cians had their patients declared dead by legal form before instituting any treatment or taking charge of the case, so if death really took place, they would not be punished. After that time, various small states and principalities in the German Empire formed codes, notably Prussia in 1625. The morality inculcated in the ancient codes and oaths is very high. Good character, good morals and professional secrecy are requisites common to all. The low state into which medicine had fallen during the Middle Ages is reflected in the codes and regulations of the times. Doctors too often had neither attainment nor character and it was deemed necessary to protect the community against them. As the Roman Empire declined and fell, learning of all kinds went into the long sleep of the Middle Ages, as did ethics and medicine, and the physician and the priest were again united, this time in the person of the monk. The influence of Greek thought was active only among the Arabs who thus played their part in preparing the way for the Renaissance. Among the Greeks, medicine was a part of philosophy, in the Middle Ages of theology, and physicians were not classed among learned men. Some of the higher clergy of the Benedictine monasteries seem to have been men of learning and to have been interested in medicine; but the medical teaching, which, in the ninth century gave the name of Civitas Hippocratica to Salernum and which developed into the university of that place in 1150, seems to have been purely secular. The monks as a class preserved literature though they added little or nothing to exact knowledge. The Benedictines, however, gave special attention to illness and some of them seem to have possessed medical as well as general learning. It is interesting to remark that the origin of the first European university was its medical school. To Salernum went William of Normandy, afterwards the Conqueror, in quest of health, which his subsequent career would seem to show that he regained. Frederick the Second, Emperor of Germany, 11941250, included in some ordinances relating to practitioners a provision that no one should be allowed to bear the title of physician unless he had passed the examination at Salernum. But we must hurry on, great as is the temptation to linger. The history of medical ethics is inseparable from the history of medicine, and broadly speaking, no real progress in ethics can take place without antecedent progress in medicine. During the seventeenth and eighteenth centuries the system makers, from Van Helmont to Hahnemann, were dominant, the resurrection of ancient literature leading at first to a blind reverence for authority, especially that of Galen, and the expenditure of brains often worthy of better things on hypothesis rather than on observation and experiment. Finally, the foundations of real progress were laid by Harvey, Sydenham and John Hunter, to select the great names of England alone. During the reign of the system-makers the lack of respect in which physicians were held, and part of the reason therefor, are reflected in the literature of the times and in the unseemly to use a mild wordprofessional wrangles of the day. Contrast the attitude of Molière toward doctors of physic with that of writers for the modern stage. A class, as well as an individual, must respect itself to win the respect of others. Too many of the leaders of the profession, garbed in a long, velvet-lined doctor's robe, later with peruke, cane and sword were mere pedants at the best, though they assumed the air of savants, and deemed it beneath their dignity to render other services to the sick than give dogmatic advice and write elaborate prescriptions. They took themselves very seriously. Perchance, had medicine stood higher in popular estimation, Rabelais, Smollett and Goldsmith might have been lost to literature. Rabelais was for fifteen years a monk, the last five years a Benedictine. The relation of the Order to medicine has already been spoken of. Had Rabelais not left the Franciscan for the Benedictine Order, would he have turned to medicine? Richard Mead, Doctor of Philosophy and Physic of Padua, later M. D. of Oxford, author among other works of "The Dominion of the Sun and Moon over the Human Body, and of the Diseases Thence Arising," the successor of Radcliffe in fashionable London practice, was bitterly attacked by Woodward, Professor of Physic in Gresham College, in print, and so rudely treated by him in public that Mead drew his sword and a duel was fought then and there. Mead disarmed Woodward and bade him beg for his life. "Never till I am your patient," was Woodward's witty reply. Later, Mead was literally chased down the grand staircase by Sarah, Duchess of Marlborough, who, offended by some remark of his at her bedside, jumped out of bed and pursued him with the purpose of pulling off his wig and throwing it in his face. Try to imagine such a thing in London today! The duel between Doctors Bennett and Williams in the eighteenth century was a forerunner of similar events at a much later period, of events not quite unknown today south of Mason and Dixon's Line. A pamphlet quarrel led to blows, and then to a challenge from Bennett, declined by Williams. Bennett then called on his confrère and called him a coward. Williams opened his door himself and shot Bennett, with a pistol and swan shot in the breast. Bennett retreated across the street to a friend's House, followed by Williams who shot again and then ran him through with his sword. Bennett managed to draw his sword and ran Williams through the chest and scapula, the sword breaking off short. Williams died before he could reach his house, Bennett in four hours. In 1830 took place near Philadelphia a duel between Dr. Smith and Dr Jeffries with pistols. Shot one at eight paces a miss; shot two breaks Smith's right arm; shot three wounds Jeffries in the thigh, causing him to bleed profusely. Bandages and brandy put him in condition for shot four, which, the men being only six feet apart, was fatal to both. One more, and less tragic, illustration of the ethics of the time. Wynter, English and fond of wine, and Cheyne, Scotch and an advocate of milk, rivals at Bath, exchange compliments as follows: Dr. Wynter to Dr. Cheyne. Tell me from whom, fat-headed Scot, Suppose we own that milk is good, Doctor, one new prescription try Dr. Cheyne to Dr. Wynter. My system, doctor, is my own, My blunders hurt myself alone, But yours your dearest friend. Were you to milk and straw confined, I can't your kind prescription try, 'Tis natural you should wish me die, If there are pessimists among us, let them read of past times. The fundamentals of human nature do not change. Fashion is still potent and always will be. But self-restraint has increased and the fire of passion is less easily lighted in those who are humbly trying to observe the facts and learn the laws of nature than in those whose pride and feelings become enlisted in the advocacy of a hypothesis or a theory. Contrast the attitude of the profession at large toward inoculation and vaccination, and toward every innovation of past time, with that toward Pasteur, Koch, Lister and other revolutionists of modern times. Contrast the doctor of the stage and fiction in past and present times. Doctors of Medicine still differ, for medicine is not an exact science though it is coming more and more to rest thereon. But now when they differ they do so temperately, recognizing that there is fair ground for difference of opinion in many matters. Doctors of Law are paid to differ. The differences of Doctors of Divinity, to whom the proverb that doctors differ was probably first applied and who have succeeded in sloughing it off on us, are patent, and led to the horrors of the Inquisition and the Reformation but are now relatively as mild as milk. Our manners are not always good. In some respects they are inferior to those of earlier times, when the liability to be called to account in a duel, made men careful, often ceremonious, even if modesty and respect for the rights of others were lacking. But we are, in the main, far more tolerant in differences of opinions, more open to conviction, far less acrimonious in. expressing our differences. Codes of medical ethics have grown shorter and simpler, where they persist, as in my own State. The very word "Code" has been dropped by the American Medical Association which prints a statement of the "Principles of Ethics" comprising helpful suggestions as to the relation of physicians to their patients, the public and one another. The British Medical Association has no Code. Ethical conduct is promoted by education, culture, example, not easily enforced on the unwilling by law, so full of loopholes for those in search of such. The laity is gradually learning that "professional etiquette," which it has characterized as inhumane, selfish, absurd, in truth rests primarily on the interest of the patient, only secondarily on that of the doctor. The relation of doctor and patient is such, such the interaction of mind and body, so largely does mere perversion of function represent, modify, or complicate definite disease, that the confidence of the patient in the knowledge, skill and character of his physician is always a very important element in the care— not infrequently an indispensable element in the cure-of the sick. It is harmful to the character of one physician to directly or indirectly sap the confidence reposed in a professional brother. It is harmful to the usefulness of the profession at large so to do. It is harmful to the sick man. A dignified silence or reserve_as regards quacks, even notorious quacks, is, as a rule, wise. We should certainly not go out of our way to break such silence. A certain proportion of the community is always ready to worship false gods, a larger proportion to be temporarily led astray. But as Mr. Lincoln is reported to have said "you can't fool all the people all the time," and in the long run truth prevails. The length of this run is shortened by absolute honesty in thought and deed on our part, by freedom from affectation of power and knowledge which we do not possess, by an attitude of mind which welcomes and recognizes progress, even though it may seem to clash with our personal interests at the time. Most of the ridicule which was unsparingly dealt to our profession in past times was richly earned by the assumption of so many of its members. The gold-headed cane, a portentous gravity of manner, a peculiarity of dress, other than that of scrupulous neatness, are trivialities which have had their day, like the proverbial dog. These particular trivialities are not likely to be reincarnated, but let us heed that other more subtle, and perhaps less venial, trivilities do not take their place. The philosophy of life has been well, even if profanely, summed up in the advice of the Missouri father to his son: "So live every day that you can look any damned man in the eye and tell him to go to hell." Note that the latter part of the injunction is permissive, not mandatory. The important thing is the mode of life. The exercise of the privilege is secondary, subject to the inhibition of modesty and common sense. Duty is ever paramount. The right which is attached thereto it may be better for us not to insist upon, and then only with careful regard for time and season. Every rose has its thorn, and one of the thorns of the lovely rose of the practice of medicine is that the daily work of the physician brings him so much in contact with his inferiors, that is, with those who defer to his judgment. He thus comes in danger of being opinionated, intolerant of difference of opinion. Efficient antidotes to this toxin are an active share in medical meetings and the careful reading of at least one first-class medical journal of general scope. I have in mind more than one physician |