LARGE FEES
AND HOW TO GET THEM

A BOOK FOR THE PRIVATE USE

OF PHYSICIANS

BY

ALBERT V. HARMON, M.D.

WITH INTRODUCTORY CHAPTER BY

G. FRANK LYDSTON, M.D.

W. J. JACKMAN, Publisher

121–127 PLYMOUTH COURT

CHICAGO

Copyright, 1911

By W. J. JACKMAN

LARGE FEES

AND

HOW TO GET THEM

CONTENTS

CHAPTER I.

CHAPTER II.

CHAPTER III.

CHAPTER IV.

CHAPTER V.

CHAPTER VI.

CHAPTER VII.

CHAPTER VIII.

CHAPTER IX.

CHAPTER X.

CHAPTER XI.

CHAPTER XII.

CHAPTER XIII.

CHAPTER XIV.

CHAPTER XV.

CHAPTER XVI.

PREFACE

There are some methods explained in this book which the author does not endorse. They are printed because they are necessary to a thorough understanding of the subject. Newspapers publish reports of murders, but this does not imply endorsement of the crimes.

Aside from these features there are many things which the practicing physician may read and follow to his advantage. The introductory chapter by Dr. Lydston will be found to be of special interest.

THE AUTHOR.

CHAPTER I
MEDICINE AS A BUSINESS

By G. Frank Lydston, M.D.

As a general proposition it is safe to assert that the practice of medicine from a business standpoint is a failure. The successful exceptions merely prove the rule. It is also safe to assume that the elements of financial non-success are cumulative in their action—a fact that is easily proved by hospital and dispensary statistics.

The practitioner of medicine, like every man who relies on his own hand and brain for a livelihood, is entitled to a bit of earth that he and his may call their own, at least a modest competence, and a well-earned rest when his sun begins to set and the twilight of his life approaches. How many doctors are in a position to enjoy or even render less awesome their twilight days? As city doctors are all supposed to be rich—at least by the public, that does all it can to prevent their becoming so—it would be interesting to know what proportion of them, even in metropolitan medical centers, own their own homes or have property investments. A far smaller proportion than is just, I fancy.

The assertion has been made that the general poverty of the medical profession is due to a lack of appreciation and a contempt for the rights of the medical man on the part of the public at large. This, however, is a secondary matter which, being self-evident, overshadows the primary cause—the asinine stupidity of the profession itself. As a broad, general proposition the reputable profession as a whole has about as much sense as the dodo, and, unless signs fail, will, sooner or later, meet the fate of that remarkable bird. How the profession can expect the respect and appreciation of the public when it has no respect or appreciation for itself is difficult to conjecture. The public cannot be expected to keep clean the nest of the medical dodo. Furthermore, the public quite rationally values the stupid thing according to its self-appraisement.

Primarily, the practice of medicine is supposed to be founded on a mawkish, blanket-like sentiment of philanthropy, which is expected to cover both God’s and the devil’s patients—the pauper and the dead-beat—the honest man and the rascal—the rich and poor alike. The doctor is expected to wallow eye-deep in the milk of human kindness, scattering it broadcast for the benefit of humanity, but he is in no wise expected to even absorb a little of it, much less to swallow a gulp or two occasionally for his own benefit. By way of piling Pelion upon Ossa, the public, having discovered that the doctor sets little value on his own services, proceeds to eye him with suspicion; the tradesman is very careful how he trusts doctors. Of course the tradesman has his own family physician “hung up” for a goodly sum, but—knowing doctors to be poor business men—the tradesman often cheats them in both the quality and price of goods.

It is a great and goodly game that plays from both ends and catches the victim in the middle. The tradesman has one redeeming feature, however; he does his best to teach his doctor patrons a lesson. He either sends his goods C.O.D., or, if the doctor be one of the favored ones, he finds the bill in his mail bright and early on the first of the month. I often think my tradesmen must sit up all night in order to get their bills in bright and early on the first. If not paid by the 15th, a collector is usually at the doctor’s office to see about it.

Yet the professional dodo—my apologies to the shade of the “sure enough” dodo—will not learn. He goes on and on, neglecting his accounts, mainly because he is afraid of offending his patrons and driving them off to some other doctor who isn’t so particular; and the worst of it is, there are plenty of contemptible fellows who draw their own salaries promptly when due, or present their bills for goods with frantic haste, who consider a doctor’s bill a flagrant insult. Will nothing ever inspire the doctor with courage enough to despise and ignore such contemptible trash? Does he prefer the role of a lickspittle to that of an independent and self-reliant man?

As illustrations of the value the profession sets on its skill and learning, the amount of gratuitous work done is striking. Our pauper—or pauperized—patrons are divided into several classes, viz.: 1. The free hospital, clinic and dispensary class. This is on the increase. According to Dr. Frederick Holme Wiggin, 51 per cent of all cases of sickness in New York City are now classed medically as paupers, as against 1.5 per cent twenty years ago! This is appalling. Of these alleged paupers it is safe to say that 75 per cent are able to pay full or at least fairly good fees. Why should pauperism be shown so prominently in the matter of medical bills, as compared with other necessities of life? And why should the profession carry a burden that belongs to the public? 2. Free patients of the private class: (a) those who can pay but will not, i.e., dead beats, and swindlers; (b) persons whose circumstances are such that the doctor feels in duty bound to render no bills; (c) persons who presume upon social acquaintance with the doctor to “hold him up” for friendly, perhaps informal, consultations.

It requires no great mental effort to see the terrible load the profession is carrying—self-inflicted, and often for fallaciously selfish motives, it is true, but none the less heavy. The college and free hospital may be the professional “old man of the sea,” but so much the worse for the medical Sinbad. Whatever the explanation, private practice is on a par with dispensary practice with regard to the impositions practiced on the doctor. It is safe to say that, of the sum total of surgical and medical patients of all kinds and social conditions under treatment in Chicago at the present time, over one-half are paupers—honest or dishonest. Pay the doctor for the work involved in this wasted and misapplied charity, and the medical profession would plunge into a sea of prosperity that might swamp it. And it is not only the rank and file of the profession that suffers. Ye celebrated professor, reaching out for glory, yea, into infinite space, clutching frantically at everything in sight, no matter how profitless—providing the other fellow doesn’t get the case—often defeats his own ends. And the great man dies, and is buried, and we take up a collection for his widow, to meet his funeral expenses, and sell his library—six feet of earth make all men of a size. Sic transit gloria mundi.

And when, like dog, he’s had his day,

And his poor soul hath passed away,

Some friendly scribe in tearful mood

Will tell the world how very good

The dear departed doctor was—

And thus win for himself applause.

One of the most potent causes of professional poverty is the mania of the doctor for a pretense of well-doing. He exhibits this in many ways. One of the most pernicious is an affectation of contempt for money. This it is that often impels him to delay the rendering of his accounts. Oftentimes his patient offers to pay all or part of his bill. With a lordly and opulent wave of his marasmic hand the doctor says, “Oh, that’s all right; any time’ll do.” And the triple-plated medical imbecile goes on his way with a dignified strut that ill befits the aching void in his epigastric region, and is decidedly out of harmony with the befringed extremities of his trousers. And then the doctor apologizes to himself on the ground of a philanthropy that is but the rankest and most asinine egotism en masque.

When will the doctor understand that payment deferred maketh the patient dishonest? When will he consider the necessities of his wife and children as outweighing the feelings of the patient who owes him money? When will he be a man, and not a time-server and truckler to appearances? He would take the money did he not fear the patient might suspect that his doctor was not prosperous. He wishes the patient to think that the doctor and his family dine with the chameleons, or are fed by ravens. Yet the medical Elijah waiteth in vain for the manna-bearing birds—they know him for what he is, a counterfeit prophet who vainly yearns for the flesh-pots of Egypt—who has a ponderous and all-consuming desire for pabulum, and a microcephalic capacity for finance.

Doctors are supposed to be keen judges of human nature. I often think this is absolutely without foundation. Defective knowledge in this direction is a very expensive luxury to the medical profession. The confidence man and sharper cannot fool the average doctor into buying a gold brick, perhaps, but they can come very near it. The oily-tongued and plausible man with a scheme finds the doctor his easiest prey. The doctor has often hard enough work to wring a few dollars out of his field of labor, and it might be supposed that it would be difficult to get those dollars away from him, but no, it’s only too easy. He bites at everything that comes along—he often rises to a bare hook. Mining stocks, irrigation and colonization schemes, expensive books that he doesn’t want, will never need and couldn’t find time to read if he would, histories of his town or state in which his biography and picture will appear for $100—proprietary medicine schemes, stock in publications of various kinds; he bites at everything going—he has embonpoint cerebrale. Oh, but the doctor is easy! I have very painful memories. The best investment I ever made was when I paid a fellow for painting a sign for the door of my consultation room, reading: “Notice—Persons with schemes will please keep out. I have some of my own to promote.”

It is rather a delicate matter, perhaps, for a college professor to touch on the evils of medical colleges in their relation to the business aspect of medicine, but I shall nevertheless speak plainly and to the point. While theoretically the better class of medical colleges were founded solely for the advancement of science, it is none the less true that self-aggrandizement has been the pedestal on which most of our disinterested giants in the teaching arena have stood and are standing. Remove the personal selfish interest of college teachers and most of our schools would be compelled to close for lack of instructors. Let us be honest with ourselves, please. Not that self-interest is reprehensible—I hold the contrary. One may teach for salary, reputation, the love of teaching, or a desire for self-improvement, it matters not, for if he be of the proper timber he is the right man in the right place. Self-interest makes better teachers on the average than philanthropy, providing the primal material is good.

Granting that self-interest is the mainspring of the college professor, is he very “long-headed” from a business standpoint? I submit the following propositions as proving that the average college professor defeats his own ends.

1. He devotes to teaching, time and labor over and above the exigencies of ordinary practice, which, if devoted to cultivating the good-will of the laity, would be much more profitable.

2. While cultivating the acquaintance and friendship of the alumni of his own school—a few each year—he alienates from himself the friendship of every alumnus of every rival school, the instant he begins teaching.

3. He assists in educating and starting in life young, active competitors to himself.

4. He is unreasonably expected to devote a large percentage of his time to the gratuitous relief of medical students and physicians. He may give his time cheerfully, but he yields up his nerve force just the same.

5. Most college professors are less successful in the long run than the more fortunate ones of the rank and file who have never aspired to teaching honors.

6. Greater demands are made on a professor’s purse than if he were in the non-teaching ranks of medicine. He, more than all others, is expected to put up a prosperous appearance.

The college clinic—especially of the surgical sort—is far-reaching in its detrimental effects on professional prosperity. Few or no questions are asked, and the millionaire is being operated on daily, side by side with the pauper, free. And the blame does not always lie with the professor who runs the clinic. General practitioners bring patients to the free clinics every day, with full cognizance of their ability to pay well. Why doctors will persist in thus cheapening surgical art is difficult to conjecture—but they do it just the same.

Of course, the college clinic is supposed to be a theater of instruction. Often, however, it is but a stage on which comedy-dramas are enacted. A brilliant operation that nobody six feet away can see, and an operator bellowing at his audience like the traditional bull of Basham—in medical terms that confuse but do not enlighten, terms that are Greek to most of the listeners—this is the little comedy-drama that is enacted for students who have eyes but see not; who have ears but hear not. Instruction? Bah! Take the theatric elements and the plays to the gallery out of some college clinics and there wouldn’t be a corporal’s guard in attendance.

Worse than the free clinics are the so-called charitable hospitals. Much has been said of dispensary abuses, but few have had the courage to say anything in adverse criticism of these institutions. While nominally founded to fill “a long-felt want”—and the number of long-felt wants, from the hospital standpoint, is legion—these hospitals are founded on strictly business principles, save in this respect—the people who found them feed on their innate capacity to get something for nothing. The first thing the founders do is to get a staff of doctors to pull the hospital chestnuts out of the fire. The members of the staff think that the hospital is performing the same duty for them, and everything is serene. And so the surgeon goes on operating on twenty patients—fifteen of whom are able to pay him a fee—in the hope that one among them all is willing to pay him a fee.

Exaggeration? Well, I cannot swear to the accuracy of the foregoing, but an eastern surgeon of world-wide fame once told me that for every patient who paid him a fee he operated on nineteen for nothing; and this man has no public clinic, either. Is it conceivable that the nineteen free patients are all paupers? Many of them go to my friend for operation from very long distances. Ought the railroads and hospitals to have all the profits? Have we not all had similar experiences in a lesser degree? With the development of charitable hospitals far in excess of any legitimate demand, it has come to pass that surgery is almost a thing unknown in general city practice. Even the minor operations have left the general practitioner—to return no more so long as there are free hospitals and dispensaries. Where is the emergency surgery, of which, in former days, every practitioner had his share? Railroaded off to the “charity” hospitals to be cared for gratis.

In a recent conversation with a practitioner of thirty years’ experience, I said, “Doctor, you used to do a great deal of general surgery throughout this section of the city. Have the hospitals affected your practice in that direction to any extent?” He replied, “Surgery with me is a thing of the past. Even emergency cases are carted off to the nearest hospital. If by chance one does fall into my hands, it is taken away from me as soon as I have done the ‘first-aid’ work.” Personally, I see very little use in teaching surgery to the majority of students who intend to practice in our large cities—they will have little use for surgical knowledge.

Here are three cases in illustration of the way our “charitable” hospitals antagonize the business interests of the profession:

1.—A very wealthy farmer engaged me to perform an exceedingly important operation. It was understood that $1,000 was to be the honorarium. He was afterwards advised to go to a certain “religious” hospital, where he was operated on by an eminent surgeon, who received nothing for his services. The patient paid $15 a week for hospital accommodation, and $25 a day to his family physician, who remained with him “for company.” What a harmonious understanding between the patient and his family doctor—and what a “soft mark” that surgeon was. I had the pleasure of telling the latter of the gold mine he didn’t find, some time later, and the shock to his system amply revenged the body surgical.

2.—A patient who was under my care for some weeks and paid me an excellent fee finally divulged the fact that he had meanwhile been living at a certain hospital as an “out patient,” at an expense of $8 a week. He had become dissatisfied with the hospital attention, he said, and, pretending great improvement, was permitted to get about out-of-doors.

3.—A man on whom I operated and who paid me my full fee without argument or question, came to me directly from one of our large hospitals, where he had been sojourning for several months.

That medical men in hospitals are imposed on is a trite observation. So long, however, as it appears to be the doctor’s advantage to be on a hospital staff, plenty of men will be found who will be glad of the chance. As for the injury which the system inflicts on the profession at large, that is no argument with the individual. Human nature operates here as elsewhere. Knowing that the system is bad, we are all anxious to become victims.

In recommending the payment of salaries to hospital men, the Cleveland Medical Journal claimed that such a plan will remedy all the evils incident to the professional side of hospital management. I do not agree in the opinion that the payment of salaries to the staffs of institutions for the care of the sick will alone correct the evils of such institutions. The writer of the aforesaid editorial is incorrect, also, when he says that an awakening is at hand. No, not at hand; it is coming, though; the handwriting is on the wall. When the revolution does come, this is what will happen:

1.—Hospital physicians and surgeons will be paid salaries.

2.—Hospitals will take as free patients or patients who pay the hospital alone only such persons as rigid investigation has shown to be indigent. All others will be compelled to pay their medical attendants, just as in private practice.

3.—Certificates of indigency will be required of every free patient, such certificate being signed by the patient’s attending physician—outside of the hospital—and at least two other persons in the community where he or she resides.

4.—General, and especially country, practitioners will cease to deceive hospital doctors as to the circumstances of their patients. One medical man should not impose on another.

Too much trouble, eh? Well, my friends of the hospital and dispensary—for the same charges should apply to the latter—you must either take your medicine or the revolution will go farther and this is what will happen: The profession at large will boycott every man who runs a college clinic, and every hospital and dispensary man. It will fight colleges and hospitals to the bitter end.

The day is perhaps not far distant when doctors outside of colleges and hospitals will run their private practices on the co-operative plan, thus dealing a death blow to the free clinic and dispensary. Every man of prominence will have his own private clinic and advertise it among his patients. What is fair for twenty or thirty men is fair and ethical for one. Each man can have his own hours for the poor; he can eliminate the unworthy ones, and, best of all, he can refer all his dead-beat patients to his clinic. Pride may bring fees from patients to whom honesty is a thing unknown. The private hospital will run most of the public hospitals off the earth. There will be no room for anything but municipal hospitals run squarely and fairly for charity, and reputable private hospitals run frankly for pecuniary profit, in which the operation and the attendance fees are the chief factors. Such hospitals will benefit, not hurt, the profession.

One of the most vital flaws in the business sense of the general practitioner is his penchant for hero worship. He hears of the medical tin god from afar, and burns incense on the altar of his greatness. The great man pats the humble doctor on the back, calls him a good boy, and tells him just where to take all his cases. Sometimes he offers to divide fees with him.

The medical tin god is truly a “self-made man in love with his maker.” He has “genius stamped upon his brow—writ there by himself.” His evolution is interesting. It is history repeating itself: Apsethus the Libyan wished to become a god. Despairing of doing so, he did the next best thing—he made people believe he was a god. He captured a large number of parrots in the Libyan forests and confined them in cages. Day after day he taught them to repeat, “Apsethus the Libyan is a god,” over and over again. The parrots’ lesson learned, Apsethus set them free. They flew far away, even into Greece. And people coming to view the strange birds, heard them say, “Apsethus the Libyan is a god; Apsethus the Libyan is a god.” And the people cried, “Apsethus the Libyan is a god; let us worship Apsethus the Libyan.” Thus was founded the first post-graduate school.

The medical Apsethus and the deluded parrots of the medical rank and file are here, and here to stay, until both are starved out. And the modest general practitioner looks up to the medical tin god and wonders “upon what meat does this our Cæsar feed that he hath grown so great?” The meat of industry? Perhaps. The meat of prodigious cerebral development? Seldom. The meat of opportunity? Yea, yea, my struggling brother, “and the devil take the hindmost.” But, more than all, he hath fed on the meat that the parrots have brought him—Elijah’s ravens were not a circumstance to those parrots. “In the kingdom of the blind the one-eyed man is king.”

How long will the general practitioner continue to play parrot to the medical tin god of the charitable hospital the very existence of which is a menace to the best interests of the profession—the profession for which the institution has no charity? In that happy time to be there will be no tin gods. There will be a more equable division of work and every prosperous community will have its up-to-date private hospitals with up-to-date men at the head of them.

As for the post-graduate teacher—good or bad—he is already defeating his own ends—he is exciting ambitions in the breasts of his pupils. Here and there among them is an embryo McDowell, a Sims, or a Battey. The backwoods country produces good, rich blood and virile brains. And the Sims, and McDowells, and Batteys of the future will be found in relatively small places, doing good work, and then—good-bye to the tin god and his horn, “for whosoever bloweth not his own horn, the same shall not be blown.” And in that day the parrot shall evolve into an eagle, and the hawk had better have an eye to windward. Meanwhile, hurrah for the post-graduate school and its pupils, and more power to the tin gods.

This business handicap is so self-evident that it is hardly necessary to touch on it. We raise the standard of medical education year by year, yet the mushroom colleges do not go—they are here to stay. If one-half the colleges were wiped out of existence there would still be more than enough to supply the demand for physicians. We have done the best we could to breed competition by manufacturing doctors, and we are doing all we can to make that competition first class—a queer business proposition in force of the oversupply of doctors. We are unjust, too, to the men we educate, by offering them inducements to enter an already overcrowded profession—but so long as human nature is as it is I see no way out of the dilemma.

There was once a time when it appeared a goodly thing for the chosen few to get together like the “three tailors of Tooley street,” and, after establishing to their own satisfaction the fact that they were indeed “the people,” formulated rules for the guidance of the many. These rules were called “ethics.” And the profession has been wrestling with its ethics ever since, trying to determine what it was all about anyhow. The ethical garment of half a century ago no longer fits—it is frayed and fringed, and baggy at the knees; full many a patch has been sewed on it, in individual attempts to make it fit from year to year, until it is now, like the Irishman’s hat, respectable by age and sentimental association only. And the public, the ever practical and heartless public, has also wondered what ’twas all about, and exhibits little sympathy for a profession which, while driveling of ethics, has “strained at gnats and swallowed camels.”

Who does not remember when all the wiseacres with number eighteen collars and number five hats seriously discussed the relative propriety of “Specialty” vs. “Practice Limited,” on professional cards? How times have changed. And then came the discussion by a learned society, of the ethical relations of “Oculist and Aurist” to “Practice Limited to Diseases of the Eye and Ear.” And it was decided that men who had the former on their cards were not ethical and could not enter that society. Ye Gods! Is the fool-killer always on a vacation? Must we always see those long ears waving over the top of the ethical fence, built by the fat hogs to keep all the little pigs out of the clover patch? What is the public to think of a profession that winks its other eye at the man who prints on his cards, “Diseases of Women Only,” but rolls up it eyes like a dying rabbit at the sight of a card reading, “Diseases of Men Only?” What has raised the woman with leucorrhea to a more exalted plane than that occupied by a man with prostatorrhea, does not appear. Why so many inconsistencies, and why such hypocrisy!

Sir Astley Cooper had his own private “hours for the poor.” Our European brethren print their college and hospital positions and all their titles on their cards. Are they less ethical than we? Homeopathy is a dead duck over there, and quackery has a hard row to hoe in Europe—queer, isn’t it?

Our system of ethics has not only been hypocritic, but somewhat confusing. The young man on the threshold of medicine doesn’t know “where he is at.” He is confronted by the unwritten law that only celebrated men and quacks may advertise. Small fry, who haven’t the ear of the newspapers nor a chance for a college position, are tacitly ordered to keep their hands off. And the young fellow watches the career of the big man, who hides every other man’s light under his own bushel, and marvels much. Especially does he marvel at the accurate photographs, life histories and clinical reports of his more fortunate confrères that appear in the newspapers without their knowledge.

Experiences differ. I haven’t yet got around to newspaper clinical reports, but it has been my fortune to be “written up” on several occasions. I do not recall that the newspapers drew on their imaginations for my photograph. I wish I might think so, and that their imaginations were distorted—the result was so uncomplimentary.

So far as I can learn, nobody protests against being legitimately represented in the newspapers. Why not be honest about it? The hypocrisy of some men is sickening. Paying clandestinely for newspaper write-ups is despicable, yet some of the very men who protest that they “really don’t see how that could have gotten into the papers,” have paid for the advertising in good “coin of the realm.” It is queer that the newspapers should write up the most minute details of the wonderful exploits of some poor fellows, together with their family histories, and publish their photographs, without their knowledge or consent—especially queer when we read in conclusion that “Professor John Doe is the greatest surgeon that ever lived.” Why not come out and acknowledge that these are paid for? This would give an equal chance to all, and especially to young fellows who have money enough to pay for similar things. He who has not the price should not find fault with the fellow who has, for, “business is business.” Meanwhile, my young friends, remember that “big mountains may do what little mountains may not do.”

When Koch’s tuberculin was yet new, soon after it escaped, half-fledged from the laboratory, only to be captured and made to perform like a trick monkey for the benefit of the laity, there came a ring at the phone of a prominent daily paper: “Hello, is this the Daily Bazoo?” “Huh, huh, it are.” “Well, I’m Dr. Squirtem Galls. I wish you would send a reporter over here at once. I want to be interviewed on Koch’s tuberculin.” It is said that $25 changed hands, but I don’t believe it. The gentleman would never advertise—at that rate—“no sir-ree.” My informant was once the sporting editor of the War Cry, and hence unworthy of credence.

And what wonderful contributions the newspaper-great-men are making to science! The daily paper is the place to study appendicitis and things. It is not long since I learned from a distinguished surgeon friend of mine, via a daily paper, that evidence of a blow having been received on the head is an imperative indication for craniectomy, whether symptoms are present or not.

In preference to the clandestine methods now in vogue, would it not be better for men in authority to write signed articles for the newspapers and intelligently present medical matter to the public? But that wouldn’t be ethical, would it? Such topics as “Advice to Young Men,” “Letters to Young Wives” and “How to Keep Healthy,” must be left to the quacks. We will confine ourselves to the surreptitious blowing of surgical horns and never mind the false notes.

Meanwhile, let us stand back and watch the procession of modest men who never advertise—oh, no! At the head, with haughty mien, comes Professor Keene Carver, preceded by a herald in blood-red garb, blowing a large brass horn. Then comes the “bearded lady,” whose blonde and breezy whiskers so delight the heart of his swell society clientele. And here comes Rip Van Winkle—a middle-of-the-road “eclectic,” gathering up his long and weedy beard to keep it from getting tangled up in the scientific barbed wire fence along the route. And here comes another sure-enough “regular,” evidently a medicine man—so rare nowadays. He is riding in a swell turnout and is on his way to his clinic. How do I know that Professor Windy Bowels is a regular? Because the gentleman who is riding beside him to his clinic is a reporter on the Chicago Daily Jib-boom.

I presume that the suggestion that I have made of the advisability of taking the public frankly into our confidence and giving it accurate information so far as its comprehension goes, by signed articles, in preference to clandestine advertising and the promulgation of fallacious ideas of medicine and surgery, will meet with bitter opposition. I nevertheless believe that a better education of the public is the only way to down quackery. The opposition will come chiefly from the surreptitious advertiser, who sees a prospect of other men getting the advertisement that he believes to be his proprietary right.

Then there is the tribe of the Microcephali. The howl of protest will be long and loud from the pews occupied by these far-famed champions of medical orthodoxy. “We won’t put our discoveries or contributions in the newspapers—not ever.” And gazing at their lemur-like front elevations, we can well believe that they would have no trouble in establishing a “halibi.”

Apropos of “discoveries,” it may as well be understood that the public is bound to get the details of them sooner or later, and, when the time is ripe, the matter should be presented to it in a clear and intelligible form—comprehensible to the layman.

CHAPTER II
THE PHYSICIAN WHO SUCCEEDS

To a great extent Nature has a commanding influence in the equipment of the successful practicing physician,—the man who actually secures the desired results in his treatment of patients, builds up and retains a good practice, and obtains a financial income of respectable proportions.

Any man of ability, with the necessary education and training, may obtain a certain amount of success as a physician and make a modest income—or drag out a miserable existence; this latter is the most probable. It is a well-established fact that the great majority of physicians are not what the world would call prosperous. This is not because they do not earn enough to secure a competence, but because they do not get it.

The doctor’s bill is almost invariably the last one paid. His practice is generally among the middle classes, people whose intentions are good, but whose incomes are limited. If there is anything left after the rent, and grocery and butcher and other bills are paid the doctor will, perhaps, get something on account, but as a rule he doesn’t.

This is mainly owing to the fact that the average physician is a poor business man; he does not place an adequate value on his services, and is slack in looking after collections. If pressed by his wife, or some friend, to be more particular in this respect, his almost invariable reply will be:

“It would not look well for me to put myself on the same plane with merchants. Mine is a profession, not a trade. Besides, I’m in duty bound to do a certain amount of charity work.”

Now charity work is all right in its place. An honest, upright practitioner will never refuse to respond to a call for his services in deserving cases because the payment of his fee is uncertain, but this does not obtain to the extent of virtually making paupers of people who are actually able to pay. And yet this is really what happens when a physician conducts his business affairs in a slipshod manner, and this is what most of them do. There is no excuse or reason for it.

But we started in to tell of Nature’s part in the equipment of the successful physician. What is the equipment? The possession of a robust, healthy physique, a sunny, cheerful disposition, and a fair knowledge of medicine, and ordinary business ability. All are essential if real success is to be attained, either in a medical sense, or in the accumulation of a respectable income.

Let us take two instances for the purpose of comparison. In one case we have a practitioner with just a fair knowledge of medicine, but in the possession of all the characteristics mentioned. His very presence in the sick chamber acts as a tonic to the patient.

Then we have a thin, undersized, nervous, dyspeptic physician; dissatisfied with himself and the world generally. He is a thorough master in medicine, and his treatment is more scientific than that of his less learned brother. His presence in the sick chamber, however, has anything but a soothing effect on the patient. On the contrary it irritates him, and the effect of the scientific treatment is nullified. This is not an exaggerated case. There are thousands of just such men in practice.

Which practitioner is going to have the greatest meed of success? The answer is easy—the one who cheers and encourages his patient by the magnetism of his presence.

Talk as we may, suggestion is a powerful factor in the practice of medicine. I do not mean by this that suggestion alone will cure illness (this statement is made without intention of affronting those who believe in Christian Science). But there is ample evidence to the effect that suggestion goes a long ways in making medical treatment effective. It is only the physician whom Nature has equipped in the manner indicated who can offer the right kind of suggestion and he does it unconsciously.

A physician of this kind is bound to become popular, and popularity begets a large practice and commensurate fees, provided the practitioner is in the right location, and has the business acumen to place the proper value on his services.

From time immemorial physicians have been imbued with the idea that they must adhere to a set scale of fees. I am speaking now of the average doctor, the man with a general practice. All patients, the laborer and the banker, the wage earner and the millionaire, are charged the same. In the country districts, the small towns and cities, this charge is usually one dollar a visit. In the larger places it is generally two dollars.

Why should this be so? The architect, the attorney, the civil engineer are all professional men in the same way that the physician is. Whoever heard of any of them adhering to a set scale of fees in the same way that doctors do? Invariably they regulate the charge for their services according to the money value involved, and the nature of the services required. The man who employs an attorney in litigation where a large money value is at stake naturally expects to pay a much larger fee than the man who employs the same attorney in a minor case. The man who wants plans for a million dollar building pays the architect greatly in excess of the one who builds a one thousand dollar house. The principle is sound and all parties concerned are satisfied.

In the eyes of the Almighty all human lives are of the same value, and it would be cruelly unjust to attempt to appraise them on a commercial basis. But this should not prevent a physician from grading his fees in proportion to the ability of his patients to pay them. What might seem like a large amount to a wage earner, would be a mere trifle to one in more affluent circumstances. The lives of both are equally dear to them, and both are willing to pay the doctor according to their respective ability.

Custom, the mother of much folly, is the only excuse for adhering to the old, antiquated system. A physician who is called out of bed on a stormy night to answer an emergency call from the home of a coal heaver would not be justified in asking more than the minimum fee. But why should he perform exactly the same service at exactly the same charge for one who is able and willing to pay ten times as much, or even more? It is not sensible, it is not fair.

“But it would be a violation of the code of ethics,” some one may say. Bah! The code of ethics be —— but that’s another story which will be told later on in this volume. The plan suggested, however, is not a violation of the code of ethics. There is nothing unethical in a physician regulating his fees to please himself, provided no injustice is done, and none of his patients is oppressed in this respect. There are certain physicians in the large cities who will not respond to a call for less than $25. There are others who perform the same services for $2. Yet both kinds are strictly ethical and are recognized by the medical authorities as such.

The reason for this wide difference is that the $25 men have used business tact in the practice of their profession, and elevated themselves to a position where, by reason of their prominence, they are justified in naming whatever fees they think they can get. And these fees are almost invariably cash.

On the other hand the $2 men are timid in a business way; they hide their light under a bushel as it were, and consequently lack widespread reputation. Their fees remain at $2 because they don’t ask any more, and their ledgers are laden with unpaid accounts.

There is no reason why a physician should not collect his bills with just as much promptness as a merchant. It is usually his own fault that they go unpaid. Statements should be sent out regularly on the first of each month, and if there is no remittance by the 15th, it can be found inconvenient to make any further calls. This, of course, is allowing that the patients are able to pay. Where real inability to meet the bill exists it becomes a matter for the physician to settle with his own conscience.

Our medical schools are full of young men who are wasting their time and doing the world at large an absolute injustice by studying medicine. They are doomed to failure before they are well started because Nature has not endowed them with necessary qualifications for successful practitioners. Their instructors realize it, but the tuition fees are needed for the support of the schools, and year after year big crops of alleged “doctors” are turned out. It might be unfair to refer to them as incompetent, and yet this is what many of them really are. Most of them know medicine theoretically and know it well, but lack the vital essentials of success.

It would be a simple matter of justice to these young men if some plan could be devised for weeding out those who are manifestly unfitted for the practice of medicine before they have wasted their time and money on medical instruction. So long as such a plan is lacking it becomes the duty of the individual to assume this responsibility himself. The mere desire to become a physician should not satisfy the aspirant for medical lore. He should question himself closely as to his fitness. His character may be the best, his ability to acquire the necessary knowledge unlimited, but unless Nature has equipped him as previously outlined, the most he can hope to attain in the medical profession is mediocrity so far as actually helping the sick, and obtaining prestige and wealth are concerned.

There are men, it is true, of high standing in the profession, who do not possess these qualifications, but they are few in number and, as a rule, are consulting, rather than practicing physicians. Other doctors call upon them for advice because of their recognized skill and learning. They give this advice wisely and well, but in the sick room would fall far short of obtaining the same results which other men, more favored by Nature, obtain by acting upon the advice they give.

Time was when the word “physician,” conveyed the idea of a man with a beard. The two were intimately connected in the public mind. In many parts of the country, especially in remote districts where modern ideas and knowledge of the germ theory have not penetrated, this relationship still exists. In such places a full beard is an efficient badge of the doctor’s calling, and is essential in establishing his professional identity among the people.

Despite the widespread knowledge of the fact that beards are nothing more nor less than nests and hatching beds in which millions of disease germs find shelter, there are to-day numerous localities in which doctors as well as the laymen cling stubbornly to the belief that a physician without a beard is “no good.”

“Go on, neighbor, don’t try to fool me. That man’s no doctor. How do I know? Why, he ain’t got no beard.”

This is no uncommon statement to encounter in rural regions, and even in some fair-sized towns. Even the doctors themselves do not appear to recognize the fact that it is possible to separate their beards from their profession, and that it would be to the benefit of their patients and the advancement of their own reputations in the end to do so.

Modern, well-educated physicians know that many, in fact nearly all the ordinary ailments, are of germ origin. They also know, for instance, that a patient suffering from typhoid, or typhus, or some like disease, is continually reproducing these germs in immense numbers. For a physician with a full beard to lean over the bedside of such a patient is to invite millions of these germs to invade his beard, and wherever he goes he carries these germs with him and spreads the disease.

It is bad enough when decent precaution is taken as the hair of the head, the mustache, and even the clothing itself will harbor too many of the bacilli. But to wear a beard is to greatly increase the accommodations for these undesirable lodgers. In this way the health and lives of thousands of people are daily jeopardized.

This is why beards should have no place on the faces of physicians, and the more highly educated and more progressive the physicians are the fewer will be the beards found among them.

Another thing is a prime requisite in successful practice and this is the most scrupulous cleanliness. This refers not only to the person and apparel of the physician, but to the instruments which he handles.

Some years ago an Iowa cattleman suffering from a chronic trouble, came to Chicago for treatment which was administered hypodermatically. He made fair progress toward recovery, and finally was in condition to return home where the treatment was continued by his family physician.

For a time the reports made by the Iowa doctor were of a glowing nature. Mr. —— was getting along nicely, and the improvement in his condition was nothing short of miraculous. Suddenly word came that there was a change for the worse, and the Chicago specialist was requested to go to Iowa and make an investigation. He did so. On arriving in the town nearest the patient’s home he first called upon the local physician and together they drove out to see Mr. ——. The latter was evidently fast approaching a collapse and the specialist was at a loss to account for the remarkable change. He was assured that his instructions had been closely adhered to, both the patient and the local doctor agreeing upon this point. Finally the specialist said:

“Doctor, let me see you administer the hypodermatic part of the treatment.”

The local physician took from his overcoat pocket a hypodermic syringe without case or other protection. This he stuck into the bottle of fluid which constituted the treatment, and was about to make the injection when the specialist shouted:

“Great heavens, doctor, don’t do that! Let me see that syringe a moment.”

Holding the syringe up to the light the specialist found it extremely dirty on the inside of the glass barrel, and the needle point covered with lint. Calling the local physician into an adjoining room he said:

“My God, Doctor, it’s a wonder your patient is not dead. You are poisoning him to death. How long is it since you sterilized this syringe?”

“Why, it was sterilized when I got it, wasn’t it?” replied the local M.D. innocently.

“Yes,” answered the specialist, “and my instructions were that it should be cleansed with alcohol before and after every injection, and sterilized in boiling water at least once a week. This has not been done.”

Then and there the visiting physician opened the eyes of his country brother as to the grave importance of utter and absolute cleanliness in all branches of practice, and especially in the administration of hypodermatic treatments.

For nearly ten weeks this doctor had not cleansed the syringe. During all this time he had unconsciously been injecting into the system of his patient the most virulent of poison in the form of the decomposed lymph which remained in the syringe barrel, as well as such foreign substances as accumulated on the unprotected needle of the syringe.

And yet this “doctor” was popular and successful in a way, (in mild cases), despite his failure to keep up with the progress of modern thought. He was one of the old-fashioned full-bearded type, ignorant of germs and germ-theory, and too self-opinionated and set in his way to keep himself posted as to what is going on in the world of medicine.

I wish I were able to state honestly that, in the instance here referred to, the patient recovered, but he did not. The damage had been done, and it was too late, when the specialist was called in, to overcome it.

This is a truthful narrative. It is being duplicated in many instances owing to the ignorance and incapacity of men who, while possessing diplomas, are really unfitted for the practice of medicine. It illustrates in a sad, but forceful way, the necessity of being “up to date,” and mixing common sense with the medical lore acquired in the schools.

“Costly thy habit as thy purse can buy,” should be the rule. A physician should never dress flashily, but he should be garbed well. It creates a good impression. The time and money expended on improving the personal appearance is well invested. Patronize a competent tailor. A portly, well-conditioned man, well clothed, and of sunny, cheerful ways, will work wonders in the practice of medicine. Impressions are created largely by appearances. The man who looks affluent, who conducts himself in a good-natured, dignified manner, will succeed even though he be lacking in a thorough knowledge of his profession. The man who is slouchy and ill-kempt, and who takes no pains to be pleasant and obliging, will fail, no matter how well grounded he may be in the science of medicine. Why? Because he will repel people instead of attracting them. This same rule holds good in all lines of business, but it is specially applicable to the practice of medicine.

CHAPTER III
THE BUGBEAR OF ETHICS

One of the first spooks with which the young practitioner will be confronted is the bugbear of Ethics—don’t overlook the big E. It will be in front of him on graduation day, his preceptor will dangle it before his eyes as he hands him his papers, and it will be continually bobbing up after he has hung out his shingle.

Now ethics in its place is a good thing. It is especially essential in the medical profession in which, without a due regard for the proprieties, many men would be tempted to go astray. And this temptation is by no means slight at times. But there is such a thing as overdoing the ethical proposition. It becomes monotonously annoying for a man to have his every movement watched and judged from the ethical standpoint by a lot of self-constituted censors. The average physician, in his bearing toward his younger brother does not ask himself the old question, “Am I my brother’s keeper?” Not at all. On the contrary the worst of it is he assumes an opposite attitude and by his actions asserts “I am my brother’s keeper.”

In a way these men assume the right to dog and spy upon the movements of other physicians on the plea that they are doing it for the benefit of the profession—to see that the great Code of Ethics is not violated. What they are really after, nine times out of ten, is to make sure that the young, progressive practitioner who has the tact and ability to build up a good-paying practice does not encroach upon their preserves. This is bad enough, but there is a worse side. In nearly every instance those who howl the loudest about violations of the code, are gross offenders themselves. This is a bold assertion, but the proof will be furnished later on.

One of the things specially cited as an unpardonable violation of ethics is the courting of newspaper and similar publicity.

“My dear boy,” one of these old-time offenders will say, “you must not allow your name to appear so frequently in print. It is undignified and unethical. Our profession is one of mighty dignity and responsibility, and you owe it to yourself and your brother physicians to avoid anything which tends to lower or debase it. I know it is only human to seek notoriety of this kind, and that it is valuable so far as the mere getting of money goes, but we must be actuated by higher, nobler motives.”

It is practically a certainty—with rare exception—that the man who gives this advice, is bending every energy, and using every possible means to secure the same kind of publicity. He knows that fame and wealth come from keeping one’s name constantly before the public.

In every large city we will find physicians of wealth and fame, of whose every movement the newspapers seem to have information in advance. How do they get it? Let us analyze the conditions.

Under his professional obligation Dr. Soakum is bound to observe and live up to the code of ethics. He prates loud and often about the beauties of an ethical life, and the uninitiated might well suppose that his was a model existence in this respect. But, is it not a trifle strange that whenever Dr. Soakum, owing to his great skill and fame, is called out of town to attend some prominent personage in another city the newspapermen know he has been summoned. More than this, they know where he is going, whom he is going to see, and what train he is going on. Strange, is it not?

It is no uncommon occurrence to read items like the following in the daily press:

Dr. Soakum, the distinguished specialist in chronic disorders, left for San Francisco yesterday, having been summoned by wire to attend the Hon. Million Moneybags, who is seriously ill with chronic nephritis. The patient, whose disability at this time is of grave import to a number of large business transactions, has been under the care of a number of famous physicians, but his great confidence in the skill of Dr. Soakum led to the hasty summoning of the latter.

Dr. Soakum, who was seen by our reporter just as he was boarding the Overland limited confirmed the report. He added that the time of his stay was uncertain, as the case is a most important one, and may demand his undivided attention for some weeks. During his absence Dr. Soakum’s vast practice will be looked after by his associate, Dr. Bleedum. He added that he was both surprised and annoyed to think the news had leaked out.

Surprised! Annoyed! Not on your life. This was only a bit of stage play, of dramatic action, on the part of Dr. Soakum. Real surprise, real annoyance and real anger would have resulted only from the failure of the reporter to appear after the careful arrangements which had been made to ensure his attendance.

How often have many of us read items like the following in the daily press:

At last there is hope for the consumptive. Dr. Killem, the eminent specialist, whose success in the treatment of tuberculosis has aroused wide interest in the medical profession, has made public the details of his treatment by means of which such wonderful results have been obtained.

“I would have done this long ago,” said Dr. Killem to a reporter for the Morning Howl, yesterday, “were it not that I desired to be absolutely certain as to the permanent efficacy of the treatment. Now that there is no longer room for doubt on this point I feel at liberty to act.

“The essential feature in my method is,”——

And Dr. Killem goes on to give what he calls a professional statement, so involved and beclouded with high-sounding terms that the poor reporter makes a sorry mess of this part of his story.

Strange as it may seem this is just what Dr. Killem wants. He knows his treatment will not stand a scientific analysis by competent men, and he avoids this by intentionally leading the reporter to misquote. And then it gives him an opportunity to write a letter of protest to the newspaper and thus obtain more publicity.

“I’m chagrined,” Dr. Killem will say to his professional brethren. “That reporter for the Morning Howl has made an ass of me, but I suppose there is no redress. I gave him a few, a very few facts, out of kindness, and he has distorted them and made me ridiculous.”

And all the time Dr. Killem is swelling with pride. He has “put another one over” on the press, and obtained a lot of valuable publicity that he could not have bought outright. Besides he would not think of doing such a thing as to pay for advertising—it would be unethical.

How do you suppose the newspapers get hold of such items? Reporters are a pretty smart lot of men with noses keenly trained on the scent of news. But none of them, so far as known, possesses the gift of being able to tell in advance what is going to occur at a given time. Smart as they are it would be out of the question for them to know that Dr. Soakum had been called out of town, or that Dr. Killem had interesting information to impart to the public, unless they got tips to this effect, and these tips are just exactly what they get.

None of these physicians have press agents. Perish the thought. That would be decidedly unethical, and too clumsily convictive. No siree. They are too smart for that. Most of them, however, especially those who work the press continually, have private secretaries. The private secretary work is light, and is attended to by stenographers and book-keepers, but the title affords a handy cloak for disguising the press agent. Ostensibly engaged as private secretaries the men who fill these positions know full well that their one and only duty is to “boost” the professional prowess of their employers; to keep them constantly before the public.

Frequently this work is done by men who have no open, direct connection with the physicians who employ them; are not even seen around their offices. This is the latest dodge, and is becoming more and more general. It has one decided advantage in the fact that it is impossible to trace any collusion between the party who gives out the news, and the party who is benefited by the publication. It also has a further advantage. It enables the physician to put on an air of surprise, should he be questioned by a brother doctor, and say:

“Smith. Who is he? He is not on my office staff, and is certainly assuming a lot when he pretends to speak for me.”

All of these press agents work on the same lines. They know the avidity with which city editors grab for news, particularly if it concerns prominent people. When the occasion arises they get into communication with some city editor, generally by phone, and a conversation something like the following ensues:

“Hello, that you Brown? This is Jones. Yes, the same, old man. Thanks. I’ve just got onto something that looks like a good tip, and I thought you would like to have it. Dr. Soakum has been called to San Francisco to attend old Moneybags, the trust magnate. If the old chap should die it would raise Old Ned in the stock market. I understand that Soakum goes this afternoon on the U. P. limited. Oh, don’t mention it. I’m glad to be able to give you the tip. Hope you’ll be able to get a story out of it.”

Jones, the press agent, does not, of course, tell his city editor friend that there’s $25 in for him (Jones) if the story is printed. He’s too smart for that. So far as the city editor knows Jones is simply trying to do him a favor in a news way. The press agent is also smart in another direction—he does not call on the same city editor too often. It might arouse suspicion.

In nearly every city of any size there are a number of newspapers. Jones works them in rotation, so far as Dr. Soakum is concerned. First it is the Morning Howl, then the Daily Screech, next the Evening Whirl, and so on. Between the Dr. Soakum stories Jones works in items about other people, for the modern press agent is an enterprising chap who represents a number of clients all eager for publicity. A good press agent can look after the interests of a physician, a lawyer, an actor, and a promoter at all the same time, and not overwork himself. It’s merely a matter of giving out the right tips in the right way. If the tip looks good the city editor and his staff does the rest.

To preserve his standing with the newspaper fraternity Jones very frequently, if he is a real live, first-class press agent, tips off a bit of actual news, something in which there is no $25 for him, and which makes the city editors rise up and call him blessed. Incidentally it also makes them all the more willing to act upon his next tip, and this is just what Jones wants. He is merely sowing seed for the crop he is to reap in the near future.

And do reputable physicians countenance this sort of thing? you may ask. They certainly do; not all of them, it is true, but a big working majority. The large cities are full of physicians of wealth and fame who have been literally boosted into prominence by the newspapers. Fancy the effect upon the public when it reads of Dr. Soakum being called to attend so distinguished a citizen as the Hon. Million Moneybags, or references to Dr. Killem, “the eminent authority on tuberculosis.” It means a stream of dollars rolling into the pockets of the doctors thus referred to, and puts them in position to name larger fees.

There are times when as a matter of business precaution the press agent resorts to opposite tactics. It would not look well to be lauding Dr. Soakum all the time. So, having previously laid out the program with the former, the press agent hunts up another physician who knows how others are prospering through publicity and is not averse to having some of it for himself. The program is explained to Dr. Squills, and he writes to the newspapers, bringing to their attention some supposedly important medical subject. It may relate to hygiene, bad management of hospitals, unsanitary condition of street cars, the proper means of stopping the spread of tuberculosis, anything to attract public attention.

City editors, unless overcrowded with more important matter—and the press agent generally selects the opportune moment—will print this kind of “stuff” in full. Having printed it about the first thing they will do is to send out reporters to ask the “eminent Dr. Soakum” for his opinion on the subject. This is just what Dr. Squills was induced to break into print for. Dr. Soakum will endorse the latter’s letter, praise it warmly and perhaps bring out some new points which Squills has purposely overlooked. This gives Squills a chance to come back with a statement as to the importance of the suggestions made by Dr. Soakum, and the two old hypocrites thus get a lot more free advertising. All of which means more prominence, more fame, and more money.

Some years ago—about ten at this writing—a new treatment for chronic nervous and mental ailments was introduced. Its sponsors were men of high standing in the profession, instructors in leading medical colleges. That the treatment had great merit is undeniable; many wonderful results were accomplished with it. It also had great money-making possibilities, but the promoters did not know how to develop this feature.

Finally they engaged a press agent—we’ll call him Mr. Johnson, because that is not his name. His terms were $50 a week salary, and a royalty on the business. For three or four days Mr. Johnson did nothing except post himself as to the scientific features of the treatment and he was soon able to talk more glibly and intelligently about it than the physicians in charge. Then one day he said:

“Trot out some of your star cases. I want to look them over.”

Mr. Johnson went over the records carefully and selected one which seemed to give promise of producing a big free advertisement. It was that of a well-known, well-to-do merchant in a neighboring city who a year before had been seized with primary dementia. Homicidal tendencies developed and his family, on the advice of prominent alienists, placed him in a sanitarium, the physicians at which, as well as those called in by the family, pronounced the case absolutely incurable and hopeless.

In time the new treatment was administered. In ninety days the patient was discharged as cured, returned to his home, and resumed charge of his business. To this day he is well mentally and physically, and no one, unacquainted with his history, would ever think he had been insane, and confined as a dangerous lunatic.

Having satisfied himself as to the accuracy of the story, Johnson’s next move was to plan out a line of action. The story to be acceptable in a news way, and carry plausibility with it must come from the patient’s home town. It would never do for Johnson to offer it to the newspapers himself. His connection with it must be carefully concealed. The first thing he did in this direction was to ascertain who handled the correspondence that was sent out to the big dailies from this particular town. He found that it was virtually in the hands of a Mr. Wheeling, city editor of a local paper.

Armed with this knowledge Johnson took a train and went to the town in question—it is only a few miles from Chicago—timing himself so as to arrive there when Mr. Wheeling had finished his rush work for the day. Arriving there he introduced himself to Wheeling as follows:

“My name is Johnson. Pardon me for intruding upon you, but I’m a stranger in town, with a little spare time on my hands, and being somewhat of a newspaper man myself it seems sort of homelike to poke around an editor’s den. It’s the best way I have of killing time and, if it doesn’t annoy you, I’d like to pass away an hour or so chatting over newspaper work and newspaper men.”

Wheeling, a cordial, whole-souled chap, made Johnson welcome, and they were soon very friendly, exchanging reminiscences, and regaling one another with their experiences. Johnson was in no hurry to spring the trap. He was too smart for that. He produced some good cigars and, after they had talked for an hour or so, invited Wheeling to take dinner with him at the hotel. Wheeling accepted, and after the meal, when fresh cigars were lighted, Johnson proceeded to set his trap as follows:

“Once a man has the newspaper fever he never gets it out of his blood, at least not entirely. I’m better off now financially than I could possibly expect to be working as a reporter or editor, and yet frequently the old desire to cover an assignment, or write a good story, takes hold of me, and takes hold hard. It’s galling for a man of my disposition to run against a good story and not be able to make use of it, but this is happening with me right along. Why this very afternoon, in conversation with a business friend just before I met you, I heard a story that’s a corker, and would make a big sensation if it ever got into print. But pshaw, what’s the use of talking, I’m simply not in position to make use of it, and might as well pass it up. It goes against the grain though, I can assure you.”

“Why not give me the tip?” asked Wheeling. “I’m correspondent here for quite a list of papers, and a real live story, one that I could spread on, would mean considerable to me.”

“Well,” replied Johnson, “I don’t mind giving you such facts as I have, but of course I can’t vouch for their accuracy. All I can say is that if your investigation establishes the truth of what I have heard all the big papers will want the story by the column, and then some.”

Johnson then proceeded to outline the story to Wheeling, hesitating purposely as if not quite sure of the patient’s name, and giving one that sounded much like it, but was not the real one. The trap was sprung. Wheeling knew the man, and at once realized that he was in line for a big Sunday spread. It would not do to waste so good a yarn on the daily issues in which a stick or two of space would be the limit when he could place a column or more in each of the Sunday papers. Wheeling furnished his correspondence at space rates, so much per column, and he naturally wanted to make the story as full and complete as possible.

That very night (it was Monday) he visited the home of the miraculously cured man. The latter talked freely, corroborating all the important details. Wheeling’s next visit was to the home of the family physician, and there he got more corroboration. The next morning he wired the various Sunday editors as follows:

Prominent business man here, after being pronounced incurably insane by eminent specialists, and confined in asylum, fully restored to reason by new and novel treatment. Big story. How much?

He was swamped with replies. Every Sunday editor wanted more or less of it. Most of them wanted it in full, the orders reading something like this:

If sure of facts, and man is really prominent, send story in full. No limit. Also get pictures of patient, and others concerned.

The following Sunday morning every newspaper in Chicago fairly “shrieked” forth the news of the new treatment. It was given to the public in the form of a first-page story with the emphasis of leaded type, “scare” heads, and pictures of the patient. The Associated Press took it up and wired a report to all American papers, while a condensed statement was cabled abroad.

Nor was this all. Managing editors from New York to San Francisco, from Toronto to New Orleans, called upon their special correspondents to rush more particulars by wire. The managing editors of the Chicago papers instructed their city editors to obtain statements in full from the physicians interested, as to the scientific nature of the treatment, its history, etc. (The names and addresses of these physicians being given in the first story, the locating of them was easy—it was part of Mr. Johnson’s plan.)

What was the result? The new treatment was immediately “boosted” into world-wide prominence. Half a million dollars would not have paid for the publicity it obtained in one week. Indeed it would have been impossible to buy this kind of publicity—straight news—at any price. It made fortunes for the men interested. To-day, ten years after this publicity, these men are still reaping its benefits.

Now these men, it should be remembered, were and are strictly ethical. They frown upon anything that smacks of violation of the code. They will not sell the treatment to physicians who advertise. Their dealings are confined to those who can show a clean bill of health in this connection. To those who meet the demands in this respect they furnish the treatment at $27.50 per 2-ounce vial; the cost of producing it is about 75 cents. Nice profitable business? Well, rather.

The lesson of all this is that it pays physicians to advertise, provided they do it in the right way, and are clever enough to hoodwink their professional brethren as well as the general public on the question of ethics. The man who openly engages a real press agent and pays his money for “display ads” in the newspapers is tabooed, his name is anathema. The man who engages a press agent quietly to get up schemes by which the gentlemen of the press may be worked for valuable publicity is thoroughly ethical, and remains in good standing in the profession.

Wherein lies the distinction? I must confess that it is too fine for me. Of the two the honor seems to be with the doctor who proceeds to ask for patients in a straight-forward business-like manner, and pays the newspapers for the space they give him. On the one hand we have the man who pays for what he gets, while on the other we have him who, in reality, is obtaining goods under false pretences.

Just another point about ethics. It is strictly unethical for a physician to prescribe or administer a remedy the formula of which he does not thoroughly understand. But thousands of them are doing it daily. Where is the physician, for instance, who knows in reality, aside from the proprietors, the composition of Anti-Kamnia, but does lack of this knowledge stop its widespread use? Not at all. It’s the same way with acetanalid and scores of other preparations. Occasionally the proprietors of some remedies seek to ease the conscience of some extra scrupulous practitioner by printing what appears to be a formula. But in such cases there can be no assurance that the formula is correctly stated, the proper quantities given, or the method of preparation absolutely stated. In all such cases the alleged facts must be taken on faith.

The author has in mind one particular instance, the accuracy of which he can vouch for because he was interested in the preparation and sale of the remedy. A certain hypodermatic treatment was placed on the medical market “for the use of physicians only.” To satisfy the ethical gentlemen the formula was given, and it was given correctly. Nothing, however, was said about the method of preservation. This was an important item as the remedy consisted of a combination of animal tissues and fluids which would decompose quickly, and if injected into the human system would work havoc. To keep it in condition for use, with its curative properties intact, it was necessary to put it through a preservative process in the course of which various chemicals and other substances were added. Nothing was said in the formula about this feature, nor did the strictly ethical physicians who used it make any enquiry about it.

Common sense, to say nothing about medical training, should have told them that a remedy prepared after the formula as stated must decompose rapidly unless some preservative process was employed, but a little thing like this did not seem to bother them. They just simply glanced at the formula, wondered they had not thought of it themselves, and jabbed it into their patients according to directions.

What assurance did they have that, if the remedy was not properly preserved it would not injure, and perhaps kill the people upon whom it was used? What assurance did they have that, if the remedy had been put through a preservative process, it did not contain some substance which would be equally injurious? None whatever. Their actions were equivalent to saying they didn’t care.

This, to the careful, conscientious physician, would seem like coming close to the danger mark, and so it was. To speak plainly it was little short of criminal carelessness, and yet these practitioners were all thoroughly ethical. The only possible excuse for them is to say they thought they knew, but this is actually no excuse at all as, under their obligation it was their duty to know beyond doubt what they were using.

As Dr. Lydston asks in the opening chapter, “Why not be honest” about this publicity matter, and, he might well have added, all the other features of modern medical practice as well. There is no excuse for honest practitioners leaving the use of the public press to quacks and fakirs—and the few really good physicians who are smart enough to take advantage of it while at the same time “pulling the wool over the eyes” of their professional brethren.

Such tactics as now prevail, cloaked under the guise of ethics, are unfair to the young medic. They keep him from doing the very thing which the self-appointed Lord High Apostles of Ethics are doing, and waxing rich and famous thereby.

CHAPTER IV
LAWFUL TO ADVERTISE

Just who put forth the dictum that it is unlawful, unprofessional, unethical, for a physician to advertise is unknown. It was probably some old codger of antiquarian ideas. At any rate the rule—and it is a rule—is so old it reeks with decay. But, among progressive physicians, it is fast coming to be recognized as a rule which is “more honored in the breach than in the observance.”

Other professional men who were once held in bonds of the same nature are breaking away. We find in the public press the cards of attorneys, architects and civil engineers, all callings which are legitimately dignified with the name of “professions.” No exception is taken to these men making their talents known, although at one time—and it is only a few years ago—they were held in ethical bonds just as strong and binding as those with which the medical practitioner is now enchained.

But time changes all things. It has changed to a degree the code of ethics which formerly obtained in the professions of law, architecture, and civil engineering, and it is slowly, but surely, changing that of medicine. True the wording of the various codes remain the same, but there is a growing tendency to wink at, to overlook evasions.

It has become a matter of convenience to the public to know where to find a competent lawyer, or architect, or civil engineer. Hence the appearance of their business cards in newspapers. On the same grounds publicity by physicians is justifiable. It is more than justifiable. Mankind can, in a pinch, get along without attorneys or architects or engineers. That is to say it is rarely imperative their services should be requisitioned in a hurry. The trial of a law case, the plans for a building, or the construction of a bridge can generally be put off for a few days at least without serious injury or inconvenience to any body.

When a doctor is needed he is generally needed badly. It may not always be an emergency case, but almost invariably when the services of a physician are required, even in chronic ailments, delay only aggravates the patient’s condition.

If a medical man has, by special study, equipped himself to handle a certain class of diseases more intelligently and satisfactorily than the general practitioner it becomes his duty to let the public know about it. If we accept the dictum of the censors of medical propriety as they present it—that the obligation taken by the physician binds him to serve the public to the best of his ability—then surely we can not get away from the proposition that men of unusual ability are in duty bound to make the public acquainted with that ability. The successful physician does not live up to his obligation if he “hides his light under a bushel.”

Medical societies, the watchdogs of ethics, do not accept this doctrine. Not only this; they try to drive out of practice, to brand with infamy, to make an outcast and wanderer of the man who indulges in it. The “it” in this instance refers to publicity fairly bought and honestly paid for over the newspaper counter. But they do not always succeed.

For years Dr. McCoy had been a surgeon at Bellevue hospital, New York, a man of rare skill and of high standing in his profession. He was a member of various medical societies, respected and honored. After a long, weary experience he made up his mind that he was entitled to a better financial reward than it was possible for him to obtain in hospital or private practice. He came to Chicago, obtained a certificate from the State authorities, and began advertising in the daily newspapers as a specialist. His medical brethren were horrified. Remonstrance being of no avail, they promptly ousted Dr. McCoy from membership in the professional societies.

Not content with this they went further and filed complaint with the state authorities with the purpose of having his certificate, or license to practice, revoked. That they would have succeeded in this if Dr. McCoy had not taken the matter into the courts, is a certainty, as the members of the State Board of Health who would pass upon the question were all physicians and prominent in the societies which were seeking to deprive McCoy of his certificate.

A long, hard-fought battle in the courts was won by McCoy. In handing down its verdict the final court said in effect:

“We fail to see wherein this appellant has committed any offense against the laws of the State. If he was competent to practice medicine at the time he received his license he is competent to practice now. Nothing that has been alleged against him has affected in any way his ability, fitness, or competency as a medical practitioner. Neither has he committed any penal offense. True he has advertised, but advertising is not a felony; not even a misdemeanor.

“The fact that the medical societies to which he belonged have revoked his membership has no bearing on the case. These societies have no official powers so far as the State is concerned. They may very properly say who may, or who may not, hold membership with them, but they have no authority to say who may, or who may not practice medicine. Societies of this kind are purely social and professional; they are not endowed with executive, administrative, or legislative power to act for the State.”

This finding established in a forceful, indisputable manner the legal right of a physician to advertise his skill as a healer of mankind without affecting his ability. It was not to the liking of the sticklers for ethics who control the medical organizations. They would have the young medics believe—and up to the time the McCoy case was decided they had succeeded—that they were all powerful; that their word was law, not only as regards membership in the societies, but also as to who might, or might not, practice medicine. They succeeded because they controlled the State Board of Health. But the ruling of the court put an end to this impudent assumption of authority. It laid down and made clear the important fact that, in passing upon the competency of applicants for licenses, medical ability and good moral character were the sole and only points to be considered.

There is advertising and advertising, one kind respectable and dignified; the other outrageously bad. The author would not for a moment countenance the use of flamboyant “ads” like those with which the “weak men” and other quacks bombard the public through the daily press. Such advertising as a general thing is positively indecent and dishonest. The men who place it and the newspaper publishers who print it should be prosecuted into the penitentiary. It is a queer thing that so-called high-class newspapers which decline to accept lottery and get-rich-quick “ads” on the ground of morality (we’ll say nothing of their illegality) will openly solicit and publish the disgusting business advertisements of medical charlatans and fakirs.

No man who respects himself or his profession will “guarantee a cure or money refunded,” no matter how apparently simple or mild the ailment he undertakes to treat may be. Neither will he offer to take cases on the “no money until you are cured” plan. These are methods which belong exclusively in the realm of quackdom. They deceive only the ignorant, and are used with success only among that class of people. But baits of this kind stare one in the face from nearly every Sunday newspaper, and from many fences.

Then there is the fakir who calls upon you in loud type to “See Old Doctor Squeeze-em. He’ll do you good!” It’s a safe bet he will “do” you good if he ever gets you into his clutches; “do” you so good that you will be lucky to have carfare left to get home with.

These are not the methods employed by smart men who, through publicity, obtain a good practice, and put themselves in position to command large fees; men to whom patients will pay $100 for an hour’s consultation and advice without hesitation, while they would begrudge $5 to a physician of equally as much or more medical skill, but not so well versed in the art of self publicity.

How do these men get before the public? They pave the way according to well-laid plans. Their every move is part of a previously laid-out program. We are writing now of those who have not progressed to the stage of employing regular press agents, or have not become well-known enough to warrant regular advertising. They join some fashionable church and mix in its affairs; take prominent part in the sociables and other doings, and when the ladies come around with a grab bag, or “take a chance on a nice piano,” dig down deep into their jeans. They may have to get along on short rations for a day or two, but the money has been invested to better advantage than if it were expended for pork and beans. A short course of this kind gets all the women talking about what a charming man Dr. Swell is, and so liberal. Pretty soon they begin to boost him into prominence by insisting upon his taking charge of some of their social affairs, and then his name gets into the papers. This is the beginning. The oftener he is mentioned the more impressed the newspaper men become with the belief that he must be a man of importance, and the first thing Dr. Swell knows he is getting the most valuable kind of publicity by the column.

And the male part of the community? Well, it’s just as easy to “con” them as it is the women. Dr. Swell joins lodge after lodge, society after society, just as fast as he can raise money for the dues. He attends the sessions faithfully, and, so far as outward appearances go, takes a deep interest in the proceedings. He has a good word, and a warm, hearty hand shake for all the brothers. While modest, he always manages to have a word to say “right out in meeting” at the proper time, even if it is no more than to voice approval of something that has been done. Then, in time, it comes quite natural for the presiding Squeejicks, or whatever his title may be, to frequently say, “We would like to hear from Dr. Swell on this matter.”

Dr. Swell is coming on. If he keeps his head down to a normal size, treats everybody courteously, and goes along making friends at every opportunity, the first thing he knows is that he is nominated for the office of Worthy High Jinks. Of course he protests that there are others better fitted, etc., but he doesn’t mean it. He is elected, and again there is legitimate excuse for getting more publicity. All the papers announce that:

“At its annual meeting last night Cockalorum Lodge No. 37840, O.B.O.A.B., elected Dr. What A. Swell as Worthy High Jinks. Under his regime Cockalorum Lodge will make many advancements during the coming year. When Dr. Swell was asked to outline his program last night he said:”

And here follows a lengthy interview which Dr. Swell, knowing he was sure to be elected, had prepared in advance. From then on it is easy sailing—if he is a smart man. He manages to keep Cockalorum Lodge doing something all the time; not that he is so desperately in love with the lodge, but because it means more and more publicity to Dr. Swell. As with Cockalorum, so with the other lodges, or churches, or societies to which he may belong.

From being at first a mere atom of news, Dr. Swell finally becomes an actual necessity to the newspaper fraternity. Its members have acquired the habit of turning to him involuntarily whenever a news problem presents itself. If the cable brings information that Emperor William has a sore throat reporters besiege Dr. Swell. He talks learnedly (or he should) of the nature of the trouble, and outlines the proper course of treatment, etc. Again it is heralded to the community that:

“On being asked concerning the nature of Emperor William’s ailment, Dr. Swell, the eminent authority on diseases of the throat, said——”

Is Dr. Swell coming on? Not at all. He has arrived—landed on both feet as it were. He is There and It. From then on it is only a matter of taking advantage of his opportunities. He may remove to a larger city where the services of a shrewd press agent will be necessary to secure the desired publicity, or he may stay in the smaller place where he has gotten a good start, and keep up the good work by a judicious distribution of coin among the newspaper boys. Not as a bribe, dear me no. That would be too raw. It would give the doctor dead away, and kill the game.

There are physicians in every large city who seem to be vital to the existence of the prominent newspapers. “See Dr. Blank,” is the order that goes forth from the city editors on every possible occasion, important or unimportant. Let the government chemist declare that ice cream is impure and deleterious to health, and a hundred Dr. Blanks in as many different cities will be interviewed at length and their views, often worthless, spread before the public adorned with glaring headlines.

Let the Ahkoond of Swat sneeze and at once we are regaled with the views of the favored doctors as to the evils of hay fever and the best means of counteracting them.

It is a poor schemer of a physician who can not in some manner, through lodge, society, or other connections, make the acquaintance of at least one city editor and, without obtrusion, make himself so valuable to the scribe that he becomes, as it were, an unsalaried member of the staff, ready at all times to help his dear friend the city editor out whenever the latter wants anything in the line of medical information.

Blame these doctors? Not at all. On the other hand I feel like patting them on the back and saying: “Go it, boys. I admire your fine work. You’ve got Bunko Bill beaten to a frazzle.”

There is one doctor now famous because he is quoted almost daily in the newspapers, who ten years ago was in hard luck financially. One day he was introduced, or rather introduced himself, to a city editor by calling at the latter’s office on an apparently innocuous errand. It happened just at the time (accidentally, of course) when public interest was aroused over the prevalence of infantile paralysis. After the doctor had concluded the business on which he called, the editor, finding him an intelligent, well-informed man, asked his opinion on the medical sensation of the day. This was the doctor’s opportunity, and he took full advantage of it.

“That is an important matter,” he replied, “and no professional man should discuss it hurriedly or carelessly. I have some pressing calls to make (this was a whopper) and haven’t the time to spare just now, but I’ll be delighted to give you my views within a few hours.”

This was acceptable, so the doctor went to a friend’s library, read up on the subject as thoroughly as he could in such a short time, and a few hours later was back in the editorial sanctum. Here he talked so well that the editor said:

“By Jove, doctor. That’s the kind of stuff I want. Can’t you write it out for me? I’m afraid to trust a reporter, as there would be a risk of getting it muddled. I’ll give you a good stenographer to dictate to.”

Barkis, which in this case was the doctor, was willing. He dictated the matter, and the next morning was paraded on the first page in big type as “the eminent Dr. ——”

His fortune dated from that day. Patients came in by the score. His newspaper friend had occasion to call on him frequently for information on current medical topics, and he was in print so much that his name was on everybody’s tongue. That was fame, and a kind of fame that brought wealth.

This particular medic had the gift of a real bunko artist. He knew how to keep the good thing moving, and to “con” the city editor who thought he was above being caught.

“Really, my dear Mr. ——,” the doctor would say when asked by phone for a statement, “really I’m too busy to do the subject justice, but I can’t refuse you. Send a stenographer over and I’ll dictate something. By the way, the World and the Express both wanted something but I had to turn them down.”

Did the city editor appreciate this favoritism? He certainly did, and saw to it that the doctor got all there was coming in the way of double leads, scare heads, and top of column positions.

CHAPTER V
GETTING COUNTRY PATIENTS

While the kind of publicity outlined in the preceding chapter is valuable and will make a man famous in his own city, it takes a long time to reach the people in outside territory. It is a peculiar fact that in medicine, as well as in other things, “distance lends enchantment.” The person afflicted with a chronic ailment who lives in the same town with a physician who has become famous for his successes in that line, is more apt to postpone his call for relief than one who lives at a distance.

The local patient argues to himself: “There’s no immediate hurry. I’ve been afflicted in this way ten years and I’m too busy just now to take the time to see the doctor. He’s right here in town, and I can reach him at any time. I’ll drop in on him some day when I’ve got more leisure.”

A certain proportion of the physician’s town folk respond to the publicity bait, but he must have the fat fish from outside if he is really going to get large fees in great number. How is he going to reach them? Here is the plan successfully worked by one doctor who has made himself wealthy.

He made arrangements with an advertising agency to secure the insertion of “pure reading matter” ads in a number of country newspapers in towns within 500 miles of Chicago. His press agent then prepared an article reading about as follows:

LOCOMOTOR ATAXIA CURED!

Remarkable Results Obtained by a Chicago Physician

Prominent Man Afflicted With This Terrible Ailment For Many Years, Restored to Sound Health After a Short Treatment.

New York, June 10.—Among the passengers on the outgoing steamer Cedric which sailed to-day for Liverpool, was Col. H. B. Thomas, of London, who is returning to his home after being successfully treated for locomotor ataxia. He walks freely, and is apparently in the best of health. When asked if it was a fact that he had been cured of locomotor ataxia, an ailment which most physicians pronounce incurable, Col. Thomas said:

“It certainly looks like it. This is the first time I have been able to walk freely, or have been without pain in ten years. I was on crutches and suffering the torments of the damned when I came to this country to take the treatment four months ago. You can see for yourself the condition I am in now.”

“Where did you take treatment?”

“With Dr. G. H. Wilkinson in Chicago. When I first got there he had to visit me at my hotel, but after the first two weeks of treatment I was able to walk to his office at —— Michigan Ave. Improvement was reasonably rapid, remarkably so, considering the obstinate nature of the ailment. Now I can walk as well as anybody, the pains have left me, and all my bodily functions are normal.”

Newspapers in the smaller towns and cities are not so particular in the definition of the term “pure news reading matter” as their larger and more prosperous contemporaries. They need the money. Consequently all the publishers who received an order from the —— Advertising Agency printed the article.

Country people as a rule are closer readers than those in the larger cities, and within a week everybody in the territory thus reached who was afflicted with locomotor ataxia was talking about the wonderful case of Col. Thomas, and writing to Dr. Wilkinson (this is not his real name) about their own cases.

Here again the services of the doctor’s secretary, who was correspondent as well as press agent, were called into play. Every letter was answered in a kindly, sympathetic manner, somewhat as follows, the stationery used being very plain and neat, but of the best obtainable material, and modestly engraved:

G. H. WILKINSON, M.D.

SPECIALIST IN CHRONIC DISEASES

—— Michigan Avenue

Chicago, August 2, 1910.

Mr. John Smith, Godfrey’s Corners, Ia.

Dear Sir: Replying to your letter of July 31st, I regret being compelled to say that, in the absence of opportunity for a complete personal examination, it would be impossible for me to say definitely what may or may not be done for you in the way of obtaining relief. If you can arrange to come to Chicago for a few days I will give your case my earnest personal attention and will then be in position to advise with you more satisfactorily.