;! ! i POPULAR ADDRESS, BEFORE THE m,WMMm ®mmmwm OB EAST TENNESSEE BY J. P. EVANS, M. D. TOGETHER WITH THE RULES OF MEDICAL ETIQUET, &c. PUBLISHED BY ORDER OF THE SOCIETY. KNOXVILLk, TENN. PRINTED BY H. & I. E. BARRY . 1847 V VM •* i POPULAR ADDRESS, DELIVERED BEFORE THE MEDICAL SOCIETY OF E. TENNESSEE, BY ^**~~ J. P. EVANS, M. D. TOGETHER WITH THE RULES OF MEDICAL ETIQUET, kc. PUBLISHED BY ORDER OF THE SOCIETY. KNOXVILLE, TENN. PRINTED BY H. & I. E. B mankind, and should engage the attention of philanthropists generally. The people should be admonished and en- lightened on the subject; convinced of the absurdity of a man being born a physician, or of becoming one without suitable preparation by the adoption of reason- able means for a reasonable length of time. But cir- cumstances in such cases are often beyond our control; we cannot expect to extirpate the evil entirely; we can only mitigate it; for, (although the proposition may appear paradoxical,) the experience of the world goes to prove, that on the subjects of which men are the most ignorant, they will often be the most credu- lous ; and there are always individuals standing ready to create, increase, and take advantage of credulity. Other things now claim my attention. It is much to be feared that some young gentlemen commence the study of medicine " with an eye single" 10 DR. EVANS' ADDRESS. to the acquisition of wealth, without having a proper sense or knowledge of the duties, responsibilities, and legitimate aims which should govern those who take upon themselves the treatment of disease. According to the plainest principles of justice, a mechanic should be well acquainted with the trade he professes to have learned, and from the operations of which he expects to derive a support—and perhaps wealth: the same rule should apply to physicians; but the moral responsibili- ties of the practitioner of medicine go far beyond those of the mechanic; for the former has the comfort and lives of hundreds or thousands of human beings in his hands ! But unfortunately there is too often a depar- ture from sound principles, which are replaced by a low selfishness, that shrouds the soul in moral darkness, and hinders it from perceiving and imbibing those ex- alted and ennobling principles—justice, humanity, be- nevolence, and philanthropy, which should live and abide in the bosom of every member of the profession. A few months' devotion to the study of medicine is deemed a sufficient preparation, and the young Hippo- crates struts forth with a wonderful degree of impor- tance, fully "armed and equipped," particularly if he have a smattering of Latin, to commence operations— otherwise, to kill or cure, according to circumstances. He speedily acquires a large and inexhaustible stock of impudence and low cunning, and during the remainder of his life, or his medical career, studies stratagem instead of science. I do not assert that such cases are numerous in our land; but that such are to be found cannot be controverted. Others arc desirous of fame; but not having suffi- cient industry, perseverance, and fortitude to undergo the usual toil, take a nearer cut, and by boasting, swag- gering, and various other means, contrive to have their names sounded far and wide as eminent physicians.— It is probable that every enlightened medical practi- tioner may be more or less ambitious of distinction ; yet every one with a well ordered mind, will sedulously DR. EVANS' ADDRESS. 11 avoid creating false impressions on the minds of the people, and will hold in scorn and abhorrence the idea of creating by trickery, a reputation to which his merits do not entitle him. The ambitious, yet honorable phy- sician, will strive to deserve the confidence and appro- bation of the people, by maturing and extending his knowledge of the science of medicine and all branches of learning which may have a bearing upon it, and by inculcating and practising a system of ethics exalted and dignified in all its bearings. Every member of "the healing art" should have expanded conceptions of its duties and tendencies: it is a high calling, and its followers should never stoop from its lofty eminence. We cannot conceal the fact, that the medical ethics of East Tennessee need a higher tone; the moral code of the profession seems to be lost sight of in the rusli after money and a factitious fame. Every medical man of moderate experience, has occasionally perceived, with painful concern—with a deep sense of humilia- tion—that if not all, at least a large portion of the people, believe physicians to be inimical to each other. The idea is entertained, that to successfully flatter and cajole one practitioner, the surest way to succeed is to depreciate another—particularly his competitor. What has led to this humiliating condition ? Doubtless it has been induced, in a great measure, by the minds of practitioners not having been suitably impressed, at a proper time, with the true aims, responsibilities, and duties of the science and practice of medicine—being influenced by mercenary views alone. Such views will not sustain and advance our profession. Permit me to give you a professional illustration Muscular contractility—a principle inherent in all muscular tissues, can be excited to action by friction, galvanism, &c.; but these, although sometimes valua- ble auxiliaries, are artificial stimuli, and only serve in a limited number of cases, and to a limited extent, as sub- stitutes for its natural stimulus—the nervous fluid. In like manner the science of medicine cannot be suffi- 12 DR. EVANS' ADDRESS. ciently and permanently elevated by all the power and influence which the desire of wealth can create: it needs a more refined and potent stimulus. Amidst all our toils and perplexities, it is sweet to reflect that we are useful members of society; that we are instrumental in mitigating the sufferings of our fellow beings; that we have endeavored by all the means in our reach, to increase our usefulness by augmenting our knowledge; that we have restored many a wretched family to joy and comparative happiness; and, that we have never, by extortion, inflicted a deeper injury than disease could do. Such reflections will sustain us in many a trying moment through life, and console us in some degree in our passage through "the valley and shadow of death." Truly it requires noble and exalted mo- tives to sustain, advance, and dignify science. Another cause may be an over-weening vanity, or self-conceit, which leads one to think himself superior to his con- temporaries, and to criticise with asperity the practice of others. He loses sight of one of the cardinal vir- tues—charity, which would cause him to exercise leni- ency towards his brethren, and rather pity than con- demn the frailties of finite minds. To such I would respectfully recommend the practice of noting down, at least for a short period of time, with correctness and impartiality, every professional blunder they may make, and I venture to affirm, that but few of them will have a blush to spare for the deficiencies of their brother practitioners. It is too often the case, that a rivalry between two physicians, consists in cultivating a popular deport- ment, and the adoption of low stratagems which would mantle the checks of the most inveterate horse-jockey in the land with shame, were he detected in them.— Let no one suppose I would have physicians to be rude or uncouth in their manners; I would have them to be gentlemen in all respects; but when politeness degene- rates into down-right demagogueism, and is then prac- tised from ungenerous motives, to say the least, it is DR. EVANS' ADDRESS. 13 beneath the dignity of the true physician, and cannot be too severely censured. A competition between two members of the profes- sion, should consist in faithfully, industriously, and honorably performing the duties of their calling.— These duties are numerous, but may be reduced to a few heads; attending on the sick faithfully; reading, studying, and observing, with a view to the advance- ment of science; and, by doing unto others as you would have them do unto you. During a physician's professional intercourse with the people, many circumstances, attributable neither to ignorance nor a culpable negligence, but to accident alone, may transpire, and create a prejudice against him. Such cases are not of unfrequent occurrence; and other practitioners have been known to increase the "hue and cry" against a brother physician thus situated ; and this manner of acting towards a col- laborator seems to be considered right, by many, and the actors are looked upon as honorable men! It is not a matter of wonder, when such a state of things prevails, that a large number of people—per- haps a majority—believe physicians to be inimical to each other; and of course the idea immediately follows, that in becoming practitioners of medicine they were actuated by mercenary motives alone; and, to find the way to the good graces of one, the surest method is to detract from the reputation of another. An infraction of moral principle by medical men, is a violation of medical ethics; for the latter are moral laws applied to the conduct of physicians; without an observance of such rules, we will inevitably sink into a low, degraded condition—be looked upon as money sharks, or medical pirates—worse than the most har- dened black-legs, who seldom devour those of the same stamp as long as others can be found to prey upon. I dislike the term competitor, when applied to physicians in the sense in which it seems to be understood by the most of the people: they ought to be brethren; for they 14 DR. EVANS' ADDRESS. all belong to a profession of mercy and benevolence.— They should all live by their calling, and perform their duties with a good conscience. Their responsibilities are of vast weight and magnitude, and he who does not to a considerable degree comprehend them, and en- deavor to cancel them by faithful performances, can- not justly be considered a worthy member of the fac- ulty. Let us give more tone to our moral code, and occupy the high position which men who have the health and lives of thousands of human beings in their hands, should have, and the profession of medicine will recov- er its legitimate and exalted sphere, and the smiles of Providence will attend us. RULES OF ETIQUET, FOR THE GOVERNMENT OF PHYSICIANS IN THEIR IN- TERCOURSE WITH EACH OTHER, AND WITH THEIR PATIENTS. The intention of all those rules governing the inter- course of physicians with one another, commonly called Medical Etiquet, is to seek the patient's good, and to preserve harmony among the members of the medical profession. So far from these time-honored rules being, arbitrary and unmeaning, perplexing and inconvenient, they are based on the principles of Medical Ethics, and are indispensable in giving those principles a prac- tical application. If the code of rules called Medical Etiquet be not strictly observed, the character and professional repu- tation of the best physician is at the mercy of every intriguing, dishonorable charlatan who may dub him- self a doctor ; and what is much worse, the private ani- mosities of rival physicians would find their way into the sick chamber, which the proper observance of Medical Etiquet would totally exclude. Rule I. No physician shall, directly, or by innuendo, criticise or censure the practice of any other physician before any person or persons not qualified to be a judge in the case. Physicians may criticise the practice of one another, when they are to themselves, and no per- son present or in hearing who is not a physician; because it is presumed that they speak before those who are judges of the correctness or incorrectness of the criticism, and that the criticism itself, instead of doing harm, may elicit information. Thus A may say to B, that C bleeds too much, or uses some remedy in 16 RULES OF ETIQUET. cases not appropriate. B being himself a physician is qualified to be a judge in the case, and can correct A if his criticism be not well founded; and if well found- ed, he can call the attention of C to the subject, and thus be the means of correcting an improper practice; thereby benefiting the public; the criticism, however, should be entirely confined to the physicians, and in no case permitted to reach the public ear, not even the most intimate friend, relative, or acquaintance, who is not a member of the medical faculty. Rule II. Every patient has a right to choose his own physician ; to have a first, a second and a third choice, and every thing which tends to deprive him of this right is empirical and contrary to the rules of Medical Etiquet. It is always presumed that the physician first sent for in any case of illness, is the first choice of the patient. If absent, or incapable of attending to the call, the second or third choice is always to give way to the first, as soon as the first is ready to take charge of the patient. In such case con- sultation fees are not to be charged by either physician, unless the patient requires the attendance of both. It is the duty of the physician who maybe the second or third choice of the patient, to inform the patient's first choice of what he has prescribed, either verbally or by writing, and to give up the case to the patient's first choice or family physician. Rule III. Surgical and obstetrical cases are not governed by the same rule which regulates medical practice so called. In all surgical cases where the fami- ly physician or first choice cannot, at the time, be had, and any other physician be called in who operates, or dresses a wound, the physician thus called should attend to the case throughout, the first choice acting jointly with him if the patient requires it. The observance of this rule assures to every patient who has met with an accident, prompt attention, and accords to every opera- tor the privilege of superintending his own work, and of personally seeing that the best course of treatment RULES OF ETIQUET. 17 that the case admits of is instituted to insure the suc- cess of his operation, and the speedy recovery of the patient, free from deformity or lameness—otherwise, the family physician, from ignorance and design, might derange the dressing or apparatus and injure the char- acter of the physician who operated or first dressed the wound. The same rule, and for the same reasons, applies in the practice of medicine proper, in all those cases where the second choice of the patient has brought on saliva- tion, made a mistake, in giving the wrong medicine, or inflicted any accidental injury on the patient; such as hurting the arm by bleeding, or making a bad ulcer by blistering, &c. In all such cases the physician who is responsible for the injury has the privilege of seeing that the best course of treatment is adopted to remedy the evil which the case admits of; but he is not at liberty to charge for his services, unless the accidental injury be owing to his directions being disregarded. Rule IV. No physician shall give his services to a patient who refuses to accord to the physician who attended him, the privileges mentioned in Rule III. Rule V. Every patient shall have the privilege of calling in any member of the faculty to see him in consultation, whom he may select, and the attending physician shall not oppose his choice unless he fixes on some one who is known to violate the rules of Medical Etiquet. This rule, however, does not deprive the attending physician of the privilege of suggesting a consulting physician of his own choice. But if the patient has a decided preference for any particular individual, he is to be gratified and not opposed. Rule VI. In consultations, the patient shall be ex- amined in presence of both physicians, who shall after- wards retire and agree upon a prescription, and deliver it either verbally or in writing, to the patient's friend or nurse, in presence of each other, and then retire.— It is not in order for the consulting physician to hold any private consultation with the patient, or to deliver 2 18 RULES OF ETIQUET. any opinion in regard to his case which is not concur- red in by the attending physician. What is said in consultation is to be regarded as private, and not to be divulged. If the patient recovers, both are to share in the credit of the cure, and if he dies, both are to bear a portion of the blame. Rule VII. In cases of emergency, where the attend- ing physician is absent, and any other be called to see the patient, the latter violates no rule of Medical Eti- quet in prescribing for the patient, if any additional prescription be necessary, but he is to inform the attend- ing physician, either verbally or in writing, of what he has done, with the reason of his prescription. In no case is he to intimate to the patient or his friends that the attending physician has been treating the case improperly, or is mistaken in regard to the na- ture of it. If he believes so, it is his duty to express his sentiments to the attending physician, who can remedy the evil, and not to the patient or his friends, who have neither the means of judging nor of acting. Rule VIII. Medical knowledge is not private, but public property. It consists of the accumulated ex- perience of all ages and countries, enlightened, guided and directed by the whole circle of sciences. Hence it is contrary to the rules of Medical Etiquet, and highly empirical for any physician to pretend that he treats diseases differently from other members of the faculty. If he does so, he is an empiric. If he does not do so, he is a deceiver, and acts disingenuously, by claiming as his own, in his individual capacity, what belongs to the whole profession, and is alike open to all. If he has actually discovered a better method of treating any disease than the world knew before, he is morally and professionally bound to make it known to his medical brethren. RULES FOR THE ADMISSION OF MEMBERS. The third article of the Constitution is in the follow- ing words: "Any physician of good moral character and re- spectable medical attainments, known as such to the " members of the society, on signing the Constitution, " himself or by proxy, and paying one dollar annually " may become a senior member. Any one wishing to " become a junior member of the society, upon pre- " senting a thesis on some medical subject, or being ex- " amined by a committee appointed for that purpose, " on the branches required, and paying one dollar an- " nually, shall be received as such, a list of whose "names shall be kept by the Recording Secretary." In addition to this, a resolution was passed at the session of the society held in Knoxville, in May, 1846, which prescribes that when an individual is proposed for senior membership, the member proposing him shall state, "in confidence," all he knows respecting the applicant's character and qualifications, and if these cannot be vouched for by some other members who are also acquainted with the applicant, the application shall be laid over until the next meeting; and a committee appointed to inquire into the applicant's standing and qualifications as a physician; and when the.committee's report shall have been made, if the candidate shall then receive two negative votes, he is rejected as a senior, though he may then be received as a junior member, by a vote of two-thirds of the members present; and all elections for membership shall be by ballot, senior members alone voting. 20 OFFICERS OF THE SOCIETV. Some discussion took place at the last session, in regard to the privileges of junior members ; the result of which was that they were permitted to vote on all subjects except the admission and trial of members— senior and junior. A committee was appointed, how- ever, to inquire into this subject, and report definitely, at the next session, as to what privileges should be granted to this class of members. OFFICERS OF THE MEDICAL SOCIETY OF EAST TENNESSEE. Elected for 12 months from the first Thursday in May, 1847. President—J. P. EVANS, of Claiborne County. Vice Presidents—S. B. BOWLES, of Marion County. T..T. YOUNG, of Washington County. Cor. Secretary—FRANK. A. RAMSEY, of Knox County. Recording Secretary—B. R. STRONG, of Knox County. Treasurer—WM. R. SEVIER, of Washington County.