The record-union., 1891-04-22

writes that the 'dispensary' practitioner
is often paid fixed annual salary, rang
ing from ESQ to G200, together with
house, coal and gas, and without special
reference to numbers entitled to his serv-
ices. In London one-tenth or one-twelfth
of the general practice is of this sort; in
other English towns one-third. The
number of practitioners engaged in this
business is comparatively small, most of
them being Scotchmen. In its early his
tory there was an attempt on the part of
medical men to oppose the business and
make it disreputable; bat this has died
out, and the system is rapidly gaining
ground. 1t is especially tiourishing in
the manufacturing districts of England
and Scotland. With reference to other
foreign countries, l learn the following:
AT LeipSic and most other German cities,
large numbers of working people are cr-
ganiZed into the RYankeRkdSSe, or Sick
Fund.- and have the choice of relief at
hospital or of attendance and medicine at
home, together with an allowance of 81 IS
week for maintenance. The physician
receives II cents for u visit to such pa
tients, or cents for office consultation.
The poorest class are attended gratui-
tously by government physicians. In
Switzerland there are no such voluntary
associations, but the government pro-
vides gratuitous medical relief to those
who need it. In Holland young physi-
clans take family practice among the
poorer classes for 10 to 20 cents week,
according to size of family, medicines in
cluded, and collect weekly. In Rouma-
MIA society practice is confined to the
Jewish population. The contributions
vary from two to five francs per capita
annually.
WHERE MOST PREVALENT.
"At New Orleans the society system
arose about twenty-five years ago. and
probably is more prevalent there than
elsewhere in this country, One of my
Louisiana correspondents informs me
that he has retired from that city to the
country solely TO escape the daily contact
with the things l lOathe;' Z. e., society
practice. There the societies are num-
bered by hundreds; and one practitioner
may have the medical business Of twenty
or more. They take all they can get: and
| am informed that one of the leading
physicians there avoWed, in his earlier
experience, that he took all he could in
order to keep them out of the hands of
others-in other words, to starve out his
rivals. The most debasing feature Of this
business is the degradation of professional
character involved in the annual canvass
for these positions; for III general they go
to the lowest bidder, aud the canvass is
quite as eager as in political office-seell-
ing.
"The over work and under-pay Of this
system, as hardships to the medical man.
have been sufficiently exhibited; and also
the superficial character Of the service
which must needs be rendered. But
these are not the only evils. The physi-
clan becomes the bondsman and common
drudge of the society, whose pitiful wages
command his attendance for the most
trivial ailments. The hired servant must
go or lose his place at the next election,
and must bear with becoming humility
the fault-tinding Of his ungrateflil
patients. On the other hand, it virtually
denies to members the choice Of medical
attendant. The descendants of the early
settlers of New England, who fled from
the oppression of an established church,
now, with strange inconsistency, volun-
tarlly assume the yoke of an established
medical relief. 1t is the proud boast of
the model republic, that every one here
can choose his own religion and physic
his soul after his own fashion; but the
society system takes charge of his body,
and puts it down to the lowest bidder 10
be physicked. There is no reasonable
doubt that most of these societies are or
ganized for the chief, if not the whole OBJ
ject of cheapening medical services; and
many well-to-do people are not ashamed
to be found in their ranks.
BASE PRACTICES.
81 am informed that in one of our
prosperous California cities persons who
enjoy an income Of more than 81, 900 per
month are base enough to take such
society benefits, thus pauperiZing them
selves and impoverishing their doctor
They are styled benevolent associations ,
| but the benevOlence is extracted from the
medical profession by superior fnesSe.
Wage workers in all the handicrafts sue
cessfully organize for the common good
especially to prevent reduction OF their
earnings; but hitherto physicians have
made conspicuous failure III their at
| tempts to combine for mutual protection.
| AT New Orleans want of success was at
| trlbutable TO attempting too much in the
| beginning, and to the refusal OF very
| few to cooperate. These few made an
! abundant harvest of the societies aband-
! oned in the enthusiasm Of reform. AT
! San Francisco there has been no rebellion
among society doctors. At New York
! there has recently been organized the
! Medical Practitioners Association OF
| New York City, whose objects are: a
| To abolish, at such time as the aSsocia-
| ton may decide, in accordance with the
| laws hereafter enacted, medical attend
| ance TO members, or their families. OF
both; of clubs, including lodges and
societies of any kind, paying the medical
| attendant stipulated fee per member, OF
/ stipulated amount per annum by con-
| tract. (2) To elevate the professional
standing of its members. 3D. To eradi-
cate charlatanism. This organization has
70 members out OF a total OF about 3 00C
| practitioners. Obviously it would now
be premature to predict its future, but the
! inherent incapacity of physicians to or
| ganiZe in large numbers for simple busi-
ness purpose makes the outlook highly
| unpromiSing.
''To be plain and candid, hope for re-
of
class of people who compose these So
| cieties. The inevitable result will be
gradual, if not rapid, deterioration in the
| quality OF service rendered by Society
doctors, until in time its value will an
proximate to its cost. Then people will
begin to wake up to the discovery that
cheap and nasty service is poor economy
in the face of disease and death. Inas-
| much as the practice is evidently spread
ing, like contagious disease, it seems
likely that all our cities and towns must
suffer an attack of greater or less severity:
and it is TO be hoped that one experience
may suffice for at least an average gener-
| ton. Most likely the malady next time
will take new shape under a different
name.
CONTRACT DOCTORS.
I'm somewhat less Objectionable form
the contract system is in vogue among
mining and manufacturing companies in
many places. Thus at Evansville. Ind,
mining companies employ physicians at
an annual salary for the employees. At
Kokomo, Ind, the Diamond Plate Glass
Company employs a contract physician.
Married men contribute dollar month,
and single men fifty cents. At Kansas
City, Mo-, several large manufacturing
companies pay about two-thirds
regular fees; others unknown salaries.
At Elmira, n. Y, mill and mining firms
supply medical service to their employees