Physician and patient

by Worthington Hooker

FOOTNOTES:

[44] Our profession, to its honor be it spoken, has as a whole, done much for the cause of temperance. “Dr. Rush,” says Dr. Stevens, “paved the way to the great Temperance reform, and that cause, at a later period, had no advocates more powerful than Dr. Sewall of Washington, and Dr. Watts of New York, formerly President of the College of Physicians and Surgeons. Among the living it now reckons Dr. Warren of Boston, and Dr. Muzzy of Cincinnati, and a host of other medical men.” It gives me much pleasure to state in this connection, that at the great entertainment given by the physicians of Massachusetts to the National Convention, at which there were more than six hundred present, ‘the feast of reason and the flow of soul’ were ample and rich without the aid of the intoxicating cup.

CHAPTER XIX.
TRIALS AND PLEASURES OF A MEDICAL LIFE.

The physician has his peculiar trials, and also his peculiar enjoyments. The principal of these it is my intention to notice very briefly and cursorily in this closing chapter.

Let us first look at the trials of a medical life.

The physician is subjected to great fatigue both of body and mind. He has no time that he can call his own. That regularity of life, which is so essential to comfort as well as to health, he must in a great measure abandon, especially if he practice in a scattered population. While most men have their stated seasons of repose, he is liable to be called for at any hour, and often night after night sleep is a stranger to his eyelids. His duties to his patients are often of such immediate importance, that no stress of weather, however violent, is considered as an excuse for delay. When prevailing disease spreads terror through the community he must be at his post, and expose himself to the pestilence under the influence of powerful predisposing causes—anxiety and fatigue. And then there are at all times anxieties and perplexities, producing a wear and tear of mind, which is worse than all the bodily fatigue that he is called to endure. It is not surprising then, that it has been satisfactorily ascertained by statistics, that physicians constitute one of the short-lived classes of the community.

And for all this generally the medical man gets comparatively a small compensation. Though some physicians acquire wealth, especially in our large cities, still as a body of men they are in moderate circumstances, and the practice of medicine may be truly said to be far from being a money-making business. A large proportion of those whom they serve are too poor to give them any compensation, and very many of those who are able to pay them do not without reluctance and delay. This, it is true, is in part to be attributed to the remissness of physicians in presenting their claims. But why this remissness? If I mistake not, it arises from the unwillingness to pay, which they so often meet with, even in quarters where they have no reason to expect it. The consequent dislike to the business of collecting begets a habit of neglecting it. A large proportion of their patients feel a less urgent obligation to pay them, than they do to pay others. I know not any other reason for this than the intangibility of the favor which is bestowed by the physician. If a man buy a coat of the tailor, or a barrel of flour of the grocer, he has a tangible memento of his obligation; for the coat is seen, and is felt upon his back, and the flour is eaten, and makes its sensible impression on the palate and stomach. But health restored is a thing of air, and the visits of the physician, as they have left no memorial behind them that addresses the senses, are easily forgotten. For the same reason a man will not so easily forget his obligations to his physician if he has amputated a limb for him, as he would if he had attended him through a course of fever. His crutch or his wooden leg, is ever present to remind him of them. And for the same reason also, as the tailor and grocer can get their pay more readily before the coat is worn out, and the flour is eaten up, than they could a long time afterward, so the physician is more cheerfully paid immediately after returning health, than he can be at any future period.

While the physician is ordinarily but poorly compensated for all his toil and anxiety, he is obliged often to see the quack and hobby-rider amassing wealth by their gross impostures. Often does the scientific and laborious practitioner, who is adding from his daily observations rich treasures to the recorded experience of the profession, suffer from the res angusta domi, while he sees some proprietor of a patent medicine, the recipe for which he purchased of some recreant physician, or filched from some medical book, acquiring a fortune almost in a day, or some ignorant pretender, adopting some system just then high in the popular favor, as Homœopathy for example, making in a brief year or two all the display of a wealthy citizen. And the offensiveness of such cases is enhanced by the fact, that many of the well-informed and the learned unite with the multitude in casting contempt upon the labors of science, by upholding the pretensions and filling the coffers of sheer imposture.

The facility, with which the public are imposed upon in regard to medicine, is a prolific source of vexation and trial to the scientific and high-minded physician. He is subjected to a constant encounter with false opinions, unfounded prejudices, unreasonable caprices, and gross misapprehensions. He hears ignorance in high places, as well as in low, putting forth its oracular opinions, as it sits in judgment upon his practice, and that of his brethren. The most reckless criticisms are made upon his mode of treatment in individual cases, and the most inconsiderate and wanton aspersions are cast upon his professional character.

If the practice of imposition were confined to those who are without the pale of the profession, it would be a trial which could be borne with comparative ease. But when the physician sees his own brethren stooping to an occasional use of the arts of the charlatan, and obtaining success thereby, even among the better portion of the community, while they do it so covertly that they do not lose caste with the profession, it is a sore trial to his spirit. He cannot but regard such men as the chief enemies of the honor of his profession, though they may talk loudly of their attachment to it, and as real opposers of the advancement of medical science, though they may make a great show of zeal in its pursuit. And yet so adroitly do they manœuvre, that they generally escape exposure. This sly quackery, which is practised by so many medical men, provoking an indignation, to which it will do no good to give utterance, is one of the prominent trials of the truly honorable physician.

It is a severe trial to the feelings of the humane physician to see valuable lives sacrificed to a blind trust in ignorance and unskilfulness. He is occasionally obliged to witness such a sacrifice, and ordinarily under such circumstances that any interference on his part would do no good, however strangely he may be urged to it by the dictates of humanity. If he utter the warning voice, however clear the case may be, it will be ascribed to interested and unworthy motives. He may feel deeply for the poor sufferer who is to be sacrificed, and for the family who are to be thus bereaved by the ruthless hand of unskilful ignorance; but hard as it is to hold his peace, he in most cases feels that he must do it, because if he do otherwise, he will not only spend his breath in vain, but will add to the evil by his ineffectual opposition.

The many sad scenes in which the physician is obliged to mingle must often make him sorrowful, if he has not suffered his feelings and sympathies to be destroyed by a total dereliction of principle. As he watches with earnestness the struggle which occurs in severe cases between life and death for the mastery, and does what he can to give it a favorable issue, how deep is his anxiety, how painful the sense of his responsibility, what balancings of hope and fear does he experience; and then when the dread moment comes, when after all this pressure and conflict of feeling, the physician becomes persuaded that the issue is certain to be fatal, how is his spirit borne down with the burden of his grief! And then, too, there are cases, in which, though he has from the first had strong hopes of a favorable termination, all at once a train of symptoms arises, threatening immediate destruction. And to add to the painfulness of the case, perhaps the friends of the patient have not perceived the change, so secret has it been. As he goes to make his usual daily visit, cheered with the expectation of finding his patient better, he is overwhelmed with surprise when he sees, as he enters the sick chamber, that death is rapidly and surely doing its work. Besides seeing his own hope extinguished in a moment, he feels an unutterable pang in the necessity, thus suddenly pressing upon him, of destroying the hopes of the fond friends by whom the patient is surrounded.

In the Chapter on the Moral Influence of Physicians, I have spoken of the intimate relation, in which the physician stands to so many families, and of the strength and tenderness which his attachment to them acquires, by the exercise of an active sympathy during a long series of years. The accumulation of sympathy which thus occurs deepens the sorrow which he feels, as he sees in the case of some member of a family, upon which he has long attended, that his efforts are unavailing, and that the resources of his art are all exhausted. And as the friends gather round the bed of death, though by a habit of self-control he has an air of composure which is generally attributed to want of feeling he makes one of that circle, entering into their griefs as the sympathizing friend, as well as the faithful physician. And the very confidence which is reposed in him, gratifying as it is, sometimes adds poignancy to his grief. ‘You saved my life, and why cant you save my husband?’—said a woman to me in the extremity of her agony, when I told her that it was not possible for her husband to recover.

Another circumstance which adds to the sorrow of the physician in such seasons, especially when long acquaintance has created a strong personal attachment, is the total want of preparation with which many come to the hour of death. Even if the physician be not a religious man, this consideration must press upon him at times with a painful interest, if he has the common feelings of humanity. Especially will this be the case, when he is obliged to witness some of those horrible scenes, which sometimes occur in the last hours of a career of vice.

The sorrowful scenes, which the physician witnesses occasionally in the ordinary routine of his business, come with a painful frequency, when some fatal epidemic is prevalent in the community. Then night and day his mind is filled with anxiety. The sorrows of bereavement continually call for his sympathy. And in the midst of all this, he avoids solicitude for his own safety, only by forgetting himself in the arduous duties which he performs for others’ welfare. While he sees others fleeing from the pestilence, he must be ever at his post. Though he may see some of his brethren falling around him, humanity demands of him that he should go on in his services to the sick, and to the honor of our profession I believe it may be said, that this demand is very seldom disregarded. During the prevalence of the yellow fever in Philadelphia in 1793, of the thirty-five physicians who remained in the city, eight (nearly one fourth of the whole number, died, and but three escaped an attack of the disease).

One of the greatest trials which the physician has to bear is the ingratitude of those upon whom he has conferred favors. There are services rendered by the medical man who is faithful to his high trust, for which no money is an adequate compensation. His reward for such services comes from two sources—the satisfaction always attending the performance of duty, and the gratitude of those to whom they are rendered. The wealthy by no means discharge in full their obligations to the physician, who attends upon them in all their sickness with unwearied fidelity, when they pay him in full for his attendance. They owe to him the affection of a true friendship, and the gratitude due to something more than a professional performance of duty in their behalf. The relation of a physician to his employers is not shut up within the narrow limits of mere pecuniary considerations. There is a sacredness in it, which should forbid its being subjected to the changes incident to the common relations of trade and commerce among men. But many do not so regard it. They dismiss a physician for as slight a reason as governs them in ceasing to buy of one man, and giving their patronage to another, or, as Dr. Rush says, “with as little feeling as they dismiss a servant, or dispose of a family horse.” A mere whim, or caprice, is often suffered to dissolve this relation, though it may have existed for years. And generally the more frivolous and unfounded the reason for the change, the greater will be the zeal with which they laud their new favorite, and the harsher will be the aspersions, which they will cast upon the professional character of the old and tried friend, whom they have deserted.

Strange as it may seem, it is the experience of every physician, that some of the strongest evidences of ingratitude come from some of those upon whom he has conferred the highest favors, perhaps those which are entirely gratuitous. One would suppose that they who have had the services of a physician without making him any compensation, would from motives of delicacy refrain from speaking ill of him, if they chose to discharge him and employ another. But blame is sometimes dealt out without stint under such circumstances. It would be supposed also that the obligation, which a gratuitous attendance imposes, would always be gratefully recognized by the patient. But it is often otherwise. Many patients are disposed to forget such obligations; and everything which may call them up to their attention, and especially to the attention of others, is carefully avoided. Dr. Rush speaks of some who had been attended gratuitously in humble life, who deserted their family physician after their elevation to rank and consequence in society, “lest they should be reminded, by an intercourse with him, of their former obscure and dependent situation.”

There is not as much gratitude in the world as is commonly supposed. This is particularly true of the services of a physician. These are received by many, as a matter of course, as being something to which they have a sort of natural right. They seem to class them among the common blessings, such as air and water, for which, because they are so common, they have no idea of being grateful. Day after day, and week after week, they may be the objects of the physician’s most assiduous attentions, and his exertions may be blessed, and obviously so, to the preservation of life; but when health comes they will grudge him even the pittance of a half day’s labor from those hands to which his skill has restored strength, though they spend days and weeks every year in the most shiftless idleness. Quite a large proportion of the poor treat the physician in this way.

An old physician of my acquaintance was used to say that there are three kinds of poor—the Lord’s poor, the devil’s poor, and poor devils; that is, the virtuous poor, the vicious poor, and those who are poor from sheer shiftlessness. The virtuous poor are always grateful; and there are none among the wealthy upon whom the physician attends more cheerfully, than he does upon some of this class. Of his kind offices to them, and of their feelings in return to him, it can be said in the beautiful language of Scripture, ‘When the ear heard me, then it blessed me; and when the eye saw me it gave witness to me: because I delivered the poor that cried and the fatherless, and him that had none to help him. The blessing of him that was ready to perish came upon me; and I caused the widow’s heart to sing for joy.’ As the physician goes his daily rounds, there is no one thing that so cheers him on in his course of toil and benevolence, as the gratitude of the virtuous poor. And if there will be tears shed at his death beyond the little circle of friends, in the very bosom of which he lives, they will shed them profusely and long.

Not so, however, with the other two classes of the poor. The shiftless poor, who were denominated by my aged friend ‘poor devils,’ who go just as wind and tide will take them, and carry to ultraism the principle of letting to-morrow take care of itself, are actually too lazy to have so lively a feeling as gratitude. And of the vicious poor it may be said, that it requires something more than the selfish principles of this world to attend upon them with cheerful faithfulness. There is often, it is true, much show of gratitude; but it is seldom, though it is sometimes, more than mere show. The romance of doing good will not stand this trial. Nothing short of the untiring benevolence of Christianity will do it. Sometimes, indeed, so much effect is produced upon the views and feelings of the poor by the bounty and kind attentions of the benevolent, that an actual reform is effected, and an abode of vice and misery is converted into one of virtue and happiness. Then, of course, the most lively gratitude is manifested. But it is rarely so. We must apparently throw away much time and effort, and it is only once in a great while that our hearts can be cheered by any obvious good results, or any real gratitude. Benevolence does now and then seem to have a magic wand, with which, almost in a twinkling, she turns scenes of gloom and desolation into those of beauty, and makes even the wilderness to blossom as the rose. But she is generally employed in real drudgery with little immediate prospect of success. She digs and digs patiently, and with the animation of hope. She finds but few gems; but these, be it remembered, will survive all the changes of time, and will shine in her coronet forever.

It is true that gratitude is sometimes awakened in the heart of the vicious poor, even when our influence does not produce any improvement in their moral condition. But it has only a momentary existence, and, amid the giddy whirl of grovelling enjoyments, our kindness is forgotten, and the recollection of it is excited only by their returning necessities. And then too, the apathy, into which the heart is apt to be schooled by the miserable monotony of a vicious poverty, effaces every trace of feeling which may occasionally be impressed upon it. This state of heart may be read in the very countenance—the wooden features, which our kindness may have roused to some degree of animation, soon resume their wonted inexpressive fixedness after the exciting cause is gone. And often, very often, the favors we dispense are received with a vacant stare, the recipients being strangers themselves to any other motive than selfishness, and therefore taking no cognizance of the existence of anything like benevolence in the bosoms of others.

There is one class of the community that have been accustomed to be attended gratuitously by physicians, who have so often wounded the feelings of our profession by the course which they have pursued, that I cannot pass them by without a particular notice. I refer to clergymen. So scantily are they generally compensated for their services, and so intimate is the relation which they hold to our profession, that medical men have commonly very cheerfully made their attendance upon them gratuitous. This being the case, they have a right to expect of them, if not gratitude, at least a proper regard for their rights as professional men. But I am constrained to say that many of this class have failed to answer this reasonable expectation. The physician often finds, that the clergyman, upon whose family he has attended without charge, perhaps for a long time, gives his certificate in recommendation of some nostrum, or employs some quack, or becomes the noisy advocate of some new system just now rising into popular favor, or perhaps, in his zeal for his sect, becomes the active patron of some practitioner of his own denomination, urging him even upon the families of the physician whose services he has so long gratuitously enjoyed. Such acts as these on the part of men who have received such favors, and who by their station and character can exert so much influence, are among the most vexatious trials of a medical life.

The feelings of the physician are tried not only by the treatment of individuals, but by that general disposition against the medical profession, which is to some extent manifest in every community. If you look candidly upon the public benefits[45] which our profession has conferred upon society, to say nothing of its toils and self-denials, you will be impressed with the fact, that it does not receive that respect and that regard for its interests to which it is fairly entitled. The radicalism which aims to overthrow it is in some measure countenanced by many, of whom we have a right to expect better things. Many of the intelligent and well informed pay an occasional tribute to empiricism, and manifest a distrust towards medicine, which they do not manifest towards any other science. Though they would be sure to employ none but lawyers of known skill, and would sit under the teachings of none but well educated clergymen; if sickness comes, they resort to some secret nostrum, or employ some pretender, of whom perhaps they know little else, than that he calls himself a German, and has an abundance of hair about his visage; and if they have a dislocated or fractured bone, they abjure scientific surgery as unworthy of confidence, and send for a natural bone-setter. The reasons which secure their respect for other sciences fail altogether when they come to medicine. They even indulge in a playful contempt in speaking of its claims. They banish it from the pale of reason; and submit themselves to vagaries and fallacies and pretensions, the folly of which they would see at once in relation to any other subject. They refuse to give to either the science, or the profession, that steady esteem which is clearly due to it from all stable and intelligent men. In seasons of trial even, instead of extending to physicians their confidence and support, they reward their toils with an ungenerous and inconsiderate fault-finding. This ingratitude of the public is sometimes manifested in the most offensive manner. After the yellow fever in Philadelphia in 1798 had subsided, at a meeting of the citizens, in which the committee who superintended the city during the prevalence of the disease was honored with a vote of thanks, a similar vote was proposed in relation to the physicians, but was not even seconded, though, as I have stated in another place, nearly one fourth of their number perished, in their efforts to save that ungrateful people from the ravages of the pestilence.

Let us turn now to the consideration of the pleasures of a medical life. On this branch of the subject I shall be brief, not because the physician has few joys, for he has many, but because they require no extended notice to make the reader appreciate them.

If we look at medicine simply as a science it is full of interest, and the study of it is therefore a rich source of gratification. Its subjects have a wide range and an endless variety. No science has such extensive and intimate connections with other sciences.[46] It gathers to itself the resources of chemistry, botany, mechanics, comparative anatomy and physiology, and mental philosophy; and fills its storehouse of facts with a variety and abundance sufficient to satisfy the wildest and most eager curiosity. The phenomena of life even in the healthy condition are exceedingly diversified; but, as modified by disease, and by the remedies which are administered, their variations are never ending. And then the mysterious connection of mind and body not only varies them still more, but opens to us a mass of facts of a mingled mental and physical character, which awaken an intense interest. The physician looks upon the human body, not merely as a machine filled with contrivances so cunning and elaborate, as to render all the mechanism of man in the comparison rude and bungling; but as a machine instinct with life, having a living nerve attached to every fibre of it, giving to it its power to act; and, more than all, as a machine holding in strange connection with its every fibre a reasoning soul, the image of the Deity, destined, not to perish like the mind of the brute with the perishing body, but to live through the ages of eternity.

The details of a science which treats of phenomena so interesting in their character, and so wide in their range, are never dry and uninteresting, as the details of other sciences sometimes are. There are no tedious technicalities, no dull abstractions. There is no tiresome monotony. There is therefore an absorbing enthusiasm in the pursuit of medical science, which is not so common in other studies. It is an enthusiasm which makes its votary disregard the loathsomeness of putrefaction, and even forget danger, in his search after truth.

An additional interest is given to his investigations by the consideration, that if he discover a fact, or help to establish one, he adds to the resources which our art can apply to the relief of human misery. To experience this pleasure, so gratifying to the humane and benevolent mind, he needs not to make any grand discovery. The joy which Jenner realized in the contemplation of the benefits of his discovery must have been almost overpowering; but the benefit which results to our race from the humblest contribution to medical knowledge is as real though not as great, and is a fitting subject for joy to him who makes it, for it will assuage many a pang and save many a life.

In the practice of medicine, though there is, as you have seen in my first chapter, much uncertainty, there is a high satisfaction in the very exercise of unravelling its perplexities, and in separating, as it can be done by untiring and careful observation, the certain from the uncertain, the true from the false. And though much is left to nature by the judicious physician, still there is much pleasure in watching her movements, in removing obstacles which oppose her salutary processes, and in assisting her efforts so far as it may be necessary to do so. This intelligent watch and guidance which medical skill exercises over nature in removing disease is far from being unsatisfactory to the rational practitioner. And then, too, though the general use of heroic remedies is injurious, there are times when the careful observer sees opportunities for employing them to great advantage in arresting morbid processes. And so accustomed is he to make the requisite discriminations, that his efforts in positive medication are well directed, and are almost sure to accomplish their object. He has a satisfaction in such achievements, of which the undiscriminating overdoser knows nothing.

The judicious physician experiences much gratification in the mental management of the sick. I refer not merely to the control which by his tact and skill he exercises over the mind which is manifestly deranged, but also to those multiplied and various mental influences which he exerts so silently, but so effectually, even in ordinary cases of sickness. Besides the pleasurable interest with which he watches the operation of these influences, there is also a high source of gratification in the consciousness of possessing such a power over the minds of his fellow men. Especially is this the case, when the power which he puts forth is exerted upon minds of great refinement, and of a high order of talent.

The results of the practice of the skilful and judicious physician are as a whole very gratifying to him. His vocation is to relieve pain and distress, and to deliver from disease; and when he fails to do this, sad as it is, it is an occasional, we may say a rare exception to the general result. In the great majority of even severe cases, in which the pressure of responsibility is such a burden upon his spirit, and the alternations between hope and fear are often so painfully exciting, his heart is at length gladdened by a favorable issue. The physician is therefore by habit a hopeful, a cheerful, a happy man. As such he enters the sick room, the scene of the triumphs of his art. As such he mingles in the family and social circles of his fellow men, inspiring by his very air and manner cheerfulness in the sad, and hope in the unfortunate and dispirited. The physician then is apt to be not only the sympathising, but the comforting friend.

But not only is the success with which he meets in combatting disease a source of happiness to the physician, but so also especially is the gratification of his humanity and benevolence, in relieving the distresses of his fellow men, and in prolonging their lives. In some cases in which the life which he has struggled to save is a valuable one, the joy which fills his heart at the final successful issue of that struggle no words can express.

It will be observed by the reader that in speaking of the gratification which is derived from the successful treatment of disease, I have had no reference at all to the reputation for success which is awarded to medical men by the community. This may be based upon real merit, or it may not be. When it is not, but is acquired by making false issues before the public, as is too often the case, it is indeed a source of gratification—a gratification, however, which is not only of a low order, but the hold which the possessor has upon it is exceedingly uncertain. He feels it to be so, and is in constant fear that some competitor, practising the same arts, will overmatch him in skill, and filch from him his ill-gotten joys. But on the other hand, the success of the honorable practitioner in acquiring a medical reputation, based as it is upon intelligent grounds, is a source of high gratification, and he has, too, the satisfaction of feeling that it is a permanent possession. True, there are some who employ and praise him from whim and caprice, who from whim and caprice may desert and blame him; but his patients are for the most part those who repose in him an intelligent and firm confidence. And this affords him a gratification, of which the caprices of the world and the intrigues of his brethren cannot despoil him.

The attachments which the physician forms in so many families in the different walks of life are rich sources of happiness. These attachments are generally reciprocal. In some cases the interest which he feels in the patient, beginning in infancy, and extending through many scenes of sickness up to adult age, has accumulated all this time more and more strength and tenderness. Sometimes in the long life of a physician, this interest in some families of patients reaches through three or even four generations. And these intimate attachments bring the physician into very near relation with some characters of rare excellence in the different walks of life. The admiration and the love with which he looks upon such noble spirits, of whom the world is not worthy, and the communion which he is permitted to have with them up to the moment of their departure to a world of bliss, are among the highest sources of the happiness of the physician.

The opportunity which the physician has for observing human character is a prolific source of enjoyment. It opens to him one of the most interesting of all studies, and in his daily intercourse with patients of every variety and degree, he finds no lack of material in illustration of any supposable variation of character.

The nature of the physician’s employment, it must be obvious to the reader, is calculated to fit him eminently to enjoy and to adorn social life. He is commonly the pleasing companion as well as the warm and faithful friend. The freedom of his intercourse with all sorts and conditions of men imparts an ease and a zest to his conversation, and he has an abundance of facts and anecdotes to illustrate every remark which may be made. It is for this reason, as Dr. Rush says, that “physicians in all countries have been the most welcome guests at the tables of the great, and are frequently waited for with the most impatience at clubs and in convivial companies.”

One of the chief sources of the happiness of the physician is the gratitude of his patients. I have already said enough upon this subject, and I would now simply remark, that, though there is much ingratitude which is a sore trial to him, many of his patients gladden him in the midst of his toils and anxieties with tokens of gratitude of the most delightful character. And among these tokens, the testimonials which he receives from the poor, humble as they are, are often more highly prized than the costly and splendid presents of the wealthy.

Finally, a great source of happiness is afforded to the truly benevolent physician in the opportunity which he has for exerting a good moral influence. When by his instrumentality the abode of vice and misery has been converted into one of virtue and peace, and especially when his counsel and influence have been the means of saving a soul from death, he has a higher joy than all success however brilliant, and honor however profusely awarded, and gratitude however ardent, can impart to his soul.

In conclusion I remark, that, though the trials and disappointments and mortifications of a medical life are numerous, very vexatious, and sometimes almost insupportable, yet the pleasures which come from the sources to which I have alluded vastly predominate over them all, and make the practice of medicine, when pursued with right motives, as a noble profession, and not as a trade, to be in the main eminently satisfactory and delightful.