Excerpt from The Sanitarian, Vol. 18: January to June, 1887

IF I were to put the question to this august representative assembly, What is the most annoying and unpleasant feature of our professional work, from what source spring our most harassing, though comparatively petty cares and our most pro voking disappointments P I think I should have no difficulty in determining, even if all spoke at once, that what we may call the financial question in medicine enjoyed that bad eminence more generally than any other which could be suggested. No doubt much of this difficulty and unpleasant ness is inherent in the very nature of the process for this is the point of metamorphosis at which our talent and industry must be coined into their equivalent of hard cash, where our lofty ambitions, noble aims, or Utopian schemes for benefiting the race come into merciless contact with the hard, cold real ities of life and the struggle for existence, always, at best, a mortifying experience. Friction at this point is inevitable a reduction to a minimum is all we can hope to effect. Whether the financial relations which we sustain to the laity are the best possible which could be assumed to effect this reduction, is the question to which I wish briefly to call your attention to-day. I stand here simply as an animated interrogation point.

Read in the Section on Public Health at the thirty-seventh Annual Meet ing of the American Medical Association.

No doubt the question has suggested itself to many of you that the treatment of this subject would have been much more appropriately undertaken by one of wider experience and longer standing in the profession, but it is the peculiar priv ilege of youth and inexperience to ask the raison d'�tre, even of truths which we have come to regard as axiomatic and customs which have grown hoary with centuries of observance. Is the system of making a physician's income from a family or community depend solely upon the amount of sickness occurring in it, the best that can be devised for the mutual interests of both parties concerned? Such practically is our system. Its philosophy might be condensed in the motto, Millions for Cure, but not one cent for Prevention. The astute Chinese, who were discussing civil service reform when our ancestors were building the reed hut and hurling the flint-tipped javelin, are said to pay their medical attendants regularly as long as they enjoy good health, but to promptly discontinue their remittances on the first appearance of sickness, to resume only on recovery which no doubt has arisen from their absurdly attempting to live up to a foolish old proverb of ours about an ounce of prevention.

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