entitled to vote for any officer or Delegate who has not paid his dues and assessments for the current year. SEC. 3. Nominations for officers and delegates shall be made at meeting, and a ballot containing all nominations sent to each member with the notice for the annual meeting.

SEC. 4. The poll for the annual election shall remain open one hour, or until every member present has had an opportunity to vote, after which the poll shall be declared closed by the president and no additional votes shall be received.

SEC. 5. At the close of the poll, the 'inspectors of election shall immediately proceed to canvass the votes and report the result to the President, who shall announce it to the society. If upon the first ballot no choice shall be made the balloting shall be repeated until all the offices shall be filled. At the second and each succeeding ballot, the name of the candidate receiving the least number of votes shall be withdrawn. A majority of the votes cast shall be necessary for an election.

SEC. 6. In the event of a vacancy occurring in any elective office of the society composing the Comitia Minora, such vacancy may be filled by a majority vote of the Comitia Minora, except where otherwise ordered in the By-Laws.

CHAPTER VI.

TRANSFER OF PROPERTY.

SECTION 1. At the expiration of his term of office each officer of the society shall transfer to his successor all property of the society in his charge and shall be given a receipt for the same.

CHAPTER VII.

STANDING COMMITTEES AND THEIR DUTIES.

The Standing Committees shall be:

1. Comitia Minora.

2. Public Health.

3. Legislation.

4. Committee on Membership (for large counties). The Comitia Minora shall for all legal purposes be the trustees of the society. It shall make all arrangements for the meetings of the society and perform such other duties as may be assigned to it by the society.

members shall constitute a quorum. It shall meet regularly within the ten days preceding each annual and regular meeting of the society and at such other times as business may require.

SEC. 3. It shall have power to direct the expenditure of the funds of the society, appropriated at the Annual Meeting or at any regular or special meeting, and shall present to the society at such times estimates of the amounts needed to carry on the business of the society. SEC. 4. It shall submit at the annual meeting a report of the work done during the preceding year.

SECTION 1. One delegate for each assembly district in the County shall be elected at the annual meeting, to represent the society in the House of Delegates of the Medical Society of the State of New York.

SEC. 2. One delegate for each hundred members or fraction thereof shall be elected at the annual meeting to represent the society at the annual meeting of the District Branch.

SEC. 3. The delegates shall be elected by ballot and the same By-Laws shall apply as in the election of officers.

SEC. 4. At the first election held after the adoption of these By-Laws, half the delegates shall be elected for one year, and half for two years, and thereafter delegates shall serve for two years. In counties entitled to but one delegate, he shall be elected to serve two years. Where a county society is entitled to an odd number of delegates, the odd number shall be elected for two years.

its office or place of transacting its official affairs, or elsewhere in the City, as may be selected by the Comitia Minora at which time officers, Chairmen of Standing Committees, delegates to the Medical Society of the State of New York and the District Branch shall be elected. The notice of the meeting shall state the date, place and hour, and shall be mailed to each member at least ten (10) days before said meeting. The affidavit of mailing by the Secretary of the society to the lastnamed address of the member, shall be deemed sufficient proof of the service of such notice upon each and every member for any and all purposes.

SEC. 3. Special meetings shall be called at the written request of members. Notice of all special meetings shall be mailed to every member at least ten (10) days before said meeting and shall state the date, place, hour and purpose of the meeting. No other business at any special meeting shall be conducted except such as is stated in the call. The affidavit of mailing by the Secretary of the society to the last-named address of the member shall be sufficient proof of the service of such notice upon each and every member for any and all purposes.

SEC. 4.

Members shall constitute a quorum. SEC. 5. The order of business shall be: 1. Reading the minutes of the last meeting.

2. Report of the Comitia Minora.

3. Election of officers.

4. Election of candidates.

5. Reports of officers and committees.

6. Unfinished business.

7. New business.

8. Scientific program: 1. Presentation of patients. 2. Paper of the meeting. 3. Presentation of specimens and instruments. 4. Reports of cases.

9. Adjournment.

CHAPTER X.

DUES.

SECTION 1. Each member shall pay annually the sum of dollars, which shall be due on the first day of January. At the same time he shall pay the amount of the per capita State assessment fixed by the House of Delegates for the current year.

SEC. 2. All members who have not paid their annual county dues and State Assessments on or before the first day of May of each year shall be placed in the list of members in arrears for dues and assessments, and so reported in the society at its next meeting, and shall not receive the publications, or notices of meeting, or defense for alleged malpractice until their dues are paid.

SEC. 3. All members who fail to pay their arrears on or before December 31st, shall be dropped from the

roll of members.

CHAPTER XI.

RULES OF ORDER.

The deliberations of this society shall be governed by parliamentary usage, as contained in "Roberts' Rules of Order," when not in conflict with the Constitution and By-Laws of the Medical Society of the State of New York.

CHAPTER XII.

SEAL.

SECTION 1. The seal of the society shall be as follows:

CHAPTER XIII.

AMENDMENTS.

SECTION 1. Amendments or additions to these ByLaws may be made by a two-thirds vote of the members present at an annual meeting, provided that notice of such amendments or additions shall have been presented in writing at the annual meeting preceding, and that a copy of such amendments or additions shall have been sent to each member with the notice for the meeting at which they are to be considered.

BIOGRAPHICAL CARD INDEX AND DIRECTORY OF THE AMERICAN MEDICAL ASSOCIATION. Since the American Medical Association began the work of accumulating personal information from the members of the medical profession for the biographical card index and the American Medical Directory, many inquiries regarding these new lines of activity have been received. Physicians all over the country have asked, "What is the biographical card index and what is its purpose? How will the American Medical Directory differ from other medical directories ?" The following is presented to answer these and other questions relating to the subject and to obviate the necessity of replying to each individual inquiry.

In order to understand the object of this work, it is necessary to examine carefully the present condition of the medical profession from a social

and economic standpoint. The last century, and particularly the last twenty-five years, have witnessed a remarkable progress in medicine and in the allied sciences. This progress will unquestionably continue, and the army of observers and investigators now at work in every branch of medical science can safely be trusted with the technical side of a physician's work. But all thoughtful members of the profession admit that there are many practical questions relating to the training, the work and the life of the individual physician, as well as to the community in which he lives, that require careful study and consideration, as well as intelligent and conservative regulation. The improvement of the preliminary training of prospective medical students, of medical schools and of medical courses; higher standards for licensure by State authorities; reciprocity, and mutual cooperation between State boards; protection of the ignorant and the sick from the quack, the faker and the charlatan; improvement of the social and financial conditions of the physician; stimulation of the desire to improve his own condition and to increase his knowledge and usefulness-all these much-needed lines of agitation and reform are blocked in the beginning by a lack of knowledge regarding the individual members of the medical profession.

As already stated, detailed information in all technical lines has increased a hundred fold in the last half century. Along practical and sociologic lines, there is little more known than there was fifty years ago. No one knows how many individuals are at present engaged in the practice of medicine in the United States. Estimates vary from 110,000 to 140,000. Of this indefinite number, no one knows how many are properly licensed by the licensing body of the State in which they live. In many States, owing to the condition of the records, the State board itself cannot tell whether a certain individual has a right to practice medicine or not. Information obtained by one State board at considerable expense and trouble is not utilized by others. Knowledge possessed by one society is not shared with other societies. Statements regarding college and year of graduation, as well as regarding State licensure, are in many cases most difficult of verification. If one desires data regarding a physician, there is no central bureau that can furnish it to him, no general clearing-house for information. Licensing bodies are continually met by the fact that they are unable to obtain reliable information whereby they may verify statements made by an applicant. There is not in existence to-day a list of the physicians of the United States whose legal qualifications to practice medicine have been verified. Out of the fifty-four State and territorial licensing bodies, only twenty-one have ever published a list of physicians legally qualified to practice medicine within their jurisdiction.

Information regarding members of the profession is difficult to obtain when desired for iden

tifying, locating or tracing an individual physician for personal notices, biographical sketches, obituary notices, and all other purposes for which such information is desired. What has long been needed is an accurate compilation of data, made up of information obtained from official sources, such information then to be carefully edited and classified and kept corrected up to date, for the use and information of licensing bodies, and for any responsible person desiring information for legitimate purposes.

While the necessity for such classified information has been long recognized, until recently, conditions have not been favorable for its establishment and maintenance. Now with organization more or less completed, such is possible. In his annual report at the Portland session, the General Secretary of the American Medical Association said:

"It has long been recognized that a permanent biographical card index of American physicians, giving data in regard to preliminary education, medical education, previous locations, etc., would be of great value to the Association and to the profession. Such an index would be of value in tracing a physician through various localities, making up matter for directories and in compiling statistics in regard to the profession. This work has been begun and is now being carried on along two different lines, namely, first, the accumulation and indexing of biographical data in regard to the member of the profession now engaged in active practice; second, the accumulation of similar data in regard to graduates of the current year and of recent licentiates of State boards of health. This has been carried on through the assistance and cooperation of medical colleges and secretaries of State licensing boards. The amount of information on hand is considerable and is steadily increasing."

This was approved by the Committee on Reports of Officers and adopted by the House of Delegates, with instructions to the General Secretary to continue the work of collecting and classifying biographical information.

In accordance with this action, a biographical card index of the medical profession has been established, and it is hoped that very soon this index will contain a card for every physician in the United States. On the card will be recorded name, place and date of birth, preliminary education, medical college and year of graduation, State license and data, medical societies, college and life insurance positions, school of practice, and specialty, if any. In connection with this fundamental information, provisions are made for recording removals, positions held and other matters that may occur in the life of the individual that are of sufficient medical interest to note. Such information is pouring into the general offices of the Association from State and county societies, from licensing bodies, from newspaper clippings, the last alone averaging over one hundred and fifty a day. Through the cooperation

of medical colleges and State boards, certified lists of graduates and licentiates, together with most of the personal information requested, have been obtained and are now being properly classified. There is now in possession of the Association a fairly complete list of graduates of American medical colleges from 1860 to 1901. This list has been supplemented and brought up to date through the cooperation of registrars and secretaries of medical colleges. Copies of the official records of more than three-fourths of the licensing bodies have been secured. The remaining records are now being copied and will soon be completed. Blanks for reports both of colleges and of licensing boards have been prepared.

Each year a supplementary list of recently graduated and licensed physicians will be procured and added to the general index. There will thus be formed a list of all medical graduates, as well as of all legally qualified practitioners, made up from official records, and carefully corrected and revised each year. Information lacking regarding individuals will be constantly added. Thus it will be seen that the informaton asked for is primarily intended for this index. As a reliable and official list of legally qualified practitioners, it will be of great value and will undoubtedly aid in securing general reciprocity among licensing bodies.

The second reason for desiring this information is for use in compiling a reliable and accurate directory. The directory, however, is only incidental to the other work. From the index will be drawn information, either personal or official, for compiling, revising and correcting the directory, for the one now in preparation, as well as for subsequent editions.

The American Medical Directory will differ from directories heretofore issued in three particulars: First, it will be a directory of the Americal medical profession published and owned by physicians themselves. Second, information regarding college and year of graduation and date. of licensure will be verified from official sources. Third, it will furnish the same information regarding each physician, whether he be a subscriber to the directory or not. No paid-for information will be included. It will also combine in one volume the purpose of a general medical directory, as well as a medical society blue book, since the names of all members in good standing of the constituent State associations and their component branches will appear in capital letters, as a distinctive mark of such membership. Information contained in the directory regarding each physician will include name in full, year of birth, college and year of graduation, office address and office hours.

The assistance and cooperation of all physicians, and especially all members of the organized profession, is earnestly requested in carrying on and developing this work. The greatest service that any physician can render at the present time is to furnish, promptly and accurately, information

regarding himself. For the purpose of obtaining this information a blank has appeared in successive numbers of The Journal for the last six weeks. About 20,000 of these have been filled out and sent in.

A number of physicians have written saying: "You will find full information regarding me in the

Directory." As practically all directories are copyrighted works, it will be readily seen that such information is not available for the purposes desired. Other physicians have replied, saying, "You will find my complete record in the Transactions of the Medical Society for the year." A moment's reflection will show the difficulty in tracing up the personal record in this way. The time required for a physician to fill out and return these blanks is infinitesimal; the time required for the directory office force to trace each individual is great. If each reader of The Journal will furnish at once, without further solicitation, the personal information regarding himself, the work of accumulating the data will be greatly simplified.

WHAT ORGANIZED MALPRACTICE DEFENSE
DOES FOR THE PROFESSION AND
THE PUBLIC.1

BY JOHN TAYLOR LEWIS, New York.

Mr. President and Gentlemen: Tis unnecessary for me to thank you for this opportunity to speak upon a subject which is very near to me, and to express my appreciation of the compliment that is implied in this invitation.

In the few minutes allowed me it would be hopeless to attempt to discuss exhaustively a subject of such magnitude as the defense proposition, one that means to the public far more than the narrow questions suggested by the malpractice suit, for it is a subject which strikes directly at scientific advancement along every line of medical and surgical progress. It seeks to safeguard a profession, which has always given freely of its time to the treatment of the poor as well as of the rich.

It has been thought that organized malpractice defense originated in the minds of members of the State Medical Association. It may have been so, but there had existed in the medical societies of England, before this defense was taken up, a similar defense proposition which had also been successfully carried on. In 1897, at the time when The New York State Medical Association was reorganized, this subject was discussed with the writer by Dr. Frederick Holme Wiggin and Dr. E. Eliot Harris, of New York.

Va

rious methods of procedure were considered, and finally the one now in use in this State was decided upon. The question of means to carry on the same was a matter of serious consideration,

1Read before The New York State Medical Association, at the Twenty-second Annual Meeting, New York, October 16-19, 1905.

and it was thought by the writer that if one of the large insurance companies would undertake this defense with their legal department fully equipped it might prove a most satisfactory plan, but after consultation with the attorneys and officers of these companies it was found that the expense would be too great, and that the policy issued by these companies would not be accepted by the entire membership of the Association. It then resolved itself into an attempt to defend the members of the Association who were sued for alleged malpractice without adding anything to the dues of the members, and under these conditions the malpractice defense proposition was first introduced at a meeting of the Medical Association and was overwhelmingly and decisively refused and discarded unconditionally. Thus ended the first attempt at assistance offered to the members of the Association, but those who had really studied the matter felt sure that the subject was not sufficiently understood by the members who had voted against it, and in the following year at the annual meeting the defense project was again brought forward by Dr. Wiggin, and was as decisively and overwhelmingly adopted. Since that time continuously this defense has been carried on.

At the time of the beginning of this defense, statistics in this State showed that one physician in every 150 was sued for malpractice. Statistics, so far as they can be gathered at present, show that in the past year one physician in every 275 was sued for malpractice. In New York State there are, according to Volume VII of the Medical Directory of New York, New Jersey and Connecticut, 11,923 physicians. Despite the fact that the number of physicians is to-day over 10 per cent. greater than when the malpractice defense was undertaken, the number of suits has been diminished by nearly 50 per cent. If the figures are correct, and we believe they are, over 40 suits were instituted last year against physicians in this State for alleged malpractice. It is interesting and gratifying to be able to report that of 27 cases where the State Association undertook the defense of the member, only one has been decided in favor of the plaintiff and that has been appealed. When a litigant or his attorney is promptly notified upon presenting a claim for alleged malpractice that the member will be defended by his State Medical Association many cases are dropped and the physician not only saved worry and annoyance but money. One method of forcing a physician to settle such claims is by constantly calling and threatening a suit, and accompanying such threats with the offer of a settlement. Many physicians have paid small and even large sums to stop this worry and the frequent calls of the lawyer or his client, despite the fact that they were innocent of any wrongdoing and had been most unjustly accused.

This shows something of the effect of persist

ent and organized defense of malpractice suits by a reputable medical organization. But this is not the point I desire to emphasize, because there is nothing in this argument that shows that the professional man is bettered in an honorable way, but it simply shows the effect which the organized defense has had upon the blackmailing litigant. I desire to refer more to the ethical effect upon members of the profession as such, and in addition, to the direct benefit which such defense has upon the public health.

You all know that surgeons, no matter how skilful and no matter how satisfactory the result of their operations may be, so far as they are concerned, never feel sure but that with the healing of the break or wound some evidence may remain which in the mind of the litigious patient might become a subject for discussion with the shyster lawyer. This fear in the mind of the medical man necessarily stands in the way of his best efforts. Perhaps the most forcible illustration of this is in the action brought for a so-called X-ray burn. No other single scientific discovery has proven itself of such benefit to the public as that of Professor Roentgen, and nothing is more uncertain than its effects.

One of the most prominent surgeons in the city, a man who had given much time and study to the use of this unknown ray, and who had furnished one of the hospitals of our city with the result of his labors and had purchased a full set of implements and contributed them, was the first against whom an action was brought for burning with the X-ray. Even now protection from these rays is uncertain, but the public must be, and of course is, indebted to the medical profession for this great light; yet there will be found those who are willing, under the advice of a shyster lawyer, to prosecute, no matter how careful the surgeon may be. Still, we are thankful to say that such ingratitude is confined to the very few, and I refer to this class of cases simply as illustrative of the point I am endeavoring to make clear-that when the medical profession realizes that it is not to be hampered by the ever-present horror of a malpractice suit, then the public may expect to receive the benefit of the best judgment of the best minds along the lines of honest and earnest experimentation.

The reports show that about 97 per cent. of these so-called malpractice cases are brought for blackmail purely and without any idea of whether there is a bona fide claim or not, and when reached for trial are abandoned. With the successful continuance of this work these cases will surely decrease. There will always remain a very small percentage of cases where there is a proper legal question to be decided by a court and facts to be decided by a jury.

Of the cases which are honestly brought I have found that most of them are the result of attempted repair of fractures which have come into the hands of others for completion, and damages are claimed for unnecessary suffering by reason

of delay or non-union or for deformity following improper union. It often happens, sometimes unintentionally, that the second medical attendant lets slip some derogatory remark or an expression criticizing the work done by his predecessor, which suggests to the patient the idea of bringing an action, and these remarks should be carefully avoided.

The legislation committee should consider the introduction of a bill in our State Legislature compelling malpractice litigants to file security for costs when action is brought. This will cause the blackmailing variety to diminish.

There are two classes of malpractice litigants who attack the medical man; one is the patient who, when threatened with suit for the doctor's bill, threatens a malpractice suit in defense; the other is the scoundrel who relies upon the natural timidity which pervades the medical profession when its professional standing is attacked, and which makes the doctor an easy prey to such a character. Scores of cases never reach the eye of any court, and I presume there are members of the Association who have been threatened with suit in reply to a bill sent, who rather than endure the publicity of a suit, even though the Association stands ready to uphold any honest endeavor on the part of the member in the treatment of his case, settled such cases instead of standing up and fighting for their rights and those of their professional brothers.

The theory under which this defense was worked out was that if insurance companies could afford to pay counsel in various parts of the country, employ agents to secure defense insurance premiums, hire expensive offices, pay large salaries to officers, and then pay a large dividend to the stockholders of the company when they would charge only $10 for the premium on a policy of defense, surely a great representative medical organization with all the conveniences of proper defense at hand, should be able, upon an economical basis, to defend its members, for a very small annual charge.

The success of the defense and the enormous influence which it has exerted on the mind of the profession and on the mind of the public is due to the fact that it is purely a defense. The public has come to know, and shyster lawyers have been given to understand, that no money will be paid to avoid a lawsuit. It is understood that when the defense of a member is once undertaken by the Association his defense will be continued to the court of last resort, which is an extremely tiresome proceeding for the shyster lawyer to contemplate. The member, of course, understands that the Association stands ready to uphold him, if what he has done is proper and he has made the best use of an enlightened judgment. This is what the law requires and what the council of the State Medical Association has demanded. It is not organized to defend those who commit illegal acts.

The success of this plan of defense conducted