THE PHYSICIAN HIMSELF 
AND 
WHAT HE SHOULD ADD 
TO 
HIS SCIENTIFIC ACQUIREMENTS 
BY 
D. W. CATHELL, M. D. 
LATE PROFESSOR OF PATHOLOGY IN THE COLLEGE OF PHYSICIANS AND SURGEONS OF BALTIMORE 
EX-PRESIDENT OF THE MEDICAL AND SURGICAL SOCIETY ; ACTIVE MEMBER OF THE 
MEDICAL AND CHIRURGICAL FACULTY OF MARYLAND ; HONORARY 
MEMBER OF THE LINCOLN PHILOSOPHICAL SOCIETY, 
ETC., ETC. 
SECOND EDITION-CAREFULLY REVISED. 
BALTIMORE: 
CUSHINGS & BAILEY^ 
262 W. Baltimore St. Entered according to the Act of Congress, in the Year 1882, by 
D- W. Cathell, M. D. 
in the Office of the Librarian of Congress, at Washington, D. C. 
Press of Isaac Friedenwald, 
BALTIMORE. THIS LITTLE WORK 
IS RESPECTFULLY DEDICATED TO 
PROFESSOR AUSTIN FLINT, Senior, 
IN ADMIRATION 
OF HIS VARIOUS CONTRIBUTIONS 
TO SCIENTIFIC MEDICINE, 
AND OF HIS 
UNTIRING DEVOTION TO THE WELFARE 
OF OUR PROFESSION. PREFACE TO THE SECOND EDITION. 
THE many favorable notices given this work by the medical 
press, and the sale of a large edition within a few weeks, are 
gratifying evidence that the profession is awake to the importance 
of the subjects it considers. 
In preparing a second edition, the author has divided the work 
into chapters, and made other changes and additions which he 
believes will greatly enhance its value. 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 at least awaken 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. C. 
2 N. Broadway, Baltimore. THE PHYSICIAN HIMSELF 
AND 
What he should add to his Scientific 
Acquirements. 
CHAPTER I. 
Professional Tact and Business Sagacity are as 
necessary to the physician, as the mariner's compass is to 
the navigator. There are gentlemen in the ranks of 
our profession who are perfectly acquainted with the 
scientific aspects of medicine, and can tell you what to 
do for almost every ailment that afflicts humanity, 
who, nevertheless, after earnest trial, have never achieved 
either reputation or practice, because they lack profes- 
siondl tact and business sagacity; and there is noth- 
ing more pitiful than to see a worthy physician deficient 
in these qualities, waiting year after year for a practice, 
and a consequent sphere of professional usefulness, that 
never come. 
Were such a physician to ask me : What shall I add 
to the strictly scientific, to make my success in practice 
more certain, more rapid, and more complete ? I should 
advise him as follows: 10 
You should, above all else, strive to start promptly 
on the road to success; for unless you let the people 
know you are about, make some mark, and get a repu- 
tation and a practice in your first six or eight years, the 
probabilities 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 does not 
generally prove as beneficial or as satisfactory as ex- 
pected, and consequently partnerships rarely continue 
long. Above all else, never ally yourself with any other 
doctor except as an equal. Julius Caesar said, " I had 
rather be the first man in a village than the second 
man in a great city." 
The location and appearance of your office will have 
a great deal to do with your progress. Select one in a 
genteel neighborhood, upon or very near an artery of 
travel, convenient to either a densely populated old sec- 
tion 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 acquire- 
ments. 
Remember, in making your selection, that a 
doctor cannot rely on his near neighbors for patronage; 
people in his immediate neighborhood may never em- 
ploy him, while some farther away would have no one 
else. 
It is risky for a beginner to locate too near a group 
of popular, energetic physicians, lest their superior ad- 11 
vantages and established reputations might keep him 
dwarfed for too long a time. 
If possible, have an office that is not used for a fam- 
ily parlor or any other purpose. Show aesthetic culti- 
vation in its arrangements, and make it look fresh, neat, 
clean and scientific. Flowers, either in bouquets or 
growing, are pleasing to every eye, and denote culture 
and refined taste on the part of the physician and those 
about him. 
It is not unprofessional to keep at hand your library, 
microscope, and other aids to precision; also your diplo- 
mas, certificates of society membership, pictures of emi- 
nent professional friends and teachers, anatomical plates, 
or anything else that has associations in your mind; but 
it is better to have such only as have relation to you as 
a student or as a physician. Professional relics and 
keepsakes whose history is connected with your medical 
studies, such as the human skeleton, either entire or in 
parts, pathological or anatomical specimens, and memen- 
tos of your dissections, are both appropriate and useful. 
A cabinet of minerals is also in good taste. Let no 
sharks' heads, impaled butterflies, miniature ships, stuffed 
birds, or anything else be seen that will place you in 
any other light before patients than that of a physician. 
Endeavor to lead every observer to think of you as a 
physician only. 
Display neither political nor religious emblems, por- 
traits, etc., about your office; these relate to your per- 
sonal sentiments, while your office is a public place for 
every class of people, and no matter what kind of par- 
tisan or sectional pictures you might display, they would 
surely be repugnant to some. 12 
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 prefer to meet either the doctor or his servant 
rather than ladies. You should respect public opinion in 
this and all other just subjects for criticism. 
A physician is judged by the company he keeps. 
Avoid associating with those who are " under a cloud," 
or are notoriously deficient, or whose hopes and ambi- 
tions are blighted. Let your associations be as far as 
possible with professional brethren, and other people of 
genuine worth. Prefer to spend your idle hours in your 
office, or at the drug stores, or with other doctors at the 
medical library, instead of lounging around club rooms, 
cigar stores, billiard parlors, barber shops, etc. No 
ordinary man ever conceived a more exalted opinion of 
a professional man by fraternizing with him at such 
places. 
Be cordial with all kinds of patients, but do not 
hand-shake and harmonize with them unreservedly; un- 
due familiarity shears many juniors of much of their 
prestige. Never become so familiar as to 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 soiling contact. 13 
What shall I say of debauchery with harlots and 
association wfith concubines ? Of drinking and of gamb- 
ling ? My dear sir, if you have entered either of these 
roads, turn from it at once, for either will blast your 
career, will be fatal to every ambition. Virtue alone 
will make you happy and enable you to withstand your 
critics. 
Do not induce young men to study medicine, as there 
are already three doctors where one is required. Be- 
sides, either their success or failure may work an injury 
to yourself. It is not usually either profitable or advis- 
able to take office students, 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 per annum. 
Do not let your office be a lounging place or a smok- 
ing room for horse-jockeys, dog-fanciers, gamesters, 
swaggerers, politicians, coxcombs, and others whose 
time hangs heavily on their hands. The public looks 
upon physicians as being singled out and set apart and 
worthy of an esteem not accorded to such people, or to 
persons engaged in the ordinary business of life; the 
conversation of such companions is not believed to be in 
harmony with a meritorious physician's mind, it destroys 
public faith or prevents its growth, and on no profession 
does faith have such influence as on ours. The public 
takes cognizance of a great many little things regarding 
medical men, and every circumstance in your manner, 
appearance, conversation, habits, etc., will be closely ob- 
served and criticised, more especially in the early years 
of your career. 14 
In getting office signs, remember that a doctor has 
signs, not as advertisements, but simply to show his office 
to those looking for him. Your signs should be neither 
too large nor too numerous. One of black smalt with 
gold letters is the neatest and most attractive of all; 
one such sign on the front wall for the daytime, and a 
glass one with black letters in the window, to be seen 
at night when your office is lighted, are sufficient. The 
letters on the outside sign should be round and well 
shaped, and not more than two inches high, with cor- 
responding 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. 
Unless there is danger of your being confounded with 
some other doctor of the same name, it is well to omit 
your given name or initials from your signs, but it 
should be on your cards. Of course, if your name is 
" Smith," or " Jones," or " Brown," it would be neces- 
sary to put your given name on your signs, but if your 
name is uncommon, it is not. People would not speak 
of Doctor John W. Garfield, but of Doctor Garfield. 
Do not allow other people's signs of tooth-drawing, 
cupping and leeching, millinery, 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. 15 
Establish regular office hours early in your career, 
and post them conspicuously in your office; also have 
them on your cards. An excellent rule is to direct at- 
tention to both the beginning and ending of your office 
hours, as: 44 Morning office hours begin at 7 and end at 
9. Afternoon office hours begin," etc., etc. Many 
people think that as your office hours are from 7 to 9, if 
they get there one minute before 9 o'clock they are in 
time; whereas if they come at that time they will be 
sure to keep you past your hour for going out. By regu- 
lating your time thus, you can accomplish doubly as 
much, with less hurry and more satisfaction to all. 
Have on a little sign over your slate, 44 In leaving a 
message for the Doctor, be careful to write the name, 
street, and number." 
You should keep a supply of cards with your name, 
residence, and office hours on them. An inch and three- 
quarters by three inches make a good size. It is also 
necessary to keep a supply of small and neat blank bills, 
envelopes and paper, with your name and. address 
printed on them. Blank forms for use in giving certifi- 
cates to sick members of societies, etc., are 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. 
When you start practice get a pocket visiting list, a 
cash book and a ledger, and commence to keep regular 
accounts at once; this will teach you system and in the 
course of time save you hundreds of dollars. 16 
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 
semi-prominent position in your office, that you may 
refer patients to it whenever occasion requires. Also, 
have a small, neat sign, with 44 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 misunder- 
standing and many a dollar. Of course you may omit 
its cash enforcement towards persons with whom you 
have a regular account. 
Having your charge from 44 $1 to $10," will enable 
you to get an extra fee for cases of an extraordinary 
character, and still allow you to charge minimum fees 
for ordinary cases. Such a schedule will make those 
who get off by paying the lowest fees, feel gratified; it 
will also show everybody that you are skilful enough 
to attend ten dollar cases. 17 
Cultivate office practice; for it is a fertile source of 
reputation and of cash fees. Try to benefit and satisfy 
every patient that comes there; for each will form some 
definite opinion, 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 ; this will familiarize you with their appear- 
ance, odor, miscibility, taste, and other characteristics, 
and also enable you to get fees from patients who can 
appreciate advice and medicine combined, but who can 
not appreciate advice alone. Also, for another reason: 
By keeping cathartic pills, aromatic spirits of ammonia, 
lime water, morphta granules, etc., you can, by sending 
a 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 
prerogative, however, tends to consume valuable time, 
and to dwarf you in other ways, and does not pay. 
Besides, it would engender the criticism and enmity of 
neighboring druggists. 
When you are summoned to confinements, colics, 
accidents, etc., if possible go immediately. Then if you 
are too late you will be blameless, and neither be cha- 
grined nor responsible. When you cannot go at once, it 
is much more satisfactory to your patient if you send a 
remedy for use till you can go, than to send a prescrip- 18 
tion; to send a prescription in such cases seems rather 
as if you do not care to attend, or as if they were on 
your secondary list, and if the case does not eventuate 
favorably, you may be severely criticised. 
If, at your office and elsewhere, you make use of 
instruments of precision-the stethoscope, ophthalmo- 
scope, laryngoscope, the clinical thermometer, magnify- 
ing glass and microscope, make urinary analyses, etc., 
they will not only assist you in diagnosis, but will 
also aid you greatly in curing people by heightening 
their confidence in you and enlisting their co-operation. 
Always carry with you a good clinical thermometer, 
a female catheter, a bistoury, a hypodermic syringe, a 
pair of small forceps, a stick of lunar caustic, a penknife, 
etc., for ready use. • 
Avoid syphilitic inoculation, septicaemia, etc., in 
making vaginal and other examinations. Cosmoline 
and vaseline answer very well; they have no affinity 
for moisture, and both keep for years without becoming 
rancid or decomposing. Get a pound can of either, 
and keep it in your office for anointing your fingers, 
instruments, etc. Wooden toothpicks and wooden 
cigar-lighters are very handy for making mops, applying 
caustics, etc. Being inexpensive, they can be thrown 
away after being used, instead of being kept for further 
use, as must be done with expensive articles. 
Be cautious and never immerse an abraded finger in 
vaginal or other suspicious fluids; if your preferable 
hand is abraded, use the other. 
You should have a special receptacle in your office 
for cast-off dressings of gonorrhoea, syphilis, septic 19 
ulcers, etc., which when they accumulate should be 
burned. 
You should live comfortably for the sake of being 
comfortable, and rest as much as possible on Sundays 
and at night; and if you would avoid the risk of break- 
ing down your physical health, as hundreds of our pro- 
fession do, consider it a cardinal duty to get your meals 
and your sleep as regularly as possible. 
Take care to be neat in your personal appearance; 
above all else, wear a clean shirt and a clean collar; 
for, if you dress well, people will employ you more 
readily, accord you more confidence-expect a larger 
bill and pay it more willingly. 
You never heard of a bank swindler, or a confidence 
man, or a gambler, or a counterfeiter, or pseudo-gentle- 
man of any kind, who dressed shabbily or appeared 
coarse. Such people are all close students of human 
nature, and no matter how abandoned they are, no mat- 
ter how tarnished 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 assuming the 'dress and manners of gen- 
tlemen. Now if genteel dress and polished manners can 
do so much for such fallen specimens of mankind, how 
much greater influence must they exert for those who 
are truly gentlemen and members of a lofty profession. 
Do not, however, be a leader in frivolous fashions, 
as though your aesthetic cultivation had overshadowed 
everything else; nor display glaring neckties, flashy 
breastpins, or any other peculiarity that indicates a 
" swell." Even though you are poor, let it be genteel 20 
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 manners 
might cause you to be shunned and criticised. You 
will see some whose heads are comparatively empty 
succeed almost entirely by attention to dress and affable 
manners, while many much better qualified will fail by 
reason of defects in these apparently trivial matters. 
Clean hands, polished boots, neat cuffs, gloves, fashion- 
able clothing, cane, sun umbrella, all indicate gentility. 
Avoid double callings. Divorce medicine from every- 
thing else-from the drug business, from giving public 
readings, singings, poetry, concerts, from base-ball, row- 
ing, etc., because the public cannot appreciate you, or 
any one else, in two dissimilar characters. Although 
it may seem paradoxical, even reputation as a surgeon 
or as a specialist militates decidedly against reputation 
in other departments of medicine. The public in gen- 
eral believes a surgeon is good only for cutting, that a 
specialist is good only for his specialty, 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 practise in 
future. All such functions seem to dwarf one's ultimate 
progress, and usually create a low-grade reputation that 
it is hard to outlive. To many people all such offices 
look somewhat like a confession of impecuniosity or in- 
feriority, and create an impression that is not overcome 
for years. If you have any merit at all, private prac- 
tice industriously followed will lead by better roads to 
speedier success. 21 
Politics, especially during a doctor's early profes- 
sional career, even when honorably pursued, is ruinous 
to his prospects; to take it up later, when his medical 
reputation is already extensive, militates against him 
but does not entirely ruin him. If honorable politics 
injures thus, how much worse are ward demagogism 
and wirepulling at primary meetings. You could make 
ten friends and ten dollars by medicine while you are 
making one of either by politics, besides 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, rather than through appreciation of 
your merits as a physician, are neither very profitable 
nor very constant. You will find that attending 
patients secured promiscuously from every direction, be- 
cause they have faith in you as a doctor, will in the 
long run pay you better than attending to politics or 
anything else. 
You should get a respectable-looking horse and car- 
riage, as soon as circumstances will possibly justify. A 
team is not only a source of health and enjoyment, in 
the beginning of practice, but it shows your practice 
is growing, and any one can ride into a full practice 
much quicker than he can walk into one. Besides, the 
unknowing public infer that a doctor who rides must 
have had extensive experience and a successful practice, 
else he could not afford it. 
A riding doctor has several advantages over the one 
who walks; he gets a rest while riding from one patient 
to another, and can spend the time in thinking; can 22 
concentrate his mind more fully on his case 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 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. 
Never let a bony horse and a seedy-looking or un- 
suitable kind of carriage stand in front of your office for 
hours at a time, as if to advertise both your poverty and 
your paucity of practice. 
If you have two horses it is better to drive singly, 
that one may be resting while the other is working. 
Driven thus, two good, well-kept horses can carry you 
to as many patients as you can attend. 
It is perfectly proper to attract attention to yourself 
by all legitimate means, but careful observation will 
convince you that driving ostentatious double teams, or 
having liveried drivers, odd-shaped or odd-colored 
vehicles, closed carriages, conspicuous running-gear, or 
blazed-faced, curious-looking horses or ponies, habitually 
driving as though the devil were in chase, and attempt- 
ing to read a book as the carriage jolts along, also 
affecting odd-style hats, long hair, heavy canes, etc., all 
generally fail in their object, and are looked upon by 
many as signs of a small mind or weak head, and ac- 
tually bring the one who affects them into ridicule and 
disrespect. Strictly avoid ostentation and every peculi- 
arity of manner, dress, office arrangement, etc., calcu- 
lated to excite either ridicule or contempt. On the 23 
contrary, do not belittle yourself, for if you are shame- 
faced, diffident, lacking in aggressiveness, or deficient in 
tact, you will never prosper until these disadvantages 
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 in newspapers, or to placard barber shops, hotels, 
etc. Puffing yourself, your cases, your apparatus or 
your skill, or winking at being^puffed, is on a par with 
the speckled-horse plan. A proper pursuit of 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 other non-professional 
pursuits; even reading the newspapers, smoking, etc., at 
times proper for study and business, have an ill effect 
on public opinion. Public opinion is the creator, the 
source of all reputation, whether good or bad, and should 
be respected; for a reputation is a large, a very large 
part of a doctor's capital. 24 
It is very natural to expect your medical neighbors 
to pay you a friendly visit after you locate, whether 
acquainted or not; but if they fail to do so, it should 
not be construed as ill-will, for it may not accord with 
the position of doubt concerning your being regular, etc., 
which they for the time being occupy. True men are 
sometimes very slow to fraternize. 
There is a very great difference between the case of 
an additional physician starting in a community or 
neighborhood, and an additional person in almost any 
other business. The demand for other things can be in- 
creased, but the demand for doctors is limited, so that 
a new doctor must create his practice out of that taken 
from other physicians. Every patient the newcomer 
adds to his list must be diverted from that of a rival, 
and of course the rival does not like it; for there is a 
little human nature still left in a man, even though he 
has studied medicine. The older practitioners are there- 
fore naturally very apt to be watchful of, if not captious 
towards their new rival, and when they see him crowd- 
ing himself 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 advantageous to the public, because it creates a spirit 
of emulation, and compels each to try to be skilful and 
successful 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 25 
newcomer to a degree bordering on monomania, because 
the new one, in coming, must exert a perturbing effect 
on the professional business of those already estab- 
lished. His coming makes more workers, and if he is 
skilful, actually makes less sickness; because rivalry 
stimulates each to try to get all curable cases well, not 
only surely, but quickly. Sickness, both in amount and 
duration, is decreased, because skilled laborers have in- 
creased. There is, of course, no greater number of 
cracked skulls, dislocated bones, sore legs, cases of 
rheumatism, or diseases of any kind, than before the new 
one came. He must therefore draw his share of the 
loaves and fishes from the others. 
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. 
Competitive 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 im- 
pulse. 
If you are conscious of any merit above mediocrity, if 
you are ahead of your brethren, let mere matters of dis- 
play remain secondary, while your merit is made the 
more prominent. This is more durable, less expensive, 
and more in harmony with the views of sensible people. 26 
Do not hesitate, however, to embrace every accidental 
or natural advantage in practice, if legal 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 deserve the reputation of being 
a sharper or of being tricky. If the balance were 
struck, it would probably be found a great deal harder 
for a doctor to trick his way along than to work it 
along. Determine, therefore, that in your effort you 
will do nothing that is criminal, nothing that will not 
stand every test, nothing for which you would hesitate 
to sue for your fee if necessary-nothing that you can- 
not approve of, with your hand on your heart and your 
face turned upwards. CHAPTER II. 
There has been of late years a disproportionate 
annual addition to our already overcrowded profes- 
sion, and the colleges of the United States are 
still turning them out at the rate of more than 2000 a 
year, without counting the ready-made physicians gotten 
by immigration. The result is 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, count- 
ing both regulars and irregulars, one for every 600; 
druggists in proportion. If there were only twice as 
many as needed it would be wholesome, and allow the 
public a choice, but, with such an excess, many worthy 
ones must necessarily languish, and those who flourish 
must do so by great skill, great tact and great industry. 
The medical door-and the window too-is open, wide 
open, to every kind, and all kinds have entered; and 
you will be unusually lucky if you encounter none who 
are maliciously antagonistic. You will not only meet 
Dr. Willing, Dr. Fair and Dr. Bland, but Dr. Cynic, Dr. 
Sneerer, Dr. Crusty and Dr. Broiler may be encountered. 
Let your conduct be fair and square on all occasions. 
Let everybody feel that you are incapable of any dishon- 
27 28 
orable act. Never begin making reprisals, nor enter into 
a wordy war with a rival; also avoid all innuendoes and 
sarcastic remarks to the laity about rivals who have 
offended you. Resolve that you will remain a gentleman, 
even under provocation, whether others do or not. Ob- 
serve the Golden Rule, and with dignity " Do unto others 
as yQu would have them do unto you," and trust the 
balance to time. Medicine is an honorable calling; re- 
solve 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 j ustice from enemies in return; 
for, were you as chaste as ice, as pure as the snow that 
falls from heaven, you could not escape misrepresenta- 
tion by adversaries with evil eyes and lying tongues. 
Although you cannot stop people's tongues nor their 
evil talk about you, yet you must look out that nothing 
is allowed to blast your reputation for honorable con- 
duct. Charges against your skill, unless very gross and 
damaging, 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 
personal, but simply expressions of lack of faith in you 
professionally. Such things are said about every 
physician in the world, and are quite different from per- 
sonal 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 29 
amount of your collections. All such, things are apt to 
create envy, disbelief, criticism and other hurtful results. 
Also avoid telling from house to house how busy you 
are, and of your numerous bad cases-as if to swell 
your own importance. Indeed, it is best to relate noth- 
ing at all to laymen about any case but the one before 
you; to do so will not enhance you any, and if you 
really have extra cases and extra skill, people will be 
sure to find it out in other ways. 
As a physician you will require a variety of talents, 
for you must come in contact with all kinds of people. 
Acuteness in adapting yourself to all classes is a very 
useful quality, and one in which most physicians are 
very deficient. 
In addition to medical learning, you should strive to 
possess a large acquaintance with general scientific 
subjects and general literature, that you may acquire 
habits of thought, and sustain the reputation for liberal 
learning naturally accorded to all physicians by the 
public. 
A good preliminary education is a powerful element 
in the professional struggle; and if yours is defective 
at the time of entering the field of medicine, the 
deficiency should be made up as fully as possible. But 
I doubt the wisdom of frittering away precious time on 
educational frivolities after practice is begun, nor is it 
wise to give special attention to collateral sciences 
whilst imperfect in medicine proper. Simultaneous 
attention to many subjects would naturally divide and 
distract your mind. Whatever studies you do under- 
take should be pursued till accomplished. 30 
The plan of forcing themselves to pursue certain fixed 
aims tenaciously constitutes the peculiarity of most 
physicians who succeed in an eminent degree. This is 
not only true in medicine, but in any calling. I once 
knew a person who by accident lost his leg at the middle 
of the thigh; previous to this he was but an ordinary 
swimmer, 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 Latin in your 
education, you should not fail to employ a good Latin 
scholar to teach you; you can get one at a nominal cost 
by advertising anonymously in any daily paper. He 
can, with the aid of a grammar and a dictionary, teach 
you in a short time sufficient about Latin to enable you 
to write prescriptions, etc., correctly, and thereby lift 
you above a feeling of deficiency in this important par- 
ticular. Besides, ability to write your prescriptions in 
correct Latin naturally assists in creating respect, or 
rather, in preventing unfriendly criticism and disrespect 
for you in the minds of your fellow-physicians, the 
druggists, and other critics. 
Many people actually believe we write prescriptions 
in Latin to conceal the ingredients from them. The true 
intent is, of course, to give every article a specific title, 
that mistakes of meaning may not occur between the pre- 
scriber and compounder. Besides, prescriptions written 
in Latin can be read by the scholars of every nation. 31 
Latin is not only more accurate, but has become highly 
respectable by long usage. A rudimentary knowledge 
of Greek is also quite useful. 
In using Latin names of medicines, and the names of 
diseases, muscles, etc., be consistent. Adopt either the 
English or the Continental pronunciation, but whichever 
you adopt, be careful to use it invariably, and correctly. 
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. Deter- 
mine to get at least a smattering of German early in 
your career. 
You will find that many foreigners prefer an American 
physician who can speak their language, to one who has 
come here from their own country; because, being a 
native, they know he has spent his whole lifetime here, 
and they believe that has made him more familiar with 
the diseases that exist in our climate, and with the 
modifying influences of our seasons, diet, etc. 
Accustom yourself to write in a good, neat, clear 
hand. Write every prescription as though critics were 
to judge you by it; principal ingredients first, adjunct 
next, and vehicle last, unless you have some special 
reason for inverting them. Such a system insures well 
balanced prescriptions, disciplines the prescriber, and 
engenders the respect and favorable criticism of all who 
notice it. 
Strictly avoid incompatibles, both chemical and phy- 
siological. It is better to use a single remedy, or, if two 32 
are indicated, to alternate them, unless you know they 
are compatible. 
Be careful that abbreviations of names, manner of 
writing quantities, etc., leave no room for mistake. A 
good rule is, to read carefully every prescription after 
you finish writing it. 
Remember that skill in practice consists not only in 
diagnosis, prognosis, and ordering medicine, but is the 
unit of all the powers that the doctor legitimately brings 
into the management of cases. In other words, the 
skilful use of medicine is but one of many elements that 
make the unit of medical skill. You must study man- 
kind as well as medicine, and remember when working 
on diseased bodies that they are inhabited by minds that 
have warm sentiments, strong passions and vivid imagi- 
nations, which sway them powerfully both in health 
and in disease. To be successful you should fathom 
each patient's mind, discover its peculiarities, and con- 
duct your efforts in harmony with its conditions. Let 
hope, expectation, faith, contentment, fear, credulity, 
resolution, will, and other psychological aids be your 
constant levers, for they may each at times exercise legi- 
timate 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 book of human nature correctly, if you 
cannot unite knowledge of physic with a knowledge of 
mankind, with the knowledge of the hidden springs and 
passions that govern our race, you will be sadly deficient 
even after twenty years' experience. 
Your professional fame is your chief capital; ambi- 
tion to increase it by all legitimate means is not only 33 
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 
or that one, are being talked of, you should have a silent, 
or at least a prudent tongue; all you say on such sub- 
jects will surely be compounded and retailed, and its 
result will be a permanent injury to you. The position 
of the gossiping doctor has ever been a very bad one, 
and he is not unfrequently called to account. Remem- 
ber, while in contact with scandalmongers, to take care 
and, if possible, keep the conversation on general or 
abstract subjects, instead of descanting upon individuals 
and private affairs. 
Notice the never-failing advantage that refined people 
with pure minds have in every station of life over the 
coarse and the vulgar, and in view thereof let your man- 
ner, conversation, jokes, etc., be always chaste and pure. 
Never forget yourself in this particular, for nothing is 
so hurtful to a doctor as the exhibition of an impure 
mind. School yourself to avoid every impropriety of 
manner. Chasten every thought, 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 and vulgar 
jokes about the sexes is sure to be shunned, and. the 34 
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 regard such doc- 
tors (and rightfully so) as being far worse than those 
who drink, cheat and swear. 
If your manners and conversation are of the kind 
that win and conciliate rather than repel children, it 
will be fortunate, and Will put money into your pocket 
that might have gone to some homoeopath. Fondling, 
kissing and dallying with people's children, however, are 
liable to be misconstrued and should be avoided. 
A cold, cheerless manner toward patients, an isola- 
tion of oneself from them socially, and failure to recog- 
nize would-be-friends on the streets and elsewhere, 
destroy all warmth towards a doctor, and usually cause 
their possessor to fail to inspire faith; and no doctor 
who cannot in some way create 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. 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 special acquaintance 
with histology, embryology, and other ultra-scientific ac- 
quirements. 
Cheerfulness is also a fountain that is never failing 
in its influence. Medicine, contrary to the general belief, 
is not a gloomy, morose profession, but a bright, cheerful 
one. While allaying pain, curing some poor wretches 
and relieving others in body and mind, you will fully 
realize the great good your profession enables you to do, 35 
and will naturally feel happy and satisfied with your- 
self and with your life-work, and this will make you 
cheerful. 
Study to acquire an agreeable and professional man- 
ner of approaching the sick, and to take leave of them 
with equal skill. There is an art in entering the sick 
one's room with a calm earnest manner that shows an 
anxiety to learn your patient's condition-making the 
necessary examination, and then departing with a cheer- 
ful, self-satisfied 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 medi- 
cine teaches any one to do. The walk, the movements, 
the language and the gestures of some doctors are 
pleasing; of others, rude, harsh and repulsive to the 
sick. 
The art of keeping hope and confidence alive in the 
bosom of the patient and of his friends is a great one; 
an easy, cheerful, soothing manner is a power that will 
nearly always infuse tranquillity and repose into your 
patient's mind. 
To be quick to see and understand your duty, as if 
possessed of intuitive skill, is one of the strongest points 
you can have. People invariably applaud boldness; 
indeed, when followed by success, a bold, prompt act 
often leads almost to idolatry. 
Flexibility of manner, self-command, quick discern- 
ment, address, and ability to adapt yourself to the ever- 
changing phases of medical practice, are great necessi- 
ties ; the lady in her boudoir and the hod-carrier, the 
beer-seller and the clergyman, the aged and the young, 36 
should each find in you his ideal. Seek to become per- 
fect in this power of adjusting yourself. 
If you have the ability to control your temper, and 
to maintain a cool, philosophic composure under the 
thousand provocations given to doctors, it will give you 
great advantage over those who cannot, and will gener- 
ally redound greatly to your credit. 
A brusque manner is bad for a doctor, unless sus- 
tained by unquestionable skill or reputation. A gentle, 
urbane, but firm manner is suitable to the largest part of 
the community. Remember that an unfeeling, or dry, 
or stiff, or rude, or abrupt manner is quite different from 
the philosophic composure acquired by constant attend- 
ance on the sick and suffering. The former is brutal 
and unprofessional, the latter is essential to enable you 
to weigh correctly and manage skilfully. 
If you have any genuine idiosyncrasy it will be no- 
ticed, and, if not disagreeable, will aid you greatly; but 
never assume one, as the counterfeit is easily detected 
by all sensible men and women. Act your own charac- 
ter everywhere and at all times. Besides being ridicu- 
lous, a doctor who assumes a fictitious or borrowed 
manner must either be wrong in his heart or weak in 
his head. 
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 bold way of cutting the 
Gordian knots so often encountered, it will help you. 
If, on the contrary, there is any necessary aid that you 
lack, study and practise constantly to acquire it. 
Ability to communicate your opinion of a case to the 
inquiring friends of the sick one, in well chosen and 37 
proper language, is a quality so useful that you must 
practise to acquire it. 
Act toward patients so as to remove all dread of 
your visits; avoid a solemn and formal or funereal 
manner, as it would give rise to dread of you, especially if 
you accompany it with a corresponding mode of dress. 
If your air and movements are naturally awkward or 
sombre, set them off by cheerfulness, 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 cases 
is another very strong faith-inspiring quality. To as- 
sure a sufferer that you will take the same interest 
in him as though he were your " own brother," or as 
if she were your " own sister," or will attend a child 
as if it were " one of your own family," and similar terse 
expressions of sincere sympathy and interest, inspire 
wonderful confidence, and are often quoted long after the 
doctor has used them. Whoever has any such manner, 
naturally, will not, can not fail to get devoted patients, 
who would willingly retain him in preference to all 
others even though they knew his skill was far below 
mediocrity. 
After a patient convalesces, or when it is not necessary 
to attend him daily, if, when you are in his neighbor- 
hood, you send to inquire how he is getting along, it 
will not only give you the desired information, but will 
also impress everybody with a grateful sense of your 
interest in the case. 38 
Having the sick child taken up for examination, 
carrying your patient to the light that you may see him 
fully and examine him carefully, having his urine, or 
his sputa, or the blood he spits, etc., saved for examina- 
tion, not only gives you very necessary information as 
to the patient's condition, but satisfies him and every- 
body else of your solicitude. 
You will find that in times of sudden sickness and 
alarm in families, there is a peculiar openness to strong 
impressions. Kindness shown then is doubly appreci- 
ated. Indifference or coldness, on the contrary, may 
then sever attachments and end friendships that have 
existed between the doctor and a family for years, in as 
many moments. Many a young doctor secures a good 
family permanently by kindness and assiduous attention 
in cases of colic, convulsions and accident; also by 
devoted attention in cases of typhoid, scarlet fever, etc. 
You will find it comparatively easy to get practice 
among the moneyless poor, and relatively hard to get it 
among the wealthier classes. You will readily get 
patients among the moneyless, because you can devote 
more time, and fix your attention on their ailments more 
anxiously, than could be reasonably expected of those 
engaged in extensive practice, and any special interest 
shown such patients is observed and appreciated. Your 
reputation will probably begin in alleys and back streets, 
where it will extend much more rapidly than in com- 
fortable quarters; but no matter whether in mansion, 
cottage or hovel, every patient you attend, white or 
black, rich or poor, will aid in shaping public opinion by 
giving you either a good or a bad name. 39 
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 
require more care and attention than older doctors, 
whose time is absorbed by numerous acute cases, can 
possibly devote to them. If you persevere with them 
until a cure is effected, you will gain a host of warm 
admirers, who will magnify and herald you forth on 
every occasion as being doubly skilful; and even though 
you receive little or no reward in the shape of money, 
you will augment your fame, and acquire valuable 
stock in the bank of experience. Such cases will school 
you in the art of reasoning and comparing, and will 
otherwise greatly benefit you. Attending the servants 
of the rich, however, who are sick at their service 
places, will not improve your reputation much; at any 
rate, not nearly so much as attending the same class of 
people at their own homes or on their own account. 
People who couple you professionally with their servants 
are apt to form a low opinion of your status and of your 
class of patients. 
Neither 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 
and send for you because they prefer you to all others, 
will be your best patients. 
You are not obliged to assume charge of any one, or 
to engage to attend a woman in confinement, or to 
involve yourself in any way against your wish; but, 40 
after doing so, you are legally bound to attend, and to 
attend properly, even though it might 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 prin- 
ciples, 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 
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 
diluted or exaggerated phrases, that it is difficult to 
judge which symptom is most important. 
Remember, that attending hospital patients, sailors, 
soldiers, etc., where there are but two classes, the really 
sick and the malingerers, is apt to give a rough and 
ready habit of either believing every patient very sick 
or that there is but little or nothing the matter, and of 
prescribing too actively and too crudely to suit the 
squeamish people with indefinite ailments, so often en- 
countered in private practice, and to feel contempt for 
the foibles of patients with frivolous complaints. In- 
deed, hospital practice is so different from private, that 
but few members of our profession shine conspicuously 
as practitioners in both spheres. We also see the same 
illustrated at college and in medical societies; the best 41 
medical orators and the most fluent debaters are not 
always the best practitioners, because the two fields are 
quite different. Theory is one thing, practice another. 
It is your duty to familiarize yourself with the Code 
of Ethics at the very threshold of your professional 
career, and never to violate either its letter or its spirit, 
but always scrupulously to observe both towards all 
regular graduates practising as regular physicians. But 
remember that you are qeither required nor allowed to 
extend its favoring provisions to any one practising 
contrary to the cherished truths that guide the regular 
profession, no matter who or what he may be. 
I am not sure that the medical profession of any other 
country than ours has a code of written ethics. Here 
the very nature of society requires that physicians shall 
have some system of written ethics, to define their 
duties and regulate their conduct towards each other 
and the public. Even were there no written rules at 
all, the vast majority of medical men, actuated by a 
lofty professional spirit, striving to do right instead of 
wrong, would naturally conform themselves to the rules 
of justice as nearly as their conscience could decide, and 
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- 
bors, 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 it possible, for such as have 
the power, to carry on a regular grab system, regardless 42 
of right or wrong, toward their professional brethren, 
and still claim to be honorable physicians, whilst those 
aggrieved would have nothing to appeal to, to prove the 
contrary. 
In view of these and many other facts it has been 
found necessary to have a code of written ethics for reg- 
ulating the conduct of every physician towards those 
around him. 
Dr. Thomas Percival, an English physician, in a 
small book published in London in 1807, proposed a 
code of ethics, which, excepting a few alterations made 
necessary by the advance of medical science, is the iden- 
tical code adopted by the American Medical Association 
in 1847, and which from then until now has governed 
our whole profession throughout this broad land. All 
physicians are supposed to have studied this code, and 
every one is supposed to be familiar with its require- 
ments. The claim which it has upon you rests not upon 
any obligation of personal friendship toward your pro- 
fessional brethren, but upon the fact that it is founded 
on the broad basis of equal rights and equal privi- 
leges to every member of the profession, and stands like 
a lighthouse to guide and direct all who wish to sail in 
an honorable course. 
This code of ethics is the oracle to which you can 
resort and learn what things justice allows and what it 
prohibits; and it is to a very great extent these lofty 
ethics that elevate the medical profession in our land so 
far above common avocations, and give its brotherhood 
esteem and honorable standing everywhere. By its 
justness this code remains as fresh and beautiful to-day 43 
as when Percival penned it seventy-five years ago, and 
if you faithfully observe it, you can truthfully exclaim, 
" I feel within me a peace above all earthly dignities, a 
clear and quiet conscience." 
In our land this code is 'the balance-wheel that regu- 
lates all professional action, and no one, either the emi- 
nent ones of the profession covered with honors and 
titles, or the beginner in the ranks, can openly ignore it 
without overthrowing that which is vital to his stand- 
ing among medical men. If you desire to act unfairly 
toward your brethren, this code will compel you to do 
the evil biddings of your heart by stealth, and even then 
your unfairness will seldom go undetected or unpunished. 
The great God of Heaven has declared that " whatso- 
ever a man soweth, that shall he also reap." Any one 
you encroach upon in an unprofessional manner will 
feel himself justified in 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 his treatment, or if it is 
likely to prove fatal, do not involve him by expressing 
a wish that you had been called sooner, or criticise his 
conduct or his remedies; it is cowardly and mean to do 
either. Remember in all such cases to reply to the 
questions of the sick one or his enquiring friends, that 
your duty is with the present and future, not with the past. 44 
Refuse either to examine or criticise the previous 
attendant's remedies. Also, make your conversation 
refer strictly to the present and future, and not to the 
past, and do not mention your predecessor at all, unless 
you can speak clearly to his advantage. As a rule, the 
less you say about the previous treatment the better. 
To take a mean advantage of any one you have 
superseded, besides being wrong, might engender a pro- 
fessional hornet, who in retaliation would watch with a 
malignant eye and sting fiercely wherever opportunity 
offered. Courtesy, truth and justice should mark every 
step of your career. Enhance your profession in public 
esteem at every opportunity, and defend your brethren 
and your profession too, when either is unjustly assailed. 
Indeed, to fail to defend the reputation of an absent 
professional brother when justice demands it is ignoble, 
unprofessional, and implies a quasi-sanction of the libel. 
We all know there are a thousand unwritten ways 
to be ethical, and a thousand undefinable ways to be 
unethical. When you doubt whether a patient is fairly 
yours or another's, give your rival the benefit of that 
doubt. Never be tenacious of doubtful rights, but let 
your conduct in this and all other respects entitle you 
to the esteem of your medical neighbors. 
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 45 
will arise that cannot be adjusted by the code, and you 
will become involved in useless, rancorous and endless 
controversies and reprisals. Friendly offices are daily 
performed by physicians for one another, and go far, very 
far, toward neutralizing the ruffles and stings which the 
very nature of our profession makes inevitable. 
Be careful not to run into any other doctor's practice, 
and never attempt unjustly to retain any one to whom 
you are called in an emergency; if you are in doubt 
whether you were 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. Circumstances may even require you to have 
the former attendant sent for, either to take the case, or 
for consultation. If your conduct toward other phy- 
sicians in these matters is invariably honorable and j ust, 
it will be discovered in due time, and will make your 
road pleasant, and if you ever unwittingly infringe, all 
will feel that it is through mistake and not intentional. 
Keep above all doubtful expedients that relate to 
getting patients and profits. 
Never visit a patient who is under the care of another 
doctor, as a medical detective for his beneficial society, to 
ascertain whether he is malingering, without that doctor's 
previous consent. It would be a still greater offence to 
remove the bandages from fractures, ulcers, etc., put on 
by another physician, whether to change treatment or 
merely to examine the case. 
Be also extremely discreet and chary of visiting 
patients under the care of other doctors, even for social 
purposes, as it is a frequent cause of suspicion and con- 
tention. 46 
Never take charge of a patient recently under the 
care of any other regular physician, without first ascer- 
taining that he has been formally notified of the change. 
The idea that governs such cases is this : When a person 
sickens he can select any physician he prefers, but after 
making a selection and when the one selected has taken 
charge, if for any reason whatever he wants to change, 
he must follow the established form in doing so. If 
there are any hard thoughts against the other doctor or 
unpleasant scenes with him, the patient and his friends 
must have them, not you. 
You should never suggest that an attending physi- 
cian be discharged so that you may be employed. 
Be chary of taking cases in families into which you 
have ever been called to consult, more especially if you 
were called at the other doctor's suggestion, for the dis- 
placed doctor, chagrined at his displacement, will be 
apt to scan every feature of the change, and if he has 
any basis at all, will conclude that instead of obeying 
the golden rule you have ungenerously elbowed him out. 
You will often be called to a patient, and upon going, 
will find he is under the care of some other doctor, 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. Unless a great emer- 
gency exists, you should positively refuse to do either; 
if you do consent it should be done for the attending 
doctor, and you should leave a note telling him what 
you have done. When persons are inveighing to you 
against an attending physician and finding fault with his 
treatment, you should never suggest that he be dis- 
charged so that you may supplant him. 47 
The rules regarding previous attendance are less 
stringent in floating office practice than in regular family 
practice; some of the most eminent prescribe for all 
ordinary office cases, with but little regard to who has 
been attending, or where, of when. 
In spite of ethics you will see much to condemn, 
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 give every one 
justice. If you err at all in this respect, let it be in 
liberality. Sometimes, even though the letter of ethics 
allows you to take a patient, it may be unkind or un- 
wise to do so; use such opportunities to harmonize, 
rather than to disrupt. You can do this and yet not 
make a habit of cheating yourself out of patients. 
Always keep a stock of good vaccine on hand, both 
for the fees it secures, when there is a demand for vac- 
cination, and for fear of a sudden outbreak of small pox. 
Vaccination, although a trifling operation, is a pro- 
lific cause of criticism and reproach to physicians. Use 
calf virus whenever it is possible to obtain it; it is pop- 
ular, and not capable of communicating syphilis, scrofula, 
etc., and needs no defence. In no case use any but pure 
virus, and be ever ready to defend its purity with proof, 
if any one you vaccinate has misfortune with it. 
Do not begin the unjust custom of vaccinating the 
child gratis in cases where you have officiated at its birth, 
as is the custom with some. Also charge the same for 
revaccinating any one to test whether his former vaccin- 
ation is still protective or not, as you would if he never 48 
had been vaccinated before, whether it takes or not, as 
revaccination takes in but a small proportion of those 
it is tried upon, and the charge is for the trial. 
You should, of course, make no extra charge for 
repeating primary vaccinations till they take, no matter 
how long the interval between the trials; also, make 
but one charge for any person who has revaccination 
attempted no matter how often, if during the same 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 influ- 
ence of vaccination gradually disappears in many people. 
A vaccine scar merely shows that vaccination took pro- 
perly, not that it still protects. 
Be very cautious how you go out of your way to per- 
suade people to let you remove warts, extract tumors, 
destroy naevi, efface tattoo marks, and to do other minor 
surgical operations gratis, with assurances of success, 
etc. There is always a remote possibility of serious or 
fatal sequelae, and you should not, especially in private 
practice, induce people to let you involve yourself for 
their benefit, without being paid for your risk and res- 
ponsibility. 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. 
Wisdom in recognizing cases that are likely to in- 
volve you in suits for malpractice, and in foreseeing and 
forestalling the suits themselves, is a valuable power. 
Take care that this wisdom does not come too late, or 
cost you too much. 49 
Never fail to send your bill promptly to dissatisfied 
patients who are threatening to sue you for malpractice, 
or attempting to injure your practice unjustly, whether 
you expect them ever to pay it or not. If you cowardly 
shrink from sending your bill in such cases, they will 
quote that as a proof that you are guilty of what they 
charge, and that you know it; sending your bill gives 
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. 
Every principle of honor and duty forbids you even 
to think of lending yourself as a medical cat's-paw in 
unjust malpractice suits against other physicians. Such 
so-called "medical experts" often excite disgust and in- 
dignation at the sophistical attitudes they assume, when 
they act against their better knowledge 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. 
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 
another, a positive reward - you will feel the approval 
of your own conscience. CHAPTER III. 
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, etc., etc.; or to limit the number of children for 
married people who already have as many as they want, 
or for ladies who assert that they are too sickly to have 
children, or that their sucking child is too young to be 
weaned, etc., you should meet them with a refusal as 
cold as ice, and never even seem to entertain the propo- 
sition. If they are too importunate, express your senti- 
ments 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 and professional ruin and 
the penitentiary, by putting himself into any one's guilty 
power, whether as a favor or for a paltry fee ? 
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 
50 51 
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 might blast her whole future and call down 
maledictions on you; if on the contrary you too quickly 
declare her " not pregnant," it might injure you greatly; 
but this mistake would be nothing in comparison with 
the other. Temporize, or suspend your opinion for 
weeks, or even months if need be, till positively certain. 
Unmarried negresses and low females who fear they 
are pregnant, will occasionally consult you, consume 
your time and get your opinion, and when you discover 
that they are really pregnant, and refuse to produce 
abortion, will try to escape payment of your office fee. 
In all such cases inform them at the beginning how 
much your fee is for your time, opinion and advice, and 
that it must be paid whether your recommendation agrees 
with their wishes or not. After settling the fee ques- 
tion, study their case and give them your opinion and 
advice. 
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; 
also never partake of a sick man's wine or liquor. To do 
such things would not only lay you open to criticism, 
but even to the most mortifying charges if a rupture of 52 
friendship should ever occur-in fact, with such things 
to fortify them, people would be more apt to welcome 
or create a rupture with you. 
You should be careful that attempts to conceal the 
presence of contagious diseases, of unlawful dangers to 
health, or births that result from clandestine marriage 
or from bastardy, do not involve you in the exposures 
and recriminations that are apt to follow. 
If you have skill in avoiding cases 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 doctors from one 
another much more than one would suppose. Physicians 
daily pass and repass each other without a look or nod; 
although fellow-workers in the profession and well 
known to each other by sight or reputation, and although 
acquaintanceship would be mutually agreeable and bene- 
ficial, they must 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 pay tributes of respect to 
deceased medical brethren, at those held to consider 
public dangers, epidemics, hygiene, etc. 
Also, join the medical societies of your neighbor- 
hood; organization does good, both to the profession 
and to individuals. Friction of mind against mind in 
amicable discussion liberalizes and enlarges the scope of 
each and acts as leaven to the entire profession. No- 53 
where else can you study the styles of different doctors, 
and learn the secrets of each one's success or non-success 
so fully as at medical meetings. There, each contributes 
to the instruction and intellectual recreation of the 
others. There, you can meet your neighbors on com- 
mon ground, and experience and opinion can be compared 
by face-to-face discussion; there, rivalries, dissensions 
and controversies can be softened, and professional friend- 
ships be formed; there, you can measure the height and 
depth of your medical contemporaries, and see the dif- 
ference between pigmies and athletes, between giants 
and dwarfs; there, you can estimate the influence of 
many undefinable excellences in some, and discover 
and learn to avoid the imperfections of others,-and in 
many other respects learn effectually to separate the 
chaff from the wheat. 
Of course, medical societies are neither a specific for 
all personal deficiencies nor a panacea for all professional 
sores. Spending a few hours among honorable physicians 
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 get new combinations of ideas 
and fresh streams of knowledge. Besides the individual 
benefits accruing to the members, a genuine professional 
spirit is generated, that constantly tends to minimize all 
that is unprofessional. 
Never oppose the admission of any one into society 
membership for private or personal reasons, or for any 
cause other than ineligibility or unfitness to receive the 54 
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 anything to say, say it in a 
careful, methodical manner, then sit down; but always 
remember that when you have nothing worth offering? 
silence should be your law-do not break it. In speak- 
ing, take care neither to abandon your medical vocabulary 
for the vernacular, nor let your professional manner 
degenerate. Remember there, as elsewhere, that there 
is nothing infallible; that a doctor must school his pre- 
judices 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 parliamentary 
battles, no matter how sharp, are usually conducted by 
men of discretion within the bounds of parliamentary 
decorum, and without violations of the ordinary rules 
of good breeding; that there is no mode of practice and 
no remedy for any disease that has not been the subject 
of obstinate dispute, and that every new announcement 
brings the whole medical world into collision, testing 
and reporting, asserting and denying. 
You will find that many of the laity entertain a be- 
lief that medical societies exist for the pecuniary ad- 
vancement of doctors, just as trades unions and other 55 
organizations do for workingmen. Be careful to correct 
this error on all suitable occasions, and to inform them 
that medical societies exist not for selfish purposes, 
but chiefly for scientific objects. 
Keep up your medical studies, or what you formerly 
acquired will rapidly become misty and glide from you. 
Without study, the details of cases and the symptoms of 
many diseases wear out of one's memory in three or 
four years; indeed, the mind does not often bring back 
the details of 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 or other countries. Also, avoid 
old medical works as guides in the progressive branches; 
medicine is an ever-growing science. New investiga- 
tions render new text-books frequently necessary. 
Subscribe to as many medical journals as you can 
read and can afford to pay for. Read them carefully, so 
as to keep abreast of the times, but neither swear at 
nor by all you see in them; be especially careful of 
such as exist for the purpose of advertising either their 
owner or his goods. As a rule you will find that state- 
ments 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 unconfirmed experience of a single individual. 
Do not be biased too quickly or strongly in favor of 
new or unsettled theories based on physiological, micro- 56 
scopical or chemical experiments. If you abandon the 
practical branches of medicine for histology, post-mortem 
researches, refined diagnostics, and abstract reasoning, 
your usefulness as a physician will almost surely dimin- 
ish. I do not refer to teachers and experimenters, who 
have hospital and laboratory facilities, and who do not 
look to their practice for support. Your most useful 
studies, as a practitioner, will be hygiene and the art 
of treating diseases with success. 
Take care that book-agents do not induce you by 
their fluency to subscribe for works you have but little 
or no use for. 
Never publish weak or trifling medical articles, as 
whatever one writes is supposed to be a mirror of his 
own mind. When you write anything for the journals, 
give your article a proper title, avoid difluseness, and use 
no far-fetched quotations from foreign languages unless 
followed immediately by translation; for unless it is 
some stale, hackneyed term, the average reader will 
probably be forced either to pass it over unsolved, or 
take down his dusty quotation book or his schoolboy 
grammar. Pity those who are either so ignorant, on 
the one hand, and those who are so high-flown on the 
other, that they cannot express themselves in their 
mother-tongue. 
The recent attempt to supersede the old weights and 
measures by the metric system did not succeed; it is 
therefore scarcely worth while to weigh its merits. 
When you report cases or publish anything in which 
weights are given, either use the old familiar weights 
and measures (which every one understands) or give 57 
both the old and the metric; to use the metric only 
savors of pedantry. Many do not attempt to carry the 
metric equivalents in their minds, and if you give metric 
measures only they might pass your effusions by with- 
out getting the information you wished 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 or very unusual feature, or militate 
against accepted theories; otherwise you will merely 
swell, without adding anything valuable to existing 
records. You will find every department of medicine 
fast becoming loaded down with empty word-building, 
old things said in a new form. You should contribute 
original work, and new ideas, if any. Be as brief and 
logical as justice to your subject will allow, and, for the 
printer's sake, prepare 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 white note 
paper; this will enable you to handle them more easily 
in writing, altering and rewriting pages, and also to carry 
and preserve them much better than if large. 
Never furnish a report, statement, or opinion on any 
important case or subject for publication either in book, 
journal or newspaper, without a proviso that you are to 
see, and if necessary revise the proof and correct 
printer's errors before it goes to press. 
When you publish anything do not follow the 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 ete's; such an 58 
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 more modest and equally as 
useful. 
Pay your honest debts punctually, even though you 
are cheated out of half you earn. The best plan is to 
pay as you go, and if you cannot pay much, do not go 
far. Owing for horses, feed, carriages, or clothes, or 
still worse, luxuries, rent, servants' wages, etc., cannot 
fail to set the tongue of scandal to wagging freely 
and injuriously. You will have to pay every debt one 
time or another, and had better be paying each as it be- 
comes 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 
doctor or patient to lend to another; if necessary, in- 
troduce the parties, and let the borrower do the borrow- 
ing on his own responsibility 
Do not squirt tobacco-juice around you at your 
visits, or have your breath reeking with its fumes, or 
with those of cloves, cardamom, alcohol, dead beer, etc., 
or you will unavoidably invite criticism and create re- 
vulsion towards you. 
Appearing in your shirt sleeves, wearing rough, creak- 
ing boots, or carpentering, painting, or showing other 59 
out-of-place talent, or chewing, smoking, sky-larking, 
etc., will show weakness, diminish your lustre, detract 
from your dignity, and lessen you in public esteem, by 
forcing on everybody the conclusion that you are after 
all but an ordinary person. You may secure faith in 
spite of these, but usually such things tend decidedly 
to decrease it. 
Drunkenness may be tolerated in doctors who are 
fully established in practice, because attachments had 
been formed and their talents had become known pre- 
vious to the formation of the habit; but it is fatal to the 
prospects of a beginner. 
An excellent course is to avoid intoxicating drinks 
yourself, and let others do as they think best. If it is 
known that you never drink, it will be of immense ad- 
vantage to your reputation; but urging temperance on 
all occasions, or being a member of temperance, of secret, 
or of beneficial societies, will not aid much in the ac- 
quirement of desirable business; indeed, the best prac- 
tice you can have is the quiet family business that you 
will attract by faithful endeavors to do your best for 
all who apply to you. 
Temperance, total abstinence, prohibition, and other 
sumptuary crusades will be apt to recoil on your head 
if you make yourself prominent in them. Pushing mat- 
ters of a partisan nature is not your function, and you 
cannot become officious in them without engendering 
rancorous enemies. You had better leave all such mat- 
ters to the laity, unless your pecuniary or social position 
is such that you can very well afford it, or you are 
driven into them by conscientious scruples that outweigh 60 
all other considerations; and even then it is better to 
let your profession be foremost in your mind. 
Presents from fond or grateful patients, or very 
liberal ones, although flattering, will almost invariably 
lead to confusion, or to a breaking up of the legitimate 
pecuniary relation between the giver and yourself to 
such a degree that it cannot be fully restored. Prob- 
ably every practitioner can recall numerous instances in 
which presents of game, fruit, cigars, wine, whips, canes, 
or new hats, have proven exceedingly expensive. When 
you foresee such a result, be guarded. 
A good rule is to decline all presents that would 
place you under embarrassing obligations to patients. 
Another good rule is to avoid mixed dealings and crossed 
accounts with hucksters, grocers, feed-men, milk-men, 
and other patients, as such an arrangement will rarely 
continue to be satisfactory; it often engenders disagree- 
ments, and will almost always result in your getting only 
about half as much for your services as if you had 
avoided entanglement and dealt on a money basis. It 
is decidedly better to avoid all such involvements, and 
let those for whom you work pay you in money, you in 
turn doing likewise. Avoid these and all other things 
that tend to weaken your business rules. 
Preserve a proper degree of gravity and dignity on 
all occasions. Frivolous conduct, vulgar jokes, great 
levity and undue familiarity are unprofessional, and 
breed contempt and scandal. Discourage all attempts to 
address you with a " Hallo Doc! " or to pass the limit 
of propriety in any way with you. Give every one his 
proper title, and exact the same respect in return. Do 61 
not understand me to condemn good-natured pleasantry; 
when manly and within bounds, it is often appropriate, 
and sometimes actually serves as a tonic to a patient's 
drooping spirits. If you wear a cheerful mien it will be 
health to you and sunshine to your patients. 
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 feel and express a genuine interest in the case and 
in the effects of the remedies you are using. 
When you scold or find fault with patients or their 
attendants, preface what you say by explaining that you 
are not scolding in anger, but because you feel an earn- 
est desire to have them do right for everybody's sake. 
By prefacing thus you will completely disarm resent- 
ment, and they will take all you say in good part. 
If you are unmarried it will often be quoted against 
you; but the truth is, there is no great professional ad- 
vantage gained by being married. The objection to 
most unmarried doctors is really not their being unmar- 
ried, but their youthfulness. To marry with an eye to 
business only would be apt to entail expenses and re- 
sponsibilities without corresponding benefits. Besides, 
you should keep both business and marriage on a higher 
plane. You will often see in your professional career 
the misery that flows from degrading marriage by enter- 
ing into it from other considerations than love and 
congeniality, and you should not risk it yourself. 
Everybody wants a lucky, conservative doctor; there- 
fore a series of dystocias, or of deaths in child-bed, or of 62 
surgical operations that fail, or of cases of any kind that 
eventuate unexpectedly ill, often injures the physician 
for years, by attaching to him-especially if he is a 
beginner-either charges of being blind to danger and to 
duty, or a long-to-be-remembered reputation for bad luck. 
If such a series unfortunately begins in your practice, 
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- 
examination whenever you have conducted yourself 
unsatisfactorily. This will teach you to conceal or 
eradicate your defects and faults, and to give promi- 
nence to your good qualities. 
No one can succeed fully without the favorable 
opinion of the maids and matrons he meets in the sick 
room. The females of every family have a potent voice 
in selecting the family physician. I have often thought 
that the secret why so many truly scientific aspirants 
fail to get practice is that their manner and acquire- 
ments do not appeal to the female mind. 
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 
children and of patients you see but rarely, and the 
salient points of former interviews with them, are very 
useful adjuncts to other qualities. 
Children's likes and dislikes will control your destiny 
in many a family. Many people patronize various forms 
of quackery for no greater reason than that " the child- 63 
ren 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 
getting practice. You may be socially a great favorite 
while all are well, but when sickness comes and death 
threatens the afflicted one, the impulses of friendship are 
dormant and do not influence the choice of a doctor. 
No member of any family circle will be spared if any 
human power can save, and persons terrified at the pos- 
sibility of losing the provident husband, beloved wife, 
blooming daughter, darling babe, dutiful son, or honored 
parent, as the case may be, instinctively send for the 
doctor in whose skill they have most confidence. They 
go past the beginner about whom they know too little,- 
past the one whose system requires so much stimulating, 
about whom they know too much,-past the gay, the 
fickle, the sentimental and the unchaste,-past all whose 
unprofessional demeanor proves them to be either unripe 
or unsuited 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 confi- 
dence centre; faith is the great controlling lever. 
There is a certain fact that you might not observe 
without having your attention called to it; it is, that 
after you get into full practice, your days, weeks, months 
and years will flit by faster than those of other people, 
because as a doctor they will be incessantly occupied 
with a medley of important cases, and the lapse of time 
will consequently be almost magical. 
You should seek proper relaxations and amusements 
while the age for enjoying them remains. Many doctors 64 
foolishly postpone all relaxation froni one time to 
another, intending to indulge in ease and pleasure when 
they get older, and thus forego seeking enjoyments till 
they lose all taste for them, till they know nothing and 
are fit for nothing but to work in the doctor's hard, 
slavish treadmill for life. A little leisure is a great 
blessing. An occasional day's sport, or a summer trip, 
or an evening at a convivial gathering or at the theatre, 
etc., will act as seasoning to your labors, will break the 
monotony, subdue mental irritability, afford diversion, 
and actually make you more philosophical and a better 
doctor. 
Newspaper notices of your departure from the city 
for seaside, mountain or other pleasure trips, will, if 
allowed, have a disturbing and hurtful influence on your 
practice while you are away, and even after your return. 
Reporters are aware how such items injure doctors, 
and seldom publish them unless requested. The register 
clerk of hotels where you register will, if asked to do so, 
omit announcing your arrival in the newspapers which 
would publish your absence from business to the whole 
world. 
When you assume charge of a case for a doctor, to 
look after during his absence from the city, or one of 
your own that has been under the care of a substitute 
while you were away, or that any one has attended in 
an emergency pending your arrival, or because the 
attending doctor has been taken sick, continue his line 
of treatment, at least for a while, if you can conscien- 
tiously do so. An abrupt radical change, either in 
diagnosis, prognosis or treatment, is both ungenerous and 65 
injurious to your co-worker. In such a case, if you be- 
lieve something more should be given, merely add it to 
what is already being done. This avoids unpleasant 
reflections. 
Give the right hand of fellowship to every regular, 
honorable physician, no matter what his misfortunes or 
how great his deficiencies; on the other hand, refuse it 
to all irregulars, no matter how great their acquirements, 
their reputation, or their pomp. 
Be polite and considerate to every one, especially 
when you are vexed or in a hurry; abruptness makes 
many useless wounds, some of which are difficult to 
heal. True politeness is a seed that costs nothing, can 
be planted anywhere-that always bears good fruit. 
Resolve that you will cultivate it as long as you live. CHAPTER IV. 
Always feel and show respect for your seniors in 
practice. There is probably no type of medical man so 
unworthy of respect as the one who shows contempt for 
his seniors. You may excel the older physicians in 
severely scientific and technical points, but they have an 
experience and an intuitive forecast of the necessities and 
the results of cases that far outweigh mere book know- 
ledge, and make them better logicians and much better 
practitioners; because knowledge derived from observa- 
tion and experience is more like part of one's very 
nature than that gotten from any other source, and is 
fixed indelibly on both One's senses and reason. Re- 
member that although younger doctors indulge more in 
scientific " extras " than older ones, yet the art of curing 
disease owes more to good judgment and common-sense 
bedside experience than to anything else. 
When you have been a doctor long enough to make 
your patients feel that you alone are acquainted with 
their moral and physical idiosyncrasies, it will give you 
great advantage, and will make attending them much 
easier. You will occasionally be employed in cases 
because you have long ago attended other members of 
the family in similar affections and are supposed to 
know the family constitution. You will find that 
'i knowing people's constitutions " is a powerful acquisi- 
tion. 
66 67 
Never ask, as you enter to pay the first visit to a 
patient, the awkward question, " What is the matter 
with you ? " or at any other visit, " How are you to- 
day ? " or he may retort, that is what he wants the 
doctor to tell him. 
Experience and skill are what the public seek in a 
physician; they are most important, and the public 
know it. You should carefully try to appear possessed 
of both. Of course, we all have aftersight, but foresight 
is what is needed. Experience will enable you each year 
to foresee many events with increased clearness, and if 
you compel yourself to be a faithful worker and good 
observer, every year will make you a better physician, 
and by the time you have worked and observed for ten 
or twelve years you will be clinically familiar with all 
the more common afflictions that are sure to confront 
you, and you will know how to shape your diagnosis 
and prognosis in each far better than your juniors. 
In' addition to the great advantage the older phy- 
sicians have over the younger ones, from increased 
ability to foresee the probable degree and duration of 
grave cases, and to give concerning them 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, and enable them to carry cases 
and retain confidence much better than younger phy- 
sicians can. This is the chief reason why the practice 
of medicine becomes relatively easier every year. You 
will find that after you have practised twelve or fifteen 68 
years, after you have forgotten much of your theoretical 
knowledge,-which was probably greater at graduation 
than it will ever be again,-your experience will be 
invaluable to you and will often serve you where 
nothing else can. This self-attained knowledge is the 
kind that makes the public always prefer the older 
physicians and distrust the younger ones. 
The public love to see a doctor appear to know 
things intuitively, and you must study and practise to 
be quick in diagnosis, and ever ready in the treatment 
of the ordinary cases that will constitute nine-tenths of 
your practice. 
Remember this : Every one likes to believe that the 
•doctor 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 scientific use 
of your opportunities whenever proper cases present 
themselves. Experiments that require vivisection would 
mot, however, add much to your reputation, as such 
things are supposed to have been studied as far as 
needful before leaving college. On the contrary, 
making clinical analyses of the urine and other fluids 
will not only lead you to invaluable information regard- 
ing your patient's condition, but will be a great element 
in giving you popularity and respect. 
Working with the microscope on proper occasions 
will not only 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, 
especially in the beginning, as it paves the way to per- 69 
manent family practice ;* but waiting at the bedside 
entails a tremendous loss of time. If you ever get so 
overrun with business that time is precious with you, 
it will overtax you, and it may become actually neces- 
sary to shut it off to get time for other patients, meals, 
sleep, etc., or at least to limit your engagements to 
attend cases as far as possible. It is a wearing branch 
of practice, one that is full of care and responsibility. 
Although midwifery cases lead to other family prac- 
tice, you will find after you get into full practice that 
the fees for attending them are, on account of loss of 
precious time, of sleep, etc., proportionately more meagre 
than in any other department of practice. 
When a patient engages you to attend her in con- 
finement, 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 
send for you than for a midwife. 
In spite of this, however, you will occasionally be 
engaged for a case, and after being kept in suspense for 
weeks or months, will learn that the labor is over, that 
a midwife or granny was sent for, and the excuse will 
be that everything occurred in such a hurry that they 
could not wait, or some other equally lame plea will be 
presented. 
You will often be called to do ugly work for mid- 
wives who are nonplussed in bad cases, and for the suf- 
ferer's sake you should never refuse to go. 
You may be surprised to learn that it is now gener- 
ally understood in many communities that every mid- 70 
wife has her regular medical referee to relieve her of 
complicated cases. If you are chosen thus you will 
have an excellent chance to show the advantage regular 
physicians have over midwives and irregulars, and to 
enhance yourself in public esteem. 
Pregnant women will sometimes want to make a one- 
sided bargain with you beforehand to come to them in 
case their midwife fails. Of course you should go to all 
cases where humanity calls, but you should never bar- 
gain 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. 
In every confinement case, after delivering the child, 
be careful to call its mother's attention to the lump in 
her own abdomen, and inform her that it is the con- 
tracted uterus. If you do not, she 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 does 
not 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 horse- 
flesh, use up more carriages, harass you at unseasonable 
hours, and expose you to bad weather more than all the 
balance of your practice. 
Keep your practice down to a number you can pro- 
perly attend; you can do this by sending your bills 
promptly, circumscribing your bounds, cutting off ob- 
stetrical engagements, etc. In refusing to take a case 71 
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, the plea of " too busy " is the least open to criti- 
cism and over-persuasion of any you can assign. 
Never offer as a reason for neglect to visit a patient, 
" I really forgot you it is unpardonable. 
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 doctor 
who attends them, when they require a physician for 
other diseases. Attending them will, however, often 
enable you to pick up a handsome cash office-fee. 
Even when you are positive that a person has syph- 
ilis, it is not always best to say so. Prudence will 
sometimes require you to reserve your opinion, but at 
the same time give the proper medicine. Indeed, in 
practising medicine, you will see and understand many 
sins and blemishes of which you must appear oblivious. 
Take care that your reputation for attending vene- 
real diseases does not overshadow or eclipse other kinds, 
and give you the title of " P-x Doctor," and entail the 
social ostracism and loss of family practice that would 
follow; or that extra success in restoring the menses in 
females who suspect pregnancy does not bring you an 
extra number of such cases and give you the title of 
"Abortionist,"-or that attending an excessive propor- 
tion of courtezans or bruisers does not give you the 
name of having a " fancy practice." 
You will find it much more pleasant to practise in 
some, families than in others; for some families will con- 72 
stantly give you intelligent co-operation, and will make 
charitable allowance for all your shortcomings and fail- 
ures, while others will, when any of their members are 
sick, appear almost as if they wanted to involve and 
harass you in every conceivable way, and to make you 
feel as if in attending them you were on trial for your 
life. Remember this, and like a philosopher make it a 
rule never to worry about anything you cannot help. 
Be guarded against asking private questions before 
persons not in the patient's confidence, unless they are 
clearly entitled to hear them; request all such to leave 
the room before asking* Be doubly cautious in this 
respect when your patient is a female and the questions 
refer to marriage, menstruation, pregnancy, lactation, 
uterine affections, constipation, or other delicate subjects. 
Do not allow indiscreet patients to go about over- 
praising you and speaking of you as a pet, etc. 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 
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 and estrangement. 
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. 
As a rule, it is better in the family group to lend at- 73 
tention at your visits chiefly to the conversation of the 
husband rather than the wife, and to address your opin- 
ions, explanations and remarks to him or whoever is at 
the head of those you meet in the sick-room, and to 
pay to all others only the respect that civility requires. 
If you do not do this, sensitive people will feel ignored, 
and may even get dissatisfied and create trouble. 
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 conversa- 
tion on him and his case. Both patients and their 
friends will naturally be more anxious to know what 
you think of their cases and to receive information 
for their benefit, than to hear of anything else. If 
the conversation digresses to other subjects, shift it 
back to your patient and his case as soon as possible. 
During consultations also observe the same caution, and 
keep the conversation between you and your colleague 
on the case under consideration, instead of digressing to 
religion, horses, politics, etc.; economy of time requires 
it, besides it is for that you are employed. Another fact 
to be kept in mind is this: If a 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- 74 
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 re- 
proaches 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. 
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 means we cannot always attain perfect re- 
sults nor give complete satisfaction, and some of those 
you have served most faithfully, and who you think will 
never change, will surprise and shock you by turning 
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. 
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. 75 
When urgent necessity or danger requires it, you 
may do the most menial work for a patient; but unless 
these exist, pulling off your coat or collar, administering 
injections, giving baths, swaddling new-born babes, 
nursing the sick, etc., will not comport with your dig- 
nity, and it may be quoted as evidence that you are 
without dignity and lack proper self-respect. 
A patient who is improving will be satisfied by a 
much shorter visit, slighter examination, and less perfect 
attention in general than one who is not doing well, 
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 a 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 judg- 
ment, and force you to study your cases and formulate 
opinions instead of lumping everything and becoming a 
mere routinist. 
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, electricity, etc., and tell why you have not 
ordered them, so as to let it be known you are wide- 76 
awake and have thought of them, but have good reasons 
for not using them. 
Never pronounce any one's sickness feigned or trif- 
ling, unless absolutely positive that it is so, and never 
make fun of people sending for you, or being alarmed at 
what appear to be trifling ailments; indeed, you should 
never joke, talk frivolously, or laugh about your patients 
or their sickness either in their presence or 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, 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 tell whether any case of 
sickness is dangerous, reply promptly, " Of course it is, 
because it is sickness, and all sickness is 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 assure people 
that sickness of any kind is not dangerous or might not 
end in death; then tell them what you think of the 
case in point. Even in doing this, do not fail to leave 
yourself a reasonable margin for uncertainties. 
In giving death certificates in mania-a-potu, syphilis, 77 
abortion, etc., never yield to importunities and substitute 
other pleasant-sounding titles that risk putting you in a 
false position. 
In giving certificates it is best to certify 44 In my 
opinion," etc. Indeed, it is wiser as well as more 
modest, in expressing an opinion, whether written or 
oral, to always say, 441 believe thus and so," or 44 In my 
opinion," etc The fact that it is your belief or opinion 
no one can dispute. 
Be exceedingly cautious in giving certificates of 
insanity with a view to committing patients to an insane 
asylum ; distinguish between the truly insane as contem- 
plated by law, and those who may only seem to be insane. 
Dissatisfied friends of such people sometimes give great 
trouble to accommodating physicians in these cases. 
Give certificates in none but clear cases, and keep a 
memorandum of all the facts in each. 
Also keep memoranda and observe great caution 
when you are a witness in will cases, suits for divorce, 
etc. 
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 smallpox 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 community. 
Carefully prevent children in whose family conta- 
gious disease exists from infecting others by attending 78 
school, or otherwise mingling with those liable to con- 
tract 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, etc., or that you are even 
attending any contagious disease, or you wrill be credited 
with causing whatever cases occur among those you tell. 
If your practice is so full of such cases that you must 
tell it to somebody, tell the health authorities; if the 
public good requires it, inform them anyhow. 
After visiting contagious diseases, always disinfect 
your clothes by walking in the open air; also wash your 
hands with very hot water, or hold them over the fire; 
also use disinfecting lotions, etc., according to apparent 
need; if necessary, take a warm bath, or even a Turkish 
bath. 
Oppose the conveyance of diphtheria, scarlet fever, 
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 use a tongue-depressor indiscriminately. For 
besides the disgust patients feel towards having an in- 
strument that has been used on everybody, put into 
their throats, it might actually convey syphilis, diph- 
theria, etc., from one patient to another, and render you 
liable to just censure. When you wish to examine a 
throat it is better to ask the nurse for a clean spoon. 79 
At your office an ivory paper-folder answers very well, 
is not disgusting, and is easily kept clean. 
Do not lend yourself too freely to other physicians 
and surgeons; never make a habit of belittling yourself 
by giving chloroform, etc., in surgical cases. There is 
a great difference between giving assistance in medical and 
in surgical cases. If you visit a medical case with 
another doctor, you will be regarded as a consultant, 
and as being at least equal or even superior to him ; 
besides, a fee may await you. If, on the contrary, you 
go and do some secondary part in a surgical case, you 
will be looked upon as a lesser light to the one you 
assist, and you will take a position of neither honor nor 
profit, and will reap nothing but responsibility. Do not 
habitually play the part of utility-man or unpaid as- 
sistant to any one except to your father or preceptor; 
servility and obsequiousness will never advance you, 
either in the community or in the profession. 
Preaching morals to patients seldom does any good, 
but you can often exert the greatest influence upon 
patients who indulge to excess in chewing, smoking, 
drinking, singing, dancing, late hours, carousing, etc. 
Your injunctions regarding the four things last named, 
if properly given, will frequently be strictly obeyed. 
The various quack bitters advertised and guaranteed 
to be " a wonderful discovery," are almost invariably 
some vile compound of bad rum or bad whiskey, and 
are the origin of much drunkenness; you should show 
the 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 80 
he is taking. When drinkers tell you that they intend 
to ' swear off' for a definite period, advise them instead 
of swearing off to swear neither to treat any one nor 
allow any one to treat them to liquor during the pre- 
scribed period. This is more manly and more apt to be 
observed. 
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. 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, even 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 V. 
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 are sometimes 
more useful to a worn and irritated patient than medi- 
cine; and even where death is near and inevitable, 
resignation often takes the place of fear when the sick 
one is skilfully informed of the probability of death. 
In fact, when cheered by religion, many show as little 
regret upon learning that they will probably die as a 
traveller does when about to start on a pleasant journey. 
When called to attend cases of angina pectoris, 
aneurism, organic heart disease, desperate wounds or in- 
juries, apoplexy, and other diseases that create liability 
to sudden death, prudence may require you to conceal 
the danger of death from the patient, lest he give up all 
hope and be overcome by apprehension and terror; but 
be sure to give, privately, proper 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 exceedingly careful in talking- 
before children with scarlatina, variola, rubeola, etc., of 
the danger of complications, or of their illness being 
serious or dangerous; also take care to banish from 
81 82 
them the fear of hydrophobia, lockjaw, etc., because 
some very young children fully realize the meaning of 
death, and such talk would terrify them. Also use the 
proper caution about patients who seem to be sleeping, 
or drunk, or semi-comatose, etc. 
It is just as natural to die as it is to be born, and 
every one's time must come. You can neither see what 
is written in the book of life, nor detain the sick soul 
when the Angel of Death summons; sometimes you will 
seem to be fighting death itself, and yet see the patient 
recover as if by resurrection, whilst on the other hand 
you will often 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 either your 
religious beliefs or disbeliefs or your political tenets 
upon patients who hold opposite views. It is really no 
part of your duty to administer to the religious cravings 
of the sick. Every sect has teachers of its own, to 
whom you must leave the spiritual. Confine your min- 
istrations to the worldly welfare of patients, and never 
suggest anything in religious matters that involves a 
creed different from that of the sick one. 
The great prospect of Eternity certainly overshadows 
all temporal things. Be ever ready, not only to allow, 
but to advise patients to have spiritual ^comfort. Re- 
ligion does good, not only hereafter but here; indeed, 
the presence of religious faith is a wonderful power, 
and if any physician does not recognise it he lacks 
the a b c of philosophy and the rudiments of observa- 
tion. You will see many a poor, sick, woe-worn, des- 83 
pondent and broken-hearted wretch calmed in mind and 
body by its cheering influence, and aided by it to get 
well, if his ailments are at all curable; if not curable, 
his spiritual wants being supplied, he becomes willing, 
or even anxious for the hour of departure. 
The automatic, seemingly anxious movements uncon- 
sciously made by the dying are popularly supposed to 
be attempts to communicate some remaining thoughts 
or secrets or special wish before death. Explain to the 
friends in such cases that Providence 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 it is awfully painful and 
harrowing to all wdio stand at the bedside and witness it. 
When attending in Catholic families, be doubly 
cautious to warn the immediate friends of danger, that 
the sick one may receive the last sacraments. 
One of the seven sacraments of the Holy Church of 
Rome is Extreme Unction. It is believed to purify the 
soul of the dying from any sin not previously expiated 
through other sacraments, and to give strength and grace 
for the death struggle. 
Catholicity teaches that moral responsibility begins 
at the age of reason; therefore Extreme Unction is 
necessary for all who have attained that age. 
Extreme Unction is given but once in the same ill- 
ness, but if the sick one has recovered and shortly after- 
ward has the same or any other kind of dangerous sick- 
ness, this sacrament is again necessary. 
Another of the seven sacraments of the Church of 
Rome, with which you should be familiar, is the Holy 
Eucharist. 84 
The Holy Eucharist, sometimes called the Wafer, is 
believed to contain Christ's whole being, his body, soul 
and divinity. It may be administered frequently in all 
cases of sickness where the patient is confined to the bed 
or to the house for any length of time, provided he has 
sufficient reason to make a full confession. 
Be careful to inform the family of the sick person if 
there is danger of the patient's becoming unconscious in 
the course of his illness, so that the clergy may be 
called, and the sick one's confession be heard, and the 
Holy Eucharist given before the reasoning powers are 
obscured. 
Those who are to receive the Holy Eucharist are 
required to fast, if possible, from midnight until they 
have received it; but if you consider that your patient's 
being without either food or medicine would be detri- 
mental 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 ad- 
minister, or have administered, conditional baptism to 
all children during or after birth, when there is the 
slightest reason to doubt their viability. The following 
are the conditions and details of conditional baptism. 
You, or any one else, whether a Roman Catholic or 
not, are allowed to administer it. A male adult is pre- 
ferable to a female, and of course a Catholic, if one is 
at hand, to a non-Catholic. The baptism is given as fol- 
lows: After procuring a glass or cup of clean water 85 
(spring water is designated, but hydrant or pump or 
any other kind of true and natural water will do), with 
suitable manner say, " Beloved child, I baptize thee in 
the Name of the Father," precisely at the word 
" Father " pouring a small portion of the water upon 
the child's head; continue, "And of the Son," at the 
word " Son " pouring another small portion; again con- 
tinue, "And of the Holy Ghost," and at the word " Holy 
Ghost " another small portion. 
Remember that in baptism every word must be ut- 
tered; were you to omit even an "of," the baptism 
would be insufficient. Also remember that the water 
must be true and natural, and must be poured exactly 
whilst the formal words are pronounced. So very im- 
portant are these details that if you arrive after a mid- 
wife or other person has baptized the child, carefully 
ascertain whether they have observed the full form and 
accurate language. If they have not, and the danger of 
death continues, you should baptize it again. In such 
a case it is necessary to preface the formal words with 
" Beloved child, if thou art not already baptized, I bap- 
tize thee," etc. 
If in a midwifery case the child 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 86 
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 dan- 
ger to all who have unfinished business of vital moment; 
persons suddenly seized may wish to summon friends, 
make wills, etc. 
In adults with almost any sickness you can safely 
predict death in a few days, at furthest, after the pulse 
has gradually increased to 160. 
Be careful to exhibit proper gravity when attending 
serious cases. 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 pos- 
sible answer him in bland terms, so as not to appall 
him and take away all hope. 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. Of course 
you must not, you cannot, put falsehood in the place of 
truth, even when talking to the sick and dying, for you 
cannot sacrifice principle or truth for expediency under 
any circumstances. But tell it in a proper manner. 
You will find but few who have the mental forti- 87 
tude to enjoy the remainder of life after they are for- 
mally told their case is permanent or incurable; and 
you should be cautious, and not unjustifiably cut off all 
hope even from those afflicted with tuberculosis, cancer, 
Bright's disease, etc., where death approaches slowly 
like a creeping shadow till in their last stages, as per- 
sons with those diseases have plenty of time while 
sinking away gradually to realize their fate. 
Avoid all such tricks as assuring a timid patient you 
will not lance his boil but merely wish to examine it, 
and then suddenly do what you assured him you would 
not do. Veracity should ever be your golden shield. 
The white and the black, the rich and the poor, the 
courtezan, the outlaw, the swaggering rowdy and the 
reprobate, will all be represented in your practice. At- 
tend anybody if you must, but seek to avoid disreput- 
able places and persons; they are more likely to be a 
curse than a blessing. Remember always that such 
people respect no doctor who does not respect himself. 
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, but also the mental. 
You have a perfect right to relinquish attendance on 
a case when you think your interest or your reputation 
requires it; when you do so, let your withdrawal be 
fully understood. It is better, however, to plead having 
too much other business and not take undesirable cases at 
all, than to take them and involve yourself, and after- 
wards relinquish or neglect them. 
Never refuse to rise from bed and make night visits 88 
to patients who require them; to refuse would be un- 
just, and would either let the patient suffer or die, or 
unjustly put your duty on some other doctor; it might 
even drive the messenger to a druggist for advice and 
medicine, or open the door to a homoeopath, 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 at- 
tending those who could have sent at a more seasonable 
time. Unnecessary night-visits rob doctors of their rest, 
and even if they bring in fees they are not an equiva- 
lent for the over-work and risk of health. 
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; 
also about attending patients for diseases under pretence 
that they are something different, in order to shield them 
by deceiving friends or relatives. 
Do not over-visit your patients, and be especially 
careful never to over-visit those with trifling injuries, 
uncomplicated cases of measles, mumps, whooping-cough, 
chicken-pox, etc. People observe and criticise a doctor's 
course in all such cases, and if he seems over-attentive 
they are apt to believe he is nursing the case and creating 
a bill unnecessarily. It is sometimes an extremely deli- 
cate 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. 
Excessive attention and numerous visits are rarely 89 
appreciated. If you can get the reputation 01 not pay- 
ing 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. 
Some well-to-do or over-solicitous people form an 
exception to this rule, and insist on your visiting them 
frequently, almost living at their house during sickness, 
to observe progress, instruct attendants, etc., regardless 
of the additional expense, and of course you should 
gratify them, but you should also at the beginning in- 
form the one who will have to pay the bill of the reason 
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; unless you do so he will certainly lose con- 
fidence, after which you will be shorn of your influence 
and will scarcely be welcomed when you call. 
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 90 
as to make you fear an arrest of improvement or a relapse, 
it is better to keep sight of him by calling once in a 
while and letting it be known when you will again call, 
with an understanding that if the patient gets worse in 
the meanwhile they will let you know, and if he is so 
much better as to render your promised visit unneces- 
sary they will also send you word. This plan is for 
many reasons better than quitting such cases abruptly. 
Earnestness and interest shown in cases are master 
qualities. They inspire both faith and confidence, and 
are often actually accepted in lieu of 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, and also take 
care neither to expose a want of memory nor a lack of 
interest. Were you to ask a patient "What kind of 
medicine did I give you last?" he and his friends 
would notice it instantly, and think you either felt but 
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 impart to you their secrets. 
One of the greatest drawbacks to many doctors is that 
they do not inspire complete confidence, and patients 
neither intrust them with the secrets of their ignorance, 
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, nor the private details of your cases, 91 
even though they are not secrets; nothing is more 
mortifying or hurtful to the feelings of patients than to 
hear that the details of their cases are being whispered 
about as coming from the doctor or those he has told. 
If you allow yourself to fall into the habit of speaking 
too freely of ordinary affections, or submit to be indis- 
criminately interviewed concerning your patients, your 
very silence in disreputable cases will betray them. The 
credit of whole families and the character of its indi- 
vidual members will sometimes be at stake, and unless 
you shut your eyes and do not see too much, also 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 
over their moral and physical afflictions, over their 
blasted hopes and the sorrows that flow from love and 
hatred, their poverty and their crimes, their vexations 
and their solicitudes; you will see their deformities, 
debilities and deficiencies with the veil lifted, and will 
become the repository of all kinds of moral and physical 
secrets. Observe reticence at your visits, and do not 
mention the private affairs of anybody from house to 
house. Seal your lips to the fact that patients have or 
ever had venereal diseases, hemorrhoids, fistula, ruptures, 
leucorrhoea, constipation, or that abortions, private opera- 
tions, etc., have taken place, or that any one. takes 
anodynes or liquor, 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 
right to tell the affairs of patients to any one without 
their consent. 92 
But while silence should be your motto, it is your 
duty to society and to the laws to expose and bring 
abortionists and unprincipled quacks and heartless vam- 
pires, whether acting under cover of a diploma or not, 
to justice, whenever you meet proof of their wicked work. 
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-dose 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 "put them into a bottle." It is 
so unusual to dispense pills in a bottle that it informs 
the compounder that the quantity is not a mistake but 
is as intended, and guards patients and attendants against 
taking or giving them in mistake. When you 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. 
A placebo or tentative remedy should as a rule be 
small and easy to take. A very good form is prepared 
thus: Purchase a pound box of No. 35 unmedicated 
homoeopathic globules, which cost but thirty-five cents, 
and immerse one half of them in fluid ext. of belladonna, 
and the other half in compound tinct. of iodine, for twenty 93 
minutes, then roll them about on a newspaper till all 
surplus fluid is absorbed, and let them dry; after which 
they can be put into bottles, with a small quantity of 
powdered cinnamon in one bottle and powdered liquorice 
root in the other to prevent agglutination. These can 
either be given as globules, or put between paper, crushed, 
and given as powders; they make cleanly, convenient 
placeboes for office use, and cost so near nothing, and a 
pound will last so long, that you can afford to give them 
away and charge such patients for advice only. They 
will suit almost any case requiring a placebo. Be care- 
ful to keep a straight face and to give minute directions 
concerning the manner and time of using inert remedies 
given simply to amuse people who are morbid on the 
subject of health, and you will do them double good. 
You will not only find that your placeboes amuse 
and satisfy people, but you will often be surprised to 
hear that some full-of-faith placebo-takers are chanting 
your praise and are actually willing to swear that they 
are cured of one or another awful thing by them; 
cheated into a feeling of health by globules, or teaspoon- 
ful doses of flavored water, or liquorice powder, as if by 
a charm; some who seem to be magically benefited by a 
teaspoonful of-nothing-will actually thank you for 
saving their lives. What a sad comment on the discern- 
ing power of the nineteenth century ! What a sad fact for 
legitimate medicine ! What a gold mine for quackery ! 
Just here let me impress a caution : Take care that 
seeing cases get well thus does not create in your own 
mind unconscious deception and lessen your belief in the 
necessity for medicine in real sickness, and modify or 
destroy your usefulness when medicines are required. 94 
Never send a patient to the drug-store with a pre- 
scription for bread-pills. It is not right to make any 
one pay for bogus medicine; besides, if, from among all 
the articles in the pharmacopoeia you cannot devise some 
trifling placebo that is more plausible than bread-pills, 
you must have an unusual paucity of resources. More- 
over, were a patient to discover that he had been paying 
for such a thoroughly insipid cheat, he would naturally 
feel victimized and indignant. 
The vast majority of people are now sensible enough 
to take medicine only when sickness demands it, and 
even then not too much. But taking " a little medicine 
for clearing the constitution in the spring of the year," 
still has patrons; and the cathartics and other depleting 
remedies are still popular with the few who cling to the 
old forty-years-ago craze for purging, sweating, vomit- 
ing, &c. 
These people always want to see and feel promptly 
and fully the -action of medicines, and think they could 
scarcely live a month without pills, salts, etc. Conse- 
quently this class often purge themselves entirely too 
often. Remember that when nature is depended on, the 
bowels ought to act daily, or at least act freely once in 
two or three days; for, when nature moves the bowels, 
the lower portion only of the intestinal cavity is evacu- 
ated, and during the interval before the next passage 
the faeces from above come down and are in turn evacu- 
ated ; but, when a purgative is taken, it sweeps out the 
entire alimentary canal, and of course such a scouring 
is not required as often as the natural though partial 
evacuation. For any adult who cannot have an evacu- 95 
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 either repel 
them or prevent your enjoying the necessary esteem. 
Many people are naturally capricious and fickle, and 
no matter how earnestly any one tries to serve and sat- 
isfy them, they will change about from one to another. 
Others are more true and will adhere to you through 
everything, good or bad, with surprising tenacity. You 
should, however, always found your hope of being re- 
tained upon deserving it. Do not set your heart or 
faith upon the continuance of the patronage of any one, 
for you will many a time be replaced by those you know 
to be far below you in everything that unites to make a 
good physician. Sometimes you will be unexpectedly 
and unjustly dropped out of a family, and the most ig- 
norant or shallow fellow in the whole section, or an old 
lady, or a homoeopath, will supersede you, and you may 
have to bear the reflection and the wrong without show- 
ing the slightest chagrin. 
Ability to promptly detect loss of confidence or dis- 
satisfaction with either yourself or your remedies is one 
of the acquirements that you must seek to attain, if you 
do not already possess it. 
A patient has a legal right to dismiss you from a 
case, and you have also a perfect right to relinquish 
attendance on him at any time. Indeed, you may 
sometimes find yourself so hampered, or harassed, or 
maltreated in a case, that to retire from it is your only 
alternative. 96 
Whenever dismissed from a case, consider attentively 
the combination of circumstances that conspired to pro- 
duce the dismissal, and how you might have averted it, 
that you may gain additional familiarity with the art 
of satisfying and retaining patients. 
Some people, indeed whole families, who will almost 
idolize you as long as you are lucky and have neither 
unfortunate cases nor deaths in their families, will turn 
as rudely and maliciously against you as soon as either 
occurs-as if you kept the book of life and controlled 
the hand of God. 
When you are unjustifiably dismissed from a case, 
especially if it is to make room for an irregular doctor, 
do not tamely consent to be thrown aside in such a man- 
ner. Express your perfect willingness and your deter- 
mination to retire, but make it known in a gentlemanly 
way that treating you thus wounds your sensibilities, 
and that such action necessarily casts undeserved reflec- 
tion on you and does your reputation a very great injury. 
Such a protest will secure for you greater respect, and 
will counteract the injury following your dismissal better 
than if you meekly submit without protesting. 
In acutely painful cases, active, even heroic doses of 
morphia or other potent medicines are often required, 
and must be given promptly, but care must be taken 
that the total amount given is not sufficient to poison 
the patient. A certain gentleman had cholera morbus; 
a physician was called, who prescribed for him twelve 
opium pills, one to be taken every six hours. He was 
entirely too slow in his therapeutics; for long before the 
time to take the second pill had arrived, the soul of that 97 
pain-racked sufferer had taken its flight to a land where 
doctors are not needed and six-hour intervals never 
occur. 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 produce 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 necessary 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 the 
dose that preceded it. 
There is a popular belief that opiates are given only 
to palliate pain, not to cure the sickness. Opiates are 
not only palliatives, but by controlling pain, restlessness, 
etc., they are powerful curatives in a long list of diseases. 
The laity expect you to examine your patient at 
every visit. Never neglect the following five cardinal 
duties : To feel the pulse, to examine the tongue, and to 
inquire about the appetite, the sleep, and the bowels. No 
matter what your case is, be sure to attend to these and 
all other evident or special duties at every visit. 
Whenever symptoms make it possible that hernia, 
carcinoma uteri, Bright's disease, or heart disease is 
present; or that the throat is diphtheritic, or the ear 
occluded by wax, or a tumor or an aneurism exists, or 98 
anything else which, overlooked, might sacrifice the 
patient, or disgrace you if discovered by some one else, 
you should always make a thorough examination, and 
it would even do no harm to let it be known for what 
you are searching. 
Never ask a question without a basis, but be careful 
to make every inquiry necessary to learn all the facts, 
and to satisfy everybody that you feel an interest; if 
you neglect this you will risk both error and loss of 
confidence. 
Prompt detection of dangerous changes or of the 
approach of death not only protects the doctor, but 
gives him eclat if he recognizes and points them out 
before the patient or friends observe them. 
Never speak of anything you do for a patient as an 
experiment; everybody, everywhere, is opposed to doc- 
tors " 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 fracture, or of smallpox, or 
of hernia, or of anything else you ever attended 
You should keep a reference book for recording par- 
ticularly good remedies, prescriptions for stubborn dis- 
eases, etc., also a case book for recording the date, diag- 
nosis, treatment, etc., of unusually important cases. 
Nothing impresses a patient who has a complicated or 
long-standing disease with a fuller conviction that you 
are interested in him, and that you intend to try to do 
him good, than to know that you keep a regular record 
of his case. 99 
When truth will allow, let your diagnosis, etc., 
either include the patient's belief or fully nullify it, 
that his mind may not distrust your opinion and antag- 
onize your treatment. 
You can more easily and permanently convince and 
impress a cavilling patient of a medical fact that militates 
against his wish or belief, for instance that shortening 
is usual after fracture, by showing it to him in the books, 
than by a hundred 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. 
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. 
Even after he is unable to swallow, or if food taken into 
the stomach is not assimilated, continue your efforts 
with inunctions of cod liver oil or of glycerine and quinia, 
rectal alimentation, etc., until he is either better or the 
breath is out of his body; for nature, by a crisis, or a 
vicarious function, or a compensatory process, may turn 
the scale and let the life-power rally and gain control 
over the disease at the last moment, and had you given 
him up you would be disgraced, while some other doctor, 
or a homoeopath, or an old woman who had stepped in, 
would get all the glory. CHAPTER VI. 
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 this or that, or 
not to do it, remember that the sin of omission, is appar- 
ently not as great as the sin of commission. 
Summon professional assistance in all ugly fractures, 
etc., where you think there is the least danger of an 
unsatisfactory termination and of being blamed or sued 
for the result. Having assistance not only divides the 
responsibility, but also makes one a teller of truth for 
the other, and prevents criticism and causeless suits for 
malpractice. Remember that when a fracture, or dis- 
location, or a disfiguring wound, or accident of any kind 
recovers with deformity or disability, there is danger of 
its being ever after exhibited as a monument to reflect in- 
juriously on the medical attendant's reputation. There- 
fore the responsibility had better be divided. In this 
respect medical and surgical practice differ-the results 
of sickness usually disappear, while those of surgery 
remain. 
Always take the precaution to listen to the heart's 
action immediately before administering anaesthetics, 
both for the patient's protection and your own. When 
possible, have another physician present whenever you 
produce anaesthesia, more especially if the patient is a 
100 101 
female. Also, have a third person present at all sexual 
examinations of females, to disprove possible hallucina- 
tions regarding either improper words or deeds and to 
prevent scandal. 
Patients through shame sometimes refuse to allow 
physicians to make examinations that require uncov- 
ering the body, or to allow him to see the underclothing, 
simply because they are unclean and unfit to be seen, 
while the doctor supposes they refuse through modesty. 
In many cases it is better, instead of proposing an imme- 
diate examination, to allow an opportunity for a change 
of linen, etc., by appointing a time for making the exam- 
ination. 
Expertness in detecting and escaping the various 
kinds of scandal and calumny admits of cultivation to 
a great degree; so also does ability to foresee and escape 
entanglement with the captious, the bad, the silly, the 
tattlers, the fraudulent, etc. 
Midwives and doctor-women often exert a malign 
influence, and tell tales or circulate falsehoods about 
doctors that must be noticed and thwarted according to 
the necessities of the case. 
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 and' encourages them to do their best. 
The conciliation of anxious, captious, impatient or 
dissatisfied friends of the sick, when sickness is not pro- 102 
gressing 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 checkmated by the most 
available means; to judge what is best to do under the 
circumstances is sometimes a great puzzle. 
In serious or strange cases, and in such as engender 
great public excitement, if you indulge in confidential or 
semi-confidential whispers to the rabble, it will often 
give rise to misrepresentation or even to total perversion 
of what you really did say or mean. Be ever on the 
alert for this danger. If necessary, give your opinion to 
the proper persons in writing, to prevent its miscon- 
struction. 
Refuse to be confidential with curious or stupid 
nurses or prying mischief-makers, and if you must 
answer their questions, do so, not in confidential whis- 
pers, but openly and in your ordinary voice. 
When a sick person puts himself under your care he 
gives you a responsible duty to perform. If he then 
neglects or refuses to take your remedies he ties your 
hands and keeps you from doing it. If, however, he 
will not or cannot do exactly as you wish, and if no 
special danger exists, it is sometimes better, after drawing 
attention to the position in which you are placed (as a 
protection to yourself), to humor his whims or weak- 
nesses, and modify or alter your therapeutics to such 
things as he can and will do. This you can do good- 
naturedly without fully yielding to him or compromis- 
ing your authority or your dignity. The wishes, preju- 
dices and errors of peculiar patients must be studied and 
to a certain extent respected. 103 
Never captiously oppose a remedy because it is sug- 
gested by a layman. The most ignorant person may 
make a wise suggestion; and laymen often talk excel- 
lent sense about indications they have noticed. Listen 
patiently to all sensible propositions, and if they seem 
simple and meritorious you may find it well to add them 
to your other means, for their moral effect, if nothing 
more. Be frank in giving credit to any good idea, no 
matter by whom advanced. When rejecting a remedy 
thus tendered, let it be known that your condemnation 
arises from conviction and not from superciliousness. 
You might in some cases even humor a whim and sanc- 
tion the use of their harmless domestic remedies,-saf- 
fron tea, plasters, onions to the feet, etc., in conjunction 
with your more reliable agents. 
When attending certain classes of very ill patients, 
e. g. the wife of a druggist or the child of a physician, 
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 wrhen you jar against an 
" old lady with an infallible salve," good for anything 
from mosquito bites up to elephantiasis. You will find 
her so full of faith in herself and in her salve that 
neither reason nor ridicule can shake it. Be very fair 
and urbane with her; but if you indiscreetly concede to 
her remedy any recognition beyond its actual merits, or 
take her into confidence or partnership in the treatment 
of any case, you will make a big mistake, and fill her 104 
as full of conceit, and of mischief too, as the sea is of 
water. 
Hypochondriacs and various other kinds of bores 
will sometimes come to your office and tax your patience 
and ingenuity when you have no time to waste and yet 
are indisposed to be rude. 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 pre- 
cious with you, they cannot deem you uncivil, and will 
be brief, unless unusually pachydermatous. If you are 
greatly annoyed, keep a placard posted with " This is 
my busy day." 
When you are to be a witness in a grave court case, 
firmly refuse to give the opposing counsel, or any other 
person, either a verbal or written statement of your 
opinion of the case or of what your testimony will be; 
also dispute their right to question you. If you are 
yielding in this respect you may actually aid them to 
distort your statement from its proper meaning, or to 
rebut it on the witness-stand, and thus bring both jus- 
tice and yourself to grief. Firmly but courteously 
inform them that they can find out all you know on the 
witness-stand. 
There is no creed or clan, except ours, whose mem- 
bers habitually confute and confront one another in 
courts and before the public. Our so-called psychologi- 
cal experts, specialists, and would-be highly scientific 
representatives have done this so often of late that the 
public have us for a jest, and believe from our kaleido- 
scopic contradictions that our boasted science of medicine 
is a cobweb tissue of mere guess-work 105 
To rid yourself of undesirable would-be patients 
will be one of the most difficult dilemmas that will con- 
front you. " Too busy to attend" is probably the most 
unassailable of all pleas. 
When you receive calls to cases that from any cause 
you cannot or will not attend, notify them to get some 
one else, in order that the patient may be saved from 
delay, and you from the annoyance of repeated messages 
and solicitations. 
No one can blame you for not being at home when 
you are needed; but if you are at home, and quibble or 
refuse to respond to a call, you will sometimes be severely 
criticised, especially if the case goes wrong in 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 
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- 106 
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. 
You must bear in mind that man is something more that 
a stomach and body, and must constantly study the use 
of psychological aids and try to compel your patient's 
will to assist you. 
The presence of sick-room critics will also often 
either impair or destroy your usefulness by diverting 
your mind and lessening your concentration. Conscious- 
ness of being under criticism will in any case lessen your 
usefulness. 
To set unused medicines aside and order others so as 
not to shake confidence, requires a great deal of clever 
management. In many cases where a remedy is ceasing 
to be useful, or indications for something different are 
appearing, it is better not to stop the old abruptly as 
though it were wrong or doing harm, but instead to in- 
struct them to set it aside and begin the new at 
o'clock. Patients will rarely complain of the price of 
medicines that are taken, but they will observe the 
waste, and criticise you when you set half-filled bottles 107 
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 
prospect 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 pre- 
scribing. 
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 wise to order only sufficient medicine 
to last from one visit to the next. 
It is better to leave your directions about medicine, 
food, etc., with the nurse or whoever is in charge, rather 
than with the patient. 
School yourself till you can prevent your thoughts 
and opinions from showing on your countenance, and 
above all discipline your features and manners, so that 
nervous and ill patients cannot detect in you unfavor- 
able reflections about themselves that you wish to 
conceal. 
You will occasionally encounter patients who have 
been kept in anxiety and terror for months or years by 
the trick of some greedy, hyena-like quack, or the error 
of some professional novice who has pronounced them 
syphilitic when in fact they have really never had even 
a sign or a symptom of that disease. 108 
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. 
You will be sure to cause unreasonable, cruel fear 
and distress in the minds of those whose chests you ex- 
amine, if you tell them of " a slight deposit in the 
apex," " an abnormal resonance," or a " bruit de diable," 
"rales," "a palpitation," "a disordered rhythm," or 
other, to them, ominous jargon. Take care never to 
say or do anything which will unnecessarily fix the 
mind of a patient on the character of his breathing, the 
action of his heart, etc. 
God only knows how many young women in our 
land are now tormented with apparitions of " womb com- 
plaint," which have no existence except in this or that 
doctor's imagination-young women that, had their 
minds never been fixed on womb complaints, would have 
lived a lifetime without even thinking of having a womb. 
The chief reason why there are so many doubtful 
cases of womb disease is obvious. When a man is told 
he has a luxated shoulder, or a cataract, or a hernia, or 
a cancer, he finds many ways to confirm or refute the 
doctor's opinion, and he can also see what the treatment 
is doing for him; but when a miserable woman, morbid 
on the mysterious subject of "womb disease," "gets 
examined" and is told, whether correctly or incorrectly, 
that her womb " is turned " or " is down," " ulcerated " 109 
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 examina- 
tion. If there is a wretch meaner than all others in 
the sight of God, it must be the doctor who, void of 
moral sense, would exaggerate his opinion and terrify 
the sick simply for dollars and cents. 
It is also a cruelty to tell patients indefinitely that 
their trouble comes from their heart, or kidneys, or 
liver, or lungs, or that they have the " liver complaint " 
or " kidney disease," or that their lungs are " affected," 
when there is only some slight or temporary affection 
of these organs. You know a man's liver or his lungs 
or his heart may be deranged this week and well next; 
but many 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, because they were 
told long ago that such and such an organ was affected, 
without explanation being given of its functional or tem- 
porary character. By explaining the difference between 
temporary ailments and those of a permanent character, 
or the difference between a functional and an organic 
affection, you will give many a patient perpetual sun- 
shine in exchange for constant gloom. It is your duty 
at least to avoid all ambiguity of language in such cases. 
You will also have patients lacking in the salt of 
wisdom, who come tormented with evil forebodings over 110 
conditions that are either imaginary or perfectly natural; 
some because they have discovered their left testicle 
hangs lower than the right, or because their scrotum 
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, or bas- 
tardy, or moral accusation has thwarted their attempts 
to copulate with loose women and led them to imagine 
they are impotent. You will also occasionally be asked 
for advice by those about to marry, and by others newly 
married, who are miserable on account of this or that 
affliction, defect or fear. Remember in all such cases 
to charge your full /ee, even though you write no 
prescription. With them the charge is for giving valu- 
able information and satisfaction. 
Be careful to warn all such people against the curse 
of falling into the hands of quacks, " friends of erring 
youth," etc., and tell them of the mischief such people 
entail on their victim's health, and also of their unscru- 
pulous voracity for money. 
The eight or ten very large papillae seen upon the 
base of every one's tongue often occasion great anxiety 
upon being discovered by • over-anxious laymen, while 
looking into their throats for syphilis, diphtheria, or 
ulcers. Great relief is expressed when they are told 
these are natural. 
You will be often consulted by true syphilitics who 
wish to know what would be the result of their mar- 
riage. Never promise certain immunity against future 111 
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, 
earnest, and let attention to his case overshadow all 
you say or do; above all, do not divert his conversation 
from himself to extraneous subjects. If it is at your 
office, do not digress by showing him the toy steamboat 
you are making, 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 such people risk syphilis, gonorrhoea, bastardy or 
exposure, or commit rape, adultery, or self-pollution, let 
it be on their own responsibility, not on yours. Perfect 
chastity is entirely compatible with good health; and I 
know of no disorder, either of body or mind, in which 
fornication is necessary. 
Remember that night emissions recurring occasionally 
in young men, partake of the nature of an overflow, and 
are perfectly compatible with health. Young men 
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. 112 
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 blood-making 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 blood-making 
power. When such patients appeal to you to restore 
their menses, you must explain why they have ceased, 
and that they will not menstruate again till their health 
and blood-making power improve. 
Consumptives sometimes have hectic fever so regu- 
larly at a certain hour day after day that they and 
their friends are persuaded that their sickness is mala- 
rial in character, and if you are not on the alert they 
may mislead you into giving an erroneous opinion. If 
quinia does no specific good for the daily fever of a 
weakly or broken-down person, you should suspect that 
it may be hectic rather than malarial fever. 
The popular belief that one is booked for consump- 
tion because a parent or brother or sister died of it is 
true only in a limited sense. If his relative's disease 
was part of his law of development and was in his char- 
ter 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 devel- 
opment 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 compro- 113 
mised, as that variety is not hereditary unless his father 
had it at the time he begot him, or his mother had it 
during pregnancy or nursing. 
One person in every seven firmly believes he has 
either heart disease or consumption. You will find that 
the management of those who really have either is one 
of the most delicate questions in practice. When your 
opinion is invoked in these cases, do not examine 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 all 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 unnecessary 
and enervating. 
People of the opposite extreme, knowing that cool 114 
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 
awake than during sleep. The butcher can attend at 
his exposed, tireless stall the coldest winter weather till 
midnight, and not even sneeze, but were he to lie down 
on his stall and sleep during a similar period, he would 
probably 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. 
Register-heat, on account of its parching dryness, is 
bad for both sleeping and sitting rooms. You will often 
smile at seeing a small pan or cup of water simmering 
under a register that is pouring out a volume of over-dry 
air, while the inmates are blissfully believing it is tem- 
pering 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 115 
power can bring on a reaction and warm it. Ice is put 
into woolen 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; 
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 imita- 
tion of those that suck. 
The ancient custom of clothing infants in flannel with 
woolen 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 to instantly pop 
through the opening, but his chief object is to sever the 
innumerable small nerves that ramify through the gum, 
and thus relieve the tension, irritation, danger of con- 
vulsions, etc. No one should incise a child's gums ex- 
cept when these evils are present. 
li Doctor, my child gets the phlegm up, but instead 116 
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. 
It is a popular belief that crossness in sick children 
argues favorably, and there often seems to be a great 
deal of truth in it, as it requires considerable strength 
and energy to exhibit crossness. 
The terms scarlatina and scarlet rash are now in 
everybody's mouth, and are spoken of by the laity as 
harmless affections. There is no such disease as scarlet 
rash, and these terms always refer either to scarlet 
fever or rotheln, and unless people are made to under- 
stand this, great damage may ensue. 
Bringing out the eruption is one of nature's processes 
in measles, scarlatina, smallpox, 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 
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 medi- 
cine, much the same as one would drive rats from their 
haunts and keep them out till annihilated. No patient 
will object to your driving his humor out or killing it, 
but if he thinks you have simply driven it in, woe to 
you if he should afterward have any severe or fatal 117 
sickness. In such cases it is well to give an internal 
remedy, whether local treatment is used or not. In 
some cases it is even better to commence the internal 
treatment eight or ten days before beginning the local. 
There is also a popular expectation of evil and a 
popular readiness to blame the doctor if any new symp- 
tom appears after he suddenly arrests or cures diar- 
rhoeas, chronic discharges, foot-sweat, bleedings, etc. 
Many people 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, the vital forces of the system, from the depress- 
ing influence of the disease. Their coming being coinci- 
dent with reorganization and returning health, probably 
occasions the belief that boils and health naturally go 
together. 
The high color of the urine occasioned by activity 
of the skin in patients whose sickness compels them to 
lie in warm beds or to keep in 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 but 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 118 
dose of castor oil, to liquefy the contents of the bowels 
and compel the intruder to travel the entire length of 
the alimentary canal alone, instead of allowing the fecal 
matter to remain as a mass to include it and prevent its 
edges and corners from doing harm. When such an 
article is swallowed, do not interfere with nature's efforts 
unless you are sure 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 many a valuable dog to be 
killed. The truth is, if the dog's mouth or teeth con- 
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 bitten one 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 
diseases, 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, 119 
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 either 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 light, filth, or other 
unfavorable, disease-producing elements are added to it; 
but neither life on board of vessels nor in moist situa- 
tions, nor the presence of 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 its total lack of value. 
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 strong mys- 
terious purgative caused her sickness; and if she happen 
to die, you will be blessed. 120 
In admitting or excluding visitors to the sick, man- 
age it so as to engender no personal enmities; also 
endeavor to acquire expertness in answering their ques- 
tions about your cases. 
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 any- 
thing else that would indicate either abstraction or in- 
competence 
You will find that you will inspire more faith in a 
prescription if you begin to write it immediately after 
receiving, to some important question, an answer that 
your manner shows is what you expected. CHAPTER VII. 
Every minute spent in studying to make your reme- 
dies agreeable will be more profitable to you than half 
an hour of any other kind of study. Whoever now gives 
much crude or coarse medicine in ordinary cases injures 
both himself and his profession, and lacks one of the 
simplest requirements of success. Indeed, one of the 
greatest drawbacks to young doctors, and one of the 
chief reasons why they do not assist their older brethren 
to supersede pleasant quackery faster, is, that having 
their attention riveted on their cases and being anxious 
to get the specific physiological effects of medicines 
quickly and fully, they too often give them in crude 
forms, forgetting that the majority of sick people are 
fastidious and have tastes and likes and dislikes that 
must be respected. 
A great and almost universal mistake that regular 
physicians make is to think that when people send for 
doctors they send solely to have medicines given. Many 
people are much more anxious to get an opinion of the 
nature and tendency of their case and words of assur- 
ance from the doctor than to begin a regular course of 
attendance and medicine. 
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 
121 122 
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 kinds. If 
you attempt to treat all these alike you will certainly 
fail. The mental management of the sick is often more 
difficult than the physical. A close study of mental 
therapeutics is one of the necessities that the regular 
profession is still extremely deficient in. Irregulars 
often give a mere placebo or useless agent, which faith 
(psychological energy) on the part of the patient poten- 
tizes and a wonderful cure (?) results. 
Novel remedies often assist the cure through mental 
influences. Many regular physicians give valuable, true 
remedies, but give them just as they would administer 
to a horse or a sheep, and seem to despise the aid of 
faith, mystery, expectation and hope. They must learn 
to depend more upon the aid of hygiene, diet, and 
mental impressions in simple cases, and less on large, 
crude doses of medicine. 
Remember that Dr. Diet, Dr. Quiet, Dr. Hope and 
Dr. Faith are four excellent assistants whose aid you 
should constantly invoke. Dr. Time is also in some 
cases very successful, but he is slow and unreliable, and 
unless Dr. Aider is called to assist, occasionally permits 
a curable patient to sink into his coffin instead of re- 
storing him. 
If you indicate to a patient for whom you prescribe 
an unpalatable medicine, at the time you order it, that 123 
it will have a bitterish or a saltish taste or any other 
unpleasant quality, his mind will be prepared for it before- 
hand, and it will not seem so repulsive to him as if his 
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 you administer, that you 
may either avoid producing them or promptly recognise 
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 cau- 
tion, or that the druggist must label " Poison," espe- 
cially with doubters and medicine-haters. 
Some people will not send for you till they are truly 
ill, for fear you will throw them into bed or salivate 
them, or bring them 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 124 
take medicine they will not be able to stop. Disarm 
all such people by the assurance that their fears are 
exaggerated or groundless. 
It is popularly believed that quinine gets into the 
bones, destroys sight and hearing, causes dropsy, etc. 
So firmly do some people believe these things that you 
will have to humor their prejudices, and give them either 
sulphate of 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. We 
know that quinia is really an almost harmless vegetable 
product, that 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, 
will subdue fire. 
Reproach is often unjustly heaped on doctors 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 call" a return," and for it 
very unjustly reproach both the doctor and the medicine. 
Of course, while the laws of nature remain as they are 
you can no more promise future immunity to convales- 
cents remaining in malarious regions than you can promise 
the anxious sailor that winds will not create waves, or 
the uneasy farmer that frosts will not nip his exposed 
plants. 
Malaria is usually contracted at night, but many 125 
people are not aware of the fact that it can also be 
caught in the daytime, and should be put on their guard. 
Keep yourself fully informed concerning dietetics 
and hygienics; also regarding the various health trips 
and summer resorts. Familiarize yourself also with the 
constituents and peculiarities of the various mineral 
waters and of the uses of each; with the comparative 
advantages of seaside and mountain trips, and with the 
classes of invalids to be benefited by one or the other; 
for these matters belong strictly to the province of medi- 
cine, and it is particularly desirable to understand them, 
because they are subjects that concern the better and 
more desirable classes of patients, with whom you will 
often have to make hygiene, medicinal waters, trips, 
etc., go hand in hand with medication. 
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 ex- 
ternally or swallowed in small quantities at a time, is 
one of nature's greatest remedies in fever, especially if 
the patient has a craving for it. 
When you are busy and wish to make a short visit, 
do not tell the patient so, but begin promptly to ask the 
necessary questions, and do not let the conversation 
digress from his case till you have learned all that is 
necessary. If the subject of the weather is broached, 
answer as if you were considering it only in reference to 
its influence on the patient, and go back to his case. 
Economize time thus; but if your patient is at all ill, 
neither mention your haste, nor show that you are in 
a hurry until you have made your examination and 126 
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 prim and prepare to receive you in the sick-room, 
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. 
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. 127 
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 
the physiological effect, than to give an indefinite medley 
on the ancient blunderbuss principle. 
It is proper to teach patients the laws of hygiene 
and facts that relate to sanitary protection, that they 
may preserve their health; but it is neither just nor 
wise to teach any but medical students the secrets of our 
art. Especially avoid giving self-sufficient people thera- 
peutical points that they can thereafter resort to and 
ignore the doctor. If you do, they will soon imagine 
they know as much about medicine as you do, or more, 
and not only take your bread from you, but will make 
hobbies of what you teach them, and trifle with them, 
till in bad cases the patient's disease is fatally seated. 
It is not your duty to cheat either yourself or other 
doctors out of legitimate practice by supplying this one 
and that one with a pharmacopoeia for general use. If 
compelled to give people remedies under a simple form, 
study to do so in such a way as not to increase their 
self-conceit and make them feel that they know enough 
to practice self-medication and dispense with your ser- 128 
vices; 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 
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 quan- 
tity of the kind which you prefer; if he needs iron, 
prescribe the kind and the dose you think proper, instead 
of making yourself a mere distributer of some enterpris- 
ing fellow's ready-made " beef, wine and iron." 
The same hat cannot fit every head, or the same shoe 
do for every foot, neither can the proportion of ingredients 
in a ready-made combination suit every patient. 
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- 129 
mark, proprietary or quack, whether advertised to the 
profession or to the public, whether the so-called formula 
is given or not. If you order A's emulsion, B's lozenges, 
C's cod liver oil, D's pills and E's bitters, to patients, 
they will, by association, soon think that X's sarsapa- 
rilla, 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 i strike a trade ' in 
your families, chiefly for the reason that their nostrums 
do more harm than good. Also for the lesser reason 
that justice to yourself and every other physician re- 
quires 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 prescriptions labeled 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 renew a prescription is while writing it. 
If you fear it will be renewed against your wish, stop 
short while writing and remark to him that it will be a 
good remedy, or make some other true remark about it, 
but that he must take only one bottle, or that it must 
not be renewed. Your order given at that time will 
seem to be founded on some motive other than that of 
protecting your own pecuniary interest, will impress 
him strongly, and will be invariably obeyed; this is 
probably the most effective of all plans to prevent pre- 130 
scriptions from being renewed and adopted as a regular 
resort in similar cases. With this exception make it a 
rule not 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 omis- 
sion nor mistake, and sign your name or initials to 
every prescription, but not till you have satisfied your- 
self 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 
inspection; but only the regular attendant's name or 
initials should be signed to it. 
A very, very useful rule in many cases is to name 
the hours at which medicine is to be taken; thus, if it 
is to be taken every five hours, instead of writing " a 
teaspoonful every five hours," write "take a teaspoonful 
at 7, 12, 5, and 10 o'clock daily." 
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 
syringe on himself, or to inhale chloroform or ether, he 
will probably adopt the habit; if he does, you will 
surely and deservedly incur the blame. The slaves of 
such habits always blame their acquired passion or their 
enslavement on the doctors who first ordered or used 
them, if they have any ground at all for doing so. 131 
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 medi- 
cine is to be taken for any length of time by getting a 
graduated tumbler or medicine glass, which is both conve- 
nient and precise. A minim is a definite quantity, a drop 
is not; therefore, in prescribing potent fluids you should 
order minims instead of drops. 
Never turn your cases over to "specialists" unless 
they have features which render it an actual duty to do 
so. If you refer every case of eye disease to the ocu- 
lists, every uterine case to the gynaecologists, ear cases 
to the aurists, surgical to surgeons, and so on throughout 
the list, you will lessen your own field of activity, soon 
lose all familiarity with the affections 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 and destroys your own fame. 
A good rule is this: whenever a case proves wholly un- 
manageable by usual treatment, or is so grave in prog- 
nosis as undoubtedly to require broader shoulders than 
yours to bear the responsibility, either call in a special- 
ist to aid in its management or turn it over entirely to 
him. Timidity and infalliblity are both bad traits in a 
doctor, but the former is the greater drawback. 
When you transfer any one from your care to a 
specialist's, always do so either by a consultation, a 
letter, or a personal interview with him, that he may 
learn directly from you your diagnosis, prognosis, treat- 132 
merit, 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 case over to a surgeon or specialist 
you do not cease to be their physician, that you have 
only turned them over for that special affection. 
Ask for a consultation in all important cases in 
which there exists any doubt as to the diagnosis, and in 
all cases where you think either the patient's interest 
or a division of the responsibility demands it. When 
from any cause you see necessity for one arising, try to 
anticipate the family by being the first to propose it. 
When you have bad surgical and other cases among 
your personal friends or relatives, or severe cases so 
near home as to involve you personally or socially, or 
in a neighborhood in which a group of patients are 
likely to be unfavorably impressed if the result is not 
good, it is especially necessary and wise to call a con- 
sulting physician, if for no other reason, to satisfy them, 
and at the same time relieve yourself of too much direct 
personal responsibility. 
If possible, always have physicians selected as con- 
sultants who will add to your efforts by exhibiting 
knowledge and skill, and who will at the same time be 
likely to harmonize with you in the management of 
your cases; for their sympathy and kindly support may 
be highly necessary to the patient's welfare and to 
your own reputation. 133 
Be punctual to the moment in keeping consultation 
engagements. You have no right to waste another's 
time in such cases; besides, it is oppressive and any- 
thing but pleasant for one physician to be kept idly 
waiting for another at the place of meeting. 
In your consultations you will often feel great anxiety 
and suspense while waiting to see whether the con- 
sulting physician will be fair towards you in the case, 
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 profession be it said, the vast majority of 
its older members are not only punctilious, but really 
kind to the deserving on these occasions. 
A radical change of diagnosis and of treatment, as the 
result of a first consultation, often naturally impresses 
upon the laity an idea that the previous diagnosis or 
treatment has been either faulty or actually wrong, and 
no material change should either be proposed or allowed 
at that time, unless some real necessity requires it. As 
a rule, the fewer apparent changes resulting from a first 
consultation, the better for the regular attendant's repu- 
tation ; especially if he is a young doctor. 
When a consulting physician is designated and called 
at your request, you should see that the payment of his 
fees is not neglected; you might with propriety broach 
the subject before he quits, to those who are to pay the 
bill. This can be done by privately informing them 
that his charges will probably be somewhat less if paid 
at his last visit than if they wait for him to send a bill, 
which might then be for the maximum amount. 134 
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 sup- 
pose him to be thinking of its scientific and therapeu- 
tical aspects, and not 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 
arrives for sending them your bill, whether he will send 
his bill separately from yours or not. If you neglect to 
explain this to them, they will almost surely think you 
ought to pay him out of your fee, and a misunderstand- 
ing will result as to whether you or they must pay his 
bill. 
When you consult with other doctors, whether in 
your cases or not, it is right to charge the same amount 
for your services as the consultants charge for theirs. 
You lose as much or more time than they at each 
consultation, your reputation is equally or more involved 
than theirs, and, unless they are celebrated specialists, 
there is no reason why your fee should not be equal to 
theirs. 
In dispensing with the consulting physician when 
his services are no longer necessary, take care to make 
him feel that it is done amicably. 
Remember that you have the right to refuse to con- 
sult with any one you deem unprofessional, or unsuitable 
to the case, also any one who is personally objectionable 135 
to you, or in whose keeping you deem your reputation 
and interests unsafe. If you are attending a case and 
such a one is pressed upon you, you have a perfect 
right to retire. Fortunately, such dilemmas are very 
rare. 
Do not refuse to consult with foreign physicians, 
with doctresses, or with colored doctors, provided they 
are regular practitioners, or even with undergraduates 
if they are advancing in the regular line towards their 
degree. You have no moral right to turn your back on 
sick and suffering humanity, by refusing to add your 
knowledge and skill to that of any honorable person 
whose professional acquirements and tenets give him a 
right to work in the professional field. It is not only 
unmanly to throw obstacles in the path of the less 
favored, but such a spirit is wholly incompatible with 
the objects of our art, and at variance with the spirit of 
science, which is cosmopolitan and knows neither caste, 
pride nor prejudice, and has no bonds except those of 
truth and duty. But every principle of right and honor 
will prevent you from ever entertaining a thought of 
fraternal association or consultation with eclectics, 
homoeopathists, hydropathists, or other exclusives, under 
the specious plea of duty to humanity. Let their retire- 
ment be the prime consideration, the inflexible condition 
under which you assume charge. 
Be exact in everything that relates to consultations. 
Let them always be formal and strictly private; con- 
sult within a room, and, if possible, one that is isolated 
from intrusion; exchange thoughts in an undertone and 
out of the sight and the hearing of eavesdroppers. 136 
Never allow any one to be present at a consultation ex- 
cept the doctors engaged in it. 
Remember that consultations are called for the pur- 
pose of deciding for the future, not to criticise the past; 
but if you are called to consult in a case and find the 
attending physician is suffering unmerited odium for his 
previous management, every principle of honor should 
impel you to volunteer to defend him. 
Never express an individual opinion of a case seen 
in consultation except in strict accordance with the 
Code. If you do, those whom you address may, either 
unintentionally or purposely, misinterpret what you say 
or otherwise involve you. 
If you are requested by letter or by a messenger to 
prescribe for an out-of-town patient who is not under 
the care of any other physician, it is perfectly 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 do so, and that 
too without expectation of a fee. 
Avoid decrying and ridiculing medicine to the laity, 
and boasting of your own and the general ignorance o ' 
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 is not an exact science; 
but the public cannot appreciate the sense in which 
such confessions are made, and they work ounces of 
harm to doctors who make them and pounds of harm 137 
to the profession at large. Because all who hear or read 
them conclude that medical practice is only a network 
of uncertainty and confusion, and ever after either do 
not employ physicians at all or do so with utter distrust. 
The truth is, physicians are far more imperfect than 
physic. For instance : there are undoubtedly 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 doctor s bad judgment or to his ignorance. 
The fact is, all physicians know of very nearly the same 
remedies, but skill in curing with them consists in 
selecting the proper ones, in proportioning the dose, judg- 
ing the time, etc. Just as different persons essaying to 
paint will exhibit different degrees of success; one pos- 
sessed of natural aptitude 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 in 
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 to do the right thing for 
him at the right time, is the essence of skill, and is the 
chief difference between successful and unsuccessful doc- 
tors, and is the great secret why the prescriptions of 138 
some medical men are much more valuable than those 
of some others. 
A proper use of medicines, instead of a wholesale 
renunciation of them, is a leading characteristic of a 
good physician. When you hear of a doctor who wishes 
to be considered especially clear, or ahead of others, or 
extraordinarily fair in his opinions, boasting that he 
"does not believe in drugs," "depends on nature," etc., 
you can safely conclude that in his zeal to become a 
medical philosopher he has lapsed in his materia medica, 
or overstates his credulity, or that his usefulness has 
run to seed. 
Does the mariner lose his faith in navigation because 
ships are tossed by the winds and waves and sometimes 
wrecked ? or does the farmer lose his faith in agriculture 
because droughts and grasshoppers sometimes ruin his 
crops ? Would any worthy sailor fold his arms and do 
nothing while the storm raged, or any philosophical 
farmer neglect to plant again when the season returned, 
because the sailor's brightest hopes . are sometimes 
crushed and the farmer's fairest prospects are often 
blighted ? 
Is there a physician on earth who would let inter- 
mittent and remittent fevers take their course without 
drugs, or who would let the syphilitic and other poisons 
develop or progress unattended? Is there a graduate 
anywhere who confesses he can do nothing for pain or 
for fever, for nervous complaints, for digestive affections 
or chest diseases; nothing for the circulation, or de- 
lirium, ■ insomnia, headache, epilepsy, hysteria, gout, 
neuralgia, worms, colic, acidity, peritonitis, constipation, 139 
diarrhoea, anaemia, scurvy, etc. ? If there is a doctor 
in the land who has never seen medicines restore health 
or prolong life, who does not sincerely believe in his 
power to benefit by drugs some of the twenty-four hun- 
dred 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 teach- 
ing 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 sick- 
nesses we have lessened the doses half as much as some 
imagine. You now give twelve or fifteen grains of 
quinia daily for the intermittent where physicians for- 
merly gave half an ounce or an ounce of crude bark 
containing but six or eight grains. You give to-day the 
same dose of opium or its representative, morphia, when 
indicated, as they gave a hundred years ago, the same 
quantity of castor oil at a dose, and about the same 
throughout the entire materia medica. The great dif- 
ference is that we do not now prescribe vaguely or rashly, 
and when cases are obscure or undeveloped our treat- 
ment is tentative instead of heroic. 
We of to-day know that three in every ten of those 
who send for doctors need no positive medication, and 140 
nine of the ten would get well sooner or later by proper 
hygiene and intelligent nursing and dieting if there were 
not a doctor in the world, and we are naturally pre- 
scribing less and less. In children's diseases especially 
we now in many cases trust chiefly to nature, and see 
them get well from what look to be alarming conditions 
almost as if by magic. CHAPTER VIII. 
The real secret, the very foundation of the success 
of various systems of practice that have arisen within the 
last century, has been nature s marvelous disease-limiting 
power, and "Old School" adjuvants, adroitly interwoven 
with hobbies that have but little value except as adver- 
tisements. Homoeopathy, the pseudological novelty that 
Hahnemann created in 1796, got a wonderful start be- 
cause it arose just when humoral pathology had satiated 
the world with crude remedies administered irrespective 
of form, taste, etc., and all were anxious for some change. 
It has not only successfully catered to fashion, but 
has actually become the profitable delusion of our day, 
and has captivated almost all ailers who, through dis- 
gust at our crude therapeutics, have become alienated 
and joined those who condemn the "old school." It 
has already lasted much longer than it would have 
done had not the regular profession been so slow to 
give up crude forms, over-medication, etc. Were any 
one to originate such a system to-day it would be still- 
born. 
One of Hahnemann's most attractive novelties, the 
dynamization of medicines, the one that he and his fol- 
lowers have praised 'most in proselytizing, is a farcical 
parody on an old and well-known principle in medicine- 
a wonder-creating something made of nothing, whose 
chief use is to amuse the feeble. It not only violates 
141 142 
common sense, but conflicts with fixed mathematical 
laws, since a part cannot be greater than the whole. 
The truth is, their dynamization of medicines bears 
about as much relation to the science of medicine as the 
kaleidoscope does to the science of astronomy. 
You can neither believe nor follow this or Hahne- 
mann's other nonsense and follies, but you can follow the 
fashion of the day and can to every fastidious or 
squeamish patient the smallest.and most pleasant dose 
that his safety will permit, and can avoid giving any 
one crude remedies to a disgusting degree. 
Aim earnestly to please every one's taste and ideas 
of medicine as far as compatible with his safety. Also 
avoid over-drugging, and remember that those who 
have been most fond of medicine often become suddenly 
surfeited and undergo a complete revulsion against both 
medicine and doctors. How can this be wondered at 
when even too long a continuation of beefsteak, partridge 
or oysters, or other choice food, causes disgust and utter 
loathing even in well people ? 
You are bound as if by an oath to use your best 
judgment for every one who puts himself under your 
care, but neither the Code of Ethics nor the Code of 
Honor prevents you from sailing as near to -every popu- 
lar breeze as truth ajid j ustice will allow. 
Now, although homoeopathy is 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 :-Curative reme- 
dies for the sick can be selected only by a study of provings 
on persons in health. 2d. Every remedy must be given by 143 
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 
postulates are sophistical and should be rejected, and 
that the last is a rule that nobody denies, that every 
rational medical man has recognized ever since the days 
of Methuselah, and cannot in any sense be monopolized 
by homoeopaths. 
Contrary to what many unthinking people believe, 
this creed gives the homoeopaths perfect liberty to give 
an atom or an ounce of lime, salt, sugar, or anything 
else, at a dose, provided they proceed on the homoeo- 
pathic principle of similars; and the question whether 
he 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 medicine in 
cases in which you would give but a grain. Their 
ounce would not make them rational physicians, nor 
your grain make you a 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 144 
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 
you thought would come nearest to doing so, you would 
be practising homoeopathically. Now, it is safe to con- 
clude 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 disease similar 
to this, or symptoms similar to these, in a well person ?" 
and attempt to deduce therefrom your line of treatment. 
Therefore take care to remember that no matter how 
small your dose, even though you prescribe only tea- 
spoonful doses of aqua pura, or let your patient smell 
an empty bottle, it will not be practising homoeopathi- 
cally. 
It is also safe to predict that 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- 
pneumonia, opium for apoplexy, and a countless myriad 
more of utterly utter nonsense. 
Study the " Organon of Medicine," by Samuel Hah- 
nemann-" Homoeopathy Fairly Represented," by Wil- 
liam Henderson, M. D.-"Hull's Jahr"-"Hughes' 
Pharmaco-Dynamics "-" Hale's New Remedies," and 
other leading homoeopathic productions, and you will 
then fully realize what an amazing folly Hahnemann 
started and why we reject it, and will also see how men 
can mistake the workings of nature, and of faith and cre- 
dulity, for the effects of-nothing-till their delusions 
completely, pervert their reasoning powers. 145 
The novelty of globalism and attenuations, like 
spiritualism and mesmerism, aims at one of the strongest 
qualities of the human mind, a quality that we should 
utilize more fully-the love of the wonderful. 
Some of the unreasoning laity may think you are 
illiberal in refusing to fraternize with homoeopathists 
and other irregular practitioners. Remember that the 
great principle which underlies our refusal is this: as 
lovers of all truth, we have no fixed, no unchangeable 
creed, but hail with delight every etiological and thera- 
peutical discovery, no matter by whom made, and take 
by the hand any one who is liberal enough to consecrate 
his life's labor to suffering humanity; but when we 
know that a certain person circumscribes himself and 
practises a botanical system only, or a homoeopathic 
system only, or a hydropathic system only, or any other 
one-idea system only, and is so tied down to that, by his 
love, or his bigotry and prejudice, that he denies the 
truth and the usefulness of all other known and honor- 
able means of aiding suffering humanity, all rational 
physicians esteem him too illiberal to be a true physi- 
cian, or for fellowship with those who profess to love 
all truth, and justly allow him to remain joined to his 
exclusive system. 
Homoeopathy would have been absorbed into ra- 
tional scientific medicine- before we were born if there 
had been anything in it worthy of absorption. 
Nothing under heaven prevents you from doing 
whatever you think best for your patient; but if in so 
doing you adopt a narrow or foolish dogma or an exclu- 
sive system, and prejudice your mind against all other 146 
ascertained truths, your partisanship will fetter you, 
abridge your usefulness, and make you unfit for fellow- 
ship in liberal medicine. Thus, when Vincent Priess- 
nitz shut his eyes to everything but hydropathy, and 
Samuel Hahnemann tied himself to the homoeopathic 
dogma and rabidly denounced ' everything else, and 
Samuel Thompson threw away everything but herbs, 
they circumscribed their own usefulness and that of all 
who follow them. 
" For never yet hath one attained 
To such perfection, but that time, and place, 
And use, have brought addition to his knowledge; 
Or made correction, or admonished him 
That he was ignorant of much which he 
Had thought he knew, or led him to reject 
What he had once esteemed of highest price." 
Not a single department of medicine has yet reached 
scientific exactness, and possibly never will. We, 
legitimate physicians, are striving hard to bring its 
various branches as near to perfection as possible, and 
are willing to learn medical truth and scientific wisdom 
wherever they can be found.' When " New Schools " 
arise, if they contain any new or valuable truths, no 
matter how great or how small, we instantly incorpor- 
ate them with the great mass to swell the records of 
rational medicine, so that the various truths possessed 
by our profession to-day form an aggregate of knowledge 
which, if put into one book, would make it thick enough 
actually to reach the skies. 
The homoeopaths and all other irregulars cunningly 
sneer at the regular profession and style us " The Old 147 
School/' "Allopaths," etc., to make it appear to the 
public that ours is but one of many branches of the 
Hippocratic oak, good enough in its day, but now effete 
and behind the times. Their aim in doing this is, of 
course, to obtain the advantage of appearing to stand 
fully equal to us, just as, for instance, in religion Catho- 
lics stand with reference to Protestants, and in politics 
Republicans stand to Democrats. You know that 
nothing could be more false. 
Remember that the title "Allopath" was the mali- 
cious invention of Samuel Hahnemann, and is applied 
to us by his followers with sinister motives; that it is 
both untrue and offensive, and is not recognized by reg- 
ular physicians. Take care to promptly disclaim it 
when any one applies it to you through enmity, and to 
disown it and also tell of its falsity when applied through 
ignorance. 
An allopathic physician would be one whose 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. 
When people ask you " what school you practise," 
you may answer that you have no special creed and 
practise no particular school, but that you try to be 
rational, and like the bee, take the honey of truth wher- 
ever you find it; that as rational liberal physicians, the 
profession to which you belong, unlike the various 
" limited schools," accepts all truths, whether winnowed 
from past experience or discovered in our own days, and 
stands ready to receive aud utilize any and every valu- 
able discovery, no matter when or by whom made. 148 
This flexibility explains why Ours is a liberal pro- 
fession-, and why the physician takes rank with the 
lawyer and the clergyman. To this trio of professions 
was long ago applied the term " The Liberal Professions," 
because their devotees have, in all ages, pursued them 
as freemen, subject to no bonds except those of Truth. 
If at any time during your career, any sect or school 
arises, no matter how great or how humble its preten- 
sions, 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. 
Strange to say, nowadays the public, blinded by 
sophistry and swayed by false sentiment, invariably 
sides with the " new school " or the quack, or anybody 
else, whenever a contest arises between them and us. 
Even the newspapers, religious as well as secular, seem 
to delight in aiming sharp shafts at the regular profes- 
sion, by making invidious comparisons between its modes 
of practice and theirs-telling of their wonderful success, 
of their steady growth in public confidence, etc., in highly 
colored terms. Editorial and other authoritative pro- 
ductions are frequently written on our exclusiveness, 
our bigotry, etc.; our disagreements, too, are magnified 
and reported in a sensational way, all apparently to 
antagonize and decry us, and enhance the interests of 
irregulars and quacks. 
You will find that if a person happens to get better, 
even of an ordinary case, while under the care of an 149 
irregular, or when taking a quack medicine, it will re- 
ceive a thousand praises; 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 Cauca- 
sian wastes. In the same degree, irregulars and quacks 
thrive on the quickening influence of mystery, the emo- 
tions, expectations, faith, hope, etc., while we, with 
our minds fixed on more tangible aids, neglect them 
far more than we should. For proof of the power of 
the mind over the body, look at the liver pads, tractors, 
amulets, charms, and dozens of other ideal remedies in 
vogue, that the young and old, black and white, edu- 
cated and illiterate, all kinds, classes and conditions of 
people are praising almost as if they had fallen from the 
skies. 
Many irregulars have another source of eclat. They 
elevate what you would call a slight cold or a quinsy 
into a " congestion of the lungs," or a " bronchial 
catarrh," or a "touch of pneumonia," "diphtheria," or 
"post-nasal catarrh." They dignify what you would 
call a disordered stomach into a " gastric affection," a 
wind colic into " borborygmus," etc., for the cure of 
which huge ailments they are fully credited and fully 
paid. There is a fellow in our section who manages 
his patrons so adroitly that he often actually reaps 
manifold more credit and patronage for stopping a chill 
and fever in seven days, than a true physician would for 
doing the same in two days, and other ailments in pro- 
portion. 
Another reason why irregulars get cases is, that if 150 
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 doctors, 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 doctor will feel less hurt if they 
dismiss him under the plea of trying " a different sys- 
tem " of doctoring, than on any other pretext. 
Another reason why irregulars have partisans is 
that there is always a sufficient sprinkling of extremists 
in every community, who for some reason or other hate 
the regular profession, and who unite to abet and sup- 
port any creed or system that practises in opposition to 
it, and of course the demand creates a supply. 
Still another reason why they get patrons is this. 
They take care to announce that they cure by mild 
powers or harmless methods, and not by painful or dan- 
gerous treatment, bloody operations, or other dernier 
ressorts that science teaches us to use-against all of 
which they have aroused much of the existing foolish 
prejudice and abhorrence. 
So great indeed is the popular dread of what 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 makes a specialty of poisoning the 
minds of its votaries, not only against the lancet, poly- 
pharmacy, and other needlessly active measures, but 
against all rational remedies, and inclining them to a 151 
pathophobic watchfulness over the minutiae of their 
health, which eventually makes them morbidly anxious 
about every function, and fills their minds with a medley 
of imaginary and exaggerated afflictions that haunt them 
like Banquo's ghost. You will often see perfectly 
healthy-bodied persons who might have passed through 
life with scarce a thought of sickness, after adopting its 
follies, become borne down by numerous magnified 
symptoms and constant indications for pellets and attenu- 
ations. 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 perfect the folly, have given them, to 
turkeys, sheep, dogs, cows, chickens, horses, geese, 
■mules, &c. 
Homoeopathy has also profited, and is still profiting, 
wherever the English language is spoken, by an acci- 
dental misleading resemblance of terms. To all English 
speaking people there is no word so dear as "home, 
sweet home." 
To you, as physicians, the term homoeopath natu- 
rally 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. 152 
By fostering the error this unfortunate resemblance 
creates-in some instances even anglicizing the term by 
dropping the oe and substituting 6 - and loudly terming 
all who practise rational medicine "Allopaths/' Hahne- 
mann's followers have materially aided themselves, 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 
medicines for homoeopaths. 
You will find that nine, out of ten of those -who run 
after sugar powders and pellets know absolutely noth- 
ing at all about the Hahnemannian principles, and take 
them themselves and give them to their families solely 
because they are fashionable, novel, dainty and easily 
taken. 
It is your duty, in the interest of truth and for the 
benefit of humanity, to make it known that the word 
"home" is of Saxon derivation, whereas the prefix 
homceo 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 knew when he 
styled himself a homoeopathist, and not a pathhomoeist, 
which has the same meaning. 
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 supporters; nor that homoeopathists do no good, 
for they do a great deal of good. But the good they do 
is not by similars, as has been proven by innumerable 153 
observers, but by the accompanying hygienics, dietetics, 
faith, expectation, etc., which would do equally as 
much were the similars left out and atoms of taffy or 
sawdust or anything else substituted, to give their 
patients room to exercise their faith, and nature time 
and opportunity to do the work. 
God help afflicted humanity were genuine homoe- 
opathy the medical man's only reliance in his struggles 
with disease. Think for a moment of a group of doctors 
entering the lazar-house depicted by Milton in Para- 
dise Lost, to combat the afflictions of that protean 
assemblage with genuine similia similibus. True, while 
ministering to mucous catarrhs, nervous headaches, 
palpitations, functional dyspepsia, tonsilitis, catarrhal 
croup, chorea, uncomplicated exanthemata and slighter 
affections that have a strong natural tendency to re- 
covery, they might, with a little adroitness and the free 
use of adjuvants, make themselves appear like magicians; 
but when they approached maladies which, unless 
thwarted by the truest medicines that are known to 
man, have a tendency to overwhelm and destroy, they 
must know in their hearts that they would be like 
unreasoning soldiers, who had irrationally abandoned 
their rifles and artillery, and with puny, valueless shot- 
guns gone to trifle with powerful foes. 
The truth is, if a man has a sickness in which the 
tendency is to death, medicines given on the principle of 
" similia similibus curantur ' ' will not, cannot avert that 
result; while some of the agents that experience and 
reason offer, and rational physicians use, might restore 
him. 154 
When chance brings you in contact with a genuine 
homoeopathist, if you believe him to be a gentleman 
(true homoeopathists are usually very respectable and 
upright), observe all the forms of politeness toward him, 
and treat him exactly as you would any other gentle- 
man, but ignore him professionally, and never allow 
yourself to fraternize with him in the management of a 
case. But have nothing, emphatically nothing to do 
with the pseudo-homoeopaths, who masquerade as 
homoeopaths by a display of Hahnemannic nonsense, 
just as ostrich-hunters assume to be ostriches by dress- 
ing in that wise bird's feathers. Many of these pretenders 
simulate the genuine by carrying awe-inspiring satchels, 
as guardedly as if an additional shake of the dynamiza- 
tions they contain might still further increase their 
potency and cause an explosion. Carefully search the 
satchel and the pockets of 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 86,000th (nonsense 
that would not vary the ailments of a fly); but search a 
little further and you will also find a full, a very full 
supply of Wm. R. Warner's, W. H. Schieffelin's, Sharp 
& Dohme's, and other varieties of sugar-coated granules 
of morphia, quinia, arsenicum, belladonna, elaterium, 
colocynth, etc. Be not startled if you also find a hypo- 
dermic syringe and a bottle of Magendie's solution- 
damning witness of his lack of moral sense and lack of 
honesty, and of his want of faith in what he professes. 
Respect every sincere believer in a false system, no 155 
matter how great his error, but let the finger of scorn 
point forever at each and every double-dealing hypocrite 
who, as an advertisement of himself, vilifies and sneers 
at "old school" remedies while slyly using opium to re- 
lieve pain, chloral to induce sleep, quinia to arrest fever, 
and all our other prominent agents just as we do in full 
doses, and crediting the good they do to homoeopathy ! 
There is also another self-adjusting variety, much less 
numerous, thank heaven! than the last, who, chameleon- 
like, are all things to all men, who actually offer to practise 
any exclusive system people wish. These are not as bad 
ae the last, for they are at least honest in their announce- 
ment. But what would you think of a clergyman whose 
love of gold and lack of scruple would allow him to vary 
his principles at will and preach anything you wished, 
whether a strictly Catholic lecture or an ultra-Protestant 
discourse, an orthodox Hebrew sermon, a fiery Moham- 
medan philippic, or an out-and-out infidel harangue ? 
He might believe in one or none, but he could not 
believe in ail. Show a decent respect for the conscien- 
tious homoeopath, but shun both the bogus and the 
any-way-you-please fellows, who use the name simply as 
a cloak because it pays to use it, as you would the 
plagues of Egypt. 
Quackery subsists almost entirely on credulity and 
ignorance, and it is your duty to expose it in every 
shape, and to save as many from its evils as you can. 
Wherever you meet it, lift its veil and show its unwor- 
thiness and the harm it does. 
One of the greatest of all wonders is that wisdom 
in law or theology, or perfection in the sciences, or skill 156 
in the arts, or acuteness, even brilliancy, in other de- 
partments of human knowledge, scarcely increase some 
people's reasoning powers a single jot in medical matters. 
Why any person can be one of the wisest of men in all else, 
and an easy, almost volunteer prey to quacks and sophis- 
tical pretenders, as soon as sickness attacks him or his, 
is a very curious psychical enigma. 
But few of the really sick who give these false and 
one-idea systems a trial, become converts. Many think- 
ing people, persuaded into trying them, soon detect 
their fallacy, their insufficiency, and when true disease 
attacks them they return to the blessings of rational 
medicine. Therefore be careful 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, espe- 
cially in conceited and silly people. 
If, in exposing any irregular system, you are careful 
not to denounce it with too much violence, and to confine 
your condemnation strictly to the impersonal abstract 
subject, showing that you speak your real sentiments 
from conscientious devotion to the truth; and if, more- 
over, 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 
you address and with the community. 157 
You will occasionally be called again to families who 
strayed in disgust from regular medicine long ago, when 
bleeding, etc., were fashionable, who will be surprised 
to learn that you no longer bleed and salivate indis- 
criminately, as they imagined. If you are prudent and 
circumspect, most of these can be permanently reclaimed. 
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 per- 
sonal knowledge, and to checkmate their representatives, 
who make great capital out of knowing all about the 
a old school system" which they of course aver does not 
compare with the " new school " 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 assume dogmas and systems that are limited. 
Were you to announce yourself as an anti-herbalist or 
anti-homoeopathist, or an anti-allopathist or an anti- 
eclectic, it would be equally as inconsistent with the spirit 
of scientific medicine as theirs are, and would abridge 
your usefulness and render you unworthy of fellowship 
just as it does all others who follow limited creeds. 
Never hold a joint discussion before the public with 
irregulars or quacks, either through the newspapers or in 
any other way, for no matter how false or shallow their 
pretences are, such joint discussion, with the public as 
judge, would result in nothing good, but would bring 
them into notice and gain for them additional partisans. 
Bear in mind that competent medical men all over 
the world, in the interest of truth and of suffering 158 
humanity, investigate and test all so-called systems 
when they arise both in hospital and private practice, 
and the conjoined result gives us a true common-sense 
verdict. And it is no more necessary for every suc- 
ceeding generation 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. 
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 antipathies, but 
recognize all kinds-Thompsonians and eclectics, real 
homoeopaths and bogus homoeopaths, hydropaths, the 
any-way-you-choose, etc., precisely as they do the regular 
profession; and if you ever occupy an official position 
under such laws, you will have to recognize certificates 
of death, vaccination, life insurance, etc., given by irreg- 
ulars just as you do those of rational physicians. In a 
word, you will have to recognize officially every person 
that the law recognizes. State medical laws that 
legalize irregulars are impaired to a corresponding ex- 
tent. Proper laws-laws that would at least weed out 
every variety of pretenders and quacks-should be en- 
acted and rigidly enforced, instead of laws that compel 
those who administer them to recognize-and legalize such 
vile impostors, and actually to give them a respectability 
before the public they would not otherwise possess. 
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 4 you are weak and need building up,' 159 
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. 
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 medi- 
cine and a grain of policy, and those that need an ounce 
of policy and a grain of medicine, you will enter the 
road of wisdom. When you have a patient who needs 
only a few drops of mint water, for mercy's sake do not 
violate common sense and force upon him an infusion of 
gentian or a large bottle of muriated tincture of iron and 
quinia, as if your chief aim were to disgust him. Give 
him nothing stronger or coarser than he needs, and leave 
the balance to nature. Chagrined homoeopathists and 
their partisans will warmly assert that in doing these 
things you are working on homoeopathic ground. But, 
although you will be catering to the popular taste 
and giving very hland medicine, you will administer 
according to common sense, without regard to similia, 
etc., and will be practising, not homoeopathically, but 
rationally. Handle all who have treacherous stomachs, 
and the fastidious, and the homoeopathically inclined, 
with kid gloves. The recent great improvements in 
the forms and palatability of medicines offer you 
splendid opportunities to do this. Neither offend 
their eyes, their palates, nor their stomachs, and you 
will succeed where neglect of these precautions would 160 
cause failure. Give hypochondriacs, dyspeptics, and 
others who are fond of your attention but not of your 
medicine, small, tasteless or palatable remedies, and, 
unless there is a real necessity for it, do not oblige any- 
body to take medicine before breakfast or during the 
night. With such people make free use of the elixirs 
and the large line of sugar-coated granules of arsenious 
acid, corrosive sublimate, cannabis indica, nux vomica, 
morphia, podophyllin, strychnia, etc., now kept in every 
drug-store. 
The smaller 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, and give a proper number of them as soon as you 
reach cases in which great pain is a symptom. By so 
doing you can often relieve the suffering, and show your 
power over pain, before the messenger could get back 
from the drug-store with the remedy you would other- 
wise order. Morphia granules given thus become 
almost a substitute for the hypodermic syringe. 
Rational physicians are everywhere rapidly conform- 
ing in trivial cases to the changed popular notion, and 
are giving more concentrated and more palatable forms 
of medicine, and are in consequence rapidly bringing 
vast numbers of the erring from the ranks of isms and 
pathies back to their faith in rational medicine. Deter- 
mine to do your share in this good work. CHAPTER IX. 
Be just and friendly towards every worthy druggist. 
Owing to the close relationship between pharmacy and 
medical practice, the pharmacists are your natural 
allies, and should receive your friendship and respect. 
Probably 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 druggists compete for your prescriptions 
and for the family patronage they influence. You will 
make a serious mistake, and engender active enemies 
too, if you step out of your way and without proper 
cause instruct patients to buy their medicines from any 
particular drug-store; if a prescription is properly com- 
pounded it makes but little difference by whom it is 
done, so the compounder is honorable and reliable. 
Do not deter your patients from patronizing a drug- 
gist simply because he is also a graduate in medicine, 
unless he is uniting the two callings from 'mercenary 
motives, or habitually prescribes, or has the drug-store 
as a stepping-stone to get acquaintances and a practice 
as a preliminary to making his debut as your antagonist 
or rival; but if you allow your prescriptions to be com- 
pounded by a drug-store physician who prescribes over 
his counter, or in the office or parlor, free of charge, 
161 162 
and makes it up on the medicine ordered, you will be 
very apt sooner or later to regret it. 
Independently of all other considerations, the prac- 
tice of both pharmacy and medicine is too much for even 
the most intelligent of men. and one or the other is apt 
to be slighted; and if your prescription falls into the 
hands of such parties, both you and your patient must 
take a great many risks. 
There is not the slightest wrong in having your 
name on your prescription papers. But neither use a 
prescription paper that has your name printed in con- 
junction with that of any druggist nor with any name 
except your own on it. If it contained the name of a 
druggist it would naturally suggest collusion or some- 
thing else not complimentary; if it contained some 
enterprising fellow's commercial puff it would indicate 
very ordinary taste for you to use it. It is probably 
better always to write on good plain paper. 
It would be wrong, very wrong, to receive from an 
apothecary a percentage on your prescriptions as pay- 
ment for sending them to his store, and for this reason: 
were you to accept such an offer it would be robbing the 
purse of either the apothecary or the patient. Were 
the forme.r to allow you ten cents for each prescription, 
and reimburse himself by adding that amount to the 
sum charged the patient for the remedy, it could not be 
looked upon in any other light than that you had com- 
bined to fleece ten extra cents from every poor sufferer 
who trusted to your honor. On the other hand, if the 
druggist had more honesty than you and allowed you to 
shear ten cents from his legitimate profit, because com- 163 
pelled to do so or lose your influence, it would place you 
in a most contemptible position, and you would live in 
constant danger of an expose and an indignant public 
sentiment that the strength of Hercules could not and 
the angry God of Justice would not subdue. You must 
live, and must have fees to enable you to do so, but 
unless you obtain every cent honestly and honorably 
you cannot escape the finger of scorn. 
If any druggist 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. 
Never supply one or a few druggists with private 
formulae that other druggists cannot understand, as it 
would at once suggest trickery. A still meaner device 
would be to have a private, a cheating code for use be- 
tween you and a druggist. Surely neither you nor any 
other honest person needs warning against such infa- 
mous systems of swindling as these, for any one who 
would resort to private codes or cipher prescriptions for 
money-getting 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 druggist, after compounding 
it, has a natural right to retain it as his voucher, but he 
has no right to repeat it without your consent. 164 
The unauthorized renewal of prescriptions has often 
produced the opium, alcoholic, chloral, and other en- 
slaving habits. We all know it is often unsafe for a 
person to take a medicine ordered for another, or even 
the same medicine at different times. Besides, how can 
Mr. B. conscientiously label the second quantity, " Take 
as directed by Dr. A.," when the doctor is not even 
aware of the renewal ? 
According to the present habit of many druggists, 
the unauthorized renewals of prescriptions probably out- 
number those of the authorized five to one. 
Drug-stores have become so numerous of late, and 
the area from which each must draw its patronage is 
so small, that druggists in order to exist have either to 
charge very high for the medicines prescribed, or substi- 
tute inferior drugs; the result is 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 costless 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 druggists, 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 165 
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, so as to swell 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 to take them. 
Another evil resulting from there being too many 
druggists for all to live by legitimate business, is that 
some, to make both ends meet, encroach on the domain 
of medical practice, usurp our province, and prescribe 
for every applicant that comes along whose case does not 
appear to be formidable, and thus build up a large office 
(or store) practice. Fully one-half of all diseases of im- 
prudence are now seen and treated by druggists or their 
apprentices before applying to physicians. Those whose 
complaints prove simple are, of course, cured like magic 
by the four little pills the druggist recommends, or by 
the liniment he devises, or by his great fever-and-ague 
mixture, 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, in- 
stead 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 druggist, there is every proba- 
bility that he who takes the prescription to be com- 
pounded will be presented at the drug-store with one or 
two quack almanacs or advertising pictures, or that 
the bottle of medicine will be wrapped in some pushing 166 
fellow's handbill. The druggist's co-operation as retail- 
ing agent for quack medicines is indispensable to 
quackery, and without it two-thirds of the quack reme- 
dies and proprietary trash that now curse our land 
would pine and perish. 
You had better avoid all druggists whose presump- 
tion leads them to assume the role of physician. This 
of course does not refer to emergencies in which a drug- 
gist acts as a humanitarian. Medicines are the doctor's 
tools; a druggist may compound them for a lifetime 
and be an excellent pharmacist, and yet know no more 
about prescribing for the sick, properly, than making 
needles or scissors teaches the mechanic dressmaking, 
or making trowels and ploughs and chisels teaches the 
instrument-maker bricklaying, farming or carpentering. 
Be also on your guard against instrument-makers 
and dealers who meddle with surgical cases, and manu- 
facturers 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 druggist, a preacher, 
or any one else, i'Doctor," unless he is a doctor. 
Avoid over-praising prescribing druggists to your 
patients, or people will, on your word, overestimate them 
and rely on their gratuitous advice, instead of on the 
doctor's, at least in all moderate cases. 
Beware of indiscreet druggists, those who talk too 
freely, and those who converse, joke, etc., while com- 
pounding prescriptions, also those who put wrong direc- 
tions or the wrong doctor's name on bottles, or surprise 167 
and alarm people by charging a different price every 
time a prescription is renewed, as if they had no system, 
or as if it were put up wrong, or in other ways show 
abstraction or careless compounding, lest they involve 
you in their errors. For such people be especially care- 
ful to dot every i and cross every t in your prescriptions. 
If you believe on good authority that any druggist 
so far forgets himself as to make disparaging comments 
upon you or your prescriptions, or to exhibit and decry 
your prescriptions to irregulars, laymen, or other doctors, 
or that he makes unauthorized substitutions, gives 
under-weight of expensive ingredients, or omits them 
altogether, or joins with our enemies in reviling our pro- 
fession and its imperfections, or has a medical protege 
under his wing to whom he is endeavoring to direct 
customers for sinister purposes, or is guilty of any other 
grossly unprofessional conduct, you are justified in direct- 
ing your patients to go elsewhere for medicines. 
Be prompt and decided in refusing to give profes- 
sional certificates to anything secret, and do not be too 
liberal even in giving them to legitimate pharmaceuti- 
cals, and never issue one founded on any other basis 
than purity of ingredients, or special skill or experience 
in compounding them. 
Willingness to give medical certificates is one of the 
universal -weaknesses of mankind. The idea of being 
" an authority " and shining in type dazzles all classes. 
Many people could almost be inveigled into certifying 
that in medical matters two and two make five, by any 
sharper who understands how to tickle their self-conceit 
and their love of notoriety. 168 
Be also chary in giving (un) professional certificates 
to any one on disputed or partisan questions, or regard- 
ing surgical appliances, copyrighted medicines, wines, 
mineral 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 and 
other well-known persons recommending all kinds of 
medical nostrums. You know and every wise man 
knows that such certificates are not worthy of credence, 
and that the preacher of Gospel truth who, 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. 
In signing certificates in life insurance or oeneficial 
societies, or in giving your name for directories, state or 
city registers of physicians, and 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. 169 
The principle governing our condemnation of secret 
nostrums is this : They not only do more harm than 
good, but, if puffing and advertising alone are enabling 
the proprietor of a quack remedy to fleece the sick, its 
unprincipled owner deserves exposure and contempt. 
If the nostrum is really valuable, which is very rarely 
the case, its composition should be freely and fully dis- 
closed for the benefit of suffering humanity. 
Whenever you are asked by proprietors and plausible 
agents, or tempted by glowing advertisements, highly 
colored certificates, etc., to prescribe semi-secret trade- 
mark pharmaceuticals, copyrighted medicines, and the 
various elixirs, restoratives, tonics, panaceas, and other 
specialties with attractive ideal titles gotten up by 
crusading druggists, manufacturing pharmacists, phar- 
maceutical associations, etc., to catch the popular eye 
and the popular dollar-think of the cunning cuckoo 
(see p. 25), and how its one egg hatches evil to the whole 
nest, and do not use them. Unless you have missed 
your profession, if you are capable of thinking and have 
any ingenuity at all, the United States pharmacopoeia 
and the dispensatory are certainly large enough to allow 
you to make any required combination, and you should 
follow this, the legitimate mode of prescribing, and let 
ready-made substitutes for medical attendance alone. 
You should also maintain your independence and 
never order A's, B's or C's make of anything, unless you 
have some specific therapeutic reason for so doing. To 
specify thus would not only reflect on every other manu- 
facturer and cause a still greater popular distrust of 
our materia medica, but would also put the compounder 170 
to additional trouble and expense; for he might have 
half a dozen other varieties of the same article and yet 
be compelled by your specification to get another. Be- 
sides, it almost invites substitution. 
Do not, however, oppose any remedial agent or any 
particular brand of anything on account of its having a 
monopoly, if that monopoly is owing to unusual skill or 
great perfection in its manufacture. 
Patients think doctors know precisely what a medi- 
cine ought to cost, and will often ask you how much 
the druggist will charge for the remedies you have 
prescribed. Answer promptly that you do not know, 
and avoid mentioning any specific sum; because, were 
you to guess too high, they might infer that he had 
either made a mistake or used inferior drugs; and were 
you to guess too low they would probably accuse the 
druggist of overcharging. 
Whenever you prescribe a remedy that is unusually 
expensive, such as musk, quinia, oil of erigeron, etc., 
take care to inform the patient of that fact, so that he 
will not be surprised when the druggist tells him how 
much he charges for it. 
Notice particularly whether an apothecary gives 
unusual prominence to nostrums, quack almanacs and 
placards, or has quack advertising signs painted oil his 
doors or outside walls, and it will give you a true in- 
sight into his aims and attitude towards our profession. 
If you see that he is pushing the quack, department, with 
quack proprietors' portraits hanging around, and his own 
name and influence used in hand-bills and almanacs as a 
vendor of nostrums, bitters, plasters, pads, etc., you 171 
may be sure that he is conducting his store on a trade 
basis instead of a professional one, and you will do right 
to rigidly shun him. 
Drugs vary greatly in quality and in strength, and 
this is one of the occasional causes of uncertainty in the 
practice of medicine, and such variability would modify 
your efforts too much to be risked in any important 
case. A badly compounded prescription may rob you 
of your reputation and deprive the patient of his chances 
of recovery. Therefore, if you think an important pre- 
scription is likely to be sent to a druggist 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 wel- 
fare and having your own reputation to care for, you 
have a perfect right, and indeed it is your duty under 
such circumstances, to order your remedies to be pro- 
cured where you believe your prescriptions will be ex- 
actly 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, without adding 
the risk of being thwarted by an unreliable druggist; 
but when you find it necessary to ignore any one for this 
reason, take care to do so in a discreet 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 terms ac. pheni- 172 
cum for carbolic acid, secale cornutum for ergot, kalium 
for potassium, natrum for sodium, 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 their wisdom by transposing 
the terms you use from the usual order and writing 
the adjective in full with the noun abbreviated; e. <7., 
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. 
You will notice that some druggists label the reme- 
dies they compound for you with their file numbers only, 
thus, 17,483; while others pursue the much more sat- 
isfactory plan of adding the date on which it was com- 
pounded, thus 17,483, 19-7-83, signifying that it is num- 
ber 17,483, and that it was compounded July 19th, 1883. 
The latter plan will enable you to distinguish between 
the dates at which you prescribed different bottles of 
medicine, and otherwise be of service to you. I am sure 
the majority of druggists would cheerfully make use of 
this system if they were aware how often it assists the 
physician. 
It is well to request neighboring pharmacists always 
to inform you of any ambiguity or apparent mistake in 
your prescriptions before dispensing them, and in return, 
when you suspect there has been a mistake in compound- 
ing a prescription, be very careful not to make your 173 
suspicion known by either word, look, or action, till you 
have conferred with the person who compounded it. 
Bear in mind that the druggist is only human, and 
that he, like every other person, requires some rest, 
and do not order mixtures requiring tedious manipula- 
tions, or direct filthy ointments to be mixed, or dirty 
plasters to be spread, suppositories to be moulded, etc., 
on Sunday or during sleeping-hours, unless they are 
urgently needed. CHAPTER X. 
As a doctor you will sustain two relations to your 
patients: first, that of a person striving to relieve or 
cure the sick and the suffering; secondly, that of a per- 
son who justly depends upon those for whom he labors, 
for a comfortable support. 
Business is business. The practice of medicine is 
the business of your life; it is as legitimate as any other. 
You must live by it just as other people live by theirs, 
but cannot do so unless you have a business system, for 
upon system depends both your professional and your 
financial success. Neither untiring study nor unselfish 
devotion as a humanitarian can lift you above the de- 
mands of the tailor, the instrument-maker, the book- 
seller, the grocer, the butcher and other creditors, not 
one of whom will take your reputation of working for 
philanthropy, or your smiles, thanks and blessings, for 
his pay; nay, even the conductor will put you off the 
street-car that carries you to your patient if you do not 
pay your fare. It is of course a pleasing thing to be 
very popular, but your popularity, even though it spans 
the whole city, will neither fill your market-basket nor 
purchase books, pay your office rent nor buy horse feed; 
and though money is not the chief object in the practice 
of medicine, it ever has been and ever must be one of 
the objects, and no one can sustain his practice without 
a money feature. If people do not pay you, you cannot 
174 175 
live by your calling, and will very soon tire of all work, 
and no pay. 
The nearer your financial department approaches 
the cash system the better for you and your family. 
It is often more advisable even to submit to a reduction 
in a bill for prompt payment, than to let the account 
stand and run the risk of losing it. After settling 
promptly, many patients will feel free to send for you 
again and make another bill, even in moderate sickness, 
instead of dallying with home remedies or quack medi- 
cines, 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 
another reason: if 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 and do not need money, or that you do not hold 
this or that person to your business rule, or are not un- 
easy 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 doctor, and that you have 
to live, and must have your fees to enable you to do so. 
The business of the world is now conducted on the 
cash system, instead of the old long credit plan, and you 
should do your share towards breaking up the unjust 
custom that doctors used to follow, of waiting six months 
or a year after rendering services before sending a bill. 
If a physician attends a person, say, in February, and 
sends his bill in March or April, it seems to the patient 176 
like a current expense, and as if the doctor lives by his 
practice, and it is apt to be paid promptly; whereas, 
had he delayed sending it until July or January, the 
debtor would naturally think the doctor had merely sent 
it out with a whole batch of others, more because he 
has posted his books than from a special desire for its 
payment; and in this belief he would probably let it 
remain unpaid for months longer, till it becomes an old 
back debt, which is the hardest kind to pay. Besides, 
time effaces details; and recollection of the number of 
visits, the doctor's watchings, cares and anxieties are 
also forgotten, and the bill, though really moderate, 
is apt to look large. All these considerations combined 
are apt to make people feel, when they do pay an old bill, 
somewhat as if they were doing a generous thing and 
making the doctor a present of that amount. 
You will have to make a great reduction in many 
large bills after they have become old, therefore look 
after them while they are small and recent. Indeed, 
were you to let one bill add to another till the total 
reaches a great amount, you might place it wholly beyond 
the power of the person to pay it, and wrongfully force 
him into the position of a dishonest man. 
The very best time to talk business and have an 
understanding about your fees with doubtful or strange 
patients is at your first visit or at the first office con- 
sultation, and the best of all times to judge people's 
true character will be when you have money dealings 
with them. Even a single dollar will sometimes show 
you exactly what a person is. 
Make it a rule never to accept a commission or fee 177 
from any one under circumstances that 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 
book, but upon how much you collect, and that if you 
never insist upon the payment of your fees you can 
never separate the chaff from the wheat. If you have 
a rule and people know it, they associate you and your 
rule together. Let the public know what your system 
is in the early years of your practice, or you cannot do 
so afterwards. When a new family employs you, render 
your bill as soon after the services end as gentility will 
allow, especially if 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 either have an understanding or part com- 
pany, 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 or 
operations, etc., always answer promptly and soberly 
"one dollar" or "ten dollars," or whatever else the 
amount is. If you avoid preceding or following this 
reply with any other words, most people will in the 
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 
believe you have no fixed charge, and will furnish them 178 
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 justice of the charge. 
Accounts for surgical cases, midwifery, poisoning, 
and in fact for all unusual cases, should be promptly 
" charged up " on your books ; for unless this is attended 
to, the patient may come unexpectedly to pay his bill, 
and you might through embarrassment or lack of full 
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, " Doctor, when shall I pay you ? " or " Shall 
I pay you now ? " A good plan is to answer promptly, 
"Well, I take money whenever I can get it; if you 
have it you might pay it now, as it will leave no bones 
to pick," or "Short payments make long friends," or 
" Prompt pay is double pay, and causes the doctor to 
think more of you," or something of that sort. Never 
give such answers as, " Oh, any time will do ! " or " It 
makes no difference when," or you will soon find it to 
be expensive, very expensive 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, " Love your neighbor 
as yourself"; it does not say, Love him more, but it 179 
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 only patients with whom you think it 
likely you will have a permanent account a page in 
your ledger. 
When a transient patient pays his bill cash, so as to 
make it unnecessary to transfer it from your visiting 
list to your ledger, the simplest way to mark it paid is 
to turn each visit mark into a P, signifying paid. 
Your visits and cash entries in your visiting-list and 
day-book should be written in ink; for being original 
entries, they would be accepted in court as legal evi- 
dence. A good way to prevent forgetting any one or 
anything is to put names, visits, etc., down in your 
visiting-list with a lead pencil without delay till you 
have a chance to rewrite them with ink. 
At the end of every week add up the amounts 
charged each one whom you have attended that week 
and put them on the visiting-list in the blank spaces 
found at the end of the lines after the Saturday space. 
By doing this weekly you can accurately estimate and 
charge the value of your services to each patient while 
they are still fresh in your mind. It is wise not only to 
enter at the end of each week the amounts charged, but 
also to write the 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 disputed. 
In posting your account books at the end of the 180 
month, if you wish to transfer your visiting-list charges 
to the ledger without missing any one, use a checking- 
off plan. A very good way is to make a list of the 
names of all patients you have done anything for 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 
March, 1882, $7.00, enter it 3-82, $7.00, then cross 
that person's name off the foolscap list, and continue 
on, page after page, through the entire ledger. By this 
crossing-off system, if you fail to charge any one's ac- 
count as you pass it, it will remain uncrossed when you 
get through the list, and will thus be detected. While 
going over the different pages of the ledger to enter 
charges, notice all accounts that need rendering, and 
take the number of each one's page on one of a pile of 
blank bills at hand for the purpose, 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 either 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 181 
bill for that amount was rendered; thus, $7.00, with 
1-8-83 after it, would signify that a bill for seven 
dollars was rendered to that person, August 1st, 1883. 
A good way to save the trouble of looking over 
worthless or dead accounts on your ledger, month after 
month and year after year, is to cross them off, using 
lead pencil, which can be erased at any time, if neces- 
sary, for such as may possibly be revived ; and for those 
that are dead, or sure, from other causes, never to 
employ you again, use ink. 
Patients will occasionally dispute the correctness or 
justice of your charges. If a bill is not correct, correct 
it cheerfully; if it is correct and just, do not allow 
yourself to be browbeaten into the position that it is 
not. Many people are not aware that the charges for 
surgical and various extra cases are higher than ordi- 
nary visits; some seem to think that for a visit at which 
you reduce a dislocation, open a large abscess, make a 
vaginal examination, or draw off the urine, you should 
charge the same as for ordinary visits. Of course, you 
must correct their error by explaining the difference, 
or, if necessary, by reference to the fee table. 
Never undercharge for your services. It is ruinous 
to your interests and the interests of the entire profes- 
sion. The tendency of undercharging is to depress the 
fee table permanently and to compel all doctors to 
work for under-pay. There is a vast difference between 
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,- 182 
in business wars one withdraws, or they compromise 
and each advances again to full prices ; warring doctors, 
on the contrary, having no goods to manufacture or to 
sell, can keep up the feud for years, give their skill to 
everybody for insignificant or nominal fees, impoverish 
one another, and almost starve those depending on them 
for support. 
The wisest rule about charging for your services is to 
ask from the beginning of your career the fees usual for 
the best attendance, neither extravagantly high nor ridi- 
culously low. 
Let people know that you strive to make your bills 
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 you are giving other people fifty dollars' worth of 
service for twenty dollars. 
Also, never bargain to attend whole neighborhoods 
of poor people at reduced rates; it never works success- 
fully. Indeed, if you ever attend a confinement or other 
case in a family for a nominal fee you will not be able 
to raise the fee to the regular price again in that family, 
or even with others who hear of it. 
Even though you are sure you will have to receipt 
your bill for a reduced amount, make it out for the 
standard sum, that the debtor may know your rates, 
and give you proper credit for whatever reduction you 
make; in other words, when you make a reduction to 183 
those vho plead poverty or other acceptable reason, 
let them understand that you are not reducing your 
charges, but are taking something off their bill, and en- 
join upon them not to tell it around, lest it injure your 
scale of charges elsewhere. 
When people talk to you about taking off part of 
their bill because they are poor and making the rich 
pay you more to make it up, take less if you think 
proper, but say not a word that would allow them to 
infer that you or any other doctor would charge any 
one, whether rich or poor, a cent more than he honestly 
owes. 
It is customary and just to charge double for the 
first visit to a case, chiefly for the following reasons: 
You must at the first visit devote an extra amount of 
time and attention to learn the history of the case- 
must involve yourself in a diagnosis, and probably in 
prognosticating too,-must establish a line of treatment 
-must instruct the nurses,-must map out the diet, and 
point out the requirements of hygiene, and formally 
assume all the responsibilities of the case, all of which 
require extra services and extra time, and justify a 
double charge for the first visit. 
There are a few people who think when a case is 
severe enough to require the physician to make more 
than one visit a day, that he should not charge for the 
additional visits, as if unconscious of the fact that cases 
dangerous enough to require an extra number of visits 
are the ones that throw upon him the greatest responsi- 
bility, cause him most anxiety, and contribute largely 
towards making his life one of hardships. 184 
You will often have people to complain that their 
bill is high and ask you to make a reduction; yet, many 
of these very people would not employ you if you were 
a third-rate or low-priced doctor; everybody wants first- 
class services, but wants them as cheaply as possible. 
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 
themselves. They reason the same way about physi- 
cians ; very few prefer or appreciate a low-price doctor. 
In unusually severe cases, and in those that require 
unusual exposure or extraordinary legal or professional 
responsibility, also for restoring persons after poisoning 
or apparent drowning, or where you have shown extra- 
ordinary skill, or had very great luck with bad cases of 
any kind, you should charge round fees. Attendance 
on an only child, an eminent or very important member 
of the community, or a stranger who has journeyed far 
with an important case that requires special attention, 
should also be charged accordingly, whether attended 
at your office or at their homes. In such cases be care- 
ful to pay no unnecessary visits; for in a very important 
case actually requiring three visits to which you make 
but three visits, they will appreciate you more highly 
and will more cheerfully pay a hundred dollars, than if 
you had also paid five additional, apparently unneces- 
sary visits and charged but $80 for all. 
Patients will often express surprise at your asking 
the same fee for an office advice as for a visit to their 
house; explain to them that although the charge is the 
same, it is much cheaper to be an office patient than to 185 
be visited at home, because an office patient usually 
comes but once, or only when his medicines are out, or 
when some important change has taken place in his 
ailment, and quits entirely as soon as possible; whereas, 
if you have him under care at his home, your responsi- 
bility and feeling of uncertainty compel you to visit 
him frequently to ascertain whether he is getting along 
as expected. For these reasons a few office consulta- 
tions with the responsibility of attending faithfully rest- 
ing on the patient, if on either, often suffice, instead of 
many house visits, and in this way office advice becomes 
very much cheaper. 
The difference between words used with office pa- 
tients 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. 
Never agree to attend any one for a " contingent 
fee," that is, do not take patients with chronic sores, 
constitutional headaches, epilepsy, cancer, post-nasal 
catarrh, piles, dyspepsia and other chronic affections, 
or cases of syphilis, gonorrhoea, etc., on the " no cure, no 
pay" plan, or to pay "if their expectations are realized" 
or " when all isover" Make no such agreements; for 
they are never satisfactory, and will generally end in 186 
your being swindled, and, it may be, charged with mal- 
practice. 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 you think are unworthy of credit that 
if they pay as they go it will encourage you, interest 
you in the case, and naturally stimulate you to do your 
best. 
Fail not to demand your fee in advance for attending 
cases of secret diseases. If you do not, your patient 
will almost surely leave you about the time the case is 
completed, with his bill unpaid; and if you bother him 
about it, he will either pay it grudgingly or not at all, 
and if you dun him for it, will meanly assert that 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 
misfortune, as other inflictions are, but of imprudence, 
and are self-inflicted. And for this reason venereal 
patients have not the usual claim upon your sympathy. 187 
Get a just fee m all cases of that kind before you begin; 
then stick to the patient until he is cured. He is not 
likely to change from you to another after he has paid 
you, and if his case proceeds slowly he cannot then sus- 
pect that you are purposely running a big bill on him, or 
delaying the cure on account of his being a good-pay 
patient, as he might do if he were paying you a dollar 
01 two a visit. 
Most men think they cannot have constitutional 
syphilis unless they have detected a terrible chancre as 
its beginning. You will often have difficulty in making 
persons who have not detected a primary sore believe 
their ailment is syphilis. Some men will actually scan 
you and quiz you when you tell them they have the 
p-x., as if they thought you an impostor, trying to 
scare) money out of them. If you can show such a 
patient a fac-simile of his case in your illustrated works 
on venereal diseases, or read to him a description of it 
from a text-book, it will generally convince him fully. 
If you are certain that your diagnosis of syphilis is cor- 
rect, look him in the eye and 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 nominal 
fee. It is a grave, long-continued disease, and the res- 
ponsibility and worry of the medical attendant are often 
very great and very long; therefore the fee should 
never be nominal. 
You can broach the fee question to any patient with 
a private disease by remarking immediately after 
making your first examination, " Well, I see what your 
case is, and am willing to take charge of it and give you 188 
my best services, if my terms will suit you" This will 
compel him to ask you what your terms are, and will 
give you an opportunity to tell him. 
Some people believe the law compels you to attend 
any one who chooses to send for you. It does -not; but 
public opinion might condemn you if you were simply, 
on account of fees, to refuse to attend an urgent case 
where humanity should prompt you to go. If you are 
either " too busy " or " not well enough f it is always 
sufficient to defend you against argument or criticism. 
But " Fm just at dinner," "Im too tired," or fl need 
sleep," or " I am afraid I will be dragged into court as a 
witness," etc., are not accepted by the public as sufficient 
reasons for refusing to go to a case, and should never be 
offered. 
Not only should you send your bill to a patient at 
the proper time, but if you do not hear from him within 
a reasonable while thereafter, emphasize it by sending 
another, for he may not have received it, or may have 
thrown it aside, or may be neglecting it in the hope 
that you will let it sleep till it is out of date. 
A very effective plan to use with a certain class of 
patients when you are in need of money is to learn the 
date at which you will have a note or bill to pay, or 
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 people will exert themselves to comply. You 
can in this way approach both your best and your worst 189 
patients-some that you cannot successfully approach 
for money in any other way. 
A good plan to pursue with those who habitually 
throw bills aside and neglect to pay them, is to send 
their bills some 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 
will make them feel impelled to pay you something the 
next time they call on you for services. 
By letting a certain prompt kind of patients know 
at the visit preceding the final one that your next visit 
will be the last, it will serve as a gentle hint and give 
them time to prepare, and will greatly increase your 
chances of getting your bill paid cash at the last visit. 
Convalescents from severe cases who visit you at your 
office after they are again able to walk off, 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. 
You cannot put all kinds of bills on the same foot- 
ing ; there is one class of patients whose bills had better 
be sent by mail, another that had better be taken by your 
collector, another that you had better deliver yourself, 
and a few prompt-pay patients with whom it is prefer- 
able to wait till they ask for their bills. 190 
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 doctor's bill that gives the items is apt to be 
disputed or criticised unless it is unjustly small. Bills 
that simply state the total amount are much more likely 
to be paid without dispute. The items of every bill 
should, however, be carefully kept on your book, that 
the charges may be verified if requisite. 
It is well to insist on giving receipts to people when 
they pay you money, even though they should deem it 
unnecessary. Compelling every one who pays to take a 
receipt not only prevents subsequent disputes, but also 
assists in keeping up a regular business form between 
you. 
To shave too closely in money matters, or to be un- 
reasonable, or too vigorous in your efforts to collect bills 
from any one, would not only be wrong, but would be 
very apt to injure your reputation and create a hostility 
that time cannot blot out. 
It will seldom pay you to sue people, even if you 
should gain the case. It is unwise for any doctor to 
begin litigation except under very aggravating circum- 
stances. 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 191 
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 cases where your services 
and efforts are not called into action, or are brief or 
nominal or clearly useless, as a bill under such circum- 
stances is generally not only not paid but is harshly 
criticised. If, however, grateful people volunteer to 
pay you for your trouble, take whatever is right. 
In cases of irremedial cancer, phthisis, etc., that, 
after going the rounds of the profession, consult you in 
their very last or hopeless stages, merely to see whether 
you can possibly do anything for them, you had better 
frankly acknowledge that you can do but little or noth- 
ing, 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 
happen to prescribe in public places where you are not 
pursuing your functions as a physician. Such exactions 
would, to say the least, risk unpleasant remembrance 
and harsh criticism. Every doctor sometimes writes 
prescriptions under circumstances where his own interests 
prevent him from making a charge or even accepting a 
fee that is tendered. 
Never make a charge where the fee would come from 
another physician's pocket; every physician attends his 
professional brethren and their families gratis. Many 
also attend clergymen and their families without charge, 192 
especially those with whom they have church relations, 
and such as receive salaries so meagre as to make the 
payment of medical fees a hardship. 
Be especially fair in your charges against estates, 
and in all other cases where unusual circumstances place 
the debtor at your mercy. These opportunities will 
truly test your honesty. When you are in doubt what 
to charge, look around you, then upwards, then make 
out your bill at such figures as will 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 divide every dollar with your fellow-worker on 
whatever basis you have agreed. 
Never acknowledge or work under the fee-table of 
any association, unless it is in harmony with the regular 
professional fee-table of your community. 
Humanity requires you to go to all cases of sudden 
emergency, accidents, etc., without regard to the pros- 
pect or non-prospect of a fee. You should do various 
things for the sake of charity; among these is to give 
relief to any one injured or in great pain, regardless of 
fees. At such times think only of your duty to humanity. 
The good Samaritan succored the wounded man, and 
took him to an inn and provided for his immediate 
necessities. You, as a physician, should, for humanity's 
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. 193 
It is your duty to raise your voice in the profession 
against the encroachments of the Free Special Dispen- 
saries that, under the great plea of charity, attract 
swarms of patients-among whom are many who are 
abundantly able to pay for medical services. Dozens of 
physicians in every city are of late cheated out of their 
living by so-called " Special " Charities, carried on in 
the interest of individuals or coteries, who treat every- 
body that applies, the rich, the poor and the interme- 
diate, without the slightest regard to the interest of other 
medical men. 
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 they may amply repay your services 
by lasting, genuine gratitude. " The poor," said Boer- 
haave, " are my best patients. God will be their pay- 
master." But even in doing charity you must discrimi- 
nate. There are said to be three classes of the poor: 
The Lord's poor, the devil's poor, and the poor devils. 
The first and last are worthy objects of every doctor's 
attention, and you should lose no opportunity to give 
relief to their distress. The less you have to do with 
the other class, the deviTs poor, the better for you, but 
you will be compelled to attend more than you choose 
even of these, on account of their relationship to better 
patients. 
" Prompt payments are fully appreciated," is a very 
useful maxim to have printed on your bills; it is truth- 
ful, and gives thanks to those who pay promptly. To 
those who do not it serves as a neat admonition. 194 
You will find that neither honesty nor dishonesty is 
confined to any nationality nor to any station in life; 
you will find very good people and very bad ones 
among the rich and the poor, the white and the black. 
You will mount many a marble step, pull many a silver 
door-bell, and walk over many a velvet carpet for pa- 
tients who will prove fraudulent in a superlative de- 
gree ; and get many an honest fee from some who make 
no great pretensions and possess but little save their 
honesty. Indeed, the demands of fashion are now so 
great that many people with moderate incomes, anxious 
to appear better off than they really are, habitually 
slight their doctors in order to help keep up appearances. 
This is not an exaggerated picture. You will see 
many a man bowed down with debt and despondency, 
while his wife and daughters 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 either to postpone or entirely prevent payment. 
The most unsatisfactory and the most troublesome 
kind of patients doctors 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 you 
know to belong to this class. It is better mildly but 
firmly to decline to take patients who can but will not 195 
pay, without assigning any reason except "too bus?/," 
than to contend with them about your fee after your 
work is done, and after all be swindled. 
Tell habitual delinquents, and those who have plenty 
of money to buy beer or to furnish their houses like 
palaces, or to follow the follies of fashion, but none to 
pay the doctor-when they come to make their bills 
larger-that they are already as large as you can afford 
to let them get,-that you are perfectly willing to go 
and serve them again after they pay you what they 
already owe you or a reasonable part of it. This atti- 
tude will bring them to some action, or at least indicate 
to you the probable prospect. 
A moderately successful practitioner has about two 
thousand persons who call him their doctor; whenever 
any one of them has a mental or physical ailment, he 
must share it. He must be bold as a lion with one 
patient and as gentle as a lamb with the next. He must 
combine all good qualities and appear the perfection of 
each to all men, and heaven knows! he deserves to be 
treated much better than he is. 
The fact that a physician must keep up appearances, 
and that many make their visits with gloved hands, in 
stylish carriages, is regarded by many unreasoning per- 
sons as evidence that ours is a path of ease-that we 
ride around during bank hours, prescribe for a few select 
patients, receive dollars by wholesale, and soon get rich, 
which is a great, a very great mistake. On the contrary, 
every older physician knows that it is almost impossible 
to get rich by the practice of medicine, unless it is 
through a money-making specialty. The truth is, when 196 
a doctor dies his family is usually left poor and helpless, 
unless he has acquired money otherwise than by prac- 
tice. 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 
instruments, your taxes, and a multitude of other items, 
for the whole thirty years, and then so far from being 
rich, even after so long and lucky a career, you would 
have but little, very little left to support you in your 
old age after a whole lifetime of anxiety, responsibility 
and usefulness. 
A good collector, one who has tact enough to get 
money without making you active enemies, will be very 
useful, and is still more necessary if you are a poor col- 
lector yourself. Having only a business transaction 
with patients, his interviews with them are all business, 
and he can persevere in his efforts to collect, to a degree 
you would find unpleasant or humiliating. Many really 
honest people are too poor to pay large debts, and were 
you to allow what they owe you to 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 pay- 
ing, 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 197 
collecting, but also regarding the conditions under which 
he is to claim it. Among other things, stipulate that 
he is to make full returns to you at least once a week, 
also that he is to have no percentage on money paid to 
you by those he has not visited for thirty days, unless 
you have at their request stopped him from going; also, 
nothing on bills placed in his hands if the people come 
and pay them before he has delivered their bills, in fact 
nothing on any bill he does not in some way assist in 
collecting. ' 
If you adopt some special color, pink or blue or 
yellow, for your bills, debtors holding them will be re- 
minded of you and of the debt every time they see the 
odd color, and it may, by reminding them of the fact, 
accelerate its payment. 
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 sys- 
tematically 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 XI. 
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 indicate that you were entirely ignorant 
of its possibility or that you feel yourself blamable. 
When there is danger of rapid or sudden death, 
beware of ordering chloral, opiates, or other potent 
drugs in such a manner as to create a belief that they 
caused or hastened death. Circumstances even make it 
wise at times to order this or that remedy under its 
common name, that, its harmless nature being under- 
stood, 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 
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 
198 199 
doing so 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. Never express any opinion of the cause in 
any such case until you have calmly and coolly col- 
lected and weighed all the circumstances. The possi- 
bility 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 developments in the case may 
expose you to strong censure and deep mortification. 
The popular belief is that if a sudden death begins 
at the heart there must have been a pre-existing heart 
disease, and the family physician is often reproached for 
not having discovered it during the patient's 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. 
A belief that stout, healthy people should endure 
accidents, operations, accouchements, diseases, etc., 
better than weaker, complaining people, is another pop- 
ular 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. 200 
You will seldom be censured for a fatal issue in the 
diseases of the aged, and never in those of hard drinkers, 
nor in cases where you have given an unfavorable prog- 
nosis from the first. On the other hand, if a woman 
dies in confinement and there is any possible chance 
to blame you, it will be done, for the reason that 
bringing forth children is unlike disease. Child-bear- 
ing is designed by nature to increase and not to 
diminish the number of our race; therefore death in 
labor, which is a physiological function, or during 
the lying-in, which is a physiological state, seems 
to be against nature and excites the criticism of every- 
body. 
In accidents obscure as to nature or degree, also 
in cases of sudden illness when you are pressed to 
know whether the case is dangerous or will be of long 
duration, choose your language deliberately and give 
only indefinite answers, till 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 surprises and uncertainties 
and either force consultations on you or entirely dis- 
place you. 
In cases of accident and injury to drunken people 
have the presence of mind to give a provisional opinion 
only, till they return to a sober state. It is better to 
say, " He is certainly drunk; whether his drunkenness 
obscures other and more important features it is at this 
time impossible for any one to say." 201 
Your patients will differ greatly in the amount of 
complaint they make in detailing their subjective 
symptoms to you. Some who are naturally stoical and 
apathetic will fall into the error of understating their 
cases, fearing that a fuller statement would alarm their 
friends, or that it would cause you to think their cases 
serious, and that they might have to take too much 
strong medicine or that the doctor might pay them too 
many visits. Such patients will sometimes die almost 
without giving a sign. Others, again, of a hysterical or 
nervous temperament, fearing that you may not consider 
them as sick as they really are, will, detailing their 
symptoms, magnify every ill. One of the many advan- 
tages a regular attendant has over others is his famili- 
arity with these peculiarities of disposition, with the 
extent of the vocabulary each of his patients employs, 
and the amount of precision each uses in describing his 
sufferings. A fine lady, a hod-carrier, a 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 be often 
criticised or upbraided for your lack of foresight regard- 
ing the recovery or death of patients. 
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 202 
aids accurately prognosticate the endurance power of 
every patient. 
To illustrate what is meant: 
Health, 0. 
1st. 
2d. 
3d. 
4th. 
5th. 
6th. 
7th. 
Classes, 
Suppose the above seven figures to represent the 
various degrees of mankind's ability to endure sickness 
and injury, and that the fourth class represents the 
average extent of human endurance power. Now, some 
patients 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 others 
will actually show tenacity enough to recover after 
going as low as the fifth or even to the sixth degree. 
Now, if you could penetrate each patient's vital recesses 
and gauge the total of his endurance power,-could 
see at which point his possibility of recovery ends and 
his dissolution begins,-there would be fewer unanswer- 
able how's and why's, and you would seldom, if ever, 
be reproached for unpredicted terminations. This you 
cannot do, but you can in every case make full use of 
ail the teachings of experience, and must avail yourself 
of every aid offered to you by medical science. 203 
In conclusion, worthy reader, if this little work en- 
ables you and others to discern the path of duty with 
increased clearness, or teaches you how to wield your 
powers until greater success, and if, as a result, it con- 
duces in any degree to the welfare of our honorable pro- 
fession, it will, to a corresponding extent, attain the object 
of ITS AUTHOR. INDEX. 
PAGE 
Abortion, solicitations to pro- 
duce 50, 51 
Accidents, demeanor in attend- 
ing..... 107,198, 200 
Ailments not to be ridiculed.... 76 
Allopathy 147 
Amenorrhcea in consumptives... 112 
Assistant, acting as 10, 79 
Attending by the year 182 
Babes, hand-fed 115 
Warming the new-born.. .114, 115 
Baptism, conditional. 84 
Bills 174 to 197 
Black lists 197 
Blame, laws that govern 200 
Boasting 28 
Boils, are they healthy ? 117 
Book agents 56 
Bores 104 
Borrowing 58 
Calls, hurried 17 
Cases, why never abandon 99 
Refusal to take 70,105 
Catholic patients, duty to. ...83 to 86 
Certificates 76, 77 
Certificates, clergymen's 168 
Certificates, legal 76, 77 
Changing medicines, ar t of.... 106 
Charity, the demands of ... .192,193 
Cheap doctors 184 
Children's influence 62 
Chloral 97 
Clandestine visits 88 
Coition, why not recommend.. Ill 
PAGE 
Collecting bills 174 to 197 
Collector 196 
Cold rooms in sickness 113 
Companions, what kind to select 12 
Competition, wars of. 181,182 
Conduct in the sick-room 37 
Confidants 74 
Confinement, purgative after .. 119 
Consult, right of refusal to...134,135 
Consultation fees 133,134 
Consultations, objects of. 136 
Radical changes after 133 
Whom to call into 132 
Consumption, errors regard- 
ing 112,113 
Contagion, fear of 118 
Contingent fee, why not work 
for 185 
Countenance, the doctor's 
107, 198, 200 
Critics and wiseacres 103,106 
Cuckoo, the 25 
Cures, guaranteeing 76,185 
Dampness 119 
Death, causes of sudden 198,199 
Debates, how to conduct 54 
Decrying medicine 136 
Degree of certainty in medi- 
cine 137,146 
Diseases, driving in 116,117 
Dismissal of medical attend- 
ants 95,96 
Dispensaries, free 193 
Dog-bites 118 206 
PAGE 
Double callings 20 
Dress and manners, influence 
of 19 
Dressing too warmly.. .113,114,115 
Drinking 59 
Druggists 161 to 173 
Drugs, &c., got gratis 163 
Drugs that enslave 130 
Duties, five cardinal 97 
Duty to the dying 81,82, 86 
Education, its importance to 
the Physician .29, 30 
Entanglements, to avoid... .101,103 
Eruptions, bringing out 116 
Estates, charges against 192 
Ethics, medical 41 to 43 
Eucharist, the Holy 83, 84 
Experiments tried on patients . 98 
Extreme Unction 83 
Fainting..'. ■ 118 
Familiarity, undue 60 
Fashionable frauds 194 
Fee in advance for secret dis- 
eases 186,187 
Fee or no fee 185 
Fee table 16,193 
Fees 174 to 197 
Fees for important cases 184 
Fees, how to collect 188,189 
Fees, joint 193 
Fees, lawsuits to recover. 190 
Fees, why not work for con- 
tingent 185 
Females, influence of. 62. 
Fever, water in 125 
Fickleness, human 80, 95 
Finances, the doctor's 195 
German, usefulness of. 31 
Gratifying whims 103 
Guaranteeing cures 76,185 
Guard yourself 93 
Gums, object of lancing 115 
Habits, disgusting 58 
Heart disease, death from 199 
PAGE 
Hectic confounded with ma- 
larial..... 112 
Heroic doses 92,96, 97 
Homoeopathy 141 to 160 
Humanity, its demands 193 
I forgot you 71 
Incompatibles 31 
Instruments of precision 18 
Insults 74 
Irregulars, joint discussions 
with 157 
Jealousy 24, 25,26,73 
Kindness, influence of 34 
Latin, use of 30 
Laws, duty to 93 
Laws, medical 158 
Life power, scale of 201, 203 
Malarial affections, recurrence 
of 134 
Malpractice cases . 48, 49,100 
Mankind, study of 33, 121,123 
Manners, influence of 34 to 37 
Marriage of doctors 61 
Marriage of syphilitics 110 
Maxim 193 
Medicine, decrying 136 
Medicine, degree of certainty 
in 137,146 
Medicine haters 131 
Medicines, art of changing 106 
Medicines, bad effects of 123 
Medicines, costly 170 
Medicines, unused... 106 
Medicines at offlce 17 
Medical art, imperfection of. 136,146 
Medical societies 52, 53, 54 
Memory of cases 55 
Menial labors 75 
Metric system 56 
Midwives, assisting 69,70 
Moralizing 79 
Name, what is in a 151,153 
Neglectful and perverse pa- 
tients ...103,103 207 
PAGE 
Newspaper squibs £3. 64 
Night emissions Ill 
No cure, no pay ... 135 
Novelty, influence of in medi- 
cine 122 
Objects of consultations 135,136 
Obstetrical cases 68, 69,70 
Office, charges for advice at 
16,110,184 
Office, location and arrange- 
ment of. , 10 
Office hours 15 
Office practice 17 
Old Lady with salve 103 
Omission versus commission.... 100 
Over-praise from patients 72 
Over-visiting 74, 88 
Palatability 121 
Partisan questions 59,168 
Partnership 10 
Patients, distant 70 
Patients, how to transfer 131,132 
Patients, neglectful and per- 
verse 102 
Patients, varieties of. 122, 201 
Patients' whims gratified 103 
Patients, worthless 105,193 
Paying debts 58 
Personal affairs 189 
Personal appearance 19 
Pharmaceutical catch-pennies. 128 
Photograph giving 80 
Physicians, increase of num- 
ber of 27 
Physicians, the new 24, 25 
Physicians, why the older ex- 
cel the younger 66, 67 
Placeboes 92,93 
Politeness, value of 65 
Politics 11,20, 21 
Polypharmacy 127 
Post-mortems and analyses 68 
Practice, limiting amount of... 70 
Precautions 97 
PAGE 
Pregnancy suspected 50, 51 
Prescriptions, about labelling... 172 
Prescriptions, expertness in 
writing 31 
Presents from patients 60 
Profession, identifying self with 
the .....52, 53, 54 
Prognosis, cautions concerning 
99, 200, 201, 202 
Purity of mind 33 
Quack bitters 79 
Quackery . „ 155 
Quantities to prescribe 107 
Questions, rule for repeating... 120 
Questions, rule regarding 98 
Quinine, popular prejudice 
against 124 
Receipts, compel people to take 190 
Record book 98 
Register heat 114 
Religion 81 
Relinquishing attendance 87 
Remedies examined at every 
visit 126 
Remedies, horrifying 123 
Renewal of prescriptions, to 
prevent 129 
Reporting cases 57 
Reputation, value of.... ■....... 32 
Responsibility, dividing 100,132 
Rich not to pay for poor 183 
Riding versus walking 21 
Rivalry, professional .24,25 
Scandal 28, 33 
Scarlet rash 116 
Scold, how to, without offend- 
ing 61 
Secrets, guarding 72, 90 
Services to physicians and cler- 
gymen 191 
Services to the poor 193 
Services, when not to charge 
for . 191 
Signatures, regarding 168 208 
PAGE 
Shame, a matter of. 101 
Signs, office 14,15 
Skill, what is medical? 137 
Social influence 63 
Specialties, when to patronize.. 131 
Spoons, variations in size of.... 131 
Springtime, taking medicine in 
the 94 
Superseding other physicians.. 64 
Surprise, showing 198, 200 
Swallowing foreign bodies 117 
Swallowing phlegm 115 
Sweating the baby 115 
Synonyms, use of. 171 
Syphilitic cases 186,187 
Terms, transposing 171 
Temper, control of. 36 
Terrifying opinions 107 to 111 
Therapeutics, crude 127 
Therapeutics, mental 122 
The ruling spirits 72 
Tongue depressors 78 
PAGE 
Too busy 105,188 
Trade-mark articles 169 
Tricks 26,87 
Trips for heal th 125 
Urine, scanty and high col- 
ored 117 
Vaccination 47,48, 77 
Variability of human endur- 
ance 201, 202 
Veins on back of hands 119 
Venereal cases 71,186,187 
Visit, double charge for first.... 183 
Visits, how to make short 125 
Visits, neighborly 24 
Visits to the sick 73. 74,88 
Vocabulary of different classes.. 201 
Volunteer services 48 
What is in a name 151,152 
Why charge for every visit.... 183 
Witness, duty to self when a... 104 
Wiseacres and critics 105, 106 
Womb doctoring 108