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Title: The Æsculapian Labyrinth Explored
       Medical Mystery Illustrated

Author: Gregory Glyster

Release Date: March 9, 2017 [EBook #54332]

Language: English

Character set encoding: UTF-8

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                                  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.


FINIS.




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Transcriber’s Notes

Obvious typographical errors have been silently corrected. All other
spelling and punctuation remains unchanged with the exception of the
following substitutions:
  lest for least
    lest you make Mr. Emetic, the apothecary, your formidable enemy
    lest that part of your patients, who condescend to visit you
  emerged for immerged
    you recently emerged from the obscurity
  Surrey for Surry
    In an excursion to Surrey,
  duchess for dutchess
    from the bedchamber of a duchess dowager

Italics are represented thus _italic_.





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