TO THE SURGEON.
I congratulate you upon your recent emancipation from incessant study, intense application, and strict hospital attendance, where I shall willingly suppose, you was a dresser of the most promising abilities; that you excelled your cotemporaries in every chirurgical opinion, became an expert dissecting pupil to one of the court of examiners, and are now burst through the cloud of your original obscurity, a perfect prodigy of anatomical disquisition.
I naturally conclude you capable of animadverting upon all the distinct branches of your art to admiration, that you are critically excellent in the use of an instrument from the humble act of simple phlebotomy, to the more important operation for a fistula in ano.—You have, beyond every shadow of doubt, paid proper attention to the fashionable precepts of the late Lord Chesterfield, and rendered yourself (with assistance from the graces) a perfect adept in polite address, displaying a variety of the most engaging attitudes, even in the adjustment of a ten tailed bandage. The professional information you have industriously collected, is such as will certainly afford you the most equitable claims upon public opinion, being in possession of every necessary acquisition from a simple gonorrhœa to a confirmed lues.
Previous to your solicitation of favour from your friends, you have necessarily passed the awful ceremony of examination at the Old Bailey, under your former tutor (and his brethren of the court) who would not pay his own abilities so improper a compliment as to ask you questions in anatomy or osteology, that he knew your qualifications inadequate to the task of technically explaining. After passing this fiery ordeal, you deposit the usual pecuniary gratuity, and receiving the badge of your newly acquired honor, we now hail you “a Member of the Corporation of Surgeons,” and conclude an ornamental plate upon the door of your habitation denotes you so accordingly.
We suppose you embarking in a sea of spirited opposition, with your competitors, for professional celebrity, and decorating your place of residence in the most applicable stile to attract attention. To effect this, let your exterior apartments be ornamented with the busts of ancients you never read, and portraits of moderns that you never knew. These form an excellent combination to excite the admiration and report of those who have occasion to court the assistance of your extensive abilities.—To gradually heighten which surprize, your interior (or audit room) must be a perfect Golgotha.—A proficiency in the science of osteology, must be powerfully impressed upon the senses of the trembling visitors, by a profusion of skeletons in different states; let the awfulness of the scene be rendered still more striking, by a variety of subjects suspended in spirits, interspersed with singular anatomical and injected preparations, both wet and dry; giving to the whole additional force by the introduction of a “few ill shaped fishes,” as the finishing stroke to a well formed plan of chirurgical ostentation. Remember to let the certificates of your professional qualifications, from your different lecturing tutors, be so placed (in elegant frames) as to meet the eye in a conspicuous direction; lest that part of your patients, who condescend to visit you in this gloomy recess, should have reason to conclude you a consummate dunce and most illiterate booby, if these learned professors had not done your friends the favour to “certify” to the contrary: and this they always chearfully do, rather than have it imagined they have eased you of a part of your property, without doing you any real service.
The domestic arrangement being thus formed, the reflections to which you must now turn your mind, are the necessary modes of practice and behaviour, that may render you not only eminent in your profession, but respectable in your property; as great events, that contribute largely to the gratification of such wish, do not frequently occur, inferior cases of every kind must be rendered subservient to the purpose. In this list, venereals are entitled to pre-eminence, as the most lucrative; the patient never hesitating to pay full as liberally for the preservation of the secret as the cure of disease.—But you may be perfectly assured, this secret never rewards so well, as when fate or fortune assists its introduction to married families; a most striking corroboration of this fact, occurred not long since in the neighbourhood of a royal residence, and afforded matter of mirth to the first circles in its environs.—This constant friend to the faculty was communicated to a married lady, by a young and celebrated personage of some national eminence, and immediately conveyed from her to her enamoured cornuto in the moments of true connubial felicity; he, in the love of variety, unluckily conferred the favour upon the house maid; and she, in the extensive liberality of her disposition, kindly bestowed a portion upon the footman. The electrical shock of this French fire was so rapidly communicated, that the four sufferers, within the space of ten days, made their separate private confessions to the medical superintendant of the family, each assigning a different cause for its introduction, and equally strangers to the mode of its being brought into so sober a family. Although this is a well authenticated fact, it is a harvest that can be very seldom expected to happen in so great a degree; yet you will find it a matter often intruding between husband and wife, and considered no indelible proof of modern inconstancy.—To this secret, you will be frequently admitted by one party—the other, or both; and have an undoubted privilege to accumulate all possible pecuniary advantage from the confidence so implicitly placed in you.
Whatever cases are submitted to your opinion, be always prepared to represent them worse than they really are; making by your technical terms, and political doubts, bad worse upon every possible occasion. Let all your proceedings have a peculiar and commanding dignity annexed to the execution; by assuming a want of feeling, even to ferocity, you will be termed a practitioner of spirit, and become properly distinguished for your professional fortitude. No tender sensations must be permitted to influence your feelings during any operation, however tedious, or painful to the patient; they are an ornament to human nature, and beneath your consideration as one of the faculty.—Custom has rendered you ineligible to a place in the jury box, as an evident proof of your professional brutality; by therefore turning “their pains to laughter and contempt,” you only justify the character you are already in possession of.
In the most trifling operations (even phlebotomy) descend to the very minutiæ of medical consequence, not only making the ceremony long, but serious, that you may be the better entitled to personal respect and pecuniary compensation. In all those dreadful accidents that alarm friends and distress families, take care to throw out (during your apparent care and attention) a variety of observations that convey large sounds with little meaning; by such ambiguous expressions you render the cure more extraordinary, whenever it happens, and is no bad preparative for the procrastination of it to your own emolument. In all cases requiring the interposition of instruments, take great care that you produce them with mysterious solemnity, impressing the spectators and assistants, with equal awe and fear of your abilities; if incisions, or separation of the soft parts, become necessary, be sure, like “old Renault,” to “shed blood enough;” it will be attended with a double advantage; first in the appearance of business, and the more pleasing consideration, that the larger and deeper the wound, the longer time will be necessary for incarnation; during the course of which, your personal attendance and daily epithemas cannot be dispensed with.
The greater operations do not occur every day, therefore tedious cicatrizations, in addition to simple and compound fractures, are comfortable aids to fill up the spaces of intervention. Fractures of the lower extremities are exceedingly favourable, for you may then exert proper authority; it becomes your duty to keep them down when they are so, for surely you may take upon you to know (with propriety and professional privilege) when they are capable of standing and walking, better than they can themselves.—Tho’ one exception to this rule has fallen within my knowledge, and nearly set aside the privilege of the practice in the neighbourhood where it happened.
An honest hearty miller, in a small parish in the county of H———, having, on the market day, made some lucky purchases, and congratulating himself upon his good fortune with a few friends over the bottle, got himself insensibly intoxicated; but obstinately persisting in his determination (and ability) to ride home, he was suffered to depart, and was found afterwards upon the road by one of his own servants almost lifeless; he was conveyed to his habitation, and one of the most eminent surgeons from a certain large and populous town was called in, who finding the trunk nearly inanimate, proceeded to venesection, then to an accurate examination of the body, in which he presently discovered “a fracture of the tibia, and two of the ribs; he had every reason to apprehend (from present symptoms) a concussion of the brain; but situated as things were, he should now administer proper palliatives, and pursue the necessary steps upon his arrival in the morning.”—He then left the patient, after strict injunctions “that he should not be suffered to move from the position he had placed him in, till his return.”—At the hour before appointed, the Doctor returned, and not finding the wife below stairs, explored the region he had left his patient in the night before, surrounded by his sorrowful friends; when, strange to relate! (stranger to believe!) the bird was flown, the bed made, and the very room exhibited a striking proof of rustic neatness. Recovering in some degree from his surprise, and feeling very forcibly the aukwardness of his situation, he descended to the kitchen, and there finding the wife (who had just returned from some business in a back yard) he eagerly enquired “How, or which way, his patient had been conveyed, and where to?”—When the poor woman very simply and civilly replied, that “her husband was gone into the fields among his folks; that she had repeatedly urged the doctor’s orders of his not getting out of bed; but he was a very obstinate man, and said he’d be d—’d if he’d ever lay in bed with a broken leg for any doctor in England, so long as he could walk upon it.”—It may be better conceived than described how severe a stroke this proved upon the reputation of the surgeon; certain it is, his practice continued in a declining state for some years, and it was not till the circumstance was nearly buried in oblivion (with the body of the miller) that he recovered his former celebrity, being at this moment one of the oldest and most eminent practitioners in the neighbourhood where he resides.
This instance sufficiently demonstrates the impropriety of overstraining the professional prerogative, especially with those obstinate uncivilized beings, who have so little pliability of disposition, as not to lay in bed when required; particularly in cases of emergency, where it is so evidently for the promotion of their own health and safety.
Remember in all cases of difficulty and danger to be mindful of the emplastrum adhæsivum of connexion, by which every branch of the faculty should be united for the preservation of the whole; advise (without the least reference to the enormity of expence) a consultation of the most eminent; this renders the case of your patient more serious and alarming, and you oblige your brethren by the recommendation; first of a physician, whose prescription introduces the apothecary; and you then proceed physically and systematically in the joint depredation and cure; your two friends, by the law of retribution, gratefully recommending your inspection of every simple laceration upon all similar occasions.
These are maxims that may at first sight seem beneath the attention of a young and brilliant practitioner, who erroneously conceiving merit a sufficient recommendation, requires no other conductor; but they are so evidently an absolute part of his necessary study, that unless such mutual arts are occasionally put in practice, he can never (in the present multiplied state of practitioners) expect to derive the common necessaries of life from a fair and generous practice of his profession.
Men of understanding, experience, and observation, know, that the benignant hand of providence continues to anticipate in a variety of instances the interpositions of art; and nature would, upon many occasions, entirely effect her own work, if not so frequently interrupted and retarded by the officious hands and interested experiments of professional jugglers.
[TO THE ACCOUCHER,]
OR,
MAN-MIDWIFE.
You fortunately make your appearance upon the boards of public patronage, under the most striking advantages; the prevalence of fashion has exceeded every consideration of decency and discretion, and you are become (by the influence of pride and imitation) as necessary to the comfort of a cottage, as the happiness of a court. From the nature of your professional destination, a pleasing exterior, and an accomplished person, are invariably expected; necessarily blending (from your intended intercourse with the purer part of the creation) the precision of taste, with the perfection of the scholar.
The certificate granted you by that elaborate lecturer, the obstetric professor, proclaims you qualified in the very minutiæ of this mysterious art. The parts, externally and internally, necessary to generation, are so perfectly familiar to your “mind’s eye,” that you can extemporaneously delineate the ovariæ, the “fallopian tubes,” the fimbriæ, and the very act of conception, from the “animalculæ” in “semen masculino,” to the last stage of gestation; the gradual expansion of the uterus, the dilatation of the os uteri, the progress of labour, and all the methods of extraction.
You can clearly define the classes as natural, laborious, and preternatural; the use of the forceps, scissars, crotchet, and blunt hook; the introduction of the catheter, the extraction of the placenta, and the separation of the funis; in fact, all the et ceteras are so perfectly clear to you in theory, that it is almost treason to suppose you can err in the practice.
But, Sir, ripe as you are in these advantages, the harvest of universal applause, and the sweets of emolument, are scarcely to be acquired even by time, labour, and the most indefatigable industry. You have in the practice of midwifery, all the ills of Pandora’s box to encounter, and after twenty years practice may be left to exclaim most emphatically,
“Vain his attempt who strives to please you all.”
The only consolation you have, is, that you are destined to cooperate with subjects, whose smiles render some degree of compensation for the incessant fatigue dependant upon the practice. Under these considerations, in the full career of your expectations, it can never prove inapplicable to prepare your mind for some of the rebuffs and disappointments that inevitably ensue. I conclude you are possessed of youth, health, diligence, and constitutional stamina; but there are other requisites, equally necessary for the performance of professional duties, to which by election you dedicate the store of knowledge you have so industriously acquired. The indispensible qualifications, for the successful execution of the arduous task you are undertaking, may be comprised in very few words, and those few exceedingly expressive and readily understood; without sobriety, fortitude, judgment, and patience, you never can expect to attain the summit of excellence, or obtain admission to those families whose patronage will contribute most to both credit and emolument. But admitting you possessed of all the requisites for mere manual operation, the process of delivery, and consistency of conduct, yet there are a multiplicity of embellishments, that nothing but previous information, private instruction, or experimental practice, can sufficiently recommend to your attention.
In the awful minute of your introduction to a scene of excruciating agony and eager expectation, where the hope of a mother, and the anxiety of friends, all center in you, as the messenger of peace, throw off the ostentatious air of self-importance, exerted over those patient paupers upon whom you practised in the days of your initiation, and recollecting yourself the humble solicitant of public opinion and private favour, display your tenderness and civility, as no bad harbinger of your better qualifications. Strengthen such favourable impression by every degree of delicacy and attention to the suffering expectant, who imploring assistance from the interposition of your art, hails you as “the god of her idolatry,” by whom she is to receive an early acquittal from all her sufferings.
As this is not often to be instantly expected, and many tedious hours frequently intervene between the hope and execution, it will be necessary (exclusive of your periodical consolations to the patient’s inspiring resignation) you address yourself to the passions and foibles of the gossips, with whom you will in general be too numerously attended, and whose clamours upon many occasions are not easily to be subdued.—Notwithstanding this, the good opinions and recommendations of these motley visitors (of all ages and constitutions) are the very materials to form the foundation of report, upon which the superstructure of your reputation and future practice is to be raised.—Although gravity, even to a certain degree of solemnity, is a characteristic of your professional practice, yet there are times when you must unavoidably come forward to enliven the good ladies with a specimen of your volubility, and variegate the natural extremities of pain with the applicable insinuations of mirth. Jocular inuendoes and double entendres are not only expected, but courted in the intervals of ease, or, as the good women generally term it, “when the business stands still.”
The introduction of the tea-table and the joke are always considered equally promoters of mirth and the delivery; the practitioner is expected to be well stocked with the most fashionable recitals of seduction, rapes, fornication, and adultery, which, if well told, and applicably introduced, insures him to a certainty the future interests of his company. It will be absolutely necessary for you to fall into all the opinions of the table, except the glass of brandy repeatedly pressed upon you by the nurse (as a specific, or grand arcana, for every ill) with the very expressive plea of its not doing you any harm; and “besides, Sir, what’s good for the goose is good for the gander.”
After such casual respites (which frequently happen) when the progress of labour calls you again to your chair of office, resume the language of commiseration, giving your patient every alleviation of hope for a speedy deliverance, at the very time you are impressing (by significant looks and emphatic gestures) the attendants and friends with an idea of great difficulty and impending danger. In the alternate moments of respiration, evade every retrospective allusion to the length of the labour, by frequent insinuations that it advances rapidly, that you have great reason to hope every obstacle will be soon surmounted; but you are afraid the consolation you administer, and the pain she suffers, will take but little hold of the memory, if you may be permitted to judge from the declaration of a very pretty woman you delivered during your attendance at the Lying-in Hospital, who, in reply to your tender admonitions of fortitude and patience, said, “She was very much obliged to you for your kindness, but she was very certain it would be just the same again by that time twelvemonth.”—This will make way for any thing applicable of your own collection, but they must be all bordering upon the original cause of the scene before you; for although the patient is in extreme pain, it is not so with the attendants; they consider it a matter of course, and feel no disgust but from fatigue, which they very justly conceive they have a right to alleviate with occasional mirth—tea, and a little good brandy.
To the nurse, great part of your attention must be directed; for she, like a bellows blower to the organist at a cathedral, will expect to be included and constitute WE in all the merit of your execution.—The rapidity, or gradual progress of labour, at length closes your complicated scene of mirth and anxiety; you deliver your patient, and proceed to the subsequencies (secundem artem) all which having concluded to general admiration, and received ten thousand thanks and blessings from your subject, you convey a pecuniary hope for future services into the hand of the nurse, take a tender leave of your patient, with a promise of seeing her again in proper time, drop an attracting nod of obedience to the surrounding females, and meeting the husband at the bottom of the stairs, congratulate him upon his son or his daughter; slightly hint the difficulty of the case, the danger you apprehended, the fatigue you had undergone, all which is not worthy a thought, perfectly happy in an event that contributes so largely to the happiness of him and his family.
That part of the work being completed, that most depended upon the efforts of Nature, it becomes your duty to promote your own interest by every exertion of art. Should, after your departure, any hemorrage ensue, inevitable danger will be apprehended, the patient will be reduced, the friends alarmed, and you, in the moments of dreadful anxiety, be immediately sent for; this lucky circumstance will operate to your earnest wish; it will afford ample scope for your most fertile invention, and happily introduce a long list of styptics, anodynes, and all those necessary concomitants that give a profitable complexion to the business, by enlarging your hopes, protracting the case, and encreasing the danger.
However, should this favourable circumstance not occur, your privilege is by no means curtailed; you immediately commence your previous intentional operation of dispatching a sufficiency of balsamic anodyne draughts, “to promote and mitigate the severity of after pains, that very much distress the patient.” These draughts should be continued every four hours at least, and as a sufficient quantity of that excellent (and cheap) medicine, spermacæti, cannot be well dissolved in each draught, without rendering it too viscid in consistence, it will be peculiarly advantageous to you (as well as the patient) to let them be accompanied with boluses to be taken at the same time, composed of pulv. sperma—confect. alkermes, &c.—Let the administration of these medicines be entirely regulated by the temper, docility, and recovery of your subject; having it ever in mind, that it is neither your duty or interest to make the least observation upon their being no longer necessary, till their frequent use is complained of by the patient sufferer; and even then you are favoured by fortune in a plea, that you “are now under the absolute necessity of making unavoidable alterations for the prevention of the milk, or puerperal fever, which you very much apprehend may ensue.” That it is an invariable rule with you, never to recommend the use of medicines, but where they are highly necessary; in the present instance, it is your duty, from the motive of gratitude, to be equally circumspect, for the promotion of her health and your own reputation.
To effect every desirable purpose, a gentle diaphoresis must be supported, to prevent obstructions and promote the necessary excretions; to procure which, you must entreat most earnestly an implicit obedience to your directions, which from a variety of unpleasant symptoms becomes indispensible. To carry which point in a still greater degree, renew, at every visit, your attentions to the nurse (who in your absence is a vortex of knowledge, in your presence all obedience) her approbation of your conduct, and good opinion of your practice must be obtained at any price; it becomes with you a consideration of greater magnitude than your patient’s recovery; for should death no longer permit her presence in the scene of sublunary events, you lose one patient only; but with the good opinion and recommendation of the nurse, vanishes hundreds of patients in embryo, to be brought forth by the influence of her exaggerated reports of your incredible abilities.
The nurse once secured and attached to your interest, becomes an admirable instrument for the promotion of all your designs, she embraces every opportunity to strengthen your directions, and urges (as you have done) the continuation of medicine, “till, with the blessing of God, her mistress is quite set up and upon her legs again.” A proper reflection upon these subjects will convince you (even in the infancy of your embarkation) that a midwifery case in a good family is no bad thing, and made the most of, with the occasional aid of perpetual cardiacs,—balsamics,—carminatives, and anodynes, to ease and “quiet the child,” every time it coughs, or belches, constitutes a harvest of industry and political necessity, that the world in general is very little acquainted with.
Previous to the closing of the curtain, you have still an additional chance for more depredations upon the unfortunate husband; should stagnant milk occasion a coagulum in the lacteals, constituting a turgency of the breasts, threatening a formation of matter, suppuration becomes almost unavoidable, and you promote it accordingly; this leads to certain operation, daily dressings, &c. all tend to encrease your interest, and give you the enjoyment of a temporary monopoly in the joint practice of midwifery, surgery, and physic.