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Some of the positions now open for medical men are: One married physician for the Sudan; one physician for India; one physician for the Presbyterian hospital in Formosa; two physicians for general medical missionary service in Honan Province, China; one physician for hospital and general medical work for Kwantung Province, South China; two physicians for Central India; one doctor for the Teheran hospital, East Persia; one doctor for Sultanabad, East Persia; one physician for Senneh, East Persia; one physician for the North Khorasan District; a physician for the Insane asylum, South China Mission; one or two physicians in Africa; one unmarried physician for St. James' hospital, Anking, China; one unmarried physician for St. Andrew's hospital, Wusih, China, etc. In Turkey one physician is wanted in Diarbekir, in the heart of Asia Minor, to carry on a large dispensary work, which last year treated 8,300 patients, but is now closed for lack of a physician. Money is also in hand to build a hospital. Medical missionaries are not required to take a theological course, but should possess a practical knowledge of the scriptures. Postgraduate training in tropical and skin diseases is advantageous, but not essential. For a full list of the positions now open and for particulars regarding them write to Mr. Wilbert B. Smith, Candidate Secretary of the Student Volunteer Movement, 125 East Twenty-seventh street, New York.

Varicose Ulcers and Syphilis.

The possible association of varicose ulcers and syphilis (Uro. Cut. Rev. Feb. 13th), has struck many observers of late, and Drs. F. Zinsser and P. Philipp (Derm. Zeitschrift Dec. 12th), have collected a series of 36 cases of varicose ulcer in which a positive Wasserman reaction was obtained in 28. In a number of instances they also found evidences of periostitis of the tibia, as shown by radiographs. Only 8 of these showed any signs or gave any history of syphilis. The authors are of the opinion that some slight injury working upon a chronically congested part is capable of giving rise to an actual periostitis.

In a considerable proportion of cases, then, it is obvious that the specific element would not have been recognized except for the radiographic assistance, the condition being simply labeled varicose ulcer.

These facts inevitably point to the advisability of treating varicose ulcerations with antisyphiletic remedies, duly controlled by the serum test. BARNHART (Omaha)

Normal Heart Signs and Their Unnecessary Treatment.

Clinicians who have had any considerable experience in the treatment of heart disease sooner or later ascertain that, in young people especially, certain abnormal signs resist all measures and that such signs are quite compatible with normal health. In a recent paper before the Royal Society of Medicine (Proceedings, January 13, 1913) James Mackenzie, whose special competence in cardiac disorders is well known, reaches the conclusion, after a special study of the subject in a large number of young people and after taking "tens of thousands" of tracings, that many such people have been and are being subjected to various forms of active treatment for phenomena deemed morbid, which experience has taught him to be signs neither of disease nor of impairment. Candidates for insurance and for the government services are rejected if they show any intermission of the pulse at rare intervals, even though such irregularity is of little or no importance. A mitral murmur, systolic in time, is dubbed "mitral disease with good compensation" if there are no signs of heart failure, although certain functional murmurs, systolic in time, with their position of maximal intensity at the apex, base, or midsternum, not only are consistent with perfect health, but never lead to the slightest sign of heart failure. Briefly, functional murmurs and irregularities may, in the young, according to Mackenzie, be manifestations of a perfectly healthy heart, and are of significance only when associated with impairment of the heart muscle.

As to the evidences by which impairment of the heart muscle may be recognized, Mackenzie attaches importance to a change in the size of the heart due either to dilatation or hypertrophy of its walls. Yet there being no standard size, shape, or position of the organ, especially in young subjects, it is only where the morbid changes are very marked that little difficulty is experienced in recognizing them. If this is associated, in a functional disorder, with a persistent increase in the rate of the heart and marked loss of power, a valuable indication of muscular lesions is formed. In this connection, however, it is well to bear in mind that impairment of the heart muscle sufficient to endanger life may be present without increase in the size of the organ. A systolic functional murmur should not be considered to be due to dilatation; it may appear in hearts normal as to size and may be evanescent, occurring in some only when they are lying down, in others only when standing, or during excitement, or even while the heart is beating slowly

and quietly. Here again, however, we may have marked dilatation with considerable heart failure and with no functional murmurs present. The view so widely held that functional systolic murmurs indicate regurgitation, and that in consequence there is danger of this regurgitation embarrassing the heart and leading to heart failure is regarded by Mackenzie as having no existence in fact. He aims to ascertain also how the heart responds to effort by studying the effects of exhaustion through subjective symptoms.

On the whole, reserve in diagnosis, particularly if the interests of the patient are harmed by a pessimistic estimate of his condition, is in order. We might add that the whole field of physical diagnosis concerning cardiac disorders seems to require a searching analysis with the view to the elimination of what erroneous conceptions it may contain.-N. Y. Med. Journal.

Medicine as a Profession

The young man of today in contemplating a professional career should consider seriously many points before deciding upon medicine. First of all, he should fully realize the enormous amount of work ahead of him. The young man with a strong physical makeup and well-balanced mind possesses a decided advantage over his weaker brother.

One should not arrive at a decision without first making a few observations. A consultation with some of his friends in the profession and a few visits to a hospital where he has the opportunity to see the different types of medical work will enable him to gain some idea of the duties of a physician.

If a young man questions his capacity for work and his ability to sustain the effort, he should not think of entering upon the study of medicine.

The selection of a school is not of as much importance as is generally supposed, so long as one selects one of the standard schools. The didactic work may be secured in any well-conducted medical school. The practical training varies greatly. The smaller schools, properly located, train far better for the profession of medicine than the larger schools which are unable to properly handle the body of students as individuals.

From the time of entering the medical department until he ceases to practice medicine, it is one continuous program of study and work. The physician who permits a year to go by without keeping abreast of the literature of that time cannot

compare favorably his knowledge of medicine with the one who has not permitted this lapse of study.

One not in the practice of medicine has but little conception of the amount of original work and scientific investigation being carried on in the many laboratories of the world. The latter term is not restricted to the immense structures which are commonly thought of when one speaks of laboratories. Some of the highest types of work are being done under adverse conditions, which only goes to show that individual mind rather than surroundings produces the result.

If one is in love with the study, it is not a labor to carry on the work. No one should consider the profession for a minute who is not thoroughly in harmony with it.

The successes and failures of physicians form an interesting study. Practically every physician should succeed if he is well qualified and has in mind the best interests of his profession. The financial return should be the last consideration. If he has done his work well, the patient is, with few exceptions, pleased to compensate him for his work. If he has treated the patient properly, both in a scientific as well as a personal manner, he need never fear the result.

The most scientific and best trained man will not succed in practice if he is unfortunate enough to have acquired any habit that makes him disagreeable in the eyes of the patient. He should think enough of himself to care for his personal makeup in a way that is above criticism. Many times he is present in the death chamber where no other than a man of the highest moral type should be. Many men fail because they fail to reach the proper standard of a gentleman. There was a time not many years since when a gentleman with but little knowledge of medicine met with a fair degree of success, but the public today has become more discerning and is seeking the physician who is both well trained and a gentleman-one who must be trusted at all times and under all conditions. One of the first things for the young practitioner to learn is to be able to keep his professional secrets strictly to himself. The law protects him in this. I have known a number of physicians who were greatly handicapped because of their disposition to discuss their patients and their patients' ailments with others.

The practice of medicine has always been regarded as a noble work. To help an afflicted brother is appreciated not

only by the brother, but also by those who have an opportunity to observe it. In some countries today the old custom obtains that the physician never makes a regular charge for his services. At certain seasons of the year his patients call and make donations. Considering this, one can readily understand a physician in such a community is not considering the remuneration, but merely that he is doing a good work and will receive his reward not in this world, but in the hereafter. No young man, looking forward to the building up of a fortune, should consider medicine as a career. There are examples here and there of men who have made great financial successes, but the great majority merely secure a comfortable living. Of those who take up the study today, comparatively few drop the work. This is in a great measure due to the fact that the student first considers the requirements for entrance and then the vast amount of work necessary before he secures his license.

It is interesting to consider the position of the physician in the country village. He is always regarded as a man of superior attainments. His educational training should have carried with it the acquirement of a general knowledge which his fellow-citizens many times call upon him to exercise. If he is right, intellectually, morally and as a gentleman, his influance in a very large measure directs the destinies of his village. When his life's work is done there is more sincere regret in his departure than in that of the average citizen. He has lived among his people, has helped them in the hour of need, counseled with the leaders of the community and imposed upon no one. There should be none of the ill-feeling that is so apt to be associated with the dealings of the commercial man, following which many times a feeling is engendered never to be forgotten. The work of the physician is always for humanity, and is therefore a noble work.-WM. WILSON PEARSON, M. D., DES MOINES, IOWA, Dean OF THE COLLEGE OF MEDICINE, DRAKE UNIVERSITY, IN IOWA MEDICAL JOURNAL.

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