Qtomplhnents of tije author. 
THE MUTUAL RELATIONS OF THE 
PROFESSION AND THE STATE. 
BUNG THE PRESIDENT'S ADDRESS. 
DELIVERED BEFORE THE MEDICAL SOCIETY OF THE STATE OF PENNSYLVANIA 
AT ITS MEETING AT HARRISBURG, MAY IO, 1896. 
BY 
WM. S. FOSTER, M. D., 
of Pittsburg, Pa. 
EX-PRESIDENT OF THE ALLEGHENY COUNTY MEDICAL SOCIETY, MEMBER AND SECRETARY 
OF THE STATE BOARD OF MEDICAL EXAMINERS. 
Reprinted from Transactions of the Society. ADDRESS OF THE PRESIDENT. 
* 
THE MUTUAL RELATIONS OF THE PROFESSION AND THE STATE. 
By WM. S. FOSTER, M. D. 
OF PITTSBURG. 
Medical men as individuals and the profession as a body 
have interests which more or less constantly bring them into 
contact with the State as an administrative body. We meet 
problems whose solving cannot be accomplished without State 
action, and that action is likely to be delayed, mistaken or 
thwarted without our professional knowledge, advice and as- 
sistance. 
There are, then, certain matters in regard to which our pro- 
fession as a whole, and we as individuals, are in honor bound 
to give the community, through the organization of the State, 
our co-operation and our best aid, if wre are to fulfill all the de- 
mands of good citizenship. And there are other matters, in 
regard to which the State owes our profession a debt of both 
duty and gratitude, which should be a debt of honor. To a 
brief consideration of both sides of the mutual relationship 
thus existing, it has seemed to me not unprofitable to devote 
our attention at this time. 
It is a most proper thing that a body which represents the 
organized strength of the medical profession in this great com- 
monwealth should set itself seriously and gravely to the task 
which is involved in the proper consideration of this subject. 
This Society is the fighting unit which represents the charac- 
ter, the dignity, the rights and privileges of nearly 8000 prac- 
ticing physicians and surgeons within the limits of Pennsyl- 
vania ; but, in addition, we hold in our hands, and we safe- 
guard by our efforts, those interests that are superior to all 
personal consideration, namely, the life and happiness, the 
1 2 
FOSTER, 
physical welfare, and much of the moral prosperity of a popu- 
lation which to-day approximates 6,000,000 souls. With such 
interests confided to our care, it is eminently fitting that we 
ask ourselves gravely how we may meet the problems of state 
medicine, pressing for solution now as they have never done 
before; and it is fitting that we answer seriously, faithfully 
and bravely after mature consideration. 
Our duty to the State concerns us : 
As citizens, 
As doctors individually, 
As an organized profession. 
A man's value to the State as a political organization is en- 
hanced by the intelligence of the man and by the integrity 
and activity with which that intelligence is employed in mat- 
ters affecting the welfare of the State. 
If you accept this statement as I do, it then follows that the 
physician who willingly, earnestly and actively fulfills the or- 
dinary demands of citizenship becomes the State's most valu- 
able citizen. There then opens up to him a larger field of use- 
fulness, as a citizen merely, than to other men. His education 
primarily, and his manner of life secondarily, make him a 
factor in the community of more actual and more relative 
value than the ordinary man. 
With this added weight in the community comes the plain 
duty to exercise one's political privileges to the utmost, from 
reasons that are at once personal, professional and political. 
To put it plainly : a doctor ought to take an interest in poli- 
tics, local, state and national. As a citizen, he should not only 
vote regularly, but he should go to the primaries and to cau- 
cuses. The time and place to make his influence felt for good 
in the political community is at the time and place that can- 
didates are chosen ; when their personal character is weighed 
in the balance, and when their friendship or antagonism for 
measures of proposed legislation will influence the choice of 
candidates. In other words, if a doctor wants to make his 
knowledge of use to the community as a whole, if he wants his 
ideals to be framed into laws and made a part of the record of 
his State's progress, he must bear his part as a citizen in the ADDRESS OF THE PRESIDENT. 
3 
simplest and most fundamental processes that contribute to 
the making of laws, or the choosing of those who answer yea 
and nay in the law-making body. It is not degrading to take 
an honest part in politics, but it is degrading to let dishonesty 
trample upon your rights. It is not degrading to strive to 
place good laws upon the statute books, but it is degrading to 
permit the enactment of bad laws, because you are either too 
bashful, too busy or too indifferent to demand the enactment 
of good laws. 
But we owe the State other duties than those which she 
may with equal propriety demand from all other men of edu- 
cation. Our professional qualifications entail upon us certain 
special duties to the State just as certainly as they entitle us to 
certain special exemptions. It has been recognized by the 
law that the peculiar requirements of our calling are such as 
to justify our exemption from service as jurors. We are in- 
debted to the community for this courtesy, small though it is. 
As medical men we should endeavor to give an impress to the 
laws that are made. There is much of recent medical discov- 
ery that affects the welfare of the people and that may be 
properly embodied in our laws, and we as physicians are dere- 
lict in duty if wTe fail to impress such matters upon our 
legislators. The individual action of each physician means 
much in this regard. If upon subjects affecting the public 
health, each doctor in this State would seriously and earnestly 
urge his knowledge of real facts upon some legislator of his 
acquaintance, it wrould not be long until really modern medi- 
cine would succeed in having placed upon our statute books 
legislation of real value to the people. 
The care of the insane and the administration of hospitals 
of all kinds have too long been under the supervision of non- 
professional men. It is humiliating to note the appointment 
of pushing politicians, third rate lawyers, and professional 
charity mongers, to those positions of honor and responsibility 
in connection with the administration of hospitals and other 
charitable institutions. 
The actual work of these institutions is in too many cases 
performed without renumeration by members of the medical 4 
FOSTER, 
profession, and their familiarity with the needs of the institu- 
tions would properly enable them to demand recognition in 
the administrative, honorary renumerative appointments. 
But with scant courtesy medical men are usually dismissed 
from consideration when these matters are considered, with 
the too frequent false assertion that they are " not business- 
like " in their methods. If the appointments as made showed 
any real consideration for this argument, we might at least 
admit its sincerity, but the character of many of the appoin- 
tees to those responsible offices is such as to absolutely nega- 
tive such a supposition. 
In other lines we owe service to the State, and we should at 
least proffer such service. How often have we felt that proper 
medical legislation might have been secured and viscious 
medical legislation prevented had the medical profession as 
capable and as large a representation in our legislative halls as 
that of the legal profession. 
There are certainly enough physicians in this State who 
have, at the same time, a good professional standing and suffi- 
cient political eminence to enable this Society at all times to 
have from ten to twenty of its members in the State Legisla- 
ture. They could not fail to influence legislation in a desira- 
ble manner and their service would be creditable alike to 
them as citizens, to us as a profession, and to our loved Com- 
monwealth. 
As an organization, there is much for this Society to do for 
the State, and in doing for the State to advance at once its 
own honor and the welfare of every citizen, however humble. 
The re-codification of our laws relating to public health, 
especially as bearing upon such subjects as correct collection 
of vital statistics, the maintenance of the purity of our streams, 
the proper reporting and quarantining of contagious diseases, 
and the establishment and enforcement of regulations for 
the limitation of disease; these are propositions which it 
should be our privilege and our high duty to formulate and 
press to enactment at as early a date as possible. 
There is ample reason why this is the paramount duty fac- 
ing us to-day. Pennsylvania's three largest cities have for ADDRESS OF THE PRESIDENT. 
5 
years maintained an unenviable reputation for typhoid fever 
prevalence. That prevalence is not simply unnecessary. In 
the light of modern sanitary science, it is a crime-a crime as 
great, as cruel and as shameful as the slaughter of the inno- 
cents in sacred history. A crime which the united voices of 
our profession must denounce and the awakened conscience of 
the Commonwealth bid to cease. 
When the water supplies of the State have been purified, it 
is probable that the typhoid fever mortality of this State will 
not range much higher than that of smallpox, and there may 
yet arise a generation of physicians to whom the one disease 
will be as great a curiosity as the other. 
And here our duty to the State and to our fellow-citizens 
and the State's duty to us, both as a profession and as citizens, 
seem to intermingle, so that they can with difficulty be distin- 
guished. We owe it as a duty to the State to elaborate a plan 
of action. The State owes it as a duty to us to accept that 
plan. We both must enforce it on behalf of that ignorant, 
helpless humanity whose cry arises to heaven and whose un- 
necessary sacrifice to an unnecessary disease must cease. 
If our united voices at this time express our unanimous de- 
mand for energetic action upon these matters, and if we each 
and all follow up that demand by personal persistent interest 
and argument during the coming year, the next legislature 
will be forced to give to our State Board of Health ample au- 
thority and a liberal appropriation for this work, and within 
a decade we shall behold its practical consummation proven 
by an annual typhoid death rate not greater than ten per 
cent of the present one. 
And now, from these necessarily brief thoughts upon our 
duties to the State, let us turn to the consideration of the du- 
ties of the State to the medical profession. The State owes us, 
first, a debt of gratitude. We have been over-modest in assert- 
ing this claim, yet there is no profession that has given so 
much to and received so little from the State. From his ear- 
liest most energetic student days, through the long and ardu- 
ous struggle for professional recognition, in the culmination 
of a finally successful career, and on into a tottering old age, 6 
FOSTER, 
the physician's life is one of constant self-sacrifice. There is 
made upon him a never ceasing call for gratuitous service 
which is unlike that made upon a member of any other 
profession, trade or business. His time, his advice, his strength, 
his medicine case and his surgical satchel are ever held by the 
populace as a free gift. No other man gives so much and re- 
ceives so little. And I say this, not to disparage the nobility 
of true charity, nor to underrate the necessity for it, but to 
condemn that selfishness which demands as charity what it 
neither needs nor deserves as such. It is not simply the abuse 
of our freely rendered services in dispensary work, but the 
added imposition of free service in hospitals, to many who can 
well afford to pay the demand by City, County and State for 
gratuitious service in positions of professional responsibility, 
and reluctant recognition by great corporations of the equality 
of our service with that of lawyers, engineers and business 
men. We are ourselves largely responsible for the low esteem 
in which these organized bodies hold our services, and for the 
grudging pecuniary recognition they accord us. We have 
competed too earnestly for their appointments and have prac- 
tically underbid each other in our anxiety for personal recog- 
nition. And the natural result is seen in the humiliating 
comparison of the positions our leading physicians and sur- 
geons hold with lawyers and other professional men in official 
positions of responsibility. 
It needs no long or searching inquiry to arrive at the un- 
derlying cause of this humiliating comparison. If the medi- 
cal profession of Pennsylvania, in common with that of all 
other states of this Union, were not over-crowded, the unneces- 
sary and unprofessional competition for official appointments 
would be so lessened that we could afford to demand proper 
recognition and proper renumeration for our professional ser- 
vices. 
Comparisons are well known to be odious, yet they are often 
instructive. Notwithstanding the undoubted honor of the 
position, no attorney would accept an appointment to the Su- 
preme Court Bench if no salary was given. Necessary to the 
public as are the services of a prosecuting attorney, what en- ADDRESS OF THE PRESIDENT. 
7 
terprising young man would give his legal services in such a 
position gratuitously ? Nor does any attorney surrender the 
legal claim to his fee for conducting the defense of poor clients 
assigned him by the courts. 
We have Boards of Charities whose business it is to investi- 
gate charitable institutions, and in some instances to disburse 
the moneys of the State and of the separate counties. Has 
anyone ever known of them refusing to accept their mileage? 
Or has the State ever failed to provide for its payment? 
When a sanitary investigation is to be made, the attorney 
gets his fee for drawing up the papers; the engineer is paid 
for his expert services; the witnesses are paid fortheir time 
in court; the doctor alone must give his time, his services, 
and his advice free. 
In a word, the State is always willing to pay everyone ex- 
cept the doctor ; he must always give the State something for 
nothing and be thankful that his ears are not cuffed in return 
for his voluntary service. 
Are we not ourselves to blame for this condition of affairs? 
Have we not fallen over each other in offering the State our 
services gratis ? Have we not cut each other's throats in our 
anxiety to secure " honorable " appointments, while we have 
forgotten to insist that honest service should be honestly paid 
for ? 
Have we not made entrance into our professional ranks so 
easy that it has tempted the incapable and the small-spirited, 
and at the same time deterred many who put the highest esti- 
mate upon themselves and their services ? I do not answer 
these questions, but I ask them in seriousness, so that you and 
I and all of us may ponder them in our hearts, and if we do 
not answer them at this time in plain words, the deeds of the 
future may speak with more definiteness and more effect than 
mere words. 
Will the State ever treat our profession better than it has 
done in the past ? To this we may safely answer yes. Our 
profession is year by year asserting itself, its rights, its privi- 
leges, and its dignity as it never did before. The State can- 
not fail to recognize such rights and privileges, when asserted 
with becoming manner and dignified statement. 8 
FOSTER, president's ADDRESS. 
When our united profession, by its unanimous demand, 
compels the State to raise the standards of medical education, 
to increase the requirements for medical practice, both of 
which the State has recently taken cognizance of, to provide 
for its public health interests with the farseeing liberality 
that befits a splendid, civilized commonwealth, rather than the 
myopic impecuniousness of a frontier village; when our ten- 
acity of purpose and sincerity of belief have wrung from ig- 
norant or unwilling legislatures practical recognition of the 
equality of the medical with other learned professions, this 
Society will be in a position to better advance the interests of 
humanity than ever before. We are standing on the thresh- 
hold of a future whose possibilities are limitless, whose oppor- 
tunities for doing good are " boundless." It is our heritage. 
Let us enter in and possess it.