TfiB Commercialization of Rletlicine; 
Or, The Physician as Tradesman, 
A Sociological Study, 
BY 
THEODORE W. SCHAEFER, M. D., 
KANSAS CITY, MO. 
Reprinted from the Boston Medical and Surgical Journal of 
November 22, i8g{. 
BOSTON: 
DAMRELL & UPHAM, Publishers, 
283 Washington Street. 
1894. S. J. PARKHILL A CO., PRINTERS 
BOSTON TIIE COMMERCIALIZATION OF MEDICINE; 
OR, THE PHYSICIAN AS TRADESMAN. 
A Sociological Study. 
BY THEODORE W. SCHAEFER, M.D., KANSAS CITY, MO. 
THE RULING IDEA OF OUR TIMES. 
We are living in an epoch of theoretical as well as 
practical materialism. The dominant, central idea of 
most every one is the speedy attainment of riches. In 
the past aristocracy was the fad and great source of 
imitation; now money is the primum mobile. Never 
was there so much wealth massed together, and never 
did history record so many millionaires, as now. 
In all the principal schools of learning — both in 
Europe and America — we have apostles making pro- 
paganda for the new faith, and in the every-day walks 
of life we see the spirit of the age manifesting its in- 
fluence upon the various avocations. The mate- 
rialistic or realistic tendency of the age, acting like a 
stimulus, sets the intellectual and physical powers of 
man in motion, influencing and moulding literature, 
the arts, the sciences, medicine, and, last not least, the 
governments in their activity of advancing the interests 
of commerce and industry. The history of civilization 
promulgates the fact that there is an onward drift of 
thought, an evolutionary progressive development of 
the various intellectual powers and capabilities, a con- 
tinuous substituting of a higher for a lower kind of 
psychic influence, the social medium thereby being ad- 
vanced in its industrial, moral, intellectual, esthetic, 
etc., phases—phenomena analogous to the history of 
evolution in the different departments of biology. The 
history of man is also the history of his thought, and 2 
the civilization of a people may be considered the re- 
flex of its intellectual status. Each sociological period 
has its ruling or guiding idea, which produces its char- 
acteristic mental type or impress. The bent of 
thought in the past was idealism, now materialism is 
the chief intellectual momentum of our times. The 
fact that materialism admits the value of itself alone to 
the exclusion of idealism, demonstrates its exaggerated 
tendency, which it manifests in all the intellectual ex- 
pressions of our times, being a kind of idee jixe. 
Industrial man is, the product of the pres- 
ent drift of thought, which gives him his characteristic 
physiognomy, recognizable in all the avocations. The 
industrial or mercantile spirit, being a phase of mate- 
rialism, pervades most all the pursuits of life. It seeks 
to over-value the material, that is, the commodities and 
money, entirely disregarding the speculative or meta- 
physical, only recognizing ideas which it can material- 
ize or realize, so to speak, subjecting them to a practi- 
cal application. 
THE INFLUENCE OF MATERIALISM OR REALISM UPON 
MEDICINE. 
Realistic and materialistic doctrines have greatly in- 
fluenced the tendency of medical thought in our day. 
The inductive method (the investigations by the 
senses) is now chiefly cultivated in our institutions of 
learning, whilst the study of ancient classics is con- 
sidered as not at all necessary and a mere waste of 
time. On perusing the literature of the day one easily 
perceives the realistic trend of thought, for the notion 
is more and more manifesting itself that common-school 
education is as good as college education ; that all the 
classical barriers should be broken down ; that the 
sciences, and medicine especially, should be brought 
within the easy reach of every one — in other words, 3 
they should be popularized; and, lastly, that these 
studies should be divested, in some mysterious manner, 
of their intricacies or minutiae, and made practical 
and comprehensible to both tradesman and student. 
The practical man, or homme machine, does not believe 
in any social or intellectual restrictions, but fosters 
free-trade ideas, so to speak, believing himself compe- 
tent to hold any of the educational stations of life. 
Being a genius for business, he chiefly concerns him- 
self with the realities of life, and considers those quali- 
ties. from his mode of thinking, which contribute to 
social efficiency and material prosperity, of far greater 
importance than those which are essentially cultural 
and humanistic. He divests medicine of its time-hon- 
ored humanistic and classical embellishments and drags 
it out of its professional realm into the domain of 
commercialism. 
THE COMMERCIALIZATION OF MEDICINE. 
In these days of active competition, when the Dar- 
winian motto, “ the struggle for existence,” finds its 
practical demonstration, there is not a single human 
avocation left untouched by the grasp of materialistic 
philosophy —not even theology ! 
Medicine, once a profession, is now a trade, and is 
making rapid strides towards its complete commercial- 
ization. The medical jobber has but one goal, and 
that is the acquisition of wealth. All higher ideals 
must give way to satisfy material desires. The physi- 
ciau of to-day must possess a mercantile mind and 
adapt himself to modern conditions of life if he hopes 
to make a success of his calling, otherwise he is a fail- 
ure. The possession of a diploma, first of all, and a 
good social knowledge and how to use business methods 
with advantage, are factors of prime importance. A 
thorough medical knowledge is not essential, for it is 4 
a notorious fact that those who possess only a smatter- 
ing of medical knowledge succeed best! 
Ou walking along the streets of our large cities one 
is really amazed to see the euormous number of doc- 
tors’ signs dangling in the air. Every little country 
town has more doctors than it can support. Almost 
on every country cross-road a doctor is waiting for pa- 
tients. Why so many d«ctors ? and can all of them 
make a living? During the preparation of this article, 
I find on my table the September number of Hie 
Forum,, which contains the very erudite and elaborate 
article, “ The Pay of Physicians and Surgeons,” by 
Dr. George F. Shrady. On reading the article, I find 
a few discrepancies in regard to the income of the 
average physician. His estimates are inaccurate and 
misleading. I wish to state right here that a great 
deal of iguorance exists in the minds of those contem- 
plating the study of medicine. The supposed fabulous 
income of a great majority of physicians is a fiction! 
The fact is that the young physician, in the first five 
years of his practice, hardly earns his board, and his 
income often does not amount to fifteen dollars a 
month in cash! 
It is but natural to expect, by reason of the appall- 
ing number of struggling physicians, that pauperism is 
making itself felt in the overcrowded ranks of the 
medical profession in this country. Many physicians 
make their living in questionable ways. In the strug- 
gle for bread ethics are cast aside and the code remains 
a dead letter. The present socio-economic conditions 
are responsible for the existence of a medicalproletariat! 
Every one of them wants to live, and in the struggle 
for self-assertion the conventional and disguised war- 
fare of civilized life, called “competition,” which is 
nothing else but individual antagonism, is brought 
into play. The saying, that “ the forward dog gets 5 
the bone,” finds its application even in medicine. 
This egotistic spirit has created the specialist, who is 
encroaching more and more upon the domain of the 
family physician, whose days are counted. A purely 
one-sided education of special branches in medicine has 
taken the place of a universal or humanistic education. 
When our so-called “medical colleges” (medical com- 
bines!) turn out men reared in inferior environments, 
with rudimentary ethics and who are sadly deficient in 
literary as well as scientific qualifications, what can 
we otherwise expect? These commercial medical col- 
leges send out men equipped with didactic, not practi- 
cal, knowledge. Physicians are not slow in adapting 
themselves to the changes of the social organism. 
They are becoming more and more gregarious, instead 
of remaining individualistic in their habits. Egotism 
must naturally give way to altruism. In congregating 
in large buildings, they imitate the sociality of bees, 
for they realize that concerted action (cooperative as- 
sociation) is far more remunerative in its results than 
antagonistic or competitive individualism. The condi- 
tions favoring the aggregation of physicians have 
greatly changed the socio-economic status of the medi- 
cal practice. The social forces are working towards 
collectivism, which favors division of labor with differ- 
entiation of function and increased centralization. 
Nowadays, especially in the cities, physicians are 
becoming more and more mercantile by imitating the 
industrialists or shopkeepers. Their offices gravitate 
toward the heart of the city, where medicine becomes 
centralized in large buildings. Here physicians are 
brought into intimate association ; they learn to culti- 
vate friendly sentiments and absorb knowledge from 
another, instead of pursuing an aggressive, individual- 
istic existence in a state of segregation. Here is life 
and motion. The busy ring of the telephone, the fa- 6 
miliar click-click of the typewriter and even of the 
telegraph instrument (by the railroad surgeon) strike 
one’s ear. Amid this tumult of mercantile enter- 
prise we find the specialist, the representative of medi- 
cal mercant lism, busily engaged in set.ding out his 
pamphlets broadcast to physicians, soliciting their 
patronage, just like the merchant who sends out his 
circulars. Is this not advertising? In short, the 
modern doctor’s office is transformed into a mercantile 
establishment. 
Our native American is, par excellence, the £wov larpinov 
of this country, and feels himself at home in medicine 
as the duck does in water. The mercantile spirit that 
dwells in his bosom is responsible for the present 
chaotic condition of medical practice. He has com- 
mercialized every branch of the medical art. The 
medical industrialist flourishes in greater numbers in 
this country than elsewhere. His mercenary mind 
creates medical combines or trusts (so-called “medical 
colleges,” hospitals, dispensaries, etc.), which are a det- 
riment to the medical profession at large. Through 
the instrumentality of these collective medical bodies, 
he is enabled to advertise and aggrandize himself and 
increase his practice and derive a revenue from stu- 
dents and doctors, depriving the latter of their proper 
clientele. 
Everything points towards centralization and nation- 
alization in medicine. These medical combines are 
becoming more and more selfish and aggressive and 
their purpose is to centralize medicine and to crush out 
the independent, general practitioner. Most of our 
hospitals, clinics and dispensaries are controlled by 
medical cliques who endeavor to monopolize all surgical 
and medical work. excluding the outside physician from 
participation. Physicians are now doing less and less 
medical and surgical practice, and the day is not far 7 
distant when patients will be treated in institutions 
and the general practitioner will be dispensed with. 
Medical practice is nowadays becoming so unre- 
munerative that physicians are compelled, from sheer 
necessity, to seek for secondary avocations in order 
“to keep the wolf from the door.” Most physicians 
are on the lookout for positions that are compatible 
with their calling. There is a lively scramble for 
positions that are remunerative. We have physicians 
who do contract labor for life-insurance companies, 
lodges, societies, railroads, street-car and cable lines, 
factories, mills, mines, smelters, packing-houses and 
other corporations too numerous to mention. Just as 
we have our corporation lawyers, so do we have our 
corporation physicians and surgeons. As every em- 
ploye is assessed a certain sum monthly from which 
the corporation physician or surgeon receives his salary, 
it will be easily perceived that this contract labor of 
physicians does a great harm to the medical profession 
and contributes materially in lowering its dignity. 
So much for medical institutionalism and contract 
labor. The changing social organism shows us con- 
spicuously that the family physician is nearing his ex- 
tinction, being supplanted by the specialist, who in 
turn is now suffering from institutional encroachment. 
The clamor for public medical positions, municipal, 
state and federal, is great. The student of socio-eco- 
nomic medicine can predict with a fair show of ap- 
proximate certainty that we are rapidly approaching 
the times when all colleges, hospitals, clinics and phy- 
sicians will be under the supervision of the general 
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