so far as you may need to give them scientific meditation, but let nothing induce you to discuss them with curious or prurient inquirers.

A physician of social disposition is tempted often to linger in the sickroom after his proper work is done. This is a venial fault that should be avoided. It is far better, however, to sin thus than to go to the other extreme-rushing in and out of houses like a milk-man, making diagnoses by snap or guess, and prescribing placebos with the easy facility of the noisy street-corner vender of panaceas for every human ill. Let your stay be long enough to enable you to thoroughly examine the patient, and to make a prescription based on scientific principles. If these trifles hold you for a brief time only, you might with profit prolong your stay until you have made such study of the sick man's face and form as will enable you at least to recognize him should you chance to meet him on the street.

And right here it would be well to lift up voice against the habit of some young doctors (and old ones, too, when angling for practice in new places), who drive along the city or village thoroughfares at a rate of speed not demanded by the exigencies of a practice yet in the embryonic state. A jockey in livery upon a pneumatic-tired sulkey, driving Sunol or Nancy Hanks over a kite-shaped track, and straining for the goal with the velocity of a lightning express train, may be an object of public admiration; but a young doctor behind such a "critter" as his judgment of horse-flesh and lightly-loaded purse lead him to select, and seated in such a buggy as the benevolence of the second-hand dealer makes it possible for him to buy, striving to outrace death on a bumpy street, is an anachronic picture at the same time comical and disgusting to the beholder.

"Be not deceived." The public is not gulled by such flimsy shows of business, and ere long the wags will accuse the offender of training to drive a patrol wagon or Buffalo Bill's Wild West stage coach.

If you would be a successful physician you must make a profound study of human nature; see it in full dress and in its shirt sleeves. Some people like a doctor who carries a long face and the solemn dignity of a funeral director- his very presence makes them feel sicker and more consequential than before; others prefer a medical adviser of a cheerful disposition. Be, if you can be, a Hamlet, or a Mercutio, as the case may require, but never so far forget the dignity of your calling as to indulge in boisterous mirth or vulgarities of speech or manner. Never laugh at a patient. Things will sometimes happen in the sick-room which are simply side-splitting; but it would be manifest lack of tact on the part of a physician to exhibit the slightest merriment over any thing except a convalescent's jokes. Whenever the feeble sufferer makes a feeble attempt at wit, the doctor's prompt appreciation and ready laugh will do more to further the return of health than tonics or reconstructives. But if merriment be, as a rule, out of place in the sick-room, certainly anger can never be in place. Keep your temper, no matter how provocative the circumstances

may be, for loss of temper is confession of weakness, and puts you at great disadvantage with the sick and the attendants.

There are physicians who, if called once or twice into a family, delude themselves with the notion that they have from thenceforth a first mortgage bond on it. This is a foolish mistake. There are some people who play no favorites, and change their doctors almost as often as they change their collars. They are like the Irishman who, on a certain occasion, was making much noise about Irishmen and their rights: "What is it that you and your countrymen want?" asked a stranger. "We don't know what we want," responded Pat, "and by the powers we're bound to have it." If you have a patient of this sort, and find that he has called in another doctor, do not be weak and undignified enough to comment on it, or to appear to notice it in any way. Rest satisfied with the knowledge that you have done your best in the case, and if called again be sure to go. Be honest with your patients. If there is any thing the sick person or his family should know, do not fail to tell him or them. If they desire to call any reputable physician in consultation, accede to the request at once, and do not hesitate to make a like demand when you think it necessary.

It is due the physician when called to a case, that he be given absolute control of it. From that moment he is responsible for the welfare of the patient. If now the family or friends interfere and seek to hamper his actions, he will hold such behavior to show that they accord him neither courtesy nor confidence, and in justice to himself and his profession, he will withdraw from the case, and refuse to be held responsible for its outcome.

There are physicians imprudent enough to express opinions of cases they have never seen, or to allow themselves to be questioned about such cases. Nothing could be more injudicious. The best doctor, with the case before him, may make mistakes. Make no statement, even privately, until you have submitted the patient to a thorough examination. Leave the diagnosis of diseases unseen and the prescribing of medicines at long range to the quack who treats patients by letter, or to the enterprising pharmacist who adapts a drug to a distant case, with about the same chance of a hit as a gunner who should fire in the dark, or of a fit as a tailor who should make a coat for an unseen and unmeasured man. It is also prudent not to be betrayed into saying any thing in criticism of another doctor's work. There are many people who will immediately declare that your remarks are inspired by jealousy, and reckoning on the principle involved in the construction of the boomerang, you may expect your opinions to recoil upon you and not to do execution upon the physician whose ability you have called in question. Be on your guard against airing your views in cases of malpractice brought against brother physicians. In most instances there are no grounds for the action, and by making yourselves conspicuous by your remarks, you belittle both yourself and your calling.

It is best never to pay unnecessary calls. People do not appreciate a physician's visit when there is no need for it, and will fancy he comes to the house merely for the purpose of running up the bill.

If you are called in to see another physician's patient, be careful that you do or say nothing that may look like a design or a desire on your part to steal the case or the family. Make your visit, do exactly what you think ought to be done, and go.

Many a doctor rides a hobby before he has made money enough to keep a horse. He introduces it in the sick-room, the lecture-room (if he be a teacher), on the street, and in social and domestic life. It wearies, if it does not drive crazy everybody who has the misfortune to know its author and promulgator. "Little Annie Rooney" pales before it, and "Ta-ra-raboom-de-ay" can not long maintain a successful rivalry. Hobbies, if not as thick as autumnal leaves in Vallambrosa, are at least as plentiful as colonels in Kentucky. Hobbies are a nuisance, and no more tolerable than puns in conversation or mosquitoes in harvest time. Neither is it wise to allow one's self to be carried away with enthusiasm over new therapeutic fads, such as the Brown-Sequard Elixir, the Koch Consumption Cure, and some more recent supposed discoveries. It is both wise and just to investigate these things that one may see what is in them, but the physician who bears the remotest relationship to King Solomon will not go around eulogizing them as life preservers until he has put them to searching tests.

Another important item in the career of the young physician, is the judicious advertisement of himself. The Code of Ethics very properly puts its ban upon such doctors as take the field with tradesmen and proclaim through the columns of the secular papers the excellency of their methods and the number of their cures. And it would be well for rational medicine, if the doctor who is so frequently interviewed by the reporter as to the sanitary state of the town, the probability of coming epidemics, etc., and those who court cheap notoriety by getting their names mentioned in connection. with accident cases and family tragedies or scandals, could be debarred from fellowship with those who stand before the public upon unvaunted merit. But there is always at least one medium through which the physician may properly court notice, and that is the leading medical journals of the day. Keep notes of your cases and report them in the journals. Don't imagine because you may be located in some out of the way place that your articles will pass unnoticed. If there is anything meritorious in what you write, it will be sure to attract attention, and that quickly. "A prophet is not without honor, save in his own country." Our profession abounds in instances of the truth of this much quoted proverb. Americans travel more than any other people. They are constantly going from place to place. Should some one from your neighborhood visit a distant town, and there learn that you had written a fine paper which the journal of that place had published, he would return with praises of your name and comments on your fame, to the enlargement of your business, your usefulness, and happiness.

The physician whose heart is in his work will not be sordid enough to do every thing with an eye to business, nor will he allow either politics or religion to influence him in the discharge of his duty.

A school-boy, upon being asked why a man could not have two wives at one time, answered, "because no man can serve two masters." This comes home with peculiar force to the physician who itches for political preferment. He should devote himself heart and soul to his profession, and seek no office except in the direct line of his business. If he be popular enough to secure a municipal, county, or State office, he should never allow its exactions to interfere with his medical work. The moment he discovers it so doing he will be a wise man, nay, more, a conscientious man, if he give the office up at once.

It is the duty of every physician to do some charity work. A doctor should never refuse to attend the poor. Bread cast upon the waters here will be found after many days. Human diseases and human nature are the same, whether met with in the palaces of the rich or in the hovels of the poor. By ministering to the needy the young physician secures a fund of valuable experience for future use, while often, through the influence of the impecunious, he is called to see patients who are able to pay for his services. But, better than all, he cultivates among the lowly suffering ones that kindness of heart and gentleness of manner, without which he can never successfully perform the offices of medicine.

You can not have urged upon you too strongly, gentlemen, the necessity of keeping accurate accounts. No matter how little you may have to put down, put it down, and thereby lay the foundation of methodical habits. Years may elapse before a patient is in a position to pay what he owes; and, if you have failed to make record of the debt, neither he nor you will be able to determine the amount. Send in your bills regularly every month, and not every six months, as many do. A patient is more apt to pay a small bill covering a brief space than a large one that has become cumulative by time.

Be careful never to commit the injustice of making the rich pay for the poor. Physicians in every locality have regular scales of prices, and you should adhere strictly to the one that touches you. Charge all as near the fixed rate as possible, and the public will respect you for firmness in refusing to be extortionate because the patient has money.

Physicians with families make a fatal mistake if they be lax upon the business side of their profession.

Many a man with a big practice living neglects this important precaution, and dying leaves his family in poverty. Some physicians, in the wild effort to get rich in a hurry, are tempted to speculate; others, through ignorance of business matters, make foolish investments, or do their families gross injustice by failing to keep a record of their work. There are instances of this sort around us everywhere, which always point a moral and too often adorn a pathetic tale.

To neglect to keep accounts is shiftless laziness. To waste one's means in wild speculation or foolish investments is weakness. To fail to make hay while the sun shines and to grow old without a competency, or die leaving one's family unprovided for, is criminal.

It is euphonious, when such a doctor dies, to talk of his generosity and kindness of heart, and to cite the fact that in giving his time and money to the poor and suffering he left his own family without means; this, indeed, sounds well, but he would have shown himself more worthy of praise and of his family if he had protected their interests, and had departed this life after the manner of that model man of whom the poet sang:

"His debts were all settled,

His wife he adored,
He died like a Christian,
And fully insured."

I trust, gentlemen, that this homespun discourse has not been wasted upon your "too diligent ears." The pursuit of medicine is neither a series of steps up Parnassus, nor a highway to the stars, but a simple pathway upon the uneven surface of common-place every-day life. You should walk this way, not as tramps striving to get something for nothing, but as ministers to human need, earning by good work the wages you receive. Do not suffer yourselves to be misled or deluded by rose-colored anticipations; but forget not that the rewards of duty done are full and beatific compensation to him who in "life's late afternoon" recalls the incidents of a well-spent life. The doctor may not soar into the empyrean with the poet, or scale the lofty peaks of thought with the philosopher, and it is rarely his to attain riches or immortality of fame, but "when the sunset gates unbar" he may, if he have been faithful, stand crowned with ineffable glory as one who loved and served his fellow-man along the sacred and ofttimes painful line of duty.

And now, on behalf of the Faculty, I wish you Godspeed and good-bye. To each and every one of you we wish happiness and success through usefulness; and you may rest assured that in future nothing will afford us greater pleasure than to know that you have done credit to your instructors and reflected honor upon your ALMA MATER, THE UNIVERSITY OF LOUIS

VILLE.

CARDIAC STIMULATION IN PNEUMONIA.*

BY JOHN A. LARRABEE, M. D.

Professor Principles and Practice of Medicine, Hospital Medical College, Louisville.

Pneumonia has probably been the subject of more medical literature than any other disease. When I graduated in medicine I am quite certain that of thirty-five theses required of candidates for graduation pneumonia constituted about twenty-five. I well remember the compliment paid me by the faculty because I had chosen some other sub

*Read before the Louisville Medico-Chirurgical Society, February 3, 1893. For discussion see p. 215.