26 Trans. Acad. Sci. of St. Louis 
of the independence conferred. The financial problems 
concerned in group medicine are legion, as the activity 
implies a great increase in labor on the part of the 
workers and the pro-rating of a single fee among them. 
The problem of the relative values and compensations 
of the different members of the group, of necessity to 
be adjusted among themselves, creates a situation not 
making for amity. Closed hospital groups imply a 
heavy endowment together with the resulting obligation 
to accomplish a large amount of teaching and charity 
work as they are generally connected with medical 
schools. While they have their function as practical out- 
lets for medical practice, they cannot be considered 
highly successful, as to even a greater degree than in 
the instance of other group plans, the personal rela- 
tionship between physician and patient, one of the sorest 
deficiencies of any group system, is most difficult of main- 
tenance. Again, hospital groups are in the main founded 
by men of great wealth who evolve systems of hospital 
practices tinctured with the commercial standards that 
gained them wealth, and naturally these do not take into 
consideration the happiness of the practicing physician 
who finds himself placed on something of the superior 
plumber basis. 
There are tendencies toward state medicine, though 
viewed with concern by most thinking medical men as 
affording opportunity for graft, politics, and retro- 
gression, through the lowering of incentive to personal 
accomplishment and as tending to develop a commercial 
medicine en-bloc. 
The present most happily functioning arrangement, 
though something by way of a makeshift and the result 
of spontaneous evolution, is the practicing of certain 
branches of medicine by certain men to whom patients 
