tangle of barbed wire, a relic of some ancient attempt to fence the wilderness. To fish under it is impossible; to fish over it equally so, for low-hanging branches sweep its upper strands. The alternative is to slip the rod through it and run the line out through the guides inch by inch with the fingers, till the fly is caught and carried down by the tumble of white water. So doing, I hook my second trout and after a struggle follow my rod through the wires and lift the flopping, struggling fish quickly on to the leafy bank. So down the great cool arch of trees I fish my brook till, as the sun sets and the cool of evening drops down from the mountains, I come to the place where my stream laughingly tumbles down its last rocky slope and loses itself in the lazy little river of the valley. And there in the cool, clear water where it mingles with the larger stream the big trout lie. Carefully I pick my way through the brush to a point where I can cast down. on the ripples. Slowly, trying each knot, I loop on a fluffy fly, all white, then another, a fuzzy pale gray miller. The dusk has settled on the world, the only sound is the murmur and gurgle of the falling water. Slowly I cast, covering the water before me with ever lengthening line, dropping the flies, now almost invisible, here and there over the wide water and gently drawing them toward me. I know the big fish is there and I know I shall get him. Another cast, a splash far down the pool! Zzzzing goes my reel, zing, and the telephone beside me brings me to my elbow, wide awake. "Maternity ward? Yes, I'll come right over." Into my white duck trousers and operating shirt, a pair of tennis slippers on my feet, a slap to my hair and I am off. Were you ever in a hospital at night? It is weird. Down the long dimly-lighted corridor I go, past the wards with their rows of beds, at the end a green-shaded lamp, where the nurse quietly works at her charts. Most of the patients are still, but here and there one sits up rocking endlessly to and fro, or leans on his elbow, wearily sighing. Past the children's ward, where, in the far corner, a nurse bends over a crying infant. Past the white and glaring emergency room, a policeman lounging in the doorway, while a white-gowned doctor and two nurses busy themselves about a moaning shape on the table. And so through a little door into the Maternity Ward. Nowhere else is romance so real as here. Here happiness and pain go hand in hand and life and death wait side by side in the shadows. COLLATION CHATS* Dr. Johnson: The Public Health Committee is certainly doing very good work. The dispensary survey was a complete analysis of the entire situation. Dr. Sneer. It was so complete that it left nothing to the imagination. Dr. J. It is not so easy to satisfy doctors; they are usually very critical. Dr. S.: Unfortunately there were few doctors present to hear the report; the attendance was made up mainly of social workers and the kindred professions and it takes so little to satisfy the so-called social worker. Their work is of such a nature that it does not permit them to scratch below the surface. Dr. J. Social workers are the very people who should be familiar with all the questions dealing with the poor of the community. Dr. S. Listening to the report one would not think that it concerned itself with the poor at all; in fact, before the committee was half through with the investigation it should have realized that in the present dispensary system the poor really were not getting a square deal. Dr. J.: What do you mean? Dr. S.: According to the report 1,250,000 people were attended in the dispensaries during the past year. No sane person would believe that in the present era of prosperity there are so many people that are povertystricken and deserving of charity. At least one member of each family in this great city honored the dispensaries last year. The per cent is still more surprising when we consider that the real poor, like schoolteachers and college professors and city employes, very seldom resort to public charity; and that the Fifth Avenue class have their own physicians and that the Christian Scientists never seek medical aid publicly. Dr. J.: The report states further that our dispensaries are inadequate for the work they are called upon to do. Dr. S.: That proves conclusively that the committee gave a great deal of painstaking study to the question. Yet, I venture to say this, that even if we were to build twice the number of dispensaries that we have, they would prove inadequate in a very short time. There is a *This chat occurred after having read the report of the dispensary survey of New York City, conducted by the Secretary of the Public Health Committee of the New York Academy of Medicine. law which penalizes imposters, but no one seems to bother about it. The only ones concerned about this law are the physicians, and they do not count. Dr. J.: A dispensary physician may refuse to attend to anyone who in his opinion is able to pay. Dr. S. He may, but he dare not for every doctor knows what will happen to his job if he objects too often. If the authorities would concern themselves with the welfare of the doctors they would not permit 2000 young doctors to give nearly 40,000 working days to the dispensaries for nothing. Dr. J.: The doctors gain a good deal of experience in the clinics. Dr. S.: Of what use is experience to a doctor if he has no patients? Besides, that old idea does not hold good any longer. Nowadays the training of a physician is such that when he gets through with the medical school and the hospital he is quite competent to treat the average patients that he may be fortunate enough to get. As things now are, a young doctor, after eight or ten years' preparation, must get ready to starve for five years or more, and very often the result is that many of them are driven to do work the nature of which would shock even the most radical of the birth-control agitators. Dr. J.: The right kind of man, no matter in what walk of life, seldom goes wrong. Dr. S. Many a young physician started out with the best intentions to practice medicine, and only after a long struggle did he find himself unable to cope with the situation, and was, therefore, compelled to travel the road of least resistance. Dr. J.: The public cannot be held responsible for that. Dr. S.: The people who manage these institutions are practically compelling these young physicians to give their time without compensation. It is the only service in the institution that is free-no wonder the community appraises it at a low value. Dr. J. No physician is compelled to work in a dis pensary. Dr. S.: The doctors are perfectly at the mercy of circumstances and helpless. They are simply the victims of a system established long ago and which is still maintained by the so-called public benefactors. In the management of the institutions the doctors have no say. Dr. J. Why do not physicians get together and point out this injustice to the proper authorities? Dr. S.: Doctors will never get together unless they are faced with economic ruin. Ordinarily, those who already are established and who have acquired large practice the so-called professors are afraid to give expression to their opinions for fear that a hospital manager may hear it. As to the younger doctors, no one ever takes them seriously or gives their opinions any amount of consideration. Besides, they are filled with trepidation and dismay when confronted by a hospital trustee. Dr. J.: Why are these questions not taken up by the proper medical societies? Dr. S. The important medical societies are usually controlled by a few men who are too young to die and too old to rule, and the result is that seldom any question pertainting to the general welfare of the profession is handled in a manner which would lead to the general betterment of the individual doctor. There would be no difficulty in demonstrating that hospitals and dispensaries can be conducted without philanthropists—but not without doctors! Dr. J.: The fact remains that poor people must have medical aid. : Dr. Ş. No physician now or in the remote past has ever refused medical assistance to the deserving poor whenever and wherever it was necessary. Dr. J.: A person may not be poverty-stricken, but still may not be able to pay for highly specialized service. Dr. S.: Expert medical service is seldom given in a dispensary. The "big specialists" are too busy even to take care of the hospital patients. They usually relegate a great part of the work to the juniors who are in the process of training. Dr. J. future. : Dr. J. As long as doctors will fight for the smallest dispensary position, so long will the hospital authorities not change their point of view. Dr. S.: If the hospital directors were men of broad vision they would not expect doctors to give 4,000,000 treatments free. They should know that neither the It is our duty to develop surgeons for the deserving poor nor the doctors are getting a square deal. Dr. J. Nothing in this world is a hundred per cent perfect. Dr. S.: The trouble is that the chiefs are remiss even in that part of the work. In a great many instances these young fellows are compelled to work out their own salvation and not infrequently they do it very well. Dr. J.: The Board of Trustees are usually not aware of everything that transpires in a hospital. : Dr. S.; Our dispensary system is not even a fiftyfifty proposition as far as the doctors and the really poor people are concerned. New York, N. Y. A. J. RONGY, M. D. EULOGY OF INSPECTOR-GENERAL COSTE (At the Fête of American Independence at Versailles, July 4, 1918.) N the Fourth of July, 1918, at the Hôtel de Ville of Versailles, the Mayor took the happy opportunity, in the presence of the principal Franco-American civil and military authorities, to recall the memory of the Medical Inspector-General, Coste, who became the first elected Mayor of Versailles February 8, 1790, after his return from America, where he had accompanied the troops of Rochambeau and of Lafayette, during the war of Independence. "De antiqua medica philosophia orbi novo adatanda" (Oratio habita in capitolio Gudiolmopolitanol, etc.) At the moment when our grand allies are preparing to leave us it seems most opportune to recall here the wise counsels which were given by our glorious ancestor in 1782. We shall see in this the road which we have traveled and the progress which has been accomplished. He alludes to the habits of the people and particularly to the abuse of tea, which he describes as universal and productive of nervous disorders. The people he deBefore a fine portrait of M. Coste, which occupied scribes as chaste, honest, temperate; they have an overpowering love of liberty, of their children and of their country. But they are inclined to melancholy and to conflict. Coste counsels them to use the gifts of Bacchus; the more that the vine dedicated to this god grows abundantly and only needs to be cultivated. one of the halls of the Hôtel de Ville, M. Simon re- Nominated Physician-in-chief of the expeditionary During his stay in the United States the Chief Physician published a short and precise Latin formulary with the following epigraph: "Quidquid praecipies, esto brevis”; also a tract upon "Asphyxia." Welcomed and acclaimed by all the learned societies of the new world, the Chief of the French army studied in turn the soil, the productions, the atmospheric conditions, the customs, the manners, the principal diseases, the epidemics and the state of American Medicine. Thus informed, Coste composed his famous discourse which he delivered in Latin, June 12, 1782, in the capital at Williamsburg, before the military chiefs of the two armies and the heads of the university. The subject was as follows: "The term of life in America is shorter than in Europe, owing to the ignorance of the medical art," he writes, and he advised the creation of three Faculties; one at Cambridge, one at Philadelphia and the third at Williamsburg. On October 7, 1782, the Commander in Chief of the American-French forces sent to Coste the following felicitous letter: MONSIEUR: I am perfectly informed of the attentive and benevolent care which you have given to the hospitals established at Williamsburg after the siege of (New) York. I pray you, Monsieur, to be persuaded that I entertain the sentiment of your goodness on this occasion and that I employ this opportunity to testify how much the public and myself owe you of recognition and thanks. I am, Monsieur, your very obedient and humble servant, On December 22, 1782, the University of Pennsylvania granted him a diploma containing this particularly eulogistic phrase: "We attest hereby how much we eulogistic phrase: esteem Jean Francois Coste, principal Physician of the armies of the King in America, Homme pleinement enstruit dans l'art médical, et dons les maniérespienvallant nous ententiérement attachéà son Roi et à la nation fran- hand and made to swing toward us, eternal champions çaise." of Liberty, the balance of destiny. As a creator of fraternal sympathies and relations, Coste has indeed deserved the recognition of his country; also in contributing to encourage this great people, who, crossing the seas, have reached to us a formidable DR. BONNETTE, Medecin Militaire. Abstracted from the "Presse Médicale," August 21, 1919, by Albert N. Blodgett, M. D., Boston, Mass. BUHOME H Now, HENRY, YOURE NOTGOING The Patient We Love. Voice at Telephone: "Say, Doc, I wish't you'd come out (5.7 miles) an' see the wife. She's been feelin' bad since mornin', but she figered she'd git along without yer. Now she's afeard she can't sleep an' she wants yer right away." |