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tice, powers to develop, knowledge to attain, graces to acquire. Circumstances may change your plan, experience may show that it requires modification, but start with it as complete as if the performance were sure to be the exact copy of the programme. If you reject this first piece of advice, I am afraid nothing else I can say will be of service. Some weakness of mind or of moral purpose can alone account for your trusting to impulse and circumstances. Nothing else goes on well without a plan; neither a game of chess, nor a campaign, nor a manufacturing or commercial enterprise, and do you think that you can play this game of life, that you can fight this desperate battle, that you can organize this mighty enterprise, without sitting down to count the cost and fix the principles of action by which you are to be governed?
It is not likely that any of you will deliberately lay down a course of action pointing to a low end, to be reached by ignoble means. But keep a few noble models before you. For faithful lifelong study of science you will find no better example than John Hunter, never satisfied until he had the pericardium of Nature open, and her heart throbbing naked in his hand. For calm, large, illuminated, philosophical intellect, hallowed by every exalted trait of character, you will look in vain for a more perfect pattern than Haller. But ask your seniors who is their living model, and if they all give you the same name, then ask them why he is thus honored, and their answers will go far toward furnishing the outline of that course I would hope you may lay down and follow.
Let us look, in the very brief space at our disposal, at some of those larger and lesser rules which might be supposed to enter as elements into the plan of a physician's life.
Duty draws the great circle which includes all else within it. Of your responsibility to the Head Physician of this vast planetary ambulance or traveling hospital which we call Earth, I need say little. We reach the Creator chiefly through his creatures. Whoso gave the cup of cold water to the disciple gave it to the Master; whoso received that Master received the Infinite Father who sent him. If performed in the right spirit, there is no higher worship than the unpurchased service of the medical
priesthood. The sick man's faltered blessing reaches heaven through the battered roof of his hovel before the Te Deum that reverberates in vast cathedrals.
Your duty as physicians involves the practice of every virtue and the shunning of every vice. But there are certain virtues and graces of pre-eminent necessity to the physician, and certain vices and minor faults against which he must be particularly guarded.
And first, of truth. Lying is the great temptation to which physicians are exposed. Clergymen are expected to tell such portions of truth as they think will be useful. Their danger is the suppressio veri, rather than direct falsehood. Lawyers stand in professional and technical relations to veracity. Thus, the clerk swears a witness to tell the truth, the whole truth, and nothing but the truth. The lawyer is expected to get out of the witness not exactly the truth, but a portion of the truth, and nothing but the truth-which suits him. The fact that there are two lawyers pulling at the witness in different directions makes it little better; the horses pulled different ways in that horrid old punishment of tearing men to pieces; so much the worse for the man. But this is an understood thing, and we do not hesitate to believe a lawyer--outside of the courtroom.
The physician, however, is not provided with a special license to say the thing which is not. He is expected to know the truth, and to be ready to tell it. Yet nothing is harder than for him always to do it. Whenever he makes an unnecessary visit, he tells a lie. Whenever he writes an unnecessary prescription, he tells a lie. It is audibly whispered that some of the general practitioners," as they are called in England, who make their profit on the medicines they dispense, are apt to be too fond of giving those which can be charged at a pleasing figure in their accounts. It would be better if the patient were allowed a certain discount from his bill for every dose he took, just as children are compensated by their parents for swallowing hideous medicinal mixtures.
All false pretences whatsoever, acted or spoken; all superficial diagnoses, where the practitioner does not know that he knows, or, still worse, knows that he does not know; all unwarranted prognoses and promises of
cure; all claiming for treatment that which may have been owing to Nature only; all shallow excuses for the results of bad practice, are lies and nothing else.
There is one safe rule which I will venture to lay down for your guide in every professional act involving the immediate relation with the object of your care; so plain that it may be sneered at as a truism, but so difficult to follow that he who has never broken it deserves canonizing better than many saints in the calendar: A physician's first duty is to his patient; his second only, to himself.
All quackery reverses this principle as its fundamental axiom. Every practitioner who reverses it is a quack. A man who follows it may be ignorant, but his ignorance will sometimes be safer than a selfish man's knowledge.
You will find that this principle will not only keep you in the great highway of truth, but that if it is ever a question whether you must leave that broad path, it will serve you as a guide. A lie is a deadly poison. You have no right to give it in large or small doses for any selfish purpose connected with your profession, any more than for other selfish objects. But as you administer arsenic or strychnia in certain cases, without blame; nay, as it may be your duty to give them to a patient; are there not also cases in which the moral poison of deceit is rightly employed for a patient's welfare? So many noble-hearted and conscientious persons have scruples about any infraction of the absolute rule of truth, that I am willing briefly to discuss and illustrate a question which will often be presented to you hereafter.
Truth in the abstract is perhaps made too much of as compared to certain other laws established by as high au thority. If the Creator made the tree-toad so like thic moss-covered bark to which it clings, and the larva of a sphinx so like the elm-leaf on which it lives, and that other larva so exquisitely like a broken twig, not only in color, but in the angle at which it stands from the branch to which it holds, with the obvious end of deceiving their natural enemies, are not these examples which man may follow? The Tibboo, when he sees his enemy in the distance, shrinks into a motionless heap, trusting that he may be taken for a lump of black basalt, such as is frequently met with in his native desert. The Australian, following
the same instinct, crouches in such form that he may be taken for one of the burnt stumps common in his forest region. Are they not right in deceiving, or lying, to save their lives? or would a Christian missionary forbid their saving them by such a trick? If an English lady were chased by a gang of murdering and worse than murdering Sepoys, would she not have a right to cheat their pursuit by covering herself with leaves, so as to be taken for a heap of them? If you were starving on a wreck, would you die of hunger rather than cheat a fish out of the water by an artificial bait? If a schoolhouse were on fire, would you get the children quietly down stairs under any convenient pretence, or tell them the precise truth, and so have a rush and a score or two of them crushed to death in five minutes ?
These extreme cases test the question of the absolute inviolability of truth. It seems to me that no one virtue can be allowed to exclude all others, with which in this mortal state it may sometimes stand in opposition. Absolute justice must be tempered by mercy; absolute truth by the law of self-preservation, by the harmless deceits of courtesy, by the excursions of the imaginative faculty, by the exigencies of human frailty, which cannot always bear the truth in health, still more in disease.
Truth is the breath of life to human society. It is the food of the immortal spirit. Yet a single word of it may kill a man as suddenly as a drop of prussic acid. “An old gentleman was sitting at table when the news that Napoleon had returned from Elba was told him. He started up, repeated a line from a French play, which may be thus Englished :
The fatal secret is at length revealed,
and fell senseless in apoplexy. You remember the story of the old man who expired on hearing that his sons were crowned at the Olympic games. A worthy inhabitant of a village in New Hampshire fell dead on hearing that he was chosen town clerk.
I think the physician may, in extreme cases, deal with truth as he does with food, for the sake of his patient's welfare or existence. He may partly or wholly with
hold it, or, under certain circumstances, medicate it with the deadly poison of honest fraud. He must often look the cheerfulness he cannot feel, and encourage the hope he cannot confidently share. He must sometimes conceal and sometimes disguise a truth which it would be perilous or fatal to speak out.
I will tell you two stories to fix these remarks in your memory. When I was a boy, a grim old doctor in a neighboring town was struck down and crushed by a loaded sledge. He got up, staggered a few paces, fell and died. He had been in attendance upon an ancient lady, a connection of my own, who at that moment was lying in a most critical condition. The news of the accident reached her, but not its fatal character. Presently the minister of the parish came in, and a brief conversation like this followed.—Is the Doctor badly hurt ?-Yes, badly.-Does he suffer much ?-He does not; he is easy.–And so the old gentlewoman blessed God and went off to sleep; to learn the whole story at a fitter and safer moment. I know the minister was a man of truth, and I think he showed himself in this instance a man of wisdom.
Of the great caution with which truth must often he handled, I cannot give you a better illustration than the following from my own experience. A young man, accompanied by his young wife, came from a distant place, and sent for me to see him at his hotel. He wanted his chest examined, he told me.- Did he wish to be informed of what I might discover ?-He did.-I made the ante-mortem autopsy desired. Tubercles; cavities; disease in full blast; death waiting at the door. I did not say this, of course, but waited for his question.—Are there any tubercles? he asked presently. Yes, there are.-There was silence for a brief space, and then, like Esau, he lifted up his voice and wept; he cried with a great and exceeding bitter cry, and then the twain, husband and wife, with loud ululation and passionate wringing of hands, shrieked in wild chorus like the keeners of an Irish funeral, and would not be soothed or comforted. The fool! He had brought a letter from his physician, warning me not to give an opinion to the patient himself, but to write it to him, the medical adviser, and this letter the patient had kept back; determined to have my opinion from my own lips, not doubting