The Medical Serf and Organized Medicine

Coercion of doctors into tribute is the secret of the present malevolent power of organized medicine. No attempt is made to mask this coercion. Thus, the Special Committee on New Members of the New York County Medical Society made the following report, in 1933, published in the Medical Week of February 10, 1934:

"2. That membership in the County Medical Society be made more desirable to the younger men, so that they will find it advantageous to join, instead of being coerced into joining."

But the Committee proceeded to recommend a new method of coercion;

"3. That the efforts of the Special Committee on Hospitals and Dispensaries be enlisted in the approach to hospitals for having membership in the County Medical Society a prerequisite for staff positions."

In this manner the fondest dreams of "Doc" Simmons have been fulfilled by his heirs.

COERCION SUPPORTED BY LAW

The law has created for organized medicine many methods of coercion of the medical profession. In this both Federal and State governments have collaborated. The states have given the State Medical Societies direct or indirect control over medical licensure once again.

The Federal government, through the Emergency Relief Administration, delegated to committees representing the county medical societies its authority to appoint needy and destitute physicians to Relief rolls. These committees led the profession to understand that appointments might not be forthcoming to non-member physicians.

Another coercive measure is an amendment of the Workmen's Compensation Act passed by the New York State Legislature in 1935. This amendment, which is clearly unconstitutional, restricts the injured in the choice of physician to a panel drawn up by the county medical societies.

The City and State of New York have created such coercive devices as the following:

"The Commissioner of Hospitals of New York City, Dr. Goldwater, has made it a rule that the privilege of the use of the facilities of hospitals and appointments to hospital staffs shall he denied the physicians who are not members of the New York county medical societies. Thus the hospital facilities provided by the community for its ill have been prostituted to organized medicine.

"In an act providing for the licensing of nurses, physicians who are not members of the New York State Medical Society were barred from signing affidavits that nurses must obtain from physicians to secure their licenses.

"A regulation issued by Commissioner of Police Valentine of New York City in 1939, extended the right of parking autos in areas forbidden to all others, to the members of the New York State Medical Society and of kindred organizations. This means that only physicians who paid tribute to those organizations would he granted the privilege of rapidly reaching the bedside of patients in the forbidden areas.

"Most perfect is the method of coercion given the Societies under the law passed by New York Legislature in 1939 permitting the formation of "non-profit" medical indemnity corporations. The regulations established for the administration of the law by the State Welfare and Insurance Departments give the societies the privilege of ousting physicians from the panel of those eligible, on any pretext that they devise.

A more perfect set-up for the rackets of organized medicine could hardly be conceived—it will hold the profession's purse strings and extract and extort what it wills.

The medical societies are taking full advantage of these laws and regulations in coercing physicians to join their ranks and do their bidding.

EXTORTION AND INTIMIDATION PRACTICED

Among the physicians who thus are being coerced and subjected to the extortion of the twenty dollars, or more, membership dues of the county medical societies are the poorest members of the profession. They are the physicians who are forced by circumstances to seek Relief; who are forced to content themselves with the absurdly meagre fees allowed for Workmen's Compensation work. In order to become eligible for even these meagre fees, the New York County Medical Society has demanded of its members that they sign away such constitutional rights as the right of "privileged communication" which the law has provided to protect the interests of the patient, and the right to recover damages for injuries sustained as a result of any action of the Society.

Members also are compelled, on joining, to sign away their freedom of speech and publication. Non-members are robbed of these rights by a conspiracy between organized medicine and the press. The organization is an autocracy that reduces the individual physician to the status of a pawn and flaunts the law with impunity.

Some of these laws and regulations not only offer stigma and affront to physicians who refuse to join the Society, but also violate the Constitution of the State by illegal delegation of power; for the Constitution provides that the power to confer the rights and prerogatives of the practice of medicine belong to the State Department of Education. The discriminatory rights and privileges extended to the New York State Medical Society, a private membership corporation, exceed the power of the State itself. It eloquently bespeaks the impotence of the individual members of the profession and of the State itself against organized medicine, that these laws have not been challenged successfully in the courts, in spite of their obvious unconstitutionality.

This situation gravely concerns everyone who is subject to human ills. Let us stop and ask ourselves:

"What is the meaning of this coercion of a group of supposedly intelligent men who are licensed to practice medicine by the State, into a membership corporation whose charter states that it is primarily organized for the purpose of protecting the interests of its members?"

Obviously it does not even do that; for if it did, it would not find it necessary to coerce the profession into membership.

STRUCTURE OF THE AMERICAN MEDICAL ASSOCIATION

Organized medicine makes its bow to the nation under the banners of the American Medical Association, the American College of Surgeons and local academies of medicine. Because of the coercive laws and regulations, tens of thousands of physicians have been forced to join the A.M.A. Its membership comprises about 116,000 physicians, or three quarters of the profession, making it the largest medical organization in the country.

The American Medical Association is built up of local county, district and state medical societies that are interlocked by officership and directorate with each other and with the national Association. Dues paid by the members of the county societies filter into the larger units and finance them.

The county medical society is the cornerstone. It is a membership corporation. The qualifications for membership are a medical degree, the payment of annual dues, and the willingness of the officers of the organization to accept the member and bis dues. Inasmuch as there is little reluctance in accepting dues, it is the dues which, as a rule, are the primary qualifications for membership. Neither competence nor reputability are signified by membership. On the contrary, the less reputable physicians invariably join to shield their malefactions.

NEW YORK COUNTY MEDICAL SOCIETY

The New York County Medical Society might be studied as a typical example of these societies. The sole privilege accorded to a member-at-large of the Society is the privilege of paying dues and of attending meetings. The latter is seldom exercised because little or nothing of scientific value generally is heard at the meetings, which cannot be found in the older textbooks and literature. The presentation of papers before the Society is regarded by its bosses as a mode of advertisement; or as a device for securing political advantages from other units of the organization. Presenters of papers are chosen chiefly for political and commercial reasons, not for scientific. The rarity of presentation of new discoveries, the officers of the Society justify on the ground that "the scientific preparation and level of intelligence of the membership is too low to permit understanding of new scientific discoveries." The true reason is the fear of the bosses that their reputations as authorities and their practices might be endangered by discoveries.

Even discussion, if any is permitted, is limited to members of a clique whose names are advertised in the program. Late in the evening, there may be a call for general discussion, after most of the members have either gone home to bed or fallen asleep in their seats. Seldom will a member rise to discuss the paper. When one dares do so, there passes through the hall a stir which awakens even the sleeping members. The daring one will be permitted a minute or two of discussion, which is rudely interrupted in the middle of a sentence by the gavel of a presiding officer, with the remark, "Your time is up!" I write from many personal experiences.

The daring or uninformed member has violated the unwritten rule that none of the rank and file members may participate in the proceedings and discussions. Unpleasant things soon begin to happen to him. He feels the vengeful hand of the Society raised to enforce its discipline. Slanderous and sometimes libelous stories are circulated among the medical fraternity and among the public to the effect that the guileless or daring member is crazy or a radical. He is shunned and ostracized by timid colleagues and reviled by bolder ones. If he is connected with a hospital or clinic, he may soon find himself ousted on the ground of incompetence—a stigma on his reputation. No effort is spared by the organization to undermine his vital asset—his reputation.

The business meeting of the Society is conducted in the same manner. When the Chairman calls for old or new business, no member of the rank and file who values his reputation dares rise to propose a new measure. All business has been "pre-arranged" in Committee by the political bosses of the Society. If a member should arise to propose new business, he is promptly informed that no new business may be introduced directly on the floor or be voted on directly by the members present; it must be referred to the dominating committee.

MEDICAL ELECTIONS

Nomination and election of officers in the Society attain the height of absurdity in formalities. Under the constitution of the Society, it is practically impossible for the rank and file of the members to pick their own officers. Nominations perpetuating the regime of the inner clique are made, "pre-arranged," by an officer of the Nominating Committee. Officers are elected two years in advance.

The activities of the County Medical Society vitally affect a number of commercial interests, including milk, insurance, and others. The officers of the Society are consequently carefully handpicked by agents of those interests who dominate the inner ring of the Society. The preferred candidates men whose affiliations and dependencies make them pliable and subject to influence and domination. The selections generally are made on the basis of hospital affiliations. To guard against upset at elections by independents, severe obstacles have been placed in the way of the nomination of independents, in the Society's Constitution.

In the case of threatened loss of control of the Society by its established bosses, no crooked political device is neglected in the battle to retain it. I participated in such an incident as nominee, in 1927. Heads of hospital staffs forced their subordinates to stand in line for hours on the penalty of losing their jobs, and vote as they were required. There were well-authenticated rumors of stuffing of ballot boxes and of deliberately fraudulent counts. I was informed by a friendly officer of the Society that I was counted out. It was then quite obvious that there were large financial stakes involved in the control of the otherwise apparently slumbering New York County Medical Society.

The New York Telegram commented editorially on this medico-political situation as follows (December 7, 1932):

"Medical Statecraft"

"Elections are simple things with the Medical Society of the County of New York. We note the official ballot of the recent election of that body. There is no chance for the voter to become confused as to his choice. Each office has one candidate, except in the case of the censors and delegates to the Medical Society of the State of New York. There were three candidates for censor, and the instructions say, 'Vote for Three.' There were ten candidates for delegate, and the instructions say, 'Vote for Ten.' The voters were, however, permitted to 'cross out names of candidates not voted for.'

"It remained for the doctors to simplify statecraft beyond even the braves of Union Square."

REWARDS OF THE MEDICAL SERF

Gag rule and steam roller prevail in all the activities of the Society. The member who is not satisfied to be repressed by such rule is eventually either coerced into silence or suspended from membership on some pretext or another.

What are the rewards of these bull-dozed, spineless specimens of humanity who let themselves be coerced into membership and plucked of the annual dues in an organization so subversive of their own interests and so insulting to their intelligence? They are eligible to contribute their services, for which they are not paid, to clinics and hospitals generously provided for them by the activities of the County Medical Society. There they may be permitted to treat patients whom, except for the existence of these organizations, they might treat in their offices for a fee.

The physician who is in such "good standing" as to be permitted to render services gratis in the clinics dominated by the bosses of the Society regards himself as fortunate. For the Society has inculcated into the public mind, with the aid of the interested social service forces, the idea that the physician who does not bow to organized medicine and man its clinics is incompetent and is not to be trusted. The docile and acquiescent physicians are given the stamp of "competence" of the Society. How untrustworthy is this stamp, will be made clear.

After he has rushed through his stint at the clinic, this "fortunate member" of the Society is free to return to his empty office, to gaze at four walls and develop claustrophobia. Few folks realize to what extent the psycho-neurosis the medical profession develop in this manner is accountable for physicians continuing to work in the clinics year after year, in spite of the fact that they thereby destroy their livelihoods, gain nothing and learn nothing.

Returned to the solitude of his office, the doctor may turn on his radio, if he happens to be able to afford one, and listen to one of his "masters," the favored of the inner ring of the Society, advertise and publicize himself over the radio. But let him not dare to follow suit and himself make a radio broadcast, if by some accident unforeseen by the medical society the opportunity should offer itself.

The dual "code of ethics" declares that when the medical "leader" or boss makes a radio broadcast, it is a case of publicity for the medical profession. But when a mere member at large makes the same broadcast, it is publicity and advertising of himself. Should he drop into such an error, the member is summoned before the Comitia Minora, as the Tweed Ring of Medicine calls itself, and disciplined by suspension. The Society seldom takes the more severe disciplinary measure of ousting an offender from membership. That would mean cutting off its income.

Or in the solitude of his office, Dr. Sucker may turn to his newspaper and read an article which has been passed and approved by the Censor of his Society, whose salary is paid from the membership dues which he and his ilk have paid into the coffers of the Society. This article informs the public that the Cash-and-Carry Medical Center—where Dr. Sucker donates his services gratis—gives infinitely superior services to its patients than does a physician such as Dr. Sucker privately in his office. Or it may announce on the basis of Federal statistics on childbirth, falsified by inclusion of abortions, that Dr. Sucker and his confreres are responsible for the death of numerous mothers, and are less competent to care for childbirths than are midwives. From this news the public can only deduce that they should turn for competent obstetrical services only to Dr. Fleecem, Dr. Skinem and other members of the Committee whose names are prominently mentioned in the publicity matter; or else have their babies in the wards of the Cash-and-Carry Hospital and Medical Center, where they will be cared for by Dr. Sucker and his confreres.

SERF VS. OVERLORD

The position of the rank and file of the profession contrasts sharply with that of the medical merchant "leader" or boss. Their position is that of serfs, puppets, and stooges of the medical-social-service rackets. They are ludicrously pathetic figures, befuddled and often not of the highest mental caliber. From the moment they enter pre-medical training, they are caught between two millstones— the social service rackets, and the treacherously racketeering medical organizations. As they advance, they are progressively ground down to a condition which eventually leaves them devoid of initiate e an thinking capacity and makes them the stupidly helpless pawns of the two super-rackets which they are coerced to join and support. In so doing they destroy their livelihood and crush themselves.

There are a few isolated cases of physicians who cherish and preserve principles and ideals in spite of terrific economic and political pressure placed on them. They are called "insurgents" and are regarded with suspicion by their confreres as being mentally unsound. But the rarest thing in the annals of history is the physician who is reckless and foolhardy enough to risk his reputation and livelihood in the attempt to clean the Augean stable of medical politics, organization and racketeering. Such prodigies are editorially attacked by the "Boss" himself in the columns of the Journal of the A.M.A. as horrible examples, as was I in April, 1930.

With rare exceptions, physicians follow the path of least resistance even though it leads to self-destruction. They find themselves in the status of mere men seeking to eke out an existence by caring for the ills and catering to the caprices of mankind. They are no more honest than the rank and file of mankind. They succumb to pressure and temptation; and accept the tenets of the self "Same rackets which destroy them. With few exceptions they cherish in their bosoms the almost forlorn hope that they may rise, some day, to the racketeering heights of medical bosses and merchants in medicine—and thereby win fame and fortune.

But the hope of winning even fortune is for a great majority of them utterly vain. For the physician's stock in trade is the faith of the patient in the falsely assumed ability of the doctor to "cure." In reality, no doctor "cures" any disease; the patient cures himself. The physician can only help in the process by making conditions for recovery favorable and by avoiding damaging interference with Nature's workings. To do this, he must at times pretend to wisdom and knowledge, when his ignorance is most abysmal; and in these moments he is, at best* a benevolent confidence man. His chief stock in trade is the patient's confidence in him. But this confidence has been destroyed by the medical and social service rackets. The medical serf has been severely handicapped by his lords and masters.

MEAGRE EARNINGS

There has never been refuted intelligently the myth that the average member of the medical profession is responsible for the "high cost of medical care." While it is true that the medical "leaders" are unconscionably exorbitant in their charges, the fee scale of the average physician is absurdly low and often less than the charges of pay clinics.

The fees of the average physician today are no higher than they were one hundred to one hundred and fifty years ago. The 1817 Fee Bill of the Boston Medical Association, and that of New York in 1790, showed charges of two to five dollars per initial visit. Consultations were five dollars for the first visit and three dollars for subsequent visits. Night visits were five dollars.

The scale of the Workmen's Compensation Insurance fee schedule recently adopted by the Medical Society of the State of New York differs slightly from those of 1790. The charge allowed for the first visit, including the filling out of numerous forms and testimony before the Compensation referee, is five dollars. Under the 1790 New York Fee Bill the charge for filling the forms alone would be ten to fifteen dollars.

The charge for a night visit in 1790 was five dollars; the present schedule allows four dollars. Incision of an abscess cost the same in 1790 as today five dollars. The charges for amputation at the shoulder—one hundred and fifty dollars—have not risen since 1790.

Some of the charges made in 1790 were slightly higher than those of today and vice versa. It should be borne in mind, however, that in those days a dozen eggs could be had for a few cents. This makes it apparent how much the cost of medical services has dropped in the past century and a half in spite of tremendously greater costs of rendering those services.

LOW WAGE SCALE

The average physician who seeks part or full-time employment is no more fortunate financially than he who seeks to eke out an existence in private practice. He finds that the wage scale for doctors is lower than that of most forms of unskilled labor. Especially is this true in public service.

The scale of salaries of physicians in public service is probably highest in New York City. Few of the world-renowned physicians who have made life safe for the citizens of New York, at the risk of their own health and lives, earn after many years of service the eighteen dollars a day of the asbestos worker, or the twenty dollars a day of the skilled tool-maker.

The average pay of doctors working on a part time basis for the Health Department of New York City is one dollar and sixty cents per hour. This rate has had the approval of the New York County Medical Society. As has been related, the Society has suggested that doctors employed by the City, especially those in the Health Department, shall be deprived of Civil Service protection and of all the rights and privileges, including sick leave, vacation and pension which are given to all other municipal workers. The Society is controlled completely by the henchmen of organized social service, and has adopted as its goal the destruction of the livelihoods of its less affluent and less influential members.

RELIEF AND UNIONIZATION

The Philadelphia County Assistance Board, a social service agency, set the following hour-wage scale in 1939: bricklayers, $1.62; plasterers, $1.55; and doctors, $1.51. The medical profession has contributed heavily to swelling Relief rolls. Approximately a third of New York's doctors were still on Relief in 1937.

Employed physicians have sought the aid of social service and of labor unions in the attempt to gain an adequate wage. The A.F.L. has always turned them down on the basis of the convenient myth that doctors, even though employed as workers, are capitalist bourgeois and independent entrepreneurs. The truth of the matter is that labor employs doctors and prefers to be free to take advantage of them without qualms. Also labor has espoused the cause of its fellow-travelers, the social service rackets that seek to prey on medicine. Under the terms of the Wagner Act, some groups of physicians have organized under the C.I.O. But their position has not been improved materially thereby. The derogatory attitude of labor towards the medical profession has become accentuated.

EDUCATION COSTS VS. EARNINGS

The wage of the doctor contrasts sharply with high and ever-mounting cost of a medical education and of keeping abreast of changing methods and of advances in medicine. It is a curious fact that the more richly medical education becomes endowed the costlier does it become to the student. It now involves study over a period of twenty to twenty-five years and an average cost of between twenty and twenty-five thousand dollars.

The average work-life of the physician is about thirty years. It can easily be calculated that to earn the costs of his education alone the doctor would have to make about fifteen hundred dollars a year. To earn a bare living plus the cost of maintenance of his office, the physician must make five thousand dollars a year. In order to keep abreast of medical advance and be a competent physician and at the same time live comfortably, the physician must earn between seven and ten thousand dollars a year. It is doubtful if more than ten percent of the medical profession of this county earn this last figure. It is questionable whether one out of four doctors now makes enough to amortize the cost of his education alone. In most cases now, the study of medicine involves a large economic loss.

LICENSING RACKET

This does not imply that there is an excessive number of physicians in the country. Many parts of the country have not sufficient physicians; and few sections of the country have too many physicians for adequate medical care of the public. But each state in the Union licenses its citizen physicians and shuts out physicians licensed by other states. This often bars the way to adequate medical services to their communities. The situation today is much the same as it was in 1846 when the State Medical Societies directly controlled the licensing of physicians and used their powers to create medical monopolies. Curiously enough, some states permit free entry to foreign physicians while barring entry of Americans.

SOCIAL SERVICE COSTS VS. MEDICAL

The average earnings of a physician in the height of prosperity—1928 and 1929—were less than those of skilled laborers. At that time, in the midst of boom and prosperity, over 60 percent of the populace requiring medical treatment in our larger cities were receiving it from hospitals and clinics gratis, or at a low figure per unit of service. During the years of depression, the persons receiving such services rose to almost ninety percent of the populace of the country requiring medical aid.

This does not mean that the cost of illness to the public is low. It is relatively high; but only a small fraction of it is paid to physicians. The bulk of the community's medical expenditures go into the purses of the social service rackets, large fractions to hospitals and nurses, and least to the doctors.

The Welfare Council of New York City estimated in prosperous 1928 that there were 40,000 paid workers engaged in social service work in New York. Their salaries amounted to approximately seventy-five million dollars. All of this money had been donated by charitable persons in the community for the care of the poor.

If only half of this money that is diverted by social service workers into their pockets were used for the payment of physicians for the care of the ailing poor, the caliber of services given could be materially improved and doctors would receive about three thousand dollars a year for their work. Money expended in this manner would more truly serve the purpose for which the funds were donated than its present use.

SERF PATHETIC

The pathos of the plight of the medical profession is accentuated and set in comic relief by the obvious absurdity of its sense of helplessness. Physicians cannot be replaced overnight. Properly organized to protect their interests, the medical profession could command a fair treatment and an adequate wage from the community.

But organized medicine has joined the social service rackets in betraying its ranks and has aided tile impoverishment and debasement of its own members. It has coerced the physician to aid in robbing himself of both his livelihood and of the respect of the community. So awed is the medical serf by the boss merchants that he does not dream of asserting himself and fighting for his existence; instead he slinks after treacherously corrupt "leaders/*

The force by which he is held, is the growing power of organized medicine and its control of hospitals and of medical licensure. The character of the licensing boards is indicated by the recent indictment in New York of an assistant attorney general who was assigned to collaborate with the Medical Board of Regents, on the charge of complicity in "fixing" for an abortion racket; and by the anxiety-caused death of his associate, an A.M.A. affiliated secretary of the Board, Dr. Harold Rypins, who was also accused.

DISCIPLINE OF THE RACKET

To incur the enmity of the American Medical Association or its local state or county society means to run the risk of loss of livelihood. Organized medicine figuratively grips the throat of every physician.

To avoid deliberately and maliciously circulated slander on his competence, the medical serf must toe the mark in the regime prescribed for him by medical bosses. As in any racket, to obey means "protection," and failure to conform means to court disaster.

Illustrative of the methods employed is my own experience. In 1931, I resigned from the N.Y. County Medical Society and the A.M.A. because I objected to racketeering of the organizations. Thereafter my scientific discoveries were barred from publication, rumors damaging to my reputation were circulated, scientific societies were urged to bar my participation in their proceedings, my works and I were libeled in publications of the A.M.A. and replies were barred. In 1937, a colleague, Dr. Guersney Frey, attempted to bar my participation in a scientific discussion in a New York Academy of Medicine meeting, on the ground that my resignation from the A.M.A. and failure to pay tribute and dues to it made me a physician "not in good standing." The allegation was widely broadcast in an effort to injure my reputation and practice by slander.

In the attempt to subordinate science to medical politics, there shines forth the blind stupidity of the medical dim-wits. Their attitude resembles most closely that of the ostrich that seeks to avert danger by burying its head in the sand.

How serious may be the consequences to a physician of disciplinary action of organized medicine is indicated by the case of Dr, W. W. Robinson. A court ordered the Spokane County Medical Society to pay him thirty thousand dollars for "slandering and humiliating him."

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BELATED ACCEPTANCE OF MY RESIGNATION FROM THE NEW YORK COUNTY MEDICAL SOCIETY

The acknowledgment of my resignation from the New York County Medical Society is here reproduced to anticipate any false allegations that my expose of the organization is prompted by pique. Though rumors were long circulated that I had been ousted from the Society, it is clear from the letter that my resignation was tendered in 1932 and was not accepted until 1938, when I insistently demanded that it be done. One of my reasons for resigning was to he free to undertake this expose. As a member of the Society. I would have been barred from so doing, because the Society demands of its members that they submit their writings for censorship. In my letter of resignation I gave this and also my disgust with the racketeering of the Society as the reason for my action.

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GROUP HEALTH ASSOCIATION INC.

The Group Health Association Inc. and the Government's indictment has brought to the attention of the nation some of the less vicious methods that the American Medical Association uses in enforcing its discipline and protecting the business of its bosses. This situation has arisen primarily out of the struggle between the organized social service and organized medicine for the control of the medical rackets.

The indictment charges the American Medical Association, its local subsidiary and the Washington hospitals with conspiring to coerce and intimidate doctors and consultants to refuse to serve the Group Health Association and to black-list and boycott doctors employed by it, with the object of preventing competition.

In the following pages will be related activities of the A.M.A. which are far more vicious and dangerous to the public, which Assistant Attorney General Thurman Arnold refused to include in the indictment. These activities do not merely jeopardize the purses of the public and of the social service cliques, but menace the health and lives of the public. An indictment based on such charges would not have been dismissed by the courts. For many of them are quite clearly conspiracy in restraint of trade and designed to create monopolies. It is probable, however, that the courts will eventually sustain the indictment as it stands.

BRITISH PRECEDENT

The gangster tactics of the A.M.A. and its subsidiaries are true to the tradition of what the profession chooses to term "medical ethics." That this "ethics" is a commercial code is revealed by the experience of Dr. Pratt with the British Medical Association, which is quoted in the "Brief of the U.S. on Demurrers in the case of U.S.A. vs. A.M.A. et al" as follows:

"The British Medical Association was incorporated in 1874 'to promote the medical and allied sciences and to maintain the honour and interests of the medical profession.' It is divided into geographical 'Divisions,' so-called, comparable to local medical societies in the United States affiliated with defendant American Medical Association, which are largely autonomous; one of these is the Coventry Division. In 1904 the British Medical Association promulgated certain 'model rules' of ethics. Among other matters, these rules covered contract practice. Rule F provides that except in circumstances of great urgency, no member shall 'meet in consultation, or hold any professional relations with' a doctor declared by a division to have violated the rules of ethics. Rule Z provides that when a Division has found a given doctor's conduct to be 'detrimental to the honour and interests of the medical profession,' a notice so stating is to be sent to each member of the Division; and a similar notice may, when necessary, be forwarded to any other British Medical Association division. Coventry Division adopted these 'model rules,' including the above provisions.

"The Coventry Provident Dispensary was founded in the early part of the nineteenth century for the purpose of securing medical attendance for its members and their families. In 1906 the then medical staff protested that members whose incomes had grown beyond the maximum permitted for membership should be asked to resign; the committee of management disagreed with this view; the medical staff contended that the management committee should be abolished and complete control of the society's affairs should be given to the medical staff; when this was refused, the medical staff resigned in a body. Thereupon, the society sought a new staff.

"In May 1907 it appointed Dr. Burke, one of the plaintiffs here. He was a licensed doctor; there was not and never had been any stigma on his professional career; he was a member of the Coventry Division of the British Medical Association. On May 26, he received a letter from the Chairman of the Coventry Division suggesting that if he joined the Dispensary staff, Rules F and Z would be invoked against him. He was not deterred, and in June began his work for the Dispensary. On June 20, the Coventry Division passed a resolution declaring that by joining the Dispensary staff Dr. Burke had violated the rules of the Division. On July 20, Dr. Burke was notified of this action and was invited to explain his position. On July 29, he replied that he was satisfied with his position and would not change it. He was warned that on the single charge of joining the Dispensary staff he would be expelled from the Division.

"On August 28, the Coventry Division executive committee resolved to ostracize Dr. Burke. On September 3, the Coventry Division recommended to the British Medical Association that it should expel Dr. Burke for violation of the rules and for conduct detrimental to the honour and interest of the medical profession. On December 18, the British Medical Association general secretary cited Dr. Burke to appear and show cause why he should not be expelled. On February 13, 1908, he was expelled, on the grounds above stated. Thereupon, the Coventry Division circulated the notice prescribed by Rule Z, and gave similar notice to certain other nearby Divisions, Under Rule F, the effect of this notice was to make it a violation of the rules for any doctor to consult with Dr. Burke; no doctor could consult 'except at the risk of being expelled from the Association on a charge of having acted against the honour and interests of the medical profession.'" [(1919) 1 K. B. at 251]

"As a result of these occurrences, in the ten years that followed, Dr. Burke was unable to obtain the services of a single consultant, and his private practice was thereby greatly injured. Moreover, he and his family were treated as social and professional outcasts. Dr. Pratt and Dr. Holmes joined the Dispensary staff in 1913; they were similarly treated, with similar results.

"Dr. Pratt, Dr. Holmes, and Dr. Burke, therefore, brought this action against the British Medical Association and against four local doctors who, from time to time, served as officials of the Coventry Division. The first cause of action asserted by plaintiffs was for conspiracy.

"Upon the foregoing facts, the court held that the defendants had instituted a cruel and unwarranted boycott of the plaintiffs; that their actions constituted an unlawful restraint of trade, and accordingly, that plaintiffs should have judgment for substantial damages."

HARDSHIPS OF A MEDICAL LIFE

The racketeering of organized medicine adds gratuitous complications to the already difficult life of the doctor. The life of the average physician is hard. It is filled with the added anxieties and cares thrust upon him by patients. He stands at the beck and call of a thousand masters, a servant of the public. He must serve on short notice, even though he is ill himself. He must go out at any time of the day or night into any weather—snow, sleet, or rain, cold or hot—when his patients demand. And even more trying is it to wait about his office until a patient calls. Though he actually starve, and many do starve today, the doctor must maintain an expensive show-front in the attempt to gain and retain the confidence of patients; for they often judge medical skill on the basis of their estimates of the size of the doctor's bank account.

The average physician little realizes when he chooses his calling that he has placed himself at the mercy of every member of the community. He discovers that the public do not trust a young physician, generally desert an old one, and often pay none.

He is expected to risk his life, and his family's, by exposure to dread contagious diseases, at the behest of any unknown beggar. When a man is crushed under a fallen wall or a collapsing tunnel in momentary danger of crashing, the doctor is expected to disregard danger and render first aid. The needlessly anxious nature of his vocation serves to shorten the doctor's life. Angina pectoris, a lethal heart disease that is precipitated by anxiety, is most widely prevalent among physicians.

THE DOCTOR AND SOCIETY

A physician's obligations to society are eternally stressed. But society is ever less mindful of its obligations to the physician. There is probably no group in American society that has fallen to as low a level of disesteem and opprobrium as has the average physician. This is in part deserved; but it is largely due to maligning of the rank and file by their professional confreres, the bosses of medicine, and to the millions of dollars of the public's money spent by the social service forces in the payment of such high priced publicity men as Edward Bernays for the deliberate purpose of discrediting the medical profession in its opposition to social service dominated "Socialized" Medicine. In recent years the detractors have been joined by governmental officials and agencies allied with the social service rackets, who use the taxpayers' money liberally in this anti-medical propaganda which they are waging for the profit of themselves and their commercial allies, and for the furtherance of Bismarxian, totalitarian doctrines.

Society sustains great losses as a result of its ingratitude to the physician and of its toleration of the rackets that prey on him. It has caused in the profession a sinister cynicism bred of bitter experience. It has served to wipe out the more delicate nuances of service which spell the saving of health and lives. This is well illustrated by an overly embittered article by a young physician published anonymously in the June 1932 issue of The Forum magazine entitled "A Doctors Advice To His Critics:"

"One familiar delusion is to the effect that doctors are animated by an old saying, to wit, 'the relief of suffering humanity shall be thine only aim.' This is a piece of poppycock that is not true and never was true. The cold fact is that most doctors practice medicine for precisely and exactly the same reason that lawyers practice law, or editors edit, or plumbers plumb, or laborers labor—namely, to make a living. If they get some pleasure out of it and do some good, then so much the better, but that is not the prime purpose.

"I hate to destroy such nice delusions, but I believe that the truth is better and that more progress can be made by adhering to it. In all my experience I do not recall one single doctor who cared anything special about suffering humanity, certainly not enough to work himself up into a lather about it. He had enough troubles of his own; indeed all too often he had been so bedeviled and imposed on and swindled by this same poor dear humanity that he hated it.

"It may be deplorable, but it is a fact that this thing we call civilization, or this present state of human affairs, is just simply not organized along the lines of brotherly love. For all the boloney to the contrary, it is founded largely on the ethics of the jungle, and it is the persistence of this jungle ethics in a highly complicated and interdependent society that has finally plunged us into the morass in which we are now stuck. Doctors are merely in the same milieu that everybody else is. We are all tarred out of the same bucket—the critics no less than the rest. Doctors find out, as all men do, that they get what they take. This leads to dishonesty, sharp practice, swinishness. I can only report that doctors as a rule are as honest as circumstances will allow them to be. I do not care to speak further than that for them.

"But I can speak for myself. Here at least I will pass no buck; I will evade no issue. It all boils down to this: a man catapulted into this life and given time to get oriented and look about a bit can do one of two things—he can take it or leave it. I prefer to take it. Very well, then, what do I find? I find that this is a hard and a harsh world. I find that my living depends entirely on my own efforts, I find that I could sweat out my life in honest and conscientious medical service to the public for nothing save a bare existence and finally come to sixty-five or seventy a broken and penniless man. I find that in exchange for this they would, if I had enough political pull, give me a cot in a poorhouse, some rags, enough food to keep me alive, and the menial job of scrubbing the floors.

"Now I prefer not to stand in breadlines nor to sleep in flophouses. I must, therefore, get money in some way or other and endeavor to keep it. It has been amply demonstrated that this latter task is perhaps even harder than the first; I have no assurance that what I have now will be with me next year or even next week. The method I have chosen by which to do this is practicing medicine. I went through high school; I spent five years in a university, four years in a medical school, two years as a hospital intern—fifteen years in all. I not only made little or nothing during this time but I spent a great deal; in fact, all I had ever been able to make at other times. In addition to that I put a lien in the form of debts on what I was to make after I finally went to work. Now that I am at work, I will get that needed money absolutely honestly if I can. If I cannot, then I will get it dishonestly.

"There, then, you have it—in cold type and with no evasion. If this is being a thug, then I am a thug. And that is that. If you are interested to know what has been my experience, I will say that the word honesty in medicine is a very elastic term. . ."

Fortunately this young man's fierce bitterness does not represent the attitude of the rank and file of the profession, who lack capacity for energetic reaction. Their attitude is one of stunned and apathetic impotence and befuddled frustration that may paralyze but does not destroy humanitarian sympathies.

SOCIETY'S OBLIGATION TO THE DOCTOR

The situation in medicine, however, does mean a tremendous waste of ability and energy which could serve, under better conditions, to spare mankind much misery. Society could render itself a real service by fighting the battle of the medical serf and destroying the medical and social service rackets.

Society should establish a fair condition of work and standards of wage for the doctor. It should relieve him of carrying the entire burden of charitable medical care in the community and should establish on a permanent basis adequate payment of the doctor for those services.

For callous indifference of Society to the plight of the physician is certain to breed eventually an ugly reaction on the part of the profession. If the public wishes to be tended with kindness and mercy by the profession, it must extend to it the same treatment. It is wrong that in return for acts of charity and mercy, in which he oft risks his life, the veteran of medicine receives no beneficence or benevolence.

Thus the physician is not protected by compensation or security plans when injured or disabled in line of duty. If the doctor who is summoned to treat a case of typhoid fever succumbs to the disease, or if the tunnel into which he crawls to succor an injured man collapses, the consequences are his own lookout or funeral.

PENSIONS FOR PHYSICIANS

A pension fund for physicians that would enable them to spend their old age in comfort is richly deserved by most members of the profession. It is a notorious fact that few of them reach the age of sixty with any reserves or savings. The more wholeheartedly a physician has devoted himself to the welfare of the community, the less apt he is to have provided for himself, and the more apt he is to spend his declining days in destitution. Thus New York newspapers announced in January 1936, that Dr. Albert Harrison Brundage, a veteran public health officer, lecturer and authority, was dispossessed from his home and cast out to die penniless and destitute.

A pension fund that would give the medical profession a belated reward for the great sacrifices that are demanded of it in the care of the poor, easily could be arranged if its merchant "leaders" and the social service forces did not block the way. The motives which prompt the latter are the fear of diversion of philanthropic funds and bequests from their own purses, and their strategy of maintaining a tradition of antagonism between the public and the medical profession.

In addition to the bequests and contributions of the philanthropically inclined members of the community there are a number of legitimate sources for pension funds for physicians. Drug manufacturers, for instance, might well contribute to such pension funds a small percentage of the wealth and income which they derive from medical research and discovery and from the business which the medical profession has given them.

I have made an effort to establish such a pension fund for physicians. But I have met with no success in securing support for it because of opposition by the medical and social service rackets.

SAD VICTIMS OF ORGANIZED MEDICINE

The rank and file member of the American Medical Association, the medical serf, can be ranked as one of its most stupidly pathetic victims. The Association and its activities have brought him to his present wretched status.

With regularity, the position taken by the A.M.A. on public questions has been the very reverse of that of the majority of its members. By medical-social-service press censorship and a sham "code of ethics" they are prevented from escaping from the false position in which they have been placed.

To free itself of the racketeering domination of medical and social service organizations, and to redeem itself and regain public- and self-esteem, the profession must first awaken to realize and acknowledge the rot which has pervaded it. Drastically the profession must purge itself; and it must adopt ideals of service that are compatible with honesty and decency.

Then if it accepts honest, intelligent and intrepid leadership in place of crooked political bosses and their ward heelers, develops an esprit de corps that will enable the adoption of a program based on principle instead of greed and cupidity, and wage war without compromise on the unscrupulous enemies of society within its ranks and in the community, any fair request that it makes on the community must be met But can this be realized?