his scheme. Necessarily these are brief, in many cases so brief as to make the work more useful for hurried reference in an unexpected time of need, rather than for thorough information, such as the practitioner, or even the advanced student, should have. The views of the author are on the whole sound, often admirable. The introduction should be read by all who are preparing for the medical course. Other indications of the high principals held by the author are often encountered through the text, and do not seem to suffer from occasional juxtaposition with recommendations of remedies not yet admitted to the "United States Pharmacopeia." In general, too, the directions for diagnosis and treatment are sound, though lapses are not infrequent. The author's tendency to look for and treat a malarial complication takes one back to the preplasmodial days. His opinion of the value of waxy casts-to indicate chronic rather than acute processes—is certainly wrong. In some of the technical directions haste has led to omissions, sometimes important for beginners, as in the descriptions of blood stains, page 44, the preparation of aniline water, and others. Sometimes the omissions are tantalizing, as when we are told (page 52): "There are peculiar cell reactions so that we can determine which cells come from primary and which from secondary tumors," without further descriptions of the alleged reactions. Repetitions are notably frequent. Antique beliefs are sometimes resuscitated, as in the assertion of the diagnostic importance of Sanirelli's bacillus. Iodophilia seems unduly exalted and its history set forth with details that would gain by references to original articles.

The directions for treatment are in the main good, but usually are too brief for anything but momentary use. Typhoid fever has a little over two pages; pneumonia not much more than one page on treatment. The work is profusely illustrated, but many of the pictures belong to the realm of portraiture rather than medicine. If one must have a cut of a stomach tube it would seem better to picture that sort in general The cut labelled "bronchocele," and also the description, seem to limit the use of that term to bronchial cyst, which is certainly not customary. The position of the patient blowing bottles is not one that is likely to further the result desired.

use.

On the whole, while the plan and scope of the book are good, it requires considerable alteration before it can be recommended for undergraduates. For the practitioner who knows enough to avoid the mistakes, it will be interesting; to others it might be dangerous if followed blindly. It is to be hoped the necessary corrections may soon be made, so that the work will all be as good as its best parts.

G. D.

By

*A Text-Book for Practitioners and Advanced Students. Augustus Caillé, M. D. With two hundred and twenty-eight Illustrations in the text. New York and London: D. Appleton & Company, 1906.

PRACTICAL DISCOURSE TO EMBARKING PHYSICIANS.*

BY FRANK B. WALKER, PH. B., M. D., DETROIT.

ADJUNCT Professor of SURGERY IN THE DEtroit college of meDICINE.

Mr. President, Associates on the Faculty, Members of the Graduating Class, Ladies and Gentlemen:

It is now thirty-eight years since this college first opened its doors to aspiring students of medicine. It is not long in point of time, but from the viewpoints of work done and of medical progress, the vista is broad and inspiring. Classes have come, pursued the round of college life, and gone, until already more than seventeen hundred and fifty students have passed before the eyes of a critical faculty and taken up the practice of medicine and surgery in thirty-nine of the United States and in many places abroad. Think of the hours of study and the efforts to teach which this army of trained men represent; calculate in your mind the services of each alumnus and the sum total of them all in the interest of life and health; picture if you can the want of all this professional skill, the kindly offices of all these devotees to duty, and then will you not place a high and lasting regard upon the results achieved through the instrumentality of this institution?

Thirty-eight years ago medical education, in spite of a hoary past, was in a very rudimentary stage of development. No one of us may hope to see the science perfected, and yet those who have lived the last. two scores of years, have witnessed greater advancement in the science and art of medicine than all the Methuselahs of the past combined. It is not my purpose to laud this faculty or to proclaim its policy, but results have demonstrated the effect of honest and earnest endeavor

*Address before the graduating class of the Detroit College of Medicine, Thursday evening, May 17, 1906.

even when unaided. Year by year saw added responsibilities put upon the college if she would do her full duty to those confiding in her nurture, and maintain a high standing among her sister institutions. These she promptly and cheerfully assumed by from time to time lengthening the course of study and enlarging its scope, by erecting larger buildings, installing and thoroughly equipping new laboratories, and withal voluntarily raising the standard of admission even though it materially cut down the income. All this has been accomplished without state, denominational, or other outside help, without any adequate financial remuneration or return for the energy expended, and often at a pecuniary loss to those engaged in the work. You may ask then the reason or need for all this labor and sacrifice. For answer I would again point to the results obtained, the charity bestowed, for in truth it is the benevolence of the work that made it live and prosper.

We have gathered here tonight, in keeping with a custom of our own, for the twofold purpose of recognizing publicly and authoritatively the completion of required medical study, and of speaking and responding for the last time as faculty and students. You, members of the graduating class, have for the past four years cast your lot with Whether or no you thoughtlessly at first chose your Alma Mater we do not know; but you knew at least that this college was particular as to who and what you were. Now that you have remained with us through to the end, and inasmuch as you are the sons not of Michigan alone but of at least eight different states, we take it that your residence here has been worth while.

us.

As the mother-bird makes a nest wherein to rear her young, and as she nurtures and protects them through the days of growth, then, when they shall have attained due strength, pushes them from the nest to try their wings in flight, now guiding and now supporting them, so your Alma Mater, after thorough education and trial of your strength, proud of your attainments, opens again her doors and leads you forth to do your part in the world's work. Life is longer than a generation; duty is for everyone; you have been drafted today.

Before dissolving the relations of the past four years it becomes us, who have been in the larger school of experience, to give you formally a few words of counsel on matters not included in the schedule of instruction. In the first place let me warn you not to be deceived by present appearances. As at your christening and on your wedding day, so now you are the cynosure of all eyes. You have just completed a long, difficult, and meritorious course of study and are about to be crowned with the laurel wreath of victory. But, unlike the victor in the games of Apollo, your real work is not done. You are merely prepared to take it up. In the school of instruction you have been fostered, excused, and protected. In the school of experience, of which Father Time is president, you will have to be solicitous, self-reliant, and courageous. Work is the law of our being. That law has greater

significance for you today than ever before. With your increased abilities and higher aspirations difficulties will be greater rather than less. You will have opportunities galore but you will also find as many others beside you seeking to take advantage of them. The question for you then is how to succeed. It is not expected of me as the spokesman of the faculty, nor is it fitting on this occasion to descant on character as a text, but you should ever bear in mind that high ideals are essential to great success. If you were to ask me to state in a word how to attain success I would answer, deserve it.

The first practical question that will come up in your minds will be where to locate? I know very well that advice on this point is seldom heeded. Everyone likes to find his own niche if possible and is willing to follow advice only in case it coincides with his own wishes. One injunction above all others on this subject, however, you should be given. Do not buy out another doctor's practice. There may be good reasons for selling and the location may be desirable, but the holding of the good will and support of another doctor's patients is very different from purchasing the good will of the doctor himself. Only recently a letter was received from a physician in the State of Washington, who asked only fifteen thousand dollars for his practice in a town of two thousand.

Another matter upon which it is customary to give advice to young physicians is that of marriage. Seven years ago we heard a member of this faculty-strange to say, still a bachelor-in speaking from this platform, declare that he doubted the patriotism of a man who does not marry. I have seen many classes go out from this institution but I have never seen one whole class depart in single blessedness. This class has not been rigidly polled, but I have been told that there are at least sixteen benedicts in it already, and another can scarcely wait until tomorrow to sing like a lark the bliss of married life. From my own observation I believe that most men need no encouragement to marry. They might, however, well take advice in regard to the choice of a wife. Burns is credited with having divided the qualities of a good wife into ten parts. Four of these he gave to good temper, two to good sense, one to wit, one to beauty-such as a sweet face, eloquent eyes, a fine person, a graceful carriage; and the other two parts he divided among the other qualities belonging to or attending on a wife—such as fortune, connections, education (that is of a higher standard than ordinary), family blood, et cetera; but he said: "Divide those two degrees as you please, only remember that all these minor proportions must be expressed by fractions, for there is not any one of them that is entitled. to the dignity of an integer."

When you shall have located you will do well to ally yourselves with the local fraternity by joining the county and state medical societies and attending their meetings. By so doing you will acquire some of your best friends, aid your establishment in the community, and

obtain the benefit of postgraduate study at home. It goes without saying that an active participation in the affairs of these organizations will secure the best results.

Your relations with your fellow-practitioners should be of the most cordial character. For your own sake do not be a "knocker." A doctor in an inland town recently told me of a fellow-practitioner with whom no other doctor in the vicinity would consult because of his unfair dealings. His aim seemed to be to disparage the abilities and methods of others. To my knowledge that particular "knocker” has already moved twice.

"The Principles of Medical Ethics," recently placed in your hands through the courtesy of the American Medical Association, indicate the correct line of conduct toward patients, fellow-practitioners, and the community, and though they are intended to be advisory merely they are well deserving of thoughtful study and adoption.

It is not supposed that any of you have taken up the profession of medicine as a money-making business. If so, there are more than nine chances in ten that you will be disappointed. You should, and doubtless will, obtain a competent living, and earn much more for which you will receive your reward in the hereafter. You will sometimes have to be satisfied without even the gratitude of patients to whom you shall have rendered valuable services. It will be gratifying to find, however, that most people expect to pay for value received. Follow the Golden Rule in your conduct and you will usually be treated in like manner. Do not be cast down if you should learn that your patients have consulted a rival. It may be that even at that moment some of your rival's patients are on their way to consult you. Be just to yourself. You need not expect to satisfy everybody or anybody always. Your individuality, if you have any, will not make it possible. Be dignified. Place a proper estimate upon your own services and do not underrate them by beating down your colleague's fees. Remember that you can never build yourself up on a substantial foundation by in any manner undermining any other person, be he physician or layman.

There has sprung up during the past few years the practice of "dividing fees." It is essentially a brokerage business, and is on a par with the practices of "runners" in "bath cities." Inasmuch as the entire transaction is done without the knowledge of and nevertheless at the expense of the patient, it becomes unscrupulous and ends in a skin game. The physician, who treats or examines and refers a patient to a specialist, should collect, for services rendered, from the patient. himself and not from the consultant, and the specialist should not exhaust the patient's ability to pay the first physician's bill. This arrangement is natural, honorable, and equitable to all concerned, while graft-seeking and bribe-giving easily descend to a traffic in human lives.

Lastly do not be a curiosity shop. Be alive to and interested in everything that attracts most men. Be public spirited. Be a politician