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SCIENCE. 



[N. S. Vol. XX. No. 503. 



labor but little of the fruits do we pluck. 

 It is demonstrated in a practical manner, 

 for when we look about us and find the 

 methods of those of our brethren whose 

 labors are not in vain each one bears the 

 scent of midnight oil. 



The development of post-graduate schools, 

 the growth of libraries, the groans of the 

 .printing press, the enthusiasm 'of medical 

 societies, all testify to the spirit of per- 

 sistent self -education that is abroad. It is 

 not for me to urge further the importance 

 of each of us taking from time to time 

 months for study and reflection. Every 

 active doctor should have his sabbatical 

 year. We dare say, extended observations 

 would uphold that in income a gain is one 

 hundredfold for each dollar invested in 

 educational outings, and for every hour 

 thus employed, ten is added to life. To 

 finance a medical man from first to last 

 successfully, we dare say spend all net 

 earnings of the first five years on self-educa- 

 tion; 25 per cent, of each five years for 

 further education ; after ten years, 10 per 

 cent, of the annual net earnings for an 

 assistant, continuing the 25 per cent, in- 

 vestment each five years. Health, happi- 

 ness, increased usefulness to the community 

 —a success which never comes from eccen- 

 tricity, equal to doubling capital every ten 

 years, would follow. To this must be added 

 the great mental satisfaction of a more 

 clairvoyant vision in the prosecution of his 

 daily duties, the inspiration that comes 

 from the doing of things, the stimulation 

 that arises from the solving of problems. 



In the course of our work it is necessary 

 for us to halt from time to time and review. 

 Few of us are they who will not find as our 

 days grow fuller an unconscious tendency 

 to slight our work, to become slipshod, to 

 hurry over matters. It is partly an evi- 

 dence of overwork. The post-graduate 

 school is the salvation. No obstacle can 

 withstand the continuity of drill, which the 



earnest of us keep in action. If, to con- 

 tinue the imposition, asked what element of 

 character is perhaps lacking to the greatest 

 detriment to the profession and public, we 

 possibly, one and all, would say courage. 

 This is seen in the hesitancy which mem- 

 bers of the profession show in giving an 

 opinion, in advising an operation and in 

 asking for an autopsy. How much confi- 

 dence is destroyed by the want of free, 

 frank avowal of the physician that he does 

 not know on the one hand, or of clear, pre- 

 cise statement of his judgment concerning 

 a case on the other! The greatest success 

 in life is confidence. How many lives are 

 lost by the worker in internal medicine not 

 advising early and unequivocally an opera- 

 tion for fear he might be wrong in his 

 diagnosis! And how many more are lost 

 because the surgeon lacks courage to do, 

 either because he fears the patient may die 

 and his record be marred, or because he 

 may operate when it is not necessary ! We 

 must admit we have had some operations 

 done when they were not required, but let 

 it be said to the credit of modern surgery, 

 we have never seen an operation of such 

 character performed by the right man that 

 did any harm to the patient. On the other 

 hand, the resort to operative procedures 

 early, and ia cases that even yet are not 

 considered of surgical relief, has saved lives 

 and lessened suffering to a degree that far 

 overbalances the now and then futile meas- 

 ure. It may be assumed, without contra- 

 diction, that every case of bad appendicitis 

 that happens to get well without surgical 

 relief has in its wake three to five that die 

 for the want of an operation. In other 

 words, the pernicious influence of a surgical 

 ease that recovers without operation is evi- 

 dent in creating the hope that other cases 

 demanding operation might get well with- 

 out it. 



And the man who does not want an au- 

 topsy—not only the centers of courage need 



