a stranger in town1 with a little spare time on my hands1 and being somewhat of a newspaper man myself it seems sort of homelike to poke around an editor's den4 ,it's the best way ,i have of killing time and1 if it doesn't annoy you1 ,i'd like to pass away an hour or so chatting over newspaper work and newspaper men40 ,wheeling1 a cordial1 whole-souled chap1 made ,johnson welcome1 and they were soon very friendly1 exchanging reminiscences1 and regaling one another with their experiences4 ,johnson was in no hurry to spring the trap4 ,he was too smart for that4 ,he produced some good cigars and1 after they had talked for an hour or so1 invited ,wheeling to take dinner with him at the hotel4 ,wheeling accepted1 and after the meal1 when fresh cigars were lighted1 ,johnson proceeded to set his trap as follows3 8,once a man has the newspaper fever he never gets it out of his blood1 at least not entirely4 ,i'm better off now financially than ,i could possibly expect to be working as a reporter or editor1 and yet frequently the old desire to cover an assignment1 or write a good story1 takes hold of me1 and takes hold hard4 ,it's galling for a man of my disposition to run against a good story and not be able to make use of it1 but this is happening with me right along4 ,why this very afternoon1 in conversation with a business friend just before ,i met you1 ,i heard a story that's a corker1 and would make a big sensation if it ever got into print4 ,but pshaw1 what's the use of talking1 ,i'm simply not in position to make use of it1 and might as well pass it up4 ,it goes against the grain though1 ,i can assure you40 8,why not give me the tip80 asked ,wheeling4 8,i'm correspondent here for quite a list of papers1 and a real live story1 one that ,i could spread on1 would mean considerable to me40 8,well10 replied ,johnson1 8,i don't mind giving you such facts as ,i have1 but of course ,i can't vouch for their accuracy4 ,all ,i can say is that if your investigation establishes the truth of what ,i have heard all the big papers will want the story by the column1 and then some40 ,johnson then proceeded to outline the story to ,wheeling1 hesitating purposely as if not quite sure of the patient's name1 and giving one that sounded much like it1 but was not the real one4 ,the trap was sprung4 ,wheeling knew the man1 and at once realized that he was in line for a big ,sunday spread4 ,it would not do to waste so good a yarn on the daily issues in which a stick or two of space would be the limit when he could place a column or more in each of the ,sunday papers4 ,wheeling furnished his correspondence at space rates1 so much per column1 and he naturally wanted to make the story as full and complete as possible4 ,that very night 7it was ,monday7 he visited the home of the miraculously cured man4 ,the latter talked freely1 corroborating all the important details4 ,wheeling's next visit was to the home of the family physician1 and there he got more corroboration4 ,the next morning he wired the various ,sunday editors as follows3 ,prominent business man here1 after being pronounced incurably insane by eminent specialists1 and confined in asylum1 fully restored to reason by new and novel treatment4 ,big story4 ,how much8 ,he was swamped with replies4 ,every ,sunday editor wanted more or less of it4 ,most of them wanted it in full1 the orders reading something like this3 ,if sure of facts1 and man is really prominent1 send story in full4 ,no limit4 ,also get pictures of patient1 and others concerned4 ,the following ,sunday morning every newspaper in ,chicago fairly 8shrieked0 forth the news of the new treatment4 ,it was given to the public in the form of a first-page story with the emphasis of leaded type1 8scare0 heads1 and pictures of the patient4 ,the ,associated ,press took it up and wired a report to all ,american papers1 while a condensed statement was cabled abroad4 ,nor was this all4 ,managing editors from ,new ,york to ,san ,francisco1 from ,toronto to ,new ,orleans1 called upon their special correspondents to rush more particulars by wire4 ,the managing editors of the ,chicago papers instructed their city editors to obtain statements in full from the physicians interested1 as to the scientific nature of the treatment1 its history1 etc4 7,the names and addresses of these physicians being given in the first story1 the locating of them was easy--it was part of ,mr4 ,johnson's plan47 ,what was the result8 ,the new treatment was immediately 8boosted0 into world-wide prominence4 ,half a million dollars would not have paid for the publicity it obtained in one week4 ,indeed it would have been impossible to buy this kind of publicity--straight news--at any price4 ,it made fortunes for the men interested4 ,to-day1 ten years after this publicity1 these men are still reaping its benefits4 ,now these men1 it should be remembered1 were and are strictly ethical4 ,they frown upon anything that smacks of violation of the code4 ,they will not sell the treatment to physicians who advertise4 ,their dealings are confined to those who can show a clean bill of health in this connection4 ,to those who meet the demands in this respect they furnish the treatment at #bg4ej per #b-ounce vial2 the cost of producing it is about #ge cents4 ,nice profitable business8 ,well1 rather4 ,the lesson of all this is that it pays physicians to advertise1 provided they do it in the right way1 and are clever enough to hoodwink their professional brethren as well as the general public on the question of ethics4 ,the man who openly engages a real press agent and pays his money for 8display ads0 in the newspapers is tabooed1 his name is anathema4 ,the man who engages a press agent quietly to get up schemes by which the gentlemen of the press may be worked for valuable publicity is thoroughly ethical1 and remains in good standing in the profession4 ,wherein lies the distinction8 ,i must confess that it is too fine for me4 ,of the two the honor seems to be with the doctor who proceeds to ask for patients in a straight-forward business-like manner1 and pays the newspapers for the space they give him4 ,on the one hand we have the man who pays for what he gets1 while on the other we have him who1 in reality1 is obtaining goods under false pretences4 ,just another point about ethics4 ,it is strictly unethical for a physician to prescribe or administer a remedy the formula of which he does not thoroughly understand4 ,but thousands of them are doing it daily4 ,where is the physician1 for instance1 who knows in reality1 aside from the proprietors1 the composition of ,anti-,kamnia1 but does lack of this knowledge stop its widespread use8 ,not at all4 ,it's the same way with acetanalid and scores of other preparations4 ,occasionally the proprietors of some remedies seek to ease the conscience of some extra scrupulous practitioner by printing what appears to be a formula4 ,but in such cases there can be no assurance that the formula is correctly stated1 the proper quantities given1 or the method of preparation absolutely stated4 ,in all such cases the alleged facts must be taken on faith4 ,the author has in mind one particular instance1 the accuracy of which he can vouch for because he was interested in the preparation and sale of the remedy4 ,a certain hypodermatic treatment was placed on the medical market 8for the use of physicians only40 ,to satisfy the ethical gentlemen the formula was given1 and it was given correctly4 ,nothing1 however1 was said about the method of preservation4 ,this was an important item as the remedy consisted of a combination of animal tissues and fluids which would decompose quickly1 and if injected into the human system would work havoc4 ,to keep it in condition for use1 with its curative properties intact1 it was necessary to put it through a preservative process in the course of which various chemicals and other substances were added4 ,nothing was said in the formula about this feature1 nor did the strictly ethical physicians who used it make any enquiry about it4 ,common sense1 to say nothing about medical training1 should have told them that a remedy prepared after the formula as stated must decompose rapidly unless some preservative process was employed1 but a little thing like this did not seem to bother them4 ,they just simply glanced at the formula1 wondered they had not thought of it themselves1 and jabbed it into their patients according to directions4 ,what assurance did they have that1 if the remedy was not properly preserved it would not injure1 and perhaps kill the people upon whom it was used8 ,what assurance did they have that1 if the remedy had been put through a preservative process1 it did not contain some substance which would be equally injurious8 ,none whatever4 ,their actions were equivalent to saying they didn't care4 ,this1 to the careful1 conscientious physician1 would seem like coming close to the danger mark1 and so it was4 ,to speak plainly it was little short of criminal carelessness1 and yet these practitioners were all thoroughly ethical4 ,the only possible excuse for them is to say they thought they knew1 but this is actually no excuse at all as1 under their obligation it was their duty to know beyond doubt what they were using4 ,as ,dr4 ,lydston asks in the opening chapter1 8,why not be honest0 about this publicity matter1 and1 he might well have added1 all the other features of modern medical practice as well4 ,there is no excuse for honest practitioners leaving the use of the public press to quacks and fakirs--and the few really good physicians who are smart enough to take advantage of it while at the same time 8pulling the wool over the eyes0 of their professional brethren4 ,such tactics as now prevail1 cloaked under the guise of ethics1 are unfair to the young medic4 ,they keep him from doing the very thing which the self-appointed ,lord ,high ,apostles of ,ethics are doing1 and waxing rich and famous thereby4 ---------------------------------------- -------------------------------- ,,chapter ,,iv ,,lawful ,,to ,,advertise ,just who put forth the dictum that it is unlawful1 unprofessional1 unethical1 for a physician to advertise is unknown4 ,it was probably some old codger of antiquarian ideas4 ,at any rate the rule--and it is a rule--is so old it reeks with decay4 ,but1 among progressive physicians1 it is fast coming to be recognized as a rule which is 8more honored in the breach than in the observance40 ,other professional men who were once held in bonds of the same nature are breaking away4 ,we find in the public press the cards of attorneys1 architects and civil engineers1 all callings which are legitimately dignified with the name of 8professions40 ,no exception is taken to these men making their talents known1 although at one time--and it is only a few years ago--they were held in ethical bonds just as strong and binding as those with which the medical practitioner is now enchained4 ,but time changes all things4 ,it has changed to a degree the code of ethics which formerly obtained in the professions of law1 architecture1 and civil engineering1 and it is slowly1 but surely1 changing that of medicine4 ,true the wording of the various codes remain the same1 but there is a growing tendency to wink at1 to overlook evasions4 ,it has become a matter of convenience to the public to know where to find a competent lawyer1 or architect1 or civil engineer4 ,hence the appearance of their business cards in newspapers4 ,on the same grounds publicity by physicians is justifiable4 ,it is more than justifiable4 ,mankind can1 in a pinch1 get along without attorneys or architects or engineers4 ,that is to say it is rarely imperative their services should be requisitioned in a hurry4 ,the trial of a law case1 the plans for a building1 or the construction of a bridge can generally be put off for a few days at least without serious injury or inconvenience to any body4 ,when a doctor is needed he is generally needed badly4 ,it may not always be an emergency case1 but almost invariably when the services of a physician are required1 even in chronic ailments1 delay only aggravates the patient's condition4 ,if a medical man has1 by special study1 equipped himself to handle a certain class of diseases more intelligently and satisfactorily than the general practitioner it becomes his duty to let the public know about it4 ,if we accept the dictum of the censors of medical propriety as they present it--that the obligation taken by the physician binds him to serve the public to the best of his ability--then surely we can not get away from the proposition that men of unusual ability are in duty bound to make the public acquainted with that ability4 ,the successful physician does not live up to his obligation if he 8hides his light under a bushel40 ,medical societies1 the watchdogs of ethics1 do not accept this doctrine4 ,not only this2 they try to drive out of practice1 to brand with infamy1 to make an outcast and wanderer of the man who indulges in it4 ,the 8it0 in this instance refers to publicity fairly bought and honestly paid for over the newspaper counter4 ,but they do not always succeed4 ,for years ,dr4 ,mc,coy had been a surgeon at ,bellevue hospital1 ,new ,york1 a man of rare skill and of high standing in his profession4 ,he was a member of various medical societies1 respected and honored4 ,after a long1 weary experience he made up his mind that he was entitled to a better financial reward than it was possible for him to obtain in hospital or private practice4 ,he came to ,chicago1 obtained a certificate from the ,state authorities1 and began advertising in the daily newspapers as a specialist4 ,his medical brethren were horrified4 ,remonstrance being of no avail1 they promptly ousted ,dr4 ,mc,coy from membership in the professional societies4 ,not content with this they went further and filed complaint with the state authorities with the purpose of having his certificate1 or license to practice1 revoked4 ,that they would have succeeded in this if ,dr4 ,mc,coy had not taken the matter into the courts1 is a certainty1 as the members of the ,state ,board of ,health who would pass upon the question were all physicians and prominent in the societies which were seeking to deprive ,mc,coy of his certificate4 ,a long1 hard-fought battle in the courts was won by ,mc,coy4 ,in handing down its verdict the final court said in effect3 8,we fail to see wherein this appellant has committed any offense against the laws of the ,state4 ,if he was competent to practice medicine at the time he received his license he is competent to practice now4 ,nothing that has been alleged against him has affected in any way his ability1 fitness1 or competency as a medical practitioner4 ,neither has he committed any penal offense4 ,true he has advertised1 but advertising is not a felony2 not even a misdemeanor4 8,the fact that the medical societies to which he belonged have revoked his membership has no bearing on the case4 ,these societies have no official powers so far as the ,state is concerned4 ,they may very properly say who may1 or who may not1 hold membership with them1 but they have no authority to say who may1 or who may not practice medicine4 ,societies of this kind are purely social and professional2 they are not endowed with executive1 administrative1 or legislative power to act for the ,state40 ,this finding established in a forceful1 indisputable manner the legal right of a physician to advertise his skill as a healer of mankind without affecting his ability4 ,it was not to the liking of the sticklers for ethics who control the medical organizations4 ,they would have the young medics believe--and up to the time the ,mc,coy case was decided they had succeeded--that they were all powerful2 that their word was law1 not only as regards membership in the societies1 but also as to who might1 or might not1 practice medicine4 ,they succeeded because they controlled the ,state ,board of ,health4 ,but the ruling of the court put an end to this impudent assumption of authority4 ,it laid down and made clear the important fact that1 in passing upon the competency of applicants for licenses1 medical ability and good moral character were the sole and only points to be considered4 ,there is advertising and advertising1 one kind respectable and dignified2 the other outrageously bad4 ,the author would not for a moment countenance the use of flamboyant 8ads0 like those with which the 8weak men0 and other quacks bombard the public through the daily press4 ,such advertising as a general thing is positively indecent and dishonest4 ,the men who place it and the newspaper publishers who print it should be prosecuted into the penitentiary4 ,it is a queer thing that so-called high-class newspapers which decline to accept lottery and get-rich-quick 8ads0 on the ground of morality 7we'll say nothing of their illegality7 will openly solicit and publish the disgusting business advertisements of medical charlatans and fakirs4 ,no man who respects himself or his profession will 8guarantee a cure or money refunded10 no matter how apparently simple or mild the ailment he undertakes to treat may be4 ,neither will he offer to take cases on the 8no money until you are cured0 plan4 ,these are methods which belong exclusively in the realm of quackdom4 ,they deceive only the ignorant1 and are used with success only among that class of people4 ,but baits of this kind stare one in the face from nearly every ,sunday newspaper1 and from many fences4 ,then there is the fakir who calls upon you in loud type to 8,see ,old ,doctor ,squeeze-em4 ,he'll do you good60 ,it's a safe bet he will 8do0 you good if he ever gets you into his clutches2 8do0 you so good that you will be lucky to have carfare left to get home with4 ,these are not the methods employed by smart men who1 through publicity1 obtain a good practice1 and put themselves in position to command large fees2 men to whom patients will pay #ajj for an hour's consultation and advice without hesitation1 while they would begrudge #e to a physician of equally as much or more medical skill1 but not so well versed in the art of self publicity4 ,how do these men get before the public8 ,they pave the way according to well-laid plans4 ,their every move is part of a previously laid-out program4 ,we are writing now of those who have not progressed to the stage of employing regular press agents1 or have not become well-known enough to warrant regular advertising4 ,they join some fashionable church and mix in its affairs2 take prominent part in the sociables and other doings1 and when the ladies come around with a grab bag1 or 8take a chance on a nice piano10 dig down deep into their jeans4 ,they may have to get along on short rations for a day or two1 but the money has been invested to better advantage than if it were expended for pork and beans4 ,a short course of this kind gets all the women talking about what a charming man ,dr4 ,swell is1 and so liberal4 ,pretty soon they begin to boost him into prominence by insisting upon his taking charge of some of their social affairs1 and then his name gets into the papers4 ,this is the beginning4 ,the oftener he is mentioned the more impressed the newspaper men become with the belief that he must be a man of importance1 and the first thing ,dr4 ,swell knows he is getting the most valuable kind of publicity by the column4 ,and the male part of the community8 ,well1 it's just as easy to 8con0 them as it is the women4 ,dr4 ,swell joins lodge after lodge1 society after society1 just as fast as he can raise money for the dues4 ,he attends the sessions faithfully1 and1 so far as outward appearances go1 takes a deep interest in the proceedings4 ,he has a good word1 and a warm1 hearty hand shake for all the brothers4 ,while modest1 he always manages to have a word to say 8right out in meeting0 at the proper time1 even if it is no more than to voice approval of something that has been done4 ,then1 in time1 it comes quite natural for the presiding ,squeejicks1 or whatever his title may be1 to frequently say1 8,we would like to hear from ,dr4 ,swell on this matter40 ,dr4 ,swell is coming on4 ,if he keeps his head down to a normal size1 treats everybody courteously1 and goes along making friends at every opportunity1 the first thing he knows is that he is nominated for the office of ,worthy ,high ,jinks4 ,of course he protests that there are others better fitted1 etc41 but he doesn't mean it4 ,he is elected1 and again there is legitimate excuse for getting more publicity4 ,all the papers announce that3 8,at its annual meeting last night ,cockalorum ,lodge ,no4 #cghdj1 ,o4,b4,o4,a4,b41 elected ,dr4 ,what ,a4 ,swell as ,worthy ,high ,jinks4 ,under his regime ,cockalorum ,lodge will make many advancements during the coming year4 ,when ,dr4 ,swell was asked to outline his program last night he said30 ,and here follows a lengthy interview which ,dr4 ,swell1 knowing he was sure to be elected1 had prepared in advance4 ,from then on it is easy sailing--if he is a smart man4 ,he manages to keep ,cockalorum ,lodge doing something all the time2 not that he is so desperately in love with the lodge1 but because it means more and more publicity to ,dr4 ,swell4 ,as with ,cockalorum1 so with the other lodges1 or churches1 or societies to which he may belong4 ,from being at first a mere atom of news1 ,dr4 ,swell finally becomes an actual necessity to the newspaper fraternity4 ,its members have acquired the habit of turning to him involuntarily whenever a news problem presents itself4 ,if the cable brings information that ,emperor ,william has a sore throat reporters besiege ,dr4 ,swell4 ,he talks learnedly 7or he should7 of the nature of the trouble1 and outlines the proper course of treatment1 etc4 ,again it is heralded to the community that3 8,on being asked concerning the nature of ,emperor ,william's ailment1 ,dr4 ,swell1 the eminent authority on diseases of the throat1 said----0 ,is ,dr4 ,swell coming on8 ,not at all4 ,he has arrived--landed on both feet as it were4 ,he is ,there and ,it4 ,from then on it is only a matter of taking advantage of his opportunities4 ,he may remove to a larger city where the services of a shrewd press agent will be necessary to secure the desired publicity1 or he may stay in the smaller place where he has gotten a good start1 and keep up the good work by a judicious distribution of coin among the newspaper boys4 ,not as a bribe1 dear me no4 ,that would be too raw4 ,it would give the doctor dead away1 and kill the game4 ,there are physicians in every large city who seem to be vital to the existence of the prominent newspapers4 8,see ,dr4 ,blank10 is the order that goes forth from the city editors on every possible occasion1 important or unimportant4 ,let the government chemist declare that ice cream is impure and deleterious to health1 and a hundred ,dr4 ,blanks in as many different cities will be interviewed at length and their views1 often worthless1 spread before the public adorned with glaring headlines4 ,let the ,ahkoond of ,swat sneeze and at once we are regaled with the views of the favored doctors as to the evils of hay fever and the best means of counteracting them4 ,it is a poor schemer of a physician who can not in some manner1 through lodge1 society1 or other connections1 make the acquaintance of at least one city editor and1 without obtrusion1 make himself so valuable to the scribe that he becomes1 as it were1 an unsalaried member of the staff1 ready at all times to help his dear friend the city editor out whenever the latter wants anything in the line of medical information4 ,blame these doctors8 ,not at all4 ,on the other hand ,i feel like patting them on the back and saying3 8,go it1 boys4 ,i admire your fine work4 ,you've got ,bunko ,bill beaten to a frazzle40 ,there is one doctor now famous because he is quoted almost daily in the newspapers1 who ten years ago was in hard luck financially4 ,one day he was introduced1 or rather introduced himself1 to a city editor by calling at the latter's office on an apparently innocuous errand4 ,it happened just at the time 7accidentally1 of course7 when public interest was aroused over the prevalence of infantile paralysis4 ,after the doctor had concluded the business on which he called1 the editor1 finding him an intelligent1 well-informed man1 asked his opinion on the medical sensation of the day4 ,this was the doctor's opportunity1 and he took full advantage of it4 8,that is an important matter10 he replied1 8and no professional man should discuss it hurriedly or carelessly4 ,i have some pressing calls to make 7this was a whopper7 and haven't the time to spare just now1 but ,i'll be delighted to give you my views within a few hours40 ,this was acceptable1 so the doctor went to a friend's library1 read up on the subject as thoroughly as he could in such a short time1 and a few hours later was back in the editorial sanctum4 ,here he talked so well that the editor said3 8,by ,jove1 doctor4 ,that's the kind of stuff ,i want4 ,can't you write it out for me8 ,i'm afraid to trust a reporter1 as there would be a risk of getting it muddled4 ,i'll give you a good stenographer to dictate to40 ,barkis1 which in this case was the doctor1 was willing4 ,he dictated the matter1 and the next morning was paraded on the first page in big type as 8the eminent ,dr4 ----0 ,his fortune dated from that day4 ,patients came in by the score4 ,his newspaper friend had occasion to call on him frequently for information on current medical topics1 and he was in print so much that his name was on everybody's tongue4 ,that was fame1 and a kind of fame that brought wealth4 ,this particular medic had the gift of a real bunko artist4 ,he knew how to keep the good thing moving1 and to 8con0 the city editor who thought he was above being caught4 8,really1 my dear ,mr4 ----10 the doctor would say when asked by phone for a statement1 8really ,i'm too busy to do the subject justice1 but ,i can't refuse you4 ,send a stenographer over and ,i'll dictate something4 ,by the way1 the ,world and the ,express both wanted something but ,i had to turn them down40 ,did the city editor appreciate this favoritism8 ,he certainly did1 and saw to it that the doctor got all there was coming in the way of double leads1 scare heads1 and top of column positions4 ---------------------------------------- -------------------------------- ,,chapter ,v ,,getting ,,country ,,patients ,while the kind of publicity outlined in the preceding chapter is valuable and will make a man famous in his own city1 it takes a long time to reach the people in outside territory4 ,it is a peculiar fact that in medicine1 as well as in other things1 8distance lends enchantment40 ,the person afflicted with a chronic ailment who lives in the same town with a physician who has become famous for his successes in that line1 is more apt to postpone his call for relief than one who lives at a distance4 ,the local patient argues to himself3 8,there's no immediate hurry4 ,i've been afflicted in this way ten years and ,i'm too busy just now to take the time to see the doctor4 ,he's right here in town1 and ,i can reach him at any time4 ,i'll drop in on him some day when ,i've got more leisure40 ,a certain proportion of the physician's town folk respond to the publicity bait1 but he must have the fat fish from outside if he is really going to get large fees in great number4 ,how is he going to reach them8 ,here is the plan successfully worked by one doctor who has made himself wealthy4 ,he made arrangements with an advertising agency to secure the insertion of 8pure reading matter0 ads in a number of country newspapers in towns within #ejj miles of ,chicago4 ,his press agent then prepared an article reading about as follows3 ,,locomotor ,,ataxia ,,cured6 -------------------------------- ,remarkable ,results ,obtained by a ,chicago ,physician --- ,prominent ,man ,afflicted ,with ,this ,terrible ,ailment ,for ,many ,years1 ,restored to ,sound ,health ,after a ,short ,treatment4 ,,new ,,york1 ,june #aj4--;,among the passengers on the outgoing steamer ,cedric which sailed to-day for ,liverpool1 was ,col4 ,h4 ,b4 ,thomas1 of ,london1 who is returning to his home after being successfully treated for locomotor ataxia4 ,he walks freely1 and is apparently in the best of health4 ,when asked if it was a fact that he had been cured of locomotor ataxia1 an ailment which most physicians pronounce incurable1 ,col4 ,thomas said3 8,it certainly looks like it4 ,this is the first time ,i have been able to walk freely1 or have been without pain in ten years4 ,i was on crutches and suffering the torments of the damned when ,i came to this country to take the treatment four months ago4 ,you can see for yourself the condition ,i am in now40 8,where did you take treatment80 8,with ,dr4 ,g4 ,h4 ,wilkinson in ,chicago4 ,when ,i first got there he had to visit me at my hotel1 but after the first two weeks of treatment ,i was able to walk to his office at ---- ,michigan ,ave4 ,improvement was reasonably rapid1 remarkably so1 considering the obstinate nature of the ailment4 ,now ,i can walk as well as anybody1 the pains have left me1 and all my bodily functions are normal40 ,newspapers in the smaller towns and cities are not so particular in the definition of the term 8pure news reading matter0 as their larger and more prosperous contemporaries4 ,they need the money4 ,consequently all the publishers who received an order from the ---- ,advertising ,agency printed the article4 ,country people as a rule are closer readers than those in the larger cities1 and within a week everybody in the territory thus reached who was afflicted with locomotor ataxia was talking about the wonderful case of ,col4 ,thomas1 and writing to ,dr4 ,wilkinson 7this is not his real name7 about their own cases4 ,here again the services of the doctor's secretary1 who was correspondent as well as press agent1 were called into play4 ,every letter was answered in a kindly1 sympathetic manner1 somewhat as follows1 the stationery used being very plain and neat1 but of the best obtainable material1 and modestly engraved3 ,g4 ,h4 ,,wilkinson1 ,m4,d4 ,,specialist ,,in ,,chronic ,,diseases ---- ,michigan ,avenue ,,chicago1 ,august #b1 #aiaj4 ,mr4 ,john ,smith1 ,godfrey's ,corners1 ,ia4 ,,dear ,,sir3 ,replying to your letter of ,july #cast1 ,i regret being compelled to say that1 in the absence of opportunity for a complete personal examination1 it would be impossible for me to say definitely what may or may not be done for you in the way of obtaining relief4 ,if you can arrange to come to ,chicago for a few days ,i will give your case my earnest personal attention and will then be in position to advise with you more satisfactorily4 ,judging from the description of your symptoms the case is plainly one of locomotor ataxia but the ailment1 as you are doubtless aware1 is of such an insidious nature that1 aside from the more prominent general and unmistakable indications1 there are few cases which manifest themselves exactly alike4 ,it is as a rule more satisfactory to both patient and physician1 and more productive of good results1 when the treatment can be arranged under the physician's personal supervision to meet the requirements of the individual4 ,this may possibly require a week1 at the end of which time you may return to your home and continue the treatment there under the direction of your family physician4 ,as regards guaranteeing a cure ,i must say frankly that this is something no reputable physician will do4 ,it is a practice resorted to only by what are known in the profession as quacks4 ,the most encouragement ,i can give you1 in the absence of a personal examination1 is that1 judging from your description the case is no worse than scores of others in which entirely satisfactory results have been obtained4 ,should you decide to visit me please advise me by letter or wire a short time in advance so arrangements may be made to give you prompt attention on arrival4 ,yours respectfully1 -------- ,the effect of such a letter on the recipient is to beget confidence in the writer4 ,it is frank and straightforward2 it sounds honest1 especially in those parts which refer to the necessity of a personal examination1 and the declination to guarantee a cure4 8,that's a real man1 not a bit stuck up10 is the comment frequently made on receipt of one of these letters by people who had hesitated to write to such a famous specialist4 ,few country people will take up treatment with a strange physician without first consulting their family doctor4 ,they are not always governed by what he says1 but they almost invariably ask his advice4 ,if he suggests a trial you are pretty sure to get the patient4 ,if he advises negatively the patient is not always lost1 but it will require more correspondence1 and when the subject does arrive he will be suspicious and hard to handle4 ,when the family doctor reads a letter like the one quoted he feels flattered that an eminent specialist should be willing to entrust the administration of his treatment to his care4 ,he looks upon the proposition differently from what he would if this sentence had been omitted4 ,his vanity has been touched4 ,inclined at first to throw cold water on the proposition1 when he comes to this part he generally says3 8,well1 of course ,i don't know anything about this treatment1 but ,dr4 ,wilkinson is a man of great reputation4 ,his success in the ,thomas case is remarkable4 ,one thing is certain4 ,we have exhausted every resource here without getting results1 and it can't do any harm to see him and get his opinion40 ,thus encouraged the sufferer1 if able to travel1 will in nine cases out of ten1 arrange to visit the specialist at the latter's office4 ,sometimes the family doctor1 from honest desire to become acquainted with the details of a new and successful treatment1 will volunteer to accompany him4 ,but1 suppose the local physician vetoes the proposition1 denounces it as a fraud1 and declines to be associated with it4 ,is the patient's business lost8 ,not at all4 ,it merely calls for a little more diplomacy4 ,after waiting a reasonable time1 say a couple of weeks1 without hearing from ,mr4 ,smith1 the latter gets another letter from ,dr4 ,wilkinson4 ,this time the specialist writes as follows3 ,g4 ,h4 ,,wilkinson1 ,m4,d4 ,,specialist ,,in ,,chronic ,,diseases ---- ,michigan ,avenue ,,chicago1 ,august #ae1 #aiaj4 ,mr4 ,john ,smith1 ,godfrey's ,corners1 ,ia4 ,,dear ,,sir3 ,not having heard from you in response to my letter of ,august #b;d1 ,i am reluctantly forced to the conclusion that conditions are such as to make your coming to ,chicago impossible4 ,this is a matter of sincere regret to me as the case appears to be one of peculiar interest and1 as a physician1 ,i would like to have opportunity of advising myself more fully as to the exact conditions4 ,if you will send me the name and address of your family physician ,i will write him asking for the necessary information1 and between us we may be able to do something for you at your home4 ,while your letter is unusually full and complete1 with the facts stated in an intelligent manner not customary with laymen1 you will readily understand that there are some complications in nearly every case which are more readily described by a physician1 and especially one who has been watching it faithfully for a long time4 ,hoping to hear from you promptly1 ,i am1 ,very truly yours1 -------- ,when ,mr4 ,smith receives this letter about the first thing he does is to show it to his family doctor and1 no matter how much the latter was opposed to the 8new-fangled0 treatment at first1 his chest swells with pride at the flattering reference to his ability4 ,he says3 8,yes1 ,mr4 ,smith1 you may send my name and address to ,dr4 ,wilkinson and when ,i hear from him ,i will write him fully about your case4 ,he is right in saying that only a professional man can give the required information properly40 ,and off marches ,mr4 ,family ,physician1 head erect1 and with the pompous air of a drum major4 ,is he not about to be consulted by the famous ,dr4 ,wilkinson1 a man known throughout the land for his wonderful successes8 ,when the specialist receives the local doctor's name and address from ,mr4 ,smith1 he writes the doctor somewhat after this style3 ,g4 ,h4 ,,wilkinson1 ,m4,d4 ,,specialist ,,in ,,chronic ,,diseases ---- ,michigan ,avenue ,,chicago1 ,august #ba1 #aiaj4 ,thomas ,h4 ,jennings1 ,m4,d41 ,godfrey's ,corners1 ,ia4 ,,dear ,,doctor3 ,i have lately been consulted by mail by ,mr4 ,john ,smith1 of your city1 who is1 ,i understand1 a patient of yours suffering from tabes dorsalis4 ,the case appears to be one of unusual interest and ,i will be under obligation to you professionally if you will make me acquainted with the details4 ,as you have been in charge of the case a long time it would be presumptuous on my part to attempt to outline the facts ,i want4 ,you will know what to write about a great deal better than ,i would1 and ,i will leave the matter entirely in your hands4 ,my only interest in the matter now is a professional one as ,i understand ,mr4 ,smith is unable to come to ,chicago4 ,trusting that you will accommodate me1 and hoping that ,i may be able to return the favor in kind1 ,i am1 ,yours fraternally1 -------- ,this does settle ,mr4 ,family ,physician for sure4 ,for years afterward he takes delight in letting it be known how he was 8called into consultation by the eminent ,dr4 ,wilkinson1 of ,chicago1 who said frankly that ,i knew more about the case than he did40 ,to the credit of ,mr4 ,family ,physician be it said that this latter statement was probably correct1 and it might with all truth have been extended to include the assertion that he was doing as much or more for the patient as ,dr4 ,wilkinson could4 ,at any rate ,dr4 ,wilkinson receives the information he asks for1 and beyond returning a brief note of thanks to the local doctor and saying that he will give the matter thorough attention as soon as he gets a little respite from his rush of duties1 that is the end of it for the time being4 ,but ,dr4 ,wilkinson is not idle4 ,he is conducting1 or rather his secretary is1 a similar correspondence with scores of other physicians and prospective patients4 ,from the letters thus received a card system is arranged1 all the 8prospects0 being grouped by localities4 ,one day ,dr4 ,wilkinson finds that he has some fifty good 8prospects0 in the immediate vicinity of some good town1 and decides to make a round up4 ,he then writes1 either to the prospective patients in that neighborhood1 or the physicians1 if his correspondence with the latter has been encouraging1 a letter somewhat as follows3 ,g4 ,h4 ,,wilkinson1 ,m4,d4 ,,specialist ,,in ,,chronic ,,diseases ---- ,michigan ,avenue ,thomas ,h4 ,jennings1 ,m4,d41 ,godfrey's ,corners1 ,ia4 ,,dear ,,doctor ,,jennings3 ,since the receipt of your letter relative to the case of ,mr4 ,smith ,i have been called to ---- for consultation in a serious case4 ,i will be at the ---- hotel on ,thursday next but will be very busy1 and do not think it safe to make any engagements1 aside from the consultation1 for that day4 ,if you can arrange to meet me on ,friday 7the following day7 between #aj and #aa a4m41 ,i will remain over4 ,i suggest this as it will afford us an opportunity of discussing ,mr4 ,smith's case to better advantage than it is possible to do by mail4 ,there will1 of course1 be no fee attached to this service on my part4 ,kindly let me know at once whether ,i may expect to have the pleasure of meeting you so that ,i may arrange my time accordingly4 ,yours fraternally1 -------- ,dr4 ,jennings is impressed by the compliment thus paid him by the eminent specialist4 ,so are the dozen or more other physicians to whom ,dr4 ,wilkinson writes1 most of them hastening to make engagements to meet the specialist at varying hours4 ,if the correspondence has been entirely with the prospective patient1 and no family physician has been enlisted as an intermediary1 the 8come on0 letter is made to read differently4 ,in cases of this kind the doctor would say3 ,g4 ,h4 ,,wilkinson1 ,m4,d4 ,,specialist ,,in ,,chronic ,,diseases ---- ,michigan ,avenue ,mr4 ,thomas ,ratcliffe1 ,eagle ,mills1 ,ia4 ,,dear ,,sir3 ,since writing you last ,i have been called to ---- for consultation in a serious case and will be at the ---- hotel on ,thursday next4 ,as ,i can arrange to have a little leisure ,i would suggest that you meet me there at #aa a4m4 so that ,i may be able to make a satisfactory diagnosis of your case1 and thus be in position to advise you intelligently as to the prospects for obtaining relief4 ,i feel free to make this suggestion as there will be no fee or charge of any kind for this service all my expenses being guaranteed by the parties with whom ,i am to consult4 ,kindly let me hear from you at once as ,i have many demands upon my time and wish to arrange my schedule to the best advantage4 ,yours very truly1 -------- ,the fact that he has not been invited to visit ----1 or any other town for consultation purposes does not bother ,dr4 ,wilkinson4 ,it is one of those 8harmless prevarications0 tolerated and even encouraged1 in all professions4 ,it would not be dignified nor ethical for a doctor to start out on the road on a hunt for patients4 ,it is not improper1 once having been 8called0 to another city1 to take advantage of the trip to do a little professional business on the side4 ,dr4 ,wilkinson must have an excuse for visiting ----4 ,the most plausible excuse is that he has been invited there in consultation by some brother physician whose name is withheld4 ,before the time comes for starting for ---- ,dr4 ,wilkinson has received replies to his letters4 ,most of these are favorable1 and the doctor is enabled to make out a time card that will keep him profitably engaged while in ----4 ,this card should read3 ,thursday1 ,sept4 #bb1 #aiaj4 #aj a4m4--,dr4 ,jennings about ,john ,smith4 #aa a4m4--,thomas ,ratcliffe4 #ab m4--,dr4 ,thompson1 ,cross case4 #a p4m4--,mary ,brown4 #b p4m4--,charles ,harris4 #c p4m4--,dr4 ,williams1 ,green case4 #d p4m4--,harry ,bronson4 ,before leaving ,chicago the doctor will have his secretary get out the correspondence with each of the 8prospects0 and this1 each lot enclosed in its own filing packet1 will be put in his suit case or hand valise4 ,arriving at ---- ,dr4 ,wilkinson will arrange with the hotel clerk to notify him when anybody calls4 ,at #aj a4m4 ,dr4 ,jennings will be announced4 8,tell him10 ,dr4 ,wilkinson will say to the bell boy1 8that ,i am very busy just now and must ask him to excuse me for ten minutes4 ,i will be able to see him promptly then40 ,this gives the doctor time to get out the ,jennings correspondence and refresh his mind as to the particulars of the ,smith case4 ,then he sends word to have ,dr4 ,jennings shown up4 8,sorry to have been compelled to keep you waiting1 doctor10 and a warm cordial handshake1 greets the country physician who is at once impressed with the fine appearance and friendly manner of his visiting brother4 ,there is a little preliminary talk about the trip1 the country1 the weather1 etc41 and then the ,smith case is taken up and thoroughly discussed4 8,if ,i had time10 says the specialist1 8,i'd like to see ,smith1 but that's out of the question4 ,your very clear and able description of the case has impressed me strongly4 ,one of these days when ,i happen to be out here again with more time on my hands1 and the patient is still living1 ,i'll ask you to take me out to see him4 ,i understand it's only a short distance from here40 8,just thirty minutes' ride on the ,lincoln branch1 doctor10 replies ,jennings4 8,why can't you run out with me this afternoon8 ,no time like the present1 you know40 8,the trouble is that ,i will be busy until #d p4m41 and then it will be too late40 8,not at all4 ,there's a train at #d3cj and we can be at ,smith's home by #e4 ,better go4 ,barring his ailment you'll find ,smith a good host4 ,he's rich and has a fine home1 and the best of everything4 ,i know he'll be glad to pay liberally for your opinion whether it is favorable or unfavorable40 8,well1 doctor1 if you think there is no doubt of my being able to get back so as to take the #aj3cj train for ,chicago ,i guess ,i'll have to go with you4 ,really ,i should not do it as ,i have a hard day's work ahead of me1 but you have aroused my interest in the case and ,i would like to see the patient4 ,i'll meet you at the depot at train time4 ,until then good bye4 ,i can't begin to tell you how much ,i appreciate your call4 ,if conditions were different ,i would insist on your being my guest for the day1 but1 as you well know we medical men are not our own masters40 ,without appearing to hurry he gets rid of ,dr4 ,jennings before it is time to receive the next caller and1 by exercising a little tact1 the various people with whom he has made engagements are kept from meeting one another4 ,out of the four appointments he has made with laymen the doctor will ordinarily obtain fees from at least two1 if not all four of his callers4 ,just how he does it will be explained in another chapter4 ,at #d3ae ,dr4 ,wilkinson is at the depot where he finds ,dr4 ,jennings waiting4 ,on the train1 the specialist delicately brings up the matter of fees4 8,one great trouble with a treatment of this kind is the expense4 ,the fees must necessarily be large and it is difficult to get even wealthy men to pay them4 ,it is a relief to be able to discuss this part of the subject candidly with a brother physician like yourself who has the brain and common sense to appreciate it40 ,once again ,dr4 ,jennings is pleased at the confidence reposed in him1 and the more so when ,dr4 ,wilkinson continues3 8,of course in a case like this where the local physician interests himself1 takes his time to visit a patient with the specialist1 gives the latter the benefit of his knowledge of the case1 and continues the treatment after the specialist has gone1 there should be a division of the fee4 ,the local physician cannot be expected to donate his services2 that would be ridiculously unfair40 ,the country doctor is more interested than ever4 ,should he be super-sensitive about acceptance of a fee1 and inclined to question the ethics of the arrangement he is quieted with the assurance that it is in common practice all over the country4 ,in most cases1 however1 there is no tendency of this kind4 ,the local practitioner is ready1 and anxious to get his share of the money4 ,his main concern is about the amount4 ,frequently he asks3 8,what do you think we can get doctor80 8,that depends upon the man4 ,you know him better than ,i do4 ,you say he is wealthy1 so his ability to pay is not to be questioned4 ,we'll fix upon an amount that will be equitable under the circumstances4 ,it should not be less than #ejj40 ,the prospect of obtaining #bej so easily is very alluring to ,dr4 ,jennings4 ,he does not realize that the specialist is using him as a bait1 making him stand sponsor as it were1 for the merit and efficiency of the treatment4 ,arrived at ,smith's home ,dr4 ,jennings is warm in his endorsement of everything ,dr4 ,wilkinson says and does4 ,the latter examines the patient carefully1 asks him numerous questions1 frequently referring to ,dr4 ,jennings for information upon technical points1 and showing deference for the opinions of the family physician4 ,finally the stage is reached where it is necessary to talk business4 8,if you should decide to take this treatment1 ,mr4 ,smith1 ,i will arrange with ,dr4 ,jennings for its administration4 ,it should be given twice a day4 ,i will furnish all the remedies and1 advised by frequent letters from ,dr4 ,jennings as to your progress1 will outline such changes from time to time as may appear necessary40 ,this naturally leads ,mr4 ,smith up to asking1 8,do you think you can cure me1 doctor80 8,well1 ,mr4 ,smith1 as ,dr4 ,jennings will tell you no reputable physician countenances the word #8cure4' ,i will say1 however1 that ,i have had many cases1 some of them apparently even worse than yours1 in which entirely satisfactory results have been obtained4 ,here are a couple of letters just received which ,i am requested by the writers to show4 ,they will probably interest you40 ,saying this the specialist brings out a couple of letters written by patients who have been benefited4 ,they are bona fide letters4 ,it would be strange if out of the large number of people treated some cases did not yield satisfactory results4 ,the letters read about as follows3 ,,pittsburgh1 ----1 #aiaj4 ,,dear ,,doctor ,,wilkinson3 ,replying to your enquiry of recent date regarding my condition ,i am most happy to be able to say that marked improvement continues4 ,the pains have entirely disappeared1 all the functions of the body are normal1 and ,i walk long distances every day without cane or crutch4 ,this result obtained in a little less than ten months of treatment is most pleasing considering that ,i was sorely afflicted for over ten years1 and that my case was pronounced incurable by the best specialists both here and abroad4 ,dr4 ,kennedy1 my family physician1 says the change in my condition is miraculous4 ,don't hesitate to show this letter to those who may be similarly afflicted4 ,it is a duty which ,i feel that ,i owe humanity to make known what has been done for me4 ,you will probably also hear from ,dr4 ,kennedy within a few days4 ,with sincere thanks1 ,i am1 ,most gratefully yours1 -------- ,drowning men clutch at straws4 ,mr4 ,smith knows that he is afflicted with an ailment which other physicians have been unable to relieve4 ,here appears to be something effective4 ,hope dawns1 and he enquires3 8,what will it cost1 doctor80 8,that1 my dear sir1 is a question ,i was in hopes you would not ask4 ,worry over the expense of treatment always tends to retard or delay complete recovery4 ,what is money compared with health4 ,why should you set one against another8 ,can you measure the monetary value of health as you would that of a ton of coal1 or a ton of hay80 ,mr4 ,smith begins to feel ashamed of himself1 and all the more so when his family physician chimes in and endorses what the visiting specialist has said3 8,i guess that's all right1 doctor10 responds ,smith4 8,you can't measure health against money1 but ,i must have some idea as to the expenses4 ,it may be beyond my means40 8,we'll fix that all right10 says ,dr4 ,wilkinson4 8,the usual fee for complete treatment is #aej a month40 8,how long will it take80 8,that's something no man can tell4 ,i've had cases in which the desired results were obtained in so short a time as four months1 and others in which they were deferred for fifteen months4 ,if there is such a thing as striking an average ,i should name it at ten months40 8,that would be #a1ejj4 ,that's an awful lot of money40 8,it's nothing in comparison with good health4 ,i have had many patients who preferred to pay a lump fee in advance in order to get the worry about money details off their minds4 ,under this arrangement the treatment is continued as long as may be necessary whether it is four months or fourteen4 ,in such cases ,i accept #a1jjj4 ,this not only pays for the entire course of treatment but it saves the patient #ejj should the course be continued for ten months1 which is not at all unlikely40 ,the saving of #ejj appeals to ,mr4 ,smith1 and he accepts the proposition4 ,while he is signing the check ,dr4 ,jennings has to pinch himself to see if he is really awake4 ,the idea of getting #ejj for his share of an hour's talk is overpowering4 ,the check delivered1 ,mr4 ,smith is assured that the remedies will be in ,dr4 ,jennings' possession within the week and that treatment will start at once4 ,once outside ,dr4 ,jennings is impelled to ask3 8,how did you come to fix the fee at #a1jjj1 doctor8 ,i thought you said it would be #ejj80 8,i said not less than #ejj4 ,but ,i found ,mr4 ,smith more responsive in this connection than most men1 and it was just as easy to get #a1jjj as it would have been #ejj4 ,by the way1 how are we going to divide this check80 ,there is nothing to do but for ,dr4 ,wilkinson to remain in town over night and for ,dr4 ,jennings to identify him at the bank the next day4 ,this is done1 and the money drawn and divided4 ,who gets the best of the bargain8 ,apparently both doctors are on the same footing1 but are they8 ,dr4 ,wilkinson has #ejj4 ,for this he will send once a month for a few months a supply of treatment the actual cost of which will not exceed #b4ej a month--perhaps #be for ten months4 ,dr4 ,jennings1 on the other hand1 must visit the patient every day1 administer the treatment1 keep track of his condition1 note such changes as may occur1 and report them to ,dr4 ,wilkinson4 ,dr4 ,jennings must perform his duty in person1 he cannot delegate it to another4 ,dr4 ,wilkinson does most of his work1 except the actual case taking1 through hired help4 ,he has a dozen1 or a hundred1 ,dr4 ,jennings working for him all the time4 ,many specialists are averse to working in connection with family physicians4 ,in some instances this is because of short-sightedness on the part of the specialist4 ,he doesn't like the idea of dividing his fee with the country practitioner4 ,in other words he is greedy and wants it all1 losing sight of the fact that in the great majority of instances the family physician is the deciding arbiter and1 without his aid1 a lot of cases would be lost4 ,then there are specialists who have not the knack of making friends with the country doctor4 ,the latter is naturally opposed to the specialist2 he thinks1 whether justly or not1 that his own method is best and looks askance on 8new-fangled0 ideas in practice1 especially when a good fee is liable to go to the stranger4 ,but1 let this same country physician be led up in the proper manner to the division of fee proposition and he takes a different view of the situation4 ,it seems like a lot of money to give away1 but it is a good investment4 ,the man who accepts the division stands committed to the treatment2 he becomes a booster instead of a knocker4 ,if the case does not turn out well there is little chance to find fault with the specialist4 ,the local ,dr4 ,jennings has been in charge and upon his shoulders rests the responsibility4 ,should the patient complain the local physician can1 and very likely will say3 8,of course it is a disappointment ,mr4 ,smith1 but the practice of medicine is full of disappointments4 ,there is one consolation4 ,you have had the benefit of the latest treatment evolved by medical science4 ,dr4 ,wilkinson arranged the treatment to meet your special needs after ,i had given him a complete history of your case1 and you must admit that ,i have been faithful in its administration4 ,i'm sorry that the results were not different1 but that is something every physician has to contend with40 ,left without the services of the local physician as an ally the specialist would probably be blamed for the failure1 and the patient might even refer to him as a swindler4 ,such things have occurred with the result that the specialist's chance of getting any more patients in that neighborhood was wiped out4 ,but1 by retaining the services of the family physician the specialist is taking out insurance against this very happening4 ,dr4 ,jennings1 of course1 does not realize that he is being made a buffer of4 ,he has had1 as he thinks1 the scientific features of the treatment carefully explained to him1 and the theory is reasonable and in thorough accord with that of accepted authorities4 ,as for the division of fee--why he certainly is entitled to pay for his services in treating ,mr4 ,smith1 and it is much better for the latter to have ,dr4 ,wilkinson stand this expense than for it to fall upon ,mr4 ,smith4 ,it's all in the viewpoint1 and the viewpoint can be just what the specialist makes it4 ,if he is a clever man it will be favorable2 if he lacks tact and is antagonistic in nature1 it will be unfavorable4 ,as to this latter contingency it may well be said that a tactless1 antagonistic man has no business operating in this field4 ,tact and suavity and an impressive appearance count far more than a knowledge of medicine1 and will get more money every time4 ,it's worth considerable to have the good will of family physicians in the country districts1 so that when occasion arises they will say3 8,dr4 ,wilkinson is an able man1 and perfectly square in his business methods4 ,we 7observe the 8we07 didn't get the desired results in the ,smith case1 but it must be remembered that it was an unusually serious one1 and ,dr4 ,wilkinson said so at the time4 ,recovery would have been little short of a miracle4 ,had the treatment been taken before the disease was so far advanced there is every reason to believe the results would have been different40 ---------------------------------------- -------------------------------- ,,chapter ,,vi ,,reception ,,of ,,office ,,patients ,to the physician who prefers to do a strictly office practice1 making few or no professional forays into the country1 well located1 neatly furnished1 attractive quarters are a necessity4 ,three rooms will be sufficient for a start4 ,these should include a reception room1 waiting parlor1 and doctor's private office4 ,size is not so important as location and furnishings4 ,the quarters should be in a modern building of high-class reputation as to the character of its tenants4 ,if the arrangement is such as to give an entrance into the doctor's room from the waiting parlor1 and an exit into another hall1 it is preferable4 ,this will make possible the separation of the callers the doctor has seen from those who are still waiting1 and this prevents a lot of talk which may have a harmful tendency4 ,people1 especially men1 waiting to see a physician are apt to get into conversation with one another4 ,when there is only one door serving as entrance and exit to the private office1 and a caller1 after seeing the physician1 has to come back into the waiting parlor in order to get out there is a temptation to stop for a few moments and chat with those who are still waiting4 ,in this way much harm1 particularly in the matter of fees1 may be done4 ,it is poor policy to give people a chance to exchange confidences4 ,they will tell each other their opinion of the physician1 the amount of the fees1 etc4 ,if these latter do not agree in amount it causes jealousies and distrust1 and it becomes difficult in many cases for the physician to explain to the satisfaction of ,mr4 ,brown why he should be charged a larger fee than ,mr4 ,jones4 ,under the best of conditions there will be too much of this sort of thing1 but it may be greatly reduced by an arrangement of the rooms which will admit of callers being taken into the doctor's office at one door and shown out at another4 ,in one instance the waiting room of a certain specialist was crowded when one of the callers came out from the office after an interview4 8,are you going to take the treatment10 was the question put to him by one of those with whom he had been talking before he had seen the doctor4 8,not much10 was the answer in a loud tone4 8,that man's a robber4 ,he wanted #ejj for the treatment40 ,this frightened away a number of men nearly all of whom would have been good for #ajj apiece when interviewed by the doctor under proper conditions4 ,but they left without seeing him2 actually scared off by the talk of the dissatisfied caller4 ,rooms arranged as described and located in a good building will command more rental than ordinary quarters1 but the investment will be a good one4 ,there will be more money in paying #ajj or #aej a month for rooms of this kind than #ej for others not similarly arranged4 ,proper furnishings create a favorable impression upon callers4 ,neat rugs1 comfortable leather covered chairs and lounges1 neat tables for books and magazines1 handsome curtains and bright1 cheerful pictures on the wall tend to make the extraction of a good-sized fee all the easier4 ,no person feels like paying a big fee to a doctor of sloppy appearance who is quartered in a shabby1 poorly furnished room4 ,shabby surroundings breed distrust4 ,an appearance of prosperous solidity on the other hand creates confidence4 ,it is easier to get #ajj from a patient in properly furnished quarters than it is to get #e when the doctor's poverty stares out from every side4 ,one of the most successful specialists in the profession had retired with a competence4 ,he got to speculating and lost heavily4 ,when he had only #a1jjj left he was compelled to resume practice4 ,he rented quarters which cost him #abe a month1 and furnished them magnificently at a cost of #a1bej1 paying #ejj down4 ,various other outlays cut his cash capital down to #ajj by the time he was ready to open his offices4 ,did he flinch8 ,not at all4 ,he was game and knew that with any ordinary luck it would be a paying investment4 ,he made a second fortune which he was wise enough to keep4 8,it was like catching flies with a bait of sugar10 he said in discussing his method4 8,they swarmed in from all sides2 the surroundings looked right1 and ,i had little trouble in landing a fair percentage of the callers4 ,if ,i had attempted to skimp in the rent or furnishings my purpose would have been defeated from the start40 ,in taking medical treatment1 as in nearly everything else1 people like to deal with the successful man1 and they judge of a man's success by his surroundings4 ,if he looks prosperous the battle is half won before the attack on the caller's pocketbook begins4 ,next to the location and furnishings of the office1 and the neat1 well-dressed appearance of the physician himself1 comes the question of the selection of the proper reception room girl4 ,here almost as much tact is needed as in the physician's private office4 ,the right kind of girls are scarce1 and when one is found she is worth much more money than the average doctor1 unacquainted with the importance of the position1 is willing to pay4 ,a thoroughly competent girl is easily worth from #ah to #be a week1 yet most doctors grumble at paying #aj or #ab4 ,it is a peculiar combination of talent1 one exceedingly hard to find1 that is required4 ,the successful attendant must be prepossessing in appearance1 a neat dresser1 intelligent1 sympathetic1 chummy to a degree without being 8fresh10 and1 above all1 must have that undefinable quality known as tact4 ,she must have the knack of making people feel at home and comfortable on their first and all subsequent visits1 without being fussy or over-prominent in her attentions4 ,quiet dignity and charm of manner in a reception room girl is a combination of great value to an employer4 ,the girl possessed of these qualities1 in addition to 8tact10 can be a valuable and powerful ally of the physician4 ,she will exert a great influence in keeping patients good natured and satisfied1 steer the malcontents away from opportunity to make trouble1 and preserve in general the harmony that should prevail in the professional family4 ,we all know what a strong factor first impression is4 ,the manner of our reception by a stranger invariably sows the seed of our opinion4 ,if the reception is courteous and kindly without being effusive we are won2 if it is cold and indifferent1 or so overly effusive that deceit is apparent1 we are repelled4 ,right here is where the reception room attendant wins or loses4 ,it makes all the difference in the world whether the prospective patient meets the doctor for the first time pleased with the manner in which he was received1 or whether he is fretted or annoyed at his treatment in the outer office4 ,the door leading from the reception room into the waiting parlor should always be kept closed4 ,there is no necessity of letting the people who are waiting to see the doctor hear what is going on in the outer room4 ,it often works harm4 ,besides this a new comer will announce himself more freely to the attendant when alone with her than he will when a dozen or more strangers are within hearing4 ,one of the furnishings of the reception1 or outer room1 unless the business warrants a separate department1 may be an unobtrusive cabinet in which the correspondence is filed4 ,this should always be closed so callers will not get an idea as to its contents4 ,men especially do not like to know that a woman is conversant with the contents of their letters to the doctor4 ,when a stranger enters the room the attendant should always rise from her desk1 meet him half way1 and enquire pleasantly3 8,what can ,i do for you80 8,i'd like to see the doctor40 8,step into the waiting room1 please1 and ,i'll let him know you are here4 ,whom shall ,i announce80 8,thomas ,carroll1 of ,providence1 ,iowa4 ,i think he expects me as ,i've had some correspondence with him40 8,all right1 ,mr4 ,carroll1 ,i will let him know you are here40 ,taking the new comer into the waiting room the attendant should give him a paper or periodical4 ,the man who is reading is not so apt to get into conversation with strangers as the one who is idle4 ,coming back into the outer office the girl closes the door1 goes at once to the correspondence cabinet and takes out the packet containing ,mr4 ,carroll's correspondence4 ,this she gives to the doctor via the outside door1 at the same time announcing ,mr4 ,carroll's arrival4 ,no doctor who is wise will receive a caller immediately upon arrival4 ,it creates a good impression to keep the caller waiting for a few moments even if there is nobody ahead of him4 ,the girl goes back to the waiting room and says3 8,the doctor is glad to know you are here1 ,mr4 ,carroll4 ,he is engaged with a patient just now1 but he will be through very soon1 and will see you in a few minutes40 ,this helps to kill time1 and to convince the caller that the attendant is looking after his interests4 ,in the meantime the doctor is reading ,mr4 ,carroll's letters and the answers thereto1 and refreshing his memory about the case so that when ,mr4 ,carroll is shown in the latter will be astonished by the doctor's knowledge of his ailment and condition4 ,the letters in the meantime are put away in a drawer out of sight4 ,finally the bell rings and1 if ,mr4 ,carroll is next on the list1 the girl will say3 8,the doctor will see you now1 ,mr4 ,carroll10 and shows him into the sanctum4 ,what happens when doctor and caller come together is told in another chapter4 ,this one deals solely with the manner in which the caller should be received by the girl in charge of the outer office4 ,should the caller become a patient the attendant who understands her duty will begin to evince a mild ladylike interest in his case4 ,without at any time becoming forward or fresh she will have a cheery word of greeting for him on his daily arrival or departure1 and finally begin to comment in a delicate manner on the improvement in his appearance4 8,good morning1 ,mr4 ,carroll4 ,you're looking better this morning4 ,by the way1 if you want to write any letters you can dictate them to our stenographer1 and you might as well have your mail sent here4 ,i'll be glad to look after it for you40 ,such attentions mean much to an invalid stranger and are more appreciated than they would be by a robust1 healthy person4 ,mr4 ,carroll may intimate that he thinks of going to some theater in the evening1 but doesn't know where to go4 ,then the attendant should say3 8,well1 that depends upon what you like4 ,if it's comedy there's the ---- ---- at the ,continental4 ,grand opera at the ,richelieu2 tragedy at the ,shakespeare and vaudeville at the ,boston4 ,if you want to see something really funny go to the ,continental4 ,i'll have our stenographer get your ticket when he goes out to luncheon1 and that will save you from being pushed around in the crowd at the box office40 ,all this1 of course1 is after the lapse of a week or so when ,carroll has become a daily caller for treatment1 and begins to think that the doctor is all right himself1 and that the reception room girl is just about as near right as they make them4 ,no matter how many girl stenographers the doctor may keep busy in a room further down the hall1 there should always be one young man for what may be called 8show0 purposes4 ,men patients don't like the idea of having their physical troubles discussed in letters written by girls4 ,when the young man stenographer is brought in to take dictation from a patient the latter not only appreciates the compliment1 but feels confident that his troubles are known only to one of his own sex4 ,by all means keep the girl stenographers out of sight1 and do not let the male patients know that a woman ever saw their letters1 or the doctor's replies to those letters4 ,adopt exactly the opposite tactics with women patients--keep the man stenographer under cover4 ,despite the utmost care there will be times when the patients will get together in the waiting room and discuss the doctor and his methods1 the merits or demerits of the treatment1 compare fees1 etc4 ,one dissatisfied patient--and every physician has them1 no matter how generally successful he may be--can create more disturbance and uneasiness in ten minutes than the doctor can overcome in a week4 ,it is right here that the reception room girl has a chance to prove her worth4 ,when she finds the conversation drifting into disagreeable channels she can adroitly step in and change the subject without seeming to have a purpose in doing so4 ,the introduction of a timely topic by a bright1 entertaining woman will start the flow of talk in a new direction and in the discussion that follows criticism of the doctor will be overlooked4 ,one day a chronic kicker1 one of those fellows who is never satisfied no matter how much is being done for him1 met another patient in the reception room and began to find fault with the treatment4 ,without seeming to listen to the conversation1 and with her mind apparently engrossed on some other topic1 the attendant said3 8,oh my1 how ,i wish ,i had a brother or a father to advise me40 8,why1 what's the trouble80 very naturally enquired one of the patients--and he happened to be the 8kicker40 ,the girl went to relate an entirely suppositious occurrence over which she pretended to be badly wrought up2 a business entanglement with a concern from which she had bought some goods on the installment plan1 and about which there was a serious misunderstanding4 ,both men were profuse in their tenders of advice1 and in their desire to be of assistance to the girl they forgot entirely the original topic4 ,the girl kept them engaged in conversation until the 8kicker0 departed1 and the danger was over for that day1 at least4 ,she reported the matter to the doctor and the latter very cleverly arranged the 8kicker's0 hours for treatment so there would be little chance of his finding other patients in the office4 ---------------------------------------- -------------------------------- ,,chapter ,,vii ,,the ,,correspondence ,,file ,no specialist1 or physician who conducts a general practice by publicity methods1 can hope to make a lasting success1 except in rare instances1 without a well-managed correspondence department4 ,in the beginning the physician may attend to this himself but1 as the business grows he will need the services of a smart1 competent man4 ,newspaper men do the best in this position4 ,the right kind of men command from #ej to #ajj a week1 and in many cases get a working interest in the business4 ,they are worth every cent they get4 ,the physician with a large office or out-of-town practice is too busy to give attention to the details of correspondence4 ,he has not the time during office hours1 and after his work for the day is done he is too weary to dictate the many letters that should go out every day4 ,not only this1 but there are very few medical men who know just what to say4 ,letter writing is a gift1 and the men who have this gift make a business of it4 ,every letter that comes into the office should be indexed by the card system and then filed away by number with the copy of the reply attached4 ,this work1 as well as the opening of the mail and the dictation of answers1 should be done in a room convenient to the doctor's office1 but away from it far enough so that the patients will not suspect the connection4 ,a letter arrives from ,hiram ,oxbow1 of ,valparaiso1 ,indiana4 ,the man in charge of the correspondence opens it and finds that1 according to the printed heading ,mr4 ,oxbow is conducting a cooperage plant4 ,the letter runs about as follows3 ,,hiram ,,oxbow ,,manufacturer ,,of ,,cooperage ,,valparaiso1 ,,ind41 ,august #aj1 #aiaj4 ,dr4 ,g4 ,h4 ,wilkinson1 ,chicago1 ,ill4 ,,dear ,,sir3 ,i have read of your success in the treatment of locomotor ataxia1 and would like to know whether you think you can do anything for me4 ,i am #de years of age1 and have been afflicted for the last eight years4 ,have doctored with nearly everybody in the country without results4 ,can you cure locomotor ataxia8 ,please let me hear from you soon4 ,yours respectfully1 ,,hiram ,,oxbow4 ,sorting out all the letters of this kind the correspondence chief gives them to one of his stenographers with instructions to look up the financial rating of the various writers as given in ,dun's or ,bradstreet's4 ,every well-equipped correspondence room will have a copy of a commercial guide of this kind4 ,the girl marks on the letters such ratings as are given in the guide4 ,mr4 ,oxbow1 for instance1 is quoted as ,a #d4 ,when the answers are written each new enquirer is given an individual card and number1 the numbers running consecutively4 ,the last number in the file we will say is #fcde4 ,mr4 ,oxbow's number will be #fcdf4 ,one of the girls then makes out a card which reads3 ,no4 #fcdf--;,hiram ,oxbow1 ,valparaiso1 ,ind4 ,rating ,a #d4 #aijg ,aug4 #aa4 ,first enquiry4 ,answered with ,no4 #c4 ,mr4 ,oxbow's letter with a carbon copy of the reply thereto is then placed in a manila paper pocket1 numbered #fcdf1 and filed in the letter cabinet4 ,if at any time it is desired to get the correspondence in the ,oxbow case the card1 which is filed alphabetically1 will give the correspondence number and the location of the letters themselves will then be easy4 ,an entry in brief is made on the card every time ,mr4 ,oxbow is heard from so that the card itself will show at all times an outline of the status of the case4 ,suppose that a number of letters pass1 and ,mr4 ,oxbow finally decides to come to ,chicago to see the doctor4 ,the card will then show entries like these3 ,no4 #fcdf--;,hiram ,oxbow1 ,valparaiso1 ,ind4 ,rating ,a #d4 #aijg ,aug4 #aj4 ,first enquiry4 ,answered with ,no4 #c4 ,aug4 #ae4 ,wants more particulars4 ,asked him to come to ,chicago4 ,aug4 #ba4 ,enquires about fees4 ,told him it was impossible to fix amount in advance of seeing patient4 ,aug4 #bf4 ,will be in ,chicago ,aug4 #cjth1 #i a4m4 ,every letter received from ,mr4 ,oxbow and a copy of every reply is filed in the same manila pocket so that when wanted they are all together1 and can be taken out in a minute4 ,suppose ,mr4 ,oxbow is not rated in ,dun or ,bradstreet8 ,it is the correspondence chief's business to ascertain his financial standing if it is possible to do so4 ,frequently this is done through the doctor's bank1 or the doctor may be a subscriber to some commercial agency4 ,in either event a confidential enquiry is made as to the responsibility of ,mr4 ,oxbow4 ,the answer may say3 8,good for #aj1jjj20 or 8credit good1 pays bills promptly20 or 8credit poor40 ,in the great majority of cases information of some kind will be secured which can be entered on the cards for future reference4 ,how are enquiries from prospective patients secured8 ,some of them are made voluntarily1 being induced by the enquirer having read in some city paper about the doctor's success in certain lines of practice--one of those articles which the clever press agent1 who is usually the correspondence chief1 has had inserted in the guise of news4 ,generally1 however1 enquiries are drawn out by a systematic campaign through the mails1 or by resort to publication in the country papers4 ,no wide-awake1 progressive correspondence chief will wait for voluntary enquiries4 ,he will make an arrangement with a clipping bureau by which for #e a hundred he will be supplied with clippings from all the papers1 large and small1 in his territory announcing the illness of citizens4 ,when the ,beeville ,bugle publishes the news that 8,abner ,skeets1 a prominent resident of ,beeville1 has become a victim of chronic arthritis10 the paper is not in the office of the clipping bureau over a few hours before the correspondence chief has received the paragraph4 ,in this manner he comes into possession of hundreds of similar news items every week4 ,all the various publicity articles which the city papers have published about ,dr4 ,wilkinson and his wonderful success have been reproduced by the zinc-etching process and thousands of slips printed in a manner which makes them bear the appearance of having been torn out of the original publications4 ,as fast as the clippings come in ,mr4 ,press ,agent sorts them by towns and has one of his stenographers make a card index1 giving the name and address of each prospect and the nature of his disease1 as well as the date of mailing the first clipping4 ,then he has plain envelopes addressed to each prospect1 and encloses in these envelopes one of the prepared news items applicable to the ailment with which the party addressed is afflicted4 ,there is no printed business card on these envelopes and1 as they are invariably addressed by hand1 the recipient is under the impression that the communication has been sent by some unknown friend who desires to let him know of this doctor's success in the treatment of just such cases4 ,the recipient does not connect the doctor with the sending of the clipping as he argues that1 if it came from a doctor1 the envelope would bear his business address1 and there would be some note of explanation4 ,besides1 there is not one chance in a million that ,dr4 ,wilkinson ever heard of him1 or knows where he lives1 or what the nature of his trouble is4 ,of course it was sent by some friend4 ,this method excites the curiosity of the sufferer1 and he gives careful attention to the clipping and begins to ask himself whether it is not worth while to write to this wonderful physician and ask his advice about treatment4 ,as fast as a batch of clippings is sent out the cards from which the addresses were taken are moved to the back of the receptacle1 and a date card1 a little higher than the others and of a different color so as to be readily noticeable1 is placed in front of them4 ,this date card shows when1 if no reply is received to the first communication1 it will be in order to send a second4 ,if the first communications are mailed on the #ajth of the month1 the date card behind which these cards are placed will bear date of the #cjth1 thus showing that on the #cjth of the month another clipping1 or some other form of literature should be sent4 ,whenever one of the parties thus addressed is heard from this card is given a file number and transferred to the prospective list1 the purport of the enquiry and the nature of the reply being noted on it4 ,there is never lack of material to work on4 ,people who have heard of the doctor are writing to him all the time1 and the clipping bureau is continually sending in items about people in various parts of the country who have become afflicted with serious chronic troubles4 ,every physician who practises in this manner should have a neat pamphlet descriptive of his treatment and the results obtained in various ailments4 ,it is the duty of the press agent or correspondence chief to prepare this4 ,it should be modest in language and give an outline of the pathology of certain diseases as well as the therapeutic effects of the treatment in a rational1 plausible manner4 ,exaggerated statement1 or defects in technical description will defeat its purpose4 ,the typography must be neat and in good taste1 and the paper of high quality4 ,right here it may be stated that many physicians are penny wise and pound foolish in the matter of literature and stationery4 ,the best is none too good4 ,neat1 handsome work attracts attention1 while the cheap1 slip-shod variety repels4 ,if the clipping first sent has not brought an enquiry by the tenth day1 mail one of the pamphlets4 ,the recipient will read this with interest and note particularly what has been accomplished in cases strikingly similar to his own4 ,on mailing the pamphlet the fact should be entered on the card1 with date of mailing1 and the card moved back another ten days1 ready to be taken up again on the #cjth4 ,by this system there is a constant stream of mail matter going out every day1 and each card contains a record of just what printed matter has been sent to each prospect1 and when4 ,allowing that neither the newspaper item or the pamphlet bring enquiries ,mr4 ,press ,agent will1 as his third effort1 address the sufferer by letter somewhat as follows3 ,g4 ,h4 ,,wilkinson1 ,m4,d4 ,,specialist ,,in ,,chronic ,,diseases ---- ,michigan ,avenue ,,chicago1 ,sept4 #i1 #aiaj4 ,mr4 ,john ,peters1 ,beeville1 ,wisconsin4 ,,dear ,,sir3 ,recently1 at the suggestion of a mutual friend1 ,i mailed to your address a copy of a pamphlet containing an account of what has been accomplished in the treatment of cases similar to yours by an entirely new method4 ,this ,i hope you have received and had time to read over carefully as ,i am confident you will find it of interest4 ,the gentleman referred to 7who requests that his name be withheld7 has told me considerable about your case--just enough to arouse professional curiosity4 ,this is my only excuse for intruding upon you4 ,if you will kindly forward details1 stating length of illness1 nature of symptoms1 what has been accomplished in the way of treatment1 etc41 ,i may be able to use the information to the benefit of others similarly afflicted4 ,should ,i be able to offer any suggestions or advice which may tend to improve your condition1 ,i shall be glad to do so4 ,for this there will be no fee or charge of any kind--it will be merely exchanging one favor for another4 ,yours very truly1 ,g4 ,h4 ,,wilkinson1 ,m4,d4 ,no appeal here to come in and be relieved of a big fee2 no intimation that the doctor would like to have ,mr4 ,peters as a pay patient4 ,on the contrary the doctor only seeks information that may be of benefit to other patients4 ,at least this is the way ,mr4 ,peters interprets it4 8,fine fellow1 that doctor10 says ,mr4 ,peters as he reads the letter1 and he sits him down 8with pen in hand0 to describe his case1 invariably winding up with an enquiry as to whether the doctor thinks there is any hope for him4 ,the reply from ,mr4 ,peters is forthcoming all the quicker because the doctor has thoughtfully enclosed a plain stamped envelope bearing the written 7not printed or type-written7 address1 8,g4 ,h4 ,wilkinson1 ---- ,michigan ,ave41 ,chicago40 ,no ,m4,d41 attached to the title1 nothing to give the inquisitive hangers-on at the post office in ,beeville a clue to the true nature of the communication4 ,when these busybodies happen to catch a glimpse of ,mr4 ,peters' letter they have no suspicion that it is a doctor their fellow townsman is writing to4 ,nothing to show it on the envelope4 ,no doctor's return card in the corner1 no printed or even type-written address4 ,no sir-ree4 ,dr4 ,wilkinson is too smart for that4 ,experience has taught him that the average man does not like to have his friends and neighbors know that he is corresponding with a strange doctor4 ,hence the 8sent-securely-sealed-in-plain-package tactics40 ,it's different in a big town or city where the facilities for becoming acquainted with the nature of a man's correspondence do not exist1 and the rush of business is so great that even postal cards go through the mails unread by any one except the sender and the receiver4 ,but in the rural districts where ,absalom ,squash and ,praise-it-all ,tompkins assist ,hiram ,gaylord in his duties as postmaster to the extent of closely inspecting every letter that comes in or goes out--why that's another story4 8,wonder what ,john ,peters is writing to that fellow in ,chicago erbout80 says ,absalom ,squash as he picks up the letter addressed to ,g4 ,h4 ,wilkinson and holds it up to the light in a vain effort to get an inkling as to the contents4 ,but this ,wilkinson chap is wise4 ,he has provided an extra heavy envelope1 white on the exterior1 but blue coated inside1 to thwart just such efforts4 ,against the postal regulations for anybody outside of the postmaster or his sworn assistants to handle the mail8 ,of course it is4 ,but this regulation is a dead one in nearly every small post office in the country4 ,when ,mr4 ,squash goes home he reports to ,samantha that 8,john ,peters is writin' to that ,chicago fellow again4 ,john had a letter from ,chicago day before yesterday1 and to-day he sent off the answer1 but he didn't write the address himself40 8,how'd you know 'twas from ,peters1 then80 8',cause his boy brought it to the office10 answers ,absalom triumphantly4 ,samantha is interested and runs over to her friend ,abigail ,simpkins to discuss the strange occurrence4 ,that they are unable to do more than enjoy a little idle gossip is owing to the lack of any clew on the envelope as to the nature of the business or occupation of the party addressed4 ,in this feature ,dr4 ,wilkinson's plan is a good one4 ,in corresponding with patients or prospective patients use plain envelopes1 or if some safeguard in the matter of return is desired1 use a post-office card in the corner such as 8,if not delivered in five days return to ,box ----1 ,chicago ,post ,office40 ,nothing more4 ,should anybody make an effort to ascertain who has rented this particular box in ,chicago1 or any other city of decent size1 he will be politely told by the postal officials that it is none of his business4 ,sometimes the parties addressed die before the letter reaches them4 ,in cases of this kind the return card in the corner of the envelope serves a good purpose4 ,it is the duty of the postmaster to return it to the address given in the card marked 8,party dead40 ,when this happens the correspondence chief takes the card from the file and destroys it4 ,there is no use wasting time1 stationery and postage on dead ones4 ,about five or six forms of these preliminary letters are prepared1 and each is given a number such as ,no4 #a1 ,no4 #b1 and so on4 ,when they are to be sent out it is not necessary for the correspondence chief to dictate a letter to each prospect4 ,he merely sorts out the cards which are due to be attended to that day and turns them over to one of the girls to send ,no4 #a1 or ,no4 #b1 or whatever letter may be in order4 ,the stenographers have copies of all these letters and1 as they write them1 the form number of the letter and the date of its mailing is entered on the prospect card4 ,after the list of letters has been exhausted the cards are transferred to another file to be used later in connection with the 8,i have been called to your town0 correspondence4 ,this is a great labor-saving system and makes possible the transaction of an immense amount of correspondence at the minimum of expense4 ,many invalids1 especially those who have tried various forms of treatment without obtaining relief are doubters--they insist upon 8being shown40 ,they insist upon some convincing evidence that this special treatment has merit4 ,this is easy in most instances although once in a while the specialist runs across a hardened old cuss who would not believe the ,angel ,gabriel under oath1 and doesn't hesitate to say so4 ,nearly every physician is sure to have some patients who have been greatly benefited by his treatment and are truly grateful for the relief obtained4 ,the securing of the right kind of letters from these patients is only a matter of request at the proper psychological moment4 ,after a friendly talk with one of these patients some day when the latter is feeling unusually exuberant1 and has deftly been led up to the stage of declaring that he can never repay the doctor for what he has done for him1 the physician will say3 8,oh1 that's all right1 ,mr4 ,brown4 ,i am sincerely happy to know that the improvement has been so great4 ,no matter what we do1 there is sure to be scoffers and doubters4 ,but a physician's hands are tied4 ,there is no way in which he can overcome this bias except with the aid of just such men as yourself4 ,now1 if you could find it convenient to write a letter stating just what has been done in your case ,i would keep it in my desk to show such doubters as may drop in on me4 ,not as an advertisement or a puff mind you1 but merely as a means of overcoming unfair statements4 ,but ,i feel that this would be asking too much of you40 8,not at all1 doctor4 ,i'll be only to glad to do it4 ,but the fact is doctor1 ,i'm a poor letter writer4 ,if you'll prepare something ,i'll sign it40 ,this is just what the doctor wants and at the first opportunity he slips out and passes the word to the correspondence chief4 ,the latter prepares a letter which the doctor copies in his own handwriting4 ,when it is submitted to ,mr4 ,brown the doctor says3 8,this will look and read better on one of your own letter heads4 ,if you will copy it on your stationery ,i'll appreciate the favor40 ,when finally written and signed the letter will be about like this3 ,,james ,h4 ,,brown ,,dealer ,,in ,,hides ,,and ,,tallow ,union ,stock ,yards ,,chicago1 ,sept4 #i1 #aiaj4 ,,dear ,,doctor ,,wilkinson3 ,i am sure you will be glad to know that the improvement in my case continues and grows1 if anything1 more noticeable daily4 ,considering the physical wreck ,i was three months ago1 the change is little short of miraculous4 ,this is not only my opinion1 but that of my friends as well4 ,it is particularly gratifying to have those who called me a fool when they heard ,i was going to ,chicago to be treated for locomotor ataxia now acknowledge that they were mistaken1 and congratulate me on my action4 ,if ,i can serve you in any way don't hesitate to call upon me4 ,it is my duty to let fellow-beings similarly afflicted know what you have done for me4 ,gratefully yours1 ,,james ,h4 ,,brown4 ,in the same manner the doctor secures similar letters from other patients4 ,these are reproduced by the zinc-etching process1 business headings and all1 and when properly printed few people can tell them from the originals4 ,when copies are sent out to prospective patients accompanied by the right kind of a letter of explanation the persons receiving them believe1 as a rule1 that the doctor has forwarded for their inspection the correspondence of ,mr4 ,brown1 or some other patient1 and this impression induces many people to return them so the doctor will not lose such valuable communications4 ,the author1 who has long experience in this line1 has had many such letters sent back with notes of thanks for the privilege of reading them4 ,one of these notes1 which he still retains1 reads as follows3 ,,oshkosh1 ,,wis41 ,april #ae1 #aiaj4 ,,dear ,,doctor3 ,i have read the letters you sent me1 with a great deal of interest1 and will say to you frankly that they have convinced me that there must be a lot of good in your treatment4 ,i am now making arrangements to come to ,chicago1 and will do so as soon as ,i can close a deal which is now pending and get hold of some cash4 ,i return the letters as ,i know you must prize them highly1 and would dislike to lose them4 ,will write you a day or two before ,i start1 as it will be necessary to have some one meet me at the depot4 ,very truly yours1 -------- ,did ,i get this man for a patient8 ,yes1 and he paid a good fat fee4 ,and the best part of it all is the fact that1 after about three months of treatment1 he went back home comparatively a well man4 ,on his first visit to the office he was in a wheel chair--he could not walk4 ,when he left he was able to walk a mile or more without undue effort4 ,it would defeat the purpose in using these letters from patients to send them broadcast as circulars4 ,discretion must be used as to the manner of distribution4 ,never send one until you have had considerable correspondence with a prospect1 and then be careful that duplicates do not get into the small towns4 ,the smaller the town the faster the news travels4 ,if ,john ,smith1 living in a hamlet of #cjj population1 receives communications of this kind it is only a matter of a few days until everybody in the place knows of it4 ,smith tells his wife1 his wife tells somebody else1 and in this manner the news is circulated4 ,now1 if ,aleck ,brown1 living in the same town1 or close by1 should get duplicates of these letters ,smith and the others would soon hear of it and1 instead of being looked upon as priceless treasures submitted for ,smith's inspection1 they would naturally be classed as some new-fangled method of circular advertising4 ,having passed several preliminary letters with ,mr4 ,smith without getting him to commit himself as to coming in for treatment1 pick out a couple of the letters from patients which apply the most directly to his case1 the particulars of which may be obtained from the prospect index4 ,enclose these with a letter of your own addressed to ,mr4 ,smith1 and reading about like this3 ,g4 ,h4 ,,wilkinson1 ,m4,d4 ,,specialist ,,in ,,chronic ,,diseases ---- ,michigan ,avenue ,,chicago1 ----1 #aiaj4 ,mr4 ,john ,smith1 ,vail's ,gate1 ,mich4 ,,dear ,,sir3 ,in a recent letter you expressed doubt as to the merit of any treatment that could be applied in a case like yours4 ,in view of the many disappointments which you have had ,i cannot criticise you for holding this opinion4 ,it is a natural one under the circumstances4 ,i am not writing this letter with a view to changing1 or attempting to alter in any way1 your decision on this point4 ,you have probably made up your mind on the subject1 and that's the end of it4 ,despite this ,i am positive that you will be interested in the enclosed letters from former patients in which they express their views as to the treatment1 and the results obtained in their cases4 ,after reading these communications ,i shall be under obligations if you will kindly return them to me1 as ,i would not like to lose them4 ,very truly yours1 ,g4 ,h4 ,,wilkinson1 ,m4,d4 ,again a plain1 stamped1 hand addressed envelope is also enclosed so that ,mr4 ,smith may be put to no expense or trouble in sending back the precious letters1 thousands of copies of which are kept in stock in the doctor's office4 ,all communications emanating from the office bear the pen-written signature of the physician in charge1 but he sees very few of them4 ,he is not even conversant with their contents1 except as he may happen to discuss the subject with his correspondence chief4 ,it is the latter who directs the correspondence and conducts it in the name of the physician4 ,he is the business getter of the concern4 ,it is his duty to get prospective patients coming into the office2 it is the physician's duty to handle them after they get there1 and to obtain as large a fee as possible in each instance4 ---------------------------------------- -------------------------------- ,,chapter ,,viii ,,getting ,,at ,,financial ,,status ,while1 with proper effort and organization1 it is possible to ascertain in advance the financial worth of nearly every prospect in the manner already outlined1 there are many instances in which this cannot be done through any of the ordinary channels4 ,some people conceal their occupation by writing under an assumed name on plain paper1 so that an enquiry through a commercial agency will reveal nothing1 except1 perhaps1 the statement 8party unknown40 ,others will come in on the physician unheralded1 without any preliminary correspondence4 ,but1 if the physician understands his business1 he will get at the facts just the same as if the callers had introduced themselves with statements from their bankers showing their financial rating4 99 99 99 99 99 ,let us imagine the case of a man who drops into the office and enquires for the doctor4 ,the reception room girl will ask his name so that she can announce his arrival4 8,the name doesn't matter10 says the caller4 8,the doctor doesn't know me40 8,have you an appointment for any specific time80 8,no4 ,just dropped in to see the doctor40 8,well1 the doctor is very busy just now1 but he'll be disengaged in a few moments4 ,take a seat please1 and as soon as he is at liberty ,i'll let him know you are here40 ,don't overlook this waiting part of the program4 ,it is important4 ,creates the impression that the doctor is a busy man1 and that time is valuable4 ,always keep a caller waiting at least ten minutes1 even if the doctor is engaged in no more profitable occupation than reading a magazine4 ,when the caller is finally shown into the consultation room the doctor receives him with dignified courtesy and apologizes for having to keep him waiting4 ,this consultation room should be so arranged that1 when doctor and caller are seated facing one another1 the light should fall on the latter's face1 the doctor being in the shade as it were4 ,this allows of close watch being kept on the emotions which may play across the caller's face1 while those which the doctor may not be able to conceal 7these will be few7 will pass unnoticed4 ,after the conventional greetings the caller will undoubtedly outline his case1 and ask the doctor for his opinion4 8,i must know more about the conditions1 ,mr4 ---- by the way1 ,i didn't get your name8 ,robinson4 ,well1 as ,i was saying1 ,i must know more about the conditions1 ,mr4 ,robinson1 before venturing to give an opinion4 ,i have many cases strikingly similar in which the results were all that could be reasonably expected4 ,at the same time1 as a matter of frankness1 ,i must admit that there are others in which ,i have been disappointed40 ,this apparent candor on the doctor's part wins the confidence of the caller and he talks freely1 describing his case in detail4 ,the doctor listens attentively1 butting in with a question only when the caller seems to lag in his talk4 ,when the ailment and its symptoms have been fully described the doctor says3 8,yours appears to be a somewhat peculiar instance1 ,mr4 ,robinson4 ,there seems to be indications of severe mental strain or worry4 ,of course1 ,i may be mistaken1 but that's the way it looks to me4 ,have you had any great domestic or business worries80 8,no1 sir4 ,everything is moving along smoothly1 both at home1 and in my business40 8,frequently a man's business1 ,mr4 ,robinson1 involves a strain which he does not realize4 ,he becomes so accustomed to its routine that he staggers along with worries that would crush a man not accustomed to them4 ,there are some occupations which are a great deal more trying in this respect than others4 ,one of my patients--of course it would not be proper to mention his name--is a banker who was on the verge of insanity when he came here1 through worry over his financial affairs40 8,oh1 there's nothing of that kind1 no worries ,i mean1 in my case4 ,my business--,i'm a stock dealer--is flourishing4 ,i'm making money4 ,cleared #be1jjj last year1 have a fine home1 a good wife and family1 and would enjoy life if it were not for this annoying trouble4 ,if it were not for the hope that relief may be found ,i would be sorely tempted to kill myself40 ,the secret is out4 ,unwittingly ,mr4 ,robinson has disclosed the fact that he is well off financially and able to pay a good fee1 which information is of more importance to the doctor than the description of the caller's physical ills4 ,the conversation drifts back to the ailment1 the caller telling of the various treatments he has taken1 and the results4 ,among other things1 he says3 8,i have consulted a number of eminent physicians1 among them ,drs4 ---- and ----1 and they all told me that there was no real cure for the trouble4 ,what do you think1 doctor80 8,naturally ,i dislike to set my opinion against that of the famous men you have mentioned4 ,they are among the ablest in the profession4 ,their ability is unquestioned4 ,still1 we may all be mistaken4 ,in the absence of a thorough physical examination ,i would not like to say positively what the outcome of this treatment would be4 ,it does seem1 however1 in view of the success obtained in similar cases1 fully as serious1 if not more so1 that there is good reason to feel sanguine40 ,no promise here4 ,no rough1 8,sure thing1 ,i can cure you10 such as the cheap #e fakirs indulge in4 ,nothing of the kind4 ,the doctor is the very personification of social and professional dignity4 ,his appearance and manner is impressive1 and the kindly way in which he takes a hidden clout at those 8famous and able specialists0 wins the caller to him4 8,what would be the fee for an examination1 ,doctor80 the caller enquires4 8,i make no charge for that service10 replies the doctor4 8,it is an essential preliminary to determining whether the case is one in which the treatment may be administered with reasonable chance of success4 ,my plan is to give every applicant a close examination and reject such cases as appear hopeless4 ,failures don't help a physician's professional reputation any1 so what's the use of wasting a man's time and money when it is a foregone conclusion that he is beyond help80 ,this is the clincher4 ,if the caller had any doubt as to the doctor's honesty and sincerity this little spiel removes it4 ,he is going to have that examination made then and there1 fervently praying all the time that the doctor may find his case one which he would be justified in taking in charge4 ,but suppose the caller does not broach the subject of an examination fee1 and thus give the doctor an opportunity to make his stump speech4 ,it matters not4 ,there are a dozen ways of leading up to the subject without exciting the suspicions of the caller4 8,when would it be convenient for you to make this examination1 ,doctor80 is a question that naturally follows from every nine out of ten callers4 8,there's no time like the present1 ,mr4 ,robinson4 ,it will take about half an hour1 and0--7here the doctor consults his watch1 and opening his engagement book runs a finger over the record7 8,yes1 ,i have just about half an hour before the next regular patient is due4 ,i suppose there are some strangers waiting to see me now1 but you are ahead of them4 ,i would make an engagement for to-morrow were it not that ,i shall be very busy and will not have time to give you the proper attention40 ,mr4 ,robinson steps behind the screen which stands in one corner of the reception room1 and when he is disrobed the doctor gives him a very thorough physical examination1 stopping now and then to make notes of the case4 ,he asks many questions relative to the ailment1 and makes a special feature of testing the sensitive1 super-sensitive and non-sensitive areas with a pair of callipers4 ,as every medical man knows there are exterior portions of the human body on which the least bit of pressure will produce a 8flinching0 on the part of the patient2 there are others on which considerable pressure may be applied without noticeable effect4 8,why1 did that hurt you1 ,mr4 ,robinson80 enquires the doctor as the caller shrinks when the callipers touch a super-sensitive spot4 8,well1 yes1 a little1 ,doctor10 is the reply4 8,anything wrong there80 8,i hope not10 is the doctor's answer1 but he shakes his head gravely1 impressing ,mr4 ,robinson with the belief that there is more serious trouble than the doctor cares to admit4 ,after some fifteen minutes of this kind of work the doctor says3 8,this is a most peculiar case1 ,mr4 ,robinson1 but there's nothing1 so far as ,i can ascertain1 but what may be overcome by proper treatment4 ,at the same time the conditions are so unusual that ,i would like to consult my associate1 ,dr4 ,thompson4 ,two heads are better than one1 you know4 ,may ,i call him in8 ,you will then have the benefit of his opinion as well as mine40 8,why certainly1 ,doctor40 ,dr4 ,thompson1 who is kept for just this purpose1 and to treat outside patients who are unable to come to the office1 is summoned by electric call1 and comes in4 ,he is a dignified1 very professional-looking old chap1 neatly clad in dark ,prince ,albert suit1 and wearing glasses--the beau ideal of a medical authority4 8,mr4 ,robinson1 allow me to introduce ,dr4 ,thompson40 ,then to ,dr4 ,thompson3 8,doctor ,i have been examining ,mr4 ,robinson and the conditions are so unusual that ,i would like to have your opinion and see how it coincides with1 or differs from1 mine4 ,i think there can be no question but what it is a pronounced instance of tabes dorsalis1 and yet the conditions are far out of the ordinary40 ,during his preliminary talk with ,mr4 ,robinson the doctor has wormed out of him the fact that his ailment is locomotor ataxia1 so he is taking no chances in committing himself to the statement that he believes the case to be a 8pronounced instance of tabes40 ,besides1 this is a convenient manner of conveying to ,dr4 ,thompson a 8tip0 as to what his verdict should be4 ,together the two doctors go all over ,mr4 ,robinson again1 making comment in professional language as the examination proceeds4 ,at the end1 while ,mr4 ,robinson is dressing1 they sit down together and discuss the conditions in a subdued tone1 but loud enough so as to make sure that ,mr4 ,robinson will catch the import of the consultation4 ,when the caller rejoins them ,dr4 ,wilkinson says3 8,i am happy to be able to say1 ,mr4 ,robinson1 that ,dr4 ,thompson agrees with me fully as to the nature of your ailment1 and also that1 while the conditions are serious1 there is every reason to expect satisfactory results1 provided proper treatment is administered without further delay40 ,dr4 ,thompson endorses this in a few well-chosen words1 and then excuses himself on the plea of being very busy4 ,he will probably retire to the correspondence room and read a magazine until summoned to play the same role again with the next caller1 but there's no use in telling ,mr4 ,robinson so4 8,very busy0 is always a trump card in the hands of 8eminent0 physicians4 ,after ,dr4 ,thompson has left the room ,dr4 ,wilkinson begins to straighten out the furniture in his office1 apparently as a hint to ,mr4 ,robinson that he is getting ready to receive another caller4 ,but he is doing nothing of the kind4 ,he is merely using tactics to bring ,mr4 ,robinson to the crucial point of declaring that he is going to take the treatment4 ,standing up1 as if to bid his caller good bye1 the doctor says3 8,there is one thing ,i would impress upon you1 ,mr4 ,robinson4 ,such troubles as yours are not benefited by delay4 ,the longer you put off treatment the more aggravated your condition will become1 and the more difficult it will be to accomplish anything in the way of relief4 ,you should take treatment from some competent physician right away40 ,there is no plea here for ,dr4 ,wilkinson's special treatment2 no solicitation to become a patient of this particular establishment4 ,mr4 ,robinson is still further impressed with the doctor's fairness1 and also his professional ability as the diagnosis was the same as that made by other physicians4 ,he does not know that he has told the doctor of the opinions and findings of the others1 and is therefore all the more strongly inclined to look upon ,dr4 ,wilkinson as a most remarkable man1 a veritable past master in the profession4 8,well1 ,i'd like to take this treatment ,doctor1 if it doesn't cost too much1 but ,i am unable to get away from my business just now4 ,i must run back home for a couple of weeks and put my affairs in shape so ,i can stay here for a while4 ,how long do you think it will take80 8,that's something ,i am unable to state definitely4 ,in some instances1 apparently fully as bad1 if not worse1 than yours1 the desired results have been obtained in three months2 in others these results have been delayed for six and nine months1 and in a few cases even longer40 8,what will it cost me1 ,doctor80 7,this subject--fixing the fee--is treated at length in another chapter--,,ix47 ,there are some specialists who lack tact is ascertaining a caller's financial responsibility1 or in gaining his confidence4 ,their work is so coarse that it repels instead of attracts4 ,these men rarely1 if ever1 obtain any considerable number of patients among well-to-do or intelligent people4 ,their practice is invariably cheap1 and #ej fees are few and far between4 ,one specialist of this description opened an office in ,chicago4 ,he was a good physician and his ability had been recognized by his appointment to important professorships in various medical colleges and hospitals4 ,he failed as a specialist because he lacked tact4 ,if ,mr4 ,robinson had called upon him he would have been brusquely received in a cheaply furnished one-room office1 and the money feature would have been uppermost in the doctor's talk4 ,instead of getting the caller interested in the treatment1 by means of a courteous reception1 and strict attention to an examination for which no charge was made1 the itch for money would have been so apparent that ,mr4 ,robinson could not help but notice it4 ,following is an almost verbatim report of the manner in which a caller was received in the office of this physician4 ,after a short discussion of the case and before an examination was made1 or even suggested1 the caller asked3 8,do you think you can cure me1 ,doctor80 8,i don't think1 ,i know10 was the surprising answer4 8,there's no question about it4 ,in three months you'll be as sound and well as you ever were40 ,the caller was an intelligent man1 and the boldness of the statement1 taken in connection with the circumstances under which it was made--the physician having had no opportunity to ascertain the exact conditions--was far from reassuring4 ,it was a bad break on the doctor's part1 but there was worse to come4 ,the caller had made up his mind not to trust himself in the hands of this physician and1 as an easy means of escape1 asked3 8,what will the treatment cost1 ,doctor80 8,how much money are you earning8 ,are you working for somebody1 or are you in business for yourself80 8,what has that got to do with it8 ,what difference does it make to you how much my income is1 or where it comes from80 8,we're not treating people for nothing here4 ,we must know that you are able to pay the fee40 8,but you have not told me what the fee is40 8,no1 and ,i don't intend to until ,i know what your income is4 ,my rule is to get about one-quarter of a patient's income for the time he is under treatment40 8,then you have a sort of sliding scale as to fees80 8,certainly4 ,if you are earning #ej a week the treatment will cost you #ab4ej a week4 ,if you are earning #ajj a week it will cost you #be a week40 ,it is any wonder the caller went away disgusted8 ,and yet this doctor is unable to understand why he cannot succeed in special practice4 ,he can see nothing wrong in his method of handling callers4 ---------------------------------------- -------------------------------- ,,chapter ,,ix ,,deciding ,,upon ,,the ,,fee ,having ascertained the financial status of the caller1 and developed the fact that he wants to take the treatment1 the next move is to fix upon an acceptable fee4 ,here1 again1 tact must be used4 ,ability to pay is not everything4 ,you must know your man4 ,take two men of equal financial rating4 ,to one a fee of #a1jjj would be an extortion2 the naming of that amount would give him a violent attack of heart disease1 and yet he could well afford to pay what was asked4 ,the second man1 with no greater financial resources1 would write out his check for #a1jjj without a murmur1 and think himself lucky to get off so cheaply4 ,it's all a matter of psychological impression4 ,if you know your man thoroughly1 and approach him at the right moment1 you can get any fee that is within his ability to pay4 ,and this 8knowing your man10 rests largely upon the manner in which you receive him1 and the impression you make upon him4 ,it is a reciprocal affair4 ,if you get his confidence to the extent that he unbosoms himself to you freely1 you 8know0 him2 if you don't you are going to have hard sleddin'4 ,if the profession is to be judged according to its own standards the low estimate of the value of medical services held by the public at large is not to be wondered at4 ,if the physician does not place the value of his skill and ability at a high figure1 how can he blame the public for taking advantage of the low rates he names4 ,surely the people are not going to volunteer to pay more for an article than the owner asks for it4 ,a young ,western physician1 with the right kind of get-there spirit1 settled in ,new ,york1 where he was called upon to care for a young woman1 the daughter of a multi-millionaire1 who was suffering from typhoid fever4 ,he saved her life1 after a struggle of six months1 and sent in a bill for #e1jjj1 hoping that he might get half of it4 ,back came a check for #e1jjj1 with a letter of thanks1 and a 8bonus0 check for #ej1jjj more4 ,this may seem improbable1 but it is a fact4 ,this instance is cited for a two-fold purpose3 ,first1 to show that it does not pay to undervalue your services2 and1 second1 that ,eastern people are1 as a rule1 financial resources being equal1 more accustomed1 and more inclined1 to pay liberally than those of the ,west4 ,in discussing this incident a ,chicago physician1 a well-known man1 said3 8,a ,chicago millionaire would have #8kicked' on the #e1jjj bill1 insisted on its being cut to #b1ejj1 or less1 and1 this being done1 would have stood suit rather than settle at his own figure40 ,in this connection ,dr4 ,lydston quotes the following case3 ,one of our greatest 8merchant princes0 was under the care of a specialist and1 as his time was very valuable1 insisted that the doctor let him in at his private door ahead of all other patients1 regardless of the order of arrival4 ,his bill at #aj a visit amounted to something over #cjj4 ,the 8kick0 registered by our 8prince0 might have been heard in ,alaska4 ,result1 the bill was cut in two and the doctor has another enemy on his list4 ,another merchant prince1 who is well known on ,state street--we will call him ,mr4 ,bird1 because that's almost his name1 and he is one--came to see me one day in this wise3 ,he had heard that ,i had recently operated on a friend of his and removed a renal calculus4 ,would ,i show him the specimen8 ,he then gradually developed the interesting fact that he had gall stones and had been advised to submit to an operation4 ,what did ,i think of his case1 and what about his operative prospects8 ,three-quarters of an hour slipped away1 and my opinion in general had been obtained1 when ,i suggested a physical examination4 8,oh1 well10 he said1 8you see1 it has grown so late that ,i will not have time to-day4 ,i'll see you day after to-morrow10 etc4 ,that same evening1 while riding to a case in consultation with one of my surgeon friends1 that gentleman said1 8,oh1 by the way1 ----1 ,i'm going to operate on ,bird to-morrow for gall stones40 ,and so it proved4 ,i sent ,mr4 ,bird a bill for consultation and he replied that he owed me 8nothing10 had 8just made a friendly call10 etc4 ,i finally threatened suit and he paid the bill grudgingly1 and as insolently as he dared at long range4 ,let me assure the reader that that #be was a sweeter morsel than ten times the amount from any other source4 ,oh1 how it must have hurt my friend ,bird6 ,i trust he will be a mine of wealth to my surgical confrre--he has 8gall0 enough to run a stone quarry in his hepatic apparatus for a hundred years to come4 ,medical fees have not yet shaken off the incubus put on them by the dollar fee of the medical 8daddies40 ,when the country was yet new1 the fee question was practically settled by some of our medical pioneers1 whose influence has never been dispelled4 ,the one-dollar consultants were over-modest4 ,we have always been ready to concede that such fees are an undervaluation of the consultant's skill4 ,the profession has ever refused to take some men at their own valuation--but it has suffered from the incubus just the same4 ,philanthropy has been advanced as an explanation of cheap fees4 ,quoth the experienced and distinguished low-priced man1 8,what would the poor people do if ,i made myself less accessible80 ,they would go around the corner to that young doctor whose shingle you see swinging to the breeze1 and pay more money for better service than you or any living man can give for the fees you charge4 ,in general1 the public gets just about what it pays for1 save where the matter is one of absolute charity or dead-beatism4 ,what does a man study law for8 ,in order that he may be able to practice successfully and make money4 ,what does he study architecture or civil engineering1 or any of the other professions for8 ,always with the one purpose of making money out of them4 ,no1 not always4 ,medicine is an exception4 ,judging by the ordinary standard of fees men study medicine in order that they may make an unappreciative public a present of their time and skill--at least most of them do4 ,no fee within the range of the patient's ability to pay is ever too great for medical services4 ,the doctor is never in danger of being overpaid4 ,he should 8temper the wind to the shorn lamb10 but appearances are deceitful1 and the doctor had best be in at the shearing1 else there will be no wool for him4 8,virtue is its own reward0 may sound very pretty1 but it is not consoling in view of the fact that it gets no other in this life and its reward in the world to come is rather problematic4 ,while always seeking to get the largest fee that is within the patient's ability and willingness to pay the clever doctor will never let the patient know but what the matter of a fee is a secondary consideration4 ,his earnest talk will be on the prospect of obtaining the desired results4 ,so far as the patient can judge from the doctor's attitude and conversation the professional features of the case have a much stronger hold upon his mind than the financial4 ,it is always best1 of course1 in the matter of fixing the fee to 8strike while the iron is hot40 ,do it at the first consultation1 if possible1 and have it out of the way4 ,but the iron is not always hot at this first meeting4 ,unless assured that you have won the entire confidence of the patient1 and that you can safely go the limit with him1 don't attempt to name the fee right away4 ,if you do it is a certainty that you will get far less than could readily be had under more favorable circumstances4 ,in a case of this kind1 should the patient press to have a fee named1 say3 8,the fee is a secondary consideration with me1 ,mr4 ----4 ,what ,i am most interested in is knowing whether ,i can benefit you4 ,if ,i can it will be an easy matter to agree upon the fee4 ,if ,i cannot1 it would be a waste of time to take the treatment1 and ,i don't want your money40 ,this is pure 8bunk40 ,the doctor doesn't mean a word of it4 ,he is merely sparring for time until he can get the patient in a more receptive condition1 but it makes a ten strike4 ,whatever of doubt or hesitancy may have remained in the patient's mind is removed4 ,with the powerful remedies now at a doctor's command it is a most unusual case in which a decided change for the better does not follow the first two or three days of a new treatment4 ,when this stage is reached the time is ripe for naming the fee4 ,a gentleman suffering from locomotor ataxia came into the office of a certain physician4 ,he was frank in his statements4 ,he admitted that he was fairly well fixed financially and had travelled all over ,europe in a vain effort to find relief4 ,he was willing to take the treatment as a sort of forlorn hope and wanted the fee fixed1 but the doctor could see that he was still a little skeptical1 and put him off in the manner outlined4 ,on the third day of treatment the patient said3 8,doctor1 ,i want to get this fee matter out of the way4 ,i know ,i'm going to get well4 ,for the last two nights ,i've slept like a baby1 something ,i haven't done before in years1 and ,i feel better in every way40 ,this was the doctor's opportunity and he took advantage of it1 saying3 8,well1 ,mr4 ----1 since you insist upon knowing the cost of treatment ,i'll name a fee of #a1jjj in your case40 ,the man's check book was out and a check written and signed in less than five minutes4 ,it was the proper psychological moment4 ,as the patient said later3 8,i was surprised1 ,doctor1 at the moderate fee4 ,if you had said #e1jjj ,i would have paid it just as quickly as ,i did the #a1jjj40 ,this man got well4 ,the state of his mind had a great deal to do with his recovery4 ,the treatment was beneficial1 but he had made up his mind that he was going to recover1 and that was a great factor4 ,allowing that the psychological moment is reached at the first meeting1 the caller being in a receptive mood and asking for the terms of treatment1 which is often the case4 ,don't be modest4 ,it is easier to lower the terms than to raise them4 ,if the figure you name is objected to as being beyond the means of the caller there is always a way out4 ,then is the time to say3 8,the figure ,i have named1 #a1jjj1 is the regular fee1 ,mr4 ----1 but ,i can readily understand that to pay this amount might work a hardship in your case4 ,we are not doing a charity practice4 ,we can't afford to4 ,and if we were ,i am positive you are not the kind of a man who would take advantage of it4 ,you want to pay for what you get1 provided it is within your means4 8,in many respects your case is a most peculiar one1 and ,i would like to undertake it as there is every reason to look for wonderful results4 ,now ,i am going to make you a proposition in strict confidence1 and with the distinct understanding that it remains a secret between the two of us4 ,i will make the fee #ejj1 and1 when you are restored to health1 you are to write me a letter which ,i may show privately to other people who are suffering in the same way4 ,but1 under no conditions are you to tell anybody what fee ,i charged40 ,jump at the proposition8 ,does a hungry fish take the bait8 ,he thinks that he is getting something for nothing2 that a special exception has been made in the matter of a fee because the doctor is confident of restoring him to health and wants the credit and reputation that would attach to such a cure4 ,during all this conversation the doctor has cleverly refrained from alluding to such a thing as a cure in direct words4 ,in no manner has he committed himself in this respect1 and yet the bait has been so skilfully dangled that the caller can get no other impression than that a cure is sure to be obtained4 ,then there is another class of men who will object to any fee that may be named in the hope of getting a reduction4 ,in most instances men of this class are abundantly able to pay1 but are 8close40 ,if gold dollars were offered to them at #ij cents apiece they would want the price lowered so as to save something4 ,when a man of this kind is encountered1 and the doctor is bent on getting the fee he has named1 the best thing to do is to make him ashamed4 ,this may be done without offending them4 ,one notably successful case taker1 famous the world over for his ability to get large fees1 made it a practice to say3 8,i agree with you1 ,mr4 ----1 that #a1jjj seems like a large fee if we leave the matter of perfect health out of the question4 ,you surely don't expect to buy health on the same basis that you would coal or grain1 or some other merchantable commodity4 ,you are too sensible a man for that4 ,when you stop to consider that this ailment is chronic--let's see1 ,i think you said you had been afflicted about eight years--and that it is going to take earnest attention on my part for a long time to restore you to a normal condition1 ,i think you will agree with me that1 even if we adopt a cold commercial basis of valuation1 the fee is not an extravagant one40 8,perhaps you're right1 ,doctor1 and if ,i could have any assurance that--0 8,assurance4 ,what can you have beyond what ,i have given you8 ,my professional reputation is at stake1 and you have been advised as to what has been accomplished in other cases4 ,surely you could have no stronger assurance1 especially that contained in the letters from patients which ,i have shown you40 ,all this is said in a low1 well-modulated tone1 without show of special desire to close the case1 and it generally wins4 ,if it does not there is always the alternative of making a special reduction in this particular case on the understanding that the terms are confidential1 etc4 ,but it is seldom that this has to be resorted to4 ,when patients go for treatment to a physician of fame1 one whom the newspapers are forever referring to as 8the eminent10 or 8the famous ,dr4 ,mc,swat10 they expect to pay large fees4 ,if they could get treatment on ordinary terms it would not be so highly esteemed4 ,fame is the open sesame to big fee getting4 ,if1 after the talk outlined1 a caller remains obdurate a star play may often be made by the physician arising1 pushing his chair back a little1 and saying3 8,i don't wish to be discourteous1 ,mr4 ----1 but ,i am compelled to ask you to excuse me4 ,i am a very busy man1 and ,i am afraid that some of the people who are waiting to see me will be getting impatient4 ,i am glad you called1 and have really enjoyed my talk with you4 ,drop in any time at your convenience4 ,i shall always be glad to see you40 ,if the caller has any real intention of taking treatment this will generally bring him to time4 ,in the first place it is equivalent to the doctor saying 8,i am too busy to waste my time on triflers10 and this touches his pride4 ,in the second place he is afraid that if he does not take advantage of the present opportunity something may arise to change conditions before he can see the doctor again4 ---------------------------------------- -------------------------------- ,,chapter ,x ,,getting ,,fees ,,in ,,advance ,it is one thing for patient and physician to agree upon a fee4 ,it is another thing for the physician to get the fee in advance4 ,still1 it can be done in most instances1 but it requires diplomacy of a high order4 ,it is frequently1 one might say almost invariably1 the case that1 after the fee has been tacitly agreed upon1 the patient will enquire3 8,how is this fee to be paid1 ,doctor80 8,in advance10 the doctor will reply in a mild1 it-doesn't-matter manner4 8,isn't that rather hard on the patient1 ,doctor80 8,it is the only way in which we can protect ourselves4 ,if we extended credit indiscriminately many patients1 when assured that they were well started on the road to recovery1 would disappear1 and it would require long1 expensive litigation to collect from them1 even if we could get service on them here1 which is doubtful4 ,the average man1 ,mr4 ----1 has a queer idea about the obligation of a doctor's bill4 ,it is the last thing he will pay voluntarily1 even when almost miraculous benefits have been obtained40 8,don't you ever extend credit80 8,oh1 yes4 ,when assured of a man's financial responsibility and honest intention1 we are glad to accommodate him in a reasonable way if it is inconvenient for him to pay cash40 ,in this1 as in naming the fee1 the physician must create the impression in the mind of the subject that payment of the fee is about the last thing he is thinking of4 ,there must be no anxiety1 no undue haste to get the money--at least not so that the patient can notice it4 ,switching the conversation for a few moments back to the case itself1 in order to get the patient's mind diverted1 the doctor will finally say3 8,now1 in your case1 ,mr4 ----1 if it is any object to you1 ,i can arrange for you to pay the fee monthly4 ,if this is satisfactory you can pay #aej a month while you are under treatment40 8,how long will that be1 ,doctor80 8,i don't know4 ,certainly six months1 perhaps twelve1 and possibly longer4 ,nobody can tell in advance how a chronic ailment like yours will respond to treatment4 ,it is very seldom that we have two cases exactly alike in this respect4 ,if there is such a thing as striking an average ,i would place it at about ten months40 8,would ,i have to remain here all that time80 8,oh1 no4 ,a month or so1 should be sufficient4 ,may be less4 ,just long enough to allow me to get the treatment graduated to meet the requirements of your case4 ,then you may return home and continue it there4 ,it would be better1 of course1 if you could stay here the entire time1 but there is no real necessity for it40 8,on the basis of ten months it would cost me #a1ejj80 8,about that4 ,perhaps a little less2 perhaps a little more4 ,by taking advantage of the #a1jjj proposition you will save about #ejj4 ,it is really immaterial to me which offer you accept save for one thing4 ,no matter how well a patient is progressing there is sure to be more or less reaction at times4 ,it would be marvellous if there were not4 ,these spells of reaction are only temporary1 but the patient1 not understanding this1 is inclined to become discouraged and1 if he is paying his fee by the month1 may quit just at the time when1 if he had continued treatment a little longer1 he would have become a well man4 ,in such a case he not only loses the money he has paid1 but also the certainty of recovering his health4 ,on the other hand1 if his fee is paid1 he will argue that he might as well stick it out as it isn't going to cost him any more4 8,naturally ,i want to obtain as great an amount of success professionally as possible4 ,for this reason when a patient asks my advice on the subject ,i tell him to pay the fee and get it off his mind4 ,this not only saves him money1 but relieves him of financial worry so that he responds more readily to treatment and1 above all1 it makes sure of his continuing the treatment until his health is restored40 ,while endeavoring to convince the patient that the fee occupies a minor place in your mind1 do so by actions and manner1 not by words4 ,never say outright that you don't care when the fee is paid1 or that you are not thinking about the fee1 or anything of that kind4 ,if the patient sees fit to form this impression1 let him do so2 it strengthens the probability of your getting the money4 ,the average man1 especially the one who has money1 is not a fool4 ,he is quick to form conclusions4 ,if he can see where he can save #ejj on a bill of #a1ejj he is going to grasp the opportunity without much urging1 provided he is reasonably well assured of getting value received4 ,this assurance is entirely a matter of confidence4 ,if the doctor has obtained the patient's confidence by dignified1 yet courteous 7not servile7 manner1 and modest talk1 he is going to get the fee then and there4 ,if he has fallen short of securing this confidence all the arguments he can advance will not induce the patient to unbelt4 ,in fact1 the more argument he makes the weaker his case becomes4 ,a discount of one-third is a proposition which appeals to any man of business sense4 ,he does not know1 of course1 that the physician has named a figure much higher than he is willing to accept1 with this very purpose in view4 ,one thousand dollars would be a lucrative fee if paid by the month1 and the doctor can well afford to accept it in advance on the terms he names4 ,few people will take treatment longer than three1 or at the most four1 months4 ,they either become well in that time1 or grow discouraged and quit4 ,another thing4 ,there is a great deal of convincing force in the statement that payment of the fee in advance holds the patient to the treatment4 ,at least it looks that way to the layman4 ,in most instances where a man has the funds in bank he will write a check without further comment4 ,occasionally a patient will be unable to do this1 owing to a shortage of funds1 and will say3 8,well1 ,i have decided to take the treatment1 ,doctor1 if you can give me a little time on part of the fee4 ,i can pay you #ejj now1 but would like about sixty days' time on the rest40 8,certainly1 ,mr4 ----4 ,if it will be an accommodation to you ,i will be glad to do it4 ,it is contrary to our usual practice1 but ,i feel that ,i am safe in making an exception in your case40 ,the check is written and handed to the doctor who1 without apparently examining it1 puts it carelessly in his pocket1 and then makes an entry in his desk diary1 noting the patient's name and address1 nature of his ailment1 date1 amount of fee1 and size of payment4 ,when all this is done the first treatment is given1 and engagement made for succeeding treatments at a certain hour each day4 ,taking advantage of the time when the patient is rearranging his clothes after treatment the doctor hurriedly fills out a sixty day note for #ejj1 making it payable to the order of the patient himself4 ,just as the latter is ready to leave the doctor will say3 8,there's just one thing more1 ,mr4 ----4 ,in order to guard against any possible misunderstanding in the future ,i have drawn up a little memorandum of our agreement as a sort of protection to you4 ,now1 if you will kindly place your signature there----0 ,as he says this the doctor rises from his chair and motions the patient into it1 at the same time dipping a pen in the ink well and handing it to him4 8,yes1 on that line2 yes1 that's the place4 ,now 7turning the note over so the back is uppermost71 once more across the end1 so4 ,there1 now we have the agreement in form so no one can take advantage of you4 ,be sure to come promptly at #aj3cj to-morrow40 ,after the first treatment most men are excited and easy to handle in this way4 ,they do what the doctor bids in a sort of unconscious way4 ,they don't realize that they are signing a note4 ,the doctor has referred to it as a memorandum of agreement1 and it seems only proper that there should be a writing of this nature4 ,sharp practice8 ,yes4 ,dishonest8 ,no4 ,the patient has agreed to pay a fee of #a1jjj4 ,he has paid #ejj down and promised to pay the rest in sixty days4 ,the doctor has merely induced him to put this promise on paper4 ,if the maker of the note is responsible 7and the doctor has assured himself of this in advance7 the full #a1jjj is secured then and there1 less an ordinary discount fee on #ejj1 as a note of this kind is easily negotiable4 ,the doctor has taken the precaution to protect himself instead of depending entirely upon the honesty and good intention of his patient4 ,the latter has barely left the office before both check and note1 properly endorsed1 are on the way to the bank where the note is discounted and the proceeds1 with the check1 deposited to the credit of the physician4 ,it may be said that this sounds too easy and simple to be true4 ,perhaps it does to those who are not acquainted with the methods of the up-to-date 8case taker40 ,but fees1 and big fees1 are being obtained in exactly this manner every day in every large city in the country4 ,the physician who has a well-established office practice does not1 as a rule1 resort to this method with his regular patrons at first4 ,he charges what seems to be a large fee1 #e to #aj each time a patient calls1 extends credit indiscriminately1 and loses fully one-half of the money represented by his book charges4 ,if he is wise he learns by experience1 and caters to the patronage of strangers from whom he can get his fees in advance4 ,he gradually gets too busy to receive those who want their fees charged4 ,he has learned his lesson and is willing to profit by the example set by other doctors who1 while not recognized as models in the line of ethics1 know how to make the practice of medicine pay4 8,how's business1 ,doc80 asked a friend of a physician who has achieved considerable fame as an office specialist4 8,bully10 was the reply4 8,did over #cjj to-day40 8,get it80 8,no1 but it's good40 ,and the poor fool actually thought so until he failed to get any adequate returns from the many bills he sent out1 or the numerous calls made by his hired collector4 ,now he is making money4 ,why8 ,because every caller1 whether regular patient or stranger1 who wants to consult that doctor professionally1 must 8ante0 his #aj with the polite secretary in the reception room before he can get into the doctor's office4 ,result1 exodus of dead beats1 and others whom there was no profit in seeing4 ,prominent attorneys adopt this system4 ,why is it not just as ethical and fair for physicians to employ it8 ,if a patient agrees to pay the fee asked by the physician there is no reason1 moral or legal1 why he should not do so4 ,and yet1 unless this fee is paid in advance1 or well secured1 the chances are about ten to one that the doctor will never get it4 ,sometimes the patient will discover that the 8memorandum0 he is signing is a note1 and may say3 8,why this is a note1 ,doctor80 8,well1 it is in note form1 but you will see that it is payable to your own order1 ,mr4 ----10 the doctor will say4 8,i don't think it will be of much use to anybody else4 ,it is put in this form for your own protection40 ,this is usually sufficient1 unless the patient is a city banker1 or an unusually smart man of business4 ,should this latter be the case1 which is not likely as men of this class invariably pay cash in advance1 an explanation is readily forthcoming to the effect that it is merely an evidence of good faith on the maker's part1 etc4 ,occasions of this kind are very rare1 however1 as most men are so thoroughly hypnotized at the moment that they readily do whatever the doctor suggests4 ,the smart man is as a rule the easiest to get a good fee from4 ,his business education has been such that he is not looking for something for nothing4 ,if a thing is really good he knows it must be paid for1 and that the price must be in accordance with its merits--or supposed merits4 ,strong belief in actual merit is a matter of education1 the doctor acting as instructor and demonstrator4 ,one holiday when the office was closed the writer and the physician with whom he was associated in business were sitting in the doctor's private room discussing ways and means for getting in more patients4 ,the main entrance door was locked4 ,suddenly the knob was heard to turn and it was evident somebody was trying to get in4 ,going to the door the writer opened it and stood face to face with one of the best known and wealthiest men in ,chicago1 a man noted for being extremely close in his financial deals4 ,affecting not to know him the writer said3 8,what can ,i do for you1 sir80 8,i'd like to see ,dr4 ----40 8,the office is not open for the reception of patients to-day1 but the doctor happens to be here for a moment4 ,if you will step in and take a seat ,i will ascertain if he can see you40 ,when the caller was seated the doctor was hurriedly notified as to his identity and financial means1 and word was sent out to show the gentleman in4 ,after a consultation of twenty minutes the caller left1 and the doctor had his check for #b1ejj4 ,as he handed it to the writer the doctor said3 8,mr4 ---- did not have one of his own checks with him1 and had to write this on one of our blank forms4 ,he doesn't want it to go through his bank in this shape and has asked me to hold it until he comes in ,saturday when he will exchange it for one of his own40 ,the check was put away and on ,saturday when ,mr4 ---- called the writer1 who was the treasurer of the concern1 was out at luncheon4 ,as the new patient handed the second check to the doctor the latter was compelled to say3 8,i'm sorry1 ,mr4 ----1 but ,i'm unable to give you back your first check right away1 ,mr4 ----1 our treasurer1 has it locked up in the safe1 and ,i cannot get it until he returns from luncheon40 8,oh1 that's all right10 replied ,mr4 ----4 8,any time will do40 ,and away he went1 leaving both checks1 representing #e1jjj1 and as good as gold1 in our possession4 ,the doctor had won his confidence from the start4 ,in this particular instance there had been no advance correspondence1 and the caller was unknown to the doctor either personally or by name4 ,the writer happened to know him by sight and thus was able to 8tip0 him off to the doctor4 ,if it had not been for this it is probable that the fee would not have been more than #ejj1 and the doctor would have congratulated himself on having done a good day's work at that4 ,what makes the case even more remarkable is the fact1 as previously stated1 that the man had the reputation of being very close in money matters4 ,yet here was an instance in which he not only paid the fee of #b1ejj in advance without a murmur1 but actually entrusted a stranger with #e1jjj of his funds4 ,after two weeks of personal treatment this same man1 acting on the advice of the doctor 7who was to share in the fee7 had partially arranged to pay another specialist #aj1jjj for the treatment of his wife1 and was on the point of closing the contract when the blundering tactics of the second physician upset the whole thing4 ,negotiations were progressing favorably1 there was no dispute as to the amount of the fee1 or anything of that kind1 when a single mis-step aroused his suspicions1 and the deal fell through4 ,in talking the matter over later ,mr4 ---- said3 8,i may be sorry1 ,doctor1 that ,i did not accept ,doctor ----'s proposition1 but to tell the truth he didn't impress me favorably4 ,now if it were you who were to conduct the treatment ,i wouldn't hesitate a moment40 ,the joke of the thing--and it was a joke--lay in the fact that of the two men the doctor he had no confidence in was by far the more able and competent of the two4 ,but he lacked tact2 he didn't know how to inspire confidence in his patients2 didn't know how to conceal the disagreeable truth and enlarge on the non-essentials making them appear as the more important of the two4 ,he was too brutally frank4 ,the doctor who got the #b1ejj fee and retained the entire confidence of his patient to the last1 was a past master in the gentle art of what is known in slang parlance as 8bull con40 ,all of which tends to show that the getting of a big cash fee rests entirely on the impression created by the physician4 ,if this impression is favorable the fee will be forthcoming2 if it is not a yoke of oxen couldn't yank it away from the patient4 ---------------------------------------- -------------------------------- ,,chapter ,,xi ,,getting ,,additional ,,fees ,it is a well-understood fact among physicians that the average man of #ej or over takes more interest and pride in his sexual virility than in any other phase of his physical system4 ,it is equally well known that in almost every instance where a man has reached the age of #ej there is a very perceptible flagging or falling off in sexual power4 ,in many instances it is entirely lost when the half-century mark is reached1 or soon afterward4 ,there are few men who care to admit this even to their family physicians1 and1 in consequence of this shyness1 they fall ready victims to quacks of the 8,be ,a ,man0 stripe4 ,when a man well past middle age comes into your office never broach the subject of sexual trouble to him at first1 no matter how strongly you suspect it4 ,if you do he will take treatment for that first1 and that is the end of it4 ,secure him on some other line of treatment first4 ,humor his ideas in this respect--he has whatever ailment he may fancy he has4 ,if you are satisfied that he is in position to pay well1 but is hard to deal with in a financial way1 it will pay you to name a modest fee for the initial treatment1 but don't let him get away4 ,he will afford fat1 liberal picking later on4 ,where men of ordinary means will haggle over a #bej fee for being successfully treated for some annoying1 really dangerous ailment1 they will pay #a1jjj or more cheerfully on anything that seems like a reasonable assurance of having their sexual power restored to its pristine vigor4 ,there is not a physician in the land with any considerable practice who doesn't know this4 ,having secured your fee from a patient of this kind for the regular treatment of the trouble concerning which he came to consult you1 and at the time when the treatment is beginning to show favorable results1 spring the trap4 ,as before stated there is generally a time when nearly every patient responds to greater or less extent to a new treatment4 ,this response may be only temporary2 it generally is4 ,when the indications of this response are seen then is the time to act4 ,it is the proper psychological moment4 ,direct the conversation to the marked improvement in his condition1 tell how much you are encouraged by the very noticeable change1 and suggest another thorough physical examination so that you may make the proper record of his case4 ,when the patient has disrobed give him the same thorough1 searching examination you did when he first came to the office4 ,pay no attention to the sexual organs at first1 but1 when nearing the end of the examination say casually3 8,how long have you been in that condition1 ,mr4 ----80 ,this is a random shot1 but it will strike home ninety-nine times out of a hundred4 ,there is very little chance of its going astray4 ,almost invariably the patient will ask3 8,what condition do you refer to1 ,doctor80 8,why your sexual organs are not exactly normal1 are they80 8,well1 to tell the truth1 ,doctor1 ,i am not as strong as ,i was a few years ago1 but suppose it's the natural result of advancing years40 8,you're not an old man yet1 ,mr4 ----4 ,you are only #ee1 ,i think you told me4 ,you ought to be good for at least ten years yet1 and perhaps longer40 8,do you really think so1 ,doctor4 ,is there any hope in that direction80 8,most certainly4 ,there is little question about the result4 ,modern science has given us an entirely new method of treatment in cases of this kind the effects of which are little short of miraculous4 ,the one trouble1 however1 is that it is expensive1 so much so that ,i hesitate to speak of it as a rule40 ,no power on earth can prevent that man from having that treatment regardless of the expense4 ,he has by this time an enlarged idea as to the doctor's ability4 ,he is pleased with the results of the treatment administered for the original ailment4 ,he is impressed by the evident professional skill of the doctor in 8discovering0 a sexual condition which he fancied was known only to himself4 ,he does not know that the physician has simply made a shrewd guess2 one that he is in the habit of making several times a week1 and generally with the same result4 ,he is in the seventh heaven of delight4 ,the doctor has adroitly dangled before his eyes a certainty which he had been vainly praying for4 ,his next question is3 8,what will it cost80 ,direct answer to this depends upon what the doctor has learned about the patient's financial rating and willingness to pay4 ,few cases of this kind are taken under #a1jjj4 ,allowing that the physician has decided upon this amount as the extreme limit1 he will reply3 8,it is hard to say exactly1 ,mr4 ----4 ,somewhere between #a1jjj and #a1ejj4 ,it depends upon what ,i have to expend for the remedies and permission to use them4 ,they come from abroad and can only be obtained with the consent of the scientist who introduced them4 ,that kind of men1 as you doubtless know1 are not always easy to deal with40 8,well1 the price is pretty steep1 but if you are satisfied the treatment will do the work ,i want it40 8,there's no doubt about the merits of the treatment1 ,mr4 ----4 ,the only thing1 as ,i said before1 that holds me back from recommending it generally1 is its high cost4 ,besides ,i don't1 as a usual thing1 care to handle cases of that nature40 ,smart doctor6 ,he has got his human fly stuck on a gummed trap from which he couldn't extricate himself if he would1 and he doesn't want to4 ,if this wonderful treatment will restore his lost sexual power1 and the doctor1 in whom he has strong confidence1 has told him it would1 he's going to have it4 ,there is a little more conversation of an innocuous sort1 and then the doctor says3 8,i'll tell you what ,i will do1 ,mr4 ----4 ,while ,i am not certain that the cost of the treatment may not run as high as #a1ejj1 you may pay me #a1jjj and ,i will endeavor to get the case closed for that amount4 ,should it be necessary to pay the other #ejj ,i'll leave it to your honor1 but ,i am reasonably confident that ,i can make the necessary arrangements for #a1jjj40 ,this looks good to the man who has rosy visions of a restoration to the fire and vigor of youth1 and he generally draws a check on the spot4 ,if his bank account will not admit of this he gives a 8memorandum10 at least that is what the doctor calls it1 and the deal is closed4 ,there are similar ways of getting additional fees from patients who have already paid well for the original treatment4 ,one man 7or woman7 needs the eyes looked after and fitted with proper glasses1 another should have the teeth fixed up1 another requires a special surgical appliance1 while still another should have a special prescription compounded4 ,the doctor always has a list of experts to whom he directs patients on the fee-sharing plan1 and these fees are never over-modest4 ,to the doctor's credit be it said that he invariably warns such patients that if they want the best they must expect to pay well for it4 ,it will undoubtedly cost considerable money1 but the results will justify the expenditure4 8,your eyes certainly need attention1 ,mrs4 ----1 and it would be a good plan to have it done while you are here in ,chicago4 ,the longer you put it off1 the more serious the complication will become4 ,but1 whatever you do1 don't go to one of these cheap occulist fakirs4 ,they are liable to ruin your eyesight40 8,who is a good man1 ,doctor80 is the natural inquiry4 8,there are a number of able1 competent oculists here4 ,dr4 ,seestraight stands at the head of his profession1 and is probably the most satisfactory of the lot4 ,i'll give you a card to him1 if you wish4 ,he has always attended to my eyes1 and has given satisfaction40 ,this proffer is gladly accepted and when the patient leaves the doctor's office she carries a note of introduction to ,dr4 ,seestraight4 ,it is an innocent looking note1 but it contains a hidden cipher which gives the oculist a tip as to the fee which he may safely name4 ,this cipher is generally made in flourishes1 under the doctor's signature1 unintelligible to the patient1 mere flourishes as it were1 but perfectly plain to ,dr4 ,seestraight4 ,when the latter collects his fee he sends half of it to the physician who recommended the patient1 and the incident is closed4 ,the same arrangements are made with certain pharmacists1 dentists1 and surgical instrument makers4 ,there was one physician in ,chicago who made it a practice to say to certain of his patients3 8,you are getting along very nicely1 but recovery would be much more rapid if you could take a little extra special treatment4 ,but ,i hesitate to suggest it on account of the expense and the difficulty of procuring the proper ingredients40 8,darn the expense1 ,doctor1 if the stuff will do me good4 ,what is it1 and where can ,i get it40 8,there are several ingredients1 and the only place in ,chicago where there is any prospect of finding them is at ,doem ,doem's4 ,but they don't always have a supply4 ,they are foreign preparations1 very expensive1 and there is such little demand for them that pharmacists dislike to carry them in stock4 ,i'll write the prescription1 but ,i can't vouch for your getting it compounded4 ,at any rate if you can't get it filled at ,doem ,doem's1 there's no use trying any other drug store40 8,you dwell so on the expense1 ,doctor1 that ,i'm curious4 ,what will it cost80 8,the expense varies somewhat4 ,the last patient ,i supplied with the prescription had to pay #bc4be40 8,that's nothing40 ,the prescription is written and ,doem ,doem find on it a cipher telling them that the patient will stand for #be4 ,as a member of the firm glances it over he says to the customer3 8,this is a very rare and expensive preparation4 ,it happens that we have just about enough material on hand to fill it1 but ,i feel that ,i should warn you first that it will be very expensive40 8,i expected that4 ,dr4 ---- told me that it would probably cost #bc or #bd40 8,that would have been a fair price a few weeks ago1 but since then there has been an advance in the cost of the materials and ,i shall have to charge you #be40 8,all right4 ,go ahead and fill it4 ,a dollar or so won't stop me40 ,the customer gets an ordinary preparation which any druggist would be glad to sell at #ej or #fj cents1 while ,messrs4 ,doem ,doem pocket #ab4ej1 and send a like amount to the enterprising doctor4 ,nor is this practice confined to what might be called the tradesmen in medicine1 the druggists1 the surgical instrument dealers1 and so on4 ,it is followed by what are known as high-class surgeons1 men of eminence in the profession1 and even finds favor among the physicians themselves4 ,it is no uncommon thing for the doctors to exchange patients and divide the fees4 8,really1 ,mr4 ----1 you ought to consult ,dr4 ,flubdub about that feature of your case10 a doctor will say to a patient when he has about exhausted him on the fee proposition4 8,that particular feature is a little out of my line4 ,it needs the attention of an expert specialist in that line1 and ,dr4 ,flubdub has made a close study of just such cases40 ,so the patient goes to see ,dr4 ,flubdub and the latter is ready for him4 ,he has been advised by phone as to what is coming about as follows3 8,hello1 is this ,dr4 ,flubdub8 ,yes4 ,this is ,dr4 ,grab4 ,i have just advised a patient--,mr4 ----1 to see you4 ,he seems to have a little ear trouble that needs attention4 ,he'll stand for about #bej40 ,thanks to the tip given by ,dr4 ,grab the ear specialist is able to speedily locate and describe the trouble with which ,mr4 ---- is afflicted4 ,dr4 ,flubdub names his fee at #bej1 collects it1 and sends #abe to his worthy brother1 ,dr4 ,grab4 ,it's a case of two pluck one4 ,when opportunity offers ,dr4 ,flubdub returns the favor by sending patients to ,dr4 ,grab who1 in turn divides the fee1 and thus the medical mill is kept busy4 ,some physicians are very bold in demanding a division of fees as if it were right1 rather than a honorarium4 ,there is a letter in a certain office in ,chicago1 preserved as an evidence of gall1 in which the writer says1 when suggesting that he can send the recipient a patient3 8,the woman will do just about what ,i tell her4 ,she is business-like1 and so am ,i4 ,i think she will stand for #bjj4 ,now1 if you can see any money in that after giving me #ajj1 ,i'll send her to you2 if not1 why ,i know plenty of others who will take the case on those terms4 ,she is my meat1 and will go where ,i say4 ,i am not charging #ajj for my time1 but for steering the case to you4 ,this is my game and ,i can steer the case where ,i please10 etc4 ,nothing modest or backward1 no hesitancy about this4 ,the writer comes bluntly to the point1 without false delicacy or reserve4 ,well1 to give the devil his due1 the fellow was honest in his straightforwardness4 ,he knew what he wanted1 and didn't hesitate to ask for it4 ,and the doctor who received the letter8 ,well1 to tell the truth1 he had conscientious scruples against that sort of thing1 so he lost the case4 ,another physician of equal prominence got the patient1 presumably on the terms named by the writer of the letter4 ,speaking of deals between physicians and undertakers1 ,dr4 ,g4 ,frank ,lydston says3 8,over on the great ,west ,side lives an undertaker friend of mine1 who1 in deference to his ancient and honorable vocation1 we will call ,mr4 ,watery ,weeps4 ,my friend ,weeps has an eye to business2 in faith1 he has two eyes to business--both of #8em red2 some say from #8red eye' homeopathically applied4 ,i do not believe this theory regarding ,mr4 ,weeps' headlights4 ,their peculiar bicycle lamp glow1 like their excessive humidity1 is due to his faithful1 sorrowful #8proxifying4' ,in the course of my practice it did befall that a certain pulmonopathic vassal of mine--we will designate him as ,mr4 ,one-,lung1 insomuch as he had no other lung--did feloniously1 with malice prepense and aforethought and intent to deceive1 up and die4 ,having a corpse on my hands1 ,i naturally bethought me of my post-medical friend1 ,weeps1 who undertaketh much in that vicinity4 ,weeps was prompt1 and my late friend of the pulmonary solitaire was soon duly boxed and crated1 ready for shipment to his ancestral home in #8,injianny1' whereupon quoth ,weeps1 lachrymosing his prettiest the while3 8#8,ahem1 ,doctor1 ,i am very much obliged to you for the favor you have shown me4 ,i hope to do a large share of your business in the future4 ,i expect a check for this job to-morrow1 and will then extend to you the usual courtesies to the medical profession4' 8#8,ah1' ,i replied1 #8and what might that be8' 8#8,why1 #be per cent4 ,i call that pretty good1 too1 considering the hard times1 don't you ,doctor8' 8,and my friend ,weeps still thinks ,i was bluffing when ,i declined the #8usual courtesies4' ,truth is strange1 passing strange--stranger than fiction40 ,then there is another class of physicians who will not hesitate to take advantage of a brother practitioner if they can do so to their own benefit4 ,this is done in several ways3 ,one method is to misrepresent the financial status of the patient whom he takes to an expert for consultation4 ,it is not long since a physician called up another by telephone and arranged for him to see a 8poor patient0 who could only pay a small fee for consultation4 ,the doctor thus called upon discovered that the patient1 who was a wealthy stock raiser from the ,west1 had paid his doctor friend a good fee already1 and had arranged to pay him #bjj more for the prospective operation--which the second doctor was expected to tell his friend how to do4 ,it is frequently the case that general practitioners call a consultant without making arrangements for the fee beforehand4 ,it is unpleasant to spend half a day or night in consultation and then have the doctor say3 8,now1 doctor1 these people haven't got much money1 so don't charge them a large fee40 ,the consultant thereupon cuts his fee in two4 8,well1 doctor1 ,i'll see that you get it in a day or two10 is the reply4 ,but the consultant never gets it4 ,should he protest1 the family physician says1 8,don't be in such a hurry1 doctor1 ,i haven't got anything out of the case myself1 yet40 ,how easy it would be for the physician who calls the consultation to see that the fee is ready when the consultant comes4 ,unless there is an understanding that the case is one of pure charity1 the physician calling the consultation should be held responsible for the fee4 ,the consultant himself cannot always do so1 but where possible he should stipulate beforehand that a certain fee be in readiness4 ,the family physician who does not know that such a plan is best for his own interests is stupid4 ,an intolerable nuisance to the consultant is the doctor who writes a friendly letter asking for 8the diagnosis1 prognosis and treatment0 of some case under his care4 ,rarely does he inclose a stamp1 never a fee4 ,the consultant who answers such letters1 save to inform the writer that office rent cannot be paid by such consultations1 is frequently laughed at for his pains1 but this should be the rule4 ,a more 8pestiferous professional parasite10 if possible1 than the foregoing1 is the doctor who refers a patient from a distance1 with a request to send the bill to him4 ,here again ,dr4 ,lydston says3 8,i have sent many such bills first and last--accent on the #8last'--but have never received a remittance1 nor do ,i expect my reward in ,heaven4 ,in the first place1 ,i am not so sure about getting there1 and if ,i were1 and knew that those doctor debtors were going to be there too1 ,i--well1 ,i'd ask for a change of venue4 ,as for the patients who are accessories to such professional #8hold-ups1' a fellow wouldn't want to chase around all over hades to collect his fees from them40 ,no less an authority than ,dr4 ,john ,p4 ,lord1 president of the ,western ,surgical ,association1 in an address delivered before the association1 said3 8,the practitioner10 he said1 8will call a man of sufficient standing to enable him to name a fancy price as the consultant's fee1 which he collects1 and then remits the consultant the minimum fee4 ,the graft element is also going into medical politics and some county societies are controlled by it40 ,it will be noticed that ,dr4 ,lord does not find fault so much with the division of fees1 as with the unfair manner of division4 ,his plaint appears to be1 not that division in itself is wrong1 but that the man who handles the money does not treat his professional brother fairly4 ,there's a lot of truth in this1 but the objectionable practice is mostly confined to a class of short-sighted practitioners who don't take the future into consideration4 ,another doctor1 speaking on the same subject1 said3 8,this is an age of commercialism in medicine and surgery4 ,graft rules the majority4 ,there are a few old fogies1 like myself1 who don't graft--but do you know why8 ,just because we're too old to learn how4 ,oh1 yes1 we'd all do it if we had a chance1 ,i presume4 ,we'd be forced to4 ,those who do it claim that they have to4 ,it may be the public's fault1 but it's certainly hard on the public which has to do the paying and which doesn't know whether it has stomach ache or appendicitis4 8,in ancient ,rome the doctors used to graft successfully4 ,they'd place a finger on the severed end of an artery and say to the patient3 #8,now1 old fellow1 just come across with the fee1 right away1 or the finger will be removed and you'll bleed to death4' 8,we are coming to that4 ,we may not work it in the same way1 but the idea will be the same4 ,even now they--or we--want money before operations1 and will endeavor to learn something of a patient's standing in the community before his check will be accepted4 ,wouldn't a business man do the same thing8 ,and if surgery is becoming a business1 why isn't it proper8 ,it is proper--from that standpoint4 ,but1 oh1 the pity of the passing of old ideals6 8,the whole matter seems to me a question of economics4 ,the medical profession is a belated profession4 ,we cannot collect a fee by statute under certain conditions--as when the call comes from a third party4 ,we must have money4 ,what is there left to do8 ,graft6 ,or #8commercialize4' ,that's a nicer name for it4 ,let's see now just what the public brings on its own head4 8,there's a man who thinks it is necessary that his leg comes off4 ,he has nerved himself for the operation and has announced his willingness to pay1 say #bej4 ,a conscientious surgeon examines the leg and saves it without the use of a knife and the man recovers the use of it4 ,in a few days he is able to sit up and dispute the bill for #ajj1 claiming it is exorbitant4 ,what do you think his argument is8 ,this3 8#8,you didn't have to operate4 ,why should it cost so much8'0 8,that may not be logic1 but it's what happens right along4 ,that is the grateful reply we get from many patients for saving them from mutilation4 ,and it is things like that which have largely influenced surgeons1 ,i believe1 to operate when it is unnecessary4 ,it is not right1 of course4 ,a surgeon should be as a father and mother to a helpless1 sick soul4 ,still he is human and he must live4 ,like ,robin ,hood1 there is a better class of surgical robber who takes only from the rich4 8,you know1 the rich are always in a precarious condition4 ,it's a mighty conscientious doctor who will tell a rich man that his trouble is only imaginary4 ,the average physician or surgeon will fly around briskly1 #8dope' the man up and then probably remove a perfectly good appendix--bill #b1jjj4 8,i attended the son of a rich man who really had appendicitis at one time4 ,the operation was successful and the boy pulled through1 although ,i never saw a more serious case4 ,i sent in a bill for #b1jjj and received no reply4 ,i tried again and received no reply4 ,shortly afterward ,i met this man on the street--you'd know his name if ,i were to mention it--and he said1 #8,i have no intention of paying your exorbitant bill4' 8,i wouldn't sue4 ,never do4 ,bad practice4 ,so ,i compromised for #ejj1 although he could have paid #aj1jjj without missing it--and the operation was worth it4 8,there are rogues in every profession4 ,there are brutes in the medical profession who will demand money from a woman before she is out of the ansthetic--who will haggle with a dying man as to terms4 ,and there are many of them4 ,i could mention names of men in ,chicago that would make you open your eyes4 ,the really first-class doctor of the old school who retains the old ideas of the profession should have a halo4 ,he deserves it4 ,of course he can't live by pursuing such antiquated methods as those of a gentleman1 but then--says the rest of the world--who needs to live1 anyway80 ,the surgeon was asked about the number of cases where lives had been lost through carelessness or stupidity on the part of surgeons4 8,caveat emptor60 was his reply4 8,you know the old gag8 ,let the purchaser beware4 ,he doesn't have to go to a poor doctor4 ,even some of the biggest grafters are eminent surgeons and at the top of their profession4 ,i do not underestimate their ability4 ,but heaven only knows there are ever so many cases of recklessness or carelessness or foolishness which have taken lives4 ,patients keep right on dying1 you know1 in spite of doctors or because of them4 8,a good example of graft which came to my notice is this3 ,a young ,swedish farmer called in a doctor in a small town4 ,he had pains and other things and looked generally shot to pieces4 ,the young doctor speedily discovered that the real trouble was lack of air--unsanitary conditions in the home4 8#8,you haven't typhoid fever1 you goat1' he told the fellow4 #8,i'll fix you in a few days4' 8,he opened the bedroom window first4 ,some one had told the farmer he ought not to raise his window nights1 and there he was sleeping in that foul atmosphere4 ,no wonder he felt badly4 ,well1 anyway1 in the course of a few days my friend had him feeling better4 ,one day he called up and said he #8wouldn't be around that day4 ,it wouldn't be necessary--patient better1' and so forth4 8,then the quack hove in sight4 ,some one had heard of him and he was sent for4 ,he gave the convalescent ,swede one look and said3 #8,my ,god1 man6 ,you've got typhoid6 ,back into bed with you immediately or you'll die4' ,the terrified farmer crawled back into bed and began to feel worse immediately4 ,then the quack #8doped' him religiously for a few days and #8completely cured him4' ,my friend had been let go in the meantime4 8,the idea of the younger generation of doctors1 ,i find1 is just opposed to the old ideal4 ,the young man wants money and as a rule he isn't particular how he gets it4 ,he hustles through school1 gorges his mind for the #8quiz'--a ridiculous thing--and gets his diploma4 ,no really good man could pass a #8quiz4' 8,some schools1 of course1 are good1 and ,i will say that the material we have in this country of which to make doctors cannot be improved on2 but1 on the other hand1 some of the schools--many of them--are so bad that no school at all would be better4 8,i must say that ,i do not entirely agree with everything you have said in your book1 but ,i must confess there is much truth in your statements4 ,as for ,dr4 ,lord's contentions--anent grafting1 fee splitting and that sort of thing--well1 almost everybody's doing it4 ,i know that4 ,the number of physicians and surgeons in ,chicago who would not do it is so small that it would be like looking for a needle in a haystack to find them40 ---------------------------------------- -------------------------------- ,,chapter ,,xii ,,proper ,,handling ,,of ,,notes ,there are times when as explained in ,chapter ,x1 the full fee cannot be obtained in cash on the spot4 ,when this occurs the only way out of the difficulty is to get the patient to sign a note4 ,but never1 when it can be avoided1 allow the note to be made payable to yourself4 ,draw it to the order of the patient and have him endorse it4 ,also make it payable at a bank1 the name of which is specified4 ,this makes it negotiable and1 if the financial standing of the maker is satisfactory1 it will be readily discounted wherever he is known4 ,it is comparatively easy for the maker of a note payable to the order of a second party to evade payment1 or at least greatly delay it1 on the plea of 8no value received40 ,it becomes doubly so in cases where the note is drawn in favor of a physician1 or the maker lives in another state4 ,when this occurs1 and it cannot be shown that the paper has passed into the possession of an innocent holder for a bona fide consideration in the ordinary course of business1 there will be trouble in collecting on it should the maker repudiate the obligation4 ,in such event collection1 if made at all1 must be enforced through the medium of a law suit4 ,this necessitates service on the maker4 ,if he can be found within the limits of the state in which the note was signed he can be sued there1 but1 as a general thing1 this is a forlorn hope4 ,as a general thing it necessitates a court action in the state where the maker resides1 and this means a hearing before a jury of his own neighbors4 ,in such cases a non-resident claimant has small chance of winning1 no matter how just his claim may be4 ,and this chance is still further reduced if he is a physician4 ,residents of other states do not look with favor upon non-resident doctors4 ,not only this1 but as a general thing they think it their duty to assist a neighbor in evading payment of an obligation to a doctor who is not one of them4 ,notes drawn in the manner described--made payable to the order of the signer and endorsed by him--are not so easily repudiated4 ,in short the burden of proof1 should a contest be made1 is not on the holder but on the maker4 ,when such a note passes into the possession of a third party the only question about collection is as to the financial worth of the signer4 ,under this latter condition notes of this kind are iron-clad4 ,when suit is brought on a note made to the order of a physician1 and the plea raised of 8no value received10 the holder must prove that full value was given and this is not always easy to do in cases of medical treatment4 ,the patient may have been absolutely cured but1 if he chooses to perjure himself and deny it who is going to prove the contrary8 ,it will be invariably held that no one is so competent to judge of improvement1 or lack of improvement1 as the patient himself4 ,law suits are uncertain1 expensive and often long drawn out4 ,frequently even the winner is a loser4 ,an easy way to avoid this annoyance and outlay is to have all notes made in the manner described4 ,never hold your notes4 ,always discount them at the first opportunity4 ,if they are made by men of means living in the town or county where you practice the local bankers will be glad to handle them at a fair rate of discount4 ,there is a specialist living in ,chicago who occasionally makes professional trips into other states4 ,on these trips he frequently has occasion to take a number of notes4 ,his patients are mostly farmers1 and these rarely carry cash4 ,just before leaving a town he will go to the local banker and introduce himself1 saying3 8,i've been doing a little business in the neighborhood and1 contrary to my usual custom1 have taken part of my fees in the form of notes4 ,if you have a few moments to spare ,i would be thankful for your opinion as to their worth40 ,he does not ask to have them discounted2 does not try to dispose of them4 ,the banker looks them over and comments on each somewhat as follows3 8,h'm1 that's ,john ,smith4 ,he's all right2 good as gold4 ,owns #bej acres of fine land clear1 and is prompt pay4 8,thomas ,jones4 ,well1 ,i'm not so sure about ,jones4 ,he's good1 but he's slow1 and will stand you off if he can40 ,thus he goes through the lot1 commenting on the financial means and willingness to pay of each signer4 ,when he has concluded the doctor gathers up the notes1 replaces them in his wallet1 chats for a moment about the weather and crop conditions1 gives the banker a fine cigar1 thanks him heartily for his courtesy1 and turns to leave4 ,country bankers make the most1 if not all of their money by discounting the notes of their neighborhood farmers4 ,they know the financial record of everybody within reaching distance4 ,men who are notoriously hard to collect from when the creditor is a stranger will pay the local banker without a murmur4 ,they don't want to 8get in bad0 with him because they want a good credit when they have occasion to borrow money4 ,the result is that the local banker can collect in full on notes which in the hands of other holders would be worthless4 ,they dislike to see notes made by their neighbors leave their bank4 ,almost invariably the banker will say3 8,what are you going to do with that paper1 ,doctor80 8,take it back to ,chicago1 and hold it until it is due1 ,i suppose10 replies the doctor4 8,i don't know what else to do with it40 8,i'll discount some of it for you1 if you wish40 8,well1 ,i wouldn't mind selling it if ,i don't have to pay too much of a share40 7,this in an indifferent manner1 as if he didn't care whether he sold the notes or kept them47 8,let me see them again10 the banker will say1 ninety-nine times out of a hundred4 ,the doctor hands them over1 and the banker sorts out some of the best1 remarking1 8,i'll take this lot at #h per cent40 8,oh1 no4 ,i don't care to dispose of them in that way4 ,it's a case of all or none4 ,i might better take a chance on them all than to have the best culled out40 ,it usually ends in the banker taking the entire lot at #aj per cent4 ,he will collect every dollar on them1 and the doctor has got rid of a lot of paper on which he would have hard work in getting half of its face value4 ,this plan seldom fails when carried out in the right way4 ,there is one class of notes on which the signers rarely make a contest4 ,these are the ones given in payment for sexual treatment4 ,a physician is1 as a rule1 safe in taking a note under these conditions as he can usually collect the full amount4 ,men are delicate about this trouble and don't want their friends and neighbors to know what they have been treated for4 ,to resist payment means a law suit in which the physician will go on the stand and1 under the questioning of his attorney1 bring out the fact that ,john ,jones1 the maker of the note1 gave it in payment of treatment for prostratitis1 or some other sexual ailment4 ,pressed for details he lays bare the whole facts of the case to the intense mortification of ,jones4 ,the doctor1 of course1 could decline to answer such questions on the ground that it would be a violation of the confidence existing between a physician and his patient1 but he doesn't want to do so4 ,he's there to collect that note1 and in furtherance of this purpose he has posted his attorney in advance as to the questions to be asked4 ,most men of sense know this and will pay their notes1 regardless of whether they have been helped or not1 rather than submit to the humiliation which they know will be heaped on them when the doctor takes the stand4 ,the hardest notes to collect are those given in payment for the treatment of ailments other than sexual disorders4 ,but even these1 if made out in the manner outlined in the opening part of this chapter1 can be realized on in full4 ,suppose a man living in ,iowa gives a note of this kind to a ,chicago physician4 ,the latter discounts it immediately at his local bank which takes it1 not because the maker is known1 but on account of the doctor's endorsement4 ,just before maturity the note is forwarded to the maker's local bank for collection4 ,the local banker notifies the maker that it holds the note1 which will be due on such a day4 ,what does the maker do8 ,why1 he antes1 of course4 ,the note is in the hands of his local banker1 a person with whom he is anxious to preserve his credit4 ,in such a case1 with the note drawn to the order of the signer and endorsed by him1 there can be no plea of 8no value received40 ,besides1 the obligation is in the hands of an innocent holder before maturity4 ,beware of collection agents who want to take your claims on a percentage commission4 ,most of them will deal with you honestly at first on small accounts1 and then get away with the entire proceeds of a big claim4 ,a few years ago a ,chicago physician gave a number of ordinary bills to a local collection agency for which he was to receive the amount of the collections less #be per cent41 the agency to stand all costs4 ,the agency did good work1 made satisfactory settlements1 and finally the doctor gave them a note for #gjj which he held against a man in another state4 ,it was to be collected on the same basis--#be per cent4 ,after several months of delay the agency advised the doctor that a compromise could be made at #djj4 ,the doctor authorized its acceptance4 ,more months rolled by1 and1 being unable to get word of any kind from the agency1 the doctor wrote direct to the local banker in the town where the maker of the note lived4 ,the banker replied1 saying that the note had been paid in full 7#gjj and interest7 several months before1 and it was then in his possession cancelled4 ,since then this physician has had his own collector1 under bond from a guarantee company1 and gets whatever money may be taken in by him4 ,it is possible that the physician might have prosecuted the agency1 but here again he would have been in a dilemma4 ,if he brought a criminal action it would not get him any money1 and if he proceeded civilly the members of the agency were execution proof--they had nothing which could be levied upon4 ,in either event1 in order to prove payment1 he would have to bring the banker here at his own expense--provided he was willing to come--so he concluded to drop the matter and accept it as a costly lesson4 ---------------------------------------- -------------------------------- ,,chapter ,,xiii ,,prescribing ,,of ,,remedies ,the time will come when the physician who has not made an arrangement with some pharmacist for a division of the prescription fees1 will be obliged to resort to old-time methods and dispense his own remedies4 ,he will have to do this1 or go out of business--excuse me1 ,i meant give up practice4 ,it's high treason1 unethical1 to speak of a doctor as being in business1 but there's no good reason for it4 ,anything that a man makes a living at is a business1 and if the doctor cannot make a living1 and something more1 why he's in the wrong rut4 ,barring the division arrangement referred to there are three things opposed to the physician's interest which the druggist must do1 or give up his store4 ,these are3 #a4--,sell patent medicines4 #b4--,prescribe over the counter4 #c4--;,charge exorbitantly for the medicines prescribed4 ,there is nothing in all this that is illegal1 but it is opposed to the best interests of the profession4 ,at first sight it appears an evidence of imbecility to send prescriptions to be compounded by a competitor4 ,yet you send them to the druggist1 who is your most active competitor4 ,not only is he one directly1 but he is often the agent of some other doctor or doctors whose merits he glibly contracts with your demerits1 for the edification of the patient4 ,you tell him1 time and again1 not to repeat your prescriptions1 but to no purpose4 ,in some cases you know that he is giving commissions to one set of doctors1 while his clerks are getting commissions from practice sent to others1 yet you stick to him4 ,now1 there's but one solution of the problem4 ,every doctor who can should dispense his own medicines4 ,the people like it1 and the profession will soon learn to like it4 ,the doctor can furnish medicines cheaply and still make a profit4 ,the patient pays a bill for services and medicines much more cheerfully than one for services alone4 ,not the least of the good things that would result from the doctor doing his own dispensing would be the familiarity with his working tools thus acquired4 ,most men enter practice without the least knowledge of the physical qualities of the drugs they expect to use4 ,many a man has prescribed1 over and over again1 remedies he never saw1 smelt or tasted4 ,the best doctor is he who is most familiar with his curative agents4 ,another desirable result would be the doctor's renunciation of polypharmacy4 ,he would soon learn that the number of serviceable drugs is by no means legion4 ,where a number of doctors occupy an office1 they should have their own dispensary4 ,when neither plan suggested is feasible1 the doctor should endeavor to find a druggist who1 in consideration of having practically a monopoly of the prescriptions of that particular physician1 will dispense his prescriptions on cipher and never without an order4 ,it is possible to find such druggists4 ,self-interest is likely to induce them to treat the doctor fairly1 when all other arguments fail4 ,there is a peculiar advantage in this system in the fact that the doctors' favorite formul can be kept in quantities already prepared1 thus saving time and assuring uniformity in dispensing4 ,under such an arrangement1 too1 the druggist is able to be much more reasonable in his prices4 ,he is also likely to keep such special preparations as the doctor may request1 thus avoiding the temptation to substitute4 ,one thing is certain in the relations of doctor and druggist1 viz41 the time is not far distant when the doctor will either dispense his own drugs or will boycott every druggist who counter-prescribes or sells patent medicines4 ,the profession will not go blindly on forever1 carrying grist to the other fellow's mill4 ,next we must contend with the proprietary medicine fakir4 ,the doctor's experience often breeds a lack of confidence in his remedies1 and his materia medica narrows year by year4 ,yet his patients clamor for relief1 and in despair the doctor receives1 with open arms1 the fakir who agrees to furnish him with speedy cures4 ,behold the result4 ,the pharmacopeia is fast drifting into the valley of dead lumber4 ,it is no longer necessary to know anything of materia medica and therapeutics--the fakir attends to all that for us4 ,we are no longer offended by the gratuitous insult offered us by the proprietary medicine fiend1 who knocks at our door1 and1 with the implied insinuation that he furnishes brains for the medical profession1 clutters our office tables up with samples1 the labels on which tell us all about diseases and the only preparations that will cure them4 ,pah6 ,how most of them smell6 ,and what a nuisance they are4 ,but the fakir has done his work well4 ,he has evolved the ready-made doctor--man of all work1 aye1 slave to the fakir4 ,how gently flows the current of ,dr4 ,readymade's professional life4 ,no more incurable cases4 ,no more midnight oil--for why should he be a slave of the lamp8 ,no more worry4 ,no more care4 ,no more expenditures for books1 journals and instruments4 ,all the doctor has to do nowadays is to read the labels on the bottles and boxes of samples the fakir brings him4 ,does the patient complain of stomach disturbance8 ,he is given 8,stomachine40 ,are his kidneys working overtime8 8,kidneyol0 is the proper caper4 ,is there a pain lurking somewhere in his economy8 ,give him one of these pretty little tablets with a hieroglyph on it1 which nobody knows the composition of--so the firm that makes them claims4 ,oh1 the practice of medicine is so easy nowadays4 ,ready-made diagnosis and treatment--what could be simpler8 ,the proprietary medicine fakir begins his little song by assuring the physician that his wonderful preparation is for the use of the profession only4 ,he is trying to introduce it 8along strictly ethical lines40 ,he has given the preparation a fanciful name and marked it with a special design 8for the protection of the physician1 who1 of course1 wants to know that his patient gets just what is ordered40 ,what an imbecile the doctor is4 ,the chief objects of the special name and hieroglyphic design are3 7#a7 ,to induce the physician to order the preparation frequently1 the name being catchy and easy to remember4 7#b7 ,to let the patient know what is ordered1 so that he can prescribe it for himself and friends without the aid of a doctor4 ,having popularized the preparation in this manner1 the proprietary medicine man often advertises his wares directly to the public via the secular press4 ,if the profession protests1 the wily medicine man says3 8,well1 you indorsed it2 the profession uses it2 hence it is a good preparation and a benefit to humanity4 ,go to1 you are bigoted and narrow-minded40 ,now1 brethren1 while the foregoing remarks are fresh in your minds1 try and recall the facts regarding 8,scott's ,emulsion0 and the 8,midy ,capsule40 ,not all proprietary medicine men take the newspaper route--they don't have to4 ,the catspaw doctor does his work too well4 ,witness the 8little joker0 anti-pain tablet already mentioned4 ,probably ten times as much of this preparation is self-prescribed as is prescribed by physicians4 ,it unquestionably contains drugs that should be taken only under medical advice1 and yet physicians prescribe it in a manner which leads directly to self-prescribing by the laity4 ,is it possible that the ,pharmacopeia offers no agent of equal or better merit8 ,has the manufacturer more wisdom than all the ages past--to say nothing of the present age of progress8 ,or is this an age of medical progress1 anyway8 ,we herewith submit the proposition that the medical catspaw is pulling the proprietary monkey's chestnuts out of the fire1 every time he prescribes a proprietary article 8protected0 by special design and under a term that he who runs may read4 ,the fakir laughs in his sleeve at the profession1 and small wonder4 ,it has come to pass that he owns us1 and when his impudent agent demands a hearing at our offices we are tacitly given to understand that our time is his by right4 ,perhaps it is1 by right of conquest1 for the medical profession seems to be thoroughly subjugated4 ,the distributor of drug samples is always working in the business interests of his firm and himself4 ,how would it do to insist on payment for our time from the agents of some of our irresponsible1 mushroom fake medicine factories8 ,there is another side to the picture4 ,drug manufacturers--even some of those engaged in the manufacture of quasi-proprietary medicines--have done much for pharmaceutic elegance and convenience4 ,many of our manufacturers are conscientiously proceeding along ethical lines4 ,we are glad to welcome their representatives and their preparations4 ,but1 unfortunately1 such manufacturers are a small minority4 ,the physician should be careful how he prescribes the preparations of even reliable firms4 ,preparations with special and striking names should be prescribed under formula1 where possible1 and always in such a manner that the patient cannot prescribe the preparation for himself offhand4 ,we have much for which to thank some of our manufacturers1 in the way of elegant and reliable preparations--honor to whom honor is due4 ,we should none the less1 however1 guard our own interests4 ,the manufacturers cannot always do so1 and sometimes will not4 ,there is no objection to secret methods of preparation of medicine so long as the formula is known4 ,the physician should know what he is prescribing4 ,it is an insult to offer him any other class of preparations4 ,when prescribing he should prescribe under a term comprehending the formula of the drug1 or under his own cipher4 ,where the nature of the preparation is such that he cannot do this1 the doctor had better look elsewhere for a remedy4 ,again we say1 if you cannot make a satisfactory division arrangement with a competent pharmacist who will protect your prescriptions1 and treat them as confidential1 dispense your own remedies4 ,never prescribe a proprietary remedy by its trade name4 ,in so doing you advise the patient of what he is taking and in time he will buy it without your prescription or advice4 ,if you are satisfied that the preparation is a good one and really has medicinal merit--which a few of them do--prescribe it1 if you must1 by formula4 ,don't let the patient know what you are giving him4 ,the money in the practice of medicine is in mystery4 ,people don't attach much importance or value to things that they know4 ,it is the mysterious that commands their attention--and money4 ,let a man know that you are giving him a certain proprietary preparation and he values it only at the established market price4 ,give him the same ingredients in the form of a regular prescription1 each item written out in its ,latin name with the proper hieroglyphics for quantities1 and he will rate you as a wonder worker4 ,add 8aqua1 quant4 suf410 and he is knocked daffy4 ,it's simply another form of that peculiar trait of human nature which leads the average man to 8kick0 when his regular family physician charges #e for making a ten-mile call on a stormy night1 when he will travel the ten miles himself and cheerfully pay a specialist #be for ten minutes' consultation in the latter's office4 ---------------------------------------- -------------------------------- ,,chapter ,,xiv ,,corporation ,,doctors ,of recent years many corporations1 especially the large manufacturing and railway concerns1 have made it part of their policy to employ doctors on contract4 ,at first such jobs paid fairly well4 ,it was to the interest of the corporations to engage men of reputation and they had to pay them4 ,it sounded well1 it created a favorable impression1 to have it known that the ,united ,states ,steel ,corporation had engaged the celebrated ,dr4 ,curem to attend to such of its employees as might become sick or disabled while in service4 ,truly1 a generous corporation1 the public would argue4 ,it not only looks after its sick and injured without charge to the unfortunate1 but it gives them the benefit of the best medical and surgical talent obtainable4 ,but the corporations did not do this from philanthropic motives4 ,not much4 ,it was a matter of business4 ,sickness and accident among a large force of employees costs money4 ,the quicker it can be overcome the better off the company will be4 ,but1 the reputation for philanthropy once established1 the corporations began to economize in their outlay for medical expenses4 ,for this the doctors and surgeons were largely at fault themselves4 ,the plum was too tempting and there was a keen competition for it1 with the result that prices took a sharp tumble4 ,physicians with a small practice who heard of other doctors getting #e1jjj a year to look after the sick and injured employees of a corporation argued that they would like to do the work for #b1jjj4 ,it would ensure living expenses1 and what they could pick up on the side in regular practice would be profit4 ,they didn't know1 until too late that the demands on their time would be such that they would have little opportunity for outside practice1 and that the #b1jjj they received from the corporation would cover their entire income4 ,so they began bidding and wire-pulling against one another1 and the corporations1 wise unto their day and generation1 took advantage of the unseemly competition4 ,in no one line of corporate endeavor is this competition more keen and noticeable than in life insurance4 ,it is not so very long ago that the position of medical examiner for a good company was a respectable1 lucrative position4 ,what is it now8 ,it is safe to say that there is hardly a company in the field to-day that pays a decent sum for its medical examinations4 ,the doctor is the watchdog of the company's treasury4 ,he stands between it and great financial loss4 ,he protects it against fraud4 ,a slight error or the least degree of negligence on his part may cost the company thousands and thousands of dollars4 ,the issuance of a policy is a very important business transaction4 ,the doctor stands in the same relation to it as does the lawyer who examines the abstract in a real estate deal4 ,contrast the fee allowed the medical examiner in a case involving the issuance of a #ajj1jjj life insurance policy and that received by the lawyer who examines the abstract in a real estate transfer involving #e1jjj1 and my argument is complete4 ,some companies expect to secure all of an expert examiner's time--and actually get it--for #b1jjj to #c1jjj a year4 ,it might be well to contrast1 also1 the commission received by the agent who writes the policy1 with the medical examiner's fee4 ,in the case of our fraternal societies the examiner's fees are pitifully low1 so low that a busy man cannot do the work save at a great loss of time4 ,there are some extenuating circumstances in the case of the co-operative societies4 ,in the case of both old line and co-operative insurance1 however1 only the overcrowded and generally poverty-stricken condition of the medical profession can possibly explain the fact that good men are to be had so cheaply4 ,railroad and manufacturing corporations have no difficulty in securing doctors to look after their interests at a rate so low as to reflect on the respectability of the profession at large4 ,there are1 for example1 instances in which doctors are rendering for #cjj a year services that should bring several thousand dollars at very ordinary fees4 ,in addition to this direct cheapening of professional values1 the company or corporation surgeon is expected to go on the stand as an expert and prevaricate in the interests of his employers4 ,as a corollary1 he is expected to testify against the interests of the poor fellow who1 perhaps1 as the result of the company's wilful neglect1 has only the wreck of a once vigorous manhood with which to oppose the company's immense capital4 ,and this the doctor does in an uncomfortable proportion of cases4 ,when the charge is made that he 8prevaricates0 it is correct4 ,it would be pitiful1 indeed1 if the expert opinions rendered by some corporation doctors were the result of ignorance4 ,the corporation expert does not always prevaricate4 ,the truth may be the best card to play4 ,he had better not let the corporation catch him telling the truth1 however1 when said truth is prejudicial to its interests4 ,there is an ax1 my brethren1 an ax that is ever ready4 ,speaking of corporation surgeons reminds me of the fact that practice in the neighborhood of our large factories is rather poor picking for everybody4 ,there is plenty of work to be done1 and there would be considerable income derived therefrom1 but the corporation surgeon gets it all1 and receives a mere pittance therefor4 ,the corporation claims to employ a surgeon for humanity's sake4 ,this is pure hypocrisy--the doctor is employed for its own protection4 ,every doctor knows of cases in which1 by the co-operation of the claim agent and the surgeon1 an injured employee has been induced to sign away his manifest rights4 ,he is usually denied the right to select his own surgeon4 ,to the non-partisan medical observer1 the bitter opposition of the average juryman to corporations is in no wise remarkable4 ,it will be argued that there are plenty of honest corporation doctors4 ,grant you that1 but it is hard to see how they hold their jobs4 ,then there is a hurtful disposition to fraternize4 ,in the good old days the regular profession ostracized him who consulted with that horrid bugaboo1 the homeopath4 ,it has come to pass that the regular lion has laid him down beside the homeopathic lamb4 ,and when they rise again the mutton shall be no more1 and the lion shall have waxed fat4 ,the latter-day regular has gone farther1 and hobnobbed1 as on equal terms1 with 8osteopaths10 8,christian ,scientists10 8faith healers10 and others of their ilk4 ,not so8 ,oh1 yes it is4 ,it is not long since the ,physicians' ,club of ,chicago invited representatives of these creeds to break bread with it1 and formally discuss the merits and demerits of their theories as opposed to regular medicine4 ,the affair was given great publicity in the newspapers1 and the wise layman1 reading thereof1 laughed exceedingly merry and said1 8,what fools these doctors be40 ,and1 from a business1 politic and social standpoint1 were they really so very clever8 ,the ,physicians' ,club gave these people standing in the public eye1 and by inviting them to a joint discussion1 gave them professional recognition--a recognition they were not slow to use as a valuable advertisement4 ,if a dinner invitation does not constitute social recognition1 what does8 ,this action of the ,physicians' ,club did more to further the interests of these people than they themselves could have done in a year4 ,still1 mistakes will happen1 and the worst that can be said of the club is that it made a serious1 impolitic and unbusiness-like blunder4 ,it is much easier to direct attention to faults than it is to suggest remedies therefor4 ,in most of the points here made1 the remedy suggests itself4 ,in general1 the remedy lies in an improvement of professional esprit de corps4 ,with a betterment of this as a foundation1 much can be done to improve the business aspect of medicine in its higher sense4 ,the time will come when professional co-operation in the broadest sense will be absolutely necessary if we would survive4 ,a little of the proper spirit of trades unionism might not be a bad thing4 ,so far as the strictly financial aspect of legitimate practice is concerned1 the sooner we impress the public with the idea that we appreciate our own market value and insist on its appreciation by the public1 the better it will be for the profession4 ,once let it be understood that ours is a business-like and financially sound profession1 and the hoi polloi will give us the respect that is our due4 ,the public should have frequent and pointed reminders that there is more than a philanthropic side to our labors4 ,the doctor's wife and children deserve quite as much consideration as the layman's4 8,i know that the world1 the great big world1 ,from the peasant up to the king1 ,has a different tale from the tale ,i tell1 ,and a different song to sing4 ,but for me--and ,i care not a single fig ,if they say ,i am wrong or right-- ,i shall always go in for the weaker dog1 ,for the under dog in the fight4 ,i know that the world1 the great big world1 ,will never a moment stop ,to see which dog may be in fault1 ,but will shout for the dog on top4 ,but for me1 ,i shall never pause to ask ,which dog may be in the right1 ,for my heart will beat1 while it beats at all1 ,for the under dog in the fight4 ,perchance what ,i've said were better not said1 ,or 'twere better ,i'd said it incog2 ,but with heart and with glass filled chock to the brim1 ,here's luck to the under dog40 ---------------------------------------- -------------------------------- ,,chapter ,,xv ,,medical 8,,steerers0 ,,and ,,their ,,work ,every doctor has his steerers1 people who drum up business for him4 ,in many instances it is a service willingly performed out of real affection and confidence in the skill and ability of the physician4 ,the latter is unconscious of any such influence being exerted in his behalf until he is told by some new patient1 8,i was advised to come to you by ,mr4 ----1 who says you are the only man who ever did him any good40 ,this is 8steering10 legitimate1 unpaid-for steering4 ,the doctor is1 of course1 grateful to ,mr4 ----1 or ought to be1 but it is seldom that he gives the matter a second thought4 ,then there is another kind of 8steering10 the cold1 commercial variety in which the labors of the steerer1 if they are successful1 are rewarded in coin of the realm4 ,nearly every advertising physician--and some who do not advertise--has one or more of the genus 8steerer0 on his staff4 ,there is just as much caste1 just as pronounced a social distinction in this calling as there is in the medical profession itself4 ,the cheap doctor has cheap1 rough steerers2 the doctor who is higher up in the social scale has smooth diplomats in his employ4 ,the object of all is the same--to get business for their employer1 and the more business they get the larger are their incomes4 ,there are some steerers who think themselves well repaid if they are handed a dollar for each patient they land in the office of the physician who employs them4 ,these are the men who can approach only a cheap class of people to whom a five dollar fee is the limit4 ,the better class of steerers1 the men who work for the big fee getters1 scorn a salary1 or a stated amount for each patient4 ,they prefer a percentage1 usually one-quarter of the fee secured from the patient4 ,there are men in ,chicago who are making #aej a week in this occupation4 ,go into the rotunda of any first-class hotel in ,chicago1 ,new ,york1 or some other large city and affect to walk lame as if afflicted with locomotor ataxia1 or make up to resemble a confirmed invalid4 ,it will not be long before you will be approached by some well-dressed1 prosperous-looking individual who will say3 8,beg pardon1 sir1 but you appear to be suffering from locomotor ataxia4 ,you will excuse me for addressing you1 but ,i was afflicted in the same way myself for ten years1 and have a sympathetic feeling for fellow sufferers40 ,if you are a genuine sufferer this will command your attention4 ,here is a robust1 healthy man who tells you that for ten years he was afflicted with the same ailment which you have been assured by many physicians is incurable4 ,naturally you want to know how the disease was overcome4 ,the stranger smiles1 and says3 8,why the thing is so easy it sounds ridiculous1 and ,i dislike to tell of it on that account4 ,for eight years ,i doctored1 and spent a large amount of money1 without obtaining the slightest relief4 ,about two years ago ,i read in a magazine of a new treatment with which wonderful results were being accomplished4 ,after so many failures ,i naturally didn't have much faith1 but things couldn't be any worse so ,i decided to investigate4 ,what ,i learned led me to take the treatment4 ,there was an improvement after the first week1 and at the end of the sixth month ,i was just as sound as ,i am to-day4 ,that was eighteen months ago1 and there are no signs of a reaction of any kind40 ,by this time the real sufferer is deeply impressed4 ,here is a prosperous stranger1 once a fellow sufferer1 dangling before his eyes the hope1 nay1 the certainty1 of cure1 with no other object than that of sympathy4 ,it is the one chance for which he has been so long and fruitlessly seeking4 ,pressed to tell where this wonderful treatment may be had1 the 8steerer10 if he is one of the sharp ones1 will be apt to say3 8,i believe the address is ,no4 ---- ,michigan ,avenue4 ,let's see1 ,i think ,i have the doctor's card in my pocket somewhere40 ,meantime he searches through various pockets 7knowing full well all the time where it is7 and finally locates the doctor's card4 8,ah1 yes1 here it is4 #8,dr4 ----1 ---- ,michigan ,avenue4'0 ,adroitly he changes the topic at this point1 shifting to the various features of the disease itself1 its excruciating pains1 the cushion-soled feet1 loss of various bodily functions1 and other unfailing accompaniments of the ailment4 ,comparing notes the two find that they have suffered much in the same way 7all ataxia patients do7 and from that moment there is a strong bond of fellowship between them4 ,the smooth steerer tells of the various treatments he had taken at great cost and without results1 glibly describes the many drugs swallowed1 and the tortures endured with mechanical appliances1 such as the 8hanging0 process1 winding up with 8but not one of them did a bit of good until ,i took up the ---- ---- treatment40 ,the actual sufferer has met a congenial spirit1 and talks freely4 ,without realizing it he tells of his business affairs1 his financial condition1 and similar matters4 ,during all this the steerer makes no suggestion that he should call on ,dr4 ----4 ,far from it4 ,he studiously avoids anything of the kind4 ,the bait has been cast and the fish will rise to it of his own accord4 ,having secured all the information he wants the 8steerer0 will rise and excuse himself on the ground of an important business engagement4 ,handing out a neatly engraved card he says3 8,if you ever come to ,new ,york1 ,mr4 ----1 ,i would like to have you hunt me up4 ,i'd stay longer with you this afternoon1 but for this pressing engagement40 ,the card reads about like this3 ,,mr4 ,g4 ,,addington ,,wells #ajbg ,broadway ,structural ,iron ,new ,york ,city ,the card is a blind4 8,g4 ,addington ,wells0 is an assumed name4 ,but it sounds well4 ,your smooth 8steerer0 never pretends to live in the same city in which he finds his victim4 ,it might be too easy to locate him in case he was wanted4 ,he lives in ,chicago1 all right1 but he assumes the role of an ,eastern business man here on business purposes4 ,his appearance1 his general 8get up10 his talk is all impressive and calculated to beget confidence4 ,that's his business4 ,he's a fake all through1 even to the nature of the ailment with which he pretends to have been afflicted4 ,he was never seriously ill in his life4 ,but he's a clever fakir2 we must give him credit for that4 ,he's an artist in his line4 ,there is one man of this kind in ,chicago so thoroughly posted in medicine that he can accurately describe the symptoms and characteristics of half a dozen chronic ailments1 and in one week has successfully played the role of having entirely recovered from each4 ,if he meets a tabetic sufferer he has been successfully treated for tabes1 and will converse intelligently about tabetic conditions4 ,chronic arthritis1 nephritis1 paralysis agitans1 lateral sclerosis2 they are all known to this chap4 ,he's had them all--in his mind--when he wants to impress a sufferer1 and he seldom makes a mistake4 ,almost invariably as the 8steerer0 is about to leave the sufferer will say3 8,if ,i can stand the trip ,i'll go down and see this ,dr4 ---- this afternoon4 ,how far is it from here80 8,well1 it's quite a journey for a man in your condition1 but ,i'll tell you what ,i'll do4 ,if you want to go now you can ride in my cab4 ,i'm going that way and ,i'll drop you out at the doctor's4 ,he will see that you get back to the hotel all right40 ,this suits the sufferer1 who is pleased with the attention shown him by the 8steerer40 ,the latter excuses himself for a moment while he 8telephones for a cab40 ,he goes into the telephone booth but1 instead of calling for a cab1 he rings up the doctor4 8,hello1 is this ,dr4 ----8 ,yes4 ,this is ,wells4 ,just landed a good one at the ,la ,salle4 ,will bring him down in about twenty minutes4 ,name is ,smith1 banker at ,pontiac4 ,well fixed40 ,then he rejoins the sufferer1 escorts him carefully to the sidewalk and places him in a taxicab4 ,the doctor's office is not far off1 but the chauffeur takes the longest way1 and during the ride the 8steerer0 tells of having lived in ,new ,york all his life with the exception of the six months he was under treatment in ,chicago1 and dilates upon the wonders of the ,eastern metropolis4 ,on reaching the doctor's the 8steerer0 looks at his watch1 saying3 8,i've got ten minutes to spare so ,i'll go up to the doctor's office with you40 ,the sufferer is glad of this assistance1 and when they reach the office is impressed by the dignified appearance of the specialist who greets 8,wells0 warmly4 8,how do you do1 ,mr4 ,wells4 ,i was afraid you had forgotten me40 8,oh1 no1 ,doctor1 ,i couldn't do that1 after all you have done for me4 ,but1 really ,i can't stop to talk now4 ,i'll see you again before ,i leave town4 ,dr4 ----1 this is ,mr4 ,smith of ,pontiac1 who is suffering the same as ,i was4 ,if you do as well for him as you did for me ,i think he will have reason to be glad he came here4 ,good day1 gentlemen4 ,excuse me for my haste1 but ,i must get away40 8,fine man1 that ,wells10 says the doctor to ,mr4 ,smith1 after the 8steerer0 has gone4 8,yes1 indeed10 replies ,smith4 8,mighty glad ,i met him4 ,he has given me a lot of valuable advice and aid40 8,one of the toughest cases ,i ever had10 continues the doctor1 8but ,i pulled him through all right1 and ,i'm proud of it40 ,by this time ,mr4 ,smith is an easy subject to handle4 8,wells0 has paved the way1 and the doctor does the rest4 ,smith pays a good-sized fee1 say #a1jjj1 and begins treatment4 ,later in the day the 8steerer0 calls on the doctor again and gets his bit--#bej4 ,any chance for the doctor to hold out on him8 ,not a chance in the world4 ,in the first place he is too valuable a man to lose and it is to the doctor's interest to treat him fairly4 ,besides this the 8steerer0 is in position to protect himself4 ,if he has any doubts about the size of the fee he will drop in on ,mr4 ,smith again at the hotel the same evening 8just for a moment's chat before ,i leave the city40 8,how did you get along with the doctor1 ,mr4 ,smith80 he will ask4 8,very nicely4 ,he seems to be a good man1 and apparently understands his business4 ,but he's pretty steep in his fees40 8,yes2 he's a good man1 and an ,a ,no4 #a physician4 ,as for fees1 all these big specialists charge pretty well1 but we shouldn't mind that if we get relief4 ,i paid him #a1jjj40 8,that's just what he charged me10 says ,mr4 ,smith4 ,after a few moments chat the 8steerer0 leaves1 satisfied that the doctor has given him the agreed-upon commission4 ,if1 on the other hand1 he finds that the doctor has 8held out0 on him he hunts him up and remonstrates4 ,should this be of no avail the 8steerer0 severs business relations with that particular specialist1 and makes a compact with one of his competitors4 ,good 8steerers0 are always in demand and the doctor who picks up an artist in this line is pretty sure to use him well so as to make sure of retaining him4 ,it is not every day that the steerer can pick up a patient that will net him #bej4 ,sometimes his 8bit0 will not be more than #ab4ej or #be1 but it is safe to say that a smooth man who thoroughly understands the business can easily average #aej a week4 ,he takes life easy1 dresses well1 and lives on the fat of the land4 ,few patients after paying a big fee to the doctor feel like staying at an expensive hotel for any length of time4 ,besides this the doctor generally manipulates matters so that the patient finds it to his interest to board at some place recommended by the physician4 ,this clears the road for the steerer at the hotels and leaves him free to operate among them without fear of running into any of his victims4 ,in a city where there are a number of large hotels it is an easy matter for the steerer to so regulate his movements as to avoid suspicion by being seen around any one house too often or continuously4 ,there are women 8steerers0 also1 but they work in a much different manner from the men4 ,in nearly every community there are women of business instinct who are not averse to earning some 8easy0 money4 ,one of these women will make an arrangement with ,dr4 ,sweatem by which she is to receive a commission on all the patients she may send him4 ,her commission is not so large as that given the men steerers because she does not work among strangers1 or personally take such patients as she may secure to the doctor's office4 ,still it is a handsome sum--generally #aj or #ae per cent of the fee--enough to give an active1 influential woman a very respectable income4 ,the woman 8steerer0 makes it her business to join various clubs and churches1 take part in all women movements1 and to get acquainted with as many of her sex as possible4 ,she especially cultivates the acquaintance of well-to-do women who are real sufferers1 or imagine themselves to be afflicted in some manner4 ,she encourages them to talk about their physical troubles1 is kindly sympathetic1 and1 at the proper moment makes delicate suggestion that it would be well for the sufferer to see ,dr4 ,sweatem4 8,he's such a grand man4 ,seems to know just what to do1 and has been so successful in treating a lot of my friends4 ,i wouldn't think of going to anyone but him myself40 ,thus the seed is sown1 and in time bears fruit4 ,the well-to-do sufferer goes to see ,dr4 ,sweatem and is relieved of a good fee1 if nothing else4 ,the doctor in the meantime has been advised over the phone by the woman 8steerer0 that ,mrs4 ---- is coming to see him1 and informed as to her financial condition1 as well as the nature of the ailment with which she thinks she is afflicted4 ,armed with this information he knows just what to do when ,mrs4 ---- arrives at his office1 and the patient is deeply impressed by the manner in which he so accurately diagnosed her case at the first interview4 ,another point of information always conveyed in advance to the doctor is the age of the prospective caller4 ,thus advised1 when the interview does take place he is in position to say3 8,a woman of your age--let's see1 you're not over #cb1 are you1 ,mrs4 ----8 ---- ought to10 etc4 8,oh1 yes1 ,doctor1 ,i'm #dj10 will be the answer4 8,you surprise me4 ,i would never think it40 ,foxy doctor4 ,he knows all the time her exact age because the 8steerer0 has told him1 but he's too smooth to give himself away4 ,and thus he makes another ally1 and easily-duped patient4 ,as for ,mrs4 ----1 she is enthusiastic4 ,she reports her visit to the 8steerer10 saying3 8,i'm glad you advised me to go4 ,he's a splendid doctor2 perfectly lovely1 and ,i know he's going to do me good40 ,and he does4 ,not only that1 but the chances are that her enthusiasm will give ,dr4 ,sweatem opportunity to 8do0 the patient's intimate friends and relatives also4 ---------------------------------------- -------------------------------- ,,chapter ,,xvi ,,what ,,should ,,the ,,physician ,,do8 ,all this leads up to the question 8,what is the young physician to do80 ,the majority of them can remain strictly ethical and drag out a miserable existence1 so far as getting a livelihood from the practice of their profession is concerned1 because they never should have studied medicine in the first place4 ,those who are equipped by nature and education for successful practice1 may gain a competence by imitating some of their elders 7those who howl the loudest about violation of ethics7 and throw down the bars4 ,just how far they may graze in the non-ethical pasture is a matter for each practitioner to judge for himself4 ,according to the ,journal of the ,american ,medical ,association1 the organ of the strictly ethical cult1 there are #adj 8acceptable0 medical colleges in the ,united ,states1 turning out on an average of #e1jjj young doctors annually1 to say nothing of those graduated from other schools4 ,the census of #aijj gave the number of physicians in the ,united ,states1 including ,alaska and ,hawaii1 as #acb1dci1 an average of one to each #abb4e families4 ,but these are not distributed pro rata4 ,naturally the doctors are most numerous in the thickly settled parts of the country4 ,hawaii has one physician to every #a1dab persons1 and ,utah one to every #ijg4 ,the ratio in the entire ,united ,states is one to every #ege4g people4 ,in the ,district of ,columbia1 however1 which is virtually co-extensive with the limits of the city of ,washington1 so far as population is concerned1 official figures show one doctor to every #big residents4 ,chicago1 with a population of #b1ahe1bhc people1 has #d1dcb doctors1 one to each #eae people4 ,the plain fact is that the medical schools are grinding out alleged 8doctors0 too fast1 and without proper regard for individual qualifications4 ,but there is some sign of improvement4 ,the better class of colleges1 notably ,rush ,medical and the ,college of ,physicians and ,surgeons1 have called a halt1 and are insisting upon a higher grade of attainments for admission1 and upon a more thorough and searching examination at graduation time4 ,last year the ,college of ,physicians and ,surgeons alone turned away #aej applicants as not being fitted for a medical career4 ,this new system has had the effect of greatly reducing the number of candidates for medical diplomas4 ,in #aijj-aija ,rush ,medical had #a1jee students on its rolls2 in #aiji-aiaj the number was only #ehd4 ,the decrease at the ,college of ,physicians and ,surgeons1 while not so marked1 was still a healthy one4 ,in #aijj-aija this college had #fgf students2 in #aiji-aiaj the number had dropped to #ebi4 ,but1 despite this reduction1 the number graduated every year is still much too large4 ,there are at least #b1jjj alleged 8doctors0 turned loose every year whose medical services could well be dispensed with--with profit to themselves1 and more safety to the community4 ,taking the average of one physician to every #abb4e families it follows that1 in order for each doctor to earn the modest income of #b1jjj a year each family must contribute #af4ca in fees every year4 ,this is preposterous4 ,again we are brought face to face with the question1 8,what is the young physician going to do80 ,as said before1 he can kick down the bars of the ethical field and emancipate himself1 if he has brains1 courage1 and a winning address4 ,or1 he may assist in the formation of a sort of labor union for the maintenance of fees and the black-listing of dead beats4 ,this latter course1 however1 is not likely to prove effective1 as there are too many needy ones in the profession ready to remain outside of such a union and grab what they can4 ,dr4 ,w4 ,a4 ,evans1 commissioner of health for the city of ,chicago and for twenty years in touch with the medical profession1 says that hundreds of physicians in ,chicago are virtually without means to support their families4 ,what a man situated like this often does do in the circumstances may work disaster even upon the general public4 ,he may help put the records of the health department to the bad4 ,here is an example in point4 8,a young doctor is called into a family which lives in the rear of a man's place of business1 above the store or next door to it4 ,the competent young physician discovers a patient suffering from diphtheria1 scarlet fever1 maybe smallpox4 ,the law requires the posting of placards and the isolation of these victims of contagious diseases4 ,but at once the family in such close connection with the place of business recognizes what such a placard may mean to the business by which the family of the patient lives4 8,will you imagine the pressure that may be brought to bear on this physician whose own family is so dependent upon him8 ,isn't it reasonable that with sufficient compensation offered him he is likely to cover up the infectious case8 ,or if the family has not thought of offering the inducement1 the young doctor himself may propose it and ask the limit of compensation40 ,educated1 brainy physicians of high standing1 are beginning to balk at some of the ethical commandments which bar the way to a doctor's increasing his income4 ,when ,dr4 ,oscar ,a4 ,king was asked what he thought about the division of fees1 he said3 8,why not8 ,the physician who has diagnosed the trouble and finds that an operation is necessary may have paid only two or three visits to the patient at #b or #c a visit4 ,the result is that1 honestly1 he must give his patient over to a surgeon4 #8,what surgeon8' is asked most frequently by the patient4 ,honestly the doctor names a man who has taken many cases from him and most successfully4 ,but where the physician gets #h or #aj1 the surgeon may get #aej1 #cjj1 or #ejj4 ,and--except for the physician--the surgeon never would have heard of the patient40 8,it's all fair enough if openly above board10 said ,dr4 ,evans1 in reply to the same question4 8,it would be a most logical thing in business1 only that the public is not prepared to compare business with the professions of medicine and surgery4 ,when it comes home that both doctor and surgeon must be assured of a living1 however1 the fact is a jar to the purely ethical40 ,another physician said3 8,i have just had an experience along the line of the split fee4 ,an old doctor friend of mine discovered the presence of gall stones in his patient4 ,it is a difficult thing to diagnose with certainty4 ,my friend1 however1 made no mistake and received #be from the wealthy patient4 ,the surgeon who operated in the comparatively simple case got a fee of #ejj4 ,it would have been only fair for the physician to have received part of that #ejj fee1 and ,i think he was a chump if he did not get it40 8,but you can't put a profession on a business basis10 shriek the high moguls of ethics4 ,why not8 ,on this subject ,prof4 ,george ,burman ,foster1 of the ,university of ,chicago1 speaks plainly1 as follows3 8,what is the difference between a profession and a business8 ,is it1 as was once thought1 that the former is fulfilled by the mind and the latter by the body8 ,but1 for example1 dentistry is quite manual and engineering or carpentry quite mental as well4 ,besides1 the old idea of a dualism between mind and body is no longer held by the modern man4 ,then is the difference that the profession is #8learned' but the business is not8 8,but we have men who are not college graduates entering the professions1 while business of a higher order is clamoring for college graduates4 ,besides1 we have changed our notion of what constitutes #8learning' and concluded that the man who by experience has learned #8life' may know quite as much as the man who has learned books in the school4 ,but is the difference1 then1 that the professional man receives a special professional training1 while the business man does not8 ,but farmers are going to agricultural schools1 while the majority of preachers still do not go to a theological school6 8,shall we say that the professional man is distinguished by eminent character and ability1 while the business man is not8 ,hardly4 ,we know that while the business principle is pagan and not ,christian to-day1 still the average business man is quite as good as the average professional man1 no matter what the profession may be4 8,who deserves more honor--the farmer who provides us with our daily bread1 or the dentist who keeps our teeth so that we can eat it1 or the physician our stomach so that we can digest it8 8,the best sign of our time is the growing sense of the worth of the profane1 of the secular1 and a growing depreciation of what once was called #8sacred' and #8holy4' ,to be sure1 of the professions the #8clerical' is still regarded as #8sacred2' but since the religion of the future is to be a secular religion1 the #8sacredness' of the ministerial office will in time pass away4 8,the students in our schools to-day are taught this4 ,they see that the distinction between profession and business is at last only traditional4 ,they are bent on fulfilling the task which is in accord with the incentive and legislation of their special natures and characters4 ,they know of something above the old honor of the profession and the new money of the business--namely3 the unfolding of moral personality and the service of their brothers4 8,they seek the calling1 disregarding the old distinctions1 which is adapted to the growth of their peculiar self and to the service of the brother4 ,hence1 the wall of partition has been broken down by interests that are above profession and above business40 ---------------------------------------- -------------------------------- ,transcriber's ,notes3 ,missing or obscured punctuation was silently corrected4 ,typographical errors were silently corrected4 ,inconsistent spelling and hyphenation were made consistent only when a predominant form was found in this book4 ,text that was in italics is enclosed by underscores 7italics72 text that was bold by 8equal0 signs 7bold74