newly qualified



men at

cles of

m.b., the Madras

Medical Association in 1898.

I tion


behalf of the Madras Medical Associa-

congratulate you, gentlemen, on your recent welcome you into our folds. success, and heartily

have all gone through a very arduous been rewarded with well-decourse and have have got through the diffiYou success. served no doubt, but the examinations, the of culties have experienced are nothing in difficulties you As Dr. to those in store for you. comparison his Convocation Kino- observed the other day in "a career that address, you have before you of of self abnegation tnves unusual opportunities If you have but little of earning wealth." the sole object of joined the profession with are sure to be dismuch money, you making In your are upright). you appointed (provided are very often likely to be future career, you the out to hygiene rules about unable carry



grouped with such artiPear's soap and brandy bottles; being a more valuable commodity it should not be advertised for sale. Sometimes advertisement may take more indirect forms. It is not unusual to find at times articles in the


An Address by



is not to be



highly flattering to some practitioners might very probably have contributed them themselves. If the practitioners in question have had any hand in them directly or indirectly, the conduct is very reprehensible. But if they know nothing about the matter, I think it

papers who

is advisable on their part to ask the Editor to insert a note to the effect that they have had nothing to do with the articles. The practice of some, of notifying their arrivals and departures in the local papers, is certainl}' another objectionable form of advertisement. Moreover, it is ridiculous that such practitioners should be vain enough to think that their movements are so important to the public as to be always watched with anxiety. I am not now speaking of such notifications of the movements of distinguished men, which are made at times in the papers without any &c., although knowledge of the men concerned. A certain regularity of sleep, meals, exercise, the same to others. The amount of publicity of movements is unavoidyou might be preaching calls unseasonable generally make it incon- j able in the case of persons who are on the venient for medical men to act up to their topmost rung of the professional ladders, howBut as irregularity ever disagreeable such notifications may be to preaching in these respects. to sure is derange your health, I themselves. Publicity is one of the penalties of habits would strongly advise you to try to arrange to be paid for distinction. to interfere with regular your work so as not Another objectionable means of securing work it a make to and point to take regular is the employment of touts, which, I am sorry habits, daily exercise and an annual holiday to recruit t,o say, is fairly prevalent in this city. The You have already learnt a good most direct your health. way is to employ somebody to deal about medicine, surgery, and various other convass for patients and pay him a certain commedical subjects, but one more subject remains mission. It can also be countenanced indirectly As in the to be learnt, viz., medical ethics. treating a patient gratis on the distinct by course of your practice you are likely to meet understanding that he is to fetch you patients. with many difficult questions of medical ethics, Another method is to enter into a contract with I will just touch upon some of them for your nurses or chemists to patronize them, they in benefit, so that you may avoid many unprofes- their turn undertaking to send you cases. It is sional and undesirable practices in your future needless to point out that all these practices are To be forewarned is to be forearmed. career. The most important reaobjectionable. highly We shall first take up the various devices for son is that the patient is not able to find out securing patients. The foremost amongst these the real merits of his doctor when engaging him " advertisement direct." is Advertising one's for the first time. The tout is ever on the alert qualifications, real as well as imaginary, and to find who are ill and tries his best to send contributing eulogistic articles about one's self the patient not to the best doctor procurable to the papers are certainly unprofessional. JNo with the patient's means, but to the doctor who member of an}r of the learned professions can most commission to himself; the patient do such an act either in Europe or America. pays all the while that he is taken to the thinking When one advertises himself, he has to give It is best man procurable with his means some reason why the public should patronize to mislead a cheating certainly downright him above all others, and so all his qualifications patient directly, or indirectly through a tout. are set forth in detail, with, of course, the covert If a patient comes to you, let him know your object of hinting the inferiority of many others. merits fully and select you with open eyes. Any undue prominence which the advertiser Further, the tout, who has absolutely no qualiusually seeks for himself is likely to be prejudi- fication but that of dishonesty, should certainly cial to the peace and goodwill of the profession. not derive a profit by merely canvassing for You must again bear in mind that professional of medicine should not be you. Your knowledge





in for medical advice from other medical men. used for any other Under such circumstances you would better purpose than that of treating the sick and avoid seeing the patient, as ai^ such social visit getting an honest livelihood for yourself. The is isapt to be misconstrued by the medical atten-

professional knowledge

debased if you enable any scamp to make dant, and to give rise to unnecessary ill-feeling between professional brethren. Let me point money under your cover. Another disgraceful device a medical man may resort to, at times, out one more questionable method of attracting to increase his clientele is to patients, vis., advertising oneself as a specialist, speak disparagingly


ora who hac been treating making people believe that one is a specialist by his conversation. do, your evident object is to make the patient .think that your prede I have already pointed out that advertising cessor is in any form is considered objectionable. I will incompetent, that you are a bettei man, and that you would be the proper person only add, now, that nobody can be called a to be consulted in the future. specialist if he has merely attended a certain Even when you think that 37o?r predecessor number of months in a special hospital as a has treated wrongly, it is your student or an apothecary. duty to be silent. No man is immaculate, and you must bear in On? becomes a specialist only by treating mind that the treatment diseases of special regions exclusively for a long 37ou think correct time. A specialist must devote his whole attenmay possibly be the wrong one and might evoke a similar tion to his special subject. A general practicriticism, if not a harsher one, from tioner can never be a specialist for the simple your successor. Again, it is unfair to criticise a brother behind reason that he does not his back. Your predecessor has study any single subject. been attending at an His attention is distracted by such a variety of early stage of the disease, ftnd the symptoms now present may not havecases that he can't make a special study of anyfully developed then. If you do criticise un-thing. I don't mean to say that general pracfavourably, not only is it unfair, but it will alsotitioners should never treat diseases of certain lower the prestige of the profession in the eyesspecial regions. As a matter of fact, they have of the public. to treat, and do treat, such cases as, say, sore If you do speak unfavourably of the previouseyes, iritis, otorrhcea, &c. But then for comtreatment, and if your predecessor comes toplaints requiring special skill he has to call in know your remarks (he will surety know onethe aid of specialists, say in such instances as day or another), he will take offence, wait forovarian tumours, cataracts, &c. Here we require an opportunity to sting you when you leastthe special skill of men who have done innuexpect it, and often to j'our great disadvantage. merable operations of a like sort, and who liiven if you are pressed by the patient to expressknow the various complications and unforseen an opinion about your predecessor's treatment, difficulties and the appropriate remedies. refuse to criticise. Patients often, with no proper I contend that a general practitioner can't have reason, dismiss a medical attendant and want to such special skill. I am sure you will all be find out some fault in his treatment as the cause engaged in general practice, and I advise you of their dismissal, and not to be tempted to call yourself specialist at thej7 naturally depend on There is nothing to prevent your }Tou for a criticism and the discovei'y of an any time. error in the a Whatsoever following up any special subject; but 3Tou must previous treatment. man soweth that shall he also want to become a specialist. reap. Whatever stick to that if you you do, you must bear in mind that a similar Next, I will pass on to the various questionable thing will in store for you, when you yourself means of making money. One of them is taking are commission from druggists for sending prescripsuperseded by a third man. Your duty is with the present and the future tions to them. I must condemn this as a very and not with the past. The past is over, and ungentlemanly and unfair practice. If you take no amount of talking about what should have commission, where is the money to come from? been done will help your patient or yourself as either from the patient or from the chemist. to the future. At all times you must bo careful In the former case, the patient is made to pay the about disparaging your professional brethren cost of the medicine plus the doctor's commission. before lay people, though it may be a public It the doctor takes no commission, the patient can duty to expose such moral delinquencies as hard get his medicine cheaper. The patient very often goes to a chemist recommended by a doctor, drinking, &c. You must avoid all doubtful expedients to believing that he has recommended the most reliobtain patients, for such tricks won't serve long, able and at the same time also probably cheap and you are sure to be found out one day or chemist, and in total ignorance of the fact that another. The public will one day perceive jrou he is being sent to the chemist who pays the most in your true light and will hold you in great liberal commission to the doctor. Fleecing the contempt. There is nothing like straightfor- patient thus on two sides, firstly, for advice, and, wardness in the long run. Very often you may secondly, for medicine, is, to say the least, highly have the misfortune to see your friends going a



before you.

If j?ou




unfair. If the patient knows that you are sending him to a chemist who subsidises you, he is naturally apt to resent and seek He may even seek other some other chemist. medical aid than yours. The practice is unfair, in the long prejudicial to your own interests be carried on stealmust which one is and run, thily. But some might argue that the doctor's commission need not be charged to the patient's account by the chemist, and that the patients might be charged just as they would be if no commission were paid to the doctor. It might be said that the cost price of the medicines is very little, while the profits occurring from the prescriptions are very large, and that the chemist can very well afford to pay a small percentage of his profits to the doctor tor his kindness in patronizing him. They consequently think that nobody is fleeced, and that there is nothing objectionable. But the commission comes now from the chemist's pocket. He pays it not because he is very contented and has got superfluous money to get rid of, but because he is compelled to give it in order to secure the doctor's patronage, which is necessary to make In these days of his investment a success. keen struggle for existence, the chemist will forego part of his profits, on the principle of "something is better than nothing." If any will not debit the doctor's commission driufist OO to the patients account, but pays it out of his own pocket, all I can say is that he is a rarity, and that he is more honest than the doctor. If you do take commission, you must fleece either the patient or the chemist; one is dishonest, and the other is unfair. It is 110 argument to say that a druggist will be satisfied with a smaller profit, while the doctor himself is greedy of getting more money in the way of commission in addition to his professional income. Another questionable practice of mute in" money is the manufacture of secret remedies. I do admit that the ingredients of such remedies may possibly be found in the pharmacopcea, but tlie same combination can never suit all cases under all circumstances.

unprofessional and



they are likely to as they will otten

cause more


harm than


be used by lay people who know nothing either of the ingredients or of their complaints. Besides, such manufacture of secret remedies smells decidedly of quacks and imposters, and. should never be countenanced by qualified medical men. One superiority of the Western methods of treatment over the native methods consists in the openness of the procedure. There is nothing secret, and any qualified man might criticise our treatment. Amongst the native quacks (I am sorry to say that they are called native doctors by some educated people, who ought to know better), the custom from time immemorial has




been to charge for the medicines ancl nothing for the advice, which probably they themselves did In fact, not think worthy of' remuneration. the role of all been have playing along they

counter-perscribing chemists; and, being such, it was their self-interest to keep the medicines secret so that they may derive a profit. It is

the reverse with us. We attach more value advice. Our advice must be paid for b}7 people who can afford it, and it is the chemists who pecuniarily profit, or at least ought to profit pecuniarily, by the prescriptions. So there is no necessity nowadays to manufacture quack medicines. I would strongly advise you not to be tempted in your future life by any prospective gain to manufacture or lend your name to the manufacture of such remedies. The market has been flooded enough with asthma cures, and ague cures, ring-worm specifics and itch specifics, fever pills, indiscretion pills, and nerve recuperators, Monday pills and tonic mixI hope you won't add to tures and what-nots. the list of such nostrums. Avoid prescribing patent medicines as much as possible. The manufacture of secret remedies is highly prejudicial to the best interests of the profession, as the public will begin to treat themselves with such nostrums to their own detriment, and to the detriment of the body of the profession, for whose services there will be less need in the future. No doubt it will benefit a small number of inventors of such nostrums; but the prestige of the profession, as well as the public safety, will be in peril. Another disgraceful method of making money is to give false certificates. The temptation js alas very large fees will ways great in such cases, be offered. But your duty is clear. If you do give, firstly, it will be a lie, and so is ungentlemanly ; secondly, it will unjustly injure certain parties or morally, as they would really be such for purposes; thirdly, by giving such sought a noble will disgrace profession in the eyes you the of public; fourthly, you prove yourself unworthy of being counted in the folds of medicine ; fifthly, you will be liable, if found out, for prosecution, which will end in disgrace; and sixthly, if you are in the Service, you will fare very badly when your misdemeanour comes to the notice of your superiors. The same remarks might well apply to certifying criminals insane, and to the production of abortion you can never be too careful in treating woman during the child-bearing period when suffering from amenorrhcea. Be very careful not to procure or abet

quite to



abortion, directly


indirectly,however tempting

the fee might be. It is unscrupulous and criminal, and involves social disgrace, professional ruin, and the penalty of the law. Those of have to enter the Service will you who may to have guard yourselves against another


March 1809.1


ful hospital patients, but should also enforce the same upright behaviour from the menial staff. way of making money, viz, taking Even in private practice }rou would better avoid money and presents from the hospital patients. I know fully well that you are all too gentlepresents of any monetary value, for such presents, however agreeable at the time, will one time or manly and honourable to do such a thing. But I just mention it here so that jrou might another be surely diminish your legitimate reit fully aware of the temptation and not yield tomuneration. Patients will think at times that even in It is not prothe remuneration might he reduced on account your weakest moment. of previous presents made. They will say?* per for various reasons. The patients who seek " Last time 1 gave the doctor some presents in relief, or at least ought to seek relief, in the charitable institution?the hospital?are the poor addition to his legitimate fee; now, as I am who deserve your compassion and kind treatshort of money and can't pay him as before, a ment. Perchance if they find it necessary to pay, small sum will do this time." Surely the some one of their relatives doctor cannot grumble after having taken the might borrow or with great difficulty procure some money; but present on the previous occasion ! Remember It that does not prove that they are well off*. that .yourself and the patient won't estimate the is quite possible that many well-to-do people money value of the present in the same degree, will get into the hospital. In their case your and you are sure to suffer pecuniarily in the proper duty is not to take money from them, but long run. But you will meet now and then to have them so that with patients whose behaviour will surprise might they discharged, be treated outside on payment. If you take 3'ou, and who will not remunerate you properly; money from some whom you think to be well-they will think that a present will be enough. to-do people, you will have to bestow moreUnder such circumstances, take it readil}7, as | attention on them (in return for the money)something is better than nothing; but have J than on the poor patients who can't pay. Other-nothing to do with them subsequently. wise why should they pajT ? They do expect Another method of making money by undeit, and 3'ou tacitly agree to it when you takesirable means is the maintenance of dispensaries money. To put it in other words, you payby medical men. Such dispensaries are undeniless attention to the really poor merely becauseably sources of profit to the men in charge, they can't afford to pay you. The poor requirebut they are to be discouraged for various reayour consideration for two reasons: firstly, theirsons. When one keeps a dispensaiy he invests poverty, and secondly, their sickness, Thosemoney 011 drugs, and he naturally expects to make who give 3'ou presents can be well treated even as much out of it as he can, just like any outside the hospital, whereas the poor cannotother trader dealing in broadcloth or boots. be well treated outside ; so I think the poor Human nature is the same everywhere, and a deserve better treatment at your hands. When trader in drugs differs in 110 way from a trader you are employed in a hospital the tacit under- in shoes or stockings or any other article of standing is that you should discharge j'our commerce. As the tendency is to make a large functions to the best of your ability. If }rou profit, the chances are that the drugs will be do take inonejr, you must have resort to two bought in the cheapest market, which is not | methods of treating similar cases, and the always advantageous to the patients. In the patients giving presents will certainly have the case of chemists, no doubt many might purbest treatment. Evidently, then, the poor can't chase in the cheapest market; but if medical have the best treatment available. So long as men take care to patronise only reliable chemists, 37ou are paid to do your work in the hospital you there will be a healthy competition amongst must discharge your work conscientiously and them, with the result that good and reliable drugs to the best of 3'our ability. The hospitals are can be procured. Incase )tou keep a dispensary intended for the poor, and so 3Tou will be paid to it is not likely that it will be completely treat the poor. If you treat them indifferently equipped, and in prescribing you are likely to or not so well as j'ou do others who pay you, carefully eschew preparations not to be found in you will be failing in duty. You must do your your almirah. Such a limitation of choice is duty without expecting presents. England ex- not an unmixed good to your patients. Every pects every man to do his duty (of course without one of us is likel}7 to err, and especially in the the incentive of a present). The same adherence commencement of practice. If you do commit to duty is preached in the Hindu books on philo- J a mistake in prescribing, and if the prescription sophy and religion. You must do 3'our duty happens to go to a stranger, it is likely to be wherever you are placed irrespective of the pointed out and also adversely criticised. Such consequences (of course the pecuniary consequen- adverse criticism, I submit, is not undesirable, ces are inasmuch as you would take that to heart, included). Again, if your superiors find out your propen- and be more careful in future. It would prevent sity to speedily get rich, you are sure to land in you from tripping in the future, whereas if you trouble. You should not only avoid taking send your prescriptions to your own dispensary, presents even when voluntarily offered by grate-








likely to go uncorrected to the of the patient. detriment great Some are tempted to keep a dispensary in order to avoid their prescriptions being seen and criticised by others. As I have already pointed out, such adverse criticism is always beneficial, as more is learnt by failure than success. Moreover, no man has a business to prescribe who is afraid of submitting his prescriptions to scrutiny. If you prescribe correctly, you have nothing to fear. If must learn, though in an unyou have not, you palatable way. There should certainly be an Practitioners who openness in prescribing. will give medicines generally keep dispensaries and not prescriptions, for the prescriptions might do give prescripgo elsewhere. Even if they are likely to write their prescriptions tions, they in some mystic language or A.B.C. Code, which can only be understood by the compounders in their own dispensaries. The giving of a prescription is thus rendered a farce. When a patient goes to one of such men for advice, lie lias not only to take his advice (which is more in the way of directing him to go to his own dispensary than anything else), but he must perforce have the doctor's own medicine poured down his throat. He must pay, too, for swallowing the medicine. He can get away if lie likes, but he can't get away with the paid-for advice, for the doctor's advice is bottled up in the alHe comes for the admirahs of his dispensary. vice, but can't have it without the doctor's own


errors are



The prostitution of a noble the papers. a such for purpose is objectionable. profession Even after qualifying as a medical man he might eschew practice altogether and set up as a pure In fact, such a man has dwindled chemist. down to a chemist. Not only do such people dishonour the profession, but may cause considerable harm to their fellow-practitioners who may in







If the dispensing doctors supply advice gratis and the medicine gratis, I can have nothing but admiration for their philanthropy ; but they can't do that, as they must live and get on. The public think that medicines have to be bought by doctors, they must be naturally paid for; and that doctors can afford to give advice gratis as they don't lose anything from their pocket. Poor fools ! they do not know that the consultation fees are duly included in the medicine bill. This practice of pretending to give advice oratis, or almost for nothing, and charge all dues under the heading of medicines is, to say the least, making money under false pretences. The public probably has no idea of what is being done. Apart from this ethical view, there is another aspect of the question in this countr}T. The public in this country has long been accustomed to the view that medical men don't deserve much remuneration, and that it is only the medicine that should be paid for. The public mind should be disabused of such an idea before the status of the profession can be medicine. raised in this country, and the advice-gratis Some will improve upon this state of affairs business is certainly not the method of achieving " Consultations gratis, mediIn the interests of the profession, and will advertise this object. cines only charged," so a patient need not comthe dispensing doctors may charge for the advice plain that he can't take away with him the and give the medicines gratis. I don't approve paid-for advice. If he likes he can take medi- of that either, but it is better than the present cine, and, as a discount, the doctor will give condition of affairs. Dispensing and doctoring are advice gratis. The doctor is so much interested If the doctors won't two different professions. in the sale of his drugs that he offers a premium stick to their business, the chemists would preon the medicines, viz., advice gratis. Another scribe. It might be said that the doctors have a improvement is to charge very low for advice, right to dispense, whereas the chemists have no and charge only the so-called cost price of the right to prescribe. It is true, but unless we medicines. Now we shall look seriously into the wash our hands off dispensing, it is too much state ol affairs. Is not this advice-gratis busito expect chemists not to prescribe as they do it ness reprehensible? Yes, it is. How is the in self-defence to make up the deficiencies in doctor living, and how is he making money ? their legitimate line. Two arguments are True, he requires no remuneration for his advice, usually brought forward in favour of dispensing but then he makes it up in the medicine bill. If doctors. They are, firstly, the convenience of by he were to charge the actual cost of the medicine the patients, and, secondly, the reliability of the he can't get on; he must collapse. He must used in making up the prescriptions. drugs make money, and that lie makes by the sale of If doctors don't dispense, and will patronise his drugs, to which his medical qualification is only those chemists who use the purest drugs merely an advertisement. It he wants to make and the ablest assistance, a healthy rivalry will money by the sale of his drugs, why should he bo created, and there ought to be no difficulty go through a long and arduous course of instrucas to the correct making up of the prescriptions. tion for a medical qualification ? There is no neAs to the convenience of the public, if doctors cessity to degrade a noble profession. He might won't dispense, chemists would find it paying have qualified himself as a chemist and druggist to open many branch dispensaries, so as to suit after a short course and stuck to advertisement the convenience of the public. I don't think





or jealousy is checked to a certain extent by will liokl water. Dispen-the existence of registration and rlie General sing by medical men is highly undesirable, parti-Medical Council. In this country, however, the cularly in India, except in country-places whereabsence of such machinery leads to various unthere are no chemists at all. Then, of course,professional acts which could not be checked in there is no option. That the view, set forth thusany way. In the absence of such safeguards, it in detail, is also held by the enlightened publicis doubly our dut}T to conduct ourselves honourfrom theably and might be evidenced by a quotation keep up the prestige of the profession. " On general prinTimes of India?a lay paper. tends more to demoralize our proNothing ciples it is unsound to get prescription and medi-afession and cause it to be undervalued than the cine from the same practitioner. It is done as mean, unworthy and cynical way in which many matter of convenience and cheapness, but it can-medical men speak of and act towards their A not be defended as the best for the patient. professional brethren. If circumstances render his for is who medical man, prescription it necessary, and if justice demands it, it is our paid bounden duty to defend them. ?nly, will order what he considers best, irrehad One spective of its price or whether it may be frequent source of ill-feeling between prac"J a titioners in this country is the habit of the particular dispensary. It does not concern him whether quinine is Rs. 10 an ounce or patients of frequently changing their medical whether there is a corner in iodide of potassium. advisers. Very often medical men are dispensed He orders the drugs that, to the best of his with for no other reason, than the want of socalled good luck; when another medical man is knowledge, the patient's condition demands. This, we presume, is the mental attitude which called in, he is not restrained by any professional adviser. etiquette, and is every patient likes to see in his medical only too glad to step in. He is His point of view, if he can afford it, is to get vain enough to think that he has been made to well citoluto et jucunde, but especially cito, supersede his predecessor on account of his own quick. He then takes the recipe to respectable greater abilities ; and he congratulates the patient chemists, with the assurance that if by any (mentally) on his strong common sense which occurs it will enabled him to hit on the right doctor at last. possibility an error of quantities have this independent check from trained dis- He begins to perceive that the world does repensers. On the other hand, the medical man, cognize merit, though rather slowly at times. He who both prescribes and dispenses must be finds fault with everything, regrets he has not the soul of honour to carry on his office with been called in earlier, and yet hopes to do the entire regard for those who consult him. The best. The treatment is completely changed, yet temptation to adopt his prescriptions to the no improvement follows. The patient's relatives furniture of his own shelves and to the prices are getting more and more anxious. Our doctor ruling in the drug-market, must be overcome, himself is getting nervous, and does not know but the position is not a fair one to the patient. what to do. He thinks of trying a new remedy, At a time when both e}7es should be turned 011 about which he has read some time back in a the question of cure, it cannot be sound to have medical journal, and which had been reported to one ej'e turned towards the prospective profits have wrought wonderful cures in similar cases. of the medicine bottle. It would be far better He refers again that night to his journal, and goes for the suffering world if the trade element be to sleep with the comfortable hope of trying it ruthlessly swept out of these relations between next day. On the morrow arrives a messenger saydoctor and patient, and medicine could every- ing that the patient is very bad, and that the docwhere be made again what it ought never to tor need not attend unless sent for. That is evia have ceased to be dently a hint to retire. He blames the people for profession." In sending your prescriptions you must, of want of patience, and the folly of dismissing him at che- the most critical course, take care thatj'ou don't patronize the period, especially as he intended mists who are fond of prescribing or criticising. to try his new remedy. He learns casually that Your patronage should be uniformly distributed Dr. Bigman had been called in, and gets wild and if there be more than one deserving reliable deplores the absence of all professional etiquette chemist. amongst'medical men in this country. He is The struggle for existence is getting keener consoled, however, on the next day by learning and keener every day. Every profession is being that Dr. Bigman's visits had ceased, as he declarto ed the case to be over crowded, and everybody is trying hard hopeless; and that the patient The secure his livelihood. overcrowding gives is in the hands of a native barber who has promised to cure b}r just three doses of a wonderful nse to considerable friction and irritation and has always basman. This basman is taken once, and the and jealousy professional ill-feeling, been present amongst medical men, whether in patient dies. The barber consoles the relatives England or in India; but they are kept under saying that the basman is a very efficacious one control in England by the sense of fair play and and that the patient was unfortunate in having .Justine and public opinion. I11 England, any died before three doses could be taken.






prompted by such




Our old friend's bluster about professional etino time. And the quette is all forgotten in is repeated day after da}\ My same episode description is not fanciful. It is a true representation of what happens only too frequently in Madras. All feel the need of greater unity amongst ourselves, but few behave in such a way as to make others wish to make common cause with them. A frequent change of practitioners is very common, and we can not prevent that to any We can no more prevent a man oreat extent. than prevent him changing his doctor changing his coat. But we expect him not to dismiss us summarily and often without cause. The man who supersedes is bound to inquire into the particulars of dismissal of his predecessor, and see that full justice is done to his feelings (and he himself takes pocket if necessary) before he is not responsible if of course, But, charge. the patient misleads him deliberately; under no circumstances should the past be criticized. If the predecessor has pursued a correct line of treatment, it must be pointed out to the patient. must You always avoid seeing patients, who are under the charge of your professional | brethren, even for social reasons. Never mind the people's statement that your visit shall be kept secret or any such bosh. If you are told that another practitioner has been dismissed and be asked to attend, you will have to communicate with the previous attendant, unless you can depend on the veracity of the patient's statement. If the previous attendant complains of the treatment meted out to him, and says he has not done with the case, you must think twice before you take charge. Although, in the interests of the profession, it is thus advisable to communicate with the predecessor and the case must be taken charge of with his consent. I must point out that any predecessor, in whom the patient has lost confidence, is exceedinglv foolish if he persists in his desire to continue in If, in the course of your practice, you charge.^ meet with quacks, which you are sure to do, you should never lose an opportunity of running them down and shake the confidence of the public in them. You should never act in concert with quacks even at the risk of losing influential practice. Whenever you are in doubt or difficulty consult with others. If you have more experienced men or men of better qualifications at hand, better consult them. If they be not available consult the men near at hand, though they may be your juniors. You don't lose anything thereby, but, on the contrary, will gain something at least. You must always bear in mind that"the chief element of consultation is the putting together of two heads. The two will view the case from different lights and there is a better chance of successful termination of the case



after the two have arrived at a common conclusion. If the new head be an old head, well and good; if not, let there be another head at any It is on this very principle that two rate. judges sit in appeal in the High Courts over the decision of a single man. The appellate judges need not necessarily be of superior mental calibre


of those of you who may set up private practitioners, I would advise you to study your cases carefully and not become If you go on senda mere distributor of cases. in nr medical cases to one man, and surgical cases to another, while you yourself go on dispensing cough mixtures and diaphoretic mixtures, and be content with dressing and compounding and administering enema, you will never learn your art sufficiently well to enable you to stand In the









legs at anytime. Further, you yourself a lauging stock. In the practice, you will be the repository of


will make course of



which it is }Tour


disclose under any circumstances. advise you strongly not to entangle




would yourself in law suits and avoid the law courts as much as possible in any capacit}7 whatsoever. It is not the place for medical men. I may tell you that some of the most distinguished, straightforward and talented medical men have been made to look foolish at times by unscrupulous lawyers under cover of their so-called privilege of the counsel. In conculsion, gentlemen, I would advise you strongly to join the Madras Medical Association, the advantages accruing therefrom are many. If you happen to be resident in Madras you can make use of the reading-room and the library that will soon be started, and attend the periodical meetings for scientific discussions with great profit to yourselves. If you be in the mofussil, you can send notes of your interesting cases, which will be read, discussed, and recorded. There is no member of the profession, however humble, who will not meet with interesting cases in the course of his practice. Sickness prevails, and in very varying conditions all over the land. You do not often meet with the typical symptoms and course described in text-books. There will be many deviations from the typical symptoms and courses. Any rare cases or any interesting features of diseases deserve to be recorded. If you meet with such, I would request you to kindly take notes and send them to our Secretaries. Whenever the mofussil members come over here, they can attend the meetings and can make use of the reading-room and the library. In course of time, the transactions, which will be periodically published may also interest If you belong to a medical and profit you. Association like this, you will naturally perceive that you are one of a great body of the profession, and you are apt to think of the profession collcctively. When you do, it is sure to make


March 1899.1



up the


of the



This Association, I may add, chiefly exists for the benefit of the hospital assistants and apothecai ics. It hopes to do for them what the South Indian Branch of the British Medical Association does for the graduates and those who are qualified in England. So I hope you will all join the Association, whose sole object is your improvement, and try your best to make it more prosperous. As you have already perused the rules in your hand, I need not tell you that the subscription has been fixed very low so as At the to enable you all to join the Association. same time I hope you will strongly resist the influence of touting agents of Associations, partly political and partly commeicial, which may pecuniarily profit a few, but will do you no good, though it may make youi


pockets lighter.


Medical Ethics.

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