IMAGE EVALUATION TEST TARGET (MT-S) 1.0 1.1 Ui Li .12 3.6 1^5 1111.4 I 2J 2.2 2.0 1.8 1.6 150mm

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Tous les autres exemplaires originaux sont film^s en commandant par la premlAre page qui comporte u-«e empreinte d'impression ou d'illustration et en terminant par 'a derniire page qui comporte une telle empreinte. Un des symboles suivants apparaitra sur la derniAre image de cheque microfiche, selon le cas: le symbole — ^ signifie "A SUIVRE", le symbole V signifie "FIN". Les cartes, planches, tableaux, etc., peuvent Atre film*s t des taux de reduction diff4rents. Lorsque le document est trop grand pour Atre reproduit en un seul clich6, il est film* 6 partir de I'angle supArieur gauche, de gauche A droite, et de haut en bas, en prenant le nombre d'images nAcessaire. Les diagrammes suivants illustrent la mAthode. 32 X 1 2 3 "\- -z't'^iw"*'! ^" ^ ; r^- ^ * JkMUptn to ACAII fif ROBERT BAYAIU), M. D. 4fc ■'*«f!a|i «^ fi". ft* ft s» ' . \ »r* .-«««&![^, 4- -rV .^_ « * ^'♦S #?' ■ <# } %igr ^ .<^'^' JN^» * =-» ,«» **-^. ^«p^im^, 'H, .«r :ly '^-H ^ ^-f il'IW. \ \ ..^ ..,^,.,^«-;-^ ■!jV"^^ tJ% ^ f%r ■ . K . tss* 'l,-:»4 4;,'' % ^ •< « ^ Tfo HEJfRY COOK, Surgeon. .^str/./: cttfr '^""".^s "^-i^j? # ♦^ ■Mi *■ % «^i»Sl; __l. T mmt «nd their dtarert attacbmenti under my orofiL voidabfy compelled to expose jour error, vou «u.t attribute it to your Wn w.nt of poC •nd prudence, a. I would hare quietlj pursiiS the tenor of my own wty, without deTiitW into you«unIe« provoked by. nece-ity, whicf ^IISJ «• one, have imrtwed and which Tcannot suffer to pass unnoticed, without actings a conipira- «?Un; T?"ur* '?"«^ *^» "y concealed M, jwlant, and although you have Wn geney^y taken in your own toils, it i. now UmttaWim an lUiberality and jealousy, which are digS^ ty to an honourable profesrion. It is A^nlw td be deplorM that such jarriugs should involve m censure a scientific pLrsuit, which ffSmVte S*" **' human,ty--iind it were well, 7f the indulgence in such ditcords could be reitrictS '^hl^u ««»««l«e"««»« •ntirely to the profession, which however deserves a better fate : But thii cannot be the ease, and the public are mora or less drawn wtthin the banefiil influence of iea- lous and contending opinions, when in sickness •r distress^ the t«nderest sympathies of individu- l^^'^^^'J''^^^'^' #*• andclaiisul sultJ wA'??"***." '" disregarded and iS- 2Sir;i..4 ii-^*** impressions,! am willingio n^ke that puWic a party in this questiiw « I ^U?^V 'i* P*rty^*te«»ted%ndTtiier«. fore feel less hetttaacy in making a pubUc expo^ ■b # ♦ my profe I am un«- irrow, you of policy Ij pursued ifttjng ioto rhicnyou^ mot suffer conipini« uid repu* cealed m« gencMMy i toMTwi* interely i involve from iiM id purest II if tbe estricted ofession. But this more or lof je*- iicknoM idividu!- umiup» and in- ning .to W ul I there- i eipo^ ntion of your proceedioM. In doing thii, I shalt dotail lome CMea to which I wat called^ after you had been lome time in previous attendance, respecting which you have asserted that^ay opi- nions of the diseases were incorrect, and conie- fluently that my practice was inadmissible : I shall refute your assertions, and substantiate my own correctness, by a reference to the received and approved authorities of the day, and by the still stronger testimony of the eventual success which marked my practice in the plurality ot cases. Justice to my own professional character dfl^ds au investigation ; fur you, as one of a ^V^^Vg^y^ been secretly endeavouring to wound *''® S^'NS!* confidence, which the public is re- posmg in%y exertions, in the hope of building up your own reputation on the ruin. I am moreover induced by my respect for the feelings of those who employ me, (o expose the fallacy of your assertions, for it would be a source of un- ceasing bitterness to them, if they suspected that they had placed an unfounded and faUl confi- dence in a physician, whose ignorance and errors had destroyed their happiness. You, Sir, have had the temerity to circulate expressions, calculated to excite suspicion, had our mutual abilities as physicians been previously untried in this community : How far thostj expressions were authorized, I will now determine : If I am correct, you must have been wrong; and if ^rona^ need scarcely add the deplorable con- seqnelPR which must necessarily follow a prac- tice, which, admissible in the imaginary, was # " '.iSWI*^ j,i^*^L ^*»cn you hftvA ,K ®^'*<»" •f • eaan ..I!!' lice, »t*hei^tt,p|^ of *fc J- *■***« «na«. 5'**"^**' »f I should Xr* * "^"^ *"^te « comparison wiOi youST »««»•, wlueli »i»e recoQUy ca«e, upo« Phied diion- f'confutjoa •We Mfn^ »«■* which ruestioDin ^ify diiier. Imllodc you Ud 'rated an BTWMll^ . edly de- nted by jutor j« K^ Esq. >o. In owanit nplica^ tfeman lai ac- ribute ne^h ^oiira^ i7"J?!!?f^^ ♦nfofined thai you Irmrtod «liit Mm. «• ••• ■ dmaw -ma Cynaaclie t 3i, 1886... " '^° ^ CARTER. .wul therefore iriTe m.. n n ■'^ ""tinguith i« • r b»»k» of fer«- «"»«. «ut we^l » "?^. '■ " •'»'»* Ike T|«<*pr„.„tt*'e ^h^sistvsr"?'"' *»^ «» .the JieT^,'^^^.?:^??* ♦iei' "filler ulcU »at rert "S^"^ "«^'««»- Now Sir, ♦lo*. I must .ppeaNoiLh'^ .1."^ **" •*"- »isit .«»yi«c^*? K,^":'* *•?■»» >*V fi«»t »h.»l*e,^X,^'^'SXj:*»?«''». ' ft<>«.fioc»Br OuttB. 1 *" *'"''^*^»»g tetter Kvred tiw •'"•fiilaiy toe n^. perfoctty she, th^ra ►D, refer«- 'ooeedior ibout ike Consider ^e ditor- '« throat, >f tbosb a> which iter, "ex*- fe sy mp*. t thein*' ore yn» id die oins -of IllSt •€<• owSit, lasier- «ught fa me- y fifst •n. I letter t€ «4tli " you, of course I coincided with your measures, *' which i then, and now think w^re faosi ad*' '' visable under the ciroumstiu^c^. *' I am, dear Sir,«o ,% » " Very sincerely yours, *' JNO. C. CARTER." ' To Robert Bayard, M. D. • ' * It is a source of much satisfaction to me that I am thus enabled to adduce the testimony of ao» experienced and seientific Physician. He wav an allentive -observei' of the cas&from the hmr he was first called in^ until ita^wtal/eQMlw^div -Ki "%» 12 piled for its removal \i^ « remedies you an. obstinate pertinacitv I* i. ^ rder, with ere.tefai8Ji„,prej;{^„/*J «n ^fT ^"''tter to prejudices in themnd!'n? ^"^ ^'''''!^ improper disposed to giTe yZtm Z"^' ll^" ™'^'»* ^e '^c ness, es^ially ^?th h^ candour and cor- no interest or inc fnrtinn 1°'^ "^-^'^ '^^^ ^i^'e or [it of jour detiils Yn?. ? '"^"""^^ *"*« ^^^ me- fioodwink the public^rth;." :? endeavoured to feltiittIeor J into the me- ieavoured to tive expecta- 1" would ne- icJencies. I »I disputant, r medical or 'H to expose —Let those, B the accu- 'ke the best f position, sufficiently he disease, rna, or UI- >" into any 'et me fol- I certainly sibility of ry disease. I I cannot ^rted tliat 13 Iroiip could not bare occurred in the case df jMrs. 6**** t because, she was labouring under Cynanche Maligna, cr Ulcerated Sore Throat, and became she was too far advanced in years lor the accession of such a disease. You have again established an opinion upon a treacherous foundation ; Croup can arise, and has supervened Cynanche Maligna, and other inflammatory af- fections of the throat, as a secondary disease-j- and it has occurred in adults hr advanced in y^ars. Here we are a^ain in direct opposition, and now for the decision. Let me premise that you would have acted wisely, if you had sheltered your error under one' of the rare possibilities attending this disease, and without denying the existence of Crot^p du- ring my attendance, if you had referred the 'ne« cessity of my practice to a change in the disease, the inflammation having extended itself along*' th^ membrane of the trachea, producing Croup" as^a secondary disease, which has sometimes been > the progress of Cynanche Maligna. But I will f" not apply this consolatory construction upon the > case in question. There was no pirevious ulcer- ation in it, therefore there was no connexi«ii'^ b^ween the two affections. r T J have asserted that Croup can follow at i^ secondary . disease, supervehmg several other>t morbid affections of the throat. CuUen, and •- 1 host of precdiing and subsequent writers, have * established this fact. When inking of Cy- nanche Trachealis, or Croup, he sa^ri-^^It may ^'iarise .first in thesie pakts^ atid continue to i^bf .» V 1'^ ft ;;jftT P^ from A^CynSeT "•"•,!•?"■"» "fy fever of a>Mllpox^J?l,*""''J<'^«ta., i22f2?y •«« ■«w3hS* k^l ?*"'«%' m of ihc Kmt of J>n»e totffect l^ousiUariak or :U is true that 'Jy?fit;and >' we inflttQ. »^ts, which it ^y sometimes, '"*■ disease. ^nctiticottiT, P niatk flajr ?"py affWn les^oiidan 'beaiipeB, * «Rini|iiif J OfCiiilflB^ >UH|«i it aiye boBn aauibda aAvaocsd aj^a, mutt ako. be admktadi Vtt& oUt§ CbeyntB obieryes he never net with it aitev the fft of puberty, but Rollo has recorded »> cai» ol an, adult affected with Croup ; Cheyne does not questioa the fact, but cefer» it to debil^ itf of the trachea, the raucous membrane of the bronehia being* debilitated pre¥iou)sly hy a^se- ▼ere attaok of catarrh, and by predisposition to crou^ priov to puberty, if ImisUke not, Croup termuuited the existanoe of General WashimA" »0N. ' *' Miehealii and lome other physicians have " thought that Croup occurs in adulte mtke- "queiitly as in. childrea, with this diffeni$nce, " that adults possess the power of expeetorat- *' iag the lymphatic exudation before i(k be- ^' comei a solid membrane." This howevev, "-^ ™***«r pf opinion, as to- its frequeaey; and- is I wish to- refipain item uaaeoessafy tfaeoMtieat inquicy, I «hall be aatisfi^, W4t& the authorvty already cUedkHibservinc tfaatit IS n^ Mg^ment againstthe: liability of eertMu •^ t» partiiGuliBi^ diseases, because seme pli^si* ciane in extenslTe pnictiee may net hfive witiie»- ■ettheni* the fisease m»y oeeup «»dbf %!»<. cuniBttaoet» and &nffuen(%4 by- causes whioli camiot b»defi{^> and i(»is an oocasioMa «oli< ttry^ oecfHrrence wkieh «hew» t^ invalidity eT •dy^eiMerab e»l«ui>fe aiaertion. Itkaetfiir <>*» praettdoner to deela|!» thalt particular df*^ cuMsiMes «re inadDHftiibIi»>.beeai|s» in hiiieie^ cm^rilKji pnctioa lie ha».;i«wit wj«Btiii# Ai^weHaHg!Un*«swK ' t m ^ieh bounds our vision Is «h« -« j ^ cause our limited sllht cannn* n ^ Z**^ "»***' ^ it Such cases nrl?.r •? *** Penetrote beyond selves, form Th^a^Zlfo^f P'T*'^ *^«»- our duty to detaiuS i?,h IP'"**'*'^*' «nd it i. ^oacine his profewS * ry^^*^'*" JU«t com^ c«c», wlch oTewhawL?^'^ '"'^^ ™««* ^it^ of medical observftfJnn 5 **^''°»!nated a Jong life this &^- ^^"^ «««««!• of Me'dicini conC of ^HaTe^Cte^^^^^ J!'^ friend, '^jv.ng administered an leUc 1?^!/-^" ** "^^ observation upon your own v^ew of H^T ^^^^ namely^ that i* wul tti , of the disease^ You have a«iib^^^^ Throat censures-J^r everadm ^""^?!:*""***« '» your ^•i Cynanche Mal?i?nT "^ ^rf * *^^ **"^« Throat^ you couftrha'exteJ^ ^°" of our most t.S«!* 'T"" e<>n"««ute gome them from my owHSicHce '''";''» fi>TOttr of . ^Hd frequent o^1""^f wtic|», nerio/ 1 b.vft "'^ opinion, any welSJ^n ?h- '^^'^ '» **»» «-% of CuUeJ^hS Slot's **a of sptce^ h^ trate beyond ntiag them- ice, and it i« ■tantial cor- ^ ju«t com- r meet with 1 a long life ay not have . ine confirm the friends tion at my ding your iie disease^ e Throat, t^in your lie diaeaie ited Sore id a more 'Ute some when gl- Uying ipproved ayour of ; ^erience * I have n m Ul- isfactoi/ Uo^ve ueitipo, th«au- active remedies of Croup, or it Mrill soon give you a meIane4ioly memorial of the insufficiency of your measures, and of the error in exclusively denying the existence of a disease, became it does not more frequently occur in common practice. Let us now inquire whether the case in ques- tion was primary or secondary croup ; that is, whether the disease was in the first place any other inflammatory affection of the throat, and whether this continuing and extending along the membrane of the mouth passed into the tra- chea, and gave rise to Croup as a secondary dis- ease. I am fully persuaded that this was the case. You may satisfy your own mind upon the other question which suggests itself, whether this extension was spontaneous, or whether it was the result of highly stimulating applications to a highly inflamed membrane. The disease may have been induced in either way. It appeared from the history of this patient, that she had been for some days complaining of the usual syitiptoms of ordinary sore throat, which in its early stage excited little or no unea- siness in her mind. The inflammation was tiot attended with any remarkable difficulty of swal- lowing, shewing that the tonsils were very little swollen. Ak the disease continued, it daily be- came worse, and the disposition to extend along the membranous surfaces was evidenced by the subsequent efliect upon the organ of hearing, as there was a slight decree of deafness, and some pain along the Eustachian tube^ shewing that this * The U?e„r«So? t "1. '"««»'»>««.o». « ordinary infl.mm.Won.T.t^f.-*"'' «. Mnces tint (hex. .»« . ""* *''roa(, ue «,i. »e«d along fembX''''''",™'' ""d d" «- found lie difficuinSnl -"J' **•»'•*'''»'. I r"" •» «dvenSioM! It?' •Ppeared loSed n>«tter in the tmcbeTl «,^!?^ "" •«««"nul.ting »" Ifiven With d^W^d JS^ l"r«««'' "">«<* vantage, u it .uinmdei fe? ^t .'^"'Powy ««- «*• hour for iVsewonZ? J?i'i.''l'^'"?"P- But •rfolly upon ^ n«r,s f^^"*"" ««elf too pow- PXieotand with th. ,„„ ' ""* <*«»'«•« of the «">. emetic We ^^T/'"? "''»' Ph^«^ ted little or no arfin system* tfeat thevexri. iere remark. ZtTultJt!^?"^^- » ™«r peculiar inactivity rfil,!. .7^ °,"^ obserred thit «ore ..pecial^'^lS' bm^'l^ '^ Croup ; aSi' ^'V c«e.. thit have yiS t it ^"^ '» of emetic*, I !,,« JIJ.1 *° *^ opemtioD inflampiatioii. ^nd deafnew iroat, are evi- 0" and do ex- s« of different the patient, I most ui^ent iared loaded and as the ccumulating Metic, which miporaryad- the opprei- i expression roup. But •hadpaoed If too pow- ment reh'ef sire of the icr phj'iici- doses, yet thejr exci- ^' I may erved this ouD ; and indeed in operation » of Ur- poweiful 'mptoms resprted lo the most active measurei for subduing ii» viz : Bleeding, regulated by the state of the puke, and the appearance of the blood drawn — Erne- fici, antimonials, cuppinrs, blisters, fomenta- tions, Ac. &c. But even from the fint we could entertain no hope of relief ; and our remedies were administered from a principle of duty, and from an unwillingness to abandon the suffering patient to her fate, without an effort to save her. The real disorder was not suspected in its com- mencementi and at the time, when remedies might have proved beneficial ; for it is only in the early stages of Croup, that these will arre«t its progress : for such is the peculiarity of the p&rts affected, and the violence of the inflamma- tion, that a few hours of uninterrupted duration advance it to an irremediable state. I shall now close my observations on this sub* ject : And while I have been compelled to ex- pose your inaccuracies, I trust! have at the samQ time detailed the most important particulars of a case, which must be interesting to the profes- sion generally, inasmuch as it establishes the ex- istence of an alarming disease at a period of life which has been supposed by some to have been incompatible with its occurrence, and hence has deceived the young practitioner, and might con- tinue to mislead and lull him into a security, al- ways fatal to his patient. It was my intention to have animadverted upon some other cases in which our opinions and prac- tices were at variance, and more particularly up- on the case of Mr. CH*KVt*», but as *bii ^ •# when .peafcinj. of^Ji ?.'• ", »» "hich I alluded *.«v« made totht exvr^Vi P""""' *«" <'enb aod theU ftt'nj^ '^!f'"» o' your p.! i" ewes of danger T° "'^ "■yse'f and other. We decidedl, fbLtI° ^^l" consultation, you you and your'aStton .Y^'"''*'''*''»"WMk •ware of the duty anT V/ ??" "« 'ufficientlr of a Phyician, aM thf ^ "'^ *^' ''"'"^er "ected iith it Do vou nLT'"'""'"""" eonf ety excWwfo fo" vC^„^"* yourrelve, in ,«*. tion ? Do you vS?^ ?Y° Personal consider motive, ? 6^ Ws bete- ""'^ '^°»> PeconSr' or his «rfety, no „rit!h^>^'r '^^ 4 wjsh^ feelmj, oryoui-prX ? Or^'"*'^ *ith you; ™;« ^ Wtioil?r «™,„^;' "* y°" aPPreU- Mwilliogto »ubmitToS;^^' '•'"''" «e«n thus «i« to any invSSnT Ha"r"'^y»"P»«- «<*llent advice Of&«?orr rS.!- '°" •«»««'« weffoiy, relahve to (he qua- snce a subject of some pro- ^^K that the the extreme 1^ has already ►pinions, and dopted with lid intend to -n I alluded »ts and out- fi the oppo- actice hen f )[our pa- Jesired th# nd others, 'ations jou would ask ufficieatly character itics con- M in soci- onsidera- 'ecuniary i? wishes, ith your »pi*ehcn- «m thus ur prac- read the be qua. / Tomitin^ and ntuaeatinff, prove useful, especit ally when employed earfy in the disease." Du" surely. Sir, you could not have been ignorant of the admiasibiUty of a remedy which is so clearly pointed opt in the initiary l)ooks of the schools. Your remark must have proceeded from other motives, familiar to your own feelings, corres- ponding with many of your other animadver- sions, and founded on a similar basis. I have said and established m\ assertion, that the disease was not Ulceiated Sore Throatj, proving thereby that you were wrong. I have also asserted that it was positively Cvnanche Trachealis, or Croup, when I attended the pa- tient. I will now proceed to show my authority for my opinion, and prove that I was right — this done, I will simply ask you whether the active and stimulating remedies of Cynanche Maligna, especially the heating gargles of Cap- sicum^ would be harmless in Croup, or whether they must not necessarily i^TQve actively delete' TtOUS, ' . f The case in question was either an original idiopathic case of Croup, or was secondary to cynanche tousillaris or common inflammatory sore throat. In either case, the remedies after the croupy symptoms had commenced, would be the same. But a very important question arises out of the consideration whether it was in the first instance cynanche tonsillaris, and seconda- rily croup— and this question is no other than tins, whether the stimulating gargles for suppo- sed Cynanche Maligna, applied to the already H Thi. Sir, 1 c«di3i, tei? vS n.;;*" •? •"«''«• «•«, and we wMhtamJu^ "r opinion of ft* CYNANCHE TlUclffire. '"" httalhing. emeciill. „i''"~J*' <» *««"« >r any .welling in the LSW '"T' "««•• muck »«ec»«»f md 1^«.^ ' '?* '"•"owing not Sir. when I «w Mri 's^r'^'^ <■""• Now wpacity of the t«eh«'« «?- *^ *«»nuh4 •nyvinileenlawemmfif A **■*"•» "•«»»» ■rnpured; il,e in»i^^oa w« ,T "" ""'«6 «Ui, marked hv a mtS:., ."S «nd laborf. d.ntly.f,omth7«™SedpZ:i"«, '^T' '^f" "on ef the lunra uf^-"" *¥^'^<",mm- '■"SuuhSg features tatrdtt.'^K^"; ^■w pushinr (he tne tnchet. pinion of thi 5 how ftr iti t. definition of LIS. "o strepenti more fere tegIuti(ioQ0 or difficuU fin the . J acurce* [owiR|^ not er. Now reiy »rea( was long iminishea •carceljr B or uvii> ^'^ ^•8 much id labori* •Me, eW- throiieli ^ of ti!, e •.>n; Intbe :estdi«« n-ewAs •light congh ejecling mttfcr of t toueh and vii- cia character— the posterior parts oftbc laiices exhibited a bright, red appearance. In lome places in the vicinity of the epiglottis, there wai a whitish substnnce, resembling the buflfy iur- face it' iho biu^d, which could be detached by the l.mdl'i of a spoon, and was separated by the ^•%rts of vomiting, leaving a clean un-ulcerated Lai highly inflamed membrane beneath it. Thii whitish substance appeared to be a continuation of the croupy membrane, which, as frequent dissections have proved, lines the internal sur- face of the trachea. There was great restless- ness, and propensity to remove from one situa- fttion and position to another. The pulse was rapid, varying from 130 to 140, the fever was actively inflammatory, and the blood when drawn, exhibited a buffy coat, which formed It- i»lfvcry quickly after the abstraction of it.— The friends of the lad^ whose case is now par- ticularised, can confirm this account of the symp- toms, as respects the breathing, the voice, the matter ejected by vomiting, the coughing, thb restlessness, and the peculiar white and fatty sur- face on the blood, which was drawn. And as for the other important and diagnostic charac- ter I must refer you to the very explicit letter of Doctor Carter, which expressly declares that there was no ulceration, even under the adven- titious membrane, when this was detached by a spoon. Compare these symptoms with the noso- logical description of Cynanche Trachealis ; compare them with those cases of Croup, which 4^ h you must have seen .„ cn«*.«. "P- ^ *e symotoma ^-^Z .. '? question anif ».• , V®*^y* and prove if r-.*^ "' oeyondal] ''^'UyZdflZ ^''®*'«' "marked bviVi' *'*^*'*'- "ure rapid course than ;« i? ^ ureases run f ''■ority iffil /t /.? "««•' often of r'*^""* ^■•« A c* d, during ses run a '*s. And compara- on^ chil- existence qual au. peculiar ne fact, uestion And if Croup, i it tho into our private contentions. Sickness in gene- ral, purities the mind, and raises it above the grosser gratifications of our nature. A sick man suffering under pain or a decaying constitution, indulges no inclination to participate in teuds, which would inflame, and not alleviate his feel- ings — He sends for his Physician as the guardian of his health — he considers him his " Lares famill- aris salutis," he entrusts him with his life, without wishing in return to be entrusted with his private quarrels, or to be made a party injured by them. When he calls for our assistance, he fairly ex* pects that every exertion will be made for the speedy restoration of his health ; when we obey his summons, we as fairly subscribe to this rea- sonable expectation. His safety should be the primary consideration, and all things being done to the best of our abilities, and t9 the abili^ ties of those whose co-operation may be requi- red, we are then justly entitled to the pecuniary recompense, which would be due to professional exertion, sympathy and talents. But there was a time, when you were all plea- sed to appreciate my professional opinion, and call my services into action. It is true, I was generally summoned by you to the sick beds of the poor. It is equally as true, that you indul- ged no squeamish feelings in privately consulting my opinions respecting the cases of your better patients — sed " tempora mutantur" et vos mu- tamini '' in illis." t was then a stranger, and less was apprehended ; but I am now establish- ed in practice, and probably in your opinions I > .Id wit wifk Mr. P Tl^'- ^-8' would not co„ "'Sj'ej.tly JeC/CXT'" ""'"■^«'^' to the hereditary f„cuZ rf fif HT '*"'^'«* •» Phwiown, SnrOTon ADotfci; "''"• '"deed *« ?rerapproaeh?d ttislC^"^ ""• "«»fX ^ the ordeal of opf^H^S^^^fr- ""o^aiJed tt«t _tb« was a dediS '«;«„? ''°"''' ««em «eIus.TeIy to the prer^K f '^»PP™Priated of a angle iadhidStlXIZVu P^'^meat racters. who morrSS Jl,'/ ""* *» ♦'"oaf cha": *nd humour. n„t,Cry ™f»erve hij inter«* «o»vuI»d ,0 many ofyo^ff ''}^^ '^™"riy d«d, audi, succe^edivi ,? " 'ongth suhB' f-no.the^.„eh;o^tt»:j.K: ■A. public cohfi- f jarring ele^ itheopinionf "c^ who uo\r Jira^c— when ^tended their «is wreck of fj. that Mr. octor B»YD ?o«SMft with 'J'sult with •d not con- >*erest and 'f Medical 'extensive Mr. C**K, considered resumptive Indeed «• Dentist, ''nasjsailed "Id seem ropriated I'ernnient ^ght of ' ose cha- interest formerly h subsil sittui as h is ca- breatb. less ex- ile from your counsels— Mjr prosperity is the target against which jour envenomed arrows have Been secretlj directed ; and as men are sel^^ dom jealous of inferiors^ I do assure you, that your united opposition, has not onlyadTanced my professional interest, but it has also excited my vanity and stimulated mv exertions ; there* fore, if I were influenced entirely by selfish con- siderations, I would subscribe to your continu* ance of hostilities ; but altho you and your col- leagties may never consent to consult with me, /7r reasons oest known to yourselves, andbesi buried in your own bosoms, believe me, when I assure you, that I should never feel the slightest reluctance or uneasiness to meet you in the apartments of my sick, Bhould they ever require it. It always has been, and always shall be my invariable maxim to acquiesce with the wishes of a patieut, in his choice of a consulting physician^ even though he should actually elect my veriest opponent. That disposition must be truly culr pable, which would be unwilUog to surrender for a few moments the mtification of the worst feelings of a man, to the well-being Of his pa- tient, and oftentimes to the safety and interest of his best friend. I ^hall conclude these remarks, which have already been lengthened out beyond my original inteption, by observing that I think the public are in error, when they unresistingly submit to any encroachment upon their claims from the profession. A little determination on thdr pari; Woiild iOon correct an evil, of which they sa ./ ioudty complain Wu '■«ter«to?!^ V "•« caprice^ m !.*"<'*««' «o "ore mi^L 1. *™"* ofdeafb iL"''«"'»««on to ^e is bound #« ^®«fidence of thi ! ^"«rie ""«/ conceal fi,' ^"^ 'or aootW ?^ ''"""ff •' "^f^^r and J«, «^iowed to 'j.-numour, or 't^on upon the tamely sub- ^use of much 'emnation to even thought fo save the eirsick. It thinks he IS Prejudice in *ers himself *he pubJic^ ^*- that he ^, ^hen in »d after he Ynmunity, '^i's estab- 've to the act with ^ Itho pro- "* 'e is aiso 'ick and ey have during- nwhom It. To 'ant Ta- Altho wouJd a tem^ 4 ^5 lifications and duties of Physicians ? Or, do you feel so perfectly confident in your own sufficien- cies, that you regard all other advice or assist- ance as supererogatory ? — Whatever you may have thou|;ht, your patients have thought other- wise, and in those instances, wherein they have thought with determination, the results have not been illustrative of your infallibilities. But, Sir, altho we might be satisfied of the unnecessary alarm which agitates a patient, it is our province to comply with his wishes in all cases where far- ther assistance, or plurality of attendants is re- quested. It is our duty not only to administer to his bodily infirmities, but to soothe the unea- siness of his mind, which in many disease^ exer- cises an important influence; and if this anxiety is unallayed, it must impede tKe progress of reco- very in eveiy case, and in some it must lead to irremediable consequences. Every objection to consultation is a direct reflection upon the judgment of a patient, and an insult to his feelings, originating either from conscious ignorance, from a jealous disposition, or from a vindictive temper — for no Physician who felt assured of the propriety or sufficiency of his practice, would shrink from any inquiry into it ; nor would he pppose the co-operation of another attendant in an obstinate disease, if he felt duly impressed with the nature of the charge committed to him. But when there is absolute danger, and th« patient and his friends have urged their wishes for other advice, I must say it borders on barbarity to resist them and' ^:ili^':.. f "■ ¥ 2$ 5J™l«th«wiU,X? P™«^^on«»,, who con's «f a desire, in which X» !^i!? *f S™«fic«tion •nd who would Mcn£?.S"i""''* toacquiwcT the yen existence of ifci' '""' '° "«nie cue. *»ve been actuate!! It *'*'«™"'e whether vou JO"' repeat^ ?efu»(^ Z^?"'"'*''' """ve^in KV"° °»»«'«"e S the*,"""*'^; **« »!.• I? •* Of the late MrA.,. *"es of Mr. »;•«'' I could ennmen..- !^"■ "• «"d othai, ci^ this question ** ""^ particulMise.lJf ,1.r'" ^XK'^r,'?"'^*''" object assure you /Afl# /jI , practitioner? IfgV, t of » ""oulderin/cX^' T '* "o' 'ke deereo »ent to »»*«oC&''~'"«/'' «««'»I»~n •trangen. huck»terinff?fc. « ?f* *"^ absolute Wth wAscrimiiate pSir'/' ""^ ^^ilini '0 support its imirovSii? '*' '""•='' *«niw not plume tnyselF^T^J'^'r- I woul3 ""to.nelei.tiin'beyonSt,' '*'"'"?"'*• «^ ingme. '"""""rower of support- "-pre.„.a.ionr.rt^Xa^,ttit I 37 eited motives a positiTe inaccuracy. I am inH aware of any act of mine, which violated that professional decorum, \fhich as a gentleman and as a physician 1 shall always maintain. J wa« urj^ed to establish mvself in this city, by expect- ations of professional support, whicn proved de*^ lusive ; and I came witn a wish and loclinatioit to act with liberal reciprocity. I relinquished • certainty with a large and dependent family, for the prospect which was held out to me in this place, and no sooner did I arrive and acquire some professional influence, than the friendship^ which I considered sincere and honorable, and. which I wished to preserve inviolate, without violating my own opinions and independence, was converted into secret opposition, and my conduct became the subject of unjust animad- version, and of the grossest misrepresentation : Time is now correcting it ; altho many will con- tinue to be biassed by malevolent insinuations and assertions, which I can never have an oppor- tunity to refute. If you and your professional a^uncts intended tnat your united opposition should mar ray pro- gress, and limit my success, I have the proud satisfaction of assuring you that your efforts have proved abortive : on the contrary, they have operated in my favour. Your real motives have been too apparent, and have discovered them- selves through the flimsy covering you would have thrown over your professional fastidionty^; Your manifest uneasiness has afforded me fre^; quent opportunities of triumph, if I could »* .r •How myself to feel flattered by the.icfor^; l«.„S? ^ " '",1?^,^.'* y^"' objecU.n8 as a private Zr mS V^^^ ^^ '?; ' ^^"1^ have admired •hiL^ 4I i"*^ ?\'''^' '^y*'" had offered it in any S' ^** ^"""'^ not equally have insulted your unoffending patients, and trampled upon their To^ L*"^ J?K^*"S?-.. T^'*^ h*^« » «»^i™ upon S*vTl ^^^ P'l^/^l^ '°«"^"^« of private ani- mosity ; a claim, which every liberal ind enlieht- to «I1 ""5^''«*»"ding vrould consider paramount nourable exercise of our duties as physiJans, *"5/« members of civilized society. ^ an^-l'*"*' 4™®" i*''^ * P"*'*^*^ <" professional, and a private or domestic character to support' 1 ?""^°'lV»a*^*hat jealousy and discord have w frequently violated the duties of both, blend- !5£l •"t^'"^^ *"^ operations, which should aiwa;rs maintain a separate existence. We have no right to carry our private quarrels into the apartments of the sick-the do2r, that opens to h^lilTv '"ff«"?S ptient, should expose our «^iw *t "^' *?^ '^**^" "^^tiring we close it, it might then terminate all farther communication ♦.. ? Di.^**?*.®"^^"^ individuals. In our charac- ter ot Physicians, we ought to be controuled by every circumstance conducive to the welfare of !n^ u ^^®?.*''"^*®^ ^^'^s- humanity and rea- son should direct our conduct, nor should we surrender it to the government of caprice and temper, or what is worse, barter it to merce- nary selfishness. It is ungenerous and unjust to - •nJist the trammelled opinions of our patients %. ^ywv ' the vicforf. as as a private lave admired ered it in any insulted your d upon their I cL im upon 'private ani- landenlight- }r paramount for the ho- 8 physi-'ans, professional^ to support, liscord nave both^ blend- irfaich should >. We have rels into the hat opens to I expose our e close it, it imunicatiou our charac- ntrouled by e welfare of ityand rea- should vfe caprice and it to merce- id unjust to . >ur patients 33 perate inquinr into circumstances, before any unintentional interference was harshly attributed to profeisional illibenlity. ^ «iiriouiea When any case requires the conjoint assist- ance of medical men, the patient and his frieads have a right to insijt upon it. I use the word mnat « oecause the abuse of consultation has made it requisite : they have the right to nomi- na e and elect whom they choose. It is their duty, however, to act with openness and can- dour, and It is ours to comply with their wishes, and with our united and best exertions, to lav aside any private feeling, should it exist, that could in any manner militate against the recove- ry of the sick. There is much that might be said respecting- consultations, both as respects the patient anS physician, and as respects tlie etiquette and pro- per conduct of Physicians to each other in the apartments of the sick : I shall however close for the present my observations, with the hope that no future circumstances may compel me to renew them. / t- v I am. Sir, Yours, &c. R. BAYARD, M. D. &c. m tft-£«.«^ I — r- ■■ *" «rf ■ -iwasL i ■••It *h^SfL"T: -■** i 1^ rt l'#. *;;nr \ •f^^r .— ■.I .jjg|^||||g|g|^. • -^ -^'i>^f% ^' jKa^lfiiP— ^'^***^- "*'*',. l'«S«' S. Lifet 17, for diuiBKuiib, read/dii Mrrata «4, toiMillai, toiitillaii, ' •.JNTCIUUI/ ceufk, •lean, iaflamnaUoa, •firetiM, wreS( loiuillit. "%. tooMllM. toiMiilML MpMildlV« bat. epagbt cicaa. iaflaaiaaUalb •Actioa. lar. m^.