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When student days are over one starts out to face the world, with its toil, its cares, and (what is still more the cause of discontent and unhappiness) its ambitions; for the ambitious man is always less happy than his contented fellow-being, whether the ambition be for riches, position, or merely “to keep up with the Joneses.” One of the world’s present leaders, Mussolini, recently said that it is better to live one day as a lion than to live a year as a lamb. Perhaps, but anyway, if we were all satisfied to vegetate, the world would not have progressed as it has, for it was ambition which stirred in the breasts of the explorers, the scientists, the statesmen, and the business leaders of past centuries, and spurred them on to great accomplishment.

At my entrance into practice, world conditions were what we now call normal. The Great War had not occurred; the world was not flooded in debt; trade was not being strangled as it is to-day by the economic nationalism of fearful nations, anxious to be able to supply their own needs in case of another world sacrifice to Mars; and the future looked promising to a cheerful and naturally optimistic young man, who had no more prevision than others as to chaotic years which were so rapidly approaching.

At that date the pioneer village of my boyhood had grown to a city of ten thousand people and was progressing toward greater things. It was for this reason that I decided to settle there rather than face the more doubtful prospects of a large city. It is often true that “a prophet is not without honour, save in his own country, and in his own house,” but this Biblical saying has certainly not applied to myself either professionally or politically during the intervening thirty years, for the friends of boyhood were so loyal and true to me that in both phases of my life I owe them infinite gratitude. Largely as a result of their friendship, though partly because of my particularly good medical and surgical training, I rapidly attained the position of being one of the leading medical men of this mid-western city, so that even by the end of the first year the manifold duties of a general practitioner monopolized my time and energy. Only a few of the interesting experiences of my professional life will be entered in these pages.

The profession of medicine is a fascinating one in many ways, and gives to the physician an opportunity to know human nature such as is possessed by few. The physician enters the bosom of the family; he knows intimately all its members; he is in many cases the father confessor of the sins of omission and commission of the mother, father and children; and he acts as the discreet repository of family secrets which, if known to other members of the family, would often bring wreck and ruin to everyone concerned. As a consequence he is trusted and respected by many as they trust and respect only their clergymen, and it may be that the physician possesses their confidence to an even greater extent, always providing that he is reasonably worthy of that confidence. A good reputation in medicine is not difficult to build up if one has had a reasonably good training in his work, and avoids the pitfalls that beset the path of young professional men. One of my old professors admonished us as follows:

“If you know your work, attend to your business, and are a gentleman, you cannot help but succeed.” Indeed, in all the years that have passed since he uttered those words, I have realized more and more that they contain the secret of success not only in medicine, but in any vocation. If one remembers also the advice which the ne’er-do-well Micawber gave to Copperfield, one possesses the key to financial contentment.

“Income £20,” said Micawber, “outgo £19 19s 6d, result happiness. Income £20, outgo £20 6d, result misery. The blossom is blighted, the leaf is withered, the god of day goes down upon the dreary scene, and you are forever floored, as I am.”

Perhaps one should add another aphorism to these, that of a great Canadian who later became world-famous as a physician in both England and the United States, Sir William Osler. He, in an address to us in my final year, said that there was one word which was the master-word of success in life, and that was the word WORK.

The practice of the three by any ambitious and reasonably intelligent young man will give him the fulfilment of any legitimate material ambition which he possesses, particularly as ambition is nearly always in direct proportion to ability.

The same Osler who wrote many non-medical works of a most delightful kind, in addition to his classical Practice of Medicine, stated in one of these that there were three kinds of medical men. The first was he who understood his work and practised it in a straightforward and honest manner, never at any time trying to humbug his patients; second, he who understood his work, but who in treating his patients employed the methods of the quack, or charlatan—endeavouring at all times to impress that he had just arrived in the nick of time to perform miracles in pulling the patient through; and, third, he who did not possess great professional knowledge, but depended entirely upon charlatanism.

“Of these three,” said Osler, “the second is often the one who makes the greatest reputation for himself.”

Most men who have practised the profession would in general agree with this conclusion, though in my own case a frank and truthful presentation of the case to the patient was adhered to, and I have never had regrets because of that attitude. But others who practised the second method had a success at least equal to my own, or perhaps even surpassed it. The reason why Osler is probably right may be due to the fact that medical knowledge remains almost as much of a mystery to the ordinary patient as the incantations of the old medicine man were to the Indians whom he treated. The average layman knows little about his physiological functions, and has an almost childish idea that in treating him the physician relies largely on drugs. As a matter of fact most intelligent medical men are (what the great Osler prided himself upon being) “therapeutic nihilists”—meaning that they realize that most drugs are useless, that in fact there are only a few drugs which have a specific point of attack on disease. However, knowing the feelings of their patients in this regard, they often bend to their predilections by prescribing some harmless “placebo” which will at least do no harm if it does no good. An old medical friend, who had practised nearly half a century, once told me that he had made many of his best cures through the patient in error rubbing on the outside something which the physician had given him to take internally. This, of course, is a harmless type of charlatanism, and is practised only because of the ignorance of so many patients who remember the old Latin proverb, “Post hoc, ergo propter hoc”—“After this, therefore because of this”—and who are prone, because of their belief in that proverb, to give blame or credit to the medicine for the results, while forgetting the importance of regimen, or rules of life, in diet, fresh air and exercise, which the sane medical man has also prescribed.

There is one type of prescribing which, even as a young student, never had my sympathy, and that was called the “gun-shot” prescription. It contained half a dozen or more drugs, having sometimes a contrary physiological effect upon one another, and was given in combination by some medical men in the hope that if one drug did not improve the patient another would. This sort of thing has always appeared to me as unintelligent as the methods of the medicine man. It is likely that much of the prescribing of medicine which is done to-day will be looked upon as proof of ignorance by the intelligent student of medicine fifty years hence.

Fortunately for all doctors nature is the real physician, and we are merely the aides-de-camp, for most patients if left alone get better, this being true of probably ninety-five per cent. of ill people. Consequently, the intelligent physician merely tries to assist nature by endeavouring, through diet, fresh air, and exercise or rest, to bring about the return of health more quickly.