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others and general helpfulness must be such as to lead all reasonable people to feel that you have been a blessing and a pleasure in the house. Of course you will meet many unreasonable people and then you must quietly do your duty by patient and doctor and never worry so long as your conscience approves. At the same time the doctors and the public have a duty to the nurse which is too often entirely overlooked. The nurse is, too often, expected to do efficient and arduous work night and day and to get her meals anyhow or do without them. The public should remember that if the nurse to do her best for her patient she must rest a little, eat regularly and sleep at regular hours. She can not stand a prolonged strain without a daily walk, and even a woman can not work night and day for many days without breaking down or ruining her health forever. The nurse's work is no emergency work, where a night and day strain is to be borne for a little while once or twice in a lifetime. One bad case may come close on another; and she must carefully attend to her own health if she is to do the best for her patient. The nurse must be no tattler, and professional gossip must be a thing forbidden. He is a very young doctor or a low-grade one who is fond of talking to the laity about the cases he has seen and the cures he has wrought; still worse is the nurse who entertains her employers with what she saw or did when she was nursing Mrs. So-and-so. Never mention your cases, or your doctors, or your experiences to the laity. Talk to each other and your doctors about your professional work as every enthusiast must, but remember that all the private affairs of your patients must be absolutely sacred and perfectly safe in your hands. Remember always there can be no ideal too high for the perfect nurse.

But I must not forget the graduate in medicine. As teachers we thank you for the earnest attention on your part that has made our labors pleasant and filled us with hope and encouragement. I have thought that it would not be unmeet to talk to you for a little, before bidding you God-speed in your career, on the subject of Medical Ethics, more especially as this is a subject unwisely neglected in our curriculum, and still more as the American Medical Association has this year rescinded its code and offered in its place its "Principles of Medical Ethics," which it "promulgates as a suggestion and advisory document." This document should be in

the hands of every young physician, and should be a part of the life of every old one. It is an excellent statement of principles and an honor to the committee who prepared it. Let me premise by saying that the essence of it all is that the physician should be a broad-minded and liberal man and a perfect gentleman toward his patients, society, and his fellow practitioners. But the best intentions need guidance sometimes, and therefore the "Principles of Medical Ethics" should find a place on your office table.

In taking up this matter I am embarrassed by the scope of ground I would like to cover in the time at my disposal, where at least six lectures would be required to do the subject justice. The first chapter treats of the duties of physicians toward their patients. If you would act as becomes the high principles which the profession has ever struggled after, you will regard your relation to your patient as on a higher plane than a mere business one. Your patient places in you the highest trust that can be put by man in man, and you must all the time be resolved to merit that great trust and to give him in return the very best service of which you are capable. First, he needs your careful, undivided attention to the relation of his symptoms, no matter how trivial they may appear. They are serious to the patient and often the most trivial symptom may throw light on a case. He comes to you for comfort and must be received with sympathetic cheerfulness. Your patient is sick, and perhaps, therefore, selfish and capricious. You must exercise toward him that reasonable indulgence which the weak have a right to expect from the strong. In treating your case you must first know what you have to treat and how you are to treat it, and then, with the utmost kindness, but with perfect firmness and truthfulness, you must take charge of the patient till he is restored to health. Perhaps, after all, your success in practice will depend most on your knowledge of human nature, and that capability for managing your fellow men which is called tact. And so easily is human nature, and especially sick humanity, played upon, that a tactful man must ever watch over himself lest he yield to the temptation to please or manage his patient instead of curing him. As you get used to practice it will require constant self-control on your part to keep yourself up to the standard of doing your very best for the case. It is so easy to smile away a patient's fears, write

a prescription, pocket a fee and pass on smilingly to the next case; and it says much for human nature that there are so many honest, conscientious doctors. This same question of honesty and truthfulness is a difficult one. A patient comes to you with the symptoms of incipient phthisis, and you find tubercle bacilli in his sputum. You must on no account soothe him into a fool's paradise with the lie that he has a throat or stomach cough; neither must you scare him with the information that he has consumption. Gently and soothingly, yet firmly and faithfully, you must tell him his condition. You must fill him with hope for the best, yet insist on the measures necessary to make that hope a thing realizable. But that is not the most difficult case. The father and breadwinner, or a delicate mother, has an incurable disease, has six months to live. Shall he or she know the truth or shall these few months be soothed by evasive answers and false hopes? Personally I believe that every sane adult patient has an inalienable right to know the truth from his or her physician; but the truth should be broken gently and the patient cheered and encouraged to bear it bravely; and if I know human nature, the days of the heroes are not past and men and women are as brave in adversity as in the days of yore, or braver. Personally, if a patient were to come to me and say, "Doctor, I want you to examine me, but if you find anything wrong, I don't want you to tell me," I should say, "Then you must get another doctor, for if I can not be honest with you, I can not be your physician." The first thing and the last thing you need from your patient is perfect trust, and you simply can not afford to lie to him. But remember, always, that you must bring sunshine and comfort with your visits and even when there is no hope of cure, there must be sympathy and encouragement to brave endurance. And remember, too, how often you may be mistaken even in your most carefully wrought out diagnoses. It is also befitting the dignity of your profession that you insist on careful attention to your directions. Further, let your influence be always exerted as occasion may present, for purity in the home and the highest ideals of family and national life.

What the Principles of Ethics have to say about your duties to your professional brethren and to the profession at large is much to the point. Professional jealousies are the reproach of the medical

fraternity and a subject of ridicule by the laity. All men are human, and physicians very much so, and really the public do their very best to get us by the ears. If you would avoid all such petty meanness, remember that if Mrs. A. be pouring adulation on yourself, her new-found physician, and representing Dr. X. as a fool or a knave, in all probability Mrs. B. is telling Dr. X. at the same moment that you evidently entirely failed to comprehend her case, and only did her harm. And it is also to be remembered that few patients can convey to one doctor a correct report of what a former doctor may have said. I have had my own statements so repeated to me by my patients as to make me conclude that if my patient correctly reported, then I must have been a bigger fool than I thought I was. Remember, too, that you are not the only doctor in the town, and, perhaps, not even the best one; and that other men are doing honest work besides yourself. Finally, take every possible opportunity to meet your brother practitioners, and to this end nothing can be so valuable as a local medical society. A great effort is being made just now by the American Medical Association to unite the profession in America by organizing county medical societies, and the efforts should meet with cordial support from all earnest physicians. To quote from the Principles: "Such county societies constituting, as they do, the chief element of strength in the organization of the profession, should have the active support of their members, and should be made instruments for the cultivation of fellowship, for the exchange of professional experience, for the advancement of medical knowledge, for the maintainance of ethical standards, and for the promotion in general of the interests of the profession and the welfare of the public."

I pass over many things that I may speak for a moment on the subject of consultation. If, when you have carefully studied a case, and have read all the literature on the subject to which you may have access, you feel that you do not understand it, or if it fail to yield to your care as you think it ought to do, you will serve your own honor and your patient's interests equally by desiring a consultation. Or if you see at any time that your patient or his relatives have any wavering of confidence in you, again you will do best to desire a consultation. Or, if your patient or his friends suggest

a consultation, you should acquiesce with the greatest good will. No man is infallible, and some new light may be thrown upon the case; or even if you feel a consultation to be needless, it will still soothe distressed relatives and they will be the more likely to feel that nothing has been left undone. Offer your clients the choice of the consultant and let no personal feelings stand in the way of your meeting their choice provided you can respect his professional opinion. If they give you the choice, get the best man you know, regardless of whether you think he will differ from or agree with you. The good of your patient should be always your first thought, your private wishes or likes and dislikes come last. But when you feel puzzled or dissatisfied with your patient's progress, do not wait till he is dying before calling for additional advice. Get your consultant early while there is yet hope of assistance. A consultant should be punctual in keeping engagements, should examine the patient only in the presence of the attending physician, should express no opinion before the patient or friends unless desired by the attending physician to do so. Personally, I prefer to tell my consultant nothing about my impression of the case till he has examined the patient himself and formed an unbiased opinion. Then we can discuss the case and compare notes with mutual benefit. The discussion of the case should be private and a mutual agreement arrived at. If no agreement can be arrived at, a third physician should be called in. I quote from The Principles: "None but the rarest and most exceptional circumstances would justify the consultant in taking charge of the case. He should not do so merely upon the solicitation of the patient or friends." With regard to consultations with homeopaths or eclectics: It is clear than in medical matters no such consultation could be productive of good, as you can not agree in principles of treatment and consultation would be a farce and productive of confusion. Yet in the words of the Document, "The broadest dictates of humanity should be obeyed by physicians whenever and wherever their services are needed to meet the emergencies of disease or accident." And there may occur surgical or obstetric emergencies where it would be positively inhuman to refuse assistance. You must never hold informal consultations about cases treated by your colleagues. Mr. A. comes to my office to talk to me about his wife, who is being treated

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