398 ANNUAL REPORT SMITHSONIAN INSTITUTION, 1946 
health. Restaurants we frequent are allowed to be conducted in ways 
which offer opportunities for the spread of disease. Kitchen help in 
various institutions are employed without examination as to the likeli- 
hood of their transmitting disease, without instruction as to their 
public responsibilities, or supervision as to their cleanliness. Unpas- 
teurized milk is sold in certain communities which has been taken from 
cows inadequately inspected. This community is no exception to these - 
criticisms. We wait for a serious epidemic to break out before giving 
thought to such matters. That isa very heavy price to pay. 
In yet another important phase is the citizen failing to profit fully 
from the advances in medical science. Medicine has been so trans- 
formed in the past several decades that the examination of the individ- 
ual is no longer a matter of the pulse, the temperature, and the appear- 
ance of the tongue. The more precise methods of the present day 
require X-ray equipment and laboratory facilities, some of which are 
complex and expensive. These in many instances are impossible to 
apply in the home or even in the average office. Thus we have seen the 
growth of clinics and specialists. The hospital has become the doctor’s 
workshop; that is, the place where he has, or should have, at his dis- 
posal every new means for diagnosis and for treatment which science 
has devised. 
These developments have led to a great increase in the cost of medical 
care. An adequate examination is more costly than the average person 
is prepared to pay if he makes no special provisions for such expenses. 
Health is still regarded as something which does not compare in the 
family budget with food, clothing, and rent; yet every thinking person 
realizes that in the last analysis provision for health is a good invest- 
ment in ensuring the more obvious and seemingly more pressing mat- 
ters of bread and butter. Means must be worked out whereby the whole 
community, the middle man as well as the rich and the poor, has access 
to the best in medical care. These means must not be stereotyped or 
routinized for good medicine cannot be practiced in that way. The 
doctor-patient relationship and the right of the patient to the free 
choice of his physician must be preserved. That is a precious heritage 
without which it would be difficult to apply the advances of science to 
the full profit of the individual. We are confronted with a serious 
and complex economic problem which must be solved. Many students 
of the subject believe that the solution can be found by making im- 
provements in the present methods of medical care rather than by 
extreme measures involving so-called “socialization” of medicine. 
The well-trained physician expects to practice his profession with 
the full utilization of modern knowledge and methods, even though 
these be costly. He has a right to expect this and a duty to inform 
his patient of the facilities which should be available to him. The 
