} worth while. Among those who are said to have given it up more or less completely, though many of them still continue to provide machines for others to use, are Debonnet, Paulhan, Bleriot, Henry Farman, Armstrong Drexel, Fournier, Rougier, Duray, Cockburn, Gibbs, Capt. Dickson, Glenn H. Curtis, Somer, Rawlinson and Singer. If this report be true it must surely indicate that while from a mechanical viewpoint, the conquest of the air may be considered as almost achieved, the biological difficulties of it for human travelling are by no means as yet overcome, and consequently the millenium of aerial transportation as an every-day affair is hardly yet established. This, however, is surely only a setback. From the recognition of a need is evolved means for its satisfaction. So far as we are aware the dangers and difficulties of diving and the recognition of caisson disease as a regular malady due to definite conditions inherent in the practice of diving, have not lessened the supply of professional divers. Wherever there is a difficult or dangerous duty to be done, there will always be found men willing to risk their healths and even their lives in doing it. The forlorn hope itself rarely lacks for volunteers. But it is one thing to find intrepid individuals to undertake a perilous feat with a definite objective in view, as indeed the history of the growth of aviation itself shows, and quite another to induce people in general to adopt the same procedure as for every-day use.

Many years ago a "business man's train" was established in England between London and Brighton, which covered the distance between these two cities-sixty miles -in an hour, and many London business men eagerly became Brighton "commuters," travelling that route twice daily. The con

stant wear and tear, however, soon began to cause serious effects on the nervous system and we believe the train was ultimately discontinued for lack of support. It is one thing to travel sixty miles an hour once in a way, but quite another thing to do the same thing twice daily. In like manner, the nervous troubles and cardiac affections that are assigned by the well known aviators above referred to as for the most part the cause of their falling away, will probably be enough to prevent the routine employment of flying machines as a means of transportation for some time to come, in spite of the mechanical perfection to which they are rapidly being brought.

The Public and the Medical Profession. The public, says Isadore Dyer, in Southern Medical Journal, is a self-constituted critic, prejudiced against the profession and clamoring for demonstrated achievement, but it is also like a great child needing to be led into the way of cleanliness, godliness and health. With the spirit of today the public is ready for education, and we owe it to ourselves to go more than half way in the effort to instruct it. When that day comes in Utopia, when the state will care for all its sick, educate, train and keep its staff of physicians, lay restrictions of community obligation to health on all citizens, provide for the prevention of disease by instruction in schools and in the communities of peoples, as well as the means to safeguard the individual, then our labors will have ceased, but until such a dream is realized, we must continue to knock at the door of the Empire of Hygeia, begging the spiritual and economic aid of all to further our cause, always humanitarian in its purpose and conservative in its results.

ORIGINAL ARTICLES.

THE PERSONAL OR BUSINESS SIDE OF A DOCTOR'S LIFE.1

BY

J. MacDONALD, JR., M. D., New York.

Managing Editor of the American Journal of Surgery; President American Medical

Editors' Association.

The receipt of your diploma will bring with it the realization that in the practice of medicine, there are two sides for professional success, each depending upon the other. One without its companion spells failure. The scientific or greater side is that one partner in which you have been, or are being trained by this faculty. The other is the personal side. To enable you to successfully fight the battles of life, you must, notwithstanding your scientific training, possess professional tact which commercially translated means business sense. It is upon the personal or business side. of the profession that I have been requested by your Dean to address you, and that is my only reason, outside of the pleasure of meeting you here this afternoon, for presuming to appear. The time has passed when a slick pair of horses driven rapidly through the streets by a well dressed doctor, with little or no scientific knowledge, but with a large bulk of nerve or a so-called good business head, can command success.

The first thought of a graduate is the location in which he will establish his office, and by consulting medical directories, he will conclude that upon a basis of 500

'Presented by invitation at the opening sessions of the College of Physicians and Surgeons, Boston, Mass., Sept. 21, 1910.

people, which is the presumed number that each doctor must have to draw upon for his practice, the field seems to be more than supplied and that no locality is waving the flag of distress for want of medical men. A careful study, however, of the number and especially the ages of physicians located in any one territory, taking their date of graduation as a basis, will shed much valuable light upon the choice of locality for beginning work.

The presence in a locality of a large number of doctors who have passed the meridian and are approaching the sunset of their lives, should not deter you from considering such a field.

As to the general location, I would paraphrase Horace Greeley and say, "Go to the country young man and grow up with its inhabitants." While it is true that the city offers some advantages, principally in the way of clinical observations, the opportunity is not there for a young man to build up a practice, and when you observe doctors with reputations acquired by years of hard work in the city, going to the country, not for their health, but driven away by the various cults and pathies, why not start right and profit by their experience?

True, they will seem to have an advantage over you, gained by years of experience, but age, proper training and ambition directed along the right lines will win out. Before locating anywhere, it is well to broaden your experience and add to the knowledge which you already possess, by a term as resident physician or a clinical assistant in some hospital. This will be a great help, particularly so if you locate in some town or village away from the clinical facilities offered in larger cities.

After you have located your office do not forget that you are a student of medicine

Series,

and always will be if you wish to succeed in your chosen profession. An elaborate. library at the beginning is not necessary or essential for your welfare, but a well selected list of text and reference books you will need, and they should be secured as soon as you start in practice or immediately afterwards. A prominent authority has stated, "that the more completely a text-book is revised, the more out of date it will be found." Notwithstanding this opinion, you will find that authoritative books upon medicine and surgery will be of great service for ready reference. I would advise a young practitioner to subscribe to as many well selected medical journals, American and foreign, as his finances will allow. These magazines will give him the advances made in the practice of medicine and surgery and other important facts for his daily consumption. It is through this source that all great discoveries are authentically given to the professional world. Our knowledge regarding that wonderful discovery "Ehrlich's 606" was furnished to the medical profession, first through the medical press. This one instance I mention to emphasize how necessary it is to be a careful and extensive medical magazine reader not only for new points but for old ones presented as a reminder of things useful.

Do not think that patients are gained by loitering around billiard parlors, saloons or the corner drug store. You must not forget that outside of the fact that such places will not only ruin your opportunities of gaining a professional standing, the practice of medicine is a dignified profession and first impressions, if rightly made, are a valuable asset in your effort to build up a practice.

Select your associates with care. It is well to affiliate with the church. The denomination is not so much to me as the fact that it will offer you a peace of mind and an opportunity for salvation in the world to come. Then again, the acquaintances you make through your church will be those you will not be ashamed to greet upon the street. Join a fraternal order if founded upon the right principles, not for the financial benefit you will receive per se, but for the purpose of broadening your acquaintance among men of healthy mind and the good it will do you outside of the financial side.

While dress does not make the man, it often reflects his characteristics. Neatness of appearance, not over-dress, and personal grooming denote attention to details which will be reflected to the mind of your patient or possible patient, and will convey the idea that the same care will be exercised in professional matters as in personal details, therefore do not fail to give particular attention to this point.

While it is true that whiskers upon a billy-goat do not denote brains any more than they do upon the human, nevertheless as it is a fact that youth does not seem to beget confidence in the practice of medicine, therefore until Father Time normally adorns you by his ravages, it might be well to lend to your facial appearance such decoration as nature will provide.

Do not carry a serious expression upon your face when entering the sick room. What prompted sending for you was the hope that you could relieve distress through your ability to cure. It is well to remember the words of Sir Walter Scott, "hope is brightest when it dawns from fears." By this I do not mean to convey to you that

you should tell your patients that you are going to cure them, but your manner of action and your determination will instill in them a trust in you and a confidence in your ability to relieve them of their suffering, that will speak louder than words. This should be well borne in mind because hope of relief is the all-pervading thought of the sick, and if you cannot encourage it, someone else will. It is a never-failing tonic.

There are always times for seriousness, but do not be too serious unless there is occasion for it; and by this I do not advise frivolity for that is not in keeping with the dignity of the profession.

The opportunity for the young practitioner to gain a livlihood in a professional way outside of his strict attendance upon the sick is becoming broader daily. Nearly every State has passed laws requiring the medical inspection of school children. The realization of the necessity and advantages of surrounding the minds of those who are being developed with a perfect physical structure, is working untold good and as medical inspectors of school children, you will be able to add to your income, and at the same time embrace an opportunity for extensive observations that will materially benefit you in your other professional work.

The examination of life insurance risks is another source of income that should be considered by those entering the practice. of medicine. While tending to broaden your acquaintance, it will also pay you a fair remuneration for your work.

There seems to be an unwritten law that doctors should be married men. While there can be no argument on the great advantages to a physician in a fortunate marriage, the fact remains that the true man

is a safe man whether he be single or married, and until such a time as you are financially able to assume the burdens of a household, there is always the possibility of making two miserable beings where two fairly contented ones may have existed.

The statement is frequently made that the physician is a poor business man. In a way this is but too true, however he has been devoting his early life to studies to perfect him in the practice of his profession, and for that reason the opportunities of acquiring business methods have not been afforded him. Then again this as-. sumption has taken form for the reason that the doctor neglects or is afraid to send his bill because he might offend his patient. You should bear in mind that “payment deferred maketh the patient dishonest." honest." The doctor is entitled to his fee whether he he writes a prescription or whether he advises simply upon matters of health or sanitation. "Do not depend upon a patient's gratitude for your fee. Bills that are allowed to accumulate, may become so large that it becomes a financial impossibility to pay, thus many times a man is branded as dishonest when a prompt collection of small fees would not have been a burden to him." In sending out your bills, it is always well to use a distinctively colored paper. "It acts as a constant reminder that the account is unpaid and is easy to find when wanted. Do not feel that it is always necessary for you to make a private sacrifice for a public benefit." While you will be called upon very often to offer your services to the poor and needy, and it goes without saying that you will do so willingly and with a whole heart, to look upon the physician as a philanthropist and one who is supposed to give his services gratuitously upon every oc

casion is an injustice, and it arises only on account of the generosity of the physician himself. As a general rule it does not pay to treat your friends without a fee. Advice that is not paid for is always lightly considered and does not redound to your professional standing or the right side of the ledger.

In office work, there is but one rule and that is "cash upon delivery" and this applies quite as effectively to obstetrical work. Again referring to office practice and the handling of patients, I wish to quote the words of Dr. Cathell in his most excellent book upon "The Physician Himself." He says: "There is a difference between words used with office patients. When you desire a patient to again visit you, do not instruct him 'to return so that you can see how he is getting along,' but 'advise him to consult with you again upon a given date.' In the first instance the patient will not expect to pay for the call. In the second, he feels an obligation to do so."

After a time, I take it that, having followed the business methods herein suggested, you will have accumulated sufficient of the world's goods, represented by cash, to think of investments. In this respect, just one point, invest in local securities where you have a fair opportunity of judging their value. Ninety-nine out of 100 mining propositions and other milliona-minute money makers are simply stock schemes, the promoters of which are merely looking for easy marks. Don't be their target.

In closing I cannot refrain from quoting from Dr. Lydston's paraphrase of "Thanatopsis" with his apology to the shade of William Cullen Bryant.

"So live, that when thy time has come to join the enumerable caravan which moves to that mysterious bourne, peopled by doctors who have died of in-nutrition, thou go not like the general practitioner called at night, scourged from his office, but sustained and soothed by the motto, 'never trust' and approach thy grave like one who wraps his stocks and bonds about him and lies down to peaceful dreams."

A FOOL'S PARADISE-SNAP DIAGNOSES.1

BY

LEGRAND KERR, M. D.,

Visiting Pediatrist to the Methodist Episcopal (Seney), the Williamsburgh and the

Swedish Hospitals, in Brooklyn, N. Y.;
Consulting Pediatrist to the E. N. Y.
Dispensary.

FOREWORD.

The possibility of being misunderstood when our thoughts are transferred to paper is so great that this foreword becomes necessary. The object of the author is in no instance meant to be critical; it is to draw attention in a manner somewhat out of the ordinary to the fact that snap diagnoses are often dangerous, frequently unnecessary and always detrimental to personal endeavor and thought. Therefore the writer would ask that more than usual attention be given to the contents of the paper, so that its purposes may be served and the chance of misunderstanding reduced to the minimum.

Figuratively speaking, Paradise is a place or state in which there is surpassing delight and entire contentment.

'Read before the Williamsburgh Medical Society, May 9th, 1910.