THE FINANCIAL RESULTS OF MEDICAL PRACTICE.

The medical men of the Bay State have been treated several times during the past decade to the mournful story of the meagre financial results from a life-long practice of medicine in that commonwealth. The detailed cases, narrated by Dr. Cotting, were pitiful enough, for they were proof that a faithful, conscientious and skillful medical career could find little laid aside for the “rainy day” of personal illness or the vacation for the tired brain and body, or the reposeful life of a physician’s family when death had closed in on his labors. In the same strain Dr. Jeffries, in his late annual address before the Massachusetts Medical Society, proclaims that “no man has made a fortune as a physician, I mean no one ever paid his expenses and laid by at interest enough to live on through the practice of medicine.”

This breathes in the atmosphere of complaint as if the profession of medicine were exceptional in life’s vocations; as if it, alone of all the lines of work, did not lead to financial results where “enough to live on was laid by at interest.” It is very pertinent to ask, in what pursuit in life inheres that tendency to make the laborers therein independent of labor? It is equally pertinent to ask, where is there an instance, in the history of labor, where a man, following the duty common to his fellow workers and relying on his own unaided hands and brain, ever acquired the competency to live, in his accustomed sphere, independent of labor? Dr. Cotting’s instances of the poverty of medical men are pitiful, but they are duplicated in the ranks of the promoters of literature, art, science and philanthropic work through historic time and will be multiplied to the end. Great wealth is the possession of but very few and, on the lines of legitimate industry, is always the result of combination and the use made of the labor of others. In the early part of the century, Mr. Astor founded a fortune by buying up pelts from the trappers of the Northwest. Had he depended on what his own hands could have done, his old age would have found him drying his skins and frying his bacon with his own hands in his forest cabin. Mr. Carnegie to-day, utilizing the labor of miners in iron and coal and giving direction to the skill and toil of a multitude of mechanics, is still adding to his fifty millions. Had he depended on the limitations of his own brawn, he might still each evening be washing the grime from his horny hands under the faucet in the hallway of his tenement house lodgings. These great possibilities of combination are in the genius of commercial enterprise, though they are realized by few. They are foreign to the genius of labor where combination is impossible, and where the labor is of such a character that there is no monopoly of skill and many can accomplish it equally well. A medical man’s labor is limited by what he can himself do, personally and unaided. He can neither delegate nor superintend. His income is limited by these personal conditions, modified only by the possession of some exceptional skill and the accidents of popularity or environment. The engrossing character of his occupation hinders him from the experience that justifies outside speculation with acquired capital and restrains him from participation in outside ventures which require freedom both of time and thought. He cannot well add another string to his bow.

The results of combination in trade and the income from professional labor are issues from distinct and opposite sources and have no right to be compared or made the subject of invidious reflection. A number of lawyers, each an expert in a special department, may form a partnership, occupy a common office, each helping the other, the emoluments going to the common fund. This is a sort of combine. But the time is not yet ripe, and probably will never come, for the incorporation of a great Medical Trust, with the names of a specialist in eye, ear, throat, nose, lungs, liver, sphincter ani, corns and fallopian tubes, and so on to the minutest subdivision, with the addition of some general practitioners and apothecaries, displayed around the casings of some common front door, to scoop in the community and pool the receipts on a graded tariff. Trade is essentially selfish and works for the individual. “If you don’t work for number one, number two will be working for you.” The accumulation of money is neither end nor contingent in professional life. The pursuit and application of medical science are on the higher level with the learning of jurists, scientists, educators and literateurs, whose mission is the unselfish search for knowledge for the immediate benefit of mankind and the advance of civilization.

While it is true that very few in any calling “lay by at interest enough to live on,” a very small number of that few do actually retire from active work and live on that interest, and this for two reasons: First, a man in successful professional life is in receipt of an income which enables him to live in luxurious surroundings, gratify tastes and enjoy recreation, which income, considered as interest, would represent a capital sum exceptional even among the results of successful trade, stock gambling or railroad wrecking. Such a man, and he is one of many, could live on what he “has laid by at interest,” if he saw fit to live in less luxury and sacrifice the gratification of tastes which have been cultivated and become necessary to his comfort. He could live on his interest, but he does not care to live in idleness. On the other hand, the conditions of a cultured life are of an ever widening horizon, and it is characteristic of medical men that their intellectual sense is inquisitive, keen, appreciative and alert in their own sphere of action, less satisfied with what is and more anxious for better results, beyond the genius of any other professional life, and this for the distinctive reason that every new discovery in medical science promotes accuracy in the application of medical art. Working becomes a passion with medical men; the more they know the more eager they are to work. This passion is not to “lay by at interest enough to live on.”

It is quite in the sentiment of medical addresses to bewail the profession as ill-paid, and that, for a learned and self-sacrificing body of men, its labor and accomplishments are very inadequately rewarded. The exact contrary is, probably, very much nearer the truth. There are many learned men in the profession and there is a wide range of special learning which is the common property of the profession, and all are more or less adept in the use of agencies of the art. There is, likewise, a vast amount of patient and uncompensated care given in the routine of practice, which is a natural outcome of the practice of the medical art. It would be absurd to claim the diploma as representing a liberal education or even high special attainments, as it would be ridiculous to assert that a dispensary patient regularly received the attention given to the German Kaiser or General Sheridan. There are instances of failure and poverty among medical men, but when the doctors in the country stand to the population in the proportion of 1 to 580, the assumption is that they have become needful, each to his 580. Doctors have many book charges that are not collected. Laborers are swindled by their bosses, and every business man meets his unlucky customers; the parish gets behind with its rector. The doctor is no worse off than the rest, and besides he has no salary list, and no accommodation at the bank to make good.

Most men are discontented, and the want of contentment is just as querulous with the cosmopolitan reputation that unblushingly pockets a double eagle for a few raps on the thorax as with its suburban and obscure double that explores a whole chest half an hour for a dollar. The latter pays a shilling to the village blacksmith to reset a shoe, and the former hands over eight dollars every time the farrier looks at his team. Discontent goes with a misfit, and Depew told the Syracuse students that “misfits were everywhere and were always cheap.” It is doubtful if, upon the whole, there are in any walk in life such an unbroken line of splendid fits, the man to his duty and his clientage, as in the medical profession. It is not to be doubted that medical men, each to his location, his culture, his taste and his instincts, are better housed and clothed, more liberally supplied with the machinery of their technique, have greater demands on their purse in the interests of charity and reform which are duly met, have better educated families, have longer and more frequent opportunities for enjoyment which are not wasted, than can be counted item for item on the balance sheet of the average worker in any other profession or occupation. And these are the proofs of financial success, and they put aside the plaint that because the doctors do not “lay by at interest enough to live on” they are an ill-used class of men. The community pays liberally for being taken care of, and it ought to. The medical man’s entire time is taken up in acquiring the experience to exercise prompt judgment in emergencies, and this is precisely what the community pays for and is far from niggardly in the payment. Experience, needful to prompt judgment, is worth more than day’s wages or marginal profits, and this the community recognizes, and its estimate on the value of this experience is generally just. It may not be invariably accurate, but a doctor’s annual cash total is a very liberal estimate of what his individual experience is worth to the community. If the doctor does not “lay by at interest,” it is not because he does not receive enough, but because his relations to life make a free expenditure of money a necessity. He is at a certain disadvantage with a fair share of the people in being compelled to pay his debts. An excellent physician who is also a bohemian or with loose ideas as to honorable obligation, would be a nondescript. He is a fixture in the community with an open reputation, and it is proof of his liberal income that he is able to make and sustain that reputation.

THE OPEN STREET-CAR WHISTLE.

The open street car is in its mid-career for 1888, and the fiend of the whistler is on the vertex of successful practice. The stranglers of the Orient were an occasional incident in that sunburnt civilization as compared with the death-dealing, pestilential prevalence of the Brooklyn open street-car conductor, literally “armed to the teeth” with his offensive weapon, out of whose depths, impelled by Æolic volumes from jerky and gigantic costo-diaphragmatic spasms, issue the ear-splitting and nerve-rending combination of fog-horn and prolonged rifle-crack. From stable to terminus and back, circulating along the outer step, holding on to the uprights with extended arms, facing forever the five-cent and helpless “fares,” two to four inches of potential reed or metal protruding from his embracing lips, like an ill-placed proboscis on a witless pachyderm, he summons the driver to screw up his brake and arrest his sportive team for a fare to unload, or to reverse the process for the temporary torture of more victims in hoisting in of other patrons of the line, and the shrill horror of his whistling signal, right in the faces of the passengers, is made more agonizing by the uncertainty of when and on whom it will discharge its blast, being forever ready for action, like the lance in rest of the jousting knight. It would be easy to aim this calliope at the curbstone or the empyrean, but this regard for the passengers’ tympanum disturbeth not the peaceful slumber of the tramway directory, whose shibboleth is the Vanderbilt curse of “the public be ——.” But sadder than the disregard of common-carriers for public comfort is the unearthed conspiracy of the otologists with the ill-paid conductors on the horse-cars. For some years this specialty throve on the otitis acquired at the bathing-houses at Rockaway and Coney Island, but the public discovered that a little cotton in the meatus was the needful prophylactic, and otitis, as a source of revenue, dwindled to the starvation point. Again, and for a time, the horn of plenty overflows in the otologist’s operating room, and his commissions to the car conductors promise to put them soon on a plane with the diamond-bedecked shirt-fronts of the average hotel clerk. It was said that so possessed was a certain London specialist with the operation of tonsillotomy that these amputated glands were each morning shoveled out of his office by the basketful. There are compensations all through life, and the hordes of cash boys, whose occupation vanished with the introduction of mechanical carriers into the great dry good bazaars, now find ample and continuous employment in sweeping out the heaped up fragments of shattered ear drums from the infirmaries of otological specialists. Verily, this deal among the ear men with the whistling open car conductors for the embezzlement of the community deserves the most summary and high-handed reprobation. There is but the faintest justification for such combination in the new code, but even that cannot fairly be pleaded when the integrity of the community’s ear is imperilled. A proper corps d’esprit would impel to the conservation of a professional brother’s prosperity, but even that laudable sentiment must have subordinate place when the profession at large, who are the conservators of society, see that society is likely to turn a deaf ear to the varied forms of human plaint, and all owing to the men who can neither stop or start an open car of a horse railroad without blowing out the ear drums of the community. The public is in peril and who shall be the Curtius to jump into the breach. The conductor cannot be appealed to. He is insensitive, and, besides, he is in authority. One cannot knock the beastly clarion from his lips’ embrace: there would be the claim for assault and ejection for disorder. The directors are a weak reed; they dread a strike. Municipal ordinance would be vainly sought: workingmen have a union and votes. The police, even the finest, are not open to bribery: they are at home in a brawl, and noise is their normal condition of repose. The profession must interfere. Henceforth let the cry be “boycott the whistle.” If it must exist, let the instruction be boldly posted at the starter’s office: “Conductors must aim their whistles at the curbstones and not in the ears of the passengers.”

PROMPT TELEPHONE SERVICE.

The telephone is too useful not to be treated properly. It is always an affair of two parties and each is in duty bound to be considerate of the other. The bell rings, it is answered promptly, and patience becomes well nigh exhausted before “central” succeeds in establishing the connection, and the time of the respondent is wasted. The reason for this rests on the thoughtlessness or selfishness of the one who makes the call. He rings and asks for a certain connection, and then hangs up his instrument, goes away to wait for a summons. In the meantime the respondent answers, stays by his instrument, “central” endeavors to call up the caller, perhaps through another office, the connection is often broken, and after much tribulation the connection is fully made. This is of very frequent occurrence and could be avoided, for the most part, by the caller staying by his instrument for the few seconds usually required to make the connection. There are occasional instances of bad management and some ugliness in the central office, but they are quite rare, and the service is very prompt. More delay and annoyance are caused by thoughtlessness of the users of the telephone than by any neglect of duty on the part of the operators at the central offices. One who is called up has a right to consider that he is wanted, and that promptly. It is the duty of the caller to be careful not to annoy the central office or waste the respondent’s time. Moral: When you call, stay by your instrument till the reply comes.

The Mayor has made his appointments to the vacancies in the Board of Education. The proper assumption is that they are all good men and true, able to read, write and cipher. It would be worse than libelous to give houseroom to the rumor that any member of this responsible Board ever “made his mark.” One would be properly horrified at the audacity of the narrator of such a tale as the following: A member of a local committee entered the class-room as the teacher was conducting the recitation in spelling from the Reader. After listening for awhile, he intimated his desire “to give out a few words,” which desire was politely acceded to, and the book handed to him. A number of words were correctly and promptly spelled, and he gave out the word “Egg-pit.” One child after another was downed by the astute member until the teacher, in pity for her flock, suggested that the word was not in the lesson. Smiling disdainfully at her ignorance and presumption, he pointed his No. 11 forefinger to E-g-y-p-t. Tableau. The Directory for 1888 intimates that we live in a city of nearly 800,000 inhabitants.