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Title: The Æsculapian Labyrinth Explored; Or, Medical Mystery Illustrated Author: William Taplin Release date: March 9, 2017 [eBook #54332] Language: English Credits: Produced by deaurider, Les Galloway and the Online Distributed Proofreading Team at http://www.pgdp.net (This file was produced from images generously made available by The Internet Archive) *** START OF THE PROJECT GUTENBERG EBOOK THE ÆSCULAPIAN LABYRINTH EXPLORED; OR, MEDICAL MYSTERY ILLUSTRATED *** Produced by deaurider, Les Galloway and the Online Distributed Proofreading Team at http://www.pgdp.net (This file was produced from images generously made available by The Internet Archive) THE ÆSCULAPIAN LABYRINTH EXPLORED; OR, MEDICAL MYSTERY ILLUSTRATED. IN A SERIES OF INSTRUCTIONS TO YOUNG PHYSICIANS, SURGEONS, ACCOUCHERS, APOTHECARIES, DRUGGISTS, AND PRACTITIONERS OF EVERY DENOMINATION, IN TOWN AND COUNTRY. INTERSPERSED WITH A VARIETY OF RISIBLE ANECDOTES AFFECTING THE FACULTY. INSCRIBED TO THE COLLEGE OF WIGS, BY GREGORY GLYSTER, AN OLD PRACTITIONER. “TWENTY MORE! KILL THEM TOO.”——BOBADIL. LONDON: PRINTED FOR G. KEARSLEY, NO. 46, FLEET-STREET. MDCCLXXXIX. [PRICE THREE SHILLINGS AND SIX-PENCE.] TO THE COLLEGE OF WIGS. “Most potent, grave, and reverend signiors, “My very noble and approved good” Doctors. The solemnity of your somniferous aspects, no less than the professional gravity of your external ornaments, lay claim to a bow of obedient recollection in passing through W—— k-lane to public inspection. As one of the most _popular_ descendants from your great progenitor, permit me to acknowledge, I revere the _vast extent_ of your _medical abilities_; that I feel most forcibly the _enormous weight_ of your _accumulated learning_, and _tremble_ at the very idea of your _experimental abilities_. Condescend, dread Sirs, to sanction this analization of _Æsculapian imposition_ and _medical mystery_, with such proof of approbation, as the dignity of a _diploma_, and the muscular rigidity of _physical countenance_ will permit you to bestow; nor let it be the less entitled to your favor, that a long list of _valetudinarians_ (to whom you are daily pensioners) become partakers of the _banquet of mirth_; or the small fry of _pharmacopolists_ (your humble dependents) _for once_ permitted to take a seat at the _same table_ with yourselves. Anxiously solicitous to obtain belief, that “I shall nothing extenuate, “Nor set down aught in malice,” you may in justice conclude me, _Sage Sirs!_ Your very candid, And obedient representative, GREGORY GLYSTER. THE ÆSCULAPIAN LABYRINTH EXPLORED. TO THE PHYSICIAN. Having passed the tedious years of abstruse study and intense application, necessary to your initiation in the mysteries of physic, and replete with a perfect remembrance of all the requisites to this _great art_, we suppose you recently emerged from the obscurity of _dreary walls_ and _dull professors_, a phenomænon of universal knowledge and _family_ admiration. The various and elaborate examinations you have passed, with scholastic approbation, having relieved you from the constantly accumulating load of anxiety, you are at length launched into life under a new character, and daily pant to display the dignity of your profession, in the happy appendage of _M. D._ to the prescriptive initials of your name. You are no longer to be considered a student labouring in the heavy trammels of _unintelligible_ lectures upon _philosophy_, _anatomy_, _botany_, _chemistry_, and the _materia medica_, with all their distinct and consequent advantages; or investigating the actual properties of _electrical fire_ and MAGNETIC ENTHUSIASM, but stamped (by royal authority) with the full force of physical agency, and have derived from your _merit_ unlimited permission to _cure_, “_kill_ or _destroy_,” to the best of your knowledge and abilities, “so help you “God.” The professional path you now begin to tread, is so replete with danger, and the probability of success so very uncertain, that the fertile world have not omitted to make it proverbial, “A physician never begins to get bread, till he has no “teeth to eat it.” The truth of this may perhaps have been _lamentingly_ acknowledged by some of the most _learned men_ that ever became dependant upon a _capricious_ world for _precarious_ subsistance. This palpable fact may concisely serve to convince you, your embarkation (with all its alluring prospects) will not only be encumbered with difficulties, but your ultimate gratification of success exceedingly doubtful. Great depth of learning may afford consolation to the equity of your own feelings (if you fortunately possess them) but it is by no means necessary to the acquisition of _public opinion_, however it may tend to contribute to the general good. To avoid entering into a sentimental disquisition upon the _honesty_, _integrity_, or _strict propriety_ of the maxims I proceed to lay down for your future conduct to obtain professional splendour, and _insure success_; I avail myself of the privilege I possess, to wave every consideration of the _conscientious kind_, and once more observe (without adverting to their consistency) they are adduced only as the unavoidable traits of character, and modes of behaviour, by which alone (in the present age) you can possibly hope for the least proportional share of practice as a physician. At your first public entré, when the college list and court calendar have announced your qualifications and advancement to the wondering world (that such list should annually increase) let your friends and relatives be doubly assiduous in propagating reports (almost incredible) of your _great humanity_, _extensive abilities_, and _unbounded benevolence_.—This will answer the intended purpose to a certainty; crouds of the afflicted and necessitous will surround your habitation, and render your place of residence constantly remarkable to all classes, who naturally enquiring the character of the proprietor, will eagerly extol your charity in contributing your “advice to the poor GRATIS.” This method alone will gain you popularity with those that rank in the line of mediocrity; with _their superiors_, success must be insured more from the efforts of _interest_, than either _personal merit_, or _sound policy_. Your attention to the wants of the poor, must soon be regulated by the preponderation of more weighty considerations; as you _affected_ to alleviate their distresses from the motive of commiseration, prompting you to promote _their ease_, you have an undoubted right to shake off such superfluous visits, to secure _your own_. In this deceptive charity, some degree of discrimination must be put in practice, for you will sometimes perceive one among the train, whose apparel or behaviour must necessarily give you reason to suspect he has assumed the cloak of necessity to save _his fee_, and avail himself of your professional liberality in such case, call to your aid a look of true _medical austerity_, and let him understand “advice is seldom of any value or “effect unless it is paid for;” this will frequently answer the purpose, and procure what you did not expect. On the contrary, so soon as you observe your prescriptions have “_worked wonders_” upon two or three of the most _credulous_ and _superstitious_, who are extolling your _great knowledge_ and “blessing _your honour_,” strengthen the _force_ of your judgment by _charitably obtruding_ a pecuniary corroboration into the hand of your afflicted patient, as a confirmation of your _unbounded skill_ in the (_miraculous_) cure of every disease to which the human frame is incident. By such _political_ practice, you insure the recital of your services with extacy, and your name reverberates from one end of the metropolis to the other. Your person and place of residence, being by these means universally known, and your name become in a proportional degree popular, let your plan and mode of behaviour be instantly changed; it will be now necessary “You “assume a” hurry “if you have it not,” Take care to be so exceedingly engaged with patients of the _first class and eminence_, that “it is with difficulty you procure time sufficient for the common purposes and gratifications of nature.” No paupers _whatever_ can be admitted to your presence without a written recommendation from _nobility_, or characters of the _first fortune_; this will insure you no farther intrusion from a class originally introduced for your _particular purpose_; that effected, they may now be permitted to fall into the back ground of the picture; from whence they were brought for no other motive than the promotion of your personal interest and professional emolument. It becomes your particular care to be always in a _hurry_; let your chariot (if you can fortunately raise one) _upon job_, be at the door regularly by nine in the morning; to prove how very much you are attached to the duties of your profession, and how anxiously you have the _salubrity_ of your patients _at heart_.—Omit no one circumstance that can contribute to a shew of being perpetually engaged. Letters written by _yourself_, and messengers of your _own dispatching_, cannot be seen at your doors too frequently; the chariot should be as repeatedly ordered—remember to leave home by _one way_, and return by _another_, and equally _in haste_; all these stratagems are considered peculiar privileges of the _College of Wigs_, and are well worthy your attention and constant practice. You need hardly be told, the superficial and unthinking part of mankind are ever caught by appearances; what proportion they bear to other distinctions, need not in the present instance be at all ascertained. Having laid down rules (that should be rigidly persevered in) for the regulation of your _public character_, I shall now advert to the strict line of conduct it will be proper for you to adopt in your personal transactions upon all professional emergencies. When called to a patient upon the recommendation of the family apothecary, you are to consider him one of your best friends, and _pay court to him_ accordingly; on the contrary, if you are engaged upon the spontaneous opinion of the patient, or his relatives, you have every reason to conclude the abilities of the apothecary are held in very slender estimation, and you may safely venture to display as much of your _own consequence_ and superiority, as circumstances will admit. After the awkward ceremony of your first appearance is over, and matters a little adjusted, take great care to be upon your guard; indulge in a variety of _significant gestures_, and _emphatical hems!_—and _hahs!_ proving you possessed of _singularities_, that may tend to excite ideas in the patient and surrounding friends, that _a physician_ is a superior part of the creation.——Let _every action_, _every word_, _every look_, be strongly marked, denoting doubt and ambiguity; proceed to the necessary enquiries of “what has been done in rule and regimen, previous to your being called in?” hear the recital with patience, and give your _nod of assent_, lest you make Mr. Emetic, the apothecary, your formidable enemy, who will then _most conscientiously_ omit to recommend the assistance of such _extraordinary abilities_ on any future occasion.—Take care to _look wisdom_ in every feature; speak but little, and let it be impossible _that little_ should be understood; let every hint, every _shrug_ be carefully calculated to give the hearers a wonderful opinion of your learning and experience.—In your _half-heard_ and mysterious conversation with your _medical inferior_, do not forget to drop a few observations upon—“the animal œconomy”—“circulation of the blood”—“acrimony”—“the non naturals”—“stricture upon the parts”—“acute pain”—“inflammatory heat”—“nervous irritability,” and all those _technical traps_ that fascinate the hearers, and render the patient yours ad libitum. To the friends or relatives of the diseased, (as the case may be) you seriously apprehend _great danger_; but such apprehension is not without its portion of _hope_; and you doubt not, but a rigid perseverance in the plan you shall prescribe, will reconcile all difficulties in a few days, and restore the patient (whose recovery you have exceedingly at heart) to his health and friends; that you will embrace the earliest opportunity to see him again, most probably at such an hour, (naming it) in the mean time you are in a great degree happy to leave him in such good hands as _Mr. Emetic_, to whom you shall give every necessary direction, and upon whose _integrity_ and _punctuality_ you can implicitly rely. You then require a private apartment for your necessary consultation and plan of _joint depredation_ upon the pecuniary property of your unfortunate invalid, which you are now going _seriously_ to attack with the full force of _physic_ and _finesse_. You first learn from your informant what has been hitherto done without effect, and determine accordingly how to proceed; but in this, great respect must be paid to the temper, as well as the constitution and circumstances, of your intended _prey_; if he be of a petulant and refractory disposition, submitting to medical dictation upon absolute compulsion, as a professed enemy to physic and the faculty, let your harvest be _short_, and complete as possible. On the contrary, should a _hypochondriac_ be your subject, with the long train of melancholic doubts, fears, hopes, and despondencies, avail yourself of the faith implicitly placed in you, and regulate your proceedings by the force of _his imagination_; let your prescription (by its length and variety) reward your _jackall_ for his present attention and future services.—Take care to furnish the frame so amply with _physic_, that _food_ may be unnecessary; let every hour (or two) have its destined appropriation—render all possible forms of the _materia medica_ subservient to the general good—_draughts_—_powders_—_drops_, and _pills_, may be given (at least) every two hours; intervening _apozems_, or _decoctions_, may have their utility; if no other advantage is to be expected, one good will be clearly ascertained, the convenience of having the _nurse_ kept constantly awake, and if _one medicine_ is not productive of success, _another may_. These are surely alternatives well worthy your attention, being admirably calculated for the promotion of your _patient’s cure_ and your _own reputation_. Having written your long prescription, and learnt from Mr. Emetic every necessary information, you return to the room of your patient, to prove your attention, and renew your admonitions of punctuality and submission;—then receiving your _fee_ with a consequential _air of indifference_, you take your leave; not omitting to drop an additional assurance, that “you shall not be _remiss_ in your attendance.” These, Sir, are the instructions you must steadily pursue, if you possess an ardent desire to become _eminent_ in your _profession_—_opulent_ in your _circumstances_—_formidable_ to your _competitors_, or a _valuable practitioner_ to the _Company_ of _Apothecaries_, from whom you are to expect the foundation of support. A multiplicity of additional hints might be added for your minute observance; but such a variety will present themselves in the course of practice, that a retrospective view of diurnal occurrences will sufficiently furnish you with every possible information for your future progress; regulating your behaviour, by the rank of your patients, from the _most_ pompous _personal ostentation_, to the meanest and _most contemptible servility_. 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_. TO THE APOTHECARY. The varieties of your past, as well as the personal requisites for your future destination, are of such a pantomimic and party-coloured complexion, that I cannot proceed to a recital so truly risible, without first offering you, in the lines of Woty, a predominant trait in my _own character_, “I love to laugh, though Care stand frowning bye, And pale Misfortune rolls her meagre eye.” Thus happily disposed to those brilliant sallies of mirth, that almost renovate life, and set melancholy at defiance, you will be the less liable to surprise, that I shall descend to the very minutiæ of your necessary qualifications, for the support of so arduous and complicated a character as you are now going to perform upon the theatre of life. It is very natural to conclude you have, during the tedious years of initiation as an apprentice, and your more mature services as a journeyman, (politely ycleped assistant) whether in the metropolis, or the country, gone through every degree of drudgery, and feelingly experienced every indignity, that _insolent pride_ could bestow, or _patient merit_ receive. Not an inferior trust (of the inferior part of the faculty) but you have carried into execution, from the injection of an _enema_ in a garret, to the separation of an _emplastrum vesicatorium_ in a workhouse. These are offices of humanity and service to your fellow creatures, that do you immortal honour; they are retrospectives that form an epoch in the mind of every practitioner, and afford him the powerful consolation of _sacred truth_, “He that humbleth himself,” &c. by which rule, and the force of a fertile imagination, any _apothecary_ may _conceive_ himself a _physician_, even in the administration of a _glyster_. In this hospitable execution (taken metaphorically) there cannot be supposed the least indignity; for it is universally known the _greatest_ and most _prudent_ generals are in the _rear_ during the heat of battle; and we are again taught seriously to believe “the last shall be first,” &c. so that you have every way, (by both _faith_ and _services_) insured a religious and prophetic _hope_ of preferment. Having for many years encountered the _worst_, you are now prepared for the _best_; and bidding adieu to the rigid rules of austere masters, embark upon your own foundation, qualified for every medical consultation, from the bedchamber of a _duchess dowager_ to the subterraneous residence of her _chairman_. You have, at this period, not only shaken off the shackles of servitude, but the very recollection of your long standing culinary connections. In your various changes of residence, tedious peregrinations, and medical observations, it is natural to conclude, you have acquired by care, study, and attention, a competent knowledge of almost every tint in the picture of life; which, with embellishments, derived from a few courses under some of the _metropolitan lecturers_, and _hospital attendance_, to qualify you for the complication of _country_ practice, there is no doubt but you come from the forge properly formed, to make wrong appear right, and right wrong, in the face of every _old woman_ in the county where you are going to reside. Exclusive of these qualifications, and the many instructions already introduced under the two preceding heads (to which you may occasionally refer) there are a great variety that must be advanced for _your particular use_, and to those you will, no doubt, pay every proper attention, if you indulge the least desire to become a popular member of the faculty. In respect to personal appearance, former distinctions and peculiarities are in some degree levelled, the world is very much relaxed in its severities, and the apothecary mixes with the general herd of mankind, without those distinguishing exteriors that _were_ his professional characteristics. The gilt-headed cane and enormous tassel are no longer in use; the _full-bottom wig_, that so universally ornamented the _os frontis_ of the faculty in general, is now almost laid aside with inferior classes, and engrossed by the _college_. The apothecary (particularly in the country) is in every respect free from the illiberal censure of former times, and treading close upon the heels of the _parson_ and the _lawyer_, enjoys, without restraint, the _chace_, the _gun_, the _bottle_, and _bona-roba_. These, if you are of a volatile disposition and amorous constitution, afford (at seasonable opportunities) a happy and high relished relaxation from the many severities of medical practice. Having fixed upon your intended spot for embarkation, let every thought be employed to display an attracting uniformity in the disposition of your apparatus, for the _claptrap_ of public approbation; and though that great investigator of human nature has beautifully portrayed “_a beggarly account of empty boxes_,” yet they become immediately necessary to your present purpose; it not being his business to explain the folly and extravagance of your placing any thing of consequence there, before you was experimentally convinced you should have occasion for its use. Let there be a _profusion of appearance_; the _shell_ of a shop is not very expensive, and druggists are so numerous, that you may be expeditiously supplied whenever circumstances require it.—The bottles (being transparent) become more immediately in need of _something_ in each, particularly a few of those articles (as hartshorn, lavender, &c.) that are in common request. The lower drawers (within reach) may be labelled with _obsolete titles_, and in each placed various paper parcels of _bran_ or _saw-dust_, to avoid a chance of the sarcasm upon the faculty by a countryman, who happened to be left alone some time in the shop of an apothecary, and whose curiosity being excited by the great _number of drawers_, was powerfully prompted to open one labelled “_Thus_,” which finding _empty_, he was induced to try a second, _still the same_; a third, _the same also_.—Oh! oh! says he, “I see plain enough how it is, they are all _Thus_.” Your shop being at length finished in a stile modern and striking, let a green silk curtain (with brass rods and rings) be affixed to your window; it is an excellent method of conveying an idea of internal mystery, and inspiring proportionate external curiosity. Let no paltry diffidence appear in the board over your door, announcing your name and qualifications; there are great numbers that can’t distinguish _small letters_ at a distance, to avoid which inconvenience, let the capitals be as conspicuous as the canvas figures at a country puppet-shew. “Thus far before the wind;” and being (as it is natural to conclude) not greatly engaged, it becomes your immediate attention to wait personally upon the different overseers of the surrounding parishes, and give them most forcibly to understand, they have been for many years the subjects of imposition; but you having more _honesty_ than the whole body of the faculty, will undertake to _farm_ the medical superintendance of the _poor_, at half the annual sum it has ever cost the inhabitants before. This political stroke will excellently answer both your purposes, for overseers in general care not how little they pay; and you being professionally callous to the tears of poverty and distress, care not how little you give for their money. _Tartar emetic_—_Pulv. contray._ c.—_Pulv. nitri_, and _Pulv. jalapii_—are medicines admirably calculated for the constitutions of the poor; and thirty or forty shillings a year in those articles, will be sufficient for the consumption of _five_ or _six_ parishes; with the additional advantage of rendering _vials_ unnecessary, a consideration of some consequence, when it is remembered they are now double their former price. These parochial connections will be productive of advantage in more ways than one, for as the unhappy paupers will be constantly seen at your door, it will afford all the appearance of sudden popularity. Ostentatious parade, and personal consequence, must be your leading traits, and never lost sight of; _a couple of horses_ will contribute largely to these objects; not that you are expected to degrade the dignity of your profession, by riding, like Hughes or Astley, _two at a time_, but their appearance will constitute an admirable shew of business in being rode _alternately_; and as most young men who have not been long their own masters, are fond of displaying their persons on the _outside of a horse_, you may exultingly not only “feed fat” the propensity, but the general run of your mechanical neighbours (who see no farther than the tips of their noses, and are ever caught by appearances) will erroneously suppose you are visiting some of the first characters in the county. As it will be now highly derogatory for you to stain your hands with any menial services, procure speedily a _journeyman_ (alias assistant) to enhance your own weight; if there is at present nothing for him to do, the curtain, before recommended, will obscure his indolence from the prying eye of public curiosity. No part of the faculty having ever been remarkable for the regularity or fervency of their _devotions_, your presence at church will consequently not be expected (particularly after the impressions you have made of being perpetually engaged) unless you politically appear there at two or three different times, merely for the convenience of being called out _by your own direction_, at the still and most awful part of the service; a circumstance that will tell much to your advantage with every superannuated _old woman_ in the parish. Take particular care that your horse is constantly brought to your door on the sabbath day, just as the neighbours are passing to church, and there paraded some time previous to your appearance, which to every weak mind will have its effects; and be equally careful to measure the steps of your _horse_, by the hands of your _watch_, so that whether your journey is accidentally long, or intentionally short, you return just at the moment of their dismission from the religious conventicle. In passing the whole body of inhabitants, be strictly careful of your self consequence—a bow of _significant respect_ to two or three of the _superiors_, may be applicable and consistent—but no familiarity with, or knowledge of, the multitude; the greater your _ostentation_ and _indifference_, the more _servile_ will be their _admiration_ and _respect_. By no means form any hasty or inconsiderate matrimonial connection; you will derive many advantages at first from a life of _celibacy_; there are always a variety of juvenile females in the country (as well as the metropolis) who considering themselves _every way qualified_ to constitute _doctor’s ladies_, will most industriously _throw_ themselves in your way upon every occasion, that their personal attractions may not escape your observation. To families where there are daughters, nieces, or cousins, who _conceive_ themselves ripe for the _gordian knot_, you may assure yourself of being called in a short time; for as you are such “a charming man” in your appearance, (and so admirably _fitting_ for a husband) there can’t be the least reason to doubt your professional qualifications. You may perhaps start some doubts, (or conscientious qualms may arise) how these appearances are to be supported in the infancy of business, without any great personal property to sanction or justify the attempt; in such diffidence you perfectly display, not only your pusillanimity, but want of knowledge and experience; for certainly out of the above description of females, who will constantly pay court to your consequence, and by a _thousand modes_ solicit your attention, surely some one of the _best possessions_ may be obtained, whose _fortune_, and advantage of family connection, may answer your most sanguine expectations: but should _fate_ conspire against you in both _business and marriage_, you will have the consolation of having made _a bold push_, and failing in the attempt, you only become a fashionable adventurer, and gratefully pay your creditors _nothing in the pound_. Having gone through a chain of circumstances and instructions, necessary for the support of your _public_ appearance, it will be naturally expected I shall revert to the modes of behaviour that are to constitute your _private_ character, in the professional transactions that you conclude will daily occur. First, let it be your constant observance to be equally reserved and difficult of access—whenever your opinion is required, even in your own shop, appear there with tedious reluctance, as if privacies of the utmost consequence prevented your earlier attendance; this will not only add to your medical weight, but raise your reputation for _good breeding_ and intercourse with the polite world; for it is universally known, none but the inferior orders are introduced to each other without ceremony; it would be therefore highly ridiculous in you to practise a mode of behaviour in use only with the lowest classes of mankind. Never leave home without letting your horse be held long enough at the door to be observed by the surrounding neighbours; the most trifling indication of business is a point in your favour, and ought by no means to be omitted. By the invariable good effect of which rule, no messenger whatever should arrive from the country for medicines, but he must be detained _as long as possible_; his preparations should never be ready when called for; on the contrary, his horse should be hung or held at the door for half an hour at least; a double advantage is derived from this necessary caution—the horse at the door will prove a striking object to the public, and the messenger will assure the family you attend, that, nothing but your great hurry occasioned the delay in his return. It will be strictly proper for you, upon all occasions, to preserve the most inflexible serenity of countenance, even to extreme gravity; and this injunction becomes the more immediately necessary, as there are a vast variety of unexpected causes for laughter, to which you will be open, in the frequent applications of unpolished rustics, for your _great opinion_ and assistance. One class will “beg the favour of you to _subscribe_ for their complaints;” another “hopes you won’t be offended, but he is come to _insult_ you upon his case;” these instances are so exceedingly common, that you will often meet with them, where they are least expected. There now lives _an alderman_, in a very capital town and place of _royal residence_, who, a few years since, labouring under an _epidemic_ complaint, was told that symptoms were alarming, and a _glyster_ was unavoidably necessary; to which representation he expostulated, begging the apothecary “to lay aside his intention, and give him any thing to _take inwardly_, but for _God’s sake_, to have no _cutting_ and _slaying_.”—Another of the same _learned body corporate_ (for they have both kissed the K—g’s hand) said “he bore the severity of his complaint with more patience, now he was _manured_ to it.” To prove the frequency of these accidental slips, it is impossible to resist the present temptation of introducing a few more, that occur to memory in the present recital. A lad upon the borders of Northamptonshire, being sent in the night to a medical practitioner at Banbury, and calling him out of bed, told him, “he must come immediately to his mistress, for she had got a _Vistula_!”——“Where? _In ano?_” “No, Zir, in the next parish to’t.” In an excursion to Surrey, I was solicited in a parish near Chertsey, to give my advice to a master carpenter there, who had been a long time indisposed; but my prescription having had the desired effect, and the poor man getting abroad, he very gratefully declared to all his friends, “I was the _best musician_ that ever came into the country.”—In the county of Berks, an elderly woman came to consult me upon the bad state of her daughter’s health; and after animadverting upon symptoms, told me _in a whisper_, “that her daughter was to have been married to a young man some time since; but something happening to break it off, she really believed _’twas nature turned inward in her_.” Paying a visit, in my earlier days, to the lady of a good old country alderman of a borough in Hertfordshire, she, after many aukward apologies for the indelicacy of the subject, tremblingly told me, “she had been very uneasy for some days, with a violent heat in her _firmament_.”—By way of suppressing those risible emotions in my disposition I have before described, I, for a moment, changed the subject, by enquiring the health of her husband; to which she replied, with thanks, “he was exceedingly well, but gone to make an _exerescence_ into the country;” plunged deeper in difficulty, and nearer the _laugh_ than before, which was now become hard to suppress, I applied myself to her snuff-box, then on the table, and passing a few encomiums on its neatness, she said, it was very much admired, being a _gypsey’s pimple_ set in _pinch-gut_. You will, no doubt, be now prepared for such unexpected misapplication of words, such _sublimity of expression_, and regulate the rigidity of your _frontal_ muscles accordingly; when called to a patient, let your personal address and behaviour be modelled entirely by the state of his _property_; if he is _your superior_ in rank and condition, every action of yours must denote it most strikingly;—you _approach_ with _respect_—you _dictate_ with _submission_—your mildness and _affected penetration_ must be perceptible in all your enquiries, making the most scrupulous observations how far you seem to gain upon the _credulity_ and good opinion of your subject, taking leave with all those attracting expressions of tenderness and sympathy, (highly tinctured with respect) that may give your patient a favourable idea of the _integrity_, it can never be your _interest_ to possess. On the contrary, when your advice and assistance is required to a patient, whose feelings are equally wounded by bodily affliction and the barbed arrow of adversity, you may safely reverse the whole mode of behaviour, and put into practice your personal pride, even to perfect impudence. This will be in many respects a consistency of conduct; it will be convincing them, as you have nothing to hope from their _affluence_, you have certainly nothing to fear from their _poverty_. Let what will be the condition of your patient, you are not to act as some few conscientious practitioners do, explaining what you conceive to be the nature of the case, original cause of complaint, or from what operation you expect expeditious relief; this may be the best practice with those unfashionable formal old fellows, who received their medical instructions near half a century since, and pique themselves upon what they call their _integrity_; but it will be perfectly _illiberal_ in you, who have received a more modern, and polished education. Ambiguity, and true medical mystery, will be your best guide upon every occasion; by not naming the case, or _cause of complaint_, you can never be accused of having _mistaken_ it; and by letting the property of the medicine you administer remain a matter of secrecy with all but yourself, you reserve the incontrovertible power of saying, “it has had the _very effect_ you _intended_,” whether it operates by _vomit_, _stool_, _urine_, _perspiration_, or _sleep_: these are precautions a _wise_ man always takes, a _fool_ never, and may be deemed something similar to the conduct of Bayes’s troops in the Rehearsal, who, the _warlike_ messenger said, “were stealing a march in _stilts_.” During the indisposition of your patient, ’tis your duty to think much more of the emolument that will arise from the _protraction_ of his case, than the _expedience_ of his cure. You must have it ever in mind, that he has paid you the the greatest compliment one man can possibly pay another on earth; he has placed an implicit confidence, and entrusted you with the care of his constitution and the key of his cash; in fact, he has put both his _life_ and _property_ into your hands; and the respect you owe to _self-preservation_ renders it necessary you make the most of _both_. Let your attachment to his health and interest be demonstrated by the frequency of your attendance; it will be impossible for you to give a greater proof of your _disinterested_ friendship, than by your large and constant supplies of different medicines; too great a quantity, too great a variety cannot be introduced; they all tend to a promotion of your emolument, and the sum total of your bill will be considered _a striking proof_ of your _merit_ and assiduity. If you find the family and friends not perfectly satisfied with your conduct, that there is the least coolness and discontent perceptible, or symptoms of present or approaching danger, strongly recommend the presence of a _better opinion_ in the form of a physician; this will prove an exertion of the soundest policy—double the quantity of medicines will be thrown into _his_ prescription for the promotion of _your_ interest, an act that the present danger will amply justify, and should the unhappy victim be doomed “To pass that bourne, From whence no traveller returns,” You have nobly and skilfully slipped your neck out of the collar, and left all the credit of _killing_ (as you really ought to do) to your superior, whose _diploma_ entitles him to the preference; and, _vice versa_, should you perceive the patient and family become dupes to your affected sincerity, and that you are daily raising yourself in their estimation, erect a structure of professional applause upon the basis of their _credulity_; insinuate every possible degree of self praise, and set the advice of a physician in the most contemptible point of view.—Affect unlimited attachment to the interest of your patient, and say, “you would recommend much better advice than your own, if you could do it with a conscientious consistency; but it had ever been an opinion of yours (which was still unaltered) if the apothecary could not plunder a family _sufficiently_, the better method would be to adopt _a consultation_, when it might be done to a _certainty_.” This open manner of dealing instantly enhances you in the estimation of patient and friends, and you will consequently stand so high in opinion that you may proceed deliberately in your _spoils_ without interruption, for where there are no _daily fees_ (swallowed up in the _vortex_ of the college) your more trifling depredations will not be considered as matters of medical magnitude or imposition. In all kinds of inferior practice render every look, every thought and action, subservient to your general intent of personal rank and pecuniary consequence; it must be your particular study to inculcate every idea in the lower class, of your great penetration and abilities; by your minute investigations, cross-examinations, and applicable nods of significance (implying the most extensive knowledge) you will discover remote symptoms, that once explained to the complaining patient, will give them reason to believe (which they very readily do) you are a supernatural agent; and one _fool_ of _this denomination_, who firmly believes you know the state of his health by the _wrinkles_ in his _forehead_, or the _cloud_ in his _urine_, will soon infect a whole county with the certainty of your infallible qualifications. This opinion once founded, the effect is absolutely incredible, an instance of which may be found in various parts of England, but more particularly in a very large and populous town, not forty miles west of the metropolis, where _fools_ from every part of the county are constantly driving (their pockets laden with _chamber-lye_) to a famous inspector of _urinals_, vulgarly denominated a _piss-pot doctor_, who, to magnify the report of his incredible skill and penetration, has adopted a certain method to impose upon the minds of the multitude, and prey upon the little pecuniary collections they can make, to become the dupes of _his villainy_ and their own _infatuation_. The mode of imposition, I shall explain in a fact as communicated by one of his most intimate friends, and leave the story itself to applaud his ingenuity:—He has (in a very respectable habitation) a small private room, to which every patient or messenger is conducted (upon a plea that the _doctor_ is not at home, or is particularly engaged) here an emissary (as if casually) asking certain questions, hears the whole story, examines the urine, and descends to particulars—the _doctor_ is in the adjoining apartment (calculated by a thin partition and certain openings, invisible to the unsuspecting visitor) where he minutely hears the entire conversation; the necessary secrets being obtained, he makes his appearance with the most commanding aspect; at this awful ceremony, the fascinated patient almost feels the effect of ANIMAL MAGNETISM; the approach of so much wisdom deprives him for a moment of speech, and the _poor devil_ undergoes a kind of temporary annihilation. An instance of this occurred not long since, when a country fellow having journeyed twelve miles to the doctor with a bottle of his wife’s _chrystal stream_, communicated the necessary particulars to the agent, when the doctor, in possession of the secret, made his appearance.—“Well, friend!”—“I have brought your honour my wife’s water, she could not _rest any longer_ without your _device_.”—“Your wife’s water—very well—let me see!—aye, I perceive she has _bruised her shoulder_.”—“Yes, Sir, she has indeed.”—“By this water (it is perfectly clear) she has _fallen down stairs_.”—“Yes, your honour!”—“She is not injured in any other part by the fall?”—“Only complains a little at the _bottom of her belly_, your honour.”—“Well, she fell from the top of the stairs to the bottom, _I see_?”—“No, your honour, she had gone down two steps before she fell.”—“Indeed! why then you have not brought me _all her water_.”—“No, your honour, there was _a little_ the bottle would not hold.”—“Why then, sirrah, the _two stairs_ are left behind.“——This circumstance, (of a thousand that might be quoted) is sufficient to demonstrate the ridiculous credulity of the multitude in all matters of quackery, and leaves us to lament, that the ignorance of one class, should become so wretched a prey to the deliberate villainy of another. The long experience you have had, in charging and posting your accompts, under different masters of equal judgment and experience, leaves little room for instruction under that head; it may however not prove inapplicable to remind you, it is no matter how incoherent or unintelligible the _writing_ is, provided your _figures_ are _bold_ and _conspicuous_; so long as you can convince them how much they _have to pay_, it is a total matter of indifference to you, how much they have _received_. There is one caution however exceedingly necessary to be advanced, to prevent your becoming subject to a reproof given by the celebrated Dean Swift to his apothecary, for presuming to be handsomely paid for the confidence of putting himself upon an equality with his superiors. This is the impropriety of letting the word ”_visits_“ constitute a part of your charge, instead of the more modest term of ”_journeys_,“ or ”_attendance_.“ The Dean having been afflicted with a long and severe fit of illness, requested, soon after recovery, the apothecary’s bill; which having perused, and finding a sum total very much beyond his expectation, he proceeded to _dissection_, and perceiving almost every _third article_ to announce the honour of a ”_visit_,” at five shillings each, he satirically adopted the following plan to punish _Mr. Emetic_, for what the Dean considered a piece of consummate assurance.—Having required his attendance to receive his demand, he paid down a certain sum of money, which the mortified apothecary continued to tell over, and repeatedly compare with the figures denoting the _sum total_; but still continuing _to tell and compare_, without seeming to get at all nearer the point of satisfaction, the Dean, in compassion to the confusion he visibly laboured under, observed, as he did not seem to be perfectly clear in his arrangement of the accompt, he would set him right.—If he would but deduct the amount of the “visits” from the sum total of his bill, he would find it exactly right; for being now pretty well recovered, he intended _paying_ him his “_visits_” again _one at a time_. You will now naturally conclude every instruction that can be possibly necessary, has been submitted to your consideration, for the promotion of your prosperous and profitable career through the medical journey of life; it is not so; for although we have gone through the usual forms of sickness, to either recovery or death, there is still one remark necessary, to the completion of consistency, in your professional character. It is a few observations, in derision of that truly contemptible burlesque upon propriety, in following the corps of your patient to the grave; a folly originating in _ignorance_, and established by _custom_; a circumstance so truly ridiculous and farcical, that it did not escape the penetration and sarcastic wit of our Aristophanes of the present century, who attacked it with the full force of his satire, in the description given by a taylor, in one of his celebrated comedies, who says, “as he was going home to a customer with a pair of breeches under his arm, he perceived his neighbour _Gargle_, the apothecary, following a _corps_ to the grave,—so says he, Master Gargle, I see you are going home with your _work too_.” The justice of this remark renders the circumstance so truly ridiculous, that it is a matter of admiration, how any man of the most common understanding can ever submit to an indignity so truly laughable. It certainly bears the appearance of your not being content with preying upon the property of the deceased, during their last hours of sublunary affliction, but you meanly pursue their very remains to the grave, and obtain a paltry hatband and gloves, at the expence of decency and discretion. Exclusive of this very striking obstacle, there is one of equal weight in the scale of your professional reputation—it certainly can add none to the eminence of your character, that the contents of the coffin was publickly known to be a subject of your skill and experimental practice. You will certainly experience some difficulty in evading a compliance with many requests, made to you for this purpose; but I would recommend it to you to encounter displeasure, rather than become the dupe of so great an absurdity. To inculcate by example, what I have strongly recommended in precept, you may be assured, that I have, during my long practice, retained so great an aversion to this inconsistency of character, that I rendered myself totally incapable of compliance, by never having in possession _a suit of mourning_; this resource has always proved my never failing friend, when no other apology would be accepted; and by never seeming to recollect _the want_ till a few hours before the _funeral_, a written apology has always proved a respectable substitute, to which there was no alternative. Having descended to the very minutiæ of a long, extensive, and successful practice, to form your mind, and regulate your manners in every professional transaction of your life, I cannot doubt, but rules so directly consonant to your personal interest and reputation, will receive every assistance from your unerring consistency and perseverance, conveying a perfect corroboration of the _gratitude_ you feel, for the intrinsic worth of so liberal and friendly a communication. TO THE CHYMISTS AND DRUGGISTS. It will create no surprise that you bring up the rear of this medical exhibition, when it is remembered that the most opulent, eminent, or respectable, generally close every public procession.—You are to the faculty, what the _hammerman_ is to the _forge_; you are in fact the _arterial reservoir_, from whose source flow the rich streams, that feed the _venal divisions_ in every branch of the profession, whether in town or country. To the fertility of your genius, to the extent of your commerce, to the enterprising spirit of your pecuniary embarkations, the faculty are indebted for the great variety and striking novelties, that render them so much the subjects of admiration. You happily derive your affluence from dealing innocently around you the various _instruments_ of _death_, with an indifference that sufficiently exculpates you from the suspicion of _murder_, even as accessaries before the fact.—Your constant, and extensive inventions (for the promotion of private emolument and public good) rank you high in general estimation, and you prudently recommend yourselves to the attention of the most learned, by your very _frequent_ and _extraordinary_ discoveries.—Your advertisements (with which almost every literary vehicle teems) are alike calculated to excite wonder and approbation; they seem to indicate proofs, that _you alone_ exceed the limits of human penetration, and display a hope of perpetual existence, by setting mortality at defiance; like a groupe of _desperate hazard players_, you are “at all in the ring,” and with a degree of emulative opposition to each other, produce from your _alembics_—_bolt heads_, and _balneum arenæs_, antidotes to every ill: the only ray of consolation to the less learned is, that _death_ (often an unexpected visitor) opens the eyes of the world to the arts of your deception, and you slide into the grave with the calm and unobserved obscurity of your neighbours. The wonderful extent of your fertile abilities are constantly conveyed to public attention, through the pompous medium of “Letters Patent” and “Royal Authority,” that are at length become (from the higher arts) the fashionable introduction to a _breeches ball_; a _tincture for the tooth ach_; a _blacking cake_, or a _gamboge horse ball_. While I lament this degradation, this prostitution of patronage, to such _trifling_, such _contemptible_ efforts of _sterility_, I cannot but consider how gratefully, how extensively, you are bound to a credulous and indulgent public, who implicitly sanction with their patronage, every production of _genius or dullness_, whether in a _philosophic taper_, a concentrated _acid of vinegar_, or a _salt of lemons_; they are undoubtedly discoveries of _immense magnitude_ to the public at large; and experience has sufficiently proved, that so much _patriotic virtue_ should meet its _own reward_. Notwithstanding the superiority and extent of your knowledge, so visibly displayed in the _sublimity_ of your frequent experiments, that have raised you to such a great degree of professional eminence, there may yet be some profitable principles of practice, inculcated by a long and studious observer, that will evidently add to your emoluments, if not to the encrease of your reputations. Your _peculiar modesty_ may have prevented your attaining the utmost perfection of your art, and left you strangers to the very great and undiscovered advantages, that the privileges of your profession so singularly entitle you to; for though you may hitherto have reconciled yourselves to a paltry _mechanical_ profit of thirty-five or forty per cent. what law forbids you making the “most of your market,” and enhancing those profits to such state, as may best accord with your idea and gratification of _city eminence_—_rural ease_—_external appearance_, and _domestic hospitality_? To insure these comforts to a certainty, accept such instructions, (as closely adhered to) will inevitably produce the purposes for which they are introduced. Hitherto, a stranger to the happy effects of necessary _adulteration_, it may not be inapplicable to say a few words upon its numerous advantages; first, at your embarkation, you should adopt it as the _ultimatum_ of all your professional views, and render it as subservient to your wishes, as the lover’s invariable observance of “_persevere_ and _conquer_,” is to his. _Adulteration_ has many pleasing advantages annexed to its practice; by the applicable introduction of an _harmless_ ingredient, you may reduce the dangerous property of a _drastic_ purgative, and render a powerful _poison_ less destructive; by such acts you will enjoy the inexpressible consolation of hourly contributing to the safety of your fellow-creatures, in exertions of _humanity_, that will do you the greatest honour. The prelude to the _Pharmacopœia_, sufficiently informs you, the _College of Wigs_ are empowered by royal sanction to invent, or constitute forms, and the _cabinet_ to enforce them; but your superior knowledge sets such arbitrary dictation at defiance, and your _practical arts_ will ever supersede their _theoretical_ penetration. Let them happily enjoy the power to alter names, and improve forms of all the compositions in that _laughable farrago_, their _new dispensatory_; they have the province to direct, and you have the pleasure to evade; obeying their injunctions no farther than is strictly consistent with your own interest and convenience. To assist the aptitude of your fertility, let me introduce to your attention (as specimens of what may be done) some few of the advantageous alterations that may be made in medicinal composition, to promote your certain emolument, without arraigning your _integrity_. In that expensive preparation _confectio cardiaca_ (newly named by college sagacity _confectio aromatica_) opportunity offers to display a part of your privilege in substituting the use of _saffron paper_, which will impart to the composition the rich colour of the original _crocus_; for those other high priced articles _cardamoms_, _cinnamon_, _nutmegs_, and _cloves_, applicable and proportional quantities of those cheaper (and equally efficacious) _cordials_ and _carminatives_, _ginger_, _grains of paradise_, or any of the inferior spices may be added. In large preparations of the _electarium lenitivum_, an introduction of the _pulp of prunes_ for the _pulp of cassia_, will save much additional expence and trouble.—In the _syrupus e spina cervina_, treacle is certainly preferable to the finest lump sugar, with this advantage, that the predominant nausea will prevent the discovery. Experience will convince you that _spiritus c. c._ (_per se_) obtained by distillation from the accumulated stale urine of a parish workhouse, or the bones of animals, will be by far preferable to that drawn from the purest _cornu cervi_; as are the rasura c. c. from the shank bones of horses, or cows, preferable to all other.—_Sp. terebinthinæ_ (carefully and proportionally incorporated) becomes an admirable associate with the _ol. juniperi_.—_Ol. amygdalinum_ (and many other articles blended _secundum artem_) form an excellent combination with, and increase the stock of _ol. anisi verum_.—_Genuine gum guaiacum_—_galbanum_—_storax_, and _bals. tolutanum_, may undergo the process of _purification_ much better, if impregnated with the occasional assistance of either the _resina nigra_, or _flava_.—The various unguents will derive advantage from the salutary introduction of _auxungiæ porcincæ_, as a substitute for those more _expensive and unnecessary_ articles _cera flava_ and _ol. olivarum_. _Pulv. anisi verum_ will be much more easily reduced from the cakes, after the seed has been expressed, the oil obtained, and their medical virtue entirely extracted; it is an article only in use for horses and cows; whether they are _killed or cured_, is an object not worthy your consideration. _Liquorice_, _fenugreek_, _diapente_, _turmeric_, and _elecampane_, are to receive their basis from _horse beans_ ground (at the medical mills) exceedingly fine, and to be impregnated properly with the different articles from which they derive their names, so as to retain each their predominant effluvia; and as these are articles in use for cattle only, you will give proof of your humanity, by drenching them with _food_ instead of _physic_. The species _hiera_ will be much more certain in its effects, if prepared with the _Barbadoes_, instead of the _Succotrine_ aloes; and the true Dutch biscuit powder, will form no unprofitable union with the powder of _Salop_. In fact, innumerable instances of professional skill and œconomy might be introduced, extending instructions to a much greater length than originally intended; protracting the explanatory parts beyond the limits of utility, an accusation it has been my principal care to avoid. It may perhaps be almost unnecessary to remind you, how absolutely needful it will be, to reduce to impalpable pulverization and complicated forms, all inferior and damaged _drugs_ of every denomination; in _powders_, _tinctures_, _electuaries_, and other preparations, their defects will not be perceptible, and it will prove matter of no small gratification to you, that many practitioners are very _inferior judges_ of the compositions they constantly prescribe; to these may be added the still greater number, that never condescend to undergo the task of inspection, forming together a major part of the very numerous and respectable body I have undertaken to instruct.—If you are a dispenser of _chemicals_ and _galenicals_ by retail, one additional observation will prove worthy your attention—never let your shop, or dispensary, get into disrepute by too much modesty, in saying you are without the most obsolete or ridiculous article that can be enquired for; if _oil of swallows_, _oil of bricks_, _lobsters’ blood_, or _milk of lilies_, should be the objects in request, let the fertility of your invention _instantly_ furnish a substitute for either; of these, such a great variety are always to be found, the least enumeration becomes unnecessary. The series of instructions advanced for the promotion of professional interest, have been promulgated without a fear of offence, or hope of reward; amidst the very great number of different practitioners, into whose hands these admonitions must inevitably fall, happy he who can exultingly exclaim, “Let the gall’d jade wince, our withers are unwrung.” From the physician, who lingers out a life of _studious suspense_, and derives a scanty subsistence from the alternate labour of morning visits and evening lectures—from that _dignified_ “member of the corporation,” whole _mercurial_ abilities are thrust into the hand of every dirty passenger, in the more dirty avenues of the metropolis—from that industrious _accoucher_, whose incessant nocturnal labour renders him, in common life, little superior to the _nightman_, and that equal drudge the metropolitan _pharmacopolist_, I can have little to expect but universal denunciation of vengeance, and threats of malevolence: to the effect of these, I oppose the stability of _truth_, that will render me _invulnerable_ to all their attacks. A steady observance of the iniquity of medical practice has long since powerfully convinced me of the absolute necessity of professional reformation, and should I (by arming the public with a weapon of self-defence) succeed in producing a change in the systematic imposition of one, and preventing perpetual depredation upon the other, every idea of personal ambition will be fully gratified, for “So little slave to what the world calls fame; As dies my body—so I wish my name.” But this obscurity in the present instance is much more anxiously to be _hoped_ than _expected_, for there cannot be the least doubt entertained but _some one_ of his Majesty’s ministers (who are ever anxious for the public good and increase of revenue) will, through the medium of the publisher, discover the joint secret of _name_ and _residence_, that by placing the author in the TREASURY, CUSTOMS, or some office equally lucrative, they may avail themselves of his INTEGRITY, not hesitating a moment to believe, that so just an investigator of professional impositions upon individuals, must unavoidably render the STATE adequate service, in the discovery of official depredations upon the PUBLIC. 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