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that it would be favorable. 'In six weeks he was dead, and I never questioned that his own folly and my telling him the naked truth killed him before his time.
If the physician, then, is ever authorized to tamper with truth, for the good of those whose lives are entrusted to him, you see how his moral sense may become endangered. Plain speaking, with plenty of discreet silence, is the rule; but read the story of the wife of Cæcinna Pætus, with her sick husband and dead child, in the letters of Pliny the Younger (Lib. III, XVI), and that of good King David's faithful wife Michal, how she cheated Saul's cutthroats (I Samuel, XIX, 13), before you proclaim that homicide is always better than vericide.
If you can avoid this most easily besetting sin of falsehood, to which your profession offers such peculiar temptations, and for which it affords such facilities, I can hardly fear that the closely related virtues which cling to truth, honesty and fidelity to those who trust you, will be wanting to your character.
That you must be temperate, so that you can be masters of your faculties at all times; that you must be pure, so that you shall pass the sacred barriers of the family circle, open to you as to none other of all the outside world, without polluting its sanctuary by your presence, it is, I think, needless for me to urge.
Charity is the eminent virtue of the medical profession. Show me the garret or the cellar which its messengers do not penetrate; tell me of the pestilence which its heroes have not braved in their errands of mercy; name to me the young practitioner who is not ready to be the servant of servants in the cause of humanity, or the old one whose counsel is not ready for him in his perplexities, and I will expatiate upon the claims of a virtue which I am content to leave you to learn from those who have gone before you, and whose footprints you will find in the path to every haunt of stricken humanity.
But there are lesser virtues, with their corresponding failings, which will bear a few words of counsel.
First, then, of that honorable reserve with reference to the history of his patients, which should belong to every practitioner. No high-minded or even well-bred man can ever forget it; yet men who might be supposed both
high-minded and well-bred have been known habitually to violate its sacred law. As a breach of trust, it demands the sternest sentence which can be pronounced on the offence of a faithless agent. As a mark of vanity and egotism, there is nothing more characteristic than to be always babbling about one's patients, and nothing brings a man an ampler return of contempt among his fellows. But as this kind of talk is often intended to prove a man's respectability by showing that he attends rich or great people, and as this implies that a medical man needs some contact of the kind to give him position, it breaks the next rule I shall give you, and must be stigmatized as lesemajesty toward the Divine Art of Healing.
This next rule I proclaim in no hesitating accents: Respect your own profession! If Sir Astley Cooper was ever called to let off the impure ichor from the bloated limbs of George the Fourth, it was the King that was honored by the visit, and not the Surgeon. If you do not feel as you cross the millionaire's threshold that your Art is nobler than his palace, the footman that lets you in is your fitting companion, and not his master. Respect your profession, and you will not chatter about your “patrons,” thinking to gild yourselves by rubbing against wealth and splendor. Be a little proud-it will not hurt you; and remember that it depends on how the profession bears itself whether its members are the peers of the highest, or the barely tolerated operatives of society, like those Egyptian dissectors, hired to use their ignoble implements, and then chased from the house where they had exercised their craft, followed by curses and volleys of stones. The Father of your Art treated with a Monarch as his equal. But the Barber-Surgeons' Hall is still standing in London. You may hold yourselves fit for the palaces of princes, or you may creep back to the Hall of the Barber-Surgeons, just as you like.
Richard Wiseman, wlio believed that a rotten old king. with the corona Veneris encircling his forehead with its copper diadem, could cure scrofula by laying his finger on its subject-Richard Wiseman, one of the lights of the profession in his time, spoke about giving his patients over to his “servants” to be dressed after an operation. We do not count the young physician or the medical student as
of menial condition, though in the noble humility of science to which all things are clean, or of that "entire affection” which, as Spenser tells us, “hateth nicer hands," they stoop to offices which the white-gloved waiter would shrink from performing. It is not here, certainly, where John Brooks—not without urgent solicitation from lips which still retain their impassioned energy-was taken from his quiet country rides, to hold the helm of our Imperial State; not here, where Joseph Warren left the bedside of his patients to fall on the smoking breastwork of yonder summit, dragging with him, as he fell, the curtain that hung before the grandest drama ever acted on the stage of time—not here that the Healer of men is to be looked down upon from any pedestal of power or opulence!
If you respect your profession as you ought, you will respect all honorable practitioners in this honored calling. And respecting them and yourselves, you will beware of all degrading jealousies and despise every unfair art which may promise to raise you at the expense of a rival. How hard it is not to undervalue those who are hotly competing with us for the prizes of life! In every great crisis our instincts are apt suddenly to rise upon us, and in these exciting struggles we are liable to be seized by that passion which led the fiery race-horse, in the height of a desperate contest, to catch his rival with his teeth as he passed, and hold him back from the goal by which a few strides would have borne him. But for the condemnation of this sin I must turn you over to the tenth commandment, which, in its last general clause, unquestionably contains this special rule for physicians—Thou shalt not covet thy neighbor's patients.
You can hardly cultivate any sturdy root of virtue but it will bear the leaves and flowers of some natural grace or other. If you are always fair to your professional brethren, you will almost of necessity encourage those habits of courtesy in your intercourse with them which are the breathing organs and the blossoms of the virtue from which they spring.
And now let me add various suggestions relating to matters of conduct which I cannot but think may influence your course, and contribute to your success and happi
I will state them more or less concisely as they
seem to require, but I shall utter them magisterially, for the place in which I stand allows me to speak with a certain authority.
Avoid all habits that tend to make you unwilling to go whenever you are wanted at any time. No over-feeding or drinking or narcotic must fasten a ball and chain to your ankle. Semper paratus is the only motto for a physician!
The necessity of punctuality is generally well understood by the profession in cities. In the country it is not unusual to observe a kind of testudineous torpor of motion, common to both man and beast, and which can hardly fail to reach the medical practitioner. Punctuality is so important, in consultations especially, to the patient as well as the practitioner, that nothing can excuse the want of it -not even having nothing to do—for the busiest people, as everybody knows, are the most punctual. There is another precept which I borrow from my wise friend and venerated instructor, the Emeritus Professor of Theory and Practice; and you may be very sure that he never laid down a rule he did not keep himself. Endeavor always to make your visit to a patient at the same regular time, when he expects you. You will save him a great deal of fretting, and occasionally prevent him sending for your rival when he has got tired of waiting for you.
Your conduct in the sick-room, in conversation with the patient or his friends, is a matter of very great importance to their welfare and to your own reputation. You remember the ancient surgical precept—Tuto, cito, jucunde. I will venture to write a parallel precept under it, for the manner in which a medical practitioner shall operate with his tongue; a much more dangerous instrument than the scalpel or the bistoury. Breviter, sauviter, caute. Say not too much, speak it gently, and guard it cautiously. Always remember that words used before patients or their friends are like coppers given to children; you think little of them, but the children count them over and over, make all conceivable imaginary uses of them, and very likely change them into something or other which makes them sick, and causes you to be sent for to clean out the stomach you have so unwittingly filled with trash; a task not so easy as it was to give them the means of filling it.
The forming of a diagnosis, the utterance of a prognosis, and the laying down of a plan of treatment, all demand certain particular cautions. You must learn them by your mistakes, it may be feared, but there are a few hints which you may not be the worse for hearing.
Sooner or later, everybody is tripped up in forming a diagnosis. I saw Velpeau tie one of the carotid arteries ior a supposed aneurism, which was only a little harmless tumor, and kill his patient. Mr. Dease, of Dublin, was more fortunate in a case which he boldly declared an abscess, while others thought it an aneurism. He thrust a lancet into it and proved himself in the right. Soon after, he made a similar diagnosis. He thrust in his lancet as before, and out gushed the patient's blood and his life with it. The next morning Mr. Dease was found dead and floating in his own blood. He had divided the femoral artery. The same caution that the surgeon must exercise in his examination of external diseases, the physician must carry into all his physical explorations. If the one can be cheated by an external swelling, the other may be deceived by an internal disease. Be very careful; be very slow; be very modest in the presence of Nature. One special caution let me add.
you are ever so accurate in your physical explorations, do not rely too much upon your results. Given fifty men with a certain fixed amount of organic disease, twenty may die, twenty may linger indefinitely, and ten may never know they have anything the matter with them. I think you will pardon my saying that I have known something of the arts of direct exploration, though I wrote a youthful essay on them, which, of course, is liable to be considered a presumption to the contrary. I would not, therefore, undervalue them, but I will say that a diagnosis which maps out the physical condition ever so accurately, is, in a large proportion of cases, of less consequence than the opinion of a sensible man of experience, founded on the history of the disease, though he has never seen the patient.
And this leads me to speak of prognosis and its fallacies. I have doomed people, and seen others doom them, over and over again, on the strength of physical signs, and they have lived in the most contumacious and scientifically unjustifiable manner as long as they liked, and some of them