to positions which demand the activity and efficiency of middle life. The practitioner who has reached that age at which, in his own estimation, he requires no further light, and discards the teachings of contemporary science, should retire to the shades of private life. He may continue a respectable practitioner, but he does not do full justice to his patients. Unfortunately, this is the precise age at which all physicians believe that they are most competent. They now rely upon their experience and grey hairs, the latter being often the more valuable of the two. If a physician who has passed into his dotage is unfit to practice his profession, how much more unfit is he to instruct the rising generation of practitioners? It is little less than madness to allow such persons to fill important chairs in medical colleges. The pupil must subsequently unlearn all that he has learned from such sources before he can become a successful student of the medical sciences. It is not to be denied that physicians may continue to improve in their profession to a great age. There are striking examples in history of men who, though far advanced in life, became proficients in various kinds of learning. And, in our own profession, Brodie, in England, and Mott, in this country, were pleasing exceptions to the general rule, that medical men cease early to advance with the science they are called upon to apply to daily practice. But nevertheless, it is true, that the vast major

ity of physicians cease to learn after the age of sixty or sixty-five, and too frequently begin to ridicule all recent discoveries. The conclusions which are to be drawn from the foregoing reflections are: 1. Medical men do not retire from business at a sufficiently early age. They are too much disposed to struggle to maintain a practice, when they have actually ceased to be competent practitioners. In general a physician at sixty-five is never as correct a practitioner as at forty, and thereafter he rapidly degenerates with advancing age. 2. Old medical men should not retain public positions. In France a physician or surgeon is compelled to withdraw from hospital practice at sixty. This is a most righteous regulation, and should be enforced in every hospital. Aside from their incompetence, the old men do great injustice to the young, who have time and talents to improve the advantage of hospital practice, by retaining these places long after they cease to improve them. And finally, it is most to be regretted that our schools retain men in their professorships who are representatives of past ages. We may daily hear the theories of a former century discussed by these antiquated teachers with the utmost earnestness and precision. In some medical schools, the surgery, midwifery-practice, and therapeutics taught, belong to the last half of the eighteenth century. The reform which is required is practicable, and we hope some day to see it established. Age

and decrepitude should not be tolerated in those responsible positions which demand youthful ardor and strength. Medical senility, resting under the shadow of a great name, sits in many a high place from which it should be cast out, to give way to those who represent contemporary medical science. In our medical schools the fact is, perhaps, still more apparent that medical men seldom grow old gracefully. Many chairs are retained by professors who have long ceased to keep progress with the advance of scientific investigation. They inculcate theories which have been discarded, and reject with the conceit of incredulous old age the recent demonstrations of science. We can, therefore, but regard it as a much needed reform in our profession, that those who have attained old age and competence should retire from active and responsible duties. They should not only yield to the young and ambitious the schools of instruction and the hospitals, but also the field of private practice. We can conceive of no position more enviable than that of the successful physician, who, recognizing the incipient stages of physical decay, gracefully retires from the active duties of his profession, while yet all respect, honor, and love him, and enjoys in the shades of retirement the enduring rewards of a well spent life. In new and peaceful occupations his days will be lengthened, while he sheds around him the healthful influence of a matured experience.

XXXIX.

FEE AND CONTRACT.

P

ROFESSIONAL remuneration, perhaps, more vitally interests the mass of American physicians than any other question which can be presented for their consideration. As a people, we are reputed to hold the almighty dollar in profound respect, and as a profession we are not exempt from the national scandal. For the most part we have reduced the practice of physic to a mere matter of business. We measure success by the amount of income, and are strongly inclined to gauge professional excellence by the same standard. At the last meeting of the Association for the Promotion of Social Science (England), a communication was read, which advocated the adoption of the contract instead of the fee system by the medical profession. The plan recommended was to dispense with the fee system, and to pay the doctor so much per annum, to include all ordinary work, and a fee to be paid for extraordinary work. Ordinary work was defined to mean periodical visits, attending to the health of the patient, etc.; and extraordinary work was held to be such exceptional services as calls to attend on

patients immediately, accidents, and so on. This arrangement, it was considered, would make prevention as well as cure the object of the doctor's care, and assimilate the interests of the physician and patient. This question has excited a lively discussion in the medical journals, and various are the arguments, pro and con. On the one hand it is alleged that if the physician make a contract of this nature he degrades his calling to the level of the common tradesman; that he is liable to be compelled to an excess of duty by being called when there is no need of his services; that it would lead to dissatisfaction of either patient or physician-of patient, if there was no sickness in the family, and of the physician if there was too much sickness. In favor of this plan it is alleged that it will "prevent many of those disgraceful insinuations which have been brought against medical men of creating practice,' of paying unnecessary visits, of perverting hospitalities to the purpose of their profession; and when the guest playing the doctor," "that it would be so far mutually beneficial, that, while the patient would have no hesitation in sending for the medical attendant at the earliest indication of illness, the practitioner would, on the other hand, feel no more reserve in exercising his discretion in the payment of visits, the purposes of which could no longer be misunderstood." The objections which are urged to the contract plan practically have