V

THE GRADUATE AS HOSPITAL-INTERNE

Relations and obligations of hospital-internes to each other to members of the Medical Board, and to the lay officersReciprocity Hospital discipline-The main forms of procedure to subserve the interests of patients and the efficiency of the medical staff-Criterion of conduct of members of the house-staff-Conduct of the medical officers in the operating

room.

On the eve of graduation, the good student, ambitious to secure the hospital internate, is dreaming, half awake, of his chances of passing successfully the competitive examination which is to determine admission to the corps of internes. Notwithstanding his long preparation for this examination with the aid of some of his fellows, his anxiety rises to fervent heat when he considers how very many are competing out of the great numbers of students who are equally desirous to enter the medical staffs of the hospitals. He is deeply saddened by the thought that he may be among the disappointed who are to be deprived of the privileges and opportunities afforded to the few successful candidates, and endeavors to be consoled by the hope that, in the event of failure, he may still be able to enjoy the privileges of bedside study of disease through the good will of his friends who are ad

mitted. But to his delight he is successful and ready and glad to grant to his less fortunate friends all the privileges he had so much desired for himself. Admitted to the grade of junior assistant, he soon finds many things to learn, not only in practical medicine, but about his various obligations as member of the staff; and desires to be told of the exact nature of these obligations for they are not all contained in the printed rules and regulations of the institution. Hence this conference which is intended to give him a brief statement of the more useful rules of conduct.

The relations, obligations, and observances of young hospital-physicians are of so many kinds, that a few only of those which are of greater import will be named at present. The graduate, realising his obligations to his colleagues, to his teachers in the Medical Board, and to the other officers of the hospital, is not likely to forget the impression he received, from his early studies in moral philosophy, that obligations must necessarily be reciprocal, and that, therefore, his colleagues, his teachers, and the other officers of the hospital are as much bound to him as he is to them, as dependent upon him as he is upon them for the accomplishment of certain duties. He finds confirmation of these views in the sermon on the Mount, in the Hippocratic Oath, in the national system of medical morals, and in his own bodily functions. There is no better illustration of the obligation of reciprocity than that afforded by the human body whose organs are so interdependent that failure of one organ to yield its

due service disturbs the apparatus of which it is a constituent part, and the disturbance of this apparatus reacts injuriously upon the others and indeed upon the whole organism. The idea of this essential reciprocity, this general interdependence, in the actions of the divers parts of the body, which, however, is almost as old as medicine, is treated very ably, though facetiously, by the learned, keen-witted Rabelais in the last paragraph of the third chapter, and in the second, third, and fourth paragraphs of the fourth chapter of the third book of Pantagruel on debtors and borrowers; taking his cue from Æsop's apologue of the dispute of the members and the stomach which was modernised and so admirably versified by the gifted fabulist, La Fontaine, who takes occasion to refer to Menenius Agrippa's happy application of this Æsopian apologue.

The new member of the house-staff having asked to be told something of the particular rules of conduct by which to be governed in his relations to his colleagues, his teachers, and others; the replies are, in substance, as follows:

His relations to fellow-internes should be fraternal, amicable, cordial, and harmonious, for he will often need their aid and counsel in his ministrations to the ills of some gravely afflicted sufferers. If then all be animated with the same zeal in the performance of duty and the observance of reciprocity, the general good will become the good of each who will always cheerfully give his help toward the promotion of the welfare of his fellows and to

maintenance of mutual aid in studies, besides fostering the good-fellowship and enduring friendship so helpful at all times, so delightful in middle life, and such a blessing in old age.

His relations to the members of the Medical Board, who are his new teachers and intellectual foster-parents, should be filial with manifestations of respect, obedience, and gratitude. By diligence in his daily labors and close attention to his duties and to the bedside instructions of these teachers he gains their warm approval, and the grateful appreciation of patients, as well as the regard of his colleagues.

His relations to the lay officers of the hospital should be of such a nature as to inspire them with good will, with friendliness, and with a disposition and a readiness always to do their best for his well-being; and it will be often in his power to reciprocate by ministering to their ails, and by other acts of kindness.

Some of the larger hospitals, consisting of several divisions, are necessarily equipped with as many separate visiting and house staffs. In former times, this circumstance has often been the chief cause of an unpleasant and even offensive distance, and of an unbecoming rivalry between the different divisions; the members of one division knowing or affecting to know little or nothing of members of another division, both sometimes lacking in the courtesies due to each other, and even to members of the visiting staff. These little miseries should not and, it is hoped, do not now exist. The exchange of civilities

among the medical as well as between the medical and lay officers cannot fail to be conducive to good will, right understanding, and general contentment. In all social, official, and professional relations, the observance of due ceremony is always becoming. It "softens manners, expands affections, and dignifies conduct."

Having entered the hospital for the faithful care of the sick and for the acquirement of knowledge, the young physician should make the best of his opportunities and do nothing likely to interfere with the accomplishment of these laudable objects. The nature of his conduct toward the patients, his colleagues, and others, will determine the character of his future professional relations and, in private life, he will be exactly what he was among his fellows at the hospital.

Each division of some hospitals has its own particular house-staff consisting of a house-physician, a senior assistant, a junior assistant, an externe, and ambulance surgeon. This system has operated well during many years, as much for the good of patients as for the general discipline of the establishment the medical government of which is confided to the visiting-staff under whose instructions the house-staff acts generally in harmony. However, troubles have sometimes arisen in the house-staff, but ordinarily of a trifling nature and soon remedied through the exercise of good sense and temper on the part of the house-physician. In the distant past, such minor vexations have occasionally been due to the overzealousness and officiousness of the incoming junior assistant before he