VO CATION AL SERI E S 
- VOCATIONAL SERIES 
THE PHYSICIAN VOCATIONAL SERIES 
THE TEACHER By Francis B. Pearson 
THE ENGINEER By John Hays Hammond 
THE NEWSPAPERMAN By Talcott Williams 
THE MINISTRY By Charles Lewis Slattery 
THE ADVERTISING MAN 
By Earnest Elmo Calkins 
THE PHYSICIAN By J. M. T. Finney 
CHARLES SCRIBNER’S SONS VOCATIONAL SERIES 
THE PHYSICIAN 
Y by 
J. M. T. FINNEY, M.D. 
NEW YORK 
CHARLES SCRIBNER’S SONS 
1923 Copyright, 1923, by 
CHARLES SCRIBNER'S SONS 
Printed in the United States of America 
Published, February, 1923 PREFACE 
The substance of this little volume is 
embodied in addresses given from time to 
time to the students composing the Medical 
Club of Princeton University. This ma- 
terial has since been revised and enlarged 
until it has assumed its present form. It is 
hoped that as it now stands it may prove of 
some service to those contemplating the 
study of medicine, in helping them to decide 
for or against it as a life work. It is hoped, 
too, that it may prove not without interest 
to those medical men into whose hands it 
may happen to fall and who may have al- 
ready advanced somewhat upon the way. 
In turning its pages, it should be borne con- 
stantly in mind, however, that this address 
was delivered in the beginning to a group of 
college students who had not as yet begun 
their life work, and that it is to a larger audi- 
ence of this same character that it is now 
chiefly addressed. CONTENTS 
CHAPTER PAGE 
I. Origin of Medicine ... i 
II. A Brief Outline of the His- 
tory of the Profession . 4 
III. Medicine as a Calling . . 24 
IV. The Problem of Disease . 46 
V. Requisites for Success in a 
Physician 53 
VI. Qualifications for the Study 
of Medicine 62 
VII. Preliminary Training ... 92 
VIII. Medical Education ... 96 
IX. The Character and Function 
of the Medical School. . 106 
X. The General Practitioner . 114 
XI. Country Versus City Practice 119 
XII. Industrial Medicine and Pub- 
lic Health 126 CONTENTS 
CHAPTER PAGE 
XIII. Group Medicine 129 
XIV. Specialties 133 
XV. Experience 138 
XVI. Ethics of Medicine . . . 144 
XVII. Criticism of One’s Colleagues 149 
XVIII. Altruism in Medicine . . . 152 
XIX. The Humorous Side of Medi- 
cine 161 
XX. The Grateful Patient . . 165 
XXI. Causes of Failure .... 170 THE PHYSICIAN THE PHYSICIAN 
CHAPTER I 
ORIGIN OF MEDICINE 
In that charming sketch by Sir William 
Osier, The Evolution of Modern Medicine 
(which every student of medicine, under- 
graduate or graduate, should keep always at 
hand), he quotes Lucretius, Pliny, Celsus, 
and many others to show the origin of primi- 
tive medicine. “Medicine arose,” says he, 
“out of the primal sympathy of man with 
man; out of the desire to help those in sorrow, 
need, and sickness. 
“‘In the primal sympathy 
Which having been must ever be; 
In the soothing thoughts that spring 
Out of human suffering.’ 
The instinct of self-preservation, the longing 
to relieve a loved one, and, above all, the 
maternal passion—for such it is—gradually 
1 2 
THE PHYSICIAN 
softened the hard race of man.” He further 
quotes Lucretius, in speaking of the growth 
of sympathy among primitive peoples, as 
follows: “When with cries and gestures they 
taught, with broken words, that ’tis right for 
all men to have pity on the weak.” 
The first lessons came to primitive man by 
injuries, accidents, bites of beasts and ser- 
pents, perhaps for long ages not appreciated 
by his childlike mind, but little by little such 
experiences crystallized into useful knowl- 
edge. The experiments of nature made 
clear to him the relation of cause and effect. 
He also quotes with approval Celsus in his 
account of the origin of rational medicine: 
“Some of the sick, on account of their eager- 
ness, took food on the first day; some, on 
account of loathing, abstained; and the 
disease in those who refrained was more re- 
lieved. Some ate during the fever, some a 
little before it, others after it had subsided, 
and those who had waited to the end did 
best. For the same reason, some at the 
beginning of an illness used a full diet, others 
a spare, and the former were made worse. 
Occurring daily, such things impressed care- 
ful men, who noted what methods of treat- ORIGIN OF MEDICINE 
3 
ment had best helped the sick and then 
began to prescribe them. In this way 
medicine had its rise from the experience 
of the recovery of some, of the death of 
others; distinguishing the hurtful from the 
salutary things. Observation came and 
with it an ever-widening experience. No 
society so primitive without some evi- 
dence of the existence of a healing art, 
which grew with its growth and became part 
of the fabric of its organization.” The 
system of medicine in practice to-day is but 
the gradual accretion of such observations 
and discoveries, and the deductions made 
from them through the ages. CHAPTER II 
A BRIEF OUTLINE OF THE HISTORY 
OF THE PROFESSION 
When we look into the history of the 
healing art two facts stand out in striking 
contrast—-the great antiquity of medicine 
and the comparatively recent period during 
which it has made its rapid advances.* 
To one who is contemplating the study 
of medicine a brief outline of the history of 
that profession should prove interesting, in- 
structive, and inspiring. It is a long story 
of an honorable profession, affected of neces- 
sity, like other professions, by the various 
vicissitudes of the times through which it 
has passed during the intervening centuries 
* The material comprising this chapter has been com- 
piled from various sources, but chiefly from published re- 
marks made by Professor William H. Welch at the Cen- 
tennial Anniversary of the Medical and Chirurgical Faculty 
of Maryland,. April 26, 1899. Papers and Addresses, vol. 
Ill, The Evolution of Modern Medicine, by Sir William 
Osier, and an unpublished paper by Dr. Walter Brem. 
4 HISTORY OF THE PROFESSION 
5 
from the time of its birth until now. Medi- 
cine in general is divided, historically, into 
three great divisions: ancient, mediaeval, and 
modem. 
ANCIENT MEDICINE 
The first period extends from the earliest 
records as found in the trephine holes of 
skulls from the Neolithic Period, to the time 
of Galen in the second century of the Chris- 
tian era. It is subdivided into (a) Egyptian 
Medicine, which begins with the papyrus 
found by Ebers. The date of this papyrus 
must be at least 1500 B. C. It is a treatise 
upon remedies used in the treatment of vari- 
ous diseases. No less than 700 remedies of 
one sort or another are mentioned. It is 
interesting to note that even at this early 
date such popular drugs as opium and castor- 
oil were being used. (b) Assyro-Babylonian 
Medicine. This is recorded chiefly in cunei- 
form tablets, consisting largely of copies of 
letters written to the King, some of which 
are written by the King’s own physician. 
(c) Hebrew Medicine. This is well illus- 
trated in the Book of Leviticus in the Bible. 
(d) Greek Medicine. This is really the be- 6 
THE PHYSICIAN 
ginning of historical medicine. Here we find 
the works of Hippocrates (from 460 B. C.), 
the so-called “Father of Medicine.” His is 
the greatest name in ancient medicine, in- 
deed “one of the greatest names in the whole 
history of medicine, a man characterized by 
simplicity of work and observation without 
speculation, and whose work has remained 
a model to the present time.”* He it was 
who delivered medicine and surgery from 
the thraldom of superstition and specu- 
lation. Hippocrates, typifying the Grecian 
spirit of his day in his insistence upon ex- 
plaining various phenomena observed with- 
out regard to dogma or tradition, taught his 
students that all diseases spring from natural 
causes and are not manifestations of the dis- 
pleasure of the gods. “That was the key- 
note of rational medicine struck over twenty- 
three centuries ago, but which had to be 
sounded again and again through many cen- 
turies ere his successors were brought into 
harmonious procession. One of the grand- 
est achievements of science is the establish- 
ment of the principle that Nature works un- 
der fixed laws. For his pioneer work in the 
* Welch. See note, page 4. HISTORY OF THE PROFESSION 
7 
establishment of this principle, Hippocrates 
deserves the greatest credit.”* 
The name of Aristotle, though he was not 
a physician, only the son of a physician, 
should be included here on account of his 
studies in anatomy, as should also the School 
of Alexandria in the time of the Ptolemys, 
where pathology and anatomy were culti- 
vated by dissection of bodies, (e) Next 
comes Roman Medicine of Asclepiades in 
the second century before Christ, when he 
introduced Greek Medicine into Rome. 
His original works were lost, but, as he was 
quoted very extensively by Galen and other 
writers, it is not difficult to get an idea of 
his opinions. Then comes Celsus in the 
first century. His work was of inestimable 
value, but occupies a position quite different 
from that of Hippocrates and Galen. He 
was an encyclopaedic writer, collecting all 
the wisdom of those who preceded him; a 
work of great value in that it presents to us 
the condition of medical knowledge in the 
time in which he wrote. He was not recog- 
nized as an original authority, and therefore 
is not quoted by Galen. He seemed to be 
* Welch. 8 
THE PHYSICIAN 
a great admirer of Hippocrates. Celsus un- 
doubtedly recognized diphtheria and gave 
an excellent description of it. Finally we 
come to Galen, one of the greatest names in 
medicine. He flourished in the second cen- 
tury after Christ. He summed up all the 
wisdom of antiquity and described that sys- 
tem of medicine which held undisputed sway 
for over one thousand years. From his time 
on to the Reformation there were no new 
contributions. Galen’s system is a wonder- 
ful monument to the man, to his power of 
observation, his acute reasoning, and his 
philosophical aid. He was the first to make 
physiological experiments. 
MEDIAEVAL MEDICINE 
This was a very dark period in the history 
of medicine, little or nothing of value hav- 
ing been contributed by any one. In the 
Eastern Empire, Oribasius, who lived in the 
fourth century A. D., and Paul of Aigina, 
were perhaps the most famous. The latter 
was a surgeon of experience, whose work was 
of considerable value in the history of sur- 
gery. Of the Arabian Period of medicine, HISTORY OF THE PROFESSION 
9 
the names of Rhazes and Avicenna stand out 
most prominently. The former was one of 
the few who actually contributed something 
to medicine during this period, the rest 
being merely followers and imitators of 
Galen. Rhazes undoubtedly first described 
smallpox, as there was no record of it previ- 
ously, and his description is very good, as 
is also that of measles. Avicenna’s great 
work, The Canon of Medicine, was a com- 
plete and very methodical system modelled 
after Galen. It was for centuries the prin- 
cipal text-book of medicine. Along in the 
tenth and eleventh centuries, the universi- 
ties first began to make their appearance, 
the first of which was that of Salernum, and 
it is interesting to note that this university 
began with a school of medicine. In the 
twelfth and thirteenth centuries first ap- 
peared the works of any Englishman. Gil- 
bert and Gordon were the first, and their 
writings thus early show traces of the prac- 
tical sense of the British physicians. Their 
works had wide distribution and are typical 
examples of scholastic medicine. In the 
next century, the fourteenth, came the dawn 
of the freedom of thought, so free, indeed, 10 
THE PHYSICIAN 
that the philosophical works of Arnold of 
Villa Nova were burned by the Inquisition. 
Among other names of those whose work is 
worthy of mention is Mondino, who was 
the first to dissect the human body since the 
time of the School of Alexandria. The lat- 
ter was a learned man, thoroughly familiar 
with the work of his predecessors who wrote 
on the subject. 
MODERN MEDICINE 
This period begins with the Renaissance 
in the fifteenth and sixteenth centuries, and 
was ushered in by three movements: classi- 
cal scholarship, the return to medicine, and 
the revolt against dogmatic authority. The 
first names to achieve note during this period 
were those of Linacre, a professor in Oxford, 
a highly cultivated man and a very active 
practitioner, and Caius, who wrote a re- 
markable and classic monograph on “Spring 
Sickness.” It was written in the true Hip- 
pocratic spirit of actual observation, and 
demonstrated that the spirit of criticism, of 
observation, and of investigation had re- 
turned. Next comes the great name of 
Vesalius, the reviver of anatomy. He dis- HISTORY OF THE PROFESSION 
11 
sected the human body and constructed the 
science of human anatomy. Galen hereto- 
fore had been supposed to be infallible, so 
much so that, when permission was asked 
of the Church to dissect human bodies, the 
authorities answered: “It is not necessary 
unless Galen has made a mistake, and he 
has not made a mistake, therefore it is 
not necessary.” Vesalius, however, recon- 
structed human anatomy and undermined 
Galen by pointing out mistakes that he had 
made in his examinations of animals. Then 
comes that strange individual, Paracelsus, 
the antagonist of all authorities, an ancient 
Bolshevik, who began his lectures by pub- 
licly burning the works of Galen and Avi- 
cenna. His conception of disease is interest- 
ing in that he thought of it as a parasite, as 
something which entered the body from the 
outside and entered into a struggle with the 
archeus. He made several material contri- 
butions to therapeutics, the principal one of 
which was antimony, which became the 
badge of his school. The next century, the 
seventeenth, that of Copernicus, gives us a 
galaxy of names famous in the history of 
medicine; chief among them perhaps are 12 
THE PHYSICIAN 
Harvey, Sanctorius, Borelli, Van Helmont, 
Glisson, Willis, Sydenham, Malphigi, and 
Van Leeuwenhoek. The name of Harvey 
is, of course, forever associated with his dis- 
covery of the circulation of the blood, first 
published in 1628, although announced by 
him in his lectures twelve years before. 
This was the greatest discovery in physiology 
and effectually overthrew Galenism. Hardly 
less important, however, than his discovery 
of the circulation was Harvey’s work on the 
development of the embryo. Sanctorius 
was the first man to count the pulse and 
the first to use instruments of precision, 
among them the thermometer. Borelli is 
interesting as the founder of the clinical 
school and the first to try to explain the 
phenomenon of life on chemical principles. 
We are indebted to Van Helmont for the 
modern conception of gas and for his dis- 
covery of carbonic-acid gas. Glisson was 
celebrated for his work on the anatomy of 
the liver, and he was the first to conceive 
the doctrine of irritability, the fundamen- 
tal property of living things. Willis gained 
fame as an anatomist, especially in the 
anatomy of the brain. Then comes Syden- HISTORY OF THE PROFESSION 
13 
ham, the greatest physician of the century 
and one of the greatest of all times. He was 
thoroughly imbued with the Hippocratic 
method. He saw things clearly and de- 
scribed clearly what he saw. His name is 
especially associated with his graphic de- 
scription of the gout, with which he himself 
suffered, his writings upon hysteria, the use 
of cinchona bark in malaria, and the use of 
cooling treatment in fevers. The beginning 
of microscopic anatomy followed the making 
of simple lenses. With the aid of these Mal- 
phigi first saw the red blood corpuscles 
and was able to study the structure of the 
lungs, kidneys, and other glandular appa- 
ratus of the body. With these same simple 
lenses Van Leeuwenhoek first discovered 
bacteria, although he did not appreciate 
their significance. These two men did all 
that could be done with simple lenses, and 
no further advance was made in this line 
until more perfect lenses were devised in the 
early part of the nineteenth century. The 
eighteenth, or the Philosophical Century, as 
it is called, contains some of the greatest 
names, perhaps the greatest in the history 
of scientific medicine, namely, that of John 14 
THE PHYSICIAN 
Hunter and also that of Edward Jenner, the 
discoverer of vaccination against smallpox. 
Among the number of those most worthy to 
be mentioned, on account of the character of 
their work and their contributions to the 
science and the art of medicine, are Boer- 
haave, Hoffman, Stahl, Haller, Wolff, and 
Morgagni, the latter probably being the first 
to make systematic post-mortem examina- 
tions. English surgery contributed, among 
others, the names of Astley Cooper, Aber- 
nethy, and Pott. Among the other celebri- 
ties may be mentioned Spallanzani, the first 
to study artificial digestion, and Galvani, an 
interesting name both in science and medi- 
cine. 
The medical history of the nineteenth cen- 
tury teems with names famous for their dis- 
coveries and other contributions to medical 
knowledge. A list of these names is like 
calling the honor roll of the profession. It 
is so long that only a few of the most promi- 
nent can be mentioned—Bichat, Laennec, 
Louis, celebrated among other things for his 
studies in typhoid fever, Charles Bell, the 
discoverer of the roots of sensory nerves; 
Liebig, who started the work in physiologi- HISTORY OF THE PROFESSION 
15 
cal chemistry, and Johannes Muller, the 
founder of the modern German school of 
physiology; Morton, the discoverer of anaes- 
thesia; Magendie; Rokitansky; Von Helm- 
holtz, the discoverer of the ophthalmoscope; 
Virchow, the great pathologist; Lister, the 
first to formulate and apply the principles 
of antiseptic work, based largely upon the 
discoveries in fermentation by the great 
Pasteur; and, finally, Koch, the discoverer, 
among other things, of the tubercle bacillus. 
The foundations of modern medicine, be- 
gun in the sixteenth century by the anat- 
omist Vesalius, who first studied scientifi- 
cally the structure of the human body, have 
been built by slow and tedious processes 
during the succeeding centuries. Physi- 
ology, microscopy, histology, and pathology 
were all slowly evolved. Every new discov- 
ery was bitterly opposed, and the early 
builders, maligned and even persecuted, 
literally hewed the foundation-stones by the 
sweat of their brows. But, in spite of all 
opposition, the edifice of knowledge grew 
slowly, but surely, until it has reached the 
highest development of to-day. One by 
one the great epoch-making discoveries were 16 
THE PHYSICIAN 
made and the growing list of names of the 
immortals in medicine—Harvey, Jenner, 
Pasteur, Lister, Koch, and others too nu- 
merous to name—was being added to all the 
while. In recent years, Ross and Reed had 
taught us much about the causes and meth- 
ods of conveyance and control of diseases 
that had for centuries been the scourge of 
mankind. Lazear had, among other mar- 
tyrs, laid down his life in demonstrating 
the propagation of yellow fever through the 
mosquito. Gorgas, profiting by these re- 
searches, had, by practical application of the 
knowledge gained, made possible the build- 
ing of the Panama Canal and had freed our 
Gulf States, Cuba, the Canal Zone, and 
other portions of the globe from the fearful 
apprehension and the dire results of a visi- 
tation of these scourges of mankind. The 
establishment of the fact of an intermediate 
host, the mosquito, flea, tick, etc., in the 
transmission of many of the communicable 
diseases was a great step in advance and 
suggested at once the possible control of 
these epidemics by limiting the activities or 
by complete extermination of these pests. 
The effect of an impure water-supply in the HISTORY OF THE PROFESSION 
17 
transmission of typhoid fever, cholera, etc., 
also was a great step. Then the introduc- 
tion of vaccination against many of these 
deadly diseases, typhoid fever, diphtheria, 
etc., has accomplished much in their control. 
Not alone has man benefited in his own 
person by these advances, but, indirectly, 
by the immunization of animals, which has 
practically saved the hog, sheep, and cattle 
industries from destruction by cholera, an- 
thrax, Texas fever, etc. 
Control of many diseases is obtained 
through control of environmental condi- 
tions, that is, by sanitation. By far the 
greatest progress in preventive medicine has 
been made in this direction by purifying the 
water and milk supplies, proper disposal of 
sewage, the reduction of the number of mos- 
quitoes, war on rats and other rodents, the 
control of lice infection, muzzling of dogs, 
etc. There is, however, another great group 
of diseases in which sanitation is largely in- 
effectual—the group of communicable or 
contagious diseases. These must be con- 
trolled chiefly through man’s education and 
his control over himself, as their prevention 
depends largely upon early recognition of 18 
THE PHYSICIAN 
infected persons and their voluntary isola- 
tion or quarantine. Some of these, diph- 
theria, smallpox, and leprosy, have been 
brought largely under control, but others, 
such as tuberculosis, while much progress 
has been made, still resist effectual control. 
Pneumonia, for instance, although the or- 
ganism causing it was discovered years ago, 
has, nevertheless, so far successfully resisted 
all efforts to conquer it. 
That there is a crying need for the exer- 
cise of preventive medicine along other lines 
than those just mentioned, is emphasized 
by the fact that the medical examinations 
made during the draft of our army during 
the recent great war showed over 33 per 
cent of men in the draft age to be physically 
unfit for military service. A study of these 
disabilities revealed the fact that the great 
majority of them could, in all probability, 
have been prevented by judicious medical 
care and education during early life, es- 
pecially during the school age. This em- 
phasizes the fact that the medical care and 
hygienic education of the school-child are, 
perhaps, the most imperative duty that con- HISTORY OF THE PROFESSION 
19 
fronts the present generation. And yet this 
duty is strenuously denied, and its fulfil- 
ment obstructed in various parts of the 
country by a vicious league of theorists, 
who are attempting to check in every way 
possible the effective carrying out of public 
health work in the schools and elsewhere. 
These same methods of preventive medicine, 
applied during the war for the protection of 
our army, were so successful that our death- 
rate from disease was lower than that of any 
army in any previous war. It is the first 
war, in fact, on record, in which disease has 
killed fewer of the combatants than were 
slain in battle. The records show that in 
the American Expeditionary Force disease 
killed only about one-third as many soldiers 
as died from battle wounds. And yet, in the 
face of all this undoubted evidence of the 
effectiveness of the methods which have been 
employed in the prevention and cure of 
disease, both in peace and war, we are con- 
fronted to-day with the extraordinary spec- 
tacle of large bodies of supposedly intelligent 
men and women who are using every effort 
to obstruct and prevent the employment of 
these methods in the control and prevention 20 
THE PHYSICIAN 
of disease, which means, in turn, the preven- 
tion and relief of untold suffering and the 
saving of countless human lives. 
“The conception that animates the mod- 
ern scientific mind at the present time, 
namely, that the cure of most diseases lies 
in the remarkable defensive and offensive 
reparative mechanism of living tissues, is of 
far-reaching importance. Under this con- 
ception the physician’s role is chiefly to sup- 
port the body in its fight against disease and 
to render every aid possible. The role of 
drugs in the practice of medicine is now a 
subsidiary one, chiefly but not wholly pal- 
liative. There are some diseases, not many, 
to be sure, which can be cured by drugs. 
Quinine in malaria and salvarsan in syphilis 
are examples. In spite of the enormous 
work that has been done, there still remain 
many problems which have, so far, baffled 
science and whose solution will be fraught 
with the greatest possible benefit for the 
human race.”* 
“To appreciate the character and extent 
of an advance made by scientific discovery, 
it is necessary to know something about the 
* Brem. See note, page 4. HISTORY OF THE PROFESSION 
21 
ideas which have been displaced or over- 
thrown by the discovery. The younger 
generation of students are in danger of for- 
getting that facts which are taught to them 
and which seem to them the simplest and 
most natural, may have cost years of pa- 
tient investigation and bitter controversy, 
and possibly have taken the place of doc- 
trines very different or even contradictory, 
which long held sway and which seemed 
to other generations equally simple and 
natural.”* Time and space will permit 
us, in passing, to refer to but one or two 
of these epoch-making events. For in- 
stance, it is difficult for us in this day and 
generation to visualize a surgical operation 
as it was performed before the days of anaes- 
thesia and antiseptics. When we read of the 
methods of performing an operation under 
the conditions which then obtained, and con- 
sider the extent and character of the opera- 
tion undertaken, it is difficult for us to de- 
termine which we admire more, the cour- 
age, dexterity, and celerity of the surgeon in 
its performance, or the wonderful fortitude 
and self-control of the patient in submitting 
* Welch. See note, page 4. 22 
THE PHYSICIAN 
to and enduring it. The introduction by 
Morton, in 1846, of general anaesthesia into 
the practice of surgery revolutionized it and 
opened wide the possibilities of surgical in- 
terference in all classes of patients. So, too, 
with the wide-reaching effect of the intro- 
duction of antiseptics, the forerunner of the 
great modern advance in the science of sur- 
gery, which dates from Lister. There are 
those still living who well remember the 
acrimonious discussions which preceded their 
general introduction into surgical practice. 
Largely as a result of these two discoveries, 
together with Virchow’s contributions, which 
laid the foundations of cellular pathology, is 
due the great development of the science of 
surgery which has taken place almost within 
a generation. 
Familiarity upon the part of the young 
physician with the biographies of the leaders 
of the profession, past and present; with the 
history of medicine and the various phases 
and vicissitudes through which it has passed 
from the earliest times to the present, will 
well repay him in every way for the time 
and effort necessary to acquire it. Nothing 
is more stimulating or helpful to the medical HISTORY OF THE PROFESSION 
23 
student than an intimate acquaintance with 
the great men whose names have added 
lustre to their chosen profession and whose 
accomplishments have done so much to re- 
lieve suffering and add to the sum total of 
human knowledge and the prolongation of 
human life. CHAPTER III 
MEDICINE AS A CALLING 
If any one contemplating the study of 
medicine would know beforehand just what 
it means, what hardships, what tests of cour- 
age and physical endurance, what insight 
into human nature, what opportunities for 
service to his fellow men, and what real joy 
and satisfaction in his work are the lot of 
the true physician, he should read that 
charming characterization of “The Country 
Doctor,” by Ian MacLaren in Beside the 
Bonnie Briar Bush. Every medical student 
should begin his professional studies by read- 
ing that wonderful tribute to a splendid 
character, Doctor MacLure, the typical 
country doctor now, owing to changing con- 
ditions in society, unhappily in danger of 
becoming extinct. The same problems, in 
a little different form; the same opportuni- 
ties, in greater or less degree, to earn the 
confidence and love of the community; the 
same intense physical and mental strain, in 
24 MEDICINE AS A CALLING 
25 
one form or another, in the service of his 
fellow men, are common to the city doctor 
as well as to his country brother, whether 
physician or surgeon, general practitioner 
or specialist. Let it be thoroughly under- 
stood at the outset that the young man or 
woman in choosing a vocation in life, who 
is looking for something easy, something 
that will afford a good social position with- 
out requiring in return the expenditure of 
any great mental or physical exertion, and 
that will at the same time yield a good in- 
come, should look elsewhere than to medi- 
cine for the fulfilment of his or her hopes, 
for it will not be found here. Success in the 
profession of medicine is achieved in one 
way only, that is, by the diligent and con- 
tinuous employment of “The Master Word,” 
which is “Work.”* 
No, there is no short cut, no royal road 
to success in the field of medicine; there is 
no such thing as medicine or surgery made 
easy. There is no trick about it that can 
be learned in a twenty-lesson course by 
watching the manual dexterity of some es- 
pecially skilful operator or listening to some 
* The Master Word in Medicine, Sir William Osier, 1903. 26 
THE PHYSICIAN 
clever charlatan vociferously declaim against 
the old accepted principles of the fathers, 
or sneer at the newer scientific or so-called 
laboratory methods. It is easy for the un- 
thinking to be led by such false prophets 
into believing that anybody can treat a 
patient or perform a surgical operation; it 
looks so easy and it seems so simple, as 
they do it. But do not be misled into the 
fatal error of supposing that that is all there 
is to it. It means a long, hard journey, 
years of close application and study, of 
mental and manual training, of observation 
and investigation in hospital, ward, and 
laboratory, before a man can acquire the 
knowledge, the experience, the insight, the 
judgment in sufficient degree to entitle him 
to the proud distinction of being rightly 
called a physician or a surgeon, and all 
that it implies. Says Valentine Mott, than 
whom were few in his day better qualified 
to judge, in speaking for surgery more par- 
ticularly (but his words apply equally to 
medicine): “We regard those as surgeons, 
and those alone, who have by conscientious 
devotion to the study of our science, and 
the daily habitual discharge of its multi- MEDICINE AS A CALLING 
27 
farious duties, acquired that knowledge 
which renders the mind of the practitioner 
serene, his judgment sound, and hands skil- 
ful, while it holds out to the patient rational 
hope of amended health and prolonged 
life.”* 
There is another side to this question. 
The inexperienced physician, owing to the 
lack of proper training and insufficient ex- 
perience, is often necessarily at fault, both 
as to his judgment and execution. He is 
attempting to do something that in the vast 
majority of cases, and for the reasons above 
mentioned, he is not competent to do. He 
is placing himself in a false position before 
the community and is laying himself open 
to charges which, in the present enlightened 
condition of the public, and certainly in 
some parts of the country, it would be diffi- 
cult for him to disprove. The thoroughly 
conscientious man will think twice and go 
very slowly before allowing himself to be 
forced into this position. He will hesitate 
long before being willing to accept the grave 
responsibilities involved—human life, the 
health and physical welfare of his patients 
* Quoted by Stephen Smith. 28 
THE PHYSICIAN 
—without thorough and adequate prepara- 
tion and training therefor. 
In order that the student of medicine may 
safely and satisfactorily survive the discour- 
agements and surmount the difficulties that 
beset his pathway throughout his entire 
career in medical school, hospital service, 
and private practice, he must have that in- 
describable something within him which is 
best defined by the good old-fashioned word 
“calling,” a calling, if you will, which exerts 
such an impelling and compelling force in his 
life that he must study medicine whether 
or no, and that would render him unhappy 
in any other association. Fortunate in- 
deed is he who is the happy possessor of 
this clear conviction as to his vocation. 
He is spared the necessity of making the 
fateful decision, so difficult for many, as to 
his life-work. To him there is no such thing 
as professional drudgery, for the spirit of 
service which inspires and controls him, 
transforms what otherwise would be toil 
and drudgery into something high and 
noble, a part of the necessary training to 
fit him for his life-work. Henceforth he has 
been set apart for a peculiar service, that MEDICINE AS A CALLING 
29 
of his fellow men. His life has been dedi- 
cated to this high purpose. It would be 
difficult to conceive of one not actuated by 
some such motive surviving the period of 
apprenticeship study and training prelim- 
inary to receiving his Doctor’s Degree, or, 
if he somehow managed to survive that or- 
deal, to suppose that he ever could experi- 
ence that feeling of genuine satisfaction and 
real enjoyment in his work which is so neces- 
sary to success. Undoubtedly there are 
some who when they enter the study of 
medicine are not inspired by the idea of 
service, but who are attracted to it by the 
opportunities which it offers for scientific 
research and study, good social position, 
and a fair pecuniary return for labor ex- 
pended, or possibly by a process of elimina- 
tion of other callings. But whatever the 
true reason may be in the beginning, the 
altruistic nature of the work of the medical 
profession is so strong that it is usually not 
long in asserting itself, and henceforth in- 
fluencing his life and work. It may be 
stated as a general proposition, however, 
that unless a young man or woman feels a 
strong impulse to study medicine, they will 30 
THE PHYSICIAN 
not be likely to succeed in it and had bet- 
ter take up something else. Personally, I 
should strongly discourage, in every way, 
the idea of studying medicine by an indi- 
vidual who is considering entering that pro- 
fession solely through a process of elimina- 
tion of other vocations. It is a curious fact 
that a doctor rarely advises his son or 
daughter to study medicine, but, on the con- 
trary, advises, even urges, frequently against 
it. One often hears some such statement 
made as this: “I couldn’t myself be happy 
doing anything else than practise medicine, 
but I wouldn’t want my son to follow in 
my footsteps.” The reason for this is not: 
dissatisfaction with his work or grumbling 
upon his part against the hardships of his 
profession, but rather a thorough apprecia- 
tion of just what those imperative profes- 
sional demands and hardships mean, and a 
natural reluctance to have a child of his sub- 
jected to the same exacting conditions that 
he himself has experienced. In spite of this 
advice, however, one sees and hears just as 
frequently expressions of satisfaction from 
the same father when, in spite of discour- 
agement and contrary advice, a son reso- MEDICINE AS A CALLING 
31 
lutely decides to follow his father’s foot- 
steps and devote his life to the practice of 
medicine. It shows how, after all, in spite 
of the hard life, irregular hours, and intense 
physical and mental strain, there is a sense 
of satisfaction that comes from the personal 
touch between physician and patient, the 
ability to render aid and comfort to a fellow 
man in sore need and dire distress, that more 
than compensates for all the disadvantages 
that come with it. 
Elsewhere I have endeavored to define 
medicine as “a profession ennobled by men 
actuated solely by their desire to devote 
their time and their talents to the relief of 
suffering humanity, willing, yes glad, at 
any time, if need be, to lay down their own 
lives for those of their fellow men; whose 
membership should embrace only men of 
singleness of purpose, unselfish, high-minded, 
zealous in their efforts to wrest from Nature 
the keys to her many mysteries; men who, 
unconsciously perhaps, in character and con- 
duct, reflect in varying degree the life and 
spirit of the Great Physician; a profession 
free from taint of commercialism or graft; 
in which there shall be no room for the base, 32 
THE PHYSICIAN 
the unscrupulous, the ignorant, or the un- 
skilled; in which the test for membership 
has to do only with character and attain- 
ment.” Are our ideals too high ? Are we 
striving after the unattainable? I do not 
think so. Unquestionably all members of 
the medical profession do not measure up to 
these requirements. But doctors are only 
human, indeed intensely so, as a class per- 
haps more human than any similar group of 
individuals, because they, from the very 
character of their work, gain such insight 
into human nature, and thus come to under- 
stand and respect it so well. This is one of 
the chief characteristics of the true doctor, 
and one of the crowning glories of a profes- 
sion, most exacting in its demands upon the 
time and talents of its members, and, at the 
same time, offering unlimited opportunities 
for usefulness in the way of service to hu- 
manity. It is this human element, this call 
to the service of his fellow men, wherein lies 
the charm that appeals so strongly to the 
true physician. The joy and satisfaction 
experienced in relieving the ills and minis- 
tering to the wants of humanity more than 
compensate him for the loss of the larger MEDICINE AS A CALLING 
33 
social and pecuniary returns that come from 
other less onerous and responsible vocations. 
The true physician is supremely happy in 
his work. He could not be happy doing 
anything else. Speaking out of his wide 
experience of the satisfaction that came to 
him in his work, Doctor E. L. Trudeau, 
himself a sufferer for most of his lifetime 
from the great “white plague,” and speak- 
ing from the standpoint of the physician, 
says: “To look about me on those whom I 
have helped in the hour of need and, even 
though in a very slight degree to have been 
instrumental in restoring many to health 
and active lives of usefulness, and to feel 
daily their gratitude and love, is a joyful 
heritage indeed, which endures in a world 
where all else passes away, and which brings 
some contentment and peace in hours of 
physical misery and discouragement.” In 
this connection consider the words of Robert 
Louis Stevenson. His long illness and the 
resulting need for medical service and his 
consequent more or less intimate association 
with medical men, render him peculiarly 
well fitted to speak from the standpoint 
of the patient. He says: “There are men 34 
THE PHYSICIAN 
and classes of men who stand above the 
common herd; the soldier, the sailor, and 
the shepherd not infrequently; the artist 
rarely; more rarely still, the clergyman; the 
physician almost as a rule. He is the flower 
(such as it is) of our civilization; and when 
that stage of man is done and only to be 
marvelled at in history, he will be thought 
to have shared as little as any in the defects 
of the period, and most notably exhibited 
the virtues of the race. Generosity he has, 
such as is possible to those who practise an 
art, never to those who drive a trade; dis- 
cretion, tested by a hundred secrets; tact, 
tried in a thousand embarrassments; and, 
what are more important, Heraclean cheer- 
fulness and courage. So that he brings air 
and cheer into the sick-room, and often 
enough, though not so often as he wishes, 
brings healing.” He does the clergymen 
an injustice, I fear. Perhaps he had been 
unfortunate in his individual experience 
with the wearers of the cloth. 
Such is the estimate, by one qualified to 
judge, of the great opportunities offered by 
the profession of medicine as a career, to a 
young man or young woman who is earnestly MEDICINE AS A CALLING 
35 
seeking to decide the all-important question 
as to what shall be his or her life-work. If 
the guiding principle is to be service of one’s 
fellow men, then the claims of medicine 
should be given careful consideration. If, 
on the other hand, money-making and social 
or political preferment are desired, one 
should look elsewhere. While a good social 
position is always assured the doctor, few 
are money-getters or succeed in politics. A 
doctor’s training and habits of life do not 
lend themselves readily to such pursuits. 
It is not our object to describe the doc- 
tor’s life either in too idealistic terms or 
paint it in too sombre colors. But the young 
man or young woman who is thinking of 
medicine as a vocation should have some 
sort of a clear conception as to what it 
means before deciding definitely whether or 
not to take it up. It is undoubtedly a hard 
life, and a very exacting one, largely because 
of the nature of the work required of the 
physician. It is generally regarded also as 
of a semi-philanthropic character, and hence 
in a different category from most other pro- 
fessions. For this reason it is not a money- 
making vocation, since mercenary motives 36 
THE PHYSICIAN 
and practices that obtain in some other pro- 
fessions are considered unethical here, and 
are frowned down in the best medical cir- 
cles. Hence it is that while the doctor and 
his family do not often lack the necessities 
of life, it not infrequently happens that they 
enjoy few of the luxuries. 
The practice of his profession, aside from 
the severe physical and nervous strain re- 
quired in a busy doctor’s daily routine, in- 
volves not a little personal danger to his own 
health or even life. How frequently does 
it not happen that the lay press or the medi- 
cal journals chronicle the death in line of 
duty of some medical man who has himself 
fallen a victim to disease contracted from a 
patient whom he was trying to save. Es- 
pecially is this true during epidemics of one 
kind or another. The recent influenza epi- 
demic was a marked illustration of this mel- 
ancholy fact. The mortality rate among 
medical men during that epidemic was truly 
appalling. Worn out by lack of rest and 
sleep, long hours and irregular meals, to say 
nothing of the strain upon their nervous 
vitality, their resistance lowered, many fell 
an easy prey to this dreaded disease. In MEDICINE AS A CALLING 
37 
addition to all these causes predisposing to 
infection, the very nature of their calling 
brings them constantly and continuously in- 
to close contact with contagions of varying 
grades of virulence. Happily, nowadays the 
dangers from this source are not nearly so 
great as formerly, thanks to a better under- 
standing of the life history of the various 
infectious agencies and the usual avenues 
through which contagion is transmitted, 
more effective methods of disinfection of ex- 
creta, etc., and more rigid antiseptic technic. 
But even so, and in spite of the advances 
made in recent years, the doctor must of 
necessity be more exposed than any other 
individual to the contraction of diseases of 
one sort or another, and he should weigh 
well this fact before undertaking the study 
of medicine as his life-work, for, once he has 
put his hand to the plough, it is too late to 
turn back. The truly conscientious physi- 
cian cannot stop to think of himself, or of 
the risks involved to his own life. He need 
not be foolhardy, nor recklessly disregard 
the ordinary precautions dictated by pru- 
dence and common sense, but there are oc- 
casions that come to every physician when 38 
THE PHYSICIAN 
the best interests of his patient, some sud- 
den emergency perhaps, some desperate 
chance to save a life, may require the utter 
forgetfulness of self and an abandonment of 
every consideration, save the paramount one 
of the patient’s welfare. When such tests 
come, and they do come sooner or later to 
every doctor, it is the glory of the profes- 
sion that few of its members are found 
wanting. Hence it is that the average life 
of the doctor is less than that of the other 
professions by a considerable amount. But 
what of that ? Better a short life and a busy 
one, crowded full of service to one’s fellow 
men, than a long one of comparative idle- 
ness and unproductiveness. The doctor’s 
family is often more in need of sympathy 
than himself. He is busy, and, if he is a 
true physician, he will be absorbed and 
happy in his work, no matter how strenuous 
it may be. He soon gets used to his irreg- 
ular mode of living. He learns to get along 
with little sleep, but his digestion sooner or 
later suffers. He frequently acquires the 
traditional gastric neurosis (most doctors 
acquire it) and, doctor-like, worries himself 
sick over it. Not infrequently, sub-rosa, he MEDICINE AS A CALLING 
39 
tries a lot of silly remedies that he would 
not recommend to his patients and would 
be ashamed to have them or his professional 
brethren know that he had tried. Yes, a 
doctor makes a poor but very human pa- 
tient; he is always thinking of the “ maybes.” 
He knows enough to appreciate just how 
little at times an honest doctor knows about 
disease, its causes and treatment. The pos- 
sibilities, not the probabilities, command his 
attention. Then, too, he is not a little in- 
fluenced in this respect by the wide-spread 
belief among members of the profession, 
that if anything out of the ordinary is going 
to happen it is very apt to happen in the 
person of a doctor or a member of his im- 
mediate family. Remarkable instances of 
this are familiar to every physician. So it 
is that the doctor’s family, especially his 
wife, has a pretty hard time. She has to 
bear the brunt of the irregularities and the 
vagaries, both of his private and professional 
life, unless he is fortunate enough to be able 
to afford a secretary, and not infrequently, 
even if he is, the wife has to listen to the 
tales of woe of his women patients over the 
telephone, in market, at afternoon teas, and 40 
THE PHYSICIAN 
elsewhere. The endless details of the sub- 
jective symptoms of the psychoneurotic are 
retailed to her and not infrequently is she 
called upon to advise when the aid of the 
family doctor is sought in the complications 
that occasionally arise in domestic affairs. 
In this latter trying situation the wise doc- 
tor will soon come to hold in high regard 
the advice and practical suggestions of his 
wife, if she is the proper sort. 
The doctor is indeed fortunate whose 
wife is able to adapt herself to his profes- 
sion, for much of his success will not infre- 
quently depend upon her social and business 
qualities, her womanly intuition, good com- 
mon sense, and the ability to control her 
tongue. There is nothing quite so fatal to 
a young doctor’s prospects as to have his 
wife discuss the maladies of his women pa- 
tients at an afternoon tea or over a game 
of bridge. Most offenses may be forgiven, 
but this one never. The patient herself 
may, and not infrequently does, delight 
(such is human nature) in discussing in de- 
tail her physical infirmities and the number 
and character of her previous operations, and 
in enumerating the particular parts of her MEDICINE AS A CALLING 
41 
anatomy that she has lost at the hands of 
the surgeon. But for the surgeon’s wife 
to trespass upon her prerogative and impart 
any “inside information,” is an unpardon- 
able breach of professional etiquette. 
It is a curious fact and one often com- 
mented upon that if a doctor has himself 
been the victim of a certain malady, forever 
afterward is he more particularly interested 
in that affection, and more sympathetic 
toward any one so afflicted. It is a rather 
fortunate thing, therefore, for a medical 
man to have had some personal experi- 
ence with illness, to have himself felt pain. 
From the standpoint of his patient’s com- 
fort and care, there can be no doubt of this. 
There is a sort of fellow-feeling established 
at once between the patient and the doctor 
who has been through the same thing. In 
this scientific age the tendency is to make 
light of such things, to look at disease as a 
problem and the patient as a thing. The 
former is all very well, but the latter is to 
be decried in every way. Unless a doctor 
comes to look at every patient as an indi- 
vidual being, a problem, if you will, but 
never to lose his personal identity, he will 42 
THE PHYSICIAN 
miss that delightfully intimate relation- 
ship existing between the true doctor and 
his patient. Through this intimate rela- 
tionship does a doctor come really to know 
and thoroughly understand his patient. 
We smile nowadays when the expression is 
used, which was so commonly heard when 
speaking of the old family doctor, “He 
knows his patient’s constitution,” because 
he had treated that family for years. But 
there is not infrequently a great deal in it, 
especially if, in addition to the knowledge 
obtained of the physical and hereditary 
traits of a certain individual or family, one 
has acquired an insight into the character 
and knows the workings of his mental proc- 
esses and his spiritual aspirations. The 
family doctor is, indeed, in a position to 
help that individual as no stranger possibly 
could. The young practitioner should early 
cultivate the faculty of getting to know his 
patient, of gaining his confidence, of making 
him feel that he, at any rate, is interested 
in him. All this presupposes that upon his 
part, as his personal physician and con- 
fidant, he is fitted by training and knowledge 
to give him proper professional advice, and MEDICINE AS A CALLING 
43 
in addition by character and human under- 
standing to prove himself a true friend, 
competent and worthy to advise him in 
other matters not strictly medical and not 
infrequently extremely complex. 
Barker has pointed out in a recent admir- 
able address how every physician needs to 
engage in some activities that merge his 
own private interests in those of the social 
order. “When,” says he, “deciding what 
to do and how to do it, there is no better 
guide than an intelligent grasp of the gen- 
eral social process, for that is most worth 
doing which most advances this process. 
Those physicians will do most to promote 
the general advance who first do the best 
practical-technical work of which they are 
capable, and secondly, exert their influence, 
whenever possible, toward better organiza- 
tion of society as a whole.” Then he pro- 
ceeds to give a list of some of the activities 
to which a doctor should naturally, in the 
course of his professional routine, give some 
time and thought, mentioning especially the 
promotion of the interest of all in health, 
wealth, sociability, knowledge, beauty, and 
right conduct. He sums it all up in this 44 
THE PHYSICIAN 
significant statement: “That physician who 
does the most intelligently to promote the 
development, the harmonious readjustment 
and the fulfilment of human desires in ways 
suited to the social situation of his time 
exerts the best and widest influence.” 
It is a rather interesting fact that medicine 
seems to be a pretty good training for other 
careers. A goodly number of doctors have 
attained eminence in other walks of life. It 
is a fair question, of course, just how much 
their medical training had to do with their 
success along these lines. “Post hoc ergo 
propter hoc” is not always acceptable as 
sound reasoning, but the fact remains that, 
especially along literary lines, the list of 
names of medical men who have become 
famous is a long one. It is not necessary 
to mention them, as the reader will readily 
recall a considerable number of such, both 
living and dead. It is also true in public 
life that many men trained as physicians 
have subsequently developed into excellent 
administrators, executives, and politicians. 
This is not to be wondered at, perhaps, 
when one considers that a doctor’s training 
and work bring him into such intimate MEDICINE AS A CALLING 
45 
contact and relationship with people that 
his special opportunity to study and know 
his fellow man gives him a point of view 
that is, as a rule, broader, less hypercritical, 
more sane and human, than that of any 
other class of individuals. Since literature 
is more particularly a mirror or record of 
human emotions and behavior, it is not sur- 
prising that doctors should shine in this 
particular field, and it is this very human 
quality, so prominently and faithfully por- 
trayed in the doctors’ writings, that gives 
the especial charm characteristic of many of 
their works. One has but to consider for a 
moment the style and subject-matter of the 
writings of Oliver Wendell Holmes, Weir 
Mitchell, Conan Doyle, and Sir William 
Osier for substantiation of this general 
statement. CHAPTER IV 
THE PROBLEM OF DISEASE 
“ Disease looms large in history and has 
been an ever-present foe of man. Into 
every ramification of life the insidious enemy 
thrusts its way. Its influence is reflected 
in language and literature, in daily forms 
of greeting and conversation, and in many 
of the institutions of mankind. Every fam- 
ily has its individual problems in the fight, 
and the aggregate of thought and effort 
stimulated and expended against it is in- 
conceivably enormous.”* 
In seeking for the answer to the question 
as to the cause and cure for disease, many 
varieties of philosophical and other theories 
have been evolved from time to time. For 
ages the idea that disease was a supernatural 
visitation dominated all others, and charms 
and incantations were used for its preven- 
tion and cure. Hippocrates was the first 
to break away from this belief. By using in- 
* Brem. Unpublished paper* 
46 THE PROBLEM OF DISEASE 
47 
ductive methods of observation and reason- 
ing, he came to the conclusion that disease 
was a natural phenomenon. But his teach- 
ings did not long prevail and they were 
finally smothered by the ignorance and su- 
perstition of the dark ages. For seventeen 
centuries no real advance was made in our 
knowledge of the causes or control of dis- 
ease. During this period the field of medi- 
cine was dominated by the priests and 
monks, and medical practice, other than by 
prayer and incantations, was forbidden by 
the church. Then blossomed forth and 
flourished healing cults galore, “beside which 
all our modern attempts are but feeble im- 
itations.” 
But with the renaissance, the smoulder- 
ing fires of scientific medicine were rekindled 
by Vesalius and began again to glow through 
the darkness. The era of the experimental 
method was ushered in, and all phases of 
scientific investigation received a tremendous 
stimulus when, about 1600 A. D., the phi- 
losopher, Francis Bacon, lord chancellor 
of England, formulated the principle of in- 
ductive reasoning. This may be considered 
the beginning of the modern contribution 48 
THE PHYSICIAN 
to civilization. Through observation of nat- 
ural phenomena and ingenious experimen- 
tation, the careful collecting, recording, and 
classifying of facts and reasoning induc- 
tively from the facts, an enormous growth 
of all phases of knowledge has taken place 
since Bacon’s time. Research workers in 
every branch of science began to apply con- 
scientiously and systematically the prin- 
ciple of study formulated, and the results 
reached their culmination only since the 
middle of the last century, during the life- 
time of men now living. 
Medical science has shared not the least 
in this general enlightenment, and its ad- 
vancement has been due to the same meth- 
ods as those of the astronomers, the mathe- 
maticians, the physicists, the chemists, and 
the other scientists. The result has been 
that the causes of disease have been largely 
uncovered, they have been removed from 
the realm of the supernatural, and can now 
be definitely placed in philosophy beside 
other natural phenomena. 
“The flickering flame of the early renais- 
sance has since been fed by an enormous 
body of knowledge, and the flame has grown THE PROBLEM OF DISEASE 
49 
into a veritable sun illuminating and puri- 
fying the darkest places of the earth. Re- 
actionary cults and pseudo-scientific bodies, 
remnants of a superstitious past and para- 
sitic growths of present greed can cast but 
temporary shadows over the minds of cer- 
tain credulous groups of men. The sun of 
true science cannot again be quenched but 
will continue to shine with undimmed light 
and undiminished heat.”* 
From a study of conditions past and 
present, we must conclude that disease is an 
antagonist of man that has stimulated his 
activities throughout the ages, and that the 
causes of disease are enormous, insidious 
forces whose unrelenting and pitiless at- 
tacks will continue to harass and discipline 
man until his intellectual, social, and spiri- 
tual faculties shall have developed to such 
a degree that he can overcome these enemies, 
as primitive man finally overcame the more 
obvious enemies that endangered his life. 
The problems unfolded for to-day are suffi- 
ciently difficult to test the mettle of an ad- 
vanced civilization. Take for example, the 
control of tuberculosis. It involves stu- 
pendous questions of sociology, govern- 
* Brem. 50 
THE PHYSICIAN 
ment, and finance. It is a problem to tax 
the highest intellectual faculties of man, 
and its solution requires a high degree of 
intelligence, energy, and unselfishness on 
the part of individuals and communities, 
and a thorough system of education. Many 
similar problems are awaiting solution. 
‘ ‘ The knowledge of the causes and means of 
prevention of disease that has been acquired 
during the past fifty years is greater than 
was the sum of all such previous knowledge, 
and not yet has there been time for it to 
diffuse through the minds of the masses 
sufficiently to become crystallized into laws 
of health. But this diffusion through edu- 
cation must take place before a very suc- 
cessful war against the insidious enemies 
can be waged. Behind the laws of health 
there must be an educated and intelligent 
public.”* 
The medical profession has to do with 
these problems. Their study and solution 
offer to young men and young women a 
challenge to the imagination, and an incen- 
tive to engage the attention of the best 
minds among them. 
Scientific medicine represents a mass of 
* Brem. THE PROBLEM OF DISEASE 
51 
knowledge, the principal facts of which can 
only be gained by prolonged study on the 
part of those whose minds have been well 
trained already by adequate preparatory 
preparation. The profession, as it is to-day, 
is far from a perfected profession. It has 
its proportion of human incompetents and 
of members with inadequate training and sel- 
fish motives. But even now the duration 
of training is longer than that in any other 
profession or trade, and the average effi- 
ciency, considering the difficulties encoun- 
tered, is extremely high. A constant effort 
is being made to improve the educational 
standards and to supply better doctors to 
the community. 
“The regular medical profession claims, 
therefore, the right to the trusteeship of the 
health of the community by virtue of the 
fact that it has evolved out of the past and 
has toiled to master and to add to the mass 
of knowledge accumulated by its fathers. 
It claims the privilege and honor of serving, 
by virtue of the altruism which it has gained 
through contact with suffering and through 
the rich heritage of the Christian attitude 
toward those in distress, a heritage which is 52 
THE PHYSICIAN 
woven inextricably into the spirit of the pro- 
fession. It claims a just remuneration for 
its services from those who are able to return 
payment. For the laborer is worthy of his 
hire, and it is the spirit of the age that a man 
shall be self-supporting. And lastly it claims 
legal protection of the healing art, for such 
protection is necessary to maintain the ele- 
vation of medical standards and to protect 
the community from reactionary cults and 
from individual and organized quackery.” * 
The medical profession is not a “school” 
of medicine. It is a vast protective force, 
an army organized and recruited for com- 
bat with disease and for the preservation 
and restoration of health. It asks no favors 
of the public, whom it aims to serve. It 
seeks no personal benefit, indeed it is con- 
stantly working against its own professional 
interests, to limit the spread and activity 
of disease. All that it does ask, and it asks 
it as a right, not as a favor, is that it should 
be allowed to minister to the needs of the 
public along well-established lines, unham- 
pered by foolish and reactionary cults and 
the various societies of the “antis.” 
* Brem. CHAPTER V 
REQUISITES FOR SUCCESS IN A 
PHYSICIAN 
Happily the gold-headed cane, the high 
hat and frock coat, the professional manner 
and the fine equipage are things of the past 
as necessary adjuncts to and as indices of 
the professional standing of the doctor. To 
be sure, even in this enlightened day and gen- 
eration they or their substitutes, the limou- 
sine and liveried chauffeur and office-boy, 
and the officious secretary or business agent 
are affected by a certain class of the profes- 
sion. It is a most impressive, at times even 
oppressive, gauntlet that the patient must 
run before being ushered into the presence 
of the “great” doctor. Unfortunately it is 
true that these external factors do carry 
some weight with a certain class of the pub- 
lic, that particular group referred to by Mr. 
Lincoln as those “who can be fooled all the 
time,” and who really seem to like it. These 
mannerisms and external appearances of 
53 54 
THE PHYSICIAN 
prosperity, cultivated for their effect upon 
the gullible portion of the public, are now 
looked upon as part of the stock in trade of 
the charlatan and quack, the badge rather 
of the prosperous medical fakir than of the 
educated physician. External appearances, 
on the other hand, should not be disregarded 
by the physician any more than by any other 
profession or class of society, indeed from 
the circumstances surrounding their con- 
tact with their patients and the conditions 
required by their professional activities, 
doctors of all people should be none the less 
scrupulous in their personal habits and ap- 
pearance than they are in their professional 
conduct and technic. No patient, whose 
sensibilities, by the very fact of his or her 
particular malady, may be overwrought and 
overactive, wants a physician to enter the 
sick-room unclean either in body or in linen, 
untidy in appearance, unshaven or unshorn, 
his person and his clothing reeking with the 
odor of stale tobacco smoke, onions, whiskey, 
or what-not. These things may seem, per- 
haps, too trivial to mention, but be assured 
they are not. The patient, from the very 
fact of being ill, is, for the time being, an REQUISITES FOR SUCCESS 
55 
abnormal individual, irritable and hyper- 
sensitive, and should be treated with every 
consideration consistent with the proper 
management of his case, and his feelings 
and sensibilities should not be in any way 
unduly offended. 
The personality of the physician is a qual- 
ity which it would be hard to overestimate 
in its far-reaching effect upon the patient. 
It is more evident in the relation that exists 
between the general practitioner and his 
patients, perhaps, than in the case of the 
specialist, from the more intimate character 
of the former, but its effect is quite generally 
evident one way or another in every case. 
With the exception, possibly, of the ministry, 
the relationship between the professional 
man and his client in all other professions 
is largely on a business basis. Their prob- 
lems primarily concern things. Incidentally 
individuals may be affected thereby. But 
the problems of the physician have an in- 
timately personal application. The entire 
energy of the whole medical profession is 
concentrated with an intensity of purpose 
that is truly remarkable upon the study of 
disease, as it manifests itself in the human 56 
THE PHYSICIAN 
body, its cause and effect and its cure. In 
order to do this and to get at all the facts, 
the individual must stand before his doctor, 
man to man, unclothed physically, mentally, 
and morally, revealing to him as he does to 
no other mortal, not even his father con- 
fessor, the secrets of his inmost soul; sub- 
mitting his person to the most thorough 
scrutiny of the physician and to varied tests, 
physical, clinical, instrumental, and what- 
not, and without hesitation committing to 
his keeping the keys of the family-skeleton 
closet, often with intense relief in sharing 
the responsibility with another or in shift- 
ing the burden to his shoulders. Is it any 
wonder, then, that the relationship existing 
between the doctor and his patient should 
differ essentially from that of any other pro- 
fession, and that the doctor of all others 
should possess certain definite qualities of 
mind, heart, and character that inspire in 
his patients that implicit confidence so nec- 
essary, in order that the highest possibilities 
of the profession may be attained ? 
The qualities, then, requisite to success in 
a physician are already indicated in what 
has just been said. Integrity, intelligence, REQUISITES FOR SUCCESS 
57 
industry—these three are fundamental to 
success in medicine, as well as in any other 
walk of life. Add to these certain char- 
acteristics of greater or less importance, such 
as a pleasing personality, tact, patience, love 
of his fellow man, and one’s success in his 
chosen profession is assured. 
It may reasonably be asked just what 
constitutes success in the profession of medi- 
cine. A good many factors enter into it, 
and much depends upon one’s point of 
view. No definition will be universally ac- 
ceptable. If we begin with the main con- 
sideration and look at it from that point of 
view, we may, perhaps, be the better able 
to weigh the question fairly. What, then, 
is the real reason for the existence of the 
doctor ? It will be generally admitted that 
the chief function of the medical man is to 
“take care of sick people.” Everything 
else is secondary to this general proposition. 
Some may object to this and claim that 
it is better to prevent people from getting 
sick than to try to cure them after they 
have become so. Ready assent will be 
given to this objection. But in order to 
arrive anywhere, one must deal with con- 58 
THE PHYSICIAN 
ditions as they actually are. From the very 
nature of the construction of the human 
body and the physical forces that surround 
and control it, disease and decay are inevi- 
table. One can look forward, then, with 
confidence to the fact that, at least for some 
time to come, the paramount issue in medi- 
cine will be the care of the sick. Preventive 
medicine has made enormous strides in re- 
cent years, witness the limitation and con- 
trol of certain diseases and the practical 
stamping out and eradication of others, with 
the consequent very material prolongation 
of the average length of human life. Far 
greater progress in this direction is to be 
confidently expected in the future as a re- 
sult of the investigations and study con- 
stantly going on in hospital ward and labora- 
tory and in endowed institutions specially 
adapted for research. Nevertheless, the 
vital processes in many directions are lim- 
ited, and in the nature of things it is utterly 
unreasonable to look forward to the discov- 
ery of that fountain of perpetual youth so 
eagerly sought after by Ponce de Leon and 
many other sanguine spirits since his time. 
One of the important departments in medi- REQUISITES FOR SUCCESS 
59 
cine will always be the study of methods of 
prevention of disease; this goes hand in 
hand with cure. What the physician is un- 
able to prevent, he must endeavor, with all 
the forces at his command, to cure. But in 
order to hope to accomplish anything that is 
at all worth while in either of these direc- 
tions, certain very necessary conditions 
must be fulfilled. Chief of these are a study 
of the phenomena of health and disease and 
the laws that govern each, in order that 
each may be recognized and correlated, and 
the one distinguished from the other—hence 
the prime importance of a thorough ground- 
ing in the fundamentals of the allied sci- 
ences of chemistry, physics, biology, physi- 
ology, pathology, bacteriology, and so on, 
before taking up the study of the cause and 
treatment of disease, for without at least a 
fair working knowledge of these various 
subjects many of the phenomena of disease 
will neither be recognized nor understood. 
First, then, of the requisites in a physi- 
cian, we would put integrity of character, 
worthiness to be trusted under all the try- 
ing circumstances that are inseparably con- 
nected with the practice of medicine in all 60 
THE PHYSICIAN 
of its branches. Especially is this true in 
relation to his women patients, from the very 
nature of the case of such an intimate and 
confidential nature. A doctor should so con- 
duct himself at all times in his professional 
as well as his other relationships that he, like 
Caesar’s wife, shall ever be above suspicion. 
And be it said to the great credit of the pro- 
fession, the great mass of the profession has 
lived up to its responsibilities and proved 
itself worthy of the trust so fully and freely 
bestowed upon it. It is rare, indeed, to 
hear of an educated, reputable physician who 
has so far forgotten himself as to take ad- 
vantage of the opportunities offered by his 
profession to disgrace himself and cast dis- 
credit upon it. 
It is a curious fact, which throws an inter- 
esting sidelight upon human nature, that a 
doctor, especially the family doctor, is con- 
sulted by his patients about many matters 
other than those pertaining strictly to health. 
It is quite essential, then, that the medical 
man should be well informed along general 
lines, as he will not infrequently find such 
knowledge most useful. Frequently in the 
answers given to questions and the advice REQUISITES FOR SUCCESS 
61 
offered, the exercise of great tact and diplo- 
macy are required. 
In general it may be said that a physician 
should, from the beginning of his pre- 
medical education, cultivate the power of 
observation of facts, both great and small, 
no matter how trivial they may appear at 
the time. He should by all means be a 
good observer, otherwise he may fail to 
grasp some essential detail or to note some 
symptom that may be the key to the solu- 
tion of the problem that is presented to him. 
Accurate observation, careful and pains- 
taking record of facts observed, thoughtful 
and thorough analysis of the data accumu- 
lated, correct reasoning and ability to draw 
proper deductions therefrom, and then the 
faculty of initiative and the confidence to 
undertake the measures of relief indicated— 
all are fundamental factors in the doctor’s 
success. CHAPTER VI 
QUALIFICATIONS FOR THE STUDY 
OF MEDICINE 
It is interesting to note that Hippocrates 
laid down the following qualifications as 
necessary in one who would undertake the 
study of medicine: “Whoever is to acquire 
a competent knowledge of medicine ought 
to be possessed of the following advantages 
—a natural disposition; instruction; a favor- 
able position for the study; early tuition; 
love of labor; leisure. First of all, a natural 
talent is required, for when nature opposes, 
everything else is vain; but when nature 
leads the way to what is most excellent, in- 
struction in the art takes place, which the 
student must try to appropriate to himself 
by reflection, becoming an early pupil in a 
place well adapted for instruction. He must 
also bring to the task a love of labor and 
perseverance, so that the instruction taking 
root may bring forth proper and abundant 
fruits.” 
62 QUALIFICATIONS FOR STUDY 
63 
To the man about to enter upon the study 
of medicine, or to the medical student, the 
fundamental aims of medicine should be 
made very clear, and they should likewise 
ever be kept in view by the practitioner. 
As handed down by the fathers from the 
best traditions of the guild and practised by 
the best element in the profession, its chief 
aims are the relief of suffering, the study and 
cure of disease, and the advancement of 
knowledge. In return for these services, 
the financial rewards should afford a decent 
living income for the doctor and his family, 
but the standards should be such that the 
altruistic nature of their profession should 
never be lost sight of by its members. The 
attention of all physicians worthy of the 
name is, therefore, to be directed at all times 
toward the service of their fellow men rather 
than the making of money. Hence it is 
that the tendency of some to demand exces- 
sive fees in return for their professional ser- 
vices, no matter how valuable, should be 
discouraged as savoring of commercialism 
and tending to discredit the entire profes- 
sion. 
In contemplating the study of medicine 64 
THE PHYSICIAN 
as a life-work, what principles should guide 
one in determining upon a choice? What 
is to be the basis of the selection ? Is it to 
be material gain, the acquisition of social 
position or political power, of fame or for- 
tune, or is it simply the desire to do good, 
to be of some real service to one’s fellow 
men ? This does not imply that one cannot 
render some service to humanity by the 
exercise, in a proper way, of any or all of 
the other properties just mentioned. Many 
marked instances can be related where in- 
dividuals possessed of some one or other of 
these endowments have used them for the 
greatest benefit to humanity. But they are 
exceptional cases. Unfortunately, for some 
reason or other, they are not, as a rule, 
closely associated in the public mind with 
altruistic motives or deeds. On the con- 
trary, the profession of medicine, along with 
those, perhaps, of teaching and the ministry, 
is especially associated with the idea of ser- 
vice, without hope of any great material 
reward, but only the reasonable expectation 
of a good social position for one’s family, a 
fair compensation in return for hard and 
faithful service, and a feeling of intense QUALIFICATIONS FOR STUDY 
65 
satisfaction that only he who has experi- 
enced it can fully know, that comes from 
personal touch with those who have felt 
both the need and the comfort, physical and 
mental, that comes from service rendered 
and received. The first thing, then, to be 
done is to decide just what one wishes to do 
with one’s life; how one shall use his one 
or his ten talents; what shall be the motive 
dominating his course of action; what shall 
be his goal. Having finally made this, the 
most momentous decision of all, the rest is 
comparatively easy. In making this de- 
cision there are several factors to be care- 
fully considered. 
In the first place, the life of a successful 
doctor is a hard one. He is not his own 
master; he belongs to the public. His own 
and his family’s interests must ever be 
secondary to those of his patients. His 
time is not his own. He can never be 
sure of keeping any but his professional en- 
gagements. His hours are very irregular. 
His meals are interrupted and delayed, and 
not infrequently missed altogether. His 
rest is disturbed and broken. He is sent 
for at all hours of the day and night, fre- 66 
THE PHYSICIAN 
quently entirely unnecessarily, by an alarmed 
patient or by some over-anxious or over- 
zealous member of the family. 
In the early years of his practice the writ- 
er, one cold, snowy winter night was called 
on the telephone by an anxious young 
mother, who wished him to come at once to 
see her three-months-old baby, about whom 
she was much worried. Owing to the ex- 
cited condition of the mother, no very satis- 
factory idea as to the actual condition of the 
child could be obtained over the telephone. 
So rather reluctantly, because convinced 
that there was no reason for his visit other 
than to reassure an over-anxious mother, he 
proceeded to dress and respond to her call. 
As it was before the days of automobiles, 
and the street-cars had stopped running at 
midnight, it was necessary to walk through 
the snow and bitter cold a half-mile or more 
to the home of the little patient. Having 
finally reached his destination, and having 
been ushered into the bedchamber and 
finding the baby sleeping peacefully as a 
healthy infant of that age usually does, he 
inquired of the mother, now somewhat more 
composed than when conversing over the QUALIFICATIONS FOR STUDY 
67 
telephone, just what she thought was wrong 
with the baby and why she had sent for 
him. Her reply was that indeed she did 
not know whether or not there was any- 
thing wrong with the baby, but it had cried 
very hard for quite a while after its last 
feeding, and then had stopped so suddenly 
and gone to sleep and had slept so soundly 
ever since that she thought there surely 
must be something the matter with it. 
What could one say or do under such cir- 
cumstances but reassure the young mother 
that her babe was happily over an attack 
of colic, a common but not serious malady, 
and trudge back through the cold and snow 
to one’s bed, musing over the eccentricities 
and vagaries of human nature and the vicis- 
situdes of a doctor’s life ? 
Unless a man is willing to sacrifice his own 
comfort and his own interest to those, fan- 
cied or real, of another, he has no business 
in the practice of medicine. “If then,” 
some one will ask, “medicine is such a hard 
life and its practice makes so many and such 
insistent demands upon one’s time and one’s 
strength of mind and body, why is it that 
any one is willing to take it up and submit 68 
THE PHYSICIAN 
to all the hardships entailed?” For an 
answer to this question, one must hark back 
to the impelling motive in one’s life. If it 
is love of his fellow men, willingness to 
serve, then none but a life of service such 
as is offered in the practice of medicine will 
suffice. He must take up something that 
offers the opportunity to get close to his 
fellow; to study his needs; to give him a 
helping hand when he most needs it; to 
assist him to his feet again after he has 
fallen; to encourage him when down-hearted; 
and to send him on his way rejoicing with a 
word of hope and cheer. All this and more 
is offered to the true physician in the prac- 
tice of his profession. His opportunities for 
doing good are limited only by his physical 
ability and his willingness to avail himself 
thereof. But in order to help him over the 
rough places, for there are many of them, 
both in the period of preparation in medical 
school and hospital as well as in practice, 
the medical student must have that some- 
thing within him, that impelling and com- 
pelling force, call it what you will, that 
makes it necessary for him to study medi- 
cine and would render him utterly unhappy QUALIFICATIONS FOR STUDY 
69 
and wretched doing anything else. Given 
this dynamic force—this love of one’s fellow 
man, this desire for service—all hard things 
are rendered easy and the rough places 
smooth. Drudgery is transformed into op- 
portunity by the spirit of service, and the 
self-denial and hardship, and the great re- 
sponsibilities so inseparable from a doctor’s 
life become the crowning glory of his pro- 
fession. The real man does not want an 
easy job; he rejoices in difficulties to be 
overcome; in problems to be solved; they 
but add zest to his efforts. The doctor, 
especially the general practitioner in the 
rural districts, is apt to be a real man. He 
must be, the very nature of his work and the 
demands made upon him tend to develop 
the best that is in him and go to make him 
resourceful and self-reliant. 
But great as are the demands of his pro- 
fession upon the physical resources of the 
true doctor, those made upon his mental 
and spiritual forces are greater still. Par- 
ticularly is this true of surgery. Here, in 
truth and in deed, does the surgeon hold the 
life of his patient in his hand, and no one 
appreciates the full significance of this re- 70 
THE PHYSICIAN 
sponsibility quite so well as the honest, 
conscientious surgeon. Loss of sleep, broken 
rest, irregular meals, long hours, all have 
their effect sooner or later in impaired di- 
gestion, premature gray hair, a disturbed 
nervous system, shortened life. But few, 
comparatively, are disabled by hard work. 
Overwork as such has a low mortality rate. 
It is worry and responsibility that kill. 
The feeling of responsibility is very great, 
in the first place, in the matter of decision. 
What is the proper thing to do in this par- 
ticular case, to operate or not to operate? 
If the former, what form should the oper- 
ation take, simple or palliative, or radical 
and capital? Then in the matter of tech- 
nical execution of the operation, which of 
several methods should be employed ? 
Then, am I capable of doing this particular 
operation in the way I know it should be 
done, or, in justice to the patient, ought I 
to refer him to another and more competent 
surgeon ? Then after the operation is done 
and over, and, for some reason or other, 
the patient isn’t doing as well as he might, 
one begins to get a bit worried and to go 
over the operation in his mind step by step, QUALIFICATIONS FOR STUDY 
71 
in order to find some possible explanation 
for existing conditions. These disquieting 
thoughts come to every conscientious sur- 
geon to disturb his rest and cause untold 
worry. Happy and fortunate indeed is that 
surgeon or medical man who does not take 
his cases to bed with him, but who can, 
when he lies down to sleep, drop his worries 
for the night and take them up the next 
morning where he left off. Many times, 
of course, these anxieties do not arise, 
as fortunately nowadays surgical skill and 
technic have reached such a high stage of 
development that one approaches a surgical 
operation with far more confidence and as- 
surance than formerly. But even so, when 
one is dealing with human life, as a medical 
man constantly is, one comes to appreciate 
the absolute necessity for attention to every 
detail in technic, the slightest infraction of 
which may at times be fraught with the 
most serious consequences. When one is 
dealing with dollars and cents, as is the case 
in a business venture, or where it is some 
other commodity, as is the case in almost 
every other walk in life except medicine, 
one may entertain a reasonable hope to re- 72 
THE PHYSICIAN 
coup on some succeeding venture what one 
may have lost in the preceding one. But 
when a mistake is made in medicine and 
surgery, who pays the price, sometimes with 
a life? No, in dealing with matters per- 
taining to human life, or even human health 
and happiness, there may be, and not in- 
frequently is, no comeback. Small wonder, 
then, that the doctor’s worries and responsi- 
bilities are different from those of others, and 
more far-reaching in their effect than ordi- 
nary ones. Here is where the quality of equa- 
nimity, so indispensable in a doctor, shines 
forth so resplendently as it does in the person 
and character of certain members of the pro- 
fession that one has known, both living and 
dead. It is a quality to be cultivated beyond 
all else, a jewel without price, the possession 
of which will do more to make a doctor’s 
life complete and bearable than any other 
quality he can possess. Fortunate indeed is 
the happy possessor of it in full measure. 
Of late years there has been brought 
about, also, a great increase in the require- 
ments for preliminary medical training. 
This fact has introduced another element 
of difficulty into the case. This is due QUALIFICATIONS FOR STUDY 
73 
almost entirely, as pointed out by Doctor 
Welch, to the fact that the college curricula 
in this country have developed and expan- 
ded with little regard to the needs of medi- 
cal education. It becomes, therefore, with 
a few notable exceptions, a matter of in- 
creasing difficulty to couple up with any 
great degree of logical sequence the respec- 
tive curricula of the colleges and the medi- 
cal schools. This is especially emphasized 
in the scientific branches by the great im- 
provement in the laboratories. “Nothing 
could be more remarkable than the develop- 
ment of laboratory work in connection with 
our medical schools during the last quarter 
of a century. Probably in our stronger 
medical schools, that development has gone 
about as far as it can go, and it would be 
unreasonable to expect more time to be 
devoted to it than is now given.”* 
The report of the Council on Medical 
Education and Hospitals, made at the an- 
nual meeting of the American Medical As- 
sociation held in Boston, June, 1921, con- 
tains much information interesting to the 
prospective medical student. Some of the 
* Welch. 74 
THE PHYSICIAN 
more important practical points contained 
therein are here summarized: The advance- 
ment in modern medicine during the last 
forty years has been so great in both the 
diagnosis and treatment of disease that the 
practice of medicine has been revolutionized. 
Forty years ago the practice of medicine was 
a comparatively simple matter. A general 
practitioner with good training, and with 
little in the way of instruments and equip- 
ment, such as he could carry about with him 
from house to house in his saddle-bags or 
in his doctor’s buggy, could give to his pa- 
tients the benefit of the medical knowledge 
of his time. To-day the practice of scien- 
tific medicine requires much more. It re- 
quires the services not only of the general 
practitioner but also of specialists trained 
in limited fields of diagnosis and therapy. 
It requires extensive plants, equipment, 
and appliances, clinical laboratory facilities, 
X-ray laboratory facilities, and equipment 
for employing diagnostic and therapeutic 
measures in the office, in the clinic, and in 
the hospital. It requires an extensive pub- 
lic-health organization to secure the bene- 
fits of preventive medicine. QUALIFICATIONS FOR STUDY 
75 
There are really two classes of medical 
men—the product of this complex scheme— 
the general practitioner and the specialist. 
The general practitioner is, and probably will 
always remain, the most important single 
factor in the practice of medicine. As a nec- 
essary corollary, then, the most important 
function of our medical schools is to train 
well-qualified general practitioners. Every 
other function must be held subservient to 
this. The specialist is, or should be, a later 
and more highly developed product of the 
graduate department. The more widely and 
deeply are the foundations laid in the allied 
sciences and the fundamentals of medicine, 
the higher and better can the superstructure 
of specialism be built upon them. It is an 
open question whether or not our modern 
medical schools are doing the best by their 
students. Formerly the clinical depart- 
ments were exploited and developed, while 
the laboratory subjects, so-called, were neg- 
lected. The trend of development of mod- 
em medical education has reversed this 
position. To-day the laboratory subjects 
are being glorified, while in the opinion of 
some competent authorities at least the 76 
THE PHYSICIAN 
clinical subjects, if not neglected exactly, 
are not being given the emphasis due to 
their relative importance in the practice 
of medicine. In other words, the modern 
tendency of medical education is toward 
the training of specialists rather than general 
practitioners. This is not the time nor 
the place to discuss medical education, but 
there is sufficient in the modern tendency to 
cause a good deal of apprehension and un- 
rest in the minds of many medical men 
who have very much at heart the welfare 
of the public as well as their profession. 
“There is and there can be but one science 
of medicine. It cannot be subdivided into 
specialties; it is not limited to the eye, the 
heart, the stomach, or the ovary, but covers 
the entire body in health and disease. The 
art or practice of medicine, on the contrary, 
can be and has been very properly divided 
into a number of specialties, and with sound 
reason. The practice of medicine has be- 
come so extensive that no one can master 
all its details. The division of practice into 
specialties enables one to devote intensive 
study to a limited field in which he can be- 
come expert in the use of special instruments QUALIFICATIONS FOR STUDY 
77 
and measures employed in diagnosis and 
therapy, and by intensive research add to 
our knowledge of the diseases of that field. 
There are, however, great dangers in special- 
ism. Unless specialists have a broad train- 
ing and experience in general medicine as a 
foundation, they are not safe practitioners. 
They are apt to limit their observations 
and therapy to the findings in their special 
fields, and to overlook other abnormalities 
in the individual, which may be the essen- 
tial cause of his illness. The narrow spe- 
cialist may do a great deal of artificial and 
unnecessary work, and if uncontrolled, may 
become a menace to his patients and to 
sound medical practice.”* 
The only safe and satisfactory way, either 
from the standpoint of the patient or the 
practitioner, is first to get as broad a train- 
ing as possible in the fundamentals. The 
better general practitioner the would-be 
specialist is to start with, the better special- 
ist will he ultimately become. 
Another glaring defect in medical educa- 
tion is the lack of adequate general super- 
vision over so-called specialists who set 
* Report of Council on Medical Education, 78 
THE PHYSICIAN 
themselves up as such without adequate 
training. Investigation has shown that cer- 
tain physicians, after inadequate study, a 
short graduate course of a few weeks at 
some post-graduate school, for instance, set 
themselves up as specialists. It is interest- 
ing to note that a general plan of graduate 
training for specialists was submitted by 
the Council on Medical Education at the 
last meeting of the American Medical Asso- 
ciation. The idea is to try to establish 
some minimum requirement for each of the 
specialties that must be fulfilled before one 
will be entitled to practise as a specialist in 
any of the recognized departments of medi- 
cine. 
A remarkable decrease in the number of 
medical schools has taken place in the 
United States during the past fifteen years. 
In 1906, there were 162 institutions in this 
country in which medical instruction was 
given, and which were empowered to grant 
medical degrees. At the present time (June, 
1921) there are only 84 such institutions in 
existence, and it is quite likely that 3 of these 
will not reopen next fall, which will reduce 
the number of medical schools in this coun- QUALIFICATIONS FOR STUDY 
79 
try by exactly one-half in fifteen years. 
This phenomenal state of affairs has been 
brought about largely through the closure 
of schools of low grade, and also through 
the combination of two or more schools 
situated in the same city. Meanwhile, 
the entrance requirements have increased 
in all of the schools until now, with few 
exceptions, all require two or more years 
of collegiate work in addition to a high- 
school education. This increase in en- 
trance requirements is an index also of 
the improvements that have taken place 
in other respects, until now the educational 
standards of medical schools in the United 
States are at least on a par with those of 
other countries which, unfortunately, has 
not been the case hitherto. The number of 
medical schools also which, from the stand- 
point of teachers, equipment, laboratory 
and clinical facilities, are comparable to the 
best schools abroad, is steadily increasing. 
An interesting situation is also revealed in 
this report of the Council on Medical Edu- 
cation with regard to medical students. 
In 1904, under the general low standard of 
medical education that existed at that date, 80 
THE PHYSICIAN 
the total registration in medical students 
in that year was 28,142. This was the 
maximum enrolment in any year before 
or since. At that time, the supply of both 
medical schools and students was abnor- 
mally large. Directly corresponding with 
the rapidly increasing entrance require- 
ments, and the marked reduction in the 
number of medical schools just referred to 
came a sharp reduction in the number of 
medical students. In 1919, the minimum 
of 13,052 students was enrolled in the vari- 
ous medical schools. This was a reduction 
of over 50 per cent in fifteen years. A con- 
siderable part of this reduction in 1919 was 
due undoubtedly to the effect of the volun- 
teering or drafting of medical students dur- 
ing the war, but the main reason, as indi- 
cated above, was the increased requirements 
for entrance and for graduation. Since this 
date, however, there has been a gradual but 
steady increase, as shown by the actual en- 
rolment of 14,088 for the year 1920, and 
incomplete reports give an estimated en- 
rolment for 1921 of 14,850, which shows 
that students are being prepared and are 
beginning to fulfil the increased entrance QUALIFICATIONS FOR STUDY 
81 
requirements. It is interesting to note that 
while the number of students in the various 
medical schools was 28,142, there were only 
5,747 medical students graduated, a very 
high rate of academic mortality among the 
students. The lowest number of graduates 
was also in the year 1919, 2,656. This 
number was increased in 1920 to 3,047, and 
an estimate for the year 1921 places the 
number at 3,350. At the same time, it is 
interesting to note that the percentage of 
graduates from medical schools rated by 
the American Medical Association as “Class 
A” has increased from 64 per cent in 
1913 to 88 per cent in 1920, and that the 
percentage of graduates from “Class B” 
colleges has decreased from 24 per cent in 
1913 to 5 per cent in 1920, and from “Class 
C” colleges from 26 per cent in 1913 to 5 
per cent in 1920, a most gratifying showing 
with regard to the elevation of medical 
standards in this country. 
It will be interesting to note that of 4,532 
medical students enrolled in the first year 
class in 76 of the 84 medical schools, 24 
per cent were between the ages of seventeen 
and twenty; 47 per cent between the ages 82 
THE PHYSICIAN 
of twenty-one and twenty-three; 22 per 
cent between twenty-four and twenty-seven; 
7 per cent twenty-eight years or over. There 
were 3,206, or 71 per cent, under twenty- 
four years of age. This indicates that four 
years later, on completing their medical 
course, 3,206 students will be from twenty- 
four to twenty-seven years of age, while 
1,326, or 29 per cent, will be twenty-eight 
years of age or over. 
In this connection it is interesting to note 
that of these 4,532 students, 2,472, or 55 
per cent, presented in addition to a four- 
year high-school education two years of 
premedical college work; 1,059, or 23 per 
cent presented three years of college work, 
and 1,002, or 22 per cent, presented four 
years of college work, or had obtained de- 
grees. It would be very interesting to com- 
pare this record with that of the educational 
system of any of the other professions. It 
would go a long way to establish the claim 
that medicine has become the learned pro- 
fession. Add to this the years of hospital 
service, at least one of which in an accredited 
hospital is required by many States before 
one can begin the practice of his profession, QUALIFICATIONS FOR STUDY 
83 
and the claim has been pretty well estab- 
lished. 
The important advances in medical edu- 
cation and extensive improvements in medi- 
cal colleges outlined above give encourage- 
ment to the hope that before very long the 
entire output from the medical colleges will 
be limited to physicians thoroughly quali- 
fied as regards both preliminary and pro- 
fessional education. 
In recent years, however, the progress in 
the elevation of standards of medical edu- 
cation and licensure has been menaced by 
the efforts of certain cults, the more aggres- 
sive of which have been the osteopaths and 
chiropractors. Under the claim that since 
they did not use drugs or perform surgical 
operations, they were not practising medi- 
cine, the so-called healers have succeeded 
in securing legislation in a number of States, 
providing for separate boards of examiners, 
or special clauses in the medical laws, per- 
mitting them to practise and exempting 
them from those educational qualifications 
which regular physicians are required to pos- 
sess. Through their central organization, 
also, these cults are carrying on a syste- 84 
THE PHYSICIAN 
matic and persistent campaign of adver- 
tising in order to create public sentiment 
in their favor. The medical profession is 
the only organization which is in a position 
to expose the fallacies of their claims and 
point out their lack of the essential knowl- 
edge and training required for any intelli- 
gent care of the sick. This is why much 
of their advertising is devoted to efforts 
to discredit the medical profession. The 
only logical and effective argument against 
them and the only reason for the medical 
profession bothering its head about them 
is their lack of training in the modern 
methods of diagnosis, treatment, and pre- 
vention of disease. Such good as there 
may be in the character of treatment they 
employ will in no way be reduced if those 
using such methods are first required to 
possess the educational qualifications which 
will make them safe practitioners of the 
healing art. 
One of the interesting and inexplicable 
peculiarities of human nature is that so 
many people who are perfectly sane and 
sensible about other things are so utterly 
unreasonable and foolish when it comes to QUALIFICATIONS FOR STUDY 
85 
questions relating to their physical well- 
being. They will so frequently fail utterly 
to apply the same law of reason and com- 
mon sense that they unhesitatingly apply 
in other relations in life to matters that 
concern their health and bodily functions. 
They will so often go chasing after strange 
gods and for a time worship ardently and 
devotedly in any so-called temple of hy- 
giene, no matter how bizarre or absurdly 
constructed it may be until (and here is 
where the pathetic side is presented to the 
intelligent well-trained physician when he 
is finally consulted) it is often too late—the 
curative stage of their malady having passed 
—and nothing remains to be done but the 
application of palliative measures. 
It is an interesting psychological study, 
this willingness of so many individuals to 
be fooled. Indeed, it seems often to go 
beyond this, since many of them seem to 
like it. Attention has been called to this 
fact many times in history. One reason for 
it in medicine is undoubtedly due to the 
fact that reputable physicians are prevented 
by their code of ethics from advertising in 
any form whatsoever—while, on the other 86 
THE PHYSICIAN 
hand, the chief stock in trade of quacks and 
medical fakirs, and of the different cults, is 
advertising in various forms, the more strik- 
ing and attractive the better for their pur- 
poses. A great tribute to the value of ad- 
vertising is furnished by the crowds that 
frequent the offices of certain well-known 
medical charlatans and the number of 
patrons of certain popular drug houses, 
dispensers of “favorite prescriptions,” pro- 
prietary cure-alls, and patent medicines. 
The medical profession has no quarrel what- 
ever with otherwise intelligent persons of 
adult age who prefer to consult an ignorant 
quack and take his nostrums in preference 
to the advice and treatment of an educated 
and competent physician after a thorough 
examination and diagnosis of his case. This 
is a free country and one can do as he pleases 
in a matter of this sort, and the individual 
injury to his own health resulting from 
faulty medical treatment or lack of any at 
all, as in faith healing and Christian Science, 
except in the case of communicable diseases, 
is a matter that concerns himself and his 
family. But the chief danger to society 
from these cults—osteopathy, chiropractic, QUALIFICATIONS FOR STUDY 
87 
Christian Science, etc.—and the various 
4 ‘ antis ’’■—anti-vaccination, anti-vivisection, 
etc.—which is really the only reason for 
paying any attention to them at all, is 
through their efforts to break down medical- 
practice laws and the confusion that they 
are causing in the medical licensure. 
It is a self-evident fact that no one 
should be authorized to treat the sick by 
any method unless he has had a thorough 
training in the fundamental medical sci- 
ences. No one should be granted “limited 
licenses.” When a patient in an emergency 
calls a doctor, he needs one who is com- 
petent to use whatever remedies or methods 
of treatment the particular ailment re- 
quires. These essentials are not provided 
in a practitioner who is neither qualified 
nor legally authorized to practise medicine 
in all its branches. The legal error was 
made when the cultists were authorized by 
legislation to practise under limited licenses. 
We know of no parallel to this in the medical- 
practice laws of any other country. “In 
each State there should be established one 
educational standard, administered by a 
single licensing board by which every one 88 
THE PHYSICIAN 
who is authorized to practise the healing 
art shall be required to prove that he has 
secured a satisfactory training in the funda- 
mentals of medicine. Furthermore, osteo- 
pathic and chiropractic colleges and all 
other healing cults should be inspected 
and classified in accordance with the same 
standards now being applied in regular 
medical schools, and by the same boards 
which pass on these medical schools. This 
is now the case in Indiana. In some States 
the osteopaths are required to take the same 
comparatively easy examination that is re- 
quired of physicians, but they are not 
required to have the same preliminary 
qualifications which all physicians are now 
required to possess. What the medical 
profession has a right to demand is a square 
deal and equal qualifications for all, and 
that there shall be no discrimination favor- 
ing any individual or group of individuals 
who are engaged in practising the healing 
art. It is highly desirable that all legisla- 
tion affecting the practice of medicine in 
the future shall support the present reason- 
ably high standards of medical education 
for which, in the last fifteen years, the vari- QUALIFICATIONS FOR STUDY 
89 
ous agencies interested in medical education 
have successfully striven.”* 
The accepted American standard is now 
a four-year high-school course, at least two 
years premedical college work (some medical 
schools now demand a full college course 
with an A. B. or other equivalent degree), 
a four-year medical curriculum, and a year’s 
internship in an approved hospital. This 
forms as high a medical standard as that 
which obtains in foreign countries. 
The educational qualifications necessary 
for the study and practice of medicine have 
thus been gone into fully in order that the 
prospective medical student may have some 
intelligent and fairly adequate idea as to 
just what he is getting into when he under- 
takes the study of medicine. It means 
years of preparation, of close application 
and study before a physician is able to meet 
his patients with that degree of confidence 
and assurance in his ability which comes 
only with thorough knowledge of disease 
in all its protean manifestations, and which 
is only acquired by familiarity with it from 
close association and study in hospital ward 
* Report of Council on Medical Education. 90 
THE PHYSICIAN 
and laboratory. Thus only will he be able 
to treat it properly in whatever form it 
may present itself. 
I have quoted thus extensively from the 
recent report of the Council on Medical 
Education of the American Medical Asso- 
ciation (i) because it is the authoritative 
mouthpiece of the medical profession; (2) 
because there seems to be so much misap- 
prehension in the public mind, due largely 
to the extravagant and erroneous state- 
ments of representatives of the various 
so-called healing or drugless cults with re- 
gard to the objects and extent of the legis- 
lation that has to do with the regulation 
of the practice of medicine and the educa- 
tional qualifications necessary thereto; (3) 
because the educational qualifications of a 
practitioner of medicine are fundamental 
to his success in the practice of the healing 
art. Nay, more than this, they determine 
whether or not he is a real benefit to society 
or a menace to the community in which he 
lives and practises his particular science or 
art, for by just so much as he is ignorant 
of the fundamental laws of health and dis- 
ease, and, regardless of this fact attempts QUALIFICATIONS FOR STUDY 
91 
to treat sick people, by just so much does 
he constitute a grave menace to society 
and should be made, before proceeding 
further on his course, either to conform to 
certain standards that have been set up 
by the combined knowledge and experience 
of those competent to judge of such matters, 
or he should be summarily suppressed. 
The great difficulty that constantly con- 
fronts the medical profession in its altruistic 
efforts to protect the public against its own 
folly in matters of public and private health 
is the ignorance and apathy of those most 
vitally concerned. It is a curiously anoma- 
lous position in which the profession finds 
itself, all the time working against its own 
interests, in trying to secure proper legis- 
lation, to induce unwilling legislators, against 
great pressure from hostile sources, “drug- 
less cults,” patent-medicine concerns, the 
various societies of the “antis” and the 
like, to pass uniform and just laws to pro- 
tect the public health and to control the 
practice of the healing art, and to keep it 
in the hands of those who by education and 
training are alone competent to deal with 
the many and complex problems involved. CHAPTER VII 
PRELIMINARY TRAINING 
The question is often asked by prospec- 
tive medical students, “How can I best 
arrange my college schedule to be of most 
benefit in my medical course?” In other 
words, “What should I study in college to 
prepare me best to study medicine ?” This 
is a most difficult question to answer, as so 
many factors are involved, but the cultural 
rather than the utilitarian idea should pre- 
vail. From a practical standpoint, the 
ideal way may be impossible to many, be- 
cause of the expense involved, both in the 
matter of time and money. Most indi- 
viduals who study medicine are poor to 
begin with. Many of them are largely, or 
entirely, dependent upon their own exertion 
for a livelihood. It is clearly impossible for 
these, without assistance from some source, 
to continue their medical studies indefi- 
nitely. Some medical students have others 
dependent upon them, still others are 
92 PRELIMINARY TRAINING 
93 
anxious to marry, having early become 
engaged. These are some of the more com- 
mon and potent reasons why many of those 
who study medicine are either unable or 
unwilling to spend a great deal of time in 
preliminary preparation for practice. 
The present-day requirements for en- 
trance into “Class A” medical schools, 
graduation therefrom, and license to prac- 
tise medicine are so stringent and time-con- 
suming of themselves as to create a growing 
tendency to cut down as far as possible the 
preliminary preparation. This is shown by 
the recent action of several of the best medi- 
cal schools in making a degree in arts or 
science no longer necessary for admission. 
In general, it may be said that “a sound 
liberal education without too strict thought 
of utilitarian purpose, including the ap- 
plication to medicine, should be advised.” 
Unquestionably this is the ideal prepara- 
tion for medicine, just as a thorough ground- 
ing in general medicine is the best prepara- 
tion for any of the specialties. The entrance 
requirements to the best medical schools 
now make it necessary for a student to have 
at least two years of college work, including 94 
THE PHYSICIAN 
a reading knowledge of French and Ger- 
man, and, in addition, a considerable amount 
of chemistry and physics. While the re- 
quirements are not uniform in all medical 
schools, it is highly desirable from every 
standpoint that the mental equipment of 
the prospective medical student should not 
fall below this standard. The better the 
preliminary education the individual has, 
the better chance he will have to occupy a 
position of influence in the community in 
which he lives. He will also be able to do 
better professional work, and will derive 
more pleasure and satisfaction from it. 
Unfortunately, for the reasons previously 
stated, it has been found necessary to 
shorten the preliminary preparation, and to 
telescope the Arts and Science courses into 
the medical course. The so-called pre- 
liminary medical courses advertised in many 
of our universities are the result. 
From a utilitarian standpoint, this de- 
velopment is a good thing. It certainly 
tends to shorten the length of time required 
in which to secure a license to practise medi- 
cine, which is a boon to the poor man. Even 
with this material shortening of the course. PRELIMINARY TRAINING 
95 
the average man will be twenty-five years 
of age, or over, before he can begin the prac- 
tice of his profession and so earn his own 
living. In most of the States, at least one 
year in an accredited hospital is now obliga- 
tory before license to practise medicine is 
granted. The longer the time spent in a 
good hospital service, the better; it affords 
the best possible training and is simply in- 
valuable. CHAPTER VIII 
MEDICAL EDUCATION 
In discussions of this subject one hears 
considerable difference of opinion expressed 
with regard to medical education. We are 
in a transition period, and there is great 
unrest and uncertainty in medical circles 
throughout the entire country. The storm 
centre just now is about the question of 
the so-called “Full-Time Teaching” in the 
clinical branches. This is not the place to 
discuss this much-vexed question; suffice 
it to say that with the general proposition, 
namely, that the head of a clinical depart- 
ment should give his principal time and 
attention to the direction of the work of 
that department; teaching the students, 
research, care of the patients, etc., every 
one is in hearty accord. When, however, 
it comes to the arrangement of important 
details—the control by the institution of the 
entire time of the individual; the practical 
limitation of his sphere of activity to the 
96 MEDICAL EDUCATION 
97 
institution; the amount of salary he should 
be paid, etc.—there is room for wide differ- 
ence of opinion. Then, too, there is lack of 
unanimity of opinion with regard to the 
effect that this method of teaching may 
have upon the product turned out by the 
medical schools, namely, the young doctors. 
Fears have been expressed lest there may be 
developed the institutional type of doctor, 
thoroughly trained scientifically, but de- 
ficient in the more human qualities that are 
so necessary in dealing with individuals, 
especially in their homes. The older meth- 
ods of education rather stressed this aspect 
of the question. What is wanted is a happy 
combination of the two, by all means as 
much of the science and art of medicine 
as the student can assimilate, but a judicious 
balance between the clinical and scientific, 
in which the human element is given due 
consideration. It is an interesting experi- 
ment and time will determine its prac- 
ticability and value in the several institu- 
tions into which it has already been intro- 
duced. Meanwhile, the introduction of 
certain changes in long-established customs, 
no matter what the ultimate outcome, will 98 
THE PHYSICIAN 
likely result in lasting benefit to medical 
education by calling general attention to 
its shortcomings. Especially is this true 
with regard to the effect of increased re- 
quirements for entrance into and graduation 
from the medical schools. These in turn 
have apparently had a marked effect upon 
the supply of medical men available for rural 
communities. From every rural section of 
the country comes the same cry with ever- 
increasing intensity: “Send us doctors. We 
want good ones, of course, but we are not 
so particular about them as we should like 
to be because of the great difficulty of get- 
ting any at all.” The doctor cannot be 
blamed for not wanting to go to the coun- 
try. But what is to become of the people 
who live there? They must be taken care 
of. At the present moment, no satisfactory 
solution offers. Shall we have two grades 
of medical schools, as advocated by some, 
or will the woman physician solve the small- 
town and country problem of the future? 
There is something to be said in favor of 
the second-grade medical school for training 
the general practitioner of medicine. Much 
objection is at once raised against this MEDICAL EDUCATION 
99 
proposition as a step backward in medical 
education. But, as President Cleveland once 
said upon a famous occasion, “We are con- 
fronted with a condition and not a theory,” 
and something must be done to remedy it. 
At the present time not nearly enough phy- 
sicians are being graduated to supply the 
demand of the entire country, and the ma- 
jority of these are going to the cities and 
large towns, and the rural districts are all 
the time becoming more deserted as the old 
doctors die off or become superannuated. 
Women are going more and more into medi- 
cine. They are well fitted for general prac- 
tice, especially among children and their 
own sex, whose maladies, perhaps, make up 
the bulk of general practice. Women are 
more willing than men to do the routine 
drudgery that belongs to a general practice 
and to accept smaller pecuniary returns 
therefrom. Then, too, in these days of 
good roads, the automobile and the tele- 
phone, social changes of all kinds are con- 
stantly taking place, town and country are 
being brought closer together, and it is not 
beyond the bounds of possibility that the 
comparatively near future may show very 100 
THE PHYSICIAN 
marked changes along these lines. Country 
people can get to town to visit the doctor 
more readily than formerly. Nurses, for 
the same reason as the doctors, do not like 
to accept cases in the country. It is quite 
natural that they should not. The com- 
parative isolation, increased difficulties and 
distance of transportation, separation from 
their friends and amusements, etc., all com- 
bine to render the country less attractive 
than the city, especially during the winter 
months. Then, too, the question of remu- 
neration is most important. After spending 
three years in training, the nurse naturally 
expects to be able to make a good living and 
have some of the comforts, if not the luxu- 
ries of life. Are we to have two grades of 
nurses’ training-schools, those for training 
teachers of nurses and those for training 
nurses to take care of the sick in general? 
It looks now as if the general trend were in 
this direction. There are, on the one hand, 
not enough nurses, as it is, to supply the 
demand and, on the other, the rates charged 
are so high as to make it prohibitive in many 
cases to secure their services. The doctor 
is so dependent upon the nurse for the MEDICAL EDUCATION 
101 
proper care of his patient that a satisfac- 
tory answer to these questions becomes of 
the highest importance to him, as well as 
to the patient. 
The modern tendency all the while is for 
the sick to go more and more to hospitals 
for treatment, which is a good thing. But 
it will be a long time before the bulk of the 
general practitioner’s practice will change 
from the home to the hospital. One potent 
reason for this will be the matter of expense. 
The average patient cannot afford to be ill 
in a hospital. It is a luxury quite beyond 
his means, even in these extravagant days. 
With the cost of a private room in the hos- 
pital, the expense of one or more trained 
nurses and various incidentals, to say noth- 
ing of the doctor, who always comes last on 
the list, few can afford it. 
In passing, let it not be forgotten that 
the practice of medicine among patients in 
hospitals is one thing, and practice among 
patients in their private homes is in many 
essential respects quite another. It will be 
a sorry day, indeed, for the profession and 
for humanity when those characteristics of 
the traditional family doctor, which so en- 102 
THE PHYSICIAN 
deared him to his patients and made him 
such a power for good in his community, 
are supplanted by others, even if of more 
highly intellectual development. The two 
are not incompatible and medical education 
is quite capable of readjustment sufficient 
to allow the development in proper pro- 
portion of those qualities of both head and 
heart which go to make up the well-rounded 
physician who, while attempting to diagnose 
and cure bodily ailments, is not unmindful 
of those mental maladies which so distress 
the soul and without an understanding of 
which complete relief to the afflicted will 
surely fail of accomplishment. 
If there is one quality that my thirty or 
more years of professional experience has 
impressed upon me as of the utmost im- 
portance in the medical man, no matter 
whether in city or in country practice, a 
general practitioner or a specialist, it is 
that he should have a heart. Courtesy of 
manner and kindness go a long way toward 
establishing that basis of mutual under- 
standing and confidence so important in 
the diagnosis and treatment of many con- 
ditions, especially that large class of func- MEDICAL EDUCATION 
103 
tional neurbses which are the natural prey 
of the faith-healers and the quacks. The 
world to-day is sick, suffering grievously 
from war wounds, not only those that pre- 
ceded and led up to the war, but those that 
followed it as a natural result. What it 
needs is not physic; neither science nor the 
healing art can cure its wounds, nationally 
and internationally, individually and col- 
lectively, but only the application of those 
principles taught by the Great Physician, 
“Love thy neighbor as thyself,” “Do unto 
others as you would have them do unto 
you.” What is true of a nation is true of 
individuals. Kindly sympathy, friendly and 
not necessarily always professional advice 
or warning, and personal interest are of 
greater actual value to a large class of 
patients suffering from real or supposed 
maladies than pill or potion. Get and keep 
their minds at rest, and the ever-present 
and powerful “vis medicatrix Naturae,” 
with slight assistance from the doctor, may 
be confidently relied upon to complete the 
cure. 
It is all a question of relative values, of 
where the emphasis is placed that deter- 104 
THE PHYSICIAN 
mines the character and trend of medical 
education in an institution or a country. 
Whether one should place the greater em- 
phasis upon research and the development 
of investigators, or whether the chief ob- 
ject of a particular school or the system of 
education in vogue is to produce well-edu- 
cated practitioners of medicine, thoroughly 
grounded in the fundamental sciences and 
well trained in the art, is largely a matter 
of individual opinion. Certain it is that at 
the present time there are marked differ- 
ences to be found among men whose opinions 
carry weight in the educational world. The 
chief function of a medical school is to train 
doctors, but they should be trained to ob- 
serve and think so that they are not com- 
pelled by defective education and training 
to follow the beaten paths, but, when occa- 
sion offers, are capable of making excursions 
into as yet untravelled fields, with the occa- 
sional result of some valuable contribution 
to medical science. The curricula of the 
medical schools and the teaching in the 
various departments should be so adjusted 
as to give to each subject its proper relative 
importance without placing undue emphasis MEDICAL EDUCATION 
105 
upon one item to the detriment of another. 
This readjustment tending toward the res- 
toration of a proper balance in the curricula 
of medical schools is certainly much to be 
desired. The pendulum is swinging wide 
just now. Presently it will stabilize itself 
with the result that the surcharged atmos- 
phere now surrounding medical education 
will have been considerably clarified by the 
passing storm. CHAPTER IX 
THE CHARACTER AND FUNCTION OF 
THE MEDICAL SCHOOL 
After a young man or woman has finally 
decided to devote his or her life to the study 
and practice of medicine, the next question 
to be decided is what particular medical 
school to attend. It may even be advisable 
not to spend one’s four years in the same 
medical school, but to divide one’s time be- 
tween two of them, taking one’s hospital 
service in still another medical centre. 
There is much to commend this plan. 
Through it one comes to have a wide circle 
of acquaintance with men and methods of 
work. One’s mental horizon is broadened, 
since one is not so prone to look at things 
through one pair of glasses. On the other 
hand, there are certain obvious objections 
to the plan which render it far less popular 
than the original method. While to many 
106 THE MEDICAL SCHOOL 
107 
apparently intelligent and even educated 
people all diplomas look alike, yet it does 
make a difference to a discriminating public 
what school name a doctor’s diploma bears. 
Even the absence of one is no bar to the 
practice of medicine in the minds of some, 
more is the pity, but it is they who suffer 
from their own foolishness in failing to dis- 
criminate between the good and the bad in 
medical practice. 
In selecting the medical school to attend, 
considerable care should be exercised. 
What is to be the basis of this choice is a 
very pertinent question. Formerly the 
fame of a single great teacher was enough 
to crowd any school with students. Un- 
doubtedly something was to be gained 
from this mass enthusiasm attendant upon 
a crowded and interested auditory, from 
the stimulus received from the personality 
of some genius of a professor; but, important 
as were these two factors in former times, 
it came to be recognized that there were 
many and glaring defects in the system of 
proprietary medical schools as then existed. 
Reforms were, therefore, instituted and the 
whole system of medical education in the 108 
THE PHYSICIAN 
country underwent change. To-day the 
task of deciding upon a proper medical 
school is a comparatively easy one. Thanks 
to the work of Mr. Abraham Flexner in 
connection with the Carnegie Foundation, 
and later that of the Council on Medical 
Education of the American Medical Asso- 
ciation and the Association of Medical Col- 
leges, practically all of the so-called propri- 
etary or independent medical schools, with 
little or no equipment, have been driven 
out of existence. This type of school has 
been gradually supplanted by the newer 
idea, that the medical school to be really 
effective must be an integral part of a uni- 
versity. This means that university ideas 
and ideals must be carried into and largely 
control the policies and teaching of the med- 
ical school. This idea has now become so 
fixed in the lay as well as the professional 
mind that no other type of school can ex- 
pect further material support from the 
public. Fortunately, at the present time, 
any one of a dozen or more schools scat- 
tered throughout the country and connected 
with well-established universities is pre- 
pared to give to the student an excellent THE MEDICAL SCHOOL 
109 
training in medicine. There is little dif- 
erence between those in the front rank, and 
the choice as to which one of these to enter 
may well be determined by circumstances. 
Doctor Welch has directed attention to 
the fact that among the more important 
causes which have led to the great change 
that has taken place in the character of 
medical education in the past twenty-five 
or thirty years is to be mentioned the great 
advancement in medicine itself. “It has 
become apparent that in order to teach 
modern medicine, the appliances of the 
early days, consisting of scarcely more than 
a lecture-room and a small chemical labora- 
tory, were insufficient to fulfil requirements. 
In a word, the advancement and develop- 
ment of medicine in itself required an im- 
provement in the methods of teaching medi- 
cine. Various factors have been at work 
and we are now in a transition period.”* 
The whole idea of medical education is 
undergoing rather radical revision along cer- 
tain lines—so much so that there is some 
danger of losing our proper orientation. The 
matter, however, is just now the subject of 
* Welch. 110 
THE PHYSICIAN 
much thought and discussion in the medical 
world, and no doubt much good will ulti- 
mately result therefrom. Meanwhile it is 
well to keep constantly in mind just what 
the real function of the medical school is 
and what should be the basis upon which 
the curriculum should be built. These 
principles have been very clearly defined 
by Doctor Welch as follows: “The funda- 
mental object of medical education is to 
make good doctors. Without question that 
should be the underlying conception in all 
schemes of medical education, and unless 
a given course of study bears on that train- 
ing, it should have no place in the medical 
curriculum. It has been stated, and accu- 
rately so, that it is impossible to impart 
the entire content of medical and surgical 
science to the student. One cannot even 
impart the content of a single subject of 
the curriculum. The utmost to be expected 
is to give to the student a fair knowledge of 
the principles of the fundamental subjects 
of medicine and a power to use the instru- 
ments and methods of his profession; to 
give him the right attitude toward his pa- 
tients and his fellow members in his pro- THE MEDICAL SCHOOL 
111 
fession; and, above all, to put him in a 
position to carry on the education which 
he has only begun in the medical school. 
Our aim, therefore, should be to put him 
in a situation to complete his education 
through the remainder of his life. With 
that point of view in mind, we cannot hope, 
therefore, to teach the student the entire 
contents of the science of medicine. The 
student cannot go out a trained practitioner, 
a trained pathologist, a trained anatomist, 
or a surgeon. Looked at from the point 
of view of knowledge alone, he has only a 
smattering. The training of his powers 
and methods of study are the important 
things. He should be put in a position to 
continue his own education.”* 
After all, the best thing that medical 
education can do for a medical student is 
to infuse into him what Sir Thomas Browne 
has so quaintly and aptly characterized as 
the “philosophic spirit.” It is the spirit 
in which a man does his work, that domi- 
nates and directs him in every part of it, 
that really counts, and not the success as 
judged by ordinary standards. “There is 
a philosophic spirit which is far more valu- 
♦Welch, 112 
THE PHYSICIAN 
able than any limited attainments in phi- 
losophy and the cultivation of which, there- 
fore, is the most precious advantage that 
can be derived from the lessons and studies 
of many academic years, a spirit which is 
quick to pursue whatever is within the reach 
of human intellect, but which is not less 
quick to discern the bounds that limit every 
human inquiry and which, therefore, in 
seeking much, seeks only what man may 
learn; which knows how to distinguish 
what is just in itself from what is merely 
accredited by illustrious names; adopting 
a truth which no one has sanctioned and 
rejecting an error of which all approve, with 
the same calmness as if no judgment were 
opposed to its own, but which, at the same 
time, alive with congenial feeling to every 
intellectual excellence and candid to the 
weakness from which no excellence is wholly 
privileged, can dissent and confute without 
triumph, as it admires without envy, ap- 
plauding gladly whatever is worthy of ap- 
plause in a rival system and venerating the 
very genius which it demonstrates to have 
erred.” * 
* Religio Medici, Sir Thomas Browne. THE MEDICAL SCHOOL 
113 
The school that aims to cultivate most 
assiduously this spirit in its students comes 
nearest to fulfilling the proper function of 
a medical school. CHAPTER X 
THE GENERAL PRACTITIONER 
The question is often asked by young 
medical students just about to leave the 
medical school, or graduates just finishing 
their internship in the hospital: “Where 
would you advise me to practise?” My 
invariable reply to this question is, “Wher- 
ever you prefer to live.” One has only 
one life to live and he had better spend 
that where and in whatever way he would 
be happiest, provided always that in so do- 
ing he pays due regard to the welfare and 
interests of others. The above answer 
is further developed and qualified by the 
advice to strive to fit himself by training 
and study to do at least one thing better 
than any one else in the community in 
which he lives. By legitimate professional 
advertising, such as reading papers, writing 
articles, and by taking part in the discus- 
sion of a particular topic or kindred sub- 
jects in the medical society meetings, finally 
114 GENERAL PRACTITIONER 
115 
—and it usually is not long—the profession, 
and then the public, begin to understand 
that he knows more about this particular 
subject or disease than anybody else in that 
region. Then his professional reputation is 
made and his grateful patients and doctor 
friends will do the rest and spread his fame 
far and wide. It is a fact quite well estab- 
lished in the commercial world, namely, 
that if a merchant offers for sale good re- 
liable goods, no matter of what particular 
variety, at a fair price, he will always, sooner 
or later, find buyers. This principle holds 
equally good in the professions. If a doctor 
is better trained, gives better service, and 
gets better results with his patients than 
his brother practitioners in the neighbor- 
hood, he will ultimately make a reputation 
for himself and get the bulk of the practice. 
There are exceptions to all rules, and now 
and then one may find a charlatan or quack, 
or some other ignoramus, who has so effec- 
tually hoodwinked and deceived the gullible 
public by the time-worn tricks of his trade 
as to fill his office with patients, to their 
own great loss both in money and health 
and to the detriment of the educated, com- 116 
THE PHYSICIAN 
petent physician. But sooner or later in 
these enlightened times the medical fakir 
gets found out. Real merit cannot remain 
long unrecognized. 
There is no limit to one’s activities or 
opportunities in medicine. It all depends 
upon the man, upon his ability, his indus- 
try, his integrity, his ambition, his willing- 
ness to do the thing that comes to his hand, 
to follow a lead slowly, carefully, painstak- 
ingly until at last he has arrived at some 
pinnacle of knowledge as yet unsealed or 
has discovered some truth hitherto un- 
known. 
The possibilities offered to the earnest 
young man or woman for doing good to 
one’s fellow man, for adding something to 
the sum total of human knowledge, for 
contributing to human happiness and ef- 
ficiency, are truly fascinating and unsur- 
passed, if indeed they are equalled by any 
other calling or profession. He will do well 
to consider them carefully before deciding 
upon his career. As pointed out so well by 
Doctor R. C. Cabot,* medicine uses all 
* Training and Rewards of the Physician, J. B. Lippin- 
cott Company, Philadelphia, 1918. GENERAL PRACTITIONER 
117 
human power. “Medical work is more 
prone than any work that I know to en- 
gage all the resources of a human being. It 
calls out all our powers. Although in one 
sense medicine is a specialty, in a more 
important sense it is a profession which can 
use the whole of a man as no other pro- 
fession can.” “A physician’s eye cannot be 
too sharp, his powers to seek and to find 
cannot be too well trained for the work 
that he has to do with the microscope or 
the scalpel.” 
“If one has any desire to go to the bot- 
tom of things, to be thorough instead of 
superficial in one’s dealings with man, fate, 
and nature, then medicine gives one an 
unparalleled opportunity for the develop- 
ment of such powers. 
“If there is any power that a doctor does 
not need in his business, I do not know it. 
If there is any man who can say with ear- 
nestness that he ‘counts nothing human 
foreign to him,’ then surely medicine is 
the job for him, the path along which he 
can find the goal of his desire. For nothing 
human is foreign to the work of a doctor, 
not the lowest or the highest in our nature, 118 
THE PHYSICIAN 
not the best nor the worst, the most realistic 
and minute, not the most scientific and 
permanent. All these summon the physi- 
cian to stand upon his feet and make his 
contribution before he dies. All contribute 
to his reward. 
“The physician is the child of his age. 
Such an opportunity as a great painter 
had in the Renaissance or a great musician 
had in the early years of the nineteenth 
century, a physician has to-day. The scien- 
tific and mechanical, the utilitarian and 
practical eagerness of our age, finds an out- 
let in him. But the deeper and more perma- 
nent hungers of the human race, the search 
for truth and to spread it, to love and serve 
our fellows, and to know God, also find their 
natural expression and development in the 
practice of medicine. It brings few to fame 
and renown. It is hard work, never finished 
in any eight or eighteen hours a day; but 
its rewards, as I see them, are beyond those 
of any other profession.”* 
* Cabot. CHAPTER XI 
COUNTRY VERSUS CITY PRACTICE 
In deciding as to his future career, be- 
tween that of a general practitioner either 
in the city or in the country, or taking up 
a specialty of some kind, the medical stu- 
dent should take into consideration sev- 
eral things. The personal qualifications of 
the individual are of prime importance. 
If there is one characteristic more than 
another needed in a general practitioner 
with a country or even a small-town prac- 
tice, it is that of self-reliance. He must, 
of necessity, stand upon his own feet; he 
must know something of all branches of 
medical practice; he must have a speak- 
ing acquaintance, at least, with all the 
medical and surgical affections common to 
his neighborhood. Furthermore, whether 
or not he possesses these prime requisites 
of a doctor of medicine, he must act. When 
a patient presents himself with no matter 
how obscure an affection or however diffi- 
cult to handle, something must be done. 
119 120 
THE PHYSICIAN 
If a man’s tastes are rural rather than 
urban, the career of a country doctor will 
naturally appeal to him. It is probable that, 
for obvious reasons — greater opportunity 
and necessity, as well as preference—the ma- 
jority of men, and women especially, will, for 
the present at least, settle in the city rather 
than the country. It is equally true, how- 
ever, that the relatively greater difficulties 
in getting an immediate start in the city 
will probably deter a number from going 
there who otherwise would. But when one 
balances the relative advantages and dis- 
advantages of the one against the other, 
in these days of the automobile and good 
roads, which have practically revolutionized 
practice in the country, there seems little 
to choose between the two in the matter of 
general practice, so far as the doctor himself 
is concerned. It is different, however, with 
his family. The attraction of town and city 
life, better schools, the lure of the movies 
and social conditions generally weigh to 
such an extent that there is grave danger 
that the country doctor, the counsellor and 
friend of the family, may become extinct,— 
that is, the type portrayed in literature, and COUNTRY VERSUS CITY 
121 
which many of us from past associations 
have pictured in our minds. 
The life of the country doctor is a rich 
and varied one. There comes into my 
mind as I write the picture of a country 
doctor of the old school whom, in the earlier 
years of my life, it was my privilege to know. 
His practice covered a radius of twenty 
miles or more in a typically rural district; 
in those days, before the automobile, a 
large area, and he knew every part of it. 
He covered this district always on horse- 
back. He was an excellent horseman and 
his horses were of the best blooded stock. 
He was fond of fox-hunting and was noted 
for his skill as a rider and huntsman. He 
preferred to ride by night, choosing by- 
paths and short cuts, not bothering to fol- 
low public roads or to stop to open gates, 
taking fences and ditches at a leap. He 
seemed to know every individual, black and 
white, in his district, calling most of them 
by their first names and having brought 
many of them into the world. He was 
consulted upon all matters, public and 
private, and not alone professional, from 
politics and religion to the most becoming 122 
THE PHYSICIAN 
color of ribbon on the baby’s new bonnet. 
All advice was given and suggestions made 
in the same kindly and interested way. A 
sympathetic hearing and helpful and cheer- 
ing answer were assured to all persons and 
all queries. He early became engaged to a 
young and beautiful girl in the neighbor- 
hood and the wedding-day had been set. 
Shortly before it she received a severe fall 
and suffered an injury to the spine from 
which in those days there was no known 
cure. As a result of this injury she became 
bedridden for the rest of her life, a period 
of over forty years. During all these years 
he remained constantly faithful, a devoted 
lover. Every day up to the beginning of his 
fatal illness, with few exceptions, due to the 
exigencies of his practice, he found time from 
his busy life, by day or by night, to ride the 
four miles which separated his home from 
hers, to bring her a flower or a book, some 
little token and a word of cheer for her lone- 
liness. Meanwhile he was giving his life and 
all that he had to the constant care of his 
fellows in that community, gradually grow- 
ing old and feeble in their service, and for 
all this he was never known to send a bill to COUNTRY VERSUS CITY 
123 
any one for professional services rendered. 
Small wonder, then, that at his funeral, 
which was one of the most impressive ex- 
periences of my life, held in the quiet coun- 
try churchyard just at sunset (his one re- 
quest) of a beautiful autumn day, there 
was gathered an outpouring of people from 
the entire countryside, such as had seldom 
been known before. The manifestations of 
grief and loss upon all sides were so spon- 
taneous and genuine that one could not but 
feel that that community had lost its best 
friend and felt the loss most keenly. 
It was the natural and universal thought 
and desire to show in some small measure 
their deep appreciation of their beloved 
physician and faithful guide and counsellor 
that prompted that community to erect, 
by popular subscription, a plain, unpolished 
granite shaft, indicative of the character of 
the man, upon which was inscribed these 
words: 
“this shaft is erected by an apprecia- 
tive AND GRATEFUL COMMUNITY TO STAND 
AS AN ENDURING MEMORIAL OF A NOBLE 
LIFE ADORNED WITH SERVICE AND CROWNED 
WITH LOVE” 124 
THE PHYSICIAN 
I could not but contrast this scene with 
another, perhaps the most impressive that 
it has ever been my privilege to witness, 
of pomp and ceremony, surrounding the 
funeral services held not long ago over the 
body of another doctor whose name is a 
household word in at least two continents; 
who, by his great work in the control of 
malaria, yellow fever, and other tropical 
diseases, has saved untold lives, rendered 
habitable large portions of the earth’s sur- 
face, and made possible the completion of 
that colossal undertaking, the Panama Ca- 
nal. It was my privilege to be present at 
the wonderfully beautiful and impressive 
services held in Old St. Paul’s Cathedral in 
London, in honor of that great physician, 
splendid character, and brave soldier, 
Major-General William C. Gorgas, Medical 
Corps, United States Army. The signal 
honor accorded his memory, and the recog- 
nition of the value of his work by the Eng- 
lish King and people were well deserved 
and will long be remembered by a grateful 
profession and nation. But who shall say 
which of these two great men (for each 
possessed in his character and illustrated COUNTRY VERSUS CITY 
125 
in his life, in different ways, to be sure, 
and in different measure, the elements and 
qualities of true greatness) is the more 
worthy of praise and emulation? Each in 
his own sphere accomplished a great work; 
each was faithful to his trust—the one 
limited to an obscure country community, 
the other world-wide in its extent, its in- 
fluence and effect lasting for all time. The 
career of the former lies open to many, for 
the one-talent man is far more numerous 
than the ten. Many doubtless can by emu- 
lating the example of the country doctor 
build monuments for themselves in the 
lives and hearts of their patients, which is 
far better than marble shafts or tablets of 
bronze. The latter career lies open to com- 
paratively few. But the point of the whole 
matter is this: to be faithful in the few things 
or the many, to use well the one talent or 
the ten, to use to the greatest advantage to 
humanity what one has; and then, in the 
final reckoning, it matters little whether one 
may be classed in the one group or the other, 
one will have left mankind one’s debtor and 
will have made the world a better place for 
having lived therein. CHAPTER XII 
INDUSTRIAL MEDICINE AND 
PUBLIC HEALTH 
A comparatively recent development 
which has opened a new and very attrac- 
tive field to the doctor is “ Industrial Medi- 
cine.” Much interesting work is being 
done in the way of preventive medicine by 
more careful supervision of physical condi- 
tions surrounding the workers in various 
trades and factories where the employees 
are, from the nature of their work, rendered 
more liable to certain diseases or accidents. 
The science of hygiene and sanitation are 
just awakening to great development and 
expansion. We are on the eve of wonderful 
discoveries and forward movements in these 
directions. A thorough survey of the en- 
vironment in which workers live and an 
exhaustive study of conditions under which 
they work are necessary in order to deter- 
mine satisfactorily the circumstances con- 
tributing toward ill health and accident, 
126 MEDICINE AND HEALTH 
127 
These studies, together with social-service 
activities, are being greatly encouraged at 
the present time by many employers of 
labor since it has been abundantly demon- 
strated already that the increased efficiency 
resulting from good health and freedom 
from unnecessary home cares and anxiety, 
avoidance of fatigue, and other unhygienic 
conditions and surroundings more than re- 
pays the pecuniary outlay necessary to 
secure it. Hence it is that medical men 
have come to pay increasing attention to 
matters of this sort and quite a medical 
specialty has been developed in conse- 
quence. 
Enough has been accomplished to demon- 
strate that there lies in this direction a 
most fertile field for development and re- 
search which only awaits the intelligent 
efforts of well-trained and earnest young 
men in order to yield boundless returns 
from their efforts. The services of com- 
petent young men at good salaries are in 
great demand by corporations of all kinds 
in order to supervise the physical activities 
of their employees and their families. 
Public health is becoming more and more 128 
THE PHYSICIAN 
an object of interest not only to the pro- 
fession but to the public itself. Public 
opinion is being enlightened and aroused 
in a way never before known and legisla- 
tion making toward a better condition of 
affairs both in town and in country is all 
the while becoming more easy to secure 
and more sure to be enforced. New oppor- 
tunities are being constantly created for 
useful, even distinguished careers for the 
young medical man who enters this depart- 
ment of public service. Schools of hygiene 
and sanitation where special study is made 
of all these problems in their widest aspect 
and application are gradually being estab- 
lished throughout the country and large 
sums of money are being donated for this 
purpose. A most attractive field in which 
to labor is here presented to the ambitious 
young doctor, much of which will be pioneer 
work, offering great opportunities for orig- 
inal investigation and research to those so 
inclined. This affords a particularly at- 
tractive field to young women anxious to 
embark upon a career of usefulness to so- 
ciety and of interesting possibilities for 
themselves. CHAPTER XIII 
GROUP MEDICINE 
It will be a sorry day for humanity if 
the type of general practitioner, the family 
guide, philosopher, and friend ever becomes 
extinct. The world and society in general 
will be the loser. He may not know so much 
medicine; he may not be able to recognize 
and call by name many of the rarer and 
more modern differentiations of disease con- 
ditions, but he has something that the in- 
dividual needs and that nothing else quite 
supplies. Certainly that modern develop- 
ment known as “group medicine,” impor- 
tant as it is, does not quite fill the bill. This 
recent development, however, has come to 
stay. It has arisen to fill a need recognized 
and felt by the profession more keenly 
than by the general public. The inability 
of any one man to become conversant with 
all the advances in medicine in its various 
departments, or to acquire sufficient skill 
129 130 
THE PHYSICIAN 
in all branches to do justice to his patient, 
has compelled the conscientious doctor to 
call in the aid of the specialist. This latter 
genus has multiplied so rapidly in recent 
years, and a thorough physical examination 
has at the same time become such a formi- 
dable and complicated affair that the services 
not alone of one but of many specialists 
may be required before a complete and 
comprehensive examination and diagnosis 
can be obtained. Hence it is that both 
the necessary amount of skill and labor in- 
volved in making a diagnosis and in the 
subsequent treatment, combined with the 
expense incident to the services of the spe- 
cialists required, render advisable some 
sort of team-work that may at the same 
time reduce the cost within the means of 
the patient. In response to this need, 
“group medicine,” or the “ diagnostic clin- 
ic,” as some prefer to call it, has arisen. It 
is simply a development of the idea of the 
division of labor and specialization of func- 
tion applied to modern medicine. This 
idea has been tried out in various quarters 
for some time past. Experience has shown 
that it is capable of high development and GROUP MEDICINE 
131 
may be productive of most satisfactory 
results. 
On the other hand, as in most things, 
there is the possibility for great harm and 
injustice to the public from combinations 
of unscrupulous individuals to exploit the 
sick, especially the large class of neurotics, 
for their own pecuniary advantage. The 
young doctor should not start out with the 
idea of joining any such combination as 
this, but should aim in every way to secure 
as broad training as possible in the labora- 
tory and clinical sides of medicine before 
he thinks of specializing. Let him become 
as proficient as possible in all departments 
before determining what, if any, specialty 
will engage his attention. The particular 
specialty chosen will usually depend upon 
a natural aptitude or liking for some one 
particular line of work or study, or one may 
be drawn into it by an especially good open- 
ing in that direction. One should be very 
sure that there is sufficient opportunity to 
develop in the special direction considered 
before finally deciding to take it up. Cer- 
tain specialties are comparatively narrow 
and limited in their scope, and do not af- 132 
THE PHYSICIAN 
ford a sufficiently wide field for great de- 
velopment. It is a mistake to confine one’s 
activities to too narrow limits. It tends 
after a while to make one feel that he knows 
all about his particular subject, which is a 
bad mental attitude; it contracts his mental 
horizon, makes him one-sided and kills 
initiative. The medical student should 
never think of the subject of a specialty, 
and the young practitioner would do well 
to consider well and long the question, and 
perfect himself in the fundamentals of his 
profession, before deciding to concentrate 
his energies along any one particular line. CHAPTER XIV 
SPECIALTIES 
The consultant or the specialist, in order 
to be in truth what he is in name, will arrive 
at this stage of professional development 
only through hard work, close application 
and study, and wide experience. Anybody 
can set up to be a consultant or call himself 
a specialist. Unfortunately, there are those 
who assume these high stations without 
adequate preparation and training; and 
more is the pity, there is no power at the 
present time to stop them. The specialist 
who is really what the term implies must 
have as the basis of his specialty, whatever 
it may be, a preliminary training in general 
medicine and surgery. He must also have 
some knowledge of the allied sciences and 
of the other specialties in order to be able 
to take a comprehensive view of the special 
case presented. Otherwise he, of necessity, 
133 134 
THE PHYSICIAN 
cannot progress beyond the narrow and 
provincial view-point. He sees all of his 
cases and problems through the same pair 
of spectacles, and hence must often fail to 
grasp the true situation, to the great detri- 
ment of his patients’ best interests and the 
discredit of the medical profession. 
Every educated physician will agree that 
any one who is considering taking up a 
specialty should first devote himself to lay- 
ing the broadest possible general scientific 
foundation upon which to build that spe- 
cialty. The more general medicine a sur- 
geon knows, the better diagnostician will 
he become, and the better able to decide 
which case should be transferred to the 
surgeon and which may safely be trusted to 
the “vis medicatrix Naturae,” supplemented 
by what assistance the doctor can render. 
Furthermore, the more that one specialist 
knows about the other specialties, the better 
will he be able to differentiate his cases. 
Some subjects may justly be entitled to 
be set apart for special consideration and 
study because they are relatively so de- 
tached from other anatomical structures 
and physiological and pathological problems SPECIALTIES 
135 
as to form, in a way, a province by them- 
selves. Such, for instance, are the eye, ear, 
nose, and throat, the surgery of the brain 
and nervous system, etc. There seems, re- 
cently, perhaps, to be too great a tendency 
toward overspecialization and the creation 
of a lot of purely artificial specialties by 
still further subdividing those already 
existing. This tendency upon the part of 
the profession should be combated as nar- 
rowing and limiting to too small a scope 
one’s intellectual and professional activities. 
That a reasonable amount of specialism is 
rendered absolutely necessary by the ever- 
increasing range of knowledge due to new 
discoveries and widening spheres of profes- 
sional activity, none will deny. One head 
can no longer contain all medical knowl- 
edge, But specialism and specialties must 
be controlled in some way and be subject 
to proper examination and supervision by 
competent authority, if the best interests of 
the public are to be conserved. Efforts 
are already under way in the various special 
departments of the American Medical As- 
sociation to correct these abuses and to 
establish certain standards of efficiency to 136 
THE PHYSICIAN 
which all who aspire to practise these 
specialties must conform, and results are 
confidently expected in the near future. 
One feature of specialism that attracts is 
the fact that one can ordinarily control 
one’s time better than when engaged in 
general work. Then, too, the hours are not 
so long and the pecuniary returns, as a 
rule, are better. There is an additional 
attraction to the lazy man in that the more 
limited the special field, the less does it re- 
quire wide study and reading in order to 
attain a reasonable degree of proficiency. 
So it is that while theoretically the special- 
ist should represent the highest type of 
professional activity and attainment, and, 
generally speaking, he does, yet not infre- 
quently the reverse is quite true, and a 
rather narrow type is the result. The re- 
lationship that exists between the special- 
ist and his patient is never quite the same 
as that between the general practitioner 
and his patient. It rarely attains the same 
close and confidential character as that 
enjoyed by the family doctor. The bulk of 
the work of the specialist is office practice. 
He does not come into contact with the SPECIALTIES 
137 
patient in his home. His work is thus kept 
on a more strictly business basis and loses 
much of the intimate personal nature en- 
joyed by the general practitioner. CHAPTER XV 
EXPERIENCE 
Sir William Osler has very well said 
that the value of experience is not in “see- 
ing much, but in seeing wisely,” and he 
never said a truer thing. Experience, to 
be of any real value in medicine, must 
always be coupled with judgment. It is 
valuable to the physician to have seen 
many cases only when he has observed them 
carefully, treated them properly, and wisely 
interpreted their lessons. Otherwise, this 
wealth of experience may but serve to con- 
firm the practitioner in his faulty premises, 
preconceived opinions, and questionable pro- 
cedures. How often is it observed that 
some ignorant fellow, lacking in sufficient 
training and in all the essentials requisite 
to good scientific work, evolves out of his un- 
tutored mind some wild, half-baked theory 
or rule of practice based upon inaccurate 
observations and unwarranted deductions 
therefrom. Because Scotchmen are gen- 
138 EXPERIENCE 
139 
erally supposed to be a hardy race, and 
because oatmeal is one of their chief articles 
of diet, it does not necessarily follow that 
oatmeal possesses unusual excellence as an 
article of diet. May it not the rather be 
taken simply as an additional evidence of 
the hardiness of the Scots that they can 
thrive upon such a diet ? 
Experience improperly interpreted may 
become a source of real danger. Instead of 
a professional asset, it may become a liabil- 
ity. How often in the course of the history 
of medicine has it not happened that some 
foolish fad or fancy founded upon some- 
body’s misinterpreted experience, backed 
by the weight of sufficient authority, has 
dominated medical thought and controlled 
medical action through long periods of time, 
to the detriment of progress along rational 
lines and to the injury of those so treated! 
Experience, in the true sense of the term, 
does not come to all with increasing years 
nor with widening opportunities. His ac- 
cumulated experiences are of value to the 
physician only in so far as they are correctly 
interpreted. They may become a source of 
positive harm if they are improperly under- 140 
THE PHYSICIAN 
stood or applied. Indeed, the larger the 
experience that one has had, that has been 
misunderstood or improperly interpreted, 
the more dangerous does that physician or 
surgeon become, for his judgment will even- 
tually be so vitiated and warped thereby 
that in his mind right may become wrong 
and wrong right. This condition of affairs 
may be observed in almost every phase of 
life, in politics, in law, in medicine, even in 
theology. What of the various “isms” with 
which the history of medicine is punctu- 
ated ? What of certain political and theo- 
logical dogmas that have from time to 
time held temporary sway in our own and 
other lands? All founded upon false theo- 
ries, the result of a misconception, an im- 
proper interpretation of facts, real or im- 
aginary. 
Shakespeare whose wonderfully accurate 
observation entitles him to be heard upon 
almost any subject, has this to say: “Ex- 
perience is by industry achieved, and per- 
fected by the swift course of time.” How 
very true! The same idea is, in a measure, 
conveyed by the adjective most often em- 
ployed in describing the individual whose EXPERIENCE 
141 
experience is such as to entitle him to be 
heard and his judgment to a measure of 
respect above that of his fellows, namely, 
“ripe.” The medical man who by his in- 
dustry in seeking out additional opportuni- 
ties for observation along all lines pertaining 
to his profession, by his painstaking accu- 
racy, by his time-consuming thoroughness, 
by his careful attention to irksome routine 
and detail, both in examination and record 
of his cases, and by burning the midnight 
oil in the study of the recorded experiences 
of others, and in mature reflection upon 
those of his own, has at last, his judgment 
mellowed like ripened fruit, become “per- 
fected by the swift course of time.” He it 
is who has in truth “by industry achieved” 
experience and a sound judgment. 
“In the investigation of any subject con- 
cerning which we regard ourselves entitled 
to a judgment, not only should we seek as 
wide a range of observation as is possible 
concerning the facts upon which we found 
the judgment, but we should acquaint our- 
selves also with what other men have 
thought and written upon the subject. This 
is to be done not that we may slavishly 142 
THE PHYSICIAN 
acquiesce in their judgment, but that by a 
critical examination of all that is known 
and reported we may be the better able to 
defend our own position, or the more reason- 
ably to modify or to abandon it, as the 
case may be.”* 
One’s experience is of benefit only when 
the observations upon which it is based are 
made with care and accuracy. The facts 
thus collected, when compared with other 
similar facts gathered elsewhere under like 
conditions and studied in their proper rela- 
tion to each other, begin to assume some 
importance. When a sufficient number of 
observations have been accumulated and 
recorded, and their significance compared 
and checked up with the observations of 
others made under similar conditions, then, 
and not until then, does the experience 
begin to be of real value. Isolated, uncon- 
firmed, and uncorroborated observations 
may be of value in the way of suggestion 
and thereby aid in developing new lines of 
thought and progress, but are of little value 
in determining policies of action or in de- 
ciding most questions of pathology, diag- 
* Hibben. EXPERIENCE 
143 
nosis, or treatment. The main result of 
wide experience along any line is to be ob- 
served in the development of one’s mental 
capabilities, increasing one’s powers of ob- 
servation, thus giving an insight into things 
otherwise obscure and providing a greater 
“breadth of view, which is of the very es- 
sence of wisdom.” CHAPTER XVI 
ETHICS OF MEDICINE 
A high standard of honor carried into 
our relations with each other is but another 
name for “medical etiquette,” a subject of 
much mystification to the public and not 
a little misapprehension as to its true sig- 
nificance among members of the profession 
itself. But it is simple enough. If one 
would only take the trouble to analyze it, 
one would find but an adaptation to pro- 
fessional needs of the time-honored Golden 
Rule, “Do unto others as you would have 
them do unto you.” There are all kinds of 
people attempting to treat human ailments 
and diseases by all manners of systems or 
cults. The methods of advertising the 
supposed virtues of these various so-called 
schools of healing, the brand of morality 
and ethics of those who practise them, and 
the systems themselves are seldom above 
reproach. They have existed from time 
144 ETHICS OF MEDICINE 
145 
immemorial and will continue to wax and 
wane as long as human nature is as it is, 
as long as people ordinarily sane and sensi- 
ble about other things continue to act as 
foolishly as they do about matters pertain- 
ing to their health. Medical ethics or eti- 
quette sprang into being as an attempt to 
protect the public from the practices that 
are a very important part of the stock in 
trade of the charlatan and quack and which 
are neither modern nor original. History 
abounds in records of medical fakirs and 
sharks, and the rise and fall of their silly 
systems and theories of medicine. While in 
special instances, perhaps, overconscientious 
or too zealous members of the profession 
have been led into error by the too literal 
interpretation of certain provisions of the 
code of medical ethics, every profession 
must have its own code of ethics, and every 
individual member of the profession must 
have his and must live up to it, if a well- 
ordered social fabric is to be maintained. 
Unless the spirit of the Golden Rule in some 
measure prevails, society will soon relapse 
into a state of barbarism. Without going 
further into details, suffice it to say that 146 
THE PHYSICIAN 
medical ethics is an important and funda- 
mental element in the education of a medical 
man, and without an adequate appreciation 
of its importance or a thorough conformity 
to its standards, a doctor may become in- 
stead of a blessing a veritable curse to a 
community. 
The code of ethics recognized by the 
medical profession and governing its con- 
duct to-day had its origin in the famous 
Hippocratic Oath, dating back to approxi- 
mately 400 B. C. and which, because of its 
interest and importance, is here quoted in 
full. “For twenty centuries this has been 
the ‘credo’ of the profession, and in many 
universities it is still the formula with which 
men are admitted to the doctorate.’’ 
I swear by Apollo, the physician, and Aescula- 
pius and Health (Hygieia) and All-Heal (Pan- 
acea) and all the gods and goddesses, that, ac- 
cording to my ability and judgment, I will keep 
this Oath and this stipulation, to reckon him who 
taught me this art equally dear to me as my 
parents, to share my substance with him, and re- 
lieve his necessities if required; to look upon his 
offspring in the same footing as my own brothers, 
and to teach them this art, if they shall wish to 
learn it, without fee or stipulation; and that by ETHICS OF MEDICINE 
147 
precept, lecture and every other mode of instruc- 
tion, I will impart a knowledge of my art to my 
own sons, and those of my teachers, and to dis- 
ciples bound by a stipulation and oath according 
to the law of medicine, but to none others. I 
will follow that system of regimen, according to 
my ability and judgment, I consider for the bene- 
fit of my patients, and abstain from whatever is 
deleterious and mischievous. 
I will give no deadly medicine to anyone if 
asked, nor suggest any such counsel; and in like 
manner I will not give to a woman a pessary to 
produce abortion. 
With purity and with holiness I will pass my 
life and practise my art. 
I will not cut persons laboring under the stone, 
but will leave this to be done by men who are 
practitioners of this work. 
In whatsoever houses I enter, I will go to them 
for the benefit of the sick, and will abstain from 
every voluntary act of mischief and corruption, 
and, further, from the abduction of females or 
males, of freemen and slaves. Whatever, in con- 
nection with my professional practice, or not in 
connection with it, I see or hear, in the life of 
men, which ought not to be spoken of abroad, I 
will not divulge, as reckoning that all such should 
be kept secret. 
While I continue to keep this Oath unviolated, 
may it be granted to me to enjoy life and the 
practice of the art, respected by all men in all 
times! But should I trespass and violate this 148 
THE PHYSICIAN 
Oath, may the reverse be my lot!—(Adams, n, 
779, cf. Littre, IV, 628.) 
Small wonder that a profession that sub- 
scribes to such an oath should be both ideal- 
istic and altruistic. It is the proud boast 
of its members that its spirit, as well as its 
letter, is the guiding principle in the lives 
of all true disciples of Aesculapius. Altru- 
ism in its highest and best sense is the pro- 
fessional watchword. 
In the last analysis, the code of medical 
ethics means simply this—that one doctor 
wants to be very sure that in all of his deal- 
ings, both with his patients and his pro- 
fessional brothers, he follows implicitly the 
spirit of the Golden Rule. CHAPTER XVII 
CRITICISM OF ONE’S COLLEAGUES 
A doctor, more perhaps than any other 
man, will need in the practice of his pro- 
fession a greater variety of talents, more 
diversified skill and attainment than a 
member of any other calling. He will be 
called upon to give advice in a wider range 
of subjects and must exercise all of his senses 
to a greater degree, perhaps, than any one 
else. It so happens, then, that a doctor 
is usually a well-rounded man. There are 
comparatively few narrow-minded mem- 
bers of the profession, and they are confined 
mostly to the specialties. He is very hu- 
man, as a rule. He must be, to succeed at 
all in his profession, for an intimate knowl- 
edge and understanding of human nature is 
essential to success. Then, too, charity is 
one of the chief characteristics of the aver- 
age doctor—not in its limited sense of alms- 
giving—although most physicians are gener- 
ous to a degree. It almost amounts to a 
fault in some, and not infrequently their 
149 150 
THE PHYSICIAN 
families are the sufferers therefrom. If any- 
thing is calculated to make a man criticise 
another less severely or judge his fellows 
less harshly, it is a thorough knowledge of 
all the facts in the case and a complete 
understanding of all the extenuating cir- 
cumstances. The true doctor soon learns 
that it never does to pass judgment upon 
any other man’s or woman’s conduct either 
in general or in particular, unless he knows 
all the circumstances in the case. It is so 
seldom that he or any one else does know 
them all that he is not long in coming to 
the conclusion that it is better never to 
criticise another’s actions harshly. The 
young doctor will do well, early in his career, 
to learn thoroughly and well the lesson that 
it is best never to criticise any one. Partic- 
ularly is this true with reference to criticism 
of another doctor, especially to a patient who 
has reported some action or word of his, be- 
cause so often, with the best of intentions, 
the particular incident may have been mis- 
represented or misunderstood. Much harm 
may thus be done to a perfectly innocent 
brother, and a doctor’s life is hard enough un- 
der the best of conditions, without the addi- CRITICISM OF COLLEAGUES 
151 
tion of any unnecessary burdens. A phy- 
sician’s first duty is always and under all 
circumstances to his patient. Every other 
consideration is secondary to this. But in 
protecting the rights of the patient, it is 
seldom necessary for one physician to criti- 
cise unfavorably the acts of another. He 
may often do what is necessary without 
taking occasion to comment unfavorably 
upon the action of his professional brother. 
Let it be distinctly understood, however, 
that when the exigencies of the occasion 
demand it, and when for any reason the 
welfare of the patient or society is to be 
conserved thereby, there should be not the 
slightest hesitation upon the part of the 
medical attendant to do the thing that is 
indicated, no matter how disagreeable—in 
other words, assume and defend the position 
required by the best interests of his patient. 
No word or deed should be omitted that is 
calculated to benefit the patient, and neither 
fear nor favor should influence his actions 
or deter him from following the course 
dictated by his better judgment, if he would 
retain his own self-respect and live up to 
the best traditions of his profession. CHAPTER XVIII 
ALTRUISM IN MEDICINE 
The spirit of altruism has ever pervaded 
the profession of medicine, and has exerted 
a dominating influence upon the lives of 
its practitioners. The statement of the 
Great Physician, “I came into the world 
not to be served, but to serve,” has ever 
been the motto of those worthy to be called 
physicians. There are many wolves in 
sheep’s clothing, trying to force themselves 
into the fold, many ignorant and misguided 
individuals practising and teaching false 
systems of medicine and strange and un- 
founded doctrines as to disease, its causes 
and treatment, whereby many have been 
deceived and much injury to health and 
loss of life have resulted. Much of this 
sort of thing is due to gross ignorance of 
the commonest and most fundamental facts 
of anatomy and physiology, of health and 
disease. This explains much that one sees 
152 ALTRUISM IN MEDICINE 
153 
and hears along this line, but it does not 
excuse it. 
The character of a doctor’s work takes 
him out of himself a great deal. Most doc- 
tors are altruistic in their outlook on life 
rather than egotistic. As a general char- 
acteristic, they are unselfish rather than 
selfish; broad-minded as distinguished from 
narrow-minded. They are optimists rather 
than pessimists. They must be so. They 
could not carry on their work satisfactorily 
if they were not. They could not bring 
the atmosphere of cheerfulness and hope- 
fulness into the sick-room if they did not 
experience some of it themselves. The 
average doctor has a rather broad outlook 
on life. He comes into such intimate con- 
tact with it, in all of its phases, that he 
unconsciously absorbs some of the spirit. 
Most doctors are lovers of nature, because 
they are dealing largely with the operation 
and effects of natural laws. Many of them 
are true philosophers. One can learn much 
from association with the average doctor, 
especially the country doctor, listening to 
his observations, keenly made and often 
originally expressed. Then that delightful 154 
THE PHYSICIAN 
association between the doctor and patient, 
which is one of the privileges and compen- 
sations of a doctor’s life, cannot be over- 
estimated. There is nothing quite like it. 
The implicit confidence, the entire depen- 
dence that is placed upon him by his pa- 
tient, while appalling to him at times, from 
the very abandon with which they are be- 
stowed, especially by his women patients, 
are nevertheless stimulating to the highest 
degree to the best that is in him. Small 
wonder, then, that the doctor occupies a 
position quite different from that of any 
other individual. 
Then there is another opportunity offered 
to the doctor which appeals strongly to 
young men and women of bright and in- 
quiring minds, namely, the opportunity to 
contribute something to the sum total of 
human knowledge. Medicine offers an un- 
limited field for investigation. Many prob- 
lems of absorbing interest and of the utmost 
benefit to mankind are yet awaiting solu- 
tion. New and attractive vistas are all 
the time opening, beckoning to eager in- 
vestigators and urging them to greater 
endeavor along many lines. To the ambi- ALTRUISM IN MEDICINE 
155 
tious there are countless opportunities, not 
only to make science and humanity their 
debtors, but to have their names inscribed 
along with the other immortals who have, 
by their painstaking investigation and cease- 
less effort, materially advanced the bounda- 
ries of knowledge. In a recent article by 
President Vincent, appearing in The Forum, 
and entitled “The Passing of the Country 
Doctor,” is given a rapid but comprehensive 
review of the underlying causes for the fact 
which has occasioned considerable alarm 
in the minds of thinking people, namely, 
that the rural districts of the country are 
at the present time not adequately supplied 
with well-trained medical men. 
The rise and development of the modem 
medical school is sketched since 1870, when 
the best medical schools in the United States 
had no requirements for entrance save abil- 
ity to pay the stated fee, the course of in- 
struction consisting chiefly of lectures and 
recitations given by busy practitioners cov- 
ering only two short terms. It was some 
years later that Harvard introduced the 
innovation of entrance-examination require- 
ments. In 1893, Johns Hopkins Medical 156 
THE PHYSICIAN 
School was organized on a basis of labora- 
tories of anatomy, physiology, and pa- 
thology. Thus the essential features of 
modern medical education were worked 
out. The necessity for a broad preparatory 
training was established. The reduction 
in the size of classes in order to keep within 
the available resources of equipment and 
personnel; the association of the medical 
schools with teaching hospitals and dis- 
pensary, the placing of greater emphasis 
on the laboratory sciences and finally the 
full-time teaching staff, both in the clinical 
as well as laboratory subjects, have been 
evolved. 
Along with these changes certain others 
have been evolved as necessary corollaries, 
namely, greater demands on clinical teach- 
ers, the increased length and cost of medical 
education, diminution in the number of 
doctors graduated, overcrowding of the 
curriculum, the introduction of new sub- 
jects, such as preventive medicine, etc. 
As a natural consequence of all this trained 
physicians who have been compelled by the 
changes referred to, to spend so much time 
and money in their training, are unwilling ALTRUISM IN MEDICINE 
157 
afterward for various reasons to go into 
the rural districts and submit to the neces- 
sary hardships and more or less isolation 
which are inseparable from country resi- 
dence. Hence it is that at the present mo- 
ment medical education is in a very unset- 
tled condition. The wisdom of the plan as 
it has been worked out and as at present in 
operation in certain centres has been sharply 
questioned by many able practitioners who 
are convinced that the innovations will do 
harm rather than good. It is too early yet 
to draw any definite conclusions. Time and 
wider experience will determine the relative 
value of the various developments. It is 
an undoubted fact that the length and cost 
of medical education constitute a very seri- 
ous problem. At the present time, the av- 
erage age of the graduate from our medical 
schools is twenty-five years. He is then 
compelled to serve an internship in some 
hospital for at least a year. Comparatively 
few doctors are making a satisfactory living 
before the age of thirty. The cost of medi- 
cal education is placed, depending on cir- 
cumstances, somewhere between five and 
ten thousand dollars. That the diminution 158 
THE PHYSICIAN 
in the number of well-trained doctors 
throughout the country is a real cause for 
concern, every one will admit. At the 
present time, the number is still decreasing, 
but it seems probable that in the near fu- 
ture a gradual increase may be reasonably 
expected. But the demand still far exceeds 
the supply. 
As has been indicated, a still more serious 
problem is the geographical distribution of 
doctors. The rural districts are being con- 
stantly stripped, and, while the urban dis- 
tricts are better off, they are not as yet 
overstocked. Several factors are recognized 
as contributing largely to this unequal 
distribution. In the first place, of course, 
the hardships and isolation which are neces- 
sarily associated with a country practice. 
But perhaps more potent than this is the 
necessary separation, under existing* condi- 
tions, of the country doctor from the bene- 
fits and assistance of laboratories and hospi- 
tals which modern medicine demands as a 
sine qua non for effective diagnosis and 
treatment. As it is now, the vast majority 
of country doctors are isolated from these 
necessary resources. As yet, no satisfactory ALTRUISM IN MEDICINE 
159 
solution of these problems has been arrived 
at. Various experiments and proposals 
have been suggested, among which may be 
mentioned diagnostic pay clinics, health 
centres, community hospitals, etc. None 
of these wholly meet the requirements and 
are not without obvious objections. The 
multiplication of small hospitals in the 
country would appear at first sight to solve 
the problem, but any one who is at all fa- 
miliar with hospital management will recog- 
nize at once the difficulties and dangers of 
this plan. A hospital improperly manned 
with unskilled staff and inefficient manage- 
ment, instead of being a benefit, is in danger 
of becoming a real menace to the health of 
the community in which it is located. The 
objections to this plan, while not insuper- 
able, are of such a character that until the 
supply of trained clinical and laboratory 
men becomes sufficient to meet the demand, 
it is clearly not feasible. A more practical 
suggestion, but one which appears to some 
to be a step backward, is the development of 
a type of medical school not so advanced as 
some of the present “Class A” medical 
schools, but, still, sufficiently advanced to 160 
THE PHYSICIAN 
give a shorter and more intensive course of 
training to a class of men with a high- 
school education, who would be willing to 
go into the country and outlying districts 
and take the place of the rapidly dwindling 
ranks of the country doctor. If some remedy 
is not found in the comparatively near future 
which will help to relieve the present unfor- 
tunate situation, the country will be over- 
run with an army of charlatans, quacks, and 
representatives of the various so-called 
“healing cults.” CHAPTER XIX 
THE HUMOROUS SIDE OF MEDICINE 
A doctor’s duties are a strange mixture 
of the pathetic and the humorous. He is 
not infrequently called upon to laugh with 
those who laugh and to weep with those 
who weep. Happy is he and thrice for- 
tunate who cannot only smile with those 
who smile but can find something to smile 
at now and then when a smile may relieve 
a very trying situation. The doctor with- 
out a well-developed sense of humor is to 
be pitied. 
In human experience tragedy is not far 
removed from comedy, and the humorous 
and pathetic are not infrequently in close 
relationship. No one realizes and appre- 
ciates this fact more than the doctor. For- 
tunate is he who can see the funny side of 
things serious. It often relieves an other- 
wise trying situation. The writer was 
once consulted by a lady dressed in the 
deepest mourning. Examination and the 
history of her trouble both strongly sug- 
161 162 
THE PHYSICIAN 
gested the presence of gall-stones and the 
advisability of a surgical operation for their 
removal. When this opinion was stated 
to her as tactfully as possible, she, with 
clasped hands and tear-filled eyes, in plead- 
ing tones exclaimed: “Oh, doctor, doctor, 
do not tell me that! You know I have just 
become a widow and I do so want to live.” 
Not having had the pleasure of the ac- 
quaintance of the lately deceased husband, 
the writer was unable to surmise whether 
it was a happy release or other prospects 
that inspired the strong desire for continued 
existence. 
Upon another occasion a maiden lady of 
uncertain age consulted the writer with 
the history of having received a serious 
fall, from the effects of which she had since 
suffered considerably. She seemed exceed- 
ingly nervous and for some unexplained 
reason was evidently greatly embarrassed 
and distressed. With some difficulty and 
the exercise of as much tact as he possessed, 
the writer finally succeeded in developing 
the fact that her chief trouble was located 
in one of her knees. It was then suggested 
as diplomatically as possible that it would THE HUMOROUS SIDE 
163 
be impossible to treat satisfactorily the in- 
jured member without inspection and ex- 
amination. After a painfully embarrassing 
pause, she produced from beneath the folds 
of a cloak which she wore a hitherto care- 
fully concealed package wrapped in brown 
paper which, after some hesitation, she 
proceeded slowly to unwrap, revealing a 
girl doll-baby completely clothed. Then, 
cautiously lifting the hem of the skirt, she 
exposed a portion of the doll’s bared knee 
and, pointing to a definite spot, remarked: 
“There, doctor, is where I have hurt my 
knee.” Long training and due regard for 
the lady’s feelings enabled the writer, with 
the utmost seriousness, carefully to in- 
spect the doll’s knee and prescribe there- 
for. Apparently the vicarious treatment 
resulted satisfactorily, or perhaps it was the 
fear of subsequent examination and ex- 
posure, for a prompt recovery followed. 
It is curious the different effect that ill- 
ness has upon men and women. As a rule, 
women, perhaps because they are more 
accustomed to it than men, act much more 
naturally than do men. They are differ- 
ently affected, both according to their 164 
THE PHYSICIAN 
varying dispositions and the nature of 
the affection. Some apparently bear their 
infirmities with stoical indifference, while 
others display a surprising lack of the tradi- 
tional masculine virtues. A man may simu- 
late with more or less success and mask his 
true feelings, but, in the case of the majority 
of women, they are not ill long before the 
doctor, if he is the proper sort, has a pretty 
true insight into their inner consciousness. 
A refreshing frankness, at times rather 
startling and even disconcerting in its very 
abandon, characterizes the relations be- 
tween the average woman and her doctor, 
if she has confidence in him. The exact 
reverse is true if this confidence is lacking, 
in which case he can do nothing. Humor 
is one of the best agencies that a doctor has 
to help him in dealing with certain classes 
of individuals. If the patient can be made 
to see the funny side of a really serious 
situation, it often helps wonderfully. This 
fact was brought out very forcibly upon 
many occasions on the battle-fields and in 
the hospitals in France during the World 
War. CHAPTER XX 
THE GRATEFUL PATIENT 
“God and the doctor we alike adore 
But only when in danger, not before. 
The danger o’er, both are alike requited, 
God is forgotten and the doctor slighted.” 
The unknown author of these lines must 
have been a doctor and must have penned 
them in a moment of despondency, such 
as comes every now and then to every 
medical man after he has had dealings 
with a certain class of patients familiar to 
us all. This type is most exacting and in- 
sistent in his demands upon our time and 
attention when he is ill or imagines that 
he is, which is frequently the case. Under 
these circumstances, he is always most in- 
different to the claims of others and selfish 
to a high degree. But when he is recover- 
ing and thinks himself safe, he is ever prone 
to become most forgetful and unapprecia- 
tive of past services rendered. Fortunately, 
165 166 
THE PHYSICIAN 
however, all patients are not like this. 
Every doctor is familiar with the genus 
“G. P.,” otherwise known as a “grateful 
patient.’’ He or she, it is more frequently 
the latter, is the cheapest and best adver- 
tisement that a doctor can There is 
no counterpart to the “grateful patient” in 
any other profession. She is a great and 
unique institution. What would a doctor 
do without her, for the most militant type 
is always of the gentler sex, to fight his 
battles for him; to stand up for him through 
thick and thin; to defend him against the 
verbal assaults of the grateful patients of 
his professional rivals; to advertise him 
and his virtues, real and fancied, at every 
afternoon tea and in every sewing-circle 
and club of which she is a member. It would 
be difficult to imagine practising medicine 
without her. The doctor’s office and home 
would be far less well furnished; his library 
book-shelves less well filled with popular 
volumes; his personal wardrobe less striking 
and complete but for her. 
The character and extent of the pro- 
fessional service may be, and frequently are, 
entirely disproportionate to the gratitude THE GRATEFUL PATIENT 
167 
of the patient. But that makes little differ- 
ence. For the past fifteen or twenty years, 
the first reminder the writer has had each 
year of the approach of the Christmas 
season has been in the shape of some little 
gift from a certain poor widow from the 
side of whose nose he had removed a small 
warty growth, the size of a grain of wheat. 
It had been so situated, however, that every 
time she opened her eyes, she saw it, and 
it looked to her as big as a house. Her 
gratitude upon its removal was correspond- 
ingly great. Every true doctor has experi- 
enced this feeling of friendship and obliga- 
tion to him that brings out and develops 
in the patient such admirable qualities of 
heart and mind, and that makes the family 
doctor the power for good that he is and 
the most loved and trusted of men. 
Grateful patients are present in every 
community. Every sewing-circle contains 
a representative. Afternoon teas and other 
social gatherings would be tame affairs 
without the animated discussions with which 
they are not infrequently enlivened as to 
the relative merits or demerits of the favor- 
ite doctor of some loquacious member. Up- 168 
THE PHYSICIAN 
on such occasions partisanship is apt to run 
high. A grateful patient of the writer, evi- 
dently a little doubtful in her own mind, 
once asked him if it was true that he had 
ever laughed while performing a surgical 
operation. . He replied in the affirmative 
and added that he was glad when he could 
find something to laugh at, as it relieved the 
nervous strain which at times is very great. 
He then inquired why she had asked the 
question. She replied that recently, at an 
afternoon tea, Mrs. X had come in all 
aglow with excitement, saying that she had 
just been calling at a friend’s home when 
some one had run down-stairs and said 
that there was a surgical operation going 
on in the house across the street. So they 
all adjourned up-stairs, where they could 
get a better look, and sure enough there 
was Doctor F to be seen in the act of 
operating upon some one. Said Mrs. X : 
“We could not see what he was doing, but 
right in the middle of it he looked up and 
laughed. The idea of such a thing! No 
hard-hearted, cold-blooded doctor like that 
could ever touch me.” “Then,” said my 
former patient, “we almost came to blows, THE GRATEFUL PATIENT 
169 
for I could not sit still and let anybody say 
anything against my doctor and not defend 
him, whether he was right or wrong. But I 
just wondered afterward whether you really 
had laughed or not.” Such is the exag- 
gerated and erroneous interpretation that 
is at times placed upon some innocent and 
harmless word or action of the doctor 
through misapprehension or the distorted 
imagination of the patient, or, more often, 
his friends. CHAPTER XXI 
CAUSES OF FAILURE 
Causes of failure are largely inherent 
in the individual himself, although they 
may be due to extraneous or accidental 
influences. One meets a considerable num- 
ber of men who have given up the practice 
of medicine after having gone through the 
medical school, and even after having spent 
some time in hospital service. The usual 
reasons for this change of occupation are, 
in the first place, lack of that “calling” that 
has been referred to elsewhere. If one has 
not this impelling force to urge him on over 
the difficulties and disagreeable experiences 
that are inseparable from the study and 
practice of medicine, he will probably not 
long survive the ordeal. 
The inheritance of a fortune is respon- 
sible for a considerable defection from the 
medical ranks. Then, too, a rich wife, as 
a rule, exercises a very discouraging in- 
fluence upon the practice of so arduous a 
profession. She seems to be jealous of a 
170 CAUSES OF FAILURE 
171 
profession that takes up so much of her 
husband’s time and attention. Whatever 
the real reason, it is seldom that a doctor, 
after marriage to a rich wife, ever amounts 
to much in a professional way. There are, 
of course, here as elsewhere, marked excep- 
tions to the rule, and they deserve especial 
credit in resisting the temptation to ex- 
change the trials and toil and, at the same 
time, the opportunities of a doctor’s life 
for the doubtful satisfaction derived from 
the flesh-pots of Egypt. 
The acquisition of bad habits upon the 
part of the doctor plays no small part in 
his success or failure. Intemperance is a 
fatal defect in a doctor. Some few of his 
more loyal friends and patients may stick 
to him for personal reasons, but the vast 
majority of right-thinking people will in- 
sist that a doctor’s habits must be such as 
not to interfere with his always being at his 
best, mentally and physically. He should 
not upon his part so far forget his respon- 
sibility to his patients as to allow himself 
ever to be placed, by indulgence in any 
habit, in the position where he is no longer 
master of himself and of all his faculties, 172 
THE PHYSICIAN 
for a doctor can never tell at what mo- 
ment he may, in some grave emergency, be 
called upon to make immediate use of all 
the mental and physical power he possesses 
to save a life or perform some notable ser- 
vice. A doctor of all people can least afford 
to trifle with his resources or his reputa- 
tion. Sooner or later fate will overtake him, 
and a hitherto enviable reputation, possibly 
by a single indiscretion, may be sadly 
marred. 
Failure to keep abreast of progress in his 
profession will, in the course of time, surely 
have its effect in lessened interest in his 
patients, in habits of indolence, both mental 
and physical, and in continuous deteriora- 
tion in the character of his work. It is al- 
ways a sad sight to see a professional man 
gradually losing his hold upon both himself 
and his work. 
In some men, there seems to be a fatal 
defect in character which may be congeni- 
tal, but also may be acquired, namely, the 
apparent inability to get along peaceably 
with their professional brethren. Such a 
one must always be in a row with some 
other doctor, or even patient. He is sure CAUSES OF FAILURE 
173 
that somebody is trying to “put something 
over on him,” or do him a “dirty trick.” 
He is utterly unreasonable about it and no 
one can convince him of his error. Incal- 
culable harm is done by such an attitude. 
The advice of St. Paul, “in so far as possi- 
ble, live peaceably” with one’s professional 
brethren, is an excellent rule of practice for 
all medical men to follow assiduously. 
Of course, if a man starts in on his pro- 
fessional career with the right attitude of 
mind toward it and then has the proper 
training in it, it will take much to wean 
him away from it. Lack of these initial 
factors, which are fundamental to success 
in his profession, will always tend, of course, 
to handicap him subsequently and render 
him a comparatively easy prey to the forces 
just indicated and to others as well that it 
is not worth while to discuss. So much de- 
pends upon a good start and the instillation 
of proper ideals and habits of thought and 
work that too much care cannot be ex- 
ercised in laying the proper foundations for 
a medical career.