THE
ÆSCULAPIAN LABYRINTH EXPLORED;
OR,
MEDICAL MYSTERY ILLUSTRATED.
IN A SERIES OF INSTRUCTIONS TO
YOUNG PHYSICIANS, SURGEONS, ACCOUCHERS, APOTHECARIES,
DRUGGISTS, AND PRACTITIONERS OF EVERY
DENOMINATION, IN TOWN AND COUNTRY.
INTERSPERSED WITH A VARIETY OF
RISIBLE ANECDOTES AFFECTING THE FACULTY.
INSCRIBED
TO THE COLLEGE OF WIGS,
BY
GREGORY GLYSTER,
AN OLD PRACTITIONER.
“TWENTY MORE! KILL THEM TOO.”——BOBADIL.
LONDON:
PRINTED FOR G. KEARSLEY, NO. 46, FLEET-STREET.
MDCCLXXXIX.
[PRICE THREE SHILLINGS AND SIX-PENCE.]
TO THE COLLEGE OF WIGS.
“Most potent, grave, and reverend signiors,
“My very noble and approved good” Doctors.
The solemnity of your somniferous aspects, no less than the
professional gravity of your external ornaments, lay claim to a bow
of obedient recollection in passing through W—— k-lane to public
inspection. As one of the most _popular_ descendants from your great
progenitor, permit me to acknowledge, I revere the _vast extent_ of
your _medical abilities_; that I feel most forcibly the _enormous
weight_ of your _accumulated learning_, and _tremble_ at the very idea
of your _experimental abilities_.
Condescend, dread Sirs, to sanction this analization of _Æsculapian
imposition_ and _medical mystery_, with such proof of approbation, as
the dignity of a _diploma_, and the muscular rigidity of _physical
countenance_ will permit you to bestow; nor let it be the less entitled
to your favor, that a long list of _valetudinarians_ (to whom you are
daily pensioners) become partakers of the _banquet of mirth_; or the
small fry of _pharmacopolists_ (your humble dependents) _for once_
permitted to take a seat at the _same table_ with yourselves.
Anxiously solicitous to obtain belief, that
“I shall nothing extenuate,
“Nor set down aught in malice,”
you may in justice conclude me,
_Sage Sirs!_
Your very candid,
And obedient representative,
GREGORY GLYSTER.
THE
ÆSCULAPIAN LABYRINTH
EXPLORED.
TO THE PHYSICIAN.
Having passed the tedious years of abstruse study and intense
application, necessary to your initiation in the mysteries of physic,
and replete with a perfect remembrance of all the requisites to this
_great art_, we suppose you recently emerged from the obscurity of
_dreary walls_ and _dull professors_, a phenomænon of universal
knowledge and _family_ admiration. The various and elaborate
examinations you have passed, with scholastic approbation, having
relieved you from the constantly accumulating load of anxiety, you are
at length launched into life under a new character, and daily pant
to display the dignity of your profession, in the happy appendage of
_M. D._ to the prescriptive initials of your name.
You are no longer to be considered a student labouring in the heavy
trammels of _unintelligible_ lectures upon _philosophy_, _anatomy_,
_botany_, _chemistry_, and the _materia medica_, with all their
distinct and consequent advantages; or investigating the actual
properties of _electrical fire_ and MAGNETIC ENTHUSIASM, but stamped
(by royal authority) with the full force of physical agency, and have
derived from your _merit_ unlimited permission to _cure_, “_kill_ or
_destroy_,” to the best of your knowledge and abilities, “so help you
“God.” The professional path you now begin to tread, is so replete
with danger, and the probability of success so very uncertain, that
the fertile world have not omitted to make it proverbial, “A physician
never begins to get bread, till he has no “teeth to eat it.” The truth
of this may perhaps have been _lamentingly_ acknowledged by some of the
most _learned men_ that ever became dependant upon a _capricious_ world
for _precarious_ subsistance.
This palpable fact may concisely serve to convince you, your
embarkation (with all its alluring prospects) will not only be
encumbered with difficulties, but your ultimate gratification of
success exceedingly doubtful. Great depth of learning may afford
consolation to the equity of your own feelings (if you fortunately
possess them) but it is by no means necessary to the acquisition of
_public opinion_, however it may tend to contribute to the general good.
To avoid entering into a sentimental disquisition upon the _honesty_,
_integrity_, or _strict propriety_ of the maxims I proceed to lay
down for your future conduct to obtain professional splendour, and
_insure success_; I avail myself of the privilege I possess, to wave
every consideration of the _conscientious kind_, and once more observe
(without adverting to their consistency) they are adduced only as the
unavoidable traits of character, and modes of behaviour, by which alone
(in the present age) you can possibly hope for the least proportional
share of practice as a physician.
At your first public entré, when the college list and court calendar
have announced your qualifications and advancement to the wondering
world (that such list should annually increase) let your friends
and relatives be doubly assiduous in propagating reports (almost
incredible) of your _great humanity_, _extensive abilities_, and
_unbounded benevolence_.—This will answer the intended purpose to a
certainty; crouds of the afflicted and necessitous will surround your
habitation, and render your place of residence constantly remarkable to
all classes, who naturally enquiring the character of the proprietor,
will eagerly extol your charity in contributing your “advice to the
poor GRATIS.”
This method alone will gain you popularity with those that rank in the
line of mediocrity; with _their superiors_, success must be insured
more from the efforts of _interest_, than either _personal merit_, or
_sound policy_. Your attention to the wants of the poor, must soon
be regulated by the preponderation of more weighty considerations;
as you _affected_ to alleviate their distresses from the motive of
commiseration, prompting you to promote _their ease_, you have an
undoubted right to shake off such superfluous visits, to secure _your
own_. In this deceptive charity, some degree of discrimination must be
put in practice, for you will sometimes perceive one among the train,
whose apparel or behaviour must necessarily give you reason to suspect
he has assumed the cloak of necessity to save _his fee_, and avail
himself of your professional liberality in such case, call to your
aid a look of true _medical austerity_, and let him understand “advice
is seldom of any value or “effect unless it is paid for;” this will
frequently answer the purpose, and procure what you did not expect.
On the contrary, so soon as you observe your prescriptions have
“_worked wonders_” upon two or three of the most _credulous_ and
_superstitious_, who are extolling your _great knowledge_ and
“blessing _your honour_,” strengthen the _force_ of your judgment by
_charitably obtruding_ a pecuniary corroboration into the hand of your
afflicted patient, as a confirmation of your _unbounded skill_ in
the (_miraculous_) cure of every disease to which the human frame is
incident. By such _political_ practice, you insure the recital of your
services with extacy, and your name reverberates from one end of the
metropolis to the other.
Your person and place of residence, being by these means universally
known, and your name become in a proportional degree popular, let
your plan and mode of behaviour be instantly changed; it will be now
necessary
“You “assume a” hurry “if you have it not,”
Take care to be so exceedingly engaged with patients of the _first
class and eminence_, that “it is with difficulty you procure time
sufficient for the common purposes and gratifications of nature.” No
paupers _whatever_ can be admitted to your presence without a written
recommendation from _nobility_, or characters of the _first fortune_;
this will insure you no farther intrusion from a class originally
introduced for your _particular purpose_; that effected, they may now
be permitted to fall into the back ground of the picture; from whence
they were brought for no other motive than the promotion of your
personal interest and professional emolument.
It becomes your particular care to be always in a _hurry_; let your
chariot (if you can fortunately raise one) _upon job_, be at the door
regularly by nine in the morning; to prove how very much you are
attached to the duties of your profession, and how anxiously you have
the _salubrity_ of your patients _at heart_.—Omit no one circumstance
that can contribute to a shew of being perpetually engaged. Letters
written by _yourself_, and messengers of your _own dispatching_,
cannot be seen at your doors too frequently; the chariot should be
as repeatedly ordered—remember to leave home by _one way_, and
return by _another_, and equally _in haste_; all these stratagems are
considered peculiar privileges of the _College of Wigs_, and are well
worthy your attention and constant practice. You need hardly be told,
the superficial and unthinking part of mankind are ever caught by
appearances; what proportion they bear to other distinctions, need not
in the present instance be at all ascertained.
Having laid down rules (that should be rigidly persevered in) for the
regulation of your _public character_, I shall now advert to the strict
line of conduct it will be proper for you to adopt in your personal
transactions upon all professional emergencies.
When called to a patient upon the recommendation of the family
apothecary, you are to consider him one of your best friends, and _pay
court to him_ accordingly; on the contrary, if you are engaged upon the
spontaneous opinion of the patient, or his relatives, you have every
reason to conclude the abilities of the apothecary are held in very
slender estimation, and you may safely venture to display as much of
your _own consequence_ and superiority, as circumstances will admit.
After the awkward ceremony of your first appearance is over, and
matters a little adjusted, take great care to be upon your guard;
indulge in a variety of _significant gestures_, and _emphatical
hems!_—and _hahs!_ proving you possessed of _singularities_, that
may tend to excite ideas in the patient and surrounding friends,
that _a physician_ is a superior part of the creation.——Let _every
action_, _every word_, _every look_, be strongly marked, denoting
doubt and ambiguity; proceed to the necessary enquiries of “what
has been done in rule and regimen, previous to your being called
in?” hear the recital with patience, and give your _nod of assent_,
lest you make Mr. Emetic, the apothecary, your formidable enemy, who
will then _most conscientiously_ omit to recommend the assistance of
such _extraordinary abilities_ on any future occasion.—Take care
to _look wisdom_ in every feature; speak but little, and let it be
impossible _that little_ should be understood; let every hint, every
_shrug_ be carefully calculated to give the hearers a wonderful
opinion of your learning and experience.—In your _half-heard_ and
mysterious conversation with your _medical inferior_, do not forget
to drop a few observations upon—“the animal œconomy”—“circulation
of the blood”—“acrimony”—“the non naturals”—“stricture upon the
parts”—“acute pain”—“inflammatory heat”—“nervous irritability,” and
all those _technical traps_ that fascinate the hearers, and render the
patient yours ad libitum.
To the friends or relatives of the diseased, (as the case may be)
you seriously apprehend _great danger_; but such apprehension is
not without its portion of _hope_; and you doubt not, but a rigid
perseverance in the plan you shall prescribe, will reconcile all
difficulties in a few days, and restore the patient (whose recovery you
have exceedingly at heart) to his health and friends; that you will
embrace the earliest opportunity to see him again, most probably at
such an hour, (naming it) in the mean time you are in a great degree
happy to leave him in such good hands as _Mr. Emetic_, to whom you
shall give every necessary direction, and upon whose _integrity_ and
_punctuality_ you can implicitly rely.
You then require a private apartment for your necessary consultation
and plan of _joint depredation_ upon the pecuniary property of your
unfortunate invalid, which you are now going _seriously_ to attack with
the full force of _physic_ and _finesse_. You first learn from your
informant what has been hitherto done without effect, and determine
accordingly how to proceed; but in this, great respect must be paid to
the temper, as well as the constitution and circumstances, of your
intended _prey_; if he be of a petulant and refractory disposition,
submitting to medical dictation upon absolute compulsion, as a
professed enemy to physic and the faculty, let your harvest be _short_,
and complete as possible. On the contrary, should a _hypochondriac_ be
your subject, with the long train of melancholic doubts, fears, hopes,
and despondencies, avail yourself of the faith implicitly placed in
you, and regulate your proceedings by the force of _his imagination_;
let your prescription (by its length and variety) reward your _jackall_
for his present attention and future services.—Take care to furnish
the frame so amply with _physic_, that _food_ may be unnecessary;
let every hour (or two) have its destined appropriation—render all
possible forms of the _materia medica_ subservient to the general
good—_draughts_—_powders_—_drops_, and _pills_, may be given (at
least) every two hours; intervening _apozems_, or _decoctions_, may
have their utility; if no other advantage is to be expected, one good
will be clearly ascertained, the convenience of having the _nurse_
kept constantly awake, and if _one medicine_ is not productive of
success, _another may_. These are surely alternatives well worthy
your attention, being admirably calculated for the promotion of your
_patient’s cure_ and your _own reputation_.
Having written your long prescription, and learnt from Mr. Emetic
every necessary information, you return to the room of your patient,
to prove your attention, and renew your admonitions of punctuality and
submission;—then receiving your _fee_ with a consequential _air of
indifference_, you take your leave; not omitting to drop an additional
assurance, that “you shall not be _remiss_ in your attendance.” These,
Sir, are the instructions you must steadily pursue, if you possess
an ardent desire to become _eminent_ in your _profession_—_opulent_
in your _circumstances_—_formidable_ to your _competitors_, or a
_valuable practitioner_ to the _Company_ of _Apothecaries_, from
whom you are to expect the foundation of support. A multiplicity of
additional hints might be added for your minute observance; but such
a variety will present themselves in the course of practice, that a
retrospective view of diurnal occurrences will sufficiently furnish you
with every possible information for your future progress; regulating
your behaviour, by the rank of your patients, from the _most_ pompous
_personal ostentation_, to the meanest and _most contemptible
servility_.
TO THE SURGEON.
I congratulate you upon your recent emancipation from incessant study,
intense application, and strict _hospital_ attendance, where I shall
willingly suppose, you was a _dresser_ of the most promising abilities;
that you excelled your cotemporaries in every _chirurgical_ opinion,
became an expert _dissecting_ pupil to one of the _court of examiners_,
and are now burst through the cloud of your original obscurity, a
perfect prodigy of _anatomical_ disquisition.
I naturally conclude you capable of animadverting upon all the
distinct branches of your art to admiration, that you are critically
excellent in the use of an _instrument_ from the humble act of simple
_phlebotomy_, to the more important operation for a _fistula in
ano_.—You have, beyond every shadow of doubt, paid proper attention to
the fashionable precepts of the late Lord Chesterfield, and rendered
yourself (with assistance from the graces) a perfect adept in polite
address, displaying a variety of the most engaging attitudes, even in
the adjustment of a _ten tailed bandage_. The professional information
you have industriously collected, is such as will certainly afford you
the most equitable claims upon _public opinion_, being in possession of
every necessary acquisition from a _simple gonorrhœa_ to a _confirmed
lues_.
Previous to your solicitation of favour from your friends, you have
necessarily passed the awful ceremony of examination at the _Old
Bailey_, under your former tutor (and his brethren of the court)
who would not pay his _own abilities_ so improper a compliment as
to ask you questions in _anatomy_ or _osteology_, that he knew your
qualifications inadequate to the task of technically explaining.
After passing this _fiery ordeal_, you deposit the usual _pecuniary
gratuity_, and receiving the _badge_ of your newly acquired _honor_, we
now hail you “_a Member of the Corporation of Surgeons_,” and conclude
an ornamental plate upon the door of your habitation denotes you so
accordingly.
We suppose you embarking in a sea of spirited opposition, with your
competitors, for professional celebrity, and decorating your place
of residence in the most applicable stile to attract attention. To
effect this, let your exterior apartments be ornamented with the
_busts_ of _ancients_ you _never read_, and _portraits_ of _moderns_
that you _never knew_. These form an excellent combination to
excite the admiration and report of those who have occasion to court
the assistance of your extensive abilities.—To gradually heighten
which surprize, your interior (or _audit room_) must be a perfect
_Golgotha_.—A proficiency in the science of _osteology_, must be
powerfully impressed upon the senses of the trembling visitors, by
a _profusion_ of _skeletons_ in different states; let the awfulness
of the scene be rendered still more striking, by a variety of
subjects suspended in spirits, interspersed with singular _anatomical
and injected preparations_, both wet and dry; giving to the whole
additional force by the introduction of a “_few ill shaped fishes_,”
as the finishing stroke to a well formed plan of _chirurgical
ostentation_. Remember to let the _certificates_ of your professional
qualifications, from your different _lecturing tutors_, be so placed
(in elegant frames) as to meet the eye in a conspicuous direction;
lest that part of your patients, who condescend to visit you in this
gloomy recess, should have reason to conclude you a _consummate dunce_
and most _illiterate booby_, if these learned professors had not done
your friends the favour to “_certify_” to the contrary: and this they
always _chearfully_ do, rather than have it imagined they have eased
you of a part of your property, without doing you any _real service_.
The domestic arrangement being thus formed, the reflections to which
you must now turn your mind, are the necessary modes of practice and
behaviour, that may render you not only eminent in your profession, but
respectable in your property; as great events, that contribute largely
to the gratification of such wish, do not frequently occur, inferior
cases of every kind must be rendered subservient to the purpose. In
this list, _venereals_ are entitled to pre-eminence, as the most
lucrative; the patient never hesitating to pay full as liberally for
the preservation of the _secret_ as the cure of _disease_.—But you
may be perfectly assured, this secret never rewards so well, as when
_fate_ or _fortune_ assists its introduction to _married families_; a
most striking corroboration of this fact, occurred not long since in
the neighbourhood of a _royal residence_, and afforded matter of mirth
to the first circles in its environs.—This constant friend to the
faculty was communicated to a married lady, by a _young_ and celebrated
personage of some national eminence, and immediately conveyed from her
to her _enamoured cornuto_ in the moments of true _connubial felicity_;
he, in the love of variety, unluckily conferred the favour upon the
_house maid_; and she, in the extensive liberality of her disposition,
kindly bestowed a portion upon the _footman_. The _electrical shock_
of this _French fire_ was so rapidly communicated, that the four
sufferers, within the space of ten days, made their separate _private_
confessions to the medical superintendant of the family, each assigning
a different cause for its introduction, and equally strangers to the
_mode_ of its being brought into so _sober a family_. Although this is
a well authenticated _fact_, it is a harvest that can be very seldom
expected to happen in so great a degree; yet you will find it a matter
often _intruding_ between husband and wife, and considered no indelible
proof of _modern inconstancy_.—To this secret, you will be frequently
admitted by one party—the other, or both; and have an undoubted
privilege to accumulate all possible pecuniary advantage from the
confidence so implicitly placed in you.
Whatever cases are submitted to your opinion, be always prepared to
represent them _worse_ than they really _are_; making by your technical
terms, and political doubts, _bad worse_ upon every possible occasion.
Let all your proceedings have a peculiar and commanding dignity
annexed to the execution; by assuming a want of feeling, even to
_ferocity_, you will be termed a practitioner of _spirit_, and become
properly distinguished for your professional _fortitude_. No tender
sensations must be permitted to influence your feelings during any
operation, however tedious, or painful to the patient; they are an
ornament to human nature, and beneath your consideration _as one of
the faculty_.—Custom has rendered you ineligible to a place in the
_jury box_, as an evident proof of your professional _brutality_; by
therefore turning “their pains to laughter and contempt,” you only
justify the character you are already in possession of.
In the most trifling operations (even phlebotomy) descend to the very
minutiæ of medical consequence, not only making the ceremony _long_,
but _serious_, that you may be the better entitled to personal respect
and pecuniary compensation. In all those dreadful accidents that alarm
friends and distress families, take care to throw out (during your
apparent care and attention) a variety of observations that convey
_large sounds_ with _little meaning_; by such ambiguous expressions you
render the cure more extraordinary, whenever it happens, and is no bad
preparative for the procrastination of it to your own emolument. In all
cases requiring the interposition of instruments, take great care that
you produce them with mysterious solemnity, impressing the spectators
and assistants, with equal _awe_ and _fear_ of your abilities; if
_incisions_, or _separation_ of the _soft parts_, become necessary, be
sure, like “old Renault,” to “shed blood enough;” it will be attended
with a double advantage; first in the appearance of business, and the
more _pleasing consideration_, that the _larger_ and _deeper_ the
wound, the longer time will be necessary for _incarnation_; during the
course of which, your personal attendance and daily _epithemas_ cannot
be dispensed with.
The _greater operations_ do not occur every day, therefore tedious
_cicatrizations_, in addition to _simple_ and _compound fractures_, are
comfortable aids to fill up the spaces of intervention. Fractures of
the _lower extremities_ are exceedingly favourable, for you may then
exert proper authority; it becomes your duty to keep _them down_ when
they _are so_, for surely you may take upon you to know (with propriety
and professional privilege) when they are capable of _standing_ and
_walking_, better than they can _themselves_.—Tho’ one exception to
this rule has fallen within my knowledge, and nearly set aside the
privilege of the practice in the neighbourhood where it happened.
An honest hearty _miller_, in a small parish in the county of
H—-—-, having, on the market day, made some lucky purchases, and
congratulating himself upon his good fortune with a few friends over
the bottle, got himself insensibly intoxicated; but obstinately
persisting in his determination (and ability) to ride home, he was
suffered to depart, and was found afterwards upon the road by one of
his own servants almost lifeless; he was conveyed to his habitation,
and one of the most _eminent surgeons_ from a certain large and
populous town was called in, who finding the trunk nearly inanimate,
proceeded to _venesection_, then to an accurate examination of the
body, in which he presently discovered “a _fracture of the tibia_,
and two of the ribs; he had every reason to apprehend (from present
symptoms) a _concussion of the brain_; but situated as things were, he
should now administer proper _palliatives_, and pursue the necessary
steps upon his arrival in the morning.”—He then left the patient,
after strict injunctions “that he should not be suffered to move from
the position he had placed him in, till his return.”—At the hour
before appointed, the _Doctor_ returned, and not finding the wife
below stairs, explored the region he had left his patient in the night
before, surrounded by his sorrowful friends; when, strange to relate!
(_stranger to believe!_) the bird was flown, the bed made, and the very
room exhibited a striking proof of rustic neatness. Recovering in some
degree from his surprise, and feeling _very forcibly_ the aukwardness
of his situation, he descended to the kitchen, and there finding the
wife (who had just returned from some business in a back yard) he
eagerly enquired “How, or which way, his patient had been conveyed, and
where to?”—When the poor woman very simply and civilly replied, that
“her husband was gone into the fields among his folks; that she had
repeatedly urged the doctor’s orders of his _not getting out of bed_;
but he was a very obstinate man, and said he’d be d—’d if he’d ever
lay in bed with a _broken leg_ for any doctor in England, so long as
he could walk upon it.”—It may be better conceived than described how
severe a stroke this proved upon the reputation of the surgeon; certain
it is, his practice continued in a declining state for some years, and
it was not till the circumstance was nearly buried in oblivion (with
the body of the miller) that he recovered his former celebrity, being
at this moment one of the oldest and most eminent practitioners in the
neighbourhood where he resides.
This instance sufficiently demonstrates the impropriety of
overstraining the professional prerogative, especially with those
obstinate uncivilized beings, who have so little pliability of
disposition, as not to lay in bed when required; particularly in cases
of emergency, where it is so evidently for the promotion of their own
health and safety.
Remember in all cases of difficulty and danger to be mindful of the
_emplastrum adhæsivum_ of connexion, by which every branch of the
faculty should be united for the preservation of the whole; advise
(without the least reference to the enormity of expence) a consultation
of the most eminent; this renders the case of your patient more serious
and alarming, and you oblige your brethren by the recommendation; first
of a physician, whose _prescription_ introduces the _apothecary_;
and you then proceed _physically_ and _systematically_ in the joint
depredation and cure; your two friends, by the law of retribution,
gratefully recommending your inspection of every simple _laceration_
upon all similar occasions.
These are maxims that may at first sight seem beneath the attention
of a young and _brilliant_ practitioner, who erroneously conceiving
_merit_ a sufficient recommendation, requires no other conductor; but
they are so evidently an absolute part of his necessary study, that
unless such _mutual arts_ are occasionally put in practice, he can
never (in the present multiplied state of practitioners) expect to
derive the common necessaries of life from a fair and generous practice
of his profession.
Men of understanding, experience, and observation, know, that the
benignant hand of providence continues to anticipate in a variety
of instances the interpositions of _art_; and _nature_ would, upon
many occasions, entirely effect her own work, if not so frequently
interrupted and retarded by the officious hands and interested
experiments of professional jugglers.
TO THE ACCOUCHER,
OR,
MAN-MIDWIFE.
You fortunately make your appearance upon the boards of public
patronage, under the most striking advantages; the prevalence
of _fashion_ has exceeded every consideration of _decency_ and
_discretion_, and you are become (by the influence of pride and
imitation) as necessary to the comfort of a cottage, as the happiness
of a court. From the nature of your professional destination, a
pleasing exterior, and an accomplished person, are invariably expected;
necessarily blending (from your intended intercourse with the _purer_
part of the creation) the precision of taste, with the perfection of
the scholar.
The certificate granted you by that elaborate lecturer, the _obstetric
professor_, proclaims you qualified in the very minutiæ of this
mysterious art. The parts, externally and internally, necessary to
generation, are so perfectly familiar to your “mind’s eye,” that
you can extemporaneously delineate the _ovariæ_, the “_fallopian_
tubes,” the _fimbriæ_, and the very act of _conception_, from
the “_animalculæ_” in “_semen masculino_,” to the last stage of
_gestation_; the gradual expansion of the _uterus_, the dilatation
of the _os uteri_, the progress of _labour_, and all the methods of
extraction.
You can clearly define the classes as _natural_, _laborious_, and
_preternatural_; the use of the _forceps_, _scissars_, _crotchet_, and
_blunt hook_; the introduction of the _catheter_, the extraction of the
_placenta_, and the separation of the _funis_; in fact, all the _et
ceteras_ are so perfectly clear to you in _theory_, that it is almost
treason to suppose you can _err_ in the practice.
But, Sir, ripe as you are in these advantages, the harvest of universal
applause, and the sweets of emolument, are scarcely to be acquired
even by time, labour, and the most indefatigable industry. You have
in the practice of _midwifery_, all the ills of _Pandora’s box_ to
encounter, and after twenty years practice may be left to exclaim most
emphatically,
“Vain his attempt who strives to please you all.”
The only consolation you have, is, that you are destined to cooperate
with subjects, whose smiles render some degree of compensation for
the incessant fatigue dependant upon the practice. Under these
considerations, in the full career of your expectations, it can never
prove inapplicable to prepare your mind for some of the rebuffs and
disappointments that inevitably ensue. I conclude you are possessed of
youth, health, diligence, and constitutional _stamina_; but there are
other requisites, equally necessary for the performance of professional
duties, to which by election you dedicate the store of knowledge you
have so industriously acquired. The indispensible qualifications, for
the successful execution of the arduous task you are undertaking,
may be comprised in very few words, and those few exceedingly
expressive and readily understood; without _sobriety_, _fortitude_,
_judgment_, and _patience_, you never can expect to attain the summit
of excellence, or obtain admission to those families whose patronage
will contribute most to both credit and emolument. But admitting you
possessed of all the requisites for mere manual operation, the process
of delivery, and consistency of conduct, yet there are a multiplicity
of embellishments, that nothing but previous information, private
instruction, or experimental practice, can sufficiently recommend to
your attention.
In the awful minute of your introduction to a scene of excruciating
agony and eager expectation, where the hope of a mother, and the
anxiety of friends, all center in you, as the messenger of peace,
throw off the ostentatious air of self-importance, exerted over
those _patient paupers_ upon whom you practised in the days of your
initiation, and recollecting yourself the humble solicitant of public
opinion and private favour, display your tenderness and civility, as no
bad harbinger of your better qualifications. Strengthen such favourable
impression by every degree of delicacy and attention to the suffering
expectant, who imploring assistance from the interposition of your art,
hails you as “the god of her idolatry,” by whom she is to receive an
early acquittal from all her sufferings.
As this is not often to be instantly expected, and many tedious hours
frequently intervene between the _hope_ and _execution_, it will be
necessary (exclusive of your periodical consolations to the patient’s
inspiring resignation) you address yourself to the passions and
foibles of the gossips, with whom you will in general be too numerously
attended, and whose clamours upon many occasions are not easily to be
subdued.—Notwithstanding this, the good opinions and recommendations
of these motley visitors (of all ages and constitutions) are the
very materials to form the foundation of _report_, upon which the
superstructure of your reputation and future practice is to be
raised.—Although _gravity_, even to a certain degree of _solemnity_,
is a characteristic of your professional practice, yet there are
times when you must unavoidably come forward to enliven the _good
ladies_ with a specimen of your volubility, and variegate the natural
extremities of pain with the applicable insinuations of mirth. Jocular
inuendoes and double entendres are not only expected, but courted in
the intervals of ease, or, as the good women generally term it, “when
the business stands still.”
The introduction of the tea-table and the joke are always considered
equally promoters of mirth and the delivery; the practitioner is
expected to be well stocked with the most fashionable recitals of
_seduction_, _rapes_, _fornication_, and _adultery_, which, if well
told, and applicably introduced, insures him to a certainty the future
interests of his company. It will be absolutely necessary for you to
fall into all the opinions of the table, except the glass of brandy
repeatedly pressed upon you by the _nurse_ (as a specific, or grand
arcana, for every ill) with the very expressive plea of its not doing
you _any harm_; and “besides, Sir, what’s good for the goose is good
for the gander.”
After such casual respites (which frequently happen) when the progress
of labour calls you again to your _chair of office_, resume the
language of commiseration, giving your patient every alleviation of
hope for a speedy deliverance, at the very time you are impressing
(by significant looks and emphatic gestures) the attendants and
friends with an idea of great difficulty and impending danger. In the
alternate moments of respiration, evade every retrospective allusion
to the length of the labour, by frequent insinuations that it advances
rapidly, that you have great reason to hope every obstacle will be
soon surmounted; but you are afraid the consolation you administer,
and the pain she suffers, will take but little hold of the memory, if
you may be permitted to judge from the declaration of a very pretty
woman you delivered during your attendance at the Lying-in Hospital,
who, in reply to your tender admonitions of fortitude and patience,
said, “She was very much obliged to you for your kindness, but
she was very certain it would be just the same again by _that time
twelvemonth_.”—This will make way for any thing applicable of your own
collection, but they must be all bordering upon the original cause of
the scene before you; for although the patient is in extreme pain, it
is not so with the attendants; they consider it a _matter of course_,
and feel no disgust but from fatigue, which they very justly conceive
they have a right to alleviate with occasional mirth—tea, and a
_little good brandy_.
To the _nurse_, great part of your attention must be directed; for she,
like a bellows blower to the organist at a cathedral, will expect to be
included and constitute _WE_ in all the merit of your execution.—The
rapidity, or gradual progress of labour, at length closes your
complicated scene of mirth and anxiety; you deliver your patient,
and proceed to the subsequencies (_secundem artem_) all which having
concluded to general admiration, and received ten thousand thanks and
blessings from your subject, you convey a pecuniary _hope_ for future
services into the hand of the _nurse_, take a tender leave of your
patient, with a promise of seeing her again in proper time, drop an
attracting _nod_ of obedience to the surrounding females, and meeting
the husband at the bottom of the stairs, congratulate him upon his son
or his daughter; slightly hint the difficulty of the case, the danger
you apprehended, the fatigue you had undergone, all which is not worthy
a thought, _perfectly happy_ in an event that contributes so largely to
the happiness of him and his family.
That part of the work being completed, that most depended upon
the efforts of _Nature_, it becomes your duty to promote your own
interest by every exertion of _art_. Should, after your departure, any
_hemorrage_ ensue, inevitable danger will be apprehended, the patient
will be reduced, the friends alarmed, and you, in the moments of
dreadful anxiety, be immediately sent for; this _lucky circumstance_
will operate to your earnest wish; it will afford ample scope for
your most fertile invention, and happily introduce a long list of
_styptics_, _anodynes_, and all those necessary concomitants that give
a profitable complexion to the business, by enlarging your hopes,
protracting the case, and encreasing the danger.
However, should this favourable circumstance not occur, your privilege
is by no means curtailed; you immediately commence your previous
intentional operation of dispatching a _sufficiency_ of _balsamic
anodyne_ draughts, “to promote and mitigate the severity of _after
pains_, that very much distress the patient.” These draughts should be
continued every _four hours at least_, and as a sufficient quantity
of that excellent (and cheap) medicine, _spermacæti_, cannot be
well dissolved in each draught, without rendering it too viscid in
consistence, it will be peculiarly advantageous to you (as well as the
patient) to let them be accompanied with _boluses_ to be taken at the
_same time_, composed of _pulv. sperma_—_confect. alkermes_, &c.—Let
the administration of these medicines be entirely regulated by the
temper, docility, and recovery of your subject; having it ever in mind,
that it is neither your duty or interest to make the least observation
upon their being no longer necessary, till their frequent use is
complained of by the patient sufferer; and even then you are favoured
by fortune in a plea, that you “are now under the absolute necessity
of making unavoidable alterations for the prevention of the _milk, or
puerperal_ fever, which you very much apprehend may ensue.” That it is
an invariable rule with you, never to recommend the use of medicines,
but where they are highly necessary; in the present instance, it is
your duty, from the motive of _gratitude_, to be equally circumspect,
for the promotion of _her health_ and your _own reputation_.
To effect every desirable purpose, a gentle _diaphoresis_ must
be supported, to prevent obstructions and promote the necessary
excretions; to procure which, you must entreat most earnestly an
implicit obedience to your directions, which from a variety of
_unpleasant symptoms_ becomes indispensible. To carry which point in
a still greater degree, renew, at every visit, your attentions to
the _nurse_ (who in your absence is a vortex of knowledge, in your
presence all obedience) her approbation of your conduct, and good
opinion of your practice must be obtained _at any price_; it becomes
with you a consideration of greater magnitude than your patient’s
recovery; for should _death_ no longer permit _her_ presence in the
scene of sublunary events, you lose _one patient only_; but with the
good opinion and recommendation of the _nurse_, vanishes hundreds of
patients _in embryo_, to be brought forth by the influence of her
exaggerated reports of your incredible abilities.
The nurse once secured and attached to your interest, becomes an
admirable instrument for the promotion of all your designs, she
embraces every opportunity to strengthen your directions, and urges
(as you have done) the continuation of medicine, “till, with the
blessing of God, her mistress is quite set up and upon her legs again.”
A proper reflection upon these subjects will convince you (even in the
infancy of your embarkation) that a _midwifery case_ in a _good_ family
is no _bad_ thing, and made the most of, with the occasional aid of
perpetual _cardiacs_,—_balsamics_,—_carminatives_, and _anodynes_,
to ease and “quiet the child,” every time it _coughs, or belches_,
constitutes a harvest of industry and political necessity, that the
world in general is very little acquainted with.
Previous to the closing of the curtain, you have still an additional
chance for more depredations upon the unfortunate husband; should
_stagnant_ milk occasion a _coagulum_ in the _lacteals_, constituting
a _turgency_ of the breasts, threatening a formation of matter,
_suppuration_ becomes almost unavoidable, and you promote it
accordingly; this leads to _certain operation_, daily dressings, &c.
all tend to encrease your interest, and give you the enjoyment of a
temporary monopoly in the joint practice of _midwifery_, _surgery_, and
_physic_.
TO THE APOTHECARY.
The varieties of your past, as well as the personal requisites for
your future destination, are of such a pantomimic and party-coloured
complexion, that I cannot proceed to a recital so truly risible,
without first offering you, in the lines of Woty, a predominant trait
in my _own character_,
“I love to laugh, though Care stand frowning bye,
And pale Misfortune rolls her meagre eye.”
Thus happily disposed to those brilliant sallies of mirth, that almost
renovate life, and set melancholy at defiance, you will be the less
liable to surprise, that I shall descend to the very minutiæ of your
necessary qualifications, for the support of so arduous and complicated
a character as you are now going to perform upon the theatre of life.
It is very natural to conclude you have, during the tedious years
of initiation as an apprentice, and your more mature services as a
journeyman, (politely ycleped assistant) whether in the metropolis,
or the country, gone through every degree of drudgery, and feelingly
experienced every indignity, that _insolent pride_ could bestow, or
_patient merit_ receive. Not an inferior trust (of the inferior part of
the faculty) but you have carried into execution, from the injection
of an _enema_ in a garret, to the separation of an _emplastrum
vesicatorium_ in a workhouse. These are offices of humanity and service
to your fellow creatures, that do you immortal honour; they are
retrospectives that form an epoch in the mind of every practitioner,
and afford him the powerful consolation of _sacred truth_, “He that
humbleth himself,” &c. by which rule, and the force of a fertile
imagination, any _apothecary_ may _conceive_ himself a _physician_,
even in the administration of a _glyster_. In this hospitable execution
(taken metaphorically) there cannot be supposed the least indignity;
for it is universally known the _greatest_ and most _prudent_ generals
are in the _rear_ during the heat of battle; and we are again taught
seriously to believe “the last shall be first,” &c. so that you have
every way, (by both _faith_ and _services_) insured a religious and
prophetic _hope_ of preferment.
Having for many years encountered the _worst_, you are now prepared
for the _best_; and bidding adieu to the rigid rules of austere
masters, embark upon your own foundation, qualified for every
medical consultation, from the bedchamber of a _duchess dowager_ to
the subterraneous residence of her _chairman_. You have, at this
period, not only shaken off the shackles of servitude, but the very
recollection of your long standing culinary connections. In your
various changes of residence, tedious peregrinations, and medical
observations, it is natural to conclude, you have acquired by care,
study, and attention, a competent knowledge of almost every tint in the
picture of life; which, with embellishments, derived from a few courses
under some of the _metropolitan lecturers_, and _hospital attendance_,
to qualify you for the complication of _country_ practice, there is no
doubt but you come from the forge properly formed, to make wrong appear
right, and right wrong, in the face of every _old woman_ in the county
where you are going to reside.
Exclusive of these qualifications, and the many instructions already
introduced under the two preceding heads (to which you may occasionally
refer) there are a great variety that must be advanced for _your
particular use_, and to those you will, no doubt, pay every proper
attention, if you indulge the least desire to become a popular member
of the faculty. In respect to personal appearance, former distinctions
and peculiarities are in some degree levelled, the world is very much
relaxed in its severities, and the apothecary mixes with the general
herd of mankind, without those distinguishing exteriors that _were_
his professional characteristics. The gilt-headed cane and enormous
tassel are no longer in use; the _full-bottom wig_, that so universally
ornamented the _os frontis_ of the faculty in general, is now almost
laid aside with inferior classes, and engrossed by the _college_. The
apothecary (particularly in the country) is in every respect free from
the illiberal censure of former times, and treading close upon the
heels of the _parson_ and the _lawyer_, enjoys, without restraint, the
_chace_, the _gun_, the _bottle_, and _bona-roba_. These, if you are of
a volatile disposition and amorous constitution, afford (at seasonable
opportunities) a happy and high relished relaxation from the many
severities of medical practice.