TH £ 
'Physician Himself 
J*, V- Ar/r ,k. 'L- /- X-- 4-irrA I&rawift . THE PHYSICIAN HIMSELF 
AND 
WHAT HE SHOULD ADD 
TO 
HIS SCIENTIFIC ACQUIREMENTS 
IN ORDER TO SECURE SUCCESS. 
BY 
D. W. CATHELL, M. D. 
Late Professor of Pathology in the College of Physicians and Surgeons of Baltimore. 
FIFTH EDITION, THOROUGHLY REVISED.' 
BALTIMORE: 
CUSHINGS & BAILEY, 
262 W. Baltimore St. 
1885. Entered according to the Act of Congress, in the Year 1885, by 
D. W. Cathell, M. D., 
In the Office of the Librarian of Congress, at Washington, D. C. 
Press op Isaac Friedenwald, 
Baltimore, Md. THIS LITTLE WORK 
IS RESPECTFULLY DEDICATED TO 
PROFESSOR AUSTIN FLINT, Senior, 
IN ADMIRATION 
OF HIS VARIOUS CONTRIBUTIONS 
TO SCIENTIFIC MEDICINE, 
AND OF HIS 
UNTIRING DEVOTION TO THE WELFARE 
OF OUR PROFESSION. PREFACE TO THE FIFTH EDITION. 
THE MARKED FAVOR with which the various editions of this 
little work have been received by the press and the profession 
throughout the country, and the number of copies sold (15,000), are 
proof that its publication was timely, and that it is materially assist- 
ing in the advancement of the interests of our profession and the 
welfare of its members. 
For the kindness everywhere shown to it by the press and profes- 
sion, words cannot express the gratitude of the author. 
In preparing a fifth edition he has carefully revised the work, and 
made such alterations in it as greater experience and more mature 
reflection have dictated. 
It is confidently believed that this revision makes the fifth a 
decided improvement on former editions. PREFACE TO THE FIRST EDITION. 
OBSERVATION has impressed the author with the belief 
that an essay on personal questions in medical practice, 
would be of decided benefit to numerous members of the profes- 
sion. He has therefore, with diffidence, attempted the duty and 
jotted down the following thoughts as they suggested themselves 
to him in the course of a busy life, and now publishes them in the 
hope that they may awaken a proper degree of attention to this 
class of subjects in the minds of his professional brethren. 
The entire work has been written in the form of a reply to a 
question, for the purpose of making what is said appear more 
direct and personal to the reader. 
D. W. 0. 
2 N. Broadway, Baltimore. THE PHYSICIAN HIMSELF 
AND 
What he should add to his Scientific Acquire- 
ments in order to secure Success. 
CHAPTER I. 
“ Things small in themselves, have often a far-reaching significance.”—Chew. 
A certain amount of professional tact and business 
sagacity is as necessary to the physician as the mariner’s 
compass is to the navigator. There are gentlemen in 
the ranks of our profession who are perfectly acquainted 
with the scientific aspects of medicine, and can tell you 
what to do for almost every ailment that afflicts human- 
ity, who, nevertheless, after earnest trial, have never 
achieved either reputation or practice, because they lack 
'professional tact and business sagacity; and there is 
nothing more pitiful than to see a worthy physician defi- 
cient in these qualities, waiting year after year for a prac- 
tice, and a consequent sphere of professional usefulness, 
that never come. 
Were a young physician to ask me: What honorable 
means can I employ, in addition to scientific knowledge 
and book-learning, in order to make my success in prac- 
tice more certain, more rapid, and more complete? I 
should offer him the following suggestions : 10 
You should, above all else, strive to start right, and 
to enter promptly on the road to success; for unless you 
make some mark, acquire a reputation and build up a 
practice in your first six or eight years, the probabili- 
ties are that you never will. 
It is better not to enter into partnership with other 
physicians. Partners are usually not equally matched 
in industry, tact and similar qualities, and are not equally 
liked by the public. Hence the union generally does 
not prove as beneficial or as satisfactory as expected, 
and consequently partnerships rarely continue long. 
Above all else, never ally yourself with any other doctor 
except as an equal. Julius Cassar said, “ I had rather 
be the first man in a village than the second man in a 
great city.” 
The location and appearance of your office will have a 
great deal to do with your progress. Select one in a gen- 
teel neighborhood, upon, or very near, an artery of travel, 
convenient to either a densely populated old section, or 
a rapidly growing new one. If you were to locate on a 
back, or unfrequented street, or other out-of-the way 
place, it would naturally suggest to the public either 
defective ambition, or distrust of your own acquirements. 
Remember, in making your selection, that a doctor 
cannot rely on his near neighbors for patronage ; people 
in his immediate neighborhood may never employ him, 
while some farther away will have no one else. 
Branch offices are as a rule not desirable. Besides con- 
suming valuable time in going to and fro, and in general 
occasioning double trouble, they create an uncertainty 
in the minds of those seeking the doctor, as to where he 11 
may most readily be found. On estimating all the ad- 
vantages and disadvantages, therefore, I think it will be 
found that a plurality of offices increases greatly neither 
one’s practice, one’s popularity, nor one’s income, and may 
be regarded as likely to prove more annoying than, 
profitable. 
It is risky for a beginner to locate too near a group of 
popular, energetic physicians, as their superior advan- 
tages and established reputations may keep him dwarfed 
for too long a time. 
If possible, have a good, light, airy and accessible 
office, one that is not used for a family parlor, or any 
other accessory purpose. A corner house has advantages. 
Exercise care in its arrangement; let it look fresh, 
neat and clean, thus showing that its occupant is pos- 
sessed of taste and gentility, as well as learning and skill; 
and at the same time that it is not a lawyer’s consult- 
ing-room, nor a clergyman’s sanctum, nor a smoker’s 
parlor, but the office of an earnest, working, scientific 
physician, who has a library, takes the journals, and 
uses the various instruments science has devised for 
him. 
Take care, however, to avoid running into a quackish 
display of the latter, and keep from sight such inappro- 
priate or even repulsive objects, as catheters, specula, 
obstetric forceps, splints, trusses, amputating knives, 
skeletons, jars of amputated extremities, tumors, and 
the unripe fruit of the uterus. 
It is not unprofessional, however, to allow to be ex- 
posed your microscope, stethoscope and other aids to pre- 
cision in diagnosis, diplomas, certificates of society mem- 12 
bership, pictures of eminent professional friends and 
teachers, academical prizes, professional relics and keep- 
sakes, or anything else that is specially associated with 
your medical studies and career. But it is better to 
limit such articles to those having relation to you as a 
student or physician. 
A case of medicines, cabinet of minerals, or works of 
art, are in good taste; so also are your dictionaries, 
encyclopedias and lexicons for ready reference; but let 
no sharks’ heads, impaled butterflies, bugs, miniature 
ships, snakes, stuffed birds, lizards, hornets’ nests, or 
anything else be seen that will place you in any other 
light than that of a physician. If you have a love for 
such things, at least keep them out of sight of the public, 
and endeavor to lead every observer to think of you only 
as a physician. 
Display no political or religious emblems, portraits, 
etc., about your office, because these relate to your per- 
sonal sentiments, and your office is a public place, not 
for any special class, but for every kind of people; 
no matter what shade of partisan or sectarian pictures 
you may display, they will surely be repugnant to some. 
Establish a regular professional and business policy at 
the beginning of your career. Have your office lighted 
punctually every evening, at the proper hour, and in all 
other respects let it show attention and system. 
Do not allow the ladies of the family to lounge about 
your office, read your books, answer the office bell, etc., 
lest it repel patients. Both messengers and patients 
would rather meet the doctor, or his servant, than ladies. 
You should respect public opinion in this and in all other 
matters justly open to criticism. 13 
A physician is judged by the company he keeps. Avoid 
associating with those who bear a merited stigma, or are 
notoriously deficient, or whose hopes and ambitions have 
been blighted by their own misconduct. Let your asso- 
ciations be, as far as possible, with professional brethren 
and people of genuine worth. Prefer to spend your idle 
time in your office, or at the drug stores, or with other 
doctors, or at the medical library, to lounging around 
club rooms, cigar stores, billiard parlors, barber shops, 
etc. No ordinary man ever conceives a more exalted 
opinion of a professional man by fraternizing with him at 
such places. 
Be cordial with all kinds of patients, but do not hand- 
shake and harmonize unreservedly; undue familiarity 
shears many juniors of much of their prestige. Never 
become so familiar as to lay all formality aside and enter 
any patient’s house, or room, without ringing, knocking, 
or calling. 
Never have companionship with Irregulars; it would 
detract from both you and rational medicine, which you 
represent, and give countenance to delusions and preten- 
ders ; avoid this, and every other contaminating alliance. 
What shall be*said of debauchery with harlots and 
association with concubines ? Of drinking and of gamb- 
ling ? My dear sir, if you have entered any one of these 
roads, turn from it at once, for they all lead downward, 
and will destroy your finer sensibilities, prove fatal to 
every ambition, and finally blast your career. Now if 
any one of these habits singly will be attended by such 
fatal consequences, what must be the combined effects of 
them all? Professional suicide! Virtue alone will 14 
make you happy and enable you to withstand your 
critics. 
Put not a feather’s weight upon the honorable ambi- 
tion of any one, or a straw in the pathway of his worthy 
aspirations, but be very cautious how you involve your- 
self by inducing young men to study medicine, as there 
are already three doctors where one is required. Be- 
sides, either their misconduct or unfair rivalry may 
work injury to yourself. 
It is not usually either profitable or advisable to take 
office students, as they are necessarily in your way and 
divert your mind from other duties; but if you should do 
so, charge them for the privilege not less than the usual 
fee of $100, each, per annum. And only take such ap- 
plicants as have a reputable character, good sense, men- 
tal and physical vigor, the necessary educational quali- 
fications, and honorable ambition. Refuse all such as 
are prompted to embrace medicine from a belief that its 
study is simply a pleasant pastime, or that it is less 
laborious than the business they have been following, or 
who are tempted by the ease with which a diploma can 
be obtained, or by a false idea that it is a smooth and 
royal road to moneymaking, or by any other motive so 
unworthy. 
Do not let your office be a lounging place, or a smok- 
ing room for horsejockeys, dog-fanciers, gamesters, swag- 
gerers, politicians, coxcombs, beaux, sports and others, 
whose time hangs heavily on their hands. The public 
look upon physicians as serious, sober men, who have 
been singled out and set apart for a lofty purpose, and 
as worthy of an esteem not accorded to such people, or to 15 
persons engaged in the ordinary business of life. The 
conversation and amusements of such company do not 
harmonize with the tastes and desires of physicians of re- 
finement, and, moreover, they tend to weaken or destroy 
the faith of the public, which is so essential in our work; 
on no profession does faith have such influence as on 
ours. The public takes cognizance of these and of a 
great many other little things regarding medical men; 
in fact, every circumstance in your manner, appearance, 
conversation, habits, etc., will be closely observed and 
criticized, more especially in the early years of your 
career. ' j 
In getting office signs, remember that a doctor 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 
gold letters is the neatest and most attractive of all; 
one such sign on the front wall for the daytime, and a 
glass one with black letters in the window, to be seen 
at night, when your office is lighted, are sufficient. The 
letters on the former should be round and well shaped, 
and not more than two inches high, with corresponding 
width. 
All signs should be neatly made and properly let- 
tered, for even a sign makes an impression, either good 
or bad, on the public, and first impressions are very 
enduring. 
It is better to put Dr , on your sign, than to 
put . . . , M. D. “ Doctor ” looks better and is under- 
stood by all. 
To put “Physician and Surgeon” or “ Physician and 16 
Accoucheur,” or other compound title on your sign, would 
be unnecessary in this region, since all physicians are 
supposed to be surgeons, accoucheurs, etc. As well might 
the confectioner say on his sign, “ Cold Ice Cream.” 
Unless there is danger of your being confounded with 
some other doctor of the same name, it is well to omit 
your given name, or initials, from your signs, but it 
should be on your cards. Of course, if your name is 
“ Smith,” or “ Jones,” or “ Brown,” it would be neces- 
sary to put your given name on your signs; but if your 
name is uncommon, it is not. People would not speak 
of Doctor John W. Garfield, hut of Doctor Garfield. 
Do not allow other people’s signs of tooth-drawing, 
cupping and leeching, millinery, dressmaking, painting 
and glazing, boarding, etc., in company with yours. 
It is unprofessional to put where you graduated and 
how long you have practised, upon your cards and signs, 
or in the newspapers. 
Establish regular office hours early in your career, 
and post them conspicuously in your office; also have 
them on your cards. 
It may be a question whether it is advantageous to 
have a sign designating your office hours on your office 
window, or on the outside front, to show them to the out- 
side public. Your situation 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, would be more apt to catch the over- 
flow, emergencies, cases of accident, or calls from strangers 
in the city, and other anxious seekers for “ any one, so he 
is a doctor,” and who have perhaps searched and found 17 
all the busier physicians away from their offices. These 
calls you would be likely to get, if an exhibition of 
your office hours does not drive them off by showing 
them before ringing the bell that they have come at 
the wrong time, when in fact you are at home and ready 
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 out- 
side, regulate matters better, and prevent various annoy- 
ances, by letting every one see his hours before ringing. 
An excellent rule is to direct attention to both the 
beginning and ending of your office hours, as : “ Morn- 
ing office hours begin at 7 and end at 9. Afternoon 
office hours begin,” etc., etc. Many people think that 
as your office hours are from 7 to 9, if they get there 
one minute before 9 o’clock they are in time; whereas 
if they come at that time they will be sure to keep you 
past your hour for going out. By regulating your time 
thus, and constantly urging those you attend to observe 
those hours strictly, you can accomplish doubly as much 
with less hurry and more satisfaction to all. Indeed, 
by persistently schooling patients to observe those hours, 
and send for you, as far as possible, before your accus- 
tomed time for starting on your regular rounds, 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 Doctor’s 
life. 
If you should ever get very busy, and be pressed for 
time, your sign might still further emphasize it, after 
stating your hours, by adding, “ No office consultation 
at other hours.” 18 
Have on a little sign over your slate something like 
this : “ In leaving a message for the Doctor, be care- 
ful to write the name, street and number.” 
You should keep a supply of cards with your name, 
residence, and office hours on them. An inch and three- 
quarters by three inches makes 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 u For 
professional services.” Blank forms for use in giving 
certificates to sick members of societies, etc., are also 
very useful. Printed professional certificates look much 
better, seem more formal, and give more satisfaction than 
written ones. 
A speaking-tube from your outside office door to your 
bedroom is of the greatest utility for night calls. 
The telephone is also both a luxury and a necessity. 
Many physicians who need a telephone are deterred 
from getting it by the fear that it will cause them to 
be summoned to patients, good and bad, at a distance 
too great for them to attend, or that its convenience 
will cause annoying calls and messages to be received at 
unseasonable hours. This belief is erroneous. The 
telephone really does the opposite, and cuts off the long 
arguments and attempts to over-persuade that we en- 
counter in personal interviews. It is much easier to 
refuse a call, or to make a plea, or give a direction, or 
order a remedy, through the telephone, than by an in- 
terview with a messenger. 
When you begin practice, get a pocket visiting-list, a 
cash book and a ledger, and commence to keep regular 19 
accounts at once; this will teach you system, and in the 
course of time save you hundreds of dollars. 
Record the full name, occupation, and residence of 
every new patient; for, although the identity of this 
one and that one may, at present, be very clear in your 
mind, yet as patients multiply and years elapse, your 
recollection of various ones will become misty and con- 
fused, and the consequent loss to you will be very great. 
Never neglect to make memoranda of office consulta- 
tions, payments, new calls, etc., in your visiting list, with 
a lead pencil, until you get an opportunity to write them 
in ink. 
Have a copy of the fee-table framed and hung in a 
conspicuous position in your office, that you may refer 
patients to it, whenever occasion requires. Also, have 
a small, neat sign, with “ Office Consultations from $1 
to $10,” posted in some semi-prominent place in your 
office. It will show your rule and tell your charge ; it 
will also remind those who really forget to pay, of the 
fact, and will put less honest people in a dilemma. 
You can, when necessary, point to it and ask for your fee, 
and let them know you keep no books for office patients. 
Such a sign will save you many a misunderstanding and 
many a dollar. Of course you may omit its cash en- 
forcement towards persons with whom you have a 
regular account. 
Having your charge from “ $1 to $10,” will enable 
you to get an extra fee for cases of an extraordinary 
character, and still allow you to charge minimum fees 
for ordinary cases. Such a schedule will make those 
who get off by paying the lowest fees, feel gratified; it 20 
will also show everybody that you are skilful enough 
to attend ten-dollar cases. 
Cultivate office practice assiduously; for it is a fertile 
source of reputation and of cash fees. Try to benefit 
and give satisfaction to every patient that comes to con- 
sult you, that every one may go away with a clear 
idea of what is the matter with him, and a belief 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 for use at your office, 
representing the most frequently employed articles of 
the pharmacopoeia, especially 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 fees from 
patients who can appreciate advice and medicine com- 
bined, but who cannot appreciate advice alone. Besides, 
by keeping cathartic pills, aromatic spirits of ammonia, 
lime water, morphia granules, etc., you can, by sending 
a suitable remedy by a messenger, save yourself many a 
tramp at night, during storms, on Sundays, great holi- 
days, at odd hours, etc., and yet give the patient both 
relief and satisfaction, till you can go. 
You have a perfect right to supply a patient with- 
medicine, if you choose. Very extensive use of this 
privilege, however, tends to consume valuable time, to 
dwarf you in other ways, and does not pay. Besides, it 
would engender the criticism and enmity of neighboring 
druggists. Supply medicines to your own patients only. 
When you are summoned to cases of colic, convulsions, 21 
accident, etc., go, if possible, immediately. Then, if you 
are too late, you will have no cause for regret, and neither 
be chagrined, nor responsible. When you cannot go at 
once, without neglecting other duties equally as urgent, 
it is much more satisfactory to your patient, if you send 
a remedy with instructions for use till you can go, than 
to send a prescription; to send a prescription in such 
cases seems rather as if you do not care to attend, or as 
if the patient was on your secondary list, and if the case 
does not eventuate favorably, you may be severely 
criticized. 
If, at your office and elsewhere, you make an honest 
and proper use of instruments of precision—the stetho- 
scope, ophthalmoscope, laryngoscope, the clinical ther- 
mometer and microscope, and those used in making uri- 
nary analyses, etc., they will not only assist you very 
materially in diagnosis, but will also aid you greatly in 
curing people by heightening their confidence in you 
and enlisting their co-operation. 
Always carry in your pocket case a good clinical ther- 
mometer, a female catheter, a bistoury, a hypodermic 
syringe, a pair of small forceps, a stick of lunar caustic, a 
penknife, etc., for ready use. Keep a little raw cotton in 
the case with your clinical thermometer, to protect it 
against breakage, and always wash the instrument imme- 
diately after use. 
Avoid syphilitic inoculation, septicaemia, etc., in mak- 
ing vaginal and other examinations. Cosmoline and 
vaseline answer very well; they have no affinity for 
moisture, and both keep for years without becoming ran- 
cid or decomposing. Get a pound can of either, and 22 
keep it in your office for anointing your fingers, instru- 
ments, etc. Wooden toothpicks and wooden cigar-1 ighters 
are very handy for making mops, applying caustics, etc. 
Being inexpensive, they can be thrown away after one 
service, instead of being kept for further use, as must be 
done with expensive articles. 
Knives, probes, needles, etc., can be readily cleaned 
and disinfected, both before and after being used, by 
thrusting them several times through a cake of wet 
soap. 
Be careful never to immerse a finger that is even 
abraded, in vaginal or other suspicious fluids; if your 
preferable hand is unsafe, use the other. 
You should have a special receptacle in your office for 
cast-off dressings from cases of gonorrhoea, syphilis, 
septic ulcers, etc., which, when they accumulate, should 
be burned. 
You should live comfortably for the sake of being com- 
fortable, and rest* as much as possible on Sundays and at 
night; and if you would avoid the risk of breaking 
down your physical health, as hundreds of our profes- 
sion do, consider it a cardinal duty to get your meals 
and your sleep as regularly as possible. 
Every physician should keep himself neat and tidy, 
and should avoid slovenliness and everything approach- 
ing to carelessness or neglect; above all else, he should 
wear a scrupulously clean shirt and a spotless collar. 
You never heard of a bank swindler, or a confidence-man, 
or a gambler, or a counterfeiter, or pseudo gentleman of 
any kind, who dressed shabbily or appeared coarse. 
Such people are all close students of human nature, and 23 
no matter how abandoned they are, no matter how tar- 
nished their characters, nor how blackened their hearts, 
they manage to hide their deformities as with a veil from 
all but the few that know their true characters, by as- 
suming the dress and manners of gentlemen. Now if 
genteel dress and polished manners can do so much for 
such fallen specimens of mankind, how much greater 
influence must they exert for those who are truly gen- 
tlemen and members of an honorable profession. 
Do not ignore the fashions of the day. A due regard 
to the customs prevailing around you will show your 
good sense and discretion. Even though the prevailing 
style of dress or living border on the absurd or extrava- 
gant, it may 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.” 
Do not, however, be a leader in frivolous fashions, ap- 
pearing as though your foppishness had overshadowed 
everything else ; nor display glaring neckties, flashy 
breastpins, fancy canes or any other peculiarity that in- 
dicates a desire to be a society man or a swell. Such 
individuals may be admired, but they are not usually 
chosen by worthy persons seeking a guardian for their 
health. 
Even though you are ever so poor, let it be genteel 
poverty, for a physician’s dress, manners and bearing 
should all agree with his dignified calling. The neglect 
of neatness of dress and the want of polite, refined man- 
ners might cause you to be criticized and shunned. You 
will see some whose heads are comparatively empty suc- 24 
ceed almost entirely by attention to appearances and 
affability of manner, while many much better qualified 
will fail by reason of defects in these apparently trivial 
matters. Clean hands, well-shaved face, polished boots, 
neat cuffs, gloves, fashionable clothing, cane, sun um- 
brella, all indicate gentility and self-respect, and give 
one a pleasurable consciousness of being well dressed 
and presentable. 
The majority of people will employ a well-dressed 
physician more readily than a shabbily dressed one; they 
will also accord to him more confidence, and expect 
from and pay to him larger bills. 
Avoid double callings. Divorce medicine from every- 
thing else—from the drug business, from giving public 
readings, from preaching, poetry, concerts, base-ball play- 
ing, rowing matches, etc., because the public cannot 
appreciate you or any one else, in two dissimilar charac- 
ters, half doctor and half druggist, or three-eighths 
doctor and five-eighths politician, or other similar mixture 
of incongruities, for it is in medicine as in religion—no 
one can serve two masters. Although it may seem para- 
doxical, 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 depart- 
ments of medicine. The public in general believe a sur- 
geon is good only for cutting, and that a specialist is 
good only for his specialty, a preacher for preaching, etc. 
Hesitate even to take such offices as vaccine physi- 
cian, coroner, city dispensary physician, sanitary inspec- 
tor, etc., in a section where you expect to practice in 
future. All such functions seem to dwarf one’s ulti- 25 
mate progress, and usually create a low-grade reputation 
that it is hard to outlive. To many people, all such 
offices look somewhat like a confession of impecuni- 
osity, or inferiority, and create an impression that is not 
overcome for years. If you have any merit at all, pri- 
vate practice industriously followed will lead by better 
roads to speedier success. 
The last remark is, also, to a certain extent true of 
the position of physician or assistant physician to hospi- 
talsj asylums, dispensaries, etc., where the employ- 
ment at a nominal salary and the comforts of a home, for 
a few years, have caused many a physician fully quali- 
fied for success, to lose the best part of his life, and let 
slip opportunities that could never be recalled. 
Politics, even when honorably pursued, are ruinous to 
a young physician’s prospects; later, when his medical 
reputation is already extensive, they will militate against 
him, although they may not necessarily ruin him. If 
honorable politics injure thus, how much worse is it to 
be drawn into low ward demagogism and wirepulling at 
primary meetings. You can in the long run make ten 
friends and ten dollars by medicine while you are making 
one of either by politics, beside escaping many anxious 
hours and bitter disappointments. 
You will also find that society, church, political and 
other special groups of patients, gained because they are 
affiliated with you in party matters, rather than through 
appreciation of your merits as a physician, are neither 
very profitable nor very constant. Banishing every 
thing that comes between you and your legitimate work, 
and cultivating patients secured promiscuously from 26 
every direction, because they have faith in your skill as 
a physician, will in the long run pay you better than at- 
tending to politics or any other outside issue. 
A riding physician has several advantages over the one 
who walks; 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 cases 
while riding than if walking, and when he reaches his 
patient he is in proper mental and physical condition to 
begin his duties, while the walking physician arrives 
tired and in need of rest. Another convenience is, he 
can salute acquaintances as his carriage meets them and 
ride on, whereas were he on foot he might be compelled 
to stop, parley-and lose valuable time with convalescent 
patients, old friends, etc. 
You should, therefore, get a respectable-looking horse 
and carriage, as soon as circumstances will at all justify. 
A team 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 physician. 
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 rides must have had 
extensive experience and a successful practice, else he 
would not require and could not afford it. 
If you unfortunately have a bony horse and a seedy- 
looking or a pre-adamite kind of buggy, do not let them 
stand in front of your office for hours at a time, as if 
to advertise your poverty, lack of taste, or paucity of 
practice. If you have two horses, it is better to drive singly, 
that one may be resting while the other is working. 
Driven thus, two good, well-kept horses can carry you 
to as many patients as you can attend. 
It is perfectly fair and proper to seek reputation 
by all legitimate means, but careful observation will 
convince you that attempts to attract attention by quack 
devices, driving ostentatious double teams, or having 
liveried drivers, odd-shaped or odd-colored vehicles, close 
carriages, conspicuous running-gear, or blazed-faced, 
curious-looking horses, or ponies, or by habitually driving 
as though the devil were in chase, and attempting to 
read a book as the carriage whirls and jolts along, also 
affecting odd-style or extra wide brim hats, long hair, 
heavy canes, etc., all generally fail in their object, are 
looked upon by many as the efforts of a small mind 
or weak head to hide a lack of ordinary skill, and ac- 
tually bring the one who affects them into ridicule and 
disrespect. Do not thus belittle yourself, but strictly 
avoid ostentation and every peculiarity of manner, dress, 
office arrangement, etc., calculated to excite either ridi- 
cule or contempt. On the other hand, however, if you 
are shame-faced, diffident, lacking in aggressiveness, or 
deficient in tact, you will never prosper, until these dis- 
advantages are overcome. 
It is customary and proper to give notice of removals, 
recovery from long sickness, return from long journeys, 
etc., in the newspapers, but it is not creditable to an- 
nounce your entrance into practice, or to advertise your- 
self generally in newspapers, or to placard barber shops, 
hotels, etc. Puffing yourself, your cases, your apparatus, 28 
or your skill, or winking at being puffed and applauded 
in the papers, is quackish, and on a par with the speckled- 
horse plan. A proper pursuit of medicine will imbue 
you with loftier sentiments and engender nobler efforts 
to gain public attention, and will spur you to build your 
fame on stronger foundations. 
Cultivate a professional manner and spirit. Do 
nothing to gain popular favor that does not accord with 
both the letter and the spirit of the code. Independent 
of the degradation you would feel, it would not pay to 
trust for business to tricks of any kind ; for the veil that 
covers such attempts is generally too thin to hide the real 
motive, or to turn aside ridicule. 
You will be more esteemed by patients who call at 
your office for any purpose, if they find you engaged in 
your professional duties and studies, than if reading 
novels, making toy steamboats, or occupied in other 
non-professional pursuits; even reading the newspapers, 
smoking, etc., at times proper for study and business, 
have an ill effect on public opinion. Public opinion is 
the creator, the source of all reputation, whether good 
or bad, and should be respected; for a good reputation 
is a large, a very large part of a physician’s capital. 
It is very natural to expect your medical neighbors to 
pay you a friendly visit after you locate, whether ac- 
quainted or not; but if they fail to do so, it should not 
be construed as ill-will, for it may be due to their position 
of doubt concerning your being regular, etc., which they 
for the time being entertain. Very true men are some- 
times slow to fraternize. 
There is a very great difference between the case of 29 
an additional physician starting in a community or 
neighborhood, and an additional person being added in 
almost any other business. The demand for other 
things can he increased, hut the demand for doctors is 
limited, so that a new doctor must create his practice 
out of that taken from other physicians. Every family 
the newcomer adds to his list must be diverted from 
that of a rival, who may have attended it long enough 
to almost deem it his private property, and of course 
the rival does not like it; for there is a little human 
nature still left in a man, even though he has studied 
medicine. The older practitioners are therefore natu- 
rally very apt to be watchful of, if not captious towards 
their new rival, and when they see him crowding him- 
self in, much as we see one do in an already crowded 
street-car, animosities and feuds are apt to arise. There 
is a proverbial rancor about medical antagonisms and 
medical hatreds; avoid them as far as lies in your 
power. Courteous rivalry between doctors is advanta- 
geous to the public, because it creates a spirit of emu- 
lation, and compels each to try to be skilful and success- 
ful in practice. 
It is in fact almost natural for an established physi- 
cian to regret the advent of another medical aspirant; 
and some are sensitive and hypercritical towards every 
newcomer to a degree bordering on monomania, 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 skilful, 
actually makes less sickness; because the spur of rivalry 
stimulates each to try to get all curable cases well, not 30 
only surely, but quickly. Sickness, both in amount and 
duration, is decreased, because skilled laborers have in- 
creased. There is, of course, no greater number of 
cracked skulls, dislocated bones, sore legs, cases of 
rheumatism, or diseases of any kind, than before the 
stranger came. He must therefore draw his share of 
the loaves and fishes from the others. 
Study the manoeuvres of that ungrateful bird the 
cuckoo; how the fostered cuckoo expels all the other 
birds from their maternal nest after its cunning mother 
has been unwisely allowed to deposit an egg, and their 
parent has watched and nourished it, until it is strong 
enough to show its ingratitude by hurling the rightful 
owners out, and you will realize why established doc- 
tors dislike to see interlopers gain a foothold in their 
section, and effect an entrance into their families. Com- 
petitive practice does not necessitate enmity; but self- 
preservation is the first law of nature, and when it is 
endangered, every human bosom feels the same impulse. 
If you are conscious of any merit above mediocrity, 
if you are ahead of your brethren, let mere matters of 
display remain secondary, while your merit is made the 
more prominent. This is more durable, less expensive, 
and more in harmony with the views of sensible people. 
Do not hesitate, however, to embrace every accidental 
or natural advantage in practice, if honest and ethical. 
You will find that intellect, genius, temperance, cor- 
rect personal habits, and other excellent qualities, will 
all fail unless you add ambition, self-reliance and aggres- 
siveness to them; but in your efforts to advance, you 
should take care not to incur the reputation of being a 31 
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, than 
to struggle along with honesty and industry. Deter- 
mine, therefore, that in your efforts you will do nothing 
that is criminal, nothing that will not stand every test 
and the severest scrutiny, nothing for which you would 
hesitate to sue for your fee, if necessary—nothing that 
you cannot approve of, with your hand on your heart 
and your face turned upwards. CHAPTER II. 
“Gently scan your brother man.”—Burns. 
There has been of late years a disproportionate annual 
addition to our already overcrowded profession, and the 
colleges of the United States—with only an exceptional, 
and that a very rudimentary preliminary examination 
into literary qualifications, and with inducements, such 
as small fees, short terms, condensed lectures, coach- 
ing and cramming, and the brief two years’ course re- 
quired for obtaining a degree—are sending out annually 
more than 2000 physicians, and this does not include 
those who reach our shores from abroad, already pre- 
pared to enter upon practice. The result is, that there 
are now in every community, probably, three or four 
doctors where one is really needed. Canada has 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 ; while we of the 
United States, blessed in physicians as in everything else, 
have, counting both regulars and irregulars, one for 
every 600; and druggists in proportion. If there were 
only twice as many as needed, it might be wholesome, 
and would allow the public a choice, but, with such an 
excess as this, many worthy ones must necessarily lan- 
guish, and those who flourish must do so by great skill, 
great tact or great industry. 33 
The medical door—and the window, too—is open, wide 
open, to every variety of individual, and all kinds have 
entered; and you will be unusually lucky if you en- 
counter none who are maliciously antagonistic. You 
will not only meet Dr. Willing, Dr. Fair and Dr. Bland, 
hut Dr. Cynic, Dr. Oblique, Dr. Sneerer, Dr. Crusty, Dr. 
Broiler and Dr. Frigid are also about and may be some- 
times encountered. Let your conduct be fair and square to 
every such person on all occasions. And strive to build a 
reputation for uprightness that will excite the respect of 
all whether friendly or inimical to you, and convince them 
that you are incapable of any dishonorable act. 
Never begin making reprisals, nor enter into a wordy 
war with a rival; avoid all innuendoes and sarcastic re- 
marks to the laity about opponents who have offended 
you. Resolve that you will remain a gentleman, even 
under provocation, whether others do or not. Observe the 
Golden Rule with dignity, u Do unto others as you would 
have them do unto you,” and trust the balance to time. 
Medicine is an honorable calling; resolve that it shall 
be no less so by your embracing it. Remember that honor 
and duty require you to do right, not for policy’s sake, 
but because it is right. Do not, however, expect exact 
justice from enemies in return ; for were you as chaste 
as ice, as pure as the snow that falls from heaven, you 
could not escape misrepresentation by adversaries with 
evil eyes and lying tongues. 
Although you cannot stop people’s tongues, nor their 
evil talk about you, yet you must see that nothing is al- 
lowed to blast your reputation for honorable conduct. 
Charges against your skill, unless very gross and dam- 34 
aging, had better be left unnoticed; even though it 
reaches your ears that some person has said he has a 
total lack of faith in you, and would not call you to attend 
a sick kitten, etc., etc., such talk need not disturb your 
equanimity—remember that such remarks are not per- 
sonal, but simply expressions of lack of faith in you pn> 
fessionally. Such things are said about every physician 
in the world, and although they grate harshly when 
they reach the ear of the one they concern, they are 
quite different from personal libels—such as charges of 
being a drunkard, or an adulterer, or an abortionist. 
Be circumspect in boasting of the number of cases you 
have, of your wonderful cures, or of the surprisingly 
large amount of your collections. All such things are 
apt to create envy, disbelief, criticism and other hurtful 
results. Also avoid telling from house to house how 
busy you are, and of your numerous bad cases—as if to 
swell your own importance. Indeed, it is better to be 
silent in regard to your own merits and to relate nothing 
at all to laymen about any case but the one before you; 
to do so will not enhance you any, and if you really have 
extra cases and extra skill, people will be sure to find 
it out in other ways. Also avoid the habit of talking to 
people about your collections, bills, etc., unless it is to a 
person about his own bill, or you will soon get the repu- 
tation of thinking and talking more about money mat- 
ters than anything else. 
As a physician, you will require a good address and 
a variety of talents, for you must come in contact with 
all kinds of people. Beadiness in adapting yourself to 
all classes sufficiently for the requirements of your 35 
profession, is a very useful quality, and one in which, 
most physicians are very deficient. 
In addition to medical learning, you should strive to 
possess an acquaintance with general scientific subjects 
which exercise the reason, rather than the memory, and 
also look into general literature, that you may be on a 
conversational level with the best you meet. Among 
educated, intelligent and intellectual people, good 
conversational powers frequently produce a greater 
impression of professional ability than is really possessed. 
A good preliminary education, although not indis- 
pensably necessary to the acquirement of skill, experi- 
ence and success as a physician, is a powerful element 
of success in the professional struggle; and if yours is 
defective, the deficiency should he made up by honest 
study as fully as possible; otherwise it will debar you 
from ever obtaining more than a limited elevation in the 
profession. Without a fair education, you will be con- 
tinually exposed to ridicule by your use of bad gram- 
mar or spelling, from those who are, perhaps, your in- 
feriors in skill and common sense. But I doubt the 
wisdom of frittering away, after practice is begun, a dis- 
proportionate amount of precious time on light litera- 
ture, educational frivolities, and schoolboy subjects, or 
giving them at all more than recreative attention allows. 
Nor is it wise to give special attention to higher mathe- 
matics, the fine arts, agriculture, mineralogy, botany, 
geology, or other collateral studies, while yet imperfect 
in the practical branches of medicine proper; because 
simultaneous attention to a plurality of subjects would 
prevent concentration of thoughts, and naturally divide 36 
and distract your mind, and prevent you from pursuing 
the more important with your full strength. But what- 
ever studies you do undertake, should be pressed with 
determination and system till accomplished. 
The plan of forcing themselves to tenaciously pursue 
certain aims of a practical character, constitutes the pecu- 
liarity of most practitioners who 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 afterwards, the fact of 
his having only one leg attracted great attention to his 
swimming. Seeing himself thus observed, stimulated 
him always to do his best, which made him more and more 
expert, until eventually he became the best swimmer I 
ever saw, because the most ambitious. 
If you have not had the advantages of embracing 
Latin in your early education, you should not fail to 
employ a good Latin scholar to teach you, at least as 
much as you need in your practice; you can get one 
at a nominal cost by advertising anonymously in any 
daily paper. He can, with the aid of a grammar and a 
dictionary, teach you in a short time, sufficient of this 
language to enable you to write prescriptions, etc., cor- 
rectly, and thereby lift you above a feeling of deficiency 
in this important particular. Besides, ability to write 
your prescriptions in correct Latin naturally assists in 
creating respect, or rather, in preventing unfriendly criti- 
cism and disrespect for you in the minds of your fellow- 
physicians, the druggists, and others. 
Many people actually believe we write prescriptions 37 
in Latin to conceal the ingredients. The true intent 
is, of course, to give every article a concise and specific 
title, and point it out in such a manner that when it is 
prescribed, it may be known from all others, and mis- 
takes of meaning between the prescriber and the com- 
pounder be prevented; besides, the Latin names of 
drugs are the same in America, Europe and elsewhere, 
and can be read by the scholars of every nation, while 
the common name is liable to differ with each nation and 
locality. Latin is a dead language, belonging to no 
modern nation, and therefore not subject to mutations. 
It is not only accurate, but has become highly respect- 
able by long usage. 
A rudimentary knowledge of Greek is also quite use- 
ful, as from it have been formed most of the compound 
terms employed in the medical and other sciences. 
In using Latin names of medicines, and of diseases, 
muscles, etc., he consistent. Adopt either the pure 
English or the Scotch pronunciation, but whichever you 
adopt, be careful to use it invariably, and correctly. 
Try to acquire a correct pronunciation of medical terms 
by frequently consulting a dictionary, of which there is 
none better than Dunglison’s latest edition. 
An acquaintance with the German language is not 
only pleasurable and a means of intellectual improve- 
ment that costs but little money, but it will assist you 
greatly with the Germans, among whom you will find 
many of your most honest and grateful patients. De- 
termine to get at least a smattering of German early in 
your career. If you speak it, mention it on your cards. 
You will find that many foreigners prefer an American 38 
physician who can speak their language, to one who has 
come here from their own country; because, being a 
native, they know he has spent his whole lifetime here, 
and they reason that he is naturally more familiar with 
the diseases that exist in our climate, and with the mod- 
ifying influences of our seasons, diet, etc. 
Accustom yourself to use current and correct orthog- 
raphy, to write in a good, neat, distinct and legible hand. 
Write every prescription as though critics were to judge 
you by it; each ingredient on a separate line, principal 
ingredients on the first, adjunct on the next, and vehicle 
on the last, unless you have some special reason for in- 
verting them. Such a system insures well-balanced 
prescriptions, disciplines the prescriber, and engenders 
the respect and favorable criticism of all who notice it. 
Strictly avoid incompatibles, both chemical and phy- 
siological, such as the combination of chlorate of potas- 
sium with tannic acid or with sulphur, oxide of silver 
with creasote, etc., which are explosives and may blow 
up either the dispenser or the patient. Charcoal is a 
simple thing—sulphur is another simple thing, and salt- 
petre is still another, but put them together and you 
have gunpowder, which is not simple, and unless that 
potent agent is intended, look out. Remember, how- 
ever, that some medicines, though physiologically incom- 
patible, are not therapeutically so, as under certain cir- 
cumstances you may combine them so that they may 
modify each other, as morphia and belladonna, acetate 
of lead and sulphate of zinc, etc. It is better to use 
a single remedy, or, if two are indicated, to alternate 
them, unless you know they are compatible. The list 39 
of incompatibles is a long one, but you should learn it 
by heart, rather than take any risk. 
Try to make every prescription you write show on 
its face, that you intend it to meet some specific 
indication. 
Be careful that abbreviations of names, manner of 
writing quantities, etc., leave no room for mistake. A 
good rule is, to read carefully every prescription after 
you finish writing it. 
You, of course, need not be told that while the names 
of the various ingredients in a prescription should be 
written in Latin, the directions, i. e. all that follows the 
S. (Signa), should be in English, as they are intended for 
the guidance of the patient. 
It is a bad habit to adopt a routine in prescribing and 
slavishly to follow your own, or anybody else’s, stereo- 
typed formulae for certain diseases. Suit your remedies 
to the case, instead of picking out a ready-made formula 
from your collection for the patient, as you would a hat 
in a hat store. One formula for all diarrhoeas, for 
instance, is about as apt to suit every case of loose 
bowels, as one coat is to fit every man in a regiment. 
Remember that skill in practice consists not only in 
diagnosis, prognosis, and prescribing medicine, but is the 
combined result of all the powers that the physician 
legitimately brings into the management of cases. In 
other words, the skilful use of medicine is but one of 
many elements that make the unit of medical skill. You 
must study mankind as well as medicine, and remember 
when working on diseased bodies that they are inhabited 
by minds that have warm sentiments, strong passions 40 
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 pecu- 
liarities, and conduct your efforts in harmony with its 
conditions. Let hope, expectation, faith, contentment, 
fear, resolution, will, and other psychological aids 
be your constant levers, for they may each at times 
exercise legitimate power. It is not length of time in 
practice, but study and reflection that teach the use of 
these. If you are not a keen observer of men and 
things, if you cannot read the hook of human nature 
correctly, and unite knowledge of physic with an under- 
standing of the thoughts, feeling and desires of mankind, 
with the knowledge of the effects of love, fear, grief, 
anger, malice, envy, lust, and other strong but hidden 
passions that govern our race, you will be sadly defi- 
cient, even after twenty years’ experience. 
Your professional fame is your chief capital; ambi- 
tion to increase it by all legitimate means is not only 
fair, but commendable. After you attain it, you will 
not be apt to lose either it or the practice it ensures, so 
long as you are sober, decent and discreet in conduct, 
and have the physical health to endure your labors. 
A pure, virtuous mind is a great gift and a great aid 
to success. When elopements, seductions, confinements, 
or abortions, or the scandal about Dr. or Rev. 
, or Miss , or the ignobleness of the pedigree of 
this one, or the secret history of that one, are being 
talked of, you should have a silent, or at least a prudent 
tongue; all you say on such subjects will surely be 
magnified and retailed, and its result will be a perma- 41 
nent injury to you. The position of the gossiping physi- 
cian has ever been a very bad one, and he is not unfre- 
quently called to unpleasant account. 
Remember, while in contact with scandalmongers, to 
take care, and, if possible, keep the conversation on gen- 
eral or abstract subjects, instead of descanting upon 
individuals and private affairs. 
Notice the never-failing advantage that refined people 
with pure minds and delicate 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 so hurtful to a physician 
as the exhibition of an impure mind. School yourself to 
avoid every impropriety of manner, and never allow 
yourself to become insensible to the demands of modesty 
and virtue. Chasten every thought, purify every word, 
and measure every phase of your deportment, if you 
would succeed fully, especially if gynaecology and ob- 
stetrics are part of your ambition. A lewd-minded phy- 
sician who indulges in coarse ambiguities, vulgar jokes 
and indelicate anecdotes about the sexes, is sure to be 
shunned, and the reason therefor is sure to be made the 
subject of gossip, and passed from one to another till it 
reaches the purest and best of the community. Thinkers 
of both sexes everywhere regard such physicians (and 
rightfully so) as being far worse than those who drink, 
cheat and swear. 
When duty requires you to ask questions on delicate 
topics, or to broach very private subjects, do so with 
a manner of gravity and simplicity, not too direct on 42 
the one hand, nor with too much circumlocution on the 
other. 
If your manners and conversation are of the kind that 
win and conciliate rather than repel children, it will be 
fortunate, and will put many a dollar into your pocket 
that might have gone to some homoeopath. Fondling, 
kissing and dallying with people’s children, however, are 
liable to be misconstrued into an effort to secure the 
good will of the parents for selfish motives, and should 
be avoided. 
A cold, cheerless, passive manner toward patients, 
isolation of oneself from them socially, and failure to re- 
cognize would-be friends on the streets and elsewhere, as 
if from a lofty independence, destroy all warmth to- 
wards a physician, and usually cause their possessor to 
fail to inspire either friendly likings or faith ; and no phy- 
sician who cannot in some way make friends or awaken 
confidence in himself, can succeed. The reputation of 
being a “ very nice man ” is even more potent with 
many than skill. To be affable and skilful too makes 
a very strong combination—one that is apt to waft its 
possessor up to the top wave of popularity. If one is 
especially polished in manner and moderately well versed 
in medicine, his politeness will do him a great deal more 
good with the public than the most profound acquaint- 
ance with histology, microscopic pathology and other 
scientific acquirements. 
Cheerfulness is a never-failing source of influence. 
Medicine, contrary to the general belief, is not a gloomy, 
morose profession, but a bright, cheerful one. While 
allaying pain, curing some poor wretches and relieving 43 
others in body and administering hope and comfort to 
their minds, you will fully realize the great good your 
profession enables you to do, and will naturally feel 
happy and satisfied with yourself and with your life- 
work, and this should make your cheerfulness apparent. 
Study to acquire an agreeable and professional man- 
ner of approaching the sick, and taking leave of them. 
There is an art in entering the patient’s room with a 
calm, earnest manner that shows interest and an anxiety 
to learn his condition—making the necessary examina- 
tion, ordering the remedies, and then departing with a 
cheerful, self-satisfied demeanor that inspires confidence 
on the part of the patient and his friends, and a belief 
that you can and will do for him all that the science of 
medicine teaches any one to do. The appearance, the 
walk, the movements, the language, the gestures and 
mode of intercourse of some physicians are pleasing; of 
others, rude, harsh and repulsive to the sick. 
Familiarity with the many little details of the sick- 
room—including the art of making beef teas, gruels, 
poultices, &c., and with the minor operations you are 
there incidentally called on to perform, create a very 
favorable impression. Indeed, it is to a very great ex- 
tent by these that watchful nurses and other habitues of 
the sick-room judge you. 
The art of keeping hope and confidence alive in the 
bosom of the patient and of his friends is a great one; a 
bright, fresh countenance and an easy, cheerful, sooth- 
ing manner is a power that will nearly always infuse 
tranquility and repose into your patient’s mind and 
carry him with you towards recovery. A cheering 
word sometimes does as much good as a prescription. 44 
It is very pleasing to the sick to be allowed to tell in 
their own way whatever they deem it important for you to 
know; allow every one a fair hearing, and even though 
they are tedious, do not abruptly cut them short, but 
listen with respectful attention. A patient may deem a 
symptom very important that you know to be otherwise, 
yet he will not be satisfied with your views unless you 
show sufficient interest in all the symptoms to at least 
hear them described. Where, for want of time to listen 
further or where the recital becomes too irrelevant, 
check him not by a rude order “ to stop,” but by asking 
him to show his tongue; this has often served my pur- 
pose with garrulous women and others. 
To be quick to see and understand your duty, and 
equally prompt and resolute in doing it, as if possessed of 
inborn acuteness of perception, and of intuitive skill, is 
one of the strongest points you can possess. People 
invariably applaud boldness; indeed, a bold, prompt act, 
if successful, often leads almost to idolatry. 
Flexibility of manner, self-command, quick discern- 
ment, address, ready knowledge of human nature and 
ability to adapt yourself to the ever-changing phases of 
medical practice, are great necessities. 
We meet patients of various and even of directly 
opposite temperaments and qualities; the refined lady, 
and the hodcarrier, the beer-seller and the clergyman, 
the aged and the young, the hopeful and the despondent, 
the diffident and the bold, the deep and the superficial. 
Let every one find in you his ideal. Seek to penetrate 
the character of each, and to become perfect in the 
power of adjusting your manner and language to the 
case before you. 45 
If you have the ability to control your temper, and 
to maintain a cool philosophic composure under the 
thousand provocations given to physicians, it will give 
you great advantage over those who cannot, and it will 
generally redound greatly to your credit. 
A brusque, autocratic manner is bad for a physician 
unless sustained by unquestionable skill, or reputation. A 
gentle, urbane, but firm manner is suitable to the largest 
part of the community. Remember that a stiff, unfeel- 
ing, abrupt or arbitrary manner, is quite different from the 
philosophic composure acquired by constant attendance 
on the sick and suffering. The former is brutal and 
unprofessional, the latter is essential to enable you to 
weigh correctly and manage diseases skilfully. 
If you have any genuine idiosyncrasy it will be 
noticed, and, if not disagreeable, will aid you greatly: 
but never assume one, as the counterfeit is easily de- 
tected by all sensible men and women. Act out your 
own plain natural character everywhere and at all times. 
Besides being ridiculous, a physician who assumes a ficti- 
tious or borrowed manner, must be either wrong-hearted 
or weak-headed. 
If you have the gift of fluency in conversation, or 
sweetness of manner, or great native courtesy, or a 
never-failing stock of politeness, or a knack for illus- 
trating your points by apt comparisons, or a bold way 
of unravelling the various puzzles, or cutting the many 
Gordian knots so often encountered, it will help you de- 
cidedly. If, on the contrary, there is any necessary aid 
that you lack, study and practise constantly to ac- 
quire it. 46 
Ability to communicate your opinion of a case to the 
inquiring friends of the patient, in well chosen, proper 
and satisfying language, is a quality so useful that you 
must endeavor to acquire it. 
Act toward children and nervous patients so as to 
remove all dread of your visits; avoid a solemn and 
formal, or funereal manner, as it would give rise to dread 
of you, especially if you accompany it with a corre- 
sponding mode of dress. If your air and movements are 
naturally awkward, or sombre, set them off by cheerful- 
ness, suitable dress, etc. 
When you visit a patient, neither tarry long enough 
to become a bore and compel the wish that you would 
go, nor make your visit so brief or abrupt as to leave 
the patient feeling that you have not given his case the 
necessary attention. 
Showing an earnest, anxious, gentle interest in the 
welfare of patients, as if you were present in mind, as 
well as body, is another very strong faith-inspiring 
quality. To assure a sufferer that you will take the 
same care of him as though he were your “ own 
brother,” or in case it be a female, as if she were your 
“ own sister,” or will attend a child as if it were “ one 
of your own family,” or to assure a woman in labor, 
that you will be as gentle in making the necessary ex- 
aminations as if she were an infant, and similar truth- 
fully-meant expressions of sincere sympathy and interest, 
inspire wonderful confidence, and are often quoted long 
after the physician has used them. 
The world is full of objects of pity. Probably no 
busy physician can give full time and exert his entire 47 
skill in every case that appeals to him, or throw into it 
his whole heart, undivided thoughts and intellectual 
strength, or even feel deep personal absorption in the 
sufferings of every patient to whom he is called; if he 
did, the endless chain of misery he sees would, through 
over-care and grief, soon unfit him for active practice. 
But you can, and should, at least, manifest some anxiety 
and interest in all cases, and avoid exhibiting indifference 
in any. Approach the sick with soft steps, and use 
kind words with them. The possession of humanity, 
or the lack of it, in a physician, can in no way be so 
accurately judged, as when he is questioning and ex- 
amining the sick — the soothing voice, the cautious 
touch, etc., all do a great deal to soften the pillow of 
sorrow and affliction. 
Be very careful to avoid inflicting pain in examining 
the sick, and assuage their fears and over-sensitiveness 
by assurances that you will not cause any more suffer- 
ing than is unavoidable, and then make your words true. 
Whoever has any such manner, naturally will not, can not 
fail to get 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 
mediocrity. 
You must depend for success chiefly, of course, on 
your skill in curing the sick. You will find neverthe- 
less that but few patients, probably not one in twenty, 
can judge the amount of technical and scientific know- 
ledge you possess. The majority are governed by 
the care and the devotion you exhibit, and form their 
opinion of you and measure your services by the little 48 
details of routine attention, which is another evidence 
that the scientific is not all that is necessary. 
Be especially courteous and civil to lady attendants of 
the sick. Woman is, and ever will be, the angel of the 
sickroom; and you as a physician will see many touch- 
ing illustrations of her tender ministrations and heroic 
devotion as mother, wife, sister or friend to the sick and 
suffering, even to the sacrifice of her own life. 
After a patient convalesces, or when it is not neces- 
sary to attend him daily, if, when you are 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 everybody with a grateful sense of your 
interest in the case. 
Having a sick child taken up for examination, carry- 
ing your patient to the light that you may see him fully 
and examine him carefully, having his urine, or his 
sputa, or the blood he spits, etc., saved for examination, 
will not only give you very necessary information as to 
the patient’s condition, but also satisfy him and every- 
body else of your interest and solicitude, and of your anx- 
iety to do your whole duty. So also does paying one the 
first visit in the morning and the last at night, or stay- 
ing, in urgent cases, to see that the medicine produces 
the desired effect. 
You will find that in times of sudden sickness and 
alarm in families, there is a peculiar susceptibility to 
strong impressions. Kindness shown then is doubly 
appreciated. Indifference or coldness, on the contrary, 
may then sever attachments and end friendships that 
have existed between the physician and a family for years, 49 
in as many moments. Many a young physician secures a 
good family permanently by kindness and assiduous 
attention in cases of colic, convulsions and accident; or 
by faithful, devoted and unwearied attention in cases of 
typhoid fever, scarlet fever, etc. 
A potent lever to assist in establishing your profes- 
sional reputation lies in curing the long-standing cases 
so often seen among the poverty-stricken. Many of 
these poor disease-ridden creatures are curable, but re- 
quire greater attention to the details, and a great deal 
more care and personal superintendence than older phy- 
sicians whose time is monopolized by acute cases, can 
possibly devote to them. If you persevere with them 
until a cure is effected, your special interest will be 
observed and appreciated, and you will gain a host of 
warm admirers, who will magnify and herald you forth 
on every occasion as being doubly skilful in making the 
blind see, the deaf hear, and the lame to walk, and 
even though you receive little, or no reward from them 
in the shape of money, you will augment your fame, 
and cultivate both your hand and your eye, and school 
yourself in the art of observing, analyzing and treating 
disease. 
You will find it comparatively easy to get practice 
among the moneyless poor, and relatively hard to get it 
among the wealthier classes. Your reputation will 
probably begin in alleys and back streets, among the 
very poorest, where it will extend much more rapidly 
than in comfortable quarters; but no matter whether 
in mansion, cottage or hovel3 every patient you attend, 
white or black, rich or poor, will aid in enriching your 50 
experience and shaping public opinion by giving you 
either a good or a bad name. 
Attending the servants of the rich, however, who are 
sick at their service places, will not improve your*repu- 
tation much ; at any rate, not nearly so much as attend- 
ing the same patients at their own homes, or on their own 
account. People who, in their minds, couple you profess 
sionally with their servants, are apt to form a low opinion 
of your status and of the character of your practice. 
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 patients. 
You are not obliged to assume charge of any one, or to 
■engage to attend a woman in confinement, or to involve 
yourself in any way against your wish ; but, after doing 
so, you are morally and legally bound to attend, and to 
attend properly, even though it may be a charity or 
“never pay” patient. You have a right, however, to 
withdraw from any case by giving proper notice. 
Remember that ethical duties and legal restraints are 
as binding in pauper and charity cases as in any other, 
for ethics and law both rest upon abstract principles, and 
govern all cases alike. 
You will probably find hospital and dispensary 
patients, soldiers, sailors, and the poor, much easier to 
attend than the higher classes ; their ailments are more 
definite and uncomplicated, the therapeutics more clearly 
indicated, and the response of their system is generally 51 
more prompt. With the wealthy and pampered, on the 
other hand, there is often such a concatenation of unre- 
lated or chronic symptoms, or they are described in such 
indefinite or exaggerated phrases, that it is difficult to 
judge which one symptom is most important. 
With hospital patients, sailors, soldiers, etc., there are 
but two classes—the really sick, suffering from affec- 
tions of a well-marked type, and malingerers. Such 
practice is apt to lead to a rough and ready habit of 
treating every patient as very sick, or else as having 
little or nothing the matter with him. These crude or 
possibly over-active methods may answer in public insti- 
tutions, but they will not suit the squeamish people with 
indefinite or frivolous ailments, for which the physician 
trained only in a hospital could hardly fail to feel and 
manifest contempt. Hospital practice is so different 
from private that but few members of our profession 
shine conspicuously as practitioners in both spheres. 
An illustration of this fact is constantly afforded in the 
colleges and in medical societies; for the greatest medical 
orators and the most fluent debaters are by no means 
always the best or most successful practitioners. The 
two fields are essentially different and lead the mind in 
different directions. In a word, theory is one thing, 
practice another. 
It is your duty to familiarize yourself at the very 
threshold of your professional career with the Code of 
Ethics, and never to violate either its letter or its spirit, 
but always scrupulously to observe both towards all 
regular graduates practising as regular physicians. But 
remember that you are neither required nor allowed to 52 
extend its favoring provisions to any one practising con- 
trary to the cherished truths that guide the regular pro* 
fession, 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. Pos- 
sibly old countries from long custom can dispense with 
them. But here the very nature of society requires 
that physicians shall have some general system of writ- 
ten ethics, to define their duties and regulate their con- 
duct towards each other and the public. Every indi- 
vidual in the profession is supposed to be a gentleman, 
actuated by a lofty professional spirit, striving to do 
right and avoid wrong, and even were there no written 
rules at all, the vast majority would naturally conform 
to the rules of justice, at least as they understood them. 
As a consequence, each one’s action, when scanned by 
watchful and knowing eyes, might probably be consid- 
ered fair in nine doubtful cases out of ten, while in the 
tenth, one might conclude differently from one’s neigh- 
bor, or might be found differing in opinion only from 
some captious rival with whom an honorable agreement 
would be impossible. The absence of rules for our gov- 
ernment would also leave each individual to make his 
own code, and no matter how crooked his ways, no one 
could charge that he acted from impure motives and not 
from error of judgment, even in the most flagrant vio- 
lation of humanity’s Golden Rule. 
Absence of a code would also make it possible for the 
unscrupulous to carry on a regular system of infringe- 
ments, self-advertising, certificate-giving, and wrong-doing 
in general, regardless of the rights of their professional 53 
brethren, and still claim to be honorable physicians, 
whilst those aggrieved would have no standard of appeal 
by which to prove the contrary. 
In view of these and many other facts it has been 
found necessary to have a code of written ethics for reg- 
ulating the conduct of physicians towards each other, 
and towards the public generally. 
Dr. Thomas Percival, an English physician, in a small 
book published in London in 1807, proposed an admir- 
able code of 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 governed our whole profession 
throughout this broad land, just as the Ten Command- 
ments of Holy Writ instruct and restrict mankind in 
general. 
The author, in common with almost the entire pro- 
fession, regrets to see that a factious minority of the 
physicians of New York, becoming restive under the wise 
provisions of the code forbidding professional consulta- 
tions with homoeopaths, and other kindred exclusionists 
and followers of isms, have abj ured the code, and proved 
themselves ingenious architects of ruin to themselves, as 
their action has severed them from their brethren, with- 
out securing for them the fellowship of those Ishmaelites 
whom they wished to conciliate. May this be the fate 
of all who rebel against what is right and just! 
All physicians are supposed to have studied this code, 
and to be familiar with its requirements. The claim 
which it has upon you rests not upon any obligation of 54 
personal friendship toward your professional brethren, 
but upon the fact that it is founded on the broad basis 
of equal rights and equal privileges to every member of 
the profession, that it stands like a lighthouse to guide 
and direct all who wish to pursue an honorable course. 
Being founded on the highest moral princqDles, its pre- 
cepts can never become useless, till regenerate and 
infallible human nature makes both codes and command- 
ments unnecessary. The code of ethics of the Ameri- 
can Medical Association is the great oracle to which you 
can resort, in order to learn what things justice allows 
and what it prohibits. 
To these lofty ethics, in very great measure, are 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 this code remains as fresh 
and beautiful to-day as when the profession adopted it 
nearly forty years ago, and if you faithfully observe it, 
you can truthfully exclaim, “ I feel within me a peace 
above all earthly dignities, a clear and quiet conscience.” 
It is as much the duty of every medical college in 
America to acquaint its students with the precepts of 
this code and to furnish to each of its alumni a copy of 
it with his diploma, as for a mother to familiarize her 
children with the Ten Commandments. 
In our land this code is the balance-wheel that regu- 
lates all professional action, and no one, either among 
the eminent of the profession, covered with honors 
and titles, or among beginners in the ranks, can openly 55 
ignore it without overthrowing that which is vital to 
his standing among medical men. If in the struggle 
and competition for business you desire to act unfairly 
toward your brethren, this code will compel you to do 
the evil biddings of your heart in a roundabout way, 
or by stealth, and even then your unfairness will seldom 
go undetected or unpunished. 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. Whenever you sow a 
thistle or a thorn you will reap thistles or thorns, 
whenever a wind is sown a whirlwind will be reaped; 
whilst the sweeter seeds sown by others will be yielding 
to others sweeter fruits. 
When called to attend a case previously under the 
care of another physician, especially if the patient and 
friends are dissatisfied with the treatment, or if the case 
is likely to prove fatal, do not disparage the previous 
attendant by expressing a wish that you had been called 
sooner, or criticize his conduct or his remedies; it is 
cowardly and mean to do either. Remember in all such 
cases to reply to the questions of the patient or his in- 
quiring friends, that your duty is with the present and 
future, not with the past. Refuse either to examine or 
criticize the previous attendant’s remedies. Also, make 
your conversation refer strictly to the present and future 
and not to the past, and do not mention the person you 
have superseded at all, unless you can speak clearly to 
his advantage. As a rule, the less you say about the 
previous treatment the better. 56 
To take a mean advantage of any one you have supers 
seded, besides being wrong, might engender a profes- 
sional hornet, which in retaliation would watch with a 
malignant eye and sting fiercely wherever opportunity 
offered. Avoid finesse. Courtesy, truth and justice 
should mark every step of your career. Enhance your 
profession in public esteem at every opportunity, and 
defend your brethren, and your profession too, when 
either are unjustly assailed. Indeed, to fail to defend the 
reputation of an absent professional brother, when justice 
demands it, is ignoble and unprofessional, and implies a 
quasi-sanction of the libel. 
We all know there are a thousand unwritten ways to 
be ethical, and a thousand undefinable ways to be un- 
ethical. When you doubt whether a patient is fairly 
yours or another’s, give your rival the benefit of that 
doubt. Never be tenacious of doubtful rights, but let 
your conduct in this, and all other respects, entitle you 
to the esteem of your medical neighbors. 
Do not captiously follow up every trifling infringe- 
ment, difficulty, or apparent contradiction; a certain 
amount of jarring and clashing in a profession like ours 
is unavoidable. Allow liberally for this, school your 
feelings, bury captiousness in the ocean of oblivion, and 
maintain your friendly attitude toward all fairly dis- 
posed neighbors. Unless you do this, many questions 
will arise that cannot be adjusted by the code, and you 
will become involved in useless, rancorous and endless 
controversies and reprisals. It is both embarrassing and 
inconvenient to pass and repass medical neighbors 
between whom and yourself there exists a chronic feud, 57 
or to meet any one else with whom, through enmity, 
friendship and even speaking acquaintance have ceased. 
Keep above all doubtful expedients that relate to 
getting patients and profits, and be careful not to run 
into any other physician’s practice, and never attempt 
unjustly to retain any one to whom you are called in 
an emergency; if you are in doubt whether you were 
deliberately chosen, or only taken in the emergency, ask 
the direct question. If another was preferred to you, 
surrender the patient to him on his arrival, even though 
you are asked to continue in attendance. Circum- 
stances may require you to have the former attendant 
sent for, either to take the case, or for consultation. 
Friendly offices are daily performed by physicians for 
one another, and go far, very far, toward neutralizing 
the ruffies and stings which the very nature of our 
profession makes inevitable. If your conduct towards 
other physicians in these matters is invariably honor- 
able and just, arising from a desire to do only that 
which is right, it will be discovered in due time, and 
will make your road pleasant, and if you ever un- 
wittingly infringe, ail will feel that it is through mistake 
and not intentional. 
Never visit a patient who is under the care of another 
physician, as a medical detective for the patient’s bene- 
ficial society, to ascertain whether he is malingering, 
without that physician’s consent. It would be a still 
greater offence to remove the bandages from fractures, ul- 
cers, etc., put on by another physician, whether to change 
treatment or merely to examine the case. 
Be also extremely discreet and chary of visiting 58 
patients under the care 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 other regular physician, without first ascer- 
taining that he has been formally notified of the change. 
The idea that governs such cases is this : When a person 
sickens he 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 he wants to 
change, he must follow the established form in doing 
so. 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 dismiss their 
attendant and get you, will sometimes contend that the 
rules regulating the 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, as our custom is identical 
with that which prevails everywhere among all classes 
of people the world over, and which requires the formal 
discharge of the old employe, before a new one can 
take his place. Besides, no person, whether laborer, 
mechanic or physician, can fill a vacancy till one exists. 
You should never suggest that an attending physician 
be discharged, so that you may be employed. 
Be chary of taking cases in families into which you 
have ever been called in consultation, more especially if 
you were called at the other physician’s suggestion, for 
the displaced attendant, chagrined at his displacement. 59 
will be apt to scan every feature of the change, and if 
he has any ground at all, will conclude that instead of 
obeying the Golden Kule, you have ungenerously elbowed 
him out. 
You will often be called to a patient, and upon going, 
will find that he is under the care of some other physi- 
cian, 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 to prescribe for him, with the promise 
that the other physician shall not be told of your having 
done it. Eemember that honor and duty require you to 
do right in these and all other positions in which you 
may be placed, and that not through fear, or for policy 
sake, but because it is right to do right, and for the 
other equally broad reason that you yourself would 
know of the wrong, whether the other physician knew 
it or not; decline, therefore, their solicitations, with an 
assurance that you desire to possess your own respect, as 
earnestly as you do that of others. Unless a great 
emergency exists, you should positively refuse to inter- 
fere; if you do consent, it should be done 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 at- 
tending physician, and finding fault with his treatment, 
you should never suggest that he be discharged, so that 
you may supplant him. 
The rules regarding previous attendance are much 
less stringent in floating office practice than in regular 
family practice, and some of the most eminent physicians 60 
prescribe for all ordinary office cases, with but little 
regard as to who has been attending, or where, or when. 
A patient with heart trouble, cough, or a skin disease, 
Will occasionally consult almost a dozen physicians at 
their offices in as many days. The principle is this: 
Office advice to strangers is everywhere cash, and the 
payment of the fee frees the patient to go to whom- 
soever else he pleases. 
You will see much to condemn in regard to ethics, 
both in the profession and in the laity. If you are ever 
compelled to attack any one’s conduct, do it boldly, or 
at least never do it anonymously or in whispers; anony- 
mous and covert attacks are cowardly. 
Be punctilious in your endeavors to do every one 
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 unkind, or unwise to 
do so; use such opportunities to harmonize, rather than 
to disrupt. You can do this, and yet not make a habit 
of cheating yourself out of patients. 
Always keep a stock of good vaccine on hand, both 
for the fees it secures, when there is a demand for vacci- 
nation, and for fear of a sudden outbreak of small-pox. 
Yaccination, although a trifling operation, is a prolific 
cause of criticism and reproach to physicians. Use calf 
virus whenever it is possible to obtain it; it is popular, 
and not capable of communicating syphilis, scrofula, etc., 
and needs no defence. In no case use any but pure virus; 
take your time and do it skilfully and thoroughly, and 
be ever ready to defend its purity with proof, if any one 
you vaccinate suffers any mishap through it. 61 
Do not begin the unjust custom of vaccinating the 
child gratis, in cases where you have officiated at its 
birth, as is the habit with some. Also charge the same 
for revaccinating any one to test whether his former 
vaccination is still protective or not, as you would if he 
never had been vaccinated before, whether it takes or not, 
as revaccination succeeds in but a small proportion of 
those it is tried upon, and the charge is for the trial. 
You should, of course, make no extra charge for re- 
peating primary vaccinations till they take, no matter 
how long the interval between the trials ; also, make but 
one charge for any person who has revaccination at- 
tempted, no matter how often, if during the same epi- 
demic or scare. Many people believe a vaccination 
protects as long as the scar shows plainly. The truth 
is a vaccine scar lasts for life, while the protective in- 
fluence of vaccination gradually disappears in some people. 
A typical vaccine scar merely shows that 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 when there are 
none, no matter how you bait your hook, nor set a pile 
of stones on fire, no matter how good the matches you 
use. 
Another error regarding small-pox: Many people im- 
agine that it can only thrive when the weather is cold; 
this is a mistake, as it may prevail with intensity at any 
season. Indeed, severe epidemics of it often prevail in 
tropical countries where there is perpetual summer. 
Be very cautious how you go out of your way to per- 62 
suade people to let you remove warts, extract tumors, 
destroy naevi, efface tattoo marks, and do other minor 
surgical operations gratis, with assurances of success. 
There is always a remote possibility of serious or 
fatal sequelae, and you should not, especially in private 
practice, induce people to let you involve yourself for 
their benefit, without being paid for your risk and re- 
sponsibility. It is an ugly thing to have a wart you 
have insisted upon tampering with, become an ulcerating 
epithelioma. Indeed, it is better to avoid all unrequited 
work and all gratuitous responsibility, except what 
charity calls for. 
For similar reasons do not persuade people to effect 
insurance on their lives, or in any particular company, 
as all such ventures carry a possibility of disappoint- 
ment or failure that might involve you. 
Wisdom in recognizing cases that are likely to involve 
you in suits for malpractice, and in foreseeing and fore- 
stalling the suits themselves, is a valuable power. 
Take care that this wisdom does not come too late, or 
cost you too much. 
Never fail to send your bill promptly to dissatisfied 
patients, who are threatening to sue you for malpractice, 
or attempting to injure your practice unjustly, whether 
you expect them ever to pay it or not. If you cow- 
ardly shrink from sending your bill in such cases, they 
will quote that as a proof that you are guilty of what 
they charge, and that you know it; sending your bill 
gives you a better position before the public, and raises 
an issue that checkmates theirs. Do not fail to charge 
the maximum fee in all such cases. 63 
Every principle of honor and duty forbids you even 
to think of lending yourself as a medical cat’s-paw in 
unjust or speculative malpractice suits against physi- 
cians. Such self-styled “ medical experts ” often excite 
disgust and indignation at the contemptible attitudes 
they assume, when they act against their better know- 
ledge and join hands with bad people and attempt to 
mulct a physician, or to clear a criminal from legal 
responsibility on the plea of “ insanity,” or other 
wicked absurdity gotten up to make money or to defeat 
justice. 
Probably there is no department of professional duty 
in which physicians are so often asked to stretch their 
consciences, as that of giving certificates to persons seek- 
ing to get government pensions. 
You may even be cajoled by friends or flattered by 
interested strangers, or tempted by gold, to give an 
opinion that one, who was mentally unfit to make a 
will, was fully able to do so, or that a person with one 
foot in the grave, the result of intemperance or disease, 
is sound or temperate, or that some one with a bias 
towards a certain disease, or with an incipient organic 
affection, is in perfect health. Or pleasure-seeking offi- 
cials may attempt to cover their absence from duty by 
obtaining a certificate from you that their absence was 
due to sickness; others may attempt through you to 
escape military or jury duty, or attendance at court as 
a witness, or for trial, or to get from you a prescription 
for a “ Sunday drink of liquor ” under the pretence of 
sickness. 
Repel all such approaches promptly; and emphati- 64 
cally refuse to stretch the truth, or to deviate from pro- 
fessional honor for any one. 
Steer clear of this and all other practices and alli- 
ances in which your part would not bear legal scrutiny, 
or detailing in the community; and you will not only 
safely pass the shoals of shame and bitterness, upon 
which so many have been wrecked, but you will have 
a positive reward—the approval of your conscience. CHAPTER III. 
“ Whatsoever a man soweth, that shall he also reap.”—Gal. vi. 7. 
When you are importuned to produce abortion, on 
the plea of saving the poor girl’s character, or to prevent 
her sister’s heart from being broken, or her father from 
discovering her misfortune and committing murder, or to 
prevent the child’s father from being disgraced, or to avert 
the shame that would fall on the family, or the church 
scandal, or to limit the number of children for mar- 
ried people who already have as many as they want, 
or for ladies who assert that they are too sickly to have 
children, or that their suckling child is too young to be 
weaned, etc., etc., you should meet such entreaties and 
solicitations with a refusal prompt, chilling and em- 
phatic, and never even seem to entertain the proposition. 
If they are too importunate, express your sentiments 
strongly. 
How could any one but a fool be induced to take the 
burden from another’s shoulders to his own, by doing a 
crimson crime; to violate both his conscience and the law; 
to risk exposure, social disgrace, and professional ruin, 
and even the penitentiary itself, by putting himself into 
any one’s guilty power, whether as a favor or for a paltry 
fee ? 
Evil rumors fly rapidly. The production of a very 
few criminal abortions (sometimes even a single one) will 66 
surely go from tongue to tongue, and give the foolish 
physician who stoops to commit them a widespread and 
long-continued notoriety as infamous and as tenacious 
as the Bloody Shirt of Nessus. 
When circumstances require you to prescribe for 
females with delayed menses, where pregnancy is prob- 
ably, or possibly 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, and tell them verbally how to 
take it. By avoiding concealment regarding the nature 
of the remedies you give, you will escape the suspicion 
or charge of giving abortifacients. 
You must give a cautious, a very cautious opinion, if 
any, in cases of unmarried females whose menses have 
ceased, and where pregnancy is feared; especially in 
cases where the suspected girl strenuously denies having 
had carnal intercourse. Erroneously to pronounce her 
pregnant may blast her whole future and call down 
maledictions on you ; if on the contrary you too quickly 
declare her “ not pregnant,” it might injure you greatly; 
but this mistake would be nothing in comparison with 
the other. Temporize or suspend your opinion for weeks, 
or even months if need be, till positively certain by hear- 
ing the foetal heart beat, or some other unequivocal 
sign. 
Unmarried negresses and low females who fear they 
are pregnant, will occasionally come and consult you, 
consume your time and get your opinion, and when you 
discover that they are really pregnant, and refuse to pro- 
duce abortion, will try to escape payment of your office fee. In all such cases inform them at the beginning how 
much your fee is for your time, 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 give them your opinion 
and advice. 
If you should ever encounter a case in which you be- 
lieve the production of abortion is necessary to save the 
mother’s life, do not consent to do it secretly, but only 
after consultation with some other physician of well- 
known probity. 
Giving directions for the prevention of conception 
or instructing in onanism, or in the guilty use of syringes 
and other expedients to aid crime or to defeat nature, 
though offences beyond the reach of the laws, are de- 
rogatory and degrading to the physician and an abuse of 
his professional office. 
Never carry away, or keep chloroform, ergot, splints, 
instruments, unused medicines, etc., that patients have 
paid for, without an agreement with them to that effect; 
and never partake of the wine or liquor intended for a 
sick person, or eat his fruit and cake, etc. To do such 
things would not only lay you open to criticism, but 
even to the most mortifying charges if a rupture of 
friendship should ever occur—in fact, with such things 
to fortify them, many people would be actually disposed 
to welcome, or create a rupture with you. 
You should be careful that attempts to conceal the 
presence of contagious diseases, of unlawful dangers to 
health, or of births that result from clandestine marriage, 
or from bastardy, do not involve you in the exposures 
and recriminations that are apt to follow. 68 
If you have skill in avoiding cases that would involve 
a summons to court as a witness, and kindred annoy- 
ances, legal and social, it will be the source of much 
comfort. 
The practice of medicine isolates the members of our 
profession from one another much more than one would 
suppose. Physicians daily pass and repass each other 
without a look or nod; although fellow-workers in the 
profession and well known to each other by sight or repu- 
tation, and although acquaintanceship and social ameni- 
ties would be mutually agreeable and beneficial and pos- 
sibly ripen into life-long friendship, they often remain as 
strangers for years, unless accident brings them together. 
Do not hold yourself aloof from the profession; but 
identify yourself with it in all public medical matters, 
at medical conventions, at assemblages of alumni, at 
medical meetings called to provide entertainment for 
visiting medical celebrities, to pay special tributes of 
respect to deceased medical brethren, at those held to 
voice the opinions or policy of the profession regarding 
public dangers or matters of hygiene, or to take action 
on epidemics, etc., etc. 
Also, join the medical societies of your neighbor- 
hood ; organization does good, both to the profession and 
to individuals. A good medical society is almost equal 
to a post-graduate school. Friction of mind in amicable 
discussion awakens reflection and deepest thought, which 
in turn increases the intellectual grasp and stimulates 
the mental digestive power, and they in turn liberalize and 
enlarge each one’s scope and act as leaven to the entire 
profession. Nowhere else can you study so well the in- 69 
dividuality and the styles of different physicians, and 
learn the secrets of each one’s success or failure so fully, 
as at medical meetings. There the specialist, the teacher 
and the general practitioner all meet, and each in his 
own way contributes to the instruction and intellectual 
recreation of the others. There, you can meet your 
neighbors on common ground, and compare experience 
and opinion by face-to-face discussion. There, rivalries, 
dissensions and controversies can be softened, and pro- 
fessional friendships be formed; there, you can measure 
the height and depth of your medical contemporaries, 
and see the difference between the judicious and the 
injudicious, between intellectual giants and dwarfs; 
there, you can estimate the influence of the undefinable 
excellences of some, and discover and learn to avoid the 
glaring imperfections of others,—and in many other 
respects learn effectually to separate the chaff from the 
wheat. 
Of course, medical societies are neither a specific for 
all personal deficiencies, nor a panacea for all professional 
sores. Spending a few hours among honorable physi- 
cians, once a week, will not convert a willing doer of 
evil into a professional Chesterfield, or give him the 
polish and value of refined gold, or lend him a conscience 
like Milton’s, but it will serve as an intellectual and 
social exchange, where one may hear the discussion of 
moot points, and get therefrom new combinations of 
ideas and fresh streams of knowledge. 
Beside the individual benefits accruing to the mem- 
bers, they as a body catch inspiration from the pro- 
ceedings, which stimulates the healthy growth of the 70 
profession at large, and generates and fosters a genuine 
professional spirit that constantly tends to minimize all 
that is unprofessional. 
Never oppose the admission of any one into society 
membership for private or personal reasons, or for any 
cause other than ineligibility or unfitness to receive the 
honors and benefits membership confers, because medi- 
cal societies exist for the benefit of all regular physi- 
cians, and for the good of mankind, and it would be un- 
just to interpose an objection, or to cast a black ball 
against any one, on purely personal grounds. 
Do not hesitate to take part in medical debates, when- 
ever you have anything valuable to offer, whether 
gleaned from literature, or from the great school of ex- 
perience. If you have a contribution to offer, a dis- 
covery to announce, or a new instrument to show, or an 
operation to describe, or a case or specimen to present, 
or anything at all to say, do it in a careful, methodical 
manner, then sit down j but always remember, that when 
you have nothing worth offering, silence should be your 
law—do not break it. In speaking, take care neither 
to abandon your medical vocabulary for the vernacular, 
nor let your professional manner degenerate. Remem- 
ber there, as elsewhere, that there is nothing infallible; 
that a physician must school his prejudices and be open 
to conviction. Those who can brook no opinion that does 
not accord with their own, are usually hot-headed, rash 
and indiscreet, and very unsafe guides. Also, remember 
that controversies, discussions and parliamentary battles, 
no matter how sharp, are usually conducted by men of 
discretion within the bounds of decorum, and without 71 
violations of the ordinary rules of good breeding; that 
there is no mode of practice and no remedy for any 
disease which has not been the subject of obstinate 
dispute, and that every new discovery or announcement 
stirs the whole medical world to action, testing, re- 
porting, asserting and denying. 
You will find that many of the laity entertain a belief 
that medical societies exist for the pecuniary advance- 
ment of physicians, just as trades-unions and other 
organizations do for workingmen, and that they in some 
way, or to some extent, limit the freedom of personal 
opinion, and abridge the 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. 
Keep up your medical studies, or the knowledge 
which you have already acquired will rapidly become 
misty and slip away from you. Without study, the 
details of cases and the symptoms of many diseases 
wear out of one’s memory; indeed, the mind does not 
often bring back the details of parallel cases, or of cases 
for comparison, after two or three years have elapsed, 
unless they are extremely uncommon or interesting. 
In consulting journals and text-books, remember that 
practice found successful in your own climate or region 
is usually more reliable for your use than that appli- 
cable in other climates. Avoid relying on antiquated 
works on practice and back volumes of journals, as 
guides in so progressive a science as medicine. New 
investigations and rapid progress render new text-books 
frequently necessary, to those who would maintain that 72 
buoyancy and self-reliance which the consciousness of 
being fully posted inspires. 
Try to get together a library of useful books as soon 
as possible after graduating; money spent in this way 
will return a hundredfold. But take care that book- 
agents, with “the greatest work ever published,” do 
not induce you by their importunities to subscribe for 
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. 
Of course you should subscribe to as many good 
medical journals as you can aflord to pay for, and read 
and digest them carefully, so as to keep abreast of the 
times; they are necessary to the progressive physician. 
But neither swear at, nor by, all you see in them; be 
especially careful of such as exist for the purpose of 
advertising either their owner or his goods. As a rule 
you will find that statements involving therapeutics 
found in the latest text-books, are more mature and 
more reliable than articles in journals, which are often 
founded on a single case, or the exaggerated fancy, or 
unconfirmed experience, or speculations of a single indi- 
vidual. 
Do not be biased too quickly, or strongly, in favor of 
new or unsettled theories based on physiological, micro- 
scopical or chemical experiments; especially when 
offered by the over-zealous to prove their own hobbies 
or pet ideas. 
Never abandon the practical branches of medicine for 
histology, pathology, microscopic anatomy, refined diag- 
nostics, bacteriamania, and other subjects that merely 73 
interest, or it will impair your practical tendency and 
give you a wrong bias, and your usefulness as a practis- 
ing physician will almost surely diminish. 
I do not apply these remarks to teachers and experi- 
menters, who have hospital and laboratory facilities, or 
are pursuing science chiefly to gain distinction therein, or 
solely as an object of pleasure, and who do not look to 
their practice for support. I mean to say that a person 
may get so deeply absorbed in science as to think of 
nothing but science, and that your most useful studies as 
a practitioner will be the practical, and above all else, 
the art of treating diseases with success. 
Never publish weak or trifling medical articles, as 
whatever one writes is supposed to be a mirror of his 
own mind. Do not, however, hesitate to write whenever 
you have anything valuable or instructive to offer, 
either for the benefit of others or to increase your own 
standing and reputation. 
When possible, base your articles on facts, or on an 
analysis of facts, rather than on speculation and theory. 
Let your diction be pure and simple, and as short and 
explicit as perspicuity will allow, so as not to weaken 
your ideas, observations or deductions, or obscure them 
in a lot of wordy trash. 
Be careful to give your article a concise, appropriate 
and attractive title, one that indicates its contents, one 
that will show with sufficient clearness the general 
character of the remarks which are to follow. This is 
especially requisite when the title of the work is to be 
put in an index or catalogue. Such titles as “A Curious 
Case,” “A New Method,” etc., furnish no clue whatever. 74 
In writing, cultivate simplicity of style, avoid diffuse- 
ness, and use no far-fetched quotations from foreign or 
dead languages, unless followed immediately by transla- 
tion ; for unless it be some stale or hackneyed term, the 
average reader will probably be forced either to pass it 
over unsolved, or take down his dusty quotation book or 
his schoolboy grammar. The English language is capa- 
ble of expressing any and every thought, and it is a pity 
that from ignorance or pedantry some are unable to ex- 
press themselves in their mother-tongue. 
The recent attempt to supersede the old weights and 
measures by the metric system did not succeed; it is 
therefore scarcely worth while to weigh its merits. 
When you report cases or publish anything in which 
weights are given, either use the old familiar weights 
and measures (which every one understands), or give 
both the old and the metric; to use the metric only 
savors of pedantry. Many make no attempt to carry the 
metric equivalents in their minds, and if you give metric 
measures only they may pass your effusions by with- 
out getting the information you wish to convey. 
Note all remarkable cases, but never report or pub- 
lish any that are not unique, or at least that do not 
present some curious, rare or very instructive feature, or 
militate against accepted theories; otherwise you will 
merely swell without adding anything valuable to ex- 
isting records. You will find every department of medi- 
cine fast becoming loaded down with theoretical discus- 
sions, speculative dissertations, compilations and empty 
word-building—old things said in a new form. You 
should contribute original work, and new ideas, if any. Use a plain, intelligible style, and be as brief and concise 
as j ustice to your subject will allow, and, for the printer’s 
sake, prepare your matter so as to require but little if 
any revision. 
When you write essays or monographs, use for con- 
venience sake the smallest sized sheets of wdiite note 
paper ; this will enable you to handle them more easily 
in writing, altering and re-writing pages, and also to 
carry and 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. 
When you write for the press, do not follow the cus- 
tom of appending to your name a long tail, consisting of 
all the titles and honors, whether strong or weak, that 
you can rake together,- with half a dozen etc’s; such an 
enumeration is in bad taste and excites the ridicule of 
discerning people. The idea governing the use of suf- 
fixes is chiefly that the individual who writes may be 
identified; a single suffix or simple title, or your town, 
street and number, are modest and yet sufficiently ex- 
plicit. Some publishing houses think titles aid the sale. 
Never furnish a report, statement, or opinion on any 
important case or subject for publication either in book, 
journal or newspaper, without a proviso that you are to 
see, and if necessary revise the proof and correct 
printer’s errors in spelling, punctuation, etc., before it 
goes to press; otherwise you may find some purblind 
proofreader, or go-ahead printer, making you say the 
reverse of what you intended, thus necessitating a long 
list of “ errata,” or even making you regret that you 
ever allowed the article to appear in print. 76 
Pay your honest debts punctually, even though you 
be cheated out of half you earn. The best plan is to pay 
as you go, and if you cannot pay much, do not go far. 
Owing for horses, carriages, feed, or clothes, or still 
worse, for luxuries, rent, servants’ wages, etc., cannot 
fail to set the tongue of scandal to wagging freely and 
injuriously, to the possible ruin of your credit. You 
will have to pay every debt one time or another, and 
had better be paying each as it becomes due, than those 
that should have been paid a month or a year ago. 
Borrowing books, instruments, umbrellas, money, etc., 
especially if you keep them beyond the proper time, or 
return them in bad condition, will tend to depreciate 
you more than you would think. Never involve your- 
self by borrowing apparatus, instruments, etc., from one 
physician, or patient, to lend to another; if necessary, in- 
troduce the parties, and let the borrower do the borrow- 
ing on his own responsibility. 
Guard against repulsive habits; do not squirt tobacco- 
juice around you at your visits, or have your breath 
reeking with its fumes, or with those of cloves, carda- 
mom, alcohol, dead beer, etc., or you will unavoidably 
invite criticism and create revulsion towards you. 
Appearing in your shirt sleeves, wearing rough, creak- 
ing boots, or chewing, smoking, sky-larking, etc., will 
show weakness, diminish your prestige, detract from 
your dignity and lessen you in public esteem, by forcing on 
everybody the conclusion that you are after all but an 
ordinary person. 
Carpentering, painting, or showing other common-place 
or out-of-place talents, will also appear as if your mind 77 
was not engrossed by your profession. You may pos- 
sibly secure faith in spite of these, but usually such 
things tend decidedly to decrease it. 
Drunkenness may be tolerated in physicians who are 
fully established in practice, because friendly attach- 
ments had been formed and their talents and worth had 
become known previous to the formation of the habit; 
but it is fatal to the prospects of a beginner. 
An excellent course is to avoid intoxicating drinks 
yourself, and let others do as they think best. If it is 
known that you never drink, it will be of immense ad- 
vantage to your reputation; but intemperately urging 
temperance on all occasions, or being a member of temper- 
ance, of secret, or of beneficial societies, will not aid 
much in the acquirement of desirable business; indeed, 
the best practice you can have is the quiet family busi- 
ness that you will attract by faithful endeavors to do 
your best for all who apply to you. 
Temperance, total abstinence, local option, and other 
sumptuary crusades will be apt to recoil on your head, 
if you make yourself prominent in them. Pushing 
matters of a partisan or secular nature is not your 
function, and you cannot become officious in them with- 
out engendering rancorous enemies. You had better 
leave all such matters to the laity, unless your pecuni- 
ary or social position is such that you can very well 
afford it, or you are driven into them by conscientious 
scruples that outweigh all other considerations; and 
even then, it is better to let your profession be foremost 
in your mind. 
Presents from fond or grateful, very liberal or roman- 78 
tically generous patients, although flattering, will almost 
invariably lead to the disarrangement or actual rupture 
of the legitimate pecuniary relations previously existing 
between yourself and the giver, which it may conse- 
quently be impossible fully to restore. Probably every 
practitioner can recall numerous instances in which 
presents of knee-blankets, whips, game, fruit, cigars, 
wine, pet animals, canes, free passes, gloves, new hats, 
curiosities, etc., have proved exceedingly expensive. 
When you foresee such a result, be guarded. 
A good rule is to decline all presents that would place 
you under embarrassing obligations to patients. Another 
good rule is to avoid mixed dealings and crossed accounts 
with hucksters, grocers, feed-men, milk-men, and other 
patients, as such an arrangement will rarely continue to 
be satisfactory; it often engenders disagreements, and 
will almost always result in your getting only about 
half as much for your services as if you had avoided en- 
tanglements. It is decidedly better to conduct affairs 
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, avoid everything that tends to 
weaken your business rules. 
Preserve a proper degree of gravity and dignity toward 
patients. Frivolous conduct, vulgar jokes, great levity 
and undue familiarity are unprofessional, and breed con- 
tempt and scandal. Discourage all attempts to rudely 
address you with a “ Hallo, Doc! ” or by your first name, 
or to pass the limit of propriety in any way with you. 
Give every one his proper title, and exact the same re- 
spect in return. Do not understand me to condemn good- 79 
natured pleasantry; when manly and within bounds, it is 
often very appropriate, and sometimes actually serves as 
a tonic to a patient’s drooping spirits. If you have a be- 
coming earnestness of deportment, and at the same time 
wear a cheerful mien, it will be health to you and sun- 
shine to your patients. 
Avoid dining out with patients, attending their tea 
or card parties, etc. Eat as seldom as possible at their 
houses—only when unavoidably detained there by cases 
of labor, convulsions and the like. There is a tendency 
to conviviality and abandon around the festive board 
that has a leveling effect, and divests the physician of 
his proper prestige. Better to eat a cold repast at home 
than to partake of the most savory viands of many a 
patient. Let a physician once unbend among certain 
kinds of patients, and he risks a complete loss of their 
esteem. 
When compelled to accept a meal, if you are served 
alone, so much the better ; if seated to eat with the 
household, be courteous but somewhat reserved, and ex- 
hibit only enough of the social element to be agreeable. 
Shun badinage and gossip, and over-praising of the 
viands, and avoid speaking afterwards of the “ snowy 
biscuits,” or the “delicious butter,” “the juicy beef- 
steak,” etc., as though you were a stranger to choice 
food. 
Try to give satisfaction at your visits; show that you 
are anxious to relieve both the body and mind of your 
patient, and you will not—cannot fail to succeed in your 
ambition to get practice. To do this fully you must, of 
course, feel and express a genuine interest in the case, 
and in the effects of the remedies you are using. 80 
When you scold or find fault with patients or their 
attendants, preface what you say by explaining that you 
are not scolding in anger, but because you feel an earn- 
est desire to have them do right for everybody’s sake. 
By prefacing thus you will completely disarm resentment, 
and they will take all you say in good part. 
If you are unmarried, it will often be quoted against 
you; but the truth is, there is no great professional ad- 
vantage gained by being married. The objection to 
most unmarried physicians is really not their celibacy, 
but their youthfulness. To marry with an eye to busi- 
ness only, would be apt to entail expenses and responsi- 
bilities without corresponding benefits. Besides, you 
should keep both business and marriage on a higher 
plane. You will often see in your professional career 
the misery that flows from degrading marriage by enter- 
ing into it from other considerations than love and con- 
geniality, and you should not risk it yourself. 
Everybody wants a lucky, conservative physician; 
therefore a series of dystocias, or of deaths in child-bed, 
or of surgical operations that fail, or of malignant cases, 
or of cases of any kind that eventuate unexpectedly ill, 
often injures the physician for years, by attaching to 
him—especially if he be a beginner—either charges of 
being blind to danger and to duty, or a long-to-be-re- 
membered reputation for bad luck. If such a series un- 
fortunately threatens you in the beginning of your prac- 
tice, strengthen yourself by consultations, etc. 
The power of impressing those you meet with a 
favorable opinion of your adaptation to your calling, is 
an important advantage. Discipline yourself by self- 81 
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. 
No one can succeed fully without the favorable opinion 
of the maids and matrons he meets in the sickroom. 
They can be his best friends or his worst enemies. The 
females of every family have a potent voice in selecting 
the family physician. I have often thought that the 
secret why so many truly scientific aspirants fail to get 
practice is, that cold logic and rigid mathematics and 
other high theoretical attainments, however much ad- 
mired, are often attained at the expense of the endear- 
ing sentiments, and hence excite no sympathy, but, on 
the contrary, are often associated with a deficiency of 
those minor qualities of head and heart which appeal to 
the female mind and work upon its emotional element. 
Ability to please and retain those who employ you in 
an emergency, or tentatively, is also a power that you 
should carefully cultivate. 
You will find that remembrance of the names of chil- 
dren and of patients whom you see but rarely, and the 
ability to recall the salient points of former interviews 
with them, are very useful adjuncts to other qualities. 
Children’s likes and dislikes will control your destiny 
in many a family. Many people patronize various forms 
of quackery for no greater reason than that “ the children 
take it easily,” knowing from experience, that an at- 
tempt to give pills or bitter doses to refractory or spoilt 
children means a fight and a failure. 
You must not rely strongly on social influence for 82 
getting practice. Your very best friends may prefer 
that you test your skill and gain your experience on 
others, rather than on them or theirs. 
You may he socially a great favorite while all are 
well, but when sickness comes and death threatens the 
afflicted one, the impulses of friendship are dormant and 
do not influence the choice of a physician. No member 
of any family circle will be spared, if any human power 
can save, and persons terrified at the possibility of losing 
the provident husband, beloved wife, blooming daughter, 
darling babe, dutiful son, or honored parent, as the case 
may be, instinctively send for the doctor in whose 
skill they have most confidence. They go past the 
beginner, about whom they know too little,—past the 
one whose system requires so much stimulating, about 
whom they know too much,—past the gay, the fickle, 
the sentimental, and the unchaste,—past all whose un- 
professional demeanor proves them to be either unripe, 
or unsuited to a stewardship so solemn, so precious, so 
weighty as that of a family physician,—past all, till 
they reach the one in whom their faith, their medical 
confidence centres; faith is the great controlling lever. 
Be polite and considerate to every one, especially when 
you are vexed or in a hurry; abruptness makes many 
useless wounds, some of which are difficult to heal. 
True politeness is a seed that costs nothing, can be 
planted anywhere—that always bears good fruit. Re- 
solve that you will cultivate it 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 something and give it freely. If ladies ask you for 
a donation to aid the heathen (!!!) or to help buy a 83 
carpet for their church, or any other laudable object, 
give willingly and cheerfully. If the tiny boy or girl 
comes to sell a concert or festival ticket, buy it laugh- 
ingly, for contributions this way not only do good, but 
have other consequences. Were you to scowl and say 
“ no,” the young man and woman and the tiny boy 
would unite in calling you “ old stingy/’ and ever after 
avoid you. 
There is a certain fact that you might not observe 
without having your attention called to it; it is, that 
after you get into full practice, your days, weeks, months 
and years will flit by faster than those of other people, 
because as a physician they will be incessantly engrossed 
with a medley of important cases, and the lapse of time 
will consequently be almost magical. 
You should get as much out of life as you can by 
seeking proper relaxations and amusements while the 
age for enjoying them remains. Many physicians, in the 
eager pursuit of business, foolishly postpone all relaxation 
from one time to another, intending to indulge in ease 
and social amenities and to pursue the pleasures of life 
when they get older; they thus forego seeking enjoy- 
ments till they lose all taste for them, till they know 
nothing and are fit for nothing but to plod in the physi- 
cian’s hard, slavish treadmill for life. 
It is asserted that working seven days in a week 
shortens a life of threescore and ten by twenty years. 
A little leisure is a great blessing. Do as little work 
on Sundays and holidays as possible. An occasional 
day’s sport with rod or gun, or a summer trip, or an 
evening at a convivial gathering, or at the theatre, etc., 
will act as seasoning to your labors, lessen the worries 84 
and cares of practice, break the monotony of life, 
subdue irritability, the result of overwork, conduce to 
longevity, and actually make you more philosophical 
and a better physician. 
Newspaper notices of your departure from the city 
for short seaside, mountain, or other brief pleasure trips, 
will, if allowed, have a disturbing and hurtful influence 
on your practice while you are away, and even after 
your return. Reporters are aware how such items in- 
jure physicians, and seldom publish them unless re- 
quested. 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 
absence from business to the whole world. 
After prolonged absence from home, or recovery from 
long sickness, it is perfectly ethical to announce the fact 
of your return to practice through the newspapers: 
Dr. will resume practice at his office, No.— 
street, July 1st, 1885. 
When you assume charge of a case for another physi- 
cian, to look after during his absence from the city, or 
one of your own that has been under the care of a sub- 
stitute while you were away, or that any one has at- 
tended in an emergency pending your arrival, or be- 
cause the attending physician has been taken sick, con- 
tinue his line of treatment, at least for a while, if you can 
conscientiously do so. An abrupt radical change, either 
in diagnosis, prognosis or treatment, is both ungenerous 
and injurious to your co-worker. In such a case, if you 
believe something more should be given, merely add it 
to what is already being done. This avoids unpleasant 
reflections. CHAPTER IY. 
“ The first step to -wisdom is to be exempt from folly.”—Horace. 
Always feel and show respect for your seniors in prac- 
tice. There is probably no type of medical man so un- 
worthy of respect as the one who shows contempt for 
his seniors. You may excel the older physicians in 
severely scientific and technical points, hut experience 
has been their teacher, and they have a ripe clinical ac- 
quaintance with disease, and an intuitive perception as 
to the choice of remedies which in general makes them 
better logicians and much better practitioners, because 
knowledge and skill derived from observation and ex- 
perience far outweigh mere book knowledge, 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. Re- 
member that although young physicians indulge more 
than older ones in scientific u extras,” and modern in- 
strumental aids to diagnosis, yet relying on these too 
much and studying rational symptoms too little, they 
seem to forget that the art of curing disease owes more 
to good judgment and sound common-sense bedside ob- 
servation and experience than to anything else. 
The older practitioner is more apt to slight the nicer 
pathological diagnosis, which discovers the technical 
character of the disease—whether, for instance, a pneu- 86 
monia is catarrhal, croupous or interstitial—and to attend 
more to the therapeutical diagnosis which indicates 
what the treatment should be; weighing the influence 
of age, season, rate of progress, secondary affections, com- 
pensatory changes, and other phenomena with a nicety 
that the junior can never learn from his books, then 
choosing with intuitive wisdom the best remedies for the 
discomforts, annoyances, and sufferings of the patient; 
reducing, evacuating, quieting, stimulating, or feeding 
him, as experience has taught. Such men do very much 
to give our profession honorable standing, and are cer- 
tainly worthy of all respect. 
When you have been a physician long enough to make 
your patients feel that you have a judgment of your 
own and evolve it out of your own brain, and that you 
alone are acquainted with their moral and physical 
idiosyncrasies, it will give you great advantage, and 
will make attending them much easier. You will occa- 
sionally be employed in cases because you have long ago 
attended other members of the family in similar affec- 
tions, and are supposed to know the family constitution, 
temperament and tendencies, and to possess sovereign 
remedies for their relief. 
You will find that the popular belief that you know 
this or that person’s constitution, and know exactly what 
they require, and their likes and dislikes, is a power- 
ful acquisition, one that gives you great authority, and 
gives them unquestioning confidence. 
Experience and skill are what the public seek in a 
physician; they are most important, and everybody 
knows it. You should carefully try to appear possessed 87 
of both. Of course, we all have aftersight, but fore- 
sight is what is needed. This is sure to come from 
practical experience in diagnosticating and combating 
disease, and will develop and improve your judgment in 
every way, and enable you each year to foresee events 
with increased clearness; and if you compel yourself to 
work faithfully and to develop the faculty of observing, 
every year will make you a better physician, and by the 
time you have worked and observed for ten or twelve 
years, you will be clinically familiar with all the more 
common afflictions that are sure to confront you, and you 
will know from experience how to avoid various errors 
and mistakes, and how to shape your diagnosis, prognosis 
and treatment in each, far better than your juniors. 
In addition to the great advantage the older phy- 
sicians have over the younger ones, from increased 
ability to foresee the probable degree and duration of 
grave cases, and to give concerning them more definite 
and truer opinions from the beginning, they can from 
experience recognize and point out cases that are dubious 
or likely to prove very slow and tedious, thereby saving 
themselves from much anxiety and blame. Of course, 
these advantages advance their reputation, give them 
greater confidence in themselves, and enable them to 
carry cases with greater steadiness and to retain confi- 
dence much better than younger physicians. This is 
the chief reason why older physicians are not harassed 
in difficult cases by meddling officiousness from outsiders, 
and dismissed, or forced to call consultations, as often as 
younger ones, and why the practice of medicine becomes 
relatively easier every year. You will find that after 88 
you have practised twelve or fifteen years, after you 
have forgotten much of your theoretical knowledge,— 
which was probably greater comparatively at graduation 
than it will ever be again,—your experience will be 
invaluable to you, and will often serve you where book- 
learning cannot; indeed, it is impossible to obtain from 
books alone sufficient knowledge of disease to become a 
good practitioner. Self-attained post-graduate know- 
ledge is the kind that makes the public prefer older 
physicians to younger ones. 
The public love to see a physician appear to under- 
stand his business fully, to know things intuitively; there- 
fore you must study and practise to be quick in diagnosis, 
and ever ready in the treatment of the ordinary cases 
that will constitute nine-tenths of your practice. 
Study the laws of prognosis and duration continually, 
for it is in these that most error is seen. Very few 
people can discover whether or not your diagnosis and 
treatment are correct, but if you say a patient will re- 
cover and he dies, or that he will die and he gets well, 
or that he will be sick a month and he gets up in three 
days, or that he will be well in three days and 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, you might also have been wrong in 
your diagnosis and treatment. 
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. 
In forming your prognosis be careful to ascertain, not 89 
only the condition of the organ chiefly diseased, but 
that of all the other vital organs, as their condition and 
action may, in some measure, compensate for the lost 
functions of the diseased organ. Look also at the sur- 
roundings of your patient, and the nursing and attention 
he can command; and lastly, learn to estimate, from 
the look, voice, gesture and general aspect, mental and 
physical, his vital resistance to the disease (which 
differs in each individual), and then form your prognosis. 
Never ask, as you enter to pay the first visit to a 
patient, the awkward question, “What is the matter 
with you ? ” or at any other visit, “ How are you to- 
day?” or he may retort, that is exactly what he wants 
the physician to tell him. 
Never display the fact that you are a junior working 
by reflected light, and thereby belittle yourself in the 
estimation of patients, by constantly quoting what the 
books say, or what such-and-such a medical celebrity 
says. 
The folly of blindly or slavishly following 
the dicta of others, is nicely depicted by Moliere in 
jV Amour Medecin, Acte ii, Scene 2, where the following 
dialogue occurs between Dr. Tomes and Lisette : 
Tomes.—How is the coachman ? 
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. 90 
Tomes.—You are mistaken. 
Lisette.—I saw it. 
Tomes.—It is impossible. Hippocrates says that 
such diseases 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 remember that your 
patients of all shades, white and black, rich and poor, 
want to know what you think, and care but little for 
what Hippocrates, Watson, Gross, or Ringer says. 
If you are determined to let people know you are 
inexperienced 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 by his host down into the kitchen and through 
the pantries, and shown his 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 
Remember this: every one likes to believe that the 
physician 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 a diathesis. 
Make post-mortem examinations, and other scientific 91 
use of your opportunities whenever proper cases present 
themselves, but never allow the inference that you are 
doing so to gratify idle curiosity, or to satisfy yourself 
alone, or that it is a very great favor to be allowed to 
do it; rather put it on the higher ground that it is for 
the benefit of science, and in the interest of suffering 
humanity, and it may be for the good of the very persons 
with whom you are talking. 
It is, of course, wrong, very wrong, to consent to 
make a post-mortem examination of any one who has 
died under the care of another physician, at the solici- 
tation of those who seek to disprove the diagnosis and 
disgrace the medical attendant. 
The hypostatic congestion that naturally follows death 
is often mistaken by the public for ante-mortem changes, 
and gives rise to the most wonderful stories of “murder,” 
“ only in a trance,” etc. Take care to inform people of 
its nature and cause, and its utter lack of significance. 
Experiments that require vivisection of animals 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 before leaving college. On the con- 
trary, making clinical analyses of the urine and other 
fluids will not only lead you to invaluable information 
regarding your patient’s condition, but will be a great 
element in giving you popularity and respect. 
Working with the microscope on proper occasions will 
not only increase your knowledge, but will also invest 
you with the benefits of a scientific reputation in public 
esteem. 
Obstetrical practice is in some respects desirable, 92 
especially in the beginning, as it paves the way to per- 
manent family practice. Doing the waiting at the bed- 
side, however, entails a tremendous loss of time. Chance 
calls of any kind you can take or not at your option, 
whereas engagements, especially obstetrical ones, must 
be kept, day or night. 
If you ever get so overrun with business that time is 
precious with you, having many obstetrical cases will 
overtax you, and it may become actually necessary, in 
self-defence, to shut off these and other engrossing en- 
gagements, to get time to attend the rest of your patients 
with something like regularity, and to obtain your meals, 
sleep, etc.; or, at least, to limit such engagements as 
much as possible. Midwifery is a wearing, exhausting 
branch of medicine, one that is full of care and responsi- 
bility ; and although it leads to other family practice, 
you will find after some years that the ordinary fees for 
attending cases of confinement are, on account of loss in 
waiting and consequent interference with other engage- 
ments and duties, and on account of the fatigue and want 
of sleep, etc., which they occasion, proportionately more 
meagre than in any other department of practice. 
If you keep a record you will probably find that nine- 
tenths of all your loss of rest is due to obstetrical cases. 
When a person engages you to attend her in confine- 
ment, write her call on one of your cards and give it to 
her, and instruct her to send it to you as soon as she 
feels that you are needed. This emphasizes the engage- 
ment, and makes her more apt, when her time comes, 
to call you in, than to employ another physician, or to 
get a midwife. 93 
In spite of your having been engaged for a case, and 
kept in suspense for weeks or months, you will sometimes 
learn that the confinement is over, that a midwife or 
granny was sent for, and the excuse will be that every- 
thing occurred in such a hurry that they could not wait 
for you, or that they had no messenger, 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 
skill, and for the sufferer’s sake you should never refuse 
to go. 
Such occasions will afford you an excellent chance to 
show the advantages regular physicians have over mid- 
wives and irregulars, and also to enhance yourself in 
public esteem. 
Pregnant women will sometimes want to make an 
Indian bargain with you beforehand, to come to them 
in case their midwife fails. Of course you should go 
to all cases where humanity calls, but you should never 
bargain with anybody beforehand to play second part to 
a midwife—she to take the fee and the eclat, if there is 
no trouble, you to take the care and responsibility for a 
nominal fee, if there is. You may be surprised to learn 
that it is now generally understood in many communi- 
ties, that every midwife has her regular medical ref- 
eree to relieve her of complicated cases—a one-sided 
bargain, which gives him an undue proportion of worry- 
ing cases. 
In every confinement case, after delivering the child, 
be careful to call the mother’s attention to the lump in 
her abdomen, and inform her that it is only the con- 94 
tracted uterus. If you do not, slie may accidentally dis- 
cover it, get greatly alarmed, and either await your 
visit in terror, or send for you post-haste. 
Attending very distant patients of any kind has a 
tendency to disorganize and diminish one’s nearer prac- 
tice ; for while absent, attending a remote call, you may 
lose three nearer ones. A long visit does not, as a rule, 
pay pecuniarily, and is an injustice to both physician 
and patient. Every one should have a family physician 
within reasonable calling distance. A few far-off patients 
will waste more time, break down more horseflesh, use 
up more carriages, harass you more at unseasonable 
hours, and expose you to bad weather more, than all 
the remainder of your practice. 
Keep your practice down to a number which you can 
attend properly; you can do this by sending your bills 
promptly, by weeding out worthless patients, by circum- 
scribing your bounds, cutting off obstetrical engage- 
ments, raising your fees, etc. In refusing to take a case 
at a distance, or one that is likely to involve you as a 
witness in court against your will, or to engage for mid- 
wifery, if you are “ too busy” name that as your chief 
reason, as it is the least open to criticism and over-per- 
suasion of any that can be assigned. 
Never offer as an excuse for neglect to visit a patient, 
“ I really forgot you it is unpardonable. 
Gonorrhoeal and syphilitic cases are not especially 
desirable on any account, except for the fees they bring; 
they are dirty, secret cases, and rather repel than 
attract their victims and their friends to the physician 
who attends them, when they require a physician for 95 
other diseases. Attending them will, however, often 
enable you to pick up a handsome cash office-fee. 
Even when you are positive that a person has syph- 
ilis, it is not always best to say so. Prudence will some- 
times require you to reserve your opinion, but at the 
same time give the proper medicine. Indeed, in prac- 
tising medicine, you will see and understand many sins 
and blemishes of which you must appear oblivious. 
Take care that your reputation for special interest in 
venereal diseases does not overshadow or eclipse other 
kinds, and give you the title of u P—x Doctor/’ and 
entail the social ostracism and loss of family practice 
that would follow; or that extra success in restoring the 
menses in females who suspect pregnancy, does not bring 
you an extra number of such cases, and give you the 
title of “ Abortionist”; or that attending an excessive 
proportion of courtezans, or bruisers, does not give you 
the name of having a “ fancy practice or that per- 
petual and indiscriminate inquiring about the urine, and 
having it bottled for you, does not earn for you the 
easily acquired title of “P—ss Doctor”; or that a liver 
hobby, or a kidney hobby, or the womb, or the stomach, 
does not become with you a scapegoat to be blamed for 
every obscure disease, and eventually lessen your use- 
fulness and injure your character as a practitioner. 
You will find it much more pleasant to practise in 
some families than in others; for some will constantly 
give you intelligent co-operation, and will make chari- 
table allowance for all your shortcomings and failures, 
while others will, when any of their members are sick, 
appear almost as if they wanted to involve and harass 96 
you in every conceivable way, and to make you feel as 
though, in attending them, you were on trial for your 
life. 
It is this feeling of personal involvement and perpetual 
anxiety, as much as over-work, that breaks down the 
health and shortens the lives of physicians. Remember 
this, and, like a philosopher, make it a rule never to 
worry about anything you cannot help. 
Be guarded against asking private questions before 
persons not in the patient’s confidence, unless they are 
clearly entitled to hear them; request all such, especi- 
ally if they are of the opposite sex, to leave the room 
before asking. Be doubly cautious in this respect when 
your patient is a female, and the questions refer to mar- 
riage, menstruation, pregnancy, lactation, uterine affec- 
tions, constipation, urination, or other delicate subjects, 
that her secrets may not be exposed, or her modesty 
shocked. 
Also avoid inquiring of a patient in stores or barber 
shops, or on the street, in the presence of strangers, 
about his ailments, or about patients at his home. Many 
persons are very sensitive concerning their ailments, and 
captious concerning the time, place and manner of ask- 
ing about them. 
Do not allow indiscreet patients to go about over- 
praising you, and speaking of you as a pet, etc. Inor- 
dinate praise, no matter from whom, is apt to arouse a 
corresponding dislike on the part of those who deem the 
praise either extravagant or misplaced; such injudi- 
cious praise will almost surely react against you, and 
might even arouse the angriest jealousy on the part of 97 
husbands, aunts, lovers, or others. Perfectly pure phy- 
sicians have actually had to cease attending in families 
where such jealousy existed, to prevent causing domestic 
strife aiid estrangement. 
As a rule, it is better in the sick chamber to lend 
attention at your visits, chiefly to the conversation of the 
husband, if he is present, rather than to the wife, and 
to address your opinions, explanations and remarks to 
him, or whoever is at the head of those whom you meet 
in the sick-room, and to pay to all others only the respect 
that civility requires. If you do not do this, sensitive 
people will feel ignored, and many will even get dis- 
satisfied and create trouble. 
Probably one of the greatest fortes you could possess 
is the power of discovering who are the ruling spirits 
in a family, and securing their faith and keeping them 
satisfied with you and your services. 
It is also in bad taste, and even inj urious, for a physician 
to have wife, or other near relative, praising him inordi- 
nately, and boasting of his great skill and wonderful 
cases to all whom she meets, as people naturally think it 
colored by interested motives. If done at all, it comes 
with a great deal more grace from strangers. 
Refuse to be confidential with curious or stupid 
nurses, or prying mischief-makers; and if you must 
answer their questions, do so, not in confidential whis- 
pers, but openly and in your ordinary voice. 
In visiting, banish all else from your mind but the 
case before you; and no matter who is present, make 
the patient, whether young or old, the central object, 
and keep your thoughts and your conversation on him 98 
and his case. Both patients and their friends will 
naturally be more anxious to know what you think of 
their cases, and to receive information for their benefit, 
than to hear of anything else. If the conversation 
digresses to other subjects, shift it back to your patient 
and his case as soon as possible. During consultations 
also observe the same caution, and keep the conversa- 
tion between you and your colleague on the case under 
consideration, and do not allow it to digress to religion, 
horses, politics, etc.; economy of time requires it, be- 
sides it is for that you are employed. Another fact to 
be kept in mind is this: 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, either 
of which may undo you. 
Shrewdness in changing either a diagnosis or prog- 
nosis is very necessary in all cases where a change must 
be made. 
Do not bind yourself too quickly or too closely in 
prognosticating the duration of a patient’s case. What- 
ever prognosis you foreshadow in the beginning is, as a 
rule, accepted. It is only when that prognosis is changed 
to greater gravity, or its duration made much longer, that 
discontent arises. One of the strongest reproaches to 
medicine is, that it is not an exact science, therefore its 
practice often lacks the element of certainty. 
Do not get insulted at the foibles and infirmities of 
the sick. Bear with the rude treatment you will occa- 
sionally receive from hysterical, peevish, or low-spirited 
patients, and do not take anything a sick or silly person 
says as an insult, unless you believe it is deliberately 
intended as such. 99 
Beware of confidants. Never become so fond of 
patients, or any one else, as to make them the repository 
either of your professional or personal secrets. With our 
imperfect therapeutical means we cannot always attain 
perfect results, or give complete satisfaction, and some of 
those whom you have served most faithfully, and who 
you think will never change, will surprise and shock 
you by turning viciously against you and decrying you 
loudly. Bear the possibility of this ever in mind, and 
while making your relations with your friends and 
patients cordial, frank and free, always avoid telling 
secrets and making confessions that would put you into 
their power, if a rupture of friendship should ever 
occur. 
To be over-assiduous in paying visits, when no suffi- 
cient cause is apparent, or to be too deferential and over 
attentive to those who think themselves extra good 
patients, is dangerous; for as soon as one imagines he is 
the best patient you have, or that you are cultivating 
him unnecessarily, he is sure to undervalue you and is 
apt to quit you. 
When urgent necessity or danger requires it, you may 
do the most menial work for a patient; but unless these 
exist, pulling off your coat or collar, administering in- 
jections, giving baths, swaddling new-born babes, nursing 
the sick, rummaging drawers or ransacking cupboards in 
search of towels, old muslin for bandages, spoons, goblets, 
etc., does not comport with your position, and it may be 
quoted as evidence that you are without dignity and 
lack proper self-respect. 
It is much better to ask for things you need, and have 
them brought to you. 100 
A patient who is improving will be satisfied with a 
much shorter visit, slighter examination, and less perfect 
attention in general, than one who is not doing well, 
especially if he is doing so well that you can express 
your emphatic satisfaction with his progress, as you 
leave. 
When a case is obscure, or in the initial stages, be 
cautious in expressing any positive or unguarded 
opinion; but in cases where you can safely do so, give 
an unequivocal, frank, free diagnosis and prognosis that 
express your full opinion. The habit of stating your 
views candidly will compel you to analyze closely, will 
discipline your judgment, and force you to study your 
cases and formulate opinions, instead of lumping every- 
thing and treating the patient for his most prominent 
symptoms, without stopping to notice or study the 
minor ones—as is done by mere routinists. 
Remember that, contrary to popular belief, the art 
of medicine does not enable you, or any one else, to diag- 
nosticate any of the eruptive fevers positively, till their 
local manifestations appear. 
Frequently when a case is grave and you are being 
importuned to know whether you cannot do more, it is 
better casually to mention the things you deem contra- 
indicated,—leeching, cupping, mustard, rubbing, baths, 
poultices, mopping the throat, electricity, etc., and tell 
why you have not ordered them, so as to let it be known 
you are wide awake and have thought of them, but have 
good reasons for not using them. 
Never pronounce any one’s sickness feigned or trif- 
ling, unless absolutely positive that it is so, and never 101 
make fun of people sending for you, or being alarmed at 
what appear to be trilling ailments or simple growths; 
indeed, you should never joke, talk frivolously, or laugh 
about your patients or their sicknesses, either in their 
presence or elsewhere, and never taunt them about the 
trifling nature of their diseases. Some people will laugh 
off such a criticism, while secretly they feel hurt and 
resolve never to have you again. Another reason is 
that trifling ailments sometimes become serious diseases, 
and simple growths sometimes put on malignancy, and 
their becoming so through fatal loss of time is apt to be 
blamed on the joker for life. 
Never guarantee a cure, or certain success, or a sure 
recovery, even for a mosquito bite; guarantee nothing, 
except that you know your duty and will do it. Medi- 
cine is not a perfect science, and life is not a definite 
quantity. When pressed to say whether any case of 
sickness is dangerous, reply promptly, “ Of course there 
may be danger, because it is sickness, and any sickness, 
even a fly bite or a pin scratch, may become dangerous,” 
and that even a well person has no guarantee of life 
from one day to another. Also remind the questioner, 
that you do not keep the book of life, that your will and 
God’s will may differ, and that you cannot guarantee 
that any case of sickness may not become dangerous, or 
not have an unfavorable issue and even end in death; 
then tell him what you think will be the issue in the 
case in point. Remember, even in doing this, that while 
every case presents a scale of probabilities, it is sur- 
rounded by a group of possibilities, and do not fail to 
mention this fact, and to leave yourself a reasonable 
margin for uncertainties. 102 
In giving death certificates in mania-a-potu, syphilis, 
abortion, etc., never yield to importunities, or a false 
tenderness for family affliction, and substitute other 
pleasant-sounding terms that risk putting you in a false 
position. 
The laws everywhere confer on physicians honors and 
judicial powers that are refused to other classes. You 
are exempted from military and jury duty, and made an 
officer of the law regarding insanity, vaccination, etc., 
and your certificate regarding deaths, births, inability to 
attend court, and numerous other offices of permanent 
trust, are everywhere respected, and it is your duty in 
return to comply cheerfully and promptly with all legal 
requirements—to aid, rather than hinder enforcement 
of the laws. 
In giving certificates, it is best to certify, “In my 
opinion,” etc. Indeed, it is wiser, as well as more modest, 
in expressing an opinion, whether written or oral, to 
always say, “ I believe thus and so,” or “ In my opinion,” 
etc. The fact that it is your belief, or opinion, no one 
can dispute, even though it should prove erroneous. 
Be exceedingly cautious in giving certificates of in- 
sanity, with a view to committing patients to an insane 
asylum. Do not yield to the importunity of mistaken or 
designing persons and commit the cruelty of depriving a 
poor fellow of his rights, liberty and property, because he 
entertains some harmless crotchet, as, for instance, that 
he is a tea-pot, 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 conducts himself and manages 
his property rightly. Distinguish between the truly 103 
insane as contemplated by law, and those who may only 
seem to be insane. Dissatisfied friends of such people 
sometimes give great trouble to accommodating physi- 
cians in these cases. Give certificates in none but clear 
cases, and keep a memorandum of all the facts in each. 
Also keep memoranda and observe great caution when 
you are a witness in will cases, suits for divorce, etc., to 
protect yourself against traitorous friends and designing 
enemies. 
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 
will generate, a suit for damages may follow if the 
patient gets small-pox while awaiting the fulfillment of 
your promise. 
Never conceal the presence of a contagious disease 
from those around who are liable to contract it, or you 
may encounter the condemnation of the whole com- 
munity. You will be apt to meet with rank opposition 
to your views when your decisions concerning the 
presence of, or danger from, cases of infectious diseases 
(smallpox, scarlatina, typhus fever, etc.), militate against 
the wishes or supposed interests of landlords, store- 
keepers, boarding-house mistresses, etc. In such cases 
do not be browbeaten into allowing any one to violate 
the laws relating to the public health. Your duty to 
the well is quite as great as to the diseased. Indeed, 
the public health is of far greater importance than the 
well-being of any individual. 
When these or any other dilemmas present themselves, 
adopt Davy Crockett’s wise motto, “ Be sure you are 
right, then go ahead.” 104 
Carefully prevent children in whose family contagious 
disease exists, from infecting others by attending school, 
or otherwise mingling with those liable to contract it 
from them. Insist upon visitors being excluded from 
such cases. Also take care 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 smallpox, scarlet fever, measles, etc., or that you are 
even attending any contagious disease, or you will be 
credited with causing whatever cases occur among those 
whom you thus inform. 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 disin- 
fect your clothes by walking in the open air; also wash 
your hands with very hot water, or hold them over the 
fire; also use disinfecting lotions, etc., according to ap- 
parent need; if necessary, take a warm bath, or even a 
Turkish bath. 
Oppose the conveyance of diphtheria, scarlet fever, 
measles, smallpox, cholera, yellow fever, typhus fever 
and other contagious diseases, in hacks, cars, and other 
public vehicles; and forbid the attendance of friends at 
the funerals of those who have died of such diseases, on 
the ground that the dead must not be allowed to kill the 
living. 
Never keep a tongue-depressor for indiscriminate use, 
for besides the disgust which patients feel at having an 
instrument that has been used on everybody, put into 
their mouths, it might actually convey syphilis, diph- 105 
theria, etc., from one patient to another, and render you 
liable to just 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 and excite the patient’s disgust, and a lively 
curiosity among all around, to know when and upon 
what kind of a case it was last used. At your office an 
ivory paper-folder answers very well, is not disgusting, 
and is easily kept clean. 
It is both rational and proper to aid a worthy friend, 
when he has a case requiring it, or to unite with any 
member of the profession in a case that will either give 
you knowledge that you desire, or increase your reputa- 
tion in a specialty in which you are interested; but it is 
unwise to lend yourself to those who would use you for 
their own good only, or to run about assuming half (or 
all) of the responsibility in cases of fracture, wounds, 
etc., for third or fourth-rate Sir Astley Coopers, or to 
administer the chloroform, hold sponges, etc., in their 
operations, unless you are properly compensated for the 
work you do, and for the responsibility you take. 
Servility and obsequiousness will never benefit your 
reputation either in the community or in the profession, 
but bad results in cases fo which you are carried as 
partner may do you a great deal of harm. 
Preaching morals to vicious patients seldom does any 
good, but you can often exert the greatest influence upon 
patients who indulge to excess in chewing, smoking, 
drinking, singing, dancing, late hours', carousing, venery, 
and other things that render them liable to disease. 
Your injunctions regarding the five things last named, if 
properly given, will frequently be strictly obeyed. When drinkers tell you that they intend to u swear 
off ” for a definite period, advise them instead of swear- 
ing off to swear neither to treat any one nor allow any 
one to treat them to liquor during the prescribed period. 
This is more manly and more apt to be observed. 
The various quack bitters advertised and guaranteed 
to be “ a wonderful discovery,” are almost invariably 
some vile compound of bad rum or bad whiskey, and are 
the origin of much drunkenness; you should point out 
the danger and condemn their use. If a person will 
take alcoholic stimulants, advise him to take them “ bare- 
footed”; then he will know what kind and how much 
he is taking. 
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 you the 
next, perhaps charge that you have maltreated them, 
killed their children, crippled their wives, or done some- 
thing else equally horrible. You will learn by melan- 
choly experience that the minds of men (and of women 
too) are subject 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 de- 
tach families from you; a whim, a caprice, a look or a 
nod will sometimes break links that have been forming 
for years ; indeed, £ven old patients will drop you when 
they get ready, with less ceremony and less regret than 
you would an office-boy or an hostler. CHAPTER Y. 
“A mind fraught with integrity is the most august possession.”—Blaykey. 
Have respect for religion. Your profession will fre- 
quently 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, sensible and pious clergyman who confines 
himself to his true work are sometimes more useful to a 
worn and irritated patient than medicine; and even 
where death is near and inevitable, resignation often 
takes the place of fear and despondency when the in- 
valid is skilfully informed of the probability of death. 
In fact, when cheered and fortified by religion, and im- 
pressed with the thought that whatever occurs they are in 
God’s hands, many show as little regret upon learning 
that they will probably die as a traveller does when 
about to start on a pleasant journey. 
When called to attend cases of angina pectoris, aneur- 
ism, organic heart disease, desperate wounds or injuries, 
apoplexy, or other diseases that create liability to 
sudden death, prudence may require you to conceal the 
danger of death from the patient, lest he at once give up 
all hope and be overcome by apprehension and terror; fear 
may exercise a deadly influence, and has often rendered 
mild diseases fatal. But be sure in such cases to give 108 
private warning to those most interested. Allow no one 
to sink away and die without making the probability 
known to relatives, friends or neighbors. Be also ex- 
ceedingly careful in talking before children with scarla- 
tina, variola, rubeola, etc., of the danger of complications, 
or of their illness being serious or dangerous; also take 
care to banish from them the fear of hydrophobia, lock- 
jaw, etc., because some very young children fully realize 
the meaning of death, and such talk would terrify them. 
Also use suitable caution in speaking within hearing of 
patients who seem to be sleeping, drunk, semi-comatose, 
etc. 
It is just as natural to die as it is to be born, and 
every one’s time must come. You can neither see what 
is written in the book of life, nor detain the sick soul 
when the Angel of Death summons; sometimes you will 
seem to be fighting death itself, and yet see the patient 
recover as if by resurrection, whilst on the other hand, 
you will often discover that patients are almost in the 
toils of death, while all around think, till you tell them 
differently, that they are getting better. 
You should never attempt to thrust your religious 
beliefs, or disbeliefs, or your political tenets, upon 
patients who hold opposite views. It is really no part 
of your duty to proselyte or to administer to the relig- 
ious cravings of the sick. Every sect has teachers of its 
own, to whom you must leave the spiritual. Confine 
your ministrations to the worldly welfare of patients, 
and never suggest anything in religious matters that in- 
volves a creed different from that of the sufferer. 
The great prospect of eternity certainly overshadows 109 
all temporal things. Be ever ready, not only to allow, 
but to advise patients to have spiritual comfort. Re- 
ligion does good, not only hereafter, but here; indeed, 
the presence of religious faith is a power that can as- 
suage the keenest sorrow and suffering, and even make 
the avenues to death smooth, and if any physician does 
not recognise it, he lacks the a b c of philosophy and the 
rudiments of observation. You will see many a poor, 
sick, woe-worn, despondent and broken-hearted wretch 
calmed in mind and soothed in body by its 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, he gets faith, hope, patience and resignation 
from it, and becomes willing, or even anxious for the 
hour of departure. 
The automatic, seemingly anxious movements uncon- 
sciously made by the dying are popularly supposed to 
be attempts to communicate some remaining thoughts, or 
secrets, or special wish before death. Explain to the 
friends in such cases that Providence has kindly drawn 
the veil of unconsciousness around the dying one and 
that he is not suffering. The dying struggle is painless 
to the unconscious patient, but is awfully painful and 
harrowing to all who stand at the bedside and wit- 
ness it. 
It is well that you, as a physician, whether a Roman 
Catholic or not, should be familiar with the following 
duties required by Catholic patients. 
When attending in Catholic families, be doubly 
cautious to warn the immediate friends of danger, that 
the sufferer may receive the last sacraments. 110 
One of the seven sacraments of the Holy Church of 
Rome is Extreme Unction. It is believed to purify the 
soul of the dying from any sin not previously expiated 
through other sacraments, and to give strength and grace 
for the death struggle. 
That church teaches that moral responsibility begins 
at the age of reason; therefore Extreme Unction is 
necessary for all who have attained that age. 
Extreme Unction is given but once in the same 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 
believed to contain-Christ’s whole being, his body, soul 
and divinity. It may be administered frequently in all 
cases of sickness where the patient is confined to the bed 
or to the house for any length of time, provided he has 
sufficient reason to make a full confession. 
If the course of the disease in your patient is likely to 
render him unconscious, be careful to inform the family 
of the fact, so that the clergy may be called, and the 
confession be heard, and the Holy Eucharist given be- 
fore the reasoning powers are obscured. 
Those who are to receive the Holy Eucharist are re- 
quired 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 incessant nausea and vomiting, the 
Holy Eucharist is either not given at all, or given in the 
smallest quantity. To expose it to being vomited is a 
grave irreverence. 
Be also equally careful in Catholic families to admin- 
ister, or have administered, conditional baptism to all 
children during or after birth, when there is the slightest 
reason to doubt their viability. The following are the 
conditions and details of conditional baptism : 
You, or any one else, whether a Roman Catholic or 
not, are allowed to administer it. A male adult is pre- 
ferable to a female, and of course a Catholic, if one is at 
hand, to a non-Catholic. The baptism is given as fol- 
lows : After procuring a glass or cup of clean water 
(spring water is designated, but hydrant, or pump, or 
any other kind of true and natural water will do), with 
suitable manner say, “ 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; con- 
tinue, “And of the Son,” at the word “ Son ” pouring 
another small portion; again continue, “And of the Holy 
Ghost,” and at the word “Holy Ghost” another small 
portion. 
Remember that in baptism every word must be ut- 
tered ; were you to omit even an “ of,” the baptism 
would be insufficient. Also remember that the water 
must be true and natural, and must be poured exactly 
whilst the formal words are pronounced. So very im- 
portant are these details that if you arrive after a mid- 
wife or other person has baptized the child, carefully 
ascertain whether she has observed the full form and used 112 
accurate language. If she has not, and the danger of 
death continues, you should baptize it again. In such 
a case it is necessary to preface the formal words with : 
“ If thou art not already baptized, I baptize thee,” etc. 
If in a midwifery case the child of Catholic parents 
is believed to be in danger of dying, it must be baptized. 
If it is partly born, baptize on its head, if the head is 
presenting; if not, upon the hand, or foot, or any other 
part that is born. If no part is born, and if you can 
reach the child through the vagina, the water must be 
applied to whatever part 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 plan that will keep the water uncon- 
taminated till it touches the child. 
You will take great risk if you use the forceps in 
Catholic families before the child has been baptized; for 
if this has been neglected and the child is born dead, 
you will not readily be forgiven. 
Remember that it is better for a person to be pre- 
pared thrice and not go, than to go unprepared; there- 
fore, if you err at all, let it be on the safe side. 
You should be careful to give timely notice of danger 
to all who have unfinished business of vital moment; 
persons suddenly seized may wish to summon friends, 
make wills, etc. 
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 to 
160. 113 
If you will observe closely, you will find that when a 
patient is firmly impressed with the belief that he will 
die he is extremely apt to do so. 
It is very much better for you to avoid leaving your 
sphere of physician to become a witness to wills; if 
called upon to do so, decline anyhow if you are not fully 
satisfied of the mental capacity of the testator, and 
never take part in interfering with the settlement, or 
division of the estate of those whom you have attended, 
as you may thereby incur the charge of abusing oppor- 
tunities which you owe solely to your position as a 
medical attendant. 
In no case be a witness to or executor of a will, when 
you are made a legatee or heir. 
Be careful to exhibit proper gravity and sincerity, 
when attending serious cases, and do not cry hope, hope! 
when you see no hope. 
If a very ill, sane adult really wishes to know whether 
he is likely to die and asks you the plain question, 
answer him frankly and truthfully; but, if possible, 
answer him in bland terms, so as not to appall him and 
injure him by taking away all hope and substituting 
despair. With your opinion, give all the encouragement 
you honestly can, and if you know anything favorable, 
either in his physical or spiritual condition, mention it 
as a solace. 
You are at liberty to be silent, or to say but little regard- 
ing the nature or degree of a person’s sickness, but, of 
course, let whatever you do say, whether much or little, 
be true. You must not, you can not, put falsehood in the 
place of truth, even when solacing the sick and dying; 114 
for, as a man and as a physician, you cannot sacrifice prin- 
ciple or honor for expediency, under any circumstances. 
But you can, you must, soften the truth and tell it in a 
proper manner. 
You will find few who have the mental fortitude to 
enjoy the remainder of life, after they are formally told 
that their cases are permanent or incurable; and you 
should be cautious, not suddenly to cut off all hope, even 
from those afflicted with tuberculosis, cancer, Bright’s 
disease, etc., where death approaches slowly like a 
creeping shadow, up to the last stage, since persons with 
those diseases have plenty of time, while sinking away 
gradually, to realize their fate. Indeed, you should not, 
in such cases, give a prognosis containing neither hope 
♦nor encouragement, unless you are willing to be replaced 
by some one, who may do no more good than you, 
except talking more hopefully. 
You can often prevent anxious patients, whose pulse 
or temperature has grown worse, or those whose diseased 
lungs, heart, etc., you are examining, from asking you 
questions that would compel you to disclose to them 
your gloomy prognosis, by having ready on your tongue’s 
end questions regarding their sleep, or appetite, or bowels, 
or something else, to ask the moment you finish listen- 
ing, counting, or testing; you thus give them no chance 
to inquire what you find or think. 
It is for several reasons better not entirely to abandon 
cases of consumption, cancer, etc., even though they be 
incurable, or in their last stages; on the contrary, keep 
them on your list, and visit them, at least occasionally, 
not only that you may give them all the relief you can, 115 
but that their friends, both present and absent, may 
have the very great consolation of knowing that they 
have full professional care and comfort. 
At every period of your career aim to convince the 
world that your profession is not in league with death, 
but that on the contrary all its symbols are indicative 
of health-giving and life-restoring power. Neither 
Hygeia, nor her father, iEsculapius, is represented with 
the habiliments of mourning, but we see instead iEscu- 
lapius armed with serpents, the symbol of wisdom and 
convalescence. 
Remember that Death is the physician’s great antago- 
nist, and that when he overcomes your efforts and takes 
away the spark of life, your duty ends. Do not, then, 
essay to offer up a prayer or stay and administer ner- 
vines to relatives or friends, or tender your services for 
promiscuous duties, e. g., carrying messages, going for the 
barber, undertaker, etc., but at the earliest suitable 
moment quietly withdraw. 
Leave the laying out of the body, the application of 
preservative fluids to the face and body of the dead, and 
all such things, to the undertaker or friends. 
Do not make a habit of visiting the mourning house 
to view the dead, and even avoid attending the funeral 
of dead patients, except when it is absolutely necessarj^. 
Above all else, do not write apologetic letters to the 
bereaved, expressing self-reproach for not recognizing 
this or that fact, or regret at not following a different 
course of treatment, and asking forgiveness. If there 
are facts connected with your relations to the case that 
require explaining, find occasion to communicate them 
verbally. 116 
Avoid all such tricks as assuring 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 do. Veracity should ever be your golden 
shield. 
The white and the black, the rich and the poor, the 
courtezan, the outlaw, the swaggering rowdy and the 
reprobate, will all be represented in your practice. At- 
tend anybody if you must, but seek to avoid disreput- 
able places, and persons who are low down in the moral 
scale ; they are more likely to be a curse than a bless- 
ing. Remember always that such people respect no 
physician who does not respect himself. 
Endeavor to establish and maintain a complete pro- 
fessional influence over all patients you attend, for with- 
out their faith and their respect you will have to contend 
not only against the physical condition, but also the 
mental and moral. 
You have a perfect right to relinquish attendance on 
a case when you think your interest, or your reputation, 
requires it; when you do so, let your withdrawal be 
fully understood. It is better, however, to plead having 
too much other business, and not take undesirable cases at 
all, than to take them and involve yourself, and after- 
wards relinquish or neglect them. 
Never refuse to rise from bed and make night visits 
to patients who require them; to do so would be unjust, 
in that it would put your duty on some other physician, 
and cause the patient unnecessary suffering, perhaps 
death, or it might even drive the messenger to a drug- 
gist for advice and medicine, or open the door to an 117 
Irregular, or whoever else could be caught up in the 
emergency, to fill your place. If, however, you charge 
full night-visit fees for all visits made after bedtime, you 
will be less often compelled to undergo loss of rest and 
exposure in attending those who could have sent at a more 
seasonable time. Unnecessary night-visits rob physicians 
of their rest, and even if they bring in fees, these are 
not an equivalent for the over-work and risk of health. 
Be exceedingly cautious about taking patients who are 
to be visited clandestinely, or having married women, 
or young females, consult you secretly at your office; 
especially, if to have vaginal or other private exami- 
nations made without knowledge of parents or husband. 
Be careful about attending patients under pretence that 
they have other than the real disease in order to shield 
them by deceiving friends or relatives. 
Do not over-visit your patients, and be especially 
careful to pay but few visits to those with trifling injuries, 
uncomplicated cases of measles, mumps, whooping-cough, 
chicken-pox, etc. People observe and criticise a phy- 
sician’s course in all such cases, and if he seems over- 
attentive, they are apt to believe either that they are 
sicker than he admits, which will cause them great 
alarm, or that he is nursing the case and creating a bill 
unnecessarily. It is sometimes an extremely delicate 
point to decide whether a patient needs another visit or 
not, and how soon. You must learn to judge correctly 
the proper time to cease attendance in different varieties 
of cases. 
Most people dread the expense of medical services, 
and excessive attention and numerous visits are rarely 118 
appreciated; a physician who pays but few visits, and 
yet cures, is always popular. If you can get the repu- 
tation of not paying any but necessary visits, it will be 
a special feature in your favor, and will almost double 
your practice. 
A good rule, the only proper rule, is to visit your 
patient when, and only when, you think he really needs 
your care, whether once a day, or once in seven days. 
Never go several times a day, without pointing out to 
him the necessity for it. 
Above all else, avoid running in to visit patients un- 
necessarily because you “ happen to be in the neighbor- 
hood.” If you visit on such a plea and charge for it, 
you will be criticised and your bill may be disputed. 
On the other hand, never visit an ill patient so seldom, 
or so irregularly, as to induce a belief that you are 
neglectful. 
Some well-to-do, or over-solicitous people form an ex- 
ception to this rule, and insist on your visiting them 
frequently, almost living at their house during sickness, 
to observe progress, instruct attendants, etc., regardless 
of the additional expense, and, of course, you should 
gratify them, but you should also at the beginning in- 
form the person who will have to pay the bill, of the 
reason for the extra visits, and of the expense it entails, 
and get his acquiescence. 
During these frequent visits you should maintain a 
strictly professional attitude, and avoid digressing from 
the patient to politics, fashions, or other current topics ; 
unless you do so, he will certainly lose confidence, after 
which you will be shorn of your influence, and will 
scarcely be welcomed when you call. 119 
When visiting a patient, always let it be known 
whether you will visit him again, and when; it will not 
only satisfy him, but will prevent all uncertainty. When 
a case has so far convalesced as to make frequent visits 
unnecessary, and yet mends so slowly or irregularly as 
to make you fear an arrest of improvement or a relapse, 
it is better to keep sight of it by calling once in a while, 
and letting it be known when you will call again, with 
an understanding that if the patient gets worse in the 
meanwhile, or if he grows so much better as to render 
your promised visit unnecessary, you shall be notified. 
This plan is, for many reasons, better than quitting such 
cases abruptly. 
Earnestness and interest shown in cases are master 
qualities. They inspire faith and confidence, and are 
often actually accepted in lieu of extra skill. Imbue 
yourself with genuine interest in your cases, and you will 
be sure to show it in a thousand ways. 
Make it a study to remember well all that is said or 
done at each of your visits, so that all you say and do 
throughout the case may be consistent. Also take care 
neither to expose a want of memory nor a lack of in- 
terest ; were you to ask a patient “ What kind of medi- 
cine did I give you last ?” or hesitate in your questions, 
he and his friends would notice it instantly, and think 
you either felt but little interest in his case or had a 
dangerous lack of memory. 
Try to make your address and manner such that 
patients will not hesitate to fully impart to you their 
secrets and the nature and seat of their disease. One of 
the greatest drawbacks to many physicians is that they 120 
do not inspire complete confidence, and patients neither in- 
trust them with the secrets of their ignorance, folly, or 
wickedness, nor employ them in afflictions that create 
hesitation or shame. 
Do not let your wife or any one else know your pro- 
fessional secrets, or the private details of your cases, 
even though they are not secrets; few persons like to 
have told from house to house what they said in their 
delirium, or how they shrank from leech-bites, or gagged 
at a pill, or to have their whims, fancies or weaknesses 
exposed. 
Many persons believe that physicians who allow their 
wives to ride around with them while making visits, 
relate everything that has taken place at the visit after 
they drive away from the house. Of course this is not 
so, but if people think so, their discomfort is the same as 
though it were. 
There is no end to the mortifications, compromises 
and estrangements a physician’s prying wife may bring 
him into. Nothing is more mortifying or hurtful to the 
feelings of sensitive patients than to hear that the de- 
tails of their cases are being whispered about as coming 
from the physician, or his wife, or others whom he or 
she has told. 
If you allow yourself to fall into the habit of speak- 
ing too freely even of ordinary affections, or submit to 
be indiscriminately interviewed by chatty people con- 
cerning your patients, your very silence in disreputable 
cases will betray them. The credit of whole families 
and the character of its individual members will some- 
times be at stake, and unless you shut your eyes and do 121 
not see too much, and your mouth and do not say too 
much, it may ruin them and involve you. 
You will be allowed to see people in a very different 
light from that by which other people view them. The 
community see one another with a veil thrown over their 
moral and physical afflictions, over their blasted hopes, 
and the sorrows that flow from love and hatred; over 
their poverty, their frailties and their crimes, their vex- 
ations, their fears and their solicitudes; you will see 
their deformities, infirmities and deficiencies with the 
veil lifted, and will become the repository of all kinds of 
moral and physical secrets. 
Love, debt or guilt may prey on the mind of a sick 
person and actually convert a simple into an incurable 
disease. As these things are apt to he kept concealed 
from you, it is necessary for you to be ever mindful that 
they are important agencies in the causation and inten- 
sification of disease, and to be prepared for their early 
recognition. 
Observe reticence at your visits, and do not mention 
the private affairs of anybody from house to house. Seal 
your lips to the fact that patients have or ever had 
venereal diseases, hemorrhoids, fistula, ruptures, leu- 
corrhoea or constipation, or that abortions, private opera- 
tions, etc., have taken place, or that any person takes 
anodynes or liquor, or that Mrs. had a baby too 
soon after marriage, or that had one without 
being married at all, or that Mr. is addicted to 
secret immoralities, or has this, that or the other bad 
habit. No matter how remote the time, if patients wish 
their secrets told, let them do the telling. You have no 122 
right to tell the affairs of patients to any one without 
their consent. 
But while silence should be your motto, it is your 
duty to society and to the state to expose and bring to 
justice abortionists, unprincipled quacks and heartless 
vampires, whether acting under cover of a diploma or not, 
whenever you meet with proof of their wicked work. 
But never charge any one with dishonorable or criminal 
conduct, unless you have at hand ample and positive 
proof of his wrong-doing; for, if you are without it, the 
accused is sure to make an indignant denial, and to bring 
against you a counter-charge of malicious persecution. 
In prescribing medicines for the sick, it is better to 
confine yourself to a limited number of remedies with 
whose uses and powers you are fully acquainted, than to 
employ a larger number of ill-understood ones. 
When 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 underscore both 
name and quantity. It is safer also to put the names 
of heavy-dosed patients on their prescriptions. When 
you order morphia, etc., in unusually large doses, it is well 
to have it made into pills or granules, and direct the 
druggist to u put them into a bottle.” It is so unusual 
to dispense pills in a bottle, that it informs the com- 
pounder that the quantity is not a mistake, but is as in- 
tended, and guards patients and attendants against 
taking, or giving them in mistake. When you prescribe 
pills, powders, etc., for sailors and persons whose busi- 
ness exposes them 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. 123 
You may occasionally have a patient who persists that 
he is conj ured, or that a pin or fish-bone is lodged in his 
throat after examination has proven there is none, or 
syphilophobic and anxious to take medicines after a 
chancroid, or morbidly afraid of hydrophobia or lock- 
jaw, or the victim of this, that or the other vagary or 
hallucination, who cannot be convinced by all your assur- 
ances that his ailments or forebodings are imaginary. 
When all else fails it may become as clearly your duty 
to employ such remedies as are likely to relieve him 
through psychological impressions as it is to give any 
one medicine for a gross physical ailment. Any remedy 
intended to relieve such a patient is called a placebo. 
A placebo should, as a rule, be small and easy to 
take; mild tonics, the bromides, valerian and other 
harmless agents are usually employed. 
Be careful to keep a straight face and to give exact 
directions concerning the time and manner of using 
remedies intended to act chiefly through the mind, and 
they will do double good. 
You will not only find that almost anything will 
relieve some of these cases, but you will be further 
surprised to learn that they are chanting its praise 
and vowing that they were cured of one or another 
awful thing by it. Some who seem to be magically 
benefited by doses of—nothing—will actually thank 
them for saving their lives. What a sad comment on 
the intelligence of the nineteenth century! What a 
sad fact for us that sugar water, etc., often receive as 
much praise as the truest remedies! What a harvest 
such people supply for those who live by fleecing! 124 
Make none but an honest and proper use of mental 
remedies (leave all that is dishonest to Dr. Fleecer), 
and if you happen to have the required medicine, give it 
gratuitously and charge for advice only; if not, write 
for something that is inexpensive and simple. 
Never send a patient to a drug store with a prescrip- 
tion for bread pills. It is not right to make any one pay 
money for anything that has no intrinsic value; besides, 
if among all the simple tonics, nervines, etc., in the phar- 
macopoeia you cannot devise some recognized agent that 
is more valuable than bread pills, you must have a great 
paucity of resources. Moreover, were a patient to 
discover that he had been paying his money for such an 
inert thing as bread pills or colored water, he could not 
help feeling victimized and indignant. 
Just here let me impress a caution: to believe too 
much and not to believe at all, are both unfortunate 
mental conditions for those who practise medicine. 
Take care that your mind is not led into an exaggerated 
view of the importance and power of drugs. Remember 
the example of the old woman of Paris 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 that the (polluted) 
water of that river was a sure cure for all the ills of the 
human race. Also guard against the opposite error, 
that medicines are useless and unnecessary ; either view 
would materially impair, if not destroy, your fitness for 
the practical duties of your profession. 
The (old 1840) custom of taking a little purgative 
medicine occasionally, with a view to “ cleaning out or 
purifying the system,’’ is still kept up by a few persons. 125 
These people always want to see and feel promptly 
and fully the action of medicines, and some of them think 
they could scarcely live a month unless they had almost 
turned themselves wrong side out with pills, salts, etc. 
Consequently they incline to purge themselves entirely 
too often. Remember that when nature is depended on, 
the bowels ought to act daily, or at least freely once in 
two or three days ; for, when nature moves the bowels, 
the lower portion only of the intestinal cavity is evacu- 
ated, and during the interval, before the next passage, 
the feces from above come down and are in turn evacu- 
ated ; but, when a purgative is taken, it sweeps out the 
entire alimentary canal, and of course such a scouring 
is not required as often as the natural, though partial 
evacuation. For any adult who cannot have an evacu- 
ation without the aid of medicine, to give a purgative 
once in three or four days is sufficiently often. 
Never solicit people, either by word or manner, to 
employ you; for such a course would surely repel them, 
or at least prevent your enjoying the necessary esteem. 
Many people are naturally fickle and capricious, and 
no matter how earnestly one tries to serve and satisfy 
them, they will quickly become wearied and disheart- 
ened, and will insist upon consultations even in the most 
trifling ailments ; they will change about with astonish- 
ing rapidity—first from one physician to another, then 
to a prescribing druggist or irregular practitioner, and 
will finally wind up with a quack mediciiie, or a quack. 
Others, truer, will adhere to you through everything, 
good and bad, with surprising tenacity. You should 
found your hope of being retained, no matter what 126 
class of patients you are treating, upon deserving it. 
Do not, however, set your heart or faith upon the 
continuance of the patronage of any one, for you will 
many a time be replaced by those whom you know to 
be far below you in everything that goes to constitute 
a good physician. Sometimes you will be unexpectedly 
and unjustly dropped by a family, and the most ignorant 
or shallow fellow in the whole section, or an old lady, or 
an Irregular, will supersede you, and you may have to 
bear the reflection and the wrong without showing the 
slightest chagrin. 
Ability promptly to detect loss of confidence, or dis- 
satisfaction with yourself or your remedies, is one of 
the acquirements which, if you do not already possess, 
you must seek to attain. Remember that continued suf- 
fering, protracted confinement and disappointed expecta- 
tion of convalescence, all tend to produce impatience 
and dissatisfaction in the mind of the patient and 
among his friends, and to create doubts of your knowl- 
edge, skill, or judgment. 
A patient has a legal right to dismiss you from a case, 
and you have also a perfect right to relinquish attend- 
ance on him, at any time. Indeed, you may sometimes 
find yourself so hampered, or harassed, or maltreated in 
a case, that to retire from it is your only alternative. 
When you find it necessary to withraw from a case, 
endeavor to do so in a courteous manner, as it is not in- 
cumbent on you to break off all friendly relations on this 
account. 
Whenever dismissed from a case, consider attentively 
the combination of circumstances that conspired to pro- 127 
duce the dismissal, and how you might have averted it, 
that you may, by self-training, gain additional famili- 
arity with the art of doing your duty acceptably, and 
of retaining your patients. 
Some people, indeed whole families, who will almost 
idolize you as long as you are lucky and have no un- 
fortunate cases, nor deaths in their families, will turn as 
rudely and maliciously against you, as soon as either 
occur—as if you kept the book of life and controlled the 
hand of God. 
When you are unjustifiably dismissed from a case, 
especially if it is to make room for an Irregular, do not 
consent tamely to be thrown aside in such a manner. 
Express your perfect willingness to retire, but make 
known in a gentlemanly way, that such treatment 
wounds your sensibilities, casts undeserved reflection 
on you, and injures your reputation in the community, to 
all of which you cannot be indifferent. Such a protest 
will not only enable you to vent your feelings, but will 
also secure for you greatly-increased respect, and will 
counteract the injury consequent upon your dismissal 
better than if you meekly submit without protesting. 
In acutely painful cases, large, even heroic doses of 
morphia or other potent medicine are often required, and 
must be given promptly, as hours, or even minutes may 
decide the result; care must, of course, be taken that 
the total amount be not sufficient to poison the patient. 
The following case will illustrate: A gentleman known 
to the author, had 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 128 
was fatally 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 suffering 
acute pain. 
Bear in mind that an opiate that has power to relieve 
acute pain will do so within an hour; failure to do so 
necessitates another dose. A dose of chloral will j)ro- 
duce sleep within half an hour, if at all, and it is useless 
to wait longer before repeating. When it is intended to 
keep a patient under the influence of opiates, it is neces- 
sary to repeat them every four hours, as the effects of a 
dose begin to wear off 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 inter- 
vals, decreasing the dose each time to one-half of that 
which preceded it. 
There is a popular belief that opiates are given only 
to allay or relieve pain, not to cure the sickness. Opiates 
are not only palliatives, but by controlling pain, restless- 
ness, etc., they are powerful curatives in a long list of 
diseases. 
The laity expect you to examine your patient at every 
visit. Let your first examination be specially 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, to inquire about the appe- 
tite, the sleep, and the bowels. No matter what the 129 
case may be, take care to attend to these and all other 
evident or special duties at every visit. 
Whenever symptoms render it probable that hernia, 
carcinoma uteri, Bright’s disease, or heart disease is pres- 
ent ; or that the throat is diphtheritic, or the ear oc- 
cluded by wax, or that a tumor or an aneurism exists, or 
that the patient is pregnant, or that any other condition 
exists which, if overlooked, might imperil the patient’s 
life and possibly make you feel the pangs of remorse for 
having committed a grave mistake, or subject you to 
disgrace if discovered by another, you should always 
make an immediate and thorough examination, and it 
would even not be out of place if you hinted gently at 
your suspicions. 
To mistake a tumor for pregnancy, or vice versa, is one 
of the most mortifying and damaging of errors. To be 
attending a female who has been ailing for weeks or 
months, and who proves to be pregnant, is also very 
damaging unless you have recognized and declared that 
fact, since if you have not, her entire illness will be 
charged to the pregnancy. You will be lucky if you 
get your fees in such cases without dispute. 
Never ask an unnecessary question, yet be careful to 
make every inquiry needed in order to learn all the facts, 
and to satisfy everybody that you feel an interest; if 
you neglect this, you will risk both error and loss of 
confidence. 
Prompt detection of dangerous changes, or of the 
approach of death, not only protects the doctor, but gives 
him 6clat if he points them out before the patient or 
friends observe them. 130 
Never speak of anything you do for a patient as an 
experiment; everybody, everywhere, is opposed to phy- 
sicians “trying experiments” upon themselves or theirs. 
For the same reason, it is not discreet to give certain 
patients the sample bottle of new pharmaceuticals sent 
to you for trial, or to let any one know that he is the 
first to whom you ever gave this or that medicine, or 
that his is the first case of that kind of fracture, or of 
smallpox, or of hernia, or of anything else that you 
ever attended. 
You should keep a reference book for recording par- 
ticularly good remedies, prescriptions for stubborn dis- 
eases, etc.; also a case book for recording the date, diag- 
nosis, treatment, etc., of unusually important cases. 
Nothing impresses a patient who has a complicated or 
long-standing disease, with a conviction that you are 
interested in him, and that you intend to try your ut- 
most to do him good, so much as to know that you keep 
a regular record of his case. 
When truth will allow, let your diagnosis either in- 
clude the patient’s belief, or fully nullify it, that his 
mind may not distrust your opinion or antagonize your 
treatment. 
You can more easily and permanently convince and 
impress a cavilling patient of a medical fact that mili- 
tates against his wish or belief, for instance, that short- 
ening is usual after fracture, by showing it to him in the 
books, than by a hundred verbal statements. 
Study to be fertile in expedients, and never confess, 
or allow the inference, that you are hopelessly puzzled 
about a case, or have reached the limit of your resources. 131 
Never be too sanguine of a patient’s recovery from a 
serious affliction, and never give one up to die in acute 
disease, unless dissolution is actually in progress; and 
above all else, never withdraw from a case of acute, or 
self-limiting disease because the patient is very ill, and 
more likely to die than to live. It is highly comforting 
to anxious relatives or friends to know that the physician 
stands ready and willing to do more, if opportunity 
offers. 
If a patient is unable to swallow, think of the 
oesophageal tube, or if food taken into the stomach is not 
assimilated, continue your efforts with inunctions of cod 
liver oil, or oil and quinia, rectal alimentation, 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 compen- 
satory process, or the tardy action of the remedies you 
have used, may turn the scale and let the life-power rally 
and gain control over the disease at the last hour; under 
such circumstances, if you have given up the case as 
hopeless, you will be disgraced, while some brother 
physician, or an Irregular, or an old woman who has 
stepped in at the lucky moment, will reap all the glory. CHAPTER VI. 
“He is most free from danger who, even when safe, is on his guard.” 
—Publius Syrus. 
You will have to foresee thousands of snags that lie 
in the professional current to catch the unwary. When 
in doubt whether duty requires you to do a thing or not, 
remember that the sin of omission is, in appearance at 
least, not so great as the sin of commission. 
Summon professional assistance in all ugly fractures, 
etc., where you think there is the least danger of an un- 
satisfactory termination, and of your being blamed or 
sued in consequence, for the result. Having assistance 
not only divides the responsibility, but also constitutes 
one a teller of truth for the other, and prevents criticism 
and causeless suits for malpractice. Remember that the 
community seem to think that physicians can and must 
restore broken bones and injured tissues as perfectly as 
the Creator made them,no matter what the injury may 
be; and remember also that when a fracture, or disloca- 
tion, or a disfiguring wound, or accident of any kind, 
recovers with deformity or disability, there is danger of 
its serving ever after as a lasting and lingering libel on 
the medical attendant’s reputation. Therefore the re- 
sponsibility had better be divided. In this respect medi- 
cal and surgical practice differ—the results of sickness 
usually disappear, while those of surgery remain. 133 
Such exclamations as “ Oh, no, Doctor, it cannot be 
that his arm (or leg) is broken, for he can work his fingers 
(or toes),” will often greet you when you pronounce that 
a bone is fractured. This error is due to the fact that 
people think that the fingers and toes are moved by the 
bones, not by the muscles. It sometimes becomes even 
necessary to explain this in defence of the opinion you 
have given. 
Always take the precaution, both for the patient’s 
protection and your own, to listen to the heart’s action 
immediately before administering an anaesthetic; and to 
watch the respiration during the administration—with- 
drawing the agent on the least approach of blueness of 
the face or lips. When possible, have another physician 
present whenever you produce anaesthesia, more especi- 
ally if the patient is a female. Also, have a third per- 
son present at all sexual examinations of females, to dis- 
prove possible hallucinations regarding either improper 
words or deeds and to prevent scandal. 
Patients sometimes refuse to allow the physician to 
make examinations that require uncovering the body, 
or to allow him to see the underclothing, simply because 
they are unclean and unfit to be seen, while the phy- 
sician supposes that they refuse through modesty on 
account of the exposure. In many such cases it is 
better, instead of insisting on an immediate examination, 
to respect thein delicacy in the matter and allow an 
opportunity for a change of linen, etc., by appointing a 
time for making the examination. 
Curious-minded husbands sometimes show a determi- 
nation to remain in the room during vaginal examina- 134 
tions, or during operations necessitating exposure of their 
wives’ persons, and you will feel tempted to ask them to 
retire that they may escape the indelicate sight, and you 
the embarrassment. If asked to retire, some might refuse 
to go, or do so with anger or jealousy. The better 
plan in such cases is to inform the husband that you are 
about to begin what your duty requires you to do, and 
he will probably retire of his own accord, unless speci- 
ally requested to remain. 
Expertness in detecting and contravening the various 
kinds of scandal and calumny admits of cultivation to a 
great degree; so also does ability to foresee and escape 
entanglement with the captious, the bad, silly tattlers, 
the fraudulent, etc. 
Jealous midwives, ignorant doctor-women, and busy 
neighbors often exert a malign influence, and tell tales 
or circulate falsehoods about physicians that must be 
noticed and thwarted according to the necessities of the 
case. 
Tact and nice discernment in establishing and main- 
taining a proper attitude toward nurses and other at- 
tendants on the sick is a valuable gift that will prevent 
or counteract possible machinations. To give attendants 
credit on proper occasions for faithfulness is not only 
just and gratifying to them, but makes firm friends of 
them; moreover, such public endorsement encourages 
them to do their best to maintain the reputation which 
you have given them. 
A bad nurse may render a curable case fatal by im- 
properly indulging the patient’s appetite for food or 
drink; or by neglecting to give him medicine, drink, 135 
diet, etc., at the proper time, or in the manner directed; 
or by appropriating his food or robbing him of the 
liquors you suppose he takes; or by keeping him too 
hot, or too cold, or giving him too much, or too little 
fresh air; or by getting drunk or becoming careless, 
etc., etc. 
The conciliation of anxious, captious, impatient or dis- 
satisfied friends of the sick, when sickness is not progress- 
ing satisfactorily, naturally requires great skill and a 
profound study of human nature. 
Scandal-mongers and malicious liars will often lie in 
ambush for you, and must be met or checkmated by the 
most available means ; to judge what is best to be done 
under the circumstances is sometimes a most annoying 
and puzzling question. 
In serious or strange cases, and in such as engender 
great public excitement, if you indulge in confidential or 
semi-confidential whispers to the rabble, or give out 
daily bulletins to them, it will often give rise to misre- 
presentation, or even to total perversion of what you 
really did say or mean, and your statements may come 
back to you so changed as to require tedious explana- 
tions from you. Be ever on the alert for this danger. If 
necessary, give your opinion to the proper persons in 
writing, to prevent its being misconstrued or misquoted. 
When a sick person puts himself under your care he 
gives you a responsible duty to perform. If he then 
neglects or refuses to take your remedies, or obeys your 
instructions in an imperfect manner, he ties your hands 
and frustrates your efforts for his relief, and cannot hold 
you to full responsibility in the case. If, however, he 136 
will not or cannot do exactly as you wish, and if no 
special danger exists, it is sometimes better, after draw- 
ing attention to the position in which you are placed (as 
a protection to yourself), to humor his whims or childish 
weaknesses, and modify or alter your therapeutics so as 
to meet his wishes and ability. This you can do good- 
naturedly, without fully yielding to him or compro- 
mising your authority or your dignity. The wishes, 
prejudices and errors of peculiar patients must be studied 
and to a certain extent respected. To do this is a mat- 
ter of policy, and is very different from yielding a ques- 
tion of principle. 
Never captiously oppose a remedy because it is sug- 
gested by a layman. The most ignorant person may 
make a wise suggestion; and laymen often talk excel- 
lent sense about facts which have come to their notice. 
Listen patiently to all sensible propositions, and if they 
seem simple and meritorious you may find it well to add 
them to your other means, for their moral,, effect, if 
nothing more. Be frank in giving credit to any good 
idea, no matter by whom advanced. When rejecting a 
remedy thus tendered, let it be known that your con- 
demnation arises from conviction, and not from super- 
ciliousness. You may in some cases even humor a whim 
and sanction the use of harmless domestic remedies,— 
saffron tea, plasters, onions to the feet, etc., in conjunc- 
tion with your more reliable agents. 
Make it a rule to accord persons credit for well-meant 
deeds, even though they may be valueless in them- 
selves ; also, when possible, to approve domestic treat- 
ment employed before you were sent for; at least 137 
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 belittle 
their honest efforts to relieve the sufferer. 
Your cordial approval of their simples, used in good 
faith with true and loving motives, will redound greatly 
to your credit, and greatly enhance your reputation for 
kindness and sympathy. 
When attending certain classes of very ill patients, 
e. g., the wife of a druggist or the child of a physician, 
if there is 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 acquiesce and allow it, in conjunction with 
your other means. 
It will be a trying ordeal when you, by accident, 
meet an “ old lady who has an infallible salve,” good 
for anything from mosquito bites up to elephantiasis. 
You will find her so full of faith in herself and in her 
salve that neither reason nor ridicule can shake it. Be 
fair and reasonable with her; but if you indiscreetly 
concede to her remedy any recognition beyond its actual 
merits, or take her into confidence or semi-partnership 
in the treatment of bone felons, ulcers, wounds, etc., you 
will make a big mistake, and fill her as full of conceit, 
and of mischief, too, as the sea is of water. 
Hypochondriacs, the hysterical, the mildly insane, 
and various other kinds of bores, will sometimes come to 
your office and tax your patience and ingenuity with an- 
noying or unnecessary questions, or exaggerated descrip- 138 
tions of their ailments, or the details of their business, 
or the history of their family affairs, when you have no 
time to waste and yet are indisposed to be rude, till you 
actually wish you could fly out at the window and get 
away from them. 
Some of these you will have to freeze out by chilling 
coldness in their reception. If you tell them as they 
come in that time is very precious with you, they can- 
not deem you uncivil, and will be brief, unless unusually 
pachydermatous. If you are greatly annoyed, keep a 
placard posted with “ This is my busy day.” 
When you are to be a witness in a grave court case, 
politely but firmly refuse to give the opposing counsel, 
or any other person, either a verbal or written state- 
ment of what you saw, heard or observed in the case, or 
what your opinion is, or what your testimony will be; 
also 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 state- 
ment from its proper meaning, or to rebut it on the wit- 
ness-stand, or to charge that you are lacking in medical 
knowledge ; thus bringing both justice and yourself to 
grief. Firmly but courteously inform them that you 
cannot give the desired information, but that they can 
find out all you know on the witness-stand. 
When in court, whether as plaintiff, defendant, or 
witness, keep cool and self-possessed; guess at nothing 
and express no opinion for which you cannot give the 
why and wherefore. 
There is no creed, or class, except ours, whose mem- 139 
bers habitually confute and confront one another in 
courts and before the public. Our so-called psycholog- 
ical experts, specialists and other would-be highly scien- 
tific representatives, have been hired by contestants to 
exhibit their power to weave favorable testimony, so 
often of late, in criminal cases, will cases, life insurance 
cases, etc., that the public jest about us, and believe 
from our kaleidoscopic contradictions that our boasted 
science of medicine is a tissue of mere guesswork. 
These remarks only apply to the pseudo-experts, who 
are willing to sell their testimony to the highest bidder. 
To rid yourself of undesirable would-be patients will 
be one of the most difficult dilemmas that will confront 
you. If you are “ Too busy to attend,” it is probably the 
most unassailable of all excuses you can employ in these 
,cases. To assume charge of a sick person and afterwards 
neglect him, is a great wrong. 
When you receive calls to cases that from any cause 
you cannot or will not attend, notify them to get some 
one else, in order that the patient may be saved from 
delay, and you from the annoyance of repeated messages 
and solicitations. 
No one can blame you for not being at home when 
you are needed; but if you are at home, and quibble or 
refuse to respond to a call, you will sometimes be 
severely criticized, especially if the case goes wrong in 
consequence of your not responding. 
The chief objection to recommending persons you 
wish to cast off, to physicians whom you wish to aid, is 
that they are then quite sure still to hanker for you, 
and to involve you as a consultant or assistant to your 140 
protege if things get serious ; whereas, if, instead of re- 
commending them to any particular one, you compel 
them to choose some one for themselves, you will get 
rid of them permanently. 
You will occasionally encounter patients, or their 
wiseacre friends, who will challenge you to controversy, 
and presume to discuss your diagnosis and your remedies 
with you. Most of these are as full of doubts, beliefs 
and theories, as a lemon is of acid,—foreknowing and 
prejudging all you do, frequently thwarting your every 
effort,—possibly drawing the curtain aside after you go, 
and exposing to everybody things that should properly 
remain your professional secrets. If you write a pre- 
scription for gonorrhoea, or cough, or almost any other 
ailment, many a presumptuous patient, or his friend, will 
read it to you and actually comment, or offer to argue 
on it. You will be often harassed by such meddlers, 
and compelled to resort to various expedients to satisfy 
or foil them, and avoid collision with their whims and 
prejudices. In fact, from this cause, the good effects of 
mystery, hope, expectation and will-power are of late 
almost entirely lost to regular physicians, all special con- 
fidence is sapped, and all you can expect in many cases 
is the gross physiological action of your medicines—and 
prejudice and fear actually do much to thwart even that. 
Such meddlers will often aid in making curable diseases 
fatal. 
The presence of self-important sick-room critics, with 
jealous 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 141 
concentration, and may even lead to mistakes in diag- 
nosis or treatment. Consciousness of being watched, or 
under unfriendly criticism, will, in many cases, embarrass 
you, to some extent cloud your judgment, and, of course, 
lessen your usefulness. 
It is better to leave your directions about medicine, 
food, etc., with the nurse, or whoever is in charge, than 
with the patient. 
School yourself till you can prevent your thoughts 
and opinions from showing in your countenance, and 
above all, discipline your features and manner, so that 
nervous and ill patients cannot detect in you unfavor- 
able reflections about themselves, which you wish to 
conceal. 
Never prescribe large quantities; it is far better to 
have the prescriptions repeated over and over again, 
than to risk having half a bottle set aside untaken. One 
of the nicest little points in medical practice is to decide 
how large a quantity of medicine to order at a time. In 
many cases, it is wiser to order only sufficient medicine 
to last from one visit to the next. 
To set aside unused medicines and order others, in such 
a way as not to impair confidence, requires a great deal 
of clever management. In many cases, where a remedy 
is ceasing to be useful, or indications for something dif- 
ferent are appearing, it is better not to stop the old 
abruptly, as though it were wrong or doing harm, but 
instead, to instruct them to set it aside and begin the 
new at o’clock. 
Patients will rarely complain of the price of medi- 
cines that are taken, but they will observe the waste, 142 
and criticize you, when you set one remedy aside and 
order others. A good plan is to order the empty bottle 
in which one medicine was gotten, to be washed and 
carried to get the next in. A medicine that has been 
put aside is very rarely again indicated. When you 
set one remedy aside, to give another, if there is a pros- 
pect of its being used again further on in the case, be 
sure to mention the fact. It does not then look so much 
like extravagance, or misjudgment in prescribing. 
Be also guarded against ordering patients to buy ex- 
pensive 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 no credit to the physician to have people exhibiting 
this or that article which cost dollars, ordered by 
him, but for one reason or another never used, and 
now referred to as a shameful instance of extravagance. 
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 deception of some 
rapacious and shameless quack, or the ignorance of some 
novice in the profession, who has pronounced them 
syphilitic, when in fact they have really never had even 
a sign or a symptom of that disease. 
It is torment enough for those who really have con- 
stitutional syphilis, to go through life filled with remorse 
for the past and fear for the future, without adding 
spurious cases. When examination proves that the 
case before you is not syphilis, it is your highest duty 
to give such explanation and assurance as will fully 
banish the error from your patient’s mind. 143 
You will be sure to produce unnecessary alarm and 
distress in the minds of those whose chests you examine, 
if you tell them of “ a slight deposit in the apex,” “ an 
abnormal resonance,” a “ bruit de diable,” “ rales,” “ a 
palpitation,” “a disordered rhythm,” or other, to them, 
ominous symptom. Take care never to say or do any- 
thing which will unnecessarily fix the mind of a patient 
on the character of his breathing, the action of his 
heart, etc. 
You will occasionally meet persons who have been told 
by physicians years ago that their lungs were gone and 
that they would not live a year, or that they had this 
or that affliction which would them in less than 
such a time. Such unnecessary forebodings cast dis- 
credit on the profession, and should draw upon those who 
make them the severest censure. 
God only knows how many young women in our land 
are now tormented with apparitions of “womb com- 
plaint,” which have no existence except in some phy- 
sician’s imagination—young women who, had the subject 
not been suggested to their minds, would have lived a 
lifetime without even a thought of such a thing as a 
womb. 
The chief reason why there are so many spurious cases 
of womb disease is obvious. When a man is told he has 
a luxated shoulder, or a cataract, or a hernia, or a 
cancer, he finds many ways to confirm or refute the 
physician’s opinion, and he can also see what the treat- 
ment is doing for him; but when a miserable woman, 
morbid on the mysterious subject of “womb disease,” 
“ gets examined,” and is told, whether correctly or incor- 144 
rectly, that her womb (like her nose) “ is turned a little 
to one side,” or “is down,” “ulcerated” or “affected,” 
it tallies exactly with her fears; and, shrinking from 
both the expense and the exposure to be endured, if she 
were to consult another doctor, she naturally submits to 
the manipulations and to the monetary exactions of 
whoever has made that examination—possibly recover- 
ing from morbid states that never existed, and paying 
for cures never performed. If there is a wretch meaner 
than all others in the sight of God, it must be the phy- 
sician who, void of moral sense, would exaggerate the 
nature of a case and terrify the sick simply for dollars 
and cents. , 
It is also cruel to tell patients indefinitely that their 
trouble comes from their heart, or kidneys, or liver, or 
lungs, or that they have the “ liver complaint ” or “ 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 to pre- 
dict immediate or impending death, even if you discover 
serious organic disease of lung or heart. The duration 
of life will depend on many circumstances that you can- 
not always foresee; the carefulness and prudence of the 
patient, the conservative powers of the system, the com- 
pensative efforts of nature, etc. You know that a man’s 
liver or his lungs or his heart may be deranged this 
week and well next; but many people think that if any 
of these organs are affected in any way it is necessarily 
permanent, and it gives them constant anxiety. Many 
people are at this moment living in as great anxiety as 
though a sword were suspended over them by a hair, 145 
because they were told long ago that such and such an 
organ was affected, without explanation being given of 
the functional or temporary character of the derange- 
ment. Contrary to the belief of the laity, and of some 
physicians, sudden death rarely occurs in heart disease, 
except in aortic obstruction and regurgitation. By ex- 
plaining the difference between temporary ailments and 
those of a permanent character, or the difference be- 
tween a functional and an organic affection, you will 
avoid magnifying real ailments or creating imaginary 
ones, and give many a patient perpetual sunshine in ex- 
change for constant gloom. It is your duty at least to 
avoid all ambiguity of language in such cases. 
In nervous, hysterical and impressible persons, it is 
possible to convert a slight, or even imaginary complaint, 
or functional trouble into 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 treat it 
unconsciously to the patient. 
Even our instruments of precision can be used in such 
a manner as to become objects of dread and terror. 
That excellent instrument, the clinical thermometer, 
often tells from day to day the unwelcome truth that 
fever continues, till the patient and those around almost 
wish it had never been invented. Try to prevent, if 
possible, such results of its use. 
Be especially careful not to allow patients’ attention 
to be fixed on their urine. Some persons have a morbid 
tendency to watch this excretion, and only need a dis- 146 
couraging word from a physician to make them as anxious 
about their kidneys—apparitions of Bright’s disease, 
diabetes, gravel, etc., arising before their distempered 
vision—as some women are about their wombs. 
You will also have patients lacking in the salt of 
wisdom, who come tormented with evil forebodings over 
conditions that are either imaginary or perfectly natural: 
some because they have discovered that their left tes- 
ticle hangs lower than the right, or because their scrotum 
remains contracted or relaxed ; others terribly alarmed 
because they have in examining themselves discovered 
the little odoriferous glands on the posterior part of their 
glans penis and imagine them to be chancres or cancers; 
others because either fear of disease, blackmail, bas- 
tardy, or moral accusation has thwarted their attempts 
to copulate with loose women and led them to imagine 
themselves impotent. You will also occasionally be 
asked for advice by those about to marry, and by others 
newly married, who are miserable on account of this or 
that affliction, defect or fear. Remember in all such 
cases that your opinions are your capital, and charge 
your full fee, even though you write no prescription. 
With them the charge is for banishing fears and anxie- 
ties, and giving valuable information and satisfaction. 
Be careful to warn all such people against the curse 
of falling into the hands of quacks, or other “ friends of 
erring youth,” through pamphlets on the evils of 
spermatorrhea, masturbation, etc., and tell them of the 
mischief such people inflict on their victim’s health, and 
also of their unscrupulous, never-ceasing voracity for 
money. 147 
It is doubtful whether the various medical guide 
books for the people, “Dr. Alpha’s Family Medical 
Guide,” Professor Omega’s “ Every one His Own Phy- 
sician,” and the hosts of others, do any one much good, 
while it is certain that they do a great deal of harm, 
by filling people with imaginary wisdom, and embold- 
ening them to try their hands at doctoring cases that 
require a physician, till either great suffering or perma- 
nent injury is entailed, or probably life itself sacrificed. 
Is it not possible that Pope had such works in view 
when he said: 
“ A little learning is a dangerous thing ” ? 
The eight or ten very large papillae seen upon the 
base of every one’s tongue, often occasion great anxiety 
upon being discovered by over-anxious laymen, while 
looking into their throats for syphilis, diphtheria, or 
ulcers. Great relief is expressed when they are told 
that these are natural. 
You will be often consulted by true syphilitics, who 
wish to know what would be the result of their mar- 
riage. Never promise certain immunity against future 
outbreaks; and do not sanction marriage, unless it has 
been at least three years, since they contracted syphilis, 
and at least two years since they had any evidences of 
the disease. They should even then marry only under 
hygienic and therapeutic restrictions. 
When a patient, alarmed about his health, consults 
you, if you want fully to satisfy him by your opinion, 
be earnest, and let attention to his case overshadow all you 
say or do; above all, do not divert his conversation from 
himself to extraneous subjects. If it be at your office, 148 
do not digress by showing him the toy steamboat you 
are making, or by telling him the latest news, or the 
history of the cigar you are smoking, or of the news- 
paper you are reading, or of the cane you are twirling. 
If he diverts the conversation from his case, bring him 
back to it at the first opportunity. 
Never recommend sexual intercourse as a remedy for 
self-pollution, nocturnal emissions, spermatorrhoea, hy- 
pochondriasis, acne, or anything else. If those subject 
to these affections choose to run the risk of syphilis, gonor- 
rhoea, bastardy, or exposure, or to commit rape, adultery, 
or self-pollution, let it be on their own responsibility, 
not on yours. Perfect chastity is entirely compatible 
with good health; and I know of no disorder, either of 
body or mind, in which fornication is necessary. 
Remember that night emissions recurring occasionally 
in young men, partake of the nature of an overflow, and 
are perfectly compatible with health. Young men, 
almost crazy with dread and remorse, will often consult 
you about these emissions. You will find that almost 
every one attributes them to self-pollution in boyhood. 
The results of self-pollution are, as a rule, not half as 
destructive as commonly supposed; when the habit is 
stopped, its results are usually quickly recovered from. 
Consumptive females whose bloodmaking power is 
destroyed by their disease, naturally cease to menstruate. 
They then attribute their decline to absence of the 
menses, while in reality the absence of the menses is due 
to the decline and consequent loss of bloodmaking 
power. When such patients appeal to you to restore 
their menses, you must explain why they have ceased, 149 
and that they will not menstruate again, till their health 
and bloodmaking power improve. 
Consumptives sometimes have hectic fever so regu- 
larly at a certain hour, day after day, that they and 
their friends are persuaded that their sickness is mala- 
rial in character, and if you are not on the alert, they 
may mislead you into giving an erroneous opinion to that 
effect. If quinia does no specific good for the daily fever 
of a weakly or broken-down person, you should suspect 
that it may be hectic, rather than malarial fever. 
The popular belief that one is booked for consumption 
because a parent, or brother, or sister died of it, is true 
only in a limited sense. If the relative’s disease was 
part of his law of development and was in his charter 
of life, it should indeed excite serious fears in every 
one who has the same charter, the same constitutional 
bias. But if his disease began after his physical de- 
velopment was fully completed, or from an accidental 
cause, the law of heredity does not apply. One whose 
father, mother, sister or brother died from phthisis, the 
sequence of bad hygiene, pneumonia, etc., is not thereby 
compromised, as that variety is not hereditary unless his 
father had it at the time when he begot him, or his mother 
had it during pregnancy or nursing. 
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 generally to the last calling it a bad 
cold. You will find that the management of those who 
really have either is one of the most delicate questions 
in practice. When your opinion is invoked in these 150 
cases, do not examine or question them at all, unless 
you have time to do so thoroughly, for your opinion and 
treatment may influence their entire future course, and 
if anything is overlooked, you may induce a neglect of 
proper remedies till the patient is beyond their reach. 
No wonder the mind dreads consumption, for it is 
humanity’s great destroyer. It scourges the young, the 
beautiful, the gentle and the gifted, and this portion of 
every community is selected for its most intractable and 
fatal forms. 
Valetudinarians almost invariably dress too warmly, 
and in their anxiety to protect their bodies from cold, 
they wear so much clothing that they shut all the 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 that when they go into cold air, or 
into a draft, the result is like jumping from the climate 
of Cuba into that of Canada. No person, sick or well, 
should ever wear more clothes than are sufficient to keep 
him comfortable. Every ounce beyond that, is unneces- 
sary and enervating. 
People of the opposite extreme, knowing that cool 
bedrooms are healthy for hearty well people, often carry 
catarrhal and croupy children and other invalids from 
the warm rooms, where they have passed the day, to 
cold sleeping-rooms, instead of giving them uniform 
warm air, day and night, till recovery takes place. It 
would even be less hurtful to reverse it and keep them 
in a cold room while awake, and in a warm one during 
sleep, because a person has more resisting power while 151 
awake, than during sleep. 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 catarrhal pneumonia 
or rheumatism. It devolves on you to point out 
these and kindred dangers to patients, who are risking 
them. 
Kegister-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 
under a register that is pouring out a volume of over-dry, 
impure air, while the inmates are blissfully believing it 
is tempering and rendering pure and moist all the air 
passing over it. A very large wet towel or folded sheet 
hung before the opening is much more effective. 
Many new-born children are unwittingly exposed to 
the bad effects of cold from lack of knowledge on the 
part of those in charge. The popular belief is that if 
the nurse puts plenty of clothes on a babe she has done 
all that is needed; whereas, if the little babe—whose 
heat-generating power is naturally very feeble—is put 
into clothes in a cold condition, without further attention, 
hours or days may elapse before its feeble heat-making 
power can bring on a reaction and warm it. Ice is put 
into 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 its heat for some time. Take care that the 
new-born babe is kept warm. As soon as it is dressed 
it should be nestled against its mother’s bosom till warm; 152 
if this does not suffice, it should be kept near the fire 
till the coldness is banished. 
Remember that the act of nursing not only supplies 
the babe with nourishment, but also communicates the 
mother’s heat, and 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 suck. 
The ancient custom of clothing infants in flannel, with 
woollen socks during hot weather, creates discomfort and 
invites sickness. Its harmfulness should be made known 
to such as you find following it. 
There is a widespread popular error, partaken of to 
some extent even by physicians, regarding the object of 
lancing children’s gums. When a physician lances or 
rubs a child’s swollen gums, he does so, not solely to let 
the tooth through, nor does he expect it 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, irritation, danger of con- 
vulsions, etc. No one should incise or rub through a 
child’s gums, except when these evils are present. 
There exists so much prejudice on this subject among 
certain people, that if you lance their sick child’s gums 
and he dies despite of it, you will risk being damned by 
them for doing it. 
There is much less popular opposition to rubbing 
children’s teeth through with a thimble, spoon-handle, 
or any other suitable article, than there is to lancing 
them; and the contused wound made by rubbing is less 
apt to reunite than a clean incision. 153 
“ Doctor, my child gets the phlegm up, but instead of 
spitting it out he swallows it again,” is a stereotyped 
expression. If he does, it makes but little difference, 
as he swallows it, not back into the windpipe or lungs, 
but into the stomach, where it becomes unimportant. 
Of course it is unnatural for a child to spit out before 
it is over three years of age. 
It is a popular belief that crossness in sick children 
argues favorably, and there often seems to be a great 
deal of truth in it, as it requires considerable strength 
and energy to exhibit crossness. At any rate the reap- 
pearance of tears in the child’s eyes when crying is a 
favorable sign. 
Never 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 they left you, they went to some drug- 
store, purchased a quack vermifuge, and sure enough 
brought away worms, and are exultingly telling it as 
proof that you were wrong and they were right. Such 
cases do one’s reputation no good. It is better, when 
worms are suspected, to give some harmless vermifuge, 
even though it do no other good than to test the fact and 
satisfy the mother. 
It is better in every kind of case 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 surrender your judgment 
for their exaggerated apprehensions or palpable errors, 
but, at least, listen to what they say, and consider their 154 
opinion in making up your own. The apparently cause- 
less fears and predictions of nurses and friends are some- 
times surprisingly confirmed, and the self-sufficient 
physician’s prophecies correspondingly unrealized. 
Condemn the keeping of commodes in bed-rooms, as 
they are a dangerous source of diphtheria, typhoid fever 
and other filth diseases. 
Every worthy housewife courts the reputation of 
keeping a clean house, and one of the proofs of her skill 
is the absence of bed-bugs, pediculi, roaches and other 
vermin from the premises. If you ever notice such 
things about a respectable patient’s body, clothing or bed- 
room, affect not to see them, as nothing is more deeply 
mortifying than to have anything of the kind noticed 
and pointed out by the physician. 
The terms scarlatina and scarlet rash are now in every- 
body’s mouth, and are spoken of by the laity as harm- 
less affections, under the belief that scarlatina is a slight 
affection, bearing about the same relation to scarlet fever 
that varioloid bears to variola. There is no such dis- 
ease 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 under- 
stand this, neglect and great damage may ensue. 
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, 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 155 
left somewhat to nature; when it is complicated, some- 
thing 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, till killed by blood 
medicine, much the same as one would drive rats from 
their haunts and keep them out till annihilated. No 
patient will object to your driving his humor out, or 
killing it, but if he thinks you have simply driven it in, 
woe to you if he should afterward have any severe or 
fatal sickness. In such cases it is well to give an inter- 
nal remedy, whether local treatment is used or not. In 
some cases where great fear or strong prej udice exhibits 
itself, it is even better to commence the internal treat- 
ment eight or ten days before beginning the local. 
There is also a popular expectation of evil and a 
popular readiness to blame the physician if any new 
symptom appear after he suddenly arrests or cures 
diarrhoeas, periodical bleedings, foot-sweat, or chronic 
discharges of any sort, etc. 
Many persons suppose boils and various eruptions to 
be healthy. Even if they are, most people will agree 
that some other mode of health is decidedly preferable. 
This belief is probably founded on the fact that during 
convalescence after certain serious diseases a crop of 
boils often appears, seemingly from a revival of the 
energies, or vital forces of the system, from the depress- 
ing influence of the disease. The fact of their coming 
being coincident with reorganization and returning health, 
probably accounts for the belief that boils and health 
naturally go together 156 
The high color of the urine occasioned by activity of 
the skin in patients whose sickness compels them to lie 
in warm beds or to keep in warm rooms, also seen in 
well people who perspire freely during warm weather, 
frequently causes alarm and induces groundless fear that 
they have kidney disease. Explain to them how the 
functions of the skin and kidneys are related, and that it 
makes hut little difference whether the urine is scanty 
or abundant if it contains all the natural excreta and is 
simply deficient in water. 
When a coin, or other small foreign body is accident- 
ally swallowed, some old lady is almost sure to give a dose 
of castor oil, thus liquefying the contents of the bowels 
and compelling the intruder to travel the entire length of 
the alimentary canal alone, instead of allowing the fecal 
matter to remain as a mass to include it and prevent its 
edges and corners from doing harm. When such an 
article is swallowed, do not interfere with nature’s 
efforts unless you are sure she cannot expel it unaided. 
When a person faints, those around run to assist him 
and instinctively raise his head, instead of lowering it as 
they should do, thus prolonging the syncope and endan- 
gering life. 
In all cases where great debility and pallor are 
present, be careful to instruct the attendants to keep the 
patient’s head low, and to prevent him from rising sud- 
denly for any purpose, and from sitting up too long, for 
fear of fatal syncope. 
“ If the dog that bites a person goes mad, the one 
bitten will also,” has caused may a valuable dog to be 
killed. The truth is, if the dog’s mouth or teeth con- 157 
tain hydrophobic virus at the time of biting the person, 
there is great risk of its being communicated; if not, 
there is no risk. If the dog is killed under the mere 
suspicion of having hydrophobia, the disproof of the 
disease is made impossible, and the person bitten and his 
friends are left to all the terrors of uncertainty. 
Foolish persons will occasionally tell you, in a boast- 
ing manner, that they have no fear of contagious dis- 
eases, and will show by either word or manner, that 
they entertain the belief that contagious diseases attack 
those who dread them and spare those who do not. It 
is proper to teach such people that the laws of smallpox, 
syphilis, gonorrhoea, hydrophobia, typhus fever, and such 
affections, are very different from what they imagine; 
that fear cannot give them to cowards, women, or chil- 
dren, who stay outside of their influence, and that lack 
of fear will not, cannot, protect nurses, friends, old people, 
babes, or braggarts, if exposed to them. 
There exists a popular prejudice against damp houses, 
leaky roofs, night air, etc., which is probably carried 
entirely too far. Dampness is, of course, inimical to 
health when mould, absence of fresh air and light, filth, 
or other unfavorable, 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. 
The low-spirited and morbid will often refer to the 
fulness or emptiness of the veins on the back of their 
hands as evidence that their blood is drying up, or that 
they need bleeding, or that they have consumption. 
Explain to them the entire lack of value of such 
conclusions. 158 
As purgatives after confinement, many physicians 
order simples, castor oil, seidlitz powders, etc., instead 
of writing regular prescriptions; it will be wise for you 
to follow the same rule and give a lying-in woman castor 
oil, or whatever other simple laxative she, or her friends, 
are accustomed to take. If you give a lying-in woman 
a Latinized prescription for a purgative, and as a coinci- 
dence, she has hyper-purgation, or puerperal fever, or 
hemorrhages, or if syncope, or anything else follows, 
she will be apt to believe firmly that your mysterious 
purgative caused her sickness; and if she happen to die, 
you will be blessed. 
Admitting or excluding those who wish to visit the 
sick, and allowing, or forbidding conversation with 
patients or within their hearing, require great delicacy 
and tact. Try to so manage the matter as to engender 
no personal enmities. Also endeavor to acquire expert- 
ness in answering anxious questions about such cases. 
Never attempt to exclude the parents, near relatives, or 
religious advisers from the room of a very ill person, 
except for the most urgent and obvious reasons, or you 
may raise among them a very natural whirlwind of 
indignation against you. 
Never ask the age of a patient oftener than once 
during attendance on his case. Also take care 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 you will inspire more faith in a 
prescription if you begin to write it with an air of deci- 
sion immediately after receiving, to some important 159 
question, an answer which your manner shows is what 
you expected. 
Take care to ask all necessary questions before be- 
ginning to write your prescriptions, lest the patient 
think you have not included the additional information 
in forming your conclusion, or considered it in writing 
the prescription, or that your treatment was determined 
on before getting all the facts. Also make it a rule to 
ask nothing further after prescribing. 
It is well to terminate your visit as soon after pre- 
scribing, as can be properly done. CHAPTER VII. 
t( The successful man is the man who knows human nature, as well as his 
profession. ’ ’—Fotherg ill. 
Every minute spent in studying how to make your 
remedies agreeable will be more profitable to you, than 
half an hour of any other kind of study. Whoever now 
gives much crude or coarse medicine in ordinary cases, 
injures both himself and his profession, and lacks one of 
the simplest requirements of success. Indeed, one of the 
greatest drawbacks to young physicians, and one of the 
chief reasons why they do not assist their older brethren 
more in superseding pleasant quackery, is that having their 
attention riveted on their cases, and studying more about 
getting them safely than comfortably through diseases, 
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 
physicians make, is to think that when people send for 
physicians, they send solely to have medicines given. 
Many people are much more anxious to get an opinion 
of the nature and tendency of their case and words of 
assurance from the physician, than to begin a regular 
course of attendance and medicine. 161 
Make special endeavors to retain every medicine- 
hater that falls into your hands. Such incorrigibles had 
better be under your care, with rational supervision and 
small doses of good treatment, than to be paying some- 
body else for harmful quackery or fancy nonsense. 
Keep ever in your mind, that many people seem to 
be two-thirds spiritual and one-third animal, and that 
others seem to be but one-third spiritual and two-thirds 
animal, between which are all intermediate grades. If 
you attempt to treat all these alike, you will certainly 
fail. The mental management of the sick is often much 
more difficult than the physical. A close study of the 
mental forces and of mental therapeutics is one of the 
necessities that the regular profession is still extremely 
deficient in. Irregulars often give a mere placebo, or 
useless agent, which unquestioning faith (psychological 
energy) on the part of the patient potentizes, and a 
wonderful cure (?) results. 
This is probably the most rational explanation of the 
fact, that newly discovered therapeutical agents, as 
bromide of potassium, salicylic acid, etc., make so 
many more wonderful cures when first heralded as rem- 
edies, than they do after they have taken a fixed rank 
in the pharmacopoeia. 
Novel remedies often assist the cure through mental 
influences. Many regular physicians give valuable, 
true remedies, but give them just as they would ad- 
minister to a horse or a sheep, as if their only duty 
consisted in telling the sick what drugs to swallow; 
they seem to despise the aid of faith, hope, mystery and 
expectation. You must learn, in simple cases, to depend 162 
more upon the aid of hygiene, diet, and mental influences, 
and less on large doses of medicine, which might allow 
room for some of your patients to say you had almost 
killed them. 
Remember particularly, that Drs. Diet, Quiet, Hope 
and Faith are four excellent assistants, whose aid you 
should constantly invoke. Dr. Time is also in some 
cases very successful, but he is slow and unreliable, and 
unless Dr. Help well is called to assist, occasionally per- 
mits a curable patient to sink into his coffin, instead of 
restoring him. 
If you indicate to a patient for whom you prescribe 
an unpalatable medicine, at the time when you order it, 
that it will have a bitterish or a saltish taste, or any 
other unpleasant quality, his mind will be prepared for 
it beforehand, and it will not seem so repulsive to him, 
as if his mind and palate were taken by surprise. 
If the directions on the bottle indicate what a remedy 
is for,—for instance, if you have it labelled “ apply to 
the injured foot as directed,” or “ for the pain in the 
chest,” or “ for the cough,”—it will be more apt to give 
a certain class of patients faith in its being a direct and 
proper remedy, and cause their minds to go 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 temporarily, and depend on hygiene, diet, 
stimulants, nursing, etc. 
Keep yourself familiar with the bad effects that may 
follow the use of the drugs which you administer, that 163 
you may either avoid producing them, or promptly 
recognize and remedy them when they occur. 
Avoid as far as possible the use of medicine that must 
be taken “ through a tube,” that must be kept “in a cool 
place ” or “ in a dark place on which “ no water 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 doubters and 
medicine-haters. 
Some people will not send for you till they are truly 
ill, for fear you will put them to bed, or salivate them, 
or bring them misery instead of relief. Others will be 
afraid you will give them quinine, or injure their teeth 
with iron, calomel, etc., or that if they begin to take 
medicine they will not be able to stop. Disarm all such 
people by the assurance that their fears are exaggerated 
or groundless. 
“Iron injures the teeth” is a cry which you will 
often hear, and it originates in the fact that muriated 
tincture of iron, which contains muriatic acid, if given 
without proper caution, will injure the teeth, not on 
account 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 the same if the 
coffee were not in it. Preparations of iron containing no 
free acid do not act upon the teeth. 
It is popularly believed that quinine gets into the 
bones, destroys sight and hearing, causes dropsy, etc. 
So firmly do some people believe these things that you 
will have to humor their prejudices, and give them sul- 164 
phate of cinchonia, compound tincture, or some other 
preparation of bark, when bark is indicated. 
• This prejudice probably depends chiefly on the fact 
that, being powerful for good, people naturally infer 
that it must be very strong and powerful for evil. It is 
also often due to the teachings of Irregulars, who seek 
through it to prejudice the public against regular physi- 
cians, while constantly but secretly using it themselves. 
I have known a conspicuous Irregular to denounce qui- 
nine strongly, and yet use 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 malarial poisoning, 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 greatest hardships you will have to endure 
is the tendency of people who have suffered protracted 
sickness, to blame you or your medicine for any perma- 
nent impairment or stubborn symptoms remaining after 
illnesses, instead of recognizing the fact that they are the 
legitimate effects of disease. 
Reproach is often unjustly heaped 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 
nature remain as they are, you can no more promise 
future immunity to convalescents with an agued frame 165 
who remain in malarious regions, 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. 
Malaria is usually contracted at night, but many 
people are not aware of the fact that it can also be caught 
in the daytime, and should be put on their guard. 
It is proper, and your duty, to advise a person to 
change his abode if his health require, or to relinquish 
an occupation if it be injurious to him. Also to dis- 
courage him from exciting employments, or from pursu- 
ing riches when his health is thereby jeopardized; but 
remember that these are extremely delicate subjects. 
Keep yourself fully informed concerning dietetics and 
hygienics, the comparative healthfulness of different 
regions, the presence or absence of malaria at different 
seasons and places, etc.; also regarding the various 
health trips and summer resorts. Familiarize yourself 
with the constituents and peculiarities of the various 
mineral waters and of the uses of each ; with the compar- 
ative advantages of seaside 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 advan- 
tages of the various hospitals, asylums, sanitaria, retreats, 
etc.; for these matters belong strictly to the province of 
medicine, and it is particularly desirable to understand 
them, because they are subjects that concern the better 
and more 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. 166 
Be cautious in advising persons far gone with danger- 
ous or hopeless maladies to leave their homes to under- 
go the discomforts of travel to distant points in search 
of health, unless there are positive reasons for the 
change, or decided probabilities that improvement or 
restoration will follow. The risk of death 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. 
Be chary of even sending people from their homes to 
hospitals, unless you are perfectly sure the management 
is humane and skilful. “ Be it ever so humble, there is 
no place like home.” To carry a sick person to a hos- 
pital, deprive him of his friends, neighbors and compan- 
ions, restrict his freedom and subject him to hum-drum 
hospital rules ; expose him possibly to the public gaze, 
clothe him hospital-fashion and put him on diet pre- 
pared 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 strong attachment to his home and 
its surroundings, such a change would be most hurtful 
and injudicious, and could scarcely fail to aggravate his 
disease. 
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 exter- 
nally or swallowed in small quantities at a time, is one 
of nature’s greatest remedies in fever, especially if the 
patient has a craving for it. 
If a person sweats more during sleep than at any 
other time, it is a sure sign of weakness. 167 
You will often be asked, “ Doctor, may be 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 anything, it would include pickles, radishes, cheese, 
ham, sausage, and a great many other indigestible things 
that might injure or kill him; adding the adjective 
simple will protect both him and you. 
When you are busy and wish to make a short visit, 
do not tell the patient so, or exhibit a hurried or abrupt 
demeanor, but begin promptly to ask the necessary ques- 
tions, and do not let the conversation become desultory 
or in any way digress from his case till you have learned 
all that is necessary. If the subject of the weather is 
broached, answer as if you were considering it only in 
reference to its influence on the patient, then go back to 
his case. Economize time thus; but if your patient is 
at all ill, neither mention your haste, nor show that you 
are in a hurry until you have made your examination 
and written your prescription. After that, if you depart 
promptly he will not feel that your hurry has caused 
any inattention to his case. 
It will often vex you, when you are busy and time 
is precious, to be kept waiting below stairs while the 
people in the sick-room prim and prepare to receive you, 
with as much prudery as if the surroundings, rather 
than the patient, were the object of your visit. Show 
every one the respect due to rank and sex, but manage 
to let such people know that your time is too precious to 
waste, and must be divided somewhat equally among 
those whom you are attending. 168 
Never assign as a reason for being habitually late in 
visiting a patient that you are over-busy. Every one 
wants a physician who is in active experience and en- 
grossed in practice, but no one is willing to be habitually 
slighted or crowded out. It is an excellent rule always 
to let patients know at your visit when they may expect 
your next visit, and go as near that time as circum- 
stances will allow. To do so gives satisfaction and pre- 
vents anxiety, and you will upon going 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. Ascertain by 
both inspection and inquiry whether it has been taken 
according to your directions, before you express any 
opinion of the patient’s progress. If you neglect to do 
so you may be caught confidently ascribing benefits to 
prescriptions that have not been filled, 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 crude remedies, and to cul- 
tivate conservative rather than radical ones. Throw 
gross physic to the dogs. Fame for not being heroic 
and not giving much strong medicine, is just now a 
splendid item in a physician’s reputation, one that might 
almost be adopted as a corner-stone. Of course, in cases 
where duty actually requires you to act promptly, or to 
use powerful remedies heroically, take the responsibility 
and do whatever is proper without shrinking. 
Avoid polypharmacy. It is much better to order 
some single remedy, or a combination of which you know 169 
the physiological effect, than to give an indefinite medley 
on the ancient blunderbuss principle. 
It is highly proper 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 
right living, proper dress, correct diet, pure air, and 
drainage, that they may preserve their health; but it is 
neither just nor wise to teach any but medical students, 
the secrets of our art. Especially avoid giving self- 
sufficient people therapeutical points that they can 
thereafter resort to and ignore the physician. If you 
do, they will soon become opinionated and imagine 
they know as much about medicine as you do, or 
more, and not only take your bread from you, but 
make hobbies of what you teach them, and trifle 
with them, till, in bad cases, the patient’s disease 
is fatally seated. It is not your duty to cheat either 
yourself or other physicians out of legitimate practice 
by supplying this person and that one with a pharma- 
copoeia for general use. If compelled to give people 
remedies under a simple form, study to do so in such a 
way as not to increase their self-conceit and make them 
feel that they know enough to practice self-medication 
and dispense with your services ; use whatever strategy 
is necessary to prevent such persons from taking unfair 
advantage of your prescriptions. 
It is unwise to instruct a person with rheumatism, 
gonorrhoea, ulcers, sore mouth, sprains, or any affliction 
whatever, to get five or ten cents’ worth of this or that 
remedy, to mix for himself, unless it be one of the very 
worthy poor; because people are sure to abuse such 170 
orders, and to try to teach every one similarly afflicted 
how to treat himself. It is better either to let such 
persons have the medicine from your office, or to write 
them a prescription for it, with instructions neither to 
repeat nor lend. 
In prescribing, and even in speaking of medicines, 
you should use officinal names, and not popular titles, 
unless there is some special reason for using a synonym. 
Do not patronize any of the semi-legitimate pharma- 
ceutical catchpennies 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 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 do not make yourself a mere distributer of some 
enterprising fellow’s ready-made “ beef, wine and iron,” 
which cheats the pharmacist out of all chance of exer- 
cising his profession, and relieves him of all responsi- 
bility in the matter, since he has nothing to do but 
hand it out, in a mechanical fashion, to customers, just 
as the grocer hands out soap, matches and tobacco. 
The same hat cannot fit every head, or the same shoe 
answer for every foot, neither can the proportion of in- 
gredients in a ready-made combination suit every patient. 
Indeed, what would cure one might kill another. 
Resolve never to prescribe a proprietary remedy, or 
one covered by a trade-mark; it is better to avoid the 
use of 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 171 
and the dose are given or not. If you order A’s emulsion, 
B’s lozenges, C’s cod-liver oil, D’s pills and E’s bitters, to 
patients, they will, by association, soon think that X’s 
sarsaparilla, Y’s buchu, and Z’s liver regulator, also meet 
with professional 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 their 
nostrums do more harm than good; also for the lesser 
reason, that justice to yourself and every other physician 
requires you to avoid prescribing or telling patients of 
preparations that enable them afterwards to snap their 
fingers in your face and renew them as often as they 
please. 
Endeavor to have your prescription labelled so as 
to prevent indiscriminate renewal, as well as to prevent 
mistakes in their administration; when they are very 
important, have the name of the patient put on the 
label. 
Remember this : The very best time to tell a patient 
not to lenew a prescription is while writing it. If you 
fear it will be renewed against your wish, stop short 
while writing and remark to him that it will be a good 
remedy, or make some other true remark about it, but 
that he must take only one bottle, or that it must not 
be renewed. Your order given at that time will seem 
to be founded on some motive other than that of pro- 
tecting your own pecuniary interest, will impress him 
strongly, and will be invariably obeyed; this is probably 
the most effective of all plans to prevent prescriptions 
from being renewed and adopted as a regular resort in 
similar cases. With this exception, make it a rule not 172 
to talk, listen to, nor answer questions while writing 
prescriptions. 
Never write a prescription carelessly. Cultivate the 
habit of scrutinizing everything you write after it is 
written, to assure yourself that there is neither omission 
nor mistake, and sign your name or initials to every pre- 
scription, but not till you have satisfied yourself that it 
is as intended. 
In consultation, the prescription agreed upon should 
be written by the regular attendant, and if the consul- 
tant is still present, should be submitted to him for in- 
spection; but only the regular attendant’s name or 
initials should be signed to it. 
A very, very useful rule in many cases is to name 
the hours at which medicine is to be taken ; thus, if it 
is to be taken every five hours, instead of waiting “ a 
teaspoonful every five hours,” write “ take a teaspoonful 
at 7, 12, 5, and 10 o’clock daily.” 
Remember, when giving directions in regard to doses, 
that spoons and drops vary greatly in size. A patient 
can save much trouble and uncertainty in cases where 
medicine is to be taken for any length of time, by get- 
ting a graduated tumbler or medicine glass, which is 
both convenient and precise. A minim is a definite 
quantity, a drop i& 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 by allowing them to know they are taking such 
articles. 
If you instruct a patient, how to use the hypodermic 173 
syringe on himself, or to inhale chloroform or ether, or 
give him chloral, opium or alcoholic liquors loosely, if 
he has any predisposition at all towards them, he will 
probably adopt the habit; if he does, you will surely and 
deservedly incur the blame. The slaves of such habits 
always cast the blame for their acquired passion, or 
their enslavement, on the physicians who first ordered 
or used the drug with them, if they have any ground 
at all for doing so. 
Hypodermic medication not only has its place and 
power, which make it at times indispensable, but also 
has various drawbacks, that should prevent its indis- 
criminate use; among other evils connected with it is 
this, that those who are charmed by it, or have become 
habituated to it, are apt to harass and worry you for its 
use at all hours, day and night. It is a real hardship 
after doing your day’s work that you must go and ad- 
minister a hypodermic of morphia to A. at 9 o’clock 
P. M.,to B. at 10, and to C. at 11 o’clock, and probably be 
called from bed again to administer to one or all of them 
before morning. 
Much of this is not only a hardship but a nuisance. 
Far better is it for both the patient and yourself that 
you order anodynes by the mouth or rectum for such 
patients, than risk what may prove to be a fatal charm. CHAPTER VIII. 
All the world’s a stage, and all the men and women merely players.” 
—Shakspeare. 
Self-reliance and self-possession are very important 
elements of success. Nothing under the sun will cause 
people to rely on you more readily and permanently 
than to see you rely on yourself. Be not arrogant, or 
self-conceited, but always hide your doubts, hesita- 
tions, uncertainties, and apprehensions as completely as 
possible. 
Never turn your cases over to “specialists,” unless 
they have features which render it an actual duty to do 
so. If you timidly refer every case of eye disease to 
the oculists, every uterine case to the gynaecologists, ear 
cases to the aurists, surgical to surgeons, nervous affec- 
tions to neurologists, throat complaints to laryngologists, 
mental afflictions to alienists, and so on throughout the 
list, you will lessen your own field of activity, and in- 
stead of gaining as much experience with one affection 
as another, you will soon lose all familiarity with the 
diseases that specialists treat, and will degenerate into a 
mere distributer of cases, a medical adviser instead of a, 
medical attendant—studying everybody’s interest except 
your own, and making reputations for them out of that 
which sinks your own individuality, depletes your own 
purse, and destroys your own fame. A good rule is this: 175 
whenever a case proves wholly unmanageable by usual 
treatment, or is so grave in prognosis as undoubtedly to 
require broader shoulders than yours to bear the re- 
sponsibility, either call in a specialist to aid in its man- 
agement, or turn it over entirely to him. Timidity and 
rashness are both bad traits in a physician, but the former 
is the greater drawback. 
When you transfer any one from your care to a 
specialist’s, always do so either by a consultation, a 
letter, or a personal interview with him, that he may 
learn directly from you your diagnosis, prognosis, treat- 
ment, etc. You will thereby give him the advantage of 
what you know of the case, and also prevent the risk of 
an injury to your reputation from an apparently radical 
difference of opinion between him and yourself; besides, 
it secures your graceful retirement from the case. 
Be careful to make your patients fully understand 
that in turning their cases over to a surgeon or specialist 
you do not cease to be their physician for future sick- 
ness, and that you have only turned them over for that 
special affection. 
Ask for a consultation in all important cases in which 
knotty problems are presented, or where there exists 
any doubt as to the diagnosis, and in all cases where you 
think either the patient’s interest, his lack of improve- 
ment, or a division of the responsibility demands it. 
When from any cause you see a necessity for one arising, 
try, if possible, to anticipate the family by being the 
first to propose it. 
Consultations lessen personal responsibility. When 
you have bad surgical and other cases among your per- 176 
sonal friends or relatives, or so near home as to involve 
you personally or socially, or in a neighborhood in which 
a group of patients are likely to be unfavorably im- 
pressed if the result is not good, it is especially neces- 
sary and wise to call a consulting physician, even though 
you have him to come but once—if for no other reason, 
to satisfy the persons concerned. 
If possible, always have physicians selected as con- 
sultants who will second your efforts by their knowledge 
and skill, and who will at the same time be likely to 
harmonize with you in the management of your cases; 
for their sympathy and kindly support may be highly 
necessary to the patient’s welfare and to your own repu- 
tation. Be cautious to denounce no physician by name. 
Be punctual to the minute in keeping consultation en- 
gagements. 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. 
In your consultations you will often feel great anxiety 
and suspense while waiting to see whether the consult- 
ing physician will be fair towards you, or whether he 
will shrewdly expose your deficiencies to a few, to be 
told to many, till you are killed in the estimation of all 
to whom the case is related. To the honor of our pro- 
fession be it said, that the vast majority of its older 
members are not only punctilious, but really kind to 
the deserving on these occasions. 
A radical change of diagnosis and of treatment, as the 
result of a first consultation, often naturally impresses 
upon the laity the idea that the previous diagnosis or 
treatment has been either faulty or actually wrong, and 177 
no material change should be proposed or allowed at 
that time, unless some real necessity requires it. As a 
rule, the fewer the apparent changes resulting from a 
first consultation, the better for the regular attendant’s 
reputation; especially if he be a young physician. 
When a consulting physician is designated and called 
at your request, you should see that the payment of his 
fee is not neglected; 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. 
You can, in such a case, speak much more plainly for 
your brother physician called at your instance than you 
could for yourself. His relations to the case suppose 
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 at all of his 
fees. Prompt settlement of the consultant’s fee will 
sometimes even bring about a more prompt payment of 
your own. 
Unless the consulting physician gets his fees cash, or 
you are aware that special arrangements exist for their 
payment, be very careful to inform the people as soon 
as he ceases coming, or at any rate before the time ar- 
rives for sending them your bill, whether he will send 
his bill separately from yours or not. If you neglect to 
explain this to them, they will almost surely think you 
ought to pay him out of your fee, and a misunderstanding 
will result as to whether you or they must pay his bill. 178 
Whenever, to please the patient or his friends, you 
give up other engagements in order to meet another 
physician in consultation, it is proper for you to charge 
for such service twice as much as for an ordinary visit, 
or perhaps even as much as the consultant does for his 
services ; for you have all the details to carry out and 
all the communications to make, and in consequence are 
entitled to extra compensation. 
In dispensing with the consulting physician when his 
services are no longer necessary, take care to make him 
feel that it is done amicably. 
Remember that you have no right to object to a 
patient’s having other advice besides your own whenever 
he insists upon it; but also that you have an undoubted 
right to refuse to consult with any one whom you deem 
unprofessional, or unsuited for the case, any one who 
is personally objectionable to you, or in whose keep- 
ing 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. Fortunately, 
such dilemmas are very rare. 
Do not refuse to consult with foreign physicians, doc- 
tresses, colored physicians, or any others, provided 
they are regular practitioners, or even with undergrad- 
uates, if they are advancing regularly towards their 
degree. You, as a physician, hold a quasi-othcial posi- 
tion in the community, and, in the discharge of your 
duties, should know nothing of national enmities, race 
prejudices, political strife, or sectarian differences; you 
have no moral right to turn your back on sick and suf- 
fering humanity, by refusing to add your knowledge and 179 
skill to that of any honorable, liberal-minded person who 
practises medicine, if his professional acquirements and 
ethical tenets give him a claim to work in the professional 
field. It is not only unmanly to make a class distinction 
and throw obstacles in the path of the less favored, but 
such a spirit is wholly incompatible with the objects of 
our profession (which is a liberal one), and at direct 
variance with the spirit of science, which is cosmopolitan, 
and in its efforts to diminish suffering and baffle death 
knows neither caste, pride, nor prejudice, and has no 
limits except those of truth and duty. 
But while you give the right hand of fellowship to 
every regular honorable physician, no matter what his 
misfortunes or how great his deficiencies, you must, on 
the other hand, remember that medicine is a liberal 
profession, and refuse it to any one whose pride, prejudice, 
or limited creed, or avowed or notorious hostility to our 
profession, prevents him from accepting every known fact 
and employing all known remedies. Refuse fellowship 
with any one and every one who cannot honestly say his 
mind is wide open for the reception of all truth, and 
that his hand shall not refuse to use anything and every- 
thing that may be needed for the benefit of the suffering. 
When called to a case in which the attendant cannot do 
this, let his retirement be one of the conditions on which 
you will assume charge. 
You may be called to a case of emergency, viz. an 
alarming hemorrhage, poisoning, or difficult labor, and 
on reaching it find an irregular practitioner or quack in 
attendance; in such cases, the path of duty is plain, for, 
owing to the great and urgent danger to life, the higher 180 
law of humanity will require you temporarily to set 
aside ethics and etiquette, and to unite your efforts with 
your chance associate’s. Treat him, then, with courtesy, 
but studiously avoid private consultations 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 allow and 
cover any act honestly 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 
agrees to the proper treatment 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 are being 
applied, or other rational treatment, endorse it and en- 
courage a continuation in the same line, but if your acci- 
dental colleague is a hydropath and favors a wet pack 
because he is morbid on the use of water, or a homoeo- 
path and advocates a lotion of cantharides because they 
burn and blister well people, it is your duty to your 
patient and also to yourself unyieldingly to insist that a 
rational course shall be pursued, if you are to take part 
in the case. Be cautious but firm in dealing with such 
contingencies, and it is due both to your self-respect and 
that which you owe the profession, that you terminate 
the unnatural connection—of course in a gentlemanly 
way—as soon as the great urgency will admit. 
Some of the unreasoning laity may think you are 
illiberal in refusing to fraternize and consult with Irreg- 181 
ular practitioners, notwithstanding these have volun- 
tarily separated themselves from the profession and 
assumed a name intended to tell the public that their 
system differs from ours, and that they are hostile to 
us. Remember that our refusal is not from a false 
sense of dignity, or from prejudice, but that the great 
principle which underlies it is this : as lovers of all 
truth, 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 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 a diploma, 
circumscribes himself and practises a botanical system 
only, or homoeopathic system only, or a hydropathic sys- 
tem 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 honorable means of aiding the sick, and endeavors 
to poison the public mind against all other systems but 
his own—all rational physicians esteem such an one as 
too illiberal to be a true physician, and justly exclude 
him as unsuitable for fellowship with those who profess 
to love all truth, and whilst he remains confined within 
the narrow limits of his own seclusion, endeavor to 
themselves steadily pursue the path of true science and 
progress. 
if, on the other hand, he uses the remedies that 
rational medicine affords, yet adopts the cloak of an 
“ ism,” simply as an advertising dodge to make the pub- 
lic believe that he practises in some manner the direct 
opposite of ourselves, and thereby assists our enemies to 182 
lessen public esteem for regular medicine, and to create 
hatred towards us as its followers, he is guilty of fraud, 
and you should, even on the ground of morality, refuse 
to countenance him. 
When people ask you “ what school you practise,” 
you may very properly answer that you are simply a 
physician, that you belong to no sect and are limited 
to no cut-and-dried creed, that you try to be rational 
and, like the bee, take the honey of truth wherever you 
find it; that as rational, liberal physicians, the regular 
profession, to which you belong, maintain perfect freedom 
of opinion and practice, and unlike the various “ limited 
schools,” have no articles of faith, which they impose 
on any one, but accept all truths, whether winnowed 
from past experience, or discovered, either scientifically 
or empirically, in our own day; that you, as one of its 
representatives, stand ready to receive and utilize any 
and every valuable discovery, no matter when or by 
whom made. 
This flexibility explains why regular medicine is one 
of the three liberal professions, and why the humane 
and benevolent physician takes rank with the learned 
expounder of the law and with the worthy man who 
inculcates religion. 
To this trio of professions was long ago applied the 
term “liberal,” because all three require the utmost 
perfection of character in their members, and because 
devotees of law, religion and medicine have, in all ages, 
pursued them as freemen, with hands unfettered and 
tongue untied, subject to no bonds, except those of 
truth. If at any time during your career, any sect or 183 
school arises, no matter how great or how humble its 
pretensions, if it has even one grain of wheat to a bushel 
of chaff, it is your duty to seize the grain of wheat and 
utilize it, and cast the chaff to the winds. This adapt- 
ability is our strength and our glory, and is the element 
that will make regular, liberal, rational medicine exist 
as long as there are sickness and suffering in the world, 
and is the feature that distinguishes genuine medicine 
from “new schools,” isms and pathies. 
Remember that the door of the profession is not only 
open to the newly graduated, but to every one who has 
the necessary educational and moral qualifications, even 
though he has been allied, whether from ignorance or 
choice, with schools which profess antagonism to the 
profession; in the latter case he is at perfect liberty at 
any time to enter our ranks by dropping his distinguish- 
ing creed, abandoning the hostility to the profession 
which it implies, and allowing ethical rules to govern 
his conduct: no conversion, no surrender of private 
opinion is at all necessary. 
Be exact in everything that relates to consultations. 
Let them always be formal and strictly private; con- 
sult within a room that is, if possible, isolated from in- 
trusion ; exchange thoughts in an undertone and out of 
the sight and the hearing of eavesdroppers. Never 
allow any one to be present, except the physicians 
engaged in it. 
Remember that consultations are called for the pur- 
pose of deciding for the f uture, not to criticize the past; 
but if you are called to consult in a case and find the 
attending physican is suffering unmerited odium for his 184 
previous management, every principle of honor should 
impel you to volunteer to defend him. 
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 Code. 
If you do, those whom you address may, either unin- 
tentionally or purposely, misinterpret what you say, or 
otherwise involve you. 
Remember that if you agree sufficiently to continue 
in joint attendance, you are in duty bound to uphold 
each other, and to refrain from hints and insinuations 
likely to affect confidence in your fellow attendant. 
If you are requested by letter, or by a messenger, to 
prescribe for an out-of-town patient who is not under 
the care of any other physician, it is perfectly profes- 
sional to do so, if you wish, even though you may never 
have seen the case. 
If a professional friend for any reason requests you to 
see a case with him, not so much for the patient’s sake 
as for his own benefit, you should lend him a ready and 
willing hand, and that, too, without expectation of a fee. 
Avoid reviling the individual members of the profes- 
sion, or the profession itself, or telling people of the mis- 
takes 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 ignor- 
ance of disease and remedies; and suppress all other 
fulsome confessions. When a physician speaks thus, he 
means it relatively only; means to say, that he is aware 
and willing to confess that medicine has its natural 185 
limits and is not an exact science, and that the applica- 
tion of therapeutics is but an art. The public cannot 
appreciate the sense in which such confessions are made, 
and they are taken up by our enemies as quickly as an 
empty sponge takes up water, and work ounces of harm 
to physicians who make them and pounds of harm to 
the profession at large; because all who hear or read 
them conclude that medical practice is only a network 
of uncertainty, inconsistencies and confusion, and ever 
after either do not employ physicians at all, or do so 
with utter disrespect and distrust. 
You know there is no such thing practically as a per- 
fectly straight line, plane surface, regular curve, exact 
sphere, or uniform solid; yet you never hear the engineer 
or surveyor boasting of it in reckless language as if to 
belittle his own profession. 
The truth is, physicians are far more imperfect than 
physic. For instance: there are undoubtedly medicines 
whose action is diuretic; but diuretics may be given 
when not indicated, or the diuretic given may not be the 
proper one, or it may be wrong in quantity, or be given 
at improper intervals, or proper restrictions for its use 
may not be enforced. Now none of these errors are 
justly chargeable to the class of medicines we call 
diuretics, nor to the art of medicine, but are plainly due 
either to the physician’s bad judgment, or to his ignor- 
ance. The fact is, all studious physicians know of very 
nearly the same remedies, but skill in curing with them 
consists in selecting the proper ones, in proportioning 
the dose, judging correctly the time for use, etc. Just 
so, different persons essaying to paint will exhibit dif- 186 
ferent degrees of success; one possessed of natural apti- 
tude or special smartness will attain 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 difference 
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. 
Ability to determine accurately the condition of a 
patient, 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 phy- 
sicians, and explains the reason why the prescriptions 
of some physicians are much more valuable than those 
of others. 
A proper use of medicines, and not a wholesale re- 
nunciation of them, is a leading characteristic of a good 
physician. When you hear of a physician who wishes 
to be considered especially clear, or ahead of others, or 
extraordinarily fair in his opinions, -boasting that he is 
skeptical, “does not believe in drugs,” “depends on 
nature,” etc., you can safely conclude that in his zeal to 
become a medical philosopher, or to coquette with some- 
body 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 sometimes 
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 correct 187 
ways of cultivating; or does he lose his faith in agricul- 
ture because droughts and grasshoppers sometimes ruin 
his crops ? Would any worthy sailor fold his arms and 
do nothing while the storm raged, or any philosophical 
farmer neglect to plant again when the season returned, 
because the sailor’s brightest hopes are sometimes 
crushed and the farmer’s fairest prospects are often 
blighted ? 
Is there a physician on earth who would let intermit- 
tent and remittent fevers take their course without 
drugs, or who would let the syphilitic and other poisons 
develop, or progress unchecked ? Is there a graduate 
anywhere who confesses he can do nothing for pain or 
for fever, for nervous complaints, for digestive affections 
or chest diseases; nothing for circulatory disorders, 
delirium, insomnia, headache, epilepsy, hysteria, gout, 
neuralgia, worms, colic, acidity, peritonitis, constipation, 
diarrhoea, anaemia, scurvy, etc. ? 
The end and aim of medical practice is to relieve, to 
cure, and to prevent death, therefore if there is a physi- 
cian in the land who has never seen medicines restore 
health or prolong life, who does not sincerely believe in 
his power to benefit by drugs some of the twenty-four 
hundred diseases and modes of decay to which mankind 
is subject, he should at once and forever, for conscience* 
sake, and for the sake of the afflicted, take down his sign 
and no longer pretend to practise. 
The tolerance of disease has greatly increased in the 
last few decades, and is still increasing, and medical 
theories and practice are undergoing great changes. The 
advance of scientific observation is constantly teaching 188 
us to distinguish more clearly between the multitude of 
simple self-limited cases daily met with and the few 
that threaten a fatal issue, and of course we of to-day 
use much lighter remedies for the former class than 
our predecessors did; but it is doubtful whether in real 
sicknesses we have lessened the doses half as much as 
some imagine. You now give twelve or fifteen grains 
of quinia daily for an intermittent fever, where phy- 
sicians formerly gave half an ounce or an ounce of crude 
bark containing but six or twelve grains. You 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 about the same throughout the entire materia 
medica. The great difference is, that we do not now 
prescribe vaguely or rashly, and when cases are obscure 
or undeveloped, our treatment is tentative instead of 
heroic. 
We of to-day know better than our predecessors the 
natural history of disease, and are aware of the almost 
infinite resources of nature, and that three in every ten of 
those who send for physicians need no positive medica- 
tion, and that nine of the ten would get well sooner or 
later by proper hygiene and intelligent nursing and diet- 
ing if there were not a drug in the world, and conse- 
quently we are naturally prescribing less and less. In 
acute diseases, and especially those of children, we now, 
in many cases, trust chiefly to nature, and see them get 
well from what look to be hopeless conditions, almost 
as if by magic, and these cases constitute a majority of 
those that seem to be restored to rosy health by thera- 189 
peutical illusions and quack medicines, which contain 
nothing of an active perturbating character. 
The deduction to be drawn from these facts is that 
the physician may show as much—nay, more—skill 
in withholding drugs when not needed as in giving them 
when they are. CHAPTER IX. 
“ Together let us beat this ample field, 
Try what the open, what the covert yield.”—Pope. 
Aim earnestly to please every one’s taste and ideas of 
medicine as far as is compatible with safety. Bear ever 
in mind that a man is something more than a stomach 
and body, and constantly study the use of psychological 
aids, and try to compel your patient to assist in curing 
his own case. Also avoid over-drugging, and remember 
that those who have been most fond of medicine, often 
become suddenly surfeited and undergo a complete re- 
vulsion against both medicine and physicians. How can 
this be wondered at when even too long a continuation 
of beefsteak, partridge, oysters, or other choice food, 
causes disgust and utter loathing even in well people ? 
This tendency in the human mind has in recent times 
received an unfortunate illustration at our expense, and 
in this way: Satiated and disgusted with Humoral 
Pathology and its crude and over-active measures, ad- 
ministered too often without regard to caprice or palate, 
the majority of people were anxiously wishing for 
almost any change, when lo! the Homoeopath entered, 
and offered as a substitute a new do-nothing system, 
resting on a creed composed of one logical and two 
pseudo-logical tenets, which admirably serves to adver- 
tise both system and disciple, and to amuse and employ 191 
those who trust to the latter, without offending either 
eye, palate or stomach ; depending really on unassisted 
nature to do the work; if adhered to, allowing cases 
that it cannot restore unaided, to become complicated or 
chronic, or to succumb and be added to the list of those 
who die of preventable deaths. 
So strong is the popular reaction against extreme and 
unnecessary medication, that this silly system has flour- 
ished to a most astonishing degree, and may be regarded 
as the greatest medical delusion of the nineteenth cen- 
tury. There can be no doubt, however, that its career 
would long since have terminated had the profes- 
sion not been so loath to accommodate itself to the 
demands of fashion, particularly with reference to medi- 
cation in slight and imaginary cases. But rational 
physicians are at last arousing to the importance of 
this subject, and are conforming to the changed popular 
sentiment. They are at the same time administering 
more concentrated and palatable forms of medicines in 
serious cases, and thanks to the labors of the many de- 
voted workers in the field of medical science, and the 
light which has been thus shed upon the subject, are 
enabled to effect cures with greater certainty, prompt- 
ness and safety than ever before. The result is that 
many of the erring are being brought back from the 
ranks of the “ isms ” and “ pathies,” to faith in a legiti- 
mate and rational system of practice. Determine that 
you will bear your share in the good work, by devoting 
time and study to the means of rendering therapeutics 
pleasant and acceptable to patients. 
You are of course bound by the most sacred obliga- 192 
tions 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 before popular breezes, pro- 
vided you violate no principle of truth and justice. 
No honest man could compromise a matter of princi- 
ple, i. e., knowingly quit the right for the wrong; yet it 
is sometimes very foolish not to compromise a matter of 
policy. In medicine the second best course often be- 
comes the best because the patient prefers it, and 
although you can neither believe nor follow Hahne- 
mann’s nonsense and follies, you can follow the fashion 
of the day, and can give to every fastidious or squeamish 
patient the smallest and most pleasant dose that his 
safety will permit, and can avoid giving any one crude 
remedies to a disgusting degree. 
Now, although homoeopathy is somewhat fashionable, 
when a case actually requires medication you can make 
very little if any rational use of its so-called principles, 
which rest on the following foolish creed :—ls£. Curative 
remedies for the sick can he selected only by a study ofprov- 
ings on persons in health. 2d. Every remedy must he given 
by itself. 3d. The similar and single remedy must he given 
in its minimum dose, i. e., the smallest dose sufficient to effect 
a cure in the case. These are the three legs upon which 
Hahnemannism is supposed to stand; an essential triune, 
an inseparable unit. Violation of any one of these 
principles by the faithful is a confessed rejection of the 
whole. 
You will observe at a glance that this creed is ex- 
actly two-thirds nonsense; that the first and second 193 
postulates are sophistical and untrue, and hence should 
be rejected, and that the last, i. e., to give the smallest 
dose that will answer the purpose, is a rule which no- 
body denies. Every rational person, whether physician 
or not, has recognized ever since the days of Methuselah, 
that it is useless to pour seven buckets of water on a fire 
when he is sure that three will put it out; which piece 
of common sense is> equally true in medicine, and cannot 
in any manner be monopolized by the homoeopath. 
Contrary to wThat many unthinking people believe, 
this creed gives the homoeopaths perfect liberty to give 
either an atom or an ounce of lime, salt, sugar, or any- 
thing else, at a dose, provided they proceed on the 
homoeopathic principle of similars; and the question 
whether they, or you, or any one else does, or does not 
practise homoeopathy does not depend upon the size of 
the dose at all. They might give an ounce of a medi- 
cine in cases in which you would give but a grain. 
Their ounce would not make them rational physicians, 
nor your grain make you a homoeopathist. 
Here is the true test as to whether you are practis- 
ing homoeopathically or not: Were you to examine a 
patient and ask yourself, What is the best treatment 
known to the world for a case like the one before me? and 
give him that, without regard to either creed or bound- 
ary, you would be practising rational medicine. If, on 
the contrary, you were to examine a case and ask your- 
self : What article would produce a totality of symptoms 
similar to these in a well person ? and give him the one 
which you thought would come nearest to doing this, you 
would be practising homoeopathically. Now, it is safe 194 
to conclude that if you practise medicine forty years, 
you will never sit down by an ill man’s bedside and ask 
yourself seriously, “ What agent would produce a dis- 
ease similar to this, or symptoms similar to these, in a 
well person ? ” and attempt to simulate it in your treat- 
ment. Therefore take care to remember that, no matter 
how small your dose, even though, in the exercise of 
your privilege, you prescribe only teaspoonful doses of 
aqua pura, or let your patient smell an empty bottle, it 
will not be practising homoeopathically. 
It is also safe to predict that while reason remains 
your mistress, you will never seriously entertain, much 
less follow, a system of medicine that in dogmatically 
seeking similars, arrives at poison oak as a remedy for 
erysipelas, croton oil as a remedy for cholera infantum, 
mercury for mumps, tartar emetic for typhoid-pneu- 
monia, opium for apoplexy, strychnia for convulsions, 
and a countless myriad more of similar nonsense. 
Study the “ Organon of Medicine ” and “ The Lesser 
Writings,” by Samuel Hahnemann—“ Homoeopathy 
Fairly Represented,” by William Henderson, M. D.— 
Hull’s “Jahr”—Hughes’ “ Pharmaco-Dynamics ”— 
Johnson’s “Therapeutic Key,” the works of Hering, 
Lippe, Guernsey, and other leading homoeopathic authori- 
ties, and you will learn that a genuine homoeopath pre- 
scribes according to what he believes to be a grand natu- 
ral law which Hahnemann by his genius discovered, and 
which is comprehended in the phrase “ similia similibus 
curantur,” or, like cures like. 
Now while it is universally admitted that quinia cures 
intermittent fever, who ever heard of its being homoeo- 195 
pathic to the periodic feature of that disease ? and yet 
where is the homoeopath that does not, in periodic fevers, 
administer sugar-coated quinine pills in full doses? 
Podophyllin is the favorite cathartic of the homoeopath. 
Does it cause constipation? No intelligent physician 
would contend that it did. That morphia relieves that 
great enemy to human life and health, pain—is one of 
the best attested facts of medical observation; will any 
homoeopath dare say that it causes pain? The same 
may be said of mercury in syphilis, and of cod-liver 
oil in scrofula and phthisis. These are not stray asser- 
tions, they are monumental facts. What then becomes 
of the law of similars ? 
Compare Hahnemann and the so-called natural law, 
published by him in the Organon in 1810—all the 
way through, with Copernicus, Newton, and other 
real discoverers of nature’s laws, and you will find his 
grandiloquent pretensions resting on so slight a founda- 
tion that it will strongly remind you of an inverted 
pyramid, and you will then fully realize what an 
amazing folly Hahnemann’s so-called natural law is, 
and why we reject it, and will also see how men can 
mistake the workings of nature, and of faith and cre- 
dulity, for the effects of—infinitesimal globules—till 
their delusions carry them to visionary regions and 
completely pervert their reasoning powers. 
You will discover that nine out of ten of those who 
run after sugar powders and pellets know absolutely 
nothing at all about the Hahnemannian principles and 
calculations, and take them themselves and give them 
to their families solely because they are fashionable, 196 
novel, cheap, easily taken, and prevent running to the 
druggist with expensive prescriptions. 
Another of Hahnemann’s grand and imposing laws, 
the dynamization of medicines, the one that he and his 
followers formerly praised most in proselyting, and 
which was used by them as a wonder-creating some- 
thing made of nothing, is a farcical parody on an old 
well-known principle in medicine. 
These notions of his not only contradict reason and vio- 
late common sense, but conflict with fixed mathematical 
laws, since a part cannot be greater than the whole. 
The truth is, the so-called dynamization of medicines 
bears about as much relation to the science of medicine, 
as the kaleidoscope does to the science of astronomy. 
The novelty of globulism and attenuations, like spirit- 
ualism and mesmerism, aims at two of the strongest 
qualities of the human mind, qualities that we might 
honestly utilize more fully—the love of the mysterious 
and novel. 
As previously stated, nothing under heaven prevents 
you from giving whatever you think best for your 
patient; whether its therapeutic action is similar, or 
antagonistic; but, if in so doing, you adopt a narrow or 
foolish dogma, or an exclusive system, and prejudice 
your mind against all other ascertained truths, your 
partisanship will fetter you, abridge your usefulness, and 
make you unfit for fellowship in liberal medicine. Thus, 
when Vincent Priessnitz, in trying to build a house of a 
single brick, shut his eyes to everything but hydropathy, 
and Samuel Hahnemann dogmatically tied himself to 
the homoeopathic delusion, and rabidly denounced every- 197 
thing else, and Samuel Thompson in his exclusivism 
threw away everything but herbs, they lessened their 
own usefulness and that of all who follow them. 
“ For never yet hath one attained 
To such perfection, but that time, and place, 
And use, have brought addition to his knowledge; 
Or made correction, or admonished him 
That he was ignorant of much which he 
Had thought he knew, or led him to reject 
What he had once esteemed of highest price.” 
Not a single department of medicine has yet reached 
scientific exactness, and possibly never will. We, as 
rational legitimate physicians, are striving hard to bring 
its various branches as near to perfection as possible, and 
are willing to learn medical truth and scientific wisdom 
wherever they can be found. When “ New Schools,” 
schisms or creeds arise, if they possess any new or valu- 
able truths, or remedies of ascertained merit, no matter 
how great or how small, whether taken from the animal, 
vegetable or mineral kingdom, we instantly single them 
out and incorporate them with the great mass to swell 
the records of rational medicine, so that the medicine of 
to-day may be said to be a living, moving, growing 
thing, founded on all its yesterdays. 
The homoeopaths and all other Irregulars cunningly 
sneer at the regular profession and style us “ The Old 
School,” “Allopaths,” etc., to make it appear to the 
public that every physician must belong to some special 
school, and that ours is merely one of these restricted 
creeds, old-fashioned and worn-out, with by-gone habits 
and ancient ways of thinking, which, though good enough 198 
in their day, are now altogether inadequate and behind 
the times. Their aim in doing this is, of course, to ob- 
tain the advantage of appearing to stand fully equal with 
us, j ust as, for instance, in religion one sect stands with 
reference to another, and in politics Republicans stand 
with Democrats. You know that nothing could be more 
false. 
Remember that the title “Allopath ” was the insig- 
nificant misnomer given to us by the great, the all-wise 
and infallible Hahnemann, as part of his little crusade 
for the destruction of all but his own dreamy system, 
and is applied to us opprobriously by his followers, with 
sinister motives; that it is both untrue and offensive, 
and is not recognized by regular physicians. Take care 
promptly to resent it when any one applies it to you 
through enmity, and to disown it and also tell of its 
falsity and hostile origin when applied through 
ignorance. 
An allopathic physician would be one whose foolishly 
restricted creed required him to substitute some other 
disease for the one he was called upon to treat. There 
is probably not an allopathist in the world, and it is 
doubtful whether there ever was one. 
Strange to say, now-a-days a section of the public, 
blinded by sophistry and swayed by false sentiment, in- 
stead of siding with them when they are right and turn- 
ing against them when they are wrong, invariably sides 
with the “new school ” or the quack, or anybody else, 
whenever a contest arises between them and us. Even 
a portion of the press, religious as well as secular, seem 
to delight in aiming sharp shafts at the regular profes- 199 
sion, and creating popular sentiment in favor of its 
enemies, by making invidious comparisons between its 
modes of practice and theirs—telling of their wonderful 
success, and of their steady growth in public confidence, 
in highly colored terms. Editorial and other authorita- 
tive productions are frequently written on our arbitrary 
exclusiveness, our intolerant bigotry, etc.; our dis- 
agreements, too, are magnified and reported in a sensa- 
tional way, all apparently to antagonize and decry us, 
and enhance the interests of Irregulars and advertising 
quacks. 
You will find that if a person happens to get better, 
even of an ordinary case, while under the care of an 
Irregular, or when taking a quack medicine, it will receive 
a thousand praises through the neighborhood; whereas 
if twenty get well by your remedies, it will scarcely 
excite a comment. 
’Tis said the Chinese are so expert in making much 
out of little, that they live and fatten on what a Cau- 
casian wastes. In the same degree, Irregulars and 
quacks thrive on the quickening influence of the emo- 
tions, expectation, faith, hope, etc., which we, with our 
minds fixed on more tangible aids, 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 in vogue, 
which the young and old, black and white, educated and 
illiterate, all kinds, classes and conditions of people, are 
praising, almost as if they had fallen from the skies. 
Fashion and wealth exert a powerful influence in 
medical affairs, and unfortunately a certain portion of 200 
the fashionable, wealthy and influential, favor and pat- 
ronize almost every novelty, schism, or delusion in medi- 
cine, and make them popular and fashionable with the 
unthinking herd, who are always ready to imitate their 
superiors. 
Many Irregulars have another source of eclat. They 
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.” They dignify what we would call a disor- 
dered stomach into a “ gastric affection,” a wind colic 
into “ borborygmus,” etc., for the cure of which huge 
ailments they are fully credited and fully paid. There 
is a fellow in our section who manages his patrons so 
adroitly that he often actually reaps manifold more 
credit and patronage for stopping a chill and fever in 
seven days, than a true physician would for doing the 
same in a day or two, and other ailments in proportion. 
This effort to exaggerate their cures was apparent in the 
famous Homoeopathic Hospital Reports at Vienna, and 
when discovered, vitiated their reliability altogether. 
Another reason why Irregulars get cases is, that if a 
physician 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 physicians, and fearing the attend- 
ant would become offended were they to dismiss him and 
employ one of his brethren, 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. 
Another reason why Irregulars have partisans is that 201 
there is always a sprinkling of extremists in every com- 
munity, who for some cause or other are imbued with 
an unreasoning antagonism to the regular profession, 
who unite to abet and support any class or system which 
practises in opposition to it, and of course such demand 
creates a supply. 
Again, a physician is sometimes compelled candidly to 
give a gloomy or despairing prognosis, and this is apt to 
cause a transfer of the case to some noisy quack who 
makes great professions and rosy promises. 
Still another reason why they get patrons is this. 
They take care to announce that they cure by mild 
means or harmless methods, and not by complicated, 
painful or dangerous measures, bloody operations under 
anaesthetics or other derniers ressorts that science teaches 
us to use—against all of which they have, by fallacious 
statistics, aroused much of the existing foolish prejudice 
and abhorrence. 
So great indeed is the popular dread of what doctors 
might do, that in choosing an attendant from among 
regular physicians, the nervous and the timid, who con- 
stitute nine-tenths of all the sick, are greatly inclined to 
shun all who treat heroically, and seek those who use 
moderate, even though less efficient means. 
Homoeopathy not only panders to whims, but also 
makes a specialty of poisoning the minds of its votaries, 
as well against the lancet, polypharmacy, and other 
needlessly active measures, as against all rational reme- 
dies, inclining them to attach undue importance to trivial 
affections, and to over-estimate the value of treatment 
therein, and creating a pathophobic watchfulness over 202 
the minutioe of tneir health, and eventually making 
them morbidly anxious about every function, and filling 
their minds with a medley of imaginary and exagger- 
ated afflictions which haunt them, like Banquo’s ghost, 
wherever they go. You will often see perfectly healthy- 
bodied persons, who might have passed through life with 
scarce a thought of sickness, after being indoctrinated 
in it and softened by its follies and habituated to its self- 
surveillance, become borne down by numerous magni- 
fied symptoms and constant indications for pellets and 
attenuations. We have a very wealthy but very silly 
lady in our section, who has become so imbued with it 
that, besides incessantly dosing herself with pellets, she 
actually plies her birds with them whenever they fail 
to sing and her kittens when they fail to mew. Other 
devotees, as if to complete the absurdity, have given 
them to turkeys, sheep, dogs, cows, chickens, horses, 
geese, mules, etc. 
Were some graceless wag to exchange or mix up the 
attenuations and globules of the different phials of sepia, 
natrum muriaticum, carbo vegetabilis, etc., so that each 
would contain specifics (!) the opposite in action from its 
label, homoeopaths with perverted perception, squinting 
judgment and turgid imagination, in blissful ignorance 
of the fact, would doubtlessly continue to make their 
cures all the same. Indeed, a short while ago some 
Chicago physicians offered to test the value of homoe- 
opathy as follows : 100 vials of pellets were to be put up 
by homoeopathic druggists, in parcels of 10 each—9 of 
the 10 vials to contain sugar pellets only, while the 
10th vial was to be filled with some active (?) homoe- 203 
opathic drug. Each, of these parcels were to be sent to 
some prominent homoeopath, who was to use them on 
his patients, and designate, by the effect, what drug the 
10th vial contained. No one was willing to accept the 
challenge! 
Homoeopathy has also profited, and is still profiting, 
wherever the English language is spoken,, by an acci- 
dental misleading resemblance of the term homoe to the 
precious word home—“ Home, sweet home.” 
To you as a physician the term homoeopath naturally 
signifies a person who practises a certain exclusive and 
visionary system. But to many of the laity, on the 
contrary, the first two syllables of the word suggest that 
he practises a simple home or domestic system of medi- 
cine, and the fact that he ordinarily 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. 
By fostering the error which this unfortunate resem- 
blance creates—in some instances even anglicizing the 
term by dropping the oe and substituting e—and loudly 
terming all who practise rational medicine ‘‘Allopaths,” 
Hahnemann’s followers have materially advanced them- 
selves with the public, and of course injured rational 
medicine in a corresponding degree. 
This error is so natural that people often actually 
mistake regular physicians who supply their own medi- 
cines for homoeopaths. 
It is your duty, in the interest of truth and for the 
benefit of humanity, to make it known that the word 204 
“home” is of Saxon derivation, whereas the prefix 
homoso is derived from the Greek homoios (similar), and 
has no possible relation to hearth and home. Hahne- 
mann seems to have built better than he intended, as far 
as the English-speaking people are concerned, when he 
styled himself a homoeopathist, and not a pathhomoeist, 
which has the same meaning. 
One of the most curious of all wonders is that wisdom 
in law or theology, perfection in the sciences, skill in 
the arts, or acuteness, even brilliancy, in other depart- 
ments of human knowledge, scarcely increases some 
people’s reasoning powers a single jot in medical matters. 
More than one gullible lawyer has put knotted strings 
around his children’s necks to cure whooping cough; 
more than one sea-captain has carried a potato in his 
pocket to charm away rheumatism; more than one 
capitalist has vowed that pellets of tartar emetic have 
restored his strength; more than one clergyman has 
certified that this or that or the other worthless quack 
medicine has saved life. 
How any individual can be one of the wisest of men 
in all else, and yet, as soon as sickness attacks him or 
his, become an easy, almost volunteer prey to shallow 
quackery and sophistical pretension whose assumptions 
are glaringly contrary to common sense, is a most 
curious psychical enigma. 
Do not infer that a genuine homoeopathist may not be 
following homoeopathy conscientiously, for there never 
has been an absurdity in regard to religious, political or 
medical questions, that has not found very sincere sup- 
porters ; nor that homoeopathists do no good, for they do 205 
a great deal of good. But the good they do is not by 
similars, as has been proven by innumerable observers, 
but by the accompanying hygienics, dietetics, faith, ex- 
pectation, good nursing, etc., which would do equally 
as much were the similars left out, and atoms of taffy or 
sawdust, or anything else substituted, to give their 
patients room to exercise their faith, and nature time 
and opportunity to do the work. 
God help afflicted humanity were genuine homoeopa- 
thy the medical man’s only reliance in his struggles with 
disease. Think for a moment of a group of physicians 
entering the lazar-house depicted by Milton in Paradise 
Lost, to combat the afflictions of that protean assemblage 
with genuine similia similibus. True, while ministering 
to catarrhs, nervous headaches, palpitations, functional 
dyspepsia, tonsilitis, catarrhal croup, chorea, uncompli- 
cated exanthemata, and slighter affections that have a 
strong tendency to spontaneous recovery, and in which 
the public cannot distinguish between cures and natural 
restoration, they might, with a little adroitness and the 
free use of adjuvants, make themselves appear like ma- 
gicians ; but when they encountered maladies which, un- 
less thwarted by the truest medicines and overcome by 
the stoutest weapons that are known to man, have a 
tendency to overwhelm and destroy their victims, they 
surely would feel in their hearts the inherent deficiency 
of their art, which had left them as powerless to com- 
bat disease as soldiers would be to meet their enemy in 
battle after being stripped of all their weapons. 
The truth is, if a man has a sickness in which the 
tendency is to death, medicines given on Hahnemann’s 206 
foolish plan will not, cannot avert that result; and the 
malady will go on from bad to worse till his sufferings 
are relieved by death, while some of the agents which 
experience and reason offer, and rational physicians 
accept, might control its downward and fatal course and 
restore him to health. 
When chance brings you in contact with a genuine 
homoeopathist, if you believe him to be a gentleman, 
observe all the forms of politeness toward him, and treat 
him exactly as you would any other gentleman, but 
ignore him professionally, and never allow yourself to 
fraternize with him in the management of a case. But 
have nothing, emphatically nothing, to do with any of the 
large flock of bread-and-butter fellows who, for their in- 
gatherings simply, masquerade as homoeopaths by a dis- 
play of Hahnemannic nonsense, j ust as ostrich-hunters 
assume to be ostriches by dressing in that wise bird’s 
feathers. 
The majority of these bogus homoeopaths simulate 
the genuine by carrying with them awe-inspiring 
satchels similar to theirs, which they guard as carefully 
as if an additional shake of the powerful dynamizations 
within might still further increase their potency and 
cause an explosion. Carefully search the satchel and 
the pockets of any one of these and you will not only 
find the usual attenuations, triturations, tinctures and 
globules, and Lehrman’s, Durham’s, Lentz’s, and Finck’s 
high dynamizations ranging from the 800th away up to 
the terrific potency of an 86000th (nonsense that would 
not vary the ailments of a fly); but search a little further 
and you will find also a full, a very full supply of Wm. 207 
R. Warner’s, W. H. Schieffelin’s, Sharp & Dohme’s, or 
some other make of sugar-coated granules of morphia, 
quinia, arsenicum, belladonna, elaterium, colocynth, etc., 
which he habitually administers with as little regard 
for “ similia,” etc., as you do. Be not startled if you 
also find a hypodermic syringe and a bottle of Magen- 
die’s solution—damning witness of his lack of moral 
sense and of honesty, and of faith in what he professes. 
Respect every sincere believer in a false system, no mat- 
ter how great his error, but let the finger of scorn point 
contemptuously at each and every graceless scamp who, 
as an advertisement of himself, denounces and sneers at 
“ old school ” remedies, meanwhile giving globules and 
attenuations in placebo cases only, and in all others, slyly 
using opium to relieve pain, chloral to induce sleep, 
quinia to arrest fever, and all our other prominent agents, 
just as we do, in full doses, yet crediting the good they 
do to homoeopathy! 
There is also a self-adjusting variety of quacks, who, 
thank heaven, are not very numerous, who chameleon- 
like, are all things to all men, and actually offer to 
practise any exclusive system people wish. These are 
not as bad as the bogus form, for they are at least 
frank and honest in their announcement. But what 
would you think of a clergyman whose love of gold and 
lack of scruple would allow him to vary his principles at 
will and preach anything you wished, whether a strictly 
Catholic lecture, or an ultra-Protestant discourse, an 
orthodox Hebrew sermon, a fiery Mohammedan philip- 
pic, or an out-and-out infidel harangue? He might 
believe in one or none, but he could not believe in all. 208 
Examine the homoeopathic creed closely (pages 192, 
193) and carefully measure all those who claim to practise 
under it, of whom you have personal knowledge, and 
you will find hut few (if any) who honestly do so. The 
genuine homoeopath never alternates or mixes remedies, 
and never employs hypodermic injections, purgatives, 
mustard plasters, ointments, washes, liniments, injections, 
cauterizations or gargles. Show a decent respect for the 
real homoeopath, hut shun, as you would the plagues of 
Egypt, the fellows who, as the lion did the ass’s skin, 
use the name simply as a cloak to deceive the gullible 
public because, just at this time, it pays to use it. 
But few of the really sick who are persuaded into 
giving these false and one-idea systems a trial, become 
converts. Therefore be careful not to banter, irritate or 
abandon people who are trying isms or pathies, lest from 
combating them and forcing argument you drive them 
into these vagaries permanently. Should they even 
contend that the earth is three-cornered, or that homoeo- 
pathic nonsense has saved their lives, or that pumpkins 
grow on trees, do not combat them too fiercely. Pride 
of opinion and determination not to be browbeaten into 
recantation, are unfortunate impulses to arouse, especi- 
ally in conceited and silly people, and will certainly 
drive them to take sides against you. 
If, in exposing any worthless system, you are careful 
not to denounce it with too much warmth or violence, as 
though prompted by envy or jealousy, and to confine 
your condemnation strictly to the impersonal abstract 
subject, showing that you speak your real sentiments 
from sober reason and conscientious devotion to the 209 
truth; and if, moreover, you avoid appearing anxious to 
excite hostility against the individuals who practise it 
honestly, your reasoning will have a great deal more 
weight with those whom you address and with the com- 
munity, than under the reverse circumstances, for human 
nature is such that if a system or creed in medicine be 
false, abuse of its representatives will be one of the best 
ways of commending it to the public favor, and hence 
is what they themselves most heartily desire. 
You will occasionally be called again to families who 
strayed in disgust from regular medicine years ago, when 
bleeding, etc., were fashionable, who will be surprised 
to learn that your therapeutics differ from those of your 
fathers—and that you no longer bleed, salivate, and give 
nauseous drugs, indiscriminately, as they supposed. If 
you are prudent and circumspect, most of these can 
be permanently reclaimed. 
Although it is wrong to spend much time and labor 
in acquiring knowledge of what is useless when known, 
yet it is well to look into the principles of mesmerism, 
homoeopathy, hydropathy, galvano-therapeutics, spiritu- 
alism, etc., to enable you to speak of them from personal 
knowledge, and to checkmate their representatives, who 
make great capital out of knowing all about the “ old 
school system,” which they of course aver does not com- 
pare with the “ new school ” under which they practise. 
Remember that it is not on account of their methods of 
medication that we object to exclusive systems and refuse 
to fraternize with their followers, but because they re- 
fuse to select remedies from all sources; assume dogmas 
and systems that are limited, and denounce all else. 210 
Were you to announce yourself as an anti-herbalist, 
anti-homoeopathist, anti-allopathist, anti-eclectic, or any- 
thing else calculated to produce division, antagonism, or 
strife, it would be unprofessional, and equally as incon- 
sistent with the spirit of scientific medicine as the 
systems which you were opposing, and would abridge 
your usefulness and render you unworthy of professional 
fellowship, just as it does all others who follow limited 
creeds. 
To limit one’s practice is, of course, quite different from 
limiting one’s creed. You have an indisputable right to 
limit your practice 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. 
Never hold joint discussions or controversies before 
the public with Irregulars or quacks, either through 
the newspapers, or in any other way, no matter how 
false or shallow their pretences are, or how easily their 
weak arguments are refuted by stronger ones. 
Such joint discussions and rejoinders, with the public 
as judge, would result in no good, but would bring your 
opponents into greater notice, gain for them new parti- 
sans, and give them a chance to raise false issues. 
Bear in mind that we condemn no system, or discovery, 
ignorantly, on the principle which governs the Indian, 211 
who disbelieves in the telegraph, or on that by which 
Galileo was persecuted; but, on the contrary, claim 
that competent, earnest, fair-minded medical men, men 
eminent in science, all over the world, both in hospital 
and private practice—with the sole object of ascertain- 
ing the truth for the benefit of science and of suffering 
mankind—eagerly investigate and fully test all dis- 
coveries, theories and so-called systems of medicine when 
they arise, and the conjoined result gives us a true com- 
mon-sense verdict. And it is no more necessary for 
every succeeding generation, with more useful things to 
think about, to waste the time necessary to retest every 
unreasonable medical vagary before rejecting it, than it 
is for every one to study spiritualism and the Book of 
Mormon before condemning them. 
Homoeopathy is not half so new as many suppose. 
Hahnemann started it in 1790, six years before Jenner 
vaccinated James Phipps, and the Organon was published 
in 1810. Now, in this long, long period, had it deserved 
scientific recognition or had there been anything at all in it 
worthy of adoption by the profession, it would surely, like 
vaccination, long since have been absorbed by scientific 
rational medicine, whereas the fact is that to-day it has 
almost faded out in the land of its birth, and is without 
a chair in any university of Europe. 
It was chiefly the over-medication of former days that 
gave it a start. Were any one to originate such a 
system to-day, it would be still-born. 
We of Maryland have unfortunately no medical laws, 
and our common laws do not enter into a consideration 
of the worth, or worthlessness, of various isms, ists and 212 
pathies, but recognize all kinds, even down to notorious 
quacks and impostors, 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, j ust as you do those of 
rational, honorable physicians. In a word, you will have 
to recognize officially every person whom the law recog- 
nizes. State medical laws that legalize everybody are im- 
paired to a corresponding extent. Proper laws—laws that 
would effectually weed out abortionists, pretenders and 
quacks who knowingly deceive and defraud—should be 
enacted and rigidly enforced, instead of laws that compel 
those who administer them, to recognize such people, 
and actually to give them a respectability before the 
public which they could never otherwise attain. 
Quackery subsists almost entirely on credulity, gulli- 
bility and ignorance, and it is your duty to expose it in 
every shape, and to save as many from its evils as you 
can. Wherever you meet it, lift its veil and show its 
unworthiness and the harm that it does. 
Over-dosing, blood-letting, salivating, purging, etc., 
are now justly unpopular, and ultra-conservative, recon- 
structive medicines are in fashion. Almost every one is 
filled with the belief that he is debilitated. Say to the 
average patient “ you are weak and need building up,” 
and you will instantly see by his countenance that you 
have struck his keynote. So much is this the case, 
that many of the sick, fully impressed with this idea, 
will want you to treat them with tonics and stimulants, 
even when their condition is such that these medicines 
are not at all indicated. 213 
You must learn to distinguish cases in which you can 
safely depend on nature, from those that nature cannot 
overcome, and treat each accordingly; for when you 
learn to recognize those that need an ounce of medicine 
and a grain of policy, and those that need an ounce of 
policy and but a grain of medicine, you will have 
entered upon the path of wisdom. When you have a 
patient who needs only a few drops of mint water, or a 
bread pill, for mercy’s sake don’t violate common sense 
and force upon him an infusion of gentian, or a large 
bottle of muriated tincture of iron and quinine, as if your 
chief aim were to disgust him. Give him nothing 
stronger or coarser than he needs, and leave the rest to 
nature. Chagrined homoeopathists and their partisans 
will warmly assert that in doing these things you are 
infringing on them and working on homoeopathic ground. 
But, although you will be catering to the popular taste 
and giving very bland medicine, you will administer 
according to common sense, without regard to similia, 
etc., and will be practising, not homoeopathically, but 
rationally. Handle those homoeopathically inclined, and 
those with highly impressible nervous systems who 
have treacherous stomachs, with kid gloves, and be 
careful to give them as little unpleasant-tasting medicine 
as possible. The recent great improvements in the forms 
and palatability of medicines offer you splendid oppor- 
tunities to do this. Offend neither their eyes, their 
palates, nor their stomachs, and you will succeed, where 
neglect of these precautions will cause failure. Also give 
hypochondriacs, dyspeptics, and others who are fond of 
your attention, but not of your medicine, small, taste- 
less or palatable remedies, and, unless there is a real 214 
necessity for it, do not oblige anybody to take medicine 
before breakfast or to be aroused for the same purpose 
during the night. With such people make free use of 
the bland elixirs, the fluid extracts and the large line 
of sugar-coated granules of arsenious acid, corrosive 
sublimate, cannabis indica, nux vomica, morphia, podo- 
phyllin, strychnia, and other results of artistic elegance 
and chemical accuracy, now kept in every drug-store. 
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 
towards it. 
The smaller, the more striking the means that seem 
to accomplish a result, the more surprising does that 
result appear to a patient. It does not seem wonderful 
to him that he should get better after taking an ounce 
or a pint dose of anything, but improvement following 
a tiny powder, or a pellet, or a tasteless solution, or a 
morphia granule, appears marvellously strange and is 
very pleasing. 
Carry a phial of sugar-coated morphia granules with 
you constantly, and give a proper number of them 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 
drug-store with the remedy you would otherwise order. 
You can also use them to give jaded sufferers an occa- 
sional night of placid slumber, or of delicious visions, 
even though they form no essential part of the treat- 
ment. 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 the hypodermic 
syringe. CHAPTER X. 
“ Behold, how good and how pleasant it is for brethren to dwell togethei 
in unity 1 ”—Psalm cxxxiii. 1. 
Be just and friendly towards every worthy pharmacist. 
Owing to the close relationship between pharmacy and 
medical practice, the pharmacists are your natural allies, 
and should receive your friendship and respect. Prob- 
ably all physicians will agree that in the ranks of no 
profession can a greater proportion of gentlemen be found 
than in the pharmaceutical. 
An excellent rule is strictly to avoid favoritism, and let 
all reliable pharmacists compete for your prescriptions 
and for the family patronage which they influence. You 
will make a serious mistake, and engender active enemies, 
too, if you step out of your way and without proper 
cause instruct patients to buy their medicines from any 
particular drug-store; if a prescription is properly com- 
pounded it makes but little difference by whom, so the 
compounder is honorable and reliable. 
Do not deter your patients from patronizing a phar- 
macist simply because he is also a graduate in medicine, 
unless he is uniting the two callings from mercenary 
motives, or habitually prescribes, or has the drug-store 
as a stepping-stone to get acquaintances and a practice, 
as a preliminary to making his debut as your antagonist 
or rival; but if you fold your arms and allow your pre- 
scriptions to be compounded by a drug-store physician 217 
who prescribes over his counter, or m the 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, sooner or later regret it. 
Independently of all other considerations, the practice 
of pharmacy and medicine simultaneously is too much for 
even the most intelligent of men, and one or the other 
is apt to be slighted; and if your prescription falls into 
the hands of such parties, both you and your patient 
must take a great many risks. 
There is not the slightest wrong in having your name 
printed on your prescription papers. But do not use a 
prescription paper which has any other name upon it 
besides your own. If it contains the name of a 
pharmacist it will naturally suggest collusion or some- 
thing else not complimentary; if it contains some en- 
terprising fellow’s commercial puff, it will indicate 
very ordinary taste for you to use it. It is probably 
better always to write on good plain paper; although it 
could do no harm to have some such phrase as the fol- 
lowing printed on the back of every prescription paper, 
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 an- 
other time, or for other persons at any time, even though 
suffering with the same affection.” 
It would be wrong, very wrong, to receive from a 
pharmacist a percentage on your prescriptions as pay- 
ment for sending them to his store, and for this reason : 
were you to accept such an offer, it would be robbing the 
purse of either the pharmacist or the patient. Were 218 
the former to allow you ten cents for each prescription, 
and reimburse himself by adding that amount to the 
sum charged the patient for the remedy, it could not be 
looked upon in any other light than that you had com- 
bined to fleece ten extra cents from every poor sufferer 
who trusted to your honor. On the other hand, if the 
pharmacist had more honesty than you and allowed you 
to shear ten cents from his legitimate profit, because com- 
pelled to do so or lose your influence, it would place you 
in a most contemptible position, and you would live in 
constant danger of exposure and an indignant public 
sentiment that the strength of Hercules could not, and 
the angry God of Justice would not, arrest. 
Honesty is the great keystone; without it, the whole 
arch of honor falls. You must live, and must have fees 
to enable you to do so, but unless you obtain every cent 
honestly and honorably you cannot escape the finger of 
scorn. 
Watch zealously that the public do not imbibe a be- 
lief that you are a part owner of, or interested in, the 
drug-store which compounds the largest number of your 
prescriptions. If such a suspicion be expressed by any 
one, take care to inform him that you have no such 
interest. 
If any pharmacist volunteers to supply a physician and 
his immediate family with medicines either free or at a 
nominal price, or with such proprietary articles as he 
needs, at cost, the favor can be conscientiously accepted, 
but it seems very unjust for any one to expect or allow 
him to supply a whole generation of uncles, aunts and 
cousins on similar terms. 219 
Never supply one or several pharmacists with private 
formulae that other pharmacists cannot understand, as it 
would at once suggest trickery. A still meaner device 
would be to have a private, a cheating code, for use be- 
tween you and a pharmacist. Surely neither you nor any 
other honest person needs warning against such infa- 
mous systems of swindling as these, for any one who 
would resort to private codes, or cipher prescriptions, for 
money-getting is weak and unworthy, and might be very 
properly classed with the Shylocks who accept a per- 
centage on prescriptions and the wretches who produce 
abortion. 
Although the law has decided that a prescription 
belongs to the patient, the pharmacist, after compounding 
it, has a natural right to retain it as his voucher, but he 
has no right to repeat it without your consent. 
The unauthorized renewal of prescriptions by pharma- 
cists has often produced the opium, alcohol, chloral, and 
other enslaving habits. Now we all 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 quantity, “ Take as directed by Dr. A.,” 
when the physician is not even aware of the renewal ? 
In consequence of the present unfair habit of many 
pharmacists, the unauthorized renewals of prescriptions 
probably outnumber those of the authorized, five to one. 
Drug-stores have become so numerous of late, and the 
area from which each must draw its patronage is so 
small, that their owners, in order to exist, have either to 
charge very high for the medicines prescribed, or substi- 220 
tute inferior drugs; the result is that drug bills have 
gradually grown greater and greater, till of late they 
almost eclipse the expense of medical attendance. Many 
people, to avoid what appear to them exorbitant prices, 
actually buy quack medicines, make home mixtures, 
wend their way to no-drug homoeopaths, or trust entirely 
to nature, instead of paying for prescriptions and then 
having to pay heavily to have them compounded. 
The cost of medicines may be slightly reduced, by 
instructing your patient to save the cost of the bottle by 
carrying one with the prescription; doing so is not at 
all objectionable to pharmacists, as they charge only cost 
price for bottles. A good way to decrease the cost of 
certain prescriptions is to omit inert and unnecessary 
ingredients; for example, if you prescribe a mixture of 
wine of colchicum root, tincture of digitalis and sulphate 
of morphia for a patient, do not amplify what would 
naturally be a one-ounce mixture, that would cost about 
thirty-five cents, into three or four ounces by adding 
syrup, water, or other vehicle, thus swelling the dose to 
a tablespoonful and the cost to a dollar. Prescribe the 
necessary articles only, and let the directions tell how 
many drops to take and how, and when. 
Another evil resulting from there being too many 
pharmacists for all to live by legitimate business, is that 
some, to make both ends meet, encroach on the domain 
of medical practice, usurp our province, and prescribe for 
every foolish applicant that comes along whose case does 
not appear to be formidable, and thus build up a large 
office (or store) practice. How many simple cases are 
in this way yearly converted into incurable ones, and 221 
how many new ailments are induced by such prescribing, 
heaven only knows. Fully one-half of all diseases of 
imprudence, biliousness, debility, cough and the like arc 
now seen and treated by pharmacists, or their apprentices, 
before applying to physicians. Those whose complaints 
prove simple are, of course, cured like magic by the 
four little pills which the pharmacist recommends, or by 
the liniment he devises, or by his great fever-and-ague 
mixture, etc.; and they, thinking that some terrible 
spell has been turned aside, laud the druggist to the 
skies and advise all to go to—Doctor Pharmacist, instead 
of consulting a physician, with assurances that he is as 
good as the latter' and a great deal cheaper. 
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, there is every 
probability that he who takes the prescription to be com- 
pounded, will be presented at tho drug-store with one or 
two quack almanacs or advertising pictures, or that the 
bottle of medicine will be wrapped in some pushing 
fellow’s handbill. The pharmacist’s co-operation as 
retailing agent for quack medicines is indispensable to 
quackery; without it most of the harm that patent 
medicine literature is doing, would cease, the vain 
promises that keep the public rushing from one noisy 
novelty to another, would no longer entice, and at least 
two-thirds of the quack specifics and proprietary trash 
that now curse our land, would pine away and perish. 
You had better avoid all pharmacists whose presump- 
tion leads them to assume the role of physician. This, 
of course, does not refer to emergencies, in which a phar- 222 
macist acts as a humanitarian. Medicines are the phy- 
sician’s tools; a pharmacist may prepare them and handle 
them for a lifetime and be an excellent compounder, and 
yet, as his studies are pharmaceutical, and not thera- 
peutical, he may know no more about prescribing for the 
sick properly, than the mechanic who makes needles or 
scissors does about dressmaking, or the manufacturer of 
trowels and ploughs and chisels about bricklaying, 
farming or carpentering. 
Be also on your guard against instrument-makers and 
dealers who meddle with surgical cases, and manufac- 
turers of appliances for deformities, etc., who presume 
to treat cases that should be referred' to the physician 
or surgeon; and in fact, avoid encouraging any one who 
encroaches on the physician’s province. 
Make it a point never to style a pharmacist, a preacher, 
or any one else, “ Doctor,” unless he is a doctor. Heaven 
knows the title is cheap enough without bestowing it on 
those who have not even applied for it. 
Avoid over-praising prescribing pharmacists to your 
patients, or people will, on your word, overestimate 
them, and rely on their gratuitous advice, instead of on 
the physician’s, at least in all moderate cases. 
Beware of indiscreet pharmacists; as those who talk too 
freely, who converse, joke, etc., while compounding pre- 
scriptions, who put wrong directions, or the wrong phy- 
sician’s name on bottles, or surprise and alarm people by 
charging a different price every time a prescription is re- 
newed, 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 mistakes of the other 223 
half, or who in other ways show abstraction or careless 
compounding. For such people be especially careful 
how you abbreviate and how you make your § ’s and 
3 *s, and carefully dot every i and cross every t in your 
prescriptions. 
In ordering syringes, brushes, atomizers, breast-pumps, 
probangs, etc., with your prescriptions, be careful to 
specify the kind or size you wish. To write a prescrip- 
tion 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. 
If you believe on good authority that any pharmacist 
so far forgets himself as to make disparaging comments 
upon you or your remedies, doses, or apparent incon- 
sistencies, or to exhibit and decry your prescriptions to 
Irregulars, laymen, or other physicians, or to make un- 
authorized substitutions, give under-weight of expensive 
ingredients, or omit them altogether, or to join with our 
enemies in reviling our profession and its imperfections, or 
in nick-naming different physicians in derision, or to keep 
his prescription file open to miscellaneous inspection, or 
to have a medical protege under his wing, to whom he 
endeavors to direct customers for sinister purposes, or to 
be guilty of any other grossly unprofessional conduct, 
you are justified in directing your patients to go else- 
where for medicines. 
You may take the following as somewhat of a guide 
in determining whether this or that drug-store is worthy 
of confidence. Among the distinguishing features of a 
properly conducted pharmacy are : 224 
1'. Proprietor a practical pharmacist. 
2. Competent and courteous assistants. 
3. Pride and skill shown in selecting and preparing 
pure medicines. 
4. Full line of pure drugs kept. 
5. Store neat and orderly. 
6. Quiet and discipline maintained. No loungers. 
7. No liquors sold as beverages. 
8. Not a bazaar of general merchandise. 
9. Nostrums shown and sold only when called for 
10. No habitual prescribing. 
11. Charges neither cheap nor exorbitant. 
12. Prompt attention and accuracy characteristic. 
Among the features that mark improperly conducted 
ones are : 
1. Patent medicine signs prominently displayed. 
2. Patent and proprietary remedies paraded and 
pushed. 
3. Wines and liquors sold as beverages. 
4. Engrossing attention to sale of soda water, cigars, 
tobacco, fancy goods, etc. 
5. Indiscriminate renewals of prescriptions. 
6. Habitual prescribing over the counter. 
7. Disparagement of physicians to the laity. 
8. Loose management of store. 
9. Store a resort for political or other cliques. 
10. Unchaste conversations and conduct. 
11. Dealing in articles used for immoral purposes. 
12. Unnecessary delay and detention of customers. 
Be prompt and decided in refusing to give professional 
certificates to anything secret; do not be too liberal 225 
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 compound- 
ing them. 
Willingness to give medical certificates is an almost 
universal weakness of mankind. The idea of being 
paraded in print as “ an authority ” dazzles all classes, 
and makes them willing to have their names and ail- 
ments paraded in almanacs, handbills and newspapers. 
Many people could almost be inveigled into certifying 
that in medical matters two and two make five, by any 
sharper who understands how to tickle their self-conceit 
and their love of notoriety. 
Be also chary in giving (un)professional certificates to 
any one on disputed or partisan questions, or regarding 
surgical appliances, copyrighted medicines, wines, min- 
eral waters, beef extracts, health resorts, etc., for they 
will affect the general professional interest, as well as 
yours. When you give one, persons who happen to 
know you, may regard its personal and not its professional 
significance, but every one else all over the land will 
notice your title only. When John Doe gives his cer- 
tified opinion that ice is hot and fire is cold, it remains 
simply John Doe’s opinion ; but when John suffixes his 
title of M. D., he undoubtedly gives that certificate a 
professional significance, and, to some extent, involves our 
entire profession therein. 
Judge certificate-giving by its effects on our own pro- 
fession. One of the worst inflictions we endure to-day 
is the endless parade of certificates from clergymen, 
politicians, merchants, lawyers and other well-known 226 
persons recommending all kinds of medical nostrums. 
You know, and every wise man knows, that such certifi- 
cates are not worthy of credence, and that the preacher 
of Gospel truth who, with absurd solemnity, lends his 
name and the cloak of religion to assist wily charlatans 
and commercial sharpers to prey on the afflicted, must 
be either a silly dupe or a cruel knave. 
Every quack knows the influence of a clergyman’s 
endorsement, and hence makes special and often successful 
efforts to obtain it, feeling certain that he can easily 
entrap the individuals of the flock after the leader is 
secured, and it is a singular fact that though few men get 
more gratuitous service out of physicians than ministers 
of the Gospel, yet no class do more to injure the pro- 
fession, by the countenance they give to various kinds 
of quackery, pathies and isms. 
In signing certificates in 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 practise, be careful to record yourself as a regular 
or rational physician, and not as an allopathist. 
Whenever you are asked by proprietors or plausible 
drummers, or tempted by glowing advertisements, highly 
colored certificates, epitomized treatises on therapeutics 
and practice, etc., to prescribe semi-secret trade-mark 
pharmaceuticals, copyrighted medicines, and the vari- 
ous elixirs, restoratives, tonics, panaceas, and other 
specialties with attractive ideal titles, gotten up by 
crusading druggists, manufacturing pharmacists, phar- 
maceutical associations, etc., to catch the popular eye 227 
and the popular dollar—think of the cunning cuckoo 
(see p. 30), tmd how its one egg hatches evil to the whole 
nest, and do not use them. 
To fully realize the enormous proportions of the pro- 
prietary remedy method of replacing physicians, and of 
the mercenary motives 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 which the 
quack and proprietary departments of any wholesale 
drug-store contain, and then reflect on the enormous 
sums of money spent in puffing them. Thus enlightened, 
you can hardly fail firmly to resolve henceforth no 
longer to immolate yourself on that altar. 
Unless you have missed your profession, and if you are 
capable of thinking and have any ingenuity at all, the 
United States pharmacopoeia and the dispensatory should 
certainly be large enough to allow you to exercise your- 
self freely in the art of prescribing, to think out your 
prescriptions and to make any required combination, and 
you should assert your intelligence and follow this, the 
legitimate mode of prescribing, and let ready-made 
substitutes for medical attendance alone. 
The principle governing our condemnation of secret 
nostrums is this: They not only do more harm than 
good, but, if puffing and advertising alone are enabling 
the proprietor of a quack remedy to fleece the sick, its 
unprincipled owner deserves exposure and contempt. 
If the nostrum is really valuable, which is very rarely 
the case, its composition should be freely and fully dis- 
closed for the benefit of the sick and suffering. 228 
You should also maintain your independence and 
never order A’s, B’s or C’s make of anything, unless you 
have some specific therapeutic reason for so doing. To 
particularize thus would not only reflect injuriously on 
every other manufacturer and cause a still greater pop- 
ular distrust of our materia medica, but would also put 
the compounder to additional trouble and expense ; for 
he might have half a dozen other varieties of the same 
article in his stock, and yet be compelled by your speci- 
fication to get another. I knew one case in which the 
pharmacist, though he had twenty-one different prepara- 
tions of cod-liver oil emulsions, had to get the twenty- 
second to fill such a prescription. Besides, it almost 
invites substitution. 
Do not, however, oppose any remedial agent that is a 
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 medicine used, or great perfection in its manufacture. 
Patients think physicians know precisely what a medi- 
cine ought to cost, and will often ask you how much the 
druggist will charge for the remedies you have pre- 
scribed. Answer promptly that you do not know, and 
avoid mentioning any specific sum; because, were you 
to guess too high, they might infer that he had either 
made a mistake, or used inferior drugs; and were you 
to guess too low, they would probably accuse the pharma- 
cist of overcharging, and perhaps drag your name into 
their squabbles. 
Whenever you prescribe a remedy that is unusually 
expensive, such as musk, quinia, oil of erigeron, etc., 229 
take care to inform the patient of that fact, and that ex- 
pensive drugs are no more profitable to the pharmacist 
than cheaper ones, so that he will not be surprised and 
cavil when the pharmacist tells him how much he 
charges for it. 
Notice particularly whether a pharmacist gives un- 
usual prominence to nostrums, quack almanacs and plac- 
ards, or has quack advertising signs painted on his doors 
or outside walls, and it will give you a true insight into 
his aims and attitude towards our profession. If you 
see that he is pushing the quack department, with quack 
proprietors’ portraits in his windows and hanging around 
his store, and his own name and influence used in hand- 
bills and almanacs as a vendor of nostrums, bitters, 
plasters, pads, etc., or selling liquor as a beverage, you 
may be sure that he is conducting his store simply as a 
tradesman, on a trade basis instead of a professional one, 
which supposes him to love his profession and to devote 
his chief attention to the inspection and preparation of 
pure and reliable drugs, and filling prescriptions with 
scrupulous exactness; and you will fulfil a moral obliga- 
tion by rigidly shunning him. 
Possibly you have no right to ask that the pharmacist 
should not handle quack and proprietary medicines, or 
anything else for which there is a demand, as he keeps 
his store to make a living; you have an undoubted right, 
however, to expect him to keep 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, syrup of ipecac, 
and other articles, instead of pushing their sale by dis- 
playing their announcements head and shoulders above 
legitimate pharmaceuticals. 230 
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 good- 
ness; some of our leading 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. Therefore, if 
you think an important prescription is likely to be sent 
to a pharmacist whom you conscientiously believe to have 
inferior or unreliable articles, it is your duty to direct 
the messenger to go elsewhere; for, being responsible 
for the patient’s welfare, and having your own reputa- 
tion to care for, you have a perfect right, and indeed it 
is your duty under such circumstances, to order your 
remedies to be procured where you believe your pre- 
scriptions will be exactly filled. The art of medicine is 
imperfect enough at best, and you will encounter plenty 
of new and strange problems to remind you of your lack 
of aids and of the insufficiency of human resources, with- 
out adding the risk of being thwarted by an unreliable 
pharmacist; but when you find it necessary to ignore any 
one for this reason, take care to do so in a discreet, 
ethical manner, and with as little personality as possible. 
You will for various reasons often wish you had 
synonyms for the terms quinia, zinc, opium, chloral, 
strychnia, morphia, and probably for other articles in 
daily use. Whenever a synonym for any of them is 
supplied, use it. By employing the terlns ac. phenicum 231 
for carbolic acid, secale cornutum for ergot, kalium for 
potassium, natrum for sodium, chinin for quinia, etc., 
you will debar the average patient from reading your 
prescriptions and hampering you, which is in many cases 
highly desirable. You can also further eclipse his 
wisdom by transposing the terms you use from the 
usual order and writing the adjective in full with the 
noun abbreviated; e. g., instead of writing quiniae 
sulph., write sulphatis quin., etc., etc. 
Take care to have all powerful remedies for external 
use labelled “for external use,” or “ not to be taken,” 
which will not only prevent misunderstandings, but in 
case they are swallowed by mistake, it will save you 
from censure; also, for the same reasons, 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'for external use, and at 
the same time one that is to be swallowed, take care to 
tell the patient how each will look and smell, that he 
may not confound them and swallow the wrong one. 
Absent-minded pharmacists have more than once put lini- 
ment labels on bottles containing remedies for internal 
use, and those designed for the latter upon liniment 
bottles, thereby leading to fatal mistakes, which a word 
of explanation from the physician to the patient might 
have prevented. 
Pharmacists might easily avoid the possibility of ex- 
changing labels thus, by compounding one and labelling 
it before beginning the other. Directing the pharmacist to 232 
put a red label on the bottle for external use offers some 
security against mistakes. 
You will notice that some pharmacists label the reme- 
dies they compound for you, with their file numbers only, 
thus, 17,483; while others pursue the much more satis- 
factory plan of adding the date on which it was com- 
pounded, thus 17,483,19-7-85, signifying that it is num- 
ber 17, 483, and that it was compounded July 19th, 1885. 
The latter plan will enable you to distinguish between 
the dates at which you prescribed different bottles of 
medicine, and otherwise be of service to you. I am sure 
the majority of pharmacists would cheerfully make use of 
this system if they were aware how often it assists the 
physician. 
It is well to request neighboring pharmacists always 
to inform you of any ambiguity or apparent mistake in 
your prescriptions before dispensing them, and in return, 
when you suspect there has been a mistake in compound- 
ing a prescription, be very careful not to make your 
suspicion known by either word, look, or action, till you 
have conferred with the person who compounded it. 
Bear in mind that the pharmacist is only human, and 
that he, like every other person, requires some rest and 
relaxation, and do not order mixtures requiring tedious 
manipulations, or direct filthy ointments to be mixed, or 
dirty plasters to be spread, suppositories to be moulded, 
or other unpleasant duties to be performed on Sunday, 
or during sleeping-hours, unless they are urgently 
needed. CHAPTER XL 
“ Sound policy is never at variance with substantial justice.”—Thaer. 
As a physician you will sustain two relations to your 
patients: first, during sickness you will give them all 
your skill and employ whatever remedies will be most 
surely, most safely and most rapidly beneficial; to this 
you will add your deepest sympathy and tenderest com- 
miseration. Later, when by recovery, or death, your 
skill and compassion are no longer required, you will 
enter upon the second, or business relation, and then you 
should demand and secure a just remuneration for your 
services. 
Business is business. The practice of medicine is the 
work of your life; it is as honest, as useful, and as legiti- 
mate as any other; in fact, no one earns his means of 
living more fairly, and often more dearly, than the 
physician. 
You are human, and must live by your avocation just 
as other people live by theirs, but this you cannot do 
unless you have a business system, for upon system de- 
pend, both your professional and your financial success. 
Neither untiring study, nor unselfish devotion as a 
humanitarian, can lift you above the demands of the tailor, 
the instrument-maker, the bookseller, the grocer, the 
butcher and other creditors, not one of whom will take 
your reputation of working for philanthropy, or your 
smiles, thanks and blessings, for his pay; nay, even the 234 
conductor 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 with. 
It is, of course, a pleasant thing to be very popular, but 
even though your popularity embrace the entire city, 
it will neither fill your market-basket nor purchase 
books, pay your office rent nor buy horse feed; and 
though money is not the immediate or chief object in the 
practice of medicine, it ever has been and ever must be 
one of the ultimate objects, and no one can sustain his 
practice without a money feature. If people do not pay 
you, you cannot live by your calling, and you will very 
soon tire of all work and no pay. 
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. 
It is often more advisable even to submit to a reduction 
in a bill for prompt payment, than to let the account 
stand and run the risk of losing it through the pay-when- 
you-please system. After settling promptly, many 
patients will feel free to send for you again and make 
another bill, even in moderate sickness, instead of dally- 
ing with home remedies or quack medicines, as they 
might do if they still owed you. 
You should present your bills while they are small, 
and your services are still vividly remembered, for an- 
other reason : fif you are neglectful or shamefaced and 
do not send your bills promptly, it will create a belief 
that you are not dependent upon your practice for a 
living, have no wants and do not need money, or that 
you do not hold this or that person to your business rule, 235 
or are not uneasy about what they owe you; and if you 
foster such notions, a bad system will grow up around 
you, and great, irreparable loss will result. Asking for 
payment reminds patients that there is still a little of 
the human left in a man, even if he is a physician, and 
that you have to live, and must have your fees to enable 
you to do so. 
The business of the world is now conducted on the 
cash system, instead of the old long credit plan, and you 
should do your share towards breaking up the unjust cus- 
tom that physicians used to follow, of waiting six months 
or a year after rendering services before sending a bill. 
If a physician attends a person, say, in February, and 
sends his bill in March or April, it seems to the patient 
like a current expense, and as though the doctor lives 
by his practice, and it is apt to be paid promptly; 
whereas, if he delays sending it until July or January, 
and then sends one headed with the semi-apology, “ Bills 
rendered January 1st and July 1st,” as an excuse for 
even sending it then, the debtor will naturally think 
that the physician has merely sent it out with a whole 
batch of others, more because he has posted his books 
than from a special desire for its payment; and in this 
belief he will probably let it remain unpaid for months 
longer, and perhaps delay its settlement till it becomes 
an old back debt, which is the hardest kind to pay. 
Besides, time effaces details; and recollection of the 
number of visits, the physician’s watchings, cares and 
anxieties are also forgotten, 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 236 
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 “ Bills collected at the 
end of every six months.” 
You will have to make a great reduction in many 
large bills after they have become old, therefore look 
after them while they are small and recent. Indeed, 
if you let one bill be added to another till the total 
reaches a considerable amount, you may place it wholly 
beyond the power of the person to pay it, and wrong- 
fully force him into the position of a dishonest man. 
The very best time to talk business and have an un- 
derstanding about your fees with doubtful or strange 
patients is at your first visit or at the first office inter- 
view, and the best of all times to judge people’s true 
character will be, not on occasions for social intercourse 
and amenities, but when you have money dealings with 
them. Even a single dollar will sometimes show you 
exactly what a person is. 
Railroad and steamboat companies and other corpora- 
tions, also proprietors of mills, factories, workshops, etc., 
whose employes get injured, in order to relieve them- 
selves from responsibility, or from fear of incurring 
public odium, or from a selfish fear that they may 
become involved in damage suits and be made pecu- 
niarily 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 237 
pay the bill, but afterwards, on one plea or another, 
(usually this—that they have supported the injured 
person during his disability, which is as much as they 
can afford), either entirely disown the debt or refuse to 
pay it, and with such excuses leave the physician in 
the lurch. 
In such cases, you can obviate this result and secure 
justice, or at least ascertain the prospect, by going, 
as soon as possible after you have taken charge, directly 
to head-quarters, or to whoever has the right to make 
the company or firm financially responsible for your 
services, and after explaining the labor and responsi- 
bility which the case involves, make known your fear 
of not being recompensed for your services unless they 
will see to it, and frankly ask if they will assume the 
responsibility. 
From similar motives, the financial 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, has a contagious disease, will some- 
times have you visit their servants, nurses or poor 
relatives, and then escape payment of your bill on one 
pretext or another. These cases should be approached 
in a similar manner as in the last instance. 
Make it a rule to enter the names of those who are 
financially responsible for such services in your book, 
and keep a memorandum of the facts that make them 
so, and make out your bill to them accordingly. 
If you take these precautions, it will prevent many 
unpleasant misunderstandings and save you many a 
hard-earned dollar. 238 
Make it a rule never to accept a commission or fee 
from any one under circumstances which you would not 
willingly submit to investigation by the public, a medi- 
cal society, or a court of justice. Your severest test will 
be when money is enticingly offered to induce you to do 
doubtful things. 
You will not have practised long before you will find 
that your welfare will not depend upon how much you 
hook, but upon how much you collect, and that if you 
never insist upon the payment of your fees, you can 
never separate the chaff from the wheat. If you have 
a rule and people know it, they associate you and your 
rule together. Let the public know what your system 
is in the early years of your practice, or you cannot do 
so afterwards. When a new family employs you, render 
your bill as soon after the services as gentility will 
allow, especially if there has been a previous attendant 
who was an indifferent collector or no collector at all. 
Send your bill as a test, and if there is objection to you 
because you want your fee, the sooner you find each 
other out and have an understanding, or part company, 
the better it will be for you. 
When patients ask you how much their bills are, or 
how much they owe you, after office consultations, 
operations, etc., always answer promptly, soberly and 
decidedly, “one dollar” or “ ten dollars,” or whatever 
else the amount is. If you avoid preceding, or follow- 
ing this reply with any other words, most people will in 
the embarrassment of the moment, proceed to pay you 
without objection, whereas if you add more words, it 
will weaken your claim in their minds, or make them 239 
believe you have no fixed charge, and will furnish them 
with a pretext to show surprise and to begin to contend 
for a reduction. When one does demur at your charge, 
show your amazement at his doing so, and be ready 
instantly to defend, or explain the j ustice of the charge. 
Accounts for surgical cases, midwifery, poisoning, and, 
in fact, for all unusual cases, should be promptly 
44charged up” on your books; for unless this is at- 
tended to, the patient may come unexpectedly to pay 
his bill, and you may through embarrassment, or lack 
of full remembrance of the services, name entirely too 
low a figure and do yourself an injustice. Besides, 
having the amount already determined upon and written 
down shows it to be the fixed price, and the patient is 
less apt to ask for a great reduction, if any. 
Take your fees whenever tendered. Patients will 
often ask, 44 Doctor, when shall I pay you ? ” or 44 Shall 
I pay you now?” A good plan is to answer promptly, 
44 Well, I 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 44 Short payments make long friends,” or 44 Prompt 
pay is double pay, and causes the physician to think more 
of his patient,” or something of that sort. Never give 
such answers as, 44 Oh, any time will do !” or 44 It makes 
no difference when,” or you will soon find it to be expen- 
sive modesty. 
Never neglect to post your account books; for it 
would be violating the first law of nature to attend 
faithfully to the department of your occupation that 
concerns others and neglect the one that concerns your- 
self. The Scripture command is, 44 Love your neighbor 240 
as yourself”; it does not say, Love him more, but it 
does say, The one who does not provide for his own 
household is worse than an infidel. 
A good plan is to put the names of transient patients 
on your cash book, instead of blurring your ledger with 
them, and give a page in the latter only to patients 
with whom you think it likely you will have a per- 
manent account. 
When a transient patient pays cash at the visits, 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 into a P, signifying' paid. 
You can fix your visiting list in a few moments, so 
that it will always open at the page then in use. To 
do this, clip off about half an inch of the upper corner of 
its front cover, thus , and then in the same way clip off 
the corners of the leaves thereby exposed, down to the 
page corresponding with the date of the act. When thus 
prepared, if you place your right thumb on the exposed 
corner of the uncut leaves, the book must open at the 
proper page. As time passes, clip each page when you 
wish to pass from it. 
Your visits and cash entries in your visiting-list and 
day-book should be written in ink; for being original 
entries, they would be accepted in court as legal evi- 
dence. A good way to prevent forgetting any one or 
anything is to put names, visits, etc., down in your visit- 
ing-list with a lead pencil without delay, till you have 
a chance to rewrite them with ink. 
At the end of every week add up the visits made to 
each one whom you have attended during the week, 241 
and after ascertaining the total sum which you should 
charge therefor, put that amount on the visiting-list in 
the blank spaces found at the end of the lines after the 
Saturday column. By doing this weekly, you can accu- 
rately estimate and charge the value of your services to 
each patient, while they are still fresh in your mind. It 
is wise not only to enter at the end of each week the 
amounts charged, but also to write the names of the 
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 dis- 
puted. 
In posting your account books at the end of each 
month, in order to avoid missing any entry in transfer- 
ring your visiting-list charges to the ledger, use a regular 
checking-oif plan. A very 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 
for each week’s services and put them after their respec- 
tive names; after you have all the charges transferred 
in this way to the foolscap, run over your ledger, page 
after page, and look at every account as you go along. 
When you reach the name of any one against whom you 
have a charge to make, add up all you have marked 
against him and enter the total on his page of the 
ledger; but, instead of wasting time to write November, 
1885, $7.00, enter it 11-85, $7.00, then cross that 
person’s name off the foolscap list, and continue on, page 
after page, through the entire ledger. By this crossing- 
off system, if you fail to charge any one’s account as you 242 
pass it, it will remain uncrossed when you get through 
the list, and will thus be detected. While going over 
the different pages of the ledger to enter charges, notice 
all accounts that need rendering, and take the number of 
each one’s page on one of a pile of blank bills at hand 
for the purpose (or on a slip of paper), so as to return 
and make out his bill after completing all your entries; 
also make, while turning the pages, a list of such delin- 
quents as it would be proper for you, or your collector, 
to ask for money during the approaching month. 
When you make out a bill, put on your ledger, in the 
space just after the amount, the date on which the bill 
for that amount was rendered; thus, $7.00, with 1-8-85 
after it, would signify that a hill for seven dollars was 
rendered to that person on the first day of the eighth 
month, 1885, or it may be written as the Quakers do, 
month first, then day, and then year, thus: 8-1-85. 
(Enter payments in a similar way.) 
A good way to save the trouble of looking over worth- 
less or dead accounts on your ledger, month after month 
and year after year, is to cross them off, using lead 
pencil, which can be erased at any time, if necessary, for 
such as may possibly be revived; and for those that are 
dead, or sure, from other causes, never to employ you 
again, use ink. 
That a patient whose name is on your hooks is a 
colored person, can he easily indicated by putting three 
dots after his name, thus: Robinson, John j 13 Colum- 
bia street. 
Patients will occasionally dispute the correctness or 
j ustice of your charges. If a bill is not correct, correct 243 
it cheerfully; if it is correct and just, do not allow 
yourself to be browbeaten into the position that it is 
not. Many people are not aware that the charges for 
surgical and various extra cases are higher than ordinary 
visits; some seem to think that for a visit at which you 
reduce a dislocation, open a large abscess, make a vagi- 
nal 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. Of course, you must correct their error by ex- 
plaining the difference, or, if necessary, by reference to 
the fee table. 
Never undercharge for your services. It is ruinous 
to your interests and the interests of the entire profession. 
The tendency of undercharging is to depress the fee 
table permanently and to compel all physicians to work 
for under-pay. There is a vast difference between 
underbidding in our profession and underbidding in ordi- 
nary business pursuits. In the latter, cut-rates are only 
temporary; for, if merchants were to sell goods at or 
below cost for a length of time, failure would result. In 
business wars one withdraws, or they compromise and 
each advances again to full prices; warring physicians, on 
the contrary, having no goods to manufacture or to sell, 
can keep up the strain of rivalry for years, give their 
skill to everybody for insignificant or nominal fees, 
impoverish one another, and almost starve those depend- 
ing on them for support. 
The wisest rule in charging for your services is to ask 
from the beginning of your career the fees usual for the 244 
best attendance, neither extravagantly high nor ridicu- 
lously low. 
Let people know that you strive to make your hills 
as small as possible, not by undercharging, but by get- 
ting them well with as few visits as possible. 
Never bargain to attend a patient or a family by the 
year; it is better to be paid for exactly what you do, 
than to have some people feel that they are giving you 
twenty dollars for five dollars’ worth of service, and to 
feel that you are giving other people fifty dollars’ worth 
of service for twenty dollars. 
Also, never bargain to attend whole neighborhoods of 
poor people at reduced rates; it is lowering and never 
works successfully. Indeed, if you ever attend a con- 
finement or other case in a family for a nominal fee, 
you will not be able to raise the fee to the regular price 
again in that family, or even with others who hear of it. 
Even though you are sure you will have to receipt 
your bill for a reduced amount, make it out for the 
standard sum, that the debtor may know your rates, 
and give you credit for whatever reduction you make. 
In attending an extra case for one who is very rich or 
specially liberal, leave to him the valuation of the bene- 
fits, unless he insists on having a bill. In the latter 
case, charge him no more than any one else for the same 
services. In the former you may, by submitting it to 
him, be paid most munificently, possibly a thousand 
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 making the rich 
pay you more to make it up, take less if you think 
proper, but say not a word that would allow them to 245 
infer that you, or any other physician, would charge any 
one, whether rich or poor, a cent more than he honestly 
owes. 
It is customary and just to charge double for the first 
visit to a case, chiefly for the following reasons: You 
must at the first visit devote an extra amount of time 
and attention to learning the history of the case—must 
involve yourself in a diagnosis, and probably also in a 
prognosis,—must establish a line of treatment,—must 
instruct the nurses,—must map out the diet, point out 
the requirements of hygiene, lay down rules regarding 
temperature and ventilation, and formally assume all 
the responsibilities of the case. These combined fully 
justify a double charge for the first visit. 
There are a few people who think that when a case 
is severe enough to require the physician to make more 
than one visit a day, he should not charge for the addi- 
tional visits, unconscious, as it were, of the fact that 
cases dangerous enough to require an extra number of 
visits are the very ones which throw upon him the 
greatest responsibility, cause him most anxiety, and 
contribute most largely towards making his life one of 
hardship and self-denial. 
You will often have people to complain that their 
bill is high and ask you to make a reduction; yet, many 
of these very people would not employ you, if you were 
a third-rate or low-priced physician. Everybody wants 
first-class services, but wants them as cheaply as pos- 
sible. It is not human nature to prefer a fifty-cent silk 
to a two-dollar silk; but if people are lucky enough to 
get the two-dollar silk for one dollar, they congratulate 246 
themselves. They reason the same way about physh 
cians; very few prefer or appreciate a low-priced 
physician. 
In unusually severe cases, in those that require very 
great exposure or extraordinary legal or professional 
responsibility, in cases of restoration after poisoning or 
apparent drowning, in small-pox and other contagious 
affections, the fear of which prevents other patients, who 
know you are attending them, from employing you, or 
which compel you to lose time in changing your clothes 
and otherwise disinfecting yourself before visiting others 
not affected, or in which you have shown extraordinary 
skill, or had very great luck in had cases of any kind, 
you should charge round fees. 
It is certainly worth more to attend a person through 
a pneumonia which causes the physician great anxiety 
and necessitates much study, than one with a sore finger 
or toe, even though the two cases require an equal 
amount of time or the same number of visits. 
In some cases your charge will be not so much for 
doing the work as for knowing how to do it; for in- 
stance, you may charge twenty dollars for the few 
minutes’ work of reducing a luxated humerus; were 
this itemized it might read: u For reducing dislocated 
shoulder, five dollars ; for knowing how to do it, fifteen 
dollars.” 
Attendance on a beloved child, an eminent or very 
important member of the community, or a stranger who 
has journeyed far with an important case that causes 
you special anxiety, justifies a special charge, whether 
attended at your office or at the homes of the patients. 247 
In such cases be careful to pay no unnecessary visits ; for 
in a very important case actually requiring three visits, 
to which you make but three visits, they will appreciate 
you more highly and will more cheerfully pay a hun- 
dred dollars, than if you had also paid five additional, 
apparently unnecessary, visits and charged but $80 for 
all. 
On the same principle, when you have severe cases of 
any kind requiring numerous daily visits, take care to 
diminish them markedly as soon as the necessity is 
over. 
In extra and complex cases and where the results are 
apt to be grave and far-reaching, or in which you go a 
long distance, or at very unusual hours, or go through 
storms or 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 an office advice as for a visit to their 
house; explain to them that although the charge is the 
same, it is much cheaper to be an office patient than to 
be visited at home, because an office patient usually 
comes but once, or only when his medicines are out, or 
when some important change has taken place in his 
ailment, and quits entirely as soon as possible; whereas, 
if you have him under care at home, your responsibility 
and feeling of uncertainty compel you to visit him fre- 
quently to ascertain whether he is getting along as ex- 
pected. For these reasons a few office consultations 
with the responsibility of attending faithfully resting on 
the patient, if on either, often suffice, instead of many 
house visits, and in this way office advice becomes very 
much cheaper. 248 
Many people who are mean about paying will want 
you to deduct largely from their bills, when these hap- 
pen to be chiefly for office consultations, vaccinations and 
other services of the simpler kind. They should be 
met with the argument that if they pay you less than 
the average for the minor services, they must pay you 
more than the average for more important ones. 
The difference between words used with office patients 
will sometimes be to you the difference between a fee 
and no fee. Some who consult you, if asked to call 
again to let you see how they are getting along, will, on 
returning, show by every word and every action that 
they do not expect to pay for calling, as they merely 
called because you requested them to do so. There- 
fore, unless you intend to omit the charge, it is better to 
advise them to consult you again, at whatever time you 
see proper to designate. This will convey an under- 
standing that your regular fee will be charged. 
When a stranger, whose honesty you have reason to 
doubt, consults you at your office, and instead of paying 
the fee postpones it, with a promise to call again, if you 
ask his name and residence and hook them before his 
eyes, you will greatly increase your chances of getting 
paid. 
Never agree to attend any one for a “ contingent fee,” 
that is, do not take patients with chronic sores, constitu- 
tional headaches, epilepsy, cancer, post-nasal catarrh, 
piles, dyspepsia and other chronic affections, or cases of 
syphilis, gonorrhoea, etc., on the “ no cure, no pay ” plan, 
or to pay “if their expectations are realizedf or “ when 
all is over.” Make no such agreements; for they are 249 
never satisfactory, and will generally end in your being 
swindled, and it may be, charged with malpractice. 
Use the argument that you are willing to undertake the 
duty, but that you charge for services, not for results, and 
must be paid for your attendance even though the 
patient dies, and that all who employ you must take the 
probabilities of cure or relief. You might also hint to 
those who you think are unworthy of credit that if they 
pay as they go it will encourage you, interest you more 
in the case, and naturally stimulate you to do your 
best. 
Some persons suffering with constitutional syphilis, 
ulcerated legs, chronic eczema, etc., in which the treat- 
ment may extend through months or years, may imagine 
you should wait for your fees till done attending. Do no 
such foolish thing, as such a case may die or move away, 
or abandon treatment, or slip from you to another, or 
even resist all your attempts to cure, and you may get 
nothing for all your work. 
It is far more just and wise in such cases to render 
your bills at the proper time—“for the three months 
ending—,” or at the very furthest the first of every July 
and January. If they demur (which they cannot justly 
do), express your surprise at their doing so, and remind 
them that you must live by your practice, and tell 
them of your entire unwillingness or inability to let 
your fees accumulate as they suggest. 
You should ordinarily manifest no undue anxiety 
about your fees, and make no mention of your intended 
charges, unless you are dealing with people notoriously 
unworthy of confidence, or when there is great danger 250 
of a misunderstanding, "but you should not fail to demand 
your fee in advance for attending cases of secret diseases. 
If you do not, your patient will almost surely leave you 
about the time the case is completed, with his bill un- 
paid ; and if you bother him about it, he will either pay 
it grudgingly or not at all, and if you dun him for it, 
will meanly assert that it was not a disease but only a 
strain, or that you did him no good, or almost killed 
him, or tell some other lie as an excuse for deserting and 
cheating you. Another reason why it is proper to get 
your fee in advance is that many would never come and 
pay it till you had sent them a bill by your collector, 
and would then indignantly claim that you had insulted 
and exposed them by sending a bill of that kind. 
You have no right, either legal or moral, to expose 
the nature of any one’s disease because he has failed to 
pay your fees. 
Venereal diseases are the result generally, not of mis- 
fortune, as other inflictions are, but of imprudence, and 
are self-inflicted. And for this reason venereal patients 
have not the claim upon your sympathy of other 
patients. Get a just fee in all cases of this kind before 
you begin treatment; then stick to the patient until he 
is cured. He is not likely to change from you to an- 
other after he has paid you, and if his case proceeds 
slowly he cannot then suspect that you are purposely 
running a big bill on him, or delaying the cure on ac- 
count of his being a good-pay patient, as he might do if 
he were paying you a dollar or two a visit. 
Most men think they cannot have constitutional 
syphilis unless they have detected a terrible chancre at 251 
the beginning. You will often have difficulty in mak- 
ing persons who have not detected a primary sore, be- 
lieve their ailment is syphilis. Some men will actually 
scan you and quiz you when you tell them they Jiave 
the p-x, as if they thought you a quack or an impostor, 
trying to scare money out of them. If you can show 
such a patient a fac-simile of his chancre, roseola or 
mucous patches in your illustrated text-books on venereal 
diseases, or even read to him a description of them, it 
will awaken him to his actual condition and guard him 
against either neglecting his case or infecting others. 
When you are certain that your diagnosis of syphilis 
is correct, look the patient in the eye, and with a manner 
that shows you speak from knowledge, tell him that in 
your opinion he has genuine 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 very protracted; therefore the fee should never be 
nominal. 
You can broach the fee question to any patient with 
a private disease by remarking immediately after mak- 
ing your first examination, “ Well, I see what your case 
is, and am willing to take charge of it and give you my 
best services, if my terms will suit you” This will 
compel him to ask you what your terms are, and will 
give you an opportunity to tell him. Or, if you regard 
the services which will be required as very valuable, 
whilst it is apparent that he thinks the reverse, if you 
will begin with the remark, “ Ah! I fear I would charge 
you more than you would be willing to pay,” this also 252 
will compel him to question you upon the subject, and 
that too in a somewhat more favorable frame of mind 
for your purpose. 
S.ome people believe the law compels you to attend 
any one who chooses to send for you. It does not; but 
public opinion would justly condemn you, if you were 
simply, on account of fees, to refuse to attend an urgent 
case where humanity should prompt you to go. If you 
are “ too busy ” or u not well enough,” or have another 
duty to perform equally as urgent, this will generally 
prove sufficient to protect you against argument or 
criticism. But “ I'm just at dinner,” “ I’m too tired," or 
“ I need sleep," or “ lam afraid I will be dragged into 
court as a witness,” etc., are not accepted by the public 
as sufficient reasons for refusing to go to a case, and 
should never be offered. 
Not only should you send your bill to a patient at the 
proper time, but if you do not hear from him within a 
reasonable while thereafter, emphasize it by sending an- 
other, for he may not have received the first, or may 
have thrown it aside, or may be neglecting it in the hope 
that you will let it sleep till it is forgotten or out of 
date. 
A very effective plan to use with a certain slow class of 
patients, when you are in need of money, is to learn the 
date at which you will have a note or bill to pay, or 
when you will have to raise money for any other special 
purpose, and to write about two weeks before that period 
and inform them briefly that you will have a special 
need for money at the time you name, and ask them to 
come and pay you on or before that date. Most worthy 253 
people will exert themselves to comply. You can in 
this way approach both your best and your worst 
patients, and some that you cannot successfully approach 
for money in any other way. Asking in this way, more- 
over, shows that you do not want simply to get it out of 
their hands into yours, but that you ask for it because 
you happen to need it. 
Another plan, good to pursue with those who habitu- 
ally throw bills aside and neglect to pay them, is to send 
their bills some day when you are in need of funds, with 
a brief note asking them to pay that day, and tell your 
urgent reasons for asking. Even though they pay you 
nothing then, knowing that they have disappointed you 
in your emergency will make them feel impelled to pay 
you something the next time they call on you for ser- 
vices. 
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, it will serve as a gentle 
hint and give them time to prepare, and will greatly in- 
crease your chances of getting your bill paid cash at the 
last visit. Convalescents from severe cases who are told 
to visit you at your office after they are again able to 
walk out, in order to let you see how they are getting 
along, are very apt to broach the subject of settling, 
and either pay, or make some definite promise before 
leaving. 
It is wise to post your books, make out bills, settle 
with your collector, and in fact to conduct all the 
features of your pecuniary department, as much out of 
public sight as possible, that the public may know little 
or nothing about you except as a medical attendant. 254 
You cannot put all kinds of bills on the same footing; 
there is one class of patients whose bills had better be 
sent by mail, another to whom they had better be taken 
by your collector, another where you had better deliver 
them yourself, and a few prompt-pay patients with 
whom it is preferable to wait till they ask for them. 
Try to gain as much benefit as possible from a study of 
this fact. 
Items and details had better never be specified on a 
bill, unless specially asked for. They often dissatisfy 
people, and lead to criticisms and disputes that would 
not arise did not the items furnish a pretext. Assume 
the position that those who confide in you sufficiently to 
put their lives and their secrets in your keeping, should 
feel sufficient confidence and gratitude to permit you to 
say what value you place on your services to them. A 
physician’s bill that gives items is apt to be disputed, 
or criticized, unless it is unjustly small. Bills that simply 
state the total amount, or amount due for services since 
date of last bill, are much more likely to be paid without 
dispute. The items of every bill should, however, be 
carefully kept on your book, that the charges may be 
verified if requisite. 
It is well to insist on giving receipts to people when 
they pay you money, even though they should deem it 
unnecessary. Compelling every one who pays to take a 
receipt, not only prevents subsequent disputes, but also 
assists in keeping up a regular business form between 
you. 
Avoid avarice in its various forms, meanness, oppres- 
sion, cruelty, etc. If you were to shave too closely in 255 
money matters, or to be unreasonable, or too vigorous in 
your efforts to collect bills from any one, it would not 
only be wrong, but would be very apt to injure your 
reputation and create a hostility that time could not 
blot out. 
For the same reason it is, as a rule, better not to 
charge for certificates of sickness furnished patients to 
enable them to draw benefits from beneficial societies, 
or for certificates of vaccination, etc. These are personal 
favors, differing from cases in which a fee is proper. 
It will seldom pay you to sue people, even if you 
should gain the case. It is unwise for you or any other 
physician to begin litigation except under very aggra- 
vating circumstances, or to maintain your reputation or 
self-respect. You should never sue any one whose failure 
to pay is due to honest poverty. Be willing to do your 
share of charity for the virtuous poor at all times, but 
the necessity of earning a living should make you care- 
ful not to let that kind crowd out your pay practice. 
It will usually be wiser not to send a bill for going 
to cases of sudden death, drowning, suicide, persons 
found dead, murder, etc., in which the victim is dead 
before you reach him, or in emergency calls, where 
another physician reaches the patient and takes charge 
before you arrive, or in other cases where your ser- 
vices and efforts are not called into action, or are brief 
or nominal or clearly useless, as a bill under such cir- 
cumstances is generally not only not paid, but is harshly 
criticized. If, however, grateful people volunteer to 
pay you for your trouble, take whatever is right. 
In hopeless cases of cancer, phthisis, etc., which, after 256 
going the rounds of the profession, consult you in the 
very last stages, merely to see whether you can pos- 
sibly do anything for them, you had better frankly 
acknowledge that you can do but little, or nothing, and 
decline the fee even if tendered. 
It is usually better to make no charge for ordinary or 
trifling advice incidentally given to patients when they 
call to pay their bill, or to persons for whom you hap- 
pen to prescribe in public places, where you are not pur- 
suing your functions as a physician. Such exactions 
would, to say the least, risk unpleasant remembrance 
and harsh criticism. Every physician sometimes writes 
prescriptions under circumstances where, even though 
he be technically entitled to compensation, his own 
interests forbid his making a charge, or even accepting 
a fee when tendered. 
Never make a charge where the fee would come from 
another physician’s pocket; every physician attends his 
professional brethren and their families gratis. Some 
also attend clergymen and their families without charge, 
especially those with whom they have church relations, 
and those who receive salaries so meagre as to make 
the payment of medical fees a hardship. 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 volun- 
tarily tendered. Many of our best physicians 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. 
Never oppress any one by exorbitant fees. Be especially 257 
fair" in your charges against estates, and in all other cases 
where unusual circumstances place the debtor at your 
mercy. These opportunities will truly test your honesty. 
When you are in doubt what to charge, look around you, 
then upwards, then make out your bill at such figures 
as will show clean hands and a clear conscience. 
When you and a professional brother do each a por- 
tion of the work in cases of accident, confinement, etc., 
a very fair plan is to agree to charge a joint fee and 
divide it. When you receive such a joint fee, go at once 
and with straightforward manner divide every dollar 
with your fellow-worker, on whatever basis you have 
agreed upon. 
Never acknowledge or work under the fee-table of 
any association or company, unless it be in harmony 
with the regular professional fee-table of your com- 
munity. 
Humanity requires you to go to all cases of sudden 
emergency, accidents, etc., in which the life or limb of 
a fellow-being is in jeopardy, without regard to the pros- 
pect, or non-prospect of a fee. You should do various 
things for the sake of charity; among these is to give 
relief to any one injured, or in great pain or distress, 
regardless of fees. At such times think only of your 
duty to humanity. The good Samaritan succored the 
wounded man, and took him to an inn and provided for 
his immediate necessities. You, as a physician, should, 
for humanity’s sake, go and bind up wounds, mitigate 
pains and relieve suffering in all cases of emergency. 
After this is done, further attendance is, of course, 
optional. 258 
When another physician is called to a case of yours, 
during your absence, not only thank him when you 
meet, but also insist on his sending his bill for what- 
ever 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. 
It is your duty to raise your voice in the profession 
against the encroachments of the free special dispen- 
saries, and low fee hospitals and infirmaries which, 
under the great plea of charity, attract swarms of 
patients—among whom are many who are abundantly 
able to pay for medical services. 
No member of the profession—and the same may be 
said of pharmacists and physicians who keep drug-stores 
and prescribe over their counters—has a right to give 
professional services to the public without fee, except to 
the moneyless poor (to whom they should be given as 
freely as the air they breathe); for even though there 
may be no loss thereby to him personally, it is taking 
bread from the mouths of others, and to that extent it 
is robbing the profession at large of its just fees. 
Thousands of dependent physicians have been, of late, 
cheated out of their living by so-called “ Special ” Chari- 
ties, carried on chiefly in the interest of individuals, or 
coteries, who, to foster reputation in their specialties, 
treat everybody that applies, the rich, the poor and the 
intermediate class, without the slightest regard to the 
interest of other medical men. The ultimate result 
of this state of things will be either that the profession 
will, in self-defence, be compelled to organize self-pre- 259 
serration associations, or that individual physicians will 
take up the case and refuse to consult with any special- 
ist, professor or surgeon who continues to render 
gratuitous service to those who are able to pay for it. 
Never slight the worthy poor who are under the iron 
heel of poverty and need medical attendance; to the 
poor, life and health are everything, and there are none 
so poor but that they may amply repay your services 
by genuine, lasting gratitude. 
Physicians render more unpaid services than any 
other class of people in the world. “ The poor,” said 
Boerhaave, “ are my best patients. God will be their 
paymaster.” But even in doing charity, you must dis- 
criminate. There seem to be three classes ofithe poor: 
The Lord’s poor, the devil’s poor, and the poor devils. 
The first and last are worthy objects of every physician’s 
attention, and you should lose no opportunity to give 
relief to their distress. The less you have to do with 
the other class, the devil’s poor, the better for you, but 
you will be compelled to attend more than you choose 
of the lowest and meanest of these, some for God’s sake, 
and some on account of their relationship to better 
patients. 
“Prompt payments fully appreciated,” is a very useful 
maxim to have printed on your bills; it is truthful, and 
gives thanks to those who pay promptly. To those 
who do not, it serves as a neat admonition. 
You will find that honesty and dishonesty are not con- 
fined to any one nationality, or to any station in life; but 
that there are many very good men and many very bad 
ones alike among the rich and poor, the white and black. 260 
You will mount many a marble step, pull many a silver 
door-bell, and walk over many a velvet carpet for pa- 
tients who will prove fraudulent in the superlative de- 
gree, and you will get many an honest fee from some 
who make no great pretensions and possess but little 
save their honesty. Indeed, the demands of fashion are 
now so great that many people with moderate incomes, 
anxious to appear better off than they really are, habit- 
ually slight their physicians in order to help keep up 
appearances. You will see many a man bowed down 
with debt and despondency, while his wife and daugh- 
ters flutter around as fine as peacocks, owing everybody 
and paying nobody. Indeed, tricky, double-dealing 
women will sometimes actually intercept your bills and 
make it impossible for you to ask their husbands for 
money, unless you resort to strategy and get your bills 
delivered by your messenger directly to the latter; and 
will even then do everything they can to postpone or 
entirely prevent payment. 
Families will occasionally conceal from the person 
who is to pay your bill, the true amount of services you 
have rendered or the full number of visits you have 
paid, and thereby lead him to think you have charged 
very high or even overcharged for the services. Be 
ready promptly to correct such errors. 
The most unsatisfactory and the most troublesome 
kind of patients physicians have to contend with are the 
unprincipled tricksters who cheat everybody that gives 
them a chance, and consider it no wrong at all to swindle 
physicians. You will be fortunate if you have tact 
enough to escape having anything to do with those 261 
whom you know to belong to this class. It is better 
mildly but firmly to decline to take patients who can 
but will not pay, without assigning any reason except 
“ too busy,” or “you had better get some one else,” than 
to have to contend with them about your fee after your 
work is done, and maybe, after all, be swindled. 
Tell habitual delinquents, and those who have plenty 
of money to buy beer, or to furnish their houses like 
palaces, or to follow the follies of fashion, but none to 
pay the physician—when they come to make their bills 
larger—that they are already as largely indebted to 
you as you can afford to let them be, but that you are 
perfectly willing to go and serve them again, after they 
pay you what they already owe you, or a reasonable 
part of it. This attitude will bring them to some 
action, or at least indicate to you the probable prospect. 
You will encounter many a person who, although 
quite amiable during your attendance, will prove very 
different when your bill is presented. Allow no ground 
for finding fault with your manner of presenting it. It 
is a useful precaution to enclose bills sent by mail or 
messenger in a half-sheet of paper, to prevent prying 
custodians from peering through the envelope and recog- 
nizing its contents. 
When possible, have the bills presented directly to 
the financially-responsible party, or the real head of the 
family, and say nothing at all about them to the other 
members of the household. 
A moderately successful practitioner has about two 
thousand persons who call him their physician ; when- 
ever any one of these has a mental or physical ailment, 262 
he must share it. He must be bold as a lion with one 
patient and as gentle as a lamb with the next. He must 
combine all good qualities and appear the perfection of 
each to all men, and heaven knows! he deserves far 
better treatment and a much more comfortable support 
than he receives. 
The fact that a physician must keep up appearances, 
and that many make their visits with gloved hands, and 
in stylish carriages, is regarded by many unreasoning 
persons as evidence that ours is a path of ease—that we 
ride around during bank hours, prescribe for a few select 
patients, receive dollars by wholesale, and soon get rich, 
which is a great, a very great mistake. On the contrary, 
every older physician knows that it is almost impossible 
to get rich by the practice of medicine, unless it be 
through a money-making specialty, commanding fancy 
fees. 
The truth is, when many a physician dies, those de- 
pendent on him are left poor and helpless, unless 
he has acquired money otherwise than by practice. 
Were you to practice for thirty years without losing a 
single day, and collect eight dollars every day of your 
life, you would receive but $87,600. Deduct from that 
amount your expenses for yourself and your family, 
your horses, your carriages, your books, your instru- 
ments, your taxes, and a multitude of other items, for 
the whole thirty years, and then, so far from being 
rich, even after so long and lucky a career in this im- 
portant and honorable profession—after a whole lifetime 
of anxiety, responsibility and usefulness—you would 
have but little, very little, left to support you in your 
old age. 263 
The physician is, as a rule, so poor a business man 
that if he collects money enough to meet his necessities, 
he is not troubled about the balance. The author had 
a friend, an excellent physician, who was so neglectful 
of his fees that he kept no systematic accounts what- 
ever; the result was that his easy terms, together 
with his skill, made him unusually popular and kept 
him over-worked day and night till, at the end of four- 
teen years, the strain broke him down and he died, 
almost, as it were, by suicide, leaving his widow and 
children nothing, except regret at his foolish lack of 
business system. What sane physician would follow 
such an example! 
A good, honest collector, one who has proper discre- 
tion and tact enough to get money from dilatory debtors 
without irritating them and making you active enemies, 
will be very useful, and is quite necessary if you have 
no time or are a poor collector yourself. Having only 
business transactions with patients, his interviews with 
them are business exclusively, and he can persevere in 
his efforts to collect, to a degree which you would find 
unpleasant or humiliating. Many really honest people 
are too poor to pay large debts, and were you to allow 
what they owe you to accumulate from time to time into 
a large bill, they could not pay it to you even if they 
wished, and you would actually place them in a 
dilemma. Having a collector prevents this, and keeps 
your financial department in a good condition. It also 
stimulates those who are habitually slow in paying, and 
sifts out the fraudulent before they run their bills very 
high. You should have some specific agreement with your 
collector, not only regarding his rate of percentage for 
collecting, but also regarding the conditions under which 
he is to claim it. Among other things, stipulate that 
he is to make full returns to you at least once a week, 
that he is to have no percentage on money paid to you 
by those whom he has not visited for thirty days, unless 
you have at their request stopped him from going; and 
that he is to receive nothing on bills placed in his hands 
if the parties come and pay them before he has delivered 
their bills; in fact nothing on any bill which he does 
not in some way assist in collecting. 
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, of the debt, 
every time the color arrests their attention, and may, 
by constantly reminding them, actually secure or accele- 
rate payment. 
An interchange of lists (black-lists) of the names of 
fraudulent patients among physicians practising in the 
same section, is mutually profitable, as it often prevents 
the unprincipled who could pay if they wished, from 
systematically imposing on a succession of physicians, 
and coerces them into retaining and paying some one. 
Of course, the worthy poor, if unable to pay, should 
always be omitted from these lists. CHAPTER XII. 
“The physician must, like the diplomatist, tread softly.”—Macness. 
Never exhibit surprise at any possible event growing 
out of sickness. You will be supposed to foreknow all 
conceivable things relating to disease, its dangers and its 
terminations. Even when death has occurred to some 
one under your treatment unexpectedly, do not let your 
manner or language indicate that you were entirely 
ignorant of its possibility or that you consider your- 
self to blame. 
When you have cases in which there is danger of 
rapid or sudden death, beware of ordering chloral, opi- 
ates, or other potent drugs in such a manner as to create 
a belief that they have caused or hastened death. Cir- 
cumstances may even make it wise at times, not to write 
any prescription at all, but simply to order this or that 
remedy under its common name, that, its harmless 
nature and appropriate character being understood by 
all, you may not be unjustly charged with doing harm. 
When any one under your treatment dies unexpect- 
edly or mysteriously, or shortly after the use of some 
new means that you have directed, or after beginning 
some new remedy, or shortly after you have performed 
some operation, or just after you have pronounced him 
better, or in any other way that could possibly expose 
you to unjust censure, it is better bravely to visit his 266 
remains without delay, so as to learn about the death, 
to discover what attitude the friends assume towards 
you, and to meet their criticisms by explanations, etc. 
On such occasions be self-possessed, and, if need be, ex- 
plain and defend your course and your treatment. By 
doing this you can anticipate evil reports and suppress, 
or shape them, before they are extensively circulated. 
When you are called to a case of sudden death, the 
utmost composure of mind and manner is of great im- 
portance; use discretion and prudent reserve, and never 
assume an oracular or prophetic air, or express any 
opinion of the cause in any such case, until you have 
calmly and coolly collected and weighed all the circum- 
stances. The possibility of death being due to disease 
of the heart, or brain, to poison, violence or suicide, 
should be carefully weighed before you express any 
opinion. If you neglect this precaution, further develop- 
ments in the case may expose you to strong censure and 
deep mortification. 
If you are called to a case of sudden death where 
violence is suspected, or to which you are summoned by 
the coroner, be careful to note everything connected with 
the corpse and its surroundings, and, where a post-mortem 
is required, the condition of the viscera, every 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 assistant at the time, stating the 
year, day of the month and hour, and should be in non- 
technical language, enumerating first the facts of the 
case, and then giving your comments and interpretation 
of them. These notes should be preserved, as you will 267 
be allowed to read them in court, if called there, in order 
to refresh your memory, though not wholly to rely on 
them. If the cause is suspected to have been poison, be 
careful to tie the stomach at both ends before its re- 
moval, and keep it and its contents in cleaned, sealed 
vessels under your own eye and custody, till a chemical 
analysis can be made. If a person is dying from violence 
(poison or wounds), when called to him, inform him of 
the fact, and if he volunteers a statement of the circum- 
stances causing his injuries, or in regard 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 a great deal of 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 violence—while 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 sepa- 
rated coloring matter escapes into the surrounding 
tissues, creating the appearance mentioned. The escaped 
fluid tends gradually to collect by the law of gravity in 
the most dependent parts of the body, as the back of 
the neck, trunk and limbs, thus leaving the higher parts 
clear and wax-like in appearance. 
You can always distinguish these post-mortem appear- 
ances, from bruises inflicted during life, by making an 268 
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 heart 
disease, and the family physician is often reproached for 
not having discovered it during the patient’s lifetime. 
Explain that the healthiest heart may suddenly become 
paralyzed or mechanically occluded and sudden death 
result. Bear in mind that the ordinary termination of 
organic heart disease is not sudden, but very slow death, 
preceded by dropsy, inability to lie down, etc., in fact 
with the exception of cases of aortic stenosis, or re- 
gurgitation, 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, 
operations, accouchements, diseases, etc., better than 
weaker, complaining people, is another popular error. 
The truth is the latter are schooled to pain, to disordered 
functions, lack of exercise, etc., and when they have 
to endure afflictions they are not so far from their usual 
condition as the former, and have not so much strength 
to be perverted-into morbid action, and are in most cases 
very much more favorable patients. Plethoric systems 
bear depletion by bloodletting, purgation, etc., badly, 269 
because their circulation is accustomed to a certain 
degree of tension and fulness, 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 thinner one might have lost that 
quantity without injury. 
Old persons seldom bear surgical operations well, 
especially if they have any disease of the urinary 
apparatus. Make it a rule always to examine the con- 
dition of their urine before operating. If any such 
patients die after you have interfered with their harm- 
less growths or deformities, or with ailments which 
they have endured for years with only a certain amount 
of inconvenience, you will probably be strongly censured. 
You will seldom be censured for a fatal issue in the 
diseases of the aged, and never in those of hard drinkers, 
or in cases where you have given an unfavorable prog- 
nosis from the first. On the other hand, if a woman dies 
in confinement and there is any possible chance to blame 
you, it will be done, for the reason that bringing forth 
children is unlike disease. Child-bearing is designed 
by nature to increase and not to diminish the number of 
our race; therefore death in labor, which is a physio- 
logical function, or during the lying-in, which is a physio- 
logical state, seems to be against nature and excites the 
wonder and criticism of everybody. 
Wretched patients who are suffering acutely, perhaps 
afflicted with painful incurable diseases, and the miser- 
able melancholiacs who are a burden to themselves and 
to others, will occasionally entreat you to give them 
something to cause death and put them out of their 
misery. Likewise, friends of those who are undergoing 270 
terrible sufferings from which recovery is impossible, 
will also sometimes hint at or even openly request that 
you give the patient a sleeping potion from which he 
will never awake. 
In many such cases you will agree that were God to 
take the sufferer it would be a blessing; yet with this 
aspect of the case you have nothing to do. In refusing 
such solicitations, let your argument be that since a per- 
son has no right to end his own existence, 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, is to prolong life, not to shorten it. 
In accidents obscure as to nature or degree, and in 
cases of sudden illness, when you are pressed to say 
whether you think the case is dangerous, or likely to be 
of long duration, choose your language deliberately and 
give only indefinite answers, until you see whether any 
new symptoms will develop, whether the system will 
react, and whether there will be a response to the 
remedies used. During the progress of such cases be 
careful to school your features and your manner, that 
people may not read your hesitations, surprises and 
uncertainties and either force consultations on you or 
entirely displace you. 
In cases of accident and injury to people found in an 
insensible condition, although you may strongly suspect 
this to be due to drunkenness, have the presence of mind 
to give a provisional opinion only, until they return to a 
sober state. It is better to say, “ He is certainly coma- 
tose ; whether his insensibility is due to alcohol or other 
causes affecting the brain, it is at this time impossible for 
any one to say.” 271 
It is well when called to cases of burns, cuts, lacera- 
tions, fractures, bites, etc., to mention incidentally the 
possibility of erysipelas, pyaemia, lockjaw, etc., and of 
deformity, or permanent impairment, or whatever other 
unpleasant results may be reasonably feared, that the 
parties may know that you are awake to all the pos- 
sibilities and probabilities of the case. Regarding burns, 
remember that the gravity of a case is due less to its 
depth than to the number of square inches involved. 
In the course of your professional career you will 
meet humanity in all its aspects and phases, and your 
patients will differ greatly in the amount of complaint 
which they will make in detailing their subjective symp- 
toms to you. Some who are naturally stoical and 
apathetic will fall into the error of understating their 
true condition, fearing that a fuller statement may alarm 
their friends, or lead you to think their case serious and 
prescribe for them much strong medicine, or cause you 
to pay them many visits. Such patients will sometimes 
die almost without giving a sign. Others, again, of a 
hysterical or nervous temperament, fearing that you 
may not consider them as sick as they really are, will, 
in detailing their symptoms, magnify every detail and 
seek in every way to impress you and others with an 
exaggerated idea of the intensity of their sufferings and 
the gravity of their condition. One of the many advan- 
tages which a regular attendant has over other physi- 
cians is his familiarity with these peculiarities of tem- 
perament, with the extent of the vocabulary each of 
his patients employs, and with the amount of pre- 
cision which each uses in answering questions and in 
describing his sufferings. A fine lady, a hod-carrier, a 272 
lawyer and a sailor would each use a different kind of 
language to express the same symptoms. 
In spite of your best endeavors, you will often be 
criticized, or upbraided for your lack of foresight regarding 
the recovery or death of patients. The ability to estimate 
the vital resistance in each case, by the look, visage, 
voice, attitude, movements and general appearance of 
the patient, is necessary to the perfection of your skill 
as a physician. It is something apart from your diag- 
nosis, pathological and therapeutical, and few attain it. 
The truth is that life is a different quantity in differ- 
ent people, and you will usually have no other way to 
judge a patient’s prospect of recovery, than by the 
average human standard. You will sometimes have 
cases which will surprise you by their having a great 
deal less than the average tenacity of life, and others 
by having a great deal more than the average; and no 
matter how careful you are, you cannot, with our present 
knowledge, accurately and unfailingly prognosticate the 
endurance power of every patient. 
To illustrate what is meant: 
Health, 
0. 
2d. 
\3d. 
4th. 
) 5th.. 
6th. 
V7th. 
Classes. 
Suppose the above seven figures to represent the 
various degrees of mankind’s ability to endure sickness 273 
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 is passed, some if the second is touched, 
others can endure to the third, and so on, while still 
others 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 re- 
cesses and gauge the total of his endurance power,— 
could see at what point his possibility of recovery ends 
and his dissolution begins, you could solve the great 
problem of life—there would be fewer unanswerable 
how’s and why’s, and you would seldom, if ever, be re- 
proached for unpredicted terminations. This you can- 
not do, but you can in every case make full use of all 
the teachings of experience, and must avail yourself of 
every aid offered to you by medical science. 
Human nature is the same everywhere. The prince 
in his palace and the beggar in his hovel, the citizen in 
his mansion and the felon in his dungeon, the sailor on 
his ship and the soldier in his tent—all nations and all 
religions, the Christian, the Jew and the Pagan, all feel 
the same fears and anxieties, and all turn their eyes and 
their hearts to the physician when sickness invades or 
death threatens; because life and health are prized 
above all things else on earth. This makes the physi- 
cian’s visit the chief event of a sick person’s day, and 
causes each patient anxiously to watch for his approach. 
Bear this ever in mind, and wherever your lot is cast, 
observe punctuality and system in attending those under 
your care. Also remember always that every phase of 274 
your conduct, every word you utter, every look, every 
shrug of the shoulders, every nod of the head, will be 
noticed, and may be dwelt upon after you depart. 
Thus, my professional brothers, I would attempt to 
show that the more closely we study the moral and 
mental peculiarities of the various classes who make up 
the community, the more clearly we will see that the 
practice of medicine has a peculiar and complex environ- 
ment, and that A physician should make skill in pre- 
venting, RELIEVING AND CURING DISEASE, HIS CENTRAL 
THOUGHT AND CHIEF RELIANCE, AND SHOULD DISCHARGE 
EACH AND EVERY DUTY WITH FIDELITY AND HONOR ; but, 
further, that he must also show professional tact and 
business sagacity, if he would succeed in his profession, 
create for himself a sphere of usefulness in the world, 
and at the same time do justice to himself and to those 
dependent upon him for support. 
In conclusion, let me add, that if the suggestions of 
this little work shall enable you to discern the path of 
duty with greater clearness, and to follow it loith increased 
hope and determination, it will fully accomplish the object 
of your well-wisher and co-worker, 
The Author. Index, Testimonials and Advertisement. INDEX. 
Abortion, solicitations to pro- 
duce 65, 66, 67 
Accidents, demeanor in attend- 
ing 141, 265, 270 
Accounts, necessity for keep- 
ing 18, 19 
Adding suffixes 75 
Advice, giving, relating to 
health 105, 165 
Aged, operations on the 269 
Ailments not to be ridiculed 100 
Allopathy, a misnomer 197, 198 
Amenorrhcea in consumptives... 148 
Anaesthetics, precautions regard- 
ing 133 
Apothecaries 216-232 
Apothecaries as propagators of 
quack remedies 221 
Apothecaries, indiscreet 222, 223 
Apothecaries, prescribing....220, 221 
Are boils healthy ? 155 
Art of changing medicines... 141, 176 
Assistant, acting as 10, 105, 184 
Assistants, four excellent 162 
Attending by the year 244 
Avoid, something to 67 
Babes, hand-fed 152 
Baptism, conditional Ill 
Bargains, Indian 93 
Beans, Panama 164 
Bills 218, 233 to 264 
Bills, how to present 261 
Bills, special color for 264 
Black lists 264 
Blame, laws that govern 164, 269 
Boasting 34 
Boils, are they healthy? 155 
Book agents 72 
Books, family medical guide 147 
Books, posting one’s 239, 240 
Bores 137, 138 
Borrowing 76 
Bread pills 124 
Business system 12 
Business, the proper time to 
talk 233, 236 
Busy, too 139, 261 
Calls, hurried 20 
Cards, business 18 
Case, withdrawing from a 126 
Cases, refusal to take 94, 139 
Cases, why never abandon.... 114, 131 
Cash system, the 235 
Catholic patients, duty to.. 109 to 112 
Cautions 21, 22 
Censure, the laws of 269 
Certificates 63, 102, 225, 226 
Certificates, clergymen’s 225, 226 
Certificates, legal 102 
Changing diagnosis and prog- 
nosis 98 
Changing medicines, art of ...141, 176 
Charities, special 258 
Charity, the demands of 49, 259 
Cheap doctors 245 
Cheerfulness in the physician... 42 
Chicago physicians, oiler of the, 202 
Children, crossness and tears in 153 
Children’s influence 81 
Chloral 128 278 
Chronic d ischarges, suppressing, 155 
Clandestine visits 117 
Clergymen 107, 225, 226, 256 
Coition, why not recommend.... 148 
Cold rooms in sickness 150 
Collecting bills 233 to 264 
Collector 263, 264 
Commission versus omission 132 
Commodes in bedrooms 154 
Companions, what kind to select. 13-14 
Competition, wars of 243 
Concealing presence of disease, 
103, 104 
Conditional baptism Ill 
Conduct in the sick-room 46, 47 
Confidants 97-99 
Confinement, purgative after.... 158 
Congestion, hypostatic 91, 267 
Consult, right of refusal to... 178, 179 
Consultation fees 177, 178 
Consultation, radical changes 
after 176 
Consultation, punctuality in at- 
tending 176 
Consultation, the suspense pre- 
ceding a 176 
Consultation, whom to call into 176 
Consultations, management of, 
178, 183, 184 
Consultations, the object of.. 175, 183 
Consulting physician, dispensing 
with 178 
Consumption, errors regarding, 
148, 149, 150 
Consumptives, why they cease 
to menstruate 148 
Contagion, fear of 157 
Contagious disease, cautions re- 
garding attendance upon 104 
Contingent fee, why not work 
for 248 
Costly medicines 228 
Countenance, the physician’s... 
141, 265, 270 
Creed, difference between limit- 
ing one’s, and limiting one’s 
practice 210 
Critics and wiseacres 140 
Cuckoo, the 30 
Cures, guaranteeing 101, 249 
Dampness 157 
Death, appearances after 267 
Death, causes of sudden..265, 2C6, 268 
Debates, how to conduct 70 
Decrying medicine 184 to 187 
Degree of certainty in medi- 
cine 185, 197,272 
Discharges, suppressing chronic, 155 
Discoveries, attitude of physi- 
cians towards 210 
Diseases, driving in 155 
Disease, the increased tolerance 
of 187, 188 
Diseases, fees in advance for at- 
tending secret 94, 248 to 251 
Diseases, urinary 145, 269 
Diseases, venereal ....94, 95, 250, 251 
Dishonesty, where found.259,260, 261 
Dismissal of medical attendants, 
58, 126, 127 
Dispensary and hospital patients 
compared with private 50, 51 
Dispensaries, free 258 
Doctor, bestowing the title of... 222 
Doctoring the womb 143 
Dog-bites 156 
Donations, making 82 
Doses, heroic 127 
Double callings 24 
Dress and manners, influence 
of 22, 23 
Dressing too warmly 150, 151, 152 
Drinking 13,77 
Druggists 216 to 232 
Drugs, etc., got gratis 218 
Drugs, necessity for pure 230 
Drugs that enslave 172, 173 
Duties, five cardinal 128 279 
Duty to the dying....107, 108, 112, 
113, 129 
Eat anything, may he ? 167 
Eating with patients 79 
Education, its importance to 
the Physician 35, 36, 37 
Endorsing domestic remedies... 
136, 137 
Entanglements, to avoid 134, 135 
Error, precautions to take 
against committing 66, 129 
Eruption, driving in 155 
Eruptions, bringing out 154 
Estates, charges against 256, 257 
Ethics, medical 51 to 57 
Eucharist, the Holy 110, 111 
Examinations, gentleness in 
making 47 
Expedients, doubtful 57 
Experiments tried on patients, 130 
Extreme Unction 110 
Fainting 156 
Familiarity, undue...13, 78, 116, 118 
Fashionable frauds 259, 260 
Fashion and wealth, influence of, 199 
Fashions, conforming to the 23 
Fear of contagion 157 
Fee in advance for secret dis- 
eases ..250, 251 
Fee or no fee 248 
Fee table 19, 257 
Fees 218, 233 to 264 
Fees, doubtful, r ule regarding... 238 
Fees, fixing the responsibility 
for 237 
Fees for important cases 239, 246 
Fees, how to collect...251 to 254, 261 
Fees, joint 257 
Fees, lawsuits to recover 255 
Fees, why not work for con- 
tingent 248 
Females, influence of 81 
Fever, water and ice in 366 
Fickleness, human 106, 125, 127 
Finances, the physician’s..261 to 263 
Foreign bodies, swallowing 156 
Forgot you, 1 94 
Formate, private, use of 219 
Formula?, stereotyped 39 
Fractures, popular error regard- 
ing 133 
Frauds, fashionable 259, 260 
Free Dispensaries 258 
German, usefulness of 37 
Gratifying whims 136 
Greek language, the usefulness 
of 37 
Guaranteeing cures 101, 248 
Guard yourself 124 
Guide in judging whether an 
apothecary store is properly 
conducted 224, 229 
Gums, object of lancing child- 
ren’s 152 
Habits, disgusting 13, 76 
Hahnemann compared with Co- 
pernicus, Newton and Jenner, 
195, 211 
Hand-fed babes 152 
Health, trips for 165, 166 
Heart disease, death from 268 
Hectic confounded with ma- 
larial fever 149 
Hell on earth 142 
Heroic doses 122, 127 
Holy Eucharist, the 110, 111 
Home, not at 139 
Homoeopathic creed, the. 192,193,208 
Homoeopaths, bogus 206, 208 
Homoeopaths, test showing 
which are real 193 
Homoeopathy 190 to 214 
Homoeopathy, is it founded on a 
natural law ? 194, 195 
Homoeopathy, one of the evils 
of 201 280 
Homoe versus home 203 
Hope, taking away.. 114 
Horrifying remedies 163 
Hospital and dispensary patients 
compared with private 50, 51 
Hospitals, sending patients to, 166 
Hours, designating the, on 
bottles 172 
How to conduct debates 70 
Human fickleness 106, 125, 127 
Human gullibility 204 
Humanity, its demands...179, 180, 
257, 259 
Human nature the same every- 
where 273 
Humoring the sick 44 
Hurried calls 20 
Hypodermic medication 172, 173 
Hypostatic congestion 91, 267 
Idiosyncrasy 45,214 
Important cases, fees for attend- 
ing 239, 246 
Incompatibles 38 
Influence of dress and manners, 22 
Influence of females 81 
Inquiries, making, etc., in pres- 
ence of strangers 96 
Instruments of precision 21, 145 
Insults 98 
Iron injuring the teeth 163 
Irregular physicians, contact 
with 179, 206 
Irregular, what constitutes 
an 181, 209, 210 
Irregulars, joint discussions 
with 210 
Irregulars, popular favor to- 
wards 198, 199 
Irregulars, proper course to- 
wards 13 
Irregulars, why patronized 
198, 199, 200, 201 
Jealousy...28, 29, 30, 33, 97,133,134 
Joint fees 257 
Joint practice of medicine and 
pharmacy 216, 217, 258 
Kindness, influence of 42, 48 
Labelling, mistakes in 231 
Labelling prescriptions 171, 232 
Labels, advantage of putting 
the date on 232 
Labels, putting the hours on.... 172 
Latin, use of 36 
Laws, duty to 122 
Laws, favor shown to physicians 
by the 102 
Laws, medical 211 
Laws, their exceptional kind- 
ness to physicians 102 
Lawsuits 255 
Lazar-house, Homoeopathy in 
Milton’s 205 
Liberal profession, why medi- 
cine is a 182 
Library, creating a 72 
Life power, scale of 272, 273 
Life, should a physician ever 
shorten ? 269, 270 
Limiting one’s practice 94, 110 
Malarial affections, recurrence 
of 164 
Malpractice cases 62, 63, 132 
Mankind, study of...40, 160, 161, 273 
Manners, influence of 34, 42 to 47 
Marriage of physicians 80 
Marriage of syphilitics 147 
Maxim 259 
Medical art, imperfection of. 184,197 
Medical ethics 51 to 57 
Medical societies 68 to 71 
Medicine, decrying 184, 185, 186 
Medicine, degree of certainty 
in...' 184, 185, 197 
Medicine, fashion in. 190,191,192, 213 
Medicine, fear of 163 
Medicine haters 161 281 
Medicines, art of changing 141 
Medicines at office 20 
Medicines, bad effects of 162 
Medicines, charges for..219, 220, 228 
Medicines, costly 228 
Medicines, dynamization of 196 
Medicines, palatability of 160, 162 
Medicines, unused 141 
Memory of cases 71, 119 
Menial labors 99 
Mental therapeutics 161 
Metric system 74 
Microscope, working with the... 91 
Mid wives, assisting 93 
Mistakes in labelling 231 
Moralizing 105 
Morphia, granules 214 
Motto on bills 259 
Name, what is in a 197, 203, 204 
Neglectful and perverse pa- 
tients 135, 136 
Neighborly visits 28 
New remedies, how aided 161 
Newspaper squibs 27, 84 
Night emissions 148 
Night visits 116 
No cure, no pay 248 
Nostrums, why condemn 227 
Novelty, influence of, in medi- 
cine 161 
Nurses, conduct towards 134 
Objects of consultations 175, 183 
Obstetrical cases 91, 92, 93 
Office, charges for advice at, 
19, 146, 247 
Office hours 16, 17 
Office, location and arrange- 
ment of 10, 11 
Office practice 20, 59 
Office signs 15, 16 
Office students 14 
Offices, branch 10 
Old lady with salve 137 j 
Old persons, operations upon.... 269 
Omen, a bad 113 
Omission versus commission 132 
Opiates, their place and power, 128 
Opinions, necessity for caution 
in giving. 270 
Opinions of patients and their 
attendants to be considered... 153 
Opinions that terrify 142 to 147 
Other physicians, attending 
after 84, 258 
Over-praise from patients 96 
Over-praise from relatives 97 
Over-visiting 99, 117, 118 
Panama Beans 164 
Partisan questions 77, 225 
Partnership 10 
Passions, influence of 121 
Patients, dining with 79 
Patients, distant 94 
Patients, hospital and dispen- 
sary, compared with private.50, 51 
Patients, how to transfer 175 
Patients, neglectful and per- 
verse 135 
Patients, quoting authorities 
to.... 89, 90 
Patients, refusal to take 139, 261 
Patients, rights of, to have ad- 
ditional advice 178 
Patients, varieties of. ...161, 271, 273 
Patients’ whims gratified.. 
135, 153, 213 
Patients, worthless, 139, 259, 260,261 
Paying debts 76 
Pay you, when shall I ? 239 
Pension claimants, certificates 
to 63 
Percentage from apothecaries... 217 
Personal affairs, privacy regard- 
ing your own 253 
Personal appearance 22, 23, 24 
Pharmaceutical catch-pennies.. 170 282 
Pharmacists 216 to 232 
Pharmacopoeia, breadth of the 
U. S 227 
Phlegm, swallowing 153 
Photograph giving 106 
Physician, how an irregular, 
may become a regular 183 
Physician, mission of the 115, 270 
Physician, the new 28, 29, 30 
Physician, what constitutes a 
regular 182, 183 
Physician’s countenance, the, 
141, 265, 270 
Physicians, increase of number 
of 32 
Physicians, the marriage of 80 
Physicians, why the older excel 
the younger 85, 86, 87 
Physicians, why they do not get 
rich 261, 262 
Placeboes 123 
Policy versus principle 192, 196 
Politeness, value of 82 
Politics 12, 25 
Pollution, self 148 
Polypharmacy 168 
Poor, attending the 49, 259 
Posting books 239, 240 
Post-mortem discolorations, pop- 
ular error regarding 267 
Post-mortems and analyses.90,91,267 
Practice, difference between 
limiting one’s, and limiting 
one’s creed 210 
Practice, limiting amount of.... 94 
Practice, soliciting 125 
Precautions 129 
Pregnancy suspected 66 
Prescribing, extravagance in. 141, 142 
Prescribing, suggestions on the 
subject of 122 
Prescribing without an inter- 
view 184 
Prescription papers 217 
Prescription, the, to whom does 
it belong? 219 
Prescriptions, about labelling. 171,232 
Prescriptions, expertness in 
writing 38, 39, 158, 159, 172 
Prescriptions, joint 172 
Prescriptions, unauthorized re- 
newal of 219 
Presents from patients 77 
Principle versus policy 192, 196 
Private formulas, use of 219 
Production of abortion 65, 66, 67 
Profession, identifying self with 
the 68 to 71 
Prognosis, cautions concerning, 
88, 113, 131, 272, 273 
Purgative after confinement 158 
Purity of mind 40, 41 
Quack bitters 106 
Quack medicines, their proper 
position in apothecary store... 229 
Quackery 146, 212 
Quantities to prescribe 141 
Questions, rule for repeating.... 158 
Questions, rule regarding 129 
Questions, unwelcome, how to 
avoid 114 
Quinine, popular prejudice 
against 163 
Quoting what the books say 89 
Receipts, compel people to take, 254 
Reclaiming those who have 
strayed 209 
Record book 130 
Recreation, necessity of 83, 84 
Reference book 130 
Register heat 151 
Religion 107 to 112 
Relinquishing attendance ... 116, 178 
Remedies, domestic, endors- 
ing 136, 137 
Remedies examined at every 
visit 168 
Remedies, horrifying 162 283 
Renewal of prescriptions, to 
prevent ... 171 
Reporting cases 73, 74, 75 
Reputation, value of 40 
Responsibility, dividing 132, 133 
Rich not to pay for poor 244 
Riding versus walking 26 
Rivalry, professional....28, 29, 30, 33 
Rule for repeating questions 158 
Ruling spirits, the 97 
Scandal 33, 40, 41 
Scarlet rash 154 
Scold, how to, without offend- 
ing 80 
Secrets 96, 119, 120, 121 
Self-medication 169 
Self-pollution 148 
Self-preservation 30, 258, 273 
Self-reliance, its value 174 
Sequelae, foreseeing 271 
Servants, attending 50 
Services for employers 236, 237 
Services to clergymen 226, 256 
Services to physicians 256 
Services to the poor 49, 258, 259 
Services, when not to charge 
for 255, 256 
Sexual intercourse, why never 
recommend 148 
Shame, a matter of 133 
Short visits, how to make.... 100, 167 
Shut your eyes, to these 154 
Sick, humoring the 44 
Signatures, regarding 226 
Signs, office 15, 16, 17 
Skill, what is medical 39, 185, 
186, 189, 273 
Small-pox, popular error re- 
garding the 61 
Social influence 81 
Society, duty to 122 
Soliciting practice 125 
Something to avoid 67 
Specialties, when to patronize... 174 
Specifying the particular make, 228 
Spoons, variations in size of 172 
Springtime, taking medicine in 
the 124, 125 
Students, taking office 14 
Suffixes, adding to one’s name, 75 
Superseding other physicians..84, 258 
Suppressing chronic discharges, 155 
Surprise, showing 265, 266 
Syphilitic cases 147, 250, 251 
Syphilitics, the marriage of 147 
System in business 12 
Swallowing foreign bodies.. 156 
Swallowing phlegm 153 
Swearing off 106 
Sweating during sleep 166 
Sweating the baby 152 
Synonyms 170, 230 
Telephone, the 18 
Temper, control of 45 
Terms, transposing 230, 231 
Terrifying opinions 142 to 147 
Therapeutics, crude 168 
Therapeutics, mental 161 
Time lost in waiting 167 
Trade-mark articles 170,226, 227 
Transposing terms 230, 231 
Tricks 27, 31, 116 
Trips for health 165, 166 
Truth, its value 113 
Unction, extreme 110 
Urinary diseases 145, 269 
Urine, scanty and high colored, 156 
Vaccination 60, 61, 103, 211 
Value of politeness 82 
Value of reputation 40 
Variability of human endur- 
ance 271, 272, 273 
Variation in the size of spoons.. 172 
Varieties of patients 161, 171 
Veins on back of hands 157 
Venereal cases 94, 95, 250, 251 284 
Visit, conduct at 46 to 49 
Visit, extra charge for the first, 245 
Visiting list, how to improve a, 240 
Visiting the patient of another 
physician 57, 59 
Visits, how to make short ....100, 167 
Visits, neighborly 28 
Visits to the sick.46,99,117,118,168 
Visitors to the sick 158 
Vivisection 91 
Vocabulary of different classes.. 271 
Volunteer services 61 
Waiting, time lost in 167 
Walking versus riding 26 
Warming the new-born 151, 152 
Wars of competition . 243 
What is in a name ? 197, 203, 204 
Whims, gratifying the, of pa- 
tients . 136 
Why charge for every visit 245 
Wife, the meddling 120 
WUls 103,112, 113 
Wiseacres and. critics.. 140 
Withdrawal from a case 126 
Witness, duty to self when a.... 138 
Woman, devotion of, to the 
sick 48 
Womb doctoring 143 
Worms, has he? 153 
Worthless patients.139, 259, 260,261 
Worthless systems of practice, 
how to expose 208 The 'publishers have placed on the next two pages a few 
commendations from well-lcnoivn sources; also, on the page 
following them, an advertisement. EXTRACTS FROM A FEW OF THE MANY LETTERS 
RECEIVED BY THE AUTHOR. 
From Prof. ROBERTS BARTHOLOW, 
Philadelphia, Pa. ' 
“ The Physician Himself” is an opportune and most 
useful book, which cannot fail to exeit agood influence 
on the morale and the business success of the Medical 
profession. 
From Prof. JOHN S. LYNCH, 
Baltimore, Md. 
I have read “ The Physician Himself” with pleas- 
ure-delight. It is brimful of medical and social 
philosophy ; every doctor in the land can study it with 
pleasure and profit. I wish I could have read such a 
work thirty years ago. 
From Prof. WILLIAM GOODELL, 
Philadelphia, 
“ The Physician Himself ” interested me so much 
that I actually read it through at one sitting. It is 
brimful of the very best advice possible for medical 
men. I, for one, shall try to profit by it. 
From Prof. A. JACOBI, 
New York. 
The book has given me great pleasure, and reflects 
great credit by both its philosophical and practical 
spirit. 
From Dr. JUKES DE STYRAP, 
Shrewsbury, England. 
I would be glad if in the true interest of the profes- 
sion in “Old England,” some able practitioner here 
would prepare a work for us on the same line as “ The 
Physician Himself.” 
From Prof. WM. A. HAMMOND, 
New York. 
It is full of valuable suggestions. 
From Prof. WM. A. BYRD, 
Quincy, III. 
I shall recommend it to the students of the “ Quincy 
College of Medicine ” as worth a thousand of the 
Hippocratic o rth. The advice in it should by them be 
taken, a beacon by day and a guiding star by night. 
From Prof. ISAAC E. TAYLOR, 
President Medical Faculty of Bellevue College. 
It is a valuable production. I have read it with 
much pleasure and instruction. 
From Prof. C. A. LINDSLEY, 
Dean of Yale College. 
“The Physician Himself” is replete with sound 
suggestions. Its perusal would be profitable to all 
practitioners, and doubly so to the younger ones, whom 
it will enable to begin right. 
From Prof. D. HAYES AGNEW, 
Philadelphia, Pa. 
I am most favorably impressed with the wisdom and 
force of the points made in “ The Physician Himself,” 
and believe the work in the hands of a young graduate 
will greatly enhance his chances for professional 
success. 
From Prof. A. B. PALMER, 
University of Michigan. 
Its suggestions are of interest and use, especially to 
the young physician. 
From Dr. J. K. BARNES, 
Surgeon-General U. S. Army. 
It is full of good suggestions and admirable advice 
which will prove very advantageous to our profession. 
From Prof. JAMES NEVINS HYDE, 
Chicago, III. 
This book is evidently the production of an un- 
spoiled mind and the fruit of a ripe career. I admire 
its pure tone and feel the value of its practical points. 
How I wish I could have read such a gu.de at the out- 
set of my career 1 
From Prof. OLIVER WENDELL HOLMES, 
Harvard University. 
It contains a great deal of good sense, well ex- 
pressed. 
From Prof. J. M. DaCOSTA, 
Philadelphia, Pa. 
“The Physician Himself ” certainly contains a great 
many very excellent suggestions. 
From Dr. EDWARD R. SQUIBB, 
Chemist, Brooklyn, N. Y. 
I am very giad the demand for this work has been 
sufficient to call for a fourth Edition, and hope that 
many more may be needed. 
From Prof. RICHARD McSHERRY, 
University of Maryland. 
Its views on morals and ethics are correct, and its 
paragraphs on the relations between physicians and 
pharmacists are equally just and commendable. 
From Prof. J. M. BODINE, 
Dean University of Louisville. 
“ The Physician Himself” is useful alike to the tyro 
and the sage—the neophyte and the veteran. It is a 
headlight in the splendor of whose beams a multitude 
of our profession shall find their way to success. 
From Prof. EDWARD WARREN (Bey), 
Chevalier of the Legion of Honor, etc., Paris, France. 
It is replete with good sense and sound philosophy. 
No man can read it without realizing that its author is 
a Christian, a gentleman and a shrewd observer. 
From Prof. A. REEVES JACKSON, 
Dean Chicago College of Physicians and Surgeons. 
This book is marvellously full of good suggestions 
and good sense. The reading of it reminds one of the 
egg story of Columbus. Every physician can solve the 
problems that most interest him, now that Dr. Cathell 
has broken the shell and made it flat-bottomed. 
From Prof. I. E. ATKINSON, 
University of Maryland. 
It is evidently based upon actual experience and a 
thorough knowledge of human nature, and discusses 
various questions with strong common sense. 
Froen Prof. A. P. DUTCHER, 
Cleveland, O. 
I have read "The Physician Himself” with great 
care. It is a most excellent work—full of wisdom, and 
gives facts that if faithfully followed will lead to 
renown and professional success. 
From Prof. WILLIAM T. LUSK, 
New York. 
I have read “The Physician Himself” carefully. 
I find it an admirable work, nd shall advise our Janitor 
to keep a stock on hand in the book department of 
Bellevue. 
From Dr. W. C. VAN BIBBER, 
Baltimore, Md. 
“The Physician Himself” is a model book, good, 
useful and elevating. Beautiful in thought, sty le and 
language. Good in religion, morals and suggestions. 
Useful to such a degree in our profession that I know 
of nothing in its«way that equals it. 
From Dr. PHILIP S. WALES, 
Surgeon-General U. S. Navy. 
Its publication is timely. It contains information 
calculated to be of great advantage. I do not know 
where else could be found so many well-digested, well- 
arranged practical hints. 
From Prof. W. H. BYFORD, 
Chicago, III. 
It must impress all its readers with the belief that it 
was written by an able and honest member of the pro- 
fession and for the good of the profession. EXTRACTS FROM MEDICAL JOURNALS. 
It is marked with good common sense, and replete 
with excellent maxims and suggestions for the guidance 
of medical men.—The British Medical Journal, 
London. 
The book is a mine of practical hints.— The Archives 
of Medicine, New York. 
There is scarcely an emergency, in a business point 
of view, that a man cannot be equal to,if hewill follow 
out strictly the advice of Dr. Cathell. He deserves a 
vote of thanks from the younger members of the pro- 
fession.— The Louisville Medical Herald. 
We strongly advise every actual and intending prac- 
titioner of medicine or surgery to have “ The Physician 
Himself,” and the more it influences his future conduct 
the better he will be.— The Canada Medical and Sur- 
gical Journal, Montreal. 
Nothing seems to have been left unsaid, and no 
point untouched.— The San Francisco Western 
Lancet. 
Rarely do we find such a practical combination of 
good common sense, purity of counsel, and strength of 
style as in “ The Physician Himself.” We unhesitat- 
ingly recommend it, and are certain all who read it 
will find most healthy engagement in its perusal.— The 
New Orleans Medical and Surgical Journal. 
There is not a subject connected with the personal 
welfare of the medical man mentally, morally or ethi- 
cally, left untouched.—- The Chicago Medical Journal 
and Examiner. 
The advice it contains counsels nothing that wotdd 
be unbecoming a gentleman and a physician. The 
physician just starting upon his professional career, let 
it be in town or country, should by all means read it, 
and after its perusal he will undoubtedly feel himself 
under a debt of gratitude to the author.— The Medical 
and Surgical Reporter, Philadelphia. 
It is full of pithy suggestions, every one of which 
is almost axiomatic.—St. Louis Medical and Surgical 
Journal. 
The amount of useful, practical information "The 
Physician Himself” succeeds in conveying to its read- 
ers is simply astonishing, and its practical value to the 
profession can hardly be over-estimated.— The Medi- 
cal Herald, St. Joseph, Missouri. 
We can only say, if its teachings are followed it 
will insure success in the career of any physician.— 
The Southern Clinic, Richmond. 
It points out all the stumbling-blocks, and the 
reader acquires in a few hours that which the elder 
members of the profession have attained by years of 
attrition in society.— The Mississippi Valley Medical 
Monthly, Memphis, Tenn. 
We would advise every doctor to well weigh the 
advice given in this book, and govern his conduct 
accordingly.— The Virginia Medical Monthly. 
The doctor who starts on his career knowing and 
practising the ethical and business maxims here re- 
corded, will be saved many a false step, and the doctor 
who attempts to go on with less will eventually have 
to pay dearly for his experience.— The Nortji Caro- 
lina Medical Journal. 
The volume is full of practical hints for a beginner, 
and we would advise all raw recruits in the profession 
to get it and read it.— The Pacific Medical and Sur- 
gical Reporter, San Francisco. 
"The Physician Himself” is unique and has been 
received with universal favor for its shrewd, practical 
common sense.— Quinan's Medical Annals of Balti- 
more. 
Of all the books that have been placed before the 
Medical readers of America, none have attracted such 
universally favorable comment as the unique little book 
of Dr. Cathell. That it has gone through three large 
editions in one yearspeaks more approvingly than any- 
thing that we could possibly say in regard to it. We 
can conscientiously say, that no one can read it and not 
be benefited.— The Southern Practitioner, Nashville, 
Tenn. 
It is full of valuable suggestions.— The New York 
Medical Record. 
Whatever others may think, we feel that there is in 
this book just that something which we have always 
lacked—that something which no previous work has 
supplied. By pointing out the best course in many of 
the embarrassing situations of professional life, the 
author has rendered the profession, and especially 
the younger members of it, a service for which we 
feel he will in the end be both thanked and compen- 
sated. The practical value of the book can hardly 
be overstated.— The Maryland Medical Journal. 
Every medical practitioner will find " The Physician 
Himself” a most valuable book.— The Sanitarian, 
New York. ' 
Prof. Cathell has evidently made a thorough study 
of the habits and customs of his brother physicians, 
and has hence produced a book of the most intensely 
interesting character. Why Dr. A is so very success- 
ful ; why Dr. B is, with an equal amount of brains, 
much less so: and why, finally, Dr. C, with more 
brains than either, has entirely failed in acquiring even 
a moderate living out of his practice, are all as plain to 
Prof. C.’s vision as the simplest problem in geometry. 
It is one of the most valuable books published in the 
last twenty-five years.—Baltimore Medical Chronicle. 
Every part bristles with practical facts, acquired 
only by experience. We believe it contains the key to 
success.— The New England Medical Monthly. 
It bristles all over with common sense hints and 
shrewd observations regarding human nature as the 
doctor meets it, and shows the irrportance of profes- 
sional tact and business sagaci.y. It touches on the 
hundred and one different matters that go to make up 
the successful physician, and will make successful 
aspirants for fame of those who otherwise, with all their 
talents, might have wasted their fragrance on the 
desert air and gained neither reputation nor compe- 
tence.— The New York Medical Gazette. 
"The Physician Himself” does what no other 
work has ever done; it treats of matters which are 
the keystone of the brilliant success of many practi- 
tioners, and the lack of which has ruined the pros- 
pects of many a bright career.— The Missouri Valley 
Medical Journal. 
The task that the author has undertaken is certainly 
a commendable, timely, and arduous one, and the man- 
ner in which he has accomplished it is as commendable, 
thorough, honorable, and worldly-wise.—Archives of 
Laryngology, New York City. 
The path of duty is clearly indicated in this book, 
and when followed will be certain to advance the wel- 
fare of our honorable profession.— The International 
Review of Medical and Surgical Technics, Boston, 
Mass. 
This volume will repay a careful perusal. Its tone 
is high. It is written in a spirited style and sets forth 
clearly and forcibly much good advice for all young 
men who desire to avoid mistakes of a personal and 
social kind, but on the principle of " never too late to 
mend," we believe that old practitioners may derive 
great many hints from it.— The Edinburgh (Scotland) 
Medical Journal, THE FIFTH EDITION. 
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THE PHYSICIAN HIMSELF 
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