MJCI IGAN DAILY
On Medicine, Medical
Economic Planning Committee Meets In Washington
L
Agencies Of Michigan Drawn
Up By Leading State Doctors
Editor's Note: This is the first of a series of articles by Profes-
sor Wesley H. Maurer of the department of journalism concerning
the report of the committee on the Survey of Medical Services and
Health Agencies in the State of Michigan. The report has just
been finished and will be submitted July 12 to the House of Dele-
gates of the Michigan State Medcal Society at the annual conven-
tion in Lansing.
By WESLEY H. MAURER
Is the cost of medical care in the State of Michigan too high? Can
the average citizen in the state afford to pay for adequate medical care?
What is the average income of the practicing physician of the state? Does
private practice provide sufficient income for physicians? Is the University
Hospital functioning as an educational institution or is it being used by
many as a means for getting cheap hospitalization? What, if anything,
is wrong with the practice of medicine in the state, and what can be done
to fit the profession of medicine into the new patterns of our social and
economic life?
These searching questions are the basis for a report now ready for
submission to the House of Delegates of the Michigan State Medical Society
prepared by a committee appointed
by the Society in 1931 to make the
study. HIGH POINTS OF ARTICLE
The study is the first complete Here are a few of the outstand-
state survey that has been made. ing statements made in the ac-
Its significance is attested by the companying article on the survey
fact that more than 40 state medical of medical services and health
associations in the United States, agencies in Michigan:
several leading foundations, and nu- "Medical practice can no more
merous health agencies have made maintain the status quo than can
inquiries regarding the statistics and any other movement in human
other facts gathtred for the study, affairs."
Prominent Names Included "Once medicine is seen as an
Rescue Expedition Starts
-earching For MILaaern
NEW YORK, June 30.-(/ -The
"Jimmie Mattern rescue expedition"
soared away from FloyciBenn"tt
field at 7:06 a. in. eastern stanmdard
time today for Alaska.
Chief Pilot Willian Alexander in
command of the rescue planze, s; id
that on reaching Nome, he and his
three companions would "divide the
map into squares" and scarch sys-
tematically for the lost flyer.
U. S. Is
Own Argui
On Stabili
S.
Rubarth
-Associated Press Photo
Business leaders of the nation, who are on the advisory and economic planning committee, are shown
as they met in Washington. Seated at table, left to right: Alfred P. Sloan, jr., of General Motors, Gerard
Swope of General Electric, Col. Edward Hurley of Chicago, Secretary Roper of the commerce department,
Walter S. Gifford of American Telephone and Tellegraph company, Melvin A. Traylor, Chicago banker;
E. Y. Mitchell, assistant secretary of commerce; John Dickinson, assistant secretary of commerce; Col.
Robert Q. Elbert of Aeolian company, H. P. Kendall, head of Kendall company, Boston; William E. Wood-
ward (behind Kendall) of New York and Fred I. Kent, New York banker.
The survey was conducted by rep-
resentative physicians of the state
who were appointed by the president
of the state society. They are Dr.
W. H. Marshall, chairman, Flint;
Dr. L. G. Christian, Lansing; Dr.
Bert U. Estabrook, Detroit; Dr. C. S.
Gorsline, Battle Creek; Dr. F. A.
Baker, Pontiac; and Dr. F. C. Warn-
shuis, Grand Rapids. These physi-
F cians engaged as director of the
study Dr. Nathan Sinai, professor of
public health at the University, who
has had wide experience in survey
work. In addition to these, 35 phy-
sicians from various parts of Michi-
gan and six public health officials
worked on subcommittees for the
study of special problems.
Every county medical society in
the state co-operated in the survey.
Questionnaires were sent to each of
the 5,585 physicians practicing in
Michigan during 1931. An effective
follow-up campaign through the sec-
retaries of the county societies gave
the committee an unusually high
percentage of returns and makes the
findings all the more comprehensive.
One of the key chapters to the
report is its study on population in-
come and costs of living prepared
for the committee by Professor
Morris Copeland and William Hoad
of the department of economics at
the University. Equally important
is the chapter devoted to the, inci-
dence, care, and cost of illness. Two
others of the 11 chapters are de-
voted to a study of the distribution
and practice of physicians in the
state and their incomes.
University Hospital Discussed
The vexing problem of the Uni-
versity Hospital, which has caused
heated arguments in local and state
medical circles, is discussed frankly,
and the various opinions of physi-
clans and the grounds for these
opinions regarding the Hospital's
policies are cited. Another phase of
the report deals with county health
organizations with special reference
to their costs to the taxpayers and
to their effectiveness in organization.
In the chapter on miscellaneous re-
ports there are discussed such prob-
lems as the free and part-pay clinics
in Detroit, the cancer problem, lab-
oratories, medical care of negroes,
the problem of tuberculosis,: care of
indigents, industrial relations, and
medical education and licensure.
In discussing the objectives of the
survey the committee writes in the
foreword to the report that it "does
not conceive the end of this study
to be concerned with the means of
making more money for physicians
... nor should the objective be mere-
ly a struggle for power; rather it
should be an- attempt to assume in-
telligent leadership, aiming at a hap-:
pier, healthier, and more secure so-
cial order." The committee writes
that the policy of laissez-faire, which
assumes that change will come of
itself and in spite of the profession's
efforts, is short-sighted, and adds
that the profession must concentrate
on a study of what seems to be
wrong and "then try to work out a
program of relief."
integrated part of the whole so-
cial and economic order, changes
will not only be expected but
planned for according to circum-
stances."
"Medical practice in Michigan,
operating on circumstances ob-
taining in the period about 1900
cannot possibly be aware of the
factors which have brought slow
but revolutionary chages in the
profession as ell as in the society
ini which it practices."
"As medicine became more effi-
cient in its treatment of illnesses,
requirements of medical services
decreased-a condition which par-
. allels technological unemployment
in the field of industry.
"The decrease in sickness and
in death is one of the amazing
arid probably the most gratifying
of all the results obtained by
Smodern medical practices. It
perits medicine to survey the
field and ask: What new forms
of employment are to be de-
veloped?"
rial advancement and its social prog-
ress."
One of the healthiest signs of
adaptability in our social institutions
is the rare characteristic of self-
criticism. Public criticism of our
professions is always valuable, for
not infrequently public pressure is
required to make them more socially
responsive. But criticism of the pro-
fession by its members is very likely
to be more pointed and more effec-
tive; in addition to this it has the
quality of being farsighted in that
it anticipates public pressure and
prepares to meet it before the pro-
fession's prestige vanishes in the in-
evitable conflict.
An example of this frankness and
self-criticism is to be found in the
conclusion of the first chapter of
the report, entitled "The Evolution
of Medical Care;" which traces the
progress of medicine in parallel with
the economic history of the United
States.
"Medical practice," the conclusion
sets forth, "can no more riiaintain
the status quo than can any other
movement in human affairs. To at-
tempt such maintenance is a symp-
tom of rigidity which soon leads to
the advocacy of the status quo ante,
a sign of decadence."
Deploring the unequal rate of
progress in the three aspects of med-
ical care, namely, research, educa-
tion and practice, the. committee
indicts the profession for allowing
habit to rule its outlook. "The in-
dividual (practitioner) who attempts
innovations," writes the committee,
"meets with little of that healthy
9kepticism displayed toward re-
search," and it adds that judgment
concerning these innovations have
been unusually emotional.
With regad t medical education,
the committee feels that the "forces
of creation and of habit" are more
equally balanced, yet, the committee
adds, while the "trend is toward the
inclusion of the new, any move to
discard,' re-evaluate, or change the
old is bitterly opp osed." In iesearch
alone, the committee -believes, is the
conflict between creative imagination
and established habit about at an
end, and the prevailing attitude, it
is held, is one of supprt and healthy
skepticism. The rate of progress of
Be sure to dance
and dine at the
DANCERS'
PARADISE
formerly the Eclipse on
Ecorse Road
OPENING NIGHT
SATURDAY, JULY 1
the three, the committee holds, is
too uneven, and the distance between
them, it is maintained, should be
shortened. "While it would be ab-
surd," the report reads, "to ever ex-
pect (them) to march abreast," it
would not be unreasonable to ex-
pect a much shorter interval between
them.
Three Theories Brought Out
The committee prefaces its dis-
cussion of the economic progress of
medicine in the United States by
pointing to the three different
theories pertaining to social charge.
One theory holds, the committee
states, that change is inevitable
through the operation of natural law
-a point of view which leads, in the
committee's opinion, to inaction. The
opposing theory is, the report reads,
that social changes lend themselves
to the guidance of man-a concept
which lays the basis for action on
knowledge and its intelligent appli-
cation. Another point of view is one
which, while holding basically to the
first theory, assumes a militant at-
titude toward the forces which would
bring about a change and commits
itself to a program of obstructionism,
the committee asserts, adding that
this notion is not consistent in view
of the fact that support of a move-
ment or obstruction of it only means
its guidance in one direction or in
another. All three theories are well
represented in the field of medicine,
the committee states. Once medi-
cine is seen as an integrated part of
the whole social and economic order,
changes, the committee believes, will
not only be expected but planned for
according to circumstances. The
committee thus lays the basis for its
contention that medical practice in
Michigan, operating on circum-
stances obtaining in the period
about 1900 cannot possibly be aware
of the factors which have brought
slow but revolutionary changes in
the profession as well as in the so-
ciety in which it practices.
Physician Was Supreme Individualist
The physician, the report states,
was probably supreme among the
individualists ii the early period of
economic development in this coun-
try during the time while nine-
tenths of the population were en-
gaged in agriculture, when wood was
the common fuel, when steel was a
semi-precious metal, when the fam-
ily was the unit of production, and
when it was easy to go into business
for oneself. After serving a short
apprenticeship to a practitioner,
during which time he "assisted,"
read books on anatomy, physiology,
and the philosophy of medicine-
learning a bit of science and a great
deal of art-he was ready to practice
for himself.
With nothing but human energy
as his investment and with very
simple and crude equipment, he was
ready for the profession. "His day
might begin," the report reads, "with
the ushering-in of a new human be-
ing, include the performance of
rough and dangerous surgery, and
end with spiritual guidance, since
the professions of clergymen and
physicians were often combined."
The relationships between his pa-
tients and himself were, the report
points out, like the relationships of
all economic and professional activi-
ties, direct and simple.
Became More Complex
But in the second period, follow-
ing the Industrial Revolution, the
practice of medicine became exceed-
ingly complex. It was during this
period when families who were not
lured by the machines into the fac-
tories pushed the frontiers westward.
The tempo of factories increased,
farms began to supply food for dis-
tant markets, machinery was intro-
duced on the farm to harvest larger
f crops, transportation was effected to
carry goods to the cities and manu-
factured goods throughout the coun-
try. Then capital outlay for private
enterprise increased, individual op-
portunity.subsequently decreased, and
the spectre of insecurity entered
American life. The evolution of med-
ical practice, the committee declares,
paralleled this. As mechanical horse-
power provided the moving impulse
for industry, so research provided the
great driving power for medicine, the
committee points out, showing that
this "systematic study by the experi-
mental method 'developed into- a
huge tidal wave of production in
science." Medical schools increased
from 5 in 1800 to 160 in 1900, de-
creasing, under stricter supervision
and higher standards, to 76 in 1929.
Formal education for the physician
lengthened to 6, 7, 8 years or longer.
Then the division of science
brought about specializations until
today there are 22 specialties listed
by the American Medical Association.
Even within these specialties there
are small divisions of specialization.
Then came specialized care with
costly hospitals, trained nurses, un-
known a century ago, and laboratory
technicians. The capital investment
of physicians increased and the med-
ical dollar becamedivided into many
parts. Equipment became more
costly, the relationship between phy-
sician and patient became more
complex, and above it all hovered
also the spectre of insecurity.
Need For Services Decreased
Then as medicine became more
efficient in its treatment of illnesses,
requirement of medical services de-
creased-a condition, the committee
believes, which parallels technologi-
cal unemployment in the field of in-
dustry. Thus if the 1900 rate of
deaths in Michigan from typhoid,
diphtheria, tuberculosis, diarrhoea,
and enteritis (under 2 years), and
mortality of infants under 1 year
had continued, there would have
been 27,069 deaths in 1931; instead
there were only 8,586 deaths. The
typhoid fever, diphtheria, and tuber-
culosis cases based on the 1900 rate
in Michigan should have been in
1931 approximately 45,460 instead of
the 8,387 cases. When all diseases
are taken into consideration, the
number of deaths in 1931, after an
adjustment is made for population
differences of two years, shows a
decrease of approximately 20,000
from the figures of 1901.
"The decrease," states the report,
"is one of the amazing and probably
the most gratifying of all the results
attained by modern medicine. It
permits medicine to survey the field
of its endeavors and ask: What new
forms of employment are to be de-
veloped? It is obvious that future
needs cannot be -projected upon the
basis of those types of service fitted
to the demand of 1900."
Sell 'flatiron'
Structure For
$100,000 Cash
NEW YORK, June 30.-()-
With a single drop of an auction-
eer's hammer, the famous old
Flatiron building was sold today
for $100,000 to the Equitable Life
Assurance Society of the United
States. -
NEW YORK, June 30.-(')-The
Flatiron building-that "stingy piece
of pie" that made some critics of
1902 moan as if they had eaten it
and got stomachache-went on the
block today..
1hirty-one years ago, the famous
building was erected to knife the
breezes at 23rd St., Broadway and
Fifth Ave. Now the mortgage has
been foreclosed, the auctioneer called
in. .
The news summoned back long-
forgotten geography lessons 'to peo-
ple throughout the land. For years
school books carried pictures of the
sliver structure, captioning it one
of the sights of New York.
When it was erected, New York's
mushroom growth already had a
good start so that the building-
rearing its 20 stories above pygmy
structures around it-never was the
city's highest.
The discussion it aroused, how-
ever, put all the others in the shade.
Some likened its shape to a battle-
ship; others to a flatiron. The flat-
iron moniker struck, although the
official name was "Fuller building."
Some, criticizing its design, could
see it only as a "stingy piece of pie."
"The monstrosity," said the artist,
William Ordway Partridge, "is a dis-
grace, an outrage to one sense of
the artistic and a menace to our
life."
T. P. Sinha To Speak
On League Of Nations
Dr. T. P. Sinha, special student in
political science, will deliver an ad-
dress on "The Religious Import of
the League of Nations" at 6 p. m.
Sunday to the Student Guild at Wes-
ley Hall, it was announced yester-
day.
Dr. Sinha, who has been a student
of the University for the past semes-
ter, received his academic degree in
India. After two years of political
science at the University of London,
followed by a similar course at the
University of Washington, he served
in Mahatma Gandhi's ambulance
corps during the war.
Dr. Sinha has had extensive jour-
nalistic experience, serving on the
paper which was later changed to
"Young India.' He was also a re-
porter for two years on the Manches-
ter Guardian, of London, and assist-
ed Dr: Howard B. Calderwood in the
Secretariat of the League of Nations.
Lectures On
Hiler Regime
(Continued from Page 1)
tary inflation had wiped out their
savings and because those that were
working were being taxed heavily to
aid the 6,000,000 to 7,000,000 unem-
ployed."
This is a higher percentage of men
out of work than in this country, ac-
cording to the speaker, and condi-
tions in Geriany are more serious
than here because the unemployed
cannot fall back on the soil to eke
out a living..
After Hitler was made dictator of
Germany, his party faced the job of
finding jobs for the 25 to 30 per cent
of the working men who were un-
employed. To put them to work it
was necessary to oust members of
other parties from all available posi-
tions.
Hitler has been anti-Jew partly
because of the fact that, being born
in Austria in a section of the coun-
try which has a large Jewish popu-
lation that is rather unpopular, he
cannot conceive of any nationalistic
movement that is not also anti-
Semetic," Dr. Rubarth said.
In regard to Hitler's army, he said
that, although the dictator's troops
are thought by many foreigners to
be dangerous and to be forbidden by
the army limitation clause in the
Versailles treaty, the group is not
militaristic and is in no way con-
nected with the official army.
"Germans have been trained to
like the psychological security of
marching ranks," he said. "Many
discouraged young men have joined
the Hitler forces because they enjoy
being ordered and like the military
discipline that they get when they
are put in the ranks."
The uniforms of the army, Dr.
Rubarth stated, were important items
in winning votes for Hitler. The men
consider the wearing of them an
honor and the women are partial to
young men who dress in the simple
brown shirt.
Citing Hitler's honesty, he con-
cluded, "I don't fear any interna-
tional trouble being caused by Ger-
many."
New Highways In Ozarks
Put Thousands To Work
SPRINGFIELD, Mo., June 30.-()
-The Ozark country this summer is
supporting thousands of families
through labor on highway projects.
At least 5,000 men are now at work
on road developments in the Missouri
hills, a survey of contractors' weekly
reports and state highway depart-
ment pay-roll figures revealed. High-
way officials estimated 10,000 fam-
ilies, or 50,000 persons, were depen-
dlent upon this construction work for
the necessities of life.
The minimum wage for common
labor is 35 cents an hour for 30 hours
a week, with higher pay for skilled
workmen and machine operators.
PAPA SOCKS-MAMA PAYS
WHEELING, W. Va., June 30-(1)
-Gregory Vaslokis was fined $10 for
wife-beating. Mrs. Vaslakis told the
court it didn't hurt very much, and
paid the fine.
Thirteeen cities and towns in the
United States bear the name of
Mansfield.
If7= i~.itewe' bay it.
Correspondence Sttioneiy
Foditmin P s, Ink, eta.
:T Oi iters all rrAes9
o D. M Q R -R 17,
-31~ I. $tto!S*, A A rlkr.
Nation Shares England's
Boat lin Eyes Of Go 1
Standard Couniitries
(continued fron Page 1)
ures, countries have become less un-
willing than formerly to adopt trade
policies which are likely to distrub
the world market, Professor Reame
said, and to align themselves, osten-
sibly at least, with isolationism.
Planned economy for any country,
according to Professor Remer, Is like-
ly to bring about a policy of appar-
ent isolation. The planers, for rea-
sons' of domestic iplomiacy,' argue!
in terms of isolation although in ae-
tual practice they take international
trade into account as eagerly as ever.
As an unfavorable precedent for a
nation prematurely returning to the
gold standard, Professor R e m ev
pointed to England, which stabilized
its currency on gold in 1925 with
undesirable consequences. F r a n ce
now has a real fear of currency ma-
nipulation, said Professor Remer, but
is more concerned over the prospet
of inflation in the United States than
over the situation in England becau,
it considers England more vulnerale
and more dependent on world trade
than America.
Professor Remer doubts that Prei-
dent Roosevelt will do any very radi-
cal manipulating of the currency.
but declares that the United States
cannot permit the impression to exist
among the population that its hands
have been tied by other countries.
He asserted yesterday that the
political situation in the Wold F o-
nomic Conference would- have been
better if something had been done
about international debts before the
conferees met. He particularly re-
mai'ked on the fact tat the Un ited
States permitted June15, the day
Onl which wai' debt payments were
due, to pass without any internation-
al conclusion having been reached
Wedding Ceremon Is
Held In League Chapel
Miss Marjorie Johnson, daughter
of Mr. and Mrs. R. H. Johnson, 512
;Hill Street, was married to Paul
Smith, son of Mr. and Mrs. H. W. D
Smith of Lockport, N. Y;, at 8 p. iii,
Thursday in the chapel of te 1I -h
igan League building. Dr. Edward
Blakeman of the First Methodist
church read the service.
The bride wore an attractive model
of egg shell crepe trimmed with vel-
vet gardenias and carried a shower
bouquet of Johanna Hill roses and
baby's breath. Her only attendant
was Miss Ruth Sessions of North-
ville, who wore yellow net over yel-
low satin and had a shoulder cor-
sage of tea roses and baby's breath.
The groom was attended by Francis
Bennett of Ann Arbor as best man.
Mrs. Johnson, mother of the bride,
was attired in flowered chiffon and
had a small corsage of roses. Mr
Smith, father of the groom, played
the organ,
A reception in the Russian tea
room followed the service, with Kap-
pi Phi sorority sisters of the bride
assisting. Among the out-of-town
guests -were Mi and Mr. Oliver
Smith and Mr. and Mrs. Charls
Allgiers from the east.
DR. FREDERICK B. FISHER
in a series of
Studies in Successful Living
Sunday Mornings at 10:45
July. 2 -- The eep Drives of
tOne's Nature
July 9 -- Getting Into Har-
mony With Oneself
July 10 - -Learning to Manage
Trifles
July 23-- Living Above
F0rictiovg
i a-1 111er m mI e s
August 0 - Tasting Deeply of
Au.,list 13 - 'The Worider Of
RulwiiuS EMerience
ltclF-IoST METHODIST
EPISCOPAL CHURCH
State & Washington
(The remaining eight
this series will be printed
ing issues of The Daily.)
articles in
in succeed-
Scientific Approach Essential
"If medical economics is to be
studied at all," the committee states,
"this must be done in a scientific
manner, and, if possible, without
prejudice. Fallowing approved so-
ciological methods, the committee
has endeavored to prepare certain
statistics which seemed essential to
an understanding of the situation..
"There are those who fear the dis-
integration of our civilization; there
are alarmists who believe that we
are on the verge of a violent revolu-
tion; there are those who fear that
the future of the private physician
is uncertain. Such catastrophes need
not happen if the profession aban-
dons its policy of drifting and uses
TYP-EWRITING
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