PAPERS ON MEDICINE AND PUBLIC HEALTH 439 



given a physician by the state is inadequate. From this 

 iiile the very delicate question arises as to who is com- 

 petent among the physicians of the community to judge 

 and pass on the efficiency of their confreres. Another 

 difficulty arises: How is the community to be assured 

 that the stamp of approval or disaiDproval of the com- 

 mittee supervising the work of the physician will not be 

 made according to the selfish interests of the staff? Still 

 another difficulty which arises is, how is such a staff once 

 appointed, to be deposed, or replaced when other better 

 qualified physicians come into the community, or when 

 the acting men grow old and less competent? 



The third regulation also calls for meetings of the 

 medical men. Such meetings can easily be arranged for 

 under the auspices of the local medical society if that is 

 not already being done, under whose auspices special 

 meetings can be set aside for the review of hospital 

 cases and records, if such meetings are for the best 

 interests of the medical profession. As to the advisabil- 

 ity of reviewing and analyzing clinical records, each phy- 

 sician would know whether or not he was Wolating the 

 confidence of his patient in so doing, whereas the hos- 

 pital authorities have no way of judging, and have no 

 legal right to permit the information contained in the 

 records of the patients to become the common knowledge 

 of the medical profession of the community and hence 

 are not in a position to enforce such a rule. 



The fourth rule is that of compiling of case records. 

 This requirement is wise and advisable, but not neces- 

 sary in every case to good medical treatment. The char- 

 acter and completeness of such records as well as the fu- 

 ture use of the same are entirely dependent upon the 

 personality of the physician in charge of the case, and 

 are quite foreign to any interest of the hospital authori- 

 ties except in so far as the hospital clerical force is 

 called upon to file and index the records that originate in 

 the hospital. 



The fifth requirement may or may not be closely re- 

 lated to the hospital management. This is the require- 

 ment for the provision of a clinical laboratory. Such a 



