406 



SCIENCE 



[Vol. LVI, No. 1450 



A second case is offered bj the specialists. 

 Men formerly were driven into specialisms 

 through professional or popiilar demand. A 

 doctor peculiarly skillful of hand or mind had 

 his day filled for him by those insistent that he 

 do continuously the thing in which he excelled. 

 The present day sjiecialist is a self-anointed 

 soul. He knows that to have a large view in 

 medicine means hard work and ibroken houi-s; 

 he sees an "opening" for a specialist, spends 

 six weeks learning the necessary tricks and 

 succumbs to the easiest way. It will be an- 

 swered that specialists are needed to do the 

 complicated things of blood analysis, bacteri- 

 ological study and X-ray investigation. The 

 truth is that these newer things have not be- 

 come additions, as they should be, to the older 

 and established methods of diagnosis and treat- 

 ment but lazy-man substitutes for them — and 

 poor ones. In the main, these "scientific" 

 methods have not decreased error in diagnosis 

 or broadened treatment. Chemical methods of 

 blood analysis have not enlarged our knowl- 

 edge of kidney disease; failures to obtain posi- 

 tive bacteriological findings have permitted 

 patients to go without a diagnosis where an 

 older generation of doctors would have judged 

 correctly the nature of the disease from its 

 signs and symptoms; while the ease of looking 

 through a patient with X-rays has dulled the 

 touch, the sight, the hearing and the judgment 

 which made great our predecessors. 



It is the common thing for our patients to 

 be sent to a laboratory man, an X-ray special- 

 ist, a nose and throat sui-geon, a skin doctor 

 and a half dozen different types of special 

 surgeons. It has even been proposed that we 

 need a specialist to determine what medicine 

 stall be given. But those engaged in these 

 types of practice are beginning to realize its 

 dangers. The dangers are to be met with 

 another specialist — one who is to gather to- 

 gether the findings of all the doctors and tell 

 the patient what he came a-seeking. He is to 

 foe known as an integrator. I sent an article 

 proposing this scheme to a friend of mine with 

 the marginal note that our colleagues were be- 

 ginning to look for doctors once more. 



I know a place where one can serve himself 

 to a diagnosis as one serves himself to a meal 



in a cafeteria. One starts with a numbered 

 card and buys himself at different counters 

 and from different men a general examination, 

 an investigation of the throat, an X-ray plate 

 of the gall bladder, a dental overhauling, a 

 surgical operation and a plaster cast for the 

 foot. Each item carries its price which is 

 punched on the ticket. What the scheme takes 

 no account of is that the patient does not care 

 whether he has Hirschsprung's disease, ery- 

 thema nodosum or pseudo-hypertrophic mus- 

 cular atrophy. What he is after is a plain 

 statement of what is the matter with him, and 

 whether he can be "cured" or not; also there 

 is wanted a little appreciation of his state of 

 mind and some understanding of the economic 

 hardships of his family in the interim of being 

 ill. The food counters do not carry these 

 dishes. 



It is a sin against the Holy Ghost to say 

 that the profession is overorganized, but such 

 it is. Organization springs from the desire of 

 minorities to live in spite of majorities. As 

 such, organizations give life, shelter and fel- 

 lowship to the threatened and despised of the 

 world. Their purposes accomplished, they tend 

 toward reaction so that rarely have they merit 

 after birth, when their powers of leadership 

 ■because of rightness of cause, are supplanted 

 by the powers of organization to impress their 

 wUl. What looks like strength is merely a 

 cramp — medically expressed, the cramp of 

 death. Once "successful," Chapman's charge 

 is correct: "All association, business or social, 

 literary or artistic, religious or scientific, is 

 opposed to any disrupting idea." How much 

 in medicine the individual cowers to-day in the 

 shadows of this mass mediocrity is innocently 

 portrayed in a recent volume on civilization in 

 the United States. Of thirty men who write 

 freely of our politics, art and religion the one 

 w5io speaks for medicine must "for obvious 

 reasons" remain anonjTnous. 



This is just a reversed way of saj'ing that 

 the present day doctor has saerified his indi- 

 viduality — the thing through which alone he 

 has gained his public standing historically or 

 in the present. Xever before has he aft'ected a 

 community throug'h mass action, and it is safe 

 to predict that through such he never — last- 



