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x___________NATIONAL LIBRARV OF MEDICINE






  NATIONAL LIBRARY OF MEDICINE
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THE PHYSICIAN HIMSELF
AND
WHAT HE SHOULD ADD
TO
THE STRICTLY SCIENTIFIC.
D. W. CATHELL, M. D.
LATB PROFESSOR OF PATHOLOGY IN THE COLLEGE OF PHYSICIANS AND SURGEONS OF BALTIMORE
  EX-PRESIDENT OF THE MEDICAL AND SURGICAL SOCIETY ; ACTIVE MEMBER OF THE
     MEDICAL AND CHIRURGICAL FACULTY OF MARYLAND; HONORARY
        MEMBER OF THE LINCOLN PHILOSOPHICAL SOCIETY,
              ETC., ETC.
trfk
    BALTIMORE:
CUSHINGS & BAILEY
   263 W. Baltimoke St.
       1882. 
   \N
   '■, 1
C3Gp3  p
Entered according to the Act of Congress, in the Year 1882, by

                 D. W. Cathell, M. D.

In the Office of the Librarian of Congress, at Washington, D. C.
Press of Isaac Friedenwald,

      BALTIMORE. 
          THIS LITTLE WORK





    IS RESPECTFULLY DEDICATED TO





PROFESSOR AUSTIN FLINT, Senior,





            IN  ADMIRATION




    OF HIS VARIOUS CONTRIBUTIONS





       TO SCIENTIFIC MEDICINE,





             AND OF HIS




 UNTIRING DEVOTION TO  THE "WELFARE





         OF OUR PROFESSION. 
 
PREFACE.
   OBSERVATION has  impressed  the author  with the belief
    that an essay on personal questions in medical practice,
would be of decided benefit to numerous members of the profes-
sion.   He has therefore, with diffidence, attempted the duty, and
jotted  down the following thoughts as  they suggested themselves
to him in the course of a busy life, and now publishes them in the
hope  that they may at least awaken attention to this circle of
subjects in the minds of his professional brethren.
   The entire work has been written in the  form of a reply to a
question, for the purpose of making what is  said,  appear more
direct and personal to the reader.
                                     D. \Y. Cathell, M. D.
2 J\r. Broadway, Baltimore, Md. 
 
 THE  PHYSICIAN  HIMSELF

                        AND

    What  he  should add to the  Strictly
                    Scientific.


PROFESSIONAL Tact and  Business Sagacity are as
^necessary to the physician, as the mariner's compass is
to the navigator.   There are gentlemen in the ranks of
our profession who are perfectly acquainted with the
scientific aspects of medicine, and can tell you what to do
for  almost every ailment that afflicts humanity—who,
nevertheless, after earnest trial, have never gotten either
reputation or practice,  because  they  lack  Professional
Tact and Business Sagacity; and there is nothing more
pitiful than to see a worthy  physician deficient in these
qualities, waiting year after  year for practice that never
comes.
    Were such  a physician  to ask, What shall I add to
the strictly scientific, to make  my success in practice
more certain, more rapid, and more complete ?  I should
advise him  as follows :
    You will find  that intellect, genius, temperance, cor-
rect personal habits, and other  excellent qualities, will
all  fail unless you add ambition, self-reliance and aggres-
siveness to them. 
10
   You should, above all else, strive to start promptly on
the road to success;  for, unless you let the people know
you  are  about, make some  mark, and  get a reputation
and a practice in your first  six or eight years, the pro-
babilities are that you never will.
   It is better not to enter  into partnership with other
physicians.  Partners are usually not equally  matched
in industry, tact, &c, and  are not equally liked  by the
public, and the union does not generally prove  as bene-
ficial or as  satisfactory as  expected, and  consequently
partnerships rarely continue long.   Above all else, never
ally  yourself with any other doctor except  as an equal.
Julius Caesar said, " I had rather be the first man in  a
village than the second man in a  great city."
  The location and appearance of your office will have  a
great deal to do with your progress.   Select one in a gen-
teel neighborhood, upon or very near an artery of travel,
convenient to either  a densely populated old section or
a rapidly growing new one.   If you were to locate on  a
back or unfrequented street, or other out-of-the-way place,
it would naturally suggest to the  public either defective
ambition or distrust of your own  acquirements.
   Remember, in making your selection,  that a doctor
cannot rely on his near neighbors for patronage; people
in his immediate neighborhood may never  employ him,
while  some  farther  away  would have no one  else.
It is risky for a beginner to  locate too near a group of
popular, energetic physicians, lest their superior  advan-
tages and established reputations might keep him dwarf-
ed for too long a time.
   If possible, have an office that  is not used for a family
parlor or any  other purpose.  Show aesthetic  cultiva- 
11
tion in its arrangement, and  make  it  look  fresh, neat,
clean and scientific.  Flowers,  either in  bouquets  or
growing, are pleasing to every eye,  and denote culture
and refined taste on the part of the physician and those
about him.
    It is proper  and advisable to display  your library,
microscope and other aids to precision; also your diplo-
mas, certificates of society membership, pictures of emi-
nent professional friends and teachers, anatomical plates,
or anything else that has associations in your mind; but
it is better to show such only as have relation to you as
a student or as a physician.   Professional relics and
keepsakes whose history is connected with your medi-
cal studies, such as the human skeleton, either entire or
in  parts,  pathological  or anatomical  specimens,  and
mementos of your dissections, are  both appropriate and
useful.   A cabinet of minerals is  also  in good  taste.
Let no sharks' heads,  impaled butterflies,  miniature
ships, stuffed birds, or anything else  be seen, that will
place you in any other light before patients than that of
a physician.  Endeavor to lead them to think of you as
a physician only.
    Display neither political nor religious emblems, por-
traits,  etc., about your office ; these  relate to  your per-
 sonal'sentiments, while your office is a public place for
 every class of people, and no matter what kind of par-
 tisan pictures you might  display, they would surely be
 repugnant to some.
    Have your  office lighted punctually every evening,
 at the  proper hour, and in all other respects let it show
 attention and system. 
12
     Do  not  allow the ladies  of the family  to  lounge
 about your office,  read  your books, answer  the office
 bell, etc., least it repel patients.  Both messengers  and
 patients prefer to meet either the doctor or his servant
 instead  of ladies.  You should respect public opinion in
 this and all other just subjects of criticism.
     A physician  is judged  by the company  he keeps.
 Avoid associating with those  who are " under a cloud."
 or are notoriously deficient, or whose hopes and  ambi-
 tions are blighted.   Let  your associations be  as far as
 possible with professional brethren, and other people of
 genuine worth.   Prefer to spend your idle hours in your
 office, or at the drug stores, or with other doctors at the
 medical library, instead of lounging around club rooms,
 cigar  stores, billiard  parlors, barber  shops,  etc.   No
 ordinary man  ever conceived a more exalted opinion  of
 a professional  man by fraternizing  with  him at such
 places.
     Be cordial  with all  kinds of patients, but do not
 hand-shake and harmonize with them unreservedly; un-
 due familiarity shears many  juniors of much of their
 prestige.  Never become so  familiar as  to enter any
 patient's house or room  without ringing,  knocking or
 calling.
    Never have companionship with Irregulars  : it would
 detract from both you and rational medicine, which you
 represent,  and give countenance to delusions and preten-
 ders ; avoid this and every other soiling contact.
    What shall I say of debauchery with  harlots and
 association with concubines ?  Of drinking and  of gamb-
ling ?  My dear sir, if you have entered either of these 
13
roads, turn from it at once, for either  will blast your
career, will be  fatal to every ambition.  Virtue  alone
will withstand  your critics.
    Do not induce young men to study medicine, as there
are already three doctors where one is required.   Be-
sides, either their success or failure may work an injury
to yourself.   It is not usually either profitable or advis-
able to take office students, they are necessarily in your
way and divert your mind from other duties;  but if you
should do so, charge them for the privilege, not less than
the usual fee of $100 per annum.
    Do not let your office be a lounging place or  a  smok-
ing  room  for  horse-jockeys,  dog-fanciers, gamesters,
swaggerers,  politicians,  coxcombs,  and  others  whose
time hangs  heavily on their hands.   The  public looks
upon physicians as  being singled out and set  apart, and
worthy of an esteem not accorded to  such people, or to
persons  engaged in the ordinary business  of life;  the
conversation of such companions is not believed to be in
harmony with  a meritorious physician's mind, it destroys
public faith or prevents its growth, and on no profession
does faith have such influence as on ours.   Every cir-
cumstance in  your  manner, appearance, conversation,
habits, etc., will be closely observed and criticised, more
especially in the early years of your  career.  The pub-
lic takes cognizance of a great many  things regarding
medical men that were not considered in the green-room.
    In getting  signs, remember that a doctor  has signs,
not as advertisements, but simply to show his  office  to
those looking for him.  Your signs should be neither too
 large nor too numerous.  One of  black smalt with gold 
14
letters is the neatest and most  attractive  of all;  one
such sign on the front wall for the daytime, and a glass
one with black letters in the window, to be seen at night
when your  office is lighted, are  sufficient.  The letters
on  the  outside  sign should be  round and  well-shaped,
and not more than two inches high, with corresponding
width.
    All signs should be neatly  made and  properly let-
tered, for even a sign makes an impression, either good
or  bad, on  the public, and first impressions are very
enduring.
    It is better to put Dr. ... on your sign, than to put
. .  .  , M. D.   Doctor  looks  better  and is  understood
by all.
    Unless there is danger of your being confounded with
some other  doctor of the  same name, it is well to omit
your given  name or initials from  your  signs, but it
should be  on your cards.  Of course, if  your name is
"Smith," or "Jones," or  "Brown,"  it would be neces-
sary to put your given name on your signs, but if  your
name is uncommon, it is not.   People would not speak
of  Doctor John W. Garfield, but of Doctor Garfield.
    Do  not  allow other  people's signs of tooth drawing,
cupping and leeching, millinery, dress making, painting
and glazing,  boarding, etc., in  company with yours.
    It is unprofessional to put  where you graduated and
how long you have practised, upon your cards and signs,
or in the newspapers.
    Establish regular office hours early in your career, and
post them  conspicuously in your office, also have them
on your cards.   An  excellent  rule is to direct attention 
15
to both the beginning and  ending of your office hours,
as: " Morning  office hours  begin at 7 and end  at  9.
Afternoon office hours  begin," etc., etc.  Many people
think  that as your  office hours are from 7 to 9, if they
get there one minute before 9 o'clock they are in time;
whereas if they come at that time, they  will be  sure
to  keep  you  past  your  hour for going  out.   By
regulating your time thus, you  can accomplish doubly
as much, with less  hurry and more satisfaction to all.
Have on a little  sign  over your  slate, " In leaving an
order  for the  Doctor, be  careful to write  the  name,
street, and number."
    You should keep a supply of cards with your name,
residence, and office hours on them.  An inch and three-
quarters by three inches make a good  size.  It is also
necessary to keep a supply of small and  neat blank bills,
envelopes and paper, with  your  name  and  address
printed on them.   Blank forms for use in giving certifi-
cates to sick members of societies, etc., are very useful.
Printed professional certificates  look much better and
give more satisfaction than written ones.
    A speaking-tube from your outside office door to your
bedroom is of the greatest utility for night calls.   The
telephone is also both a luxury  and a necessity.
    When you  start practice get a pocket visiting list, a
cash  book and a ledger,  and commence to keep regular
accounts at once ;  this will teach you system, and in the
course of time save you hundreds of dollars.
    Record the full  name, occupation, and  residence of
every new patient; for, although the identity of this one
and that one may at present be very clear in your mind, 
16
yet, as patients multiply and years elapse, your recollec-
tion of various ones will become misty and confused and the
consequent loss to you will become very great.   Never
neglect  to make  memoranda  of  office  consultations,
payments, etc., in your visiting list with a lead  pencil,
until  you  get an  opportunity  to write  them  in  ink.
When a transient  patient  pays his  bill cash, so as  to
make it unnecessary to transfer it from your visiting list
to your ledger, the simplest way to mark it paid, is  to
turn each visit mark into a P, signifying paid.
   Have a copy of the fee table framed and hung in a
semi-prominent position  in your  office, that you may
refer  patients  to  it whenever occasion requires.  Also,
have a small, neat sign, with ;' Office Consultation from
$1 to $10," posted in some semi-prominent place in your
office.  It will show  your  sign and tell  your charge;
it will also remind those who really forget to pay, of that
fact, and will put  less  honest people in a dilemma.  You
can, when necessary, point to it and ask for your fee, and
let them  know you keep no books  for office patients.
Such  a sign will save  you man}' a misunderstanding and
many a  dollar.   Of course you may omit its cash en-
forcement towards persons with whom you have a regu-
lar account.
  Having your charge  from "$1  to  $10," will  enable
you  to get an extra  fee  for cases of an extraordinary
character, and still allow you  to charge minimum fees
for  ordinary cases.  Such  a schedule will make those
who get  off by paying the lowest fees, feel gratified ;  it
will  also show everybody that you are skilful  enough
to attend ten dollar cases. 
17
   Cultivate office practice; for it is a fertile source of
reputation  and of cash fees.   Try to benefit and satisfy
every patient  that comes there, for each will give you
either a good or a bad name.
  Keep a small case of medicines at your  office, repre-
senting the most frequently used articles of the pharma-
copoeia, especially during the first years of practice; this
will  familiarize you with their appearance, odor, misci-
bility, taste, and other characteristics, and also enable you
to get fees from some who can appreciate advice and medi-
cine  combined, but who cannot appreciate advice alone.
Also, for another reason   By keeping cathartic pills,
aromatic spirits of ammonia, lime water, morphia gran-
ules, etc., you  can, by sending a remedy by the messen-
ger, save yourself many a tramp at night, during storms,
on Sundays, great holidays, at odd hours, &c, and yet
give the patient  both  relief and  satisfaction   till you
can go.
    You  have  a perfect right to supply a  patient with
medicine, if you choose.   Very extensive use of this
prerogative, however, tends to  consume  valuable time,
and to dwarf you in other ways, and does not pay.   Be-
sides, it would  engender  the criticism  and enmity of
neighboring druggists.
    When you  are  summoned  to confinements, colics,
accidents, etc., if possible go immediately.  Then if you
are too late you will be blameless, and neither be cha-
grined nor responsible.   When you cannot  go at once, it
is much  more satisfactory to your patient if you send a
remedy  for use till you can go, than to send a  prescrip-
tion ; to send a prescription in such cases seems  more 
18
as if you do not care  to  attend, or as if they were on
your secondary list, and if the case does not eventuate
favorably, you may be severely criticised.
   If, at your office, and elsewhere, you make use of in-
struments of precision—the stethoscope, ophthalmoscope,
laryngoscope,   the  clinical   thermometer,   magnifying
glass, microscope, urinary analysis, etc., they will not
only assist you in diagnosis, etc., but will  also aid  you
greatly in curing people by heightening their confidence
in you and enlisting their co-operation.
   Always carry with you a good clinical thermometer,
a female catheter, a bistoury, a hypodermic syringe, a
pair of small forceps, a stick of lunar caustic, a penknife,
&c, for ready  use.  Wooden tooth-picks  and  wooden
cigar-lighters are very handy for making mops, applying
caustics, etc.   Being inexpensive,  they can  be thrown
away after being used, instead of being kept for further
use, as must be done with expensive articles
   Avoid  syphilitic  inoculation,  septecemia, etc., in
making  vaginal  and other  examinations.   Cosmoline
and vasoline answer very well, they both keep for years.
Get a pound can of either, and keep it in your office for
anointing your fingers, instruments, etc.  Be cautious and
never immerse an abraded finger in vaginal or other sus-
picious fluids;  if your preferable  hand  is abraded, use
the other.
   You should have a special receptacle in your office
for cast-off dressings of gonorrhoea,  syphilis, septic ulcers,
etc.,  which, when they  accumulate sufficiently,  should
be burned.
   You should live comfortably for the sake of being
comfortable, and rest  as much as possible on Sundays 
19
and at night; and if you would avoid the risk of breaking
down your  physical  health, as hundreds of our profes-
sion do, consider it a cardinal  duty  to get  your meals
and your sleep as regularly as possible.
    Take  care to be neat in your personal appearance;
above all else, wear a clean shirt and a clean collar ; for,
if you dress well, people will employ you more  readily,
accord you  more confidence—expect a larger bill, and
will pay it  more willingly.
    You never heard  of a bank swindler, or a confidence
man, or a gambler, or a counterfeiter, or  pseudo-gentle-
man  of any kind who  dressed  shabbily or  appeared
coarse.  Such  people are all  close students of human
nature, and  no  matter  how abandoned they  are, no
matter how tarnished their characters, nor how black-
ened their hearts, they manage to hide their deformities
as with a veil from all but the few that know their true
characters,  by assuming the dress and manners of gen-
tlemen.  Now if genteel  dress and polished manners can
do  so much for such  fallen  specimens of  mankind, how
much greater influence  must  they exert for those who
are truly gentlemen and  members of a lofty profession.
Clean hands, polished boots,  neat cuffs, gloves,  fashion-
able  clothing, cane, sun  umbrella, all indicate gentility.
   Do not, however, be a leader in frivolous fashions, as
though your  aesthetic cultivation had run away with
everything  else; nor display glaring neckties, flashy
breastpins,  or any other peculiarity  that indicates  a
"swell."   Even though  you are poor, let it  be genteel
poverty, for a physician's dress, manners and  bearing
should all agree with his dignified calling.  The neglect 
20
of neatness of dress and want of polite, refined manners
might  cause you  to  be  shunned  and  criticised.  You
will see some  whose heads are comparatively empty,
succeed almost entirely by attention to dress and affable
manners, while many much better qualified will fail by
reason of defects in these apparently trivial matters.
    Avoid double callings.  Divorce medicine from every-
thing else—from the drug  business, from giving public
readings, singings, poetry, concerts, from  base-ball, row-
ing, etc., because the public cannot appreciate you, or
any one else, in two dissimilar characters.  Although it
may seem  paradoxical, even reputation as a surgeon or
as a specialist,  militates decidedly against reputation
in other departments.  The public in general believes a
surgeon is good only for  cutting, that a specialist is good
only for his specialty, &c.
    Hesitate even to take the office of vaccine physician,
coroner, or city dispensary physician, sanitary inspector.
etc., in a section where you expect to practise in future.
All such functions seem to dwarf one's ultimate progress,
and usually create a low-grade reputation that it is hard
to outlive.   To many people all such offices look some-
what like  a confession of impecuniosity or inferiority,
and create an impression that is not overcome for years
If you  have any merit at all, private practice indus-
triously followed will lead by better  roads to speedier
success.
    Politics, especially during a doctor's early professional
career, even when honorably pursued, are ruinous to his
prospect and  put a thousand roaring  lions in his way;
to  take  them up later,  when his medical  reputation is 
21
already extensive,  militates against him  but does not
entirely ruin  him.  If  honorable politics  injure thus,
how much worse are ward demagoguery and wirepulling
at primary meetings.  You could make ten friends and
ten dollars by medicine while you were  making one of
either by  politics, besides escaping many anxious hours
and bitter disappointments.  You will find that attending
patients gotten promiscuously from every direction, be-
cause they have faith in you as a doctor, will in the long
run pay you better than attending to anything else.
    You will also find that society, church,  political and
other special groups of patients gotten because they are
affiliated  with you,  rather than through appreciation of
your  merits as a physician, are  neither very profitable
nor very constant.
    You should get a respectable-looking  horse and  car-
riage, as soon as circumstances will possibly justify.  A
team is not only a source of health and enjoyment, in
the beginning of practice,  but it  shows your practice
is growing,  and any one  can ride into  a  full prac-
tice much  quicker  than he  can walk into one.   Be- *
sides, the  unknowing  public  infer that one  who rides
must have had extensive  experience and a successful
practice, else  he could not afford it.
    A riding doctor has several advantages over the one
who walks ; he gets a rest while riding from one patient to
another, and can concentrate his mind more fully on his
case while  riding than if walking; when he reaches his
patient he is in proper mental and physical condition to
begin his  duties, while  the walking M. D. arrives tired
and in need of rest.  Another is, he can salute persons as his 
22
carriage meets them  and ride on, whereas were he on
foot he might be compelled to stop, parley and lose valu-
able time with convalescent patients, old friends, etc.
    Never let a bony horse and seedy or unsuitable kind
of carriage, stand in front  of your office  for hours at a
time, as if  to advertise both  your proverty and  your
paucity of practice.
    If you have two horses, it is better to drive singly,
that one  may be resting  while the other is working.
Driven thus, two good, well kept horses  can  carry  you
to as many patients  as you can attend.
    It is perfectly proper to attract attention to  yourself
by  all legitimate means,  but careful  observation will
convince you that driving ostentatious double teams, or
having liveried drivers, odd shaped or odd colored vehi-
cles, closed carriage, conspicuous running-gear, or  blaz-
ed-faced, curious looking  horses  or  ponies,  habitually
driving as though the devil were in chase, and attempt-
ing to read  a  book as the carriage  jolts  along, also
affecting odd style hats, long hair, heavy canes, etc., all
generally fail in their object, and are looked upon  by
many as signs of a  small  mind or weak head, and  ac-
tually bring  the one who affects  them into  ridicule  and
disrespect.   Strictly avoid  ostentation and every peculi-
arity of manner, dress, office arrangement, etc., calcu-
lated to excite either ridicule  or contempt.  On  the
contrary/ if  you are shame-faced, diffident,  lacking in
aggressiveness, or deficient in tact, you will never pros-
per until these disadvantages are overcome.
    It is customary and proper to give notice of removals,
recovery from long  sickness, return from long journeys, 
23
etc., in the newspapers, but  it is not creditable to an-
nounce your entrance into practice, or to  advertise your-
self in  newspapers, or to placard barber shops, hotels,
etc.   Puffing  yourself,  your  cases,  your apparatus  or
your  skill, or winking at being puffed, is on a par with
the speckled-horse  plan.  A  proper pursuit of medi-
cine will imbue you with loftier sentiments and engen-
der nobler efforts to gain public attention, and will spur
you to build your fame on stronger foundations.
    Cultivate  a professional  manner  and  spirit.   Do
nothing to gain popular favor  that does not accord with
both the letter and the spirit of the code.  Independent
of the degradation  you  would feel, it would not pay to
trust  for business  to tricks of any kind;  for  the veil
that  covers such  attempts  is generally too  thin to hide
the real motive or to turn aside ridicule.
    Never deserve the reputation of being a sharper or of
being tricky.   If the balance were struck, it would pro-
bably be found a great deal harder for a doctor to trick
his way along, than to work it along.  Determine that in
your effort you will do nothing that is criminal, nothing
that will not stand every test, nothing for which you
would hesitate to sue for your fee if necessary—nothing
that  you cannot  approve of, with your hand on your
heart, and your face turned  upwards.
    If you are conscious of any merit above mediocrity, if
you are ahead of your brethren, let mere matters of dis-
play remain  secondary, while your  merit  is made the
more  prominent.   This is more  durable, less expensive,
and more in harmony with the views of  sensible people.
Do not hesitate, however, to  embrace every accidental
or natural advantage in practice, if ethical and  legal. 
24
   You will  be more esteemed by patients who call at
your office for any purpose, if they find  you engaged in
your  professional duties  and studies, than if reading
novels, making toy steamboats, or other non-professional
pursuits;  even reading the newspapers, smoking, etc.,
at times proper for study and business, have an ill effect
on public opinion.  Public opinion is the  creator, the
source of all reputation, whether good or bad, and should
be respected;  for a reputation is  a large part of a doc-
tor's capital.
   It is very natural to expect your medical neighbors
to pay you  a  friendly visit  after you  locate, whether
acquainted  or  not;  but if they fail to do  so, it should
not be construed as  ill-will, for it may  not accord with
the position of doubt  concerning your being regular, etc.,
which they, for the time being occupy.   True men are
sometimes very  slow to  fraternize.  Competitive prac-
tice  does not necessitate enmity;  but self-preservation
is the first law of nature, and when it is  endangered,
every human bosom feels the same impulse.
    Study the  manoeuvres of that ungrateful bird, the
cuckoo;  how the fostered cuckoo expels all the other
birds from their maternal nest after its  cunning mother
has  been unwisely allowed to deposit  an egg, and their
parent has watched  and nourished it  until  it is strong
enough to show its ingratitude by hurling  the rightful
owners out, and you will  realize  why established doc-
tors  dislike to see interlopers gain a foothold in their
section, and effect an  entrance into their  families.
   It is in fact almost natural for an established M. D.
to regret  the advent of another  medical aspirant;  and 
25
some are sensitive and hypercritical towards every new-
comer  to  a degree bordering  on monomania, because
the new one, in coming, must  exert  a perturbing effect
on  the professional business  of those  already  estab-
lished.  His coming makes more workers, and if he is
skilful, actually makes less sickness ;  because  rivalry
stimulates each  to  try to get all  curable cases well, not
only surely, but quickly.  Sickness, both in amount and
duration is decreased, because skilled laborers have in-
creased.  There  is,  of  course, no  greater number  of
cracked skulls,  dislocated  bones, sore legs, of  rheum-
atism, or  diseases of any kind, than before the new one
came.   He must therefore draw his share of the loaves
and fishes, from the others.
    There has  been  of  late years a disproportionate
annual  addition   to  our  already   overcrowded  pro-
fession,  and  the  colleges  of the  United  States, are
still turning  them out  at the rate  of more than 2000
a year, without counting the readymade M. D.'s gotten
by immigration.
    There are now  in every community, probably, three
or  four doctors  where one is  really needed.  Canada
has one M. D. for  every 1193 inhabitants, Austria one
for every 2500, Germany one for  every 3000,  Great
 Britain one for every 1652, France  one for every 1814,
 while we of the United  States, blessed  in physicians as
 in  everything else,  have,  counting both regulars  and
 irregulars, one for  every 600.   Druggists in proportion.
 If there  were only twice  as  many as needed, it would
 be wholesome, and allow the public a choice, but, with
 such  an   excess, many  worthy ones must necessarily
       3 
26
languish, and  those who do  flourish  must do so  by
great skill, great tact and great industry.
   There is a very great difference between the case of
an additional  physician starting  in  a community or
neighborhood, and an additional  person in  almost any
other business.  The demand for other things can be
increased, but the demand for  doctors is limited, so that
a new doctor must create his practice out of that taken
from other M. D.'s.  Every patient the newcomer adds
to his list, must be diverted from that of a rival, and of
course the .rival does not like it; for  there is  a  little
human  nature still left in a man, even though  he has
studied  medicine.   The older M. D.'s are  therefore
naturally very apt  to be  watchful of, if not captious
towards their  new rival, and when they see  him crowd-
ing  himself in, much  like  we  see anyone do in an
already crowded street-car, animosities and feuds are  apt
to arise.  There is a proverbial  rancor about  medical
antagonisms and medical hatred:  avoid them as far as
lies  in  your power.  Courteous  rivalry of doctors is
advantageous to the  public, because it creates a spirit of
emulation, and compels each to try to be skilful  and suc-
cessful in practice.
    The medical door—and the window too—is open, wide
open, to every kind, and all kinds have entered ; and you
will be unusually lucky if you encounter none who are ma-
liciously antagonistic.  You will not only meet Dr. Wil-
ling, Dr. Fair, and Dr. Bland ; but Dr. Cynic,  Dr. Sneerer,
Dr. Crusty and Dr. Broiler may be encountered. Let your
conduct be fair and square on all occasions.   Let it be felt
that you are incapable of any dishonorable act.   Never 
27
begin making reprisals, nor enter into a wordy war with
a rival;  also avoid all innuendoes, and sarcastic remarks
to the laity about rivals who have offended you, and
resolve  that you will  remain a gentleman  even under
provocation,  whether others do or not.   Observe the
Golden Rule, and with dignity " Do unto others as you
would have them do unto you," and trust the balance to
time.  Medicine is an honorable  calling ;  resolve that
it shall be no less so by your embracing it   Remember
that honor and duty require you  to do right, not for
policy's sake, but because it is right.  Do not, however,
expect exact justice from  enemies in return; for, were
you as chaste as ice, as pure  as the snow that falls from
heaven,  you could  not escape  misrepresentation,  by
adversaries with evil eyes and lying tongues.
   Although you cannot stop people's tongues nor their
evil talk about  you, yet you must  look out that nothing
is allowed to blast your reputation for honorable conduct.
Charges  against your skill, unless very gross and  dam-
aging,  had better  be left unnoticed; even though it
reaches your ears that some person has said he has no
faith in  you, and would  not  call you to attend a sick
kitten,  etc.,  etc.,  such  talk need not disturb  your
equanimity—remember that  such  remarks   are  not
personal,  but simply expressions of lack of faith in you
professionally.   Such things are said about every physi-
cian in the world, and  are  quite different from personal
libels—such as charges  of being  a drunkard, or  an
adulterer, or an abortionist.
   Be circumspect in boasting of the number of cases you
have, of your wonderful cures, or of the surprisingly large 
28
amount of your collections.   All such things are apt to
create envy, disbelief, criticism  and other hurtful results.
Also avoid telling from house  to  house how busy you
are, and of  your numerous bad cases—as if, to  swell
your  own importance.  Indeed, it is best to relate noth-
ing at all to laymen about any case but the  one before
you ;  to do  so will  not  enhance  you any, and if you
really have extra cases and  extra skill, people will be
sure to find it out in  other ways.
    You will require a variety of talents, for you must
commune with  every kind  of people.    xicuteness  in
adapting yourself to all classes is  a very useful quality,
and one in which most physicians are very deficient, in
which  none are perfect.
    In addition to medical learning, you should strive to
possess  a large  acquaintance  with metaphysics, ethics,
political economy, and general literature, that  you may
sustain the reputation for liberal learning  naturally ac-
corded to all physicians by the public.
    A  good  preliminary education  is  a mighty ele-
ment  in the  professional struggle; and  if  yours  is
defective at  the time of entering  the field  of  medi-
cine,  the deficiency should  be  made  up  as fully  as
possible. But I  doubt the wisdom  of  frittering away
precious  time  on  educational frivolities  after  prac-
tice  is  begun,  nor  is  it wise to  give  special  atten-
tion to  collateral sciences whilst  imperfect in medicine
proper.  Simultaneous attention to many subjects  would
naturally divide and distract  your  mind.   Whatever
studies  you  do undertake, should  be pursued till ac-
complished. 
29
  The plan of forcing themselves to pursue certain fixed
aims  tenaciously, constitutes the  peculiarity of most
physicians who succeed in an eminent degree.  This is
not only true in  medicine, but in any calling.   I  once
knew a person who by accident lost his leg at the middle
of the thigh;  previous  to this he was but  an ordinary
swimmer ; afterwards, his having only one leg attracted
great attention to his swimming.   Seeing himself thus
observed stimulated  him always to do his  best, which
made him more  and more expert, until eventually he
became the best  swimmer I ever saw. because the most
ambitious.
    If you  have not had the advantages of Latin in your
education, you should not fail to employ a good  Latin
scholar to teach you :  you  can get  one at  a nominal
cost by advertising in any daily paper: he can, with the
aid of a grammar and a dictionary, teach you, in a short
time, sufficient about Latin to enable you to write pre-
scriptions,  etc., correctly, and thereby lift you above a
feeling   of deficiency  in  this  important  particular.
Besides, ability  to write  your  prescriptions  in correct
Latin, naturally assists in creating  respect, or rather, in
preventing unfriendly criticism and disrespect for you
in the minds  of  your fellow physicians, the druggists,
and other critics.
    In using Latin names  of medicines, and the names of
diseases, muscles, etc.. be consistent.   Adopt either the
English or the Continental pronunciation, but whichever
you  adopt, be consistent and  utter it properly.  Many
people actually believe we write prescriptions in Latin to
conceal the ingredients from them.  The true intent is, of 
30
course, to give every article a specific title, that mistakes
of meaning may not occur between  the prescriber and
compounder.    Besides, prescriptions written in  Latin
can be read by the scholars of every nation.  Latin is not
only more accurate, but has become highly respectable
by long usage.  A rudimentary knowledge of the Greek is
also useful.
    An acquaintance with the German language is  not
only pleasurable  and a source of professional improve-
ment that costs but little money, but it will  assist you
greatly with the Germans, among whom you will find
many of your most honest and grateful patients.   Deter-
mine to get  at least a smattering of German early in
your career.
    You will find that many foreigners prefer an Ameri-
can  physician who can speak their language, to those
who have come here from their own country ; because,
being a native, they know he  has spent his whole life-
time here, and they believe that has made him more
familiar with the diseases that exist in our climate, and
with the modifying influence of our seasons, diet, etc.
    Accustom yourself to write in a  good, neat, clear
hand.  Write every prescription  as though critics were
to judge you by it: principal  ingredients first,  adjunct
next, and vehicle last, unless you  have some special
reason for inverting them.  Such a system insures well
balanced  prescriptions, disciplines the prescriber, and
engenders the respect and  favorable criticism of all who
notice it.
    Strictly avoid incompatibles, both chemical and physi-
ological.   It  is better  to  use a single remedy, or, if two 
31
are indicated, to alternate them, unless  you know they
are compatible.
    Be careful  that  abbreviations of names, manner of
writing quantities, etc., leave no room for mistake.
    Remember that skill in practice  consists not only in
diagnosis, prognosis, and ordering medicine, but is the
unit of all the powers that the doctor legitimately brings
into the management of cases.   In other words, the
skilful use of medicine is but one of many elements that
make the unit of medical skill.   You must study man-
kind as well as medicine, and remember when working
on diseased bodies, that they are inhabited by minds that
have warm sentiments, strong passions and vivid imagi-
nations,  which  sway  them powerfully  both  in health
and in disease.   To  be successful  you should fathom
each patient's mind, discover its peculiarities, and con-
duct your  efforts in harmony with  its  conditions.  Let
hope,  expectation,  faith, contentment,  fear,  credulity,
resolution, will, and other psychological aids be your con-
stant levers, for they may  each at times exercise  legiti-
mate power.  It is not length of time in practice,  but
study and reflection that teach the use of these.  If you
cannot read the book of human nature correctly, if you
cannot unite knowledge of physic with a knowledge of
mankind, with a  knowledge of the  hidden springs  and
passions that govern our race, you will be sadly deficient
even after twenty years' experience.
     Your professional  fame is your chief capital: ambi-
tion to increase it by  all legitimate means is not only
 fair, but commendable; after you attain it, you will not
 be apt to lose either it, or the practice it ensures, as long 
32
as you are sober, decent and discreet  in conduct, and
have the physical health to endure your labors.
   A pure, virtuous mind is a great gift and a great lever.
When elopements, seductions, confinements or abortions,
or the scandal about Dr.----, or Rev.----, the ignoble-
ness of the pedigree of this or that one, are being talked
of, you should have a still  or, at  least, a virtuous, pru-
dent tongue ; all you say on such subjects will surely be
compounded and retailed, and its  result will be a per-
manent injury to you.   The position of the gossiping doc-
tor has ever been a very bad one, and he is not unfrequent-
ly called to account.   Remember, while in contact  with
scandalmongers, to take care and, if possible,  keep the
conversation on  general or abstract subjects, instead of
descanting upon individuals and private affairs.
    Notice the never-failing advantage that refined people
with  pure minds, have in every station of life over the
coarse and the vulgar, and in view thereof let your man-
ner, conversation, jokes, etc., be always chaste and pure.
Never forget yourself  in this particular, for nothing is
so hurtful to a  doctor  as the exhibition of an  impure
mind.   School yourself to  avoid  every impropriety of
manner.   Chasten every thought, and  purify every word,
and  measure  every phase  of your deportment, if you
hope to succeed  fully,  especially  if gynecology and ob-
stetrics are  part of your ambition.   A lewd-minded  phy-
sician who indulge sin coarse  ambiguities  and  vulgar
jokes  about the sexes,  is sure  to be shunned, and  the
reason therefor sure to be  made the  subject of  gossip,
and passed from one to another, till it reaches the purest
and best of the community.   Thinkers regard such doc- 
33
tors (and rightfully so) as  being far  worse than those
who drink, cheat and swear.
    If your manners and words are of the kind that win
and conciliate, instead  of repelling children, it will be
fortunate,  and will put  money  into  your pocket that
might have  gone to some  homeopath.   Fondling,  kis-
sing, and dallying, with people's children, however, are
liable to be misconstrued and should be  avoided
    A cold, cheerless manner toward patients, or an isola-
tion of himself from them socially, failure  to recognize
would-be-friends on the streets and elsewhere, destroys
all warmth towards a doctor, and  usually causes their
possessor to fail to inspire  faith; and any doctor who
cannot in some way, inspire faith in himself, cannot suc-
ceed.  The reputation  of being  a "very nice man" is
even more potent  with many than skill.   To be affable
and skilful too, makes  a very strong combination.  If
one is especially polished and moderately well versed in
medicine, his politeness will  do him  a great  deal more of
good with  the public  than, special acquaintance with
histology, embryology, and  other laboratory extras.
    Cheerfulness is also a fountain that is never failing in
its influence.   Medicine, contrary to the general  belief,
is not a  gloomy, morose profession, but  a cheerful one.
While allaying pain, curing some  poor wretches,  and
relieving  others  in body  and  mind, you will fully
realize the great good your profession enables you to do,
and will naturally feel happy  and satisfied with your-
self, and  with your life-work, and  this  will make  you
cheerful
    The art of keeping hope and  confidence alive  in the
bosom of the patient and of his friends,  is a great one; 
34
an easy, cheerful, soothing manner is a power that will
nearly always infuse tranquillity and repose into your
patient's mind.
    To be  quick  to  see and understand your duty, as if
possessed of intuitive skill, is one of the strongest points
you can have.   People invariably applaud boldness,—
indeed, when  followed  by success, a bold, prompt act
often leads almost to idolatry.
    Study to acquire an acceptable and professional man-
ner of approaching  the sick, and to take leave of them
with equal skill.  There is an art in entering the sick
one's room, with a calm, earnest manner that shows an
anxiety to learn your patient's condition—making  the
necessary examination and then departing with a cheer-
ful  self-satisfied manner that inspires confidence on  the
part of the patient and his friends, and a belief that you
can and will do for him, all that the science of medicine
teaches any one  to do.  The walk, the movements, the
language and the gestures of some doctors are pleasing ;
of others, rude, harsh and repulsive to the sick.
    A brusque manner is bad for a doctor, unless sus-
tained by  unquestionable skill or reputation.   A gentle,
urbane but firm, manner is suitable to the largest part of
the community.   Remember that an unfeeling, or dry,
or stiff, or rude, or abrupt manner is quite different from
the philosophic composure acquired by constant attend-
ance on the- sick and suffering.  The former is  brutal
and unprofessional,  the latter is essential  to enable you
to weigh correctly and manage skilfully.
    If you have  any  genuine idiosyncrasy,  it will be
noticed, and will aid you greatly ; but never assume one, 
35
as the counterfeit is easily detected  by all sensible men
and women.   Act your own character everywhere, and
at all times.   Besides  being ridiculous, a doctor who
assumes a fictitious or borrowed manner, must be either
wrong in his heart, or weak in his head.
    If 3^ou have the gift of fluency, or sweetness of man-
ner, or a never-failing stock of politeness, or a  bold way
of cutting the Gordian knots so often encountered, it will
help you.   If, on the contrary, there is any necessary aid
that you lack, study and practise constantly to acquire it.
    Flexibility of manner, self-command, quick discern-
ment, address, and  ability  to adapt yourself to the
ever-changing  phases of medical   practice,  are great
necessities ;  the lady in her boudoir and the hod carrier,
the beer-seller and  the clergyman,  the  aged and  the
young should each  find  in }^ou  his ideal:—seek to
become perfect in this power of adjusting yourself.
    You will find it comparatively easy to get practice
among the moneyless poor, and relatively  hard to get it
among  the  wealthier  classes.   You will readily  get
practice among  the  moneyless, because you  can devote
more time, and fix your attention on their ailments more
anxiously, than could be reasonably expected of those
engaged in extensive practice, and  any special interest
shown them is observed and appreciated.   Your reputa-
tion  will  probably  begin  in  alleys and  back streets,
where it will  extend much  more rapidly than in com-
fortable quarters ;  but no difference whether in mansion,
cottage or' hovel,  every patient you attend,  white  or
black, rich or poor, will aid in shaping public opinion by
giving you either a good or a bad name. 
36
    Ability to communicate your opinion of a case to the
inquiring friends of the sick one, in well chosen, proper
language, is a quality so useful  that you must practise
to acquire it.
    Act toward patients so as to remove all dread of your
visits; avoid a solemn and formal or  funereal manner,
as it would  give rise  to dread of you, especially if you
accompanied it with a corresponding  mode of dress ; if
your  air  and  movements are  naturally awkward,  or
funeral-like,  set   them   off  by cheerfulness,  suitable
dress, etc.
    When you visit a patient, neither tarry long enough
to become a bore and compel people to wish you would
go, nor make  your visit so brief or  abrupt as to  leave
the patient feeling that  you have  not given his case
the necessary attention.
    Showing an earnest, anxious, gentle interest, is another
very strong  faith-inspiring quality.   To assure a suf-
ferer that you will take the same  interest in  him  as
though he were your "own brother," or as if she were
your "own sister," or attend their child as if  it were
"your own sister's," or  will watch the sick one like an
eagle watches its young, and  similar terse expressions of
sincere sympathy,  and interest,  inspire wonderful confi-
dence, and  are often quoted  long after the doctor has
used them.   Whoever has any such manner, naturally,
will not, can not fail to get devoted patients, who would
willingly accept it even though they knew his skill was
far below mediocrity.
   After a patient convalesces, or when it is not necessary
to attend him daily, if,  when you are  in his neighbor- 
37
hood, you send  to inquire how he is getting along, it
will not only give you the desired information, but will
also impress everybody with  a grateful sense of your
interest in the case.
    Having  the  sick child  taken  up for  examination,
carrying your patient to the light that you may see him
fully  and examine him  carefully,  having  his urine, or
his sputa, or the blood  he spits, etc., saved for exami-
nation,  not  only gives you very necessary information
as  to  the patient's  condition,  but satisfies  him and
everybody else of your solicitude.
    A  potent  lever  to assist  in establishing  your pro-
fessional reputation, lies in curing the long-standing cases
so  often seen  among the  poverty-stricken.  Many  of
these  poor  disease-ridden  creatures are  curable, but
require more care and  attention  than  older doctors,
whose time is absorbed by numerous acute  cases, can
possibly devote to them.   If  you persevere with them
until a cure  is  effected, you  will  immediately  gain
a  host  of  warm  admirers   who will   magnify and
herald you  forth on  every occasion, as  being doubly
skilful;   and  even though  you  receive  little, or  no
reward  in  the  shape of  money,  you will augment
your  fame,  and acquire  valuable  stock  in  the bank
of  experience.   Such cases  will   school  you in  the
art  of reasoning and  comparing,  and  will  otherwise
greatly benefit you.   Attending the servants of the rich
and pampered, however, who are  sick at  their service
place, will not  improve your reputation much ;  at any
rate, not nearly so much as attending the  same class of
people at their  own homes or on  their own account. 
38
People  who  couple  you  professionally  with   their
servants, are apt to form a low opinion  of your status
and of your variety of patients.
   Neither will you find it very satisfactory to attend
those who "just call  you in to see a sick  member of
their family " because you are attending across the street,
or in the neighborhood.  Those who select you, and send
for you, because they prefer you to all others, will be
 your best patients.
    You are not obliged to assume charge of any one, or
 to engage to  attend  a woman in confinement, or any
 other case against your wish ; but, after doing so, you
 are legally responsible to attend, and to attend properly,
 even though it might be a charity or " never pay" pati-
 ent.  You may, however, relinquish any case by giving
 notice.
     Remember that ethical duties and legal restraints are
 as binding in pauper and  charity cases as in any other,
 for ethics and law both rest upon abstract principles,
 and govern all cases  alike.
     You will probably find hospital and dispensary pati-
 ents,  soldiers, sailors and the  poor, much easier to attend
 than the higher classes; their ailments are more defi-
 nite and uncomplicated;  the  therapeutics more clearly
 indicated, and the  response of their system is  generally
 more  prompt.   With the wealthy and  pampered, on the
 other hand, there is often such a concatenation of unre-
 lated or chronic symptoms, or  they are described in such
 a  diluted or exaggerated tone, that it is  difficult to judge
which  symptom is most important.  Kemember, that
attending  the poor, and hospital  patients,  sailors, sol- 
39
diers, etc., where there are but two classes, the  really
sick, and the malingerers, is apt to give a rough  and
ready habit of believing every patient either very  sick
or that there is but little or  nothing the matter, and of
prescribing too  actively  and too  crudely to suit  the
squeamish people  with indefinite ailments, so  often en-
countered in private practice, and  to feel contempt for
the foibles of patients with  frivolous complaints.   In-
deed, hospital practice is so  different from private,  that
but few members  of our profession  shine conspicuous as
practitioners in both spheres.  We also see the same il-
lustrated at college and  in  medical  societies; the  best
medical orators and most fluent debaters  are not always
the best jDractitioners, because the  two fields are quite
different.  Theory is one thing, practice another.
    It is your duty to familiarize yourself with the Code
of Ethics at the  very threshold  of your professional
career, and never  to violate either  its letter or its spirit,
but always scrupulously observe both towards all regu-
lar graduates practising as regular physicians.  But re-
member  that  you are neither required, nor allowed, to
extend  their  favoring  provisions to  any one practising
contrary to the cherished truths that guide the  regular
profession, no difference who, or what, he  is.
    I am not sure that the medical profession of any coun-
try but ours,  has  a code of  written  ethics.   Here, the
very  nature of society requires that physicians shall
have some system of written ethics, to define  their du-
ties and regulate their conduct towards each  other  and
the public.  Even  were there no  written rules at all,
the vast majority  of  medical men, actuated by a lofty 
40
professional spirit, striving to do right instead of wrong,
would naturally conform themselves to the rules of jus-
tice, as nearly as their conscience could decide,  and as a
consequence, each one's  action, when scanned by watch-
ful  and knowing eyes, might probably be considered fair
in nine doubtful cases out of ten, while in the tenth he
might conclude differently from his neighbors, or  might
be found differing in opinion only  from  some  captious
rival, with whom an honorable agreement would be im-
possible.    The absence  of  rules  for our  government,
would also leave it possible for such as have  the power,
to carry on a regular grab system,  regardless of right or
wrong, toward their professional brethren, and still claim
to be honorable physicians, and  those aggrieved would
have nothing to appeal to, to prove the contrary.
    In view of  these and many other facts, it has been
found necessary to have a code of written ethics for reg-
ulating the conduct  of  every physician  towards those
around him.
    Dr.  Thomas Percival, an English  physician, in a
small book published in London  in 1807, proposed a
code of ethics,  which, excepting a few alterations made
necessary by the advance of medical science, is the iden-
tical code adopted by the American Medical Association
in 1847, which from then until now, has governed our
whole profession throughout this broad land.   All phy-
sicians  are supposed to  have studied  this  code,  and
every one is supposed to be familiar with its requirements.
The claim  which it has  upon you,  rests not upon any
demand for personal friendship  for your professional
brethren, but because it is founded  on the broad basis of 
41
equal rights, and equal privileges to every member of the
profession, and  stands like a lighthouse, to guide  and
direct all who wish to sail in the honorable course.
    This code of ethics is the oracle to which you can re-
sort and learn what things justice allows, and  what it
prohibits; and it is to a very great extent, these lofty
ethics, that elevate the medical  profession in our land so
far above common avocations, and give its  brotherhood
esteem  and  honorable  standing everywhere.    By its
justness, this code remains as fresh and beautiful to-day,
as when Percival  penned it seventy-five years ago,  and
if you faithfully observe it, you can truthfully exclaim,
" I feel within me a peace above all earthly dignities,  a
clear and quiet conscience."
    In our land this code is the balance-wheel that regu-
lates all  professional  action,  and  no one,  neither  the
eminent ones of the profession bedecked with honors  and
titles, nor the beginner in  the ranks, can openly ignore
it without overthrowing that which is vital to his stand-
ing among medical men.   If you desire to  act unfairly
towards your brethren, this code will compel you to do
the evil biddings of your heart by stealth, and even then
your unfairness will seldom go undetected or unpunished.
The great God of Heaven has declared that " whatso-
ever a man  soweth, that  shall he also  reap."  Any  one
you encroach upon  in an unprofessional  manner, will
feel  himself justified in fighting you  with your own
weapons; and you will reap a crop similar  to the seed
sown.   Whenever you sow a thistle or a thorn, you will
reap thistles or thorns; whenever  a wind  is  sown, a
whirlwind will  be reaped;  whilst the  sweeter seeds
      3 
42
sown  by  others,  will  be yielding to  others  sweeter
fruits.
    When called to  attend a case previously under  the
care of another doctor, especially if the patient  and
friends are dissatisfied  with his treatment, or  if it is
likely to prove fatal, do not  involve him by expressing
a wish that  you had been called sooner, or criticise his
conduct or his remedies; it is  cowardly and mean to
do either.   Remember in all such cases  to reply to  the
questions of the sick one or  his enquiring friends, that
your duty is with the future, not  idth the past.  Refuse
either  to  examine or criticise the previous attendant's
remedies.   Also, make  your conversation refer  strictly
to the  present and future, and not to the past, and do
not mention  your predecessor at all, unless you  can
speak clearly to  his advantage.  As a rule, the less you
remark about the previous treatment the better.
    We all know there are a thousand unwritten ways
to be ethical, and a thousand undefinable ways to  be
unethical.  When you doubt whether a patient is fairly
yours or another's, give  your rival the  benefit  of that
doubt.   Never be tenacious  of doubtful rights, but  let
your conduct in  this and  all other respects entitle you
to the esteem of your medical neighbors.
   To take a mean advantage of any one you have super-
seded, besides being wrong, would engender a professional
hornet,  who  in  retaliation would watch with a malig-
nant eye and  sting fiercely wherever opportunity offered.
Courtesy,  truth  and  justice should mark every step of
your career.  Enhance your profession in public esteem
at every  opportunity, and  defend your  brethren   and 
                          43

your  profession too, when either  is unjustly assailed.
Indeed, to fail  to  defend the reputation of an absent
professional brother when justice demands it, is ignoble,
unprofessional, and implies a quasi-sanction of the  libel.
    Do  not captiously follow up every trifling infringe-
ment,  difficulty or apparent contradiction;  a  certain
amount of jarring and clashing in  a profession like ours
is unavoidable.  Allow liberally for this, school  your
feelings, bury caption  in  the  ocean of  oblivion, and
maintain  your friendly  attitude towards  all fairly dis-
posed  neighbors.   Unless you  do this, many questions
will arise that cannot be adjusted by the Code, and you
will become involved in  useless, rancorous and  endless
controversies, reprisals,  etc.  Friendly offices  are  daily
performed by physicians for one another, and go far, very
far, toward neutralizing the ruffles and stings which the
very  nature of our profession makes possible.
    Be careful not to run into any other doctor's practice,
and never attempt unjustly to retain any one to whom
you are called  in  an  emergency ; if you are in doubt
whether  you were coolly chosen, or  only taken in the
emergency, ask the direct question.  If another was their
choice, surrender  the  patient  to  him  on his  arrival.
Circumstances  may  even require  you  to have the
former attendant sent for, either to take the case or  for
consultation.   If your conduct towards other physicians
in these matters is invariably honorable and just, it will
be  discovered in  due  time, and  will make  your road
pleasant,  and if you ever do  unwittingly infringe, all
will feel that it is through mistake and not intentional.
Keep  above  all   doubtful  expedients  that  relate  to 
                         44

getting patients and profits.   Be also extremely discreet
and chary of visiting patients  under the care of other
doctors, even  for social  purposes, as it is  a frequent
cause of suspicion and contention.
   Never visit a patient under the care of another doctor,
as a  medical  detective  for  his beneficial  society, to
ascertain  whether  he  is malingering,  without  that
doctor's previous consent.   It would be a still  greater
offence to remove the bandages from fractures, ulcers,
etc., put on by another physician, whether  to  change
treatment or merely to examine the case.
    Never take charge of a patient recently  under the
care of any other regular physician, without  first ascer-
taining that he has been formally notified of the change.
The idea that governs such cases is this : when a person
sickens he can select any physician he prefers, but  after
making a selection and the one selected has taken charge,
if, for any reason whatever he  wants to change, he must
follow the established form in doing so.  If there are any-
hard thoughts against  the  other doctor or   unpleasant
scenes with him, the patient and his friends  must have
them, not you.
    Be chary of taking cases in families into which you
have ever been called to consult, more especially if you
were called at the other doctor's suggestion,  for the dis-
placed doctor, chagrined at his  displacement,  will be
apt to scan  every feature of the change, and if he has
any basis at all, will conclude that instead of obeying the
golden rule, you  have ungenerously elbowed him out.
    You will often be called to  a patient, and upon going,
find he is under the care of some other doctor, and will 
45
of course, refuse to attend, but you  will  almost surely
be urged just to look at the  patient, and  tell what you
think, or to prescribe for him.  Unless a great emergency
exists, you should positively  refuse to do either;  if you
do consent it should be done for  the  attending  doctor,
and you should leave a note  telling him what you have
done.   You should never suggest that an attending phy-
sician be discharged so that you may be employed.
   Ethics are less stringent  in office practice, and with
out-door patients, than in regular family practice; some
of the  most eminent, prescribe for every out-door patient
that presents himself, without regard to who has been
attending, or where, or when.
   In spite of ethics you will see much to condemn ; both
in the  profession and in the laity.   If you are ever com-
pelled  to attack  any one's conduct, do it boldly, or at
least never  do so anonymously, or in whispers;  anony-
mous and covert attacks are  cowardly.
   Be punctilious in your endeavors to give every  one
justice.  If you err at all in this respect, let it be in
liberality.   Sometimes, even though the letter of ethics
allows you to take a patient, it may be unkind, or  un-
wise to  do so; use such opportunities  to harmonize,
rather than to disrupt,   You can do  this and  yet  not
make a habit of cheating yourself out of patients.
   Always  keep  a stock of good vaccine  on hand, both
for the fees  it secures, when  there is a demand for vac-
cination, and for fear of a sudden outbreak of small pox.
   Vaccination, although a trifling operation, is a prolific
cause of criticism and reproach to physicians.  Use  calf
virus whenever it is possible to obtain it; it is  popular 
46
and not capable of communicating syphilis, scrofula, etc.,
and  needs no defence.  In no  case use  any but pure
virus, and be ever ready to defend  its purity with proof,
if any one you vaccinate has misfortune with it.
    Do  not begin the  unjust custom of vaccinating  the
child gratis in  cases  where you have officiated  at its
birth, as  is the  custom with  some.   Also charge  the
same, for revaccinating  any one  to  test whether his
former  vaccination is still protective or not, as you
would if  he never had been vaccinated before, whether
it takes or not, as revaccination takes in but  a  small
proportion of those  it  is  tried  upon, and  the charge
is for the trial.
    You should, of course, make no extra charge for re-
peating primary vaccinations till they take, no difference
how long the interval  between the trials—also,  make
 but one charge  for any  person who has revaccination
attempted no difference how often, if during the same
epidemic or scare.  Many  people  believe a vaccination
protects as long as the scar shows plainly.   The  truth
is a vaccine scar lasts for life, while the protective influ-
ence of vaccination gradually disappears in many people.
A vaccine scar merely shows that vaccination took pro-
perly—not that it  still protects.
    Be very cautious how you go out of your way to per-
suade people to let you  remove warts, extract  tumors,
destroy nevi, efface tatoo marks, and to do other minor
surgical operations gratis, with assurances of  success,
etc.   There is always a remote possibility of serious or
fatal  sequelae, and  you should not, especially in private
practice, induce people to let you  involve yourself  for 
47
their benefit, without  being paid  for  your  risk  and
responsibility.   It is  an ugly  thing to have a  wart
you   have  insisted  upon  tampering   with, become
an  ulcerating  epithelioma.   Indeed it is  better  to
avoid all  unrequited work  and all gratuitous respon-
sibility, except what charity calls for.
    Wisdom in recognizing cases that are likely to involve
you  in suits for malpractice, and in  foreseeing  and fore-
stalling the suits themselves, is a valuable power.  Look
out that this wisdom does not come  too late, or cost you
too much.
    Never fail to send your bill promptly to dissatisfied
patients who are threatening to sue  you for malpractice,
or attempting to  injure your practice unjustly, whether
you  expect them ever to pay it or not.  If you cowardly
shrink from  sending your bill  in such cases,  they will
quote that as a proof that you are  guilty of  what they
charge, and that you  know it—sending your bill gives
your position, and raises an issue that checkmates theirs.
Do not fail to charge the  maximum  fee in all such cases.
    Every principle of honor and duty forbids you even
to think of lending yourself as a medical cat's-paw in
unjust malpractice suits against other physicians.  These
so-called "medical experts" often  excite  disgust  and
indignation  at the  sophistical  attitudes they assume
when they join hands with  bad people  and  attempt to
mulct a physician, or  to clear a  criminal from legal
responsibility on the plea of " insanity "  or other wicked
absurdity  gotten up to make money, or defeat justice.
   Steer clear of all practice and all alliances, in  which
your part would not bear legal scrutiny, or detailing in 
48
the community.  And you will not only safely pass the
shoals  of shame and bitterness,  upon which so many
have been wrecked, but you will have another, a posi-
tive reward—you will feel the approval of your own
conscience.
   When circumstances  require  you to  prescribe for
females  with  delayed  menses,  where pregnancy  is
probably  or possibly  the  cause, it  is better, instead  of
giving  a  Latinized prescription, to order some suitable
simple thing, such as hop tea, tincture of valerian,  or
wine of iron, under its common English name.
   You must give a cautious, a very cautious opinion, if
any, in cases of  unmarried females whose menses  have
ceased,  and pregnancy is feared ;  especially in  cases
where  the  suspected  girl  strenuously  denies  having
had carnal intercourse.  Erroneously to pronounce her
pregnant, might blast her whole future and  call down
maledictions on you ; if on the contrary, you too quickly
declare her " not pregnant," it might injure you greatly;
but this  mistake would be nothing  in comparison with
the other.   Temporize, or  suspend your  opinion  for
weeks, or even months, if need be, till positively certain.
   When you are importuned to produce abortion, on the
plea of saving the  poor girl's character, or to prevent the
child's father from being disgraced, or to prevent her
sister's heart from being broken,  or her father  from
finding it out and committing murder, or to avert the
shame that would fall on the family,  or the church
scandal, etc., etc.; or to limit the  number of children for
married people who already have as many as they want,
or for ladies who assert that they are too sickly to have 
49
children, or that  their sucking child is too young to be
weaned, etc.,  you should meet them with a refusal as
cold as ice, as pure as snow: and never even seem to enter-
tain the proposition.   If they are too importunate and
refuse to take "no" for an answer, get  indignant.
    How could any one but a fool be induced to take the
burden  from  another's shoulders to his own, by  doing
a  crimson  crime;  to  violate  both  his  conscience
and the law;   to risk exposure,  social and   profes-
sional   ruin  and   the  penitentiary, by putting  himself
into any one's guilty power, whether as a favor, or for
a paltry fee ?
    Unmarried  negresses  and  low  females  who  fear
they are pregnant, will occasionally consult you, consume
your time  and get your  opinion, and when you discover
that they  are  really  pregnant, and refuse to produce
abortion, will try to escape payment of your office fee.
In  all such  cases inform  them  at  the beginning how
much  your  fee  is  for  your  time, and   opinion, and
advice,  and that it must be paid whether your  advice
agrees, with their wishes or not.  After settling the fee
question, study their case  and give them your opinion
and advice.  If you doubt  the existence  of  pregnancy,
and give any medicine to women who believe  themselves
pregnant, order it under its plain English  name, instead
of giving a regular prescription, and tell them verbally
how to  take  it.   By avoiding  concealment regarding the
nature of the remedies  you  give, you will  escape  the
suspicion or charge of giving abortifacients.
    Never carry away or keep chloroform, ergot, splints,
instruments,  unused medicines, etc., that  patients have 
50
paid for, without an agreement with them to that effect;
also never partake of a sick man's wine or liquor; to do
such things, would not only lay you open to criticism, but
even  to  the most  mortifying charges if a rupture of
friendship should ever occur—in fact,  with such things
to fortify them, people would be more apt to welcome
or create a rupture with you.
    You  should be careful that attempts to conceal the
presence of  contagious diseases, of  unlawful dangers to
health, of births that result from clandestine marriage,
or from bastardy, etc., do not  involve  you in the expo-
sures and recriminations that are apt to follow   If you
have  skill in avoiding cases that would involve a sum-
mons to court as a witness,  and  kindred annoyances
legal  and social, it will be the source  of much comfort.
    Identify yourself with  the profession  in all public
medical  matters, at  Medical Conventions, at  Medical
Meetings  called to pay  tributes of respect to deceased
medical  brethren,  at  those  held  to consider public
dangers,  epidemics, hygiene, etc.
    The  practice of medicine  isolates  doctors from one
another much more than one would  suppose.  Physicians
daily  pass and repass each other without a look or nod—
although  fellow-workers in the  profession  and  well
known to each other by sight or reputation, to whom
acquaintanceship would be mutually agreeable and bene-
ficial.  They must remain as strangers for years, unless
accident brings them together.
    Join the  Medical  Societies of your neighborhood ; or-
ganization does  good,  both to the profession and to the
individuals.   Friction of mind against  mind in amicable 
51
 discussion liberalizes and enlarges the minds of all and
 acts as leaven to the entire profession.   Nowhere else
 can you study the styles of different doctors, and learn
 the secrets of each one's success, or non-success so fully
 as  at medical  meetings.  There,  each contributes  to
 the  instruction   and  intellectual  recreation  of the
 others.  There, you  can meet your neighbor on  com-
 mon ground, experience and opinion can be  compared
 by  face-to-face   discussion,  and  each  be  benefited ;
 there,  rivalries,  dissensions  and controversies  can  be
 softened,  and   professional   friendships  be  formed:
 there, you can measure  the  height and depth of your
 medical contemporaries, distinguish  between  pigmies
 and  athletes, between giants and  dwarfs; there, you
 can estimate the influence of many  undefinable excel-
 lencies in  some,  and  discover  and learn to avoid the
 imperfections of  others,—and in many other respects
 learn effectually to separate the chaff from the wheat.
    Of course, Medical Societies are neither a specific for
 personal deficiencies  nor a  panacea for all  professional
 sores—spending a few hours among honorable physicians
 once a week, will not make a willing doer of evil into a
 professional Chesterfield, or give him the polish and value
 of refined  gold, or lend him  a conscience like Milton's,
 but it does serve  as an intellectual and social exchange,
 where,  besides the individual benefits accruing to the
members, a genuine professional  spirit is generated  that
constantly  tends  to minimize all that is unprofessional.
    Never oppose the admission of any one  into society
membership for private or personal  reasons, or for  any
cause other than  ineligibility  or unfitness to  receive the 
52
honors and benefits membership confers;  because, med-
ical societies exist for the  benefit of all regular physi-
cians, and for the good of mankind, and it would be un-
just to  interpose  an  objection,  or to cast a black ball
against any one, on purely personal grounds.
   Do not hesitate to take part in medical debates when-
ever  you  have  anything valuable  to  offer,  whether
gleaned from literature or from the great school of ex-
perience:   But always remember  that when you have
nothing worth offering, silence is your law—do not break
it; if you have  anything to say, say it, then sit down.
In speaking, take care neither to abandon your medical
vocabulary for the vernacular, nor let your professional
manner  degenerate.  Remember  there,  as  elsewhere,
that there is  nothing infallible.  That a doctor must
school his  prejudices and  be open to conviction,—those
who can  brook  no opinion that does not accord with
their  own, are usually hot-headed, rash and indiscreet,
and very unsafe  guides.  There is no  mode  of prac-
tice  and  no  remedy for any  disease  that  has  not
been  the  subject of  obstinate  dispute,  and every
new  announcement  brings the  whole  medical world
into  collision,  testing   and  reporting,   asserting  and
denying.
   You will find that many of the laity entertain a be-
lief that medical societies  exist for the  pecuniary  ad-
vancement of doctors, just as trades unions and  other
working men's organizations do.   Be careful to correct
this error on all suitable  occasions, and  to inform them
that medical societies exist not for selfish purposes, but
chiefly for scientific objects. 
53
   Keep up your medical studies, or what you formerly
acquired will rapidly become misty and glide from you.
Without study, the details of cases and symptoms  of
many diseases  wear out  of one's  memory in three  or
four years, indeed the mind does not often bring back
the details of a case for comparison after two or three
years have elapsed, unless it is extremely unique.
   In consulting journals and textbooks, remember that
practice found successful in your own climate or region,
is usually more reliable to  follow, than if observed  in
other climates or other  countries.
   Avoid old  medical  works  as guides in the progres-
sive  branches.   Recent investigations make recent text
books necessary.   Subscribe to as many medical journals
as you can read and can afford to pay for.  Read them
carefully so as  to keep abreast of the times, but neither
swear at, nor  by, all  you  see  in  them, be  especially
careful of such as exist for the purpose  of advertising
either their owners  or their  goods.  As  a rule  you
will  find that  statements involving therapeutics, found
in the latest text books, are  more  mature  and more
reliable  than  articles  in journals,  which   are often
founded  on the  unconfirmed  experience of a  single
individual.
   Never publish weak or trifling medical  articles,  as
whatever one writes is  supposed to be a  mirror  of his
own mind.   When you write anything for the journals,
give your article a proper title, avoid diffuseness and use
no far-fetched quotations from foreign languages  unless
followed immediately by translation;  for unless it  is
some  stale,  hackneyed  term, the  average reader will 
54
probably be forced either  to pass it over unsolved, or
take down his dusty quotation book  or  his schoolboy
grammar.  Pity  those  who are either so ignorant,  on
the one hand, and those who are so high  flown  on the
other,  that  they  cannot  express  themselves  in  their
mother tongue.
    The recent attempt  to supersede the old weights and
measures by the metric system, did not  succeed; it is
therefore  scarcely  worth  while to weigh its merits.
When  you report cases or publish  anything in  which
weights are  given, either  use the  old  familiar weights
and measures (which every one understands) or give
both the old  and the metric;  to  use  the metric only,
savors  of pedantry.  Many do not attempt to  carry the
metric  equivalents in their minds, and  might pass your
effusion without getting the information you  wished  to
convey.
    Note all  remarkable cases ;  but never report or pub-
lish any that are not truly novel, unless they present some
curious or very  unusual  feature,  or  militate against
accepted theories;  otherwise you  will merely  swell,
without adding anything  valuable  to  existing records.
You will  find  every  department of medicine fast  be-
coming loaded down  with empty word  building, old
things  said  in a  new  form.   You should  contribute
original work, and new  ideas, if any.   Be  as brief and
logical  as  justice to your subject  will allow  and,  for
the printer's sake, prepare it so as to  require but little
if any  revision.
   When  you write essays or monographs, use for con-
venience sake the smallest size white note paper; its 
55
smallness will enable you to  handle it easily in writing,
altering and re-writing pages, which you can carry and
preserve much better than if large.
    Never furnish a report, statement or opinion, on any
important case or subject for publication, either in book,
journal or newspaper, without a proviso that you are to
see, and if necessary, revise the proof, and correct printer's
errors before it goes  to press.
    When you publish anything do not follow the custom
of suffixing to your name a long tail, consisting of all the
titles and honors whether strong or weak, that you can
rake together, with half a dozen etc's; such an enumera-
tion is in bad taste and excites the ridicule of discerning
people.  The  idea  governing  the use  of  suffixes is
chiefly that  the individual who writes may be  identi-
fied,—a single suffix, or simple title, or your own town,
street, and number, is more modest and equally as useful.
    Take care that  book agents do not induce you  by
their fluency into subscribing to works you have but little
or no use for.
    Pay  your honest debts punctually, even though you
are cheated out of half you  earn; the best plan is to
pay as you go, and if you cannot  pay much, do  not  go
far; owing for horses, or carriages, or  feed, or clothes,
or still worse, luxuries, for rent, servants' wages, etc., can-
not fail to set the tongue of scandal to wagging freely and
injuriously.   You will have to pay your debts anyhow,
and will be paying all the time, and had better be pay-
ing those just due, than to be paying those  that  should
have been paid a month'or a year ago.
    Borrowing books, instruments, umbrellas, money, etc.,
especially if you keep them beyond the proper time, or 
56
return them in bad condition, will tend to depreciate
you more than you would think.  Never borrow appa-
ratus, instruments, etc., from one  doctor  or patient, to
lend to another ; if necessary, introduce the parties, and
let the borrower do the borrowing  on his own responsi-
bility.
    Do not  squirt tobacco-juice around  you  at your
visits, or have your  breath reeking with  its fumes, or
 with those of cloves, cardamom, alcohol, dead beer, etc.,
 or you will unavoidably invite criticism, and  create re-
 vulsion towards you.
    Appearing in your shirt sleeves, wearing rough creak-
 ing boots, or carpentering, painting,  or showing other
 out-of-place  talent, or  chewing, smoking,  sky-larking,
 etc., will show weakness, diminish your  halo, detract
 from your dignity, and lessen you in  public esteem, by
 forcing on everybody the conclusion that you are, after
 all, but an ordinary person.   You may secure  faith in
 spite of these, but  usually, such things tend decidedly
 to decrease it.
    Drunkenness may be tolerated in  doctors who are
 fully established in  practice, because  attachments  had
 been formed, and their talents had become known  pre-
 vious to the formation of the habit;  but  it is  fatal to
 the prospects of a beginner.
    An excellent course is to  avoid intoxicating drinks
 yourself, and let others do as they think best.   If it is
 known that you never drink, it will be of immense ad-
 vantage to your reputation ; but, urging temperance, on
all occasions,  or being a member of temperance, of secret,
or of beneficial societies, will not aid much in the acquire- 
57
ment of desirable business ;  indeed, the best practice you
can have, is the quiet family business that you will  at-
tract by faithful endeavors to  do your best in mixed
practice.
    Temperance, total abstinence, prohibition, and other
sumptuary crusades, will be apt to recoil on your  head
if you  make yourself prominent in them.   Pushing mat-
ters of a partisan nature is  not  your function, and you
cannot become officious in them without engendering
rancorous enemies.  You had better leave all such mat-
ters to the laity, unless your pecuniary or social position
is such  that  you can very well afford  it,  or  you  are
driven into them by conscientious scruples that outweigh
all other considerations; and even then, it is better to
let your profession be first in your mind.
    Presents  from  fond  or grateful  patients,  or  very
liberal ones, etc., although  flattering, will almost  inva-
riably lead to  confusion  or to  a  breaking up of  the
legitimate pecuniary relation between the giver and your-
self, to such a degree that  it cannot  be  fully restored.
Probably  every practitioner  can  recall  numerous in*
stances in which presents of game, or fruit, or cigars, or
wine, whips, canes, or new hats, have proven exceedingly
expensive.   When you foresee such a result, be guarded.
    A  good  rule is to  decline all  presents that would
place  you under  embarrassing  obligations  to  patients.
Another good rule is to avoid mixed dealings and crossed
accounts with hucksters, grocers, feed-men, milk-men,
and other patients,  as in business it will rarely continue
satisfactory, it often engenders disagreements, and will
almost always result in  your getting only about half as
       4 
58
much for your services, as if you had avoided entangle-
ment and dealt on a money basis.   It  is decidedly bet-
ter to  avoid  all  such involvements, and let those for
whom  you  work, pay you in money, you  in  turn  doing
likewise.   Avoid these and evervthing else  that  tends
to blur your business rules.
   Preserve a proper degree of gravity and dignity on
all occasions, frivolous conduct, vulgar jokes, great levity
and undue  familiarity are unprofessional and breed con-
tempt, scandal, etc.   Freeze off all attempts to " Hallo
Doc !" or to pass the limit of propriety in any way with
you.   Give every one his proper title and exact the same
respect in return.   Do not understand  me to condemn
good-natured pleasantry ; congeniality, if manly, is often
appropriate, and sometimes actually serves as a  tonic to
a patient's drooping spirits.  If you wear a cheerful  mien
it will be healthy to you,  and sunshine to your patients.
   If you are unmarried,  it will often be quoted against
you, but the truth is, there is no great professional ad-
vantage gained  by  being  married.    The objection to
most unmarried doctors, is really not their being unmar-
ried, but their youthfulness.   To marry with an eye to
business only, would be apt to entail expenses, responsi-
bilities, etc., without corresponding benefits.   Besides,
you  should keep both business and marriage on a higher
plane.   You will often see in your professional career,
the misery that flows from degrading marriage, by enter-
ing  into it from  other considerations  than love and
congeniality.
    The power of impressing those you  meet, with a
favorable opinion of your adaptation to  your calling, is 
59
an important  advantage.   Discipline yourself by self-
examination,  whenever you have conducted  yourself
unsatisfactorily.  This will teach you  to conceal  and
eradicate  your defects and faults; and to give promi-
nence to your good qualities.
    Ability to please and retain those who employ  you
in an emergency, or tentatively, is also a power that you
should carefully cultivate.
    No  one can  succeed   fully without  the favorable
opinion of the maids and matrons he meets in the sick
room.   The females of every family have a potent voice
in selecting the family physician.   I have often thought
the secret why so many truly scientific aspirants fail to
get practice, is that their manner  and acquirements do
not appeal to  the female mind.
    You must not rely strongly on  social influence for get-
ting practice.  You may be,  socially, a great favorite while
all are well, but when sickness comes and death threatens
the afflicted one, the impulses of friendship are dormant
and do not influence the choice of a doctor. No member
of any family circle will be spared if  any  human power
can save, and persons terrified  at the possibility of losing
the provident husband, beloved wife, blooming daughter,
darling babe, dutiful son, or honored parent, as  the case
may be, instinctively send  for  the doctor in whose skill
they have most confidence.  They go past the beginner
about whom  they know too little,—past the one whose
system requires so much  stimulating, about whom they
know too much,—past the gay, the fickle, the sentimental
and  the   unchaste,—past all   whose  unprofessional
demeanor  proves them  to  be either  unripe or unsuited 
60
to a stewardship so solemn, so precious, so  weighty as
that of a family physician,—past all, till they reach the
one  in  whom  their  faith,  their  medical confidence
centres ;  faith is the great controlling lever.
    You will find  that at times of sudden sickness and
alarm  in families,  there is a peculiar openness  to strong
impressions.   Kindness  shown then is doubly appreci-
ated.  Indifference or coldness on  the  contrary,  may
then sever attachments and end friendships that  have
existed between the doctor  and a family for years,  in as
many moments.  Many a young doctor secures a  good
family permanently by kindness and assiduous attention
in cases of  colic, convulsions and  accident;  also by
devoted attention in cases of typhoid, scarlatina, etc.
    There is a certain fact that you might not observe
without  having your attention called to it:  it is that
after  you  get  into full  practice, your  days, weeks,
months and years  will flit by faster  than  those of other
people, because as a  doctor,  your days  and hours
will be incessantly occupied with a medley of important
cases, and the lapse of time, will consequently be almost
magical.
    You should seek proper  relaxations and amusements
while the age for enjoying them remains ; many doctors
foolishly postpone all  relaxation   from  one  time to
another, intending to take it easy and see pleasure when
they get  older, and thus forego seeking enjoyments till
they lose all taste for them, till they know nothing and are
fit for nothing but to work in the doctor's hard, slavish
treadmill  for life.  A little leisure  is a great  blessing.
An occasional  day's  sport,  or a summer  trip or an 
61
evening at a convivial gathering, or at the theatre, etc.,
will act as seasoning to your  labors, will break the
monotony, afford diversion, and actually make you more
philosophical and a better doctor.
    Newspaper notices of your departure  from the city
for seaside, mountain or other  pleasure  trips, will, if
allowed, have a disturbing and hurtful influence on your
practice.  Reporters are aware of how such items injure
doctors,  and  seldom publish them unless requested.
The register clerk of hotels where you register, will, if
you ask him to do so, omit announcing your arrival, in
the newspapers which would publish your absence from
business to the whole world.
    When you assume charge of a case for a doctor, to
look after during his absence from the city, or one of
your own that has been under  the  care of a substitute
while you were away, or that any one has attended in
an  emergency pending  your arrival,  or because the
attending doctor  has been taken sick; continue his line
of treatment,  at  least for a while, if you  can  conscien-
tiously do so.   An  abrupt, radical  change,  either  in
diagnosis, prognosis or treatment, is both ungenerous and
injurious to your co-worker.   In such a case if you be-
lieve something more should be given, merely add it to
what is already being done.  This  does  not reflect  so
harshly.
    Give the right hand of fellowship to  every regular,
honorable physician,  no  matter what his  misfortunes or
how great his deficiencies ; on the other hand, refuse it
to all  irregulars,  no  matter how great  their acquire-
ments, their reputation,  or their pomp. 
62
    Give satisfaction at  your visits ;  show that  you are
anxious  to  relieve both the  body and  mind  of your
patient, and you will not, cannot fail to succeed  in your
ambition to get practice.  To do this fully you must
feel and express a genuine interest in the  case, and in
the remedies you are using.
    Be polite  and  considerate to  every  one, especially
when you are vexed, or in a hurry ;  abruptness makes
many useless  wounds,  some  of which are difficult  to
heal.  True politeness is a seed that costs nothing, can
be  planted  anywhere—that  always  bears  good  fruit.
Resolve that you will cultivate it as long as you live.
    Always  feel and  show respect for  your seniors  in
practice.  You may  excel  the older M. D.'s, in the
dogmatic, and in severely scientific and technical points,
but they have  an experience, and an intuitive  forecast
of the necessities and the results of cases, that  far out-
weigh mere book  knowledge, and make them better
logicians,  and much  better  practitioners.   Because
knowledge gotten from  observation  and experience is
more like part of one's  very nature,  than  that  gotten
from any other source, and is fixed indelibly on both his
senses   and  his  reason.  Remember  that  although
younger doctors indulge more in scientific  extras than
older ones, yet that the  art of curing disease owes more
to common sense  bedside experience, than to anything
else.
    When you have been a doctor long enough to make
your patients  feel that  you  alone are acquainted with
their moral  and physical idiosyncrasies, it will give you
great advantage,  and will make  attending them much 
63
easier.  You will occasionally  be employed  in  cases
because you have long  ago attended  other members of
the family  in  similar  affections, and are supposed  to
know  the  family constitution.   You  will  find  that
"knowing people's constitutions" is a powerful lever.
    Never ask  as you  enter to  pay the first visit  to a
patient, the awkward  question,  "What  is the matter
with you?" or at any other visit, "How are you to-
day?"  or he  may retort, that  is what  he wants the
doctor to  tell him.
    Experience and skill  are what the  public  seek in a
physician;  they  are  very important  and  the public
know it—you should carefully  try to appear possessed
of both.  Of course all  have aftersight, but foresight is
what is needed—experience will  enable you each  year
to foresee many events  with  increased clearness, and if
you compel yourself to be a faithful worker and  good
observer,  every year will make you a better physician,
and by the time you have worked and  observed for ten
or  twelve years, you will be clinically  familiar  with
epilepsy,  tonsilitis,  tuberculous  meningitis,  cerebral
softening, malarial diseases, membranous croup, phthisis,
tuberculosis, Bright's disease, the various  heart diseases,
typhoid  fever,  scrofula,  erysipelas, whooping-cough,
dysentery, calculi, hip  disease,  and a  host  of  other
afflictions that  are sure to confront you, and  you will
know how to shape your diagnosis and prognosis in each,
far better than your juniors.
    In addition  to the great advantage  the older  phy-
sicians  have over the  younger  ones, from  increased
ability to foresee the  probable  degree  and  duration of 
64
grave cases, and to give concerning  them  truer opinions
from  the beginning,  they can from experience recog-
nize cases that are dubious, or likely to prove very slow
and tedious, thereby saving themselves from  much
anxiety and blame. Of course, these advantages advance
their  reputation, and  enable them  to carry cases and
retain confidence much better than  younger physicians
can.  This is the chief reason why the practice  of med-
icine becomes relatively  easier  every year.  You will
find that after  you  have practised  twelve or fifteen
years; after you have forgotten much of your technical
knowledge,—which was probably greater  at graduation
than it ever will  be  again,—your experience  will be
invaluable to  you,  and  will often  serve  you where
nothing else can.  This self-attained knowledge is the
kind that makes  the public  always prefer the older
physicians and distrust the younger ones.
    Make post-mortem examinations, and  scientific use
of your  opportunities whenever proper  cases  present
themselves.   Experiments  that  require vivisections,
etc., would not, however,  add much to your reputation,
as such things are supposed  to have been studied as far
as  needful  before leaving college.   On  the contrary.
making clinical  analyses of  the  urine, and other fluids,
will not only lead you to invaluable information regard-
ing your patient's  condition, but will be a  great element
in giving you popularity and respect.  Working with
the microscope, on proper occasions, will not only in-
crease  your knowledge, but   will  also  invest  you
with the benefits  of  a scientific  reputation  in public
esteem. 
65
    Obstetrical practice is in  some respects desirable,
especially in the beginning, as  it paves the way to per-
manent family practice, but it entails a tremendous loss of
time.  If you ever get so overflowed with business, that
time is precious with you, it will  cease to  pay, and it
may become necessary to shut it off, to get time for office
patients, meals, sleep, etc.,  or at least to  limit your
engagements to attend cases, as far as possible.  It is a
wearing branch of practice, one that is full  of care and
responsibility.   You  will occasionally be engaged for a
case, and after being  kept  in suspense for weeks  or
months, will learn that the labor occurred, a midwife or
granny was sent for instead of  you, and the  excuse will
be that everything occurred  in such a hurry that they
could not wait, or some other equally lame  plea will be
presented.
    Although obstetrical cases lead to other family prac-
tice, you will find, after you get into full practice that
the fees for  midwifery are, on account of loss of time, of
sleep,  etc.,  proportionately more  meagre than  in -any
other department  of practice.
    When a patient engages you to attend in confinement,
write her call on one of your cards and give it  to her,
and  instruct her to send it as soon as she feels that you
are needed.  This emphasizes the engagement, and makes
her more apt when her time comes, to send for you than
for a midwife.
    You will often be called to do ugly work for mid-
wives who are stuck in bad cases, and for the sufferer's
sake you should never refuse to go.
   You will be mortified to  learn  that it is  now gener- 
66
ally understood in  many communities that every mid-
wife has  her regular  medical satellites, who,  for the
prospective fees  have bargained  to  go whenever she
calls  them,  to do  her  complicated  work.   Pregnant
women will  sometimes  even want  to  make  a  one-
sided bargain with  you  beforehand,  to come to  them
in case their midwife fails.   Of course  you should go
to  all  cases where  humanity calls, but you should
never bargain with anybody beforehand to play second
fiddle to a midwife—she to take the  fee, and  the  eclat,
if there is no trouble,  you to take the care and respon-
sibility, for a nominal fee if  there is.
    In  every  confinement  case,  after  delivering the
child,   be  careful  to   call   its  mother's  attention
to the  lump in her  own abdomen, and  inform her
that it is  the contracted uterus.   If you  do  not,
she  rmay   accidentally   discover   it,  get   greatly
alarmed,  and either await your  visit in terror, or send
for you post haste.
    Attending very distant patients of any kind does not
pay  pecuniarily,  and is  an injustice  to both  physician
and patient.   Everyone should have a family  physician
within reasonable calling distance.  A  few far-off pa-
tients will waste more time, break down more horseflesh,
and  use up  more carriages, and harass and expose you
to bad weather more than all the balance of your  prac-
tice.
   Keep your practice down  to a number you can pro-
perly attend; you  can do  this by sending your bills
promptly,  circumscribing your  bailiwick, cutting off
obstetrical engagements, etc.  In refusing to take a case 
67
at a distance,  or  one that is likely to involve you as a
witness in court, against your will, or to engage for mid-
wifery, etc., the plea of " too busy"  is the least  open
to criticism and over-persuasion of any you can assign.
    Never offer as a reason for neglect to visit a patient,
" I really forgot you;"  it is unpardonable.
    It is always safer, as well as more modest, in giving
your opinion,  to  say, "I believe  thus and so," or "In
my opinion, etc."
    Even when you are positive that a person has syph-
ilis,  it is  not always  best to say so.   Prudence will
sometimes require you to reserve your opinion, but at
the same time, give the proper medicine.  Indeed, in
practising  medicine,  you  will  see  and  understand
many  sins and  blemishes of  which  you must  appear
oblivious.
    Gonorrhoeal and syphilitic cases  are not especially
desirable  on  any  account,   except for  the fees  they
bring ;  they are dirty secret cases and rather repel than
attract their victims and their friends, from the doctor
who attends them when they require a physician for
other diseases.   Attending  them  will, however, often
enable you to pick up a handsome cash office-fee,
    Take care that your reputation for attending venereal
diseases, does not  overshadow, or eclipse other kinds,
and give you the title of "P—x Doctor," and entail the
social ostracism and loss of family practice that would
follow,—or that extra success in restoring the menses,
in females who suspect pregnancy, does not bring  you
an extra number of such cases, and give you the title of
"Abortionist,"—or that attending an  excessive propor- 
68
tion  of courtezans or  bruisers,  does  not give you  the
name of having a  " Fancy Practice."
   When you scold, or find fault with patients or their
attendants, preface what you say by explaining that you
are not^ scolding in anger, but because you feel an earn-
est desire to have them do right for everybody's sake.
By prefacing  thus you will  completely disarm  resent-
ment and they will take all you say in good part.
   You will  find  it much more pleasant to practise in
some families than  in others:  some families will con-
stantly give you intelligent co-operation, and  will make
charitable allowance for all your short-comings and fail-
ures; while others will, when any of their members are
sick,  appear almost as  if they wanted to involve  and
harass  you  in every  conceivable  way, and to  make
you  feel as if, in attending them, you were on trial
for your life.   Remember this, and like a philosopher,
make it a rule never  to worry about anything  at  all
you cannot help.
    Be  guarded against asking  private questions before
persons not in the patient's  confidence, unless they are
clearly entitled to hear them;  request all such to leave
the room before asking.   Be doubly cautious in this re-
spect when your patient is a female  and the questions
refer to marriage,  or menstruation, pregnancy, lactation,
uterine affections,  constipation or other delicate subjects.
    Do  not  allow  indiscreet patients  to go about over-
praising you,  and  speaking of you as  a pet, etc.   In-
ordinate praise, no difference from whom, is apt to arouse
a  corresponding dislike on the part of those  who deem
the  praise either extravagant  or  misplaced,—such in- 
69
judicious praise will almost surely react against you, and
might even  arouse  the  angriest jealousy on the part of
husbands,  aunts, lovers or  others.    Perfectly  pure
physicians have actually had to cease attending in famil-
ies where  such jealousy  existed,  to prevent  causing,
domestic strife and estrangement.
    As a rule, it is better in the family group to lend at-
tention at your visits, chiefly  to the conversation of the
husband, instead of the wife, and to address your opin-
ions, explanations, and remarks to him or whoever is at
the head of those you meet in the sick room.  And  to
pay to all  others, only the  respect that civility requires.
If you  do not do this, sensitive people will feel ignored
and may get dissatisfied  and create trouble.
    The public  love  to see  a doctor appear to know
things intuitively,  and  you must study and practise to
be quick in diagnosis, and ever ready in the treatment
of the ordinary cases that  will constitute nine-tenths of
your practice.
    Remember this :  Everyone likes to believe that the
doctor is treating him by a  regular plan, instead of firing
at random, more especially in diseases that are believed
to depend on the blood, or on a diathesis.
    In visiting,  banish all  else from your mind, and no
difference who is present,  make the patient, whether
young or old the central object, and keep your thoughts
and your conversation on him  and his case; both patients
and their friends will naturally be more anxious to know
what  you think of their  cases and to receive information
for their benefit, than to hear of anything else:  if the
conversation digresses to other  subjects, shift it  back 
70
 to  your patient and his case, as soon as possible.   Du-
 ring  consultations also observe  the  same  caution and
 keep the conversation between you and your colleague
 on  the case under  consideration, instead  of digressing
 to  religion, horses, politics, etc.;   economy of  time
 requires it,  besides, it is  for that you are  employed.
 Another fact to be  kept in mind is this : if  a consulta-
 tion lasts too long, it is apt either to  terrify  the patient
 and his friends, or induce a belief that you  either disa-
 gree or are puzzled,  either of which may  undo you.
    Shrewdness in changing either a diagnosis or progno-
 sis, is very  necessary in all cases where  a  change must
 be made.
    Do  not  bind yourself too  quickly, or too closely in
 prognosticating the duration of a patient's case.   What-
 ever  prognosis you  foreshadow  in the beginning, is, as
 as a  rule, accepted; it is  only  when that  prognosis is
 changed to  greater  gravity or its duration made much
 longer,  that discontent  arises.   One of the strongest re-
 proaches to  the practice of medicine is that it is not
 founded on  science,  therefore it  lacks the  element of
 certainty.
    Do  not  get insulted at the foibles and infirmities of
 the sick.   Bear with the rude treatment 3'ou will occa-
 sionally receive from hysterical,  peevish  or low-spirited
 patients, and do not  take anything a sick or silly person
 says,  as an insult, unless you believe  it  is deliberately
intended as  such.
    Beware  of confidants.   Never  become  so  fond of
patients, or any one else, as to make them the repository
either of your professional or personal secrets.  With 
                         71

our imperfect means we cannot always attain perfect re-
sults, nor give complete satisfaction, and some of those
you have served most faithfully, and who you think will
never  change,  will  surprise and shock you by turning
against you and loudly decrying you.  Bear the possibi-
lity of this ever in mind, and while making your relations
with  your friends  and patients cordial, frank and free,
always avoid all secrets, confessions, etc., that  would
put you into their  power.
    To be over assiduous in paying visits when no suffi-
cient cause is apparent, orto be too deferential and over-at-
tentive to those who think themselves extra good patients,
is dangerous; for as soon as one imagines he is the best
patient you have,  or that you are cultivating him un-
necessarily, he is sure to undervalue you, and is apt to
quit you.
    If you adopt the habit of presenting your photograph,
etc., to every one enamored of your professional skill, or
of your manners, good looks, style  of dress, etc., it will
be  the cause  of many awkward dilemmas.  Many  pa-
tients who would swear by you one week, will curse you
the next, it may be  charge that you have mistreated
them, killed their child,  crippled   their wife, or done
something else equally horrible.  Many who would hold
your picture above all soiling associations this month or
this year, would tear it down, or give it to the  hangman
the  next.  Trifles  light as air will sometimes serve to
detach families from you; a whim, a caprice, a look or a
nod will sometimes break links that have been forming
for years ; indeed,  even  old patients will drop you, when 
72
they get ready, with less ceremony and less regret than
you would an office boy or an hostler.
   When  urgent  necessity or danger  requires it, you
may do the most menial work, for a patient;  but unless
these exist, pulling off your coat or collar, administering
injections,  giving  baths,  swaddling  new-born  babes,
nursing the sick,  etc., will not comport with your dig-
nity, and may suggest that you lack proper self-respect.
   A  patient who is  improving, will  be satisfied by a
much shorter visit, slighter examination, and less perfect
attention in general, than one who is not doing well, es-
pecially if he is doing so well that you can express your
emphatic satisfaction with  his progress as you leave.
   When a case is blurred, obscure, or in the initial stages,
be cautious in expressing any  other than  a  tentative
opinion; but  in  cases where you can safely do so, give
a frank, free  diagnosis and prognosis that express your
full opinion.   Speaking your opinion candidly,  will com-
pel you to analyze closely,  will discipline your  judg-
ment, and compel you to study your cases and formulate
opinions, instead  of lumping your cases and becoming a
mere routinist
   Remember that the art of medicine does not enable
you, or any  one  else, to diagnosticate any of the erup-
tive fevers positively, till its local manifestations appear.
   Frequently when  a case is grave, and you  are being
importuned to know whether you cannot do more, it is
better casually to mention  the things you deem contra-
indicated,—leeching, or cupping, or mustard, or rubbing,
or baths, or poultices, or electricity, etc., and tell why you
have not ordered  them, so  as to let it be known you are 
73
wide awake, and have  thought of them, but have good
reasons for not using them.
    Never pronounce any one's sickness  feigned or trif-
ling, unless absolutely positive  that  it is so, and  never
make fun of people sending for you, or for being alarmed
at  what appear to  be trifling  ailments—indeed, you
should never joke,  talk frivolously or laugh  about your
patients or their sickness, either in their presence or else-
where,  and never taunt them about the trifling nature of
their disease.   Some people will  laugh  off such a criti-
cism, while secretly they  feel  hurt and resolve  never
to have you again.  Another reason is  that trifling ail-
ments sometimes become serious, and their becoming so
is apt to be blamed on the joker for life.
    Never guarantee a cure, or certain success, or a sure
recovery, even for  a mosquito  bite:  guarantee nothing,
except that you know your duty and will do it.   Medi-
cine is not a science, and life is not  a definite quantity.
When  pressed  to  tell  whether any case  of sickness is
dangerous, reply promptly, " Of course it is,  all  sickness
is dangerous."   Also remind them that  you  do not keep
the book of life, that your will and God's will may dif-
fer, and that you have  long ago ceased to assure people
that sickness of any kind is not dangerous, or might not
end in death;  and then tell them what you think of the
case in  point;  even in  doing this, do not fail to leave
yourself a little margin for uncertainties.
    In giving death certificates in mania-a-potu, syphilis,
 abortion, etc., never yield to importunities and substitute
 other pleasant sounding titles that risk  putting you in a
false position.   In  giving certificates it is best to certify
" In my opinion," etc.,  which no one can dispute.
      5 
74
   Be exceedingly cautious in giving certificates of in-
sanity for committing patients to an insane asylum, dis-
tinguish  between  the truly insane as contemplated by
law, and those who are not insane.  Dissatisfied friends of
such people sometimes give great trouble to accommo-
dating physicians in these cases.   Give certificates in
none but clear cases, and keep a memorandum of all the
facts in each.
    Also  keep memoranda and observe great caution when
you are a witness in Will cases, suits  for divorce, etc.
    You are legally as well as morally bound to vaccinate
a person  after engaging  to do so.   Besides  the harsh
criticism it will generate, a suit for damages  may follow
if you neglect it, and the patient ever gets small pox.
    Never conceal the presence  of  a contagious  disease
from  those around, who are liable to contract it, or you
may encounter the condemnation of the whole community.
    Carefully prevent children  in  whose family conta-
gious disease exists from infecting others by attending
school, or otherwise  mingling with those liable to con-
tract it from them.  Insist upon visitors being excluded
from such cases.  Also  see that its presence in hotels,
stores, etc.,  is not kept secret at the public risk.
    Never let people know that you are just  from a case
of small  pox, scarlet fever, etc., or that you are even at-
tending any contagious disease, or  you will  be  credited
with  giving whatever cases occur among those you tell.
If your practice is so full of such cases that you  must
tell it to somebody, tell the health  authorities; if the
public good requires it, inform them anyhow.
    After visiting contagious  diseases, always disinfect 
75
your clothes by walking in the open air; also wash your
hands with very hot water, or hold them over the fire; also
use disinfecting lotions, etc., according to apparent need ;
if necessary take a warm  bath, or even a Turkish bath.
    Oppose the  conveyance of diphtheria, scarlet fever,
small pox, cholera, yellow fever, typhus fever and other
contagious diseases, in hacks, cars and  other public vehi-
cles ;  and forbid the attendance of friends at the funerals
of those who have died of such diseases, on the  ground
that the dead must not be allowed to kill the living.
    Never use a tongue depressor indiscriminately.  For
besides the  disgust  patients  feel towards  having  an
instrument, thathasbeen used on everybody, put into their
throats, it might actually convey syphilis, diphtheria, etc.,
from one patient to another and render you liable to just
censure.  When you wish to examine a throat it is bet-
ter to ask the nurse for a  clean spoon.   At the office an
ivory paper-folder answers very  well,  is not disgusting,
and is easily kept clean.
    Do not lend yourself too freely to other physicians
and surgeons ; never make a  habit  of playing  second
fiddle by giving chloroform, etc., in surgical cases.  There
is a great difference  between giving assistance in medi-
cal and in surgical cases.  If you visit a medical case
with another  doctor, you  will  be regarded as  a  consul-
tant, and  as being at least equal  or  even superior  to
him;  besides, a fee may await you.  If, on the  contrary,
you go  and do  some secondary part in a surgical case,
you will be looked upon as a lesser light to the one you
assist; and you will take  a position of neither honor, nor
profit, and will reap nothing but  responsibility.   Do not 
76
habitually  play the  part  of utility-man. or unpaid  as-
sistant to any one  except  to your  father or preceptor ;
servility  and obsequiousness will never advance you,
either in the community or in the profession.
   Preaching morals to patients seldom does any good,
but you can  often exert the greatest influence upon pa-
tients wrho go to excess in chewing, smoking, drinking,
singing, excessive dancing, late hours,  carousing,  etc.
Your injunctions regarding  the four last named,  if pro-
perly given, will frequently be strictly obeyed.
   The various quack bitters advertised and guaranteed to
be " a wonderful discovery," are almost invariably some
vile compound of bad rum, or bad whiskey, and are the
origin of much  drunkenness; you should show the dan-
ger,  and condemn  their  use.   If a person will take
alcoholic stimulants, advise him  to take  them  i bare-
footed '; then he will  know what kind, and how much he
is taking.   When drinkers tell you that they intend to
' swear off' for a definite period, advise  them instead of
swearing off, to swear neither to treat any one nor allow
any  one to treat them to liquor during the prescribed
period.  This is more manly and more apt to be observed.
   Have respect for  religion.  Your profession will fre-
quently bring you into contact with the clerg}^men of vari-
ous denominations.   Do right and you will not only find in
them firm  friends,  but  also  your  chief supporters in
many of your most trying cases.  The ministrations of
a  cheerful,  pious,  sensible  clergyman are sometimes
more useful to a patient than medicine;  and even where
death is near and inevitable, resignation often takes the
place of fear when the sick  one  is skilfully informed of 
77
the  probability  of death.   In fact,  when  cheered by
religion, many show as little regret  upon learning that
they will probably die, as a traveller does when about to
start on a pleasant journey.
    When  called  to  attend cases of angina pectoris,
aneurism, organic  heart disease, desperate wounds, in-
juries, apoplexy and other diseases that create liability
to sudden death, caution and prudence may require  you
to conceal the danger of death from the patient, lest he
give up all hope, and be injured by terror and fear ;  but
be sure to  give, privately, proper  warning to the ones
most  interested.   'Allow no  one to sink  away and die
without  making that  probability  known to  relatives,
friends  or neighbors.  Be  also exceedingly careful in
talking before children with  scarlatina, variola, rubeola,
etc., of the danger of complications,  or of their illness
being serious or dangerous;  also take  care to banish from
them the fear of hydrophobia,  lockjaw,  etc., because
some  very young children fully realize the meaning of
death, and such talk  would terrify them.  Also use the
proper caution about patients who seem to be sleeping or
drunk, or semi-comatose, etc.
    It is just  as natural to die as it is to be born,  and
every one's time must come.   You  can neither see what
is written  in the book of life, nor detain the sick soul
when the Angel of Death summons; sometimes you will
seem to be fighting death itself, and  yet see the patient
recover as if by resurrection, whilst on the other  hand,
you will often find  patients almost in  the toils  of death,
while all around think, till you tell them  differently,
that he is getting better. 
78
    You  should never attempt to  thrust either your
religious beliefs or disbeliefs,  or your political tenets,
etc., upon patients who hold opposite views.   It is really
no part of your duty to administer to the religious cravings
of the sick.  Every sect has  teachers of its  own,  to
whom you must leave the spiritual.   Confine your min-
istrations to the worldly welfare of patients,  and never
suggest anything in religious matters that involves a creed
different from that of the sick one.
    The great prospect of Eternity certainly overshadows
all temporal things.  Be  ever ready, not only to allow,
but to advise patients, to have spiritual  comfort.  Re-
ligion does good, not only hereafter but here.   You will
see many a poor, sick, woe-worn, despondent and broken-
hearted wretch, calmed in mind and body by its  cheering
influence, and aided by it to  get well, if his ailments are
at all curable ; if not curable, his spiritual wants being sup-
plied, he becomes willing or even anxious for  the hour of
departure.
  The automatic, seemingly anxious movements, uncon-
sciously made by the dying, are popularly supposed  to
be attempts to  communicate  some remaining thoughts,
or secrets, or special wish before death.  Explain to the
friends in such  cases that Providence  had kindly drawn
the veil of unconsciousness  around the dying one, and
that he is not suffering.   The dying struggle  is painless
to the unconscious patient, but is awfully painful  and
harrowing  to all who stand at the  bedside and witness, it.
    When attending  in  Catholic families,  be  doubly
cautious to warn the immediate friends of danger, that
the sick one may receive  the last sacraments. 
79
  One of the seven sacraments of the Holy Church of
Rome is Extreme Unction.   It is believed to purify the
soul of the dying from any sin not previously expiated
through other sacraments, and to give strength and grace
for  the death struggle.
    Catholicity teaches that moral responsibility  begins
at  the  age of reason ; therefore  Extreme Unction is
necessary for all who have attained that age.
    Extreme Unction is given  but once in the same ill-
ness, but if the sick one has recovered and shortly after-
wards has the same or any other kind of dangerous sick-
ness, this sacrament  is  again necessary.
    Another of the seven sacraments of the Church of
Rome with which you should be familiar, is the Holy
Eucharist.
    The Holy Eucharist, sometimes called the Wafer, is
believed to contain Christ's whole being, his body,  soul
and divinity.  It may  be administered frequently in all
cases of  sickness where  the  patient is confined  to the
bed or to the house for any length of time, provided he
has sufficient reason  to make a full confession.
    Be careful to inform the family of the sick person if
there is danger of the patient's becoming unconscious in
the course  of his illness, so that the clergy may be  called,
and the  sick one's confession be heard, and the Holy
Eucharist  given before the  reasoning  powers  are ob-
scured.
    Those who are to  receive  the Holy Eucharist, are
required to fast, if  possible, from midnight until they
have  received it;  but if you consider that your patient's
being without either food or medicine would be detri-
mental to  his welfare, the clergy should be informed. 
80
    Where there is incessant nausea  and vomiting, the
Holy Eucharist is either  not given  at  all, or given in
the smallest quantity.   To expose it to being vomited is
a grave irreverence.
    Be also equally careful in Catholic  families, to ad-
minister or have administered, conditional baptism, to
all  children during, or after birth, when there  is the
slightest reason to doubt their viability.    The following
are the conditions and details of conditional baptism.
    You, or any one else, whether a Roman Catholic or
not, are allowed to administer it.   A male adult is pre-
ferable to a female, and of course, a Catholic, if one is at
hand, to a non-Catholic.  The baptism  is given as fol-
lows :  After procuring a  glass  or cup  of clean water
(spring water is  designated, but  hydrant or  pump, or
any other kind of true and natural water will do,) with
suitable manner, say, " Beloved  child, I  baptize thee in
the  Name  of  the  Father," precisely  at  the word
" Father" pour a small portion of the  water upon the
child's head ; continue, "And of the Son," at  the word
■• Son " pour another small portion; again continue, " And
of the Holy Ghost," and  at  the word  "Holy Ghost"
another small portion.
    Remember  that in baptism every word must be ut-
tered,  were you to omit  even  an " of," the baptism
would be insufficient.  Also remember  that  the water
must  be true and natural,  and must be  poured, exactly
whilst the formal words are pronounced.  So very im-
portant are these details that if you arrive after a  mid-
wife or other  person has  baptized the  child, carefully
ascertain whether they have observed the full form and 
81
accurate language.  If they have not, and the danger of
death continues, you should baptize it again.  In such a
case it is  necessary to preface the formal words with
" Beloved child, if thou art not already baptized, I bap-
tize thee," etc.
    If in a midwifery case the child is believed to be in
danger of dying, it must be  baptized.  If it  is partly
born, baptize on its head if the head is presenting;  if
not, upon the  hand, or  foot or  any  other part  that  is
born.  If no part is born, and if you can reach the child
through the vagina, the water must be applied to what-
ever part can be touched.  In all cases of unborn child-
ren, preface the regular form with the words   " If  thou
canst be baptized, I baptize,"  etc.  In such a case apply
the water to its body with  a syringe, or by any other
plan that will keep the water  uncontaminated till  it
touches the child.
    You will take great risk if you use the  forceps  in
Catholic families before the child has been baptized;  for
if the child is born dead, you will not readily be forgiven.
    Remember that  it is better for a person to be pre-
pared thrice and not go, than to go unprepared ; therefore,
if you err at all, let it be on the safe side.
    You should be careful to give timely notice of danger
to all who have unfinished business of vital moment; per-
sons suddenly seized may wish to summon friends, make
 wills, etc.  In adults with almost any sickness, you can
safely predict death in a few days, at furthest, after the
pulse has gradually increased to 160.
    Be careful  to exhibit proper gravity when attending
seriouscases. If a very ill sane adult really wishes to know 
82
whether he is likely to die, and asks you the plain ques-
tion, answer him frankly and truthfully, but if possible,
answer him in bland terms, so as not to appall him and take
away all  hope.   With  your opinion,  give all  the  en-
couragement  you honestly can, and if you know any-
thing favorable either in his physical  or spiritual condi-
tion, mention it as  a solace.  Of course you  must not,
you  cannot, put falsehood in the place of truth, even
when talking to the sick and dying, for you cannot sac-
rifice principle or truth for  expediency under  any cir-
cumstances.  But tell it in a proper manner.
   You will find but  few who have  the mental forti-
tude to enjoy the  remainder of life after they  are for-
mally told their case is permanent, or incurable ;  and you
should be cautious,and not unjustifiably cut off all hope
even  from those  afflicted with  Tuberculosis,  Cancer,
Bright's Disease,  etc., where death approaches slowly
like a creeping shadow, till in  their last stages, as per-
sons with those  diseases have plenty of time, while
sinking away, gradually to realize their fate.
   Avoid all such tricks as assuring a  timid patient
you will not lance his boil, merely wish to examine it,
and then suddenly do what you assured him you would
not do.  Veracity should ever be your golden shield.
   The white and the black, the rich and the poor, the
courtezan, the outlaw,  the swaggering rowdy, and the
reprobate, will all be represented in your practice.  At-
tend anybody if you must, but, seek to avoid disreput-
able places and persons;  they are more likely  to be a
curse than a blessing.   Remember always  that such
people respect no doctor who does not respect himself. 
                          83

   Endeavor to establish and  maintain a complete pro-
fessional influence  over all patients you  attend,  for
without their faith and their respect you will have to
contend not only against  the  physical,  but  also  the
mental.
   You have a perfect right to relinquish attendance on
a case when you think your interest or your reputation
requires it; when you  do so, let your withdrawal  be
fully understood.   It is better, however, to plead having
too much other business and not take undesirable cases at
all, than to take them and involve yourself, and after-
wards desert, or neglect them.
    Be  exceedingly cautious about taking patients to be
visited  clandestinely, or having married women or young
females consult  you  secretly at your office; also of at-
tending a patient for a disease under pretence  that it is
something else,  in  order to shield or deceive friends or
relatives.
    Do not over-visit your pa tients.  Excessive attention
and numerous visits are rarely appreciated.  If you can
get the  reputation of not paying any but necessary visits,
it will be  a special feature in your favor, and will almost
double your practice.
    A good rule, the only proper rule, is  to visit  your
patient  when, and only when, you think he really needs
your  care, whether once a day, or  once in  seven days.
Never go several times a day without pointing out to
them the necessity for it.
   Above all else,  avoid running in to visit patients un-
necessarily, because you " happen to be in  the  neighbor-
hood."  If you visit on such a plea, and charge for it,
you will be criticised and your bill may be disputed. 
                          84

    Some  well-to-do, or over-solicitous  people, form an
exception to this rule, and  insist on your visiting them
frequently, almost living at their house during sickness,
to observe progress, instruct attendants, etc., regardless
of the additional  expense, and of course you  should
gratify them, but you  should, also, at the beginning in-
form the one who will have to pay the bill, of the reason
and expense of the extra visits, and get his acquiescence.
    During these frequent visits you should maintain a
strictly professional attitude;  unless you  do so,  they
will certainly  lose  confidence,  after  which you  will
be shorn of your influence and  reckoned a mere cipher.
    Make it a study to remember well all that is said or
done at each of  your visits, so that all  you say and do
throughout the  case may be consistent, and also take
care neither to  expose a want of  memory nor a lack of
interest.   Where you to ask a  patient,  " what kind of
medicine  did I  give you  last?" he, and his   friends
would notice it instantly and think you either felt but lit-
tle interest in his case or had a dangerous lack of memory.
    Earnestness  and interest shown in cases are master
qualities.   They are often actually accepted in lieu of
skill,  and are always prime aids.  Imbue yourself with
genuine interest  in your cases, and you  will  be  sure to
show  it in a thousand ways.
    When visiting a patient, always let  it  be known
whether  you  will  visit  him  again, and  when;  it
will not only satisfy him, but will prevent all uncertainty.
    Be specially  careful never to over-visit patients with
trifling injuries,  uncomplicated cases of measles,  mumps
whooping-cough, chicken pox, etc.  People observe and
criticise a doctor's course  in all  such  cases, and if he 
85
seems over-attentive they are apt to believe  he is nurs-
ing the case,  and creating  a bill  unnecessarily.  It is
sometimes an extremely delicate point to decide whether
a patient needs another visit or not, and how soon. You
must  learn to judge  correctly the  proper  time to cease
attendance in different diseases.
    Bringing out the eruption is one of nature's processes
in measles, scarlatina, small pox,  etc., and  there is no
doubt  that the large  quantities  of saffron  tea, ginger
toddy, hot lemonade,  etc., used by Grannies to bring
them out, do more harm  than good, by disordering  the
stomach, inflaming  the eruption, etc.  This "bringing
out the eruption " when uncomplicated  had better be
left somewhat  to nature,  when  it is complicated, some-
thing more reliable than teas is  indicated.
    The  terms Scarlatina  and  Scarlet Rash  are now
in every body's mouth, and are spoken of  by the laity as
harmless affections ; there is no such disease  as  scarlet
rash, and  these  terms always  refer either  to  Scarlet
fever or  Rotheln, and  unless people are made to under-
stand this, great harm may ensue.
    There is also a popular  belief that all skin diseases
result from humors in the blood that must be driven
out, or if already out, kept out till killed  by blood medi-
cine ; much the same as one would drive  rats from their
haunts, and keep them out till annihilated.  No patient
will object to your driving his humor out, or killing it,
but if he thinks  you have  simply driven it in, woe to
you if he should afterwards have any  severe or fatal
sickness.   In such  cases it is well to  give  an internal
remedy, whether local treatment is  used or not.   In 
86
some cases it is  even better  to  commence  the internal
treatment eight or ten days  before beginning  the local.
    There is also  a  popular expectation of evil, and a
popular readiness to blame the doctor, if any new symp-
tom appears after he suddenly arrests,  or cures diar-
rheas, chronic discharges, bleedings, etc.
    Many people suppose boils and various eruptions to be
healthy;  even if they were, most people will agree that
some  other mode  of health  is  decidedly  preferable.
This belief is probably founded on the fact that during
convalescence  from certain serious  diseases, a series of
boils often appears, seemingly from a revival of the ener-
gies, the  vital forces of the system, from the depressing
influence of the disease.   Their coming, being coincident
with reorganization and returning health, probably occa-   i
sions the belief that boils and health go together.
    Do not be biassed too quickly or strongly in new theo-
ries based on  physiological, microscopical or chemical
experiments.  If you abandon the practical branches of
medicine  for histology, post-mortem  phenomena, and re-
fined diagnostics, your  usefulness  as a physician  will
almost surely diminish.  I  do not refer to teachers and
experimenters who have hospital and laboratory facili-
ties, and  who do not look to their practice for support.
Your most  useful studies, as a  practitioner will be hy-
giene and the art of treating diseases with success.
    Try to make your  address and  manner  such  that
patients will not hesitate  to  impart to you  their secrets.
One of the greatest drawbacks to  many doctors is, that
they do not  inspire  complete  confidence, and  patients
neither intrust them with the secrets of their ignorance 
87
folly or their wickedness, nor employ them in afflictions
that create  hesitation or shame.
    Do not let your wife or anyone else know your pro-
fessional secrets,  nor the private  details of your cases,
even  though  they are not  secrets; nothing  is  more
mortifying or hurtful to the feelings of patients, than to
hear that the details of  their cases are being whispered
about as coming from the doctor or those he has told. If
you allow yourself to fall into the habit of speaking too
freely  of ordinary affections, or submit to be indiscrim-
inately interviewed concerning  your patients, your very
silence  in disreputable  cases will betray them.   The
credit  of whole families  and the  character of its in-
dividual members will sometimes be at stake, and unless
you shut your eyes and do not see too much, also your
mouth, and don't say too much; it may ruin them and
involve you.  You will be allowed  to see people in a
very different light from that by which  other people
view them.   The community see one another with a veil
over  their  moral  and  physical  afflictions,  over their
blasted hopes and the sorrows that flow from love and
hatred, their poverty and their crimes, their vexations
and their solicitudes  ; you will see them with the veil
lifted,  and will become  the  repository of all  kinds of
moral  and physical secrets.  Observe reticence  at your
visits,  and do not mention the private affairs of anybody
from house to house.  Seal your lips to  the  fact that
patients have, or ever had, venereal diseases, hemor-
rhoids, fistula, ruptures, leucorrhea, constipation, or that
abortions, private operations, etc.,  have taken place; or
that any one takes anodynes or liquor, or has this, that, 
88
or the other bad habit.  No matter how remote the time,
if patients wish their secrets told, let them do the telling.
You have no right to tell the  affairs of patients to any-
one  without their  consent.   Your ears  will  hear and
your eyes will see many things that illustrate the moral
and physical infirmities of poor fallen  humanity, but in
the midst of all  you must have a silent tongue.
   In prescribing medicines for the sick it is better to use
a limited number of remedies with whose uses and powers
you are fully acquainted, than to employ a whole chaos
of ill-understood ones.
   When you order  unusually heavy doses of opiates,
etc., take care either to write the quantity out in full
instead of using the common signs, or to underscore both
name and quantity.  It is safer also  to  put the names
of heavy dose patients on  their prescriptions.   When
you order morphia, etc., in unusually heavy doses, it is
also  well to  have it made  into pills  or granules, and
direct the druggist to " put  them into a bottle."   It is
so unusual to dispense pills in a bottle, that  it informs
the compounder  that the quantity is not a mistake but is
as intended, and guards patients and  attendants against
taking  or giving  them   in mistake.   When you pre-
scribe pills,  powders,  etc.,  for  sailors  and persons
whose business exposes them to get their medicines wet
or wasted, direct them to be  put  in  bottles instead  of
paper boxes.
   A placebo or tentative remedy should,  as a rule, be
small and easy to take.   A very  good form is to pur-
chase a pound box of No. 35  unmedicated  homeopathic
globules, which  cost but 35c, and immerse one half of 
89
them in fluid ext. of belladonna, and  the other half in
compound tine, of iodine, for twenty minutes, then roll
them about on  a newspaper till  all surplus fluid is ab-
sorbed, then let them dry ; after which they can be put
into bottles, with a small quantity of powdered cinnamon
in one bottle, and powdered liquorice root in the other,
to prevent agglutination; these can either be given as
globules,  or put between paper, crushed, and given as
powders;  they make cleanly, convenient placeboes for
office use, and  cost  so  near nothing,  and a pound will
last so long, that  you can afford to give them away and
charge  such  patients for advice only.   They will suit
almost  any case  requiring a placebo.   Be  careful to
keep a straight face and to give minute  directions con-
cerning the manner and time of using remedies intended
simply to amuse  people who are morbid on the subject
of health, and you will do them double good.
    You will find that your placeboes not  only amuse and
satisfy people, but you will be  surprised to hear  that
some full-of-faith  persons are chanting your  praise and
are actually willing to  swear  that  they are cured of
one  or  another awful  thing  by  them; cheated  into
health by globules, or  tea-spoonful  doses  of  flavored
water, or liquorice  powder, as  if by a  charm;   some
who seem to  be  magically benefited by a tea-spoonful
of—nothing—will actually  thank you for saving their
lives.   What a sad comment on the discerning power of
the nineteenth century ! what a sad  comment on medi-
cine ! what a gold mine for quackery!
    Never prescribe  bread pills :  it is not right to make
a patient  pay for bogus  medicine ; besides, if you can-
      6 
90
not devise some placebo more professional  than bread
pills, you must have an unusual paucity of resources.
Moreover, were a patient to discover that he had been
paying for such an insipid cheat as bread pills, he would
naturally  feel victimized and indignant.
    The vast majority of people are now sensible enough
to take medicine only when sickness  demands it, and
even then not too much; but  taking ' a  little medicine
for clearing the constitution in the  spring of the year,'
still has patrons; and the cathartics and  other depleting
remedies are still popular with the few who  cling to the
old forty  years ago craze for purging, sweating, vomit-
ing, &c.
    These people always want to see and feel, promptly
and fully, the action of medicines, and think they could
scarcely live a  month  without pills, salts, etc.   Conse-
quently this class often purge themselves  entirely too
often.  Remember that when nature is depended on, the
bowels ought to act daily, or at least act freely once  in
two or three days;  for, when nature moves  the  bowels,
the lower portion only  of the intestinal cavity is  evacu-
ated, and  during the interval before the next passage,
the faeces from above come down and are in turn evacu-
ated ; but, when a purgative is taken, it sweeps out the
entire alimentary canal, and of course, such a  scouring
is not required  so often as  the natural  though partial
evacuation.  For any adult  who cannot have an evacu-
ation without the aid of medicine, purgatives given once
in three or four days, is sufficiently often.
    Never solicit  people, either  by word or manner,  to
employ you ; for such a course would surely either repel
them, or prevent your enjoying the necessary esteem. 
91
    Many people are naturally capricious and fickle, and
no matter how earnestly any one tries to serve and sat-
isfy them, they will change about from one to another.
Others are  more true and  will  stick to  you through
everything, good or bad, with surprising tenacity.   You
should, however, always found your hope of being re-
tained, upon  deserving it.   Do  not set your  heart  or
faith upon the continuance of the patronage of any one,
for you will many a time be replaced by those you know
to be far below you in everything that unites to make a
good physician ; sometimes you will be unexpectedly and
unjustly dropped out of a family, and the most ignorant
or shallow fellow in the whole section, or  an old lady,
or a homeopath whose very name strikes you with dis-
gust, will be called to supersede you, and you may have
to bear the reflection, and the wrong, without showing
the slightest chagrin.
    Ability promptly to detect loss of confidence  or dis-
satisfaction  with either yourself or your  remedies,  is
one  of the  acquirements  that you  must  seek  to pos-
sess.
    When you are  ungratefully dismissed  from a case,
especially if it is to make room for an irregular doctor,
do not appear willing to be thrown aside in such a man-
ner, but make it known in a gentlemanly way, that dis-
missing you thus, wounds your  sensibilities, and that
such  action necessarily casts undeserved  reflection on
you, and does your reputation a very  great injury.   Such
a protest will  secure  for you  greater respect and will
counteract the injury  better than  if you submit without
protesting. 
92
   Whenever dismissed from a case, consider attentively
the combination that conspired, and  how you might
have averted it, that you may gain additional familiarity
with the art of managing and retaining patients.
   Some people, indeed, whole families who will almost
idolize you as long as you are  lucky, and  have neither
unfortunate cases nor deaths  in their families, will  turn
as rudely and maliciously against  you as soon as either
occurs—as if you  kept the book of life, and controlled
the hand of God.
   In acutely painful cases, active, even heroic  doses of
morphia or other  potent medicines are often required,
and must be  given  promptly,  but care must be taken
that  the total amount  given is not sufficient to poison
the patient.   A certain  gentleman had cholera morbus;
a physician was called  who  prescribed for him  twelve
opium pills, one to be taken every six hours.   He was
entirely too slow in his therapeutics ; for long before the
time to take the second  pill had arrived, the soul of that
pain-racked sufferer had taken  its flight to a land where
doctors are unknown, and six hour intervals never occur.
Avoid his  error  and never  leave  great long intervals
between the doses for patients suffering acute pain.
   There is a popular belief that opiates are given only
to palliate pain,  not to cure  the sickness.   Opiates are
not only palliatives, but by controlling pain, restlessness,
etc., they are powerful curatives in a long list of diseases.
   When danger of rapid or sudden death is imminent,
beware of  ordering medicines that might be  charged
with killing.   It is even occasionally wise  to order the
medicine under its simple name, so that, its nature being 
93
understood, you may not risk being charged with poison-
ing.
   When any one under your treatment dies unexpect-
edly, or mysteriously, or shortly after the  use  of some
new means you have directed, or after beginning some
new remedy, or shortly after you have performed some
operation, or just after you have pronounced him better,
or in any other way that could possibly expose you to
unjust censure, it is better bravely to visit his remains
without delay, to learn about the death, discover what
attitude the friends assume towards you, to meet their
criticisms by explanations, etc   On such occasions be
self-possessed, and if need be, explain  and  defend your
course and your treatment.   By doing so you can anti-
cipate  evil reports, and shape or  dispute them,  before
they are extensively circulated.
   The  laity expect  you to examine your  patient at
every visit.   Never neglect  the  following five  cardinal
duties:  to feel the pulse, to  examine the tongue, to in-
quire about the appetite, the sleep and the  bowels.   No
difference what  your case is, be sure to attend  to these
and all other evident or special duties,  at every visit.
   Whenever symptoms make it possible  that hernia,
carcinoma uteri, Bright's disease, or  heart  disease  is
present; or  that'the  throat is diphtheritic, or the ear
occluded by  wax, or a  tumor or an  aneurism exists, or
anything else which  overlooked  might  sacrifice  the
patient, or disgrace  you if discovered  by some  one else,
you should always  make a  thorough  examination, and
it  would even  do  no  harm  to  let  it  be  known  for
what  you are searching. 
94
    Never ask a question without a basis, but be careful
to ask every question necessary to learn all the  facts,
and to satisfy everybody that you  feel an  interest; if
you neglect this, you  will risk both error  and loss  of
confidence.
    Prompt detection of dangerous changes, or the  ap-
proach of death, etc., not only protects  the  doctor, but
gives him eclat if  he recognizes and points them out,
before the patient or friends detect  them.
    Study to be  fertile in expedients, and never confess,
or allow the inference that you are hopelessly puzzled
about a case, or have reached the limit of your resources.
    Even after a patient with  an acute disease of a kind
that is at all curable, is unable to  swallow, or if food
taken into the stomach is not assimilated, continue your
efforts with inunctions of cod liver oil,  or of glycerine
and quinia—rectal  alimentation, etc., until he  is  either
better or the breath is out of  his body.
    Never speak of anything you do for a patient as an
experiment; everybody, everywhere, is  opposed to doc-
tors " trying experiments " on them  or  theirs; for the
same reason it is not discreet to give certain  patients the
sample bottle of new  pharmaceuticals 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 fracture, or of smallpox, or  of hernia, or of
anything else, you ever attended.
   You should keep a reference book for recording par-
ticularly good remedies, prescriptions  for stubborn dis-
eases, etc., also a case  book for recording the date, diag-
nosis, treatment,  etc., of unusually important  cases. 
95
Nothing impresses a  patient who has a complicated, or
long-standing disease with a fuller conviction that you are
interested in him, and that you intend to try to do  him
good, than to know  that you keep a regular record of
his case.
    When truth will allow, let your diagnosis, etc., either
include the patient's  belief, or fully nullify it, that his
mind may not distrust your opinion, and  antagonize your
treatment.
    You can more easily and permanently convince and
impress a patient of a medical fact that  militates against
his wish or belief, for instance that shortening is usual
after fracture, etc., by showing it to  him  in  the  books,
than by a hundred verbal statements.
    You will have to foresee thousands of snags that lie
in the professional field to catch the unwary.   When in
doubt whether duty  requires you to do this, or that, or
not to do it, remember that the sin of omission  is appar-
ently not as great as the  sin  of commission.
    Summon professional  assistance in all ugly fractures,
etc., where you think there is the least  danger of an
ugly termination, and of being blamed  or sued for the
result.   Having assistance not only divides the responsi-
bility, but also  makes one a teller of truth for the other,
and prevents  causeless suits for malpractice.  Remem-
ber that when a fracture, or dislocation, or a disfiguring
wound, or accident of any kind, recovers with deformity
or  disability, there  is danger of its being  ever  after
exhibited as a  monument to  reflect  injuriously on the
medical attendant's reputation  for life.   Therefore, the
responsibility had better be  divided.  In this respect 
96
medical and surgical practice differ—the results of sick-
ness usually disappear, while those of surgery remain.
    Always take the precaution to listen to  the heart's
action immediately before  administering  anesthetics,
both for the patient's protection and your own.  When
possible, have another M. D. present whenever you pro-
duce anesthesia in anybody, more especially if the pati-
ent is a female.   Also, have a third person present at
all sexual examinations of females, to prevent  scandal,
and to disprove possible hallucinations regarding  either
improper words or deeds.
    If you have the ability to control your temper, and
to maintain  a cool philosophic composure under the
thousand provocations  given to doctors, it will give you
great advantage over those who cannot, and will  gener-
ally redound greatly to your credit.
    Expertness in  detecting and  escaping  the various
kinds of scandal and calumny, admits of cultivation to a
great degree; so also does  ability to foresee and escape
entanglement with the captious, the  bad, the  silly, the
tattlers, the  fraudulent, etc.   But while peace should
be your motto,  it is your  duty to society, and to the
laws, to expose and bring abortionists and unprincipled
quacks and heartless vampires, whether acting under
cover of a diploma or not, to justice whenever you meet
proof of their wicked work.
    Tact and nice discernment in establishing and main-
taining a proper attitude towards nurses and  other  at-
tendants on the sick, is a valuable gift that will prevent
or counteract possible machinations.   To give attendants
credit on proper  occasions  for faithfulness, is not only 
97
just and gratifying to them, but makes firm friends of
them, and encourages them to do their best.
    Midwives  and doctorwomen  often exert  a malign
influence, and  tell tales, or circulate  falsehoods about
doctors, that must be noticed and thwarted according to
the necessities  of the case.
    The conciliation of  anxious  and captious and impa-
tient and dissatisfied friends of the sick, when sickness
is not progressing satisfactorily, also requires great skill,
and a profound study of human nature.
    Scandal-mongers and malicious liars will often lie in
ambush for you, and must be checkmated  by the most
available means;  to  judge what is best to do, is some-
times a great puzzle.
    In serious or strange cases, and in  such as engender
great public excitement, if you indulge in confidential or
semi-confidential whispers  to the  rabble, it  will  often
give rise to misrepresentation or even  to total perversion
of what you really do  say or  mean.   Be  ever on the
alert for this danger.   If necessary, give your opinion to
the proper  ones  in writing  to   prevent its miscon-
struction.
    Refuse  to  be  confidential  with  curious  or stupid
nurses, or  prying mischief-makers,  and  if  you  must
answer their questions, do so, not  in  confidential whis-
pers, but openly and in your ordinary voice.
    When a sick person puts himself under your care, he
gives you a responsible  duty to perform.   If he then
neglects, or refuses to take  your remedies, he  ties your
hands  and  keeps you  from  doing it.  If, however, he
will not, or cannot do exactly as you wish, if no special 
98
danger  exists,  it  is  sometimes better,  after  drawing-
attention to the position  in which  you are placed, (as a
protection to yourself,) to humor his whims  or weak-
nesses, and  modify or alter your  therapeutics to such
things as he can and  will do.   This you can do  good-
naturedly without fully yielding to him or compromis-
ing your authority or your dignity.  The wishes, preju-
dices, and errors of peculiar patients must be studied, and
to a certain extent respected.
    Never captiously oppose a remedy because it is sug-
gested by  a layman. The most ignorant person may
make a wise suggestion.   And laymen often talk excel-
lent-sense about indications they have noticed.   Listen
patiently to all sensible  propositions, and  if they seem
simple and meritorious, you may find it well to add them
to your other means  for  their moral effect, if  nothing
more,—be  frank in giving  credit  to  any good idea,  no
matter by whom advanced.   When rejecting a  remedy
thus tendered, let it be known that your condemnation
arises from conviction and not from superciliousness.
You might in some cases even humor a whim, and sanc-
tion the use of their harmless domestic remedies, saffron
tea, plasters, onions to the feet, etc., in conjunction with
your more  reliable agents.
    When attending certain classes of very ill patients,
e. g. the wife of a druggist, or the  child of a physician,
etc., if  there is any simple remedy in which they have
great  faith, and wish  to try, every  consideration should
incline you, unless there  is some clear contra-indication,
to acquiesce and allow it in conjunction with your other
means. 
99
    It will be a trying ordeal when  you jar against an
"old lady with an infallible salve," good for anything,
from mosquito bites up to elephantiasis.  You will  find'
her so full of faith in herself, and in her salve, that
neither reason nor ridicule can shake it.  Be  very fair
and urbane with her, but if you indiscreetly concede to
her remedy  any recognition  beyond its actual  merits,
or  take her into partnership  in the treatment  of  any
•case, you will make a big mistake, and fill her as full of
conceit, and of mischief, too, as the sea, is of water.
    Hypochondriacs and  various  other kinds  of bores,
will sometimes tax your patience and ingenuity when you
have neither  time  to waste nor disposition to  be rude;
some of these you will have  to freeze out  by chilling
coldness in their reception.  If you tell them when they
 come  in that  time is precious  with you, they cannot
deem  you uncivil  and will  be brief— unless unusually
 pachydermatous.  If you are greatly annoyed, keep a
 placard posted with, " This is my busy day."
     When you are to be a witness in a grave court case,
 firmly refuse  to give the opposing  counsel, or any one
 else, either a verbal or written statement of your opinion
 of the case, or of what your testimony will be;  dispute
 their  right to question you.   If you are weak  in  this
 respect, you may actually aid them to distort your state-
 ment  from its proper meaning, or to rebut it on the wit-
 ness stand, and thus bring both justice and yourself to
 grief.   Firmly, but  courteously inform them that  they
 can find out all you know on the witness-stand.
     There is no creed, or clan, except ours, whose mem-
 bers  habitually confute  and  confront  one another in 
100
courts and before the public.  Our so-called psychologi-
cal experts, specialists, and other would-be representa-
tives have done this  so often  of late, that the public
have  us for a jest, and believe  from our kaleidoscopic
contradictions that  our boasted  science of medicine is
worse than guess-work.
    To  rid yourself of undesirable  would-be  patients,
will be  one of the most difficult dilemmas that confront
you.  " Too busy to attend" is  probably the most unas-
sailable of all pleas.
    When you receive calls to cases that, from any cause
you cannot or  will not attend, notify them to get some
one else, in order that the patient may be saved from
delay, and you  from the annoyance of repeated messages
and solicitations.
    No one can  blame you for not being at home  when
he needs you, but if you are at  home and quibble  or
refuse to respond to a call, you will sometimes be severely
criticised, especially  if the case  goes wrong  in conse-
quence of your not responding.
    The chief objection to recommending persons you
wish to cast off, to physicians whom you wish to aid,  is,
that they are then quite sure still to hanker  for you,
and to involve you as a consultant, or  assistant to your
protege, if things  get serious;  whereas,  if instead  of
recommending them  to  any particular one, you  compel
them to choose  some one for themselves,  you  will get
rid of them permanently.
    You will occasionally encounter patients or their wise-
acre friends, who will challenge you to controversy, and
presume to discuss  your diagnosis and your remedies 
101
with you.   Most of these are  as  full of doubts, beliefs
and theories as a  lemon  is of acid,—foreknowing  and
prejudging all  you do, frequently thwarting your every
effort,—possibly drawing the curtain aside after you go,
and exposing to everybody things that should properly
remain  your professional  secrets.   If you write a  pre-
scription for gonorrhoea or cough, or almost any other
ailment, many a  presumptuous  patient or his friend
will  read  it  to you and actually comment or  argue
on it.   You will  be often harassed by such meddlers,
and  compelled  to resort to  various   expedients, to
satisfy  or  foil them,  and avoid collision  with their
whims  and  prejudices.   In fact, the  good effects of
mystery, hope, expectation, and  will-power are of  late
almost  entirely lost to regular  physicians,  from  this
cause, and  all special confidence is sapped,  and all  you
can expect in  many cases is the  gross physiological
action  of your  medicines ; and prejudice and fear, ac-
tually do much to thwart even that.   You must  con-
stantly  study the  use of psychological  aids and try to
compel  your patient's will to assist you.
   The presence  of sick-room critics will  also  often,
either  impair,  or destroy,  your usefulness  by diverting
your mind  and lessening your concentration.   Conscious-
ness of  being under criticism will unavoidably shear you
of a portion  of your usefulness.
   To set unused  medicines aside and order others so as
not to  shake confidence, requires  a great deal of clever
management; patients will rarely complain of the price
of medicines that are taken, but  they will observe the
waste,  and  criticise you when you set half-filled  bottles 
                         102

aside and  order others.  A good plan  is to  order the
empty bottle in which  one  medicine was  gotten, to be
washed and carried to get the next in.  A medicine that
has been put aside, is very rarely again indicated.   When
you do stop one remedy  to give another, if  there is a
prospect of its being used again further on in the case,
be sure to mention the  fact.   It does not then look so
much as if you misjudged in prescribing.
    Never prescribe large quantities: it  is far better to
have the prescriptions  repeated over  and over  again,
than to risk having half a bottle set aside untaken. One
of the nicest little points in medical practice, is to decide
how large a quantity  of medicine to order at a time
    It is better not  to leave your directions about  medi-
cine, food, etc , with the patient, but with whoever is in
charge.
    School  yourself till you can  prevent thoughts and
opinions from showing  on your countenance, and  above
all  discipline your  features and manners, so  that ner-
vous and ill patients cannot detect in you unfavorable
reflections about themselves that you wish to conceal.
    You will occasionally encounter patients  who have
been kept in anxiety and terror for months or years, by
the trick of some greedy, hyena-like quack, or the error
of some  novice  who  has pronounced  them  syphilitic
when in fact they  have really never had  even a  single
symptom of that disease.
    It is  torment enough for those who really have con-
stitutional  syphilis, to go through  life filled  with re-
morse for the past, and fear for the  future, without add-
ing spurious cases.  When examination proves that the 
103
case before you is not  true syphilis, it is your highest
duty to give proof by text-book and explanation, till you
fully banish the error from your patient's mind.
    You will  be sure  to cause  unreasonable, cruel fear
and distress in the minds of those  whose chests you ex-
amine, if you tell  them of  " a slight deposit  in  the
apex," " an abnormal resonance," or a " bruit de diable,"
"rales," " a palpitation,"  "a  disordered rhythm"  or
other, to them, ominous jargon.  Take  care never to say
or do anything which will unnecessarily fix the mind of
a patient on the character of his breathing, the action of
his heart, etc.
    God only knows how  many young women  in  our
land are now tormented with apparitions of " womb com-
plaint," which have no existence except in  this or that
doctor's imagination—young  women  that, had their
minds never been fixed on womb complaints,  would have
lived  a lifetime without  even thinking of  having a
womb.
    The chief reason why there are so many doubtful
cases of womb disease is obvious—when a  man is told
he has a luxated shoulder, or a cataract, or  a hernia, or
a  cancer,  he finds many ways to  confirm or refute the
doctor's opinion, and he can also see what the treatment is
doing for him; but when a miserable woman, morbid on the
mysterious subject of " womb disease,"  " gets examined
and is told, whether correctly or incorrectly, that her
womb  "is turned,"  or, "is  down,"   "ulcerated," or
" affected," it tallies exactly with  her fears, and shrink-
ing from  both the  expense and the exposure to be en-
dured,  if  she were to consult another  doctor, she natu- 
104
rally submits to the manipulations, and to the monetary
exactions, of whoever has made that examination. If
there is a wretch meaner than all others in the  sight of
God, it  must be the doctor  who  would exaggerate his
opinion, and terrify the sick simply for dollars and cents.
   It is also a cruelty to tell patients indefinitely that
their  trouble  comes  from  their heart, or kidneys, or
liver, or lungs, or that they have the " liver complaint,"
or "kidney disease," or that their lungs are  "affected,"
when there is only some  slight or temporary affection of
these organs.   You know a man's liver or his lungs, or
his heart, may be deranged this week and well  next—
but many of the public think if any of these organs are
affected in  any way, it is necessarily permanent, and it
gives  them permanent anxiety.   Many  people are at
this  moment  living in  as  great anxiety as though  a
sword was suspended over them by a hair, because told
long ago that such and such an organ was affected, with-
out explanation being given  of its functional or tempor-
ary character.   By  explaining the  difference between
temporary ailments and those of a permanent character, or
the difference between a functional and an organic affec-
tion, you will give many  a patient perpetual sunshine in
exchange for constant gloom.   It is your duty at least to
avoid all ambiguity of language in such cases.
   You  will also have  patients  lacking  in  the salt of
wisdom, who come tormented with evil forebodings over
conditions that are either  imaginary or perfectly natural;
some,  because they  have discovered  their left  testicle
hangs lower than the right, or  because their scrotum
stays contracted, or  relaxed;  others, terribly alarmed 
105
because they have in examining themselves, discovered
the little odoriferous glands on the back portion of their
glans penis and imagine them to be chancres or cancers;
others because either  fear of disease, or of blackmail,
or of bastardy, or moral accusation, has thwarted their
attempts to couple with loose women, and  led  them to
imagine they are impotent.   You will also occasionally
be asked  for advice by those about to  marry, and by
others newly married, who are miserable  on account of
this  or that affliction, or defect, or fear.   Remember in
all such cases, to charge your full fee, even though you
write no prescription.   In these cases, the charge is for
giving valuable information and satisfaction.
    Be careful to warn all such cases against the curse of
falling  into  the hands  of quacks,  " friends of  erring
youth," etc., and tell them of the mischief such people
entail on their victim's health, and of their unscrupulous
voracity for money.
   The eight or ten very large  papillae seen  upon the
base of every one's tongue, often occasion great anxiety
upon being  discovered  by over-anxious  laymen,  while
looking into their  throats  for  syphilis, diphtheria,  or
ulcers.  Great  relief is expressed when  they are told
these are natural.
   You will be often consulted  by true syphilitics who
wish information regarding the results if they were to
marry.   Never promise certain immunity against future
outbreaks ; and  do not sanction their marriage unless it
has been at  least three years since  they  caught their
syphilis, and not even then unless they have been free
from outbreaks  for at least two years.   They should,
      7 
106
even then, marry only  under hygienic and therapeutic
restrictions.
    When a patient alarmed about his health consults
you, if you want fully  to satisfy him by your opinion,
be earnest, and let attention to his case overshadow all
you say or do; above all, do not divert his conversation
from himself to extraneous subjects.  If it is at your
office, do not digress by showing him the toy steamboat
you are making, nor by telling him the latest news, or
the history of the cigar you are smoking, or of the news-
paper you are reading, or of the cane you are twirling.
If he diverts the conversation from his case, bring him
back to it at the first opportunity.
    Never recommend sexual intercourse as a remedy for
self-pollution,  nocturnal emissions, spermatorrhoea,  hy-
pochondriasis, or acne.
    If such people risk  syphilis, gonorrhoea, bastardy or
exposure, or commit rape, adultery, or self-pollution, let
it be on their own responsibility, not on yours.  Perfect
chastity is entirely compatible with good health ; and I
know of no disorder, either  of body  or mind, in which
fornication is necessary.
    Remember that night emissions recurring occasionally
in young men, partake of the nature of an overflow,  and
are perfectly  compatible with  health.  Young men al-
most crazy with dread  and remorse, will  often consult
you about these emissions. You will find that almost every
one attributes them to self-pollution in boyhood.  The re-
sults of self-pollution are not half  as destructive as com-
monly supposed ;  when the habit is stopped, its  results
are usually quickly  recovered from. 
107
    Consumptive females  whose  blood-making power is
destroyed by their disease, naturally cease  to  menstru-
ate.  They then attribute their decline to absence of the
menses, while in reality, the absence of the menses  is
due to the decline, and  consequent loss of blood-making
power.   When  such appeal   to  you to restore  their
menses, you must explain why they have ceased, and that
they will never  again menstruate till their health and
blood-making power improve.
    Consumptives sometimes have hectic fever so regu-
larly, at a certain hour, day  after day, that they and
their friends are persuaded that their sickness is mala-
rial in character, and if you are not on  the alert they
may mislead you into giving an erroneous  opinion.   If
quinia does no  specific good for the daily  fever of a
weakly or broken-down person, you should suspicion that
it may be hectic, instead of malarial fever.
    The popular belief that one  is booked' for  consumption
because  a parent, or brother or sister died of it, is true
only in a limited sense.   If his  relative's  disease  was
part of his law of development, and was in his charter of
life, it should indeed excite serious fears in all who have
the same charter, the  same  constitutional  bias.   But
if his disease began after  his physical development was
fully completed, or from an accidental cause, the heredi-
tary  law  does  not  apply.    Those whose father or
mother, or sister or brother died from phthisis, the se-
quence of bad hygiene, pneumonia, etc., are  not thereby
compromised, as  that variety is not hereditary, unless
their father had  it at the time  he begot them, or their
mother had it during pregnancy or nursing. 
108
   One person in every seven firmly believes  he has
either heart disease or consumption.   You will find that
the management of those who really have either, is one
of the  most delicate questions in practice.  No wonder
the mind  dreads consumption, for it is humanity's great
destroyer.  It loves to scourge the young, the beautiful,
the gentle, and the gifted, and this portion of every com-
munity is selected for its most intractable and fatal forms.
When your opinion is invoked in these cases, do not ex-
amine them at all, unless you have  time to do  so thor-
oughly, for your opinion  and treatment may influence
their entire future course, and if anything is overlooked,
you may  induce  a neglect of proper remedies till the
patient is beyond their reach.
   Over-cautious people often make the mistake of be-
lieving that to put on a  double  quantity  of clothing  in
cold or windy weather, will  secure them  from all dan-
ger of  taking cold, whereas colds may not only be caught
through  the  body, but  also  through the mouth.  No
matter how warmly  one is  dressed, he must  breathe
whatever kind of air is around him.   May it not be that
most cases  of pneumonia,  pleurisy,  bronchitis,  croup,
tonsilitis, and  other throat  and lung affections are caught
in breathing?
    Valetudinarians almost invariably dress too warmly,
and in their anxiety to protect their bodies, overheat
their skin, and keep it constantly relaxed, and of course,
reduce or destroy  their natural  resisting power, so that
when they go into cold air or into a draft, the result  is
like jumping   from  the  climate of Cuba  into that  of
Canada.   No  person, sick or well, should ever wear more 
109
clothes than sufficient to keep him comfortable; every
ounce beyond that is unnecessary, and enervating.
    People  of the opposite  extreme, knowing that cool
bed-rooms  are healthy for hearty  well people,  often
carry catarrhal and croupy children and  other  invalids
from the warm rooms  where they have passed the day,
to cold sleeping-rooms, instead  of giving them uniform
warm air, day and night, till recovery takes place.  It
would even be less hurtful to reverse it,  and keep them
in a cold room while awake, and in  a  warm one dur-
ing sleep, because a person has  more resisting  power
while awake  than  during sleep.  The  butcher can at-
tend  at his  exposed,  tireless  stall  the  coldest winter
weather till midnight, and not even sneeze,  but were he
to lie down on his stall and sleep during a similar period,
he would  probably  contract catarrhal  pneumonia or
rheumatism.  It will devolve on you to point out these
and kindred dangers to patients who are risking  them.
    Register-heat, on account of its parching dryness, is
bad for both sleeping and sitting-rooms.   You will often
smile  at seeing a small pan or cup of water simmering
before a register that is pouring out a volume of  choke-
dry air, while the inmates  are  blissfully believing it is
tempering  the element they breathe.  A very large wet
towel, or folded sheet hung before the opening, is  much
more effective.
    Many  new-born children  are unwittingly exposed
to  the bad effects of cold, from lack of knowledge on
the part of those in charge.  The popular belief is that
if plenty of clothes are put on a babe, they are a suffi-
cient protection; whereas, if the little babe—whose heat- 
110
generating power is  naturally very feeble—is put into
clothes  in a  cold  condition, without  further  attention,
hours or days may elapse  before its feeble  heat-making
power can bring on a reaction and warm it.   Ice is put
into woolen cloths or blankets to prevent it from melt-
ing ; cold bread wrapped in a blanket would  never warm
itself, but if  warmed and then wrapped in a blanket, it
would retain  its  heat much  longer.  Take care that
the new-born babe  is  kept warm.  As soon as it is
dressed,  it should  be nestled against its mother's bosom
till warm; if this does not suffice, it should be kept near
the fire till the coldness is banished.
    Remember that the act of nursing not only supplies
the babe with nourishment, but also  communicates the
mother's heat and electricity ; it is therefore well to have
all hand-fed  babes nestled to some one's  bare breast  at
intervals of a few hours, in exact imitation of those that
suck.
    There is a widespread popular error, partaken  of  to
some extent even by physicians, regarding the object of
lancing  children's  gums.   When a physician lances  or
rubs a child's swollen gums, he does so, not  solely  to let
the tooth through,  nor does he expect it to instantly pop
through  the opening, but his chief object is to sever the
innumerable small nerves  that ramify through the gum,
and  thus relieve  the tension, irritation, danger of con-
vulsions, etc.   No one should touch a child's gums, except
when these evils are  present.
    " Doctor, my child gets the phlegm up, but instead
of spitting it out, he swallows it  again,"  is a stereo-
typed  expression.   If he  does,  it  makes  but  little 
Ill
difference, as he swallows it, not back into the windpipe or
lungs, but into the stomach where it becomes unimportant.
    It is a popular belief that crossness in sick children
argues favorably, and  there  often seems  to  be a great
deal of truth in it, as it  requires considerable strength
and energy  to exhibit  crossness.
    The high color of the urine  occasioned  by activity
of the skin, in patients whose sickness compels  them to
lie  in warm beds or to keep in warm rooms ; also when it
is occasioned in well people by copious perspiration dur-
ing warm weather, frequently causes alarm and induces
groundless fear that they have kidney disease.   Explain
to them how the skin and kidneys vary the activity of
each other, and that it makes but little difference if the
urine is scanty if it contains all the natural excreta, and
is simply deficient in water.
    When a coin or other small foreign body is accident-
ally swallowed, some old lady is almost sure to give a
dose of castor oil, to fluidize  the contents of the bowels
and compel the intruder to  travel the entire  length of
the alimentary  canal alone, instead of allowing the fecal
matter to remain as a mass to include it and prevent its
edges and  corners from doing harm.  When  such an
article is swallowed do not interfere with nature's efforts,
unless you  are sure slie cannot expel it unaided.
    When a person faints, those around run to assist him,
and instinctively raise his head instead of lowering it as
they should do, thus prolonging the  syncope and  endan-
gering life.  In all  cases  where  great debility  and
pallor are present, be careful to instruct the attendants to
keep the patient's head  low  and to prevent him from 
112
rising suddenly for any purpose, and from sitting up too
long, for fear of fatal syncope.
   " If the dog that bites a person goes mad, the  one
bitten  will also," has caused many a valuable dog to
be killed.  The truth is, if the dog's mouth  or teeth
contain hydrophobic virus  at  the time  of biting  the
person, it risks being communicated.  If the dog is killed
under the mere suspicion of having  hydrophobia, the
disproof of the disease is made impossible, and the bitten
one and his friends are left to all  the  terrors  of uncer-
tainty.
   There exists  a  popular  prejudice  against  damp
houses, leaky roofs, night air,  etc., which  is  probably
carried entirely too far.   Dampness is  of course inimical
to health when mould, absence of light, or other unfavor-
able,  disease-producing elements  are  added to it;  but
neither life on board of vessels, nor in moist situations,
nor the presence of dampness, as in rainy weather, are
in themselves unhealthful.
   The low-spirited and morbid will often  refer to the
fulness or emptiness of the  veins  on  the back of their
hands, as evidence that their blood is drying up, or that
they  need bleeding, or  that they have  consumption.
Explain to them its total lack of value.
   You will find  that remembrance  of the  names of
children and of patients you  see but rarely, and  the
salient points of former interviews with them, are  very
useful adjuncts to other qualities.
   Children's likes and dislikes will control your destiny
in many a family.   Many people patronize various forms
of quackery, for no greater reason than that " the child- 
113
ren take it easily," knowing from experience that an at-
tempt to give pills or  bitter doses to refractory or puny
children, means a fight and a failure.
    Never ask the age of a patient but once during atten-
dance on his case.  Also take  care  neither to ask  any
question twice at the same visit, nor to do anything  else
that would indicate either abstraction or incompetence.
    You will find that you will inspire  more faith in  a
prescription if you begin to write it immediately after
receiving, to some important  question, an answer, that
your manner shows is what you expected.
    Probably one of the greatest fortes you could possess,
is the  power of discovering who are the ruling  spirits
in a family, and securing their faith  and keeping them
satisfied with you and your treatment.
    In admitting or excluding visitors to  the sick, man-
age it so as to engender no personal enemies; also en-
deavor  to  acquire expertness  in answering their ques-
tions about your cases.
    As  a purgative after confinement, many physicians
order simples, castor  oil, seidlitz  powders, etc., instead
of writing regular prescriptions; it will be wise for  you
to follow the same rule and give a lying-in woman castor
oil  or whatever other simple laxative she or her friends
are accustomed to  take.  If you give a lying-in woman
a Latinized prescription for a purgative, and as a coinci-
dence she  has hyper-purgation, or  puerperal  fever or
hemorrhages ; or if syncope, or anything else follows, she
will be  apt to believe firmly that your strong mysterious
purgative caused her sickness ;  and if she happen to die,
you will be blessed. 
114
   A great and  almost universal mistake  that  regular
physicians make is, to think that when people send  for
doctors they send solely to have medicines given.   Many
people are much more anxious to get  an opinion  of  the
nature and tendency of their case, than to begin a regular
course of medicine.
   Every minute spent in studying to make your reme-
dies agreeable, will be more profitable to you  than half
an hour of any other kind of study.  Whoever now gives
much crude or coarse  medicine in ordinary cases, injures
both himself and his profession, and lacks one of  the
simplest  requirements of success.    Indeed, one of  the
greatest drawbacks to young doctors,  and one  of  the
chief reasons why  they do not  assist their brethren to
supersede pleasant quackery faster, is, that having their
attention riveted on their cases, and being anxious to get
the specific physiological effects of medicine quickly and
fully, they too often give them in crude forms,  forgetting
that the majority of sick people  are fastidious, and have
tastes and likes and dislikes that must be respected.
   Endeavor  to retain every  medicine-hater  that falls
into your hands;  such incorrigibles had better be under
your  care with rational supervision and small doses of
good  treatment, than to  be  paying somebody else  for
quackery or fancy nonsense.
   Keep  ever in your mind that many people seem to
be two-thirds spiritual and one-third animal, and that
others seem to be but one-third spiritual and two-thirds
animal, between  which  are all intermediate kinds.   If
you attempt  to treat all these alike you will certainly
fail.   The mental management of the sick  is often more 
115
difficult  than the  physical.  A close  study of mental
therapeutics is  one  of the necessities  that  the regular
profession  is  still  extremely  deficient in.   Irregulars
give a mere placebo or useless agent, which  faith on the
part of the patient potentizes.   Remember, that Dr. Diet,
Dr.  Quiet, Dr.  Hope and Dr. Faith are four excellent
assistants whose aid you should constantly invoke.  Dr.
Time  is also, in some cases, very necessary, but  he  is
slow and unreliable,  and unless Dr. Aidwell is  called  in
to assist, occasionally permits a patient to sink  into his
coffin instead of restoring him.
    Many regular physicians  give valuable, true reme-
dies,  and seem  to  despise  the  aid  of  Faith, Mystery,
Expectation  and  Hope.   They must  learn to depend
more upon the aid of hygiene,  diet,  and mental impres-
sions in  simple  cases, and less  on  large, crude doses  of
medicine.
    If you indicate to  a patient for whom you prescribe an
unpalatable medicine, at  the time  you  order it, that
it will have a bitterish or a saltish taste, or any other un-
pleasant quality, it will  prepare his mind for it before-
hand, and  will not seem so repulsive  to  him as if his
palate were taken by surprise.
    Remember that even a highly proper remedy may be
pushed too far, or continued  too long.   Indeed,  cases
sometimes  reach a point, at which it is  better to stop all
medicine, and depend on hygiene, diet, nursing, etc., at
least for a while.
    Avoid  as  far as  possible  the use of medicine that
must be taken ' through a tube,' that must be kept ' in
a cool place,' or  in ' a dark place '; on which ' no water 
116
must be taken,' or that the druggist must label ' poison,'
especially with doubters and medicine-haters.
   Some people will not send for you till they are truly
ill, for fear you will  throw them into bed or  salivate
them, or bring them woe, instead of relief.   Others will
be afraid  you  will give them  quinine, or injure their
teeth  with  iron, calomel, etc.,  or that if they  begin to
take medicine they  cannot stop.    Disarm all such people
by the assurance that their fears are groundless.
   It is popularly believed that quinine gets into  the
bones, destroys sight and hearing, causes  dropsy,  etc.
So firmly do some people  believe these things  that you
will have to humor their prejudices, and give them either
sulphate of cinchona, compound tincture or some other
preparation of  bark, when bark is indicated.
  This  prejudice probably depends chiefly on  the fact
that,  being powerful for good,  people  naturally infer
that it must be very  strong and powerful for evil.   We
know that it is really an almost  harmless vegetable pro-
duct that acts on malarial poisoning, not by great strength,
but through its antidotal  influence, just as water,  an
agent, harmless enough to drink, will subdue fire.
   Malaria is usually  contracted at night, but many
people are not aware of the fact  that it  can also  be
caught in the daytime, and should be put on their guard.
   Novel remedies often assist the cure through mental
influences ; for proof, look at the liver pads, tractors, amu-
lets, charms and dozens of other ideal remedies in vogue,
that the young and old, black  and white, educated  and
illiterate,  all kinds, classes and conditions of people are
praising almost as if they had fallen from the skies. 
117
    In prescribing, and even  in speaking  of medicines,
you should use officinal names instead of popular titles,
unless there is some special reason for using a synonym.
    Keep  yourself fully  informed concerning dietetics
and hygienics; also regarding the various health trips
and summer resorts: familiarize yourself also  with the
constituents  and  peculiarities of  the various mineral
waters and of the uses of each; of the comparative ad-
vantages of seaside and mountain trips, and of the classes
of invalids to  be benefited by  one  or the other, for these
matters belong strictly to the province of  medicine, and
it is particularly desirable to  understand them, because
they  are subjects that concern the better  and  more de-
sirable classes of patients,  with whom you will often have
to make medication, hygiene, medicinal waters,  trips, &c,
go hand in hand.
    The belief that taking water or ice is dangerous in
fever, is still very general.  People are wonderfully slow
in recognizing the fact that water, whether applied exter-
nally, or swallowed in small quantities at  a time, is one
of nature's greatest remedies in fever, especially if the
patient has a craving for  it.
    When you are  busy and wish to make a short visit,
do not tell the patient so, but  begin promptly to ask the
necessary questions, and do not let the conversation digress
from  his case  till you have  learned all that is necessary.
If the subject of the weather is broached, answer as  if
you were considering it only in  reference to its influence
on  the patient,  and go back to  his  case.  Economize
time thus ; but if your patient is at all ill, neither men-
tion your haste, nor show that you are in  a hurry until 
118
you have made your examination and written your pre-
scription.  After that,  if you  do depart promptly,  he
will not feel that your hurry has caused any inattention
to his case.
   It will often vex you, when you  are busy and time
is precious, to be kept  waiting below stairs while the
people prim and prepare to receive you in the sick room
with as much prudery as if the surroundings, instead of
the patient, were the object of your visit.  Show every
one the respect due to rank and sex,  but let such people
know that your time is too precious to waste.
    Never assign as a reason for being habitually late in
visiting a patient  that  you are over-busy.  Every one
wants a physician  who is in active experience  and en-
grossed in practice, but no one is willing to be habitually
slighted.   It is an  excellent rule always  to let  patients
know  at  your  visit  when  they  may expect  your
next visit, and go  as near  that  time as circumstances
will allow.   To do so gives satisfaction and  prevents
anxiety, and you will generally find them prepared  to
see you without detention or flurry.
    It is very  important always to ask to see the  medi-
cine as soon as possible, at your visit.   Ascertain by
both inspection and inquiry whether it has been  taken
according to your  directions,  before  you express any
opinion of the patient's progress.   If you neglect to do
so you may be caught confidently ascribing benefits to pre-
scriptions that have either not been filled, or to remedies
that have either been  thrown out  of the window,  or
emptied into the garbage-box, and you will be the victim
of a never-to-be-forgotten joke. 
119
   School yourself to avoid crude therapeutic and culti-
vate  conservative  remedies  instead  of  radical  ones.
Throw gross physic to the dogs.   Fame for not being he-
roic and not giving much strong medicine, is  a splendid
item in a physician's reputation, one that might almost be
adopted as a corner-stone.   Of course, when  duty actu-
ally requires you to act  promptly or to use powerful
remedies heroically, take the responsibility and do what-
ever is proper, without shrinking.
    Avoid  polypharmacy.   It is much better to order
some single remedy or a combination of which you know
the physiological effect, than an indefinite medley.
    It is proper to teach patients the laws of hygiene, and
facts that relate  to  sanitary  protection, that they may
preserve their health; but it  is neither just  nor wise to
teach any  but medical students  the secrets  of our  art.
Especially avoid giving self-sufficient people therapeu-
tical points that  they can thereafter resort to and ignore
the doctor.   If  you do, they  will soon imagine  they
know as much about medicine as you do, and not only
take your bread from you, but will  make  hobbies of
what you  teach them, and trifle with them  till, in  bad
 cases, the  patient's  disease is fatally  seated.  It  is not
 your duty to cheat either yourself or other  doctors out
 of legitimate  practice by  supplying  this one and  that
 one with a pharmacopoeia for  general use.  If compelled
 to give people remedies under  a simple form, study to
 do so in such a way as not to increase their  self-conceit
 and make them  feel that they know enough to dispense
 with your services;  use whatever  strategy is necessary
 to prevent such persons from  taking unfair advantage
 of your prescriptions. 
120
    It is unwise to instruct a person with  rheumatism,
gonorrhoea, ulcers, sore mouth, sprains or  any affliction
whatever, to get five or ten cents' worth of this or that
remedy to mix for himself, unless it be one of the very
worthy poor; because people are sure to abuse such orders,
and to try to teach every  one, similarly afflicted, how to
doctor himself.   It is better either to let such persons
have the  medicine from your  office, or to write them a
prescription  for it, with  instructions  neither  to repeat
nor lend.
    Do  not patronize any of the pharmaceutical catch-
pennies that are now flooding our land.   Resolve never
to  prescribe a proprietary remedy or one  covered by a
trade-mark; it is  better  to  avoid the use  of all ready-
put-up  remedies,  whether trade-mark, proprietary  or
quack, whether advertised to the profession or to the
public, whether the  so-called  formula is  given or not.
If you order A's Emulsion, B's Lozenges, C's Cod Liver
Oil, D's Pills and  E's Bitters, to patients, they will, by
association, soon think that X's Sarsaparilla, Y's Buchu,
and Z's Liver Regulator, also, meet with professional ap-
proval.   Determine that  you will not aid  any specula-
tor in life  and health to ' strike a trade,' in your families,
chiefly  for the reason that their nostrums do more harm
than good.   Also for the  lesser  reason  that justice  to
yourself, and to every other physician, requires you  to
avoid prescribing or telling of preparations that patients
can afterwards snap their fingers in your face and renew
as often as they please.
    Endeavor to have your prescriptions labelled so  as
to prevent indiscriminate renewal, as well as to prevent 
12 L
mistakes  in  their  administration; when they are very
important, have  the name of the patient put on  the
label.
    Remember this:   The  very best  time to  tell a
patient not to renew a prescription  is while writing it.
If you fear it will be renewed against your wish, stop
short while writing and remark to him that it will be a
good remedy, or make some other true remark about it,
but that he must take only one bottle, or  that  it must
not  be renewed.   Your order given at that time will
seem to  be founded on some  motive other than that of
protecting your own pecuniary  interest,  will  impress
him strongly and will be invariably  obeyed ; this is pro-
bably the best of all ways to  prevent prescriptions from
being renewed and adopted as  a regular resort in similar
cases.  With this exception make it a rule neither to talk,
listen  to, nor  answer questions while writing prescrip-
tions.
    Never write a prescription carelessly.   Cultivate  the
habit  of  scrutinizing everything you write after it is
written, to assure yourself that there is neither omission
nor mistake, and sign your name or initials to every one,
but not  till  you have  looked and seen that it is as in-
tended.
    In consultation, the prescription agreed upon should
be written by the  regular attendant, and  if the consul-
tant is still present, should be submitted to  him for in-
spection;  but  only the  regular  attendant's name  or
initials should be signed to it.
    A very, very  useful rule in some cases is to name the
hours at  which medicine is to be taken;  thus, if it is to
       8 
122
 be  taken every five hours, instead of writing  " a  tea-
 spoonful every five hours," write " take a teaspoonful at
 7, 12, 5  and 10 o'clock daily."
    Neither alarm your patients nor their friends, nor risk
 the dangers of the chloral or opium or other bad habit,
 by  allowing them to know they are taking such articles.
    If you instruct a patient how to use the hypoder-
 mic syringe on himself, or to inhale chloroform or aether,
 he will probably adopt the habit; if he does,  you will
 surely and deservedly incur the  blame.  If  suffering
 people have any chance at all to blame their bad habits
 or their  enslavement on you, they will rarely fail to do
 so.
    Remember, when giving directions in regard to doses,
 that teaspoons vary greatly in  size.   A teaspoon should
 hold sixty drops of water.   By dropping sixty drops of
 water in a  wineglass  and marking this with a strip of
 paper  pasted  on its outside, a patient can save much
 trouble and uncertainty in cases where medicine is to be
 taken for any  length of time.  A graduated tumbler or
 medicine glass is however more convenient  and precise.
 A minim is a definite  quantity, a  drop is  not; there-
fore, in prescribing potent fluids, order minims instead of
drops.
    Never turn your cases  over to ''specialists" unless
 they have features which render it an actual duty to do
 so.  If you refer every case of eye disease  to the ocu-
 lists, every  uterine case to the gynecologists, ear cases
 to the aurists, surgical  to surgeons, and so on throughout
 the list, you will lessen your own scope, and soon lose all
familiarity with the affections that specialists treat,  and 
123
will degenerate into a mere distributer of cases, a medi-
cal adviser instead of a medical  attendant—studying
everybody's interest except your own, and making repu-
tation  for them out of  that  which sinks  your  own
individuality and destroys your own fame.  A good rule
is this : whenever a case proves wholly unmanageable by
usual treatment, or is so grave in prognosis as  undoubt-
edly to require broader  shoulders  than  yours to bear
the responsibility,  either call in a  specialist to aid in
its management,  or  turn  it  entirely  over  to him.
Timidity  and infallibility are both bad  traits in  a
doctor, but the former is  the greater drawback.
    When you  transfer  any one  from your care to  a
specialist's, always do so either  by a consultation,  a
letter, or  a  personal interview with him, that  he may
learn  directly  from  you,  your   diagnosis, prognosis,
treatment,  etc.   You  will  thereby give  him  the
advantage of what  you know of  the  case,  and also
prevent the  risk of an injury to  your reputation from
an apparently radical difference of  opinion between him
and you—besides, it  secures your graceful retirement
from the  case.
    Ask for a consultation in all cases where you think
either the patient's interest or a division of the respon-
sibility demands it.    When  from  any  cause you see
necessity  for one arising,  try to anticipate the family by
being  the first to propose it.  When  you have  bad
surgical and other  cases among your personal friends or
relatives,  or severe cases so near home as to involve you
personally or socially; or in a neighborhood  in which
a group of patients  are  likely to  be  unfavorably im- 
124
pressed  if  the  result  is  not good,  it  is  especially
necessary and wise  to have  a consultation, so  as  to
satisfy them, and at the same time relieve yourself of
too much direct personal responsibility.
    If  possible,  always  have  physicians selected  as
Consultants, who will add  to  your efforts by  exhibiting
knowledge and skill, and who will at the same time be
likely  to harmonize with  you in the management of
your cases;  for their sympathy and kindly support may
be  highly necessary for the patients' welfare, and for
your own reputation.
    In your consultations you will often feel great anxiety
and suspense while you are waiting to see  whether the
consulting physician will  be fair  towards you in  the
case, or whether he will shrewdly expose your deficien-
cies to a few, to  be told to  many, till  you are killed in
the estimation of all  to whom the case is related.  To
the honor of our profession be it said, the vast majority
of its older members are not only punctilious,  but really
kind to the deserving on these occasions.
    A radical change of diagnosis or of treatment, as the
result  of a first consultation,  often naturally  impresses
upon the laity that the previous diagnosis or treatment
has been either faulty, or actually wrong, and as a rule
no material change should either be proposed  or allowed
at that time, unless some real  necessity requires it.  As
a rule, the fewer apparent changes resulting from a first
consultation, the better for the regular attendant's repu-
tation ;  especially if he is a young doctor.
    When a consulting physician is designated and called
at your  request, you should  see  that  the  payment of 
125
his fees is not neglected ;  you  might with  propriety
broach the subject  before he quits, to those who are to
pay the bill.   This can be done by privately informing
them that his charges will probably be somewhat less if
paid  at  his  last  visit,  than if they  wait  for  him to
send  a  bill,  which would then be  for  the  maximum
amount.   His relations  to the case  suppose him to be
thinking of its scientific  and therapeutical aspects, and
hot of his  fees.   You can, in  such a case, speak much
more plainly for your  brother physician  called at your
instance, than  you could for yourself.   Prompt pay-
ment of the consultant's fee will sometimes even  bring
about a more prompt payment of your own.
    Unless the consulting  physician  gets his  fees cash,
or you  are aware  that  special  arrangements exist for
their payment, be very careful to inform the  people as
soon as he ceases coming, or at any rate before the time
arrives for sending them your bill, whether he will send
his bill separately from yours or not.   If you neglect to
explain this to them, they will almost surely think you
ought to pay him out  of your fee, and  a misunder-
standing will result as  to whether you or they must pay
his bill.
    Be punctual to the moment in keeping consultation
engagements.  You have  no right  to waste  another's
time  in that way; besides, it is constraining and any-
thing but  pleasant for one physician to be kept idly
waiting for another at  the place for consulting.
    When you consult with other doctors,  whether in
your cases or not, it is  right to charge the same  amount
for your services as the consultants charge for theirs— 
126
you  lose as much or more  time than they do at each
consultation, your reputation is equally or more involved
than theirs, and there is no reason why your fee should
not be equal to theirs.
   In dispensing with  the  consulting physician when
his services are no longer necessary, take care to make
him feel that it is done  amicably.
   A  patient  has a legal right to dismiss you from a
case,  and  you have also  a  perfect right to relinquish
attendance  on  him at any time.  Indeed,  you  may
sometimes  find  yourself  so hampered,  or harassed or
maltreated in a case, that to retire from  it is your only
alternative.
   Remember  that  you  have  the right to  refuse to
consult with any one you deem unprofessional, or un-
suitable to the  case, also any  one who is  personally
objectionable to you, or in whose keeping  you deem your
reputation  and interests  unsafe.  If you are attending a
case  and such  a one is pressed  upon you, you have  a
perfect right to retire.   Fortunately, such dilemmas are
very rare.
   Neither refuse to consult  with foreign  physicians,
with  doctresses, nor with  colored doctors,  provided
they  are  regular practitioners, nor even with under-
graduates  if they  are  advancing  in  the regular line
towards their M. D.  You have no moral right to turn
your back on sick and  suffering humanity, by refusing
to add your knowledge  and  skill to that of any honor-
able person whose professional acquirements and tenets
give him a right to  work in the professional field   It is
not only unmanly to throw obstacles in the path of the 
127
 less favored, but such a  spirit is wholly  incompatible
 with the  objects of our art, and at variance with the
 spirit of  science,  which  is  cosmopolitan  and knows
 neither  caste, pride nor prejudice, and has no bounds
 except those of truth and honor.  But  your love  of
 these twin virtues, truth  and honor, will  prevent you
 from  ever entertaining a thought of consulting  with
 Eclectics,  Homeopathists, Hydropathists,  or other ir-
 regular  practitioners, under the specious  plea of duty
 to humanity.   Let  their retirement  be  the prime
 consideration under which you assume charge.
    Be exact  in  everything that relates to  consultation.
 Let them  always  be  formal  and strictly private;  con-
 sult within a  room; exchange thoughts in an undertone,
 and out  of the sight and the  hearing of eavesdroppers.
 Never allow any one to be present at a consultation ex-
 cept the doctors  engaged in it.
    Remember that consultations are called for  the pur-
 pose of deciding for the future, not to criticise the past;
 but if you are called  to consult in a case, and  find the
 attending physician is suffering unmerited odium for his
 previous management, every principle of honor should
 impel you  to volunteer to defend him.
    Never  express  an individual opinion of a case seen
 in  consultation  except  in  strict  accordance with  the
 Code.  If  you do, those whom you address may, either
 unintentionally or purposely, misinterpret what  you say
 or otherwise involve you.
    If you  are requested by letter or  by a messenger to
prescribe for an  out-of-town patient who is not under
the care of any other physician, it is perfectly professional 
128
to do so if you wish, even though you may never have
seen the case.
    If a professional friend for any reason requests you
to see a  case  with him, not so much for the  patient's
sake as for his own benefit, you  should do so,  and that
too without charge.
    Avoid decrying and ridiculing medicine to the laity,
and boasting of your own and the general ignorance of
disease and of remedies; and suppress all other fulsome
confessions.   When a  physician  speaks  thus, he means
it relatively only, means to say that medicine is not an
exact  science; but the  public cannot appreciate the
sense in which such confessions are made, and they work
an ounce of harm to the doctor who makes them, and a
pound of  harm to the  profession  at  large.   Because all
who hear or read  them conclude that medical practice
is only a  tissue of uncertainty and confusion, and  ever
after either do not employ  physicians at all, or do so
with utter distrust.
    The truth  is, physicians are far more imperfect  than
physic.  For  instance:  there are  undoubtedly medi-
cines whose action is diuretic; but diuretics may be given
when not indicated, or  the diuretic given may not be the
proper one, or  it may be wrong in quantity, or  be given
at improper intervals,  or proper  restrictions for  its use
may  not  be enforced.   Now  none of these errors are
justly chargeable  to  the  class  of  medicines  we  call
diuretics, but are plainly due  either to the doctor s bad
judgment or to his ignorance.  The fact is, all  physi-
cians know of very nearly the same remedies, but  skill
in curing with them consists in selecting the  proper one, 
129
in proportioning the dose, judging the time, etc., just as
different persons essaying to  paint will exhibit different
degrees of success, one attaining wonderful skill, another
reaching mediocrity, while a third fails in his attempts
and quits in disgust; this difference in result being  due
not to  a difference  in  the material or colors  at the
command  of each,  but  in  the more or less excellent
judgment and tact shown by each in selecting and using
them.
    Ability to determine accurately the  condition of a
patient, and to conceive  and to do the right thing for
him at the right time, is the essence of skill, and is the
chief difference  between successful  and  unsuccessful
doctors, and is the great secret why the prescriptions of
some medical men are much more valuable than those
of some others.
    A proper use of  medicines, instead of a wholesale re-
nunciation of  them, is a leading characteristic of a good
physician.   When you hear of a doctor  who wishes to
be considered especially clear, or ahead of others, or ex-
traordinarily fair  in his opinions, boasting that he " does
not  believe in drugs," " depends on nature," etc., you
can safely  conclude  that in his zeal to become a medical
philosopher, he has either lapsed in his materia medica,
or overstates  his  credulity, or  that  his  usefulness has
run to seed.
    Does the mariner lose his faith in navigation because
ships are tossed by the winds and waves,  and sometimes
wrecked ; or, does the farmer lose his faith in agriculture
because droughts and grasshoppers sometimes ruin his
crops ?   Would any worthy sailor fold his arms  and do 
130
nothing while  the storm raged, or any  philosophical
farmer neglect to plant again when the season returned,
because  the sailor's  brightest  hopes  are  sometimes
crushed, and  the farmer's fairest  prospects are  often
blighted ?
    Is there a physician on earth who would let inter-
mittent or any other malarial fever take its course with-
out drugs ?   Or who would let the syphilitic and other
poisons develop or progress unattended?   Is there  a
graduate anywhere who confesses he can do  nothing for
pain or for fever,  for nervous  complaints, for digestive
affections, or chest diseases; nothing for the  circulation
or delirium, or insomnia, headache, epilepsy, hysteria,
gout, neuralgia, worms, colic, acidity, peritonitis, con-
stipation,  diarrhoea, anemia, scurvy, etc. ?—If there is a
doctor in the land who has never seen medicines restore
health or prolong life, who does not sincerely believe in
his power to benefit by drugs  some of the twenty-four
hundred diseases and modes of decay to which mankind
is subject,  he should  at  once, and  forever,  for con-
science' sake,  and for the sake of the afflicted,  take
down his  sign, and no longer pretend to practise.
    The tolerance  of disease has greatly increased in the
last few  decades, and  is  still  increasing, and medical
theories  and  practice  are undergoing  great changes.
Observation  is  constantly  teaching us  to distinguish
more clearly between  the  multitude of  simple  self-
limited cases daily met with, and the few that threaten
a fatal  issue,  and of course  we of to-day  use  much
lighter remedies for the former than our  predecessors
did; but  it is  doubtful  whether in real sicknesses we 
131
have at all lessened the doses.   You now give twelve or
fifteen grains of quinia daily for the intermittent, where
physicians formerly gave half an ounce or an ounce of
crude  bark containing but six or eight grains.  You
give the  same dose  of opium, or its  representative,
morphia, to-day when  indicated, as they gave a hundred
years ago, the same quantity of castor oil at a dose, and
about the same throughout the entire materia medica.
    We of to-day know that three in  every ten of those
who send for doctors need  no positive medication;  and
nine of the ten would  get well sooner or later by proper
hygiene and intelligent nursing and  dieting,  if there
were not a doctor in the world; and we are naturally
prescribing less and less.   In children's  diseases especi-
ally, we now, in many cases, trust almost entirely to
nature and placebos, and see  them get well  from what
look to be alarming conditions almost as if by magic.
    The real  secret, the very  foundation, of the success
of various systems of practice that have arisen within
the last century, has been nature s disease-limiting power,
and  "-Allopathic" adjuvants,  adroitly interwoven with
hobbies that  have  but little value except  as advertise-
ments.  Homeopathy, the ism that Hahnemann created
in 1 796, got  an extra  start because it arose just when
humoral pathology  had  satiated the world with crude
remedies administered irrespective of form, taste, etc.,
and all were  anxious for some change.   It  has become
the chief delusion of our day, and has captivated many
of those who, through disgust  at our crude therapeutics,
have joined  the opposition  and gone to an extreme re-
actionary  limit.   It has lasted much  longer  than  it 
132
would have done, had not the regular profession been so
slow  to  give up crude  forms, over  medication, etc.
Were  any one to originate  such a  system  to-day, it
would be still-born.
   You can neither endorse nor follow its nonsense and
follies, but you also can follow the fashion and can  give
to every fastidious or squeamish patient the smallest
and  most pleasant dose that his safety will permit, and
can avoid giving any  one crude remedies to a disgusting
degree.  Aim earnestly to please every one's taste and
ideas of  medicine as  far as compatible with his  safety.
Also, avoid over-drugging, and  remember  that those
who have been most  fond of medicine often become sur-
feited  and undergo a complete revulsion against both
medicine and  doctors.  How can this be wondered at
when even too long  a continuation of beefsteak or par-
tridge or oysters, or  other choice  food,  causes  disgust
and  utter loathing even in well people ?
   You  are  bound, as if by an  oath, to use your  best
judgment for  even'  one who puts himself under your
care, but neither the  Code of Ethics nor the Code of
Honor prevents you from sailing as near  to every popu-
lar breeze as truth and justice will allow.
   Unfortunately, when a case actually requires medica-
tion, you can make but little, if any, rational use of the
so-called " Homeopathic" principles,  which rest  on the
following foolish creed :—1st.  Curative remedies for the
sick  can  be selected only by a study of provings on persons
in health.  2d.  Every remedy must be given by itself.  3d.
The  similar and single remedy must be given in its mini-
mum dose, i. e., the smallest dose sufficient  to effect  a cure 
133
in  the  case.  These are the  three legs upon  which
Hahnemannism is supposed to stand ; an essential triune,
an  inseparable  unit.  Violation  of any  one  of  these
principles by the faithful is a confessed rejection  of the
whole.
    You will observe that this  creed  is exactly  two-
thirds delusion ;—that the first and second postulates are
sophistical and should be rejected, and that the last is a
rule that every rational medical men has recognized
ever since the days of Methuselah,  and cannot, in any
sense, be monopolized by Homeopaths.
    Contrary to what many  unthinking people believe,
this creed gives the Homeopaths perfect liberty to give an
atom or an  ounce of lime, salt, sugar, or anything else,
at a dose, provided they proceed on  the homeopathic
principle of similars; and the question whether he, or you
or any one else does or does not practise Homeopathy does
not depend upon the size of the dose at all.   They might
give an ounce of a medicine in cases in which you  would
give but a  grain.  Their ounce  would not make them
rational physicians, nor your grain make you a homeo-
pathist.  Here  is the true test: Were you to examine a
patient  and  ask yourself, What  is  the  best treatment
known in  the  world for a case like the one before me ?
and  give   that, without  regard  to  either  creed or
boundary, you would  be practising rational  medicine.
If, on the contrary, you were to examine a case and ask
yourself, What would produce a totality of symptoms
similar to these in a well person ? and prescribe whichever
you thought would come nearest to doing so, you  would
be  practising homeopathically.  Now, I am confident 
134
that if you practise forty years, you will never sit down
by  an ill  man's  bedside and  ask yourself seriously,
" What agent would produce a disease similar to this, or
symptoms similar to these in a well person ?" and attempt
to deduce therefrom your line of treatment.   And, to be
more specific, I am also confident that you will  never
seriously entertain, much less follow, a system of medi-
cine that, in seeking similars, arrives at Poison Oak as a
remedy for Erysipelas, Arsenic as a remedy for Rheuma-
tism, Croton Oil  as a remedy  for Cholera  Infantum,
Mercury  for  Mumps,  Tartar  Emetic  for Typhoid-
Pneumonia, Opium for Apoplexy, and a countless myriad
more of utterly utter nonsense.   Therefore take care to
remember that no matter  how  small  your dose,  even
though  you  prescribe only teaspoonful doses of  aqua
pura, or even let  your patient smell  an empty bottle,
it will not be practising homeopathically.
    You will find that nine  out of ten  of those who run
after sugar powders and pellets, know absolutely nothing
at  all about the  Hahnemannian principles, and  take
them themselves and give them  to their families solely
because they are dainty and easily taken.
    Some  of the unreasoning laity  may think you are
illiberal in refusing to fraternize with homeopathists and
other irregular practitioners.  Remember that the great
principle which underlies our refusal is this: as lovers
of all truth, we have no fixed, no unchangeable creed,
but hail with  delight every  discovery, no matter by
whom made,  and  take  by the hand any one who is
liberal enough  to consecrate his  life's labor to suffering
humanity; but when we know that a certain person 
135
circumscribes himself and practises a Botanical system
only, or a Homeopathic system only, or a Hydropathic
system only, or any other one-idea system  only, and is
so tied  down  to  that, by his love, or his bigotry and
prejudice, that he denies the  truth and  the usefulness
of all  other means of aiding suffering  humanity, all
rational physicians esteem him too illiberal to be a true
physician, or for  fellowship with those who profess to
love all  truth, and  justly allow  him to  remain joined
to his exclusive system.
    Study the  Organon of Medicine, by Samuel Hahne-
mann—Homeopathy  Fairly Represented,  by William
Henderson,  M. D.—Hull's  Jahr—Hughes' Pharmaco-
Dynamics—Hale's  New Remedies, and  other leading
Homeopathic  productions,  and  you  will  then fully
realize what an amazing  folly Hahnemann started, and
why we  reject it, and will also see how men can mis-
take the workings of nature, and of faith and credulity,
for the  effects of—nothing—till  their  delusions com-
pletely pervert their reasoning powers.
    Homeopathy  would  have  been  absorbed into ra-
tional medicine before we were  born, if it had been
worthy of absorption.
    Nothing under  heaven  prevents  you  from  doing
whatever you think best for your patient;  but if in so
doing you adopt a narrow or foolish dogma, and preju-
dice your mind  against all other ascertained truths,
your partisanship will fetter you, abridge  your  useful-
ness, and make you unfit for fellowship in liberal medi-
cine.  Thus, when  Vincent  Priessnitz shut  his eyes to
everything  but Hydropathy,  and Samuel  Hahnemann 
136
tied himself to the  Homeopathic notion, and rabidly
denounced  everything  else, and  Samuel Thompson
threw away everything  but Herbs, they  circumscribed
their own  usefulness  and  that of  all  who follow
them.
     " For never yet hath one 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."
Not a single department of medicine has yet reached
scientific  exactness,  and  possibly  never  will.   We,
legitimate physicians, are  striving hard  to   bring  its
various branches  as near to perfection as possible, and
are willing  to learn medical  truth and  scientific wis-
dom  wherever  they can be   found.   When  " New
Schools" arise, if they  contain any  new or valuable
truths,  no difference  how great or how  small, we  in-
stantly incorporate them with the great mass to swell
the records of rational medicine, so that the truths pos-
sessed  by our profession to day form an aggregate of
knowledge which, if put  into one book, would make it
thick enough actually to reach the skies.
    The Homeopaths and all other irregulars cunningly
sneer at the regular profession and style  us " The Old
School," "Allopaths," etc., to  make it  appear to the
public that ours is but one of many systems, effete, good
enough in  its  day,  but now  behind the  times,  etc.
Their aim in doing this  is to obtain  the advantage of
appearing to stand fully equal to us, just  as in politics 
137
we  see  Republicans  versus  Democrats.   You  know
that nothing could be more false.
    Remember that the  title " Allopath " is applied  to
us  by our enemies with sinister  motives,  and is both
false and offensive, and is not recognized by regular phy-
sicians.  Take care to disclaim it when any one applies
it to you, whether done  through  enmity or ignorance.
    An Allopathic  physician would  be one whose creed
required him to substitute some  other  disease for the
one he was called upon to treat.   There is probably not
an  Allopathist in the world, and it is doubtful whether
there ever was one.
    When people ask you " what school you practise,"
answer them that you have no special creed  and practise
no  particular school, but  that,  like the bee, you try to
be  rational and take the honey of truth wherever you
find it.
    Strange to say, the public, blinded by sophistry and
swayed by false sentiment, invariably sides with the
" new school " or the quack, or anybody else, whenever
a contest arises between  any  of them  and us.  Even
the newspapers, religious as well as secular,  seem  to
delight in aiming sharp shafts at  the regular profession
by  making invidious comparisons  between  its modes of
practice  and  theirs—telling of their wonderful  success,
of their  steady growth in public  confidence, etc.  Edi-
torial and other authoritative productions are frequently
written on our exclusiveness, our  bigotry, etc.;  our dis-
agreements, too, are magnified,  and reported in  a sensa-
tional way, all apparently to decry us, and enhance the
interests  of irregulars and quacks.
      9 
138
    'Tis said the Chinese are so expert in making much
out of little, that they live and fatten on what a Cau-
casian wastes.  In the same degree, Irregulars thrive on
the quickening influence of mystery, the emotions, expec-
tations, faith, hope, etc., while  you, with your mind
fixed on more tangible aids, neglect them far more than
you should.
    You will  find that if a person happens to get better,
even  of an ordinary case, while  under the care of an
Irregular,  or  when  taking  a quack  medicine,  it  will
receive a thousand praises; if twenty get well by your
remedies, it will scarcely excite a comment.
    Many Irregulars have another source of eclat.  They
elevate what you would call a slight cold  or  a quinsy,
into a  "congestion of  the  lungs,"  or a  "bronchial
catarrh," or a " touch of pneumonia," " diphtheria," or
" post-nasal catarrh."   They dignify  what you  would
call a disordered stomach into a " gastric affection," a
wind  colic into "borborygmus," etc., for  the cure of
which huge ailments they are fully credited  and fully
paid.   There is a  fellow in our section who manages
his patrons  so  adroitly that he often  actually reaps
manifold more credit and patronage for stopping a chill
and fever in seven days, than a true physician would for
doing the same in two days—other ailments in propor-
tion.
    Another reason why Irregulars get cases is,  that if
a physician grows tired of a case and loses interest, or
the case gets  tired of him and loses faith, the family is
apt to desire a change of doctors, and fearing the attend-
ant would  become  offended were they to  dismiss  him 
139
and employ one of his brethren, they get an Irregular,
under the belief that the doctor will  feel less hurt if
they dismiss him under the plea of trying " a  different
system" of doctoring, than on any other pretext.
    Still another reason why Irregulars get patrons is
this.   They take care to announce that they cure by Mild
Powers or Harmless  Methods, instead  of by painful or
dangerous treatment,  or bloody operations, or other der-
nier ressorts that science teaches us to use—against all of
which they have  aroused much of the existing foolish
prejudice and abhorrence.
    So great, indeed, is the popular dread of what doc-
tors might do, that in choosing an attendant from among
Regular physicians, the nervous  and the timid, who con-
stitute nine-tenths of  all the  sick, are  greatly inclined
to shun all who treat heroically, and  seek those who
use moderate, even though less efficient, means.
    Everybody wants  a lucky, conservative doctor;  there-
fore, a series of dystocias or of deaths in child-bed, or of
surgical operations that fail, or of cases  of any kind that
eventuate unexpectedly  ill, often injure the physician
for years, by attaching to him—especially if he is a
beginner—either charges of being blind to danger and to
duty, or a long-to-be-remembered reputation for bad luck.
    As rational liberal physicians, we, unlike the various
"limited schools,"  accept all truths, whether winnowed
from  past experience or  discovered  in our own  days;
and stand ready to receive and  utilize  any and  every
valuable discovery, no matter when, or  by  whom made.
This explains why Ours is a liberal profession, and why
the Physician takes  rank with the Lawyer  and  the 
140
Clergyman.  This trio  of  professions  was  long ago
styled " The Liberal Professions," because their  devo-
tees have,  in all ages, pursued them as freemen, subject
to no  bonds except those of Truth.  If at any time
during your career, any sect, or school, arises, no differ-
ence how great or how humble its pretensions, if it has
even one grain  of wheat to a bushel of chaff, it is your
duty to seize the grain of wheat and utilize it, and cast
the chaff to the winds.   This adaptability is our strength
and our glory, and is the element that will make regular,
liberal, rational medicine exist as long as  there is sick-
ness and suffering in the world.
    Homeopathy makes  a specialty of poisoning the
minds of its votaries, as with a virus, not only against
the  lancet, polypharmacy, and other  needlessly active
measures, but against all rational remedies; and inclines
them to a  morbid  watchfulness  over the minutiae  of
their health, which eventually makes them morbidly
anxious, and  fills their minds with a medley of im-
aginary and exaggerated afflictions that haunt them like
Banquo's Ghost.   You will often see perfectly healthy-
bodied persons, who might have passed through life with
scarce a thought of sickness, after adopting its follies,
become borne down by numerous magnified  symptoms,
and  constant indications for  pellets and  attenuations.
We have a very wealthy, but very silly, lady in our sec-
tion, who has become so imbued with it, that besides inces-
santly  dosing herself with pellets, she actually plies her
birds with them whenever they fail to sing, and her
kittens when they fail to mew.  Other devotees, as if to
perfect the  folly, have given them to turkeys, sheep, dogs,
cows, chickens, horses and—geese. 
141
    Do  not infer that  a genuine  Homeopathist may
not be following Homeopathy conscientiously, for there
never  has been  an  absurdity  in  regard to religious,
political or medical questions, that has not found very
sincere supporters ; nor that Homeopathists do no good,
for they do a great deal of good; but  the good they do
is not by similars, as  has been proven  by innumerable
observers, but by the accompanying Hygienics, Dietetics,
Faith, Expectation, etc:, which  would  do equally as
much were the similars left out, and atoms of taffy, or
sawdust, or  anything  else, substituted, to give their
patients  room to  exercise their  faith, arid nature, time
and opportunity to do the work.
    God  help afflicted  humanity, were genuine  Home-
opathy the medical man's only reliance in his struggles
with disease.  Think for a moment  of a group of doc-
tors entering the Lazar House  depicted by Milton in
Paradise Lost, to combat the afflictions  of that Protean
assemblage  with  genuine  similia  similibus.    True,
while ministering to mucous catarrhs, nervous headaches,
palpitations,  functional  dyspepsia,  tonsilitis,  catarrhal
croup, chorea, uncomplicated exanthemata and slighter
affections that have a strong natural tendency to  recov-
ery, they might, with a little adroitness and the £ree
use of adjuvants, make themselves appear like magi-
cians :  but when  they approached  maladies  which,
unless thwarted by the truest of medicines, have a tend-
ency to overwhelm and destroy, they must know in their
hearts that they would  be like foolish soldiers who had
abandoned  their  rifles  and artillery,  and  with  puny,
valueless shotguns gone to trifle  with powerful foes. 
142
   The truth is, if a man has a sickness in which  the
tendency is to death, medicines given on the principle of
" similia, similibus curantur" will not, cannot avert that
result; while some of the  agents that  experience  and
reason offer, and rational physicians use, might  restore
him.
   The novelty of globulism, like spiritualism and mes-
merism, aims at  one of the strongest  qualities  of the
human mind, a quality that  we  might  utilize more
fully—the love of the wonderful.
   That  other,  that truly Homeopathic  novelty,  the
dynamization of medicines, that they from the  time of
Hahnemann  have talked so much about  to the inno-
cent,  is  simply a  wonder-creating  something made of
nothing, whose  chief use  is  to  amuse the feeble.  It
bears about as much relation to the science of medicine
as  the kaleidoscope does to  the science of Astronomy.
   When chance brings you in contact  with  a genuine
Homeopathist, if you believe him  to  be  a gentleman,
(true Homeopathists are usually very  respectable  and
upright,)  treat him exactly as you  would  any other
gentleman, but  ignore  him professionally, and never
allow yourself to fraternize  with  him in the management
of a case.  But, have nothing, emphatically nothing, to
do with  the  Pseudo-Homeopaths,  who masquerade as
homeopaths by a display of Hahnemannic nonsense, just
as ostrich hunters assume to be ostriches by dressing in
that wise  bird's feathers.   Many of these fellows simu-
late  the  genuine by carrying awe-inspiring satchels, as
guardedly as  if an additional shake of the dynamizations
they contain  might  still further increase  their  potency 
143
and  cause  an explosion.  Carefully search the satchel
and  the pockets of one of these Fashionables, and you
will not only find  the  usual  attenuations, triturations,
tinctures,  and  globules;  and  Lehrman's,  Durham's,
Lentz's, and  Finck's High Dynamizations ranging from
the 800th  away up to the terrific (nonsense that would
not vary^ the ailments of a fly) potency of an 86,000th,
but, search a little  further and you will also find a full,
a very full supply  of Wm. R. Warner's,  W. H. Schief-
felin's, Sharp & Dohme's, and other varieties of sugar-
coated granules of Morphia, Quinia, Arsenicum, Bella-
donna,  Eleterium,  Colocynth,  etc.  Be not  startled if
y^ou  also find  a hypodermic  syringe and  a bottle  of
Magendie's Solution—damning witnesses of  his  lack
of honesty, and of his lack of faith  in  what he pro-
fesses.  Respect every sincere believer in a false system,
no difference how great  his error, but,  let the finger of
scorn point for ever at  each and every double-dealing
hypocrite who vilifies and sneers at "old  school"  reme-
dies while slyly using them just as we do in full  doses,
and crediting the good they do to  Homeopathy!
    There  is  also another class,  much less numerous,
thank heaven !  than the last, who, chameleon-like, are
all things to all men, who actually offer to practise any
way people wish.   These are not as bad as the last, for
they are at least honest in their announcement.  But
what would you think of a  clergyman whose  love  of
gold, and lack of scruple, would allow him to vary his
principles  at  will  and  preach anything  you wished,
whether a strictly Catholic lecture, or an ultra-Protestant
discourse, an orthodox Hebrew sermon, a fiery Moham- 
144
medan philippic, or an  out-and-out infidel harangue?
Show a decent respect for the conscientious Homeopath,
but shun  both  the bogus and  the any-way-you-please
fellows as you would the plagues of Egypt.
   Remember that the law recognizes all kinds—Thomp-
sonians  and  Eclectics,  real  Homeopaths  and  bogus
Homeopaths, the Any-way-you-choose and the Hydro-
paths, Indian doctors and Midwives, precisely as it does
the regular profession; and if you ever occupy an official
position, you will have to recognize their certificates of
death,  vaccination, life  insurance,  &c,  the  same as
those of legitimate physicians;  in a word,  you  will
have to recognize, officially, every person that  the  law
recognizes.  This necessity renders State Medical Laws
and  State Boards  of Examiners,  organized  to  break
up quackery (?)  and prevent malpractice (?), of very
doubtful utility.
   But few of the really sick who  give these false  and
one-idea systems a trial, become converts.   Many think-
ing people, persuaded into trying them, soon detect their
fallacy,  their insufficiency, and when true  disease attacks
them, they return to the blessings of rational medicine.
Therefore be careful neither to banter, irritate, nor aban-
don  people  who are  trying false  systems,  lest from
combating them  and  forcing argument you drive them
into  these vagaries permanently.   Should they even
contend that the earth is three-cornered, or that Homeo-
pathy has saved  their lives, or that pumpkins  grow on
trees, do not combat them too fiercely.   Pride of opinion,
and determination not to be browbeaten into recantation,
are unfortunate  impulses  to  arouse, especially in silly
people. 
145
    If, in  condemning any irregular  system, you  will
be  careful  not  to denounce it with  too much  vio-
lence, and to confine  your condemnation strictly to the
abstract subject, as if from conscientious devotion to the
truth ; and  will avoid appearing anxious to excite  hos-
tility towards the individuals who practise  them  hon-
estly, your reasoning will have a great deal more weight
with  the community,  and  will  exert much greater
influence.
    You will occasionally be called again to families  who
strayed in disgust from regular medicine long ago, when
bleeding, etc., were fashionable, who  will  be surprised
to learn that you no longer bleed and salivate, as they
imagined.   If you are careful, most of  these can be
permanently reclaimed.
    It  is well to look into the principles of Mesmerism,
Homeopathy, Hydropathy, Galvano-therapeutics, Spirit-
ualism, etc., to enable you to speak of  them from  per-
sonal knowledge, and to checkmate their representatives,
who make great  capital out of knowing  all about the
" old school system" which  they, of course, aver does not
compare with the "new school."
    Bear in  mind that competent medical men all  over
the world,  in the interest of truth  and  of suffering
humanity, investigate and test all so-called systems, both
in hospital and private' practice, when they arise, and the
conjoined  result gives us a true common-sense verdict;
and it is no  more necessary for every succeeding genera-
tion to re-test every  unreasonable medical vagary be-
fore rejecting it, than it is for  every one to study Spiritu-
alism and  the  Book of Mormon before condemning
them. 
146
    Over-dosing, blood-letting,  salivating,  purging, etc.,
are now justly unpopular, and  ultra-conservative, recon-
structive medicines are in fashion.   Almost every one is
filled with the belief that he is debilitated.  Say to the
average patient, 'you are weak and need building up,'
and you will instantly see by his countenance  that you
have struck his key-note.   So much is this  the case,
that many of the  sick, fully impressed  with this idea,
will want you to treat them with tonics  and stimulants,
even when their condition is such  that these medicines
are not at all indicated.
    You must learn to distinguish cases in which you
can safely depend  on  nature,  from  those  that nature
cannot overcome, and treat  each accordingly;  for when
you learn to recognize  those that need an ounce of med-
icine and a grain of policy, and those that need an ounce
of policy and  a grain  of medicine,  you  will enter the
road  of wisdom.   Handle  all who have  treacherous
stomachs, and the  fastidious, and  the homeopathically
inclined, with kid  gloves.   The recent  great  improve-
ments in the forms and  palatability of  medicines offer
y-ou splendid opportunities  to  do  this.  Neither  offend
their eyes,  their palates, nor their  stomachs, and you
will succeed where neglect  of  these precautions would
cause  failure;  give hypochondriacs, dyspeptics  and
others, who are fond of your attention, but not of your
medicine,  small, tasteless or palatable  remedies, and,
unless there is a real necessity  for  it, do  not oblige any-
body to take medicine before  breakfast, or  during the
night.  Make free use of the elixirs, and the large line
of sugar-coated granules of arsenious acid, corrosive sub- 
147
limate, cannibis indica, nux vomica, morphia, podophyl-
lin, strychnia, etc., now kept  in  every drug store, with
such people.
    Regular physicians  are now rapidly conforming  in
trivial cases  to  the changed  popular notion, and are
giving more concentrated  and more  palatable forms  of
medicine, and are in consequence rapidly  bringing vast
numbers of the erring from the ranks of isms and pathies
back to their faith in rational medicine.
    When you have a patient who needs only a few drops
of mint water, for mercy's sake do not  violate  common
sense and force upon him  an  infusion  of gentian or a
large bottle of muriated tincture of iron and quinia,  as
if your  chief aim  were to disgust him.   Give him
nothing stronger  or coarser than he needs, and leave the
balance to nature.   Chagrined homeopathists, and their
partisans, will warmly assert that in doing these  things
you are working on homeopathic ground.   But, although
you will be catering to the  popular taste, and  giving
very bland medicine, you will administer according  to
common  sense,  without  regard to  Similia,  etc., and
will be practising, not homeopathically, but rationally.
    The  smaller  the means that seems to accomplish a
result, the more  surprising does that result  appear to a
patient.   It does not seem wonderful  to him that he
should get better after taking an ounce or  a  pint dose
of anything, but improvement following a tiny powder,
or a pellet, or a  tasteless solution, or a morphia granule,
appears marvellously strange.
    Carry  a  phial  of  sugar-coated  morphia  granules
with  you, and  give  a  proper number  of  them  as 
148
soon as you reach cases in which great pain is a symp-
tom.  By so doing  you can often relieve the suffering,
and show your power over  pain, before  the messenger
could get back from  the  drug store with  the  remedy
you  would otherwise order.   Morphia  granules given
thus  become almost  a substitute  for the  hypodermic
syringe.
    Be just and friendly towards  every worthy drug-
gist.  Owing to the close relationship between pharmacy
and medical practice, the pharmacists are your natural
allies,  and  should   receive  your friendship  and re-
spect,  Probably all physicians will agree  that in the
ranks of no profession can a  greater proportion of gen-
tlemen be found than in the pharmaceutical.
    An excellent rule  is strictly to avoid favoritism, and
let all reliable druggists compete for your prescriptions,
and for the family patronage they influence.   You will
make a serious mistake, and engender  active enemies
too, if you  step out  of your way, and  without proper
cause instruct patients to buy their medicines from any
particular drug store ; if a prescription is properly com-
pounded, it makes but little difference  by whom it  is
done, so he is honorable and reliable.
    Do not deter your patients from patronizing a drug-
gist simply because  he is also a graduate  in medicine,
unless  he  is uniting  the two callings from  mercenary
 motives, or habitually prescribes, or has the drug store
 as a stepping-stone to get  acquaintances and  a practice
 as your antagonist or rival; but if you allow your pre-
 scriptions to be compounded  by a drug-store physician
 who prescribes over his counter, or in the office or parlor, 
149
free of charge, and makes it up on the medicine ordered,
you will be very apt, sooner or later, to regret it.
   Independent of all other considerations, the practice
of both Pharmacy and Medicine is too much for even the
most intelligent of men, and one or the other is apt to
be slighted ; and if your prescription falls into the hands
of such parties, both  you  and your patient must take a
great many risks.
   There  is not  the  slightest wrong in  having  your
name on your prescription papers.  But neither use a
prescription paper that has your name printed  in con-
junction with  that of any  druggist, nor with any name
except your own on it.  If it contained  the name of a
druggist, it would naturally suggest collusion, or some-
thing  else  not  complimentary;  if it contained some
enterprising fellow's commercial puff, it  would indicate
very ordinary^ taste for you to use  it.   It is  probably
better always  to write on good plain paper.
   It  would be wrong, very wrong, to receive from  an
apothecary, a  percentage on your prescriptions as pay-
ment  for  sending them to his store; for  this reason:
were you to accept such an offer, it would be robbing the
purse of either  the apothecary  or the patient.  Were
the former to  allow you ten cents for each prescription,
and reimburse himself by adding that amount to the
sum charged the patient for the remedy,  it could not be
looked upon in any other light than that you had com-
bined to fleece ten extra cents from  every  poor sufferer
who trusted to your honor.  On the other hand, if the
druggist had more honesty than you, and allowed you to
shear ten cents from his legitimate profit, because com- 
150
pelled to do so or lose your influence, it would place you
in a  most contemptible  position, and you would live in
constant  danger of an expose, and  an  indignant public
sentiment, that the strength of Hercules could not, and
the  angry God of Justice would not, subdue.  You
must live and  must have fees to enable you to do so,
but unless you  obtain every cent honestly and honor-
ably, you cannot escape the finger of scorn.
   Never  supply one or  a few druggists with private
formulae  that other druggists cannot  understand,  as it
would at once suggest trickery.  A still meaner device
would be to have a private, a cheating, code for use be-
tween you and  a druggist.  Surely  neither you nor any
other honest person needs warning against  such infa-
mous systems  of swindling  as these,  for any one who
would resort to  private  codes or cipher prescriptions for
money-getting, might  be very  properly classed with the
Shylocks who accept a percentage on  prescriptions, and
the wretches who produce abortion.
   The  druggist, after  compounding  your prescription,
has  a  natural  and a  legal right  to  retain it, as  his
voucher, but he has no right to repeat it without  your
consent.
   The unauthorized renewal of prescriptions has often
produced the opium,  alcoholic, chloral, and other  en-
slaving habits.   We all know it is often unsafe  for a
person to take a medicine ordered  for another, or even
the same medicine at different times.   Besides, how can
Mr. B. conscientiously label the second  quantity " take
as directed  by Dr. A.,"  when  the doctor  is not even
aware of the renewal. 
151
    According to the present habit of many druggists,
the unauthorized renewal of prescriptions probably out-
numbers that of authorized renewals five to one.
    Drug stores  have become so numerous of late, and
the radius from which each must draw its patronage is
so small, that druggists, in  order to exist, have either to
charge very high for the medicines prescribed, or substi-
tute inferior drugs; the result is, many people, to avoid
what  appear to them exorbitant prices, actually buy
quack medicines, make home mixtures, wend their way
to costless  Homeopaths, or trust entirely  to  Nature,
instead of paying  for prescriptions, and  then having to
pay  heavily to have them compounded.   Drug  bills
have gradually grown  greater and  greater, till  of late
they almost eclipse the expense of medical  attendance.
    The cost of  medicines  may be slightly reduced by
instructing your patient to save the cost of the bottle by
carrying one with  the prescription; doing so is not  at
all  objectionable to druggists, as they charge only cost
price for bottles.  A good  way to decrease the  cost  of
some prescriptions is, to avoid compelling  patients to pay
for  inert ingredients: for example,  if  you prescribe a
mixture  of  wine of colchicum root, tincture  of digitalis
and sulphate  of morphia  for a  patient, do  not make
what  would naturally  be  a one ounce  mixture, that
would cost thirty-five cents, into three or four ounces by
adding syrup, water, or other vehicle, so  as to swell the
dose to a tablespoonful and the cost  to a dollar. Pre-
scribe  the necessary articles only, and let the directions
tell how  many  drops to take, and how and when  to
take them. 
152
   Another evil  resulting from there being too many
druggists for all to live  by legitimate business, is  that
some, to make both ends meet, encroach on the domain
of medical practice, usurp our province, and prescribe for
every applicant that comes  along whose case  does not
appear to be formidable, and thus build up a large office
or store practice.   Fully one-half of all diseases of im-
prudence are now seen and treated by druggists or their
apprentices,  before  applying  to   physicians.  Those
whose complaints  prove  simple are, of  course, cured
like  magic by  the four  little  pills   the   druggist
recommends, or  by the  liniment he devises, or by  his
great fever-and-ague mixture, &c.;  and they,  thinking
that some terrible spell has been turned aside, laud the
druggist to the skies, and  advise all to go to—Doctor
Pharmacy—instead of consulting a physician, with assur-
ances that  he  is as good as the M.  D., and a great deal
cheaper.
    Make it a  point never to style a  druggist, or a
preacher, or any one else, " Doctor,"  unless he is a doctor.
    Avoid  praising any prescribing  druggist  to  your
patients, or people  will, on  your word,  overestimate
him and rely  on his gratuitous advice, instead of on
the doctor's, at least in all moderate cases.
    Another, although  less, evil is: if a patient's better
sense carries him in the first place to  a  physician  for
advice, instead  of to a druggist, there is every probability
that he  who takes the prescription to be compounded
will be presented  at the drug store with one or two
quack almanacs,  or advertising pictures,  or  that the
bottle  of medicine  will  be wrapped in some pushing 
153
fellow's handbill.  The druggists' co-operation as retail-
ing  agents  for  quack medicines is  indispensable to
quackery, and without it two-thirds of the quack reme-
dies  and proprietary trash that  now curse  our land
would pine and perish.
   You had  better avoid all druggists whose  presump-
tion leads them to assume the role of physician.   This of
course does not refer  to emergencies in which a druggist
acts  as  a humanitarian.   Medicines  are  the doctor's
tools;  a druggist may compound them, for all his life,
and  be an excellent pharmacist, and yet know no more
about  prescribing for  the  sick, properly, than making
needles or scissors teaches the mechanic dressmaking,
or making trowels and  ploughs and  chisels teaches the
instrument-maker bricklaying, farming or carpentering.
   Beware of indiscreet druggists, those who talk too
freely, and those who  converse, joke, etc., while com-
pounding prescriptions, also those who put wrong direc-
tions or the wrong doctor's name  on bottles, or surprise
and alarm people by charging a different price every time
a prescription is renewed, as if they had no system, or as
if it were put up wrong, or in other ways show abstrac-
tion—lest they involve you in their errors.   For such
people be especially  careful to dot  every i and  cross
every t in your prescriptions.
   If  you believe on good authority that any druggist
so far forgets himself as to make disparaging comments
upon you or your prescriptions, or exhibits  and decries
them to Irregulars, laymen, or other doctors, or that he
makes unauthorized substitutions, gives under-weight of
expensive ingredients, or omits them altogether, or joins
      10 
154
with  our enemies in  reviling our  profession and  its
imperfections, or has  a medical protege under his wing
to  whom he is  endeavoring  to direct customers  for
sinister purposes, or is guilty of any other grossly unpro-
fessional  conduct, you are justified in directing  your
patients to go elsewhere for medicines.
    Willingness to give medical certificates is one of the
universal  weaknesses  of mankind.   The idea of being
" an authority " and shining in type dazzles all classes.
Many people  could almost be inveigled into certifying
that in medical matters, two and two make five, by any
sharper who understands how to tickle their self-conceit
and their  love of notoriety.
    Be prompt and  decided in refusing to give profes-
sional certificates  to anything secret, and do not be too
liberal even  in  giving them  to legitimate pharma-
ceuticals,  and never  issue one  founded on any  other
basis  than purity of  ingredients, or  special skill  or
experience in compounding them.
    Be also chary  in giving (un)professional certificates
to  any  one  on  disputed  or  partisan  questions,  for
they will affect the general professional interest as well
as yours.  When you  give one, persons who  happen to
know you will regard its personal and not its professional
significance,  but every  one else all  over the land will
notice your M. D.  only.  When John Doe gives his cer-
tified opinion that  ice is hot and  fire is  cold, it remains
simply- John Doe's opinion; but when John suffixes his
M. D., he undoubtedly gives that certificate a profes-
sional significance, and to some extent  involves our  en-
tire profession therein. 
155
  Judge certificate-giving by its effects on our own profes-
sion.  One of the worst inflictions we endure to-day is the
endless  parade of certificates from clergymen and other
well-known  persons recommending all kinds of medical
nostrums.  You know, and every wise man knows, that
such certificates are not worthy of credence, and that
the  preacher of  Gospel  truth  who lends his name
and  the cloak of religion to assist wily charlatans and
commercial  sharpers to  prey on the afflicted  must be
either a silly dupe or a cruel knave.
    The principle governing our condemnation of secret
nostrums  is this :  They not only do more harm than
good, but, if puffing and advertising  alone are enabling
the  proprietor of a quack remedy to fleece the sick, its
unprincipled owner deserves  exposure  and  contempt.
If the  nostrum  is really valuable,  which is very rarely
the case, its  composition should be freely and fully dis-
closed,  for the benefit of suffering humanity.
    Quackery subsists almost  entirely on credulity and
ignorance, and it is your duty to expose it in every shape,
and  to save as many from  its evils as you can.  Wher-
ever you  meet it, lift its veil and show its un worthiness,
and the harm it does.   One of the greatest of all wonders
is, that wisdom  in law or in  theology, or perfection  in
the sciences or skill in the arts, or acuteness—even bril-
liancy—in  other  departments  of  human knowledge,
scarcely increases  a man's  reasoning powers a single jot
in medical matters.   Why a person  may be one of the
wisest of  men in all else, and an easy, almost volunteer,
prey to quacks  and  sophistical  pretenders, as soon  as
sickness attacks him or his, is a curious enigma. 
156
    Whenever you are asked by proprietors and travel-
ing agents, or tempted by glowing advertisements, highly-
colored  certificates, etc., to  prescribe semi-secret trade-
mark pharmaceuticals, copyrighted  medicines, and the
various  elixirs, restoratives, tonics, panaceas and  other
specialties  with  attractive  ideal  titles gotten up by
crusading druggists,  manufacturing  pharmacists,  phar-
maceutical  associations, etc., to catch the  popular eye,
and  the popular dollar—think of the  cunning cuckoo
and how its little offspring gets possession  of the whole
nest,—and  do not use them.   Unless you have missed
your profession, the  United States  Pharmacopeia and
the Dispensatory are certainly large enough to  allow
you to make any required combination,  and you should
follow this,  the legitimate mode of prescribing, and let
ready-made  substitutes for medical  attendance  alone.
You should  also maintain your independence and  never
order A's,  B's or C's make,  of  anything, miless you
have some specific therapeutic reason for so doing.  To
specify thus you would not only reflect on every  other
manufacturer, and  cause a still  greater  popular dis-
trust  of our  materia  medica, but you would  also
put  the compounder to additional trouble  and ex-
pense :  he  might have half a dozen  other varieties
of the  same article, and yet be  compelled  by your
specification to get another.  Besides, it almost invites
substitution.
    Do not,  however, oppose any remedial  agent, or any
particular brand of anything on account of its having a
monopoly, if that monopoly  is owing to unusual skill  or
great perfection in its manufacture. 
157
    Patients think doctors know precisely what a medi-
cine ought  to  cost; and will often  ask  you how much
the druggist will charge  for the remedies  you  have
prescribed.   Answer promptly that you  do  not  know,
and avoid mentioning any specific sum;  because, were
you to guess too high,  they might infer that he  had
either made a mistake, or used inferior drugs;  and
were you to guess too low, they would probably accuse
the druggist of over-charging.
    Whenever you prescribe a remedy that is unusually
expensive, such as Musk, Quinia, Oil of  Erigeron,  etc.,
take care to inform the patient of that  fact,  so that he
will not be  surprised when  the druggist tells him  how-
much he charges for it.
    Notice particularly whether an apothecary gives
unusual prominence to. nostrums, quack  almanacs and
placards, or has quack advertising signs painted on his
doors or outside walls, and it will give you a true insight
into his aims  and attitude towards our  profession ;  if
you see that he is pushing the quack department, with
quack   proprietors' portraits hanging  around,  and his
own name and  influence used in hand-bills and almanacs
as a vendor of nostrums, bitters, plasters,  pads, etc., you
may be sure that he is conducting his store on a trade
basis, instead of a professional one, and you will do right
to rigidly shun him.
    Drugs vary greatly in quality and in  strength, and
this is  one of the occasional causes of uncertainty in the
practice of medicine, and such variability  would modify
your  efforts  too  much to be risked in any important
case.   A badly compounded prescription  may  rob  you 
158
of your reputation, and deprive the patient of his chances
of recovery.   Therefore if you think an important pre-
scription is likely to be sent  to a druggist who you
conscientiously believe has inferior or unreliable articles,
it is your duty to direct the messenger to go elsewhere;
for, being responsible for the patient's welfare, and hav-
ing your own reputation to care  for, you have a perfect
right,  and  indeed  it is your duty under such circum-
stances, to  order your remedies to be procured  where
you believe your  prescriptions  will  be exactly  filled.
The  art  of Medicine  is imperfect enough at best, and
you will encounter plenty of new and strange problems
to remind you of your lack of aids, and  of the insuffi-
ciency of human resources,  without adding the risk  of
being  thwarted by  an unreliable druggist; but when you
find it necessary to ignore any- one for this reason, take
care to do  so  in a discreet  parliamentary manner, and
with as little personality as  possible.
   You  will  for  various reasons often wish you  had
synonyms for the  terms Quinia, Zinc, Opium, Chloral,
Strychnia,  Morphia, and probably for other  articles  in
daily  use.  Whenever a  synonym for any of them  is
supplied, use it.  By  employing  the  terms Ac.  Pheni-
cum  for Carbolic Acid, Secale  Cornutum  for  Ergot,
Kalium for Potassium,  Natrum for  Sodium,  &c, you
will debar  the average patient  from  reading your pre-
scriptions and hampering you, which  is in many cases
highly desirable.  You can also further eclipse their
wisdom  by transposing  the terms you  use, from the
usual order, and writing the adjective in full, with the
noun abbreviated ;  e. g., instead of writing Quiniae Sulph.,
write Sulphatis Quin., etc., etc. 
159
   Take care to have all powerful remedies for external
use labelled  "for external use," or "not  to be taken,"
which will not only prevent misunderstandings, but in
case  they are swallowed  in mistake, it will  save you
from censure.
   If  the directions on  the  bottle indicate what  a
remedy is for;  for  instance, if you  have it labelled
"apply to the injured  foot  as  directed,"  or  "for the
pain in the chest," or "for the cough," it will be more
apt to give a certain class of patients greater faith in its
being a direct and proper remedy, and cause their minds
to go with it, instead of against it.
   You will notice that some druggists label the reme-
dies they7 compound for  you with their file numbers only,
thus, 17,483; while others pursue the much  more sat-
isfactory plan of adding the date on  which it  was com-
pounded, thus 17,483, 19-7-82, signifying that  it is num-
ber 17,483, and that it was put up July 19th, 1882.  The
latter plan will enable you to distinguish between the dates
at which you prescribed different bottles of medicine, and
otherwise be of service  to you.   I am sure the majority
of druggists would cheerfully make use of this system if
they were aware how often it assists the physician.
   It is well to request neighboring pharmacists always
to inform you of any ambiguity or apparent mistake in
your prescriptions before dispensing them.
   Bear in mind that the  druggist is only human, and
that  he,  like every other person, requires some  rest,
and do not order mixtures requiring  tedious  manipula-
tions, or direct filthy ointments to be mixed, or dirty
plasters to be spread, suppositories to be  moulded, etc., 
160
on  Sunday or during sleeping-hours, unless  they are
urgently needed.
    You will, of course, attend the meritorious poor free
of charge, and will applaud all who do likewise.  " The
poor," said Boerhaave, " are my best patients.   God
will be their paymaster."   But  it is your duty to  raise
your voice, in the profession, against the so-called  Free
Special Dispensaries that, under the great plea of charity,
attract  swarms of patients—among whom  are many
who are abundantly  able to pay for medical services.
Dozens of physicians  in every city are of late cheated
out  of  their living by so-called " Special"  Charities,
carried on  in the  interest of individuals or coteries, who
treat everybody that applies, the rich, the poor and the
intermediate, without the slightest regard to the inter-
ests of other medical men.   Some of these places, instead
of" being for the really poor, seem to be mere nets, through
whose meshes  patients of small means may slip on the
free plan,  while  those who are  in  comfortable circum-
stances are attracted  there and  then netted into some-
body's private practice, and a fee expressed from them
somewhat  as  roe are obtained  from fish  in artificial
hatching.
    Be on  your guard against Instrument Makers  and
Dealers who  meddle  with  surgical cases,  and  of
Manufacturers of appliances for deformities, etc.,  who
presume to treat cases that should  be referred to the
physician or surgeon,  and in fact avoid encouraging any
one who encroaches on the physician's province.
    As a doctor, you will sustain two  relations to  your
patients;  first, that of a  person striving  to  relieve or 
161
cure the sick and the suffering;  secondly, that of a
person who depends upon  those for whom he labors, for
his support.
    Business  is business.  The practice  of  medicine is
the business  of your  life;  it is as legitimate  as  any
other.   You  must live  by it, just as other  people  live
by theirs, but cannot do so unless you have .a business
system, for upon system depends  both  your  professional
and financial success.   Neither untiring study, nor un-
selfish devotion as a humanitarian, can  lift you above
the demands of the tailor,  the instrument  maker,  the
bookseller, the grocer, the butcher and other creditors,
not one of  whom will take  your reputation of working
for philanthropy, or your smiles, thanks and blessings
for his pay,  nay, even the conductor will  put  you off
the street-car that carries you to your patient if you do
not pay your fare.  It is of course a pleasing thing to be
very popular, but your  popularity, even though  it spans
the whole  city, will neither fill your market-basket nor
purchase books, neither will it pay your office rent nor
buy horse feed ; and though money is not the chief object
in the practice of medicine, it  ever has  been, and  ever
must be, one of the objects, and no  one  can sustain his
practice without a money feature.   If people do not pay
you, you  cannot  live  by your  calling, and will  very
soon tire of all work and no pay.
    The nearer  your financial department approaches
the cash system,  the  better for you  and your family.
It is often more advisable even to submit to a reduction
in a bill for cash, than  to let the account stand, and run
the risk of  losing it.   After  settling promptly, many 
162
patients will feel  free to send  for you again, and make
another bill, even in moderate sickness, instead of dally-
ing with home remedies or quack medicines.
    You should present your bills while they are small,
and  your  services  are  still  vividly remembered, for
another reason;  if you are  neglectful or shamefaced,
and  do not send  your  bills promptly, it will  create a
belief  that you  are either  not dependent upon your
practice for a  living, or that  you do  not hold this or
that person to your business rule, or are  not uneasy
about what they  owe you, or that  you are  rich and do
not need money,  and if you  foster such notions, a bad
system will grow  up around you, and great, irreparable
loss  will result.   Asking for  payment reminds patients
that there is still  a little of the human left in a man even
if he is a doctor, and that you  have to  live, and must
have your  fees to enable you to  do so.
    The business of the  world  is now conducted on the
cash system, instead of the old long credit plan, and you
should do your share towards breaking up the  unjust
custom that doctors used to follow, of waiting six months
or a year after rendering services, before sending a  bill.
If a physician attends a person, say, in February, and
sends his bill in March  or April, it  seems to the patient
like a current  expense, and as if the doctor lives by his
practice, and it is apt  to be  paid  promptly;  whereas,
had he delayed sending it until July or January, the
debtor  would naturally think the doctor had merely
sent it  out  with a whole batch of others, more because
he has posted  his books  than  from  a special desire  for
its payment; and in this belief, he would probably let 
163
it  remain unpaid for months longer, till it becomes an
old back debt,  which  is  the hardest kind  to pay.
Besides,  time  effaces details;  and recollection of the
number  of  visits, the  doctor's  watchings,  cares, and
anxieties are also forgotten, and the bill, though really-
moderate, is apt to look large.   All these considerations
combined are apt to  make people feel, when they do pay
an old bill,  somewhat as if  they were  doing  a  generous
thing, and making the doctor a present of that amount.
    You  will have to make a great reduction  in  many
large bills  after  they have become old, therefore look
after them  while they are small and  recent.   Indeed,
to let one  bill add  to another till the  total reaches  a
great amount, might place  it wholly beyond  the power
of the person to pay it, and wrongfully force him into the
position  of a dishonest man.
    The  very  best  time to talk business  and have an
understanding  about your fees with doubtful or strange
patients, is at  your  first visit, or at the first office con-
sultation ;  and the  best of all times  to judge people's
true  character will  be when you have money dealings
with them.  Even  a single dollar will sometimes show
you exactly what a person is.
    Make it a  rule never to accept a  commission  or fee
from any one,  under circumstances that you would not
willingly submit to  investigation by the public, a medi
 cal society, or the  Courts.   Your severest test will be
 when money  is  enticingly offered to induce you to do
 doubtful things.
    You will not have practised long before you will find
 that your welfare will not depend upon how much you 
164
  book, but upon how much you  collect, and that if you
  never insist upon the payment of your fees, you can never
  separate the chaff from the wheat.   If you have a rule,
  and people  know it, they associate you  and your  rule
  together.  Let the public know what your system is in
  the early years of your practice, or you cannot do so
  afterwards.   When a new  family employs you, render
  your bill as soon after the services end as gentility will
  allow, especially if they have  previously had a doctor
  who was an indifferent collector, or no collector at  all.
  Send your bill and test them, and, if any object to you
  because you want your fee,  the sooner you  find each
  other out, and either have an understanding or part com-
  pany, the better it will be for you.
     When a patient asks you how much his bill is, or how
  much he owes you,  after an office consultation or an
  operation, etc., always answer  him promptly and soberly
  "one dollar"  or "ten dollars," or whatever  else  the
  amount is.   If you avoid preceding or following this
  reply with  any other words, most people will in  the
  embarrassing  moment proceed to pay you without ob-
 jection, whereas if you add  more words, it will weaken
 your  claim in their  minds, or make them  believe you
 have no fixed charge, and will furnish them with a pre-
 text to  show surprise, and to  contend for a reduction.
 When  one does  demur  at  your  charge,  show  vour
 amazement at his doing  so, and be ready  instantly to
 defend or explain the justice of the charge.
    The  wisest  rule about charging for your  services
 is to ask from  the beginning of  your career  the fees
 usual  for the  best attendance, neither  extravagantly
high nor ridiculously low. 
165
    Accounts for surgical  cases,  midwifery,  poisoning,
and in fact for  all unusual cases, should be promptly
" charged up " on your books ;  for unless this is attended
to, the patient may come unexpectedly to pay his bill, and
you might through embarrassment, or lack of full re-
membrance of the services,  name  entirely too low  a
figure, and do  yourself  an injustice.  Besides,  having
the amount already determined upon and written down
shows it to be the fixed price, and  the  patient is less
apt to ask  for a great reduction, if any.
    Take your  fees whenever tendered.   Patients will
often ask, " Doctor, when shall I pay y/ou ? " or,  " Shall
I pay you now ? " A good plan is  to answer promptly,
" Well, I take money whenever I  can  get it;  if you
have it with you, you might pay it now, as it will leave
no  bones to pick,"  or, " Short  payments make  long
friends," or " Prompt pay is double pay,  and causes the
doctor to think more of you,"  or something of that sort.
Never give such answers as,  " 0,  any time will do! "
or,  " It makes no difference when," or y^ou will soon find
it to be expensive, very expensive modesty.
    Never re&ise  to rise from bed and make night visits
to patients  who require  them; to refuse would be un-
just, and either let the patient suffer, or die, or unjustly
put your duty on some other doctor ; it might even drive
the messenger to a druggist for advice and medicine, or
open the door to a homeopath, or whoever else could be
caught up in the emergency  to  fill your  place.  You
should,  however, charge  full night-visit  fees  for all
visits made after bedtime, and  you will be less often
compelled  to undergo loss of rest and exposure in at- 
166
 tending those who could have sent at a more seasonable
 time—unnecessary night-visits rob doctors of their rest,
 and even if they bring  in  fees, they are not an equiva-
 lent for the over-work and risk of health.
    Never  neglect to post your  account books;  for it
 would be violating  the first  law of nature  to attend
 faithfully to the department  of  your  occupation  that
 concerns others, and neglect the one that concerns your-
 self.  The Scripture command is  " Love your neighbor
 as yourself"; it does not say,  Love him wore.
   A good plan is to put the names of transient patients
 on your cash book, instead of blurring your ledger with
 them, and  give only patients with whom you  think it
 likely  you will have a permanent account, a page  in
 your ledger.
    Your visits and cash entries in your visiting-list and
 day-book should be  written in ink; for being original
 entries, they would  be  accepted  in court as legal evi-
 dence.   A  good way to prevent  forgetting  any one  or
 anything is  to  put  names, visits, etc., down in  your
 visiting-list with  a lead pencil, without delay, till you
 have a chance to re-write them with ink.
    At the  end of every  week,  add  up the amounts
 charged each one you have attended that week, and put
 the amount on the visiting-list in  the blank  space found
 at the end of his line behind  the Saturday space.  By
 doing this  weekly  you can  accurately  estimate  and
charge the  value of your services to each patient while
they are still fresh in your mind.   It is wise not  only  to
enter at the end of each week the amounts charged, but
also to write the name of the member of the  family who 
167
has been under your care during the week, in the visiting
list,  over the visits, for reference in case your attendance
should ever be disputed.
   In posting your account books at the end of the month,
if you wish to transfer your visiting-list charges to the
ledger without missing any  one, use a  checking-off plan.
A very7 good way is to make a  list of the names of all
patients you have done anything for during that month,
on  a sheet of foolscap  paper;  then  bring  from the
visiting-list to the foolscap the amounts marked for each
week's  services,  and  put  them  behind the person's
name;  after you have  all the charges transferred  in
this  way to the  foolscap, run over your  ledger, page
after page, and look at every account as you go along.
When you reach the name of any one against whom
you  have  a  charge  to make,  add up all you  have
marked  against  him and enter the total  on his page
of the ledger; but, instead of wasting time  to write
March, 1882, $7.00, enter it 3-82, $7.00, then cross that
person's name off the foolscap list, and continue on page
after page through the entire ledger.   By this crossing-
off system, if you fail to charge  any  one's  account  as
you  pass it, it will  remain  uncrossed  when you get
through the list, and will thus be detected.  While going
over the different pages of  the ledger to enter charges,
notice all accounts  that  need rendering, and take their
names and the  number  of their pages on a strip  of
paper at hand for the purpose, so as to return and make
out their bills after completing all  your entries ; also
make, while turning  the pages, a separate list of such
delinquents as it would be proper for either you or your 
168
collector to  ask for money, during  the approaching
month.
    When you  make out  a bill, put on your ledger, in
the space just behind the amount, the date at which the
bill for that amount was  rendered:  thus, $7.00,  with
1-8-82 behind it, would signify that a  bill for  seven
dollars was rendered  to that  person, August 1st,  1882.
  A  good  way  to  save  the trouble of looking over
worthless or  dead accounts on your ledger, month  after
month and year after year, is to cross them off, using
lead pencil, which can be erased at any time, if necessary,
for  such as may possibly be revived;  and for those that
are dead, or sure, from other causes, never to employ
you again, use ink.
    Patients will occasionally  dispute the correctness or
justice of your charges.   If a bill is not correct, correct
it  cheerfully ;  if it  is  correct and just,  do  not  allow
yourself to  be  browbeaten into the  position that it is
not.  Many  people are not  aware that the charges for
surgical  and  various  extra cases are  higher than  ordi-
nary visits; some seem to think that for a visit at which
you reduce  a dislocation, open a large abscess, make a
vaginal examination, or draw off the urine, you should
charge the  same as for ordinary visits.  Of course, you
must  correct  their error by explaining the difference, or,
if necessary, by reference to the fee table.
    Never undercharge for your services.   It is ruinous
to your interests and the interests of the entire profes-
sion.   The tendency of  undercharging is to depress the
fee  table permanently, and to compel all  Doctors to
work  for under-pay.   There is a vast difference between 
169
underbidding  in  our  profession, and  underbidding in
ordinary business pursuits;  in theirs, cut-rates are only
temporary;  for, if merchants were to  sell goods at, or
below cost for a length of time, failure would result,—
in business  wars one  withdraws, or they compromise
and each advances again to full prices ; warring doctors,
on the contrary, having no  goods to manufacture or to
sell, can keep  up the feud  for years, give  their skill
to everybody  for  insignificant or  nominal fees,  and
impoverish one another, and almost starve those depend-
ing on them for support
    Let people know that you strive to make your bills
as small as possible, not by undercharging, but by getting
them well with as few visits as possible.
    Never bargain to attend a patient or  a family by the
year; it is better to be paid for exactly what you do,
than  to have  some people feel they are giving  you
twenty dollars  for five dollars'  worth of service,  and to
feel you are giving  other people fifty  dollars' worth of
service for twenty dollars.
    Also, never bargain to attend whole  neighborhoods
of poor people at reduced rates; it never works success-
fully.  Indeed, if you even attend a confinement or other
case in a family, for a nominal fee, you will not be  able
to raise the fee to the regular price again in that family,
or even with others who hear of it.
    Even though you are sure you will have to receipt
your bill  for a reduced  amount, make  it out for the
standard sum,  that  the  debtor may know your rates,
and give you proper credit for  whatever  reduction  you
make ; in other words—when you make a reduction to
      11 
170
those who plead poverty, or other acceptable reason, let
them understand that you are not reducing your charges,
but are taking something off their bill,  and enjoin upon
them not to tell it  around, lest  it injure your scale  of
charges elsewhere.
    When people  talk to you about taking off part  of
their bill because they  are poor, and making the rich
pay you  more  to make it up,  take less if you think
proper, but say not a word that would  allow  them  to
infer that y-ou,  or any other  doctor, would  charge any
one, whether rich or poor, a cent more than he honestly
owes.
    It  is  customary and just  to charge double  for the
first visit to a  case, chiefly for  the following  reasons :
You must at the first visit devote an extra amount  of
time and attention  to  learn the history of the^case—
must involve yourself in  a diagnosis, and probably  in
prognosticating too,—must establish a line of treatment
—must instruct the nurses,—must map out the diet, and
point out the  requirements  of  hygiene, and  formally
assume all the responsibilities of the case, all of which
require extra  services  and extra time, and  justify a
double charge for the first visit.
    You will often have people  to complain that their
bill is high, and ask you to make a reduction ; yet, many
of these very people would not employ you if you were a
third rate or low-priced doctor; everybody wants first-
class services, but wants- them  as cheaply  as  possibly.
It is not  human nature to  prefer  a  fifty-cent silk to a
two-dollar silk; but if people are lucky enough to  get
the two-dollar  silk for one  dollar, they  congratulate 
171
themselves.   They reason the same way about physi-
cians ;  very few prefer or appreciate a low-price doctor.
    In unusually severe cases, and in those that  require
unusual exposure or extraordinary legal  or professional
responsibility, also for restoring persons  after poisoning
or apparent drowning, or where you have shown extra-
ordinary skill, or had very great luck with bad  cases of
any kind, you  should charge  round  fees.  Attendance
on an only child, an eminent or very important member
of the community, or a stranger who has journeyed  far
with an important case that requires special attention,
should also be  charged accordingly, whether attended
at your office or at their homes.  In such cases be care-
ful to pay no unnecessary visits;  for in a very important
case actually requiring three visits to which you make
but three visits, they will appreciate you more highly
and will more cheerfully pay a hundred dollars, than if
you had also  paid five more, apparently unnecessary
visits, and charged but $80 for all.
    Patients will often express surprise  at your asking
the same fee for an office advice as for  a visit to their
house; explain to them that although the charge is the
same, it is much cheaper to be an office patient  than to
be  visited  at  home,  because an office  patient  usually
comes but once, or only when his medicines  are out, or
when some important change has taken place in his
ailment,  and quits entirely as soon as possible; whereas,
if you have him under care at  his home, your responsi-
bility and  feeling of uncertainty compel you  to  visit
him frequently to ascertain whether he is getting along
as  expected.  For these reasons a few office consulta- 
172
tions with the responsibility of attending faithfully rest-
ing on  the  patient, if on either, often suffice, instead of
many house visits, and in this way office advice becomes
very- much cheaper.
    Never agree  to  attend any one  for  a " contingent
fee," that is, do not take patients  with  chronic  sores,
constitutional  headaches, epilepsy,  cancer,  post-nasal
catarrh, piles, dyspepsia and other chronic afflictions;  or
cases of syphilis, gonorrhea, etc., on  the  "no cure,  no
pay " plan, or to pay " when all is over."  Make no such
agreements; for  they are never satisfactory, and will
generally end in  your being  swindled, and  it may be,
charged with malpractice.  Make  the point that you
are willing to do your duty, but that you must live, and
must be paid for your services even though the patient
dies, and that all who employ you must take the prob-
abilities of  cure or relief.   You might also hint that
if they  pay  as  they go  it will  encourage you, interest
you in the case, and stimulate you to do your best.
    Fail not to  demand your fee in advance for attending
cases of secret diseases.   If you do not,  your patient
will almost  surely leave  you about the time the case is
completed,  with  his  bill  unpaid; and if you  bother
him about it, he  will either  pay it grudgingly,  or not
at all, and, if you dun him for it, will meanly assert that
you did  him  no good,  or almost killed him, or tell
some other lie, as an  excuse for deserting and cheating
you.  Another reason why it is  proper to  get your fee
in advance,  is that many would never come and pay it
till you had sent them  a  bill   by  your collector, and
would  then indignantly  claim  that you  had insulted
and exposed them, by sending a bill of that kind. 
173
   You have no right, either  legal or moral, to expose
the nature of any one's disease because he has failed  to
pay your fees.
   Venereal diseases are the result, not of misfortune, as
other afflictions are, but of imprudence, and  are  self-
inflicted.   And for  this reason, venereal patients have
not the usual claim upon your  sympathy.   Get a just fee
in all cases of that kind before you begin,—then stick to
the patient until he is cured.  He is not likely to change
from you  to another after he has paid  you, and if his
case proceeds slowly, he cannot then suspect that you
are purposely running a big bill on him, or delaying the
cure on account  of his being a good-pay patient, as  he
might do  if he were paying you a dollar or two a visit.
   Most  men  think they cannot  have  constitutional
syphilis unless they have detected  a  terrible chancre as
its beginning.   You will often have difficulty in making
persons who have not  detected a primary sore believe
they have secondary syphilis.   Some men will actually
scan you, and quiz you, when you tell  them  they  have
the p-x,  as if they thought you an impostor, trying to
scare money  out of them.   If you can  show such a
patient a  fac-simile of his case in your illustrated works
on venereal diseases, or read  to him  a description  of it
from a text-book, it will generally convince him fully.
If you are certain that your diagnosis of syphilis is cor-
rect, tell him that, in your opinion, it is genuine syphilis,
and be careful not to be browbeaten  into taking charge
of the case  for a  nominal  fee.  It is a grave,  long-
continued  disease, and the responsibility and  harassment
of the medical attendant are  often very great and very
long ;  therefore the fee should never be nominal. 
174
    You can broach the fee question to any patient with
a  private  disease  by remarking  immediately  after
making your first examination—" Well, I see  what
your case is, and  am willing to take  charge of it, and
give you my best services, if my terms will suit you"
—this  will compel him to ask you what your terms are,
and will give you an opportunity to tell him.
    Some people believe the law compels you to attend
any one who chooses to send for you.  It does not: but
public  opinion might condemn you if you were simply,
on account of fees, to  refuse to attend an  urgent case
where  humanity should prompt  you to go.  If you are
either " too busy " or " not well enough" it is always suffi-
cient to defend you against argument or criticism.   But,
" Fm just at dinner" " I'm too tired," or " I need sleep,"
or u I am afraid I will be dragged into court as a witness,"
etc., are not accepted by the public as  sufficient reasons
for refusing  to  go  to a  case,  and  should never  be
offered.
    Not only should you send your bill to a patient at
the proper time, but, if you do not hear from him within
a reasonable time thereafter, emphasize it by sending
another, for he may not have received it, or may have
thrown it aside,  or may be neglecting it in the hope that
you will let it sleep till it is out of date.
   A very effective plan to use with a certain class of
patients, when you are in need of money, is to learn the
date at which you will have a note or bill to pay, or to
raise money for any other special purpose, and to write
about two weeks before that period, and inform them
briefly  that you will have a  special  need  for money at 
175
the time  you name, and ask them to pay  you on  or
before that date.  Most worthy people will exert them-
selves to  comply.   You  can,  in  this way, approach
both your best and your worst patients—some that you
cannot successfully  approach for  money  in  any other
way.
    A  good plan to pursue with  those who  habitually
throw bills aside and  neglect to pay them, is to send
their bills some time when you are short of needed funds,
with  a brief note  asking them to pay that day, and
give your urgent reasons for asking.  Even though they
pay you nothing then, knowing that they have disap-
pointed you  will make  them feel  impelled to pay you
something the next time they call on you for services.
    By letting a certain  prompt kind of patients know
at the visit preceding the final one, that your next visit
will be the last, it will serve as a gentle hint and give
them  time to  prepare, and  will greatly increase your
chances of getting your bill paid cash at the last visit.
Convalescents from severe cases who visit you at your
office  after they are again able to walk out, in order  to
let  you see how they  are getting along, are very apt to
broach the subject of settling, and either  pay or make*
some definite promise before quitting.
    It is wise to post your  books, make out bills, settle
with your collector, and in fact to conduct all the features
of your pecuniary department,  as  much  out of  public
sight  as possible, that the public  may know little  or
nothing about you, except as a medical attendant
   You cannot put all kinds of bills  on the same footing;
there is one class of patients  whose bills  had  better be 
176
 sent by mail, another that had better be taken  by your
 collector, another that you had better deliver yourself,
 and a few prompt-pay patients with whom it is preferable
 to wait till they ask for their bills.
    Items and details had better never be specified on a
 bill unless specially  asked for.   They  often dissatisfy
 people, and originate criticisms and disputes that would
 not  arise, did not the items furnish a pretext.   Assume
 the  position that those who confide in you sufficiently
 to  put their  lives and  their secrets in your keeping,
 should feel sufficient confidence and gratitude to permit
 you to say what value you place on your services to
 them.  A doctor's  bill that gives the items is apt to be
 disputed or criticised unless it is  unjustly small.   Bills
 that simply state the total amount are much more likely
 to be paid without dispute.    The items  of every bill
 should, however, be carefully  kept on your book, that
 the charges may be verified if requisite.
    It is well to insist on giving receipts to people when
 they pay  you  money, even though they should deem it
 unnecessary.   Compelling every one who pays to take a
 receipt, not only prevents subsequent disputes, but also
•assists in keeping up  a regular  business form between
 you.
    To shave too closely  in  money matters, or to be
 unreasonable,  or too vigorous  in  your efforts to collect
 bills from any one, would not  only be wrong, but would
 be very apt to injure  your reputation.
    It will seldom  pay you to sue people, even  if you
 should gain the case.   It is unwise for any doctor to
 begin litigation except under very aggravating  circum- 
177
tances.   You should never sue any one whose failure
to pay is due to honest poverty.   Be willing to do your
share of charity for the virtuous poor at all times, but
the necessity of earning a living should make you care-
ful not to let that kind crowd out your pay practice.
    It will usually be wiser not to  send a bill for going
to cases of sudden death, drowning, suicide, found dead,
murder,  etc., in which  the  victim is dead  before  you
reach him, or in cases where your services  and efforts
are not called into action, or are  brief or nominal, or
clearly  useless,  as a bill under such circumstances is
generally not only not paid, but  is  harshly criticised.
If,  however, grateful people volunteer to pay you for
your trouble, take whatever is right.
    In cases  of  irremediable cancer, phthisis, &c, that
after  going the  rounds of the profession, consult you in
their  very last, or hopeless stages, merely to see whether
you can possibly do anything for them, you  had better
frankly acknowledge that you cannot, and  decline the
fee, even if tendered.
    It is usually better  to make no charge for ordinary
or trifling advice incidentally given to patients when thev
call to pay their bill, or to persons for whom you hap-
pen to prescribe in public places where you are not pur-
suing your  functions as a  physician.   Such exactions
would, to say the least, risk unpleasant remembrance and
harsh criticism.   Every doctor sometimes writes  pre-
scriptions under circumstances where his own interests
prevent him from making a charge, or even accepting a
fee that is tendered.
    Never make a charge where the fee would come from 
178
another physician's pocket; every physician attends his
professional brethren and their families gratis.  Many
physicians also attend clergymen and their families
without  charge, especially if  they have  Church  rela-
tions with them, or if they receive a salary  so meagre
as to make the payment of medical fees a  hardship.
    Be especially  fair in  your charges against estates,
and in all other cases where unusual circumstances place
the  debtor at  your mercy.  These  opportunities  will
truly test your honesty.   When you are in doubt what
to charge, look around you—then upwards—then make
out your bill at such figures as  will indicate clean hands
and a clear conscience.
    When you and a professional brother do each a  por-
tion of the work in cases of accident, confinement, etc.,
a very fair plan is to  agree to charge  a joint  fee and di-
vide it.   When you receive such joint fee, go at once and
divide every dollar with your fellow-worker on whatever
basis you have agreed.
    Never acknowledge, or work under the fee-table of
any association, unless it  is in  harmony with the regu-
lar professional fee-table of your community.
    Humanity requires you to go to all cases of sudden
emergency, accidents, etc., without  regard  to  the pros-
pect or non-prospect of a fee.   You should do various
things for the sake of charity ; among these, is to  give
relief to any one injured, or in  great  pain,  regardless of
fees. At such times think only of your duty  to humanity.
The good Samaritan succored the wounded man  and
took him to an inn, and  provided  for his  immediate
necessities.  You, as a physician, should, for humanity's 
179
sake, go and bind up wounds, mitigate pains and relieve
sufferings, in all cases of emergency.  After this is done,
further attendance is, of course, optional.
    Never slight the worthy poor who are under the iron
heel of poverty and need  medical  attendance;  to the
poor, life and health are everything, and there are none
so poor but  may amply repay your services by lasting,
genuine gratitude.  But even in doing charity you must
discriminate.  There are said  to be three classes of the
poor :  The Lord's poor, the devil's poor,  and the poor
devils.  The first and last are worthy objects of every
doctor's attention, and you should lose no opportunity
to give relief to their distresses   The less  you have
to do with the  other class, the devil's poor, the better
for you, but you will  be  compelled to  attend  more
than you  choose even   of  these,  on  account  of their
relationship to better patients.
    If you adopt some  special color,  pink, or blue,  or
yellow, for your bills, debtors holding them will  be
reminded  of you, and of the debt, every time they see
the odd color, and  it may, by  reminding  them  of the
fact, accelerate its payment.
    "Prompt payments are fully appreciated,"  is a very
useful maxim to have printed  on your bills, it is truth-
ful and gives thanks to  those who pay promptly.  To
those who do not, it serves as  a very neat admonition
    You will find that neither  honesty nor  dishonesty is
confined to any  nationality nor to any station in life ;
you will  find  very good  people and very  bad ones
among the rich and  the  poor, the white and the black.
You will mount many a marble  step, pull many a silver 
180
door bell, and walk over many a  velvet carpet for pa-
tients who will prove  fraudulent in the superlative de-
gree ; and get many .an honest fee from some who make
no great pretensions, and possess but little  save their
honesty.  Indeed, the demands of fashion are  now so
great that many people with moderate incomes, anxious
to appear better  off than they really are, perpetually
slight their doctors, to help to keep up appearances.
   This is not a distorted picture.  You will see many
a man going about bowed down with debt and despond-
ency, while his wife and daughters flutter around as fine
as peacocks,  owing  everybody  and  paying  nobody.
Indeed, tricky women  will sometimes actually intercept
your  bills, and  make  it impossible  for  you   to  ask
their husbands for money, unless  you resort to strategy,
and get your bills delivered by your messenger directly
to him; they will even then do  everything they can
either to postpone or entirely prevent  payment.
   The most  unsatisfactory and the most troublesome
kind of patients we have to contend with, are  the un-
principled scoundrels who cheat  everybody  that gives
them a chance, and consider it no wrong at all to swindle
doctors; you will  be fortunate if  you have tact  enough
to escape having anything to do with  those  you know
to belong to this  class.   It is better mildly, but firmly,
to decline to take patients who can, but will not pay,
without assigning any reason except "too busy,"  than to
contend with  them  about your fee after your work  is
done, and after all be swindled.
   Tell habitual  delinquents and those who have plenty
of money to  buy beer, or to furnish  their houses like 
181
palaces, or to follow the follies of fashion, but none to
pay  the doctor, when they come to make their bills
larger, that they are already as large as you can  afford
to let them get,—that you are perfectly willing  to go
and  serve  them again, after they pay you what they
already owe you, or a reasonable part of it.  This atti-
tude will bring them to some action, or at least indicate
to you the probable prospect.
    A   good collector, one  who  has tact enough to
get money without making you active enemies, will be
very  useful, and  is still more necessary if you  are a
poor collector yourself.   Having only a business  trans-
action with  patients,  his interviews with  them are all
business, and he can persevere in his efforts to collect,
to a degree you would find  unpleasant  or  humiliating.
Many really honest people  are  too  poor  to pay large
debts, and were you to allow what they owe you to ac-
cumulate from time to time  into a large bill, they could
not pay it to you  even  if they wished, and you  would
actually place them in a  dilemma.  Having a collector
prevents this, and keeps your financial department in
a good  condition.   It  also stimulates those who are
habitually slow in paying, and sifts out the fraudulent
before they run their bills very high.
    You should have some specific agreement with your
collector, not only regarding his rates of percentage for
collecting, but also regarding the conditions under which
he is to claim it.   Among other things, stipulate that he
is to make full returns to you  at  least once a week, also
that  he is to have no percentage on money paid  to you
by those he has  not visited for thirty  days,  unless 
182
you have, at their request, stopped him from going;
also, nothing on bills placed in his hands if the people
come and pay them before he has delivered  their  bills,
in fact nothing  on any bill he does not  in some way
assist in collecting.
    An interchange of lists (black-lists) of the names of
fraudulent patients among physicians practising in the
same section, is mutually profitable, as  it often pre-
vents the  unprincipled who could pay7 if they wished,
from imposing on a succession  of  physicians, and coerces
them into retaining and paying  some one.  Of course,
the worthy poor, if unable to pay, should always be
omitted from these lists.
    The  Esculapian art is an  aggregate of progressive
sciences ;  each  generation  contributes its quota to the
general fund, thereby making the office of Physician
more complex  in each wave of time.   I believe the
profession  of to-day can boast as clear a  field, as free
from blemishes, and as thoroughly cultivated, as that of
any age since  the times  of Hippocrates.   In fact, so
much  is now known  that to become even a tolerably
good  Physician  requires  good  sense and long study.
The human body (as you  know) is a complex structure,
composed  of many organs,  systems,  senses, nerves,
tissues, bones,  cartilages,  ligaments, &c, with a  com-
plexity of machinery whose normal workings are essen-
tial to  a  continuation of life and health.  Reflect that a
healthy adult has sixty bones in the head, sixty-seven
in the trunk, sixty-two in the arms and hands, and sixty
in the  lower extremities,  which  are  governed  by four
hundred  and thirty-four  muscles,  which  enable  him 
183
to imitate  almost  every motion except that of flying;
and that there  are  twenty-four hundred diseases  and
modes of decay to  which  this  wonderful, wonderful
tabernacle  of  God-like  form is subject.  To undo, or
rather cut these Gordian knots successfully, you must be
intimately  acquainted with the laws of life and rules of
Pathology, besides  understanding individual diseases and
their remedies, and even then you will be often criticised
or upbraided  for your  lack of foresight regarding the
recovery or death  of patients
    The  truth is,  that life is a  different  quantity in
different people, and you  will usually have no other
way to judge  a patient's prospect  of recovery than by
the average human standard.  You will sometimes have
cases which will surprise you  by  their having  a great
deal less than the average  tenacity of life, and others
that have  a great  deal more than  the average ; and no
matter how careful you are, you cannot with our present
aids accurately prognosticate the  endurance power of
every  patient.
    To illustrate what is meant:
  Suppose the above seven lines to represent the entire
gamut of  human ability  to endure sickness and  injury,
and that the central line represents the average of man's
endurance power: now, some patients will succumb, and 
184
die like  sheep, if the  first line is passed, some  if the
second is touched, others can endure to the third, and
so on, while others will actually show tenacity enough
to recover after going as low  as the fifth, or even  to the
sixth line.  Now if  you could penetrate each patient's
vital recesses, and gauge the exact  amount of his en-
durance,—could see where his  life-power ends and his
death-line begins, there  would be fewer  unanswerable
how's and why's, and you would seldom, if ever, be
reproached  for  unpredicted  terminations.   This  you
cannot do, but you can, and  must, in every case, make
full  use  of  the  teachings of experience,  and of  every
aid offered to you by medical science.
    In accidents of obscure kinds, or of uncertain degree,
and also  in cases of sudden illness, when you are pressed
to know  whether the case is dangerous or will continue
long, choose your language deliberately, and never give
any but  a tentative  answer; till you see whether  any
marked symptoms will develop,—whether  the system
reacts,—and whether there is a response to the  reme-
dies used.   During the progress of such cases be careful
to school your features and your manner that people may
not read  your surprises  and uncertainties,  and  either
force consultations on you, or entirely displace you.
    Your patients will differ greatly in  the amount of
complaint  they  make  in  detailing  their  subjective
symptoms to you.   Some who are naturally stoical and
apathetic will fall into the error of understating their
cases, fearing that a  fuller statement would alarm their
friends, or that it would cause you to think their cases
serious, and that they might  have to take  too much 
185
strong medicine, or that the doctor might pay them too
many visits.   Such patients will sometimes die almost
without giving a sign.  Others, again, of a hysterical or
nervous temperament, fearing that you may not consider
them as sick as they really are, will  magnify every ill.
One of the many advantages a  regular attendant has
over those who are unfamiliar with the sick one's nature
is, his familiarity with the peculiarities of disposition,
with  the  extent  of  the  vocabulary each one employs,
and the amount of  precision each  uses  in  describing
his sufferings.  A fine lady, a hod-carrier, a lawyer, and
a  sea-captain, would each  use a different number and
kind of terms to express the same symptoms.
    Never exhibit surprise at any possible event growing
out of sickness.    You will  be supposed to foreknow all
conceivable things relating to disease, its dangers and
its terminations.   Even when death has occurred  to
any one under your  treatment unexpectedly, do not let
your manner indicate  that you were entirely ignorant
of its possibility, or that you feel yourself blamable.
    In cases of accident and injury to drunken people,
have the presence of mind to give a  tentative opinion
only, till  they return  to a sober state.   It is better  to
say, " he is certainly  drunk ; whether  his drunkenness
obscures other and more important features, it is at this
time impossible for any one to say."
    Whemyou are called to a case of sudden death, the
utmost composure of  mind and manner is of great im-
portance.    Never express  any  opinion of the cause  in
any such case until you have calmly and coolly collected
and weighed  all the circumstances.  The possibility of
      12 
186
its being due to the heart or the  brain, to poison, or
violence or suicide, should all be carefully weighed be-
fore you  express any opinion; if you neglect  this pre-
caution,  further  developments  of  the  case  may ex-
pose you to strong censure and deep mortification.
   The popular belief is, that if a sudden death begins
at the heart, there must have been a pre-existing heart
disease, and the family physician is  often reproached for
not having  discovered it during  the patient's life-time.
Explain that the healthiest heart may suddenly become
paralyzed, or  mechanically occluded, and sudden death
result.  Bear in mind that the ordinary termination of
organic heart disease is not sudden, but very slow death,
preceded by dropsy, inability to lie down, &c.
   A belief that stout, healthy people should endure
accidents, operations, accouchements, diseases, etc., bet-
ter than weaker, complaining  people, is another popular
error ; the truth is,' the latter are  schooled to pain, to
disordered functions, lack of exercise, etc., and when they
have to endure afflictions, they are not so far from their
usual condition as the former, and have not so much
strength  to be perverted into  morbid action, and are in
most cases very much more favorable patients.
   Never be too sanguine of a patient's recovery from a
serious affliction, and never give one up to  die  in acute
disease unless  dissolution  is actually in progress;  and
above all else, never withdraw from a  case  of  acute or
self-limiting disease because the patient is very ill; for
nature, by a crisis, or a vicarious function, or a  compen-
satory process, may turn the scale and let the life-power
rally and  gain  control over the  disease  at  the  last 
187
moment, and had you given him up you would  be dis-
graced, while some other doctor, or a Homeopath, or an
old woman who had stepped  in,  would get  all the
glory.
    You will seldom be censured for a fatal issue in the
diseases of the aged, and never in those of hard drinkers,
nor in cases where you have given an unfavorable  prog-
nosis from the  first.   On the other hand, if a  woman
dies in confinement,  and there is any possible chance to
blame you, it will be done, for the reason that bringing
forth children is unlike disease  Child-bearing is intended
by nature to increase instead of diminishing the number of
our race, therefore death in labor, which is a physiological
function, or during the lying-in, which is a physiological
state, seems to be  against nature  and arouses every-
body.
    A moderately successful practitioner has about two
thousand persons who call him their doctor; whenever
any one of them has a mental or physical ailment, he
must share it.   He  must be bold  as  a lion with one
patient, and as gentle as a lamb with the next.  He must
combine all qualities and  supply all things to all  men,
and deserves, yes, Heaven  knows! he  deserves to be
treated much better  than  he is.
    The fact that a physician must keep up appearances,
and that many make their visits with  gloved  hands, in
stylish carriages, is regarded by many unreasoning per-
sons as evidence that ours is a  path of ease—that we
ride around during bank hours, prescribe for a few select
patients, receive dollars by wholesale, and soon get rich,
which is a great, a very great mistake. 
188
    Every older physician knows that it is almost impos-
sible to get rich  by the practice of medicine, unless it
is  through  a money-making  specialty.   The truth  is,
when a doctor dies, his family is usually left poor and
helpless, unless he has acquired money otherwise than
by  practice.   Were you  to practise  for thirty years
without  losing a single day,  and collect eight  dollars
every day of your life, you would receive but $87,600.
Deduct from that  amount your expenses for yourself
and  your  family,' your  horses, your carriages, your
books, your instruments, your taxes, and  a multitude of
other items, for the whole thirty years, and then  so far
from  being rich, even  after so long and lucky a career,
you  would have  but little, very little left  to support
you in your old age after a whole  lifetime  of anxiety,
responsibility and usefulness. 
INDEX. 
 
INDEX.
                             PAGE
Abortion, Solicitations to pro-
  duce .....................48, 49
Accidents, Demeanor  in attend-
  ing......................184-185
Acting as Assistant..........  10,75
Ailments not to be ridiculed...  73
Allopathy................ 136,137
Amenorrhea in Consumptives .. 107
Attending by the Year.........169
Babes, Hand-fed............110
  Warming the new-born...... 109
Baptism, Conditional...........  80
Bills....................  160 to 182
Black Lists.................... 182
Blame, Laws that govern....... 187
Boasting......................  27
Boils, Are they healthy ?........  86
Book Agents..................  55
Bores.........................  99
Borrowing....................  55
Calls, Hurried................  17
Cases, Why never abandon. 94,186
  Refusal to take........... 66,100
Catholic Patients,  Duty to---78, 81
Certificates........... 154,  155, 156
Certificates, Clergymen's :..... 155
Certificates, Legal............73, 74
Changing Medicines,  Art of---101
Charity, The Demands of...... 178
Cheap Doctors................ 170
Children's Influence..........112
Clandestine Visits.............  83
Coition, Why not  recommend.. 106
Collecting Bills..........161  to 182
                            PAGE
Collector......................  181
Cold Rooms in Sickness.......  109
Companions, What Kind  to se-
  lect.......................   12
Competition, Wars of.....168,169
Conduct in the Sick Room...  36, 37
Confidants..................   70
Confinement, Purgative after...  113
Consult, Right of Refusal to....  126
Consultation Fees............125
Consultations, Object of........  127
  Radical Changes after.......  122
  Whom to call into.........124
Consumption,   Errors  regard-
  ing....................  107,108
Contingent Fee, Why not work
  for..........................  172
Countenance, The Doctor's....
                      102, 184, 185
Critics  and Wiseacres___100, 101
Cuckoo, The..................   24
Dampness.....................  112
Deaths, Causes of sudden......
                      93,185, 186
Decrying  Medicine............ 128
Degree of Certainty in  Medi-
  cine..................129, 136
Dismissal  of  Medical Attend-
  ants  ................91, 92, 126
Dispensaries, Free  ........... 160
Dog-bites.................... 112
Double Callings..............  20
Dress and Manners, Influence of.  19
Dressing too warmly.........108 
192
                             PAGE
Drinking..................  56, 57
Druggists............... 148 to 160
Drugs  that enslave........... 122
Duties, Five  cardinal..........  93
Duty to the Dying.... 77, 78, 81, 82
Education, Its Importance to the
  Physician..................  28
Entanglements, to avoid.....  96, 97
Eruptions, Bringing out.......  85
Estates, Charges against...... 178
Ethics, Medical.............39 to 43
Eucharist, The Holy...........  79
Experiments tried on Patients..   94
Extreme Unction............  79
Fainting..................... Ill
Familiarity, Undue...........  58
Fashionable Frauds......179, 180
Fee  in advance for Secret Dis-
  eases .............. 172,173,174
Fee  Table................  16, 178
Fees....................  160 to 182
Fees for Important Cases....... 171
Fees, How to collect...... 174,175
Fees, Joint................... 178
Fees, Law-suits to  recover.... 176
Fees, Why not work for con-
  tingent..................... 172
Females, Influence of..........  59
Fever,  Water in.............. 117
Fickleness, Human............  91
Finances, The Doctor's___187, 188
G-erman, Usefulness of........  30
Gratifying Whims............  98
Guaranteeing Cures..........  73
Gums, Object of Lancing...... 110
Habits, Disgusting...........  56
Heart  Disease, Death from..... 186
Hectic confounded with Malarial. 107
Heroic Doses..............88 to 92
Homoeopathy........... 131 to 147
Humanity, its Demands....... 178
I forgot you..................  67
Incompatibles.................  30
Instruments of Precision.......  18
                             PAGE
Insults........................  70
Jealousy.............  24,25,26,68
Kindness, Influence of..:.....  33
Latin, Use of..................  29
Laws, Duty to................  96
Life Power, Scale of........... 183
Limiting Amount of Practice..  66
Malpractice Cases........... 47,96
Mankind, Study of.....31,114, 115
Manners, Influence of.... 33, 34, 35
Marriage of Doctors...........  58
Marriage of Syphilitics........ 105
Maxims...................... 179
Medicine, Decrying.......... 128
Medicine, Degree of certainty
  in.................... 129,136
Medicine Haters............... 114
Medicines, Art of  Changing...  101
Medicines, Costly............ 157
Medicines, Unused.,.......... 101
Medicines at Office____......  179
Medical Art, Imperfection of.. 128
Medical Societies........ 50, 51, 52
Memory of Cases.............  53
Menial Labors.................  72
Metric System.................  54
Moralizing...................  76
Neglectful  and  Perverse  Pa-
  tients..................... 97,98
Newspaper Squibs.........22, 61
Night Emissions.............106
No Cure no Pay............. 172
Novelty, Influence of in Medi-
  cine....................... 116
Objects of Consultations....... 127
Obstetrical Cases............  65, 66
Office, Charges  for  Advice  at
                       16, 105, 171
Office, Location  and  Arrange-
  ment of.....................  10
Office Hours..................  14
Office Practice................  17
Old Lady with  Salve..........  99
Omission versus Commission....  95 
193
                             PAGE
Over-praise from Patients......   68
Over-visiting............ 71, 83, 84
Palatability..................  114
Partisan Questions.............   57
Partnership..................   10
Patients, Distant..............   66
Patients, Neglectful  and  Per-
  verse ...................97, 98
Patients, Varieties of..........  114
Patients' Whims gratified......   98
Patients, Worthless...........  100
Paying Debts.................   55
Personal Affairs...............  175
Personal Appearance..........   19
Pharmaceutical Catch-pennies..  120
Photograph Giving............   71
Physicians, Increase  of Num-
  ber of......................   25
Physicians, the new......24, 25, 26
Physicians, Why  the older  ex-
  cel the younger........62, 63, 64
Placeboes..................88, 89
Politeness, Value of............   62
Politics....................  11, 20
Polypharmacy...............  119
Post-mortems and Analyses....   64
Practice, Limiting amount of..   66
Precautions ..................   93
Pregnancy suspected.......  48, 49
Prescriptions, about Labelling..  159
Prescriptions,  Expertness   in
  Writing....................   30
Presents from Patients.........   57
Profession, Identifying self with
  the.....................50, 51
Prognosis, Cautions concerning
                           185, 186
Purity of Mind................   32
Quack Bitters.................   76
Quackery....................  155
Quantities to Prescribe.........  102
Questions, Rule for repeating...  113
Questions, Rule regarding......   94
                             PAGE
Quinine,   Popular   Prejudice
  against................... 116
Receipts, Compel People to take. 176
Record Book..................  94
Register Heat................109
Religion......................  76
Relinquishing Attendance.....  83
Remedies,  Examined at every
  visit....................... 118
Remedies, Horrifying.......... 115
Renewal of  Prescriptions,  To
  prevent.................... 121
Reporting Cases............. 54, 55
Reputation, Value of..........  31
Responsibility,  Dividing......  95
Rich not to pay for poor......170
Riding versus Walking.........  21
Rivalry,  Professional..........  24
Scandal....................27,32
Scarlet Rash..................  85
Scold, How to, without offend-
  ing........................  68
Secrets, Guarding............  68
Services to Physicians and Cler-
  gymen ..................:... 177
Services to the Poor........... 179
Services, When not to Charge
  for........................ 177
Signs, Office..............  13 to 16
Skill, What is Medical ?........ 129
Skin Diseases, Driving in.... 85, 86
Social Influence...............  59
Specialties, When to patronize. 122
Spoons, Variations in Size of.... 122
Springtime, Taking Medicine in
  the........................  CO
Superseding other Physicians ..  61
Surprise, Showing........184, 185
Swallowing Foreign Bodies---111
Swallowing Phlegm  .........110
Synonyms, Use of........  117, 158
Syphilitic Cases..........  172, 173
Terms,  Transposing.......... 158 
194
                            PAG i:
Temper, Control of............   96
Terrifying Opinions---102 to 106
The Ruling Spirits............  113
Therapeutics, Crude  .........119
Therapeutics, Mental......  114, 115
Tongue Depressors............   75
Too Busy.....................  174
Trade-Mark Articles..........   156
Tricks........................   82
Trips  for Health..............  117
Urine, Scanty and  High Col-
  ored........................  Ill
Vaccination.............45, 46, 74
                             PAGE
Variability of Human  Endur-
  ance.................... 183,186
Veins on Back of Hands.......112
Venereal Cases............. 67, 172
Visit, Double charge for first.. 170
Visits, How to make  short---117
Visits to  the Sick........  71, 83,84
Visits, Neighborly............  24
Vocabulary of Different Classes. 184
Volunteer Services.............  46
Witness, Duty to self when a..  99
Wiseacres and Critics  .... 100, 101
Womb Doctoring.............. 103 
Cushings & Bailey,

   262 West Baltimore Street,

         BALTIMORE, MD.


   Keep constantly on hand a full and com-
plete stock of



which they offer for sale at low prices.
   Catalogue of Medical works furnished on
application.
   Also keep on hand a complete stock of

Clascal, Law and Miscellaneous Boolp
              —AND--

    FOREIGN  AND DOMESTIC STATIONERY,
SOLD AT LOW PRICES. 
2339 
 
NAL UBRARY OF MEDICINE
NATIONAL LIBRARY OF MEDICINE
NATIONAL LIBRARY OF MEDICINE
 
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NATIONAL LIBRARY OF MEDICINE

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