SECTION 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 upon his physician the details of his business nor the history of his family concerns.

SECTION 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.

SECTION 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 direct tions 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.

SECTION 8. When a patient wishes to dismiss his physician,

justice and common courtesy require that he should declare his reasons for so doing.

SECTION 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.

SECTION 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.

The demands for medical services are so irregular, occurring at all times of both day and night, that a physician in full practice can not systematize his work. He must often forego periods of study, sleep, and needed rest, meals at stated times, social enjoyments, and recreation. The demands frequently can not be deferred, and the services perhaps can not be performed by a substitute, even if one be available. These are not trifling hardships, but of greater weight are the peculiar anxieties and responsibilities pertaining to the practice of medicine. The pressure of these is felt as a heavy burden by most physicians, although it may be concealed by calmness, cheerfulness, and either brusque or jovial manners.

Notwithstanding its arduous duties and the many sacrifices which it involves, the medical profession does not lack members, and in many places it is overcrowded. There are but few communities in which patients have not a choice among a considerable number of practitioners. In selecting

a medical adviser or a family physician, most patients are influenced not a little by external appearances and by feelings of friendly interest. It can not be expected that they can judge critically of professional attainments. To form any accurate judgment of skill in therapeutics is by no means always easy for the medical observer, and it is simply impossible for those who are not versed in medical knowledge to decide how much to attribute to nature and how much to art in recovery from disease. True it is that very many believe themselves fully warranted in assuming to determine in individual cases whether a practitioner deserves credit or blame; but this belief is no evidence of the correctness of the assumption. Many do not hesitate to decide as to the relative merits of what is known as the regular practice and the various systems which appeal to popular favor on the ground of having originated in advanced views of medicine. This fact is proof of credulity in matters pertaining to the practice of medicine; for surely no one can claim that the decisions often so readily formed have any logical foundation. Undoubtedly a pleasing address, together with good judgment and tact in matters not strictly connected with medical services, often goes far toward obtaining and preserving the confidence of patients. There is nothing wrong in this; but it need not be argued that to deserve confidence something more than these recommendations is requisite. It follows from what has been stated that the evidence of having received a good medical education is not to be overlooked in selecting a medical adviser. Of this evidence every one can form an opinion. Aside from official testimony, the good sense which a physician shows in matters not connected with medicine is to be taken into account, and the esteem in which he is held by his professional brethren. The importance of a discrimination among physicians according to their educational rec

ommendations does not relate exclusively to the interests of patients in selecting medical advisers. Such a discrimination is likely to have not an inconsiderable influence on the promotion of medical education.

Intemperance is a calamity as great in the practice of medicine as in any other calling. There are few spectacles more painful than a drunken doctor at the bedside of a patient affected with a disease involving immediate danger to life. Such a spectacle happily is rare. It can not be said that intemperance is largely prevalent in the medical profession. There is no need of impressing upon patients the fact that a physician devoted to drinking-saloons, the billiard-table, horse-racing, and other kindred pleasures so called, or to the gayeties of fashionable life, is not to be preferred to one of different habits and tastes. This is well enough understood. The acquaintances which a doctor makes in frivolous or low associations do not prefer him as their medical adviser. In like manner the public is sufficiently alive to the damaging effect on the professional character of the medical practitioner by an unduly absorbing interest in art, literature, or pursuits of any kind which, although in themselves worthy, direct the attention from the duties of his profession.

It is wise to select a medical adviser when in health. No one should be uncertain upon whom to call for professional services. The selection, if deferred in case of illness until a time when these services are needed, perhaps suddenly, can not be deliberate, and must often be determined by accident. A patient under those circumstances is liable to be placed in a situation of much embarrassment; the physician accidentally in charge may not prove acceptable, but it is painful to make a change. The responsibility in cases of disease should be concentrated upon one person. It is unwise to have several medical advisers—one for dis

eases of the chest, another for nervous diseases, etc. The interests of patients are best subserved by having those who are distinguished as specialists always act in concert with the one who stands in the relation of medical adviser. It is the duty of the latter to decide whether certain ailments are trivial, or whether they betoken an important malady; hence, the importance of consulting him at once, wherever there are any symptoms of disease. Patients who have a proper degree of confidence in their physicians will be unreserved in their communications, thus giving every opportunity of judging respecting the agencies which may be involved in producing or maintaining the conditions of disease. A physician never considers anything to savor of indelicacy which may have a bearing on the knowledge of the case which he is called upon to treat. On the other hand, the patience of physicians is sometimes sadly tried by needless details. After a brief account, a competent physician understands vastly better than the patient the different directions in which it is desirable to push inquiries. Lengthened descriptions of morbid sensations or feelings are not only needless and tiresome, but confusing. Above all, patients should forbear writing out a full history of their subjective symptoms.

There is a class of patients much dreaded by physicians, namely, those who insist upon being taken into a medical consultation with regard to the treatment. Such patients desire not only to know what medicines are prescribed, but to discuss the reasons therefor; they are not content without exercising their own judgment concerning therapeutic indications and the means of fulfilling them. Still more, they sometimes undertake to dispense with or to modify the directions of the physician in his absence, according to their own ideas or modes of reasoning. It is not only very unsatisfactory to treat such patients, but they are likely to