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                         THE HOSPITAL BULLETIN


      Published Monthly in the Interest of the Medical Department
                     of the University of Maryland

                          PRICE $1.00 PER YEAR

        Contributions invited from the Alumni of the University.
                    Business Address, Baltimore, Md.

                  Entered at the Baltimore Post-office
                        as Second Class Matter.

            VOL. V BALTIMORE, Md., APRIL 15, 1909      No. 2

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                THE ETHICS OF THE GENERAL PRACTITIONER.

             _An Address delivered Before the University of
                     Maryland Medical Association,
                            March 16, 1909_,

                          BY GUY STEELE, M. D.
                           Of Cambridge, Md.


A celebrated divine once said that the most difficult part of a sermon
was the selection of a proper text. I must thank the President of this
society for saving me this trouble. When, however, Webster's is
consulted for a proper definition of the word "Ethics," and it is found
to mean "The science of human duty," it would seem that he has chosen a
text almost too comprehensive for the limits of a short paper, even when
restricted to the "ethics of the medical profession." It may not be out
of place to thank him for the honor he has conferred upon me by deeming
one whose student days are scarce twelve years behind him worthy of
presenting this subject to you, for a paper on this topic is almost of
itself a sermon, and we naturally look up to those, whose many years of
experience and works have brought them prominence, for instruction in
morals and duty. Still, I take it, whether young or old, all of us like
to preach on fitting occasions, and not the least part of the
inspiration to effort is the character of the audience. My invitation
was to read a paper before the Clinical Society, and incidentally I was
told that some of the students had expressed a desire to be present.
Little, however, did I anticipate such a flattering attendance from them
when examination time so nearly approached, and it is evidence of a most
commendable spirit when they can bring themselves to take even an hour
of their most valuable time from study to devote to a consideration of
the moral duties and responsibilities which shall be theirs when they
shall have passed through the April ordeal. Much that I have to say
tonight will be directed especially to them, and if they or their elders
in the profession may in the years to come look back upon this night
with the recollection that I have more forcibly brought to mind some of
the old and half-forgotten maxims and axioms that make for a better and
purer professional life, I will have been more than repaid for the time
I have expended in the preparation of this paper.

In discussing the ethics of the general practitioner towards his
patient, I would have you remember that your first and most important
duty is to give to those who trust you the very best that is in you.

To you young men, full of enthusiasm for your new profession, and imbued
with Utopian ideas of the mission which you have undertaken for the good
of mankind, it would seem almost foolish for me to mention this as the
first advice I would offer you. But I think I can see a smile of
understanding flit across the faces of those who have for some years
fought the battle of life, and who have had the wire edge of early
ambitions and determinations blunted by contact with unappreciative
patients and unworthy professional competition and the daily incidents
of a busy life. They know that it is very easy to feel too tired, or be
too busy, or have some other engrossing affair in mind which prevents
that entire devotion to duty which all admit is essential to success in
medicine. Half of success in life or in any undertaking is due to a
successful start; therefore, let me ask you to firmly determine on one
or two fixed principles, and to stick to those principles through thick
and thin. Be fully assured that no halfway devotion to your profession
will ever bring you prominence or success. The time-worn phrase that
"Medicine is a jealous mistress" loses none of its truth by frequent
repetition. Recently I saw in a prominent medical journal the advice
given that doctors should take a prominent part in politics and bring
themselves forward in other ways, and that thereby in some way unknown
to me the glory of the profession would be enhanced, and much benefit
result to the community. Far be it from me to discourage a proper civic
spirit and a proper interest in public affairs, or to advise an
avoidance of any duty which good citizenship imposes upon every honest,
patriotic man, whatever his business or profession. But I take it that
no more baneful, no more dangerous advice can be given to our young
professional man than this. You cannot be successful in both politics
and medicine, and while we can point to one member of our profession in
the United States Senate, and to some notable exceptions in our own
State, where men of our profession have, for a time, abandoned medicine
and returned to it to win success, you can rest assured that the medical
politician possesses little beyond a musty diploma to remind the world
that he was once of our cult. So don't be a halfway politician and
halfway doctor. Success in either field will take all of your best
effort and all of your time.

What I have said of politics will apply, though not quite so forcibly,
to any other engrossing business or pleasure. Time forbids me to
elaborate this idea, and in concluding it let me say that you cannot be
a successful politician, merchant, sport or what not and carry medicine
as a side line.

It may seem useless to remind you that, in order to give the best that
is in you, you must keep abreast with what is new and best in
professional literature and scientific progress. You all have determined
to be students, and even those who pride themselves on having passed
through the University without having opened a book have a half-formed
desire to really know something beyond spotting a possible examination
question, and when once examinations are over, and they have reluctantly
withdrawn themselves from the delights of the city by gaslight for the
pine woods and mountain trail, they will burn the midnight oil and
browse diligently through their musty tomes. May I tell you that nothing
is harder than to find time for study. Many of us, even though city men,
with the best and latest literature at our elbows, are ashamed to think
how thoroughly we abhor the sight of a medical book or magazine, and how
easily we can persuade ourselves that we are too tired and stale, and so
engrossed during the day with scenes of sickness and suffering that we
must have our brief hours of release from duty for recreation. We do
need our hours of relaxation and rest and our too infrequent holidays,
and they are absolutely essential to good health and good work. Don't,
however, confuse the words rest and relaxation with sloth and idleness,
and don't think your professional work completed when your round of
daily visits is done. Indeed, if you would know medicine you must woo
your mistress in the small hours of the night, and in many of the
leisure moments that the day may bring you.

Much has been spoken of the man who practices by common sense, and whose
school has been that of observation and hard experience. A most worthy
brother he is at times, and many are his friends and wonderful his
success. But if the science of medicine is to advance, more is required
for progress than mere common sense, and observation untrained and
experience undirected and unguided by the observation and experience of
others will rarely discover a new bacillus or elaborate a side chain
theory. So, to be truly ethical in the duty you owe to give the best
that is in you, you should be reading men. Take one or more of the
medical journals. Buy for reference the latest and best text-books. Make
the opportunity to read the daily papers and something of current
literature. A well-rounded man can afford to do nothing less. Besides
the information you obtain, it pays in the respect of the community to
have the reputation of being posted in your profession. Often the
country man simply hasn't time at home to read. A busy life, with its
miles upon miles of dusty roads to travel, precludes all chance for the
easy chair. Then cultivate the habit of reading while driving. Many are
the useful and happy hours I have spent in my carriage with my journals
and magazines. I am frank to say that, but for this habit, I never could
have found time for one-half of the reading I have done. Last year I was
somewhat amused when a most worthy, well-educated and well-posted man
summed up his opinion of another by saying that he was one of those who
read magazines in his carriage. If I mistake not, this indictment was
brought against the late Dr. Miltenberger, who as a young and busy man
was forced to form this habit, and I could but think that, could I die
with half the honor and respect and love that were his, I could plead
guilty to even this mark of devotion to my profession and desire to
advance in it.

Would you be ethical in giving the best that is in you to your patients,
you must give ungrudgingly of your time. This may again seem a useless
piece of advice, and yet almost all of us are familiar with the man
whose motto is "Veni, Vidi, Vici"--"I came, I saw, I conquered." This
intuitive diagnostician is by no means a myth. The man who comes in a
rush and goes in a rush, and who, with pencil in one hand and
prescription pad in the other, feels the pulse while the thermometer is
under the tongue; who sees at a glance, without necessity of personal or
family history or of physical examination, just what is the matter, and
who, giving four or five prescriptions, rushes out, trusting that
something in his shotgun therapy may hit the enemy. Perhaps the next day
he prescribes four or five more remedies or combination of remedies, and
should the patient begin to improve, prides himself that he has made and
confirmed a diagnosis by his experimental therapy. Is it necessary for
me to say that no ethical man with any regard for the rights of his
patients and his obligation to his profession can really practice
medicine in this manner? The plea that you are too busy to give the
proper time to your cases is no justification for your neglect. Anything
less than a careful inquiry into family and personal history, followed
by a painstaking and thorough physical examination, is unjust to your
patient and unjust to yourself. No ethical man can give the best that is
in him by doing less than this. If you haven't the time to do your work
thoroughly, make a clean breast of the matter and take fewer cases. But
you will say that a man, even in large practice, cannot afford to give
any of it up. He needs every dollar that honestly comes his way, and to
say that he hasn't time for his work is only another way of throwing
practice into the hands of a rival. This is, indeed, a proposition hard
to solve, as most of us do need every dollar that honestly comes our
way; but if our work is only half done, if we have neglected some
important point in diagnosis, and thereby omitted some equally important
measure in treatment, have our dollars been honestly earned? Let us
start out with and carry in mind this axiom of a truly ethical life,
that success in medicine cannot be measured by commercial success; that,
while no sensible man can neglect the business side of his vocation, or
refuse to demand and collect just compensation for his service, such
compensation cannot be measured in dollars and cents alone; that a good
conscience and whole-souled devotion to duty, giving ungrudgingly of the
very best that is in you to those that have confided in you, will be
your very best asset when the final account is made up.

May I impress the fact upon you that an ethical man, with a just
appreciation of his duty to his patients, can never be a vendor of
patent or unofficial medicines. Indeed, I would be lacking in my duty
if, with the opportunity this paper offers me, I did not, from the
standpoint of experience, impress upon you with all of the force at my
command the necessity of being wary of the detail man and the alluring
advertising literature with which your mail will be flooded. You will
scarcely have opened your office, and be waiting with what patience you
can command that rush of the halt, the lame and the blind to which you
feel that your talents entitle you, before the suave detail man, having
heard of the new field, puts in