Part 2

This palpable fact may concisely serve to convince you, your embarkation (with all its alluring prospects) will not only be encumbered with difficulties, but your ultimate gratification of success exceedingly doubtful. Great depth of learning may afford consolation to the equity of your own feelings (if you fortunately possess them) but it is by no means necessary to the acquisition of public opinion, however it may tend to contribute to the general good.

To avoid entering into a sentimental disquisition upon the honesty, integrity, or strict propriety of the maxims I proceed to lay down for your future conduct to obtain professional splendour, and insure success; I avail myself of the privilege I possess, to wave every consideration of the conscientious kind, and once more observe (without adverting to their consistency) they are adduced only as the unavoidable traits of character, and modes of behaviour, by which alone (in the present age) you can possibly hope for the least proportional share of practice as a physician.

At your first public entré, when the college list and court calendar have announced your qualifications and advancement to the wondering world (that such list should annually increase) let your friends and relatives be doubly assiduous in propagating reports (almost incredible) of your great humanity, extensive abilities, and unbounded benevolence.—This will answer the intended purpose to a certainty; crouds of the afflicted and necessitous will surround your habitation, and render your place of residence constantly remarkable to all classes, who naturally enquiring the character of the proprietor, will eagerly extol your charity in contributing your “advice to the poor GRATIS.”

This method alone will gain you popularity with those that rank in the line of mediocrity; with their superiors, success must be insured more from the efforts of interest, than either personal merit, or sound policy. Your attention to the wants of the poor, must soon be regulated by the preponderation of more weighty considerations; as you affected to alleviate their distresses from the motive of commiseration, prompting you to promote their ease, you have an undoubted right to shake off such superfluous visits, to secure your own. In this deceptive charity, some degree of discrimination must be put in practice, for you will sometimes perceive one among the train, whose apparel or behaviour must necessarily give you reason to suspect he has assumed the cloak of necessity to save his fee, and avail himself of your professional liberality in such case, call to your aid a look of true medical austerity, and let him understand “advice is seldom of any value or “effect unless it is paid for;” this will frequently answer the purpose, and procure what you did not expect.

On the contrary, so soon as you observe your prescriptions have “worked wonders” upon two or three of the most credulous and superstitious, who are extolling your great knowledge and “blessing your honour,” strengthen the force of your judgment by charitably obtruding a pecuniary corroboration into the hand of your afflicted patient, as a confirmation of your unbounded skill in the (miraculous) cure of every disease to which the human frame is incident. By such political practice, you insure the recital of your services with extacy, and your name reverberates from one end of the metropolis to the other.

Your person and place of residence, being by these means universally known, and your name become in a proportional degree popular, let your plan and mode of behaviour be instantly changed; it will be now necessary

“You “assume a” hurry “if you have it not,”

Take care to be so exceedingly engaged with patients of the first class and eminence, that “it is with difficulty you procure time sufficient for the common purposes and gratifications of nature.” No paupers whatever can be admitted to your presence without a written recommendation from nobility, or characters of the first fortune; this will insure you no farther intrusion from a class originally introduced for your particular purpose; that effected, they may now be permitted to fall into the back ground of the picture; from whence they were brought for no other motive than the promotion of your personal interest and professional emolument.

It becomes your particular care to be always in a hurry; let your chariot (if you can fortunately raise one) upon job, be at the door regularly by nine in the morning; to prove how very much you are attached to the duties of your profession, and how anxiously you have the salubrity of your patients at heart.—Omit no one circumstance that can contribute to a shew of being perpetually engaged. Letters written by yourself, and messengers of your own dispatching, cannot be seen at your doors too frequently; the chariot should be as repeatedly ordered—remember to leave home by one way, and return by another, and equally in haste; all these stratagems are considered peculiar privileges of the College of Wigs, and are well worthy your attention and constant practice. You need hardly be told, the superficial and unthinking part of mankind are ever caught by appearances; what proportion they bear to other distinctions, need not in the present instance be at all ascertained.

Having laid down rules (that should be rigidly persevered in) for the regulation of your public character, I shall now advert to the strict line of conduct it will be proper for you to adopt in your personal transactions upon all professional emergencies.

When called to a patient upon the recommendation of the family apothecary, you are to consider him one of your best friends, and pay court to him accordingly; on the contrary, if you are engaged upon the spontaneous opinion of the patient, or his relatives, you have every reason to conclude the abilities of the apothecary are held in very slender estimation, and you may safely venture to display as much of your own consequence and superiority, as circumstances will admit.

After the awkward ceremony of your first appearance is over, and matters a little adjusted, take great care to be upon your guard; indulge in a variety of significant gestures, and emphatical hems!—and hahs! proving you possessed of singularities, that may tend to excite ideas in the patient and surrounding friends, that a physician is a superior part of the creation.——Let every action, every word, every look, be strongly marked, denoting doubt and ambiguity; proceed to the necessary enquiries of “what has been done in rule and regimen, previous to your being called in?” hear the recital with patience, and give your nod of assent, lest you make Mr. Emetic, the apothecary, your formidable enemy, who will then most conscientiously omit to recommend the assistance of such extraordinary abilities on any future occasion.—Take care to look wisdom in every feature; speak but little, and let it be impossible that little should be understood; let every hint, every shrug be carefully calculated to give the hearers a wonderful opinion of your learning and experience.—In your half-heard and mysterious conversation with your medical inferior, do not forget to drop a few observations upon—“the animal œconomy”—“circulation of the blood”—“acrimony”—“the non naturals”—“stricture upon the parts”—“acute pain”—“inflammatory heat”—“nervous irritability,” and all those technical traps that fascinate the hearers, and render the patient yours ad libitum.

To the friends or relatives of the diseased, (as the case may be) you seriously apprehend great danger; but such apprehension is not without its portion of hope; and you doubt not, but a rigid perseverance in the plan you shall prescribe, will reconcile all difficulties in a few days, and restore the patient (whose recovery you have exceedingly at heart) to his health and friends; that you will embrace the earliest opportunity to see him again, most probably at such an hour, (naming it) in the mean time you are in a great degree happy to leave him in such good hands as Mr. Emetic, to whom you shall give every necessary direction, and upon whose integrity and punctuality you can implicitly rely.

You then require a private apartment for your necessary consultation and plan of joint depredation upon the pecuniary property of your unfortunate invalid, which you are now going seriously to attack with the full force of physic and finesse. You first learn from your informant what has been hitherto done without effect, and determine accordingly how to proceed; but in this, great respect must be paid to the temper, as well as the constitution and circumstances, of your intended prey; if he be of a petulant and refractory disposition, submitting to medical dictation upon absolute compulsion, as a professed enemy to physic and the faculty, let your harvest be short, and complete as possible. On the contrary, should a hypochondriac be your subject, with the long train of melancholic doubts, fears, hopes, and despondencies, avail yourself of the faith implicitly placed in you, and regulate your proceedings by the force of his imagination; let your prescription (by its length and variety) reward your jackall for his present attention and future services.—Take care to furnish the frame so amply with physic, that food may be unnecessary; let every hour (or two) have its destined appropriation—render all possible forms of the materia medica subservient to the general good—draughts—powders—drops, and pills, may be given (at least) every two hours; intervening apozems, or decoctions, may have their utility; if no other advantage is to be expected, one good will be clearly ascertained, the convenience of having the nurse kept constantly awake, and if one medicine is not productive of success, another may. These are surely alternatives well worthy your attention, being admirably calculated for the promotion of your patient’s cure and your own reputation.

Having written your long prescription, and learnt from Mr. Emetic every necessary information, you return to the room of your patient, to prove your attention, and renew your admonitions of punctuality and submission;—then receiving your fee with a consequential air of indifference, you take your leave; not omitting to drop an additional assurance, that “you shall not be remiss in your attendance.” These, Sir, are the instructions you must steadily pursue, if you possess an ardent desire to become eminent in your profession—opulent in your circumstances—formidable to your competitors, or a valuable practitioner to the Company of Apothecaries, from whom you are to expect the foundation of support. A multiplicity of additional hints might be added for your minute observance; but such a variety will present themselves in the course of practice, that a retrospective view of diurnal occurrences will sufficiently furnish you with every possible information for your future progress; regulating your behaviour, by the rank of your patients, from the most pompous personal ostentation, to the meanest and most contemptible servility.

TO THE SURGEON.

I congratulate you upon your recent emancipation from incessant study, intense application, and strict hospital attendance, where I shall willingly suppose, you was a dresser of the most promising abilities; that you excelled your cotemporaries in every chirurgical opinion, became an expert dissecting pupil to one of the court of examiners, and are now burst through the cloud of your original obscurity, a perfect prodigy of anatomical disquisition.

I naturally conclude you capable of animadverting upon all the distinct branches of your art to admiration, that you are critically excellent in the use of an instrument from the humble act of simple phlebotomy, to the more important operation for a fistula in ano.—You have, beyond every shadow of doubt, paid proper attention to the fashionable precepts of the late Lord Chesterfield, and rendered yourself (with assistance from the graces) a perfect adept in polite address, displaying a variety of the most engaging attitudes, even in the adjustment of a ten tailed bandage. The professional information you have industriously collected, is such as will certainly afford you the most equitable claims upon public opinion, being in possession of every necessary acquisition from a simple gonorrhœa to a confirmed lues.

Previous to your solicitation of favour from your friends, you have necessarily passed the awful ceremony of examination at the Old Bailey, under your former tutor (and his brethren of the court) who would not pay his own abilities so improper a compliment as to ask you questions in anatomy or osteology, that he knew your qualifications inadequate to the task of technically explaining. After passing this fiery ordeal, you deposit the usual pecuniary gratuity, and receiving the badge of your newly acquired honor, we now hail you “a Member of the Corporation of Surgeons,” and conclude an ornamental plate upon the door of your habitation denotes you so accordingly.

We suppose you embarking in a sea of spirited opposition, with your competitors, for professional celebrity, and decorating your place of residence in the most applicable stile to attract attention. To effect this, let your exterior apartments be ornamented with the busts of ancients you never read, and portraits of moderns that you never knew. These form an excellent combination to excite the admiration and report of those who have occasion to court the assistance of your extensive abilities.—To gradually heighten which surprize, your interior (or audit room) must be a perfect Golgotha.—A proficiency in the science of osteology, must be powerfully impressed upon the senses of the trembling visitors, by a profusion of skeletons in different states; let the awfulness of the scene be rendered still more striking, by a variety of subjects suspended in spirits, interspersed with singular anatomical and injected preparations, both wet and dry; giving to the whole additional force by the introduction of a “few ill shaped fishes,” as the finishing stroke to a well formed plan of chirurgical ostentation. Remember to let the certificates of your professional qualifications, from your different lecturing tutors, be so placed (in elegant frames) as to meet the eye in a conspicuous direction; lest that part of your patients, who condescend to visit you in this gloomy recess, should have reason to conclude you a consummate dunce and most illiterate booby, if these learned professors had not done your friends the favour to “certify” to the contrary: and this they always chearfully do, rather than have it imagined they have eased you of a part of your property, without doing you any real service.

The domestic arrangement being thus formed, the reflections to which you must now turn your mind, are the necessary modes of practice and behaviour, that may render you not only eminent in your profession, but respectable in your property; as great events, that contribute largely to the gratification of such wish, do not frequently occur, inferior cases of every kind must be rendered subservient to the purpose. In this list, venereals are entitled to pre-eminence, as the most lucrative; the patient never hesitating to pay full as liberally for the preservation of the secret as the cure of disease.—But you may be perfectly assured, this secret never rewards so well, as when fate or fortune assists its introduction to married families; a most striking corroboration of this fact, occurred not long since in the neighbourhood of a royal residence, and afforded matter of mirth to the first circles in its environs.—This constant friend to the faculty was communicated to a married lady, by a young and celebrated personage of some national eminence, and immediately conveyed from her to her enamoured cornuto in the moments of true connubial felicity; he, in the love of variety, unluckily conferred the favour upon the house maid; and she, in the extensive liberality of her disposition, kindly bestowed a portion upon the footman. The electrical shock of this French fire was so rapidly communicated, that the four sufferers, within the space of ten days, made their separate private confessions to the medical superintendant of the family, each assigning a different cause for its introduction, and equally strangers to the mode of its being brought into so sober a family. Although this is a well authenticated fact, it is a harvest that can be very seldom expected to happen in so great a degree; yet you will find it a matter often intruding between husband and wife, and considered no indelible proof of modern inconstancy.—To this secret, you will be frequently admitted by one party—the other, or both; and have an undoubted privilege to accumulate all possible pecuniary advantage from the confidence so implicitly placed in you.

Whatever cases are submitted to your opinion, be always prepared to represent them worse than they really are; making by your technical terms, and political doubts, bad worse upon every possible occasion. Let all your proceedings have a peculiar and commanding dignity annexed to the execution; by assuming a want of feeling, even to ferocity, you will be termed a practitioner of spirit, and become properly distinguished for your professional fortitude. No tender sensations must be permitted to influence your feelings during any operation, however tedious, or painful to the patient; they are an ornament to human nature, and beneath your consideration as one of the faculty.—Custom has rendered you ineligible to a place in the jury box, as an evident proof of your professional brutality; by therefore turning “their pains to laughter and contempt,” you only justify the character you are already in possession of.

In the most trifling operations (even phlebotomy) descend to the very minutiæ of medical consequence, not only making the ceremony long, but serious, that you may be the better entitled to personal respect and pecuniary compensation. In all those dreadful accidents that alarm friends and distress families, take care to throw out (during your apparent care and attention) a variety of observations that convey large sounds with little meaning; by such ambiguous expressions you render the cure more extraordinary, whenever it happens, and is no bad preparative for the procrastination of it to your own emolument. In all cases requiring the interposition of instruments, take great care that you produce them with mysterious solemnity, impressing the spectators and assistants, with equal awe and fear of your abilities; if incisions, or separation of the soft parts, become necessary, be sure, like “old Renault,” to “shed blood enough;” it will be attended with a double advantage; first in the appearance of business, and the more pleasing consideration, that the larger and deeper the wound, the longer time will be necessary for incarnation; during the course of which, your personal attendance and daily epithemas cannot be dispensed with.

The greater operations do not occur every day, therefore tedious cicatrizations, in addition to simple and compound fractures, are comfortable aids to fill up the spaces of intervention. Fractures of the lower extremities are exceedingly favourable, for you may then exert proper authority; it becomes your duty to keep them down when they are so, for surely you may take upon you to know (with propriety and professional privilege) when they are capable of standing and walking, better than they can themselves.—Tho’ one exception to this rule has fallen within my knowledge, and nearly set aside the privilege of the practice in the neighbourhood where it happened.

An honest hearty miller, in a small parish in the county of H—-—-, having, on the market day, made some lucky purchases, and congratulating himself upon his good fortune with a few friends over the bottle, got himself insensibly intoxicated; but obstinately persisting in his determination (and ability) to ride home, he was suffered to depart, and was found afterwards upon the road by one of his own servants almost lifeless; he was conveyed to his habitation, and one of the most eminent surgeons from a certain large and populous town was called in, who finding the trunk nearly inanimate, proceeded to venesection, then to an accurate examination of the body, in which he presently discovered “a fracture of the tibia, and two of the ribs; he had every reason to apprehend (from present symptoms) a concussion of the brain; but situated as things were, he should now administer proper palliatives, and pursue the necessary steps upon his arrival in the morning.”—He then left the patient, after strict injunctions “that he should not be suffered to move from the position he had placed him in, till his return.”—At the hour before appointed, the Doctor returned, and not finding the wife below stairs, explored the region he had left his patient in the night before, surrounded by his sorrowful friends; when, strange to relate! (stranger to believe!) the bird was flown, the bed made, and the very room exhibited a striking proof of rustic neatness. Recovering in some degree from his surprise, and feeling very forcibly the aukwardness of his situation, he descended to the kitchen, and there finding the wife (who had just returned from some business in a back yard) he eagerly enquired “How, or which way, his patient had been conveyed, and where to?”—When the poor woman very simply and civilly replied, that “her husband was gone into the fields among his folks; that she had repeatedly urged the doctor’s orders of his not getting out of bed; but he was a very obstinate man, and said he’d be d—’d if he’d ever lay in bed with a broken leg for any doctor in England, so long as he could walk upon it.”—It may be better conceived than described how severe a stroke this proved upon the reputation of the surgeon; certain it is, his practice continued in a declining state for some years, and it was not till the circumstance was nearly buried in oblivion (with the body of the miller) that he recovered his former celebrity, being at this moment one of the oldest and most eminent practitioners in the neighbourhood where he resides.

This instance sufficiently demonstrates the impropriety of overstraining the professional prerogative, especially with those obstinate uncivilized beings, who have so little pliability of disposition, as not to lay in bed when required; particularly in cases of emergency, where it is so evidently for the promotion of their own health and safety.

Remember in all cases of difficulty and danger to be mindful of the emplastrum adhæsivum of connexion, by which every branch of the faculty should be united for the preservation of the whole; advise (without the least reference to the enormity of expence) a consultation of the most eminent; this renders the case of your patient more serious and alarming, and you oblige your brethren by the recommendation; first of a physician, whose prescription introduces the apothecary; and you then proceed physically and systematically in the joint depredation and cure; your two friends, by the law of retribution, gratefully recommending your inspection of every simple laceration upon all similar occasions.

These are maxims that may at first sight seem beneath the attention of a young and brilliant practitioner, who erroneously conceiving merit a sufficient recommendation, requires no other conductor; but they are so evidently an absolute part of his necessary study, that unless such mutual arts are occasionally put in practice, he can never (in the present multiplied state of practitioners) expect to derive the common necessaries of life from a fair and generous practice of his profession.