this misery the misery of his being forced to pay the price of the disease — in diagnosis, in treatment, and in deprivation of work — especially in those diseases against which the individual patient cannot, by himself, protect himself, but for whose striking him the government, or the community, and the medical body itself, are all responsible?

Yes — we, the company of doctors, can no longer bear the patients' reproach that exposes us. At one time we devise free clinics as publicity for ourselves, not as a service to the patient; at another time we devise the novelties of medical insurance in its various kinds, whose pivot, for the most part, is the doctor's interest before the patient's... And what is the patient's fault, if the doctor spent years — so many of them — in acquiring his learning, and spent sums of money — so great the degree of their debts — before obtaining his diploma, and his family's demands have grown, that he should pay to this expensive, indebted doctor his health and his money together, as the price of consulting him? Our arguments, we doctors, against the patients are many: in our eyes they are ignorant, they do not follow advice as they should, they do not seek professional help until the ailment has grown grave and the time has passed, they do not value science at its true worth, nor the doctor, except when his fees are high, or his disparagement of his colleagues frequent, or his boasting over them loud; and so the doctor is forced, in deference to this mentality in his surroundings, to descend from his scientific and moral level to the level of self-interest, to earn his bread.

And let every citizen and every colleague know, on this occasion, that every system of medical practice — no matter whether it be the old system of individual practice, or the new one of group practice, with insurance or without insurance — does not keep the doctor from moral or scientific lapse; because the practice of medicine is, in the end, a scientific service and an ascetic, moral sacrifice, nothing more. Every doctor who will not accept this medical cross must withdraw from

medicine, to make room for others to join together in carrying it — out of sheer delight, nothing more, in warding off ailment, curing sickness, and easing pain — and to trace, in this spirit, not the mercenary spirit, the designs of medical insurance, so as to secure the scientific benefit, good and complete, for the greatest number of those people most in need of it, and at the cheapest prices.

Yes, the patients' reproach has grown until it has all but toppled the pillar of the medical bloc; and we, the fraternity of doctors, cannot preserve our dignity by closing ranks or by syndicates, but only by stopping the people's reproach of us, and forestalling their grievances against our company — by each one of us counting himself responsible for the health of his surroundings, for his patient's awareness of the basic matters of health, for his government's awareness of its preventive duty; and responsible, at the same time, for the full perfection of his work, by persevering in study, keeping abreast of what is new, searching out the latest, and consecrating his science as a means for the patient as an end in himself — not counting his science and the patient together as a mere means to his fame and his livelihood.....

Yes: human medicine, in its loftiness, was a service; we must not degrade its dignity by making it a trade.

Dr. Zaken Shakhashiri Secretary of the Lebanese Society for Public Health

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