*[Read before the Homoeopathic Medical Society of the City of Philadelphia, on Thursday Evening, April 19th, 1860.]

BY RICHARD GARDINER, M. D., PHILADELPHIA.

With a single exception, the science and practice of medicine places its fellows in the most elevated and responsible position in life. Such being its claims, dignity of character should ever distinguish the physician, without which he is not worthy of claiming a position in the high rank in which his profession is calculated to place him, or worthy of the confidence of the community or of his patients; he not only is the physician, but frequently the counsellor to the patient, for to him are entrusted the trials, troubles, difficulties, and not unfrequently the more private affairs, of the patient or family; for he is looked upon, under the most distressing circumstances, as one in whom confidence can be placed and whose counsel can be safely taken. Therefore, the dignity of his profession requires that he should be truthful, temperate, and honest, with all the qualifications of the gentleman; standing up for the dignity of the profession, the reputation of which is more or less involved, with that of the medical character. Since the physician may, by his own conduct, increase or diminish the estimation in which the profession will be held, he should carefully cultivate all the exteriors which characterize the gentleman but, especially, cultivate the moral senses, looking not only to future prosperity in this world, but also to that which is to come; basing his actions morally, professionally and religiously upon truth, that he may elevate his position in life with that of the great cause in which he is engaged. His profession, from the God-like principles which it embraces, leads to certain duties which it becomes necessary on the part of the physician to carry out in life.

The foregoing preliminary remarks lead to an inquiry into the more minute duties existing between the professional character and his patients, fellow-practitioners and the community at large.

The physician should not only be ever-ready to obey the calls of the sick, but his mind ought also to be imbued with the greatness of his mission and the responsibility he habitually incurs in its discharge. These obligations are the more deep and enduring, because there is no tribunal other than his own conscience to adjudge the penalties for carelessness or neglect.

Physicians should, therefore, minister to the sick with due impressions of the importance of their office; reflecting that the case, the health and the lives of those committed to their charge depend on their skill, attention and fidelity.

They should study also in their deportment, so to unite tenderness with firmness, and condescension with authority, as to inspire the minds of their patients with gratitude, respect and confidence.

Every case, committed to the charge of the physician, should be treated with attention, steadiness and humanity. Reasonable indulgence should be granted to the mental imbecility and caprices of the sick; secrecy and delicacy, when required, by peculiar circumstances should be strictly observed; and the familiar and confidential intercourse to which physicians are admitted in their professional visits should be used with discretion and with the most scrupulous regard to fidelity and honor.

The obligation of secrecy extends beyond the period of professional services. None of the privacies of personal and domestic life, no infirmity of disposition, or flaw of character observed during professional attendance, should ever be divulged by the physician, except when he is imperatively required to do so. The force and necessity of this obligation are indeed so great, that professional men have, under certain circumstances, been protected in the observance of secrecy by courts of Justice.

Frequent visits to the sick are, in general, requisite, since they enable the physician to arrive at a more perfect knowledge of the disease, to meet promptly every change which may occur, and also tend to preserve the confidence of the patient, But unnecessary visits are to be avoided, as they give useless anxiety to the patient, tend to diminish the authority of the physician, and render him liable to be suspected of interested motives.

The physician should not be forward to make gloomy prognostications, because they savour of empiricism, by magnifying the importance of his services in the treatment or cure of the disease. Hasty opinions, either in diagnosis or treatment, not unfrequently lead to unhappy results. A shake or nod of the head, to the eye of some observant patient, would do them more injury than days of the best treatment will repair. It is said of Dr. Wistar, formerly Professor of Anatomy in the University of this City, that he always entered the sick-room with a smile; it has its effect, and that a salutary one. The physician should not fail, on proper occasions, to give to the friends of the patient timely notice of danger when it really occurs, and even to the patient himself if absolutely necessary. This office, however, is so peculiarly alarming, when executed by him, that it should be declined whenever it can be assigned to any other person of sufficient judgment or delicacy. We speak from experience in this matter, looking over the past and remembering where we have been discharged for being candid in such cases. The physician should be the minister of hope and comfort to the sick, that by administering counsel to the drooping spirits, which would be like a cordial, he may smooth the bed of death, revive expiring life, and counteract the depressing influence of those maladies which often disturb the tranquillity of the most resigned in their last moments. The life of a sick person can be shortened, not only by the acts, but also by the words or the manner of a physician. It is, therefore, his sacred duty to guard himself carefully in this respect, and to avoid all things which have a tendency to discourage the patient and depress his spirits.

The physician ought not to abandon his patient because the case is deemed Incurable, for his attendance may continue to be highly useful to the patient and comforting to the relatives around him, even in the last period of a fatal malady, by alleviating pain and other symptoms, and by soothing mental anguish. To decline attendance, under such circumstances, would be sacrificing to fanciful delicacy and mistaken liberality, that moral duty which is independent or, and far superior, to all pecuniary consideration.

Consultations should be promoted in difficult or protracted cases, as they give rise to confidence, energy and more enlarged views in practice.

The opportunity which a physician not unfrequently enjoys of promoting and strengthening the good resolutions of his patients, suffering under the consequences of vicious conduct ought never to be neglected. His counsels or even remonstrances will give satisfaction, not offence, if they be proffered with politeness and evince a general love of virtue, accompanied by sincere interest in the welfare of the person to whom they are addressed.

In closing these remarks on the duties of the physician to his patient, we would name one that is too much neglected that is the attendance and treatment of the poor. It being too much the feeling of the young practitioner to commence the duties of the profession where his seniors leave off, not willing to give that attention, kindness and sympathy which the destitute and often wretched condition of the poor so often call for. It was remarked by the celebrated Rush, that the poor were the rounds of the ladder by which the young physician was to climb into the houses of the rich.

It is the best school for the young practitioner; it is there he gains his experience and becomes the debtor to the poor patient, who has entrusted his life in the hands of the inexperienced in the treatment of disease. The physician who has passed through this ordeal of rising in his profession, looks back with gratitude and pleasure to the many poor, to whom he has administered in their necessities, and thus gained that experience which has enabled him to gain entrance into the houses of the rich.

Of the duties of Physicians to each other.

Every individual on entering the profession, as he becomes thereby entitled to all its privileges and immunities, incurs an obligation to exert his best abilities to maintain its dignity and honor, to exalt its standing and to extend the bounds of its usefulness. He should, therefore, observe strictly such laws as are instituted for the government of its members; should avoid all contemptuous and sarcastic remarks relative to the faculty as a body; and while, by unwearied diligence, he resorts to every honorable means of enriching the science, he should entertain a due respect for his seniors, who have, by their labors, brought it to the elevated condition in which he finds it.

There is no profession, from the members of which greater purity of character and a higher standard of moral excellence, are required than the medical; and to attain such eminence, is a duty every physician owes alike to his profession and to his patients. It is due to the latter, as without it he cannot command their respect and confidence, and to both, because no scientific attainments can compensate for the want of correct moral principles. It is also incumbent upon the faculty to be temperate in all things, for the practice of physic requires the unremitting exercise of a clear and vigorous understanding; and, on emergencies, for which no professional man should. be unprepared, a steady hand, an acute eye, and an unclouded head may be essential to the well-being, and even to the life of a fellow-creature.

It is derogatory to the dignity of the profession to resort to public advertisements, or private cards, or hand-bills, inviting the attention of individuals affected with particular diseases — publicly offering advice and medicine to the poor gratis, or promising radical cures; or to publish cases and operations in the daily prints, or suffer such publications to be made; to invite laymen to be present at operations, to boast of cures and remedies, to adduce certificates of skill and success, or to perform any other similar acts. These are the ordinary practices of empirics, and are highly reprehensible in a regular physician.

Equally derogatory to professional character is it for a physician to hold a patent for any surgical instrument or medicine; or to dispense a secret nostrum, whether it be the composition or exclusive property of himself or of others. For, if such nostrum he of real efficacy, any concealment regarding it is inconsistent with beneficence and professional liberality; and, if mystery alone give it value and importance, such craft implies either disgraceful ignorance or fraudulent avarice. It is also reprehensible for physicians to give certificates attesting the efficacy of patent or secret medicines, or in any way to promote the use of them.

Professional services of physicians to each other.

All practitioners of medicine, and their wives, and children while under the paternal care, are entitled to the gratuitous services of any one or more of the faculty residing near them, whose assistance may be desired. A physician afflicted with disease is usually an incompetent judge of his own case; and the natural anxiety and solicitude which he experiences at the sickness of a wife, a child, or any one who, by the ties of consanguinity, is rendered peculiarly dear to him, tend to obscure his judgment and produce timidity and irresolution in his practice. Under such circumstances, medical men are peculiarly dependent upon each other, and kind offices and professional aid should always be cheerfully and gratuitously afforded. Visits ought not, however, to be obtruded officiously, as such unasked civility may give rise to embarrassment, or interfere with that choice on which confidence depends. But, if a distant member of the faculty, whose circumstances are affluent, requests attendance, and an honorarium be offered, it should not be declined; for no pecuniary obligation ought to be imposed, which the party receiving it would wish not to incur.

Of the duties of physicians as respects vicarious offices.

The affairs of life, the pursuit of health, and the various accidents and contingencies to which a medical man is peculiarly exposed, sometimes require him temporarily to withdraw from his duties to his patients, and to request some of his professional brethren to officiate for him. Compliance with this request, is an act of courtesy which should always be performed with the utmost consideration for the interest and character of the family physician, and, when exercised for a short period, all the pecuniary obligations for such service should be awarded to him. But, if a member of the profession neglect his business in quest of pleasure and amusement, he cannot be considered as entitled to the advantages of the frequent and long continued exercise of this fraternal courtesy, without awarding to the physician who officiates the fees arising from the discharge of his professional duties.

In obstetrical and important surgical cases, which give rise to unusual fatigue, anxiety and responsibility, it is just that the fees accruing therefrom should be awarded to the physician who officiates.

Of the duties of physicians in regard to consultations.

A regular medical education furnishes the only presumptive evidence of professional abilities and acquirements, and ought to be the only acknowledged right of an individual to the exercise and honor of his profession. Nevertheless, as in consultations, the good of the patient he sole object in its view, and this is often dependent upon personal confidence, no intelligent regular practitioner, who has a license to practice from some medical board of known and acknowledged respectability, and who is in good moral and professional standing in the place in which he resides, should be fastidiously excluded from fellowship, or his aid refused in consultations, when it is requested by the patient. But, no one can be considered as a regular practitioner or a fit associate in consultation, whose practice is based on an exclusive dogma to the rejection of the accumulated experience of the profession, and of the aids actually furnished by anatomy, physiology, pathology, and organic chemistry.

In consultations, no rivalship or jealousy should be indulged; candor, probity, and all due respect should be exercised toward the physician having charge of the case.

In consultations, the attending physician should be the first to propose the necessary questions to the sick; after which, the consulting physician should have the opportunity to make such further inquiries of the patient as may be necessary to satisfy him of the true character of the case. Both physicians should then retire to a private place for deliberation, and the one first in attendance should communicate the directions agreed upon to the patient or to his friends, as well as any opinions it may be thought proper to express. But no statement or discussion of it should take place before the patient or his friends, except in the presence of all the faculty attending and by their common consent; and no opinions or prognostications should be delivered, which are not the result of previous deliberation and concurrence.

In consultations, the physician in attendance should deliver his opinion first; and when there are several consulting, they should deliver their opinions in the order in which they have been called in. No decision, however, should restrain the attending physician from making such variations in the mode of treatment, as any subsequent change in the character of the case may demand. Bat such variation, and the reason for it, ought to be carefully detailed at the next meeting of consultation. The same privilege belongs also to the consulting physician, if he is sent for in an emergency, when the regular attendant is out of the way, and similar explanations must be made by him at the next consultation.

The utmost punctuality should be observed in the visits of physicians when they are to hold consultations together, and this is generally practicable. But, as professional engagements may sometimes interfere and delay one of the parties, the physician who first arrives should wait for his associate a reasonable period; after which, the consultation should be considered as postponed to a new appointment. If it be the attending physician who is present, he will of course see the patient and prescribe; but if it be the consulting one, he should retire, except in case of emergency or when he has been called from a considerable distance, in which latter case he may examine the patient and give his opinion in writing, and under seal, to be delivered to his associate.

A physician, who is called upon to consult, should observe the most honorable and scrupulous regard for the character and standing of the practitioner in attendance; the practice of the latter, if necessary, should be justified as far as it can be, consistently with a conscientious regard for truth, and no hint or insinuation should be thrown out which could impair the confidence reposed in him, or affect his reputation. The consulting physician should also carefully refrain from any of those extraordinary attentions or assiduties, which are too often practised by the dishonest for the base purpose of gaining applause, or ingratiating themselves into the favor of families and individuals.

Duties of physicians in cases of interference.

Medicine is a liberal profession, and those admitted into its ranks should found their expectations of practice upon the extent of their qualifications, not on intrigue or artifice.

A physician, in his intercourse with a patient under the care of another practitioner, should observe the strictest caution and reserve. No meddling inquiries should be made, no disingenuous hints given relative to the nature and treatment of his disorder, nor any course of conduct pursued that may directly or indirectly tend to diminish the trust reposed in the physician employed.

The same circumspection and reserve should be observed when, from motives of business or friendship, a physician is prompted to visit an individual who is under the direction of another practitioner. Indeed, such visits should be avoided, except under peculiar circumstances; and when they are made, no particular inquiries should be instituted relative to the nature of the disease or the remedies employed, but the topics of the conversation should be as foreign to the case as circumstances will admit.

A physician ought not to take charge of or prescribe for a patient who has been recently under the care of another member of the faculty in the same illness, except in cases of sudden emergency, or in consultation with the physician previously in attendance, or when the latter has relinquished the case, or been regularly notified that his services are no longer desired. Under such circumstances, no unjust and illiberal insinuations should be thrown out in relation to the conduct or practice previously pursued, which should be justified as far as candor and regard for truth and probity will permit; for it often happens that patients become dissatisfied when they do not experience immediate relief, and, as many diseases are naturally protracted, the want of success, in the first stage of treatment, affords no evidence of a lack of professional knowledge and skill.

When a physician is called to an urgent case, because the family attendant is not at hand, he ought, unless his assistance in consultation be desired, to resign the care of the patient to the latter immediately on his arrival.

It often happens, in cases of sudden illness or of recent accidents and injuries, owing to the alarm and anxiety of friends, that a number of physicians are simultaneously sent for. Under these circumstances, courtesy should assign the patient to the first who arrives, who should select from those present any additional assistance that he may deem necessary. In all such cases, however, the practitioner who officiates, should request the family physician, if there be one, to be called, and, unless his further attendance be requested, should resign the case to the latter on his arrival.

When a physician is called to the patient of another practitioner in consequence of the sickness or absence of the latter, he ought, on the return or recovery of the regular attendant and with the consent of the patient, to surrender the case.

When a physician who has been engaged to attend a case of midwifery is absent, and another is sent for, if delivery is accomplished during the attendance of the latter, he is entitled to the fee, but should resign the patient to the practitioner first engaged.

Of differences between physicians.

Diversity of opinion and opposition of interest may, in the in the medical as in other professions, sometimes occasion controversy and even contention. Whenever such cases unfortunately occur and can not be immediately terminated, they should be referred to the arbitration of a sufficient number of physicians, or a court-medical.

As peculiar reserve must be maintained by physicians toward the public in regard to professional matters, and as there exist numerous points in medical ethics and etiquette through which the feelings of medical men may be painfully assailed in their intercourse with each other, and which can not be understood or appreciated by general society; neither the subject-matter of such differences nor the adjudication of the arbitrators should be made public, as publicity in a case of this nature may be personally injurious to the individuals concerned, and can hardly fail to bring discredit on the faculty.

Of pecuniary acknowledgments.

Some general rule should be adopted by the faculty in every town or district, relative to pecuniary acknowledgments from their patients; and it should he deemed a point of honor to adhere to these rules with as much uniformity as varying circumstances will admit.

Duties of the profession to the public.

As good citizens, it is the duty of physicians to be ever vigilant for the welfare of the community, and to bear their part in sustaining its institutions and burdens. They should also be ever ready to give counsel to the public in relation to matters especially appertaining to their profession, as on subjects of medical police, public hygiene and legal medicine. It is their province to enlighten the public in regard to quarantine regulations; the location, arrangement and dietaries of hospitals, asylums, schools, prisons and similar institutions; in relation to the medical police of towns, as drainage, ventilation, &c.; and in regard to measures for the prevention of epidemic and contagious diseases; and when pestilence prevails, it is their duty to face the danger and to continue their labor for the alleviation of the suffering, even at the jeopardy of their own lives.

Medical men should always be ready, when called on by the legally constituted authorities, to enlighten coroner's inquests and courts of justice, on subjects strictly medical, such as involve questions relating to sanity, legitimacy, murder by persons or other violent means, and in regard to the various other subjects embraced in the science of medical jurisprudence. But in these cases, and especially where they are required to make a post mortem examination, it is just, in consequence of the time, labor and skill required, and the responsibility and risk they incur, that the public should award them a proper honorarium.

There is no profession, by the members of which gratuitous services are more liberally dispensed than the medical; but justice requires that some limits should be placed to the performance of such good offices. Poverty, professional brotherhood, and certain of the public duties referred to recently, should always be recognized as presenting valid claims for gratuitous services; but neither institutions, endowed by the public or by rich individuals, societies for mutual benefit, for the insurance of lives or for analogous purposes, nor any profession or occupation, can be admitted to posses such privilege. Nor can it be justly expected of physicians to furnish certificates of inability to serve on juries, to perform militia duty, or to testify to the state of health of persons wishing to insure their lives, obtain pensions or the like, without a pecuniary acknowledgment. But to individuals in indigent circumstances, such professional services should always be cheerfully and freely accorded.

It is the duty of physicians, who are frequent witnesses of the enormities committed by quackery, and the injury to health and even the destruction of life caused by the use of quack medicines, to enlighten the public on these subjects, to expose the injuries sustained by the unwary from the devices and pretensions of artful empircics and impostors.

It is by carrying out the principles here laid down, that the dignity of the profession is sustained and the elevation of the physician secured.

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