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 Book on the physician himself and things 
 
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 ON 
 
 The Physician Himself 
 
 AND THINGS THAT CONCERN 
 
 His Reputation and Success. 
 
 BY 
 
 D. W. CATHELL, M.D., 
 
 Baltimore, Md. 
 
 Tlie Ninth Edition, Revised and Enlarged. 
 
 PHILADELPHIA AND LONDON : 
 
 F. A. DAYIS, PUBLISHER. 
 
 1889. 
 
7?o. /*2£3 
 
 Entered according to Act of Congress, in the year 1889, by 
 
 F. A. DAVIS, 
 
 In the Office of the Librarian of Congress, ait Washington, D. C, U. S. A. 
 
 All rights reserved. 
 
 Philadelphia: 
 
 The Medical Bulletin Printing House, 
 
 1231 Filbert Street. 
 
 
THE AUTHOR 
 
 RESPECTFULLY DEDICATES 
 
 THIS LITTLE WORK TO 
 
 THE MEMORY OF THAT GREAT AND GOOD MAN, 
 
 The Late PEOFESSOE 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 NINTH EDITION. 
 
 Impressed with the belief that a "Book on the Physician 
 Himself and Things that Concern His Reputation and Success " 
 would be of decided benefit to numerous members of the pro- 
 fession, and finding that no such work existed, the author, with 
 diffidence, attempted the duty of writing one. This book is the 
 result. 
 
 The marked favor with which it has been received by the 
 medical press, the expressions of approval by many well-known 
 members of the profession, and the demand for edition after 
 edition of it, are taken as proof that such a work was greatly 
 needed, and that it is finding its way into the hands of many 
 of those for whom it was written. 
 
 Grateful for this result, and desiring to render it more 
 worthy of the flattering commendations it has received, the 
 author has carefully revised the entire work, and made such 
 alterations in it as greater experience and more mature reflection 
 have dictated. 
 
 He has also added a great deal of new material, the result 
 of further thought and of later observations. 
 
 It is confidently believed that the revision and new material 
 make this, the ninth, edition a very great improvement on the 
 older ones. D. "W. C. 
 
 1308 X. Charles Street, 
 Baltimore, Md. 
 
BOOK 
 
 ON 
 
 THE PHYSICIAN HIMSELF 
 
 AND THINGS THAT CONCERN 
 
 His Reputation and Success. 
 
 CHAPTER I. 
 
 "Things small in themselves have often a far-reaching significance." — Chew. 
 
 To fight the battles of life successfully, it is as necessary 
 for even the most skillful physician to possess a certain amount 
 of professional tact and business sagacity, as it is for a ship to 
 have a rudder. There are gentlemen in the ranks of our 
 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 professional tact and business sagacity; and 
 there is nothing more pitiful than to see a worthy physician 
 deficient in these qualities, waiting year after year, until his hair 
 turns gray, for a practice, and a consequent sphere of profes- 
 sional usefulness, that never come. 
 
 Were a worthy inquirer to ask me : " How shall I conduct 
 myself in the profession, and what honorable means can I 
 employ, in addition to scientific knowledge and book-learning, 
 in order to make my success more certain, more rapid, and more 
 complete, and to excel in the great battle of life to the fullest 
 extent that lies in me V I should, in answer to these great 
 questions, offer the following suggestions : — 
 
 First, last, and in the midst of all, you should, as a man and 
 as a physician, always, and above all else, keep whatever is 
 
 (1) 
 
2 THE PHYSICIAN HIMSELF: 
 
 honest, whatever is true, whatever is just, and whatever is pure 
 foremost in your mind, and be governed by it. 
 
 If you do not you ought not to succeed in the profession, 
 and no honest man can wish you success. 
 
 Whether, after graduation, you start to practice without 
 any intermediate course, or wisely strive to further prepare 
 yourself for your life's work, by a limited term of service in some 
 hospital; or by taking a course in diagnosing, prescribing, and 
 manipulations at some Post-Graduate school in one of our own 
 great cities ; or make a journey to the hospitals and clinics of 
 London, Paris, Berlin, Vienna, or Leipsig, is a matter of both 
 money and time ; but whenever and wherever you start your 
 private practice, you should, above all else, strive to start right, 
 and by the aid of energy, industry, and perseverance to enter 
 promptly on the road to success ; for unless you gain popular 
 favor by a worthy display of ability, acquire some reputation, 
 and build up a fair practice in your first six or eight years, the 
 probabilities are that you never will. 
 
 Contract no entangling alliances. It is better not to enter 
 into partnership with other physicians. Partners are usually 
 not equally matched in industry, tact, and similar qualities, and 
 are not equally liked by the public. Hence the union generally 
 does not prove as beneficial or as satisfactory as expected, and, 
 consequently, partnerships rarely continue long. Above all else, 
 never ally yourself with any other physician as assistant or junior 
 partner, to do the drudgery ; or on any other terms, except as an 
 equal. The sooner you learn to depend wholly on yourself the 
 better. Julius Caesar said, " I had rather be the first man in a 
 village than the second man in a great city." 
 
 " Call not on Hercules for help ; his aid 
 Ne'er serves the man who will not serve himself. 
 Thine own arm must the conflict meet, 
 Thy purpose being the victo^." 
 
 Unless you have your place of residence or the locality 
 already selected, you may find it the most difiicult problem 
 
HIS REPUTATION AND 'SUCCESS. 6 
 
 of your life to find an unoccupied nook or corner for a 
 settlement. 
 
 With the whole world before you, to accurately balance 
 and weigh the difficulties and advantages of this, that, or the 
 other opening — whether to locate in a populous city, a moderate- 
 sized town, or in the country: in the East or the West, the 
 North or the South, of our wide-spread land — is truly a puzzling 
 puzzle. 
 
 Many big blunders are made by locating in the wrong 
 place, therefore give the subject your very best thought ; decide 
 with great care, and only after duly considering your own 
 qualities and qualifications, as well as the locations ; — whether 
 you are self-reliant and pushing, or quiet and unobtrusive ; 
 whether you have abilities that will compel people in a populous 
 centre to employ you in preference to your neighbors, or 
 whether, being less fully armed, you had better seek mediocrity 
 and become a country doctor in a less thickly settled location, 
 where there is less competition and less talent to encounter. 
 
 By all means seek to locate in a community to which you 
 are suited; that will be congenial as a place to live in, and 
 in which you are likely to get business and be useful to your 
 fellow-beings, and also to earn a living for yourself. Remember 
 that unpopular opinions in politics or religion injure, and that, 
 all else equal, you will be more likely to succeed in a section 
 where your views, habits, and tastes are naturally in harmony 
 with the bulk of the people, morally, socially, and politically. 
 
 No difference where you locate, if you are youthful you 
 will encounter difficulties that older physicians do not. " He 
 looks too young ;" " He lacks experience ;" " He don't know 
 anything;" "He has no practice, therefore is no good;" "He 
 shouldn't doctor me, I'd send him off and get an older phy- 
 sician," are among the often-heard expressions. Face them all 
 bravely. Show the world that you deserve to succeed, and 
 success will surely come. 
 
 If you begin practice in a city or town, the location and 
 
4 THE PHYSICIAN HIMSELF: 
 
 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 section or a rapidly growing new one. If you were to locate 
 on a back or unfrequented street, or other out-of-the-way place, 
 it would naturally suggest to the public either that you had poor 
 judgment or that you were made of timorous, apathetic material^ 
 or that you lacked the spirit of enterprise and enthusiasm, or 
 had defective ambition or distrust of your own acquirements. 
 
 Remember, in making your selection, that a physician can- 
 not rely on his near neighbors for patronage ; people in your 
 immediate neighborhood may never employ you, while some 
 farther away will have no one else. 
 
 Avoid frequent removals, and do not shift or change from 
 one place to another, unless it is clearly to better yourself. 
 Select a place suited to your abilities and taste, and then be 
 tenacious. Reputation is a thing that grows slowly, and every 
 distant removal imperils one's practice, necessitates new labor, 
 and sometimes compels a commencing of life over again. A 
 physician's frequent removals naturally create a bad impression, 
 and look like dissatisfaction from lack of success. 
 
 Branch offices are, as a rule, not desirable. Besides con- 
 suming valuable time in going to and fro, and in general 
 occasioning double trouble, they create an uncertainty in the 
 minds of those seeking the physician as to where he may most 
 readily be found. On estimating all the advantages and dis- 
 advantages, therefore, it will be found that a plurality of offices 
 increases greatly neither one's practice, one's popularity, nor 
 one's income, and may be regarded as likely to prove more 
 annoying than profitable. 
 
 It is risky for a beginner, Avho has no influence and but 
 little money, to locate in a section already overstocked with 
 popular, energetic physicians, as their superior advantages, 
 established reputations, and warm competition may keep him 
 limited and crippled for too long a time before a chance or a 
 
HIS REPUTATION" AND SUCCESS. 5 
 
 S 
 
 change comes. Your first necessity is to possess knowledge and 
 skill as a physician, the second is to find a field in Avhich to 
 exercise and display them. 
 
 A corner house is naturally preferable to one in the middle 
 of a row, since it not only has facilities for constructing an office 
 entrance on the side street, leaving the front door free for other 
 callers, but also insures to the consulting-room a good light for 
 examinations, operations, and study. 
 
 If possible, have a good, light, airy, comfortable, and acces- 
 sible office, one that is not used for a family parlor, or any other 
 accessory purpose. 
 
 Exercise care in its arrangement ; give it a pleasing exterior ; 
 make it look fresh, neat and clean outside, and make it snug, 
 bright and cosy inside, thus showing that its occupant is pos- 
 sessed of good taste and gentility, as well as learning and skill ; 
 and at the same time that it is neither a lawyer's consulting- 
 room nor a clergyman's sanctum, nor an instrument-maker's shop, 
 nor a smoking club's headquarters, nor a dude's parlor, nor a 
 loafing room for the unemployed, nor a social meeting-place, 
 of any kind, but the office of a live, earnest-working, scientific 
 physician, who has a library, takes the journals, and makes use 
 of the various instruments science has devised for him. 
 
 Take care, however, to avoid running into a quackish dis- 
 play of instruments and tools, and keep from sight such inappro- 
 priate or even repulsive objects as catheters, syringes, obstetric 
 forceps, splints, trusses, amputating knives, skeletons, grinning 
 skulls, jars of amputated extremities, tumors, mannikins, and 
 the unripe fruit of the uterus. Also, avoid such habits as 
 keeping specula or human bones on your desk for use as paper- 
 weights. 
 
 It is not unprofessional, however, to have about you, in 
 your outfit, your microscope, stethoscope, spirit-lamp, test-tubes, 
 re-agents for testing urine, and other aids to precision in diag- 
 nosis; or to hang up your diplomas, certificates of society 
 membership, portraits, busts of eminent professional friends; or 
 
6 THE PHYSICIAN" HIMSELF: 
 
 of teachers or medical celebrities : Hippocrates, Galen, Harvey, 
 Gross, or whomever else you specially admire ; academical prizes, 
 professional relics, and keepsakes, or anything else that is spe- 
 cially associated with your medical studies and career. But it 
 is better to limit such articles to those having relation to you as 
 a student or physician. 
 
 In buying your office outfit beware of stocking yourself 
 with novelties and instruments that will probably go out of 
 fashion or rust before you will use them. It is better not to in- 
 vest heavily at first, and to wait and buy none but the usual 
 everyday instruments, until you have a use for others. Remember 
 that soft-rubber goods, and soft goods generally, deteriorate and 
 finally become worthless in keeping. 
 
 A neat case of well labelled and well corked medicines, or 
 a cabinet of minerals, or works of art, are in good taste ; so 
 also are your dictionaries, encyclopaedias, and lexicons for ready 
 reference ; but display no miniature museum of sharks' heads, 
 stuffed alligators, tortoise shells, impaled butterflies, bugs, minia- 
 ture ships, mummies, snakes, stuffed birds, lizards, crocodiles, 
 beetles, tape-worms, devil-fish, ostrich-eggs, hornets' nests, or 
 anything else that will advertise you in any other light than 
 that of a physician. It will, to the thinking portion of the 
 public, seem very much more appropriate for you, as a physician, 
 to be jubilant over a restored patient or a medical discovery 
 than to be enthusiastic over a stuffed flying-fish, an Egyptian 
 mummy, or a rare shell. If you have a love for such incon- 
 gruous things, or are a bird or dog fancier, or a bug-hunter, at 
 least keep the fact private and keep your specimens out of sight 
 of the public, and endeavor to lead every observer to think of 
 you only as a physician. 
 
 It is your duty, as well as to your interest, to display no 
 political or religious emblems, portraits, etc., about your, office, 
 because these relate to your personal sentiments ; you are em- 
 phatically a public man, and your office is a public place, not 
 for any special class, but for every kind of people; no matter 
 
HIS REPUTATION AND SUCCESS. 7 
 
 what shade of partisan or sectarian pictures you may display, 
 they will surely be repugnant to some. The obtrusion of un- 
 popular political or religious views have marred the prospects 
 of many a physician, and what is popular to-day may be unpop- 
 ular to-morrow. Keep your heart and your office open to all 
 denominations and to all parties. This will recommend you 
 equally to all. 
 
 Establish a regular professional and business policy at the 
 beginning of your career. Be as regularly at your post as pos- 
 sible, and have your office lighted promptly every evening, at 
 the proper hour, and in all other respects show punctuality 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 
 certain kinds of desirable patients. Both messengers and patients 
 would rather meet you, or your servant, than ladies. You 
 should respect public opinion in this and in all other matters 
 justly open to criticism. 
 
 A physician is judged by the company he keeps. Avoid asso- 
 ciating with aimless idlers and those who bear a merited stigma, 
 or are notoriously deficient, or whose hopes and ambitions have 
 been blighted or wrecked by intemperance, or their good names 
 tarnished by their own misconduct. Let your associations be, 
 as far as possible, with professional brethren and people of 
 genuine worth. Prefer to spend your unoccupied moments in 
 your office, with your standard works and medical journals, or 
 at . a friend's drug store, or with other physicians, or at the 
 medical library, to lounging around club rooms, cigar stores, 
 billiard parlors, barber shops, or corner groceries with lazy 
 feUows, who love the occupation of doing nothing, in frivolity 
 and dissipation, or in taking them out riding or to the horse 
 races, or to join the throng at the base-ball game. No ordinary 
 man ever conceives a more exalted opinion of a professional man 
 by fraternizing with him at such places. 
 
 Be social with all kinds of patients with whom necessity or 
 
8 THE PHYSICIAN HIMSELF: 
 
 duty brings you into contact, but beware of talking too much, 
 and do not handshake and harmonize and associate unreservedly 
 with the coarse, ignorant, and unappreciative. Undue familiarity 
 shears many juniors of much of their prestige. Never become 
 so familiar with a patient as to lay all formality aside and enter 
 his house, or room, without ringing, knocking, or calling. 
 
 Never have companionship with Irregulars; it would de- 
 tract from both you and rational medicine, which you represent, 
 and give countenance to delusions and pretenders; avoid this, 
 and every other contaminating alliance. 
 
 What shall be said of self-mutilation with harlots and asso- 
 ciation with concubines % Of drinking and of gambling 1 You, 
 in the dethroning fields of Venus and Bacchus! Oh! young 
 physician, if you have entered any one of these DANGEROUS 
 roads follow the dictates of common sense and turn from it this 
 day, this hour ! for they both lead rapidly downward, and either 
 of them will deform and warp all your finer sensibilities, prove 
 fatal to every ambition, and speedily put a death-blight on your 
 career. And if indulging any one of these habits singly will be 
 like sowing dragon's teeth for yourself, what will be the com- 
 bined effects of them all? It will be social and moral death! 
 Professional suicide, short, quick, and sure ! An unspotted name 
 is the only thing that will enable you to withstand your critics ; 
 for neither you nor any other physician can successfully lead a 
 double life, or afford to despise public opinion. 
 
 Put not a feather's weight upon the honorable ambition of 
 any one, or a straw in the pathway of his worthy aspirations, but 
 be very cautious how you involve yourself by inducing young- 
 men to study medicine, as there are already three physicians 
 where one is required. Besides, either their failure in the pro- 
 fession, or their misconduct, or their unfair rivalry may in time 
 to come work great injury to you. 
 
 It is neither profitable nor advisable for you, a private 
 practitioner, to take aspirants for iEsculapian honors as office 
 students, as they will necessarily be in the way and divert your 
 
HIS REPUTATION AND SUCCESS. 9 
 
 mind from other duties ; but if you do take any, charge them a 
 fair price for the privilege, and remember that in taking stu- 
 dents you stand as a guardian at one of the outer gates of the 
 profession, and listen only to such applicants as have a pure, 
 high-souled, and just appreciation of the profession, good sense, 
 sobriety, mental and physical vigor, and a strictly honorable 
 ambition to be a worthy physician. 
 
 Remember that good gas makes a good light, and bad 
 gas a poor one ; that a good battery generates good electricity, 
 and that a bad one necessarily makes a poor kind; so, also, 
 that a good brain, a good mental soil creates better ideas, better 
 fruit than an ordinary one. Brains and common sense are a rare 
 gift from heaven ; and a diploma from every medical college 
 on the face of the earth, each bedizened with ribbons — red, 
 white, and blue — and each stowed away in a gold case set with 
 diamonds, cannot give them to those who lack them. Remember 
 this, and dissuade and refuse every one who wants to embrace 
 medicine from a belief that its study is simply a pleasurable 
 pastime, or that it is a mere trade, or that it is less laborious 
 than the business they are following, or Jacks-at-all-trades, who 
 are tempted, by the ease with which a diploma can be obtained, 
 to add it to their others, or by the false notion that it is a gay 
 and pleasant life, or a smooth and rosy road to money-making ; 
 or simply to please his grandmother or his fond papa, or the 
 tough, ox-faced fellow who feels an anxiety to see the shedding 
 of human blood, or any other applicant so unworthy. The 
 standard has fallen lower and lower, until we have at last reached 
 a point at which the untitled, brainless bumpkin, who has hardly 
 mastered the multiplication table, and knows not the difference 
 between a single angle and a triangle, who is following the plow, 
 or driving the jack-plane, or measuring ribbons and tape to-day, 
 thinks he can find a place where he can be metamorphosed into 
 an M.D. to-morrow, and that a sign or door-plate with his name 
 (and prefix Doctor) on it, and a buggy at his door, is about all 
 that is necessary. 
 
10 THE PHYSICIAN HIMSELF: 
 
 Select your associates with great care, and do not let your 
 office be a lounging place or a smoking-room for horse-jockeys, 
 dog-fanciers, base-ballers, politicians, mimics, chatty blockheads, 
 or others whose time hangs. heavily on their hands. The public 
 look upon physicians as public characters — earnest, sober men 
 with scientific tastes and habits, who have been singled out and 
 set apart for a lofty purpose, and as socially, mentally, and 
 morally worthy of an esteem not accorded to such people, or other 
 private citizens engaged in the ordinary business of life. The 
 idle jokes, amusements, common-place gabble and boyish non- 
 sense, the habits and prevailing tone of mind of such light- 
 minded people, do not harmonize with the studies, tastes, and 
 desires of worthy physicians ; and, moreover, they tend to weaken 
 or destroy the faith of the public, which is so essential in our 
 work; on no profession does faith have such influence as on 
 ours. The public, and especially the female portion of it, with 
 eyes as of a microscope, takes cognizance of the associations and 
 of a thousand other little things regarding medical men ; in 
 fact, every circumstance in your appearance, manners, walk, 
 conversation, habits, etc., will be closely observed and criticised 
 in order to arrive at a true verdict, more especially in the early 
 years of your career. 
 
 No one can succeed fully without the favorable opinion of 
 the gentle maids and acute matrons he meets in the sick-room. 
 They can be his best friends or his worst enemies. Females 
 have more sickness than males, and 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 but 
 dry-as-dust physicians of a statistical or hypothetical turn, to 
 whom a patient is the same as a rock is to a geologist, or as a 
 flower is to a botanist, who, more naturalists than physicians, 
 love the rays of philosophy and the beams of science better than 
 humanity ; and who, with their eye at the end of the micro- 
 scope, watch cases merely from a scientific point of view, or to 
 study the action of medicine ; very often decidedly and perma- 
 
HIS REPUTATION AND SUCCESS. 11 
 
 nently lack popularity, and fail to get much practice ; is that cold 
 logic and ' rigid mathematics, chemistry, physiology, and other 
 high theoretical attainments, however much admired abstractly, 
 are not a certain guarantee of popular favor, since they are often 
 attained at the expense of the endearing sentiments, and hence 
 create none of those ties upon which many a successful prac- 
 tice depends; but, on the contrary, are often associated with a 
 deficiency of those minor qualities of head and heart which 
 appeal to the weak side of woman — her emotions — and gain her 
 favoring opinions, and get her good will and word. If you are 
 deficient in the social half, cultivate it. 
 
 In getting office signs, remember that a physician has them, 
 not as advertisements, but simply to show his office to those 
 looking for him. Your signs should be neither too large nor 
 too numerous. One of black smalt with gold letters is the 
 neatest and most attractive of all; one such sign on the front 
 wall for the day-time, and a glass one with black letters in the 
 window, to be seen at night, when your office is lighted, are 
 sufficient. The letters on the former should be round and well 
 shaped, and not more than two inches high, with corresponding 
 width. 
 
 All signs should be neatly made and properly lettered, 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 understood by all. 
 
 To put " Physician and Surgeon " or " Physician and Ac- 
 coucheur," or other compound title on your sign, would be un- 
 necessary in this region, since all physicians are supposed to be 
 surgeons, accoucheurs, etc. The practice of medicine on the 
 human body allows no such, This or That, division of learning ; 
 the medical case of to-day is the surgical or obstetrical case of 
 to-morrow; almost as well might the confectioner say on his 
 sign, "Cold Ice-Cream." 
 
 Unless there is danger of jour being confounded with some 
 
12 THE PHYSICIAN HBISELF : 
 
 other physician 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 necessary 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, cup- 
 ping and leeching, millinery, dressmaking, painting and glazing, 
 boarding, etc., in company with yours. 
 
 The lettering on your window-glass may be protected from 
 being scratched, or otherwise defaced, by having a pane of 
 common glass behind the lettered one. 
 
 It is deemed unprofessional to put where you graduated 
 and how long you have practiced upon your cards and signs, 
 or in the newspapers. 
 
 Establish regular office hours early in your career, and post 
 them conspicuously in your office; also have them on your 
 cards. 
 
 It may be a question whether it is advantageous to have a 
 sign designating your office hours on your office window, or on 
 the outside front, to show them to the outside public. Your 
 situation in business should influence your decision on this 
 point. A young physician, or one who has much spare time at 
 home, in addition to his stated hours, would be more apt to 
 catch the overflow, emergencies, cases of accident, or calls from 
 strangers in the city, and other anxious seekers for "any one, 
 so he is a physician," and who have perhaps searched and found 
 all the busier physicians away from their offices. These calls 
 you would be likely to get, if an exhibition of your office hours 
 does not drive them off by showing them before ringing the bell 
 that they have come at the wrong time, when in fact you are at 
 home and ready for calls. On the contrary, one busily engaged 
 in outside practice, who has no other time for office consulta- 
 tions than the specified hours, can, by displaying them outside, 
 
HIS REPUTATION AND SUCCESS. 13 
 
 regulate matters better, and prevent various annoyances, by 
 letting every one see his hours before ringing. 
 
 An excellent rule is to direct attention to both the beginning 
 and ending of your office hours, as : " Morning office hours begin 
 at 7 and end at 9; afternoon office hours begin," etc. Or: 
 " Office hours : morning, between 8 and 9 o'clock ; afternoon, 
 between 1 and 3 o'clock," etc. Many people think that as your 
 office hours are from 7 to 9, if they get there one minute before 
 9 o'clock they are in time ; whereas if they come at that time 
 they will be sure to keep you past your hour for going out. By 
 regulating your time thus, and constantly urging those you 
 attend to observe those hours strictly, you can accomplish 
 doubly as much with less hurry and more satisfaction to all. 
 Indeed, by persistently schooling patients to observe those hours, 
 and send for you, as far as possible, before your accustomed time 
 for starting on your regular rounds, you will do much to system- 
 atize your business, and to lessen the number of calls at odd and 
 inconvenient times, which do so much to increase the hardships 
 of the physician's life. For patients to come strolling into a busy 
 physician's office for advice at odd or unseasonable hours, or at 
 seasons allotted to privacy and rest, amounts almost to perse- 
 cution. So, also, does having to visit the same neighborhood 
 half a dozen times a day, in consequence of his patients not send- 
 ing for him before he commences his rounds. The time allotted 
 to office patients may be greatly curtailed by naming certain 
 times at which you can be found at your office ; for instance, 
 instead of having it " Morning, from 8 to 9 o'clock ; afternoon, 
 from 1 to 3 o'clock ; evening, from 6 to 8 o'clock," have the 
 sign read, " Office hours : morning, about 8 o'clock ; afternoon, 
 about 2 o'clock ; and evening, about 7 o'clock," which times are 
 easily remembered, and will cause all who come to get there 
 about those hours. 
 
 If you should ever get very busy, and be pressed for time, 
 your sign might still further emphasize it, after stating your 
 hours, by adding, " No office consultation at other hours." 
 
14 THE PHYSICIAN HIMSELF: 
 
 Have on a little sign over your slate something like this : 
 " In leaving a message for the Doctor, be careful to write the 
 name, street, and number." 
 
 You should keep a supply of cards with your name, resi- 
 dence, and office hours on them. An inch and three-fourths 
 by three inches make a good size. A physician is at perfect 
 liberty to state on his cards and signs that he speaks French, 
 Italian, Spanish, Bohemian, German, or any other foreign 
 language ; and such a statement should, if made, be in the 
 language of the people for whom it is intended. 
 
 It is also necessary to keep a supply of small and neat 
 blank bills, and to have envelopes and paper with your name 
 and address printed on them. Let your bills read, " For pro- 
 fessional services." Blank forms for use in giving certificates 
 to sick members of societies, etc., are also very useful. Printed 
 professional certificates look much better, seem more formal, and 
 give more satisfaction than written ones. 
 
 A speaking-tube from your outside office door to your bed- 
 room prevents exposure to raw night air at an open window, 
 and is of the greatest utility for night calls. 
 
 The telephone is also both a luxury and a necessity. Many 
 physicians who need a telephone are deterred from getting it by 
 the fear that it will cause them to be summoned to patients, 
 good and bad, at a distance too great for them to attend, or that 
 its convenience will cause annoying calls and messages to be 
 received at unseasonable hours. This belief is erroneous. The 
 telephone xeally does the opposite, and cuts off the long argu- 
 ments and attempts to overpersuade that we encounter in per- 
 sonal interviews. It is much easier to refuse a call, or to make 
 a plea, or give a direction, or order a remedy through the tele- 
 phone, than by an interview with a messenger. If you have a 
 telephone, put your telephone number on your cards, bills, 
 envelopes, paper, etc. 
 
 When you begin practice, get a pocket visiting-list, a cash 
 book and a ledger, and commence to keep regular accounts at 
 
HIS REPUTATION AND SUCCESS. 15 
 
 once ; this will teach you system, and in the course of time save 
 you hundreds of dollars. 
 
 One's visiting-list can be most conveniently carried in a wide 
 but shallow pocket on the left hip. 
 
 Record the full name, occupation, and residence of every 
 new patient you get ; 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 confused, and the consequent loss to 
 you will be very great. 
 
 Never neglect to make memoranda of office consultations, 
 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 suitable 
 place in your office, that you may refer patients to it whenever 
 occasion requires. It is also wise to have a small, neat sign, with 
 " Office Consultations from $1 to $10, cash," posted in some 
 semi-prominent place in your office. It will show your rule and 
 tell your charge ; it will also remind any who might forget to 
 pay of the fact, and will confront less honest people and put 
 them in a dilemma. You can, when necessary, point any one 
 to it and ask him for your fee ; it will also give you a chance to 
 let him know you keep no books for office patients. Such a 
 sign will save you many a misunderstanding and many a dollar. 
 Of course, you may omit its cash enforcement toward persons 
 with whom you have a regular account. 
 
 Having your charge from " $1 to $10," will enable you to 
 get an extra fee for cases of an extraordinary character, and still 
 allow you to charge minimum fees for ordinary cases. Such a 
 schedule will make those who get off by paying the lowest 
 fees feel gratified; it will also show everybody that you are 
 skillful enough to attend $10 cases. 
 
 Cultivate office practice assiduously ; for it is a fertile source 
 of reputation and of cash fees. Try to benefit and give satisfac- 
 tion to every patient that comes to consult you, that every one 
 
16 THE PHYSICIAN HIMSELF: 
 
 may go away with a clear idea of what is the matter with him, 
 and a belief that you will do your best to remedy it ; for each 
 will, while there, form some definite opinion in regard to you, 
 and will ever after give you either a good or a bad name. 
 
 Keep a small case of medicines for use at your office, repre- 
 senting the most frequently employed articles of the pharma- 
 copoeia, especially during the first years of practice ; handling 
 them will not only familiarize you with their appearance, odor, 
 miscibility, taste, and other characteristics, but also enable you 
 to get fees from patients who can appreciate advice and medicine 
 combined, but who cannot properly value advice alone. Besides, 
 by keeping cathartic pills, aromatic spirits of ammonia, lime- 
 water, morphia granules, etc., you can, by sending a suitable 
 remedy by a messenger, save yourself many a tramp at night, 
 during storms, on Sunday, great holidays, at odd hours, etc., 
 and yet give the patient both relief and satisfaction, till you 
 can go. 
 
 You have a perfect right to supply a patient with medicine, 
 if you choose. Very extensive use of this privilege, however, 
 tends to consume time that might be much better employed, and 
 to dwarf you in other ways, and does not pay. Besides, it would 
 engender the criticism and enmity of neighboring druggists. 
 Supply medicines to your patients only. 
 
 Be prompt and punctual in all your duties, so as to get 
 them out of the way of whatever may come after. When you 
 are summoned to cases of colic, convulsions, accident, etc., go, 
 if possible, immediately. Then, if you are too late, you will 
 have no cause for regret, and neither be chagrined nor respon- 
 sible. When you cannot go at once, without neglecting other 
 duties equally as urgent, it is much more satisfactory to your 
 patient if you send a remedy with instructions for use until you 
 can go, than to send a prescription ; for to send a prescription in 
 such cases seems rather more as if you do not care to attend, or 
 as if the patient was on your secondary list, and if the case does 
 not eventuate favorably you may be severely criticised. 
 
HIS REPUTATION AND SUCCESS. 17 
 
 When you reach a patient whose friends have, in the 
 excitement, sent for a number of physicians, with no special 
 choice among them, it is well to have them promptly send a mes- 
 senger or note to the others to cancel the call and save them 
 trouble, by informing them their services are no longer needed. 
 
 If, at your office and elsewhere, you make an honest and 
 proper use of instruments of precision — the stethoscope, oph- 
 thalmoscope, laryngoscope, the clinical thermometer, and micro- 
 scope, and those used in examining tumors, sputa, calculi, for 
 urinary disorders, etc. — they will not only assist you very 
 materially in diagnosis, but will also aid you greatly in curing 
 nervous and terrified people by heightening their confidence in 
 you and enlisting their co-operation. 
 
 Always carry in your pocket-case a good clinical ther- 
 mometer, a female catheter, a bistoury, a hypodermic syringe, a 
 pair of small forceps, a stick of lunar caustic, a penknife, etc., 
 for ready use. Keep a little raw cotton in the case with your 
 clinical thermometer, to protect it against breakage, and always 
 wash the instrument immediately after use. 
 
 Avoid svphilitic 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 supply of either, and keep it in your office for anointing 
 your fingers, instruments, etc. Wooden toothpicks and wooden 
 cigar-lighters are also very handy for making mops, applying 
 caustics, etc. Being inexpensive, they can be thrown away after 
 one service, instead of being kept for further use, as must be 
 done with expensive articles. 
 
 Knives, probes, needles, and other instruments can be 
 readily cleaned and disinfected, both before and after being used, 
 by thrusting them several times through a cake of wet soap. 
 
 Be careful never to immerse a finger that is even abraded, 
 in vaginal or other suspicious fluids ; if your preferable hand is 
 unsafe, use the other. 
 
18 THE PHYSICIAN HIMSELF: 
 
 You should have a special receptacle in your office for cast- 
 off dressings from cases of gonorrhoea, syphilis, septic ulcers, and 
 other filthy affections, which, when they accumulate, should be 
 burned. 
 
 A decent respect for the opinion of the world should lead 
 you to practice all that constitutes politeness in dress and de- 
 portment. Keep yourself neat and tidy, and avoid slovenliness 
 and everything approaching carelessness or neglect. You should 
 live comfortably for the sake of being comfortable, and rest as 
 much as possible on Sunday and at night ; and, if you would 
 avoid the risk of breaking down your physical health, as hun- 
 dreds of our profession do, consider it a cardinal duty to get 
 your meals and your sleep as regularly as possible. 
 
 Do not ignore the fashions of the day. A due regard to 
 the customs prevailing around you will show your good sense 
 and discretion. Even though the prevailing style of dress or 
 living borders on the absurd or extravagant, it may still be wise 
 to conform to it to a certain extent. Young says : — 
 
 "Though wrong the mode, comply ; more sense is shewn 
 In wearing others' follies than our own." 
 
 You never heard of a bank swindler, or a confidence-man, or a 
 gambler, or a counterfeiter, or a pseudo-gentleman 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 matter 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 external appearance and manners of gentlemen. 
 Now, if genteel dress and polished manners and good conversa- 
 tional powers can do so much for such fallen specimens of man- 
 kind, how much greater influence must they exert for those who 
 are truly gentlemen and members of an honorable profession. 
 
 Do not, however, be a leader in loud or frivolous fashions, 
 appearing as though your starchy foppishness and love of fine 
 clothes had overshadowed everything else; nor display glaring 
 
HIS REPUTATION AND SUCCESS. 19 
 
 neckties, flashy breastpins, loud, dangling watch-seal, brilliant 
 rings, fancy canes, or any other peculiarity in your dress or 
 actions that indicates overweening self-confidence, or a desire to 
 be a society man, a dandy, or a swell. Such high-fashion indi- 
 viduals may be admired, but they are not usually chosen by 
 worthy persons seeking a guardian for their health. 
 
 Even though you are ever so poor, let your garb show 
 genteel poverty, for a physician's dress, manners, and bearing 
 should all agree with his dignified calling. The neglect of neat- 
 ness of dress and the want of polite, refined manners might 
 cause you to be criticised and shunned. You will sometimes see 
 spruce little Dr. Tact, whose head is comparatively empty, suc- 
 ceed in getting extensive and lucrative practice, and paying 
 heavy bills for horseshoes, almost entirely by attention to the 
 outer trappings and affability of manner, while Dr. Talent, much 
 better qualified, will languish, and never learn the price of car- 
 riages and oats, by reason of defects in these apparently trivial 
 matters. Clean hands, well-shaved face, polished boots, neat 
 cuffs, gloves, fashionable clothing, cane, sun-umbrella, all relate 
 to personal hygiene, and indicate gentility and self-respect, and 
 naturally give their possessor a pleasurable consciousness of 
 being well dressed and presentable. 
 
 The majority of people will employ a tidy, well-dressed 
 physician of equal, or even inferior, talent more readily than a 
 shabbily dressed one; they will also accord to him more confi- 
 dence, and expect from and willingly pay to him larger bills. 
 
 Avoid extraneous pursuits and a multiplicity of callings. 
 Divorce medicine from all other avocations — from the drug 
 business, dealing in petroleum, or salt, or cattle, or horses; or to 
 be equally interested in the practice of medicine and in pushing 
 the jack-plane, or in following the plow ; from giving public 
 readings, from preaching, scribbling poetry on subjects not con- 
 nected with medicine, fiddling or singing at concerts ; or base- 
 ball playing, rowing matches, etc., because the public cannot 
 appreciate you or any one else in two dissimilar characters, or 
 
20 THE PHYSICIAN HIMSELF: 
 
 in two incompatible pursuits : half physician and half druggist, 
 or three-eighths physician and five-eighths politician, or one- 
 third physician and two-thirds sportsman, or other similar mix- 
 ture of incongruities, for it is in medicine as in religion — no one 
 can serve two masters. Of course, if you choose to change off 
 from medicine to any other calling it is legitimate to do so, but 
 be a whole one thing or another. 
 
 Although it may seem paradoxical, even reputation as a 
 surgeon (though surgery is but a branch of our art), or as a 
 specialist of any kind, militates decidedly against reputation in 
 other departments of medicine. The public in general believe 
 a surgeon, with his sharp saws and thirsty knives, is good only 
 for whipping off limbs or other cutting operations, and that a 
 specialist is good only for his specialty, a preacher for preach- 
 ing, etc. 
 
 Hesitate even to take such offices as vaccine physician, 
 coroner, city dispensary physician, sanitary inspector, etc., in a 
 section where you expect to practice in future, more especially if 
 you must have illiterate political demagogues or buffoons for 
 employers or companions. All such functions seem to dwarf 
 one's ultimate progress, and usually create a low-grade reputa- 
 tion that it is hard to outlive. To many people, all such offices 
 look somewhat like a confession of impecuniosity, or inferiority, 
 and create an impression that is not overcome for years. If you 
 have any merit at all, private practice industriously followed will 
 lead by better roads to greater success. 
 
 The last remark is, also, to a certain extent true of the 
 position of permanent physician or assistant physician to hos- 
 pitals, infirmaries, lunatic asylums, dispensaries, almshouses, 
 reformatory or penal institutions, or in the army, or on board 
 emigrant or naval vessels, where employment in a snug or easy 
 job, at a petty salary and the comforts of a home, for a few of 
 his most precious years, have caused many a physician fully 
 qualified for success as a practitioner to lose the best part of' his 
 life, and let slip opportunities that could never be recalled. 
 
HIS REPUTATION AND SUCCESS. 21 
 
 Remember that such positions can never be depended on longer 
 than those in power find it to their interest to change. 
 
 If you ever become a teacher of medicine in a college with 
 a choice of branch, instead of taking Physiology, Materia 
 Medica, Jurisprudence, Hygiene, or other non-personal subjects, 
 take care to aim for one that relates directly to the sick, and 
 that is likely to increase your skdl and advance your private 
 practice. > 
 
 Shun politics and electioneering tactics; for politics, even 
 when honorably pursued, are ruinous to a young physician's 
 prospects; later, when his medical reputation is already exten- 
 sive, they will militate against him, although they may not nec- 
 essarily ruin him. If the best of good politics injure thus, how 
 much worse is it to be drawn into the dirty pools of partisan 
 politics, at ward rallies and bar-room conferences, or into dema- 
 gogism, and wire-pulling, and slate-making, at primary meetings, 
 caucuses, conventions, etc., with "the b'hoys." No! no! thrice 
 no ! You can in the long run make ten friends and ten dollars 
 by being no man's man, and sticking to your profession, while 
 you are making one of either in the polluted and polluting 
 waters of party politics, and scrambling for office with those 
 who belong to the party chiefly to struggle for its loaves and 
 fishes ; besides escaping many anxious hours and bitter disap- 
 pointments. 
 
 Never join a church or a religious society for the purpose 
 of gaining popularity or church influence. You will surely find 
 that society, church, political, and other special groups of sec- 
 tarian patients, gained because they are affiliated with you in 
 party matters rather than through appreciation of your merits as 
 a physician, are neither very profitable nor very constant. If 
 you will banish everything that comes between you and your 
 legitimate work, and cultivate patients secured promiscuously 
 from all parties and from eve*ry direction, because they believe 
 that you as a physician possess solid merit; and have faith in 
 your brain and your heart, and in your hand; it will in the 
 
22 THE PHYSICIAN HIMSELF: 
 
 long run make you more friends, and better friends, and pay 
 you better than attending solely to any one political sect or 
 religious creed, or following any other outside issue. 
 
 A riding physician has several advantages over the one 
 who walks; he gets rest while riding from one patient to 
 another, and can spend the time in thinking ; can collect and 
 concentrate his mind more fully on his cases while riding than 
 if walking, and when he reaches his patient he is in proper 
 mental and physical condition to begin his duties, while the 
 walking physician arrives out of breath, excited, and in need of 
 rest. The former can prescribe and be gone while the latter is 
 waiting to regain his breath. Another convenience is, he can 
 salute acquaintances as his carriage meets them and ride on, 
 whereas Dr. Footpace is compelled to stop, parley, and lose 
 valuable time with convalescent patients, old friends, etc. 
 
 You should, therefore, get a respectable-looking horse and 
 carriage as soon as your finances and other circumstances will 
 at all justify. A team is not only a source of health and enjoy- 
 ment in the beginning of practice> but getting it indicates that 
 your practice is growing. Many persons consider success the 
 chief test of merit, and prefer a much-employed, riding physician 
 to the worn pedestrian. This is one of the reasons why any one 
 can ride into a full business much quicker than he can walk 
 into one. Besides, the inexperienced public, with nothing else 
 to judge by, infer that a physician who rides to his patients in a 
 carriage must have had extensive experience and a successful 
 practice, else he would not require and could not afford one. 
 
 If you unfortunately have a bony horse and a seedy- 
 looking or a pre-adamite kind of buggy, do not let them stand 
 in front of your office for hours at a time, as if to advertise your 
 poverty, lack of taste, or paucity of practice. 
 
 If you have two horses, it is better to drive singly, that one 
 may be resting while the other is working. Driven thus, two 
 good, well-kept horses can always carry you to as many patients 
 as you can attend. 
 
HIS REPUTATION AND SUCCESS. 23 
 
 If a pair is driven, they should be first-class. It is better 
 to use one genteel-looking horse to a handsome phaeton than a 
 shabby pair to a seedy-looking vehicle. 
 
 A modest monogram or initial letter is often put on the 
 bridle-blind's or carriage-panels. This is proper and ethical. 
 
 Either have a person with you to mind your carriage, or 
 tie your horse before entering your patient's house, that you 
 may not be wondering what it is doing, or running to the 
 window or out at the door at every noise, to see whether it has 
 started off with the carriage, as if it were more important than 
 the patient. 
 
 It is perfectly fair and proper to seek reputation by all 
 legitimate means, but avoid all intriguing and scheming to obtain 
 practice. Attempts to puff yourself, your cases, your opera- 
 tions, or your skill into celebrity by driving ostentatious double 
 teams, or having liveried drivers, odd-shaped or odd-colored 
 vehicles, close carriages, conspicuous running-gear, loud mono- 
 grams, flashy plumes, or oversized initials on harness or carriage- 
 panels, or blazed-faced, curious-looking horses or ponies; or by 
 driving very fast when not in a hurry, as though the devil were 
 in chase, book in hand, attempting to read it as the carriage 
 whirls and jolts along ; also, affecting odd-style or extra wide- 
 brim hats, long hair, and heavy canes, and showing everybody 
 affected kindness or meddlesome attention, etc., all generally fail 
 in their object, are looked upon by many as either an unethical 
 display of the humbug element, or the efforts of a small mind or 
 weak head to hide a lack of ordinary skill, or to get himself 
 talked of, and actually sometimes bring the one who affects them 
 into ridicule and disrespect. Do not thus belittle yourself, but 
 strictly avoid ostentation and every peculiarity of manner, dress, 
 office arrangement, etc., calculated to make you offensively con- 
 spicuous, and excite either ridicule or contempt. On the other 
 hand, however, if you are bashful, shame-faced, diffident, lacking 
 in aggressiveness, or deficient in tact, you will never prosper 
 until these disadvantages are overcome. 
 
24 ' THE PHYSICIAN HIMSELF: 
 
 In medicine, reputation that comes easily goes easily. 
 Accident or trick may bring one into notice, but they cannot 
 sustain him, and he is finally estimated at his true value. The 
 best reputation is that acquired by a display of talent and merit. 
 If one is tossed into reputation he does not merit, he will surely 
 sink again to his true level. Even if you get reputation 
 for distinguished abilities by superior talent, and desire to sus- 
 tain it, you must work hard, and from time to time present 
 additional ideas and give new proofs of your talents and intel- 
 lectual strength. 
 
 It is customary and proper to give simple notice of removals, 
 recovery from prolonged sickness, return from long journeys, 
 etc., in the newspapers, but it is not creditable to announce your 
 entrance into practice, or to advertise yourself generally in 
 newspapers, of to placard barber-shops, hotels, etc. Puffing 
 yourself, your cases, your apparatus, or your skill, or winking at 
 being puffed and applauded in the newspapers is quackish and 
 on a par with the speckled-horse plan. A proper pursuit of 
 medicine will imbue you with loftier sentiments and engender 
 nobler efforts to gain public attention, and will spur you to 
 build your fame on stronger foundations. 
 
 Cultivate a professional manner and spirit. Much of your 
 usefulness and comfort will depend on it. Do nothing to 
 gain popular favor that does not accord with both the letter 
 and 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 long hide the real motive, or to turn aside ridicule. 
 
 You will be more esteemed by patients who call at your 
 office for any purpose, if they find you engaged in your profes- 
 sional duties and studies, than if reading novels, making toy 
 steamboats, chasing butterflies, or. occupied' in other non-profes- 
 sional, or trivial pursuits ; even reading the newspapers, smok- 
 ing, etc., at times proper for study and business, have an ill 
 effect on public opinion. Public opinion is the creator, the 
 
HIS REPUTATION AND SUCCESS. 25 
 
 source of all reputation, whether good or bad, and should be 
 respected; for a good reputation is a large, a very large, yea, 
 the chief part of a physician's capital. 
 
 It is very natural to expect your near medical neighbors to 
 pay you a friendly visit after you locate, for the purpose of 
 establishing reciprocal and friendly relations, whether acquainted 
 or not; but if they fail to do so, it should not be construed as 
 discourtesy or ill-will, for it may be due to their position of doubt 
 concerning your being a regular, or they may deem it your duty 
 to make the first call, or may wish time to scrutinize your prin- 
 ciples, or your character, or your conduct, qualifications, temper, 
 etc. Besides, the best of men are sometimes very slow to make 
 friendly overtures. 
 
 Your first efforts in practice will bring you into contact and 
 contrast, perhaps also into collision, with the other practitioners 
 of your vicinity. 
 
 There is a very great difference between the case of an ad- 
 ditional physician starting in a community or a neighborhood, and 
 an additional person being added in almost any other business. 
 The demand for other things can be increased, but the demand 
 for physicians is limited, so that a new physician must create his 
 practice out of that taken from other physicians. Every family 
 the new candidate adds to his list must be diverted from that of a 
 rival, who may have attended it long enough to almost deem it 
 his private property, and of course the loser does not like this, for 
 there is a little human nature and love of monopoly still left in 
 a man, even though he has studied medicine. The older prac- 
 titioners are, therefore, naturally very apt to feel a tinge of 
 jealousy, and to be watchful of, if not captious toward, Dr. Last ; 
 and when they see him crowding himself in, interlocking and 
 overlapping, much as we see a new passenger do in an already 
 crowded street-car, they are apt to look upon him as an antago- 
 nist and opponent, and unpleasant animosities and feuds are apt 
 to arise. There is a proverbial rancor and bitterness of spirit 
 about medical antagonisms and medical hatreds, some of which 
 
26 THE PHYSICIAN HIMSELF: 
 
 terminate only with life ; avoid them as far as lies in your power, 
 and do what you can to reconcile the estranged and to calm 
 the angry. Nothing is more disagreeable than to have enmity 
 and a rupture of all intercourse with those we must often face. 
 Honest, conscientious, courteous rivalry between physicians is ad- 
 vantageous to the public, because it creates a spirit of emulation, 
 and compels each to try to be skillful and successful in practice. 
 If your opponents look after their own good, and do all they 
 can for themselves in a fair, equitable, well-directed manner, you 
 have no right to complain. 
 
 It is in fact almost natural for established physicians to re- 
 gret the advent of another medical aspirant; and some are sus- 
 picious, cold, and sensitive and hypercritical toward every new- 
 comer to a degree bordering on monomania, because the stranger, 
 in coming, must exert a perturbing effect on the professional 
 business of those already established. His coming makes more 
 workers, and, if he is skillful, actually makes less sickness, be- 
 cause the spur of rivalry, constant and sharp, stimulates each 
 person to try to get all curable cases well, not only surely, but 
 quickly. Sickness, both in amount and duration, is decreased, 
 because skilled laborers have increased. There is, of course, no 
 greater number of cracked skulls, mangled limbs, or medical 
 cases, or of diseases of any kind, than before Dr. Last 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 Dr. 
 Elder, Dr. Bigbiz, Dr. Nopolizer, and other old and prosperous 
 physicians dislike to see interlopers gain a foothold in their sec- 
 tion, and effect an entrance into their families. Competitive 
 practice does not necessitate jealousy or enmity; but self-preser- 
 
HIS REPUTATION AND SUCCESS. 27 
 
 vation is the first law of nature, and, when it is endangered, 
 every human bosom feels the same impulse. 
 
 Be not boastful or intrusive, but if you are conscious of 
 any superior aptitude or intellectual power, or are ahead of your 
 brethren in any essential quality, or talent or experience, let 
 mere matters of display remain secondary, while your solid 
 merit is made the more prominent. This is more durable, less 
 expensive, and more in harmony with the views of sensible 
 people. 
 
 Every one on the face of the globe studies his own inter- 
 ests, therefore do not hesitate to fully embrace every accidental 
 or natural advantage of birth or wealth, or the favoritism of 
 influential patrons or powerful friends in practice, if honest and 
 ethical. 
 
 You will find that intellect, genius, temperance, correct 
 personal habits, and other excellent qualities will all fail to make 
 you successful, unless you add ambition, self-reliance, and aggres- 
 siveness to them ; but in your efforts to advance you should take 
 care not to incur the reputation of being a sharper, or of being 
 tricky. If the balance were struck, it would probably be found 
 a great deal harder for a physician to worm and intrigue his 
 way through life, by ingratiating and mancenvering, than to 
 struggle along with honesty and industry. Determine, there- 
 fore, under God, that in your efforts you will act like a man, 
 from your diploma to your death-bed, that you will do nothing 
 that is criminal, nothing that will not stand the strongest sun- 
 light and the severest scrutiny; nothing for which you would 
 hesitate to sue for your fee ; and, if necessary, to stand up before 
 a judge and jury to get it; nothing that you cannot approve of 
 with your hand on your heart and your face turned upward. 
 
CHAPTER II. 
 
 '* Who does the best his circumstance allows, 
 Does well, acts nobly, angels could do no more." — Young. 
 
 There has been of late years a disproportionate annual 
 addition to our already overcrowded profession, and the number- 
 less doctor-making colleges of the United States, in their fatal 
 competition for numbers — with only an exceptional, and that a 
 very rudimentary preliminary examination into literary qualifica- 
 tions ; and with too great inducements to students : such as small 
 fees, short terms, condensed, nutshell lectures, with clinics and 
 quizzes sandwiched between ; stuffing the memory, and spasmodic 
 " loading up," or " cramming " at the heel of the session from 
 "compends," "epitomes," "vade mecums," pocket lexicons, and 
 other " multum in parvo " guide-books, followed at the eleventh 
 hour by evenings at grinding clubs,, and the brief two years' 
 course required for astonishing the professors in the green room, 
 by saying back their sayings with readiness and increased accu- 
 racy; and — obtaining a degree — are manufacturing annually 
 more than two thousand graduates, — and this does not include 
 the flocks who reach our shores from abroad, already dubbed 
 M.D., and prepared to enter at once upon practice. The 
 result is that, if it requires a population of at least 1800 to sup- 
 port each physician, and if every physician must have a paying 
 clientage of 1000 or 1200 persons to enable him to live and 
 thrive, there is now in every American community more than 
 twice as many physicians as there is room for. 
 
 Every hamlet, every village, every cross-roads, every nook 
 and every corner everywhere, can now boast a physician or two. 
 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, Italy one for 
 
 (29) 
 
30 THE PHYSICIAN' HIMSELF: 
 
 every 3500; while we of the United States, blessed in phy- 
 sicians as in everything else, have, counting both regulars and 
 irregulars, one for every 600, and druggists in proportion. 
 If there were only a few more than needed to fill vacancies 
 caused by death and increase of population, it might be whole- 
 some, and would allow the public a choice, but with such an 
 overproduction as this many worthy aspirants must necessarily 
 languish, and those who flourish must do so by great skill, great 
 tact, or great industry. Another result of issuing diplomas 
 so freely is that diplomas are now away down in public estima- 
 tion, and are not received as evidence of their owners' com- 
 petency either by army or naval examining boards, or even by 
 State licensing boards. 
 
 The door to the iEsculapian temple — and the window, too 
 — is open, wide open, to every variety of individual, and all 
 kinds are rushing in; and you will be unusually lucky if you 
 encounter none who are maliciously antagonistic. You will not 
 only meet Dr. Merry man, Dr. Fair, Dr. Ettykett, and Dr. Warm- 
 grasp, but Dr. Growler, Dr. Oblique, Dr. Sneerer, Dr. Crusty, 
 Dr. Squeely, Dr. Triflewell, Dr. Boodlebee, Dr. Showoff, Dr. 
 Broiler, Dr. Frigid, Dr. Gall, and Dr. Spitfire are also about and 
 may be encountered in unfriendly collision. Be affable and frank, 
 and let your conduct be fair and square to everybody on all occa- 
 sions ; and strive, in your daily life, to build a reputation for 
 uprightness that will excite the respect of all, whether friend or 
 foe, and convince them that you are incapable of any dishonor- 
 able act. 
 
 Avoid all quarrels, bickerings, and disputes with your medi- 
 cal brethren, and if ever a question arises between you and a 
 brother-physician that you cannot settle yourselves submit it to 
 the decision of mutual friends. Never begin making reprisals 
 and avoid all innuendoes and sarcastic remarks to the laity about 
 rivals or opponents who have offended you, and exhibit a total 
 absence of professional tricks, but resolve that you will remain a 
 gentleman, even under provocation, whether others do or not. 
 
HIS REPUTATION AND SUCCESS. 31 
 
 Observe the golden rule with dignity, " Do unto others as you 
 would have them do unto you," and trust the balance to time. 
 Medicine is an honorable calling ; resolve that it shall be no 
 less so by your embracing it. Remember that honor and duty 
 require you to do right, not for policy's sake, but because it is 
 right. Do not, however, be so boyish as to expect exact justice 
 from rivals and enemies in return, for were you as chaste as ice, 
 as pure as the snow that falls from heaven, you could not escape 
 misrepresentation by evil eyes and lying tongues. 
 
 Although you cannot stop people's tongues nor their evil 
 talk about you, yet you must see that nothing is allowed to blast 
 your reputation for honorable conduct. Charges against your 
 skill, unless very gross and damaging, had better be overlooked 
 or passed over with indifference. Even though it reaches your 
 ears that some Witling has said he has a total lack of faith in 
 you, and would not call you to attend a sick kitten, etc., etc., 
 such sarcasm need not disturb your equanimity ; remember that 
 such remarks are not personal, but simply expressions of lack 
 of faith in you professionally. These things are said about every 
 physician in the world, and although they grate harshly when 
 they reach the ear of the one they concern they are quite differ- 
 ent from personal libels, or those that bring your morals or integ- 
 rity into question, such as charges of being a swindler or a 
 drunkard, or an adulterer, or a seducer, or a murderer, or an 
 abortionist. 
 
 Be circumspect in boasting of the number of cases you 
 have, of your remedies, operations, and wonderful cures, or of 
 the surprisingly large amount of your collections. All such 
 things are apt to create envy, disbelief, criticism (Dr. Hornblower 
 or Dr. Puffer), and other hurtful results. Also avoid telling from 
 house to house how terribly busy you are, and of your numerous 
 bad cases, as if due to self-inflation or an attempt to swell your 
 own importance. Indeed, it is better to be silent in regard to 
 your own merits, either to exaggerate or to diminish, and to 
 relate nothing at all to laymen about any case but the one before 
 
32 THE PHYSICIAN HIMSELF: 
 
 you ; bragging will not enhance you any, and if you really have 
 extra cases and extra skill, or are a great anatomist or eminent 
 surgeon, people will be sure to find it out in other ways. Also 
 keep your business affairs and your money matters to yourself, 
 and avoid the habit of talking to people about your collections, 
 bills, etc., unless it is to a person about his own bill, or you will 
 soon get the reputation of thinking and talking more about 
 money matters than anything else. 
 
 As a physician, you will require a good address and a 
 variety of talents, for you must come in contact with all kinds 
 of people. Readiness in adapting yourself to all classes suffici- 
 ently for the requirements of your profession is a very useful 
 quality, and one in which most physicians are very deficient. 
 
 In addition to medical learning, you should strive to possess 
 an acquaintance with general scientific subjects which exercise 
 the reason rather than the memory, and also look into general 
 and polite literature, that you may acquire improved power of 
 expressing yourself and be on a conversational level with the 
 best you meet. Among educated, intelligent, and intellectual 
 people, good conversational powers and broad culture frequently 
 produce a greater impression of a physician's professional ability 
 than is really possessed. Besides, there is a perpetual delight in 
 the possession of knowledge, therefore keep your dictionaries and 
 encyclopaedias at your elbow, and patronize them freely ; they 
 are very convenient and very useful for reference, and in looking 
 up facts and opinions when ,you have but a few moments to 
 devote to an inquiry ; or when your reading or musing raises 
 your curiosity on any subject you can turn to them and be 
 informed. 
 
 One who can neither conjugate amo nor decline penna 
 may, of course, reduce a dislocation, adjust a fracture, tie an 
 artery, or prescribe a drug as skillfully as the Latinist who 
 can, yet a good (classical) education and the mental discipline 
 that follows, although not indispensably necessary to the acquire- 
 ment of skill, experience, and success as a physician, is a power- 
 
HIS DEPUTATION AND SUCCESS. 33 
 
 ful element in the professional straggle. Therefore, if you 
 have begun late in life and are defective in this respect, you 
 should not be cast down ; but to rid yourself of the charge of 
 illiteracy, make up the deficiency by earnest self-education as 
 fully as possible ; otherwise it will either keep you hid among 
 the nonentities of the profession, or debar you from ever obtaining 
 more than a limited elevation in it. 
 
 Without proper education and other qualifications you can 
 no more reach true eminence than a pigeon can fly upward with 
 but one wing. The true secret of success is to be qualified for 
 advancement ; besides, without a fair education you will be con- 
 tinually exposed to ridicule for your ignorance of orthography 
 and grammatical construction, or the use of ungrammatical or 
 vulgar expressions and mispronunciations, by persons who are, 
 perhaps, very much your inferiors in those peculiar gifts of 
 heaven — genius and common sense. But I strongly doubt the 
 wisdom of frittering away, after practice is begun, a dispropor- 
 tionate amount of precious time on light literature, educational 
 frivolities, and school-boy subjects, or giving them at all more time 
 than recreative attention allows. Nor is it wise to give special 
 attention to higher mathematics, the fine arts, the great classics, 
 zoology, comparative anatomy, agriculture, mineralogy, botany, 
 geology, conchology, mythology, or other collateral studies, while 
 yet imperfect in the practical branches and essential principles 
 of medicine proper; because simultaneous attention to multi- 
 farious subjects would prevent concentration of thoughts, and 
 naturally divide and distract your mind, and prevent you from 
 pursuing the strictly needful studies with your full strength. 
 Do not attempt to grasp more than you can hold, but whatever 
 studies you do undertake should be pressed with manly deter- 
 mination and methodic effort until accomplished. 
 
 The plan of forcing themselves to tenaciously pursue cer- 
 tain aims of a practical character constitutes the peculiarity of 
 most practitioners who succeed in an eminent degree. This is 
 not only true in medicine, but in any calling. I once knew a 
 
34 ' THE PHYSICIAN HIMSELF: 
 
 person who by accident lost his leg at the middle of the thigh ; 
 previous to this he was but an ordinary swimmer, but afterward 
 the fact of his having only one leg attracted 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. 
 
 A knowledge of Latin to even a limited extent is of ines- 
 timable value. If you are not a scholar and have not had the 
 advantages of embracing it in your early education, you should 
 not fail to employ some Latin scholar to teach you at least as 
 much as you need in your practice ; you can get one at a nom- 
 inal cost by advertising anonymously in any daily paper. He 
 can, with the aid of a Latin grammar and a dictionary, teach 
 you in a short time sufficient of the outlines of the Latin lan- 
 guage to enable you to master the etymology and pronunciation 
 of technical terms, to write prescriptions, etc., correctly, and 
 thereby lift you above a feeling of utter deficiency in this obviously 
 important particular, which will be a perpetual satisfaction. No 
 difference where you get your Latin, so you get it somewhere. 
 Ability to write your prescriptions in correct Latin, also, natu- 
 rally assists in creating respect, or, rather, in preventing un- 
 friendly criticism and disrespect for you and your (canine) 
 •Latin in the minds of your fellow-physicians, the druggists, and 
 others. Besides, every layman supposes every physician under- 
 stands some Latin, and if they find him ignorant of this they 
 naturally think him equally ignorant of everything else. 
 
 Many people actually believe we write prescriptions in, 
 Latin to conceal the common name of the ingredients. The true 
 intent is, of course, to give every article (and every quantity) 
 a concise and specific title, and point it out in such a manner 
 that when we call for it in a prescription we may get it, and 
 nothing else, thus making mistakes of meaning between the 
 prescriber and the compounder impossible; besides, the Latin 
 names of drugs are the same in America, Europe, and else- 
 
HIS REPUTATION AND SUCCESS. 35 
 
 where, and can be read by the scholars of every nation, while 
 the common name, salts of lemon, laudanum, black wash, etc., 
 is liable to differ with each nation and locality. Thus, aqua is 
 water in Baltimore, and is the same in Paris, in Calcutta, and 
 in St. Petersburg. Latin is a dead language, belonging to no 
 modern nation, and therefore fixed, and not subject to muta- 
 tions. It is also perfectly accurate, and has become highly 
 respectable by long usage. 
 
 A rudimentary knowledge of Greek is also very useful, as 
 from it have been formed three-fourths of the compound terms 
 employed in the medical and other sciences. Indeed, Latin 
 and Greek have furnished the materials for building up the 
 language of the various sciences for more than two thousand 
 years. The meaning of the terms semi-lunar and dys-uria are as 
 plain and descriptive to all who understand Latin and Greek as 
 the words milk-pail and steam-boat are to those who understand 
 English. 
 
 In using the Latin names of medicines, diseases, muscles, 
 etc., be consistent. Adopt either the broad English or the 
 (Roman) Continental pronunciation, but, whichever you adopt, 
 be careful to use it invariably and correctly. You may acquire 
 a correct pronunciation of the various medical terms by fre- 
 quently consulting a dictionary, of which there is none better 
 than Dunglison's latest edition. 
 
 An acquaintance with the German language is not only 
 pleasurable and a means of intellectual improvement that costs 
 but little money, but it will assist you greatly with the industri- 
 ous, faithful, and thrifty Germans, among whom you will find 
 many of your most honest and grateful patients. Determine to 
 get at least a smattering of it early in your career. If you 
 speak it, mention the fact on your cards. 
 
 Remember, that no one can learn to speak this or any 
 other language unless conversation enter largely into his teach- 
 ing ; he must learn it through his ears, as well as through his 
 eyes. 
 
36 THE PHYSICIAN HIMSELF: 
 
 You will find that many foreigners prefer an American 
 physician who can speak their language to one who has come 
 here from their own country, and have more confidence in him, 
 because, being a native, they know he has spent his whole life- 
 time here, and they reason that he is naturally more familiar 
 with the diseases that exist in our climate and with the modify- 
 ing influences of our seasons, diet and modes of living ; the 
 peculiarities of the vicinity, etc. 
 
 A German, Frenchman, Spaniard, Italian, or Bohemian 
 will often be delighted to find a physician with whom he can 
 converse in his own tongue. Foreigners often pay much more 
 liberally than natives, and usually treat their physicians with 
 much greater respect. 
 
 Accustom yourself to use current and correct orthography; 
 and to write, not with a scrawling hand, in the true zigzag or 
 worm-fence style, but in a good, neat, distinct, and legible hand. 
 "Write every prescription as though critics were to judge you 
 and your penmanship by it ; each ingredient on a separate line, 
 the principal article, or the strongest drug on the first, adjunct 
 on the next, and vehicle on the 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. 
 
 Conform your prescriptions to the changes that are from 
 time to time made in the names of the officinal articles of the 
 pharmacopoeia by authorized bodies and nomenclators, that you 
 may keep step with the changed vocabulary. 
 
 Strictly avoid incompatibles, both chemical and physio- 
 logical, such as the combination of chlorate of potassium with 
 tannic acid or with sulphur; nitrate of silver with creasote, etc., 
 which are explosives, and may blow up either the dispenser or 
 the patient. Charcoal is a simple thing, sulphur is another 
 simple thing, and saltpetre is still another, but put them together 
 and you have gunpoW"der, which is not simple, and, unless that 
 potent agent is intended, look out. Remember, however, that 
 
HIS REPUTATION AND SUCCESS. 37 
 
 some medicines, though physiologically incompatible, are not 
 therapeutically so, as under certain circumstances you may com- 
 bine them so that they may modify each other, as morphia and 
 belladonna, acetate of lead and sulphate of zinc, etc. 
 
 Instead of writing prescriptions three inches in length, it is 
 better to use a single remedy, or, if two are indicated, to alter- 
 nate them, unless you know they are compatible. The list of 
 incompatibles is a long one, but you should learn it by heart, 
 rather than take any risk. 
 
 Your prescription is the expression of you"r opinion and of 
 your skill in a case ; therefore, try to make every one you Avrite 
 show on its face that you have prescribed with a definite pur- 
 pose, to meet some clear indication. 
 
 Be careful that abbreviations of names, manner of writing 
 quantities, etc., leave no room for mistake. A good rule is, to 
 read carefully every prescription after you finish writing it. 
 
 You, of course, need not be told that while the names of 
 the various ingredients in a prescription should be written in 
 Latin, the directions, i.e., all that follows the S. (Signa), should be 
 in English, as they are intended for the guidance of the patient. 
 
 Remember that the cloven foot ~R/,, that is placed at the 
 head of every prescription (Prse, beforehand; scriba, to write), 
 although originally the astrological sign for Jupiter (%), and for- 
 ages placed by the ancients at the head of prescriptions, to invoke 
 the aid of the great God of Thunder, is now everywhere used 
 merely as a symbol to represent the Latin word Recipe (take 
 thou). 
 
 While it is proper, strictly speaking, to commence every 
 word, after the first, in the names of the articles in your pre- 
 scription with a small letter, i.e., Liquor potassii arsenitis, yet 
 many physicians purposely begin each with a capital, chiefly 
 because it looks better, and also renders the word less mistakable. 
 
 Sign either your initials or full name to every prescription 
 you write. 
 
 To such as are likely to be compounded by pharmacists 
 
38 THE PHYSICIAN HIMSELF: 
 
 who know you well, the initials Avill be sufficient ; but to all that 
 are likely to be put up by those who know you not, put 
 your full name. 
 
 It is a bad habit to adopt a routine in prescribing and 
 slavishly to follow your own, or anybody else's, stereotyped for- 
 mulae for certain diseases. Suit your remedies to the case, 
 instead of picking out a ready-made, set formula or specific from 
 your collection, for the patient, as you would a hat in a hat 
 store. One formula for all diarrhoeas, for, instance, is about as 
 apt to suit every case of loose bowels, as one coat is to fit every 
 man in a regiment. 
 
 Remember that medicine is a mass of facts, and that he 
 who best interprets these facts is the best physician, and that 
 skill in practice consists not only in diagnosis, prognosis, and 
 prescribing medicine, and in distinguishing what one can and 
 what he cannot do ; but is the combined result of all the powers 
 that the physician legitimately brings into the management of 
 cases. In other words, the skillful use of medicine is but one 
 of many elements that make the unit of medical skill. You 
 must study mankind as well as medicine, and remember when 
 working on diseased bodies that they are inhabited by minds 
 that have variable emotions, 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 conduct your efforts in 
 harmony with its conditions. Let hope, expectation, faith, con- 
 tentment, fear, resolution, will, and other psychological aids be 
 your constant levers, for they may each at times exercise legiti- 
 mate power, and impart the greatest amount of good to the sick. 
 It is not length of time in practice, but study and reflection, that 
 teach one to measure the heart's deep passions and emotions, and 
 if you are not a keen observer of men and things, if you cannot 
 read the book of human nature correctly, and unite knowledge 
 of physic with an understanding of the thoughts, feelings, and 
 desires of mankind, with the knowledge of the effects of love, 
 
HIS REPUTATION AND SUCCESS. 39 
 
 fear, grief, anger, malice, envy, lust, and other strong but hidden 
 passions that govern our race, you will be sadly deficient, even 
 after twenty years' experience. 
 
 Your professional fame is your chief capital ; ambition to 
 increase it by all legitimate means is not only fair, but com- 
 mendable. After you attain this, you will not be apt to lose 
 either it or the practice it insures, so long as you are sober, 
 decent, and discreet in conduct, and have the physical health to 
 endure your labors. 
 
 There are two kinds of reputation a physician may acquire 
 — a popular one with the people and a purely professional one 
 with his brethren. These are often based on entirely different 
 grounds, and are usually no measure of each other ; many phy- 
 sicians strive for the former, chiefly because, being altogether 
 practical, it requires less skill, talent and study to acquire it, and 
 because it is more profitable. Many such have little or no public 
 life, but, avoiding scientific labors and controversies, remain 
 shut up within themselves, and move about quietly and almost 
 unobserved except by those they attend, and a knowledge of their 
 habits and doings is confined' to the domestic bedside and narrow 
 circle of their private practice, and the degree of their skill and 
 experience always remains somewhat unknown and mysterious. 
 
 Without one or the other variety of reputation no physician 
 can reap the honors or rewards which are the objects of his 
 ambition, whether that be the acquisition of money, the desire 
 of usefulness, or the love of fame. Try to possess both. 
 
 One fact that you will notice is that the public naturally 
 prefer a full-of-health, ever-ready physician, to a delicate or 
 sickly one, and ailing physicians often conceal the fact that they 
 are sickly or that their health is failing, as much and as long as 
 possible, well knowing that if reports of their ailments become 
 current talk the public will believe that solicitude for their own 
 condition will absorb it from their patients, and they will be 
 abandoned as unfit to practice, and their business will be 
 thereby injured or ruined. 
 
40 THE PHYSICIAN HIMSELF: 
 
 After you have practiced awhile and discovered what your 
 chief deficiencies are, and determine what course you will pursue, 
 if you will spend a few months in earnest study in some of the 
 great American or European hospitals, and then return and 
 settle down, it will be of great benefit to you in more ways 
 than one. 
 
 A pure, virtuous mind is a great gift and a great aid to 
 success. When elopements, seductions, confinements, or abor- 
 tions, or the scandal about Dr. so-and-so, or Rev. , or Miss 
 
 , or the ignobleness of the pedigree of this one, or the 
 
 secret history of that one, or the wrecked and wretched great- 
 ness of the other one, or the intrigues of Mrs. C, or the evil re- 
 ports about this virgin, that wife, or the other widow are being 
 talked of, perhaps in terms that decency would require to be 
 printed only with initial and terminal letters, with a dash be- 
 tween, you should have a silent, or at least a prudent, tongue ; 
 all you say on such subjects will surely be magnified and re- 
 tailed from mouth to mouth, and its result will be a permanent- 
 injury to you. The position of the gossiping physician has 
 ever been a very bad one, and he is not unfrequently called to 
 unpleasant account. 
 
 Remember, while in contact with tale-bearers and scandal- 
 mongers, to take care, and, if possible, keep the conversation on 
 general or abstract and legitimate subjects, instead of descanting 
 upon individuals and private affairs, or what somebody, or a 
 coterie or clique of somebodies, has said. 
 
 Notice the never-failing advantage that refined people with 
 pure thoughts and delicate language have in every station of 
 life over the coarse and the vulgar, and in view thereof let vour 
 manner, conversation, jokes, etc., be always chaste and pure. 
 Never forget yourself in this particular, for nothing is so hurtful 
 to a physician as the exhibition of an impure mind. School 
 yourself to avoid every impropriety of manner, and never allow 
 yourself to become insensible to the demands of modesty and 
 virtues. Chasten every thought, purify every word, and measure 
 
HIS REPUTATION AND SUCCESS. 41 
 
 every phase of your deportment, especially that which concerns 
 the fair fame of woman, and let your treatment of females be 
 refined and delicate, if you would succeed fully, especially if 
 gynaecology and obstetrics are part of your ambition. A lewd- 
 minded physician who indulges in dirty, coarse ambiguities, 
 vulgar jokes, and indelicate anecdotes about the sexes with 
 other men or with coarse women, even though he is disguised 
 as a gentleman, is sure to be shunned, and the reason therefor 
 is certain to be made the subject of gossip, and passed from one 
 to another in social whispers till it reaches the purest and best 
 of the community. Critical eyes of both sexes everywhere re- 
 gard such libertines (and rightfully so) as being far more amena- 
 ble to criticism and far more dangerous to invite into the 
 bosoms of their families than rough-mannered, loud-voiced per- 
 sons who cheat, or swear, or get drunk. 
 
 " For modest words we need no defense, 
 The want of decency shows the want of sense." 
 
 Study the art of questioning, and when duty requires you 
 to interrogate patients, or to ask questions on delicate topics, or to 
 broach very private subjects, do so with a manner of gravity and 
 simplicity, not too direct on the one hand, nor with too much 
 circumlocution on the other. 
 
 Your personality and deportment in the presence of patients, 
 will have much to do with your success. A cold or cheerless 
 manner toward people; an austere, studied, or sanctimonious 
 isolation of one's self from them socially ; and failure to recog- 
 nize would-be friends on the streets and elsewhere, as if from a 
 proud independence, or as if they were inferior mortals and be- 
 neath you, often gives unmeant offense, destroys all warmth 
 toward a physician, and usually causes their possessor to fail 
 to inspire either friendly likings or faith; and a physician who 
 cannot in some way make friends or awaken faith in himself 
 cannot fail to fail. The reputation of being a "very nice man" 
 makes friends of everybody, and is even more potent with many 
 than skill. To be affable in manner and skillful and prompt in 
 
42 THE PHYSICIAN HIMSELF: 
 
 action makes a very strong combination — one that is apt to waft 
 its possessor up to the top wave of popularity ; indeed, if one 
 is especially polished and elegant in manner, and moderately 
 well versed in medicine, his politeness will do him a great deal 
 more good with many than the most profound acquaintance with 
 histology, microscopic pathology and other scientific acquire- 
 ments. 
 
 If your manners and movements are of the gentle, tender, 
 and persuasive kind that win and conciliate rather than repel 
 children it will be fortunate, and will put many a dollar into your 
 pocket that might have gone to some irregular. The habit of 
 fondling and kissing people's children, however, is liable to be 
 misconstrued into an effort to secure the good will of the parents 
 for selfish motives, and should be avoided. 
 
 Cultivate a cheerful temperment; gentle cheerfulness is a 
 never-failing source of influence. It is a nerve tonic and stimu- 
 lant; it cheers the timorous, encourages the despondent, and 
 comforts the despairing. Medicine, contrary to the general 
 belief, is not a melancholy, sombre, mournful profession, but a 
 bright, cheerful, vivifying one. The grateful faces you Avill see 
 and the " Thanks to God ! " you will hear while completely curing 
 some poor wretches and relieving others of pain and ailments, 
 and dispelling fear and administering comfort to the minds of 
 multitudes of others, will convince you of your usefulness, and 
 the great good your profession enables you to do, and will 
 make you feel happy and satisfied with yourself and take 
 pleasure in your life's work, keep you on the bright side of 
 life, and make your cheerfulness apparent. 
 
 The physician's visit is the chief event of a sick person's 
 day, and is eagerly watched for. Study to acquire an agree- 
 able, courteous, gentlemanly, and professional manner of 
 approaching the sick and taking leave of them. There is an art, 
 a perfection, in your entering the patient's room with a collected, 
 well-poised, earnest, elevated manner that shows interest and an 
 anxiety to learn his condition — asking necessary questions, 
 
HIS REPUTATION AND SUCCESS. 43 
 
 making the requisite examination, ordering the proper remedies, 
 and then departing with a cheerful, self-satisfied demeanor that 
 puts the patient at his ease and inspires confidence on the part 
 of himself and his friends, and a belief that you can and will 
 do for him all that the science of medicine teaches any one to 
 do. The appearance, the polite bow, the walk, the movements, 
 the well-modulated voice, the language, the gestures and mode 
 of intercourse of some physicians are as warming and cheering 
 as a May day; of others, as rude, harsh, and repulsive as a 
 March wind, to the sensitive nerves of the sick. 
 
 Familiarity with the many little details of the sick-room — 
 including the art of applying bandages, making beef-teas, gruels, 
 mustard plasters, poultices, etc., and with dressing wounds, pass- 
 ing catheters, preparing the obstetric bed, and doing various 
 minor surgical operations you are there incidentally called on to 
 perform or direct — often do more to create a favorable impression 
 than your pills and powders. Indeed, it is to a very great extent 
 by these that watchful nurses and other habitues of the sick- 
 room judge you. 
 
 A physician should be a hopeful person, and shoidd not 
 even abandon cases usually considered hopeless. Hope creates 
 ideas, generates new views, brings up useful reflection, and 
 leads to fresh endeavors. Indeed, it has been said that "the 
 only way to get well after a physician gives you up is to give 
 him up." 
 
 The art of keeping hope and confidence alive in the bosom 
 of the patient and of his friends is a great one, and the look 
 with which you meet them has much to do with this ; a bright, 
 fresh, thoughtful, countenance, and an easy, cheerful, soothing 
 manner is a power that will nearly always infuse tranquility and 
 repose into your patient's mind and carry him with you toward 
 recovery. A cheering word sometimes rekindles the . lamp of 
 hope, and does the timorous and despondent as much good as a 
 prescription, and it is your duty to gain and retain the confidence 
 of your patient and his friends by all honorable means — to be 
 
44 THE PHYSICIAN" HIMSELF: 
 
 gay, pleasant, amusing, serious, or sympathizing as occasion 
 requires. 
 
 It is very pleasing to the sick to be allowed to tell in their 
 own way whatever they deem important for you to know. Allow 
 every one a fair hearing, and, even though their long statements 
 are tedious, do not abruptly cut them short, but endure them 
 and listen with respectful attention. A patient may deem a 
 symptom very important that you know to be otherwise, yet he 
 will not be satisfied with your views unless you show sufficient 
 interest in all the symptoms to at least hear them described. 
 Where, for want of time to listen further, or where the recital 
 becomes too irrelevant, check him, not by a rude order to 
 "stop," but by suddenly asking him some question about his 
 sickness, feeling his pulse, or asking him to show his tongue, as 
 if completing your examination. This has often served my 
 purpose with hypochondriacal old men, whimsical or garrulous 
 women and others. 
 
 To be quick to see and understand your duty, and equally 
 prompt and self-reliant in doing it, as if possessed of a gift or 
 genius for medicine and of corresponding skill, is one of the 
 strongest points you can possess, and gives easy advantage over 
 Dr. Dullard, who is as painfully slow, undetermined, and cautious, 
 as if every pebble were a rock and every molehill a mountain. 
 People invariably applaud boldness ; indeed, a bold, prompt act, 
 that strikes the right nail on the head, done with unwavering 
 steadiness of mind and nerve, if successful, often leads almost to 
 idolatry. 
 
 If you know a patient's ailments so well as to sit down and 
 tell him and his friends exactly how he feels better than he can 
 tell you, he will be apt to believe all you afterward say and do. 
 
 The study of character is part of our duty. To be many- 
 sided; to possess flexibility of manner, self-command, quick dis- 
 cernment, address, ready knowledge of human nature, and the 
 happy genius of accommodating ourselves to varying circum- 
 stances and to all people, at the couch of splendor and the 
 
HIS REPUTATION" AND SUCCESS. 45 
 
 squalid cot, are great necessities in our chequered profession. 
 We meet patients of various and even of directly opposite 
 temperaments and qualities; the refined lady and the hod- 
 carrier, the beer-seller and the clergyman, the aged and the 
 young, the hopeful and the despondent, the gay and the sorrow- 
 ful, the diffident and the bold, the deep aud the superficial. Let 
 every one find in you his ideal. Seek to penetrate the character 
 of each and to become perfect in the power of adjusting your 
 manner and language to all circumstances, and to all people. 
 
 If you have the self-command to control your emotions, 
 temper, and passions, and to maintain a cool, philosophic equi- 
 poise under the thousand irritative provocations given to you by 
 foolish patients and their friends, who rile at your coming too 
 early or too late, too often or not often enough, or accuse you 
 of giving the wrong medicine or in the wrong doses, it will give 
 you great advantage over nervous and excitable physicians who 
 cannot, and will generally redound greatly to your credit. 
 
 A brusque, tornado-like manner, or eccentric rudeness is 
 fatal to a physician's success unless sustained by unquestionable 
 skill or reputation. A simple, humane, gentle, and dignified 
 manner and low tone of voice are suitable to the largest part of 
 the community. Remember that a rough, unfeeling, abrupt, in- 
 delicate, or arbitrary manner, as if the heart were a butcher's or 
 made of marble, is quite different from the serene composure ac- 
 quired by constant attendance upon the sick and suffering. The 
 former is brutal and unprofessional; the latter is essential to 
 enable you to weigh correctly and manage diseases skillfully. 
 
 If you have any slight but pleasant peculiarity of character 
 or singularity of manner it will be noticed, and, if not disagree- 
 able, will do you no harm ; but never assume one, as the coun- 
 terfeit is easily detected by all sensible men and women. Be not 
 only a gentleman, but also a gentle man, and act out your own 
 plain, natural character everywhere and at all times, among the 
 rich and the poor (no man has two natural manners). Besides 
 being ridiculous, a physician who assumes a fictitious, mysterious, 
 
46 THE PHYSICIAN HIMSELF: 
 
 or rude mannei'is afflicted with unsoundness of either head or 
 heart. 
 
 If you have the gift of fluency in conversation, or sweet- 
 ness of manner, or great native courtesy, or a never-failing stock 
 of politeness, facility of expression, or a knack for illustrating 
 your points by apt comparisons, or a bold way of unraveling the 
 various puzzles ; or of cutting the many Gordian knots so often 
 encountered, it will help you decidedly. If, on the contrary, 
 there is any necessary aid that you lack, study and practice con- 
 stantly to acquire it. 
 
 Never leave a bedside before qualifying yourself to com- 
 municate your ideas and opinion of a case to the inquiring 
 friends of the patient clearly and in good language, in case they 
 should ask for your opinion. 
 
 Never utter a diagnosis or a prognosis in a hurry. Give 
 your opinion only after sufficient thought, and, if possible, do 
 not afterward change it. Also avoid making varying statements 
 to different inquirers from time to time, but, as nearly as possible, 
 use the same words and the same terms to every one. 
 
 Act toward timid children and nervous patients so as to 
 remove all dread of your visits. Avoid a set, sad countenance, 
 solemn and formal or funereal solemnity of visage and manner, as 
 it would give rise to thoughts of crape, hearse, undertaker, and 
 grave, and to dread of you, especially if you accompany it with 
 a corresponding mode of dress. If you have a lengthened visage, 
 or your air and movements are naturally awkward, sombre, 
 or singular, offset them 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 the welfare 
 of patients, as if you were present in mind as well as in body, 
 is another very strong, faith-inspiring quality. To assure a suf- 
 ferer, in sincerity and kindness, that you will take the same care 
 
HIS REPUTATION AND SUCCESS. 47 
 
 of him as though he were your " own brother," or, in case it be 
 a female, as if she were your " own sister," or will attend a child 
 as if it were " one of your own family," or to assure a woman 
 in labor that you, will be as gentle in making the necessary 
 examinations as if she were an infant, and similar truthfully 
 meant expressions of sincere sympathy and interest, inspire 
 wonderful confidence, and are often quoted long after the phy- 
 sician has used them. 
 
 The world is full of objects of pity. Probably no busy 
 physician can give full time and exert his entire industry and 
 skill in every case that appeals to him, or throw into it his whole 
 heart, undivided thoughts, feelings, and intellectual strength, 
 or even feel deep personal absorption in the sufferings of every 
 patient to whom he is called ; if he did, the endless chain of 
 misery he sees would, through overcare and grief, soon unfit 
 him for active practice. But you can, and should, at least ' 
 make a careful examination, and manifest some anxiety and 
 intelligent interest in all cases and avoid exhibiting indifference 
 in any. Approach the sick with grave cheerfulness and soft 
 steps, and use kind words with them. The possession of hu- 
 manity, or the lack of it, in a physician, can in no way be so 
 accurately judged as when he is questioning and examining the 
 sick ; the soothing voice, the soft touch, gentle manner, etc., all 
 do a great deal to soften the pillow of sorrow and affliction. Be 
 very careful, in examining the sick, to avoid inflicting pain in 
 delicate and painful parts, and assuage their fears and oversensi- 
 tiveness by assurances that you will not cause any more suffering 
 than is unavoidable, and then make your words true. Whoever 
 has any such manner naturally will not, can not, fail to get 
 devoted patients, who will willingly trust and retain him in 
 preference to all others, even though they know his general 
 reputation for skill to be far below mediocrity. 
 
 You must depend for success chiefly, of course, on your 
 skill in curing the sick. You will find, nevertheless, that but 
 few patients — probably not one in twenty — can judge the amount 
 
48 THE PHYSICIAN HIMSELF: 
 
 of technical and scientific knowledge you possess. The majority 
 are governed by the care and devotion you exhibit, and form 
 their opinion of you and measure your services by the little 
 details of routine attention, which is positive evidence that the 
 scientific is not all that is necessary. 
 
 Be especially courteous and civil to lady attendants of the 
 sick. Woman, gentle, noble woman ! as pure as Diana, with 
 the look of heaven in her face, is, and ever will be, the angel 
 of the sick-room ; and you as a physician will daily see touching 
 illustrations of her tender ministrations and heroic, unselfish 
 devotion as mother, wife, sister, daughter, nurse, or friend to the 
 sick and suffering, watching around the bedside by day and 
 by night, and ministering with an angel's spirit, even to the 
 sacrifice of her own life. 
 
 "Woman's soft hand my early cradle spread, 
 Her gentle care bedecked my bridal bed ; 
 By AVoman let my dying hours be nurst, 
 Her love the last fond solace as the first." 
 
 After a patient convalesces, or when it is not necessary to 
 attend him daily, if, when you are in his neighborhood, 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 grate- 
 ful sense of your interest in the case. Having a sick child taken 
 up for examination, carrying your patient to the light that you 
 may see him fully and examine him carefully, having his urine, 
 or his sputa, or the blood he spits, etc., saved for examination, 
 will not only give you very necessary information as to the pa- 
 tient's condition, but also satisfy him and everybody else of your 
 interest and solicitude, and of your anxiety to do your whole 
 duty. So also does paying one the first visit in the morning, or 
 the last at night, or staying in urgent cases to see that the medi- 
 cine produces the desired effect. 
 
 You will find that in times of sudden sickness and alarm 
 in families there is a peculiar susceptibility to strong impressions. 
 Kindness and delicate attention shown then is doubly appre- 
 
HIS REPUTATION AND SUCCESS. 49 
 
 ciated. Often even a single kind word, opportunely uttered, is 
 long remembered. Indifference, coldness, a slight offense, an 
 inopportune remark, or an unlucky word may, on the contrary, 
 sever attachments and end deep and tender friendships that have 
 existed between the physician and the family for years in as 
 many moments. Many a young physician gains a hold on the 
 hearts of a family, and becomes beloved, and secures the family 
 permanently by heartfelt interest and assiduous attention in cases 
 of colic, convulsions, and accident, or by sleepless anxiety and 
 faithful, devoted and unwearied attention, and an exhibition of 
 good intentions in cases of typhoid fever, scarlet fever, etc., 
 where, perhaps, life hangs day after day by a single thread. 
 
 A potent lever to assist in establishing your professional 
 reputation lies in curing the long-standing cases so often seen 
 among the poverty-stricken. Many of these miserably poor, 
 disease-ridden sons and daughters of poverty are curable, but 
 require greater attention to the details, and a great deal more 
 care, strength, and personal superintendence than older phy- 
 sicians, whose time is monopolized by acute cases, can possibly 
 devote to them. If you use your best judgment and persevere 
 with them until a cure is effected, your special interest and 
 anxious attention will be observed and appreciated ; you will be 
 credited with all the prosperous accidents of the case, get the 
 credit of the cure, and will gain a host of warm admirers, who 
 will magnify and herald you forth on every occasion as being 
 doubly skillful in making the blind see, the deaf hear, the lame 
 to walk, the broken whole, the senseless well again, the weak 
 and debilitated strong, rotten lungs sound again ; and, even 
 though you receive little or no reward from them in the shape of 
 money, it will act as a mental gymnasium, help to develop 
 your professional character, show your skill and ingenuity, aug- 
 ment your fame, and cultivate both your undisciplined hand and 
 your inexperienced eye, and school yourself in the art of observ- 
 ing, analyzing, and treating the very diseases you will be called 
 upon to treat daily all the days of your life ; besides teaching 
 
50 THE PHYSICIAN HIMSELF: 
 
 you to overcome the thousand and one embarrassments encoun- 
 tered by the beginner. 
 
 Take care to promise old chronic cases, that more experi- 
 enced physicians have pronounced incurable, nothing but that 
 you will do your best for them. Never stake your reputation on 
 their cure, and allow yourself plenty of time in speaking of the 
 period necessary for the trial. 
 
 You will find it comparatively easy to get practice among 
 the moneyless poor and relatively hard to get it among the 
 wealthier classes. Your reputation will probably begin at the 
 bottom : in cellars and garrets, alleys and back streets, among 
 the poorest of the poor ; the degraded and the vicious, even in 
 hovels of filth and vermin, and in dens of iniquity and vice, 
 where it will extend much more rapidly than in comfortable 
 quarters; but no difference whether in mansion, cottage, or 
 hovel, every man, woman, and child you attend, white and 
 black, rich and poor, will aid in enriching your experience and 
 in shaping public opinion by giving you either a good or a bad 
 name. 
 
 The wheel of fortune sometimes makes the very poor very 
 rich, and a few of the grateful kind then remember the physician 
 who remembered them. 
 
 Attending the servants of the rich, however, who are sick 
 at their service places, will not improve your reputation much 
 with the powers above stairs; at any rate, not nearly so much as 
 attending the same patients at their own homes, or on their own 
 account. Proud and haughty silk-stocking-kind of people, who, 
 in their minds, couple you professionally with their servants, gar- 
 rets and kitchens, are apt to form a low opinion of your status 
 and to sneer at the character of your practice. Again, if you 
 attend a poor person gratuitously, you will seldom, if ever, be 
 called to his rich relatives, and if Dame Fortune ever makes that 
 poor patient rich he may then become supercilious and drop you. 
 
 Nor will you find it very satisfactory to attend people who 
 "just call you in to see a sick member of their family," because 
 
HIS REPUTATION AND SUCCESS. 51 
 
 you are attending across the street or in the neighborhood. 
 Those who select you, or send for you because they prefer you 
 to all others, will be your best and truest patients. 
 
 The adoption of a specialty, to the exclusion of other 
 varieties of practice, is successful with but a few who attempt 
 it. It should never be undertaken without first attaining a few 
 years experience as a general practitioner. 
 
 You are not obliged to assume charge of any one, or to 
 engage to attend a woman in confinement, or to involve your- 
 self in any way against your wish ; but, after doing so, you are 
 morally and legally bound to attend, and to attend properly, 
 even though it may be a charity or "never pay" patient. You 
 have a right, however, to withdraw from any case by giving 
 proper notice. 
 
 Remember that ethical duties and legal restraints are as 
 binding in pauper and charity cases as in any other, for ethics 
 and law both rest upon abstract principles, and govern all cases 
 alike. 
 
 You will probably find hospital and dispensary patients, 
 soldiers, sailors, and the poor, much easier to attend than the 
 higher classes; their ailments are more simple, definite, and un- 
 complicated, the therapeutics are more clearly indicated, and the 
 response of their system is generally more prompt, and one can 
 usually predict the duration, issue, etc., of their cases with great 
 accuracy. With the wealthy and pampered, on the other hand, 
 there is often such a concatenation of unrelated or chronic 
 symptoms and strange sympathies, or they are described in such 
 indefinite or exaggerated phrases that it is difficult to judge 
 which one symptom is most important to-day or which will be 
 to-morrow. 
 
 With hospital patients, sailors, soldiers, paupers, etc., there 
 are but two classes — the really sick, suffering from affections of 
 a well-marked type, and malingerers. Hence, exclusive hospital 
 education and practice are apt to lead to a rough-and-ready habit 
 of treating every patient as if very sick, or else as having little or 
 
52 THE PHYSICIAN HIMSELF: 
 
 nothing the matter with him. These crude or possibly over- 
 active methods may answer in public institutions, but they will 
 not suit the squeamish people with nerves tuned to a high key, 
 so often seen in private practice, with indefinite or frivolous ail- 
 ments, for which the physician trained only in a hospital could 
 hardly fail to feel and manifest contempt. Hospital practice is 
 so different from private that but few members of our profession 
 shine conspicuously as practitioners in both spheres. An illus- 
 tration of this fact is constantly afforded in the colleges and in 
 medical societies ; for the greatest Ciceronian orators and clin- 
 icians in medical colleges, and the most fluent, voluble debaters 
 in medical societies are by no means always the best or most 
 successful practitioners. The two fields are essentially different, 
 and lead the mind in different directions. In a word, the pos- 
 session of knowledge and the power of applying it are very 
 different things. 
 
 Observe, and strictly practice every acknowledged rule of 
 professional etiquette. For this purpose it is your duty to 
 familiarize yourself at the very threshold of your professional 
 career with the " Code of Ethics of the American Medical Asso- 
 ciation," and never to violate either its letter or its spirit, but 
 always scrupulously to observe both toward all regular gradu- 
 ates practicing as regular physicians. But remember that you 
 are neither required nor allowed to extend its favoring pro- 
 visions to any one practicing contrary to the liberal tenets that 
 govern all regular physicians, no matter who or what he may be. 
 
 I am not sure that the medical profession of any other 
 country besides ours has a code of written ethics. Possibly old 
 countries from long custom can dispense with them. But in our 
 Young Land of Freedom the very nature of society requires that 
 physicians shall have some general system of written ethics to 
 define their duties, and, in cases of doubt, regulate their conduct 
 toward each other and the public in their intercourse and in com- 
 petition. Every individual in the profession is, of course, sup- 
 posed to be a gentleman, actuated by a lofty professional spirit, 
 
HIS REPUTATION AND SUCCESS. 53 
 
 striving to do right and to avoid wrong, and, even were there 
 no written rules at all, the vast majority would conform to the 
 rules of natural justice and honor ; at least, as they understood 
 them. As a consequence, each one's action when scanned by 
 watchful and knowing eyes, might probably be considered fair 
 in nine doubtful cases out of ten, while in the tenth one might 
 honestly err greatly, or conclude differently on some mooted 
 point from his neighbor, or might be found differing in opinion 
 only from some jealous or captious rival, or low, crafty, or un- 
 principled competitor, with whom an honorable agreement 
 would be impossible. The absence of rules for our government 
 would also leave Dr. Graball or any other individual to make 
 his own code, which might violate all logic and all propriety, 
 and no matter how equivocal his position, or how crooked his 
 ways, no one could prove that he acted from impure motives 
 and not from error of judgment, even in the most flagrant vio- 
 lation of the cardinal, the glorious, old-fashioned Golden Rule, 
 the climax of all ethics, laid down by Confucius and quoted by 
 " Our Saviour," " Do unto another what you wouki he should 
 do unto you, and do not unto another what you would not 
 should be done unto you," — truly, a world of ethics in a nut- 
 shell, an ocean of morals in a drop. 
 
 Absence of a code would also make it possible for Dr. G. 
 to pounce on the patients of Drs. A., B., C, D., E., and F. like a 
 wolf on sheep, and to carry on a regular cold-blooded system of 
 infringements, self-advertising, certificate-giving, and wrong- 
 doing in general, regardless of their rights, and still claim to be 
 as honorable as Socrates, while those aggrieved would have no 
 visible standard of appeal by which 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 regulating the 
 conduct of physicians toward each other and toward the public 
 generally. 
 
 Dr. Thomas Percival, an English physician, in a small book 
 published in London in 1807, proposed an admirable code of 
 
54 THE PHYSICIAN HIMSELF: 
 
 ethics, which, excepting a few alterations made necessary by the 
 lapse of time and the advance of medical science, is the identical 
 code adopted by the American Medical Association in 1847, and 
 which from then until now has instructed and governed nine- 
 tenths of our profession throughout this broad land, protecting 
 the good and restraining the bad, just as the Ten Command- 
 ments of Holy Writ instruct and restrict mankind in general. 
 
 You and every true physician among us unquestionably 
 owe to this code his sacred allegiance. 
 
 You and all other physicians are supposed to have studied 
 this code, and to be familiar with its requirements. The claim 
 which it has upon you rests not upon any obligation of personal 
 friendship toward your professional brethren ; but upon the fact 
 that it is founded on the broad basis of equal rights and equal 
 privileges to every member of the profession. To-day it shines like 
 the pole-star to guide and direct all who wish to pursue an 
 honorable course, and, being founded on the highest moral prin- 
 ciples, its precepts can never become useless till regenerate and 
 infallible human nature makes both codes and commandments 
 unnecessary. The code of ethics of the American Medical 
 Association is the great oracle to which you can resort and 
 study the moral aspect of various subjects that are likely to 
 confront you from time to time, and no better code of moral 
 principles can be found 'anywhere. 
 
 To these lofty ethics, in a very great measure, are due the 
 binding together and elevation, far above ordinary avocations, of 
 the medical profession of our land, and the esteem and honor- 
 able standing which it everywhere enjoys. 
 
 By its dignity and justness this code remains as fresh and 
 beautiful to-day as when the profession adopted it more than 
 forty years ago, and if you faithfully observe its canons you can 
 truthfully exclaim, " I feel within me a peace above all earthly 
 dignities, a clear and quiet conscience." 
 
 Professional morals are an important part of medical edu- 
 cation universally required, and it is as much the duty of every 
 
HIS REPUTATION AND SUCCESS. 55 
 
 medical college in America to acquaint its students with the 
 precepts of this code and to furnish to each of its alumni a copy 
 of it with his diploma as it is for a mother to familiarize her 
 children with the Ten Commandments. 
 
 In our land this code is the balance-wheel that regulates all 
 professional action, and neither Professor Bigbee nor Dr. Littlefish 
 can openly ignore it without overthrowing that which is vital to his 
 standing among medical men. If in the struggle and competi- 
 tion for business you desire to act unfairly toward your brethren, 
 this code will compel you to do the evil biddings of your heart in 
 a roundabout way, or by stealth ; and even then your unfairness 
 will seldom go undetected or unpunished. The great God of 
 Heaven has declared that " whatsoever a man soweth, that shall 
 he also reap." Any one upon whom you encroach in an unpro- 
 fessional 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. Away, then, with all that is unethical. 
 
 When called to attend a case previously under the care of 
 another physician, especially if the patient and friends are dis- 
 satisfied with the treatment, or if the case is likely to prove fatal, 
 be carefully just. Do not backbite or disparage the previous 
 attendant 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 ques- 
 tions of the patient or his inquiring friends that your duty is 
 with the present and future, not with the past. Inform yourself 
 as to what has been done for the case, but 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 the physician you have 
 superseded at all unless you can speak clearly to his advantage. 
 As a rule, the less you say about previous treatment the better. 
 
56 THE PHYSICIAN HIMSELF: 
 
 Every physician has his successes and his failures. Where 
 you are highly successful in diagnosis or treatment after others 
 have failed, be modest and avoid pushing your triumph so far 
 as to wound the feelings or mortify the pride of your less fortu- 
 nate predecessors. Take just credit, but be guarded in your words 
 and actions and take no undue advantage of their errors, that 
 you may not in turn invite disparagement or arouse their hatred. 
 
 To take a mean advantage of any one you have superseded, 
 besides being altogether wrong, might engender a professional 
 hornet, which in retaliation would watch with a malignant eye 
 and sting fiercely wherever opportunity offered. Avoid finesse. 
 Courtesy, truth, and justice should mark every step of your 
 career. Enhance your profession in public esteem at every 
 opportunity, and defend your brethren, and your profession too, 
 when either are unjustly assailed. Indeed, to fail to defend the 
 reputation of an absent professional brother, when justice 
 demands it, is feeble, ignoble, and unprofessional, and implies a 
 quasi-sanction of the libel. 
 
 We all know there are a thousand unwritten ways to be 
 ethical, and a thousand undefinable ways to be unethical. When 
 you doubt whether this or that patient is fairly yours or another's, 
 give your rival the benefit of that doubt. Never be tenacious 
 of doubtful rights, but let your every-day conduct in this, and 
 all other respects, entitle you to the esteem of your medical 
 neighbors. 
 
 Do not captiously follow up every trifling infringement, 
 difficulty, or apparent contradiction, as if you courted war with 
 everybody; a certain amount of jarring of interests and clashing 
 of opinion 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 disposed neighbors. Unless you do this, many ques- 
 tions will arise that cannot be adjusted by an appeal to the code, 
 and you will become involved in useless, rancorous, and endless 
 controversies and reprisals. 
 
HIS REPUTATION AND SUCCESS. 57 
 
 Sometimes, — 
 
 "The very silliest thing in life 
 Creates the most material strife." 
 
 It is both embarrassing and inconvenient to pass and repass 
 medical neighbors between whom and yourself there exists a 
 chronic feud, or to meet any one else with whom, through 
 enmity, friendship and even speaking acquaintance have ceased. 
 
 If ever you have cause to believe a medical neighbor has 
 mistreated you, or misconstrued your conduct or motive, go di- 
 rectly to him, and in an urbane manner make or ask an expla- 
 nation. 
 
 Keep above all doubtful expedients that relate to getting 
 patients and profits, as if you cast off or assumed the code of 
 ethics just as it suits your purpose; and be careful not to encroach 
 upon any other physician's practice; also, never attempt unjustly 
 to retain any patient to whom you are called in an emergency ; if 
 you are in doubt whether you were deliberately chosen, or only 
 taken in the emergency,- do not hide yourself behind a mean and 
 sorry technicality of ethics, but ask the direct quest/on. If 
 another was preferred to you, surrender the patient to him on 
 his arrival, even though you may be, for politeness' sake, asked 
 to continue in attendance. Circumstances may even require you 
 to have the former attendant sent for, either to take charge of 
 the case, or for consultation. 
 
 Acts of neighborly kindness are daily performed by physi- 
 cians for one another, and go far, very far, toward neutralizing the 
 ruffles and stings and collision of interests which the very nature 
 of our profession makes inevitable. If your conduct toward 
 other physicians in these matters is invariably high-toned and 
 gentlemanly, as if arising from a generous, frank, and open 
 desire to do only that which is right, it will be discovered in due 
 time, and will make your road pleasant, and if you ever un- 
 wittingly infringe all will feel that it is not intentional, but 
 through mistake. 
 
 When you are called, in an emergency, to prescribe for a 
 
58 THE PHYSICIAN HIMSELF: 
 
 patient who is under the care of another physician, it is better 
 to leave for him a copy of your prescription, that he, knowing 
 its exact character, may be able to judge whether or not he 
 should continue its use. 
 
 Never visit a patient who is under the care of another phy- 
 sician, as a "smelling committee," or medical detective for the 
 patient's beneficial society, to ascertain whether he is malingering, 
 without that physician's consent. It would be a still greater 
 offense 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 physicians, even for business or social 
 purposes, as it is a frequent cause of suspicion and discontent. 
 
 Never take charge of a patient recently under the care of 
 any other regular physician without first ascertaining that he 
 has been formally notified of the change. The idea that governs 
 such cases is this :, When a person sickens he is at liberty to 
 select any physician he prefers, but after making a selection, 
 and when the case has been taken charge of by him, if for any 
 reason whatever the patient wants to change, he must follow 
 the established form in doing so. If there are any hard thoughts 
 against the other physician, or unpleasant scenes with him, the 
 patient and his friends should have them, not you. 
 
 The dissatisfied persons who wish to dismiss their attendant 
 and get you will sometimes try to cast contempt on medical 
 ethics, and contend that to have rules for regulating the taking 
 charge of patients, recently under the care of another physician, 
 are harsh and unjust, and peculiar to the medical profession. 
 Neither of these statements is true, as our custom is identical 
 with that which prevails everywhere among all classes of people 
 the world over, which requires the formal discharge of the 
 old employe before a new one can take his place. Besides, no 
 person, whether laborer, mechanic, or physician, can fill a 
 vacancy till one exists. 
 
HIS REPUTATION AND SUCCESS. 59 
 
 Be chary of taking cases in families into which you have 
 ever been called in consultation, more especially if you were 
 called at the family physician's suggestion, for he, chagrined at 
 his displacement, will be apt to scan every feature of the change, 
 and, if he has any ground at all, will conclude that, instead of 
 obeying the Golden Rule, you have taken advantage of the 
 introduction he gave you, ingratiated yourself in, and ungener- 
 ously elbowed him out. Firmly, but courteously, decline to be 
 placed in this position. 
 
 You will often be called to a patient, and, upon going, will 
 find that he is under the care of some other physician, and will, 
 of course, refuse to attend ; but you will almost surely be urged 
 just to look at the patient and tell him what you think ; or 
 whether the attending physician's treatment is not wrong ; or to 
 prescribe for him ; Avith the promise that the other physician 
 shall not be told of your having done it. Remember that honor 
 and duty require you to do right in these and all other positions 
 in which you may be placed, and that not through fear, or for 
 policy sake, but because it is right to do right, and for the other 
 equally broad reason that you yourself would know of the 
 wrong, whether the other physician knew of it or not, and it 
 would lower you in your own eyes ; decline, therefore, their 
 solicitations, with an assurance that you desire to possess your 
 own respect as earnestly as you do that of others. Unless 
 a great emergency exists, you should positively refuse either to 
 sit in judgment on his work, or to interfere; if you do con- 
 sent, it should be done for the attending physician, and you 
 should leave a note telling him what you have done. Take 
 care to make no charges for such services. 
 
 When persons are inveighing to you against an attending 
 physician, or one who has been discarded, and finding fault with 
 his treatment, or at the patient's being so long unrelieved, you 
 should never suggest that he be discharged, so that you may 
 supplant him, as it seems like intriguing for a place not vacant. 
 Some physicians would brand it as piracy. 
 
60 THE PHYSICIAN HIMSELF: 
 
 The rules regarding previous attendance are much less 
 stringent in floating office practice than in regular family prac- 
 tice, and some of the most eminent physicians prescribe for all 
 ordinary office cases with but little regard as to who has been 
 attending, or where, or when. Most people, with long-standing 
 ailments, are unwilling to resign themselves to the stroke of 
 Providence until numerous physicians have been tried in vain. 
 A patient with heart trouble, cough, or a skin disease, will occa- 
 sionally consult almost a dozen physicians at their offices in as 
 many days. The principle is this: Office advice to strangers is 
 everywhere cash, and the payment of the fee frees the patient to 
 subsequently go to whomsoever else he pleases. 
 
 You will see much to condemn in regard to ethics, both in 
 the profession and in the laity. If you are ever compelled to 
 attack any one's conduct, do it boldly, or at least never do it 
 anonymously or in whispers ; anonymous and covert attacks are 
 cowardly. 
 
 Be punctilious in your endeavors to do every one justice. 
 If you err at all in this respect, let it be in liberality. Suffer 
 injustice, rather than participate in it. Sometimes, even though 
 the letter of ethics allows you to take a patient, it may be un- 
 kind or unwise to do so; use such opportunities to harmonize, 
 rather than to disrupt. You can do this, and yet not make a 
 habit of cheating yourself out of patients. 
 
 Always keep a stock of good vaccine on hand, both for the 
 fees it secures, when there is a demand for vaccination, and for 
 fear of a sudden outbreak of small-pox. 
 
 Vaccination, although a trifling operation, is a prolific 
 cause of criticism and reproach to physicians. Use calf virus 
 whenever it is possible to obtain it ; it is popular, and not capa- 
 ble of communicating syphilis, scrofula, etc., and needs no de- 
 fense. In no case use any but pure virus ; take your time and 
 do it skillfully and thoroughly, and be ever ready to defend its 
 purity with proof, if any one you vaccinate suffers any mishap 
 through it. 
 
. HIS REPUTATION AND SUCCESS. 61 
 
 Do not begin the unjust custom of vaccinating the child 
 gratis, in cases where you have officiated at its birth, as is the 
 habit with some. Also charge the same for revaccinating any 
 one to test whether his former vaccination is still protective 
 or not, as you would if he never had been vaccinated before, 
 whether it takes or not, as revaccination succeeds in but a small 
 proportion of those it is tried upon, and the charge is for the 
 trial. 
 
 A public vaccinator should under no circumstances insist 
 upon vaccinating a child or other unvaccinated person who is 
 known to have a discreet, watchful medical attendant, unless 
 small-pox is actually prevailing around them. They should, on 
 the contrary, be referred to him. 
 
 You should, of course, make no extra charge for repeating 
 primary vaccinations till they take, no matter how long the 
 interval between the trials ; also, make but one charge for any 
 person who has revaccination attempted, no matter how often, 
 if during the same epidemic, or small-pox scare. Many people 
 believe a vaccination protects as long as the scar shows plainly. 
 The truth is a vaccine scar lasts for life, while the protective in- 
 fluence of vaccination gradually disappears in some people. A 
 typical vaccine scar merely shows the vaccination once took 
 properly, not that it still protects. 
 
 Some people think a revaccination must be made to take 
 anyhow, even though they are still protected by the old one. 
 You cannot catch fish when there are none, no matter how you 
 bait your hook ; nor set a pile of stones on fire, no matter how 
 good the matches you use. 
 
 Another error regarding small-pox : Many people imagine 
 that it can only thrive when the weather is cold ; this is a mis- 
 take, as it may prevail with intensity at any season. Indeed, 
 severe epidemics of it often prevail in tropical countries where 
 there is perpetual summer. 
 
 Avoid volunteer practice, and be very cautious how you go 
 out of your way to persuade people to let you remove warts, 
 
62 THE PHYSICIAN HIMSELF: 
 
 extract tumors, destroy naevi, efface tattoo-marks, and do other 
 minor surgical operations gratis, with assurances of success. 
 There is always a remote possibility of serious or fatal sequelae ; 
 the most trivial operation, even a puncture on the tip of the 
 finger by a pin, needle, or splinter, is occasionally followed by 
 death, and you should not, especially in private practice, induce 
 people to let you involve yourself for their benefit, without being 
 paid for your risk and responsibility. 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 unre- 
 quited work, and all gratuitous responsibility, except what 
 charity demands. 
 
 For similar reasons do not persuade people to effect insur- 
 ance on their lives, or in any particular company, as all such 
 ventures carry a possibility of disappointment or failure that 
 might involve you. 
 
 Wisdom in recognizing cases that are likely to involve you in 
 suits for malpractice, and in foreseeing and forestalling the suits 
 themselves, is a valuable power. Take care that this wisdom does 
 not come too late or cost you too much. Remember that when you 
 are employed professionally you are regarded as contracting that 
 you possess and will exercise ordinary skill in your profession, 
 and that you will be guilty of no negligence. Beyond this you 
 are not responsible for the result, no matter how bad, as medi- 
 cine is not an exact science; but if you fail either in ordinary 
 skill or care, you are legally liable to the injured person to the 
 full extent of the damage sustained. Remember that in your 
 professional rounds you will not find the various diseases as 
 clearly marked as they are in the books — not labeled as plainly 
 as the bottles in a pharmacy. A mistake in diagnosis is not suf- 
 ficient cause for action, and every physician may be, and often 
 is, mistaken ; and many cases are so obscure, or masked, or 
 irregular, or complicated, that nothing but an autopsy, and 
 sometimes not even that, can reveal their exact nature. 
 
 Never fail to send your bill promptly to dissatisfied patients 
 
HIS REPUTATION AND SUCCESS. 63 
 
 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 a 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. 
 
 When you are to be a witness in a grave court case, politely 
 but firmly refuse to give the opposing counsel, or any other 
 person, either a verbal or written statement of what you saw, 
 heard, or observed in the case, or what your opinion is, or what 
 your testimony will be. Also dispute their right to question 
 you at all on the subject. 
 
 If you are yielding in this respect you may actually aid 
 them to set traps for you, by distorting your statement from its 
 proper meaning or to rebut it on the witness-stand, or to charge 
 that you are lacking in medical knowledge, thus bringing both 
 justice and yourself to grief. Firmly but courteously inform 
 them that you will not give the desired information in advance, 
 but that they must wait and find out what you know when on 
 the witness-stand. 
 
 When in court, whether as plaintiff, defendant, or witness, 
 keep cool and self-possessed ; guess at nothing, and express no 
 opinion for which you cannot give the why and wherefore. 
 
 There is no creed or class, except ours, whose members 
 habitually confute and confront one another in courts and before 
 the public. Our so-called psychological experts, specialists, and 
 other would-be highly scientific representatives have been hired 
 by contestants to exhibit their power to weave testimony that 
 will get somebody's neck out of the halter so often of late, in 
 criminal cases, will cases, life insurance cases, etc., that the public 
 jest about us, and believe from our kaleidoscopic contradictions 
 that our boasted science of medicine is merely a tissue of 
 guess-work. 
 
64 THE PHYSICIAN HIMSELF: 
 
 These remarks only apply to double-visioned pseudo-experts, 
 who can paint things black, white, or lead-colored, as they 
 desire, and are willing to sell their testimony to the highest 
 bidder. 
 
 Every principle of honor and duty forbids you even to think 
 of lending yourself as a medical cat's-paw, either to go on the 
 witness-stand or to prompt counsel in their efforts to break down 
 medical witnesses on cross-examination in rascally or speculative 
 malpractice suits against reputable physicians who have conscien- 
 tiously discharged their duty in cases of sickness, accident, or 
 surgical operation. 
 
 Those suits are generally trumped up and entered at the 
 instance either of designing physicians, intent on the ruin of 
 rival practitioners, or (on the Champerty plan) by unprincipled, 
 pettifogging lawyers, not with the hope that they may come to 
 trial on their merits, but with the expectation that the accused 
 physician, through natural dread of the expense and annoyance, 
 will pay a snug sum as 7msh money. 
 
 The court records make it appear that the poorer a patient, 
 and the more that charity has been exercised, the more likely he 
 is to enter suit and show the basest ingratitude. If ever a worth- 
 less, lying loafer gets a chance at you, look out for him. 
 
 So-called " medical experts " often excite disgust and indig- 
 nation at the contemptible attitudes they assume when they act 
 against their better knowledge in court cases, and join hands 
 with bad people and attempt to mulct a physician, or strive to 
 clear a dark-browed criminal from legal responsibility, perhaps 
 let go a murderer, 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 asked to stretch their consciences so much as that 
 of giving certificates to persons seeking to get invalid soldiers' 
 pensions. 
 
 You may even be cajoled by friends or blandished or flat- 
 tered by interested strangers, or tempted by gold, to give an 
 
HIS REPUTATION AND SUCCESS. 65 
 
 opinion that one who was mentally unfit to make a will was 
 unclouded in mind and fully competent to do so, or that a per- 
 son with one foot in the grave, the result of intemperance or 
 disease, is sound or temperate ; or that Mr. Somebody, with a 
 bias toward a certain disease or with an incipient organic affec- 
 tion, is in perfect health. Or unprincipled, pleasure-seeking 
 officials may attempt to cover their absence from duty by obtain- 
 ing a certificate from you that their absence was due to sickness ; 
 others may attempt through you to escape military or jury duty, 
 or attendance at court as a witness, or for trial, or try to get 
 from you a prescription for a "Sunday drink of liquor," under 
 the stale pretense of sickness. 
 
 Repel all such approaches promptly, and emphatically re- 
 fuse to be seduced from your integrity, or to stretch the truth, or 
 to deviate from your honest conviction for any one. 
 
 Be firm and unwavering in your determination to steer 
 clear of this and all other practices and alliances in which your 
 part would not bear legal scrutiny or detailing in the community; 
 and you will not Only safely pass the shoals of shame and bitter- 
 ness, upon which so many have been wrecked, but you will have 
 a positive reward — the approval of your conscience. Perish all 
 that conflicts with the attainment of this. 
 
CHAPTER III. 
 
 "Whatsoever a man soweth, that shall he also reap." — Gal. vi. 7. 
 
 When you are importuned to produce abortion, on the plea 
 of aiding to save 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 (sic) disgraced, or to avert the shame that 
 would fall on the family, or the church scandal about one of the 
 weak brethren ; or, in cases where there is no inceptive guilt, to 
 limit the number of children for married people who already 
 have as many as they want, or to accommodate ladies who assert 
 that they are too sickly to have children, or that their suckling 
 child is too young to be weaned, or other anticipated evils, or 
 that they have been pregnant only a short time, etc., etc., even 
 though it is only the size of a mustard seed, you should not stop 
 to discuss the subject lengthily with a "h'm " and a "haw," but 
 should meet their entreaties and solicitations with a refusal 
 prompt, strong, and positive, and never let yourself appear to 
 entertain the proposition. If they are too importunate, express 
 your sentiments in plain and definite language, and with 
 American frankness. 
 
 It is always safe to do right, and never safe to do wrong. 
 How could any one but a fool be induced to stain his hands 
 and his heart by doing a crimson crime; to violate both his 
 moral conscience and the civil law; to risk exposure, social dis- 
 grace, and professional ruin, and even the penitentiary itself by 
 taking the guilty burden from another's shoulders to his own, 
 thereby putting himself into their sinful power, whether as a 
 favor or for a paltry bribe, or even for all the gold of California ! 
 
 Evil rumors fly rapidly. The production of a Aery few 
 criminal abortions (sometimes even a single one) will surely go 
 
 (67) 
 
68 THE PHYSICIAN HIMSELF". 
 
 from tongue to tongue, and give the damphool physician who 
 stoops to commit them a widespread and long-continued notoriety 
 as infamous and as tenacious as the Bloody Shirt of Nessus. 
 Take care — 
 
 "That the immaculate whiteness of your fame 
 Shall ne'er be sullied with one taint or spot." 
 
 When circumstances require you to prescribe for females 
 with delayed menses, where pregnancy is possibly or probably 
 the cause, it is better, instead of giving a Latinized prescription, 
 to order some simple thing, such as hop-tea, tincture of valerian, 
 or wine of iron, under its common English name, and tell them 
 verbally how to take it. By avoiding concealment regarding 
 the nature of the remedies you give, you will walk on solid 
 ground and in the middle of the road, and escape the suspicion 
 or charge of giving abortifacients. 
 
 To give a woman who applies for an abortifacient an inert 
 agent would, to say the least, be unwise ; it is better to plainly 
 refuse to give her anything, whether pretended or real. 
 
 The charge or suspicion of criminal abortion is more apt to 
 be brought when the woman is single than when she is married. 
 
 You must give a cautious, a very cautious opinion, if any, 
 in cases of unmarried females whose menses have ceased and 
 pregnancy is feared, especially in cases where the suspected girl, 
 after everybody else has left the room, strenuously denies having 
 had carnal intercourse. Many will not confess the truth while 
 a third person is present. Erroneously to pronounce an honest, 
 virtuous woman pregnant may blast the whole future life, honor, 
 and innocence of one who was spotlessly virtuous, and call down 
 maledictions on you ; if, on the contrary, you too quickly declare 
 any one "not pregnant," or that it is " the dropsy," or "a tumor," 
 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 cer- 
 tain that it is " a kicking tumor " by hearing the foetal heart- 
 
HIS REPUTATION AND SUCCESS. 69 
 
 beat or feeling the fluttering of the child within the uterus, or 
 some other unequivocal sign. 
 
 Unmarried negresses, ladies of easy virtue, and other low 
 females (and sometimes even the wealthy and beautiful), who 
 fear they are pregnant, will occasionally come to 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 question, study their case, and give them your opinion 
 and advice. 
 
 If you should ever encounter a case in which you believe 
 the destruction of the unborn is, for physical reasons, necessary 
 to save the mother's life, do not consent to do it secretly, but. 
 only after a regular consultation with some other physician of 
 well-known probity. 
 
 Giving directions for the prevention of conception or in- 
 structing in onanism, buggery, or other nasty conjugal sins, or 
 in the guilty use of condums, sponges, syringes, and other expe- 
 dients to aid crime or to defeat nature, though offenses beyond 
 the reach of the laws, are essentially immoral, therefore deroga- 
 tory and degrading to the physician and a disgraceful violation 
 of his professional office. 
 
 Never carry away or keep chloroform, ergot, splints, instru- 
 ments, or other unused articles that patients have paid for, with- 
 out an agreement with them to that effect; and be very, very 
 careful how you partake of the wine or liquor intended for a 
 sick person, or eat his fruit and cake, etc. To do such things 
 would not only lay you open to criticism, but even to the most 
 mortifying charges of dishonesty if a rupture of friendship 
 should ever occur — in fact, with such things to fortify them, 
 many people would be actually disposed to welcome or create a 
 rupture with you. 
 
70 THE PHYSICIAN HIMSELF: 
 
 You should be careful that attempts to conceal the presence 
 of contagious diseases, of unlawful dangers to health, or of 
 births that result from clandestine marriage, or from bastardy, 
 do not involve you in the exposures and recriminations that are 
 apt to follow. 
 
 If you have skill in avoiding cases that would involve a 
 summons to court as a witness, and kindred annoyances, legal 
 and social, it will be the source of much comfort. 
 
 Cultivate agreeable relations with your professional "neigh- 
 bors, and keep old friendships in repair. The practice of medicine 
 isolates the members of our profession from one another much 
 more than one would suppose. Physicians, fellow-workers in 
 the profession and well known to each other by sight or repu- 
 tation, daily pass and repass each other without a look or nod ; 
 and, although acquaintanceship and social amenities would be 
 mutually agreeable and beneficial and possibly ripen into life- 
 long friendship, they often remain as strangers for years, unless 
 accident brings them together. 
 
 Every physician ultimately finds his proper place among his 
 fellows. Determine that you will be something more than a 
 mere visiter of the sick. 
 
 Do not hold yourself aloof from the profession ; but iden- 
 tify yourself head and heart with the medical family in all public 
 medical matters. From the very beginning you have social and 
 fraternal duties, as well as individual and solitary ones ; attend 
 the medical conventions, at assemblages of alumni, at medical 
 meetings called to provide entertainment for visiting medical 
 celebrities, at memorial meetings held to pay special tributes of 
 respect to deceased medical brethren, at general meetings of 
 the profession, at those held to voice the opinions or policy of 
 the profession as a body, regarding public dangers or to take 
 associated action on matters of public hygiene, or regarding 
 medical laws, or to devise and urge the adoption of sanitary 
 measures against epidemics, etc., etc. Your presence will be 
 an earnest of the spirit that actuates you. 
 
HIS REPUTATION AND SUCCESS. 71 
 
 Also, join the medical societies of your neighborhood ; and 
 if none exist induce your medical brethren to join you in found- 
 ing one. Society membership is a guarantee of your good 
 standing and that you pursue legitimate practice ; organization 
 gives protection both to the profession and to individuals. A 
 good medical society is also something of a post-graduate 
 school. The collision of mind with mind, and of thought with 
 thought, in amicable discussion awakens reflection and deepest 
 thought, which in turn increases one's intellectual grasp and 
 stimulates the mental digestive power, and they in turn liberal- 
 ize and enlarge each one's scope, and act as leaven to the entire 
 profession. Nowhere else can you study so well the indi- 
 viduality and the styles of different physicians, and discover the 
 reasons why each one is what he is, so fully, as at medical meet- 
 ings. At these democratic assemblages the specialist, the 
 teacher, the general practitioner, and the book-worm all meet, 
 and each in his own way contributes to the instruction and in- 
 tellectual recreation of the others. There you can meet your 
 neighbors on common ground, grasp each other by the hand, 
 look into each other's faces, and compare investigations, experi- 
 ence and opinion by face-to-face discussion. There bitter feel- 
 ings, rivalries, dissensions, jealousies, and controversies can be 
 softened, and professional friendships be formed and cemented ; 
 there you can find opportunities for professional conversation 
 with worthy men, and can also silently measure the height and 
 depth of your medical contemporaries, and see the difference 
 between the judicious and the injudicious, between intellectual 
 giants and mental dwarfs ; there you can estimate the influence 
 of the pleasing actions and deportment, and the intellectual 
 and moral worth of some, and discover and learn to avoid the 
 glaring imperfections that cause a want of success seen in others, 
 — and in many other respects learn effectually to separate the 
 chaff from the wheat. 
 
 Of course medical societies are neither an absolute specific 
 for all personal deficiencies, nor a panacea for all professional 
 
72 THE PHYSICIAN HIMSELF*. 
 
 sores. There you may find men good enough ordinarily to ap- 
 pear with the best, but weak enough, under temptation, to be- 
 have with the worst. Spending a few hours among honorable 
 physicians once a week will not lift knaves into angelhood, or 
 change a clown into a gentleman, convert a willing doer of evil 
 into a professional Chesterfield, or lend him a conscience like 
 Milton's. But, to repeat: intercourse at a medical society does 
 serve as an intellectual exchange, where one may hear the dis- 
 cussion of various moot points and live questions, and at the 
 same time establish with his brethren reciprocal friendly and 
 honorable relations. 
 
 Besides the individual benefits and mutual encouragement 
 and improvement accruing to the members of medical societies, 
 they give a sound and healthy tone to the entire profession and 
 stimulate the healthy growth of the profession at large, and also 
 generate and keep alive a genuine professional and social spirit 
 that constantly tends to minimize all that is unprofessional. 
 
 Never oppose the admission of any clean-handed, honorable, 
 and competent one into society membership for private or per- 
 sonal reasons, or for any cause other than ineligibility or unfit- 
 ness to receive the honors and benefits membership confers, 
 because medical societies exist for advancement of medical and 
 surgical knowledge and for the benefit of all regular physicians, 
 and it would be unjust to mix private feelings with professional 
 duties, and interpose an objection or to cast a black ball against 
 any one on purely personal grounds. 
 
 Do not hesitate to take part in medical debates whenever 
 you have anything valuable to offer, whether gleaned from 
 literature or from the great school of experience. If your views 
 differ from another's, express them with delicacy and respect. . 
 If you have a contribution to offer, an invention, or new patho- 
 logical views, or a discovery or new secret to announce, a new 
 instrument to show, an operation to describe, a patient or speci- 
 men to present, a report to make, or a new treatment, or a new 
 therapeutic agent or a talismanic charm to tell of, or anything 
 
HIS REPUTATION AND SUCCESS. 73 
 
 whatever to say, do it in a careful, clear, methodical manner, 
 then sit down; but always remember that when you have 
 nothing worth offering Ciceronian silence should be your law — 
 do not break it. In speaking, take care neither to abandon 
 your medical vocabulary for the vernacular, nor let your profes- 
 sional manner degenerate. This will soon teach you to arrange 
 your thoughts, quickly and to express them clearly. Remember 
 there, as elsewhere, that there is nothing infallible; that a phy- 
 sician must school his prejudices and be open to conviction. 
 Toleration of a difference of opinion is a lofty virtue. Say or 
 do nothing to wound the pride or feelings of any other member, 
 and if any incautious remark or misstatement or personal 
 reflection drops from your lips, be not slow to make proper 
 atonement. Those who are always positively right, while all 
 others are positively wrong; 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 differ- 
 ences of opinion are quite compatible with friendship ; and that 
 controversies, discussions, and parliamentary battles, no matter 
 how sharp, are usually conducted by men of discretion within 
 the bounds of decorum, and without violations of the ordinary 
 rules of good breeding; and also, that there is no mode of prac- 
 tice and no remedy for any disease which has not been the 
 subject of obstinate dispute, and that every new discovery or 
 startling announcement stirs the whole medical world to action, 
 testing and reporting, asserting and denying. 
 
 You will find that many of the laity entertain a belief that 
 medical societies exist for the pecuniary advancement of phy- 
 sicians, just as trades-unions and other organizations do for 
 workingmen, and that their by-laws in some way, or to some 
 extent, limit the freedom of personal opinion and abridge the 
 rights of their members. Be careful to correct such errors on 
 all suitable occasions, and to inform those thus misled that med- 
 ical societies exist not for selfish, but mainly for scientific 
 purposes and the public good. 
 
74 THE PHYSICIAN HIMSELF: 
 
 Keep up your medical studies, or the knowledge which 
 you have already acquired will rapidly become misty and slip 
 away from you. Without study, the details of common cases 
 and the symptoms of many diseases wear out of one's memory; 
 indeed, the mind does not often bring back the details of parallel 
 cases, or of cases for comparison, after two or three years have 
 elapsed, unless they are extremely uncommon or interesting. 
 Test the fact by answering these questions : What did you have 
 for breakfast on the third day of last month % What kind of a 
 day was the ninth of last February 1 
 
 In consulting journals and text-books, remember that prac- 
 tice found successful in your own climate or region is usually 
 more reliable for your use than that applicable in other climates. 
 There is an art in selecting literature to read. Avoid relying on 
 antiquated works on practice, and back volumes of journals as 
 guides in so progressive a science as medicine. New investiga- 
 tions and rapid progress render new text-books frequently 
 necessary to those who would maintain that buoyancy and self- 
 reliance which the consciousness of being fully posted inspires. 
 
 Try to get together a library of standard professional works 
 as soon as possible after graduating; books are the tools, the 
 literary apparatus with which we cut and dig our way to 
 knowledge, and we now have more books and better books than 
 ever before. Money spent in this way will return a hundred- 
 fold. Buy the best authors and always the latest editions, but 
 take care that irrepressible book-agents, with " the greatest 
 work ever published," do not induce you by their importunities 
 to subscribe for books for which you have but little or no use. 
 No one can patronize everything, or even read one-tenth of all 
 that is offered, unless he has nothing else to do. 
 
 You should not fail to have a good Dispensatory and a 
 Medical Jurisprudence among your books. 
 
 Of course, you should subscribe to one or more medical 
 journals and scientific publications, and read and digest them 
 carefully, so as to keep abreast of the discoveries and theories 
 
HIS REPUTATION AND SUCCESS. 75 
 
 of the passing day. They are necessaiy to the progressive phy- 
 sician. 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's hobby or his goods, or a college, clique, or 
 section. As a rule, you will find that statements involving 
 •therapeutics found in the latest text-books and in standard 
 monographs are more mature, more jointed, and more represen- 
 tative of collective learning, and generally much more reliable, 
 than articles in journals, which are often founded on a single 
 case, or the exaggerated fancy of some unbalanced enthusiast, 
 or the unconfirmed experience or speculations of a single indi- 
 vidual (or perhaps of some unreliable chick or goslin) riding a 
 hobby and pitting himself against everybody. 
 
 Acquaint yourself fully with the contents of your library, 
 so as to be able to refer to whatever you need without hunting; 
 also, have a certain place for every book. 
 
 Do not be biased too quickly or strongly in favor of new, 
 or unique, or unsettled theories, or startling originalities based on 
 physiological, microscopical, or chemical experiments, especially 
 when offered by the overzealous to prove their own hobbies or 
 pet ideas, or by those who have identified themselves with the 
 latest medical novelty. 
 
 Never allow yourself to be led from the practical branches 
 of medicine for histology, pathology, microscopic anatomy, 
 refined diagnostics, bacteriamania, comparative anatomy, biology, 
 psychology, and other captivating subjects that merely interest 
 and create a fondness or monomania for the marvelous ; or it will 
 impair your practical tendency and give your ardor a wrong 
 bias, and your usefulness as a practicing physician will almost 
 surely diminish. The first question to ask yourself in every- 
 thing of this kind is, What is the use 1 
 
 I do not apply these remarks to school-men, or to teachers, 
 scientists, and experimenters, who have hospital and laboratory 
 facilities, or, having inherited wealth and leisure, are pursuing 
 the higher reaches of purely scientific investigations, chiefly for 
 
76 THE PHYSICIAN HIMSELF: 
 
 love of them, or to gain distinction therein; or others, who, 
 being favorably situated and fortunately endowed, having exten- 
 sive leisure and wealth, are delving solely as an object of 
 pleasure, and who do not look to their practice for support. I 
 am not speaking to such persons, or saying these are useless 
 kinds of knowledge. I mean to say that the practice of medi- 
 cine does not depend so much on what the physician knows 
 abstractly as what he knows and has the use of, and that a 
 person may get so deeply absorbed in hemi-, demi-, semi- 
 quavers of the deep labyrinths and fine subtleties of science as 
 to think of nothing but science, and that your most useful 
 studies as an every-day practitioner will be to keep posted up in 
 the well-ascertained facts of the profession, in the kind of facts 
 required for the daily duties of the profession, which embraces a 
 general knowledge of anatomy and a more minute acquaintance 
 with the structures connected with accidents, operations, and 
 surgical affections, and of those of the organs that are the prin- 
 cipal seats of medical diseases, the practical subjects, and, above 
 all else, the art of treating diseases with success. 
 
 The great popular test of medical ability is curing the sick ; 
 and you will find that your success will depend more on the 
 successful treatment of your cases than upon familiarity with the 
 ultra-scientific, and that there are physicians possessed of com- 
 paratively small knowledge so dextrous in its use that they have 
 done great good in the world, and ridden over the heads of 
 others far better versed in the books. 
 
 Never publish weak or trifling medical articles, as whatever 
 one writes is supposed to be a mirror of his own mind. Do not, 
 however, hesitate to write whenever you have anything valuable 
 or instructive to offer, either for the benefit of others or to 
 increase your own standing and reputation. 
 
 When possible, base your articles on solid facts, or on an 
 analysis of facts, rather than on speculation and theory. Let 
 your diction be pure and simple, and as short and aphoristic as 
 perspicuity will allow, so as not to weaken your ideas, observa- 
 
HIS REPUTATION AND SUCCESS. 77 
 
 tions or deductions, or obscure them in a lot of redundant 
 verbiage, or make them long-winded ; rather make every word 
 count, in expressing clear, bright ideas. 
 
 Be careful to give your article a concise, appropriate, and 
 attractive title, — one that indicates its contents; one that will 
 show with sufficient clearness the general character of the 
 remarks which are to follow. This is especially requisite when 
 the title of the work is to be put in an index or catalogue. 
 Such titles as "A Curious Case," "Plain Facts," "A New 
 Method," "A Case of Interest," etc., furnish no clue whatever. 
 
 In writing, cultivate perspicuity, precision, simplicity, and 
 method, avoid unmerciful diffuseness, and do not interlard it 
 with far-fetched, jaw-breaking scraps and patches from foreign or 
 dead languages, unless followed immediately by translation; for 
 unless it be some stale or hackneyed quotation the average 
 reader will probably be forced either to pass it over unsolved, or 
 take down his dictionaries, his dusty quotation-books, or his 
 school-boy grammars. The English language, the language of 
 Shakespeare, Milton, and Bacon, is capable of expressing any 
 and every thought, and it is a pity that from superfluous wis- 
 dom, or pedantic pretension (anglo-agraphic aphasia) some seem 
 unable to express themselves in the vernacular without throw- 
 ing in handfuls of Latin and Greek, almost as a cook peppers 
 his broth. 
 
 The recent attempt to supersede the old weights and meas- 
 ures 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 under- 
 stands), or give both the old and the metric ; to use the metric 
 only savors of pedantry. Many make no attempt to carry the 
 metric equivalents in their minds, and if you give metric meas- 
 ures only they may not take trouble to calculate it, and pass 
 your effusions by without getting the information you wish to 
 convey. 
 
78 THE PHYSICIAN HIMSELF.* 
 
 Note all remarkable cases, but never until they reach their 
 termination ; even then neither report nor publish any that are 
 not unique, or at least that do not present some curious, rare, or 
 very instructive feature, or militate against accepted theories ■ 
 otherwise you will merely swell without adding anything val- 
 uable to existing records. You will find every department of 
 medicine fast becoming loaded down with theoretical discussions, 
 speculative dissertations, compilations, and empty word-building, 
 stale and obsolete things said in a new form, many pens seeming 
 to say: — 
 
 " In pity spare me, while I do my best 
 To make as much waste-paper as the rest." 
 
 You should omit book-matter generally known, and contribute 
 original work, new things, or new ideas, if any. Use a plain, 
 intelligible style ; do not count your words, but see that every 
 word counts ; avoid such ambiguous descriptions as " the color 
 of an orange," " as large as a strawberry," " about as thick as 
 blood," etc. ; and be as brief and concise as justice to your sub- 
 ject will allow, and,' for the poor printer's sake, prepare your 
 matter so as to please his eye and require but little, if any, 
 revision on account of grammatical errors, bad phraseology, or 
 faulty style of construction. 
 
 When you essay authorship and write books, essays, or 
 monographs, use for convenience sake the smallest sized sheets 
 of white note-paper ; this will enable you to handle them more 
 easily in writing, altering and re-writing pages, and also to carry 
 and preserve them much better than if large. If intended for 
 the press, write only on one side of the sheet, and leave a 
 margin at the edge. 
 
 When you write an article do not follow the useless custom 
 of appending to your name an excessively long tail (like the 
 tail of a comet), consisting of all the titles and honors, whether 
 strong or weak, that you can rake together, with half a dozen 
 etceteras. The idea governing the use of suffixes is chiefly 
 that the individual who writes may be identified ; a single suffix 
 
HIS REPUTATION AND SUCCESS. 79 
 
 or simple title, or your town, street and number, are modest and 
 yet sufficiently explicit. Some publishing houses think the use 
 of titles by the author aid the sale of a work. 
 
 Never furnish a report, statement, or opinion on any im- 
 portant case or subject for publication, either in book, journal, 
 or newspaper, without a proviso that you are to see, and if 
 necessary revise, the proof and correct printer's errors in spell- 
 ing, punctuation, etc., before it goes to press; otherwise you 
 may find some purblind proof-reader or go-ahead printer mak- 
 ing you say the reverse of whal^you intended, thus necessitating 
 a long list of " errata," or even making you regret that you ever 
 allowed the article to appear in print. 
 
 Pay your honest debts punctually, even though you be 
 cheated out of half you earn. The best plan is to pay as you 
 go, and if you cannot pay much do not go far. Owing for 
 horses, carriages, feed, or clothes, or, still worse, for luxuries, 
 rent, servants' wages, etc., cannot fail to set the tongue of 
 scandal to wagging freely and injuriously, to the possible ruin 
 of your credit. You will have to pay every debt one time or 
 another, and had better be paying each as it becomes due, than 
 those that should have been paid a month or a year ago. 
 
 Be especially careful to keep your medical society and 
 journal dues and other professional debts paid promptly. 
 
 Borrowing books, instruments, umbrellas, money, etc.^ espe- 
 cially if you keep them beyond the proper time, or return them 
 hi bad condition, will tend to depreciate you more than you 
 would think. Never involve yourself by borrowing apparatus, 
 instruments, etc., from one physician, or patient, to lend to 
 another ; if necessary, introduce the parties, and let the borrower 
 do the borrowing on his own responsibility. 
 
 It is needless to say that health and decency require you to 
 guard against uncouth, untidy and repulsive habits ; do not 
 pick your teeth or pare your finger-nails, or squirt tobacco-juice 
 around you at your visits, or have your breath, hair and clothes 
 reeking with pipe or cigar fumes, or with those of cloves, carda- 
 
80 THE PHYSICIAN HIMSELF: 
 
 mom, alcohol, stale tobacco, dead beer, etc., or you will unavoid- 
 ably prove obnoxious and disgusting, and invite criticism and 
 create revulsion toward you. 
 
 Coarseness and vulgarity are sufficiently disgusting under 
 all circumstances, but in a physician, and especially in the 
 presence of females, they are unpardonable. 
 
 Appearing in your shirt-sleeves, with unwashed hands, 
 dingy cuffs, egg-spotted or tobacco-stained shirt-bosom, greasy 
 coat, out at elbows ; ragged pants, fly-speckled or crumpled hat, 
 and four or five days' beard on the face ; rough, creaking, or 
 dirty boots, or chewing, smoking, sky-larking, unseasonable 
 jocularity, using coarse, vulgar and impassioned language, 
 habitual swearing, etc., will show weakness, diminish your pres- 
 tige, detract from your dignity and lessen you in public esteem, 
 by forcing on everybody the conclusion that you are, after all, 
 but an ordinary person. 
 
 Carpentering, painting, or showing other common-place or 
 anti-professional talents will also appear as if your mind was 
 not engrossed by your profession. You may possibly secure 
 faith in spite of these, but usually such things tend decidedly to 
 decrease it. 
 
 The tips of your fingers will have much to do with your 
 skill and success; their nerves are sometimes superior to the 
 sense of sight ; to palpate the chest or abdomen, examine tumors, 
 make vaginal examinations, do surgical work, etc., the hand 
 must be steady and the touch must be nice and delicate. If 
 your fingers, instead of being protected and their tips educated, 
 are rendered callous and clumsy by rough usage their delicate 
 nerves will be unfit for these duties. 
 
 Beware of a certain evil to which the practice of medicine 
 specially exposes you. The irregularities, anxieties, and ex- 
 haustions; the cold, the wet, the hunger, the- night-work and 
 loss of sleep, and the hospitality of patients and other friends, 
 all unite to tempt physicians to use alcoholic stimulants. Remem- 
 ber that drunkenness, and the idle habits associated with it, may 
 
HIS REPUTATION AND SUCCESS. 81 
 
 be tolerated in physicians who are fully established in practice, 
 because confidence and friendships had been formed and their 
 talents and worth had become known previous to the formation 
 of the habit ; but it will be fatal to any one in the formative stage 
 of reputation, and, also, to the one who is just beginning to gain 
 the confidence of the community ; for neither will be trusted or 
 employed. Even when the older physician, who drinks, is em- 
 ployed, it is done with loathing, and only to use the good half 
 of him, which cannot be separated from the bad, and even then 
 his visits are looked for, by the trembling ones whom necessity 
 puts into his hands, with agony and dread. 
 
 What is a more disgusting spectacle than a drunken, swear- 
 ing, reckless sot of a physician, staggering around the bed of a 
 sick person"? 
 
 An excellent course is to avoid intoxicating drinks, which 
 cause so much crime, sickness, and poverty, yourself, and let 
 others do as they think best. If you are foolish enough to drink 
 liquor, wine, or beer when people offer it to you, nine chances 
 to one they will be the first ones to add the charge that "he 
 drinks " whenever any other person says anything else against 
 you. If it is known that you never touch the demon it will be 
 of immense advantage to your reputation; but intemperately 
 urging puritanical, ball-and-chain temperance on all occasions, 
 or being a loud member of temperance, of secret, or of bene- 
 ficial societies, will not aid much in the acquirement of desirable 
 business; indeed, the best and most pleasant practice you can 
 have is the quiet family business that you will attract by faith- 
 ful endeavors to do your best for all who apply for your services 
 as a physician. 
 
 A physician's life is full of wonderful changes, and being a 
 public character he knows not the day he may need the friend- 
 ship or good offices of this, that, or the other person toward 
 whom he may have felt and shown political, or religious, or 
 personal hostility. 
 
 Do not allow yourself to grow warm on temperance, total 
 
82 THE PHYSICIAN HIMSELF: 
 
 abstinence, local option, prohibition, and other sumptuary cru- 
 sades, as they will be apt to recoil on your head if you make 
 yourself prominent in them. If your office is located very much 
 nearer the church than the tavern, and if you lean to the Sabba- 
 tarian element, so much the better ; but proselyting and pushing 
 matters of a partisan, political, or secular nature is not your func- 
 tion, and you cannot become officious in them and their irritat- 
 ing methods, without setting (about) one-half of the community 
 against you, and engendering personal hostility and rancorous 
 enemies. You had better leave all subjects for discord and 
 angry discussion 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 all 
 other considerations ; and even then it is better to let your 
 profession and your patients be your first and principal care. 
 
 When requested to write a prescription to enable an ailing 
 one, who really needs it, to procure liquor on Sunday or in a 
 local option district, comply with becoming good nature, but 
 accept no fee for it. 
 
 Presents from fond or grateful, very liberal or romantically 
 generous patients, although flattering, will almost invariably lead 
 to the disarrangement or actual rupture of the legitimate pecu- 
 niary relations previously existing between yourself and the 
 giver, Avhich it may consequently be impossible fully to restore. 
 Probably every practitioner can recall numerous instances in 
 which presents of knee-blankets, whips, a basket of game or 
 fruit, a box of cigars, wine, pet animals, canes, free passes, gloves, 
 new hats, curiosities, etc., have spoiled his bill and proved ex- 
 ceedingly expensive. When you foresee such a result be 
 guarded. 
 
 A good rule is to decline all presents and favors 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 
 dealing will rarely continue to be satisfactory; they often en- 
 
HIS REPUTATION AND SUCCESS. 83 
 
 gender disagreements or lawsuits, and will almost always result 
 in your getting only about half as much for your services as if 
 you had avoided entanglements. It is decidedly better to con- 
 duct affairs upon strictly business principles, i.e., let those for 
 whom you work pay you in money, you in turn doing the same. 
 In a word, avoid everything that tends to weaken your business 
 rules. 
 
 Preserve a proper degree of gravity and dignity toward 
 patients. Frivolous, rough-and-tumble conduct, vulgar jokes, 
 clownish levity and undue familiarity are unprofessional, and 
 breed contempt and scandal. Discourage the attempts of roughs 
 and toughs to address you with a " Hallo, Doc ! " or by your 
 first name, or to pass the limit of propriety in any way with you. 
 Show every one proper respect, and exact the same respect in 
 return. Do not understand me to condemn good-natured pleas- 
 antry, good jokes, and even levity; for when gentlemanly and 
 within bounds they are often very appropriate, and sometimes 
 actually serve as a tonic to a patient's drooping spirits. If you 
 have a becoming earnestness of deportment, and at the same 
 time wear a cheerful mien, it will be health to you and sunshine 
 to your patients. 
 
 Avoid dining out with patients, attending their tea or card 
 parties, etc. Eat as seldom as possible at their houses — only 
 when unavoidably detained there by cases of labor, convulsions, 
 and the like. There is a tendency to conviviality and abandon 
 around the festive board that has a leveling effect, and divests 
 the physician of his proper prestige. Better to eat a cold repast 
 at home than to occupy the best seat at the table and partake 
 of the most savory viands of many a patient. Let a physician 
 once unbend among certain kinds of people and he risks a com- 
 plete loss of their high esteem. 
 
 When compelled to accept a meal, if you are served alone 
 so much the better; if seated to eat with the household, be 
 courteous but somewhat reserved, and exhibit no uncalled-for 
 levity, but only enough of the social element to be agreeable. 
 
84 THE PHYSICIAN HIMSELF: 
 
 Shun badinage and gossip and overpraising of the viands, and 
 avoid speaking afterward of the "snowy biscuits," or the "de- 
 licious butter," "the juicy beef-steak," etc., as though you were 
 a stranger to plentiful dinners and choice food. 
 
 Try to give satisfaction at your visits; show that you are 
 anxious to relieve both the body and the mind of your patient, 
 and you will not, can not, fail to succeed in your ambition to get 
 practice. To do this fully you must, of course, feel and express 
 a genuine interest in the case and in the effects of the remedies 
 you are using. 
 
 When you scold or find fault with your patients or their 
 attendants, either preface or follow what you say by explaining 
 that you are not scolding in anger, but because you feel an 
 earnest desire to have them do right for everybody's sake. By 
 prefacing thus you will completely disarm, resentment, and they 
 will take all you say in good part. 
 
 If you are unmarried, it will often be quoted against you ; 
 but the truth is, there is no great professional advantage gained 
 by being married. The objection to most unmarried physicians 
 is really not their celibacy, but their youthfulness. It is true 
 that " it is not good for man to be alone," and that every phy- 
 sician should marry and make for himself a home ; but to marry 
 with an eye to business only would be an imprudent marriage, 
 and apt to entail expenses and responsibilities without corre- 
 sponding benefits. Besides, you should keep both business and 
 marriage on a higher plane. You will often see, in your profes- 
 sional career, the misery that flows from degrading the tender 
 bonds of marriage by entering into it from ill-regulated passions 
 or other considerations than pure love and congeniality of souls, 
 and you had better seek no friend this side of heaven than risk 
 the formation of the wrong kind of domestic relations yourself. 
 
 Everybody wants a lucky, conservative physician; there- 
 fore a series of dystocias, or of deaths in child-bed, or of surgical 
 operations that fail, or of malignant cases, or of cases of any 
 kind that eventuate unexpectedly ill, often injures the physician 
 
HIS REPUTATION AND SUCCESS. 85 
 
 for years, by attaching to him — especially if he be a beginner — 
 either charges of being blind to danger and to duty, or a long- 
 to-be-remembered reputation for bad luck. If such a series 
 unfortunately threatens you in the beginning of 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 
 prominence to your good qualities. 
 
 Ability to please and make friends of 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 whom you see but rarely, and the ability to recall 
 the salient points of former interviews with them, are very useful 
 adjuncts to other qualities. 
 
 Children's likes and dislikes will control your destiny in 
 many a family. Many people patronize various forms of quack- 
 ery for no greater reason than that " the children take it easily," 
 knowing from experience that an attempt to give pills or bitter 
 doses to refractory or spoilt children, whose nurses and mothers 
 have taught them to look on " the Doctor " as a barbarian or 
 butcher, means a fight and a failure. 
 
 You must not rely strongly on social influence for getting 
 practice. Your very best friends may prefer that you test your 
 skill and gain your experience on others rather than on them or 
 theirs. 
 
 You may be socially a great favorite while all are well, but 
 when sickness comes and death threatens the afflicted one, the 
 impulses of friendship and kindred are dormant and do not 
 influence the choice of a physician. No member of any family 
 circle will be spared, if any human power can save, and thought- 
 ful persons, terrified at the possibility of losing the provident 
 
86 THE PHYSICIAN HIMSELF: 
 
 husband, beloved wife, blooming daughter, darling babe, dutiful 
 son, or honored parent, as the case may be, instinctively send 
 for the physician in whose skill they have most confidence. 
 They go past 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 aim- 
 less, the sentimental, and the unchaste — past all whose unpro- 
 fessional demeanor proves them to be either unripe or unsuited 
 to duties so delicate, so precious, so weighty as that of a family 
 physician — past all, till they reach the one in whom their faith, 
 their medical confidence, centres ; faith is the great controlling 
 guide in choosing the one who is to stand by what may be one's 
 death-bed or the death-bed of his loved ones. 
 
 The two greatest elements of medical faith are: first, a 
 belief on the part of the patient that you are anxious to do the 
 best that can be done for him ; second, that you know how to 
 do that. 
 
 Be polite and courteous 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 — fruit that never withers. Resolve that you 
 will cultivate it as long as you live. 
 
 When boys or young men come to you for assistance for 
 their base-ball clubs, or their library, and the like, give some- 
 thing and give it freely. If ladies ask you for a donation to aid 
 the heathen (! ! !) or to help buy a carpet for their church, or 
 any other laudable object, give willingly and cheerfully. If the 
 tiny boy or girl comes to sell a concert or festival ticket, buy it 
 laughingly, for contributions this way not only do good, but 
 have other consequences. Were you to scowl and say "no," 
 the young man and woman and the tiny boy would unite in 
 calling you " old stingy," and ever after avoid you. 
 
 There is a certain fact which you might not observe without 
 having your attention called to it ; it is, that after you get into 
 
HIS REPUTATION AND SUCCESS. 87 
 
 full practice, your days, weeks, months, and years will flit by 
 faster than those of other people, because, as a physician, they 
 will be incessantly engrossed with a medley of important cases, 
 with your occupation hourly changing, and the lapse of time 
 will consequently be almost magical. 
 
 You, yourself, are mortal, and you should get as much out 
 of life as you can, by seeking proper relaxations and amuse- 
 ments while the age for enjoying them remains. Many phy- 
 sicians, in the eager pursuit of business, foolishly postpone all 
 relaxation from one time to another, intending to give up some 
 of the worst of their work and privations, and fall back on their 
 reputation for faithfulness and punctuality, and to indulge in 
 ease and social amenities, and to pursue the pleasures of life 
 when they get older, in the autumn of life, when the hair begins 
 to grow gray ; they thus unwisely forego seeking enjoyments till 
 they lose all taste for them, till they know nothing and are fit 
 for nothing but to do routine drudgery daily and nightly in the 
 rough, hard, slavish treadmill for life. The slave of the sick 
 public, hurrying from one sick-room to another, from a horrible 
 sight to a stinking case, or to a dangerous amputation, and from 
 that to a repulsive obstetric case, or to a puking baby, or some 
 other kind of weak, petulant, or exacting patient. Running up 
 stairs to the chambers of the sick, often summoned unnecessarily 
 and at unseasonable hours, then at home poring over books and 
 thinking day and night, till from long-continued and extraor- 
 dinary exertions they become a prime candidate for one or the 
 other of the physician's great afflictions, organic heart disease, 
 or atheroma of the cerebral arteries, then — apoplexy. 
 
 The Sabbath, or day of rest, was instituted by God himself 
 in Paradise, and is a blessing to all. It is asserted that violating 
 The Gospel of Rest, and working seven days in a week, instead 
 of six, shortens a life of threescore and ten by twenty years. 
 
 A little leisure, either to rest or play, or rational amusement 
 of any kind, soothes the troubled waters of professional life, and 
 is a great blessing, — ree-reation is re-creation. Do as little work 
 
88 THE PHYSICIAN HIMSELF." 
 
 on Sundays and holidays as possible, and do not hold consulta- 
 tions on Sunday, except in cases of urgent necessity. I know a 
 busy physician who, to protect himself, has a sign in his office 
 saying " No Office hours on Sunday." An occasional day's sport 
 with rod or gun, or a summer trip, or an evening at a convivial 
 gathering or at the theatre, etc., will work off nervousness and 
 act as a seasoning to your labors, lessen the worries, frets, 
 tumults, jarring, and cares of practice, break the monotony of 
 life, subdue mental tension and remove brain-weariness the 
 result of overwork, also the ups and downs and continual mental 
 excitement and nervous strain; will conduce to health and 
 longevity, and actually make you more philosophical and a 
 better physician. 
 
 The cost of a pleasure trip, or a few days' recreation is 
 not, however, to be counted by the expense of your journey 
 only, but you must add the far heavier loss of practice; and 
 unmerited blame for being absent may also follow. 
 
 Newspaper notices of your departure from the city for 
 short seaside, mountain, or other brief pleasure trips, will, if 
 allowed, have a disturbing and hurtful influence on your prac- 
 tice while you are away, and even after your return. Reporters 
 are aware how such items injure physicians, and seldom publish 
 them unless requested. The register clerk of hotels where you 
 register will, if asked to do so, omit announcing your arrival in 
 the newspapers, which would publish your absence from business 
 to the whole world. 
 
 If a professional friend is prevented from attending to his 
 practice by sickness, or even by sickness in his family, it is just 
 and proper to attend to practice for him without reward ; but, if 
 one goes in quest of pleasure and amusement, it is proper and 
 just for him to adequately remunerate you or whoever else he 
 gets to do his work. 
 
 When you leave the city your work will be much less 
 laborious for the physician who attends for you, if you have 
 your office patients sent from your office to him at his own, 
 
HIS REPUTATION AND SUCCESS. 89 
 
 instead of compelling him to spend or waste stated hours at 
 your office. Also, to have your family to send the calls to him 
 when received, instead of compelling him to call again and 
 again to see whether he is needed. 
 
 After prolonged absence from home, or recovery from long 
 sickness, it is perfectly ethical to announce the fact of your 
 
 return to practice through the newspapers: "Dr. will 
 
 resume practice at his office, No. Street, July 1, 1889." 
 
 Further than this, keep your name out of the newspapers, and 
 leave self-advertising to quacks. 
 
 When yOu assume charge of a case for another physician, 
 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 physician has been taken 
 sick, take care to do as much good as possible for the patient, 
 with as little harm as possible to the former attendant; 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 injurious to 
 your co-worker. In such a case if you believe something more 
 should be given, instead of stopping his red or black medicine 
 and ordering a white one, or his pills and ordering powders, 
 merely add yours to what is already being done. This avoids 
 unpleasant reflections. 
 
CHAPTER IV. 
 
 "The first step to wisdom is to be exempt from folly." — Horace. 
 
 Always feel and show respect for your seniors in practice- 
 There is probably no type of medical man so unworthy of re- 
 spect as the highly illuminated young fellow who considers him- 
 self the most learned man in the profession, and shows contempt 
 for his seniors. Being fresh from college, and medicine being 
 a progressive science, you may excel the older physicians in 
 severely scientific and technical points, but experience has 
 been their constant teacher, and they have a progressive clinical 
 acquaintance with disease which gives an intuitive perception 
 as to the choice of remedies which in general makes them better 
 logicians and much better practitioners, because knowledge and 
 skill derived from observation and experience far outweigh mere 
 book knowledge, are more like part of one's very nature than that 
 gotten from any other source, and are fixed indelibly on both 
 one's senses and reason, to be brought forth again when needed. 
 Remember that although young physicians indulge more than 
 older ones in scientific "extras," fine-drawn distinctions and 
 modern instrumental aids to diagnosis, yet, relying on these too 
 much and studying rational symptoms too little, they seem to 
 forget that the art of curing disease OAves more to solidity of 
 judgment and sound common sense clinical observation and 
 experience than to anything else. 
 
 The practitioner who has grown gray in the profession is 
 naturally more apt to slight the nicer pathological diagnosis, 
 which discovers the technical character of the disease — whether, 
 for instance, a pneumonia is catarrhal, croupous or interstitial — 
 and to attend more to the therapeutical diagnosis which indi- 
 cates what the treatment should be ; weighing the influence of 
 age, season, rate of progress, secondary affections, compensatory 
 
 (91) 
 
92 THE PHYSICIAN HIMSELF: 
 
 changes, and other phenomena with a nicety that the junior 
 with all his brains can never learn wholly from his books, then 
 choosing with intuitive wisdom the best remedies for the dis- 
 comforts, annoyances, and sufferings of the patient; reducing, 
 evacuating, quieting, stimulating, or feeding him, as superior 
 foresight and experience have taught. Such sage, modest, pure 
 and faithful men, white-bearded and bald-headed though they 
 may be, have done very much to give our profession honorable 
 standing, and to smooth the way for us, and are certainly 
 worthy of all respect. 
 
 On the other hand, the older physicians, having had their 
 turn, and remembering the rough and difficult trials of their 
 own beginning, should favor their younger brothers and fear 
 not, for, no matter how many aspirants appear, there is always 
 enough work left for the older physician who has done his duty 
 in the world. Yes, the world is wide enough, and there is sick- 
 ness and misery enough to keep every hand, and every head, 
 and every heart employed ! 
 
 When you have been a physician long enough to acquire 
 an address in the management of the sick and to make your 
 patients feel that you have an accurate, solid, and practical 
 judgment of your own, and evolve wisdom out of your own 
 brain, and that you are acquainted with their moral and physi- 
 cal 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 peculiarities of their blood, and to understand the 
 weak points in the family constitution, temperament, and 
 tendencies, and to possess sovereign remedies for their relief. 
 
 You will find that the popular belief that you know this 
 or that person's constitution, both physical and moral, from top 
 to bottom, from the surface rind to the innermost core, and 
 know exactly what they require within and without, and their 
 likes and dislikes ; is a powerful acquisition, one that gives you 
 
HIS REPUTATION AND SUCCESS. 93 
 
 great authority, and a fair, unquestioned chance to show your 
 skill, and also gives them unquestioning confidence. 
 
 Experience and skill are what the public seek in a physi- 
 cian ; they are most important, and everybody knows it. You 
 should carefully try to appear possessed of both. Of course, 
 we all have aftersight, but far-seeing, penetrating foresight is 
 what is needed. This is not described in your text-books, or 
 supplied in the lecture, but is sure to come from practical ex- 
 perience in diagnosticating and combating disease, and will 
 develop and improve your judgment in every way, and enable 
 you each year to see more fully into the very middle of cases, 
 and to foresee all events with increased clearness ; and if you 
 compel yourself to work faithfully and to develop the faculty 
 of observing, every year will make you a better physician, and 
 by the time you have worked and observed for ten or twelve 
 years you will be clinically familiar with all the more common 
 afflictions that are sure to confront you, and you will then know 
 far better how to wave the iEsculapian wand, how to avoid 
 various errors and mistakes, and how to shape your diagnosis, 
 prognosis, and treatment in each, far better than when a junior. 
 
 In addition to the great advantage the older physicians, 
 grown gray in practice, have over the younger ones, from in- 
 creased ability to foresee the probable degree and duration of 
 grave cases, and to give concerning them more definite and truer 
 opinions from the beginning, they can from experience recog- 
 nize 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 enable them to reap 
 the full value of their skill, advance their reputation, give them 
 a better address and greater confidence in themselves, and enable 
 them to carry cases with greater steadiness and to retain confi- 
 dence much better and much longer than younger physicians. 
 This is the chief reason why older physicians are not harassed 
 in difficult cases by meddling officiousness from outsiders, and 
 dismissed, or forced to call consultations, as often as younger 
 
94 THE PHYSICIAN HIMSELF: 
 
 ones, and why the practice of medicine becomes relatively easier 
 and lighter every year. You will find that after you have prac- 
 ticed twelve or fifteen years, after many of the fine precepts, 
 beautiful descriptions, and nice distinctions gotten from the pro- 
 fessors have taken wings, after you have forgotten much of your 
 theoretical Text-Book knowledge, — which was probably greater 
 comparatively at graduation than it will ever be again, — your 
 experience will give you an immense storehouse of practical 
 facts that will be invaluble to you, and will often serve you 
 where book learning cannot; indeed, it is impossible to obtain 
 from books alone sufficient knowledge of disease to become a 
 good practitioner. The possession of self-attained post-graduate 
 knowledge gathered from the great book of Nature will make 
 you appear to those around as if you know what to do and how 
 to do it, and is the kind that makes the public prefer older, 
 well-seasoned physicians to younger ones. 
 
 The public love to see a physician appear to understand his 
 business fully and to know things intuitively; therefore you 
 must study and practice to be quick in diagnosis, and ever ready 
 in the treatment of the ordinary diseases and emergencies that 
 will constitute nine-tenths of your practice. 
 
 Study the laws of prognosis and duration continually, for 
 it is in these that most error is seen. Errors of diagnosis and 
 prognosis are ordinarily far more damaging to the physician 
 than errors of treatment. Very few people can discover whether 
 or not your diagnosis and treatment are correct, or otherwise 
 judge the truth of your assertions or the justice of your reason- 
 ing ; but if you say a patient will recover and he dies, or that 
 he will die and he gets well, or that he will be sick a month 
 and he gets up in three days, or that he will be well in three 
 days and he is sick a month, everybody will see that you are 
 wrong, and will very naturally infer that, as you were wrong in 
 your prognosis, you might also have been wrong in your diag- 
 nosis and treatment, and they will naturally seek some one else 
 with more experience or deeper thought. 
 
HIS REPUTATION AND SUCCESS. 95 
 
 Skill in these things will enable you to foretell a favorable, 
 a doubtful, or a fatal termination, and to foreknow the duration 
 in a greatly increased proportion of your cases and save you a 
 vast amount of anxiety. 
 
 In forming your prognosis use all five of your senses, if 
 necessary, and be careful to ascertain not only the condition of 
 the organ chiefly diseased, but that of all the other vital organs, 
 as their condition and action may, in some measure, compensate 
 for the lost functions of the diseased organ. Look also at the 
 surroundings of your patient, and the nursing and attention he 
 can command; and, lastly, learn to estimate, from the look, 
 the voice, the groan, the cry, the breathing, the complexion, the 
 gesture, and general aspect mental and physical, his vital resist- 
 ance to the disease (which differs in each individual), and then 
 form your prognosis. 
 
 Remember this : In your desire to soothe the fears of 
 anxious relatives, do not wrong yourself in serious cases by pro- 
 nouncing them lighter or less dangerous than they really are. 
 Such mistakes often bring sorrow and cause blame. 
 
 Never ask, as you enter to pay the first visit to a patient, 
 the awkward question, "What is the matter with you'?" or 
 salute him at any other visit with "How are you to-day 1" or he 
 may retort, that is exactly what he wants the physician to tell 
 him. 
 
 Never display the fact that you are a junior or tyro work- 
 ing by reflected light, and thereby belittle yourself in the esti- 
 mation of patients, by constantly quoting what the books say, 
 or what such-and-such a medical celebrity thinks, or, worse still, 
 by taking down your text-books to learn what they say; as 
 if you were deficient in readiness or nerve, or had to rely on 
 the opinions of others for all you know. 
 
 Also, never carry a ready-written prescription to a patient, 
 as if copied from somebody else's book ; rather commit it to 
 memory or jot it down in your visiting-list, to be written off at 
 the proper time. 
 
96 THE PHYSICIAN HIMSELF: 
 
 The folly of blindly accepting or slavishly following the 
 dicta of others, and blindly pinning your faith to this or that 
 master, is nicely depicted by Moliere in U Amour MSdSciu, 
 Acte ii, Scene 2, where the following dialogue occurs between 
 Dr. Tomes and Lisette : — 
 
 Tomes. — How is the coachman'? 
 
 Lisette. — He is dead. 
 
 Tomes. — Dead ] 
 
 Lisette. — Yes. 
 
 Tomes. — That is impossible. 
 
 Lisette. — It may be impossible, but it is so. 
 
 Tomes. — He cannot be dead, I say. 
 
 Lisette. — I tell you he is dead and buried. 
 
 Tomes. — You are mistaken. 
 
 Lisette. — I saw it. 
 
 Tomes. — It is impossible. Hippocrates says that such dis- 
 eases do not terminate till the fourteenth or twenty-first day, and 
 it is only six days since he was taken sick. 
 
 Lisette. — Hippocrates may say what he pleases, but the 
 coachman is dead. 
 
 Take a lesson from this, and remember that your patients 
 of all shades, white and black, rich and poor, want to know 
 what you think, and care but- little for what you have been told 
 in lectures or read in Hippocrates, Watson, Gross, or Ringer. ( 
 
 If you are determined to let people know you are inexperi- 
 enced and have no opinion of your own, you should at least, 
 spare them the infliction of following you to the sources from, 
 and through the processes by which your borrowed opinions 
 were obtained. 
 
 If one is invited to dinner, he may imagine his host does 
 not prepare it all himself, but he does not care to be taken by 
 his host down into the kitchen and through the pantries, and 
 shown his pots and pans and rolling-pins, and to be introduced 
 to the cooks and waiters, all to let him know exactly how the 
 feast is prepared. One will feel much better entertained if he is, 
 
HIS REPUTATION AND SUCCESS. 97 
 
 at the proper time, simply introduced to the table, smoking and 
 groaning with its bounteous supply. 
 
 Remember this: Every one likes to believe that the phy- 
 sician is treating him by a regular plan rather than firing at 
 random, more especially in diseases that are believed to depend 
 on the blood or on a diathesis. 
 
 Make post-mortem examinations and other scientific use of 
 your opportunities to confirm or correct your diagnosis, and to 
 become more familiar with the machinery of life, whenever cases 
 of interest present themselves ; but never allow the inference that 
 you are doing so to gratify idle curiosity, or to satisfy yourself 
 alone, or that it is a very great favor to be allowed to do it ; 
 rather put it on the higher ground that human post-mortems 
 are for the benefit of science and in the interest of suffering hu- 
 manity, and that it may be for the good of the very persons with 
 whom you are talking. 
 
 In making autopsies in private families be doubly care- 
 ful to avoid unnecessary mutilation, and let your manner evince 
 the greatest respect for the sleeping dead, especially if a promis- 
 cuous audience, or non-professional persons, are present, and 
 after concluding hide the traces of your work as fully as pos- 
 sible. 
 
 The important uses of the dead to the living is the only, 
 but all-sufficient, justification for human dissection. 
 
 It is, of course, wrong, very wrong, to consent to make a 
 post-mortem examination of any one who has died under the 
 care of a brother physician, at the solicitation of persons who, 
 with mischief in their faces, seek to disprove the diagnosis and 
 disgrace the medical attendant. 
 
 In making autopsies, even in cases of accident or sudden 
 death, deceased's regular medical attendant should, when pos- 
 sible, be invited to be present. 
 
 The hypostatic congestion that naturally follows death is 
 often mistaken by the public for ante-mortem changes, and gives 
 rise to the most wonderful stories of " murder," " only in a 
 
98 THE PHYSICIAN HIMSELF: 
 
 trance," etc. Take care to inform people of its nature and cause, 
 and its utter lack of significance. 
 
 The useless and unjustifiable repetition of physiological 
 and pathological experiments, made to illustrate already known 
 • facts, that require vivisection of animals have received popular 
 opprobrium, and will not add much to your reputation, if done 
 with that in view, as such things are supposed to have been 
 studied in the laboratory and dissecting-room 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 regarding your patient's condition, but will be a 
 great element in giving you popularity and respect. 
 
 Working with the microscope on proper occasions will not 
 only increase your knowledge, but will also invest you with the . 
 benefits of a scientific reputation in public esteem. 
 
 Obstetrical practice is in some respects desirable, especially 
 in the beginning, as it paves the way to permanent family prac-. 
 tice. Doing the waiting at the bedside, however, entails a tre- 
 mendous loss of time. Chance calls of any kind you can take 
 or not at your option, whereas specific engagements, especially 
 obstetrical ones, must be kept, day or night. 
 
 If you ever get so overrun and oppressed with business 
 that time is doubly precious with you, attending many obstet- 
 rical cases will overtax you, and it may become actually neces- 
 sary, in self-defense, to shut off these and other "time-consuming 
 engagements in order to get time to breathe and to attend to the 
 rest of your patients with something like regularity, and to obtain 
 your meals and the necessary eight hours' sleep, etc., also to do 
 your writing and studying ; or, at least, to limit such engagements 
 as much as possible. Midwifery is a wearing, exhausting branch 
 of medicine, that interferes with regular, healthy living, one 
 that is full of care and responsibility ; and, although it leads to 
 other family practice, you Avill find after some years that the 
 ordinary fees for attending cases of confinement are, on account 
 of loss of time in waiting and consequent interference with 
 
HIS REPUTATION AND SUCCESS. 99 
 
 other engagements and duties, and on account of the nights of 
 fatigue, after days of toil, and the loss of sleep, risk of breaking 
 down, etc., which they occasion, proportionately more meagre 
 than in any other department of practice. 
 
 If you keep a record you will probably find that nine- 
 tenths of all your loss of rest is due to obstetrical cases. 
 
 When a person engages you to attend her in confinement, 
 write her . call on one of your cards and give it to her, and in- 
 struct her to send it to you as soon as she feels that you are 
 needed. This emphasizes the engagement, and makes her more 
 apt, when her time comes, to call you in than to employ another 
 physician, or to get a midwife. 
 
 In spite of your having been engaged for a case, and kept 
 in suspense for weeks or months, you will sometimes learn that 
 the confinement is over, that a midwife or granny was sent for, 
 and the excuse will be that everything occurred in such a hurry 
 that they could not wait for you, or that they had no messenger, 
 or some other equally lame plea. 
 
 You will often be called upon in bad cases to do ugly work 
 for midwives who have reached the limit of their skill, and for 
 the sufferer's sake you should never refuse to go. 
 
 Such occasions will afford you an excellent chance to show 
 the superiority of regular physicians over midwives and irregu- 
 lars, and also to enhance yourself greatly in public esteem. 
 
 Pregnant women will sometimes want to make an Indian 
 bargain with you beforehand, to come to them in case their mid- 
 wife fails. Of course you should go to all cases where humanity 
 calls, but you should hardly bargain with anybody beforehand to 
 play second part to a midwife — she to take the fee and eclat, if 
 there is no trouble ; you to take the care and responsibility for a 
 nominal fee, if there is. You may be surprised to learn that it 
 is now generally understood in many communities that every 
 midwife has her regular medical referee to relieve her of com- 
 plicated cases — a one-sided bargain, which gives him an undue 
 proportion of worrying cases of tedious labor. 
 
100 THE PHYSICIAN HIMSELF: 
 
 When you first reach a woman in labor it is a wise rule to 
 ask her whether she has felt the motions of the child since labor 
 began, that, in case she has not, and it is born dead, you may 
 have some evidence that it was dead before you arrived, if such 
 is truly the case. Also, if your examination of a primipara 
 shows any unusual smallness of the vaginal orifice mention the 
 fact, and tell of the possibility of laceration of the perineum, 
 that you may not be unjustly blamed if that should occur. 
 
 In every confinement case, after delivering the child, be 
 careful to call the mother's attention to the lump in her abdo- 
 men, and inform her that it is only the contracted uterus. If 
 you do not, she may accidentally discover it, get greatly alarmed, 
 and either await your visit in terror, or send for you post-haste. 
 
 Attending very distant patients of any kind 'has a tendency 
 to disorganize and diminish one's nearer practice, for while absent 
 attending a remote call you may lose three nearer ones. A long 
 visit does not, as a rule, pay pecuniarily, and is an injustice to 
 both physician and patient. Every one should have a family 
 physician within reasonable calling distance. A few far-off 
 patients will waste more time, break down more horseflesh, use 
 up more carriages, harass and fag you more, keep you from bed, 
 and expose you to bad weather more, and do more to make your 
 life- a hard one, than all the remainder of your practice. 
 
 Keep your practice down to a number which you can 
 attend properly ; you can do this by sending your bills promptly, 
 by weeding out worthless patients, by circumscribing your 
 bounds, cutting off obstetrical engagements, increasing your 
 charges, etc. In refusing to take a case at a distance, or one 
 that is likely to involve you as a witness in court against your 
 will, or to engage for midwifery, if impossible because you are 
 " too busy" name that as your chief reason, as it is the least open 
 to criticism and overpersuasion of any that can be assigned. 
 
 Never offer as an excuse for neglect to visit a patient, " I 
 really forgot you ; " it is unpardonable. 
 
 Gonorrhceal and syphilitic cases are not especially desirable 
 
HIS REPUTATION AND SUCCESS. 101 
 
 on any account, except for the fees they bring ; they are dirty, 
 secret cases, and rather repel than attract their victims and their 
 friends to the physician who attends them, when they require a 
 physician for 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 syphilis, 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 practicing medicine, you will see and un- 
 derstand many sins and blemishes of which you must appear 
 oblivious. 
 
 Take care that your reputation for special interest in vene- 
 real diseases does not overshadow or eclipse other kinds, and 
 give you the title of " P — x Doctor," and entail the social ostra- 
 cism 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 pro- 
 portion of courtezans, or bruisers, does not give you the name 
 of having a " fancy practice ; " or that perpetual and indiscrimi- 
 nate inquiring about the urine, and having it bottled for you 
 (urology), does not earn for you the easily acquired title of 
 "P — ss Doctor;" or that a liver hobby, or a kidney hobby, or 
 the womb, or the stomach, does not become with you a scape- 
 goat to be blamed for every obscure disease, and eventually lessen 
 your usefulness and injure your character as a practitioner. 
 
 You will find it much more pleasant to practice in some 
 families than in others ; for some will constantly give you intelli- 
 gent co-operation, and will make charitable allowance for all 
 your shortcomings and failures, while others will, when any of 
 their members are sick, appear almost as if they wanted to in- 
 volve and harass you in every conceivable way, and to make you 
 feel as though, in attending them, you were on trial for your 
 fife. 
 
 It is this painful thinking, this feeling of personal involve- 
 
102 THE PHYSICIAN HIMSELF: 
 
 merit and perpetual meditation, connected with anxiety, as much 
 as overwork, that wears down the health and shortens the lives 
 -of physicians. Remember this, and, like a philosopher, make it 
 a rule never to worry about anything you cannot help. 
 
 Be guarded against asking private questions, especially 
 about diseases of an immodest nature, before persons not in the 
 patient's confidence, unless they are clearly entitled to hear 
 them ; request all such, especially if they are of the opposite sex, 
 to leave the room before asking. Be doubly cautious in this 
 respect when your patient is of the modest sex, and the ques- 
 tions refer to marriage, menstruation, pregnancy, lactation, 
 uterine affections, constipation, urinary derangements, or other 
 delicate subjects, that her secrets may not be exposed, her 
 chastity offended, or her modesty shocked. 
 
 Also avoid inquiring of a patient in stores or barber shops, 
 or on the street, in the presence of strangers, about his ailments, 
 or about patients at his home. Many persons are very sensitive 
 concerning their maladies and weaknesses, and captious con- 
 cerning the time, place, and manner of asking about them. 
 
 Do not allow indiscreet patients to go about overpraising 
 you, and speaking of you as a pet, etc. Inordinate 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 injudicious praise will almost surely react 
 against you, and do mischief while meaning well. It might 
 even arouse the angriest jealousy or hatred on the part of hus- 
 bands, aunts, lovers, or others. Perfectly pure physicians have 
 actually had to cease attending in families where such jealousy 
 existed, to prevent causing domestic strife and estrangement. 
 
 It is also in bad taste, and even injurious, for a physician 
 to have wife or other near relative praising him inordinately, 
 and boasting of his great skill and wonderful cases to all whom 
 she meets, as people naturally think it is an attempt to send fish 
 to his hook, colored by other interested motives to bring grist to 
 his mill. If done at all, it comes with more grace from strangers. 
 
HIS REPUTATION AND SUCCESS. 103 
 
 Probably one of the greatest powers you could possess is 
 that of discovering who are the ruling spirits in a family, and 
 honestly securing their faith and keeping them satisfied with you 
 and your services. Also to learn the character and consequence 
 of the different ones who may on some occasion give you trouble. 
 
 As a rule, it is better in the sick-chamber to lend attention 
 at your visits chiefly to the conversation of the husband, if he is 
 present, rather than to the wife, and to address your opinions, 
 explanations, and remarks to him, or whoever is at the head of 
 those whom you meet in the sick-room, and to pay to all others 
 only the respect that civility requires. If you do not do this, 
 sensitive people will feel ignored, and many will even get 
 dissatisfied and create trouble. 
 
 Refuse to be confidential with curious or stupid nurses, or 
 prying mischief-makers ; but if you must answer their questions, 
 do so, not in whispers, but openly and in your ordinary voice. 
 
 In visiting, banish all else from your mind but the case 
 before you ; and, no matter who is present, make the patient, 
 whether young or old, the central object, and keep your thoughts 
 and your conversation on him 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, and do not allow it to digress 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 prognosis is 
 very necessary in all cases where a change must be made. 
 
 Do not bind yourself too quickly or too closely in prog- 
 
104 THE PHYSICIAN HIMSELF: 
 
 nosticating the duration of a patient's case. Whatever prognosis 
 you foreshadow in the beginning is, as a rule, accepted. It is 
 only when that prognosis is changed to greater gravity, or its 
 duration made much longer, that discontent arises. One of the 
 strongest reproaches to medicine is that it is not an exact science, 
 therefore its practice often lacks the element of certainty. 
 
 Do not get insulted at the foibles and infirmities and the 
 hasty and angry words of your patients. The sick are the most 
 selfish of mankind. Bear with the rude treatment you will 
 occasionally receive from the hysterical and the peevish, whose 
 patience is down to zero and petulance up to a hundred ; and the 
 frenzied, the eccentric, the unreasonable, the impulsive, the irri- 
 table, the weak, the excited, and the low spirited; and do not take 
 anything a sick or silly person says in a paroxysm of anger, or 
 during a period of despondency, or in great pain (or for want 
 of sense), as a personal insult, unless you believe it is deliber- 
 ately and wilfully 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 therapeu- 
 tical means we cannot always attain perfect results or give com- 
 plete satisfaction, and some of those whom you have served 
 most faithfully, and who you think will never change, will sur- 
 prise and shock you by turning viciously against you and decry- 
 ing you loudly. Bear the possibility of this ever in mind, and, 
 while making your relations with your friends and patients cor- 
 dial, frank and free, always avoid telling secrets and making 
 confessions that would put you into their power if a rupture of 
 friendship should ever occur. 
 
 To be overassiduous in paying visits when no sufficient 
 cause is apparent, or to be too deferential and superserviceable 
 to those who think themselves extra good patients, is 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 under- 
 value you and is apt to quit you. 
 
HIS REPUTATION AND SUCCESS. 105 
 
 When urgent necessity or great danger require it, you may 
 let yourself down to do the most menial work for a suffering 
 patient, hut, unless these exist, pulling off your coat or collar, 
 administering injections, giving baths, swaddling new-born 
 babes, nursing the sick, dressing or undressing invalids or mov- 
 ing about the room, rummaging drawers or ransacking cup- 
 boards in search of towels, old muslin for bandages, spoons, 
 goblets, etc., in the presence of other help, as a body-servant 
 would, does not comport with the dignity of your position, and 
 it may be quoted as evidence that you are too familiar and lack 
 proper self-respect. 
 
 It is much better to ask for things you need and have them 
 brought to you. 
 
 A patient who is improving will be satisfied with a much 
 shorter visit, slighter examination, and less perfect attention in 
 general than one who is not doing well, especially if he is doing 
 so well that you can express your emphatic satisfaction with his 
 progress as you leave. 
 
 When a case is obscure, or in the initial stages, be cautious 
 in expressing any positive or unguarded opinion, but in . cases 
 where you can safely do so give an unequivocal, frank, free 
 diagnosis and prognosis that express your full opinion. The 
 habit of stating your views thoughtfully and candidly will com- 
 pel you to search for the underlying cause and to analyze and 
 weigh details closely; will discipline your judgment, and force 
 you to study your cases and mature your opinions, instead of 
 lumping everything under the term "biliousness" (1) or "heavy 
 cold," " effects of malaria," or some other ambiguous name, and 
 prescribing after a moment's conversation, or a hasty catechising 
 of the patient for his most prominent symptoms, without stopping 
 to notice or study the minor ones — as is done by mere routinists. 
 
 A careless or superficial examination of patients, or inatten- 
 tion to the history of tedious cases, neglecting to name a disease, 
 or calling it by a wrong one at the outset, has caused regret and 
 loss of practice to many a physician. 
 
106 THE PHYSICIAN HIMSELF: 
 
 Remember that, contrary to popular belief, the art of medi- 
 cine does not enable you, or any one else, to diagnosticate any 
 of the eruptive fevers positively till their local manifestations 
 appear. 
 
 Frequently when a case is grave and you are being impor- 
 tuned to know whether you cannot do more, it is better casually 
 to mention the things you deem contra-indicated — leeching, cup- 
 ping, mustard, rubbing, baths, poultices, mopping the throat, 
 electricity, etc. — and tell why you have not ordered them, so as 
 to let it be known you are wide awake and have thought of 
 them, but have good reasons for not using them. 
 
 Never pronounce any one's sickness feigned or trifling 
 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 or simple growths that will get well of themselves 
 or that require no treatment, etc.; indeed, you should never 
 joke, talk frivolously, or laugh about your patients or their 
 sicknesses, either in their presence or elsewhere, and never taunt 
 them about the trifling nature of their diseases. Some people 
 will laugh off your treating their slight ailments slightingly, 
 Avhile secretly they feel hurt and resolve never to have you again, 
 but see another physician, or perhaps resort to quack medicines 
 for fear he might also laugh. Another reason is that trifling 
 ailments sometimes become serious diseases, and simple growths 
 sometimes put on malignancy, and their becoming so through 
 fatal loss of time is apt to be blamed on the joker for life. 
 
 Never guarantee a cure, or certain success, or a sure recov- 
 ery, even for a mosquito-bite ; guarantee nothing except that 
 you know your duty and will do it. Medicine is not a perfect 
 science and life is not a definite quantity. When pressed by per- 
 sons who want the consolation of certainty to say that this, that, 
 or the other case of sickness is not dangerous, reply promptly, " Of 
 course, there may be danger, because there is danger in every- 
 thing, and any sickness, even a fly-bite or a pin-scratch, may 
 prove fatal," and that even a well person has no guarantee of 
 
HIS REPUTATION AND SUCCESS. 107 
 
 life from one day to another. Also remind the questioner that 
 you yourself are but a mortal man, and that you do not hold in 
 your hands the keys of life and death, and have not life-giving 
 power; that your will and God's will may differ, and that, since 
 medicine is not a life-insuring science, you cannot guarantee 
 that any case of sickness may not develop some new symptom 
 suddenly and become dangerous or have an unfavorable issue, 
 and even end in death ; then tell him what you think will be 
 the probable issue in the case in point. Remember, too, that 
 while every case presents a scale of probabilities it is surrounded 
 by a group of possibilities, and do not fail to mention this fact, 
 and to leave yourself a reasonable margin for uncertainties. 
 
 In giving death certificates in mania-a-potu, syphilis, abor- 
 tion, etc., never yield to importunities, or a false tenderness for 
 family affliction, and substitute other pleasant-sounding terms 
 that risk putting you in a false position. 
 
 The laws everywhere clothe physicians with honors and 
 quasi-judicial powers that are refused to other classes. You 
 are exempted from military and jury duty, and made an officer 
 of the law regarding insanity, vaccination, etc., and your cer- 
 tificate regarding deaths, births, inability to attend court, and 
 numerous other offices of permanent trust, are everywhere 
 respected, and it is most certainly your civil and moral duty in 
 return to comply cheerfully and promptly with all necessary 
 restrictions and legal requirements — to aid, rather than hinder, 
 enforcement of the medical police laws. 
 
 In giving certificates, it is best to certify, " In my opinion/' 
 etc. Indeed, it is wiser, as well as more modest, in expressing 
 an opinion, whether written or oral, always to say, " I believe 
 thus and so," or " In my opinion," etc. The fact that it is your 
 belief or opinion no one can dispute, even though it should 
 prove erroneous. 
 
 Be exceedingly cautious in giving certificates of insanity, 
 with a view to committing supposed lunatics to an insane 
 asylum. Do not yield to the importunity of mistaken or 
 
108 THE PHYSICIAN HIMSELF: 
 
 designing persons and commit the cruelty of depriving a poor 
 fellow of his rights, liberty, and property because he has tempo- 
 rary insanity, is harmlessly eccentric, or entertains some harmless 
 crotchet, as, for instance, that he is a tea-pot, or that his legs are 
 of glass, or that some lady of high rank is in love with him, 
 while in all other respects he is sane and conducts himself and 
 manages his property rightly. Distinguish between the truly 
 insane as contemplated by law, and those who may only seem 
 to be insane. Dissatisfied friends of such people sometimes 
 give great trouble to accommodating physicians in these cases. 
 Give certificates in none but clear cases, and keep a memoran- 
 dum of all the facts in each. 
 
 Also keep memoranda and observe great caution when you 
 are a witness in will cases, suits for divorce, etc., to protect your- 
 self against traitorous friends and designing enemies. 
 
 Rancorous feuds and venomous contests among those inter- 
 ested in wills and estates will occasionally show you how selfish, 
 bitter and unscrupulous mankind can be over the dead one's old 
 clothes and the dirty dollar. Avoid entanglement. 
 
 Remember that you are legally as well as morally bound to 
 vaccinate a person after promising to do so. Besides the regrets 
 and harsh criticism your neglect will generate, a suit for damages 
 may follow if the patient gets small-pox while awaiting the 
 fulfillment of your promise. 
 
 Never conceal the presence of a contagious disease from 
 those who are interested, or those around who are liable to con- 
 tract it, or misrepresent small-pox as " measles" or cholera as 
 " intestinal catarrh," or yellow fever as " the bilious," etc., as 
 has been done, or you may encounter the condemnation of the 
 whole community. You will be apt to meet with rank opposi- 
 tion to your views, when your decisions concerning the presence 
 of, or danger from, cases of infectious diseases (small-pox, scarla- 
 tina, typhus fever, etc.), and of their origin here, there, or the 
 other place, from local or domestic causes militate against the 
 wishes or supposed interests of hotel-keepers, store-keepers, 
 
HIS REPUTATION AND SUCCESS. 109 
 
 boarding-house mistresses, etc. In such cases do not be brow- 
 beaten into allowing any one to violate the laws relating to the 
 public health. Your duty to the well is quite as great as to the 
 diseased. Indeed, the protection of the public health is of far 
 greater importance than the well-being of any individual. 
 
 When these or any other dilemmas present themselves, 
 adopt Davy Crockett's wise motto, " Be sure you are right, then 
 go ahead." 
 
 Carefully prevent children in whose family contagious dis- 
 ease exists from infecting others by attending school, or other- 
 wise mingling with those liable to contract it from them. Insist 
 upon visitors being excluded from such cases. Also take care 
 that its presence in hotels, stores, etc., is not kept secret at the 
 public risk. 
 
 Never let people know that you are just from a case of 
 small-pox, scarlet fever, measles, etc., or that you are even 
 attending any contagious disease, or you will be credited with 
 causing whatever cases occur among those whom you thus 
 inform. If your practice is so full of such cases that you must 
 tell it to somebody, tell the health authorities ; indeed, the 
 public good requires that you inform them, anyhow. 
 
 After visiting contagious diseases, take care to 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 disin- 
 fecting lotions, etc., according to apparent need ; if necessary, 
 take a warm bath, or even a Turkish bath. 
 
 Oppose the conveyance of diphtheria, scarlet fever, measles, 
 small-pox, cholera, yellow fever, typhus fever, and other conta- 
 gious 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 infecting particles 
 from the dead must not be allowed to kill the living. 
 
 Never keep a tongue-depressor for indiscriminate use, for, 
 besides the disgust which patients feel at having an instrument 
 that has been used on everybody put into their mouths, it might 
 
110 THE PHYSICIAN HIMSELF: 
 
 actually convey syphilis, diphtheria, etc., from one patient to 
 another, and render you liable to just censure. When you wish 
 to examine a throat at the patient's home, it is better to ask the 
 nurse for a clean spoon, than to take a tongue-depressor from 
 your pocket and excite the patient's disgust, and a lively curi- 
 osity among all around to know when and upon what kind of a 
 case it was last used. At your office an ivory paper-folder 
 answers very well, is not disgusting, and is easily kept clean. 
 
 It is both rational and proper to lend a helping hand to aid 
 a worthy friend or great scientific superior, when he has any kind 
 of a case requiring it, or to unite your friendly assistance with 
 any member of the profession where humanity requires, or in 
 any case that will either give you knowledge that you desire, or 
 increase your reputation in a specialty in which you are inter- 
 ested ; but be careful how you lend yourself as a jump-jack to 
 bungling practitioners who would use you as a handicraftsman 
 for their own good only ; or to run about assuming half (or 
 all) of the responsibility in cases of fracture, wounds, luxations, 
 etc., for third- or fourth- rate Sir Astley Coopers ; or to administer 
 the chloroform, hold sponges, etc., in their steel-edged exploits : 
 hacking and hewing, cutting and slashing ; unless you are prop- 
 erly compensated for the work you do, and for the responsibility 
 you take. 
 
 Servility and obsequiousness will never be of any solid 
 benefit to your reputation either in the community or in the 
 profession, but bad results in cases to which you are carried to 
 assist the hero may do you a great deal of harm. It is much 
 better for you, as an aspirant, to come out and stand on your 
 own foundation before the world. 
 
 For somewhat similar reasons, if sickness, accident, or 
 other providential contingency, compels a neighboring physician 
 to ask you to attend patients for him for a short while, whatever 
 you earn should be tendered to him, but if one inclines to neg- 
 lect his business to dissipate, or to pursue pleasure, he cannot 
 expect you to gratuitously attend for him either long or often. 
 
HIS REPUTATION AND SUCCESS. Ill 
 
 Preaching morals to truly vicious patients seldom does 
 much good, as moral distempers are usually too deeply rooted 
 to be overcome by an appeal to the feelings, but you often can, 
 by earnest, truthful, friendly advice and proper cautions, recon- 
 cile the estranged and calm the angry. You can also exert the 
 greatest influence upon patients who have been injured by 
 indulging to excess in chewing, smoking, drinking, singing, 
 dancing, late hours, carousing, venery, the use of cosmetics, and 
 other things that render them liable to disease. Your injunc- 
 tions regarding the weaknesses, follies and errors named, if 
 properly given, will frequently be strictly obeyed. 
 
 When drinkers tell you that they intend to " swear off" 
 for a definite period, advise them, instead of swearing off, to 
 pledge themselves neither to treat any one nor allow any one to 
 treat them to liquor during the prescribed period. This is more 
 manly and more apt to be observed. Treating and the treater 
 make the drunkard. 
 
 The various quack bitters advertised and guaranteed to be 
 " a wonderful discovery " are almost invariably some A'ile com- 
 pound of bad rum or bad whisky, and are the origin of much 
 drunkenness ; you should point out the danger and condemn 
 their use. If a person ivill take alcoholic stimulants, advise 
 him to take them " bare-footed ; " then he will know what kind 
 and how much he is taking. 
 
 If you adopt the habit of presenting your photograph to 
 every one enamored of your professional skill, or of your man- 
 ners, 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 something else equally horrible. You will learn by mel- 
 ancholy experience that the minds of men (and of women too) 
 are subject to rapid changes. Many who would regard your 
 picture with highest esteem this month or this year would tear 
 it down or give it to the hangman the next. Trifles light as 
 
112 THE PHYSICIAN HIMSELF. 
 
 air will sometimes serve to detach 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. 
 
 " A mind fraught with integritj- is the most august possession." — Blaykey. 
 
 Have respect for religion. Your profession will frequently 
 bring you into contact with the clergymen of various denomina- 
 tions. 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, discreet and pious clergyman, 
 " The Messenger of God," who confines himself to his true 
 work, are sometimes more useful to a worn and irritated patient 
 than medicine ; and even where death is near and inevitable, 
 repose and resignation often takes the place of fear and de- 
 spondency when the invalid is skillfully informed of the proba- 
 bility of death. In fact, when cheered and fortified by religion, 
 and impressed with the thought that whatever occurs they are 
 in God's hands, many of the careworn and sick show as little 
 regret upon learning that they will probably die as a traveler 
 does when about to start on a pleasant journey. 
 
 When called to attend cases of angina pectoris, aneurism, 
 organic heart disease, desperate wounds or injuries, paralysis, 
 or other diseases that create liability to sudden death, prudence 
 may require you to conceal the danger of death from the pa- 
 tient, lest he at once give up all hope and be overcome by 
 tumultuous grief, apprehension and terror ; fear may exercise a 
 deadly influence, and has often rendered mild diseases fatal in 
 persons of a nervous constitution. But be sure in such cases to 
 give private warning to those most interested. Allow no one to 
 sink away and die without making the probability known to 
 relatives, friends or neighbors. Be also exceedingly careful in 
 talking before children with scarlatina, variola, rubeola, etc., of 
 the danger of complications, or of their illness being serious or 
 dangerous, and never terrify them when they are to be operated 
 
 s (113) 
 
114 THE PHYSICIAN HIMSELF: 
 
 upon by loud preparations and an awful array of instruments ; 
 also take care to banish from them the fear of hydrophobia, 
 lock-jaw, etc., because many very young children fully realize 
 the meaning of death, and painting their cases in frightful colors 
 would terrify them. Also use suitable caution in speaking 
 within hearing of patients who seem to be sleeping, drunk, 
 semi-comatose, etc. Bear in mind that a person, young or old, 
 is not always asleep when his eyes are shut. 
 
 In this world of short meetings and long farewells it is 
 just as natural to die as 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, suffering 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 a patient has 
 almost entered the gates of death, while all around ■ think, till 
 you tell them differently, that he is getting better. 
 
 In serious illness you can very properly prepare the way 
 for the introduction of the clergyman, but you should never at- 
 tempt to roughly thrust your theological convictions, or religious 
 beliefs, or disbeliefs, or your political tenets, upon patients who 
 hold opposite views. Your specific duty is with the patient's 
 body, and it is really no part of your duty to proselyte or to 
 administer to the religious cravings of the sick. Every sect has 
 teachers of its own, to whom you must leave the spiritual. We 
 are the physicians of the physical body, the temporal life ; they 
 are the physicians of the eternal life, of the soul. Do no theo- 
 logical talking or teaching, and for the sake of spiritual decency 
 advance nothing that you do not believe and feel, that your lips 
 may remain unaffected, and your hands unspotted. Confine 
 your ministrations to the worldly welfare of patients, and never 
 suggest anything in religious matters that involves a creed 
 different from that of the sufferer. 
 
 The great prospect of eternity certainly overshadows all 
 temporal things. Be ever ready, not only to allow, but to advise 
 
HIS REPUTATION AND SUCCESS. 115 
 
 patients to have spiritual comfort. Religion does good, not only 
 hereafter, but here ; indeed, the presence of religious faith point- 
 ing to a life of blessedness and immortality is a power that can 
 assuage the keenest sorrow and suffering, and even makes the 
 avenues to death smooth, and if any physician does not recog- 
 nize it, or, if he feels contempt for religious practices or feelings, 
 he (need I add ?) lacks the a b c of mental philosophy and the 
 rudiments of observation. You will see many a poor, sick, woe- 
 worn, despondent and broken-hearted wretch calmed in mind 
 and soothed in body by its cheering influence, and aided by it 
 to get well, if his ailments are at all curable ; if not curable, . 
 his spiritual wants being supplied by the citation of the promises 
 of the Bible and the repetition of the Saviour's name, and the 
 voice of prayer to a benign Father, he gets faith, calm resigna- 
 tion and joyful hope from it, and becomes willing, or even 
 anxious, for the hour of departure. Indeed, one who has relig- 
 ious hopes is more likely to survive a severe disease and go on 
 to longevity than one who has not. 
 
 The automatic, convulsive agitations, and seemingly anx- 
 ious movements unconsciously made by many of the dying are 
 popularly supposed to be attempts to communicate some remain- 
 ing thoughts, or secrets, or special wish before death. Explain to 
 the friends in such cases that Providence has kindly drawn the 
 veil of insensibility and unconsciousness around the dying one 
 and that he is obtunded and past suffering. The dying struggle 
 is painless to the unconscious patient, but is awfully painful and 
 harrowing to all who witness it. 
 
 It is well that you, as a physician, whether a Roman Catho- 
 lic or not, should be familiar with the following duties required 
 by Catholic patients : — 
 
 When attending in Catholic families be doubly cautious to 
 warn the immediate friends of danger, that the sufferer may 
 receive the last sacraments. 
 
 One of the seven sacraments of the Holy Church of Rome 
 is Extreme Unction. It is believed to purify the soul of the 
 
116 THE PHYSICIAN HIMSELF: 
 
 dying from any sin not previously expiated through other sacra- 
 ments, and to give strength and grace for the death struggle. 
 
 That church teaches that moral responsibility begins at the 
 age of reason; therefore Extreme Unction is necessary for all 
 who have attained that age. 
 
 Extreme Unction is given but once in the same illness, but 
 if the patient has recovered and shortly afterward has the same, 
 or any other kind of dangerous sickness, this sacrament is again 
 necessary. 
 
 Another of the seven sacraments of the Church of Rome, 
 with which you should be familiar, is the Holy Eucharist. 
 
 The Holy Eucharist, sometimes called the Wafer, is be- 
 lieved to contain Christ's whole being, — his body, soul, and 
 divinity. It may be administered frequently in all cases of sick- 
 ness where the patient is confined to the bed or to the house for 
 any length of time, provided he has sufficient reason to make 
 a full confession. 
 
 If the course of the disease in your patient is likely to ren- 
 der him unconscious, be careful to inform the family of the fact, 
 so that the clergy may be called, and the confession be heard, 
 and the Holy Eucharist given before the reasoning powers are 
 obscured. 
 
 Those who are to receive the Holy Eucharist are required to 
 fast, if possible, from midnight until they have received it ; but 
 if you consider that your patient's being without either food or 
 medicine would be detrimental to his welfare, the clergy should 
 be informed. 
 
 Where there is 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 administer, 
 or have administered, conditional baptism to all children during 
 or after birth, when there is the slightest reason to doubt their 
 viability. The following are the conditions and details of con- 
 ditional baptism : — 
 
( HIS REPUTATION AND SUCCESS. 117 
 
 You, or any one else, whether a Roman Catholic or not, 
 are allowed to administer it. A male adult is preferable to a 
 female, and of course a Catholic, if one is at hand, to a non- 
 Catholic. The baptism is given as follows : After procuring a 
 glass or cup of clean water (spring-water is designated, but 
 hydrant, or pump, or any other kind of true and natural water 
 will do), with suitable manner say, "I baptize thee in the Name 
 of the Father," precisely at the word " Father" pouring a small 
 portion of the water upon the child's head; continue, "And of 
 the Son," at the word "Son" pouring another small portion; 
 again continue, "And of the Holy Ghost," and at the words 
 " Holy Ghost " another small portion. 
 
 Remember that in baptism every word must be uttered,; 
 were you to omit even an "of" the baptism would be insufficient. 
 Also remember that the water must be true and natural, and 
 must be poured exactly whilst the formal words are pronounced. 
 So very important are these details that if you arrive after a 
 midwife or other person has baptized the child, carefully ascer- 
 tain whether she has observed the full form and used accurate 
 language. If she has not, and the danger of death continues, 
 you should baptize it again. In such a case it is necessary to 
 pre'face the formal words with, "If thou art not already baptized, 
 I baptize," etc. 
 
 If in a midwifery case the child of Catholic parents is be- 
 lieved to be in danger of dying, it must be baptized. If it is 
 partly born, baptize on its head, if the head is presenting; 
 if not, upon the hand, or foot, or any other part that is born. 
 If no part is born, and if you can reach the child through the 
 vagina, the water must be applied to whatever part can be 
 touched. In all cases of unborn children, preface the regular 
 form with the words, " If thou canst be baptized, I baptize," etc. 
 In such a case apply the water to its body with a syringe, or by 
 any. other plan that will keep the water uncontaminated till it 
 touches the child. 
 
 You will take great risk if you use the forceps in Catholic 
 
118 THE PHYSICIAN HIMSELF: 
 
 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 an immortal spirit to be pre- 
 pared thrice and not go, than to go unprepared; therefore, if ' 
 you err at all, let it be on the safe side. 
 
 You should be careful to give timely notice of danger to 
 all who have unfinished business of vital moment ; persons sud- 
 denly seized may wish to reflect on their awful situation, on the 
 affairs of eternity, to assemble the family, summon friends from 
 a distance, make wills, etc. 
 
 In an adult with almost any sickness you can safely predict 
 that a hearse will be at his door in a few days, at furthest, after 
 tbe pulse has (heart failure) gradually increased to 160. Also, 
 if, after wounds or in acute sickness, he emaciates to two-fifths of 
 his usual weight. 
 
 If you will observe closely, you will find that when a pa- 
 tient is firmly impressed with the belief that he will die he is 
 extremely apt to do so. 
 
 It is very much better for you to avoid leaving your sphere 
 of physician to become a witness to wills; if called upon to do 
 so, decline anyhow if you are not fully satisfied of the mental 
 capacity of the testator, and never take part in interfering with 
 the settlement or division of the estate of those whom you have 
 attended, as you may thereby incur the charge of abusing oppor- 
 tunities which you owe solely to your position as a medical 
 attendant. 
 
 Of course, if a person whom you have served long and 
 faithfully chooses to remember you for it in a corner of his will, 
 if it is done without your connivance, it is lucky and all right. 
 
 In no case be a witness to or executor of a will, when you 
 are made a legatee or heir. 
 
 Be careful to exhibit proper gravity and sincerity when 
 attending very serious cases, and do not obtrude the cry of hope, 
 hope ! when you see no hope. 
 
HIS REPUTATION AND SUCCESS. 119 
 
 If a very ill, sane adult really wishes to know his real situa- 
 tion, whether he is in great danger or likely to die, and asks you 
 the plain question, answer him frankly and truthfully, and state 
 fairly and fully the ground on which your opinion rests, and 
 thus relieve yourself of responsibility ; but, if possible, answer 
 him in bland terms, so as not to appall him and injure him by 
 taking away all hope and substituting despair. With your 
 opinion, give all the encouragement you honestly can, and if you 
 know anything favorable, either in his physical or spiritual 
 condition, mention it as a solace. 
 
 You are at liberty to be silent or to say but little regarding 
 the nature or degree of a person's sickness, but, of course, let 
 whatever you do say, whether much or little, be true. You 
 must not, you can not, put falsehood in the place of truth, even 
 when solacing the sick and dying; for, as a man and a phy- 
 sician, you cannot sacrifice principle or honor for expediency 
 under any circumstances, especially to a person in a terrible and 
 trying situation. But you can, you must, soften the truth and 
 tell it in a proper manner. 
 
 You will find few who have the mental fortitude to enjoy 
 the remainder of life, after they are formally told that their cases 
 are permanent or incurable; and you should be cautious, not 
 suddenly to extinguish the flame of hope, even from those 
 afflicted with lingering maladies, tuberculosis, cancer, Bright's 
 disease, etc., where death approaches slowly, like a creeping 
 shadow, up to the last stage, since persons with those diseases 
 have plenty of time, while the face gradually grows thinner, 
 their eyes dimmer, cheeks paler, pulse quicker, breath faster, 
 limbs weaker, sinking away gradually, to realize their fate. 
 Indeed, you should not, in such cases, tell how many you have 
 attended who died of the same disease, or give a merciless prog- 
 nosis, containing, like a death-warrant, neither hope nor encour- 
 agement, unless you are willing to be replaced by some one, 
 who may do no more good than you, except talking more 
 hopefully. 
 
120 THE PHYSICIAN HIMSELF: 
 
 To tell a patient that he has a grave-yard cough, or that you 
 would not have his throat, or heart, or lungs, or liver, or kid- 
 neys for a thousand dollars, would add the depressing influence 
 of despair to the sedative influence of the disease, and could not 
 fail to destroy his moral will-power, and either murder him by 
 inches or work serious injury to him. 
 
 You can often prevent despondent and anxious patients, 
 whose pulse or temperature has grown worse, or those whose 
 diseased lungs, heart, etc., you are examining, from asking you 
 questions that would compel you to disclose to them your gloomy 
 prognosis, by having ready on your tongue's end questions re- 
 garding their sleep, or appetite, or bowels, or something else to 
 ask the moment you finished listening, counting, or testing ; you 
 thus give them no period of solemn silence, and no fair chance 
 to inquire what you find or think, or to see what thoughts you 
 show. 
 
 We have to do, not only with sickness, but the sick ; not 
 only with death, but the dying. It is for several reasons better 
 not entirely to abandon cases of consumption, cancer, etc., even 
 though they be incurable, or in their last stages ; on the 
 the contrary, keep them on your list, and visit them, at least 
 occasionally, not only that you may give them all the relief you 
 can, but that their friends, both present and absent, may have 
 the very great consolation of knowing that they have full pro- 
 fessional care and comfort up to the very time the dark curtain 
 falls, after the last act. 
 
 At every period of your career aim to convince the world 
 that you, as a physician, are an apostle of hope, of faith, of 
 sympathy, of comfort and of relief, and that your profession is not 
 in league with the grim forces of death and mourning, but that, 
 on the contrary, all its symbols are indicative of health-givino- 
 and life-restoring power. Neither vEsculapius, nor his daughter 
 Hygeia is represented as bowed in tears, with the habiliments 
 of mourning, but we see instead iEsculapius with the serpent 
 coiled around his staff, the symbol of rejuvenescence, and 
 
HIS REPUTATION AND SUCCESS. 121 
 
 Hygeia is seen affording to another warmth and succor — a 
 beautiful symbol of health and preventative medicine. 
 
 Remember that Mr. Death is the physician's great antago- 
 nist, and that when he overcomes your efforts and takes away 
 the spark of life your duty ends. Do not, then, essay to offer 
 up a prayer or make a prolonged stay to administer nervines to 
 relatives or friends, or tender your services for promiscuous 
 duties, e.g., carrying messages, going for the barber, under- 
 taker, etc., but at the earliest suitable moment quietly withdraw. 
 
 Leave the laying out of the body, the application of pre- 
 servative fluids to the face and body of the dead, and all such 
 things, to the undertaker or friends. 
 
 Do not make a habit of visiting the mourning house to 
 view the dead, and even avoid attending the funeral of dead 
 patients, except when it is absolutely necessary. 
 
 Above all else, do not write apologetic letters to the be- 
 reaved, expressing self-reproach for not recognizing this or that 
 fact, or unceasing regret at not following a different course of 
 treatment, and asking forgiveness. If there are facts connected 
 with your relations to the case that require explaining, find 
 occasion to communicate them verbally. 
 
 Avoid all such tricks as assuring a timid patient that you 
 will not lance his boil, but merely wish to examine it, and then 
 suddenly doing what you assured him you would not do. 
 Veracity should, in all situations and under all circumstances, 
 be your golden shield. 
 
 Ours is a checquered life, and humanity in all its varieties, 
 the white and the black, the rich and the poor, the putrid prosti- 
 tute, the outlaw, the boor, the swaggering rowdy whose character 
 can be read on his physiognomy, the reprobate and the thug, 
 Swearing Joe, Thirsty Jack, and Joking Jim will all be repre- 
 sented in your practice. Attend anybody if you must, as your 
 mission is to all sick people, but seek to avoid disreputable 
 places, and do not be hail-fellow-well-met with persons in whom 
 the moral thermometer registers low, as they are more likely 
 
122 THE PHYSICIAN HIMSELF: 
 
 to be a curse than a blessing. Remember always that such 
 people respect no physician who does not fully respect himself. 
 
 Endeavor to establish and maintain a complete professional 
 influence over all patients you attend, for without their faith and 
 their respect you will have to contend not only against the phys- 
 ical condition, but also the mental and moral. 
 
 You have a perfect right to relinquish attendance on a 
 case when you think your interest, or your reputation, or other 
 valid reason requires it ; when you do so, give formal written 
 notice, and let your withdrawal be fully understood, that you 
 may not be held responsible for subsequent occurrences. 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 afterward relinquish or neglect them. 
 
 Never refuse to quit your bed and make night visits to 
 patients who require them ; to do so would be unjust, in that 
 it would put your duty on some other physician, and cause the 
 patient unnecessary suffering, perhaps death, or it might even 
 drive the messenger to a pharmacist for advice and medicine, or 
 open the door to an Irregular, or whoever else could be caught 
 up in the emergency to fill your place. If, however, you charge 
 full night-visit fees for all visits made after bed-time, you will be 
 less often called out at nights and compelled to undergo loss of rest 
 and exposure ; perhaps to go two or three miles on cold winter's 
 nights, or before breakfast, on a half-run or dog-trot, to attend 
 to needless but harassing calls from frightened ailers, who fancy 
 they are about to die, and others who could have sent at a 
 more seasonable time., Unnecessary night visits rob physicians 
 of necessary rest, and even if they bring in fees, and if your life 
 is a busy one, these are not an equivalent for the risk of health 
 from overwork and loss of sleep. 
 
 Be exceedingly cautious about taking degraded or vicious 
 patients, who are to be visited clandestinely, or having married 
 women or young females consult you surreptitiously at your 
 office ; especially, if to have vaginal or other private examina- 
 
HIS REPUTATION AND SUCCESS. 123 
 
 tions made without knowledge of parents or husband. Also, be 
 careful about attending patients from, the effects of intemperance 
 or prostitution, under pretence that they have other than the real 
 disease, in order to shield them, by deceiving their friends or 
 relatives. 
 
 Do not overvisit your patients, and be especially careful to 
 pay but few visits to those with trifling injuries, uncomplicated 
 cases of measles, mumps, whooping-cough, chicken-pox, etc. 
 People observe and criticise a physician's course in all such cases, 
 and if he seems overattentive they are apt to believe either that 
 they are sicker than he admits, which will cause them a great 
 alarm, or that he is nursing and prolonging the case and 
 creating a bill unnecessarily. It is sometimes an extremely 
 delicate point to decide whether a patient needs another visit or 
 not, and how soon. You must learn to judge correctly the 
 proper time to cease attendance in different varieties of cases, 
 so as to satisfy the patient and his friends that you are simply 
 intent on discharging your duty. 
 
 Most people dread the expense of medical services, and 
 excessive attention and numerous visits are rarely appreciated ; 
 a physician who pays but few visits and yet cures is always 
 popular. If you can make known your habit, and get the repu- 
 tation of not paying any but necessary visits, it will be a special 
 feature in your favor, and will almost double your practice. 
 
 A good rule, the only proper rule, is to visit your patient 
 when, and only when, you think he really needs your care, 
 whether once a day, or once in seven days. Never go several 
 times a day without pointing out to him the necessity for it. 
 
 Above all else, avoid running in to visit patients unneces- 
 sarily because you " happen to be in the neighborhood." If 
 you visit on such a plea and charge for it, you may be criticised 
 for making obtrusive visits and forcing unasked civilities, and 
 your bill may be disputed. On the other hand, never visit an 
 ill patient so seldom, or so irregularly, as to induce a belief that 
 you are neglectful. 
 
12-4 THE PHYSICIAN HIMSELF : 
 
 Some well-to-do or oversolicitous people form an excep- 
 tion to this rule, and insist on your visiting them more fre- 
 quently than is necessary, 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 inform the person 
 who will have to pay the bill of the reason for the extra visits, 
 and of the expense it entails, and get his acquiescence. 
 
 During these frequent visits you should avoid a careless 
 bearing, and should avoid becoming what is termed " a friend 
 of the family." Maintain a professional attitude, and that only, 
 and avoid the habit of digressing from the patient to politics, 
 fashions, or other current topics ; for unless you do so he will cer- 
 tainly lose confidence, after which the moral effect of your visits 
 will be lost, you will be shorn of your influence, and will scarcely 
 be honored or even 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 as to make you fear an arrest of improvement or a 
 relapse, it is better to keep sight of it by calling once in a while 
 and letting it be known when you will call again, with an under- 
 standing that if the patient gets worse in the meanwhile, or if 
 he grows so much better as to render your promised visit un- 
 necessary, you shall he notified. This plan is, for many reasons, 
 better than quitting such cases abruptly. 
 
 Chronic cases often do us the greatest injury, for among the 
 surest fruits of neglecting them will be the employment of quack 
 medicines, or the entrance of an irregular or charlatan, whom 
 some busybody has pressed upon them during your absence. It 
 is very mortifying to drop in to see a patient, after prolonged 
 neglect, and see a big bottle of quack medicine, or a vial of pel- 
 lets, or the two tasteless glasses sitting on the table beside him, 
 and hear this or that story of why they changed. 
 
HIS REPUTATION AND SUCCESS. 125 
 
 Earnestness and interest shown in cases are master qualities. 
 They inspire faith and confidence, and are often actually ac- 
 cepted in lieu of extra skill. Imbue yourself with genuine 
 interest in your cases, and you will be sure to show it in a thou- 
 sand ways. 
 
 Make it a study to remember well all that is said or done 
 at each of your visits, so that all you say and do throughout the 
 case may be consistent. Also take care neither to expose a want 
 of memory nor a lack of interest. Were you to ask a patient, 
 "What kind of medicine did I give you last!" or hesitate in 
 your questions, he and his friends would notice it instantly, and 
 think you either felt but little interest in his case or had either 
 a dangerous lack of memory or a worn-out one. 
 
 Try to make your address and manner such that patients 
 will not hesitate to unlock their hearts and fully impart to you 
 their secrets and the nature and seat of their disease, as fully as 
 the pious Catholic would to his Father Confessor. One of the 
 greatest drawbacks to many physicians is that they 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. 
 
 Have but little to do with your patients' family squabbles 
 or with neighborhood quarrels. 
 
 Do not let your wife or any one else know your professional 
 secrets, or the private details of your cases, or the methods or 
 instruments used in their treatment, even though they are not 
 secrets ; few persons like to have their foibles told from house 
 to house — what they said in their delirium, or hoAv they shrank 
 from leech-bites, or gagged at a pill — or to have their whims, 
 fancies, or infirmities exposed. 
 
 Many persons believe that physicians who allow their wives 
 to ride around with them while making visits relate everything 
 that has taken place at the visit after they drive away from the 
 house. Of course, this is not so, but if people think so their 
 discomfort is the same as though it were. 
 
126 THE PHYSICIAN- HIMSELF: 
 
 There is no end to the mortifications, compromises, and 
 estrangements a physician's prying and babbling wife may bring 
 him into by her tittle-tattle. Nothing is more mortifying or 
 hurtful to the feelings of sensitive patients than to hear that the 
 details of their cases are being whispered about from ear to ear, 
 as coming from the physician, his trumpet-tongued wife, or other 
 busybodies whom he or she has told. 
 
 If you allow yourself to fall into the habit of giving out 
 the latest inside news, or of speaking too freely even of ordinary 
 affections, or submit to be indiscriminately interviewed by chatty 
 people from Meddlesome Row concerning your patients, your 
 very silence in disreputable cases will betray them. The credit 
 of whole families and the character of their individual members 
 will sometimes be at stake, and unless you shut your eyes and 
 do not see too much and your mouth and do not say too much, 
 it may ruin them and involve you. 
 
 Indeed, -many persons suffering with venereal diseases are 
 so much afraid that their family physician might reveal the 
 secret that they would sooner suffer the ravages of the disease, 
 or apply to a quack, than to run that risk of exposure and 
 disgrace. 
 
 You will be, to a certain extent, an honorary member of 
 every family you attend, and will be allowed to see people in a 
 very different light from that by which other people view them: 
 when their spirits are humbled in the hour of pain and the day 
 of distress. The community see one another with a veil thrown 
 over their moral and physical afflictions ; over their strong pas- 
 sions and feeble control ; over their blasted hopes and the sor- 
 rows that flow from their love and hatred; over their poverty, 
 their frailties, their crimes, and their vexations ; over their cruel 
 disappointments and rude mortifications, their follies and dis- 
 asters, their fears, their delinquencies, their solicitudes. You 
 will see their deformities, infirmities, and deficiencies with the 
 inner veil lifted and the book of the heart wide open ; you will 
 see grief and joy, anger and shame, hope and despair, and will 
 
HIS REPUTATION AND SUCCESS. 127 
 
 hear conversations that it would be exceedingly wrong to re- 
 hearse; you will, in short, become the repository of all kinds 
 of moral and physical secrets. Keep them with Masonic 
 fidelity. 
 
 Love, or debt, or guilt, or shame, or anxiety for revenge may 
 prey on the mind of a sick person and actually convert a simple 
 into an incurable disease. As these things are apt to be kept 
 concealed from you, it is necessary for you to be ever mindful 
 that they are important agencies in the causation and intensifi- 
 cation of disease, and to be prepared for their early recognition. 
 
 Observe reticence at your visits, and do not mention the 
 private affairs of anybody from house to house. Seal your lips 
 with a seal as solemn as that of death to the fact that patients 
 have, or ever had, venereal diseases, haemorrhoids, fistula, rup- 
 tures, leucorrhcea, or constipation ; or that abortions, private 
 operations, etc., have taken place ; or that any person takes ano- 
 dynes or liquor ; or that Mrs. had a baby too soon after 
 
 marriage, or that had one without being married at all ; or 
 
 that Mr. is addicted to secret immoralities, has or has had 
 
 a venereal disease, or has this, that, or the oth$r,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. 
 
 But while silence should be your motto, it is your duty to 
 society and to the State to expose and bring to justice abortion- 
 ists, unprincipled quacks, and other heartless vampires, whether 
 acting under cover of a diploma or not, whenever you meet with 
 proof of their wicked work. But never directly charge any one 
 with dishonorable or criminal conduct unless you have at hand 
 ample and unequivocal proof of his wrong-doing; for, if you 
 are without it, the accused is sure to find a loop-hole, or to 
 make an indignant denial, and cunningly bring against you a 
 counter-charge of malicious persecution. 
 
 In prescribing medicines for the sick, it is better to confine 
 yourself to a limited number of remedies with whose uses and 
 
3 28 THE PHYSICIAN HIMSELF: 
 
 powers you are fully acquainted, than to employ a larger 
 number of ill-understood ones. 
 
 Memorize the rules for dosage, and keep in mind the max- 
 imum and minimum quantities given of every article you admit 
 into your list of remedies. 
 
 AVhen you order unusually heavy doses of so-called poisons, 
 instead of using the common signs, take care either to write the 
 quantity out in full, or to underscore both name and quantity, 
 or in some other unmistakable way show on the prescription 
 that you are aware of all that is written. A good plan is to 
 write at the bottom, " The above is just as intended." Again, 
 when you write for a potent article that is but seldom used, it is 
 well to also add its common name, that the pharmacist may feel 
 no doubt as to what is intended. It is safer also to put the 
 names of heavy-dosed patients on their prescriptions. When 
 you order morphia, etc., in unusually large doses, it is well to 
 have it made into pills and 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 attend- 
 ants against taking or giving them in mistake. "When you 
 prescribe pills, powders, etc., for sailors and other persons whose 
 business 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. 
 
 You may occasionally have a patient who persists that he 
 is conjured, or that a pin or fish-bone is lodged in his throat 
 after examination has proven there is none; or syphilophobic 
 and anxious to take medicines after a chancroid; or morbidly 
 afraid of hydrophobia or lock-jaw; or the victim of this, that, or 
 the other vagary, hallucination or whim ; who cannot be con- 
 vinced by all your assurances that his ailments or forebodings 
 are imaginary. When all else fails, as it is your object to cure, 
 it may become as clearly your true and manly duty to employ 
 such remedies as are adaptable to the case on hand, demanded 
 
HIS REPUTATION AND SUCCESS. 129 
 
 by the mental condition of the patient, and are likely to satisfy 
 his mind and relieve his psychical disease through psychological 
 impressions, or the action of mind on mind, as it is to give any 
 one ponderous doses for a gross physical ailment. Any remedy 
 or expedient honestly intended to aid in relieving such a patient 
 is called a placebo. Giving a placebo in such a case is a very 
 different thing from practicing upon and increasing a patient's 
 fears, as is done by the charlatan. Despise not policy, but let 
 your policy consist in honorable expedients. 
 
 A placebo should, as a rule, be small and easy to take ; 
 mild tonics, the bromides, the valineates, and other harmless 
 agents are usually employed. 
 
 Be careful to keep a straight face and to give exact 
 directions concerning the time and manner of using remedies 
 intended to act chiefly through the mind, and they will do 
 double good. 
 
 You will not only find that almost anything will relieve 
 some of these mental cases, but you will be further surprised 
 to learn that they are chanting its praise and vowing that they 
 were cured of one or another awful thing by it. Some who 
 seem to be magically benefited by doses of — nothing — will 
 actually thank them for saving their lives. What a sad com- 
 ment on the intelligence of the nineteenth century ! What a 
 sad fact for us that sugar-water, etc., often receive as much 
 (presto, be gone !) praise as the truest remedies ! What a har- 
 vest such people supply for those who live by fleecing ! 
 
 Make none but an honest and proper use of mental reme- 
 dies (leave juggling and all that is dishonorable to disreputable 
 pretenders), and if you happen to have the required medicine 
 give it gratuitously and charge for advice only ; if not, write for 
 something that is inexpensive and simple. 
 
 Never send a patient to a drug store with a prescription for 
 bread pills. It is not right to make any one pay money for 
 anything that has no intrinsic value ; besides, if among all the 
 simple tonics, nervines, etc., in the pharmacopoeia you cannot 
 
130 THE PHYSICIAN HIMSELF: 
 
 devise some recognized agent that is more valuable to a depressed 
 patient than bread pills, you must have a great paucity of 
 resources. Moreover, were a patient to discover that he had 
 been paying his money for such an inert thing as bread pills or 
 colored water, he could not help feeling victimized and indignant. 
 
 Just here let me impress a caution : to believe too much 
 and not to believe at all are both unfortunate mental conditions 
 for those who practice medicine. Take care that your mind is 
 not led into an exaggerated view of the importance and power 
 of drugs. Remember the example of the old woman of Paris 
 who filled bottles with water from the river Seine, sold it as a 
 cure-all, and heard of so many cures wrought by it on all sides 
 that she died (with a bushel of certificates of cure in her trunk) 
 fully convinced that the (polluted) water of that river was a sure 
 cure for all the ills of the human race. Also guard against the 
 opposite error, that medicines are useless and unnecessary; either 
 view would materially impair, if not destroy, your fitness for the 
 practical duties of your profession. 
 
 The very shape and fashion of medicine have changed with 
 the present generation, and eight-ounce bottles and thirty-two- 
 ounce bowls of bad-tasted purgative, expectorant, or diaphoretic 
 medicines are (thank Providence !) seldom seen. 
 
 The vast majority of people are now sensible enough to 
 avoid every-day medicine taking, and to take remedies only 
 when sickness demands, and even then not too much; but 
 taking a little " searching " medicine that " scours " four or five 
 times, or a bottle of salts, or of cream of tartar, or ten and ten 
 of calomel and jalap for " clearing the constitution," in the spring 
 of the year, still has patrons, who believe in it just as the good 
 housewife believes in spring and fall house-cleaning ; and cathar- 
 tics and other depleting remedies are still popular with the few 
 who cling to the old forty-years-ago mania for purging, 
 sweating, and cleaning the blood. 
 
 These people always want to see and feel promptly and 
 fully the action of medicines, and some of them think they could 
 
HIS REPUTATION AND SUCCESS. 131 
 
 scarcely live a month unless they had almost turned themselves 
 wrong side out with pills, salts, etc. Consequently they incline 
 to purge themselves entirely too often. Remember that when 
 nature is depended on, the bowels ought to act daily, of at least 
 freely once in two or three days; for when nature moves the 
 bowels the lower portion only of the intestinal cavity is evacu- 
 ated, and during the interval, before the next passage, the faeces 
 from above come down and are in turn evacuated ; 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 evacuation without the aid of medicine, to give a purga- 
 tive once in three or four days is sufficiently often. 
 
 Never solicit people, either by word or manner, to employ 
 you; for such a course would surely repel them, or at least pre- 
 vent your enjoying the necessary esteem. 
 
 Many families are naturally fickle and capricious, and can- 
 not be depended on to adhere to you, even from one day to the 
 next ; no matter how earnestly one tries to serve and satisfy them, 
 they will quickly become wearied and disheartened, and will in- 
 sist upon consultations even in the most trifling ailments ; per- 
 haps change about with astonishing rapidity — first from one phy- 
 sician to another, then to a prescribing druggist or irregular 
 practitioner, and will finally wind up with a quack medicine, or 
 a quack doctor. Others, truer, will .adhere to you with steady 
 confidence, through thick and thin, good and bad, with surpris- 
 ing tenacity. You should found your hope of being retained, 
 no matter what class of patients you are treating, upon deserv- 
 ing it. Do not, however, set your heart or faith upon the con- 
 tinuance of the patronage and friendly influence of any one, for 
 you will many a time be unceremoniously replaced, after days or 
 weeks of unremitting attention, by those whom you know to be 
 in head and heart far below you in everything that goes to con- 
 stitute a good physician. Sometimes, after you have shown every 
 attention, spent sleepless nights, and done all that is possible, 
 
132 THE PHYSICIAN HIMSELF: 
 
 you will be unexpectedly and unjustly dropped by a family, and 
 Dr. Lowebb, or Dr. Pettyhook, or Dr. Bobtail (who spends half 
 his time in trading horses and talking politics), or an old lady, 
 or an Irregular, will supersede you, and you may have to bear 
 the reflection, the ingratitude, and the wrong without showing 
 the slightest chagrin. 
 
 Poor people, when rapidly raised to wealth (from dirt to 
 delirium), often not only move from the old house to a mansion 
 in a different section, sell their old, shabby furniture and buy 
 new ; pull off plain clothes and put on fine ones ; cut old ac- 
 quaintances and seek new ones ; but, as if to efface all the past t 
 even their old physician, who has stood by them through every- 
 thing, is abandoned. 
 
 Ability promptly to detect loss of confidence, or dissatisfac- 
 tion with yourself or your remedies, is one of the acquirements 
 which, if you do not already possess, you must seek to attain. 
 Remember that continued suffering, protracted confinement, un- 
 satisfied suspense, and disappointed expectation of convalescence, 
 all tend to produce impatience and dissatisfaction in the mind 
 of the patient and among his friends, and to create strong doubts 
 of your knowledge, skill, or judgment. 
 
 If in any case you say that the patient will positively die, 
 unless the fact is obvious to all, it will probably be speedily 
 used as a pretext for changing physicians. 
 
 A patient has a legal right to dismiss you from a case at 
 any time, provided it is done decently and in order, 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 either retire from it 
 formally or discontinue your visits are your only alternatives. . 
 
 When you find it necessary to withdraw from a case, en- 
 deavor to do so in a courteous manner, as it is not incumbent on 
 you to break off all friendly relations on this account. 
 
 Whenever dismissed from a case, consider attentively the 
 combination of circumstances that conspired to produce the dis- 
 
HIS REPUTATION AND SUCCESS. 133 
 
 missal, and how you might have averted it, that you may, by 
 self-analysis and self-training, gain additional familiarity with the 
 art of doing your duty acceptably, and of retaining your patients. 
 
 Some people, indeed whole families, who will almost idolize 
 you as long as you are lucky and have no unfortunate cases, nor 
 deaths in their families, will turn as rudely and maliciously 
 against you, as soon as either occur — as if you kept the book of 
 life and controlled the hand of God. 
 
 When you are unjustifiably dismissed from a case, espe- 
 cially if it is to make room for an Irregular, or bloated quack, 
 do not consent tamely to be thrown aside in such a manner. 
 Express your perfect willingness to retire, but make known in a 
 polite, gentlemanly way, that you expected fair play and cour- 
 teous treatment, that such dismissal wounds your sensibilities, 
 casts undeserved reflection on you, and injures your reputation 
 in the community ; to all of which you cannot be indifferent. 
 Such a protest will not only enable you to vent your mortifica- 
 tion, disappointment, and disgust, but will also secure for you 
 greatly-increased respect, and will counteract the injury conse- 
 quent upon your dismissal better than if you meekly submit 
 without protesting. 
 
 In acutely painful cases, large, even heroic doses of mor- 
 phia or other potent medicine are often required, and must be 
 given promptly, as hours, or even minutes, may decide the re- 
 sult ; care must, of course, be taken that the total amount be 
 not sufficient to poison the patient. Here is a case in point: 
 A gentleman known to the author had cholera morbus; a 
 physician was called, who prescribed for him twelve opium 
 pills, one to be taken every six hours. In that case the phy- 
 sician was fatally slow in his therapeutics, for long before the 
 time to take the second pill had arrived the soul of that pain- 
 racked sufferer had taken its flight to a land where medicine is 
 not needed and six-hour intervals can do no harm. Take care 
 to avoid his error, and never leave long intervals between the 
 doses for patients suffering acute pain. 
 
134 THE PHYSICIAN HIMSELF: 
 
 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 repeat- 
 ing. 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 intervals, decreasing the 
 dose each time to one-half of that which preceded it. 
 
 There is a popular belief that opiates are given only to allay 
 or relieve pain, not to cure the sickness. Opiates are not only 
 palliatives, but by controlling pain, lessening functional motion, 
 etc., they are powerful curatives in a long list of diseases. 
 
 The laity expect you to examine your patient at every visit. 
 Let your first examination be specially thorough ; omit nothing 
 that can shed light on the case, and never neglect the following 
 five cardinal duties : To feel the pulse, to examine the tongue, 
 to inquire about the appetite, the sleep, and the bowels. No 
 matter what the case may be, take care to attend to these and 
 all other evident or special duties at every visit. 
 
 Whenever symptoms render it probable that hernia, carci- 
 noma uteri, Bright's disease, or heart disease is present ; or that 
 the throat is diphtheritic, or the ear occluded by wax ; or that a 
 tumor or an aneurism exists ; or that one's femur is fractured 
 within the capsular ligament, or his shoulder is dislocated ; or 
 that a patient is pregnant, or has placenta prsevia, or a uterine 
 polypus ; or that any other condition exists which, if overlooked, 
 might imperil the patient's life and possibly make you feel the 
 pangs of remorse for having committed a grave mistake, or sub- 
 ject you to disgrace or diminished dignity if discovered by 
 another, you should always make an immediate and thorough 
 examination, and it would even not be out of place if you hinted 
 gently at your suspicions. 
 
HIS REPUTATION AND SUCCESS. 135 
 
 If you are careless or neglectful in these matters you will 
 often be surprised to see another, who has been called into con- 
 sultation, or who has superseded you, discover the whole truth 
 of the case ; not so much from his superior skill, but because he 
 made some examination or inquiry that you omitted. 
 
 To mistake a tumor for pregnancy, or vice versa, is one of 
 the most mortifying and damaging of errors. To be attending 
 a female who has been ailing for weeks and months, and who 
 proves to be pregnant, is also very damaging, unless you have 
 recognized and declared that fact, since, if you have not, her 
 entire illness will be charged to the pregnancy. You will be 
 lucky if you get your fees in such cases without dispute. 
 
 Never ask an unnecessary question, yet be careful to make 
 every inquiry needed in order to learn all the facts, and to satisfy 
 everybody that you feel an interest ; if you neglect this, you 
 will risk both error and loss of confidence. 
 
 Prompt detection of dangerous changes, or of the approach 
 of death, will not only protect you, but will give you eclat if 
 you point them out before the patient or friends observe them. 
 
 Never speak of anything you do for a patient as an experi- 
 ment, or for curiosity ; everybody, everywhere, are opposed to 
 physicians "trying experiments" upon themselves or theirs. For 
 the same reason it is not discreet to give certain patients the 
 sample bottles of new pharmaceuticals that will be so liberally 
 sent to you for trial, or to let any one know that he is the first 
 to whom you ever gave this or that medicine ; or that his is the 
 first case of that kind of fracture, or of small-pox, or of hernia, 
 or of anything else that you ever attended. 
 
 You should keep a register or a reference-book for collecting 
 and retaining particularly good remedies, prescriptions for stub- 
 born diseases, and important things that you have seen, heard, 
 read, or thought. Such a record possesses continual interest and 
 more value to its owner than any other book in his library. Also 
 have a clinical case-book or a diary for recording the date, diag- 
 nosis, treatment, etc., of unusually important cases. Nothing im- 
 
136 THE PHYSICIAN HIMSELF: 
 
 presses a patient who has a complicated or long-standing disease 
 with a conviction that you are steady and industrious, and that 
 you are interested in him, and that you intend to try your utmost 
 to do him good, so much as to know that you keep a regular 
 record of his case. 
 
 Besides, these records will furnish you important cases for 
 relation at the societies or for publication in the journals. 
 
 When truth will allow, let your diagnosis either include 
 the patient's belief or fully nullify it, that his mind may not dis- 
 trust your opinion or antagonize 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 frac- 
 ture — by showing it to him in the books than by a hundred 
 verbal statements. 
 
 Demonstration to a patient or his friends of certain diseases 
 and injuries that admit of it, by comparing, in plain language, 
 the affected parts to sound ones on a well-drawn pencil-sketch, 
 or a. diagram on a prescription paper, gives great satisfaction, 
 makes them understand that you understand, and does good. 
 
 Study to be fertile in expedients, and never confess, or 
 allow the inference, that you are hopelessly puzzled about a 
 case, are at your wit's end, or have reached the limit of your 
 resources. 
 
 Never be too sanguine of a patient's recovery from a serious 
 affliction, and never give one up to die in acute disease unless 
 dissolution is actually in progress. Wiseacres say that "the 
 only way to get well after a physician gives you up is to give 
 him up "(?). Above all else, never withdraw from a case of acute 
 or self-limiting disease because the patient is very ill and more 
 likely to die than to live ; for the human system can often endure 
 a great deal and still live. It is highly comforting to anxious 
 relatives or friends to know that the physician stands ready and 
 willing to do more, if opportunity offers. 
 
 If a patient is unable to swallow, think of the oesophageal 
 
HIS REPUTATION AND SUCCESS. 137 
 
 tube, or if food taken into the stomach is not assimilated con- 
 tinue your efforts with inunctions of cod-liver oil or oil and quinia, 
 rectal alimentation, etc., until he is either better or the breath is 
 out of his body ; for nature, by a crisis, or a vicarious function, 
 or a compensatory process, or the tardy action of the remedies 
 you have used, may turn the scale and let the life-power, or the 
 natural powers of a vigorous constitution, rally and gain control 
 over the disease at the very verge of life. Under such circum- 
 stances, if you have given up the case as hopeless, you will be 
 disgraced, while some brother-physician, or an irregular, or an 
 old woman, who has stepped in at the lucky moment, vill reap 
 all the glory of setting the laws of nature aside, and bringing 
 back to life one already mourned as dead. 
 
CHAPTER VI. 
 
 "He is most free from danger who, even when safe, is on his guard." 
 
 — Publius Syrvs. 
 
 You will have to foresee thousands of snags that lie.in the 
 professional current to catch the unwary. When in doubt 
 whether duty requires you to do a thing or not, between doing 
 nothing and a dangerous operation, if all else is equal, remember 
 that the sin of omission is, in appearance at least, not so great 
 as the sin of commission. 
 
 A very safe guide, in determining what line to pursue in 
 grave or puzzling cases, is to imagine yourself to be in the 
 patient's dilemma, and then ask yourself, What would I have 
 done] 
 
 The most skillful physician may and often does get results 
 that he deplores, but, with every care, is powerless to prevent ; 
 therefore summon professional assistance in all ugly fractures, 
 critical cases, capital operations, etc., where you think there is 
 the least danger of an unsatisfactory termination, and of your 
 being blamed for the loss of life or limb, or sued in consequence 
 of that result. Having assistance not only divides the great 
 responsibility, but also constitutes one a teller of truth for the 
 other, and by making each the guardian of the other's character, 
 prevents criticism, charges of unskillfulness, or of mis-diagnosis, 
 and causeless suits for malpractice. Remember that the com- 
 munity seem to think that physicians can and must restore 
 broken bones and injured tissues as perfectly as the Creator 
 made them, no matter what the injury may be ; and remember 
 also that when a fracture, or dislocation, or a disfiguring wound, 
 or accident of any kind, recovers imperfectly, or with deformity, 
 or shortening, or deviation of any kind, or contracted tendons, 
 or rigid cicatrices, or a limp, or requires a cane or crutch, there 
 is danger of its being shown ever after as a botch or failure, and 
 
 (139) 
 
140 THE PHYSICIAN HIMSELF: 
 
 becomes a lasting and lingering libel on the medical attendant's 
 reputation. A badly set limb, or an unnecessary or bungling 
 amputation, injures our whole profession, and the limb or stump 
 may be held up in court in a suit for damages ; therefore, the 
 responsibility had better be divided. In this respect medical 
 and surgical practice differ — the results of sickness usually dis- 
 appear, while those of unsuccessful or unfortunate surgery 
 remain, and, if bad, may induce wicked, jealous rivals, tricky 
 lawyers, or other conspirators to help cast you into the fiery 
 furnace of a lawsuit. 
 
 Among the reasons why many malpractice suits spring 
 from surgical cases, and but few from medical ones, are these : 
 Although one is as liable to a prosecution by the laws for medi- 
 cal as for surgical malpractice, it happens that medical cases are 
 treated in a more private manner, and may each be treated in 
 numerous ways ; and persons interested, even though dissatisfied 
 with the result, are not competent to judge of the physician's 
 skill and treatment to the extent of a suit ; whereas the ampu- 
 tation of limbs, the adjustment of fractures, the reduction of 
 dislocations, the management of wounds, bandaging, etc., all 
 depend on a knowledge of anatomy and on manipulative dex- 
 terity, and are all open to public observation and criticism ; and 
 the methods proper to pursue in any case are so well agreed 
 upon by surgeons, and the results aimed at are so obvious, that 
 even the vulgar may criticise and prophesy. Having anatomy 
 for his foundation, and the science of surgery for his guide, the 
 surgeon is expected to follow certain definite rides, to have in- 
 fallible foresight, to overcome all surmountable difficulties, and 
 to get a perfect result. If he does this eclat awaits him, but if 
 he gets a bad result, and is presumed to have omitted any duty, 
 the painful task of vindicating himself against a lawsuit may 
 follow. 
 
 The sooner your account with a dissatisfied patient is 
 settled in one way or another after your services are no longer 
 required the less likely you will be to have a lawsuit, and, if 
 
HIS REPUTATION AND SUCCESS. 141 
 
 you do have one, the sooner after the services are rendered the 
 better, while witnesses are still accessible and all the unfavor- 
 able influences are fully remembered. 
 
 Remember that you have no right to do more to a patient 
 under anaesthesia than it was agreed to do. To put a patient 
 under chloroform to amputate a finger, or to remove an eye, and 
 then to amputate the whole hand or both eyes, would give great 
 reason for blame. 
 
 Keep your surgical knowledge at your fingers' ends ; medi- 
 cal cases can be read up as they progress, but a broken limb, or 
 a dislocated bone, or a wound, will not wait, and you must be 
 ever ready to treat them correctly. 
 
 Bandages, either too tightly applied or under which the 
 tissues have swollen and constricted the circulation, have been 
 a fruitful source of blame and lawsuits. 
 
 Always take the precaution, both for the patient's protec- 
 tion and your own, to listen to the heart's action immediately 
 before administering an anaesthetic ; and to watch the respiration 
 during the administration — withdrawing the agent on the least 
 approach of blueness of the face or lips. Always have reliable 
 assistants present, and have it in your minds to hang the patient 
 head downward the moment alarming weakening of the heart's 
 action, or of respiration, occurs. When possible, have another 
 physician present whenever you produce anaesthesia, or narco- 
 tism, more especially if the patient is a female. Also, have a 
 third person present at all sexual examinations of females, espe- 
 cially at your office, to disprove possible hallucinations regard- 
 ing either improper words or deeds, and to avoid scandal and 
 the traps of designing people. 
 
 Here, I may say, beware of personal violence. Midnight 
 desperadoes may lead you into their traps by feigning sickness, 
 and then rob or murder you ; or* your brute, crazy with drink ; 
 or your homicidal maniac; or your fever-tossed patient who 
 knows not what he does ; or your lunatic with a delusion ; or 
 the infuriated fellow in whom you have made a wrong diagnosis 
 
«142 THE PHYSICIAN HIMSELF: 
 
 or given the wrong medicine ; or the unreasoning tiger in whose 
 family you have had sad deaths, or unfortunate surgery, or of 
 midwifery ; or the insane wretch whom you have through kind- 
 ness sent to an asylum ; the thug, the fanatic, the madman — 
 any blood-thirsty demon may suddenly assault and try to maim 
 or kill you. 
 
 All anaesthetics are dangerous ; refuse to give them in tri- 
 fling cases of minor surgery, and where a moment's fortitude on 
 the part of the patient is all that is required. Such occasions 
 do not justify the risk. 
 
 Never examine a female to ascertain whether she is illicitly 
 pregnant, at the instance of parents or others, without her own 
 full consent to the proceeding. 
 
 Such exclamations as " Oh no, Doctor, it cannot be that 
 his arm (or leg) is broken, for he can work his fingers (or 
 toes) " will often greet you when you pronounce that a bone is 
 fractured. This error is due to the fact that people think that 
 the fingers and toes are moved by the bones, not by the muscles. 
 It sometimes becomes even necessary to explain this in defense 
 of the opinion you have given ; every one of us can move our 
 tongues, which have no bones. 
 
 Patients of the fair sex, whether virgin, wife, or widow, some- 
 times hesitate to allow the physician to make examinations that 
 require uncovering the body, or to allow him to see the under- 
 clothing, simply because their bodies or their underskirts are 
 unclean and unfit to be seen, while the physician supposes that 
 they refuse through modesty on account of the exposure. In 
 many such cases it is better, instead of insisting on an imme- 
 diate examination, to respect their delicacy in the matter and 
 allow an opportunity for a change of linen, etc., by appointing 
 another time for making the examination. 
 
 Cnrious-minded husbands sometimes show a determination 
 to remain in the room during vaginal examinations, or during 
 operations necessitating exposure of their wives' persons, and 
 you will feel tempted to ask them to retire that they may escape 
 
HIS REPUTATION AND SUCCESS. 143 
 
 the indelicate sight, and you the embarrassment. If asked to 
 retire, some might refuse to go, or do so with anger or jealousy. 
 The better plan in such cases is to inform the husband that you 
 are about to begin what your duty requires you to do, and he 
 will probably retire of his own accord, unless specially requested 
 to remain. 
 
 Expertness in detecting and contravening the various kinds 
 of scandal and calumny admits of cultivation to a great degree ; 
 so also does ability to foresee and escape entanglement with the 
 captious and the bad, also with silly tattlers, the fraudulent, etc. 
 
 Key-hole and back-window scandal-mongers, and malicious 
 liars, will also often lie in ambush for you, trying to make some- 
 thing out of nothing. These must be met and checkmated by 
 the most available means. To judge what is best to be done 
 tinder the circumstances is sometimes a most annoying and 
 puzzling question. 
 
 Jealous midwives, ignorant doctor-women, and busy neigh- 
 bors, and Job's comforters too, often exert a malign influence, 
 and tell tales, give instances of ignorance and of lack of atten- 
 tion, or circulate other falsehoods and rumors about physicians 
 that must be noticed and thwarted according to the necessities 
 of the case. 
 
 Tact and nice discernment in establishing and maintaining 
 a proper attitude toward nurses and other attendants on the 
 sick is a valuable gift that will prevent or counteract possible 
 machinations. Love of approbation is natural; to give attend- 
 ants credit on proper occasions for faithfulness is not only just 
 and gratifying to them, but makes firm friends of them ; more- 
 over, such public indorsement secures co-operation and encourages 
 them to do their best to maintain the reputation which you have 
 given them. 
 
 A bad nurse may render a curable case fatal by improperly 
 indulging the patient's appetite for food or drink, or by neglecting 
 to give him medicine, drink, diet, etc., at the proper time, or in 
 the manner directed; or by appropriating his food or robbing 
 
144 THE PHYSICIAN HIMSELF: 
 
 him of the liquors you suppose he takes; or by keeping him 
 too hot or too cold, or giving him too much or too little fresh 
 air ; or by getting drunk, becoming careless, etc., etc. 
 
 The conciliation of anxious, captious, impatient, or dissatis- 
 fied friends of the sick, when sickness is not progressing satisfac- 
 torily, requires great skill and profound study of human nature. 
 
 In serious or strange cases, and in such as engender great 
 public excitement, if you indulge in confidential or semi-confi- 
 dential whispers to the trumpet-tongued rabble, or incautiously 
 give out daily bulletins to them regarding the patient's pulse, 
 temperature, respiration, excretions, discharges, etc., it may give 
 rise to misrepresentation, or even to total perversion of what you 
 really did say or mean, and your statements may come back to 
 you so changed as to require tedious explanations from you. 
 Be ever on the alert for this danger. Tf necessary, give your 
 opinion to the proper persons in writing, to prevent its being 
 misconstrued or misquoted. 
 
 When a sick person puts himself under your care he gives 
 you a responsible duty to perform. % If he then neglects or re- 
 fuses to take your remedies, or obeys your instructions in a half- 
 way or imperfect manner, he ties your hands and frustrates your 
 efforts for his relief, and cannot hold you to full responsibility in 
 the case. If, however, he will not or can not 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 antipathies, whims, pr 
 childish weaknesses, and modify or alter your therapeutics so as 
 to meet his wishes and ability. This you can do good-naturedly, 
 without fully yielding to him or compromising your authority 
 or your dignity. The wishes, prejudices, impulses, and errors 
 of headstrong and fastidious patients must be studied and to a 
 certain extent respected. To do this is a matter of policy, and 
 is very different from yielding a question of principle. If a 
 patient is determined to use an improper or dangerous agent, 
 you should of course refuse your sanction. 
 
HIS REPUTATION AND SUCCESS. 145 
 
 Never captiously oppose a remedy because it is suggested 
 by a layman. The most ignorant person may make a wise sug- 
 gestion ; and laymen often talk excellent sense about facts which 
 have come to their notice. Listen patiently to all sensible prop- 
 ositions, 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 may in some 
 cases even humor a whim and sanction the use of harmless 
 domestic (Grandmother) remedies, — saffron-tea, plasters, onions 
 to the feet, etc., in conjunction with your more reliable agents. 
 
 Make it a rule to accord persons credit for well-meant deeds, 
 even though they may be valueless in themselves; also, when 
 possible, to approve domestic treatment employed before you 
 were sent for; at least, do not condemn it iii a violent or offen- 
 sive manner. Listen patiently to those around while they relate 
 how they did the best they knew, and do not pooh-pooh, shrug 
 your shoulders, or smile sarcastically, and thus harmfully be- 
 little their honest efforts to relieve the sufferer. 
 
 Your cordial approval of their catnip-tea and other simples, 
 used in good faith with true and loving motives, will redound 
 greatly to your credit, and greatly enhance your reputation for 
 kindness and sympathy. 
 
 When attending certain classes of very ill patients, e.g., the 
 wife of a druggist or the child of a physician, if there is any 
 simple remedy in which they have great faith and which they" 
 Avish to try, every consideration should incline you, unless there 
 is some clear contra-indication, to cordially acquiesce and allow 
 it, in conjunction with your other means. 
 
 It will be a trying ordeal when you, by accident, meet an 
 
 "old lady who has a never-failing salve," good for anything 
 
 from mosquito-bites up to tuberculosis. You will find her so 
 
 full of faith in herself and in her great catholicon that neither 
 
 10 
 
146 THE PHYSICIAN HIMSELF: 
 
 reason nor ridicule can shake it. Be fair and reasonable with 
 her, and treat her with decent respect ; but if you feign a mild 
 attack of awe, or indiscreetly chop logic with her, and concede 
 to her remedy any recognition beyond its actual merits, or take 
 her into confidence or semi-partnership in the treatment of a 
 bone felon, or an ulcer, or a wound, you will make her the hero 
 of the case and fill her matronly head as full of conceit, and of 
 mischief, too, as the sea is of water. 
 
 Cultivate the quality of being a good listener, and let a 
 patient tell his story in his own way, although tedious. Hypo- 
 chondriacs, the hysterical, the garrulous, the mildly insane, and 
 various other kinds of chatty bores, chronic wrecks, and per- 
 petual invalids will sometimes come to your office, and want to 
 murder an hour of your time with annoying or unnecessary 
 questions, or exaggerated descriptions of their ailments, for 
 which a whole apothecary shop might be vainly prescribed ; or 
 persecute you with the details of their business, or a tedious 
 history of their family affairs, with a whole Pandora's box of 
 sighs and laments, when you have no time to waste and yet are 
 indisposed to be rude ; and tarry so long after the consultation 
 proper is ended that you actually wish you could say something 
 bad, or fly out at the window and get away from them. 
 
 Some of these you will have to freeze out by chilling cold- 
 ness in their reception. If you tell them as they come in that 
 time is very precious with you, they cannot deem you uncivil, 
 and will be brief, unless unusually pachydermatous. If you are 
 greatly annoyed, keep a placard posted with "Please be brief, 
 as I am busy to-day." 
 
 To rid yourself of undesirable would-be patients will be 
 one of the most difficult dilemmas that will confront you. If 
 you are " Too busy to attend" or "Not at home," they are proba- 
 bly the most unassailable of all reasons in these cases. To 
 assume charge of a sick person and afterward neglect him is a 
 great wrong. 
 
 You have a right to absolutely decline to take charge of a 
 
HIS REPUTATION AND SUCCESS. 147 
 
 case, but if you do assume the duty it constitutes a contract 
 in which you agree to give proper attention and your best skill. 
 To take charge and afterward neglect him is a great wrong. It 
 is very much better to plead having too much other business, or 
 any other true reason, and not take undesirable cases at all, 
 than to take them, involve yourself, and afterward relinquish 
 them, and be open to criticism and abuse. 
 
 When you receive calls to cases that from any cause you 
 can not or will not attend, notify them of that fact, that they 
 may get some other physician, in order that the patient may be 
 saved from delay, and you from the annoyance of repeated mes- 
 sages and solicitations. 
 
 No one can blame you for not being at home when you are 
 needed, since you cannot be everywhere at once ; 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. It is much 
 easier for a lawyer to refuse to take a client, or for a mechanic 
 to decline a job or a merchant a sale, than for a physician to 
 refuse to go to a case. 
 
 If you have a friend whom you would like to see called to 
 a case that you decline, mention him to them by name. You 
 can advise them to send for Dr. A., or B., or C, or D. If you 
 have anything against Dr. E., be careful to avoid saying, "Do 
 not send for Dr. E. ; " merely omit to mention him. You are 
 not bound to recommend a man, but you might have some sub- 
 sequent unpleasantness were you to practically denounce him. 
 
 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 con- 
 sultant or assistant to your protegS if things get serious ; 
 whereas, if, instead of recommending 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 troublesome or presump- 
 
148 THE PHYSICIAN HIMSELF: 
 
 tuous patients or their wiseacre friends or relatives, who will 
 make meddling inquiries, examine and cross-question you, and 
 rudely thrust their opinions on you, or challenge you to contro- 
 versy, and presume to discuss your diagnosis and your remedies 
 with you, and parley about the merits of various medicines. 
 Most of these are as full of doubts, beliefs, and destructive 
 theories as a lemon is of acid — foreknowing and prejudging all 
 you do, frequently thwarting your every effort — possibly drawing 
 the curtain aside after your back is turned, and exposing to 
 everybody things that should properly remain your professional 
 secrets. If you write a prescription for gonorrhoea, or cough, 
 or almost any other ailment, many a presumptuous patient or 
 his keen friend will read it to you and actually comment, or 
 offer to argue on it. You will be often harassed and cross- 
 examined by such self-constituted Solomons, and compelled to 
 resort to various expedients to satisfy or foil them, and avoid 
 collision with their whims, insinuations, and prejudices. In 
 fact, from this cause, the good effects of mystery, hope, expecta- 
 tion, and will-power are of late almost entirely lost to regular 
 physicians ; all special confidence is sapped, and all you can 
 expect in many cases is the gross physiological action of your 
 medicines on the stomach and bowels, and prejudice and fear 
 actually do much to thwart even that. Such meddlers will 
 make your duty difficult, and often actually aid in making 
 curable diseases fatal. 
 
 When you prescribe a mixture of two or more articles that 
 such a patient is familiar with, take care to make him under- 
 stand that to judge the relative proportions needed of each 
 ingredient is just as important as the ingredients themselves. 
 
 The presence of self-important sick-room critics, with jeal- 
 ous eyes and unbridled tongues, will, if you are at all timid, 
 often impair or destroy your usefulness, by either diverting your 
 mind from your case, or lessening your concentration, and may 
 even lead to mistakes in diagnosis or treatment. Consciousness 
 of being watched by those hoping to detect some flaw, or under 
 
HIS REPUTATION AND SUCCESS. 149 
 
 unfriendly criticism, will, in many cases, embarrass you, to 
 some extent cloud your judgment, and, of course, lessen your 
 usefulness. 
 
 It is better to leave your directions about medicine, food, 
 etc., with the nurse, or whoever is in charge, than with the 
 patient. Leave no room for unpleasant mistakes or queer 
 blunders. Tell when and how every remedy is to be used, and 
 leave nothing to the discretion or guess-work of patients or 
 nurses. " A few drops," " a little," " a pinch," " a sip," " a 
 swallow," " a gulp," " a thimbleful," " a mouthful," " a hand- 
 ful," " a cupful," " big as a peach," " the size of a bean," etc., 
 can each open the door for big mistakes. 
 
 Give all your directions at one time instead of in scattered 
 fragments, and take care to make them precise and complete, 
 and if you have doubts whether they are fully understood make 
 the person you have given them to repeat them to you. 
 
 School yourself till you can prevent your thoughts, embar- 
 rassments, and opinions from showing in your countenance 
 during anxiety and emergencies, and, above all, discipline your 
 features and manner, so that nervous and ill patients cannot 
 detect in you unfavorable reflections about themselves which 
 you wish to conceal. 
 
 Never prescribe large quantities in acute cases, as they may 
 change from day to day or even from hour to hour ; 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 some acute cases 
 it is even wiser to order only sufficient medicine to last from one 
 visit to the next. 
 
 To set aside unused medicines and order others in such a 
 way as not to impair confidence requires a great deal of clever 
 management. In many cases where a remedy is ceasing to be 
 useful, or indications for something different are appearing, it is 
 better not to stop the old abruptly, as though it were wrong or 
 
150 THE PHYSICIAN HIMSELF: 
 
 doing harm, but, instead, to instruct them to set it aside at 
 
 o'clock and then begin with the new. 
 
 Patients will rarely complain of the price of medicines 
 that are taken, but they will observe the waste and criticise you 
 when you set one remedy aside and order others. A good plan 
 is to order the empty bottle in which one medicine was gotten 
 to be washed and carried to get the next in. A medicine that 
 has been discontinued is very rarely again indicated. When you 
 stop one remedy 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 prescribing. 
 
 Be also guarded against ordering patients to buy expensive 
 instruments, reclining chairs, supporters, braces, atomizers, or 
 other costly articles, unless you are very sure they will answer 
 the purpose and will be used. It is no credit to the physician 
 
 to .have people exhibiting this or that article which cost 
 
 dollars, ordered by him, but for one reason or another never 
 used, and now referred to as a shameful instance of ill-spent 
 money. 
 
 You will occasionally encounter patients who have been 
 kept in a furnace of anxiety and terror for months or years (hell 
 on earth) through the deception of some rapacious and shame- 
 less quack, or the ignorance of some novice in the profession, 
 who has pronounced them syphilitic and painted the ravages 
 and horrors of that disease to them in the blackest colors, when 
 in fact they have really never had even a sign or a symptom of 
 that disease. 
 
 It is torment enough for those who really have constitu- 
 tional syphilis to go through life filled with gnawing 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 produce unnecessary alarm and distress 
 
HIS EEPDTATION AND SUCCESS. 151 
 
 in the minds of those whose chests you examine if, after your 
 scientific movements, you tell them of " a slight deposit in the 
 apex," "an abnormal resonance," a bruit de didble" "rales," 
 " a palpitation," " a disordered rhythm," or other, to them, omi- 
 nous symptom or harbinger. Take care never to say or do any- 
 thing which will unnecessarily fix the mind of a patient on the 
 character of his breathing, the action of his heart, etc., and then 
 leave him in unsatisfied suspense and darkness. 
 
 You will occasionally meet persons who have been told by 
 Dr. Longface years ago that their lungs were gone and that they 
 would not live a year, or that they had this or that affliction 
 which would destroy them in less than such a time. Such un- 
 necessary forebodings cast discredit on the profession, and should 
 draw upon those who make them the severest censure. 
 
 God only knows how many young women in our land are 
 now nervous and dyspeptic, with hollow eyes, sunk in deep dis- 
 tress, because tormented with apparitions of " womb complaint," 
 which have no existence except in Dr. Scarecrow's imagination 
 — young women who, had the subject not been suggested to 
 their minds, would have lived a happy lifetime with scarcely a 
 thought of having a womb. 
 
 The chief reason why womb-doctoring might tempt to 
 untruthfulness, and why there are so many spurious cases of 
 womb disease, is obvious. When a man is told he has a luxated 
 shoulder, or a cataract, or a hernia, or a cancer, he finds many 
 ways to confirm or refute the physician's opinion, and he can 
 also see what the treatment is doing for him ; but when a miser- 
 able woman, morbid on the mysterious subject of" womb disease," 
 "gets examined" by Dr. Bugaboo, and is told, with a lengthened 
 and solemn phiz, and with the force of a proclamation, whether 
 correctly or incorrectly, that her womb (like many a nose) is 
 " turned a little to one side," or " is down," "ulcerated," " dislo- 
 cated," or "affected," it tallies exactly with her fears ; and, shrink- 
 ing from both the expense and the exposure to be endured if she 
 were to consult another physician, she naturally submits to the 
 
152 THE PHYSICIAN HIMSELF: 
 
 mechanical fumbling and to the monetary exactions of whoever 
 has made that examination — possibly recovering from morbid 
 states that never existed and paying for cures never performed. 
 If there is a wretch meaner than all others in the sight of God it 
 must be the physician who, void of moral sense, would exag- 
 gerate the nature of a case and terrify the sick simply for dollars 
 and cents. 
 
 It is also cruel to tell patients indefinitely that their trouble 
 comes from their heart, or kidneys, or liver, or lungs, or that 
 they have the " liver complaint," or "kidney disease," or that 
 their lungs are "affected," when there is only some slight or 
 temporary affection of these organs. And it is still more cruel 
 and unwise to predict immediate or impending death, even if 
 you discover serious organic disease of lung or heart. The 
 duration of life will depend on many circumstances that you 
 cannot always foresee— the carefulness and prudence of the 
 patient, the conservative powers of the system, the compensative 
 efforts of nature, etc. You know that a man's liver, or his 
 lungs, or his heart may be deranged this week and well next; 
 but many people think that if any of these organs are affected 
 in any way it is necessarily permanent, and it gives them con- 
 stant anxiety. Many people are at this moment living in as 
 great anxiety as though a sword were suspended over them by a 
 hair, because they were told long ago by old Dr. Vinegar that 
 such and such an organ was affected, without explanation being 
 given of the functional or temporary character of the derange- 
 ment. Contrary to the belief of the laity, and of some phy- 
 sicians, sudden death rarely occurs in heart disease, except in 
 aortic obstruction and regurgitation. By explaining the differ- 
 ence between temporary ailments and those of a permanent 
 character, or the difference between a functional and an organic 
 affection, you will avoid magnifying real ailments or creating 
 imaginary ones, and give many a patient perpetual sunshine in 
 exchange for constant gloom. It is your duty, at least, to avoid 
 all ambiguity of language in such cases. 
 
HIS REPUTATION AND SUCCESS. 153 
 
 In nervous, hysterical, and impressible persons it is pos- 
 sible to convert a slight or even an imaginary complaint or 
 functional trouble into a serious one by fixing their attention on 
 the organ deranged ; hence, in these cases, ignorance is bliss, 
 and the physician should divert the mind of the patient as much 
 as possible from the real or supposed seat of disease, even if he 
 has to treat it unconsciously to the patient. 
 
 Even our instruments of precision can be used in such a 
 manner as to become objects of dread and terror. That excel- 
 lent instrument, the (try life) clinical thermometer, often tells 
 from day to day the unwelcome truth that fever continues, till it 
 seems to the patient and those around that you are measuring 
 how long he has to live, and almost wish it had never been in- 
 vented. Try to prevent, if possibe, such results of its use. 
 
 Many now rush to the vaginal speculum on the slightest 
 pretext. Never make an examination with it unless a correct 
 diagnosis imperatively demands. 
 
 Be especially careful not to allow patients' attention to be 
 fixed on their urine. Some persons have a morbid tendency to 
 watch this excretion, and only need a discouraging word from 
 a physician to make them as anxious about their kidneys — 
 apparitions of Bright's disease, diabetes, gravel, etc., arising 
 before their distempered vision — as some women are about their 
 wombs. 
 
 You will also have patients lacking in the salt of wisdom, 
 generally soft-bearded youths who have not yet cut their last 
 molar teeth, who come tormented with evil forebodings over 
 conditions that are either imaginary or perfectly natural : some 
 because they have discovered that their left testicle hangs lower 
 than the right, or because their scrotum remains contracted 
 or relaxed ; others terribly alarmed because they have in exam- 
 ining 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, bastardy, or moral accusation, reluctance to sin, 
 
154 THE PHYSICIAN HIMSELF: 
 
 or disgust for the woman, has thwarted their attempts to 
 copulate with loose women and led them to imagine them- 
 selves 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. A good chance to go crazy. Remember in all such cases 
 that your opinions are your capital, and charge your full fee, 
 even though you write no prescription. With them the charge is 
 for banishing fears and anxieties, and giving valuable information 
 and satisfaction. 
 
 Be careful to warn all these sexual hypochondriacs against 
 the curse of falling into the hands of " manhood restorers," Filthy 
 Pseudo-scientific Anatomical Museum Impostors, their terrifying 
 plates and their models of venereal diseases, and other "friends 
 of erring youth," who advertise through pamphlets on the 
 evils of spermatorrhoea, masturbation, etc., and tell them of the 
 mischief such skulking impostors inflict on their victim's health, 
 and also of their merciless, never-ceasing voracity for money. A 
 whole book could be filled in telling how these fellows wring 
 money from their victims as you would the water from a sponge. 
 
 "Oh ! for a whip in every honest hand, 
 To lash such rascals naked through the land." 
 
 It is doubtful whether the various medical guide-books for 
 the people, Dr. Solomon Wiseacre's " Family Medical Guide," 
 Professor Scolasticus Lollypop's "Every One His Own Phy- 
 sician," and the hosts of others, do any one much good, while 
 it is certain that they do a great deal of harm, by filling people 
 with imaginary wisdom, and emboldening them to try their 
 hands at doctoring cases that require a physician, till either 
 great suffering or permanent injury is entailed, or probably life 
 itself sacrificed. 
 
 Are not the attempts of such works to teach the laity how to 
 treat diseases like trying to teach one how to read when he does 
 not know how to spell 1 
 
HIS REPUTATION AND SUCCESS. 155 
 
 The eight or ten very large papillae seen upon the base of 
 every one's tongue often occasion great anxiety, upon being dis- 
 covered by overanxious laymen, while looking into their throats 
 for syphilis, diphtheria, or ulcers. Great relief is expressed 
 when they are told that these are natural. 
 
 You will be often consulted by true syphilitics, who wish 
 to know what would be the result of their marriage. Never 
 promise certain immunity against future outbreaks ; and do not 
 sanction marriage, unless it has been at least three years since 
 they contracted syphilis, and at least one year since they had 
 any evidences of. the disease. They should even then marry 
 only under hygienic and therapeutic restrictions. 
 
 When a patient, alarmed about his health, consults you, if 
 you want fully to satisfy him by your opinion, be earnest, and 
 let attention to his case overshadow all you say or do ; above 
 all, do not divert his conversation from himself to extraneous 
 subjects. If it be at your office, 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 
 newspaper or novel you are reading, or of the cane you are 
 twirling. If he diverts the conversation from his case to 
 anything foreign bring him back at the first opportunity. 
 
 Never promote immorality by recommending sexual inter- 
 course as a remedy for self-pollution, nocturnal emissions, hyper- 
 activity of the sexual system, spermatorrhoea, hypochondriasis, 
 emotions, acne, sexual excitement, priapism, prostatitis, or any- 
 thing else. If persons with disorderly or unruly passions, or 
 those subject to these affections choose to run the risk of syphilis, 
 or gonorrhoea, or bastardy, or exposure; or to commit rape, 
 adultery, or self-pollution, let it be on their own responsibility, 
 not on yours. Perfect chastity is entirely compatible with good 
 health ; and I know of no disorder, either of body or mind, in 
 which fornication is necessary, but I do know it is far better to 
 grow up pure in mind and body. 
 
 Remember that night emissions recurring occasionally in 
 
156 THE PHYSICIAN HIMSELF: 
 
 young men partake of the nature of an overflow from seminal 
 plethora, and are perfectly compatible with health. Young 
 men, almost crazy with dread and remorse, will often consult 
 you about these emissions. You will find that almost every 
 one attributes them to self-pollution in boyhood. The results 
 of self-pollution are, as a rule, not half so dire and destructive 
 as commonly supposed; when the nasty, unnatural habit is 
 stopped, its results are usually quickly recovered from. 
 
 Consumptive females whose bloodmaking power is de- 
 stroyed by their disease naturally cease to menstruate. They 
 then attribute their decline to absence of the menses, while 
 in reality the absence of the menses is due to the decline and 
 consequent loss of bloodmaking power. When such patients 
 appeal to you to restore their menses, you must explain why 
 they have ceased, and that they will not menstruate again till 
 their health and bloodmaking power improve. 
 
 Consumptives sometimes have hectic fever so regularly at a 
 certain hour, day after day, that they and their friends are per- 
 suaded that their sickness is malarial in character, and if you 
 are not on the alert they may mislead you into giving an 
 erroneous opinion to that effect. If quinia does no specific 
 good for the daily fever of a weakly or broken-down person, 
 you should suspect that it may be hectic rather than malarial 
 fever. 
 
 The popular belief that one is boohed for consumption 
 because a parent, or brother, or sister died of it, is true only in 
 a limited sense. If the relative's disease was part of his law of 
 development and was in his charter of life, developing just 
 when the rose-bud becomes the full-blown flower, it should 
 indeed excite serious fears in every one who has the same char- 
 ter, the same constitutional bias. But if his disease began after 
 his physical development was fully completed, or from an acci- 
 dental cause, the law of heredity does not apply. One whose 
 father, mother, sister, or brother died from phthisis, the sequence 
 of bad hygiene, pneumonia, etc., is not thereby compromised, 
 
HIS REPUTATION AND SUCCESS. 157 
 
 as that variety is not hereditary unless his father had it at the 
 time when he begot him, or his mother had it during pregnancy 
 or nursing. Only about thirty-six per cent, of those who die 
 of consumption inherit it. 
 
 One person in every seven firmly believes that he has 
 either heart disease or consumption, while those really affected 
 with either are rarely willing to admit it, the consumptive gen- 
 erally to the last calling it a bad cold. You will find that 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 or question them at all, unless 
 you have time to do so thoroughly, for your opinion and treat- 
 ment 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, with its flushed 
 cheek, brilliant eye, and husking cough, for it is humanity's 
 great destroyer. Many once gay and happy are now sunk into 
 deep distress, "because doomed by it to a certain and lingering 
 death. 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, dreading every change of weather and 
 every variation of temperature, 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 sunlight, 
 electric, and other health-giving influences from their bodies, 
 overheat their skin, and keep it constantly relaxed, and, of 
 course, reduce or destroy their natural resisting power, so that 
 when they go into cold air, or into a draft, the result is like 
 jumping from the climate of Cuba into that of 1 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 bed- 
 
158 THE PHYSICIAN HIMSELF: 
 
 rooms 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 there is more nervous energy and a person 
 has more resisting power while awake than during sleep, which 
 makes the system more able to withstand cold. 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 overdry, impure air, while the inmates 
 are blissfully believing it is tempering and rendering pure and 
 moist all the air passing over it. A very large wet towel or 
 folded sheet hung before the opening is much more effective. 
 
 Many newborn children are unwittingly exposed to the bad 
 effects of cold from lack of knowledge on the part of those in 
 charge. The popular belief is that if the nurse puts plenty of 
 clothes on a shivering babe she has done all that is needed ; 
 whereas, if the little babe — whose heat-generating power is 
 naturally very feeble, after a prolonged oiling, and soaping, and 
 washing, and turning, and wiping, and bandaging— is put into 
 clothes in a cold condition, without further attention, hours or 
 days may elapse before its feeble heat-making power can bring 
 on a reaction and warm its blue feet and cold nose. Ice is put 
 into woollen cloths or blankets to prevent it from melting ; cold 
 bread wrapped in a blanket would never warm itself, but if 
 warmed and then wrapped in a blanket it would retain its heat 
 
HIS REPUTATION AND SUCCESS. 159 
 
 for some time. Take care that the newborn babe is kept warm. 
 As soon as it is dressed it should be nestled against its mother's 
 bosom till warm ; if this does not suffice, it should be kept near 
 the fire till the coldness is banished. 
 
 Remember that the act of nursing not only supplies the 
 babe with nourishment, but also communicates the mother's 
 heat, and possibly electricity, or some other occult but useful 
 influence ; at any rate, it can do no harm to have all hand-fed 
 babes nestled to some one's warm, bare breast at intervals of a 
 few hours, in exact imitation of those that suck. 
 
 The ancient custom of clothing infants in flannel, with 
 woollen socks, during hot weather creates discomfort and invites 
 sickness. Its harmfulness should be made known to such as 
 you find following it. 
 
 There is a widespread popular error, partaken of to some 
 extent even by physicians, regarding the object of lancing chil- 
 dren's gums. When a physician lances or rubs a child's 
 swollen gums, he does so, not solely to let the tooth through, 
 nor does he expect it instantly to pop through the opening, but 
 his chief object is to sever the innumerable small nerves that 
 ramify through the gum, and thus relieve the tension, irritation, 
 danger of convulsions, etc. No one should incise or rub 
 through a child's gums, except when these evils are present. 
 
 There exists so much prejudice on this subject among cer- 
 tain people, that if you lance their sick child's gums and he 
 dies despite of it you will risk being damned by them for 
 doing it. 
 
 There is much less popular opposition to rubbing children's 
 teeth through with a thimble, spoon-handle, or any other suit- 
 able article, than there is to lancing them ; awd the contused 
 wound made by rubbing is less apt to reunite than a clean 
 incision. 
 
 " Doctor, my child gets the phlegm up, but instead of spit- 
 ting it out he swallows it again," is a stereotyped expression. 
 If he does, it makes but little difference, as he swallows it, not 
 
160 THE PHYSICIAN HIMSELF: 
 
 back into the windpipe or lungs, but into the stomach, where it 
 becomes unimportant. Of course it is unnatural for a child to 
 spit out before it is over three years of age. 
 
 It is a. popular belief that crossness in sick children argues 
 favorably, and there often seems to be a great deal of truth in 
 it, as it requires considerable strength and energy to exhibit 
 crossness. At any rate the reappearance of tears in the child's 
 eyes when crying is a favorable sign. 
 
 Never poh ! poh ! or make fun of mothers because they 
 believe their children have worms, for in some instances they 
 are correct in their opinions, and if you scout the idea and fail 
 to give a trial remedy you may be chagrined to learn that after 
 they left you they went to some drug store, purchased a quack 
 vermifuge, and sure enough brought away worms, and are ex- 
 ultingly telling it as proof that you were wrong and they were 
 right. Such cases are a cause for blushing, and do one's repu- 
 tation no good. It is better, when worms are suspected, to 
 respect such opinions and desires and give some harmless ver- 
 mifuge, even though it do no other good than to test the fact 
 and satisfy the mother. Mothers are generally acute observers, 
 even though not good prescribers. 
 
 It is better in every kind of case to allow a certain degree 
 of weight to the opinions of the patient and his attendants, 
 ' especially those who sit up with him at night ; not that you 
 should surrender your judgment for their exaggerated appre- 
 hensions or palpable errors, but, at least, listen to what they 
 say, and consider their opinion in making up your own. They 
 see him the whole twenty-four hours, while you see him but five 
 or ten minutes a day. The apparently causeless fears and 
 predictions of nurses and friends are sometimes surprisingly 
 confirmed, and the self-sufficient physician's prophecies corre- 
 spondingly unrealized. 
 
 Many people think it is of no use to call a physician to 
 sick infants, because they are unable to make any verbal com- 
 munication, or to place their hands on the seat of their diseases 
 
HIS REPUTATION AND SUCCESS. 161 
 
 to assist him in making a diagnosis. This opinion is erroneous, 
 for the diseases of infants are usually simple in character, and 
 their symptoms, being neither disguised, concealed, nor exag- 
 gerated, can be read and correctly treated by any wise physician. 
 
 Condemn the keeping of commodes in bedrooms, as they 
 are a dangerous source of diphtberia, typhoid fever, and other 
 tilth diseases. Also, direct that the alvine discharges in all con- 
 tagious diseases and the sputa of consumptives shall be either 
 disinfected or destroyed. 
 
 Every worthy housewife courts the reputation of keeping 
 a clean house, and. one of the proofs of her skill is the absence 
 of bed-bugs, fine-tooth-comb insects, roaches, and other vermin 
 from the premises. If you ever notice such things about a re- 
 spectable patient's body, clothing, or bedroom, affect not to see 
 them, as nothing is more deeply mortifying than to have any- 
 thing of the kind noticed and pointed out by the physician. 
 Also, be oblivious to all mortifying accidents, immodest mistakes, 
 or the accidental exposures that so often occur in the sick- 
 chamber. 
 
 The terms scarlatina and scarlet rash are now in everybody's 
 mouth, and are spoken of by the laity as harmless affections, 
 under the belief that scarlatina is a slight affection, bearing 
 about the same relation to scarlet lever that varioloid bears to 
 variola. There is no such disease as scarlet rash, and the cases 
 to which these terms are applied are usually either scarlet fever 
 or rotheln (German measles), and unless people are made to 
 understand this neglect and great damage may ensue. 
 
 Bringing out the eruption is one of nature's processes in 
 
 measles, scarlatina, small-pox, etc., but there is no doubt that 
 
 the large quantities of saffron-tea, ginger-toddy, hot lemonade, 
 
 etc., used by grannies to bring them out do more harm than 
 
 good, by disordering the stomach, inflaming the eruption, etc. 
 
 This " bringing out the eruption," when uncomplicated, had 
 
 better be left somewhat to nature ; when it is complicated, 
 
 something more reliable than teas is indicated. 
 
 u 
 
16£ THE PHYSICIAN HIMSELF: 
 
 There is also a popular belief that all skin diseases result 
 from humors in the blood that must be driven out, or, if already 
 out, kept out till killed by blood medicine, much the same as 
 one would drive rats from their haunts and keep them out till 
 annihilated. No patient will object to your driving his humor 
 out, or killing it, but if he thinks you have simply driven it in, 
 woe to you if he should afterward have any severe or fatal sick- 
 ness. In such cases it is well to give an internal remedy, 
 whether local treatment is used or not. In some cases, where 
 great fear or strong prejudice exhibits itself, it is even better to 
 commence the internal treatment eight or ten days before begin- 
 ning the local. 
 
 There is a popular expectation of evil and a popular readi- 
 ness to blame the physician if any new symptom appear after 
 he suddenly arrests or cures diarrhoeas, periodical bleedings, 
 foot-sweat, or chronic discharges of any sort, etc. 
 
 Many persons suppose boils and various eruptions to be 
 healthy. Even if they are, most people will agree that some other 
 mode of health is decidedly preferable. This belief is probably 
 founded on the fact that during convalescence after certain serious 
 diseases a crop of boils often appears, seemingly from a revival 
 of the energies, or vital forces of the system, from the depressing 
 influence of the disease. The fact of their coming being coin- 
 cident with reorganization and returning health probably ac- 
 counts for the belief that boils and health naturally go together. 
 
 The high color of the urine occasioned by activity of the 
 skin in patients whose sickness compels them to lie in warm 
 beds or to keep in hot rooms, also seen in well people who 
 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 accidentally 
 
HIS REPUTATION AND SUCCESS. 163 
 
 swallowed, some old lady is almost sure to give a dose of castor- 
 oil, thus liquefying the contents of the bowels and compelling 
 the intruder to travel the entire length of the alimentary canal 
 alone, instead of allowing the faecal matter to remain as a 
 mass to include it and prevent its edges and comers 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 
 in those agitating moments instinctively raise his head, instead 
 of lowering it as they should do, thus prolonging the syncope 
 and endangering life. 
 
 In all cases where great debility and pallor are present, be 
 careful to instruct the attendants to keep the patient's head 
 low, and to prevent him from rising suddenly for any purpose, 
 and from sitting up too long, for fear of fatal syncope. 
 
 "If the dog that bites a person goes mad, the one bitten 
 will also," has caused many a valuable dog to be killed. The 
 truth is, if the dog's mouth or teeth contain hydrophobic 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, all inquiries as 
 to its madness are cut short, the disproof of the disease is made 
 impossible, and the person bitten and his friends are left to all 
 the terrors of uncertainty. 
 
 A hydrophobic dog is said to never live longer than ten 
 days after it becomes so ; therefore, if a dog bites a person, it 
 should by all means be allowed to live beyond this period to 
 ascertain beyond doubt whether it has hydrophobia or is harm- 
 less (1). 
 
 Foolish laymen will occasionally tell you, in a boastful 
 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 
 
164 THE PHYSICIAN HIMSELF: 
 
 laws of small-pox, syphilis, gonorrhoea, hydrophobia, typhus fever, 
 and such affections, are very different from what they imagine ; 
 that fear cannot give them to cowards, women, or children, who 
 stay outside of their influence, and that lack of fear will not, 
 can not, protect nurses, friends, old people, babes, or braggarts, 
 if exposed to them. 
 
 You will often be asked what physicians carry or what they 
 use to protect themselves against the epidemics they face. So it 
 always should be, but so it sometimes is not, for we do not always 
 escape; yet a fearless heart, a cheerful mind, and love of duty 
 often do seem at such times to unite with hygienic precautions 
 to protect us while we do battle, while the cowardly fellow who 
 flees from the epidemic would probably die if he were to stay. 
 
 There exists a popular prejudice against damp houses, leaky 
 roofs, night air, dews, etc., which is probably carried entirely too far. 
 Dampness is, of course, inimical to health when mould, absence 
 of fresh air and sunlight, filth, noxious gases, or other defective 
 conditions, or disease-producing elements are added to it ; but 
 neither life on board of vessels, nor the presence of excessive 
 dampness, as in rainy weather, is in itself unhealthful. Dark 
 houses and basement rooms, where the natural light does not 
 reach, are, of course, unhealthy. 
 
 The low-spirited and morbid will often refer to the fullness 
 or qniptiness of the veins on the back of their hands, and count 
 the •wrinkles, as evidence that their blood is drying up, or that 
 they need bleeding, or that they have consumption. Explain 
 to them the entire lack of value of such conclusions. 
 
 When liniments are applied to the extremities for swell- 
 ings, pains, etc., the popular custom is to rub outward toward 
 the fingers and toes, aiming, thereby, to rub the disease down 
 and out ; while physiology tells us to aid the impeded circula- 
 tion by rubbing toward the heart, — a fact that is impossible to 
 make people appreciate. 
 
 As purgatives after confinement, many physicians order 
 simples, castor-oil, seidlitz powders, etc., instead of writing regu- 
 
HIS REPUTATION AND SUCCESS. 165 
 
 lar 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 coincidence, she has hyper-purgation, or puerperal fever, or 
 hemorrhages, or if syncope or anything else follows, she will 
 be apt to believe firmly that your mysterious purgative caused 
 her sickness ; and if she happen to die you and it will be 
 blessed. 
 
 Admitting or excluding those who wish to visit the sick, 
 and allowing or forbidding ill-timed visits or fatiguing conversa- 
 tion with ill patients, or within their hearing, require great deli- 
 cacy and tact. Exclude gossips and bores from the bedrooms 
 of those who are seriously ill, but try to so manage the. matter 
 as to engender no personal enmities. Also endeavor to acquire 
 expertness in answering anxious questions about such cases. 
 Never attempt to exclude the parents, near relatives, or Ministers 
 of the Gospel, or other privileged persons from the room of a 
 very ill person, and never interdict bibles, prayers, and religious 
 exercises, except for the most urgent and obvious reasons, or you 
 may raise a very natural whirlwind of indignation against you. 
 
 To interrupt public business and travel by roping or barri- 
 cading the streets, because somebody is sick in one of the houses, 
 is seldom either necessary or justifiable, as most dwellings have 
 back rooms into which the sick one can be taken out of reach 
 of the noise of travel ; make it a point to advise the latter course 
 instead of the former. Where the former is not feasible, a good 
 bed of tan on the street will completely prevent the rattle of 
 passing vehicles. 
 
 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 show inconsistency of 
 manner or speech, or to do anything else that would indicate 
 abstraction, lack of memory, or incompetence. 
 
 You will find that you will inspire more faith in a prescrip- 
 
166 THE PHYSICIAN - HIMSELF. 
 
 tion if you begin to write it with an air of decision immediately 
 after receiving, to some important question, an answer which 
 your manner shows is what you expected. 
 
 Take care to ask all necessary questions before beginning 
 to write your prescription, lest the patient think you have not 
 included the additional information in forming your conclusion, 
 or considered it in writing the prescription, or that your treat- 
 ment was determined on before getting all the facts. Also make 
 it a rule to ask nothing further after prescribing. 
 
 It is well to terminate your visit as soon after prescribing 
 as can be properly done. 
 
CHAPTER VII. 
 
 "The successful man is the man who knows human nature, as well as his 
 profession. ' ' — Fotherpll. 
 
 Ea'Ery minute spent in studying how 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 phy- 
 sicians, and one of the chief reasons why they do not assist their 
 older brethren more in superseding pleasant quackery, is that 
 having their attention riveted on their cases and studying more 
 about getting them safely than comfortably through diseases, 
 and being anxious to get the specific physiological effects of 
 medicines quickly and fully, they too often give them in crude 
 forms, forgetting that the majority of sick people are fastidious, 
 and have likes and dislikes that must be respected. 
 
 A great and almost universal mistake that regular phy- 
 sicians make is to think that when people send for physicians 
 they send solely to have medicines given. Many people, not 
 being judges of which cases need medicines and which do not, 
 are much more anxious to see one who knows, chat with him, 
 and get an opinion of the nature and tendency of their case and 
 words of assurance from him, than to be drenched at every pore, 
 or begin a regular medicine-taking siege, or a fierce bombard- 
 ment with gross drugs. 
 
 Make special endeavors to retain every medicine-hater that 
 falls into your hands. Such incorrigibles had better be under 
 your care, with rational supervision and small doses of good 
 treatment, than to be paying somebody else for harmful 
 quackery or fancy nonsense. 
 
 Keep ever in your mind, that mankind has both a material 
 
 (167) 
 
168 THE PHYSICIAN HIMSELF: 
 
 and a spiritual nature, and that different people seem to be 
 made of different and almost opposite qualities ; some seem to 
 be two-thirds spiritual and one-third animal, and others seem to 
 be but one-third spiritual and two-thirds animal, between which 
 are all intermediate grades. If you attempt to treat all these 
 alike, you will certainly fail. ' The moral and mental manage- 
 ment of the sick is often much more difficult than the physical. 
 A close study of the moral forces and of mental therapeutics in 
 affections connected with the brain and nervous system is one 
 of the necessities that the regular profession is still extremely 
 deficient in. Irregulars often give a mere placebo, or useless 
 agent, which unquestioning faith and the increased psychologi- 
 cal energy they excite in the wondering patient potentizes, and an 
 astonishing recovery is the result. 
 
 This is probably the most rational explanation of the fact, 
 that newly discovered therapeutical agents, as bromide of potas- 
 sium, salicylic acid, etc., make so many more wonderful cures 
 when first heralded as remedies than they do after they have 
 taken a fixed rank in the pharmacopoeia. 
 
 Novel remedies often assist the cure of certain ailments 
 through mental influences. Many regular physicians give 
 valuable, true remedies, but give them just as they would ad- 
 minister to a sick horse or sheep, as if their only duty consisted 
 in telling the sick what drugs to swallow, and seem to despise 
 the aid of faith, hope, mystery and expectation. You must 
 learn, in simple cases, to depend more upon the aid of hygiene, 
 diet, and moral influences, and less on large doses of disturbing 
 medicine, which might allow room for some of your patients to 
 say you had almost killed them. 
 
 Remember particularly, that Drs. Diet, Quiet, Hope and 
 Faith are four excellent assistants. The Oil of Time and Tinc- 
 ture of Patience are also very useful, but too slow for some 
 cases and not adequate for others, and unless Dr. Heavyhelp 
 takes the case out of Dr. Doolittle's hands they put a lar«e 
 proportion of their devotees into the care of Mr. Sexton. 
 
t 
 HIS REPUTATION AND SUCCESS. 160 
 
 It is bad to let nature take her course when she takes a 
 bad or wrong one. You will often see patients sink and die 
 because you were called too late to aid her and direct her course. 
 
 If you indicate to a patient for whom you prescribe an un- 
 palatable medicine, at the time when you order it, that it will 
 have a bitterish or a saltish taste, or any other unpleasant 
 quality, his mind will be prepared for it beforehand, and it will 
 not seem so repulsive to him as if his mind and palate were 
 taken by surprise. 
 
 If the directions on the bottle indicate what a remedy is 
 for, — for instance, if you have it labeled "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 tempo- 
 rarily, and depend on hygiene, diet, stimulants, nursing, etc: 
 
 Keep yourself familiar with the bad effects that may follow 
 the use of the drugs which you administer, that you may either 
 avoid producing them, or promptly recognize and remedy them 
 when they occur. 
 
 Avoid as far as possible the use of medicine that must be 
 taken "through a tube," that will burst the bottle unless kept 
 "in a cool place," or "in a dark place;" on which "no water 
 must be taken;" that must be handled with caution, or that 
 must be stopped- when the eyelids begin to swell, or when the 
 muscles begin to jerk, or that the druggist must label "Poison," 
 especially with doubters and medicine-haters. 
 
 Some people will not send for you until they are truly ill, 
 for fear you will put them to bed, so as to keep your carriage at 
 their door ; 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 
 
170 THE PHYSICIAN HIMSELF: 
 
 to take medicine they will not be able to stop. Disarm all such 
 people by the assurance that their fears are exaggerated or 
 groundless. 
 
 Herb doctors, root doctors, vegetable-pill makers and others 
 have created a belief in the public mind that remedies obtained 
 from the mineral kingdom — iron, mercury, arsenic, lead, lime, 
 etc. — are poisonous, and should not be taken ; while articles from 
 the vegetable are in consequence thereof innocuous and harm- 
 less. The truth is, the most powerful agents — hydrocyanic 
 acid, belladonna, eleterium, cro ton-oil, lobelia, opium, stra- 
 monium, colchicum, digitalis, aconite, strychnia, and a long list 
 of other very active agents — are "Vegetable;" therefore the 
 announcement, " Purely Vegetable," is but one of the numerous 
 songs of these greedy syrens. 
 
 " Iron injures the teeth" is a cry which you will often hear, 
 and it originates in the fact that muriated tincture of iron, which 
 contains muriatic acid, if given without proper caution, will 
 injure the teeth, not on account of the iron, however, but of the 
 acid that is associated with it ; just as the water that makes a pot 
 of boiling coffee would scald a person all the same if the coffee 
 were not in it. Preparations of iron containing no free acid do 
 not act upon the teeth. 
 
 It is popularly believed that quinine gets into the bones, 
 destroys sight and hearing, causes dropsy, etc. So firmly do 
 some people believe these things that you will have to humor 
 their prejudices, and change the form of your prescription to 
 sulphate of cinchonia, compound tincture, or some other prepa- 
 ration of bark, when bark is indicated. 
 
 This prejudice probably depends chiefly on the fact that, 
 being powerful for good, people naturally infer that it must be 
 very strong and powerful for evil. It is also often due to the 
 teachings of Irregulars who seek through it to prejudice the 
 public against regular physicians, while constantly but secretly 
 using it themselves. I have known a conspicuous Irregular to 
 denounce quinine strongly, and yet use ovoid, gelatin-coated 
 
HIS REPUTATION AND SUCCESS. 171 
 
 quinine pills under the name of "Panama Beans" for the cure 
 of his patient. We know that quinine, when properly used, is 
 really an almost harmless vegetable product, which acts on 
 malarial poisoning, not by great strength, but produces inertness 
 through its antidotal influence, just as water, an agent harmless 
 enough to drink or bathe in, acts on fire. 
 
 One of the greatest hardships you will have to endure is 
 the tendency of people who have suffered protracted sickness to 
 blame you or your medicine for any permanent impairment or 
 stubborn symptoms remaining after illnesses, instead of recog- 
 nizing the fact that they are the legitimate effects (sequela?) of 
 their disease. 
 
 Reproach is often unjustly heaped on physicians and on 
 medicine by people living in malarious districts, who sicken with 
 this or that malarial affection, send for a physician, and get well, 
 and might remain so, but, being still surrounded by malaria, they 
 again inhale it and are again poisoned. This they erroneously 
 call " a return," instead of a repoisoning. Of course, while the 
 laws of His Majesty, King Malaria, remain as they are, you can 
 no more promise future immunity to convalescents with an agued 
 frame who remain in malarious regions than you can promise 
 the anxious sailor that future winds will not again create waves, 
 or the uneasy farmer that recurring frosts will not again nip his 
 exposed plants. 
 
 Malarial exhalations from the earth are usually greater at 
 nights (and greatest on the still, damp nights of autumn). 
 Malarial affections, therefore, are usually contracted in autumn 
 and at night, but many people are not aware of the fact that 
 they can also rise, and be caught, during the greater part of the 
 year ; it can also be caught in the day-time, and they should be 
 put on their guard. 
 
 It is proper, and your duty, to advise a person to change his 
 abode if his health require, or to relinquish an occupation if it 
 be injurious to him. Also to discourage him from exciting em- 
 ployments, or from pursuing riches when his health is thereby 
 
172 THE PHYSICIAN HIMSELF: 
 
 jeopardized; but remember that these are extremely delicate 
 subjects. 
 
 Keep yourself fully informed concerning suitable clothing, 
 physical exercise, and proper diet ; also the value of pure air, 
 pure water, and pure soil, the comparative healthfulness of 
 different regions, the presence or absence of malaria at different 
 seasons and places, etc. ; also regarding the various health trips 
 and summer resorts. Familiarize yourself with the constituents 
 and peculiarities of the various mineral waters, and of the uses 
 of each ; with the comparative advantages of seaside and moun- 
 tain trips, and with the classes of invalids to be benefited by one 
 or the other ; also with the various baths — hot, cold, tepid, Rus- 
 sian, Turkish, electric, vapor, etc. — and the comparative advan- 
 tages of the various hospitals, asylums, sanitaria, retreats, etc. ; 
 for these matters belong strictly to the province of medicine, and 
 it is particularly desirable to understand them, because you are 
 sure to be asked about them, and sure to be ashamed if you 
 cannot answer, and the inquirer will feel disappointment and 
 distrust of your knowledge ; they are subjects that concern the 
 better and more desirable classes of patients, many of whom are 
 semi-invalids, with whom you will often have to make hygiene, 
 medicinal waters, trips, etc., go hand in hand with medication. 
 
 Be cautious in advising exhausted patients, or persons far 
 gone with obstinate and dangerous, or invincible, or hopeless 
 maladies to leave their homes and business to undergo the dis- 
 comforts of travel to the seashore, or mountains, or other distant 
 points, or to foreign countries in search of health among stran- 
 gers, unless there are positive reasons for the change or decided 
 probabilities that improvement or restoration will follow. The 
 risk of breathing their last away from home, family, and kindred, 
 or of a return made worse by the inevitable fatigues and expo- 
 sures of travel, is not to be assumed without full consideration. 
 
 Be chary of even sending people from their homes to hos- 
 pitals, unless you are perfectly sure the management is humane 
 and skillful. While hospitals are an unspeakable blessing to 
 
HIS REPUTATION AND SUCCESS. 173 
 
 sick wanderers and to the homeless, they are less so to those 
 who have friends and a place to call home. "Be it ever so 
 humble, there is no place like home." To carry a weary or 
 worn sick person from his home to a hospital, deprive him of 
 his friends, neighbors, and companions, and all the little, endear- 
 ing sympathies and solaces of domestic life, restrict his freedom 
 by half-way imprisonment, and subject him to the risk of rugged 
 indifference on the part of coarse nurses, and to austere, hum- 
 drum hospital rules — to bed, to meals, to everything at the sound 
 of the bell ; expose him possibly to the public gaze, merely as 
 an object of medical treatment, or for experiment with new 
 remedies, or for the clinical advantage of medical students, clothe 
 him hospital-fashion, and put him on diet prepared at regulation 
 hours by stranger hands that know not his peculiarities or tastes, 
 his likes and dislikes — if he be a person of domestic tastes and 
 sensitive disposition, with a natural attachment to his home and 
 its surroundings, such a change from home treatment would be 
 most hurtful and injudicious, and could scarcely fail to aggravate 
 his disease. Worse still, if it is a medical college hospital, and, 
 in addition, he is used as a subject for the demonstration of his 
 disease, or carried through repeated or prolonged examinations 
 for the education of students. 
 
 The belief that taking water or ice is dangerous in fever is 
 still very general. People are wonderfully slow to recognize the 
 fact that water, whether applied externally or swallowed in small 
 quantities at a time, is one of nature's greatest remedies in fever, 
 especially if the patient has a craving for it. 
 
 If a person sweats more during sleep than at any other 
 time, it is a sure sign of weakness. 
 
 You will often be asked, " Doctor, may he eat anything he 
 wishes'?" If you think that ordinary food will do him no 
 injury, be careful to answer, " Yes, he can have any simple 
 thing he wishes." Were you to say, " He can have anything" 
 it would include pickles, radishes, cheese, bam, sausage, and a 
 great many other indigestible things that might injure or kill 
 
174 THE PHYSICIAN HIMSELF: 
 
 him; adding the adjective simple will protect both him and 
 you. 
 
 You can have a small, single-page diet list printed for the 
 use of patients, containing every article of diet in common 
 use, alphabetically arranged, at the top of which you can say, 
 " Every article on this list is forbidden except those that are 
 marked." Supply one to each patient requiring it, and mark 
 or erase from time to time such articles as you deem proper. 
 
 When you are busy and wish to make a short visit, do not 
 tell the patient so, or exhibit a hurried or abrupt demeanor, but 
 begin promptly to ask the necessary questions in orderly relation, 
 and do not allow the patient leisure to introduce foreign subjects 
 or to let the conversation become desultory or in any way digress 
 from his case till you have learned all that is necessary. Have 
 neither eyes nor ears for anything but your patient. If the 
 subject of the weather is broached, answer as if you were con- 
 sidering it only in reference to its influence on the patient before 
 you, then go back to his case. Economize time thus ; but if your 
 patient is at all ill, neither mention your haste nor show that 
 you are in a hurry until you have made your examination and 
 written your prescription. After completing the circle of duty 
 and giving all the attention absolutely required, if you depart 
 promptly he will not feel that your hurry has caused any inat- 
 tention to his case, as he would if you had leaped into his room 
 precipitately, thrown down your hat and gloves, dropped into a 
 chair, asked a few hurried, desultory questions, made an incom- 
 plete examination, scribbled off a prescription, and hurried away. 
 
 Unless there is an obvious reason for an opposite course, it 
 is better to avoid all desultory conversation on general subjects 
 at the beginning of your visit. 
 
 It will often vex you, when you are busy and time is 
 precious, to be kept waiting below stairs while the people in the 
 sick-room prim and prepare to receive you with as much pru- 
 dery and tedious ceremony as if the surroundings, rather than 
 the patient, were the object of your visit. Show every one the 
 
HIS REPUTATION AND SUCCESS. 175 
 
 respect due to rank and sex, btit manage to let such people 
 know that your time is too precious to waste, and must be 
 divided somewhat equally among those whom you are attending. 
 
 Never assign as a reason for being habitually late in visiting 
 a patient that you are overbusy. Every one wants a physician 
 who is in active experience and engrossed in practice, but no 
 one is willing to be habitually slighted or crowded out. A case 
 of obstetrics or an accident is, however, deemed by all an 
 acceptable excuse. 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 circumstances will allow. To do so 
 gives satisfaction and prevents 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 confi- 
 dently ascribing benefits to prescriptions that have not been 
 filled, or to remedies that have either been thrown out of the 
 window or emptied into the garbage-box, and you will become 
 the victim of a never-to-be-forgotten joke. 
 
 School yourself to avoid crude remedies and to cultivate 
 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 physi- 
 ological effect, than to give an indefinite medley on the ancient 
 blunderbuss principle. 
 
1 76 THE PHYSICIAN HIMSELF : 
 
 It is highly proper to warn people of dangers to the public 
 health, and to devise means to prevent or remove such dangers ; 
 also to teach patients the importance of right living, proper 
 dress, correct diet, pure air, and drainage, that they may preserve 
 their health ; but it is neither just nor wise to teach any but 
 medical students the secrets of our art, or to familiarize them 
 with the drugs you employ. Especially avoid giving self-suffi- 
 cient people therapeutical points that they can thereafter resort 
 to and ignore the physician. If you do, they will soon feel 
 brimful of wisdom, become opinionated and imagine they know 
 as much about remedies as you do, or more of medicine and 
 medical practice than all our profession combined, and begin 
 amateur prescribing and neighborly doctoring, and not only take 
 your bread from you, but make hobbies of what you teach 
 them, and trifle with them, till, in bad cases, the patient's dis- 
 ease is fatally seated ; after which even correct treatment may be 
 interrupted by the undertaker. It is not your duty to cheat 
 either yourself or other physicians out of legitimate practice by 
 supplying this person and that one with a word-of-mouth phar- 
 macopoeia for general use. If compelled to give a person reme- 
 dies under a simple form, study to do so in such a way as not 
 to increase his self-conceit and make him feel that he knows 
 enough to practice self-medication and dispense with your ser- 
 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, gonor- 
 rhoea, 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 become self-constituted doctors, and 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. 
 
 It is better to make your analysis of urine, etc., at your 
 
HIS REPUTATION AND SUCCESS. 177 
 
 office, instead of the patient's house, where an explanation of 
 processes, re-agents used, etc., may be the. result, else they and 
 their friends will quickly become oversmart, begin to test for 
 themselves, think they know more than they really do, and give 
 you trouble. 
 
 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. 
 
 Confine your prescriptions to officinal medicines, and to 
 preparations whose formulas are public property as fully as pos- 
 sible, and do not patronize any of the semi-legitimate pharma- 
 ceutical catchpennies, with life in every drop, about which you 
 know nothing but what their labels and wrappers tell you, 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 suit- 
 able quantity of the kind which you prefer ; if he needs iron, 
 prescribe the kind and the dose that you think proper, and do 
 not make yourself a mere unthinking distributer of some enter- 
 prising fellow's ready-made " beef, wine and iron," which cheats 
 the pharmacist out of all chance of exercising his proper pro- 
 fession, and in fact relieves him of all mental exertion and all 
 responsibility in the matter, since he, or his errand boy, has 
 nothing to do but act as a middle man and hand it out, in a 
 mechanical fashion, to customers, just as the grocer and his boy 
 hand out paint and putty, soap, sugar and tobacco. 
 
 The same hat cannot fit every head, or the same shoe 
 answer for every foot, neither can the proportion of ingredients 
 in a ready-made combination suit every patient. Indeed, what 
 would cure one might kill another. 
 
 Resolve never to prescribe a proprietary remedy, or one 
 covered by a trade-mark ; it is better to avoid the use of all 
 such ready-prepared remedies, whether trade-mark, proprietary, 
 or quack, whether advertised to the profession or to the public, 
 whether the so-called formula and the dose are given or not. If 
 
 12 
 
178 THE PHYSICIAN HIMSELF: 
 
 you order A.'s emulsion, B.'s lozenges, C.'s cod-liver oil, D.'s pills 
 and E.'s bitters to patients, they will, by association, soon think 
 that X.'s sarsaparilla, Y.'s buchu and Z.'s liver regulator also 
 meet with professional approval. Determine that you will not 
 aid any speculator in life and health to " strike a trade " in 
 your families ; and chiefly for the reason that their nostrums do 
 more harm than good ; also for the lesser reason that justice to 
 yourself and to every other member of the profession requires 
 you to avoid prescribing or telling patients of preparations that 
 enable them afterward to snap their fingers in your face and 
 renew them as often as they please, and recommend them to 
 others Avho treat themselves with them without your further aid. 
 One trade-mark prescription from you may sell twenty or a 
 hundred bottles that you do not prescribe, and for which you 
 get neither credit nor compensation. 
 
 Endeavor to have your prescriptions labeled so as to pre- 
 vent indiscriminate renewal, as well as to prevent mistakes in 
 their administration ; when they are very important be careful 
 to have the name of the patient put on the label, that every one 
 may know whose medicine it is. 
 
 Remember this : The very best time to tell a patient not to 
 renew a prescription is while writing it. If you fear it will be 
 renewed against your wish, stop short while writing and 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 protect- 
 ing your own pecuniary interest, will impress him strongly, and 
 will be invariably obeyed ; this is probably the most effective of 
 all plans to prevent prescriptions from being renewed and adopted 
 as a regular resort in similar cases. With this exception, make 
 it a rule neither to talk, listen, nor answer questions while 
 writing prescriptions. 
 
 Never write a prescription carelessly. Legibility is the first 
 requirement, neatness the second. Cultivate the habit of sera- 
 
HIS REPUTATION AND SUCCESS. 179 
 
 tinizing everything you write after it is written, to assure your- 
 self that there is neither omission nor mistake, and sign your 
 name or initials to every prescription, but not till you have satis- 
 fied yourself that it is as intended. Mistakes are seldom dis- 
 covered unless at the moment of their occurrence. 
 
 In consultation, the prescription agreed upon should be 
 written by the regular attendant, and, if the consultant is still 
 present, should be 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 seven, twelve, five, and ten 
 o'clock daily." 
 
 Remember, when giving directions in regard to doses, that 
 spoons and drops vary greatly in size. A patient can save much 
 trouble and uncertainty in cases where medicine is to be taken 
 for any length of time by getting a graduated tumbler or medi- 
 cine-glass, which is both convenient and precise. A minim is a 
 definite quantity, a drop is not ; therefore, in prescribing potent 
 fluids, you should order minims instead of drops. 
 
 Neither alarm your patients nor their friends, nor risk the 
 dangers of the chloral, opium, or other bad habit 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, or give him cocaine, 
 chloral, opium, alcoholic liquors, or other exhilarating and fas- 
 cinating agents, loosely, if he has any predisposition at all 
 toward them he will probably adopt the habit ; if he does, you 
 will surely and deservedly incur the blame. The "slaves of such 
 habits always cast the blame for their acquired passion, or their 
 enslavement, on the physicians who first ordered or used the 
 drug with them, if they have any ground at all for doing so. 
 
 Hvpodermic medication not only has its place and power, 
 which make it at times indispensable, but also has various 
 
180 THE PHYSICIAN HIMSELF. 
 
 drawbacks that should prevent its indiscriminate use. Among 
 other evils connected with it is this, that those who are delighted 
 by it, or have become habituated to it, are apt to harass and 
 worry you for its use at all hours, day and night. It is a real 
 hardship, after doing your day's work, that you must go and 
 administer a hypodermic night-cap of morphia to the Rev. Mr. 
 Cantsleep at eight o'clock p.m., to Mrs. Allnerves at nine, to 
 Colonel Bigdrinker at ten, and to Miss Nary wink at eleven 
 o'clock, and probably be called from bed again to insert the 
 sleep-giving needle for one or all of them before morning. 
 
 Much of this is not only a hardship but a nuisance. Far 
 better is it for both the patient and yourself that you order ano- 
 dynes by the mouth or rectum for such patients than to have all 
 this extra trouble, and at the same time expose him to what 
 may prove to him a fatal charm, and, by the reflex action of 
 public opinion, do your reputation great injury. 
 
CHAPTER VIII. 
 
 "The wise and brave conquer difficulties 
 By daring to attempt them : sloth and timidity 
 Shiver and sink at sights of toil and hazard, 
 And make the impossibility — they fear." — Binyon. 
 
 It does not require the eye of a Newton or the brain of a 
 Bacon to discover that self-reliance and self-possession are capi- 
 tally important elements of success. Nothing under the sun 
 will cause people to believe in and rely on you more readily and 
 permanently than to see you believe in and rely on yourself. 
 Be hot arrogant, or self-conceited, but cultivate the power of 
 thinking in the midst of excitement and distracting forces, and 
 study to hide your doubts, hesitations, uncertainties, self-distrust, 
 and apprehensions as completely as possible. 
 
 Never turn your cases over to "specialists" unless they 
 have features which render it an actual duty to do so. If you 
 distrust your own capacities, and timidly parcel your practice 
 out and refer every case of eye disease to the oculists, every 
 uterine case to the gynaecologists, ear cases to the aurists, surgi- 
 cal to surgeons, nervous affections to neurologists, throat com- 
 plaints to laryngologists, mental afflictions to alienists, skin 
 diseases to dermatologists, crooked legs to orthopaedists, warts 
 to a manicure, and so on throughout the list, you will lessen 
 your own field of activity, and instead of gaining as much 
 experience with one affection as another, and thereby becom- 
 ing many-sided and armed at all points, you will soon lose 
 all familiarity with the diseases that specialists treat, and will 
 dwindle and degenerate into a mere distributer of cases, a medi- 
 cal adviser instead of a medical attendant — advancing every- 
 body's professional and pecuniary interest except your own, and 
 gaining the admiration of the community, and making for them 
 honor, credit, and fees out of that which sinks your own indi- 
 
 (181) 
 
182 THE PHYSICIAN HIMSELF: 
 
 viduality, robs your own purse, and throws you back into the 
 shade. A good rule is this : Consult in cases of irreducible 
 strangulated hernia, stone in the bladder, and in all other capital 
 operations if you yourself are not a good operator ; also when- 
 ever a serious case, whether in head or body, hands or feet, 
 puzzles or defeats your judgment, or proves wholly unmanage- 
 able by usual treatment, or is so grave in prognosis as undoubt- 
 edly to require broader shoulders than yours to bear the 
 responsibility, either call in a specialist to aid in its management, 
 or turn it over entirely to him. If you study all the branches, 
 and keep yoiirself abreast of the times, such occasions will soon 
 be very rare to you. Timidity and rashness are both bad traits 
 in a physician, but the former is the greater drawback. 
 
 When you transfer any one from your care to a specialist's, 
 always do so either by a consultation, a letter, or a personal in- 
 terview with him, that he may learn directly from you your 
 diagnosis, prognosis, treatment, etc. You will thereby give him 
 the advantage of what you know of the case, and also prevent 
 the risk of an injury to your reputation from an apparently 
 radical difference of opinion between him and yourself; besides, 
 it secures your graceful retirement from the case. 
 
 Be careful to make your patients fully understand that in 
 turning their cases over to a surgeon or specialist you do not 
 cease to be their physician for future sickness, and that you 
 have only turned them over for that special affection. 
 
 Ask for a consultation in all important cases in which 
 knotty problems are presented, or where there exists any doubt 
 as to the diagnosis, when you are in doubt as to the propriety 
 of a surgical operation, and in all cases where you think either 
 the patient's interest, his protracted lack of improvement, or 
 the appearance of fresh or puzzling symptoms, or a division of 
 the responsibility demands it ; then another eye and a different 
 mind may be of great service. When from any cause you see a 
 necessity for a consultation arising, try, if possible, to anticipate 
 the family by being the first to propose it. 
 
HIS REPUTATION AND SUCCESS. 183 
 
 Although a patient should never send for a consulting phy- 
 sician without the express consent of the attending physician, 
 yet, when it is done through their ignorance of ethics, the dis- 
 courtesy had better be condoned and the consultation held. 
 
 Consultations lessen personal responsibility. When you 
 have bad surgical cases, or an operation in which life will be 
 risked, or difficult, or complicated cases of midwifery, or heavy 
 or anomalous cases of any kind among your personal friends or 
 relatives, creating doubts or difficulties ; or so near home as to 
 involve you personally or socially; or in a neighborhood in 
 which a group of patients are likely to be unfavorably im- 
 pressed if the result is not good, it is especially necessary and 
 wise to call a consulting physician to lighten your burden, even 
 though you have him to come but once — if for no other reason, 
 to satisfy the persons concerned. 
 
 If possible, always have high-minded, honorable physicians 
 selected as consultants who will second your efforts by their 
 knowledge and skill, and who will at the same time be likely to 
 harmonize with you in the management of your cases ; for their 
 sympathy and kindly support may be highly necessary to the 
 patient's welfare and to your own reputation. 
 
 When you happen to be the one consulted, do not examine 
 the patient or ask him questions, except in the presence of your 
 conferee, and have all communications when he is present. 
 
 Be punctual to the minute in keeping consultation engage- 
 ments. You have no right to waste another's time in such 
 cases, or to impose upon him the necessity of awaiting idly for 
 you at the place of meeting. 
 
 Under ordinary circumstances it rests with the consulting 
 physician and not with the regular attendant to name the hour 
 of meeting. 
 
 In your consultations you will often feel great anxiety and 
 suspense while waiting to see whether the consulting physician 
 will be frank and fair toward you, or whether he will by a nod 
 or wink, hint or inuendo, expose your deficiencies to a few, to 
 
184 THE PHYSICIAN HIMSELF: 
 
 be told to many, until he reduces you to a mere cypher in the 
 estimation of all to whom the case is related. To the honor of 
 our profession be it said, that the vast majority of its members 
 are not only punctilious, but really kind to the deserving on 
 these occasions. 
 
 A radical change of diagnosis and of treatment, or a re- 
 verse and opposite course in any respect, as the result of a first 
 consultation, often naturally impresses upon the laity the idea 
 that the previous diagnosis or treatment has been either faulty 
 or actually wrong, and no material change should be proposed 
 or allowed at that time, unless some real necessity requires it. 
 As a rule, the fewer the apparent changes resulting from a first 
 consultation the better for the regular attendant's reputation; 
 especially if he be a young physician. 
 
 If you are ever brought into contact with one who, from 
 what appears to be lack of wisdom, or from sinister motives, 
 persists in differing from an opinion that you are sure is correct, 
 and you fear he may injure you thereby with the patient and 
 his friends, insist on calling some eminent member of the pro- 
 fession into the conference,' that he may decide between you. 
 After that is done, if you think your interests require it, you can 
 retire from the case without discredit. Such a person might 
 almost do such things as change your diagnosis of. " bilious re- 
 mittent fever " to " malarial fever " and change your sulph. 
 quinise and mass, hydrarg, to sulph. cinchona? and hydrarg. cum 
 creta as soon as your back was turned. 
 
 When a consulting physician is designated and called at 
 your request, you should see that the payment of his fee is not 
 neglected ; you might with propriety broach the subject to those 
 who are to pay the bill before he quits. This can be done bv 
 privately informing them that his charges will probably be some- 
 what 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. 
 
 To prevent ' misunderstanding, it is, in many cases, wise 
 to say a word or two about the fee to the patient or his 
 
HIS REPUTATION AND SUCCESS. 185 
 
 friends at the time the subject of having a consultation is first 
 mentioned. 
 
 You can, in such a case, speak much more plainly for your 
 brother physician called at your instance than you could for 
 yourself. His relations to the case suppose him to have nothing 
 in view but the welfare of the patient, and to be thinking only 
 of the scientific and therapeutical aspects of the case, and without 
 any thought of money or pay. Prompt settlement of the con- 
 sultant's fee will sometimes even bring about a more prompt 
 payment of your own. 
 
 Never make yourself responsible for the payment of an- 
 other's fee. Aid him in a proper degree to get it, but do 
 nothing more. 
 
 It is for several reasons better for the consulting physician 
 to send his bill before the regular attendant sends his; when 
 the latter sends his first it looks as if he is more anxious for 
 the safety of his fees, hence is in a greater hurry than the 
 stranger is. 
 
 Unless the consulting physician gets his fees cash, or you 
 are aware that special arrangements exist for their payment, be 
 very careful to inform the patient, or his family, 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 misunderstanding will result as to whether you or they must 
 pay his bill. 
 
 Whenever, to please the patient or his friends, you are 
 forced to set aside other duties in order to meet another phy- 
 sician in consultation, it is proper for you to charge for such 
 service twice as much as for an ordinary visit, or perhaps even 
 as much as the consultant does for his services ; for you have 
 all the details that flow from the consultation to carry out and 
 all the communications to make, and all directions to give, and 
 in consequence are entitled to extra compensation. 
 
186 THE PHYSICIAN HIMSELF: 
 
 In dispensing with the consulting physician when his ser- 
 vices are no longer necessary, take care to secure his acquies- 
 cence, and make him feel that it is done with a feeling of amity 
 and good will. 
 
 In consultations it is usual for the regular attendant to pre- 
 cede the consultant in entering the sick one's room, and to 
 follow in leaving it. 
 
 Friends of your patients, who have special confidence in 
 their own physicians, will often persuade such as are suffering 
 with stubborn cases that you do not fully understand their 
 affection, and strenuously advise them to call in their favorite. 
 In such cases remember that you have no right to object to a 
 patient's having other advice besides your own whenever he in- 
 sists upon it; but also that you have an undoubted right to re- 
 fuse to consult with any one who is antagonistic to the profes- 
 sion, or any one whom you deem unprofessional, or unsuited for 
 the case, any one who is personally objectionable to you, or in 
 whose keeping you deem your reputation and interests unsafe. 
 If you are attending a case, and such an one is pressed upon 
 you, you have a perfect right to retire, and should at once offer 
 to withdraw, and thus afford your patient the liberty of choice 
 between you and your rival. Fortunately, such dilemmas are 
 very rare. 
 
 Do not refuse to consult with foreign physicians, doctresses, 
 colored physicians, or any others, provided they are regular 
 practitioners, or even with undergraduates, if they are advancing 
 regularly toward their degree. You, as a physician, hold a 
 quasi-official position in the community, and, in the discharge 
 of your duties, should know nothing of national enmities, race 
 prejudices, political strife, or sectarian differences. Rescue is 
 the cry ! You have no moral right to turn your back on sick 
 and suffering humanity, by refusing to add your knowledge and 
 skill, on a plane of real and brotherly equality, to that of any 
 honorable, liberal-minded person who practices medicine if his 
 professional acquirements and ethical tenets give him a claim to 
 
HIS REPUTATION AND SUCCESS. 187 
 
 work in the professional field. It is not only unmanly to make 
 a class distinction and throw obstacles in the path of the less 
 favored, but such a spirit is wholly incompatible with the 
 objects of our profession (which is a liberal one), and at direct 
 variance with the spirit of science (which is cosmopolitan), and 
 in its efforts to diminish suffering and baffle death knows 
 neither country, race, nor creed, and has no limits except those 
 of truth and duty. 
 
 But while you bid " All Hail !" and give the right 
 hand of fellowship to every regular honorable physician, and 
 become the friend and brother of all the friends of rational 
 medicine, no matter what his misfortunes or how great his de- 
 ficiencies, you must, on the other hand, remember that medi- 
 cine is a liberal profession, and not a mere trade, and keep aloof 
 from those belonging to a party or association whose exclusive 
 system, narrow creed, or avowed or notorious hostility to our 
 profession, prevents them from accepting every known fact and 
 employing all known remedies. Refuse fellowship with any 
 one and every one who cannot honestly say his mind is wide 
 open for the reception of all truth, and that his hand shall not 
 refuse to use anything and everything under the blue vault of 
 heaven that may be needed to overcome disease and save the 
 life of a human being, — conduct that constitutes a voluntary 
 disconnection from the profession. When called to a case in 
 which the attendant cannot do this, you cannot agree with him, 
 and must let his retirement be one of the conditions on which 
 you will assume charge. 
 
 You may be called to a case of emergency, viz., an alarm- 
 ing hemorrhage, poisoning by accident or design, partial 
 drowning, or choking, or convulsions, or difficult labor, and on 
 reaching it find an irregular practitioner or quack in attendance, 
 with whom you are thus brought face to face. In such cases 
 the path of duty is plain, for, owing to the great and urgent 
 danger to life, the higher law of humanity will require you 
 temporarily to set aside all quibbling about ethics and etiquette, 
 
188 .THE PHYSICIAN HIMSELF: 
 
 and to unite your efforts with your chance associate's. Treat 
 him, then, with courtesy, but studiously avoid formal consulta- 
 tions, or private, or whispering conversation with him, or any 
 other act that might imply association in consultation. 
 
 Thus you see there is not the least antagonism between 
 medical ethics and humanity, but that they waive all considera- 
 tions of etiquette, and allow and cover any act honestly 
 performed for the benefit of humanity. 
 
 Fortunately, the indications for rational treatment are 
 generally so very clear in such cases that no one can ignore 
 them. If the Irregular has assumed charge before your arrival 
 and is pursuing proper treatment, or agrees to the proper treat- 
 ment suggested by you, that is all you can ask ; for instance, if 
 the patient has received a terrible burn and linseed-oil and lime- 
 water are being applied, or other rational treatment, indorse it 
 and encourage a continuation in the same line, but if your acci- 
 dental colleague favors a wet pack because he is morbid on the 
 use of water, or advocates a lotion of cantharides because they 
 burn and blister well people, it is your duty to your patient and 
 also to yourself unyieldingly to insist that a rational course 
 shall be pursued if you are to take part in the case. Be cau- 
 tious but firm in dealing with such contingencies, and it is due 
 both to your self-respect and that which you owe the profession, 
 that you terminate the unnatural connection — of course, in a 
 gentlemanly way— as soon as the great urgency will admit. 
 
 Some of the unreasoning laity may think you are illiberal 
 in refusing to fraternize and consult with Irregular practitioners, 
 notwithstanding these have voluntarily separated themselves 
 from the regular profession and assumed a name intended to tell 
 the public that their system differs from ours, and that they are 
 at war with it and with us. Remember that our refusal is not 
 from a false sense of dignity or from prejudice, but that the 
 great principle which underlies it is this: as lovers of all truth, 
 and ever anxious to benefit our fellow-man, we have no fixed 
 no unchangeable creed, but hail with delight every etiological 
 
HIS REPUTATION AND SUCCESS. 189 
 
 and therapeutical discovery, no matter by whom made, and take 
 by the hand and recognize as a brother any one who is liberal 
 enough to consecrate his life's labor to the relief of the sick ; 
 but when we know that a certain person, even if he has an 
 armful of diplomas, circumscribes himself and practices a botan- 
 ical system only, or, like a pigeon with but one wing, a vito- 
 pathic system only, ox a hydropathic system only, ox a omniopathic 
 system only, or an electropathic system only, or any other 
 " pathy" only, and is so tied down and limited to that, by his 
 love, bigotry, or prejudice, that he denies the usefulness of all 
 other known and honorable means of aiding the sick, and 
 endeavors to poison the public mind against all other therapeu- 
 tics but his own — all rational physicians esteem such an one as 
 too illiberal to be a true physician, and ignore him, and justly 
 exclude him as unworthy of fellowship with those who profess 
 to love all truth, and whilst he remains imprisoned within the 
 narrow limits of his own ball-and-chain system, endeavor to 
 themselves steadily pursue, perhaps with less zeal, but with more 
 sense, the path of true science and progress. 
 
 If, on the other hand, he uses the remedies that rational 
 medicine affords, yet adopts the cloak of an " ism " simply as 
 an advertising dodge to make the public believe that he practices 
 in some manner the direct opposite of ourselves, and thereby 
 assists our enemies to lessen public esteem for regular medicine, 
 and to create hatred toward us as its followers, he is guilty of 
 fraud, and you should, even on the ground of morality, refuse 
 to countenance him. 
 
 When people ask you " what system you practice," you 
 may very properly answer that you are simply a physician, a 
 member of the regular medical profession, that you have no 
 fixed orthodoxy, belong to no sect, and are limited to no ism or 
 ology ; that you stand on a broad, unsectarian platform, and 
 are at liberty to construct your own articles of faith, only seek- 
 ing to do your best for every sick sufferer who trusts to your 
 skill and honor; that you accordingly try to be rational, and, 
 
190 , THE PHYSICIAN HIMSELF: 
 
 like the bee, take the honey of truth wherever you find it ; that 
 as rational, liberal physicians, the regular medical profession, to 
 which you belong, has no branches, no sects, no dogmas, but is 
 held together solely by the common bond of rational medicine, 
 maintain perfect freedom of opinion and practice, select any 
 remedy they please, in whatever dose they please, and under 
 whatever theory they please, and, unlike the various " limited 
 schools," have no articles of faith which they impose on any 
 one, but accept all truths, whether winnowed from the store- 
 house of centuries, or discovered, either scientifically or empiri- 
 cally, in our own day ; that you, as one of its representatives, 
 stand ready to embrace and utilize any and every valuable dis- 
 covery, no matter when or by whom made. 
 
 "Pledged to no party's arbitrary sway, 
 We follow truth where'er she leads the way." 
 
 This flexibility explains why regular medicine is one of 
 the three liberal professions, and why the humane and 
 benevolent follower of the healing art takes rank with the 
 learned expounder of the law and with the worthy man who 
 inculcates religion, all three uniting to protect the interests of 
 soul, body, and estate. But medicine is the only science which 
 regards the entire man, physical, intellectual, and moral. The 
 lawyer looks on a man as a being possessing certain rights, and 
 subject to certain duties to his neighbors. The divine looks on 
 man simply as a moral, responsible being, who has, or should 
 have, a conscience, to which he directs his ministrations, while 
 tee deal with the whole man, physical, intellectual, and moral. 
 
 To this trio of professions was long ago applied the term 
 " liberal," because for their pursuits, preventing and curing sin, 
 preventing and curing disease, and preventing and curing legal 
 wrong, all three require the utmost perfection of character, and 
 because devotees of law, religion, and medicine have in all ages 
 pursued them as freemen, with hands unfettered and tongue 
 untied, subject to no bonds except those of truth. If at any 
 
HIS REPUTATION AND SUCCESS. 191 
 
 time during your career, any sect, schism, or one-sided school 
 arises, no matter how great or how humble its pretensions, if it 
 has even one grain of life-saving or health-guiding wheat to its 
 bushel of chaff, it is your duty to seize the grain of wheat and 
 plant it in the domain of rational medicine, and to cast the chaff 
 and brambles and thistles to the winds. This adaptability is 
 our strength and our glory, and is the element that will make 
 regular, liberal, rational medicine exist as long as there is 
 sickness and suffering in the world, and is the feature that 
 distinguishes regular medicine from " new schools," isms, and 
 pathies. 
 
 Remember that we have no secrets, no patents, no monopo- 
 lies ; our books, our laboratories, our lecture-rooms and our medi- 
 cines are open to every qualified person, and that the door of the 
 profession is not only open to the newly graduated and regularly 
 initiated, but to every one who has the necessary educational and 
 moral qualifications, even though he has been an outsider, allied, 
 whether from ignorance or choice, with a system which professes 
 antagonism to the profession ; in the latter case he is at perfect 
 liberty at any time to enter the regular vEsculapian fold, and 
 become one of us, by dropping his distinguishing creed or 
 system, abandoning the hostility to the profession which it im- 
 plies, and allowing ethical rules to govern his conduct : no con- 
 version, no surrender of private opinion, or favorite theories, or 
 hypothesis, or of unlimited freedom to practice as he chooses is 
 at all necessary. 
 
 Be religiously exact in everything that relates to consulta- 
 tions. Let them always be formal and strictly private ; after 
 the necessary examination and inquiries, both physicians should 
 retire and consult within a room that is, if possible, isolated 
 from intrusion ; they should exchange thoughts in an undertone 
 and out of the sight and the hearing of eavesdroppers, and should 
 never allow any one to be present except the physicians engaged 
 in it. It is the duty of. the attending physician to give all the 
 directions, etc., flowing from the consultation. 
 
192 THE PHYSICIAN HIMSELF: 
 
 Remember that consultations are called for the purpose of 
 deciding for the future, not to criticize 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. 
 
 Let all that follows a consultation show that you act in 
 concert and that it is the result of joint action, and never express 
 an individual opinion of a case seen in consultation, except in 
 strict accordance with the code. If you do, those whom you 
 address may, either unintentionally or purposely, misinterpret 
 what you say, or otherwise involve you. 
 
 Remember that if you agree sufficiently to continue in joint 
 attendance, you are in duty bound to act in concert and uphold 
 each other, and to refrain from telling whose opinion prevailed, 
 or by whom the course pursued was suggested, and from all 
 other hints and insinuations likely to affect confidence in your 
 fellow-attendant. 
 
 If you are requested by letter, or by a messenger, to pre- 
 scribe for an out-of-town patient who is not under the care of 
 any other physician, it is perfectly professional to do so, if you 
 wish, even though you may never have seen the case. 
 
 Be prompt to the minute in answering your professional 
 correspondence. 
 
 If a professional friend for any reason requests you to see 
 a case with him, not so much for the patient's sake as for his 
 own benefit, you should lend him a ready and willing hand, and 
 that, too, without expectation of a fee. 
 
 Revere the past, have confidence in the present, and hope 
 for the future of our glorious profession, and strictly avoid revil- 
 ing the individual members of the profession, or the profession 
 itself, or telling, as excoriating anecdotes, the mistakes and dis- 
 creditable dilemmas of yourself or others ; and also avoid decry- 
 ing and ridiculing medicine to the laity, and boasting of your 
 own and the general ignorance of disease and remedies, and 
 your distrust of your own capacities, or of the number of people 
 
HIS REPUTATION AND SUCCESS. 193 
 
 whose health you have ruined, or killed, or maimed, or mutilated: 
 and suppress all other fulsome confessions. When a physician 
 speaks thus, he means it relatively only ; means to say that he is 
 aware and willing to confess that medicine has its natural limits, 
 and is not an exact science, and that the application of thera- 
 peutics is but an art. The public cannot appreciate the sense in 
 which such imprudent confessions are made, and they are taken up 
 by our Doubting Thomases and Lying Pauls as quickly as an 
 empty sponge takes up water, and work great harm .to physi- 
 cians' who make them and immeasurable harm to the profession 
 at large ; because all who hear or read them conclude that our 
 prescriptions are only a series of guesses, and that medical prac- 
 tice is only a hodge-podge of uncertainty, inconsistencies and 
 confusion ; whose votaries ask whether we can be certain of any- 
 thing, or be certain that we are certain of nothing; and ever 
 after crack jokes at our expense, and either do not employ 
 physicians at all, or do so with utter disrespect and distrust. 
 
 You know there is, strictly speaking, no such thing as a 
 perfectly straight line, plane surface, regular curve, exact sphere, 
 or uniform solid ; yet you never hear the civil engineer or the 
 surveyor boasting of it from the housetop or mountain peak in 
 reckless language, as if to belittle his own profession. Take the 
 other learned professions : law is still very imperfect and fidl of 
 uncertainties. Its books are full of conflicting opinions, and 
 the decisions of to-day are liable to be overthrown by those of 
 to-morrow. Religion, too, has its opposing creeds and its innu- 
 merable sects, — sad proofs that Medicine is not alone imperfect. 
 
 The truth is, physicians are personally far more imperfect 
 than physic. For instance : there are undoubtedly medicines 
 whose action is diuretic ; but diuretics may be given Avhen 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 
 
 13 
 
194 THE PHYSICIAN HIMSELF: 
 
 either to the physician's bad judgment, or to his ignorance. 
 The fact is, all studious physicians know of very nearly the 
 same remedies, but skill in curing with them consists in apply- 
 ing one's knowledge correctly, in thinking of and selecting the 
 proper ones at the proper time, skill in proportioning the dose, 
 and genius in judging correctly the time for use, etc. Just so, 
 different persons essaying to paint will exhibit different degrees 
 of success ; one possessed of natural aptitude or special smart- 
 ness will, attain wonderful skill, another less apt will reach me- 
 diocrity, while a third will fail entirely in his attempts and quit 
 in disgust — this difference in result being due not to a difference 
 in the material or colors at the command of each, but to the 
 more or less perfect judgment and skill shown by each in 
 combining and applying them. 
 
 Timeliness. — Ability to determine accm*ately the condition 
 of a patient, and to conceive and do the right thing for him at 
 the right time, is the essence of skill, constitutes the chief dif- 
 ference ' between successful and unsuccessful physicians, and 
 explains the reason why the prescriptions of some physicians 
 are much more valuable than those of others. One may know 
 a vast deal about the profession and yet be a poor practitioner. 
 
 A proper use of medicines, and not a wholesale renuncia- 
 tion of them, is a leading characteristic of a good physician. 
 When you hear of a physician who wishes to be considered 
 especially clear, or ahead of others, or extraordinarily fair in his 
 opinions, boasting that he is skeptical, "does not believe in 
 drugs," "depends on nature," etc., you can safely conclude that 
 he has a very weak spot somewhere ; either that in his zeal to 
 become a medical philosopher, or to coquette with somebody 
 else's opinion, he has lapsed in his materia medica, or overstates 
 his credulity, or that his usefulness has run to seed. 
 
 Does the mariner lose his faith in navigation because ships 
 are tossed by the winds and waves and sometimes wrecked by 
 uncontrollable storms 1 Or does the farmer deny the fertility 
 of the soil because his neighbor has neglected the proper season 
 
HIS REPUTATION* AND SUCCESS. 195 
 
 for planting and correct ways of cultivating ] Or does he lose 
 his faith in agriculture because droughts, and grasshoppers and 
 frosts sometimes ruin his crops'? Would any worthy sailor fold 
 his arms and do nothing while the storm raged, or any philo- 
 sophical 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 1 
 
 Is there a physician on earth who would let intermittent 
 and remittent fevers take their course without drugs, or who 
 would let the syphilitic and other poisons develop, or progress 
 unchecked % Is there a graduate anywhere who, in the face of 
 all the positive facts offered by anatomy, and physiology, and 
 pathology, and chemistry, and hygiene, and materia medica, 
 confesses that he can do nothing for pain or for fever, for nervous 
 complaints, for digestive affections or chest diseases; nothing 
 for circulatory disorders, delirium, insomnia, headache, mania, 
 epilepsy, hysteria, gout, neuralgia, worms, colic, acidity, perito- 
 nitis, child-bed fever, constipation, convulsions, diarrhoea, anae- 
 mia, scurvy, cholera morbus, poisoning, casualties, etc.'? 
 
 The end and aim of medical practice is to relieve, to cure, 
 and to prevent death ; therefore, if there is any one among us 
 who has never seen medicines restore health or prolong life, who 
 does not sincerely believe in his power to benefit by drugs some 
 of the twenty-four hundred diseases and modes of decay to 
 which mankind is subject, he is an infidel in medicine, and 
 should at once and forever, for conscience' sake, and for the sake 
 of the afflicted, take down his sign and no longer pretend to 
 practice. What think you of a man preaching religion who does 
 not believe in the usefulness of religion 1 
 
 The tolerance of disease has greatly increased in the last 
 few decades, and is still increasing, and medical theories and 
 practice are undergoing great changes. The advance of scien- 
 tific observation is constantly teaching us to distinguish more 
 clearly between the multitude of simple, self-limited cases daily 
 met with and the few that threaten a fatal issue, and of course 
 
196 THE PHYSICIAN HIMSELF. 
 
 we of to-day use much lighter remedies for the former class than 
 our predecessors did ; but it is doubtful whether in real sicknesses 
 we have lessened the doses half as much as some imagine. You 
 now give twelve or fifteen grains of quinia daily for an inter- 
 mittent fever, where physicians formerly gave half an ounce or 
 an ounce of crude bark containing but six or twelve grains. 
 You give to-day the same dose of opium, or its representative, 
 morphia, when that drug is indicated, as they gave a hundred 
 years ago, the same quantity of castor-oil at a dose, and about 
 the same throughout the entire materia medica*- The great dif- 
 ference is that we do not now prescribe vaguely or rashly, and 
 when cases are trifling, or obscure, or undeveloped, our treat- 
 ment is tentative instead of heroic. 
 
 "We of to-day know tenfold better than our predecessors the 
 natural history of disease, and are aware of the almost infinite 
 resources of nature, and that three in every ten of those who send 
 for physicians need no positive medication, that recovery from dis- 
 ease is everywhere the rule and death the exception, and that nine 
 of the ten would get well sooner or later by proper hygiene, air, 
 exercise, dieting, and intelligent nursing if there were not a drug 
 or physician in the world, and consequently we are naturally pre- 
 scribing less. and less. In acute diseases, and especially those of 
 children, we now, in many cases, trust chiefly to the recupera- 
 tive laws of nature, and see them get well from what look to be 
 hopeless conditions almost as if by magic, and these cases consti- 
 tute a majority of those that seemed to be restored to rosy health 
 by therapeutical illusions and quack medicines, which contain 
 nothing of an active, perturbating character. 
 
 The deduction to be drawn from these facts is that the 
 prudent physician may show as much — nay, more — skill in 
 withholding drugs when not needed as in giving them when 
 they are. 
 
CHAPTER IX. 
 
 "Together let us beat this ample field, 
 Try what the open, what the covert yield." — Pope. 
 
 Aim earnestly to please every one's taste and ideas of medi- 
 cine as far as is compatible with safety. Bear ever in mind that 
 a man is something more than an animal machine, a mere 
 stomach and body, and constantly study the use of psychological 
 aids, and try to compel your patient to assist in curing his 
 own case. Also avoid overdosing, and remember that those 
 who have been most fond of medicine often become suddenly 
 surfeited and undergo a complete revulsion against both medicine 
 and physicians. How can this be wondered at when even too 
 long a continuation of beefsteak, partridge, oysters, or other 
 savory food causes disgust and utter loathing even in well 
 people 1 
 
 This tendency in the human mind has in recent times re- 
 ceived an unfortunate illustration at our expense, and in this 
 way: Satiated and disgusted with Humoral Pathology and its 
 crude and overactive measures, administered too often without 
 regard to caprice or palate, a great many mis-drugged and over- 
 dosed people were anxiously wishing for almost any change, 
 when lo ! Samuel Christian Friedrich Hahnemann, of Meissen, 
 Germany, appeared and accommodated them with a new do- 
 nothing system, resting on a creed composed of one logical and 
 two pseudo-logical tenets, which admirably serves to advertise 
 both system and disciple, and to amuse and employ those who 
 trust to the latter, without offending either eye, palate, or 
 stomach ; depending really on unassisted nature to do the work, 
 if adhered to, allowing cases that it cannot restore unaided to 
 become complicated or chronic, or to succumb and be added to 
 the list of those who die of preventable deaths. 
 
 (197) 
 
198 THE PHYSICIAN HIMSELF: 
 
 So strong is the popular reaction against extreme and un- 
 necessary medication, that this silly system has a large and 
 earnest following, and has mounted up and enjoyed the sunshine 
 of popular favor among people with susceptible minds, to a 
 most astonishing degree, and may be regarded as the great medi- 
 cal delusion of the nineteenth century. There can be no doubt, 
 however, that its career would long since have terminated had 
 the profession not been so loath to accommodate itself to the de- 
 mands of fashion, particularly with reference to medication in 
 slight and imaginary cases. But rational physicians are at last 
 arousing to the importance of this subject, and are conforming 
 to the demands of fashion. They are at the same time admin- 
 istering more concentrated and palatable forms of medicines in 
 serious cases, and, thanks to tire labors of the many devoted 
 workers in the field of medical science, and the light which 
 has been thus shed upon the subject, are now enabled to 
 effect cures with greater certainty, promptness, and safety than 
 ever before. The result is that many of the erring, who had 
 gone over to it and other "isms" and " pathies," are being 
 brought back from their ranks to faith renewed in our legiti- 
 mate and rational system of practice. Determine that you will 
 bear your share in the good work by devoting time and study to 
 the means of rendering therapeutics useful and at the same time 
 pleasant and acceptable to patients. 
 
 You are, of course, bound by the most sacred obligations 
 to use your best judgment and endeavors for the good of every 
 one who comes under your professional care, but neither the 
 Code of Ethics nor the Code of Honor forbids your sailing be- 
 fore any and every popular breeze, provided you violate no 
 principle of truth or justice. 
 
 No honest man could compromise a matter of principle, 
 i.e., knowingly quit the right for the wrong, or for one moment 
 permit policy to sit above honesty ; yet it is sometimes very 
 foolish not to compromise a matter of mere policy. In medicine 
 the second-best course often becomes the best because the patient 
 
HIS REPUTATION AND SUCCESS. 199 
 
 likes it best ; and although you can neither believe nor follow 
 Hahnemann's nonsense and follies, you can follow the fashion 
 of the day, and can give to every fastidious or squeamish patient 
 the smallest and most pleasant dose that his safety will permit, 
 and can avoid giving any one crude remedies to a disgusting 
 degree. 
 
 Now, although this ridiculous delusion is somewhat fashion- 
 able, when a case actually requires medication you can make 
 veiy little if any rational use of its so-called principles, which 
 rest on the following foolish postulates : 1st. 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 itself. 
 3d. The similar and single remedy must be given in its mini- 
 mum dose, i.e., the smallest dose sufficient to effect a cure in the 
 case. These are the three legs upon which Samuel Christian 
 Friedrich Hahnemann's substitute is supposed to stand ; his 
 entire stock in trade; an essential triune, an inseparable unit. 
 Violation of any one of these principles by the faithful is a con- 
 fessed rejection of S. C. F. H.'s whole system. 
 
 You will observe at a glance that this creed is exactly two- 
 thirds nonsense ; that the first and second postulates are sophis- 
 tical and untrue, and hence should be rejected, and that the last, 
 i.e., to give the smallest dose that will answer the purpose, is a 
 rule filched from the regular practice, which nobody denies. 
 Every free and thinking person, whether physician or not, has 
 recognized ever since the days of Pliny and Plutarch that it is 
 useless to pour nine buckets of water on a fire when he is sure 
 that one will put it out ; which piece of common sense is equally 
 true in medicine, and cannot, by any amount of sophistry or 
 " hocus pocus," be monopolized by any New School. 
 
 Contrary to what many unthinking people believe, this 
 creed gives the homoeopaths perfect liberty to give either an 
 atom or an ounce of mercury, sugar, opium, or anything else, at 
 a dose provided they proceed on the homoeopathic principle of 
 similars ; and the question whether they, or you, or any one else 
 
200 THE PHYSICIAN HIMSELF: 
 
 does or does not practice homceopafchically does not at all depend 
 upon the size of the dose. They might give an ounce of a medi- 
 cine in cases in which you would give but a grain. Their ounce 
 . would not make them regular physicians, nor your grain make 
 you a homceopathist. 
 
 The practice of rational medicine is as distinct and free 
 from all pathies as America is from Asia. Here is the true test 
 as to whether you are practicing rationally, homoeopathically, or 
 . allopathically : Were you to examine a patient and ask yourself, 
 without regard to the so-called (humbug) pathies, or to any other 
 creed or boundary. What is the best treatment known to the world 
 for a case like the one before me? and give him that, you ' 
 will be practicing rational (regular) medicine. If, on the con- 
 trary, you were to examine a case (with the Will-o'-the-wisp ■' 
 array of pathies in your mind), and ask yourself, What article 
 loould produce a totality of symptoms similar to these in a well 
 person ? and give him the one which you thought would come 
 nearest to doing this, you would be practicing homoeopathically. 
 On the contrary : were you to sit down (with the chimera of 
 pathies in your mind) and, with lengthened phiz, ask yourself 
 what article would jingle with an opposite totality of symptoms, 
 and irrationally base your treatment on that false ground, you 
 would be practicing allopathically. Now, it is safe to conclude 
 that if you practice medicine forty years you will never sit down 
 by an ill man's bedside (conjure the pathies) and ask yourself 
 either, " What agent would produce a disease similar to this, 
 or symptoms similar to these in a well person V or " What 
 would cure by agreeing with opposite pathies V and attempt to 
 simulate it in your treatment. Therefore, take care to remember 
 that, no matter how small your dose, or what the article, or bv 
 whom first used as a medicine, even though, in the exercise of 
 your privilege as a regular or rational physician, you prescribe 
 nothing but infinitesimal doses of oyster-shell, or teaspoonful ' 
 doses of aqua pura, or let your patient smell an empty bottle 
 with but one nostril once in nine days, or give him but one drop 
 
HIS REPUTATION AND SUCCESS. 201 
 
 of Aqua Cinnamomi or an unmedicated globule of saccharum 
 every Friday night, they will not be given by the square and 
 compass of the so-called pathies at all, and you will be proceed- 
 ing neither homceojpathicalJi/ nor allopathically. 
 
 I\, is also safe to predict that while reason remains your 
 mistress you will never agree that twelve twelves make a hun- 
 dred and forty-five, or seriously entertain, much less follow, a mon- 
 strous system of symptom-worship, that in dogmatically seeking 
 to follow the (so-called) law of similars, arrives at poison oak 
 as a remedy for erysipelas, croton-oil as a remedy for cholera 
 infantum, mercury for mumps, tartar emetic for typhoid pneu- 
 monia, opium for apoplexy, strychnia for convulsions, can- 
 tharides for burns, and an immense farrago of other similar 
 nonsense, that rivals Mother Goose's : — 
 
 "There was a man in our town, and he was wondrous wise, 
 He jumped into a bramble bush and scratched out both his eyes. 
 And when he saw his eyes were out, with all his might and main, 
 He jumped into another bush and scratched them in again." 
 
 Study the " Organon of Medicine " and " The Lesser 
 Writings," by Samuel Hahnemann ; " Homoeopathy Fairly 
 Represented," by William Henderson, M.D. ; Hull's " Jahi' ;" 
 Hughes' " Pharmaco-Dynamics ;" Johnson's "Therapeutic 
 Key;" the works of Hering, Lippe, Guernsey, and other lead- 
 ing homoeopathic authorities who delight to believe in and prac- 
 tice homoeopathy, and you will read that a homoeopath must 
 prescribe according to what he claims to be the grand, the only 
 law of medicine and rule of practice which S. C. F. Hahnemann 
 by his genius discovered, and which is comprehended in the 
 phrase "similia similibus cnvuntur" or like cures like. It is 
 this loud and false claim that makes homoeopathy one of the 
 many systems of quackery. 
 
 It is universally admitted that quinia cures intermittent 
 fever, but who ever heard of its being homoeopathic to the 
 periodic feature of that disease ? And yet where is the homoeo- 
 path that does not, in periodic fevers, administer sugar-coated 
 
202 THE PHYSICIAN HIMSELF.* 
 
 quinine pills in full doses 1 Podophyllin is the favorite cathartic 
 of the homoeopath. Does it ever cause constipation except by 
 the secondary exhaustion and impairment of sensibility common 
 to all cathartics 1 No intelligent physician would contend that 
 it did. That morphia relieves that great enemy to human life 
 and health — pain — is one of the best-attested facts of medical 
 observation ; will any homoeopath dare say that it causes pain] 
 The same may be said of mercury in syphilis, and of cod-liver 
 oil in scrofula and phthisis. These are not stray assertions; they 
 are monumental facts, that will surely banish the homoeopath 
 and his silly law of similars; for neither Samuel Christian 
 Friedrich Hahnemann's nor any one else's sophistry can main- 
 tain itself permanently before the light of truth and science. 
 
 Truth is a unit ; there can be but one science of one subject, 
 and there is but one science of medicine. Compare Samuel Chris- 
 tian Friedrich Hahnemann, whose whole life was full of unnatural 
 thoughts and peevish fancies, and the shallow and delusive so- 
 called natural law, published in his presumptuous work called the 
 " Organon," in 1810, in which he talks as if he alone had 
 charge of the key of knowledge and the casket of truth — all the 
 way through, with Copernicus, Newton, Harvey, Davy, Galileo, 
 Franklin, and other real discoverers of nature's laws, and you 
 will find his baseless and unscientific assertions resting on a foun- 
 dation so slight that it will strongly remind you of an inverted 
 pyramid, that must fall before the truth for want of sufficient 
 base to stand upon, and you will then fully realize what an 
 absurd and unnatural delusion S. C. F. Hahnemann's so-called 
 therapeutic science is, and why we reject it. 
 
 Those illustrious men did discover the natural laws of 
 astronomy, gravitation, electricity, etc., consequently their sys- 
 tems have extended, or have been but slightly changed. Hahne- 
 mann did not discover the natural law of medicine, therefore, his 
 system has beaten about from psora and dynamization to the 
 tasteless, the infinitesimal, etc., changing with every decade, 
 until now it scarcely exists at all except in name. 
 
HIS REPUTATION AND SUCCESS. 203 
 
 You will discover that nine out of ten of those who run 
 after its sweet nothings know absolutely nothing at all about 
 Hahnemann's so-called principles and sophistical calculations, 
 BUT (and this is a very big but) take them themselves and give 
 them to their families solely because they are fashionable, novel, 
 cheap, very easy to take, and prevent running to the druggist 
 with expensive prescriptions. 
 
 Another of S. C. F. H.'s doctrines was the dynamization 
 of medicines, one that, despite Euclid, he and his followers 
 formerly praised from the housetops, and which was used by 
 them as a wonder-creating something made of nothing. His 
 assertion that a millionth of a grain of medicine had more power 
 than a grain, or that a drop of alcohol well shaken had more 
 power than an unshaken pint, helps to show his unparalleled 
 assurance and intense egotism. 
 
 These notions of his not only contradict reason and violate 
 common sense, but conflict with fixed' mathematical laws, since 
 a part cannot be greater than the whole. The truth is, the so- 
 called dynamization of medicines is pure bosh, and bears about 
 as much relation to the science of medicine as the kaleidoscope 
 does to the science of astronomy. 
 
 The novelty of globulism, attenuations, and infinitesimal 
 dosage, like spiritualism and mesmerism, aims at two of the 
 strongest qualities of the human mind — qualities that all might 
 honestly utilize more fully — the love of the mystical and the 
 charm of novelty. 
 
 As previously stated, nothing under heaven prevents you 
 from giving whatever you think best for your patient, whether 
 its therapeutic action is similar, antagonistic, or anything else 
 in the circle ; but if, in so doing, you adopt a narrow or foolish 
 dogma, or an exclusive system, and prejudice your mind against 
 all other ascertained truths, your one-sided partisanship will 
 fetter you, abridge your usefulness, and make you unfit for fellow- 
 ship in liberal medicine. Thus, when Vincent Priessnitz, Avith 
 his wet sheets and water-tub, in trying to build a house of a 
 
204 THE PHYSICIAN HIMSELF: 
 
 single brick, shut his eyes to everything but hydropathy ; and 
 one-sided John Brown founded Brunonianism on incitability ; 
 and Broussais went wild on Inflammation, Gastroenteritis, the 
 lancet and leeches ; and Basori overdosed with his system of 
 " Contraria Contraries ;" and peevish S. C. F. Hahnemann, in 
 his overweening vanity and savage partisanship, deserted free 
 therapeutical science and tied himself to a so-called pathy, and 
 rabidly denounced everything else ; and Samuel Thompson, in 
 his exclusivism, threw away everything but herbs — they each 
 ignored a host of important facts and thereby lessened their own 
 usefulness and that of all who follow them. 
 
 "For never yet hath one attained 
 To such perfection, but that time, and place, 
 And use, have brought addition to his knowledge ; 
 Or made correction, or admonished him 
 That he was ignorant of much which he 
 Had thought he knew, or led him to reject 
 What he had once esteemed of highest price." 
 
 Thus it is with agriculture, and navigation, and medicine, 
 and every other advancing art. Medical science has no goal ; 
 its law is progress. 
 
 Not a single department of medicine has yet reached scien- 
 tific exactness, and possibly never will, while the world stands. 
 We, as rational regular physicians, are striving hard to bring its 
 various branches as near to perfection as possible, and are will- 
 ing to* learn medical truth and scientific Avisdom wherever they 
 can be found. When " New Schools," schisms, or creeds arise, 
 if they possess any new or valuable truths, or remedies of ascer- 
 tained merit, no matter how great or how small, whether taken 
 from the animal, vegetable, or mineral kingdom, from the sponge, 
 the weed, the insect, the mineral; product of wilderness, ocean, 
 or prairie, we instantly single them out and incorporate them 
 with the great mass to swell the' records of rational medicine, 
 and press onward ; so that the medicine of to-day mav be said 
 to be a living, moving, growing, wondrous array, founded on all 
 its yesterdays. 
 
HIS REPUTATION AND SUCCESS. 205 
 
 Irregulars of every kind feel that, to exist, they must be at 
 war with the regular profession, and derisively style us " The 
 Old School," " Allopaths," etc., to make it appear to their par- 
 tisans and others that a creed is necessary, and that every phy- 
 sician must bear the trade-mark of some special school or petty 
 sect, with wide-apart principles ; and that ours is merely one of 
 these restricted sects, with hoary dogmas; and an old-fashioned 
 and dilapidated, moss-grown, ivy-covered creed, twenty-four 
 centuries old. That we have by-gone habits, ancient ways of 
 thinking, and set rules and doctrines, that are handed down 
 from teacher to pupil, to run in the same old channels and 
 ruts forever, which, though good enough in olden days, are now 
 altogether inadequate, behind the times, and in their declension. 
 Their aim in doing this is, of course, to draw us on to false 
 ground before the public, and to obtain for their ism or pathy the 
 honorable distinction and the business advantage of appearing 
 to stand co-equal with us ; just as, for instance, in religion one 
 sect (Pharisees versus Sadducees or Catholics versus Protestants) 
 stands with reference to another, and in politics Republicans 
 stand with Democrats. 
 
 Faugh on such nonsense ! Who are the heroes of modern 
 medical science \ What men are to-day, as ever, bearing for- 
 ward the flag of medical discovery, and making the star of 
 truth shine over the hilltops of medical discovery as clear as 
 the noonday sun 1 Regular physicians ! Who are the great 
 authorities, and who hold the most advanced views on anatomy, 
 physiology, pathology, gynaecology, ophthalmology, insanity, 
 bacteriology, etc. I None other than regular physicians ! Where 
 stand quacks and irregulars of every kind in the upward track 
 of scientific medical progress % 
 
 Remember that the epithet or by-word " Allopath " is a 
 narrow nick-name, not chosen by us at all, but coined for us by 
 our enemy, Samuel Christian Friedrich Hahnemann, in contradis- 
 tinction to his own dreamy system, as part of his intemperate and 
 ridiculous attempt to put out the lights of therapeutic science, 
 
206 THE PHYSICIAN HIMSELF: 
 
 and to substitute his own silly, Jack-with-the-lantern system; 
 and is applied to us opprobriously by our bitterest enemies, with 
 intent to injure; that it is both untrue and offensive, and is no 
 more accepted by regular physicians than the term " Heretic " is 
 accepted by Protestants, " Ch***t-killers " by the Jews, or "Lo- 
 cofoco " by the Democrats. We are not " paths " of any kind, 
 but Regular Physicians. Take care promptly to resent the term 
 " Allopath " when any one applies it to you through enmity, 
 and to politely disown it and also tell of its falsity and hostile 
 origin when applied by those who do not know what the term 
 implies. 
 
 S. C. F. H.'s allopathic sectarian physician would be one 
 whose silly creed required him to fiddle' on some other sympathy, 
 or to create some other disease as a substitute for the one he was 
 called upon to treat. Now any man, with but one eye even, 
 can see why there will be Protestant bakers and Catholic gar- 
 deners, Baptist laundresses and Quaker boot-blacks, Vegetarian 
 blacksmiths and Presbyterian shoemakers, Spiritualism bankers 
 and Masonic carpenters, Odd Fellow bricklayers, Republican 
 barbers and Democratic bakers, Homoeopathic doctors and Swe- 
 denborgian undertakers, as long as there are people who wish 
 to employ dogmatists in these things ; but certainly no sensible 
 person wants an allopathic physician, consequently no thinking 
 man professes to be one, and we should not let our enemies put 
 us in that cage ; but there is, and ever will be, everywhere, a 
 demand for rational physicians who will do for their patients 
 whatever under heaven seems best, without regard to creeds and 
 pathies. Away from us, then, at once and forever, with the 
 false title, "Allopath!" 
 
 We have a wealthy but very silly, fanciful, globule-ridden 
 lady living in our section, who has become such an infatuated be- 
 liever in Similia, etc., that, besides incessantly hunting up indi- 
 cations and symptoms in herself, and dosing herself with pellets 
 of table-salt when she dreams there are robbers in the house, of 
 veratrum when she dreams she eats her shoes, of hyoscyamus 
 
HIS REPUTATION AND SUCCESS. 207 
 
 when she dreams she climbs the stove-pipe, or is pretending to 
 drive away peacocks, etc., etc., she actually pellets her birds 
 whenever they fail to sing, and Tabby and Tommy when they 
 fail to mew. Other silly but zealous men and women, in the 
 fervor of their zeal, as if to complete the absurdity and show 
 their child-like trust, have given attenuated tinctures, etc., to 
 turkeys, sheep, dogs, cows, chickens, horses, geese, mules, etc., 
 and would almost ask you to believe that they had seen a red 
 calf with blue eyes changed into a blue calf with red eyes. All 
 this in the blaze of the nineteenth century. 
 
 Homoeopathy not only panders to the whims of such, but 
 also makes a specialty of poisoning the minds of all its votaries, 
 not only against the lancet, overtreatment, polypharmacy, and 
 other needlessly active measures, but against rational remedies, 
 inclining them to attach undue importance to trivial affections, 
 and to overestimate the value of placebo treatment, which not 
 only tends to produce an effeminate type of character that cow- 
 ardly shrinks from every ailment, but also creates a pathophobic 
 overattention to the minutiae of their health, and eventually 
 making them morbidly anxious about every function, and filling 
 their minds with a medley of imaginary and exaggerated afflic- 
 tions, which haimt them, like Banquo's ghost, wherever they go. 
 
 You will often see perfectly healthy-bodied persons, who 
 might have passed through life with scarcely a thought of sick- 
 ness, after being indoctrinated in it and softened by its follies, and 
 being (with book in hand) habituated to its self-surveillance, 
 become borne down into valetudinarianism or hypochondriasis by 
 numerous magnified symptoms and constant indications for 
 pellets and attenuations ; and, by the way, if you will read the 
 provings in any of their standard works — Hughes' " Pharmaco- 
 Dynamics," for instance — you will find that many of the symp- 
 toms said to follow their provings are too nasty to be repeated, 
 and that the majority of the others are too silly to be respected 
 — more like the idle fancies of Spiritualists or day-dreamers than 
 the work of rational persons. 
 
208 THE PHYSICIAN HIMSELF : 
 
 Were some graceless wag to exchange or mix up the atten- 
 uations and globules of the different phials of sepia, natrum 
 muriaticum, carbo vegetabilis, etc., so that each would contain 
 specifics (!) the opposite in action from its label, the faithful, 
 with perverted perception, squinting judgment and turgid imag- 
 ination, in blissful ignorance of the fact, would doubtlessly con- 
 tinue to make their cures all the same. Indeed, a short Avhile 
 ago some Chicago physicians offered to test the value of ho- 
 moeopathy as follows: 100 vials of pellets were to be put up by 
 homoeopathic druggists, in parcels of 10 each — 9 of the 10 vials 
 to contain sugar pellets only, while the 10th vial was to be 
 filled with some active (?) homoeopathic drug. Each of these 
 parcels were to be sent to some prominent homoeopath, who was 
 to. use them on his patients, and designate, by the effect, what 
 drug the 1 0th vial contained. No one would accept the challenge ! 
 
 Homoeopathy has also profited, and is still profiting, 
 wherever the English language is spoken, by an accidental mis- 
 leading resemblance of the term homce to the precious word 
 home — "Home, sweet home." 
 
 To you as a physician the term homoeopath naturally sig- 
 nifies a person who practices a certain dogmatic and visionary 
 system. But to many of the laity, on the' contrary, the first 
 two syllables of the word suggest that he practices a simple 
 liome or domestic system of medicine, and the fact that he ordi- 
 narily prepares his own globules, solutions, etc., either at his 
 own home or at the homes of those who employ him, instead 
 of sending prescriptions to drug stores as we do, adds strength 
 to this popular error. 
 
 By fostering the error which this unfortunate resemblance 
 creates — in some instances even anglicizing the term by drop- 
 ping the ce and substituting e — and falsely terming those who 
 practice rational medicine "Allopaths," Hahnemann's followers 
 have materially advanced themselves with the public, and of 
 course injured rational medicine in a corresponding degree. 
 
 This error is so natural that people often actually designate 
 
HIS REPUTATION AND SUCCESS. 209 
 
 regular physicians who happen to supply their own medicines 
 '• Home-o-paths." 
 
 It is your duty, in the interest of truth and for the benefit 
 of humanity; to make it known that the word " home " is of 
 Saxon derivation, whereas the prefix homceo is derived from the 
 Greek homoios (similar), and has no possible relation to hearth 
 and home. S. C. F. H. seems to have built better than he knew, 
 as far as the home-loving, English-speaking Americans are 
 concerned, when he styled himself a homceopathist, and not a 
 pathomceist, which has the same meaning. 
 
 One of the most amazing of all wonders, one that does no 
 honor to mankind, is that wisdom in the mysteries of the law or 
 in the doctrines of theology, philosophical acumen in the sci- 
 ences, skill in the polished arts, or keenness and culture in other 
 departments of human knowledge, scarcely increases some 
 people's reasoning powers & jot above the Ancient Egyptians in 
 medical matters, or prevents their being led completely astray 
 by the thousand-and-one false notions of cures, remedies, spe- 
 cifics and antidotes. Indeed, some persons think that to follow 
 the incomprehensible emancipates them from the inelegant, 
 proves their superior penetration and sapiency, and places them 
 among the most advanced. 
 
 More than one (intelligent) lawyer has, in this the last 
 quarter of the nineteenth century, put knotted red strings 
 around his children's necks to cure whooping-cough; more 
 than one sea-captain has carried a potato or a "chunk" of 
 brimstone in his pocket, or wore one stocking wrong side out, to 
 charm away rheumatism ; more than one millionaire has vowed 
 that fairy globules of tartar emetic have restored his strength; 
 and such is poor human nature, that many a clergyman and 
 poet and orator and member of the elite has solemnly certified 
 that this, that, or the other worthless quack swindle has saved 
 his life, yea, saved him, even after he had actually stood on the 
 crater of the awful volcano of death, and positively heard the 
 rustling of the wings of the black angel. 
 
 14 
 
210 THE PHYSICIAN HIMSELF: 
 
 How any individual can be a wise logician in all else, and 
 yet, as soon as sickness attacks him or his, leave all reason be- 
 hind, and with open mouth and closed eyes become an easy, almost 
 voluntary prey to shallow quackery, and exhibit ■'the strongest 
 faith in sophistical pretension whose assumptions are glaringly 
 ■contrary to common sense, is a psychical enigma that almost 
 weakens one^s faith in the common sense of half of mankind. 
 
 ©0 not infer that a real homoeopath (or an omnipath, or 
 hydropath, ot vitopath) may not be influenced by the highest 
 motives, or may not be following his pathy conscientiously, for 
 there never has been an absurdity in regard to religious, politi- 
 cal, or medical questions that has not found very sincere sup- 
 porters; nor that they do no good, for they may do a great deal 
 of good, and even get patients well, but the good they do is not 
 by their silly pathies, as has been proven by innumerable ob- 
 servers, but by the accompanying hygienics, dietetics, faith, ex- 
 pectation, good nursing, time, etc., which would do equally as 
 much were the pathy portion left out, and globules of sugar, 
 or bread pills, or colored water, or any other make-believe 
 remedy substituted, to give their patients room to exercise their 
 faith, and rest, regimen, the vital force, and time, an opportunity 
 to do the work. 
 
 God help afflicted humanity were genuine homoeopathy 
 the medical man's only reliance in his struggles with the twenty- 
 four hundred (Sauvage) diseases to which mankind is subject ! 
 Imagine for a moment a group of physicians entering the lazar- 
 house depicted by Milton in " Paradise Lost," to combat the pains, 
 suffering, and physical distress of that protean assemblage ; who, 
 instead of arming themselves, at all points, with every available 
 therapeutic weapon, had provided themselves with S. C. F. H.'s 
 similia similibus only. True, while ministering to. ephemera, 
 catarrhs, nervous headaches, palpitations, functional dyspepsia, 
 tonsilitis, catarrhal croup, chorea, uncomplicated exanthemata, 
 and slighter affections that (with nature on their side) have a 
 strong tendency to spontaneous recovery, and in which the 
 
HIS KEPUTATION AND SUCCESS. 211 
 
 public cannot distinguish between cures and natural restoration, 
 they might, with a little adroitness and the free use of our adju- 
 vants, make themselves appear like magicians among certain 
 people; but when they encountered grave maladies which, un- 
 less thwarted by the truest medicines and overcome by the 
 stoutest weapons that are known to man, have a tendency to 
 overwhelm and destroy their victims, they surely would turn 
 pale as the curable became incurable, and feel in their hearts 
 the inherent deficiency of the airy nothings which had left them 
 as powerless to combat disease as soldiers would be to meet their 
 merciless enemies in battle after being stripped of all their 
 weapons, and almost curse the pen that wrote the folly. 
 
 As well expect a mouse to pull a coal-cart, or the steam 
 from a pint tea-kettle to propel an ocean steamer ! 
 
 The truth is, if a man has a sickness in which the ten- 
 dency is to death, medicines given on S. C. F. H.'s piddling plan 
 will not, can not, avert that result ; and the malady will go on 
 from bad to worse, till his sufferings are relieved by death, while 
 good medical treatment with some of the agents which expe- 
 rience and reason offer, and rational physicians accept, might 
 control its downward and fatal course and restore him to health. 
 
 If ever chance brings you in contact with a real homceo- 
 pathist, if you believe him to be a gentleman, observe all the 
 forms of politeness toward him, and treat him exactly as you 
 would any other gentleman, but ignore him (as he probably 
 will you) professionally, and make no attempt to fraternize with 
 him in the management of a case. 
 
 Suppose an attempt to consult: patient has — well, say, 
 convulsions, the result of teething. You examine the case 
 together— retire for consultation — the subject of treatment is 
 finally reached. You (true to humanity) then survey the whole 
 field of rational therapeutics and conclude : first, that the cause 
 should be removed as far as possible by incising the gums for 
 the purpose of severing their irritated nerves; second, that 
 sedatives and antispasmodics are indicated, He (true to his 
 
212 THE PHYSICIAN HIMSELF: 
 
 creed) puts on his Hahnemanni'c spectacles, surveys the totality 
 of symptoms by the square and compass of Similia Similibus 
 Curantur, and arrives at strychnia, in the tenth dilution ! 
 Result : a therapeutic dead-lock, unless You agree to give up 
 common sense for his nonsense. 
 
 But how, oh, how ! can any true man have much to do 
 with any of the other flock — the chatty, flexible fellows who are 
 not homoeopaths at all, but solely for business reasons masque- 
 rade as homoeopaths by a display of Hahnemannic nonsense, 
 just as ostrich-hunters assume to be ostriches by dressing in 
 that wise bird's feathers 1 
 
 The majority of these sham homoeopaths palm off as real 
 by providing themselves with awe-inspiring satchels, which they 
 handle as carefully in opening and closing them, in getting in 
 and out of their buggies, going up stairs, and in crossing streets, 
 as if an additional shake of the powerful dynamizations within 
 might still further increase their potency, endanger their patients' 
 lives, or cause an explosion. Carefully look into the satchel and 
 the pockets of any one of these, and you will not only find the 
 usual attenuations, triturations, tinctures, and globules — Lehr- 
 man'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 find also a full — a very 
 full — supply of Wm. R. Warner's, or W. H. Schieffelin's, or 
 Sharp & Dohme's, or some other make of sugar-coated gran- 
 ules of morphia, quinia, arsenicum, belladonna, elaterium, colo- 
 cynth, etc., whose rational use he has borrowed from the regular 
 profession, which he habitually administers with as little regard 
 for " similia" etc., as you do. Be not startled if you also find 
 a hypodermic syringe and a bottle of Magendie's solution — irre- 
 futable witness of his lack of honesty and lack of faith in Avhat 
 he professes. Respect every sincere believer in anything who 
 fights a fair battle for it, no matter how great his error, but let 
 the finger of scorn point at each and every false fellow who, as 
 
HIS REPUTATION AND SUCCESS. 213 
 
 an advertisement of himself and to catch patients, denounces and 
 sneers at "Allopaths" and u old school" remedies, meanwhile 
 giving shamming pellets and attenuations in placebo cases only, 
 and in all others leaving the similia similibus cttrantur out, and 
 slyly using opium to relieve pain, chloral to induce sleep, quinia 
 to arrest lever, and all our other prominent agents, just as ive do, 
 in full doses, yet, with unparalleled impudence and assurance, 
 crediting the good they do to similia similibus curantur. 
 
 There is also a self-adjusting variety of pretenders, who, 
 thank heaven ! are not very numerous, who are homoeopaths in 
 one house and anything-you-wish in the next, actually offering 
 to leave it with sick men, women, and children to choose which 
 system of practice they will have. These, although inconsistent 
 with themselves, are not as bad as the make-out kind, for they , 
 are at least open and honest in their announcement. But what 
 words would exaggerate the meanness of a clergyman whose 
 love of gold and lack of scruple would allow him to vary his 
 principles at trill and preach anything you wished, whether a 
 strictly Catholic lecture, or an ultra-Protestant discourse, an 
 orthodox Hebrew sermon, a fiery Mohammedan philippic, or an 
 out-and-out infidel harangue] He might believe in one or 
 none, but he could not believe in all, and, if he professed to do 
 so, would deserve to be kicked out of his own door. 
 
 Science has everywhere convincingly shown that Homoe- 
 opathy contains its own refutation, and is a fraud on the people. 
 It is not half so new as many suppose. Hahnemann started it 
 in 1790, six years before Jenner vaccinated James Phipps, and 
 the " Organon " was published in 1810. Now, in this long, long 
 period, had it deserved scientific recognition or had there been 
 anything at all in it worthy of adoption by the profession, it 
 would surely, like vaccination, long since have been absorbed by 
 scientific rational medicine, whereas the fact is that its silly 
 creed has taken no root at all in the regular profession. To-day 
 it is withering like a girdled fig-tree, and Hahnemann no longer 
 stands on a pedestal, is no longer worshiped as a hero, and his 
 
214 THE THYSICIAN HIMSELF: 
 
 system has almost faded out in the land of its birth, and is 
 without a chair in any university of Europe, and is rarely 
 mentioned there without a smile. 
 
 It was chiefly the over-medication of former days that gave 
 it a start. Were any one to originate such a silly system to-day, 
 there would be no excuse for its existence and it would be still- 
 born. 
 
 Even here, in Free America, the Homoeopathic book and 
 case of numbered similars are fast disappearing from the hands 
 of the laity, its specifics are now kept among the patent medicines 
 in every drug store, and the system is no longer exciting ama- 
 teurs, and is about to furnish another proof that no religious 
 creed, no political doctrine, no medical ism or pathy can long 
 endure if it is opposed to the common sense of mankind. 
 
 Examine the homoeopathic creed closely (pages 199, 200) 
 and carefully watch the practice of all those who claim to prac- 
 tice under it of whom you have personal knowledge, and you 
 will find but few (if any) who honestly do so. The number of 
 those who pretend to practice homoeopathy may be still some- 
 what on the increase, yet pure homoeopathy itself (similia, etc., 
 based on provings) is rapidly disappearing. I doubt whether 
 there is at this time a pure Hahnemannic Homceopathist in 
 Maryland. For the confirmation of this I refer to any qualified 
 pharmacist who comes into contact with homoeopathic therapeu- 
 tics. The genuine homoeopath never gives tonics, never orders 
 mineral waters, never orders emulsions, never alternates or 
 mixes remedies, and never employs hypodermic injections, pur- 
 gatives, mustard plasters, ointments, lotions, washes, liniments, 
 medicated injections, cauterizations, sprays, or gargles. Show 
 a decent respect for the real homoeopath, and for every one's 
 views if honestly held, but carefully shun the fellows who, as 
 the ass did when in the lion's skin, plume themselves as homoe- 
 opaths simply as a sham to deceive the public because, just at 
 this time, it pays. 
 
 Inquiry will show you that many of the latter were 
 
HIS REPUTATION AND SUCCESS. 215 
 
 formerly fourth- or fifth- rate regular practitioners, who Avere 
 crowded out of the profession into their present occupation by 
 the well-known law of " the survival of the fittest," and that 
 many of the remainder obtained what medical education they 
 got in regular colleges by falsifying about their future intentions. 
 
 In considering the nothingness of homoeopathy think what 
 it is to-day — that its disciples no longer follow their master, 
 that every change they make is toward regular practice, and 
 that the majority of the flock seem to be on their way back to 
 Regular practice in everything except in name and in affiliation. 
 
 Leaving the subject of homoeopathy, its representatives and 
 friends, let us consider other features of our environment : — 
 
 Remember that it is not on account of their therapeutics 
 at all that we object to exclusive systems and refuse to fraternize 
 with their followers, but because they refuse to select remedies 
 from all sources, assume dogmas and systems that are limited, 
 and denounce all else. 
 
 Were you to announce yourself as an anti-botanic, anti- 
 omnipathist, anti-allopathist, anti-eclectic, anti-electropath, anti- 
 hydropath, anti'vitopath, or anti-anything else calculated to pro- 
 duce division, antagonism, or strife, it would be unprofessional, 
 and equally as inconsistent with the spirit of scientific medicine 
 as the systems which you were opposing, and would abridge 
 your usefulness and render you unworthy of professional fellow- 
 ship, just as it does other persons who follow limited creeds. 
 
 Although it is wrong to spend much time and labor in ac- 
 quiring knowledge of anything that is useless when known, yet 
 it is well to look into the principles of mesmerism, hydropathy, 
 galvano-therapeutics, spiritualism, etc., to enable you to speak 
 of them from personal knowledge, and to checkmate their rep- 
 resentatives, who make great capital out of knowing all about 
 the " old school system" which they, of course, aver does not 
 compare with the "' new school " under which they practice. 
 
 To limit one's practice to any certain segment of the medi- 
 cal circle is, of course, quite different from limiting one's creed. 
 
216 THE PHYSICIAN HIMSELF: 
 
 You have an indisputable right to limit your practice to any 
 specialty or department of medicine you please, but as it is a 
 self-imposed limitation of your sphere you should take care in 
 your signs and cards simply to add to your general title the 
 words, " Practice limited " to the eye, or to the throat, or to skin 
 diseases, or to whatever else your specialty may be. Such an 
 announcement is honest and professional, and claims nothing 
 more in the way of skill than your M.D. presumes. A sign or 
 card with the words, " Practice limited to," etc., is perfectly pro- 
 fessional; one that reads, "Special attention given to," etc., is 
 not. 
 
 Compte says : " Facts, and the invariable laws that govern 
 them, are the pursuit, and the only legitimate pursuit, of science." 
 Bear in mind that we, governed by this, condemn no system or 
 discovery, ignorantly, on the principle which governs the Indian, 
 who disbelieves in the locomotive and telegraph, or on that 
 by which Galileo was persecuted, or accept anything as a blinded 
 Hindoo devotee does his religion; but, on the contrary, thou- 
 sands of competent, earnest, fair-minded, truth-loving students, 
 men eminent in science and untrammeled by clique, all the 
 world over, both in hospital and private practice, with open eves 
 and alert ears; with the true spirit of philosophy and philan- 
 thropy, solely for the purpose of ascertaining- the truth for the 
 benefit of medical science and of suffering mankind, and anxious 
 to see new links added to the great chain of therapeutic 
 aids, eagerly, and fairly, and deliberately investigate and fully 
 test all the alleged discoveries, theories, and so-called reforms 
 in medicine from A to Z when they arise, and the conjoined re- 
 sult gives us a true common-sense verdict. And it is no more 
 necessary for every succeeding generation, with more useful 
 things to think about, to turn aside and discuss whether George 
 Washington was fairly elected president, or whether Napoleon 
 Bonaparte was a real person or only a myth, or to waste the 
 time necessary to re-sift, re-weigh, and re-judge unreasonable 
 medical vagaries and nonsensical dogmas that have been a hun- 
 
HIS REPUTATION AND SUCCESS. 217 
 
 dred times disproved before rejecting them, than it is for every 
 one to study spirit-rappings and table-turnings, the Book of 
 Mormon, and the ins-and-outs of all other false doctrines, after 
 thousands and tens of thousands have proven them false. 
 
 Never hold joint discussions or controversies before the 
 public with Irregulars or wide-mouthed quacks, either through 
 the newspapers, or in any other way, no matter how false or 
 shallow their oily pretenses are, or how easily their weak argu- 
 ments are refuted by stronger ones, because such joint discus- 
 sions and rejoinders, either by speech or pen, with the public as 
 judge, would result in no good, but give your opponents an 
 opportunity to make the noise and clamor they desire, and bring 
 them into greater notice, gain for them new partisans, and give 
 them a chance to raise additional false issues. 
 
 You will occasionally be called again to families who 
 strayed in disgust from regular medicine years ago, when bleed- 
 ing, etc., were fashionable, who will wonder over the Now and 
 Then of medicine, and be surprised to learn that the shape and 
 fashion of medical practice has changed, and that your thera- 
 peutics differ very decidedly from those of old Doctor Van 
 Winkle, and that you have not taken an oath to practice as your 
 fathers did, and no longer bleed, salivate, and give nauseous 
 drugs, indiscriminately, as they supposed. If you are prudent 
 and circumspect, most of these can be permanently reclaimed. 
 
 But few of the really sick who are persuaded into giving 
 false and one-idea systems a trial become converts ; common 
 sense prevents. Therefore be careful not to banter, irritate or 
 abandon people who are trying an ism or pathy, or believe in it 
 a little, lest from combating their maybes and questioning their 
 prudence and forcing argument you drive them into these 
 vagaries permanently. Should they even contend that the 
 earth is three-cornered, or that sugary nonsense has saved 
 their lives, or that pumpkins grow on trees, or declare white to 
 be black, or that castor-oil is made of dead men's bones, laugh 
 in your sleeve if you must, but do not combat them too fiercely. 
 
218 THE PHYSICIAN HIMSELF: 
 
 Pride of opinion and determination not to be browbeaten into 
 recantation are unfortunate impulses to arouse, especially in 
 conceited and silly people, who admire their own ingenuity in 
 discovering arguments, and will certainly drive them to take 
 sides against you, possibly to swear by the error in all the 
 moods and tenses, and to thenceforth injure rational medicine 
 to the full extent of their influence, for : — 
 
 "Faith, fanatic faith, once wedded fast 
 To some dear falsehood, hugs it to the last." 
 
 If, in exposing any delusive or false system, you are careful 
 not to denounce it with too much warmth or violence, as though 
 prompted by prejudice or self-interest, and to confine your con- 
 demnation strictly to the impersonal abstract subject, showing 
 that you speak your real sentiments from sober reason and con- 
 scientious devotion to the truth ; and if, moreover, you avoid 
 appearing anxious to hoot down or excite hostility against the 
 individuals who really may practice it honestly, your reasoning 
 will have a great deal more weight with those whom you address, 
 and with the community, than under the reverse circumstances, 
 for human nature is such that if a system or creed in medicine 
 be false, unkind or untrue, abuse of its representatives will be 
 one of the best ways of commending it to public favor, and 
 hence is what they themselves most heartily desire. 
 
 This is the age of quackery ; quackery in law, quackery in 
 religion, quackery in medicine, quackery in everything. Med- 
 ical quackery subsists on credulity, gullibility and ignorance, 
 and when your opinions are asked, and whenever you have a 
 fair opportunity, it is your duty to expose it, and to save as 
 many as you can from its clutches. Wherever you meet it, 
 lift its veil and show its unworthiness and the harm that it does 
 to the public health. 
 
 Medical laws are everywhere essential for the public safety, 
 but we of Maryland have none, and our common laws do 
 not protect our citizens against the ravages, or enter into the 
 
HIS REPUTATION AND SUCCESS. 219 
 
 slightest consideration of the worth, or worthlessness, of various 
 urns, ists and pathies, but recognize all kinds, even down to no- 
 torious quacks and ignoble impostors, who never saw farther 
 into the human body than th« skin, precisely as they do the 
 regular profession ; therefore, if you ever occupy an official po- 
 sition under such laws, you will have to recognize certificates 
 of death, vaccination, life insurance, etc., given by irregulars of 
 every shade, no difference how fictitious their pretensions, or 
 how profoundly ignorant of common medical truths ; just as 
 you do those of intelligent, rational, honorable physicians. In 
 a word, you will have to recognize officially every person whom 
 the law recognizes. State medical laws that legalize every igno- 
 ramus are impaired to a corresponding extent. Proper laws for 
 the protection of the people — laws that, while recognizing and 
 protecting the rights of all educated physicians, without regard 
 to their creeds or modes of treatment — would effectually uproot 
 and weed out the whole unwhipt mass of abortionists, self- 
 commissioned pretenders, Street-corner-orator Doctors, Hotel 
 Itinerants, Indian Doctors, Steam Doctors, Pow-wow Doctors and 
 the Root Doctors, who can neither read nor write (who get their 
 larning about yarbs " by revelation from the Lawd "), also the 
 " cullud gemman " who cures the conjured, and kindred swindlers 
 who know as little about a physician's duties as they do about 
 the constellations of the heavens, but can answer the unanswer- 
 able in medicine and cure the incurable ; in short, all who know- 
 ingly deceive and defraud. Just laws should be enacted and 
 rigidly enforced, instead of weak laws that compel those who 
 administer them to recognize arch-humbugs and outright 
 swindlers, and actually give respectability before the public to 
 fellows who deserve the cat-o '-nine-tails. 
 
 It would be well and wise if all diplomas and officinal cer- 
 tificates were written in plain English, instead of Latin ; then 
 everybody could read and see what each was, and when, why, 
 where, and to whom each was given. 
 
 Strange to say, nowadays a section of the public, blinded 
 
220 THE PHYSICIAN HIMSELF: 
 
 by the waves of sophistry and swayed by the winds of false sen- 
 timent, instead of siding with our opponents when they seem to 
 be right and turning against them when they are wrong, invari- 
 ably Ha ! Ha ! Ha ! and, with gross unfairness, side with the 
 " new school " or the quack, or anybody else, whenever a con- 
 test arises between them and us. Even a portion of the press, 
 religious as well as secular, seem to delight in aiming sharp 
 shafts at the regular profession, and creating popular sentiment 
 in favor of its enemies, by making invidious comparisons between 
 its modes of practice and theirs — telling with great gusto of their 
 wonderful success, and of their steady growth in public confi- 
 dence, in highly colored terms. Censorious editorial and other 
 authoritative productions are frequently written on our arbitrary 
 exclusiveness, our intolerant bigotry, etc. ; our bickerings and 
 our disagreements, too, are magnified, and our family matters, 
 squabbles, and disputations are reported in a sensational way, 
 all apparent!;/ to antagonize and decry us, and to cheer on and 
 assist the daring onsets of struggling Irregulars and advertising 
 quacks, under their false but popular cry of " persecution.'''' 
 
 You will find that if a person happens to get better, even 
 of an ordinary case, under some new method of treatment, or 
 under the chance play of an Irregular, or when taking a quack 
 medicine, it will receive a thousand eager praises ; whereas, if 
 twenty get well under the skillful practice of a regular physician, 
 it is considered quite a matter of course, and will scarcely excite 
 a comment. 
 
 "lis said the Chinese are so expert in making much out of 
 little that they live and fatten on what a Caucasian wastes. In 
 the same degree, Irregulars and quacks thrive on the quickening 
 influence of the emotions — expectation, faith, hope, etc. — which 
 we, with our minds fixed on more tangible aids, neglect far more 
 than we should. For proof of the mighty power of the mind 
 over the body, look at the liver pads, tractors, amulets, charms, 
 and dozens of other humbug agents in vogue, which the young 
 and old, black and white, educated and illiterate, all kinds, 
 
HIS REPUTATION- AND SUCCESS. 221 
 
 classes, and conditions of people, are praising, almost as if they 
 had fallen from the skies. 
 
 Fashion and wealth exert a powerful influence in medical 
 affairs, and unfortunately the novelty-seeking portion of the 
 fashionable, wealthy, and influential foster with their influence 
 and patronize with their wealth almost every pathy, ology, and 
 ism in medicine, and make them popular and fashionable with 
 the unthinking herd, who stand with their eyes, ears, and mouth 
 all open, ready to follow. 
 
 Many Irregulars have this source of eclat. Having the 
 humbug element fully developed in them, they, with owl-like 
 look of profound wisdom, resort to numerous big words and high- 
 sounding technical terms, and with great-swelling phrases mag- 
 nify what we would call a slight cold, or a quinsy, into a " con- 
 gestion of the lungs," a '-bronchial catarrh," a " touch of pneu- 
 monia," " diphtheria," or " post-nasal catarrh." They dignify 
 what we would call a disordered stomach into a " gastric affec- 
 tion," a wind colic into " borborygmus," etc., for the cure of 
 which huge ailments they are duly credited and fully paid. 
 There is a fellow in our section who manages his patrons so 
 adroitly that he reaps more credit and confidence from mistreat- 
 ing a case that dies therefrom than you would receive from one 
 properly treated that gets well, and often actually reaps manifold 
 more credit and patronage for stopping a chill and fever in seven 
 days than a true physician would for doing the same in a day or 
 two, and other ailments in proportion. 
 
 Another reason why Irregulars get cases is, that if a phy- 
 sician grows tired of a case and loses interest, or the patient gets 
 tired of him and loses faith, the family is apt to desire a change 
 of treatment, and, fearing the attendant would become offended 
 were they to dismiss him and employ one of his brethren, they 
 get an Irregular, under the belief that the physician will feel 
 less hurt if they dismiss him under the plea of trying "a different 
 system" of doctoring than on any other pretext. 
 
 There are fully five times as many regular physicians as 
 
222 THE PHYSICIAN HIMSELF: 
 
 there are irregulars, and we, in the course of events, naturally 
 get a great many more stubborn cases, and of dissatisfied pa- 
 tients, who turn from us to them, with the intention of " trying 
 another system," than there are to come from their smaller 
 number to us. 
 
 The advent of our specialists is very fortunate for us in 
 this respect, as they now get most of our stubborn cases, which 
 are thereby kept with the regular profession. 
 
 Again, a physician is sometimes compelled to tell disagree- 
 able truths, and candidly to give a gloomy or despairing prog- 
 nosis, and this, on the principle of a drowning man catching at 
 a straw, is apt to make the patient and his friends argue that 
 regular medicine offers him no means of safety, and a transfer 
 of the case to some irregular practitioner, or noisy quack, who 
 makes great professions and rosy promises, is apt to ensue. 
 
 Another reason why Irregulars have partisans is that legiti- 
 mate medicine is unsuited to the peculiarities of some minds, and 
 will never obtain their confidence. They would almost rather die 
 under the hands of an irregular than to recover under a regular. 
 There is, also, always a sprinkling of extremists, pharisees of 
 every conceivable mind, opponents of vaccination, and intel- 
 lectual cranks in every community, who for some cause or other 
 are imbued with dogged antagonism to the regular profession, 
 and the man who discards it is their doctor. Others believe in 
 vegetable remedies only; the vender of herbs is his doctor, etc. 
 These all unite, by affinity, to abet and support classes and 
 systems that practice in opposition to us, and of course such 
 demand creates a supply of irregulars of various kinds. 
 
 You will find that not only in medicine, but on every im- 
 portant subject, when the plain, common sense of a community 
 reaches a conclusion, there are always persons who think they 
 exhibit finer qualities of mind by reaching the opposite conclu- 
 sion, and will contend bitterly on points where rational doubt is 
 impossible. Others think it is evidence of great natural acute- 
 ness and subtlety of intellect and of speculative philosophy to 
 
HIS REPUTATION AND SUCCESS. 223 
 
 cling to the opposition, and imagine they thus place themselves 
 among the most advanced thinkers. 
 
 Still another reason why they get patrons is this : they 
 take care to announce that they cure by mild means or harmless 
 methods, and not by complicated, painful, or dangerous meas- 
 ures, bloody operations under anaesthetics, or other dernier 
 ressorts, that science teaches truer physicians to use — against all 
 of which they have, by false assertions and fallacious statistics, 
 aroused much of the existing foolish prejudice and abhorrence. 
 
 So great indeed is the popular dread of what physicians 
 might do, that in choosing a medical attendant, the nervous and 
 the timid, who constitute nine-tenths of all the sick, are greatly 
 inclined to shun Prof. Sawbones, Dr. Doubledose, Dr. Cutem- 
 upalive, Dr. Bigpill, and all who treat heroically and enforce 
 rigid discipline, and seek Prof. Tweedle, Dr. Golightly, and 
 others, who undertake to cure without cutting, and who use 
 moderate, even though less efficient, means. 
 
 You must learn to distinguish cases in which you can safely 
 depend on nature from those that nature cannot overcome, and 
 treat each accordingly ; for when you learn to recognize those 
 that need an ounce of medicine and a grain of policy, and those 
 that need an ounce of policy and but a grain of medicine, you 
 will have entered upon the path of wisdom. When you have a 
 Lah-de-Dah patient who needs only a few drops of mint-water, 
 or a bread pill, for mercy's sake don't, don't violate common 
 sense and force upon him some horrible mixture that seems as 
 if made of dead men's skulls, or an infusion of gentian, or a 
 large bottle of muriated tincture of iron and quinine, or other 
 medley of nastiness, as if your chief aim were to cause him 
 nausea and disgust for everything, food included. Give him 
 nothing stronger or coarser than he needs, and leave the rest to 
 nature. 
 
 Handle those with highly impressible nervous systems, or 
 sensitive skin, delicate palate or tender throat, or treacherous 
 stomachs (and wry faces) with kid gloves, and be careful to avoid 
 
224 THE PHYSICIAN HIMSELF: 
 
 all useless severities, and to give them as little unpleasant-tasting 
 medicine as possible, and never more than they can bear. The 
 recent great improvements in the forms and palatability of medi- 
 cines offer you splendid opportunities to do this. Offend neither 
 their eyes, their ears, their nostrils, their palates, nor their stom- 
 achs, and you will succeed where neglect of these precautions 
 would cause failure. Bear in mind that medicines prescribed 
 unsuccessfully, if they have given pain or great inconveni- 
 ence, will injure your reputation and may cause your dismissal. 
 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 anybody to take medicine before breakfast, or to 
 be aroused for the same purpose during the night. With such 
 people make free use of the bland elixirs, the fluid extracts, and 
 the large line of sugar-coated granules of arsenious acid, cor- 
 rosive sublimate, cannabis indica, mix vomica, morphia, podo- 
 phyllum, strychnia, and other results of artistic elegance and 
 chemical accuracy now kept in every drug store. 
 
 Overdosing, blood-letting, salivating, purging, etc., are now 
 justly unpopular, and ultra-conservative, reconstructive medi- 
 cines are in fashion. Almost every one is filled with the belief 
 that he is debilitated. Say to the average patient, " You are 
 weak, 'below par,' and need building up," and you will instantly 
 see by his countenance that you have struck his key-note. 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 medi- 
 cines are not at all indicated. 
 
 Never attempt to force the use of a remedy — mercury, 
 arsenic, iodide of potassium, opium, asafcetida, valerian, etc. — 
 on a person after he has exhibited an idiosyncrasy or a hatred 
 toward it. Also, when possible, change the form of your pre- 
 scription from pills to powders, or from liquids to capsules, or 
 from sweet to bitter, and vice versa, for those who desire it. 
 
HIS REPUTATION AND SUCCESS. 225 
 
 A good plan to pursue with patients who actually need the 
 prolonged benefit of two different medicines, who cannot or 
 will not take them at alternating hours every day, is to use one 
 to-day and the other to-morrow ; for instance, if a nervine and 
 a tonic are prescribed separately, let him take full doses of the 
 nervine on Monday and full doses of the tonic on Tuesday, 
 nervine on Wednesday and tonic on Thursday, etc. Almost 
 any patient can and will alternate thus without tiring. 
 
 The smaller, the more striking the means that seem to ac- 
 complish 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 marvelously strange 
 and is very pleasing. 
 
 It is wise and proper to carry a few well-chosen remedies 
 with you, to be used at night, and on occasions of great or sud- 
 den emergency. Above all others, have a phial of morphia 
 granules (or soluble tablets) with you constantly, and give a proper 
 number of them in hot water as soon as you reach one of the 
 thousand cases in which great pain is a symptom. By so doing 
 you can often adroitly meet the emergency, relieve the suffering, 
 and show your power over pain before the messenger could get 
 back from the drug store with the remedy you would otherwise 
 order. 
 
 Rest for the patient is rest for the nurse, and when all 
 around are broken down and worn out this is an important con- 
 sideration. The value of a night's rest to a very ill patient is 
 often incalculable, and for this morphia granules are highly 
 valuable. You can also use them to give other jaded sufferers 
 an occasional night of placid slumber, or of delicious visions, 
 even though they form no essential part of the treatment. 
 
 Morphia granules given thus make a vivid impression in 
 the physician's favor, and do great good, becoming, in fact, 
 almost a perfect substitute for that drug hypodermatically. 
 
 15 
 
CHAPTER X. 
 
 "Behold, how good find how pleasant it is for brethren to dwell together in 
 unity !" — Psalm cxxxiii. 1. 
 
 Be just and friendly toward every worthy pharmacist. 
 Owing to the very close relationship and mutual dependence 
 between pharmacy and medical practice, the pharmacists are 
 your natural allies, and should receive your firm friendship and 
 respect. Probably all physicians will agree that in the ranks 
 of no profession can a greater proportion of gentlemen, and 
 manly men, be found than in the pharmaceutical. This, and 
 your joint interests, should make you brothers. 
 
 An excellent rule is strictly to avoid favoritism, and let all 
 reliable pharmacists compete for your prescriptions and for the 
 family patronage which they influence. You will make a 
 serious mistake, and engender active enemies, too, if you step 
 out of your way and without proper cause instruct patients to 
 buy their medicines from any particular pharmacy; if a pre- 
 scription is properly compounded it makes but little difference 
 by whom, so the compounder is known to be honorable and 
 reliable. 
 
 Do not deter your patients from patronizing a pharmacist 
 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 (with a window full of bottles of 
 colored water and quack placards) as a stepping-stone to get 
 acquaintances and an introduction to practice, as a preliminary 
 to making his debut as your antagonist or rival ; but if you fold 
 your arms and allow your prescriptions to be compounded by a 
 drug-store physician who prescribes over his counter, or in the 
 office or parlor, free of charge, and makes it up on the medicine 
 ordered, you will, unless he shows less than the usual amount 
 of selfishness, sooner or later regret it. 
 
 (227) 
 
228 THE PHYSICIAN HIMSELF." 
 
 Independently of all other considerations, the practice of 
 scientific pharmacy and modem medicine simultaneously is too 
 much for the grasp of any one human intellect, and any one 
 needs all his time to do justice to either, and one or the other is 
 apt to be slighted ; and if your prescription falls into the hands 
 of such parties, or is left to apprentices or assistants, both you 
 and your patient must take a great many risks. 
 
 There is not the slightest wrong in having your name 
 printed on your prescription papers. But do not use a prescrip- 
 tion paper which has any other name upon it besides your own. 
 If it contains the name of a pharmacist it will naturally suggest 
 collusion or something else not complimentary; if it contains 
 some enterprising fellow's commercial puff, it will indicate very 
 ordinary taste for you to use it. It is probably better always to 
 write on good plain paper ; although it could do no harm to 
 'have some such phrase as the following printed on the back of 
 every prescription paper, for the benefit of the public and the 
 protection of your 'own interests: "A remedy that is useful for 
 a patient at one time may be improper for the same patient at 
 another time, or for other persons at any time, even though 
 suffering with the same affection." 
 
 Plain white paper clippings suitable for prescription blanks 
 can be purchased cheaply at any printing-office or book-bindery, 
 or you can buy a ream of cheap paper at any wholesale paper 
 Avarehouse, and they will cut it into any size you wish. 
 
 It would be wrong, wrong in every light, to go hand-in- 
 hand with a pharmacist, receive from him a percentage on your 
 prescriptions as payment for sending them to his store, and for 
 this reason : were you to accept such an offer, it would be 
 robbing the purse of either the pharmacist or the patient. Were 
 the former to allow you ten cents for each prescription, and re- 
 imburse 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 combined to fleece ten extra cents from 
 every poor sufferer who trusted to your honor, just as you would 
 
HIS REPUTATION AND SUCCESS. 229 
 
 look upon a lawyer who took fees from both sides. On the other 
 hand, if the pharmacist had more honesty than you and allowed 
 you to shear ten cents from his legitimate profit, because compelled 
 to do so or lose your influence, it would place you in a most 
 contemptible position, and you would live in constant danger of 
 exposure and an indignant public sentiment that the strength 
 of Hercules could not, and the angry God of Justice would not, 
 arrest. 
 
 Honesty is the great keystone ; without it, the whole arch 
 of honor falls. You must live, and must have fees to enable 
 you to do so, but unless you obtain every dollar and every dime 
 honestly and honorably you cannot escape the finger of scorn. 
 
 Watch zealously that the public do not imbibe a belief that 
 you are a part owner of or are interested in the loaves and fishes 
 of the drug store which compounds the largest number of your 
 prescriptions. If such a suspicion be expressed by any one, or 
 if any one insinuates that you seem to prescribe for the purse of 
 the pharmacist rather than for the health of the patient, take 
 care to inform him that you have no such interest. 
 
 If any pharmacist volunteers to supply a physician and his 
 immediate family with medicines either free or at a nominal 
 prite, or with such proprietary or other 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 several pharmacists with private 
 marks, technical terms, or formulae that other pharmacists can- 
 not understand, as it would at once suggest trickery and corrupt 
 motives. A still meaner device would be to have a secret or 
 cabalistic code, for use between you and a pharmacist, intelligible 
 to him alone. Surely neither you nor any other honest person 
 needs warning against such rascally 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 contemptible vultures 
 
230 THE PHYSICIAN HIMSELF: 
 
 who rejoice at sickness and desire the epidemic, and the wretches 
 who produce abortion. 
 
 A prescription is intended simply to tell the pharmacist 
 what medicine the physician wishes the patient to receive. 
 When sent to the pharmacist it is an order for a certain medi- 
 cine prepared in a certain way. The law has decided that this 
 prescription or order belongs to the patient ; the pharmacist, after 
 compounding it, has, however, a natural right to retain it as his 
 voucher, but he has no right to refill the order without your 
 consent. 
 
 The unauthorized refilling of prescriptions by pharmacists 
 has often produced the opium, alcohol, chloral, and other en- 
 slaving habits. We very well know that it is often unsafe for a 
 person to take a medicine ordered for another, or even the same 
 medicine at different times. Furthermore, how can the phar- 
 macist conscientiously label the second quantity, "Take as 
 directed by Dr. Faraway," when Dr. Faraway is not even aware 
 of the refilling ? 
 
 In consequence of the present unfair habit of many phar- 
 macists, the unauthorized refilling of prescriptions probably 
 outnumber those of the authorized, five to one. 
 
 Drug stores have become so numerous of late, and the 
 area from which each must draw its patronage is so small, that 
 their owners, in order to exist, have either to charge very high 
 for the medicines prescribed, or substitute inferior drugs ; the 
 result is that drug bills have gradually grown greater and greater, 
 till of late they almost eclipse the expense of medical attend- 
 ance. Many people, to avoid what appear to them exorbitant 
 prices, actually buy this, that, or the other quack medicines, 
 make home mixtures, wend their way to no-drug irregulars, en- 
 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 instruct- 
 ing your patient to save the cost of the bottle by carrying one 
 with the prescription ; doing so is not at all objectionable to 
 
HIS REPUTATION AND SUCCESS. 231 
 
 pharmacists, as they charge only cost price for bottles. A good 
 way to decrease the cost of certain prescriptions is to omit inert 
 and unnecessary ingredients ; for example, if you prescribe a 
 mixture of wine of colchicum-root, tincture of digitalis, and sul- 
 phate of morphia for a patient, do not amplify what would 
 naturally be a one-ounce mixture, that would cost about thirty- 
 five cents, into three or four ounces by adding syrup, water, or 
 other vehicle, thus swelling the dose to a tablespoonful and the 
 cost to a dollar. Prescribe the necessary articles only, and let 
 the directions tell how many drops to take, and how and when. 
 
 A dose of medicine in powder or pill form is usually more 
 expensive than the same in fluid form. 
 
 Another evil resulting from there being too many pharma- 
 cists for all to live by legitimate business, is that some, not con- 
 tent with the great profits derived from the sale of medicines, 
 encroach on the domain of medical practice, usurp our province, 
 and prescribe, by the smattering of knowledge they pick; up- 
 while compounding the prescriptions of competent physicians, 
 for every foolish applicant whose case does not appear to be 
 formidable, even selecting, by guess-work, random remedies for 
 cases they have not even seen, because asked to do so by foolish 
 messengers, and thus build up a large office (or store) practice. 
 How many simple, functional cases are given simple medicines 
 which do no good, but produce harm by taking the place of 
 that which might have done great service at the proper time, 
 and are in this way, during their first few hours or days, con- 
 verted into incurable or organic ones, and how many new ail- 
 ments are induced by such haphazard prescribing heaven only 
 knows. Fully one-half of all cases of venereal disease, bilious- 
 ness, debility, cough, and the like are now seen and treated by 
 pharmacists (or their greenhorn apprentices) before applying to 
 physicians. Four out of five of these whose complaints prove 
 simple are, of course, cured like magic by the four little pills which 
 the pharmacist recommends, or by the liniment he devises, or by 
 his great fever-and-ague mixture, or his universal elixir, that is 
 
232 THE PHYSICIAN HIMSELF: 
 
 simple and can't do any harm, etc. ; and they, thinking that 
 some terrible spell has been turned aside, laud the pharmacist 
 to the skies and advise all to go to the " Apothecary Doctor " for 
 their livers, and kidneys, and lungs, and brains, and stomachs, 
 instead of .consulting a physician, with assurances that he is as 
 good as the latter and a great deal cheaper. 
 
 Hear Shelley in his scenes from the "Chalderon Dialogue": 
 
 "Demon. And such is ignorance ! Even in the sight of 
 knowledge it can draw no profit from it. 
 
 "Cyprian. Have you studied much'? 
 
 "Demon. No : and yet I know enough not to be wholly 
 ignorant. 
 
 " Cyprian. Pray, Sir, what sciences may you know 1 
 
 "Demon. Many. 
 
 " Cyprian. Alas ! much pains must we expend on one 
 alone, and even then attain it not ; but you have the presump- 
 tion to assert that you know many without study. 
 
 "Demon. And with truth, for in the country whence I 
 come sciences require no learning ; they are known. 
 
 " Cyprian. Oh ! would I were of that bright country ! for 
 in this the more we study we the more discover our great igno- 
 rance." 
 
 No one who is incompetent to examine a patient is compe- 
 tent to prescribe for him, and I would ask what pharmacist 
 would trust himself, or his wife, or his child, to the prescriptions 
 of a neighboring pharmacist ? 
 
 Another, although lesser, evil is this : If a patient's better 
 sense carries him in the first place to a physician for advice, in- 
 stead of to a pharmacist, ten to one he who takes the prescrip- 
 tion to be compounded will be presented at the drug store with 
 one or two quack almanacs filled with infamous and alarming 
 falsehoods, or a handful of advertising pictures, or that the 
 bottle of medicine will be wrapped in Foolembad's or some other 
 pushing fellow's handbill. The pharmacist's co-operation as 
 retailing agent for quack medicines is indispensable to quackery; 
 
HIS REPUTATION AND SUCCESS. 233 
 
 without it nineteen-twentieths of the harm that patent medicine 
 literature is doing would cease, the vain promises that keep the 
 public rushing from one lying wonder to another would no longer 
 entice, and at least two-thirds of the quack humbugging propri- 
 etary trash that now curses our land would slink from sight. 
 
 You had better avoid all pharmacists whose presumption 
 leads them to assume the role of physician. This, of course, 
 does not refer to emergencies, in which a pharmacist acts as a 
 humanitarian. The manufacture of steel is one thing, and 
 applying watch-springs is another. Medicines are the physician's 
 tools; a pharmacist may prepare them and handle them for a 
 lifetime and be an excellent compounder, and yet, as his studies 
 are pharmaceutical and not therapeutical, he may know no more 
 about prescribing for the sick properly than the mechanic who 
 makes needles or scissors does about dressmaking, or the instru- 
 ment-maker does about operative surgery, or the manufacturer 
 of trowels and plows and chisels about bricklaying, farming, 
 or carpentering. 
 
 If a sick person asks a pharmacist for a dose of cathartic 
 pills, or an ounce of tincture of iron, there is no reason why he 
 should refuse to sell them ; but if he asks him what is the best 
 thing to take for this, that, or his other affliction, that is another, 
 a therapeutical matter, and is beyond his sphere. 
 
 Be also on your guard against instrument-makers and 
 dealers who meddle with surgical cases, and manufacturers of 
 appliances for deformities, examining or prescribing opticians, 
 etc., who presume to treat cases that should be referred to the 
 physician or surgeon, and, in fact, avoid encouraging any one 
 who encroaches on the physician's province. 
 
 Make it a point never to style a pharmacist, a preacher, or 
 any one else, " Doctor," unless he is a doctor. Heaven knows 
 the much-abused title is cheap and promiscuous enough without 
 bestowing it on those who have not even applied for it. 
 
 Avoid overpraising prescribing pharmacists to your patients, 
 or people will, on your word, overestimate them, and rely on 
 
234 THE PHYSICIAN HIMSELF: 
 
 their gratuitous advice instead of on the physician's ; at least in 
 all moderate cases. 
 
 Beware of indiscreet pharmacists, as those who talk too 
 freely, who converse, joke, etc., while compounding prescrip- 
 tions ; who knowingly insinuate to those who carry them pre- 
 scriptions that they know what they are for, and have extra impu- 
 dence when cubebs, ergot, etc., are ordered ; who suggest to 
 purchasers that the dose prescribed is too large or too small ; 
 also those who misread prescriptions or miscopy directions, or 
 put wrong directions or the wrong physician's name on bottles, 
 or surprise and alarm people by charging a different price every 
 time a prescription is renewed, as if they had no system, or as if 
 the medicines were put up wrong; who make the impression 
 that it takes them half their time to correct the blunders and 
 mistakes of the other half; who leave prescriptions partly com- 
 pounded to wait on other customers, or to unscrew soda-water 
 for sports who are in a hurry, or who in other ways show 
 abstraction or careless compounding. For such people be espe- 
 cially careful how you abbreviate, and how you make your g's 
 and 3's, and carefully dot every i and cross every t in your pre- 
 scriptions, so as to afford them no shelter if a mistake occurs, 
 and, above all, to prevent a coroner's jury, or to clear yourself 
 if a death certificate is made necessary. 
 
 Prescriptions written with ink instead of pencil have the 
 decided advantage that they are not easily defaced, do not admit 
 of erasure, etc. 
 
 A very good and safe rule in prescription-writing is to put 
 down all the ingredients first ; next write the directions to the 
 pharmacist and the directions for use ; then the number of doses 
 should be decided on, and, lastly, the quantity of each ingredi- 
 ent should be carefully calculated and carefully written, fol- 
 lowed by your name or initials. 
 
 Mistakes in putting up prescriptions occur more often from 
 improper haste, and trying to do two or three things at once, 
 than from incompetency. 
 
HIS REPUTATION AND SUCCESS. 235 
 
 In ordering syringes, brushes, atomizers, breast-pumps, pro- 
 bangs, etc., with your prescriptions, be careful to specify the 
 kind or size you wish. To write a prescription for a solution, 
 and add, "also a syringe for using," is often as perplexing to 
 the pharmacist as if you were to send for a slip of adhesive 
 plaster as long as a string, or for a lump of rhubarb the size of 
 a piece of chalk. 
 
 If you believe on good authority that any pharmacist so 
 far forgets himself as to make disparaging comments upon you, 
 or your professional ability, or your remedies, doses, or apparent 
 inconsistencies ; or to show your prescriptions to Irregulars, lay- 
 men, or other physicians, and proclaim errors in them, or pre- 
 dicts against their proving useful ; or to make unauthorized sub- 
 stitutions, give underweight of expensive ingredients, or omit 
 them altogether ; or to join with our enemies in reviling our 
 profession and its imperfections, or in nicknaming different phy- 
 sicians in derision ; or to keeping his prescription-file open to the 
 inspection of your business rivals, or to have a medical protege 
 under his wing, into whose hands he endeavors to turn your 
 patients; or to be guilty of any other grossly unprofessional 
 conduct, you are justified in directing your patients to go else- 
 where for medicines. 
 
 When any one is unable to pay the full price for what you 
 prescribe, the words " poor patient " in your handwriting, at the 
 top of the prescription, will secure from any pharmacist the 
 greatest reduction in price that he can afford to make. 
 
 You may take the following as somewhat of a guide in 
 determining whether this or that drug store is worthy of confi- 
 dence. Among the distinguishing features of a properly con- 
 ducted pharmacy are : — 
 
 1. Proprietor a practical pharmacist, of intelligence, ca- 
 pacity, and integrity. 
 
 2. Competent and courteous assistants. 
 
 3. Pride and skill shown in selecting and preparing pure 
 medicines. 
 
236 THE PHYSICIAN HIMSELF: 
 
 4. Full line of pure drugs kept. 
 
 5. Store neat and orderly. 
 
 6. Quiet and discipline maintained. No loungers. 
 
 7. No liquors sold as beverages. 
 
 8. Xot a bazaar of general merchandise. 
 
 9. Nostrums shown and sold only when called for. 
 
 10. No habitual prescribing. 
 
 11. Charges neither cheap nor exorbitant. 
 
 12. Prompt attention and accuracy characteristic. 
 Among the features that mark improperly conducted ones 
 
 are : — 
 
 1. Patent medicine signs prominently displayed. 
 
 2. Patent and proprietary remedies paraded and pushed. 
 
 3. Wines and liquors sold as beverages. 
 
 4. Engrossing attention to sale of soda-water, cigars, to- 
 bacco, fancy goods, etc. 
 
 5. Indiscriminate refilling of prescriptions. 
 
 6. Habitual prescribing over the counter. 
 
 7. Disparagement of physicians to the laity. 
 
 8. Loose management of store. 
 
 9. Store a resort for political or other cliques. 
 
 10. Unchaste conversations and disreputable conduct. 
 
 11. Dealing in articles used for criminal or immoral pur- 
 poses. 
 
 12. Unnecessary delay and detention of customers. 
 
 Be prompt and decided in refusing to give laudatory pro- 
 fessional certificates to anything secret ; do not be too liberal 
 even in giving them to legitimate pharmaceuticals, and never 
 issue one founded on any other basis than purity of ingredients, 
 or special skill or experience in compounding them. 
 
 Willingness to give medical certificates is an almost uni- 
 versal weakness of mankind. The idea of having one's name 
 paraded in print as " an authority " in connection with some 
 wonderful cure is pleasing to thousands of people in every sta- 
 tion of life, and makes them willing to have their names and 
 
HIS REPUTATION AND SUCCESS. 237 
 
 ailments paraded in almanacs, handbills and newspapers. Many 
 poorly balanced and impressible people, whose bump of wonder 
 is easily touched, could almost be obfusticated into certifying 
 that in medical matters two and two make five by any sharper 
 who understands how to tickle their self-conceit and their love 
 of notoriety. 
 
 Be also chary in giving (un)professional certificates to any 
 one on disputed or partisan questions, or regarding surgical 
 appliances, copyrighted medicines, wines, mineral waters, beef 
 extracts, articles of commerce, patent contrivances, health re- 
 sorts, etc., for they are often made subservient to purposes not 
 anticipated, and 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 sig- 
 nificance, but thousands of others all over the land will notice 
 your title only. When amiable John Doe gives his certified 
 opinion that ice is hot and fire is cold,' it remains simply John 
 Doe's opinion ; but when John suffixes his title of M.D., he 
 undoubtedly gives that certificate a professional significance, 
 and, to some extent, involves our entire profession therein. 
 
 Judge certificate-giving by its effects on our own profession. 
 One of the worst inflictions we endure to-day is the endless 
 parade of fallacious certificates from wide-mouthed clergymen, 
 politicians, merchants, lawyers, D.D.'s, LL.D.'s (A.S.S.'s, N.G.'s), 
 and other well-known persons recommending all kinds of medi- 
 cal nostrums. You know, and every wise man knows, that such 
 certificates are not worthy of credence, and that the (quasi) 
 preacher of Gospel truth who (instead of confining himself to 
 preaching the Glorious undefiled Gospel of the blessed God, the 
 God of the Bible), bribed by a box of pills, or a bottle of bitters, 
 forgets his high mission, the cure of souls, and with sanctimo- 
 nious solemnity turns up the whites of his eyes, and, with a 
 grave, starched phiz, lends his name and the protecting cloak 
 of theology to assist the Diabology of wily charlatans and com- 
 mercial sharpers who prey on the afliicted with quack nostrums 
 
238 THE PHYSICIAN HIMSELF: 
 
 that are not worth the cost of the bottle they are in, must he 
 either a silly dupe or a cruel knave. 
 
 Every shrewd quack knows the influence of a clergyman's 
 indorsement published in a Sunday paper, and hence makes 
 special and often successful efforts to obtain it, feeling certain 
 that he can easily hoodwink and entrap the dupable portion of 
 the flock after the (False) Shepherd is secured ; and it is a sin-- 
 gnlar fact that, though few men get more gratuitous service out 
 of physicians than ministers of the Gospel, yet no class do more 
 to injure the profession, by the ridiculous countenance they give 
 to various kinds of quackery and pathies and isms. Truth 
 teaches teachers to teach the truth. 
 
 In signing certificates for life insurance, or beneficial socie- 
 ties, or in giving your name for directories, State or city registers 
 of physicians, or in other cases in which the form requires you 
 to state what school of medicine you practice, be careful to 
 record yourself as a regular or rational physician, and not as an 
 allopathist. 
 
 To call yourself a physician instead of a doctor, and to 
 speak of your professional brethren as physicians instead of 
 doctors, seems more distinctive and falls better on the ear. 
 
 Whenever you are asked by proprietors or plausible drum- 
 mers, or tempted by glowing advertisements, highly colored cer- 
 tificates, epitomized treatises on therapeutics and practice, etc., 
 to prescribe and make a market for their semi-secret trade-mark 
 pharmaceuticals, copyrighted medicines, and the various elixirs, 
 restoratives, tonics, panaceas, and other specialties with attrac- 
 tive ideal titles, gotten up by crusading druggists, manufacturing 
 pharmacists, speculating pharmaceutical associations, etc., to 
 catch the popular eye and the popular dollar — think of the 
 cunning cuckoo (see p. 26), and how its one egg hatches evil to 
 the whole nest, and do not use them. 
 
 Patent medicines are wolves in wolves' clothing. Propri- 
 etary medicines are wolves in sheep's clothing. 
 
 To fully realize the colossal proportions of the proprietary 
 
HIS REPUTATION AND SUCCESS. 239 
 
 remedy method of replacing physicians, and of the mercenary 
 motives and humbuggery that lie at the bottom of it, and the 
 injury it inflicts on health, credit, and business, go and take a 
 bird's-eye view of the vast and bewildering array of empirical 
 and proprietary syrups, balsams, expectorants, panaceas, and 
 other magical compounds, good for everything, asthma and sore 
 eyes, the itch and worms ; and at the bushels of recommendations 
 under which the shelves in the quack and proprietary depart- 
 ments of every wholesale drug store groan, and then reflect on 
 the enormous sums of money spent in telling (Quack ! Quack ! 
 Quack !) of their virtues in the newspapers and on rocks, 
 fences and dead walls. Thus enlightened, you can hardly fail 
 firmly to resolve henceforth no longer to immolate yourself on 
 that altar. 
 
 Unless you have missed your profession, and if you are 
 capable of thinking and have any ingenuity at all, our standard 
 and accepted agents, the United States Pharmacopoeia and 
 the dispensatories, should certainly be large enough and reliable 
 enough to allow you to exercise yourself freely in the art of 
 prescribing, to think out your prescriptions, to make any 
 required combination, and to accurately adjust the relative 
 proportion of every ingredient to the condition of your patient ; 
 and you should assert your intelligence and follow this, the 
 legitimate mode of prescribing, and let commercial men's for- 
 mulae and other kinds of ready-made novelties and dish-water 
 substitutes for medical attendance alone. 
 
 Of course, if anything truly useful or unmistakably better 
 than the old is discovered, but not yet in the pharmacopoeia, 
 you would not, should not fail to give your patient the benefit 
 of it ; but beware of all articles that are being pushed on 
 catchpenny principles. 
 
 The principle governing our condemnation of secret nos- 
 trums 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 
 
240 THE PHYSICIAN HIMSELF: 
 
 exposure and contempt. If the nostrum is really valuable, 
 which is very rarely the case, its composition should be freely 
 and fully disclosed for the benefit of the sick and suffering. 
 
 You should also maintain your independence and never 
 order A.'s, B.'s, or C.'s make of anything unless you have some 
 specific therapeutic reason for so doing. To particularize thus 
 would not only reflect injuriously on every other manufacturer 
 and cause a still greater popular distrust of our materia medica, 
 but would also put the compounder to additional trouble and 
 expense ; for he might have half a dozen other varieties of the 
 same article in his stock, and yet be compelled by your specifi- 
 cation to get another. I knew one case in which the pharmacist, 
 though he had twenty-one different preparations of cod-liver oil 
 emulsions standing spoiling on his shelves, had to get the 
 twenty-second to fill such a prescription. Besides, it almost 
 invites substitution. 
 
 Do not, however, oppose any remedial agent that is a dis- 
 tinct improvement in pharmacy, or any particular brand of 
 anything on account of its being a monopoly, if that monopoly 
 is owing to unusual skill, superior quality of medicine used, or 
 great perfection in its manufacture. 
 
 Patients believe that pharmacists have about ninety cents 
 profit in every dollar, and also think physicians know precisely 
 what a medicine 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, that some medicines 
 cost the pharmacist twenty times as much as others, and avoid 
 mentioning any specific sum; because, were you to guess too 
 high, they might infer that he had either made a mistake or 
 used inferior drugs; and were you to guess too low, they woidd 
 probably accuse the pharmacist of overcharging, and perhaps 
 drag your name into their squabbles. 
 
 Whenever you prescribe a remedy that is unusually expen- 
 sive, such as musk, salicin, resorcin, salol, oil of erigeron, etc., 
 take care to inform the patient of that fact, and that expensive 
 
HIS REPUTATION AND SUCCESS. 241 
 
 drugs are no more profitable to the pharmacist than cheaper 
 ones, so that he will not be surprised and cavil when the phar- 
 macist tells him how much he charges for it. 
 
 Notice particularly whether a pharmacist gives unusual 
 prominence to nostrums, quack almanacs and placards, or has 
 quack advertising signs painted on his doors or outside walls, 
 and it will give you a true insight into his aims and attitude 
 toward our profession. If you see that he is pushing the quack 
 department in a hurrah way, with quack proprietors' portraits 
 in his windows and hanging around his store, and his own name 
 and influence used in handbills and almanacs as a vendor of 
 nostrums, bitters, plasters, pads, etc., or selling liquor as a 
 beverage, or selling medicines at retail or less than his pharma- 
 ceutical neighbors pay for them at wholesale, you may be sure 
 that he is conducting his store simply as a tradesman, on a 
 money-making basis instead of a professional one, which sup- 
 poses him to love pharmacy and to devote his chief attention to 
 the inspection and preparation of pure and reliable drugs, and 
 filling prescriptions with scrupulous exactness; and you will 
 fulfill a moral obligation by shunning him. 
 
 To sell abortifacients, or vile nostrums intended to produce 
 abortion, with the pretended caution, " Perfectly harmless, but 
 not to be taken by women in a certain condition," is criminal. 
 
 Possibly you have no right to ask that the pharmacist 
 should not handle quack and proprietary medicines, or anything 
 else for which there is a demand, as he keeps his store to make 
 a living ; you have an undoubted right, however, to expect him 
 to show the equity of his position between their owners and us 
 by keeping them out of sight, to be shown only when called 
 for, just as he does sweet spirits of nitre, syrup of the iodide of 
 iron, aromatic spirits of ammonia, and all other fruits of phar- 
 maceutical chemistry, instead of pushing their sale by displaying 
 their announcements head and shoulders above his own and our 
 legitimate pharmaceuticals. 
 
 In drugs and medicines purity and accuracy are of the first 
 
 is 
 
242 THE PHYSICIAN HIMSELF: 
 
 importance, because the uniformity in action of every medicine 
 is in proportion to its purity and goodness ; some of our leading 
 remedies vary greatly in quality and in strength, and this is one 
 of the occasional causes of uncertainty in the practice of medi- 
 cine, and such variability would modify your efforts too much 
 to be risked in any important case. A badly compounded pre- 
 scription may rob you of your reputation and deprive the pa- 
 tient of his chances of recovery. Therefore, if you think an 
 important prescription is likely to be sent to a pharmacist whom 
 you conscientiously believe to have inferior or unreliable articles, 
 it is your duty to direct the messenger to go elsewhere; for, 
 being responsible for the patient's welfare, and having your own 
 reputation to care for, you have a perfect right, and indeed it is 
 your duty under such circumstances, to order your remedies to 
 be procured where you believe your prescriptions will be exactly 
 filled. The art of medicine is imperfect enough at best, and 
 you will encounter plenty of new and strange problems to re- 
 mind you of your lack of aids and of the insufficiency of human 
 resources, without adding the risk of being thwarted by the 
 error, or fraud, or accident of an unreliable pharmacist with de- 
 teriorated, adulterated, or inert drugs; but when you find it 
 necessary to ignore any one for this reason, take care to do so in 
 a discreet, ethical manner, with as little personality as possible. 
 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 syno- 
 nym for any of them is supplied, use it. By employing the 
 terms ac. phenicum for carbolic acid, secale cornutum for er«ot 
 kalium for potassium, natrum for sodium, chinin for quinia, etc., 
 you will debar the average patient from reading your prescrip- 
 tions and hampering you, which is in many cases highly desira- 
 ble. You can also further eclipse his wisdom by transposing 
 the terms you use from the usual order and writing the adjec- 
 tive in full with the noun abbreviated, e.g., instead of writing 
 quinia? sulph., write sulphatis quin., etc., etc. 
 
HIS REPUTATION AND SUCCESS. 243 
 
 Take care to have all powerful remedies for external use 
 labeled "for external use," or "not to be taken," which will 
 not only prevent misunderstandings, but in case they are swal- 
 lowed by mistake it will save you from censure ; also, for the 
 same reasons, be careful to order all mixtures that may separate 
 on standing, to be shaken before pouring out the dose, otherwise 
 the patient may get all the active ingredients in either the first 
 few or the last few doses. ' 
 
 When you prescribe a remedy for external use, and at the 
 same time one that is to be swallowed, take care to tell the pa- 
 tient how each will look and smell, that he may not confound 
 them and swallow the wrong one. Absent-minded pharmacists 
 have more than once put liniment labels on bottles containing 
 remedies for internal use, and those designed for the latter upon 
 liniment bottles, thereby leading to a jury of inquest, which a 
 word of explanation from the physician to the patient might 
 have prevented. 
 
 Pharmacists might easily avoid the possibility of exchanging 
 labels thus, by compounding one and labeling it before begin- 
 ning the other. Directing the pharmacist to put a red label on 
 the bottle for external use offers some security against mistakes. 
 
 You will notice that some pharmacists label the remedies 
 they compound for you with their file numbers only, thus, 
 17,483; while others pursue the much more satisfactory plan 
 of adding the date on which it was compounded, thus, 17,483, 
 19-7-89, signifying that it is numbered 17,483, and that it was 
 compounded July 19th, 1889. The latter plan will enable you 
 to distinguish between the dates at which you prescribed dif- 
 ferent bottles of medicine, and otherwise be of service to you. 
 I am sure the majority of pharmacists would cheerfully ma'ke 
 use of this system if they were aware how often it assists the 
 physician. 
 
 Even with the best care every one is liable to make mis- 
 takes, and even the wisest men are not always wise. One might 
 write tablespoonful where he meant teaspoonful, or sulph. 
 
244 THE PHYSICIAN HIMSELF. 
 
 morph. instead of sulph. quin., or acid carbolic when he meant 
 acid boracic, or tinct. opii when he meant tinct. opii camph. 
 
 When a prescription is for an infant, or a young child, it is 
 a great safeguard against error in compounding to put at the 
 head of the prescription, " Tor an Infant," or, " For little 
 Willie," etc. 
 
 It is well, therefore, 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 compounding a pre- 
 scription, be very careful not to make your suspicion known to 
 the patient by either word, look, or action, till you have con- 
 ferred with the person who compounded it. 
 
 Bear in mind that the Sons of the Mortar and Pestle are 
 only human, with long hours and short pay, and that they, like 
 other persons, require some rest and relaxation from their drug- 
 mixing and drug-selling slavery ; and do not order mixtures re- 
 quiring tedious manipulations, or direct filthy ointments to be 
 mixed, or dirty plasters to be spread, suppositories to be 
 moulded, or other unpleasant duties to be performed on Sunday, 
 or during sleeping-hours, unless they are urgently needed. 
 
CHAPTER XI. 
 
 "Sound policy is never at variance with substantial justice." — Timer. 
 
 As a physician you will sustain two relations to your 
 patients : first, during sickness you will feel a humane interest in 
 them and a scientific interest in their diseases, give them all 
 your skill and employ whatever remedies will be most surely, 
 most safely, and most rapidly beneficial ; to this you will add 
 your deepest sympathy and tenderest commiseration. Later, 
 when, by recovery or death, your interest, skill, and compassion 
 are no longer required, you will enter upon the second, or busi- 
 ness relation, and then you should, unless poverty forbids, demand 
 and secure a fair and honorable recompense for your services. 
 
 Business is business. You must be clothed and fed, and 
 must support those dependent upon you, just as other people do. 
 Every person naturally and properly looks to whatever occupa- 
 tion he follows for support, therefore let not false delicacy or 
 out-of-place politeness interfere with your business rules in 
 money matters. The practice of medicine is the work of your 
 life ; it is as honest, as useful, and as legitimate a branch of 
 human industry as any other ; in fact, no one earns his means of 
 .living more fairly, and often more dearly, than the physician, 
 and both common sense and common prudence require that 
 you should try to provide properly for yourself and for those 
 dependent on your labors for support. 
 
 You are human, and must live by your avocation just as 
 other people live by theirs, but this you cannot do unless you 
 follow a business system in your financial affairs, for upon system 
 depend both your professional and your financial success. No 
 man is at his best when saddled with poverty ; and no one can 
 practice medicine with earnestness and effect if his mind is 
 depressed and distracted, health lowered, and temper vexed by 
 
 (245) 
 
246 THE PHYSICIAN HIMSELF: 
 
 the debts he owes, who is annoyed and dunned at every 
 corner, or whose discontented stomach is uncertain where the 
 next meal is to come from, or who knows not which knock at 
 the door will be the sheriff's. These and other cares that poverty 
 entails dwarf any man's mind and body and cripple his work ; 
 and it is only when free from the incubus, the mental . solicitude 
 of grinding poverty, that his mind and his energies can do full 
 justice to his attainments. 
 
 In this sordid age, neither untiring study, nor unselfish 
 devotion as a humanitarian, nor the bubble of applase, can teach 
 you to live on wind, or lift you above the demands of the tailor, 
 the instrument-maker, the bookseller, the grocer, the butcher, 
 and other creditors, not one of whom will take your reputation 
 of working for philanthropy, or your promises, smiles, empty 
 thanks and blessings for his pay ; nay, even the conductor will 
 repudiate such sentimental notions, and put you off the street- 
 car which is carrying you to your patient, if you do not have 
 money to pay your fare with. It is, of course, a pleasant thing 
 to be very popular, but even though your popularity widens and 
 spreads for the moment over the entire city, checks on the Bank 
 of Faith will neither fill your market-basket nor purchase books, 
 pay your office rent nor buy horse-feed ; and, though the accu- 
 mulation of money is neither the primary nor 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 live by 
 your calling, and you will very soon tire of all worh and no pay. 
 Almost better to starve without a patient. 
 
 In your money affairs be systematic and correct. The 
 nearer your financial arrangements approach the cash system, 
 the better it will be for you and your family. Frequent accounts 
 are best for the physician. If he renders bills promptly, it teaches 
 people to look for them, and to prepare to pay them, just as 
 promptly as they do their other family expenses. It is often 
 more advisable even to submit to a reduction in a bill for 
 
HIS REPUTATION AND SUCCESS. 217 
 
 prompt payment, than to let the account stand and run the risk 
 of losing it through the pay-when-you-please system. Besides, 
 while you are waiting debtors may fail and rogues abscond. 
 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 medicines, as 
 they might do if they still owed you. 
 
 You should present your bills while they are small, and 
 your services are still vividly remembered, for 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, have no wants and do not need 
 money ; or that you do not hold this or that person to your busi- 
 ness rule, or are not uneasy about what he owes you ; and if 
 you foster such notions a bad system will grow up around you, 
 and great, irreparable loss will result. Asking foe payment 
 reminds patients that there is still a little of the human left in a 
 man, even if he is a physician, and that you have- to. live, and 
 must have your fees to enable you to do so. 
 
 The business of the world is now conducted on the cash 
 system, instead of the old long credit plan, and youi should do 
 your share toward breaking up the unjust custom that phy- 
 sicians used to follow, either through carelessness or to maintain 
 the favor of patients, of waiting six months or a year after ren- 
 dering services before sending a bill. If a physician attends a 
 person, say, in February, and sends his bill in March or April, 
 it seems to the patient like a current expense, and as though 
 the doctor lives by his practice, and it is apt to be paid promptly ; 
 whereas, if he delays sending it until July or January, and then 
 sends one headed with the semi-apology, "Bills rendered Janu- 
 ary 1st and July 1st," as an excuse for even sending it then, the 
 debtor will naturally think that the physician has merely sent it 
 out with a whole batch of others, more because he has posted 
 his books than from a special desire for its payment ; and in this 
 belief he will propably let it remain unpaid for months longer, 
 
248 THE PHYSICIAN" HIMSELF: 
 
 and perhaps delay its settlement till it becomes an old back debt, 
 which is the hardest kind to pay. Besides, time effaces details ; 
 and recollection of the number of visits, the physician's watch- 
 ings, cares, and anxieties are also forgotten, and the bill, though 
 really moderate, is apt to look large. All these circumstances 
 combined are apt to make people feel, when they do pay an old 
 bill, not as though they are paying a well-earned fee, but more 
 as if they are doing a generous thing and making the physician 
 a present of that amount. 
 
 If, in spite of these facts, you do send your bills only every 
 six months, instead of putting on them " Bills rendered every 
 six months," put "All bills collected at the end of every six 
 months." 
 
 You will have to make a great reduction in many large 
 bills after they have become old, therefore look after them while 
 they are small and recent. Indeed, if you let one bill be added 
 to another till the total reaches a considerable amount, you may 
 place it wholly beyond the power of the person to pay it, and 
 wrongfully force him into the position of a dishonest man. 
 
 The very best time to talk business, and have an under- 
 standing about your fees with doubtful or strange patients, is at 
 your first visit or at the first office interview, and the best of all 
 times to judge people's true character will be, not on occasions 
 for social intercourse and amenities, but when you touch their 
 pocket nerve and have money dealings with them. Even a 
 single dollar will sometimes show you exactly what a person is, 
 whether he is a knave or a man of honor. 
 
 Make it a rule never to accept a commission or fee from 
 any one under circumstances which you would not willingly 
 submit to investigation by the public, a medical society, or a 
 court of justice. Your severest test will be when money is 
 enticingly offered to induce you to do doubtful things. 
 
 Many and many a patient will quit employing you to escape 
 from paying an old bill, and then, to hide from their surprised 
 neighbors the true cause of their quitting you, will trump up 
 
HIS REPUTATION AND SUCCESS. ' 249 
 
 some falsehood or another, and give you a bad name, to prevent 
 them from employing you and thereby learning from your lips 
 the true reason why they quit. 
 
 Eailroad and steamboat companies and other corporations, 
 also proprietors of mills, factories, workshops, etc., whose em- 
 ployees get injured, in order to relieve themselves from responsi- 
 bility, or from fear of incurring public odium, or from a selfish 
 fear that they may become involved in damage suits and be 
 made pecuniarily responsible for the injury, often send, directly 
 or indirectly, for a physician to attend, and in one way or another 
 create an impression in his mind that they will pay the bill, but 
 afterward, on one plea or another (usually this — that they have 
 supported the injured person during his disability, which is as 
 much as they can afford), either entirely disown the debt or 
 refuse to pay it, and with such excuses leave the physician in 
 the lurch. 
 
 In such cases you can obviate this result and secure justice, 
 or, at least, ascertain the prospect, by going, as soon as possible 
 after you have taken charge, directly to headquarters, or to who- 
 ever has the right to make the company or firm financially re- 
 sponsible for your services, and, after explaining the labor and 
 responsibility which the case involves, make known your fear 
 of not being recompensed for your services unless they will see 
 to it, and frankly ask if they will assume the responsibility, and 
 let you enter the account on your books in their name. 
 
 From similar motives, the financial heads of families, for 
 their own satisfaction, for social reasons, or from a feeling of 
 insecurity lest some inmate of their house who has become sick 
 has a contagious disease, will sometimes have you visit their ser- 
 vants, nurses, or poor relatives, and then escape payment of your 
 bill on one pretext or another. These cases should be ap- 
 proached in a similar manner as in the last instance. 
 
 Remember the fact that when a person, even though a 
 banker or a millionaire, comes for you, or summons you, or re- 
 quests you to attend another person, he is not thereby made 
 
250 THE PHYSICIAN HIMSELF: 
 
 legally responsible for your fees, unless he distinctly promises or 
 agrees to be responsible for the debt. 
 
 Make it a rule to enter the names of those who are finan- 
 cially responsible for such services in your book, and keep a 
 memorandum of the facts that make them so, and make out 
 your bill to them accordingly. 
 
 If you take these precautions it will prevent many unpleas- 
 ant misunderstandings, and save you many a hard-earned dollar. 
 
 You will not have practiced 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 business 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 afterward. When a new family employs you, 
 render your bill as soon after the services as gentility will allow, 
 especially if there has been a previous attendant who was an 
 indifferent collector, or no collector at all. Send your bill as a 
 test, and if there is objection to you because you want your fee, 
 the sooner you find each other out and have an understanding, 
 or part company, the better it will be for you. 
 
 There are patients who will pay one physician but will not 
 pay another, there being certain persons with whom they desire 
 to stand well and others for whose opinions they do not care. 
 Try to be in the former class with all persons of doubtful 
 integrity. 
 
 When patients ask you how much their bills are, or how 
 much they owe you, after office consultations, operations, etc., 
 always answer promptly, soberly, and decidedly, " one dollar," 
 or " ten dollars," or whatever else the amount is. If you avoid 
 preceding or 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 
 
HIS REPUTATION AND SUCCESS. 251 
 
 you have no fixed charge, and will furnish them with a pretext 
 to show surprise and to begin to contend for a reduction. When 
 one does demur at your charge, show your amazement at his 
 doing so, and be ready instantly to defend or explain the 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 may through embar- 
 rassment or lack of full remembrance of the nature of services, 
 or of the number and circumstances of the visits, name entirely 
 too low a figure and do yourself a provoking 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 1 ?" or "Shall 1 pay you 
 now 1" A good plan is to answer promptly, " Well, I take 
 money whenever I can get it ; if you have it, you may pay it 
 now, as it will leave no bones to pick," or " Short payments 
 make long friends," or "Prompt pay is double pay, and causes 
 the physician to think more of his patient," or something of 
 that sort. Never give such answers as, " Oh, any time will do ! " 
 or " It makes no difference when," or you will soon find it to be 
 expensive modesty. 
 
 Although Sunday is a holy day, on which bills should not 
 be sent, yet it is perfectly right for a physician to accept fees 
 earned or tendered on that day. 
 
 Never neglect to post your account-books, for it would be 
 violating the first law of nature, which supposes that the first ob- 
 ject of every rational being is the supply of his own natural and 
 necessary wants, to attend faithfully to the department of your 
 occupation that concerns others, and neglect the one that concerns 
 yourself. The Scripture command is, "Love thy neighbor as 
 thyself; " it does not say love him more, but Paul does say to 
 
252 THE PHYSICIAN HIMSELF: 
 
 Timothy : The man who does not ■ provide for his own house- 
 hold 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 
 to give a page in the latter only to patients with whom you think 
 it likely you will have a permanent account. 
 
 Try to get cash from strangers for catheterization, certifi- 
 cates, vaccination, and other minor services, instead of blurring 
 your ledger with petty accounts. 
 
 When a transient patient pays cash at the visits, so as to 
 make it unnecessary to transfer his account from your visiting 
 list to your ledger, the simplest way to mark it paid is to turn 
 each visit mark into a P, signifying paid. 
 
 A good plan to use in making out the list of calls you are 
 to make each day, and the order in which you wish to make 
 them, is this : Tear up a lot of foolscap or note-paper into slips 
 as long as the page and half as wide, and draw a line down the 
 middle of one side of each ; go over your list each morning and 
 cull out the names of all who are to be visited, and put them 
 on one of these strips, left side of the line. Then select and 
 arrange them carefully on the other side of the line in the exact 
 order you wish to observe in visiting them, putting urgent 
 cases and early calls at the top. Cut off this list when com- 
 pleted and carry it in your outer coat or vest-pocket, refer to it 
 often,.and tear off each name as his visit is made. 
 
 You can fix your visiting-list in a few moments, so that it 
 will always open at the page then in use. To do this, clip off 
 about half an inch of the upper corner of its front cover, thus ^, 
 and then in the same way clip off the corners of the leaves 
 thereby exposed, down to the page corresponding with the date 
 of the act. When thus prepared, if you place your right thumb 
 on the exposed corner of the uncut leaves, the book must open 
 at the proper page, As weeks pass, clip each page when you 
 wish to turn from it. The most convenient way to carry your 
 visiting-list is in a wide, shallow pocket on the left hip. 
 
HIS REPUTATION AND SUCCESS. 253 
 
 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 evidence. A good way to 
 prevent forgetting any one or any thing is to put names, visits, 
 street promises, etc., down in your visiting-list with a lead-pencil 
 without delay, till you have a chance to re-write them with 
 ink. 
 
 Purple, green, and blue inks all fade badly, and occasion a 
 great deal of trouble. You had better keep your books with 
 good black ink. 
 
 At the end of every week add up the visits made to each 
 one whom you have attended during the week, and after ascer- 
 taining the total sum which you should charge therefor, put that 
 amount on the visiting-list in the blank spaces found at the end 
 of the lines after the Saturday column. By doing this weekly 
 you can accurately estimate and charge the value of your ser- 
 vices 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 each month, 
 in order to avoid missing any entry in transferring your visiting- 
 list charges to the ledger, use a regular checking-off plan. A 
 very good way is to make a list of the names of all patients 
 whom you have treated during the month on a sheet of foolscap 
 paper, then bring from the visiting-list to the foolscap the 
 amounts marked for each week's services and put them after 
 their respective 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 
 
254 THE PHYSICIAN HIMSELF: 
 
 write November, 1889, $7.00, enter 11-89, $7.00, then cros; 
 that person's name off the foolscap list, and continue on, pa^, > 
 after page, through the entire ledger. By this crossing-off * 
 system, if you fail to charge any one's account 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 (or on a slip of paper), so as 
 to return and make out his bill after completing all your entries; 
 also make, while turning the pages, a list of such delinquents 
 as it would be proper for you, or your collector, to ask for money 
 during the approaching month. 
 
 When you make out a bill, put on your ledger, in the 
 space just after the amount, the date on which the bill for that 
 amount was rendered ; thus, $7.00, with 1-8-90 after it, would 
 signify that a bill for seven dollars was rendered to that person 
 on the first day of the eighth month, 1890, or it may be written 
 as the Quakers do, month first, then day, and then year, thus : 
 8-1-90. (Enter payments in a similar way.) 
 
 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 necessary, for such as may possibly be re- 
 vived ; and for those that are dead, or sure, from other causes, 
 never to employ you again, use ink. 
 
 That a patient whose name is on your books is a colored 
 person can easily be indicated by putting three dots after his 
 name, thus: Eobinson, John \ 13 Columbia Street. 
 
 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 
 ordinary visits ; some seem to think that for a visit at which 
 
HIS REPUTATION AND SUCCESS. 255 
 
 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 ; others have an idea that physicians do 
 not, or should not, charge for every visit when they make more 
 than one visit in a day, or for every patient when more than one 
 in a house is sick. Of course, you must correct their error by 
 explaining the difference, or, if necessary, by reference to the 
 fee-table. 
 
 Never undercharge for your services with a view of obtain- 
 ing business, or in any other odious sense. Habitual deviation 
 from the uniform rate of charging is considered dishonorable. 
 To do so is ruinous to your interests and the interests of the 
 entire profession. The public know that no man will be con- 
 tent with small and insufficient fees while his brethren are re- 
 ceiving greater, unless he rates his abilities at a less price. 
 Small fees are, therefore, set off against small skill in the public 
 belief. The tendency of undercharging is to depress the fee- 
 table permanently and to compel all physicians to work for 
 under-pay. There is a vast difference between underbidding in 
 our profession and wars of competition in ordinary business 
 pursuits. In the latter, cut-rates, and severe and crushing com- 
 petition, are only temporary ; for, if merchants were to sell 
 goods at or below cost for a length of time, failure would result. 
 In business wars one withdraws, or they compromise and each 
 advances again to full prices ; snapping and snarling physicians, 
 on the contrary, having no goods to manufacture or to sell, one 
 determined to triumph, and the other resolved to prevail, can 
 keep up the strain of rivalry, and efforts to crush or banish each 
 other, for years, give their skill to everybody for insignificant or 
 nominal fees, impoverish one another, and almost starve those 
 depending on them for support. 
 
 Unless you already have a regular scale of charges in your 
 region, try to bring about a uniform fee-table or rate of charg- 
 ing among the body of physicians. 
 
 The wisest rule in charging for your services is to do your 
 
256 THE PHYSICIAN HIMSELF: 
 
 work well, then ask, even from the beginning of your career the 
 fees usual for skillful, prompt attendance, neither exorbitantly 
 high, like an extortioner, nor ridiculously low. And always 
 maintain that your services are as good as the best. 
 
 Manage to let people know that you strive to make your 
 bills as small as possible, not by undercharging, but by getting 
 them well with as few visits as possible. 
 
 Never bargain to attend a patient or a family by the week, 
 month or year ; it is better to be paid for exactly what you do, 
 than to have some people feel that they are giving you twenty 
 dollars for five dollars' worth of service, and to feel that you are 
 giving other people fifty dollars' worth of service for twenty 
 dollars. 
 
 Also, never bargain to attend whole neighborhoods or clubs 
 of poor people at reduced rates ; it is lowering and never works 
 successfully. Indeed, if you ever attend a confinement or other 
 case in a family for a nominal fee, or lump your bill, they will 
 always expect to pay what they paid before, and you will not 
 be able to raise your scale of charges to the regular price in 
 that family after your standing and skill improve, and your time 
 becomes more valuable ; or even with others who hear of it. 
 
 It is a mistake to think that you can greatly augment the 
 charges you make in the beginning of your practice as you ad- 
 vance in age, skill and experience, as everybody will appeal to 
 your former charges and refuse. Old patients will think you 
 ought to charge them less instead of more ; so that if ever you 
 feel unwilling to repeat services of any kind for the sum received 
 for a previous case, be careful to give the patient fair notice of 
 your intention to raise your charges. 
 
 Even though you are sure that, to meet one's means of 
 remuneration, you will have to receipt your bill for a reduced 
 amount, make it out for the standard sum, that the debtor may 
 know your rates, and give you credit for whatever reduction 
 you make ; in other words, when you make a reduction to those 
 who plead poverty, or other acceptable reason ; let them under- 
 
HIS REPUTATION AND SUCCESS. 257 . 
 
 stand that you are not reducing your charges, but are taking 
 something off their bill ; and enjoin upon them not to tell it 
 around, lest it injure your scale of charges elsewhere. 
 
 In attending an extraordinary case for the great Mr. Pluto- 
 crat, or Governor Goldmine, or Mr. Creamyrich, or General 
 Doublebank, or Major Opulent, or any one else who is very rich 
 or notoriously liberal, leave to him the valuation of the benefits, 
 unless he insists on having a bill. In the latter case, charge 
 him no more than any one else for the same services. In the 
 former you may, by submitting it to him, from his feeling of 
 superlative delight at the successful issue, be paid most munifi- 
 cently, possibly ten times as much as your bill would have been. 
 
 "When people talk to you about taking off part of their 
 bill because they are poor, and 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 physician, 
 would charge any one, whether rich or poor, a cent more than 
 he honestly owes. 
 
 It is customary and just to charge double for the first, or 
 an only visit to a case, chiefly for the following reasons : You 
 must at the first visit devote an extra amount of time and atten- 
 tion to learning the history of the case, — maybe make a minute 
 time-consuming examination, — must involve yourself in a diag- 
 nosis, and probably also in a prognosis, — must carefully think 
 over and decide upon a whole line of treatment, — must instruct 
 the nurses, — must map out the diet, drink, exercise, etc., — point 
 out the requirements of hygiene, — lay down rules regarding 
 lighting, heating, and ventilation, the clothing, the toilet, etc., 
 and formally establish yourself in the case, and assume all 
 the responsibilities of the issue. These combined make it an 
 extraordinary visit and fully justify a double charge for the first 
 visit. 
 
 There are a few people who think that when a case is 
 severe enough to require the physician to make more than one 
 visit a day, he should not charge for the additional visits, 
 
 17 
 
258 THE PHYSICIAN HIMSELF: 
 
 unconscious, as it were, of the fact that cases dangerous enough 
 to require an extra number of visits are the very ones which 
 throw upon him the greatest responsibility, cause him most 
 anxiety, and contribute most largely toward making his life 
 one of hardship and self-denial. 
 
 You will often have people to hum and haw, and complain 
 that their bill is high and ask you to make a reduction ; yet, 
 many of these very people would not employ you if you were 
 a third-rate or low-priced physician. Everybody wants first- 
 class services, but wants them as cheaply as possible. It is not 
 human nature to prefer a fifty-cent to a two-dollar silk ; but if 
 people are lucky enough to get the two-dollar silk for one dollar, 
 they congratulate themselves. They reason the same way about 
 physicians ; very few prefer or appreciate a low-priced physician. 
 
 In unusually severe cases, in those that require very great 
 exposure or extraordinary legal or professional responsibility : in 
 cases of restoration after poisoning or apparent drowning, in 
 small-pox and other loathsome and contagious affections, the 
 fear of which prevents other patients, who know you are attend- 
 ing them, from employing you, or which compel you to lose 
 time in changing your clothes and otherwise disinfecting your- 
 self before visiting others not affected, or cases in which you 
 have shown extraordinary skill, or had very great luck in bad 
 cases of any kind, you should charge round fees. 
 
 It is certainly worth more to attend an important or dis- 
 tinguished person through a case of pneumonia — in which you 
 save his life as clearly as if you had dragged him helpless from 
 the flames, or plucked him drowning from the water, or for apo- 
 plexy, or with a wound, ulcer, fracture, or a luxation, or in a 
 case of contagious disease, in which you risk losing your own 
 life, in fact anything that causes you great anxiety and necessi- 
 tates much study — than one for whom nobody cares, with a sore 
 finger or toe, or chicken-pox, mumps, or hives, even though the 
 two cases require an equal amount of time or the same number 
 of visits. 
 
HIS REPUTATION AND SUCCESS. 259 
 
 In some cases your charge will be not so much for doing 
 the work as for knowing how to do it ; for instance, you may 
 charge twenty dollars for the few minutes' work of reducing a 
 luxated humerus ; were this itemized it might read : " For re- 
 ducing dislocated shoulder, frve dollars ; for knowing how to do 
 it, fifteen dollars." "You charge me fifty sequins," said a 
 Venetian nobleman to a sculptor, " for a bust that cost you only 
 ten days' labor." " You forget," replied the artist, " I have 
 been thirty years learning how to make that bust in ten days." 
 
 Such cases as attendance on Colonel Bigbee's beloved child, 
 an eminent or very important member of the community, or one 
 of the great men of the land, for whose life you have fought a 
 great battle, or a well-satisfied stranger who has journeyed far 
 with an important case that causes you special solicitude and 
 anxiety, or a case that presents peculiar difficulties, each justifies 
 a special charge, whether attended at your office or at the homes 
 of the patients. In such cases pay every necessary attention, 
 but be careful to pay no unnecessary visits ; for in a very im- 
 portant case, actually requiring three visits, to which you make 
 but three visits and then discharge yourself, they will appreciate 
 you more highly and will more cheerfully pay a hundred dollars, 
 than if you had also paid five additional, apparently unnecessary, 
 visits, and charged but eighty dollars for all. 
 
 On the same principle, when you have severe cases of any 
 kind requiring numerous daily visits, take care to diminish them 
 markedly as soon as the necessity is over. 
 
 In extra and complex cases, and where the results are apt 
 to be grave and far-reaching, or in which you go a long distance 
 or at very unusual hours, or go through storms or dangers, the 
 charge should be, not by the visit, but for the case. 
 
 Patients will often express surprise at your asking the same 
 fee for office advice as for a visit to their house ; explain to them 
 that, although the charge is the same, it is much cheaper to be 
 an office patient than to be visited at home, because an office 
 patient usually comes but once, or only when his medicines are 
 
260 THE PHYSICIAN HIMSELF: 
 
 out, or when some important change has taken place in his 
 ailment, and quits entirely as soon as possible ; whereas, if you 
 have him under care at home, your responsibility and feeling of 
 uncertainty compel you to visit him frequently to ascertain 
 whether he is getting along as expected. For these reasons a 
 few office consultations with the responsibility of attending 
 faithfully resting on the patient, if on either, often suffice, in- 
 stead of many house visits, and in this way office advice becomes 
 very much cheaper. 
 
 Many people who are mean and miser-like about paying 
 will want you to deduct largely from their bills when these hap- 
 pen to be chiefly for office consultations, vaccinations, and other 
 services of the simpler kind. They should be met with the 
 argument that if they pay you less than the average for the 
 minor services, they must pay you more than the average for 
 more important ones. 
 
 The difference between words used with office patients will 
 sometimes be to you the difference between a fee and no fee. 
 Some who consult you, if asked to call again to let you see hoio 
 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 understanding that your regular 
 fee will be charged. 
 
 When a new patient, whose honesty you have reason to 
 doubt, consults you at your office, and instead of paying the fee 
 postpones it, with a promise to call again, if you ask his name 
 and residence and book them before his eyes, you will greatly 
 increase your chances of getting paid. 
 
 Never agree to attend any one for a " contingent fee," that 
 is, do not take patients with chronic sores, constitutional head- 
 aches, epilepsy, cancer, post-nasal catarrh, pimpled faces, piles, 
 dyspepsia, hypochondriasis, and other chronic affections, or cases 
 
HIS REPUTATION AND SUCCESS. 261 
 
 of syphilis, gonorrhoea, etc., on the "no cure, no pay" plan, or 
 to pay "if their rainbow expectations are realized" or "when 
 all is over." Make no such one-sided agreements to do things 
 that may prove impossible, for they are never satisfactory, and 
 will generally end in your being swindled, and, it may be, 
 charged with malpractice. Use the argument that you are 
 willing to undertake the duty, but that you charge for services, 
 not for results, and must be paid for your attendance even though 
 the patient proves incurable or dies, and that all who employ you 
 must take the probabilities of cure or relief from your well- 
 intended endeavors. You might also hint to those whom you 
 think are unworthy of credit that if they pay as they go, instead 
 of running up a bill, it will encourage you, interest you more in 
 the case, and naturally stimulate you to do your best. 
 
 Some persons suffering with constitutional syphilis, ulcer- 
 ated legs, chronic eczema, etc., in which the treatment may 
 extend through months or years, or even through a lifetime, 
 may imagine you should wait for your fees till done attending. 
 Do no such foolish thing, as such a case may die, or move away, 
 or abandon treatment, or slip from you to another, or to begin 
 with grandmother remedies, or with "yarbs from those who 
 have no lamin','' or even resist all your attempts to cure, and 
 you may get nothing except misrepresentation for all your work. 
 
 It is far more just and wise in such cases to render your 
 
 bills at the proper time — "for the three months ending ," 
 
 or at the very furthest the first of every July and January. If 
 they demur (which they cannot justly do), express your surprise 
 at their doing so, and remind them that you must live by your 
 practice, and tell them of your entire unwillingness or inability 
 to let your fees accumulate as they suggest. 
 
 You should ordinarily exact no previous stipulation of pay, 
 or manifest 'any undue anxiety about your fees, and make no 
 mention of your intended charges, unless you are dealing with 
 people notoriously unworthy of confidence, or when there is 
 great danger of a misunderstanding ; but you may very properly 
 
262 THE PHYSICIAN HIMSELF: 
 
 demand your fee in advance for attending cases of secret dis- 
 eases. If you do not, Mr. Hightone, or Mr. Lowtone, or Mr. 
 Notoneatall, as the case may be, will, five times in six, leave you 
 about the time that Richard's himself again, 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 abuse you, and, 
 with vinegar or ice in his looks, meanly assert that he is abso- 
 lutely a Joseph, and that it was not an ignoble disease at all, 
 but only a strain, or that you did him no good, or almost killed 
 him, or tell some other lie as an excuse for deserting and cheat- 
 ing you, and ever after injure you to the full extent of his 
 influence. Another reason why it is proper to get your fee in 
 advance is that many Avould 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, even though he had gonorrhceal disease, or was covered 
 from the crown of his head to the soles of his feet with syphilis. 
 
 Venereal diseases are the result generally, not of providen- 
 tial misfortune, as other inflictions are, but of voluntary indul- 
 gence in vice, and are self-inflicted. And for this valid reason 
 such venereal patients have not the same natural claim upon 
 your sympathy as other patients. Get a just fee in all cases of 
 merited venereal disease before you begin treatment ; 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 pro- 
 ceeds slowly he cannot then suspect 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 or two a visit. 
 
 Most men think they cannot have constitutional syphilis 
 unless they have detected a terrible chancre at the beginning. 
 You will often have difficulty in making persons who have not 
 
HIS REPUTATION AND SUCCESS. 263 
 
 detected a primary sore believe their ailment is syphilis. Some 
 men will actually gape and stare, scan and quiz you, when you 
 tell them they have the p-x, as if they thought you a quack or 
 an impostor trying to scare money out' of them. If you can 
 show such a patient a fac-simile of his chancre, roseola, or 
 mucous patches in your illustrated text-books on venereal dis- 
 eases, or even read to him a description of them, it will awaken 
 him to his actual condition and guard him against either neglect- 
 ing the cure of his case or infecting others. 
 
 When you are certain that your diagnosis of syphilis is 
 correct, look the patient in the eye, and with a manner that 
 shows you speak the solid truth from knowledge, tell him that 
 in your opinion he has genuine syphilis, and be careful not to 
 be browbeaten into taking charge of the case for a trifling fee. 
 It is a grave disease, and the responsibility and worry of the 
 medical attendant are often very great and very protracted; 
 therefore, the fee for attending it 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 will- 
 ing to take charge of it and give you my best services, if my 
 terms will suit you." This will compel him to ask you what 
 your terms are, and will give you an opportunity to tell him. 
 Or, if you regard the services which will be required as very valu- 
 able, whilst it is apparent that he thinks the reverse, if you will 
 begin with the remark, " Ah ! I fear I would charge you more 
 than you would be willing to pay," this also will compel him to 
 question you upon the subject, and that too in a somewhat more 
 favorable frame of mind for your purpose. 
 
 Some people believe the law compels you to attend any one 
 who chooses to send for you. It does not ; yftu have a right to 
 refuse for any reason that is satisfactory to yourself, but public 
 opinion would angrily condemn you if you were simply, on ac- 
 count of fees, to refuse to attend an urgent case where humanity 
 should prompt you to go. If you are " too busy" or " not well 
 
264 THE PHYSICIAN- HIMSELF: 
 
 enough" or have another duty to perform equally as urgent, this 
 will generally prove sufficient to protect you against argument 
 or criticism. But "Pm just at dinner" "Pm too tired," or "/ 
 need sleep," or "I am afraid T icill be dragged into court as a 
 witness," etc., look like a hard and vulgar indifference, and are 
 not accepted by the public as sufficient reasons for refusing to 
 go to a case, and should never be offered. What business has a 
 physician to be at dinner ! What right has he to be tired while 
 he is yet able to crawl, or still has strength enough to think a 
 thought, or to hold a pen, when any one gives a beck or call ! 
 
 A few persons also believe there is some law or rule that 
 prevents a physician from attending his own wife and children, 
 and other near kinsmen, when they are sick. This belief has 
 been created by the fact that some esteemed brother-physician is 
 generally intrusted with such cases through a fear, in the phy- 
 sician's anxious mind, that personal interest in ones so near and 
 dear to him might warp his judgment, or in the event of fatal 
 issue might leave a deep and lasting regret in his mind that 
 this, that, or the other line of treatment was not pursued in- 
 stead of .that which was. 
 
 After your work is done you will often have to use this, 
 that, or the other stratagem to get your fees. You should not 
 only send your bill to a patient at the proper time, but if you do 
 not hear from him within a reasonable while thereafter empha- 
 size it by sending another, with the same date, etc., as the first, 
 marked "duplicate " or " 3d bill," " 4th bill," as the case may be ; 
 for he may not have received the first, or may have thrown it 
 aside with a Tra-la-la-la ! or may be neglecting it in the hope 
 that you will let it sleep till it is forgotten or out of date. 
 
 A very effective plan to use with a certain slow class of 
 patients, when you are in need of money, is to leam 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, 
 
HIS REPUTATION AND SUCCESS. 265 
 
 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 patients, 
 and some that you cannot successfully approach for money in 
 any other way. Asking in this way, moreover, shows that you 
 do not want simply to get it out of their hands into yours, but 
 that you ask for it because you happen to need it. 
 
 Another plan, good to pursue with those who 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 ask- 
 ing them to pay that day, and tell your urgent reasons for 
 asking. Even though they pay you nothing then, knowing that 
 they have disappointed you in your emergency will make them 
 feel impelled to pay you something the next time they call on 
 you for services. 
 
 By letting your prompt-paying patients know in some way 
 or other at the visit preceding the final one that your next 
 visit will be the last, it will serve as a gentle hint and give them 
 time to prepare, and will greatly increase your chances of getting 
 your bill paid cash at the last visit. Convalescents from severe 
 cases who are told to visit you at your office after they are again 
 able to walk out, in order to let you see how they are getting 
 along, are very apt to broach the subject of settling, and either 
 pay, or make some definite promise before leaving. 
 
 You cannot put all kinds of bills on the same footing ; there 
 is one class of patients whose bills had better be sent by mail, 
 another to whom they had better be taken by your collector, 
 another where you had better deliver them yourself, and a few 
 prompt-pay patients with whom it is preferable to wait till they 
 ask for them. Try to gain as much benefit as possible from a 
 study of this fact. 
 
 Items and charges had better never be set forth 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 
 
266 THE PHYSICIAN HIMSELF: 
 
 confide in you sufficiently to put their lives and their secrets in 
 your keeping should feel sufficient confidence and gratitude to 
 permit you to say what value you place on your services to them. 
 A physician's bill that gives the items is apt to be disputed, or 
 criticised, unless it is unjustly small. Bills that simply state the 
 total amount, or amount due for services since date of last bill, 
 are much more likely to be paid without dispute. The items 
 of every bill should, however, be carefully kept on your book, 
 that the charges may be verified if requisite. 
 
 It is well to insist on giving, receipts to people when they 
 pay you money, even though they should deem it unnecessary. 
 Compelling every one who pays to take a receipt, not only pre- 
 vents subsequent disputes, but also assists in keeping up a 
 regular business form between you. 
 
 Avoid avarice in its various forms: meanness, oppression, 
 cruelty, etc. If you were to shave too closely in money matters, 
 to hold watches, jewelry, or other articles as security for the 
 payment of your fees, or to compel their owners to pawn or sell 
 them, or to charge interest on bills, because not promptly paid, 
 or to be unreasonable (Shylock) or too vigorous in your efforts 
 to collect bills from any one, it would not only be wrong, but 
 would be very apt to injure your reputation, and create preju- 
 dices and hostility against you that time could not blot out. 
 
 For the same reason it is, as a rule, better not to charge for 
 certificates of sickness furnished your regular patients to enable 
 them to draw benefits from beneficial societies, or for certificates 
 of vaccination given to school-children, etc. These are personal 
 favors, .differing from cases in which a fee is proper. 
 
 It will seldom pay you to sue people, even if you should in 
 equity gain the case. It is unwise for you or any other phy- 
 sician to begin litigation to enforce your claims except under 
 very aggravating circumstances, or to maintain your reputation 
 or self-respect. Physicians who frequently go to law to recover 
 fees generally lose more in the end than the yield, by exciting 
 prejudice and making enemies. You should never resort to 
 
HIS REPUTATION AND SUCCESS. 267 
 
 compulsory measures with any one whose failure to pay is due 
 to honest poverty. While naturally seeking to get good patients, 
 who can and will pay for your services, be also willing to do your 
 share of charity for the virtuous poor at all times, but the neces- 
 sity of earning a living should, of course, -make you careful not 
 to let that kind of "people crowd out your pay practice. 
 
 It will usually be wiser not to send a bill for the trouble of 
 going to cases of sudden death, drowning, suicide, persons found 
 dead, murder, etc., in which the victim is dead before you reach 
 him, or in emergency calls, where another physician reaches the 
 patient and takes charge before you arrive, or in other cases 
 where your 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, talce whatever is right. 
 
 In obstinate and invincible maladies, such as hopeless cases 
 of cancer, phthisis, aneurism, etc., which, after going the rounds 
 of the profession, consult you in the last stages, with the hope 
 of getting a new pair of lungs or having other miracles per- 
 formed, or merely to see whether you can possibly do anything 
 for them, you had better deal candidly with them and frankly 
 acknowledge that you can do but little or nothing, and decline 
 the fee even if tendered. 
 
 It is usually better to make no charge for ordinary or trifling 
 advice incidentally given to patients when they call to pay their 
 bill, or to persons for whom you 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 remem- 
 brance and harsh criticism. Every physician sometimes writes 
 prescriptions under circumstances where, even though he be 
 technically entitled to compensation, Ids own interests forbid his 
 making a charge, or even accepting a fee when tendered. 
 
 Never make a charge where the fee would come from an- 
 other physician's pocket; every physician attends his professional 
 
268 THE PHYSICIAN HIMSELF: 
 
 brethren and their families gratis. Some also attend clergymen 
 and their families without charge, especially those with whom 
 they have church relations, and those who receive salaries so 
 meagre as to make the payment of medical fees a hardship. 
 Where a clergyman is in the receipt of a liberal salary, and his 
 calls on you are frequent or onerous, I know of nothing in ethics 
 to forbid your accepting from him a fee voluntarily tendered. 
 Many of our best physicians make it a rule to charge half fees, 
 to their own spiritual advisers; that is, they make out the bills 
 for the full amount and receipt them upon payment of half the 
 sum. Their influence, if properly directed, cancels the re- 
 mainder. 
 
 Never oppress any one by exorbitant fees. Nearly every one 
 depends on his physician's unwatched honesty. 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 fully test whether true honesty has a seat in 
 your heart. When you are in doubt what to charge, look 
 around you, then upward, then make out your bill at such 
 figures as will show clean hands, morally, as well as antisepti- 
 cally. Even-handed justice is the basis of all lasting reputation. 
 
 Great injury is inflicted on our entire profession when Dr. 
 Bigclip or Dr. Windfall or any other of our guild charges those 
 whom chance has placed in his power a fee so large or extor- 
 tionate as to cause great gossip or newspaper notice of it. 
 
 When you and a professional brother do each a portion of 
 the work in cases of accident, confinement, etc., a very fair plan 
 is to agree to charge a joint fee and divide it. When you re- 
 ceive such a joint fee, go at the earliest possible moment and 
 divide every dollar, fairly and squarely, with your fellow-worker, 
 on whatever basis you have agreed upon. 
 
 When another physician is called to a case of yours, dur- 
 ing your absence, not only thank him at the first opportunity, 
 but also insist on his sending his bill for whatever services he 
 has rendered. No one can be expected to work under such 
 
HIS REPUTATION AND SUCCESS. 269 
 
 circumstances without fee. His kindness to you consists in 
 having responded to the call. 
 
 Never acknowledge or work under the job-lot fee-table of 
 any association or company, unless it be in harmony with the 
 regular professional fee-table of your community. 
 
 A fee-table should never be extravagantly high on one 
 hand, or meanly low on the other, and should always allow a 
 reduction if the patient's circumstances require ; and should also 
 allow attendance on the moneyless poor gratis. 
 
 Humanity requires you (as God's instrument) to go with 
 railroad velocity to all cases of sudden emergency, accidents, 
 etc., in which the life or limb of a fellow-being is in jeopardy, 
 without regard to the prospect or non-prospect of a fee. You 
 should do various things for the sake of charity ; among these 
 is to give relief to any one injured, or in great pain or distress, 
 regardless of fees. At such times regard only Man ; show no 
 distinction between rich and poor, high and low, but think only 
 of your manly duty to humanity. The good Samaritan suc- 
 cored the wounded, man by the wayside, 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, and you 
 are really no more bound to continue to attend him gratuitously 
 than the baker is to give away his bread to the hungry for 
 nothing, or the tailor is to give away his clothes to the ragged. 
 
 It is your duty to raise your voice in the profession against 
 the fearful abuse of medical charities by the people at the various 
 free special dispensaries, and low-fee hospitals, college clinics, 
 and church infirmaries, which, of late, under the great plea of 
 charity, attract not only aching beggars and the poverty-stricken 
 sick, but also thousands of stingy impostors and miserly drones, 
 who are abundantly able to pay for medical services ; besides, 
 offering a refuge in their rainy day to the lazy and vicious, 
 against which, such, consequently, need not provide by industry, 
 
270 THE PHYSICIAN HIMSELF: 
 
 sobriety, and economy. Make a person a pauper in one thing 
 and he is apt to degenerate and become worthless in many. 
 
 No member of the profession — and the same may be said 
 of pharmacists and physicians who keep drug stores and pre- 
 scribe over their counters — has, in the spirit of common justice, 
 a right to give professional services to the public without fee, 
 except to the moneyless poor (to whom they should be given, in 
 the holy name of charity, as freely as the air they breathe) ; for, 
 even though there may be no loss thereby to him personally, it 
 has a pauperizing tendency on them, and is taking bread from the 
 mouths of others by monopolizing practice that would otherwise 
 fall into their hands, and to that extent it is robbing the pro- 
 fession at large of its legitimate emoluments. For an individual 
 to advertise gratuitous attendance on the poor at his office, or at 
 certain times, or under certain conditions, is unprofessional. 
 
 Thousands of young and deserving sons of iEsculapius 
 have been, of late, cheated out of their living by so-called 
 '■'Special'" Charities, carried on chiefly in the interest of indi- 
 viduals, or coteries, who, to foster reputation in their specialties, 
 and to keep out rivals, treat everybody that applies, the rich, 
 the poor, and the intermediate class, whether entitled to the 
 benefits of its charity or not, without the slightest regard to the 
 interest of other medical men. The ultimate result of this state 
 of things will be either that the profession will, in self-defense, 
 be compelled to organize self-preservation associations, or that 
 individual physicians will take up the case and resolve neither to 
 turn over cases to nor to call into consultation any specialist, pro- 
 fessor, or surgeon who continues to render gratuitous service to 
 those who are able to pay for it. The latter course would prob- 
 ably influence the transgressors strongly. 
 
 Probably a considerable proportion of those who are able 
 to pay for services, who impose on these institutions, would be 
 exposed to the public and debarred from doing so by the prom- 
 inent display of some such sign as the following: "This 
 Dispensary is for the. moneyless poor only." 
 
HIS REPUTATION AND SUCCESS. 271 
 
 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; their very poverty and lack of comforts 
 make them more likely to get sick and to suffer more in sick- 
 ness than the rich, and kindness to them should be as broad as 
 God's earth. Besides, there are none so poor but that they may 
 amply repay your services by their earnest " God bless you, 
 Doctor," and their genuine, lasting gratitude. 
 
 Physicians render more unpaid services than any other class 
 of people in the world. " The poor," said Boerhaave, " are my 
 best patients. God will be their paymaster." But even in do- 
 ing charity you must discriminate. There seem to be three 
 classes of the poor — the Lord's poor, the devil's poor, and the 
 poor devils. The first and last are worthy objects of every phy- 
 sician's attention, and you should lose no opportunity to give 
 relief to their distress. The less you have to do with the other 
 class (the devil's poor), and the less health and strength you 
 waste on them, the better for you ; but you will be compelled 
 to attend more than you choose of the lowest and meanest 
 victims of vice, intemperance, and sensual indulgence — perhaps 
 a curse to their families and a nuisance to the neighborhood — 
 some for God's sake, and some on account of their relationship 
 to your more fortunate and provident patients. 
 
 Found your idea of Christian duty, and of doing charity, 
 on the fifth, sixth, and seventh chapters of Matthew and the 
 thirteenth chapter of First Corinthians, and you cannot go far 
 astray. 
 
 "Prompt payments fully appreciated," is a very useful 
 maxim to have printed on the margin of 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. 
 
 The size of the house does not always show the size of the 
 owner's honesty. You will find that honesty and dishonesty are 
 not confined to any one nationality or to any station in life, but 
 that there are many very good men and many very bad ones alike 
 
272 THE PHYSICIAN HIMSELF: 
 
 among the rich and poor, the white and black. You will mount 
 many a marble step, pull many a silver door-bell, and walk over 
 many a velvet carpet for well-housed, sumptuously fed, fashion- 
 ably clothed, dangling watch-seal, diamond-studded patients, 
 who will prove fraudulent in- the superlative degree, and you 
 will get many a willing fee from some coarser and rougher, who 
 make no great pretensions and possess but little save their honest 
 hearts. 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 physicians in order 
 to help keep up appearances. You will see many a man bowed 
 down with debt and despondency, while his trinketed wife and 
 dazzling 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 to postpone or entirely prevent payment. 
 
 Families will occasionally conceal from the person who is 
 to pay your bill the true amount of services you have rendered 
 or the full number of visits you have paid, and thereby lead him 
 to think you have charged very high or even overcharged for 
 the services. Be ready promptly to correct such errors. 
 
 The most unsatisfactory and the most troublesome kind of 
 patients physicians have to contend with are the unprincipled, 
 thorough-bred tricksters, who cheat everybody that gives them a 
 chance, and consider it no wrong at all to swindle physicians, 
 and would not cross their fingers to keep us all from going to 
 the almshouse. You will be fortunate if you have tact enough 
 to escape having anything to do with those whom you know to 
 belong to this class. It is better mildly but firmly to decline to 
 take patients who can but will not pay, without assigning any 
 reason except " too busy" or " Pd rather you ivould get some 
 one else" than to have to contend with them about your fee 
 
HIS REPUTATION AND SUCCESS. 273 
 
 after your work is done, and maybe, after all, you get neither 
 fees nor thanks. 
 
 Have your wits about you and tell habitual delinquents, 
 and hard customers who have plenty of money to smoke ex- 
 pensive cigars, go to places of amusement, buy beer, or fill the 
 brandy bottle, or to furnish their houses like palaces, or to follow 
 the follies of fashion, but ?ione to pay the physician — when they 
 come, with assumed lamentations, to make their bills larger — 
 that they are already as largely indebted to you as you can 
 afford to let them be, but that you are perfectly willing to go 
 and serve them again, after they pay you what they already owe 
 you, or a reasonable part of it, or, if they will pay you for the 
 new services cash at each visit. This attitude will bring them 
 to some action, or at least indicate to you the probable prospect. 
 
 You will encounter many a person who, although quite 
 amiable during your attendance, will prove very different when 
 your bill is presented. Allow no ground for finding fault with 
 your manner of presenting it. It is a useful precaution to in- 
 close every enveloped bill sent by mail or messenger in a half- 
 sheet of blank paper, to prevent prying custodians from peering 
 through the envelope and recognizing its contents. 
 
 In spite of all, were you a Solomon and an Angel com- 
 bined, many patients will meanly quit you when you send your 
 bill or ask for your fee, no difference how or when you do it. 
 
 When possible, have the bills presented directly to the 
 financially-responsible party, or the real head of the family, and 
 say nothing at all about them to the other members of the 
 household. 
 
 A moderately successful practitioner has about two thou- 
 sand persons who call him their customary physician (fully three 
 hundred of whom are moneyless, or bad pay) ; whenever any 
 one of these has a mental or physical ailment, he must share it 
 by head-work, and hand-work, and heart-work. He must be 
 bold as a lion with one patient, as patient as an ox with an- 
 other, and as gentle as a lamb with the next. Self-sacrificing, 
 
 18 
 
274 THE PHYSICIAN HIMSELF: 
 
 his own aches and pains must go unnoticed. Being the slave 
 of the sick public he must also face contagion and inhale 
 noxious vapors, encounter the filthiest kind of filth and the 
 worst of all stinks, and perform many distasteful and disagreea- 
 ble and disgusting duties. He must endure all temperatures, — 
 August suns and December blasts, — drowned with the rain and 
 choked by the dust he must trudge, at noon or midnight; while 
 others are resting or refreshed with sleep and oblivious to care he 
 must go ; must be with families at all seasons, in death and re- 
 covery, of sorrow and joy. A soldier may serve his whole term 
 without smelling powder or even getting within long range of 
 danger. A physician is in continual danger, and when, like a 
 wild tornado, the swift, gaunt, ghastly, withering epidemic begins 
 its work of death, no difference how great the danger, he must 
 depend on Providence, and, from pure love of humanity, take 
 his life in his own hands and stand (like Aaron) between the 
 living and the dead, to fight the monster, in filthy and ill-venti- 
 lated localities, while thousands are falling around him, and 
 other terror-stricken thousands are fleeing for their lives ! He 
 must have an eye like an eagle's, a heart like a lion's, and a 
 hand like a lady's, — must combine all good qualities, and appear 
 the perfection of each to all men, and, heaven knows ! he de- 
 serves far better treatment, and a much more comfortable sup- 
 port than he receives. 
 
 Some one has divided man's life into four periods, and 
 called the first twenty years the period of preparation, — from 
 twenty to forty the period of struggle, — from forty to sixty the 
 period of victory, — and after sixty, rest. Not so with the 
 physician, his struggle lasts (if he is able to walk or hold a pen) 
 until his life ends. 
 
 Computed by the ten-hour system the busy physician does 
 no less than five hundred days' work a year, loses his sleep and 
 meals, and has to serve many masters at any hour from sunrise 
 to sunrise. Every year, measuring by work and care, the 
 average practitioner has three years of brainwork and mental 
 
HIS REPUTATION AND SUCCESS. 275 
 
 strain, has to endure all kinds of criticism, does more charity, 
 and then lets his accounts, against those who are able to pay, 
 run longer than any other person in the whole community. 
 
 The trades and common occupations are learned in three 
 or four years ; perfection in them is soon reached, and the 
 balance of life is simply a routine employment ; not so with us, 
 for in medicine the law is progress, perfection is never reached, 
 and study and mental exertion are never done. 
 
 The fact that a physician must keep up appearances, and 
 that many make their visits with gloved hands and in stylish 
 carriages, is regarded, by unreasoning persons, as evidence that 
 ours is a path of ease, a bed of roses; that we ride around 
 during bank-hours, prescribe for a few select patients, receive 
 dollars by wholesale, and soon get rich enough to retire and live 
 on the interest ; which is a great, a very great, mistake. On the 
 contrary, every older physician knows that owing to the diffi- 
 cult collections, and the large proportion of the poor, the prac- 
 tice of medicine is not an Eldorado, or a money-making profes- 
 sion, and that it is almost impossible to get rich by the practice 
 of medicine, unless it be a celebrated surgeon, commanding 
 great fees ; or here and there a fashionable favorite, who is lucky 
 enough to attend groups of patients who have copious and open 
 purses ; or, through a money-making specialty, commanding 
 fancy fees. In fact, I know of no legitimate business in which 
 the same amount of capital laid out, and labor, industry, and 
 prudence exercised, that would not be likely to prove much 
 more lucrative. 
 
 The income of the most successful physicians is far below 
 what is commonly imagined. Besides, ours is not a long-lived 
 profession, and many a conscientious, able, and worthy physician 
 dies, and, instead of leaving an Aladdin's lamp, leaves those 
 dependent upon him poor and helpless, unless he has acquired 
 money otherwise than by his practice. 
 
 After his death, a physician's outstanding bills are rarely 
 collectable. Many a one with a large practice dies, and his 
 
276 THE PHYSICIAN HIMSELF: 
 
 estate is found to be not worth administering On. According to 
 Dr. Jarvis' tables, ,the average of the lives of physicians is fifty- 
 six years. If you began practice at twenty-four, your active- 
 life prospect will be thirty-two years, and from a thousand to 
 fifteen hundred dollars will represent your average yearly income. 
 
 Now were you (through God's mercy) to practice these 
 thirty-two years without losing a single day, and collect (say) 
 eight dollars every day of the time, you would receive but 
 $93,440. Deduct from that amount your expenses for yourself 
 and your family, your horses, carriages, books, periodicals, and 
 instruments ; your taxes, insurance, and a multitude of other 
 items for the whole thirty-two years (11,680 days), and then, so 
 far from being rich, even after this long and active life of use- 
 fulness, in this most important and honorable profession ; after a 
 whole life-time of scientific work, mental toil, and slavery to our 
 unrelenting taskmaster, The Sick Public ; from the days of the 
 dirty, unwholesome dissecting-rooms through all life's phases to 
 old age; with not even the 1564 Sabbaths to call your own, — ■ 
 you would have but little, very little, left to support you after 
 you naturally reach the down-hill of life, or are broken down 
 in health and faculties deteriorated, and in need of a physician 
 yourself, through worry, anxiety, and fatigue in the discharge 
 of your duty. 
 
 The physician is, as a rale, so poor a business man that if 
 he collects money enough to meet his necessities he is not 
 troubled about the balance. The author had a friend (an excel- 
 lent physician), who had no regular business habits, and was so 
 neglectful of his fees that he kept no systematic accounts what- 
 ever ; the result was that his easy, careless terms, together with 
 his skill, made him unusually popular, the love of which gave 
 him more business than he could do justice to, more reputation 
 than he could sustain, and kept him overworked day and 
 night till, at the end of fourteen years, the incessant fatigue, 
 exposure, and anxiety of a harassing practice broke him down 
 and he died, almost, as it were, by suicide, leaving his loved 
 
HIS REPUTATION AND SUCCESS. 277 
 
 wife and dear children moneyless, with nothing except penury 
 and regret at his foolish self-sacrifice, improvidence, and lack of 
 business system. What sane physician would follow such an 
 example ! 
 
 One would suppose that physicians, whose lives are spent in 
 preventing and curing disease in others, might themselves claim 
 exemption from disease and decay, and attain unusual longevity ; 
 but not so ; we, too, are mortal, and bear no charmed lives, but, 
 having a perpetual wear and tear of body and mind, suffer sick- 
 ness, are deprived of health, pay the natural debt, and fill an 
 early grave fully as often as other men. 
 
 If your death would leave your loved ones otherwise un- 
 provided for, it would be wise to provide for them by an assur- 
 ance on your life, which can be gotten and maintained at a small 
 cost. 
 
 Try to put away part of your income for a rainy day or old 
 age. No one knows what ill-luck may overtake him during 
 life, or how dire may sometime be his need of money ; it is the 
 dollars saved during the first years of practice that roll up into 
 future competence. 
 
 A good, honest collector, one who has proper discretion and 
 tact enough to wake up hard customers and get money on the 
 installment or other plan from delinquent and dilatory debtors 
 without irritating them and making you active enemies, will be 
 very useful, and is quite necessary if you are too high-spirited 
 to allow a direct transfer of your remuneration from old friends, 
 or lady patients, or if you have no time or are a poor collector 
 yourself. Having only business transactions with patients, his 
 interviews with them are husiness exclusively, and he can perse- 
 vere in his efforts to collect to a degree which you would find 
 unpleasant or humiliating. Many really honest people are too 
 poor to pay large debts, and were you to allow what they owe 
 you to accumulate from time to time into a large bill, they could 
 not pay it to you even if they wished, and you woidd actually 
 place them in a dilemma. Having a collector prevents this and 
 
278 THE PHYSICIAN HIMSELF: 
 
 keeps y<3ur financial department in a good condition. It also 
 stimulates those who are habitually slow in paying, and sifts out 
 the fraudulent before they run their bills very high. 
 
 You should have some specific agreement with your col- 
 lector, not only regarding his rate of percentage for collecting, 
 but also regarding the conditions under which he is to claim it. 
 Among other things, stipulate that he is to make full returns to 
 you at least once a week, that he is to have no percentage on 
 money paid directly to you by those whom he has not visited for 
 thirty days, unless you have at their request stopped him from 
 going ; and that he is to receive nothing on bills placed in his 
 hands if the parties come and pay them before he has delivered 
 their bills ; in fact, nothing on any bill which he does not in 
 some way assist in collecting. 
 
 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. 
 
 If you adopt some special shade or color for your bills, it 
 will not only make them easy to find when patients mingle them 
 with others, but will also remind those who are remiss or tardy 
 in paying the debt every time the color arrests their attention, 
 and may, by constantly reminding them, actually secure or 
 accelerate payment. 
 
 The publication of lists (black-lists) of the names of fraud- 
 ulent patients among physicians practicing in the same section 
 is mutually profitable, as it often prevents the unprincipled who 
 could pay if they wished from systematically imposing on a suc- 
 cession of physicians, and coerces them into retaining and pay- 
 ing some one. Of course, the worthy poor and the unfortunate 
 who are visibly unable to pay should always be omitted from 
 these lists. 
 
 A good way to get up " The Physicians' Mutual Protection 
 Association" is to have a meeting of the physicians of your sec- 
 
HIS REPUTATION AND SUCCESS. 279 
 
 tion, and after organizing appoint a Publication Com'mittee, to 
 which every member shall hand a list of the names, occupations, 
 and addresses of all who have owed them bills unjustly long. 
 
 All these names should be alphabetically arranged and 
 published, in a small, plain, cloth-bound " Reference Book," one 
 copy for each member. Also, have to accompany each book a 
 separate printed slip, containing the names of each physician 
 who has given a list, with the number given to Irim by the 
 committee placed before his name : — 
 
 1. Dr. John Allen, 
 
 2. Dr. Henry Blair, 
 
 3. Dr. "William Curry, etc. ; 
 
 these slips to be kept sacredly private, for the use of their own- 
 ers only. Suppose Dr. James Shaw is No. 16 and Dr. Thomas 
 AVilson is No. 31 on the slip or key. We find among the 
 delinquents the name of Samuel Adams, No. 127 N. Bond 
 Street, with 16 behind it. This, of course, shows that Samuel 
 Adams has been unjustly slow in paying No. 16 (Dr. Shaw) a 
 bill that he owes. If 16 and 31 both appear behind his name, 
 it shows that he is in bad standing with both Drs. Shaw and 
 Wilson, and has been reported by both. The object of such an 
 association should be, not to forbid any one who chooses to. 
 attend to delinquents from doing so, but simply to point them 
 out, so that any one may either decline to attend them, or do so 
 with his eyes open. 
 
 The list of names in the book should, for obvious reasons, 
 follow some such mild title as: — 
 
 "Buffalo, N. Y., January 1, 1891. 
 " The following is a list of persons who have been 
 indebted to various physicians unjxistly Jong: — 
 
 "Adams, Samuel, No. 12 N. Bond Street, 16. 
 
 " Bowman, Daniel, No. ] 79 W. Biddle Street, 23, 44." 
 
 Every few years a new volume should be gotten up and 
 issued. 
 
CHAPTER XII. 
 
 The physician must, like the diplomatist, tread softly." — Macness. 
 
 Be alert, observant and apprehensive, and never exhibit 
 surprise at any possible event growing out of sickness. You 
 will be supposed to foreknow and expect all conceivable things 
 relating to disease, its dangers and its terminations. Even when 
 death has occurred to some one under your treatment unex- 
 pectedly, do not let your manner or language indicate that you 
 were entirely ignorant of its possibility, or that you consider 
 yourself to blame. 
 
 When you have cases in which there is danger of rapid 
 or sudden death, beware of ordering chloral, opiates, or other 
 potent drugs in such a manner as to create a belief that they 
 have caused or hastened death (manslaughter). Circum- 
 stances may even make it wise at times not to write any pre- 
 scription at all, but simply to order this or that remedy under its 
 common name, that, its harmless nature and appropriate char- 
 acter being understood by all, no blame can be attached to you 
 or your medicines. 
 
 When any one under your treatment dies unexpectedly 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 toward you, and to 
 meet their criticisms by explanations, etc. On such occasions 
 be self-possessed, and, if need be, explain and defend your 
 course and your treatment. By doing this you can anticipate 
 evil reports by the disappointed or censorious household, and 
 
 (281) 
 
282 THE PHYSICIAN HIMSELF: 
 
 suppress or shape them before they are extensively circulated 
 by agitated relatives and friends. 
 
 Dropping in for the purpose of preparing and giving to 
 the family the death certificate affords a good chance for an 
 interview. 
 
 When you are called to a case of sudden death the utmost 
 composure of mind and manner is of great importance ; use 
 discretion and prudent reserve, and never assume an oracular or 
 prophetic air, or express any opinion of the cause in any such 
 case (but show a determination to neither form nor deliver 
 one), until you have calmly and coolly collected and weighed 
 all the circumstances. The possibility of death being due to 
 embolism, or paralysis of the heart, or to syncope, or pulmonary 
 apoplexy, or other disease of the heart, or lungs, or brain, or to 
 poison, violence or suicide, should be carefully weighed before 
 you express any opinion. If you rush in with a flurry, neglect 
 this precaution, and christen the disease according to your first- 
 born opinion, further developments in the case may prove it to 
 be some other affection well known to the laity, and expose you 
 either as a butt for pleasantry and ridicule, to deep mortification 
 or strong censure. 
 
 If you are called to a case of sudden death where violence 
 is suspected, or to which you are summoned by the coroner, be 
 careful to note everything connected with the corpse and its sur- 
 roundings, and, where a post-mortem is required, the condition 
 of the viscera, every one of which should be carefully examined 
 before giving an opinion as to the cause of death. Your notes 
 should be taken by yourself or an assistant at the time, stat- 
 ing the year, day of the month and hour, and should be in non- 
 technical language, enumerating first the facts of the case, and 
 then giving your comments and interpretation of them. These 
 notes should be preserved, as you will be allowed to read them 
 in court, if called there, in order to refresh your memory, 
 though not wholly to rely on them. If the cause is suspected 
 to have been poison, be careful to tie the stomach at both ends 
 
HIS REPUTATION AND SUCCESS. 283 
 
 . before its removal, and keep it and its contents in cleaned, sealed 
 vessels under your own eye and custody, till a chemical analysis 
 can be made. If a person is dying from violence (poison or 
 wounds), when called to him, inform him of the fact, and if he 
 volunteers a statement of the circumstances causing his injuries, 
 or in regard to his assailants, take his words down at once in his 
 exact language, as such a statement will be received in court as 
 if made under oath, provided the person makes it under the 
 belief that he is about to die of his injuries. 
 
 The mottled, reddish or livid patches, and the purplish- 
 black discolorations which appear on bodies shortly after death 
 occasion a great deal of talk and exaggeration among the laity, 
 and are often cited as evidence of the malignant or putrefac- 
 tive nature of the death sickness, or as proof of ante-mortem 
 violence — while really due to post-mortem contraction of the 
 walls of the arteries, which squeeze the greater part of their 
 blood into the veins, through whose flaccid coats a portion of 
 its separated coloring matter escapes into the surrounding tis- 
 sues, creating the appearance mentioned. The escaped fluid 
 tends gradually to collect by the law of gravity in the most 
 dependent parts of the body, as the back of the neck, trunk 
 and limbs, thus leaving the higher parts clear and wax-like in 
 appearance. 
 
 You can always distinguish these post-mortem appearances 
 from bruises inflicted during life, by making an incision into 
 them. If post-mortem, you will find the blood stain superficial 
 and not involving the tissues beneath, but the contrary if due to 
 violence during life. In the latter case, moreover, they cannot 
 be removed by pressure or change in the position of the body. 
 
 The popular belief is that if a sudden death begins at the 
 heart there must have been a pre-existing heart disease, and the 
 family physician is often reproached for not having discovered it 
 during the patient's life-time. Explain that the healthiest heart 
 may suddenly become paralyzed or mechanically occluded (em- 
 bolism) and sudden death result. Bear in mind that the ordinary 
 
284 THE PHYSICIAN' HIMSELF: 
 
 termination of organic heart disease is not sudden but very slow- 
 death, preceded by dropsy, inability to lie down, etc. ; in fact, 
 with the exception of cases of aortic stenosis, or regurgitation, 
 or fatty degeneration, there are few if any forms of organic 
 heart disease that cause sudden death. Of course, syncope, 
 from mental emotion or physical exhaustion, if not promptly 
 and p^perly met, may cause sudden death, even when the 
 heart is entirely free from disease. 
 
 A belief that stout, healthy people endure accidents, opera- 
 tions, accouchements, diseases, etc., better than weaker, com- 
 plaining people is another popular error. The truth is the 
 latter are schooled to pain, to disordered functions, lack of exer- 
 cise, etc., and when they have to endure afflictions they are not 
 so far from their usual condition as the former, and have not so 
 much strength to be perverted into morbid action, and are in most 
 cases very much more favorable patients. Plethoric systems 
 bear depletion by blood-letting, purgation, etc., badly, because 
 their circulation is accustomed to a certain degree of tension and 
 fullness, anything short of which causes disturbance of the 
 different functions. The loss of a few ounces of blood will 
 sometimes cause a plethoric man to faint, while a thinner one 
 might have lost that quantity without injury. 
 
 Old persons seldom bear surgical operations well, especially 
 if they have any disease of the urinary apparatus. Make it a 
 rule always to examine the condition of their urine before 
 operating. If any such patients die from shock, narcosis, or 
 hemorrhage, or after your steel-edged interference with their 
 harmless growths or deformities, or with ailments which they 
 have endured for years with only a certain amount of inconve- 
 nience, you will probably be strongly censured and accused of 
 having operated simply for the expected fee, or to show your 
 terrible energy, or your smooth and rapid dexterity in surgery. 
 
 You are not expected to set aside the laws of nature, and 
 will seldom be censured for a fatal issue in the diseases of the 
 aged, and never in those of hard drinkers, or in cases where you 
 
HIS REPUTATION AND SUCCESS. 285 
 
 have given an unfavorable prognosis from the first. On the 
 other hand, if a woman dies in confinement you will be cuss'd 
 and discussed, and if there is any possible chance to blame you 
 it will be done, for the reason that bringing forth children is 
 unlike disease. Child-bearing is designed by nature to increase 
 and not to diminish the number of our race ; therefore death in 
 labor, which is a physiological function, or during the lying-in, 
 which is a physiological state, seems to be against nature and 
 excites the wonder and criticism of everybody. 
 
 Wretched patients who are suffering acutely, perhaps 
 afflicted with painful, incurable diseases, and the miserable, de- 
 spondent melancholiacs who are a hopeless burden to themselves 
 and to others, will occasionally almost ask, 
 
 "Is there no smooth descent, no gentler way — 
 To mingle kindly with our fellow-clay?" 
 
 and entreat you from the depths of earnestness to give them 
 something to cause death and put them out of the (to them) 
 weary, weary, weary world. Likewise, friends of those who are 
 writhing and groaning with sufferings from which recovery is 
 impossible will also sometimes hint at or even openly request 
 that you give the patient a sleeping potion from which he will 
 never awake. 
 
 In many such cases you will agree that were God to release 
 the poor wretch from his miserable sufferings it would be a 
 blessing ; yet Avith this aspect of the case you have nothing to 
 do. In refusing such solicitations, let your argument be that 
 human life is sacred, and that no man has a right to say another's 
 life is useless ; also that since a person has no right to end his 
 own existence, he cannot delegate such a right to another, and, 
 even if he could, you would be the wrong person to ask, since 
 your province, as a physician, in the great drama of life is to 
 prolong life, not to shorten it. 
 
 So sacred is human life that were you to perform craniotomy 
 and the child be still alive when born, or should you deliver a 
 
286 THE PHYSICIAN HIMSELF: 
 
 monster unfit for earth, you have no right to extinguish life in 
 either. 
 
 Many cases admit but gradually of a diagnosis and prog- 
 nosis. In accidents obscure as to nature or degree, and in cases 
 of sudden illness, when you are pressed to say whether you 
 think the case is dangerous, or likely to be of long duration, 
 choose your language deliberately and give only indefinite an- 
 swers, until you see whether any graver affection is hidden 
 behind the present symptoms, whether new symptoms will de- 
 velop, 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 perplexities, surprises, and uncer- 
 tainties, and either force consultations on you or, from lack of 
 confidence, entirely displace you. Therefore, in giving a diag- 
 nosis or prognosis, you should use the plainest (English) lan- 
 guage and as concisely as possible, and, whenever it is necessary 
 to repeat it, adhere as closely as possible to the same phraseology. 
 
 In cases of accident and injury to people found in an in- 
 sensible condition, although you may strongly suspect this to be 
 due to drunkenness, have the presence of mind not to guess, but 
 to give a provisional opinion only, until they return to a sober 
 state. It is better to say, " He is certainly comatose ; whether his 
 insensibility is due to alcohol, or to other causes affecting the 
 brain, it is at this time impossible for any one to say." 
 
 Never pronounce that an injured limb is " only sprained," 
 and order a liniment, with assurances that it will be all right in 
 a few days, until you are positive that it is not fractured or dis- 
 located or the continued pain and swelling may carry him to 
 some more cautious physician, who will discover the truth, to 
 his great honor and your great shame. A great many of your 
 brethren have been caught in this trap. 
 
 Bear in mind that death following an injury does not 
 always mean that it resulted from the injury. 
 
 It is well when called to cases of burns, cuts, lacerations, 
 
HIS REPUTATION AND SUCCESS. 287 
 
 fractures, bites, etc., to mention incidentally the possibility of 
 erysipelas, septicaemia, lock-jaw, etc., and of deformity, or perma- 
 nent impairment, or whatever other unpleasant results may be 
 reasonably feared, that the parties may know that you are awake 
 to all the possibilities and probabilities of the case. Regarding 
 burns, remember that the gravity of a case is due less to its 
 depth than to the number of square inches involved. 
 
 In the course of your professional career you will meet 
 humanity in all its aspects and phases, and your patients will 
 differ greatly in the amount of complaint Avhich they will make 
 in detailing their subjective symptoms to you. Some who are 
 naturally stoical and apathetic will fall into the error of under- 
 stating their true condition, fearing that a fuller statement may 
 alarm their friends, or lead you to think their case serious and 
 prescribe for them much strong medicine, or cause you to pay 
 them many visits. Such patients will sometimes die almost 
 without giving a sign. Others, again, of a hysterical or nervous 
 temperament, fearing that you may not consider them as sick 
 as they really are, will, in detailing their symptoms, magnify 
 every detail and seek in every way to impress you and others with 
 an exaggerated idea of the intensity of their sufferings and the 
 gravity of their condition. One of the many advantages which 
 one's regular medical attendant has over other physicians is his 
 familiarity with these peculiarities of temperament, with the 
 extent of the vocabulary each of his patients employs, and with 
 the amount of precision which each uses in answering questions 
 and in describing his sufferings. A gilt-edged society lady and a 
 hod-carrier, a lawyer, a backwoodsman, a school-miss, a straight- 
 laced old maid, a sailor, and a girlish dude would each use 
 a different kind of language to express the same symptoms. 
 
 In spite of your best endeavors, you will often be criticised 
 or upbraided for your lack. of foresight regarding the recovery or 
 death of patients. The ability to estimate the vital resistance in 
 each case, by the look, visage, voice, attitude, movements, and 
 general appearance of the patient, is necessary to the perfection 
 
288 THE PHYSICIAN HIMSELF: 
 
 of your skill as a physician. It is something apart from your 
 diagnosis (pathological and therapeutical), and few attain it. 
 
 The truth is that life is a different quantity in different 
 people: one man will scratch his finger with a pin and die, an- 
 other will get both legs cut off and live, and you will usually have 
 no other way to judge a patient's prospect of recovery from either 
 of the twenty-four hundred different maladies that afflict man- 
 kind than by the average human standard. You will sometimes 
 have cases which will baffle every method of calculation, and 
 surprise you by their having a great deal less than the average 
 tenacity of life, and others by having a great deal more than the 
 average; and no matter how careful you are, you cannot, with 
 our present knowledge, accurately and unfailingly prognosticate 
 the endurance power of every patient. 
 
 To illustrate what is meant : — 
 
 Health, 0. 
 
 1st. 
 2d. 
 3d. 
 
 Classes, . . ' . . . . { 4th. 
 
 5th. 
 
 6th. 
 
 ,7th. 
 
 Suppose the above seven figures to represent the various 
 degrees of mankind's ability to endure sickness and injury, and 
 that the fourth figure represents the average extent of human 
 endurance power : some patients, then, will actually succumb 
 and die like sheep if the first degree is passed, some if the 
 second is touched, others can endure to the third, and so on, 
 while still others have tenacity of life enough to recover after 
 going as low as the fifth, or even the sixth degree. Now, if you 
 could penetrate each patient's vital recesses and measure with 
 the rule and the compass his assimilation and innervation, 
 absorption and secretion, reproduction and decay, sensation, 
 
HIS REPUTATION AND SUCCESS. 289 
 
 motion, and reflex action, and the total of his endurance power, 
 and could see at what point his possibility of recovery ends 
 and his dissolution begins, you could solve the great problem of 
 life, and make the strength of its web a matter of mathematical 
 certainty; there would then be fewer unanswerable hows and 
 whys, and you would seldom, if ever, be reproached for unpre- 
 dicted terminations. This neither you nor any other mortal at 
 present can do, but you can prepare yourself on all points, and 
 must in every case keep your eyes and ears, mind and heart 
 wide open, and make anatomy and physiology your grammar 
 and dictionary, and the study of pathology your crowning study ; 
 also make live and vigorous use of all the teachings of experience, 
 and avail yourself fully of every therapeutical aid offered to you 
 by medical science. 
 
 Disease and death are parts of the plan of creation. 
 Disease daily afflicts millions of earth's children in every clime, 
 while death (on his pale horse) is busy from pole to pole. Fear 
 of the former and dread of the latter are parts of human nature, 
 and these (fear and dread) cause mankind everywhere to employ 
 physicians : the prince in his palace, the peasant in his cottage, 
 and the beggar in his hovel; the citizen in his mansion, the 
 laborer in his shanty, and the felon in his dungeon ; the million- 
 aire and the penniless ; the prince and the conqueror ; the lord 
 and the serf; the sailor on the pathless ocean and the soldier on 
 the tented field ; the purple of authority, the ermine of rank, 
 and the rags of squalor ; the man of religion, the man of law, 
 and the man of science ; the Christian, the Jew, and the Pagan ; 
 the pale-faced Caucasian, the painted Feejee, and the oily savage 
 on the burning plains of Africa ; the tattooed, naked, fierce, and 
 brutal New Zealander, and the sinewy savage of our own far 
 west ; those in the blood-chilling Arctic regions, and those in the 
 pestilential swamps and jungles of the tropics ; man, man, man! 
 sick and suffering man, everywhere turns to our guild for relief, 
 yea, we stand at the gates of life as humanity enters the world, 
 and at the gates of death as it goes out of it, and the children of 
 
 19 
 
290 THE PHYSICIAN HIMSELF: 
 
 Adam everywhere, at noon and midnight, from helpless infancy 
 to old age, in dread of the sick-bed and the death-bed, the 
 hearse and the grave, turn their eyes and their hearts to the 
 physician whenever sickness seizes or death threatens to hurl 
 the spear that strikes but once. 
 
 Humanity's reliance on you as a physician skilled to heal 
 their wounds and cure their diseases naturally brings you in 
 contact, on one side, with mankind's greatest, most vital interests, 
 and on the other with the great science and glorious art of medi- 
 cine, and makes your power in your sphere almost monarchial. 
 You will wield influence over husbands, wives, children, and 
 servants, and lay down laws to govern each, and be obeyed 
 almost as implicitly as though you were Julius Caesar or the 
 Czar of Russia. 
 
 Bear, therefore, the greatness of your trust, and the respon- 
 sibility and glory of your almost divine mission, ever in your 
 mind. Remember at all times that every phase of your con- 
 duct, every word you utter, every look, every nod of your head, 
 tremble of your tongue, quiver of your lips, wink of your eye, 
 and shrug of your shoulders, will be observed and considered. 
 Therefore, strive to make your manner and your methods as 
 faultless as possible. Also keep your lamps trimmed and your 
 oil ready, and observe punctuality and system in attending all 
 who place themselves under your care, and strive to do the 
 greatest absolute good for each and every one of your patients, 
 that you may merit to be called A Model Physician. 
 
 Thus, my professional brothers, I would attempt to show 
 that the more closely we study the moral and mental peculiari- 
 ties of the various classes who make up the community, the 
 more clearly we will see that the practice of medicine has a 
 peculiar and complex environment, and that We should make 
 skill in preventing, relieving, and curing disease our central 
 thought and our chief reliance, and, as men and brothers, 
 
HIS REPUTATION AND SUCCESS. 291 
 
 SHOULD DISCHARGE EACH AND EVERT DUTY TO OUR GREAT MAS- 
 TER'S entire family with fidelity and honor; and further, that 
 we must also possess professional tact and business sagacity if 
 we would succeed in the profession to the fullest extent that lies 
 in us, and create for ourselves corresponding spheres of useful- 
 ness in the world. 
 
 In conclusion: If this little book causes yon to see the great 
 path of duty more clearly, and to follow it more bravely, more 
 faithfully, and more successfidly, it will accomplish the chief 
 object that prompted me to unite A Book on The Physician 
 Himself. D. W. C. 
 
INDEX. 
 
 Ability, popular tests of professional, 76 
 Abortifacients, prescribing pretended, 68 
 Abortion, solicitations to produce, 67, 68, 
 
 69 
 Accidents, demeanor in attending, 149, 281, 
 
 286 
 Accounts, necessity for keeping, 14, 15 
 Adding suffixes, 78 
 Advice, giving, relating to health, 111, 171, 
 
 172 
 jEsculapius and Hygeia, symbols of, 120 
 Aged, operations on the, 284 
 Ailments not to be ridiculed, 106 
 Allopathy, a misnomer, 205, 206 
 Amenorrhcea in consumptives, 156 
 Analyses, why make your, at home, 176 
 Anaesthetics, in trifling cases, 142 
 
 precautions regarding, 141 
 Are boils healthy ? 162 
 Art of changing medicines, 149, 184 
 Assistant, acting as, 2, 110, 192 
 Assistants, four excellent, 168 
 Attending another's practice, 89 
 
 by the year, 256 
 Autopsies on private cases, 97 
 Avoid, something to, 69 
 
 Babes, hand-fed, 158, 159 
 Bandaging too tightly, 141 
 Baptism, conditional, 116 
 Bargains, Indian, 99 
 Beans, Panama, 170 
 Bills, 14, 245-279 
 
 how to present, 265, 273 
 
 special color for, 278 
 Black lists, 278 
 
 Blame, laws that govern, 170, 171, 284 
 Boasting, 31 
 
 Boils, are they healthy ? 162 
 Book agents, 74 
 Books, family medical guide, 154 
 
 posting one's, 251-254 
 Bores, 146 
 Borrowing, 79 
 Bread pills, 129 
 Business system, 7 
 
 the proper time to talk, 249-251, 261 
 Busy, too, 146, 272 
 
 Calls, hurried, 16, 17 
 
 list of, to prepare, 252 
 Cards, business, 14 
 
 Carriages and horses, 22, 23 
 Case, withdrawing from a, 132 
 Cases, refusal to take, 100, 146 
 
 why never abandon, 120, 136 
 Cash system, the, 247 
 Catholic patients, duty to, 115-118 
 Cautions, 17, 281-287 
 Censure, the laws of, 284 
 Certificates, 23, 64, 107, 236-238 
 
 clergymen's, 237, 238 
 
 legal, 107 
 Changing diagnosis and prognosis, 103 
 
 medicines, art of, 149, 184 
 Chapters, beginning of, 1, 29, 67, 91, 113, 
 
 139, 167, 181, 197, 227, 245, 281 
 Charges, increasing one's, 256 
 Charities, special, 270 
 Charity, the demands of, 49, 271 
 Cheap doctors, 258 
 Cheerfulness in the physician, 42 
 Chicago physieians, offer of the, 208 
 Children, crossness and tears in, 160 
 Children's influence, 85 
 Chloral, 134 
 Chronic discharges, suppressing, 162 
 
 diseases, patients with, 119, 124 
 Clandestine visits, 122 
 Clergymen, 113, 225, 226, 268 
 Coition, why not recommend, 155 
 Cold rooms in sickness, 157 
 Collecting bills, 245-279 
 Collector, 277, 278 
 Commission versus omission, 139 
 Commodes in bedrooms, 161 
 Companions, what kind to select, 7, 8, 10 
 Competition, wars of, 255 
 Concealing presence of disease, 108, 109 
 Conditional baptism, 116 
 Conduct in the sick-room, 45, 46, 47 
 Confidants, 103, 104 
 Confidence, the, of patients, 43 
 Confinement, purgative after, 164 
 Confinements, attending women in, 98 
 Congestion, hypostatic, 97, 283 
 Consult, right of refusal to, 186, 187 
 Consultation fees, 184, 185 
 
 punctuality in attending, 183 
 
 radical changes after, 184 
 • the suspense preceding a, 183 
 
 whom to call into, 183 
 Consultations, management of, 191, 192 
 
 object of, 182, 192 
 
 (293) 
 
294 
 
 INDEX. 
 
 Consulting physician, dispensing with, 186 
 
 Consumption, errors regarding, 156, 157 
 
 Consumptives, why they cease to menstru- 
 ate, 156 
 
 Contagion, fear of, 163, 164 
 
 Contagious disease, cautions regarding at- 
 tendance upon, 108, 109 
 
 Contingent fee, why not work for, 260 
 
 Contracts to do, what a physician, 62, 
 147 
 
 Costly medicines, 240 
 
 Countenance, the physician's, 149, 281, 282, 
 286 
 
 Creed, difference between limiting one's, and 
 limiting one's practice, 215 
 
 Critics and wiseacres, 148 
 
 Cuckoo, the, 26 
 
 Cures, guaranteeing, 106, 261 
 
 Dampness, 164 
 
 Death, appearances after, 283 
 
 causes of sudden, 281-283 
 Debates, how to conduct, 72 
 Decrying medicine, 192-194 
 Degree of certainty in medicine, 192, 193, 
 
 204, 288 
 Dialogues, 96, 232 
 Diet list, 174 
 
 Discharges, suppressing chronic, 162 
 Discoveries, attitude of physicians toward, 
 
 204, 205 
 Diseases, chronic, 119, 124 
 
 driving in, 161, 162 
 
 fees in advance for attending secret, 101, 
 261-263 
 
 number of mankind's, 210 
 
 the increased tolerance of, 195, 196 
 
 urinary, 153, 284 
 
 venereal, 101, 262, 263 
 Dishonesty, where found, 271-273 
 Dismissal of medical attendants, 58, 59, 131, 
 
 132 
 Dispensary and hospital patients compared 
 
 with private, 51 
 Dispensaries, free, 269, 270 
 Doctor, bestowing the title of, 233 
 
 or physician, 238 
 Doctoring the womb, 151 
 Dog-bites, 163 
 Donations, making, 86 
 Dosage, rules for, 128 
 Doses, heroic, 122, 128, 133 
 Double callings, 19, 20 
 Dress and manners, influence of, 18, 19 
 Dressing too warmly, 157, 158, 159 
 Drinking, 8, 80, 81 
 Druggists, 227-244 
 Drugs, etc., got gratis, 229 
 
 necessity for pure, 242 
 
 that enslave, 179 
 Duties, five cardinal, 134 
 Duty to the dying, 113, 114, 118, 119 
 
 Eat anything, may he ? 173 
 
 Eating with patients, 83 
 
 Education, its importance to the physician, 
 
 32-34 
 Emergency cases, 16, 17, 57 
 Endorsing domestic remedies, 145, 146 
 Entanglements, to avoid, 143 
 Epidemics, 109, 164 
 
 Error, precautions to take against commit- 
 ting, 68, 134 
 Eruption, driving in, 161, 162 
 Eruptions, bringing out, 161 
 Estate of deceased physician, 275, 276 
 Estates, charges against, 268 
 Ethics, medical, 52-60 
 Eucharist, the Holy, 116 
 Examinations, careless, 134 
 
 gentleness in making, 47 
 Expedients, doubtful, 57 
 Experiments tried on patients, 135 
 Experts, pseudo-medical 63, 64 
 Extreme Unction, 115 
 Extremists, 222 
 
 Fainting, 163 
 
 Familiarity, undue, 7, 83, 121, 124 
 
 Family, a physician attending his own, 264 
 
 Fashionable frauds, 271, 272 
 
 Fashion and wealth, influence of, 221 
 
 Fashions, conforming to the, 18 
 
 Fear of contagion, 163, 164 
 
 Fee in advance for secret diseases, 261, 262 
 
 or no fee, 260 
 
 table, 15, 255, 269 
 Fees, 245-279 
 
 doubtful, rule regarding, 248 
 
 fixing the responsibility for, 249 
 
 for important cases, 258, 259 
 
 how to collect, 263-265, 273 
 
 joint, 268 
 
 lawsuits to recover, 266 
 
 why not work for contingent, 260 
 Female, examining a, against her will, 142 
 Females, influence of, 10 
 Fever, water and ice in, 173 
 Fickleness, human, 111, 131, 133 
 Finances, the physician's, 275-278 
 Fingers, the tips of a physician's, 80 
 Foreign bodies, swallowing, 162 
 Forgot you, I, 100 
 Formulae, private, use of, 229 
 
 stereotyped, 38 
 Fractures, popular error regarding, 142 
 Frauds, fashionable, 271, 272 
 Free Dispensaries, 269, 270 
 
 German language, usefulness of the, 35 
 
 Golden rule, the, 31 
 
 Gratifying whims, 144 
 
 Greek language, the usefulness of, 35 
 
 Guaranteeing cures, 106, 261 
 
 Guard yourself, 130 
 
INDEX. 
 
 295 
 
 Guide in judging whether an apothecary- 
 store is properly conducted, 235, 241 
 Gums, object of lancing children's, 159 
 
 Habits, disgusting, 8, 80 
 
 Hahnemann compared with Copernicus, 
 
 Newton, and Jenner, 202, 213 
 Hand-fed babes, 159 
 Health, trips for, 172 
 Heart disease, death from, 283 
 Hectic confounded with malarial fever, 156 
 HelL on earth, 150 
 Heroic doses,' 128, 133 
 Holy Eucharist, the, 116 
 Home, not at, 146 
 Homoeopathic creed, the, 199, 200 
 Homoaopaths, bogus, 212-214 
 
 test showing which are real, 214 
 Homoeopathy, 197-215 
 
 is it founded on a natural law ? 202 
 
 one of the evils of, 207 
 Homce versus home, 209 
 Hope, taking away, 43, 119 
 Horrifying remedies, 169 
 Horses and carriages, 22, 23 
 Hospital and dispensary patients compared 
 
 with private, 51, 52 
 Hospitals,' sending patients to, 172 
 Hours, designating the, on bottles, 179 
 How to conduct debates, 72 
 Human fickleness, 111, 131, 133 
 
 gullibility, 209 
 
 nature the same everywhere, 289 
 Humanity, its demands, 187, 188, 209, 271 
 Humoring the sick, 44, 144 
 Hurried calls, 16, 17 
 Hydrophobia, 163 
 Hypodermic medication, 179, 180 
 Hypostatic congestion, 97, 283 
 
 Idiosyncrasy, 45, 224 
 
 Important cases, fees for attending, 251, 257, 
 
 258 
 Incompatibles, 36 
 
 Infants, having physicians for, sick, 154 
 Influence of dress and manners, 18, 19 
 
 of females, 10 
 Ink, best color to use, 253 
 Inquiries, making, in presence of strangers, 
 
 102 
 Instruments of precision, 17, 153 
 Insults, 104 
 
 Iron injuring the teeth, 170 
 Irregular physicians, contact with, 8, 187, 211 
 
 what constitutes an, 187, 189, 210 
 Irregulars, joint discussions with, 217 
 
 popular favor toward, 220-224 
 
 proper course toward, 8, 211 
 
 why patronized, 203, 220-224 
 
 Jealousy, 25, 26, 30, 103, 142, 143 
 Joint fees, 268 
 
 Joint practice of medicine and pharmacy, 
 216, 217, 270 
 
 Kindness, influence of, 42, 48 
 
 Labeling, mistakes in, 243 
 
 prescriptions, 178, 243 
 Labels, advantage of putting the date on, 243 
 
 putting the hours on, 179 
 Languages, learning foreign, 35, 36 
 Latin, use of, 32, 34, 35 
 Laws, duty to, 127 
 
 favor shown to physicians by the, 107 
 
 medical, 218, 219 
 
 their exceptional kindness to physicians, 
 
 Lawsuits, 63, 266 
 
 Lazar-house, homoeopathy in Milton's, 210 
 
 Legal duty to patients, 62, 147 
 
 Liberal profession, why medicine is a, 190 
 
 Library, contents of one's, 7'4, 75 
 
 creating a, 74 
 Life insurance for self, 277 
 
 power, vital, scale of, 288 
 
 should a physician ever shorten ? 285 
 Limiting one's practice, 98, 210 
 List of visits, how to prepare a, 252 
 Local option, ordering liquor under, 82 
 Locate, where to, 2-5 
 Longevity of physicians, 277 
 
 Malarial affections, recurrence of, 171 
 Malpractice cases, 62, 63, 139 
 
 suits, why there are more surgical than 
 medical, 140 
 Mankind, study of, 38, 167, 168, 287 
 Mankind's dependence on physicians, 289 
 Manners, influence of, 41-46 
 Marriage of physicians, 84 
 
 of syphilitics, 155 
 Maxim, 271 
 Medical profession, greatness of the, 2S9, 290 
 
 art, imperfection of, 192, 193, 205 
 
 ethics, 52-60 
 
 societies, 71-73 
 Medicine, decrying, 192-194 
 
 degree of certainty in, 193, 194, 204 
 
 fashion in, 130, 197, 198 224 
 
 fear of, 169 
 
 haters, 167 
 Medicines, art of changing, 149 
 
 at ofHce, 16 
 
 bad effects of, 169 
 
 charges for, 230, 231, 240 
 
 costly, suggestions regarding, 240 
 
 palatability of, 167-169 
 
 the dynamization of, 203 
 
 unused, 149 
 Memory of cases, 74, 125 
 Menial labors, 105 
 Mental therapeutics, 168 
 Metric system, 77 
 
296 
 
 INDEX. 
 
 Microscope, working with the, 98 
 Midwives, assisting, 99 
 Mineral versus vegetable medicines, 170 
 Mistakes of pharmacists, 243 
 
 in compounding, cases of, 233 
 Moralizing, 111 
 Morphia granules, 225 
 Motto on bills, 271 
 
 Name, what is in a? 205, 208 
 
 Neglectful and perverse patients, 144 
 
 Neighborly visits, 25 
 
 New remedies, how aided, 168 
 
 Newspaper squibs, 24, 88 
 
 Night emissions, 155 
 
 visits, 122 
 No cure, no pay, 261 
 Nostrums, why condemn, 239 
 Novelty, influence of, in medicine, 168 
 Nurses, conduct toward, 143 
 
 Objects of consultations, 182, 192 
 
 Obstetrical cases, 98, 99, 100 
 
 Office, charges for advice at, 16, 154, 259 
 
 hours, 12, 13 
 
 location and arrangement of, 3-5 
 
 outfit, 5, 6, 16 
 
 practice, 13, 16, 60 
 
 signs, 16 
 
 students, 8, 9 
 Offices, branch, 4 
 Old lady with salve, 145 
 
 persons, operations upon, 284 
 Omen, a bad, 112, 113 
 Omission versus commission, 139 
 Only sprained, 286 
 
 Opiates, their place and power, 133, 134 
 Opinions, necessity for caution in giving, 46, 
 114, 281, 282 
 
 of patients and their attendants to be 
 considered, 160 
 
 that terrify, 150-154 
 Other physicians, attending after, 55, 89, 268 
 Overpraise from patients, 102 
 
 from relatives, 102 
 Overvisiting, 104, 105, 123, 124 
 
 Panama Beans, 170 
 Partisan questions, 81, 237 
 Partnership, 2 
 Passions, influence of, 127 
 Patients, dining with, 83 
 
 distant, 100 
 
 foreigners as, 36 
 
 hospital and dispensary, compared with 
 private, 51 
 
 how to transfer, 182 
 
 physician's legal duty to, 62, 147 
 
 neglectful and perverse, 144 
 
 purse-proud, 132 
 
 quoting authorities to, 95, 96 
 
 refusal" to take, 147, 272, 273 
 
 Patients, rights of, to additional advico, 186 
 varieties of, 167, 287-290 
 whims gratified, 44, 144, 160, 223 
 worthless, 146, 272, 273 
 Pay you, when shall I ? 251 
 Paying one's debts, 79 
 Pencil sketches, 136 
 Pension claimants, certificates to, 64 
 Percentage from apothecaries, 228 
 Personal affairs, privacy regarding your own, 
 278 
 
 appearance, 18, 19 
 Pharmaceutical catch-pennies, 177 
 Pharmacists, 227-244 
 
 indiscreet, 234 
 
 prescribing, 233 
 Pharmacopoeia, breadth of the U. S., 239 
 Phlegm, swallowing, 159 
 Photograph giving, 111 
 Physician, a sickly, 40 
 ' estate of deceased, 275, 276 
 
 how an irregular, may become a regu- 
 lar, 191 
 
 mission of the 120, 187, 289, 290 
 
 or doctor, as a title, 238 
 
 the new, 25, 26 
 
 versus doctor as a title, 238 
 
 what constitutes a regular, 189-191 
 Physician's countenance, the, 149, 281, 286 
 Physicians, assaults upon, 141 
 
 drunken, 8, 80, 81 
 
 increase of number of, 29 
 
 sickly, 39 
 
 taking office, 20 
 
 the marriage of, 84 
 
 why the older excel the younger, 91-94 
 
 why they do not get rich, 274-277 
 
 young, 3 
 Placeboes, 128, 129 
 Policy versus Principle, 144, 198, 203 
 Politeness, value of, 86 
 Politics, 6, 21 
 Pollution, self, 155 
 Polypharmacy, 175 
 Poor, attending the, 49, 271 
 Popular test of skill, 76 
 Posting one's books, 251-254 
 Post-mortem discolorations, popular error 
 
 regarding, 283 , 
 
 Post-mortems and analyses, 97, 98, 283 
 Practice, difference between limiting one's, 
 and limiting one's creed, 215, 216 
 
 limiting amount of, 98 
 
 soliciting, 131 
 Precautions, 134, 135 
 Pregnancy suspected, 68 
 Prescribing, extravagance in, 149, 150 
 
 suggestions on the subject of, 127, 128 
 
 without an interview, 192 
 Prescription, object of a, 230 
 
 papers, 228 
 
 the, to whom does it belong ? 230 
 
INDEX. 
 
 297 
 
 Prescriptions, about labeling, 178, 243 
 
 expertness in writing, 36, 37, 165, 166, 
 178, 179 
 
 joint, 179 
 
 ready written, 95 
 
 unauthorized renewal of, 230 
 Presents from patients, 82 
 Press, writing for the medical, 76-79 
 Principle versus Policy, 198, 203 
 Private formulae, use of, 229 
 Production of abortion, 67, 68, 69 
 Profession, identifying self with the, 70-73 
 Professorship, choice of a, 21 
 Prognosis, cautions concerning, 94, 118-120, 
 
 136, 286, 288 
 Provings, homoeopathic, 207 
 Purgative after confinement, 164 
 Purity of mind, 40 
 
 Quack bitters, 111 
 
 medicines, their proper position in 
 apothecary store, 241 
 relation of pharmacists to, 232, 241 
 Quackery, ours the age of, 218 
 Quacks and imposters, depredations by, 154, 
 
 218 
 Quantities to prescribe, 149 
 Questions, rule for repeating, 165 
 rule regarding, 135 
 unwelcome, how to avoid, 120 
 Quinine, popular prejudice against, 170 
 Quoting what the books say, 95, 96 
 Quotations at beginning of chapters, 1, 29, 
 67, 91, 113, 139, 167, 181, 197, 227, 
 245, 281 
 
 R as a sign or symbol, 37 
 
 Receipts, compel people to take, 266 
 
 Reclaiming those who have strayed, 217 
 
 Recommending other physicians, 147 
 
 Eecord-book, 135 
 
 Recreation, necessity of, 87-89 
 
 Reference-book, 135 
 
 Register heat, 158 
 
 Religion, 113-120 
 
 Relinquishing attendance, 122, 175, 184, 186 
 
 Remedies, domestic, endorsing, 145 
 
 examined at every visit, 175 
 
 horrifying, 169 
 Removals, frequent, 4 
 Renewal of prescriptions, to prevent, 178 
 Reporting cases, 76-79 
 Reputation, value of, 39, 41 
 
 varieties of, 24, 39 
 Responsibility, dividing the, 139, 140 
 Rich not to pay for poor, 257 
 
 the poor who get, 132 
 Riding versus walking, 22 
 Rivalry, professional, 25, 26, 30 
 Rule for repeating questions, 165 
 
 the golden, 53 
 Ruling spirits in family, the, 103 
 
 Sauvage's estimate of number of mankind's 
 
 diseases, 210 
 Scandal, 31, 40, 41, 134 
 Scarlet rash, 161 
 
 Scold, how to, without offending, 84 
 Secrets, 102, 125, 126, 127 
 Selection of a location, 2-5 
 Self-medication, 176 
 Self-pollution, 155 
 Self-preservation, 26, 258 
 Self-reliance, its value, 181 
 Seniors, respect due our, 91 
 Sequelse, foreseeing, 287 
 Servants, attending, 50 
 Services for employers, 249, 250 
 
 to clergymen, 238, 268 
 
 to physicians, 267 
 
 to the poor, 49, 272 
 
 when not to charge for, 266-268 
 Sexual intercourse, why never recommend, 
 
 155 
 Shame, a matter of, 142 
 Short visits, how to make, 105, 174 
 Shut your eyes, to these, 161 
 Sick, humoring the, 44 
 Sickly physicians, 39 
 Signatures, regarding, 238 
 Signs, office, 11-13 
 
 Skill, what is medical, 38, 193, 194, 289 
 Slavery of a physician's life, 86, 87, 273-276 
 Small-pox, popular error regarding the, 61 
 Social influence, 85 
 Society, duty to, 127 
 Soliciting practice, 131 
 Something to avoid, 69 
 Speaking-tube, 14 
 
 Specialties, when to patronize, 181, 182 
 Specialty, adoption of a, 51 
 Specifying the particular make, 240 
 Speculum, abuse of the vaginal, 151, 153 
 Spoons, variations in size of, 179 
 Sprain, fracture or dislocation, 286 
 Spring-time, taking medicine in the, 130 
 Streets, barricading or roping the, 165 
 Students, increase of, 29 
 Suffixes, adding to one's name, 78 
 Sunday as a day of rest, 87, 244, 251 
 
 prescribing liquor on, 82 
 
 practicing on, 87 
 Superseding other physicians, 55, 88, 89, 
 
 268 
 Suppressing chronic discharges, 162 
 Surprise, showing, 281, 282 
 Syphilitic cases, 150, 262, 263 
 Syphilitics, the marriage of, 155 
 System in business, 7 
 Swallowing foreign bodies, 162 
 
 phlegm, 159 
 Swearing off from drink, 111 
 Sweating during sleep, 173 
 
 the baby, 159 
 Synonyms, use of, 177, 242 
 
298 
 
 INDEX. 
 
 Telephone, the, 14 
 Temper, control of, 45 
 Terms, transposing, 242 
 Terrifying opinions, 150-154 
 Therapeutics, crude, 175 
 
 mental, 168 
 Time lost in waiting, 174 
 Toleration of difference of opinion, 73 
 Trade-mark articles, 177, 238-240 
 Transposing terms, 242 
 Tricks, 23, 31, 121 
 Trips for health, 172, 173 
 Triumphs, 56 
 Truth, its value, 119 
 
 Unction, Extreme, 115 
 
 Urinary diseases, 153, 284 
 
 Urine, scanty and high colored, 162 
 
 Vacation, the physician's, 87, 89 
 Vaccination, 60, 61, 108, 213 
 Value of politeness, 86 
 
 of reputation, 39 
 Variability of human endurance, 287-289 
 Variation in the size of spoons, 179 
 Varieties of patients, 167, 271, 289 
 Vegetable versus mineral medicines, 170 
 Veins on back of hands, 164 
 Venereal cases, 100, 101, 262, 263 
 Verse, 2, 18, 41, 48, 57, 68, 78, 154, 190, 201 
 
 204, 218, 285 
 Visit, conduct at, 41-48 
 
 extra charge for the first, 257 
 
 Visiting-list, best way to carry one's, 252 
 how to improve a, 252 
 
 the patient of another physician, 55, 
 57, 58, 59 
 Visitors to the sick, 165 
 Visits, how to make short, 105, 174 
 
 neighborly, 25 
 
 to the sick, 46, 100, 122-124, 175 
 Vivisection, 98 
 
 Vocabulary of different classes, 287 
 Volunteer services, 61 
 
 Waiting, time lost in, 174 
 Walking versus riding, 22 
 Warming the newborn, 158, 159 
 Wars of competition, 255 
 What is in a name ? 205, 208 
 Whims, gratifying the, of patients, 44, 144 
 Why charge for every visit, 257 
 Wife, the meddling, 125, 126 
 Wills, 108, 118 
 Wiseacres and critics, 148 
 Withdrawal from a case, 132 
 Witness, duty to self when a, 63 
 Woman, devotion of, to the sick, 48 
 Womb doctoring, 151 
 
 Work, amount of, done by every busy phy- 
 sician, 273-276 
 Worms, has he ? 160 
 Worthless patients, 146 
 
 systems of practice, how to expose, 218 
 Writing for the medical press, 76-79 
 
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 BACTERIOLOGICAL DIAGNOSIS— TABULAR AIDS FOR USE II 
 PRACTICAL WORK. By James Eisenberg, Ph.D., M.D., Vienna. Trans 
 lated and augmented, with the permission of the author, from the Second Genua 
 Edition, by Nobval H. Pieeoe, M.D., Surgeon to the Out-Door Department c 
 Michael Reese Hospital ; Assistant to Surgical Clinic College of Physician* and Sui 
 geons, Chicago, 111. In one Octavo volume. In Peess. 
 
 LECTURES ON ARTISTIC ANATOMY AND THE SCIENCES USE 
 FUL TO THE ARTIST. A series delivered at the Art Institute, Chicago, b; 
 S. V. Olevengeb, M.D., Consulting Physician Reese and Alexian Hospitals ; Membe 
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 TWELVE LECTURES ON THE STRUCTURE OF THE CENTRAI 
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 DISEASES OF THE HEART, LUNGS, AND KIDNEYS. By N. S 
 Davis, Je., A.M., M.D., Professor of Principles and Practice of Medicine in tlie 
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 CHILDBED: ITS MANAGEMENT: DISEASES AND THEIR TREAT- 
 MENT. By Waltee P. Manton, M.D., Visiting Physician to the ■ Detroit 
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 See Pages 3, 20, 21, and 27 for those now published, and the 
 upper part of this page for those in preparation. 
 
 2 (F. A. DAVIS, Medical Publisher, Philadelphia, Pa., U.S.A.) 
 
\ JUST PUBLISHED— A NEW AND VALUABLE WORK ON 
 
 Practical Electricity 
 
 —IN— 
 
 MEDICINE AND SURGERY. 
 
 -BY- 
 
 G. A. LIEBIG, Jr., Ph.D., 
 
 .Assistant in Electricity, Johns Hopkins University; Lecturer on Medical Electricity, College of Phy- 
 sicians and Surgeons, Baltimore; Member of the American Institute 
 of Electrical Engineers, etc., 
 
 —AND- 
 
 GEORGE H. ROHE, M.D., 
 
 Professor of Obstetrics and Hygiene, College of Physicians and Surgeons, Baltimore ; Visiting Physician 
 
 to Bay View and City Hospitals; Director of the Maryland Maternite; Associate 
 
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 PROFUSELY ILLUSTRATED BY WOOD-ENGRAVINGS AND ORIGINAL DIAGRAMS, AND PUBLISHED IN ONE 
 
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 The part on Physical Electricity, written/' by Dr. Liebig, one of the recognized 
 authorities on the science in the United States, treats fully such topics of interest as 
 Storage Batteries, Dynamos, the Electric Light, and the Principles and Practice of. 
 Electrical Measurement in their relations to Medical Practice. 
 
 Professor Rohe, who writes on Electro-Therapeutics, discusses at length the recent 
 developments of Electricity in the treatment of stricture, enlarged prostate, uterine 
 fibroids, pelvic cellulitis, and other diseases of the male and female genito-urinary organs. 
 
 The-applications of Electricity in dermatology, as well, as in the diseases of the 
 nervous system, are also fully considered. 
 
 THE SECOND VOLUME IN THE PHYSICIANS" AND STUDENTS' 
 READY REFERENCE SERIES. 
 
 HAND-BOOK 
 
 OF 
 
 Materia Medica, Pharmacy, and Tbepapeotics 
 
 By CUTHBERT BOWEN, M.D., B.A., 
 
 Editor of "Notes on Practice." 
 
 EXTRACT FROM THE PREFACE.— "While this is essentially a Student's Manual, a large 
 amount of matter has been incorporated which, it is hoped, will render it a useful reference-book to the yo^ng 
 graduate who is just entering on his professional career, and more particularly the individual whose sphere 
 of work demands a more practical acquaintance with pharmaceutical processes than is required of the ordi- 
 naryxity practitioner. Great care has been taken throughout, the book to familiarize the student with (the 
 best methods of administering the various drugs he will be called upon to use, and with this object a laijge 
 number of standard prescriptions haye been selected from, the works of the most eminent authorities, which 
 he can either adopt, with modificatitms to suit particular cases, or use as models on which to construct his own 
 formula?." 
 
 This excellent manual comprises in its 366 small 
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 formation on the subjects indicated in its title as 
 could well be crowded into the compass. The book 
 is exhaustively and correctly indexed, and of a con- 
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 brevier) is highly to be commended,' as opposed to 
 the nonpareil and agate usually used incompendsof ^ 
 this sort, and which are destructive to vision and 
 temper alike. — St. Louis Med. and Surg. Jour. 
 
 In going through it, we have been favorably im- 
 pressed by the plain and practical suggestions in 
 regard to prescription writing, and the metric sys- 
 tem, and the other things which must be known in 
 order to write good and accurate prescriptions. — 
 Medical and Surgical Reporter. 
 
 Many works claim more in their title-pages than 
 can be verified further on, but the only adverse 
 
 criticism we can make on this volume is that it does 
 not claim enough. — Southern California Prac- 
 titioner. 
 
 The book is one of the very best of its class.— 
 Columbus Medical Journal. 
 
 This is a very condensed and valuable resume 
 of the drugs recognized by the United States Phar- 
 macopoeia, and all the officinal and important 
 preparations. — Southern Medical Record. 
 
 Dr. Bowen's work is a very valuable one indeed, 
 and will be found "to fill a want" beyond a doubt. 
 — Cincinnati Medical News. 
 
 It is short and concise in its treatment of the 
 subjects, yet it gives sufficient to gain a very correct 
 knowledge of everything that comes under this head-, 
 ing. This is .a ready work for the country physician, 
 who must of necessity have a more practical acquain- 
 tance- with pharmaceutical processes. — Medical 
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 One 12mo volume of 370 pages. Handsomely Bound in Dark-Blue Cloth. 
 
 Price, post-paid, in the United States and Canada, $1.40, net; 
 
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 (F. A. DAVIS, Medical Publisher, Philadelphia, Pa., U.S.A.) 3 
 
Bashore's Improved Clinical Chart. 
 
 For the SEPARATE PLOTTING- of TEMPERATURE, PULSE, and RESPIRATION. 
 
 Designed for, the Convenient, Accurate, and Permanent Daily Recording of Cases in 
 Hospital and Private Practice. 
 
 By HARVEY B. BASHORE, M.O. 
 
 Vase Ac... 
 Ifatne 
 
 Initial Date . 
 
 Diagnosis 
 
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 HistorVtd'lympfo^" $T-rto££& "** *"* """""fr «™ ^ *» ~« *-* "Clinical 
 
 ,h,JV tS JrJ hC P i!|, yS . i< fc an "j u . s « ure a>c« » complete record of his cases as will enable him to review 
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 the practice of his profession, the value of which can hardly be overestimated. 
 
 I 
 
 4 (F. A. DAVIS, Medical Publisher, Philadelphia, Pa., U.S.A.) 
 
^BOOK#- 
 
 ON 
 
 The Physician Himself 
 
 AND THINGS THAT CONCERN 
 
 HIS REPUTATION AND SUCCESS. 
 
 D. W. CATHELL, M.D., 
 
 BALTIMORE, MD. 
 
 the NINTH EDITION (Enlarged and Thoroughly Revised) of the "PHYSICIAN 
 HIMSELF, AND WHAT HE SHOULD ADD TO HIS SCIENTIFIC ACQUIREMENTS 
 IN ORDER TO SECURE SUCCESS.'' 
 
 In One Handsome Octavo Volume of 298 Pages, Bound in Extra Cloth, 
 
 Price, Poet-paid, in United States and Canada, $2.00, Net; Great 
 
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 This remarkable book has passed through eight (8) editions in less 
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 Profession, and is practically indispensable to every' young graduate 
 who aims at success in his chosen profession. It has just undergone a 
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 ing many points and elucidating many excellent ideas not included in 
 former editions. This unique book, the only complete one of the kind 
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 tioner of many years' standing, as well as to the young physician who 
 needs just suclra work to point the wajl to success. 
 
 We give below a few of the many unsolicited letters received by 
 the author, and extracts from reviews in the Medical Journals of the 
 former editions : 
 
 " 'The Physician Himself is an opportune and 
 most useful book, which cannot fail to exert a good 
 influence on the morale and. the business success of 
 the Medical profession." — From Prof. Roberts 
 Bartholoiv, Philadelphia, Pa. 
 
 " I have read 'The Physician Himself with 
 pleasure — delight. It is> brimful of medical and 
 social philosophy; every doctor in the land can 
 study it with pleasure and profit. I wish 1 could 
 • have read such a work thirty years ago." — From 
 Prof. John S. Lynch, Baltimore, Md. 
 
 "*The Physician Himself interested me so 
 
 much that I actually read it through at one sitting. 
 
 It is brimful of the very best advice possible for 
 
 ' medical men. I, for one, shall try to profit by it." — 
 
 Fran Prof. William Goodell, Philadelphia. 
 
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 profession m < Old England/ some able practitioner 
 here would prepare a work for us on the same line as 
 'The Physician Himself/" — From Dr. Jukes de 
 Styrap, Shrewsbury, England. 
 
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 wisdom and force of the points made in ( The Phy- 
 sician Himself/ and believe the work in the hands 
 of a young graduate will greatly enhance his chances 
 for professional success." — From- Prof . D. Hayes 
 Agnew, Philadelphia, Pa 
 
 "This book is evidently the production of an 
 unspoiled mind and the fruit of a ripe career. 1 
 admire its pure tone and feel the value of its practi- 
 cal points. How I wish I could have read such a 
 guide at the outset of my career!" — From Prof. 
 James Nevins Hyde, Chicago, Hi. 
 
 " It contains a great deal of good sense, well 
 expressed." — Front Prof . Oliver Wendell Holmes, 
 Harvard University. 
 
 " 'The Physician Himself' is useful alike to the , 
 tyro and the sage — the neophyte and the veteran. It 
 is a headlight in the splendor of whose beams a 
 .multitude of our profession shall find their way to 
 success." — From Prof J. M. Bodine, Dean Uni- 
 versity of Louisville. 
 
 " It is replete with good sense and sound phi- 
 losophy. No man can read it without realizing that 
 its author is a Christian, a gentleman, and a shrewd 
 observer." — From Prof . Edward Warren*(Bey), 
 Chevalier of the Legion of Honor, etc., Paris, 
 France. 
 
 "I have read 'The Physician Himself,' care- 
 fully. I find it an admirable work, and shall advise 
 our Janitor to keep a stock on hand in the book de- 
 partment of Bellevue." — From Prof. William T. 
 Lusk, New York. 
 
 " It must impress all its readers with the belief ' 
 that it was written by an able and honest member of 
 the profession and forjhe goodof the profession." — 
 \ From Prof. W. H. Byford, Chicago, III. 
 
 "It is marked with good common sense, and . 
 replete with excellent maxims and suggestions for 
 the guidanceof medical men. "—From The British 
 Medical Journal, London. 
 
 " We strongly advise every actual and intend- 
 ing practitioner of medicine or surgery to have 
 * The Physician Himself,' and the more it influences 
 his future conduct the better he will be."— From 
 The Canada Medical and Surgical Journal, 
 Montreal. 
 
 "We would advise every doctor to well wp*gh 
 the advise given in this book, and govern his con- 
 duct accordingly. " — From The Virginia Medical 
 Monthly. ■ 
 
 (F. A. DAVIS, Medical Publisher, Philadelphia, Pa., U.S.A.} 
 
AN IMPORTANT PUBLICATIONOF GREAT VALUE TO THE MEDICAL 
 AND LEGAL PROFESSIONS. 
 
 Spinal Concussion: 
 
 Surgically Considered as a Cause of Spinal Injury, and Neurologi- 
 
 eally Restricted to a Certain Symptom Group, for 
 
 which is Suggested the Designation 
 
 ERICHSEN'S DISEASE, AS ONE FORM OF THE TRAUMATIC NEUROSES. 
 
 S. V. CLEYENGER, M.D., 
 
 CONSULTING PHYSICIAN REESE AND ALEXIAN HOSPITALS; LATE PATHOLOGIST COUNTY INSANE ASYLUM, 
 CHICAGO; MEMBER'OF NUMEROUS AMERICAN SCIENTIFIC AND MEDICAL SOCIETIES; COLLABORATOR , 
 
 AMERICAN NATURALIST, ALIENIST AND NEUROLOGIST, JOURNAL OF NEUROLOGY AND 
 PSYCHIATRY, JOURNAL OF NERVOUS AND MENTAL DISEASES; AUTHOR OF "COM- 
 PARATIVE PHYSIOLOGY AND PSYCHOLOGY," "ARTISTIC ANATOMY," ETC. 
 
 For more than twenty years this subject has occasioned bitter con- 
 tention in law courts, between physicians as well as attorneys, and in 
 that time no work has appeared that reviewed the entire field judicially, 
 until Dr. Clevenger's book was written. It is the outcome of five years' 
 special study and experience in legal circles, clinics, hospital and private 
 practice, in addition to twenty years' labor as a scientific student, writer, 
 and teacher. 
 
 The literature of Spinal Concussion has been increasing of late years 
 to an unwieldy shape for the general student, and Dr. Clevenger lias in this 
 work arranged and reviewed all that has been done by observers since 
 the days of Erichsen and those who preceded him. The different arid 
 sometimes antagonistic views of many authors are fully given from the 
 writings of Erichsen, Page, Oppenheim, Erb, Westphal, Abercrombie, 
 Sir Astley Cooper, Boyer, Charcot, Leyden, Rigler, Spitzkn, Putnam, 
 Knapp, Dana, and manj^ other European and American students of the 
 subject. The small,, but important, work of Oppenheim, of the Berlin 
 University, is fully translated, and constitutes a chapter of Dr. Cleven- 
 ger's book, and reference is made wherever discussions occurred in 
 American medico-legal societies. 
 
 There are abundant illustrations, particularly for Electro-diagnosis, 
 and, to enable a clear comprehension of the anatomical and pathological 
 relations. 
 
 The Chap'ters are : I. Historical Introduction ; II. Erichsen on 
 Spinal Concussion ; III. Page on Injuries of the Spine and Spinal Cord: 
 IV. Recent Discussions of Spinal Concussion ; V. Oppenheim on Trau- 
 matic Neuroses; VI. Illustrative Cases from Original and all other 
 Sources; VII. Traumatic Insanity; VIII. The Spinal Column; IX, 
 Symptoms ; X. Diagnosis ; XI. Pathology ; XII. Treatment ; XIII. 
 Medico-legal Considerations. 
 
 Other special features consist in a description of modern methods 
 of diagnosis by Electricity, a discussion of the controversy concerning 
 hysteria, and the author's original pathological view that the lesion is 
 one involving the spinal sympathetic nervous system. In this latter 
 respect entirely new ground is taken, and the diversity of opinion con- 
 cerning the functional and organic nature of the disease is afforded a 
 basis for reconciliation. 
 
 Ever// Physician and Lawyer should own this work. 
 
 In one handsome Royal Octavo Volume of nearly 400 pages, with 
 Thirty Wood-Engravings. Net price, in United States and Canada, 
 $2.50, post-paid ; in Great Britain, lis. 3d. ; in France, 15 fr. 
 
 « ( F - A DAVIS, Medical Publisher, Philadelphia, Pa.. U.S.A.) 
 
JUST READY A NEW AND IMPORTANT WORK. 
 
 - =*= ESS AY = - 
 
 — un— . 
 
 MEDICAL PNEUMATOLOGY I AEROTHERAPY: 
 
 A 'PRACTICAL INVESTIGATION OF THE CLINICAL AND THERAPEUTIC VALUE 
 
 OF-THE GASES IN MEDICAL AND SURGICAL PRACTICE, WITH ESPECIAL 
 
 REFERENCE TO THE VALUE AND AVAILABILITY OF 
 
 OXYGEN, NITROGEN, HYDROGEN, AND NITROGEN MONOXIDE. 
 
 By d. N. DEMARQUAY, 
 
 Surgeon to the Municipal Hospital, Paris, and of the Council of State ; Member of the Imperial Society 
 
 of Surgery ; Correspondent of the Academies of Belgium/Turin, Munich, etc. ; Officer 
 
 of the Legion of Honor ; Chevalier of the Orders of Isabella-the- 
 
 Catholic and of the Conception, of Portugal, etc. 
 
 TRANSLATED, WITH NOTES, ADDITIONS, AND OMISSIONS, 
 
 By SAMUEL S. WALLIAN, A.M., M.D., 
 
 Member of the American Medical Association ; Ex-President of the Medical Association of Northern New 
 York ; Member of the New York County Medical Society, etc'. 
 
 In one Handsome Octavo Volume of 316 Pages, Printed on Fine Paper, in the Best 
 Style of the Printer's Art, and Illustrated with 81 Wood-Cuts. 
 
 United States. Canada (duty paid). Great Britain. France. 
 
 NET PRICE, CLOTH, Post-paid, S3. 00 S3.20 8s. 6d. 12 fr. 40 
 
 %-KUSSIA, " 3.00, 3.30 13s. 18 fr. 60 
 
 For some years past there has been a growing demand for something more satisfac- 
 tory and more practical in the way of literature on the subject of what has, by common 
 consent, come to be termed " Oxygen Therapeutics." On all sides professional men of 
 standing and ability are turning their attention to the use of the gaseous elements about 
 us as remedies in disease, as well as feustainers in health. In prosecuting thejr inquiries, 
 the first hindrance has been the want of any' reliable, or in any degree satisfactory, 
 literature on the subject. 
 
 Purged of th'e much quackery heretofore associated with it, Aerotherapy is now, 
 recognized as a legitimate department of medical practice. Although little noise is .made 
 about it, the use of' Oxygen Gas as a remedy has increased in thiB country within a few 
 years to such an extent that in New York City alone the consumption for medical pur- 
 poses now amounts to more than 300,000 gallons per annum. 
 
 This work, translated in the main from the French of Professor Demarquay, contains ■ 
 also a very full account of recent English, German, and American experiences, prepared 
 by Dr. Sftmuel S. Wallian, of New York, whose experience in this field antedates that of 
 any other American writer on the subject. 
 
 Plain Talks on Avoided Subjects. 
 
 — BY — 
 
 HENRY N. GUERNSEY, M.D., 
 
 Formerly Professor of Materia Medica and Institutes in the Hahnemann Medical College of Philadelphia; 
 
 Author of Guernsey's «' Obstetrics," including the Disorders Peculiar to Women and 
 
 Young Children ; Lectures on Materia Medica, etc. 
 
 IN ONE NEAT 16mo VOLUME. BOUND IN EXTRA CLOTH. Price, Post-paid, in 
 United States and Canada, $1.00 ; Great Britain, 4s. 6d. ; France, 6 fr. 20. 
 
 This is a little volume designed to convey information upon one of the most important subjects con- 
 nected with our physical and spiritual well-being, and is adapted to both sexes and all ages and conditions 
 of society ; in fact, so broad is its scope that no human being can well afford to be without it, and so com- 
 prehensive inits teachings that, no matter how well informed one may be, something can yet be learned from 
 this, and yet it is so plain that any one who can read at all can fully understand its meaning. 
 
 The Author, Dr. H. N. Guernsey, has had an unusually long and extensive practice, and .his teachings ia 
 this volume are the results of his observation and actual experience with all conditions of human life, 
 
 His work is warmly indorsed by many leading men in all branches of professional life, as well as by 
 many whose business connections have caused them to be close observers. 
 
 The following Table of Contents shows the scope of the book: — 
 
 CONTENTS. Chapter I.— Introductory. II.— The Infant. III.— Childhood. IV.— Adoles- 
 cence of the Male. V.— Adolescence of the Female. VI. — Marriage: The Husband. VII. — 
 ^he Wife. VIII. — Husband and Wife. IX. — To the Unfortunate. X.— Origin of the Sex. ■ 
 
 (F. A. DAVIS, Medical Publisher, Philadelphia, Pa., U.S.A.) 7 
 
■NEW EDITION^ 
 
 Lessons in Gynecology. 
 
 By "WILLIAM GrOODELL, A.M., M.D., Etc., 
 
 Professor of Clinical Gynecology in the University of Pennsylvania. 
 
 With 112 Illustrations. Third Edition, Thoroughly Revised and Greatly Enlarged. 
 ONE VOLUME, LARGE OCTAVO, 578 PAGES. 
 
 This exceedingly valuable work, from one of the most eminent specialists and teachers in gynecology 
 in the United States, is now offered to the profession in a much more complete condition than either of the 
 previous editions. It embraces all the more important diseases and the principal operations in the field of 
 gynecology, and brings to bear upon them all the extensive practical experience and wide reading of the 
 author. It is an indispensable guide to every practitioner who has to do with the* diseases peculiar to , 
 women. 
 
 Fig. 44. 
 
 Natural Position of the Womb When the Blabber is Full. 
 After Briesky. 
 
 These lessons are so well known that it is en- 
 tirely unnecessary to do more than to call attention 
 to the fact of the appearance of the third edition. 
 It is too good a book to have been allowed to remain 
 out of print, and it has unquestionably been missed. 
 The author has revised the work with special care, 
 adding to each lesson such fresh matter as the prog- 
 ress in the art rendered necessary, and he has en- . 
 larged it by the insertion of six new lessons. This | 
 edition will, without question, be as eagerly sought 1 
 for as were its predecessors. — American yournal j 
 of Obstetrics. 
 
 The former editions of this treatise were well 
 received by the profession, and there is no doubt [ 
 that the new matter added to the present issue makes j 
 it more useful than its predecessors. — New York 
 Medical Record. 
 
 His literary style is peculiarly charming. There 
 
 is a directness and simplicity about it which is easier 
 to admire than to copy. His chain of plain words 
 and almost blunt expressions, his familiar compari- 
 son and homely illustrations, make his writings, like 
 his lectures, unusually entertaining. The substance 
 of his teachings we regard as equally excellent. — 
 Phila. Medical and Surgical Reporter 
 
 Extended mention of the contents of the book is 
 unnecessary; suffice it to say that every important 
 disease found in the female sex is taken up and dis- 
 cussed in a common-sense kind of a way We wish 
 every physician in America could read and qarry 
 out the suggestions of the chapter on ' ' the sexual re- 
 lations as causes of uterine disorders — conjugal 
 onanism and kindred sins." The department treat- 
 ing of nervous counterfeits of uterine diseases is 
 a most ' valuable one. — Kansas City Medical 
 Index. 
 
 Price, in United States and Canada, Cloth, $5.00; Full Sheep, $6.00. Discount, 20 per 
 
 cent., making it, net, Cloth, $4.00 ; Sheep, $4.80. Postage, 27 Cents extra. Great 
 
 Britain, Cloth, 18s. ; Sheep, £1.2s., post-paid, net. France, 30 fr. 80. 
 
 (F. A- DAVIS, Medical Publisher, Philadelphia, Pa., U.S.A. 
 
AMERICAN RESORTS, 
 
 WITH NOTES UPON THEIR CLIMATE. 
 
 By BUSHROID W. trAM^S, jft-.M., 3XLTZ)., 
 
 Member of the American Association for the Advancement of Science, the American Public Health Association, the 
 
 .Pennsylvania Historical Society, the Franklin Institute, and the Academy of Natural Sciences, Philadelphia; 
 
 the Society of Alaskan Natural History and Ethnology, Sitka, Alaska, etc. 
 
 WITH A TRANSLATION FROM THE GERMAN, BY Mr. S. KAUFFMANN, 
 
 Of those chapters of " Die Klimate der Erde" written by Dr. A. Woeikof, of St. Petersburg, Russia, that 
 relate to North and South America and the islands and oceans contiguous thereto. 
 
 In One Octavo Volume. Handsomely Bound in Cloth. Nearly 300 Pages. Price, 
 Post-paid, in U. S. and Canada, $2.00, net. Great Britain, 8s. 6d. France, 13 IV. 40. 
 
 This is a unique and valuable work, and useful to physicians in all parts of the country. It is just such 
 :» volume as the Medical Profession have stood in need of- for many years. . We mention a few of the merits 
 it possesses: First. List of all the Health Resorts of the country, arranged according to their climate. 
 Second. Contains just the information needed by tourists, invalids, and, those who visit summer" or winter 
 resorts. Third. The latest and best large railroad map for reference. Fourth. It indicates the climate 
 •each one should select for health. Fifth. The author has traveled extensively, and most of his suggestions 
 are practical in reference to localities. 
 
 Taken altogether, this is by far the most complete ex- 
 position of the subject of resorts that has yet been put 
 "forth, and it is one tliat every physician must needs possess 
 intelligent information upon. We predict a large demattd 
 -Jbr this useful and attractive book. — Bvffalo Med. and 
 J5urg.Jour. 
 
 The special chapter on the therapeutics of climate . . 
 is excellent for its precautionary suggestions in the selec- 
 tion of climates and local conditions, with reference to 
 known pathological indications and constitutional predis- 
 positions. — The Sanitarian. 
 
 It is arranged in such a manner that it will be of great 
 .service to medical men whose duty it often becomes to rec- 
 ommend a health resort.— N. W. Med. Jour. 
 
 A well-arranged map of the United Sjtates serves as the 
 frontispiece of the book ; and an almost -perfect index is 
 ■-appended, while between the two is an amount of informa- 
 tion as to places for the health-seeker that cannot be gotten 
 elsewhere. "We most cordially recommend the bookito 
 travelers and to the doctor.— Virginia Med. Monthly. 
 
 This is a work that has long been needed, as there is 
 scarcely a physician who has not had occasion to look up 
 the authorities on climate, elevation, dryness, humidity, 
 etc , etc., of the various health resorts, and has had great 
 difficulty in finding reliable information. It certainly 
 
 ought, as it deserves, to recei%B a hearty welcome from the 
 profession. — Medical Advance. 
 
 The book before us is a very comprehensive vplume, 
 giving all necessary information concerning climate, tem- 
 perature, humidity, sjmshine, and indeed everything neces- 
 sary to be stated for the benefit of the physician or invalid 
 seeking a health resort in the United Sta.tea.^Southern 
 Clinic. 
 
 This work is extremely valuable, owing to the liberal 
 and accurate manner in whieli it gives information regard- 
 ing the various resorts on the American continent, without 
 being prejudiced in the least in favor of any particular one, , 
 but giving all in a fair manner. . . . All physicians 
 need just such a work, for the dootor is always asked to 
 give information on the subject to his patients. Therefore, 
 it should find a place in every physician's library.— The 
 Med. Brief. " 
 
 The author of this admirable work has long made a 
 ^ -study of American climate, from the stand-point of a phy- 
 sician, with a view to ascertaining the most suitable locali- 
 ties for the residence of invalids, believing proper climate 
 to be an almost indispensable factor in the treatment, pre- 
 vention, and cure of many forms of disease. . . . The 
 book evidences careful research and furnishes much useful 
 information not to be found elsewhere. — Pacific Med. Juur. 
 
 f 
 
 'JUST PUBLISHED-- 
 
 MCORD-BOOK OF MEDICAL EXAMINATIONS 
 
 For Life Insurance. 
 
 3DesigT3aea. Toy TOH2ST 1^/L. KEATIITG, 1MZ.1D. 
 
 In examining for Life Insurance, questions are easily overlooked and the answers to 
 "them omitted ; and, as these questions are indispensable, they must be answered before the 
 -ease can be acted upon, and the examiner is often put to much inconvenience to obtain 
 ihis information. 
 
 The need has long been felt among examiners for a reference-book in which could be 
 noted the principal points of an examination, and thereby obviate the necessity of a 
 -second visit to the applicant when further, information is required. 
 
 After a careful study of all the forms of examination blanks now used by Insurance 
 •Companies, Dr. J. M. Keating has compiled such a record-book which we are sure will fill 
 this long-felt want. 
 
 This record-book is small, neat, and" complete, and. embraces all the principal points 
 that are required by the different companies. It is made in two sizes, viz. : No. 1, cover- ■ 
 ing one hundred (100) examinations, and No. 2, covering two hundred (200) examina- 
 tions. The size of the book is 7x3J inches, and can be conveniently carried in the. 
 pocket. 
 
 NET PRICES, POST-PAID. 
 
 U. S. and Canada. Great Britain. France. 
 
 No. 1, For 100 Examinations, in Cloth, » .50 2s. 6cl. 3 fr. go 
 
 No. 2, For 200 Examinations, in Full 
 
 Leather, with Side Flap, ... l.oo 4s. 6d. 6 fr. 20 
 
 (F. A. DAVIS, Medical Publisher, Philadelphia, Pa., U.S A.) 
 
■DISEASES* 
 
 Heart and Circulation 
 
 IN INFANCY AND ADOLESCENCE. 
 
 With an Appendix entitled "Clinical Studies on the 
 Pulse in Childhood." 
 
 BY — 
 
 . JOHN M. KEATING, M.D., 
 
 Obstetrician to the Philadelphia Hospital, and Lecturer on Diseases of Women and Children; Surgeon to* 
 
 the Maternity Hospital ; Physician to St. Joseph's Hospital ; Fellow of the 
 
 College of Physicians of Philadelphia, etc.,' 
 
 — AND— 
 
 WILLIAM A. EDWARDS, M.D., 
 
 Instructor in Clinical Medicine and Physician to the Medical Dispensary in the University of Pennsylvania ^ 
 
 Physician to St. Joseph's Hospital ; Fellow of the College of Physicians ; formerly 
 
 Assistant Pathologist to the Philadelphia Hospital, etc. 
 
 ILLUSTRATED BY PHOTOGRAPHS AND WOOD-ENGRAVINGS. 
 
 About 225 Pages. 8vo. Bound In Cloth. Price, post-paid, in U. 
 and Canada, $1.50, net; Great Britain, 6s. 6d. ; France, 9 fr. 35. 
 
 S. 
 
 There are many excellent text-books on children's diseases, but they have failed to give a satisfactory- 
 account of the diseases of the heart ; and, indeed, as far as known, this work of Keating and Edwards'- now 
 presented to the profession is the only systematic attempt that has been made to collect in book form the 
 abundant material which is scattered throughout medical literature in the form of journal articles, clinical, 
 lectures, 'theses, and reports of societies. 
 
 The authors have endeavored, in their difficult task, to collect these valuable materials and place them 
 within easy reach of those who are interested in this important subject. That they have succeeded will we 
 believe, be conceded by all who obtain and make use of their very valuable contribution to this hitherto* 
 neglected field of medical literature. 
 
 An appendix, entitled " Clinical Studies on the Pulse in Childhood," follows the index in the book, and" 
 will, we are sure, be found of much real value to every practitionerof medicine. The work is madeavailabler 
 for ready reference by a well-arranged index. We append the table of contents showing the scope of the- 
 book : — 
 
 COITTEITTS 
 
 Chapter I. — The Methods of Study — Instruments— 
 
 Fcetal Circulation — Congenital Diseases of the 
 
 Heart — Malformations — Cyanosis. 
 Chapter II, — Acute and Chronic Endocarditis—? 
 
 Ulcerative endocarditis. 
 Chapter III. — Acute and Chronic Pericarditis. 
 Chapter IV. — The treatment of Endo- and Peri- 
 
 carditis — Paracentesis Pericardii — Hydropericar- 
 
 d ium — H smoper i cardi um— Pneumopericard i um. 
 Chapter V. — Myocarditis — Tumors, New Growths, 
 
 and Parasites 
 Chapter VI.— Valvular Disease: Mitral, Aortic, 
 
 Pulmonary, and Tricuspid., 
 
 Aneu-r 
 Angina Pectoris- 
 
 Chapter VII.— General Diagnosis, Prognosis, and" 
 Treatment of Valvular Disease. 
 
 Chapter VIII.— Endocarditis— Atheroma 
 rism. 
 
 Chapter IX.— Cardiac Neuroses- 
 — Exophthalmic Goitre. 
 
 Chapter X.— Diseases of the Blood : Plethora, 
 Anasmia, Chlorosis, Pernicious Anemia l.eu- 
 
 . kaunia-Hodgkin's Disease— Hasmophi Ha, Throm- 
 bosis, and Embolism. 
 
 INDEX. 
 
 APPENDIX.— Clinical Studies on the Pulse: 
 in Childhood. 
 
 Drs. Keating and Edwards have produced a work that 
 will give material aid to every doctor in his practice among 
 children. The style of the took is graphic and pleasing, 
 the diagnostic points are explicit and exact, and the thera- 
 peutical resources include the novelties of medicine as well 
 as the old and tried agents. — Pittsburgh Med. Review. 
 
 A very attractive and valuable work has been given to 
 the medical profession by Drs. Keating and Edwards, in 
 their treatise on the diseases of the heart and circulation 
 in infancy and adolescence, and theyv deserve the greatest 
 credit for the admirable manner hi which they have col- 
 lected, reviewed, and made use of the immense amount of 
 materfal on this important subject. — Aroliiven of Pediatrics, 
 
 The plan of the work is the correct one, viz., the sup- 
 plementing of the observations of the better class of prac- 
 titioners by the experience of those who have given the 
 subject systematic attention. — Medical Age. 
 
 It is not a mere compilation, hut a systematic treatise,, 
 and bears evidence of considerable labor and observation on- 
 the part of the authors. Two fine photographs of dissec- 
 tions exhibit mitral stenosis and mitral regurgitation;- 
 there are also a number of wood-cuts.— Cleveland Medical' 
 Gazelle. 
 
 As the works upon diseases of children give little or no- 
 attention to diseases of the heart, this work of Drs. Keat- 
 ing and Edwards will supply a want. "We think that, 
 there will be no physician, who takes an interest in the- 
 affections of yoiing folks, who will not wish to consult it- 
 — Cincinnati Med. News. 
 
 The work takes up, in an able and scientific manner, 
 diseases of the heart in children. This is a part of the* 
 field of, medical science which has not been cultivated" tp» 
 the extent that the importance of the subject deserves.— 
 Canada Lancet. 
 
 10 
 
 (F. A. DAVIS, Medical Publisher, Philadelphia, Pa., U.S.A.) 
 
PERPETUAL CLINICAL INDEX 
 
 — TO — 
 
 MATERIA MEDICA, CHEMISTRY, AND PHARMACY CHARTS. 
 By A. H. KELLER, Ph.G., M.D. 
 
 Consisting of (1) the "Perpetual Clinical Index," an oblong volume, 9x6 inches, 
 neatly bonnd in extra Cloth ; (3) a Chart of "Materia Medica," 32x44 inches, 
 mounted on muslin, with rollers ; (3) a Chart of « Chemistry and Phar- 
 macy, 1 ' 32x44 inches, mounted on muslin, with rollers* 
 
 United States. 
 
 Net Price for the Complete Work, $5.00 
 
 Canada (duty paid). 
 
 $5.50 
 
 Great Britain. 
 
 £l.ls. 
 
 France. 
 
 30 fr. 30 
 
 Bead the Following Description and Explanation of the Work : 
 
 In presenting the objects and- advantages of these Charts and " Perpetual Clinical Index" it becomes 
 necessary to state that- the Author's many years' experience as a physician and Pharmacist enables him 
 to produce, in terse language, a volume of facts that must be of inestimable value to the busy physician and 
 pharmacist, qr to any student of either profession. He has endeavored to describe all that have borne inves- 
 tigation up to date. 
 
 The system will" prove to be of great value in this, that so little labor will be - required to add new 
 investigation as fast as may be gathered from new books, journals, etc. The classification is alphabetical 
 and numerical in arrangement, and serves so to unite the various essentials of Botany, Chemistry, and 
 Materia Medica, that the very thought of the one will readily associate the principal properties and uses, as/ 
 well as its origin. 
 
 The "MATERIA MEDICA " CHART, in the first place, aids at a glance: ist, Botanical or 
 XI. S. P. Name; zd, The Common Name ; 3d, Natural Order ; ^.th, Where Indigenous ; 5th, Principal Con- 
 stituent; 6th, Part Used — herbs, leaves, flowers, roots, barks, etc. ; 7th, Medicinal Properties — mainly con- 
 sidered; 8th, The Dose — medium arid large. 
 
 . On this Chart there are 475 first names ;_§ection A. is numbered from 1 to 50, each section commencing 
 with the capital letter, and having its own numbers on both left-hand and right-hand columns, to prevent 
 mistakes in lining out, all in quite large type. In the centre of the Chart, occupying about 6 inches in 
 width, is a term index of common names. In the second column of Chart, like this : 
 Aconite Leaves, . . . 4 A. 
 
 . Then by reference, to 4 A in first column, you there find the Botanical or U. S. P. Name, On this Chart is 
 also found a brief definition oT the terms used, under the heading " Medicinal Properties." 
 
 The "CHEMISTRY" CHART takes in regular order the U. S. Pharmacopoeia Chemicals, with . 
 the addition of many new ones, and following the name, the Chemical Formula, the Molecular Weight, and 
 next the Origin. This is a brief but accurate description of the essential points in the manufacture : The 
 Dose, medium and large; next, Specific Gravity; then, whether Salt or Alkaloid; next, Solubilities, by 
 abbreviation^ in Water, Alcohol, and Glycerine, and blank columns for solubilities, as desired. 
 
 Alkaloids and Concentrations are tabulated with reference numbers for the Perpetual Clinical Index, giving 
 Medicinal Properties, Minute Dose and Large Dose. For example, Alkaloids and Concentrations : 
 
 , " A. 
 
 Medicinal Properties. 
 
 Minute Dose. 
 
 Large -Dose. 
 
 (a) Aconitine. 
 
 Narcotic and Apyretic. 
 
 1-500 gr. 
 
 1-16 gr. 
 
 Following this, Preparations of the Pharmacopoeia, each tabulated. For example : 
 
 TINCTURAL. 
 
 TlNCTURA. 
 
 Drug. 
 
 Amount. 
 
 Alcohol. 
 
 Dose. 
 
 * Aconiti. 
 
 (■Aconite. 
 
 1 Tartaric Acid, 60 f P. 
 
 $%, oz. to 24 gr. 
 
 100 
 
 1 to 3 drops. 
 
 * 60 Fineness of Powder as per U. S. P. 
 
 t P. Macerate 24 hours. Percolate, adding Menstruum to complete (1) pint tincture. 
 
 They are all thus abbreviated, with a ready reference head-note. 
 
 Next, Thermometers, Metric Table of Weights, Helps to the Study of Chemistry, Examples in Work- 
 ing Atomic Molecular Formulae Next, Explanation of Terms Used in Columns of Solubilities, List of 
 Most Important Elements Now in Use, and Definitions or Terms Frequently Used in Chemistry and' 
 ' Pharmacy. 
 
 ■ The "PERPETUAL CLINICAL INDEX" is a book 6 by 9 inches, and one-half inch thick. 
 It contains 135 pages, divided as follows (opposite pages blank) : 
 
 The Index to Chemistry Chart occupies two pages ; Explanations, Abbreviations, etc., forty pages, with 
 diseases, and with an average of ten referericesto each disease, leaving room for about forty more remedies' 
 for each disease. The numbers refer to the remedies used in the diseases by the most celebrated-physicians, 
 and surgeons, and the abbreviations to the manner in which they are used. Eight pages, numbered and 
 bracketed, for other diseases not enumerated. The Materia Medica, Explanations, Abbreviations, and 
 Remedies suggested for, occupy twenty-six pages. For Abbreviated Prescriptions, seventeen blank pages. 
 Then the Index to Alkaloids and Concentrations. These, already enumerated, with their reference, number 
 six blank tabulated pages, for noting any new Alkaloids and Concentrations. Then the Chemistry Index, 
 giving the same number as on Chart, with Name, Doses, Specific Gravity, Salt or Alkaloid in the same 
 line, as for example : 
 
 Name. 
 
 Doses. 
 
 Specific Gravity. 
 
 Salt or Alkaloid. 
 
 Memoranda. 
 
 
 ' 
 
 
 . 
 
 
 This Memoranda place is for Physicians' or Pharmacists' reference notes ; and with the addition of 
 several tabulated blank pages, in which to add any new chemical, with doses, etc. The remaining sixteen 
 pages for Materia Medica Index, leaving blanks following each other for new names and reference numbers/ 
 
 To show the ready and permanent use of the "Perpetual Clinical Index" of the "Chemistry" and 
 "Pharmacy" Charts or Index in the book, suppose the' Physician reads in a Book or' journal that Caffeine 
 Citras is useful in the disease Chorea, and he wishes to keep a permanent record of that, he refers to the 1 
 Chart and if it does noC already appear there, it can be placed opposite and numbered, and thereafter used 
 for reference. But we find its permanent number is No. 99, so he will write down in the line left blank for ■< 
 future use in his book, in line already used, running parallel with other reference numbers in Chorea, the 
 No. 99, and immediately under he can use the abbreviation, in the manner in which it is given. Though 
 years may have passed, he can in a moment, by referring there, see that No. 99 is good for Chorea. If fail- 
 ing to remember what No. 99 is, he glances at the Chart or Index. He sees that. No. 99 is Caffeine Citras, 
 and he there learns its origin and dose and solubility, and in* a moment an intelligent prescription can be 
 constructed. 
 
 CF.A. DAVIS, Medical Publisher, Philadelphia, Pa., U.S.AJ 11 
 
New Edition of an Important and Timely Work Just Published. 
 
 Electricity in the Diseases of W omen > 
 
 "With Special Reference to the Application of Strong Currents. 
 
 By G. BETTON MASSEY, M.D., 
 
 Physician to the Gynecological Department of Howard Hospital ; Late Electro-Therapeutist to the Phila- 
 delphia Orthopaedic Hospital and Infirmary for Nervous Diseases : Member of the American 
 Neurological Ass'n, of the Philadelphia Neurological Society, of the Franklin Institute, etc. 
 
 Second. 33a.itJ.oEi.. 3SeT7-ised. and. ZEzilargfed.. 
 
 WITH NEW AND ORIGINAL WOOD-ENGRAVINGS. HANDSOMELY BOUND IN CLOTH. OVER 200 PAGES. 
 
 12mo. Price, in United States and Canada, $1.60, net, post-paid. 
 
 In Great Britain, 6>. 6d. In France, 9 fr. 35. 
 
 This work is presented to the profession as the most complete treatise yet issued o» 
 the electrical treatment of diseases of women, and is destined to fill the increasing demand 
 for clear and practical instruction in the handling and use of strong currents after the 
 recent methods first advocated by Apostoli. The whole subject is treated from 'the present 
 stand-point of electric science with new and original illustrations, the thorough studies of 
 the author and his wide clinical experience rendering him an authority upon electricity 
 itself and its therapeutic applications. The author has enhanced the practical value of 
 the work by including the exact, details of treatment and results in a number of eases , 
 taken from his private and hospital practice. 
 
 Fig. i8. — Ball Electrode for Administering Franklinic Sparks. 
 
 -CCaTTEiTTS- 
 
 Chapter I, Introductory ; II, Apparatus required in gynecological applications of the galvanic current ; 
 HI, Experiments illustrating the physical qualities of galvanic currents ; IV, Action of concentrated gal- 
 vanic currents on organized tissues ; V, Intra-uterine galvano-chemical cauterization ; VI, Operative details 
 •f pelvic electro-puncture ; VII, The faradic current in gynecology ; VIII, The franklinic current In gyne- 
 cology ; IX, Non-caustic vaginal, urethral, and rectal applications ; X, General percutaneous applications in 
 the treatment of nervous women ; XI, The electrical treatment of fibroid tumors of the uterus ; XII The 
 electrical treatment of uterine hemorrhage ; XIII, The electrical treatment of subinvolution ; XIV The 
 electrical treatment of chronic endometritis and chronic metritis ; XV, The electrical treatment of chronic 
 diseases of the uterus and appendages; XVI, Electrical treatment of pelvic pain; XVII The electrical 
 treatment of uterine displacements ; XVIII, The electrical treatment of extra-uterine pregnancy ; XIX 
 The electrical treatment of certain miscellaneous conditions ; XX, The contra-indications and limitations to 
 the use of strong currents. 
 
 An Appendix and a Copious Index, including the definitions of terms used in the work, concludes 
 the book. 
 
 , The author gives us what he lias seen, and of which 
 
 he is assured by scientific study is correct We 
 
 are certain that this little work will prove helpful to all 
 physicians who desire to use electricity iu the management 
 of the diseases of women. — The American Lancet. 
 
 To say that the author is rather conservative in his 
 ideas of the curative powers of eleotricity is only another 
 way of saying that he understands his subject thoroughly. 
 The mild enthusiasm of our author is unassailable, because 
 it is founded on science and reared with experience. — The 
 Medical Analectic. 
 
 The work is well written, exceedingly practical , and 
 ean be trusted. We commend it to the profession." — Mary- 
 land Medical Journal. 
 
 ' The book is one which should be possessed by every 
 physician who treats diseases of women by electricity. — 
 The Brooklyn Medical Journal. 
 
 The departments of electro-physics, pathology, and 
 electro-therapeutics are. thoroughly and admirably con- 
 
 sidered, and by means of good wood-cuts the beginner has 
 before his eye the exact method of work required.— The 
 Medical Register. 
 
 " The author of this little volume of 210 pages onght 
 to have added to its title, " and a most happy dissertation 
 upon the methods of Using this medicinal agent; " for in 
 the first 100 pages he has contrived to desoribe the techni 
 ol electrization in as clear and happy a manner as » 
 author has ever succeeded in doing, and fortius part of the 
 book alone it is almost priceless to the beginner in the 
 
 treatment with this agent The little book is 
 
 worthy the perusal of every one at all interested in the 
 subject of electricity in medicine— The Omaha Clinic 
 
 The treatment of fibroid tumor of the uterus will 
 perhaps, interest the profession more generally than anv 
 other question. This subject has been accorded ample 
 space. The method of .treatment in many cases has been 
 recited in detail, the results in every instance reported be- 
 ing beneficial, and in many ourative.— Pacific Med. Jeur 
 
 12 
 
 (F. A. DAVIS, Medical Publisher. Philadefahia p<. ».«j 
 
PRACTICAL SURGERY. 
 
 By J. EWING HEARS, M.D., 
 
 Lecturer on Practical Surgery and Demonstrator of Surgery in Jefferson Medical College; Professor of 
 Anatomy, and Clinical Surgery in the Pennsylvania College of Dental Surgery, etc. 
 
 With 490 Illustrations. Second edition, revised and enlarged. 794 pp. 12mo. 
 
 PRICE, IN UNITED STATES AND CANADA .; CLOTH, $3.00. DISCOUNT, 20 PER CENT., MAKING IT, NET. 
 $2.40; P0STA6E, 20 CENTS EXTRA.. GREAT BRITAIN, 13s. FRANCE, 18 fr. 75. 
 
 Mears' Practical Surgery includes chapters on Surgical Dress- 
 ings, Bandaging, Fractures, Dislocations, Ligature of Arteries, Amputa- 
 tions, Excisions of Bones and Joints. This 
 work gives a complete account of the 
 methods of antiseptic surgery. The dif- 
 ferent agents used in antiseptic dressing, 
 their methods of preparation, and their 
 application in the treatment of wounds are 
 fully described. With this work as a guide 
 it is possible for every surgeon to practice 
 antiseptic surgery. The great advances 
 made in the science and art of surgery are 
 largely due to the introduction of anti- 
 septic methods of wound treatment, and it 
 is incumbent upon every progressive sur- 
 | geon to employ them. 
 
 An examination of this -work will 
 show that it is thoroughly systematic in 
 its plan, so that it is not only useful to the practitioner, who maybe 
 called upon to perform operations, but of great value to the student in 
 his work in the mrgical room, where he is required to apply bandages 
 and fracture dressings, and to perform operations upon the cadaver. The 
 experience of the author, derived 'from many years' service as a teacher 
 (private and public) and practitioner, has enabled him to present the 
 topics discussed in such a manner as to fully meet the needs of both prac- 
 titioners and students. 
 
 It is full of common sense, and may be safely 
 taken as a guide in the matters of which it treats. 
 Tt would be hard to point out all the excellences of 
 this book. We can heartily recommend it to students 
 and t6 practitioners of surgery. — American Jour- 
 nal of the Medical Sciences. 
 
 We do not 'know of any other work which would 
 be of greater value to the student in connection with 
 his lectures in this department — Buffalo Medical 
 and Surgical Journal. 
 
 The work is excellent. The student or practi- 
 
 tioner who follows it intelligently cannot easily go 
 astray .—Journal American Medical Asso'n. 
 
 We cannot speak too highly of the volume under 
 review.— Canada Med, and Surg. Jour. 
 
 The space devoted to fractures and dislocations 
 — by far the most difficult and responsible part of 
 surgery — is ample, and we notice many new illustra- 
 tions explanatory 'of the text. — North Carolina 
 Medical Journal. 
 
 It is one of the most valuable of the works of its 
 kind. — New Orleans Med. and Surg. Jour. 
 
 (F. A. DAVIS, Medical Publisher, Philadelphia, Pa., U.S.A.) 
 
 13 
 
AN ENTIRELY NEW PHYSICIAN'S VISITING LIST. 
 
 . THE ^=-— --=■= 
 
 ]V\edical Bulletin Visiting List 
 
 OR 
 
 Physician's C ALL Record. 
 
 ARRANGED UPON AN ORIGINAL AND CONVENIENT MONTHLY AND WEEKLY PLAN 
 FOR THE DAILY RECORDING OF PROFESSIONAL VISITS. 
 
 Frequent Rewriting of Names Unnecessary. 
 
 This Visiting List is arranged upon a plan best adapted to the most 
 convenient use of all physicians, and embraces a new feature in recording 
 daily visits not found in any other list, consisting of stub or half leaves 
 in the form of inserts, a glance at which will suffice to show that as the 
 first week's record of visits is completed the next week's record may be 
 made by simply turning over the stub-leaf, without the necessity of re- 
 writing the patients' names. This is done until the month is completed, 
 and the physician has kept his record just as complete in every detail of 
 visit, charge, credit, etc., as he could have done had he used any of the 
 old-style visiting lists, and has also saved himself three-fourths of the 
 time and labor formerly required in transferring names every week. 
 There are no intricate rulings ; everything is easily and quickly under- 
 stood ; not the least amount of time can be lost in comprehending the 
 plan, for it is acquired at a glance. 
 
 The Three Different Styles Made. 
 
 The No. 1 Style of this List provides ample space for the daily 
 record of seventy (70) different names each month for an entire year 
 (two full pages, thirty-five [35] names to a page, being allowed to each 
 month), so that its size is sufficient for an ordinary practice ; but for 
 physicians who prefer a List that will accommodate a larger practice we 
 have made a No. 2 Style, which provides ample space for the daily 
 record of one hundred and five different names (105) each month for 
 an entire year (three full pages being allowed to each month), and for 
 physicians who may prefer a Pocket Record Book of less thickness than 
 either of these styles we have made a No. 3 Style, in which " The 
 Blanks for the Recording of Yisits In " have been made into removable 
 sections. These sections are very thin, and are made up so as to answer 
 in full the demand of the largest practice, each section providing ample 
 space for the daily record of two hundred and ten (210) different 
 names for one month; or one hundred and five (105) different names 
 daily each month for two months ; or seventy (TO) different names daily 
 each month for three months ; or thirty-five (35) different names daily 
 each month for six -months. Four sets of these sections go with each 
 copy of No. 3 Style. 
 
 Special Features Not Found in Any Other List. 
 
 In this No. 3 Style the printed matter, and such matter as the 
 blank forms for Addresses of Patients, Obstetric Record, Vaccination 
 Record, Cash Account, Births and Deaths Records, etc., are fastened 
 permanently in the back of the book, thus reducing its thickness. The 
 addition of one of these removable sections does not increase the size 
 quite an eighth of an inch. This brings the book into such a small com- 
 pass that no one can object to it on account of its thickness, as its bulk 
 
 .14 
 
is very much less than that of any, visiting list ever published. Every 
 physician will at once understand that as soon as a section is full it can 
 betaken out, filed away, and another^ inserted without the least incon- 
 venience or trouble. 
 
 , This Visiting List contains a Calendar for the last six mfonths 
 of last year, all of this, and next year; Table of Signs to be used 
 In Keeping Accounts; Dr. Ely's Obstetrical Table; Table of Cal- 
 culating the Number of Doses in a given R, etc., etc. ; for converting 
 .Apothecaries' Weights and Measures into Grammes ; Metrical Avoirdu- 
 pois and Apothecaries' Weights; Number of Drops in a Fluidrachm ; 
 ■graduated Doses for Children ; Graduated Table for Administering 
 Laudanum ; Periods of Eruption of the Teeth ; The Average Frequency 
 -of the Pulse at Different Ages in Health ; Formula and Doses of Hypo- 
 dermic Medication ; Use of the Hypodermic Syringe ; Formiilse and 
 Doses of Medicine for Inhalation ; Formulae for Suppositories for the 
 Hectum ; The Use of the Thermometer in Disease ; Poisons and their 
 Antidotes ; Treatment of Asphyxia ; Anti-Emetic Remedies ; Nasal 
 Douches ; Eye-Washes. , , 
 
 Most Convenient Time- and Labor- Saving List Issued. 
 
 It is evident to every one that this is, beyond question, the best and 
 :most convenient time- and labor-saving Physicians' Record Book ever 
 published. Physicians of many years' standing and -with large practices 
 pronounce this the Best List they have ever seen. It is handsomely 
 tiound in fine, strong leather, with flap, including a pocket for loose 
 ^memoranda, etc., and is furnished with a Dixon lead-pencil of excellent 
 vquality and finish. It is compact and convenient for carrying in the 
 pocket. Size, 4 x 6| inches. 
 
 IN THREE STYLES-NET PRICES, POST-PAID. 
 
 U. S. and Canada. Greafe Britain. France. 
 Ho. *. Regular Size, for 70 patients daily each month for one year, $1.35 5s. 3. 7 t'r. 75 . 
 
 "No. -z. Large Size, for 105 patients daily each month for one year, 1.50 6s. 6. 9 ffr. 35 
 
 "No. 3. In which "The Blanks for Recording Visits in" are in re- 
 movable sections, as described above, - - - 1.75 7s. 3. 12 ir. 4u 
 
 -EXTRACTS FROM REVIEWS. 
 
 "While each page records only a week's visits, 
 ryet by an ingenious device of half leaves the names 
 •of the patients require to be written but once a 
 _month, and a glance at an opening of the book 
 :shows the entire visits paid to any individual in a 
 ^nonth. It will be found a great convenience." — 
 ^Boston Medical and Surgical Journal. 
 
 "Everything about it is_ easily and quickly 
 ^understood." — Canadian Practitioner. 
 
 "Of the many visiting lists before the profes- 
 sion, each has some special feature to recommend 
 
 it. This list is very ingeniously arranged, as by a 
 ^series of narrow leaves following a wider one, the 
 
 name of the patient is written but once during the 
 
 Tnonth, while the acoounf can run for thirty-one 
 -days, space being arranged for a weekly debit 
 ;and credit summary and for special memoranda. 
 'The usual pages for cash account, obstetrical 
 -record, addresses, etc., are included. A large 
 
 amount of miscellaneous information is presented 
 
 in a condensed form." — Occidental Medical 
 
 Times. 
 
 "It is a monthly instead of a weekly record, 
 -thus obviating the transferring of names oftener 
 .-than once a month. There is a Dr. and Cr. column 
 
 following each week's record, enabling the doctor 
 -to carry a patient's account for an indefinite time, 
 or until he is discharged, with little trouble."— 
 And i ana Medical Journal 
 
 "Accounts can begin and end at any date. 
 Each name can be entered for each day of every 
 month on the same line. To accomplish this, four 
 leaves, little more than one-third as wide as the 
 usual leaf of the book, follow each page. Oppo- 
 site is a full page for the recording of special 
 memoranda. The usual accompaniments of this 
 class of books are made out with care and fitness." i 
 — The American Lancet. 
 
 "This is a novel list, and an unusually con- 
 venient one." — Journalof the Amer. Med. Assoc. 
 
 "This new candidate for the favor of physi- 
 cians possesses some unique and useful points. 
 The necessity of rewriting names every week is 
 obviated by a simple contrivance in the make-up 
 of its pages, thus saving much valuable time, 
 besides reducing the bulk of the book." — Buffalo 
 Medical and Surgicail Journal. 
 
 "This list is an entirely new departure, and 
 on a plan that renders posting rapid and easy. It 
 is just what we have often wished for, and really 
 fills along-felt want."— The Medical Waif. 
 
 "It certainly contains the largest amount of 
 practical knowledge for the medical practitioner 
 in the smallest possible volume, besides enabling 
 the poorest accountant to keep a correct record, 
 and render a correct bill at a moment'snotice." — 
 Medical Ckifs: 
 
 (F. A. DAVIS, Medical Publisher, Philadelphia, Pa., U.S.A.) 
 
 15 
 
HAND-BOOK OF ECLAMPSIA 
 
 OR, 
 
 Notes and Cases of Puerperal Convulsions. 
 
 BY 
 
 E. Michener, M.D., J. H. Stubbs, M.D., R. B. Ewing, M.D., 
 
 B. Thompson, M.D., S. Stebbins, M.D. 
 
 Price, in United States and Canada, Bound in Cloth, 16mo, Net, 75 Cents; in Great 
 Britain, 3 Shillings ; in France, 4 fr. 20. 
 
 In our medical colleges the teachers of Obstetrics dwell upon the use of blood-letting (phlebotomy) in* 
 oases of puerperal convulsions, and to this method Dr. Michener and his fellows give their unqualified 
 support— not to take a prescribed number of ounces, but to bleed far effect, and from a large orifice. This- 
 is plainly and admirably set forth in his book. To bleed requires a cutting instrument, — not necessarily jl 
 lancet, — for Dr. M. states how in one case a pocket-knife was used and the desired effect produced. 
 
 Let the young physician gather courage from this little book, and let the more experienced give testi- 
 mony to confirm its teaching. ( 
 
 We have always thought that this treatment was 
 indorsed, approved, and practiced by physicians generally ; 
 and to such as doubt the efficacy of blood-letting we would 
 commend this little volume. — Southern Clinic. 
 
 The authors are seriously . striving to restore /the 
 
 "lost art" of blood-letting, and we must commend the- 
 modesty of their endeavor. — North Carolina Med. Jour. 
 
 The cases were ably analyzed, and this plea for vene- 
 section should receive the most attentive consideration from, 
 obstetricians. — Medical and Surgical Reporter. 
 
 TTJST BEADY.: 
 
 A MANUAL OF INSTRUCTION 
 
 FOR GIVING 
 
 Swedisb Movement* Massage Treatment. 
 
 BY 
 
 Prof. Hartvig Nissen, 
 
 Director of the Swedish Health Institute, Washington, D.C. ; Late Instructor in Physical Culture andl 
 
 Gymnastics at the Johns Hopkins University, Baltimore, Md, ; Author o'f 
 
 " Health by Exercise without Apparatus." 
 
 ILLUSTRATED WITH 29 ORIGINAL WOOD-ENGRAVINGS. 
 
 In One 12mo Volume of 128 Pages. Neatly Bound in Cloth. Price. 
 
 post-paid, in United States and Canada, Net, $1.00; in 
 
 Great Britain, 4s. 3d. ; in Prance, 6 fr. 20. 
 
 This is the only publication in the English language treating this very important 
 subject in a practical manner. Full instructions ire given regarding the mode of 
 
 applying 
 
 The Swedish Movement and Massage Treatment 
 
 in various diseases and conditions of the human system with the greatest degree o€ 
 effectiveness. Professor Nissen is the best authority in the United States upon this prac- 
 tical phase of this subject, and his .book is indispensable to every physician who wishes to- 
 know how to use these valuable handmaids of medicine. 
 
 This manual is valuable to the practitioner, as 1 it 
 contains a terse description of a subject but too little under- 
 stood in this country The book is got up verv 
 
 creditably.— N. Y. Med. Join: 
 
 The present volume is a modest account of the appli- 
 cation of the Swedish Movement and Massage Treatment, 
 j n which the technique of the various procedures are clearly 
 stated as well as illustrated in a very excellent manner. 
 — North American Practitioner. 
 
 This little manual seems to be written by an expert, 
 and to those who desire to know the details connected with 
 
 the Swedish Movement and Massage we commend the- 
 book. — Practice. 
 
 This attractive little book presents the subject in a very- 
 practical shape, and makes it possiblefor every physicianfo- 
 understand at least how it is applied, if it does not give hint 
 dexterity in the art of its application. He can certainly 
 acquire dexterity by following the'directions so plainly ad- 
 vised in this book.— CJiicago Med. Times. 
 
 It is so practical and clear in its demonstrations that 
 it you wish a work of this nature you cannot do better than, 
 peruse this one.— Medical Brief. 
 
 (F. A. DAVIS, Medical Publisher, Philadelphia, Pa., U.S.A.) 
 
JUST READY— THE LATEST AND BEST PHYSICIAN'S ACCOUNT- 
 BOOK EVER PUBLISHED. 
 
 THE PHYSICIAN'S 
 
 5\ll*Req(jisite Time* 
 *«£ Labor* 5avinq 
 
 Account-Book: 
 
 BEING A LEDGER AND ACCOUNT-BOOK FOR PHYSICIANS' USE, MEETING ALL 
 THE REQUIREMENTS OF THE LAW AND COURTS. 
 
 DESIGNED BY 
 
 TXTIIjIjI.A.3^ .A.. SEIEEET, 2svd.3D-, 
 
 Of Easton, Fa. 
 
 Probably no class of people lose more "money through carelessly kept 
 accounts and overlooked or neglected bills than physicians. , Often 
 detained at the bedside of the sick until late at night, or deprived of 
 even a modicum of rest, it is with great difficulty that he spares the 
 time or puts himself in condition to give the same care to his own 
 financial interests that a merchant, a lawyer, or even a farmer devotes. 
 It is then plainly apparent that a system of bookkeeping and accounts 
 that, without sacrificing accuracy, but, on the other hand, ensuring it, at 
 the same time relieves the keeping of a physician's book of half their 
 complexity and two-thirds the labor, is a convenience which will be 
 eagerly welcomed by thousands of overworked physicians. Such a sys- 
 tem has at last^been devised, and we take pleasure in offering it to- the 
 profession in the form of The Physician's All-Requisite Time- and 
 Labor- Saving Account-Book. 
 
 There is no exaggeration . in stating that this Account-Book and 
 Ledger reduces the labor of keeping your accounts more than one-half, 
 and at the same time secures the greatest degree of accuracy. We may 
 mention a few of the superior advantages ' of The Physician's All- 
 Requisite Time- and Labor- Saving Account-Book, as follow: — 
 
 any similar book; the 300-page book 
 contains space for 900 accounts, and the 
 600-page book contains space for 1800 1 
 accounts. 
 Ninth — There are no smaller spaces. 
 
 First — Will meet all the requirements of 
 the law and courts. 
 
 Second — Self-explanatory ; no cipher code. 
 
 Third — Its completeness without sacrificing 
 anything. 
 
 Fourth — No posting ; one entry only. 
 
 Fifth — Universal ; can be commenced at any 
 time of year, and can be continued in- 
 definitely until every account is filled. 
 
 Sixth — Absolutely no waste of space. 
 
 Seventh — One person must needs be sick 
 every day of the year to fill his account, 
 or might be ten years about it and re- 
 quire no- more than the space for one 
 account in this ledger. 
 
 Eighth — Double the number and many times 
 more than the number of accounts in 
 
 Tenth — Compact without sacrificing com- 
 pleteness ; every account complete- on 
 same page — a decided advantage and 
 ' recommendation. 
 
 Eleventh — Uniform size of leaves. 
 
 Twelfth — The statement of the most com- 
 plicated account is at once before you 
 at any time of month or year — in other 
 words, the account itself as it stands is 
 its simplest statement. 
 
 Thirteenth — No transferring of accounts, 
 balances, etc. 
 
 To all physicians desiring a quick, accurate, and comprehensive 
 method of keeping their accounts, we can safely say that no book as 
 suitable as this one has ever been devised. 
 
 NET PRICES, SHIPPING- EXPENSES PREPAID. 
 
 No. 1. 300 Pages, for 900 Accounts per Year, 
 
 Size 10x18, Bound in % Bussia, Raised In u - s 
 
 Back-Bands, Cloth Sides, 
 No. 2. 600 Pages, for 1800 Accounts per Yeai;, 
 
 Size 10x18, Bound in % Bussia, Baised 
 
 Back-Bands, Cloth Sides, 
 
 $5.00 
 
 8.00 
 
 Canada 
 (rluty paid). 
 
 So. 50 
 
 8.80 
 
 Great 
 Britain. 
 
 SO. 18s. 
 
 France. 
 SO fr. 30 
 
 1.13s. 49 fr. 40 
 
 (F. A. DAVIS, Medical Publisher, Philadelphia, Pa., U.S.A.) n 
 
PHYSICIANS' INTERPRETER 
 
 IN FOUR LANGUAGES. 
 
 (ENGLISH, FRENCH, GERMAN, AND ITALIAN.) 
 
 Specially Arranged for ^Diagnosis by M. von V. 
 
 The object of this little work is to meet a need often keenly felt by 
 the busy physician, namely, the need of some quick and reliable method 
 of communicating intelligibly with patients of those nationalities and 
 languages unfamiliar to the practitioner. The plan of the book is a sys- 
 tematic arrangement of questions upon the various branches of Practical 
 Medicine, and each question is so worded that the only answer required 
 of the patient is merely Yes or No. The questions are all numbered, 
 and a complete Index renders them always available for quick reference. 
 The book is written by one who is well versed in English, French, Ger- 
 man, and Italian, being an excellent teacher in all those languages, and 
 who has also had considerable hospital experience. 
 
 Bound in Full Russia Leather, for Carrying in the Pocket. (Size, 5 x 2f 
 
 Inches.) 206 Pages. Price, post-paid, in United States and 
 
 Canada, $1.00, net; Great Britain, 4s. 6d. ; France, 6 fr. 20. 
 
 To convey some idea of the scope of the questions contained in the 
 Physicians' Interpreter, we append the Index : — 
 
 NOS. 
 
 General health i- 5° 
 
 "Special diet 31- 47 
 
 Age of patient. r , 52- 62 
 
 Necessity of patients undergoing an opera- 
 tion ,. ... 63- 70 
 
 Office hours, 7i- 77 
 
 Days of the week , 78- 84 
 
 Patient's history: hereditary affections in his 
 family; his occupation; diseases from 
 
 his childhood up 85-13C 
 
 Months of the year 106-117 
 
 Seasons of the year .'...., 118-121 
 
 Symptoms of typhoid fever -..131-158 
 
 Symptoms of Bright's disease 159-168 
 
 Symptoms of lung diseases 169-194 and 311-312 
 
 Vertigo 195-201 
 
 The eyes 201-232 
 
 Paralysis and rheumatism 236-260 
 
 Stomach complaints and chills 261-269 
 
 Falls and fainting spells „ 271-277 
 
 How patient's illness began, and when pa- 
 tient was first taken sick .„, . . .278-7279 
 
 Names for various parts of the body 283-299 
 
 The liver 300-301 
 
 The memory 304-305 
 
 Bites, stings, pricks ■ 314-316 
 
 Eruptions 317-318 
 
 Previous treatment 319 
 
 Symptoms of lead-poisoning „ 320-324 
 
 Hemorrhages 325-328 
 
 Burns and sprains 33°-33* 
 
 The throat 33 2- 33S 
 
 The ears 33^-339 
 
 General directions concerning medicines, 
 baths, bandaging, gargling, painting 
 
 swelling, etc 34°~373 
 
 Numbers pages 202-204 
 
 The work is well done, and calculated to be of great 
 service to those who w^ish to acquire familiarity with the 
 phrases used in questioning patients. More than this, we 
 believe it would lie a great help in acquiring a vocabulary 
 to be used in reading medical books, and that it would fur- 
 nish an excellent basis for beginning a study of any one of 
 the languages which it includes. — Medical and Surgical 
 Reporter. " 
 
 Many other books of the same sort, with more ex- 
 tensive vocabularies, have been published, but, from their 
 size, and from their being usually devoted to equivalents 
 in English and one other language only, they have not had 
 ihe advantage which is pre-eminent in this — convenience. 
 It is handsomely printed, and bound in flexible red leather 
 in the form of a diary. It would scarcely make itself felt 
 in one's hip-pocket, and would insure its bearer against any 
 ordinary conversational difficulty in dealing with foreign- 
 speaking people, who are constantly coming into our city 
 hospitals. — New York Medical Journal. 
 
 In our larger cities, and in the whole Northwest, the 
 physician is constantly meeting with immigrant patients, 
 to whom it is diffioult for him to make himself understood, 
 <or to know what they say in return. This difficulty will 
 
 be greatly obviated by use of this little work. — The Phy- 
 sician and Surgeon. 
 
 The phrases are well selected, and one might practice 
 long without requiring more of these languages than this 
 little book furnishes. — Phila. Medical Times. 
 
 How oftin the physician is called to attend those with ~ 
 whom the English language is unfamiliar, and many phy- 
 sicians are thus deprived of the means, save through an - 
 interpreter, of arriving at a correct knowledge on which to 
 base a diagnosis. An interpreter is not always at hand, 
 but with this pocket interpreter in your hand you are able 
 to ask all the questions necessary, aud receive the answer 
 in such manner that you will be able to fully comprehend. 
 — The Medical Brief. 
 
 This' little volume is one of the most ingenious aids 
 to the physician which we have seen. We heartily com- 
 mend the book to any one who, being without a knowledge ■ 
 of the foreign languages, is obliged to treat those who do 
 not know our own language. — St. Louis Courier of Medi- 
 cine. 
 
 ~- It will rapidly supersede, for the practical use of the 
 doctor who cannot take the time .to learn another language, 
 all other suggestive works. — Chicago Medical Times. 
 
 18 
 
 (F. A. DAVIS, Medical Publisher, Philadelphia, Pa., U.S.A.) 
 
An Important Aid to Students in the Study of Anatomy. 
 
 Three Charts op 
 
 The Nervo- Vascular System. 
 
 PART I.— THE NERVES. 
 
 BART II.— THE ARTERIES. 
 
 PART III.— THE VEINS. 
 
 Arranged by W. HENRY PRICE, A.M., M.D., AND S. POTTS EAGLETON. 
 ENDORSED BY LEAblNG ANATOMISTS. 
 
 PRICE, IN THE UNITED STATES AND CANADA, 50 CENTS, NET, COMPLETE; 
 GREAT BRITAIN, 2s. 6d. FRANCE, 3 fr. 60. 
 
 "THE NERVO- VASCULAR SYSTEM' OP CHARTS" far Excels Everjr Other System 
 in their Completeness, Compactness, and Accuracy. 
 
 Part I. The Nerves. — Gives, in a clear form not only the Cranial 
 and Spinal Nerves, showing the formation of the different Plexuses 
 and their .branches, but also the complete distribution of the 
 (Sympathetic Nerves, thereby making it the most complete and 
 concise chart of the Nervous System yet published. 
 
 Part II. The Arteries. — Gives a unique grouping of the Arterial 
 System, showing the divisions and subdivisions of all the vessels, 
 beginning from the heart and tracing their continuous distribution 
 to the periphery, and showing at a glance the terminal branches 
 of each artery. 
 
 Part III. The Veins. — Shows how the blood from the periphery 
 Of the body is gradually collected by the larger veins, and these 
 coalescing forming still larger vessels, until they finally trace 
 themselves into the Right Auricle of the heart. 
 
 It is therefore readily seen that " The Nervo-Vascular System of 
 Charts" offers the following superior advantages: — 
 
 1. It is the only arrangement which combines the Three Systems, 
 and yet each is perfect and distinct in itself. 
 
 2. It is the only instance of the Cranial, Spinal, and Sympathetic 
 Nervous Systems being represented on one chart. 
 
 3. From its neat size and clear type, and being printed only upon 
 one side, it may be tacked up in any convenient place, and is always 
 ready for freshening up the memory and reviewing for examination. 
 
 4. The nominal price for which these charts are sold places them 
 within the reach of all. 
 
 For the student of anatomy there can possibly be no 
 more concise way of acquiring a knowledge of the nerves, 
 reins, and arteries of the human system. It presents at a 
 .glance their trunks and branches in the 'great divisions of 
 the body. It will save a world of tedious reading, and will 
 impress itself on the mind as no ordinary vade mecum, 
 even, could. Its price is nominal and its value inestima- 
 ble. No student should be without it.— Pacific Record of 
 Medicine and, Surgery. 
 
 We take pleasure in calling attention to these charts, 
 as they are so arranged that a study of them will serve to 
 impress them more mdellibly on your mind than can be 
 gained in any other way. They are also valuable for 
 reference. — Sfedical Brief. 
 
 These are three admirably arranged charts for the 
 use of students, to assist in memorizing their anatomical 
 studies. — Buffalo Med. and Swrg. Jour. 
 
 1 This is a series of charts of the nerves, arteries, and 
 
 veins of the human body, giving names, origins, distribu- 
 tions, and functions, very convenient as memorizers and 
 reminders. A similar series, prepared by the late J. H. 
 Armsby, of Albany, N. Y., and framed, long found a place 
 in the study of the writer, and on more than one occasion ' 
 was the means of saving precious moments that muBt 
 otherwise have been devoted to tumbling the pages of ana- 
 tomical works.— ■ifed. Age. 
 
 These three charts will be of great assistance to 
 medical students. They can be hung on the wall and read 
 across any ordinary room. The price is only fifty cents for 
 the set. — Practice. 
 
 These charts have been carefully arranged, and will 
 prove to be very convenient for ready reference. They 
 
 are three in number, each constituting a part 
 
 It is a high recommendation that these charts have been 
 examined and approved by John B. Deaver, M.D., Demon- 
 strator of Anatomy in the University of Pennsylvania. — 
 Pacific Med. and Swrg. Jour, and Western Lancet, 
 
 (F. A. DAVIS, Medical Publisher Philadelphia, Pa., U.S.A.) 
 
 19 
 
BVEKX SANITARIAN SHOULD HAVE KOHE'S "TEXT-BOOK OF HYGIENE" 
 AS A WORK OF REFERENCE. 
 
 SECOND EEITIOIT.^ 
 
 =I3>T PEESS. 
 
 TEXT-BOOK OF HYGIENE: 
 
 A COMPREHENSIVE TREATISE ON THE PRINCIPLES AND PRACTICE OF PREVENTIVE MEDICINE 
 FROM AN AMERICAN STAND-POINT. 
 
 By GEORGE M. ROH^, M.O., 
 
 Frofessor of Obstetrics and Hygiene in the College of Physicians and Surgeons, Baltimore ; Director of the Maryland 
 
 Maternite ; Member of the American Public Health Association ; Foreign Associate of the Societe Francaise 
 
 d'Hygiene, of the Societe des Chevalierfl-Sauveteurs des Alpes Maritimes, eto. 
 
 Net Price, in the United States, 82.50; in Canada (duty paid), 92.75; in 
 Great Britain, lis. 3d. ; France, 16 tr. 80. 
 
 Second Edition— Thoroughly Revised and Largely Rewritten, with many Illustrations- 
 and Valuable Tables. Rohe's Hygiene is the Standard Text-Book in many Medical Colleges in the 
 . United States and Canada. It is a sound guide to the most modern and approved practice in Applied 
 Hygiene. This New Edition will he issued early in the Spring of 1890, in one handsome 
 Octavo volume of about 400 pages, bound in Extra Cloth. Read what competent critics have said of the 
 first edition of Rohe's "Text-Book of Hygiene": — 
 
 Nothing better for the teacher, practitioner, or student. 
 — Mississippi Valley Medical Monthly. 
 
 Contains a mass of information of the utmost impor- 
 tance.— Independent Practitioner. 
 
 Just the work needed by the medical student and the 
 busy, active, sanitary Officer. — Southern Practitioner. ■ 
 
 This very UBeful work. — American Jour, Med. Sciences. 
 
 Comprehensive in scope, well condensed, .clear in style, 
 and abundantly supplied with references. — Journal Amer- 
 ican Medical Association. 
 
 A storehouse of facts. — British Medical Journal. 
 
 Of invaluable assistance to the student. — Sanitary News. 
 
 This interesting and valuable book. — Pacific Medical 
 and Surgical Journal. 
 
 Based upon sound principles and good practice.— Phila- 
 delphia Medical Times. 
 
 Full of important matter, told in a very interesting 
 maimer. — Science. 
 
 In harmony with the most recent advances in pathology. 
 — Medical Times and Gazette, London. 
 
 JUST ISSUED 
 
 PHYSICIANS' AND STUDENTS' READY-REFERENCE SERIES 
 
 The Neuroses of the Genito-Urinary System 
 
 IN THE M-iPs-LE^ 
 WITH STERILITY AND IMPOTENCE. 
 
 DR. R. ULTZMANN, 
 
 Professor of Genito-Urinary Diseases in the University of Vienna. 
 TRANSLATED, WITH THE AUTHOR'S PERMISSION, BY 
 
 GARDNER W. ALLEN, M.D., 
 
 Surgeon in the Genito-Urinary Department Boston Dispensary. 
 
 Illustrated- 13mo. Handsomely Bound in Dark-Blue Clotli. Net Price, in the United! 
 States and Canada, SI. 00, Post-paid ; Great Britain, 4s. 6d. ; France, 6 fr. 20. 
 
 This great work upon a subject which, notwithstanding the great strides that have 
 been made in 'its investigation and the deep interest it possesses for all, is nevertheless 
 still but imperfectly understood, has been translated in a most perfect manner, and pre- 
 serves most fully the inherent excellence and fascinating style of its renowned and 
 lamented author. Full and complete, yet terse and concise, it handles - the subject with 
 such a vigor of touch, such a clearness of detail and description, and such a directness to 
 the result, that no medical man who once takes it up will be content to lay it down until 
 its perusal is complete, — nor will one reading be enough. 
 
 Professor Ultzmann was recognized as one of the greatest authorities in his chosen 
 specialty, and it is a little singular that so few of his writings have been translated into 
 English. Those who have been so fortunate as to benefit by his instruction at the Vienna 
 Polyclinic can testify to the soundness of his pathological teachings and the- success of his 
 methods of treatment. He approach ed the subject from a somewhat different point of 
 view from most surgeons, and this gives a peculiar value to the work. It is-believed, 
 moreover, that there is no convenient hand-book in English treating in a broad manner 
 the Genito-urinary. Neuroses. 
 
 SYNOPSIS OF CONTENTS. Fiest Part.— I. Chemical Changes in the Urine in 
 Cases of Neuroses. II. The Neuroses of the Urinary and of the Sexual Organs, classi- 
 fied as: 1, Sensory Neuroses ; 2, Motor Neuroses ; 3, Secretory Neuroses. Second Part. 
 
 Sterility and Impotence. 
 
 The Treatment in all Cases is Described Clearly and Minutely. 
 
 20 
 
 (F. A. DAVIS, Medical Publisher, Philadelphia, Pa., U.S.A.) 
 
Hay Fever 
 
 ITS SUCCESSFUL TREATMENT BY SUPERFICIAL ORGANIC 
 ALTERATION OF THE NASAL MUCOUS MEMBRANE. 
 
 CHARLES E. SAJOUS, M.O., 
 
 lecturer on Rhinology and Laryngology in Jefferson Medical College; Vice-President of the American LaryngologiCal 
 
 Association ; Officer of the Academy of France and of Fublio Instruction of Venezuela ; Corresponding 
 
 Member of the Royal Sooiety of Belgium, of the Medical Society of Warsaw (Poland)', 
 
 and of the Sooiety of Hygiene of France ; Member of the American 
 
 Philosophical Society', etc., etc. 
 
 WITH 13 ENGRAVINGS ON WOOD. 12mo. BOUND IN CLOTH. BEVELED 
 
 EDGES. PKICE, IN UNITED STATES AND CANADA, NET, 81.00; 
 
 GREAT BRITAIN, 4s. 3d.; FRANCE, 6 fr. 30. ' 
 
 The object of this little work is to place in the hands of the general 
 practitioner the means to treat successfully a disease which, until lately, 
 was considered as incurable; its history, causes, pathology, and treat- 
 ment are carefully described, and the latter is so arranged, as to be 
 practicable, by any physician. 
 
 Dr. Sajous' volume must command the attention of 
 "those called upon to treat this heretofore intractable com-_ 
 plaint. — Medical and Surgical Reporter. 
 
 Few have had the success in this disease which has 
 so much baffled the average practitioner as Dr. Sajous, con- 
 sequently his statements are almost authoritative. The 
 "book must be read to be f appreciated. — American Medical 
 Digest. 
 
 Dr. Sajous has admirably presented the subject, and, 
 m this method of treatment is now generally recognized 
 as efficient, we can recommend this book to all physicians 
 
 who are called upon to treat this troublesome disorder. — 
 Tlie Buffalo Medical and Surgical Journal. 
 
 The symptoms, etiology, pathology, and treatment) of 
 Hay Fever are fully and ably discussed. The reader will 
 not regret the expenditure of the small purchase price of 
 this work if he has cases of the kind to treat. — California 
 Medical Journal. 
 
 ' We are pleased with the author's views, and heartily 
 commend his book to the consideration of the profession. 
 — The Southern Clinic. 
 
 PHYSICIANS' AND STUDENTS' READY REFERENCE SERIES. 
 
 :3STO. 1.= 
 
 OBSTETRIC SYNOPSIS. 
 
 By JOHN S. STEWART, M.D., 
 
 Demonstrator of Obstetrics" and Chief Assistant in the Gynaecological Clinic of the Medico-Chirurgical 
 
 College of Philadelphia. 
 
 WITH AN INTRODUCTORY NOTE BY 
 
 WILLIAM S. STEWART, A.M., M.D., 
 
 Professqr of Obstetrics and Gynaecology in the Medico-Chirurgical College of Philadelphia. 
 
 42 ILLUSTRATIONS. 202 PAGES. 12 mo. HANDSOMELY BOUND IN DARK-BLUE CLOTH. 
 
 Price, Post-paid, in the United States and Canada, Net, $1.00; 
 Great Britain, 4s,. 3d. ; France, 6 fr. 20. 
 
 By students this work will be found particularly useful. It is based 
 upon the teachings of such well-known authors as Playfair, Parvin, 
 Lush, G-alabin, andCazeaux and Tarnier, and, besides containing much 
 new and important matter of great' value to both student and practi- 
 tioner, embraces in an Appendix the Obstetrical Nomenclature sug- 
 gested by Professor Simpson, of Edinburgh, and adopted by the 
 Obstetric 1 Section of the Ninth International Medical Congress held i» 
 Washington, D.C., September, 1887. 
 
 It is well written, excellently illustrated, and fully up 
 tm date in every respect. Here we find all the essentials of 
 Obstetrics in a nutshell, Anatomy, Embryology, Physi- 
 «l«gy. Pregnancy, Labor, Puerperal State, and Obstetric 
 Operations all being carefully and accurately described.— 
 Buffalo Medical and Surgical Journal. 
 
 It is clear and concise. The chapter on the develop- 
 ment of the ovum is especially satisfactory. The judicious 
 
 use of bold-faced type for headings, and italics for impor- 
 tant statemonts, gives the book a pleasing typographical 
 appearance.— Medical Record. 
 
 This volume is done with a masterly hand. The 
 scheme is an excellent one. . . . The whols is freely 
 and most admirably illustrated wi* well-drawn, new 
 engravings, and the book is of a very convenient sise.— 
 St. Louie Medical and Surgical Journal. 
 
 (F. A. DAVIS, Medical Publisher, Philadelphia, Pa., U. S. A.) 
 
DIPHTHERIA: 
 
 Croup, Tracheotomy, *s» Intubation. 
 
 FROM THE FRENCH OF A. SANNE. 
 
 TRANSLATED AND ENLARGED BY 
 
 HENRY Z. OILL, IVt.D;, LL.D. 
 
 
 United States. 
 
 Canada (duty paid). 
 
 Great Britain. 
 
 France. 
 
 Net Price, Post-paid, Cloth, - 
 
 ■ $4.00. 
 
 $140. 
 
 £ 0.18s. 
 
 24 fr. 60 
 
 " " Leather, 
 
 5.00. 
 
 5.50. 
 
 1. Is. 
 
 30 fr. 30 
 
 The' above work, recently isBued, is a translation from the French of Sann#s great 
 •work on " Diphtheria,*" by H. Z. Gill, late Professor of' Surgery in Cleveland, Ohio. 
 
 Sauna's work is quoted, directly or indirectly, by every writer since its publication, 
 as the highest authority, statistically, ' theoretically, and practically. The translator, 
 having given special study to the subject for many years, has added over fifty pages, in- 
 cluding the Surgical Anatomy, Intubation, and the recent progress in the branches 
 treated down to the present date; making it, beyond question, the most complete work 
 extant on the subject of Diphtheria in the English language. 
 
 Facing the title-page is found a very fine Colored Lithograph Plate of the parts con- 
 cerned in Tracheotomy. Next follows an illustration of a cast of the entire Trachea, and 
 bronchi to the third or fourth division, in one piece, taken. from a photograph of a case- 
 in which the cast was expelled during life from a patient sixteen'years old. This is the 
 most complete cast of any one recorded. 
 
 Over fifty other illustrations of the surgical anatomy of instruments, etc., add to the 
 practical value of the work. 
 
 Diphtheria having become such a prevalent, wide-spread, and fatal disease, no- 
 general practitioner can afford to be without this work. It will aid in preventive meas- 
 ures, stimulate .promptness in the application of, and efficiency in, treatment, and 
 , moderate the extravagant views which have been entertained regarding certain specifics- 
 in the disease Diphtheria. 
 
 A full Index accompanies the enlarged volume, also a List of Authors, making 
 altogether a very handsome illustrated volume of over 680 pages. 
 
 In this book we have a complete review and 
 compendium of all worth preserving that has hitherto 
 been said or written concerning diphtheria and the 
 kindred subjects treated of by" our author, collated, 
 arranged, and commented on by both author and 
 translator. The subject of intubation, so recently 
 revived in this country, receives a very careful and 
 "impartial discussion at the hands of the translator, 
 and a most Valuable chapter on the prophylaxis of 
 diphtheria and croup closes the volume. 
 
 His notes are frequent and full, displaying deep 
 knowledge of the subject-matter. Altogether the 
 book is one that is valuable and timely, and one 
 that should be in the hands of every general practi- 
 tioner. — St. Louts Med. and Surgical Journal. 
 
 Sanne's work is quoted, directly or indirectly,. 
 by many writers since its publication, as the highest 
 authority, statistically, theoretically, and practi- v 
 cally. The translator, having given special study 
 to the subject for many years, has added over fifty 
 pages, including the surgical anatomy, intubation, 
 and the recent progress in the branches treated, 
 down to the present date ; making it, beyond ques- 
 tion, the most complete work extant on the subject 
 of diphtheria in the English language. Diphtheria, 
 having become such a prevalent, wide-spread, and 
 fatal disease, no -general practitioner can afford to- 
 be without this work. It will aid in preventive 
 measures, stimulate promptness in application of, and 
 efficiency in, treatment. — Southern Practitioner. 
 
 STANTON'S PRACTICAL AND SCIENTIFIC PHYSIOGNOMY 
 
 M:0"\x7" TO K.E-A.ID . FACES." 1 
 
 By MARY OLMSTED STANTON. 
 
 Copiously Illustrated. 
 
 , Two Large Octavo Volumes. 
 
 United States. Canada (duty paid). Great Britain. France. 
 
 S5.00 SS.r.O £1.18. - 30 fr. 30> 
 
 6.00 6.60 1.68. 36 fr. 40 
 
 7.00 7.7.0 1.9s. 43 fr. 3» 
 
 fl.OO Discount for Cash. Sold only by Subscription, or sent direct on receipt of price, shipping expenses prepaid. 
 
 Price, per Volume, Cloth, 
 « << Sheep, 
 
 « " Half-Russia, 
 
 The author, Mrs. Mary O. Stanton, has given over twenty years to the preparation of this work. Her 
 style. is easy, and, by her happy method of illustration of every point, the book reads like a novel, and 
 memorizes itself. To physicians the diagnostic information conveyed is invaluable. To the general 
 reader each page opens a new train of ideas. (This book has no reference whatever to Phrenology.) 
 
 22 
 
 (F. A. DAVIS, Medical Publisher, Philadelphia, Pa., U.S.A.) 
 
IMPORTANT ANNOUNCEMENT. 
 
 A TREATISE 
 
 ON — 
 
 Materia Medica, Pharmacology, ^ Therapeutics. 
 
 BY 
 
 cJOHN V. SHOEMAKER, A.M., M.D., 
 
 Professor pf Materia Medica, Pharmacology, and Therapeutics in the Medico-Chirurgical College of Phila- 
 delphia, and Member American Medical Association, 
 
 AND 
 
 * cJOHN AVLDE, M.D., 
 
 Demonstrator of Clinical Medicine and of Physical Diagnosis in the Medico-Chirurgical College of Phila- 
 delphia, and Member American Medical Association. 
 
 IN TWO HANDSOME ROYAL OCTAVO VOLUMES. 
 
 MET PRICES, per Volume, in United States: Cloth, $2.50; Sheep, $3.25. In Canada 
 
 (duty paid) : Cloth, $2.75 ; Sheep, $3.55. In Great Britain: Cloth, lis. 3d. ; 
 
 Sheep, 14s. 6d. In France : Cloth, 16 fr. 20 ; Sheep, 20 fr. 20. 
 
 THE Publisher takes pleasure in announcing that Volume I of this eagerly -looked-for 
 work is Now Ready, and that the utmost diligence will be exercised: in filling with 
 the greatest rapidity, and in regular order of receipt, the numerous orders now awaiting 
 its publication. 
 
 The general plan of the work embraces three parts, each of which is practically inde- 
 pendent of the other, as will be understood from the accompanying analysis, and of which 
 jarts I and II are contained in the volume now announced ; this, however, is not the only 
 advantage accruing from the preparation of the work in two volumes. Each volume will 
 thus be much smaller and more convenient to handle,^ while some may wish to secure a 
 particular portion of the work, and to them the cost is lessened. 
 
 Several blank sheets of closely -ruled letter-paper are inserted at convenient places in 
 the work, thus rendering it available for the student and physician to add valuable notes- 
 concerning new remedies and other' important matters. 
 
 Part I embraces three subdivisions, as follow : — 
 
 Mrst. A brief synopsis Upon the subject of pharmacy, in which is given a clear and 
 concise description of the operations and preparations taken into account Dy the physician 
 when prescribing medicines, together with some practical suggestions regarding the most 
 -desirable methods for securing efficiency and palatability. 
 
 Second. A Classification of Medicines is presented under the head of " General Phar- 
 macology and Therapeutics," with a, view to indicate more especially the methods by 
 which the economy is affected. Thus' there are' Internal and External Remedies, and, 
 besides, a class termed Chemical Agents, including Antidotes, Disinfectants, and Anti- 
 septics, and an explanatory note is appended to each group, as in the case of Alteratives, 
 Antipyretics, Antispasmodics, Purgatives, etc. 
 
 Third. A Summary has been prepared upon Therapeutics, covering methods of 
 Administration, Absorption and Elimination, Incompatibility, Prescription-writing, and 
 Dietary for the Sick, this section of the work embracing nearly one hundred and fifty 
 pages. 
 
 Part II is devoted to "Remedies and Remedial Agents Not .Properly Classed with 
 Drugs," and includes elaborate articles upon the following topics: Electro-Therapy, 
 Hydro-Therapy, Masso-Therapy, Heat and Cold, Oxygen, Mineral-Waters, and, in addi- 
 tion thereto, other subjects, perhaps of less significance to the practitioner, such as Clima- 
 tology, Hypnotism and Suggestion, Metallo-Therapy, Transfusion, and Baunscheidtismus, 
 have received a due share of attention. This section of the work embraces over two hun- 
 dred pages, and will be found especially valuable to the student and recent graduate, as. 
 these articles are fully abreast of the times. < 
 
 Volume II, which is Part III of the work, is wholly taken up with the consideration 
 of drugs, each remedy being 1 studied from three points of view, viz., the Preparations, or 
 Materia Medica; the Physiology and Toxicology, or Pharmacology, and, lastly,, its 
 Therapy. It will be Ready about May 1, 1890. 
 
 The typography of the work will be found clean, sharp, and easily read without 
 injury to the visual organs, and the bold-face type interspersed throughout the text makes 
 the different subjects discussed quick of reference. The paper and binding will also be up 
 to the standard, and nothing will be left undone to make the work first-class in every 
 particular, 
 
 (F. A, DAVIS, Medical Publisher, Philadelphia, Pa., U.S A.) 23 
 
=JUST PUBLISHED. 
 
 THE PHYSIOLOGY 
 
 OF THE 
 
 Domestic Animals. 
 
 A TEXT-BOOK FOR VETERINARY AND MEDICAL 
 STUDENTS AND PRACTITIONERS. 
 
 — BY— 
 
 ROBERT MEADE SMITH, A.M.,*M.D., 
 
 Professor of Comparative Physiology in University of Pennsylvania ; Fellow of the College of Physicfcms 
 
 and Academy of the Natural Sciences, Philadelphia ; of the American Physiological 
 
 1 Society ; of the American Society of Naturalists ; Associe Etranger 
 
 de la Societe Francaise D' Hygiene, etc. 
 
 Fie. 117. — Parotid and Submaxillary Fistula in the Horse, after Colin. 
 
 {Thanhoffer and Tormay.') 
 
 K, K', rubber bulbs for collecting saliva ; c#, cannula in the parotid duct. 
 
 In One Handsome Royal Octavo Volume of over 950 Pages, Pro- 
 fusely Illustrated -with more than 400 Fine "Wood- 
 Engravings and many Colored- Plates. 
 
 NET PRICES, CLOTH, . 
 SHEEP,.. 
 
 United States. 
 
 . $5.00 
 . e.oo 
 
 Canada (duty paid). 
 
 $5.50 
 6.60 
 
 Great Britain. 
 
 £1. 
 1.6. 
 
 France. 
 
 30 fr. 30. 
 36 fr. 20. 
 
 HTHIS new and important work, the most thoroughly complete in the English language 
 on this subject, has just been issued. In it the physiology of the domestic animals 
 is treated in a most comprehensive manner, especial prominence being given to the sub- 
 ject of foods and fodders, and the character of the diet for the herbivora under different 
 conditions, with a full consideration of their digestive peculiarities. Without being over- 
 burdened with details, it forms a complete text-book of physiology, adapted to the use of 
 students and practitioners of both veterinary and human medicine. This work has already 
 been adopted as the Text-Book on Physiology in the Veterinary Colleges of the United 
 States, Cheat Britain, and Canada. 
 
 24 
 
 (F. A. DAVIS, Medical Publisher, Philadelphia, Pa., U.S.A.) 
 
Abstracts froa Reviews^-Smith's Physioloqy. 
 
 ^3^ 
 
 :S& 
 
 The work throughout is well balanced. 
 Broad, though not encyclopaedic, concise 
 without sacrificing clearness, it' combines 
 the essentials of a successful text-book. It 
 is eminently modern, and, although first in 
 the field, iB of such grade of excellence that 
 successors must reach a high standard be- 
 fore they become competitors. — Annals of 
 Surgery. 
 
 Dr. Smith has conferred a great benefit 
 upon the veterinary profession by his con- 
 tribution to their use of a work of immense 
 value, and has provided the American vet- 
 erinary student with the only means by 
 which he can become properly familiar with 
 the physiology of our domestic animals. 
 Veterinary practitioners and graduates will 
 read it with pleasure. Veterinary students 
 will readily acquire needed knowledge from 
 its pages, and veterinary schools which 
 would be well equipped for the work they 
 aim to perform cannot ignore it as their 
 text-book in physiology. — American Veteri- 
 nary Review. 
 
 Dr. Smith's presentment of his subject 
 is as brief as the status of the science per- 
 mits, and to this much-desired conciseness 
 he has added an equally welcome clearness 
 of statement. The illustrations in the work 
 are exceedingly good, and must prove a 
 valuable aid to the full understanding of 
 (he text. — Journal of Comparative Medicine 
 and Surgery. 
 
 "We have examined tb e work in a great 
 many particulars, , and find the views so 
 correct, where we have had the means of 
 comparison of statements with those of some. 
 recognized authority, that we will be com- 
 pelled hereafter to look to this* work as the 
 text-book on {fhysiology of animals. The 
 -book will prove of incalculable benefit to 
 veterinarians wherever they may be found ; 
 and to the country physician, who is often 
 called upon to attend to sick animals as 
 well as human beings, we would say, lose 
 no time in getting this work and let him 
 familiarize himself with the facts it con- 
 tains. — Virginia Medical Monthly. 
 
 Altogether, Professor Smith's " Physi- 
 olpgy of the Domestic Animals" is a happy 
 production, and will be hailed with delight 
 in both the human medical and veterinary 
 medical worlds. It should find its place 
 besides in all agricultural libraries. — Paul 
 Paquin, M.D., VS., in the Weekly Medical 
 Review. 
 
 It may be said that it supplies to the 
 veterinary student the place in physiology 
 that Chauveau's incomparable work — " The 
 Comparative Anatomy of the Domesticated 
 Animals" — occupies in anatomy. Higher 
 praise than this it is not possible to bestow. 
 And since it is true that the same laws of 
 physiology which are applicable to the vital 
 process ofthe domestic animals are also ap- 
 plicable to man, a perusal of this carefully 
 written book will repay the medical student 
 or practitioner. — Canadian Practitioner. 
 
 ~3- 
 
 The work before us fills the hiatus of 
 which complaint has ,so often been made, 
 and gives in the compass of less thau a 
 thousand pages a very full and complete 
 account of the functions of the body in both 
 carniyora and herbivora. The author has 
 judiciously made the nutritive functions the 
 strong point of the work, and has devoted 
 special attention to the subject of foods and 
 digestion. In looking through the other 
 sections ofthe work, it appears to us that a 
 just proportion of space is assigned to each, 
 in view of their relative' importance to the 
 practitioner. Thus, while the subject of re- 
 production is dismissed in a few pages, a 
 chapter of considerable length is devoted 
 to locomotion, and especially to the gaite of 
 the horse. — London Lancet. 
 
 This is almost the only work of the kind 
 in the English language, and it so fully 
 covers every detail of general and special 
 physiology that there is no room for any 
 rival. . The excellence of typographical 
 work, and the wealth, beauty, and clear- 
 ness of the illustrations,' correspond with 
 the thoroughness , and clearness of the 
 treatise. — Albany Medical Annals. 
 
 It is not often that the medical profes- 
 sion has the opportunity of reading a new 
 book upon a new subject, and doubtless 
 English-speaking physicians will feel grate- 
 ful to Professor Smith for his admirable 
 and pioneer work in a branch of medical 
 science upon which a great amount of ignor- 
 ance prevails. . . . The last portion of 
 the work is devoted to the reproductive 
 functions, and contains much valuable in- 
 formation upon a portion of animal physi- 
 ology concerning which many are ignorant.. 
 The book is a, valuable one in every way, 
 and will be consulted largely by veterinary , 
 and medical students and practitioners. — 
 Buffalo Medical and Surgical , Journal. 
 
 The appearance of this work is most op- 
 portune. It will be much appreciated, as 
 tending to secure the thorough comprehen- 
 sion of function in the domesticated ani- 
 mals, and, in consequence, their general 
 well-being — a matter of world-wide impor- 
 tance. With a thorough sense of gratifica- 
 tion we have perused its pages : throughout 
 we find clear expression, clear , reasoning, 
 and that patient accumulation of facts so 
 valuable in a text-book for students. — 
 British Medical Journal. 
 
 For notice this time, I take up the vol- 
 ume on the " Physiology of the Domestic 
 Animals," by Dr. R. Meade Smith, a volume 
 of 938 pages, closely printed, and dealing 
 with its subject in a manner sufficiently ex- 
 haustive to insure its place as a text-book 
 for fifteen years at the very least. Its 
 learning is only equaled by its industry, 
 and its industry by the consistency and 
 skill with which its varied parts are brought 
 together into harmonious, lucid, and in- 
 tellectual unity.— Dr. Benjamin Ward 
 Richardson, in the London Asclepiad. 
 
 ~SSc- 
 
 (F. A. DAVIS, Medical Publisher, Philadelphia, Pa., U.S.A.) 
 
TH b — ~ 
 
 International pocket Medina! Popmnlapjj, 
 
 ARRANGED THERAPEUTICALLY. 
 
 By G. SUMNER WlTHERSTlNE, M.S., M.D., 
 
 Associate Editor of the "Annual of the Universal Medical Sciences ;" Visiting Physician of the Home for 
 the Aged, Germantown, Philadefphia; Late House-Surgeon Charity Hospital, New York. 
 
 \ 
 
 More than 1800 Formula* from Several Hundred Well-finown Authorities. 
 
 With an Appendix containing a Posological Table, the newer remedies included ; Important lncompati- 
 bles ; Tables on Dentition and the Pulse ; Table of Drops in a Fluidrachm and Doses of Laudanum graduated 
 for age ; Formulae and Doses of Hypodermic Medication, including the newer remedies ; Uses of the Hypo- 
 dermic Syringe; Formulae and Doses for Inhalations, Nasal Douches, Gargles, and Eye-washes ; Formula; 
 for Suppositories ; Use of the Thermometer in Disease ; ' Poisons, Antidotes, and Treatment ; Directions for 
 Post-Mortem and Medico-Legal Examinations; Treatment-of Asphyxia, Sun-stroke, etc. ; Anti-emetic 
 Remedies and Disinfectants; Obstetrical Table; Directions for Ligation of Arteries ; Urinary Analysis; 
 Table of Eruptive Fevers : Motor Points for Electrical Treatment, etc., etc. 
 
 This work, the best and most complete of its kind, contains about 275 printed pages, besides 
 extra blank leaves. Elegantly printed, with red lines, edges, and borders ; with illustrations. Boand 
 in leather, with side flap. It contains more than 1800 Formulae, exclusive of the large amount of 
 - other very valuable m,atter. / 
 
 Price, Post-paid, in the United States and Canada, $2.00, net ; 
 Great Britain, 8s. 6d. ; France, 12 fr. 40. 
 
 TFN QPAQfiMQ WHY EVERY MEDICAL MAN SHOULD POSSESS A COPY OF - 
 I CIV nCAQUWQ THE INTERNATIONAL POCKET MEDICAL FORMULARY. 
 
 ■ X. Because it is a handy book of reference, replete with.the choicest formula; (over 1800 in number) of 
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 known American and foreign modern authorities. 
 
 3. Because it contains the latest, largest (66 formulae) and most complete collection of hypodermic formulae 
 (including the latest pew remedies) ever published, with doses and directions for their use in over 
 fifty different diseases and diseased conditions. 
 
 1- Because its appendix is brimful of information, invaluable in office work, emergency cases, and the 
 daily routine of practice. 
 
 5. Because it is a reliable friend to consult when, in a perplexing or obstinate case, the usual line of treat- 
 ment is of no avail. (A hint or a help from the best authorities, as to choice of remedies, correct 
 dosage, and the eligible, elegant, and most palatable mode of exhibition of the same.) 
 
 6> Because it is compact, elegantly printed and bound, well illustrated, and of convenient size and shape 
 for the pocket. 
 
 7. Because the alphabetical arrangement of the diseases and a thumb-letter index render reference rapid 
 and easy. x / 
 
 S. Because blank leaves, judiciously distributed throughout the book, afford a place to record and index 
 • favorite formulae. 
 
 9. Because, as a student, he needs it for study, collateral reading, and for recording the favorite prescriptions 
 
 of his professors, in lecture and clinic ; as a recent graduate, he needs it as a reference hand-book for 
 daily use in prescribing ^gargles, nasal douches, inhalations, eye-washes, suppositories, incompatible, 
 poisons, etc.) ; as an old practitioner , he needs it to refresh his memory on old remedies" and combi- 
 nations, and for information concerning newer remedies and more m6dern approved plans of treatment. 
 
 10. Because no live, progressive medical man can afford to be without it. 
 
 It is sometimes important that such prescriptions as 
 have been well established in their usefulness be preserved 
 for reference, and this little volume serves such a purpose 
 better than any other we have seen. — Columbus Medical 
 Journal. 
 
 Without doubt this book is the best one of its class 
 
 that we have ever seen The printing, binding. 
 
 and general appearance of the volume are beyond praise. — 
 University Medical Magazine. . 
 
 It may be possible to get more crystallized knowledge 
 in an equally small space, but it does not seem probable. — 
 Medical Classics. 
 
 A very handy and valuable book of formulae for the 
 physician's pocket. — St. Louis Medical and Surg. Journal. 
 
 This little pocket-book contains an immense number 
 of prescriptions taken from high authorities in this and 
 other countries. — Northwestern Lancet. 
 
 This one is the most complete as well as the most 
 conveniently arranged of any that have come under our 
 attention. The diseases are enumerated in alphabetical 
 order, and for each the latest and most approved remedies 
 from the ablest authorities are prescribed. The book is in- 
 dexed entirely through after the order of the first pages of 
 a ledger, the index letter being printed on morocco leather 
 and thereby made very diirable. — Pacific Medical Journal. 
 
 Itisa'book desirable for the old practitioner and for 
 his younger brothers as well.— St. Joseph Medical JBerald. 
 
 As long as "combinations" are sought such a book 
 will be of value, especially to those who cannot spare the 
 time required to learn enough of incompatibilities before 
 commencing practice to avoid writing incompatible and 
 dangerous prescriptions. The constant use of such a book 
 by such prescribers would save the pharmacist much 
 anxiety. — The Druggists' Circular. 
 
 In judicious selection, in accurate nomenclature, in 
 arrangement, and in style it leaves nothing to be desired. 
 The editor and the publisher are to be congratulated on the 
 production of the very best book of its class. — Pittsburgh 
 Medical Reviexc. 
 
 One must see it to realize how much information can 
 be got into a work of so little bulk. — Canada MedicnL 
 Record. 
 
 To the young physician just starting out in practice 
 this little book will prove an acceptable companion. — 
 Omaha Clinic. 
 
 The want of to-day is crystallized knowledge. This 
 neat little volume contains in it the most accessible form. 
 It is bound in morocco in pocket form, with alphabetical 
 divisions of diseases, so that it is possible to turn instantly 
 to the remedy, whatever may be the disorder or wherever 
 
 the patient may be situated To the physician 
 
 it is invaluable, and others should not be without it. We 
 heartily commend the work to our readers.— Minnesota 
 Medical Journal. 
 
 26 
 
 (F. A. DAVIS, Medical Publisher, Philadelphia, Pa., U.S. A 
 
JUST ISSUED. 
 
 PHYSICIANS' AND STUDENTS' READY-REFERENCE SERIES. 
 
 -ZfcTo. 3, ' 
 
 Synopsis of Human Anatomy: 
 
 Being a Complete Compend of Anatomy, including the 
 Anatomy of the Viscera, and Numerous Tables. 
 
 JAMES K. YOUNG, M.D., 
 
 Instructor in Orthopaedic Surgery and Assistant Demonstrator of Surgery, University of Pennsylvania; 
 Attending Orthopaedic Surgeon, Out-Patient Department, University Hospital, etc. 
 
 ILLUSTRATED WITH 76 WOOD-ENGRAVINGS. 390 PAGES. 
 
 12mo. HANDSOMELY BOUND IN DARK-BLUE CLOTH. 
 
 Price, Post-paid, in the United States and Canada, 
 Great Britain, 6s. 6d. ; France, 9 fr. 25. 
 
 1.40, net; 
 
 While the author has prepared this work especially • for students, sufficient de- 
 scriptive matter has been added to render it extremely valuable to the busy practitioner 
 particularly the sections on the Viscera, Special Senses, 
 and Surgical Anatomy. 
 
 The work includes a complete account of Osteology, 
 Articulations and Ligaments, Muscles, Fascias, Vascular 
 and Nervous Systems, Alimentary, Vocal, and Respiratory 
 and Genito-Urinary Apparatuses, the Organs of Special 
 Sense, and Surgical Anatomy. 
 
 In addition to a most carefully and accurately prepared 
 text, wherever possible, the value of the work has been 
 enhanced by tables to facilitate and minimize the labor of 
 students in acquiring a thorough knowledge of this impor- 
 tant subject. The (section on the teeth has also been 
 especially prepared to meet the requirements of students 
 of Dentistry. 
 
 In its preparation, Gray's Anatomy [last edition], 
 edited by Keen, being the anatomical work most used, has 
 been taken as the standard. ■» 
 
 
 
 
 
 
 
 J/J&L 
 
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 Anatomy is a theme that allows such concen- 
 tration better than, most medical subjects, and, as 
 the accuracy of this little book is beyond question,^ 
 its value is assured. As a companion to the dis- 
 secting -table, and a convenient reference for the 
 practitioner, it has a definite field of usefulness. — 
 Pittsburgh Medical Review. 
 
 This is a very carefully prepared compend of 
 anatomy, and will be useful to students'for college 
 or hospital examination. There are some excellent 
 tables in the work, particularly the one showing the' 
 origin, course, distribution, and functions of the 
 cranial neVves. — Medical Record. 
 
 Dr. Young has compiled a very useful book. 
 We are not inclined to approve - of compends as a 
 general rule, but it certainly serves a good purpose 
 to have the subject of anatomy presented in a com- 
 pact, reliable way, and in a book easily carried to 
 the dissecting-room. This the author has done. 
 The book is well printed, and the illustrations well 
 selected If a student can indulge in more than one 
 work on anatomy, — for, of course, he must have a 
 general treatise on the subject, — he can hardly do 
 better than to purchase this compend! It will save 
 the larger work, and can always be with him during 
 the hours of dissection. — Buffalo Medical and 
 Surgical Journal. 
 
 Excellent tables have been arranged, which 
 tersely and clearly present important anatomfcal 
 facts, and the book will be found very convenient 
 for ready reference. — Columbus Medical Journal' 
 
 The book is much more satisfactory than -the 
 "remembrances" in vogue, and yet is not too cum- 
 bersome to be carried around and read at odd 
 moments — a property which the student will readily 
 appreciate. — Weekly Medical Review. 
 
 If a synopsis of human anatomy may serve_a 
 purpose, and we believe it does, it is very important 
 that the synopsis should be a good one.' In this 
 respect the above work may be recommended as a 
 reliable guide. Dr. Young has shown excellent 
 judgment in his selection of illustrations, in the 
 numerous tables, and in the classification of the 
 various subjects. — Therapeutic Gazette. 
 
 Every unnecessary word has been excluded, out 
 of regard to the very limited time at the medical 
 student's disposal. It is also good as a reference 
 book, as it presents the facts about which he wis-hes 
 to refresh his memory in the briefest manner 
 consistent with clearness. — New York Medical 
 Journal: 
 
 it is certainly concise and accurate, and should 
 be in the hands of every student and practitioner. — 
 The Medical Brief. 
 
 (F. A. DAVIS, Medical Publisher, Philadelphia, Pa., U.S.A.) 
 
--:-=-^ ANNUA L==— 
 
 OF THE 
 
 Universal Medical Sciences. 
 
 A YEARLY REPORT OF THE PROGRESS OF THE , GENERAL SANITARY 
 SCIENCES THROUGHOUT THE WORLD. 
 
 Edited by CHARLES E. SAJOTJS, M.D., 
 
 LECTURER ON LAKVNGOLOGY AND RHINOLOGY IN JEFFERSON MEDICAL COLLEGE, PHILADELPHIA, ETC.. 
 
 AND 
 
 SEVENTY ASSOCIATE EDITORS, 
 
 Assisted by over TWO HUNDRED Corresponding Editors and Collaborators. 
 
 In Five Royal Octavo Volumes of about 500 pages each, bound in Cloth and Half-Russia, 
 
 Magnificently Illustrated with Chromo- Lithographs, Engravings, 
 
 Maps, Charts, and Diagrams. 
 
 =-^ BEIrVO INTENDED=^ 
 
 1st. To assist the busy practitioner in his efforts to keep abreast of the rapid strides 
 of all the branches of his profession. 
 
 Hd. To avoid for him the loss of time involved in searching for that which is new in 
 the profuse and constantly increasing medical literature of our day.' 
 
 3d. , To enable him to obtain the greatest possible benefit of the limited time he is 
 able to devote to reading, by furnishing him with new matter only. 
 
 4th. To keep him imormed of the work done by all nations, including many other- 
 wise seldom if ever heard from. 
 
 5th. To furnish him with a review of all the new matter contained in the periodicals 
 to which he cannot (through their immense number) subscribe. 
 
 6th. To cull for the specialist all that is of a progressive nature in the general and 
 special publications of all nations, and obtain for him special - reports from countries in 
 which such publications do not exist, and 
 
 Lastly, to enable any physician to possess, at a moderate cost a complete 
 
 CONTEMPORARY HISTORY OF UNIVERSAL MEDICINE, 
 
 edited by many of America's ablest teachers, and superior in every detail, of print, paper, 
 binding, etc., etc., a befitting continuation of such .great works as " Peppers System of 
 Medicine," "Ashhurst's International Encyclopedia of Surgery," "Buck's Keference 
 Hand-Book of the Medical Sciences," etc., etc. 
 
 EDITORIAL STAFF of the ANNUAL of the UNIVERSAL MEDICAL SCIENCES. 
 
 issue; of iS8S. 
 
 Chief Editor, DR. CHARLES E. SAJOtJS, Philadelphia 
 
 ASSOCIATE STAFF. 
 
 Volume I. — Obstetrics, Oynoecoloyy, Pediatrics, Anatomy, Physiology, Pathology, 
 Histology, and Embryology . 
 
 Prof. Wm. L. Richardson, Boston. 
 Prof. Theophilna Parvin, Philada. 
 Prof. Louis Starr, Philadelphia. 
 Prof. J. Lewis Smith, New York City. 
 Prof. Paul F. Mundi and Dr. E. H. 
 Grandin, New York City. 
 
 Prof. William Goodell and Dr. W. C. | Prof. H. Newell Martin and Dr. W. H. 
 
 Goodell, Philadelphia. 
 Prof. E, C. Dndley, Chicago. 
 Prof. W. H. Parish, Philadelphia. 
 Prof. William S. Forbes, Philadelphia. 
 
 Howell, Baltimore. 
 Dr. Chas. S. Minot, Boston. 
 Dr. E. O. Shakespeare, Philadelphia. 
 Dr. W. X. Sudduth, Philadelphia. 
 
 "Volume II. — Diseases of the Respiratory, Circulatory, Digestive, and Nervous Systems: 
 Fevers, Exanthemata, etc., etc. 
 
 Prof. A. L. Loomis, New York City. 
 Prof. Jas. T. Whittaker, Cincinnati. 
 Prof. W. H. Thomson, New York City 
 Prof. W. W. Johnston, Washington. 
 Prof Jos. Leidy, Philadelphia. 
 
 Prof. E. C. Seguin, New York City. 
 Prof. E. C. Spitzka, New York Citv. 
 Prof.Chas.K. Mills and Dr. J. H.Lloyd 
 
 Philadelphia. 
 Prof. Franois Delaneld, N. Y. City. 
 
 Volume HI. — General Surgery, Venereal Diseases, Anaesthetics, Surgical Dressings 
 
 Dietetics, etc., etc. 
 
 Prof. Jas. Tyson, Philadelphia. 
 Prof. N. S. Davis, Chicago. 
 Prof. John Guiteras, Charleston, S. C. 
 Dr. Jas. C. Wilson, Philadelphia. 
 
 Prof. D. Hayes Agnew, Philadelphia. 
 Prof. Hanter MoGuire, Richmond. 
 . Prof. Lewis A. Stimson, New York. 
 Prof. P. S. Conner, Cincinnati. 
 Prof. J. EwingMears, Philadelphia. 
 Prof. E. L. Keyes, New York City. 
 
 Volume IV 
 
 Prof. F. R. Sturgis, New York City. Prof. T. G. Morton and Dr. Wm. Hunt, 
 
 Prof. N. Senn, Milwaukee. J Philadelphia. 
 
 Prof. J. E. Garretson, Philadelphia. Dr. Morris Longstrefch, Philadelphia. 
 
 Prof. Christopher Johnston, Baltimore. Dr. Chas. Wirgman, Philadelphia. 
 Dr. Chas. B. Kelsey, New York City. |, Dr. C. C. Davidson, Philadelphia. /■ 
 
 Ophthalmology, Otology, Laryngology, Rhinology, Dermatology, Dentistry, 
 Hygiene, Disposal of the Dead, etc., etc. 
 
 Prof. William Thomson, Philadelphia. I Prof. C. N. Peirce, Philadelphia. 1 Dr. Chas. S. Turnbull, Philadelphia 
 Pro/. J. Solis Cohen, Philadelphia. Prof. John B. Hamilton, Washington. Dr. Edw. C. Kirk, Philadelphia. 
 Prof. D. Bryson Delavan, New York. Prof. H. M. Lyman, Chicago. Dr. John G. Lee, Philadelphia. 
 
 Prof. A. Van Harlingen, Philadelphia. | Prof. S. H. Guilford, Philadelphia. I Dr. Chas. E. Sajons, Philadelphia. 
 28 
 
Last of Collaborators to Denial Department. 
 
 Prof. James Truman, Philadelphia. 
 Prof. J. A. Marshall, Chicago, 111. 
 Prof. A. W. Harlan, Chicago, III. 
 Prof. G. V. Black, Chicago? 111. 
 Prof. C. H. Stowell, Ann Arbor, Mich. 
 Prof. Xj. C. Ingersoll, Keokuk, Iowa. 
 Prof. F. J. S. Gorgas. Baltimore. Md. 
 Prof, H. A. Smith, Cincinnati, Ohio. 
 Prof. C. P. Pengra, Boston, Mass. 
 
 Prof. E. H. Angle, Minneapolis, Minn, i Dr. J. O. Patterson, Kansas City, 9f*. 
 
 Prof. J. E. Cravens, Indianapolis, ind 
 Prof. B. Stubblefield, Nashville. Tenn 
 Prof. W. C. Barrett, Buffalo, N. Y. 
 Prof. A. H. Thompson, Topeka, Kan 
 Dr. James *W. White, Philadelphia. 
 Dr. L. Ashley Faught, Philadelphia. 
 Dr. Robert S. Ivy, Philadelphia. 
 Dr. W. Storer How, Philadelphia. 
 
 Dr. J. B. Hodgkin, Washington, D. C. 
 Dr. R. R, Andrews, Cambridge, Mass. 
 Dr. Albion M. Dudley, Salem, Mass. 
 Dr. Geo. S. Allen, New York City. " 
 Dr. G. S. Dean, San Francisco, Cal. 
 Dr. M. H. Fletcher, Cincinnati, Ohio. 
 Dr. A. Morsman, Omaha, Neb. 
 Dr. G. W. Melotte, Ithaca, N. Y. 
 
 Volume V. — General and Experimental Therapeutics, Medical Chemistry, Medical 
 Jurisprudence, Demography, Climatology, etc., etc. 
 
 Prof. William Pepper, Philadelphia. , Prof. George H. Rohe, Baltimore. i Dr. W. P. Mantou, Detroit, Mioh. 
 
 £*°£ £' ™* Dra P er - Boston. Dr. Albert L. Gihon, U. S. N. Dr. Hobart A.' Hare, Philadelphia. 
 
 Prof. J. W. Holland, Philadelphia. Dr. R. J. Dunglison, Philadelphia. Dr. C. S. Witherstine, Philadelphia. 
 
 Prof. A. L. Banney, New York City. II 
 
 THE STJaBSCRI^TIOIsr FRIOE 
 (Including the "SATELLITE" for one year). 
 
 United States. Canada (duty paid). . Great Britain. France. 
 
 Cloth, 5 Vols., Eoyal Octavo, - - $15.00 $16.50 £3.6s. 93 fr. 95 
 
 Half-Rusaia, 5 Vols., Eoyal Octavo, - 20.00 22.00 4.6s. 124 fr. 35 
 
 EXTRACTS FROM REVIEWS. 
 
 We venture to say that all who saw the Annual as it appeared in 1888 were on the 
 lookout for its reappearance this (1889) year ; but there are many whose knowledge of this 
 magnificent undertaking will date with this present issue, and to those a mere examina- 
 tion of the work will suffice to show that it fills a legitimate place in the evolution of 
 knowledge, for if does what no single individual is capable of doing. 
 
 These volumes make readily available to the pusy practitioner the best fruits of 
 medical progress, for the year, selected by able editors from the current literature of the 
 world ; such a work cannot be overlooked by anyone who would keep abreast of the 
 times. With so much that is worthy of notice incorporated in one work, and each depart 
 ment written up with a minuteness arid thoroughness , appreciated particularly by the 
 specialist, it would avail nothing to cite particular instances of progress. Let it be suffi- 
 cient to say, however, that while formerly there was a possible excuse for not having the 
 latest information on matters pertaining to the medical sciences, there can no longer be 
 such an. excuse while the Annual is published. — Journal of the American Medical 
 ■ Association. 
 
 .We have before us the second issue of this Annual, and it is not speaking too 
 strongly when we say that the series of five volumes of which it consists forms a most 
 important and valuable addition to medical literature. 
 
 Great discretion and knowledge of the subjects treated of are required at the hands 
 of those who have taken charge of the various sections, and the manner in which the 
 gentlemen who were chosen to fill the important posts of sub-editors have acguitted 
 themselves fully justifies the choice made. We know of no branch of the profession to 
 which this Annual could fail to be useful. Dr. Sajous deserves the thanks of the whole 
 profession for his successful attempt to facilitate the advance of medical literature and 
 practice. — -London Lancet. 
 
 This very valuable yearly report of the progress of medicine and its collateral 
 sciences throughout the world is a work of very great magnitude and high importance. 
 It is edited by Dr. C. E. Sajous, assisted, it is stated, by seventy associate editors, whose 
 names are given, making up a learned and most weighty list. Their joint labors have 
 combined \o produce a series of volumes in which the current progress throughout the 
 world, in respect to all the branches of medical soienbe, is very adequately represented. 
 The general arrangements of the book are ingenious and complete, having regard to 
 thoroughness and to facility of bibliographical reference. — British Medical Journal. 
 
 ANNUAL, 1890. 
 
 The editor and publishers of the Annual op, the Universal 
 Medical Sciences take this opportunity to thank its numerous friends 
 and patrons for the liberal support accorded it in the past, and to 
 announce its publication, as usual, in 1890. Recording, as it does, the 
 progress of ithe world in medicine and surgery, its motto continues to 
 be, as in the past, " Improvement," and its friends may rest assured that 
 ■no effort will be spared, not only to maintain, but to surpass, the high 
 standard of excellence already attained. 
 
 The Subscription Price will be the same as last year's issue and 
 the issue of 1888. ■ ' 
 
 (F. A. DAVIS, Medical Publisher, Philadelphia, Pa.„ U.S.A.) 29 
 
ISSUE OK 1889: 
 
 The Annual of the Universal Medical Sciences. 
 
 In Five Royal Octavo Volumes of over 500 pages each, bound in Cloth and 
 
 Half-Kussia, Magnificently Illustrated with Chromo-Llthographs, 
 
 Engravings, Haps, Charts, and Diagrams. 
 
 THE SUBSCRIPTION PRICE (including the ••Satellite" for one year). 
 
 United States. Canada (duty paid). Great Britain. France. 
 
 Cloth, 5 Vols., Eoyal Octavo, - - $15.00 $16.50 £3.6s. 93fr.95 
 
 Half-Russia, 5 Vols., Royal Octavo, - 20.00 22.00 4.6s. 124 fr. 35 
 
 This work is bound in above styles-only, and sold by subscription. 
 
 Published in Connection with the Annual and for Subscribers Only. 
 
 THE SATELLITE 
 
 —OF THE — 
 
 ANNIIAL OK THE UNIVERSAL MEDICAL SCIENCES. 
 
 \ Monthly Review of the most important articles upon the practical branches of medicine appearing in 
 
 the medical press at large, edited by the Chief Editor of the Annual and an able staff. 
 
 Editorial Staff of the Annual of the Universal Medical Sciences, issue of 1889. 
 
 Chief Editor, Dr. CHAS. B. SAJOTJS, Philadelphia. 
 
 ASSOCIATE STAI^B'. 
 Volume I. — Diseases of the Lungs, Diseases of the Heart, ' Diseases of the Gastro- 
 Hepatic System, Diseases of the Intestines, Intestinal Entozoa, Diseases of 
 the Kidneys and Bladder, Fevers, Fevers in Children, Diphtheria, Rheu- 
 matism and Gout, Diabetes, Volume Index. 
 
 Dr. Jas. C. Wilson, Philadelphia. 
 ProfL Louis Starr, Philadelphia. 
 Prof. J. Lewis Smith, New York. 
 Prof. N. S. Davis, Chicago. ' 
 , Prof. Jas. Tyson, Philadelphia. 
 
 Prof. Jas. T. Whittaker, Cincinnati. 
 Prof. A. L. Loomis, New York-City. 
 Prof. E. T. Bruen, Philadelphia. 
 Prof. W. W. Johnston, Washington. 
 Dr. L. Emmett Holt, New York. 
 Prof. Jos. Leidy, Philadelphia. 
 
 Volume II. — Diseases of the Brain and Cord, Peripheral Nervous System, Mental 
 Diseases, Inebriety, Diseases of the Uterus, Diseases of the Ovaries, Diseases 
 of the External Genitals in Women, Diseases of Pregnancy, Obstetrics, Dis- 
 -eases of the Newborn, Dietetics of Infancy, Growth, "volume Index. 
 
 Prof. E. C. Seguin, New York City. 
 Prof. Henry Hun," Albany. 
 Dr. E. N. Brush, Philadelphia. 
 Dr. W. R. Birdsall, New York. 
 
 Prof. W. H. Parish, Philadelphia. 
 Prof. Theophilus Parvin, Philadelphia. 
 Prof. Wm. L. Richardson, Boston. 
 Dr. A. F. Currier, New York. 
 Prof. Louis Starr, Philadelphia. 
 Dr. Chas. S. Minot, Boston. 
 
 Prof. Paul F. Munde, New York City. 
 Prof. Wm. Goodell, Philadelphia. 
 Dr. W. C. Goodell, Philadelphia. 
 
 Volume III. — Surgery of 'Brain, Surgery of Abdomen, Genito-Urinary Surgery, Dis- 
 eases of Rectum and Anus, Amputation and Resection and Plastic Surgery, 
 Surgical Diseases of Circulation, Fracture and Dislocation, Military Surgery, 
 Tumors, Orthopaedic Surgery, Oral Surgery, Surgical Tuberculosis, etc., Sur> 
 gical Diseases, Results of Railway Injuries, Anaesthetics, Surgical Dressings, 
 Volume Index. 
 
 Prof. N. Senn, Milwaukee. 
 Prof. E. L. Keyes, New York City. 
 Prof. J. Ewing Mears, Philadelphia. 
 Dr. Chas. B. Kelsey v New York City. 
 Prof. P. S. Conner, Cincinnati. 
 Dr. John H. Packard, Philadelphia. 
 Prof. Lewis A. Stimson, New York City. 
 Dr. J. M. Barton, Philadelphia. 
 
 Prof. D. Hayes Agnew, Philadelphia. ' 
 Dr. Morris Longstreth, Philadelphia. 
 Dr. Thos. G. Morton, Philadelphia. 
 Prof. J. E. Garretson, Philadelphia. 
 Prof. J. W. White, Philadelphia. 
 Prof. C. Johnston, Baltimore. 
 Prof. E. C. Seguin, New York City. 
 
 Volume IV. — Skin Diseases, Ophthalmology, Otology, Rhinology, Diseases of Pharynx, 
 etc., Intubation, Diseases of Larynx and CEsophagus, Diseases of Thyroid 
 Gland, Legal Medicine, Examination for Insurance, Diseases of the Blood, 
 Urinalysis, Volume Index. 
 
 Prof. A. Van Harlingen, Philadelphia. 
 Dr. Chas.' A. Oliver and Dr. Geo. M. 
 Gould, Philadelphia. 
 
 Dr. Charles S. Turnbull, Philadelphia. 
 Prof. J. Solis Cohen, Philadelphia. 
 Prof. J ohn Guiteras, Charleston, S. C. 
 
 Dr. Chas. E. Sajous, Philadelphia. 
 Prof. D. Bryson Delavan, New York. 
 Prof. R. Fletcher lngals, Chicago. 
 Prof. F. W. Draper. Boston. 
 Prof. Jas. Tyson, Philadelphia. 
 
 Volume V. — General Therapeutics, Experimental Therapeutics, Poisons, Electric 
 Therapeutics, Climatology, Dermography, Technology, Bacteriology, Embry- 
 ology, Physiology, Anatomy, General Index. 
 
 Dr. J. P.Crozer Griffith, Philadelphia. 
 Dr. Hobart A. Hare, Philadelphia. 
 Prof Geo. H. Rohe, Baltimore. 
 Prof. John Jb\ Hamilton, Washington. 
 Dr. Harold C. Ernst, Boston. 
 Prof. H. Newell Martin, Baltimore. 
 Dr. R. J. Dunglison, Philadelphia. 
 
 Dr. C. Sumner Witherstine, Philadelphia 
 Prof. J. W. Holland, Philadelphia. 
 Prof. A. L. Ranney, New York. 
 Dr. Albert H. Gihon, U. S. N. 
 Dr. W. P. M anion, Detroit. . 
 Dr. W. X. Sudduth, Philadelphia. 
 Prof. Wm. T. Forbes, Philadelphia. 
 
 30 
 
 (F. A. DAVIS, Medical Publisher, Philadelphia, Pa., U.S.A.) 
 
THE LATEST BOOK OF REFERENCE ON NERVOUS DISEASES. 
 
 Lectures on Nervous Diseases, 
 
 • FROM THE STAND-POINT OF CEREBRAL AND SPINAL LOCALIZATION, AND 
 
 THE LATER METHODS EMPLOYED IN THE DIAGNOSIS AND 
 
 TREATMENT OF THESE AFFECTIONS. 
 
 By AMBROSE L. RANNEY, A.M., M.D., 
 
 Pri.cssor of the Anatomy and Physiology of the Nervous System in the New York Post-Graduate Medical 
 
 School and Hospital ; Professor of Nervous and Mental Diseases in the Medical Department of the 
 
 University of Vermont, etc. ; Author of "The Applied Anatomy of the Nervous System/' 
 
 " Practical Medical Anatomy," etc., etc. 
 
 With. Original Diagrams and Sketches in Color by the Author* carefully selected Wood- 
 Kngraviiigs, and Reproduced Photographs of Typical liases. 
 
 ONE HANDSOME ROYAL OCTAVO VOLUME OF 780 PAGES. 
 
 United States. Canada (duty paid). Great Britain. France. 
 
 CLOTH, $5.50 $6.05 £1.3s. 34 fr. 70 
 
 SHEEP, - - 6.50 7.15 1.6s. 40 fr. 45 
 
 HAXF-KUS91A, - 7.00 7-70 1.9s. 43 i'r. 30 
 
 solid oisrxrsr ttsr STTBSGie*i^"ri03sr. 
 
 It is now generally conceded that the nervous system controls all of the physical 
 
 . functions to a greater or less extent, and also that most of the symptoms encountered at 
 
 the bedside can be explained and interpreted from the stand-point oLnervous physiology. 
 
 The unprecedented sale of this work during the short period which has elapsed since 
 its publication has already compelled the publishers" to print a, second edition, which is 
 already nearly exhausted. 
 
 We are glad to note that Dr. Ranney has pub- 
 lished in c -ok form his admirable lectures on nervous 
 diseases. His book contains over seven hundred 
 large pages, and is profusely illustrated with origi- 
 nal diagrams and sketches in colors, and with many 
 carefully selected wood-cuts and reproduced photo- 
 graphs of typical cases. A large amount of valua- 
 ble information, not a little of which has but recently 
 
 appeared in medical literature, is presented in com- 
 pact form, and thus made easily accessible. In our 
 opinion, Dr. Ranney's book ought to meet with a 
 cordial reception at the hands of the 'medical pro- 
 fession, for, even though the author's views may be 
 sometimes open to question, it cannot be disputed 
 that his work bears evidence of scientific method and 
 honest opinion. — American Journal of Insanity. 
 
 LECTURES 
 
 ON THE 
 
 Diseases of the Nose and Throat. 
 
 DELIVERED AT THE JEFFERSON MEDICAL COLLEGE, PHILADELPHIA, 
 By CHARLES E. SAdOUS, M.D., 
 
 Lecturer on Rhinology and Laryngology in Jefferson Medical College ; Vice-President of the American Laryngologies! 
 
 Association ; Officer of the Academy of France and of Public Instruction of Venezuela ; Corresponding Member 
 
 of the Royal Society of Belgium, of the Medical Sooiety of Warsaw (Poland), and of the Society of 
 
 Hygiene of France ; Member of the American Philosophical Society, etc., etc. 
 
 IIXU8TRATED WITH 100 CHROMO-MTHOGRAPHS, FROM OIL PAINTINGS B\ 
 THE AUTHOR, AND 93 ENGRAVINGS ON WOOD. 
 
 ONE HANDSOME ROYAL OCTAVO VOLUME. SOLD ONLY BY SUBSCRIPTION. 
 
 Cloth, Royal Octavo, 
 Half-Russia, Royal Octavo, 
 
 United States. 
 
 S4.00 
 
 5.00 
 
 Canada (duty paid). 
 
 S4.40 
 
 S.50 
 
 Great Britain. 
 SO. 18s. 
 1. Is. 
 
 France. 
 84 fr. 60 
 30 fr. 30 
 
 Sknce the publisher brought this valuable work before the profession, it has become: 
 1st, the text-book of a large number of colleges; 2d, the reference-book of the TJ. 8. Army, 
 Navy, and the Marine Service; and, '3d, an important and valued addition to the librariea 
 of over 7000 physicians. ' 
 
 : This book 'has not only the inherent merit of presenting a clear expose of the subject, 
 but it is written with a view to enable the general practitioner to treat his cases himself. 
 To facilitate diagnosis, colored plates are introduced, showing the appearance of the differ- 
 ent parts in the diseased state as they appear in nature by artificial light. No error can 
 thus De made, as each affection of the nose and throat has its representative in the 100 
 chromo-lithographs presented. In the matter of treatment, the indications are so complete 
 that even the slightest procedures, folding of cotton for the forceps, the use of the probe, 
 etc., are clearly explained. 
 
 It is intended to furnish the general practitioner 
 not only with ? guide for the treatment of diseases of 
 the nose and throat, but also to place before him a 
 representation of the normal and diseased parts as 
 
 they would appear to hini were they seen in the 
 living subject. As a guide to the treatment of the 
 nose and throat, we can cordially recommend this 
 work.— Boston Medical and Surgical Journal. 
 
 (F. A. DAVIS, Medical Publisher, Philadelphia, Pa., U.S.A.) 
 
 31 
 
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 IN PRESS, SECOND EDITION. 
 
 Ointments and Oleates in Diseases of the Skin. 
 
 — BY — 
 
 cJOHN V. SHOEMAKER, A.M., M.D., 
 
 Professor of Materia Medica, Pharmacology, Therapeutics, and Clinical Medicine, and Clinical Professor of Diseases 
 of the Skin in the Medico-Chirurgieal College of Philadelphia, eto. 
 
 16mo. NBATIT BOUND IN CI.OTH. PRICE, IN UNITED STATES AND CANADA, 
 NET, SI. 00, POST-PAID ; GREAT BRITAIN, 4s. 3d. ; FRANCE, 6 fr. 20. 
 
 The accompanying Table of Contents will give a general idea of the work : 
 CONTENTS. Part I.— History and Origin. Part II.— Process of Manufacture. Part 
 III.— Physiological Action of the Oleates. Part IV.— Therapeutic Effect of the Oleates 
 Part V.— Ointments : Local Medication of Skin Diseases.— Antiquity of Ointments. Different Indi- 
 cations for Ointments, Powders, Lotions, etc.— Information about Ointments: Scanty, Scattered and 
 Insufficient —Fats and Oils: Animal and Vegetable.— Their Chemical Composition.— Comparative 
 Permeability of Oils into Skin ; of Animal, of Vegetable. Incorporation of Medicinal Substances into 
 Fats: (i) Mode of Preparation, (2) Vegetable Powders and Extracts, (3) Alkaloids, (4) Mineral Sub- 
 stances, (5) Petroleum Fats ; Chemical Composition; Uses and Disadvantages.— List of Officinal Oint- 
 ments— Indications.— Substances often Prescribed Extemporaneously in Ointment Form. Indications. 
 
 A FULL INDEX RENDERS THE BOOK CONVENIENT FOR QUICK REFERENCE. 
 
 CRITICISMS OF FIRST EDITION. 
 
 The profession in both countries is deeply in- 
 debted to Dr. Shoemaker for his excellent work in 
 thii department of medicine.— William Whitla. 
 M.D. (Q.U.J.). 
 
 It is the most complete exposition of their action 
 which has yet appeared. They are very valuable 
 accessions to the materia medica, and should be 
 familiar to every practitioner. — Medical and Sur- 
 gical Reporter. 
 
 To those of our readers who wish to learn the 
 therapeutic effects of a class of preparations which 
 are destined to grow in favor as their merits be- 
 come more generally known, we commend this 
 book. — Journal of Cutaneous and Venereal 
 Diseases. 
 
 No physician pretending to treat skin diseases 
 should be without a copy of this very instructive 
 little book. — Canada Medical Record. 
 
 32 - (F. A. DAVIS. Medical Publisher, Philadelphia, Pa., U.S.A.)