One of the striking features of our economic development is the disappearance of the small community and the small business, with the personal interest of each in all, employer and employed; and in its place we see the herding together of great masses of people in our large cities, each class by itself; the corporation taking the place of the individual owner, and the growth of vast business enterprises, with its inevitable loss of personal interest and sense of personal responsibility.
The old relation of the physician to his patient has also changed; partly because of the growth of the specialties, partly from the growth of the hospital and dispensary, where the great number of patients makes an investigation into each one's individual circumstances and surroundings easier to neglect than to follow up; but more largely still, to that want of intimate acquaintance and the mutual confidence bred of intimate acquaintance incident to life in a large community.
To meet this problem and to help the less fortunate, who, as a class, suffer most from this change, we have the growth of settlement work, of personal service, the better administration of charities, the getting closer to the personal life of the unfortunates, with a better knowledge of their trials, hopes and disappointments, giving more advice, counsel, sympathy and practical help and less alms.
We have, of course, a class of nervous invalids, whose condition is the result of the strain of business and pleasure; but another, and much larger class, whose condition is due to ignorance, misfortune and actual hardship. Hospital men are beginning to recognize that simply a thorough physical examination with a prescription for some medicine and a few hurried words of advice are not enough; that much of our effort and of our hospital endowment has been wasted, because we did not know anything about the conditions under which our patients lived; did not know whether our advice could be followed or not and, even if it could, did not follow them up, see that they understood it and that the instructions were carried out.
To order for one patient a diet that he cannot possibly procure; for the next, a vacation that he is too poor to take; to forbid the third to worry, when the necessary cause of worry remains unchanged; to give the fourth directions for an outdoor life, which you are morally certain he will not carry out; to try to teach the fifth (a Jewish mother) how to modify milk for her baby, when she understands perhaps half what you say and forgets most of that half;—this makes a morning's work not very satisfactory in the retrospect to anybody.
We see at once the necessity of getting back to the old idea of the physician, as the friend, adviser and guide of his patients; to a closer personal relation between physician and patient, and where, as in a large hospital clinic, this is impossible, an organization which, under his direction, shall follow his patients to their homes, see what is
