no ground for hope. This fact renders it injudicious for the physician to pronounce a positively fatal prognosis even in cases which are apparently hopeless. There is no need of saying that death is certain, inasmuch as the statement of extreme danger answers every purpose as regards duty toward the relatives or friends, and, also, the patient. The physician should avoid committing his own mind to a fatal prognosis whenever there is the slightest foundation for hope, because the effect will be relaxation of his medical efforts. The effect of an abandonment of all hope on the minds of nurses, relatives, and friends, is bad. Their cooperative efforts are thereby relaxed, and not infrequently, as a desperate alternative, the patient is given over to experimentation with some irregular methods of practice.

It is trying to a physician to continue to visit patients when he feels that the resources of medicine are powerless, and to witness the closing scenes of life. But there is room for his good offices under those circumstances, and he should not withhold them. He can often do much toward lessening pain or discomfort-mental and physical; he can contribute to euthanasia, and he can comfort those who surround the bed of death by assurances that in the “last agony," as it is miscalled, these manifestations of distress are usually unattended by conscious suffering.

SECTION 6. Consultations should be promoted in difficult or protracted cases, as they give rise to confidence, energy, and more enlarged views in practice.

Erroneous views respecting consultations prevail largely in the public mind, and, to a considerable extent, among members of the medical profession. A request for a consultation is often considered as implying lack of confidence in the attending physician. It is not an uncommon notion that the function of a consulting physician is to judge con

cerning the practice which has been pursued, and announce his decision to the patient and friends. Some persons have the idea that the physician in consultation assumes entire control of the case, and that he is entitled to whatever credit may pertain to the management. It is not to be wondered at that, recognizing and perhaps sharing in these erroneous popular views, practitioners are anxious to dispense with consultations, if they can be avoided, and consent with reluctance when they are proposed. It is highly important that the public should have correct views of the proper objects of consultations. These objects are: co-operation in the management of cases of disease, a division of responsibility, and the satisfaction of patients and those interested, by enabling them to feel that, whatever may be the result, they have done all that lies in their power to secure the best resources of medicine. A medical consultation should not necessarily imply that the consulting physician has more knowledge and skill than the physician in attendThe advantage is in having two or more heads instead of one head. Life and health are certainly of sufficient importance to claim the judgment of more than one person. Questions in law, or of the affairs of business, or of comparatively unimportant matters relating to rules of conduct, are often deemed of sufficient consequence to obtain collective opinions. How inconsistent, therefore, to rely upon a single mind in cases of disease which may lead, if not to death, to a permanent impairment of the mental or physical powers! Consultations, when their true objects are recognized by all parties, are of great comfort to an attending physician. Undoubtedly, a reason for their being distasteful to him often is a want of full confidence in the honor of the consulting physician. Hence, it is important that physicians comply conscientiously with the rules laid down by the code in respect of con

ance.

sultations. These rules will be considered under another heading.

SECTION 7. The opportunity which a physician not unfrequently enjoys of promoting and strengthening the good resolutions of his patients, suffering under the consequences of vicious conduct, ought never to be neglected. His counsels, or even remonstrances, will give satisfaction, not offense, if they be proffered with politeness, and evince a genuine love of virtue, accompanied by a sincere interest in the welfare of the person to whom they are addressed.

Members of the medical profession, as such, are not called upon to be expounders of doctrines of morals, still less partisans of any particular form of religious faith. The tendency of that knowledge of human character which is incident to the practice of their profession is to make physicians charitable, and tolerant of diversities of opinion in relation to ethics and religion. Seeing, as they can not fail to do, all that lies beneath the surface in the different stations and varied conditions of human life, they know that the worst traits of character may be found in the highest, and the best in the lowest, of the conventional grades of society. Owing to the intimate and unreserved relations of the physician to his patients, he can often do much toward carrying out the injunctions of that portion of the code which is prefixed to these remarks. It is undoubtedly true that persons will often listen more considerately to counsels or remonstrances from a medical adviser than to those of relatives, friends, and neighbors, or even to the admonitions of the clergy. It is, perhaps, true that most persons are influenced more by considerations which have reference to life and health than to those which appeal directly to the moral nature. The evils resulting from the abuse of alcohol, the dangers connected with the habitual use of opium, chloral, and other drugs, and the consequences of

licentiousness, may, in not a few instances, be pointed out more effectively by a physician who has the confidence of his patients than by any one else. It is clearly his duty not to forego any opportunity of "promoting and strengthening the good resolutions of his patients."

ART. II. Obligations of Patients to their Physicians.

There are several reasons why this portion of the code calls for but little in the way of commentary. In the first place, the commentator being a member of the medical profession, it is a matter of delicacy not to dilate too largely on the obligations of patients to their physicians. In the second place, although in the preparation of these commentaries the hope is entertained that they will have interest for nonmedical readers, there is probably little ground for the expectation that they will have an extensive popular circulation. In the third place, a large proportion of patients are fully sensible of their obligations to their physicians; and, lastly, the portion of the code which defines the obligations of patients to their physicians is so clear and comprehensive as not to offer much scope for addition or elucidation. For these reasons, instead of making each subdivision a separate heading for comments, the entire article. will be first given, and, afterward, brief remarks on the topics which it embraces, following the order in which they are presented in the code.

SECTION 1. The members of the medical profession, upon whom is enjoined the performance of so many important and arduous duties toward the community, and who are required to make so many sacrifices of comfort, ease, and health for the welfare of those who avail themselves of their services, certainly have a right to expect and require that their patients should entertain a just sense of the duties which they owe to their medical attendants.

SECTION 2. The first duty of a patient is to select as his medical adviser one who has received a regular professional education. In no trade or occupation do mankind rely on the skill of an untaught artist; and in medicine, confessedly the most difficult and intricate of the sciences, the world ought not to suppose that knowledge is intuitive.

SECTION 3. Patients should prefer a physician whose habits of life are regular, and who is not devoted to company, pleasure, or to 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.

SECTION 4. Patients should faithfully and unreservedly communicate to their physician the supposed cause of their disease. This is the 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.