CHAPTER XIX.

TRIALS AND PLEASURES OF A MEDICAL LIFE.

The physician has his peculiar trials, and also his peculiar

enjoyments. The principal of these it is my intention to notice very

briefly and cursorily in this closing chapter.

Let us first look at the _trials_ of a medical life.

The physician is subjected to great fatigue both of body and mind. He

has no time that he can call his own. That regularity of life, which

is so essential to comfort as well as to health, he must in a great

measure abandon, especially if he practice in a scattered population.

While most men have their stated seasons of repose, he is liable

to be called for at any hour, and often night after night sleep is

a stranger to his eyelids. His duties to his patients are often

of such immediate importance, that no stress of weather, however

violent, is considered as an excuse for delay. When prevailing

disease spreads terror through the community he must be at his post,

and expose himself to the pestilence under the influence of powerful

predisposing causes—anxiety and fatigue. And then there are at all

times anxieties and perplexities, producing a wear and tear of mind,

which is worse than all the bodily fatigue that he is called to

endure. It is not surprising then, that it has been satisfactorily

ascertained by statistics, that physicians constitute one of the

short-lived classes of the community.

And for all this generally the medical man gets comparatively a small

compensation. Though some physicians acquire wealth, especially

in our large cities, still as a body of men they are in moderate

circumstances, and the practice of medicine may be truly said to

be far from being a money-making business. A large proportion of

those whom they serve are too poor to give them any compensation,

and very many of those who are able to pay them do not without

reluctance and delay. This, it is true, is in part to be attributed

to the remissness of physicians in presenting their claims. But why

this remissness? If I mistake not, it arises from the unwillingness

to pay, which they so often meet with, even in quarters where they

have no reason to expect it. The consequent dislike to the business

of collecting begets a habit of neglecting it. A large proportion

of their patients feel a less urgent obligation to pay them, than

they do to pay others. I know not any other reason for this than the

_intangibility_ of the favor which is bestowed by the physician. If

a man buy a coat of the tailor, or a barrel of flour of the grocer,

he has a _tangible_ memento of his obligation; for the coat is seen,

and is felt upon his back, and the flour is eaten, and makes its

_sensible_ impression on the palate and stomach. But health restored

is a thing of air, and the visits of the physician, as they have

left no memorial behind them that addresses the _senses_, are easily

forgotten. For the same reason a man will not so easily forget his

obligations to his physician if he has amputated a limb for him, as

he would if he had attended him through a course of fever. His crutch

or his wooden leg, is ever present to remind him of them. And for the

same reason also, as the tailor and grocer can get their pay more

readily before the coat is worn out, and the flour is eaten up, than

they could a long time afterward, so the physician is more cheerfully

paid immediately after returning health, than he can be at any future

period.

While the physician is ordinarily but poorly compensated for all

his toil and anxiety, he is obliged often to see the quack and

hobby-rider amassing wealth by their gross impostures. Often does

the scientific and laborious practitioner, who is adding from his

daily observations rich treasures to the recorded experience of the

profession, suffer from the _res angusta domi_, while he sees some

proprietor of a patent medicine, the recipe for which he purchased of

some recreant physician, or filched from some medical book, acquiring

a fortune almost in a day, or some ignorant pretender, adopting

some system just then high in the popular favor, as Homœopathy for

example, making in a brief year or two all the display of a wealthy

citizen. And the offensiveness of such cases is enhanced by the

fact, that many of the well-informed and the learned unite with

the multitude in casting contempt upon the labors of science, by

upholding the pretensions and filling the coffers of sheer imposture.

The facility, with which the public are imposed upon in regard

to medicine, is a prolific source of vexation and trial to the

scientific and high-minded physician. He is subjected to a constant

encounter with false opinions, unfounded prejudices, unreasonable

caprices, and gross misapprehensions. He hears ignorance in high

places, as well as in low, putting forth its oracular opinions, as

it sits in judgment upon his practice, and that of his brethren.

The most reckless criticisms are made upon his mode of treatment in

individual cases, and the most inconsiderate and wanton aspersions

are cast upon his professional character.

If the practice of imposition were confined to those who are without

the pale of the profession, it would be a trial which could be borne

with comparative ease. But when the physician sees his own brethren

stooping to an occasional use of the arts of the charlatan, and

obtaining success thereby, even among the better portion of the

community, while they do it so covertly that they do not lose caste

with the profession, it is a sore trial to his spirit. He cannot but

regard such men as the chief enemies of the honor of his profession,

though they may talk loudly of their attachment to it, and as real

opposers of the advancement of medical science, though they may make

a great show of zeal in its pursuit. And yet so adroitly do they

manœuvre, that they generally escape exposure. This sly quackery,

which is practised by so many medical men, provoking an indignation,

to which it will do no good to give utterance, is one of the

prominent trials of the truly honorable physician.

It is a severe trial to the feelings of the humane physician

to see valuable lives sacrificed to a blind trust in ignorance

and unskilfulness. He is occasionally obliged to witness such

a sacrifice, and ordinarily under such circumstances that any

interference on his part would do no good, however strangely he

may be urged to it by the dictates of humanity. If he utter the

warning voice, however clear the case may be, it will be ascribed

to interested and unworthy motives. He may feel deeply for the poor

sufferer who is to be sacrificed, and for the family who are to be

thus bereaved by the ruthless hand of unskilful ignorance; but hard

as it is to hold his peace, he in most cases feels that he must do

it, because if he do otherwise, he will not only spend his breath in

vain, but will add to the evil by his ineffectual opposition.

The many sad scenes in which the physician is obliged to mingle

must often make him sorrowful, if he has not suffered his feelings

and sympathies to be destroyed by a total dereliction of principle.

As he watches with earnestness the struggle which occurs in severe

cases between life and death for the mastery, and does what he can to

give it a favorable issue, how deep is his anxiety, how painful the

sense of his responsibility, what balancings of hope and fear does he

experience; and then when the dread moment comes, when after all this

pressure and conflict of feeling, the physician becomes persuaded

that the issue is certain to be fatal, how is his spirit borne down

with the burden of his grief! And then, too, there are cases, in

which, though he has from the first had strong hopes of a favorable

termination, all at once a train of symptoms arises, threatening

immediate destruction. And to add to the painfulness of the case,

perhaps the friends of the patient have not perceived the change, so

secret has it been. As he goes to make his usual daily visit, cheered

with the expectation of finding his patient better, he is overwhelmed

with surprise when he sees, as he enters the sick chamber, that

death is rapidly and surely doing its work. Besides seeing his own

hope extinguished in a moment, he feels an unutterable pang in the

necessity, thus suddenly pressing upon him, of destroying the hopes

of the fond friends by whom the patient is surrounded.

In the Chapter on the Moral Influence of Physicians, I have spoken

of the intimate relation, in which the physician stands to so many

families, and of the strength and tenderness which his attachment

to them acquires, by the exercise of an active sympathy during a

long series of years. The accumulation of sympathy which thus occurs

deepens the sorrow which he feels, as he sees in the case of some

member of a family, upon which he has long attended, that his

efforts are unavailing, and that the resources of his art are all

exhausted. And as the friends gather round the bed of death, though

by a habit of self-control he has an air of composure which is

generally attributed to want of feeling he makes one of that circle,

entering into their griefs as the sympathizing friend, as well as

the faithful physician. And the very confidence which is reposed in

him, gratifying as it is, sometimes adds poignancy to his grief. ‘You

saved _my_ life, and why cant you save my husband?’—said a woman to

me in the extremity of her agony, when I told her that it was not

possible for her husband to recover.

Another circumstance which adds to the sorrow of the physician in

such seasons, especially when long acquaintance has created a strong

personal attachment, is the total want of preparation with which many

come to the hour of death. Even if the physician be not a religious

man, this consideration must press upon him at times with a painful

interest, if he has the common feelings of humanity. Especially

will this be the case, when he is obliged to witness some of those

horrible scenes, which sometimes occur in the last hours of a career

of vice.

The sorrowful scenes, which the physician witnesses occasionally in

the ordinary routine of his business, come with a painful frequency,

when some fatal epidemic is prevalent in the community. Then night

and day his mind is filled with anxiety. The sorrows of bereavement

continually call for his sympathy. And in the midst of all this, he

avoids solicitude for his own safety, only by forgetting himself in

the arduous duties which he performs for others’ welfare. While he

sees others fleeing from the pestilence, he must be ever at his post.

Though he may see some of his brethren falling around him, humanity

demands of him that he should go on in his services to the sick,

and to the honor of our profession I believe it may be said, that

this demand is very seldom disregarded. During the prevalence of the

yellow fever in Philadelphia in 1793, of the thirty-five physicians

who remained in the city, eight (nearly one fourth of the whole

number, died, and but three escaped an attack of the disease).

One of the greatest trials which the physician has to bear is the

ingratitude of those upon whom he has conferred favors. There are

services rendered by the medical man who is faithful to his high

trust, for which no money is an adequate compensation. His reward

for such services comes from two sources—the satisfaction always

attending the performance of duty, and the gratitude of those to whom

they are rendered. The wealthy by no means discharge in full their

obligations to the physician, who attends upon them in all their

sickness with unwearied fidelity, when they pay him in full for his

attendance. They owe to him the affection of a true friendship, and

the gratitude due to something more than a professional performance

of duty in their behalf. The relation of a physician to his

employers is not shut up within the narrow limits of mere pecuniary

considerations. There is a sacredness in it, which should forbid

its being subjected to the changes incident to the common relations

of trade and commerce among men. But many do not so regard it. They

dismiss a physician for as slight a reason as governs them in ceasing

to buy of one man, and giving their patronage to another, or, as

Dr. Rush says, “with as little feeling as they dismiss a servant,

or dispose of a family horse.” A mere whim, or caprice, is often

suffered to dissolve this relation, though it may have existed for

years. And generally the more frivolous and unfounded the reason for

the change, the greater will be the zeal with which they laud their

new favorite, and the harsher will be the aspersions, which they will

cast upon the professional character of the old and tried friend,

whom they have deserted.

Strange as it may seem, it is the experience of every physician, that

some of the strongest evidences of ingratitude come from some of

those upon whom he has conferred the highest favors, perhaps those

which are entirely gratuitous. One would suppose that they who have

had the services of a physician without making him any compensation,

would from motives of delicacy refrain from speaking ill of him,

if they chose to discharge him and employ another. But blame is

sometimes dealt out without stint under such circumstances. It would

be supposed also that the obligation, which a gratuitous attendance

imposes, would always be gratefully recognized by the patient.

But it is often otherwise. Many patients are disposed to forget

such obligations; and everything which may call them up to their

attention, and especially to the attention of others, is carefully

avoided. Dr. Rush speaks of some who had been attended gratuitously

in humble life, who deserted their family physician after their

elevation to rank and consequence in society, “lest they should be

reminded, by an intercourse with him, of their former obscure and

dependent situation.”

There is not as much gratitude in the world as is commonly supposed.

This is particularly true of the services of a physician. These are

received by many, as a matter of course, as being something to which

they have a sort of natural right. They seem to class them among the

common blessings, such as air and water, for which, because they are

so common, they have no idea of being grateful. Day after day, and

week after week, they may be the objects of the physician’s most

assiduous attentions, and his exertions may be blessed, and obviously

so, to the preservation of life; but when health comes they will

grudge him even the pittance of a half day’s labor from those hands

to which his skill has restored strength, though they spend days

and weeks every year in the most shiftless idleness. Quite a large

proportion of the poor treat the physician in this way.

An old physician of my acquaintance was used to say that there are

three kinds of poor—the Lord’s poor, the devil’s poor, and poor

devils; that is, the virtuous poor, the vicious poor, and those

who are poor from sheer shiftlessness. The _virtuous_ poor are

always grateful; and there are none among the wealthy upon whom the

physician attends more cheerfully, than he does upon some of this

class. Of his kind offices to them, and of their feelings in return

to him, it can be said in the beautiful language of Scripture, ‘When

the ear heard me, then it blessed me; and when the eye saw me it

gave witness to me: because I delivered the poor that cried and the

fatherless, and him that had none to help him. The blessing of him

that was ready to perish came upon me; and I caused the widow’s heart

to sing for joy.’ As the physician goes his daily rounds, there

is no one thing that so cheers him on in his course of toil and

benevolence, as the gratitude of the virtuous poor. And if there will

be tears shed at his death beyond the little circle of friends, in

the very bosom of which he lives, _they_ will shed them profusely and

long.

Not so, however, with the other two classes of the poor. The

shiftless poor, who were denominated by my aged friend ‘poor

devils,’ who go just as wind and tide will take them, and carry to

ultraism the principle of letting to-morrow take care of itself, are

actually too lazy to have so lively a feeling as gratitude. And

of the _vicious_ poor it may be said, that it requires something

more than the selfish principles of this world to attend upon them

with cheerful faithfulness. There is often, it is true, much show

of gratitude; but it is seldom, though it is sometimes, more than

mere show. The romance of doing good will not stand this trial.

Nothing short of the untiring benevolence of Christianity will do

it. Sometimes, indeed, so much effect is produced upon the views

and feelings of the poor by the bounty and kind attentions of the

benevolent, that an actual reform is effected, and an abode of vice

and misery is converted into one of virtue and happiness. Then, of

course, the most lively gratitude is manifested. But it is rarely so.

We must apparently _throw away_ much time and effort, and it is only

once in a great while that our hearts can be cheered by any obvious

good results, or any real gratitude. Benevolence does now and then

seem to have a magic wand, with which, almost in a twinkling, she

turns scenes of gloom and desolation into those of beauty, and makes

even the wilderness to blossom as the rose. But she is generally

employed in real drudgery with little immediate prospect of success.

She digs and digs patiently, and with the animation of hope. She

finds but few gems; but these, be it remembered, will survive all the

changes of time, and will shine in her coronet forever.

It is true that gratitude is sometimes awakened in the heart of

the vicious poor, even when our influence does not produce any

improvement in their moral condition. But it has only a momentary

existence, and, amid the giddy whirl of grovelling enjoyments, our

kindness is forgotten, and the recollection of it is excited only

by their returning necessities. And then too, the apathy, into

which the heart is apt to be schooled by the miserable monotony

of a vicious poverty, effaces every trace of feeling which may

occasionally be impressed upon it. This state of heart may be read

in the very countenance—the wooden features, which our kindness may

have roused to some degree of animation, soon resume their wonted

inexpressive fixedness after the exciting cause is gone. And often,

very often, the favors we dispense are received with a vacant stare,

the recipients being strangers themselves to any other motive than

selfishness, and therefore taking no cognizance of the existence of

anything like benevolence in the bosoms of others.

There is one class of the community that have been accustomed to be

attended gratuitously by physicians, who have so often wounded the

feelings of our profession by the course which they have pursued,

that I cannot pass them by without a particular notice. I refer to

clergymen. So scantily are they generally compensated for their

services, and so intimate is the relation which they hold to our

profession, that medical men have commonly very cheerfully made

their attendance upon them gratuitous. This being the case, they

have a right to expect of them, if not gratitude, at least a proper

regard for their rights as professional men. But I am constrained to

say that many of this class have failed to answer this reasonable

expectation. The physician often finds, that the clergyman, upon

whose family he has attended without charge, perhaps for a long

time, gives his certificate in recommendation of some nostrum, or

employs some quack, or becomes the noisy advocate of some new system

just now rising into popular favor, or perhaps, in his zeal for his

sect, becomes the active patron of some practitioner of his own

denomination, urging him even upon the families of the physician

whose services he has so long gratuitously enjoyed. Such acts as

these on the part of men who have received such favors, and who by

their station and character can exert so much influence, are among

the most vexatious trials of a medical life.

The feelings of the physician are tried not only by the treatment

of individuals, but by that general disposition against the medical

profession, which is to some extent manifest in every community. If

you look candidly upon the public benefits[45] which our profession

has conferred upon society, to say nothing of its toils and

self-denials, you will be impressed with the fact, that it does not

receive that respect and that regard for its interests to which it

is fairly entitled. The radicalism which aims to overthrow it is

in some measure countenanced by many, of whom we have a right to

expect better things. Many of the intelligent and well informed pay

an occasional tribute to empiricism, and manifest a distrust towards

medicine, which they do not manifest towards any other science.

Though they would be sure to employ none but lawyers of known

skill, and would sit under the teachings of none but well educated

clergymen; if sickness comes, they resort to some secret nostrum,

or employ some pretender, of whom perhaps they know little else,

than that he calls himself a German, and has an abundance of hair

about his visage; and if they have a dislocated or fractured bone,

they abjure scientific surgery as unworthy of confidence, and send

for a natural bone-setter. The reasons which secure their respect

for other sciences fail altogether when they come to medicine. They

even indulge in a playful contempt in speaking of its claims. They

banish it from the pale of reason; and submit themselves to vagaries

and fallacies and pretensions, the folly of which they would see

at once in relation to any other subject. They refuse to give to

either the science, or the profession, that steady esteem which is

clearly due to it from all stable and intelligent men. In seasons of

trial even, instead of extending to physicians their confidence and

support, they reward their toils with an ungenerous and inconsiderate

fault-finding. This ingratitude of the public is sometimes manifested

in the most offensive manner. After the yellow fever in Philadelphia

in 1798 had subsided, at a meeting of the citizens, in which the

committee who superintended the city during the prevalence of the

disease was honored with a vote of thanks, a similar vote was

proposed in relation to the physicians, _but was not even seconded_,

though, as I have stated in another place, nearly one fourth of their

number perished, in their efforts to save that ungrateful people from

the ravages of the pestilence.

Let us turn now to the consideration of the _pleasures_ of a medical

life. On this branch of the subject I shall be brief, not because the

physician has few joys, for he has many, but because they require no

extended notice to make the reader appreciate them.

If we look at medicine simply as a science it is full of interest,

and the study of it is therefore a rich source of gratification. Its

subjects have a wide range and an endless variety. No science has

such extensive and intimate connections with other sciences.[46] It

gathers to itself the resources of chemistry, botany, mechanics,

comparative anatomy and physiology, and mental philosophy; and fills

its storehouse of facts with a variety and abundance sufficient to

satisfy the wildest and most eager curiosity. The phenomena of life

even in the healthy condition are exceedingly diversified; but, as

modified by disease, and by the remedies which are administered,

their variations are never ending. And then the mysterious connection

of mind and body not only varies them still more, but opens to us

a mass of facts of a mingled mental and physical character, which

awaken an intense interest. The physician looks upon the human body,

not merely as a machine filled with contrivances so cunning and

elaborate, as to render all the mechanism of man in the comparison

rude and bungling; but as a machine instinct with life, having a

living nerve attached to every fibre of it, giving to it its power to

act; and, more than all, as a machine holding in strange connection

with its every fibre a reasoning soul, the image of the Deity,

destined, not to perish like the mind of the brute with the perishing

body, but to live through the ages of eternity.

The details of a science which treats of phenomena so interesting

in their character, and so wide in their range, are never dry and

uninteresting, as the details of other sciences sometimes are. There

are no tedious technicalities, no dull abstractions. There is no

tiresome monotony. There is therefore an absorbing enthusiasm in

the pursuit of medical science, which is not so common in other

studies. It is an enthusiasm which makes its votary disregard the

loathsomeness of putrefaction, and even forget danger, in his search

after truth.

An additional interest is given to his investigations by the

consideration, that if he discover a fact, or help to establish one,

he adds to the resources which our art can apply to the relief of

human misery. To experience this pleasure, so gratifying to the

humane and benevolent mind, he needs not to make any grand discovery.

The joy which Jenner realized in the contemplation of the benefits

of his discovery must have been almost overpowering; but the benefit

which results to our race from the humblest contribution to medical

knowledge is as real though not as great, and is a fitting subject

for joy to him who makes it, for it will assuage many a pang and save

many a life.

In the practice of medicine, though there is, as you have seen in my

first chapter, much uncertainty, there is a high satisfaction in the

very exercise of unravelling its perplexities, and in separating,

as it can be done by untiring and careful observation, the certain

from the uncertain, the true from the false. And though much is left

to nature by the judicious physician, still there is much pleasure

in watching her movements, in removing obstacles which oppose her

salutary processes, and in assisting her efforts so far as it may be

necessary to do so. This intelligent watch and guidance which medical

skill exercises over nature in removing disease is far from being

unsatisfactory to the rational practitioner. And then, too, though

the general use of _heroic_ remedies is injurious, there are times

when the careful observer sees opportunities for employing them to

great advantage in arresting morbid processes. And so accustomed

is he to make the requisite discriminations, that his efforts in

positive medication are well directed, and are almost sure to

accomplish their object. He has a satisfaction in such achievements,

of which the undiscriminating overdoser knows nothing.

The judicious physician experiences much gratification in the

_mental_ management of the sick. I refer not merely to the control

which by his tact and skill he exercises over the mind which is

manifestly deranged, but also to those multiplied and various mental

influences which he exerts so silently, but so effectually, even in

ordinary cases of sickness. Besides the pleasurable interest with

which he watches the operation of these influences, there is also a

high source of gratification in the consciousness of possessing such

a power over the minds of his fellow men. Especially is this the

case, when the power which he puts forth is exerted upon minds of

great refinement, and of a high order of talent.

The _results_ of the practice of the skilful and judicious physician

are as a whole very gratifying to him. His vocation is to relieve

pain and distress, and to deliver from disease; and when he fails

to do this, sad as it is, it is an occasional, we may say a _rare_

exception to the general result. In the great majority of even severe

cases, in which the pressure of responsibility is such a burden upon

his spirit, and the alternations between hope and fear are often so

painfully exciting, his heart is at length gladdened by a favorable

issue. The physician is therefore by habit a hopeful, a cheerful, a

happy man. As such he enters the sick room, the scene of the triumphs

of his art. As such he mingles in the family and social circles of

his fellow men, inspiring by his very air and manner cheerfulness in

the sad, and hope in the unfortunate and dispirited. The physician

then is apt to be not only the sympathising, but the _comforting_

friend.

But not only is the success with which he meets in combatting disease

a source of happiness to the physician, but so also especially is

the gratification of his humanity and benevolence, in relieving the

distresses of his fellow men, and in prolonging their lives. In some

cases in which the life which he has struggled to save is a valuable

one, the joy which fills his heart at the final successful issue of

that struggle no words can express.

It will be observed by the reader that in speaking of the

gratification which is derived from the successful treatment of

disease, I have had no reference at all to the _reputation_ for

success which is awarded to medical men by the community. This may

be based upon real merit, or it may not be. When it is not, but is

acquired by making false issues before the public, as is too often

the case, it is indeed a source of gratification—a gratification,

however, which is not only of a low order, but the hold which the

possessor has upon it is exceedingly uncertain. He feels it to be

so, and is in constant fear that some competitor, practising the

same arts, will overmatch him in skill, and filch from him his

ill-gotten joys. But on the other hand, the success of the honorable

practitioner in acquiring a medical reputation, based as it is upon

intelligent grounds, is a source of high gratification, and he has,

too, the satisfaction of feeling that it is a permanent possession.

True, there are some who employ and praise him from whim and caprice,

who from whim and caprice may desert and blame him; but his patients

are for the most part those who repose in him an intelligent and

firm confidence. And this affords him a gratification, of which

the caprices of the world and the intrigues of his brethren cannot

despoil him.

The attachments which the physician forms in so many families in

the different walks of life are rich sources of happiness. These

attachments are generally reciprocal. In some cases the interest

which he feels in the patient, beginning in infancy, and extending

through many scenes of sickness up to adult age, has accumulated all

this time more and more strength and tenderness. Sometimes in the

long life of a physician, this interest in some families of patients

reaches through three or even four generations. And these intimate

attachments bring the physician into very near relation with some

characters of rare excellence in the different walks of life. The

admiration and the love with which he looks upon such noble spirits,

of whom the world is not worthy, and the communion which he is

permitted to have with them up to the moment of their departure to a

world of bliss, are among the highest sources of the happiness of the

physician.

The opportunity which the physician has for observing human character

is a prolific source of enjoyment. It opens to him one of the most

interesting of all studies, and in his daily intercourse with

patients of every variety and degree, he finds no lack of material in

illustration of any supposable variation of character.

The nature of the physician’s employment, it must be obvious to

the reader, is calculated to fit him eminently to enjoy and to

adorn social life. He is commonly the pleasing companion as well as

the warm and faithful friend. The freedom of his intercourse with

all sorts and conditions of men imparts an ease and a zest to his

conversation, and he has an abundance of facts and anecdotes to

illustrate every remark which may be made. It is for this reason, as

Dr. Rush says, that “physicians in all countries have been the most

welcome guests at the tables of the great, and are frequently waited

for with the most impatience at clubs and in convivial companies.”

One of the chief sources of the happiness of the physician is the

gratitude of his patients. I have already said enough upon this

subject, and I would now simply remark, that, though there is much

ingratitude which is a sore trial to him, many of his patients

gladden him in the midst of his toils and anxieties with tokens of

gratitude of the most delightful character. And among these tokens,

the testimonials which he receives from the poor, humble as they are,

are often more highly prized than the costly and splendid presents of

the wealthy.

Finally, a great source of happiness is afforded to the truly

benevolent physician in the opportunity which he has for exerting

a good moral influence. When by his instrumentality the abode of

vice and misery has been converted into one of virtue and peace,

and especially when his counsel and influence have been the means

of saving a soul from death, he has a higher joy than all success

however brilliant, and honor however profusely awarded, and gratitude

however ardent, can impart to his soul.

In conclusion I remark, that, though the trials and disappointments

and mortifications of a medical life are numerous, very vexatious,

and sometimes almost insupportable, yet the pleasures which come

from the sources to which I have alluded vastly predominate over

them all, and make the practice of medicine, when pursued with right

motives, as a noble profession, and not as a trade, to be in the main

eminently satisfactory and delightful.

FOOTNOTES:

[45] To estimate the public benefits which the medical profession

has conferred upon the world, you need only to look at the zealous,

and I may say _leading_, agency, which it has always exercised in

instituting and maintaining Hospitals, Asylums for the Insane,

Institutions for the Instruction of the Deaf and Dumb, and the Blind,

and Associations for the advancement of the sciences.

[46] Hence comes the fact, that many of the most eminent men in the

various departments of science have been furnished from the ranks of

the medical profession.

APPENDIX

LETTERS[47]

FROM A SENIOR TO A JUNIOR PHYSICIAN.

ON THE IMPORTANCE OF PROMOTING THE RELIGIOUS WELFARE OF HIS PATIENTS.

LETTER I.

ON THE DIFFICULTIES OF THE UNDERTAKING.

MY DEAR FRIEND,

You were pleased to desire me to send you the result of my

observation and experience on the deeply interesting subject of

endeavoring to promote the spiritual welfare of the sick committed to

your care. I cheerfully accede to your wish, although I can scarcely

hope to offer any suggestions which have not already occurred to your

own reflective mind.

If the soul of man be immortal, and if the state of the soul, at

the moment of its separation from the body, determine its happiness

or misery through endless ages, with what deep solicitude should

every Christian approach the bed of a fellow creature, who, to

all appearance, is about to undergo the momentous change, yet

unprepared “to meet his God!” If we saw a human being proceeding

blindfold towards a tremendous precipice, even already at its brink,

how eagerly should we try to snatch him from the threatening

destruction! And can we, my friend, remain insensible to the

spiritual danger of the dying man, who seems about to “take a leap

in the dark” into the gulf of inconceivable—irretrievable ruin?

How often, alas! are we called to witness the appalling scene,

unalleviated by the presence of a Christian minister, or any pious

relative, who might direct the helpless sufferer to Him, “who is able

to save to the uttermost!”

I am aware, indeed, that those alone who, like ourselves, have

felt the weight of medical responsibility, can fully estimate the

difficulties to be encountered in attempting to advance the _highest_

interest of a patient, while conscientiously discharging our primary

duty, in the exertion of our utmost efforts for the restoration or

relief of his bodily frame. Even to those, who, by habits of early

rising, punctuality, systematic arrangement, and calm despatch, have

been able to allot a sufficient portion of time to each appointment

of the day,—how often does it happen that some unexpected emergency,

some sudden complication of disease, the alarming sickness of

another member of the family, some anxious inquiries of the patient

or his friends, or other unforeseen circumstances, have more than

consumed the allotted time, and in justice to the indispensable

claims of other cases, rendered an immediate departure necessary:

thus affording no opportunity of even alluding to “things unseen and

eternal.”

Another difficulty is often found to arise, from the almost exclusive

occupation of the physician’s mind by the diseased condition of

the sufferer, the relief of which is, of course, our primary and

incumbent duty. In order to give to each symptom, as well as to the

whole assemblage of symptoms, a close and discriminating attention,

and to adapt, with equal care, a corresponding treatment in medicine,

diet and general management; to do this within a limited space of

time, requires a concentration of all the energies of the mind in a

degree scarcely compatible with attention to any other subject. Under

such circumstances, it is difficult in the extreme, to dispossess

the mind of the engrossing anxiety just described, so as to leave

it sufficiently free for availing itself of any suitable moment for

introducing, with needful delicacy and tenderness, the all-important

subject of eternity. How frequently, too, have we found that by the

time we have completed our medical inquiries and directions, the

patient has become too much exhausted to render any further exertion

safe or practicable!

In addition to the obstacles already specified, you have probably,

my dear friend, sometimes encountered opposition from the mistaken

kindness of the patient’s relatives, who have deemed it next to

madness to endanger the comfortable serenity of one “whose goodness

of heart,” they persuade themselves, “must secure him a happy

hereafter.” Generally, however, the confidence reposed in the

kindness and discretion of the medical attendant, will soon allay

such a feeling of alarm, and afford the assurance that nothing will

be attempted of a doubtful or hazardous character.

But the most formidable hindrance, I apprehend, exists _within

ourselves_. I refer to the prevailing impression among us, that the

religious welfare of a patient is foreign to our province; that to

aim, in any direct manner, at promoting it, is superfluous, if not

also obtrusive; and that the attempt might be regarded, moreover, as

an unbecoming interference with the sacred office. The _sedative_

influence of this opinion is often rendered still more paralysing by

a consciousness of not possessing the facility and tact supposed to

be essential to the success of the effort. Hence, opportunities for

speaking “a word in season,” are scarcely looked for or desired. The

mind, at length, rests satisfied with an abandonment of the matter,

as hopeless and impracticable, not duly considering _whose cause it

is_, nor recollecting the divine promise that “strength shall be made

perfect in weakness.”

Such, my valued friend, are among the difficulties in our way;

great, indeed, we must allow them to be, yet, happily, they are not

insurmountable.

Assuming, for the moment, that the duties and qualifications of

the medical practitioner do not impose upon him a higher degree of

responsibility, relative to the spiritual good of his patient, than

attaches to every other well-informed Christian, in reference to

his neighbor, I may safely assert that the profession of medicine

does in no wise release its member from a duty common to all

Christians—that of embracing every opportunity to testify their

gratitude to the adorable Saviour, and their anxious desire to

extend the blessings of redeeming mercy to those who “are ready to

perish.” But the assumption itself is incorrect; for it would not

be difficult to prove that the favorable opportunities and peculiar

facilities possessed by the physician do proportionably _augment_

his responsibility, and the consequent amount of obligation. Nor can

this fearful responsibility be evaded, by a general impression of our

unfitness for the task, unless we can conscientiously affirm that we

have tried to the utmost—that we have done all that we were able to

do.

As regards the alleged interference with the ministerial office,

I may truly say that, to the extent of my own observation, the

apprehension is entirely groundless. So far removed, indeed,

are the judicious, well-timed suggestions of the physician, in

relation to the immortal interests of his patient, from anything

like interference with the sacred function, that, in the instances

in which they are most needed, they may be strictly regarded as

_precursory_ and introductory to the more direct instructions of the

minister; as opening a way for him which would otherwise be closed,

as removing ill-founded objections to his assistance, and enkindling

a desire for his spiritual counsel. In many other instances, the

Christian physician proves a powerful _auxiliary_ to the faithful

minister of Christ, especially by facilitating his visits, pointing

out at what time, under what circumstances, and to what extent,

the patient may be likely to attend, with safety and advantage, to

“the things which make for his eternal peace.” I have good reason,

indeed, to believe that the enlightened ambassadors of the Saviour,

so far from entertaining a feeling of jealousy, do really hail with

cordial satisfaction such auxiliaries, in their trying visits to the

bed of sickness and death; persuaded that none can feel a deeper

interest than a Christian physician, in the well-being of _the whole

man_, bodily and spiritually, in reference to eternity as well as to

time. And how can jealousy be felt? Is not the glory of his Divine

Master in the salvation of immortal souls, the supreme object of

every pious minister’s pursuit? If so, even the feeblest attempt to

subserve the same cause must gain his hearty concurrence. Happily,

the un-scriptural, un-Protestant notion of religious instruction

devolving exclusively on the clergy has become obsolete. As well

might the Bible itself be read and studied by them alone. The very

constitution, indeed, of our most efficient religious institutions

speaks a contrary language; especially that of the visiting and

district societies, in which the principle of lay co-operation is

clearly recognized, and the obligation thence arising is fully

avowed. In truth, it requires but little sagacity to predict that,

in the noble enterprise now in progress for evangelizing the world,

the zealous exertions of Christians generally will be more and more

called forth. Such an active and pervading influence seems evidently

implied in the prophecy of Jeremiah, as cited by the apostle of the

Gentiles, alluding to the period when “they shall not teach _every

man_ his neighbor, and _every man_ his brother, saying, ‘know the

Lord;’ for all shall know me, from the least unto the greatest.” We

have yet, indeed, to realize the happy day when, even comparatively,

_every_ man shall seek the spiritual good of his neighbor; but we

are surely authorized to expect it, as well as bound to hasten it,

by earnest prayer and vigorous endeavor. We are even encouraged to

anticipate the more distant and glorious period, when the omnipotent

Saviour shall have given complete efficiency to the universal labor

of love, and when “He shall be all in all.”

Not to weary your patience further, I will here close my letter;

hoping, in a second communication, to present a few _encouragements_

which may serve to cheer you under the difficulties we have been

considering. I shall endeavor also to add some practical suggestions,

in reference to the most eligible _methods_ of introducing the

subject of religion to persons dangerously ill. Of the power of

executing the latter part of my task, especially, I cannot but

entertain much self-distrust.

I remain, my valued friend,

Your’s, with sincere regard,

T. H. BURDER.

_Tilford House, Jan. 1st, 1836._

LETTER II.

ON THE ENCOURAGEMENT TO BE EXPECTED IN THE ATTEMPT.

MY DEAR FRIEND,

In my former communication I placed before you the considerations

which had most impressed my own mind, in reference to the

_importance_ of aiming to promote the spiritual welfare of the sick.

You will have observed that, far from concealing, I fully admitted

the difficulties attendant on the effort, while I endeavored to show

that they were by no means insurmountable. I am now desirous of

presenting to your attention a few of the _encouragements_ which the

physician is warranted to expect in pursuing this “work of faith and

labor of love.” Such, I apprehend, will be found to arise from THE

PECULIAR FACILITIES WHICH THE PROFESSION AFFORDS; FROM THE DIVINE

BENEDICTION WHICH MAY BE HUMBLY, YET CONFIDENTLY, ANTICIPATED; AND

FROM THE SUCCESS WHICH HAS ALREADY CROWNED SIMILAR EFFORTS.

1.—No one who has witnessed the respect and confidence with which

the suggestions of a conscientious physician are received, can

doubt of his possessing an almost unlimited influence in the sick

chamber. He has become, in truth, the attached friend of the

family, to whom they freely unbosom their sorrows and their fears,

particularly such as appear to be inducing or aggravating any

existing or threatened disease. Hence the medical adviser, having

gained an important acquaintance with the mental constitution of his

patient, its individual peculiarities and tendencies, and with the

varying complexion of thought and feeling which bodily disturbance

has been wont to excite, is already prepared to introduce with

delicacy and address, such incidental remarks in reference to his

highest interests as the peculiar condition of the sufferer may

naturally call forth; and in the way best adapted to interest and

impress, while least likely to endanger that general quietude, on

the maintenance of which his recovery may materially depend. Being

aware, moreover, of the different aspect in which other topics of

practical importance have at various times appeared to his patient,

or to persons under similar circumstances, while viewed through

the distorting medium of disease, he will not be surprised if the

momentous subject of religion should also share (so far as natural

effects may be permitted) in the obliquity or indistinctness of the

mental vision. The same previous knowledge will often enable him

to calculate, with tolerable precision, the degree of influence,

whether exciting or depressing, which an allusion to the realities

of eternity may be likely to exert on the patient’s bodily frame;

and thus to attemper and apportion his suggestions to the particular

exigencies of the case.

2.—Among the _facilities_ to which we have adverted, I cannot but

regard as one of the most valuable, that arising from the numerous

opportunities possessed by the physician of connecting in the most

easy and natural manner, some serious remark with his medical

counsel. So intimately, indeed, is the mind united to the body,

and so generally does the one sympathize with the sufferings of

the other, as constantly to demand a considerable portion of the

physician’s vigilance and discrimination. He cannot but observe the

baneful influence of agitating and corroding emotions, in thwarting

every healing expedient; and being constrained, therefore, to

inculcate the importance of tranquillity, acquiescence, and cheering

hope, he is led by the most gentle transition to trace those virtues

to the true source of “every good and perfect gift,” and to the

surpassing value and efficacy of the Saviour’s peace, and of the

“hope that maketh not ashamed.”

You have often, my friend, observed in the moment of danger, with

what eager, anxious attention the patient listens to every word that

falls from his physician. He knows that his friend and counsellor is

deeply concerned for his well-being, and can have no interest apart

from his. He is aware of the value of professional time, and has

experienced the unwearied assiduities which have been exerted for the

preservation of his life. Should, therefore, the physician appear

to overstep the precise boundary of his province while touching

upon the concerns of immortality, the patient, I am persuaded, will

usually regard the solicitude thereby evinced, as an additional and

gratifying proof of genuine friendship. The sick man has also the

tranquillizing conviction, that nothing is likely to proceed from

his judicious adviser which would either aggravate the disease,

or interfere with the salutary operation of remedies. Hence, no

alarm, no perturbation is induced; while two or three well-adapted

hints are gaining a quiet admission into the mind, and affording

useful materials for private meditation and self-inquiry. Now, my

dear friend, if such be the advantageous position of a humane and

Christian physician in the chamber of sickness, and I am sure your

own observation will verify the statement, how deep must be the

regret that such ’vantage ground has ever been lost, yea, lost for

ever! That where the sick man’s anxious eye betokened confidence,

expectation, desire, we should have allowed so fair an opportunity

to pass away, without affectionately and urgently directing him to

“Behold the Lamb of God!” I will not again expatiate on the serious

responsibility which these facilities involve, but I respectfully

entreat my professional brethren to be on their guard, lest timidity,

apathy, or worldly policy should deprive them of the exalted

privilege of being instrumental in saving a soul from death, and

thus adding another jewel to the Redeemer’s crown. It may still be

said, that the afflicted patient will not be disposed to listen to

the _religious_ advice of his physician, considering it as altogether

foreign to his department. I believe, on the contrary, that such

advice, when tendered with kindness and discretion, will generally be

regarded the more highly because it is _not_ professional, because

it is _not_ a matter of course, but springing spontaneously from

the lively interest which the physician feels in the entire welfare

of his charge. This view of the subject seems to me quite compatible

with the sincerest respect for the labors of a Christian minister in

the time of sickness. His invaluable instructions have the weight and

sanction of official character; while, from the aptitude afforded by

kindred studies and pastoral duties, they may be expected to possess

an appropriateness not otherwise attainable. They are held, moreover,

in high estimation, because they are regular and ministerial; whereas

the religious hints of the physician, as I have before remarked,

acquire much of their interest and influence from the very opposite

consideration,—from the fact of their being occasional, unexpected,

and spontaneous.

3.—The powerful incentive arising from _an humble expectation

of the Divine blessing_, appears to me fully authorized. If I

have adequately shown the importance of the endeavor, and have

satisfactorily proved that the peculiar facilities afforded to

the physician, involve a proportionate amount of obligation (in

those cases, at least, which have not and perhaps cannot have,

the advantage of ministerial instruction,) it will follow, as a

necessary consequence, that in performing a Christian duty of such

moment, we are warranted to implore and to expect the special aid

of Omnipotence. The object at which we aim is nothing less than the

glory of the Divine Saviour, in the salvation of an immortal soul,

and how cheering are the assurances of infallible truth,—“I will

make my strength perfect in weakness.” “Him that honoreth me, I will

honor!” “He that converteth a sinner from the error of his ways,

shall save a soul from death, and hide a multitude of sins.”

And let not my valued friend be discouraged at the difficulty of the

undertaking. The cause is God’s. He hath all hearts in his hand,

all events at his disposal, and is often pleased to effectuate the

greatest designs by the most feeble instrumentality, in order to show

that “the excellency of the power is not in man, but in God” alone.

Far be it from me to depreciate the value of prudence and discretion

in an attempt of such importance; but I am bound to confess that

the danger has not generally arisen from the neglect of cautionary

maxims, but from permitting them to obtain an undue and paralysing

influence. Where eternity is at stake, let us not be exclusively

guided by the cold, calculating axioms of worldly policy. Selfishness

may whisper, “Am I my brother’s keeper?” and as the priest and the

Levite in the parable of the good Samaritan were probably willing to

persuade themselves that there spiritual functions imposed upon them

no obligation to afford _bodily_ succor to the “wounded, half-dead

man,”—so, my friend, may we be in danger of resting satisfied in

withholding our spiritual aid from our dying patients, on the hollow

and untenable ground that our responsibility extends only to the

body and to time. Oh! let us be rather like the good Samaritan, and

without hesitation or delay, endeavor to pour into the wounded spirit

the wine and oil of heavenly consolation,—thus adopting our blessed

Lord’s special application of the parable—“Go, and do thou likewise!”

Surely we may confidently hope that in rendering this obedience, we

shall experience super-human aid; and though our path may be dark and

rugged, and the obstacles many and powerful, yet may we cheerfully

and implicitly rely on that Almighty God, who is “a Sun and a Shield”

to those who put their trust in Him.

May I not add as a collateral encouragement, that while thus aiming

to promote the honor of the Divine Emanuel, we may humbly hope

that he may be “_with us_,” in granting efficiency to our strictly

professional exertions? When it is considered that the skilful or

unskilful decision of a moment may save or lose a valuable life, and

that even a well-selected remedy may prove salutary or detrimental as

the Divine benediction is vouchsafed or withheld, how inconceivably

important must we regard the guidance and the smile of Him, “in

whom we live and move, and have our being,” and in whom are all our

springs of intelligence and of usefulness! By “seeking the kingdom

of God and his righteousness” in the way we have described, we may

be rendered the happy instruments of giving occasion to our grateful

patients, to unite with the sweet singer of Israel, in ascribing

from their inmost souls, blessing and praise to Jehovah, for having

not only “forgiven all their iniquities,” but also “healed all their

diseases.”

One especial ground of encouragement yet remains—that which rests

upon _the actual success with which the God of all grace has been

pleased to crown similar efforts_. He, who hath all power in heaven

and on earth, _has_ given efficiency to such exertions: and while,

with “a single eye to His glory,” they are “begun, continued, and

ended in Him,” we cannot doubt that the ardent desire and persevering

endeavor to rescue immortal souls from endless perdition will be

accompanied by these gracious influences which can at once direct,

and animate and bless. Thus, “our labors shall not be in vain in the

Lord.”

It has already been remarked, that, in aiming to subserve the

spiritual as well as temporal interests of our patients, we shall

usually retain, if not increase, their confidence and regard.

Sometimes, however, it may prove otherwise; especially in reference

to the relatives and friends of the sick. This was strikingly evinced

in the experience of an aged and eminent, but now deceased physician,

then practising in Westminster, as communicated by him to the writer

of this letter. The veteran practitioner was called to the bedside of

a young lady, whom he found passing to her long home, yet destitute

of hope, unacquainted with the way to Christ, and peace, and heaven,

and surrounded by relatives equally ignorant with herself. He placed

in the hands of her attentive and (as it afterwards appeared) pious

nurse, a volume of the “Village Sermons,” requesting that a portion

might be occasionally read to the youthful patient. On getting out of

his carriage on his next visit, he was met by the mother, and thus

abruptly accosted—“I will not trouble you to go up stairs;” assigning

no motive for so unceremonious a dismission, except such as might be

read in a countenance of high displeasure. My sagacious friend at

once penetrated her mind, and retired. After some time had elapsed,

the nurse informed him that the young lady lived but a few days after

his visit, yet long enough to afford a delightful evidence of having

obtained pardon and peace through a crucified Redeemer. The very

volume, it appeared, that excluded the physician from the family, was

rendered instrumental in introducing the dying patient into spiritual

life. And never can I forget the pious elevation and the grateful

emphasis, with which my venerable friend closed his affecting

narrative: “cheerfully,” said he, “would I lose the best family in my

professional connection, if by my feeble instrumentality I could be

the means of saving another soul from death.”

Thus, my dear friend, I have endeavored to set before you the

principal encouragements for the endeavor. I have still to accomplish

the most difficult part of my task—that of submitting to you a few

suggestions on the _mode_ of communicating serious counsel to the

sick. This I must attempt in a future letter.

Believe me, with esteem,

Your very faithful friend,

T. H. B.

_Tilford, Jan. 28th, 1836._

LETTER III.

ON THE MOST ELIGIBLE METHODS TO BE PURSUED.

MY DEAR FRIEND,

In accordance with your request, I now proceed to offer a few

suggestions derived from personal observation, on the methods which

appear to me best calculated to secure the important object of our

present correspondence. You will remember, that, even at a distance,

I doubted my ability for properly executing this part of the

undertaking; and I candidly own that my consciousness of inadequacy

has not diminished on a nearer view of the attending difficulties.

Should, however, the plain remarks you are about to receive, possess

little value in themselves, they may, I am willing to hope, prove

indirectly useful, by engaging your own attention more closely and

continuously to the subject.

You are too well aware, how deeply the feeling of medical

responsibility has pressed upon myself, to suppose for a single

moment, that I would inconsiderately superadd to a similar burthen

upon you any unnecessary weight of obligation as connected with the

spiritual condition of your patients. I cannot, indeed, relinquish

the opinion I have deliberately formed, and which has been before

avowed, namely, that the peculiar facilities afforded to the medical

practitioner entail upon him a proportionate responsibility; yet am

I very solicitous not to endanger the peace of a conscientious mind,

by incautious or exaggerated statements, or by urging the adoption

of any doubtful or impracticable measures. On a subject of such

manifest delicacy as well as difficulty, it is highly important that

our views should be well defined, and our opinions of the duties

and obligations involved, most carefully guarded and qualified,

otherwise we may not only inflict a needless wound on a pious mind,

but may actually defeat the very object we desire to promote, by

the disheartening influence of plans of operation unfeasible in

themselves, or inconsistent with our proper, indispensable, and

untransferable duties. Allow me, therefore, to request your attention

to two preliminary observations.

First,—I would remark that the desire of promoting the patient’s

religious welfare should never be allowed to interfere with the

thorough performance of medical duties. These cannot be superseded

by any other claims. Under this decided impression I would suggest,

as a general rule, the propriety of giving your sole, undivided

attention to the relief of the patient’s malady, as well as to every

circumstance and arrangement which his bodily condition may demand,

before you permit yourself to advert to his spiritual exigences.

You will kindly observe that I recommend this as a _general_ rule,

which may possibly admit of some exceptions. For example, I can

conceive that some highly-gifted individuals may have the power

of interspersing, in an unobjectionable manner, a few religious

hints among their medical enquiries and directions, and without

materially distracting their attention, or endangering the temporal

well-being of their charge. Yet, even with such facilities, there

would sometimes, I apprehend, be a risk of dispersing those energies

of mind which the physician ought assuredly, in the first place, to

concentrate on his patient, in the earnest, persevering endeavor to

remove his disease and preserve his life. Consequently the talent

referred to should be used with much judgment and caution. But I

foresee that your habits of discrimination will lead you to doubt

whether the example I have supposed really constitutes an exception

to the rule. It certainly is not foreign to the _spirit_ of the rule,

which I think may be thus expressed:—that no attempt should be made

by the physician to promote the religious welfare of the sick, which

is incompatible with the full, efficient, satisfactory discharge of

his medical duties and obligations.

The second preliminary relates to the distinction which it is

important to mark between that _general_ responsibility which, in my

humble opinion, requires the physician to be always on the alert to

profit by every incidental opportunity of employing his influence

for the spiritual good of his patient; and that _special_ obligation

which may sometimes devolve upon him, (in consequence of the total

absence of religious instruction,) to attempt, in a more particular

manner, to rescue the sinking soul from perdition, and direct it to

Him, who is able “to save to the uttermost.” This distinction leads

me to propose, as a second general rule, that, inasmuch as religious

instruction forms a part of ministerial and relative duty, it would

be highly inexpedient for the physician to add to his already onerous

engagements, that of undertaking the spiritual supervision of his

patient, except under circumstances of imperious necessity. Whenever,

therefore the aid of a Christian minister or a pious relation can be

obtained, the medical practitioner may, I conceive, regard himself as

free from any special obligation of that nature.

These limitations obviously imply that, in by far the greater number

of instances, the religious influence of the physician should be

exercised in an occasional, rather than in a stated and formal

manner. If alive to the spiritual welfare of his patient, such

opportunities of usefulness will not be wanting. Perhaps, nothing

would so essentially contribute to the furtherance of the object, as

the offering up of earnest supplications to the “Father of lights,”

for His especial guidance and help, before the physician enters

upon his daily engagements, that he may be enabled both to discern

and improve every suitable opportunity, which even in the ordinary

exercise of his profession may be presented, of doing good to the

souls of his patients.

In seeking, and humbly expecting, thus to employ your influence in

this sacred cause, I feel the most encouraging persuasion that “your

labors will not be in vain in the Lord.”

It may be convenient to arrange the few thoughts which have occurred

to me in reference to the _mode_ of offering “a word in season” in a

few leading particulars; premising that, next to the Divine blessing,

the secret of usefulness will be found, I humbly anticipate, in

the careful, discriminating adaptation of advice to the particular

circumstances of the case. Age, sex, degree of intellect and

cultivation, particular habits of body and of mind, the actual stage

of the disease, the hopes and fears of the patient in relation to

futurity, the religious knowledge already possessed, the presence or

absence of spiritual instruction, and many other circumstances, will,

I am persuaded, appear to you deserving of special consideration. I

can, therefore, only hope to suggest a few general principles which

may be indefinitely modified and applied, according to the varied and

ever-varying circumstances of each individual case.

My first suggestion has already been anticipated. I refer to the

importance of recommending and even urging the assistance of a

Christian minister or a pious friend, in cases of serious and

dangerous illness. I am aware that the very mention of the subject is

sometimes productive of considerable alarm, and certainly requires

much prudence and caution. With skilful management, however, the

exciting of any injurious degree of apprehension and foreboding may

generally, I would hope, be avoided. One may say, for example, in

the course of conversation, to a patient apparently unconcerned or

uninstructed in reference to Eternity, “You must find the change

from active life to the confinement of this room rather irksome.

Yet some time for calm reflection is really needful for us all.

When withdrawn from busy life, we can look upon the world at a

distance, as well as come into closer contact with ourselves. Indeed,

serious consideration can never be unsuitable. Human life itself

is confessedly uncertain, and of course, under disease, still more

so. Should you not find a little conversation with a pious minister

interesting under your present circumstances?” In this familiar way,

(pardon its homeliness,) one may sometimes introduce the subject

without abruptness. From having had much personal illness, I have

been able to press the matter further, by assuring the patient that

such assistance has repeatedly proved very consolatory to my own

mind; thus, presenting a living instance of the incorrectness of the

popular opinion that, to propose the visit of a minister to the sick,

is tantamount to a death-warrant.

Should the recommendation prove entirely fruitless; should the

unhappy patient, notwithstanding our utmost professional efforts,

be so rapidly hastening into eternity as to afford no opportunity

of procuring more efficient spiritual aid, the case will then

present one of those _special_ occasions before alluded to, which

call for our more immediate and devoted attention, in reference to

the immortal spirit. And who, that values his own soul, would not,

under such circumstances, endeavor with all possible earnestness and

affection, to exhibit to the dying man the compassionate and Almighty

Redeemer, as able to save even at the eleventh hour?

I may next suggest that the allusions of the physician to the subject

of religion should generally be _incidental_ and conversational;

arising spontaneously from a solicitous regard to the particular

situation of the sufferer. When such occasional advice appears

naturally to flow from the heart, partaking of the disposition

and character of the speaker, and having an evident bearing on

the special circumstances of the patient, there will be little

risk of its being regarded as superfluous or obtrusive. On the

contrary, I believe, it will usually be welcomed as a gratifying

proof of disinterested friendship. In this incidental way, one may

sometimes refer to the experience of great and good men under similar

sufferings, and to the signal support vouchsafed to them, and to

the happy results of their afflictions. On some occasions, it may

be useful to adduce the remarkable fact, that some of the brightest

ornaments of the Church and of the world have ascribed much of their

success in life to the discipline they were once called to endure in

the chamber of sickness and seclusion.

May I add, that the occasional hints of the physician should also be

_brief_? A single sentence well-timed, well-directed, appropriate,

and expressive, will possess the great advantage of not wearying the

attention of the sufferer, while it may, notwithstanding, supply

ample material for reflection during the succeeding hours of solitude

and silence. “_A word_ spoken in season, how good it is!”

Nor is it less important, I conceive, that such advice be expressed

with _clearness and simplicity_, in a few plain words and short

sentences, bearing a direct and obvious meaning, and free from

ambiguity and circumlocution.

Allow me also to suggest that the advice should be _considerate and

kind_; the evident effect of genuine sympathy and tender concern. No

word should be dropped that might seem to imply an unmindfulness of

the suffering, helpless, unresisting state of the patient, or oblige

him to attempt a lengthened and laborious reply. One kind sentence

delivered in a tone of kindness, and accompanied with a look of

kindness, may, and often will, _juvante Deo_, penetrate the heart.

In certain states of disease, in which high excitement, or extreme

debility prevails, it may sometimes be expedient to address a passing

hint to a relative or friend who may be present rather than to the

patient himself, thus leaving to the option of the latter, whether or

not to reply to the observation.

Yet should the hints be _faithful_. Any approach to temporizing

would be cruel in itself, and might prove fatally delusive in its

consequences. It would be, in effect, to administer a moral opiate,

from which the helpless victim might awake—only in Eternity.

Permit me also to remark that, whenever the circumstances of the

case will permit, our allusions to spiritual subjects should be

_attractive and encouraging_. Doubtless, the torpid insensibility of

the sinner may require to be roused by an alarming representation of

the direful consequences of transgression and unbelief; nor can we

reasonably expect that mercy will be sought until it be felt to be

needed. In general, however, I apprehend, that a cheering exhibition

of the Almighty Saviour, as “full of grace and truth,” as “ready to

forgive,” and “plenteous in mercy to all who call upon Him,” will be

found most effectual in softening the heart, and in exciting those

earnest desires for pardon and acceptance, which are emphatically

described, in our Lord’s own test of sincerity, in the case of

Saul,—“Behold, he prayeth.” Let us, my friend, never forget that “he

who _winneth_ souls is wise.” The promises of the gospel are, indeed,

peculiarly adapted to meet the exigencies of the afflicted and

distressed. The blessed Redeemer was pleased to described himself as

having come purposely “to seek and to save that which was lost.” Were

we even restricted to the use of a single sentence, as a scriptural

_vade-mecum_ in the sick chamber, we should still have a volume of

encouragement and consolation in our Lord’s assurance,—“Him that

cometh to me, I will in no wise cast out.”

Upon the whole, my dear friend, the best preparation for speaking

“a word in season” will be found in carefully studying the example,

and seeking to imbibe the spirit, of the incarnate Saviour, that

all-perfect Physician of the soul and of the body. What a lovely

union of simplicity and sincerity, of faithfulness and tenderness,

pervaded _His_ addresses to the sick and afflicted! How much is

comprised in that short sentence, “The gentleness of Christ!” He did

“not break the bruised reed nor quench the smoking flax; but came to

bind up the broken-hearted,” and heal their every wound. May we be

enabled by grace from on high, though necessarily in a very humble

measure, to tread in His steps!

In truth, _the Christian-like deportment_ of the physician comprises

within itself a sphere of very important usefulness, affording ample

scope for the development of those graces and affections which

characterise the sincere follower of the meek and forbearing, the

benevolent and sympathizing Saviour. And even should my friend find

it sometimes difficult or impracticable to offer a word of spiritual

counsel as he could wish, he may yet, in his habitual demeanor,

present to the patient and the surrounding relatives, a living

“epistle” which they can read and understand, and which, by directing

them to the source of every good gift, may issue in the attainment of

true and saving wisdom.

In concluding this letter, I must not altogether omit to refer to

_the season of convalescence_, as peculiarly favorable to religious

impression. If ever the mind and the heart be open to the feelings

of gratitude, love and praise, it is under the circumstances of

returning ease and health, and in the hope of being again permitted

to enter on the duties and enjoyments of life. It is then that the

physician, in my humble opinion, is more especially bound to avail

himself of the grateful attachment of his patient by referring

any skill or care he may have evinced to the God of all grace, and

thus endeavor to give a right direction to those kind and gladsome

emotions, which are bursting from a full heart. It is then, I

conceive, that the rescue from the grave should be held out as a

signal warning, and as a powerful incentive. Then, also, by adroitly

following out the convalescent’s own suggestions, a powerful appeal

may be made to his best feelings, and an affectionate plea presented

for an immediate and entire surrender of himself, “body, soul,

and spirit,” unto an Almighty and most merciful Father, who “hath

redeemed his life from destruction, and crowned him with loving

kindness and tender mercies.”

At such a period, too, we may often recommend, with great advantage,

some interesting volume adapted to our patient’s state. Biography and

easy letters, as being both interesting and not requiring much effort

of attention, will often be found peculiarly acceptable. Indeed,

the judicious recommendation of books and tracts may be regarded as

an important mode of employing our influence during every period of

illness, but particularly during the season of convalescence.

Such, my dear friend, are the few imperfect hints which have occurred

to me. I might, indeed, have availed myself of the assistance of

some valuable writers on the subject of affliction, particularly of

the highly interesting work of my pious and intellectual friend,

Mr. Sheppard, “_On Christian Encouragement and Consolation_;” and

the excellent “_Thoughts in Affliction_,” by another able friend,

the Rev. A. S. Thelwall. I might also have enriched these humble

letters by a reference to the “_Essays to do Good_,” of the eminent

Dr. Cotton Mather, which contain some admirable suggestions on the

same subject. From these several works I have formerly derived

much instruction and pleasure, but was unwilling to have recourse

to them on the present occasion, as well as from the wish of not

unnecessarily extending these letters, as in compliance with your

particular desire that I would send you the result of my own

observation and experience.

With every kind wish,

Believe me, my dear Friend,

Ever faithfully your’s,

T. H. B.

_Tilford, March 1st, 1836._

FOOTNOTES:

[47] These letters were written by Dr. Burder, an English physician,

in answer to the inquiry made of him by Dr. Hope, “Can your

opportunities and experience furnish me with some hints how to

offer ‘a word in season’ to those who are seriously ill?” They

were published first in a periodical of extensive circulation, and

afterwards in the Appendix to the Memoir of Dr. Hope.

CODE OF MEDICAL ETHICS

ADOPTED BY THE

NATIONAL MEDICAL CONVENTION IN PHILADELPHIA, JUNE, 1847.

CHAPTER I.

OF THE DUTIES OF PHYSICIANS TO THEIR PATIENTS AND OF THE OBLIGATIONS

OF PATIENTS TO THEIR PHYSICIANS.

ART. I.—_Duties of physicians to their patients._

§ 1. A physician should not only be ever ready to obey the calls of

the sick, but his mind ought also to be imbued with the greatness

of his mission, and the responsibility he habitually incurs in its

discharge. Those obligations are the more deep and enduring, because

there is no tribunal other than his own conscience, to adjudge

penalties for carelessness or neglect. Physicians should, therefore,

minister to the sick with due impressions of the importance of their

office; reflecting that the ease, the health, and the lives of those

committed to their charge, depend on their skill, attention and

fidelity. They should study, also, in their deportment, so to unite

_tenderness_ with _firmness_, and _condescension_ with _authority_,

as to inspire the minds of their patients with gratitude, respect and

confidence.

§ 2. Every case committed to the charge of a physician should

be treated with attention, steadiness and humanity. Reasonable

indulgence should be granted to the mental imbecility and caprices

of the sick. Secrecy and delicacy, when required by peculiar

circumstances, should be strictly observed; and the familiar and

confidential intercourse to which physicians are admitted in their

professional visits, should be used with discretion, and with the

most scrupulous regard to fidelity and honor. The obligation of

secrecy extends beyond the period of professional services;—none

of the privacies of personal and domestic life, no infirmity of

disposition or flaw of character observed during professional

attendance, should ever be divulged by him except when he is

imperatively required to do so. The force and necessity of this

obligation are indeed so great, that professional men have, under

certain circumstances, been protected in their observance of secrecy,

by courts of justice.

§ 3. Frequent visits to the sick are in general requisite, since they

enable the physician to arrive at a more perfect knowledge of the

disease,—to meet promptly every change that may occur, and also tend

to preserve the confidence of the patient. But unnecessary visits are

to be avoided, as they give useless anxiety to the patient, tend to

diminish the authority of the physician, and render him liable to be

suspected of interested motives.

§ 4. A physician should not be forward to make gloomy

prognostications, because they savor of empiricism, by magnifying the

importance of his services in the treatment or cure of the disease.

But he should not fail, on proper occasions, to give to the friends

of the patient timely notice of danger, when it really occurs; and

even to the patient himself, if absolutely necessary. This office,

however, is so peculiarly alarming when executed by him, that it

ought to be declined whenever it can be assigned to any other person

of sufficient judgment and delicacy. For, the physician should be the

minister of hope and comfort to the sick; that, by such cordials to

the drooping spirit, he may smooth the bed of death, revive expiring

life, and counteract the depressing influence of those maladies which

often disturb the tranquillity of the most resigned, in their last

moments. The life of a sick person can be shortened not only by the

acts, but also by the words or the manner of a physician. It is,

therefore, a sacred duty to guard himself carefully in this respect,

and to avoid all things which have a tendency to discourage the

patient and to depress his spirits.

§ 5. A physician ought not to abandon a patient because the case is

deemed incurable; for his attendance may continue to be highly useful

to the patient, and comforting to the relatives around him, even in

the last period of a fatal malady, by alleviating pain and other

symptoms, and by soothing mental anguish. To decline attendance,

under such circumstances, would be sacrificing to fanciful delicacy

and mistaken liberality, that moral duty, which is independent of,

and far superior to all pecuniary consideration.

§ 6. Consultations should be promoted in difficult or protracted

cases, as they give rise to confidence, energy, and more enlarged

views in practice.

§ 7. The opportunity which a physician not unfrequently enjoys of

promoting and strengthening the good resolutions of his patients,

suffering under the consequences of vicious conduct, ought never

to be neglected. His counsels or even remonstrances, will give

satisfaction, not offence, if they be proffered with politeness and

evince a genuine love of virtue, accompanied by a sincere interest in

the welfare of the person to whom they are addressed.

ART. II.—_Obligations of patients to their physicians._

§ 1. The members of the medical profession, upon whom are enjoined

the performance of so many important and arduous duties towards

the community, and who are required to make so many sacrifices

to comfort, ease, and health, for the welfare of those who avail

themselves of their services, certainly have a right to expect and

require, that their patients should entertain a just sense of the

duties which they owe to their medical attendants.

§ 2. The first duty of a patient is, to select as his medical adviser

one who has received a regular professional education. In no trade

or occupation, do mankind rely on the skill of an untaught artist;

and in medicine, confessedly the most difficult and intricate of the

sciences, the world ought not to suppose that knowledge is intuitive.

§ 3. Patients should prefer a physician, whose habits of life are

regular, and who is not devoted to company, pleasure, or to any

pursuit incompatible with his professional obligations. A patient

should, also, confide the care of himself and family, as much

as possible to one physician, for a medical man who has become

acquainted with the peculiarities of constitution, habits, and

predispositions, of those he attends, is more likely to be successful

in his treatment, than one who does not possess that knowledge.

A patient who has thus selected his physician, should always apply

for advice in what may appear to him trivial cases, for the most

fatal results often supervene on the slightest accidents. It is of

still more importance that he should apply for assistance in the

forming stage of violent diseases; it is to a neglect of this precept

that medicine owes much of the uncertainty and imperfection with

which it has been reproached.

§ 4. Patients should faithfully and unreservedly communicate to

their physician the supposed cause of their disease. This is the

more important, as many diseases of a mental origin stimulate those

depending on external causes, and yet are only to be cured by

ministering to the mind diseased. A patient should never be afraid of

thus making his physician his friend and adviser; he should always

bear in mind that a medical man is under the strongest obligations of

secrecy. Even the female sex should never allow feelings of shame or

delicacy to prevent their disclosing the seat, symptoms and causes

of complaints peculiar to them. However commendable a modest reserve

may be in the common occurrences of life, its strict observance in

medicine is often attended with the most serious consequences, and a

patient may sink under a painful and loathsome disease, which might

have been readily prevented had timely intimation been given to the

physician.

§ 5. A patient should never weary his physician with a tedious detail

of events or matters not appertaining to his disease. Even as relates

to his actual symptoms, he will convey much more real information

by giving clear answers to interrogatories than by the most minute

account of his own framing. Neither should he obtrude the details of

his business nor the history of his family concerns.

§ 6. The obedience of a patient to the prescriptions of his physician

should be prompt and implicit. He should never permit his own crude

opinions as to their fitness, to influence his attention to them. A

failure in one particular may render an otherwise judicious treatment

dangerous, and even fatal. This remark is equally applicable to diet,

drink, and exercise. As patients become convalescent they are very

apt to suppose that the rules prescribed for them may be disregarded,

and the consequence, but too often, is a relapse. Patients should

never allow themselves to be persuaded to take any medicine whatever,

that may be recommended to them by the self-constituted doctors

and doctresses, who are so frequently met with, and who pretend to

possess infallible remedies for the cure of every disease. However

simple some of their prescriptions may appear to be, it often happens

that they are productive of much mischief, and in all cases they

are injurious, by contravening the plan of treatment adopted by the

physician.

§ 7. A patient should, if possible, avoid even the _friendly visits

of a physician_ who is not attending him,—and when he does receive

them, he should never converse on the subject of his disease, as an

observation may be made, without any intention of interference,

which may destroy his confidence in the course he is pursuing, and

induce him to neglect the directions prescribed to him. A patient

should never send for a consulting physician without the express

consent of his own medical attendant. It is of great importance

that physicians should act in concert; for, although their modes of

treatment may be attended with equal success, when employed singly,

yet conjointly they are very likely to be productive of disastrous

results.

§ 8. When a patient wishes to dismiss his physician, justice and

common courtesy require that he should declare his reasons for so

doing.

§ 9. Patients should always, when practicable, send for their

physician in the morning, before his usual hour of going out; for,

by being early aware of the visits he has to pay during the day,

the physician is able to apportion his time in such a manner as to

prevent an interference of engagements. Patients should also avoid

calling on their medical adviser unnecessarily during the hours

devoted to meals or sleep. They should always be in readiness to

receive the visits of their physician, as the detention of a few

minutes is often of serious inconvenience to him.

§ 10. A patient should, after his recovery, entertain a just and

enduring sense of the value of the services rendered him by his

physician; for these are of such a character, that no mere pecuniary

acknowledgment can repay or cancel them.

CHAPTER II.

OF THE DUTIES OF PHYSICIANS TO EACH OTHER, AND TO THE PROFESSION AT

LARGE.

ART. I.—_Duties for the support of professional character._

§ 1. Every individual, on entering the profession, as he becomes

thereby entitled to all its privileges and immunities, incurs an

obligation to exert his best abilities to maintain its dignity

and honor, to exalt its standing, and to extend the bounds of its

usefulness. He should therefore observe strictly, such laws as

are instituted for the government of its members;—should avoid

all contumelious and sarcastic remarks relative to the faculty,

as a body; and while, by unwearied diligence, he resorts to every

honorable means of enriching the science, he should entertain a due

respect for his seniors, who have, by their labors, brought it to the

elevated condition in which he finds it.

§ 2. There is no profession, from the members of which greater

purity of character, and a higher standard of moral excellence are

required, than the medical; and to attain such eminence is a duty

every physician owes alike to his profession and to his patients. It

is due to the latter, as without it he cannot command their respect

and confidence, and to both, because no scientific attainments can

compensate for the want of correct moral principles. It is also

incumbent upon the faculty to be temperate in all things, for the

practice of physic requires the unremitting exercise of a clear and

vigorous understanding; and, on emergencies for which no professional

man should be unprepared, a steady hand, an acute eye, and an

unclouded head may be essential to the well-being, and even to the

life, of a fellow creature.

§ 3. It is derogatory to the dignity of the profession, to resort to

public advertisements or private cards or handbills, inviting the

attention of individuals affected with particular diseases—publicly

offering advice and medicine to the poor gratis, or promising radical

cures; or to publish cases and operations in the daily prints or

suffer such publications to be made;—to invite laymen to be present

at operations,—to boast of cures and remedies,—to adduce certificates

of skill and success, or to perform any other similar acts. These are

the ordinary practices of empirics, and are highly reprehensible in a

regular physician.

§ 4. Equally derogatory to professional character is it, for a

physician to hold a patent for any surgical instrument, or medicine;

or to dispense a secret _nostrum_, whether it be the composition or

exclusive property of himself, or of others. For, if such nostrum

be of real efficacy, any concealment regarding it is inconsistent

with beneficence and professional liberality; and, if mystery alone

give it value and importance, such craft implies either disgraceful

ignorance, or fraudulent avarice. It is also reprehensible for

physicians to give certificates attesting the efficacy of patent or

secret medicines, or in any way to promote the use of them.

ART. II.—_Professional services of physicians to each other._

§ 1. All practitioners of medicine, their wives, and their children

while under the paternal care, are entitled to the gratuitous

services of any one or more of the faculty residing near them, whose

assistance may be desired. A physician afflicted with disease is

usually an incompetent judge of his own case; and the natural anxiety

and solicitude which he experiences at the sickness of a wife, a

child, or any one who by the ties of consanguinity is rendered

peculiarly dear to him, tend to obscure his judgment and produce

timidity and irresolution in his practice. Under such circumstances,

medical men are peculiarly dependent on each other, and kind offices

and professional aid should always be cheerfully and gratuitously

afforded. Visits ought not, however, to be obtruded officiously; as

such unasked civility may give rise to embarrassment, or interfere

with that choice, on which confidence depends. But, if a distant

member of the faculty, whose circumstances are affluent, request

attendance, and an honorarium be offered, it should not be declined;

for no pecuniary obligation ought to be imposed, which the party

receiving it would wish not to incur.

ART. III.—_Of the duties of physicians as respects vicarious offices._

§ 1. The affairs of life, the pursuit of health, and the various

accidents and contingencies to which a medical man is peculiarly

exposed, sometimes require him temporarily to withdraw from his

duties to his patients, and to request some of his professional

brethren to officiate for him. Compliance with this request is an

act of courtesy, which should always be performed with the utmost

consideration for the interest and character of the family physician,

and when exercised for a short period, all the pecuniary obligations

for such service should be awarded to him. But if a member of the

profession neglect his business in quest of pleasure and amusement,

he cannot be considered as entitled to the advantages of the frequent

and long-continued exercise of this fraternal courtesy, without

awarding to the physician who officiates the fees arising from the

discharge of his professional duties.

In obstetrical and important surgical cases, which give rise to

unusual fatigue, anxiety and responsibility, it is just that the fees

accruing therefrom should be awarded to the physician who officiates.

ART. IV.—_Of the duties of physicians in regard to consultations._

§ 1. A regular medical education furnishes the only presumptive

evidence of professional abilities and acquirements, and ought to

be the only acknowledged right of an individual to the exercise

and honors of his profession. Nevertheless, as in consultations

the good of the patient is the sole object in view, and this is

often dependent on personal confidence, no intelligent regular

practitioner, who has a license to practice from some medical

board of known and acknowledged respectability, recognized by this

association, and who is in good moral and professional standing

in the place in which he resides, should be fastidiously excluded

from fellowship, or his aid refused in consultation when it is

requested by the patient. But no one can be considered as a regular

practitioner, or a fit associate in consultation, whose practice is

based on an exclusive dogma, to the rejection of the accumulated

experience of the profession, and of the aids actually furnished by

anatomy, physiology, pathology, and organic chemistry.

§ 2. In consultations no rivalship or jealousy should be indulged;

candor, probity, and all due respect should be exercised towards the

physician having charge of the case.

§ 3. In consultations the attending physician should be the first

to propose the necessary questions to the sick; after which the

consulting physician should have the opportunity to make such farther

inquiries of the patient as may be necessary to satisfy him of the

true character of the case. Both physicians should then retire to

a private place for deliberation; and the one first in attendance

should communicate the directions agreed upon to the patient or his

friends, as well as any opinions which it may be thought proper to

express. But no statement or discussion of it should take place

before the patient or his friends, except in the presence of all the

faculty attending, and by their common consent; and _no opinions_ or

_prognostications_ should be delivered, which are not the result of

previous deliberation and concurrence.

§ 4. In consultations, the physician in attendance should deliver his

opinion first; and when there are several consulting, they should

deliver their opinions in the order in which they have been called

in. No decision, however, should restrain the attending physician

from making such variations in the mode of treatment, as any

subsequent unexpected change in the character of the case may demand.

But such variation and the reasons for it ought to be carefully

detailed at the next meeting in consultation. The same privilege

belongs also to the consulting physician if he is sent for in an

emergency, when the regular attendant is out of the way, and similar

explanations must be made by him, at the next consultation.

§ 5. The utmost punctuality should be observed in the visits of

physicians when they are to hold consultation together, and this is

generally practicable, for society has been considerate enough to

allow the plea of a professional engagement to take precedence of

all others, and to be an ample reason for the relinquishment of any

present occupation. But as professional engagements may sometimes

interfere, and delay one of the parties, the physician who first

arrives should wait for his associate a reasonable period, after

which the consultation should be considered as postponed to a new

appointment. If it be the attending physician who is present, he will

of course see the patient and prescribe; but if it be the consulting

one, he should retire, except in case of emergency, or when he has

been called from a considerable distance, in which latter case he may

examine the patient, and give his opinion in _writing_, and _under

seal_, to be delivered to his associate.

§ 6. In consultations, theoretical discussions should be avoided,

as occasioning perplexity and loss of time. For there may be much

diversity of opinion concerning speculative points, with perfect

agreement in those modes of practice which are founded, not on

hypothesis, but on experience and observation.

§ 7. All discussions in consultation should be held as secret and

confidential. Neither by words nor manner should any of the parties

to a consultation assert or insinuate, that any part of the treatment

pursued did not receive his assent. The responsibility must be

equally divided between the medical attendants,—they must equally

share the credit of success as well as the blame of failure.

§ 8. Should an irreconcilable diversity of opinion occur when several

physicians are called upon to consult together, the opinion of the

majority should be considered as decisive; but if the numbers be

equal on each side, then the decision should rest with the attending

physician. It may, moreover, sometimes happen, that two physicians

cannot agree in their views of the nature of a case, and the

treatment to be pursued. This is a circumstance much to be deplored,

and should always be avoided, if possible, by mutual concessions,

as far as they can be justified by a conscientious regard for the

dictates of judgment. But in the event of its occurrence, a third

physician should, if practicable, be called to act as umpire, and

if circumstances prevent the adoption of this course, it must be

left to the patient to select the physician in whom he is most

willing to confide. But as every physician relies upon the rectitude

of his judgment, he should, when left in the minority, politely

and consistently retire from any further deliberation in the

consultation, or participation in the management of the case.

§ 9. As circumstances sometimes occur to render a _special

consultation_ desirable, when the continued attendance of two

physicians might be objectionable to the patient, the member of

the faculty whose assistance is required in such cases, should

sedulously guard against all future unsolicited attendance. As such

consultations require an extraordinary portion both of time and

attention, at least a double honorarium may be reasonably expected.

§ 10. A physician who is called upon to consult, should observe the

most honorable and scrupulous regard for the character and standing

of the practitioner in attendance; the practice of the latter, if

necessary, should be justified as far as it can be, consistently with

a conscientious regard for truth, and no hint or insinuation should

be thrown out, which could impair the confidence reposed in him, or

affect his reputation. The consulting physician should also carefully

refrain from any of those extraordinary attentions or assiduities,

which are too often practiced by the dishonest for the base purpose

of gaining applause, or ingratiating themselves into the favor of

families and individuals.

ART. V.—_Duties of physicians in cases of interference._

§ 1. Medicine is a liberal profession, and those admitted into its

ranks should found their expectations of practice upon the extent of

their qualifications, not on intrigue or artifice.

§ 2. A physician, in his intercourse with a patient under the care

of another practitioner, should observe the strictest caution and

reserve. No meddling inquiries should be made; no disingenuous hints

given relative to the nature and treatment of his disorder; nor any

course of conduct pursued that may directly or indirectly tend to

diminish the trust reposed in the physician employed.

§ 3. The same circumspection and reserve should be observed, when,

from motives of business or friendship, a physician is prompted

to visit an individual who is under the direction of another

practitioner. Indeed, such visits should be avoided, except under

peculiar circumstances, and when they are made, no particular

inquiries should be instituted relative to the nature of the

disease, or the remedies employed, but the topics of conversation

should be as foreign to the case as circumstances will admit.

§ 4. A physician ought not to take charge of, or prescribe for a

patient who has recently been under the care of another member of the

faculty in the same illness, except in cases of sudden emergency,

or in consultation with the physician previously in attendance, or

when the latter has relinquished the case or been regularly notified

that his services are no longer desired. Under such circumstances no

unjust and illiberal insinuations should be thrown out in relation to

the conduct or practice previously pursued, which should be justified

as far as candor and regard for truth and probity will permit; for

it often happens, that patients become dissatisfied when they do not

experience immediate relief, and, as many diseases are naturally

protracted, the want of success, in the first stage of treatment,

affords no evidence of a lack of professional knowledge and skill.

§ 5. When a physician is called to an urgent case, because the

family attendant is not at hand, he ought, unless his assistance in

consultation be desired, to resign the care of the patient to the

latter immediately on his arrival.

§ 6. It oftens happens, in cases of sudden illness, or of recent

accidents and injuries, owing to the alarm and anxiety of friends,

that a number of physicians are simultaneously sent for. Under

these circumstances courtesy should assign the patient to the first

who arrives, who should select from those present any additional

assistance that he may deem necessary. In all such cases, however,

the practitioner who officiates, should request the family physician,

if there be one, to be called, and, unless his further attendance be

requested, should resign the case to the latter on his arrival.

§ 7. When a physician is called to the patient of another

practitioner, in consequence of the sickness or absence of the

latter, he ought, on the return or recovery of the regular attendant,

and with the consent of the patient, to surrender the case.

§ 8. A physician, when visiting a sick person in the country, may

be desired to see a neighboring patient who is under the regular

direction of another physician, in consequence of some sudden change

or aggravation of symptoms. The conduct to be pursued on such an

occasion is to give advice adapted to present circumstances; to

interfere no farther than is absolutely necessary with the general

plan of treatment; to assume no future direction, unless it be

expressly desired; and, in this last case, to request an immediate

consultation with the practitioner previously employed.

§ 9. A wealthy physician should not give advice _gratis_ to the

affluent; because his doing so is an injury to his professional

brethren. The office of a physician can never be supported as an

exclusively beneficent one; and it is defrauding, in some degree, the

common funds for its support, when fees are dispensed with, which

might, justly be claimed.

§ 10. When a physician who has been engaged to attend a case of

midwifery is absent, and another is sent for, if delivery is

accomplished during the attendance of the latter, he is entitled to

the fee, but should resign the patient to the practitioner first

engaged.

ART. VI.—_Of differences between physicians._

§ 1. Diversity of opinion, and opposition of interest, may, in the

medical, as in other professions, sometimes occasion controversy and

even contention. Whenever such cases unfortunately occur, and cannot

be immediately terminated, they should be referred to the arbitration

of a sufficient number of physicians, or a _court-medical_.

As peculiar reserve must be maintained by physicians towards the

public, in regard to professional matters, and as there exists

numerous points in medical ethics and etiquette through which

the feelings of medical men may be painfully assailed in their

intercourse with each other, and which cannot be understood or

appreciated by general society, neither the subject matter of such

differences nor the adjudication of the arbitrators should be made

public, as publicity in a case of this nature may be personally

injurious to the individuals concerned, and can hardly fail to bring

discredit on the faculty.

ART. VII.—_Of pecuniary acknowledgments._

§ 1. Some general rules should be adopted by the faculty, in every

town or district, relative to _pecuniary acknowledgments_ from their

patients; and it should be deemed a point of honor to adhere to these

rules with as much uniformity as varying circumstances will admit.

CHAPTER III.

OF THE DUTIES OF THE PROFESSION TO THE PUBLIC, AND OF THE OBLIGATIONS

OF THE PUBLIC TO THE PROFESSION.

ART. I.—_Duties of the profession to the public._

§ 1. As good citizens, it is the duty of physicians to be ever

vigilant for the welfare of the community, and to bear their part in

sustaining its institutions and burdens: they should also be ever

ready to give counsel to the public in relation to matters especially

appertaining to their profession, as on subjects of medical police,

public hygiène, and legal medicine. It is their province to enlighten

the public in regard to quarantine regulations,—the location,

arrangement, and dietaries of hospitals, asylums, schools, prisons,

and similar institutions,—in relation to the medical police of towns,

as drainage, ventilation, &c.,—and in regard to measures for the

prevention of epidemic and contagious diseases; and when pestilence

prevails, it is their duty to face the danger, and to continue their

labors for the alleviation of the suffering, even at the jeopardy of

their own lives.

§ 2. Medical men should also be always ready, when called on by the

legally constituted authorities, to enlighten coroners’ inquests and

courts of justice, on subjects strictly medical,—such as involve

questions relating to sanity, legitimacy, murder by poisons or other

violent means, and in regard to the various other subjects embraced

in the science of Medical Jurisprudence. But in these cases, and

especially where they are required to make a post-mortem examination,

it is just, in consequence of the time, labor and skill required, and

the responsibility and risk they incur, that the public should award

them a proper honorarium.

§ 3. There is no profession, by the members of which, eleemosynary

services are more liberally dispensed, than the medical, but justice

requires that some limits should be placed to the performance of

such good offices. Poverty, professional brotherhood, and certain

public duties referred to in section 1 of this chapter, should

always be recognized as presenting valid claims for gratuitous

services; but neither institutions endowed by the public or by rich

individuals, societies for mutual benefit, for the insurance of lives

or for analogous purposes, nor any profession or occupation, can be

admitted to possess such privilege. Nor can it be justly expected of

physicians to furnish certificates of inability to serve on juries,

to perform militia duty, or to testify to the state of health of

persons wishing to insure their lives, obtain pensions, or the like,

without a pecuniary acknowledgment. But to individuals in indigent

circumstances, such professional services should always be cheerfully

and freely accorded.

§ 4. It is the duty of physicians, who are frequent witnesses of

the enormities committed by quackery, and the injury to health and

even destruction of life caused by the use of quack medicines, to

enlighten the public on these subjects, to expose the injuries

sustained by the unwary from the devices and pretensions of artful

empirics and impostors. Physicians ought to use all the influence

which they may possess, as professors in Colleges of Pharmacy, and

by exercising their option in regard to the shops to which their

prescriptions shall be sent, to discourage druggists and apothecaries

from vending quack or secret medicines, or from being in any way

engaged in their manufacture and sale.

ART. II.—_Obligations of the public to physicians._

§ 1. The benefits accruing to the public directly and indirectly

from the active and unwearied beneficence of the profession, are

so numerous and important, that physicians are justly entitled

to the utmost consideration and respect from the community. The

public ought likewise to entertain a just appreciation of medical

qualifications; to make a proper discrimination between true

science and the assumptions of ignorance and empiricism,—to afford

every encouragement and facility for the acquisition of medical

education,—and no longer to allow the statute books to exhibit the

anomaly of exacting knowledge from physicians, under liability to

heavy penalties, and of making them obnoxious to punishment for

resorting to the only means of obtaining it.

THE END.

ERRATA.

Page 38 and 39, for “abcess” read abscess.

” 40, line 19, for “inoperative” read in operation.

” 48, ” 4, for “idiosyncrasies” read idiosyncrasy.

” 115, ” 10, insert between “of” and “the,” certain substances,

for example.

” 253, ” 20, for “organic relations” read organizations.

” 256, ” 6, for “officially” read sufficiently.

” 262, ” 15, for “voluntary” read voluntarily.

” 340, ” 20, for “succeed” read succeeded.

” 387, ” 20, insert “is” between “it” and “an.”

” 403, ” 13, for “approbation” read appellation.

Transcriber’s Notes

pg 1 of advertisements Changed: Edwin Hall, Pastor of the Frst

to: Edwin Hall, Pastor of the First

pg xviii Changed: Different theories of fever—Boerrhave

to: Different theories of fever—Boerhaave

pg xix Changed: its warfare with empricism

to: its warfare with empiricism

pg xxiii Changed: Though proper sometimes to withold

to: Though proper sometimes to withhold

pg 32 Changed: which act in entire secresy

to: which act in entire secrecy

pg 42 Changed: with the idea that it was controled

to: with the idea that it was controlled

pg 88 Changed: Was the introduction of innoculation

to: Was the introduction of inoculation

pg 96 Changed: Though this limiment had such wonderful power

to: Though this liniment had such wonderful power

pg 116 Changed: given to it from the similiarity

to: given to it from the similarity

pg 119 Changed: they have now amedical faculty

to: they have now a medical faculty

pg 141 Changed: they base their preference is so limiited

to: they base their preference is so limited

pg 181 Changed: vivid recollection of one which occured

to: vivid recollection of one which occurred

pg 230 Changed: and their exert their full influence

to: and they exert their full influence

pg 245 Changed: You will have to do something more, to convine

to: You will have to do something more, to convince

pg 252 Changed: the abounding and mnltiform

to: the abounding and multiform

pg 253 Changed: this leads to me say

to: this leads me to say

pg 297 Changed: This incident leads to me remark

to: This incident leads me to remark

pg 340 Changed: He succeed in obtaining a grant for a new trial

to: He succeeded in obtaining a grant for a new trial

pg 388 Changed: manifestly blunts the sensibibilities

to: manifestly blunts the sensibilities

pg 428 Changed: maintainence of which his recovery

to: maintenance of which his recovery

pg 451 Changed: The office of a physcian

to: The office of a physician

The Erratas on page 454 have be corrected in the text.