Febr. 20 - 1934.
My dear Clarence,
I read over your letter very carefully and like yourself I felt discouraged over the length of time and amount of work you must do before you are ready to hang out a shingle labeled "Dennis, Surgeon". However after thinking it over I decided to talk with Dr. Ritchie. He and Dad went through medical school together and were close friends all these years and he would have a real interest in your best opportunities. Also I
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knew he had recently gone over this matter very carefully in regard to his own son Wallie so that his information would be recent. So I took your letter to him and he cleared up many things in my own mind. For instance, as Dr. Zimmermann put it, "it would depend on how much Dad's friends could do for you" -- that is, turn work your way. You might label yourself a surgeon but, until a certain amount of time had elapsed and you had a certain amount of experience, a patient would hesitate to trust his life in your hands. You might much better be in a hospital where you are getting the best experience and the most in a few years time
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where, with good work, you are building up a prestige for yourself, so that at the end of the nine years spent in Johns Hopkins you may walk out with a reputation so well established that no one would hesitate to refer work to you -- provided there is any to be referred as I'll explain later. Meanwhile you have room, board, and later a small salary or fellowship. Many do not stay the full nine years but four or five or six give just that much prestige and experience most valuable -- much more than you would be able to get in private practice, working toward surgery until you have joined a clientele and confidence of your patients.
With a few words Dr. Ritchie made clear to me that the whole practice of medicine has changed tremendously since the time he and Dad started in. Most doctors are trying to do their own surgery and are not referring cases to the surgeon as they did in the past. Also, their work is much of it contract work, that is, the man working for the Great Northern Railroad, being in need of an operation for appendicitis goes to the G. N. surgeon. The man working for the Heist and Duirck co. goes to the surgeon of that company for years and is quite commonly established now.
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You may remember that Dad was the consulting surgeon for the Great Northern Railroad and the surgeon for the Great Western. I think much that Dr. Ritchie said was a repetition of the things Dr. Burch had said and evidently what Dr. Zimmermann wrote you but it clarified the conditions to my own mind.
As for the financial outlook, it is a long hard pull anyway for a man in medicine and surgery is perhaps one step slower. During the last few years of business depression, many of the doctors here have been very hard
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pressed. Some few have had to close up offices entirely, some are far behind in rents and other bills. Mrs. Burch said she heard Dr. Foley say that he hadn't collected enough for two years to pay office expenses, let alone household and family expenses and he has one of the largest practices here. He is lucky, of course, to have private means.
Dr. Burch's talk has been so pessimistic that I have been annoyed. Of course he himself is "sitting pretty" but all his views as expressed to me are black -- about medicine and financial conditions. He has painted things so black, that my reaction has been to discount what he says.
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Perhaps it was only badly expressed when he was tired because he is not a morbid person. He and Mrs. Burch are spending a month in Florida. Katherine and Glen are stationed in Washington for five months where Glen is doing some special economics for the government I think.
Dr. Burch said before he left that he thought some service this next summer here at the Anoka Hospital would be a good thing for you. He also said that he thought to continue the service at Johns Hopkins Hospital working toward the Resident would be the very best raining for you, if you could get the appointment. No one favors your taking any part of the four years course at any other school, after all when you are getting the very best the country offers, why change? And there is a prestige goes with the name "Johns Hopkins." All think the two months there in Obstetrics this summer would be a fine experience, if you can get it.
Now we turn to the plans Dr. Ritchie has made for Wallie and which he felt might be good for you since you both wish to take up surgery. Wallie had four years at Johns Hopkins, graduating from the medical School there. He spent one summer
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in Edinburg studying Pathology and Anatomy. He had one year internship (rotating service) at Union Memorial Hospital in Baltimore, one year service on the faculty of U. of Minn. doing Pathology and studying Pathology. Now he has a three years fellowship at the U. of Minn. Hospital. He is working like the dickens. He has one night a month off, I believe. He is engaged to Alice Otis and I believe she sits at home just hoping he may have a minute during the day when he will have time to telephone her. When they will marry, I don't know. But of course she will
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have her own private income and Wallie will have the backing of a very large and influential family of Winters'. There you are! It is not especially bright for immediate financial results. But I don't think anyone ever expects that of a man starting in medicine. Dad considered himself fortunate to be taken into the firm of Wheaton and Rogers, where for two years he was paid twenty-five dollars a month (no room or board). As a special favor he was allowed to open a cot and sleep in the office at night. He had a bottle of milk for breakfast, a free lunch with beer at one of the saloons so common there, and a twenty five cent dinner. He managed to go
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to the opera occasionally where he and Dr. Goodrich sat in the gallery. It was stiff times and hard work and a long slow pull. There is more competition now. He was married at thirty-two and his wedding trip was a gift of the doctors with whom he was then associated. He couldn't have afforded it himself. We were married when he was thirty-seven and then he had enough ahead to study abroad for a year with a wee nest egg in reserve. It was there he specialized in surgery.
I believe all this is explained to the best of my ability. If there is any obscurity let me know and I'll do my best to find out.
Dr. Ritchie said he would inquire around at the U. and see if there was any likelihood of you being able to get this same fellowship here in two or three years if you thought you would want it. He will let me know after awhile. Not necessary for you to write him at present. Be sure to write Dr. Zimmermann and thank him for his advice if you haven't already done so. I understand he spent several hours looking things up before answering.
I saw Nancy and her charming children when she was home. I hope to drive out for C.S.'s commencement if I can. Don't you yet for certain and not sure about driving to Baltimore. I'd like to. Did I tell you that announcement is recently made of the marriage last Sept. of Elinor Cary and John Murray?
Affectionately
Mother