prevent, as far as possible, excuse for such action. I regret to say that we possess no positive prophylactic measures against malpractice suits. Dr. Sanger3 has shown in his report that any case may be contested in the courts. Your patient may sue you as soon as your services are rendered, or, if a minor, action can be delayed until the period of majority, be that five or twenty years, and then commence proceedings against you. Nay, more; after you are dead and laid away, and unable to appear in your own behalf, suit may be instituted against your estate, and your widow and orphaned children be pauperized.*

Dr. Black, now deceased, and a former member of the Delaware County Medical Society, was sued a few years ago by a young man and compelled to pay three hundred dollars and cost of suit. Thirteen years before, when the young man was a lad of eight years of age, he received a severe lacerated wound of the hand, followed by gangrene and necessitating amputation at the wrist. As soon as the age of twenty-one was reached, he brought suit against the doctor with the result stated.

Seventeen years ago a gentleman, who is a member of this Society, was called to treat a boy with a dislocation of the head of the radius. After the reduction, the father told the physician that he need not call again, as he felt perfectly competent himself to manage the case. Later the bone became displaced and remained so,

3 Report on Malpractice. Maine Medical Association, 1878.

*[Since delivering my address my attention has been called to a recent decision of the Supreme Court of the State of Indiana, which shows that my statement is erroneous. I am under obligations to Ellis & Walterhouse, of Muncie, for the following statement: "Until recently, all Indiana courts have held that any physician or surgeon who undertook for pay to treat any patient, thereby impliedly' contracted that such treatment would be good and skilful, and that for breach of such 'implied contract' a cause of action 'survived,' and might be maintained after death of either party, by or against the administrator or other legal representative. (See cases of Staley vs. Jameson, 46 Ind. Rep., p. 159; Burns vs. Barenfield, 84 Ind. Rep., p. 43; Goble vs. Dillon, 86 Ind. Rep., p. 327.) But on the 4th of November, 1885, in case of Boor, Adm'r, vs. Lowrey, 103 Ind. Rep., p. 468, the Supreme Court (two judges dissenting) decided that 'an action against a surgeon for malpractice to recover for an injury to the person,' does not 'survive' against the administrator of the dead surgeon; thus limiting or overruling their decisions in the earlier cases; intimating, however, that special damages to property or estate' of the patient may yet be recovered in an action against such administrator, if such damages can be shown."]

but no advice was sought from a physician. The friends of the boy made some complaint and the physician never presented his bill. During the past winter that boy became of age and brought suit against the physician, who paid him one hundred and fifty dollars rather than risk the chances of a jury trial.

Unfortunately, the greatest danger arises in treating the poor, a class that appeals stronger than any other to our sympathy. They can prosecute without any risk of reaction, and they make a strong appeal to the jury. After the Maine Medical Association had listened to the report of Dr. Sanger, it adopted the resolution "that, with the existing State laws on civil malpractice, it is unsafe to practice surgery among the poor."

First, it

While we can not always prevent litigation, we can take some precautionary steps to fortify against malpractice suits. is best in all grave and doubtful cases of surgery to be supported by one or more in consultation. Second, in all such cases have an early settlement with your patient after your services are no longer needed. If he has a supposed grievance with you, it is better to consider it at once, while the witnesses are accessible. The scriptural injunction is good in this case, as usual: "Agree with thine adversary quickly while thou art in the way with him." Delays are dangerous, and after the lapse of a number of years, when your witnesses are dead or removed, you will make an unequal contest against the person who stands up before a jury and exhibits a stump or a deformed limb.

If we ever reach a period when this class of cases is discountenanced or unknown, it will be when the medical profession unanimously refuse to engage in encouraging or assisting lawyers in such work. The whole system is wrong. In almost every case of supposed malpractice among intelligent physicians, it will be found that the results could not be avoided or were caused and augmented by the carelessness of the patient. Who among us has not met with results in medical and surgical practice that he greatly deplored, and yet was unable to prevent? Is there a surgeon here whose cases have always terminated in an assuring manner? If so, I congratulate him. Let us remember in all cases of deformity to withhold censure until the facts are fully known.

There is no profession whose members are more closely associ

ated in sympathy and every-day affairs of life than the medical. A single clergyman will assume the responsibility of advising a dying man what he "must do to be saved." A single lawyer consents without hesitation to write a will and dispose of thousands of dollars worth of property to the satisfaction of his client-if not his heirs. Usually, however, the case is different with the physician, who feels more keenly the weight of responsibility, and asks for counsel. How the load lightens when we can share it with a professional brother in whom we have confidence. In all cases of surgery involving doubts and difficulties; in trying obstetrical cases, when the life of a mother is involved, and two lives hang in the balance, as well as many other cases, how we esteem the advice and assistance of another in whom we can trust. Our burdens and sorrows are lightened, while our joys are multiplied by their division with our fellows.

A physician should always strive to maintain a state of friendly feeling with his brother practitioners. He ought to be a gentleman, and treat others gentlemanly. Legitimate rivalry, based on skill and knowledge, is proper; but underhanded chicanery is contemptible and unworthy of any practitioner. A quarrelsome or a jealous physician ought to be abhorred in any community. Such an one is usually a "busy-body in other men's matters," with no business of his own. He bears the same relation to his professional brethren that a malignant growth does to healthy tissues-one is feared, the other detested.

A companion piece to the troublesome doctor is found in the officious layman. This genus is composed of both sexes, and is organized for the purpose of proclaiming the superior qualifications of its own doctor, and detracting from the reputation of others. When sickness occurs in the family of a neighbor who employs another physician, some member of this class is ready to proffer advice. "Who is your physician?" "Doctor Lancet!" "Well, he couldn't treat a dog for me! I employe Dr. Cureall, who never lost such a case as this." Even the funeral is not sacred from the approach of these pests. They are present to discuss the uncertainty of life and the inevitableness of death, as well as to enliven the occasion with criticisms on the needlessness of dying, and the infatuation of the deceased with that doctor of his! "Offered him

my doctor but he was obstinate!" I need not dwell upon the picture. If I address a non-professional man or woman to-night let me admonish you to tread lightly the threshold, and speak prudently in the sick room of your neighbor. You believe you employ the best physician in town; your neighbor has the same faith, but he employs another. Do not rudely thrust your opinions upon him. A man's religion and his family physician should not be changed except for good reasons.

Our code says: "Consultations should be promoted in difficult or protracted cases, as they give rise to confidence, energy, and more enlarged views in practice." Among true and honorable physicians consultations bring about this state of affairs; with unprincipled competitors the opposite results are induced. I believe the greatest hindrance at the present day to consultations is the advantage taken, too often, by the consulting physician to ingratiate himself into the favor of families into which he is called to render advice or assistance. Thou shalt not covet anything that is thy neighbor's, means your neighbor's patients as much as his house, his ox, or his ass.

Dr. Holmes says: "A physician's first duty is to his patient; his second only to himself. All quackery reverses this principle as its fundamental axiom. Every practitioner who reverses it is a quack." This is the true principle of legitimate medicine, and we may well be proud of our record of the past. The unselfishness of our profession has always been recognized. There has never been a want of physicians on the most sanguinary battlefield or in the most fatal epidemics. When disease and death have reigned, medical men have been present and faithfully discharged their duty. Our own society is honored with the name of Dr. Renner, a former resident of Indianapolis. A few years since, when Memphis was so severely scourged by the yellow fever, he went and labored with that distressed and afflicted people until "the relief-extending hand was itself paralyzed by the scourge whose ravages it had helped to mitigate, and after five days of torture, on the 16th of September, 1878, his light went out, and his life was laid as a sacrifice upon the altar of our common humanity."

994

* Dr. Lyons, Trans. Ind. State Med. Soc., 1880, p. 238.

But we are not compelled to go to battlefields or stricken cities in all instances to find medical heroes. Annually we fill up our death roll with names of physicians who have given their lives to the cause of humanity in their respective localities. Since we last met several of our number have passed away, and we shall see their faces and hear their voices no more. Among the number is our venerable ex-president, Dr. Joel Pennington, whose professional life alone embraced a period of more than half a century. Death came to him in the serenity of age; others fell in the prime of life, amid professional cares. Our friend, Dr. J. L. Wooden, was waiting in his office for his conveyance to carry him to a patient's house, when the more urgent call came and took precedence.

Benjamin Rush is the ideal American physician and teacher, and his character and tenderness have been stamped on those who have succeeded him. It is to the credit of the teachers in our American medical colleges that they have been and are humane. This is especially marked in the clinics where the poor apply for advice.5

As practitioners we should cultivate the same spirit in our intercourse with our patients; especially should we respect poverty. As the late Dr. Graves said, "If we are accused of disrespect for the dead, let us answer the accusation by our humanity to the living."

Possessing a knowledge of the laws of hygiene, we are under obligations to the public to warn the masses against the inroads of disease. Our first duty is to prevent as far as possible, and if we fail in this, then to cure or alleviate disease.

During the past few years we have made important discoveries of the origin of various diseases, and whether we choose to accept the germ theory of disease in whole or in part, we have learned many practical facts. We know that antiseptic precaution in the treatment of wounds is beneficial, and ought not to be undervalued. We know that cleanliness is essential to good health, and it is our duty to impress this fact upon the people.

Two years ago a severe epidemic of typhoid fever visited Ply

5 This is in contrast with some other nationalities. Thus, Dr. Clark relates that he has heard the case of a phthisical person explained in all its bearings by a professor at Bologna, Italy, in the patient's presence; in another instance, which occurred at the same place, a female, laboring under cancer of the uterus, burst into tears on hearing a detailed account of the nature of her complaint.