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said child to have scarlatina, or that the limping boy has hip disease, or after a more leisurely and careful examination, that the young woman's headaches are due to Bright's disease, or that the man who has fallen has a fracture or a dislocation, instead of merely a sprain, all to your discredit. The same risk of overlooking important facts, or of seeing partial development only, attaches to all consultations on the curbstone, at the theaters, on the streets, cars, etc.; take care to go wrong on them as seldom as possible.

To mistake a tumor for pregnancy or vice versa is one of the most mortifying and personally damaging errors of judgment that can be made. To be attending a female who has been obscurely ailing for weeks and months, and who finally proves to be pregnant, is also very damaging, unless you have recognized and declared that concomitant fact; otherwise her entire illness is apt to be attributed to the pregnancy. In such cases some objections will probably be made to the payment of your fees. Cases of false pregnancy, in which you have babyclothes made for one that isn't there, are also very damaging.

Ask no unnecessary questions, yet be careful to make every inquiry essential to ascertain all the facts in every case, and also to satisfy the patient and others that you feel an interest in the case; if you neglect to do so, you will cause unsatisfied suspense and darkness, and risk both an error and loss of confidence.

Prompt detection of dangerous changes, or of the approach of death, will not only shield you from blame, but will gain you praise and prestige if you point them out before the patient himself or those around observe them.

Be careful never to speak of anything you do for a patient as an experiment or merely to gratify curiosity, for every body is more or less opposed to physicians' "trying experiments" upon themselves or theirs. For the same reason, it is risky to give patients the sample bottles of new remedies

sent to you for trial, or to let any one know that he is the first to whom you ever gave this or that medicine; or that his is the first case of this or that fracture, or of smallpox, or of hernia, or of anything else you ever attended, or distrust of you may take the place of confidence.

You should keep a reference-book for collecting and retaining specially good remedies, prescriptions for stubborn diseases, medical clippings, self-devised apparatus and expedients, self-discovered facts, and important things that you have seen, heard, read, or thought, the substance of all. Such a record possesses continual interest and more value to its owner than any other book in his library; also a clinical case-book or a diary for recording the date, diagnosis, treatment, etc., of unusually important cases. For sometimes a mere reminder will make you master of an otherwise puzzling situation, and enable you to conduct a case with decision and success. Besides, nothing impresses a patient suffering from a complicated or long-standing disease with a conviction that you feel an interest in him, and intend to try your utmost for him, more than to know that you are keeping a careful record of his case. Besides, these records will gradually become a storehouse of facts, and furnish you important cases for relation at the societies or for publication.

When truth will allow, let your diagnosis either include the patient's belief or fully disprove it, that his mind may not distrust your opinion and treatment, and thus tend to counteract your efforts.

You can more easily impress and permanently convince a doubting patient of a medical fact which militates against his wish or belief-for instance, that shortening is usual after fracture-by showing it to him in black and white than by a hundred verbal statements.

Demonstrations to a patient or his friends of certain 'diseases and injuries by making a well-drawn pencil-sketch or

diagram on a prescription paper, and patiently explaining facts that are not clear to them, gives great satisfaction, and also makes them appreciate that you fully understand the subject.

Study to be fertile in expedients, and be very slow to confess or allow the inference, that you are hopelessly puzzled about a case, are at your wit's end, or have reached the limit of your resources.

Never be too sanguine of a patient's recovery from a serious affliction, and never give one up to die in acute disease unless the process of dissolution be actually in progress. Wiseacres say that "the only way to get well after a physician gives you up is to give him up,” knowing that another can at least have no less hope and do no less good. Above all else, never withdraw from a case of acute or selflimiting disease because the patient is very ill, or seems as cold as ice, and more likely to die than to live, for a human being can endure a great deal and still survive; besides, it is always highly comforting to anxious relatives or friends to know that the physician, with strong arm and hopeful heart, stands as a stay and support, ready and willing to do more if the slightest opportunity occurs.

Icy coldness sometimes seems to make death inevitable within a few hours, and the physician hastens to announce it, when, lo! reaction and high fever appear, whip up and revive the failing powers again, and make it seem as if he lost hope and abandoned the patient entirely too soon.

If a patient be unable to swallow, think of the esophageal tube; or if food taken into the stomach be not assimilated, continue your efforts with inunctions of cod-liver oil or oil and quinia; also by rectal alimentation:

What on earth shall I do for this fellow next?

hypodermic injections of strychnine, inhalation of oxygen, injection of the normal salt solution, etc., until he is either

better or the breath is out of his body, for Nature, by a crisis, or a vicarious function, or a compensatory process, or the tardy action of the remedies you have been using, may turn the scale and let the life-power, or the latent vitality of the constitution, rally and gain control over the disease at the very last hour. Under such circumstances, if you have hastily given up and abandoned the case as hopeless and merely lingering, you may be justly accused of bad judgment or mistaken diagnosis, while some brother physician or an Irregular or a Christian Scientist, or an old woman, who has stepped into the field at the lucky moment, will reap the glory of setting the laws of Nature aside and bringing back to life one whom you had given up as dead.

A few costly errors like this will make you much wiser on this and many other subjects, and also open your eyes to a great deal of practical wisdom, and among other lessons this: Never be too positive regarding any indefinite symptom, or too sure of any doubtful event. But when errors do occur, be not too much discouraged, for, were you, or any other physician, to observe as closely as Hippocrates, or to practice medicine to the age of Methuselah, surprises and disappointments would still occasionally confront you:

For never yet hath anyone attained

To such perfection, but that time, and place,

And use have brought addition to his knowledge;

Or made correction, or admonished him

That he was ignorant of much which he
Had thought he knew, or led him to reject
What he had once esteemed of highest price.

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B

E on your guard against the thousands of snags and pitfalls which lie hidden in the medical path to mislead and entrap the unwary. When in doubt whether duty requires you to do a thing or not, -for instance, between doing nothing and a risky operation,-if all else be equal, remember that the sin of omission is, in appearance at least, not so great as the sin of commission.

A very safe guide, in determining what line to pursue in grave or puzzling cases, is to imagine yourself to be in the patient's position, and then look yourself squarely in the face and ask your own heart: what would I do if I were the patient?

We, of all men, need to be as wise as serpents and as harmless as doves. The most skillful physician may, and often does, get results that he deplores almost as much as the patient does, but which his sincerest desires and every care and his best judgment are powerless to prevent; therefore, in ugly fractures, in capital operations, and in all other serious dilemmas, be they what they may, in which you believe there is any danger of an unsatisfactory termination, and of your being blamed or sued in consequence, do not hesitate to seek professional aid. Having a brother physician not only divides the great responsibility, but also constitutes each a witness of truth for the other, if you agree as to what is the matter and what should be done; and, by making each the guardian of the other's safety and character, will help to prevent hostile

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