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whose simple, gentle manners, dignified mien, majestic stature, massive head, intellectual expression of countenance, great learning, admirable diagnostic skill, and rare prognostic wisdom, always inspired the physician with reverence in and out of the consulting room, the patient with confidence, and the family with hope-he was indeed an exemplarily good man and great physician, almost as skilful as he was honest. One of his eminent contemporaries was Doctor John T. Metcalfe, the optimistic, clever family physician and elegant man, who retained a large and lucrative fashionable clientage for nearly half a century; and another was the learned, loved, cheering Doctor Austin Flint whose presence in the sick-room was always hailed by all as a benediction, who was held in the greatest reverence by his grateful hospital patients, by his students, by his appreciative colleagues, and by the many physicians whom he so much aided in consultation.
Spurious healers, pretenders, and would-be fashionable medicasters disappear from the medical horizon as soon as their fraudulent schemes are discovered; whilst true men last and thrive by reason of professional ability, simple manners, pleasing cheerfulness, good taste in letters and art, consummate tact, absolute self-command, and masterly discretion.
The third and fourth sections of this second article are so full and explicit as to leave no doubt in the mind of the reader regarding their utility and importance to the patient, and therefore require no explanation or elaboration. "Patients should prefer a physician whose habits of life
are regular, and who is not devoted to company, pleasure, or any pursuit incompatible with his professional obligations. A patient should also confide the care of himself and family, as much as possible, to one physician; for a medical man who has become acquainted with the peculiarities of constitution, habits and predispositions of those he attends is more likely to be successful in his treatment than one who does not possess that knowledge. A patient who has thus selected his physician should always apply for advice in what may appear to him trivial cases, for the most fatal results often supervene on the slightest accidents. It is of still more importance that he should apply for assistance in the forming stage of violent diseases; it is to a neglect of this precept that medicine owes much of the uncertainty and imperfection with which it has been. reproached."
"Patients should faithfully and unreservedly communicate to their physician the supposed cause of their disease. This is more important, as many diseases of a mental origin simulate those depending on external causes and yet are only to be cured by ministering to the mind diseased. A patient should never be afraid of thus making his physician his friend and adviser; he should always bear in mind that a medical man is under the strongest obligations of secrecy. Even the female sex should never allow feelings of shame or delicacy to prevent their disclosing the seat, symptoms, and causes of complaints peculiar to them. However commendable a modest reserve may be in the common occurrences of life, its strict observance in
medicine is often attended with the most serious consequences, and a patient may sink under a painful, and loathsome disease, which might have been readily prevented had timely intimation been given to the physician."
The fifth section interests not only the patient but the physician who should take good care to enforce its wise provisions.
"A patient should never weary his physician with a tedious detail of events or matters not appertaining to his disease. Even as relates to his actual symptoms, he will convey much more real information by giving clear answers to interrogatories, than by the most minute account of his own framing. Neither should he obtrude upon his physician the details of his business nor the history of his family concerns."
The sixth section of this article of the first chapter of the American System relates not only to the obligation of obedience on the part of the patient, but points out the dangers of the disregard of instructions and of the acceptance of extraneous advice and of the use of medicines recommended by unqualified persons. It is as follows:
"The obedience of a patient to the prescriptions of his physician should be prompt and implicit. He should never permit his own crude opinions as to their fitness to influence his attention to them. A failure in one particular may render an otherwise judicious treatment dangerous, and even fatal. This remark is equally applicable to diet, drink, and exercise. As patients become convalescent they are very apt to suppose that the rules prescribed for
them may be disregarded, and the consequence, but too often, is a relapse. Patients should never allow themselves to be persuaded to take any medicine whatever that may be recommended to them by the self-constituted doctors and doctresses who are so frequently met with, and who pretend to possess infallible remedies for the cure of every disease. However simple some of their prescriptions may appear to be, it often happens that they are productive of much mischief, and in all cases they are injurious, by contravening the plan of treatment adopted by the physician."
The admonitions of the seventh section are also very wholesome to patients:
"A patient should, if possible, avoid even the friendly visits of a physician who is not attending him-and when he does receive them, he should never converse on the subject of his disease, as an observation may be made, without any intention of interference, which may destroy his confidence in the course he is pursuing, and induce him to neglect the directions prescribed to him. A patient should never send for a consulting physician without the express consent of his own medical attendant. It is of great importance that physicians should act in concert; for although their modes of treatment may be attended with equal success when applied singly, yet conjointly they are very likely to be productive of disastrous results."
A very good rule, generally adhered to by honorable medical men, is never to visit a sick friend who is under the care of another physician, unless summoned in con
sultation, and no loyal physician ever thinks of intruding himself into a consultation, nor does he obey any call for a consultation that is not made by, or with the consent of, the physician in charge.
The eighth section is a fair and equitable demand for justice to the physician, who is surely entitled to the opportunity of exculpation when a charge or charges are made which lead to his dismissal.
"When a patient wishes to dismiss his physician, justice and common courtesy require that he should declare his reasons for so doing."
A physician may be dismissed on account, as may have been alleged, of his having, in some way forfeited the confidence of the patient or family; and motives of delicacy may deter either from revealing the precise cause of this loss of confidence which may have been due to the evil influence of some tale-bearing person, or to damaging reports generally unfounded-made covertly by an intriguing, dishonorable rival for the purpose of supplanting him. Unfortunately, however, he does not always ascertain the truth until it is too late. His wounded pride deterring him from ever resuming his professional relations with a family that gives credence to false charges, even though the patient and family had discovered his innocence and reconsidered their hasty determination. Therefore it is always due to the physician that the reason for dissatisfaction, and for the desire to dismiss him, be promptly given by the patient or a member of the family, in order that he may have an ample opportunity to dis