MEDICAL ESSAYS. 
Nullius addictus jurare in verba magistri 
Nec sequar aut fugiam quæ diligit ipse vel odit. 



THE following trifles have met with their 
share of praise and of abuse; the former 
was eagerly swallowed by the keen appetite of 
a literary adventurer, and the shafts of the 
latter were blunted by juvenile vanity, that 
soothing kind of self-approbation, which by 
a specious, and perhaps an allowable decep- 
tion, secures the slender portion of happiness 
allotted to mankind. 
In reply to what has been advanced against 
my ideas of Solvents, I can with truth assert, 
that, after having minutely re-considered the 
subject, and adverted as well to my own prac- 
tice, as to that of a numerous and respectable 
medical acquaintance, my opinion is still the 
same.—If I have, by the essay on that sub- 
ject, rescued one patient from the ravenous 
jaws of a quack; and if by the second, I have 
kindled one spark of candour or liberality of 
sentiment in a breast not already enlightened, 
ample has been my reward. 
As I now take leave of Physic and all its 
appendages, I embrace this opportunity of 
bidding adieu to all my friends, in a part of 
the world where I practised several years, and 
of acknowledging the more than common 
marks of friendship I received. 
The


(iv)
The formality of taking a personal leave, 
would have been a fatiguing and a melancholy 
task. 
To the gentle hints which mistaken par- 
tiality has suggested, of the culpable danger of 
strong passions and active talents, undirected 
and unemployed, I can only reply, that I 
could not stop my ears against the fyren voice 
of independance, which, in exchange for mid- 
night dangers, deranged feelings, and the 
frivolous ardor of petty competition, offered 
literary leisure, select society, and the luxury 
of ease. 
Nor can that man be said to have passed 
his life wholly unuseful, who, while death 
and calamity were stalking through his fa- 
mily, devoted the fourteen best years of his 
life, to the study and exercise of a liberal but 
laborious profession.
J. W. NEWMAN. 
DORSETSHIRE, 
October 3d, 1787. 

A 
SHORT ENQUIRY 
INTO THE 
MERIT OF SOLVENTS, 
So far as may be necessary to compare them 
with the 
OPERATION OF LITHOTOMY. 
BY 
J. W. NEWMAN, 
Hoc opus, hoc studium, parvi properemus et ampli, 
Si patriœ volumus, si nobis vivere chari. Horat. Epist. 
THE SECOND EDITION. 
LONDON: 
Printed for J. DODSLEY, PALL-MALL, 1781. 
Price 1s. 6d. 




TO 
Dr. WILLIAM CADOGAN, 
FELLOW OF THE ROYAL COLLEGE OF 
PHYSICIANS, LONDON, 
THE FOLLOWING ENQUIRY 
IS HUMBLY INSCRIBED, 
AS A PUBLIC ACKNOWLEDGEMENT OF GRATI- 
TUDE AND RESPECT 
DUE TO HIS EMINENT PROFESSIONAL AND LITE-  
RARY ABILITIES, 
BY 
HIS OBLIGED HUMBLE SERVANT, 
The Author.



PREFACE. 
IT is not intended, in the following en- 
quiry, to enter into a chymical exami- 
nation of the several remedies, which have 
been proposed as solvents of the stone in the 
human bladder; the basis of most of those 
compositions being generally known. 
In the present instance, the author wishes 
to take a view of the general method of treat- 
ment by internal medicines, and its general 
effects; and, in as concise a manner as may be, 
to compare the advantages and evils result- 
ing from a reliance on that mode of treat- 
ment, with those attending the extraction by 
manual operation. 
Thus a question of no less concern to the 
lives of patients, than to the honor of sur- 
gery is considered. 
For if it should appear that we are at this 
time possessed of a safe and efficacious inter- 
nal medicine, as a solvent, we certainly are 
not authorized to persist in the operation of 
cutting for the stone. 
If, on the contrary, it should be evident, 
that most of the methods of internal treat-
B ment

2 PREFACE. 
ment have not only wanted efficacy, but have 
been highly injurious: justice and humanity 
require us to place no further confidence in 
them; nor in that case can we be justly ac- 
cused either of rashness or cruelty, in assert- 
ing, that lithotomy remains, as our last, our 
only resource. 
It may possibly be asked, Why a subject of 
such importance is treated in so superficial and 
cursory a manner? The author can only la- 
ment, that his abilities have not kept pace 
with his wishes, otherwise, this his first effort 
should not have been submitted to the public 
in so defective a state. 
The common excuse, of meaning this weak 
attempt as an incitement to some more able 
hand to take up the subject, might be here 
made use of; but expressions of that kind, 
though they wear the face of humility, carry 
with them a degree of importance, which, in a 
Preface to a bare recital of facts, with short 
comments, would be misplaced, unnecessary, 
and absurd. 
A SHORT

A 
SHORT ENQUIRY 
INTO THE 
MERIT of SOLVENTS, &c. 
CHAPTER THE FIRST. 
A Prejudice against Surgeons considered.—Intro- 
duction.—Lithotomy.—The Opposition it met 
with, and some Reasons for it spoken of.— 
The general Theory and Basis of Solvents.— 
Mrs. Stephens's Preparation mentioned.—An 
extraordinary Case.—Its Consequence.—A 
Proneness in Mankind to encourage Error and 
Imposture. 
A PARTIALITY for operations has 
been, for many ages, a commonly re- 
ceived idea, annexed to the character of a 
surgeon.—This scandal has been heightened 
by the force of ridicule, and supported by 
serious assertion; and that which first origi- 
nated from resentment against the igno-
B2 rance 

[4] 
rance of pretenders, has been indiscriminately 
charged on modern professors; who, though 
surgeons, are not observed to divest them- 
selves of that tenderness and humanity which 
they ought to possess as men.—The number 
of dismembered objects occurring in the 
streets of this metropolis, has been produced 
in favor of the argument; but if they, who 
mention this, would be candid enough to 
consider, that every one of those objects was 
in a situation, in which, saving of the limb 
was incompatible with the preservation of 
life, and determine how they would decide 
in such circumstances, the objection will be 
fully refuted. Besides, we ought to consider 
that London, from the vast concourse of per- 
sons of every description to it, is the last re- 
fuge of most objects in the whole kingdom, 
who, from the loss of health or limbs, may be 
supposed to excite pity and relief. 
Among the variety of operations which 
from disease and accident become necessary 
to be performed on the human body, the 
making a lateral incision into the neck of the 
bladder *, as it has been improperly called, 
and
* That the antients took most of their anatomical de- 
scriptions from the dissections of brutes, is clear, and 
particularly so, when they describe the bladder; which 
in man really has no neck. Though at present we retain
the

[5] 
and extracting the calculus or stone, has raised 
at different times no small opposition. 
The horrors of patients, who shuddered at 
the thoughts of a painful operation, naturally 
inclined them on the side of its opposers, 
and added weight to their cause: these, assisted 
by a love of novelty inseparable from the 
human heart, and attracted by a rich har- 
vest of emolument to adventurers, afforded a 
temporary triumph to the enemies of litho- 
tomy. 
Each armed with a specific, arraigned the 
folly of patients for submitting to it, and 
the obstinate cruelty of surgeons for perse- 
vering in it. 
They proffered comfort, ease, and a radical 
cure to the afflicted; whilst they alledged, 
that the operation, independent of its pain 
and danger, which their interest taught them 
to aggravate, was at best but a palliative 
the name for conveniency, it conveys an idea of its 
shape so exactly opposite to its natural one, that the 
part of the bladder, where the urethra enters, is larger 
than the fundus, and its connection with the urethra 
may be compared to a spherical body pierced by a cy- 
lindrical tube. This error has been zealously embraced, 
and accurately copied, both in plates and verbal descrip- 
tions, in all the editions of books of anatomy; where the 
compilers paid an implicit confidence to the assertions of 
others, without being at the pains of dissecting and 
examining the parts themselves. 
B3 cure

[6] 
cure: as, to make use of their own language, 
the wretched patient, after being tortured by 
the bloody apparatus, was in a few years, if 
not months, liable to a return of his disease, 
and to an equal necessity for a second opera- 
tion. 
Their assertions were received with the most 
implicit faith, and their medicines swallowed 
with avidity. 
Fear and credulity, two infirmities to which 
all men in a greater or less degree give way, 
were in the present case turned to good ac- 
count, by those who had greater dexterity in 
the arts of deception, than real necessary know- 
ledge, and who were more dexterous as casuists 
than as physicians: with them, as with most 
branches of the medical profession, an art- 
ful application to the passions, the preju- 
dices, and even the follies of mankind, is a 
much easier road to emolument and same, 
than the rugged and difficult paths of study, 
diligence and application, which generally 
prevent the attainment of that versatility of 
manners, and that winning deportment, with- 
out which so little can be done; and a son 
of science might spend many unavailing years 
in anatomical pursuits, and pore over Hip- 
pocrates and Van Swieten in obscurity, while 
a genius of an illiterate, but more sprightly 
cast, would make his way to affluence and 
honors untainted by the dissecting-room, and
2 his 


[7] 
his hand unsoiled with the rust of any books, 
but those of Machiavel, Voltaire, and Ches- 
terfield. 
The above truth, and a melancholy one it 
is, urged me to deviate somewhat from my 
subject. 
Without entering into a fatiguing detail of 
the several particular remedies, that have been 
offered to the public as solvents of the human 
calculus, which would be neither interesting, 
useful, nor necessary: the whole number may 
be comprehended under the two titles of al- 
calies and acids, taken either by the mouth, 
or injected into the bladder. 
The general theory of their action was ac- 
counted rational, and thought incontrover- 
tible, by patients, who took them with as flat- 
tering hopes, and as earnest a reliance, as a 
person, to whom poison had been administer- 
ed, would swallow the most undoubted anti- 
dote. 
The solvent medicine, as the name of it 
signified, was supposed to act upon the stone, 
by dissolving the glutinous matter, which unit- 
ed like a cement, and bound the earthy parti- 
cles of it together; as the texture of it was 
thus destroyed, it would naturally crumble to 
pieces, and its component parts be discharged 
from the bladder with no great inconveni- 
ency. Besides this, it was also concluded, 
that the same remedy, which dissolved, would 
B4 effectually


[8] 
effectually prevent a re-production of calcu- 
lous matter. 
Calculi that had been extracted from the 
human bladder, were submitted to the ac- 
tion of the solvent, and this experiment of 
their effects on concretions out of the body, 
strengthened their theory, and induced the 
encouragers of the internal method of treat- 
ment, to draw a prognostic in favor of their 
efficacy in the body. 
But we ought to remember, that it was 
their business, at all events, that the medicine 
should act on the stone; and we are justified 
in supposing, that their effects in this in- 
stance, were the consequence of such a de- 
gree of strength and causticity, as rendered 
their admission or retention in the bladder im- 
possible: besides the palpable difference be- 
tween the vessel they made the experiment in, 
and the internal coat of the bladder. 
This reason is so insuperable against the use 
of solvent injections, that I see no probability 
of their being ever made use of with advan- 
tage. But, unfortunately for the medicines, 
as well as mankind, these antidotes for the 
stone were in many cases found ineffectual, and 
generally injurious. 
Nor is it improbable, that the introduction 
of alcalies into the human body, in such 
quantities as they have been generally ex-
hibited, 

[9] 
hibited, should be productive of very distres- 
sing, and in many cases of fatal effects. 
An extraordinary effort of nature, in the con- 
stitution of a patient, under a course of a cele- 
brated solvent, seemed to remove, and indeed, for 
a time, did remove every doubt of its efficacy. 
I trust that it will not be thought foreign to 
the subject, to speak further of this case, as it 
may serve to teach us a very necessary lesson— 
to be diffident and guarded in our opinions; 
and points out to us the mistakes, the best 
informed of us all are liable to, in tracing 
causes and their effects, and that too in an 
instance where there seemed the least proba- 
bility of being deceived. 
A patient was produced by Mrs. Stephens, 
and it was agreed that he should be a decisive 
test of the merit of her medicine. A stone was 
plainly felt, and, by several gentlemen of emi- 
nence appointed for the purpose, unanimous- 
ly allowed to be at that time existing in the 
bladder. 
There medy was administered to the patient; 
the quantities given, and the time it was per- 
severed in, being left to the disposal of the in- 
ventor. 
After such a space of time as was supposed 
to be sufficient for a due exhibition and ope- 
ration of the medicine, the patient was again 
produced, and after as judicious and accurate 
an examination as the circumstance seemed to
require, 


[10] 
require, the gentlemen appointed to decide 
on the fact, gave in a report, which by the 
world was thought decisive in favor of a me- 
dicine, that, as far as could be judged, seemed 
to promise such permanent benefits to human 
nature. 
They reported, that at the time they 
searched the patient in question, they had the 
most unequivocal proofs of a stone in the 
bladder: that for such a time the medicine 
had been given, and that on a second careful 
examination nothing like a stone could be 
felt. 
A liberal gift, worthy a British parliament, 
was the immediate consequence of this re- 
port: the case was generally thought so de- 
cisive, that a further trial of it was judged 
unnecessary: the medicine was made public, 
and enjoyed the temporary reputation of an 
undoubted dissolver or breaker-down of the 
stone in the human bladder. 
But death brought truth to light, and nei- 
ther popularity nor confidence could enable 
it to survive the patient, whose case gave it so 
great a sanction; the total loss of its same, 
which had been gradually declining, was 
the consequence of his death. 
This happened some years afterwards, and 
afforded an opportunity for inspecting the 
body; when nothing of a calculous nature 
could be discovered in the bladder, but on a
further 

[11]
further search, a stone was discovered in the 
cavity of the pelvis, surrounded by a quan- 
tity of adventitious cellular membrane, and 
inveloped in a portion of the internal coat of 
the bladder.  
It appeared, that a part of this membra- 
nous coat, containing the stone, had been forc- 
ed by some præternatural irritation into the pel- 
vis, through or between the fibres of the mus- 
cular coat, which forms the external covering 
of the bladder, and is called by anatomists, 
Musculus Detrusor Urinœ; the alteration which 
took place, was very similar to what happens 
in the ventral hernia, where the peritonœum, 
the internal membrane which lines the abdo- 
men, is protruded, with its contents, between 
the fibres of the abdominal muscles. 
In the present remarkable instance, the mus- 
cular fibres contracting, and co-operating with 
the weight of the stone, which could not fail 
dragging down the sac, effectually prevented 
a return of the protruded parts. 
The world is generally rash and precipitate 
either to condemn or applaud, and the warm- 
est advocate for this medicine could not pre- 
tend to attribute so extraordinary an effort in 
the body to any specific power it possessed. 
Abundans cautela non nocet, is a safe but un- 
fashionable doctrine: had it been adhered to 
in this case, perhaps no resolution would 
have taken place, until the body of the pa-
tient 


[12] 
tient had been examined after death, and the 
public money would have been saved. 
The report the gentlemen made was couch- 
ed with all necessary caution, and though it 
amounted to nothing more than a bare recital 
of facts, it answered for a time every purpose 
of a decision in favor of the preparation. 
When we consider this case, we may ac- 
count for the immediate cessation of bad 
symptoms which is said to have taken place; 
and we can as readily believe, that an instru- 
ment introduced into the bladder for the pur- 
pose of searching, could not come in contact 
with the stone. 
But it must be a matter of surprize, that 
a medicine, which in the instance above re- 
cited was proved not to have produced any 
solvent effects, should have obtained, or have 
been able to support any degree of credit 
from the time of its publication, and previous 
to it, until the death of the patient. 
The erroneous opinion of the efficacy of 
this preparation, was most likely assisted by se- 
veral complaints having symptoms very simi- 
milar to those attending the stone in the blad- 
der; and in many of these, nature, by time 
and accident, without the assistance of much 
medicine, will often cure herself: so that we 
cannot doubt, but they had in this case, as in 
many others, the credit of dissolving the stone,
merely 

[13] 
merely from the circumstance of there never 
having been one in the bladder. 
Nor is it improbable, that persons perfectly 
free from the stone, have been reported to die 
in consequence of it, when the mode of inter- 
nal treatment was actually the cause of their 
deaths; and this supposition will appear still 
better founded, when we come to speak of the 
nature and tendency of some remedies that 
have been made use of. 
Among the complaints, whose symptoms 
are not unfrequently similar to those of the 
stone, such may be reckoned as proceed from 
a defect or superfluity in the quantity or qua- 
lity of the urine;—an undue retention of it, 
from a variety of causes;—and many tempo- 
rary affections of the bladder, kidnies, and 
their appendages, not unfrequently arising 
from plethora, debility, excess, and local in- 
jury. 
And on this ground, candour would in- 
cline us to assent to the truth of many mira- 
culous cures, related from the most respect- 
able authorities, which, taken in any other 
point of view, would be contradictory to 
theory, practice, and common sense. 
It is necessary to mention another circum- 
stance, which often confirms patients in the 
opinion, that several of the disorders I have 
just spoken of, arise from there being a stone 
in the bladder; which is, their observing a 
gritty

[14] 
gritty matter at the bottom of the vessel con- 
taining the urine: under this opinion, they 
often apply for advice and medicines to those 
who may honestly be of the same opinion, or 
whose interest may induce them to recom- 
mend a course of solvents. 
What they observe, is nothing more than 
the selenite assuming the colour of the urine 
in which it has formed; and such a chrystal- 
lization will frequently be found in the urine 
of the most healthy. 
What greatly assists this error is, that the 
urine is generally examined at many hours 
distance from the time of its being received 
into the vessel: now gravel, or any calculous 
matter, by its specific gravity descends to the 
bottom of the vessel, and may very easily be 
discovered soon after the urine has been void- 
ed; the contrary to this is the fact respecting 
the selenite, which requires to be out of the 
body, and at rest, for a considerable time before 
its formation takes place; and if this circum- 
stance should not have been taken notice of 
until solvents have been given, it will not fail 
being imputed to their efficacy. 
As another reason for this remedy having 
kept up its name, I can only add a fatal dis- 
position in mankind, to adopt and embrace 
error and prejudice, rather than truth and 
plain facts, because the latter often carry un- 
welcome tidings to the human heart.
The 


[15] 
The ease with which mankind are duped, 
is evident enough, were it not proved to a 
demonstration, by the fraternity of impostors 
and upstarts in every profession, science, and 
business, who insult the understanding of the 
age, and excite at once both anger and con- 
tempt. 
Had the author, who some centuries since 
exclaimed, with so much truth and justice, 
Mundus vult decipi; et decipiatur: 
Had he lived in the present time, when ig- 
norance, effrontery, and impudence, at once 
draw their support from, and impose on the 
public, without sense or probability to assist 
their cheats, he certainly would have added 
energy to the expression, have adopted a lan- 
guage more severe, and reprobated, with the 
keenest satire, the insolence of the spurious 
fantastical tribe. 
CHAP


[16] 
CHAPTER THE SECOND. 
Some Causes that hurt Lithotomy considered.— 
Delay.—Long Courses of Solvents.—A Case. 
—Mr. Garrick mentioned.—A few Reasons 
against the Efficacy of Preparations supposed to 
act on the Stone.—Prejudice and false Reason- 
ing have been opposed to the Operation.—The 
Term Anceps misapplied. 
I Have endeavoured to shew, that surgeons 
have not that predilection for operations, 
so generally charged on them; as they were 
ready to forward the success of a prepara- 
tion, which it was supposed would render li- 
thotomy unnecessary. 
It has likewise appeared, that this remedy 
did not dissolve the stone; which renders it 
more than probable, that all medicines on the 
same principle will be equally ineffectual. 
I shall next venture to speak of some of the 
causes, which have co-operated in rendering 
lithotomy less successful than it would other- 
wise have been; some of them being equally 
applicable to any other disease requiring ma-
nual operation, does not appear to me any 
just objection to my mentioning them in this 
place.
They 

[17] 
They may be considered in the following 
order; and in treating of them, I shall be led 
to speak further of solvents, and some of their 
general effects. 
First—Procrastination. 
Secondly—Long continued courses of lixi- 
vial and other remedies, intended as solvents. 
Thirdly—The contaminated air of hospi- 
tals; most of the patients offering for this 
operation, being objects for hospitals. 
Fourthly—An inattention to a few parti- 
culars previous to, and during, the operation. 
And first, we cannot but lament the fre- 
quency and fatality of delay, which probably 
induced Frere Jacques to exclaim in his 
religious zeal for the operation, that if, as its 
opposers asserted, lithotomy had killed thou- 
sands, putting off the operation until the pa- 
tient’s strength and constitution were exhaust- 
ed, had killed tens of thousands. 
Nor ought we to be surprized, that pa- 
tients are willing to have the operation de- 
layed, when we consider how inherent a prin- 
ciple it is in the human breast to fly from 
pain. The expediency of suffering a present 
increase of it, for the sake of future relief, a 
reason though the most clear and convinc- 
ing, is what their minds, blinded by the ter- 
rors of the knife, either cannot or will not 
comprehend. 
Like the drowning wretch catching at a 
twig, they eagerly grasp every shadow of
C hope, 


[18] 
hope, to save them from the impending evil; 
thus are they fatally deluded and prevented 
from obtaining substantial relief. 
Nor has it unfrequently happened, that per- 
sons have been produced, whose situations 
rendered them fitter objects for the grave than 
the table of the operator. 
In such cases, surgeons generally have men- 
tioned the impossibility of success, and have 
prudently declined the operation. 
Yet, strange as it may appear, persons at 
other times inimical to it, have net been want- 
ing to enforce and encourage the performance 
of it at this period, and under circumstances 
that promised so fatal an event. 
The only motive for so contradictory and 
so criminal a conduct, must be a hope, that 
from the ill success which would attend it, 
and be laid to its charge, they should add 
weight to their arguments against the opera- 
tion, and that the death of the patient, hasten- 
ed, perhaps brought on by their specifics, 
would be imputed to the fatality of cutting 
for the stone, and save the credit of their me- 
dicine. I need not point out the folly and 
cruelty of such a conduct, nor the character 
of such men; they must be void of every prin- 
ciple of honesty and humanity. 
With respect to delay, in cases of the stone, 
we may reasonably conclude, that a morbid 
irritability of the patient’s system, a train of 
complaints of the nervous kind, and an injury
5 of 

[19] 
of the functions of the parts affected, may be 
produced by an extraneous body, irritating 
the bladder to frequent præternatural con- 
tractions;—and these cannot fail being ag- 
gravated by the distress of mind, inseparable 
from a disease, peculiarly excruciating, and 
the constant dread of an operation. 
It must be allowed, that instances have oc- 
curred, where it was probable, and almost cer- 
tain, that a stone must have existed and been 
forming in the bladder for some time before 
any disagreeable symptoms came on. A case 
of this kind happened at an hospital of this 
metropolis very lately. 
The patient had enjoyed a state of perfect 
health until within a fortnight of the opera- 
tion; when the usual symptoms of a stone in 
the bladder coming on and increasing to a vio- 
lent degree, after being searched, he was cut, 
and a stone of some size was extracted. 
Others have been afflicted with severe at- 
tacks for a long period, and their complaints, 
without any medicine being taken, or any 
visible cause, have left them for a consider- 
able time, and have afterwards returned in as 
unaccountable a manner; but a few excep- 
tions can never cancel a general rule. 
In the year 1777 I assisted in opening the 
body of a gentleman aged about thirty; whose 
general health and looks were so impaired, and 
his body so emaciated, that the gentleman
C2 concerned 

[20] 
concerned with me, thought him at least fifty 
years old. 
As I received an account of this unhappy 
man’s case from one of his relations, having 
never seen him during his life, I hope I shall 
be excused on that account, for the imperfect 
manner I relate it in. 
His fits of the stone, as they are generally 
called, were frequent and dreadful; a con- 
vulsion of the whole frame seemed on these 
occasions to take place, accompanied with a 
discharge of the contents of the stomach and 
the rectum.—The knees were forcibly drawn 
up to the abdomen, from whence every effort 
to remove them, as long as the paroxysm con- 
tinued, was ineffectual; as that went off he 
gradually recovered himself, a cold sweat hung 
in large drops on the surface of his body, and 
a faintness remained, under which his attend- 
ants supported him with great difficulty: at 
length death closed the wretched scene, and 
the harrassed patient, after a fit, which seemed 
longer and more violent than usual, expired 
in a kind of syncope. 
I was given to understand, that be had la- 
boured under this complaint for more than 
two years and an half; that at first he was 
treated by an apothecary with oily, and pro- 
bably diuretic mixtures, with opiates at in- 
tervals; and lastly, Castile soap, which he took 
in considerable quantities. 
The 




[21] 
The ease and relief that he received, were 
of course but temporary, the symptoms gra- 
dually increased, and he had recourse to some 
solvent that is vended. In this, and in others 
of the same kind, he persevered for a consider- 
able time; a loss of appetite and digestion 
were added to his other complaints; and a 
bottle of some preparation was brought to 
me, which from its taste and appearance 
seemed of the lixivial kind; of this I was told 
he had taken within three weeks of his death. 
On inspecting the kidnies, great part of 
their substance was degenerated into hydatids, 
the ureters were enlarged, and their oblique 
perforation, or valvular manner of entering 
the bladder, was destroyed. 
The coats of the bladder were amazingly 
thickened; or, to use a more technical expres- 
sion, the muscular coat of it, from its in- 
creased action, was improved. 
A stone was found in it larger than the egg  
of a hen; the shape was an oblong flattened 
oval; the surface of it was irregular, in some 
parts smooth, in others rough and bordering 
on angular points, which accounted for the ex- 
traordinary violence of the symptoms. 
For the last six months of this person’s 
life, his bladder lost its retentive power, and 
the urine dropped from him as it was se- 
creted from the kidnies.
C3 An 

[22] 
An anxiety to preserve the stone, induced 
my friend to secure it immediately, which 
prevented our weighing it at the time of 
opening the body; and it was either broken 
or taken from him afterwards, which pre- 
vented doing it at all. 
The calculus almost filled the cavity of the 
bladder, which had contracted to such a de- 
gree, as to render itself unfit for, and incap- 
able of being a reservoir for the urine; which 
accounts for the incontinency coming on. 
In this case, I fear, the most sanguine pro- 
moter of lithotomy would have trembled for 
its success, even during any of the last twelve 
months of the affecting tragedy: two of the 
causes I have before mentioned, combining 
to render the success of it hazardous, delay, 
and a long course of solvents. 
In circumstances so alarming, in a situa- 
tion so truly melancholy, patients own their 
fatal mistake, and lament a reliance on me- 
dicines, ineffectual and injurious; but, alas! 
lament it too late: for on this occasion, as 
on several others in life, men are apt to neg- 
lect evils that may be remedied, because at 
first they do not seem of great consequence, 
until the opportunity for being relieved is ir- 
recoverably lost; as, after a certain time, we 
ought to consider, that every day, nay, every 
hour, that we lose by delay, will rob the ope-
ration 

[23] 
ration of a proportionate probability of suc- 
ceeding. 
Besides, it has happened, that the ill suc- 
cess which was owing to a want of atten- 
tion to the time and circumstances necessary 
for its being performed with the prospect of a 
happy event, has been most unreasonably 
charged on the operation itself; and this may, 
with the strictest propriety, be applied to most 
operations in surgery. 
Deductions against lithotomy, from such 
false and inconclusive reasoning, would be a 
species of argument similar to, and as ratio- 
nal, as the prejudiced aversion which I was 
lately told a burgomaster’s wife in Holland 
had taken against bleeding. 
This lady could not, for a long time, be pre- 
vailed on to suffer herself, or any of her fa- 
mily, to lose blood, because she had been de- 
prived of a distant relation, in a putrid sever, 
who, it was naturally supposed, died in conse- 
quence of phlebotomy being imprudently per- 
formed.—A pleurisy which raged soon after, 
put the zealous matron’s resolution to the test; 
and her mistaken prejudice, but for the inter- 
position and remonstrances of her friends, 
would have cost three of her family their 
lives. 
With respect to lixivial remedies, it ap- 
pears to me, that if given with caution, and 
in small doses, they leave the patient pre-
C4 cisely 

[24] 
cisely in the same state they found him; if 
the quantity is increased, they produce fe- 
verish heats, and an uneasiness in the system, 
disorder the primœ viœ, appetite and digestion, 
increase the secretion of urine, and render it 
perhaps more turbid than it naturally is: and 
if medicines of this kind are given in large 
quantities, and are persevered in, they ulti- 
mately tend to destroy the patient; nor in- 
deed can preparations of this kind be given, 
even in small doses, in some constitutions, with- 
out hazarding the life of the patient, and the 
credit of the prescriber. 
Besides this, general practice does not au- 
thenticate their having performed any actual 
cures, where the stone was felt previous to 
their exhibition; while reason and experience 
point out to us the fallacy of trusting entirely 
to symptoms, in determining the difference of 
diseases; and daily mistakes evince, how cau- 
tious we ought to be, in affording an implicit 
confidence to the descriptions and aggravated 
feelings of patients. 
And indeed we ought not to be surprized 
at its want of success, when we take a view of 
the variety of channels and alterations it must 
pass through, and the diluted state in which 
it must of necessity pass into the bladder. 
From the stomach, we are to suppose it 
absorbed, and mixed with the chyle convey- 
ed into the blood; then carried to the kidnies
by 

[25] 
by the emulgent arteries; it there undergoes 
a process which we are not acquainted with, 
compared by some to filtration; and finally, 
by the ureters it gets into the bladder to act 
on the stone. 
So that, before it can possibly reach the feat 
of the disease, the whole mass of blood must 
become lixivial; and it would be very unrea- 
sonable to suppose, that a preparation, whose 
activity depended, in a great degree, on its 
causticity, should become inert and harmless in 
its passage, through parts so minute, so deli- 
cate, and possessed of so great sensibility, as the 
internal coat of the bladder is more especi- 
ally endued with, for very obvious purposes: 
and indeed the irritability of this membrane 
is such, that no fluid but the natural one 
can be long contained in it, even pale urine, 
or urine with matter in it, exciting, in a de- 
gree, symptoms of the stone, and forcing the 
person to void it very quickly. 
That delight and wonder of the age, Mr. 
Garrick, who was as much beloved as his 
death, was universally lamented, laboured 
for many years under a calculous complaint: 
partial to medicines, and eager to embrace 
every thing that possessed or promised any 
efficacy, he persisted in the use of many sol- 
vents; and a violent pain in the stomach, 
which latterly was frequent, he generally at-
tributed 


[26] 
tributed to the effects of these medicines, as 
he had not experienced it until their use.—On 
inspecting the body after death, the organiza- 
tion and substance of the kidnies were found 
almost destroyed; a stone of considerable size 
was found in the bladder; the surface of which 
plainly evinced, that it had not been in any 
degree abraded, dissolved, or broken down; 
though it might have been expected, from 
the vast quantities of drugs he swallowed, his 
long perseverance, and the boasted efficacy of 
them. 
Instead of acting as lithontriptics, and de- 
stroying the stone, in this melancholy in- 
stance, they were generally supposed to have 
brought on a destruction of the system.— 
Could Mr. Garrick have been persuaded to 
submit to the operation before he took the 
solvents, the world might still have been bless- 
ed with his presence, and his friends might 
not, for many years, have felt the irreparable 
loss of so entertaining, so instructive, and so 
amiable a man. 
As to solvents,—a long course of them, 
from their evident effects, cannot be fa- 
vourable to the operation of lithotomy, the suc- 
cess of which will be proportionably lessened 
as the general health is impaired. 
A languor and debility, with a disposition 
to feverish complaints, accompanied with a
loss 

[27] 
loss of appetite and digestion, are, in greater or 
less degrees, consequences, which I have not 
in the least aggravated. 
Under these, and their attendant circumstan- 
ces, a disease, not in general dangerous, will 
often become fatal; stone patients being liable 
to other incidental complaints in common 
with mankind. 
I have seen two instances, where the pa- 
tients, in a distinct benign species of the small- 
pox, both died, though the disease in the 
neighbourhood was by no means fatal: they 
were taking solvents when the symptoms of 
the small-pox came on; and though it could 
not be certainly said, that the solvents were 
the cause of their death, the natural and im- 
partial inference would render it more than 
probable. 
A third patient, under a course of sol- 
vents, was seized with a putrid fever, and 
ulcers in the throat, under which he sunk, 
though Port wine, bark, blisters, &c. were 
liberally used, and under the direction of a 
gentleman, who is an honor to his profes- 
sion; this last patient was remarkably healthy 
before he was afflicted with the stone.—I 
was not permitted to examine either of these 
bodies after death, to ascertain whether they 
really had calculi in their bladders, and how
far

[28] 
far the solvents had produced any effects; 
nor can I help lamenting the mischievous ob- 
structions, which this prejudice lays in the 
way of surgical knowledge. 
Scrupulously observed, in times of abject 
barbarity, or superstitious bigotry, the student 
in anatomy will find a difficulty to overcome 
it in times so enlightened in many other re- 
spects as the present; nor is it improbable, that 
in some remote period, posterity may mention 
it to the disgrace of an age not hood-wink- 
ed by superstition, but encouraging most 
branches of useful and polite arts, that the 
hands of industry and diligence were tied on 
so interesting a subject, and that so great an 
avenue to improvement was barred up, as 
the examination of morbid appearances after 
death. 
Having endeavoured to shew how far in- 
ternal medicines obstructed the success of li- 
thotomy, and some other causes; I shall 
proceed in the next chapter to a short con- 
sideration of another cause or two; and af- 
ter some necessary observations, I shall hasten 
to a conclusion. And I believe, that most stone 
patients would readily submit to the opera- 
tion, were they not deluded on the one hand 
by flattering, but false promises, and terrified 
on the other by alarming descriptions.
It 


[29] 
It has been tritely observed, anceps reme- 
dium melius quam nullum; but remedies, whose 
curative effects are uncertain, and whose in- 
juries to the constitution are highly probable, 
cannot, with propriety, be comprehended un- 
der the description of this axiom.
CHAPTER 


[30] 
CHAPTER THE THIRD. 
Hospital Air.—Defects in some Parts of the Ope- 
ration considered.—Fixed Air mentioned.— 
Some Objections to Lithotomy spoken of.—Cir- 
cumstances in favor of Solvents proved not to 
be so.—Mr. Cheselden's Account.—Conclusion. 
I Have mentioned the contaminated air of 
hospitals as another cause operating against 
the success of lithotomy. As this is acknow- 
ledged and lamented by all, I shall be very ex- 
plicit in considering it.—So far as it affects 
the general health of patients, it will tend to 
this purpose. 
But the proper digestion, and healing of 
the sore, are what seem principally to suffer 
from it. 
And whoever has attended to the patients 
in the hospitals in this city, after they have 
been cut for the stone, must have observed 
many instances, where the sore put on a bad 
appearance, with a thin gleety discharge for 
months; but on the patient’s retiring into the 
country for a few weeks, a kind granulation 
took place, the sore soon healed, and the pa- 
tient perfectly recovered.
The

[31] 
The general fatality of compound frac- 
tures in this metropolis, which surgeons of the 
first eminence complain of, may in a great 
measure be attributed to this cause: it re- 
mains to be decided, how far it would be 
either expedient or possible, to erect a build- 
ing in an airy situation, separate from the 
hospital, and to appropriate it solely to pa- 
tients of a certain description. 
It may be necessary to observe, that when I 
said, “ most patients, subjects for this opera- 
“ tion, were objects for hospitals, ” I did not 
mean to infer, that one rank of men were more 
liable to the stone than another, as I do not 
know that it is so; what I said, arose from this 
fact, that the comparative number of those, 
who were able to employ an operating hospital 
surgeon at their own houses, was very small. 
And the advantages of having recourse to 
the best medical and surgical advice, which 
the very lowest people in great cities possess, 
is a privilege, which the useful rank of man- 
kind, between affluence and poverty, cannot, 
or must not, take the benefit of; whilst the 
undiscerning and thankless multitude either 
demand it with stubborn insolence, or enjoy 
it with silent ingratitude. 
The blessings of ease and comfort should 
be diffused with a liberal and unreserved hand, 
to every individual of the creation; and he 
who does not feel an ample reward, in having
relieved 


[32] 
relieved a fellow-creature, does not deserve to 
practise, or even to live. 
The last cause I mentioned, was a defect in 
a part of the operation:—and I speak of it 
with the awe and timidity of a young mari- 
ner, venturing his little bark in dangerous 
feas, and in the tracts of able and experienced 
navigators. 
The circumstance I meant to speak of, is the 
external incision; which every one in the ha- 
bit of attending to operations, must at times 
have observed to be small and inadequate to 
the purpose of admitting the extraction of the 
stone; nor has the whole strength and repeat- 
ed efforts of the operator been able some- 
times to effect it; though assisted (as I have 
been informed) by the arms of an assistant ap- 
plied round his body.—I have seen two ope- 
rations performed, where, after several ineffec- 
tual trials, the stone could not be extracted 
until the incision was enlarged.—Nor can 
I see that any of the dangers, attending an ex- 
ternal incision of the common size, will be 
any ways increased or diminished, by making it 
half an inch, or even an inch longer or shorter. 
The cutting gorget, for which the world is 
indebted to Sir Cæsar Hawkins, generally 
makes the oblique internal wound sufficient- 
ly large, assisted by the yielding quality of 
the bladder, to admit the extraction of most 
stones: the integuments yield but little in 
proportion, being more rigid and thicker:—
and 


[33] 
and the great injury the parts must receive, 
from forcing a large body through a small 
wound, will add the dangers of laceration and 
contusion to those common to the operation; 
and daily experience evinces the facility 
with which inflammation, from external 
wounds, communicating with cavities, ex- 
tends, by what physiologists have called, 
consent of parts, over their internal sur- 
faces. 
A notion that quickness is an indispen- 
sable qualification in a lithotomist, has been 
productive of very fatal mischiefs; and an 
operator must be possessed of a good share of 
coolness and intrepidity, who would not be 
affected by thirty or forty watches being taken 
out, in a theatre, to determine critically the 
precise time in which the operation was per- 
forming: in such situations I have felt for the 
patient, and in no small degree for the sur- 
geon. 
I am told, that a gentleman who brought 
lithotomy to a great pitch of perfection, ge- 
nerally gave his watch to an assistant, to deter- 
mine the time with exactness: both the pre- 
cedent and principle on which it was found- 
ed, are dangerous; it may be taken up by 
men of equal ambition, but less dexterity. 
Sat cito si sat bene, 
though a less brilliant and less flattering 
D doctrine, 


[34] 
doctrine, is certainly a more safe and a more 
useful one: and being five or ten minutes 
longer performing the operation, will be 
thought, by prudent men, a very trifling in- 
convenience, compared to the danger of 
pushing the gorget between the bladder and 
the rectum, the not being able to extract the 
stone, and other alarming accidents; which 
the enemies to surgery will ever be ready to 
impute to a criminal weakness in the opera- 
tor, whom they will accuse of sacrificing his 
patient, to the vain wish of being thought a 
quick and dexterous operator. 
I need not dwell on the necessity for gentle- 
ness in searching; the puerile circumstance of 
the instrument being heard to resound against 
the stone, by persons at a distant part of a 
room, will not warrant us in moving the staff 
rudely and rapidly in the cavity of the blad- 
der, where there is a possibility of striking it 
against the internal membrane; which, be- 
sides increasing the pain, might be produc- 
tive of disagreeable consequences. 
Fixed air introduced into the system, either 
in the form of brisk fermented liquors, or 
collected during its escape, from a mixture 
of alcalies and acids, has been spoken of as 
an useful lithontriptic in some cases; its 
total inefficacy in others, and the want of 
proof, that a stone really existed where it
16 was 

[35] 
was supposed to have been beneficial, pre- 
vent any thing being decided in its favor. 
Though this mode of treatment has not 
yet been introduced into general practice, 
experiments, authenticated by the most re- 
spectable of all authorities, demonstrate, that 
calculi which have been extracted from the 
human bladder, and submitted, for a due 
space of time, to the action of liquors strong- 
ly impregnated with fixed air, have not suf- 
fered the least diminution of size; neither have 
their surfaces been eroded, or their hardness 
and texture been at all affected in conse- 
quence of such exposure. 
It has been objected to lithotomy, that 
there is no probability or possibility of its 
preventing the formation of a second calcu- 
lus in the bladder: but this objection may 
be applied, with equal propriety, to solvents, 
which cannot possibly prevent the remote 
causes of calculous concretion, such as in- 
temperance, a sedentary life, and others 
which we are as yet unacquainted with. 
That patients have been cut at two dif- 
ferent times, is true; that this does not fre- 
quently happen, is equally so. 
The little acquaintance we have with the 
different causes uniting to form a predisposi- 
tion to different diseases, opens a wide field 
for theory and conjecture; and the pheno- 
mena of nature are so obscure in most in-
D2 stances,

[36] 
stances, as to afford but little satisfactory 
ground for a rational enquiry or real know- 
ledge. 
The accidental circumstance of some ex- 
traneous substance being introduced into the 
bladder, has, in some cases, been the only 
cause that could be assigned for a calculus 
forming; as patients, in this case, were per- 
fectly free from calculous complaints pre- 
vious to the introduction of the nucleus into 
the bladder, and after the operation, were free 
from the stone for the remainder of their 
lives. 
In other instances, an unnatural detention 
of the urine in the bladder, from whatever 
cause, has seemed to produce a disposition 
to calculous concretion. 
As it was not proposed to enter into a 
particular consideration, either of the dis- 
ease or its treatment, I shall proceed no fur- 
ther on those heads; and as to abstruse rea- 
soning and ingenious theory, I have neither 
inclination nor ability to pursue them. 
The great quantities of ropy matter that 
have been discharged with the urine of those 
under a course of solvents, has been consi- 
dered as an infallible proof of their efficacy; 
as it was urged, that such great quantities 
of a thick glutinous discharge, if retained in 
the bladder, could not fail affording a con- 
stant

[37]
stant supply of materials for the formation 
of calculous concretion. 
The mucus of the bladder and urinary 
passages, in a natural healthy state, is but 
in small quantities. 
When any irritating cause, either from 
disease or local injury, affects these parts, 
the quantity of this mucus is constantly in- 
creased. 
These are precisely the effects of solvents, 
which, as they stimulate the surfaces they pass 
through, excite, and produce, a proportionate 
secretion and discharge of this mucus. 
This is very analogous to, and is clearly 
explained by, what takes place from any ir- 
ritating cause that is applied to the eye; 
which never fails bringing on an increased se- 
cretion, and copious discharge of the lacrymal 
fluid. 
I cannot help mentioning a circumstance, 
which in my own mind operates strongly in 
favor of lithotomy; it is that inward serenity 
and content, easier imagined than described, 
with which surgeons generally proceed to this 
operation; owing to a rational conviction, that 
what they are going to do, will tend to the 
speedy recovery and perfect health of an af- 
flicted fellow-creature—The contrary to this 
is very evident, in those cases, and too many 
such there are, where certain and speedy 
death must ensue, if something is not done,
D3 and

[38]
and where, even after an operation, the 
prospect of cure, or even of life, is distant, 
doubtful, and melancholy. The feelings of 
humanity, in this case, diffuse a sympathe- 
tic gloom over the countenance of the ope- 
rator:—he beholds, with a visible concern, 
an unhappy wretch sinking under a disease, 
and submitting to additional pain, when the 
advantage resulting from it is uncertain; 
though he is not prevented from doing 
strict justice to his patient, he is undoubtedly 
affected with sensations very different from 
those which arise in the mind of an expe- 
rienced lithotomist; who is firmly persuad- 
ed, that with care, the extraction of the 
stone is almost certain; that the degree of 
danger is ascertained; and from former ex- 
perience, he thinks himself justified in draw- 
ing a favourable presage to future practice. 
It will be necessary before I conclude, to 
endeavour to determine, what is the gene- 
ral success of lithotomy; and on enquiry, it 
perhaps may prove to be much greater than 
the timidity of patients, the opinions of the 
prejudiced, and the assertions of the interest- 
ed, would lead us to imagine. 
To do this with the minutest accuracy is 
impossible; as a list of operations, and their 
success, if it did not comprehend a period 
of many years, and a large circle of prac- 
tice, would not at all answer the purpose.
No 

[39]
No regular annual account of this kind is 
preserved in our hospitals, from the circum- 
stance of the annual succession of house sur- 
geons; who, when they retire from their of- 
fice, carry with them their own papers and 
observations.—This culpable defect has been 
invidiously attributed to a wish to conceal 
what might injure surgery, from the public 
eye; under a supposition, that it would be 
impolitic to expose a long catalogue of opera- 
tions, various, cruel, and unsuccessful:—the 
perfection to which modern surgery has been 
brought, and the ingenuous and candid be- 
haviour of those gentlemen who conduct our 
hospitals, incline us not to credit the asser- 
tion. 
That private lists of this kind, which would 
enable us to form an average account, to- 
lerably accurate, have been preserved by 
gentlemen who have been at the head of 
their profession in London for many years, 
we have little reason to doubt, from their 
diligence, attention, and fund of knowledge 
in other professional matters. 
What Mr. Cheselden has favoured the world 
with, of his hospital practice, in cutting for 
the stone, will afford some very satisfactory 
materials for judging of its general success 
under his hands:—nor can I proceed, without 
paying a tribute of thanks to this gentle- 
man, who rendered such great and essential 
services

[40]
services to surgeons and mankind.—After 
practising the high operation for the stone 
for several years, and with various success, he 
at length relinquished it, in consequence of 
an accident from an over-distension of the 
bladder by injection; from the peritonœum 
being cut through or burst; and on account 
of the general well-founded objection, that the 
urine lying constantly on the wound, retarded 
its healing:—but even in this method of ope- 
rating, which was given up as less success- 
ful than the lateral way, at present univer- 
sally established, he declared (and the world 
did him the justice to believe him) that he 
lost but one in seven.—His delicacy in de- 
clining to mention the success of his private 
practice, because he could not sufficiently 
witness it, is a conduct that has been often 
commended, and seldom imitated. 
The patients he publicly cut for the stone, 
in St. Thomas’s Hospital, were two hundred 
and thirteen; their different ages, and the 
number that died, I shall endeavour to ar- 
range.
Number 

[41]
Number of   
patients cut. 
Years old
each. 
died. 
105
10
3 
62 from 
10 to 20
4 
12
20 to 30
3 
10
30 to 40
2 
10
40 to 50
2 
7
50 to 60
4 
5
60 to 70
1  
2
70 to 80
1 
213
20 
The proportion of twenty out of such a 
number, cannot be thought great or alarming. 
Mr. Cheselden observes, that several had the 
small-pox during their cure, some of whom 
died. 
One of the first hundred and five had a 
violent whooping cough, which carried him 
off. In this case, the urgency of the stone 
symptoms, most likely rendered the opera- 
tion immediately necessary; otherwise, waiting 
until the incidental disease was better, would 
have been adviseable. 
So that from the general opinion of sur- 
geons, from Mr. Cheselden’s account, from 
what has been imparted to me on the best 
authority, and from what has fallen under 
my own observation, during my attendance at 
hospitals;—we cannot assert with truth, that
more 

[42]
more than one out of eleven die in conse- 
quence of being cut for the stone. 
Were we or could we divest the opera- 
tion of some of its accidental disadvantages, 
and be careful enough to guard against some 
of the causes I have before mentioned, can- 
dour might allow us to bring the number to 
one in fourteen; a degree of danger which 
attends few capital operations in so small a 
proportion. 
As the method of attempting to dissolve 
the stone in the bladder, by means of injec- 
tions, has, for several obvious reasons, fallen 
into general disuse; I have spoken but little 
of them in particular, because many of the 
reasons urged against other modes of treat- 
ment, were equally cogent against this. 
Should a solvent be hereafter offered to the 
world, it will be necessary, towards forming a 
proper judgment of its efficacy, to examine 
all who take it, after death: the effects of the 
medicine on the primœ viœ  and general health 
of the patient, should be strictly attended to; 
and the number on whom the trial is made, 
should be considerable. 
Should future ages possess a solvent, effica- 
cious, but not destructive to the system, litho- 
tomy may perhaps be superseded: until then, 
reason and experience point it out as the best 
and only resource. 
And it seems very clear, that the same,
which 

[43]
which the most reputed solvents have ac- 
quired, has been built on errors in judge- 
ment, or interested views. For the human 
calculus seems to be a substance, that can be 
acted upon only by such preparations, the 
introduction of which into the body, in any 
necessary degree of strength, is inconsistent 
with the delicacy of the parts they must pass 
through; hurtful to the general health of the 
patient, and peculiarly injurious to the func- 
tions of the parts affected, and their append- 
ages. 
I shall conclude with advising those, who 
have prudent resolution enough to undergo 
the operation, to do it in time, before the ir- 
ritation of the disease itself, or the deleterious 
use of solvents, have impaired their general 
health: for in a morbid state of the blood 
and juices, no wound can heal kindly; and 
the operation, however safe and skilfully per- 
formed, by such means may be rendered ha- 
zardous and frequently fatal. 
FINIS. 



AN 
ESSAY 
ON THE 
PRINCIPLES AND MANNERS 
OF THE 
MEDICAL PROFESSION. 
WITH 
SOME OCCASIONAL REMARKS 
ON THE 
USE AND ABUSE OF MEDICINE. 
By J. WHITAKER NEWMAN, 
Member of the Corporation of Surgeons, London. 
Ubi verò animus ex multis periculis atque miseriis requievit, non 
suit consilium socordiâ atque desidiâ bonum otium conterere; ne 
vitam silentio transeam sicut pecora, quæ natura prona atque 
ventri obedientia finxit. e SALLUSTIO. 
LONDON: 
PRINTED FOR J. DODSLEY, PALL-MALL. 
M.DCC.LXXXIII. 
[ Price 1s. 6d.] 



TO 
ARTHUR NEWMAN, ESQ. 
OF 
RINGWOOD, 
In the County of SOUTHAMPTON. 
DEAR SIR, 
I HOPE not to incur the suspicion of 
interested flattery, in making those 
acknowledgements which gratitude and 
justice demand. 
The warmth of expression and lively 
sentiments, which, in general addresses of 
this kind, degenerate into fulsome adu- 
lation, have been thought necessary and 
decent, when considered as the efforts of 
filial duty and affection. 
a2 If

iv DEDICATION. 
If I have enjoyed or profited, from any 
opportunities which my education af- 
forded, either before or after I turned 
my mind to medical pursuits, it is to 
your tender assiduity, and anxious endea- 
vours that I owe the advantages of them. 
It is you, Sir, I am to thank, for being 
in the early part of life an eye-witness 
to the manual dexterity of a Ranby, the 
philosophic genius and erudition of a 
Monsey, and the elegant accomplish- 
ments of an Adair. 
And while I contemplate the exer- 
tions of Dr. Hunter, whose merit is as 
unequalled as his loss will be irreparable, 
I feel my obligations to you increase, 
for placing me within the happy in- 
fluence of his peculiar talents for in-  
struction. 
Nor am I less ready to attribute my 
most fatal errors to neglecting, than I 
am willing to impute, the most fortu- 
nate events of my life, to following the 
advice and suggestions of parents, whom 
it has been and still is my happiness to 
venerate and love.
9 Under 

v DEDICATION.  
Under the glowing impulse of such 
convictions, which I am neither able or 
willing to resist, it would betray a defect 
both of the head and heart, not to testify 
on all occasions, that I am by nature and 
reason, 
Dear Sir, 
Your obedient 
and devoted 
humble servant, 
J. WHITAKER NEWMAN. 
PREFACE.




PREFACE. 
TO defend an extensive Society 
of men from undeserved re- 
proach, to point out some faults, 
by way of caution to those who are 
entering into life, and to inculcate 
the necessity of liberal behaviour, is 
the business of this Essay. 
Vulgar prejudices, and senseless 
bigotry, have been, and still are, in- 
veterate enemies to rational improve- 
ment in every branch of science. 
He who combats such formidable 
monsters with success, deserves our 
praise, and an ineffectual effort, per- 
haps, will not be despised. 
As publications on every subject, 
abound so much, the presenting one 
to 

viii PREFACE. 
to the public eye, that lays claim to 
no extraordinary merit, but the ne- 
gative one, of being without false- 
hood or absurdity, seems to require 
some apology. 
To fill up the intervals of a re- 
covery from a dangerous illness, and 
to divert the attention from brood- 
ing on some domestic calamities, is a 
reason, but not an excuse for this 
attempt. 
AN

AN 
ESSAY, &c. 
CHAPTER THE FIRST. 
Introduction.—The Incitements and Discourage- 
ments of Practitioners mentioned.—A Decla- 
ration of Men of Eminence—That the 
Practice of Medicine is degenerated—That 
the Behaviour of the World has rendered it 
necessary.—Some Objections against Medical 
Men spoken of.—No general Rule without 
an Exception. 
To alleviate the sorrows of the distressed, 
and to be instrumental in restoring 
health and spirits to the infirm and dejected, 
are pursuits which a liberal mind must en- 
gage in, with a sincere and rational delight.
B Nor 

[2]
Nor is such an employment without cir- 
cumstances, which render it a probable 
source of mutual benevolence and grati- 
tude. 
A husband, or a father, restored to the 
arms of a despairing wife and children; and 
the grateful voice of a patient, snatched from 
the jaws of death, and pressing the hand of 
his benefactor to a glowing bosom, is cer- 
tainly a refined pleasure, and one of as ex- 
alted and exquisite a nature as it has pleased 
our bountiful Creator to render the human 
mind capable of enjoying. 
So alluring and so flattering does the pros- 
pect appear to the eye of a superficial ob- 
server; that we ought rather to lament than 
be surprized at the vast numbers of infatuated 
parents, who so indiscriminately, not to say 
cruelly, sacrifice their devoted children, to 
the attractions, and too often, to the wretch- 
edness of a medical life. 
But the experienced practitioner, whose 
life and habits have led him to a more inti- 
mate acquaintance with men and things, has 
been heard to lament with a sigh, that this 
enjoyment has its alloy, of neglect, ingrati- 
tude, and reproach.
He 


[3]
He has found his best efforts for the wel- 
fare of mankind, resisted and traduced by 
folly, detraction, and obstinacy; while his 
anxious attendance on the sick, and his mode 
of treatment, have been imputed solely to 
motives, as dishonourable and mean as the 
souls of those who suggested them. 
In the place of implicit confidence he has 
met with suspicion, and the soul-soothing 
language of lively gratitude, has given way 
to cold formality, perhaps to keen invective: 
his attendance and medicines have been 
either ridiculed or disregarded, and their 
good effects not unfrequently attributed to 
the preposterous exhibitions of an ignorant 
but bold empiric.—If his attempts for the 
recovery of his patient should not be attended 
with success, that constant companion (in 
the world’s eye) to real merit, his same will 
be blasted by the malignant breath of envy, 
his reputation be sacrificed by scandal and 
malice at the altar of private resentment, and 
his mangled name be offered up to appease 
the injured manes of a slaughtered friend. 
While his calamities are regarded as the 
avenging hand of Heaven punishing his mis- 
deeds, his prosperity will be considered as 
B2 built 

[4]
built on the ghastly ruins of mankind, and 
any eminence he may attain to in his pro- 
fession, as an ingenious method of torturing 
the groans, the diseases, and the misfortunes 
of his fellow-creatures, to the base purposes 
of avarice and sordid lucre. 
He will be accused, of never feeling the 
soft luxury of a tear, of being callous to those 
social and endearing ties which bind man to 
man, and (absorbed in the idea of a fee) of 
losing all relish for that noblest that best of 
all fees, the pleasure which results from 
reflecting on a virtuous and benevolent 
action. 
That such has been and still is the general 
complaint of those, whose opportunities, ap- 
plication, or abilities, have not been able to 
procure them rank and emolument, is an ac- 
knowledged truth. 
But equally true it is, that men at this 
time in the British metropolis, ornaments at 
once to the profession and the age in which 
they live, have declared that they studied 
physic, and entered on the practice of it, on 
the broad, liberal, and comprehensive basis, 
of honour, of generosity, and humanity.
The

[5]
The task of relating their declaration, 
would have been a pleasing one, had it gone 
no farther; but they added with regret, such 
was the want of candour in mankind, and 
such the disposition of the multitude to 
plunge into the infatuations of error, absur- 
dity, and imposition, that in their own de- 
fence, they were obliged to wield the same 
weapons, which their adversaries had exer- 
cised against them with so much severity. 
“ Suo sibi gladio hunc jugulo. ” 
Under these circumstances, they found 
the medical profession reduced, by a strange 
kind of base necessity, to a low illiberal trade, 
supported by mean finesse, chicanery, and 
collusion; requiring rather the despicable arts 
of servility and cunning, than the happy ge- 
nius and enlightened talents of a man of 
science. 
Nor is this to be considered as the fabri- 
cated effusion of a warm imagination, but as 
actually and frequently asserted, by men of 
respectable age, practice, and ability. 
Such have been the expressions of the Fa- 
culty, heightened perhaps by the aggravat-
B3 ing

[6]
ing colours of resentment, prejudice, and par- 
tiality. 
Nor has the world been silent in answer- 
ing or even anticipating these complaints, 
appealing to experience, and asserting that 
what they said was the voice of nature; a 
voice, to which, with more malice than 
truth, they observed, their antagonists were 
much in the habit of turning a deaf ear. 
By these steady advocates for mankind, 
the profession have had the tables turned on 
themselves, and have been boldly accused, 
of rapacity, want of candour, and even of 
common honesty. According to these de- 
claimers, those who in the hour of sickness 
and affliction, have relied on them, have 
found in this mercenary tribe, for disin- 
terested regard, an inordinate love of gold, 
and instead of friendly advice or gentle be- 
haviour, loads of nauseating drugs and unin- 
telligible jargon. 
Consultations, for the forming of which 
neither expence or labour have been spared, 
and on the result of which the lives of the 
nearest and dearest in the most respectable 
families have depended, have been too often
devoted, 


[7]
devoted, to idle discussions, uninteresting to- 
pics, vague hypotheses, and unmanly al- 
tercation. 
Nor has the purpose of the meeting been 
at all attended to, until the plaintive voice of 
a berest widow, or a miserable orphan, has 
driven the remorseless spoilers from the house 
of forrow. 
Neither have they forgot to observe, that 
in the prescription of medicines, the nature 
of the patient’s complaint has been only a 
secondary object of consideration. 
The opportunity in this case has been 
seized on as a happy one, to convince the 
apothecary how much the physician studies 
to be grateful, by promoting trade, and 
loading in medicines, as it has been emphati- 
cally called. 
To these charges many others have been 
added, as caprice or resentment dictated; a 
distinct consideration of each of them, would 
be inconsistent with the limits of a short 
essay. 
In this catalogue, we perhaps might find, 
a general over-rating of merit, and its con- 
fequence, demands proportionately exorbi- 
tant a profligacy and relaxation of morals,
B4 with 

[8]
with a total inattention to the duties of re- 
ligion. 
The last article of the impeachment, I 
may be blamed for not wholly omitting, as 
it has been said, that in the present degene- 
rate times *, it is too applicable to every 
rank of men, by those who are so much in 
the habit of indulging their talent, in de- 
claiming against the peculiar tendency of 
the age they live in to moral turpitude. 
But having frequently been in company 
with those, whose education, profession, and 
lives, ought to make them competent judges 
* There generally have been, and probably always will 
be, declaimers, that think every age increases in vice and 
irreligion, “ They can remember that things were very 
“ different when they were young. ” 
As in the different ages of the world, the manners of 
its inhabitants must have depended on their degree of 
improvement and refinement, from the Casrarian to the 
polished European; it seems rational to conclude, that 
their moral defects have (habita ratione partium) been 
nearly equal in all countries and in all ages. And how- 
ever frivolous and dissipated the present age may appear, 
it does not seem generally to exhibit crimes, of so black 
a cast, and so inimical to human nature, as those which 
stain the annals of two or three centuries ago.
of 

[9]
of moral rectitude; and having heard re- 
spectable characters among them declare, 
that they thought the medical profession in 
its several branches, the most inattentive of 
any to religious duties, equally, if not more 
profligate and dissipated than all, I thought it 
my duty, as well as a respect and deference 
due to these gentlemen, and their holy office, 
to give it a place here. 
Having been thus led by the nature of my 
subject, to consider the profession as it stands 
in its several relations to the world, it would 
not be wandering far from my purpose to re- 
view in a cursory way their treatment of 
each other. 
But previous to such a discussion, it seems 
a necessary piece of justice, to vindicate, as 
far as is consistent with truth, the behaviour 
of practitioners from some aspersions, which 
have occurred in reviewing the conduct of 
both parties; and this is a task, which it 
should seem my duty, my interest, and my 
inclination to undertake. 
I shall also endeavour to set in a clear 
point of view, some circumstances which 
have hitherto escaped observation. 
These subjects, with some reflections and in-
ferences

[10]
ferences which will naturally arise in treating 
of them, with an enquiry into some of the 
causes which have united in degrading the 
profession in the eyes of the world, and in- 
juring their interests, will be taken up in the 
following pages. 
And if in the course of this Essay, some 
disagreeable truths should arise, which ap- 
pear to cast any oblique and invidious re- 
flections on either side of the question, the 
trite but just observation, that there is no 
general rule without an exception, ought to 
be remembered. 
From the nature of the present system it 
must happen, that in every extensive society 
of men, there will be a greater or less num- 
ber of unworthy members of it. 
But he who should be rash enough to as- 
sert, that, censuring the undeserving indi- 
viduals, exposing their faults, and bestowing 
on their conduct its proper epithets, was 
aspersing the character, lowering the dignity, 
and laying the axe to the very root of the 
whole society, would be equally contemp- 
tible for his folly, his falsehood, and his ab- 
surdity. 
Were a judicious critic to inveigh with 
I severity,

[11]
severity, against the nonsense, which the 
English press, like a mountain in labour, 
every day, nay every hour, groans with; 
justice, taste, and common sense, would rea- 
dily acquiesce in the truth. But were he to 
deduce from this argument, any thing de- 
rogatory or unfavourable to the sublimity 
and classical elegance of a Gibbon, or the 
chaste imagination and poetical genius of an 
Hayley, his reasoning and abilities would 
meet with the ridicule, the contempt they 
so justly deserved.
CHAPTER

[12]
CHAPTER THE SECOND. 
A common-place Observation applied to Prac- 
titioners and their Patients,—The superior 
Advantages of a Physician compared to the 
Treatment of the lower Ranks of the Pro- 
fession.—Dr. Rattcliffe's Advice to Dr. 
Mead.—Observations and Reflections on it. 
THAT the impressions of a favour re- 
cently conferred, produce more im- 
mediate and lively symptoms of gratitude, 
than the remembrance of former acts of 
kindness however beneficial or important, is 
a fact which experience confirms, but honour 
disapproves. 
A grateful heart, ardently pants to make 
a quick return for offices of benevolence, 
leaving prudence and reflection to pause and 
to delay.—For it frequently happens, that 
what in the moment of thankful rapture, was 
magnified as a God-like action, dwindles, in 
the long-extended perspective of time and 
policy, into a kindness, a duty, and a trifling 
favour.
Did 

[13]
Did a due sense of the importance of 
obligations, equally diminish in the minds 
of those who confer and those who receive 
them, the mutual complaints of ungrateful 
and unreasonable tempers would not be so 
often heard. 
But it happens unfortunately in the gene- 
ral intercourses of life, that the conferrer of 
a benefit heightens and overvalues it, in the 
same proportion, that the person obliged ap- 
preciates and lowers it. 
From a consideration of these truths, which 
are deduced from a view of the conduct of 
mankind in general, we can easily account 
for the same motives operating still more 
powerfully, in the concerns of the medical 
profession in particular.—A profession which 
exists in relieving calamities, and lives by 
being rewarded for it.—The physician, it is 
true, has often the advantage of receiving his 
fee, accompanied with the most solemn pro- 
testations of respect and esteem, and attended 
with ten thousand indescribable circum- 
stances that increase its value. 
While the impressions of present pain, 
hope, and fear, are deep in the hearts of the 
patient and his friends; while the love of
money 

[14]
money is repressed by increasing danger and 
anxiety, he is considered and received as an 
invaluable friend, as one on whom the hap- 
piness and tranquillity of the family depend; 
while medicine is considered as the last and 
only method of preserving a doubtful life. 
In this case, the present is generally such 
as a generous mind is proud to bestow, and 
such as will not disgrace acknowledged merit 
to receive. 
Happy intercourse, where gratitude and 
liberality increase the pleasure of doing 
good, and give a zest to that best of all 
efforts, an effort to bless! 
But in branches of the profession, less ho- 
nourable, less lucrative, but more fatiguing 
and laborious, the case is far otherwise: these 
unhappy men are seldom employed from any 
preference of opinion, but chiefly because 
their advice and assistance are procured at the 
cheapest rates, and not unfrequently, because 
they may be defrauded and imposed on with 
less difficulty, and less fear of detection and 
punishment. 
It is a matter of ease, and often of triumph, 
to an illiberal mind, to find out some plau- 
sible pretence for disappointment, delay, or
refusal: 


[15]
refusal: nor indeed can it be denied, that 
the infamous returns of abuse and defama- 
tion, are cheap methods of discharging or 
rather evading a demand. 
We may in some degree excuse the cele- 
brated Dr. Rattcliffe *, for his unjustifiable 
advice to Dr. Mead, under the supposition 
that he was irritated by similar treatment, and 
provoked by ill usage. 
An uncomplying kind of behaviour, such 
as Rattcliffe’s, bordering on cruelty, would 
be unsufferable in a man of less eminence, 
but would be highly culpable in any one. 
His peculiarities, though accompanied by 
sterling merit, and many good qualities, can 
only be accounted for and palliated, by his 
constitutional asperity, and an independent 
spirit, called forth perhaps by the slavish and 
unmanly submission, or the injurious treat- 
ment of his predecessors or cotemporaries, 
* Mead, you are just entering into practice; it will 
not perhaps be long before I shall leave it, and I ought 
to be some judge of the treatment, men in our line have 
to expect from mankind: use the world ill, or by— 
they will use you so. 
and


[16]
and heightened at last by the petulancy of 
old age. 
His liberal donations to Oxford, and the 
essential services he rendered to medicine, 
will be remembered and revered, when his 
foibles and his singularities are buried in 
oblivion. 
The subaltern practitioner must attain or 
assume more philosophy, or he must not eat: 
he must learn to submit with patience to the 
insults and injuries, which the lower orders 
of his profession are daily exposed to. 
And if he does not receive a considerable 
gratification from the exercise of a benevo- 
lent disposition, independent of the profits of 
his practice, he may look with envy on the 
preferable condition of a hewer of wood, or 
a drawer of water. 
The dexterity requisite for effecting a 
good day's work, and the plausible exhibition 
of innocent no-meaning trifles in all cases, 
certainly requires no great exertion of the 
mind in investigating the complaints of a 
patient, and may be termed an easy way of 
doing business. 
But such a conduct, how well soever it 
may answer the present purposes of profit,
will

[17]
will afford no satisfaction in the retired mo- 
ments of unbiassed reflection: when a man 
shall find that he has lost many opportunities 
of producing some essential advantage, or re- 
moving some threatening evil. 
His negative treatment of the patient, and 
his interested activity with regard to himself, 
is a contrast which must effectually damn him 
in his own mind, and in the eyes of the world. 
To assert that unworthy and infamous cha- 
racters are never to be met with in the pro- 
fession, or to affirm that they never experience 
ungenerous and cruel treatment, would be as- 
signing them an enviable lot inconsistent with 
the present state of things. 
To suppose that a few shillings, or a few 
pounds, are a full and adequate return to a 
practitioner, for being instrumental in saving 
a life or a limb, and to imagine that all idea 
of the obligation is cancelled and obliterated 
by a see, is a mode of reasoning never the less 
false for its being frequent. 
The loss of rest, the weight on the spirits, 
and the daily risque of reputation, to which 
the practice of the several branches of medi- 
cine exposes men, may be rendered support- 
able, by the good offices, the candour, and 
the friendship of a recovered patient. 
But the see of insulting pride, given with- 
out delicacy, shall be accepted without 
C emotion,

[18]
emotion, while the poor man’s mite, moist- 
ened with the tear of gratitude, shall be re- 
ceived with delight. 
Whenever the unenlightened idol of often- 
tation, shall give pain by his manner of con- 
ferring a favour, it is the duty of every mem- 
ber of the Faculty to vindicate the dignity of 
man, as well as the honour of his profession, 
by supporting this position with decency and 
firmness— 
A practitioner's love of money may be grati- 
fied by an exorbitant present; but he can only re- 
ceive his deserts, by being treated with the can- 
dour, delicacy, and attention, of a friend, a bene- 
factor, and an equal. 
The whiffling apothecary may employ his 
subordinate bows and abject deportment, from 
the drawing-room to the butler’s pantry, with 
the self-satisfaction and grimace of a monkey; 
but he may rest assured, that with whatever 
countenance or language he is received, his 
meanness and unmanly behaviour, cannot fail 
exciting inward contempt and abhorrence. 
After he has been made use of as a tool to 
execute some base and ignominious purpose, 
he will be deservedly kicked out of door, like 
that domestic animal whose fawning tricks 
and despicable gestures, he so closely and so 
happily imitates.
CHAPTER 

[19]
CHAPTER THE THIRD. 
A Prejudice against the Art of Healing con- 
sidered.—Has Medicine upon the whole been 
most useful or most prejudicial to Mankind.— 
The Folly of too great a Reliance on it.—The 
Mischief of having no Opinion of its Use.— 
The Pleasures and the Inconveniencies of Ig- 
norance.—A Reflection.—Some Instances of 
Credulity spoken of.—A few Hints on modern 
Improvements.—It is much easier to contract 
than to cure a Disease.—A Comparison. 
“ GOD never made his works for man to 
mend," has been the echo of popular 
clamour, and the burthen of the poet’s song. 
The proposition may appear specious, 
the verse harmonious, and some arguments 
offered in favour of it may seem convincing; 
but should the votary of the Muses, be so un- 
fortunate as to labour under a putrid fever, or 
to have a rupture of an arterial branch, his 
conduct on either of these occasions, though it 
might not immediately overset the assertion, 
would at once give the lie to his faith and his 
professions.
C2 Neverthe- 

[20]
Nevertheless, many have still hesitated in 
pronouncing whether Medicine, under the 
many disadvantages it labours, has been bene- 
ficial or injurious to mankind *. 
That it is like the manna showered down, 
from heaven upon the favoured but ungrate- 
ful descendants of Jacob, and meant as a 
blessing, but converted by their folly and per- 
verseness, to a most bitter and inveterate curse, 
is in many respects a faithful representation. 
The credulous valetudinarian, who trem- 
blingly alive all over, sinks under his delicate 
nerves and exquisite sensibility, and allots to 
each hour of the day, its draught and its pill, 
without regard either to diet or exercise, is an 
object of ridicule and pity. 
If he expects to remove his disorders with- 
out attending to, and guarding against the 
causes which united in producing them, he 
will find himself mistaken, and still worse, 
when it is too late. 
* “ You see two men whom they are burying; they 
“ are two brothers, that were both sick of the same dis- 
“ ease, but took different measures; one of them relied 
“ with an entire confidence on his physician; the other 
“ let nature take her course; yet they are both dead, the 
“ former from taking all the physic the doctor ordered, 
“ and the latter because he would take nothing." 
Le Diable Boiteux, chap. 3d.
9 The 

[21]
The medical sceptic, who would lie panting 
and burning under the fell attacks of a pleu- 
risy, without having recourse to the delusive 
chimœras of art, as he terms them, would suf- 
fer martrydom for his criminal infatuation. 
His too credulous neighbour might be con- 
ducted with him to the cells of a mad-house, 
with the same propriety that we should setter 
the devoted suicide raving for the dagger or 
the bowl. 
The illiterate peasant, inveloped in the 
shades of ignorance and innocence, who con- 
siders Medicine as a never-failing resource, on 
which he may with confidence rely in the hour 
of affliction, as a certain remover of every pain 
and every disease, may be considered as happy 
in the harmless delusion, which so effectually 
quiets his fears and his apprehensions. 
He may be commended as a supporter of 
the credit of the Faculty, and as an excellent 
patient; but is in many respects equally if not 
more injurious to the cause of enlightened 
science, than he who has no faith in Medicine 
at all. 
It were rather to be wished, that the fabric 
should sink, than totter under the weak and 
ignominious pillars of ignorance and impo- 
sition. 
A candid patient (thank Heaven such there 
C3 are)

[22]
are) well informed of what Medicine can, and 
what it cannot do, will be as far from a super- 
stitious confidence in its favour, as he is from 
illiberal and ill-grounded prejudices against 
it *. 
Ever ready to make proper allowances for 
ill success, he will not form unreasonable ex- 
pectations. 
Qualified to judge of what may and what 
ought to be done, he will readily detect, and 
justly condemn an ignorant or unprincipled 
practitioner. 
The patient of an opposite description, will 
be led into error, absurdity, and unavailing 
disappointment. 
He would hear with astonishment, and be 
convinced with reluctance, that there is no 
composition in his much-loved dispensary that 
can cure an hydrocephalon. 
He would look with a mixture of pity and 
contempt on that art, which is frequently 
obliged to have recourse to amputation, in 
* On this principle I cannot but readily agree with 
those who consider several late publications as serviceable 
to liberal practitioners, though they have been strongly 
condemned by some, under the idea that it was imparting 
too much knowledge to the world. 
“ Excessit Medicina Modum. ”
diseases,

[23]
diseases, where his invaluable compounds and 
his infallible remedies have been ineffectually 
applied. 
When the principles of Medicine, and the 
laws of the animal œconomy, have been ex- 
plained to him; when the phænomena of those 
laws, and the uncertainty of the best of reme- 
dies, have been pointed out to him, 
—Pol me occidistis, amici. 
Non servastis, ait, cui sic extorta voluptas, 
Et demptus per vim, mentis gratissimus error. 
he perhaps would confess with a sigh, that 
an increase of knowledge had only produced 
an augmentation of forrow. 
After all that has been said, it cannot be 
denied, that this art in able and honest hands 
is highly beneficial and necessary in the frail 
and imperfect condition of man, exposed as 
he is, to internal disease, and external acci- 
dent. 
Like a self-evident proposition, it requires 
not a proof; to deny it, would be disavowing 
the efficacy of the Peruvian bark in shorten- 
ing the paroxysm of an intermittent, or the 
specific power of mercury in curing the lues 
venerea. 
The Pharmacopœiæ of antient, and some of 
C4 modern


[24]
modern times, afford remarkable instances of 
credulity or dishonesty. 
The sagacious surgeon, who with gravity 
and unaffected assurance, would order the 
weapon with which a wound had been inflicted, 
to be rubbed with his mystical sympathetic 
powder, was possessed of at least a harmless 
secret: provided it was not enjoined that sti- 
mulating applications were to be used to the 
part, and as long as it did not prevent his 
paying a due attention to the state of the 
wound. 
We may be allowed to smile at the recital, 
but some modern ideas of curing ulcers on 
the leg, however various their cause, by large 
doses of nitre, without rest or attending to 
peculiarities of constitution, do not fall much 
short of it in absurdity. 
Nor are thoseless paradoxical, which suppose 
it possible for an ointment, without internal 
medicines, to cure a sore, in spite of the most 
vitiated habit of body. 
I have given nitre in long-repeated and 
large doses, without any benefit to an ulcer, but 
with evident ill effects on the general health. 
And it is hardly necessary to observe, that 
the best-contrived applications, will neither 
produce advantage to the patient, or credit to 
the

[25]
the surgeon, without attending to regimen, 
and medicines capable of correcting a bad 
state of the blood. 
Rest, a light moderate diet, with gentle al- 
teratives, and above all the Peruvian bark, are 
what I have found of the utmost service in the 
few years I have lived. 
And indeed that most excellent medicine, 
the bark, with the mere superficial applica- 
tion of dry lint, and keeping the parts clean, 
with proper bandages, has procured me a cre- 
dit in some cases, when I neither expected or 
deserved it. 
A Scultetus, or even a Heister, would pro- 
bably allow but little merit to the present 
practice of surgery, which consides so little in 
art, and leaves so much to nature; they would 
lament to see their powders, their plaisters, 
and ointments, mouldering into neglect, and 
giving place to the simplest, the mildest, and 
the most inartificial of all applications. 
The root of Contrayerva, for which England 
is indebted to Sir Francis Drake, and declared 
by some to have added as great a lustre to his 
name as his naval expeditions, seems at present 
to be deservedly in its decline. 
A long and pompous train of restoratives, 
alexipharmicks, and cordials, the terror of the
sick, 

[26]
sick, and the Pactolean * mystery of physick, 
have been happily succeeded by the solid and 
unequivocal advantages of the Peruvian 
bark. 
Nor has the Confectio Cardiaca, of long- 
revered name and memory, been able to sup- 
port its reputation, with those who have found 
every desirable effect, from the preferable and 
exhilarating qualities of a glass of generous 
wine.  
To expect that a draught or a pill in a few 
hours, or even in a few days, should be able 
entirely to remove a disease which has been 
produced by the indolence, the irregularities, 
and the excesses of half a man’s life, is a vain 
and idle supposition. 
The avenues which lead to disease are va- 
rious and seducing, embellished by the re- 
finements of art and imagination. 
The charms of social intercourse, the luxu- 
ries of the table, and the gentle but irresistible 
impulse of love, are daily tempting us to 
that precipice, from which human resolution 
is so often dashed down, to the ruin of our 
health, our fortune, and our peace. 
* Cujus votis non suffecerat aurum 
Quod Tagus et rutila volvit Pactolus arena. 
JUVENAL.
The 

[27]
The difficulties which present themselves 
to the practitioner are increased, and his suc- 
cess rendered precarious, in the same propor- 
tion that we are tempted to exceed the simple, 
the moderate, and the innocent demands of na- 
ture. 
The rank debauch of a night, the intoxi- 
cating pleasures of the bowl, and the dull city 
feast, distinguished by disgusting profusion, 
gross appetite, and brutal gratification, are 
capable of producing complaints, sufficient to 
perplex the most consummate medical know- 
ledge. 
The tedious but necessary regulations of 
diet and regimen, without which so little can 
be done in Medicine, are worse than death to 
the voluptuous glutton, whose life and con- 
versation clearly evince that he lives but to 
eat. 
He pathetically deplores the decay of his 
appetite, which already obliges him to have 
recourse to the most exquisite refinements of 
modern cookery, before he is enabled to make 
a tolerable repast. 
Under such mortifying circumstances, must 
he, or can he resign, the complicated richness 
of his soups, the stimulating poignancy of his 
sauces, and the elegant variety of his dishes? 
He views with envy the robust constitution,
the 


[28]
the keen appetite, and the refreshing repose of 
the hardy peasant; but considers with horror 
and pity, his daily labour, his homely diet, 
and his temperate enjoyments. 
His delicacy is shocked, when he compares 
these with his own habits of life, which consist 
of eating without hunger, drinking without 
thirst, and seeking in vain for refreshing sleep, 
on his bed of down, without fatigue: his great- 
est exertion a morning visit, and his chief ex- 
ercise the artificial motion of a sedan. 
Enervated by inactivity, listless through 
satiety, yet provoked by licentious spectacles, 
and stimulating food, to unnatural and exces- 
sive debauch, we ought not to be surprized 
at the debilitated bodies, the uncultivated 
minds, the vicious inclinations, and the puny 
race of the infatuated sons of dissipation. 
CHAPTER

[29]
CHAPTER THE FOURTH. 
Some Considerations on the Propriety of informing 
the Sick when they are in a dangerous Situa- 
tion.—A State of Anxiety or Despair unfa- 
vourable towards Recovery.—In these Cases 
the Task of the Clergy not so irksome as that of 
the Physician.—Modern Credulity.—The Per- 
sian's Opinion. 
THE arts of delusion so frequently, so 
systematically, and after all so ineffec- 
tually practised by the serious and the gay, to 
stifle the voice of conscience and reflection in 
their passage through life, have been by some 
thought necessary, and by others condemned 
as unjustifiable in a state of sickness. 
In this case the necessity for plain truth, and 
for acquainting a man with the degree of dan- 
ger he is in, has been emphatically insisted on, 
for reasons of a spiritual as well as a temporal 
nature. 
Whether that repentance which is so na- 
turally produced by the approaches of disso- 
lution, is a rational ground for hope of future 
mercy; and whether it is expedient, or even ne- 
cessary, to fill the mind with apprehensions 
and


[30]
and fears, under a state of disease, where an 
uneasy mind is incompatible with recovery, and 
where the efficacy of the point in question is 
denied by many, and a matter of doubt with 
all; are subjects which it is neither my bu- 
siness or inclination to discuss. 
I can only lament our fatal negligence, in 
thus postponing so necessary a work, that in 
the midst of the blessings we enjoy, we should 
forget from whence they spring, and defer that 
to old age, and sickness, which ought to be 
the chief business and pleasure of life in the 
days of health and vigour. 
If we are either inclined or permitted to 
listen to the voice of nature or reason, we may 
perhaps, without giving offence, be induced 
to conclude, that ringing the alarum of ever- 
lasting torments, and an angry Deity, in the 
deaf ear of a miserable wretch, whose mental 
and corporal faculties, are deranged and dis- 
tracted by the agonies of pain, has no advan- 
tages which can compensate for the real evils 
of despair and relapse, so frequently and so 
naturally produced by such a conduct. 
Nor can I dismiss this subject, which I may 
be blamed for having enlarged upon too much, 
as foreign to my purpose, without suggesting, 
that we are authorized in drawing a source of 
comfort from the mercy, as well as of terror
and 

[31]
and dismay, from the inexorable justice of a 
wise but compassionate Creator of the uni- 
verse. 
The moralist and divine, may declaim with 
studied eloquence on the superior charms of 
virtue, may call in truth to assert the solid ad- 
vantages of morality, and may charitably strive 
to soften the rigour of divine vengeance by the 
solacing tears of pity and condolence. 
After this, his work is done; he retires to 
enjoy with complacency, the respectful atten- 
tions, the domestic pleasures, and the gentle 
inactivity of an ecclesiastical life. 
But when the ruinous career of riot and de- 
bauch is finished, it becomes the melancholy 
task of the physician, to see the ghastly devas- 
tation, and to feel his inability to repair it. 
He beholds the ineffectual struggles of na- 
ture and art, closes the haggard eyes of wan 
despair, and at last is obliged to submit with 
silence, to the reproach, of not being a worker 
of miracles rather than a rational practi- 
tioner. 
The pleasing fables of antient allegory, en- 
riched with classical, and adorned with poeti- 
cal elegance, which describe with such beauty 
a perpetuity of days, and the renewing old 
age with youthful vigour, however they may 
excel in poetry and stile, fall vastly short of
the 

[32]
the miraculous relations * and undoubted pro- 
mises, so confidently held forth, and so de- 
voutly believed, in the days of modern empi- 
ricism and irrational credulity. 
Nor ought we to contemn the declaration of 
the honest Persian, that none could possibly suf- 
fer themselves to die in England, but the ava- 
ricious, the poor, and the senseless, whilst 
health and length of days were daily exposed 
to sale. 
Such is the severe but just picture of an age, 
which lays claim to acknowledged improve- 
ment and perfection, in the solid comforts, as 
well as the elegant superfluities of life. 
* “ Madam, if you were less lavish of your implicit 
“ faith to the quack, and would reserve a small share of 
“ it for your poor confessor, it would be an essential step 
“ towards the salvation of your soul, and I flatter myself 
“ would be no ways injurious to the health of your 
“ body. ” 
Such was the well-meant but ineffectual advice of a 
venerable father, almost two centuries ago, to a lady, who, 
though her conscience hesitated at the doctrine of the 
Wafer, yet she was a dupe to every idle impostor.—Whe- 
ther it is at all applicable to Protestant freethinkers, is not 
our business to determine.
CHAPTER 

[33]
CHAPTER THE FIFTH. 
The Causes which injure and degrade Medicine 
mentioned.—A superfluous Number of Practi- 
tioners—Their Dissentions among themselves. 
—A Penchant for Apprentice Fees.—A sup- 
posed Defect in the Mode of Education.—Young 
Men too much their own Masters—The ill 
Effects of it.—Poverty.—Disinclination and 
Inability.—Exorbitant Profits.—Reflections. 
WITHOUT aiming at, or pretending to 
that perfectly disinterested character, 
which has been so often assumed, so generally 
praised, but has so seldom existed, I shall con- 
sider it as the business of every one who treats 
of the medical profession, to enquire into some 
of the real and supposed causes, which have 
united in degrading it in the eyes of the 
world. 
The first and principal one, from which 
many of the rest originate, is the great and 
superfluous number of members of the Fa- 
culty. 
The facetious Sir Samuel Garth (whose pen 
dealt in much pleasanter lines than prescrip- 
tions) doubted even in his days, whether in
D London, 

[34]
London, doctors or patients were most nu- 
merous during the summer season. 
Nor have modern wits been wanting, who 
assert, that mankind would suffer no dimi- 
nution in number, if the former were less nu- 
merous than they now are. 
From this cause may be deduced, that gene- 
ral, and often that dishonourable avidity for 
business, which stoops to any meanness to at- 
tain it, and defective, through ignorance or 
indolence, of real merit, disdains not to call in 
the unmanly aid, of adulation, detraction, and 
foul-mouthed abuse. 
Nor is there in life a pursuit, which more 
peculiarly exposes a man to the malicious 
shafts of an inveterate opponent or an invi- 
dious world. 
The illiberal prejudice of a nurse, the whim 
of a child, or the caprice of an unreasonable 
patient, are often able to prevail against the 
abilities, experience, and integrity of the most, 
established practitioner. 
But the candidate for practice should re- 
member, that the same ears which listen so at- 
tentively to the tale of calumny against his 
rival, will with the same readiness, and the 
same uncharitable spirit, be expanded, to re- 
ceive any scandalous reports, which may here- 
after be propagated against himself. 
Let

[35]
Let him be slow to condemn, and let him be 
deaf to whispers against his adversaries; he may 
otherwise expect a similar treatment, when- 
ever a competitor shall occur, as meanly dis- 
posed as himself, and endued with superior 
cunning and versatility. There is no line of 
life which renders it more necessary to observe 
Horace’s advice; 
“ Quid de quoque viro et cui dicas fæpe videto. ” 
The assassin who gives the deadly blow, con- 
cealed in the shades of night, shall in his turn 
be stabbed in the dark, without a hand to heal, 
or a heart to sympathize with his sorrows. 
To enter into a minute detail of the fre- 
quent and frivolous animosities in the several 
branches of the profession, would be descend- 
ing to a useless and uninteresting task; we may 
however conclude, that their disagreements, 
and attempts to counteract and undermine 
each other, will not fail affording the world 
opportunities to take unfair advantages of 
them. The interests and (if we may be al- 
lowed the expression) the honour of physic 
have on these occasions been too often sacri- 
ficed to selfishness and revenge, the most infer- 
nal, but the most seducing of all our crimes. 
Nor ought the dishonest conduct of those 
men to be mentioned without the severest cen-
D2 sure, 


[36]
sure, who, for the sordid consideration of an 
apprentice-fee, undertake to educate and in- 
struct in the second orders of the profession, 
an unnecessary number of young men, when 
they are at the same time conscious that their 
practice, abilities, and application, are totally 
inadequate to it. 
The conveniency of being frequently sup- 
plied with a handsome sum of money, no one 
will deny; but to convert a friend’s son, libe- 
rally educated, to a drudge and a menial ser- 
vant, to leave him without a guide in his hours 
of business and leisure, to dismiss him igno- 
rant and uninformed in that which is to be the 
support of his future life, are circumstances 
which must wring the heart of every parent, 
and cannot fail extorting from them the bit- 
terest curses on the detestable author of their 
calamities. 
Against such men, and their abandoned 
traffic, let every parent and every friend pro- 
vide, by previous caution and enquiry. 
A want of liberal establishments for the pur- 
pose of education in London, and an abuse of 
the present unsystematic mode, have been spo- 
ken of as injurious to the cause of medicine. 
While Scotland, without a third part of the 
opportunities for improvement which London 
possesses, is copiously furnished with founda-
tions 


[37]
tions and endowments, for the advancement 
of professional learning, the metropolis of 
England is without a college or professorship, 
adequate to the purpose of improving by- 
theory and physiology its superior practical 
advantages. Gratitude and truth declare that 
the gentlemen who preside over the several 
branches they teach there, treat the subjects 
they discuss, with honour and emolument to 
themselves, with instruction and pleasure to 
their hearers. 
But as long as we are deprived of the solid 
and permanent advantages of an academic 
system of education, and the minds of young 
men are left undirected in their studies and pur- 
suits, while their time is so much at their own 
disposal, we must expect every evil, from un- 
profitable application, time mis-spent, or ta- 
lents uncultivated. 
A young man enjoying with rapture that 
liberty, which he has long and ardently panted 
after, stands in need of every motive, and every 
possible inducement, to attract his industry, 
fix his attention, and guard him against the 
bewitching allurements of vice and dissipation, 
which every where surround and invite him. 
A happy taste in the disposition of a side- 
curl, the important choice of a coat of many 
colours, and a daily visit to the theatres and 
other places of resort, may be decent, and per- 
haps necessary to compleat the gentleman.
D3 But 


[38]
But dress and accomplishments, however 
splendid and striking, only serve to set pro- 
fessional defects in a more glaring point of 
view. 
To make that the employment of life, 
which, if allowable, should only serve to relax 
the fatigues of intense application; to neglect 
to qualify ourselves for the practice of a pro- 
fession, which enables us to improve our for- 
tunes, and gives a scope to our disposition for 
blessing mankind (however light we may 
make of it) is adding fraud and inhumanity to 
the crimes which already undo us. 
When we have, by culpable ignorance, 
murdered or dismembered an unhappy wretch, 
it will be adding insult to injury, to tell his 
weeping friends, that we could criticise with 
judgment on the drama, that we were allowed 
to sing a good song, or that we were noted 
for leaping over five-barred gates. 
The time and talents so frequently and so 
ruinously prostituted on these acquirements, 
which of themselves, and at proper intervals, 
are innocent, might have rendered us happy 
in ourselves, and useful to mankind: but in 
this case are only instrumental in making us 
murderers and cheats. 
Without meaning in the most distant man- 
ner, to insult an honourable state of poverty, 
which in a million of instances has been found 
the

[39]
the laudable spur to great and good actions, 
we may be permitted to wish that parents in 
general would not be so eager to educate their 
sons in this pursuit, unless their circumstances 
enable them, to make some decent provision 
for their support, in the early years of their 
establishment, when their want of acquaint- 
ance and experience may be presumed to be a 
probable impediment to an immediate and 
profitable practice. 
Were they conscious of the peculiar set of 
pains, which a poor practitioner agonizes un- 
der, or of the difficulties to which he is ex- 
posed by being obliged to support some ap- 
pearance with a less than scanty income, they 
would prefer the solid comforts of a mechanic’s 
life, to the genteel embarrassments of a medi- 
cal one. 
The accidental circumstances which (to 
use a hazardous expression) throw men into 
this profession, have frequently been owing to 
the inclination, the pride, and the folly of 
parents: it is hardly credible, that much atten- 
tion is ever paid to the capricious starts, of an 
unsteady puerile mind, which not unfrequently 
has a foolish fondness for some particular oc- 
cupation for the very reason that mature judg- 
ment would condemn it. 
A family connection, a situation to appear-
D4 ance 

[40]
ance desirable, and an unforeseen event, have 
often deposited a man, in a line of life, ut- 
terly incompatible with his ability, his in- 
clination, and his fortune. 
With a mind soured by disappointments, 
unable to practise either with credit or self- 
satisfaction, we ought not to be surprized at, 
however we may regret, his adopting disho- 
nourable practices, which nothing but the iron 
hand of necessity would ever have compelled 
him to submit to. 
The irreligion and profligacy of practi- 
tioners, have also been supposed, to injure the 
credit of the Faculty. 
Without again pointing out the injustice 
and absurdity, of condemning a whole society, 
for the faults of some members of it, we may 
perhaps trace this scandal to its source. 
The accidents and calamities to which the 
frail state of man is exposed, frequently de- 
mand attendance on those days * set apart for
the 
* I have lately seen a hint, published, I believe, in the 
work of a Divine, for remedying this evil, by charging 
nothing for attendance on that day; the idea is a good 
one, but the remedy would increase the disease, as the 
day of rest would probably be the most fatiguing one 
in the week. It brings to my mind, without meaning to 
offend this charitable gentleman, what I have seen or
heard

[41]
the necessary purposes of worship and devo- 
tion: and the uncharitable part of mankind, 
will often assert, that the absenting ourselves 
from the public services of religion, which is 
sometimes the consequence of necessity, gra- 
dually degenerates into habit and matter of 
choice. 
But those who censure with so much se- 
verity this supposed enormity, should remem- 
ber, that it is not more criminal to be em- 
ployed on a Sunday, in the service of the 
helpless, though not immediately necessary, 
than to return, after the most pious ejacu- 
lations and devout deportment, to spend the 
remainder of the day in scandal, insipidity, 
and cabal. It cannot be denied that a very 
considerable practice may be carried on with- 
out interfering with religious duties; as it 
becomes every man to postpone his engage- 
ments to the next day, except in cases of life 
or limb, which cannot dispense with imme- 
diate or regular attendance. And indeed, 
however exalted our station, and however 
valued we may be as professional men, it re- 
quires no deep reasoning to prove, that we do 
heard of a philosophic character: “ I never knew a man 
“ bear the misfortunes of others with greater calmness 
“ and composure. ” 
not

[42]
not add any lustre to our character, by openly 
ridiculing religion, morality, or common de- 
cency. 
The furious whirlwind of passion may 
sometimes force us beyond these barriers, but 
we find that in deserting them we abandon 
our peace. 
We cannot but readily join with those who 
conceive a shocking idea, of a physician and 
an anatomist void of a spirit of religion; he 
who could behold the inimitable structure, 
the variety of parts, and the complex me- 
chanism of our frame, without humbly adoring 
the almighty Creator: and he who sees in his 
daily rounds, the devastation, the agonies, 
and the worse than deaths, produced by ex- 
cess and criminal indulgence, without emo- 
tion and influence, must have a weak head, 
and an abandoned heart. 
The exorbitant profits in the practice of 
medicine, have been often exclaimed against, 
and as often exaggerated. Those who coolly 
profess that they should be satisfied with the 
moderate profit of five per cent in mercantile 
and other occupations, forget that such a pro- 
fit, which, in their vast returns, produces 
affluence and ease, would not afford the prac- 
titioner the bare necessaries of life. 
But while we pronounce it every man’s du- 
ty, to procure a decent subsistence, and to
prepare

[43]
prepare a resource for sickness and old age; 
we would not be understood to defend the 
iniquitous conduct of those, who drain the 
purses of the sick, the infirm, and the un- 
fortunate, to indulge an affected taste for in- 
consistent splendor, profligacy, and dissipa- 
tion. 
Nor can it be expected that patients will 
tamely submit to fraud and imposition, when 
a man has impoverished himself by an inglo- 
rious taste for painting and virtù, or when 
his pocket has been emptied by the bound- 
less extravagance of a rapacious whore. 
It may not be amiss to observe, that if 
mankind expect medical attendance in all the 
pomp of equipage, they should not scruple 
paying for its support. The vivifying and 
cordial effects of an elegant chariot, and the 
specific qualities of a footman in livery, 
agreeably gild the pill, and happily disguise 
or relieve the awkward circumstances of ill- 
ness. 
CHAPTER

[44]
CHAPTER THE SIXTH. 
Conclusion.—Is real Merit the sure Road to 
Eminence?—Are any other Qualifications ne- 
cessary?—An Example or two.—Reflections 
on them.—A Piece of Advice to fortunate 
Candidates. 
AN humble but impartial enquiry into the 
most probable methods of attaining su- 
perior same and emolument, seems a necessary 
but delicate part, of an Essay on the Manners 
of the Faculty. 
To blindly coincide with vulgar and irra- 
tional prejudices, might be considered as sa- 
crificing truth to timidity and caution. And 
a free discussion of subjects, which seem to 
affect great characters, might appear envious 
and dishonourable. 
We would wish to ask, but with proper sub- 
mission, the following question. Are great 
abilities, and unwearied application, the un- 
erring guides to preferment? 
If after properly considering the subject, it 
should be answered, that they most certainly 
are, it might appear conceited and arrogant 
in an obscure individual to differ from a gene-
ral opinion.
It 

[45]
It would be rather his duty and interest, to 
concur with the fashionable doctrine, and to 
declare, with equal pleasure and truth, that 
among his acquaintance, gentlemen in the se- 
veral branches of the profession, had acquired 
that honour and affluence, which their abilities 
and virtues were justly entitled to. 
But as there always exist some unfashion- 
able mortals, who will not be so ready to 
take things for granted without examining 
them; who dare to doubt, and to dissent from 
this or any generally-received opinion; im- 
partiality obliges us to propose a second 
question. 
Are not success, connection, superficial ac- 
complishments, and political deception, the 
necessary steps to a profitable and extensive 
practice? 
If it be true that real merit is the sure road 
to preferment, and that lucky incidents avail 
nothing, how can we account for talents, that 
would have shone with splendor in the meri- 
dian of a metropolis, languishing, 
“ Alive unnoticed, and when dead forgot? ” 
A fortuitous train of circumstances, that in 
one instance would have buried a Hunter in 
obscurity, in another might have raised the 
favourite child of fortune, without genius, 
without

[46]
Without effort, and perhaps without a wish, to 
reputation and affluence. 
If on the other hand, it should be said, that 
accidental success, family connection, and po- 
litical deception, are not necessary for these 
attainments; how happens it, that the rise and 
progress of those should be so rapid, who are 
particularly distinguished for these qualifica- 
tions, but are notoriously deficient in that know- 
ledge, which is necessary for the skilful prac- 
tice of their profession? 
“ Quo spectanda modo, quo sensu credis et ore? ” 
A person, whose name I forget, was dis- 
gracefully rejected at a public examination, 
where he exhibited shameful proofs of igno- 
rance and inability; yet a minister, as much 
beloved by his sovereign as detested by the 
people, gave him an appointment, from which 
a great and good man * was dismissed, who 
would have reflected honour on any country 
and in any age. 
The present day would, perhaps, afford us 
some similar instances, in which a noble al- 
liance, an abject behaviour, private services, 
and a predilection which could not be resisted, 
have been able to obliterate the remem- 
brance of the most sacred promises and me- 
ritorious actions. 
* Dr. Francis Nicholls.
I From 

[47]
From what has been said, and the general 
fate of practitioners, it seems highly probable, 
that the greatest and best-cultivated talents, 
unassisted by connection, success, and political 
manœuvre, will not be sufficient to gain dis- 
tinguished same and emolument. 
But if a young man with a decent person 
and address, is so happy as to unite, genius, 
application, and prudence, with an extensive 
acquaintance, and the golden art of rendering 
himself agreeable and necessary to the great, 
affluence and dignity are almost his certain 
lot. 
Should some lucky event take place, so as 
to render him the object of public attention 
and general conversation, should his eclat be 
such as 
“ Digito monstrari et dicier hic est. ” 
his success is beyond a doubt. 
He may then look forward with ecstacy on 
the fruits of his toil; and after a twenty years 
pursuit of profit, pleasure, and respect, he 
may honourably retire, with a fortune ade- 
quate to his wishes, to enjoy by turns his town 
and country house, and the sweet society of a 
select circle of friends. 
When arrived at the summit of his hopes, 
his behaviour will be moderate and unassum-
ing; 

[48]
ing; he will remember the difficulties he him- 
self encountered when struggling into life. 
Without putting on the strange reserve, 
affected hurry, and insulting haughtiness of 
some unworthy upstarts, he will prove that 
he is equal to the situation he enjoys, and 
treat the pupils and students that surround 
him with friendship, tenderness, and respect. 
FINIS. 
This Day is published, 
The SECOND EDITION of 
AN ENQUIRY into the MERITS 
of SOLVENTS FOR THE STONE 
in the Human Bladder. 
By J. W. NEWMAN, 
Member of the Corporation of Surgeons, of London. 
Hoc opus, hoc studium, parvi properemus et ampli, 
Si patriæ volumus, si nobis vivere chari. 
HORAT. Ep. 
LONDON: Printed for J. DODSLEY, Pall-Mall.