When Sir William Osler made his valedictory address to the University of Pennsylvania in 1889, he chose the subject "Aequanimitas." He said, "In the physician or surgeon no quality takes rank with imperturbability." Then he defined the word: "Imperturbability means coolness and presence of mind under all circumstances, calmness amid storm, clearness of judgment in moments of grave peril, immobility, impassiveness, or to use an old and expressive word, phlegm." He was doubtful that it could be acquired except by inheritance and he thought that some of his students, "owing to congenital defects," might never be able to acquire it. He counseled, nevertheless, that education with practice and experience might help to attain Imperturbability in fair measure. The doctor, Osler felt, should develop an "inscrutable face by education of his nerve centers.

People who live under primitive conditions need shoes only to keep the feet warm and to protect them against the roughness of the ground when walking. Soft leather moccasins were therefore worn by Indians and Eskimos. In modem cities people walk on cement, wood, and brick surfaces, against which the feet must be protected. Because of changes in weather and other environmental conditions, feet must also be protected against heat, cold, moisture, and infection. Modem conditions of work demand that some people stand for long hours, whereas others may sit three or four hours at a time.

The shoes of babies and growing children and the shoes of women are constructed quite differently from those of grown men, because the needs and desires are different. Children run and jump in their shoes. As the feet grow, the muscles and the ligaments need room to move. Little babies really do not need any foot coverings, but custom demands little stockings and bootees. Later, the infant has to have a shoe with a stiff sole, but with plenty of freedom above so that the foot can be moved without any difficulty.

Some of the methods that have been used for centuries are still valuable in detecting cancer, but modem medicine has developed many new techniques for aiding diagnosis of disease.

One of the most important single procedures used by the physician is the use of his hands in order to palpate or feel changes that have occurred underneath the surface of the body. As medicine is practiced in some parts of the world, patients seldom get time even to remove the necessary clothing to permit the doctor to look at the skin or to put his hands on various portions of the body in order to feel changes that have taken place.

When there is a suspicion of a new growth the doctor will look to see if there is any visible sign of a change on the surface of the body. He will then press with his fingers to determine whether or not lumps may be felt underneath the skin, or whether the outlines of various organs in the abdomen have been changed from what is usually felt.

Cancer is wild, unrestrained growth of cells. Some disturbance occurs which disrupts the balance of cells of different kinds in the body. The cells seem to return to their primitive state or to the infantile or fetal type. The body of a baby before birth grows much faster than does a cancer, but the growth of the cells in the developing child is controlled or regulated by an internal mechanism.

Many substances have the ability to stimulate the growth of cells. Pure chemicals, glandular substances, or physical forces like heat or pressure may stimulate cell growth. The changes that initiate the sudden, rapid growth of cancer cells and the traveling of these cells into other parts of the body involve many different factors related to the chemistry of the body, its nutrition, damage to tissues by inflammation and infection, and modifications of growth brought about by glandular action.

Each blood collection situation is unique. A competent phlebotomist must not only possess the technical skills necessary to collect a quality specimen, but must also understand the numerous patient variables, complications, and procedural errors that can affect the integrity of the specimen or the health and safety of the patient to avoid or reduce any negative impact.

The doctor's functions include not only relief from symptoms, but the prevention of disease and its cure when possible. Moreover, modem medicine realizes that the whole human being is always involved-not just one spot of pain or disability. The doctor studies the patient as a complete unit, including both mind and body and the effects on mind and body of the patient's surroundings or environment.

The doctor sees people nowadays for periodic physical and mental examinations, for study before the insurance company undertakes insurance, and for a survey before the person undertakes any employment or enters on any new activity. The doctor has to know why the patient wants an examination. Is he or she contemplating marriage or giving birth to a child? Does the young man or woman want to engage in sports that carry with them hazards to life and health? Is the young man trying to get into the armed services, or is he trying to get out of them? Is the woman trying to find an alibi for avoiding some unpleasant duty or relationship? The doctor must evaluate the situation, because the nature of the patient's symptoms and his method of description may be greatly influenced by his reasons for being examined.

The human being suffers a variety of reactions when exposed to high temperatures. Usually there are three different forms of this reaction. They are called "heat cramps," "heat exhaustion" and "heat stroke." They may occur during exposure to the heat from the sun in climates where the sun is especially hot, and they occur particularly to people who have not been acclimated by exposure to the sun gradually over a long period of time. After a while the body accustoms itself to heat by a decline in the amount of sodium in the perspiration.