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In medical practice at its best, no one factor is more important than the proper relation between doctor and patient. This factor assumes particular significance in dealing with older patients. So much of pediatric practice consists of giving routine immunizations, recording weights and measurements, and prescribing formulas for various ages that a well-trained nurse can take over a great many of the pediatrician's duties. The doctor can usually stay in the youngster's good graces by giving him a lollipop or bright piece of cardboard after the nurse has done the dirty work of puncturing his skin.The oldster, however, is not so easily managed. The years have taught him caution in bestowing his confidence, and his diseases are apt to be of a chronic or recurrent nature. A satisfactory relation with his doctor is most important to the patient's well-being and peace of mind. Such a relation is most often

At a time when the medical pendulum is swinging further and further toward specialization, the future of general practice offers an endless field for speculation— and endless speculations are being offered about it. The current controversy regarding the family doctor's place in the scheme of medical practice recalls the words of Solomon "The thing that hath been, it is that which shall be; and that which is done is that which shall be done: and there is no new thing under the sun."1Some of you are old enough to remember that after the first world war there was a similar trend toward specialism. Then, as now, obituary notices of the family doctor were being published. Long before World War I—in 1902—Sir William Osler told the Canadian Medical Association that "it is amusing to read and hear of the passing of the family physician."2FACTORS RESPONSIBLE FOR THE

The long-term management of the older patient is to be distinguished from the treatment of acute illness. The first interview must help to establish a satisfactory long-term relationship between patient and physician. The physical examination must be systematic and complete, but thoroughness is not incompatible with gentleness and tact. Methods of treatment should take into account the patient's life-long habits, and in cases where treatment is only palliative a careful choice of words often brings about acceptance of the situation. Prophylactic geriatrics seeks to prevent, postpone, or prepare for the infirmities of old age. The family doctor can help both his youngest and his oldest patients by leading the family to appreciate their need of a recognized place in the community.

"Let your light so shine before men, that they may see your good works" (Matthew 5: 16).A recent book by Stuart Chase has a most fascinating title—"The Tyranny of Words." The very name is enough to stimulate endless reflection as to how almost everybody, no matter how intelligent, is influenced, if not dominated, by the meaning attached to certain words or phrases. How contradictory may be one's reactions to different terms with virtually the same meanings! For example, it makes all the difference whether a woman is called "slender" or "skinny," "fat" or "pleasingly plump"; whether a man is called "generous" or "spendthrift," "thrifty" or "stingy," "conservative" or "a mossback reactionary," "liberal" or "radical"; whether he is said to have "the courage of his convictions" or to be "as stubborn as a mule." A college student appreciates being told he has the power of concentration but resents being called

The Atlantic Monthly for October offers fulfillment of the scriptural prophecy, "And a man's foes shall be they of his own household." Dr. James Howard Means, Harvard's brilliant and capable Professor of Clinical Medicine, is a member of the American medical profession; but Isidore Falk, Oscar Ewing, Claude Pepper, J. Howard McGrath, and other bitter enemies of that organization must have been made happy by his savage attack on it under the title "The Doctors' Lobby." There are officers of the A. M. A. far more capable of defending it than I; but the fact that I have absolutely no official connection with the organization places me in a better strategic position to speak for it than they are. It is true that over the past two decades I have missed few meetings of the A. M. A., and have frequently represented North Carolina's State Medical Society in its House

Ever since Sir Walter Raleigh's servant first saw his master smoking and poured a bucket of water over him to put out the fire, the habit of tobacco smoking has had enough metaphorical cold water poured over it to make Niagara Falls a mere brook by comparison. Among some recently discovered letters of John Adams,1 second President of the United States, to Benjamin Waterhouse, then professor of physic at Harvard University, was one commending him for a pamphlet he had written on the harmful effects of tobacco. Mr. Adams confessed, however, that he had been using it himself for sixty years, but said, "I am unable to take into my mouth a morsel no larger than a Swan Shot without sensible and immediate injury. One quarter of the quantity I have used in some parts of my life, I fully believe would now kill me immediately." As he lived to

When I was asked to discuss this subject, just out of curiosity I consulted Webster's dictionary to see exactly what "prestige" means. I found that the word comes from the Latin praestigium, meaning "delusion," "illusion." The first meaning given was "a conjurer's trick; a sorcery; an illusion; a deception." The second meaning was "power to charm, dazzle, or command admiration; hence, eclat, renown." The third, the most common today, was "ascendancy derived from general admiration or esteem; commanding position in men's minds."These three definitions represent an evolutionary process. Unfortunately the first and second meanings still apply to the exalted position of the specialist. Specialism is allowed to dazzle entirely too much; there is an illusion about it which we should get away from. The prestige of the general practitioner is based on the final meaning of "prestige" "ascendancy gained from general...esteem." That is a solid foundation which has endured

TO THE EDITOR:— Dr. Bernard P. Cronan's report (J. A. M. A.143:1040 [July 15] 1950) on reactions to small amounts of alcohol recalls the experience of Marion Sims, as related in his autobiography, "The Story of My Life" (pages 83-85). At an Independence Day celebration, when he was about nine years old, he drank "not more than two tablespoonfuls of Madeira wine" and "had to be carried to the house, in the course of half an hour, and put to bed, dead drunk." He drank no more wine until he went to South Carolina College, when he went with some friends to an oyster saloon and "indulged in a small glass of Madeira. The others drank freely; none of them seemed to feel it." When they started back to the college, he had to be held up by a man on either side. He made a conscientious effort