EUGENE 
 
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 GIFT OF MRS. DOROTHY CHAPMAN TO THE U.C.L.A. LIBRARY
 
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 BOOI^ 
 
 ON 
 
 The Physician Himself 
 
 AND THINGS THAT CONCERN 
 
 His Reputation and Success. 
 
 BY 
 
 D. W-ICATHELL, M.D., 
 
 Baltimore, Md. 
 
 '■' I'd sketch the workl exactly as it goes." 
 
 teisctk: h:iditio]sc. 
 
 Carsfu-lly IE^e;-u-ise;ci a.nd. C3ri'e;<3.tly HIn.la.rgsd.. 
 (author's final revision.) 
 
 Philadelphia, New York, Chicago : 
 THE F. A. DAVIS COMPANY, PUBLISHERS. 
 
 1900.
 
 Entered according to Act of Congress, in the year 1892, by 
 THE F. A. DAVIS COMPANY, 
 la the Office of the Librarian of Congress, at Washington, D. C, U. S. i 
 All rights reserved. 
 
 Philadelphia, Pa., U. S. A.: 
 
 The Medical Bulletin Printing House, 
 
 1916 Cherry Street.
 
 
 TO THE 
 
 YOUNGER MEMBERS OF OUR PROFESSION, 
 
 AND 
 
 ALSO TO THE OLDER ONES 
 
 Who Have Paused at Less than the Average Degree of 
 Success in Life, 
 
 this little book is 
 
 CORDIALLY DEDICATED, 
 
 With the Hope that All Who Study its Pages 
 May be Benefited by it. 
 
 "Reject it not, although it hring 
 Appearances of some fantastic thing 
 At first unfolding 1"
 
 PREFACE TO THE TENTH EDITION. 
 
 Impressed with the belief that a "Book on the Physician 
 Himself and Things that Concern His Reputation and Success " 
 would be of decided benefit to numerous members of the pro- 
 fession, and finding no such work extant, I, with difiidence, 
 attempted the duty of writing one. This book is the result. 
 
 The marked favor with which it has been received by the 
 medical press, the expressions of approval by many well-known 
 members of the profession, and the* demand for edition after 
 edition of it, are taken as proof that such a work was greatly 
 needed, and that it is finding its way into the hands of many 
 of those for whom it was written. 
 
 Grateful for this kind reception, and desiring to render it 
 more worthy of the flattering commendations it has received, 
 I have very carefully revised this, the tenth edition, and have 
 also added a great deal of new material that greater experience 
 and further reflection have dictated. 
 
 I beg you to judge it, good reader, not by opening it here 
 or there, nor by glancing at detached paragraphs ; but read it 
 through, from cover to cover, or, better still, study its pages, 
 and thus qualify yourself to weigh correctly its teachings, which 
 I would fain have to harmonize with the advice given by the 
 Bishop of Lonsdale to those who came to him inquiring the 
 way to heaven: "Turn to the right, then go straight forward." 
 
 D. W. C. 
 
 1308 N. Charles Street, 
 Baltimore, Md.
 
 book: 
 
 ON 
 
 THE PHYSICIAN HIMSELF 
 
 AND THINGS THAT CONCERN 
 
 His Reputation and Success. 
 
 CHAPTER I. 
 
 "These are my thoughts; I miglit have spun them out into a greater 
 length ; but I think a little plot of ground thick sown is better than a 
 great field which, for the most part of it, lies fallow." 
 
 To FIGHT the battles of life successfully, it is as necessary 
 for even the most skillful physician to possess a certain amount 
 of professional tact and business sagacity as it is for a ship to 
 have a rudder. There are gentlemen in the ranks of our pro- 
 fession who are perfectly acquainted with the scientific aspects 
 of medicine, and can tell you what to do for almost every ail- 
 ment that afflicts humanity, yet, nevertheless, after earnest trial, 
 have failed to achieve reputation or acquire practice simply be- 
 cause they lack the professional tact and business sagacity that 
 would make their other qualities successful ; and there is noth- 
 ing more pitiful than to see a worthy physician deficient in 
 these respects, waiting year after year for practice, and a 
 consequent sphere of professional usefulness, that never come. 
 
 Were any such graduate to ask me: " How can I conduct 
 myself in the profession, and what honorable and legitimate 
 means shall I add to my scientific knowledge and book-learn- 
 ing, in order to make my success in the great professional 
 struggle more certain, more rapid, and more complete"?" I 
 should offer him the foUowino: suijgestions : — 
 
 First, last, and in the midst of all, you should, as a man 
 
 (1)
 
 2 THE PHYSICIAN HIMSELF: 
 
 and as a physician, found your expectations of success on your 
 personal and scientific qualifications, and keep whatever is hon- 
 est, whatever is true, whatever is just, and whatever is pure, 
 foremost in your mind, and he governed by i't. If you do not 
 you will not deserve to succeed in the honorable profession of 
 medicine, and no honest man can wish you success. 
 
 Whether, after graduation, you commence to practice with- 
 out any intermediate course, or wisely strive to further prepare 
 and refine and broaden yourself for your life's work by a limited 
 term of service as resident physician or assistant in some hos- 
 pital, or by taking a systematic course in diagnosing, prescribing, 
 and manipulations at some post-graduate school in one of our 
 own great cities, or endeavor to obtain a complete scientific 
 knowledge of the profession by making a journey to the hos- 
 pitals and clinics of London, Paris, Berlin, Vienna, or Leipzig, 
 that your eyes may see the work, and that your ears may drink 
 in the thoughts of their great teachers, is a matter of taste, 
 money, time, and opportunity; but, whenever and wherever you 
 commence your private practice, you should, above all else, be 
 seriously in earnest and strive to start right, and, by the aid of 
 hope, tireless industry, and determination, to enter promptly on 
 the road to success; for, unless you gain popular favor by a 
 wortliy display of ability, acquire some reputation, and build 
 up a fair practice in your first six or eight years, the probabilities 
 are that you never will. In the battle of life it is not simply 
 the events of school days and college hours, but the after- 
 performances, that prove the physician. 
 
 "Life is a sheet of paper, white, 
 Whereon each man of ns may write 
 His word or two, and then conies night." 
 
 Beware of entangling alliances. It is, as a rule, better not 
 to enter into partnership with other physicians. Partners are 
 usually not equally matched in industry, capacity for work, 
 tact, temperament, and other qualities indispensable to an inti- 
 mate and congenial fellowship, and are not equally cared for by
 
 HIS REPUTATION AND SUCCESS. 6 
 
 the public. Pleuce such professional alliances do not generally 
 prove as beneficial or us satisfactory as expected, and conse- 
 quently partnerships rarely continue long. Above all else, 
 never ally yourself with any other pliysician as assistant or 
 junior partner, to do the drudgery, or on any other terms than 
 as an equal. The sooner you learn to depend wholly on your- 
 self, the better. Julius CsBsar said : " I had rather be the first 
 man in a village than the second man in a great city." 
 
 "The fame that a man wins himself is best; 
 That, he may call his own." 
 
 Unless you have the locality and your place of residence 
 already selected, you may find it the most difficult problem of 
 your life, with the whole boundless continent before ^-ou, to ac- 
 curately balance and weigh the difficulties and advantages of 
 this, that, or the otlier nook, corner, or opening. Whether to 
 locate in your own town, among the generation you have grown 
 up with, and where everybody knows all about you and your 
 pedigree from the cradle up, or elsewhere, among strangers ; in 
 a populous city or moderate-sized town, or in a village or a 
 rural district ; in the East or the West, the North or the South 
 of our wide-spread land, is truly a puzzling puzzle, and may be 
 the turning-point in your life. 
 
 Many big blunders are made at the outset by locating in the 
 wrong place ; therefore, give the subject your very best thought, 
 and decide with great care, and only after duly considering 
 your own qualities and qualifications, as well as the locations, 
 — whether you are self-reliant and pushing, or quiet and unob- 
 trusive ; whether you have abilities that will enable you to com- 
 pete with the wisest and the best, and compel people in a popu- 
 lous centre to employ you in preference to your neighbors ; or 
 whether, being less fully armed, you had better be satisfied with 
 mediocrity, and become a modest country doctor in a less 
 thickly settled location, where there is less competition and less 
 talent to encounter, or go to the new States and grow with the 
 growth of the settlements, or rise with the villages, or spread
 
 4 THE PHYSICIAN HIMSELF I 
 
 with the cities that are springing up. I may remind you, how- 
 ever, that 
 
 "Where there is nothing great to be done, a great man is impossible." 
 
 Medicine, hke everything else, thrives best in good ground. 
 By all means seek to locate in a community to which you are 
 suited ; that will be congenial as a place to live in, and in which 
 you are likely to get business and be useful to your fellow- 
 beings, and also to earn a living for yourself. Bear in mind 
 that unpopular opinions in politics or religion injure, and that, 
 all else equal, you will be more likely to succeed and be con- 
 tented in a section where your views, habits, and tastes are 
 naturally in harmony with the bulk of the people, morally, 
 socially, and politically. 
 
 No matter where you start, if, alas ! 
 
 " You wear the bloom of youth upon your cheek," 
 
 you will hear the adjective "young" oftener than is pleasant, 
 and encounter up-hill difficulties that older physicians do not. 
 " He looks too young ;" " He lacks experience ;" "• He don't 
 know anything;" "He has no practice, therefore is no good;" 
 " He shouldn't doctor me," and " I'd send him off and get an 
 older physician," are among tlie often-heard expressions. Face 
 them all bravely. Never doubt, but show the world, by good 
 management and good habits, that you deserve to succeed, and 
 success will surely come. Strict attention to the opportunities 
 that will present themselves for winning confidence in cases 
 that are incidentally thrown into your hands, and a diligent 
 cultivation of your talents, with promptness, civihty, courtesy, 
 and unobjectionable conduct to all, rich and poor, and pleasant 
 manners, but no time to gossip, will bring it. Even a single 
 event, or an accident, may fortunately give you an introduction 
 to extensive business. 
 
 If you are young and youthful-looking, unless you have 
 some special reason to the contrary, let your beard grow, if it 
 will ; and remember that our Saviour and Alexander each Hved
 
 HIS REPUTATION AND SUCCESS. 5 
 
 but thirty-three years, and Napoleon commanded the army of 
 Italy at twenty-seven. 
 
 If you begin practice in a city or town, the location and 
 appearance of your office will, more or less, affect your progress, 
 and you will do well to select one, easy of access, in a genteel 
 neighborhood, upon or very near one or more of the main thor- 
 oughfares, and convenient to either a densely populated old sec- 
 tion, or a rapidly growing new one. The nearer to busy centres 
 of mechanics and laborers, the better. If you were to locate on 
 a back or unfrequented street or other out-of-the-way place, or 
 in the country, where the land is unproductive and the population 
 sparse, simply because there is but little or no competition, it 
 would naturally suggest to the public that you had poor judg- 
 ment or were made of timorous, negative material, or lacked 
 the spirit of enterprise and entliusiasm, or were waiting for 
 ])ractice to come naturally, and for success to be handed to you 
 on a silver platter, or else had defective ambition and distrust 
 of your own acquirements. 
 
 " He tlmt does not show himself is overlooked." 
 
 Remember, in making your selection, that a physician can- 
 not rely on his near neighbors for patronage ; Y)eople in your 
 immediate neighborhood may never employ you, while some 
 farther away will have no one else. 
 
 If your first location disappoints you, remove to another; 
 but avoid frequent removals, and do not shift or change from 
 one place to another unless it is clearly to better yourself. 
 Select a place suited to your abilities and taste, and then bo 
 tenacious. Reputation is a thing that grows slowly, and every 
 distant removal imperils one's practice, necessitates new labor, 
 and sometimes even compels a commencing of life over again. 
 A physician's frequent removals may also create a bad imprcs- 
 >ion, and look like natural instability or dissatisfaction from 
 lack of success. 
 
 Branch offices are, as a rule, not desirable, for, in addition 
 to the loss of time, and wear and tear in going to and fro, and
 
 6 THE PHYSICIAN HIMSELF: 
 
 double trouble in general, they are apt to create an uncertainty 
 in the minds of those who may be in want of the physician, as to 
 where and when he is most likely to be found. On estimating 
 all the advantages and disadvantages, it will probably be found 
 that, as a rule, a plurality of offices increases greatly neither 
 one's practice, one's popularity, nor one's income, but does add 
 greatly to the labor, and hence may be regarded as likely to 
 prove more annoying than profitable. 
 It has been said that 
 
 "A physician never gets bread 
 Till he has no teeth to eat it." 
 
 Be this as it may, it is risky for you, if a beginner, with no 
 influence and but little money, to locate in a section already 
 overstocked with popular, energetic physicians, as their superior 
 advantages, established reputations, and warm competition may 
 keep you limited and crippled for too long a time before a chance 
 or a change comes. Also, guard against going too close to large, 
 free hospitals and dispensaries. Your first necessity is to possess 
 knowledge and skill as a pliysician, your second is to find a 
 field in which to exercise and display them ; but, no matter 
 where you locate, if you expect business immediately to 
 follow your annunciation of being ready to receive it, you 
 will, except under very extraordinary circumstances, be rudely 
 disappointed. 
 
 A corner house is naturally preferable to one in the middle 
 of a row, since it is convenient for persons coming from all 
 directions, and not only has facilities for constructing an office 
 entrance on the side street, leaving the front door free for other 
 callers, but also insures to the consulting-room a good light for 
 examinations, operations, and study. 
 
 Regarding offices : Try to have a good, comfortable waiting- 
 room, with a recessed front door ; also, a good, light, airy, 
 and accessible consulting-room of moderate dimensions, with, if 
 at all convenient, two doors, — one for the entrance and the other 
 for the exit of patients, — for many of those who consult you will
 
 HIS REPUTATION AND SUCCESS. I 
 
 prefer to be let out through a passage or private door, and thus 
 escape the gaze and possibly the comments of others in waiting. 
 
 Exercise special care in their arrangement; give them a 
 pleasing exterior and make them look fresh, neat, and clean out- 
 side; and inside, give them a snug, bright, and cosy medical 
 tone, and let their essential features show that their occupant is 
 possessed of good taste and gentility, as well as learning and 
 skill ; and that tliey are not a lawyer's consulting-rooms, nor a 
 clergyman's sanctum, nor an instrument-maker's shop, nor a 
 smoking-club's head-quarters, nor a sportsman's rest, nor a loaf- 
 ing room for the gay, the idle, the dissipated, and the unem- 
 ployed ; nor a family parlor, nor a social meeting-place of any 
 kind ; but the offices of an earnest, working, scientific physician, 
 who has a library, takes the journals, and makes full use of 
 the instruments and methods that science has devised for him, 
 and regards his office as the twin sister to the sick-room. 
 
 Take particular care, however, to avoid making a quackish 
 display of instruments and tools, and keep from sight such 
 inappropriate and repulsive objects as catheters, syringes, stom- 
 ach-pumps, obstetric forceps, splints, trusses, amputating knives, 
 skeletons, grinning skulls, jars of amputated extremities, tumors, 
 manikins, the unripe fruit of the uterus, etc. Also, avoid such 
 chilling or coarse habits as keeping vaginal specula or human 
 bones on your desk for paper-weights. 
 
 But while you should make no undue exhibition of books, 
 surgical instruments, etc., it is not unprofessional to have about 
 you — not for display, but for ready and actual use — your outfit : 
 microscope, stethoscope, laryngoscope, ophthalmoscope, spirit- 
 lamp, test-tubes, reagents for testing urine, and the various other 
 aids to precision in diagnosis, and the numerous instruments 
 you make use of in treatment ; also, to ornament your office 
 with diplomas, certificates of society membership, potted or 
 cut flowers or growing plants or vines, fine etchings, pictures 
 of eminent professional friends or teachers, or of medical celeb- 
 rities, — Hippocrates, Galen, Harvey, Gross, or whomever else
 
 8 THE PHYSICIAN HIMSELF: 
 
 you specially admire; academical prizes, professional relics, 
 keepsakes, mementoes, medals, or anything else that tells of 
 your mental or physical prowess in earlier days, or is specially 
 associated with your medical studies and career. But, unless it 
 be a few artistic ornaments or works of art, it is better to limit 
 such articles to those having relation to you as a student or 
 physician. 
 
 In buying your office outfit see that the walls and floors 
 are tastefully covered. Articles of furniture should be few in 
 number, but good, including a small, and if means will admit, 
 handsome book-case, with writing-table and chairs to correspond. 
 Have comfortable chairs for your patients' use, so arranged that 
 they may sit in a good light during examination, but beware 
 of stocking yourself with novelties and instruments that will 
 probably go out of fashion or rust or spoil before you will need 
 them. It is prudent not to invest heavily at first, and to wait 
 and buy none but the usual every-day instruments, which the 
 urgency of certain cases will not give you time to go for, when 
 occasion arises for their use, until you have a use for others. 
 Bear in mind that soft-rubber goods, and soft goods generally, 
 deteriorate and finally become worthless in keeping. 
 
 A neat case of well-labeled and well-corked medicines, or a 
 cabinet of minerals, is of use and not unornamental; so also 
 are dictionaries, encyclopaedias, and lexicons for ready reference ; 
 also, a non-striking time-piece to quietly notify the time to 
 physician and patient by its tick-tick-tick ; but display no minia- 
 ture museum of sharks' heads, stufied alligators, tortoise-shells, 
 impaled butterflies, bugs, ships, steam-boats, mummies, snakes, 
 fossils, stuffed birds, lizards, crocodiles, beetles, tape-worms, devil- 
 fish, ostrich-eggs, hornets' nests, or anything else that will 
 advertise you in any other light than that of a physician. It 
 will, to the thinking portion of the public, seem very much 
 more appropriate for you, as a physician, to be jubilant over a 
 r(;stored patient or a useful medical discovery than to be ecstatic 
 over a stuffed flying-fish, an Egyptian mummy, or a rare shell.
 
 HIS REPUTATION AND SUCCESS. S^ 
 
 If you have a natural love for such incongruous things, or are 
 a bird- or dog- fancier, or a bug-hunter, at least keep the fact 
 private and keep your specimens out of sight of the public, and 
 endeavor to lead every one to think of you only as a physician. 
 It is your duty, as well as your interest, to display no 
 political or religious emblems, portraits, etc., about your office, 
 because these relate to your personal sentiments ; being em- 
 phatically a public man, and your office a public place, not for 
 any special class, but for every faith and party, no matter what 
 shade of partisan or sectarian pictures you may display, they 
 will surely be repugnant to some, — 
 
 "On life's stormy ocean diversely we sail," — 
 
 and in this and other matters fairly open to criticism it is a wise 
 maxim to respect public opinion. Difference in religion or poli- 
 tics has often either prevented the employment of physicians or 
 caused their dismissal, and the obtrusion of unpopular political 
 or religious views has marred the prospects of many a physician ; 
 besides, what is popular to-day may be unpopular to-morrow; 
 therefore, keep your heart and your office open to all denomina- 
 tions and to all parties. This will recommend you equally to all. 
 
 Establish a regular professional and business policy at the 
 beginning of your career. Be at your post as punctually as pos- 
 sible, and have your office lighted regularly every evening at tlie 
 proper hour, your door-bell answered promptly, professional 
 messages entered on the slate by the person in charge, and in 
 all other respects show punctuality and system. You will find 
 that absence from your office when needed, particularly if away 
 tor .sport or pleasure, is a fruitful source of loss of practice ; if, 
 on the contrary, you are at your post, people will credit you 
 with seriousness in your profession, which will advertise you 
 and bring you patronage. 
 
 Do not allow the ladies of the family to lounge about your 
 office, or read your books, answer the office-bell, etc., lest it re- 
 pel certain kinds of desirable patients. Both messengers and 
 patients would rather meet you or your servant than ladies.
 
 10 THE PHYSICIAN HIMSELF: 
 
 You should respect public opinion in this and in all other 
 matters justly open to criticism. 
 
 Still more important to success will be the morals of the 
 companions you make in your early career; in fact, all through 
 life a physician is judged by the company he keeps. Avoid 
 associating with aimless idlers and those who bear a merited 
 stigma, or are notoriously deficient, or whose hopes and ambi- 
 tions have been blighted or wrecked by intemperance ; or their 
 good names otherwise tarnished by their own misconduct. On 
 the contrary, let your associations be, as far as possible, with 
 professional bretliren and people of genuine worth. Prefer to 
 spend your unoccupied moments in your office with your stand- 
 ard works and medical journals, or in rational conversation with 
 high-minded friends, or otlier physicians, or at medical meet- 
 ings, or at the medical library, to lounging around drug-stores, 
 hotel-bars, saloons, club-rooms, cigar-stores, billiard-parlors, 
 barber-shops, or corner-groceries, with lazy fellows, who love 
 doing nothing, frivolity, and dissipation ; or to taking such per- 
 sons out riding in your carriage, or to the horse-races, or to join 
 the throng at the base-ball game. No ordinary man ever 
 conceives a more exalted opinion of a professional man by 
 fraternizing with him at such places, or in seeing him in such 
 company. 
 
 As a further but minor aid to successful progress, be court- 
 eous to all kinds of patients with whom necessity or duty brings 
 you into contact; but while you treat all men as brothers, and all 
 women as sisters, beware of talking too freely, and do not hand- 
 shake and harmonize and associate with the coarse, ignorant, 
 and unappreciative indiscriminately, for undue familiarity shears 
 many juniors of influence and prestige. Also, never become so 
 familiar as to lay formality aside and enter a patient's house or 
 room without announcing yourself by a gentle rap or ring at 
 the door. 
 
 Avoid companionship with quacks and irregulars, as it 
 would detract from both you and rational medicine which you
 
 HIS REPUTATION AND SUCCESS. 11 
 
 represent and give countenance to delusions and pretenders. 
 Shun this and every other contaminating alliance that would 
 confound them with us before the public. 
 
 What shall be said regarding self-mutilation with harlots 
 and association with varnished concubines'? Of drinking and 
 of gambling'? Of the dethroning fields of Venus and Bac- 
 chus ! Oil ! physician, if you have entered either of these 
 Dx\NGEROUS roads, follow the dictates of common sense, and 
 turn from it this day, this hour! for they both lead rapidly 
 downward, and either of them will deform and warp all your 
 finer sensibilities, prove fatal to every ambition, and speedily 
 put a death-blight on all your prospects. And if indulging any 
 one of these habits singly will be like sowing dragon's teeth for 
 yourself, what will be the combined effects of them all 1 It will 
 insure social and moral death! Professional suicide, — short, 
 quick, and sure! while your relatives and friends will weep in 
 all the bitterness of disap[)ointed hope for your dishonorable 
 downfall. 
 
 "Too late to grieve when the chance is past." 
 
 An unspotted, honorable name is the only thing that will 
 render your life happy and enable you successfully to withstand 
 the critics, for neither you nor any other physician can success- 
 fully lead a double life, or afford to despise public opinion. 
 
 " A pebble in the streamlet scant 
 Has turn'd the coarse of many a river." 
 
 Unfortunate acquaintances have been the downMl and ruin 
 of many a promising young physician ; therefore, select your as- 
 sociates with great care, and do not let your office be a loung- 
 ing place or a smoking-room for horse-jockeys, dog-fanciers, 
 base-ballers, politicians, chatty blockheads, or others whose time 
 hangs heavily on their hands. The public look upon physicians 
 as public characters, — earnest, sober, studious men, with scien- 
 tific tastes and temperate habits, who have been singled out and 
 set apart for a lofty purpose, and as socially, mentally, and 
 morally worthy of an esteem not accorded to such people, or
 
 12 THE PHYSICIAN HIMSELF: 
 
 even to ordinaiy citizens engaged in the private business of life. 
 The idle jokes, childish amusements, boyish gambols, common- 
 place gabble, and tone of thought common to light-minded 
 people do not harmonize with the studies, tastes, and desires 
 of worthy physicians, and, moreover, tend to weaken or destroy 
 the faith of the public, which is so essential in our work, for on 
 no profession does faith have such influence as on ours. You 
 as a physician are public property, and the public, and especially 
 the female portion of it, with eyes like a microscope, will take 
 cognizance of your associations and of a thousand other little 
 facts regarding you. 
 
 "Things small in themselves have often a far-reaching significance." 
 
 In fact, every circumstance in your appearance — dress, manners, 
 actions, walk, speech, conversation, habits, where you are to be 
 found when not professionally engaged, etc. — will be closely 
 observed and criticised in order to arrive at a true verdict, more 
 especially in the early years of your career. The question will 
 never be asked whether you were graduated at the new or the 
 old college, or whether from the "college of wigs, or abroad," 
 but it will be, " Is he a good physician ?" 
 
 Put not a feather's weight upon the honorable ambition of 
 any one, or a straw in the pathway of his worthy aspirations, 
 but be very cautious how you involve yourself by inducing 
 persons to study medicine, as there are already three physicians 
 where one is required. Besides, their failure in the profession, 
 or their misconduct, or their unfair rivalry may, in time to 
 come, work great injury to you. 
 
 "Out of a white egg often comes a black chicken." 
 
 Besides, it is neither profitable nor advisable for you, a private 
 practitioner, to take aspirants for ^sculapian honors as office 
 students, as they will necessarily be in the way and divert your 
 mind from other duties ; but, if you do take any, charge them a 
 fair price tor the privilege, and remember that in taking students 
 you stand as a guardian at one of the outer gates of the profes-
 
 HIS REPUTATION AND SUCCESS. 13 
 
 sion, and listen only to such applicants, rich or poor, as have a 
 pure, liigh-souled, and just appreciation of the profession, well- 
 balanced, good sense, sobriety, mental and physical vigor, good 
 habits, intellectual capacity, natural aptitude, and a strictly 
 honorable ambition or enthusiasm to be a worthy phj'sician. 
 
 Remember that you cannot polish a fungus or make a 
 sponge shine, and that good gas makes a good light and bad gas 
 a poor one ; that a good battery generates good electricity, and 
 that a bad one necessarily makes a poor kind ; so, also, that a 
 good brain, a good mental soil, creates better ideas and bears 
 better fruit than an ordinary one. A high-thinking, practical- 
 minded youth from the corn-field or a log-cabin, with scarcely 
 enough clothes to hide his nakedness, and the aimless son of a 
 millionaire may each apply. If you take either, be not long in 
 choosing. Brains and common sense are a rare gift from heaven ; 
 and a diploma from every medical college on the face of the 
 earth, each bedizened with ribbons — red, white, and blue — and 
 each stowed away in a gold case set with diamonds, cannot give 
 them to those who lack them. Bear this in mind, and dissuade 
 and refuse every one who has been seduced from his true calling 
 in humble life to embrace medicine, from a belief that its study 
 is merely a pleasurable pastime, or that it is simply a trade, or 
 that it is less laborious than the business he is foUowins" : or 
 Jacks-at-all-trades, who are tempted to add M.D. to their list, by 
 the ease with which a "sheepskin" can be obtained; or by the 
 false notion that to be a physician is a gay and pleasant life, or 
 a smooth and rosy road to money-making; or simply to please a 
 fond grandmother, or a doting papa ; or from a false dream of 
 an easy life. Also, turn your back on the callous, the tough, and 
 the ox-hearted, rough-fisted fellow, who boasts that he is stony, 
 can stand anything, and wants to be a surgeon, because he feels 
 an anxiety to see the shedding of human blood, or any other 
 applicant so unworthy. 
 
 The popular opinion that now the untilled, thoughtless, 
 brainless bumpkin, who has hardly mastered tlie multiplication
 
 14 THE PHYSICIAN HIMSELF: 
 
 table, and knows not the difference between an angle and a tri- 
 angle, can stop following the plough, or driving the jack-plane, 
 or drop the yard-stick, or pen, or teacher's rod; or desert his lap- 
 stone and bad shoemaking to-day and in a few months be meta- 
 morphosed into an M.D., — 
 
 "While all who know him wonder how he passed," — 
 
 and that an ornamental sign or a fancy door-plate with a name 
 (and the prefix Doctor) on it, with a buggy at the door, is about 
 all that is necessary, is now causing thousands of young men* 
 to quit their proper avocations in life and study medicine, only 
 to fail in its pursuit. 
 
 In getting your office signs or door-plates, remember that 
 a physician has them not as advertisements, but simply to show 
 his office to those looking for him. Your signs should be 
 neither too large nor too numerous. One of black smalt with 
 jrold letters is tlie neatest and most attractive of all ; one such 
 sign on the front wall for the day-time, and a glass one with 
 black letters in the window, to be seen at night, when your 
 office is lighted, are sufficient. The letters On the former should 
 be round and well shaped, and not more than two inches high, 
 with corresponding width. A polished brass sign, engraved with 
 your name, and the letters filled in with black, and mounted on 
 a finished, hard-wood board, is also neat and stylish. 
 
 All signs should be neatly made and correctly lettered, for 
 even one's sign makes an impression, either good or bad, on 
 the public, and first impressions are very enduring. 
 
 In this country it is better to put Dr. ... on your sign 
 or door-plate than to put . . . , M.D. " Doctor " looks better, 
 and is understood by all ; but to speak of yourself as a phy- 
 sician rather than a doctor, or to refer to your professional 
 brethren as physicians ratlier than doctors, sounds more dis- 
 tinctive and falls better on the ear. 
 
 To put " Physician and Surgeon " or " Physician and 
 Accoucheur," or other compound addition, on your sign would 
 seem unnecessary in this region, since all physicians (except
 
 HIS REPUTATION AND SUCCESS. 15 
 
 the specialists) are supposed to be surgeons, accoucheurs, etc. 
 The practice of medicine on tlie human body now allows no 
 such This-or-That division of learning, and all are blended by 
 the law ; the medical case of to-day may be the surgical or 
 obstetrical case of to-morrow ; almost as well might the confec- 
 tioner's sign say " Cold Ice-Cream." 
 
 Unless your name is likely to be confounded witli that of 
 some other physician, it will be well to omit your given name 
 or initials from your signs or door-plate ; but it sliould be on 
 your cards. Of course, if your name is " Smith," or " Jones," 
 or " Brown," it would be necessary to put your given name on 
 your signs ; but if your name is uncommon, it is not. People 
 will not speak of Doctor John W. Garfield, but of Doctor 
 Gai-field. 
 
 Do not allow otlier people's signs of tooth-drawing, cup- 
 ping and leeching, millinery, dressmaking, painting and glazing, 
 boarding, etc., in company with yours. 
 
 The lettering on your window-glass may be protected from 
 being scratched, or otherwise defaced, by having a pane of 
 common glass placed behind the lettered one. 
 
 It is deemed unprofessional to state where you graduated 
 and how long you have practiced, upon your cards and signs, 
 or in the newspapers. 
 
 Adopt regular office hours early in your career, and post 
 them conspicuously in your office ; also, have them on your 
 cards. 
 
 It may be a question whether it is advantageous to have a 
 sign designating your office hours on your office window, or on 
 the house front, to be seen by the outside public. Your situa- 
 tion in business should influence your decision on this point. 
 A young physician, or one who has much spare time at home, 
 in addition to his stated hours, will be more apt to catch the 
 overflow, emergencies, cases of accident, calls from those who 
 are strangers in the city, and other anxious seekers for "any 
 one, so he is a physician," and who have perhaps searched and
 
 16 THE PHYSICIAN HIMSELF: 
 
 found all the busier physicians away from their offices, if an 
 exhibition of his office hours does not drive them off by telling 
 them before ringing the bell that they have come at the wrong 
 time, when in fact he is at home wishing for calls. On the 
 contrary, one busily engaged in outside practice, who has no 
 other time for office consultations than the specified hours, can, 
 by displaying them outside, regulate his business, and prevent 
 various annoyances, by letting every one see his hours before 
 
 An excellent rule is to direct attention to both the begin- 
 ning and ending of your office consultation hours, as : " Morning 
 office hours begin at 7 and end at 9 ; afternoon office hours 
 begin," etc. Or : " Office hours : morning, between 8 and 9 
 o'clock ; afternoon, between 1 and 3 o'clock," etc. Many people 
 inconsiderately think that as your office hours are from 7 to 9, 
 if they get there one minute before 9 o'clock they are in time ; 
 whereas, if they come at that time they will be sure to keep you 
 past your hour for beginning your outside professional work. 
 By regulating your timp trius, and constantly urging those you 
 attend to observe your home hours strictly, you can accomplish 
 doubly as much, with less hurry and more satisfaction to all. 
 Indeed, by persistently schooling patients to observe these hours, 
 and to send for you, as far as practicable, before your accustomed 
 time for starting on your regular rounds, preferably in the 
 morning, you will do much to systematize your business, and 
 to lessen the number of calls at odd and inconvenient times, 
 which do so much to increase the hardships of the physician's 
 life. For persistent late-comers to come strolling into a busy 
 physician's office for advice at odd or unseasonable hours, or at 
 seasons allotted to privacy and rest, amounts almost to persecu- 
 tion. So, also, does having to visit the same neighborhood half 
 a dozen times a day, in consequence of his patients not sending 
 for him before he leaves home to commence his rounds. The 
 time allotted to office patients may be greatly curtailed by 
 naming certain times at which you can be found at your office ;
 
 HIS REPUTATION AND SUCCESS. 17 
 
 for instance, instead of having- it " Morning, from 8 to 9 o'clock ; 
 afternoon, from 1 to 3 o'clock ; evening, from 6 to 8 o'clock," 
 have the sign read, " Office hours : morning, about 8 o'clock ; 
 afternoon, about 2 o'clock ; and evening, about 1 o'clock," which 
 times are easily remembered, and will cause all who come to 
 get there about those hours. 
 
 If you should ever get very busy, and be pressed for time, 
 your sign might still further emphasize it, after stating your 
 hours, by addnig, " No office consultation at other hours." 
 
 Have a slate in a convenient place, whereon messages may 
 be left during your absence from your office, and have over it a 
 little sign something like this : " In leaving a message for the 
 Doctor, be careful to write the name, street, and number." 
 
 You should keep a supply of cards, with your name, resi- 
 dence, and office hours on tliem. An inch and three-fourths by 
 three inches make a good size. 
 
 It is also necessary to keep a supply of small and neat 
 blank bills, and to have envelopes and paper with your name 
 and address printed on them. Let your bills read, " For pro- 
 fessional services." Blank forms for use in giving certificates 
 to sick members of societies, etc., are also very useful. Printed 
 professional certificates look much better and more formal, and 
 generally give more satisfaction tlian written ones. 
 
 A speaking-tube, from your outside office door to your bed- 
 room, prevents exposure to raw night-air at an open window, 
 and is of great utiUty when your night-bell rings. 
 
 The telephone is also both a luxury and a necessity. Many 
 physicians, however, are deterred from having one by the fear 
 that it will cause them to be summoned to patients, good and 
 bad, at a distance too great for tliem to attend, or that its con- 
 venience will cause annoying calls and messages to be sent at 
 unseasonable hours. This belief is erroneous. Tlie telephone 
 really does the opposite, and enables one to resist the arguments 
 and attempts at persuasion so often encountered in personal 
 interviews. It is, moreover, far easier to decline to pay a visit,
 
 18 THE PHYSICIAN HIMSELF I 
 
 to urge a plea, to suggest a remedy, or give direct instructions 
 through the telephone, than by an interview with a fallible mes- 
 senger. If you have a telephone, put its number on your cards, 
 bills, envelopes, letter-paper, etc. 
 
 On commencing practice, you should get a pocket visiting- 
 list, a cash-book, and a ledger, and commence to keep regular 
 accounts at once, taking care to " post up " regularly either 
 weekly or monthly ; this will teach you system, and in the 
 course of time save you thousands of dollars. 
 
 Be careful to record the iull name, occupation, and residence 
 of every new patient ; for, although the identity of this one and 
 that one may, at the time, be very clear in your mind, yet as 
 patients increase and multiply and years elapse, your personal 
 recollection of each will become misty and confused, and conse- 
 quently may entail on you considerable money loss. Method in 
 business is one of its chief instruments. Also, never neglect to 
 jot down memoranda of office consultations, payments, new calls, 
 etc., in your visiting-list, witli a lead-pencil, until you get an op- 
 portunity to write them in ink. 
 
 One's visiting-list can be most conveniently carried in a 
 wide but shallow pants pocket on the left hip. 
 
 It is well to have a copy of the fee-table framed and hung 
 in a suitable place in your office, that you may refer patients to 
 it whenever occasion requires. It is also wise to have a small, 
 neat sign, with "Office Consultations from $1 to $10, cash," 
 posted in some semi-prominent place in your office. It will show 
 your rule and tell your charge ; it will also remind any who might 
 forget to pay of the fact, and by confronting less honest people will 
 put them in a dilemma. You can, when necessary, point any one 
 to it and ask him for your fee ; it will also give you a chance to let 
 him know you keep no books for office patients. Such a sign will 
 save you many a misunderstanding and many a dollar. Of 
 course, you may omit its cash enforcement toward patients with 
 whom you have a regular account. 
 
 Having your charge from "$l to $10 " will enable you to
 
 HIS REPUTATION AND SUCCESS. lt| 
 
 get an extra fee for cases of an extvaordinaiy character, and stiH 
 allow you to charge minimum fees for ordinary cases. Such g, 
 schedule will also make those who get off by paying the lowest 
 fees feel gratified, and will show everybody that you assume to 
 be skillful enough to attend $10 cases. 
 
 Cultivate office-consultation prt\ctice assiduously, for it is i\, 
 fertile source of reputation and of cash fees; attending such 
 patients as are able to go out-doors, at your own office, is a great 
 saving of time and fatigue to the physician. Strive to benefit 
 and give satisfaction to every patient who comes to consult you, 
 that every one may go away impressed with a belief that the 
 nature of his malady is clearly recognized and understood, and 
 that you will do your best to remedy it ; for each will, while 
 there, form some definite opinion in regard to you, and will ever 
 after give you either a good or a bad name. 
 
 Keep a small case of medicines at your office representing the 
 most frequently employed articles of the pharmacopoeia, espe- 
 cially during the first years of practice ; handling them will not 
 only familiarize you with their appearance, odor, miscibility, 
 taste, and other characteristics, but also enable you to get your 
 fees from unreliable patients, and such others as can appreciate 
 advice and something tangible combined, but who cannot prop- 
 erly value advice alone. Besides, by keeping cathartic pills, aro- 
 matic spirits of ammonia, lime-water, morphia granules, etc., 
 you can save yourself many a tramp at night, during storms, on 
 Sunday, great holidays, at odd hours, etc., by sending a suitable 
 remedy by the messenger ; and give the patient both relief and 
 satisfaction, till you can go. You have a perfect right to supply 
 a patient with medicine if you choose. Very extensive home 
 dispensing, or running a rudimentary drug-store, or a pill and 
 globule traffic, however, tends to consume time that might be 
 much better employed, and to dwarf one in other ways. Fur- 
 nishing his own medicines does not pay, if a physician is estab- 
 lished in good, reliable circles, because it is far better for him to 
 base his charges squarely on the abstract value of his time and
 
 20 THE PHYSICIAN HIMSELF! 
 
 skill. Besides, one's high tariff and rough compounding would 
 engender the criticism and enmity of neighboring druggists and 
 others. Never under any circumstances sell medicines to any 
 but your own patients. 
 
 Dispatch every professional duty promptly and punctually, 
 so as to get it out of the way of wliatever may happen to come 
 after. When summoned to cases of colic, convulsions, accident, 
 etc., go, if possible, immediately. Then, if you are too late to 
 be of service, you will neither have cause for self-reproach nor be 
 responsible for default of duty. When you cannot go at once 
 without neglecting anotlier pressing case that has a prior claim on 
 your services, or other duties equally as urgent, it is much more 
 satisfactory to your patient if you send a remedy, with instructions 
 for use until you can go, than to write a prescription ; because, 
 to send a prescription in such cases seems rather as if you do 
 not sympathize, or as if the patient was on your don't-care-to- 
 attend list, and, if the case takes an unfavorable turn, or does 
 not eventuate favorably, you may be blamed and criticised. 
 
 "Of all sad words of tongue or pen, 
 The saddest are these : it might have been." 
 
 When you reach a patient whose friends have, in the ex- 
 citement, sent for a number ot physicians, with no special choice 
 among them, it is well to have them promptly send a trusty 
 messenger or a courteous note to the others to cancel the call 
 and save them trouble, by informing them their services will not 
 be required. 
 
 If, at your office and elsewhere, you make a judicious and 
 intelligent use of your instruments of precision, — the stethoscope, 
 ophthalmoscope, laryngoscope, the clinical thermometer, the 
 tape, the microscope, and the reagents necessary to a careful 
 examination of tumors, sputa, calculi, urinary disorders, etc., — 
 they will not only assist you very materially in diagnosis, but 
 will also aid 3^ou greatly in curing nervous and terrified people, 
 by increasing their confidence in your ability, and enlisting 
 their sympathetic concurrence in your remedial treatment.
 
 HIS REPUTATION AND SUCCESS. 21 
 
 Always carry with you, in your professional rounds, a good 
 clinical thermometer, female catheter, bistoury, hypodermatic 
 syringe, small forceps, lunar caustic, probe, needles, pen-knife, 
 etc., lor ready use. Keep a little raw cotton in the case with your 
 clinical thermometer to protect it against breakage, and never 
 omit to wash it and all otlier instruments immediately after use. 
 
 Be especially careful to avoid syphilitic inoculation, septi- 
 caemia, etc., and never, under any circumstances, use a cut or an 
 abraded finger in making vaginal and other examinations ; if 
 your preferable hand is unsafe, use the other. Cosmolin and 
 vaselin answer a good purpose ; they have no affinity for 
 moisture, and both keep for years without becoming rancid or 
 decomposing. Get a supply of either, and keep it in your 
 office for anointing your fingers, instruments, etc. Wooden 
 tooth-picks and cigar-lighters are also very handy for making 
 mops, applying caustics, etc. Being inexpensive, each one can 
 be thrown away after one service, instead of being kept for 
 further use, as must be done with expensive articles. 
 
 Knives, probes, needles, and other instruments can be 
 readily cleaned and disinfected, both before and after being used, 
 by thrusting them several times through a wet, well-soaped 
 towel or rag, or into a cake of wet soap. 
 
 You should have a special receptacle in your office for 
 cast-off dressings from cases of gonorrhoea, syphilis, septic ulcers, 
 and other filthy affections, which, when they accumulate, should 
 be burned. 
 
 With the view to maintain your physical health, you should 
 endeavor to live temperately and comfortably, and to rest as 
 much as possible on Sundays and at night ; and, moreover, if 
 you would avoid the risk of break-down in health, as happens 
 to hundreds of our profession, make it a cardinal point of duty 
 to yourself and family to get your meals and sleep as regularly 
 as possible, and to keep your digestion in order ; then you need 
 have but little fear of overwork. 
 
 A decent respect for the opinion of the world should lead
 
 22 THE PHYSICIAN HLMSELF : 
 
 you to practice all that constitutes politeness in dress and de- 
 portment. Keep yourself neat and tidy, and avoid everything 
 approaching carelessness or neglect. Do not altogether ignore 
 the fashions of the day, for a due regard to the customs prevail- 
 ing around you will show your good sense and discretion. 
 Even though the prevailing style of dress or living borders on 
 tlie absurd or extravagant, it mav still be wise to conform to it 
 to a certain extent. Young says : — 
 
 "Though wrong the mode, comply ; more sense is shewn 
 In wearing others' follies than our own." 
 
 You never heard of a designing swindler, or a confidence-man, 
 or a gambler, or a pseudo-gentleman of any kind, who dressed 
 shabbily or in bad taste, for 
 
 "These men's souls are in their clothes." 
 
 Such people are all close students of human nature, and, no 
 matter how abandoned they are, no matter how tarnished in 
 character or how blackened in heart, they too often manage to 
 hide their deformities as with a veil from all but tlie few who 
 know their true characters, by assuming the dress, manners, 
 and tone of gentlemen. Now, if genteel dress, polished man- 
 ners, and cultured address can do so much for such fallen speci- 
 mens of mankind, how much greater influence must appear- 
 ance, manners, and voice exert for those who are truly gentlemen 
 and members of an honorable profession. 
 
 Nevertheless, do not, under any plea, be a leader or 
 patroriizer of loud or frivolous fashions, as though your starchy 
 foppishness and love of fine clothes had overshadowed all else ; 
 discard, also, glaring neckties, flashy breastpins, loud watch-seals, 
 brilliant rings, fancy canes, cologne, perfumes, attitudinizing, and 
 all other Yjcculiarities in your dress or actions that indicate over- 
 weening self-confidence, or a desire, with the assistance of the 
 Graces, to be regarded as a man of fashion, or a swell. 
 
 " Cupid, have mercy !" 
 
 Such peacockish individuals may be admired, but they are not 
 usually chosen by discerning persons seeking a guardian for their 
 health.
 
 HIS REPUTATION AND SUCCESS. 23 
 
 Even though you be ever so poor, let your garb show gen- 
 teel poverty, for every physician's dress, manners, and bearing 
 should agree with his noble and dignified calling. The neglect 
 of neatness of dress and the want of polite, refined manners 
 might cause you to be criticised or shunned. You Avill some- 
 times see superficial but spruce little Dr. Tact, whose head is 
 comparatively empty, who always sat on the back benches at 
 college, succeed in getting extensive and lucrative practice, and 
 paying heavy bills for horseshoes, almost entirely by attention 
 to the outer trappings and aft'ability of manner ; while Dr. Pro- 
 fundus, Dr. Alltrue, and Dr. Talent, professionally more able 
 and personally more worthy, will languish, and never learn the 
 cost of carriages and the price of horse-feed, by reason of defects 
 in these apparently trivial matters. Alas ! 
 
 "Veneering often outshines the solid wood. 
 
 Clean hands, well-shaved face or neatly-trimmed beard, unsoiled 
 shirt and collar, an imim peach able hat, polished boots, spotless 
 cuff's, well-fitting gloves, fashionable clothing, cane, sun-um- 
 brella, all relate to personal hygiene, severally indicate gentility 
 and self-respect, and naturally impart to their possessor a pleas- 
 urable consciousness of being well dressed and presentable. 
 
 "lam not a handsome man, but my beaver doth lend me 
 an air of respectability." 
 
 The majority of people will employ a tidy, well-dressed 
 physician, of equal or even inferior talent, more readily than a 
 slovenly one ; they will also accord to him more confidence, 
 and expect from and willingly pay to him larger bills. 
 
 Avoid extraneous pursuits and a multiplicity of callings, 
 especially such as would interfere with your duties as a phy- 
 sician, or would give you a distaste for the profession, or cause 
 you to resume its duties vvith a feeling of irksomeness. Divorce 
 medicine from all other avocations, however important, respect- 
 able, or lucrative, — from the drug business, dealing in petro- 
 leum, or salt, or cattle, or horses ; nor be equally interested in 
 the practice of medicine and in school-teaching, or in pushing
 
 24 THE PHYSICIAN HIMSELF: 
 
 the jack-plane, or in following the plow ; or giving public read- 
 ings, or preaching, scribbling poetry on subjects not connected 
 with medicine, or fiddling or singing at concerts ; or base-ball 
 playing, rowing matches, amateur photographing, etc., — because 
 the public cannot appreciate you or any one else in two dissim- 
 ilar characters or in two incompatible pursuits : half physician 
 and half druggist, or three-eighths physician and five-eighths 
 politician, or one-third physician and two-thirds sportsman, or 
 otlier similar mixture of incongruities: for it is in medicine as 
 in religion, — no one can serve two masters. Of course, if you 
 choose to change off and quit medicine for any other calling, it 
 is legitimate to do so ; but it is better to be a whole one thing 
 or another. 
 
 Although it may seem paradoxical, even reputation as a 
 surgeon (though surgery is but a branch of our art), or as a 
 specialist of any kind, militates decidedly against reputation in 
 other departments of medicine. The public in general believe 
 that a surgeon, with his sharp saws and thirsty knives, delights in 
 spilling blood, and is good only for ivhipping q^' limbs, or other 
 cutting operations, and that a specialist is good only for his 
 specialty, just as a preacher is for preaching. 
 
 Hesitate even to take such offices as vaccine physician, 
 coroner, city-dispensary physician, sanitary inspector, etc., in a 
 section where you expect to practice in future, more especially 
 if you must have illiterate political demagogues or buffoons for 
 employers or companions. 
 
 "Jack in office is a great man." 
 
 All such functions tend to dwarf one's ultimate progress, and 
 sometimes create a low-grade reputation that it is hard to out- 
 live. To many people, taking such offices for the fees to be 
 obtained looks somewhat like a confession of impecuniosity or 
 of inferiority, and creates an adverse impression that is not over- 
 come for years. If you have any merit at all, and an open field, 
 private practice industriously followed will lead by better roads 
 to greater success.
 
 HIS REPUTATION AND SUCCESS. 25 
 
 The last remark is, also, to a certain extent true of the 
 position of permanent physician or assistant physician to hos- 
 pitals, infirmaries, lunatic asylums, dispensaries, almshouses, 
 reformatory or penal institutions ; or in the army, or on board 
 eraig-rant or naval vessels, where employment in a snug or easy 
 job, at a petty salary and the comforts of a home, for a few of 
 his most precious years, have caused many a physician fully 
 qualified for success as a practitioner to pass the flower of his 
 days, to lose the best, the golden part of his life, and let slip 
 opportunities that could never be recalled. 
 
 "Too soon, too soon 
 
 The noon will be the afternoon ; 
 
 Too soon to-day will be yesterday." 
 
 Bear in mind that such positions can never be depended on 
 longer than those in power find it to their interest to change. 
 
 If you ever become a teacher of medicine in a college, 
 with a choice of branch, instead of taking Physiology, Ma- 
 teria Medica, Jurisprudence, Hygiene, or other non-personal 
 subjects, take care to aim for a practical chair, one that relates 
 directly to the sick, and that is likely to increase your skill, 
 get you special work to do, or otlierwise advance your reputa- 
 tion and your private practice. 
 
 Shun politics and electioneering tactics ; for politics, even 
 when honorably pursued, are injurious to a young physician's 
 prospects ; later, when his medical reputation is already exten- 
 sive, they generally lessen his professional popularity, although 
 they may not necessarily ruin him. If the best of good politics 
 injure thus, how much worse is it to be dabbling in the dirty 
 pools of partisan politics, at ward rallies and bar-room confer- 
 ences, or plunging into demagogism, and wire-pulling, slate- 
 making, log-rolling and pipe-laying at primary meetings, 
 caucuses, conventions, etc., with "the b'hoys." No! no! thrice 
 no ! For, besides escaping many anxious hours and bitter dis- 
 appointments, you can in the long run make ten friends and 
 ten dollars by being no man's man, and calmly sticking to your
 
 26 THE PHYSICIAN HIMSELF: 
 
 profession, while you are making one of either in the polluted 
 and polluting waters of party politics, lending your name to 
 help the campaign, or intriguing and scrambling for office with 
 those who belong to the parties chiefly for their loaves and 
 fishes. 
 
 Array yourself on the side of morality, virtue, honesty, 
 religion, etc., but neither make your religion nor your irreligion 
 a stepping-stone to practice, and never join a church or a 
 religious society for the purpose of gaining popularity or church 
 influence. You will surely find that society, church, political, 
 and other special groups of sectarian patients, gained because 
 they belong to the same society or party in politics, or are 
 affiliated with you in society matters, or go to the same church, 
 or because you deal with them in business, or live on the same 
 street, or because they like the way you walk or dress, rather 
 than through appreciation of your merits as a physician, are 
 neither very profitable nor very constant. If, instead, you will 
 banish everything that comes between you and your legitimate 
 work, try to bring practice hy your practice, and cultivate patients 
 secured promiscuously from all parties, and from every direc- 
 tion, because they believe that you, as a physician, possess solid 
 merit ; and have faith in your brain and your heart and your 
 hand ; it will in the long run make you more friends, and firmer 
 friends, and pay you better than attending solely to any one 
 political sect or religious creed, or following any other outside 
 issue. 
 
 A riding physician has several advantages over the one 
 who makes his rounds on foot ; not only is he able to see a 
 greater number in a given time, and with much less fatigue to 
 himself; but he gets rest while riding from one patient to 
 another, and can spend the time in thinking ; can collect and 
 concentrate his mind more fully on his serious and puzzling 
 cases while riding than if walking, and when he reaches his 
 patient he is in good mental and physical condition to begin his 
 duties, while the walking physician arrives out of breath, excited.
 
 HIS REPUTATION AND SUCCESS. 2t 
 
 and in need of rest. The former can prescribe and be gone 
 while the latter is waiting to regain his breath. Another con- 
 venience is, that Tenderfoot salutes acquaintances as his carriage 
 meets tliem and rides on ; whereas, Trudger is compelled to stop, 
 and loses valuable time in conversing with convalescent patients, 
 old friends, and others. 
 
 You sliould, therefore, get a good-looking horse and a gen- 
 teel carriage as soon as your circumstances will justify. Such a 
 turn-out is not only a source of health and enjoyment in the 
 beginning "of practice, but getting it indicates that your practice 
 is growing. Many persons consider success the chief test of 
 merit, and prefer a much-employed riding physician to the worn 
 pedestrian. This is one of the reasons why any one can ride 
 into a full business much quicker than he can walk into one. 
 Besides, the inexperienced public, with nothing else to judge by, 
 infer that a physician who finds a carriage necessary must have 
 an extensive and successful practice, else he would not require 
 and covdd not afford one. 
 
 If you unfortunately have a bony horse and a seedy-looking^ 
 pre-Adamite, dust-covered, rust-eaten kind of buggy, do not 
 let them habitually stand in front of your office for hours at a 
 time, or drive a vehicle covered with last week's mud or clav, as if 
 to advertise your poverty, lack of taste, and paucity of practice. 
 
 If you have two horses, and two only, it is better to drive 
 singly, that one may be resting while the other is working. 
 Driven thus, two good, well-kept horses can surely carry you 
 to as many patients as you can attend. 
 
 If a pair is driven, they should be first-class ; for it is bet- 
 ter to use one genteel-looking horse to a handsome phaeton, than 
 a shabby pair to a rickety-looking vehicle. 
 
 Many physicians have a modest monogram or their initial 
 letter put on their bridle-blinds or carriage-panels. Such desig- 
 nations, when within bounds, are both genteel and ethical. 
 
 Either have a person with you to mind your horse, or tie 
 it before entering your patient's house, that you may not be
 
 28 THE THYSICIAN HIMSELF.* 
 
 wondering what it is doing, or running to the window or out at 
 the door at every noise, to see whether it has started off with 
 the carriage, as if your mind were more on it than on the patient. 
 When possible, it is better and safer to keep a driver. 
 
 While it is perfectly fair and proper to seek reputation by 
 all legitimate means, and to embrace every fair opportunity 
 to make known your attainments, avoid all intriguing and 
 sensational scheming to obtain practice. Attempts to puiF 
 yourself, your cases, your operations, or your skill, into celebrity, 
 by driving ostentatious double teams, or having a flashily liv- 
 eried driver, odd-shaped or odd-colored vehicles, close carriages, 
 conspicuous running-gear, loud monograms, flashy plumes, or 
 oversized initials on harness or carriage-panels, or blazed-faced, 
 peculiar-looking horses or ponies; or pretending to be over- 
 run with business by driving unnecessarily fast, as though the 
 devil were in chase, book in hand, attempting to read as the 
 carriage whirls and jolts along ; or having yourself unnecessa- 
 rily called out of church, at the stillest and most solemn part of 
 the service — 
 
 "You assume a hurry, if you have it not ;" 
 
 and, worse still, afl'ecting odd-style or extra wide brim hats, long 
 hair, and heavy canes ; .or showing everybody afliected kindness 
 or meddlesome attention ; and other vulgar, mean, and dishonor- 
 able attempts to pass for more than one is worth, to get busi- 
 ness, — all generally fail in their object, and are looked upon by 
 many as either an illegitimate, unethical display of artifices and 
 tricks, or the efl'orts of a small mind or of a weak and ig- 
 norant Dr. Sham or Dr. Gullumall to hide a lack of ordinary 
 skill, or to get oneself talked of, and actually sometimes bring 
 him who aflects them into ridicule and disrespect. 
 
 "Full many a shaft with purpose sent, 
 Finds mark the archer little meant." 
 
 Be cautious not to thus belittle yourself, but strictly avoid 
 ostentation and every peculiarity of manner, dress, oflice ar- 
 rangement, etc., calculated to make you offensively conspicuous.
 
 HIS REPUTATION AND SUCCESS. 29 
 
 and excite ridicule, disrespect, or contempt. On the other hand, 
 however, if you are bashful, shame-faced, diffident, and lacking 
 in aggressiveness or deficient in tact, you will never prosper 
 until these disadvantages are overcome. 
 
 In medicine, reputation that comes easily goes easily. Ac- 
 cident or trick may bring one into notice, but they cannot sus- 
 tain him, and he is finally estimated at his true value. The 
 best reputation is that acquired by a display of talent and merit. 
 If one is tossed into reputation he does not merit he will surely 
 sink again to his true level. Even if you get reputation for 
 distinguished abilities by superior talent, and desire to sustain 
 it, you must still work hard, — 
 
 "A great reputation is a great charge," — 
 
 and from time to time present additional ideas and show new 
 proofs of possessing talents and intellectual strength. 
 
 It is customary and proper to give simple notice of remov- 
 als, recovery from prolonged sickness, return from long jour- 
 neys, etc., in the newspapers, but it is neither legitimate nor 
 creditable to announce your entrance into practice ; nor to ad- 
 vertise yourself generally in newspapers, nor to placard barber- 
 shops, hotels, etc. Pufhng yourself, your cases, your apparatus, 
 your skill, or your fame, through the medium of the press, and 
 winking at being puffed and applauded in the newspapers, are 
 quackish, stale, unprofessional, dishonorable, and on a par with 
 Dr. Hugh DeBrass and his speckled-horse plan. A proper 
 pursuit of medicine will imbue you with loftier sentiments and 
 engender nobler efforts to gain public attention and to get your- 
 self talked of, and will spur you to build your fame on much 
 stronger foundations. 
 
 Cultivate the true art and spirit of professional manner and 
 deportment. Much of your usefulness and comfort will depend 
 on it. But do nothing to gain popular favor that does not ac- 
 cord with both the letter and spirit of the ethical code. Inde- 
 pendent of the degradation you would feel, it would not pay to
 
 80 THE PHYSICIAN HIMSELF; 
 
 trust, for business, to tricks of any kind; for the veil that covers 
 such attempts is generally too thin long to hide the real motive 
 or to turn aside ridicule. 
 
 You will be more esteemed by patients who call at your 
 office, for any purpose, if they find you engaged in your profes- 
 sional duties and studies, than if reading novels, making toy 
 steam-boats, chasing butterilies, or occupied in other non-profes- 
 sional or trivial pursuits ; even reading the newspapers, smoking, 
 etc., at times proper for study and business, have an ill effect on 
 public opinion, which is the creator, the source of all reputation, 
 whether good or bad, and should he respected ; for a good rep- 
 utation is a large, a very large, yea, sometimes the cliief part 
 of a physician's capital. 
 
 It is very natural to expect your near medical neighbors to 
 pay you a visit of courtesy after you commence practice, or 
 change your location ; for the purpose of establishing reciprocal 
 and friendly intercourse, whether previously acquainted or not ; 
 but if they fail to do so, it should not be too quickly construed 
 as discourtesy or ill-will, for it may be due to their position of 
 doubt concerning your being a regular physician ; or they may 
 deem it your duty to make the first call, to announce your in- 
 tention to practice in the locality, and to tell of your honorable 
 business hopes and ethical intentions, and to ask for kindly, 
 courteous treatment ; or, they may wish time to scrutinize your 
 principles, or your character, or your conduct, qualifications, 
 temper, etc. The very best of men are sometimes the slowest 
 to make friendly overtures. 
 
 There is a very great difference between the case of an ad- 
 ditional physician starting in a community or a neighborhood, 
 and an additional perspn being added in almost any other busi- 
 ness. The demand for other things can be increased, but the 
 demand for physicians is limited ; so that a new physician must 
 create his practice by securing this patient, then that, then 
 another, from other physicians. Every family the new competitor 
 adds to his list during his first years of practice must leave or
 
 HIS REPUTATION AND SUCCESS. 31 
 
 be diverted from that of some other, who may have attended 
 it long enough to almost deem it his private property ; and, 
 of course, the loser does not enjoy the loss of his old patients, for 
 there is a little of the old Adam and love of monopoly still left 
 in a man, even thougli he does practice medicine. The older 
 practitioners are, therefore, naturally very apt to feel a tinge of 
 jealousy, and to be watchful of, if not captious toward, Dr. 
 Newcomer ; and when they see him crowding himself in, inter- 
 locking and overlapping them, much as we see a new passenger 
 push into an already crowded street-car, they are apt to look 
 upon him as a presuming antagonist and opponent, and, as self- 
 preservation leads every man to prefer himself to his neighbor, 
 unpleasant animosities and feuds are apt to arise, either among 
 those who are well disposed or otherwise. Beware of these 
 differences, and try to nip them in the bud. 
 
 There is a proverbial rancor and bitterness of spirit about 
 medical antagonisms and medical hatreds, some of which termi- 
 nate only with life ; avoid them as far as lies in your power, and 
 endeavor to be in amicable and brotherly relations with the 
 physicians of your neighborhood ; and should you ever feel 
 that you have cause for complaint against a brother physician 
 let him know of it, and give him an opportunity to explain and 
 defend his action, or to acknowledge his error, if he is in error ; 
 then, if you disagree, refer the case to mutual professional 
 friends for adjustment ; or, if you have been too badly treated to 
 admit of these, you may feel compelled to drop intercourse and 
 pass him silently. Remember, however, that nothing is more 
 disagreeable than to have enmity and a rupture of intercourse 
 with those we must often face. 
 
 It is natural for established physicians to regret the advent 
 of another medical aspirant ; and some are suspicious, cold, 
 sensitive, and hypercritical toward every new-comer; because 
 the stranger, in coming, must exert a perturbing effect on the 
 professional business of those already established. His coming 
 makes more workers, and, if he is skillful, actually makes
 
 32 THE PHYSICIAN HIMSELF: 
 
 less sickness, because the spur of rivalry, constant and sharp, 
 stimulates each person to try to get all curable cases well, not 
 only surely, but quickly. Sickness, both in amount and du- 
 ration, is decreased, because skilled laborers have increased. 
 There is, of course, no greater number of cracked skulls, man- 
 gled limbs, cut fingers, ague, fits, or medical cases of any kind, 
 than before Dr. Last came. He must, therefore, draw his share 
 of the loaves and fishes from the others. 
 
 Read how eager young Absalom was to push old David 
 from his throne, and study the manoeuvres of that ungrateful 
 bird, the cuckoo ; how the fostered cuckoo hurls all the other 
 birds from their maternal nest after its cunning mother has 
 been unwisely allowed to deposit an egg, and their parent has 
 watched and nourished it until it is stronsr enouoli to show its 
 ingratitude by hurling the rightful owners out, and you will 
 realize why Dr. Elder, Dr. Bigbiz, Dr. Nopolizer, Dr. Duwell, 
 Dr. Kurumm, and other old and prosperous physicians dislike 
 to see new Richmonds gain a foothold in their section, and un- 
 der their very noses effect an entrance into their families. Com- 
 petitive practice does not necessitate jealousy or enmity ; but 
 self-preservation is the first law of nature, implanted by the 
 great Creator of us all ; when it is endangered, every human 
 bosom feels the same impulse. 
 
 Bear in mind, honest, conscientious, courteous rivalry be- 
 tween physicians is advantageous to the public, because it creates 
 a spirit of emulation and compels each to try to be skillful and 
 successful in practice ; and that if your opponents look to their 
 own good, and do all they can for themselves in a fair, equitable, 
 well-directed manner, you have no right to complain. 
 
 Your first efforts in practice will bring you into contact and 
 contrast, perhaps also into collision, with the other practitioners 
 of your vicinity, and then you can each learn what the other is. 
 
 Be not boastful or intrusive, but if you are conscious of 
 any superior aptitude or intellectual power, or are ahead of your 
 brethren in any essential quality, or eclipse them in talent or
 
 HIS REPUTATION AND SUCCESS. 33 
 
 experience, let mere matters of display remain secondary, and 
 depend chiefly on your solid merit for success. This is more 
 durable, less expensive, more in harmony with the views of 
 sensible people, and will help you more in climbing toward the 
 top, and, when you get there, will be the surest means to keep 
 you there. 
 
 Every one on the face of the globe tries to be wise for him- 
 self, and studies his own interests, and desires his own advance- 
 ment; therefore, do not hesitate to embrace fully every accidental 
 or natural advantage of birth or wealth, or the favoritism of 
 influential patrons or the recommendation of powerful friends, 
 if honest and ethical. 
 
 You will find that intellect, genius, temperance, correct 
 personal habits, and other excellent qualities will all fail to make 
 you successful, unless you add ambition, self-reliance, and aggres- 
 siveness to them ; but in your eflbrts to advance you should take 
 care not to incur the reputation of being a sharper or of being 
 tricky. If the balance were struck, it would probably be found 
 a great deal harder for a physician to worm and intrigue his 
 way through life, by ingratiating and manoeuvring, than to 
 struggle along with honesty and industry. Determine, there- 
 fore (under God), that in your efforts you will act lilve a man, 
 from your diploma to your death-bed; that you will begin well, 
 continue well, and end well ; and will do nothing that is criminal, 
 nothing that will not stand the strongest sunlight and the 
 severest scrutiny ; nothing for which you would hesitate to sue 
 for your fee ; and, if necessary, to stand up before a judge and 
 jury to claim it; nothing, in fact, that you cannot api)rove of 
 with your hand on your heart and your face turned upward.
 
 CHAPTER IT. 
 
 "Tie who does the best his circumstance allows, 
 Docs well, acts uobly, angels could do no more." 
 
 There has been of late years a large, annual addition to 
 our already overcrowded profession, and the doctor-making col- 
 leges of tlie United States, with their tempting inducements to 
 students, — small fees, condensed lectures, quizzes, " loading up " 
 at the licel of the session from "compends," "epitomes," "vade 
 mecums," and "multum in parvo" guide-books, and evenings 
 at grinding clubs; with the two short courses of lectures required 
 for astonisldng the j)rofessors in the green-room, by accurately 
 repeating the majority of their own sapient sayings, and 
 thereby obtaining the M.D., — are now manufacturing annually 
 more than four thousand graduates, besides tlie medical im- 
 migrants representing all nations wlio reach our shores from 
 abroad, already dubbed M.D,, and prepared to enter at once 
 upon practice. The result is that, if it requires a population of 
 1800 to support each pliysician, and if every pliysician must 
 have a paying clientage of 1000 or 1200 persons to enable him 
 to live and thrive, there are now in every American community 
 more than twice as many physicians as are required by the 
 professional work. 
 
 Yea, every city, town, hamlet, and village, every cross-roads, 
 every nook and every corner, everywhere in our land, can now 
 boast a physician or two. Canada lias but one for every 1193 
 inhabitants, Austria one for every 2500, Germany one for every 
 3000, Great Britain one for every 1652, France one for every 
 1814, Italy one for every 3500, while we of the United States, 
 blessed C?; in pliysicians as in everything else, have, counting 
 both regulars and irregulars, one for every 600, and druggists 
 in proportion. If there were only a few more than needed to 
 fill vacancies caused by death and increase of population it 
 (34)
 
 HIS REPUTATION AND SUCCESS. 35 
 
 might be wholesome, and would allow the public a choice, but 
 with such an overproduction as this there is not professional 
 work enough to employ all, and many worthy aspirants must 
 necessarily languish, and those who do flourish must do so by 
 great skill, great tact, or great industry. Another result of 
 issuing diplomas so freely is that diplomas aie now far down 
 in public estimation, and are not received as evidence of their 
 owners' competency either by army or naval examining boards, 
 or even by State licensing boards. 
 
 The doors to the ^sculapian temple are open, — too open 
 to every variety of individual, — and all kinds are rusliing in, 
 and you will be unusually lucky if you encounter none who are 
 maliciously antagonistic. You will not only meet Professor 
 Loveall, Dr. Fair, Dr. Ettykett, Dr. Warmgrasp, and Dr. Dove, 
 but Professor Crank, Dr. Oblique, Dr. Sneerer, Dr. Crusty, Dr. 
 Quackit, Dr. Squabler, Dr. Frigid, and Dr. Spitfire are also 
 about, and may be encountered in unfriendly collision. 
 
 Bear this fact in mind, and avoid all manifestations, and, if 
 possible, all feelings of petty jealousy, and let your conduct be 
 affable and frank, fair and square to everybody on all occasions, 
 and strive, in your daily life, to build a reputation for profes- 
 sional probity that will excite the respect of all, whether friend 
 or foe, and convince them that you are incapable of any dis- 
 honorable act. 
 
 Avoid all quarrels, bickerings, and disputes with your 
 medical brethren, and be ever ready to yield a point, where it 
 involves no principle, rather than engage in controversy and con- 
 tention ; and if ever a question arises between you and a brother 
 physician that you cannot settle yourselves or by the code of 
 ethics, submit it to the decision of mutual friends, but never 
 begin to retaliate or make reprisals, and avoid all innuendoes and 
 sarcastic remarks to the laity about opponents who have offended 
 you. Exhibit a total absence of professional tricks, and resolve, 
 once for all, that you will remain and act as a gentleman, even 
 under provocation, wliethev others do so or not. Fail not to
 
 36 THE PHYSICIAN HIMSELF I 
 
 practice the golden rule, and " do unto others as you would have 
 them do unto you," and trust the balance to time. Medicine is 
 an honorable calling ; resolve that it shall be no less so by your 
 adopting it. 
 
 Remember, too, that honor and duty require you to do 
 right not only because it is good policy, but because it is right. 
 Do not, however, be so trusting as to " look for wings on a 
 wolf," or expect exact justice from rivals and personal enemies 
 in return ; for, were you as chaste as Diana and as pure as 
 the falling snow, you could not escape misrepresentation by evil 
 eyes, wicked hearts, and deceitful tongues. 
 
 Like every other physician, you will have your friends to 
 extol you and your enemies to condemn and decry you, and 
 althougli you can neither stop the latters' tongues nor prevent 
 all unfavorable public criticism, yet you must take care that 
 nothing be permitted to blast your reputation for upright, honor- 
 able conduct. Charges against your skill, unless very gross and 
 damaging, had better be left unnoticed, or passed over with in- 
 difference; even though it reaches your ears that some Little- 
 wit, or Grundy, or Glibtongue has said he has a total lack of 
 faith in you, and would not call you to attend his ailing cat or 
 dog, such sarcasm need not disturb your equanimity, nor be 
 taken as personal; remember that such remarks are simply indi- 
 vidual expressions of lack of faith in you professionally. Such 
 things are said about every physician in the world, and, although 
 they grate harshly when they reach the ear of him to whom 
 they apply, they are quite different from personal libels, or such 
 as bring your morals or integrity into question, — charges of 
 being a swindler, or a drunkard, or an adulterer, or a seducer, or 
 a murderer, or an abortionist, for example. 
 
 Never boast of the number of cases you have ; of your 
 remedies, operations, and wonderful cures ; or of the surprisingly 
 large amounts of your collections. All such things are apt to 
 create envy, jealousy, disbelief, adverse criticism (Professor 
 Pufliimself or Dr. Hornblower), and other hurtful results.
 
 HIS REPUTATION AND SUCCESS. 37 
 
 Also avoid talking about yourself, or telling from house to house 
 how terribly busy you are, and of your numerous bad cases, 
 and claiming to save the lives of all wlio do not die. Indeed, 
 it is better to say but little in regard to your own merits, either 
 in the way of exaggeration or depreciation, and to relate noth- 
 ing at all to laymen about any case but the one before you ; 
 phthoothorn bragging will not enhance your merits with sensible 
 people, and if you really have extra cases and extra skill, or are 
 a great anatomist or eminent surgeon, people will be sure to find 
 it out in other ways. Also keep your business affairs and your 
 money matters to yourself, and avoid the habit of talking to people 
 about your collections, bills, etc., unless it be to a person about 
 his own bill, or you will soon get the reputation of thinking and 
 talking more about money matters than anything else. 
 
 As a physician, you will require a good address and varied 
 talents, for you must come in contact with all kinds of people. 
 An intelligent readiness in adapting yourself to all classes suffi- 
 ciently for the requirements of your profession is an iuA'aluable 
 faculty, and one in which most physicians are sadly deficient. 
 
 In addition to professional knowledge, you should make 
 yourself fairly conversant with general scientific subjects that 
 tend to exercise the reason rather than the memory, and also 
 with general and polite literature, that you may acquire ideas, 
 a nice discrimination of words, and improved power and facility 
 of expression, and so put yourself on a conversational level with 
 the cultured classes with whom you are likely to be brouglit 
 into contact. In fact, among intellectual and educated people, 
 good conversational powers and broad culture often actually 
 })roduce a higher opinion of a physician's professional ability 
 than is really possessed. Besides, 
 
 "Wisdom is the sunlight of the soul," 
 
 and there is a perpetual delight in the possession of knowledge. 
 Therefore, keep your dictionaries and encyclopsedias at your 
 elbow ; patronize them freely, and, when your reading or musing 
 excites your curiosity on any subject, turn to them and be
 
 38 THE PHYSICIAN HIMSELF I 
 
 informed. They are very convenient and useful in looking up 
 iacts and opinions when you have hut a few moments to devote 
 to an inquiry. 
 
 "We live in thoughts, not breaths. 
 He most lives who thinks most." 
 
 One who can neither conjugate amo nor decline penna may 
 reduce a dislocation, adjust a fracture, tie an artery, or prescribe 
 a drug as skillfully as the Latinist can ; yet a good (classical) 
 education, and the mental images, ideas and discipline that fol- 
 low, although not indispensably necessary to the acquirement 
 of skill, experience, and success as a physician, are powerful 
 elements in the professional struggle. Therefore, if you have 
 begun late in life, and are defective in early training, be not cast 
 down ; but, to rid yourself of the charge of illiteracy and misap- 
 plication of words, make up the deficiency by dint of study 
 and self-education, as fully as possible ; otherwise, it will make 
 you ashamed of your want of knowledge, and either keep you 
 hid among the nonentities of the profession or perpetually debar 
 you from obtaining more than a limited elevation in it. 
 
 Indeed, without educational and other qualifications you 
 can no more enjoy social or professional rank, or reach true 
 eminence, than a pigeon can fly upward with but one wing. 
 The true secret is to be qualified for advancement ; besides, 
 without a fair education you will be continually exposed to 
 ridicule for your ignorance or vulgarism by persons who are, 
 perhaps, very much your inferiors in those peculiar gifts of 
 heaven, — genius and sound common sense. But while a phy- 
 sician cannot know too mucli, I strongly doubt the wisdom of 
 frittering away, after practice is begun, a disproportionate 
 amount of time on educational frivolities and school-boy sub- 
 jects, or giving them more time than recreative attention allows. 
 Nor is it wise to give special attention to higher mathematics, 
 the fine arts, the great classics, zoology, comparative anatomy, 
 mineralogy, botany, Egyptology, geology, conchology, or other 
 collateral studies, while yet imperfect in the practical and essen-
 
 HIS REPUTATION AND SUCCESS. 39 
 
 tial principles of medicine, because simultaneous attention to 
 multifarious subjects prevents concentration of thoughts, and 
 naturally divides and distracts one's mind, and prevents one 
 from pursuing the strictly needful studies with his full strength. 
 Do not attempt to grasp more than you can hold, but pursue 
 whatever you do undertake with manly determination and 
 continuity of effort. 
 
 The plan of forcing themselves tenaciously to pursue aims 
 of a practical character constitutes the peculiarity of most men 
 who rise much above the ordinary level and succeed in an 
 eminent degree. This is not only true in medicine, but in any 
 calling. 1 once knew a person who by accident lost his leg 
 at the middle of the thigh ; previous to this he was but an 
 ordinary swimmer, but afterward the fact of his having only 
 one leg attracted special attention to his swimming. Seeing 
 himself thus observed stimulated him continually to do his best, 
 which made him more and more expert, until eventually he 
 became the best swimmer I ever saw, because the most ambitious. 
 
 A knowledge of Latin to even a limited extent is of ines- 
 timable value. If you are not a scholar, and have not had the 
 advantage of embracing it in your early education, you should 
 not fail to employ some Latin scholar to teach you at least as 
 much as you need in your practice ; you can get one at small 
 cost by advertising anonymously in any daily paper. He can, 
 with the aid of a Latin grammer (Gildersleve's Latin primer is 
 excellent) and a dictionary, teach you in a short time sufficient 
 of the outlines of the Latin language to enable you to understand 
 the etymological import and pronunciation of words, phrases, 
 and technical terms, and to write prescriptions, etc., correctly, 
 and thereby lift you above a feeling of abashment at your de- 
 ficiency in this obviously important particular, give a constant 
 sense of security, and afford perpetual satisfaction. No matter 
 where you get your Latin, so you get it somewhere. Ability to 
 write prescriptions in correct Latin, also, naturally assists in 
 creating respect, or, rather, in preventing unfriendly criticism
 
 40 THE PHYSICIAN HIMSELF I 
 
 and disrespect, in the minds of your fellow-physicians, the drug- 
 gists, and others. Besides, all laymen suppose that every phy- 
 sician understands some Latin, and if they find him ignorant of 
 this they naturally think him equally so in everything else. 
 
 Many people really believe we write prescriptions in Latin 
 in order to mask their ingredients. The true intent, however, 
 is to give every article (and every quantity) a concise and specific 
 title, and to point it out in such a manner that when we call for 
 it in a prescription we may get it, and nothing else, thus making 
 mistakes of meaning between the prescriber and the compounder 
 impossible ; besides, the Latin names of drugs are the same in 
 America, Europe, and elsewhere, and can be read by the scholars 
 of all nations, while the common names, sugar of lead, lauda- 
 num, black wash, etc., are liable to differ with each nation and 
 locality. Thus, aqua is water in Baltimore, and is the same in 
 Paris, in Calcutta, and in St. Petersburg. Latin is a dead lan- 
 guage, belonging to no modern nation, and therefore fixed, and 
 not subject to mutations. It is not only perfectly accurate, but, 
 by long usage, is in high repute. 
 
 A rudimentary knowledge of Greek is also useful, as from 
 it have been formed three-fourths of the compound terms em- 
 ployed in the medical and other sciences. Indeed, Latin and 
 Greek have furnished the materials for building up the lan- 
 fifuaofe of the various sciences for more than two thousand years. 
 The meaning of the terms semi-lunar and dys-uria are as plain 
 and descriptive to those who understand Latin and Greek as 
 the words milk-pail and steam-boat are to those who understand 
 English. 
 
 In using the Latin names of medicines, diseases, muscles, 
 etc., be consistent. Adopt either the broad English or the 
 (Roman) Continental pronunciation, but, whichever you adopt, 
 be careful to use it invariably and correctly. You may acquire 
 a correct pronunciation of the various medical terms by fre- 
 quently consulting a dictionary, of which there is none better 
 than Dunglison's latest etUtion.
 
 HIS REPUTATION AND SUCCESS. 41 
 
 German is another of tlie world's great languages, and an 
 acquaintance with it is not only pleasurable and a means of in- 
 tellectual improvement that costs but little money, but it will 
 assist you greatly with the industrious, faithful, and thrifty 
 Germans, among whom you will find many of your most honest 
 and grateful patients. Determine to get at least a smattering 
 of it early in your career. If you speak German, it is well to 
 mention the fact on your cards. 
 
 Remember that no one can learn to speak the German or 
 any other language unless conversation enters largely into his 
 teaching ; he must learn it through his ears, as well as through 
 his eyes. 
 
 You will find that many foreigners prefer an American 
 physician who can speak their language to one who has come 
 here from their own country, and have more confidence in him, 
 because, being a native, they know he has spent his whole life- 
 time here, and they reason that, although the great principles 
 of medicine may be taught and learned anywhere, he is by ex- 
 perience more familiar with the diseases that exist in our 
 climate, the peculiarities of the vicinity, and the modifying in- 
 fluences of our seasons, diet, and modes of living. 
 
 A German, Frenchman, Spaniard, Italian, or Bohemian 
 will often be delighted to find a physician in an English-speak- 
 ing community with whom he can converse in his own tongue. 
 Foreigners often pay much more liberally than natives, and 
 usually treat the physician with much greater respect. 
 
 A physician is at perfect liberty to state on his cards and 
 signs that he speaks French, Italian, Spanish, Bohemian, Ger- 
 man, or any other foreign language ; and such a statement 
 should, if made, be in the language of the people for whom it is 
 intended. 
 
 Accustom yourself to use current and correct orthography, 
 and to write, not with a scrawling hand, in a zigzag or the 
 worm-fence style, but in a good, neat, distinct, school-day hand. 
 Write every prescription as though critics were to judge you
 
 42 THE PHYSICIAN HIMSELF: 
 
 and your penmanship by it ; each ingredient on a separate line, 
 the principal article, or the strongest drug on the first, adjunct on 
 the next, and veliicle on the last, unless you have some special 
 reason for inverting them. Such methodical system msures 
 well-halanced prescriptions, and engenders the respect and favor- 
 able criticism of those into whose hands they chance to fall. 
 Also, take care to conform your prescriptions to the changes that 
 are from time to time made in the names of the officinal articles 
 of the pharmacopoeia by authorized bodies and nomenclators. 
 
 Strictly avoid prescribing incompatibles, both chemical and 
 physiological, such as the combination of chlorate of potassium 
 with tannic acid or with sulphur, nitrate of silver with creasote, 
 etc., which are explosives, and may blow up either the dispenser or 
 the patient. Cliarcoal is a simple thing, sulphur is another, 
 and saltpetre is still another, but put them together and you 
 have gunpowder, which is not simple, and, unless that potent 
 agent is intended, look out. Although the list of incompatibles 
 is a long one, you will do well to learn it thoroughly, otherwise 
 you will subject yourself to the sarcastic remarks of the pliar- 
 macist, and possibly to whispering doubts and disparaging innu- 
 endoes. Remember, however, that some medicines, though 
 physiologically incompatible, are not therapeutically so, as 
 under certain circumstances you may combine them so that 
 they may favorably modify each other, as morphia and belladonna, 
 acetate of lead and sulpliate of zinc, etc. 
 
 Instead of writing prescriptions three inches in length, it is 
 better to use a single remedy, or, if two are indicated, to alter- 
 nate them, unless you know they are compatible and will not 
 make an unsightly mixture. 
 
 Again, your prescription is always the expression of your 
 opinion and of your skill in a case : — 
 
 "The mind is the man." 
 
 Therefore, try to make every one you write show on its face that 
 you have prescribed with a definite purpose, to meet some clear 
 indication.
 
 HIS REPUTATION AND SUCCESS. 43 
 
 Be careful that abbreviations of names, manner of writing 
 quantities, etc., leave no room for mistake or inexactness in dis- 
 pensing, and make it a rule to read carefully every prescription 
 after you finish writing it. 
 
 It is scarcely necessary to add that, while the distinctive 
 names of the several ingredients in a prescription sliould be 
 written in Latin, the directions for use, i.e.^ all that follows the 
 S. (signa), should be in English, as they are intended for the 
 guidance of the patient. 
 
 Remember that the cloven-foot I^, that is placed at the 
 head of every prescription (prse, beforehand ; scriba, to write), 
 although originally the astrological sign for Jupiter (1/), and 
 for ages placed by the ancients at the head of prescriptions, to 
 invoke the aid of the God of Thunder, is now used merely as a 
 symbol to represent the Latin word Recipe (take thou). 
 
 While it is proper, strictly speaking, to commence every 
 word, after the first, in the names of the articles in your pre- 
 scription with a small letter, i.e.. Liquor potassii arsenitis, yet 
 many physicians purposely begin each with a capital, chiefly 
 because it looks well, and also renders the word less mistakable. 
 
 Sign either your name or initials to every prescription you 
 write, that the pharmacist may recognize its writer ; to such as 
 are likely to be compounded by pharmacists who know you well 
 the initials will be sufficient, but, to all that are likely to be put 
 up by those who know you not, put your full name. 
 
 Li prescribing, it is a bad and injudicious habit to adopt a 
 routine practice, or slavishly to follow your own, or anybody 
 else's, stereotyped formulae for certain diseases. You should 
 invariably adapt your remedies to the case, instead of heedlessly 
 picking out a ready-made formula from your collection as you 
 would a hat in a hat-store. One formula, for instance, for the 
 several forms of diarrhoea, is about as apt to suit every case of 
 relaxed bowels as one coat is to fit every man in a regiment. 
 
 Remember that medicine is a mass of facts, and that he 
 who best interprets these facts is the best physician, and that
 
 44 THE PHYSICIAN HIMSELF I 
 
 skill in practice consists not only in diagnosis, prognosis, and 
 prescribing medicine, and in knowing what one can and what 
 one cannot do, bnt is the combined resnlt of all the powers that 
 the physician legitimately brings into the management of cases. 
 In other words, the skillful use of drugs is but one of many ele- 
 ments that make the unit of medical skill. You must also study 
 mankind as well as medicine, and remember, when w^orking on 
 diseased bodies, that they are inhabited by minds that have vari- 
 able emotions, strong passions, and vivid imaginations, which 
 sway them powerfully, both in health and in disease. To be 
 successful you should fathom each patient's mind, discover its 
 peculiarities, and conduct your efforts in harmony wdth its con- 
 ditions. Let hope, expectation, faith, contentment, fear, resolu- 
 tion, will, and other psychological states be your constant aids, 
 for they may each at times exercise legitimate power, and impart 
 the greatest amount of good to the sick. It is not length of 
 time in practice, but observation and reflection, that teach one 
 to measure human passions and emotions ; and if you are not a 
 keen observer of men and things, if you cannot read the book 
 of human nature correctly, and unite knowledge of physic with 
 an understanding of the effects of love, fear, grief, anger, malice, 
 envy, lust, and other hidden but strong passions that govern 
 our race, you will be sadly deficient even after twenty years' 
 experience : — 
 
 "Hair gray, and no brains yet." 
 
 Professional fame is a physician's chief capital ; ambition 
 to increase it by all legitimate means is not only fair, but com- 
 mendable. After you attain this, you will not be apt to lose 
 either it or the practice it insures, so long as you are sober, 
 decent, and discreet in conduct, and have the physical health 
 to endure the watching, fatigue, and exposure incident to our 
 business. 
 
 There are two kinds of legitimate reputation a physician 
 may acquire, — a popular or common one with the people, and 
 a higher professional one with his brethren. These are often
 
 HIS REPUTATION AND SUCCESS. 45 
 
 based on entirely different grounds, and are usually no measure 
 of each other ; a few of the most excellent, with loftier ambition, 
 struggle earnestly for the latter, Avhile the mass are striving 
 for the former, chiefly because, being altogether practical, it 
 requires less skill, talent, and study to acquire, and, also, because 
 it is more profitable. Many such avoid all great scientific 
 labors and controversies, and, having little or no public life, 
 remain shut up within themselves, moving about quietly and 
 almost unobserved except by those whom they attend ; conse- 
 quently, a knowledge of their habits and doings is confined to 
 the domestic bedside and the narrow circle of their private prac- 
 tice, and the degree of their skill and experience always remains 
 somewhat unknown and mysterious. 
 
 Without one or the other variety of reputation no phy- 
 sician can reap the honors or rewards which are the objects of 
 his ambition, whether that be the acquisition of money, the 
 desire of usefulness, or the love of fame. You should strive to 
 acquire both varieties. 
 
 One fact that you will notice is, that the public naturally 
 prefer a full-of-health, ever-ready physician to a delicate or 
 sickly one, and ailing physicians often conceal the fact that 
 they are sickly or that their health is failing as much and as 
 long as possible, well knowing that the competition in our pro- 
 fession is now so great that for every person whose powers fail 
 ten are ready, with fresh strength, to take his place, and that, 
 if reports of their ailments become current talk, the public will 
 believe that solicitude for their own condition will absorb it 
 from their patients, and they will be abandoned as unrehable 
 and unfit to practice, and their business will be thereby injured 
 or ruined. 
 
 After you have practiced awhile and discovered what your 
 chief deficiencies are, and determine exactly what course you 
 ought to pursue, if you will spend a few months in additional 
 study of the great prhiciples of our science in some of the 
 great American or European hospitals, and then return and
 
 46 THE PHYSICIAN HIMSELF I 
 
 settle down, it will be of tenfold benefit to you in more ways 
 than one. 
 
 A discreet tongue is a great gift and a great aid to success. 
 When elopements, seductions, rapes, confinements, or abortions ; 
 or the scandal about Dr. Bigscamp, or Rev. Mr. Blacksheep, or 
 Miss Oilyeve, or the ignobleness of tlie pedigree of Mrs. But- 
 terfly, or the secret history of Miss Pride, or the wrecked and 
 wretched greatness of Mr. Pomp, or the adulteries or intrigues 
 of Mrs. Freelove, or the evil reports about this virgin, that wife, 
 or the other widow, are being talked of, perhaps in terms that 
 decency would require to be printed only witli initial and 
 terminal letters, with a dash between, you should have a silent, 
 or at least a prudent, tongue ; all you say on such subjects will 
 surely be magnified and repeated from mouth to mouth, and its 
 results will be a permanent injury to you. The position of the 
 gossiping physician has ever been a very bad one, and he is 
 sometimes called to unpleasant account. 
 
 Take especial care, while in contact with tale-bearers and 
 scandal-mongers, or scandal-loving crowds, to keep the conver- 
 sation on general or abstract and legitimate subjects, and deter- 
 minedly avoid descanting upon hidividuals and private affairs, 
 or what somebody, or a coterie or clique of somebodies, has 
 said. 
 
 Be careful, also, to note tlie great and never-failing advan- 
 tage that refined people, with virtuous minds, pure thoughts, 
 and courteous language, have, in every station of life, over the 
 coarse and the vulgar ; and in view thereof let your manner, 
 conversation, jokes, etc., be always chaste and pure. Never 
 forget yourself in this particular, for nothing is more hurtful to 
 a physician than the exhibition of an impure mind. School 
 yourself to avoid all and every impropriety of language and 
 manner, and never allow yourself to become insensible to the 
 demands of modesty and virtue. Chasten every thought, 
 weigh well every word, and measure every phase of your 
 deportment, — especially that which concerns the fair fame of
 
 HIS REPUTATION AND SUCCESS. 47 
 
 woman, — and let your treatment of all females be refined and 
 delicate, if you would succeed fully, especially if gynaecology 
 and obstetrics be the one great aim of your ambition. A lewd- 
 minded physician who indulges in double eutendres, coarse 
 ambiguities, vulgar jokes, jocular innuendoes, and indelicate 
 anecdotes about the sexes — 
 
 "To reflect on women ever ready" — 
 
 with other men or with coarse women, even though he pcses as 
 a gentleman, is sure to be shunned, and the reason therefor made 
 the subject of gossip and passed from one to another in social 
 whispers, till it reaches the purest and best of the community. 
 Thoughtful people of both sexes everywhere rightfully regard 
 such libertines as being far more amenable to criticism, and far 
 more dangerous to admit into the bosoms of their famihes, than 
 rough-mannered believers in social purity who gamble, drink, 
 or swear. 
 
 '-Immodest words admit of no defense, 
 For want of decency is want of sense." 
 
 Study the art of questioning, and when it devolves on you, 
 in the course of professional duty, to ask questions on delicate 
 topics, or to broach very private subjects, do so with a chaste, 
 grave simplicity,— neither too direct on the one hand, nor with 
 too much circumlocution on the other. 
 
 Physicians are made in the colleges, but tried in the world. 
 Your personality and deportment in the presence of patients 
 will have much to do with your success. Blessed is the phy- 
 sician who has the gift of making friends. A pompous, or cold, 
 or cheerless, heartless or indifferent manner toward peo[)le; or 
 a studied or sanctimonious isolation of one's self from them 
 socially ; or failure to recognize would-be friends on the streets 
 and elsewhere, as if from a lofty independence, or as if they 
 were inferior mortals and beneath you, — 
 
 "I am resolved on death or dignity," — 
 
 oflen gives unmeant offense, and tends to destroy all warmth 
 toward a physician, and usually causes their hapless possessor
 
 48 THE PHYSICIAN HIMSELF: 
 
 to fail to inspire either friendly partiality or faith ; and a phy- 
 sician who cannot in some way make friends or awaken faith in 
 himself cannot fail to fail. The reputation of being a " very 
 nice man " makes friends of everybody, and is, with many, even 
 more potent than skill. To be both affable in manner and skill- 
 ful in action makes a very strong combination, — one that is apt 
 to waft its possessor up to the top wave of professional success 
 and repute. If, moreover, he be especially refined in manner 
 and moderately well versed in medicine, his politeness will make 
 him a troop of friends, and will be professionally more effective 
 with them than the most profound acquaintance with histology, 
 microscopic pathology, and other scientific acquirements. 
 
 If your manners and conversation are of the gentle, soft, 
 and tender kind, that win and conciliate rather than repel chil- 
 dren, it will be fortunate, and probably will put many a dollar 
 into your pocket that might have gone to some irregular. Such 
 habits as fondling and kissing people's teetsy-weetsy children, 
 or carrying them pockets of candy, however, are liable to be 
 misconstrued into an effort to secure the good will of the parents 
 for selfish motives, and should therefore be avoided. 
 
 Cultivate a cheerful mental temperament ; gentle cheer- 
 fulness is a never-failing source of influence. It is a magnetic 
 nerve tonic and stimulant ; it diffuses sunshine, cheers the tim- 
 orous, dispels the deadening fogs of hopelessness, encourages the 
 despondent to look on the bright side, and comforts the despair- 
 ing. The science of medicine, contrary to the general belief, is 
 not a melancholy, sombre, mournful profession, but a bright, 
 cheerful one. The sincerely grateful faces you will see and the 
 "Thanks to God!" you will hear while completely curing some 
 poor fellow-creatures and relieving others of pain and ailments, 
 and allaying fear and administering comfort to the minds of 
 multitudes of others, will make you realize your usefulness and 
 the great good your noble, humane, and beneficent profession 
 enables you to confer on suffering humanity, — the contemplation 
 of which should make you cheerful and happy, and satisfied
 
 HIS REPUTATION AND SUCCESS. 49 
 
 with yourself and your elected life-work, in spite of the many con- 
 tradictions and disappointments you are subject to in practice. 
 
 Bear in mind that the physician's visit, being the chief event 
 of a sick person's day, is eagerly watched for, and let no ordinary 
 engagements interfere with your punctuality in making it; 
 also study to acquire an agreeable, courteous, gentlemanly, 
 and professional manner of approaching the sick and taking 
 leave of them. There is an art, a perfection, in entering the 
 chamber of sickness with a dignified yet gentle manner, that 
 clearly evinces interest and a determination to master the case, — 
 in asking the necessary questions, in making the requisite ex- 
 amination, then carefully and wisely ordering the proper reme- 
 dies, and departing with a cheerful, self-satisfied demeanor that 
 puts the patient at his ease, and inspires confidence on the part 
 of himself and his friends, and a belief that you can and will 
 do for him all that the science of medicine enables you to do. 
 The personal appearance, the walk, the movements, the gestures, 
 the polite bow, the well-modulated voice, the language, the 
 natural mode of intercourse, and the elegant and instructive 
 conversation of some physicians are as cheering and confidence- 
 inspiring, to the sensitive nerves of the sick, as a sunbeam on a 
 May day ; the manners of others, as rude, coarse, cold, heartless, 
 indifferent, and repulsive as a March wind. 
 
 Familiarity with the many little details of the sick-room — 
 including the necessary art of applying bandages, making beef- 
 teas, gruels, mustard plasters, poultices, etc., and with dressing 
 wounds, passing catheters, reducing herniae ; getting a fish-bone 
 from the throat, a splinter or a needle from the hand, or a mote 
 from the eye, or teaching the nurse how to prepare the obstetric 
 bed ; seeing that those working subordinate to you do their 
 duty, and various other minor duties that you may be there 
 incidentally called on to perform or direct — often do more to 
 create a favorable impression than your pills and powders. In- 
 deed, it is to a very great extent by minor matters that watchful 
 nurses and other habitues of the sick-room will judge you.
 
 50 THE PHYSICIAN HIMSELF: 
 
 As a physician you should be hopeful, and not indiscreetly 
 abandon cases usually considered hopeless. Hope creates ideas, 
 generates new expedients, brings up useful reflection, and leads 
 to fresh endeavors. Indeed, it has been said that the only way 
 to get cured, and render impossibility possible, after a physician 
 loses hope and gives you up, is to give him up. 
 
 The faculty of keeping hope and confidence alive in tlie 
 bosom of the patient and of his friends is a great one, and the 
 look with which you meet them has much to do with this ; a 
 bright, fresh, thoughtful countenance, and an easy, cheerful, 
 soothing, professional air and manner are powers that will well- 
 nigh always impart tranquillity and repose to your patient's 
 mind and carry him with you toward recovery. A cheering 
 word sometimes rekindles the lamp of hope, and does the tim- 
 orous and despondent as much, or more, good than a prescrip- 
 tion. It is, therefore, your duty to gain and retain the confi- 
 dence of your patient and his friends by all honorable means, — 
 to be gay, pleasant, amusing, serious, or sympathizing, as 
 occasion requires. 
 
 It is often very pleasing to the sick to be allowed to tell, in 
 their own way, whatever they deem important for you to know ; 
 allow to all a fair, courteous hearing, and, even though Mr. 
 Humdrum's and Mrs. Lengthy 's long statements are tedious, do 
 not abruptly cut them short, but endure and listen with calm, 
 respectful attention. A patient may deem a symptom very im- 
 portant that you know to be otherwise, yet he will not be satis- 
 fied with your views unless you show sufificient interest in all the 
 symptoms at least to hear them described. When, for want of 
 time, you cannot listen further, or where the recital grows too 
 tedious and becomes too irrelevant, do not lose temper or manifest 
 any annoyance, or check him by a rude order to " stop," but 
 quietly ask him a diverting question about his sickness, or to 
 show his tongue, or feel his pulse, as if completing your exami- 
 nation. Such expedients often serve the purpose with hypochon- 
 driacal men, garrulous women, and tedious chronics in general.
 
 HIS REPUTATION AND SUCCESS. 51 
 
 To be quick to see and understand your duty, and equally 
 prompt and self-reliant in doing it, as if possessed of inborn acute- 
 ness of perception and of intuitive skill, is one of the strongest 
 points you can possess, and gives easy advantage over Dr. Lazi, 
 Dr. Dragg, and Dr. Dallhead, who mildly and formally perform 
 their part, and are as painfidly slow, undetermined, and cau- 
 tious, as if every, pebble were a rock and every molehill a 
 mountain. People invariably admire and appreciate the man 
 who can take the responsibility in critical moments ; indeed, a 
 bold, prompt act, done at the opportune moment, with steadiness 
 of mind and nerve, if successful, often creates a species of faith 
 bordering on professional idolatry. 
 
 Capital operations in surgery illustrate this : the manual 
 parts — expertness with the knife, etc. — are deeply impressive, 
 and receive vastly more praise from the crowd than knowing 
 when to operate and how to conduct the after-treatment. In- 
 deed, the public imagine that the comparative scarcity of sur- 
 geons is because but few of our number dare to do great oper- 
 ations. The truth is, almost every physician does minor 
 surgery, — adjusts fractures, reduces dislocations, etc., — and would 
 prepare to perform capital operations but for the reason that 
 only a few are required to do all there is to be done, and only 
 a very few can live by it. A large city with its hundreds of 
 physicians will have less than a dozen who are prepared to do 
 capital operations, and the majority of these have a great deal 
 more medical than surgical practice. 
 
 If you know a patient's ailments so well as to sit down and 
 tell him and his friends exactly how he feels better than he can 
 tell you, he will be apt to believe all you afterward say and do. 
 Mind-reading, or the study of character, is part of your duty. 
 To be many-sided ; to possess flexibility of temper and suavity 
 of manner, self-command, quick discernment, address, ready 
 knowledge of human nature, and the happy genius of honestly 
 adapting yourself to A-arying circumstances and to all people, at 
 the couch of splendor and the squalid cot, are great necessities
 
 62 THE PHYSICIAN HIMSELF: 
 
 in our checkered profession. You will meet patients of various 
 and even of directly opposite temperaments and qualities : the 
 refined lady and the liod-carrier, the clergyman and the beer- 
 seller, the aged and the young, the hopeful and the despondent, 
 the bold and the diffident, the profound and the superficial. Let 
 each and all find in you his ideal. Seek to penetrate the char- 
 acter of each, and to become an adept in adapting your manner 
 and language to whoever and whatever is before you. 
 
 If you also have the self-command to control your emo- 
 tions, temper, and passions, and to maintain a cool, philosophic 
 equipoise and inflexible serenity of countenance, under the 
 thousand irritative provocations given to you by foolish patients 
 and their querulous and rude, or fidgety friends, who rile at your 
 coming too early or too late, too often or not often enough, or 
 accuse you of giving the wrong medicine or in the wrong doses, 
 of being too fast or too slow, it will give you great advantage 
 at the critical moment over nervous, quick-tempered, and excit- 
 able physicians who unguardedly blurt out with " , : ; 
 
 !!'?'? *]!!! !! -V', and will generally redound both 
 
 to your advantage and credit. 
 
 A brusque, tornado-like manner, or eccentric rudeness, is 
 fatal to a physician's success uuless sustained by unquestionable 
 skill or reputation. A simple, humane, gentle, and dignified 
 manner and low tone of voice are suitable to the largest part of 
 the community. 
 
 "Manners gentle, discourse pure." 
 
 E^member that a rough, unfeeling, abrupt, indelicate, sour, or 
 arbitrary manner, as if the heart were a butcher's, or made of 
 marble, is quite different from the serene composure and intelli- 
 gent sympathy acquired by constant attendance upon the sick and 
 suftering. The former is brutal and unprofessional ; the latter 
 is essential to enable you to weigh correctly and manage diseases 
 skillfully. 
 
 If you chance to inherit any slight but pleasant pecu- 
 liarity of character or singularity of manner it will be noticed,
 
 HIS REPUTATION AND SUCCESS. 53 
 
 and, if not disagreeable, will do you no harm ; * but never 
 assume one for the sake of making an impression on the public, 
 for the counterfeit is easily detected by all sensible men and 
 women. Be not only a gentleman, but also a gentle man, and 
 {jct out your own natural character every where and at all times, 
 among the rich and the poor (no man has two natural manners). 
 Besides making himself ridiculous, a physician who assumes a 
 fictitious, mysterious, or rude manner must either be wrong- 
 hearted or weak-headed. 
 
 If, moreover, you possess fluency of language, or the gift 
 of conversational power, or gentleness or tenderness of manner, 
 or great natural courtesy, or a never-failing stock of politeness, 
 facility of expression, or a talent for illustrating your points by 
 apt comparisons, or a bold, resolute way of encountering pro- 
 fessional puzzles, or of deftly catting the many Gordian knots 
 so often encountered, it will help you decidedly. If, on the con- 
 trary, there is any point in which you are deficient, study and 
 practice until you attain it. 
 
 When you reach a patient's house ascertain, if possible, 
 from whoever meets you, his condition, etc., that you may know 
 with what manner to approach him, especially in cases of 
 severe illness, in which it is important to show him no surprise, 
 nor to disturb him with questions that can be avoided. 
 
 Never leave a bedside before qualifying yourself to com- 
 municate your ideas and opinions of a case to the inquiring 
 friends of the patient clearly, in well-chosen and faith-inspiring 
 language, in case they should be asked. 
 
 Never utter a diagnosis or a prognosis in a hurry or 
 flurry. Give your opinion only after sufficient thought, and, 
 if possible, do not afterward change it. Also, to prevent 
 being misunderstood, avoid making varying statements about 
 a case to different inquirers from time to time, but, as nearly 
 as possible, use the same tactful words and apply exactly the 
 
 *It is said that the thee and thou of Dr. Fothergill, of London, was worth 
 £2000 per year to him.
 
 54 THE PHYSICIAN HIMSELF: 
 
 same terms to the disease, and even more particularly in consul- 
 tation cases. 
 
 Act toward timid children and nervous patients so as to 
 remove all dread of your visits. Avoid a set, sad countenance, 
 and a formal or funereal solemnity of manner, as these would 
 excite thoughts of crape, hearse, undertaker, and tombstone, 
 and a fear of you, especially if you associate them with a 
 corresponding style of dress. If you have a lengthened, severe 
 visage, simulating 
 
 "A walking prayer-meeting," 
 
 or your air and movements are awkward, sombre, severe, smile- 
 less or singular, offset them by enforced cheerfulness, suitable 
 dress, etc. 
 
 When you visit a patient, neither tarry long enough to 
 become a bore and give rise to the wish that you would go, nor 
 make your visit so brief or abrupt as to leave the patient with 
 the impression that you have not given his case the necessary 
 attention. 
 
 To evince an earnest, anxious, tender interest in the welfare 
 of patients, and serious attention to the nature of their disease, 
 and sympathy with their sufferings, as if you were present in 
 mind as well as in body, is another very strong, faith-inspiring 
 quality. To find occasion to assure a sufferer that you will 
 take the same care of him as tliough he were your " own 
 brother," or, in case it be a female, as if she w^ere your " own 
 sister," or to assure a female in labor that you will be as gentle 
 in making the necessary examinations as if she were an infant, 
 and similar trutli fully-meant expressions of sincere sympathy 
 and interest, and letting your conduct be such that they may 
 feel it is so, inspire great confidence, and are often quoted long 
 after the physician has used them. 
 
 "A little thing often helps." 
 
 The world is full of objects of pity, and it may be that no 
 really busy physician can devote full time and exert his utmost 
 skill in every case that appeals to him, or throw into it his
 
 HIS REPUTATION AND SUCCESS. 55 
 
 whole heart, undivided force, tlioughts, feelings, and intellec- 
 tual strength ; or even feel deep interest in the agonies, the woes, 
 the bruises, the afflictions, and sufferings of every patient to 
 whom he is called ; if he did, the endless chain of misery with 
 which he is brought in contact would prove to be too great a 
 strain on his sensibilities, and, through overcare and grief, would 
 soon unfit him for active practice. But you can, and should at 
 least, make a careful examination, in a grave and thoughtful 
 manner, manifest liumane anxiety and intelligent interest, and 
 show uniform kindness in all cases, and avoid exhibiting a 
 rough, abrupt manner, unfeeling, thoughtless haste, or chilly in- 
 difference in any. Be careful to approach the sick, rich and 
 poor alike, with noiseless step, with kindly, hopeful greeting, 
 and gentle, thoughtful speech. The possession of a feeling of 
 true humanity, or the lack of it, in a physician, can in no way 
 be so accurately judged as in his questioning and examination 
 of the sick ; the soothing voice, the tender touch, and the sym- 
 pathetic feeling tend not a little to soften the pillow of sorrow 
 and affliction. 
 
 In examining the sick, be especially careful to use the pro- 
 fessional touchy and avoid inflicting pain in delicate and painful 
 parts, and assuage their fears and oversensitiveness by assur- 
 ances that you will not cause any more suffering than is una- 
 voidable, and then proceed to make good your words. He who 
 possesses such manner and tact naturally will not, cannot, fail 
 to gain devoted patients, who will willingly trust and retain him 
 in preference to all others, even though they know his general 
 reputation for skill to be far below that of professional neigh- 
 bors. 
 
 Human life is precious above all on earth ; but some per- 
 sons think that being so often in contact with sickness and 
 death naturally makes pliysicians less alive to life's value and 
 more callous to suffering than other men, and nothing is more 
 gratifying to all, and especially to such as are interested in one 
 who is lying sick, than to hear the physician expressing a lofty
 
 56 THE PHYSICIAN HIMSELF: 
 
 estimate of the value of human life in general, and why the life 
 then at stake is specially valuable, and wortliy of an earnest 
 determination on the part of all to save it if possible. 
 
 For ultimate success you must, of course, depend chiefly 
 on your skill in curing the sick. You will find, nevertheless, 
 that but few patients — probably not one in twenty — can estimate 
 the amount of technical and scientific knowledge you possess. 
 The majority are governed by the care and devotion you ex- 
 hibit, and form their opinion and rate your services by the 
 little details of routine attention, which is additional evidence 
 that mere skill is not all that is necessary to make a successful 
 physician. 
 
 While civil and urbane to all, without distinction, be 
 especially courteous to female attendants on the sick ; for woman, 
 noble woman ! as true to duty as Diana, with voice soft, gentle, 
 and low, and the look of heaven in her face, is, and ever will be, 
 the angel of the sick-room, — 
 
 "Sweet is her voice in the season of sorrow," — 
 
 and you, as a physician, cannot fail to witness many touching 
 evidences of her tender ministrations; and heroic, unselfish de- 
 votion as mother, wife, sister, daughter, nurse, or friend to the 
 sick and suffering, watching around the bedside by day and by 
 night, and ministering with an angel's spirit, even at the risk 
 of her own life. 
 
 "Woman, fairest of creation, God's last and best gift to man." 
 
 After a patient convalesces, or when it is not necessary to 
 visit him daily, if, when you chance to be attending in his neigh- 
 borhood, you send to inquire how he is getting along, it will not 
 only give you the desired information, but will also impress him 
 and his with a grateful sense of your interest in the case. Having 
 a sick child taken up for examination, carrying your patient to 
 the light that you may see him fully and examine him carefully, 
 also having his urine, or his sputa, or tlie blood spat, etc., saved 
 for examination, will not only give you much necessary informa-
 
 HIS REPUTATION AND SUCCESS. 57 
 
 tion as to the patient's condition, but also satisfy him and the 
 family of your interest and solicitude, and of your anxiety to 
 fulfill your duty. A like effect is also produced by paying- one 
 your first visit in the mornino-, or the last at night, or staying, 
 in urgent cases, to see that the medicine produces the desired 
 effect, and such things help to make the cure. 
 
 You will find that, in times of sudden sickness and alarm 
 in families, there is a peculiar susceptibility to strong impressions, 
 and kindness and extra attention shown them in such emergen- 
 cies is doubly appreciated. Often even a single kind expres- 
 sion, opportunely uttered, is long remembered. Indifference, 
 coldness, a slight offense, an inopportune remark, an unlucky 
 word, or an impatient ejaculation, may, on the contrary, sever 
 attachments and terminate friendships that have existed between 
 the physician and the family for years, in as many moments. 
 Many a young physician gains a hold on the hearts of a good 
 family, becomes beloved, and secures the family permanently by 
 the exhibition of good, hopeful intentions, and simple kindness 
 and assiduous attention in those dreadful accidents and emer- 
 gencies that alarm friends and distress families ; and, also, in 
 cases of colic, convulsions, and the like ; or by sleepless anxiety 
 and faithful, devoted, and unwearied attention, trying to steer 
 here to avoid this rock, and there to escape that eddy, in cases 
 of typhoid fever, scarlet fever, etc., where, perhaps, life hangs, 
 day after day, as if by a single thread. 
 
 A powerful lever to assist in establishing your professional 
 reputation will be found in curing the long-standing cases so 
 often seen among the poverty-stricken. Many of these poor, 
 disease-ridden sons and daughters of poverty are curable, but 
 require greater attention in regard to the details, and a great 
 deal more care, strength, and personal superintendence than 
 old-established physicians, whose time is monopohzed by acute 
 cases, can possibly devote to them. If you are seriously in 
 earnest, use your best judgment, and persevere with them until 
 a cure is effected ; your special interest and anxious attention will
 
 58 THE PHYSICIAN HIMSELF I 
 
 be observed and appreciated ; you will be credited with all the 
 prosperous accidents of the case, get the credit of the cure, and 
 gain a host of warm admirers, who will magnify and herald you 
 far and wide as being doubly skillful in making the blind see, 
 the deaf hear, the lame walk, the broken whole again, the 
 senseless well, the weak and debilitated strong, rotten lungs 
 sound again ; and, even though you receive little or no pecuniary 
 reward from them, it will serve as a mental gymnasium, help to 
 train and develop your professional character, show your skill 
 and ingenuity, augment your fame, and educate both your hand 
 and your eye, and school you in the art of recognizing, studying, 
 and treating the very diseases you will daily be called upon to 
 attend all the days of your life ; besides, teaching you to over- 
 come the thousand and one embarrassments encountered by 
 the beginner, and bring you eventual success in life. And when 
 success does come, forget not those by wliom it came, and with 
 grateful heart be true to all the friends of your struggling years. 
 
 "Thine own friend, and thy 
 Father's friend, forsake not." 
 
 Take care to promise old chronic cases — that more experi- 
 enced physicians have pronounced incurable, and annoying and 
 troublesome, but penniless patients, taken for older physicians 
 who wish to discard them — nothing but that you will do your 
 best for them. Never stake your reputation on their cure, and 
 allow yourself plenty of time in speaking of the period necessary 
 for the trial, instead of promising too much, or good results 
 too soon. 
 
 You will find it comparatively easy to get practice in the 
 slums and among the moneyless poor, and relatively hard to do 
 so among the wealthier classes. Your practice will probably 
 begin in cellars and garrets, lanes and back streets, among 
 the poorest of the poor, the degraded and the vicious, — even in 
 hovels of filth and vermin, in putrid alleys and fetid courts, where 
 
 "I have counted two-and-seventy stenches, 
 All well defined."
 
 HIS REPUTATION AND SUCCESS. 59 
 
 You will also be called to attend people who wash with invisible 
 soap, in imperceptible water, and use immaterial towels, who 
 will furnish astonishing illustrations of 
 
 " The survival of the filthiest ; " 
 
 and will also enter dens of iniquity and vice, where you must 
 pick your way through mud and mire amid 
 
 " Poverty, hunger, and dirt," 
 
 where your reputation will extend much more rapidly than in 
 comfortable quarters ; but, no matter whether in mansion, cottage, 
 or hovel, every man, woman, or child you attend, white and black, 
 rich and poor, will aid in enriching your experience and in shap- 
 ing public opinion by giving you either a good or a bad name. 
 
 " Over rough roads, indeed, 
 Lies the way to medical glory." 
 
 Bear in mind that the wheel of fortune sometimes makes 
 the poor rich, and a few of the more grateful kind then remember 
 the physician who remembered them. Attending the servants 
 of the rich, however, who are sick at their service places, or paid 
 for by the latter, will not improve your reputation much with 
 the powers above stairs : at any rate, not nearly so much as 
 attending the same patients at their own homes, or on their own 
 account. Proud and haughty people who, in their minds, 
 couple you professionally with their servants, garrets, and 
 kitchens are apt to form a low opinion of your status, and of the 
 nature and class of your practice. It is also true that if you 
 attend a poor person gratuitously you will seldom, if ever, be 
 called to his rich relatives; and if Dame Fortune ever makes 
 that poor patient rich, even he may become supercilious, and 
 drop you. 
 
 Nor will you find it very satisfactory to attend people who 
 "just call you in to see a sick member of their family," because 
 you are attending across the street or in the neighborhood. 
 Those who select you or send for you because they prefer you 
 to all others will be your best and most devoted patients. 
 
 The adoption of a specialty, to the exclusion of other
 
 60 THE PHYSICIAN HIMSELF: 
 
 varieties of practice, is successful with but a few of those who 
 attempt it. It should never be undertaken without first study- 
 ing the whole profession and attaining a few years' experience 
 as a general practitioner. 
 
 You are not obliged to assume charge of any case, or to 
 engage to attend a woman in confinement, or to involve your- 
 self in any way against your wish ; but, after doing so, you are 
 morally, if not legally, bound to attend, and to attend properly, 
 even though it may be a charity or " never pay " patient. At 
 the same time you liave a right, should necessity arise, to with- 
 draw from any case by giving proper notice. 
 
 Bear in mind that ethical duties and legal restraints are 
 as binding in pauper and charity cases as in any other, for both 
 ethics and law rest upon abstract principles, and govern all cases 
 alike. 
 
 You will probably find hospital and dispensary patients, 
 soldiers, sailors, and the poor, much easier to attend than the 
 higher classes ; their ailments are more simple, definite, and un- 
 complicated, the treatment more clearly indicated, and the re- 
 sponse of their system is generally more prompt, and one can 
 usually predict the duration, issue, etc., of their cases with great 
 accuracy. With the wealthy and pampered, on the other hand, 
 there is often such a concatenation of unrelated or chronic 
 symptoms and strange sympathies, or they are described in such 
 indefinite or exaggerated phrases, that it is difficult to judge 
 which one symptom is most important to-day or which will be 
 to-morrow. 
 
 With hospital patients, sailors, soldiers, paupers, etc., on 
 the contrary, there are but two classes, — the really sick, suffer- 
 ing from affections of a well-marked type, and malingerers. 
 Such practice is apt to lead the unguarded youth to a rough-and- 
 ready habit of treating every patient as very ill, or else as 
 having little or nothing the matter with him; later, he finds 
 that these crude or possibly overactive methods may answer in 
 public institutions, but they will not suit the squeamish people
 
 HIS REPUTATION AND SUCCESS. 61 
 
 with nerves tuned to a high key, so often seen in private practice, 
 with indefinite or frivolous ailments, for which the physician 
 trained in a hospital could hardly fail to feel and manifest con- 
 tempt. Hospital practice is so different from private that but 
 few members of our profession shine conspicuously as practi- 
 tioners in both spheres. An illustration of this fact is afforded 
 in colleges and medical societies; for the greatest Ciceronian 
 orators in the colleges, and the most fluent debaters and paper 
 philosophers in medical societies, are not necessarily the best or 
 most successful practitioners. The fields are decidedly different, 
 and may lead the mind in different directions. In a word, the 
 possession of didactical knowledge, and the power of applying 
 it at the bedside, are very different things. 
 
 Observe and strictly practice every acknowledged rule of 
 professional etiquette. For this purpose it is your duty to 
 familiarize yourself at the very threshold of your professional 
 career with the " Code of Ethics of the American Medical As- 
 sociation," and never to violate either its letter or its spirit, but 
 always scrupulously to observe botli toward all regular gradu- 
 ates practicing as regular physicians. But remember that you 
 are neither required nor allowed to extend its favoring pro- 
 visions to any one practicing contrary to the liberal tenets that 
 govern all regular physicians, no matter who or what he may be. 
 
 I am not sure that the medical profession of any other 
 country besides ours has a code of written ethics. Possibly old 
 countries from long custom can dispense with them. But in our 
 Young Land of Freedom the very nature of society requires that 
 physicians shall have some general system of written ethics to 
 define their duties, and, in cases of doubt, regulate their conduct 
 toward each other and the public in their intercourse and com- 
 petition. Every individual in the profession is, of course, sup- 
 posed to be a gentleman, actuated by a lofty professional spirit, 
 striving to do right and to avoid wrong, and, even were there 
 no written rules at all, the vast majority would naturally con- 
 form to the rules of justice and honor, as far as they understood
 
 62 THE PHYSICIAN HIMSELF: 
 
 them. As a consequence, each one's action, when scanned by 
 watchful and knowing eyes, might probably be considered fair 
 in nine doubtful cases out of ten, while in the tenth one might 
 lionestly err greatly, or conclude differently from his neighbor 
 on some mooted point, or might be found differing in opinion 
 only from some jealous or captious rival, or crafty, unprincipled 
 competitor, with whom an honorable agreement would be 
 impossible. 
 
 The absence of rules for our government would also leave 
 Dr. AUforself and others at liberty to frame their own codes, 
 which might violate all logic and all propriety, — 
 
 " The wrong-doer never lacks a pretext," — 
 
 and no matter how equivocal their position, or how crooked and 
 insincere their ways, no one would be in position to prove 
 that they acted from unworthy motives, and not from error of 
 judgment, even in the most flagrant violation of the cardinal, the 
 glorious old-fashioned Golden Rule, the climax of all ethics, laid 
 down by Confucius, and quoted by " Our Saviour," " Do unto 
 another what ye would he should do unto you, and do not unto 
 another what you would not sliould be done unto you," — truly, 
 a world of ethics in a nutshell, an ocean of morals in a drop. 
 
 The non-existence of a code would also make it possible 
 for Dr. G. to pounce on the patients of Drs. A., B., C, D., E., 
 and F. like a wolf on sheep, and to carry on a regular system 
 of infringements, self-advertising, certificate-giving, and wrong- 
 doing in general, regardless of their rights, and still claim to be 
 as honorable as Socrates, while those aggrieved would have 
 no visible standard of appeal by which the contrary could be 
 proved. 
 
 In view of these and many other facts, it has been found 
 necessary to have a code of written ethics for regulating the 
 conduct of physicians toward each other and toward the public 
 generally. 
 
 Dr. Thomas Percival, an English physician, in a small book 
 published in London in 1807, proposed an admirable code of
 
 HIS REPUTATION AND SUCCESS. 63 
 
 ethics, which, excepting a few alterations made necessary by the 
 lapse of time and the advance of medical science, is the identical 
 code adopted by the American Medical Association in 1847, and 
 which from then until now has instructed and governed nine- 
 tenths of our profession throughout this broad land, protecting 
 the good and restraining the bad, just as the Ten Command- 
 ments of Holy Writ instruct and restrict mankind in general. 
 
 You and every other true physician among us unquestion- 
 ably owe to it his sacred allegiance. 
 
 You and all other physicians are supposed to have studied 
 this code, and to be familiar with its requirements. The moral 
 claim which it has upon you rests not upon any obligation of 
 personal friendship toward your professional brethren, but upon 
 the fact that it provides for every relation, contingency, and occa- 
 sion, and is founded on the broad basis of justice and equal 
 rights to every member of the profession, shining like the pole- 
 star to guide and direct all who wish to pursue an honorable 
 course ; and, being founded on the highest moral principles, its 
 precepts can never become useless till regenerate and infallible 
 human nature makes both codes and commandments unneces- 
 sary. It is the great oracle of right and reason, to which you 
 can resort and study the moral aspect of all the subjects that 
 are likely to confront you from time to time, and no better code 
 of moral principles can be found anywhere. 
 
 To this lofty code, in a great measure, is due the binding 
 together and elevation, far above ordinary avocations, of the 
 medical profession of our land, and the esteem and honorable 
 standing which it everywhere enjoys. 
 
 By its dignity and justness it remains as fresh and useful 
 to-day as when the profession adopted it, more than forty years 
 ago, and if you faithfully observe its canons you can truthfully 
 exclaim : " I feel within me a peace above all earthly dignities, 
 a clear and quiet conscience." 
 
 Professional morals are an important part of medical edu- 
 cation, and it is as much the duty of every medical college in
 
 64 THE PHYSICIAN HIMSELF I 
 
 America to acquaint its students with the precepts of the code 
 of ethics of the American Medical Association, and to furnish 
 to each of its alumni a copy of it with his diploma, as it is for 
 a mother to familiarize her children with the Ten Command- 
 ments. 
 
 In our land the code is regarded as the balance-wheel that 
 regulates all professional conduct, and neither Professor Bigbee 
 nor Dr. Littlefish can openly ignore it without overthrowing that 
 which is vital to his standing among medical men. If in the 
 struggle and competition for practice you desire to act unfairly 
 toward your brethren, the code will compel you to do the evil 
 biddings of your heart by stealth ; and even then your unfair- 
 ness will seldom go undetected or unpunished, for the great God 
 of Heaven has declared that " Whatsoever a man soweth, that 
 shall he also reap." Any one upon whom you encroach in an 
 unprofessional manner will feel himself justified in retaliating 
 with your own weapons, and you will reap a crop similar to the 
 seed sown. AVhenever you sow a thistle or a thorn you will 
 reap thistles or thorns, whenever a wind is sown a whirlwind 
 will be reaped ; whilst the sweeter seeds sown by others will be 
 yielding to them sweeter fruits. 
 
 When called to attend a case previously under the care of 
 another physician, especially if the patient and friends are dis- 
 satisfied with the treatment, or if the case is likely to prove 
 fatal, be carefully just. Do not disparage the previous attend- 
 ant by expressing a wish that you had been called in soojer, 
 or criticise his conduct or his remedies ; it is mean and cow- 
 ardly to do either. In all such cases do not fail to reply, to the 
 questions of the patient or his inquiring friends, that your duty 
 is ivith the present and future, not iciih tlie past. Inform your- 
 self as to what line of treatment has been followed in the case, 
 but refuse either to examine or criticise the previous attendant's 
 remedies. Let your conversation also refer strictly to the pres- 
 ent and future and not to the past, and in no way allude to 
 the physician superseded, unless you can speak clearly to his
 
 HIS REPUTATION AND SUCCESS. 65 
 
 advantage. As a rule, the less you say about the previous 
 treatment, the better. 
 
 To take a mean advantage of any one whom you have 
 superseded, besides being morally wrong, might engender a 
 professional hornet, which, in retaliation, would watch with a 
 malignant eye and sting fiercely v^'herever opportunity offered. 
 Eschew all sorts oi' finesse, and let courtesy, truth, and justice 
 mark every step in your career. Seek, moreover, to enhance 
 your profession in pubhc esteem on every fitting opportunity, 
 and defend your brethren and your profession, also, when 
 either are unjustly assailed. Indeed, to fail to defend the repu- 
 tation of an absent professional brother, even by a conspiracy of 
 silence, when justice demands you to speak, is not only unpro- 
 fessional, but is more or less dishonorable, and implies a quasi- 
 sanction of the libel. 
 
 Every physician has his successes, and also his failures. 
 Where you are highly successful in diagnosis, or have worked 
 wonders in treatment after others have failed, observe a proper 
 degree of modesty, and avoid pushing your triumph so far as to 
 wound the feelings or mortify the pride of your less-fortunate 
 predecessors, on the principle of 
 
 "Hit him again, he has no friends." 
 
 Take just credit, but be guarded in your words and actions, and 
 take no undue advantage of their errors, that you may not in 
 turn invite disparagement or arouse hatred. 
 
 "No man likes to be surpassed by men of his own level." 
 
 We all know there are a thousand unwritten ways to show 
 an ethical spirit and a thousand undefinable ways to evince an 
 unethical one. Wlien you doubt whether this or that patient is 
 fairly yours or another's, give your rival the benefit of that 
 doubt. Never be tenacious of doubtful rights, but let your 
 every-day conduct, in this and all other respects, entitle you to 
 the esteem of your medical neiiihbors. 
 
 Also, while alive to your own interests, do not captiously
 
 66 THE PHYSICIAN HIMSELF: 
 
 follow up every trifling ethical infringement, difficulty, or ap- 
 parent contradiction, as if you were ever on the watch for provo- 
 cations and angry collision with your neighhors, and courted a 
 war with everybody for what you may be pleased to call your 
 " rights." A certain amount of jarring and clashing in a pro- 
 fession like ours is unavoidable ; allow liberally for this ; school 
 your feelings; bury pettiness, captiousness, and narrowness in 
 the ocean of oblivion, and maintain a friendly attitude toward 
 all fairly-disposed neighboring physicians. Unless you do so, 
 many questions will arise that cannot well be adjusted by an 
 appeal to the code, and you will become involved in useless, 
 rancorous, and endless controversies and reprisals with those 
 whose paths may happen to cross your own. 
 Sometimes — 
 
 "The very silliest thing in life 
 Creates the most material strife." 
 
 You will find it both inconvenient and embarrassing to pass 
 and repass a medical neighbor between whom and yourself 
 there exists a chronic feud, or individual estrangement, jeal- 
 ousy, and hatred, as, also, to meet any one else with whom, 
 through enmity or otiier cause, friendship and speaking 
 acquaintance have ceased. If ever you have cause to believe a 
 medical neighbor has treated you unfairly, or misconstrued your 
 own conduct or motive, instead of the fierce onslaught and bitter 
 rejoinder, go or send directly to him, and in an earnest but 
 urbane manner make or ask an explanation. 
 
 Eschew all doubtful expedients that relate to getting patients 
 and profits, as though you cast off or assume tlie code of ethics 
 just as suits your purpose ; and be very careful not unjustly to 
 encroach on any other physician's practice; also, never attempt 
 unjustly to retain any patient to wliom you are called in an 
 emergency ; if you are in doubt whether you were deliberately 
 chosen, or only taken in the emergency, do not hide yourself 
 behind a mean technicality of ethics, but ask the direct question. 
 If you learn that another was really preferred to you, surrender
 
 HIS REPUTATION AND SUCCESS. 67 
 
 the patient to him on liis arrival, even though you may be, for 
 pohteness' sake, asked to continue in attendance. Circum- 
 stances may even require you to have the former attendant sent 
 for in a case, either to take charge of it or for consuUation. 
 
 Acts of neighborly kindness are frequently performed by 
 physicians for one another, and go far, very far, toward neutraliz- 
 ing the ruffles, stings, and collision of interests which the very 
 nature of our profession makes inevitable. If your conduct 
 toward other physicians at such times is invariably just and 
 honorable, as if arising from a simple desire to do that only 
 which is right, it will in due time be recognized and appreciated, 
 and will not only assist in making your road pleasant, but, if 
 you ever unwittingly infringe, one and all will acquit you of any 
 intentional error. 
 
 When you are called, in an emergency, to prescribe for a 
 patient who is under the care of another physician, it is better 
 to leave for him a copy of your prescription, that he, knowing 
 its exact character, may be able to judge whether or not he 
 should continue its use. 
 
 Be it your invariable rule never to visit a patient who is 
 under the care of a brother physician, as a "smelling commit- 
 tee," or medical detective for the patient's beneficial society, 
 with a view to ascertain whether he is malingering, or for an 
 employer, friend, or relative who is anxious and apprehensive in 
 regard to his illness, or for one in fear of an impending damage- 
 suit, with a view to report thereon, without the distinct sanction 
 of the attending physician. It would be a still greater wrong 
 to clandestinely remove the bandages from fractures, ulcers, etc., 
 applied by another physician, whether it be to change treatment 
 or merely to examine the case. 
 
 Be also extremely discreet and chary of visiting patients 
 under the care and treatment of other physicians, even for social 
 purposes, as it is a frequent cause of suspicion and contention. 
 
 Never take charge of a patient recently under the care of 
 any regular physician without first ascertaining that he has been
 
 68 THE PHYSICIAN HIMSELF: 
 
 formally notified of the change. The principle that governs 
 such cases is this : When a person is taken ill he is at liberty 
 to select any physician he prefers, but after making a selection, 
 and when the case has been taken charge of, if for any reason 
 whatever the patient wants to change, he must, in doing so, 
 follow the established custom, for if there are any hard thoughts 
 against the other physician, or unpleasant scenes with him, the 
 patient and his friends should have them, not you. 
 
 The dissatisfied persons who wish to discard their medical 
 attendant and employ you, will sometimes contend that the 
 rules relative to taking charge of patients, recently under the 
 care of another physician, are harsh and unjust, and peculiar to 
 the medical profession. Neither of these statements is true, 
 for our custom is identical with that which prevails everywhere 
 among all classes of people, which requires the formal discharge 
 of the old employe before a new one can take his place. Be- 
 sides, no person, whether menial, mechanic, or physician, can 
 fill a vacancy till one exists. 
 
 Be especially chary of taking cases in families into which 
 you have ever been called in consultation, more particularly if you 
 were called in at the former attendant's suggestion, on account 
 of your supposed greater merits, for he, chagrined at his displace- 
 ment, will be apt to scan every feature of the change, and, if 
 there be any ground at all for suspicion, he will conclude that, 
 instead of obeying the Golden Rule, and sternly refusing to sup- 
 plant him, you have taken advantage of the introduction he 
 gave you, ingratiated yourself in, and ungenerously elbowed 
 him out. 
 
 "I taught you to swim, and now you would drown me." 
 
 You will sometimes be called to a patient, and, upon going, 
 will find that he is under the care of some other physician, and 
 will, of course, refuse to attend ; but you will almost surely be 
 urged just to look at the patient and tell what you think ; or 
 whether the attending physician's treatment is not wrong ; or 
 to prescribe for him ; with the assurance that the other physician
 
 HIS REPUTATION AND SUCCESS. 69 
 
 shall be kept in ignorance of your visit. Bear in mind that honor 
 and duty require you to do right in these and all other positions 
 in which you may be placed ; not through fear, or for policy's 
 sake, but because it is right to do right, and for the other equally 
 broad reason that you yourself would be cognizant of the wrong, 
 whether the other knew of it or not, and it would lower you in 
 your own eyes ; decline, therefore, courteously but firmly, their 
 solicitations, with an impressive assurance that you desire to 
 possess your own respect as earnestly as you do that of others. 
 Unless a great emergency exists, you should determinedly refuse 
 either to sit in judgment on another's work, or in any way to 
 interfere ; if, however, the case be one of urgency, your services 
 should be rendered for the attending physician, and you should 
 leave a note telling him what you have done. Take care to 
 make no charges for such services. 
 
 When persons are inveighing to you against an attending 
 physician, or one who has been discarded, and finding fault witli 
 his treatment, or at the patient's being so long unrelieved, you 
 should never suggest that he be discharged, so that you may 
 supplant him, as it would seem like piracy, or intriguing for a 
 brother's place not vacant. 
 
 The rules regarding previous attendance are much less 
 stringent in floating office practice than in regular family prac- 
 tice, and it is not essential to inquire wliether an office patient 
 is under the care of another ; I believe that all of tlie most 
 eminent physicians prescribe for all ordinary office patients with 
 but little regard as to who has been attending, or where, or when. 
 Most people, with long-standing, or peculiar, or indefinite ail- 
 ments, are unwilling to resign themselves to the stroke of Provi- 
 dence until numerous physicians have been tried in vain ; and a 
 patient with heart trouble, cough, or a skin disease, will occa- 
 sionally consult almost a dozen physicians at their offices in as 
 many weeks. The principle followed is simply this: Office advice 
 to strangers is everywhere cash, and the payment of the fee frees 
 the patient to go subsequently to whomsoever else he pleases.
 
 70 THE PHYSICIAN HIMSELF I 
 
 You will see much to condemn in regard to ethics, both in 
 the profession and in the laity. Should you ever feel constrained 
 to attack or impugn any one's conduct, do it in an open, manly 
 way, and never covertly or anonymously, — for underhand, clan- 
 destine, and dark-lantern attacks are despicable. 
 
 "All ambusbed attacks are botb cowardly and mean." 
 
 Be punctilious in your endeavors to do every person justice. 
 If you err at all in this respect, let it be in liberality. Suffer 
 injustice, rather than participate in it. Sometimes, even though 
 the letter of ethics allows you to take a patient, it may be un- 
 kind or unwise, or brutal to do so; use such opportunities to 
 harmonize, rather than to disrupt. You can do this, and yet not 
 
 make a habit of cheating yourself out of patients. 
 
 ■ * * * * * * * 
 
 Always keep some good vaccine virus on hand, both for the 
 fees it secures, when there is a demand for vaccination, and for 
 fear of a sudden outbreak of small-pox. 
 
 Vaccination, although a trifling operation, is a prolific 
 cause of criticism and reproach to physicians ; take your time, 
 and do it skillfully and thoroughly. In lieu of humanized 
 virus or arm-to-arm vaccination, use calf-virus whenever it is 
 possible to obtain it; it is, more popular, and not capable of com- 
 municating syphilis, scrofula, etc., and needs less defense. In no 
 case use any but pure virus, and be ever ready to defend its 
 purity with proof if any one you vaccinate suffers any mishap 
 through it. 
 
 Remember that you are legally as well as morally bound to 
 vaccinate a person after promising to do so. Besides the regrets 
 and harsh criticism your neglect would generate, a suit for 
 damages might follow, if the patient sliould get small-pox while 
 awaiting the fulfillment of your promise. 
 
 Do not begin the unjust custom of vaccinating children 
 gratuitously, in cases where you have officiated at their birth, 
 as is the habit with some. Make tlie same charge also for re- 
 vaccinating any one, to test whether his former vaccination is
 
 HIS REPUTATION AND SUCCESS. 71 
 
 still protective, whether it takes or not, as you would if he 
 never had been vaccinated before, as revaccination succeeds in 
 but a small proportion of those it is tried upon, and the charge 
 is for making the test. 
 
 A public vaccine physician should never insist upon vac- 
 cinating a child or other unvaccinated person who is known to 
 have a discreet, watchful medical attendant, unless small-pox is 
 actually prevailing. They should, on the contrary, be referred 
 to him. 
 
 You should, of course, make no extra charge for repeating 
 primary vaccinations till they take, no matter how long the 
 interval between the trials; also, make but one charge for any 
 person who has revaccination attempted, no matter how often, 
 if during the same epidemic or small-pox scare. Many people 
 believe a vaccination protects as long as the scar shows plainly. 
 The truth is, a vaccine scar lasts for life, while the protective in- 
 fluence of vaccination gradually disappears in some people. A 
 typical vaccine scar merely shows the vaccination once took 
 properly, not that it still protects. 
 
 Some people think a revaccination must be made to take 
 anyhow, even though they are still protected by the old one. 
 You cannot catch fish where there are none, no matter how you 
 bait your hook ; nor set a pile of stones on fire, no matter how 
 good the matches. 
 
 Another error regarding small-pox : Many people imagine 
 that it can only thrive when the weather is cold ; this is a mis- 
 take, as it may prevail with intensity at any season. Indeed, 
 severe epidemics of it often prevail in tropical countries where 
 there is perpetual summer. 
 
 Avoid volunteer practice, and be very cautious how you go 
 out of your way to persuade people to let you remove warts, 
 extract tumors, efface tattoo-marks, destroy nsevi or superfluous 
 or disfiguring hairs, and do other minor surgical operations 
 gratuitously, Avith assurances of success. There is always a pos- 
 sibility of serious or fatal sequelae ; the most trivial operation —
 
 72 THE PHYSICIAN HIMSELF: 
 
 even a puncture on the tip of the finger by a pin, needle, or 
 splinter — is occasionally followed by death, and you should 
 not, especially in private practice, induce people to let you 
 involve yourself for tlieir benefit, without being paid for 
 your risk and responsibility; for instance, it is an ugly 
 matter to have a wart you have insisted upon tampering 
 with become an ulcerating epithelioma. It is better, indeed, 
 to avoid all unrequited work, and all gratuitous responsibility, 
 other than what charity calls for. 
 
 For similar reasons do not persuade people to effect insur- 
 ance on their lives, or in any particular company, as all such 
 ventures carry a possibility of disappointment or failure that 
 might involve you. 
 
 Wisdom in recognizing cases that are likely to involve you 
 in suits for malpractice, and in foreseeing and forestalling the 
 suits themselves, is also a valuable power. Take care that this 
 wisdom does not come too late or cost you too much. Remem- 
 ber that when you are employed professionally you are regarded 
 as contracting that you possess and will exercise ordinary skill 
 in your profession, and that you will be guilty of no negligence. 
 Beyond this you are not responsible for the result, no matter 
 how bad, as medicine is not an exact science ; but if you fail 
 either in ordinary skill or care, you are legally liable to the 
 injured person to the full extent of the damage sustained. Skill 
 should, of course, be measured by the time and place in which 
 it is exercised; whether on land or on ship-board, in places 
 where facilities are few, or where they are many, are matters to 
 be taken into account. In your professional rounds you will not 
 find the various diseases as clearly marked as tliey are in the 
 books, — not labeled as plainly as the bottles in a pharmacy, — 
 therefore a mistake in diagnosis is not sufficient cause for action, 
 and every physician may be, and often is, mistaken ; indeed, 
 many cases are so obscure, or masked, or irregular, or compli- 
 cated, that notliing but an autopsy, and sometimes not even 
 that, can reveal their exact nature.
 
 HIS REPUTATION AND SUCCESS, 73 
 
 Never fail promptly to send in your professional account to 
 dissatisfied patients who may be unjustly attempting to injure 
 your reputation and practice, and especially to such as may be 
 threatening- to sue you for malpractice, whether or not you ex- 
 pect them ever to pay it. If you cowardly shrink from doing so 
 in such cases, it will be quoted as proof that you are guilty of 
 what they charge, and that you know it. The presentation of your 
 bill will give you a better position before the public, and raise an 
 issue that greatly tends to checkmate them. In all such cases 
 do not fall to charge the maximum fee. 
 
 When you are to be a witness in court in a grave case, 
 courteously but firmly decline to give any person connected 
 with the opposite side either a verbal or written statement of 
 what you saw, heard, or observed in the case, or what your 
 opinion is, or what your testimony will be. Also, if need be, 
 dispute their right to question you at all on the subject. 
 
 If you are yielding in this respect, you may actually aid 
 them to set traps for you, by distorting your statement from its 
 proper meaning and hitent, or to rebut it on the witness-stand, 
 or to prepare to charge that you are lacking in medical knowl- 
 edge, and thus bring both justice and yourself to grief. Often, 
 in such cases, 
 
 "Your enemy makes you wise." 
 
 Firmly but courteously inform such agents that you will not give 
 the desired information, but that they can elicit all you know on 
 the witness-stand. 
 
 When giving evidence in court, whether as plaintiff, de- 
 fendant, or witness, endeavor to keep cool and self-possessed, 
 and give your evidence with manly and honest candor ; guess 
 at nothing, and express no opinion for which you cannot give 
 the why and wherefore. 
 
 There is no class or profession other than our own whose 
 members habitually confront and confute one another in the 
 courts and before the public. Our so-called psychological 
 experts, specialists, and other would-be highly scientific repre-
 
 74 THE PHYSICIAN HIMSELF: 
 
 sentatives, have so often been hired by contestants with a view 
 to use their dialectic powers to frame or elicit favorable testi- 
 mony, or the reverse, as the case may require, in will, life- 
 insurance, criminal cases, etc., that the public are led to freely 
 jest about tlie differing opinions of physicians, and not un- 
 naturally to believe, from our lamentable professional contradic- 
 tions and divergence of opinion, that there is no case so disrepu- 
 table, no claim so monstrous, that it cannot be bolstered up by 
 medical evidence ; and that our boasted science of medicine is 
 merely a tissue of guess-work, and that a certain class of 
 pseudo-experts can make things appear to be either black, 
 white, or lead-colored, and are willing to sell testimony to the 
 highest bidder, on any side of any question. 
 
 So-called "medical experts" often excite disgust and indig- 
 nation at the contemptible attitudes they assume when they act 
 against their better knowledge, and join hands with mercenary 
 and venal people to attempt to mulct a physician, or to free a 
 criminal from legal responsibility, perhaps to let go a murderer 
 whom all the world knows is guilty, or to condone other 
 scoundrelism on the plea of " insanity," " hypnotism," or im- 
 moral pretext gotten up to make money, defeat justice, or 
 obtain notoriety — 
 
 "And help to blind both judge and jury, not to give them eyes." 
 
 Never forget that every principle of honor and duty re- 
 quires us to stand by and defend each other in everything that is 
 reasonable and just, and forbids us to think of lending our- 
 self as " medical cat's-paws," either to go on the witness-stand or 
 to prompt council in their efforts to bandy and break down 
 medical witnesses on cross-examination, in rascally or specula- 
 tive malpractice suits against reputable physicians who have 
 conscientiously discharged their duty in cases of sickness, acci- 
 dent, or surgical operation. Fractures about the wrist or elbow 
 furnish a large proportion of these cases ; eye cases, also, furnish 
 another large share.
 
 HIS REPUTATION AND SUCCESS. 75 
 
 These slanderous suits against physicians are generally 
 trumped up and entered either at the instance of designing 
 physicians intent on the ruin of rival practitioners, or by un- 
 principled, case-hunting, Champerty lawyers, — 
 
 "The words of their mouths are smoother than butter, 
 But guile is in their hearts," — 
 
 not with the hope that they may come to trial on their merits, 
 but that the accused physician, through natural dread of the 
 expense and annoyance, will pay a snug sum as hush money. 
 
 The court records make it appear that the poorer a pa- 
 tient, and the more that charity has been exercised, the more 
 likely he is to enter suit and otherwise show the basest ingrati- 
 tude. If ever a worthless, lying loafer gets a chance at your 
 pocket-book, look out for him. 
 
 Probably there is no department of professional duty in 
 which physicians are asked to stretch their consciences so much 
 as that of giving certificates that the disability of persons seek- 
 ing to get soldiers' invalid pensions was contracted in the army. 
 
 It is also possible that you may be cajoled by friends, or 
 blandished or flattered by interested strangers, or even tempted 
 by gold, to give an opinion that old Jinglecash, who was men- 
 tally unfit to make a will, was unclouded in mind and fully 
 competent to do so, or that Mr. Drinkhard or Mrs. Halfgone, 
 with one foot in the grave, the result of intemperance or disease, 
 is sound or temperate, and thereby to swindle an insurance 
 company ; or that Mr. Badbody or Mrs. Dysoon, with a bias to- 
 ward a certain disease or with an incipient organic affection, is in 
 perfect health. Or Highflyer or other pleasure-loving officials 
 may seek to cover their absence from duty by your certificate 
 that their non-attendance was due to sickness; or Mr. Mak- 
 out may attempt through your aid to escape military or jury 
 duty, or attendance at court as a witness, or for trial, or try to get 
 from you a prescription for a " Sunday drink of liquor " for the 
 thirsty, under the old pretense of " very sick." 
 
 Repel all such attempts promptly and decidedly, and em-
 
 76 THE PHYSICIAN HIMSELF: 
 
 phatically refuse to be seduced from the path of honor and in- 
 tegrity, or to deviate from your honest conviction, for any one. 
 With professional honesty for your pilot, be firm and un- 
 wavering in your determination to steer clear of practices and 
 alliances in which your part would not bear legal scrutiny 
 or detailing in the community ; and you will not only safely 
 pass the various rocks of shame and whirlpools of bitterness 
 which have wrecked so many of our profession, but you will have 
 the full approval of your own conscience. Perish all that conflicts 
 with the attainment of this.
 
 CHAPTER III. 
 
 " Whatsoever a man soweth, that shall he also reap," 
 
 When you are importuned to produce abortion, on the plea 
 of hiding from the world the yet-undiscovered guilt and saving 
 the poor girl's character, or preventing her sister's heart from 
 being broken, or her father from discovering her misfortune and 
 committing murder or suicide, or him who has taken criminal 
 advantage of her from being (sic) disgraced, or to avert the 
 shame that would fall on the family, or the church scandal 
 about one of the weak brethren ; or, in cases where there is no 
 previous guilt, to limit the number of children for married people 
 who already have as many as they want, or who are just married 
 and do not want the inconvenience of them so soon, or to ac- 
 commodate ladies who assert that they are too sickly to have 
 children, or that their suckling child is too young to be weaned, 
 or that they have been pregnant only a short time, or to avoid 
 other anticipated evils, etc., etc., even though it be only the size 
 of a mustard seed, you should not stop to discuss the subject 
 lengthily with a " h'm " and a " haw," but should meet all such 
 entreaties and solicitations with a refusal prompt, strong, and 
 positive, and never let yourself appear to entertain the proposi- 
 tion. If they are too importunate, express your sentiments in 
 unmistakable language, and with plain, American frankness, bow 
 them out, but remember that these are terrible secrets, and seal 
 your lips doubly tight. 
 
 It is always safe to do right, and never safe to do wrong. 
 How could any one but an idiot, or an utterly unprincipled 
 man, be induced to stain his hands and his heart by committing 
 a crimson crime ; to violate both his moral conscience and the 
 criminal law ; to risk exposure, social disgrace, and professional 
 ruin for himself and family, and even the penitentiary itself, by 
 taking the guilty burden from others' shoulders to his own, 
 
 (77)
 
 78 THE PHYSICIAN HIMSELF: 
 
 thereby putting himself in their shiful power, whether as a favor 
 or for a paltry bribe, or even for all the gold of California ! 
 
 Evil rumors fly rapidly. The production of a very few 
 criminal abortions (sometimes even a single one) will surely go 
 from tongue to tongue, and give the damphool physician who 
 stoops to commit them a widespread notoriety as infamous and 
 as tenacious as the Bloody Shirt of Nessus. Take care 
 
 "That the immaculate whiteness of your fame 
 Shall ne'er be sullied with one taint or spot." 
 
 A single misstep from the heights of integrity may wreck one's 
 whole life. 
 
 When circumstances render it necessary for you to pre- 
 scribe for females with suspended menses, where pregnancy is 
 possibly or probably the cause, it is better, instead of giving a 
 Latinized prescription, to order some simple thing, such as hop- 
 tea, tincture of valerian, or wine of iron, under its common 
 English name, with full written instructions how to take it. By 
 thus avoiding all secrecy regarding the nature of the remedies 
 prescribed, you will avert the suspicion or, may be, a charge of 
 giving abortifacients. 
 
 To give a woman who applies for an abortifacient an inert 
 agent would, to say tlie least, be unwise ; it is better plainly to 
 refuse to give her anything, whether a pretended or real remedy. 
 
 The charge or suspicion of criminal abortion is much more 
 apt to be brought when the woman is single than when she is 
 married. 
 
 " The physician must, like the diplomatist, tread softly." 
 
 You must give a cautious, a very cautious opinion, if any, in 
 cases of unmarried females whose menses have ceased and preg- 
 nancy is feared, or as to whetlier an apparent pregnancy is real, 
 especially in a case where the suspected girl, after everybody 
 else has left the room, strenuously denies having had carnal in- 
 tercourse. Many will not confess the trutli while a third person 
 is present. Erroneously to pronounce an honest, virtuous woman 
 pregnant may blast the whole future life, honor, and innocence
 
 HIS REPUTATION AND SUCCESS. 79 
 
 of one who was provided with a shield of virtue and clothed in 
 the mantle of purity, — 
 
 "A soul as white as heaven," — 
 
 and call down maledictions on you ; if, on the other hand, and 
 on insufficient evidence, you too quickly declare her "not preg- 
 nant," or that it is " the dropsy," or " a tumor," it might seriously 
 injure you ; but this mistake would bear no comparison to the 
 former, or to the injury you might inflict on an innocent person 
 by an inconsiderate and fallacious opinion. In every instance, 
 therefore, in which the slightest reasonable doubt exists, tem- 
 porize or suspend your opinion for weeks, or even montlis if 
 need be, till positively certain that it is " a kicking tumor," by 
 hearing the foetal hemrt-beat or feeling the fluttering of the child 
 within the uterus, or some other unequivocal sign. 
 
 Unmarried negresses, ladies of easy virtue, and other low 
 females (and sometimes even the wealtliy, young, and beautiful ; 
 in silk, satin, velvet, and gold), who fear they are pregnant, will 
 occasionally come to consult you, consume your time, and get your 
 opinion, and when you disco \er that they are really pregnant, 
 and refuse to produce abortion, will try to escape the payment 
 of your office fee. Where you fear such injustice, courteously 
 inform them at the beginning how much your fee is for your 
 time, opinion, and advice, and that it must be paid whether 
 your recommendation agrees with their wishes or not. After 
 settling the fee question, study their case, and candidly give 
 them your opinion and advice. 
 
 Should you ever encounter a case in which you believe the 
 destruction of the unborn child is (for physical reasons) necessary 
 to save the mother's life, do not consent to do it secretly, but 
 only after regular consultation with some other physician of well- 
 known probity. 
 
 To give directions for the prevention of conception ; or in- 
 structing in onanism, buggery, or other nasty conjugal sins; or 
 in the guilty use of condoms, sponges, syringes, or preventives 
 against venereal diseases, that encourage the timid to venture ;
 
 80 THE PHYSICIAN HIMSELF! 
 
 or in other instruments or expedients to aid crime or to defeat 
 nature ; though offenses beyond the reach of the laws, is, never- 
 theless, most derogatory and degrading to the physician, and a 
 disgraceful violation of his professional office. 
 
 Never carry away or keep chloroform, ergot, splints, instru- 
 ments, or other unused articles that patients have paid for, with- 
 out a clear agreement with them to that effect ; and be very, 
 very careful how you infringe upon the wine or liquor intended 
 for a sick person, or eat his cake, fruit, etc. Foolishly to do 
 such things would not only lay you open to criticism, but even 
 to the most mortifying charges of meanness or dishonesty if a 
 rupture of i'riendship should ever occur, — in fact, with such 
 things to fortify them, many people would be somewhat dis- 
 posed to welcome or create a rupture with you. 
 
 Be careful that attempts to conceal the presence of con- 
 tagious diseases, or other recognized sources of danger to 
 health, or of births resulting from clandestine marriage, or from 
 bastardy, do not involve you in the exposures and recriminations 
 that are apt to follow. 
 
 If you have skill in avoiding cases likely to render your 
 attendance necessary in court as a witness and other time-con- 
 suming annoyances, legal and social, it will prove a source of 
 much comfort and relief. 
 
 Cultivate agreeable relations with your professional neigh- 
 bors and keep old friendships in repair. The practice of medi- 
 cine isolates the members of our profession from one another 
 much more than one would suppose. Neighboring physicians, 
 fellow- workers in the same humane and beneficent profession, 
 and well known to each other by sight or reputation, daily pass 
 and repass each other without a look or nod ; and, although 
 acquaintancesliip and social amenities might be mutually agree- 
 able and beneficial, and possibly ripen into life-long friendships, 
 they often remain as strangers for years, unless some fortuitous 
 circumstance brings them together. 
 
 Two and two are four, — this is always true, whether we
 
 HIS REPUTATION AND SUCCESS. 81 
 
 are counting pebbles, people, or planets, but it is no more true 
 than that every physician ultimately rises or falls to his proper 
 position among his fellows. 
 
 "Pygmies are pygmies though perched on the Alps, 
 And pyramids are pyramids in vales." 
 
 Determine, therefore, that you will become something more 
 than a mere visiter of the sick. 
 
 From the very beginnhig of your career you have social 
 and fraternal duties, as well as individual and solitary ones ; 
 hence neither hold yourself aloof from the profession nor attempt 
 to isolate yourself, and attend to your own interests merely ; but 
 identify yourself, head and heart, with your medical brethren in 
 all legitimate public professional matters : attend the medical 
 conventions, assemblages of alumni, medical meetings called to 
 provide entertainment for visiting medical celebrities, memorial 
 meetings held to pay special tributes of respect to deceased 
 medical brethren, general meetings of the profession, held to 
 voice the opinions or policy of the profession as a body, regard- 
 ing public dangers, or to take associated action on matters of 
 public hygiene, or regarding medical laws ; or to devise and urge 
 the adoption of sanitary measures against epidemics, etc., etc. 
 Your presence at these unions and reunions will keep you in 
 touch with the profession, and be an earnest of the spirit that 
 actuates you. 
 
 Also, join the medical societies of your neighborhood ; and 
 if none exist, induce your medical brethren to join you in found- 
 ing one. Organization gives protection both to the profession 
 and to individuals. Society membership is a guarantee of your 
 good standing and that you pursue legitimate practice. 
 
 A good medical society is also something of a post-graduate 
 school. 
 
 " Steel whets steel." 
 
 And, next to actual personal experience, there is nothing so 
 valuable to the young practitioner as the medical society, for 
 there the collision of mind with mind, and of thought with
 
 82 THE PHYSICIAN HIMSELF: 
 
 thought, in amicable discussion, awakens reflection and deeper 
 reasoning, increases the intellectual grasp, stimulates the mental 
 digestive power, and liberalizes and enlarges the scope of both 
 the speaker and the listener, and acts as leaven to the entire pro- 
 fession. Nowhere else can you study so well the individuality 
 and the styles of different physicians, and discover the reasons 
 why each one is what he is, so fully, as at medical meetings. 
 There the specialist, the teacher, the general practitioner, and 
 the book-worm all meet, 
 
 "Well armed with mighty arguments," 
 
 and each in his own way contributes to the instruction and in- 
 tellectual recreation of the others. There you can meet your 
 neighbors on common ground, grasp each other by the hand, 
 look into one another's faces, and compare investigations, experi- 
 ence, and opinion by face-to-face discussion. 
 
 "Many things, obscure to me before, now clear up, and become visible." 
 
 There rivalries, dissensions, jealousies, and controversies can 
 be softened, and professional friendsliips be formed and cemented ; 
 there you can find opportunities for pleasant, social intercourse 
 with worthy men. There you can also silently measure the 
 height and depth of your medical contemporaries, and see the 
 difference between the serious and the superficial tliinker, the 
 convincing and the faulty logician, the judicious and the in- 
 judicious, the alert and the stupid, intellectual giants and men- 
 tal dwarfs ; there you can also estimate the influence of pleasing 
 actions and deportment, and the intellectual and moral worth 
 of those who command respect, and discover and learn to avoid 
 the glaring imperfections of others who do not, — and in many 
 other respects learn effectually to separate the chaff from the 
 wheat. 
 
 Medical societies, of course, are neither a specific for all 
 personal deficiencies nor a panacea for all professional sores. 
 There you may find men good enough ordinarily to appear with 
 the best, but weak enough, under temptation, to behave with
 
 HIS REPUTATION AND SUCCESS, 83 
 
 the worst ; some, too, who neglect all their better duties under 
 the plea of "lack of time," and attend only when there is to 
 be an election, a feast, or a quarrel. Spending a few hours 
 among honorable physicians once a week will not life Prof Sin- 
 bad into angelhood, change Dr. Buffoon into a gentleman, or 
 convert Dr. Trickmore or Dr. Quackfrombirth into professional 
 Chesterfields, or lend Dr. Oilyone or Dr. Doubleways consciences 
 like Milton's. But, to repeat : intercourse at a medical society 
 does serve as an intellectual exchange, where one may hear the 
 discussion of moot points and live questions in medicine, and at 
 the same time establish with his brethren friendly and honorable 
 relations. One often sees distrust converted into friendship 
 merely by acquaintance. 
 
 Independently of the benefits and improvement accruing 
 to the members of medical societies individually, they give a 
 sound and healthy tone to the entire profession, stimulate tlie 
 growth of medical science, and also generate and keep alive a 
 genuine professional and brotherly spirit that tends to minimize 
 all that is unprofessional. 
 
 Never oppose the admission of any clean-handed, honorable, 
 and competent person into society membership for private or per- 
 sonal reasons, or for any cause other than ineligibility or unfit- 
 ness for the honors and benefits membership confers, because 
 such societies exist for the advancement of medical and sursical 
 knowledge and for the benefit of all regular physicians, and it 
 would be unjust to mix private feelings with professional duties, 
 and interpose an objection or a blackball on purely personal 
 grounds. 
 
 Do not hesitate to take part in the medical debates when- 
 ever you have anything valuable to ofi"er, whether it is gleaned 
 from literature, or from the great school of experience. If your 
 views difi"er from anotlier's, express them with courtesy and 
 respect. If you have a contribution or new fact to offer, an 
 invention, or new pathological views, or a discovery or new 
 secret to announce, a new instrument to show, an operation to
 
 84 THE PHYSICIAlSr HIMSELF*. 
 
 describe, a patient or specimen to present, a report to make, 
 or a new treatment, a new therapeutic agent, a promising theory 
 or a talismanic charm to tell of, or anything whatever to say, 
 do it in a careful, clear, methodical manner, then sit down ; but 
 when you have nothing worth offering, do not talk for talk's 
 sake, but make Ciceronian silence your law, and do not break 
 it. When on the floor, take care neither to abandon your 
 medical vocabulary for the vernacular, nor let your professional 
 manner degenerate. This will soon teach you to arrange your 
 thoughts quickly and to express them clearly. 
 
 Remember in debate, as elsewhere, that there is nothing 
 infallible ; that the pliysician must school his prejudices and be 
 open to conviction. Toleration of a difference of opinion is a 
 lofty virtue ; therefore, say or do nothing to wound the pride or 
 feelings of any other member, and if any incautious remark, 
 misstatement, or personal reflection drops from your lips, be not 
 slow to make proper atonement. Those who, Xero-like, are 
 alwavs positively right, while all others are positively wrong; 
 who can brook no opinion that does not accord with their own, 
 are usually deemed hot-headed, rash, and indiscreet, and very 
 unsafe guides. Also, remember that differences of opinion are 
 quite compatible with friendship, and that controversies, discus- 
 sions, and parliamentary battles, no matter how sharp or ex- 
 cited, are usually conducted by men of discretion within the 
 bounds of decorum, and without violations of the ordinary rules 
 of good breeding; and, also, that there is no mode of practice 
 nor remedy for any disease which has not been the subject of 
 obstinate dispute, and that every great discovery or startling 
 announcement stirs the whole medical world to testing and 
 reporting, asserting and denying. 
 
 You will find that many people entertain a belief that 
 medical societies exist for the pecuniary advancement of their 
 members, just as trades-unions and like organizations strive for 
 fewer hours and more pay for the working-classes, and that, in 
 some way or other, they tend to limit the freedom of personal
 
 HIS REPUTATION AND SUCCESS. 85 
 
 opinion and abridge the individual rights of their members. Be 
 careful to correct such errors on all suitable occasions, and to 
 inform those thus misled that medical societies exist not for 
 selfish, but mainly for scientific, purposes, and the public good. 
 
 Keep up your medical studies, or the knowledge which 
 you have already acquired will soon become misty and ere long- 
 slip from your memory. Without more or less continuous 
 study the details of cases and the symptoms of many diseases 
 are apt to be forgotten ; indeed, after two or three years have 
 elapsed, the mind does not often bring back the details of par- 
 allel cases, or of cases for comparison, unless they are ex- 
 tremely uncommon or interesting, and their utilization is thus 
 lost to mankind. Test your memory noAv by asking yourself 
 the following questions: What did you have for breakfast on 
 the third day of last month'? What kind of a day was the 
 ninth of last February i 
 
 In consulting journals and text-books, remember that 
 Y)ractice found successful in your own climate or region is, as a 
 rule, more to be relied upon locally than that applicable to the 
 same disease in other climates. Also, avoid relying on anti- 
 quated works on practice and back volumes of journals as 
 guides in so progressive a science as medicine. New investiga- 
 tions and rapid progress render new text-books essential to those 
 who would keep up with the medical world and maintain the 
 skilled readiness and self-reliance which the consciousness of 
 being fully posted on new instruments, methods, and improve- 
 ments naturally inspires. 
 
 Endeavor to collect and form a library of standard profes- 
 sional works as soon as possible after graduating ; books are the 
 tools, the literary apparatus with which we cut and dig our way 
 to knowledge, and we now have more books and better books 
 than ever before. Money spent in this way will return a 
 hundredfold. There is an art in selecting material to read ; buy 
 the best authors and always the latest editions, but take care 
 that irrepressible book-agents, with "the greatest work ever
 
 86 THE PHYSICIAN HIMSELF: 
 
 published," do not induce you by their importunities to sub- 
 scribe for a jumble of books for which you have but little or no 
 use. No one can patronize everything-, or even read one-tenth 
 of all that is offered, unless he has nothing else to do. You 
 need not be ashamed of a library of twenty or thirty well- 
 selected volumes of recent date, provided you have thumbed 
 them well, and are lamiliar with their contents ; and were you 
 even to buy one volume at a time and study that well before 
 ii'ettiu"' the next it would be no mistake. 
 
 Subscribe to one or more medical journals and scientific 
 publications, and read and digest them carefully, so as to keep 
 abreast of the discoveries and theories of the passing day. They 
 are necessary to the progressive physician. But neither swear 
 at nor by all you see in them ; be especially distrustfid of pub- 
 lications, edited by Dr. Inkpot or Prof Penn, that exist for the 
 purpose of advertising either their owner's hobby or his goods, 
 or a college or its clique. As a rule, you will find that state- 
 ments found in the text-books and in standard monographs are 
 more mature, more pointed, and more representative of collect- 
 ive learning, and, in relation to therapeutics, generally much 
 more reliable than those in journals, which are often founded 
 on a single case, or the fine-wrought theories or exaggerated 
 i'ancy of some unbalanced rainbow chaser, 
 
 "Educated beyond his intellect ;" 
 
 or the unconfirmed experience, representations, expectations, or 
 speculations of some partial observer, riding a hobby or pitting 
 himself against everybody. 
 
 Take care to have a good Dispensatory and a work on 
 Medical Jurisprudence among your books. 
 
 Acquaint yourself fully with the contents of your library, 
 so as to be able to refer to whatever you need without hunting ; 
 also, have one certain place for every book. 
 
 Never allow yourself to be biased too quickly or strongly 
 in favor of new or unsettled theories, based on physiological, 
 microscopical, chemical, or other experiments, especially when
 
 HIS REPUTATION AND SUCCESS. 87 
 
 offered by the overzealoiis to establish their own conclusions or 
 preconceived ideas, or by those who have identified themselves 
 with the latest medical novelty. 
 
 Also, do not allow yourself to be led too far from the 
 practical branches of your profession into histology, pathology, 
 microscopic anatomy, refined diagnostics, bacteriomania, — 
 
 "Ha! liu ! thou, too, hust some crotchets iu thy head," — 
 
 comparative anatomy, biology, psychology, the arrangements 
 of electrical currents in muscular fibre, and analogous subjects, 
 that merely interest or create a fondness for the marvelous ; else 
 it will impair your practical tendency and give your mind a 
 wrong bias, and your usefulness as a practicing physician will 
 almost surely diminish. The first question for you, as a prac- 
 titioner, to ask yourself in everything of this kind is. What is 
 its use 1 
 
 I would not apply these remarks to school-men, or to pro- 
 fessional teachers and experimenters, who have hospital and 
 laboratory facilities, and, perhaps, wealth and leisure, and are 
 nobly pursuing the higher reaches of purely scientific investi- 
 gation and original thinking on borderland questions, chiefly for 
 unselfish love of them, or to gain fame or distinction therein, 
 and become truly great; — 
 
 "That man is great, and he alone, 
 "Who serves a greatness not liis own;" — 
 
 or to others who, being favorably situated, are delving solely for 
 the pursuit of pleasure, and not looking to their practice for 
 support. Nor would I dare say these are not priceless kinds 
 of knowledge. I mean to say that skill in the practice of med- 
 icine does not depend so much on what the practitioner knows 
 abstractly as what he knows and has the use of, and that a per- 
 son may get so deeply absorbed in the hemi-, demi-, semi- 
 quavers of the deep labyrinths and fine subtleties of science and 
 high-thinking as to regard nothing but them, and that your 
 most useful studies as an eveiy-day practitioner will be the 
 well-ascertained facts of the profession, which are essential to
 
 88 THE PHYSICIAN HIMSELF: 
 
 every skillful physician : knowledge that relates to the structures 
 connected with accidents, operations, and surgical affections, 
 and to those of the organs that are the principal seats of medi- 
 cal diseases ; practical subjects required for the daily duties of 
 the profession, and, above all else, the art of treating diseases 
 with success. To know how to relieve a colic, pass a catheter, 
 or cure a node, is a thousand times more valuable than to 
 know that the anterior cornu of the fourth ventricle of the 
 brain runs a course that is backward, outward, downward, for- 
 ward, and inward ! 
 
 The great popular test of medical skill is curing the sick ; 
 and you will find that your reputation will depend more on the 
 successful treatment of your cases than upon familiarity with the 
 ultra-scientific ; and you will meet physicians, possessed of 
 comparatively small knowledge, so dextrous in its use that they 
 have done great good in the world, and ridden over the heads 
 of some far better versed in the books. 
 
 Never, for the sake of appearing in print, publish trifling 
 or hastily prepared medical articles, as whatever one writes is 
 naturally supposed to be a mirror of his own mind. Do not, 
 however, hesitate to write whenever you have anything valuable 
 or instructive to offer, both for the benefit of others and to 
 enhance your own value, reputation, personal respect, and 
 dignity. 
 
 "Of all the arts in which the wise excel, 
 Nature's chief masterpiece is, writing well." 
 
 All people respect the man who thinks. 
 
 When possible, base your articles on solid facts, or on an 
 analysis of facts, rather than on s])ecidation and theory. Let 
 your diction be pure and simple, and as short and aphoristic as 
 perspicuity will allow, so as not to weaken the effect of your 
 ideas, or obscure them in a lot of long-winded or idle verbiage ; 
 rather go straight to the point, and make every word count, in 
 expressing clear, bright ideas, and let accuracy be characteristic 
 of all you write.
 
 HIS REPUTATION AND SUCCESS. 89 
 
 Be especially careful to give your paper, essay, or book a 
 concise, appropriate, and, as far as possible, an attractive title, — 
 one that indicates its contents, and shows with sufficient clear- 
 ness the general character, purpose, and point of the remarks 
 which are to follow. 
 
 "Oh, liow that title befits my composition ! " 
 
 This is essentially necessary when the title of the work is to be 
 put in an index or catalogue. Such indefinite titles as " A 
 Curious Case," " Clinical Communication," " Plain Facts," — 
 
 " Bless us ! what a word on 
 A title-page is this ! " — 
 
 " A New Method," " A Case of Interest," etc., furnish no clue 
 whatever. 
 
 In writing, cultivate perspicuity, precision, simplicity, and 
 method ; avoid flaws of grammar or logic, and unmerciful diffuse- 
 ness, and do not interlard with far-fetched, jaw-breaking scraps 
 and patches from the dead or foreign languages, unless a trans- 
 lation be appended ; for, unless it be some time-honored phrase, 
 or hackneyed quotation, the average reader will probably be 
 forced either to pass it over luisolved, or take down his classical 
 dictionaries, dusty book of quotations, or his school-boy grammar; 
 besides: — 
 
 " Every man is not bred at a 'Varsity.' " 
 
 The English language, the language of Shakespeare, Milton, 
 and Bacon, is of itself capable of giving lucid, eloquent ex- 
 pression to every thought of man, and it is to be regretted that 
 Fortislingua, or any one else, should, from superfluous wisdom, 
 or pedantic pretension (Angiographic aphasia), fail to express 
 himself in his own mother-tongue, and make his work brilliantly 
 incomprehensible by throwing in handtuls of Latin and Greek, 
 almost as a cook peppers his broth, as if 
 
 "This writer has been to a great feast of languages and stolen all the scraps." 
 
 The recent attempt to supersede the old weights and meas- 
 ures (which every one understands) by the foreign-looking 
 metric system did not succeed ; it is therefore scarcely worth
 
 90 THE PHYSICIAN HIMSELF I 
 
 while now to discuss its merits. When you report cases or pub- 
 Ush anything in wliich weights are given, either use the famiUar 
 Enghsh w^eights and measures, or give both the old and the 
 metric ; to use the French system only savors of affectation. 
 The average reader makes no attempt to carry the metric equiv- 
 alents in his mind, and if you give metric measures only he may 
 not take the trouble to calculate, but pass your effusions by 
 without getting the information you wish to convey. 
 
 Take notes of all remarkable cases, but do not report or 
 publish any that are not unique, or at least tliat do not present 
 some curious, rare, or very instructive feature, or militate in 
 some way against accepted theories ; otherwise, you will merely 
 increase without adding anything valuable to existing records. 
 You will find every department of medical literature is fast 
 becoming loaded down with theoretical discussions, speculative 
 dissertations, compilations, and word-building; old, universally- 
 known things said in a new form ; many 
 
 "An anxious blockliead ignorantlj'^ read. 
 With loads of learned timber in his head," 
 
 seeming to say : — 
 
 "In pity spare me, while I do my best 
 To make as much icaste-paper as the rest." 
 
 You should omit book-matter generally known, and contribute 
 original work, new things rather than new phrases, new ideas 
 rather than new words. Use a plain, intelligible style ; do not 
 count your words, but see that every word counts; also, avoid 
 such ambiguous descriptions as " the color of an orange," " tlie 
 size of a strawberry," " about three inches long," " about as 
 thick as blood," etc.; and be as brief and concise as justice to 
 your subject will allow, and, for the poor printer's sake, prepare 
 your matter so as to please his eye and require but little or no 
 revision on account of grammatical errors, bad phraseology, or 
 faidty style of construction. 
 
 When you begin authorship and write books, essays, or 
 monographs, use, for the sake of convenience, the smallest-sized 
 sheets of white note-paper, and avoid rolling ; this will enable
 
 HIS REPUTATION AND SUCCESS. 91 
 
 you to keep them flat and to handle them more easily hi writing, 
 altering-, and rewriting pages ; also, to carry them to and fro, 
 and to preserve them much better than if large. If intended 
 for the press, write only on one side of the sheet, and leave a 
 margin at the edge. 
 
 Be careful, also, to avoid the useless custom of appending 
 to your name an excessively long list (like the tail of a comet) 
 of all the titles and alphabetical appendages that you can rake 
 together, with lialf a dozen etceteras ; such enumeration is in bad 
 taste, and tends to excite the ridicule of persons of discernment. 
 The chief use of sufiixes is that the identity of the writer may 
 be recognized ; a single suffix, or simple title, or the name of 
 your town, street and number, are unpretentious and yet suf- 
 ficiently explicit. Some publishing houses evidently think the 
 use of titles by authors who have reputation as writers aids the 
 sale of a work. 
 
 Never furnish a report, statement, or opinion on any im- 
 portant case or subject for publication, either in book, journal, 
 or newspaper, without a proviso that you are to see, and if 
 necessary revise the proof, and correct the printer's errors in 
 spelling, punctuation, etc., before it goes to press ; otherwise, 
 you may find some purblind proof-reader or go-ahead printer 
 making you say the reverse of what you intended, thus necessi- 
 tating a long list of " errata," or may be causing you to regret 
 that you ever allowed the article to appear in print. 
 
 Do not fail to pay your honest debts punctually, even 
 though you be cheated out of lialf you earn. Tlie best plan is 
 to restrict your expenditures to your income, and pay as you 
 go, and if you cannot pay much do not go far ; for to be in debt 
 for horses, carriages, horse-feed, or, still worse, for dress, lux- 
 uries, rent, servants' wages, etc., cannot fail to set the tongue 
 of scandal to wagging freely and injuriously, to the possible 
 ruin of your credit. Payment must be made sooner or later, 
 and it is far better to discharge each liability as it becomes due 
 than to be paying those that should have been paid a month or
 
 92 THE PHYSICIAN HIMSELF: 
 
 a year ago. Be especially careful to keep your medical society 
 and journal dues paid promptly, and to discharge all other pe- 
 cuniary obligations. To borrow books, instruments, umbrellas, 
 money, etc., especially if you keep them beyond the proper 
 time, or return tliem in bad condition, will also tend to depre- 
 ciate you more with the lenders than you would suppose. 
 Never involve yourself by borrowing any apparatus, instru- 
 ments, etc, from one physician, or patient, to lend to another; 
 if necessary, introduce the parties to each other, and let the 
 borrower borrow on his own responsibility. 
 
 It is needless to say that health and decency require you to 
 guard against uncouth, untidy, and repulsive habits ; do not 
 pick your teeth or pare your finger-nails, or squirt tobacco- 
 juice around you at your visits, or have your breath, liair, and 
 clothes as redolent as a bar-room spit-box with pipe or cigar 
 fumes, alcohol, stale tobacco, dead beer, etc., or w4th cloves, car- 
 damom, and other masking aromatics, or the smell of iodoform, 
 carbolic acid, and other disgusting medicines on hands or 
 clothes, or you will unavoidably prove obnoxious and disgust- 
 ing, and invite criticism and possibly engender aversion, and 
 entail the loss of your patient. Coarseness and vulgarity are 
 sufficiently disgusting in anybody and under any circumstances, 
 but in a physician, and especially in the presence of females, 
 they are unpardonable. 
 
 Avoid every habit that can give reasonable offense : to make 
 your appearance in your shirt-sleeves, witli unwashed hands, 
 dirty finger-nails, dingy cuffs, egg-spotted or tobacco-stained 
 shirt-bosom ; greasy coat, out at elbows ; ragged pants, fly- 
 speckled or crumpled hat, shaggy whiskers, or four or five days' 
 beard on the face ; rough, creaking, or dirty boots ; or with pipe 
 or stump of cigar in mouth, or chewing a quid of tobacco; 
 or skylarking, showing unseasonable jocularity ; using coarse, 
 vulgar, and impassioned language ; habitual swearing, loud 
 guffaws, etc., will by many be regarded as evincing moral Aveak- 
 ness, and tend to diminish your influence and prestige, detract
 
 HIS REPUTATION AND SUCCESS. 93 
 
 from your dignity, and greatly lessen you in public esteem, by 
 impressing people with the idea that, after all, you are but an 
 ordinary person, and not up to their ideal standard. 
 
 Moreover, to be seen carpentering, painting, or displaying 
 other common-place or out-of-place talents, would also suggest 
 that your mind was not engrossed witli your profession. You 
 may possibly secure faith in spite of these, but usually such 
 proclivities unquestionably tend to decrease it. 
 
 The nerves and tactile corpuscles of the tips of your fingers 
 will have much to do with your skill and success ; these nerves 
 are sometimes even superior to the sense of sight ; to palpate 
 the chest or abdomen, examine tumors, make vaginal examina- 
 tions, do surgical work, etc., the hand must be steady and the 
 touch must be nice and delicate. If your fingers, instead of 
 having their sensibility protected and their tips educated, are 
 rendered callous and clumsy by manual labor or rough usage, 
 their delicate nerves will be unfit for these duties. 
 
 Beware of a certain temptation to which the practice of 
 medicine especially exposes you. The irregularities, anxieties, 
 and exhaustions ; the cold, the wet, the hunger, the night-work 
 and loss of sleep, and the hospitality of patients and other friends, 
 all unite to tempt physicians to use alcoholic stimulants. Re- 
 member that, although drunkenness and the idle life asso- 
 ciated with it may be tolerated in physicians who are fully 
 established in practice, because confidence and friendships had 
 been formed and their talents and worth had become known 
 previous to the formation of the habit, it would be fatal to any 
 one in the formative stage of reputation, or just beginning to 
 gain the confidence of the community ; for no one who begins 
 life burdened with this vice will be trusted or employed. 
 Even when the older physician, who drinks, is employed, it is 
 done with loathing, and only to make use of the good half of 
 him, which cannot be separated from the bad, and his visits are 
 looked for by those whom necessity puts into his hands with 
 disquietude and dread.
 
 94 THE PHYSICIAN HIMSELF I 
 
 AVhat is a more disgusting spectacle than a drunken, swear- 
 ing, reckless sot-of-a physician, with whisky-soaked breath, 
 staggering around the bed of a sick or dying person, profan- 
 ing the occasion by the thoughts he excites, and by his gross- 
 ncssl The wisest policy for you personally is to avoid 
 intoxicating drinks, which cause so much crime, sickness, and 
 poverty, and allow others to do as they think best. The cause of 
 drunkenness is drinking, and if you are foolish enough to drhik 
 liquor, wine, or beer when people offer it to you, you not only 
 run the risk of getting fond of it, but nine chances to one tliose 
 very people Avill be the first to add the charge that "he drinks'* 
 whenever any other person says anytliing else against you ; but 
 when it becomes known that you never touch the demon it will 
 be of immense advantage to your reputation. But intemperately 
 to urge puritanical ball-and-chain temperance on others, or being 
 an officious member of temperance, secret, or beneficial societies, 
 will aid you but little if any in tlie acquirement of practice, — 
 the most desirable class of which is the quiet family business 
 that you will attract by a faithful and kindly endeavor to do 
 your very best for all who apply for your services as a 
 physician. 
 
 A physician's life, like a pantomime, is full of wonderful 
 changes, and, being a public character, lie knows not the day 
 he may need the friendship or good offices of this, that, or the 
 other person toward wliom he may have felt, and unwisely 
 shown, political, or religious, or personal hostility; therefore, 
 do not allow yourself to grow morbid on temperance, total 
 abstinence, local option, prohibition, and other sumptuary cru- 
 sades, partisan strifes, and puerile contentions ; as they will be 
 apt to recoil on your head if you make yourself prominent in 
 them. If your office is located very much nearer the cliurcli 
 than the tavern, and if you lean to tlie Sabbatarian element in- 
 stead of the pitfalls of infidelity and atheism, so much the better; 
 but proselyting and pushing matters of a partisan, political, 
 radical, or secular nature is not your function, and you cannot
 
 HIS REPUTATION AND SUCCESS. 95 
 
 become officious in them and their irritating methods without 
 setting (about) one-half of the community against you, and 
 exciting enmity, and maybe personal liostility. You had, 
 therefore, better leave all subjects for discord, heart-burnings, 
 animosities, and angry discussion, whether political or religious, 
 to the general public, unless your pecuniary or social position is 
 such that you can very well afford to run the risk, or are driven 
 to do so by conscientious scruples that outweigh all other con- 
 siderations ; and even then it is better to let your profession 
 occupy the dominant place and your patients be your first and 
 principal care. 
 
 AY hen requested to write a prescription to enable an ailing 
 person, who really needs it, to procure liquor on Sunday or in a 
 local-option district, comply with becoming good nature, but 
 accept no fee for it. 
 
 Presents from fond or grateful, very liberal or romantically 
 generous patients, although flattering, will almost invariably 
 lead to the disarrangement, if not actual rupture, of the legiti- 
 mate pecuniary relations previously existing between yourself 
 and the giver, which it may consequently be impossible fully to 
 re-establish. 
 
 "In the long run, gifts are often losses." 
 
 Most practitioners can probably recall instances in which presents 
 of knee-blankets, whips, baskets of game or fruit, boxes of cigars, 
 wine, pet animals, canes, free passes, gloves, new hats, curiosi- 
 ties, baby-named-for-you, etc., have spoiled their bill, and proved 
 not only unprofitable, but exceedingly expensive. When you 
 foresee such a result, be guarded. 
 
 You will find it a good rule to decline all presents and 
 favors that are likely to place you under embarrassing obliga- 
 tions to patients, A still more important rule is to avoid mixed 
 dealings and crossed accounts witli careless hucksters, grocers, 
 feed-men, milk-men, and other patients, as such dealing will 
 rarely continue to be satisfactory; they often lead to dis- 
 agreements, and in " squaring-up " will almost always result in
 
 96 THE PHYSICIAN HIMSELF: 
 
 your getting only about half as much for your services as if you 
 had avoided entanglements. It is decidedly better to conduct 
 your affiiirs upon strictly business principles, i.e., let those for 
 whom you work pay you in money, you in turn doing the same. 
 In a word, you had better avoid everything that tends to efface 
 your business rules. 
 
 Preserve a proper degree of gravity and dignity toward 
 patients. Frivolous conduct, vulgar jokes, horse-play, clownish 
 levity, unseasonable sportiveness, — 
 
 "I love to laugh, though Care stands frowning by, 
 And pale Misfortune rolls her meagre eye," — 
 
 and bar-room familiarity are unprofessional, and tend to breed 
 contempt and scandal. Discourage all attempts of roughs and 
 toughs to rudely address you with a " Hallo, Doc !" or by your 
 first name, or in any way to pass the limit of propriety with you. 
 Show every one proper respect, and exact the same in return. 
 Do not, however, understand me to advocate solemn pomposity, 
 or to condemn good-natured pleasantry. Not so ; for, when gen- 
 tlemanly and in moderation, it is often very appropriate, and 
 sometimes actually serves as a tonic to a patient's drooping spirits. 
 If you, happily, possess a becoming earnestness of deportment, 
 and at the same time wear a cheerful mien, it will be health to 
 yourself and sunshine to your patients. 
 
 Avoid dining out with your patients and attending their 
 tea or card parties. Eat as seldom as possible at their houses, — 
 only when unavoidably detained there by cases of labor, con- 
 vulsions, and tlie like. There is a tendency to conviviality and 
 abandon around the festive board that has a leveling effect, and 
 divests the physician of his legitimate prestige. It is far better 
 to eat a cold repast at home than to occupy the best seat at the 
 table and partake of the most savory viands of some patients. 
 Let a physician once unbend himself among a certain class of 
 people, and he risks a complete loss of their professional appre- 
 ciation and regard. 
 
 When compelled by circumstances to accept a meal, if you
 
 HIS REPUTATION AND SUCCESS. 97 
 
 chance to be served alone, so much the better ; if seated to eat 
 with the family, be courteous, but somewhat reserved, and 
 exliibit no uncalled-for levity, but simply endeavor to render 
 yourself agreeable. Shun all badinage and gossip and undue 
 extolling of the viands, and be careful to make no after allusions 
 elsewhere to the " snowy cloth," the " delicious butter," the 
 "juicy beefsteak," etc., as though you were a stranger to these. 
 
 Try to give satisfaction at your visits ; show that you are 
 anxious to relieve both the body and the mind of your patient, 
 and you will not, can not, fail to succeed in your ambition to get 
 practice. To do this fully you must, of course, feel and express 
 a genuine interest in the case and in the effects of the remedies 
 you are employing. Bear in mind, also, that, with any prac- 
 titioner, the first essential to success is that he should command 
 the confidence of his patients. 
 
 When necessary to scold or find fault with your patients or 
 their attendants (as is often the case), either preface or follow 
 what you say by explaining that you are not scolding in anger^ 
 but because you feel an earnest desire to have tliem do right for 
 their own and others' sake. By thus prefacing your reproof you 
 will completely disarm resentment, and, no matter how severe, 
 all you say will be taken in good part. 
 
 If you are unmarried, it will, no doubt, be often cited 
 against you ; but the truth is, there is no great professional ad- 
 vantage gained by simply being married. The objection to 
 most unmarried physicians is really not their celibacy, but their 
 youthfulness, which may also be quoted against you even if 
 married. It is true that the conversation and society of intelli- 
 gent and virtuous females impart self-respect to man, and give 
 elegance and tone to his manners ; and for him to feel that the 
 inspiring eye of such a one is upon him often inflames his soul 
 with ambition to reach the highest goal and to win the greenest 
 laurels. It is also true that " it is not good for man to be alone," 
 and that every physician should, when his pecuniary circum- 
 stances justify the step, look out for a wise helpmate, settle
 
 98 • THE PHYSICIAN HIMSELF: 
 
 down, and make for himself a home ; but to marry with an eye 
 to business only would be a very imprudent step, and entail 
 expenses and responsibilities without corresponding benefits. 
 Besides, you should keep both business and marriage on a higher 
 plane. 
 
 " Without hearts there is but little home, and less happiness." 
 
 You will, in your professional career, often witness the misery, 
 cares, and anxieties that flow from degrading the tender, half- 
 human, half-divine bonds of marriage by entering into it simply 
 to gratify lust, to obtain money, or from other ill-regulated pas- 
 sions, or from any other considerations whatever than pure love 
 and congeniality of souls, and you had better seek no friend 
 this side of heaven than risk the formation of the wrong kind 
 of domestic relations yourself. 
 
 Everybody wants a lucky, conservative medical attendant, — 
 
 "Many funerals discredit a physician," — 
 
 therefore, a series of dystocias, or of deaths in childbed, or of 
 unsuccessful surgical operations, or of malignant cases, or cases 
 of any kind that have terminated unsatisfactorily, often injuri- 
 ously affect the physician for years by attaching to him — es- 
 pecially if he be a beginner — either charges of being blind to 
 danger and to duty, or a long-to-he-reinemhered reputation for 
 bad luck. If such a series unfortunately threatens you in the 
 beginning of your practice, seek to strengthen yourself by con- 
 sultations with able brethren. 
 
 No one can succeed fully without the favorable opinion of 
 the gentle maids and acute matrons with whom he may be asso- 
 ciated in the sick-room. They can be his best friends or his 
 worst enemies. AVomen and cliildren constitute four-fifths of 
 all the population. Females have more sickness than males, 
 and the females of every family are the autocrats of the sick- 
 room, and have a potent voice in selecting the flimily physician. 
 I have sometimes thought that the real secret why so many truly 
 scientific physicians — to whom a patient is an object of scientific 
 interest, just as a rock is to a geologist, or as a flower is to a
 
 HIS REPUTATION AND SUCCESS. 99 
 
 botanist, who, more naturalists than physicians, love the rays of 
 philosophy and the beams of" science better than humanity ; and 
 with their eye at the end of the microscope, watch cases merely 
 from a scientific point of view, or to study the action of 
 medicine — very often decidedly lack popularity, and fail to get 
 much practice, is that cold, unemotional, impassive logic and 
 high theoretical attainments, however much admired abstractly, 
 are not a certain guarantee of popular favor, since they are often 
 attained at the expense of the endearing sentiments, and hence 
 create none of those friendly ties upon which getting practice 
 partly depends; but, on the contrary, are often associated with 
 a deficiency of the qualities of head and heart which appeal to 
 the weak side of woman — Iter emotions — and gain her favoring 
 opinions, and secure her good will and word. 
 
 The power to impress those you meet with a favorable 
 opinion of your adaptation to your calling is a potent and 
 important factor. Discipline yourself by rigid self-examination 
 whenever you have conducted yourself unsatisfactorily. This 
 will teach you to conceal or eradicate your defects and faults, 
 and to give prominence to your good qualities. 
 
 The faculty of being able to please, and thereby make 
 friends of those who employ you in an emergency or tenta- 
 tively, is likewise a power that you should carefully cultivate. 
 
 You will find, also, that remembrance of the names of 
 children and of patients whom you see but rarely, and the 
 ability to recall the salient points of former interviews with 
 them, gives you a reputation for a good memory, and is a very 
 useful adjunct to other qualities. 
 
 Three-fourths of all the population are children ; and their 
 likes and dislikes will control your destiny in many a family. 
 Many people patronize various forms of quackery for no better 
 reason than that "the children take it easily," knowing from 
 experience that an attempt to give pills or bitter doses to refrac- 
 tory children who dislike compulsion, or spoilt children with 
 resolute wills, whose nurses and mothers have taug-ht them to
 
 100 THE PHYSICIAN HIMSELF I 
 
 look on " the doctor " as a barbarian or butcher, means a fight 
 and a failure. 
 
 In your efforts to estabhsh a practice you must not rely 
 strongly on friendship or social influence, for men are influenced 
 by self-interest, and your truest friends and acquaintances who 
 knew you when you were a boy may prefer that you test your 
 skill and gain your experience by attendance on others rather 
 than on them or theirs. 
 
 Socially, you may be a great favorite while all are well ; 
 but when sickness occurs and death threatens, the principle 
 of self-interest arises, and the impulses of friendship and 
 kindred become dormant and do not determine the choice of 
 of a physician. Xo member of any family circle will be spared, 
 if any human power can save, and thouglitful persons, terrified 
 at the possibility of losing the kind, provident husband, the 
 beloved wife, blooming daughter, darling babe, dutiful son, or 
 honored parent, as the case may be, instinctively send for the 
 physician in whose skill they have most confidence. They go 
 past Dr. Newstart, about whom they know too little ; past Dr. 
 Drinker, whose system requires so much stimulating, about 
 whom they know too much; past Dr. Gay, Dr. Fickle, Dr. Aim- 
 less, Dr. Butterfly, Dr. Misfit, Dr. Strangeways, Dr. Blackleg, Dr. 
 Phunnyman, Professor Halfsmart, and all others whose \mpro- 
 fessional demeanor proves them to be either unripe or unsuited 
 to duties so delicate, so precious, so weighty as that of a family 
 physician, — past all, till they reach Dr. Standbest, in whom their 
 faith, their medical confidence, centres. Faith is the great con- 
 trolling guide in choosing him who is to stand by what may 
 be one's death-bed or the death-bed of one's loved ones. The 
 greatest two elements of medical faith are : first, a belief on the 
 part of the patient that you are anxious to do the best that can 
 be done for him ; second, that you are not only willing, but 
 know how. 
 
 Be courteous and considerate to every one, especially when 
 you are vexed or in a hurry ; discourteous abruptness in phy-
 
 HIS REPUTATION AND SUCCESS. 101 
 
 sicians inflicts many useless wounds, some of wliich are difficult 
 to heal. Politeness and courtesy are seed that cost nothing, 
 can he. planted anywhere, that always bear good fruit, — fruit 
 that never withers. Resolve that you will cultivate them as 
 long as you live. 
 
 When boys or young men come to you for assistance for 
 their base-ball clubs, or their library, and the like, give some- 
 thing, and give it freely. If ladies ask you for a donation to aid 
 the heathen (! ! !) or to help buy a carpet for their church, for 
 the relief of some one afflicted, or any other laudable object, 
 give willingly and cheerfully. If the tiny boy or girl comes to 
 sell a concert or other ticket, buy it laughingly; for contributions 
 of this sort not only do good to others, but often prove to be a 
 judicious professional investment for self Were you to scowl 
 and, with lengthened phiz, say " no ! ! " the young man and 
 woman and the tiny boy would all unite in calling you " old 
 stingy," and ever after avoid you. 
 
 There is a significant fact which you might not observe 
 without having your attention called to it ; it is that, after you 
 get into full practice, your days, weeks, months, and years will 
 flit by faster than those of other people, like the mists of the morn- 
 ing, because, as a physician, you will be incessantly engrossed 
 with a medley of important absorbing cases, with the nature of 
 your occupation constantly changing, and the flight of your 
 time will consequently be almost magical. 
 
 You, yourself, are mortal ; therefore, you should not only try 
 to prolong your life, but to get as much out of it as you can, by 
 seeking proper relaxations and amusements while the age for 
 enjoying them remains : — 
 
 "As we journey through life, 
 Let us live by the way." 
 
 Many physicians, in the eager pursuit of business, foolishly 
 postpone all relaxation from one time to anotiier, intending to 
 give up some of the hardest of their work and worst of their 
 privations, and to fall back on their reiautation for skill and
 
 102 THE PHYSICIAN HIMSELF I 
 
 experience, and then to take life easier, indulge in diversions, 
 social amenities, and pleasure, when they get older, — in the 
 autumn of life, — when the hair grows gray, etc., forgetting 
 that 
 
 "An unlaid egg is an uncertain thing," 
 
 and thus unwisely neglect to seek enjoyments till they lose all 
 taste for them, till they know nothing, and are fit for nothing 
 but 
 
 "Work ! Work ! ! Work ! ! 1 " 
 
 and to wear out their lives in routine toil and drudgery daily and 
 nightly, as the slave of the sick public, on the rough, hard, joy- 
 less treadmill of practice, hurrying up-stairs, down-stairs, from 
 one sick-room to another, from some horrible sight to a stinking 
 case, a death-bed, or a dangerous amputation, and from that to 
 a repulsive obstetric case, or a puking baby, or some other kind 
 of patient, weak, petulant, or exacting ; often summoned un- 
 necessarily, too, at unseasonable hours, or bored at home with 
 office patients ; then pouring over books and thinking day and 
 nisht, till, from Ion o-con tinned and extraordinarv mental and 
 physical exertions, they become prime candidates for one or the 
 other of the physician's two afflictions, — organic heart disease 
 or atheroma of the cerebral arteries, — then progressive heart- 
 failure or apoplexy; next — death, as the penalty. 
 
 A little leisure, either to rest or to play, or rational amuse- 
 ment of any kind, soothes the troubled waters of professional 
 life, and is a great blessing, — rec-reation is re-creation. Make it 
 your rule to do as little work on Sundays and holidays as is con- 
 sistent wdth your duty to others, and do not hold consultations 
 on Sunday, except in cases of urgent necessity. The Sabbath, 
 or day of rest, was instituted in Paradise, by God himself, and 
 is a blessing to all. It is asserted that violating The Gospel of 
 Rest, and working seven days in a week, instead of resting the 
 tired brain, shattered nerves, and fatigued limbs on the seventh, 
 shortens a life of three-score and ten by twenty years. I know 
 a busy physician who, to protect himself, has a sign in his office
 
 HIS REPUTATION AND SUCCESS. 103 
 
 saying "No Office Hours on Sunday," An occasional day's 
 sport with rod or gun, or a summer trip, or an evening at a 
 convivial meeting, or at the theatre, a change of occupation, or 
 alternation of labor with ease of any kind, will work off nervous- 
 ness and act as a refresliment to your labors; break the worries, 
 frets, tumults, jarring, and cares of practice; vary the monotony 
 of life, subdue mental tension, remove brain-weariness, soften 
 the ups and downs, soothe mental excitement and nervous 
 strain, conduce to health and longevity, and actually make you 
 more philosophical and a better physician. 
 
 The cost of a pleasure trip or a few days' recreation is not, 
 however, to be counted by tlie expense of your journey only, 
 but you must also add the far heavier loss in practice, and the 
 unmerited blame that is apt to follow being absent from those 
 who need you. 
 
 Newspaper notices of your departure from the city for 
 short sea-side, mountain, or other brief pleasure trips will, if al- 
 lowed, have a disturbing and hurtful influence on your practice 
 while you are away, and even after your return. Reporters are 
 aware how such items injure physicians, and seldom publish 
 them unless requested. The register-clerk of hotels where you 
 register will, if asked to do so, omit announcing your arrival in 
 the newspapers, which would publish your brief absence from 
 business to the whole world. 
 
 If a professional friend is prevented from attending to his^ 
 practice by sickness, or even by sickness or death in his family, 
 it is just and proper to attend to practice for him without re- 
 ward ; but, if one goes in quest of pleasure and amusement, it 
 is proper and just for him adequately to remunerate you or 
 whomever else he gets to do his work. 
 
 When you get another to do your work, it will be much 
 less laborious for him if you have your office patients sent 
 from your office to his, instead of compelling him to spend 
 or waste your stated office hours at your office ; also, to have 
 your family send each new call to him when received, instead
 
 104 THE PHYSICIAN HIMSELF I 
 
 of compelling him to call again and again to learn whether he 
 is needed. 
 
 . After prolonged absence from home or recovery from long 
 sickness, it is wise and perfectly ethical to announce the fact of 
 
 your return to practice through the newspapers: "Dr. , 
 
 No. — Street, has returned from his vacation (or recovered from 
 his sickness), and will resume his practice immediately." Further 
 than this keep your name out of the newspapers, and leave 
 medical self-advertising to physicians who prefer to quack! 
 quack! quack! and to rival pill-mongers. 
 
 Merchants and tradesmen attract customers by handbills 
 and newspapers, and yet, even though they do exaggerate, such 
 methods are not considered dishonest, because their customers 
 are supposed to know something of the prices and quality of 
 the articles offered; besides, they can go from dealer to dealer, 
 to examine and compare before buying; but with quacking 
 physicians the stranger has no such opportunity, no such safe- 
 guard ; because their ads. and puffs tell only one-half of 
 the story, — cures and successes, — and studiously omit the other 
 half, — failures to cure and cases made worse, — and, since 
 strangers allured to physicians by them can neither compare 
 their skill, weigh their pretenses, nor gauge their honesty, all 
 such resorts are deemed ethically wrong. 
 
 When you assume charge of a case for another physician, 
 to look after during his sickness or absence from the city, or one 
 of your own that has been under the care of a substitute while 
 you were away, or that any one has attended in an emergency 
 pending your arrival, take care to do as much good as possible 
 for the patient, with as little harm as possible to the former at- 
 tendant ; continue his line of treatment, at least for awhile, if 
 you can conscientiously do so. An abrupt, radical change, 
 either in diagnosis, prognosis, or treatment, or designedly dif- 
 fering with him, either in opinion or practice, is both ungener- 
 ous and injurious to your co-worker. In such a case, if you 
 believe something more should be given, instead of stopping his
 
 HIS REPUTATION AND SUCCESS. 105 
 
 red or black medicine and ordering a white or yellow one, or 
 his pills or capsules, and ordering tablets or powders, merely 
 add yours to what is already being done, and thus avoid 
 unpleasant reflections.
 
 CHAPTER IV. 
 
 "The first step to wisdom is to be exempt from folly." 
 
 Always entertain and show respect for your seniors in 
 practice. There is probably no type of medical man more 
 unworthy than coxcombical young Dr. Knowaheap, who over- 
 estimates himself, and considers that he is the most learned 
 person in the profession ; underestimates his seniors, and shows 
 a corresponding contempt for them. Being fresh from college, 
 and medicine being a progressive science, he may excel the 
 older physicians in the use of the microscope, the stethoscope, 
 and other severely scientific and technical points ; but long 
 experience has been their additional teacher, and they have a 
 progressive clinical acquaintance with disease which gives an 
 intuitive perception as to the choice of remedies, and in general 
 makes them better logicians and much better practitioners ; 
 because there are peculiarities which belong to almost every 
 disease, about which there is little or nothing to be learned 
 from the books ; and knowledge and skill derived from obser- 
 vation and experience far outweigh mere college learning, 
 book knowledge, and specific formulas, to be learned by rote 
 and applied by routine ; and are more like part of one's very 
 nature than that gotten from any other source, and are fixed 
 indelibly on both one's senses and reason, to be brought forth 
 again when needed. Remember, too, that although young 
 physicians have recourse to scientific " extras," fine-drawn dis- 
 tinctions, and modern instrumental aids to diagnosis, and the 
 very latest in treatment, more than do the older ones, yet in 
 relying on these too much and on rational subjective symp- 
 toms and common methods, and especially on the unaided eye, 
 too little, they are apt to forget the fact that the best part of 
 every man's knowledge is that which he has acquired for him- 
 self, and that the art of curing disease owes more to sound 
 (106)
 
 HIS REFUTATION AND SUCCESS. 107 
 
 judgment and common-sense bedside observation and experi- 
 ence than to anytliing else. 
 
 True, the practitioner who has grown gray and wrinkled 
 in the profession is more apt to disregard the nicer pathological 
 diagnosis, which defines the technical variety of the disease, — 
 whether, for instance, a pneumonia is catarrhal, croupous, or 
 interstitial, — and to be more attentive to the therapeutical diag- 
 nosis which indicates what the treatment should be ; weighing 
 the influence of age, season, rate of progress, complications, 
 secondary affections, compensatory changes, and other clinical 
 phenomena with a nicety that the junior with all his brains can 
 never acquire from his text-books or in the lecture-room, and 
 then, as with intuitive wisdom determining as to the best reme- 
 dies for the mental and bodily sufferings of the patient before 
 him, — reducing, evacuating, quieting, stimulating, or feeding 
 him as foresight and experience have taught. The reputation 
 of every physician is twofold, — one portion earned by himself, 
 the other acquired from the general respectability and reputa- 
 tion of the profession, and public confidence in it ; and such 
 men — white-bearded or bald-headed or furrow-cheeked thouofh 
 they may be — have done very much to give our profession this 
 honorable standing, and to smooth the way for others, and 
 hence are certainly worthy of all respect. 
 
 On the other hand, the older physicians, having had their 
 turn, and remembering the rough and difficult trials, the painful 
 responsibilities, exhausting toils, and heart-rending doubts and 
 anxieties and ill-treatments, and the blunders and sufferings 
 and dearly-bought lessons of their own beginning, should show 
 favor to their younger brothers without fear, and work side by 
 side, with friendly feelings ; for no matter how many aspirants 
 appear, there is always enough work left for the older physician 
 who has done his duty in the community ; yea ! the world is 
 wide enough, and there is sickness and misery enough in it to 
 keep every worthy hand and head and heart employed ! 
 
 Life is a school for all. When you have been in practice
 
 108 THE PHYSICIAN HIMSELF I 
 
 long enough to cultivate observation and to acquire an address 
 in the management of the sick and to impress your patients with 
 the fact that you have good common sense in everything and 
 uncommonly good sense in medicine ; have accurate judgment, 
 and evolve practical wisdom out of your own brain ; and that 
 you know the duty of a physician in their sickness, and, in 
 addition, are especially conversant with their moral and physi- 
 cal idiosyncrasies, such impressions will be of great advantage to 
 you, and will make professional attention to them much easier. 
 
 "He knows the water best who has waded through it." 
 
 You will occasionally be employed in cases because you 
 have long ago attended other members of the family in similar 
 affections, and are very naturally supposed to know the peculi- 
 arities of their blood, and to understand the various points in 
 the family constitution, — their temperament and hereditary ten- 
 dencies and predispositions, — and to possess sovereign remedies 
 for their relief. 
 
 You will find that the belief that you understand this or 
 that person's constitution from brain to toe, from surface rind to 
 innermost core, and know exactly what they require within and 
 without, their likes and dislikes, is a powerful advantage, — one 
 that gives you unusual prestige and a favorable chance to show 
 your skill and to give them a still greater confidence. 
 
 Experience and skill are what the public especially seek in 
 a physician ; they are truly important, and everybody knows it. 
 You should carefully try to show that you possess both. Of 
 course, we all have aftersight, but far-seeing, prognostic fore- 
 sight, and ability to correctly comprehend all the changes that 
 have taken place between your medical visits, is what is needed. 
 This is not described in your text-books, or furnished by lec- 
 tures, but is sure to come from practical, dear-bought experience 
 in diagnosing and combating diseases, and will develop and 
 improve your jtidgment in every way, and enable you each year 
 to see more fully into the very essence of your cases, and to
 
 HIS REPUTATION AND SUCCESS. 109 
 
 foresee their events with increased clearness; and if you compel 
 yourself to work faithfully and to develop the faculty of observa- 
 tion, every year will make you a better physician, and by tlie 
 time you have worked and observed for ten or twelve years you 
 will have attained the calmness of wisdom, and become clini- 
 cally familiar with the symptoms and events of all the more 
 common afflictions that confront us, and you will then know far 
 better than now how to wave the ^sculapian wand, liow to 
 avoid former errors and mistakes, and also more easily and 
 more exactly to shape your diagnosis, prognosis, and treatment 
 in each. 
 
 In addition to the great advantage the older physicians 
 have over the younger ones, from increased ability to discern 
 the true nature and to foresee the probable degree and dura- 
 tion of grave and critical cases, and to give, concerning them, 
 more discreet, definite, and truer opinions from the beginning, 
 they can also, from experience, recognize and point out cases that 
 are doubtful or likely to prove slow and tedious ; they also have 
 more staid judgment, and give better cautions and more solid 
 precepts, and thereby relieve themselves of much anxiety and 
 risk of blame. Such advantages naturally enhance their repu- 
 tation, and enable tbem to reap the full value of their skill; 
 give them a better address and greater confidence in themselves, 
 and enable them to treat serious and tedious patients with steadi- 
 ness, and, meanwhile, to retain confidence much better and much 
 longer than younger physicians. This is the chief reason why 
 physicians, sharpened by long practice, are less harassed in dif- 
 ficult cases by meddling officiousness from outsiders, and either 
 dismissed or forced to call in a consultant, than younger ones, 
 and why the practice of medicine becomes relatively easier 
 and lighter every year. You will find that after you have prac- 
 ticed twelve or fifteen years ; after many of the fine precepts, 
 beautiful descriptions, and nice distinctions gotten from the pro- 
 fessors at college have taken wings ; after you have forgotten 
 much of your theoretical Text-Book knowledge, — which was
 
 110 THE PHYSICIAN HIMSELF! 
 
 probably greater comparatively at graduation than it will ever be 
 again, — your experience will give you an immense storehouse of 
 practical facts that will be invaluable to you, and will often serve 
 you in cases in which book-learning cannot ; indeed, it is impos- 
 sible to obtain from books alone sufficient knowledge of disease 
 to make you a good practitioner. The possession of self-attained 
 post-graduate knowledge gathered from tlie great book of Na- 
 ture will make it appear to those around tliat you know what 
 to do and how to do it, and is the kind that will make the 
 public prefer you to your younger, less-experienced brother. 
 
 The public love to see a physician appear to understand his 
 business fully and to discover the actual condition at a glance, or 
 to know things intuitively; therefore, you must study and practice 
 to be quick in diagnosis, and ever ready in the treatment of the 
 common diseases and ordinary emergencies that will probably 
 constitute nine-tenths of your practice. 
 
 Study carefully the laws of prognosis and probable dura- 
 tion of disease, for it is in these that young physicians are most 
 deficient. Errors of prognosis are ordinarily far more damag- 
 ing to the physician than errors of diagnosis and of treatment. 
 Very few people can discover whetlier or not your diagnosis and 
 treatment are correct, or otherwise judge tlie truth of your as- 
 sertions or the justice of your reasoning ; but if you say a pa- 
 tient will recover and he dies, or that he will die and he gets 
 well, or that he will be sick a month and yet he gets up in three 
 days, or that he will be well in three days and yet he is sick a 
 month, everybody will see that you are wrong, and will very 
 naturally infer that, as you were wrong in your prognosis, your 
 diagnosis and treatment may have been equally so, and they 
 will naturally seek some one else with more experience and 
 keener foresight. 
 
 Skill in these things will enable you to foretell a favorable, 
 a doubtful, or a fatal termination, and to foreknow the duration 
 in a greatly increased proportion of your cases and save you a 
 vast amount of anxiety.
 
 HIS REPUTATION AND SUCCESS. Ill 
 
 In forming your prognosis use all five of your senses, if 
 necessary ; and be careful to ascertain not only the condition of 
 the organ chiefly aftected, but of the other vital organs also, 
 since their condition and action may, in some degree, compen- 
 sate for the lost or impaired functions of the diseased organ. 
 Look also at the surroundings of your patient, and the nursing 
 and attention he can command ; and, lastly, learn to estimate, 
 from the look, the voice, the groan, the cry, the breathing, the 
 conlplexion, the gesture, and general aspect, — mental and physi- 
 cal, — his vital resistance to the disease (which differs in each 
 individual), and then form your prognosis. 
 
 Bear this in mind : In your desire to soothe the fears of 
 anxious relatives, do not wrong yourself in serious cases by pro- 
 nouncing them lighter or less dangerous than they really are. 
 Such mistakes often bring us sorrow and cause blame. The 
 little pleurisy or the slight gastritis of to-day may be something- 
 greater to-morrow. 
 
 Never ask, as you enter to pay the first visit to a patient, 
 the apparently simple, yet awkward, question, " What is the 
 matter with you 1 " or salute him at any other visit with " How 
 are you to-day 1 " or he will probably retort that is exactly what 
 he wants you, the physician, to tell him. 
 
 Do not display the fact that you are a junior or a tyro work- 
 ing by reflected light, and thereby belittle yourself in the esti- 
 mation of patients, by constantly quoting what this or that man's 
 book says, or what such-and-such a medical celebrity thinks, or, 
 worse still, by taking down your text-books before tliem, to 
 learn what they say ; as if you were deficient in readiness or in 
 nerve, or had to rely on the opinions of others for all you know. 
 
 Also, never carry a ready-written prescription to a patient, 
 as if copied from somebody else's book ; rather commit it to 
 memory, or jot it down in your visiting-list, to be glanced at and 
 written off at the proper time. 
 
 The folly of blindly accepting or slavishly following the 
 dicta of this or that master is nicely depicted by Moliere in
 
 112 ' THE PHYSICIAN HIMSELF: 
 
 L' Amour Medecin, Acte ii, Scene 2, where the following dia- 
 logue occurs between Dr. Tomes and Lisette : — 
 
 Tomes. — How is the coachman 1 
 
 Lisette. — He is dead. 
 
 Tomes. — Dead % 
 
 Lisette. — Yes. 
 
 Tomes. — That is impossible. 
 
 Lisette. — It may be impossible, but it is so. 
 
 Tomes. — He cannot be dead, I say. 
 
 Lisette. — I tell you he is dead and buried. 
 
 Tomes. — You are mistaken. 
 
 Lisette. — I saw it. 
 
 Tomes. — It is impossible. Hippocrates says that such dis- 
 eases do not terminate till the fourteenth or twenty-first day, and 
 it is only six days since he was taken sick. 
 
 Lisette. — Hippocrates may say what he pleases, but the 
 coachman is dead. 
 
 Take a lesson from this, and, if you have no experience of 
 your own to guide you, adopt that of otiiers ; but remember that 
 your patients of all shades, white and black, rich and poor, want 
 to know what you think, and care but little for high-sounding 
 names, or for what you have read in Hippocrates, Watson, 
 Gross, or been told in lectures by your preceptor. 
 
 If you are determined to let people know you are inexperi- 
 enced and have no opinion of your own, you should at least 
 spare them the infliction of following you to the sources from, 
 and through the processes by, which your borrowed opinions 
 were obtained. If one is invited to dinner, he may imagine his 
 host does not prepare it all himself, but he does not care to be 
 taken down into the kitchen and through the pantries, and 
 shown the pots and pans and rolling-pins, and to be introduced 
 to the cooks and waiters, all to let him know exactly how the 
 feast is prepared. One will feel much better entertained if he is, 
 at the proper time, simply introduced to the table, smoking and 
 groaning with its bounteous supply.
 
 HIS REPUTATION AND SUCCESS. 113 
 
 Remember this : Every one likes to believe that the phy- 
 sician is treating him by a regular plan rather than firing at 
 random, more especially in diseases that are believed to depend 
 on the blood or on any peculiar diathesis. 
 
 Make post-mortem examinations and scientific use of 
 your opportunities, to confirm or correct your diagnosis and to 
 become more familiar with the machinery of life, whenever fit- 
 ting cases or questions as to the cause of death from unknown 
 complaints present themselves ; but never allow the inference 
 that you are cutting or mangling the bodies of the dead to 
 gratify idle curiosity ; or to satisfy yourself alone, or to show 
 that your feelings and emotions have passed through a process 
 of hardening, or that it is a very great favor to be allowed to 
 do it ; but put it rather and emphatically on the higher ground 
 that it is done for the benefit of science and in the interest of 
 suffering humanity, and that it may be for the good of the very 
 persons with whom you are then talking. 
 
 In making autopsies in private families never hurry, but 
 take time and do them thoroughly, and be doubly careful to 
 avoid unnecessary mutilation, and let your neatness and man- 
 ner evince the greatest respect for their sleeping dead, and 
 due regard to the feelings of those around, more especially if a 
 promiscuous audience, or non-professional persons, are present, 
 and, after concluding, hide all traces of your work as fully as 
 possible, and then compare what you have discovered with your 
 view of the case before death. 
 
 Bear in mind that all civilized and all savage nations re- 
 spect the dead, and that the important uses of the dead to the 
 living are the only, but all-sufficient, justification for human 
 dissection. 
 
 Also, that it is morally and ethically wrong to consent to 
 make a post-mortem examination of any one who has died 
 under the care of a brother physician, at the solicitation of 
 persons who, with mischief in their hearts, seek to disprove the 
 diagnosis and disgrace the medical attendant ; also, that when
 
 114 THE PHYSICIAN HIMSELF: 
 
 making autopsies, even in cases of accident or sudden death, the 
 deceased person's regular medical attendant should, if possible, 
 be invited to be present. 
 
 Out of respect to both the dead and the living, defer 
 making post-mortem examinations for a few hours after death, 
 if possible ; as the hypostatic congestion that naturally fol- 
 lows death is often mistaken by the public for ante-mortem 
 changes, and gives rise to the most wonderful stories of " a 
 murder," " only in a trance," etc. It will always be well to 
 point out to them its true nature and cause, and its utter lack 
 of significance. 
 
 The useless and unjustifiable repetition of physiological 
 and pathological experiments, made to illustrate already known 
 facts, that require vivisection of animals is, by many, called 
 cruel sport, and has received popular opprobrium, and will not 
 add much to your reputation, if done with that in view, as such 
 things are supposed to have been studied as far as needful in the 
 laboratory and dissecting-room before leaving college. On the 
 contrary, making clinical analyses of the urine and other fluids 
 as an aid to diagnosis will not only lead to invaluable informa- 
 tion regarding your patient's condition, but will be a great 
 element in giving you popularity and professional respect. 
 
 Working with the microscope on proper occasions will not 
 only increase your knowledge, but will also invest you, in the 
 eyes of the public, with the benefits of a scientific reputation 
 and its attendant advantages. 
 
 Obstetrical practice is undoubtedly, in some respects, desir- 
 able, especially in the beginning of professional life, as each case 
 partakes somewhat of the nature of a battle in which the ac- 
 coucheur is (thanks to Providence) nineteen times in twenty victo- 
 rious, and his services are appreciated and extolled, and in future 
 relied on, which gives hiin a retaining hold upon that patient, 
 and paves the way to other permanent family practice. The 
 inevitable and wearisome ivalting at the bedside, however, en- 
 tails a serious loss of time. Chance calls of any kind you can
 
 HIS REPUTATION AND SUCCESS. 115 
 
 take or not at your discretion, but specific engagements, es- 
 pecially in obstetric cases, must be kept, day or nigbt. 
 
 Should you ever get so overburdened with work that time 
 is doubly precious with you, attending many obstetrical cases 
 will so overtax your powers tliat it may become actually neces- 
 sary, in self-defense, to restrict or withdraw from these and 
 other time-consuming engagements, in order that you may get 
 time to breathe and to attend to the rest of your patients with 
 something like regularity, and to obtain your meals, sleep, etc., 
 and do your writing and studying. Midwifery is a wearing 
 and exhausting branch of medicine, — the hardest kind of hard 
 work, — and in filth but little superior to the Nightman's; it 
 seriously interferes witli regular, healthy living, and is fvdl 
 of care and responsibility ; and, although it does lead to other 
 family practice, you will find, after some years, that the ordinary 
 fees for attending cases of confinement are, on account of 
 trouble, and anxiety while absent from them before or during- 
 labor, loss of time in waiting and consequent interference witli 
 the fulfillment of other duties and engagements, together with 
 the nights of work, after days of toil, loss of sleep, risk of 
 breaking down, etc., which they occasion, proportionately more 
 meagre than in any other department of practice. 
 
 If you keep a daily record, you will probably find that nine- 
 tenths of all your loss of rest is due to obstetrical cases. 
 
 When a woman engages you to attend her in confinement, 
 write her name and address on one of your cards and hand it to 
 her, with instructions to send it to you as soon as she feels that 
 your services are likely to be required. This will empliasize 
 the engagement, serve to remind her of the mutual obligation 
 or contract, and make her more apt, when her time comes, to 
 call you in than to call another physician, or to get a midwife 
 with a view to save expense. 
 
 In spite of your having been engaged to attend a case, and 
 being kept in suspense for weeks or months, you will sometimes 
 learn that the confinement is over, tliat a midwife or granny was
 
 116 THE PHYSICIAN HIMSELF: 
 
 sent for, and the excuse will be that everything occurred in such 
 a hurry that they could not wait for you, or had no messenger 
 to send, or some other equally lame plea. 
 
 You will often be called upon in bad cases to do ugly work 
 for midwives who have reached the limit of their obstetric knowl- 
 edge, and for the sufferer's sake you should never refuse to go and 
 assume charge of the case. Such occasions will afford you 
 valuable opportunities to 
 
 "Do two hours' work in forty minutes," 
 
 and to show the practical superiority of qualified physicians over 
 the unskilled midwiie and unpractised irregular, and also to en- 
 hance your position in the estimation of the public. 
 
 Pregnant women will sometimes want to make an Indian 
 bargain with you beforehand, to come to them only in case their 
 midwife fails. Of course, you should go to all cases where hu- 
 manity calls, but you should hardly bargain with anybody before- 
 liand to play second part to a midwife, — she to take the fee and 
 eclat^ if there is no trouble ; you to take the care and responsi- 
 bility for a nominal fee, if there is. You may be surprised to 
 learn that it is now generally understood in many communities 
 that every midwife has her regular medical referee to assist her 
 in her complicated cases, — a one-sided bargain, which gives her 
 the unearned ecJat^ if there is any, and him an undue proportion 
 <of worrying cases of tedious labor. 
 
 When you first visit a woman in labor it is a wise rule to 
 •ask her, among other questions, whetlier she has felt the motions 
 of the child since labor began, that, in case she has not, and it 
 is born dead, you may have some evidence that it was dead 
 before you arrived, if such is truly the case. Also, if your ex- 
 amination of a primipara shows very unusual smallness of the 
 vaginal orifice, incidentally mention the fact, and tell of the pos- 
 sibility of laceration of the perineum, that you may not be 
 unjustly blamed if that should unavoidably occur. 
 
 In every primipara case of confinement, after delivering 
 the child, be careful to call the mother's attention to the lum^
 
 HIS REPUTATION AND SUCCESS. 117 
 
 in her abdomen, and inform her that it is only tlie contracted 
 womb. If you omit to do so, she may accidentally discover it, 
 get greatly alarmed, and either await your visit with dread, or 
 send for you post-haste. . 
 
 The enlarged, pouched, or protuberant abdomen, that be- 
 gins in many females a few months or years after confinement, 
 believed by them to be enlargement of the womb caused by not 
 ])eing properly bandaged after labor, is due to adipose tissue 
 accumulating in the omentum and in the abdominal walls, and 
 also encumbering the abdominal viscera. 
 
 Attendance on patients at long distances has a tendency to 
 derange and diminisli your nearer practice, for while absent 
 attending a remote call you may lose three nearer ones. Nor 
 do distant visits, as a rule, pay in a pecuniary sense, but they 
 do work an injustice to both physician and patient. Every one 
 should have a family physician within reasonable calling dis- 
 tance. A few far-off patients will waste more time, break down 
 more horseflesh, use up more carriages, harass you at unseason- 
 able hours, keep you from bed, and expose you to bad weather 
 more, and do more to make your life a hard one than all your 
 other practice combined. 
 
 Keep your practice down to a number that you can prop- 
 erly attend ; you can do this by sending in your bills promptly, 
 weeding out worthless patients, circumscribing your field of 
 practice, declining other than desirable obstetrical engagements, 
 increasing your cliarges, etc. In refusing to take a case at a 
 distance, or one that is likely to involve you as a witness in 
 (;ourt contrary to your wish, or to accept an obstetric engage- 
 ment, if you are really " too busi/,^' assign that as your chief 
 reason, as it is the least open to criticism and persuasibility of 
 any that can be assigned. 
 
 Never offer as an excuse for neglect in visiting a patient, 
 " I really forgot you ; " to forget the sick is unpardonable. 
 
 Gonorrhoeal and syphilitic cases are not very desirable on 
 any account, except for the fees they bring ; they are dirty.
 
 118 THE PHYSICIAN HIMSELF: 
 
 secret cases, and rather repel than attract their victims and their 
 friends to the physician who attends them when they require a 
 pliysician for other diseases. Accepting them will, however, 
 often enable you to pick up a handsome cash office-fee. 
 
 Even when you are positive that a person has syphilis, it 
 is not always judicious to say so. 
 
 "All truth is not to be told at all times." 
 
 Prudence will sometimes require you to reserve your opinion, 
 but at the same time take care to give the proper treatment. 
 Indeed, in practicing your profession, you will see and under- 
 stand the results of many sinful habits and vicious courses to 
 which you must appear more or less bhnd. 
 
 Be careful that your reputation for special interest in 
 venereal diseases does not oversliadow or ecUpse other kinds, 
 and give you the unenviable title of " P — x Doctor," and entail 
 the social ostracism and loss of genteel family practice that 
 Avould surely follow ; — or that extra success in restoring the 
 menses in females who suspect pregnancy does not bring an 
 extra number of such cases to consult you, and give you the 
 title of " Abortionist ; " — or that attending an excessive propor- 
 tion of sporting, courtezan, and bruiser classes does not give 
 you the undesirable notoriety of having a " fancy practice ; " — 
 or, again, that perpetual and indiscriminate inquiring about the 
 lu'ine, and having it bottled for you (urology), does not earn for 
 you the easily acquired title of " P — ss Doctor ; " — 
 
 " Four lovely berries moulded on one stem; " — 
 
 or that a liver hobby, or a kidney hobby ; or that the womb, or 
 the stomach, does not become with you a scapegoat to be 
 blamed for every obscure disease, give you the title of " crazy- 
 ologist," and thus eventually impair your usefulness and harm 
 your position as a practitioner. 
 
 You will iind it much more pleasant and satisfactory to at- 
 tend in some families than in others. From some you will con- 
 stantly receive intelligent co-operation, and they will make 
 charitable allowance for any little failure or shortcoming, while
 
 HIS REPUTATION AND SUCCESS. 119 
 
 from others you will experience the reverse, and it will seem as 
 it' they want to perplex and harass you in every conceivable 
 way, and as if they would make you feel, in attending them, 
 that you were on trial for your life. 
 
 It is this harassment and continued feeling of personal in- 
 volvement and perpetual anxiety, quite as much as overwork, 
 that wears down the health and shortens the life of the phy- 
 sician. Bear this in mind, and let it be your philosophic rule 
 and determination never unnecessarily to worry about anything 
 you cannot help or avoid. 
 
 You cannot be too guarded in asking private questions, 
 especially about diseases of an immodest nature, before people 
 not in the confidence of the patient, unless they are clearly en- 
 titled to hear them ; in such case, request all, and particularly 
 those of the opposite sex, to leave the room before putting the 
 questions. Be doubly cautious in this respect when your pa- 
 tient is a female, and the questions refer to marriage, men- 
 struation, pregnancy, lactation, uterine affections, constipation, 
 urinary derangements, or other delicate subjects, that her confi- 
 dential secrets may not be exposed, or her modesty ofiended. 
 
 You will find it judicious also to avoid inquiring of a pa- 
 tient in stores or barber-shops, or on the street or other public 
 places, in the presence of strangers, about his ailments, or those 
 of patients at his liome, unless they can be referred to without 
 the slightest impropriety. Many persons are very sensitive in 
 reference to their complaints and weaknesses, and captious 
 concerning the time, place, and manner of asking about them. 
 
 So far as your influence can prevent, do not allow ill-judg- 
 ing and partial friends or patients to go about overpraising you, 
 and speaking of you as a pet, etc. Inordinate praise, no mat- 
 ter from whom, is apt to arouse a corresponding dislike on the 
 part of those who deem the praise either extravagant or mis- 
 placed; and such injudicious praise, while meaning well, will 
 almost surely react against you, and do mischief It might 
 even arouse the angriest jealouvsy or hatred on the part of bus-
 
 120 THE PHYSICIAN HIMSELF: 
 
 bands, aunts, lovers, or others. Perfectly pure physicians have 
 actually had to cease attending in families where such jealousy 
 existed, to prevent causing domestic strife and estrangement. 
 
 It is also in very bad taste, and even injurious, for a wife 
 or other near relative of a physician to praise him inordinately, 
 and boast of his great skill and wonderful cases and cures ; for 
 people very naturally think such boasting is an attempt to send 
 fish to his hook and grist to his mill. If done at all, it comes 
 with more grace from comparative strangers. 
 
 Probably one of the most constantly useful faculties you 
 could possess is the power of discovering, by a study of faces, 
 etc., which are the ruling spirits in a family, and honestly se- 
 curing their good-will, and keeping them satisfied with your ser- 
 vices and your remedies. Also, learning the character and con- 
 sequence of those who are likely to show dissatisfaction and 
 give you trouble if opportunity offers. 
 
 While making your visits it is better, as a rule, to give 
 your attention chiefly to the reports and conversation of the 
 husband, if he be present, rather than to the wife, and to ad- 
 dress your opinions, explanations, and remarks to him, or, in 
 his absence, to whoever is at the head of those w-hom you meet 
 in the sick-room, and to pay to all others only the respect that 
 civility requires. If you do not do this sensitive " head ones " 
 will feel ignored, and many will even get dissatisfied and create 
 trouble for you. 
 
 Carefully avoid making communications to inquisitive or 
 hostile nurses, or other prying mischief-makers, and, if necessary 
 to answer their questions, do so in an ordinary voice, and not in 
 seemingly confidential whispers. 
 
 Wlien making a professional visit, banish all else from your 
 mind but the case before you; and, no matter who may be present, 
 let the patient, whether young or old, be the central object, and 
 keep your thoughts and your conversation centred on him and 
 his case. Both patients and their friends will naturally feel more 
 anxious to know what vou tliink of their cases, and to receive
 
 HIS REPUTATION AND SUCCESS. 121 
 
 suggestions and advice for their benefit, than to hear anything 
 else. If the conversation digress to other subjects, change it 
 back to your patient and his case as soon as possible. 
 
 Adopt the same precautions, also, during consultations, and 
 keep the conversation between you and your colleague on the 
 case under consideration, and do not allow it to digress to re- 
 ligion, horses, politics, etc. ; economy of time, both on your own 
 and your patient's account, requires it, for, if a consultation lasts 
 too long, it is apt either to terrify the patient and his friends, or 
 induce a belief that you disagree, or are puzzled, or are talking 
 horses or politics, either of which may undo you. 
 
 Skilli'ulness in changing or modifying your diagnosis or 
 prognosis is all-important in all cases where a change has to be 
 made. 
 
 In prognosticating the probable duration of a case, do not 
 too hastily or definitely commit yourself; for whatever prognosis 
 you foreshadow at the outset will, as a rule, be accepted. It 
 is only when such prognosis is altered and assumes a graver 
 form, or the duration which you have assigned for the case is 
 much lengthened, that dissatisfaction arises. One of the great- 
 est of all reproaches to medicine is that it is not an exact science; 
 consequently, the practice of it must lack the element of certainty. 
 
 Do not get insulted at the foibles and infirmities and the 
 hasty and angry words of your patients. Do not forget that the 
 sick, unless tlieir sensibilities are blunted by disease, are the most 
 sensitive and the most selfish of mankind; and bear with the rude 
 and discourteous treatment you will occasionally receive from the 
 hysterical and the peevish, whose patience is down to zero and 
 petulance up to a hundred; and from the frenzied, the eccentric, 
 the unreasonable, the impulsive, the irritable, the weak, the excit- 
 able, and the low-spirited ; and do not take anything a sick or 
 silly person says in a paroxysm of anger, or during a period of 
 despondency, or in great pain (or for want of sense) as a personal 
 insult, unless you believe it is deliberately and willfully intended 
 as such; in that case, do whatever self-respect seems to dictate.
 
 122 THE PHYSICIAN HIMSELF: 
 
 Beware of confidants, and never become so partial to pa- 
 tients, or others, as to make them the repository of your profes- 
 sional or personal secrets. Witli our imperfect therapeutical 
 means we cannot always attain perfect results or give com[)lete 
 satisfaction, and some of those whom you have served most 
 fait] 1 fully, and regard as unlikely ever to change, will surprise 
 and shock you by turning round and loudly decrying you. Bear 
 the possibility of this ever in mind, and, while seeking to make 
 your relations with your friends and patients cordial, frank, and 
 free, take care to avoid telling secrets and making confessions 
 that might be spitefully revealed, or put you in their power, if 
 a rupture of friendship should ever occur. 
 
 When urgent necessity or great danger requires, you need 
 not hesitate to do the most menial work for a suffering patient ; 
 but, unless these exist, pulling off your coat or collar, adminis- 
 tering injections, giving baths, swaddling newborn babes, nurs- 
 ing the sick, dressing or undressing invalids, or moving about 
 the room, rummaging drawers or ransacking cupboards in search 
 of towels, muslin for bandages, spoons, goblets, etc., in the pres- 
 ence of other help, as a servant would, does not comport with 
 professional dignity, and may be quoted as evidence that you are 
 too familiar and lack proper self-respect. It is much better to 
 ask for things you need and to let them be brought to you. 
 
 To be overassiduous in paying visits when no sufficient 
 cause is apparent, or to be too deferential and superserviceable 
 to those who think themselves extra good patients, is very inju- 
 dicious, for as soon as one conceives himself to be your best 
 patron, or that you are cultivating his good opinion too earn- 
 estly, or are calling oftener than he needs, he is almost sure to 
 undervalue you and is apt to quit you. 
 
 A patient who is improving will generally be satisfied with 
 a much shorter visit, a slighter examination, and less perfect 
 attention in general than one who is not doing well, and es- 
 pecially if he is doing so well that, on taking your leave, you 
 can express your emphatic satisfaction with his progress.
 
 HIS REPUTATION AND SUCCESS. 123 
 
 When a case is obscure, or in its initial stage, be cautious 
 in expressing any positive or unguarded opinion ; but in cases 
 where you can safely do so, give free, honest expression to your 
 diagnosis and prognosis. The habit of stating your views 
 thoughtfully and candidly will compel you to search for the 
 underlying cause and to analyze and weigh details closely ; will 
 also discipline your judgment and force you to study your cases, 
 and to make a definite, clear, and discriminating diagnosis in 
 any case coming before you, instead of rushing in and examin- 
 ing mthout thermometer, stethoscope, or other aids, lumping 
 everything under the term " biliousness " (i) or " heavy cold," 
 "heart trouble," "effects of malaria," "a complication of dis- 
 eases," or some other ambiguous name, and prescribing, on the 
 blunderbus principle, — that 
 
 "Mixed diseases must have mixed remedies," — 
 
 afler a moment's stare at the face, glance at the tongue, and 
 touch of the wrist, and an equally hasty catechising of the 
 patient concerning his most prominent symptoms, scarcely stop- 
 ping to notice or study the minor ones, or waiting for a reply or 
 maturing an opinion, and being off again in a moment, — as is 
 too often done by careless routinists. 
 
 A careless or superficial examination of patients, or in- 
 attention to the history of tedious cases, neglecting to give a 
 definite name to a disease, or calling it by a wrong one, or 
 making light of it at the outset, has caused regret and loss of 
 practice to many a physician. 
 
 It may be important for you to remember that, contrary to 
 the popular belief, the art of medicine does not enable you, or 
 any one else, to diagnose positively any of the eruptive fevers 
 until their local manifestations appear. Where obscurity exists 
 state it, for if you give a positive opinion and it turns out to be 
 incorrect your reputation will suffer. 
 
 Frequently, when a case is grave, and you are being im- 
 portuned to know whether you cannot do more, it is expedient 
 casually to mention the things you deem contra-indicated, —
 
 124 THE PHYSICIAN HIMSELF: 
 
 leeching, cupping, mustard, rubbing, baths, poultices, mopping 
 the throat, electricity, etc., — and tell why you have not had 
 recourse to them, so that they may realize the fact that you are 
 wide awake and liave thought of them, but have good reasons 
 for not using them. 
 
 Never pronounce any one's sickness feigned or trifling 
 unless absolutely positive that it is so, and, moreover, never 
 make fun of people sending for you, or being alarmed at what 
 may to you appear trifling ailments or simple growths that 
 will get well of themselves or that require no treatment, etc. ; 
 indeed, you should never joke, talk frivolously, or laugh about 
 your patients or their sicknesses, either in their presence or 
 elsewhere, nor taunt them about the trifling nature of their 
 diseases. Some people will laugh off your treating their slight 
 ailments slightingly, while secretly they ^vill feel deeply hurt 
 and resolve never to have you again, but see another physician, 
 or perhaps resort to quack medicines for fear he might also 
 laugh. Still another reason is that trifling ailments sometimes 
 develop into serious diseases, and simple tumors may assume a 
 malignant form, and their becoming so through fatal loss of time 
 in recognizing the true nature of the disease is very apt to be 
 ever after blamed on the jesting physician. 
 
 Again, never guarantee a cure, or certain success, or a sure 
 recovery, for anything, — even a mosquito-bite ; guarantee noth- 
 ing, except that you know your duty and will do it ; that if 
 your patients will do their best you will do your best, and leave 
 the result to God. Medicine is not a perfect science, nor is life 
 a definite quantity. When pressed by persons who want the 
 consolation of certainty to say that this, that, or the other case 
 of sickness is not dangerous, it may in some instances be well 
 to reply promptly, " Of course, no one can say there is no dan- 
 ger, because there is danger in everything, and any sickness, 
 even a fly-bite or a pin-scratch, may prove fatal;" tliat thousands 
 of lives have been lost when the danger did not seem greater, 
 and tens of thousands have been rescued from danger that
 
 HIS REPUTATION AND SUCCESS. 125 
 
 seemed more imminent, and that even a well person has no 
 guarantee of life from one day to another. Also, remind the 
 questioner that you, the physician, are hut a mortal man, and 
 that you do not possess supernatural wisdom, and do not hold 
 in your hands the keys of life and death, and have not life- 
 giving power; that your will and God's will may differ; and 
 that, since medicine is not a life-insuring science, you cannot 
 guarantee that any case of sickness may not develop some new 
 symptom and become dangerous or have an unfavorable issue, 
 or even end in death ; then state what you think will be the 
 probable issue of the case in question, llemember, too, that 
 while every case presents a group of probabilities it is sur- 
 rounded by a chain of possibilities, — a fact that you should not 
 fail to mention, — and thus leave yourself a reasonable margin 
 for uncertainties. 
 
 In giving death-certificates in mania-a-potu, syphilis, abor- 
 tion, etc., never yield to importunities, or a false tenderness for 
 family affliction, and substitute other pleasant-sounding terms 
 that may possibly put you in a false position. 
 
 The laws everywhere confer on physicians honors, immu- 
 nities, and judicial powers that are withheld from other classes. 
 You are exempted from military and jury duty, and made an 
 officer of the law over other citizens regarding insanity, vaccina- 
 tion, etc., and your certificates with reference to births, deaths, 
 inability to attend court, serve on juries, do military duty, etc., 
 are everywhere respected, and it is most certainly your civil and 
 moral duty as a good citizen to comply cheerfully and promptly 
 with all necessary restrictions and legal requirements, — to aid, 
 rather than impede, enforcement of the laws. 
 
 Further, in giving certificates, it is best to certify, " In my 
 opinion," etc. Indeed, not only is it more prudent, but far less 
 pretentious, in expressing an opinion, written or oral, always to 
 state simply, " I believe thus and so," or " In my opinion," etc. 
 The fact that it is your opinion or belief no one can dispute, 
 even though it should prove erroneous.
 
 126 THE PHYSICIAN HIMSELF I 
 
 Be exceedingly cautious in giving- certificates of insanity, 
 with a view to consign patients to an insane asylum, and never 
 yield to the importunity of mistaken or designing persons, and 
 be guilty of the cruelty of depriving a fellow-creature of his 
 rights, liberty, and i)roperty because he has temporary insanity, 
 is harmlessly eccentric, or entertains some harmless crotchet, as, 
 for instance, tliat he is a grandee, or that his legs are of glass, or 
 that some lady of high rank is in love with him, while in all 
 other respects he is sane and demeans himself and manages his 
 property rationally. Be careful to distinguish between the 
 really insane as contemplated by law, and those who are only 
 seemingly so. Dissatisfied friends of such people sometimes 
 give great trouble to accommodating physicians in these cases. 
 Refuse to give certificates in all but clear cases, and keep a 
 memorandiun of all the facts in each. 
 
 Keep memoranda also, and be very guarded when called 
 as a witness in will cases, suits for divorce, etc., with a view to 
 protect yourself and, maybe, others against traitorous friends or 
 designing enemies. 
 
 Rancorous feuds and venomous contests among those in- 
 terested in wills and estates will occasionally arise and show 
 you how selfish, and bitter, and mean, and unscrupulous man- 
 kind can be over dead people's old clothes and the dirty dollar. 
 In all such disputes and family wars carefully avoid entangle- 
 ment. 
 
 "Gold begets in brethren hate, 
 And gold doth friendships separate." 
 
 Never conceal the presence of a contagious disease from 
 those around who are liable to contract it, or misrepresent 
 small-pox as " measles," or cholera as " intestinal catarrl)," or 
 yellow fever as "the bilious," etc., as lias been done, or you 
 may very justly encounter the condemnation of the community 
 at large. When your decisions concerning the presence of, or 
 danger from, cases of infections diseases (small-pox, scarlatina, 
 typhus fever, etc.), and of their origin here, there, or in the other
 
 HIS REPUTATION AND SUCCESS. 127 
 
 place, from local or domestic causes, militate against the wishes 
 or su})posed interests of liotel-keepers, store-keepers, boarding- 
 lionse mistresses, etc., your views will, in all probability, be met 
 by strong opposition. In such event, do not allow yourself to be 
 brow-beaten into allowing any one to violate the laws relating 
 to the public health. Your duty to the healthy is quite as great 
 as to the diseased. Indeed, the protection of the public health 
 is of far greater importance than the well-being of any indi- 
 vidual. AVhen, therefore, these or other dilemmas present 
 themselves, adopt Davy Crockett's wise motto : — 
 
 " Be sure you are right, then go ahead.' 
 
 Be careful to prevent children, in whose family contagious 
 disease exists, from infecting others by attending school, or other- 
 wise mingling with those liable to contract it from them, and 
 at the same time insist upon visitors being, excluded. Take 
 care, also, that its presence in hotels, stores, etc., is not kept 
 secret at the public risk. 
 
 Never let people know that you are just from a case of 
 small-pox, scarlet fever, measles, etc., or even that you are at- 
 tending any contagious disease, for, in the event of any case oc- 
 curring among those to whom you have made it known, blame 
 will certainly be attached to you as having been the cause. If 
 your practice is so full of such cases that you must tell it to 
 somebody, tell the health authorities; indeed, the public good 
 requires that you inform them anyhow. 
 
 After visiting contagious diseases, take care to disinfect 
 your clothes by walking or riding in the open air; also, wash 
 your hands with very hot water, or, if that be not at hand, hold 
 them over the fire; disinfecting lotions, etc., may likewise be 
 used with advantage; and further, if necessary, take a warm 
 bath, or even a Turkish bath. 
 
 Oppose the conveyance of diphtheria, scarlet fever, measles, 
 small-pox, cholera, yellow fever, typhus fever, and other con- 
 tagious diseases in hacks, cars, and other public vehicles, and, if
 
 128 THE PHYSICIAN HIMSELF: 
 
 private ones are used, give specific instructions for their subse- 
 quent disinfection. Protest, also, against the attendance of 
 friends at the funerals of persons who have died of such diseases, 
 and insist on the imperative moral obligation that infecting 
 particles from the dead must not be allowed to imperil the 
 living. Make it your duty to enlighten the public on this 
 melancholy subject ! 
 
 Never keep a tongue-depressor for indiscriminate use, for, 
 irrespective of the disgust that patients would naturally feel at 
 having an instrument put into their mouths that had served a 
 like purpose in many others, it might actually convey tlie virus 
 of syphilis, diphtheria, etc., from one patient to another, and 
 render you liable to very grave censure. When you wish to 
 examine a throat at the patient's home, it is better to ask the 
 nurse for a clean spoon, than to take a tongue-depressor from 
 your pocket, or spatula from your case, and excite the patient's 
 aversion and a lively curiosity among those present to know 
 upon what kind of a case it was last used. At your office a 
 clean, white, ivory paper-folder, kept lying on your desk, not 
 only serves its usual purpose, but also answers very well for 
 ordinary examinations ; it is not at all disgusting, and is easily 
 cleaned. 
 
 It is both right and proper that you should cheerfully lend 
 a helping hand to aid a professional friend or great scientific 
 superior, when he has any kind of case requiring it, and 
 unite your friendly assistance with any member of the profes- 
 sion where humanity requires, or in any case that will either 
 give you knowledge that you specially desire, or increase your 
 reputation in a specialty in which you are interested; but be 
 careful how you lend yourself as a jump-jack to bungling prac- 
 titioners who would use you as a handicraftsman for their own 
 benefit and repute, or run about assuming half (or all) of the 
 responsibility in cases of fracture, wounds, luxations, etc., for 
 third — or fourth — rate Sir Astley Coopers, or administer the 
 chloroform, hold instruments, thread needles, use sponges, etc.,
 
 HIS REPUTATION AND SUCCESS. 129 
 
 for Dr. Rainbowe or Dr. Blockhead in their ambidextrous hack- 
 ing and hewing, cutting and slashing exploits, — 
 
 "In every act such mind the motto old : 
 'Be bold ! Be bold ! and everywhere. Be bold ! ' " — 
 
 unless you are properly compensated for the work you do and 
 for the responsibility entailed. 
 
 Obsequiousness and subserviency should be heedfully 
 avoided, for, not only will they never be of any solid benefit to 
 your reputation, either in the eyes of the public or of the profes- 
 sion, but bad results in cases to which you are carried to assist 
 the hero tend to depreciate you and to do you harm. It is 
 much better for you, as an aspirant, to come out and stand be- 
 fore the world on your own foundation. 
 
 For somewhat similar reasons, if sickness, accident, or other 
 providential contingency compel a neighboring physician to 
 ask you to attend his patients for a short while, whatever you 
 earn should be tendered to him ; but if one incline to neglect 
 his business for dissipation, or to pursue pleasure, he cannot 
 expect you gratuitously to attend for him either long or often. 
 
 Preaching morals to dissolute patients seldom effects any 
 practical good or makes the vicious virtuous, as moral distem- 
 pers are usually too deeply rooted to be overcome by an appeal 
 to the feelings; but you often can, by earnest, truthful advice 
 and proper cautions, reconcile the estranged and calm the angry, 
 and possibly turn the drunkard from his path. You can also 
 exert the greatest influence upon patients who are being injured 
 by indulging to excess in chewing, smoking, tippling, feasting, 
 dancing, late hours, carousing, venery, the use of cosmetics, and 
 other things that provoke or render them liable to disease. 
 Your injunctions, indeed, in regard to these weaknesses, follies, 
 and errors, if properly given, will be respectfully and attentively 
 listened to, and will frequently be strictly obeyed. 
 
 When tipplers tell you that they intend to " swear off " 
 for a definite period, advise them, instead of swearing off, to 
 pledge their word neither to treat any one nor allow any one to
 
 130 THE PHYSICIAN HIMSELF: 
 
 treat them to liquor during the prescribed period. Such a 
 pledge will be more manly and more apt to be observed. 
 
 " Eggs and oaths are easily broken." 
 
 Treating and the treater make seven drunkards in every ten. 
 
 The various quack bitters advertised and guaranteed to be 
 " a wonderful discovery " are almost invariably some vile com- 
 pound of bad rum or bad whisky, and are the origin of much 
 drunkenness ; you should point out the dangers and condemn 
 their use. If a person icill take alcoholic stimulants, advise 
 him to take them " bare-footed " ; then he will know what kind 
 and how much he is taking. 
 
 A word about photographs may fitly close the chapter. If 
 you adopt the habit of presenting your photograph to every one 
 enamored of your professional skill, or of your manners, good 
 looks, style of dress, etc., it will be the cause of many awkward 
 dilemmas. Many patients who would swear by you one week 
 will curse about you the next, perhaps charge that you have mal- 
 treated them, killed their children, crippled their wives, or done 
 something else equally horrible. You will learn by melancholy 
 experience that the minds of men (and of women too) are sub- 
 ject to rapid changes. Many who would regard your picture 
 with highest esteem this month or this year would tear it down 
 or give it to the hangman the next. Trifles light as air will 
 sometimes serve to detach families from you ; a whim, a word, 
 a look, or a nod will sometimes break links that have been form- 
 ing for years ; indeed, even old patients whom you have served 
 through cold and heat, darkness and light, rain and sunshine, 
 will drop or dismiss you when they get ready, with less ceremony 
 and less regret than you would an office-boy or an hostler. 
 
 I
 
 CHAPTER V. 
 
 " A. inind fraught with integrity is the most august possessiou." 
 
 Have due and proper respect for religion. Your profession 
 will frequently bring- you into contact with the clergymen of 
 various denominations. Do right, and you will not only find 
 in them firm friends, but also your chief supporters in many of 
 your most trying cases. The ministrations of a cheerful, dis- 
 creet, and pious clergyman, — the Messenger and Servant of the 
 Most High God,— 
 
 "With a face like a benediction," — 
 
 who confines himself to his true vocation, i.e., healing the mal- 
 adies of the soul, applying salutary balms to the wounded 
 conscience, binding up the broken-hearted, and comforting those 
 who mourn, with remedies prescribed by the Great Physician, 
 are sometimes more useful to a worn-out and irritated patient 
 than medicine ; and even in cases in which death is near and 
 inevitable, calm resignation often takes the place of despondent 
 fear and apprehension when the invalid is skillfully informed 
 of the probability of death. In fact, when cheered and sus- 
 tained by religion, and impressed with the belief that whatever 
 may occur they are in God's hands, many of the careworn and 
 sick show as little regret, upon being gently apprised of the 
 probable near approach of death, as a traveler doeswhen about 
 to start on a pleasant journey. 
 
 " And hope, like the rainbow of summer, 
 Gives a promise of Lethe at last." 
 
 When summoned to attend cases of angina pectoris, aneu- 
 rism, organic heart disease, desperate wounds, paralysis, or other 
 serious injuries and diseases that create liability to sudden death, 
 ])rudence may require you to conceal from the patient the dan- 
 ger of death, lest he at once lose all hope and be overcome by 
 despair and tumultuous grief, which may exercise a grave and 
 
 (131)
 
 132 THE PHYSICIAN HIMSELF: 
 
 possibly fatal influence ; these may even render mild diseases 
 fatal in persons of a nervous constitution. In such cases, how- 
 ever, take care to give timely private warning to those especially 
 interested, and never deceive them willfully, and never, so far 
 as it is possible to avoid it, let any fellow-creature — high or low, 
 rich or poor — pass away from life without your making the prob- 
 ability of such an event known to relatives, friends, or neighbors. 
 Be also exceedingly careful in talking before children laid up 
 with scarlatina, variola, rubeola, etc., of the danger of compli- 
 cations, or of their illness being serious or dangerous, and never 
 terrify them, when they are to be operated upon, by loud prep- 
 arations and an awful array of instruments; also, take care to 
 banish from their minds the fear of hydrophobia, lock-jaw, etc., 
 for many young children fully realize the meaning of death, and 
 giving their cases such frightful importance would tend to ter- 
 rify them. Be alike cautious in speaking within hearing of 
 patients who seem to be sleeping, drunk, semi-comatose, etc. 
 Bear in mind that a person, young or old, is not always asleep 
 when his eyes are shut. 
 
 In this world of short meetings and long farewells it is just 
 as natural to die as to be born, and every one's time must come 
 sooner or later, and, although you can neither see what is writ- 
 ten in the Book of Life nor detain the living soul when sum- 
 moned by the Angel of Death, you will sometimes have cases 
 in which you will seem to be vainly fighting death itself, and 
 yet, to your astonishment, see the patient recover as if by resur- 
 rection ; and, on the other hand, you will often discover that 
 the patient has almost entered the gates of death, while friends 
 around think that he is getting better, until your practical skill 
 enables you to detect the gloomy fact. Be prepared, therefore, 
 for such incidents. 
 
 In serious illness you can very properly prepare the way for 
 the introduction of the clergyman, but you should never attempt 
 to thrust your religious beliefs or disbeliefs or your political opin- 
 ions upon patients who hold opposite views. Your specific duty
 
 HIS REPUTATIOif AND SUCCESS. 133 
 
 is with the patient's body, and it is really no part of your duty 
 to proselyte or to administer to the religious cravings of the sick. 
 Every sect has a clergy of its own, to teach religion, to soothe 
 the parting moments of the dying, and to make the sad event a 
 useful lesson to the survivors, and to these you must leave the 
 spiritual work. We are the physicians of the physical body, 
 the temporal life ; they are the physicians of the eternal life, of 
 the soul. Do little or no theological talking or teaching, and, 
 for the sake of spiritual decency, advance nothing that you do 
 not believe and feel, that your lips may remain unaffected and 
 your hands unspotted. Veil your views and confine your min- 
 istrations to the worldly welfare of patients, and never obtrude 
 anything in religious matters that involves a creed antagonistic 
 to that of the sufferer, and never belittle anything theological 
 that the sick earnestly and honestly believe. 
 
 The momentous question of eternity is certainly more im- 
 portant than the transitory things that belong to earth ; be, 
 therefore, ever ready not only to allow, but, if need be, to ad- 
 vise patients to have spiritual comfort. 
 
 Religion does good not only hereafter, but here ; indeed, 
 the presence of religious faith pointing to a life of blessedness 
 and immortality is a power that can assuage the keenest sorrow 
 and suffering, and even make the avenues to death smooth; 
 and if any physician doefe not recognize it, or if he feels con- 
 tempt for religious practices or feelings, or speaks slightingly of 
 religious beliefs, he {need I add?) lacks the A B C of philos- 
 ophy and observation. Your own eyes will see many a poor, 
 sick, woe-worn, despondent, and broken-hearted creature calmed 
 in mind and soothed in body by its comforting and cheering in- 
 fluence, and aided by it to get well, if his ailments are at all 
 curable ; if not curable, his spiritual wants being supplied by 
 the citation of the Bible promise that 
 
 "These ruins shall be built again, 
 And all this dust shall rise," 
 
 and by the repetition of the Saviour's name, and the voice of
 
 134 THE PHYSICIAN HIMSELF: 
 
 prayer to a benign Father, he gets unfaihng faith, patience, 
 resignation, and hope from it, seems thankful to hear the worst, 
 and becomes wilHng, or even anxious, for the hour of departure. 
 Indeed, one who has strong rehgious hopes is more hkely to 
 survive a severe disease and go on to longevity than one who 
 has not. 
 
 "Hope is the pillar of the world." 
 
 The involuntary, mechanical, automatic agitations, and 
 seemingly anxious movements unconsciously made by many of 
 the dying are popularly supposed to be attempts to communi- 
 cate some remaining thoughts, or secrets, or special wish before 
 death. In such cases do not fail to explain to the friends that 
 a kind Providence has mercifully draw^n the veil of unconscious- 
 ness around the dying, and that he is insensible to suffering ; 
 that the merchant has then forgotten his ships, the miser 
 his gold, tlie millionaire his possessions, and the beggar his 
 poverty. 
 
 The act of dying, in itself, is probably painless, and the 
 last stages of painful diseases are, as a rule, less so than those 
 that precede ; but the dying struggle, though painless to the un- 
 conscious patient, is, nevertheless, often distressingly hurtful and 
 harrowing to all who witness it. 
 
 Respect the religious belief of your patients ; it is well that 
 you, as a physician, whether a Roman Catliolic or not, should 
 be famiUar with the following duties required at the hands of a 
 physician by Catholic patients : — 
 
 When in attendance on Catholic families, be especially 
 careful, in cases of dangerous illness, to warn the immediate 
 friends of danger, that the sufferer may receive the last sacra- 
 ments. 
 
 One of the seven sacraments of the Great Church of Rome 
 is Extreme Unction. It is believed to purify the soul of the 
 dying from any sin not previously expiated through other sacra- 
 ments, and to give strength and grace for the death struggle. 
 
 This church teaches that moral responsibility begins at the
 
 HIS REPUTATION AND SUCCESS. 135 
 
 age of reason ; therefore, Extreme Unction is necessary for all 
 Avho have attained that age. 
 
 Extreme Unction is given but once in the same illness, but 
 if the patient has recovered and shortly afterward has the same, 
 or any other kind of dangerous sickness, this sacrament is again 
 necessary. 
 
 Another of the seven sacraments of the Church of Rome, 
 with which you should be familiar, is the Holy Eucharist. 
 
 The Holy Eucharist, sometimes called the Wafer, is be- 
 lieved to contain Christ's whole being, — his body, soul, and di- 
 vinity. It may be administered frequently in all cases of sick- 
 ness in which the patient is confined to the bed or to the house 
 for any length of time, provided he has sufficient reason to 
 make a full confession. 
 
 If the nature of your patient's disease is likely to render 
 him unconscious, be careful to inform the family of the fact, so 
 that the clergy may be sent for, and the confession be heard, 
 and the Holy Eucharist given before the reasoning powers are 
 obscured. 
 
 Those who are to receive the Holy Eucharist are required 
 to fast, if possible, from midnight until they have received it ; 
 but if you consider that your patient's being without either food 
 or medicine would be detrimental to his welfare the clergy 
 should be informed. 
 
 Where there is excessive nausea and vomiting, the Holy 
 Eucharist is either not given at all or given in the smallest 
 quantity. To expose it to being vomited is a great irreverence. 
 
 Be also equally careful in Catholic families to administer, 
 or have administered, conditional baptism to all children during 
 or after birth, when there is the slightest reason to doubt their 
 viability. The following are the conditions and details of con- 
 ditional baptism : You, or any one else, whether a Roman 
 Catholic or not, are allowed to administer it. A male adult is 
 preferable to a female, and of course a Catholic, if one is at 
 hand, to a non-Catholic. The baptism is administered as fol-
 
 136 THE PHYSICIAN HIMSELF: 
 
 lows : After procuring a glass or cup of clean water (spring- 
 water is designated, but hydrant-, or pump-, or any other kind 
 of true and natural water will do), in a suitable manner say- 
 " I baptize thee in the Name of the Father," precisely at the 
 word " Father " pouring a small portion of the water upon the 
 child's head ; continue, " And of the Son," at the word " Son " 
 pouring another small portion; again continue, "And of the 
 Holy Ghost," and at the words " Holy Ghost " another small 
 portion. 
 
 Bear in mind that in baptism every word must be uttered ; 
 were you to omit even an " of" the baptism would be insufficient. 
 Also, remember that the water must be true and natural, and 
 must be poured exactly whilst the formal words are pronounced. 
 So very important are these details, that if you arrive after a 
 midmfe or other person has baptized the child, carefully ascer- 
 tain whether she has observed the full form and used accurate 
 language. If she has not, and the death seems impending, you 
 should baptize it again. In such a case of doubt it is necessary 
 to preface the formal words with, " If thou art not already 
 baptized, I baptize," etc. 
 
 If in a midwifery case the child of Catholic parents is be- 
 lieved to be in danger of dying it must be baptized. If it is 
 partly born, baptize on its head, if the head is presenting ; if 
 not, upon the hand, or foot, or any other part that is bom. If 
 no part is born, and you can reach the child through the vagina, 
 the water must be applied to such part as can be touched. In 
 all cases of unborn children, preface the regular form with the 
 words, " If thou canst be baptized, I baptize," etc. In such a 
 case apply the water to its body with a syringe, or by any other 
 means by which the water will remain uncontaminated till it 
 touches the child. 
 
 In Catholic families you will run great risk if you use the for- 
 ceps before the child has been baptized ; for if this be neglected. 
 and the child be born dead, you will not readily be forgiven. 
 
 Remember that it is better that a Catholic patient should
 
 HIS REPUTATION AND SUCCESS. 137 
 
 be thrice prepared and not pass away than to go unprepared ; 
 therefore, if you err at all, let it be on the safe side. 
 
 "A good judgment is a great thing." 
 
 You should be especially careful to give timely warning of 
 danger to all who have business of vital importance to transact, 
 and to those who have the best right to know, in cases of sudden, 
 serious illness ; for instance, friends may have to be summoned, 
 wills executed, and other arrangements made, and, more impor- 
 tant still, the sick may also wish time to reflect on their awful 
 situation and the more serious afl"airs of eternity. 
 
 In an adult with almost any sickness you can safely predict 
 that a hearse will be at his door in a few days, at furthest, after 
 the pulse has gradually increased (heart- failure) to 160. Also, 
 if, after wounds or in acute sickness, he emaciates to two-fifths 
 of his usual weight. 
 
 If you will observe closely, you will find that when a pa- 
 tient becomes fully and firmly impressed with the belief that he 
 will die he is extremely apt to do so. 
 
 It is very much better for you to decline to leave your 
 sphere as physician to become a witness to wills if called upon 
 to do so, and especially in cases in which you are not fully sat- 
 isfied of the mental capacity of the testator ; and determinedly 
 refuse to take part in, or in any way interfere with, the settle- 
 ment or division of the estate of those whom you have pro- 
 fessionally attended, as you may thereby incur the charge of 
 misusing the opportunities afi"orded you by your position as a 
 medical attendant. Of course, if a person whom you have 
 served long, successfully, or faithfully, chooses to remember you 
 for it in a corner of his will, if it is done without your conniv- 
 ance it will be lucky and all right. 
 
 In no case be a witness to or executor of a will when you 
 are made a legatee or heir, as any legacy or pecuniary interest 
 therein devised to you will be void. 
 
 When attending very serious cases, be careful to exhibit 
 proper gravity and sincerity, and never try to excite hope in
 
 138 THE PHYSICIAN HIMSELF: 
 
 cases that are hopeless, or obtrude the cry of hope, hope ! when 
 you really see none. If, moreover, a very ill, sane adult really 
 wishes to know his real situation : whether he is in great dan- 
 ger or likely to die, and pointedly asks you the question, answer 
 him frankly and truthfully that he is a very sick man, and 
 state fairly and fully the ground on which your opinion rests, 
 and thus relieve yourself of the responsibility ; but, if possible, 
 couch your answer in kind and gentle language, so as not to 
 appal and unadvisedly depress him by taking away all hope 
 and substituting despair. At the same time, in expressing your 
 opinion, give him all the hope, assurance, and sympathy you 
 honestly can, and if you know anything favorable, either in his 
 physical or spiritual condition, mention it as a solace. In an- 
 ticipation of such painful incidents, it is well to be prepared with 
 consolatory and advisory language adapted to the respective 
 cases. 
 
 You are at liberty to be silent or to say but little regarding 
 the nature or degree of a person's sickness, but, of course, let 
 whatever you do say, whether much or little, be conscientiously 
 truthful. You must not, can not put a falsehood in the place 
 of the truth, not even when attending to the sick and dying ; 
 neither as a man nor as a physician must you, under any cir- 
 cumstances, sacrifice principle or honor for expediency, especially 
 to a person in a terrible and trying situation. But you can, 
 you must, as far as possible, soften the truth and blend it in a 
 proper manner with feeling and sympathy. 
 
 You will find few who have the necessary fortitude and 
 submissive resignation to seek to enjoy their remaining life after 
 being told that their cases are incurable ; you should be cautious, 
 therefore, not suddenly to cut off all hope, even from those 
 afflicted with lingering maladies, — tuberculosis, cancer, Bright's 
 disease, and like cases, — in which death approaches slowly, like 
 a creeping shadow, up to the last stage, knowing that persons 
 with those diseases have plenty of time while sinking away — the 
 face gradually grows thinner, their eyes dimmer, cheeks paler,
 
 HIS REPUTATION AND SUCCESS. 139 
 
 pulse quicker, breatli iaster, limbs weaker, vitality and all else 
 lower and on the wane — gradually to realize their true state. 
 Indeed, you should not, in such cases, tell how many you have 
 attended who died of the same disease, or give a merciless 
 prognosis, containing, like a death-warrant, neither hope nor 
 encouragement, unless you are prepared to be replaced by 
 Dr. Bigsmoke, or Dr. Guller, or Prof. Oilytongue, who, 
 unless by speaking more hopefully, can do no greater good 
 than yourself. Be on your guard, therefore. 
 
 An imprudent and ill-timed remark may destroy life 
 where buoyed-up hope would preserve it. To tell a patient that 
 he has a grave-yard cough, or that he will never see spring 
 again, or that you would not have his throat, or heart, or lungs, 
 or liver, or kidneys for a thousand dollars, would add the 
 depressing influence of despair to the sedative influence of the 
 disease, and could not fail to destroy his moral will-power, and 
 either murder him by inches or work serious injury to his case. 
 
 You may often prevent despondent and anxious patients — 
 whose pulse or temperature has grown worse, or whose diseased 
 lungs, heart, etc., you are examining — from asking you incon- 
 venient questions that would necessitate a disclosure of your 
 gloomy prognosis, by having ready on your tongue's end, 
 questions regarding their appetite, sleep, state of the bowels, or 
 something else to ask the moment you finish listening, counting, 
 or testing ; you thus give them no period of solemn silence, and 
 so, temporarily at least, no chance for inopportune questioning 
 as to what you find or think, or to see what your thoughts then 
 show. Be prepared, however, for such at a later time. 
 
 We have to do not only with sickness, but the sick ; not 
 only with death, but the dying. It is, for several reasons, better 
 never entirely to abandon a patient with consumption, cancer, 
 etc., even though he be incurable, or in the last stages of a fatal 
 malady ; on the contrary, keep him on your list and visit him, 
 at least occasionally, not only that you may give him all the 
 comfort you can, by suggestions for the relief of pain and mental
 
 140 THE PHYSICIAN HIMSELF: 
 
 anguish, but that his sorrowing friends — present and absent — 
 may have the very great consolation of knowing that their loved 
 one will receive all necessary professional care and attention up 
 to the very time the dark curtain falls. 
 
 In every stage of your career aim to convince the world 
 that you, as a physician, are an apostle of hope, — 
 
 "White-handed hope, the hovering angel, gilt with golden wings," — 
 
 of faith, of sympathy, of comfort, and of relief, and that your 
 profession is not in league with the grim forces of death and 
 mourning, but that, on the contrary, all its characteristics are 
 indicative of health-giving and life-restoring power. Neither 
 blue-eyed and rosy-cheeked Hygeia, nor her parent, ^sculapius, 
 is represented as in tears, with the habiliments of mourning ; 
 but we see instead ^sculapius armed with serpents, the symbol of 
 wisdom and convalescence, and Hygeia is seen affording to others 
 warmth and succor, — a beautiful symbol of health and preventive 
 medicine. 
 
 Remember that old Mr. Death is the physician's great 
 antagonist, and that when he defeats your best efforts and 
 extinguishes the spark of life your duty ends. Do not, then, 
 essay (otherwise than mentally) to offer up a prayer, or make a 
 prolonged stay to administer nervines to relatives or friends, or 
 tender your services for promiscuous duties, such as carrying 
 messages, going for the barber, or the undertaker, etc., but at 
 the earliest fitting moment quietly withdraw. 
 
 Leave the laying out and the application of preservative 
 fluids to the face and body of the deceased, and all such 
 matters, to the undertaker and friends. 
 
 Abstain, also, from visiting the house of mourning to view 
 the dead (unless from professional necessity or obligation), and, 
 except when it is absolutely necessary, even avoid attendance 
 at the funeral services of your deceased patients, or following 
 their corpses to the grave. 
 
 More especially refrain from writing apologetic letters to
 
 HIS REPUTATION AND SUCCESS. 141 
 
 the bereaved, expressing self-reproach for failhig to recognize 
 this, that, or the other fact, or regret at not having followed a 
 different course of treatment, and asking forgiveness. If there 
 are any facts in connection with the case that call for an 
 explanation, find occasion to communicate them verbally. 
 
 Ours is a chequered life, and we see humanity in all its vari- 
 eties, — and are necessarily, familiar with many of the most humil- 
 iating and revolting phases of human life, — the white and the 
 black, the rich, the poor, the indigent, the putrid prostitute, the 
 rascally outlaw, the swaggering rowdy (whose character can be 
 read on his physiognomy), the depraved reprobate, and the 
 sneaking thug; Swearing Joe, Thirsty Jack, Tough Moll, 
 Joking Jim, — 
 
 "Puns and sarcasm he would pour forth at his own funeral," — 
 
 Vulgar Sally, and Blackleg Tom (sin in satin and vice in 
 velvet), will all be represented in the Babel of your practice. 
 Attend anybody if you must, even in the haunts of idleness, 
 shiftlessness, and drunkenness, as your mission is to all sick 
 people, — the vicious as well as the virtuous ; but, as far as pos- 
 sible, avoid disreputable places and the incurably wicked, and 
 do not be hail-fellow-well-met with persons in whom the moral 
 thermometer registers low, as they are more Hkely to prove a 
 curse than a blessing ; nevertheless, do not hesitate to do your 
 duty to a suffering fellow-creature, however low in the scale of 
 humanity and morality. At the same time remember that such 
 Samsons and Delilahs respect no physician who does not fully 
 respect himself, and take care to treat all such with ceremonious 
 politeness. 
 
 Avoid all such deceptive tricks as to assure a timid patient 
 that you will not lance his boil, but merely wish to examine it, 
 and then suddenly doing what you assured him you would not 
 attempt. Veracity should, in all the situations of life, and 
 under all its circumstances, be your golden shield. 
 
 Endeavor to acquire and maintain a complete professional 
 influence over all your patients, for unless you enjoy their con-
 
 142 THE PHYSICIAN HIMSELF I 
 
 fidence and respect you will have to contend not only against 
 their physical condition, but their mental and moral also. 
 
 You have a perfect right to relinquish attendance on a case 
 when you find your intei'est, or reputation, self-respect, limit of 
 endurance, or other valid reason requires it ; when you do so, 
 give formal notice, and let the cause of your withdrawal be 
 fully understood, that you may not be responsible for subse- 
 quent occurrences. It is better, however, to decline undesirable 
 cases at the first interview, on the plea of great press of other 
 work, than to take them, involve yourself, and then have to 
 relinquish or neglect them. 
 
 Never refuse to rise from your bed to pay necessary night 
 visits to patients ; to do so would not only subject you to the 
 poignant reflection that you had been recreant to the call of 
 duty, but would also be unjust, in that it would put your duty 
 on some other physician, and by delay cause the patient un- 
 necessary suftering, possibly death ; or it might even drive the 
 messenger to a pharmacist for advice and medicine, or necessi- 
 tate the calling in of an Irregular, or other undesirable person 
 who could be cauglit up in the emergency. If, however, you 
 will make it a rule to charge full night-visit fees for all visits 
 made after bed-time, you will be spared much loss of rest and 
 night exposure ; calls to hurry two or three miles on cold, 
 wintery nights, or before breakfast, on a half-run or dog-trot, 
 because some one has sneezed, or to attend to other needless 
 and harassing demands from frightened ailers, who fancy they are 
 about to die, and from others who could have sent at a more 
 seasonable time. Unnecessary/ night visits rob physicians of 
 necessary rest, and even if they do bring extra fees, if your life 
 is a busy one, they afford no fair equivalent for the risk to health 
 from overwork and loss of sleep. 
 
 Be exceedingly cautious in accepting degraded or vicious 
 patients, to be visited clandestinely, and in having married 
 women or young females consult you secretly at your office, — 
 especially if it be for vaginal or other private examinations, —
 
 HIS REPUTATION AND SUCCESS. 143 
 
 without knowledge of husband or parents. Also, be careful 
 about attending patients suffering from the effects of intem- 
 perance or prostitution, under pretence that they have other than 
 their real ailment, with the view to screen them, by misleading 
 their friends or relatives. 
 
 Do not overvisit your patients, and be especially careful to 
 pay but few visits to those with trifling injuries, uncomplicated 
 cases of measles, mumps, wliooping-cough, chicken-pox, etc. 
 People observe and criticise a physician's course in all such 
 cases, and, if he apjiear overattentive, they are apt to believe 
 either that tliey are sicker than he admits, which will cause 
 them great alarm, or that he is nursing and prolonging the 
 case and running up a bill imnecessarihj . It is sometimes an 
 extremely delicate point to decide whether a patient needs 
 another regular visit or not, and how soon ; whether the case is 
 of a kind in which changes are liable to be sudden and fre- 
 quent or not. Practice should soon enable you to judge cor- 
 rectly. You must also learn the art of telling the proper time 
 to cease attendance in different varieties of cases, so as to satisfy 
 the patient and his friends that you are simply intent on dis- 
 charging your duty. 
 
 Most people dread the expense of professional services, 
 and excessive attention, numerous visits, and repeated changes 
 of treatment are rarely appreciated ; a physician who pays but 
 few visits and yet cures is always popular. If you can acquire 
 this habit, and gain the reputation of paying no unnecessary 
 visits, it will be regarded as a special feature in your favor, and 
 will almost double your practice. A good and the only proper 
 rule is to visit your patient when, and only when, you con- 
 scientiously believe it to be necessary, whether once a day or 
 once in seven days. Never go several times a day to observe 
 the variation of symptoms or effect of treatment without point- 
 ing out the necessity for it. 
 
 Do not mix professional and social visits together; go 
 either as a physician, and be one, or as a friend ; and, above all
 
 144 THE PHYSICIAN HIMSELF: 
 
 else, avoid running in to visit patients unnecessarily because 
 you " happen to be in the neighborhood." If you visit Tight- 
 fist on such a pretext, and charge for it in the bill, you may be 
 sharply criticised for making obtrusive visits and forcing un- 
 asked civilities, and your bill possibly disputed. On the other 
 hand, never visit a seriously ill patient so seldom, or so irregu- 
 larly, as to lose sight of the details, or induce a belief that you 
 are neglectful or indifferent. 
 
 Some well-to-do or overanxious people form an exception 
 to this rule, and insist on your visiting them more frequently 
 than is necessary, so as to almost live at tlieir house during 
 sickness, to observe progress, instruct attendants, etc., regardless 
 of the additional expense; and, of course, you may gratify them, 
 provided such attendance does not interfere with the fulfillment 
 of your duty to other patients ; but at the same time, if other 
 than the patient himself will have to pay the bill, the person 
 responsible should (if need be) be informed of the reason why 
 the extra visits are made and of the unnecessary expense en- 
 tailed. No blame can then attach to you. 
 
 During such frequent visits you should maintain a profes- 
 sional attitude, and avoid the habit of digressing from the 
 patient to politics, the fashions, or other current topics ; other- 
 wise, he and his friends will be apt to lose confidence, after 
 which the moral efiect of your visits will be lost, you will be 
 shorn of your influence, and may receive scant courtesy, and 
 scarcely be honored or welcomed at your visits. 
 
 When visiting a patient, always let it be known whether 
 and when you will visit him again ; it will not only satisfy him, 
 but prevent all uncertainty, and relieve the anxious expectancy 
 of "The Doctor's Rap." Remember that to judge the condition 
 or progress of some cases it is better to visit them at diflerent 
 periods of the day, or even at night, while others should be seen as 
 nearly as possible at the same hour each day. AVhen a case has 
 so far convalesced as to make frequent visits unnecessary, and 
 yet improves so slowly or irregularly as to make you fear an ar-
 
 HIS REPUTATION AND SUCCESS. 145 
 
 rest of improvement or a relapse, it is better to keep an eye upon 
 it by looking in occasionally, and letting it be known when you 
 will call again, with an understanding that if in the meanwhile 
 the patient becomes worse, or, on the other hand, if he gets so 
 much better as to render your promised visit unnecessary, you 
 shall be notified thereof. This plan is, for many reasons, better 
 than quitting such cases more or less abruptly. 
 
 The old, chronic cases that beset our paths often do us 
 great injury ; for among the surest fruits of neglecting them 
 will be the employment of quack medicines, or the entrance of 
 an Irregular or charlatan, whom some busybody has pressed 
 upon them during your absence. It is very mortifying to drop 
 in to see a patient, after prolonged neglect, and see a big bottle 
 of quack medicine, or a vial of pellets, or the two tasteless 
 glasses sitting on the table beside him, and then to hear this ol 
 that story why they changed. When you first encounter a case 
 already chronic, be frank and candid as to the time required, 
 and as to doubts of possible cure, and use no disguise or equivo- 
 cation, and make no rash promises. 
 
 To evince an earnestness and personal interest in your 
 cases are potent, master qualities that inspire confidence and 
 respect, and are often freely and readily accepted in place of 
 superior skill. Seek therefore to imbue your mind with a feel- 
 ing of genuine interest in your cases, and you cannot fail to 
 show it in a thousand ways. 
 
 Make it a study to remember well all that is said or done 
 ut your visits, so that your line of conduct may be consistent 
 throughout the case. Also, take care neither to betray a want 
 of memory — 
 
 "Memory is the first faculty that age invades" — 
 
 or a lack of interest, for, were you to ask a patient, " AVhat kind 
 of medicine did I give you last '?" or to hesitate in your ques 
 tions, he and his friends would at once notice it, and suspecf 
 that you either felt but little interest in his case or suffered from 
 a failing memory.
 
 146 THE PHYSICIAN HIMSELF: 
 
 Study to make your address and manner such that patients 
 will not hesitate to open their hearts and fully impart to you 
 their secrets and the nature, seat, and cause of their disease as 
 fully as the pious Catholic would to his Father Confessor. One 
 of the greatest drawbacks to many physicians is that they fail 
 to inspire complete confidence, and consequently patients neither 
 intrust them with the secrets of their folly, simpleness, or wicked- 
 ness, nor consult them in afflictions that create feelings of hesi- 
 tancy or shame. 
 
 Have little or nothing to do with your patients' family 
 squabbles or with their neighborhood quarrels, and do not let 
 your wife or any one else know your professional secrets, or the 
 private details of your cases, or of the methods or instruments 
 used in their treatment, even though they be not secrets. Few 
 persons like to have their foibles retailed around from house to 
 house: what they said in their delirium, or how they shrank 
 from leech-bites ; how she " cut up " in her labor, or he gagged at 
 a pill, — or to have other whims, fancies, or infirmities exposed. 
 
 "Whispers often separate chief friends." 
 
 Many persons labor under the impression that physicians 
 who (injudiciously) allow their wives, for the benefit of fresh 
 air, to ride around with them while making professional visits, 
 relate to them all that has transpired during the visit after they 
 drive away. Such, of course, is not the case; nevertheless, if 
 people think so, the discomforting thought is the same whether 
 it be true or not. 
 
 There is no end to the mortifications, compromises, and 
 estrangements into which a physician's prying and babbling 
 wife may lead him by her tittle-tattle. Notliing is more mor- 
 tifying or vexatious to the feelings ot sensitive patients than 
 to hear that the details of their cases are being whispered about, 
 as coming from the physician, his trumpet-tongued wife, or 
 others whom he or she has told. 
 
 If you allow yourself to fall into the habit of giving out 
 the latest inside news, or of speaking too freely ever of ordinary
 
 HIS REPUTATION" AND SUCCESS. 14^ 
 
 affections, or submit to be indiscriminately interviewed by In- 
 quisitive Jack and Peeping Jenny, Mrs. Knowaheap, Mrs. 
 Blabber, Mrs. Picklock, Longtongue, and other key-hole nota- 
 bles from Meddlesome Row, concerning your patients, your 
 very silence in disreputable cases will betray them. The credit 
 of whole lamilies and the character of their individual members 
 will sometimes be at stake, and unless you shut your eyes and 
 close your mouth, lest you see and say too much, it may ruin 
 them and involve you. Indeed, many persons would rather suffer 
 or even die than be subjected to public shame or disgrace by an 
 exposure of the affections they are laboring under ; and some 
 persons suffering with venereal diseases are so much afraid that 
 their family physician might reveal the secret, that they would 
 sooner allow the ravages of the disease, or apply to a quack, 
 than run that risk of exposure and disgrace. 
 
 You will be, to a certain extent, an honorary member of 
 every family you attend, and will be allowed to see people in a 
 very different light from that in which other people see them, 
 when their spirits are humbled in the hour of pain and the day 
 of distress. The community, as a rule, view one another with 
 a veil thrown over their moral and physical afflictions; their 
 strong passions and feeble control ; their blasted hopes and the 
 sorrows that flow from their love and hatred; their poverty, 
 their frailties, their crimes, their vexations, and their meanness; 
 their cruel disappointments and rude mortifications, their follies 
 and disasters, fears, delinquencies, and solicitudes. You will see 
 the trappings of greatness and the cloak that hides deformity 
 dropped, their infirmities and imperfections of mind and body 
 with the veil uplifted, and the book of the heart wide open, — 
 the homeless, the betrayed, the deserted, and the victims of 
 intemperance, grief and joy, anger and shame, hope and despair. 
 
 "Mouth shut, eyes open." 
 
 You will hear conversations that it would be cruel to rehearse ; 
 you will become the repository of all kinds of moral and phys- 
 ical secrets. Keep them all, with Masonic fidelity.
 
 148 THE PHYSICIAN HIMSELF: 
 
 Love, debt, guilt, shame, jealousy, grief, domestic trouble, 
 superstition, poverty, anxiety, thirst for revenge, and the like 
 may prey on the mind of a sick person, and actually convert a 
 simple into an incurable malady. As such matters are apt to 
 be concealed from you, it is necessary that you should bear in 
 mind that they are important agents in the causation and 
 intensification of disease, and be prepared for their early recog- 
 nition. 
 
 Observe reticence at your visits, and do not allude to the 
 private affairs of anybody from house to house. Let your lips 
 be hermetically sealed to the fact that So-and-so has, or ever 
 had, venereal disease, haemorrhoids, fistula, ruptures, leucorrhoea, 
 or constipation ; or that abortions, private operations, etc., have 
 taken place ; or that any person has recourse to anodynes or 
 stimulants ; or that Mrs. Ohmy had a baby too soon after her 
 marriage, or that Miss Awfulone or Miss Angelicus had one 
 without being married at all ; or that Mr. Badegg is addicted 
 to secret immoralities, or that Moonlight or Sunrise has or has 
 had a venereal disease ; or that Allgood is not good at all, but 
 has this, that, or the other bad habit. No matter how remote 
 the time, if patients wish their secrets told let them be their 
 own tale-bearer. You have no right to disclose the affairs of 
 j)atients to any one without their consent. 
 
 But while judicious silence should be your general rule, it 
 is your higher duty as a member of society, and to the laws, to 
 expose and bring to justice abortionists, — 
 
 "Tremble, thou wretch, that hast within thee undivulged crimes, 
 unwliipped of justice," — 
 
 unprincipled quacks, and other heartless vampires, whether act- 
 ing under cover of a diploma or not, whenever you meet with 
 proof of their iniquitous work. But (even though morally cer- 
 tain thereof) never take a step for which you are not prepared 
 to be held personally responsible, and never directly charge any 
 one with dishonorable or criminal conduct on hearsay evidence, 
 or unless you have at hand ample and unequivocal proof of his
 
 HIS REPUTATION AND SUCCESS. 149 
 
 wrong-doing ; for, if you are without it, the accused is sure to 
 find a loop-hole of escape, — 
 
 "It is hard to catch a weasel asleep," — 
 
 or to make an indignant denial, on the principle that 
 
 My " No " is as good as your "Yes," 
 
 and cunningly bring against you a counter-charge of malicious 
 persecution, with its legal consequences ; after which he will 
 •resume — ^increased business — "a< the old stand.^'' 
 
 In prescribing medicines for the sick, it is better to confine 
 yourself to a limited number of remedies with the power and 
 uses of which you are fully acquainted, than to employ a larger 
 number of ill-understood ones ; for which reason, you will act 
 wisely in avoiding new remedies until their value as remedial 
 agents has been satisfactorily proven. It may also be well to 
 remember that the number of remedies actually required in 
 combating disease is relatively small. 
 
 Memorize the rules for dosage, and keep in mind the max- 
 imum and minimum doses of every article you admit into your 
 list of remedies. 
 
 Whenever you order unusually heavy doses of opiates, etc., 
 instead of using the common signs, take care either to write the 
 quantity out in full, or to underline both the name and quan- 
 tity, or in some other unmistakable way show on the prescription 
 that you are awake to all that is written. A good plan is to 
 write at the bottom, " The above is just as intended." Again, 
 when you write for a potent article that is but seldom used, it is 
 well also to add its common name, that the pharmacist may feel 
 no doubt as to what is intended. It is safer also to put the 
 names of heavy-dosed patients on their prescriptions. When 
 you order morphia, etc., in other than the ordinary doses, it will 
 be well to have it made into pills and granules, and direct the 
 pharmacist to "put them into a bottle." It is so unusual to 
 dispense pills in a bottle, that it intimates to the compounder 
 that the prescribed dose is not a blunder, but is as intended, 
 and acts as a guard to patients and attendants against taking
 
 'ISO THE THYSICIAN" HIMSELF: 
 
 or giving them in mistake. When you prescribe pills, powders, 
 etc., for sailors and other persons whose business renders them 
 liable to get their medicines wet or wasted, it is better to 
 direct them to be put into bottles or tin boxes instead of paper 
 boxes. 
 
 You should have sufficient honesty and sufficient independ- 
 ence to do nothing, and to give nothing, to a patient when that 
 is the proper course, but you may occasionally come across a 
 patient with disordered imagination, who persists that he is be- 
 witched, or that a pin or fish-bone is lodged in his throat, even 
 after your careful examination has proven that there is none; 
 or syphilophobic and anxious to take constitutional remedies 
 after a chancroid ; or morbidly afraid of hydrophobia or lock 
 jaw ; or the half-insane victim of this, that, or the other vagary 
 or hallucination, and who cannot be convinced by all your as- 
 surances that his ailments or forebodings are imaginary. In 
 such a case, when classical medicine and all else fails, as it is 
 your object to cure, it may become not only justifiable, but as 
 clearly your true and manly duty to employ such innocent rem- 
 edies as are likely to relieve his heated and deluded imagina- 
 tion through psychological impressions, or the action of mind on 
 mind, as it is to give certain medicines for a well-defined dis- 
 ease. Any remedy or expedient honestly intended to excite a 
 definite expectation, or hope, in order to aid in relieving such 
 a patient, is called a placebo. Giving a placebo in such a case 
 is a very different thing from practicing upon and increasing a 
 patient's fears, as is done by the charlatan. Despise not policy, 
 but take care that your policy consists in honorable expedients 
 for honest purposes. 
 
 A mental agent should, as a rule, be small and easy to 
 take ; the bromides, the valerianates, mild tonics, and other 
 harmless remedies are sometimes given. 
 
 Should you ever have recourse to remedies intended to act 
 chiefly through the mind, if you will take care to look your 
 patient earnestly and steadily in the face, and give precise
 
 HIS REPUTATION AND SUCCESS. 151 
 
 instructions concerning the time and mode of using them, they 
 will do double good. 
 
 You will not only find that almost anything will relieve 
 some of these mental cases, but will be further surprised to learn 
 that it has evoked their enthusiasm, and that they are chanting 
 its praise and vowing that they were cured of one or another 
 awful thing by it. Some, indeed, who seem to be magically 
 benefited by doses of — nothing — will actually credit them with 
 saving their lives. What a sad comment on the boasted intelli- 
 gence of the nineteenth century ! What a pitiable fact for truth 
 and science that flavored water, etc., often receive as much 
 (presto, be gone !) praise as the soundest remedies ! What a 
 harvest such people supply for those who live by fleecing ! 
 
 " Shame ! Shame ! ! Shame ! ! !" 
 
 Of mental remedies make none but an honest and proper 
 use (leave juggling and all that is dishonorable to disreputable 
 pretenders), and, if you happen to have the appropriate remedy 
 give it gratuitously and charge for advice only ; if not, write a. 
 prescription for something that is not unusually expensive. 
 
 Never send a patient to a drug-store with a prescription for 
 bread-pills or anything else you know to be inert. It is not 
 right to cause any one to pay money for articles that have no 
 intrinsic value ; besides, if among all the simple tonics, nervines, 
 etc., in the pharmacopoeia you cannot select some recognized 
 agent of more remedial value to a depressed patient than inerts, 
 your resources must indeed be limited. Moreover, if a patient 
 were to discover that he had not only been paying money for 
 such inert, valueless articles as bread-pills or colored water, but 
 wrongly exposed to the criticism and derision of the pharmacist, 
 he could not help feeling victimized and indignant. 
 
 Let me here impress a caution: to believe too much and 
 not to Delieve at all are both unfortunate mental conditions ihv 
 those who practice medicine. Take care that your mind is not 
 led into an exaggerated view of the importance and power of 
 drugs. Bear in mind the example of the old woman of Paris
 
 152 THE PHYSICIAN HIMSELF: 
 
 who filled bottles with water from the river Seine, sold it as a 
 cure-all, and heard of so many cures wrought by it on all sides 
 that she died fully convinced by a throng of patients and a 
 bushel of certificates of cure that the (polluted) water of that 
 river was a sure cure for all the ills of the human race. Guard 
 yourself, also, against the opposite and grave error that medicines 
 are useless and unnecessary ; for either view would materially 
 impair, if not destroy, your fitness for the practical duties of 
 your profession. 
 
 The very shape and fashion of medicine have changed with 
 the present generation, and eight-ounce bottles and thirty-two 
 ounce bowls of bad-tasting, purgative, expectorant, or diapho- 
 retic m'edicines, wasting the strength in the beginning that is 
 needed during convalescence, are (thank Providence !) seldom 
 seen, for the vast majority of people are now sensible enough to 
 avoid every-day medicine taking, and to use remedies only 
 when sickness demands, and even then not too much ; but 
 taking a little " searching " medicine that " scours " lour or five 
 times, or a bottle of salts, or of cream of tartar, or ten and ten 
 of calomel and jalap for " clearing the constitution," in the 
 spring of the year, still has patrons, who believe in positive 
 medication with positive results, just as the good housewife 
 believes in spring and fall house-cleaning ; and cathartics and 
 other depleting remedies are still popular with the few who cling 
 to the old FORTY- YEARS-AGO mania for purging, sweating, and 
 cleaning the blood. 
 
 Such people always want to see and feel promptly and 
 fully the action of medicines, and purge themselves entirely too 
 often ; and some of them think they could scarcely live a month 
 unless they had almost turned themselves wrong side out with 
 pills, salts, etc. Remember that when nature is relied upon 
 the bowels ought to act daily, or at least freely once in two or 
 three days; for when the bowels are naturally moved, the lower 
 portion only of the intestinal canal is cleared out, and, during 
 the interval before the next evacuation, the fsecal matter from
 
 HIS REPUTATION AND SUCCESS. 153 
 
 above passes down and is in turn evacuated ; but, when a pur- 
 gative is taken, it sweeps out the entire alimentary canal, and 
 of course such a scouring out is not required as often as the 
 natural, though partial evacuation. For any adult who cannot 
 have an evacuation without the aid of medicine, to give an 
 aperient or purgative once in three or four days is sufficiently 
 often. 
 
 Never tell patients too minutely how the prescribed medi- 
 cine Avill act, as it may vary enough from your promise to dis- 
 appoint them, and to brand you as a false prophet. There are 
 also a few patients who would feel worried if you were plainly 
 to tell them exactly what ails them. 
 
 Never solicit people, either by word or otherwise, to em- 
 ploy you ; for such a course would tend to repel rather than 
 attract them, and could not fail to deprive you of necessary 
 respect and esteem. Besides, respect for yourself and the pro- 
 fession make it far better to wait until your professional acquaint- 
 ance is sought. 
 
 Many people are naturally ackle and capricious, and can- 
 not be depended on to adhere to you, even from one day to the 
 next ; no matter how earnestly one tries to serve and to satisfy 
 them, they will quickly become wearied and disheartened, and 
 will insist upon consultations even in the most trifling ailments ; 
 perhaps, also, change about with astonishing rapidity, — first from 
 one physician to another, then maybe to a prescribing druggist 
 or irregular practitioner, and will finally wind up with a quack 
 or quack medicine. Others will adhere to you with steady con- 
 fidence, through good and bad, with firm tenacity. You should, 
 nevertheless, under any and all circumstances, base your hope 
 of being retained and respected, no matter on what class of pa- 
 tients you are attending, upon the just and true foundation of 
 deserving it. Do not, however, set your heart or faith on a con- 
 tinuance of the patronage and friendly influence of any one, for 
 you will many a time be unceremoniously replaced, after days or 
 weeks of unremitting attention, by those whom you know to be
 
 154 THE PHYSICIAN HIMSELF: 
 
 in head and heart far below you in everything that constitutes 
 a good physician. Sometimes, after you have shown every at- 
 tention, spent days of toil and sleepless nights, and done all that 
 is possible, you will be unexpectedly and unjustly dropped by a 
 family without reasonable courtesy or explanation, sometimes even 
 when the patient is out of danger or nearly^cured, and possibly be 
 superseded by Dokter Lowebb, or Prof Kornkutter, or little Dr. 
 Bighead, or Docktur Killcow, or Dr. Bobtail (who spends half 
 his time in trading horses and talking politics), or " an old 
 woman," or an Irregular, who may at once change your diagnosis 
 of " bilious remittent fever " to " malarial fever," or " typhoid," 
 and change your sulph. quiniee and mass hydrarg. to sulph. cin- 
 chonise and hydrarg. cum creta, and you have to submit to the 
 humiliation, the icy ingratitude, and the wrong, without being 
 in a position at all to resent it, and you will feel the force of 
 Solomon's soliloquy : " If it befall me as it befalleth to the 
 fools, why should I labor to be more wise ? " 
 
 " I have seen a stately cedar foil, 
 And in its place a mushroom grow." 
 
 foor people, when raised to wealth (from the dirt to de- 
 lirium), often move irom the obscure, old house, or dirty rooms, 
 to a mansion in a different section, sell their old, shabby turni- 
 ture, and buy new, — 
 
 "But yesterday out of the egg, to-day they despise the shell," — 
 
 pull off plain clothes and put on fine ones ; and, as if to efface 
 all the past, even the physician, who attended them in obscurity, 
 and stood by them through everything, is also abandoned, and 
 Prof Highkite or Dr. Newmode is employed. 
 
 " And thus the world goes round and round ; 
 Some go up, and some go down." 
 
 The faculty promptly to detect loss of confidence, or dis- 
 satisfaction with yourself or your remedies, is one of the acquire- 
 ments which, if you do not already possess, you must seek to 
 acquire. Bear in mind that continued suffering, protracted con- 
 finement, unsatisfied suspense, and disappointed expectation of
 
 HIS REPUTATION" AND SUCCESS. 155 
 
 convalescence all tend to produce impatience and dissatisfaction 
 in the mind of the patient and his friends, and to create doubts 
 of your knowledge, skill, or judgment, — for which due allow- 
 ance should be made. 
 
 Even to proclaim a truth is not seldom attended with 
 unpleasant consequences. Thus, you may deem it your duty 
 to announce to a patient, or to some member of his family, that 
 he has an incurable disease, or that he will positively die. Un- 
 less the fact is obvious to all, you will probably lose your patient, 
 not by his death, but by his changing to some other physician, 
 in the hope that he may reverse your verdict and give a more 
 hopeful prognosis. Hence, before you give utterance to such 
 opinion, make sure of the facts upon which it is based, for 
 a hopeless prognosis deduced from insufficient evidence will in- 
 flict unnecessary pain on others and bring discredit on you. 
 Nevertheless, being quite sure your judgment is correct, the pos- 
 sibility of the patient's quitting you should not deter you from 
 giving timely intimation of the state of things, as it may be, 
 for various reasons, of the highest importance that the patient 
 and his family shall know it. 
 
 A patient has a legal right to dismiss you from a case at 
 any time, but you can very justly expect that it shall not be 
 done without cause, or without reasonable courtesy and expla- 
 nation; and you have also a perfect right to relinquish attend- 
 ance upon him at any time, provided it be done decently and in 
 order. Indeed, you may sometimes find yourself so hampered, 
 or hara ssed, or badly treated in a case, that either formally to re- 
 tire from it or discontinue your visits are your only alternatives. 
 When you discontinue your visits, give fair and timely notice 
 to the person or persons chiefly interested, that you may not be 
 liable for any had consequences of neglect. 
 
 When you find it necessary to withdraw from a case, en- 
 deavor to do so in a courteous manner, for such withdrawal does 
 not necessarily make it incumbent on you to break off" all friendly 
 relations with the family.
 
 156 THE PHYSICIAN HIMSELF: 
 
 Whenever dismissed from a case, con over and carefully 
 reflect upon the various circumstances that conspired to produce 
 the dismissal, and the means by which you might have averted 
 it, that, by self-analysis and self-training, you may acquire the 
 art of doing your duty acceptably, and thus retain your patients. 
 
 Some people, indeed, who will almost idolize you as long 
 as you are lucky and have neither unfortunate cases nor deaths 
 in their families, will, as soon as either occurs, turn as rudely 
 and maliciously against you, as if you kept the Book of Life 
 and could control the hand of God. 
 
 When you are unjustifiably dismissed from a case, espe- 
 cially if it be to make room for an Irregular, or a foul quack, do 
 not consent tamely to be cast aside in such a manner. Express 
 your perfect willingness to retire, but, at the same time, make 
 it known, in a courteous, gentlemanly manner, that you expected 
 fair play and courteous treatment ; that such dismissal grossly 
 wounds your feelings, casts undeserved reflection on you, and 
 injures your reputation in the eyes of the public, to none of 
 which you can be indifferent. Such a protest will not only 
 enable you to vent your mortification, disappointment, and 
 disgust, but will also secure for you greatly increased respect, 
 and, moreover, tend more effectually to counteract any injury 
 likely to arise from your dismissal, than if you meekly submit 
 without protest. 
 
 In acutely painful cases of tetanus, cholera morbus, etc., it 
 may be found necessary to disregard the ordinary rules of dosage 
 and give large, even heroic, doses of morphia, chloral, or other 
 potent medicine, which must, moreover, be given promptly, as 
 hours, or even minutes, may decide the result ; care must, of 
 course, be taken that the total quantity be within the limits of 
 safety, and not sufficient to poison the patient. The following 
 case will illustrate the point: A gentleman known to the 
 author had a bad case of cholera morbus; a physician was 
 called, who prescribed for him twelve opium pills, one to be 
 taken every six hours. In that case the physician was fatally
 
 HIS REPUTATION AND SUCCESS. 157 
 
 slow in his therapeutics, for long before the time to take the 
 second pill had arrived the soul of that pain-racked sufferer had 
 taken its flight to a land where medicine is not needed and six- 
 hour intervals can do no harm. Take care to avoid his error, 
 and never leave long intervals between the doses for patients 
 suflering acute pain. 
 
 Bear in mind tliat an opiate that has power to relieve 
 acute pain will do so within an hour ; failure to do so necessi- 
 tates a second or third dose. A dose of chloral will produce 
 sleep within half an hour or so. if at all, and it is useless to 
 wait longer before repeating it. When it is intended to keep a 
 patient under the influence of opiates, it is necessary to repeat 
 them every four hours or so, inasmuch as the effects of a dose 
 begin to wear ofl" after that time. 
 
 When opiates are no longer needed, the nausea that might 
 follow their abrupt withdrawal may be prevented by continuing 
 them in decreased doses at four-hour intervals, decreasing the 
 dose each time to one-half of the preceding one. 
 
 There is a popular belief that opiates are given only to 
 allay or relieve pain, not to cure the sickness. People should be 
 made to understand that opiates are not only palhatives, but by 
 controlling pain, lessening functional activity, etc., they are 
 powerful curatives in a long list of diseases. 
 
 You will often recognize the character of a case, or see 
 the patient's exact condition, before you ask a single question ; 
 yet the laity expect you to examine your patient at every visit. 
 Let your first examination be careful and thorough ; omit 
 nothing that can shed light on the case, and never neglect the 
 following five cardinal duties : to feel the pulse, to examine the 
 tongue, and to inquire about the appetite, the sleep, and the 
 bowels. No matter what the case may be, take care to attend 
 to these and all other evident or special duties at every visit, else 
 the patient may think — in your rush and hurry — he has not 
 gotten the worth of his money, or is not properly attended. 
 
 Whenever symptoms render it probable that hernia, carci-
 
 158 THE PHYSICIAN HIMSELF: 
 
 noma uteri, Blight's disease, or heart disease is present ; or that 
 tlie throat is diphtheritic, or the ear occluded by wax ; or that 
 a tumor or an aneurism exists ; or that one's femur is fractured 
 within the capsuhir hgament, or his shoulder dislocated; or 
 that a patient is pregnant, or has placenta prsevia, or a uterine 
 polypus ; or fissure of the anus, or fistula ; or that any other con- 
 dition exists which, if overlooked, might cause unnecessary suffer- 
 ing or imperil the patient's life, and possibly consign you to the 
 never-dying goadings of remorse for having overlooked a patent 
 fact, or committed a grave mistake, or subject you to humilia- 
 tion and disgrace, if discovered by another, who has come in, — 
 all mind, all heart, all eye, all ear, all touch, — determined to 
 show the wisdom of .his being called, you should always make 
 an immediate and thorough examination, and, if need be, 
 gently hint to the patient or to the friends your suspicions and 
 apprehensions. 
 
 " Too late, too late's the curse of life." 
 
 If you are careless or neglectful in these matters, you will 
 often be surprised to see another, who has been called in con- 
 sultation, or who has superseded you, discover the whole truth 
 of tlie case; not so much from his superior skill, but because he 
 made some examination or inquiry that you omitted. One of 
 the most certain signs of a good and conscientious physician is. 
 to make an earnest, long-continued, and careful examination of 
 the patient. 
 
 To mistake a tumor for pregnancy, or vice versa, is one of 
 the most mortifying and personally damaging errors of judg- 
 ment that can well be made. To be attending a female W'ho 
 has been ailing for weeks and months, and who finally proves 
 to be pregnant, is also very damaging, unless you have recog- 
 nized and declared that fact ; otherwise, her entire illness will be 
 attributed to tlie pregnancy. In such cases some demur will 
 probably be made to the payment of your fees. 
 
 Never ask an unnecessary question, yet be careful to make 
 every inqniry essential to ascertain all the facts, and to satisfy
 
 HIS REPUTATION AND SUCCESS. 159 
 
 the patient and others that you feel an interest in his case; if 
 you neolect to do so, vou will risk both an error and loss of 
 confidence. 
 
 Prompt detection of dangerous changes, or of the approach 
 of death, will not only shield you from blame, but will giye you 
 a certain kind of prestige if you point them out before the 
 patient or his friends observe them. 
 
 Be careful never to speak of anything you may do for a 
 patient as an experiment or from curiosity; for everybody is 
 more or less opposed to physicians "trying experiments" upon 
 themselves or theirs. For the same reason, it is unwise to give 
 patients the sample bottle of new remedies sent to you for trial, 
 or to let any one know that he is the first to whom you ever gave 
 this or that medicine ; or that his is the first case of the kind of 
 fracture, or of small-pox, or of hernia, or of anything else you 
 ever attended, or suspicion may take the place of confidence. 
 
 You should keep a register or a reference-book for collect- 
 ing and retaining particularly good remedies, prescriptions for 
 stubborn diseases, medical clippings, self-devised apparatus and 
 expedients, self-discovered facts, and important things that you 
 have seen, heard, read, or thought, — the substance of all. Such 
 a record possesses continual interest and more value to its 
 owner than any other book in his library ; also a clinical case- 
 book or a diary for recording the date, diagnosis, treatment;, 
 etc., of unusually important cases. Nothing impresses a patient 
 suffering from a complicated or long-standing disease with a 
 conviction that you feel an interest in him, and intend to try 
 your utmost for him, so much as to know that you keep a daily 
 or other regular record of his case. Besides, these records will 
 become a store-house of facts, and furnish you important cases 
 for relation at the societies or for publication in the joiu-nals. 
 
 When truth will allow, let your diagnosis either include 
 the patient's belief or fully disprove it, that his mind may not 
 distrust your opinion and treatment, and so tend to counteract 
 your treatment.
 
 160 THE PHYSICIAN HIMSELF.* 
 
 You can more easily impress and permanently convince a 
 doubting patient of a medical fact which militates against his 
 wish or belief — for instance, that shortening is usual after 
 fracture — by showing it to him in the books than by a hundred 
 of your own verbal statements. 
 
 Demonstrations to a patient or his friends of certain diseases 
 and injuries that admit of it, by comparing, in plain language, 
 the affected parts to sound ones on a well-drawn pencil-sketch 
 or diagram on a prescription paper, and patiently explaining 
 simple facts that are not clear to them, gives great satisfaction, 
 and makes them appreciate that you understand the case. 
 
 Study to be fertile in expedients, and be very, very, very 
 slow to confess, or allow the inference, that you are hopelessly 
 puzzled about a case, are at your wit's end, or have reached the 
 limit of your resources. 
 
 Never be too sanguine of a patient's recovery from a serious 
 affliction, and never give one up to die in acute disease unless 
 the process of dissolution be actually in progress. Wiseacres say 
 that " the only way to get well after a physician gives one up is 
 to give him up " (I). Above all else, never withdraw from a 
 case of acute or self-limiting disease because the patient is very 
 ill, or seems as cold as ice, and more likely to die than to live ; 
 for the human system can often endure a great deal and still 
 live ; besides, it is always highly comforting to anxious relatives 
 or friends to know that the physician, with his strong arm, kindly 
 stands as a stay and support, ready and willing to do more, if the 
 slightest opportunity occurs. 
 
 Icy coldness sometimes seems to make death inevitable 
 within a few hours, and the physician hastens to announce it, 
 when lo ! reaction and high fever appear, whip up and revive 
 the failing powers again, and make it seem as if he lost hope 
 and abandoned the patient several days too soon. 
 
 If a patient be unable to swallow, think of the oesophageal 
 tube ; or if food taken into the stomach be not assimilated, con- 
 tinue your efforts with inunctions of codliver-oil, or oil and quinia; 
 
 I
 
 HIS REPUTATION AND SUCCESS. 161 
 
 also, by rectal alimentation, hypodermatic injections, etc., until he 
 is either better or the breath is out of his body ; for nature, by 
 a crisis, or a vicarious function, or a compensatory process, or 
 even the tardy action of the remedies you have already used, 
 may turn the scale and let the life-power, or the special vitality 
 of a vigorous constitution, rally and gain control over the dis- 
 ease at the very last hour. Under such circumstances, if you 
 have hastily given up the case, and ingloriously abandoned the 
 patient as hopeless, you will be justly mortified, while some 
 brother-physician or an Irregular, or, may be, an old woman, 
 who has stepped into the field at the lucky moment, will reap 
 the glory of setting the laws of nature aside, and bringing back 
 to life one already given up as dead. 
 
 u
 
 CHAPTER VI. 
 
 " He is most free from danger who, even when safe, is on his guard." 
 
 You will have to be on your guard against thousands of 
 snags, pitialls, and rocks, which lie hid in the paths and under 
 currents to entrap and upset the unwary. When in doubt 
 whether duty requires you to do a thing or not, — for instance, 
 between doing nothing and a dangerous operation, — if all else 
 be equal, remember that the sin of omission is, in appearance at 
 least, not so great as the sin of commission. 
 
 A very safe guide, in determining what line to pursue in 
 grave or puzzling cases, is to imagine yourself to be in the 
 patient's dilemma, and then earnestly ask yourself. What would 
 I have done 1 
 
 We, of all men, need to be as wise as serpents and as harm- 
 less as doves. The most skillful physician may and often does 
 get results that he deplores almost as much as the patient does, 
 but wliich his sincerest desu'es and every care and his best judg- 
 ment are powerless to prevent ; therefore, in all ugly fractures, 
 in capital operations, and all other serious cases, be they 
 what they may, in which you think there is any danger of an 
 unsatisfactory termination, and of your being blamed or sued in 
 consequence for the result, never hesitate to seek professional 
 aid. Having a second physician not only divides the great 
 responsibility, but also constitutes each a witness of truth for the 
 other, and, by making each the guardian of the other's charac- 
 ter, will tend to divert hostile criticism, charges of unskillfulness, 
 or of mis-diagnosis, and causeless suits for malpractice : — 
 
 "Much caution does no harm." 
 
 Keep in view, moreover, that the general community have 
 
 the idea that physicians can and should restore broken bones 
 
 and injured tissues, no matter what the injury may be, as per- 
 
 fectlv as the Creator made them. Bear in mind, also, that 
 
 (162)
 
 HIS REPUTATION AND SUCCESS. 16o 
 
 when a fracture, or dislocation, or disfiguring wound, or acci- 
 dent of any kind, results in deformity, or shortening, or 
 disablement, — contracted tendons, or rigid cicatrices, or a limp, 
 or requires a cane or crutch, — there is danger of its being- 
 shown ever after as a botch or failure, and becoming a lasting 
 and lingering libel on the reputation of the medical attend- 
 ant, A badly set limb, or an unnecessary or bungling am- 
 putation, injures our whole profession, and the limb or stump 
 may be held up in court in a suit for damages ; therefore, the 
 responsibility had better be divided. In this respect medical 
 and surgical practice differ, — the results of sickness usually dis- 
 appear, while those of unsuccessful or unfortunate surgery 
 remain, and, if bad, may induce jealous rivals, tricky lawyers, 
 or other conspirators to incite the patient to cast you into the 
 fiery furnace of a lawsuit. Juries place a high estimate on the 
 value of life and limb when sacrificed by supposed negligence 
 or want of skill. 
 
 Among the reasons why many malpractice suits spring from 
 surgical cases, and but few from medical ones, are these : 
 Although one is as liable to a prosecution by the laws for medi- 
 cal as for surgical malpractice, it happens that medical cases 
 are treated in a more private manner, and may each be treated 
 in numerous ways, — some the very opposite of others, — and we 
 are not compelled to give an exact name to every form and 
 feature of disease, and a logical reason for every plan of treat- 
 ment pursued ; and persons interested, even though dissatisfied 
 with the result, are not competent to judge of the physician's 
 skill and treatment to the extent of a lawsuit ; whereas, the 
 amputation of limbs, the adjustment of fractures, the reduction 
 of dislocations, the management of wounds, bandaging, etc., all 
 depend on a knowledge of anatomy and on manipulative dex- 
 terity, and are all open to public observation and criticism ; and 
 the methods proper to pursue in any case are so well agreed 
 upon by surgeons, and the results aimed at are so obvious, that 
 even the vulgar may criticise and also prophesy. Having
 
 164 THE PHYSICIAN HIMSELF: 
 
 anatomy for his foundation and the science of surgery for his 
 guide, the surgeon is expected to follow certain definite rules, 
 to have infallible foresight, to overcome all surmountable diffi- 
 culties, and to get a perfect result. If he does this, eclat awaits 
 him, but if he gets a bad result, and is presumed to have omitted 
 any duty, the painful task of vindicating himself against a law- 
 suit may follow. 
 
 The sooner your accoulit with a dissatisfied patient is 
 settled in one way or another, after your services are no longer 
 required, the less likely you will be to have a lawsuit ; and, if 
 you do have one, the sooner after the services are rendered the 
 better, while witnesses are still accessible and all the unfavorable 
 influences are fully remembered. 
 
 Bear in mind that you have no right to do more to a 
 patient under anaesthesia than it was agreed to do. To put a 
 patient under chloroform to amputate a finger, or to remove an 
 eye, and then to amputate the whole hand or both eyes, would 
 give great reason for blame. 
 
 Keep your surgical knowledge at your fingers' ends ; medi- 
 cal cases can be read up as they progress, but a broken limb, or 
 a dislocated bone, or a wound, will not wait, and you must be 
 ever ready to treat them correctly ; and never forget that band- 
 ages, either too tightly applied or under which the tissues have 
 swollen and constricted the circulation, have always been a 
 fruitful source of blame and of lawsuits. 
 
 Always take the precaution, as well for your own as for the 
 patient's protection, to examine carefully the action of the heart 
 immediately before administering an anaesthetic ; and to watch 
 the respiration during the administration, — withdrawing the 
 agent on the least approach of blueness of the face or lips. 
 Take care to have another physician or a reliable assistant pres- 
 ent in all cases in which it is necessary to produce anaesthesia, 
 more especially if the patient be a female ; and be ready to 
 hang the patient head downward the moment weakening of the 
 heart's action, or of respiration, or narcotism, requires. Also,
 
 HIS REPUTATION AND SUCCESS. 165 
 
 have a third person present at all sexual examinations of 
 females, especially if at your office, to disprove possible halluci- 
 nations regarding either improper language or actions, and to 
 protect against scandal and the traps of designing people : — 
 
 "An enem)'^ has sharp eyes and acute ears." 
 
 Here, I may say, beware of personal violence. Midnight 
 desperadoes may, under pretence of sickness, decoy you into 
 their traps, and then rob or murder you ; or your brute, crazy 
 with drink ; or your homicidal maniac ; or your fever-tossed 
 patient who knows not what he does ; or your lunatic with a 
 delusion ; or the infuriated fellow in whom you have made a 
 wrong diagnosis or had a mistjake in the medicine ; or the un- 
 reasoning tiger in whose family you have had sad deaths, or an 
 unfortunate case of surgery, or of unsatisfactory midwifery ; or 
 the insane wretch whom you have through kindness sent to an 
 asylum ; or the disappointed and desperate would-be suicide 
 whom you have restored ; the blackguard, the thug, the fanatic, 
 the madman, — any blood-thirsty demon or member of the dan- 
 gerous class may suddenly assault and try to maim or kill you. 
 
 You will not only have frequent lucky coincidences, which 
 Avill give you unearned credit, but also occasional unlucky coin- 
 cidences, in which the most unwelcome events will follow your 
 therapeutics so closely as to seem to be due to them. Be ever 
 ready to explain and defend. 
 
 All anaesthetics are dangerous ; refuse to give them in 
 trifling cases of minor surgery, or where a moment's fortitude 
 on the part of the patient is all that is required. Such occasions 
 do not justify the risk. 
 
 Never examine a female to ascertain whether she is illicitly 
 ])regnant, at the instance of parents or others, without her own 
 lull consent to the proceeding. 
 
 Such exclamations as " Oh no, Doctor ! it cannot be that 
 liis arm (or leg) is broken, for he can work his fingers (or 
 toes)" will often greet you when you pronounce that a bone is
 
 166 THE PHYSICIAN HIMSELF: 
 
 fractured. This error is due to the fact that people think that 
 the fingers and toes are moved by the bones instead of tlie 
 muscles. It sometimes becomes necessary to explain this in 
 defense of the opinion you have expressed, or to silence some 
 dissenter ; every one can move his tongue, which has no bones. 
 
 Patients, especially those of the fair sex, whether virgin, 
 wife, or widow, sometimes decline to allow the physician to 
 make examinations that necessitate uncovering the body, or to 
 allow him to see the underclothing or body, simply because they 
 are unclean and unfit to be seen, while the physician erroneously 
 supposes that the refusal is dictated by overshyness or modesty 
 on account of the examination. In many such cases it is better, 
 instead of insisting on an immediate examination, to respect 
 their delicacy, or comfort, or convenience in the matter, and 
 defer it to another time, to afford the desired opportunity for a 
 change of linen, etc. 
 
 Occasionally, some suspicious father, or curious-minded 
 husband, will show a determination to remain in the room dur- 
 ing vaginal examinations, or during operations necessitating 
 exposure of his wife's body, and you will feel tempted to ask 
 him to retire, that he may escape the indelicate sight and you 
 the embarrassment. If asked to retire, one or another might 
 refuse to go, or do so with suspicious anger. The better plan 
 in such cases is to inform the person that you are about to begin 
 what your delicate duty requires you to do, and he will prob- 
 ably retire of his own accord, unless specially requested to 
 remain. In the event of his antagonistic refusal to leave, it 
 may become a question whether to proceed with the examination 
 or operation, or to abandon or defer it. 
 
 Expertness in detecting and contravening the various kinds 
 of scandal and calumny admits of cultivation to a great degree ; 
 so also does the ability to foresee and avoid entanglement with 
 the captious, the mischief-maker, the silly tattler, the malicious 
 liar, and the like. 
 
 Key-hole and back-window scandal-mongers, and lying
 
 HIS REPUTATION AND SUCCESS. 167 
 
 snakes in the grass, may also lie in ambush for you, trying to 
 make something or mucli out of little or nothing : — 
 
 "Much broth is often made of little meat." 
 
 These must be met and checkmated by the most available 
 means. To judge what is best to be done under the circum- 
 stances is at times a most annoying and puzzling question to be 
 confronted. 
 
 Jealous midwives, chattering nurses, ignorant doctor- 
 women, busy neighbors, and Job's comforters often exert a 
 malign influence on patients, and tell tales and give instances 
 of ignorance and of lack of attention, and circulate damaging 
 falsehoods and rumors about physicians, that must be noticed 
 and coped with according to the necessities of the case, but 
 neither malice nor envy can do you any harm unless your own 
 misdeeds prepare the way. 
 
 Tact and nice discernment in establishing and maintainhig 
 a proper attitude toward nurses and other attendants on tlie 
 sick is a valuable power that will prevent or counteract many 
 possible machinations. Love of approbation is natural ; and to 
 give attendants due credit on fitting occasions for the faithful 
 discharge of their duty is not only just and gratifying to them, 
 but tends to make them your firm friends. Such public in- 
 dorsement, moreover, secures their further co-operation, and 
 encourages them to do their best to maintain the reputation 
 which you have given them. 
 
 A bad or ignorantly careless nurse may render a curable 
 case fatal by improperly indulging the patient's appetite for 
 food or drink, or by neglecting to give him medicine, drink, 
 diet, etc., at the proper time, or in the manner directed ; or by 
 appropriating his food or robbing him of the stimulants directed 
 to be given ; or by subjecting him to excessive heat or cold, 
 or giving him too much or too little fresh air ; or by getting 
 drunk, or becoming careless, etc. 
 
 The conciliation of anxious, captious, impatient, or dissatis- 
 fied friends of the sick, when the sickness is not progressing
 
 168 THE PHYSICIAN HIMSELF: 
 
 satisfactorily, requires no little skill and a comprehensive study 
 of human nature. 
 
 In serious or rare cases, and particularly in such as engen- 
 der great neighborhood or general excitement, if you indulge in 
 confidential or semi-confidential whispers to the people or rab- 
 ble, as the case may be ; or incautiously give out daily bulletins 
 to them regarding the patient's pulse, temperature, respiration, 
 excretions, discharges, etc., it will often give rise to misrepresen- 
 tation, or even to utter perversion of what you really did say or 
 mean, and your statements may come back to you so changed 
 as to necessitate tedious and irksome explanations from you. 
 You will act wisely, therefore, in being ever on the alert to 
 avoid danger. If it be necessary, express your opinion briefly 
 to the proper persons, in writing, with the view to prevent its 
 being misrepresented or perverted. 
 
 When a sick person puts himself under your care he gives 
 you a responsible duty to perform, and he has no right to ask 
 your advice without a sincere intention of following it ; for if 
 he then neglect or refuse to use your remedies, or obeys your 
 instructions in a half-way or imperfect manner, he ties your 
 hands and frustrates your efi"orts for his relief, and cannot hold 
 you to full responsibility in the case. If, however, he will not 
 or can not do exactly as you wish, and if no special danger ex- 
 ist, it is sometimes better, after drawing attention to the position 
 in which you are placed (as a protection to yourself), to humor 
 his antipathies, whims, or childish weaknesses, and modify or 
 alter your therapeutics so as to meet his wishes and ability. 
 This you can do in a good-natured way, without fully yielding 
 to him or compromising your authority or dignity. The wishes, 
 prejudices, impulses, and erroneous views of exceptional and 
 fastidious patients must be studied and to a certain extent 
 respected. To do this is a matter of policy, and is very dif- 
 ferent from yielding a question of principle. But if a patient 
 be determined to use an improper or dangerous agent, you 
 should of course refuse your sanction ; or where you find it
 
 HIS REPUTATION AND SUCCESS. 169 
 
 impossible to secure a faithful observance of your directions on 
 the part of the nurse, or where they are bent on trying the 
 latest nostrum, it may then become your duty to consider 
 whether to go on with the case or retire : — 
 
 " Two captains siak the ship." 
 
 Never captiously oppose a remedy because it is suggested 
 by a layman. An amateur nurse or the most ignorant person 
 may make a wise suggestion ; and laymen often talk excellent 
 sense about medical facts which have come to their notice. 
 Listen patiently to all sensible propositions, and, if simple and 
 unobjectionable, you may find it judicious, if only for tlieir 
 moral effect, to utilize them in conjunction with your own par- 
 ticular treatment. Be frank in giving credit to any good idea, 
 no matter by whom advanced ; and when rejecting a remedy 
 thus tendered, let it be known that your disapproval thereof 
 arises from conviction and not from superciliousness. You mav, 
 also, in some cases humor a whim and sanction the use of harm- 
 less domestic (Grandmother) remedies, — herb-tea, mustard and 
 other plasters, onions to the feet, etc., in conjunction with your 
 more reliable agents. 
 
 Make it a rule to accord persons credit for well-meant 
 deeds, even though they be valueless in themselves ; also, when 
 possible, to approve domestic treatment adopted before you were 
 sent for ; at least, do not condemn it in a violent or offensive 
 manner. Listen patiently to those around while they relate 
 how they did the best they knew, and do not pooh-pooh, shrug 
 your shoulders, or smile sarcastically, and thus unfeehngly be- 
 little their honest efforts to relieve the sufferer. 
 
 "Be to their faults a little blind, 
 And to their virtues very kind." 
 
 Your cordial approval of their simples, used in good faith 
 witli true and loving motives, will greatly redound to your 
 credit, and greatly enhance your reputation for kindness and 
 sympathy. 
 
 When attending certain classes of seriously ill patients.
 
 170 THE PHYSICIAN HIMSELF: 
 
 e.g.^ the wife of a druggist or the child of a physician, if there 
 be any simple remedy in which they have great faith and which 
 they wish to try, every consideration should incline you, unless 
 there is some clear contra-indication, to freely acquiesce and 
 allow it, in conjunction with your other means. 
 
 It will be a trying ordeal when, by accident, you meet an 
 " old lady who has a never-failing salve," good for everything, 
 from mosquito-bites up to tuberculosis. You will find her so 
 full of faith in herself and in her great catholicon that neither 
 reason nor ridicule can shake it. Be fair and .reasonable with 
 her, and treat her with courtesy and respect ; but if you feign 
 an attack of awe, or indiscreetly chop logic with her, and con- 
 cede to her remedy any recognition beyond its actual merits, or 
 meet her as an equal and take her into confidence or semi- 
 partnership in the treatment of felons, ulcers, or wounds, you 
 will make a mistake, and fill her matronly head as full of 
 conceit, and of mischief, too, as the sea is of water. 
 
 Cultivate the quality of being a good listener, and let a 
 patient tell his story in his own way, even though it be unneces- 
 sarily prolix or tedious. Hypochondriacs, who live in an end- 
 less midnight of gloom, the hysterical, the garrulous, the slightly 
 insane, and various other kinds of incorrigible bores, who want 
 you to " subscribe " for them, or who have become " manured " 
 to suffering, and want to " insult " you on their cases, because 
 they have heard you are a good " musician ;" chronic wrecks, 
 perpetual invalids, and troublesome " old women of both sexes " 
 with a low level of health, looking ever on the sad side of life, 
 will sometimes come to your office, and want to murder your 
 time with annoying or unnecessary questions, or exaggerated 
 descriptions of their ailments, for which a whole apothecary 
 shop might be vainly prescribed ; or to persecute you with the 
 details of their business or their ancestry, or the history of their 
 family affairs, with a whole Pandora's box of sighs and laments 
 added, when you have no time to waste and yet are indisposed 
 to be rude ; and then tarry so long after the consultation is
 
 HIS REPUTATION AND SUCCESS. 171 
 
 ended and the prescription given that you actually wish you 
 could rise in your chair, make a polite bow, and open the exit 
 door, else fly out at the window and escape from them. 
 
 Some of these you will have to freeze out by chilling cold- 
 ness in their reception ; or if you courteously let them know as 
 they come in that time is very precious with you, they cannot 
 deem you uncivil, and will be brief, unless they are unusually 
 pachydermatous. If you are greatly annoyed by such visitors, 
 have a placard posted with " Please be brief, as, being busy, I must 
 divide my time." Another good plan is : at the first conclusion 
 of a topic, or the first movement of the patient after the true 
 business of his or her visit is finished, courteously to rise from 
 your chair, as if you anticipated his or her rising to go. 
 
 To rid yourself of attending undesirable would-be patients 
 will be one of the most difficult dilemmas that will confront 
 you. If you are " Too busy to attend,^'' or " Not at home," these 
 are probably the most unassailable of all reasons in such cases. 
 To assume charge of a sick person and neglect him afterward 
 is unjustifiable. 
 
 You have a right absolutely to decline to take charge of a 
 case, but, if you do assume the duty, it constitutes a contract in 
 which you agree to give proper attention and your best skill. 
 To take charge and afterward neglect it is a great wrong. It 
 is very much better at once to plead having too much other 
 business, or any other true reason, and not take undesirable 
 cases at all, than to take them, involve yourself, and afterward 
 relinquish them, and expose yourself to criticism and abuse. 
 
 When you receive calls to cases that from any cause you 
 can not or will not attend, you should at once notify them of 
 that fact, that they may seek some other physician, so that the 
 patient may be spared needless delay and you the annoyance 
 of repeated messages and solicitations. 
 
 No one can blame you for not being at home when your 
 services may chance to be needed, since you cannot be every- 
 where at once; but if you are at home, and quibble or refuse
 
 172 THE PHYSICIAN HIMSELF: 
 
 to respond to a call, you will sometimes be severely criticised, 
 especially if the case should happen to go wrong in consequence 
 of your not responding. It is much easier for a lawyer to refuse 
 to take a client, or for a mechanic to decline a job or a mer- 
 chant a sale, than for a physician to refuse to go to a case. 
 
 If you have a friend whom you would like to see called to 
 a case that you decline, mention him to them by name. You 
 can advise them to send for Dr. A., or B., or C, or D. If you 
 have anything against Dr. E., be careful to avoid saying, "Do 
 not send for Dr. E;" merely omit to mention him. Your 
 silence will be condemnation sufficient. You are not bound 
 to recommend a man, but you might have some subsequent 
 unpleasantness were you to practically denounce him. 
 
 The chief objection to recommending persons whom you 
 wish to cast off, to physicians whom you wish to aid, is that they 
 are then quite sure still to hanker for you, and to involve you as 
 a consultant or assistant to your j^ro^e^e if things get serious; 
 whereas, if, instead of recommending them to any particular 
 person, you compel them to choose some one for themselves, 
 you will get rid of them permanently. 
 
 You will occasionally encounter presumptuous patients, or 
 their wiseacre friends or relatives, — 
 
 "All impudence and tongue," — 
 
 whose ignorance is shown by the very fact that they do not 
 know they are ignorant, who will, with a double meaning in 
 every word, make meddling inquiries, examine and cross-ques- 
 tion you, and rudely interject tlieir opinions, or challenge you 
 to controversy, or seek and presume to discuss your diagnosis 
 and your remedies with you, thrust forward their own favorite 
 doctors, or obtrude their prescriptions of food or medicines, and 
 parley about the merits of various medicines. Such people are 
 generally as full of doubts, beliefs, and theories as a lemon is 
 of acid, — foreknowing and prejudicing all that you do, often 
 destroying faith, and thwarting your every effort ; may be, draw- 
 ing the curtain aside after your back is turned, and exposing to
 
 HIS REPUTATION AND SUCCESS. 173 
 
 everybody things that should rightly be regarded as your pro- 
 fessional secrets. If you write a prescription for gonorrhoea, or 
 cough, or, indeed, any other ailment, many a presumptuous 
 patient or his keen friend will read it as fast as you have written 
 it, and proceed to comment or argue on it. 
 
 "I ain't afeard to argify the topic with 'im." 
 
 You will often be harassed and cross-examined by such self- 
 constituted Solomons, and compelled to resort to various ex- 
 pedients to satisfy or baffle them, and at the same time avoid 
 collision with their whims, insinuations, and prejudices. In 
 fact, from this cause, the good effects of mystery, hope, expecta- 
 tion, and will-power are of late almost entirely lost to regular 
 physicians ; all special confidence being sapped, all that you can 
 expect in many cases is the gross physiological action of your 
 medicines on the stomach and bowels of the patient, and preju- 
 dice and fear actually do much to thwart even that. Such 
 meddling, ignorant gossips will make your duty difficult, and 
 often actually aid in making curable diseases fatal. 
 
 When you prescribe a mixture of two or more articles that 
 such a patient is familiar with, take care to make him under- 
 stand that to judge the relative proportions needed of each 
 ingredient is just as important as the ingredients themselves. 
 
 The presence of self-important sick-room critics, with jeal- 
 ous eyes and unbridled tongues, will, if you are at all timid, 
 often impair or destroy your usefulness, by either diverting your 
 mind from your case, or lessening your concentration upon it, 
 and mav even lead to mistakes in diao;nosis or treatment. Con- 
 sciousness of being watched by hostile nurse or visitor, who is 
 hoping to detect some flaw, or a chance to make unfriendly 
 criticism, or find fault merely to show that he is a zealous friend 
 to the sick person, will, in many cases, embarrass your demeanor, 
 and to some extent cloud your judgment, and, of course, mar 
 your usefulness. More patients are visited to death by neigh- 
 bors and friends than die by neglect. 
 
 It is better to leave your directions about medicine, food,
 
 174 THE PHYSICIAN HIMSELF: 
 
 etc., with the nurse, or whoever may be in charge, than with 
 tlie patient. Leave no room for unpleasant mistakes or queer 
 bhmders. Tell him in a concise, clear, distinct manner when 
 and how every remedy is to be used, and how you expect it to 
 act, and leave nothing to the discretion or guess-work of patients 
 or nurses. "A few drops," "a little," "a pinch," "a sip," "a 
 swallow," " a gulp," " a thimbleful," " about a mouthful," " a 
 handful," " a cupful," " big as a peach," " the size of a bean," 
 "every hour or two," etc., can each open the door for big mis- 
 takes. Be explicit as to whether the patient is to be aroused 
 from sleep to take the medicine or not. Also, whether it is 
 to be taken during the night at all, with or without water, etc. 
 
 Give all your directions at one time instead of in scattered 
 fragments ; take care to make them precise and complete, and 
 if you have doubts whether they are fully understood, ask the 
 person to whom you have given them to repeat them to you, or, 
 if highly important, write them down. 
 
 Study so to control your countenance as to prevent your 
 thoughts, embarrassments, and opinions from showing upon it 
 during anxiety and emergencies, and be especially guarded in 
 your manner, so that nervous and ill patients cannot detect in 
 your flushing cheek, quivering eyelash, or faltering voice, un- 
 favorable reflections about themselves which you wish to con- 
 ceal ; for while your eyes are fastened on them to appreciate 
 their condition, theirs will be riveted on you to read their fate. 
 
 Make it a rule not to prescribe large quantities at a time 
 in acute cases, as they may change from day to day, or even 
 from hour to hour ; it is far better to have tlie prescriptions re- 
 peated over and over again than to risk having half a bottle set 
 aside untaken. It is always a nice point in practice to decide 
 how large a quantity of medicine to order at a time. In many 
 acute cases you may find it wiser to order only suflicient medi- 
 cine to last from one visit to the next. 
 
 To set aside unused medicines and order otliers in such a 
 way as not to impair confidence requires not a little clever man-
 
 HIS KliPUTATION AND SUCCESS. 175 
 
 agement. In many cases where the effect of a remedy is ex-. 
 haiisted and it is ceasing to be useful, or where any other indi- 
 cations for a change of treatment appear, it is better not to stop 
 the old abruptly, as though it were wrong or doing harm, but, 
 
 insitead, to give instructions to discontinue it at o'clock and 
 
 then begin with the new. 
 
 Patients will rarely complain of the cost of medicines that 
 are taken, but they will observe the waste and criticise you when 
 you set one half-used remedy aside and prescribe another. A 
 good plan is to order the empty bottle in which one medicine 
 was gotten to be washed and carried to get the next in. A medi- 
 cine that has been discontinued is rarely again indicated. If, 
 when you stop one remedy and order another, there be any pros- 
 pect of its being used again later in the case, take care to men- 
 tion it, as it will tend to avert the otherwise probable impression 
 tliat there has been extravagance or misjudgment in prescribing. 
 
 Be also guarded against ordering patients to buy expensive 
 instruments, reclining chairs, supporters, braces, atomizers, or 
 other costly articles, unless you are very sure they will answer 
 the purpose and will be used. It is anything but creditable to 
 the physician to have people exhibiting this or that article that 
 
 cost , ordered by him, but for one reason or another never 
 
 used, and now referred to as a shameful instance of needless 
 expense. 
 
 You will occasionally encounter patients who have been 
 kept in a furnace of anxiety and terror for months or years (hell 
 on earth) through the ignorance of some novice in the profession, 
 who has examined their simple sore, or abrasion, and mistakenly 
 pronounced them syphilitic, or through the deception of some 
 rapacious and shameless quack, who, for the sake of fleecing, has 
 falsely announced the existence of specific disease, to which their 
 folly has unfortunately exposed them, and whose ravages and 
 horrors their fears have painted to them in the blackest colors, 
 when in fact they have really never had any true sign or symp- 
 tom of that disease. It is torture enough for those who really
 
 176 THE PHYSICIAN HIMSELF I 
 
 have constitutional syphilis to go through life filled with gnawing 
 remorse for the past, and consumed with horror for the future, 
 without adding spurious cases. When examination proves that 
 the case before you is not real syphilis, it is your highest duty 
 to give such explanation and assurance as will fully banish the 
 error from your patient's mind. 
 
 You will be sure to produce unnecessary alarm and distress, 
 in the minds of those whose chests you examine, if, after going 
 through your scientific movements, or, with your watch in one 
 hand and the fingers of the other on their pulse, you tell them of 
 " a slight deposit in the apex," " an abnormal resonance," " a 
 hrait de diahle^'* " rales," " a palpitation," "disordered rhythm," 
 or other, to them, ominous symptom or harbinger. Be careful, 
 therefore, to avoid saying or doing anything that will unneces- 
 sarily fix the mind of a patient on the character of his breathing, 
 the action of his heart, etc. 
 
 You will occasionally meet with persons who were told 
 years ago by Dr. Longface, or Dr. Ogre, or Dr. Spliynx, with a 
 face as long as the bedstead, that their lungs were gone, and that 
 they would not live a year ; or that their measles would turn to 
 consumption, or that they had the seeds of this or that affliction 
 which would destroy life within such a time. Such unnecessary 
 and unwise forebodings cast not a little discredit on the pro- 
 fession, and justify severe censure on the erring prophets who 
 make them. 
 
 God only knows how many young women in our land are 
 now nervous and dyspeptic, with hollow eyes, sunk in deep 
 anxiety, tormented with apparitions of " womb complaint," 
 which have no existence except in Dr. Spayemall's imagina- 
 tion or in Dr. Squintum's opinion ; young women who — had 
 not the subject been suggested to their minds — would have lived 
 a life-time with scarcely a thought of such a thing as a womb. 
 
 The chief reason why womb-doctoring might tempt to dis- 
 simulation, and why there are so many spurious cases of womb 
 disease, is obvious. When a man is told he has a luxated
 
 HIS REPUTATION AND SUCCESS. 177 
 
 shoulder, or a cataract, or hernia, or cancer, he finds many 
 ways by which to confirm or refute tlie physician's opinion, and 
 lie can also see what effect the treatment is having ; but when a 
 miserable, nervous woman, morbid on the mysterious subject of 
 " womb disease," goes to Dr. Bugaboo or Dr. Fallopius, mounts 
 his gynaecological table or chair, with its elevating mechanism, 
 *' gets examined," and is told, correctly or otherwise, with a 
 solemn phiz, and with all the force of a proclamation, that her 
 womb (like many noses) is " turned a little to one side," or " is 
 down," " ulcerated," " dislocated," or " affected," or that she 
 has pyosalpinx, or salpingitis, it tallies exactly with her fears ; 
 and, shrinking from both the expense and the exposure to be 
 endured if she were to consult another physician, she naturally 
 submits to the manipulations, long periods of treatment, and 
 the monetary exactions of the physician or the charlatan who 
 first made the examination, — possibly recovering from morbid 
 states that never existed and paying for cures never performed. 
 
 "Small justice shown, and still less pity." 
 
 If there be a knave meaner than all others in the sight 
 of God it must be the swindler who, void of moral sense, 
 pretends to make operations on parts of the body the patient 
 cannot see, or makes useless ones, or, with cold-hearted selfish- 
 ness, exaggerates the nature of any case and terrifies the suf- 
 ferer for dollars and cents. 
 
 "Remember him, the villain, righteous heaven ! 
 In thy great day of vengeance." 
 
 It is also cruel to tell patients, without due explanation, 
 that their trouble arises from the heart, or kidneys, or liver, or 
 the lungs ; or that they have the " liver complaint," or " kid- 
 ney disease," or that their lungs are "affected," when there is 
 only some slight or temporary affection of these organs. And it 
 is still more cruel and unwise, and terrorizing, to predict imme- 
 diate or impending death, even if you discover serious organic 
 disease of the heart or the lungs. The duration of life will, in
 
 178 THE PHYSICIAN HIMSELF: 
 
 many cases, depend on circumstances that you cannot always 
 foresee, — the cheerfuhiess or depression of the patient, his care- 
 fulness and prudence, the conservative powers of his system, the 
 compensative efforts of nature, etc. You know that a man's 
 liver, or his lungs, or his heart may be deranged this week and 
 well the next ; but many people think that if any of these 
 organs are aifected in any way it is necessarily permanent, and 
 it gives them long and constant anxiety. Many people are at 
 this moment living in as great anxiety as though a sword were 
 suspended over them by a hair, because they were told long ago 
 by old Dr. Vinegar, or Prof Hasty, or Dr. Cowhelp, or Dr. 
 Shallow that this or that organ was affected, without explana- 
 tion being given of the functional or temporary character of the 
 derangement. By explaining the difference between temporary 
 ailments and those of a permanent character, or the difference 
 between a functional and an organic affection, you will avoid 
 magnifying real diseases or creating imaginary ones ; infuse 
 new joy into life, and insure many a patient perpetual sunshine 
 in exchange for constant gloom. It is your duty, at least, to 
 avoid all ambiguity of language in such cases. 
 
 Contrary to the belief of the laity, and of some phy- 
 sicians, sudden death rarely occurs in heart disease, except in 
 aortic obstruction and regurgitation. 
 
 In nervous, hysterical, and impressible persons it is pos- 
 sible to convert a slight or even an imaginary complaint or 
 functional trouble in to a serious one by fixing their attention on 
 the organ deranged ; hence, in these cases, ignorance is bliss, 
 and the physician should divert the mind of the patient as 
 much as possible from the real or supposed seat of disease, even 
 if he has to avoid letting him know exactly what he is being 
 treated for. 
 
 Even our instruments of precision can be used in such a 
 manner as to excite the brain, and become objects of study, fear, 
 and dread. That excellent instrument, the (try life) clinical 
 thermometer, often tells from day to day tlie unwelcome trutli
 
 HIS REPUTATION AND SUCCESS. 179 
 
 tliat fever continues, till it seems to the patient and those 
 around that you do little else than measure how long he has to 
 live, and they almost wish it had never been invented. Try, 
 therefore, so to use it as to prevent, if possible, such ill results. 
 
 Many now rush to the vaginal speculum on the slightest 
 pretext. Never make an examination with it unless a correct 
 diagnosis imperatively demands. 
 
 Take especial care not to allow patients' attention to be- 
 come unduly fixed on their urine. Some persons have a morbid 
 tendency to watch this excretion, and only need a discouraging 
 word from the physician to make them as anxious about their 
 kidneys — with apprehensions of Bright's disease, diabetes, 
 gravel, etc., arising before their distempered vision — as are 
 some women about their wombs. 
 
 You will also have patients lacking in sound common 
 sense — the salt of wisdom — (generally soft-bearded youths who 
 have not yet cut their last molar teeth), who come tormented 
 with evil forebodings over alleged conditions that are either 
 imaginary or perfectly natural : some because they have discov- 
 ered that their left testicle hangs lower than the right, or 
 because their scrotum remains contracted or relaxed ; — 
 
 " How green you are, and fresh, in this old world ; " — 
 
 others terribly alarmed because they have, in examining them- 
 selves, discovered the little odoriferous glands on the posterior 
 part of the glans penis, and imagine them to be chancres or 
 cancers ; others because the fear of disease, or of blackmail, 
 or of a charge of bastardy, or self-accusation, or a reluctance to 
 sin, or disgust for the (cow) female has thwarted their attempts 
 to copulate with loose women and made them imagine them- 
 selves impotent. You will also occasionally be asked for 
 advice by those about to marry, and by others newly married; 
 and also by old sinners, who have burned the sexual candle too 
 fast in youth and lived too fast in general, who find their pas- 
 sions or powers of flesh gone ; and others who are almost crazy 
 on account of this or that affliction, defect, or fear. In all such
 
 180 " THE PHYSICIAN HIMSELF: 
 
 cases bear distinctly in mind that your opinions and advice are 
 your capital, and do not fail to charge \onv fall fee, even though 
 you write no prescription. With such patients the charge is 
 for banishing fears and anxieties and giving valuable information 
 and satisfaction. No one has a right to tax your time and talent 
 in any way without proper remuneration. 
 
 Be careful to warn all such people against the curse of 
 falling into the hands of " Lost-manhood Quacks," Pseudo-scien- 
 tific Anatomical Museum Impostors, with their terrifying plates 
 and examples of venereal diseases, and other " friends of erring 
 youth," who circulate pamphlets on the evils of spermatorrhoea, 
 masturbation, etc., and do not fail to tell them of the mischief 
 ■such skulking impostors inflict on* their victim's health, and also 
 of their merciless, never-ceasing voracity for money. A whole 
 book could be filled in telling the various ways in which these 
 human foxes wring money from their victims as you would 
 water from a sponge. 
 
 " Oh ! for a whip in every honest hand. 
 To lash such rascals naked through the land." 
 
 It is doubtful whether the various medical guide-books for 
 the public — Dr. Quackem Wiseacre's " Family Medical Guide," 
 Professor Scolasticus Lollypop's " Every One His Own Phy- 
 sician," and a host of others — ever do any one much good. It is 
 certain, however, that people cannot understand them as they 
 are intended to be understood, and that they do a great deal of 
 harm, by filling men's minds with imaginary wisdom, and em- 
 boldening them to try their hands at doctoring cases that requu'e 
 a physician until either much suffering or permanent injury has 
 been entailed, or possibly life itself sacrificed. 
 
 Are not such attempts to teach the laity how to treat dis- 
 eases like trying to teach one how to read who does not know 
 how to spell 1 
 
 The eight or ten large papillae seen upon the base of every 
 one's tongue often occasion much anxiety, on being discovered 
 by overanxious laymen, while looking into their throats for indi-
 
 HIS REPUTATION AND SUCCESS. 181 
 
 cations of syphilis, diphtheria, or ulcerations, and great reUef 
 is afforded when told that these are natural. 
 
 You will often be consulted by true syphilitics, who wish 
 to know what would be the result of their marriage. To such 
 never promise certain immunity against future outbreaks; and 
 do not sanction marriage, unless three years at least have elapsed 
 since they contracted syphilis, and at least two years since they 
 had any indications of the disease. Even then they should 
 marry only under hygienic and therapeutic restrictions. 
 
 When a patient, alarmed about his health, consults you, if 
 you wish your opinion fully to satisfy him, he earnest^ and let 
 personal intentness to his case overshadow all that you say or 
 do ; take especial care not to divert his conversation from himself 
 to extraneous subjects. If it be at your office, do not digress 
 by showing him your paintings, or the toy steam-boat you are 
 making, or by telling the latest bits of news or gossip, or the 
 history of the good cigar or fine pipe you are smoking, or 
 of the newspaper or novel you are reading, or of the cane you 
 are twirling. If he divert the conversation from his case, bring 
 him back to it at the first opportunity, and know nothing but 
 your professional duty. 
 
 Never, under any circumstances, recommend sexual inter- 
 course as a remedy for self-pollution, nocturnal emissions, hyper- 
 activity of the sexual system, spermatorrhoea, hypochondriasis, 
 disordered emotions, acne, unruly sexual excitement, priapism, 
 prostatitis, or anything else. If those who are subject to these 
 affections choose to run the risk of syphilis, or gonorrhoea, or 
 bastardy, or exposure ; or to commit rape, adultery, or self- 
 ])ollution, or marry merely as a remedial agent for masturba- 
 tion or nocturnal emissions, let it be on their own responsibility, 
 not on yours. Perfect chastity is not only entirely compatible 
 with good health ; but I know of no disease, either of body or 
 mind, in which sexual intercourse is essential as a remedy or 
 palliative, and I do know that it is far better for all, male and 
 female, to grow up pure in mind and body.
 
 182 THE PHYSICIAN HIMSELF : 
 
 Bear in mind that night emissions recnirring occasionally in 
 young men partake of the nature of an overflow from seminal 
 plethora, and are perfectly compatible with sound health. Young 
 fellows, half-crazed with dread and remorse, will often consult 
 you about these emissions, and you will find that almost every 
 one attributes them to self-pollution in boyhood. The results 
 of masturbation, however, are, as a rule, much less baneful and 
 destructive than commonly supposed ; when the nasty, unnatural 
 habit is stopped, its results are, as a rule, quickly recovered from. 
 
 Consumptive females whose blood-making power is less- 
 ened by their disease naturally cease to menstruate. They then 
 attribute their decline in healtli to the absence of the menses, 
 whereas, the cessation is really due to the decline and consequent 
 loss of blood-making power. When such patients appeal to 
 you to restore their menses, you should explain why they have 
 ceased, and why they will not return until their health and their 
 blood-making power improve. 
 
 Consumptive persons sometimes have hectic fever so regu- 
 larly at a certain hour, day after day, that they and their friends 
 are persuaded that their sickness is malarial in cliaracter, and if 
 you are not on the alert they may mislead you in your diagnosis, 
 and into giving an erroneous opinion to that eflect. If tlie 
 administration of quinia has no specific effect on the periodic 
 daily fever, in a weakly or health-broken person, you may suspect 
 that it is hectic rather than malarial fever. 
 
 The popular belief that one is hooked for consumption 
 because a parent, or brother, or sister died of it, is true only in 
 a limited sense. If the relative's disease were part of his law of 
 development and were in his charter of life, so to speak, develop- 
 ing just when the rose-bud becomes the full-blown flower, it 
 should indeed excite serious fears in every one who has the same 
 charter, the same constitutional tendency. But if his disease 
 began after his physical development was fully completed, or if 
 it were brought on by an accidental cause, tlie law of heredity 
 does not apply. One whose father, mother, sister, or brother
 
 HIS REPUTATION AND SUCCESS. 183 
 
 died from phthisis, the sequence of bad hygiene, pneumonia, 
 etc., is not thereby necessarily compromised, inasmuch as that 
 variety is not hereditary unless his father had it at the time when 
 he begot him, or his mother during her pregnancy or time of 
 nursing. Only about thirty-six per cent, of those who die of 
 consumption inherit it. 
 
 One person in every seven firmly believes that he has 
 either heart disease or consumption, while those really affected 
 with either are rarely willing to admit it, the consumptive gen- 
 erally to the last calling it a bad cold. You will find that tlie 
 management of those who are actually suffering with one or the 
 other is one of the most delicate questions in practice. When 
 your opinion is invoked in these cases, do not examine or ques- 
 tion them at all, unless you have time to do so thoroughly, for 
 your primary opinion and treatment may influence their entire 
 future course, and if anything be overlooked at the onset you 
 may unwittingly induce a neglect of essential remedies until the 
 patient is beyond their reach. 
 
 No wonder the mind dreads the great white plague, con- 
 sumption, with its pale, ghastly white face, flushed yet pallid 
 cheek, brilliant yet dimmed eye, husky cough, rattling lung 
 and unsteady hand ; for it is humanity's great destroyer. Many, 
 once gay and happy, are to-day sunk into deep distress, because 
 doomed by it to a certain and lingering death. It loves to 
 scourge the young, the beautiful, the gentle, and the gifted, — 
 
 "Those made of Heaven's finest clay," — 
 
 and this portion of every community is selected for its most in- 
 tractable and rapid forms. 
 
 Valetudinarians, dreading every change of weather and 
 every variation of temperature, almost invariably dress too 
 warmly and heavily, and, in their anxiety to protect their bodies 
 from cold, wear so much clothing that they shut all the air, sun- 
 light, electric, and other health-giving influences from their 
 bodies, overheat their skin, and keep it constantly relaxed, and, 
 of course, reduce or destroy their natural resisting power, so tliat
 
 184 THE PHYSICIAN HIMSELF 
 
 when the winds of heaven, or the cold air, or a draught, or 
 even the gentle dews of night fall upon them, the result is like 
 jumping from the climate of Cuba mto that of Canada. No 
 one, sick or well, should ever wear more clothes than are suf- 
 ficient to keep him comfortable. Every ounce beyond that is 
 unnecessary and enervating, and increases the cold-catching 
 tendency. 
 
 People of the opposite extreme, knowing that cool bed- 
 rooms are healthy for hale and hearty persons, often carry chil- 
 dren, subject to catarrhs and croup, and other invalids, from the 
 warm rooms in which they have passed the day to cold sleeping- 
 rooms, instead of giving them uniform warm air, day and 
 night, till recovery takes place. It would even be less hurtful 
 to reverse it, and keep them in a cold room while awake and in 
 a warm one during sleep, because there is more nervous energy, 
 and a person has greater resisting power while awake than dur- 
 ing sleep, which makes the system more able to withstand cold. 
 For instance, the butcher can attend at his exposed, fireless 
 stall the coldest winter weather till midnight, and not even 
 sneeze ; but, were he to lie down on his stall and sleep during a 
 similar period, he would probably get chilled and contract catar- 
 rhal pneumonia or rheumatism. It devolves on you to point 
 out these and kindred dangers to patients who are risking them. 
 
 Register-heat, on account of its parching dryness, is bad for 
 both sleeping- and sitting- rooms. You will often smile at seeing 
 a small pan or cup of water simmering on a stove, or under a 
 register that is pouring out a volume of overdry, impure air, 
 while the inmates are blissfully believing that it is tempering and 
 rendering pure and moist all the air passing over it. A ^ery 
 large wet towel or folded sheet hung over the opening, with its 
 lower end in a basin of water, is much more effective. 
 
 Many newborn children are unwittingly exposed to the 
 bad effects of cold from lack of knowledge on the part of those 
 in charge. The popular belief is, that if the nurse puts plenty of 
 clpthes on a shivering babe she has done all that is needed ;
 
 HIS REPUTATION AND SUCCESS. 185 
 
 whereas, if the little babe, whose heat-generating power is 
 naturally very feeble, after a prolonged oiling, and soaping, and 
 washing, and turning, and wiping, and powdering, and band- 
 aging, be put into clothes in a cold condition, without further 
 attention, hours or days may elapse before its feeble heat-making 
 power can bring on a reaction, and warm its blue feet and cold 
 nose. Ice is put into woollen cloths or blankets to prevent it 
 from melting; cold bread wrapped in a blanket would never 
 warm itself, but if warmed and then wrapped in a blanket it 
 would retain the heat for some time. Take care, therefore, that 
 the newborn babe is kept warm. As soon as it is dressed it 
 should be nestled against its mother's bosom till warm ; if this 
 does not suffice, it should be kept near the fire till the requisite 
 warmth has been imparted. 
 
 Remember that the act of nursing not only supplies the 
 babe with nourishment, but also communicates a new supply of 
 heat from the mother, and possibly electricity, or some other 
 occult but useful influence ; at any rate, it can do no harm to 
 have all hand-fed babes nestled to some one's warm, bare breast 
 at intervals of a few hours, in exact imitation of those that 
 suckle. 
 
 The ancient custom of clothing infants in flannel, with 
 woollen socks, during hot weather, creates discomfort and dis- 
 poses to infantile sickness. Its harmfulness should, therefore, be 
 made known to those whom you find following it. 
 
 There is a wide-spread popular error, participated in to some 
 extent even by physicians, regarding the real object of lancing 
 children's gums. When a physician lances or rubs a child's 
 swollen gums, he does so not solely to let the tooth through, 
 nor does he expect it instantly to pop through the opening, but 
 his chief object is to sever the innumerable small nerves that 
 ramify through the gum, and thus relieve the tension, pain, 
 irritation, danger of convulsions, etc. No one should incise or 
 rub through a child's gums, except when these evils are present, 
 for so much prejudice exists on this subject among certain
 
 186 THE PHYSICIAN HIMSELF I 
 
 people, that if you lance their sick child's gums and in despite 
 of it he dies, you will incur their malediction for doing it. 
 
 There is much less popular opposition to rubbing children's 
 teeth through with a thimble, spoon-handle, or any other suit- 
 able article, than there is to lancing them ; and the contused 
 wound made by rubbing is less apt to reunite than a clean 
 incision. 
 
 " Doctor, my child gets the phlegm up, but instead of spit- 
 ting it out he swallows it again," is a stereotyped expression. 
 If he does, it makes but little difference, inasmuch as he swal- 
 lows it, not back into the windpipe or lungs, but into the 
 stomach, where it becomes unimportant. It is, of course, un- 
 natural for a child to spit before he is three years of age. 
 
 It is a popular belief that crossness in sick children is a 
 favorable sign, and there often appears to be a great deal of 
 truth in it, since it requires considerable strength and energy to 
 exhibit crossness. The re-appearance of tears in the child's eyes 
 when crying is also a favorable sign. 
 
 Never pooh ! pooh ! or make fun of mothers because they 
 believe their children have worms, for in some instances they 
 are correct in their opinions, and if you scout the idea and fail 
 to give a trial remedy, you may be chagrined to learn that after 
 leaving you they went to some drug-store, purchased a quack 
 vermifuge, which, sure enough, brought away worms, and are 
 exultingly telling it as proof that you were wrong and they were 
 right. Such cases are a cause for blushing, and do one's repu- 
 tation no good. It is better, when worms are suspected, to 
 respect their opinions and desires, and give some harmless ver- 
 mifuge, even though it do no other good than to test the fact 
 and satisfy the mother. Mothers are often acute observers, even 
 though they are not good prescribers. 
 
 It is better in all cases to allow a certain degree of weight 
 to the opinions of the patient and his attendants, especially 
 those who sit up with him at night ; not that you should sur- 
 render your judgment to their exaggerated apprehensions or
 
 HIS REPUTATION AND SUCCESS. 187 
 
 palpable errors, but, at least, listen calmly to what they say, and 
 take in consideration their opinion in making up your own. 
 
 "The nurse's tongue is privileged to talk." 
 
 They see him the whole twenty-four hours, while you may see 
 him but five or ten minutes a day. The apparently causeless 
 fears and predictions of nurses and friends are sometimes sur- 
 prisingly confirmed, and the self-sufficient physician's prophecies 
 correspondingly unrealized. 
 
 Many persons think it is of no use to call a physician to 
 sick infants, because they are unable to make any verbal com- 
 munication, or to place their hands on the seat of their diseases 
 to assist him in making a diagnosis. This opinion is erroneous, 
 for the diseases of infants are usually simple in character, and 
 their symptoms, being neither disguised, concealed, nor exag- 
 gerated, can be read and correctly treated by any wise physician. 
 
 Condemn the keeping of commodes in bedrooms, as they 
 are a dangerous source of diphtheria, scarlatina, typhoid fever, 
 and other filth diseases. Also, direct that the alvine discharges 
 in all contagious diseases and the sputa of consumptives shall 
 be either disinfected or destroyed. 
 
 Every worthy housewife courts the reputation of keeping 
 her house clean, and one of the proofs of her skill is the absence 
 from the premises of bed-bugs, fine-tooth-comb insects, roaches, 
 and other vermin. Should you ever notice such things about 
 a respectable patient's body, clothing, or bedroom, affect not to 
 see them, for nothing is more deeply mortifying than to have 
 anything of the kind noticed and pointed out by the family 
 physician. Also, be oblivious to all mortifying accidents, im- 
 modest mistakes, and accidental exposures that may occur in 
 the sick-chamber. 
 
 " Doctors must often shut their eyes and close their ears." 
 
 The terms scarlatina and scarlet rash are now in everybody's 
 mouth, and are spoken of by the laity as harmless affections, 
 under the belief that the word " scarlatina " means a slisht
 
 188 THE PHYSICIAN HIMSELF: 
 
 affection, bearing about the same relation to scarlet fever that 
 varioloid bears to variola. There is no such disease as scarlet 
 rash, and the cases to which these terms are applied are usually 
 either scarlet fever or rotheln (German measles), and, unless 
 people are made to understand this, neglect of the necessary 
 precautions and great damage may result. 
 
 Bringing out the eruption is one of nature's processes in 
 measles, scarlatina, small-pox, etc., but there is no doubt that 
 the large quantities of saffron-tea, ginger-toddy, hot lemonade, 
 home-made wines, etc., used by grannies to bring them out, do 
 more harm than good, by disordering the stomach, inflaming 
 the eruption, etc. This "bringing out the eruption," when 
 uncomplicated, had better be left somewhat to nature ; when 
 it is complicated, something more reliable than teas is indicated. 
 
 There is also a popular belief that all skin diseases result 
 from humors in the blood that must be driven out, or, if already 
 out, kept out, until killed by blood medicine, much the same as 
 one would drive rats from tlieir haunts and keep them out until 
 annihilated. No patient will object to your driving his humor 
 out, or killing it, but if he thinks you have simply driven it in, 
 woe be to you should he subsequently have any severe or fatal 
 sickness. In such cases it is well to give an internal remedy, 
 whether local treatment is used or not. In some cases, where 
 great fear or strong prejudice exhibits itself, it is even better to 
 commence the internal treatment some days before beginning 
 the local. 
 
 There is likewise a popular expectation of evil and a like 
 readiness to blame the physician if any new symptom appear 
 after he suddenly arrests or cures periodical bleedings, diarrhoeas, 
 foot-sweat, or chronic discharges of any kind. 
 
 Many persons suppose boils and various eruptions to be 
 healthy. Not so ; but, even if they were, most people will 
 agree that some other mode of health is decidedly preferable. 
 The belief is probably foimded on the fact that during conva- 
 lescence after certain serious diseases a crop of boils often appears^
 
 HIS REPUTATION AND SUCCESS. 189 
 
 seemingly from a revival of the energies, or vital forces of the 
 system, from the depressing influence of the disease. The fact 
 of their appearance being coincident with reorganization and 
 returning health probably accounts for the belief that boils and 
 health naturally go together. 
 
 The high color of the urine occasioned by activity of the 
 skin in patients whose sickness compels them to lie in warm 
 beds or to keep in hot rooms, also seen in well people who per- 
 spire freely during warm weather, frequently creates alarm, and 
 induces groundless fear that they have kidney disease. Explain 
 to them how the functions of the skin and kidneys are in rela- 
 tion to each other, and that it makes but little difference whether 
 the urine is scanty or abundant if it contain all the natural 
 excreta and be simply deficient in water. 
 
 When a coin or other small foreign body is accidentally 
 swallowed, some old lady is almost sure to recommend a dose 
 of castor-oil or other purgative, thus liquefying the contents of 
 the bowels and necessitating the passage of the extraneous body 
 the entire length of the alimentary canal alone, instead of allow- 
 ing the fsecal matter to remain as a mass to inclose it and 
 prevent its corners and sharp points or edges from doing harm. 
 When such an article is swallowed, do not interfere with the 
 eff'orts of nature unless you feel sure she cannot expel it un- 
 aided. 
 
 When a person faints, those around run to assist him, and 
 in those agitating moments instinctively raise his head, instead 
 of lowering it as they should do, thus prolonging the syncope 
 and endangering life. 
 
 In all cases where great debility and pallor are present, be 
 careful to instruct the attendants to keep the patient's head low, 
 and to prevent him from rising suddenly for any purpose, and 
 from sitting up too long, or unwatched, for fear of fatal syncope. 
 
 " If the dog that bites a person goes mad, the one bitten 
 will also," has caused many a valuable dog to be killed. The 
 truth is, if the dog's mouth or teeth contain hydrophobic 'sirus
 
 190 THE PHYSICIAN HIMSELF I 
 
 at the time of biting the person there is great risk of its being 
 communicated ; otherwise, there is no risk. If the dog be killed 
 under the mere suspicion of having hydrophobia, all inquiries as 
 to its madness are cut short, the disproof of the disease is ren- 
 dered impossible, and the person bitten and his friends are left 
 to all the terrors of uncertainty. 
 
 A hydrophobic dog is said never to live longer than ten days 
 after it becomes so ; therefore, if a dog bite a person, it should 
 by all means be allowed to live beyond this period to ascertain 
 beyond doubt whether it has hydrophobia, or is harmless ("?). 
 
 Foolish persons will occasionally tell you, in a boastful 
 manner, that they have no fear of contagious diseases, and will 
 sliow^ either by word or manner that they entertain the belief 
 that contagious diseases attack those who dread them and spare 
 those who do not. It is well to teach such people that the laws 
 of small-pox, syphilis, gonorrhoea, hydrophobia, typhus fever, 
 and such affections, are very different from what they imagine ; 
 that fear cannot communicate them to timorous persons — man, 
 woman, or child — who are not exposed to their influence, and 
 that mere courage or absence of fear will not, can not, protect 
 nurses or friends, old people or babes ; nor braggarts, nor even 
 persons who are unaware of their presence, if exposed to them. 
 
 You will often be asked what physicians carry or what 
 they use to protect themselves against the epidemics and con- 
 tagious diseases which they face. So it always should be, but so 
 it sometimes is not, for we do not always escape ; yet a fearless 
 heart, a cheerful mind, and love of duty often do seem at such 
 times to unite with hygienic precautions to protect us in our 
 battles, while the cowardly fellow who flees from the danger 
 w^ould probably die if he were to stay. 
 
 "Epidemics kill hundreds, fear kills thousands." 
 
 There exists a popular prejudice against damp houses, leaky 
 roofs, night air, dews, etc., which is probably carried entirely too 
 far. Dampness is, of course, inimical to health when mold, 
 absence of fresh air and sunliglit, filtli, noxious gases, or other
 
 HIS REPUTATION AND SUCCESS. 191 
 
 defective conditions, or disease-producing elements are added to 
 it ; but neither life on board of vessels, nor the presence of 
 excessive dampness, as in rainy weather, is in itself unhealthful. 
 Dark houses and basement rooms, where the natural light does 
 not reach, are, of course, unhealthy, and may breed microbes. 
 
 The low-spirited and the morbid will often refer to the 
 fullness or emptiness of the veins on the back of their hands, 
 and count the wrinkles, as proof that their blood is drying up, or 
 that they need bleeding, or that they are consumptive. Explain 
 to them the folly of such conclusions. 
 
 When liniments are applied to the extremities for swell- 
 ings, pains, etc., the popular notion is, that to rub outward^ 
 toward the fingers and toes, is the proper and only way to carry 
 off the disease, while physiology tells us to aid the impeded 
 circulation by rubbing toward the heart, — a fact that it seems 
 impossible to make people appreciate. 
 
 As purgatives after confinement, many physicians order 
 simples : castor-oil, rhubarb, seidlitz-powders, etc., instead of 
 writing regular prescriptions ; it will be wise for you to follow 
 the same rule and order castor-oil for a lying-in woman, or what- 
 ever other simple laxative she or her friends are accustomed to 
 take, for if you give her a Latinized prescription for a purgative, 
 and, as a coincidence, she has hyper-purgation, or puerperal 
 fever, or heemorrhages, or if syncope or anything else follow, 
 she will be very apt to believe that your purgative was too 
 strong, and caused her sickness ; and if she happen to die you 
 and it will be blessed. 
 
 The admission or exclusion of persons who wish to enter 
 the sick-room, and allowing or forbiddine^ conversation with ill 
 patients, or within their hearing, require no little delicacy and 
 tact. Exclude gossips and bores from the bedrooms of those 
 who are seriously ill; also, kind but thoughtless idiots, who come 
 to tell the sick how badly they look, or of the death or misfor- 
 tunes of neighbors, or of those who had similar seizures ; but 
 try to manage the matter so as to engender no personal enmity.
 
 192 THE PHYSICIAN HIMSELF: 
 
 Endeavor, also, to acquire expertness in answering anxious 
 questions relative to such cases, but never attempt to exclude 
 the parents, near relatives, religious advisers, or other privileged 
 persons from the room of any one who is seriously ill, and never 
 interdict Bibles, prayers, and religious exercises, except for the 
 most urgent and obvious reasons, such as, when he is highly 
 delirious, or has just taken an urgently needed sleeping potion, 
 or where he is determinedly opposed to the mtroduction of 
 religious conversation ; else you may raise among them a very 
 natural whirlwind of indignation against you. 
 
 To interrupt public business and travel by roping or barri- 
 cading the streets, because somebody is sick in one of the 
 houses, is seldom either necessary or justifiable, as most dwell- 
 ings have back rooms into which the sick can be taken out 
 of reach of the noise of travel ; make it a point to advise the 
 latter course instead of the former. Where the former is not 
 feasible, a good bed of spent tan on the street will completely 
 prevent the rattle of passing vehicles, and show everybody that 
 a person is sick whom noise will injure. 
 
 Never ask the age of a patient more than once during 
 attendance on his case. Take care, also, neither to ask any 
 question twice at the same visit, nor to do anything else that 
 would indicate abstraction, lack of memory, or incompetence. 
 
 You will find that patients will be inspired with more faith 
 in a prescription if you begin to write it with an air of decision 
 immediately after receiving, to a more or less important question, 
 an answer which your manner indicates is what you expected. 
 
 Take care to ask all necessary questions before you com- 
 mence to write your prescription, lest the patient think that, in 
 forming your opinion, you liave not included the additional 
 information or taken it in consideration in writing the prescrip- 
 tion, or that your treatment was determined on before you 
 obtained all the facts. Make it a rule, also, to ask no further 
 questions after prescribing. It is well to terminate a visit as 
 soon after prescribing as can be properly done.
 
 CHAPTER VII. 
 
 "The successful man is the mau who knows human nature, as well 
 as his profession." 
 
 Every minute spent in studying how to make your reme- 
 dies agreeable will be more advantageous to you than half an 
 hour of any other kind of study. Whoever, in these days, pre- 
 scribes nauseous, repellant medicine in ordinary cases injures 
 both himself and his profession, and is deficient in one of the 
 most simple and essential requirements. Indeed, one of the 
 great drawbacks to young physicians, and one of the chief 
 reasons why they fail to render more practical assistance to their 
 older brethren in superseding pleasant quackery, is that, hav- 
 ing their attention riveted on their cases and studying more 
 about getting them safely than comfortahly through their ail- 
 ments, and being anxious to get the specific physiological effects 
 of medicines quickly and fully, they too often give them in crude 
 forms, forgetting that the majority of sick people are fastidious, 
 and have likes and dislikes that must be respected. 
 
 A great and almost universal mistake that regular phy- 
 sicians make is in supposing that when people send for them 
 it is for the sole purpose of having medicine prescribed. Many 
 people, not being judges as to what cases need medicines and 
 what do not, are much more anxious to see one who does know, 
 have a talk with him, and get an opinion of the nature, danger, 
 probable course, and result of their cases, and words of assurance 
 from him, and some simple remedy, if necessary, than to be 
 drenched at every pore, or begin a medicine-taking siege, or a 
 bombardment with gross drugs. 
 
 Make special endeavors to retain every medicine-hater who 
 chances to fall into your hands. Such incorrigihles had better 
 be under your care, with rational supervision and small doses 
 of good treatment, than to be paying some one else for harmful 
 quackery or fantastic nonsense. 
 
 ^' (193)
 
 194 THE PHYSICIAN HIMSELF: 
 
 Keep ever in your mind that mankind has both a material 
 and a spiritual nature, and that different people seem to be 
 made of different and almost opposite qualities; some seem to 
 be two-thirds spiritual and one-third animal, others seem to be 
 but one-third spiritual and two-thirds animal, between which 
 are all intermediate grades. If you treat all these alike, you 
 will certainly fail. The mind belongs to the legitimate domain 
 of the physician as well as the body, and the moral and 
 mental management of the sick is often far more difficult than 
 the physical. A close, thoughtful study of mental forces 
 and of mental therapeutics in affections connected with the brain 
 and nervous system is one of the necessities that the regular 
 profession is still extremely deficient in. Irregulars often give 
 a placebo, a mysterious mystery, or a useless agent, which un- 
 questioning faith and other mental operations based on hopes 
 of recovery excited in the wondering patient — potentizes — and 
 an astonishing cure (?) results. 
 
 This is probably the most rational explanation of the fact, 
 that newly discovered therapeutical agents, as bromide of potas- 
 sium, salicylic acid, etc., make so many more wonderful cures 
 Avhen first heralded as remedies than they effect after they have 
 taken a definite position in the pharmacopoeia. 
 
 New or novel remedies often aid the cure through mental 
 influences. Many regular physicians prescribe valuable, true 
 remedies, but give them just as they would administer them to 
 a horse or sheep, as if their only duty consisted in telling the 
 sick what drugs to swallow, and seem to despise the aid of 
 faith, hope, and expectation. You must learn, in simple cases, 
 to depend more upon the aid of hygiene, diet, and mental in- 
 fluences, and less on large doses of disturbing medicine, which 
 might allow room for some patients to say that you had almost 
 killed them. 
 
 Bear carefully in mind that Drs. Diet, Quiet, Hope, and 
 Faith are four excellent assistants whose aid you should con- 
 stantly invoke. The Oil of Time and Tincture of Patience are
 
 HIS REPUTATION AND SUCCESS. 195 
 
 also very useful in some cases, but too slow and inadequate for 
 others, and unless Dr. Dosomething takes the serious case out 
 of Dr. Donothing's, Dr. Tardy's, or Dr. Timorous's hands, they 
 occasionally give one of the confiding kind a wooden overcoat 
 and put him into the hands of Mr, Sexton. 
 
 It is bad to let nature take her course when she takes a 
 bad or a wrong one. You will often see her put a curable pa- 
 tient in his coffin because you were called too late to aid and 
 direct her course. 
 
 If, at the time, you indicate, to a patient for whom you pre- 
 scribe an unpalatable medicine, that it will have a bitterish or a 
 saltish taste, or any other unpleasant quality, his mind will be 
 prepared, and it will not seem so objectionable to him as it 
 would were his mind and palate taken by surprise. 
 
 If the directions on the bottle indicate what the remedy is 
 for, — for instance, if you have it labeled " to be applied to the 
 injured foot as directed," or " for the pain in the chest," or 
 " for the cough," — it will tend to give a certain class of patients 
 faith in its being a direct and special remedy, and cause their 
 minds to act with it rather than against it. 
 
 Remember that even a highly proper remedy may be 
 pushed too far, or continued too long. Indeed, cases sometimes 
 reach a point at which it is better to stop all medicine tempo- 
 rarily, and rely on hygiene, diet, stimulants, nursing, etc. 
 
 You should keep yourself familiar with the ill effects that 
 may arise from the use of the various drugs which you pre- 
 scribe, in order that you may avoid producing them, or promptly 
 recognize and remedy them if they occur. 
 
 Avoid as far as possible the use of medicine that must be 
 taken " through a quill or tube," or that will burst the bottle 
 unless kept " in a cool or dark place ; " on which " no water 
 must be taken ; " that must be handled with caution, or that 
 must be stopped when the eyelids begin to swell, or when the 
 muscles begin to jerk, or that the druggist must label " Poison ;" 
 especially with medicine-haters and skeptics.
 
 196 THE PHYSICIAN HIMSELF : 
 
 Some people will not send for you until they are really ill, 
 for fear you might put them to bed, and thereby keep your car- 
 riage at their door ; or salivate them, or entail upon them dis- 
 comfort instead of affording relief Others will be afraid you 
 will give them quinine, or injure their teeth with iron or calo- 
 mel, etc., or that if they once begin to take medicine they will 
 not be able to stop. Disabuse the minds of all such people with 
 the assurance that their fears are groundless. 
 
 Herb doctors, root doctors, vegetable-pill makers, and others 
 have created a belief in the public mind that remedies obtained 
 from the mineral kingdom — iron, mercury, arsenic, lead, lime, 
 etc. — are poisonous, and should not be taken ; while articles 
 from the vegetable are in consequence thereof innocuous and 
 harmless. The truth is, — the most powerful agents — hydro- 
 cyanic acid, belladonna, elaterium, croton-oil, lobeUa, opium, 
 •stramonium, colchicum, digitalis, aconite, strychnia, and a long- 
 list of other very active agents — are "Purely Vegetable;" 
 therefore, the announcement, "Purely Vegetable," is but one 
 vof the numerous songs of these greedy sirens. 
 
 " Iron injures the teeth" is a remark which you will often 
 hear, and it originates in the fact that the old muriated tincture 
 of iron (tinct. ferri chloridi), which contains muriatic acid, if 
 given without the usual caution, will injure the teeth, not on ac- 
 count of the iron, however, but of the acid that is associated with 
 it ; just as the water that makes a pot of boiling coffee would 
 scald a person all tlie same if the coffee were not in it. Prepara- 
 tions of iron containing no free acid do not act upon the teeth. 
 
 Iron temporarily blackens the tongue and the stools ; and 
 it is well to tell persons this to prevent needless alarm. 
 
 It is believed by many that quinine gets into the bones, 
 affects sight and hearing, causes dropsy, etc. So firmly do 
 some people believe these things that you will at times have to 
 humor their prejudices, and change to sulphate of cinchonia, 
 compound tincture, or some other preparation of bark, when 
 bark is indicated.
 
 HIS REPUTATION AND SUCCESS. 197 
 
 This prejudice depends chiefly on the fact that, being pow- 
 erful for good, people naturally infer that it must be very 
 strong ; hence, also, powerful for evil. It is also often due to 
 the teachings of Irregulars, who seek through it to prejudice the 
 public against regular physicians, while constantly but secretly 
 using it themselves. I have known a conspicuous Irregular to 
 denounce quinine strongly, and yet use three-grain ovoid, gelatin- 
 coated quinine pills under the name of '•'■Panama Beans " for the 
 cure of his patient. We know that quinine, when properly used, is 
 really an almost harmless vegetable product, which acts on the 
 malarial poison not by great strength, but through its antidotal 
 influence, just as water, an agent harmless enough to drink or 
 bathe in, acts on fire. 
 
 One of the most provocative and annoying hardships you 
 will have to endure is the tendency of some people who have 
 suffered protracted sickness to blame you or your medicine for 
 any permanent impairment or persistent lingering symptoms 
 after illnesses, instead of recognizing and acknowledging the 
 fact that they are the real effects (sequelae) of the disease. 
 
 Reproach is often unjustly cast on physicians and on 
 medicine by people living in malarious districts, who sicken with 
 this or that malarial affection, send for a physician, and get well, 
 and might remain so, but, being still surrounded by malaria, they 
 again inhale it and are again poisoned. This they erroneously 
 call " a return," instead of a re-poisoning. Of course, while the 
 laws of His Majesty, King Malaria, remain as they are, you can 
 no more promise future immunity to convalescents with an agued 
 frame who remain in malarious districts than you can promise 
 the anxious sailor that future winds will not again create waves, 
 or the uneasy farmer that recurring frosts will not again nip his 
 exposed plants. 
 
 Malarial exhalations from the earth are usually greater 
 at night, and greatest on the still, damp nights of autumn. 
 Malarial affections, therefore, are usually contracted in autumn 
 and at night, but many people are ignorant of the fact that
 
 198 THE PHYSICIAN HIMSELF: 
 
 they can also rise, and be caught, during the greater part of the 
 year ; they can also be caught in the day-time, and persons 
 should be put on their guard. 
 
 It is proper, and your duty, to advise a person to change his 
 abode if necessary for his health, or to relinquish an occupation 
 if it be injurious to him. Also to dissuade him from exciting 
 pursuits, or from striving to amass riches when his health is 
 thereby jeopardized ; at the same time, bear in mind that such 
 subjects are both tender and delicate to deal with. Be on your 
 guard, therefore. 
 
 Keep yourself well informed in regard to suitable clothing, 
 physical exercise, and proper diet ; also as to the value of pure 
 air, pure water, and pure soil, the comparative healthfulness of 
 different regions, the presence or absence of malaria at different 
 seasons and places, etc. ; also in regard to the various health trips 
 and summer resorts. Familiarize yourself likewise with the con- 
 stituents and peculiarities of the various mineral waters, and the 
 special uses of each ; with the comparative advantages of sea- 
 side and mountain trips, and with the classes of invalids to be 
 benefited by one or the other ; also with the various baths — 
 hot, cold, tepid, Russian, Turkish, electric, vapor, etc. — and the 
 comparative advantages of the various hospitals, asylums, sani- 
 taria, retreats, etc. ; for such matters belong strictly to the 
 province of medicine, and it is especially desirable that you 
 should understand them, because you are sure to be asked about 
 them, and sure to be ashamed if you cannot answer, and the 
 refined and intelhgent inquirer will feel disappointment and 
 distrust of your knowledge ; they are subjects that concern the 
 better and more desirable classes of patients, many of whom are 
 semi-invalids, with whom you will often have to make hygiene, 
 medicinal waters, trips, etc., go hand-in-hand with medication; 
 also, remember that your duty does not terminate with the cure 
 of the malady which you are called upon to treat, for in almost 
 every case you should lay down rules and regulations to prevent 
 a relapse, sequelae, or future attacks.
 
 HIS REPUTATION AND SUCCESS. 199 
 
 You cannot be too cautious in advising exhausted patients 
 Avith impaired appetite and weakened digestion, or others far 
 gone with obstinate and dangerous, invincible, or hopeless mala- 
 dies, to leave their homes and undergo the fatigue and discom- 
 forts of travel to the sea-shore, mountains, or other distant places, 
 or to foreign countries, among strangers, in search of health, 
 unless there are sound and good reasons for the belief that the 
 change will be beneficial and that improvement or restoration 
 to health will result. The risk of breathing their last away 
 from home, family, and kindred, or of a return made worse by 
 the inevitable fatigues and exposures of travel, is not to be 
 assumed without full consideration. We sometimes actually 
 hear it hinted that the physician has sent the patient away to 
 get rid of him, or because he did not know how to treat him. 
 
 Be chary of sending people from their homes to tlio 
 crowded wards of hospitals, unless you feel assured tliat tlie 
 management is kind, humane, and skillful, for, Avhile hospitals 
 and almshouses are an unspeakable blessing to sick wan- 
 derers, to the castaways, the forgotten, and the homeless, they 
 are to a less extent, if at all so, to those who have friends and 
 a place to call home. 
 
 "Be it ever so humble, there is no place like home." 
 
 To remove a weary and worn invalid from the little 
 spot he calls " home " to a hospital or other asylum for poverty, 
 deprive him of his friends, neighbors, and companions, and all 
 the little endearing sympathies and solaces of domestic life, re- 
 strict his freedom by prison discipline and half-way imprison- 
 ment, and subject him to the sense of friendlessness that is too apt 
 to seize the mind in the hours of sickness, and to the foul effluvia 
 and diseased emanations that lurk about the wards of large and 
 overcrowded hospitals, and to the risk of rugged indifference on 
 the part of paid, possibly coarse, nurses, and to irksome, hum- 
 drum, hospital rules — to bed, to meals, to everything at the 
 sound of the bell, gong, or whistle ; to expose him possibly to the 
 public gaze, merely as an object of medical treatment, or for
 
 200 THE PHYSICIAN HIMSELF I 
 
 experiment with new remedies, or for the dinical advantage of 
 medical students, designate liim by a number, clothe him hospital 
 fashion, and put him on diet prepared at regulation hours by 
 stranger hands that know not his peculiarities or tastes, his likes 
 and dislikes — if he be a person of domestic tastes and sensitive 
 disposition, with a natural attachment to his home and its sur- 
 roundings, such a change would be most hurtful and injudicious^ 
 and could scarcely fail to aggravate his disease. Worse still, if 
 he be carried to a medical-college hospital, with its busy crowds 
 shuffling feet, wilderness of gazing eyes, and sea of eager faces 
 gathered around while he is used as a subject for the demon- 
 stration of his disease, or carried through repeated or prolonged 
 examinations for the education of students. 
 
 The belief that taking water or ice is dangerous in fever is 
 still very general. People are wonderfully slow to recognize the 
 fact that water, whether applied externally or sipped and swal- 
 lowed in small quantities at a time, is one of nature's greatest 
 remedies in fever, especially if the patient have a craving for it. 
 
 If a person perspire more during sleep than at any other 
 time it is a sure sign of weakness. 
 
 You will often be asked, "• Doctor, may the patient eat any- 
 thing he wishes ? " If you think that ordinary food will do 
 him no injury, be careful to answer, " Yes ; he can have any 
 simple thing he wishes." Were you to say, " He can have any^ 
 tJiing," it would include pickles, radishes, cheese, ham, veal, 
 sausage, and a great many other indigestible things that might 
 injure or kill him ; the addition of the adjective simple will 
 protect both him and you. 
 
 You can have a small, single-page diet-list printed for the 
 use of patients, containing every article of diet in common use, 
 alphabetically arranged, at the top of which you can say, 
 " Every article on this list is forbidden except those that are 
 marked." Supply one to each patient requiring it, and mark or 
 erase from time to time such articles as you deem proper. 
 
 When you are busy and wish to make a short visit, do not
 
 HIS REPUTATION AND SUCCESS. 201 
 
 tell the patient so on entering, or exhibit a hurried or abrupt 
 demeanor, but begin promptly to ask the necessary questions in 
 orderly relation, and do not allow the patient time to introduce 
 other subjects, or in any way digress from his case until you 
 have learned all that is necessary. Have neither eyes nor ears 
 for anything except your patient. If the subject of the weather 
 is broached, answer as if you were considering it only in refer- 
 ence to its influence on the patient before you, then go back to 
 his case. Economize time thus; but if your patient is ill, 
 neither allude to your haste nor in any way show that you are 
 in a hurry until you have made your examination and written 
 your prescription. After completing the circle of duty and giv- 
 ing all the attention absolutely required, if you courteously de- 
 part forthwith, he will not feel that your haste has caused any 
 inattention to his case, as he would if you had leaped into his 
 room precipitately, thrown down your hat and gloves, dropped 
 into a chair, asked a few h.urried, desultory questions, made an 
 incomplete examination, jumped to your diagnosis, scribbled off 
 a prescription, leaped into your carriage, and hurried away. 
 
 Unless there is an obvious reason for an opposite course, it 
 is better to avoid all desultory conversation on general subjects 
 at the beginning of your visits. 
 
 It will often vex you, when you are busy and time is 
 precious, to be kept waiting below stairs while the people in 
 the sick-room prim and prepare to receive you with as much pru- 
 dery and tedious ceremony as if the surroundings, rather thau 
 the patient, were the object of your visit. Show every one the 
 respect due to sex and rank, but manage at the same time to 
 let such people know that your time is too precious to be waste- 
 fully expended, and must be divided somewhat equally among 
 those whom you are attending. 
 
 Never assign as a reason for being habitually late in visiting 
 an ill patient that you are overbusy. Every one wants a phy- 
 sician who is in active experience and engrossed in practice, but 
 no one likes to be habitually slighted or crowded out. A case
 
 202 THE PHYSICIAN HIMSELF: 
 
 of obstetrics or an accident is, however, deemed by all an accept- 
 able excuse. It is an excellent rule always to let patients know 
 at your visit when they may expect your next visit, and to keep 
 your engagement as near to the time as circumstances will allow. 
 Such a system gives satisfaction and prevents anxiety, and you 
 will then generally find them prepared to see you without 
 detention or flurry. 
 
 It is very important always to ask to see the patient's 
 medicine as soon as possible at your visit, and to ascertain by 
 both inspection and inquiry whether it has been taken according 
 to your directions before you express any opinion of the patient's 
 progress. If you neglect to do so, you may be caught confi- 
 dently ascribing improvements to prescriptions that have not 
 been used, or to remedies that have either been thrown out of 
 the window or emptied into the garbage-box, and you will 
 become the victim of a never-to-be-forgotten joke. 
 
 School yourself to avoid cruda remedies and to cultivate 
 conservative rather than radical ones. Throw gross physic to 
 the dogs. A repute for not being heroic in treatment and not 
 giving much strong medicine is at this time a telling item in a 
 physician's reputation, one that might almost be adopted as a 
 corner-stone. Of course, in cases in which duty actually re- 
 quires you to act promptly and decisively, or to use powerful 
 remedies heroically, you must not hesitate to take the respon- 
 sibility and do whatever is right and proper. 
 
 Avoid polypharmacy. It is much better to order some 
 single remedy, or a combination of which you know the physi- 
 ological effect, than to order an indefinite medley on the ancient 
 blunderbuss principle. 
 
 It is highly proper, and a duty, to warn people of dangers 
 to the public health, and to devise means to prevent or remove 
 such dangers ; also, to teach patients the importance of regular 
 living ; proper, careful diet, good water, pure air, effective drain- 
 age ; also, of the dangers that may follow the sun's rays and 
 evening dews, that they may escape disease and preserve health;
 
 HIS REPUTATION AND SUCCESS. 203 
 
 l3ut it is neither just nor wise to teach other than medical students 
 the secrets of our art, nor to famiUarize tlie laity with the 
 drugs you employ. You should especially avoid giving self- 
 sufficient people therapeutical information that they can there- 
 after resort to and ignore the physician. If you do, they will 
 soon feel brimful of wisdom, become opinionated, and imagine 
 they know as much about medicine as you do, or than all our 
 profession combined, and begin amateur prescribing and neigh- 
 borly doctoring, and not only take your bread from you, but 
 make hobbies of what you have taught them, and trifle with 
 serious affections until the patient's disease is fatally seated ; 
 after which even correct treatment may be interrupted by the 
 undertaker. It is your duty to cheat neither yourself nor other 
 physicians out of legitimate practice by supplying this person 
 or that one with a word-of-mouth pharmacopoeia for general 
 use. If compelled to give a person remedies under a simple 
 form, study to do so in such a way as not to increase his self- 
 conceit, and make him feel that he knows enough to practice 
 self-medication and dispense with your services ; and use what- 
 ever strategy is necessary to prevent him from taking unfair 
 advantage of your prescriptions. 
 
 It is unwise to instruct a person with rheumatism, gonor- 
 rhoea, ulcers, sore mouth, sprains, or any other affliction, to get 
 "five or ten cents' worth of this or that remedy, to mix for him- 
 self, unless it be one of the worthy poor ; for people are sure to 
 become self-constituted doctors and abuse such instructions, and 
 try to teach others similarly afflicted how to treat themselves. 
 
 "Every sore-eyed person is an oculist." 
 
 It is better to let such persons have the medicine from your 
 office, or to write a prescription for it, with instructions neither 
 to repeat nor lend. 
 
 It is also better to make your analysis of urine, etc., at your 
 v)wn office rather than at the patient's house, and to keep the 
 details of the processes, reagents used, points of differentiation,
 
 204 THE PHYSICIAN HIMSELF: 
 
 and other secrets of the art, etc., to yourself; else Keensighfc 
 and his friends will quickly become oversmart, begin to test for 
 themselves, and think they know more than they really do. 
 
 "The silent man has many things in his favor." 
 
 In prescribing, and even in talking of medicines, you should 
 use officinal and not popular names, unless there is some special 
 reason for using the vulgar, or a synonym. 
 
 Confine your prescriptions to officinal medicines, and to 
 preparations whose formulas are public property, as fully as pos- 
 sible, and do not patronize any of the semi-legitimate pharma- 
 ceutical catchpennies (about which you know nothing but what 
 their labels and wrappers tell) that are now flooding our nostrum- 
 ridden land. For instance, if a patient needs beef, let him eat 
 beef, or have beef-soup, or beef-tea, or beef-extract made for 
 him ; if he needs wine, order for him a suitable quantity of the 
 kind which you prefer ; if he needs iron, prescribe the kind and 
 the dose that you think proper, and thereby prevent making 
 yourself a mere distributor of some enterprising fellow's ready- 
 made " beef, wine, and iron," which cheats the pharmacist out 
 of all chance of exercising his proper profession, and frees him 
 from all mental exertion and all responsibility in the matter, 
 since he and his apprentice boy have nothing to do but serve as 
 dealers, and hand it out to customers, just as the grocer and his 
 clerks hand out salt and sugar, soap and candles, molasses and 
 tobacco. 
 
 The same hat cannot fit every head, or the same shoe every 
 foot, neither can the proportion of ingredients in any ready- 
 made combination suit every patient. Indeed, what would cure 
 one might injure or kill another. 
 
 "What has cured Sancho might kill Martha." 
 
 Let it be your firm resolve never to prescribe a proprietary 
 remedy, or one covered by a trade-mark ; it is better to shun all 
 such ready-prepared remedies, whether trade-mark, proprietary, 
 or quack, whether advertised to the profession or to the public, 
 whether the so-called formula and the dose are given or not. If
 
 HIS REPUTATION AND SUCCESS. 205 
 
 you order A.'s emulsion, B.'s lozenges, C.'s codliver-oil, D.'s 
 pills, and E.'s bitters to patients, they will, by association, soon 
 think that X.'s sarsaparilla, Y.'s buchu, and Z.'s liver regulator 
 also meet with professional approval. Determine that you will 
 not aid any speculator in life and health to " strike a trade " in 
 your families ; and chiefly for the reason that tlieir nostrums do 
 more harm than good ; also for the lesser reason that justice to 
 yourself and to all other members of the profession requires you 
 to avoid prescribing or telling patients of preparations that will 
 enable them subsequently to snap their fingers in your face and 
 renew them as often as they please, and to recommend them to 
 others who treat themselves with them without your aid. A 
 single trade-mark prescription from you may sell twenty or a 
 hundred bottles that you do not prescribe, and for which you 
 get neither credit nor compensation. 
 
 Endeavor to have your prescriptions labeled so as to pre- 
 vent indiscriminate renewal, as well as to prevent mistakes in 
 their administration ; when they are very important, be careful 
 to have the name of the patient put on the label, that every one 
 may know whose medicine it is. 
 
 Remember this : The very best time to tell a patient not to 
 renew a prescription is while writing it. If you fear it will be 
 renewed against your wish, stop short while writing and explain 
 to him why it will be a good remedy, or make some other true 
 remark about it, but that he must take only one bottle of it, or 
 that it must not. be renewed. Your order given at that time 
 will seem to be founded on some motive other than that of pro- 
 tecting your own pecuniary interest, will impress him strongly, 
 and will be invariably obeyed ; this is probably the most effect- 
 ive of all plans to prevent prescriptions from being renewed 
 and adopted as a regular resort in similar cases. With this ex- 
 ception, make it a rule neither to talk, listen, nor answer ques- 
 tions while writing prescriptions. 
 
 Never write a prescription carelessly. Legibility is the first 
 requirement, neatness the second. Cultivate the habit of scru-
 
 506 THE PHYSICIAN HIMSELF: 
 
 tinizing everything you write after it is written, to assure your- 
 self that there is neither omission nor error, and sign your name 
 or initials to every prescription, but not until you have satisfied 
 yourself that it is as intended. Mistakes are seldom discovered 
 unless at the moment of their occurrence. 
 
 In consultation, the prescription agreed upon should be 
 written by the regular attendant, and, if the consultant is still 
 present, should be offered to him for inspection ; but only the 
 regular attendant's name or initials should be signed to it. 
 
 A very, very useful rule in many cases is to specify the 
 hours at which medicine is to be taken ; thus, if it is to be 
 taken every five hours, instead of writing " a teaspoonful every 
 five hours," write "Take a teaspoonful at seven, twelve, five, and 
 ten o'clock daily," taking care that the specified hours do not 
 interfere with those for nutriment, and be especially careful to 
 give instructions as to whether the patient is to be awakened 
 at night, or from refreshing day-slumber, either for medicine or 
 food. 
 
 In giving directions in regard to doses, bear in mind that 
 spoons and drops vary greatly in size. Much trouble and un- 
 certainty can be avoided in cases where medicine will have to 
 be taken for any length of time by getting a graduated medi- 
 cine-glass, which is both convenient and precise. A minim is a 
 definite quantity, a drop is not ; therefore, in prescribing potent 
 fluids, you should order minims instead of drops. 
 
 Neither alarm your patients nor their friends, nor risk the 
 dangers of the chloral, opium, or other bad habit being ac- 
 quired, by allowing the sick to know that they are taking such 
 remedies. 
 
 If vou instruct a patient how to use the hypodermatic syringe 
 on himself, or to inhale chloroform or ether, or give him cocaine, 
 chloral, opium, alcoholic liquors, or other exhilarating and fas- 
 cinating agents without discrimination, or to use according to 
 his own judgment, if he have any predisposition toward them he 
 will probably acquire the habit ; and if he does, you will surely
 
 HIS REPUTATION AND SUCCESS. 207 
 
 and deservedly incur the blame. The slaves of such blighting 
 habits always cast the blame for their acquired passion, or their 
 withering enslavement, on the physicians who first ordered the 
 drug or stimulant for them, if they have the least ground for 
 doing so. 
 
 Hypodermatic medication not only has its place as a valu- 
 able remedial agent, but at times becomes really indispensable ; 
 it also has various drawbacks that should prevent its indiscrim- 
 inate use. Among the lesser evils connected with it is that 
 those who are soothed and temporarily comforted by it, or have 
 become habituated to it, are apt to harass and worry you for its 
 application at all hours, day and night ; and you will often find 
 it a real hardship, after doing your day's work, to be obliged to 
 go and administer a hypodermatic (night-cap) of morphia to the 
 Kev. Mr. Cantsleep at eight o'clock p.m., to Mrs. AUnerves at 
 nine, to Colonel Bigdrinks at ten, and to Miss Narywink at 
 eleven o'clock, and probably be called from bed again to insert 
 the sleep-giving needle for one or all of them before morning, 
 
 Much of such work is not only a hardship but a nuisance. 
 Far better is it for both the patient and yourself that anodynes 
 be administered by the mouth or rectum in such cases, than for 
 you to have all this extra trouble, and at the same time expose 
 him to what may prove, to him, a fatal charm, and, to you, a. 
 sorrowful lesson.
 
 CHAPTER VIII. 
 
 "Call not on Hercules for help ; his aid 
 Ne'er serves the man who will not serve himself. 
 Thine own arm must the conflict meet, 
 Thy purpose being the victory." 
 
 It does not require the eye of a Newton or the brain of a 
 Bacon to discover that self-reliance and self-possession are capi- 
 tally important elements of success. Nothing under the sun 
 will cause people to believe in and rely on you more readily and 
 permanently than to see you believe in and rely on yourself 
 Your own faith will promote faithfulness. Be not arrogant or 
 self-conceited, and exhibit neither rashness nor weakness, but 
 cultivate self-reliance and the power of thinking and acting in 
 the midst of excitement and distracting forces, and endeavor to 
 conceal all doubts, hesitations, uncertainties, self-distrust, and 
 apprehensions as completely as possible. 
 
 "The wise and brave conquer difficulties 
 By daring to attempt them." 
 
 Never turn your cases over to " specialists,''^ but keep them 
 under your own watchful supervision, unless they present features 
 which render it an actual duty to do so. If you distrust your 
 own capacities, shrink and shirk and timidly refer your cases 
 of eye disease to the oculists, your uterine cases to the gynaecol- 
 ogists, ear cases to aurists, surgical to surgeons, nervous affec- 
 tions to neurologists, throat complaints to laryngologists, mental 
 afflictions to alienists, skin diseases to dermatologists, crooked 
 legs and stubbed toes to orthopaedists, warts to a manicure, and 
 so on throuofhout the list of " olog^ies," vou will lessen vour 
 own field of activity, and instead of gaining as much experience 
 with one affection as another, and becoming many-sided and 
 armed at all points, — 
 
 "Dexterity comes by experience," — 
 
 you will soon lose all familiarity with the diseases that specialists 
 (208)
 
 HIS REPUTATION AND SUCCESS. 209 
 
 treat, they will be " out of my line," and you will dwindle and 
 degenerate into a mere distributor of cases, — 
 
 "One starts the hare, another bags it," — 
 
 a medical adviser instead of a medical attendant, — advancing 
 everybody's professional and pecuniary interest except your own, 
 aiding them to gain the admiration of the community, and to 
 make reputation and fees out of that which sinks your own 
 individuality, robs your own purse, and throws (little) you into 
 the shade. A good rule is this : Consult, in cases of irreducible 
 strangulated hernia, stone in the bladder, and in all other capital 
 operations, if you yourself are not, a good operator ; also, when- 
 ever a serious case, whether in head or body, hand or foot, 
 puzzles or defeats your judgment, or proves wholly unmanage- 
 able by usual treatment, or is so grave in prognosis as undoubt- 
 edly to require broader shoulders than yours to bear the 
 responsibility, either call in a specialist to aid in its manage- 
 ment, or, if need be, turn it over entirely to him. If you study 
 all the branches, and keep yourself abreast of the times, such 
 occasions will soon be very rare to you. Timidity, from a want 
 of confidence in one's own merits, and rashness are both bad traits 
 in a physician, but the former is the greater drawback, since 
 every physician's success must be within himself and must come 
 out of himself, and he must not only have knowledge in his 
 head, but he must have it at his fingers' ends and on his tongue's 
 end, and must not only know how to do a thing, but must also 
 believe that he is able to do it. 
 
 Whenever you transfer any one from your care to a special- 
 ist's, always do so either by a consultation, a letter, or a per- 
 sonal interview with him, so that he may learn directly from you 
 your diagnosis, prognosis, treatment, etc. You will thereby 
 give him the advantage of your knowledge of the case, and also 
 avoid the risk of any injury to your reputation from an appar- 
 ently radical difference of opinion between him and yourself; 
 it will also secure your graceful retirement from the case. At 
 the same time, be careful to make your patients fully understand
 
 210 THE PHYSICIAN HIMSELF: 
 
 that in turning their cases over to a surgeon or specialist you 
 have only turned them over for that special ajfection^ and do 
 not cease to be their physician in any future sickness. 
 
 Ask for a consultation in all important cases in which 
 singular difficulty, or obscurity, or knotty problems are pre- 
 sented, or where any doubt exists as to the diagnosis ; also, when 
 you are in doubt as to the propriety of a surgical operation, and 
 in all cases in which you think either the patient's interest, his 
 lack of improvement, the appearance of fresh or puzzling symp- 
 toms, or a division or sharing of the responsibility demands 
 it ; for then, another eye, or a different mind, or an older or 
 more experienced hand, may be of great service. When from 
 any cause you see that confidence in you is wavering, or that 
 necessity for a consultation is arising, endeavor to anticipate the 
 family by being the first to propose it. 
 
 Do not conclude that a request for a considtation always 
 implies a mistrust of your knowledge and skill, for it is oftener 
 due to the natural anxiety of the patient's family and friends. 
 We often perceive the limits of our own resources, and, sympa* 
 thizing with the patient's friends as to the result of the ill- 
 ness, are most willing and anxious for a consultation. On the 
 other hand, when they wish a consultation, they should respect 
 your feelings and susceptibilities, and make known their wish to 
 you, instead of taking you by surprise by springing a consultant 
 upon you without notice ; they should, indeed, never send for a 
 consulting physician without your express consent, yet, when it 
 is done through their ignorance of ethics, the discourtesy had 
 better be condoned and the consultation held, for were you to 
 decline to join a consultation under such circumstances you 
 would incur a grave responsibility. 
 
 Consultations lessen personal responsibility and, in some 
 degree, anxiety. Besides, they are highly profitable to the pro- 
 fession in more ways than one, and conducive to the advantages 
 of the sick. When you chance to have bad surgical and other 
 cases, or an operation in which life will be risked, or difficult
 
 HIS REPUTATION AND SUCCESS. 211 
 
 or complicated cases of midwifery, or great or anomalous cases 
 of any kind among your personal friends or relatives, or so 
 near home as to involve you personally or socially ; or in a 
 neighborhood in which a group of patients is likely to be un- 
 favorably impressed if the result be unfortunate, it is especially 
 necessary and judicious to call in a consulting physician or sur- 
 geon to lighten your burden, even though you have him to come 
 for but a single visit, — to satisfy, if for no other reason, the 
 persons concerned. 
 
 If possible, always select high-minded, honorable physicians 
 as consultants, who will second your efforts by their skillful 
 knowledge, and at the same time be likely to harmonize with 
 you in the management of your cases ; for their kindly sym- 
 pathy and co-operation may be highly necessary to the welfare 
 of the patient and to your own reputation ; but, when a con- 
 sultation is held merely to satisfy a patient or his friends, it 
 is then better to throw the selection on them, and to accept 
 whoever is offered to you, if he be a regular physician and a 
 gentleman. 
 
 When you happen to be the one consulted, do not enter 
 the sick-chamber, or examine the patient before your conferree's 
 arrival, or ask him questions, except in the presence of your 
 conferree, and have all communications in his presence. 
 
 Be punctual to the minute in keeping consultation engage- 
 ments. You have no right to waste another's time in such 
 cases, or to impose upon him the necessity of awaiting idly for 
 you at the place of meeting. 
 
 Under ordinary circumstances it rests with the consulting 
 physician and not with the regular attendant to name the hour 
 of meeting. 
 
 In your earlier consultations you Avill often feel no little 
 anxiety and suspense while waiting to see whether the consult- 
 ant will act fairly toward you and strive to hide your demerits, 
 or whether he will, by nod or wdnk, hint, question or innuendo, 
 expose your deficiencies to a few, to be told to many, until you
 
 212 THE PHYSICIAN HIMSELF: 
 
 are reduced to a mere cipher in the estimation of those to whom 
 the case is related. To the honor of our profession be it said, 
 that the vast majority of its older members are not only punc- 
 tilious, but really kind on these occasions, as if still remembering 
 the anxieties and responsibilities of their own early professional 
 lives. 
 
 A radical change of diagnosis and of treatment, or a re- 
 verse and opposite course in any respect, as the result of a first 
 consultation, often and very naturally impresses the laity with 
 the idea that the previous diagnosis or treatment has been either 
 faulty or actually wrong, and, therefore, unless some real neces- 
 sity demands it, no material change should be proposed or allowed 
 at that time. As a rule, the fewer the apparent changes result- 
 ing from a first consultation the better for the family attendant, 
 and especially if he be a young physician with insecure repu- 
 tation. 
 
 No physician who has the least regard for honor or principle 
 will persist in an error of which he is aware. If you are ever 
 brought into contact with a colleague who, through what appears 
 to be lack of wisdom, or from self-conceit or sinister motives, 
 persists in differing from an opinion or course that you are sure 
 is correct, or insists on doing what you believe to be maltreat- 
 ment, or shows culpable neglect, and you fear he may injure 
 you thereby, either withdraw, or insist on calling some eminent 
 member of the profession into the conference, that he may de- 
 cide between you. After that is done, if you think your inter- 
 ests require it, you can retire from the case without discredit. 
 
 When a consulting physician or a surgeon is designated 
 and called at your request, you should see that the payment of 
 his fee is not neglected, and you might with propriety broach 
 the subject to those who are to pay the bill, before he quits. 
 This can be done by privately informing them that his charges 
 will probably be somewhat less if paid at his last visit than if 
 they wait for him to send a bill, which might then be for the 
 maximum amount.
 
 HIS REPUTATION AND SUCCESS. 213 
 
 To prevent misunderstanding, it is, in many cases, wise to 
 say a word or two about consultant's fees to the patient or his 
 friends at the time the subject of having a consultation is first 
 mentioned. 
 
 You can, in such a case, speak much more plainly on 
 behalf of your brother physician called at your instance than 
 you could for yourself His relations to the case presuppose 
 him to have nothing in view but the welfare of the patient, and 
 to be thinking only of the scientific and therapeutical aspects of 
 the case, and not of his expected fees. Prompt settlement of 
 the consultant's fees will sometimes conduce, moreover, to a more 
 prompt payment of your own. 
 
 Never make yourself responsible for the payment of another's 
 fee. Aid him in a proper degree to get it, but do nothing more. 
 
 It is, for several reasons, better for the consultant to send 
 his bill before the regular attendant sends his ; when the latter 
 sends his first, it looks as if he is more anxious for the safety of 
 his fees, hence is in a greater hurry than the stranger is. 
 
 Unless the consultant gets his fee cash after the consulta- 
 tion, or you are aware that special arrangements exist for its 
 payment, be careful to inform the people, as soon as his attend- 
 ance ceases, or at any rate before the time arrives for sen'ding 
 them your bill, whether he will render his bill separately or not. 
 If you neglect to explain this to them, they will almost surely 
 think you ought to pay him out of your charges, and a mis- 
 understanding will result as to whether you or they should pay 
 his bill. 
 
 Whenever, to please the patient or his friends, you are 
 forced to set aside other duties in order to meet another phy- 
 sician in consultation, it is right that you should charge twice as 
 much for such service as for an ordinary visit, or perhaps even 
 as much as the consultant does, inasmuch as consultative meet- 
 ings not only involve extra time, but the carrying out of the 
 details will devolve upon you and entail additional trouble, and 
 consequently you are entitled to extra compensation.
 
 214 THE PHYSICIAN HIMSELF I 
 
 111 dispensing with the services of tlie consultant when no 
 longer necessary, take care to secure his acquiescence, and make 
 him see that it is done with a feeling of amity and good will. 
 
 In consultations it is proper for the regular attendant to 
 precede the consultant in entering the patient's room, and to 
 follow in leaving it. 
 
 Friends of your stubborn-case patients, who have special con- 
 fidence in their own physicians, will often persuade, and sometimes 
 convince, them that you do not fully understand their affection, 
 and strenuously advise them to call in their flivorite. In such 
 cases remember that you have no right to object to a patient's hav- 
 ing the advice of any one whom he particularly desires in addition 
 to your own whenever he insists upon it; but also, tliat you have 
 a like undoubted right to refuse to consult witli an irregular or 
 any one who is antagonistic to the profession, or whose conduct 
 you deem unprofessional, or who is unfitted for the case ; also, 
 any one who is highly objectionable to you for any other reason, 
 or in whose keeping you deem your reputation and interests 
 unsafe. If you are attending a case, and such an one is pressed 
 upon you, you have a perfect right to retire, and should at once 
 offer to withdraw, and thus afford your patient the liberty of 
 choice between you and your rival. Fortunately, such dilemmas 
 are very rare. 
 
 Do not refuse to consult with foreign physicians, doctresses, 
 colored physicians, or any other regular practitioners ; for you, 
 as a physician, hold a quasi-official position in the community, 
 and, in the discharge of your duties, should know nothing of 
 national enmities, race prejudices, political strife, or sectarian 
 differences. Rescue ! is our battle-cry, and you, as a physician, 
 belong to the world of mankind, and have no moral right to 
 turn your back on sick and suffering humanity, by refusing to 
 add your knowledge and skill, on a plane of real and brotherly 
 equality, to that of any honorable, liberal-minded person who 
 practices medicine, if his professional acquirements and ethical 
 tenets give him a claim to work in the professional field. It is
 
 HIS REPUTATION AND SUCCESS. 215 
 
 not only unmanly to make a class distinction and throw obstacles 
 in the path of the less favored, but such a spirit is wholly incom- 
 patible with the objects of our profession (which is a liberal one), 
 and at direct variance with the spirit of science (which is cosmo- 
 politan), and in its efforts to diminish suffering and baffle death 
 recognizes neither caste, pride, nor prejudice, and knows no 
 limits except those of truth and duty. 
 
 But while you bid "All Hail!" and give the right hand 
 of fellowship to every honorable, unrestricted physician, and 
 become the friend and brother of all the friends of rational 
 medicine, no matter what their misfortunes or how great their 
 deficiencies ; you must, on the other hand, remember that medi- 
 cine is a liberal profession and not a mere trade, and refuse to 
 extend the hand of brotherhood to any one belonging to a party 
 or association whose exclusive system^ narrow creed, or avowed 
 or notorious hostility to our profession, prevents him from ac- 
 cepting every known fact and employing all useful remedies, 
 whether dug from the earth, taken from the air, or wrested 
 from the sea, — to any one and every one who cannot honestly 
 say his mind is wide open for the reception of all medical 
 truths, and that his hand shall not refuse to use anything and 
 everything under the blue vault of heaven that may be needed 
 to relieve suffering and save the life of a human being; as that 
 constitutes a voluntary disconnection from the profession. 
 When called in to a case in which the medical attendant 
 cannot do this, you cannot agree with him, and must let his 
 retirement be one of the conditions on which you will assume 
 charge. 
 
 You may, however, be called to a case of pressing emergency, 
 such as an alarming haemorrhage, poisoning, drowning, choking, 
 convulsions, or difficult labor, and find on your arrival that an 
 irregular practitioner or quack is in attendance, with whom you 
 are thus brought face to face. In such urgent cases the path 
 of duty is plain, for, owing to the great danger to life, the 
 higher law of humanity will require you temporarily to set aside
 
 216 THE PHYSICIAN HIMSELF: 
 
 ethics and etiquette, and to unite your efforts — head, heart, and 
 hand — with those of your chance associate. Treat liim with 
 courtesy, but studiously avoid formal consultations, or private 
 professional dealings, or whispering conversation with him, or 
 any other act that might imply association in consultation. 
 
 Thus, you see, there is not only no antagonism between 
 medical ethics and humanity, but that they overlook all ques- 
 tions of etiquette, and allow and cover any and every act hon- 
 estly performed for the benefit of humanity. 
 
 Fortunately, the indications for rational treatment are 
 generally so very clear in such cases that no one can ignore 
 them. If the Irregular has assumed charge before your arrival, 
 and is pursuing proper treatment, or assents to the proper treat- 
 ment suggested by you, that is all you can ask ; for instance, if 
 the patient has received a terrible burn, and linseed-oil and lime- 
 water or a strong solution of soda are being applied, or other 
 rational treatment, indorse it, and advise its continuation ; but 
 if your accidental colleague is a hydropath, and wrongly insists 
 on a wet-pack because he is morbid on the use of water, or 
 one who obstinately advocates a lotion of cantharides because 
 they burn and blister people in health, it is your duty to your 
 patient, and to yourself also, unyieldingly to insist that a 
 rational course shall be pursued if you are to take part in the 
 case. Be cautious and firm in dealing with such contingencies, 
 and it is a duty which you owe both to yourself and to your 
 profession that you terminate the accidental and unnatural con- 
 nection — in a gentlemanly way, of course — as soon as the 
 pressing urgency will admit. 
 
 Some unreasoning people may think you are illiberal in 
 refusing to fraternize and consult with Irregular practitioners, 
 regardless of the fact that they have voluntarily divorced them- 
 selves from the profession and boastingly assumed a name 
 intended to notify the public that their system differs from 
 ours; and, moreover, that they are hostile to it and to us. Bear 
 in mind that our refusal does not arise from a false sense of
 
 HIS REPUTATION AND SUCCESS. 217 
 
 dignity or from prejudice, but that the great principle which 
 underlies it is this : as lovers of all medical truths^ we have no 
 fixed, no unchangeable creed, but hail with delight every 
 etiological and therapeutical discovery, no matter by whom 
 made, and take by the hand and recognize as a brother any 
 one who is liberal enough to consecrate his life's labor to the 
 relief of the sick ; but when we know that a certain person, 
 even if he has an armful of diplomas, circumscribes himself to 
 half a truth and practices a botanical system only, or, like a 
 pigeon with but one wing, a vitopathic system only, or a hydro- 
 pathic system only, or an omniopathic system only, or an elec- 
 tropathic system only, or any other one-idea system only, and is 
 so tied down and limited to that, by his love, bigotry, or preju- 
 dice that he denies the usefulness of all other known and legiti- 
 mate means of aiding the sick, and endeavors to poison the public 
 mind against all other therapeutics but his own, — all rational 
 physicians esteem such an one as too illiberal to be a true phy- 
 sician, and justly exclude him as unworthy of fellowship with 
 those who profess to love all truth, and, whilst he remains im- 
 prisoned within his own ball-and-chain system, themselves 
 endeavor to steadily pursue, with perhaps less zeal, but with 
 more sense, the path of true science and progress. 
 
 If, on the other hand, he uses the remedies that rational 
 medicine supplies, yet adopts the cloak of an " ism " simply as 
 an advertising dodge, — 
 
 "Blow, blow, bugle blow," — 
 
 to make the public believe that he practices in some manner 
 diametrically opposite to our system, and thereby assists our 
 opponents to lessen public esteem for legitimate medicine and 
 to create aversion to us as its followers, he is guilty of fraud, 
 and you should, therefore, even on the ground of morality, refuse 
 to countenance him. 
 
 When people ask you " what system of medicine you 
 practice," you may very properly reply that you are simply a 
 DOCTOR of MEDICINE, a PHYSICIAN, a member of the regular un-
 
 218 THE PHYSICIAN HIMSELF: 
 
 restricted medical profession, that you have no fixed orthodoxy, 
 helong to no sect, and are hmited to no " ism," " pathy," or 
 " ology ; " that you stand on a broad, unsectarian platform, 
 and are at Hberty to think whatever you may, only seeking to 
 do your best for every sick sufferer who trusts to your skill and 
 honor ; that you accordingly try to be rational, and, hke the 
 bee, take the honey of truth wherever you find it ; that as 
 rational, hberal physicians, the regular medical profession, to 
 which you belong, has no branches, no sects, no dogmas, and 
 bears no man's name, for it is simply the work of the human 
 race, and is held together solely by the common bond of rational 
 medicine ; that it maintains perfect freedom of opinion and 
 practice, selects any remedy it pleases, in whatever dose it pleases, 
 and under whatever theory it pleases, and, unlike the various 
 " limited schools," has no articles of faith which it imposes on 
 any one, but accepts all truths, whether winnowed from the 
 store-house of centuries, or discovered, either scientifically or 
 empirically, in our own day; and that you, as one of its rep- 
 resentatives, stand ready to embrace and utilize any and every 
 valuable discovery, no matter when or by whom made. 
 
 " I shall this good lesson keep, 
 As ■watchman to my heart." 
 
 This freedom and latitude explains why unrestricted 
 
 MEDICINE IS ONE OF THE THREE LIBERAL PROFESSIONS, and wliy 
 
 the humane and benevolent physician of the body takes rank 
 with the learned expounder of the law and with the worthy man 
 who inculcates religion, all three uniting to protect the interests 
 of soul, body, and estate. Bear proudly in mind, however, that 
 our useful and excellent science is the only one which regards 
 the entire man, physical, intellectual, and moral ; for the lawyer 
 looks on a man as a being possessing certain rights, and subject 
 to certain duties to his neighbors, whilst the divine looks on 
 man simply as a moral, responsible being, who has, or should 
 have, a conscience, to which he directs his ministrations. 
 
 To this triad of professions was long ago applied the term
 
 HIS REPUTATION AND SUCCESS. 219 
 
 *' LIBERAL," because for their pursuits, preventing and curing sin, 
 preventing and curing disease, and preventing and curing legal 
 wrong, each of the trio requires the utmost perfection of char- 
 acter, and because the high-souled sons of law, religion, and 
 medicine have in all ages pursued their avocations as freemen, 
 with hands unfettered and tongue untied, subject to no bonds 
 except those of truth ; and yet, as if to blur the grandeur of the 
 picture, law has its shysters, religion its hypocrites, and medicine 
 its quacks. If at any time during your career any sect, schism, 
 or one-sided school arise, no matter how great or how humble its 
 pretensions, if it have even one grain of life-saving or health-guid- 
 ing wheat to its bushel of chaff, it is your duty to seize the grain 
 of wheat, plant it in the domain of rational medicine, and to 
 cast the chaff, brambles, and thistles to the winds. This deter- 
 mination to enlarge our field of knowledge from all possible 
 source is our life-blood, our invincible strength, and our dis- 
 tinction, the saving element that will cause regular, liberal, 
 rational medicine to exist as long as there are sickness and suf- 
 fering in the world, and the great feature that distinguishes gen- 
 uine medicine from all "new schools," "isms," and "pathies." 
 Remember that we have no secrets, no patents, no monopo- 
 lies ; and that our books, our colleges, our laboratories, our 
 lecture-rooms, our medicines, and the door of the profession 
 itself, are open not only to the newly graduated and the regu- 
 larly initiated, but to every one who has the necessary edu- 
 cational and moral qualifications, even though he may have 
 been an outsider, allied, whether from ignorance or choice, with 
 schools which are antagonistic to the profession ; in the latter 
 case it is only necessary for the applicant to drop his distinguish- 
 ing creed or system, abandon the hostility to the profession 
 which it implies, and to allow ethical rules to govern his con- 
 duct; therefore, no conversion, no standard of orthodoxy, no sur- 
 render of private opinion or of favorite theories, or hypotheses, 
 or of unlimited freedom to practice as he chooses, is at all neces- 
 sary, and each and all such should be individually invited to
 
 220 THE PHYSICIAN HIMSELF: 
 
 cease to foster irrational, absurd, and credulous doctrines, and 
 embrace true, rational, scientific medicine. 
 
 Be religiously exact in everything that relates to consulta- 
 tions. Let them always be conducted in proper form, and strictly 
 private ; before entering the patient's room give the consultant 
 a brief sketch of the history and treatment of the case, then 
 invite him in to a chair at the bedside ; after making the neces- 
 sary examination and inquiries, retire and consult, within a 
 room that is private and exempt from intrusion, if possible ; ex- 
 change thoughts in an undertone, and out of the sight and the 
 hearing of eavesdroppers, and, if possible, never let your con- 
 versation be overheard, — 
 
 "The very shadows seem to listen," — 
 
 and never allow any one to be present except the physicians 
 engaged in it. When the consultation ends, the attending 
 physician should, of course, re-enter the sick-chamber and give 
 all the directions, etc., determined upon in the consultation. 
 
 Bear in mind, also, that consultations are called for the 
 purpose of deciding for t\\e future, not to criticise the past; how- 
 ever, if you are called in to a case, and find that the attending 
 physician is suffering unmerited odium for his previous treat- 
 ment, every principle of honor should impel you to volunteer to 
 defend him. Beyond this, never pass any opinion on the plan 
 of treatment in hearing of the patient or friends, unless it be 
 an approbatory one, and where the circumstances truthfully 
 admit of it. 
 
 Let all that follows a consultation show that you act in 
 concert and that it is the result of joint action, and never express 
 an individual opinion of a case seen in consultation, except in 
 strict accordance with the ethical code. If you do, those whom 
 you address may, either unintentionally or purposely, misinter- 
 pret what you say, or otherwise discreditably involve you. 
 
 Remember, moreover, that if you are sufficiently agreed to 
 continue in joint attendance, you are in duty bound to act in 
 concert, uphold each other, and refrain from telling whose
 
 HIS REPUTATION AND SUCCESS. 221 
 
 opinion prevailed, or by whom the course pursued was suggested, 
 and from all other hints and insinuations likely to diminish 
 confidence in your fellow-attendant. 
 
 ' If for any reason a professional friend ever request you to 
 see a case with him, not so much for the patient's welfare as on 
 his own behalf, ^^e., to confirm a correct diagnosis, and thus 
 protect him against undeserved censure, or to divide unusual 
 responsibility toward a poor or worthless, but exacting patient, 
 or to advise what course to pursue under any other very trying 
 circumstances, you should lend him a ready and willing hand, 
 and that, too, without expectation of a fee. 
 
 "Hast thou no friend to set thy mind aright? " 
 
 It would be sad, indeed, were any honorable physician to fail to 
 find at least one medical friend to consult without fee in such 
 a dilemma. 
 
 Be prompt to the minute in answering all professional cor- 
 respondence. 
 
 If you are ever requested by letter, or by a messenger, to 
 prescribe for an out-of-town patient who is not under the care 
 of any other physician, it is perfectly professional to do so, if you 
 wish, even though you may never have seen the case ; but, 
 unless the case is a clear one, it might not be judicious. 
 
 Revere the past, have confidence in the present, and hope 
 for the future of our glorious profession, and strictly avoid dis- 
 paraging the individual members of the profession, or the pro- 
 fession itself, or telling people jokingly of the mistakes and 
 discreditable dilemmas of yourself or others ; and also avoid 
 decrying and ridiculing medicine to the laity, and boasting of 
 your own and the general ignorance of disease and remedies, and 
 your distrust of your own capacities, or of the number of people 
 killed, maimed, mutilated, or destroyed in health, and suppress 
 all other fulsome confessions. 
 
 "Evil is wrought by want of thought, 
 As well as want of heart." 
 
 When a physician makes such unguarded and sweeping
 
 222 THE PHYSICIAN HIMSELF: 
 
 remarks, he means them relatively only ; he means to say that he 
 is aware and willing to confess that medicine has its natural 
 limits, and is not an exact science, and that the application of 
 therapeutics is but an art. The public, however, cannot appre- 
 ciate the sense in which such imprudent confessions are made, 
 and they are taken up by Doubting Thomases and Lying Pauls- 
 as quickly as a sponge takes up water, and work no little harm 
 to pliysicians who make them and to the profession at large ; 
 because, all who hear or read them conclude, with Tom Hood, 
 that " it takes a great many M.D.s to be worth a d — n," and 
 that our prescriptions are only a series of guess-work, and that 
 medical practice is only a shapeless mass of uncertainties, con- 
 tradictions, and inconsistencies, as irregular and lawless as that 
 of the winds; whose votaries ask whether we are certain of any- 
 thing, or certain that we are certain of nothing ; and ever after 
 crack jokes at our expense, — 
 
 "God cures and the doctors charge," — 
 
 and either do not employ physicians at all, or do so with feel- 
 ings of disrespect and distrust. 
 
 You know there is no such thing practically as a perfectly 
 straight line, plane surface, regular curve, exact sphere, or uni- 
 form solid ; yet you never hear the engineer or the surveyor 
 boasting of it from the housetop, or in reckless language, as if 
 to belittle his own profession. Look at the other learned pro- 
 fessions: law is still very imperfect and full of uncertainties, and 
 it has its reproaching pettifoggers just as we have our quacks. 
 Its books teem with conflicting opinions, and the best decisions, 
 of to-day are liable to be overthrown by others of to-morrow. 
 Religion, too, has its opposing creeds, its rival spires, and its 
 innumerable sects, and its ignorant and often unprincipled 
 expounders, — sad proofs that Medicine is not alone imperfect. 
 
 "All things are big with jest ; nothing that's plain 
 But may be perverted if thou hast the vein." 
 
 The truth is, physicians personally are far more imperfect 
 than physic. For instance, there are undoubtedly medicines
 
 HIS REPUTATION AND SUCCESS. 223 
 
 the action of which is diuretic ; but diuretics may be given 
 when not indicated, or the diuretic given may not be the 
 proper one, or it may be given in improper doses or at wrong in- 
 tervals, or it may not be continued long enougli, "or too long, or 
 without proper restrictions. Now, none of these errors are 
 justly chargeable to the class of medicines which we call 
 diuretics^ nor to the art of medicine, but are plainly due either 
 to the physician's bad judgment or to his ignorance. 
 
 "A hand-saw is a useful thing, but not to shave with." 
 
 The fact is, all studious physicians are more or less conversant 
 with the same remedies, but skill in effecting a cure with them 
 consists in applying one's knowledge correctly, in thinking of and 
 selecting the proper ones, skill in proportioning the dose, and 
 genius in judging correctly the time and necessity for their use, 
 etc. Just as different persons essaying to paint will exhibit dif- 
 ferent degrees of success: one possessed of natural aptitude or 
 special gift will obtain wonderful skill, another less apt will reach 
 mediocrity, while a third will fail entirely in his attempts and quit 
 in disgust, — this difference in result being due not to a differ- 
 ence in the material or colors at the command of each, but to 
 the more or less perfect judgment and skill shown by each in 
 selecting and using them. There must be a reason for giving 
 medicines and also for withholding them, and there must be 
 medication in sufficient doses when there is an indication for it. 
 
 The ability to determine accurately the condition of a pa- 
 tient, and to conceive and do the right thing for him at the 
 right time, is the essence of skill, constitutes the chief difference 
 between successful and unsuccessful physicians, and explains 
 the reason why the prescriptions of some physicians are much 
 more valuable than those of others. One may know a vast deal 
 about the profession and yet be a very poor practitioner. 
 
 A judicious use of medicines, and not a wholesale renun- 
 ciation of them, is a leading characteristic of a good physician. 
 When you hear of a physician who wishes to be regarded as
 
 224 THE PHYSICIAN HIMSELF: 
 
 especially clear, or ahead of others, or exceptionably.fair in his 
 opinions, boasting that he is skeptical, " does not believe in 
 drugs," " depends on kitchen physic," "on nature," etc., you 
 can safely conclude that he has a very weak spot somewhere ; 
 either that 
 
 "He has mistook his calling," 
 
 or in his zeal to become a medical philosopher, or to coquette with 
 somebody else's opinion, he has lapsed in his materia medica, or 
 overstates his credulity, or that his usefulness has run to seed. 
 
 Does the mariner lose his faith in navigation because ships 
 are tossed by the winds and waves and too often wrecked by 
 uncontrollable storms'? Or does the farmer deny the fertility 
 of the soil because his neighbor has neglected the proper season 
 for planting and the right mode of cultivation ■? Or does he 
 lose his faitli in agriculture because droughts and insects, and 
 irregularities of sun, rain, and frosts, sometimes ruin his crops ? 
 Would any worthy sailor fold his arms and do nothing while 
 the storm raged, or any thoughtful farmer neglect to plant again 
 when the season returned, because the sailor's brightest hopes 
 are sometimes crushed and the farmer's fairest prospects are often 
 blighted] Or is medicine to be abandoned because in some 
 cases it is unable to do all that is expected of it ? 
 
 "Medicine is God's Second Cause of Health." 
 
 Is there a physician on earth who would let intermittent 
 and remittent fevers take their course without drugs, or who 
 would let the syphilitic and other poisons develop or progress 
 unchecked 1 Is there one who, in the face of the positive facts 
 offered by anatomy, and physiology, and pathology, and chemis- 
 try, and hygiene, and materia medica, will confess that he can do 
 nothing for pain, or for fever, for nervous complaints, for digest- 
 ive ailments or chest diseases ; nothing for diseases of the circu- 
 latory system, delirium, insomnia, headache, epilepsy, hysteria, 
 gout, neuralgia, worms, colic, acidity, peritonitis, child-bed fever, 
 constipation, convulsions, diarrhoea, anaemia, scurvy, cholera 
 morbus, poisoning, casualties, etc. ?
 
 HIS REPUTATION AND SUCCESS. 225 
 
 The end and aim of medical practice being to relieve, to 
 cure, and to prevent death, if there is a physician in the land 
 who has never seen medicines restore health or prolong life, and 
 does not sincerely believe in his power to benefit by drugs some 
 of the twenty-four hundred diseases and modes of decay to 
 which mankind is subject, he is an icy infidel in medicine, and 
 should at once and forever, for conscience's sake and for the sake 
 of the afflicted, take down his sign, burn his diploma, drop his 
 title, and no longer pretend to practice. What think you of a 
 man preaching religion and living by the pulpit who does not 
 believe in the usefulness of religion I 
 
 " Seem a saint and play the devil." 
 
 The tolerance of disease has greatly increased in the last 
 few decades, and is still increasing, and medical theories and 
 practice are undergoing great changes. The advance of scien- 
 tific observation is constantly teaching us to distinguish more 
 clearly between the numerous self-limited cases daily met with 
 and the few that threaten a fatal issue, and of course we of 
 to-day use much simpler remedies for the former class than did 
 our predecessors ; but it is doubtful whether in serious illness 
 we have lessened the doses half as much as some imagine. We 
 now give twelve or fifteen grains of quinia daily for an inter- 
 mittent fever, where physicians formerly gave half an ounce or 
 an ounce of crude bark containing but six or twelve grains. 
 We give to-day the same dose of opium, or its representative, 
 morphia, when that drug is indicated, as they gave a hundred 
 years ago ; the same quantity of castor-oil at a dose, and so 
 througliout the whole materia medica. The great difference is, 
 that we do not now prescribe vaguely or rashly, and when cases 
 are trifling, or obscure, or undeveloped, our treatment is tenta- 
 tive instead of heroic. 
 
 We of to-day know better than our predecessors the natu- 
 ral history of disease, and are aware of the almost infinite 
 resources of nature, and that three in every ten of those who
 
 226 THE PHYSICIAN HIMSELF! 
 
 send for physicians need no positive medication ; that recovery 
 from disease is everywhere the rule and death the exception ; 
 and that nine of the ten vs^ould get well, sooner or later, by 
 proper hygiene, air, exercise, dieting, and intelligent nursing if 
 there were not a drug or a physician in the world, and conse- 
 quently we are naturally prescribing less and less medicine. In 
 acute affections, and especially the cyclical diseases of children, 
 we now, in many cases, mainly trust to nature, and see them 
 get well spontaneously from seemingly hopeless conditions almost 
 as if by magic, and these cases constitute a majority of those 
 that seem to be restored to rosy health by a thousand and one 
 therapeutical illusions and quack medicines now in vogue. 
 
 The deduction to be drawn from these facts is, that the 
 prudent physician may show as much — nay, more — skill in 
 withholding drugs, and especially those of an active, perturbing 
 character, when not needed, as in giving them when they are.
 
 CHAPTER IX. 
 
 "Pledged to no party's arbitrary sway, 
 Follow Truth, where'er she leads the way." 
 
 Bear in mind that nothing under heaven prevents you from 
 giving whatever you believe to be best for your patient, whether 
 its therapeutic action be similar, antagonistic, or anything else 
 in the circle; but if, in so doing, you adopt a narrow or foolisli 
 dogma, or an exclusive system, and prejudice your mind against 
 all other ascertained truths, your one-sided partisanship will 
 fetter you, abridge your usefulness, and make you unfit for 
 fellowship in liberal medicine. Thus, when Vincent Priessnitz, 
 with his wet sheets and water-tub, in trying to build a house of 
 a single brick, shut his eyes to everything but hydropathy; and 
 one-sided John Brown founded Brunonianism on incitability ; 
 and Broussais went wild on Inflammation, Gastro-enteritis, the 
 lancet, and leeches; and Rasori overdosed with his system of 
 " Contraria Contraries," and rabidly denounced everything else ; 
 and Samuel Thompson, in his exclusivism, threw away every- 
 thing but herbs, they each ignored a host of important facts 
 for jumbles of vain, useless, and fanciful speculations, and there- 
 by lessened their own usefulness and that of all who follow 
 them, 
 
 "Foi* iievef yet liath one attained 
 To such perfection, but that time, and place, 
 And use have brought addition to his knowledge ; 
 ^ Or made correction, or admonished him 
 
 That he was ignorant of much which he 
 Had thought he knew, or led him to reject 
 What he had once esteemed of highest price." 
 
 Thus it is with agriculture, and navigation, and every other 
 human occupation, but medical science, above all others, has 
 no goal, — its greatest law is progress. 
 
 Medicine is neither a perfect nor a stationary science ; not 
 a single department of medicine has yet reached scientific exact- 
 
 (227)
 
 228 THE PHYSICIAN HIMSELF I 
 
 ness, and possibly never will. We, as rational, unrestricted phy- 
 sicians, absolutely free to think and free to act, are striving hard 
 to bring its various branches as near to perfection as possible, 
 and are willing to learn medical truth and scientific wisdom 
 wherever they can be found, and there is to-day nothing of any 
 value in any exclusive system that is not taught by the teachers 
 of the regular profession. 
 
 " And thus we are the true Eclectics." 
 
 When " New Schools," schisms, or creeds arise, if they 
 possess any new or valuable truths, or remedies of ascertained 
 merit, no matter how great or how small, whether taken from 
 the animal, vegetable, or mineral kingdom ; from sponge, weed, 
 insect, or mineral ; product of wilderness, ocean, or prairie, we 
 instantly single them out and incorporate them with the great 
 mass, to swell the records of rational medicine, and press on- 
 ward; so that the medicine of to-day may be said to be a living, 
 moving, growing array, founded on all its yesterdays. 
 
 Irregulars of every kind feel that, to exist, they must be at 
 war with the regular profession, and derisively style us " The 
 Old School," " Allopaths," etc., to make it appear to their par- 
 tisans that a creed is necessary, and that every physician must 
 bear the trade-mark of some restricted school or petty sect, with 
 wide-apart principles; and that we are merely one of these 
 restricted sects, with hoary dogmas, and an old-fashioned and 
 dilapidated, moss-grown, ivy-covered creed, twenty-four centuries 
 old. That, 
 
 "Slaves to rnsty rules," 
 
 we have by-gone habits, ancient ways of thinking, and set rules 
 and doctrines, which, though good enough in olden days, are 
 now altogether inadequate and behind the times, and in their 
 declension. Their aim in doing this is, of course, to draw un- 
 restricted physicians on to ililse ground before the public, and 
 to obtain for their own ism or patliy the honorable distinction and 
 the business advantage of appearing to stand co-equal with us ; 
 just as in religion one sect (Pharisees versus Sadducees, or
 
 HIS REPUTATION AND SUCCESS. 229 
 
 Catholics versus Protestants) stands with reference to another, 
 and in politics Republicans stand with Democrats. 
 
 Faugh on such nonsense ! Who are the heroes of modern 
 medical science % What men are to-day, as ever, bearing for- 
 ward the flag of medical discovery, and making the star of truth 
 shine over the hill-tops of medical discovery as clear as the noon- 
 day sun % Regular, unrestricted physicians ! Who are the great 
 authorities, and who hold the most advanced views on anatomy, 
 physiology, pathology, gynaecology, ophthalmology, insanity, 
 bacteriology, etc. % None other than regular physicians ! Where 
 stand quacks and irregulars of every kind in the upward track 
 of scientific medical progress "? What have they done for 
 science'? o o o nothing! 
 
 Remember, that it is not on account of their therapeutics 
 at all that we object to exclusive systems and refuse to fraternize 
 with their followers, but because they deny the usefulness of 
 remedies taken from any source but theirs ; assume dogmas and 
 systems that are limited, and decry and denounce all else. 
 
 Were you to announce yourself as an anti-botanic, anti- 
 omnipathist, anti-allopathist, anti-eclectic, anti-electropath, anti- 
 hydropath, anti-vitopath, or anti-any thing else calculated to pro- 
 duce division, antagonism, or strife in the ranks, it would be 
 unprofessional, and equally as inconsistent with the spirit of 
 scientific medicine as the systems you were opposing, and would 
 abridge your usefulness and render you unworthy of professional 
 fellowship, just as it does others who follow opposing creeds. 
 
 Although it is wrong to spend much time and labor in ac- 
 quiring knowledge of anything that is useless when known, yet 
 it is well to look into the principles of mesmerism, hydropathy, 
 galvano-therapeutics, hypnotism, spiritualism, etc., to enable you 
 to speak of them from personal knowledge, and to checkmate 
 their representatives, who, in their arguments to the laity, make 
 great capital out of hnoioing all about the " old-school s/jstem,'"' 
 which they, of course, aver does not compare with whatever 
 " new school " they practice.
 
 230 THE PUYSICIAN HIMSELF: 
 
 To limit one's practice to any certain segment of the medi- 
 cal circle is, of course, quite different from limiting one's creed. 
 You have an indisputable right to confine yourself to any 
 specialty or department of medicine you please, but as it is a 
 self-imposed limitation of your sphere you should take care in 
 your signs and cards simply to add to your general title the 
 words "Practice limited" to the eye, or to the throat, or to skin 
 diseases, or to whatever else your specialty may be. Such an 
 announcement is honest and professional, and claims nothing- 
 more in the way of skill than your M.D. presumes. A sign or 
 card with the words "Practice limited to," etc., is perfectly pro- 
 fessional; one that reads "Special attention given to," etc., is 
 not. 
 
 Bear in mind that we condemn no system or discovery, 
 io-norantly, on the principle which governs the Indian, who dis- 
 believes in the locomotive and telegraph, or on that by which 
 Galileo was persecuted, which, by the way, was theological, not 
 scientific ; neither do we accept anything as a blinded Hindoo 
 devotee does his religion; but, on the contrary, thousands of 
 competent, earnest, fair-minded, truth-loving deep-thinkers and 
 clear-seers all the world over, both in hospital and private prac- 
 tice, with open eyes and alert ears, solely for the purpose of 
 ascertaining the truth for the benefit of medical science and of 
 suffering mankind, and anxious to see new links added to the 
 great chain of therapeutic aids, eagerly, and fairly, and deliber- 
 ately investigate and test all the alleged important discoveries, 
 plausible theories, and so-called reforms in medicine fi'om A to 
 Z when they arise, and by the conjoined result from a thousand 
 sick-rooms and laboratories give a true common-sense verdict. 
 
 " When free from folly, we to wisdom rise." 
 
 And it is no more necessary for every succeeding generation, 
 with more useful things to think about, to turn aside and dis- 
 cuss whether cholera first appeared at Jessore or in Bengal, or 
 whether iEsculapius was a real person or only a myth, or to 
 re-sift, re-weigh, and re-judge unreasonable medical vagaries and
 
 HIS REPUTATION AND SUCCESS. 231 
 
 nonsensical dogmas that have been a hundred times disproved 
 before rejecting- them, than it is for every one to study spirit- 
 rappings, jingoism, table-turning, the Book of Mormon, and 
 the ins and outs of all other freaks, frauds, frenzies, jackassical 
 doctrines, therapeutic follies, and theoretical crazes, after thouands 
 and tens of thousands have proven them false. 
 
 One of the most amazing of all wonders is that wisdom in 
 the mysteries of the law or in the doctrines of theology, acumen 
 in the sciences, skill in the polished arts, or keenness and cul- 
 ture in other departments of human knowledge, scarcely in- 
 creases some people's reasoning powers a jot above the Ancient 
 Egyptians in medical matters, or prevents their being led astray 
 by false notions of cures, remedies, specifics, and antidotes. 
 
 More than one prominent citizen continues to put knotted 
 red strings around children's necks to cure whooping-cough, or 
 a bag of camphor or of asafoetida to ward off the epidemic; 
 more than one sea-captain carries a potato or a "chunk" of 
 brimstone in his pocket, or wears one stocking wrong side out, 
 to charm away rheumatism; more than one millionaire has 
 vowed that globules of tartar emetic have restored his strength ; 
 and such is poor human nature, that many a victim is actually 
 ready solemnly to certify that this, that, or the other worthless 
 quack swindle has saved his life, yea, even after he had stood on 
 the crater of the volcano of death and heard the rustling of the 
 black angel's wings. 
 
 "Heuce, Sharper, pitch thy trammel where thou please, 
 Thou canst not fail to catch such fish as these." 
 
 How any individual can be a wise logician in all else, and 
 yet, as soon as sickness attacks him or his, leave all reason be- 
 hind, and with open mouth and closed eyes become an easy, 
 almost voluntary prey to shallow quackery, and exhibit the 
 strongest faith in sophistical pretension whose assumptions are 
 glaringly contrary to common sense, is a psychical enigma that 
 almost weakens one's faith in the common sense of half of man- 
 kind.
 
 232 THE PHYSICIAN HIMSELF: 
 
 Never hold joint discussions or controversies before the non- 
 professional piibHc, with Irregulars, noisy quacks, or wrong- 
 headed enthusiasts, either through the newspapers or in any- 
 other way, no matter how false or shallow their doctrines or oily 
 pretenses are, or how easily their weak arguments are refuted 
 by stronger ones; because such joint discussions and rejoinders, 
 either by speech or pen, with the public as judge, would result 
 in no good, but give PoUywantsacracker & Co. an opportunity 
 to make the noise and clamor they desire, bring them into 
 greater notice, gain for them new partisans, and give them a 
 chance to cloud the truth, raise additional false issues, and pose 
 as martyrs to scientific persecution. 
 
 You will occasionally be called again to families who, on 
 account of the blunder or misconduct of some unlucky or in- 
 competent member of the profession, strayed in disgust from 
 regular medicine years ago, when bleeding, etc., were fashion- 
 able, who will be surprised to learn that the fashion of medical 
 practice has changed, and that your therapeutics differ very 
 decidedly from those of Professor Oldkind and Doctor Van 
 Winkle, and that you have learned to unlearn many things and 
 have not taken an oath to practice as our great-grandfathers 
 did, and no longer bleed, salivate, and give nauseous drugs 
 indiscriminately. If you are prudent and circumspect, most of 
 these can be permanently reclaimed. 
 
 "Then, grasp the skirts of happy chance." 
 
 But few of the really sick who are persuaded into giving 
 false and one-idea systems a ' trial become converts ; common 
 sense prevents. Therefore be careful not to banter, irritate, or 
 abandon people who are trying an ism or a ])athy^ or believe in 
 it a little, lest from combating their maybes, questioning their 
 prudence, and forcing argument, you drive them into these 
 vagaries permanently. Should one even contend that the earth 
 is three-cornered, or that sugary nonsense has saved his life, or 
 that pumpkins grow on trees, or declare white to be black, or 
 that castor-oil is made of dead men's bones, or that a horse-
 
 HIS REPUTATION AND SUCCESS. 233 
 
 chestnut and a chestnut horse are one and the same thing:, laus-h 
 in your sleeve if you must, but do not combat him too fiercely^ 
 lor pride of opinion and determination not to be browbeaten 
 into recantation are unfortunate impulses to arouse, especially 
 in conceited and silly people, who admire their own ingenuity 
 in discovering arguments, and will certainly drive them to take 
 sides against you with energy and zeal, possibly to swear by the 
 error in all the moods and tenses, and thenceforth to injure 
 rational medicine to the full extent of their influence ; for, 
 
 "Faith, fanatic faith, once wedded fast 
 To some dear falsehood, hugs it to the last." 
 
 If, in exposing any delusive or false system, you are careful 
 not to denounce it with too much warmth, as though prompted 
 by prejudice or self-interest, and confine your condemnation 
 strictly to the impersonal abstract subject, showing that you 
 speak your real sentiments from sober reason and conscientious 
 devotion to the truth ; and if, moreover, you avoid appearing 
 anxious to hoot down or excite hostility against the individuals 
 who appear to practice it honestly, your reasoning will have a 
 great deal more weight with those whom you address, and witli 
 the community, than under the reverse circumstances ; for human 
 nature is such that, if a system or creed in medicine be false, 
 unkind or untrue abuse of its representatives will be one of the 
 best ways of commending it to public favor, and, therefore, is 
 vs^hat they themselves most heartily desire. 
 
 Ours is the age of quackery, — quackery in law, quackery 
 in religion, quackery in medicine, quackery in everything. Med- 
 ical quackery subsists on credulity, gullibility, and ignorance, 
 and, whenever you have a fair opportunity, it is your duty to 
 expose it, and to save as many as you can from its clutches. 
 
 Medical laws that discriminate in favor of the true men of 
 science and integrity, and against the empiric and impostor, 
 are everywhere essential to the public health and the public 
 safety ; but many of our States have no medical laws at all, 
 and their common laws do not protect their citizens as^ainst
 
 234: THE PHYSICIAN HIMSELF: 
 
 imposition or enter into the slightest consideration of the 
 worth, or worthlessness, of various isms, isfs, and 2:>atliies^ but 
 recognize all kinds, regular, irregular, and mongrel, even down 
 to notorious quacks and ignoble impostors, who never saw- 
 farther into the human body than the skin, precisely as they do 
 the regular profession ; therefore, if you ever occupy an official 
 position under such laws, you will have to recognize certificates 
 of death, vaccination, life-insurance, etc., given by irregulars of 
 every shade, no matter how fictitious their pretensions, or how 
 profoundly ignorant of common medical truths, just as you do 
 those of intelligent, rational, honorable physicians. In a word, 
 you will have to recognize officially every person whom the law 
 recognizes. State medical laws that indiscriminately legalize 
 people of all kinds, of all colors, of both sexes, and of all 
 nations, or give a license to practice to every ignoramus, are 
 impaired to a corresponding extent. What we need is proper 
 laws for the protection of the people, — laws that, while recog- 
 nizing and protecting the rights of all educated physicians, with- 
 out regard to their creeds or modes of treatment, would unspar- 
 ingly uproot and weed out the whole miscellaneous rabble of 
 abortionists, self-commissioned faith-cure pretenders, oxygen 
 quacks, the Street-corner Doctor, — 
 
 "From his discourse he should eat nothing hut hay," — 
 
 Ambulating Electric Itinerants, Indian Doctors with their 
 wongnim and bunyip, Steam Doctors, Pow-wow — 
 
 " Every inch that is not fool is rogue " — 
 
 and Root Doctors, with their " passel of yerbs," who neither 
 read nor write, but get their "tolerabl' sartin " larning about 
 RUTES AND YERBS, " by revelation from the Lawd " ; also Dr. 
 Squish, the " cullud gemman " who learned to cure the con- 
 jured " by 'speriments," — 
 
 "Just hefo' de wah," — 
 
 and other mean and soulless swindlers who know as little about 
 a physician's duties as they do about a geometrical icosahedron
 
 HIS REPUTATION AND SUCCESS. 235 
 
 or the constellations of the heavens, but pretend to answer the 
 unanswerable, and make lying promises to cure the mcurable ; 
 and all other outlaws who knowingly deceive and defraud. 
 
 "Expunge the whole." 
 
 Just laws requiring written examinations upon the funda- 
 mentals of Anatomy, Physiology, Chemistry, Surgery, Practice 
 of Medicine, Materia Medica, Therapeutics, Obstetrics, Gynae- 
 cology, Pathology, Medical Jurisprudence, and Hygiene, should 
 be enacted and rigidly enforced in every State, instead of weak 
 laws that confound the worthy and the worthless, the skillful 
 and the useless, the educated and the ignorant ; and not only 
 compel those who administer them to recognize fool-quacks, 
 illiterate boobies, consummate dunces, and a whole troop of 
 *' nat'ral " born, darn'd fools, but also lend respectability before 
 the public to knave-quacks who deserve the cat-o'-nine-tails. 
 
 But when you see that blessed day, 
 Then order your ascension robe." 
 
 Mixed examining boards are objectionable ; better to have 
 separate boards, each consisting of seven members, the Board 
 of Regular Physicians to examine all who wish a license to 
 practice Regular Medicine in the State, the Eclectic, Homoe- 
 opathic, and other boards to do the same for theirs, as in the 
 present medical law of Maryland. 
 
 It would be well and wise if all medical diplomas and offi- 
 cial certificates were written in plain English, instead of Latin ; 
 then everybody could read and see what each was, and when, 
 why, where, and to whom each was given. 
 
 Strange to say, nowadays a section of the public, blinded 
 by the waves of sophistry and swayed by the winds of false sen- 
 timent, instead of siding with our opponents when they seem to 
 be right and turning against them when they seem wrong, invari- 
 ably Ha ! Ha ! Ha ! and, with gross unfairness, side with the 
 *'new school" or the quack, or anybody else, whenever a con- 
 test arises between them and us. 
 
 "Truth forever on the scaffold, 
 Wrouii; forever on the throne. "
 
 236 THE PHYSICIAN HIMSELF: 
 
 Even the press seems to delight in aiming shafts at the regular 
 profession and creating popular sentiment in favor of our ene- 
 mies, by making invidious comparisons between their modes of 
 j)ractice and ours, telling of their wonderful success and steady- 
 growth in public confidence in highly colored terms. Censori- 
 ous editorials and lampoons are frequently written on our arbi- 
 trary exclusiveness, our bigotry, etc. ; our bickerings and our 
 disagreements, too, are magnified, and our professional squab- 
 bles and disputations are reported in a sensational way, all 
 apparently to antagonize and decry us and to cheer on and 
 assist the onsets of struggling Irregulars and advertising quacks, 
 under their false but popular cry of " persecution." 
 
 You will find that if a person happens to get better, even 
 of an ordinary affection, under the chance play of an Irregular, or 
 by fool's luck when taking a quack medicine, it attracts general 
 attention and every one will speak of it; whereas, if twenty, 
 equally important, get well under the skillful practice of 
 regular physicians, it is considered quite a matter of course, and 
 scarcely excites a comment. 
 
 'Tis said the Chinese are so expert in making much out of 
 little that they live and fatten on what a Caucasian wastes. In 
 the same degree, Irregulars and quacks thrive on the quicken- 
 ing influence of the emotions — expectation, faith, hope, etc. — 
 which we, with our minds fixed on more tangible agents, neglect 
 far more than we should. For proof of the mighty power of 
 the mind over the body, look at the liver-pads, tractors, amulets, 
 •charms, and dozens of other humbug agents now in vogue, 
 which the young and old, black and white, educated and illiter- 
 ate, all kinds, classes, and conditions of people, are praising, 
 almost as if they had fallen from the skies. 
 
 Fashion and wealth exert a powerful influence in medical 
 affairs, and, unfortunately, the novelty-seeking portion of the 
 fashionable, wealthy, and influential foster with their influence 
 and patronize with their wealth almost every pathy, ology, and 
 ism in medicine, and make them popular and fashionable, while
 
 HIS REPUTATION AND SUCCESS. 237 
 
 some of the lower strata stand with eyes, ears, and mouth all 
 open, ready to follow every fashionable foible. 
 
 Some Irregulars have this source of eclat. Having the 
 humbug element fully developed in them, they, with a look of 
 owlish wisdom, big words, and a jargon of technical terms, 
 magnify what we would call a slight cold, or a quinsy, into a 
 *' congestion of the lungs," a " bronchial catarrh," a '' touch of 
 pneumonia," "diphtheria," or "post-nasal catarrh"; dignify 
 what we would call a disordered stomach into a " gastric affec- 
 tion," a wind colic into " borborygmus," a wen into a " cancer," 
 etc., for the cure of which hard-named diseases they are duly 
 credited in their statistics and fully paid by their patients, who 
 are thus added to the list of " saved," and the family are fully 
 convinced of that ism's or pathy's remarkable power in those dis- 
 eases. There is a fellow in our section who works this trick so 
 adroitly that he actually reaps more credit and confidence from 
 mistreating a case that dies therefrom than you would receive 
 from one properly treated that gets well, and reaps more credit 
 and patronage for stopping a chill and fever in seven days than 
 an honest physician would for doing the same in a day or two. 
 
 Another reason why Irregulars get cases is, that if a phy- 
 sician grows tired of a case and loses interest, or the patient 
 gets tired of him and loses faith, the family is apt to desire a 
 change of treatment, and, fearing the attendant would become 
 offended were they to dismiss him and employ one of his breth- 
 ren, they get an Irregular, under the belief that the physician 
 will feel less hurt if they dismiss him under the plea of trying 
 " a different system " of doctoring than on any other pretext. 
 Besides : there are fully five times as many regular physicians as 
 there are irregulars, and we naturally get more stubborn cases, 
 and more dissatisfied patients, who turn from our larger number 
 to them, to "try another system," than there are to come from 
 their smaller number to us. We suffer more because we have 
 more to lose. 
 
 Irregulars have thus been catching numbers of patients
 
 238 THE PHYSICIAN HIMSELF: 
 
 under the idea that they are " speciaUsts in therapeutics." The 
 advent of our true speciaUsts is very fortunate for us in this 
 respect, as more and more of our stubborn cases now fall into 
 their hands instead of wandering off, and are thereby kept with 
 the regular profession. 
 
 " For this relief, much thanks." 
 
 Again, a physician is sometimes compelled to tell disagree- 
 able truths, and candidly to give a gloomy or despairing prog- 
 nosis, and this, on the principle of a drowning man catching at 
 a straw, is apt to make the patient and his friends argue that, as 
 regular medicine offers him no guarantee of safety, they had 
 better transfer the case to some irregular practitioner, or to a 
 noisy quack, who makes great professions and rosy promises. 
 
 Another reason why Irregulars have partisans is, that 
 legitimate medicine is unsuited to the peculiarities of some 
 minds, and will never obtain their confidence. Some would 
 almost rather die under the hands of an irregular than to 
 recover under a regular. There is, also, always a sprinkling 
 of extremists and pharisees, long-haired men and short-haired 
 women, of every conceivable type of mind, — 
 
 "Nature in her time has framed strange bedfellows," — 
 
 opponents of vaccination. Spiritualists, and other well-known 
 malcontents in every community, who for one cause or other 
 are imbued with dogged antagonism to the regular profession, 
 and the fellow who discards it is their doctor ; others believe in 
 vegetable remedies only ; the prescriber of herbs is their doctor,, 
 etc. All such unite, by affinity, to abet and support classes and 
 systems that practice in opposition to us, and, of course, such 
 demand creates a supply. 
 
 You will find that not only in medicine, but on every 
 important subject, when the plain, common sense of a commu- 
 nity reaches a conclusion, there are always persons who think 
 they exhibit finer qualities of mind by reaching the opposite 
 conclusion, and will contend bitterly on points where rational 
 doubt is impossible. Other " intelhgent enemies " think it.
 
 HIS REPUTATION AND SUCCESS. 239 
 
 evinces great natural acuteness and subtlety of intellect to cling 
 to the opposition, and imagine they thus show superior penetra- 
 tion and sapiency. 
 
 Still another reason why Irregulars get patrons is this : 
 they all take care to announce that WE cure by mild means or 
 harmless methods, and not by complicated, painful, or danger- 
 ous measures, bloody operations under anaesthetics, or other 
 dernier ressorts that science teaches truer physicians to use — 
 against all of which they have, by false assertions and fallacious 
 statistics, aroused much of the existing prejudice and abhorrence. 
 
 " Fear has big eyes." 
 
 So great, indeed, is the popular dread of what physicians 
 might do, that in choosing a medical attendant, tlie nervous and 
 the timid, the friables and the feebles, who constitute nine-tenths 
 of all the sick, are greatly inclined to shun Prof. Sawbones, Dr. 
 Doubledose, Dr. Drastic, Dr. Cutemupalive (with liis ostenta- 
 tious preparations and formidable array of instruments), Dr. Big- 
 pill, Dr. Caustic, and all who treat heroically and enforce rigid 
 discipline, and to seek Prof. Tweedlum, Drs. Golightly, Lamb- 
 like, and Silky, who undertake to cure without cutting, and 
 who use moderate or pleasanter, even though less efficient, 
 means. 
 
 The rational treatment of disease varies from expectant to 
 heroic, according to the exigencies of each case, and you must 
 learn to distinguish cases in which you can safely depend on 
 nature from those that nature cannot combat, and treat each 
 accordingly ; for when you learn to recognize those who need 
 an ounce of medicine and a grain of policy from those who 
 need an ounce of policy and but a grain of medicine, you will 
 have entered upon one of the paths of wisdom, and will make 
 yourself and your profession more useful and more acceptable. 
 When you have a Lah-de-Dah patient, with taste or imagina- 
 tion unusually developed, who needs little or nothing, for 
 mercy's sake don't violate common sense and force upon him 
 some horrible mixture that seems as if made of dead men's
 
 240 THE PHYSICIAN HIMSELF: 
 
 skulls, or a bitter infusion, or a large bottle of muriated. tincture 
 of iron and quinine, or other medley of nastiness, as if your 
 chief aim were to cause nausea and disgust. Give no one any- 
 thing stronger or coarser than he actually needs, and leave the 
 balance to nature. 
 
 Also, handle all who have highly impressible nervous sys- 
 tems, or sensitive skin, delicate palates, tender throats or treacher- 
 ous stomachs (and wry faces), so to speak, with kid gloves, and 
 be careful to avoid all useless severities, and to give them as 
 little unpleasant-tasting medicine as possible, and never more 
 than they can bear. The recent great improvements in the 
 forms and palatability of medicines, in addition to your own 
 knowledge of the elegant, offer you splendid opportunities to 
 do this. Keep clear of their prejudices, and offend neither 
 their eyes, their ears, their nostrils, their palates, nor their stom- 
 achs, and you will succeed where neglect of these precautions 
 might cause failure. Also, bear constantly in mind that pain- 
 ful operations that fail, or disagreeable medicines used unsuc- 
 cessfully, if they have given pain or great niconvenience, will 
 injure your reputation and may even cause your dismissal. 
 Give hypochondriacs, dyspeptics, and other Pooo-oo-oo-oo-r 
 Cre-e-eatures who are fond of attention, but not of medicine, 
 small, tasteless, or palatable remedies, and, unless there is a real 
 necessity for it, do not oblige anybody to take medicine before 
 breakfast, or to be aroused for that purpose during the night. 
 With such people make free use of bland elixirs, the fluid 
 extracts, sugar-coated granules, pepsins, emulsions, troches, 
 lozenges, capsules, and other results of artistic elegance and 
 chemical accuracy now kept in every drug-store. 
 
 Overdosing, blood-letting, salivating, purging, etc., are now 
 justly unpopular, and ultra-conservative, reconstructive medi- 
 cines are in vogue. iVlmost every one is filled with the belief 
 that he is debilitated. Say to the average patient, " You are 
 weak, ' below par,' and need building up," and you will at on-ce 
 see bv his countenance that you have struck Ids key-note. So
 
 HIS REPUTATION AND SUCCESS. 241 
 
 much is this the case that many of the ailing, strongly impressed 
 with this idea, will want you to treat them with tonics and 
 stimulants, even when their condition is such that these medi- 
 cines are contra-indicated. 
 
 Never attempt to force the use of a remedy — mercury, 
 arsenic, iodide of potassium, opium, asafoetida, valerian, etc. — 
 on a person after he has exhibited an idiosyncrasy or a hatred 
 toward it. Also, when possible, change the form of your pre- 
 scription from pills to powders, or from liquids to capsules, or 
 from sweet to bitter, and vice versa, for those who desire it. 
 
 A good plan to pursue with patients who actually need the 
 prolonged benefit of two different medicines, who can not or will 
 not take them at alternating hours every day, is to use one to- 
 day and the other to-morrow; for instance, if a nervine and a 
 tonic are prescribed separately, let them take full doses of the 
 nervine on Monday and full doses of the tonic on Tuesday, 
 nervine on Wednesday, tonic on Thursday, etc. Almost any 
 patient can and will alternate thus without tiring. 
 
 The smaller, the more striking the means that seem to pro- 
 duce the desired result, the more surprising does it a])pear to a 
 patient. It does not seem wonderful to him that he should get 
 better after taking on ounce or a pint of anything, but for relief 
 and improvement to follow a tiny powder, or a pellet, or a taste- 
 less solution, or a morphia granule appears marvelously strange, 
 and commands loud praise. 
 
 Instead of being armed with paper and pencil only, carry 
 with you a few well-chosen remedies to be used at night, and 
 on occasions of great or sudden emergency. Above all 
 others, carry a supply of morphia granules or tablets with 
 you constantly, and give a proper number of them in an 
 ounce or two of liot water as soon as you reach one of the 
 thousand cases in which great pain is a symptom. By so 
 doing you can often adroitly meet the emergency, relieve the 
 suffering, and show your power over pain before the messenger 
 could get back from the pharmacy with the remedy you would
 
 242 THE PHYSICIAN HIMSELF: 
 
 otherwise order. It also often prevents the necessity of writing 
 more than one prescription at a visit. 
 
 Rest for the patient is rest for the nurse, and, when all 
 around are broken down and worn out, this is an important con- 
 sideration. The value of a night's rest to a very ill patient is often 
 incalculable, and to secure this morphia granules are highly 
 valuable, even when -they form no essential part of the treat- 
 ment. You can also use them to give any jaded sufferer an 
 occasional night of delicious visions, or of placid slumber, that 
 will make him wonder what has become of the night. 
 
 Morphia granules given thus make a vivid impression in 
 the physician's favor, and do great good, becoming, in fact, 
 almost a perfect substitute for morphia hypodermatically. 
 
 Endeavor to please every one's taste and ideas of medicine 
 as far as is compatible with safety, and bear ever in mind that a 
 patient is something more than a mere stomach and body ; also, 
 study the various psychological aids, and try to compel the pa- 
 tient to assist mentally in curing his own case. Carefully avoid 
 overdosing, and remember that persons who have been most 
 fond of taking medicine often become surfeited and undergo a 
 complete revulsion against both medicine and physicians. How 
 can we wonder at this, when even too long a continuation of 
 beefsteak, partridge, or other savory food causes disgust, even 
 in well people ! 
 
 This tendency in the human mind has just now received 
 a wholesale illustration at our expense, and in this way: 
 Satiated and disgusted with crude and overactive measures, a 
 great many misdrugged and overdosed people were wishing 
 for a change, when lo! Samuel Christian Friedrich Hahne- 
 mann, of Meissen, Germany, accommodated them with a pseudo- 
 scientific, do-nothing system, resting on a creed composed of one 
 logical and two illogical tenets, which nevertheless, by its ap- 
 parent simplicity, serves specially to advertise both system and 
 disciple, and to fascinate those who trust to it, without offending 
 either eye, palate, or stomach ; depending on nature to do what
 
 HIS REPUTATION AND SUCCESS. 240 
 
 she can do, while itself supinely allowing cases that she cannot 
 restore to become complicated or chronic, or maybe die prevent- 
 able deaths. 
 
 " Diseases desperate grown, 
 By desperate appliances are relieved, 
 Or not at all." 
 
 You are, of course, bound by the most sacred obligation? 
 to use your best judgment and endeavors for the good of every 
 one who comes under your professional care, but neither the 
 Code of Ethics nor the Code of Honor forbids your sailing be 
 fore any and every popular breeze, provided you violate no 
 principle of truth or justice. No honest man could compromise 
 a matter of principle, i.e., knowingly quit the right for tlic 
 wrong, or sell the truth to serve the hour, or for one moment 
 permit policy to sit above honesty ; yet it is sometimes ver) 
 foolish not to compromise a matter of mere policy. In medicine 
 the second-best course sometimes becomes the best because the 
 patient likes it best ; and, although you can neither believe no7 
 follow Hahnemann's nonsense and follies, — 
 
 "Your key fits not that lock," — 
 
 you can follow the fashion of the day^ and give to every fastidi- 
 ous or squeamish patient the smallest and most pleasant dose 
 that his safety will permit, and can avoid giving any one crude 
 remedies to a disgusting degree. 
 
 So strong has been the reaction against old-timed medica- 
 tion, that Hahnemann's silly system has secured a large and 
 earnest following, and enjoys the sunshine of popular favor 
 among the susceptible to such an astonishing degree that it ma) 
 be regarded as the grand delusion of the nineteenth century, — 
 
 " How long, O Lord, how long ! " — 
 
 and there is to-day no (lawful) human occupation that yields so 
 large a return for the amount of capital and brains required as 
 the practice of homoeopathy, and that so few have deserted the 
 crowded paths of rational medicine to seek its shekels is a monu-
 
 244 THE PHYSICIAN HIMSELF: 
 
 ment to man's preference of the true and noble patli. There 
 can be no doubt that its prosperity would have already termi- 
 nated had the profession not been so slow to accommodate itself 
 to the demands of fashion, particularly with reference to medi- 
 cation in slight and imaginary cases. But rational physicians 
 are arousing to the importance of this feature, and are rapidly 
 conforming to it. They are also administering more concen- 
 trated and palatable forms of medicines in serious cases, and, 
 thanks to the labors of many devoted workers in the field of 
 medical science, and to the light they have shed upon the sub- 
 ject, are now enabled to effect cures with greater certainty, 
 promptness, and safety than ever before. The result is that 
 many of the erring, who had gone over to "isms" and "pathies," 
 are being brought back from delusions to renewed faith in legiti- 
 mate and rational methods of practice. Determine that you will 
 bear your share in the good work by devoting time and study to 
 rendering therapeutics useful and at the same time cheap, 
 pleasant, and acceptable to patients. If you will carry a small 
 pocket vial-case of your favorite pills, tablets, granules, etc., both 
 strong and weak, for use on suitable occasions, you can meet 
 homoeopaths in the matter of free-dispensing, and also have as 
 much benefit as they of the mystery that envelops the name and 
 nature of the drugs thus employed. Besides, you will escape 
 the drug-store " repeats," and if there be any repeating you will 
 do it yourself. 
 
 Now, although homoeopathy is somewhat fashionable, when 
 a disease actually requires medication you can make little if 
 any rational use of its so-called principles, which rest on the 
 following foolish postulates, which are no more applicable to 
 the treatment of disease than to building a steam-boat : Ist. 
 Curative remedies for the side can he selected onhj hij a study of 
 provings on jyersons in health. 2d. Evert/ remedy must he given 
 by itself Sd. The similar and single remedy must he given in 
 its ininimum dose., i.e., the smallest dose sufficient to effect a cure 
 in the case. These constitute Samuel Christian Friedrich Hahne-
 
 HIS REPUTATION AND SUCCESS. 245 
 
 mann's substitute for rational tlierapeutics, — his entire stock in 
 trade ; an essential triune, an inseparable unit, — violation of 
 any one of which is a confessed rejection of this German 
 dreamer's whole system, and you will observe at a glance that 
 it is actually two-thirds nonsense ; that the first and second 
 postulates of his creed are sophistical and untrue, and hence 
 should be rejected; and that the last, ?'.e., to give the smallest 
 dose that will answer the purpose, nobody denies, — 
 
 "It is as old as the itch," — 
 
 since it is useless to pour two buckets of water on a fire when 
 sure that one will put it out. 
 
 Contrary, however, to what many unthinking people believe, 
 this creed gives its disciples perfect liberty to give either an atom 
 or an ounce of mercury, sugar, opium, or anything else, at a 
 dose, provided they proceed on the so-called principle of simi- 
 lars; and the question whether any one does or does not prac- 
 tice homcEopathically does not at all depend upon the size of the 
 doses. They might give an ounce of a medicine where you 
 would give but a grain. Their ounce would not make them 
 regular physicians, nor your grain make you a homceopathist, 
 for you in selecting your remedies would not think of pathies 
 at all, while they would think of nothing else. 
 
 Bear in mind that the practice of rational medicine is also as 
 distinct and free from allopathy and all other pathies as America 
 is from Asia. Here is the true and only test as to whether you 
 are practicing rationally, homoeopathically, or allopathically : 
 Were you to examine a patient and ask yourself, without regard 
 to nonsensical pathies, or to any other creed or boundary. What 
 is the best treatmeyit known to the world for a case like the one 
 before we ? and use that, you would be practicing rational^ unre- 
 stricted, regular medicine. If, on the contrary, you were to 
 examine a patient (with the Will-o'-the-wisp idea of liomoeopa- 
 thy in your mind), and ask yourself, What article icould pro- 
 duce a totality of symptoms similar to his in a well j^^J'son ? 
 and give him the one which you thought would come nearest to
 
 246 THE PHYSICIAN HIMSELF: 
 
 doing this, you would be practicing homceopathically ; or were 
 you to sit down (with the chimera of allopatliy in your mind), 
 and ask yourself what article would jingle with another sympa- 
 thy or totality of symptoms dissimilar to these, and irrationally 
 base your treatment on that ground, you would be practicing 
 *allopathically. Now, it is safe to conclude that if you practice 
 medicine forty years you will never sit down by a patient's bed- 
 side (conjure the pathies) and ask yourself either " What 
 agent would produce a disease similar to this, or symptoms 
 similar to these in a well person ■?" or " What would cure by 
 agreeing with dissimilar sympathies 1 " and attempt to simulate 
 this in your treatment. Therefore, remember that, no matter 
 liow small your dose, or what the article, or by whom first used 
 as a medicine, it would not be given by the square and compass 
 of the so-called pathies at all, and you would be proceeding 
 neither liomoeopatliicaHy nor allopathically, but rationally. 
 
 It is also safe to predict that while reason remains your 
 mistress you can never agree that twelve twelves make a hun- 
 dred and fort)'-five, or follow a system of symptom-worship that, 
 in dogmatically seeking to follow the (so-called) law oi' similars, 
 arrives at poison oak-globules as a remedy for erysipelas, croton- 
 oil globules as a remedy for cholera infantum, mercury globules 
 for mumps, tartar-emetic globules for typhoid pneumonia, opium 
 globules for apoplexy, strychnia globules for convulsions, can- 
 tharides globules for burns, and an immense farrago of other 
 nonsense as true as, but no truer than — 
 
 "There was a man in our town, and he was wondrous wise. 
 He jumped into a bramble-bush and scratclied out both his eyes. 
 And when he saw his eyes were out, with all his might and main, 
 He jumped into another bush and scratched them in again." 
 
 Study the " Organon of Medicine," by Samuel Hahnemann ; 
 " Homoeopathy Fairly Represented," by Henderson ; Hull's 
 "Jahr"; Hughes's " Pharmaco-Dynamics " ; Johnson's " Thera- 
 peutic Key " ; the works of Hering, Lippe, and Guernsey, and 
 you will read that a homoeopath must prescribe according to 
 what he claims to be the homoeopathic, the SOLE, law of nature
 
 HIS REPUTATION AND SUCCESS. 247 
 
 in therapeutics, comprehended in the phrase " similia similihas 
 curantiu^'' or like cures Hke. It is this SOLE-LAW pretension 
 and false claim to an exclusive possession of therapeutical truth 
 that stamp homoeopathy a variety of quackery. 
 
 "Vaulting ambition, that o'erleaps itself, 
 And falls on the other side." 
 
 It is universally admitted that quinia cures intermittent 
 fever, but who ever heard of its being homoeopathic to the 
 periodic feature of that disease "? And yet where is the homoeo- 
 path who does not, in periodic fevers, administer sugar-coated 
 quinine granules in full doses'? Podophyllin is the favorite 
 cathartic of the homoeopath. Does it ever cause constipation 
 except by the secondary exhaustion and impairment of sensi- 
 bility common to all cathartics? No intelligent physician would 
 contend that it did. That morphia relieves pain is one of the 
 best-attested facts of medical observation ; will any homoeopath 
 dare say that it causes pain 1 These are not stray assertions ; 
 they are monumental facts, destined to overturn homoeopathy 
 and its silly law of similars ; for neither S. C. F. H.'s nor any 
 one else's pseudology can maintain itself permanently before the 
 light of truth and science. 
 
 Truth is a unit ; there can be but one science of one sub- 
 ject, and there is but one science of medicine, and to talk of 
 rival systems of medicine is as absurd as to talk of rival systems 
 of mathematics or rival laws of gravity. Compare S. C. F. H. 
 (whose whole life was full of unnatural thoughts, foolish ideas, 
 and peevish fancies) and the shallow and delusive so-called sole 
 law of cure, published in his " Organon," in 1810, in which he 
 rails at the profession and talks as if he alone had charge of the 
 key of knowledge and the casket of truth, all the way through, 
 with Copernicus, Newton, Harvey, Davy, Galileo, Franklin, and 
 other real discoverers of nature's laws, who are an honor to the 
 human race, and you will find his baseless and unscientific chain 
 of assertions so weak that 
 
 "Whatever link we strike, 
 Tenth or ten thousandth, breaks the chain alike."
 
 248 THE PHYSICIAN HIMSELF: 
 
 Those illustrious men did discover the natural laws of 
 astronomy, gravitation, electricity, etc. ; consequently, their sys- 
 tems have extended or have been but slightly changed. 
 
 "Truth is God's own daughter." 
 
 Hahnemann did not discover the natural, the sole, the universal 
 law of medicine ; therefore his frail, temporary system has beaten 
 about from psora and dynamization to the tasteless, the infini- 
 tesimal, etc., until to-day it scarcely exists except in name. 
 
 Among S. C. F. H.'s chief doctrines was the dynamization 
 (spiritualization) of medicines, and his angry assertion that a 
 millionth of a grain of medicine had more power than a grain, 
 or that a drop of alcohol well shaken had more power than an 
 unshaken pint, goes far to illustrate his unparalleled assurance 
 and egotism. 
 
 "Yet still some wondered — and the wonder grew — how one 
 small head could carry all he knew." 
 
 These notions of his not only contradict reason and violate 
 common sense, but conflict with fixed mathematical laws, since 
 a part cannot be greater than the whole. The truth is, the 
 so-called dynamization, or attenuation, or spiritualization of 
 medicines is bosh, and bears about as much relation to the 
 science of medicine as the kaleidoscope does to the science of 
 astronomy. Indeed, were some graceless wag to exchange or 
 mix up the contents of a disciple's satchel so that each vial 
 would contain attenuations the very opposite of its label, its 
 owner, in blissful ignorance of the fact, would doubtless con- 
 tinue to hear of their great usefulness all the same. 
 
 To test the value of dynamization the Milwaukee Academy 
 of Medicine, in 1878, made the following offer : a vial of sugar 
 pellets, moistened with the 30th attenuation of a drug and 
 placed among a number of vials of sugar pellets moistened with 
 alcohol only, to be given to each believer in dynamization found 
 willing to use them, he, at the end of one year, to designate by 
 their effects on his patients which of the vials contained the 
 medicated pellets.
 
 HIS REPUTATION AND SUCCESS. 219 
 
 The project was indorsed by the leading journals and by 
 The New York Homoeopathic Medical Society. A mixed com- 
 mittee of believers and unbelievers, of which E-ev. Geo. T. 
 Ladd, Professor in Bowdoin College, Maine, was the Chairman, 
 dispensed the sets of pellets, giving them to none but avowed 
 believers in the efficacy of attenuations, each applicant being- 
 allowed to name the drug he would use in the trial. 
 
 The result was as follows : Number of trial sets applied 
 for, seventy-two ; number who ventured to report at the end of 
 the year, ten ; number who found the medicated vial, one. 
 
 Since this we have heard less and less of dynamization. 
 Hear Hahnemann himself on the subject : — 
 
 " It holds good, and will continue to hold good, as a 
 homoeopathic therapeutic maxim, not to be refuted by any 
 experience in the world, that the best dose of the properly- 
 selected remedy is always the very smallest one in one of the 
 high dynamizations, as well for chronic as for acute diseases." 
 
 Remember that the epithet or by-word "Allopath " is a 
 false nick-name — 
 
 "A thing devised by the enemy" — 
 
 not chosen by regular physicians at all, but coined for us, 
 and put in use against us, by our enemy, S. C. F. Hahnemann, 
 in contradistinction to his own dreamy system, to prove that 
 the theory and therapeutics he proposed in his absurd "' allo- 
 pathy's " place was of a totally different or opposite character 
 from it ; and cunningly used as part of his ridiculous attempt 
 to blot out all the existing facts of free therapeutic science, and 
 to substitute his own silly system, and now applied to us 
 opprobriously, with all the collateral insinuations and derisive 
 use the term affords, by all our rivals and enemies, with intent 
 to injure. 
 
 "As the old bird sings, the young ones twitter." 
 
 It is both untrue and offensive, and is no more accepted by 
 us than the term "Heretic" is accepted by Protestants, "Ch — t- 
 killers " by the Jews, or " Locofoca " by the Democrats.
 
 250 THE PHYSICIAN HIMSELF: 
 
 Bear in mind that we do not study the so-called pathies at 
 all ; therefore, are not " paths " of any kind, but are Rational, 
 Unrestricted Physicians, and take care resolutely and promptly 
 to resent the term "Allopath " when any one applies it to 
 you through enmity, and courteously to disown it, and tell 
 of its falsity, hostile origin, and sinister intent, when applied by 
 those who do not know what malice the term implies. 
 
 S. C. F. H.'s so-called allopathic physician would be one 
 whose silly creed tied him to a jargon of pathies and confined 
 him to fiddling on what dreamers call " opposite sympathies," 
 even trying in practice to create some dissimilar, perhaps worse, 
 disease, as a substitute for the one he was called upon to treat. 
 Now, there are fully a hundred times as many squinting-brained 
 people in every community as there are squint-eyed persons, 
 and any man, with but one eye even, can see why policy and self- 
 interest bring forth Protestant bakers and Catholic gardeners. 
 Baptist washerwomen and Quaker boot-blacks. Mormon black- 
 smiths and Presbyterian shoe-makers, Masonic carpenters and 
 Odd Fellow bricklayers, Bepublican barbers and Democratic 
 tailors, Methodist-Episcopal astronomers, Homoeopathic doctors, 
 French mathematicians, and Botanical druggists, whenever 
 and wherever there are squinting-brained people who prefer to 
 employ dogmatists in these things. Verily it seems as if 
 
 " All the world's a stage, 
 And men and women merely players ;" 
 
 but everybody knows that no sensible person wants a (Hetero- 
 pathic) physician who will cure one disease or symptom by^ 
 creating some contrary, perhaps worse, one ; consequently, no 
 thinking person professes to be an Allopath, and no unrestricted 
 physician should allow himself, or the regular profession which 
 he represents, to be thus belied and belittled ; but there is, and 
 ever will be, everywhere, a dozen times greater demand for 
 unrestricted, rational practitioners of medicine, who will do 
 whatever under heaven seems best for their patients, without 
 regard to likes or contraries, creeds or pathies, than for one of
 
 HIS REPUTATION AND SUCCESS. 251 
 
 any other kind. Away, then, at once and forever, with the 
 absurd and false title " Allopath !" and, if a designating title 
 becomes necessary, let it be Regular or Unrestricted Physician. 
 
 Also, in signing certificates for life-insurance or beneficial 
 societies, or in giving your name for directories, State or city 
 registers of physicians, or in other cases in which the form 
 requires you to state what school of medicine you practice, be 
 careful to have your name mentioned as a regular or rational 
 physician, or simply " physician," and not as an allopathist. 
 
 Folly-engendering homoeopathy not only panders to the 
 whims of the whimsical, but also makes a specialty of poison- 
 ing their minds, as well agahist clearly rational remedies as 
 against the lancet, polypharmacy, and other debatable or 
 spoliative measures, and inclines them to attach undue impor- 
 tance to every trivial afiection, and to overestimate the value 
 of placebo treatment, and thus not only tends to produce an 
 effeminate type of patients, who cowardly shrink from every 
 ailment, but also creates a pathophobic overattention to the 
 minutiae of health, and eventually makes them morbidly anxious 
 about every function, and fills their mind with a medley of 
 imaginary and exaggerated afiflictions, which haunt them, like 
 Banquo's ghost, wherever they go. 
 
 " In form a man, 
 With spirit less than infancy, 
 And nerveless as the weakest woman." 
 
 You will often see persons who might have passed through 
 life well and strong, with scarcely a thought of sickness, who, 
 from being indoctrinated in it, softened by its follies, and 
 habituated to its self-surveillance and constant contemplation 
 of their symptoms, become borne down into valetudinarianism 
 or hypochondriasis by a net-work of magnified trifles, and con- 
 stant indications for pellets and attenuations. 
 
 "I'm doing this for my health, 
 I'm doing this for my health, 
 For my health, for my health, 
 I'm doing this for my health."
 
 252 THE PHYSICIAN HLMSELF I 
 
 We have a wealthy but very fanciful lady living in our 
 section who has become so enamored ol' similia, etc., that, 
 besides incessantly hunting up indications and symptoms in 
 herself, and dosing herself with globules of table-salt when she 
 dreams there are robbers in the house, of veratrum when she 
 dreams she eats her shoes, and of hyoscyamus when she dreams 
 she climbs the stove-pipe, she also banquets her birds on globules 
 of sun-dew% etc., whenever they fail to sing, and Tabby and 
 Tommy w^hen they fail to mew. Other silly but zealous Hahne- 
 maniacs, as if to complete the absurdity and show their zeal 
 and childlike fascination, have given its similars to turkeys, 
 dogs, chickens, horses, geese, etc., and would almost ask you 
 to believe that they had seen it change a red calf with blue 
 eyes into a blue calf with red eyes. 
 
 "O dark, dark, dark; total eclipse. 
 Amid the blaze of noon." 
 
 Not only this, but read the provings in any standard 
 homoeopathic work, — Hughes's " Pharmaco-Dynamics," for in- 
 stance, — and you will find that many of their remedies and 
 many of the symptoms said to follow homoeopathic provings 
 are too nasty to be repeated, and that the majority of the others 
 are more like the idle fancies of SpirituaUsts or day-dreamers 
 than the work of rational persons. 
 
 You will discover that nine out of ten of those who to-day 
 long for its sweet nothings know absolutely naught about the 
 so-called principles and sophistical calculations of homoeop- 
 athy, BUT (and this is a big but) take themselves and give 
 their sugar-plum Materia Medica to their families solely because 
 their remedies are fashionable, novel, easy to take, and prevent 
 the trouble and expense of running to the druggist with 
 prescriptions. 
 
 Homoeopathy has also profited, and is still profiting, wher- 
 ever the English language is spoken, by the accidental mis- 
 leading resemblance of the term homoe to the precious word 
 home, — " Home, sweet home."
 
 HIS REPUTATION AND SUCCESS. 253 
 
 To you, as a physician, the term homoeopath naturally 
 signifies a person who practices a certain silly, dogmatic, and 
 visionary system. But to many of the laity, on the contrary, the 
 first two syllables of the word suggest that he practices a simple 
 liome or domestic system of medicine, and the fact that he ordi- 
 narily prepares his own globules, solutions, etc., either at his 
 own home or at the homes of those who employ him, instead of 
 sending prescriptions to drug-stores as we do, adds strength to 
 this popular error, which is so natural that many people often 
 actually call regular physicians who happen to supply their own 
 medicines " Home-o-paths." 
 
 It is your duty, in the interest of truth and for the benefit 
 of humanity, to make it known that the word " home " is of 
 Saxon derivation, whereas the prefix homoeo is derived from the 
 Greek homoios (similar), and has no possible relation to hearth 
 and home. S. C. F. H. seems to have built better than he 
 knew, as far as the home-loving, English-speaking Americans 
 are concerned, when he styled himself a homoeopathist, and not 
 a pathomoeist, which has the same meaning. 
 
 Do not infer that no homoeopath. (or omnipath, or hydro- 
 path, or vitopath, or any other path or ist) can be influenced 
 by the very quintescence of high motives, or be following his 
 2:)atliy with the full purity of truth and the perfect honorable- 
 ness of honesty, and with the sincerest intention of giving the 
 utmost assistance and relief that the art of medicine enables 
 one to give ; for there never has been an absurdity in regard to 
 religious, political, or medical questions that has not found very 
 sincere, well-meaning supporters, educated, refined, and zeal- 
 ously in earnest, who have somehow or other been led into 
 those paths ; nor that a homoeopath does no good, for he may do 
 a great deal of good, and even get patients well, but the good he 
 does is not by his silly pathies, as has been proven by innumer- 
 able observers, but by the accompanying tact of tongue, hygien- 
 ics, dietetics, faith, expectation, good nursing, time, etc., which 
 would do equally much were the patliy portion left out, and
 
 254 THE PHYSICIAN HIMSELF I 
 
 globules of sugar, saw-dust pills, colored water, or any other 
 make-believe remedy substituted, to give the confiding room to 
 exercise their faith, and rest, regimen, the vital force, time, etc., 
 an opportunity to make the cure. 
 
 A preacher, a lawyer, or an agriculturalist may be a fraud ; 
 or a navigator, an astronomer, or a mathematician may be a 
 swindler, while the system by which they pretend to be guided 
 is perfectly true. But homoeopathy is the reverse of all these ; it 
 itself is nothing but a fanciful pseudo-science ; hence, not solely 
 the disciple, but the system itself sins against truth. 
 
 If ever chance, or a crossing of paths, bring you in contact 
 with a real homoeopathist, if you believe him to be a gentleman, 
 harbor no ungenerous feelings or personal animosity, and 
 observe all the forms of politeness toward him, and treat him 
 exactly as you would any other gentleman, — 
 
 His faith may be as sincere as yours, — 
 
 but ignore him (as he probably will you) pr-ofessionalli/, and 
 make no attempt to fraternize with him in the management of 
 a case, it being far better for each kind to consult with its own. 
 
 Suppose you were to attempt to consult: patient has — 
 well, say, convulsions, the result of teething. You examine 
 the case together — retire for consultation — the subject of treat- 
 ment is finally reached. You (true to humanity) survey the 
 whole field of rational therapeutics and conclude : first, that 
 the cause should be removed a^ far as possible by incising the 
 gums for the purpose of severing their irritated nerves ; second^ 
 that sedatives and antispasmodics are indicated. He (true to 
 his creed) puts on his homoeopathic spectacles, surveys the 
 totality of symptoms by the square and compass of Similia 
 Similibus Curantur, and arrives at strychnia, in the tenth dilu- 
 tion ! Result : emphatically a therapeutic dead-lock, unless, 
 false to your convictions, false to your profession, and false to 
 the interests of humanity, You agree to give up common sense 
 for his nonsense. 
 
 But how, oil, liow ! can anv true man have much to da
 
 HIS REPUTATION AND SUCCESS. 255 
 
 with any of the other flock, — the degenerate knaves who are 
 not homoeopaths at all, but solely for business reasons burlesque 
 as homoeopaths and carry awe-inspiring satchels of Hahneman- 
 nic nonsense which they handle as carefully, in walking the 
 streets, in getting in and out of their buggies, in going up stairs, 
 and in opening and closing them in the sick-room, as if an 
 additional (here is where the biggest laugh comes in) shake of 
 the powerful dynamizations within might still further increase 
 their terrific potency and cause an explosion. 
 
 He seems as far from fraud as heaven from earth. 
 
 The whole life of such a fellow, though he lives in luxury and 
 rolls in a gilded chariot, is a living lie, — a sad burlesque on 
 physic, a long-drawn ode to finesse. 
 
 Respect every believer in anything, no matter how great 
 his error, if his views be honestly held, provided he show his 
 true colors and fight a fair battle for it ; but let the finger of 
 scorn point at every so-called son of Hahnemann who, as an 
 advertisement of himself and to catch patients, denounces and 
 sneers at "Allopaths" and '-^ old-scIiooV^ remedies, meanwhile 
 giving pellets and attenuations in placebo cases only^ and in all 
 others slyly using our opium to relieve pain, our chloral to 
 induce sleep, our quinia and antipyrin to arrest fever, and all 
 our other prominent agents, just as we do, in full doses, yet 
 crediting the good they do to similia simiUbus curantur, be- 
 cause just now to call one's self a homoeopathist and dispense 
 pellets free to all who will pay for advice, and to surround 
 the name and nature of the remedies with mystery, brings grist 
 to one's mill and shekels to his coffers; but, 
 
 "What soul would in such a carcass dwell?" 
 
 There is also another variety of fellows, who talk homoe- 
 opathy to one person and anything-you-wish to the next. 
 These, although inconsistent with themselves, are not so pos- 
 itively dishonorable, for they are at least outspoken in their 
 doubleness ; but what words would exaggerate the meanness of 
 a clergyman whose love of gold and lack of scruple would allow
 
 256 THE PHYSICIAN HIMSELF I 
 
 him to vary his principles at v:iU and preach anything one 
 wished, whether a strictly Catholic lecture, or an ultra-Protes- 
 tant discourse, an orthodox Hebrew sermon, a fiery Mohamme- 
 dan philippic, or an out-and-out infidel harangue'? He might 
 believe in one or none, but he could not believe in all, and, if 
 he professed to do so, would deserve to be kicked out of his 
 own door. 
 
 "An eagle's life 
 Is worth a world of crows." 
 
 Science has everywhere convincingly shown that Homoe- 
 opathy contains its own refutation, and is a fraud on science. 
 Hahnemann started it in 1790, six years before Jenner vacci- 
 nated James Phipps, and his " Organon" was published in 1810. 
 Now, in this long, long period, had it deserved scientific recog- 
 nition, or had there been anything at all in it worthy of adop- 
 tion by the profession, it would surely, like vaccination, elec- 
 tricity, and all other truths, long since have been absorbed by 
 scientific rational medicine, whereas the fact is that its silly 
 creed has taken no root at all in the regular profession. To-day 
 pure homoeopathy is withering like a girdled fig-tree in Europe j 
 and Hahnemann is no longer placed on a lofty pedestal — 
 
 " Take him for all in all, 
 "We scarce shall look upon his like again" — 
 
 or worshiped as a hero, and his silly system has almost faded 
 out in the land of its birth, and is without a chair in any uni- 
 versity in Europe, and is rarely mentioned there without a smile. 
 The Homoeopathic Medical Directory, recently published 
 in London, shows that there were in Great Britain and Ireland, 
 in 1875, two hundred and sixty-nine homoeopaths, and in 1889 
 but two hundred and fifty-six. In Austria there are now seven 
 thousand one hundred and eighty-three physicians, of whom but 
 one hundred and eighteen claim any connection with homoe- 
 opathy, and only forty-four of these profess to practice it exclu- 
 sively ; Germany was its birtli-place, yet there are but nineteen 
 in all Vienna ; and in all Europe, with a population of at least
 
 HIS REPUTATION AND SUCCESS. 257 
 
 three hundred millions of souls, there are now but one thousand 
 and twenty-two so-called homoeopaths, — an actual decrease, and 
 that, too, in the face of an enormous increase of the number 
 of regular physicians. 
 
 Even here, in Free America, it has passed its zenith, its 
 feast is almost over, and its Mene, Mene, Tekel is already on 
 the wall, for it has almost ceased to be the topic of conversation 
 in fashionable circles ; the homoeopathic book and case of num- 
 bered globules are also fast disappearing from the hands of the 
 laity ; its so-called specifics are kept among the patent medicines 
 in every drug-store; the system is no longer exciting amateurs, 
 and, far above all, its wholesale desertion of its own principles is 
 about to furnish another proof that no religious creed, no political 
 doctrine, no medical ism or pathy, can extend beyond a limited 
 sphere or period, if it be opposed to the common sense of 
 mankind. 
 
 The New York Homoeopathic Medical Society and other 
 homoeopathic bodies now merely consider Similia Similibus 
 Curantur the best general guide in selecting remedies, BUT from 
 which any may depart, if experience or his individual judgment 
 so direct. 
 
 Well ! well ! ! well ! ! ! Shades of departing greatness. 
 
 Homoeopathy has temporarily maintained its ground here 
 not from any intrinsic merit, but chiefly because its pellets, etc., 
 are easily gotten and at small cost, and easily applied in self- 
 medication at the home or from the pocket of its votaries. 
 
 In considering the nothingness of homoeopathy, think what 
 it is to-day, — that its disciples no longer follow their master, that 
 every change they make is toward regular practice, and that 
 the vast majority of its representatives seem to be on their way 
 back to Regular practice in everything except in name and 
 affiliation. 
 
 When Hahnemann started homoeopathy, the sciences 
 upon which modern medicine is based — chemistry, physiology, 
 pathology, etc. — had, practically, no existence, and it was this
 
 258 THE PHYSICIAN HIMSELF: 
 
 and the overmedication of former days that gave it the start. 
 Were any one to originate such a silly system to-day there 
 could be no excuse for its existence, and it would either fall 
 still-born or be laughed to death. 
 
 Study the homceopathic creed closely, and then carefully 
 watch the practice of all those who to-day claim to practice 
 under it, of whom you have personal knowledge, and you will 
 soon discover that few (if any) honestly do so ; and although 
 the number of those who pretend to practice homoeopathy may 
 still be somewhat on the increase in this country, and enthusiasts 
 here and there are still donating and bequeathing money and 
 holding fairs for the benefit of homceopathic colleges, hospitals, 
 dispensaries, and societies, and its disciples are boasting over their 
 numerical increase and exulting over this political favor they 
 have secured, and over that iiifiiiential patient they have netted, 
 and over the other fresh partisan who is praising it, just as they 
 were in Europe thirty or thirty-five years ago ; yet, pure homoe- 
 opathy itself — similia, etc., based on provings — is rapidly dis- 
 appearing, and I sincerely doubt whether there are at this time 
 half a dozen omnibus-loads of true Hahnemannic homoeopaths 
 in our land, and for the confirmation of this assertion I refer to 
 any qualified pharmacist or manufacturer of granules, tablets, 
 and pills who comes in contact with the homoeopathic thera- 
 peutics of to-day. The genuine homoeopath never prescribes 
 tonics, never orders mineral waters, never gives emulsions, never 
 alternates or mixes remedies, and never uses hypodermatic in- 
 jections, purgatives, mustard plasters, ointments, lotions, washes, 
 liniments, medicated injections, cauterizations, sprays, or gargles : 
 and whoever does so is under the bitter anathemas of Hahne- 
 mann, who said : " He who does not walk on exactly the same 
 line with me, who diverges if it be but the breadth of a straw, 
 to the right or to the left, is an apostate and a traitor, and with 
 him I will have nothing to do." 
 
 " More miglit be said hereof to make a proof. 
 Yet more to say were more than is enough."
 
 CHAPTER X. 
 
 "Behold, how good and how pleasant it is for brethren to dwell 
 together in unity ! " 
 
 Be just and friendly toward every worthy pharmacist. 
 Owing- to the relationship and mutual dependence between 
 pharmacy and medical practice, the pharmacists are your natural 
 allies, and should receive your respectful regard. Probably all 
 physicians will agree that in the ranks of no occupation can a 
 greater proportion of gentlemen and manly men be found than 
 in the pharmaceutical. This, and your joint interests, should 
 make you brothers. 
 
 It will be found an excellent rule strictly to avoid favor- 
 itisms and antagonisms, and to let all reliable pharmacists com- 
 pete for your prescriptions and for the family patronage which 
 they influence. You will make a serious mistake, and engender 
 active enemies, too, if you go out of your way and without just 
 cause instruct patients to obtain their medicines from any par- 
 ticular pharmacy ; if a prescription be properly compounded it 
 makes but little difference by whom, so the compounder i& 
 honorable and reliable. 
 
 Do not deter your patients from patronizing a pharmacist 
 simply because he is also a graduate in medicine, unless he be 
 uniting the two callings from mercenary motives, or habitually 
 prescribe, or have a drug-store (with a window full of bottles of 
 colored water and quack placards) merely as a stepping-stone to 
 get acquaintances and an introduction preliminary to making his 
 (febut as your antagonist or rival ; or if you fold your arms and 
 allow your prescriptions to be compounded by a drug-store phv- 
 sician who prescribes over his counter, or in office or parlor, free 
 of charge, and makes it up on the medicine ordered, you will, 
 unless he shows less than the usual amount of selfishness, be 
 apt finally to regret it. 
 
 Independently of all other considerations, the joint prac- 
 
 (259)
 
 260 THE PHYSICIAN HIMSELF: 
 
 tice of scientific pharmacy and modern medicine is too much for 
 the grasp of any one human intellect, and a person needs all his 
 time to do justice to either, else one or the other is apt to be 
 slighted ; and if your prescription fall into the hands of such 
 parties, or be left to their apprentices or assistants, both you and 
 your patient must take a great many risks. 
 
 There is not the slightest wrong in having your name 
 printed on your prescription blanks. But do not use a prescrip- 
 tion paper which has any other name upon it besides your own. 
 If it contain the name of a neighboring pharmacist, it will natu- 
 rally suggest collusion or something else not complimentary ; if 
 it contain some enterprising fellow's commercial puff, it will 
 indicate very ordinary taste for you to use it. It is probably 
 better to write on good, plain paper ; although it could do no 
 harm to have some such truthful phrase as the following printed 
 on the back of each prescription blank, for the benefit of the 
 public and the protection of your own interests : " A remedy 
 that is useful for a patient at one time may be improper for the 
 same patient at another time, or for other persons at any time, 
 even though suffering with a similar affection." 
 
 Plain white-paper clippings suitable for prescription blanks 
 can be purchased cheaply at any printing-office or book-bindery, 
 or you can buy a ream of suitable paper from wholesale paper 
 dealers, who will cut it into any size you wish. 
 
 It would be wrong, very ivrong, to work hand-in-hand with 
 a pharmacist, and receive from him a percentage on your pre- 
 scriptions for sending them to his store, and for this reason : 
 were you to accept part, it would be robbing either the pharma- 
 cist or the patient. Were the former to allow you so much for 
 each prescription, and re-imburse himself by adding the extra 
 amount to the sum charged the patient for the remedy, it could 
 not be looked upon in any other light than that you had com- 
 bined to fleece an extra amount from every unfortunate who 
 trusted to your honor, just as one would look upon a lawyer 
 who took fees from both sides. On the other hand, if the phar-
 
 HIS REPUTATION AND SUCCESS. 261 
 
 macist possessed more honesty than you and allowed you to 
 reduce his legitimate profit, because compelled to do so or lose 
 your influence, it would place you in a most contemptible po- 
 sition, and you would live in constant danger of exposure and a 
 public condemnation that the strength of Hercules could not, 
 and the God of Justice would not, silence. 
 
 Honesty is the true keystone, without which the whole arch 
 of honor falls. 
 
 "If I lose my honor I lose myself!" 
 
 You must live, and must have fees to enable you to do so, 
 but, unless you obtain every dollar and every dime honestly and 
 honorably, you cannot escape the finger of scorn ; therefore, 
 watch zealously that the public do not imbibe a belief that you 
 are a part owner of or are interested in the loaves and fishes 
 of the drug-store which compounds the largest number of your 
 prescriptions. If such a suspicion be expressed by any one, or 
 if any one insinuate that you seem to prescribe for the purse 
 of the pharmacist rather than for the health of the patient, take 
 care to inform him that you have no such interest. 
 
 If any pharmacist volunteer to supply a physician and 
 his immediate family with medicines either free or at a nominal 
 price, or with such proprietary or other articles as he needs, at 
 cost, the favor can be conscientiously accepted, but it would be 
 unjust to allow him to supply uncles, aunts, and cousins on 
 similar terms. Bear in mind that such a course naturally entails 
 more or less obligation or reciprocal professional attendance on 
 the pharmacist and his family, and should be taken into con- 
 sideration when accepting favors. 
 
 Duty, alike to yourself, your patients, and the profession, 
 forbids you to supply one or several pharmacists with private 
 marks, technical terms, or hieroglyphic symbols that other phar- 
 macists cannot understand, as it would at once suggest trickery 
 and corrupt motives. A still meaner (swindling) device would 
 be to have a secret or cabalistic code, for use between physician 
 and pharmacist, intelligible to them alone. Surely, neither you
 
 262 THE THYSICIAN HIMSELF I 
 
 nor any other honest person needs warning- against such abuses 
 as these, for any one wlio would resort to ])rivate codes or cipher 
 prescriptions lor money-getting is neither honorable nor honest, 
 and might very properly be classed with the vulture who re- 
 joices at sickness, and the wretch who desires the epidemic. The 
 trail of the serpent is over them all ; knaves — 
 
 "Whom none can love, whom none can thank, 
 Creation's blot, creation's blank." 
 
 Your prescription is intended simply to tell the pharmacist 
 what medicine you wish the patient to receive. When sent to 
 the pharmacist it is an order for a certain medicine prepared in 
 a certain way. The law has decided that this prescription or 
 order belongs to the patient ; the pharmacist, after compound- 
 ing it, has, however, a natural right to retain it as his voucher, 
 but he has no right to refill your order without your consent. 
 
 The unauthorized refilling of prescriptions by pharmacists 
 has often produced the opium, alcohol, cocaine, chloral, and 
 other enslaving habits. We also well know that it is often 
 unsafe for a person to take a medicine ordered for another, 
 or even the same medicine at different times. Furthermore, 
 how can the pharmacist conscientiously label the second quan- 
 tity, " Take as directed by Dr. Faraway," when Dr. Faraway is 
 not even aware of the refilling 1 
 
 In consequence of the present unfair habit of many phar- 
 macists, the unauthorized refilled prescriptions probably out- 
 number those of the authorized, five to one. 
 
 Drug-stores have become so numerous of late, and the area 
 from which each must derive its patronage and support is so 
 limited, that their proprietors, in order to keep their heads 
 above water, have either to charge very high for the medicines 
 prescribed or substitute inferior drugs ; the result is that drug- 
 bills have gradually grown greater and greater, till of late they 
 almost eclipse the charges for medical attendance. Many people, 
 to avoid what appear to them exorbitant prices, now actually 
 buy this, that, or the other quack medicine, make home mix-
 
 HIS REPUTATION AND SUCCESS. 263 
 
 tures, wend their way to no-drug irregulars or some over-the- 
 counter-prescribing druggist, or trust entirely to nature, instead 
 of paying physicians for prescriptions and then having to pay 
 heavily to have them compounded. 
 
 The cost of medicines may be slightly reduced by instruct- 
 ing your patient to save the cost of the bottle by carrying one 
 with the prescription ; doing so cannot be objectionable to phar- 
 macists, as they charge only cost price for bottles. A good and 
 legitimate way to lessen the cost of certain prescriptions is to 
 omit inert and unessential ingredients ; for example, if you pre- 
 scribe a mixture of wine of colchicum-root, tincture of digitalis, 
 .and sulphate of morphia for a patient, do not increase what 
 would naturally be a one-ounce mixture, that would cost about 
 thirty-five cents, into six or eight ounces, by adding syrup, 
 water, or other vehicle, thus swelling the dose to a tablespoon- 
 ful and the cost to a dollar. Prescribe the essential ingredients 
 only, and let the directions specify how many drops to take and 
 how and when. 
 
 A dose of medicine in powder or pill form is usually more 
 expensive than the same in fluid form ; besides, poisons and 
 very active remedies can be more accurately divided when in 
 solution. 
 
 Another evil resulting from there being too many pharma- 
 cists for all to live by legitimate business is, that not a few, not 
 content with the great '■'■apothecaries^ profit " derived from the 
 sale of medicines, encroach on the domain of medical practice, 
 and prescribe, by the smattering of knowledge they pick up 
 from the prescriptions of competent physicians, for every foolish 
 applicant whose case does not appear to be formidable ; even 
 selling, by guess-work, this, that, or the other thing for liome 
 cases which they have not even seen, because asked to do so b^ 
 the foolish ; and thus build up a large office (or store) practice. 
 How many, how very many, simple, functional cases are thus 
 given medicines which do no good, but great harm, by taking 
 the place of others which might have been of great benefit if
 
 264 THE PHYSICIAN HIMSELF: 
 
 given at the proper time, and are in tliis way, during the first 
 few hours or days, converted into incurable or organic ones by 
 such " medicine-men " ; and how many new ailments are 
 induced by Mr. Emetic's, Mr. Gargle's, and Mr. Jackall's hap- 
 hazard prescribing heaven only knows. Fully one-half of all 
 cases of venereal disease, biliousness, debility, cough, and the 
 like, are now seen and treated by pharmacists (and their clerks 
 and greenhorn apprentices) before calling on physicians. Four 
 out of five of those whose complaints prove simple are, of 
 course, cured like magic by the four little pills which the phar- 
 macist recommends, or by the great liniment he sells, or by his 
 noted fever-and-ague mixture or equally famous tonic, or his 
 universal elixir, that is simple and caii't do any harm, etc. ; and 
 they, thinking that he has turned some dire disease aside, laud 
 the pharmacist to the skies and advise all to go — 
 
 "Fools go in throngs " — 
 
 to Him for their livers, and kidneys, and lungs, and brains, and 
 stomachs, instead of consulting a legitimate physician, with 
 assurances that He is as good as any doctor, and a great deal 
 cheaper. 
 
 Hear Shelley in his scenes from the " Chalderon Dia- 
 logue " : — 
 
 " Cf/. Have you studied much ? 
 
 " De. No : and yet I know enough not to be wholly 
 ignorant. 
 
 " Cy. Pray, Sir, w^hat sciences may you know 1 
 
 " De. Many. 
 
 " Ci/. Alas ! much pains must we expend on one alone, 
 and even then attain it not ; but you have the presumption to 
 assert that you know many without study. 
 
 " De. And with truth, for in the country whence I come 
 sciences require no learning ; they are known. 
 
 " Cy. Oh ! would I were of tliat bright country ! for in 
 this the more we study we the more discover our great igno- 
 rance."
 
 HIS REPUTATION AND SUCCESS. 265 
 
 No person who is incompetent to examine a patient is com- 
 petent to prescribe for him; and I would ask what sensible 
 pharmacist would trust himself, or his wife, or his cliild to the 
 examination and " subscriptions " of a neighboring pharmacist ] 
 
 Another, although lesser, evil is this : If a patient's better 
 sense carries him, in the first place, to a physician for advice, 
 instead of to a pharmacist, ten to one he will be presented at 
 the drug-store with one or two quack almanacs filled with 
 infamous and alarming falsehoods, or a handful of advertising- 
 pictures, or that the bottle of medicine will be wrapped in 
 Foolembad's or some other pushing fellow's handbill. The 
 co-operation of the pharmacist as retailing agent for quack 
 medicines is indispensable to quackery ; and without it seven- 
 eighths of the harm that patent-medicine literature is doing 
 would cease, the vain promises that keep the public rushing 
 from one lying wonder to another would no longer entice, and 
 at least two-thirds of the quack and humbugging proprietary 
 trash that now curses our land would slink from sight. 
 
 "Oh, where is the still, small voice of conscience?" 
 
 You will do well to avoid, as far as possible, all pharma- 
 cists whose presumption leads them to assume the role of a 
 physician. The recommendation does not, of course, refer to 
 emergencies, in which a pharmacist acts as a humanitarian. 
 The manufacture of steel is one thing, and applying watch- 
 springs is another. Medicines are the physician's two-edged 
 tools ; a pharmacist may prepare them and handle them for a 
 life-time and be an excellent compounder, and yet, as his studies 
 are pharmaceutical and not therapeutical, he may know no 
 more about prescribing for the sick properly than the mechanic 
 who makes needles or scissors does about dressmaking ; or the 
 instrument-maker does about operative surgery ; or the manu- 
 facturer of trowels and plows and chisels about bricklaying, 
 farming, or carpentering. 
 
 If a sick person ask a pharmacist for a plaster, a dose of 
 cathartic pills, or an ounce of tincture of iron, there is no
 
 266 THE PHYSICIAN HIMSELF: 
 
 reason why he should refuse to sell them ; but if he ask him 
 what is the best remedy for this, that, or his other affliction, 
 with a view to purchase whatever he designates, that is another, 
 a therapeutical matter, and is beyond his sphere. 
 
 "Michael, Michael, you have no bees, and yet you sell honey." 
 
 Be also on your guard against instrument-makers and 
 dealers who meddle with surgical cases, and manufacturers of 
 appliances for deformities, examining or prescribing opticians, 
 masseurs, etc., who presume to treat cases tliat should be referred 
 to the physician or surgeon. In fact, avoid encouraging any 
 one who encroaches on the physician's province. 
 
 Every patient should be warned that it is dangerous to 
 wear spectacles, trusses, supporters, braces, pessaries, and the 
 like, that have not been prescribed by a physician. 
 
 Make it a point never to style a pharmacist, an optician, a 
 preacher, or any one else, " Doctor," or " Professor," unless he he 
 one. Heaven knows the much-abused titles are cheap and pro- 
 miscuous enough without bestowing them on ignorant spectacle- 
 pedlers, and others who have not even applied for them. 
 
 Avoid overpraising any prescribing pharmacist to your 
 patients, or people will, on your word, overestimate him, and 
 begin to rely on his gratuitous advice, instead of on the phy- 
 sician's, in all cases considered moderate. 
 
 Bevi^are of pharmacists who indiscreetly talk too freely, or 
 converse, joke, etc., while compounding prescriptions, or know- 
 ingly insinuate to those who carry them prescriptions that they 
 know what they are for, and have extra impudence when 
 cubebs, ergot, etc., are ordered ; or suggest to purchasers that 
 the dose prescribed is too large or too small ; also, the blunder- 
 ing blockheads who misread prescriptions or miscopy directions, 
 or put wrong directions or the wrong physician's name on 
 bottles, or surprise and alarm people by charging a different 
 price every time a prescription is renewed, as if they had no 
 system, or as if the medicines were put up wrong ; who make 
 the impression that it takes them half their time to correct the
 
 HIS REPUTATION AND SUCCESS. 267 
 
 blunders and mistakes of the other half; who leave prescrip- 
 tions partly compounded to wait on other customers, or to 
 unscrew soda-water for sports who are in a hurry; or who in 
 other ways allow interruption, or show abstraction or careless 
 compounding. For such people be especially careful how you 
 abbreviate, and how you make your S's and 5's, and carefully 
 dot every i and cross every t in your prescriptions, so as to 
 afford them no shelter if a mistake occur, and, above all, to 
 prevent a coroner's jury ; or to clear yourself if a death- 
 certificate is made necessary. 
 
 Mistakes in writing and in compounding- prescriptions 
 occur more often from improper haste, and by trying to do two 
 or three things at once, than from incompetency. 
 
 Prescriptions written with ink instead of pencil have the 
 decided advantage that they are not easily defaced and do not 
 admit of easy erasure, etc. 
 
 A very good and safe rule in prescription-writing is to put 
 down all the ingredients first ; next write the directions to the 
 pharmacist and the directions for use ; then the number of 
 doses should be decided on, and, lastly, the quantity of each 
 ingredient should be carefully calculated and carefully written, 
 followed by your name or initials. 
 
 Look on the back of every prescription paper you use 
 to see that there is nothing of a mistake-causing nature 
 accidentally written on it. 
 
 If you believe on good authority that any pliarmacist so 
 far forgets himself as to make disparaging comments upon you, 
 or your professional ability, or your remedies, doses, or apparent 
 inconsistencies ; or to exhibit and decry your prescriptions to 
 Irregulars, laymen, or other physicians, or to predict that they 
 will not prove useful ; or to make unauthorized substitutions, 
 give under-weight of expensive ingredients, or omit them alto- 
 gether, — 
 
 "Who knows the right, and yet the wrong pursues," — 
 
 or to join with our enemies in reviling our profession and its
 
 268 THE PHYSICIAN HIMSELF: 
 
 imperfections, or in nick-naming different physicians in derision ; 
 or to keep liis prescription-file open to miscellaneous inspection, 
 or to liave a medical protege under his wing, into whose hands 
 lie endeavors to direct customers for selfish purposes, or to be 
 guilty of any other grossly unprofessional conduct, you will be 
 fully justified in directing your patients to go elsewhere for 
 medicines. 
 
 In ordering syringes, brushes, atomizers, breast-pumps, pro- 
 bangs, etc., with your prescriptions, be careful to specify the 
 kind or size you wish. To write a prescription for a solution, 
 and add, " also a syringe for using," is often as perplexing to 
 the pharmacist as if you were to send for a slip of adhesive 
 plaster as long as a string or for a lump of rhubarb the size of 
 a piece of chalk. 
 
 When any one is unable to pay the full price for what you 
 prescribe, the words " Poor patient " in your handwriting, at the 
 top of the prescription, will secure from any pharmacist the 
 greatest reduction in price that he can afford to make. 
 
 You may take the following as somewhat of a guide in 
 determining whether this or that pharmacy is conducted on a 
 proper plane and worthy of confidence. Among the dis- 
 tinguishing features of a legitimate and properly conducted 
 pharmacy are : — 
 
 1. Proprietor an experienced practical pharmacist, of intel- 
 ligence, capacity, and integrity. 
 
 2. Competent and courteous assistants. 
 
 3. Pride and skill shown in selecting and preparing pure 
 medicines. 
 
 4. Prescriptions compounded only by graduates in phar- 
 macy. 
 
 5. A full and comprehensive line of pure drugs, apparatus 
 and appliances for use in the care of the sick, also dietetics and 
 sick-room conveniences kept. 
 
 6. An orderly and perfectly equipped prescription depart- 
 ment. Store neat and attractive.
 
 HIS REPUTATION AND SUCCESS. 269 
 
 7. Quiet and discipline maintained. No loungers or 
 smokers. 
 
 8. No liquors sold as beverages. 
 
 9. Not a bazaar of general merchandise. 
 
 10. Patent medicines and other nostrums shown and sold 
 only when called for. 
 
 11. No habitual prescribing or giving medical advice. 
 
 12. Prices neither cheap nor exorbitant, but reasonable. 
 
 13. Prompt attention and accuracy characteristic. 
 Among the features that mark improperly conducted ones 
 
 aife; — 
 
 1. Habitual prescribing over the counter. 
 
 2 Indiscriminate refilling of prescriptions. 
 
 3. Unnecessary delay and detention of customers. 
 
 4. Careless handling of medicines and loose management 
 of store. 
 
 5. Patent and proprietary remedies paraded and pushed. 
 
 6. Disparagement of physicians to the laity. 
 
 7. Store a resort for political or other crowds or cliques. 
 
 8. Unchaste conversations and disreputable conduct. 
 
 9. Wines and liquors sold as beverages. 
 
 10. Dealing in articles used for criminal or immoral pur- 
 poses. 
 
 11. Engrossing attention to sale of soda-water, cigars, 
 tobacco, fancy goods, etc. 
 
 12. Store kept merely as an adjunct to some other project. 
 
 13. Lack of sobriety in proprietor or clerks. 
 
 * * 41: 
 
 Be prompt and decided in refusing to give laudatory pro- 
 fessional certificates to any secret article; do not be too liberal 
 even in giving them to legitimate pharmaceuticals, and never 
 issue one founded on any other basis than purity of ingredients, 
 or special skill or experience in compounding them. 
 
 Willingness to give medical certificates is an almost uni- 
 versal weakness of mankind. The idea of being paraded in
 
 270 THE PHYSICIAN HIMSELF: 
 
 print as " an authority " in connection with some wonderful 
 cure is pleasing to thousands of people in every station of life, 
 and makes them willing to have their names and even their 
 pictures paraded in almanacs, hand-bills, and newspapers. In- 
 deed, many impressible people, whose bump of wonder is easily 
 touched, could almost be inveigled into certifying in medical 
 matters that two and two make five by any sharper wlio 
 understands how to tickle their self-conceit and love of 
 notoriety. 
 
 Be alike determined in declining to give (un)professional 
 certificates to any one on disputed or partisan questions, or 'in 
 regard to surgical appliances, copyrighted medicines, rival wines, 
 competing mineral waters, beef-extracts, baking powders, arti- 
 cles of commerce, patent contrivances, health resorts, etc., for 
 they are often improperly used and made subservient to pur- 
 poses not anticipated, and will affect the interests of the profes- 
 sion at large, as well as your own. If you ever give one, 
 people who happen to know you may regard its personal and 
 not its professional significance, but every one else throughout 
 the land will know your title only. When amiable John Doe 
 gives his certified opinion that ice is hot and fire is cold,, it 
 remains simply John Doe's opinion ; but when John suffixes his 
 title of M.D., he undoubtedly gives that certificate a profes- 
 sional significance, and, to some extent, involves the entire 
 profession therein. 
 
 You may judge certificate-giving by its prejudicial effiects 
 on our own profession. One of the worst inflictions we endure 
 to-day is the endless parade of misleading certificates from wide- 
 mouthed clergymen, politicians, merchants, lawyers, D.D.s, 
 LL.D.s (A.S.S.s, N.G.s), and other "distinguished citizens," 
 known and unknown, recommending all kinds of medical 
 nostrums. 
 
 "Heigh ho, the devil must be dead." 
 
 You know, and every sensible person knows, that such Peck- 
 sniffian certificates are not worthy of credence, and that the
 
 HIS REPUTATION AND SUCCESS. 271 
 
 preacher of Gospel truth who (instead of confining himself to 
 preaching the Glorious undefiled Gospel of the blessed God, the 
 God of the Bible), bribed by a box of pills, or a bottle of bit- 
 ters (that make drunkards and kill forty times as quick as 
 whisky does), forgets his high mission, the cure of dying and 
 perishing souls, and with reverential sanctimonious solemnity 
 (ahem !) turns up the whites of his eyes, — 
 
 "O hollow, hollow, hollow !" — 
 
 and lends his name and the cloak of theology to assist the 
 Diabology of charlatans and sharpers who deceive the afflicted 
 with quack nostrums that are not worth the cost of the bottle 
 they are in, must be eitlier a silly dupe or a cruel knave. 
 
 "Knaves and fools divide the world." 
 
 Prof. Brass, Dr. Skinem, and every other sharp quack 
 knows the influence of a clergyman's religio-medical indorse- 
 ment published in a Sunday paper, and hence makes special and 
 too often successful efforts to obtain it, feeling certain that thev 
 can easily entrap the dupable portion of the flock after the 
 Shepherd (?) is secured, — 
 
 "He steers his boat well," — 
 
 and it is a singular fact that, though few men get more gratui- 
 tous advice out of physicians than ministers of the Gospel, yet 
 no class do more to injure the profession, by the ridiculous 
 countenance they give to various kinds of quackery and pathies 
 and isms. Truth should teach teachers to teach truth. 
 
 Suppose it suited the pride and the principles of our pro- 
 fession to enter the self-advertising arena, with quacks and 
 patent-medicine men, and to scatter reports of all our daily cures 
 and successes all over the land ! Where would the petty 
 triumphs of quackery, and patent pills, and bottled nostrums 
 stand in the contest? Austin Flint vs. Hostetter; Samuel D. 
 Gross vs. Brandeth, Johns Hopkins Hospital vs. Keeley's. 
 
 Whenever you are asked by traders in medicine, or their 
 plausible drummers, who have no further interest in sickness
 
 272 THE PHYSICIAN HIMSELF I 
 
 than as it advances the sale of their nostrnms ; and when tempted 
 by glowing advertisements, highly-colored certificates, epitomized 
 treatises on therapeutics and practice, etc., to prescribe and make 
 a market for their semi-secret trade-mark pharmaceuticals, copy- 
 righted medicines, and the nine hundred and ninety-nine 
 elixirs, restoratives, tonics, panaceas, and other specialties "with 
 attractive empirical names, gotten up by middlemen, crusad- 
 ing druggists, manufacturing pharmacists, and pharmaceutical 
 associations, with labels that give suggestions for their use, to 
 catch the popular eye and the popular dollar — think of the cun- 
 ning cuckoo (see p. 32), and how its one eg^ hatches evil to the 
 whole nest, and do not use them. Patent medicines are wolves 
 in wolves' clothing ; proprietary medicines are wolves in sheep's 
 clothing, whose owners are begging favors from you with one 
 hand and intercepting your patients with the other. 
 
 To fully realize the colossal proportions of the lucrative 
 proprietary remedy method of superseding physicians, and of 
 the mercenary motives and humbuggery that lie at the bottom 
 of it, and the injury it inflicts on health, credit, and business, go 
 and take a bird's-eye view of the vast and bewildering array of 
 empirical and proprietary compounds: syrups, balsams, expec- 
 torants, and panaceas, each good for everything, — asthma and 
 sore eyes, the itch and worms; and at tlie bushels of recom- 
 mendations under which the shelves in the quack and proprie- 
 tary departments of every wholesale drug-store groan, and tlien 
 reflect on the enormous sums of money spent in telling — 
 
 Quack ! Quack ! ! Quack ! ! !— 
 
 of their virtues in the newspapers, and on rocks, fences, and 
 dead walls. Thus enlightened, you can hardly fail firmly to 
 resolve henceforth to abjure them. 
 
 "The path of duty is the path of safety." 
 
 Unless you have mistaken your profession, are incapable 
 of thinking and lack ingenuity, our standard and accepted 
 agents, the United States Pharmacopoeia and the dispensatories,
 
 HIS REPUTATION AND SUCCESS. 273 
 
 should certainly be large enough and reliable enough to allow 
 you to exercise yourself freely in the art of prescribing, and to 
 make any required combination, and to accurately adjust the 
 relative proportion of every ingredient to the condition of your 
 patient ; and you should, therefore, assert your intelligence and 
 follow this, the legitimate mode of prescribing, and let our com- 
 mercial rival's ready-made novelties, patented articles, and dish- 
 water substitutes for medical attendance alone. 
 
 Of course, if anything truly useful or unmistakably better 
 than the old is discovered, but not yet in the pharmacopoeia, 
 you would not, you sliould not fail at once to give your patient 
 the benefit of it ; but beware of all articles that are being adver- 
 tised and pushed on catchpenny principles. 
 
 The principle which governs our condemnation of secret 
 nostrums is this : They not only do more harm than good, but, 
 if puffing and advertising alone enable the proprietor of a 
 quack remedy to fleece the sick, its unprincipled owner deserves 
 exposure and contempt. If the nostrum is really valuable, 
 which is very rarely the case^ its composition should be freely 
 and fully disclosed for the benefit of suffering humanity. 
 
 You should also maintain your independence and never 
 order A.'s, B.'s, or C.'s make of anything unless you have some 
 specific therapeutical reason for so doing. To thus particularize 
 would not only reflect injuriously on every other manufacturer 
 and cause a still greater popular distrust of our materia medica 
 and pharmacopoeia, but also put the compounder to additional 
 trouble and expense ; for he might have several other varieties 
 of the same article in his stock, and yet be compelled by your 
 specification to get another. It almost invites substitution. I 
 knew one case in which the pharmacist, though he had twenty-one 
 different preparations of codliver-oil emulsions, resembling each 
 other so closely in all important respects that but a hair divided 
 them, standing spoiling on his shelves, had to get the twenty- 
 second to fill such a prescription. 
 
 Do not, however, 0})pose any remedial agent that is a
 
 274 THE PHYSICIAN HIMSELF: 
 
 distinct improvement in pharmacy, or any particular brand of 
 anything on account of its being a monopoly, if that monopoly 
 is owing to unusual skill, superior quality of materials used, or 
 great perfection in its manufacture. 
 
 Patients are under the impression that pharmacists have 
 about ninety cents profit in every dollar, and also think phy- 
 sicians know precisely what a medicine ought to cost, and will 
 often ask you liow much the druggist will charge for the reme- 
 dies you have prescribed. Reply promptly that you do not 
 know, that some medicines cost the pharmacist twenty times as 
 much as others, and avoid mentioning any specific sum ; 
 because, were you to guess too high, they might infer that he 
 had either made a mistake or used inferior drugs ; and were you 
 to guess too low, they would probably accuse the pharmacist of 
 overcharging, and perhaps drag your name into their squabbles. 
 Further, the people naturally overlook one all-important, price- 
 less ingredient that every good pharmacist employs in com- 
 pounding prescriptions, the worth of which he justly adds : I 
 mean, the concentrated extract of brains. 
 
 Whenever you prescribe a remedy that is unusually expen- 
 sive, such as musk, salicin, resorcin, salol, oil of erigeron, etc., 
 take care to inform the patient of the fact, and that expensive 
 drugs are no more profitable to the pharmacist than cheaper 
 ones, so that he will not be surprised and cavil when the phar- 
 mat^ist tells him how much he charges for it. 
 
 Notice particularly whether a pharmacist gives unusual 
 prominence to nostrums, quack almanacs and placards, or has 
 quack advertising signs painted on his doors or outside walls, 
 and it will give you a true insight into his aims and attitude 
 toward our profession. If you see that he is pushing his quack 
 department in a hurrah way, with quack proprietors' portraits 
 in his windows and hanging around his store, — 
 
 "Roaring, roaring, roaring, nothing but roaring," — 
 
 and his own name and influence used in handbills and almanacs 
 as a vendor of nostrums, bitters, plasters, pads, etc., or selling
 
 HIS REPUTATION AND SUCCESS. 275 
 
 liquor as a beverage, or selling- medicines at retail or less than 
 his pharmaceutical neigh l)ors pay for them at wholesale, you mav 
 be sure that he is conducting his establishment simply as a trades- 
 man, on a trade basis rather than on a professional one, which 
 latter presumes him to love pharmacy and to devote his chief 
 attention to the inspection and preparation of pure and reliable 
 drugs, and compounding prescriptions with scrupulous exact- 
 ness; and by shunning him you will fulfill a moral obligation. 
 To sell abortifacients, or vile nostrums intended to produce 
 abortion, with the pretended caution, " Perfectly harmless, but 
 not to be taken by women in a certain condition," is criminal. 
 
 " Cunning has but little honor." 
 
 Probably you have no right to ask or expect that the phar- 
 macist should not deal in quack or proprietary medicines, or 
 anything else for which there is a demand, as he keeps his store 
 to make a living ; you have, however, an undoubted right ta 
 expect him to show the equity of his position between their 
 owners and us by keeping them out of sight, to be shown only 
 when called for, just as he does sweet spirits of nitre, syrup of 
 the iodide of iron, aromatic spirits of ammonia, and other 
 fruits of pharmaceutical chemistry, instead of pushing their 
 sale by displaying their announcements far more prominently 
 than legitimate pharmaceuticals. 
 
 In drugs and medicines purity and accuracy are of the first 
 importance, because the uniformity in action of every medicine 
 is in proportion to its purity and goodness ; some of our impor- 
 tant remedies vary greatly in quality and in strength, and this 
 is one of the occasional causes of uncertainty in the practice 
 of medicine, and such variability would modify your efforts too 
 much to be risked in any important case. A badly compounded 
 prescription may rob you of your reputation and deprive the 
 patient of his chances of recovery. If you think, therefore, that 
 an important prescription is likely to be sent to a pharmacist 
 whom you conscientiously believe to use inferior, stale, or impure 
 articles, it is your duty to take care that it be sent elsewhere;
 
 276 THE PHYSICIAN HIMSELF. 
 
 for, being responsible for the patient's welfare, and having your 
 own reputation to care for, you have a perfect right, and indeed 
 it is your duty under such circumstances, to have your remedies 
 procured where you believe your prescriptions will be properly 
 made up. 
 
 Pharmacy requires nice and delicate skill and imposes great 
 responsibility, and the art of medicine is imperfect enough at 
 best, and you will encounter more than enough of new and 
 strange problems to remind you of your lack of aids and of the 
 insufficiency of human resources, without adding the risk of 
 being thwarted by the error, fraud, or accident of an unreliable 
 pharmacist with deteriorated, adulterated, or inert drugs ; but 
 when you find it necessary to ignore any one for this reason, 
 take care to do so in a discreet, ethical manner, with as little 
 personality as possible. 
 
 Whether to allow a patient to know the name and nature 
 and action of the remedies you prescribe, or not, requires great 
 discretion, and good judgment is required to distinguish between 
 persons who would and those who would not be benefited by 
 an explanation of the intended remedies. There is often a 
 temptation to endeavor to enlist the patient's confidence by fur- 
 nishing him an insight into the nature and object of the agents 
 employed ; but the majority of experienced physicians seldom 
 commit themselves, or if, in certain cases, to gratify the patient's 
 whims, they appear to >deld to the temptation, their explana- 
 tions are advisedly ambiguous, and you, while judiciously seek- 
 ing to inspire confidence in your patients, had better keep them, 
 as far as may be, in ignorance of the remedies employed. But 
 few physicians have escaped the chagrin of seeing their reasons 
 and their remedies made use of to blame them and to cast dis- 
 credit on their skill. You will, indeed, often wish you had 
 synonyms for the terms quinia, zinc, opium, chloral, strychnia, 
 morphia, and probably for other articles in daily use. When- 
 ever a synonym for any of them is supplied, it will be judicious 
 in many cases to use it. By employing the terms ac. phenic.
 
 HIS REPUTATION AND SUCCESS. 277 
 
 for carbolic acid, secale corniit. for ergot, kalium for potassium, 
 natrum for sodium, cliinin for quinia, tinctura thebaica for tinc- 
 tura opii, etc., you will debar many a patient from reading your 
 prescriptions and hampering you, — a check which is often highly 
 desirable. You can also further eclipse his wisdom by trans- 
 posing the terms you use from the usual order and writing the 
 adjective in full and abbreviating the noun, — e.g., instead of 
 writing quiniae sulpli., write sulphatis quin.; compound cathartic 
 pills, cath. pil. comp., etc., etc. 
 
 The official pharmacopoeia distinctly recognizes the neces- 
 sity of concealing the nature of certain preparations ; and opium 
 may be ordered under several synonyms without giving the 
 slightest suspicion of its presence. You cannot greatly err in 
 honestly seeking to conceal from your patients the nature of the 
 remedies prescribed for their ailments. 
 
 "The silent physician has many advantages." 
 
 Be very careful to have all powerful remedies intended for 
 external use labeled " For external use," or " Not to be taken," 
 which will not only tend to prevent errors and misunderstand- 
 ings, but in case they are swallowed by mistake it will save you 
 from censure. For the same reasons, also be careful to order 
 all mixtures, that may separate on standing, to be shaken 
 before pouring out the dose, otherwise the patient may get all 
 the active ingredients in either the first few or the last few 
 doses. 
 
 When you prescribe a remedy of such an active character 
 that it would poison if taken in large doses, or all at once, it is 
 wise to make such verbal cautionary remarks about it as will 
 fully put those who administer it on their guard. Also, when 
 you prescribe a remedy for external use, and at the same time 
 one that is to be taken internally, be careful to tell the patient 
 how each will look and smell, so that he may not confound 
 them and swallow the wrong one. Absent-minded pharmacists 
 have more than once put liniment labels on bottles containing
 
 278 THE PHYSICIAN HIMSELF: 
 
 remedies for internal use, and those designed for the latter upon 
 the liniment-bottles, thereby leading to a jury of inquest, which 
 a word of explanation from the physician to the patient might 
 have prevented. 
 
 Pharmacists might easily avoid the possibility of thus ex- 
 changing labels by compounding one and labeling it before 
 commencing the other. By instructing the pharmacist to put a 
 red label on all the bottles for external use, security against 
 mistakes is better insured. 
 
 If, in prescribing such agents as tincture of belladonna or 
 tincture of iodine, for external use, you direct the pharmacist to 
 " put brush in the cork," seeing the brush when the bottle is 
 opened, will almost surely prevent its being taken internally. 
 
 You will notice that some pharmacists label the remedies 
 they compound for you with their file numbers only, thus, 7483 ; 
 while others adopt the much more satisfactory plan of adding 
 the date on which it was compounded, thus, 7483, 19-7-93, 
 signifying that it is numbered 7483, and that it was com- 
 pounded July 19, 1893. The latter plan will enable you to 
 distinguish between the dates at wliich you prescribed different 
 bottles of medicine, and may otherwise be of service to you. I 
 am quite sure the majority of pharmacists would cheerfully make 
 use of this system if they were aware how often it assists the 
 physician. 
 
 Even with the best care every one is liable to make mis- 
 takes, and even the wisest men are not always wise. One might 
 write tablespoonful where he meant teaspoonful, or sulph. 
 morph. instead of sulph. quin., or acid, carbolic, when he meant 
 acid, boracic, or tinct. opii when he meant tinct. opii camph., etc. 
 
 It is well, therefore, to request neighboring pharmacists 
 always to inform you of any ambiguity or apparent mistake in 
 prescriptions bearing your initials before dispensing them, and, 
 in return, when 
 
 "Some one has blundered," 
 
 and you have reason to suspect the mistake has been in com-
 
 HIS REPUTATION AND SUCCESS. 279 
 
 pounding the prescription, be careful not to make your suspicion 
 known either by word, look, or action, till you have conferred 
 with the person who dispensed it. The error, if one exist, is 
 just as apt to be yours as his. 
 
 When a prescription is for an infant, or a young child, it is 
 a great safeguard against error in compounding to put at the 
 head of the prescription, " For an infant," or " For a child," or 
 " For little AVillie," etc. 
 
 Bear in mind that the pharmacist, like yourself, is only 
 human, with long hours and short pay, and that he, like other 
 persons, requires some rest and relaxation from his drug-mixing 
 and drug-selling slavery ; and do not order mixtures requiring 
 tedious manipulations, or direct filthy ointments to be made, or 
 dirty plasters to be spread, suppositories to be molded, or other 
 unpleasant duties to be performed on Sunday, or during sleep- 
 ing-hours, unless they be urgently needed.
 
 CHAPTER XL 
 
 "Sound policy is never at variance with substantial justice." 
 
 As a physician you will hold two positions in relation to 
 patients : first, during sickness you will feel a humane interest 
 in them and a scientific interest in their diseases, give them 
 your best skill and your labor, and employ whatever remedies 
 will be most surely, most safely, and most raY)idly beneficial ; 
 to this you will add sincere sympathy and commiseration. 
 Later, when, by recovery or death, your interest and skill are 
 no longer required, you will enter upon the second, or business 
 relation, and then you should, unless poverty forbid, demand 
 and secure, in a business-like manner, a just remuneration for 
 your services. 
 
 Business is business, and should always be regarded as 
 such. You must be clothed and fed, and must support those 
 dependent upon you, just as other people do. Every person 
 naturally and properly looks to whatever occupation he follows 
 for support; therefore, let not false delicacy or out-of-place 
 politeness break up the business part of your profession, or inter- 
 fere with your rules in money matters, or prevent your knowing 
 where sentiment ends and business begins. You are human, 
 and must live by your practice, just as the priest lives by the 
 altar, the lawyer by the bar, and all other people by their 
 avocations. The practice of medicine is the work of your life ; 
 it is as honest, useful, and legitimate a branch of human indus- 
 try as any other on the face of the globe, and no one earns 
 his means of living more fairly, and often more dearly, than 
 the hard-worked physician, and both common sense and vital 
 necessity require that you should try to provide properly for 
 yourself and for those dependent on your labors for support. 
 
 This you cannot do unless you have a business system, for 
 upon system depends both your professional and your financial 
 (280)
 
 HIS REPUTATION AND SUCCESS. 281 
 
 success. No man is at his best when handicapped by poverty ; 
 and no one can practice medicine with clearness and penetra- 
 tion, earnestness and effect, if his mind be depressed and dis- 
 tracted, or health lowered and temper vexed by the debts he 
 owes, or be annoyed and dunned by hungry creditors at every 
 corner ; or whose discontented stomach is uncertain where the 
 next meal, for himself and his care-worn family, is to come 
 from ; or who walks the floor and knows not which knock at 
 the door will be the sherift''s. These and other cares, that pov- 
 erty entails, dwarf any (Deadbroke) physician's mind and body, 
 and cripple his work ; and it is only when free from the incu- 
 bus, the mental solicitude of debt and poverty, that his mind 
 and his energies can do full justice to his attainments. 
 
 "Anticipated rents and bills unpaid 
 Force many a doctor into the shade." 
 
 In these days neither untiring study, nor unselfish devo- 
 tion as a humanitarian, nor the bubble of applause will enable 
 you to live on wind, — 
 
 "All leaf and no fruit," — 
 
 or lift you above the demands of the tailor, the instrument- 
 maker, the book-seller, the grocer, the butcher, and other cred- 
 itors, not one of whom would accept your reputation for pro- 
 fessional devotion, or of working for philanthropy, or your 
 smiles, thanks, and blessings for his pay ; nay, even tlie con- 
 ductor will repudiate such sentimental notions, and put you off 
 the street-car which is carrying you to your patient, if you do 
 not have money to pay your fare. 
 
 "Wrinkled jjurses make wrinkled faces." 
 
 It is, naturally, a pleasant thing to be very popular ; but even 
 were your air-built popularity and verbal fame to embrace the 
 whole city, neither it nor checks on the Bank of Fame will fill 
 your market-basket nor purchase books, pay your rent nor feed 
 your horse ; and although the Glittering Dust is neither the 
 primary nor the chief incentive in the practice of medicine, it
 
 282 THE PHYSICIAN HIMSELF: 
 
 ever has been and ever must be one of the objects, for no one 
 can sustain his practice without a money feature. 
 
 "Necessity has sharp teeth." 
 
 If people do not pay you you cannot live by your calling, and 
 you will very soon tire of all iDorh and no pay. Almost as 
 well to starve without a patient. 
 
 In your money affairs be systematic and correct, for it is as 
 important to charge your visits as it is to make them ; malve it 
 your habit never to retire to bed without making some kind of 
 record of every visit, etc., made during the day. The nearer 
 your financial arrangements approach the cash system, the 
 better it will be for you and your family. Frequent accounts 
 are best for the physician. If he render bills promptly, it 
 teaches people to look for them, and to prepare to pay them, 
 just as promptly as they do other family expenses. It is often 
 more advisable even to submit to a reduction in a bill for 
 prompt payment, than to let the account stand over and run 
 the risk of losing it through the pay-when-you-please system, 
 for while you are waiting some may fail and others abscond. 
 Besides, after settling promptly, many patients will feel free to 
 send for you again and make another bill, even in moderate 
 sickness, instead of dallying witli home remedies or quack 
 medicines, as they might do if they still owed you. 
 
 You should render your bills while they are small, and 
 your services are still vividly remembered, not only because 
 gratitude is the most evanescent of human emotion, but for 
 another reason : if you are neglectful or shamefaced and do not 
 send your bills promptly, it will create a belief that you do not 
 believe in prompt collecting, or are not dependent • upon your 
 practice for a living, or have no wants and do not need money ; 
 or that you do not hold this or that person to your business 
 rule, or are not uneasy about what they owe you ; and if you 
 foster a bad system of book-keeping a bad system of collecting 
 will grow up around you, and great loss will result. Asking 
 for payment reminds patients that there is still a little of the
 
 HIS REPUTATION AND SUCCESS. 283 
 
 human left in a man, even if he have become a physician, and 
 that, since you have to hve, you must have your fees to enable 
 you to do so. 
 
 The business of the world is now conducted on the cash 
 system, instead of the old Jong credit plan, and you should do 
 your share to 
 
 "Break the legs of the evil custom," — 
 
 the unjust habit that physicians used to follow, either through 
 carelessness or to maintain the favor of patients, of waiting six 
 months or a year after rendering services before sending a bill. 
 If a physician attend a person, say in February, and send his 
 bill in March or April, it seems to the patient like a current ex- 
 pense, and as though the physician lives by his practice, and it 
 is apt to be paid promptly; whereas, if he delay sending it 
 until July or January, and then send one headed with the semi- 
 apology, "Bills rendered January 1st and July 1st," as an ex- 
 cuse for even sending it then, the debtor will naturally think that 
 the physician has merely sent his out with a whole batch of others, 
 more because he has posted his books than from a special de- 
 sire for its payment ; and in this belief he will probably let it 
 remain unpaid for months longer, and perhaps delay its settle- 
 ment till it becomes an old back debt, which is the hardest kind 
 to pay. All sorts of strange accidents are continually happen- 
 ing that may prevent payment ; besides, time effaces details, 
 and recollection of the number of visits, the physician's watch- 
 ings, cares, and anxieties are forgotten, responsive sensibility is 
 lost, and the bill, though really moderate, is apt to look large. 
 All these circumstances combined are apt to make people feel, 
 when they do pay an old bill, not as though they are paying a 
 well-earned fee, but more as if they are doing a generous thing 
 and making the physician a present of that amount. 
 
 If, in spite of these facts, you do send your bills only every 
 six months, instead of putting on them " Bills rendered every 
 six months," put " All bills collected at the end of every six 
 months," or " Prompt settlement of bills is kindly requested."
 
 284 THE PHYSICIAN HIMSELF I 
 
 Also, show that you keep records of your cases and of your 
 
 fees by having on all your bills the word Folio after the 
 
 patient's name, with the number of his page inserted in the blank- 
 
 You will have to make considerable reduction in many 
 large bills after they have become old ; therefore, look after them 
 while they are small in amount and recent in date. Indeed, if 
 you let one bill be added to another till the total reaches a con- 
 siderable amount, you may place it wholly beyond the power of 
 the person to pay it, and wrongfully force him hito the position 
 of a dishonest man. Besides, long-standing bills frequently lead 
 to a disruption of friendly feeling and loss of practice. 
 
 "Old reckonings breed new disputes." 
 
 The very best time to talk business, and have an under- 
 standing about fees with doubtful or strange patients, is at your 
 first visit or the first office interview, and the best of all times 
 to judge a person's true character will be not on occasions for 
 social intercourse and the ordinary amenities of life, but when 
 you touch his financial pocket-nerve and have money dealings 
 with him. 
 
 "Then you will find out what stuff they're made of." 
 
 Even a single dollar will sometimes show you exactly what a 
 person is, whether a knave or a man of honor. 
 
 Make it an invariable rule never to accept a commission or 
 fee from any one under circumstances which you would not 
 wiUinghj submit to public exposure or investigation by a medi- 
 cal society, or a court of justice. Probably your severest test 
 will be when money is enticingly offered to induce you to do 
 doubtful things. 
 
 Many and many a patient will quit employing you to escape 
 from paying an old bill, and then, to hide from their surprised 
 neighbors the true cause of their quitting you, will trump up 
 some falsehood or another, and give you a bad name, to prevent 
 them from employing you and thereby possibly learning from 
 your lips the true reason why they changed.
 
 HIS REPUTATION AND SUCCESS. 285 
 
 Railroad and steam-boat companies and other corporations, 
 also proprietors of mills, factories, workshops, etc., whose em- 
 ployes get injured, in order to relieve themselves from responsi- 
 bility, or from fear of incurring public odium, or from a selfish 
 fear that they may become involved in suits for damages, and be 
 made pecuniarily responsible for the injury, often send, directly 
 or indirectly, for a physician to attend, and in one way or another 
 create an impression in his mind that they will pay the bill, but 
 afterward, on one plea or another (usually this — that they have 
 supported the injured person during his disability, which is as 
 much as they can aiford), either entirely disclaim the debt or 
 refuse to pay it, and with such excuses leave the physician in 
 the lurch. 
 
 "Rank injustice that smells to heaven." 
 
 In such cases you may obviate this result and secure justice, 
 or, at least, ascertain the prospect, by going, as soon as possible 
 after you have taken charge and given the initial attention, 
 directly to headquarters, or to the person who has the authority 
 to make tlie company or firm financially responsible for your 
 services, and, after explaining the labor and responsibility which 
 the case involves, make known your doubts of not being recom- 
 pensed for your services unless they will see to it, and frankly 
 ask if they will assume the responsibility and let you enter the 
 account on your books in their name. 
 
 From similar motives, the heads of families, for their own 
 satisfaction, for social reasons, or from a feeling of insecurity 
 lest some inmate of their house who has become sick may have 
 a contagious disease, will sometimes request you to visit their ser- 
 vants, nurses, or maybe poor relatives, and then seek to avoid 
 payment of your bill on one pretext or another. If there be 
 reasonable doubt of prospective payment in these cases, you 
 had better at once seek to determine the financial responsibility, 
 as suggested in the preceding paragraph. 
 
 Bear in mind the fact that when a person, even though a 
 banker or a millionaire, comes for you, or summons you, or
 
 286 THE PHYSICIAN HIMSELF: 
 
 requests you to attend another person, he is not thereby made 
 legally responsible for your fees, unless he distinctly promises or 
 agrees to be responsible for the debt. Hence, make it a rule 
 to enter the names of those who are held financially responsible 
 for such services in your book, and keep a memorandum of tlie 
 facts that make them so, and make out your bill to them accord- 
 antly. If you take these precautions it will prevent many 
 unpleasant misunderstandings, and save you many a hard-earned 
 dollar. 
 
 Before you have practiced long you will find that your wel-« 
 fare will depend not upon how much you book, but upon how 
 much you collect, and that if you never insist upon the payment 
 of your fees you can never separate the wheat from the chaff. 
 If you have a business rule, and people know it, they will asso- 
 ciate you and your rule together, and be guided thereby. Let 
 the public know, in the early years of your practice, what your 
 rule or system is, or you cannot do so later in life. When a 
 new family employs you, render your bill as soon after the ser- 
 vices as the ordinary courtesies of life will allow, and especially 
 if there have been a previous attendant who was a careless or 
 indifferent collector, or no collector at aU. Send it in as a test, 
 and if there be any objection to you consequent on the early 
 presentation of your bill, or because you want your fee, the 
 sooner you arrive at an understanding of each other, or part 
 company, the better for you. 
 
 Some physicians have more tact in getting fees than others, 
 and, curiously enough, there are patients who will pay one phy- 
 sician but will not pay another, there being certain persons with 
 whom they desire to stand well, and others for whose opinions 
 they do not care. Try to be in the former class with all persons 
 of doubtful integrity. 
 
 When patients ask you how much their bills are, or how 
 much they are indebted for office consultations, operations, etc., 
 always reply, with courteous promptness and decision, " one 
 dollar," or " ten dollars," or whatever else the amount may be,
 
 HIS REPUTATION AND SUCCESS. 287 
 
 large or small; and if you be careful to avoid prefacing or fol- 
 lowing this reply with other words, most people will, in the 
 embarrassment of the moment, proceed to pay you without ob- 
 jection, whereas if you add more words it will weaken your 
 claim in their minds, or impress them with the belief that you 
 have no settled charge, and will furnish them with a pretext to 
 show surprise and contend for a reduction. When one does 
 demur at the amount, show your amazement, and be prepared 
 at once to defend or explain the justice of the charge. 
 
 Your accounts for surgical cases, midwifery, poisoning 
 cases, and, in fact, for all exceptional cases, should be promptly 
 posted and charged in your ledger; otherwise, the patient 
 may call unexpectedly to pay his bill, and you may, either 
 through haste, or embarrassment, or temporary forgetfulness of 
 all attendant circumstances, name much too low a figure and do 
 yourself provoking injustice. Besides, the amount being already 
 determined on and entered in your book shows it to be the 
 settled charge, and the patient is less apt to ask for a reduction. 
 
 Take your fees for honest services whenever tendered. 
 Patients will often ask, "Doctor, when shall I pay you] " or 
 " Shall I pay you now 1 " A good plan is to answer promptly, 
 "Well, T take money whenever I can get it; if you have it, 
 you may pay it now, as it will leave no bones to pick," or 
 " Short payments make long friends," or " Prompt pay is double 
 pay, and causes the physician to think more of his patient," or 
 something to that effect. Never give such answers as "Oh, any 
 time will do!" or "It makes no difference when," or you will 
 soon find it to be very expensive modesty. 
 
 Although Sunday is a holy day, on which bills should not 
 be sent, yet it is perfectly right for physicians to accept fees 
 earned or incidentally tendered on that day. 
 
 Never neglect regularly to post your account-books, for it 
 would be violating nature's first law — which says that the first 
 object of every being is to supply his own wants — to attend 
 faithfully to the department of your occupation that concerns
 
 288 THE PHYSICIAN HIMSELF; 
 
 others and neglect the one that concerns yourself. The 
 Scripture command is, " Love your neiglibor as yourself;" it 
 does not say love him more, but Paul does say to Timothy: 
 If any one provide not for his own, and specially those of his 
 own house, he is v^^orse than an infidel. 
 
 It is a good plan to insert the names of transient patients 
 in your cash-book, instead of blurring your ledger v^ith them, 
 and to give pages in the latter only to probable permanent 
 patients. 
 
 Try to get cash from strangers for catheterization, certifi- 
 cates, vaccination, and other minor services, instead of blurring 
 your ledger with petty accounts. 
 
 When a prompt-paying patient pays cash at each visit, or 
 settles at your last visit, so as to make it unnecessary to transfer 
 his account from your visiting list to your ledger, the simplest 
 way to mark it paid is to turn each visit-mark (/) on your book 
 into a P^ signifying paid. 
 
 A good plan to use in making out the list of calls you are 
 to make each day, and the order in which you wish to make 
 them, is this: Tear up a lot of foolscap or note-paper into slips 
 as long as the page and half as wide, and draw a line down the 
 middle of one side of each ; go over your list each morning, and 
 cull out the names of all wlio are to be visited, and put them 
 on one of these strips, left side of the line. Then select and 
 arrange them carefully on the other side of the line in the exact 
 order you wish to observe in visiting them, putting urgent cases 
 and early calls at the top. Cut off this list when completed 
 and carry it in your outer coat- or vest- pocket, refer to it often, 
 and tear off each name as the visit is made. 
 
 You can readily fix your visiting-list so that it will always 
 open at the page in use. To do this, clip off about half an inch 
 of the upper corner of its front cover, thus^, and then in like 
 manner cut off the corners of the leaves thereby exposed, down 
 to the page corresponding to the date thereof. When thus 
 prepared, if, in opening the book, you place your right thumb
 
 HIS REPUTATION AND SUCCESS. 289 
 
 on the exposed corner of the nncut leaves, it must open at the 
 proper page. As weeks pass, dip each page as required. The 
 most convenient way to carry your visiting-list is in a wide but 
 shallow pocket on the left hip. 
 
 Do no unnecessary bookkeeping, but take care to do enougli 
 to keep your accounts correctly. The visits and cash entries in 
 your visiting-list and day-book should be written in ink ; for, 
 being original entries, they would be accepted in court as legal 
 evidence. A good way to prevent any one or any thing being- 
 forgotten is to write names, visits, street promises, etc., in your 
 visiting-list with a lead-pencil without delay, till you have a 
 chance to rewrite them with ink. 
 
 Purple, green, and blue inks all fade badly, and occasion 
 a great deal of trouble. You liad better keep your books with 
 good black ink. 
 
 At the end of every week add up the visits made to each 
 patient whom you have attended during the week, and after 
 ascertaining the total sum which you should charge therefor, 
 insert that amount in the blank spaces found at the end of the 
 lines after the Saturday column in the visiting-list. By doing 
 this weekly you can fairly estimate and charge the value of 
 your services to each patient while they are still fresh in your 
 mind. It is not only wise to enter at the end of each week the 
 amounts charged, but also to enter the names of tlie individual 
 members of the family who have been under your care during 
 the week, in the visiting-list over the visits, for reference^ in 
 case your attendance should ever be disputed. 
 
 In posting your books at the end of each month, in order to 
 avoid missing any entry in transferring the items from your visit- 
 ing-list to the ledger, make use of the simple checking-off plan. 
 A good way is to make a list of the names of all patients whom 
 you have treated during the month on a sheet of foolscap paper, 
 then bring from the visiting-list to the foolscap the amounts 
 marked against them for each week's services and put those of 
 each after his name ; when you have all the charges transferred 
 
 19
 
 290 THE PHYSICIAN HIMSELF: 
 
 in this way to the foolscap, begin and go over your ledger, page 
 after page, and scan every account as you go along. When 
 you reach the name of any one against whom you have a charge 
 to make, add up all you have marked on the foolscap against 
 him, and enter the total on his page of the ledger ; but instead 
 of wasting time to write November, 1892, $7.00, enter 11-92, 
 $7.00, then cross that person's name off the foolscap list, and 
 continue on, page after page, through the entire ledger. By 
 this crossing-off system, if you chance to pass over any one's 
 account, it will remain uncrossed when you are through the list, 
 and will thus be detected. While going over the different pages 
 of the ledger note down on the blank after the word folio, on 
 one of the small pile of blank bills lying at hand for the pur- 
 pose, the number of each one's page whose account needs 
 RENDERING, so that on completing your entries you may 
 readily return and make out the bills in question ; also, take 
 care while turning the pages to make a list of the indebted 
 patients whose accounts it would be well for you or your 
 collector to look after during the ensuing month. 
 
 When you make out a bill, enter in your ledger, in the 
 space just after the amount, the date on which the bill for that 
 amount was rendered ; thus, $7.00, with 1-8-92 after it, would 
 signify that a bill for seven dollars was rendered to that person 
 on the first day of the eighth month, 1892; or it may be written 
 as the Quakers do, month first, then day, and then year, thus: 
 8-1-92. Payments may be similarly entered. 
 
 A good way to save the trouble of looking over worthless 
 or lapsed accounts in your ledger, month after month and year 
 after year, is to cross them off, using lead-pencil, which can be 
 erased at any time, if necessary, for sucli as may possibly be 
 revived ; and for those that are dead or, from other causes, 
 never likely to employ you again, use ink. 
 
 That a patient whose name is on your books is a colored 
 person can easily be indicated by putting three dots after his 
 name, thus: Robinson, John, • 13 Columbia Street.
 
 HIS REPUTATION AND SUCCESS. 291 
 
 Patients will occasionally dispute the correctness or just- 
 ness of your charges. If a bill be not correct, correct it at once 
 and willingly, with such an expression of regret at the error as 
 may be judicious ; if, however, it be correct and just, do not 
 allow yourself to be browbeaten into the position that it is other- 
 wise. Many people are not aware that the charges for surgiccC 
 and various other cases are higher than for ordinary visits ; some 
 appear to think that for a visit at which you reduce a disloca- 
 tion, open a large abscess, make a vaginal examination, or draw 
 off the urine, you should charge the same as for ordinary visits ; 
 others have an idea that physicians do not, or should not, charge 
 for every visit when they make more than one visit in a day, or 
 for every patient when more than one in a house is sick. You 
 must, of course, correct their error by explaining the relative 
 difference, or, if necessary, by reference to the fee-table. 
 
 Never undercharge for your services with a view of obtain- 
 ing business, or in any other odious sense. A community never 
 values a physician higher than he values himself; besides, ha- 
 bitual deviation from the uniform rate of charging is considered 
 dishonorable and is ruinous to one's interests and to the inter- 
 ests of the profession at large. Moreover, the public knows that 
 no man will be content with small and insufficient fees while 
 his brethren are receiving greater, unless he rates his abilities at 
 a less price. Small fees are, therefore, set off against small 
 skill in the public belief. The tendency of undercharging is 
 to put a lower value on the medical profession, to lower the fee- 
 table permanently, and to compel all physicians to work for 
 inadequate pay. There is a vast difference between underbid- 
 ding in our profession and that seen in wars of competition in 
 ordinary business pursuits. In the latter, underselling, cut-rates, 
 and other results of severe and crushing competition are onlv 
 temporary ; for, if merchants or traders were to sell goods at or 
 below cost for a length of time, failure would result. In com- 
 mercial or business wars one or other withdraws, or they enter 
 into a compromise and each advances again to full prices ; snap-
 
 292 THE PHYSICIAN HIMSELF '. 
 
 ping and snarling physicians, on the contrary, having no goods 
 to manufacture or sell, one determined to triumph and the other 
 resolved to prevail over his " opponent " (!) by underbidding 
 and exposing each other's misfortunes, may keep up the strain 
 of rivalry and efforts to crush or banish each other for years, 
 dispensing their skill to everybody for insignificant or nominal 
 fees, impoverishing one another, and almost starving those 
 depending on them for support. 
 
 "Wars bring scars." 
 
 Besides, 
 
 "What can war, but endless war still breed?" 
 
 Surely we suffer enough annoyance in the proper pursuit 
 of our profession, without adding to our troubles by such 
 struggles. 
 
 Unless you already have a regular scale of charges in your 
 I'egion, try to bring about a somewhat uniform fee-table or rate 
 of charging among the body of physicians. 
 
 The wisest rule in charging for your services is to do your 
 work well, then ask, even from the beginning of your career, 
 the fees usual for conscientious, skilled attendance,^ — neither 
 exorbitantly high, like an extortioner, nor absurdly low. And 
 always maintain that your services are as good as the best. 
 
 Let people know that you honestly strive to make your 
 bills as small as possible, not by undercharging, but by getting 
 them well by good treatment and with as few visits as possible. 
 
 Never enter into an auction bargain to attend a patient or 
 a family by the week, month, or year ; it is far better to be 
 paid for what you actually do, than to have some people feel 
 that they are giving you twenty dollars for five dollars' worth 
 of service, while you, on the other hand, are, in many other 
 exacting cases, giving fifty or a hundred dollars' worth of ser- 
 vice for twenty dollars, and have no alternative but to fulfill 
 the contract. 
 
 Also, never bargain to attend whole neighborhoods or clubs 
 of poor people at reduced rates, or at half- or quarter- price,
 
 HIS REPUTATION AND SUCCESS. 293 
 
 because your antiquated or unripe neighbor does ; it is bad 
 policy, and never works successfully. Indeed, if you ever 
 attend a confinement or other case in a family for a nominal 
 fee, or lump your bill for ready money, they will always expect 
 to pay what they paid before, and you will not be able to raise 
 your scale of charges to the regular price in that family after 
 your standing and skill improve and your time becomes more 
 valuable ; or even with other patients who hear of it. 
 
 It is a mistake to think that you can greatly augment the 
 charges you make in the beginning of your practice as you 
 advance in age, skill, and experience, as everybody will appeal 
 to your former charges, and object. After becoming accustomed 
 to small prices, old patients will even think you ought to charge 
 them less instead of more ; so that, if ever you feel unwilling to 
 repeat services of any kind for the sum received for a previous 
 case, be careful to give the patient fair notice of your intention 
 to raise your charges. 
 
 One of the hardships of our profession is that the older 
 men, perhaps now rich, or deriving their support chiefly from 
 their stocks, bonds, four-per-cents, or farms, continue to charge 
 the low prices of half a century ago, while the price of living, 
 etc., have all advanced; so that the younger physician, without 
 these, must charge somewhat the same, and thus hardly get 
 revenue enough to support him. 
 
 A wise man usually accommodates himself to circumstances 
 and takes what he can get, but even when you are sure that, to 
 meet one's means of remuneration, you will have to receipt 
 your bill for a reduced amount, make it out for the standard 
 amoimt, so that the debtor may see the real extent of his in- 
 debtedness and give you credit for the amount of the reduction ; 
 in other words, when you make a reduction to those who plead 
 poverty or other acceptable reason, let them understand that 
 you are not reducing your charges, but are taking something off 
 their bill ; and enjoin upon them not to tell it around, lest it 
 lower your scale of charges elsewhere.
 
 29i THE PHYSICIAN HIMSELF: 
 
 In attending an extraordinary case for Mr. Bullion, or Gov. 
 Goldmine, or Gen. Doublebank, or Maj. Opulent, or Capt. 
 Creamyrich, Mrs. Bountiful, or any one else who is very rich 
 or notoriously liberal, after properly calling his attention to the 
 immeasurable value of the life you have saved, or of the bless- 
 ing and health your services have given, leave to him the money 
 valuation of the benefits the restoration brings, or the worth of 
 exemption from death, unless he insist on having a bill. In 
 the latter case, charge him no more than any one else for the 
 same services. In tlie former you may, by submitting it to him, 
 from his feeling of superlative delight at the successful issue, be 
 paid most munificently, possibly ten times as much as your bill 
 would have been. 
 
 When people talk to you about taking off part of their bill 
 because they are poor, and charging the rich more to make it 
 up, take less if you think proper, but under no circumstances 
 allow tliem to infer that you, or any other physician, would 
 charge any one, whether rich or poor, a cent more than is 
 honestly your due. 
 
 It is customary and just to charge a double fee for the first 
 or for an only visit in a case, chiefly for the following reasons : 
 You must at the first visit devote an extra amount of time and 
 attention to learning the history of the case, — maybe make a 
 minute time-consuming examination, — must involve yourself in 
 a diagnosis, and probably also in a prognosis, — must carefully 
 think over and decide upon a whole line of treatment, — must 
 instruct the nurses, — map out the quality and quantity of diet, 
 drink, exercise, etc., — point out the requirements of hygiene, 
 maybe institute asepsis or antisepsis, — lay down general rules 
 regarding lighting, heating, and ventilation, the clotliing, the 
 temperature, the toilet, idiosyncrasies, etc., and formally establish 
 yourself in the case, and assume all the responsibilities of the 
 issue. These combined make it an extraordinary visit, and fully 
 justify a double charge for the first visit. 
 
 The first visit to a case may be easily designated by turning 
 the visit-mark (/) into an F.
 
 HIS REPUTATION AND SUCCESS. 295 
 
 It is also just to charge extra for a visit in which you are 
 detained longer tlian (say) a half-hour, or in an obstetrical case 
 over five or six hours, either by the urgency of the case or 
 where the family request you to remain. 
 
 There are a few people who consider that when a case is 
 serious enough to require the physician to make more than one 
 visit a day he should not charge for the additional visits, uncon- 
 scious, as it were, of the fact that cases dangerous enough to 
 require an extra number of visits are the very ones which entail 
 upon him the greatest responsibility, cause him most anxiety, 
 and contribute most largely toward making liis life one of 
 wearying labor and self-denial. 
 
 When you attend two or more patients in a family at the 
 same time, take care to charge full rates for one patient and 
 half-rates for each of the others. 
 
 You will often have people to hum and haw, and complain 
 that their bill is high, and ask you to make a reduction ; yet, 
 many of these very people would not employ you if you were 
 a third-rate or low-priced physician. Everybody wants first- 
 class services, but wants them as cheaply as possible. It is not 
 human nature to prefer a fifty-cent to a two-dollar silk : but 
 if people be lucky enough to get the two-dollar silk for one 
 dollar, they congratulate themselves. They reason the same 
 about physicians ; very few prefer or appreciate a low-priced 
 (cheap-John) physician. 
 
 In unusually severe cases, and in those which require 
 very great exposure or extraordinary legal or professional 
 responsibility : in cases of recovery after poisoning, or of appar- 
 ent drowning, or suft'ocation, of small-pox and other loathsome 
 and contagious diseases, the fear of which prevents other 
 patients, who know you are attending them, from employing 
 you, or which necessitate loss of time in changing your clothes 
 and otherwise disinfecting yourself before visiting others who 
 are not affected, or in which you have evinced remarkable skill, 
 or where you have had very great luck in bad cases of any kind, 
 you should charge good, round fees.
 
 296 THE PHYSICIAN HIMSELF: 
 
 It is certainly worth far more successfully to attend an 
 important or distinguished member of the community in a case 
 of pneumonia — in which you save his life as clearly as if you 
 had dragged him helpless from the flames, or plucked him 
 drowning from the water ; or a patient with apoplexy, or with 
 a wound, ulcer, fracture, or a luxation, or a contagious disease 
 in which you risk losing your own life ; in fact, anything that 
 causes you great anxiety and necessitates much study — than one 
 for whom nobody cares, with a sore finger or toe, or chicken- 
 pox, mumps, or hives, even though the two cases require an 
 equal amount of time, or a like number of visits. 
 
 In some cases your charge will be not so much for the 
 work actually performed as for your knowledge and skill in 
 knowing how to do it; for instance, you may charge twenty 
 dollars for the few minutes' work of reducing a luxated hume- 
 rus ; if this were duly itemized it might read thus : " For re- 
 ducing dislocated shoulder, five dollars ; for expense and study 
 of learning how to do it, fifteen dollars." " You charge me 
 fifty sequins," said a Venetian nobleman to a sculptor, " for a 
 bust that cost you only ten days' labor." " You forget," replied 
 the artist, " I have been thirty years learning how to make that 
 bust in ten days. 
 
 Attendance on Bigbee's beloved child, on an eminent or 
 very important member of the community, or on one of the 
 great men of the land, for whose life you have fought a great 
 battle, or on a well-satisfied stranger who has journeyed far 
 with an important case that causes you special solicitude and 
 anxiety, or on a case that presents peculiar difiiculties, justifies 
 you in making a special charge, whether attended at your own 
 office or at the homes of the patients. In such cases pay every 
 necessary attention, but be careful to make no unnecessary 
 visits, unless by special request ; for in a very important case, 
 in which three visits would be really necessary, to which you 
 make but three and then discharge yourself, your services will 
 be appreciated more highly, and the family will more cheer-
 
 HIS REPUTATION AND SUCCESS. 297 
 
 fully pay a fee of a hundred dollars than if you had also made 
 five additional, apparently unnecessary, visits, and charged but 
 eighty dollars. 
 
 On the same principle, when you have severe cases of any 
 kind that necessitate several visits in the course of the day, take 
 care to diminish the number markedly as soon as the necessity 
 ceases. 
 
 In extraordinary and complex cases ; also, where the re- 
 sults are apt to be great and far-reaching, or in which you go a 
 long distance, or at very unusual hours, or through great storms, 
 or extra dangers, the charge should be not by the visit, but for 
 the case. 
 
 Patients will often express surprise at your asking the same 
 fee for office advice as for a visit to their house ; explain to them 
 that, although the charge is the same, it is much cheaper to be 
 an office patient than to be visited at home, because an office 
 patient usually comes but once, or oiiJi/ when his medicines are 
 out, or when some important change has taken place in his 
 ailment, and quits entirely as soon as possible ; whereas, if you 
 have him under care at home, your responsibility and feeling of 
 uncertainty compel you to visit him frequently to ascertain 
 whether he is getting along as expected. For these reasons a 
 few office consultations with the responsibility of attending 
 faithfully resting on the patient, if on either, often suffice, in- 
 stead of many house visits, and in this way office advice becomes 
 very much cheaper. 
 
 Some people who are mean and miser-like about paying 
 — as big and exacting as tyrants when sick, and as small as 
 potato-bugs at bill time — will want you to deduct largely from 
 their bills, especially if they happen to be mostly for office con- 
 sultations, vaccinations, and other services of a less important 
 character. Meet them at once with the argument that if they 
 are to pay you less than the average for the minor services, you 
 will have to charge them on a much higher scale of fees for the 
 more important ones. But with such people the question is not
 
 298 THE PHYSICIAN HIMSELF: 
 
 services, but money, and you will often have a stinted sum 
 grudgingly given, even for the saving of life. 
 
 Be kind to the poor and lenient with the unfortunate, but 
 when people are able you should be as rigid in requiring your 
 pay as other men. 
 
 The difference between words used with your office patients 
 will sometimes make all the difference between a fee and no fee. 
 Some who consult you, if asked to call again to let you know 
 Jioio they are getting on, will, on returning, show by every word 
 and action that they do not expect to pay, as they merely called 
 because you requested them to do so. Therefore, unless you 
 intend to omit the charge, it is better to advise them, to consult 
 you again, at such time as you deem proper to specify. This will 
 distinctly intimate to them that your usual fee will be charged. 
 
 When a new patient, whose honesty you have reason to 
 doubt, consults you at your office, and instead of paying the fee 
 defers it, with a promise to call again, if you request- his name 
 and residence, and book them in his presence, your chances of 
 getting paid will be greatly increased. 
 
 Never agree or enter into a contract to attend any one for a 
 "contingent fee" ; that is, do not take patients with chronic sores, 
 constitutional headaches, epilepsy, cancer, post-nasal catarrh, 
 pimpled faces, haemorrhoids, dyspepsia, hypochondriasis, and 
 other chronic affections ; or victims of syphilis, gonorrhoea, the 
 ruthless blight of scrofula, etc., on the "?^o cure, 710 2)(iy" system, 
 or to pay ''if their rainhoio expectations are realized,^^ or '"'when 
 all is over^ Enter into no such one-sided agreements to do 
 things that may prove impossible, for they are never satisfactory, 
 and will generally end in your being swindled, and, it may be, 
 charged with incompetence or malpractice. In expressing your 
 willingness to undertake such case, let it be clearly understood 
 that if the case be curable, then you are there to cure it, but that 
 you charge for services, not for residts, and must be paid for 
 your attendance even though the patient proves incurable or 
 dies, and that all who seek your advice must take the proba-
 
 HIS REPUTATION AND SUCCESS. 299 
 
 bilities of cure or relief from your well-intended endeavors. 
 Hemember : having accepted charge of a case, you are morally 
 bound, pay or no pay, conscientiously to fulfill your duty to the 
 patient; you may, nevertheless, fairly intimate to those who 
 you think are unworthy of credit, that if they pay as they go 
 on, instead of running up a bill, it will tend to encourage and 
 interest you more in the case, and naturally inspire and stimu- 
 late you to do your best. 
 
 Some persons suffering from constitutional syphilis, ulcer- 
 ated legs, chronic eczema, broken constitution, etc., in which the 
 treatment may extend through many months, or maybe for 
 years, or even through life-time, will probably suggest that you 
 should wait for your fees till done attending. Do no such fool- 
 ish thing, as such a case may die, or move away, or abandon 
 treatment, or slip away from you to another, or begin with, 
 jjrandmother remedies, or with " varbs from those who have no 
 larnin','' or even resist all your attempts to effect a cure, and 
 you may get nothing except misrepresentation for all your 
 work. 
 
 In such cases, it is far more just and wise to render your 
 accounts at the proper time, — " for the three months ending 
 
 ," or, at the very furthest, the first day of every July and 
 
 January. If they demur (which they cannot justly do) do not 
 hesitate to express your surprise at their doing so, and, in re- 
 minding them of the necessity for living by your practice, 
 cautiously but firmly tell them of your entire unwillingness or 
 financial inability to allow your fees to accumulate as they 
 suggest. 
 
 You should ordinarily exact no previous stipulation of pay, 
 and manifest no undue anxiety in respect to your fees, and make' 
 no reference to your intended charges, unless you are dealing 
 with people notoriously unworthy of confidence, or when a mis- 
 understanding is apprehended ; but in most instances, unless 
 the patient be well known to you, you should not hesitate to 
 require your fee in advance (your chance of compensation will
 
 300 THE PHYSICIAN HIMSELF: 
 
 grow worse as the patient grows better) for attending cases 
 of secret diseases. If you fail to do so, Mr, Hightone or Mr. 
 Lowtone, or Mr. Notoneatall, as the case may be, will almost 
 certainly leave you, about the time that Richard's himself again, 
 with his bill unpaid ; and if you press him about it, he will 
 either pay it grudgingly or not at all ; and, should you dun him 
 for it, will abuse you, and, with vinegar or ice in his looks, 
 meanly assert that he is absolutely a Joseph, and that it was 
 not an ignoble disease at all, but only a strain, or that you did 
 him no good, or almost killed him ; or tell some other falsehood 
 as an excuse for deserting and trying to defraud you, and ever 
 after try to bring you into public odium and to injure you to 
 the extent of his influence. In such case it would serve him 
 right to " Court " him. Another reason why it is proper to get 
 your fee in advance is that many would never come and pay it 
 till you had sent them a bill by your collector, and would then 
 indignantly claim that you had insulted and exposed them by 
 sending a bill of that kind. 
 
 Also, when at all convenient, get your fees in advance for 
 transient attendance on persons injured in bawdy-house fights, 
 drunken buggy-rides, soldiers, sailors, and the like. 
 
 At the same time, bear in mind that you have no right, 
 either legal or moral, to expose the nature of any person's dis- 
 ease to any one, on account of his having failed to pay your 
 fees, even though it was gonorrhoea or he was covered from the 
 crown of his head to the soles of his feet with syphilis. 
 
 Venereal diseases are the result, generally, not of providen- 
 tial misfortune, as are other inflictions, but of voluntary indul- 
 gence in vice ; therefore, self-inflicted. And for this valid reason 
 such venereal patients have not the same natural claim upon 
 your sympathy as other sufferers. In all cases of this kind try 
 to get a just, remunerative fee before you undertake the treat- 
 ment ; then honestly do your duty to the patient until he is 
 cured. Having paid you, he is not likely to change from you 
 to another, and should his case proceed slowly he cannot then.
 
 HIS REPUTATION AND SUCCESS. 301 
 
 suspect that you are purposely running a heavy bill on him, or 
 delaying the cure on account of his being a good-pay patient, 
 as he might do if he were paying you a dollar or two for each 
 consultation. 
 
 Many men imagine that they cannot be suffering from con- 
 stitutional syphilis unless they have detected a terrible chancre 
 at the beginning ; and you will often experience a difficulty in 
 making persons who have not detected a primary sore believe 
 their case to be syphilis. Some men will actually stare, scan, 
 and quiz you when you tell them they have the p-x, as if they 
 thought you a quack or impostor trying to frighten them out 
 of money. If you can show such a patient a fac-simile of his 
 chancre, roseola, or mucous patches in your text-books on vene- 
 real diseases, or even read with him a description of them, it 
 will awaken him to his real condition and put him on his guard 
 against either neglecting his case or infecting others. 
 
 When you feel certain that your diagnosis of syphilis is 
 correct, look the patient in the face, and, with a manner that 
 indicates your practical knowledge of the matter, tell him that 
 in your opinion he has true syphilis, and be careful not to be 
 browbeaten into taking charge of the case for a trifling fee. 
 It is a grave disease, and the responsibility and worry of the 
 medical attendant are often very great and protracted ; the fee, 
 therefore, should never be nominal. 
 
 You can readily broach the fee question to any patient suf- 
 fering from a private disease by remarking, immediately after 
 making your first examination, " Well, I see what your case is, 
 and am willing to take charge of it and give you my best ser- 
 vices, if my terms will suit you.'''' This will necessitate his 
 asking what your terms are, and will afford you the oppor- 
 tunity to tell him. Or, if you regard the services likely to be 
 required as important and valuable, whilst he evidently thinks 
 the reverse, if you will incidentally begin with the remark, 
 *'Ah ! I fear my charges will be more than you would be will- 
 ing to pay," this also will compel him to question you upon the
 
 302 THE PHYSICIAN HIMSELF I 
 
 subject, and that, too, in a somewhat more favorable frame of 
 mind for your purpose. 
 
 Some people labor under the impression that physicians are 
 public functionaries, and that tlie law compels them to answer 
 the beck and call of any one who chooses to send for them, pay 
 or no pay. It does not ; you have a perfect right to refuse for 
 any reason that is satisfactory to yourself; but your time is sup- 
 posed to belong somewhat to your suffering fellow-creatures, and 
 you are expected to be ever waiting and watching in complete 
 readiness ; and both the profession and public opinion would 
 severely judge and condemn you if you were to refuse to attend 
 an urgent case to which common humanity should prompt you 
 to go, — especially if you refused on account of fees, and particu- 
 larly if other physicians were not easily accessible. If you are 
 really " too busy" or " not well enough^" or are immersed in 
 another engagement that cannot be set aside, or have another 
 equally urgent duty to perform, these will generally be regarded 
 as sufficient reasons, and protect you against argument or criti- 
 cism. But "/'??7 just at dinner^" '■'"Fm too tired," or "/ need 
 sleep,''^ or "/ am afraid I luill be dragged hito court as a 
 icltness" etc., look like a hard indifference, and are not accepted 
 by the public as adequate reasons for refusing to go, and in cases 
 of urgency should never be offered. In the name of Jupiter, 
 what business has any physician to be at dinner, or sleepy, or 
 tired, while yet young enough to crawl, or with strength enough 
 left to think a thought, or hold a pen, when the sick public give 
 a call or whistle 1 
 
 A few persons also believe there is some law or rule that 
 prevents a physician from attending his own wife and children, 
 or other near kinsmen, when they are sick. This belief has 
 been created by the fact that some esteemed brother-physician 
 is generally intrusted with such cases through a fear, in the 
 physician's anxious mind, that personal interest in those so near 
 and dear to him might warp his judgment, or in the event of 
 fatal issue might leave a deep and lasting regret in his mind
 
 HIS REPUTATION AND SUCCESS. 303 
 
 that this, that, or the other Une of treatment was not pursued 
 instead of that which was. 
 
 After your work in many a case is done you may have to 
 
 "Assume tlie cloak of necessity to save the fee," 
 
 and use this, that, or the other stratagem to get your fees. Not 
 only should you send your bill to a patient in due time, but if 
 you fail to hear from him within a reasonable while, emphasize 
 it by sending another, with the same date, etc., as the first, 
 marked *' duplicate," or " 3d bill," " 4th bill," as the case may 
 be ; for he may not have received the first, or may have thrown 
 it aside with a Tra-la-la-la ! or may be purposely neglecting it 
 in the hope that you will cease your claim forever, or trying to 
 let it stand over till it is forgotten or is out of date. 
 
 An effective plan to adopt with a certain tardy class of 
 patients, when you are in need of money, is to ascertain the 
 date at which you will have a debt or note to pay, or will have 
 to raise money for any other special purpose, and then to write 
 a week or two before the time and briefly inform them that you 
 will have a special need for money at the time specified, and 
 ask them kindly to pay you on or before that date. Most 
 people of any worth will exert themselves to comply with the 
 request, if courteously made. In this manner you can well 
 approach both your best and your worst patients, and some that 
 you cannot successfully approach for money in any other way. 
 A request so conveyed, moreover, shows that you do not want 
 merely to get it out of their pocket into your own, but that you 
 ask for it because you really happen to need it. One who is in 
 debt has always a legitimate excuse for sending in his bills as 
 soon as his patients recover. 
 
 Another plan, good to pursue with those who habitually 
 throw bills aside and neglect to pay them, is to send your 
 accounts some day when you are in need of funds, with a brief 
 note asking them to pay in the course of the day, and assign 
 your reasons for making so pressing a request. Even though
 
 304 THE PHYSICIAN HIMSELF I 
 
 they pay you nothing then, knowing that they have disap- 
 pointed you in your dilemma, they will feel impelled at least to 
 pay something on the account when they again need your services. 
 
 Also, using the phrase on your bills, " Amount now on the 
 books $ ," or " Balance still on the books $ ," and in- 
 closing a brief note with the bill of a delinquent for whom 
 you are tired of waiting, telling him that his account is greatly 
 overdue, and asking him kindly to call and settle, as you are 
 anxious to close the account " on the books," remind him of 
 the fact that it is " on the books" and overdue, hence probably 
 seen and thought over by you daily, and may arouse him to the 
 extent of calling to pay, or to make some definite arrangement. 
 
 By letting your prompt-paying patients know in some way 
 or other, at the visit preceding the final one, that your next visit 
 will be the last that you deem it necessary to make, it will serve 
 as a gentle hint and afford them an opportunity to prepare, and 
 will greatly increase the chances of your being paid cash at the 
 last visit. Convalescents from severe illnesses who are told 
 to pay you a visit at your office when able to walk out again, 
 in order that you may see how they are getting along, are very 
 apt to broach the subject of your fees, and either then pay or 
 make some definite promise before leaving. 
 
 You cannot put all classes of bills on the same footing; 
 there is mie class of patients whose bills had better be sent by 
 mail, another to whom they should be taken by your collector 
 or other person, (mother to whom you had better deliver them 
 yourself, and a few promptly-paying patients whom you had bet- 
 ter allow to ask for them. A careful study of these facts will 
 be of essential assistance to you. 
 
 Items and details are, as a rule, better omitted in profes- 
 sional accounts, unless specially asked for, inasmuch as they 
 tend to dissatisfy people, and lead to criticisms and disputes 
 that would not arise did not the items furnish a pretext. As- 
 sume the position that he who confides in you sufficiently to put 
 the lives and secrets of himself and family in your keeping should
 
 HIS REPUTATION AND SUCCESS. 305 
 
 feel sufficient confidence and gratitude to intrust you to say Avhat 
 value you deem mutually fair to place on your professional ser- 
 vices. In fact, a physician's bill that gives in detail the various 
 items is more apt to be disputed or criticised unless it be unjustly 
 small. Bills that simply state the total amount, or " amount due 
 for services since date of last bill," or - amount now on the books," 
 are much more likely to be paid without dispute. The items, 
 however, of every bill should be carefully entered in tlie ledger, 
 in order that the charges may be verified if requisite ; and each 
 and every charge should rest on a distinct financial base of its 
 own. Should a patient question the accuracy of a non-itemized 
 bill, at once concede his right to be furnished with a statement 
 of the number and dates of visits and any special services charged 
 for, or permission to see the items on the ledger should be per- 
 mitted or suggested. But few who would intrust you with their 
 lives would push you to this extent after serving them faithfully, 
 and these had as well be erased from your list of patients. 
 
 On the payment of money other than a simple cash fee by 
 your patients, it is well to msist on giving receipts, even though 
 they should deem it unnecessary. Compelling every one who 
 pays a debt that has been booked to take a receipt not only 
 prevents subsequent disputes, but assists also in maintaining a 
 regular and desirable business-like system between you. 
 
 Be especially careful to avoid soul-narrowing avarice in its 
 various forms — meanness, greed, oppression, stony heart — and 
 all other hateful extremes. If you attempt to shave too closely 
 in money matters, — when a patient is so low that it is no longer 
 decent to take fees, or hungrily hold watches, jewelry, or other 
 articles as security for the payment of your fees, or compel their 
 owners to pawn or sell them for your benefit, or charge interest 
 on your bills because not promptly yiaid, or be unreasonable 
 (Shylock) or too vigorous in your efforts to collect fees from 
 any one, — it would not only be morally wrong, but would be 
 very apt to prejudice your reputation and create a feeling of 
 hostility against you that time could not efface.
 
 306 THE PHYSICIAN HIMSELF: 
 
 For a like reason it is, as a rule, better not to charge for a 
 certificate of sickness furnished to patients to enable them to 
 draw sick-pay from clubs and other beneficial societies, or for 
 school-children's certificates of vaccination, etc. These should 
 be regarded as personal favors, differing from cases in w^hich a 
 fee is right and proper. 
 
 But in every case requiring you to go and make an affidavit 
 before a court or magistrate, a moderate charge is proper. 
 
 It will seldom pay you to sue people, even though your 
 suits be successful ; indeed, it is, generally speaking, undesirable 
 for you or any other physician to begin litigation to enforce 
 your claims, except under very aggravating circumstances or to 
 maintain your reputation or self-respect. Physicians who fre- 
 quently go to law to recover fees generally lose more in the end 
 than the yield, by exciting prejudice and making enemies. You 
 should never resort to compulsory measures with any one whose 
 failure to pay is due to honest poverty. While naturally seek- 
 ing to get good patients, who can and will pay for your services, 
 be ever willing to do your share of charity for the deserving 
 poor; at the same time the necessity of earning a living for 
 yourself should make you careful not to let it crowd out your 
 remuneratory practice. 
 
 When called upon to attend cases of sudden death, drown- 
 ing, suicide, persons found dead, murder, etc., in which the un- 
 fortunate victim is dead before you can get to him, or in calls 
 of emergency, where another physician reaches the patient and 
 takes charge before your arrival, or in other cases where your 
 services are not called into action, or are merely nominal or 
 clearly useless, it will, as a rule, be wise not to send in an 
 account, as under such circumstances not only would it gen- 
 erally be left unpaid, but be harshly criticised. If, however, a 
 feeling of gratitude induce the people interested to tender you 
 fees, for your trouble, accept whatever is right. 
 
 In obstinate and invincible maladies, such as hopeless cases 
 of cancer, phtliisis, aneurism, etc., in which, after liaving gone
 
 HIS REPUTATION AND SUCCESS. 307 
 
 the rounds of the profession, you are consulted m the very last 
 stages, with the hope of getting a new heart, or a new pair of 
 lungs, or having other miracles performed; or merely to see 
 ^vhether you can possibly do anything of benefit to them, you 
 had better deal candidly, and frankly acknowledge that you can 
 do but little, or nothing, and decline the fee even if tendered. 
 
 It is better, as a general rule, to make no charge for ordi- 
 nary or trifling advice incidentally given to patients when they 
 call to pay their bill, or to persons for whom you happen to pre- 
 scribe in public places (curbstone prescriptions), where you are 
 not pursuing your professional avocation. Such exactions would, 
 to say the least, tend to engender unpleasant reminiscences and 
 harsh criticism. Every physician occasionally writes prescrip- 
 tions under circumstances that, even though he be technically 
 entitled to remuneration, Ms own interests forbid his charging 
 or even accepting a fee when tendered. 
 
 Never make a charge where the fee would come from an- 
 other physician's pocket ; every physician attends his professional 
 brethren and members of their families gratis. Some also- 
 attend clergymen and their families without a charge of money^ 
 especially those with whom they have church relations, and 
 those who receive salaries so meagre as to make the pay- 
 ment of medical fees a hardship. But where a clergyman is in 
 the receipt of a liberal salary, and his calls on you are frequent 
 or onerous, I know of nothing in ethics to forbid your accepting 
 from him a fee voluntarily tendered. Some of our best phy- 
 sicians make it a rule to charge half-fees to their own spiritual 
 advisers ; that is, they make out the bills for the full amount 
 and receipt them upon payment of half the sum. Their influ- 
 ence, if properly directed, is supposed to cancel the remainder. 
 
 Never oppress any one by exorbitant fees. Nearly every 
 one depends on his physician's unwatched integrity, believing 
 that he will be honest in his conduct, honest in his treatment, 
 and honest in his charges. Be especially fair in your charges 
 against estates, and in all other cases where unusual circum-
 
 308 THE PHYSICIAN HIMSELF: 
 
 stances place the debtor at your mercy. These opportunities 
 will fully test whether true honesty has a seat in your heart. 
 
 "As a man thinketh iii his heart, so is he." 
 
 When you are in doubt what to charge, look upward, then 
 make out your bill at such figures as you may deem just to the 
 patient, to the profession, and to yourself, and thus show clean 
 hands, morally as well as antiseptically. Even-handed justice 
 is the basis of all lasting reputation. 
 
 Great injury is inflicted on our entire profession when 
 Dr. Chiselum, Dr. Tinchaser, Dr. Highprice, Prof Twentyfold, 
 Dazzlefee, or any other of our guild places an exorbitant 
 value on his time and labor, and charges those whom chance 
 has placed in his power a fee so enormous or outrageously extor- 
 tionate as to cause great gossip or newspaper notice of it. But, 
 carefully avoid making censorious or derogatory comment, in 
 the presence of non-professional persons, on the fees claimed by 
 another physician, unless you are fully acquainted with all the 
 circumstances, for he may actually have good and sufficient 
 reasons for the charges made. 
 
 When you and a professional brother do each a portion of 
 the work in cases of accident, confinement, etc., a very fair plan 
 is to agree to charge a joint fee and divide it. When you re- 
 ceive such a joint fee, go at the earhest possible moment and 
 divide every dollar, fairly and squarely, with your fellow- worker, 
 on whatever basis you have agreed upon. 
 
 When another physician is called to a case of yours, dur- 
 ing your absence, not only thank him at the first opportunity, 
 but also insist on his sending his bill for whatever services he 
 has rendered. No one can be expected to work under such 
 circumstances without fee. His kindness to you consists in 
 having responded to the call. 
 
 Never acknowledge or work under the job-lot fee-table of 
 any association or company, unless it be in harmony with the 
 regular professional fee-table of your community.
 
 HIS REPUTATION AND SUCCESS. 309 
 
 A fee-table should never be extravagantly high on one 
 hand, nor meanly low on the other, but should be reasonable in 
 its tariff, and should always allow a reduction if the patient's 
 circumstances require ; and should also allow attendance on the 
 moneyless poor gratis. 
 
 Humanity requires you (as God's instrument) to go promptly 
 to all cases of sudden emergency, accidents, and the like, in 
 which the life or limb of a fellow-creature is in jeopardy, with- 
 out regard to the prospect or otherwise of a fee. You should 
 do various things for the sake of charity ; among these is to give 
 relief to any one injured, or in great pain or suffering, regard- 
 less of fees. At such times regard only Man in distress ; show 
 no distinction between rich and poor, high and low, but consider 
 only your simple duty to suffering humanity. The good 
 Samaritan succored the wounded man, took him to an inn, and 
 provided for his immediate necessities. You, as a physician, 
 should be equally humane and prompt to go and bind up 
 wounds, and relieve suffering in all cases of emergency. After 
 this is done further attendance is, of course, optional, and de- 
 pends upon whether you choose to render it, or feel that you can 
 afford it ; but you are really no more bound to continue to attend 
 such a one gratuitously than the baker is to give away his 
 bread to the hungry, or the tailor to give away his clothes to 
 the ragged. 
 
 But, take care never to slight the worthy poor, who are 
 under the iron heel of poverty and need medical attendance. To 
 the poor life and health are everything; their very poverty and 
 lack of comforts make them more likely to get sick and to suffer 
 more in sickness than the rich, and worthy kindness to them in 
 worthy ways should be as broad as God's earth. Besides, there 
 are none so poor but that they may amply repay your services 
 by their earnest "God bless you, Doctor," and their genuine, 
 lasting gratitude. Besides, how heartfelt and pure the gratifica- 
 tion to wrest a fellow-being from destruction ! 
 
 Physicians render more gratuitous and unpaid services than
 
 310 THE THYSICIAN HIMSELF: 
 
 any other class of people in the world. Allowing- that there are 
 in the United States fifty thousand regular practicing physicians, 
 and that each does one hundred dollars' worth of lahor to charity 
 practice a year, — which is far below the average, — we have the 
 enormous sum of five millions of dollars of charitable labor 
 given by its medical profession every year. 
 
 " The poor," said Boerhaave, " are my best patients. God 
 will be their paymaster." But even in dispensing charity, care- 
 ful discrimination is essential. There would seem to be three 
 classes of the poor, — the Lord's poor, the devil's poor, and the 
 poor devils. The first and last are worthy objects of every phy- 
 sician's attention, and you would do well to lose no opportunity 
 to give relief to their ailments. The less, however, you have to 
 do with the other class {the devlVs poor), and the less health 
 and strength you waste on them, the better for you; neverthe- 
 less, you will be more or less compelled to attend more than you 
 would otherwise care to do of the lowest and vilest victims of 
 vice, intemperance, and sensual indulgence, — who are perhaps 
 a curse to their families and a nuisance to the neighborhood, — 
 and watch over them as faithfully as if they were noblemen ; 
 some for God's sake, and others, it may be, on account of their 
 relationship to better and more provident patients ; you will 
 generally find, however, that, " though this citizen and that 
 fellow may be brothers, their pocket-books are not sisters." 
 
 It is your duty to raise your voice in the profession against 
 the fearful abuse of medical charities by the people, and the 
 largely increasing numbers of free special dispensaries, college 
 clinics, and the out-door departments of hospitals, church infirm- 
 aries, and private retreats, which, of late, under the color of 
 charity, attract not only aching beggars from squalid streets and 
 alleys, drunken and worthless men's families, the poverty-stricken 
 sick and humble people out of employment, whose forlorn aspect 
 is unmistakable, but also thousands of stingy impostors and 
 miserly drones, who are ahundantJjj able to pay for medical 
 services; and, which, still worse, offer a refuge in their rainy
 
 HIS REPUTATION AND SUCCESS. 311 
 
 day to the lazy and vicious, against which, the latter, conse- 
 quently, need not provide by industry, sobriety, and economy. 
 Make a person a pauper, or encourage him to become a lazy 
 beggar, or destroy his independence and manhood in one thing, 
 and he is apt to degenerate and become improvident and 
 worthless in many. 
 
 No member of the profession — and the same may be said 
 of pharmacists and physicians who keep drug-stores and pre- 
 scribe over their counters — has, in the spirit of common justice, 
 a right to give professional services to the public without fee, 
 except to the moneyless poor (to whom they should be rendered 
 in the holy name of charity, as freely as the air they breathe) ; 
 for, although there may be no loss thereby to him personally, it 
 has a pauperizing tendency on a certain class of people, and is 
 taking bread from the mouths of struggling physicians by mo- 
 nopolizing practice that would otherwise fall into their hands, 
 and to that extent it is despoiling the profession of its legitimate 
 fees. 
 
 Glory built on selflsli principles is shame and guilt. 
 
 Thousands of young and deserving sons of ^sculapius 
 have been, of late, cheated out of what would be to them bread 
 and a slender support, and a chance to get into practice, by so- 
 called " Hospital " or " Church " Charities, carried on chiefly in 
 the interest of individuals, or coteries, who, to foster reputation 
 in their specialties, and to outstrip rivals, treat everi/hody that 
 applies, — the rich, the poor, and the intermediate class, — whether 
 entitled to the benefits of their charity or not, without tlie slightest 
 regard to the interest of other medical men, or their desire to do 
 a share of charity. 
 
 Immortal gods 1 Such stony injustice 
 Blots all the heaven-born features. 
 
 The ultimate result of this state of things will be either that 
 the profession will, in self-defense, be compelled to organize 
 self-preservation associations, or tliat individual physicians will 
 take up the case and resolve neither to turn over cases to nor
 
 312 THE PHYSICIAN HIMSELF I 
 
 to call into consultation any specialist, professor, or surgeon who 
 continues to render gratuitous service to those who are able to 
 pay for it. The last-mentioned course would probably influence 
 the transgressors strongly. THE SHAMEFUL WRONG 
 DONE to the profession by such institutions lies not so much 
 in the working of the hospitals themselves, but IN the conduct 
 of THEIR DISPENSARIES AND OUT-DOOR DEPART- 
 MENTS. 
 
 Probably a considerable proportion of the impostors and 
 frauds able to pay for services, who impose on these institutions, 
 knowing the risk of being unearthed and turned away, would 
 shrink from venturing such exposure to the public by the 
 prominent display of some such sign as the following: "This 
 Dispensary is for the moneyless poor only." 
 
 Bear in mind, for an individual to advertise gratuitous 
 attendance on the poor at his office, or at certain times, or under 
 certain conditions, is unprofessional. 
 
 Found your ideas of Christian duty and of doing charity 
 on the fifth, sixth, and seventh chapters of Matthew and the 
 thirteenth chapter of First Corinthians, and you cannot go far 
 astray. 
 
 " Prompt payments are appreciated by everybody " is a 
 very useful maxim to have printed on the margin of your bills; 
 it is truthful, and gives thanks to those who pay promptly. To 
 those who do not it serves as a neat admonition. 
 
 The size of the house does not always show the size of the 
 owner's honesty. You will find, in the course of your profes- 
 sional career, that honesty and dishonesty are not confined to 
 any one nationality or to any station in life, but that there are 
 many very good men and others equally bad among the rich 
 and poor alike. You will, perhaps, mount many a marble 
 step, puU many a silver bell-knob, and walk over many a velvet 
 carpet for well-housed, sumptuously fed, fashionably clothed, 
 diamond-studded patients, — 
 
 " "With the manners of a marquis," —
 
 HIS REPUTATION AND SUCCESS. 313 
 
 who will turn out unscrupulously fraudulent, and at the same 
 time you will get many an honest fee from others who make no 
 great pretensions and possess but little save their truly honest 
 hearts ; it will touch you, to see these come with part of their 
 small pittance to share it with you. Others, who know what it 
 cost to get what they have, know how to hold it, and the 
 demands of fashion are now so great on those who are trying 
 to keep up with it, that many with moderate incomes habitually 
 ignore their physicians' bills in order to aid in keeping up ap- 
 pearances of being worth more than they are. You will see 
 many a man bowed down with debt and despondency, while his 
 trinketed wife and dazzling daughters parade about as gay and 
 as fine as strutting peacocks, indebted to everybody and paying 
 nobody. Artful, double-dealing w^omen will sometimes actually 
 intercept your bills and make it impossible for you to solicit 
 payment from their husbands, unless you resort to strategy and 
 get your bills delivered direct to the latter ; and will even then 
 enter the field of falsehood and do everything they can to defer 
 or altogether prevent payment. 
 
 Families will occasionally conceal from the person who 
 holds himself responsible for your bill the true amount of ser- 
 vice you have rendered, or the actual number of visits you have 
 paid, and thereby lead him to think you have charged very 
 high, or even exorbitantly. Be prepared, therefore, promptly to 
 correct such errors. 
 
 The most unsatisfactory and troublesome kind of patients 
 physicians have to contend with are the unprincipled tricksters^ 
 who, wholly void of moral sense, cheat everybody that affords 
 them a chance, and consider it only an honorable transaction to 
 victimize physicians, and would not cross their fingers to keep 
 us from going to the almshouse. You will be fortunate if you 
 have sufficient tact to avoid having anything to do with those 
 who belong to this class. It is far better courteously, but firmly, 
 to decline to accept as patients those who can but will not 
 pay, without assigning any reason, except that you are " too
 
 314 THE PHYSICIAN HIMSELF: 
 
 hiisi/,^' or "/'r/ rather you would consult someone else,'' than 
 to have to wrangle with them about your fees after your work 
 is done, and maybe, after all, get neither fees nor thanks. 
 
 Have your wits about you, and tell Hardnut, Spendall, 
 Dedbroke, Poormouth, BlufFum, Codiisli, and other habitual 
 delinquents, who have plenty of money to smoke expensive 
 cigars, go to places of amusement, buy beer, or fill the brandy- 
 bottle, or to furnish their houses like palaces, or to follow the 
 follies of fashion, but none to pay the physician, — when they 
 have the temerity to come, with lamentations and a hatful of 
 excuses, to increase their indebtedness, — that they are already 
 as largely indebted to you as you can afford to let them be, but 
 that you are perfectly willing to serve them again after they 
 pay you what is already on the books, or a reasonable part of 
 it, or if they will pay you for the new services cash at each 
 visit ; and base your position in the matter not so much on the 
 fact that they are in question, as that you are acting in accord- 
 ance with a regular rule. Such attitude on your part will very 
 probably lead to some more or less satisfactory action on theirs, 
 and thus indicate to you what course to pursue. 
 
 In dunning delinquents for fees, it is better to charge them 
 with carelessness in the matter of paying, than with dishonesty. 
 
 You will encounter many a person who, although quite 
 amiable during your attendance, will prove very different — 
 maybe as sensitive as the eyeball — when your bill is presented ; 
 then, — 
 
 " Oh, such vinegar aspect ! " 
 
 In such cases, take especial care to give no cause for fault- 
 finding with your mode of presenting it. It is a useful precau- 
 tion to inclose each bill sent by mail or messenger in a half- 
 sheet of blank paper, so as to prevent prying custodians from 
 peering through the envelope and recognizing its contents. 
 
 When possible, let your bills be presented direct to the 
 party financially responsible, or to the real head of the family, 
 and say nothing about them to other members of the household.
 
 flIS REPUTATION AND SUCCESS. 315 
 
 In spite of all, were you a Solomon and an Angel com- 
 bined, many patients will find fault, show ill-temper, and meanly 
 quit you, under one pretence or another, when you send your 
 bill or ask for your fee, no matter how or when you do it. 
 
 A moderately successful practitioner has about two thou- 
 sand persons who call him tJieir " doctor " (fully three hundred 
 of whom are moneyless or bad pay) ; and whenever any one 
 of these is suffering from mental or physical ailment, he must 
 share it by head-work and hand-work and heart-work. He 
 must combine all good qualities, and appear the perfection of 
 each to all men, must be bold as a lion with one patient, as 
 patient as an ox with another, and as gentle as a lamb with the 
 next. Self-sacrificing, his own aches and pains must be con- 
 cealed or go unnoticed, — 
 
 "It is a fortunate head that never aches," — 
 
 and, being the slave of the sick public, he must face contagious 
 disease and inhale noxious vapors, miasms, and malaria; en- 
 counter the filthiest kind of filth and the worst of all stinks, 
 and perform many distasteful and disagreeable and disgusting 
 duties, amid embarrassments, disappointments, and vexations. 
 
 "None but a physician knows a physician's cares." 
 
 He must endure all temperatures, — August suns and December 
 blasts ; drowned with the rain and choked by the dust, he must 
 trudge, hungry and sleepy, at noon or midnight, while others, 
 oblivious to care, are resting, or being refreshed with sleep ; must 
 be with families at all seasons, in death and recovery, in sorrow 
 and joy. A soldier may serve his whole term witliout smelling 
 powder or even getting within long range of danger. A phy- 
 sician is in continual danger, and when, like a wild and relentless 
 tornado, the swift, gaunt, ghastly, withering epidemic begins its 
 work of death, no matter how great the danger, he cannot 
 £ee but in dishonor, — no personal considerations, no domestic 
 relations, no plea whatever can excuse him, — but he must depend 
 on Providence, and, from pure love of humanity, take his life 
 
 ■
 
 316 THE PHYSICIAN HIMSELF: 
 
 in his own hands, hazard the danger, and stand (hke Aaron) 
 between the living and the dead, in localities filthy and ill- 
 ventilated, to fight the monster — 
 
 " With aspect stern and gloomy stride " — 
 
 face to face, even though, without reward or expectation of 
 reward, he sufier martyrdom in the conflict, while thousands 
 are falling, like sheep, around him, and other terror-stricken 
 thousands are fleeing for their lives ! He must have an eye 
 like an eagle's, a heart like a lion's, and a hand like a lady's, 
 — must combine all good qualities, and appear the perfection of 
 each to all men, and, heaven knows ! from the narrowness, 
 and crookedness, and steepness, and roughness of his life's road, 
 he deserves far more generous treatment, and a much more 
 comfortable support, than he receives. 
 
 Some one has divided man's life into four periods, and 
 called the first twenty years the period of preparation ; from 
 twenty to forty, the period of struggle ; from forty to sixty, the 
 period of victory; and after sixty, rest. No fourth period for 
 the physician ; his struggle lasts (if he is able to walk, to see, or 
 to hold a pen) until his life ends. 
 
 How nice it would be if a physician could retire, with 
 honors and a competence, at sixty, and leave the path open for 
 other and younger men ! 
 
 " A youth of labor with an age of ease." 
 
 Computed by the ten-hour system, every busy physician 
 does no less than five hundred days' work a year, loses much 
 sleep and many meals, and has to serve numerous masters at 
 all hours, from sunrise to sunrise. Every year, measuring by 
 Avork, vexations, anxieties, discouragements, and care, the aver- 
 age practitioner has three years of brain-work and mental strain, 
 has to endure all kinds of criticism, does more charity, and then 
 lets his accounts against those who are able to pay run longer 
 than any other person in the whole community. 
 
 The trades and common occupations are learned in three or 
 four years ; perfection in them is then reached, and the balance
 
 HIS REPUTATION AND SUCCESS. 317 
 
 of life is simply a routine employment ; not so with us, for in 
 medicine the law is progress, perfection is never reached, and 
 study and mental exertion are never done. 
 
 New discoveries teach new duties. 
 
 The fact that a physician has to keep up an external show 
 of prosperity, and that many pay their visits with gloved hands 
 and in stylish carriages, leads not a few unreasoning persons to 
 infer that ours is a path of ease, almost a bed of roses ; that we 
 drive about during bank-liours, prescribe for a few select 
 patients, receive fees by wholesale, and soon get rich enough 
 to retire and live on the interest; all which is a very great 
 mistake. On the contitiry, every older physician knows that 
 after working hard day and night, owing to the difficult collec- 
 tions and the large proportion of the poor, the practice of med- 
 icine is neither an Eldorado nor a money-making profession, 
 and that it is almost impossible to get rich by the practice of 
 medicine, unless one have extraordinary professional skill and 
 repute, or be a celebrated surgeon, commanding great fees; or 
 a fashionable favorite, lucky enough to attend groups of patients 
 who have copious and open purses, or a leading speciaHst, 
 charging what he pleases — 
 
 "Their hens lay eggs with double yelks." 
 
 In fact, I know of no legitimate business in which the same 
 amount of capital and time laid out, and labor, industry, 
 and prudence exercised, would not be likely to prove much 
 more lucrative. Other men, — the farmer, the merchant, the 
 mechanic, and the artisan, — successful in their pursuits, can 
 increase their business to any extent by employing additional 
 liands and superintendents. A physician does nothing by 
 proxy, and must undertake no more than he can do personally, 
 and has no gains but from his own individual efforts. Besides, 
 the expense of living and the cost of library and apparatus 
 have all greatly increased within the last few years, and the 
 fees for services have certainly not advanced in the same ratio.
 
 318 THE PHYSICIAN HIMSELF: 
 
 The income of the most successful physicians is far below 
 what is commonly imagined, and many a physician is in a 
 constant state of poverty and debt, even after economising in 
 every direction and foregoing the purchase of many books and 
 instruments which he actually needs. Besides, ours is' not a 
 long-lived profession, and many a conscientious, able, time-worn 
 physician dies, and, instead of bequeathing an Aladdin's lamp, 
 leaves those dependent upon him poor and helpless, unless he 
 has acquired money otherwise than by his practice. 
 
 After his death, a physician's outstanding bills are rarely 
 collectable. Many a one with a large practice dies, his poor 
 family inherits only a book of worthless accounts, and his 
 estate is found to be scarcely worth administering on ; as if they 
 had spent their lives in 
 
 " Dropping buckets into empty wells, 
 And growing old in drawing nothing out." 
 
 According to the mortality tables, the average of the lives of phy- 
 sicians is fifty-six years. If you begin practice at twenty-four, 
 your active-life prospect will be thirty-two years, and from a 
 thousand to fifteen hundred dollars will represent your average 
 yearly income. 
 
 "Facts are stubborn things." 
 
 Now, were you (through God's mercy) to practice these 
 thirty-two years without losing a single day, and collect (say) 
 eight dollars every day of the time, you would receive but 
 ninety-three thousand four liundred and forty dollars. Deduct 
 from that amount your expenses for yourself and family, your 
 horses, carriages, books, periodicals, and instruments ; your 
 taxes, insurance, and a multitude of other items for the whole 
 thirty-two years, and then, so far from being rich, even after 
 this long and active life of usefulness in our important and 
 honorable profession ; yea ! after a whole life-time of scientific 
 work, mental toil, and of slavery to our unrelenting taskmaster, 
 The Sick Public ; from the days of the dirty, unwholesome dis- 
 secting-rooms through all life's phases to old age ; with not even
 
 HIS REPUTATION AND SUCCESS. 319 
 
 the Sabbaths to call your own, — when your harvest is past and 
 your summer is ended you will have but little, very little, left 
 to support you when you reach the down-hill of life, or are 
 broken down in health, with memory worn out, eyes dim, arms* 
 strength and hands' cunning lost, other faculties deteriorated^ 
 unfit, unable to work, and in need of a physician yourself. 
 
 " Thus they who reach 
 Gray hairs die piecemeal." 
 
 The physician is, as a rule, so poor a man of business 
 that if he receives money enough to meet his necessities he 
 is but seldom troubled about the balance. Money comes, 
 money goes, and he saves nothing. The writer had a friend, a 
 strong man and an excellent physician, who detested keeping- 
 accounts, and was so neglectful about his fees that he kept no 
 systematic register of charges and payments whatever, trusted 
 all to his memory, and rarely sent a bill ; the result was that 
 his easy and convenient terms, together with his superior skill, 
 made him extremely popular, and brought him more business 
 than he could do justice to, and kept him overworked day and 
 night, until, at the end of fourteen years, the incessant fatigue, 
 exposure, anxiety, and crowding cares of his overgrown prac- 
 tice ran him off his legs, broke down his giant strength, and 
 he died, almost, as it were, by suicide, leaving his starving wife 
 and unfed children without a dollar — yes ! nothing — exce])t 
 painful regret at his improvidence and lamentable lack of busi- 
 ness system. He was, indeed, the "pet of the town " while he 
 lived ; but how fared his wife and children after his life's work 
 was over'? 
 
 Be it your duty to self and to others to guard against such 
 a system, or, rather, lack of system ; for, while you owe certain 
 duties to your patients, you also owe some to yourself and some 
 to your family, if you have one, and no man should ever sacrifice 
 and neglect either department for the other. 
 
 One would suppose that physicians, whose lives are spent 
 in preventing and curing disease in others, might themselves
 
 320 THE PHYSICIAN HIMSELF: 
 
 claim exemption from disease and decay ; might turn aside from 
 their own bosoms the arrows which their skill has turned aside 
 from so many others, and attain unusual longevity ; but not so. 
 On the scroll of the Icy King of Terrors we are but men like 
 other men, and have no exemption from the common lot; are 
 bound by the same laws of mortality, and, subject to perpetual 
 wear and tear of body and mind ; we suffer sickness, we are de- 
 prived of health, our bosoms receive the shaft, and we pay the 
 natural debt, and fill an early grave fully as often as other men. 
 
 " Death ! — great proprietor of all — 
 Will seize the Doctor too." 
 
 Remember that other business-men's resources and produc- 
 tiveness survive their death or outlast their ability to work, while 
 a physician's gains represent nothing more stable than his indi- 
 vidual capacity for labor, and end when he does ; tlierefore, 
 while you are young and healthy determine to put away part 
 of your income as a nest-egg for a rainy day, or to fall back on 
 in sickness, or when old and tired of occupation ; for no one 
 knows what ill-luck may overtake him in the course of life, or 
 how dire may sometime be his need for money ; furthermore, 
 even if one is lucky enough to remain healthy, it is the dollars 
 saved during the first years of practice that roll up into future 
 competence. 
 
 "For age and want, save while you may." 
 
 Besides, if your death would leave your loved ones other- 
 wise unprovided for, it would be wise and reasonable to take 
 time by the forelock and provide for them by a sufficient assur- 
 ance on your life, which can be gotten and maintained at a 
 small cost ; then, if you should be taken, 
 
 "The widow's heart shall sing for joy, 
 The orphans shall be fed." 
 
 Beware of investing your earnings in popular speculations, 
 and refuse to go security for other people's debts, etc. Phy- 
 sicians are notoriously unfortunate in such ventures, and they
 
 HIS REPUTATION AND SUCCESS. 321 
 
 have caused many of our number to end their days disappointed 
 and moneyless, instead of in comfort with a competence. 
 
 A good, honest collector — one who possesses judgment and 
 sufficient tact to wake up hard customers and get money on an 
 easy installment, or other plan, from reluctant and dilatory debt- 
 ors without irritating and converting them into active enemies 
 — will be found very useful, and is quite necessary if you be 
 too tender or too high-spirited to allow a direct transfer of 
 remuneration from old friends or refined patients, or if you 
 have no time, or are an indifferent collector yourself Having 
 only business transactions with patients, his interviews with 
 them are business exclusively^ and he can persevere in his eff'orts 
 to collect to a degree that you would find unpleasant or humili- 
 ating. Many thoroughly honest people are too poor to pay large 
 bills, and if you allowed their account to accumulate from time 
 to time into a large bill they would be unable to pay it, even 
 if they wished, and consequently you would place them in a 
 position of embarrassment. Having a collector prevents this and 
 keeps one's financial department in a healthy condition. It also 
 tends to stimulate those w^ho are habitually slow of payment, and, 
 at the same time, sifts out undesirable patients and erases their 
 names from your list before they run their bills very high. 
 
 You should have some specific agreement with your col- 
 lector, not only in regard to his rate of percentage for collecting, 
 but also as to the conditions under which he is to claim it. 
 Among other things, you should stipulate that he is to make 
 full returns to you once a week, or, at least, once a fortnight ; 
 that he is to have no percentage on money paid to you by those 
 whom he has not visited for a month, unless you have at their 
 request stopped him from calling ; and that he is to receive 
 nothing on bills placed in his hands if the indebted parties 
 call and pay before he has delivered their bills ; in fact, nothing 
 on any bill which he does not in some way assist in collecting. 
 
 It is wise to post your books, make out bills, settle with 
 your collector, and, in fact, to conduct all the features of your
 
 322 THE PHYSICIAN HIMSELF: 
 
 pecuniary department as much out of public sight as possible^ 
 so that the pubUc may know little or nothing about you except 
 as a medical attendant. 
 
 If you adopt some special shade or color for your bills, it 
 will not only make them easy to find when patients mingle them 
 with others, but will also remind those who are remiss or tardy 
 in paying the debt, every time the color arrests their attention, 
 and may, by thus constantly reminding them, actually secure or 
 accelerate payment. 
 
 The publication of lists (black-lists) of the names of fraud- 
 ulent patients among physicians practicing in a given area is 
 mutually profitable, as it is a means of debarring those who can 
 pay if they wish from systematically imposing on a succession 
 of physicians, and coercing them into paying and retaining 
 some one. From such lists the deserving poor, unable to pay, 
 should always be omitted. 
 
 A good way to get up " The Physicians' Protective Alli- 
 ance " is to have a meeting of the physicians of your section, 
 and, after organizing, appoint a Publication Committee, to 
 which every member shall, within a specified time, hand a list 
 of the names, occupations, and addresses of able-to-pay patients 
 who have, through apparent carelessness or lack of good prin- 
 ciple, owed them bills nnjiistly long. 
 
 All these names should be alphabetically arranged and 
 published, in a small, plain, blue, cloth-bound " Reference 
 Book," one copy for each member. Also, have to accompany 
 each book a separate printed slip, containing the name of each 
 physician who has given a list, with the number assigned to him 
 by the committee placed before his name : — 
 
 1. Dr. John Allen, 
 
 2. Dr. Henry Blair, 
 
 3. Dr. William Curry, etc. ; 
 
 these slips to be kept sacredly private, and seen by their owners 
 only. Suppose Dr. James Shaw is No. 16 and Dr. Thomas 
 Wilson is No. 31 on the slip or key. We find among the
 
 REPUTATION AND SUCCESS. 323 
 
 delinquents the name of Samuel Adams, plasterer, No. 127 
 N. Bond Street, with 16 behind it. This, of course, shows that 
 Samuel Adams has been careless or unjustly slow in paying- No. 
 16 (Dr. Shaw) a bill that he owes. If 16 and 31 both appear 
 behind his name, it shows that he is in bad standing with both 
 Drs. Shaw and Wilson, and has been reported by both. The 
 object of such an association should be: not to forbid any one 
 who chooses to attend to delinquents from doing so, but simply 
 to tell one another of them, so that any one may either decline 
 to attend them or do so with his eyes open. 
 
 The list of names in the book should, for obvious reasons, 
 follow some such inoffensive title as : — 
 
 The Physician's Protective Alliance. 
 
 "Buffalo, N. Y., January 1, 1893. 
 
 " The following is a list of persons who, through 
 apparent carelessness or lack of just principle, have been in- 
 debted to various physicians unjustly Jong : — 
 
 "Adams, Samuel, plasterer, 127 N. Bond Street, 16. 
 
 " Bowman Daniel, engineer, 479 W. Biddle Street, 23, 44." 
 
 Every two or three years a new volume should be gotten 
 up and issued.
 
 CHAPTER XII. 
 
 "The more one believes in the possibility of error, 
 the surer will he be to avoid mistakes." 
 
 Be alert, observant, and apprehensive. You will be sup- 
 posed to foreknow all conceivable things relating to disease, its 
 dangers and its terminations ; therefore never exhibit self -accus- 
 ing surprise at any possible event growing out of sickness. 
 Even when cunning death has unexpectedly visited some one 
 under your treatment, either directly or as a coincidence, do not 
 let your manner or expressions indicate that you were altogether 
 ignorant of its possibility, or that you regard yourself as deserving 
 of blame, since every case has not only its probabilities, but also 
 its possibilities. 
 
 When you are attending cases in which there is danger of 
 rapid or sudden death, beware of ordering chloral, opiates, or 
 other potent drugs in such a manner as to create a belief that 
 they have caused or hastened death (manslaughter). Circum- 
 stances or fear of coincidence may at times even render it judi- 
 cious to avoid writing a prescription at all, and simply to order 
 this or that appropriate remedy under its common name, so that, 
 its suitableness to the case and its innocuous nature being 
 understood by all, you may not be unjustly charged with doing 
 harm with it. 
 
 When any one under your treatment sinks unexpectedly, 
 or dies mysteriously, or shortly after the use of some agent that 
 you have directed, or after the administration of some new 
 remedy, or shortly after you have performed some operation, or 
 soon after you have pronounced him better, — 
 
 "Joy and sorrow are next-door neighbors," — 
 
 or in any other way that could possibly subject you to unjust 
 imphcation or blame, it is better quietly but resolutely to make 
 a visit to the house of mourning, with a view to ascertain the 
 (324)
 
 HIS REPUTATION AND SUCCESS. 325 
 
 cause of death, and also to discover what attitude the friends 
 assume toward you, and to meet their criticisms and protect 
 yourself by explanations, etc. On such occasions you cannot 
 be too calm and self-possessed, nor too well prepared to explain, 
 and, if necessary, defend your course and the treatment. By so 
 acting you can anticipate injurious and prejudicial reports and 
 suppress or shape them before they become widely circulated. 
 
 On eagle's wings, scandals fly. 
 
 Bear in mind that such deaths are often due to gross im- 
 prudence of patient or friends, or to some mischievous article 
 of food or drink that has been smuggled in. 
 
 Dropping in for the purpose of preparing and giving to the 
 family the certificate of death affords a good chance for a de- 
 sired interview after any one's decease. 
 
 AVhen you are called to a case of sudden death the greatest 
 composure of mind and manner is essential and important; be 
 guarded and discreetly reserved, — 
 
 " The tongue is the rudder of our ships," — 
 
 and never assume an oracular or prophetic air, or express any 
 opinion of the cause in any such case, but show a Sphynx-like 
 determination neither to form nor deliver one, until you have 
 carefully collected and duly considered all the circumstances. 
 
 " Second thoughts are best." 
 
 The possibility of death being due to embolism, or paralysis of 
 the heart, syncope, pulmonary apoplexy, or other disease of the 
 heart, or lungs, or brain ; to poison, violence, or suicide ; should 
 be calmly and thoughtfully weighed before you express any 
 opinion ; for, should you rush in with a flurry, neglect this 
 precaution, and un-call-back-ably christen the disease according 
 to your first-born opinion, further developments in the case may 
 prove it to be some other well-known affection, and expose you 
 either as a butt to pleasantry and ridicule, or to severe censure 
 and deep mortification. 
 
 If you are called to a case of sudden death in which violence
 
 326 THE PHYSICIAN HIMSELF.* 
 
 is suspected, or to which you are summoned by the police or 
 coroner, be very careful to note everything in connection with 
 the body and its surroundings, and also where a post-mortem is 
 necessary, the condition of the viscera, each one of which should 
 be carefully examined before giving an opinion as to the cause 
 of death. Your notes should be taken by yourself or an assist- 
 ant at the time, in non-technical language, recording first the 
 year, day of the month, and the hour, then the facts of the case and 
 your interpretation thereof, and subsequently your comments. 
 These notes should be preserved ; as you will be allowed to 
 peruse them in court, if summoned there to give evidence, in 
 order to refresh your memory ; though not wholly to rely on 
 them. If the cause is suspected to be poison, be very careful to 
 tie the stomach at both ends before its removal, and keep it and 
 its contents in clean, sealed vessels, under your own eye and 
 custody, till a chemical analysis can be made, unless their care 
 be confided to the police. If a person be dying from the effects 
 of violence (wounds or poison), when called to him, calmly and 
 feelingly impart the fact to him, and if he volunteer a state- 
 ment of the circumstances causing his injuries, or in reference 
 to his assailants, take his words down at once in his exact 
 language, as such a statement will be received in court as if 
 made under oath, provided the person makes it under the belief 
 that he is about to die of his injuries. 
 
 The mottled, reddish, or livid patches, and the purplish- 
 black discolorations which appear on bodies shortly after death 
 occasion no little talk and exaggeration among the laity, and 
 are often cited as evidence of the malignant or putrefactive 
 nature of the death sickness, or as proof of ante-mortem vio- 
 lence, while they are really due to post-mortem contraction of 
 the walls of the arteries, which squeeze the greater part of their 
 blood into the veins ; through whose flaccid coats a portion of 
 its separated coloring matter escapes into the surrounding tis- 
 sues, creating the appearance mentioned. The escaped flnid 
 tends gradually to collect, by the law of gravity in the most
 
 HIS REPUTATION AND SUCCESS. 327 
 
 dependent parts of the body, as the back of the neck, trunk, 
 and Hmbs, thus leaving the higher parts clear and wax-like in 
 appearance. 
 
 You can always distinguish these post-mortem appearances 
 from bruises inflicted during life by making an incision into 
 them. If post-mortem, you will find the blood-stain superficial 
 and not involving the tissues beneath, but the contrary if due to 
 violence during life. In the latter case, moreover, they cannot 
 be removed by pressure or change in the position of the body. 
 
 The popular belief is that if a sudden death begins at the 
 heart there must have been a pre-existing disease of the heart, 
 and the family physician is often reproached for not having dis- 
 covered it during the patient's life-time. You will do well to 
 explain that the healthiest heart may suddenly become para- 
 lyzed or mechanically occluded (thrombosis or embolism) and 
 sudden death result. Bear in mind, also, that the ordinary 
 termination of organic heart disease is not sudden, but verv 
 slow, death, preceded by dropsy, inability to lie down, etc. ; in 
 fact, with the exception of cases of aortic stenosis, or regur- 
 gitation, or fatty degeneration, there are few, if any, forms of 
 organic heart disease that cause sudden death. Of course, 
 syncope, from mental emotion or physical exhaustion, if not 
 promptly and properly met, may cause sudden death, even 
 when the heart is entirely free from disease. 
 
 A belief that stout, healthy people endure accidents, opera- 
 tions, accouchements, diseases, etc., better than weaker, com- 
 plaining people is another popular error. The truth is tlie 
 latter are scliooled to pain, to disordered functions, lack of exer- 
 cise, etc., and when they have to endure afflictions, the mutation 
 from their ordinary condition is less than in the former, and 
 they have not so much vital force to be perverted into morbid 
 action, and in many instances their cases turn out more satisfac- 
 torily. Plethoric systems generally, strange as it may seem, bear 
 depletion by blood-letting, purgation, etc., badly, because their 
 circulation is accustomed to a certain degree of fullness and ten-
 
 328 THE PHYSICIAN HIMSELF: 
 
 sion, anything short of which causes disturbance of the different 
 functions. The loss of a few ounces of blood will sometimes 
 cause a plethoric man to faint, while a spare one might have 
 lost a like or larger quantity without injurious effect. 
 
 Old persons seldom bear surgical operations well, especially 
 if they have any disease of the urinary organs. Make it a rule, 
 therefore, always to examine their urine before operating. If 
 any such patients die from shock, narcosis, haemorrhage, or 
 sepsis, after your steel-edged interference with harmless growths; 
 or deformities, or ailments which they have endured for years 
 with only a certain amount of inconvenience, you will, in all 
 probability, be greatly blamed, and accused of having operated 
 simply for the expected fee, or to show applauding by-standers 
 your energy, your dazzling skill, or your manual dexterity. 
 
 You are not expected to set aside the laws of nature, and 
 will seldom be censured for a fatal issue in the diseases of the 
 ao-ed, and never in those of hard drinkers, or in cases in which 
 you have given an unfavorable prognosis from the first. On the 
 other hand, if a woman dies in her confinement you will be 
 cuss'd and discussed, and if there is any possible chance to 
 blame you it will be done, for the reason that parturition is 
 rightly regarded as totally dissimilar to disease. Child-bearing 
 is designed by nature to increase and not to diminish the number 
 of our race ; death, therefore, in labor, which is a physiological 
 function, or during the lying-in, which is a physiological state, 
 seems contrary to nature, and produces a shock, and often evokes 
 severe criticism. 
 
 Wretched, heart-broken patients who are suffering acutely, 
 perhaps afflicted with painful, incurable diseases, and the miser- 
 able, flabby melancholiacs, with all their emotional chords out 
 of tune, who are a hopeless burden to themselves and to others, 
 will occasionally imploringly ask, 
 
 "Is there no short, no gentler way 
 To mingle with our fellow-clay?" 
 
 and prayerfully plead to you from the depths of earnestness to
 
 HIS REPUTATION AND SUCCESS. 329 
 
 give them something to put them out of the (to them) weary, 
 weary, weary world. Likewise, in the case of those who are 
 enduring terrible sufferings from which recovery is impossible, 
 or at the birth of deformed and monster infants, or with helpless 
 imbeciles, the friends will also sometimes hint at, or even openly 
 request, that a sleeping potion may be given with the view to 
 release the unfortunates — by death. 
 
 " It were an alms to hang him." 
 
 In many such cases you will agree with the view that — 
 were God to take the poor sufferer it would be a blessing ; yet 
 with this aspect of the case you have nothing to do. In re- 
 fusing such solicitations, in sympathetic but explicit language, 
 let your argument be that human life is sacred, and that no man 
 has a right to say another's life is useless, or with Nero, — 
 
 "Twenty more with no excuse for living ! Kill them, too," — 
 
 and, also, that since a person has no right to end his own exist- 
 ence, he cannot delegate such a right to another, and, even if 
 he could, you would be the wrong person to ask, since your 
 province, as a physician, in the great drama of life is to prolong 
 life, not to shorten it. 
 
 So sacred is human life that were you to perform craniotomy 
 and the child be still alive when born, or should you deliver a 
 monster unfit for earth, you have no right to extinguish life in 
 either. You may, occasionally, actually be blamed for saving a 
 life that selfish guardians don't want saved, — whom they want 
 out of the way. 
 
 Many cases admit but gradually of a diagnosis and prog- 
 nosis. In accidents obscive as to nature or degree, and in cases 
 of sudden illness, when you are pressed to say whether you 
 consider the case dangerous, or likely to be of long duration, 
 reply deliberately and avoid giving definite answers, until you 
 see whether any graver affection is hidden behind the present 
 symptoms, whether new symptoms will develop, whether the 
 system will react, and whether there will be a response to the
 
 330 THE PHYSICIAN HIMSELF I 
 
 remedies used. During the progress of such cases be careful to 
 school your features and your manner, so that people may be 
 unable to read your hesitations, doubts, and surprises, — 
 
 Like the pages of a printed book, — 
 
 and either insist on consultations or, maybe, dispense with your 
 services. Therefore, in giving a diagnosis or prognosis, you 
 should always use the plainest (English) language and as con- 
 cisely as possible, and, whenever and wherever it is necessary to 
 repeat it, it is best to adhere as closely as possible to the same 
 phraseology. 
 
 In cases of accident and injury to people found in an in- 
 sensible condition on the highways, or lying in bar-rooms or 
 at station-houses, life itself may depend wholly on a proper 
 diagnosis ; therefore, although you may strongly suspect them 
 to be due to drunkenness, you will act wisely to do no guessing, 
 but give a provisional opinion only, until they return to a sober 
 state. It is better to say, " He is unconscious ; whether his 
 insensibility be due to alcohol, or to other causes affecting the 
 brain, it is at this time impossible for any one to say." 
 
 Never pronounce that an injured limb is " only bruised or 
 sprained," and order liniment, with assurances that it will be 
 all right in a few days, until you are positive that it is not frac- 
 tured or dislocated ; or the continued pain and swelling may 
 carry the patient to some more cautious physician, who will dis- 
 cover the truth, to his great honor and your great shame. A 
 great many of your brethren have been caught in this trap. 
 
 Bear in mind that death following an injury does not 
 always mean that it resulted from the injury. 
 
 "Death has a thousand doors to let life out." 
 
 It is well when called to cases of serious burns, cuts, lacer- 
 ations, fractures, bites, etc., to mention incidentally to the family 
 the possibility of the supervention of erysipelas, septicaemia, 
 lock-jaw, etc., and of deformity, or permanent impairment, or 
 whatever other unpleasant results may be reasonably feared, so
 
 HIS REPUTATION AND SUCCESS. 331 
 
 that the parties may know that you are ahve to all the possibil- 
 ities and probabilities of the case. With regard to burns, remem- 
 ber that the gravity of a burn is often due less to its depth than 
 to the extent of surface involved. 
 
 In the course of your professional career you will come into 
 contact with humanity in all its varied aspects and phases, and 
 your patients will greatly differ in the nature and extent of 
 complaint which they will make in detailing their subjective 
 symptoms to you. Some who are naturally stoical and apa- 
 thetic will fall into the error of imderstating their true condi- 
 tion, fearing that a fuller statement may alarm their friends, or 
 lead you to think their case serious, and to prescribe much and 
 strong medicine for them, or induce you to pay them manv 
 visits. Such patients will sometimes die almost without giving 
 a sign. Others, again, of a hysterical or nervous temperament, 
 fearing that you may not consider them as ill as they really are, 
 or as they conceive themselves to be, will, in detailing their 
 symptoms, magnify every detail, and seek in every way to im- 
 press you and others with an exaggerated idea of the intensity 
 of their sufferings and the gravity of their condition. One of 
 the many advantages which one's regular attendant has over 
 other physicians is his familiarity with these peculiarities of 
 temperament, with the extent of the vocabulary that each of 
 his patients employs, and with the amount of precision which 
 each uses in answering questions and in describing his sufferings. 
 A gilt-edged society lady, a hod-carrier, a lawyer, a backwoods- 
 man, a school-miss, a straight-laced old maid, a sailor, and a 
 girlish dude would each use a different kind of language to 
 express the same symptoms. 
 
 In spite of your earnest and best endeavors, you will often 
 be criticised or upbraided for your lack of foresight in relation 
 to the recovery or death of patients. The ability to estimate the 
 vital resistance in each case, by the temperature, pulse, look, 
 visage, voice, attitude, movements, and general appearance of 
 the patient, is essential to the perfection of your skill as a phy-
 
 332 THE PHYSICIAN HIMSELF: 
 
 sician. It is something apart from your diagnosis, pathological 
 and therapeutical, and few attain it. 
 
 The truth is that life is a different quantity in different 
 people : one man will scratch his finger with a pin and die, 
 another will get both legs cut off and live, and you will usually 
 have no other way to judge this or that patient's prospect of 
 recovery from either of the twenty-four hundred different mala- 
 dies that afflict mankind than by the average human standard. 
 You will sometimes have cases which will baffle every method 
 of calculation and surprise you by their possessing a great deal 
 7e5s, and others by having a great deal more^ than the average 
 tenacity of life ; and, no matter how careful you are, there exist 
 rocks that are not to be climbed, and pits not to be fathomed, 
 and things which are, from their very nature, unknowable ; 
 hence, you cannot, with our present knowledge, accurately and 
 unfailingly prognosticate the endurance power of every patient. 
 
 To illustrate what is meant : — 
 
 Health, 0. 
 
 1st. 
 
 2d. 
 
 3d. 
 Classes, { 4:th. 
 
 5th. 
 
 6th. 
 
 7th. 
 
 Suppose the above seven figures to represent the various 
 degrees of mankind's ability to endure sickness and injury, and 
 that the fourth figure represents the average extent of human 
 endurance power : some patients, then, will actually succumb 
 and die like sheep if the first degree be passed, some if the 
 second be reached, others can endure to the third, and so on, 
 while still others, with iron constitutions", have tenacity of life 
 enough to recover after going as low as the fifth, or even the 
 sixth degree. Now, if you could penetrate each patient's vital
 
 HIS REPUTATION AND SUCCESS. 333 
 
 recesses and measure, as with the rule and the compass, his 
 assimilation and innervation, absorption 'and secretion, repro- 
 duction and decay, sensation, motion, and reflex action, and the 
 total of Ms endurance power, — could see at what point his pos- 
 sibility of recovery ends and his dissolution begins, — you could 
 disentangle and unroll the concatenated web of life from perfect 
 health to death, solve the great problem, and make the strength 
 of this web a matter of mathematical certainty. There would 
 then be fewer unanswerable hows and whys, and you would 
 seldom, if ever, be reproached for unpredicted terminations. 
 This neither you nor any other mortal can do ; but you can 
 prepare yourself on all points, and make anatomy and physiol- 
 ogy your grammar and dictionary, and pathology your crown- 
 ing study ; also, keep your eyes and ears, mind, heart, genius, 
 and talent, all wide open, and make use of the teachings of 
 accumulated experience, and avail yourself fully of every aid 
 oftered to you by advancing medical science. 
 
 Full many a pupil has become 
 More famous than his master. 
 
 Disease and pain and death are parts of the plan of crea- 
 tion. Disease is ever afflicting thousands of earth's children in 
 every clime, while death (on his pale horse) is busy from pole 
 to pole. Fear of the former and dread of the latter are parts 
 of human nature, and these (fear and dread) cause mankind 
 everywhere to employ physicians : the prince in his palace, the 
 peasant in his cottage, and the outcast in his hovel ; the citizen 
 in his mansion, the laborer in his shanty, and the felon in his 
 dungeon ; the millionaire and the beggar ; the conqueror and 
 the captive ; the lord and the serf ; the sailor and the soldier ; 
 the purple of authority, the ermine of rank, and the rags of 
 squalor ; the man of religion, the man of law, and the man of 
 science ; every nation and tongue, the Christian, the Jew, and 
 the Pagan ; the pale-faced Caucasian, the Hindoo, the painted 
 Feejee, the oily and savage Hottentot on the burning plains 
 of Africa ; the tattooed, fierce, brutal New Zealander, and the
 
 334 THE PHYSICIAN HIMSELF: 
 
 sinewy savage of our own far west ; the Esquimau in tlie blood- 
 chilling Arctic regions, and humanity in the pestilential swamps 
 and jungles of the tropics ; wherever sick and suffering man- 
 kind is, they turn to our guild for relief. 
 
 This reliance of humanity on you as a physician skilled 
 to heal its wounds and to cure its diseases naturally brings 
 you in contact, on one side, with mankind's greatest, most vital 
 interests, and, on the other, with the great science and glorious 
 art of medicine, and makes your power in your legitimate sphere 
 almost monarchial. You go when you please and come when 
 you will, order what you choose and forbid what you may. 
 You are intrusted with secrets that would be confided to no 
 other person, and -are as an honorary member and guardian to 
 every family you attend ; and you wield strong influence over 
 husbands, wives, children, and servants, and lay down laws to 
 govern each in matters of life and death, and are obeyed almost 
 as implicitly as though you were Julius Csesar or the Czar of 
 Russia, — 
 
 "The foremost man in all this world," — 
 
 and your knowledge, skill, and attention will be many and 
 many a one's last earthly hope. 
 
 Thus, you see, no other men under heaven can do as much 
 good as physicians ! Others may have the will, but they have 
 not the power and opportunity ; this, with its humane nature, 
 makes ours as noble a calling as exists on the face of the earth, 
 — a calling capable of developing all the good qualities of one's 
 heart, hand, and brain. 
 
 Bear, therefore, the greatness of your trust and the respon- 
 sibility and glory and almost divine mission of our sublime and 
 ennobling profession ever in mind, and remember at all times 
 that every action, every phase of your conduct, every word you 
 utter, every look, every nod of your head, tremble of your 
 tongue, quiver of your lips, wink of your eye, and shrug of 
 your shoulders, will be observed and weighed. Therefore, strive 
 to make your character and your methods as faultless as pos-
 
 HIS KEPUTATION AND SUCCESS. 335 
 
 sible, and let no word ever escape you unsuitable to the occasion. 
 Also keep your lamps trimmed and your oil ready, and observe 
 punctuality and system in attending all who place themselves 
 under your care, and strive to do the greatest absolute good for 
 each and every one who trusts to your skill for relief, that you 
 may fill every bosom with kindness toward you, and every 
 mouth with praise ; and be truly called A Good Physician. 
 
 Thus, my professional brothers, I would attempt to show 
 that the more closely we study the moral and physical peculi- 
 arities of the various classes that make up the community, the 
 more clearly we will see that the practice of medicine has a 
 peculiar and complex environment, and that We should make 
 skill in preventing, relieving, and curing disease our cen- 
 tral thought and our chief reliance, and, as men and 
 brothers. should discharge each and every duty to our 
 Great Master's entire family, at all times and in all 
 PLACES, WITH fidelity AND HONOR; and, further, that we must 
 also possess professional tact and business sagacity if we would 
 succeed in the profession to the fullest extent that lies in us, 
 and create for ourselves corresponding spheres of usefulness in 
 the world. 
 
 In CONCLUSION, I FONDLY HOPE THAT THIS LITTLE BoOK ON 
 
 The Physician Himself may teach those who follow its 
 suggestions to surmount the many obstacles and decide 
 the many dilemmas that arise in the course of profes- 
 sional life ; and also aid them to discern the straight and 
 noble path more clearly; and to follow it more bravely, 
 more faithfully, and more successfully; for the book 
 that does these will be of unspeakable benefit, and will 
 live to serve the profession for many, many years; and 
 
 neither chisel nor hand of bronze, marble, or gold 
 
 could build its author a better or more enduring monument. 
 
 D. W. C.
 
 INDEX. 
 
 A.billty, popular tests of professional, 88 
 Abortifacients, prescribing pretended, 78 
 Abortion, solicitations to produce, 77, 78, 
 
 79 
 Accidents, demeanor in attending, 174, 
 
 324, 330 
 Accounts, necessity for keeping, 18 
 Adding suffixes, 91 
 Advertising, why unethical, 104 
 Advice, giving, relating to health, 129, 
 
 198. 199 
 ^sculapius and Hygeia, symbols of, 140 
 Aged, operations on the, 328 
 Ailments not to be ridiculed, 124 
 Allopathy, a misnomer,- 245, 249, 250, 
 
 251 
 AmenorrhcEa in consumptives, 182 
 Analyses, why make your, at home, 203 
 Anaesthetics, in trifling cases, 165 
 
 precautions regarding, 164 
 Are boils healthy ? 188 
 Art of changing medicines, 174, 212 
 Assistant, acting as, 3, 128, 129, 221 
 Assistants, four excellent, 194 
 Attending another's practice, 103, 104, 
 
 129 
 by the year, 292 
 Autopsies on private cases, 113 
 Avarice, 305 
 Avoid, something to, 79 
 
 Babes, hand-fed, 184, 185 
 Bandaging too tightly, 164 
 Baptism, conditional. 135 
 Bargains, Indian, 111 
 Beans, Panama, 197 
 Bills, 17, 280-323 
 
 how to present, 303, 304, 315 
 
 special color for, 322 
 Black lists, 322 
 
 lilame, laws that govern, 196, 197, 338 
 Boasting, 36, 37 
 Boils, are they healthy? 188 
 Boldness, 51 
 Book-agents, 85 
 Books, buying, 85, 86 
 Books, family medical guide, 180 
 
 posting one's, 387, 390 
 Bores, 50, 170, 171 
 Borrowing, 92 
 Bread-pills, 151 
 Business system, 9 
 
 the proper time to talk, 285, 301 
 Busy, too, 171, 302 
 
 Calls, hurried, 20 
 
 list of, to prepare, 288 
 Cards, business, 17 
 Carriages and horses, 26, 27, 28 
 Case, withdrawing from a, 155 
 Cases, refusal to take, 115, 117, 171 
 
 why never abandon, 139, 160 
 Cash system, the, 283 
 Catholic patients, duty to, 117-137 
 Cautions, 21, 325, 380 
 Censure, the laws of, 328 
 Certificates, death and other, 75, 125, 269, 
 270, 271 
 
 clergymen's, 270, 271 
 
 legal, 125 
 Changing diagnosis and prognosis, 121 
 
 medicines, art of, 174, 212 
 Chapters, beginning of, 1, 35, 77, 106, 
 131, 163, 193, 208, 227, 259, 280. 
 324 
 Charges, increasing one's, 293 
 Charities, special, 310, 311, 312 
 Charity, the demands of, 57, 101, 309, 
 
 310 
 Cheap doctors, 295 
 Cheerfulness in the physician, 48 
 Children, crossness and tears in, 186 
 Children's influence. 54, 99 
 Chloral and other hypnotics, 157, 206 
 Chronic discharges, suppressing, 145, 188 
 
 diseases, patients with, 138, 145 
 Clandestine visits, 131, 142 
 Clergymen, ministrations of, 131, 237, 
 
 238, 270, 271 
 Coincidences, good and bad, 165 
 Coition, why not recommend, 181 
 Cold rooms in sickness, 184 
 Collecting bills, 280, 323 
 Collector, 321 
 
 Commission versus omission, 162 
 Commodes in bedrooms, 187 
 Companions, what kind to select, 10, 11 
 Competition, wars of, 291, 292 
 Concealing presence of disease, 126, 127 
 Conditional baptism. 135 
 Conduct in the sick-room, 46-56 
 Confidants, 120, 122 
 Confidence, the, of patients, 50 
 Confinement, purgative after, 191 
 Confinements, attending women in, 114- 
 
 117 ^ 
 
 Congestion, hypostatic, 114, 326, 327 
 Consult, right of refusal to, 214, 215 
 Consultation fees, 212, 213 
 
 ' (337)
 
 338 
 
 INDEX. 
 
 Cousultation, punctuality in attending, 
 211 
 radical changes after, 213 
 room, arraugemeat of, 6, 7, 8 
 the suspense preceding a, 211 
 whom to call into, 211 
 Consultations, management of, 121, 220 
 
 object of, 210, 220 
 Consulting physician, dispensing with, 
 
 214 
 Consumption, errors regarding, 182, 183 
 Consumptives, why they cease to men- 
 struate, 182 
 Contagion, fear of. 190 
 Contagious disease, cautions regarding 
 
 attendance upon, 126, 127 
 Contingent fee, why not work for, 293 
 Contracts to do, what a physician, 70, 
 
 72, 171 
 Costly medicines, 274 
 Countenance, the physician's, 174, 324, 
 
 325, 330 
 Creaking boots, 92 
 
 Creed, difference between limiting one's, 
 and limiting one's practice, 229, 
 230 
 Critics and wiseacres, 172, 173 
 Cuckoo, the, 32 
 Cures, guaranteeing, 124, 298 
 
 Dampness, 191 
 
 Death, appearances after, 326 
 
 causes of sudden, 178, 327 
 Death, the power of, 132, 139, 140 
 Debates, how to conduct, 83, 84 
 Decrying medicine, 221-225 
 Degree of certainty in medicine, 221, 
 
 222, 227, 332 
 Dialogues, 112, 264 
 Dictionaries and encyclopaedias, 37 
 Diet-list, 200 
 Dining out, 96 
 
 Discharges, suppressing chronic, 188 
 Discoveries, attitude of physicians to- 
 ward, 230 
 Discussions, joint, 232 
 Diseases, chronic, 138 
 
 driving in, 188 
 
 fees in advance for attending 
 secret, 117, 299, 300, 301 
 
 number of mankind's, 332 
 
 the increased tolerance of, 225, 226 
 
 urinary, 179, 328 
 
 venereal, 118, 300, 301 
 Dishonesty, where found, 312, 313, 314 
 Dismissal of medical attendants, 67, 68, 
 
 155, 156 
 Dispensarj^ and hospital patients com- 
 pared with private, 60 
 Dispensaries, free, 310, 311, 312 
 Doctor, bestowing the title of, 236 
 
 or physician, 14 
 
 Doctoring the womb, 176 
 
 Dog-bites, 189 
 
 Donations, making, 101 
 
 Dosao;e, rules for, 149 
 
 Doses, heroic, 149, 152, 156 
 
 Double callings, 23, 24. 25 
 
 Dress and manners, influence of, 21, 22, 
 
 23 
 Dressing too warmly, 183, 184, 185 
 Drinking, 11, 93, 94 
 Druggists, 259-279 
 Drugs, etc., got gratis, 261 
 
 necessity for pure, 275, 276 
 
 that enslave, 206 
 Duties, five cardinal, 157 
 Duty to the dying, 131-138 
 Duty to the laws, 125, 148 
 
 Eat anything, may he? 200 
 
 Eating with patients, 96 
 
 Education, its importance to the phy- 
 sician, 38, 39 
 
 EiTiergency cases, 20, 67, 122 
 
 Engagements, making, 60, 70 
 
 Enmity, personal, 35, 36, 94 
 
 Entansilements, to avoid, 166, 167 
 
 Epidemics, 126, 127 
 
 Error, precautions to take against com- 
 mitting, 78, 157, 158 
 
 Eruption, driving in, 188 
 
 Eruptions, bringing out, 188 
 
 Estate of deceased physician, 818, 319, 
 320 
 
 Estates, charges against, 307 
 
 Ethics, medical, 60-70 
 
 Eucharist, the Holy, 135 
 
 Examinations, careless. 158 
 
 gentleness in making, 54, 55 
 
 Examining boards, 235 
 
 Expedients, doubtful, 66 
 
 Experience, value of, 107, 108, 109 
 
 Experiments tried on patients, 159 
 
 Experts, pseudo-medical, 73, 74 
 
 Exposing false systems, 233 
 
 Extreme Unction, 134 
 
 Extremists, 238 
 
 Fainting, 189 
 
 Familiarity, undue, 10, 96, 141, 144 
 
 Family, a'physician attending his own, 
 
 302 
 Fashionable frauds, 312, 313 
 Fashion in medicine, 152 
 Fashion and wealth, influence of, 236 
 Fashions, conforming to the, 22 
 Fear of contagion, 190 
 Fee in advance for secret diseases, 299, 
 300 
 
 or no fee, 298 
 
 table, 18, 291, 309 
 Fees, 245-323 
 
 doubtful, rule regarding, 283, 284
 
 INDEX. 
 
 339 
 
 Fees, fixincr the responsibility for, 285 
 
 for important cases, 295, 296, 297 
 
 how to collect, 301, 302, 303, 314, 315 
 
 joint, 308 
 
 lawsuits to recover, 306 
 
 office, 18, 19 
 
 why not work for contingent, 298, 
 299 
 Female, examining a, against her will, 
 
 165 
 Females, influence of, 12, 98 
 Feuds, professional, 35 
 Fever, water and ice in, 200 
 Fickleness, human, 130, 153-156 
 Finances, the physician's, 317, 321 
 Fingers, the tips of a physician's, 93 
 Foreign bodies, swallowing, 189 
 Forgot you, I, 117 
 Formulae, private use of, 261 
 
 stereotyped, 43 
 Fractures, popular error regarding, 165 
 Frauds, f\ishionable, 312, 313 
 Free dispensaries, 310, 311, 312 
 Friends, making, 47, 48, 49 
 
 German language, usefulness of the, 41 
 
 Golden rule, the, 36, 62 
 
 Gratifying whims, 168 
 
 Greek language, usefulness of, 40 
 
 Guaranteeing cures, 124, 298 
 
 Guard yourself, 151 
 
 Guides in judging whether a pharmacy 
 
 is properly conducted, 268, 274 
 Gums, object of lancing children's, 185, 
 
 186 
 
 Habits, disgusting, 9-10, 92, 93, 96 
 
 professional, 31, 32. 33 
 Hahnemann compared with Copernicus, 
 
 Newton, and Jenner, 247 
 Hand-fed babes, 184, 185 
 Health, how to maintain your, 21, 101, 
 
 102, 103 
 trips for, 198, 199 
 Heart disease, death from, 327 
 Hectic confounded with malarial fever, 
 
 ICO 
 
 Hell on earth. 175 
 
 Heroic doses, 149, 152, 156 
 
 High science, 87, 88 
 
 Holy Eucharist, the, 135 
 
 Home, not at, 171 
 
 Homoeopathic creed, the, 244, 245 
 
 Homoeopaths, bogus, 254, 255 
 
 test showing which are real, 258 
 Homoeopathy, 243-258 
 
 is it founded on the sole natural 
 law? 247, 248 
 
 one of the evils of, 251, 252 
 HomcBO versus liome, 252, 253 
 Hope, 50 
 
 taking away, 50, 139 
 
 Horrifying remedies, 195 
 Horses and carriages, 26, 27, 28 
 Hospital and dispensary patients com- 
 pared with private, 60, 61 
 Hospitals, sending patients to, 199 
 Hours, designating the, on bottles, 206 
 How to conduct debates, 83 
 Human fickleness, 130, 153-156 
 
 gullibility, 231 
 
 life, value of, 55 
 
 nature the same everywhere, 327 
 Humanity, its demands," 216, 217, 253, 
 
 309 
 Humoring the sick, 50, 168 
 Hurried calls, 20 
 Hydrophobia, 189, 190 
 Hypodermatic medication, 206, 207 
 Hypostatic congestion, 114, 326 
 
 Idiosyncrasy, 58, 241 
 
 I forgot you ! 117 
 
 Important cases, fees for attending, 287, 
 294-297 
 
 Incompatibles, 42 
 
 Indian bargains, 116 
 
 Indorsing domestic remedies, 169 
 
 Infants, having physicians for sick, 187 
 
 Influence of dress and manners, 21, 22, 
 23 
 of females, 12, 98 
 
 Ink, best color to use, 289 
 
 Inquiries, making, etc., in presence of 
 strangers, 119 
 
 Instruments of precision, 20, 178 
 
 Insults, 121 
 
 Interest, evincing, in cases, 56, 57 
 
 Iron injuring the teeth, 196 
 
 Irregular pliysicians, contact with, 10, 
 215, 255 
 what constitutes, 215, 217 
 
 Irregulars, joint discussions with, 232 
 popular favor toward, 235, 236 
 proper course toward, 10, 215, 254 
 why patronized, 235-239, 252 
 
 Jealousy, 30, 31, 32, 35, 120, 167 
 Jenner, 256 
 Joint fees, 308 
 
 discussions, 232 
 
 practice of medicine and pharmacy, 
 259, 311 
 Junior, posing as a. 111, 112 
 
 Kindness, influence of, 50, 57 
 
 Labeling, mistakes in, 278 
 
 prescriptions, 195, 205, 277, 278 
 
 Labels, advantage of putting the date 
 on, 278 
 putting the hours on, 206 
 
 Languages, learning foreign, 41 
 
 Latin, use of, 38, 39. 40
 
 uo 
 
 INDEX. 
 
 Laws, duty to, 125, 148 
 
 favor shown to physicians by the, 
 
 125, 126 
 medical, 233, 234, 235 
 their exceptional kindness to phy- 
 sicians, 105 
 Lawsuits, 72, 73, 306 
 Ledger, why keep a, 18 
 Legal duty to patients, 70, 72, 171 
 Liberal profession, wliy medicine is a, 
 
 219 
 Library, contents of one's, 85, 86 
 
 creating a, 85, 86 
 Life-insurance, 72 
 for self, 320 
 power of human endurance, scale 
 
 of, 332 
 should a physician ever shorten? 
 328, 329 
 Limiting one's practice, 117, 229, 230 
 List of visits, how to prepare a, 288 
 Local option, ordering liquor under, 95 
 Locate, where to, 3-6 
 Longevity of physicians, 319 
 
 Malarial affections, recurrence of, 197 
 Malingerers, 60, 124 
 Malpractice cases, 72-75, 162, 163, 164 
 suits, wlxy there are more surgical 
 than medical, 163 
 Mankind, study of, 44, 193, 194, 831 
 Mankind's dependence on physicians, 
 
 333, 334 
 
 Manners, influence of, 37, 47-49, 51-54, 
 
 92, 93, 99 
 Marriage of physicians, 97 
 
 of syphilitics, 181 
 Marriages, unlucky, 97, 98 
 Maxim, 312 
 Medical profession, greatness of the, 333, 
 
 334, 335 
 
 art, imperfection of, 221, 222, 223, 
 227 
 
 ethics, 61-70 
 
 examining boards, 235 
 
 societies, 81-84 
 Medicine, decrying, 221, 222, 223 
 
 degree of certainty in, 221, 222, 223, 
 227 
 
 fashion in, 152, 240, 243 
 
 fear of 193, 194, 195 
 
 haters, 193 
 Medicines, art of changing, 174 
 
 at office, 19 
 
 bad effects of 195 
 
 charges for, 262. 263, 274 
 
 costly, suggestions resrarding, 263 
 
 palatability of, 193, 194 
 
 the dynamization of, 348, 249 
 
 unused, 174 
 Memory of cases, 85, 145 
 Menial'labors, 122 
 
 Mental therapeutics, 150, 151, 194 
 
 Metric system, 90 
 
 Microscope, working with the, 114 
 
 Midwives, assisting, 116 
 
 Milwaukee physicians, offer of the, 248 
 
 Mineral versus vegetable medicines, 196 
 
 Mischief-makers, 120 
 
 Mistakes of pharmacists, 266, 277, 278 
 
 in compounding, cases of, 266 
 Moralizing, 129 
 Morphia siranules, 242 
 Motto onlaills, 312 
 
 Name, what is in a? 249, 250, 251. 253 
 Neglectful and perverse patients, 168 
 Neighborly visits, 30 
 New remedies, how aided, 194 
 Newspaper squibs, 29, 103, 170 
 Night emissions, 182 
 
 visits, 142 
 No cure, no pay. 298 
 Nostrums, why condemn, 273 
 Novelty, influence'of, in medicine, 168 
 Number of mankind's diseases, 332 
 Nurses, conduct toward, 167, 186 
 
 Objects of consultations, 210, 220 
 
 Obstetrical cases, 114-117 
 
 Office, absence from, 15 
 
 Oflace, charges for advice at, 18, 180, 297 
 
 hours, i6, 17, 18 
 
 location and arrangement of, 5-9 
 
 outfit, 6, 7, 19 
 
 practice, 16-19 
 
 signs, 14-18 
 
 students, 12, 13 
 Offices, branch, 5 
 OJd lady with salve, 170 
 
 persons, operations upon, 328 
 Old woman of Paris, 151 
 Omen, a bad, 137 
 Omission vei'S'is commission, 163 
 Only sprained. 330 
 Only drunk, 330 
 Opiates, their place and power, 156, 
 
 157 
 Opinions, necessity for caution in giv- 
 ing, 53, 123, '324, 325, 329. 330 
 
 of patients and their attendants to 
 be considered, 186 
 
 that terrify, 175-178 
 Other physicians, attending after, 64, 65, 
 
 103, 104, 308 
 Overlooking diseases, 157, 158 
 Overpraise from patients, 119, 120 
 
 from relatives, 120 
 Overvisiting, 123, 143, 144 
 
 Panama beans, 197 
 
 Partisan questions, 26, 94, 270 
 
 Partnership, 2 
 
 Passions, influence of, 147, 148
 
 INDEX. 
 
 341 
 
 Patients, dining with, 96 
 
 distant, 117 
 
 foreigners as, 41 
 
 hospital and dispensary, compared 
 with private, 60, 61 
 
 how to transfer, 209 
 
 physician's legal duty to, 70, 72, 
 171 
 
 neglectful and perverse, 168 
 
 purse-proud, 154 ^ 
 
 quoting authorities to. 111, 112 
 
 refusal to take, 171, 172, 313, 314 
 Patients, rights of, to additional advice, 
 214 
 
 varieties of, 141, 193, 194, 381, 333 
 
 whims gratified, 50, 168, 186, 239, 
 240, 242 
 
 worthless, 146, 313, 314 
 Pay you, when shall I '? 287 
 Paying one's debts, 91 
 Peculiarity of manner, 52 
 Pencil sketches, 160 
 Penmanship, 41 
 
 Pension claimants, certificates to, 75 
 Percentage from pharmacists, 260, 261 
 Personal afRxirs, privacy regarding your 
 own, 321 
 
 appearances, 21, 22, 23 
 Pharmaceutical catch-pennies, 204, 205 
 Pharmacists, 259-279 
 
 indiscreet, 266 
 
 prescribing, 265, 311 
 PharmacopcBia, breadth of the U. S., 272, 
 
 273 
 Phlegm, swallowing, 186 
 Photograph giving, 130 
 Physician, a sickly, 45 
 
 estate of deceased, 318, 319 
 
 how an irregular may become a 
 regular, 219 
 
 mission of the, 140, 214, 309, 333, 
 334, 335 
 
 or doctor as a title, 14 
 
 the new, 30-33 
 
 versus doctor as a title, 14 
 
 what constitutes a regular, 217, 219 
 Physician's countenance, the, 174, 324, 
 
 325, 330 
 Physicians, assaults upon, 165 
 
 associates of, 10, 11 
 
 drunken, 11, 93, 94 
 
 increase of number of, 34, 35 
 
 sickly, 45 
 
 taking office, 23, 24, 25 
 
 the marriage of, 97 
 
 why the older excel the younger, 
 107-109 
 
 why they do not get rich, 316-321 
 
 young, 4 
 Placebos, 150, 151 
 Pocket visiting-list, 18 
 Policy versus Principle, 168, 243 
 
 Politeness, value of, 38, 89, xOO 
 
 Politics, 9, 25 
 
 Pollution, self, 182 
 
 Polypharmacy, 202 
 
 Poor, attending the, 57, 58, 59, 309, 312, 
 
 322 
 Popular test of skill, 49, 86, 88 
 Posting one's books, 287, 290 
 Post-mortem discolorations, popular 
 
 error regarding, 326 
 Post-mortems and analyses, 113, 114, 326 
 Practice, difterence between limiting 
 one's, and limiting one's creed, 
 230 
 limiting amount of, 117 
 Practice, preparing one's self for, 3, 45 
 
 soliciting, 153 
 Precautions, 157, 164 
 Pregnancy suspected, 78, 79, 158 
 Prescribing, extravagance in, 174, 175 
 suggestions on tlie subject of, 156. 
 
 157 ' 
 without an interview, 221 
 Prescription, object of a, 262 
 papers, 260 
 
 the, to whom does it belong? 262 
 Prescriptions, about labeling, 205, 206, 
 277, 278 
 expertness in writing, 42, 43, 191, 
 
 202 
 joint, 206 
 ready written. 111 
 unauthorized renewal of, 262 
 Presents from patients, 95 
 Press notices, 104 
 
 from physicians, 104 
 writing for the medical, 88-91 
 Principle versus Polic3^ 168, 243 
 Private formulae, use of, 261 
 Production of abortion, 77, 78, 79 
 Profession, identifying self with the, 80, 
 
 81 
 Professorship, choice of a, 25 
 Prognosis, cautions concerning, 53, 110, 
 
 111, 121. 138, 139, 160, 325, 330 
 Provings, homoeopathic, 252 
 Purgative after confinement, 191 
 Purity of mind, 46 
 
 Quack bitters, 130 
 
 medicines, their proper position in 
 the apothecary-store, 277 
 relation of pharmacists to, 265, 274 
 Quackery, ours the age of 233 
 Quackish methods, 28 
 Quacks and impostors, depredations by, 
 
 172, 180, 233 
 Quantities to prescribe, 174 
 Question, an awkward. 111 
 Questions, asking private, 119 
 rule for repeating, 192 
 rule regarding, 47, 158
 
 342 
 
 INDEX. 
 
 Questions, unwelcome, how to avoid, 139 
 Quinine, popular prejudice a.itainst, 196 
 Quoting what the books say. Ill, 112 
 Quotations at beffinnino; of chapters, 1, 
 
 34, 77, 106,131, 163, 193, 208, 227, 
 
 259, 280, 324 
 
 R as a sign or symbol, 43 
 
 Receipts, why compel people to take, 305 
 
 Reclaiming those who have strayed, 232, 
 
 233 
 Recommending other physicians, 172 
 Record-book, 159 
 
 Recreation, necessity of, 101,102, 103 
 Reference-book, 159 
 Register heat, 184 
 Religion, 131-141 
 
 Relinquishing attendance, 142, 212, 214 
 Remedies, domestic, indorsing, 169 
 
 examined at every visit, 202 
 
 horrifying, 195 
 Removals, frequent, 5 
 Renewal of prescriptions, to prevent, 205 
 Reporting cases, 88, 89 
 Reputation, value of, 44, 45 
 
 varieties of, 29, 44 
 Responsibility, dividing the, 162, 163 
 Rich not to pay for poor, 294 
 
 the poor who get, 154 
 Riding versus walking. 26 
 Rivalry, professional, 31, 32, 35 
 Routine practice, 43 
 Rule for repeating questions, 192 
 
 the golden, 36, 62 
 Ruling spirits in family, the, 120 
 
 Scandal, 36, 46. 47, 157 
 Scarlet rash, 187 
 
 Scold, how to, without offendina:, 97 
 Secrets, 119, 146, 147, 148 
 Selection of a location, 3-6 
 Self-medication. 203, 204 
 Self-pollution, 182 
 Self-preservation, 30, 31 
 Self-reliance, its value, 208 
 Seniors, respects due our, 106-109 
 SequeUe, foreseeing, 330 
 Servants, attending, 59 
 Services for emploj^ers, 285 
 
 to clergymen, 271, 307 
 
 to physicians, 307 
 
 to the poor, 57, 58, 309, 310, 322 
 
 when not to charge for, 306, 307 
 Sextial intercourse, why never recom- 
 mend, 181 
 Shame, a matter of. 166 
 Short visits, how to make, 122, 200 
 Shut your eyes, to these, 187 
 Sick, humoring the, 50 
 Sickly physicians, 45 
 Signatures, regarding, 251 
 Signs, office, 14, 15 
 
 Skill, what is medical, 43, 56, 222, 223, 
 
 332, 333 
 Slavery of a physician's life, 101, 102, 103, 
 
 315-320 
 Small-pox, popular error regarding the. 
 
 71 
 Social influence, 100 
 Society, duty to, 148 
 Soliciting practice, 155 
 Something to avoid, 79 
 Speaking-lube, 17 
 
 Specialties, when to patronize, 208, 209 
 Specialty, adoption of a, 59 
 Specifying the particular make, 273 
 Speculum, abuse of the vaginal, 177, 179 
 Spoons, variations in size of, 206 
 Sprain, fracture or dislocation, 330 
 Spring-time, taking medicine in the. 152 
 Stepping-stones to practice, 57, 58, 59 
 Streets, barricading or roping the, 192 
 Students, increase of 13, 34 
 Suffixes, adding to one's name, 91 
 Sunday as a day of rest, 102, 279, 287 
 prescribing liquor on, 95 
 practicing on, 102, 103 
 Superseding other physicians, 64, 65, 103, 
 
 104, 308 
 Suppressing chronic discharges, 188 
 Surgeons, why demand for, is limited, 
 
 51 
 Surprise, showing, 324. 325 
 Syphilitic cases, 175, 299, 300. 301 
 Syphilitics, the marriage of, 181 
 \ System in business, 9 
 j Swallowing foreign bodies, 189 
 I phlegm, 186 
 Swearing off from drink. 129 
 Sweating during sleep, 200 
 
 the baby, 185 
 Synonyms, use of, 204, 276, 277 
 
 Telephone, the, 17 
 Temper, control of, 53, 101 
 Terms, transposing, 277 
 Terrifying opinions, 175-178 
 Therapeutics, crude, 193, 194 
 mental, 150, 151, 193, 194 
 Thermometer, clinical, 21 
 Time, rapid flight of a physician's, 101 
 Time lost in waiting, 201 
 Toleration of difference of opinion, 84 
 Tongue-depressors, 128 
 Trade-mark articles, 204, 272, 273 
 Transposing terms, 277 
 Tricks, 28, 33, 121 
 Trips for health, 198, 199 
 Triumphs, 65 
 Truth, its value, 138, 249 
 
 Unction, extreme, 134 
 
 Urinary diseases, 179, 328 
 
 Urine, scanty and high colored, 189
 
 INDEX. 
 
 343 
 
 Vacation, the physician's, 101, 103, 103 
 
 Vaccination, 70/71 
 
 Value of politeness, 98, 99, 100 
 
 of reputation, 43, 44 
 Variability of human endurance, 333 
 Variation in tlie size of spoons, 30(3 
 Varieties of patients, 193, 194, 331 
 Vegetable versus mineral medicines, 196 
 Veins ou back of hands, 191 
 Venerea] cases, 117, 118, 399, 300, 301 
 Visit, conduct at, 46-56 
 
 extra cluirge for the first, 394 
 Visiting-list, best way to carry one's, 389 
 
 how to improve a, 388 
 Visiting the patient of another physi- 
 
 c'ian, 64, 65, 103. 104, 139 
 Visitors to the siclv, 191 
 Visits, how to make short, 133, 300 
 
 neighborly, 31, 80 
 
 to the sick, 49, 130, 143. 144, 191, 
 193 
 Vivisection, 114 
 
 Vocabulary of different classes, 331 
 Volunteer services, 71 
 
 Waiting, time lost in, 301 
 
 Walking versus riding. 36, 37 
 
 Warming the newborn. 184, 185 
 
 Wars of competition. 393 
 
 What is in a name ? 349, 350, 351. 353 
 
 Whims, gratifying the, of patients, 50, 
 
 168 
 Why charge for every visit, 395 
 Wife, the meddling, 146 
 Wills, 136, 137 
 
 Wiseacres and critics, 173, 174, 303 
 Withdrawal from a case, 155 
 Witness, duty to self when a, 73 
 Woman, devotion of to the sick, 56 
 Womb-doctoring. 176 
 Work, amount of done by every busy 
 
 physician. 315-319 
 Worms, has he ? 186 
 Worthless patients, 171 
 
 systems of practice, how to expose, 
 
 333 
 Writing for tlie medical press, 88-91 
 
 Youthful physicians, 4, 111, 113
 
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