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knows that this man exaggerates the slightest ill, while another never complains, even if pain is very great and his trouble is serious. True, there are times when a family physician becomes a fossil, when through this very familiarity, he gets to following a routine treatment, and serious disease invades the household and insidiously grasps at the very vitals of its dearest member. Such instances go far to destroy the belief that there can be an ideal family physician. The rise of the specialists in medicine has tended to break up the influence of the family physician and has lessened his authority. It is greatly to the mutual benefit of the community and of the medical profession that there should be specialists. The field of medicine is constantly broadening. There is need of continual practice in certain lines to obtain requisite knowledge,- a knowledge that can only come from the seeing and examining a large number of patients.
A good specialist must have been first a good general practitioner, since one branch of medicine overlaps and depends upon another, so that the various departments are like interlacing circles. Those who are really specialists stand towards the other members of the profession and the community, not as specialists, but as experts.
There are in the community medical tramps. Every physician knows them. They are both credulous and unbelieving. This statement may seem paradoxical; but nevertheless, these are the crowning characteristics of such people. They are credulous in regard to what is told them of the marvellous cures their friends or their neighbors' doctors have wrought; and are unbelieving in regard to what their present physician bas told them of their own troubles; and they doubt the efficacy of his prescriptions. They half follow directions, they are irregular in their attendance upon their physician; and, after a few trials after this manner, they float off to some one else. Often they think themselves the prey to some startling malady, even sometimes priding themselves upon it. It is from this class that the faith-and-mind-healers obtain their brilliant results. One patient told me, with considerable pride, , that she had had twenty-seven doctors, and not one of them had understood her case.
In surgery, the two and two which will make four can be seen ; but very many inedical cases are algebraic problems in which are the unknown quantities, x, y, z; and the physician must study with care and patience to work out the proper solution of health.
Much time and money are lost, much pain and suffering are endured by the community, because of lack of faith in the physician, because of lack of perseverance, because of lack of comprehension that a diseased condition which has been in existence for years, cannot be removed in a few weeks.
Intelligent obedience, coupled with confidence, are the great requisites to obtain from physicians the good wbich it is in their power to do. It was an ancient law in one of the countries of the Orient that if the physician forbade his patient, while under his care, to take wine, and he did so, even if the patient recovered, he was to be put to death. Laws were not always so advantageous to the physician as this, for there was a code in the Middle Ages which read as follows: “ The physician shall not demand anything, if his patient die. And if a gentleman die after the effects of an operation, the physician shall be delivered up to the relations of the deceased, who may treat him as to them seemeth meet: but if it be a serf whom he has wounded or caused the death of, he shall be made to restore another to the lord.” Too often patients hold a physician responsible for lack of success, when it is due to their own carelessness and failure to comply with the directions given.
The question then arises : How can we feel implicit confidence in physicians when we know that they have one set of doctrines in regard to disease during one decade which they entirely set aside the next; when, for one half-century, they bleed and deplete, and the next half-century, stuff their patients; when one drug is allpowerful with one generatiou and is set aside by the next as possessing no virtue? How can we believe that, in our day and generation, physicians have come to know all things? The physician is not infallible, nor does he claim to be, but he should claim to have studied and perfected himself, as far as he is able, in all that is known of surgery and medicine at the present day. The community, in whose hands the matter rests, should insist that the physician should have studied in colleges in which the highest standard is maintained. Too often is a preference shown for those who get their diplomas in a factory for the same. Public opinion, in this country, does not exact a longer course than two, or at most, three years for its physicians, while in Europe, five to seven years are requisite for graduation. Our government, instead of assisting physicians in their studies, makes their expensive instruments, which must be imported, one-third or one-half as expensive again because of the duty levied upon them. The question of government aid to the physician is a deep and important one. If the government were to extend patronage to any of the arts and sciences, it would seem that it should do so to that branch of science which has the most to do with the health and welfare of its citizens. Fortunately, private individuals, of enormous wealth, have sufficient benevolence to do something toward increasing the facilities for improving physicians.
Many physicians are patient and painstaking investigators of disease. They are overwhelmed sometimes with the importance of making accurate and close observation. The medical profession of today are aware of the loss that has resulted from the failure of past generations to hand down to posterity the valuable results of experience, which would have helped to make medicine a more exact science. Modern medicine, with its enlightened knowledge and its hospitals, has already attained such results in saving and prolonging life that social scientists are puzzling their brains what to do with that class of individuals which the ancient Greeks disposed of either by slaying them out of hand, or by killing them with neglect. The question of government aid in medical scientific inquiry; the social problems raised by the prolongation of life in individuals who are crippled or injured; the advancement made in various departments of medicine because of modern investigation, are one and all topics which would require an elaborate essay to discuss.
What the medical code styles the “ pecuniary acknowledgements” of the physician should, perhaps, be touched upon. The community is rather inclined to under-pay him. Certain it is that the doctor's fees are much smaller in proportion than the lawyer's. The calling of a physician is a most arduous one. His burden of anxieties and cares shortens his life, so that it is not so long as that of the lawyer or of the clergyman. It is seldom that a physician is a good business man, and too often he is called away to his last account, leaving on his ledgers columns of figures, representing bills which will never be paid. The community in general should pay their physicians more readily, more cheerfully, and more in accordance with the importance of the service. A thousand dollars retainer for a lawyer of reputation is not regarded as excessive where a large amount of property is involved, but we have heard the same amount quoted as a monstrous charge for an operation, the successful performance of which saved the life of the individual. “ Doctors earn their money easily,” said a woman the other day, as she paid $500 for an operation in which the slightest deviation of the scalpel (as in the majority of operations) would have meant death to the patient. She considered neither the responsibility the surgeon assumed, nor the time and industry required to perfect himself for the operation, nor the years of experience and waiting for the reputation essential for the trust. Madame Dill pays for ber diamonds and for her dresses ; she would neither go without the jewels, nor have fewer and less elaborate costumes; but she would cheapen her doctor's bills, and grumble at their amount. A friend of mine recently remarked that there is no more heroic figure in modern life than that of the country physician, who cheerfully gets up in the dead of night and rides ten miles to attend some poor woman, who, he knows, can never repay him. Numerous are the calls upon the benevolence of a physician. An important case carries with it so much scientific interest that the money consideration sinks into insignificance in comparison.
Sickness never enters into the calculation of the light-hearted children of men, and to pay money for it when it comes, in addition to all the other discomforts that it brings, is like piling Pelion
We will dwell but a moment upon the social relation of the phy: sician to the community. It is generally of the most pleasant nature. Du Maurier has characterized one aspect somewhat peculiar to it, when he represents the pompous London physician taking out to dinner a stout old Dowager, who looks up at him with a winning smile, and says: “ Doctor, I am so glad that I am going out to dinner with you, since you can tell me what to eat, what to drink, and what to avoid.” The medical man is more often called upon in society to express a professional opinion than either of his other professional friends. The clergyman in these days is by no means expected to preach or pray in the drawingroom. It would be a bold person who would ask a lawyer a legal question while exchanging the small talk of society.
A prominent New York banker relates that, in a matter of litigation, he recently called upon the services of a distinguished Wall Street attorney, whose career in public life has given him great prominence. The affair terminated in a settlement outside of the Court, pending which some dinners were given, where the principals and their attorneys came together. When the banker asked for his bill from the attorney, the figures were $15,000. It struck the man of money that this was a trifle high, and be asked for an itemized account. It read as follows:
$5,000 To attendance on five dinners at Delmonico's, $2,000 each $10,000
It is seldom that a doctor in social life escapes a challenge for an opinion on some health topic, personal or impersonal,- oftentimes his interlocutor having the misguided notion that in this way a physician can be most agreeably entertained.
There may be those who have listened to this paper who will think t.at the relations of the community to the physician' have been dwelt upon rather to the neglect of converse. This, you see, has arisen from the necessity of the case the physician cannot in any sense afford to neglect the community. He must strive, like Madame Blaize, “ with manners wondrous winning,” to please the community, since he rises or falls according to its opinion of him. Then again, he is bound by the solemn oath of great Hippocrates himself, to do all that is honorable and noble. Moreover, if he is a good and regular physician, he is sworn to a code which will not permit him to blow his own trumpet and advertise his proficiencies; which will not permit him to let the outside world know if he is at sword's points with any of his colleagues ; which will not permit him to quarrel over patients with other practitioners, nay, rather to let the patient perish before he would do this vile thing; which will not permit him to have any secrets about his methods of practice. And if he invent an instrument, he must not patent it, since it is for the benefit of humanity - and the instrument makers, who can pocket all the profits.
In closing, I can do no better than to quote what the American Medical Association says, as regards the “Obligation of the Public to Physicians": “The benefits accruing to the public, directly or indirectly, from the active and unwearied beneficence of the profession, are so numerous and important that physicians are justly entitled to the utmost consideration and respect from