The unit of measure for visual acuity should be an angle of one minute. This is the unit which was adopted by Sneilen, and experience has shown that the standard established with it as a basis is a reliable one, although many eyes have more than full normal vision according to it. Consideration of the confusion which should arise between the records of the past and those of the future, in case it were altered, makes one devoutly thankful that no such change is suggested.

The illumination of the test-types should be by diffused daylight coming from opposite to the type and not laterally. There is, no doubt, much variation. in practice in this respect, but considering the impossibility of always obtaining daylight and the variations in its illuminating power, which may occur

within short intervals of time, even at midday, in places not exposed to the terror of London fogs, it would seem as if a standard artificial illumination would have been preferable, especially considering that, as will be shown later, the committee recommended an inconvenient form of test-object with a view of obtaining uniformly comparable results.

The degree of visual acuity is regarded as proportional to the smallest angle under which (or the greatest distance at which) the test-object is distinguished. Here, again, Snellen's principle is rightly adopted rather than the suggestion of Vierordt, that it should be regarded as inversely proportional to the tangent square of the smallest perceptible visual angle.

SOLILOQUY.

To be killed, or scared to death; that is the question.

Whether 'tis better to grow fat than thin,
Better to eat your bread and drink your tea,
Unmindful of the germs that lurk therein,
Or to take arms against the bacteria horde,
To sterilize, to Pasteurize, to boil, to chew,
To chew-and by much chewing end
The stomach-ache and all aches, not a few,
That flesh is heir to. 'Tis a consummation
Devoutly to be wished. Chewing is good
But what is good to chew? Ay, there's the rub.
We must not chew adulterated food.
And what is pure? The vegetarian
Says, "Naught with eyes is proper food for

man.

Alas for all the habits of the race!
Meat and potatoes fall beneath this ban.
"Proteids are poison," say A, B and C.
"The conquering races eat 'em," answers Z.
Says A, "You quite forget the Japanese."
Thus everlastingly they disagree,
Argue, assert, question and criticize,
Till naught is left to eat that's really nice,
Except, for those who like it, buttermilk.
And for a treat, occasionally, rice.
Ah, who would stand eternally on guard
Against the germ that lurks in every kiss,
In every cup, in every breath of air,
When he might easily escape from this
With a bare bodkin, duly sterilized,
But for the paralyzing, awful fear
Of meeting after death the souls of germs
That he has slaughtered in cold blood down
here?

Perchance I err, ut oft it seems to me
In certain reckless, atavistic moods
That I would gladly give up my Near-Tea,
Near-Coffee and the latest breakfast foods
To live as all my ancestors have lived
On pork and pickles, apple pie and cheese;
To die as all my ancestors have died
Of some old-fashioned, orthodox disease,
And, if the idea strike my aged head,
I may die on a nice fat feather bed.

-Nautilus.

A

PREJUDICED DIAGNOSES.

St. Louis daily paper, commenting editorially on the recent JeffriesJohnson fight, points out that, previous to the encounter, all the pugilistic experts had the opportunity of inspecting the condition of the men and their course

of training. Never were prospective results so industriously analyzed as at Reno and the chances placed in the scale with such nicety. But, sad to relate, the scales were hopelessly wrong. The man who lost was lacking in the essential quality, and none of the old tacticians on the ground seems to have discerned it. Even the keenest and oldest hands in the betting game took the wrong side, though many of them were on the spot to estimate the probabilities for themselves. The veterans picked him as a sure win

ner.

Explaining this fatuous unanimity of error, the newspaper shrewdly says:

It was the former fighter they kept in mind, and if they noted any difference explained it on the grounds so apt to suggest themselves on the side of sympathy. So the numerous ex-champions could reason only through memory and imagination, and the betting fraternity had it all wrong, as frequently happens in speculative circles. All of which shows again that it is easy to believe what is acceptable, and to back emotional preferences instead of cold facts.

Is it not true that many of us fall into disastrous error in the making of physical diagnoses from the same temperamental weakness? Open confession is good for the soul. The writer remembers an instance to the point in his own experience, in the days when he was actively engaged in medical practice. He was called in consultation upon the case of a five-year-old boy in whom, about six months previously, he had diagnosed tuberculosis. The boy's present illness was in the nature of a low enteric fever -one of those conditions which may be

anything, from true typhoid to menin gitis; temperature 103°, pulse 130, diarrhea, tympanitis, intense headache, stupor sometimes amounting to coma, and the rest of the train of symptoms. Influenced by his former experience of the patient, the writer diagnosed genera! tuberculosis with marked intestinal localization, and gave a very gloomy prognosis. The attending physician, a young graduate, disagreed, opined that the trouble was a simple intestinal infection, and predicted that in a day or two the boy would be at play again—which proved to be correct. Now, of course, the writer's diagnosis may have been faulty in more ways than one. He does not hold himself as an expert diagnostician even as against a new-fledged graduate. But the point is that, had he not been prejudiced by his former experience of the patient, he would doubtless have viewed the case in the sane, hopeful way that the young attendant did.

So have we seen even eminent internists biased and prejudiced in their diag noses by various prior influences. To be sure, such influences are not often in the nature of emotional or sentimental considerations, as they were in the estimate of the gladiators referred to. On the contrary they are usually the considerations that could only influence a man of science; but they are undue influences just the same. Sometimes it is that a man is engaged in a certain line of investigation or research; and for the time all of his diagnoses are colored by that line of work, so that he finds in almost every patient he examines signs of the disease on which he is engaged. Sometimes, as in the writer's case, the physician is obsessed by his pre-knowledge of a patient; this is often the case when the doctor knows that his patient has had

syphilis, and he is prone to lay everything that afflicts that patient to his syphilitic taint.

Whatever the undue influence may be, it is a factor that must be striven against in the making of diagnoses. The surest and most effective way of avoiding it is to recognize the fact that every man is susceptible to it, and to be constantly and actively on one's guard against it. To be warned is to be forearmed. It is because of this proneness to bias that a physician does not, if he is wise, attempt to diagnose the troubles of his own family and kin. But he should realize that the susceptibility to prejudiced opinion extends, in another form, to every case that he meets, and especially to those cases involving pre-knowledge of the patient or of the facts. And in every diagnosis that he makes, the careful and conscientious doctor will make a definite effort to divest himself of all prejudices and undue influences of every sort, and to approach the case de novo, on the sheer basis of the facts that are before him. This does not mean, of course, that all previous knowledge of the patient is to be discarded, as though it were not. But it is to be given only its proper and due place in the array of present data on which the diagnosis is to be based.

THE MYSTERIOUS SYSTEM. Under this title, Bruce Logan contributes to The Druggist and Chemist (England) a suggestive anecdote which, with appropriate change in the detail, carries an equally shrewd moral to the practicing physician.

Everybody in Bleckton knew the secret of Mr. Packham's success. Yet for years the more intelligent villagers had marvelled that “Old Packham,” as he was familiarly called, should do all the business, while his brother chemist lolled behind his more resplendent counters in an apathy of unrealized anticipation.

But at last an American merchant staying in the village offered the elusive

explanation: "Guess that man's gotten a right good system," he drawled, and the none-too-comprehending villagers accepted his words as explaining the secret of Mr. Packham's success, until "Packham's System" became a by-word throughout the village.

"Go to Mr. Packham," the old women would advise the young mother. "Eh! but he's an awfully clever man." Then, almost in a whisper, they would add, "They do say as how he's invented a wonnerful system."

What the system was nobody seemed to know, and the cheery laughter of Mr. Packham when questioned served little to enlighten their ignorance.

Years passed by, and the pharmacist continued his barely challenged career of success until prosperity having lost its sweetness, the old man decided to retire on his well-invested fortune, and with characteristic generosity determined to give the business to the assistant who had so ably assisted him in the past.

At last there came a day when everything had been settled, and the two men talked together in the small sitting room of the pharmacy.

"Sir," said the late assistant, "I can not thank you sufficiently for your generosity, but I have an anxiety regarding the future of the business."

The old pharmacist motioned him to proceed.

"Your system, sir. I am entirely ignorant of it, and fear that the business may suffer in consequence."

For a moment a merry light twinkled in the old man's eye. "Listen," he said. "I will explain: Be nice to the babiesa little sweet occasionally, a pleasant smile always. Never overlook a child. When they are young you get their mothers and fathers—a little older they bring their relatives-still a little older they call in with their sweethearts and friends, and finally with their wives and

families. That is my system-to always make friends of the babies."

"Thank you, sir," dutifully replied the young man; but the disappointed expression on his face plainly told the old pharmacist that the sage philosophy of his system was too simple to receive the attention which its wisdom merited.

VALUE OF OPTIMISM IN MEDICINE.

Edward L. Trudeau, himself the high priest of optimism in its noblest aspects, insists that the practicing physician and surgeon must have optimism if he is to develop a full degree of efficiency in meeting the terrible emergencies of acute illnesses and accidents, or the long-drawn-out struggle with lingering and hopeless disease, and at the same time inspire his patients with a degree of optimism which means everything to them in the ordeals they have to pass through. To the practicing physician and surgeon optimism is even more necessary than to the scientist, for, besides molding the doctor's character and guiding him in his decisions as to the case, his optimism is at once reflected to the patient and influences his condition accordingly. How great this influence may be we are learning more and more to appreciate. In his hour of need the patient has no means of judging of the physician's intellectual attainments; it is the faith that radiates from the doctor's personality that he seizes upon and that is helpful to him. Any encouragement that emanates from the physician will help keep up the patient's courage and carry him through long days of ilness and suffering to recovery; and, where recovery is impossible, if the doctor's optimism--that is, his faith-is of the kind that extends to the future, not only here but hereafter, it may dispel for the patient much of the darkness and despair which brood over the end of life, and perhaps even illume for him that

vast forever, otherwise so shrouded in impenetrable gloom.

Ian Maclaren's optimism was of this kind, and Dr. Grenfell's optimism is every day helping him to heal not only the sick bodies, but the broken spirits of men as well. This is the highest type of optimism the doctor may attain to, as its influence may reach not only to the physical, the intellectual, and the psychical, but even to that dim ethereal region of the spiritual, from which spring man's most sacred and cherished aspirations. This side of the doctor's life of service to humanity is known but to himself and to those who, in the hour of death, have turned to him for help; to the world this is a closed book, but what is written in its pages has helped to make the medical profession a benediction to mankind.

QUACKERY AND QUACKERY.

A writer in the New Mexico Medical Journal very properly reminds us that all the quacks are not necessarily outside the regular profession, nor are all conscientious medical workers necessarily inside the charmed circle. Says this writer: "A man may be very unethica!. and yet be a capable practician of medicine, who does the best he possibly can. for every one who employs him. Such a man is certainly not a quack, though he may be a very 'undesirable' member of the profession.

"We know men whose 'quackery' consists in frightening the patient into the belief that his malady is worse than it really is; and this is their only unethical act. We know the most objectionable 'quacks,' who are graduates of the best medical schools, and who are well equipped and who employ skillfully the best and latest drugs, but their quackery consists in making the patient believe they are the only men who can cure this particular affection, and in exhibiting their equipment of instruments and putting the patient through ridiculous. 'tests' and 'examinations,' thus creating

undue alarm, so that they may extract an exorbitant fee. We once knew such a man to use a stethoscope and assure his trusting patient that he was undergoing an X-ray examination.'

a

"A 'skillful' quack can practice his blandishments on a patient, and yet say nothing and commit no overt act that would indict him before medical society. He may be so bland that no decent practician can recognize him, and there are all shades and degrees of distinction between these two extremes. Therefore we do not believe 'quack' can be defined.

"A man might advertise and make true and honest statements; he may be skillful and well equipped; he may do the best possible practice he can; yet such a man would be branded as a quack, because custom forbids advertising. A man may be the lowest type of a 'quack' and yet never advertise, nor commit any act that could be properly and positively assailed; he may be a member of numerous medical societies, and prate loudly of ethics; and yet in contact with his patients he may in a thousand ways live the life of the most contemptible quack.

"Let me plead with the doctors to frown upon abortions and to accentuate a spirit of brotherly love. Let us go back to the day when the doctor was an important man in his town, a big man in the country and an honored citizen in the city. Let us go back to the old days of courtesy and ethics. Do not go into a house and pitch out of the window medicine left by a brother practitioner. Do not say you can cure certain diseases you know are incurable. Do not say: 'Madam, had I not come just at this moment your child would have been dead,' and 'this one remedy is the only one which will save him.' Do not tell a poor, heart-broken mother that her child has a disease which you know it has not. Don't say to the poor old mother: 'Your child is threatened with diphtheria, pneumonia, etc.,' when

you know this to be untrue, for one either has a disease or has it not, and can not be threatened with it. * *

"The worst quack is not the open quack, but that man who just had enough learning, cramming or coaching to obtain. his diploma and license, perhaps even an appointment, who must make a living by the practice of medicine. They do not advertise in newspapers; they advertise themselves by hanging around the street corners and making themselves popular. They blow their own horn. People will notice that they are shunned by the honest and studious practitioner. They make capital of this disgrace. They knock the 'Doctors' Trust' and play the martyr of an inferior but jealous profession."

UNCONSCIOUS WORRY.

A great many people, among whom the physician is a conspicuous example, worry unconsciously. They don't understand why they are so tired in the morning, why their sleep was so disturbed and troubled.

This mental disturbance is often caused by the habit of taking things too seriously, carrying too great a weight of responsibility. Everywhere we see people who take life too seriously. Most of us are like the motorman, who not only starts and stops the car and tries to keep from running over people, but also feels tremendous anxiety and responsibility about the motive power.

One of the most helpful lessons life can impart is that which shows us how to do our work as well as it can be done, and then let principle take care of the result. How often have we been amazed to find things come out much better than we anticipated; to find that the great unseen power that governs our lives through a wilderness of trial and tribulation into the open has guided our life ship through the fogs of difficulties and sorrow, through storms of hardship and losses, safely into port.