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80 uncoimion as only to be seen once are not likely to be seen again. Thirdly, Don't be in a hurry. Wait till you have all the facts, remembering that a laboratory report (for example) may at the last miioment upset all your calculations. Reserve your decision, therefore, ia a difficult case; take it, as the Scotch lawyers say, " to avizandum." If you oome to a premature conclusion it is difficult to alter it afterwards, not only Lcecause it involves awkward explanations to the patient, but because, by the mere fact of having made a diagnosis, you become insensibly biased and more impervious to the reception of fresh evidence. It is for this reason that all " snap-slhot " diagnosis is to be condemned. It is impressive but perilous. " Life," as Dr. Johnson said, " is not to be sacrificed to an affectation of quick discernment, or of criowded practice, but may be required, if trifled away, at the hand of the plhysician." Fourthly, Don't be faddy. This is the besettingsiii of the specialist. He sees onily what he is always seeinig and what lie wanits to see. To the cardiologist few hearts are healthy; to the tubelculosis expert nio lung is sound. The syphilogralher sees disease only in terms of syphilis; the psycho-anealyst only in those of sex. Beware, therefore, when you find yourself alwavs diagnosing the same thing; beware also of the " stunt " of the moment" avitaminosis," " focal sepsis," " disturbanice of endocrine balance," or what not. Try to see the case steadily and see it whole. Fifthly, Don't mistake a label for a diagnosis. Such diagnoses " as " gastritis," *" neuritis," " influenza," "neurasthenia, are, mole often than not, miere labels; they have no essential relation to reality. It may be necessary in the exigencies of practice, and in order to satisfy the patient's mind, to use such labels for a time, but don't let them deceive you into thinking that you uniderstand the nature of the case. Be miienitally honiest. Sixthmly, Don't diagnose twvo diseases simuultaneousiy in the same patient. Remlember the law of " paucity of causation." Don't, for examplle;e, explain some features of a case by a diagnosis of canicer and others by -assuming the presence of tubercuilosis. There is, of course, no reason wliy patients should not run two diseases simultanieously, but as a matter -of fact they rarelydo. Make it a rule, then, if you possibly can, to account for all the clinical features of the case by assuming tIme presence of only one pathological process. Sovenithly, Don't be too cock-sure. " Think it possible," ag Cromwell said to the Scotch bigots, " that you imay be mistaken." On the otlher hand, don't hesitate too long bet*veen two alternative diagnoses, like the proverbial ass between two bundles of hay. Cock-sureness in diagnosis is the vice of the inexperienced; excessive caution that of the man who has seein too much. Eighthly, Don't be biased. Avoid preconceptions. Approach every case with an open minld, anid don't listen to the opinion of others, even that of the relations or nurse, till you have formed your own. This is the main reason for consuiltations: the consultant approaches the case, or shoulddo so, with an open mind. It is also the justification for the layman's desire for " an independent opinion "-that is, for the opinion of one who .is approaching time case fresh and without any preconceived ideas about it. Finally, Don't hesitate to revise your diagnosis from time to time in a chronic case. Things may change, new signs may appear which put a totally different complexion on the matter, anid the original and provisiolnal diagnosis may no longer be able to stand. I was once told by a shrewd and. experieniced practitioner that lie made it a rule always to re-examiaie his patielnt on the morning of a consultation. On the one occasion when he omitted to do this he was badly caught out. In conclusion, let me say that it is quite impossible that you should always be right in your diagnosis, if only for the reason that disease does not always play the game. It is better, however, to be.wrong on sounld principles than right by chance. Guessing is to be avoidled at all costs; for if y-ou once get into the habit of guessing you are diagnostically damned. RAIN-BEARING WINDS AND EARLY PITHISIS IN DERBYSHIRE.

RAIN-BEARING WINDS AND EARLY PHTHISIS IN DERBYSHIRE