Another group was composed of the poor, who could not afford private medical care. Those were treated at the dispensary, and they were pretty sure to get good service.

Finally, a great many people came who could not be admitted to the dispensary because it was a charitable institution. They went back to their neighborhoods and got service of a varying character. Some got good service, some did not. As Dr. Warner had said, the day was past when a man could treat every human disorder well. There was no longer room for the man whose sign stated he "specialized in the diseases of men, women, and children."

When it came to working on a salary basis, the doctors had not yet been able to see how it would be as remunerative as other forms of practice. Doctors treated a great many people for nothing, but they made the man who had money pay for it. If a doctor operated on somebody at ten in the morning for a fee of $10,000 he could spend the rest of the day operating on several others for nothing, and still be pretty well paid for the day's work.

If we were to have health insurance, which he took it amounted to private medical service for a large group of people who at present had very little or no medical care, it would be just as well to go a step farther and provide a means by which everybody could have adequate treatment. The laws must recognize dispensaries. He believed the bill that was submitted to the Massachusetts legislature to allow a dispensary or a hospital or any organized group of physicians to operate would cover this. There was no question but that it could be done better and more economically. For example, there was the matter of drugs. His dispensary asked each patient who could to pay 10 cents for each prescription. About 75 per cent of the patients paid at the 10-cent rate for each prescription, and that covered the cost of the medicines and the salary of the druggist.

A COMMISSIONER asked whether that was so on account of large purchases.

MR. RANSON replied that it was not. He did not think the dispensary made any cheaper purchases than most places. Occasionally it picked up a bargain in some line of drugs, but outside druggists did the same. The dispensary purchases were probably heavier, but at no better figure. When a druggist was questioned about his

high prices he always came back with the fact that he must supply many things for nothing-information, postage stamps, for in

stance.

SENATOR ALBERS, himself a druggist, interposed that if the dispensary was getting along so well with a fee of 10 cents a prescription it was either giving the patient very little or buying drugs by the wholesale.

People of Moderate Means Not Provided For

MISS FOLEY wished to tell about her experience in tuberculosis work. A man came into the dispensary, and gave his history, physical, and otherwise. When the doctor got through examining him he was pronounced in the second stage, plus, of tuberculosis. The man offered $20 for treatment, but it was explained to him that the service was free and that the money could not be accepted. He said he was a poor man and had been trying for two years to find out what was the matter with him, and now that he could afford to pay he did not see why the institution should discriminate against him just because he was so unfortunate as to have the money to spend.

Continually, people of moderate and even considerable means came in and asked if they might have the same sort of examination that their cooks, chauffeurs, or gardeners were given. They came to a municipal dispensary because they felt that a dispensary organized to look after these cases would treat them very much better than some of the physicians whom they might select.

Attitude of Dentists

CHAIRMAN WINSLOW inquired whether anyone knew about the attitude of the dentists toward health insurance.

MR. LAPP replied that as a rule dental dispensaries were backed by dental societies. They were usually ready to promote good practice and to give free service. They had paid out of their own. pockets many times to begin the work in the schools, paying the expenses until they were able to get the schools to take it over. Most dental clinics were begun in this way. He had never heard the

subject discussed in the dentists' association or by individuals, but he would say that the dentists were more ready for organized practice than the doctors.

DR. WARNER said he had had some experience with organized dentistry. In a way the dentists were more fitted to take up organized practice. There was in Cleveland an institution known as the Western Reserve University Dental College. At one time he arranged to send poor people from the hospital there to get proper dental care, he to pay for the materials and the college to keep track and in due time send in a bill.

Two or three times he had tried to get a bill, but could not get one, and finally he began to wonder why. Other charitable organizations in the city were also sending the college patients galore. At length, after a little investigation, he found that this dental clinic netted a clean profit to the college; the amount they collected from the poor people the charitable institutions had been sending up there paid the entire cost of running the dental college, and the tuition paid by the students was clear profit. Apparently the dentists were better organized for cooperative work, and the reason was that it had been for their profit.

MR. LAPP pointed out that the dental association had instituted free dental clinics in the public schools, with the cooperation of the school board. They were doing that for the purpose of developing the interest of the people in good dental work, but their willingness to do it without any compensation whatever showed a greater willingness to do things than the average doctor showed.

DR. WARNER admitted that there were socially minded dentists in the country, but not more than there were doctors. Many good doctors were giving their time to school work, as well as dentists.

How About the Optometrists?

CHAIRMAN WINSLOW asked how about the optometrists?

DR. WARNER replied that in his dispensary he had to deal with the glasses situation for many years. A lot of patients were examined and given prescriptions for glasses, which they could take to any

optician they chose. But it was found that only a small percentage ever got the glasses. He went to whom he thought was the best oculist in town and talked it over with him. He said he would send a man down to the dispensary daily to fit the frames, receive the orders, verify the glasses with the prescription, and see that the thing was done right. That looked good, and Dr. Warner asked what it was going to cost. The oculist inquired whether he would be dealing with the patients or with the dispensary? Dr. Warner told him he would be dealing with the dispensary-he had had his dental experience then. The oculist agreed to charge the hospital so much for spherical lenses, so much for compound lenses, so much for frames, etc., and Dr. Warner could give them to the patients at any price he wished. They had been going on that basis now for several years, 100 per cent of the patients who were given prescriptions got glasses, and the department was so swamped that he had to put on extra men. The school authorities had to fall into the same system. Between $3,000 and $4,000 worth of glasses were bought by the dispensary yearly; they were sold to the patients who could pay, and some got them for nothing. Those glasses cost on the average about $3.50 because they were bought in an organized way, in comparison to $10 if it was done in the usual way.

The Midwife Situation

CHAIRMAN WINSLOW further inquired what the situation was with regard to midwives.

MR. RANSON answered that in Illinois they were licensed. Of course, there was the question of their recognition under the health. insurance law. If they were to be regularly licensed the matter. should be given careful consideration, although he presumed they would be included because there would be too much opposition if the law were otherwise planned. Maternity care for people who could not afford to pay much was another point in regard to which the medical profession was not well organized. The dispensary with which he was connected had a department for obstetrical service which took care of about 1,000 cases a year, and was supported in part by funds from Rush Medical College. In this service people were allowed to pay something if they wanted to. Some paid $1,

some $5. But the work was carried on primarily as a matter of education in the foreign communities where the midwives were used almost exclusively and where there was objection to them on the part of the local physicians. These people were being educated to have medical rather than midwife service, and he did not believe that many who went to the free dispensaries continued to go there after they could hire private doctors. That was no reflection on the dispensary, but most people preferred to pay for what they got.

DR. HAMILTON thought it was only those who had dealt with the foreign communities who realized how important the subject of midwifery was. In Illinois the state licensed the midwife, but took no responsibility for her training. Unless things had been changed recently, the midwife passed a written examination. She had known women to qualify who had never been present at an obstetrical case. The only good midwives in her neighborhood were those who were trained in Italy or Russia. The foreign women were insistent on employing midwives, and she thought they got far better service than they did from the ordinary physician. The midwife did real nursing service, she helped in the housework. But even so, the medical service these people got was very inadequate. In small cities where there was no visiting nurses' association the obstetrical situation was very bad, indeed. It was commonly known that 15,000 women died in childbirth in the United States every year.

Maternity care was possibly the most expensive branch of health insurance. She did not know how it would be provided for, but there was a great need for trained midwives and she thought the question could be taken up. Midwifery was opposed by the organized doctors, but it should not be.

MISS FOLEY said she would like to see a system of organized medicine through health insurance or some other way, whereby every expectant mother would receive good medical attention. If the physicians had not the time or the means or the skill to give proper service now, she would like to see them trained so that they could do it, and have the community give them the means and the time.