"While there is being done enough poor surgery that is honest and well intended, there is much being done that is useless, conscienceless, and done for purely commercial ends. This is truly a disagreeable and painful topic and one that I would gladly pass by, did I not feel that its importance demands some word of condemnation coming through such representative surgical organizations as this. "The spirit of graft that has pervaded our ranks, especially here in the West, is doing much to lower the standard and undermine the morals and ethics of the profession. When fee-splitting and the paying of commissions for surgical work began to be heard of something like a decade ago, it seemed so palpably dishonest and wrong that it was believed that it would soon die out, or be at least confined to the few in whom the inherited commercial instinct was so strong that they could not get away from it. But it did not die; on the other hand, it has grown and flourished. "In looking for an explanation for the existence of this evil, I think several factors must be taken into account, among them being certain changes in our social and economic conditions. This is an age of commercialism. We are known to the world as a nation of "dollar chasers," where nearly everything that should contribute to right living is sacrificed to the Moloch of money. The mad rush for wealth which has characterized the business world, has in a way induced some medical men, whether rightfully or wrongfully, to adopt the same measures in self-protection. The patient or his friends too often insist on measuring the value of our services with a commercial yard-stick, the fee to be paid being the chief consideration. In this way the public must come in for its share of responsibility for existing conditions. So long as there are people who care so little who operates on them, just so long will there be cheap surgeons, cheap in every respect, to supply the demand. The demand for better physicians and surgeons must come in part from those who employ their services.