the comfort you have received from a pat upon your back and the words 'the most unselfish profession,' etc., ad nauseum.

In 1917 about forty thousand of us changed our street attire into well-fitting suits of olive drab, and took vacations from our regular work, for varying lengths of time (over 12 years in my personal case). And what happened? The fellows who did not get into uniforms were doubly busy doing our work and their own; so all-fire ding-busted busy that they let the National Politicians raise the Harrison Ante to $3.00 a year in place of the $1.00 that went through with the law 'just to make it legal.' Now then, when they raise the ante 200% at one shot, and get by with it, it begins to look as if you were too busy at attend to your own welfare. And then what? Oh, nothing, nothing at all save the pending health legislation; to ape the ways of decadent foreign medicine, etc. (Compulsory Health Insurance).

By the way, my dear doctor, did you ever note the lawyers, (who comprise most of our law making bodies), endeavoring to establish a law that will give everybody all the legal advice and protection that they may think they need, for a stipulated (small) sum annually. The 'No's' have it. And you get yours between the 'I's' when the law makers go to work upon your privileges.

Look at yourself. Your head in a cloud and your feet in the mud; wondering with your head, how you will complete the college schooling of your offspring; and mucking around, with your feet not Take a good look now even seeking firm ground.

and see if you are not proud of the image you see. The brains of a mental colossus and business ability that is (generally) less than that of the sixteenyear-old newsboy who has a business of his own You know by the time he arrives at voting age. exactly how to make a diagnosis of a hemorrhage into the posterior columns of Gaul, but I will wager a ten cent cigar (5c before the war), that you cannot tell a good oil stock certificate from a bad one. a part of The medical schools should devote the time spent in learning, to a course in businessgenuine business training.

An old 'con' man, a patient of mine for years, who always kept 'within the law,' once told me that if he ever went into the game again, he would work exclusively with the medical profession, as they were the easiest of all easy morks.

Sure; nice pat But medicine is a 'higher calling.' upon the back. 'More at stake than dollars and cents,' but it takes the dollars and cents to buy the steaks that put meat upon your bones. "Looked upon as a learned profession'-oh, yes, we admit all that twaddle. It is just such bunk that makes you wait for your bill against an estate (if you ever get it), until certain other claims are satisfied. laboring man can take the clothes from off your back, to satisfy an unpaid claim, but you cannot even garnishee unless he makes more than a stipulated minimum sum per week.

The

In the name of all things holy, why is it that the physician should be a member of the 'professions,'

can

a

I am wondering how many readers of this little heart-to-heart talk have ever sat down and carefully analyzed the medical situation as it exists today. We all remember the time when 'paper' devoted to the commercial side of medical practice would have been 'boo-ed' off the platform, and yet today, we occasionally hear some courageous brother M. D. sounding the danger Klaxon to us. Do we listen? Not so as one could notice it. Do we organize? Sure! For scientific purposes only. It would be unsuited that such a noble profession should prostitute its honor by organizing for sordid gain, or the protection of the monetary welfare of its members. Bosh, Brother, Bosh. Take your little verbal reward, and trot along home; if you expect to live and wear clothes and eat food, you had better get busy, and that, soon. Even sooner if possible.

Now then, you dreamer of dreams, who is paid for his sacrifices by laudatory words; what have you to say? Not a damn word, eh? I thought not.

When words buy beans; when enconiums purchase houses; when citations can be banked and checks drawn against them, will be the time that I agree with you in your aloofness to matters concerning 'sordid gold.' Until then, I'm for organization.

Why not show the good common sense of the plumbers, bakers, brick masons, printers, hattersin fact of almost everybody but you.

"Petty jealousies would wreck the structure?" Don't you suppose that the carpenters and the steam fitters have their little internecine feuds? Do you suppose that the miners are without their intramural 'scraps.' But they stick together and when they decide to demand that which you have decided is their right, you, my dear brother, and I, and all of us, have to sit up and take notice.

Do not think that I am advocating an eighthour day for doctors. That is too utopian for this day. But I should like to see a six-day week for the physician, with Sundays reserved for his pleasure and relaxation, except when interfered with my emergencies (which are mostly) I would like to see him spend his nights in slumber instead of in a Ford. Three-fourths of all night calls are unnecessary, but in our unorganized fight for existence, if we do not bow humbly to the telephone bell or to the peremptory rap upon the door, the next and nearest doctor will get the call and the patient -because we are not organized.

Wait, just wait until they try out the "health insurance" idea and see how much leisure is yours. In England, many doctors must average about 20 patients daily to live. Could that state of affairs have come into being if the profession had been organized as are the miners or the plumbers? Of course, it could not.

The oldest of military rules are first, "never di

vide your forces" and secondly, "try to separate the forces of the enemy." Are we undivided?

Unless the profession of medicine organizes; takes time to fight vicious legislation; and (literally) fathers laws to further its own welfare, the future of medicine in the United States is far from a dream of bliss.

In Chicago, Ill., the insurance companies (organized) became so arrogant, that when bills were rendered by doctors who had not subscribed to their fee schedule, they not only did not pay, but threatened the presumptious doctor with a well-regulated boycott. Finally, the society of Chicago physicians awakened and organized to such extent that the roaring lions of insurance avocation, became like suckling doves, and came to partake of the grain that was tendered them instead of the quivering flesh that they had expected.

Just discourage your offspring from the study of medicine; discourage others; tell them the truth ás concerns the future in medicine; then in a quarter of a century, the broad vested legislators who are ever philanthropic so long as their own welfare is not concerned, will realize what their damnable meddling has accomplished.

Study it over. Is the medical outlook at all brilliant? The "noes" have it.

My son soon enters upon his first collegiate year. He wanted to be a doctor, until I explained to him. Now then, brothers, I have done my part-it is up to you to do yours.

"If this be treason, make the most of it."

In closing this sermon whose purport is to beg that you begin to start to commence to prepare to "organize" I cast about for a "climax" that with a warp of fire and a woof of flame, would burn an irreparable hole into your thinking apparatus, and would make you remember.

Providence placed in my hands the clipping that is quoted verbatim below. I can think of no better ending for this appeal for "life" liberty and the pursuit of happiness' than from The Medical Pocket Quarterly.

WHY?

Why does a lawyer get $10-without moving from his seat-for making out a lease that any trained stenographer can fill out in ten minutes, while a physician gets only $1 to $3 for diagnosing and prescribing for a patient's ills, the correction of which will keep him fit to earn thousands? Why does a mechanical engineer get $50 to $250 for looking over a plant and telling a manufacturer where to place machinery so as to get out of it maximum efficiency, and a physician gets 1-25 to 1-125 that sum for looking over a man and tell

ing him how to get the maximum efficiency out of himself.

Why are attorneys able to collect their fees usually in advance and doctors two months to a year after service is rendered, if they ever get them at all?

Why do doctors give away $100,000,000 worth of free service a year in hospitals, clinics, home office treatment, while other men give away nothing?

Why are butchers, bakers, grocers and milkmen without education, many hardly able to read or write, able to earn more money than thousands of physicians with education?

Why do legislatures concede to lawyers practically every request they make for laws increasing the emoluments and safeguarding the interest of their profession and refuse practically all requests for increasing the emoluments and protecting the interest of physicians engaged in public health work and otherwise?

Why do doctors have to work 1 to 18 hours a day, seven days a week, to earn the monetary rewards of mechanics and other lay workers, work. ing only 8 hours a day, five days a week and half a day Saturday, with all holidays off?

Why is it that a doctor making a honest mistake in the treatment of a patient is sued for malpractice and often mulcted in heavy damages, while a lawyer making the same honest mistake in the trial and handling of a client's case is never sued and never obliged to pay a cent of damages?

Why is it that we have to pay larger premiums for indemnity insurance than rum sellers, manu facturers employing workers at hazardous tasks, and almost every other type of risk?

Because we are considered the softest and easiest class on earth on which to impose and the value of the service we render the world the least appreciated.

Isn't it time we woke up and got on our toestime we became more aggressive for our rights? FRED S. O'HARA, M. D. Springfield, Ill.

THE JOURNAL

IS

YOUR FORUM—

WE INVITE YOU

TO UTILIZE

IT FOR THE

EXPRESSION OF

YOUR VIEWS

ON

MEDICAL SUBJECTS

A. F. JENNINGS AND J. E. DELPH
DETROIT, MICH.

During a period of three weeks, in April and May, there appeared on the medical service of Harper Hospital three cases of acute pericarditis with effusion, which are reported in this paper. The details of the history and examination are summarized in the tables and diagrams. All cases were the result of acute rheumatic fever, the joint symptoms preceding the pericarditis by fourteen, seven and twentyseven days. Two of the patients, both young girls, had previously had acute rheumatic fever. One of them had her tonsils removed some years before the first attack-the other, following her first rheumatism.

The two girls did not enter the hospital until some days of their illness had elapsed. Case

Case II-Miss M. H.

Case III-Miss K. K.

II was observed by Dr. H. M. Rich and Dr. L. J. Piney. Although a pericardial friction. sound was observed by them, they concluded that there was consolidation of the whole left lower lobe. The diagnosis of pneumonia was further substantiated by a high temperature and respiration, and a rapid drop of temperature on the seventh day. Case III was carefully observed by Dr. Walter Ford. His conclusions were that endocarditis alone was present. She was indeed the most difficult case for diagnosis, and the question was open to argument up to the time of her death. Case I was under our observation in the hospital from the onset. Although the pericardial friction was observed on the second day, the pulmonary signs led to a diagnosis of pneumonia. Dyspnea was the most distressing symptom. It was very great in Case I and marked in Case II. Pain was severe in Case I and II-precordial in location. Cough was severe in Case I associated with pulmonary edema. Case I showed a mild delirium for some days. Case

II vomited. Case III, in whom the symptoms were not at all severe, was the one to eventually die.

The pericardial friction rub was heard in all three. In Case I and II it was leathery and rough in character, and could not be mistaken. In Case III it was soft and distinguished with difficulty from an endocardial sound. The diagnosis would have remained in doubt had not necropsy disclosed the condition. The friction rub persisted throughout the period of effusion in all cases.

The borders of cardiac dullness were interesting. In all there was an increase in the areas of dullness in the course of a few days at the beginning and a decrease during convalescence. The cardio-hepatic angle was diminished in all patients, but not more then would have been possible in dilatation of the right heart. The increase of dullness in these patients was most strikingly upward, reaching the first interspace or rib, and forming a broad curve in the second and third interspaces.

In all patients the apex impulse was well palpated throughout the illness, and near to the left border of dullness. The sounds became of poorer quality as the illness reached its peak, but not more so than would occur in dilatation. In Case II and III previous valvular disease had resulted in cardiac hypertrophy. In Case I, however, the enlargement of the heart must have been due to dilatation since there was no evidence of disease upon his entrance to the hospital.

In all patients the pulmonary signs were those of a considerable area of consolidation at the left lower lobe. In addition to this, in Cases I and II there was a smaller area of consolidation at the base of the right lung. The cause of this has not been determined. In Case III there was pleural effusion on the right, and later a pleural friction on the left. At autopsy pleuritis was observed. Severe pulmonary edema occurred in Case I in whom cyanosis was marked.

The graphic chart showed the pulse and respiration exceedingly high, while the temperature was only moderately elevated. This ratio. is not at all characteristic of other acute infectious diseases.

There was marked abdominal distention in all cases-most in I and least in III. The liver was enlarged and tender in Case II after some days. It was not palpated in the others. Edema of the legs and feet also appeared in Case II.

Perspiration was a marked feature in Cases I and II.

The roentgen study of the heart of Case III showed no signs of fluid, although the clinical and anatomical findings warranted the diagnosis of a small effusion. That of Case II was suggestive of fluid in that the heart shadow was excessively broad, reaching to the thoracic wall on the left, and was of the squat oval shape. The shadow of the great vessels was also markedly shortened. On the other hand, the cardio-hepatic angle was not diminished.

Aphonia, distended veins of neck, and pulsus paradoxus were not observed.

The treatment was in all cases symptomatic. Digitalis, caffeine, camphor and strychnine were used without appreciable effect. The distention was benefited by stupes and enemata. When Case I was most desperately sick, pituitrin was given, which seemed to relieve the distention and increase the volume of the pulse.

Paracentesis was considered in all cases, but not attempted. Case III was not in need of it. Cases I and II showed on examination that the ventricles were in contact with the chest wall nearly to the left border of cardiac dullness, and it was felt that the chances of withdrawing fluid in these circumstances were not sufficient to warrant the procedure. They both have recovered.