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For DECEMBER, 1769.
Obfervations on the Duties and Offices of a Phyfician; and on the Method of profecuting Enquiries in Philofophy. fewed. Strahan, and Cadell.
HERE is scarce any thing that affords a clearer proof of an enlarged and liberal turn of mind, than a man's rifing fuperior to the narrow prejudices and contracted notions of his own profeffion. The foldier, the lawyer, the phyfician, &c. has, each, not only a certain peculiarity of air and manner, but a certain fet of notions that diftinguishes him, and often expofes him to ridicule. This has been remarkably the cafe with phyficians. Hence we find that, in every age, much wit and raillery has been pointed against them; to fuch a degree, indeed, that, as our Author obferves, we never meet with a phyfician in a dramatic representation, but he is treated as a folemn coxcomb and a fool.
Many phyficians, however, have been as eminent for their candid and generous way of thinking, and their contempt of the low, paltry arts of their profeffion, as for their fuperior knowledge. Such characters are highly refpectable, and fuch appears to be the character of the Author of the Obfervations now before us. We have read them with pleafure more than once, and can fay, with great truth, that we know not which to admire moft, the enlarged and comprehenfive views of the philofopher, or the ingenuous and liberal fentiments of the gentleman, the friend to virtue, religion, and humanity.
Every reader, who has the least tincture of philofophy, will receive both inftruction and entertainment from our Author's' Obfervations; ftudents of medicine, in particular, will derive great advantage from an attentive perufal of them. They will conceive an early contempt of that little, illiberal fpirit, or, to ufe our Author's words, that corporation fpirit, which difgraces a certain clafs of phyficians, and which is animadverted upon VOL. XLI.. Dd
by our Author with a dignity and generofity of cenfure, which, how difagreeable foever it may be to those who are the objects of it, muft neceffarily be applauded by every liberal-minded reader. They will fee that it is below the dignity of a physician of real merit, to refufe to confult with another, because he had not his degree at this or that univerfity; that a stateliness and folemnity of air and manner, and the nicest and most exact attention to every external formality, are no marks of fuperior merit, and are fo far from fupporting the dignity of the profeffion, that they often expofe it to ridicule and contempt. They will clearly perceive that a creeping fervility of manners, and an abject flattery of people of rank and fortune, is a difgrace to men of learning and ingenuity;-that infidelity is no proof of a fuperior understanding;-that a man may be truly polite, without being impious;-and that a diffoluteness of principle is equally dangerous to fociety, and to their own intereft and honour. In a word, he will learn to diftinguish between the duties of a liberal profeffion, and the private police of a corporation; and will fee, that the fyftem of conduct in a physician, which tends moft to the advancement of his art, is fuch as will moft effectually maintain the true dignity and honour of the profeffion, and even promote the private intereft of such of its members as are men of real capacity and merit.
From the advertisement prefixed to this work, we learn, that
The following fheets contain two preliminary lectures, read not long ago, in one of the universities of a neighbouring kingdom, by a medical profeffor ;-that many copies, from the general fatisfaction they afforded his audience, were taken down in fhort-hand; and that of thefe, the reader is here prefented with the most correct. The Editor Aatters himself, that from the free and liberal fpirit of enquiry. which animates the whole of them, they will prove a most acceptable prefent to the public; and, of course, do no difcredit to the ingenious Author.'
The first lecture contains obfervations on the duties and office of a physician; a fubject of great importance, and of a very delicate nature for a phyfician to treat of with openness and freedom. In the profecution of this fubject, our Author confiders, in the first place, what kind of genius, understanding and temper naturally fit a man for being a physician;-in the second, what are the moral qualities to be expected from him in the exercife of his profeffion, viz. the obligations of humanity, parience, attention, difcretion, fecrecy, and honour, which he lies under to his patients.-In the third place, he takes notice of the decorums and attentions peculiarly incumbent on him as a phyfician, and which tend most effectually to fupport the dignity of the profeffion; as likewife the general propriety of his manners, his behaviour to his patients, to his brethren, to furgeons and apothecaries.In the fourth, he particularly de
fcribes that courfe of education which is neceflary for qualifying a phyfician to practife with fuccefs and reputation; and, at the fame time, mentions thofe ornamental qualifications expected from the physician, as a gentleman of a liberal education, and without which it is difficult to fupport the honour and rank of the profeffion.
Part of what he fays concerning those moral qualities which are peculiarly required in the character of a physician, we shall lay before our Readers:
The most obvious of thefe, fays he, is humanity; that fenfibility of heart which makes us feel for the diftreffes of our fellow-creatures, and which of confequence incites us in the most powerful manner to relieve them. Sympathy produces an anxious attention to a thoufand little circumftances that may tend to relieve the patient; an attention which money can never purchase: hence the unspeakable advantages of having a friend for a phyfician. Sympathy naturally engages the affection and confidence of a patient, which in many cafes is of the utmost confequence to his recovery. If a phyfician poffeffes foftness and gentleness of manners, a compaffionate heart, and what Shakespeare fo emphatically calls "the milk of human kindness," a patient feels his approach like that of a guardian angel ministering to his relief; while every vifit of a phyfician who is unfeeling, harth or brutal in his manners, makes his heart fink within him, as at the prefence of one, who is come to pronounce his fentence of death. Men of the moft compaffionate tempers, by being daily converfant with scenes of diftrefs, acquire in procefs of time that compofure and firmness of mind fo neceffary in the practice of phyfic. They can feel whatever is amiable in pity, without fuffering it to enervate or unman them. Such phyficians as are callous to every sentiment of humanity, affect to treat this fympathy with great ridicule, and reprefent it either as hypocrify, or the indication of a feeble mind. That it is often affected is beyond queftion; but this affectation is eafily feen through. Real fympathy is never oftentatious; on the contrary, it always ftrives to conceal itself. But what moft effectually detects this hypocrify, is a phyfician's different manner of behaving to people in high and people in low life; to those who fee him genteelly, and thofe who cannot fee him at all. A generous and ele vated mind is even more fhy in expreffing fympathy with thofe of better rank, than with thofe in humbler life; being jealous of the unworthy conftruction fo ufually annexed to it. The infinuation that a compaffionate and feeling heart is the effect of a feeble mind, is equally replete with malignity and falfehood. Univerfal expe rience demonftrates, that a gentle and humane temper, fo far from being inconfiftent with vigour of mind, is its ufual attendant; and that rough, bluftering manners very generally accompany a weak un derstanding and a daftardly foul, and are indeed frequently affected by men void of magoanimity and perfonal courage, to conceal their
There is a fpecies of good-nature different from the fympathy I have been speaking of, which is very amiable in a phyfician. It confifts in a certain gentlenefs and flexibility, which makes him fuffer
with patience, and even apparent chearfulnefs, the many contradic tions and disappointments he is fubjected to in his practice. If he is extremely rigid and particular in his directions about regimen, he may be affured they will not be strictly followed; and if he is fevere in his manners, the deviations from his rules will as certainly be concealed from him. The confequence is, that he is kept in ignorance of the true ftate of his patient; he afcribes to the confequences of the difeafe, what is merely owing to irregularities in diet, and attributes effects to medicines which were every day thrown out of the window. The dangerous errors which in this way he may be led into, are fufficiently obvious, and might easily be prevented by a prudent relaxation of rules which will never be obeyed. The government of a phyfician over his patient should undoubtedly be abfolute, but this abfolute government very few patients will fubmit to. A prudent phyfician fhould therefore prefcribe fuch laws, as, though not the best, are yet the best that will be obeyed; of different evils he fhould choose the leaft, and, at any rate, never lose the confidence of his patient, and thus be deceived as to his true fituation. This indulgence, however, which I am pleading for, must be managed with great judgment and discretion; as it is very neceffary that a phyfician hould fupport a proper dignity and authority with his patients, for their fakes as well as his own. There is a numerous clafs of patients who put a phyfician's good nature and patience to a fevere trial; those I mean who fuffer under nervous complaints. Although the fears of thefe patients are generally groundless, yet their fufferings are real; and the difeafe is as much feated in the conftitution as a rheumatism or a dropfy. To treat it with ridicule or neglect, from fuppofing it the effect of a crazy imagination, is equally cruel and abfurd. It is generally produced or attended with bodily disorders, obvious enough; But fuppofing them not obvious, ftill it is the phyfician's duty to do every thing in his power for the patient's relief. Disorders in the imagination may be as properly the object of a phyfician's attention as a diforder of the body; and furely they are, frequently, of all diftreffes the most dreadful, and demand the most tender fympathy: but it requires great address and good fenfe in a phyfician to manage them properly. If he feems to treat them flightly, or with unfeasonable ridicule, the patient is fhocked beyond measure; if he is too anxiously attentive to every little circumftance, he feeds and rivets the disease. For the patient's fake, therefore, as well as his own, he muft endeavour to strike the due medium between negligence and farcaftic ridicule, on the one hand, and an anxious folicitude about every trifling symptom on the other. He may fometimes divert the mind, without feeming to intend it, from its prefent fufferings, and from its melancholy profpects of the future, by infenfibly introducing fubjects that are amufing or interefting; and fometimes he may fuccefsfully employ a very delicate and good-natured ridicule.It is not unufual to find phyficians treating thefe complaints with the most barbarous neglect, or mortifying ridicule, when the patients can ill afford to fee them; while at the fame time, among patients of higher rank, they fofter them with the utmost care and apparent fympathy: there being no difeafes, in the ftyle of the trade, fo lucrative as thofe of the nervous kind.
• We sometimes fee a very remarkable difference between the behaviour of a phyfician at his first fetting out in life, and afterwards when he is fully established in reputation and practice.
beginning the world he is affable, polite, humane, and affiduously attentive to his patients; but when in procefs of time he has reaped the fruits of fuch a behaviour, and finds himself above the world, and independent, he affumes a very different tone; he becomes haughty, rapacious, careless, and fometimes perfectly brutal in his manners. Conscious of the afcendency he has acquired, he acts the part of a defpotic tyrant, and infolently boafts, that no man, in the place where he refides, dare die without his leave. He not only takes a moft ungenerous advantage of the confidence which people have in his abilities, but lives upon the effects of his former reputation, when all confidence in his abilities has cealed: because a physician who has once arrived at a very extenfive practice, continues to be employed by many people for their friends, who think of him themselves with contempt; they employ him because it is fashionable to do fo, and because they are afraid, if they neglected it, their own characters might fuffer in the world.
A phyfician, by the nature of his profeffion, has many opportunities of knowing the private characters and the private tranfactions in families. Befides what he learns from his own obfervation, he is often admitted to the intimate confidence of thofe, who perhaps think they owe their life to his care. He fees people in the most difadvantageous circumftances, very different from thofe in which the world views them ;--oppreffed with pain, fickness, and low fpirits. In these humbling fituations, instead of ufual chearfulness, evennefs of temper, and vigour of mind, he meets with peevishness, impatience, and a spirit perfectly broken and enervated. Hence it appears how much the characters of individuals, and the peace and happiness of families, may fometimes depend on the difcretion, fecrecy, and honour of a phyfician; who, without deviating from truth, may render characters that are truly refpe&table, ridiculous and contemptible. The most profound fecrecy is particularly requifite where women are concerned. Independent of the peculiar tenderness with which a woman's character fhould be treated, there are certain circumftances of health, which, though in no refpect connected with her reputation, every woman, from the natural delicacy of her fex, is extremely anxious to conceal; and, in fome cafes, the concealment of thefe circumftances may be of the greatest confequence to her health, her intereft, and her happiness -A phyfician, who is a man of gallantry, has many advantages in his endeavours to feduce his female patients; advantages but too obvious, but which it would be improper to recite. A phyfician who avails himself of these, is a mean and unworthy betrayer of his charge, or of that weaknefs which it was his duty, as a man of honour, to conceal and protect.'
In treating of the peculiar decorums and attentions fuitable to a physician, and which tend most effectually to fupport the dignity of his profeffion, our Author takes occafion to make fome obfervations on a charge of a very heinous nature, which has been often urged against phyficians, viz. their infidelity, and con