If any man should be so "peculiar," or "crotchety," as to consider that names are of little import, and that "Vice is vice, for a' that," and venture to anathematize any custom, or even refuse to be an accessory, in declining to wink at it, he may encounter charges of violating professional confidence, of being deficient in a proper esprit de corps, and be outvoted, for no better reason than that he cannot concur in the dogma, that a vicious sophism is more valuable than a simple truth; nor agree with the currier, "that leather is the best material for fortification." He may possibly be let off by conceding his connivance; which is little better than declining to be thief, as too shocking; but having no objection to the more lubricated position of the receiver.
But does any one for one moment believe that all this can be hung on any trade, or profession, with no effect? Or that it will not have a baneful influence on every calling, and that in proportion as its real and proper duties are beneficent and exalted? Now, whilst we claim for the medical profession a character which, in its single-mindedness and benevolence, yields to no other whatever, we fear it is not entirely free from these technical besettings.
In the medical profession, we trust, that which we, for want of a better term, designate as technical immoralities are exceptions. Exceptional they may be, and we sincerely hope they are; but, in a crowded island, exceptions, even if relatively few, may be absolutely numerous; and whenever they occur, especially if men hold any position, one case of compromise of duty does more harm than a hundred of the most inflexible adhesions to it can remedy. Suppose a patient apply to a surgeon with a complaint requiring one operation, and his fears incline him to another; he is informed it is improper for his case: that so far from relieving him, it will indefinitely increase his sufferings. The patient reiterates his wishes; the surgeon declines doing that which he would not have done in his own person. On lamenting what he believes to be the consequences of the patient's determination, to a brother surgeon, he is met by: "What a fool you must be to throw away —— guineas; if you don't do it, somebody else will."
He is too right in his prediction, and so is the surgeon who refused to operate, and he has lost a large fee; he receives the verification of his prediction subsequently from the patient, who exclaims, "Sir, I never have a moment's ease!" and when, after weeks of suffering, the patient dies, the surgeon consoles himself with the melancholy satisfaction of not having contributed to sufferings which he was called in too late to remedy.
The more plastic practitioner has, it is true, taken fifty or a hundred guineas, it may be, out of the one pocket, and put it into his own; but in what way are mankind benefited? or does any one really think that the apparent gainer can ultimately be so? The fault in this, as in many other cases, is the ignorance of the public. There is nothing in the foregoing sketch that was not as easily intelligible to the commonest understanding, as that two and two are equal to four! And is it no evil that one man should pay so large a sum for so plain a piece of honesty? or that another should be rewarded, as the case may be, for ignorance, or a compromise of his duty?
Let us take another case. A gentleman was called on to give a certificate; he examined the case, and found that the wording of the certificate called on him to certify to that which was diametrically opposite to the fact. He naturally declined, and, as the point was of some importance, went to the parties to explain. He was then informed that two professional men had, the previous day, given the certificate without hesitation. He is complimented on his conscientiousness, but never employed again by that family; and he has the further satisfaction of hearing that his place is supplied by one of his more accommodating brethren! We fear that in such a case there is a balance to be adjusted between the several persons, and an appropriate appellation to be discovered besides. We respectfully leave it to the reader's judgment to adjust the one, and to draw on his aptitude for nomenclature to supply the other.
Again, a man is called in to a consultation; he disapproves of the treatment, but declares to the friends of the patient that every thing has been very properly done. In another case of consultation, finding that every thing has been really conducted properly, he commences an apparently different treatment, but essentially the same, without giving his confiding brother the benefit which his acquiescence in his views would necessarily imply.
In an operation, where the course is doubtful and the opinion various, the choice is left to the patient—that is, the decision of how the surgeon is to act is to be determined by him who is confessedly really least capable of judging. Can it be right to perform a doubtful operation under such circumstances? Should not the patient reflect that the temptations are all on one side? The attempt to dispense with the operation is laborious, time-consuming, anxious, encouraged perhaps only by small, minute accessions of improvement, interspersed with complaints of tedium and delay, and the result admitted to be doubtful; the operation, on the other hand, is a work of a few minutes, the remuneration munificent, the éclat productive, and the labour nothing. All this and much more no man can entirely prevent; the real cause is the ignorance of the public, which a very little of the labour they bestow on many far less important subjects would easily and quickly dispel.
If these and multitudes of similar things are evils; if they contribute to debase a profession and to charge the conscientious with unthankful office and unrequited labour, and to confer fame and profit on a triumphant chicanery; we surely must feel indebted—not only as professional men, not merely as patients, but in a far higher and wider sense—to a man who, availing himself of a commanding position for the highest purposes, endeavoured, by precept and example, to oppose all such proceedings, and to cultivate a high morale in the conduct of the profession. Now no one more sedulously aimed at this than John Abernethy. Although we shall not, we trust, be accused of underrating the obligations we owe him in a professional or scientific sense, we think that, great as they are, they are at least equalled by those arising out of that duty-to-your-neighbour spirit which was so universally diffused through every thing he taught, and which, in his intercourse with his pupils, he never on any occasion failed to inculcate. We will endeavour to render what we mean intelligible, and perhaps we cannot do this better than by selecting a few illustrations from observation of "Abernethy in Consultation."