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developed today. The musculature of the body is in decidedly hypotonic state; patellar reflexes absent. Argyll-Robertson pupil present.

The gait is that of a typical tabes; speech is rather slow. Examination of the fundi of the eyes showed negative results. No nystagmus; hearing normal. Marked ataxia in the upper extremities; no disturbance of sensation, sphincters normal. Intelligence of the child is absolutely intact. Nogouchi's modification of Wasserman's reaction of the blood is positive. The child is unable to walk or stand without being supported; deep muscular sense gone; otherwise doing very well. III Second St., New York.

THE MEDICAL LIBRARY AND ITS INFLUENCE ON MEDICAL CULTURE AND REMUNERATION.

BY

BAYARD HOLMES, M. D.,
Chicago.

When I came to Chicago in 1882, the Public Library was housed in the uppermost story of the City Hall and was under the management of that prince and pioneer of librarians, Wm. F. Pool. One north room contained the medical department, which was made up of donations from the Chicago Medical Society, from local medical journals and from individuals. No additions were purchased by the library board and little attention was bestowed upon the so-called medical department by the management. While a student and interne in the County Hospital I often visited this, the only medical library in Chicago, and remember my wonder that I was always alone, meeting no other readers and seeing no attendants.

The present conditions in Chicago are quite striking. The Crerar Library, in the

Marshall Field building contains a wonderful collection of medical literature which is rapidly approaching a condition of completeness comparable only with the National Library at Washington and the Library of the Academy of Medicine of New York and of similar organizations in Boston and Philadelphia. A large reading room with excellent tables is provided quite away from the general reading room and trained attendants are at hand to assist the readers who crowd every table from early in the morning to the late closing hour. All the current medical journals are on file and are never away at the binders and inaccessible, for the binding is done in the building. The books are conveniently classified and very completely catalogued.

But this is not the only medical library in Chicago. Each of the medical schools and the University of Chicago has its own medical library for the use of students and professors. The collections are not very complete but they are large enough to give the students a conception of the medical horizon which those of a decade ago rarely attained. They are large enough also to allow improved methods of teaching which, unfortunately, have not been very generally adopted.

For years the medical school has been too obviously a trade school. It has been so managed and the instruction has been on such a plan that the university has not given it that recognition as cultural training which the school of engineering has commanded. The motive and method of the medical school has been narrow and smug. Fortunately for our profession which is now reaping the full measure of disgrace from such past neglect, a few schools have set examples of the highest standard in motive and method and in almost every school ex

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ceptional teachers have striven more or less wisely, more or less successfully for better things. These teachers may not know the extent of their influence on a minority of their students but that influence was felt and will be more strongly felt in the future.

The professional man is distinguished from the tradesman by his mental horizon. The tradesman has a personal outlook, large or small according to the extent of his personal experience. The professional man's horizon is bounded by his knowledge of the experience of the whole profession in the whole world, modern and ancient, national and international.

The tradesman is fixed in his ways and means and adapts himself only with the greatest difficulty to unexpected emergencies and unfamiliar surroundings. The professional man, however, who is familiar with the experience of the world of his profession can scarcely meet an emergency which he does not share in memory with thousands of his colleagues. The education of the tradesman is designed to produce such skill as will produce the most uniform standard of commercially available excellence in the work of his hands. The education of the professional man should attain or be designed to attain the most comprehensive and masterful conception in the scholar of the complicated relations he may meet in his professional experience. The tradesman must produce the largest possible product of a definite but not necessarily excellent standard. His whole duty is to his employer as expressed in the product of his labor. If he has any other obligation it is toward himself as expressed in obligation to his class or trade. The professional man owes his first obligation to society as a whole. The doctor, for example were he a tradesman would have his door open to

every patient to sell him such services as he might demand; now an abortion, now a dose of poison to relieve a loved friend of the horrors and sufferings of cancer, now a placebo for imagined ills. How often is the tradesman or the so-called business man shocked at the refusal of the doctor to use his knowledge profitably for a purpose which seems humane, reasonable and charitable!

The medical library furnishes the most complete if not the only possible record of the experience of the medical profession. The text books of medicine are abstracts of this experience, incomplete, abridged and colored by the idiosyncracy and mental attitude of the authors or editors. The physician who goes to his text books and cyclopedias alone for the experience of the medical profession of the world will get a telescopic view with the telescope reversed. These views map-like and comprehensive are corrected by the study of the original material as found only in the medical library. This study should be a large factor in medical education and in post graduate study. It orients the cyclopedic and text book view and reduces their horizon to the proper perspective.

It is not difficult to understand the slow progress of pedagogy in the medical school. Barring the exceptional teacher the ancient method of Edinburg and Paris prevails in most colleges with only the modern graft of sapless, time consuming and unrelated laboratory course. The natural conservatism of our profession has been further fixed in our educational institutions by the Chinalike written examination demanded by our state examinations for license to practice. medicine. The medical school has become one great quiz class. the best quiz master.

The best teacher is Our medical educa

tion is thus co-ordinate with the catechism classes of the church.

With such a system of instruction, for it can not be called education, the general tradesman-like attitude of the medical profession in relation to fads such as the X-ray treatment, the Bier's treatment and many other methods of limited or doubtful utility can also be understood.

The lumber room behind many a doctor's office stands as a mute reminder of the easy credulity of our profession to the suave argument if not instruction of the traveling salesman. The ready acceptance of methods of doubtful utility, soon places its monument more conspicuously in the cemetery or in the sad memory of a community. With what tradesman-like avidity did we receive the tuberculin cure of consumption! How eagerly was the Crede ointment rubbed into our unfortunate patients dying of septicaemia! How many felons were opened and foreskins cut off under the anaesthesia produced by the injection of cocain into the cerebro-spinal lake! What numbers of questionable procedures are now being undertaken in the profound sleep of scopolamin-morphine injections! In the same catagory and often with the same mute monuments are the

opposite acts of blind madness, such as the failure to vaccinate against smallpox, to use the serum for and against diphtheria, and the mercurials for syphilis. These fads and obstinate acts of conservatism are not the only evidences of lack of medical culture and rational perspective which face us as a profession, but they suffice to enforce our argument.

The reward of the medical profession in our economic system depends upon the general standard of usefulness of the united

profession. Where medical culture is low and the quality of the men who compose it is inferior the compensation is also low. Where the doctor is "the wise and the good" doctor, the economic reward increases. But the pay is not for personal excellence but for a general professional superiority. No trade unionism can raise the doctor's fee. It is the public recognition of the prevailing high standard of the whole profession that commands the economic reward. The system of the union may help the "lame ducks" but it can not help the reputation of the medical faculty.

It appears to me little short of a catastrophe that so much attention is now given to the trades-union aspects of our medical societies and so little to the promotion of medical culture. With the trades-union movement in medicine has come the idea of medical institutes, similar to the teachers' institutes

which preceded professional pedagogic training. These medical institutes may have a place in supplementing an inadequate medical education, but they promote sordid mediocrity and encourage the tradesman's attitude of mind rather than that traditional motive of our profession which is after all the only thing which dignifies our vocation. Describe the useful

doctor's doings for only a single week in the language of the street and you could not hire a scullion or even a scavenger to go through the same manipulations for twice the doctor's fees. It is the attitude of mind. and motive which ennobles menial personal service.

Why is it that the lackey's uniform, the dress coat of the butler and the waiter, the white coat of the barber and the cook's cap are hated, detested and abhorred by every high minded young man, while the obstet

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