grounds under the control and management of the school itself (as by the Massachusetts law of 1907); the teaching of hygiene, mental and physical, in schools and colleges, all mark a long step in the advance of public, preventive, educational medicine.

This, together with the development of factory inspection, protection of machinery, tenement house legislation, public parks, baths and playgrounds, the growing efficiency of public diagnosis-laboratories and free drugs (quinine, diphtheria anti-toxin, and in Porto Rico thymol), is driving the private doctor more and more to the wall. The "good, old-fashioned epidemics of typhoid, diphtheria, and malaria are getting rarer and the doctors are feeling the loss of income. Yellow fever and smallpox are gone. The number of chronic invalids requiring long and expensive medical attendance is being diminished by the growth of successful surgery,

of efficient psychotherapeutics, of outdoor life, and by the sanatorium treatment of tuberculosis.

Partly as a result of this, the number of doctors and of medical students has begun within the past five years to diminish not only in America but in all parts of Europe. We doctors are actually beginning to abolish ourselves by merging ourselves in the wider profession of public, preventive medicine, whose activities are inextricably interwoven, as this chapter aims to show, with social and educational work. I am thankful that it is so.

Here are the cheerful facts:'

1 See Report of U. S. Commissioner of Education.

Vol. II, p. 777, 1908.

CHAPTER IV

TEAM-WORK OF DOCTOR AND PATIENT

THROUGH THE ANNIHILATION

OF LYING

TEAM-WORK, genuine co-operation, has been my guiding interest throughout this book. It is largely because people can't or won't pull together that the world moves on no faster than it does. We are held apart by professional narrowness and professional case-hardening (as when a nurse refuses to help a gasping, brokenwinded teamster up the hospital stairs, "because it is the ward tender's business"), or by mutual suspicion (as between ministers and doctors), or simply by ignorance of each other's existence. But still more I think we hold each other at arm's length by our persistent habits

of lying and prevarication. A doctor lies to his patient about the medicine which he is asked to take. The patient pours the medicine down the sink and lies to the doctor about it. Poor team-work, that! Friends cool down to mere acquaintanceship because their cordial faces and effusive manners don't prevent their reading behind the mask (with the marvelous insight of aroused suspicion) what each has said of each in other company.

I believe that the art of healing is going to spring ahead with astonishing swiftness in the next decade because the community is coming to realize that doctor and patient can work together to exterminate or limit disease. Preventive medicine, first fostered by the social workers and by the national government, now tardily taken up by the medical profession in great cities, makes for frankness, for education of the whole public, for the general diffusion of medical knowledge, and for the abolition

of professional secrecy and unprofessional buncombe.

But the battle is still not won. Far from it! The great bulk of medical work, public and private, is still done by menhigh-minded men-who believe that it is impossible to deal frankly and openly with patients. The social workers are not always as truthful as they might be. The head of a great humanitarian enterprise recently asked me to co-operate with her in a complicated deception of one of her temporary employees. When I remonstrated with her, she quoted to me Lecky's saying that in such matters we must be guided by "a combination of good sense and good feeling." Her good sense and good feeling taught her to lie in the same kindly paternal way used by many doctors when they fool their patients, strictly for the latter's good, but still to the destruction of all team-work and enlightenment.

I have thought it worth while, therefore,