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to take a holiday from his work. Anxious cases have an awkward habit of developing just when he is ready to start; he may have made engagements to attend midwifery cases during the holiday season, and so on; thus, when the time comes round the doctor may find himself booked up and so engaged as to make it impossible for him to leave. Such contingencies may and do happen, but every doctor ought to make it a point of duty to take three or four weeks' absence from his routine work each year. This is not only fair to himself, but also to his patients. It is impossible for a man to go on working year after year continuously without getting stale and worn out, if not in body then in mind. His intellect will not be nearly so acute and receptive as one which is allowed to rest for a little at stated intervals. Therefore from a physical, as well as mental point of view, the annual vacation is to be strongly recommended.
As a rule medical practice is least active in summer and early autumn, and these are usually the best times to take vacation.
In towns, if one's practice is not too extensive, one can arrange for one's work to be done by one or two fellow practitioners during one's holiday, dividing the work between them, as is most convenient; you, of course, undertaking their duty when they go on holiday. By this mutual reciprocation one's work is carried on very well and at no expenditure of money. If, however, one's practice be too large for this, then it is necessary to engage a locum tenens to carry on the work, and the same must be done in country practices. This naturally in
creases the cost of a holiday very considerably, yet it must be looked upon as a good investment and as money well laid out, as it conserves one's health and allows one to return to work with renewed vigour.
Apart altogether from this purely business point of view in regard to holidays, think of the duty we owe to ourselves in enlarging our minds. The whole spiritual nature of man becomes cramped by being "long in populous city pent, Where houses thick, and sewers annoy the air."
The man who has passed his entire life in the sole study of disease in human beings has really only partly lived. He has omitted to "meditate the Book of Nature, ever open." What a world of wonders he has missed! Medical men are trained as few others are to cultivate their powers of observation, and thus they cannot but find a continual feast to eye and ear in almost every object in the country side. How marvellous is the bursting forth of life in spring; how glorious are the flowers of summer; then comes harvest and the preparation of autumn for the peaceful rest of winter. Can any human music equal that to which we may be treated every day if we listen to the exquisite singing of the birds, the gentle purling of the brook, the rustling of the leaves, the breaking of the waves upon the shingle, the deep diapason of the breakers, the whistling of the wind amongst the pine trees, the mighty cannon-roar of the storm or the crash of thunder.
For one's soul's sake, therefore, spend as much time as possible away from the busy haunts of men and "in lovely Nature see the God of Love."
Or again, one's holiday may be spent abroad, where, amid fresh scenes, new peoples with new manners and customs, the weeks will fly like an enchanting dream. Not only will the pleasure be a present one, but for years afterwards, recollection will revive all the delights of those precious weeks of foreign travel. As the practitioner grows older and the battle of life more strenuous, it becomes all the more necessary that he should seek periods of rest and quiet. Time which has strewn his head with silver will probably have lined his pockets with gold, and so he will be able more easily to afford the means of securing this release from work. He will, at any rate, be wise to follow the teaching of Mahomet, that if a man finds himself with bread in both hands, he should exchange one loaf for some flowers, since the loaf feeds the body indeed, but the flowers feed the soul.
CHAPTER VII ...
ON KEEPING ABREAST OF SCIENTIFIC STUDY
It is not sufficient that the practitioner has had a thorough medical and surgical education. Our art is a most progressive one and every few months some new symptom or sign of disease is discovered and instruments or methods devised for the determination of the same. It is, therefore, necessary that the practitioner should know what these are and that he should employ the newest aids to diagnosis.
Almost every physician now uses the binaural stethoscope, not so much because it is better than the old-fashioned single one, but because patients look upon the doctor who uses the latter as oldfashioned. Again, it is a common request for a patient to ask that his blood-pressure be taken, and what shall he think of his doctor if he says he has not got a sphygmomanometer? Again, in the diagnosis of blood and other diseases, a differential blood count has to be made and films stained to show the relative proportions of erythrocytes and leucocytes present, and the character and proportion of constituents in the latter.
In order, therefore, to keep oneself in line with advancing medicine, it is advisable that the practitioner should every four or five years study for a few weeks at a post-graduate medical school. He
can choose those subjects in which he is most interested and so regain what he may have forgotten or add to his knowledge newer methods of diagnosis or treatment.
Apart from this, the doctor ought to join one or two medical societies, and he must make it a point of duty to attend the meetings. By conversation, communications and discussions at these assemblies he will hear all that is going on in the medical world, and will in this way not allow his intellect to grow old.
There are also the medical and scientific associations which meet in this country every year. Attendance at these gatherings yields a large fund of information, and incidentally allows one to keep fresh the friendships of former days, as well as to form new ones. Or again, we may combine holiday with instruction by attending some of those foreign congresses which meet periodically at various centres.
Original Work.-Besides this, it is expected that every medical man will do his utmost to further the advance of his profession. Opportunity is open to every doctor to do this in some way or another, and in the manner which appeals to him most. He ought to cultivate that subject in which he is most interested, and by frequently adding to observations and facts, he may at length be able to produce some work of value to medical science.
"No profit grows, where is no pleasure ta'en;
Lord Bacon held " every man a debtor to his profession; from the which, as men of course do