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+*** START OF THE PROJECT GUTENBERG EBOOK 78821 ***
+
+
+
+
+PERCIVAL’S MEDICAL ETHICS.
+
+_The Profits of this little work, if any, will be given to some Medical
+Charity._
+
+ OXFORD:
+ PRINTED BY I. SHRIMPTON.
+
+
+
+
+ MEDICAL ETHICS;
+
+ OR, A CODE OF
+ INSTITUTES AND PRECEPTS,
+ ADAPTED TO THE
+ PROFESSIONAL CONDUCT
+ OF
+ PHYSICIANS AND SURGEONS.
+
+ BY THE LATE
+ THOMAS PERCIVAL, M.D., F.R.S.
+
+ _THIRD EDITION._
+
+ OXFORD:
+ JOHN HENRY PARKER.
+ LONDON: JOHN CHURCHILL, PRINCES STREET, SOHO.
+
+ M DCCC XLIX.
+
+
+
+
+ TO
+ STANLEY PERCIVAL, ESQ.,
+ OF BRIDGEFOOT, MIDDLESEX,
+ ONLY SURVIVING SON
+ OF DR. PERCIVAL,
+ THIS NEW EDITION
+ OF HIS FATHER’S LAST AND
+ MOST VALUABLE WORK
+ IS RESPECTFULLY OFFERED.
+
+
+
+
+EDITOR’S PREFACE.
+
+
+As the late Dr. Percival’s Code of Medical Ethics is commonly quoted as a
+work of authority, not only in this country, but also in America[1], and
+as the original edition[2] has now become somewhat scarce, it was thought
+that it might be usefully republished.
+
+The present edition is reprinted from that published by Dr. Percival
+himself, (8vo. Manchester, 1803,) corrected occasionally by his
+unfinished and unpublished edition[3], and also by the posthumous reprint
+contained in vol. ii. of his collected “Works.” (4 vols. 8vo. Bath,
+1807.) The references have been verified, and in several instances the
+quotations have been corrected, but no other alteration has been made in
+the _text_ of the work; as, even when the statements contained in it
+were positively erroneous, the Editor preferred correcting them (where
+necessary,) in a note[4]. Of the Notes and Illustrations added by Dr.
+Percival several have been omitted, as being no longer wanted, as also
+has the “Discourse on Hospital Duties” by his son.
+
+By republishing Dr. Percival’s Code the Editor does not mean to imply
+his agreement with all the opinions it contains, or his entire approval
+either of the plan or the execution of the work. The want of a detailed
+and scientific treatise on the subject of Medical Ethics, suited to
+the present state of the Profession in Great Britain, (as M. Simon’s
+admirable “Déontologie Médicale” is to France,) is beginning to be
+universally felt. It has indeed long occupied the Editor’s thoughts,
+and (as he has already ventured to intimate to the public[5],) he still
+hopes, if life and leisure be allowed him, and if no abler writer step
+forward to anticipate his design, to endeavour at some future time to
+supply it.
+
+_Sept. 11, 1849._
+
+
+FOOTNOTES:
+
+[1] In the Note prefixed by Dr. Hays to the “Code of Ethics of the
+American Medical Association,” he writes as follows:—“On examining
+a great number of Codes of Ethics adopted by different societies in
+the United States, it was found that they were all based on that by
+Dr. Percival, and that the phrases of this writer were preserved to a
+considerable extent in all of them. Believing that language so often
+examined and adopted, must possess the greatest of merits for such a
+document as the present, clearness and precision, and having no ambition
+for the honors of authorship, the Committee which prepared this Code have
+followed a similar course, and have carefully preserved the words of
+Percival, whenever they convey the precepts it is wished to inculcate.”
+
+[2] A new edition was published in 1827, but the Editor’s notes are of
+such a nature as to render the book absolutely mischievous.
+
+[3] Of this rare volume the only copy that the Editor has seen or heard
+of is in the library of the Manchester Royal Infirmary, and was given by
+Dr. Percival himself. In the beginning there is the following Note in
+his own hand-writing:—“The completion of the Medical Jurisprudence has
+been long suspended; and it is uncertain when the undertaking will be
+resumed. A title page; an introduction; a fifth and sixth section; and an
+appendix, containing Notes and Illustrations, are wanting to finish this
+little work.
+
+_Manchester, March 17, 1794._”
+
+It ends abruptly on p. 96, which terminates chap. iv. The text for the
+most part agrees with that which was afterwards published, except that
+this latter contains about twenty paragraphs that are not to be found
+in the original sketch, and that great part of what forms Note XIV.
+in the present edition is there found in the _text_. At the end of
+the treatise there is the following Note, also in Dr. Percival’s own
+hand-writing:—“Two sections wanting. Sect. V. On the Powers, Privileges,
+Honours, and Emoluments of the Faculty. Sect. VI. On the Moral,
+Religious, and Political Character of Physicians.”
+
+[4] All the Editor’s additions are placed within brackets.
+
+[5] In the Advertisement to Gisborne “On the Duties of Physicians.”
+
+
+
+
+Nulla enim vitae pars, neque publicis neque privatis, neque forensibus
+neque domesticis in rebus, neque si tecum agas quid, neque si cum altero
+contrahas, vacare officio potest; in eoque colendo sita vitae est
+honestas omnis, et in negligendo turpitudo.—(Cicero, _De Off._ i. 2.)
+
+
+
+
+CONTENTS.
+
+
+ Page
+
+ Sketch of the Life of Dr. Percival 13
+
+ Author’s Dedication 17
+
+ Author’s Letter to E. C. Percival 19
+
+ AUTHOR’S PREFACE.
+
+ Origin of the work.—Suspension of it.—Farther progress of
+ it.—Addition of supplementary Notes and Illustrations 21
+
+ CHAPTER I.
+
+ _Of Professional Conduct relative to Hospitals, or other
+ Medical Charities._
+
+ § 1. Duties of hospital Physicians and Surgeons.—Tenderness.—
+ Steadiness.—Condescension.—Authority 27
+
+ § 2. Choice of their attendant Physician or Surgeon, how far
+ allowable to hospital patients ib.
+
+ § 3. Feelings and emotions of patients, under critical
+ circumstances, to be duly regarded 28
+
+ § 4. No discussion concerning the nature of their case to be
+ entered into before them ib.
+
+ § 5. Delicacy in many cases particularly required; and secrecy
+ sometimes to be strictly observed 29
+
+ § 6. Moral and religious influence of sickness to be cherished
+ and promoted 29
+
+ § 7. Propriety of suggesting to patients, under certain
+ circumstances, the importance of making their last will and
+ testament 30
+
+ § 8. Parsimony in prescribing wine and drugs of high price
+ reprobated ib.
+
+ § 9. Hospital affairs and occurrences not to be incautiously
+ revealed 31
+
+ § 10. Professional charges to be made only before a meeting of the
+ Faculty ib.
+
+ § 11. Proper discrimination between the Medical and Chirurgical
+ cases to be strictly adhered to 32
+
+ § 12. What circumstances authorize new remedies and new methods of
+ Chirurgical treatment ib.
+
+ § 13. Unreserved intercourse should subsist between the gentlemen
+ of the Faculty; and an account of every case or operation which
+ is rare, curious, or instructive, should be regularly drawn up
+ and preserved ib.
+
+ § 14. Scheme for hospital registers 33
+
+ § 15. Advantages arising from the scheme 34
+
+ § 16. Close and crowded wards reprobated 35
+
+ § 17. Establishment of a committee of the gentlemen of the
+ Faculty considered 36
+
+ § 18. Importance of frequent consultations, and the mutual
+ assistance of the Physicians and Surgeons ib.
+
+ § 19-22. Rules to be observed in consultations ib.
+
+ § 23. Rules to be observed respecting operations 38
+
+ § 24. Hospital consultations ought not to be held on Sundays,
+ except in cases of urgent necessity 39
+
+ § 25. Stated days for operations often inconvenient and improper 39
+
+ § 26. Dispensaries ib.
+
+ § 27. Asylums for female patients labouring under syphilis.—Rules
+ to be observed in Lock Hospitals 41
+
+ § 28. Asylums for insanity 43
+
+ § 29. Modes of acquiring knowledge in the treatment of insanity
+ recommended 44
+
+ § 30. Treatment of lunatics—tenderness—indulgence 45
+
+ § 31. Boldness of practice sometimes required in cases of
+ mania.—Hospitals for small-pox—inoculation, &c. &c., require
+ no professional duties not already enumerated ib.
+
+ CHAPTER II.
+
+ _Of Professional Conduct in Private or General Practice._
+
+ § 1. Moral rules of conduct, the same with those to be observed
+ towards hospital patients 47
+
+ § 2. The strictest temperance required ib.
+
+ § 3. Proper conduct to be observed respecting prognostications, and
+ the disclosure of circumstances to the friends of the patients 48
+
+ § 4. Proper conduct respecting interference in cases under the
+ charge of another 49
+
+ § 5. Conduct to be observed towards a Physician formerly employed
+ by the patient, but not now consulted 50
+
+ § 6. Distinction between the provinces of Physic and Surgery to be
+ steadily maintained ib.
+
+ § 7. Consultations to be promoted in difficult or protracted cases 51
+
+ § 8. Special consultation.—Conduct of the Physician called in 52
+
+ § 9. Theoretical discussions to be avoided in consultations 53
+
+ § 10. Rules for consultations the same with those prescribed to
+ the Faculty attending hospitals.—Seniority, how determined ib.
+
+ § 11. Education of Medical men—what influence it ought to have in
+ the consideration of their brethren ib.
+
+ § 12. Punctuality in visits of consultation—further rules to be
+ observed 54
+
+ § 13. Visits to the sick not to be unseasonably repeated 55
+
+ § 14. Rules to be observed with regard to fees, when a Physician
+ officiates in the absence, or at the request, of another ib.
+
+ § 15. Importance of adopting some general rule respecting
+ pecuniary acknowledgements 56
+
+ § 16. Medical men and their families, when to be attended
+ gratuitously 57
+
+ § 17. Peculiar delicacy and attention often required in attendance
+ upon them 58
+
+ § 18. Attendance on clergymen in narrow circumstances ib.
+
+ § 19. Consultation by letter 59
+
+ § 20. Rules to be observed in furnishing certificates ib.
+
+ § 21. Use of quack medicines to be discouraged 60
+
+ § 22. The dispensing of nostrums reprobated 61
+
+ § 23. Duty incumbent on individuals to promote the general
+ reputation of the Faculty collectively ib.
+
+ § 24. Rule to be observed in professional controversy and contention 62
+
+ § 25. Giving advice gratis ib.
+
+ § 26. Rule to be observed in visiting the patient of another
+ Physician 63
+
+ § 27. Another case of the same ib.
+
+ § 28. Review of the treatment and progress of interesting cases
+ recommended ib.
+
+ § 29. Moral and religious advice to patients 64
+
+ § 30. Observance of the Sabbath by Medical gentlemen considered 65
+
+ § 31. Co-operation of young and aged practitioners ib.
+
+ § 32. Period of senescence in Physicians considered 66
+
+ CHAPTER III.
+
+ _Of the Conduct of Physicians to Apothecaries._
+
+ § 1. Connection between the Apothecary and Physician 69
+
+ § 2. The Apothecary often precursor to the Physician, and commonly
+ acquainted with the diseases of the family ib.
+
+ § 3. Rule to be observed in the intercourse and co-operation of
+ the Physician and Apothecary 71
+
+ § 4. Duty and responsibility of the Physician ib.
+
+ § 5. Particular directions to be observed in visiting country
+ patients with the Apothecary 72
+
+ § 6. Profits of Apothecaries 73
+
+ § 7. Physicians visiting the patients of Apothecaries in their
+ absence, not approved of 74
+
+ § 8. Duty of Apothecaries in recommending Physicians to families 75
+
+ § 9. Establishment of funds for the benefit of the widows and
+ children of Apothecaries 76
+
+ CHAPTER IV.
+
+ _Of Professional Duties in certain Cases which require a
+ Knowledge of Law._
+
+ § 1. Medical gentlemen exempt from serving on inquests, juries,
+ &c.; but frequently called upon to exercise duties which require
+ juridical knowledge 78
+
+ § 2. Duty of Physicians in cases of last will and testament—knowledge
+ of law required 79
+
+ § 3. Commissions of lunacy—appointment of a curator 83
+
+ § 4. Treatment of lunatics as authorized by law 85
+
+ § 5. Asylums for lunatics subject to strict regulations of law ib.
+
+ § 6. Opinions given in cases of sudden death 87
+
+ § 7. Justifiable homicide 88
+
+ § 8. Excusable homicide 89
+
+ § 9. Suicide 92
+
+ § 10. Manslaughter—Murder 93
+
+ § 11. Murder of bastard children 96
+
+ § 12. Duelling 102
+
+ § 13. Duty of Surgeons with respect to attending a duellist to
+ the field of combat 106
+
+ § 14. Private and personal duty of Physicians with respect to
+ duel—true honour considered 108
+
+ § 15. Homicide by poison—cases adduced 109
+
+ § 16. Law in cases of rape 113
+
+ § 17. Nuisances defined and considered 117
+
+ § 18. Duty of Medical gentlemen when summoned to attend coroners,
+ magistrates, and judges 120
+
+ § 19. Importance to gentlemen of the Faculty of settling their
+ opinions concerning the right of magistrates to inflict capital
+ punishment.—The limits prescribed to the exercise of the right;
+ and the duty of giving full efficiency to law 122
+
+ § 20. Cautions relative to professional testimony in cases of
+ peculiar malignity 125
+
+ NOTES AND ILLUSTRATIONS.
+
+ Note
+
+ I. Caution or temerity in practice 129
+
+ II. Temperance of Physicians 130
+
+ III. A Physician should be the minister of hope and comfort to
+ the sick.—Enquiry, how far it is justifiable to violate truth
+ for the supposed benefit of the patient 132
+
+ IV. The practice of a prior Physician should be treated with
+ candour, and justified, so far as truth and probity will permit 141
+
+ V. Theoretical discussions should be generally avoided 142
+
+ VI. Regular academical education ib.
+
+ VII. Pecuniary acknowledgements 146
+
+ VIII. Public worship; scepticism and infidelity 150
+
+ IX. Union in consultation of senior and junior Physicians 166
+
+ X. [On Wills] 168
+
+ XI. Partial insanity, with general intelligence—Lucid interval 169
+
+ XII. [On the new Lunatic Act] 175
+
+ XIII. [Legal penalties on duelling] 181
+
+ XIV. Duelling.—Letter from Dr. Franklin ib.
+
+ XV. Punishment of the crime of rape 192
+
+ XVI. [Medical evidence at inquests] 194
+
+
+
+
+SKETCH OF THE LIFE OF DR. PERCIVAL[6].
+
+
+Thomas Percival was born at Warrington in Lancashire, Sept. 29, 1740.
+When only three years old, he had the misfortune to lose both his
+parents; and the care of his early education devolved upon his eldest
+sister. When of proper age, he was placed at a private academy in the
+neighbourhood of his native town; to the free grammar-school of which he
+was subsequently removed.
+
+In 1757 his name was enrolled as the first student at the Warrington
+academy, then just instituted under the superintendence of Dr. Aikin.
+After having acquired a high reputation for diligence in classical and
+theological studies, he proceeded in 1761 to Edinburgh, where he applied
+himself with great assiduity to medical pursuits. He would, it appears,
+have gone either to Oxford or Cambridge, but for his scruples about
+subscription to the Thirty-nine Articles. Whilst in Edinburgh he became
+acquainted with Mr. Hume and Dr. Robertson; and during a visit to London
+contracted a close intimacy with Lord Willoughby de Parham, who made him
+his constant companion, and became his warmest friend and patron. He was
+indebted to this nobleman for an early introduction to the most eminent
+literary characters of the day; and through his recommendation became a
+Fellow of the Royal Society in 1765.
+
+In the same year he took his degree of M.D. at Leyden, and afterwards
+visited Paris and Hamburgh. He then returned to Warrington; at which
+place, after a residence of a few months, he married the daughter of
+Nathaniel Bassnett Esq. In 1767 he settled at Manchester, where he passed
+the remainder of his life.
+
+Dr. Percival held a distinguished rank both as a literary character,
+and a physician. In the latter capacity he displayed quick penetration,
+discriminating judgement, patient attention, and above all, says
+Abp. Magee, a deep sense of responsibility. As an author he obtained
+considerable reputation in the philosophical and religious world,
+particularly by his “Essays, Medical and Experimental,” and his last
+work entitled, “Medical Ethics,” in which, it is said, while delineating
+the requisites and qualifications of the medical practitioner, he has
+unconsciously displayed the most exact portraiture of himself. His
+other more important productions include “A Father’s Instructions;”
+“Moral and Literary Dissertations,” (which have rarely been surpassed
+by any didactic composition of a similar extent, for genuine feeling,
+refined taste, purity of style or aptness of illustration;) and several
+papers published in the Transactions of the Manchester Literary and
+Philosophical Society, of which he was an original member, and continued
+the president from its first foundation to the end of his life. He was
+the first who attempted to establish public lectures on mathematics,
+commerce, and the fine arts, in that town. In addition to his other
+honours he was a fellow of the Royal Society of Edinburgh, and a member
+of several foreign Societies. His correspondence was extensive, and
+embraced a variety of subjects: among his epistolary friends, were
+Archdeacon Paley, Dr. Priestley, Dr. Franklin, Dr. Beattie, and Hannah
+More. In one of his letters to the first of these celebrated characters,
+he avows himself a dissenter; but he rarely alludes to the fact
+elsewhere, and he is known to have entertained a sincere respect for the
+Church of England, of which his eldest son was a minister. He died at
+Manchester Aug. 30, 1804, in the sixty-fourth year of his age. A Latin
+epitaph by the Rev. Dr. Parr is inscribed on his tomb in the church at
+Warrington; and over the president’s chair, in the hall of the Manchester
+Philosophical Society, a mural tablet has been erected to his memory.
+His works were collected and published in 4 vols. 8vo., 1807, with a
+biographical memoir by his son Dr. Edward Percival, of Bath.
+
+
+FOOTNOTES:
+
+[6] Taken, with a few alterations, from “the Georgian Era,” vol. ii.
+
+
+
+
+ TO
+ SIR GEORGE BAKER, BART.,
+ PHYSICIAN TO THEIR MAJESTIES,
+ FELLOW OF THE ROYAL SOCIETY,
+ AND
+ LATE PRESIDENT OF THE COLLEGE OF PHYSICIANS, &c. &c.
+ THIS CODE OF
+ PROFESSIONAL ETHICS,
+ WHICH HE HAS
+ HONOURED WITH HIS SANCTION,
+ AND IMPROVED BY HIS COMMUNICATIONS,
+ IS GRATEFULLY AND RESPECTFULLY
+ INSCRIBED,
+ BY HIS
+ OBLIGED AND AFFECTIONATE FRIEND,
+ THE AUTHOR.
+ [1803.]
+
+
+
+
+Quicquid dignum sapiente bonoque est.
+
+(Horace, _Ep._ i. 4. 5.)
+
+
+
+
+TO E. C. PERCIVAL[7].
+
+
+Permit me, my dear Son, to offer to your acceptance this little manual
+of MEDICAL ETHICS. In the composition of it, my thoughts were directed
+towards your late excellent brother[7], with the tenderest impulse of
+paternal love; and not a single moral rule was framed without a secret
+view to his designation, and an anxious wish that it might influence his
+future conduct.
+
+To you, who possess in no inferior degree my esteem and attachment,
+who are prosecuting the same studies, and with the same object, my
+solicitudes are naturally transferred: and I am persuaded, these united
+considerations will powerfully and permanently operate upon your
+ingenuous mind.
+
+It is the characteristic of a wise man to act on determinate principles;
+and of a good man to be assured that they are conformable to rectitude
+and virtue. The relations in which a Physician stands to his patients,
+to his brethren, and to the public, are complicated and multifarious;
+involving much knowledge of human nature, and extensive moral duties. The
+study of professional Ethics, therefore, cannot fail to invigorate and
+enlarge your understanding; whilst the observance of the duties which
+they enjoin, will soften your manners, expand your affections, and form
+you to that propriety and dignity of conduct, which are essential to the
+character of a gentleman. The academical advantages you have enjoyed at
+Cambridge, and those you now possess in Edinburgh, will qualify you,
+I trust, for an ample and honourable sphere of action. And I devoutly
+pray, that the blessing of GOD may attend all your pursuits, rendering
+them at once subservient to your own felicity, and the good of your
+fellow-creatures.
+
+Sensible that I begin to experience the pressure of advancing years, I
+regard the present publication as the conclusion, in this way, of my
+professional labours[8]. I may, therefore, without impropriety, claim the
+privilege of consecrating them to you, as a paternal legacy. And I feel
+cordial satisfaction in the occasion of thus testifying the esteem and
+tenderness, with which, whilst life subsists, I shall remain,
+
+ Your affectionate friend,
+
+ THOMAS PERCIVAL.
+
+_Manchester, Febr. 20, 1803._
+
+
+FOOTNOTES:
+
+[7] [See below, p. 22.]
+
+[8] [This anticipation was correct: Dr. Percival died in the following
+year, Aug. 30, in the sixty-fourth year of his age.]
+
+
+
+
+AUTHOR’S PREFACE.
+
+
+The first chapter of the following work was composed in the spring of
+1792, at the request of the Physicians and Surgeons of the Manchester
+Infirmary: and the substance of it constitutes the code of laws, by
+which the practice of that comprehensive institution is now governed.
+The Author was afterwards induced, by an earnest desire to promote the
+honour and advancement of his Profession, to enlarge the plan of his
+undertaking, and to frame a general system of Medical Ethics; that the
+official conduct and mutual intercourse of the Faculty might be regulated
+by precise and acknowledged principles of urbanity and rectitude. Printed
+copies of the scheme were therefore distributed amongst his numerous
+correspondents, by most of whom it was warmly encouraged, and by many of
+them was honoured with valuable suggestions for its improvement.
+
+Whilst the Author was thus extending his views, and carrying on his
+work with ardour, he lost the strongest incentive to its prosecution,
+by the death of a beloved son[9], who had nearly completed the course
+of his academical education, and whose talents, acquirements, and
+virtues, promised to render him an ornament to the healing art. This
+melancholy event was followed, not many years afterwards, by a second
+family loss equally afflictive[10]; and the design has ever since been
+wholly suspended. The Author now resumes it, animated by the hope that
+it may prove beneficial to another son[11], who has lately exchanged the
+pursuits of general science at Cambridge, for the study of Medicine at
+Edinburgh. He feels at the same time impressed with the conviction that
+the languor of sorrow becomes culpable, when it obstructs the offices of
+an active vocation. “I hold every man,” says Lord Bacon[12], “a debtor
+to his profession; from the which as men of course do seek to receive
+countenance and profit, so ought they of duty to endeavour themselves, by
+way of amends, to be a help and ornament thereunto. This is performed
+in some degree by the honest and liberal practice of a profession,
+when men shall carry a respect not to descend into any course that is
+corrupt and unworthy thereof, and preserve themselves free from the
+abuses wherewith the same profession is noted to be infected: but much
+more is this performed if a man be able to visit and strengthen the
+roots and foundation of the science itself; thereby not only gracing
+it in reputation and dignity, but also amplifying it in profession and
+substance.”
+
+It was the Author’s original intention to have treated of the powers,
+privileges, honours, and emoluments of the Faculty. But he now conceives
+that this would lead him into a field of investigation too wide and
+digressive; and therefore chooses to confine himself to what more
+strictly belongs to Medical Ethics.
+
+To these institutes he has annexed an Anniversary Discourse, delivered
+by the late Rev. Thomas Bassnett Percival, LL.B., before the President
+and Governors of the Infirmary at Liverpool[13]. As it is an address to
+the gentlemen of the Faculty, the officers, the clergy, and the trustees
+of the charity, on their respective hospital duties, by one competent to
+the subject from his early studies, it cannot but be deemed sufficiently
+appropriate to the present work, exclusively of a father’s claim to the
+privilege of its insertion.
+
+The aphoristic form of this code of Medical Ethics, though adapted
+to such an undertaking, forbids in a great measure all digression,
+and even precludes the discussion of many interesting points nearly
+connected with the subject. Supplementary Notes and Illustrations,
+therefore, are necessary to the completion of the Author’s plan: and
+he trusts the candid reader will grant him the liberty of thus stating
+his opinions more at large; of rectifying misconceptions, to which the
+brevity essential to the work may give rise; and of correcting whatever
+subsequent reflection, or the judicious observations of his friends, may
+discover to be erroneous.
+
+A considerable portion of these sheets was communicated to the Rev.
+Thomas Gisborne, M.A.[14], whilst engaged in the composition of his
+“Enquiry into the Duties of Men,” a work that reflects the highest
+honour on the abilities and philanthropy of the author, and which may
+be justly regarded as the most complete system extant of practical
+ethics. The chapter concerning Physicians[15] contains a reference to
+these institutes, expressed in the most gratifying terms of friendship;
+and it treats so largely of the duties of the Faculty, as to seem,
+at first view, to supersede the use of the present manual. But the
+two publications differ not only in their plan, but in many of their
+leading objects; and it may be hoped they will rather illustrate than
+interfere with each other. The same remarks may be applied to the
+excellent “Lectures” of Dr. Gregory[16]. Even the “Statuta Moralia” of
+the College of Physicians[17], whatever merit or authority they possess,
+are not sufficiently comprehensive for the existing sphere of Medical and
+Chirurgical duty; and by the few regulations which they establish, they
+tacitly sanction the recommendation of a fuller and more adequate code of
+professional offices.
+
+Copies of the former unfinished impression of this work have been
+transmitted to the libraries of several infirmaries in different parts of
+the kingdom; and the Author has reason to hope that they have contributed
+to excite attention to the subject of hospital police. Amongst other
+pleasing proofs of this truth, he refers with peculiar satisfaction to
+the late publications of his friends, Sir G. O. Paul, Bart., and Dr.
+Clark[18], of Newcastle-upon-Tyne.
+
+This work was originally entitled “Medical Jurisprudence;” but, some
+friends having objected to the term _Jurisprudence_, it has been
+changed to _Ethics_. According to the definition of Justinian, however,
+Jurisprudence may be understood to include moral injunctions as well as
+positive ordinances:—“Juris praecepta sunt haec; honeste vivere, alterum
+non laedere, suum cuique tribuere.” (_Instit._ i. 1. § 3.)
+
+_Manchester, Febr. 15, 1803._
+
+
+FOOTNOTES:
+
+[9] [James Percival, who died Febr. 25, 1793, in the twenty-fourth
+year of his age, of a malignant fever, which he had contracted while
+prosecuting his medical studies at Edinburgh. See _Memoirs of Dr.
+Percival_, prefixed to his “Works,” p. clxxix.]
+
+[10] [The death of his eldest son the Rev. Thomas Bassnett Percival, in
+the thirty-second year of his age, May 27, 1798. See _Memoirs &c._ p.
+ccii.]
+
+[11] [Edward Cropper Percival, the editor of his father’s collected
+Works, and author of “Practical Observations on Typhous Fever,” 8vo.
+1819; who settled first at Dublin, and afterwards at Bath, where he died,
+1819, at the age of 36.]
+
+[12] In the preface to his _Elements of the Common Laws of England_.
+(_Works_, vol. iv. p. 9.)
+
+[13] [This Sermon is omitted in the present edition.]
+
+[14] [The author of numerous religious works; born Oct. 31, 1758, died
+March 24, 1846. See _Gent. Mag._ for June 1846.]
+
+[15] [The twelfth chapter, which has been extracted, and reprinted in a
+separate form, 1847, Oxford, 16mo.]
+
+[16] [Dr. John Gregory’s well-known “Lectures on the Duties and
+Qualifications of a Physician.”]
+
+[17] [“Statuta Moralia Collegii Regalis Medicorum Londinensium,” 1722,
+8vo. pp. 16.]
+
+[18] [Author of “Observations on Fevers,” &c. 1780, 8vo., and other
+works.]
+
+
+
+
+MEDICAL ETHICS;
+
+_&c. &c._
+
+
+
+
+CHAPTER I.
+
+_Of Professional Conduct, relative to Hospitals, or other Medical
+Charities._
+
+
+§ 1. Hospital Physicians and Surgeons should minister to the sick with
+due impressions of the importance of their office; reflecting that the
+ease, the health, and the lives of those committed to their charge
+depend on their skill, attention, and fidelity. They should study,
+also, in their deportment, so to unite tenderness with steadiness, and
+condescension with authority, as to inspire the minds of their patients
+with gratitude, respect, and confidence.
+
+§ 2. The choice of a Physician or Surgeon cannot be allowed to hospital
+patients, consistently with the regular and established succession of
+medical attendance. Yet personal confidence is not less important to
+the comfort and relief of the sick poor, than of the rich under similar
+circumstances; and it would be equally just and humane to enquire
+into and to indulge their partialities, by occasionally calling into
+consultation the favourite practitioner. The rectitude and wisdom of
+this conduct will be still more apparent, when it is recollected, that
+patients in hospitals not unfrequently request their discharge on a
+deceitful plea of having received relief, and afterwards procure another
+recommendation, that they may be admitted under the Physician or Surgeon
+of their choice. Such practices involve in them a degree of falsehood,
+produce unnecessary trouble, and may be the occasion of irreparable loss
+of time in the treatment of diseases.
+
+§ 3. The feelings and emotions of the patients, under critical
+circumstances, require to be known and to be attended to, no less than
+the symptoms of their diseases: thus, extreme timidity with respect to
+venesection contra-indicates its use in certain cases and constitutions.
+Even the prejudices of the sick are not to be contemned, or opposed with
+harshness; for, though silenced by authority, they will operate secretly
+and forcibly on the mind, creating fear, anxiety, and watchfulness.
+
+§ 4. As misapprehension may magnify real evils, or create imaginary
+ones, no discussion concerning the nature of the case should be entered
+into before the patients, either with the House-Surgeon, the pupils of
+the hospital, or any medical visitor.
+
+§ 5. In the large wards of an infirmary the patients should be
+interrogated concerning their complaints in a tone of voice which cannot
+be overheard. Secrecy, also, when required by peculiar circumstances,
+should be strictly observed. And females should always be treated with
+the most scrupulous delicacy. To neglect or to sport with their feelings
+is cruelty; and every wound thus inflicted tends to produce a callousness
+of mind, a contempt of decorum, and an insensibility to modesty and
+virtue. Let these considerations be forcibly and repeatedly urged on the
+hospital pupils.
+
+§ 6. The moral and religious influence of sickness is so favourable to
+the best interests of men and of society, that it is justly regarded
+as an important object in the establishment of every hospital. The
+institutions for promoting it should therefore be encouraged by the
+Physicians and Surgeons, whenever seasonable opportunities occur; and,
+by pointing out these to the officiating clergyman, the sacred offices
+will be performed with propriety, discrimination, and greater certainty
+of success. The character of a Physician is usually remote either from
+superstition or enthusiasm; and the aid, which he is now exhorted to
+give, will tend to their exclusion from the sick wards of the hospital,
+where their effects have often been known to be not only baneful, but
+even fatal.
+
+§ 7. It is one of the circumstances which softens the lot of the poor,
+that they are exempt from the solicitudes attendant on the disposal of
+property. Yet there are exceptions to this observation; and it may be
+necessary that an hospital patient, on the bed of sickness and death,
+should be reminded by some friendly monitor of the importance of a last
+will and testament to his wife, children, or relatives, who otherwise
+might be deprived of his effects, of his expected prize-money, or of
+some future residuary legacy. This kind office will be best performed
+by the House-Surgeon, whose frequent attendance on the sick diminishes
+their reserve, and entitles him to their familiar confidence. And he will
+doubtless regard the performance of it as a duty; for whatever is right
+to be done, and cannot by another be so well done, has the full force of
+moral and personal obligation.
+
+§ 8. The Physicians and Surgeons should not suffer themselves to be
+restrained by parsimonious considerations from prescribing wine, and
+drugs even of high price, when required in diseases of extraordinary
+malignity and danger. The efficacy of every medicine is proportionate
+to its purity and goodness; and on the degree of these properties,
+_caeteris paribus_, both the cure of the sick and the speediness of
+its accomplishment must depend. But, when drugs of inferior quality
+are employed, it is requisite to administer them in larger doses, and
+to continue the use of them a longer period of time; circumstances
+which probably more than counterbalance any savings in their original
+price. If the case, however, were far otherwise, no economy of a fatal
+tendency ought to be admitted into institutions, founded on principles
+of the purest beneficence, and which, in this age and country, when well
+conducted, can never want contributions adequate to their liberal support.
+
+§ 9. The Medical gentlemen of every charitable institution are in some
+degree responsible for, and the guardians of, the honour of each other.
+No Physician or Surgeon, therefore, should reveal occurrences in the
+hospital, which may injure the reputation of any one of his colleagues;
+except under the restriction contained in the succeeding article.
+
+§ 10. No professional charge should be made by a Physician or Surgeon,
+either publicly or privately, against any associate, without previously
+laying the complaint before the gentlemen of the Faculty belonging to the
+institution, that they may judge concerning the reasonableness of its
+grounds, and the measures to be adopted.
+
+§ 11. A proper discrimination being established in all hospitals between
+the Medical and Chirurgical cases, it should be faithfully adhered to by
+the Physicians and Surgeons on the admission of patients.
+
+§ 12. Whenever cases occur, attended with circumstances not heretofore
+observed, or in which the ordinary modes of practice have been attempted
+without success, it is for the public good, and in an especial degree
+advantageous to the poor, (who, being the most numerous class of society,
+are the greatest beneficiaries of the healing art,) that new remedies
+and new methods of Chirurgical treatment should be devised. But in the
+accomplishment of this salutary purpose the gentlemen of the Faculty
+should be scrupulously and conscientiously governed by sound reason,
+just analogy, or well authenticated facts. And no such trials should be
+instituted without a previous consultation of the Physicians or Surgeons,
+according to the nature of the case.
+
+§ 13. To advance professional improvement, a friendly and unreserved
+intercourse should subsist between the gentlemen of the Faculty, with
+a free communication of whatever is extraordinary or interesting in
+the course of their hospital practice. And an account of every case or
+operation, which is rare, curious, or instructive, should be drawn up
+by the Physician or Surgeon to whose charge it devolves, and entered in
+a register kept for the purpose, but open only to the Physicians and
+Surgeons of the charity.
+
+§ 14. Hospital registers usually contain only a simple report of
+the number of patients admitted and discharged. By adopting a more
+comprehensive plan they might be rendered subservient to Medical science
+and beneficial to mankind. The following sketch is offered with deference
+to the gentlemen of the Faculty. Let the register consist of three
+tables: the first specifying the number of patients admitted, cured,
+relieved, discharged, or dead; the second, the several diseases of the
+patients, with their events; the third, the sexes, ages, and occupations
+of the patients. The ages should be reduced into classes; and the tables
+adapted to the four divisions of the year. By such an institution, the
+increase or decrease of sickness; the attack, progress, and cessation of
+epidemics; the comparative healthiness of different situations, climates,
+and seasons; the influence of particular trades and manufactures
+on health and life; with many other curious circumstances, not more
+interesting to Physicians than to the community, would be ascertained
+with sufficient precision.
+
+§ 15. By the adoption of the register recommended in the foregoing
+article, Physicians and Surgeons would obtain a clearer insight into the
+comparative success of their hospital and private practice; and would be
+incited to a diligent investigation of the causes of such difference.
+In particular diseases it will be found to subsist in a very remarkable
+degree: and the discretionary power of the Physician or Surgeon in
+the admission of patients, could not be exerted with more justice or
+humanity, than in refusing to consign to lingering suffering and almost
+certain death a numerous class of patients, inadvertently recommended
+as objects of these charitable institutions. “In judging of diseases
+with regard to the propriety of their reception into hospitals,” says
+an excellent writer, “the following general circumstances are to be
+considered:—
+
+“Whether they be capable of speedy relief; because, as it is the
+intention of charity to relieve as great a number as possible, a quick
+change of objects is to be wished; and also because the inbred disease
+of hospitals will almost inevitably creep in some degree upon one who
+continues a long time in them, but will rarely attack one whose stay is
+short.
+
+“Whether they require in a particular manner the superintendence of
+skilful persons, either on account of their acute and dangerous nature,
+or any singularity or intricacy attending them, or erroneous opinions
+prevailing among the common people concerning their treatment....
+
+“Whether they be contagious, or subject in a peculiar degree to corrupt
+the air and generate pestilential diseases....
+
+“Whether a fresh and pure air be peculiarly requisite for their cure, and
+they be remarkably injured by any vitiation of it[19].”
+
+§ 16. But no precautions relative to the reception of patients who labour
+under maladies incapable of relief, contagious in their nature, or liable
+to be aggravated by confinement in an impure atmosphere, can obviate
+the evils arising from close wards, and the false economy of crowding
+a number of persons into the least possible space. There are inbred
+diseases which it is the duty of the Physician or Surgeon to prevent, as
+far as lies in his power, by a strict and persevering attention to the
+whole medical polity of the hospital. This comprehends the discrimination
+of cases admissible, air, diet, cleanliness, and drugs; each of which
+articles should be subjected to a rigid scrutiny at stated periods of
+time.
+
+§ 17. The establishment of a committee of the gentlemen of the
+Faculty, to be held monthly, would tend to facilitate this interesting
+investigation, and to accomplish the most important objects of it. By the
+free communication of remarks, various improvements would be suggested;
+by the regular discussion of them, they would be reduced to a definite
+and consistent form; and by the authority of united suffrages, they would
+have full influence over the governors of the charity. The exertions
+of individuals, however benevolent or judicious, often give rise to
+jealousy, are opposed by those who have not been consulted, and prove
+inefficient by wanting the collective energy of numbers.
+
+§ 18. The harmonious intercourse which has been recommended to the
+gentlemen of the Faculty will naturally produce frequent consultations,
+viz. of the Physicians on Medical cases, of the Surgeons on Chirurgical
+cases, and of both united in cases of a compound nature, which, falling
+under the department of each, may admit of elucidation by the reciprocal
+aid of the two professions.
+
+§ 19. In consultations on Medical cases the junior Physician present
+should deliver his opinion first, and the others in the progressive
+order of their seniority. The same order should be observed in
+Chirurgical cases; and a majority should be decisive in both: but if the
+numbers be equal, the decision should rest with the Physician or Surgeon
+under whose care the patient is placed. No decision, however, should
+restrain the acting practitioner from making such variations in the mode
+of treatment, as future contingencies may require, or a farther insight
+into the nature of the disorder may shew to be expedient.
+
+§ 20. In consultations on mixed cases the junior Surgeon should deliver
+his opinion first, and his brethren afterwards in succession, according
+to progressive seniority. The junior Physician present should deliver his
+opinion after the senior Surgeon, and the other Physicians in the order
+above prescribed.
+
+§ 21. In every consultation the case to be considered should be concisely
+stated by the Physician or Surgeon who requests the aid of his brethren.
+The opinions relative to it should be delivered with brevity, agreeably
+to the preceding arrangement, and the decisions collected in the same
+order. The order of seniority among the Physicians and Surgeons may be
+regulated by the dates of their respective appointments in the hospital.
+
+§ 22. Due notice should be given of a consultation, and no person
+admitted to it except the Physicians and Surgeons of the hospital,
+and the House-Surgeon, without the unanimous consent of the gentlemen
+present. If an examination of the patient be previously necessary, the
+particular circumstances of danger or difficulty should be carefully
+concealed from him, and every just precaution used to guard him from
+anxiety or alarm.
+
+§ 23. No important operation should be determined upon, without a
+consultation of the Physicians and Surgeons, and the acquiescence of
+a majority of them. Twenty-four hours notice should be given of the
+proposed operation, except in dangerous accidents, or when peculiar
+circumstances occur which may render delay hazardous. The presence of
+a spectator should not be allowed during an operation, without the
+express permission of the operator. All extra-official interference in
+the management of it should be forbidden. A decorous silence ought to
+be observed. It may be humane and salutary, however, for one of the
+attending Physicians or Surgeons to speak occasionally to the patient,
+to comfort him under his sufferings, and to give him assurance (if
+consistent with truth,) that the operation goes on well, and promises a
+speedy and successful termination[20].
+
+As a hospital is the best school for practical Surgery, it would be
+liberal and beneficial to invite in rotation two Surgeons of the town,
+who do not belong to the institution, to be present at each operation.
+
+§ 24. Hospital consultations ought not to be held on Sundays, except
+in cases of urgent necessity; and on such occasions an hour should be
+appointed which does not interfere with attendance on public worship.
+
+§ 25. It is an established usage in some hospitals to have a stated day
+in the week for the performance of operations. But this may occasion
+improper delay, or equally unjustifiable anticipation. When several
+operations are to take place in succession, one patient should not
+have his mind agitated by the knowledge of the sufferings of another.
+The Surgeon should change his apron, when besmeared; and the table or
+instruments should be freed from all marks of blood, and every thing that
+may excite terror.
+
+§ 26. Dispensaries afford the widest sphere for the treatment of
+diseases, comprehending not only such as ordinarily occur, but those
+which are so infectious, malignant, and fatal, as to be excluded from
+admission into infirmaries. Happily also they neither tend to counteract
+that spirit of independence which should be sedulously fostered in the
+poor, nor to preclude the practical exercise of those relative duties,
+“the charities of father, son, and brother,” which constitute the
+strongest moral bonds of society. Being institutions less splendid and
+expensive than hospitals, they are well adapted to towns of moderate
+size; and might even be established without difficulty in populous
+country districts. Physicians and Surgeons in such situations have
+generally great influence; and it would be truly honourable to exert it
+in a cause subservient to the interests of Medical science, of commerce,
+and of philanthropy.
+
+The duties which devolve on gentlemen of the Faculty engaged in
+the conduct of Dispensaries, are so nearly similar to those of
+hospital Physicians and Surgeons, as to be comprehended under the
+same professional and moral rules. But greater authority and greater
+condescension will be found requisite in domestic attendance on the
+poor; and human nature must be intimately studied, to acquire that full
+ascendancy over the prejudices, the caprices, and the passions of the
+sick and of their relatives, which is essential to Medical success.
+
+§ 27. Hospitals appropriated to particular maladies are established
+in different places, and claim both the patronage and the aid of the
+gentlemen of the Faculty. To an asylum for female patients labouring
+under syphilis it is to be lamented that discouragements have been too
+often and successfully opposed. Yet whoever reflects on the variety
+of diseases to which the human body is incident, will find that a
+considerable part of them are derived from immoderate passions and
+vicious indulgences. Sloth, intemperance, and irregular desires are the
+great sources of those evils which contract the duration and imbitter
+the enjoyment of life. But humanity, whilst she bewails the vices of
+mankind, incites us to alleviate the miseries which flow from them. And
+it may be proved that a Lock Hospital is an institution founded on the
+most benevolent principles, consonant to sound policy, and favourable to
+reformation and to virtue. It provides relief for a painful and loathsome
+distemper, which contaminates in its progress the innocent as well as
+the guilty, and extends its baneful influence to future generations.
+It restores to virtue and to religion those votaries whom pleasure has
+seduced or villany betrayed, and who now feel by sad experience that
+ruin, misery, and disgrace are the wages of sin. Over such objects
+pity sheds the generous tear, austerity softens into forgiveness, and
+benevolence expands at the united pleas of frailty, penitence, and
+wretchedness[21].
+
+No peculiar rules of conduct are requisite in the Medical attendance on
+Lock Hospitals: but, as these institutions must from the nature of their
+object be in a great measure shut from the inspection of the public,
+it will behove the Faculty to consider themselves as responsible in an
+extraordinary degree for their right government; that the moral, no less
+than the Medical purposes of such establishments may be fully answered.
+The strictest decorum should be observed in the conduct towards the
+female patients; no young pupils should be admitted into the house; every
+ministering office should be performed by nurses properly instructed; and
+books adapted to the moral improvement of the patients should be put into
+their hands, and given them on their discharge. To provide against the
+danger of urgent want, a small sum of money and decent clothes should at
+this time be dispensed to them; and, when practicable, some mode should
+be pointed out of obtaining a reputable livelihood.
+
+§ 28. Asylums for insanity possess accommodations and advantages, of
+which the poor must in all circumstances be destitute; and which no
+private family, however opulent, can provide. Of these schemes of
+benevolence all classes of men may have equal occasion to participate the
+benefits; for human nature itself becomes the mournful object of such
+institutions. Other diseases leave man a rational and moral agent, and
+sometimes improve both the faculties of the head and the affections of
+the heart. But lunacy subverts the whole rational and moral character,
+extinguishes every tender charity, and excludes the degraded sufferer
+from all the enjoyments and advantages of social intercourse. Painful is
+the office of a Physician, when he is called upon to minister to such
+humiliating objects of distress; yet great must be his felicity, when he
+can render himself instrumental, under Providence, in the restoration of
+reason and in the renewal of the lost image of GOD. Let no one, however,
+promise himself this divine privilege, if he be not deeply skilled in
+the philosophy of human nature; for, though casual success may sometimes
+be the result of empirical practice, the _medicina mentis_ can only be
+administered with steady efficacy by him, who, to a knowledge of the
+animal economy and of the physical causes which regulate or disturb its
+movements, unites an intimate acquaintance with the laws of association,
+the control of fancy over judgement, the force of habit, the direction
+and comparative strength of opposite passions, and the reciprocal
+dependences and relations of the moral and intellectual powers of man.
+
+§ 29. Even thus qualified with the pre-requisite attainments, the
+Physician will find that he has a new region of Medical science to
+explore; for it is a circumstance to be regretted both by the Faculty
+and the public, that the various diseases which are classed under the
+title of insanity remain less understood than any others with which
+mankind are visited. Hospital institutions furnish the best means of
+acquiring more accurate knowledge of their causes, nature, and cure;
+but this information cannot be attained, to any satisfactory extent, by
+the ordinary attention to single and unconnected cases. The synthetic
+plan should be adopted; and a regular journal should be kept of every
+species of the malady which occurs, arranged under proper heads, with
+a full detail of its rise, progress, and termination; of the remedies
+administered, and of their effects in its several stages. The age, sex,
+occupation, mode of life, and (if possible,) hereditary constitution
+of each patient should be noted; and, when the event proves fatal, the
+brain and other organs affected should be carefully examined, and the
+appearances on dissection minutely inserted in the journal. A register
+like this in the course of a few years would afford the most interesting
+and authentic documents, the want of which on a late melancholy
+occasion[22] was felt and regretted by the whole kingdom.
+
+§ 30. Lunatics are in a great measure secluded from the observation of
+those who are interested in their good treatment; and their complaints of
+ill-usage are so often false or fanciful, as to obtain little credit or
+attention, even when well founded. The Physician, therefore, must feel
+himself under the strictest obligation of honour, as well as of humanity,
+to secure to these unhappy sufferers all the tenderness and indulgence
+compatible with steady and effectual government.
+
+§ 31. Certain cases of mania seem to require a boldness of practice,
+which a young Physician of sensibility may feel a reluctance to adopt. On
+such occasions he must not yield to timidity, but fortify his mind by the
+councils of his more experienced brethren of the Faculty. Yet, with this
+aid, it is more consonant to probity to err on the side of caution than
+of temerity[23].
+
+Hospitals for the small-pox, for inoculation, for cancers, &c. &c., are
+established in different places; but require no professional duties,
+which are not included under, or deducible from, the precepts already
+delivered.
+
+
+FOOTNOTES:
+
+[19] See Aikin’s _Thoughts on Hospitals_, p. 21.
+
+[20] The substance of the five preceding articles (§§ 19-23) was
+suggested by Dr. Ferriar and Mr. Simmons, at the time when I was desired
+by them and my other colleagues to frame a code of rules for the
+Manchester Infirmary. The additions now made are intended to adapt them
+to general use.
+
+[21] See two Reports, intended to promote the establishment of a Lock
+Hospital at Manchester, in the year 1774, inserted in the Author’s
+_Essays Medical, Philosophical, and Experimental_, vol. ii. p. 263.
+(_Works_, vol. iv. p. 203.)
+
+[22] [Alluding to the case of George III.]
+
+[23] See Notes and Illustrations, No. I.
+
+
+
+
+CHAPTER II.
+
+_Of Professional Conduct in Private or General Practice._
+
+
+§ 1. The moral rules of conduct prescribed towards hospital patients
+should be fully adopted in private or general practice. Every case
+committed to the charge of a Physician or Surgeon should be treated with
+attention, steadiness, and humanity; reasonable indulgence should be
+granted to the mental imbecility and caprices of the sick; secrecy and
+delicacy, when required by peculiar circumstances, should be strictly
+observed; and the familiar and confidential intercourse, to which the
+Faculty are admitted in their professional visits, should be used with
+discretion, and with the most scrupulous regard to fidelity and honour.
+
+§ 2. The strictest temperance should be deemed incumbent on the Faculty;
+as the practice both of Physic and Surgery at all times requires the
+exercise of a clear and vigorous understanding: and on emergencies, for
+which no professional man should be unprepared, a steady hand, an acute
+eye, and an unclouded head, may be essential to the well-being, and even
+to the life, of a fellow-creature. Philip of Macedon reposed with entire
+security on the vigilance and attention of his general Parmenio. In his
+hours of mirth and conviviality he was wont to say, “Let us drink, my
+friends; we may do it with safety, for Parmenio never drinks!” The moral
+of this story is sufficiently obvious when applied to the Faculty; but it
+should certainly be construed with great limitation by their patients[24].
+
+§ 3. A Physician should not be forward to make gloomy prognostications;
+because they savour of empiricism, by magnifying the importance of his
+services in the treatment or cure of the disease. But he should not fail
+on proper occasions to give to the friends of the patient timely notice
+of danger when it really occurs, and even to the patient himself, if
+absolutely necessary. This office, however, is so peculiarly alarming
+when executed by him, that it ought to be declined whenever it can be
+assigned to any other person of sufficient judgement and delicacy; for
+the Physician should be the minister of hope and comfort to the sick,
+that by such cordials to the drooping spirit he may smooth the bed of
+death, revive expiring life, and counteract the depressing influence of
+those maladies, which rob the philosopher of fortitude, and the Christian
+of consolation[25].
+
+§ 4. Officious interference in a case under the charge of another should
+be carefully avoided. No meddling enquiries should be made concerning the
+patient, no unnecessary hints given relative to the nature or treatment
+of his disorder, nor any selfish conduct pursued, that may directly
+or indirectly tend to diminish the trust reposed in the Physician or
+Surgeon employed. Yet, though the character of a professional busy-body,
+whether from thoughtlessness or craft, is highly reprehensible, there are
+occasions which not only justify, but require, a spirited interposition.
+When artful ignorance grossly imposes on credulity, when neglect puts
+to hazard an important life, or rashness threatens it with still more
+imminent danger, a Medical neighbour, friend, or relative, apprized of
+such facts, will justly regard his interference as a duty. But he ought
+to be careful that the information on which he acts is well founded,
+that his motives are pure and honourable, and that his judgement of the
+measures pursued is built on experience and practical knowledge, not
+on speculative or theoretical differences of opinion. The particular
+circumstances of the case will suggest the most proper mode of conduct.
+In general, however, a personal and confidential application to the
+gentleman of the Faculty concerned, should be the first step taken, and
+afterwards, if necessary, the transaction may be communicated to the
+patient or to his family.
+
+§ 5. When a Physician or Surgeon is called to a patient who has been
+before under the care of another gentleman of the Faculty, a consultation
+with him should be proposed, even though he may have discontinued his
+visits. His practice also should be treated with candour, and justified,
+so far as probity and truth will permit: for the want of success in the
+primary treatment of a case is no impeachment of professional skill or
+knowledge; and it often serves to throw light on the nature of a disease,
+and to suggest to the subsequent practitioner more appropriate means of
+relief[26].
+
+§ 6. In large and opulent towns the distinction between the provinces of
+Physic and Surgery should be steadily maintained. This distinction is
+sanctioned both by reason and experience. It is founded on the nature
+and objects of the two professions; on the education and acquirements
+requisite for their most beneficial and honourable exercise; and tends
+to promote the complete cultivation and advancement of each. For the
+division of skill and labour is no less advantageous in the liberal than
+in the mechanic arts; and both Physic and Surgery are so comprehensive,
+and yet so far from perfection, as separately to give full scope to
+the industry and genius of their respective professors. Experience has
+fully evinced the benefits of the discrimination recommended, which is
+established in every well regulated hospital, and is thus expressly
+authorized by the Faculty themselves, and by those who have the best
+opportunities of judging of the proper application of the healing art. No
+Physician or Surgeon, therefore, should adopt more than one denomination,
+or assume any rank or privileges different from those of his order.
+
+§ 7. Consultations should be promoted in difficult or protracted cases,
+as they give rise to confidence, energy, and more enlarged views in
+practice. On such occasions no rivalship or jealousy should be indulged:
+candour, probity, and all due respect should be exercised towards the
+Physician or Surgeon first engaged; and, as he may be presumed to be best
+acquainted with the patient and with his family, he should deliver all
+the medical directions agreed upon, though he may not have precedency
+in seniority or rank. It should be the province, however, of the senior
+Physician, first to propose the necessary questions to the sick, but
+without excluding his associate from the privilege of making farther
+enquiries, to satisfy himself, or to elucidate the case.
+
+§ 8. As circumstances sometimes occur to render a special consultation
+desirable, when the continued attendance of another Physician or Surgeon
+might be objectionable to the patient, the gentleman of the Faculty whose
+assistance is required, in such cases, should pay only two or three
+visits, and sedulously guard against all future unsolicited interference.
+For this consultation a double gratuity may reasonably be expected from
+the patient, as it will be found to require an extraordinary portion both
+of time and attention.
+
+In Medical practice it is not an unfrequent occurrence, that a
+Physician is hastily summoned, through the anxiety of the family or the
+solicitation of friends, to visit a patient who is under the regular
+direction of another Physician, to whom notice of this call has not been
+given. Under such circumstances no change in the treatment of the sick
+person should be made, till a previous consultation with the stated
+Physician has taken place, unless the lateness of the hour precludes
+meeting, or the symptoms of the case are too pressing to admit of delay.
+
+§ 9. Theoretical discussions should be avoided in consultations, as
+occasioning perplexity and loss of time; for there may be much diversity
+of opinion concerning speculative points, with perfect agreement in those
+modes of practice which are founded not on hypothesis, but on experience
+and observation[27].
+
+§ 10. The rules prescribed for hospital consultations may be adopted
+in private or general practice[28]. And the seniority of a Physician
+may be determined by the period of his public and acknowledged practice
+as a Physician, and that of a Surgeon by the period of his practice as
+a Surgeon, in the place where each resides. This arrangement, being
+clear and obvious, is adapted to remove all grounds of dispute amongst
+Medical gentlemen; and it secures the regular continuance of the order of
+precedency established in every town, which might otherwise be liable to
+troublesome interruptions by new settlers, perhaps not long stationary.
+
+§ 11. A regular academical education furnishes the only presumptive
+evidence of professional ability, and is so honourable and beneficial,
+that it gives a just claim to pre-eminence among Physicians, in
+proportion to the degree in which it has been enjoyed and improved.
+Yet, as it is not indispensably necessary to the attainment of
+knowledge, skill, and experience, they who have really acquired in a
+competent measure such qualifications without its advantages, should
+not be fastidiously excluded from the privileges of fellowship. In
+consultations especially, as the good of the patient is the sole object
+in view, and is often dependent on personal confidence, the aid of an
+(_any?_) intelligent practitioner ought to be received with candour and
+politeness, and his advice adopted, if agreeable to sound judgement and
+truth[29].
+
+§ 12. Punctuality should be observed in the visits of the Faculty, when
+they are to hold consultation together; but, as this may not always be
+practicable, the Physician or Surgeon who first arrives at the place
+of appointment, should wait five minutes for his associate, before
+his introduction to the patient, that the unnecessary repetition of
+questions may be avoided. No visits should be made but in concert, or
+by mutual agreement; no statement or discussion of the case should take
+place before the patient or his friends, except in the presence of each
+of the attending gentlemen of the Faculty, and by common consent; and
+no prognostications should be delivered, which are not the result of
+previous deliberation and concurrence.
+
+§ 13. Visits to the sick should not be unseasonably repeated; because,
+when too frequent, they tend to diminish the authority of the Physician,
+to produce instability in his practice, and to give rise to such
+occasional indulgences, as are subversive of all Medical regimen.
+
+Sir William Temple has asserted, that “an honest Physician is excused
+for leaving his patient, when he finds the disease growing desperate,
+and can, by his attendance, expect only to receive his fees, without
+any hopes or appearance of deserving them.” But this allegation is not
+well founded; for the offices of a Physician may continue to be highly
+useful to the patient and comforting to the relatives around him even in
+the last period of a fatal malady, by obviating despair, by alleviating
+pain, and by soothing mental anguish. To decline attendance under such
+circumstances would be sacrificing to fanciful delicacy and mistaken
+liberality that moral duty which is independent of, and far superior to,
+all pecuniary appreciation.
+
+§ 14. Whenever a Physician or Surgeon officiates for another who is sick
+or absent during any considerable length of time, he should receive the
+fees accruing from such additional practice; but, if this fraternal
+act be of short duration, it should be gratuitously performed, with
+an observance always of the utmost delicacy towards the interest and
+character of the professional gentleman previously connected with the
+family.
+
+§ 15. Some general rule should be adopted by the Faculty in every town
+relative to the pecuniary acknowledgements of their patients; and it
+should be deemed a point of honour to adhere to this rule with as much
+steadiness as varying circumstances will admit: for it is obvious that
+an average fee, as suited to the general rank of patients, must be an
+inadequate gratuity from the rich, who often require attendance not
+absolutely necessary, and yet too large to be expected from that class of
+citizens, who would feel a reluctance in calling for assistance without
+making some decent and satisfactory retribution.
+
+But in the consideration of fees, let it ever be remembered, that,
+though mean ones from the affluent are both unjust and degrading, yet
+the characteristical beneficence of the Profession is inconsistent with
+sordid views and avaricious rapacity. To a young Physician it is of
+great importance to have clear and definite ideas of the ends of his
+Profession, of the means for their attainment, and of the comparative
+value and dignity of each. Wealth, rank, and independence, with all the
+benefits resulting from them, are the primary[30] ends which he holds
+in view; and they are interesting, wise, and laudable: but knowledge,
+benevolence, and active virtue, the means to be adopted in their
+acquisition, are of still higher estimation; and he has the privilege and
+felicity of practising an art, even more intrinsically excellent in its
+mediate than in its ultimate objects. The former, therefore, have a claim
+to uniform pre-eminence[31].
+
+§ 16. All members of the Profession (including Apothecaries, as well as
+Physicians and Surgeons,) together with their wives and children, should
+be attended gratuitously by any one or more of the Faculty residing near
+them whose assistance may be required; for, as solicitude obscures the
+judgement, and is accompanied with timidity and irresolution. Medical
+men, under the pressure of sickness, either as affecting themselves or
+their families, are peculiarly dependent upon each other. But visits
+should not be obtruded officiously; as such unasked civility may give
+rise to embarrassment, or interfere with that choice on which confidence
+depends. Distant members of the Faculty, when they request attendance,
+should be expected to defray the charges of travelling; and, if their
+circumstances be affluent, a pecuniary acknowledgement should not be
+declined: for no obligation ought to be imposed, which the party would
+rather compensate than contract.
+
+§ 17. When a Physician attends the wife or child of a member of the
+Faculty, or any person very nearly connected with him, he should
+manifest peculiar attention to his opinions, and tenderness even to his
+prejudices. For the dear and important interests which the one has at
+stake, supersede every consideration of rank or seniority in the other;
+since the mind of a husband, a father, or a friend, may receive a deep
+and lasting wound, if the disease terminate fatally, from the adoption
+of means he could not approve, or the rejection of those he wished to
+be tried. Under such delicate circumstances, however, a conscientious
+Physician will not lightly sacrifice his judgement; but will urge with
+proper confidence the measures he deems to be expedient, before he leaves
+the final decision concerning them to his more responsible coadjutor.
+
+§ 18. Clergymen who experience the “res angusta domi” should be visited
+gratuitously by the Faculty. And this exemption should be an acknowledged
+general rule, that the feeling of individual obligation may be rendered
+less oppressive. But such of the clergy as are qualified either from
+their stipends or fortunes to make a reasonable remuneration for Medical
+attendance, are not more privileged than any other order of patients.
+Military or naval subaltern officers in narrow circumstances are also
+proper objects of professional liberality.
+
+§ 19. As the first consultation by letter imposes much more trouble and
+attention than a personal visit, it is reasonable on such an occasion to
+expect a gratuity of double the usual amount: and this has long been the
+established practice of many respectable Physicians. But a subsequent
+epistolary correspondence on the further treatment of the same disorder
+may justly be regarded in the light of ordinary attendance, and may be
+compensated as such according to the circumstances of the case or of the
+patient.
+
+§ 20. Physicians and Surgeons are occasionally requested to furnish
+certificates, justifying the absence of persons who hold situations of
+honour and trust in the army, the navy, or the civil departments of
+government. These testimonials, unless under particular circumstances,
+should be considered as acts due to the public, and therefore not to be
+compensated by any gratuity. But they should never be given without an
+accurate and faithful scrutiny into the case; that truth and probity
+may not be violated, nor the good of the community injured, by the
+unjust pretences of its servants. The same conduct is to be observed by
+Medical practitioners when they are solicited to furnish apologies for
+non-attendance on juries, or to state the valetudinary incapacity of
+persons appointed to execute the business of constables, church-wardens,
+or overseers of the poor. No fear of giving umbrage, no view to present
+or future emolument, nor any motives of friendship, should incite to a
+false, or even dubious declaration; for the general weal requires that
+every individual who is properly qualified should deem himself obliged
+to execute, when legally called upon, the juridical and municipal
+employments of the body politic; and to be accessory by untruth or
+prevarication to the evasion of this duty, is at once a high misdemeanour
+against social order, and a breach of moral and professional honour.
+
+§ 21. The use of quack medicines should be discouraged by the Faculty, as
+disgraceful to the Profession, injurious to health, and often destructive
+even of life. Patients, however, under lingering disorders, are sometimes
+obstinately bent on having recourse to such as they see advertised or
+hear recommended with a boldness and confidence which no intelligent
+Physician dares to adopt with respect to the means that he prescribes. In
+these cases, some indulgence seems to be required to a credulity that
+is insurmountable; and the patient should neither incur the displeasure
+of the Physician, nor be entirely deserted by him. He may be apprized of
+the fallacy of his expectations, whilst assured at the same time that
+diligent attention should be paid to the process of the experiment he
+is so unadvisedly making on himself, and the consequent mischiefs, if
+any, obviated as timely as possible. Certain active preparations, the
+nature, composition, and effects of which are well known, ought not to be
+proscribed as quack medicines.
+
+§ 22. No Physician or Surgeon should dispense a secret nostrum,
+whether it be his invention, or exclusive property; for, if it be of
+real efficacy, the concealment of it is inconsistent with beneficence
+and professional liberality; and if mystery alone give it value and
+importance, such craft implies either disgraceful ignorance or fraudulent
+avarice.
+
+§ 23. The _esprit du corps_ is a principle of action founded in human
+nature, and, when duly regulated, is both rational and laudable. Every
+man who enters into a fraternity engages by a tacit compact not only
+to submit to the laws, but to promote the honour and interest, of the
+association, so far as they are consistent with morality and the general
+good of mankind. A Physician, therefore, should cautiously guard against
+whatever may injure the general respectability of his Profession; and
+should avoid all contumelious representations of the Faculty at large,
+all general charges against their selfishness or improbity, and the
+indulgence of an affected or jocular scepticism concerning the efficacy
+and utility of the healing art.
+
+§ 24. As diversity of opinion and opposition of interest may in the
+Medical, as in other professions, sometimes occasion controversy and
+even contention; whenever such cases unfortunately occur, and cannot be
+immediately terminated, they should be referred to the arbitration of a
+sufficient number of Physicians or of Surgeons, according to the nature
+of the dispute; or to the two orders collectively, if belonging both to
+Medicine and Surgery. But neither the subject matter of such references,
+nor the adjudication, should be communicated to the public; as they may
+be personally injurious to the individuals concerned, and can hardly fail
+to hurt the general credit of the Faculty.
+
+§ 25. A wealthy Physician should not give advice gratis to the affluent,
+because it is an injury to his professional brethren. The office of
+Physician can never be supported but as a lucrative one, and it is
+defrauding in some degree the common funds for its support, when fees
+are dispensed with, which might justly be claimed.
+
+§ 26. It frequently happens that a Physician, in his incidental
+communications with the patients of other Physicians or with their
+friends, may have their cases stated to him in so direct a manner, as
+not to admit of his declining to pay attention to them. Under such
+circumstances his observations should be delivered with the most delicate
+propriety and reserve: he should not interfere in the curative plans
+pursued, and should even recommend a steady adherence to them, if they
+appear to merit approbation.
+
+§ 27. A Physician, when visiting a sick person in the country, may be
+desired to see a neighbouring patient who is under the regular direction
+of another Physician, in consequence of some sudden change or aggravation
+of symptoms. The conduct to be pursued on such an occasion is to give
+advice adapted to present circumstances, to interfere no farther than
+is absolutely necessary with the general plan of treatment, to assume
+no future direction unless it be expressly desired, and, in this case,
+to request an immediate consultation with the practitioner antecedently
+employed.
+
+§ 28. At the close of every interesting and important case (especially
+when it hath terminated fatally,) a Physician should trace back in calm
+reflection all the steps which he had [_has?_] taken in the treatment of
+it. This review of the origin, progress, and conclusion of the malady,
+of the whole curative plan pursued, and of the particular operation of
+the several remedies employed, as well as of the doses and periods of
+time in which they were administered, will furnish the most authentic
+documents on which individual experience can be formed. But it is in
+a moral view that the practice is here recommended; and it should be
+performed with the most scrupulous impartiality. Let no self-deception
+be permitted in the retrospect; and, if errors either of omission or
+commission are discovered, it behoves that they should be brought fairly
+and fully to the mental view. Regrets may follow, but criminality
+will thus be obviated; for good intentions, and the imperfection of
+human skill which cannot anticipate the knowledge that events alone
+disclose, will sufficiently justify what is past, provided the failure
+be made conscientiously subservient to future wisdom and rectitude in
+professional conduct.
+
+§ 29. The opportunities 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. And his counsels, or even remonstrances, will give
+satisfaction, not disgust, if they be conducted 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.
+
+§ 30. The observance of the Sabbath is a duty to which Medical men are
+bound, so far as is compatible with the urgency of the cases under their
+charge. Visits may often be made with sufficient convenience and benefit,
+either before the hours of going to church, or during the intervals of
+public worship; and in many chronic ailments the sick, together with
+their attendants, are qualified to participate in the social offices of
+religion, and should not be induced to forego this important privilege by
+the expectation of a call from their Physician or Surgeon[32].
+
+§ 31. A Physician who is advancing in years, yet unconscious of any
+decay in his faculties, may occasionally experience some change in the
+wonted confidence of his friends. Patients, who before trusted solely to
+his care and skill, may now request that he will join in consultation,
+perhaps with a younger coadjutor. It behoves him to admit this change
+without dissatisfaction or fastidiousness, regarding it as no mark of
+disrespect, but as the exercise of a just and reasonable privilege in
+those by whom he is employed. The junior practitioner may well be
+supposed to have more ardour than _he_ possesses in the treatment of
+diseases, to be bolder in the exhibition of new medicines, and disposed
+to administer old ones in doses of greater efficacy. And this union of
+enterprise with caution, and of fervour with coolness, may promote the
+successful management of a difficult and protracted case. Let the Medical
+parties, therefore, be studious to conduct themselves towards each other
+with candour and impartiality; co-operating by mutual concessions in the
+benevolent discharge of professional duty[33].
+
+§ 32. The commencement of that period of senescence, when it becomes
+incumbent on a Physician to decline the offices of his profession, it
+is not easy to ascertain; and the decision on so nice a point must be
+left to the moral discretion of the individual. For, one grown old in
+the useful and honourable exercise of the healing art, may continue
+to enjoy, and justly to enjoy, the unabated confidence of the public;
+and, whilst exempt in a considerable degree from the privations and
+infirmities of age, he is under indispensable obligations to apply his
+knowledge and experience in the most efficient way to the benefit of
+mankind: for the possession of powers is a clear indication of the will
+of our Creator concerning their practical direction. But in the ordinary
+course of nature the bodily and mental vigour must be expected to decay
+progressively, though perhaps slowly, after the meridian of life is
+past. As age advances, therefore, a Physician should from time to time
+scrutinize impartially the state of his faculties, that he may determine
+_bona fide_ the precise degree in which he is qualified to execute the
+active and multifarious offices of his profession; and, whenever he
+becomes conscious that his memory presents to him with faintness those
+analogies on which Medical reasoning and the treatment of diseases are
+founded, that diffidence of the measures to be pursued perplexes his
+judgment, that, from a deficiency in the acuteness of his senses, he
+finds himself less able to distinguish signs or to prognosticate events,
+he should at once resolve (though others perceive not the changes which
+have taken place,) to sacrifice every consideration of fame or fortune,
+and to retire from the engagements of business. To the Surgeon under
+similar circumstances this rule of conduct is still more necessary; for
+the energy of the understanding often subsists much longer than the
+quickness of eye-sight, delicacy of touch, and steadiness of hand, which
+are essential to the skilful performance of operations. Let both the
+Physician and Surgeon never forget that their professions are public
+trusts, properly rendered lucrative whilst they fulfil them, but which
+they are bound by honour and probity to relinquish as soon as they find
+themselves unequal to their adequate and faithful execution.
+
+
+FOOTNOTES:
+
+[24] See Notes and Illustrations, No. II.
+
+[25] See Notes and Illustrations, No. III.
+
+[26] See Notes and Illustrations, No. IV.
+
+[27] See Notes and Illustrations, No. V.
+
+[28] See above, chap. i. §§ 19-21.
+
+[29] See Notes and Illustrations, No. VI.
+
+[30] [The word _primary_ is omitted in ed. 1807.]
+
+[31] See Notes and Illustrations, No. VII.
+
+[32] See Notes and Illustrations, No. VIII.
+
+[33] See Notes and Illustrations, No. IX.
+
+
+
+
+CHAPTER III.
+
+_Of the Conduct of Physicians towards Apothecaries._
+
+
+§ 1. In the present state of Physic in this country, where the Profession
+is properly divided into three distinct branches, a connection peculiarly
+intimate subsists between the Physician and the Apothecary; and various
+obligations necessarily result from it. On the knowledge, skill, and
+fidelity of the Apothecary depend in a very considerable degree the
+reputation, the success, and usefulness of the Physician. As these
+qualities, therefore, justly claim his attention and encouragement, the
+possessor of them merits his respect and patronage.
+
+§ 2. The Apothecary is in almost every instance the precursor of the
+Physician; and, being acquainted with the rise and progress of the
+disease, with the hereditary constitution, habits, and disposition of
+the patient, he may furnish very important information. It is in general
+therefore expedient (and, when health or life are at stake, expediency
+becomes a moral duty,) to confer with the Apothecary before any decisive
+plan of treatment is adopted, to hear his account of the malady, of the
+remedies which have been administered, of the effects produced by them,
+and of his whole experience concerning the _juvantia_ and _laedentia_
+in the case. Nor should the future attendance of the Apothecary be
+superseded by the Physician; for, if he be a man of honour, judgement,
+and propriety of behaviour, he will be a most valuable auxiliary through
+the whole course of the disorder, by his attention to varying symptoms,
+by the enforcement of Medical directions, by obviating misapprehensions
+in the patient or his family, by strengthening the authority of the
+Physician, and by being at all times an easy and friendly medium of
+communication. To subserve these important purposes, the Physician
+should occasionally make his visits in conjunction with the Apothecary,
+and regulate by circumstances the frequency of such interviews; for, if
+they be often repeated, little substantial aid can be expected from the
+Apothecary, because he will have no intelligence to offer which does not
+fall under the observation of the Physician himself, nor any opportunity
+of executing his peculiar trust, without becoming burdensome to the
+patient by multiplied calls and unseasonable assiduity.
+
+§ 3. This amicable intercourse and co-operation of the Physician and
+Apothecary, if conducted with the decorum and attention to etiquette
+which should always be steadily observed by professional men, will add
+to the authority of the one, to the respectability of the other, and
+to the usefulness of both. The patient will find himself the object of
+watchful and unremitting care, and will experience that he is connected
+with his Physician, not only personally, but by a sedulous representative
+and coadjutor. The Apothecary will regard the free communication of the
+Physician as a privilege and mean of improvement, he will have a deeper
+interest in the success of the curative plans pursued, and his honour
+and reputation will be directly involved in the purity and excellence of
+the medicines dispensed, and in the skill and care with which they are
+compounded.
+
+§ 4. The duty and responsibility of the Physician, however, are so
+intimately connected with these points, that no dependence on the probity
+of the Apothecary should prevent the occasional inspection of the drugs
+which he prescribes. In London the law not only authorizes, but enjoins,
+a stated examination of the simple and compound medicines kept in the
+shops; and the policy that is just and reasonable in the metropolis, must
+be proportionably so in every provincial town throughout the kingdom.
+Nor will any respectable Apothecary object to this necessary office, when
+performed with delicacy and at seasonable times; since his reputation
+and emolument will be increased by it, probably in the exact ratio, thus
+ascertained, of professional merit and integrity.
+
+§ 5. A Physician called to visit a patient in the country, should
+not only be minute in his directions, but should communicate to the
+Apothecary the particular view which he takes of the case; that the
+indications of cure may be afterwards pursued with precision and
+steadiness, and that the Apothecary may use the discretionary power
+committed to him, with as little deviation as possible from the
+general plan prescribed. To so valuable a class of men as the country
+Apothecaries great attention and respect is due; and, as they are the
+guardians of health through large districts, no opportunities should
+be neglected of promoting their improvement, or contributing to their
+stock of knowledge, either by the loan of books, the direction of their
+studies, or by unreserved information on Medical subjects. When such
+occasions present themselves, the maxim of our judicious poet[34] is
+strictly true,
+
+ “The worst avarice is that of sense;”
+
+for practical improvements usually originate in towns, and often remain
+unknown or disregarded in situations where gentlemen of the Faculty have
+little intercourse, and where sufficient authority is wanting to sanction
+innovation.
+
+§ 6. It has been observed by a political and moral writer of great
+authority[35], that “Apothecaries’ profit is become a bye-word, denoting
+something uncommonly extravagant. This great apparent profit, however,
+is frequently no more than the reasonable wages of labour. The skill of
+an Apothecary is a much nicer and more delicate matter than that of any
+artificer whatever, and the trust which is reposed in him is of much
+greater importance. He is the Physician of the poor in all cases, and
+of the rich when the distress or danger is not very great. His reward
+therefore ought to be suitable to his skill and his trust, and it arises
+generally from the price at which he sells his drugs. But the whole drugs
+which the best employed Apothecary in a large market town will sell in a
+year, may not perhaps cost him above thirty or forty pounds. Though he
+should sell them, therefore, for three or four hundred, or at a thousand
+per cent. profit, this may frequently be no more than the reasonable
+wages of his labour, charged, in the only way in which he can charge
+them, upon the price of his drugs.” The statement here given exceeds the
+emoluments of the generality of Apothecaries in country districts. And a
+Physician, who knows the education, skill, and persevering attention, as
+well as the sacrifice of ease, health, and sometimes even of life, which
+this profession requires, should regard it as a duty not to withdraw from
+those who exercise it any sources of reasonable profit, or the honourable
+means of advancement in fortune. Two practices prevail in some places
+injurious to the interest of this branch of the Faculty, and which ought
+to be discouraged: one consists in suffering prescriptions to be sent to
+the druggist, for the sake of a small saving in expense; the other in
+receiving an annual stipend (usually degrading in its amount, and in the
+services it imposes,) for being consulted on the slighter indispositions
+to which all families are incident, and which properly fall within the
+province of the Apothecary.
+
+§ 7. Physicians are sometimes requested to visit the patients of the
+Apothecary in his absence. Compliance in such cases should always be
+refused, when it is likely to interfere with the consultation of the
+Medical gentleman ordinarily employed by the sick person or his family.
+Indeed this practice is so liable to abuse, and requires in its exercise
+so much caution and delicacy, that it would be for the interest and
+honour of the Faculty to have it altogether interdicted. Physicians are
+the only proper substitutes for Physicians, Surgeons for Surgeons, and
+Apothecaries for Apothecaries.
+
+§ 8. When the aid of a Physician is required, the Apothecary to the
+family is frequently called upon to recommend one. It will then
+behove him to learn fully whether the patient or his friends have any
+preference or partiality; and this he ought to consult, if it lead not
+to an improper choice; for the maxim of Celsus is strictly applicable
+on such an occasion, “Ubi par scientia, melior est amicus medicus quam
+extraneus[36].” But if the parties concerned be entirely indifferent,
+the Apothecary is bound to decide according to his best judgement, with
+a conscientious and exclusive regard to the good of the person for whom
+he is commissioned to act. It is not even sufficient that he selects the
+person on whom in sickness he reposes his own trust; for in this case
+friendship justly gives preponderancy, because it may be supposed to
+excite a degree of zeal and attention, which might overbalance superior
+science or abilities. Without favour or regard to any personal, family,
+or professional connections, he should recommend the Physician whom
+he conscientiously believes, all circumstances considered, to be best
+qualified to accomplish the recovery of the patient.
+
+§ 9. In the county of Norfolk, and in the city of London, benevolent
+institutions have been lately formed, for providing funds to relieve the
+widows and children of Apothecaries, and occasionally also members of
+the Profession who become indigent[37]. Such schemes merit the sanction
+and encouragement of every liberal Physician and Surgeon; and were they
+thus extended, their usefulness would be greatly increased, and their
+permanency almost with certainty secured. Medical subscribers from every
+part of Great Britain should be admitted, if they offer satisfactory
+testimonials of their qualifications. One comprehensive establishment
+seems to be more eligible than many on a smaller scale; for it would be
+conducted with superior dignity, regularity, and efficiency, with fewer
+obstacles from interest, prejudice, or rivalship, with considerable
+saving in the aggregate of time, trouble, and expence, with more accuracy
+in the calculations relative to its funds, and consequently with the
+utmost practicable extension of its dividends.
+
+
+FOOTNOTES:
+
+[34] [Pope’s _Essay on Criticism_, pt. iii.]
+
+[35] See Adam Smith’s _Wealth of Nations_, bk. i. ch. 10. pt. 1.
+
+[36] [“Ideoque [conjicio], cum par scientia sit, utiliorem tamen
+medicum esse amicum, quam extraneum.” Cels. _De Medic._ i. præf.]
+
+[37] [Of these Societies (besides several whose benefits are confined
+to certain counties and districts,) there are in England the four
+following:—1. “Society for Relief of Widows and Orphans of Medical Men
+in London and its Vicinity,” instituted in 1788; 2. “Medical Benevolent
+Society, for the Relief of its distressed Members,” instituted in 1816;
+3. “Benevolent Fund of the Provincial Medical and Surgical Association,”
+instituted in 1836, for the relief of distressed Medical Men, and their
+widows and orphans; and 4. “General Medical Annuity Fund,” instituted in
+1845, for the relief of distressed members, and their widows and orphans.]
+
+
+
+
+CHAPTER IV.[38]
+
+_Of Professional Duties in certain Cases which require a Knowledge of
+Law._
+
+
+§ 1. Gentlemen of the Faculty of Physic, by the authority of different
+parliamentary statutes, enjoy an exemption from serving on inquests or
+juries, from bearing armour, from being constables or church-wardens,
+and from all burdensome offices, whether leet or parochial[39]. These
+privileges are founded on reasons highly honourable to Medical men, and
+should operate as incentives to that diligent and assiduous discharge
+of professional duty, which the legislature has generously presumed to
+occupy the time and to employ the talents of Physicians and Surgeons,
+in some of the most important interests of their fellow-citizens. It
+is perhaps on account of their being thus excused from many civil
+functions, that Sir William Blackstone, in his learned “Commentaries,”
+judges the study of the law to be less essential to them, than to any
+other class of men. He observes, that “there is no special reason why
+gentlemen of the Faculty of Physic should apply themselves to the study
+of the law, unless in common with other gentlemen, and to complete the
+character of general and extensive knowledge; a character which their
+profession, beyond others, has remarkably deserved[40].” But I apprehend
+it will be found that Physicians and Surgeons are often called upon to
+exercise appropriate duties, which require not only a knowledge of the
+principles of jurisprudence, but of the forms and regulations adopted in
+our courts of judicature. The truth of this observation will sufficiently
+appear from the following brief detail of some of the principal cases, in
+which the science of law is of importance to Medical practitioners. To
+enter at large on so comprehensive a subject, would far exceed the bounds
+of the present undertaking.
+
+§ 2.[41] When a Physician attends upon a patient, under circumstances
+of imminent danger, his counsel may be required about the expediency of
+a last will and testament. It behoves him therefore to know, whether,
+in case of intestacy, the daughters or younger children of the sick
+person would be legally entitled to any share of his fortune; whether the
+fortune would be equally divided, when such equality would be improper
+or unjust; whether diversity of claims and expensive litigations would
+ensue, without a will, from the nature of the property in question; and
+whether the creditors of the defunct would by his neglect be defrauded of
+their equitable claims. For it is a culpable deficiency in our laws, that
+real estates are not subject to the payment of debts by simple contract,
+unless expressly charged with them by the last will and testament of
+the proprietor[42]; although credit is often founded, as Dr. Paley well
+observes, on the possession of such estates. This acute moralist adds,
+“He, therefore, who neglects to make the necessary appointments for the
+payment of his debts, as far as his effects extend, sins in his grave;
+and, if he omits this on purpose to defeat the demands of his creditors,
+he dies with a deliberate fraud in his heart[43].”
+
+Property is divided by the law into two species, personal and real; each
+requiring appropriate modes of transfer or alienation, with which a
+Physician should be well acquainted. It may also be required of him to
+deliver an opinion, and even a solemn judicial evidence, concerning the
+capacity of his patient to make a will, a point sometimes of difficult
+and nice decision; for various disorders obscure, without perverting,
+the intellectual faculties; and even in delirium itself there are lucid
+intervals, when the memory and judgement become sufficiently clear,
+accurate, and vigorous, for the valid execution of a testament. In such
+cases the will should commence with the signature of the testator,
+concluding with it also, if his hand be not, after continued mental
+exertions, too tremulous for subscription; and it should be made with all
+possible conciseness and expedition[44].
+
+If the patient be surprised by sudden and violent sickness, the law
+authorizes a _nuncupative will_ in the disposal of personalty[45]. But,
+to guard against fraud, the testamentary words must be delivered with an
+explicit intention to bequeath; the will must be made at home, or among
+the testator’s family or friends, unless by unavoidable accident; and
+also in his last sickness,—for, if he recover, it is evident that time is
+given for a written will[46].
+
+The law excludes from the privilege of making a will madmen, idiots,
+persons in their dotage, or those who have stupified their understandings
+by drunkenness. But there is a high degree of hypochondriacism, which
+not unfrequently falls under the cognizance of a Physician, and on which
+he may be required to decide whether it amounts to mental incapacity
+for the execution of a last will and testament. To define the precise
+boundaries of rationality is perhaps impossible; if it be true, according
+to Shakespear[47], that
+
+ “The lunatic, the lover, and the poet
+ Are of imagination all compact.”
+
+But a partially distempered fancy is known to subsist with general
+intelligence; and a man, like Mr. Simon Browne, believing the extinction
+of his rational soul by the judgement of GOD, may uniformly evince in
+every other instance very distinguished intellectual powers, and be
+capable of directing his concerns and disposing of his property with
+sufficient discretion. To preclude one so affected from being a testator,
+seems inconsistent either with wisdom or justice; especially if the
+will which has been made, discover in its essential parts no traces
+of a disturbed imagination or unsound judgement. But, whenever false
+ideas of a practical kind are so firmly united as to be constantly and
+invariably mistaken for truth, we properly denominate this unnatural
+alliance _Insanity_; and, if it give rise to a train of subordinate
+wrong associations, producing incongruity of behaviour, incapacity for
+the common duties of life, or unconscious deviations from morality and
+religion, _Madness_ has then its commencement[48].
+
+§ 3. A lunatic, or _non compos mentis_, in the eye of the law, is one
+who has had understanding, but has lost it by disease, grief, or other
+accident. The king is the trustee for such unfortunate persons, appointed
+to protect their property, and to account to them, if they recover, for
+their revenues; or, after their decease, to their representatives. The
+Lord Chancellor, therefore, grants a commission to enquire into the
+state of mind of the insane person; and if he be found _non compos_
+by a jury, he usually commits the care of his person, with a suitable
+allowance for his maintenance, to some friend, who is then called his
+Committee[49]. The Physician who has been consulted about the case will
+doubtless be called upon to deliver an opinion concerning his patient;
+and, before he becomes accessory to his deprivation, as it were, of all
+legal existence, he will weigh attentively the whole circumstances of
+the disorder, the original cause of it, the degree in which it subsists,
+its duration, and probable continuance. For, if the malady be not fixed,
+great, and permanent, this solemn act of law must be deemed inexpedient,
+because it cannot be reversed without difficulty; and when insanity has
+been once formally declared, there may be grounds of apprehension that
+the party will be consigned to neglect and oblivion. With regard to the
+waste or alienation of property by the person thus afflicted, little risk
+is incurred, if he be put under the ordinary restraint of a judicious
+curator; for, whilst his mind remains in the state of alienation, he is
+incapable of executing any act with validity; and the next heir, or other
+person interested, may set it aside, on the plea of his incapacity. But
+the use of a guardian or committee of a lunatic is chiefly to renew, in
+his right, under the direction of the court of chancery, any lease for
+lives or years, and to apply the profits for the benefit of the insane
+person, of his heirs, or executors.
+
+§ 4. The law justifies the beating of a lunatic, in such manner as the
+circumstances may require[50]. But it has been before remarked[51], that
+a Physician who attends an asylum for insanity is under an obligation
+of honour as well as of humanity, to secure to the unhappy sufferers
+committed to his charge all the tenderness and indulgence compatible with
+steady and effectual government; and the strait waistcoat, with other
+improvements in modern practice, now preclude the necessity of coercion
+by corporal punishment[52].
+
+§ 5[53]. Houses for the reception of lunatics are subject to strict
+regulations of law. These regulations refer to the persons keeping such
+houses, to the admission of patients into them, and to their inspection
+by visitors, duly authorized and qualified. If any one conceal more
+than a single lunatic without a licence, he becomes liable to a penalty
+of five hundred pounds. The licences in the cities of London and
+Westminster, or within seven miles of the metropolis, are granted by the
+College of Physicians; who are empowered to elect five of their fellows
+to act as commissioners for inspecting the lunatic asylums, within their
+jurisdiction. Houses for the reception of lunatics in the country are to
+be licensed by the justices of the peace during their quarter-sessions:
+and at the time when the licence is granted the magistrates are directed
+to nominate two of their own body, and also one Physician, to visit
+and inspect such licensed houses. This inspection they are empowered
+to make as often as they judge it to be expedient; and an allowance is
+to be granted for the expences incurred. The keeper of every licensed
+house is bound, under the penalty of one hundred pounds, not to admit or
+confine any person as a lunatic, without having a certificate in writing,
+under the hand and seal of some Physician, Surgeon, or Apothecary, that
+such person is proper to be received into the house, as being _non
+compos mentis_. And he is further required, under the same penalty, to
+give notice of this certificate to the secretary of the commissioners,
+appointed either by the College of Physicians, or the magistrates at
+their quarter-sessions. The Act of Parliament which establishes these
+regulations states this important proviso, “That in all proceedings
+that shall be had under his Majesty’s writ of _Habeas Corpus_, and in
+all indictments, informations, and actions, that shall be preferred and
+brought against any person or persons, for confining or ill-treating
+any of his Majesty’s subjects, in any of the said houses, the parties
+complained of shall be obliged to justify their proceedings, according to
+the course of the common law, in the same manner as if this Act had not
+been made[54].”
+
+The legal allowance to a Medical commissioner, for the visitation and
+inspection of a lunatic-asylum, is fixed by the statute at one guinea.
+This gratuity, which cannot be regarded as a just compensation for the
+time and trouble bestowed, it may often be proper to decline; for to
+a Physician of a liberal mind an inadequate pecuniary acknowledgement
+is felt as a degradation, but he will be amply remunerated by the
+consciousness of having performed an office, enjoined at once by the laws
+of humanity, and of his country.
+
+§ 6. In the case of sudden death, the law has made provision for
+examining into the cause of it by the Coroner, an officer appointed for
+the purpose, who is empowered to summon such evidence as is necessary
+for the discharge of his inquisitorial and judicial functions. On these
+occasions the attendance of a Physician or Surgeon may often be required,
+who should be qualified to give testimony consonant to legal, as well
+as to medical knowledge. To this end he must not only be acquainted
+with the signs of natural death, but also of those which occur when it
+is produced by accident or violence. And he should not be a stranger
+to the several distinctions of homicide, established in our courts of
+judicature; for the division of this act into _justifiable_, _excusable_,
+and _felonious_, will aid his investigation, and give precision to the
+opinion which he delivers.
+
+§ 7. When a crime, which the law has adjudged to be capital, is attempted
+to be committed by force, the resistance of such force, even so as to
+occasion the death of the offender, is deemed _justifiable homicide_.
+Mr. Locke carries this doctrine to a much greater extent; asserting,
+that all manner of force, without a right, upon a man’s person, puts
+him in a state of war with the aggressor, and of consequence, being in
+such a state of war, he may lawfully kill him that puts him under this
+unnatural restraint[55]. But Judge Blackstone considers this conclusion
+as applicable only to a state of uncivilized nature; and observes, that
+“the law of England is too tender of the public peace, too careful of the
+lives of the subjects, to adopt so contentious a system; nor will suffer
+with impunity any crime to be _prevented_ by death, unless the same, if
+committed, would also be _punished_ by death[56].”
+
+§ 8. With cases of justifiable homicide, however, gentlemen of the
+Faculty are seldom likely to be professionally concerned. But _excusable_
+homicide may frequently fall under their cognizance, and require their
+deliberate attention and accurate investigation. It is of two sorts;
+either _per infortunium_, by misadventure; or _se defendendo_, upon
+a principle of self-preservation. Death may be the consequence of a
+lawful act, done without any intention of hurt. Thus, if an officer,
+in the correction of a soldier, happen to occasion his death, it is
+only misadventure; the punishment being lawful. But if the correction
+be unwarrantably severe, either in the manner, the instrument, or the
+duration of punishment, and death ensue, the offender is at least
+guilty of manslaughter, and in some circumstances, of murder. A Surgeon
+therefore is usually present when soldiers are chastised with the lash
+in pursuance of the sentence of a court-martial; and on his testimony
+must depend the justification of the mode and degree of punishment
+inflicted.—When medicines administered to a sick patient, with an honest
+design, to produce the alleviation of his pain or cure of his disease,
+occasion death, this is misadventure, in the view of the law; and the
+Physician or Surgeon who directed them is not liable to punishment
+criminally, though a civil action might formally lie for neglect or
+ignorance. But it hath been holden that such immunity is confined to
+_regular_ Physicians and Surgeons. Sir Matthew Hale, however, justly
+questions the legality of this determination, since physic and salves
+were in use before licensed Physicians and Surgeons. “Wherefore he treats
+the doctrine as apocryphal, and fitted only to qualify and flatter
+Licenciates and Doctors in Physic; though it may be of use to make
+people cautious how they meddle too much in so dangerous an employment.”
+The College of Physicians, however, within their jurisdiction, which
+extends seven miles round London, are vested by charter with the power
+of fine and imprisonment _pro mala praxi_[57]. Yet Dr. Groenevelt, who
+was cited in the year 1693 before the Censors of the College[58], and
+committed to Newgate by a warrant from the President for prescribing
+cantharides in substance, was acquitted on the plea that bad practice
+must be accompanied with a bad intention, to render it criminal. This
+prosecution, whilst it ruined the doctor’s reputation and injured his
+fortune, so that he is said to have died in want, excited general
+attention to the remedy, and afterwards established the use of it; though
+it must be acknowledged that his doses were too bold and hazardous. But,
+whatever be the indulgence of the law towards Medical practitioners, they
+are bound by a higher authority than that of the most solemn statute,
+not to exercise the healing art without due knowledge, tenderness, and
+discretion; and every rash experiment, every mistake originating from
+gross inattention, or from that ignorance which necessarily results from
+defective education, is, in the eye of conscience, a crime both against
+GOD and man.
+
+It must frequently devolve on the Faculty to decide concerning the nature
+and effects of blows, strokes, or wounds inflicted, and how far the death
+of the sufferer is to be ascribed to them, or to some antecedent or
+subsequent disease. In homicide, also, _se defendendo_, the manner and
+time of the defence are to be considered; for, if the person assaulted
+fall upon the aggressor when the fray is over and he is running away,
+this is revenge, and not defence; and, though no witness were present,
+the situation of the wound or of the blow would afford, if in the back
+of the assailant, presumptive evidence of felonious homicide.
+
+§ 9. This crime, which in atrocity exceeds every other, is considered by
+the law under the three heads of _suicide_, _manslaughter_, and _murder_,
+concerning each of which the Faculty are occasionally obliged to give
+professional evidence. A _felo de se_ is one who has deliberately put
+an end to his existence, or committed any unlawful malicious act, the
+immediate consequence of which proved death to himself. To constitute
+this act a crime, the party must have been of years of discretion, and
+in the possession of reason. A Physician, therefore, may be called
+upon by the coroner to state his opinion of the mental capacity of the
+defunct. And the law will not authorize the plea, that every melancholic
+or hypochondriac fit deprives a man of the power of discerning right
+from wrong. Even if a lunatic kill himself in a lucid interval, Sir
+Matthew Hale affirms that he is a _felo de se_.—And the Physician who
+has attended him is best qualified to judge of the degree, the duration,
+or periodical seasons, of such returns of sanity. But there are cases
+of temporary distraction, when death may be rushed upon apparently with
+design, but really from the influence of terror, or the want of that
+presence of mind which is necessary to the exercise of judgement and the
+discrimination of actual from imaginary evil. Of this kind the reader
+will find an affecting instance related by Dr. Hunter in the “Medical
+Observations and Inquiries,” published by “a Society of Physicians in
+London[59].”
+
+§ 10. _Manslaughter_ is defined “the unlawful killing of another without
+malice either express or implied; which may be either voluntarily, upon
+a sudden heat; or involuntarily, but in the commission of some unlawful
+act.” Yet, though this definition is delivered from Sir Matthew Hale, by
+the excellent Commentator on the Laws of England so often quoted[60], it
+is not sufficiently precise and comprehensive. For, when a person does an
+act lawful in itself, but which proves fatal to a fellow-citizen, because
+done without due circumspection, it may, according to circumstances, be
+either misadventure, manslaughter, or murder. Thus, when a workman kills
+any one by flinging down a stone or piece of timber into the street, if
+the accident be in a country village, where there are few passengers, and
+if he give warning by calling out to them, it is only _misadventure_;
+but if it be in London, or any other populous town, where persons are
+continually passing, it is _manslaughter_, though warning be loudly
+given; and it is _murder_, if he know of their passing, and yet gives no
+warning; for this is malice against all mankind[61].
+
+On the like grounds we may reason concerning the cases of death
+occasioned by drugs designed to produce abortion. This purpose is not
+always unlawful; for the configuration of the pelvis in some females
+is such as to render the birth of a full-grown child impossible, or
+inevitably fatal. But even in such instances the guilt of manslaughter
+may be incurred by ignorance of the drastic quality of the medicine
+prescribed, or want of due caution in the dose administered; and, when
+no moral or salutary end is in view, the simple act itself, if fatal in
+the issue, falls under the denomination of murder[62]. “If a woman be
+quick with child, and, by a potion or otherwise, killeth it in her womb,
+this is a great misprision, yet no murder; but if the child be born
+alive, and dieth of the potion or other cause, this is murder[63].” The
+procuring of abortions was common amongst the Romans; and, it is said,
+was liable to no penalty before the reigns of Severus and Antoninus.
+Even those princes made it criminal only in the case of a married woman
+practising it to defraud her husband of the comforts of children, from
+motives of resentment; for, the foetus being regarded as a portion of
+the womb of the mother, she was supposed to have an equal and full right
+over both. This false opinion may have its influence in modern, as well
+as in ancient, times; and false it must be deemed, since no female can
+be privileged to injure her own bowels, much less the foetus, which is
+now well known to constitute no part of them. To extinguish the first
+spark of life is a crime of the same nature, both against our Maker and
+society, as to destroy an infant, a child, or a man; these regular and
+successive stages of existence being the ordinances of GOD, subject alone
+to His Divine will, and appointed by Sovereign Wisdom and Goodness as the
+exclusive means of preserving the race, and multiplying the enjoyments
+of mankind. Hence the Father of Physic, in the Oath enjoined on his
+pupils, (which some Universities now impose on the candidates for Medical
+degrees,) obliged them solemnly to abjure the practice of administering
+the πεσσὸς φθόριος[64]. But, in weighing the charge against any person
+of having procured abortion, the methods employed should be attentively
+considered by the Faculty; as this effect has often been ascribed to
+causes inadequate to its production. Even the pessary, so sanctimoniously
+forbidden by Hippocrates, has little of that activity and power which
+superstition assigned to it.
+
+§ 11. The law of England guards with assiduous care the lives of infants,
+when endangered by motives which counteract, and too often overbalance,
+the strong operation of maternal love. In cases of bastardy, therefore,
+it is declared, by a statute passed in the reign of James the First,
+that, “If any woman be delivered of any issue of her body, male or
+female, which, being born alive, should by the laws of this realm be
+a bastard, and she endeavour privately, either by drowning, or secret
+burying thereof, or any other way, either by herself, or the procuring of
+others, so to conceal the death thereof, as that it may not come to light
+whether it was born alive or not, but be concealed, she shall suffer
+death, as in case of murder, except she can prove, by one witness at
+least, that the child was born dead[65].” This law, though humane in its
+principle, is much too severe in its construction[66]. To give certainty
+to punishment, by facilitating conviction, is doubtless an essential
+object of jurisprudence; and it has been well observed, that the statute
+which made the possession of the implements of coining a capital offence,
+by constituting such possession complete evidence of guilt, has proved
+the most effectual mean of enforcing the denunciation of law against
+this dangerous and tempting crime[67]. But the analogy which the able
+moralist has drawn between this ordinance and that relating to bastardy,
+is not fully conclusive. For possession, in the former case, clearly
+implies a specific purpose, for which the legislature with sufficient
+wisdom and justice has provided a specific punishment. Whereas secrecy
+in the mother, concerning the death of her illegitimate offspring,
+hardly amounts to the lowest degree of presumptive evidence of felonious
+homicide. Gentlemen of the Faculty have often melancholy experience of
+the distraction and misery which females suffer under these unhappy
+circumstances; and, when it becomes their painful office to deliver
+evidence on such occasions, justice and humanity require that they should
+scrutinize the whole truth, and
+
+ “nothing extenuate,
+ Nor set down aught in malice[68].”
+
+“What is commonly understood to be the murder of a bastard child by the
+mother,” says Dr. Hunter, “if the real circumstances were fully known,
+would be allowed to be a very different crime in different circumstances.
+In some (it is to be hoped _rare_,) instances, it is a crime of the very
+deepest dye.... But, as well as I can judge, the greatest number of what
+are called murders of bastard children, are of a very different kind.
+The mother has an unconquerable sense of shame, and pants after the
+preservation of character: so far she is virtuous and amiable. She has
+not the resolution to meet and avow infamy. In proportion as she loses
+the hope either of having been mistaken with regard to pregnancy, or of
+being relieved from her terrors by a fortunate miscarriage, she every
+day sees her danger greater and nearer, and her mind more overwhelmed
+with terror and despair. In this situation many of these women, who are
+afterwards accused of murder, would destroy themselves, if they did not
+know that such an action would infallibly lead to an enquiry, which would
+proclaim what they are so anxious to conceal. In this perplexity, and
+meaning nothing less than the murder of the infant, they are meditating
+different schemes for concealing the birth of the child; but are wavering
+between difficulties on all sides, putting the evil hour off, and
+trusting too much to chance and fortune. In that state often they are
+overtaken sooner than they expected; their schemes are frustrated; their
+distress of body and mind deprives them of all judgement and rational
+conduct; they are delivered by themselves, wherever they happened to
+retire in their fright and confusion; sometimes dying in the agonies of
+child-birth, and sometimes being quite exhausted they faint away and
+become insensible of what is passing, and, when they recover a little
+strength, find that the child, whether still-born or not, is completely
+lifeless. In such a case, is it to be expected, when it could answer
+no purpose, that a woman should divulge the secret? Will not the best
+dispositions of mind urge her to preserve her character? She will
+therefore hide every appearance of what has happened as well as she
+can; though, if the discovery be made, that conduct will be set down as
+a proof of her guilt.... Here let us suppose a case, which every body
+will allow to be very possible. An unmarried woman, becoming pregnant,
+is striving to conceal her shame, and laying the best scheme that she
+can devise for saving her own life and that of the child, and at the
+same time concealing the secret; but her plan is at once disconcerted by
+her being unexpectedly and suddenly taken ill by herself, and delivered
+of a dead child. If the law punishes such a woman with death for not
+publishing her shame, does it not require more from human nature, than
+weak human nature can bear? In a case so circumstanced, surely the only
+crime is the having been pregnant, which the law does not mean to punish
+with death; and the attempt to conceal it by fair means should not be
+punishable by death, as that attempt seems to arise from a principle of
+virtuous shame[69].”
+
+The observations here quoted have a just claim to attention from the
+extensive experience which the author possessed, and still more from
+his intimate knowledge of the female character. Yet to the moral and
+political philosopher, Dr. Hunter may appear to have exalted the
+sense of shame into the principle of virtue; and to have mistaken the
+great end of penal law, which is not vengeance, but the prevention of
+crimes. The statute, indeed, which makes the concealment of the birth
+of a bastard child full proof of murder, confounds all distinctions of
+innocence and guilt; as such concealment, whenever practicable, would
+be the wish and act of all mothers, amiable or vicious, under the same
+unhappy predicament. Law, however, which is the guardian and bulwark
+of the public weal, must maintain a steady, and even rigid, watch,
+over the general tendencies of human actions: and, when these are not
+only clearly understood, but interpreted according to the rules of
+wisdom and rectitude, that may justly be constituted a civil crime,
+which, if permitted, might give occasion to atrocious guilt, though in
+its own nature innocent. The measure of punishment, however, should be
+proportionate, as nearly as possible, to the temptation to offend, and
+to the kind and degree of evil produced by the offence. If inadequate
+to the former, it will be nugatory; and if too severe for the latter,
+it will defeat itself, by furnishing a just plea for superseding its
+execution[70]. A revision of our sanguinary statutes is much wanted[71];
+and it would be happy if means could be devised of suppressing the
+punishment, by obviating the crime, when it is merely positive or
+municipal. This we have seen accomplished with respect to the coinage of
+money, by the simple introduction of a standard weight in the payment
+of gold. And a sagacious legislator might doubtless discover and adopt
+similar improvements in other branches of penal jurisprudence.
+
+Much observation is required to discriminate between a child still-born,
+and one that has lived after birth only a short space of time. Various
+appearances, also, both internal and external, may be mistaken for
+marks of violent death. Even the swimming of the lungs in water, a
+test on which so much reliance is placed, will, on many occasions, be
+found fallacious. But these are points of professional science, which
+do not strictly fall under the subject of this section; and the reader
+is particularly referred to the paper already quoted, and also to J.
+F. Faselii “Elementa Medicinae Forensis [Regim. 4to. 1787.];” or to a
+valuable epitome of the same work in English by Dr. Farr[72].
+
+§ 12. Duelling is another species of felony, even though the consequences
+of it should not prove fatal: and gentlemen of the Faculty are peculiarly
+interested in the knowledge of the laws relating to it; because they are
+not only liable to be summoned on the trial of the parties, if either or
+both of them be wounded, but are frequently professional attendants on
+them in the field of combat[73]. It is astonishing that a practice which
+originated in ages of Gothic ignorance, superstition, and barbarism,
+should be continued in the present enlightened period, though condemned
+by the ordinances of every state, and repugnant to the spirit and
+precepts of Christianity. Sir Francis Bacon, when Attorney-General,
+in the reign of James I., delivered a Charge before the Court of
+Star-Chamber touching duels, which gives a clear and animated view of the
+light in which they were then regarded. “The first motive,” he says, “is
+a false and erroneous imagination of honour and credit; and therefore
+the King, in his last proclamation, doth most aptly and excellently
+call them _bewitching duels_. For, if one judge of it truly, it is no
+better than a sorcery, that enchanteth the spirits of young men that bear
+great minds with a false shew, _species falsa_; and a kind of satanical
+illusion and apparition of honour against religion, against law, and
+against moral virtue.... Hereunto may be added, that men have almost lost
+the true notion and understanding of fortitude and valour. For fortitude
+distinguisheth of the grounds of quarrels whether they be just; and not
+only so, but whether they be worthy; and setteth a better price upon
+men’s lives than to bestow them idly. Nay, it is weakness and disesteem
+of a man’s self, to put a man’s life upon such liedger[74] performances;
+a man’s life is not to be trifled away; it is to be offered up and
+sacrificed to honourable services, public merits, good causes, and noble
+adventures. It is in expense of blood as it is in expense of money; it
+is no liberality to make a profusion of money upon every vain occasion;
+nor no more it is fortitude to make effusion of blood, except the cause
+be of worth[75].”
+
+The decree of the Star-Chamber against Priest and Wright, the objects of
+Sir Francis Bacon’s Charge, was, that they should both be committed to
+prison; that the former should be fined £500, and the latter 500 marks;
+and that at the next assizes they should publicly acknowledge their high
+contempt of, and offence against, GOD, the King’s majesty, and his laws,
+shewing themselves penitent for the same.—Though this judgement appears
+to have been founded in wisdom and equity, yet, happily for our country,
+the court which passed the sentence has been long suppressed; and we
+are now governed, not by arbitrary will, but by known and fixed laws.
+Those which subsist against duelling, I shall quote on the authorities
+of Foster, Blackstone, Hawkins and Burn. “Deliberate duelling, if death
+ensueth, is in the eye of the law murder; for duels are generally
+founded in deep revenge; and, though a person should be drawn into a
+duel, not upon a motive so criminal, but merely upon the punctilio of
+what the _swordsmen falsely call honour_, that will not excuse; for he
+that deliberately seeketh the blood of another upon a private quarrel,
+acteth in defiance of all laws human and divine, whatever his motive may
+be[76].” “Express malice is when one, with a sedate deliberate mind and
+formed design, doth kill another.... This takes in the case of deliberate
+duelling, where both parties meet avowedly with an intent to murder;
+thinking it their duty as gentlemen, and claiming it as their right, to
+wanton with their own lives and those of their fellow-creatures, without
+any warrant or authority from any power either divine or human, but in
+direct contradiction to the laws both of GOD and man. And therefore the
+law has justly fixed the crime and punishment of murder on them and on
+their seconds also[77].” “The law so far abhors all duelling in cold
+blood, that not only the principal who actually kills the other, but
+also his seconds, are guilty of murder, whether they fought or not: and
+it is holden, that the seconds of the party slain are likewise guilty
+as accessaries[78].”—From variations in the moral and intellectual
+character of man, it is impossible to ascertain the precise period when
+the passions may be supposed to become cool, after having been violently
+agitated. Judgement, therefore, must be founded on the circumstances of
+deliberation which are delivered in the course of evidence. In many cases
+it has been determined that death, in consequence of an appointment and
+meeting a few hours subsequent to the provocation, is murder[79].
+
+§ 13. Before a Surgeon engage professionally to attend a duellist to the
+field of combat, it behoves him to consider well, not only how far he is
+about to countenance a deliberate violation of the duties of morality and
+religion; but whether, in the construction of law, he may not be deemed
+an aider and abettor of a crime which involves in it such turpitude that
+death is alike denounced against the principal and the accessary. Does
+he not voluntarily put himself into a predicament, similar, in many
+essential points, to that of the second, who is expressly condemned by
+the legislature of this country? Both are apprized of the purpose to
+commit an act of felony; both take an interest in the circumstances
+attendant upon it; and both are present during the execution, the one to
+regulate its antecedents, the other to alleviate its consequences. But I
+suggest these considerations with much diffidence: and, though I observe
+some passages in Sir Michael Foster’s “Discourse concerning Accomplices,”
+which seem to confirm them, yet it may be proper to quote the following,
+apparently adverse, opinion of this excellent judge. “In order to render
+a person an accomplice and a principal in felony, he must be aiding and
+abetting at the fact, or ready to afford assistance, if necessary: and
+therefore if _A._ happeneth to be present at a murder, for instance, and
+taketh no part in it, nor endeavoureth to prevent it, nor apprehendeth
+the murderer, nor levieth hue and cry after him; this strange behaviour
+of his, though highly criminal, will not of itself render him either
+principal or accessary[80].”
+
+But, whatever be the objections against the attendance of a Surgeon in
+the field of combat, they cannot be construed to extend to the affording
+of all possible assistance to any unfortunate sufferer in an affair of
+honour; provided such assistance be not preconcerted, but required as
+in ordinary accidents or emergencies. For in the offices of the healing
+art no discrimination can be made either of occasions or of characters;
+and it must be acknowledged, that many of the victims of duelling have
+been men, from their talents and virtues, possessing the justest claim
+to assiduous and tender attention. That lives of such inestimable value
+to their friends, to their families, and to the public, should be at
+the mercy of any profligate rake who wantonly gives affronts or idly
+fancies he receives them, is a great aggravation of the folly, as well as
+of the guilt, of duelling. This reflection seems to shew the propriety
+of a change in the penal code respecting it; and that the punishment
+inflicted should be confined to the aggressor; strict inquisition into
+the circumstances of the case being previously made by the coroner, or
+some magistrate authorized and bound to exercise this important trust.
+And _he_ may with reason be regarded as the aggressor, who either
+violates the rules of decorum by any unprovoked rudeness or insult,
+or who converts into an offence what was intended only as convivial
+pleasantry[81].
+
+§ 14. A Physician has no special interest in an acquaintance with
+the statutes relative to duelling; but, as he possesses the rank of
+a gentleman, both by his liberal education and profession, the law
+of honour (if that may be termed a _law_, which is indefinite and
+arbitrary,) has a claim to his serious study and attention. As a
+philosopher also it becomes him to trace its origin, and to investigate
+the principles on which it is founded; and as a moralist duty calls
+upon him to counteract its baneful influence and ascendancy: for in
+principle it is distinct from virtue; and as a practical rule it extends
+only to certain formalities and decorums, of little importance in the
+transactions of life, and which are spontaneously observed by those who
+are actuated with the true sense of propriety and rectitude. Genuine
+honour in its full extent may be defined, a quick perception and strong
+feeling of moral obligation, in conjunction with an acute sensibility to
+shame, reproach, or infamy. In different characters these constituent
+parts of the principle are found to exist in proportions so diversified,
+as sometimes to appear almost single and detached. The former always
+“aids and strengthens virtue:” the latter may occasionally “imitate
+her actions[82],” when fashion happily countenances, or high example
+prompts to, rectitude; but, being connected for the most part with a
+jealous pride and capricious irritability, it will be more shocked with
+the imputation, than with the commission, of what is wrong; and thus it
+will constitute that spurious honour, which, by a perversion of the laws
+of association, “puts evil for good and good for evil,” and, under the
+sanction of a name, perpetrates crimes without remorse and even without
+ignominy[83].
+
+§ 15. Homicide by poison is another very important object of medical
+jurisprudence. When it is the effect of inadvertency, or the want of
+adequate caution in the use of substances dangerous to health and life,
+the law regards it as a _misdemeanour_; when it is the consequence
+of rashness, of wanton experiment, or of motives unjust though not
+malicious[84], it becomes _manslaughter_; and when the express purpose
+is to kill by means of some deleterious drug, it constitutes a most
+atrocious species of _murder_. In cases of this nature the Faculty are
+called upon to give evidence concerning the nature of the poison, the
+symptoms produced by it, and the actual fatality of its operation. I
+know not whether the period of this fatal operation be extended, as in
+the infliction of blows and wounds, to a year and a day; but, if it be,
+the most nice and accurate investigation of the progressive advances
+of disease and death will be incumbent on the Physician or Surgeon
+who is consulted on the occasion. No subject has given rise to more
+misconception and superstition than the action of poisons. Numberless
+substances have been classed as such, which, if not inert, are at least
+innoxious; and powers have been ascribed to others, far exceeding their
+real energy. Even Lord Verulam, the great luminary of science, in his
+Charge against the Earl of Somerset for the murder of Sir Thomas Overbury
+in the tower of London, seems to give credit to the story of Livia, who
+is said to have poisoned the figs upon the tree, which her husband was
+wont to gather with his own hands; and he seriously states, that Weston
+chased the poor prisoner “with poison after poison; poison in salts,
+poison in meats, poison in sweet-meats, poison in medicines and vomits,
+until at last his body was almost come, by use of poisons, to the state
+that Mithridates’s[85] body was by the use of treacle and preservatives,
+that the force of the poisons was blunted upon him: Weston confessing,
+when he was chid for not dispatching him, that he had given him enough to
+poison twenty men[86].” In this criminal transaction the truth probably
+was (what has been judiciously suggested by Rapin,) that the lieutenant
+of the Tower, refusing to be concerned in the crime, yet not daring to
+discover it from the fear of the Viscount Rochester’s resentment, seized
+the victuals sent from time to time for the prisoner, and threw them
+into the house of office. Sir Thomas Overbury, however, fell a victim at
+last to an empoisoned glyster.
+
+When the particular drug, or other mean employed, can be accurately
+ascertained, its deleterious qualities should be fully investigated; and
+these should be cautiously compared with the effects ascribed to it in
+the case under consideration. It may often be expedient also to examine
+the body of the sufferer by dissection; and this should be accomplished
+as expeditiously as possible, that the changes imputed to death may
+not be confounded with those which are imputed to poison. But on such
+points reference can alone be made to the knowledge and experience of
+the practitioner, and to the lights which he may acquire by consulting
+Faselius and other works of a similar nature. I shall, therefore, close
+this article with a few passages of the charge of Mr. Justice Buller to
+the grand jury, relative to the trial of Captain Donellan, for the murder
+of Sir Theodosius Boughton, at the Warwick assizes, in March 1781. “In
+this case, gentlemen,” he says, “you will have two objects to consider,
+first, whether the deceased did die of _poison_? secondly, whether the
+person suspected did assist in _administering_ the poison? With respect
+to the first of these considerations, you will, no doubt, hear the
+sentiments of those who are skilled in the nature and effects of poison,
+which is of various sorts, and most subtile in its operation. From the
+information of such persons you will be able to form an opinion upon
+the effects which different poisons have on different persons; and also
+of the effects the same poisons have on persons of different habits and
+constitutions.... If you find he did get his death by poison, the next
+case is, to consider who gave him that poison. Where poison is knowingly
+given, and death ensues, it is wilful murder; and if one is present when
+poison is given by another, he is not an accessary but a principal[87].”
+
+§ 16. In all civilized countries the honour and chastity of the female
+sex are guarded from violence by the severest sanctions of law: and this
+protection is at once humane, just, and necessary to social morality.
+It is consonant to humanity that weakness should be secured against
+the attacks of brutal strength; it is just that the most sacred of all
+personal property should be preserved from invasion; and it is essential
+to morality that licentious passion should be restrained, that modesty
+should not be wounded, nor the mind contaminated, in some instances,
+before it is capable of forming adequate conceptions of right and
+wrong. The crime of rape, therefore, subjects the perpetrator to condign
+punishment by every code of jurisprudence, ancient or modern[88]. Amongst
+the Jews death was inflicted, if the damsel was betrothed to another
+man; and, if not betrothed, a fine amounting to fifty shekels of silver
+was to be paid to her father by him who had “laid hold of the virgin,”
+and she was to become his wife; and, “because he had humbled her, he
+might not put her away all his days[89]:”—for the privilege of divorce
+was authorized by the Jewish institutions. The Romans made this offence
+capital, superadding the confiscation of goods. Even the carrying off a
+woman from her parents or guardians, and cohabiting with her, whether
+accomplished by force or with her full consent, were made equally penal
+with a rape, by an imperial edict. For the Roman law seems to have
+supposed, that women never deviate from virtue without being seduced
+by the arts of the other sex; and, therefore, by imposing a powerful
+restraint on the solicitations of men, they aimed at a more effectual
+security of the chastity of women. “Nisi etenim eam solicitaverit,
+nisi odiosis artibus circumvenerit, non faciet eam velle in tantum
+dedecus sese prodere.” But the English law, as Judge Blackstone has
+observed[90], does not entertain such sublime ideas of the honour of
+either sex, as to lay the blame of a mutual fault on one only of the
+transgressors; and it is therefore essential to the crime of rape, that
+the woman’s will is violated by the execution. But, by a statute of Queen
+Elizabeth, if the crime be perpetrated on a female child under the age of
+ten years, the consent or non-consent is immaterial, as she is supposed
+to be of insufficient judgement. Sir Matthew Hale is even of opinion,
+that such profligacy committed on an infant under _twelve_ years, (the
+age of female discretion by common law,) either with or without consent,
+amounts to a rape and felony[91]. But the decisions of the courts have
+generally been founded on the statute abovementioned.
+
+A male infant under the age of fourteen years is deemed by the law
+incapable of committing, and therefore cannot be found guilty of, a rape,
+from a presumed imbecility both of body and mind. This detestable crime
+being executed in secrecy, and the knowledge of it being confined to the
+party injured, it is just that her single testimony should be adducible
+in proof of the fact. Yet the excellent observation of Sir Matthew Hale
+merits peculiar attention: “It is an accusation,” says he[92], “easily
+to be made, and hard to be proved; and harder to be defended by the party
+accused, though never so innocent.” He then relates two extraordinary
+cases of malicious prosecution for this crime, which had fallen under
+his own cognizance; and concludes, “I only mention these instances,
+that we may be the more cautious upon trials of offences of this
+nature, wherein the court and jury may, with so much ease, be imposed
+upon, without great care and vigilance; the heinousness of the offence
+many times transporting the judge and jury with so much indignation,
+that they are over-hastily carried to the conviction of the person
+accused thereof, by the confident testimony sometimes of malicious and
+false witnesses.” Collateral and concurrent circumstances of time and
+place[93], appearances of violence on examination, &c., are, therefore,
+necessary to be added to the mere affirmative evidence of the prosecutor;
+and the inspection of a Surgeon is often required, to ascertain the
+reality of the alleged violence. On such occasions his testimony should
+be given with all possible delicacy, as well as with the utmost caution.
+Even external signs of injury may originate from disease, of which the
+following examples, which have occurred in Manchester, are adduced on
+very respectable authorities.
+
+A girl about four years of age was admitted into the Manchester Infirmary
+on account of a mortification in the female organs, attended with great
+soreness, and general depression of strength. She had been in bed with a
+boy fourteen years old, and there was reason to suspect that he had taken
+criminal liberties with her. The mortification increased, and the child
+died. The boy, therefore, was apprehended, and tried at the Lancaster
+assizes; but was acquitted on sufficient evidence that several instances
+of a similar disease had appeared, near the same period of time, in
+which there was no possibility of injury or guilt. In one of these cases
+the body was opened after death. The disorder had been a typhus fever,
+accompanied with a mortification of the pudenda. There was no evident
+cause of this extraordinary symptom discoverable on inspection. The
+lumbar glands were of a dark colour; but all the viscera were sound.
+
+§ 17. Concerning nuisances, the investigation and testimony of the
+Faculty may be required, whenever they are of a nature offensive by the
+vapours which they emit, and injurious to the health of individuals
+or of the community. The law defines any thing that worketh hurt,
+inconvenience, or damage, to be a nuisance[94]. Thus, if a person
+keep hogs or other noisome animals so near the house of another that
+the stench incommodes him and renders the air unwholesome, this is a
+nuisance, because it deprives him of the enjoyments and benefits of his
+habitation. A smelting house for lead, the smoke of which kills the grass
+and corn, and injures the cattle of a neighbouring proprietor of land,
+is deemed a nuisance. Dye-houses, tanning-yards, &c., are nuisances,
+if erected so near a water-course as to corrupt the stream. But a
+chandler’s factory, even when situated in a crowded town, is said to be
+privileged from action or indictment, because candles are regarded as
+necessaries of life. Hawkins, however, questions the authority of this
+opinion, since the making of candles may be carried on in the country
+without annoyance[95]. But this is scarcely practicable in a populous
+neighbourhood; and, as Lord Mansfield has adjudged, that, in such cases,
+what makes the enjoyment of being and property uncomfortable, is, in the
+view of the law[96], a nuisance, various works and trades, essential
+to the happiness and interest of the community, may fall under this
+construction. But chemistry, mechanics, and other arts and sciences,
+furnish methods of diminishing or obviating almost every species of
+noisome vapour; and there can be no doubt that vitriol works, aqua-fortis
+works, marine acid-bleaching works, the singeing of velvets, &c., may be
+carried on with very little inconvenience to a neighbourhood, by means
+neither difficult nor expensive. The same observation may be applied to
+the business of the dyer, the fell-monger, the tanner, the butcher, and
+the chandler; and, as these with many other disgustful trades are in some
+degree necessary in large towns, justice and policy require that they
+should only be prosecuted as nuisances, when not conducted in the least
+offensive mode possible. To guard against arbitrary powers in municipal
+government, and to render the decision and investigation of such points
+perfectly consistent with the liberty of the subject, the reference
+should be made to a jury; or at least, any individual should be allowed
+an appeal to one, if he think himself aggrieved.
+
+The frequency of fires in large manufacturing towns makes it expedient
+that magistrates or commissioners should be authorized to scrutinize
+rigidly into the causes of them when they occur, to punish neglect or
+carelessness, as well as malicious intention, and to enforce suitable
+measures of prevention. The plans proposed for this last very important
+purpose by Mr. Hartley and Lord Stanhope have been proved to be
+effectual, and are not expensive[97]. The adoption of them, therefore,
+or of other means which may hereafter be discovered, should be required,
+under a heavy penalty, in cases deemed by insurers _doubly hazardous_.
+
+§ 18. It is a complaint made by coroners, magistrates, and judges, that
+Medical gentlemen are often reluctant in the performance of the offices
+required from them as citizens qualified by professional knowledge to aid
+the execution of public justice. These offices, it must be confessed, are
+generally painful, always inconvenient, and occasion an interruption to
+business, of a nature not to be easily appreciated or compensated; but,
+as they admit of no substitution, they are to be regarded as appropriate
+debts to the community, which neither equity nor patriotism will allow to
+be cancelled[98].
+
+When a Physician or Surgeon is called to give evidence, he should avoid,
+as much as possible, all obscure and technical terms, and the unnecessary
+display of Medical erudition. He should deliver, also, what he advances,
+in the purest and most delicate language consistent with the nature of
+the subject in question.—When two or more gentlemen of the Faculty are
+to offer their opinions or testimony, it would sometimes tend to obviate
+contrariety, if they were to confer freely with each other, before
+their public examination. Intelligent and honest men, fully acquainted
+with their respective means of information, are much less likely to
+differ, than when no communication has previously taken place. Several
+years ago a trial of considerable consequence occurred relative to a
+large copper work; and two Physicians of eminence were summoned to the
+assizes, to bear testimony concerning the salubrity or insalubrity of the
+smoke issuing from the furnaces. The evidence they offered was entirely
+contradictory. One grounded his testimony on the general presumption
+that the ores of copper contain arsenic; and consequently that the
+effluvia proceeding from the roasting of them, must be poisonous because
+arsenical. The other had made actual experiments on the ore employed
+in the works under prosecution, and on the vapours which it yielded:
+he was thus furnished with full proof that no arsenic was discoverable
+in either. But the affirmative prevailed over the negative testimony,
+from the authority of the Physician who delivered it; an authority
+which he probably would not have misapplied, if he had been antecedently
+acquainted with the decisive trials made by his opponent.
+
+§ 19. It is the injunction of the law, sanctioned by the solemnity of
+an oath, that in judicial testimony “the truth, the whole truth, and
+nothing but the truth” shall be delivered. A witness, therefore, is
+under a sacred obligation to use his best endeavours that his mind be
+clear and collected, unawed by fear, and uninfluenced by favour or
+enmity. But in criminal prosecutions, which affect the life of the person
+accused, scruples will be apt to arise in one, who, by the advantages
+of a liberal education, has been accustomed to serious reflection, yet
+has paid no particular attention to the principles of political ethics.
+It is incumbent, therefore, on gentlemen of the Faculty to settle their
+opinions concerning the right of the civil magistrate to inflict capital
+punishment, the moral and social ends of such punishment, the limits
+prescribed to the exercise of the right, and the duty of a citizen to
+give full efficiency to the laws.
+
+The magistrate’s _right_ to inflict punishment, and the _ends_ of
+such punishment, though intimately connected, are in their nature
+distinct. The _right_ is clearly a substitution or transfer of that
+which belongs to every individual by the law of nature, viz. instant
+self-defence, and security from future violence or wrong. The _ends_
+are more comprehensive, extending not only to complete security against
+offence, but to the correction and improvement of the offender himself,
+and to counteract in others the disposition to offend. Penal laws are
+to be regulated by this standard; and the lenity or severity with which
+they are executed, should, if possible, be exactly proportionate to it.
+In different circumstances, either personal or public considerations
+may preponderate; and in cases of great moral atrocity, or when the
+common weal is essentially injured, all regard to the reformation of a
+criminal is superseded, and his life is justly forfeited to the good of
+society. In the participation of the benefits of the social union, he has
+virtually acceded to its conditions; and the violation of its fundamental
+articles renders him a rebel and an enemy, to be expelled or destroyed,
+both for the sake of security, and as an awful warning to others. When
+capital punishments are viewed in this light, the most humane and
+scrupulous witness may consider himself as sacrificing private emotions
+to public justice and social order; and that he is performing an act at
+once beneficial to his country and to mankind. For political and moral
+economy can subsist in no community, without the steady execution of wise
+and salutary laws; and every atrocious act, perpetrated with impunity,
+operates as a terror to the innocent, a snare to the unwary, and an
+incentive to the flagitious. The criminal, also, who evades the sentence
+of justice, like one infected with the pestilence, contaminates all whom
+he approaches. He, therefore, who, from false tenderness or misguided
+conscience, has prevented conviction by withholding the necessary
+proofs[99], is an accessary to all the evils which ensue. The maxim, that
+“it is better ten villains should be discharged than a single person
+suffer by a wrong adjudication,” is one of those partial truths which are
+generally misapplied, because not accurately understood. It is certainly
+eligible that the rules and the forms of law should be so precise and
+immutable, as not to involve the innocent in any decision obtained by
+corruption, or dictated by passion and prejudice; though this should
+sometimes furnish an outlet for the escape of actual offenders. The plea,
+also, may have some validity in crimes of a nature chiefly political,
+(with which, however, the Faculty can professionally have no concern,)
+such as coining and forgery, or in cases wherein the punishment much
+exceeds the evil or turpitude of the offence. For Lord Bacon has well
+observed, that “over-great penalties, besides their acerbity, deaden the
+execution of the law[100];” and, when they are discovered to be unjustly
+inflicted, its authority is impaired, its sanctity dishonoured, and
+veneration gives place to disgust and abhorrence.
+
+But the dread of innocent blood being brought upon us by explicit and
+honest testimony, is one of those superstitions, which the nurse has
+taught, and which a liberal education ought to purge from the mind: and
+if, in the performance of our duty, innocence should unfortunately be
+involved in the punishment of guilt, we shall assuredly stand acquitted
+before GOD and our own consciences. The convict himself, lamentable as
+his fate must be regarded, may derive consolation from the reflection,
+that, though his sentence be unjust, “he falls for his country, whilst
+he suffers under the operation of those rules, by the general effect
+and tendency of which the welfare of the community is maintained and
+upholden[101].”
+
+§ 20. When professional testimony is required in cases of such peculiar
+malignity as to excite general horror and indignation, a virtuous mind,
+even though scrupulous and timid, is liable to be influenced by too
+violent impressions, and to transfer to the accused that dread and
+aversion, which, before conviction, should be confined to the crime,
+and as much as possible withheld from the supposed offender. If the
+charge, for instance, be that of parricide, accomplished by poison,
+and accompanied with deliberate malice, ingratitude, and cruelty; the
+investigation should be made with calm and unbiassed precision, and
+the testimony delivered with no colouring of passion, nor with any
+deviation from the simplicity of truth. When circumstantial proofs are
+adduced, they should be arranged in the most lucid order, that they may
+be contrasted and compared in all their various relations with facility
+and accuracy; and that their weight may be separately and collectively
+determined in the balance of justice. For in such evidence there
+subsists a regular gradation from the slightest presumption to complete
+moral certainty; and, if the witness possess sufficient information in
+this branch of philosophical and juridical science, he will always be
+competent to secure himself, and, on many occasions, the court also, from
+fallacy and error. The Marquis de Beccaria has laid down the following
+excellent theorem concerning judicial evidence:—“When the proofs of a
+crime are dependent on each other, (that is, when the evidence of each
+witness, taken separately, proves nothing,) or when all the proofs are
+dependent upon one, the number of proofs neither increases nor diminishes
+the probability of the fact; for the force of the whole is no greater
+than the force of that on which they depend; and, if this fails, they all
+fall to the ground. When the proofs are independent of each other, the
+probability of the fact increases in proportion to the number of proofs;
+for the falsehood of one does not diminish the veracity of another....
+The proofs of a crime may be divided into two classes, perfect and
+imperfect. I call those _perfect_, which exclude the possibility of
+innocence; _imperfect_, those which do not exclude this possibility. Of
+the first, one only is sufficient for condemnation; of the second, as
+many are required as form a perfect proof; that is to say, that, though
+each of these, separately taken, does not exclude the possibility of
+innocence, it is nevertheless excluded by their union[102].”
+
+
+FOOTNOTES:
+
+[38] [In this chapter there are numerous statements on different points
+of law, which after the lapse of nearly half a century are no longer
+accurate: these, where material, the Editor has endeavoured to correct,
+chiefly by the assistance of Edward Herford Esq., Coroner of Manchester.]
+
+[39] [See Willcock’s _Laws relating to the Medical Profession_.]
+
+[40] Introd. § 1. vol. i. p. 13.
+
+[41] [See Notes and Illustrations, No. X.]
+
+[42] [This is no longer the case; as, by 3 & 4 Will. IV. c. 104, freehold
+and copyhold estates in all cases are made assets for the payment of
+simple contract as well as specialty debts.]
+
+[43] _Moral and Political Philosophy_, bk. iii. pt. i. ch. 23.
+
+[44] “In the construction of the statute 29 Car. II. c. 3. it has been
+adjudged that the testator’s name, written with his own hand, at the
+beginning of the will, as, ‘I, John Mills, do make this my last will and
+testament,’ is a sufficient signing, without any name at the bottom;
+though the other is the safer way.” See Blackstone’s _Comment._, bk. ii.
+ch. 23. vol. ii. p. 376. [This is no longer law.]
+
+[45] [Nuncupative wills are now abolished, except in the case of sailors
+and soldiers in actual service.]
+
+[46] See Blackstone’s _Comment._, bk. ii. ch. 32. vol. ii. p. 501.
+
+[47] [_Midsummer Night’s Dream_, act v. sc. 1.]
+
+[48] See the Author’s _Moral and Literary Dissertations_, p. 127 (or
+_Works_, vol. ii. p. 82); also Notes and Illustrations, No. XI.
+
+[49] Blackstone’s _Comment._, bk. i. ch. 8. vol. i. p. 304.
+
+[50] Hawkins, _Pleas of the Crown_, bk. i. ch. 60. § 23; Burn’s
+_Justice_, vol. iii. p. 1288. (ed. 1845.)
+
+[51] Ch. ii. § 30.
+
+[52] [If Dr. Percival could say this in 1793, much more may _we_
+thankfully repeat the statement in 1849.]
+
+[53] [See Notes and Illustrations, No. XII.]
+
+[54] See _Statutes at Large_, vol. viii. 14 Geo. III. c. 49. § 31; [also
+9 Geo. IV. c. 40; 3 & 4 Will. IV. c. 36 & 64; 1 & 2 Vict. c. 14 & 64; 3 &
+4 Vict. c. 54; 5 & 6 Vict. c. 87, and 7 & 8 Vict. c. 101. s. 27.]
+
+[55] _Treatises of Government_, bk. ii. ch. 3. (_Works_, vol. iv. p. 347.)
+
+[56] Blackstone’s _Comment._, bk. iv. ch. 14. vol. iv. p. 181. [This
+test, however, by the relaxation of the criminal law with respect to
+rape, burglary, and some other crimes, is no longer applicable.]
+
+[57] [See Willcock’s _Laws relating to the Medical Profession_, p. 91.]
+
+[58] [See Groenevelt’s _Tutus Cantharidum in Medicina Usus Internus_,
+præf.]
+
+[59] Vol. vi. p. 279.
+
+[60] [Blackstone’s _Comment._, bk. iv. ch. 14. vol. iv. p. 190.]
+
+[61] Blackstone’s _Comment._, bk. iv. ch. 14. vol. iv. p. 191.
+
+[62] See Burn’s _Justice_, vol. iii. p. 810. [By 7 Will. IV. and 1 Vict.
+c. 85. the unlawfully administering any poison or other noxious thing,
+or using any instrument or other means to procure miscarriage, is made
+felony, punishable with transportation for life.]
+
+[63] _Ibid._, vol. i. p. 10. (ed. 1845.)
+
+[64] [Οὐδὲ γυναικὶ πεσσὸν φθόριον δώσω. Hippocr. _Jusjur._, tom. i. p. 2.
+ed. Kühn.]
+
+[65] Burn’s _Justice_, vol. i. p. 613. (ed. 1845.)
+
+[66] [It has long been repealed; and the endeavour to conceal the birth
+of a child is now a misdemeanour punishable with imprisonment.]
+
+[67] See Paley’s _Moral and Political Philosophy_, bk. vi. ch. 9.
+
+[68] [Shakespear’s _Othello_, act v. sc. 2.]
+
+[69] _Medical Observations and Inquiries_, vol. vi. pp. 271, 286.
+
+[70] “L’atrocité des lois en empêche l’exécution.—Lorsque la peine
+est sans mesure, on est souvent obligé de lui préférer l’impunité.”
+(Montesquieu.)
+
+[71] [This has taken place, and the punishment of death is now inflicted
+in comparatively few cases.]
+
+[72] “Elements of Medical Jurisprudence, &c. &c. by Samuel Farr, M.D.”
+3rd. ed. 12mo. Lond. 1815. [Or the more modern works of Beck, Christison,
+Taylor, &c.]
+
+[73] [See Notes and Illustrations, No. XIII.]
+
+[74] Liedger, i. e. _slight_, _trifling_, from the French _leger_.
+
+[75] Bacon’s _Works_, vol. iv. p. 401.
+
+[76] Sir Michael Foster’s _Discourse of Homicide_, ch. 5. § 5. (in his
+_Crown Law_, 8vo. p. 297.)
+
+[77] Blackstone’s _Comment._, bk. iv. ch. 14. vol. iv. p. 198.
+
+[78] Hawkins, _Pleas of the Crown_, bk. i ch. 31. § 31; and Burn’s
+_Justice_, vol. iii. p. 812. ed. 1845.
+
+[79] See Legg’s case, in Kelyng’s _Reports_, p. 27; Eden’s _Principles of
+Penal Law_, chap. 20. p. 224.
+
+[80] Foster’s _Crown Law_, 8vo. p. 350.
+
+[81] See Notes and Illustrations, No. XIV.
+
+[82] Addison’s _Cato_, act ii. sc. 5.
+
+[83] See the Author’s _Moral and Literary Dissertations_, p. 295. (or
+_Works_, vol. ii. p. 203.)
+
+[84] “If an action unlawful itself be done deliberately, and with
+intention of mischief or great bodily harm to particulars, or of mischief
+indiscriminately, fall it where it may, and death ensue against or beside
+the original intention of the party, it will be murder. But if such
+mischievous intention doth not appear, (which is matter of fact and to
+be collected from circumstances,) and the act was done heedlessly and
+incautiously, it will be manslaughter, not accidental death, because the
+act upon which death ensued was unlawful.” (Foster’s _Crown Law_, p. 261.)
+
+[85] [See Galen, _De Antid._ i. 1; _De Ther. ad Pis._ c. 16. tom. xiv.
+pp. 3, 283.]
+
+[86] Bacon’s _Works_, vol. iv. p. 481.
+
+[87] _Hist. Sketches of Civil Liberty_, p. 209.
+
+[88] See Notes and Illustrations, No. XV.
+
+[89] Deut. xxii. 25, 28, 29.
+
+[90] [_Comment._, bk. iv. ch. 15. vol. iv. p. 210.]
+
+[91] [It is now created a misdemeanour by statute.]
+
+[92] [_Hist. Placit. Coronae_, Pt. i. ch. 58. vol. i. p. 635.]
+
+[93] These circumstances are particularly adverted to in the Mosaic Law.
+See Deut. xxii. 25-27.
+
+[94] See Blackstone’s _Comment._, bk. iii. ch. 13. vol. iii. p. 216 &c.;
+and bk. iv. ch. 13. vol. iv. p. 161 (?)
+
+[95] Hawkins, _Pleas of the Crown_, bk. i. ch. 75. § 10; Burn’s
+_Justice_, vol. iii. p. 233 ed. 1845.
+
+[96] Burrow’s _Reports_, p. 333; Burn, _ibid._
+
+[97] [Mr. Hartley’s plan the Editor has not been able to find; that of
+Lord Mahon (afterwards Earl Stanhope,) is contained in the _Philos.
+Trans._ for 1778, p. 884. The titles of more recent works on the same
+subject may be seen in Watt’s _Bibl. Brit._]
+
+[98] [See Notes and Illustrations, No. XVI.]
+
+[99] “The oath administered to the witness is, not only that what
+he deposes shall be true, but that he shall also depose the _whole_
+truth; so that he is not to conceal any part of what he knows, whether
+interrogated particularly to that point or not.” Blackstone’s _Comment._,
+bk. iii. ch. 23. vol. iii. p. 372.
+
+[100] See _Proposal for Amending the Laws of England_. (_Works_, vol. iv.
+p. 367.)
+
+[101] Paley’s _Moral and Political Philosophy_, bk. vi. ch. 9.
+
+[102] _Essay on Crimes and Punishments_, chap. 14.
+
+
+
+
+NOTES AND ILLUSTRATIONS.
+
+
+NOTE I. Chap. i. § 31. p. 45.
+
+_Caution or temerity in practice._
+
+It is the observation of an elegant writer on the subject of morals, and
+applicable to Medical practice, that “The best character is that which
+is not swayed by temper of any kind; but alternately employs enterprise
+and caution, as each is useful to the particular purpose intended. Such
+is the excellence which St. Evremond ascribes to Mareschal Turenne,
+who displayed every campaign, as he grew older, more temerity in his
+military enterprises; and being now, from long experience, perfectly
+acquainted with every incident in war, he advanced with greater firmness
+and security, in a road so well known to him[103].” Yet it is said of
+the great Duke of Marlborough, that ten years of such uninterrupted and
+splendid success as no other general could boast of, never betrayed him
+into a single rash action[104].
+
+That boldness in Medical practice is more frequently the antecedent than
+the consequence of experience, is a melancholy truth; for it is generally
+founded either on theoretical dogmas, or on pride which disclaims
+authority. To the consideration of Physicians who are thus prematurely
+confident in their own powers, the remark of Lord Verulam[105] may be
+recommended: “This is well to be weighed, that boldness is ever blind;
+for it seeth not dangers and inconveniences: therefore it is ill in
+counsel, good in execution: so that the right use of bold persons is,
+that they never command in chief, but he seconds, and under the direction
+of others. For in counsel it is good to see dangers, and in execution not
+to see them, except they be very great.”
+
+
+NOTE II. Chap. ii. § 2. p. 48.
+
+_Temperance of Physicians._
+
+“Though much has been said, and with some truth, of the good effects
+of wine in producing rapidity and vivacity of thought, it has scarce
+ever been pretended that it favoured the exercise of discrimination
+and judgement. The only persons in whom it has ever been supposed not
+to have the very opposite effects, are some gentlemen of the Faculty.
+The ignorant vulgar would think _a priori_, that, _caeteris paribus_,
+a Physician who was sober, would attend more accurately to the case of
+his patient, and compare and distinguish all circumstances better, and
+judge more soundly, and prescribe more rationally, than he could do
+when he was drunk. But some Physicians, who should be supposed to know
+themselves best, and who certainly must have known how they acquitted
+themselves in those different situations, have boasted that they
+prescribed as well drunk as sober. In this they could not be mistaken;
+for, whether we consider the matter physically or logically, their boast
+amounts precisely to this, that they prescribed no better when they were
+sober than they did when they were drunk; which is undoubtedly a noble
+accomplishment, but it is not surely either wonderful or rare[106].”
+
+Tacitus, in his admirable treatise “De Situ, Moribus et Populis
+Germaniae,” has stated, that those nations “de reconciliandis invicem
+inimicis, et jungendis affinitatibus, et adsciscendis principibus, de
+pace denique ac bello, plerumque in conviviis consultant: tamquam nullo
+magis tempore aut ad simplices cogitationes pateat animus, aut ad magnas
+incalescat. Gens non astuta nec callida, aperit adhuc secreta pectoris
+licentia loci. Ergo detecta et nuda omnium mens postera die retractatur;
+et salva utriusque temporis ratio est. Deliberant dum fingere nesciunt:
+constituunt dum errare non possunt[107].” (c. 22.)
+
+In deliberation it may on some peculiar occasions be of importance
+to break off all former strong associations. A fit of drunkenness
+accomplishes this fully: sleep has the same tendency, and hence the
+proverb, “I will sleep upon it.” But such deliberation bears no analogy
+to what is required from a Physician, when he is to consider the case of
+a patient.
+
+“Universal temperance,” says Mr. Gisborne[108], “both in eating and
+drinking, is particularly incumbent on a Physician in every period of
+his practice, not merely as being essentially requisite to preserve
+his faculties in that alert and unclouded state which may render him
+equally able at all times to pronounce on the cases which he is called
+to inspect; but because it is a virtue which he will very frequently
+find himself obliged to inculcate on his patients, and will inculcate on
+them with little efficacy, if it be not regularly exemplified in his own
+conduct.”
+
+
+NOTE III. Chap. ii. § 3. p. 49.
+
+_“A Physician should be the minister of hope and comfort to the sick.”_
+
+Mr. Gisborne, in one of his interesting letters to me on the subject of
+Medical Ethics, suggests, that it would be advisable to add, _as far
+as truth and sincerity will admit_. “I know very well,” says he, “that
+the sentence, as it now stands, conveys to you, and was meant by you to
+convey to others, the same sentiment which it would express after the
+proposed addition. But, if I am not mistaken in my idea that there are
+few professional temptations to which Medical men are more liable (and
+frequently from the very best principles,) than that of unintentionally
+using language to the patient and his friends more encouraging than
+sincerity would vindicate on cool reflection, it may be right
+scrupulously to guard the avenues against such an error.”
+
+In the “Enquiry into the Duties of Men,” the same excellent moralist thus
+delivers his sentiments more at large[109]. “A professional writer[110],
+speaking in a work already quoted[111] respecting the performance of
+Surgical operations in hospitals, remarks, that it may be a salutary
+as well as an humane act in the attending Physician, occasionally to
+assure the patient that every thing goes on well, _if that declaration
+can be made with truth_. This restriction, so properly applied to the
+case in question, may with equal propriety be extended universally to
+the conduct of a Physician, when superintending operations performed,
+not by the hand of a Surgeon, but by Nature and Medicine. Humanity,
+we admit, and the welfare of the sick man, commonly require that his
+drooping spirits should be revived by every encouragement and hope which
+can honestly be suggested to him. But truth and conscience forbid the
+Physician to cheer him by giving promises, or raising expectations, which
+are known or intended to be delusive. The Physician may not be bound,
+unless expressly required, invariably to divulge at any specific time
+his opinion concerning the uncertainty or danger of the case; but he is
+invariably bound never to represent the uncertainty or danger as less
+than he actually believes it to be; and whenever he conveys, directly
+or indirectly, to the patient or to his family, any impression to that
+effect, though he may be misled by mistaken tenderness, he is guilty of
+positive falsehood. He is at liberty to say little; but let that little
+be true. St. Paul’s direction, _not to do evil that good may come_[112],
+is clear, positive, and universal.”
+
+Whether this subject be viewed as regarding general morality, or
+professional duty, it is of high importance; and we may justly presume
+that it involves considerable difficulty and intricacy, because opposite
+opinions have been advanced upon it by very distinguished writers. The
+ancients, though sublime in the abstract representations of virtue, are
+seldom precise and definite in the detail of rules for its observance.
+Yet in some instances they extend their precepts to particular cases;
+and Cicero, in the third book of his “Offices,” expressly admits of
+limitations to the absolute and immutable obligation of fidelity and
+truth. (cc. 24, 25.)
+
+The maxim of the poet, also, may be adduced as intended to be
+comprehensive of the moral laws, by which human conduct is to be
+governed:—
+
+ “Sunt certi denique fines,
+ Quos ultra citraque nequit consistere rectum[113].”
+
+The early Fathers of the Christian Church, Origen, Clement, Tertullian,
+Lactantius, Chrysostom, and various others, till the period of St.
+Augustine, were latitudinarians on this point. But the holy father last
+mentioned, if I mistake not, in the warmth of his zeal, declared that
+he would not utter a lie, though he were assured of gaining Heaven by
+it[114]. In this declaration there is a fallacy, by which Augustine
+probably imposed upon himself: for a lie is always understood to consist
+in a _criminal_ breach of truth, and therefore under no circumstances can
+be justified. It is alleged, however, that falsehood may lose the essence
+of lying, and become even praiseworthy, when the adherence to truth is
+incompatible with the practice of some other virtue of still higher
+obligation. This opinion almost the whole body of civilians adopt, with
+full confidence of its rectitude. The sentiments of Grotius may be seen
+at large in the satisfactory detail which he has given of the controversy
+relating to it[115].
+
+Puffendorff, who may be regarded as next to this great man in
+succession as well as authority, delivers the following observations
+in his “Law of Nature and Nations,” which are pointedly applicable to
+the present subjects, yet carried assuredly to a very reprehensible
+extent:—“Since those we talk to may often be in such circumstances,
+that, if we should tell them the downright truth of the matter, it would
+prejudice them, and would incapacitate us for procuring that lawful
+end we propose to ourselves for their good; we may in these cases use
+a fictitious or figurative way of speech, which shall not directly
+represent to our hearers our real thoughts and intentions: for, when
+a man is desirous, and it is his duty, to do a piece of service, he
+is not bound to take measures that will certainly render his attempts
+unsuccessful[116].”—“Those are by no means guilty of lying, who, for the
+better information of children, or other persons not capable of relishing
+the naked truth, entertain them with fictions and stories; nor those who
+invent something that is false, for the sake of a good end, which by the
+plain truth they could not have compassed; as, suppose, for protecting
+an innocent, for appeasing a man in his passion, for _comforting the
+afflicted_, for _animating the timorous_, for _persuading a nauseating
+patient to take his physic_, for overcoming an obstinate humour, for
+making an ill design miscarry[117].”
+
+Several modern ethical writers of considerable celebrity have been
+no less explicit and indulgent on this question. Amongst these it
+may suffice to cite the testimony of the late Dr. Francis Hutcheson
+of Glasgow; of whom it is said by his excellent biographer, that “he
+abhorred the least appearance of deceit either in word or action[118].”
+“When in certain affairs,” says he, “’tis known that men do not conceive
+it an injury to be deceived, there is no crime in false speech about
+such matters.... No man censures a Physician for deceiving a patient too
+much dejected, by expressing good hopes of him, or by denying that he
+gives him a proper medicine which he is foolishly prejudiced against:
+the patient afterwards will not reproach him for it.... Wise men allow
+this liberty to the Physician in whose skill and fidelity they trust: or
+if they do not, there may be a just plea from necessity[119].”—“These
+pleas of necessity some would exclude by a maxim of late received, _We
+must not do evil that good may come of it._ The author of this maxim is
+not well known. It seems, by a passage in St. Paul[120], that Christians
+were reviled as teaching, that, since the mercy and veracity of God were
+displayed by the obstinate wickedness of the Jews, they should continue
+in sin that this good might ensue from it. He rejects the imputation upon
+his doctrine; and hence some take up the contradictory proposition as
+a general maxim of great importance in morality. Perhaps it has been a
+maxim among St. Paul’s enemies, since they upbraid him with counteracting
+it. Be the author who they please, the sentence is of no use in morals,
+as it is quite vague and undetermined. Must one do nothing for a good
+purpose, which would have been evil without this reference? ’Tis evil to
+hazard life without a view to some good; but, when ’tis necessary for a
+public interest, ’tis very lovely and honourable. ’Tis criminal to expose
+a good man to danger for nothing; but ’tis just even to force him into
+the greatest dangers for his country. ’Tis criminal to occasion any pains
+to innocent persons, without a view to some good; but for restoring of
+health we reward chirurgeons for scarifyings, burnings, and amputations.
+‘But,’ say they, ‘such actions, done for these ends, are not evil. The
+maxim only determines that we must not do, for a good end, such actions
+as are evil even when done for a good end.’ But this proposition is
+identic and useless; for who will tell us next, what these actions,
+sometimes evil, are, which may be done for a good end? and what actions
+are so evil that they must not be done even for a good end? The maxim
+will not answer this question; and truly it amounts only to this trifle;
+_you ought not for any good end to do what is evil, or what you ought not
+to do, even for a good end_[121].”
+
+Dr. Johnson, who admits of some exception to the law of truth,
+strenuously denies the right of telling a lie to a sick man for fear of
+alarming him. “You have no business with consequences,” says he; “you are
+to tell the truth. Besides, you are not sure what effect your telling him
+that he is in danger may have. It may bring his distemper to a crisis,
+and that may cure him. Of all lying I have the greatest abhorrence of
+this, because I believe it has been frequently practised on myself[122].”
+
+If the Medical reader wishes to investigate this nice and important
+subject of casuistry, he may consult Grotius _De Jure Belli ac Pacis_,
+Puffendorff, Grove’s _Ethics_, Balguy’s _Law of Truth_, Fénelon’s
+_Telemachus_, Butler, Hutcheson, Paley, and Gisborne. Every practitioner
+must find himself occasionally in circumstances of very delicate
+embarrassment, with respect to the contending obligations of veracity
+and professional duty; and when such trials occur, it will behove him to
+act on fixed principles of rectitude, derived from previous information
+and serious reflection. Perhaps the following brief considerations, by
+which I have conscientiously endeavoured to govern my own conduct, may
+afford some aid to his decision.
+
+Moral truth, in a professional view, has two references; one to the
+party to whom it is delivered, and another to the individual by whom
+it is uttered. In the first, it is a _relative_ duty, constituting a
+branch of justice; and may be properly regulated by the Divine rule of
+equity prescribed by our SAVIOUR, to do unto others, as we would (all
+circumstances duly weighed,) they should do unto us[123]. In the second,
+it is a _personal_ duty, regarding solely the sincerity, the purity,
+and the probity of the Physician himself. To a patient, therefore,
+(perhaps the father of a numerous family, or one whose life is of the
+highest importance to the community,) who makes enquiries, which, if
+faithfully answered, might prove fatal to him, it would be a gross and
+unfeeling wrong to reveal the truth. His right to it is suspended, and
+even annihilated; because, its beneficial nature being reversed, it would
+be deeply injurious to himself, to his family, and to the public: and
+he has the strongest claim, from the trust reposed in his Physician, as
+well as from the common principles of humanity, to be guarded against
+whatever would be detrimental to him. In such a situation, therefore,
+the only point at issue is, whether the practitioner shall sacrifice
+that delicate sense of veracity, which is so ornamental to, and indeed
+forms a characteristic excellence of, the virtuous man, to this claim
+of Professional justice and social duty. Under such a painful conflict
+of obligations a wise and good man must be governed by those which are
+the most imperious; and will therefore generously relinquish every
+consideration referable only to himself. Let him be careful, however, not
+to do this, but in cases of real emergency, which happily seldom occur;
+and to guard his mind sedulously against the injury it may sustain by
+such violations of the native love of truth.
+
+I shall conclude this long note with the two following very interesting
+biographical facts. The husband of the celebrated Arria, Caecina Paetus,
+was very dangerously ill. Her son was also sick at the same time, and
+died[124]. He was a youth of uncommon accomplishments, and fondly beloved
+by his parents. Arria prepared and conducted his funeral in such a
+manner, that her husband remained entirely ignorant of the mournful event
+which occasioned that solemnity. Paetus often enquired with anxiety about
+his son; to whom she cheerfully replied, that he had slept well, and was
+better. But if her tears, too long restrained, were bursting forth, she
+instantly retired, to give vent to her grief; and when again composed,
+returned to Paetus with dry eyes and placid countenance, quitting, as
+it were, all the tender feelings of the mother at the threshold of her
+husband’s chamber.
+
+“Lady Russell’s only son, Wriothesley, Duke of Bedford, died of the
+small-pox in May 1711, in the 31st year of his age[125].... To this
+affliction succeeded, in Nov. 1711, the loss of her daughter, the Duchess
+of Rutland, who died in child-bed. Lady Russell, after seeing her in the
+coffin, went to her other daughter, married to the Duke of Devonshire,
+from whom it was necessary to conceal her grief, she being at that time
+in child-bed likewise; therefore she assumed a cheerful air, and with
+astonishing resolution, [verbally] agreeable to truth, answered her
+anxious daughter’s enquiries with these words: ‘I have seen your sister
+out of bed to-day.’”
+
+
+NOTE IV. Chap. ii. § 5. p. 50.
+
+“_The practice of a prior Physician should be treated with candour, and
+justified, so far as truth and probity will permit._”
+
+Montaigne in one of his “Essays” treats with great humour of Physic and
+Physicians; and makes it a charge against them, that they perpetually
+direct variations in each other’s prescriptions. “Who ever saw,” says
+he, “one Physician approve of another’s prescription, without taking
+something away, or adding something to it? By which they sufficiently
+betray their art, and make it manifest to us that they therein more
+consider their own reputation, and consequently their profit, than their
+patients’ interest[126].”
+
+
+NOTE V. Chap. ii. § 9. p. 53.
+
+_Theoretical discussions should be generally avoided._
+
+This rule is not only applicable to consultations, but to any reasonings
+on the nature of the case and of the remedies prescribed, either with
+the patient himself or his friends. It is said by my lamented friend Mr.
+Seward in his entertaining “Anecdotes,” that the late Lord Mansfield gave
+this advice to a military gentleman, who was appointed Governor of one
+of our islands in the West Indies, and who expressed his apprehensions
+of not being able to discharge his duty as chancellor of his province:
+“Always decide, and never give reasons for your decision. You will in
+general decide well; yet give very bad reasons for your judgement[127].”
+
+
+NOTE VI. Chap. ii. § 11. p. 54.
+
+_Regular academical education._
+
+“It is the general opinion,” says Dr. Johnson[128], “that Sydenham was
+made a physician by accident and necessity; and Sir Richard Blackmore
+reports in plain terms[129], that he engaged in practice without any
+preparatory study, or previous knowledge, of the Medicinal sciences; and
+affirms, that, when he was consulted by him what books he should read to
+qualify him for the said profession, he recommended _Don Quixote_. That
+he recommended Don Quixote to Blackmore,” continues Dr. Johnson, “we
+are not allowed to doubt; but the relater is hindered, by that self-love
+which dazzles all mankind, from discovering that he might intend a satire
+very different from a general censure of all the ancient and modern
+writers on Medicine; since he might perhaps mean, either seriously or in
+jest, to insinuate that Blackmore was not adapted by nature to the study
+of Physic, and that, whether he should read Cervantes or Hippocrates, he
+would be equally unqualified for practice, and equally unsuccessful in
+it. Whatsoever was his meaning, nothing is more evident than that it was
+a transient sally of an imagination warmed with gaiety, or the negligent
+effusion of a mind intent upon some other employment, and in haste to
+dismiss a troublesome intruder.” Sydenham himself has declared[130],
+that, after he determined upon the profession of Physic, he applied in
+earnest to it, and spent several years in the University of Oxford,
+before he began to practise in London. He travelled afterwards to
+Montpelier in quest of more information; “so far was he from any contempt
+of academical institutions, and so far from thinking it reasonable to
+learn Physic by experiments alone, which must necessarily be made at the
+hazard of life[131].”
+
+But it is highly injurious to the usefulness and honour of the
+Profession, to suppose the education of a Physician may be confined to
+the pursuit of Medicine as an _art_. Sir William Blackstone, in the
+Introduction to his “Commentaries on the Laws of England[132],” has
+reprobated the custom of placing the juridical student “at the desk of
+some skilful attorney, in order to initiate him early in all the depths
+of practice, and render him more dexterous in the mechanical part of
+business.” This illiberal path to the bar is not to be sanctioned,
+he observes, by a few particular instances of persons, who, through
+the force of transcendent genius, have been able to overcome every
+disadvantage. And he points out, in very forcible terms and with sound
+argument, how essential it is to the lawyer to form his sentiments by
+the perusal of the purest classical authors; to learn to reason with
+precision, by the simple but clear rules of unsophisticated logic; to fix
+the attention, and steadily to pursue truth through the most intricate
+deductions, by an acquaintance with mathematical demonstration; and to
+acquire enlarged conceptions of nature and of art, by a view of the
+several branches of experimental philosophy. Now, if this be the _vantage
+ground_, (to adopt the language of Lord Bacon,) from which the study of
+the Law should commence, it ought to be deemed at least equally necessary
+to qualify for the prosecution of Medicine—a science which has man, as
+a compound of matter and mind, for its subject, and an infinitude of
+substances derived from the animal, vegetable, and mineral kingdoms for
+its instruments. This sentiment seems to have been early prevalent in
+the celebrated school of Physic, established at Salerno in Italy. For it
+was enacted, A.D. 1237, by the heads of colleges there, that the pupils
+should be bound to pass three years in the acquisition of philosophy, and
+five subsequent years in that of Medicine[133]. The like regulations were
+afterwards adopted in other Universities; but in various countries have
+fallen into disuse.
+
+On the first revival of learning in Europe, science was held in the
+highest estimation; and the three faculties of Law, Physic, and Divinity
+assumed particular honours and privileges. Academical degrees were
+conferred on their members; and these titles, with the rank annexed
+to them, were admitted _ubique gentium_; being, like the order of
+knighthood, of universal validity. Doctors indeed contended sometimes
+with knights for precedence, and the disputes were not unfrequently
+terminated by advancing the former to the dignity of knighthood. It
+was even asserted that a doctor had a right to that title without
+creation[134].
+
+
+NOTE VII. Chap. ii. § 15. p. 57.
+
+_Pecuniary acknowledgements._
+
+The following fact is applicable to the professional conduct of
+Physicians towards their friends:—“When Addison was in office, [under
+the earl of Wharton, as Lord Lieutenant of Ireland,] he made a law to
+himself, as Swift has recorded, never to remit his regular fees in
+civility to his friends: ‘for,’ said he, ‘I may have a hundred friends;
+and, if my fee be two guineas, I shall, by relinquishing my right, lose
+two hundred guineas, and no friend gain more than two; there is therefore
+no proportion between the good imparted, and the evil suffered[135].’” In
+recording Mr. Addison’s _prudential_ conduct, his probity, with respect
+to pecuniary acknowledgements, should not be unnoticed. In a letter,
+relative to the case of Major Dunbar, he says:—“And now, Sir, believe
+me, when I assure you, I never did, nor ever will, on any pretence
+whatsoever, take more than the stated or customary fees of my office. I
+might keep the contrary practice concealed from the world, were I capable
+of it; but I could not from myself; and I hope I shall always fear the
+reproaches of my own heart, more than those of all mankind[136].”
+
+At a period when empirics and empiricism seem to have prevailed much in
+Rome, the exorbitant demands of Medical practitioners, particularly for
+certain secret compositions which they dispensed, induced the Emperor
+Valentinian to ordain, that no individual of the Faculty should make an
+express charge for his attendance on a patient, nor even avail himself
+of any promise of remuneration during the period of sickness; but that
+he should rest satisfied with the donative voluntarily offered at the
+close of his ministration[137]. By the same law, however, the Emperor
+provided that one practitioner, at least, should be appointed for each
+of the fourteen sections into which the Roman metropolis was divided,
+with special privileges, and a competent salary for his services; thus
+indirectly, yet explicitly, acknowledging that a Physician has a full
+claim in equity to his professional emoluments. Is it not reasonable,
+therefore, to conclude, that what subsisted as a _moral_ right, ought
+to have been demandable, under proper regulations, as a _legal_ right?
+For it seems to be the office of law to recognise and enforce that which
+natural justice recognises and sanctions.
+
+The Roman advocates were subject to the like restrictions, and from a
+similar cause; for their rapacity occasioned the revival of the Cincian
+Law, “qua cavetur antiquitus, ne quis ob causam orandam pecuniam donumve
+accipiat.” But Tacitus relates, that, when the subject was brought into
+discussion before Claudius Caesar, amongst other arguments in favour
+of receiving fees, it was forcibly urged, “sublatis studiorum pretiis,
+etiam studia peritura;” and that, in consequence, the prince “capiendis
+pecuniis posuit modum, usque ad dena sestertia, quem egressi repetundarum
+tenerentur[138].”
+
+A precise and invariable _modus_, however, would be injurious both to
+the barrister and the Physician, because the fees of each ought to be
+measured by the value of his time, the eminence of his character, and by
+his general rule of practice. This rule, with its antecedents, being well
+known, a _tacit compact_ is established, restrictive on the claims of
+the practitioner, and binding on the probity of the patient. Law cannot
+properly by its ordinances establish the custom, which will and ought
+to vary in different situations and under different circumstances. But
+a court of judicature, when formally appealed to, seems to be competent
+to authorize it if just, and to correct it if unjust. Such decisions
+could not wholly change the honorary nature of fees; because they would
+continue to be increased at the discretion of the affluent, according to
+their liberality and grateful sense of kind attentions; and diminished
+at the option of the Physician to those who may from particular
+circumstances require his beneficence.
+
+From the Roman code the established usage in different countries of
+Europe relative to Medical fees has probably originated. This usage,
+which constitutes common law, seems to require considerable modification
+to adapt it to the present state of the Profession. For the general
+body of the Faculty, especially in the united kingdom of Great Britain
+and Ireland, are held in very high estimation on account of their
+liberality, learning, and integrity[139]; and it would be difficult to
+assign a satisfactory reason why they should be excluded from judicial
+protection, when the just remuneration of their services is wrongfully
+withheld. Indeed a Medical practitioner (one especially who is settled
+in a provincial town, or in the country,) may have accumulated claims
+from long-protracted and often expensive attendance; and his pecuniary
+acknowledgements may be refused from prejudice, from captiousness, from
+parsimony, or from dishonesty. Under such circumstances considerations of
+benevolence, humanity, and gratitude, are wholly set aside; because, when
+disputes arise, they must be suspended or extinguished, and the question
+at issue can alone be decided on the principles of _commutative justice_.
+
+
+NOTE VIII. Chap. ii. § 30. p. 65.
+
+_Public worship; scepticism and infidelity._
+
+The neglect of social worship, with which Physicians have been too
+justly charged, may be traced in many instances to the period of their
+academical education, particularly in the Universities, where young
+men are permitted to live at large, and are subject to no collegiate
+discipline. Sunday, affording a recess from public lectures, is devoted
+by those who are ardent in study to a review of the labours of the
+past week, to preparations for Medical or scientific discussions
+in the societies of which they are members, or to other pursuits,
+belonging to their Profession, but unconnected with Religion. The
+idle and the gay in such situations are eager to avail themselves of
+opportunities so favourable to their taste for recreation, or to their
+aversion to business and confinement. In each of these classes, though
+actuated by different principles, there is much danger that devotional
+impressions will be gradually impaired for want of stated exercise and
+renewal; and a foundation will thus be laid for habitual and permanent
+indifference in future life to Divine services, whenever Medical
+avocations furnish a _salvo_ to the mind, and a plausible excuse to the
+world, for non-attendance on them. This coldness of heart, this moral
+insensibility, should be sedulously counteracted before it has acquired
+an invincible ascendancy. No apology should be admitted for absence
+from the stated offices of piety, but that of duties to be performed of
+immediate and pressing necessity. When the church is entered with just
+views, it will be found that there is a sympathy in religious homage,
+which at once inspires and heightens devotion; and that to hold communion
+with God in concert with our families, our friends, our neighbours,
+and our fellow citizens, is the highest privilege of human nature.
+But, with a full conviction of the obligation of public worship, as a
+social institution founded on common consent, and enjoined by legal
+authority; as a moral duty connecting us by the most endearing ties
+with our brethren of mankind, who are joint dependants with ourselves
+on the pardon, the protection, and the bounty of GOD; and as a debt of
+general homage to our Creator, Benefactor, and Judge; yet there may
+subsist in a devout and benevolent mind scruples respecting doctrines
+and forms, sufficient to produce an alienation from the sacred offices
+of the temple. Such doubts, when they originate from serious enquiry,
+and are not the result of fastidiousness or arrogance, have a claim to
+tenderness and indulgence; because to act in contradiction to them,
+whilst they subsist, would be a violation of sincerity, amounting in some
+cases to the guilt of hypocrisy. But in a country where private judgement
+is happily under no restraint, and where so great a diversity of sects
+prevails, it will be strange if a candid and well-informed man can find
+no Christian denomination, with which he might accord in spirit and in
+truth. Sir Thomas Brown, in the statement which he has given in his
+“Religio Medici[140],” seems to have allowed himself on these points very
+extensive latitude:—“We have reformed _from_ them, [viz. the Papists,]
+not against them; ... and therefore I am not scrupulous to converse and
+live with them, to enter their churches in defect of ours, and either
+pray _with_ them or for them. I could never perceive ... that a resolved
+conscience may not adore her Creator any where, especially in places
+devoted to His service; where, if _their_ devotions offend Him, mine may
+please Him; if theirs profane it, mine may hallow it.... I could never
+hear the _Ave-Mary_ bell without an elevation, or think it a sufficient
+warrant, because _they_ erred in one circumstance, for me to err in
+all,—that is, in silence and dumb contempt: whilst therefore _they_
+directed their devotions to _her_, I offered mine to GOD, and rectified
+the errors of _their_ prayers by rightly ordering my own.”
+
+But authority much more respectable than that of Sir Thomas Brown may be
+adduced in favour of the spirit of catholicism in Christian communion.
+Mr. Locke, a short time before his death, received the Sacrament
+according to the rites of the Church of England, though it is evident
+from his writings that he dissented from many of her doctrines. When
+the office was finished, he told the minister, “that he was in the
+sentiment of perfect charity towards all men, and of a sincere union
+with the Church of CHRIST, under whatever name distinguished[141].”—Dr.
+David Hartley was originally intended for the clerical profession, but
+was prevented from going into holy orders by his scruples concerning
+subscription to the Thirty-nine Articles. He continued, however, to the
+end of his life, a well-affected member of the Establishment, approving
+of its practical doctrines, and conforming to its public worship. He
+was a Catholic Christian, says his son and biographer, in the most
+extensive and literal sense of the term. On the subject of religious
+controversy he has left the following testimony of his sentiments:—“The
+great differences of opinion and contentions, which happen on religious
+matters, are plainly owing to the violence of men’s passions more than
+to any other cause. When Religion has had its due effect in restraining
+these, and begetting true candour, we may expect a unity of opinion both
+in religious and other matters, as far as is necessary for useful and
+practicable purposes.”
+
+These examples of the conduct of wise and conscientious Christians
+evince, that, in their estimation, forms, ceremonies, and doctrines,
+are of a moment subordinate to the benefits and obligations of social
+worship. But they are not adduced to sanction an _indifference_, either
+to religious rites, or religious truth. The mind will always be in the
+best frame for holy exercises, when the modes by which they are conducted
+are consonant to its sentiments of propriety and rectitude; and that
+church should be habitually resorted to, if practicable, the public
+services of which accord most satisfactorily with the views of the
+individual, concerning the attributes of GOD, and the revelation of His
+will and promises to man. No personal friendship, no party connection, no
+professional interest should be allowed to predominate in the choice. For
+genuine piety, which is the joint offspring of reason and of sentiment,
+admits of no substitutions. It consists in a full conviction of the
+understanding, accompanied with correspondent affections of the heart;
+and in its exercises calls forth their united and noblest energies.
+
+It will not be foreign to the subject of this note to investigate
+briefly, the imputation of scepticism and infidelity, which has been laid
+against the Medical Faculty. The Rev. Dr. Samuel Parr, whose candour is
+unquestionable, and whose learning and genius entitle him to the highest
+respect, has lately sanctioned it, as will appear by the following
+passage from his “Remarks on the Statement of Dr. Charles Combe,”
+(p. 82[142]):—“While I allow,” says he, “that peculiar and important
+advantages arise from the appropriate studies of the three liberal
+professions, I must confess, that in erudition, in science, and in habits
+of deep and comprehensive thinking, the pre-eminence in some degree must
+be assigned to Physicians. The propensity which some of them have shewn
+to scepticism upon religious topics is indeed to be seriously lamented;
+and it may be satisfactorily explained, I think, upon metaphysical
+principles, which evince the strength rather than the weakness of
+the human mind, when contemplating under certain circumstances the
+multiplicity and energy of physical causes. But I often console myself
+with reflecting on the sounder opinions of Sir Thomas Brown, Sydenham,
+Boerhaave, and Hartley, in the days that are past: and of our own times
+posterity will remember that they were adorned by the virtues, as well as
+the talents, of a Gregory, a Heberden, a Falconer[143], &c.”
+
+Mr. Gisborne, in his “Enquiry into the Duties of Men, in the Higher
+and Middle Classes of Society[144],” a work to which I have already
+referred, as an admirable system of practical and appropriate ethics,
+has very explicitly and forcibly delivered his sentiments on this
+interesting subject. “The charge,” he says, “may have been made on
+partial and insufficient grounds; but the existence of it should excite
+the efforts of every conscientious Physician to rescue himself from
+the general stigma. It should stimulate him, not to affect a sense of
+Religion which he does not entertain, but openly to avow that which
+he actually feels.... If the charge be in some measure true, it is of
+importance to the Physician to ascertain the causes from which the fact
+has originated, that he may be the more on his guard against their
+influence. The following circumstances may not have been without their
+weight. They who are accustomed to deep researches into any branch of
+philosophical science; and find themselves able to explain to their own
+satisfaction almost every phenomenon, and to account (as they apprehend,)
+for almost every effect by the operation of such causes as in ordinary
+language are termed _natural_, are apt to acquire extravagant ideas of
+the sufficiency of human reason on all subjects: and thus learning to
+doubt the necessity, become prejudiced against the belief, of Divine
+Revelation. In the next place, they who justly disclaim the empire of
+authority in Medical theories, may carelessly proceed to regard religious
+doctrines as theories, resting on no other foundation, and deserving of
+no better fate. Thirdly, it is to be observed, that men may be divided
+into two distinct classes, with respect to the sort of testimony on
+which they receive truths of any kind. They who are chiefly addicted
+to investigations and reasonings founded on analogy, look primarily
+and with extreme partiality to that species of evidence; and, if the
+thing asserted appears contrary to the common course of nature, more
+especially if it militate against any theory of their own, (and such
+persons are much disposed to theorize,) they are above measure reluctant
+to admit the reality of it, and withhold their assent until such a
+number of particular proofs, incapable of being resolved into fraud or
+misconception, is produced, as would have been far more than sufficient
+to convince an unbiassed understanding: whereas other men, little used
+to analogical enquiries, look not around for such testimony either in
+support or in refutation of an extraordinary circumstance affirmed to
+them; but readily give credit to the fact on its own distinct proofs, or
+from confidence in the veracity and discernment of the relator. It is
+evident that Physicians are to be ranked in the class first described,
+and are consequently liable to its prejudices: and it is equally evident
+that those prejudices will render all on whom they fasten, particularly
+averse to recognise the truth of miracles; and will probably prevent
+them from examining with impartiality the evidence of a religion founded
+on miracles, and perhaps from examining it at all. Fourthly, to the
+preceding circumstances must be added the neglect of Divine worship too
+customary among persons of the Medical profession. This neglect seems
+to have contributed not only to excite and to strengthen the opinion of
+their scepticism and infidelity, but sometimes to produce scepticism and
+infidelity itself; for it is a natural progress, that he who habitually
+disregards the public duties of Religion, should soon omit those which
+are private, should speedily begin to wish that Christianity may not
+be true, should then proceed to doubt its truth, and at length should
+disbelieve it.”
+
+The late Dr. [John] Gregory of Edinburgh, anxious to support the honour
+of a profession which he loved, and of which he was a distinguished
+ornament, very strenuously repels the charge against it of scepticism
+and infidelity. Though his excellent Lectures are doubtless in the
+hands of most Physicians, yet I am tempted to make a transcript from
+them, because I wish the present important subject to be viewed in the
+several lights in which it has been presented to the mind by different
+writers of acknowledged probity, information, and judgement. “I think
+the charge,” he observes[145], “ill founded, and will venture to say,
+that the most eminent of our Faculty have been distinguished for real
+piety. I shall only mention as examples, Harvey, Sydenham, Arbuthnot,
+Boerhaave, Stahl, and Hoffmann.—It is easy, however, to see whence this
+calumny has arisen. Men whose minds have been enlarged by knowledge, who
+have been accustomed to think, and to reason upon all subjects with a
+generous freedom, are not apt to become bigots to any particular sect or
+system. They can be steady to their own principles, without thinking ill
+of those who differ from them; but they are impatient of the authority
+and control of men, who would lord it over their consciences, and
+dictate to them what they are to believe. This freedom of spirit, this
+moderation and charity for those of different sentiments, have frequently
+been ascribed by narrow-minded people to secret infidelity, scepticism,
+or, at least, to lukewarmness in Religion; while some who were sincere
+Christians, exasperated by such reproaches, have sometimes expressed
+themselves unguardedly, and thereby afforded their enemies a handle to
+calumniate them. This, I imagine, has been the real source of that charge
+of infidelity, so often and so unjustly brought against Physicians....
+The study of Medicine[146], of all others, should be the least suspected
+of leading to impiety. An intimate acquaintance with the works of Nature
+raises the mind to the most sublime conceptions of the Supreme Being;
+and at the same time dilates the heart with the most pleasing views of
+Providence. The difficulties that necessarily attend all deep enquiries
+into a subject so disproportionate to the human faculties, should not
+be suspected to surprise a Physician, who, in his practice, is often
+involved in perplexity, even in subjects exposed to the examination of
+his senses.
+
+“There are, besides, some peculiar circumstances in the profession of a
+Physician, which should naturally dispose him to look beyond the present
+scene of things, and engage his heart on the side of Religion. He has
+many opportunities of seeing people, once the gay and the happy, sunk
+in deep distress, sometimes devoted to a painful and lingering death,
+and sometimes struggling with the tortures of a distracted mind. Such
+afflictive scenes, one would imagine, might soften any heart, not dead
+to every feeling of humanity, and make it reverence that Religion, which
+alone can support the soul in the most complicated distresses; that
+Religion, which teaches to enjoy life with cheerfulness, and to resign it
+with dignity.”
+
+The judicious and animated considerations which are here delivered,
+could proceed only from a mind actuated by the principles of virtue
+and Religion; and I trust the great majority of Physicians have their
+feelings in unison with those of the amiable writer I have quoted. But
+there may be some who have been hardened to moral apathy by the very
+causes which should excite benevolence and piety. It has been well
+remarked by divines and metaphysicians, that _passive impressions_
+become progressively weaker by frequent recurrence; and that the heart
+is liable to grow callous to scenes of horror and distress, and even to
+the view of death itself. This law of nature is intended by the wise and
+benignant Author of our frame to answer the most salutary purposes, by
+co-operating with another of equal, perhaps superior, force: for _active
+propensities_ are formed and gradually strengthened by the like renewal
+of the circumstances which excite them. The love of goodness is thus
+rendered habitual; and rectitude of conduct is steadily and uniformly
+pursued without struggle or perturbation.
+
+The human character then attains the highest excellence of which this
+probationary state is capable; and perhaps the Medical profession is more
+favourable than any other to the formation of a mental constitution, that
+unites in it very high degrees of intellectual and moral vigour; because
+it calls forth the steady and unremitting exertions of benevolence, under
+the direction of cultivated reason; and, by opening a wider and wider
+sphere of duty, progressively augments their reciprocal energies. But
+the connection between the laws of impression, and of habit, is not so
+determinate and necessary as to be wholly independent of the agent who
+is under their influence. By a perversion of the understanding and the
+will, they may be, and sometimes are, separated. The affections also,
+when the temperament is phlegmatic, subsist only in a languid state; and
+are too evanescent to produce a permanently correspondent frame of mind.
+If with this coldness of heart a sceptical turn of thinking happen to be
+associated, either constitutionally or from the casualties of study and
+connections, virtuous principles will gradually decay; all the tender
+charities of life will soon be extinguished; a future state will be
+either disbelieved or regarded with indifference; and practical atheism
+will ensue, with the whole train of evils which result from a denial
+of the creative agency of GOD, or His Divine administration. Allowing
+this to be an extreme and barely possible case, (a concession which I
+am solicitous to grant to my countrymen, notwithstanding what has been
+fatally experienced in a neighbouring kingdom,) yet different gradations
+towards it may subsist, and the first step should be avoided with
+sedulous care. The countervailing power of Religion is here essentially
+necessary, because nothing besides can furnish motives to rectitude,
+of adequate dignity, weight, and authority. To restore the impressions
+of piety which have been lost or impaired, without falling into the
+fervours of enthusiasm, or the gloom of superstition, may be an arduous
+task, a task that will require time and perseverance to accomplish. But
+the attainment will amply repay the labour, by the sweet satisfaction
+which a Physician cannot fail to derive from the consciousness that he
+exercises his profession under the inspection of a Being Who approves and
+will reward every effort to acquire His favour by doing good to mankind.
+In his offices of humanity, he will feel an interest and elevation,
+of which those can have no conception who regard the human race, (and
+consequently the sufferers under their care,) not as the offspring of
+GOD, or as expectants of immortality, but as the creatures of a day,
+formed by the casual concourse or the natural appetencies of atoms, and
+born only to perish. Such degrading and unhappy notions often spring
+from a love of paradox, a passion for novel hypothesis, ambition to
+be victorious in subtle disputation, and a contempt for established
+authority, accompanied for the most part with an implicit submission to
+empirics in science, who dogmatize most when they assume the mask of
+scepticism. To the successful pursuit of truth it is necessary to bring
+a well-disciplined mind, modest and sober in its views, and uninfluenced
+not only by vulgar, but by philosophical prejudices, which are far more
+dangerous, because more plausible and fascinating. When subjects which
+relate to theology are investigated, reverence and humility should be
+associated with all our reasonings. No practice is more subversive of
+devotional sentiment, than that of carrying into religious discussions
+the licentiousness of thought and expression, which young Physicians
+are too apt to indulge on Medical topics. He who can suffer himself to
+treat his Maker with indifference and with levity, whether it be in
+utterance or in contemplation, will soon lose the religious impressions
+of reverence, gratitude and love; and his mind will then be prepared for
+the systems of impiety and atheism, which of late have been so boldly
+promulgated under the imposing name of philosophy. Productions of this
+class should be shunned, even by those who are thoroughly grounded in
+rational faith; because familiarity with them can hardly fail to impair
+the moral sensibilities of the heart. They are “evil communications,”
+which forcibly tend to “corrupt good manners.”
+
+To the comprehensive view of a well-educated Physician, the Divine
+Being will appear, with the fullest manifestation, in all without and
+all within him. Through the several kingdoms of nature, with which he
+is intimately acquainted, he traces every where design, intelligence,
+power, wisdom, and goodness; and in the frame of his own body, as well
+as in the constitution of his mental faculties, he finds especial reason
+to conclude, that, above all the other works of the creation, “he is
+fearfully and wonderfully made[147].” The daily offices of his profession
+disclose to him irrefragable proofs of the providence and moral
+government of GOD. Health, as consisting in the soundness and vigour
+of the bodily organs, and in their complete aptitude for exertion and
+enjoyment, is doubtless of inestimable consideration. But the occasional
+suspension of this blessing may be necessary to obviate the abuses to
+which it is liable, to evince its high value, to remedy the injuries it
+may have sustained, and to insure its future more permanent duration. A
+strong constitution is too often made subservient to sensuality, ebriety,
+and other licentious indulgences, which, if not seasonably interrupted by
+the experience of consequential suffering, would prove destructive to the
+animal economy, and bring on premature decrepitude or death. Diseases,
+under these circumstances, furnish a beneficial restraint, and preserve
+the mind from contamination, whilst they are often the remedies which
+nature has kindly provided for the restoration of the vital functions.
+A good, which has been lost and beneficently restored, will be prized
+according to its high desert; and, being cherished with assiduous care,
+will be prolonged and applied to its proper uses in the great business of
+life. But sickness, it must be acknowledged, is not always remedial in
+its tendency; and frequently produces degrees of protracted languishment
+and pain, grievous to endure, and obstructive of those active offices,
+which, in his present sphere, man is called upon to perform. There are
+duties, however, of another class, not less essential to the improvement
+and excellence of his moral and religious character; and where is a
+school to be found like the chamber of sickness for meekness, patience,
+resignation, gratitude, and devout trust in GOD? There pride is humbled,
+the angry passions subside, animosities cease, and the vanities of the
+world lose their bewitching attractions. False associations are there
+corrected, true estimates are formed; and, whilst the passive virtues
+are cultivated in the suffering individual, all who minister to him have
+their best dispositions exercised and improved. Tenderness, humanity,
+sympathy, friendship, and domestic love, on such occasions, find that
+sphere which is peculiarly adapted to their exertion; and all the softer
+charities derive from these sources their highest refinements[148].
+
+Rational theism leads the mind, by fair and necessary induction, to
+extend its views to Revelation. He who has discovered the Divine
+wisdom, power, and goodness, through the various works of creation,
+will feel a solicitude to make farther advances in sacred knowledge;
+and, the more profoundly he venerates the Author of his being, the more
+earnest will he be to become acquainted with His will, with the means
+of conciliating His favour, with the duration of his own existence, and
+with his future destination. Several distinguished characters in the
+heathen world have in a very explicit manner testified the truth of this
+observation. Suffice it to state only the following remarkable passages
+from Plato[149]:—“A divine revelation is necessary to explain the true
+worship of GOD—to add authority to moral precepts—to assist our best
+endeavours in a virtuous course—to fix the future rewards and punishments
+of virtuous and vicious conduct—and to point out some acceptable
+expiation for sin.” He introduces Socrates, assuring Alcibiades, “that
+in a future time a divine person will appear, who, in pure love to
+man, shall remove all darkness from his mind, and instruct him how to
+offer his prayers and praises in the most acceptable way to the Divine
+Being.” The privileges which this intelligent and amiable philosopher
+ardently looked for, we happily enjoy. Christianity has “brought life and
+immortality to light[150];” and the Gospel is the sacred charter of our
+expected inheritance of felicity. To regard with indifference what is so
+momentous, is the grossest folly; to be dissatisfied with its evidence,
+argues the want of discernment and of candour; and to reject it, without
+deliberate and conscientious investigation, is a high degree of impiety:
+the appeal, however, must finally be made to the judgement of every
+individual; and we may humbly hope, that He Who knoweth our frame, will
+pity intellectual infirmity, and pardon involuntary error.
+
+
+NOTE IX. Chap. ii. § 31. p. 66.
+
+_Union in consultation of senior and junior Physicians._
+
+“Heat and vivacity in age,” says Bacon[151], “is an excellent composition
+for business. Young men are fitter to invent than to judge, fitter for
+execution than for counsel, and fitter for new projects than for settled
+business; for the experience of age, in things that fall within the
+compass of it, directeth them, but in new things abuseth them. The errors
+of young men are the ruin of business; but the errors of aged men amount
+but to this, that more might have been done or sooner. Young men, in the
+conduct and manage of actions, embrace more than they can hold; stir more
+than they can quiet; fly to the end without consideration of the means
+and degrees; pursue some few principles, which they have chanced upon,
+absurdly; care not to innovate, which draws unknown inconveniences; use
+extreme remedies at first; and, that which doubleth all errors, will not
+acknowledge or retract them; like an unruly horse, that will neither
+stop nor turn. Men of age object too much, consult too long, adventure
+too little, repent too soon, and seldom drive business home to the full
+period, but content themselves with a mediocrity of success. Certainly
+it is good to compound employments of both; for that will be good for
+the present, because the virtues of either age may correct the defects
+of both; and good for succession, that young men may be learners, while
+men in age are actors; and lastly, good for extern accidents, because
+authority followeth old men, and favour and popularity youth. But for the
+moral part, perhaps youth will have the pre-eminence, as age hath for the
+politic.”
+
+
+[NOTE X. Chap. iv. § 2. p. 79.
+
+_On Wills._
+
+In case of intestacy if a man leave a wife and children, the wife takes
+one third of the personal estate, and the other two thirds belong to
+the child or children. If the deceased leave a wife, but no child, one
+half of his personal estate will descend to his wife, and the other half
+will be divisible among his nearest of kindred, in the same manner as
+the whole would have been divisible if he had left no wife. But under no
+circumstances is the wife entitled to more than half of her husband’s
+estate, if he die intestate. The father of an intestate without issue
+is entitled to one half of his estate if he leave a widow, and to the
+whole if he leave none. When the nearest of kindred are the mother and
+the brothers and sisters, the personal estate is divisible into equal
+portions, one of which will belong to the mother, and one to each of the
+brothers and sisters[152]
+
+By Stat. 1 Vict. c. 26, one settled rule is established, which is
+applicable to every species of Wills and every description of property;
+it being enacted that no Will shall be valid unless it shall be in
+writing, and signed at the foot or end thereof by the testator, or by
+some other person in his presence and by his direction. Every will must
+have at least two witnesses, who must be present at the same time during
+the signature of the testator, and must attest and subscribe the Will
+in the presence of the testator:—but no particular form of attestation
+is necessary.—If a person to whom a legacy is given, be witness to a
+Will, he forfeits his legacy; but a creditor may be a witness to a Will
+without forfeiting his debt, and also an executor without invalidating
+his appointment to the executorship.]
+
+
+NOTE XI. Chap. iv. § 2. p. 83.
+
+_Partial insanity, with general intelligence. Lucid interval._
+
+Sir Matthew Hale has stated[153], that “There is a _partial_ insanity of
+mind; and a _total_ insanity. The former is either in respect to things,
+_quoad hoc vel illud insanire_; some persons, that have a competent
+use of reason in respect of some subjects, are yet under a particular
+_dementia_ in respect of some particular discourses, subjects, or
+applications; or else it is particular in respect of degrees; and this is
+the condition of very many, especially melancholy persons, who for the
+most part discover their defect in excessive fears and griefs, and yet
+are not wholly destitute of the use of reason; and this partial insanity
+seems not to excuse them in the committing of any offence for its matter
+capital; for doubtless most persons that are felons of themselves, and
+others, are under a degree of partial insanity, when they commit these
+offences.... The person that is absolutely mad for a day, killing a
+man in that distemper, is equally not guilty, as if he were mad without
+intermission. But such persons as have their lucid intervals (which
+ordinarily happens between the full and change of the moon,) in such
+intervals have usually at least a competent use of reason, and crimes
+committed by them in these intervals are of the same nature, and subject
+to the same punishment, as if they had no such deficiency; nay, the
+alienations and contracts made by them in such intervals are obliging to
+their heirs and executors.”
+
+Partial insanity and general intelligence may subsist in various degrees
+and proportions to each other in different persons, and even in the
+same person at different times. If Socrates had lived at this period,
+and had not only professed himself to be governed by the influences
+of a familiar spirit, or demon, but had also uniformly regulated his
+conversation and actions by this persuasion, he would have been justly
+chargeable with derangement of mind, notwithstanding the profound wisdom
+which he displayed in his instructions concerning morals and the conduct
+of life. Lord Herbert of Cherbury was highly distinguished both for
+talents and erudition: but, having unfortunately adopted prejudices
+against Christianity, he wrote an elaborate work entitled, “De Veritate,
+prout distinguitur a Revelatione;” and, knowing it would meet with
+much opposition, he remained some time in anxious suspense about the
+publication of it. Providence, however, as he informs us in his own
+biographical memoirs, kindly interposed, and determined his wavering
+resolutions. “Being thus doubtful in my chamber, one fair day in the
+summer, my casement being opened towards the south, the sun shining
+clear, and no wind stirring, I took my book, ‘De Veritate,’ in my hand,
+and kneeling on my knees, devoutly said these words:—‘O Thou eternal GOD,
+... I am not satisfied enough whether I shall publish this book, “De
+Veritate;” if it be for Thy glory, I beseech Thee give me some sign from
+heaven; if not, I shall suppress it.’ I had no sooner spoken these words,
+but a loud though yet gentle noise came from the heavens, (for it was
+like nothing on earth,) which did so comfort and cheer me, that I took my
+petition as granted, and that I had the sign I demanded; whereupon also
+I resolved to print my book.” This was not a temporary delusion of the
+imagination, but continued a permanent object of belief through life. And
+the impression was more extraordinary, and more indicative of an unsound
+mind, because Lord Herbert’s chief argument against Christianity is,
+the improbability that Heaven shall reveal its laws _only to a portion
+of the earth_. For how could he, who doubted of a _partial_, confide in
+an _individual_, revelation? or is it possible that he could rationally
+think his book of sufficient importance to extort a declaration of
+the Divine will, when the interest and happiness of a fourth part of
+mankind were deemed by him objects inadequate to the like display of
+goodness[154].
+
+The history of the Rev. Simon Browne still more remarkably exemplifies
+the union of vigour and imbecility, of rectitude and perversion in
+the same understanding. The loss of his wife and of his only son so
+powerfully affected him, that he desisted from the duties of his clerical
+function, and could not be persuaded to join in any act of worship to the
+Deity, either public or private. “He imagined that Almighty GOD, by a
+singular instance of Divine power, had, in a gradual manner, annihilated
+in him the thinking substance, and utterly divested him of consciousness:
+that, though he retained the human shape, and the faculty of speaking, in
+a manner that appeared to others rational, he had all the while no more
+notion of what he said than a parrot. And, very consistently with this,
+he looked upon himself as no longer a moral agent, a subject of reward or
+punishment.” In this conviction he continued with very little variation,
+to the close of life. Yet, whilst under the influence of this strange
+phrenzy, his faculties, in all other respects, appeared to be in full
+vigour. He applied himself with ardour to his studies; and was so acute
+a disputant, that his friends were wont to say, “he could reason as if
+possessed of _two_ souls.” Indeed, both his imagination and his judgement
+were so improved as to surpass the state in which they subsisted during
+his perfect sanity[155].
+
+In J. J. Rousseau, we have a most interesting example of morbid
+sensibility and depraved imagination, combined with extensive knowledge
+and pre-eminent genius. It is said by Madame de Staël[156] that
+“sometimes he would part with you, with all his former affection; but,
+if an expression had escaped you, which might bear an unfavourable
+construction, he would recollect it, examine it, exaggerate it, perhaps
+dwell upon it for a week, and conclude by a total breach with you. Hence
+it was, that there was scarce a possibility of undeceiving him; for the
+light which broke in upon him at once, was not sufficient to efface the
+wrong impressions which had taken place so gradually in his mind. It was
+extremely difficult too to continue long on an intimate footing with him:
+a word, a gesture, furnished him with matter of profound meditation; he
+connected the most trifling circumstances, like so many mathematical
+propositions, and conceived his conclusion to be supported by the
+evidence of demonstration[157].”
+
+I have hazarded an opinion in the text, contrary to what, I believe, is
+usually adopted by lawyers, that there may be cases of partial insanity
+with a high degree of general intelligence, in which the individual
+ought not to be precluded from the privilege of making a last will
+and testament. To deny the testamentary qualification to one, who,
+notwithstanding some false predominant conception, has been held capable
+of managing his concerns with discretion, and whose bequests discover
+no traces of a disturbed imagination, or unsound judgement, seems to be
+inconsistent both with wisdom and with natural justice. Such a person,
+I presume, is capable of acquiring property by legacy, by bargain, by
+transfer, by industry, or by office; and he is not prohibited during life
+from giving or expending possessions thus obtained. Why then does the law
+deprive him of the right of bequeathing after death, that which he might
+have dispensed, when alive, without control? Whatever be the opinion
+which a Medical practitioner may have entertained concerning the capacity
+or incapacity for making a will of one under these circumstances, it can
+hardly be necessary to observe, that his evidence, when called for in a
+course of legal enquiry, should be delivered explicitly, and without any
+bias from his pre-conceptions. On the point litigated it is the exclusive
+province of the judge and jury to decide, after a full investigation of
+the case.
+
+To determine the existence of a lucid interval in the delirium of fever,
+or in the more permanent alienation of mind which constitutes insanity,
+the testimony of a Physician is sometimes required in courts of law. It
+will be incumbent on him, therefore, to possess a clear and definite
+opinion on the subject, founded both on the nature of the malady, and the
+state of the patient. The cessation of febrile delirium is not difficult
+to ascertain, because the rational faculties, being unimpaired by a
+short suspension, at once manifest their renewal by signs which cannot
+be misunderstood; but the complete remission of madness is only to be
+decided by reiterated and attentive observation. Every action and even
+gesture of the patient should be sedulously watched, and he should be
+drawn into conversations at different times that may insensibly lead
+him to develope the false impressions under which he labours. He should
+also be employed occasionally in business or offices connected with,
+and likely to renew, his wrong associations. If these trials produce
+no recurrence of insanity, he may, with full assurance, be regarded as
+legally _compos mentis_ during such period, even though he should relapse
+a short time afterward into his former malady.
+
+
+[NOTE XII. Chap. iv. § 5. p. 85.
+
+_On the new Lunatic Act._
+
+By Lord Ashley’s new “Act for the Regulation of the Care and Treatment of
+Lunatics,” (8 and 9 Vict. c. 100.) many alterations were made in the old
+law, of which the following are some of the most important[158].
+
+We have, in the first place, secured by this act a permanent body of six
+able and experienced gentlemen to officiate as visiting Commissioners,
+three of whom are barristers, and three are physicians, and who are
+required to devote their time exclusively to the performance of their
+official duties. They are not permitted to hold any other office for
+which they derive remuneration, or to be connected either directly or
+indirectly with any public or private establishments for the reception
+of the insane; neither can they exercise their respective professions
+of law and medicine. They receive a salary of £1500 per annum; and the
+appointment is for life. They are empowered not only to visit private
+lunatic asylums, but gaols, workhouses, and hospitals,—in fact, every
+place in which insane persons are confined. They are to institute the
+most rigid scrutiny into their condition, with the view of ascertaining
+whether they are unjustly confined, or improperly treated; and, if such
+should be the case, to report accordingly to the Lord Chancellor, who is
+invested with full authority to redress any injury which may have been
+inflicted.
+
+With respect to the medical certificates required of those who have
+the power of consigning a fellow-creature to an asylum, formerly, the
+Physician, Surgeon, or Apothecary, was merely called upon to certify to
+the abstract fact of the presence of unsoundness of mind in any given
+case; but, according to the present law, it is necessary for the person
+signing it to state the facts in connexion with the case upon which he
+has founded his opinion. Independently of thus affording an additional
+protection to the public, a body of valuable information will be
+obtained, which may be turned by the Commissioners to useful account. In
+connexion with this branch of the subject may be mentioned the Medical
+“Case Book,” which the Act requires every Medical superintendent of
+the insane to keep for the inspection of the Commissioners. He is not
+merely (as under the old law,) to enter the name, form of the malady,
+the place of abode, age, and social condition of each patient intrusted
+to his care, but he is, at the same time, to give in writing a correct
+description of the medicine and other remedies prescribed for the
+treatment of his disorder.
+
+Among the minor, but still important, amendments effected in the law,
+the following may be mentioned: the Act enables a proprietor of an
+asylum to retake a patient who may have escaped from confinement. Again,
+parties guilty of ill-treating a patient may be proceeded against
+for misdemeanour. Individuals considering themselves to have been
+ill-treated, or wilfully neglected, may, after having regained their
+liberty, obtain, upon application to the Secretary of the Commissioners,
+a copy of the medical certificates and order with the view to legal
+proceedings. In the case of the death of any patient, a statement of the
+cause of death, with the name of any person who may have been present,
+is to be drawn up and signed by the Medical attendant, a copy of which
+is to be sent to the Commissioners. Patients may now be transferred,
+with the consent of the party signing the order, from one licensed house
+to another, without renewing the medical certificates; while, under
+the former Act, the proprietor had to procure fresh certificates for
+each patient before such a change of residence could be effected. The
+Commissioners have the power of making a night visitation to any house
+in which they may have reason to believe that the patients are subjected
+to ill-treatment. No patient pronounced by the Medical superintendent
+to be “dangerous” can be removed from an establishment, unless for the
+purpose of transferring him to another, without the consent of the
+Commissioners. The Commissioners also have the power of regulating the
+dietary of pauper patients confined in licensed houses and hospitals.
+There is to be a weekly meeting of the board for the consideration of,
+and adjudication upon, any matters touching the working of this Act,
+which will very much facilitate the practical operation of the law, as
+the Commissioners have the power to apply an immediate remedy for any
+abuse which may be brought under their notice.
+
+Proprietors of asylums are by the new law much more effectually protected
+than under the former Act. If a party insane, or alleged to be so, is
+received into a licensed house or hospital, with a written order for
+his reception, and two medical certificates, the person so admitting
+him, having complied with the provisions of the act of parliament,
+is protected from any vexatious actions which might be brought
+against him by persons representing themselves to have been unjustly
+confined and detained. The Act enables the proprietor, superintendent,
+servants, and any person engaged in receiving, detaining, retaking, and
+confining a person legally certified to be insane, to plead the order
+and certificates in bar of all proceedings at law. No action can be
+maintained against any individual who has in respect of such persons
+kept within the strict letter of the enactment.
+
+Again, the Act allows the superintendent and proprietor fourteen days to
+retake a patient who may have made his escape from an asylum, without the
+necessity of having to procure a fresh order and medical certificate.
+
+But perhaps the most important provision in the new Act, is that which
+relates to single patients in unlicensed houses and cottages. By the
+present Act, no one insane, or said to be so, can be sent to, or received
+in, any unlicensed place, unless two medical certificates have been
+obtained certifying to the patient’s insanity. The person taking charge
+of such patient is immediately to make a return of his name to the
+Commissioners, and he is subject to their visitation. The friends or
+relatives of the patients are compelled by the Act to appoint a Medical
+superintendent to visit occasionally persons confined in unlicensed
+places, who is required to enter into a “Medical Visitation Book” all the
+particulars connected with each case, with an account of the medical and
+moral treatment adopted. This book is to be open to the inspection of the
+Commissioners.
+
+By this Act, therefore, (irrespectively of many minor improvements,) four
+important amendments in the law relating to the regulation of lunatics
+and lunatic asylums are introduced. First, by the establishment of a
+permanent body of experienced Commissioners, authorized to inspect
+every place in which the insane are confined, (excepting those placed
+under the care of persons who derive no remuneration for undertaking
+their management, or those who have been the subject of a commission of
+lunacy, and who are residing with the committee appointed by the Lord
+Chancellor,) a more vigilant and searching scrutiny into the condition
+of the insane will be enforced. Secondly, the law throws an additional
+protection around those who are authorized to keep establishments for
+the treatment of insanity. Thirdly, by the alteration required in the
+character of the medical certificates, and the statement which the Act
+compels every Medical superintendent to keep of the particulars of
+the medical treatment adopted by him in each case under his care, a
+valuable collection of facts connected with the pathology of insanity
+will be recorded, from the study and classification of which important
+conclusions may be deduced. Fourthly, the abolition of the cottage
+system of treating the insane cannot but be productive of the most
+advantageous results. These unhappy persons will now have a fair chance
+of being restored to health, and to the enjoyment of their social rights
+and privileges. As the objects for which they were formerly confined in
+cottages and other unlicensed places—viz. privacy and secrecy—no longer
+exist, it is hoped that the insane will now be sent to well conducted
+private establishments, where they will have a chance of being restored
+to sanity.]
+
+
+[NOTE XIII. Chap. iv. § 12. p. 102.
+
+_Legal penalties on Duelling._
+
+Simply wounding one’s antagonist in a duel is now a capital offence. To
+shoot at a person, though no bodily injury ensue, is a felony punishable
+with transportation for life. (Stat. 7 Will. IV. and 1 Vict. c. 85.)
+Challenging another to fight a duel, and using opprobrious language with
+intent to provoke a person to send a challenge, are misdemeanours at
+common law.]
+
+
+NOTE XIV. Chap. iv. § 13. p. 108.
+
+_Duelling._
+
+In the usages of the ancient Germans, evident traces of duelling may
+be discovered. But it was employed by them either as an appeal to the
+justice, or to the prescience, of the gods. Velleius Paterculus informs
+us that questions, decided amongst the Romans by legal trial, were
+terminated amongst the Germans by arms or judicial combat[159]. Tacitus
+describes it as a species of divination, by which the future events of
+important wars were explored[160]. A captive from the enemy was compelled
+to fight with a man selected from their own nation. Each was accoutred
+with his proper weapons, and the presage of success was determined by the
+issue of the battle. A law is quoted by Stiernhöök[161], which shews
+that judicial combat was at first appropriated to points respecting
+personal character, and that it was only subsequently extended to
+criminal cases and to questions relative to property. The terms of the
+law are, “If any man shall say to another these reproachful words, ‘You
+are not a man equal to other men,’ or, ‘You have not the heart of a
+man,’ and the other shall reply, ‘I am a man as good as you;’ let them
+meet on the highway. If he who first gave offence appear, and the person
+offended absent himself, let the latter be deemed worse than he was
+called; let him not be admitted to give evidence in judgement either for
+man or woman, and let him not have the privilege of making a testament.
+If the person offended appear, and he who gave the offence be absent,
+let him call upon the other thrice with a loud voice, and make a mark
+upon the earth, and then let him who absented himself be deemed infamous,
+because he uttered words which he durst not support. If both shall appear
+properly armed, and the person offended shall fall in the combat, let a
+half compensation be paid for his death. But if the person who gave the
+offence shall fall, let it be imputed to his own rashness. The petulance
+of his tongue hath been fatal to him. Let him lie in the field without
+any compensation being demanded for his death.”
+
+Montesquieu, on the authority of Beaumanoir, whom he quotes with great
+respect, deduces the rise and formation of the articles relative to
+the point of honour from the following particular judicial usages. The
+accuser declared in the presence of the judge that such a person had
+committed such an action; the accused made answer that he lied; upon
+which the judge gave orders for the duel. Thus it became an established
+rule, that, whenever the lie was given to a person, it was incumbent
+on him to fight. Gentlemen combatted on horseback, completely armed;
+villeins fought on foot, and with bâtons. The bâton, therefore, was
+regarded as an instrument of affront, because to strike a man with it was
+to treat him as a villein. For the like reason, a box on the ear, or blow
+on the face, was deemed a contumely, to be expiated with blood; since
+villeins alone were liable to receive such disgraceful blows, as it was
+peculiar to them to fight with their heads uncovered[162].
+
+Practices like these were so congenial to the proud and martial spirit
+of the times, as well as to the superstition which prevailed, that they
+became universal throughout Europe. But it is evident that they could not
+fail to subvert the regular course of justice, diminish the authority
+of government, and violate the sacred ordinances of the Church. For the
+clergy uniformly remonstrated against, and even anathematized them, as
+adverse to Christianity; and the civil power frequently interposed, to
+set bounds to usages, which its authority was too feeble to suppress.
+Henry I. of England, in the twelfth century, prohibited trial by combat
+in all questions concerning property of small value. Louis VII. of France
+issued an edict to the same effect. St. Louis, who was a distinguished
+legislator, considering the rude age in which he reigned, attempted a
+more perfect jurisprudence by substituting trial by evidence in place of
+that by combat. And afterwards it became the policy of every monarch,
+who possessed power or talents, to explode these relics of Gothic
+barbarism. By degrees the practice became less and less frequent: courts
+of judicature acquired an ascendancy; law was studied as a science, and
+administered with great regularity; and the ferocious manners of the
+inhabitants of Europe yielded to the arts of peace, and to the benefits
+of social and civilized life. But an event occurred in the year 1528,
+which both revived the practice of single combat, and gave a new form
+to it, more absurd and fatal. The political and personal enmity, which
+subsisted between the Emperor Charles V. and Francis I., led the former
+to commission the French herald, sent to him with a denunciation of war,
+to acquaint his sovereign, that he should from that time consider him
+not only as a base violator of public faith, but as a stranger to the
+honour and probity of a gentleman. Francis instantly sent back the herald
+with a cartel of defiance, giving the Emperor the lie, and challenging
+him to single combat. Charles accepted the challenge; but, it being
+impracticable to settle the preliminaries, this romantic and ridiculous
+enterprise of course was never accomplished. The transaction, however,
+excited such universal attention, and reflected so much splendour and
+dignity on this novel mode of single combat, that every gentleman thought
+himself entitled, and even bound in honour, to draw his sword, and to
+demand satisfaction of his adversary for affronts trivial and even
+imaginary[163]. The best blood in Christendom was shed; personages of the
+first distinction were devoted to death; the ease, the familiarity, and
+the confidence of private intercourse were interrupted; and war itself
+was hardly more destructive to life and to its dearest enjoyments than
+this fatal and seductive frenzy[164].
+
+Evils of such magnitude required adequate remedies; and all the terrors
+of law were every where exerted to repress them. But they have hitherto
+been employed in vain: nor is it likely that sanguinary punishments will
+prevail, because the dread of such punishment would be deemed equally
+dishonourable with the fear of death in the chances of combat. A heavy
+fine, strictly levied, would operate with greater force on some of the
+most active principles of the human mind; and if it amounted to half,
+or one third, of the convicted person’s fortune, (such portion being
+placed in chancery, for the benefit of his heirs or children,) this
+privation would not only extend to his comforts and accommodations, but
+would be felt as a species of infamy, by depriving him of the means of
+maintaining his rank and station in life. Lord Verulam has proposed
+the following remedy for duelling; which, if effectual with men of
+quality, would soon disgrace the practice amongst those of inferior
+degree[165]:—“The fountain of honour is the King and his aspect, and
+the access to his person continueth honour in life, and to be banished
+from his presence is one of the greatest eclipses of honour that can be;
+if his Majesty shall be pleased, that, when this court shall censure
+any of these offences in persons of eminent quality, to add this out of
+his own power and discipline, that these persons shall be banished and
+excluded from his court for certain years, and the courts of his Queen
+and Prince, I think there is no man that hath any good blood in him,
+will commit an act that shall cast him into that darkness, that he may
+not behold his sovereign’s face.” This proposal of Lord Verulam seems to
+receive some confirmation from a story related by Lord Shaftesbury in his
+“Characteristicks[166].” “A certain gallant of our court, ... being asked
+by his friends, why one of his established character for courage and good
+sense would answer the challenge of a coxcomb, confessed, ‘that for his
+own sex, he could safely trust their judgement; but how should he appear
+at night before the maids of honour?’”
+
+Thus the principle on which duelling is founded, is now neither an appeal
+to the justice of Heaven, nor an expression of resentment for wrong
+sustained; but generally a mere punctilio of honour, which would affix a
+stigma on the character for courage of him who omits to offer, and on the
+opponent who declines the acceptance of, a challenge. Hence forgiveness
+of injury and reparation from the consciousness of having committed it,
+those noble sentiments of just and generous minds, are wholly precluded
+in the intercourse of fashionable life.
+
+A very able moralist, whom I have often quoted with peculiar
+satisfaction, has reduced the question concerning duelling, as now
+practised, to this single point: whether a regard for our own reputation
+is, or is not, sufficient to justify the taking away the life of
+another. “‘A sense of shame,’” says he, “‘is so much torture; and no
+relief presents itself otherwise than by an attempt upon the life of our
+adversary.’ What then? The distress which men suffer by the want of
+money is oftentimes extreme, and no resource can be discovered but that
+of removing a life which stands between the distressed person and his
+inheritance. The motive in this case is as urgent, and the means much the
+same, as in the former; yet this case finds no advocates.
+
+“For the army, where the point of honour is cultivated with exquisite
+attention and refinement,” continues the same excellent writer, “I would
+establish a _Court of Honour_, with a power of awarding those submissions
+and acknowledgements, which it is generally the purpose of a challenge
+to obtain; and it might grow into a fashion with persons of rank of all
+professions, to refer their quarrels to this tribunal[167].”
+
+An institution, like the one thus forcibly recommended by Dr. Paley,
+might probably have prevented the late fatal duel between Colonel
+Montgomery and Captain M’Namara. The address of the latter to the
+gentlemen of the jury gives just grounds for this opinion, and claims
+on that account the attention of the legislature. “Gentlemen,” said he,
+“I am a captain in the British Navy. My character you can only hear
+from others; but to maintain my character in that station, I must be
+respected. When called upon to lead others into honourable danger, I must
+not be supposed to be a man who had sought safety by submitting to what
+custom has taught others to consider as a disgrace. I am not presuming
+to urge any thing against the laws of GOD, or of this land. I know
+that, in the eye of religion and reason, obedience to the law, though
+against the general feelings of the world, is the first duty, and ought
+to be the rule of action: but in putting a construction upon my motives,
+so as to ascertain the quality of my actions, you will make allowances
+for my situation[168].” In referring to the foregoing disastrous case,
+it is proper to notice, that a Surgeon of considerable eminence, who
+attended on the field of combat in his _professional capacity_, was on
+this account arrested and sent to Newgate by a warrant from the civil
+magistrate as a _principal_ in the alleged murder, having been present at
+the duel and antecedently privy to it. Nor was he liberated from prison
+till the grand jury had rejected the indictment.
+
+It has recently been stated in one of the periodical prints, that a law
+to prevent duelling was passed in the general assembly of North Carolina
+during their last session, by which it was enacted, “That no person
+sending, accepting, or being the bearer of a challenge, for the purpose
+of fighting a duel, even though no death should ensue, shall ever after
+be eligible to any office of trust, power, or profit in the state, any
+pardon or reprieve notwithstanding: and that the said person shall
+further be liable to be indicted, and on conviction shall forfeit and
+pay the sum of one hundred pounds to the use of the state. And if any
+one fight a duel, by which either of the parties shall be killed, then
+the survivor, on conviction thereof, shall suffer death without benefit
+of clergy; and the seconds shall be considered as accessaries before the
+fact, and likewise suffer death[169].”
+
+I shall insert the following communication from my late venerable friend
+Dr. Benjamin Franklin, on the subject of duelling, because the deliberate
+opinion of a man peculiarly distinguished by perspicacity, soundness
+of judgement, and extensive knowledge of the world, cannot fail to be
+interesting to the reader. The letter was written in the 79th year of his
+age, and evinces the same vein of humour which characterized him through
+life. A few passages are omitted, being merely complimentary and personal.
+
+ “_Passy, near Paris, July 17, 1784._
+
+ “Dear Sir,
+
+ “I received, yesterday, by Mr. White, your kind letter of May
+ 11th, with the most agreeable present of your new book. I read
+ it all before I slept.... It is astonishing that the murderous
+ practice of duelling, which you so justly condemn, should
+ continue so long in vogue. Formerly, when duels were used to
+ determine law-suits from an opinion that Providence would in
+ every instance favour truth and right with victory, they were
+ more excusable. At present they decide nothing. A man says
+ something, which another tells him is a lie. They fight; but,
+ whichever is killed, the point in dispute remains unsettled.
+ To this purpose they have a pleasant little story here: A
+ gentleman in a coffee-house desired another to sit farther from
+ him. ‘Why so?’ ‘Because, Sir, you smell offensively.’ ‘That is
+ an affront, and you must fight me.’ ‘I will fight you, if you
+ insist upon it, but I do not see how that will mend the matter;
+ for, if you kill me, I shall smell too; and if I kill you, you
+ will smell, if possible, worse than you do at present.’—How can
+ such miserable sinners as we are, entertain so much pride as to
+ conceive that every offence against our imagined honour merits
+ death? These petty princes, in their own opinion, would call
+ that sovereign a _tyrant_, who should put one of them to death
+ for a little uncivil language, though pointed at his sacred
+ person. Yet every one of them makes himself judge in his own
+ cause, condemns the offender without a jury, and undertakes
+ himself to be the executioner.
+
+ “Our friend Mr. Vaughan may perhaps communicate to you some
+ conjectures of mine, relating to the cold of last winter, which
+ I sent him in return for the observations on cold of Professor
+ Wilson. If he should, and you think them worthy so much notice,
+ you may shew them to your Philosophical Society, to which I
+ wish all imaginable success. Their rules seem to me excellent.
+
+ “With sincere and great esteem, I have the honour to be your
+ most obedient, and most humble servant,
+
+ B. FRANKLIN.”
+
+
+NOTE XV. Chap. iv. § 16. p. 114.
+
+_Punishment of the crime of Rape._
+
+The atrocity of this crime appears to have been variously estimated at
+different periods, and in different countries; if we may judge from the
+diversity of punishments inflicted on the perpetrators of it. The reader
+will find a copious and interesting enumeration of them in a volume
+entitled, “A View of Ancient Laws against Immorality and Profaneness,”
+by John Disney, M.A. Cambridge, 1729, fol. I would refer him also to the
+“Principles of Penal Law,” by Mr. Eden, now Lord Auckland. As both these
+valuable works are out of print, a few extracts from each may form an
+acceptable addition to the present note.
+
+“The Burgundian laws provided, that, if the young woman carried off,
+returned to her parents actually corrupted, the offender should pay six
+times her price; [that is, six times her _weregild_, or legal valuation;]
+and also a mulct (to the Crown, I suppose,) of twelve shillings. If he
+had not wherewithal to pay this, he should be given up to her parents,
+or near relations, to take their revenge of him in what way they
+pleased[170].”
+
+By the law of Æthelbert, the first Christian king of Kent, it was
+enacted, that, if any person take a young woman by force, he shall
+pay her parent or guardian fifty shillings; and shall make a farther
+composition for her ransom. If she were espoused, he shall compensate
+the husband by an additional payment of twenty shillings: but if she
+were with child, the augmented fine shall be five and thirty shillings,
+and fifteen more to the king[171].
+
+There is an ordinance of King Alfred, for the punishment of rapes
+committed upon country wenches who were servants, an offence which may
+be supposed to have been prevalent at that time. It is delivered in the
+following terms:—“Si quis coloni mancipium ad stuprum comminetur, quinque
+solidis colono emendet, et sexaginta solidis mulctae loco. Si servus
+servam ad stuprum coëgerit, compenset hoc virga sua virili. Si quis
+puellam tenerae aetatis ad illicitum concubitum comminetur, eodem modo
+puniatur, quo ille qui adultae servae hoc fecerit[172].”
+
+By the Welsh laws of Prince Höel Dha, if two women were walking together
+without other company, and violence was offered to either or both of
+them, it was not punishable as a rape; but if they had a third person
+with them, they might claim their full legal redress. If the perpetrator
+of a rape, being accused, confessed the fact, besides full satisfaction
+to the woman, he was to answer for the crime to his sovereign, by the
+present of a silver stand as high as the king’s mouth, and as thick as
+his middle finger, with a gold cup upon it, so large as to contain what
+he could take off at one draught, and as thick as the nail of a country
+fellow who had worked at the plough seven years. If the offender was not
+able to make such a present, _virilia membra amittat_.
+
+Sir Edward Coke states this offence as a felony at the common law,
+which had a punishment, “under such a condition as no other felony had
+the like.” The criminal was adjudged “amittere oculos, quibus virginem
+concupivit; amittere etiam testiculos, qui calorem stupri induxerunt.”
+
+In the ancient law of England, exclusive of the punishment inflicted on
+the criminal, his horse, greyhound, and hawk, were also subjected to
+great corporal infamy: but the woman who was the sufferer might prevent
+all the penalties, if, before judgement, she demanded the offender for
+her husband. The Roman law was in the same spirit:—“Rapta raptoris aut
+mortem aut indotatas nuptias optet;” upon which there arose what was
+thought a doubtful case: “Una nocte quidam duas rapuit; altera mortem
+optat, altera nuptias[173].”
+
+
+[NOTE XVI. Chap. iv. § 18. p. 120.
+
+_Medical Evidence at Inquests._
+
+By the Act (6 and 7 Will. 4. cap. 89.) a Medical man is liable to a
+penalty of £5 for failing to attend when summoned upon an inquest: he is
+entitled to a fee of one guinea for his attendance, and to another guinea
+in case of a _post mortem_ examination.]
+
+
+Deo Gloria.
+
+
+FOOTNOTES:
+
+[103] Hume’s _Inquiry concerning the Principles of Morals_, sect. vi. pt.
+1. (or _Essays_, vol. ii. p. 272.)
+
+[104] See Adam Smith’s _Theory of Moral Sentiments_, pt. vi. sect. 3.
+vol. ii. p. 158.
+
+[105] [_Essays_, § 12. (_Works_, vol. ii. p. 271.)]
+
+[106] See the Introduction to _Philosophical and Literary Essays_, by Dr.
+James Gregory of Edinburgh, p. clxxxvii.
+
+[107] The learned editor, Lipsius, observes in his note on this passage,
+“Persarum similis mos, ... et Cretensium, ... et Graecorum omnium
+veterum.”
+
+[108] _Duties of Men_, chap. 12. vol. ii. p. 150.
+
+[109] Chap. 12. vol. ii. p. 159.
+
+[110] [Gisborne calls him “an _eminent_ writer.” There is a similar
+instance of Percival’s modesty below, p. 155.]
+
+[111] Percival’s _Medical Ethics_, chap. i. § 23.
+
+[112] [Rom. iii. 8.]
+
+[113] Horace, _Sat._ i. 1. 106.
+
+[114] [Alluding perhaps to _De Mendac._ c. 21. § 42. tom. vi. p. 444. ed.
+Bened., or to _Cont. Mendac._ c. 20. § 40. tom. vi. p. 472; but if so,
+St. Augustine’s meaning is not quite correctly given in the text.]
+
+[115] _De Jure Belli ac Pacis_, lib. iii. cap. 1. sect. 10 [9?] §§
+2-4.—See also cap. 1. sect. 14-16.
+
+[116] Spavan’s Puffendorff, vol. ii. chap. 1. p. 6.
+
+[117] _Ibid._ p. 9.
+
+[118] Leechman’s biographical Preface to Hutcheson’s _System of Moral
+Philosophy_, p. xxiv.
+
+[119] _System of Moral Philosophy_, bk. ii. ch. 10. § 4. vol. ii. p. 32.
+
+[120] [Rom. iii. 8.]
+
+[121] _System of Moral Philosophy_, bk. ii. ch. 17. § 7. vol. ii. p. 132.
+
+[122] See Boswell’s _Life of Johnson_, June 13, 1784.
+
+[123] [St. Matth. vii. 12.]
+
+[124] Pliny, _Epist._ iii. 16.
+
+[125] Lady Rachel Russell’s _Letters_; Note to Letter 149.
+
+[126] _Essays_, bk. ii. ch. 37. p. 703. [654. ed. 1711.]
+
+[127] _Anecdotes of some Distinguished Persons_, vol. ii. p. 386.
+
+[128] _Life of Sydenham._ (_Works_, vol. xii. p. 182.)
+
+[129] In the Preface to his _Treatise upon the Small-Pox_.
+
+[130] [In the Dedication to his _Observationes Medicae_.]
+
+[131] Johnson’s _Life of Sydenham_, p. 183.
+
+[132] [§ 1. vol. i. p. 32.]
+
+[133] See Bulæi _Hist. Univers. Paris._, tom. iii. p. 158; Henry’s _Hist.
+of Great Britain_, bk. iv. ch. 4. § 1. vol. viii. p. 206.
+
+Dr. Freind has given a somewhat different account of the celebrated
+School of Salerno:—“Sunt in eo decem Doctores, qui sibi invicem, juxta
+creationis ordinem, succedunt. Candidatorum examinatio severissima est,
+quae fit aut in Galeni _Therapeuticis_, aut in primo primi _Canonis_
+Avicennae, aut in _Aphorismis_. Is qui Doctoratum ambit unum ac viginti
+annos habere debet, (verum hic lapsum subesse autumo, cum scribendum
+sit _viginti quinque_ vel _septem_,) ac testimonia proferre, quae per
+septem annos eum Medicinae studuisse doceant. Quod si inter Chirurgos
+recipi cupiat, anatomiam per anni spatium didicisse hunc oportet:
+jurandum ei est, fidelem se ac morigerum Societati futurum, praemia a
+pauperibus oblata recusaturum, neque Pharmacopolarum lucri participem
+fore. Tum liber in ejus manum traditur, annulus digito induitur, caput
+laurea redimitur, atque ipse osculo dimittitur. Multa alia statuta sunt
+ad praxeos ordinationem pertinentia; Pharmacopolae praesertim, ut juxta
+Medici praecepta componant medicamenta, et ut ea certo pretio divendant,
+obligantur.” _Hist. Medic._ (in _Oper. Med._ p. 537.)
+
+[134] Consult Seb. Bacmeisteri _Antiq. Rostock._ [in Westphalen’s _Monum.
+Ined. Rer. German._, tom. iii.]; Crevier, _Hist. de l’Univers. de
+Paris._, tome i. p. 96; and Robertson’s _Hist. of Charles V._, vol. i.
+Note 28.
+
+[135] Johnson’s _Life of Addison_. (_Works_, vol. x. p. 85.)
+
+[136] _Ibid._ (?)
+
+[137] See _Cod. Theodos._ xiii. 3. § 8.
+
+[138] _Annal._ xi. 5, 7.
+
+[139] Of this truth it has been my duty and inclination to offer several
+proofs, of unquestionable authority, in different parts of the present
+work. Two additional ones now occur to my recollection, which I shall
+here insert. Mr. Pope, writing to Mr. Allen concerning his obligations
+to Dr. Mead and other Physicians, about a month before his death,
+says:—“There is no end of my kind treatment from the Faculty. They are
+in general the most amiable companions and the best friends, as well as
+the most learned men I know.”—The Rev. Dr. Samuel Parr, in a letter, with
+which he honoured me in September 1794, thus expresses himself:—“I have
+long been in the habit of reading on Medical subjects; and the great
+advantage I have derived from this circumstance is, that I have found
+opportunities for conversation and friendship with a class of men, whom,
+after a long and attentive survey of literary characters, I hold to be
+the most enlightened professional persons in the whole circle of human
+arts and sciences.”
+
+[140] Pt. i. § 3.
+
+[141] See _Biographia Britannica_.
+
+[142] [Or _Works_, vol. iii. p. 485.]
+
+[143] [Dr. Parr adds, “and a _Percival_.” See above p. 133.]
+
+[144] Chap. 12. vol. ii. p. 191.
+
+[145] Lect. 2. p. 64.
+
+[146] Lect. 2. p. 68.
+
+[147] [Ps. cxxxix. 14.]
+
+[148] See Percival’s _Father’s Instructions_, pt. iii. p. 312. (_Works_,
+vol. i. p. 277.)
+
+[149] [Alluding probably to _Alcib. II._ pp. 141 sq., 150 sq.]
+
+[150] [2 Tim. i. 10.]
+
+[151] _Essays_, § 42. (_Works_, vol. ii. p. 343.)
+
+[152] [See Hudson’s _Directions for Making Wills_, where more minute
+information on the subject may be found.]
+
+[153] _Hist. Placitor. Coronae_, pt. i. ch. 4. p. 30.
+
+[154] See Walpole’s _Cat. of Royal and Noble Authors_, vol. i. p. 188;
+also Percival’s _Moral and Liter. Dissert._, p. 82. (_Works_, vol. ii. p.
+52.)
+
+[155] See _Biogr. Britann._ (ed. Kippis,) Art. “Simon Browne.”
+
+[156] _Lettres sur les Ecrits et le Caractère de J. J. Rousseau._
+
+[157] The reader is referred to Dugald Stewart’s _Philosophy of the Human
+Mind_, ch. 7. § 5, for some admirable remarks on the evils which result
+from an ill-regulated imagination.
+
+[158] For further details the reader may consult Dr. Winslow’s edition
+of the Act, (1845, small 8vo.) from which the following observations are
+taken, p. 32 &c.
+
+[159] _Hist. Rom._ ii. 118.
+
+[160] _German._ c. 10.
+
+[161] _De Jure Sueonum et Gothorum Vetusto_, i. 7. p. 76; quoted by
+Robertson, _Hist. of Charles V._, vol. i. Note 22.
+
+[162] See Montesquieu, _De l’Esprit des Loix_, liv. xxviii. ch. 20.
+
+[163] See Robertson’s _Hist. of Charles V._ bk. v.
+
+[164] The History of Lord Herbert of Cherbury, who lived in the reigns
+of Queen Elizabeth and James I., fully exemplifies the folly and danger
+of adopting false principles of honour. During the abode of this
+romantic nobleman at the Duke of Montmorenci’s, about twenty-four miles
+from Paris, it happened one evening that a daughter of the Duchess de
+Ventadour, of about ten or eleven years of age, went to walk in the
+meadows with his lordship and several other gentlemen and ladies. The
+young lady wore a knot of riband on her head, which a French chevalier
+snatched away, and fastened to his hatband. He was desired to return it,
+but refused. The lady then requested Lord Herbert to recover it for her.
+A race ensued; and the chevalier, finding himself likely to be overtaken,
+made a sudden turn, and was about to deliver his prize to the young
+lady, when Lord Herbert seized his arm, and cried out, “I give it you.”
+“Pardon me,” said the lady, “it is he who gives time.” “Madam,” replied
+Lord Herbert, “I will not contradict you, but if the chevalier do not
+acknowledge that I constrain him to give the riband, I will fight with
+him.” And the next day, he sent him a challenge, “being bound thereto,”
+says he, “by the oath taken when I was made Knight of the Bath.” See the
+Life of Lord Herbert of Cherbury; also Percival’s _Moral and Literary
+Dissertations_, p. 299. (_Works_, vol. ii. p. 206.)
+
+[165] _Charge against Duels._ (_Works_, vol. iv. p. 403.)
+
+[166] _Advice to an Author_, vol. i. p. 273.
+
+[167] Paley’s _Moral and Political Philosophy_, bk. iii. pt. ii. ch. 9.
+
+[168] See _Annual Register_, for 1803, p. 14*.
+
+[169] See _Courier_, March 9, 1803.
+
+[170] [Disney, Tit. i. chap. 9. p. 174.]
+
+[171] [See Disney, _ibid._ p. 177 &c.]
+
+[172] [See Wilkins, _Concil. Magn. Britann._, vol. i. p. 193.]
+
+[173] [See Eden, chap. 22. p. 239.]
+
+
+
+
+_Published (uniform in 16mo.) by John Churchill, Princes Street, Soho,
+London._
+
+
+LIFE OF DR. BATEMAN. _In the Press._
+
+DR. WARE ON THE DUTIES AND QUALIFICATIONS OF PHYSICIANS. 1849.
+
+CODE OF ETHICS OF THE AMERICAN MEDICAL ASSOCIATION. 1849. 8_d._
+
+REV. F. D. MAURICE ON THE RESPONSIBILITIES OF MEDICAL STUDENTS. _Second
+Edition._ 1849. 9_d._
+
+LIFE OF MR. TRYE. 1848. 1_s._
+
+GISBORNE ON THE DUTIES OF PHYSICIANS, resulting from their Profession.
+1847. 1_s._
+
+HUFELAND ON THE RELATIONS OF THE PHYSICIAN to the Sick, to the Public,
+and to his Colleagues. 1846. 9_d._
+
+LIFE OF DR. GEORGE CHEYNE. 1846. 2_s._ 6_d._
+
+LIFE OF DR. BURDER. 1845. 4_s._
+
+BURDER’S LETTERS FROM A SENIOR TO A JUNIOR PHYSICIAN, on the Importance
+of Promoting the Religious Welfare of his Patients. 1845. 6_d._
+
+LIFE OF SIR JAMES STONHOUSE. 1844. 4_s._ 6_d._
+
+ADDRESS TO A MEDICAL STUDENT. _Second Edition. In the Press._
+
+PRAYERS FOR THE USE OF THE MEDICAL PROFESSION. _Second Edition._ 1849.
+1_s._ 6_d._
+
+_The profits of these little works, if any, will be given to some Medical
+Charity._
+
+ANECDOTA SYDENHAMIANA. _Second Edition._ 16_mo._ 1847. 2_s._
+
+
+
+
+PROSPECTUS.
+
+
+ “_It would certainly form an agreeable task, and might not
+ be unprofitable, to rescue from oblivion the memorable
+ instances of Medical men, in whom piety was combined with high
+ attainments and professional eminence, whose acquirements were
+ duly appreciated by their contemporaries, and whose learned or
+ useful writings have transmitted their names with honour to
+ posterity._” (Pearson’s _Life of Hey_, Preface, § 7.)
+
+1. It is proposed (with GOD’S assistance,) to publish in a series the
+lives of those Physicians who have been most eminent for their piety, in
+whatever age and country they may have lived.
+
+2. The profits (if any,) arising from these publications will be given
+eventually to some Medical Charity.
+
+3. In this undertaking the Editor will be happy to receive literary
+assistance from such of his friends as may take an interest in the work.
+
+4. As the whole of the present expense and risk falls upon the Editor
+alone, he will gladly accept any donations or subscriptions in aid of the
+design from persons who may feel an interest in it.
+
+5. The lives will of course vary much in length, some forming each a
+volume of itself, and others constituting a distinct class consisting of
+much shorter notices. The volumes will not be published in any particular
+order, but they will be strictly uniform in size, type, &c.
+
+6. The number of volumes to be published annually must depend on the
+amount of money received either from the sale of the works, or from the
+donations of friends.
+
+7. The Editor will be answerable for the general accuracy and fidelity of
+the narratives, for the tone and spirit of the whole work, and for the
+selection of the lives to be published; and accordingly he will be deeply
+pained, if any person of piety and good sense shall consider, either
+that he has inserted in his list any name but those of Physicians really
+fearing GOD and loving CHRIST, or that he has published any life written
+in a low or unchristian spirit: but, as it is proposed to comprehend
+Physicians of all ages and countries, and not merely those who have been
+members of the Church of England, (still less those who have belonged
+to this or that particular party in it,) it is manifest that neither
+the Editor nor the Writers are to be considered responsible for the
+particular theological opinions which any of these individuals may have
+held.
+
+_Oxford, All Saints’ Day, 1844._
+
+
+The Editor will be much obliged to any one who will furnish him with any
+Letters, Papers, or information of any kind, relating to the life and
+character of the following individuals.
+
+ JOHN ABERCROMBIE, M.D.; born 1781, died 1844.
+ THOMAS BATEMAN, M.D.; born 1778, died 1820.
+ SIR RICHARD BLACKMORE, M.D.; born ----, died 1729.
+ WILLIAM BLAIR; born ----, died 1822.
+ HERMAN BOERHAAVE, M.D.; born 1668, died 1738.
+ SIR THOMAS BROWNE, M.D.; born 1605, died 1682.
+ JOHN CHEYNE, M.D.; born 1777, died 1836.
+ JOHN FOTHERGILL, M.D.; born 1712, died 1780.
+ JOHN D. GODMAN, M.D.; born 1794, died 1830.
+ JOHN MASON GOOD, M.D.; born 1766, died 1827.
+ ALBERT VON HALLER, M.D.; born 1708, died 1777.
+ JOHN HAMON, M.D.; born 1618, died 1687.
+ DAVID HARTLEY, M.D.; born 1705, died 1757.
+ PHILIP HECQUET, M.D.; born 1661, died 1737.
+ WILLIAM HEY; born 1736, died 1819.
+ JAMES HOPE, M.D.; born 1801, died 1841.
+ CHRIST. WILL. HUFELAND, M.D.; born 1762, died 1836.
+ JAMES KENNEDY, M.D.; born ----, died 1827.
+ JAMES MEIKLE; born 1730, died 1799.
+ PHILIP SYNG PHYSICK, M.D.; born 1768, died 1837.
+ BENJAMIN RUSH, M.D.; born 1745, died 1813.
+ JOHN RUTTY, M.D.; born 1698, died 1775.
+ THOMAS SYDENHAM, M.D.; born 1624, died 1689.
+ SAM. AUG. AND. DAV. TISSOT, M.D.; born 1728, died 1797.
+ MICHAEL UNDERWOOD, M.D.; born 1737, died 1820.
+ THOMAS WILLIS, M.D.; born 1622, died 1675.
+
+_Sept., 1849._
+
+*** END OF THE PROJECT GUTENBERG EBOOK 78821 ***
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