allowable for the doctor to receive the former as a new patient.

If, on the other hand, the patient had wished to call in the services of another doctor because, perhaps, the former attendant had insisted on an operation as one of necessity, and the new doctor finds by questioning that in his opinion the operation was imperative, then it would be acting in an unprofessional manner were he to take on the patient, seeing that he concurs in the treatment which the former doctor had advocated.

No medical man likes to lose a patient, and if we take another practitioner's patients, no matter how conscientiously we may have acted, he will undoubtedly feel a certain amount of resentment against us, and one can hardly expect him to exhibit an altruistic spirit towards us, even though his loss was our gain. No doctor can be long in practice, however, before some of his patients leave him, and it may be that we only hear long afterwards, and perhaps accidentally, that another practitioner is attending them. The latter has probably not given himself any trouble or worry about receiving them as patients, having probably suffered in like manner from the loss of his own patients. It is much to be deplored that certain practitioners have such low ideals of their professional obligations. When such annoyances come to us, the only way to meet them is to look on them "in the calm lights of mild philosophy" with an equable frame of mind, and not to allow such happenings to upset the orderly course of one's life. Such events happen to the best as well as to the worst doctors, and so, being the lot

common to us all, we ought to bear it with equanimity. The vexatious circumstance which is usually present is that it is those patients upon whom we have bestowed more abundant care and who have given us most anxiety who leave us in this unsatisfactory manner.

Let me warn the young practitioner not to fall into the evil habit of taking patients without first notifying their former medical attendants, even though the latter may not have had the courtesy to inform you that they had appropriated some of your patients.

It is only by living your professional life in a thoroughly upright and honest manner that you will be able to derive satisfaction from it and win approbation from your conscience. Do not be discouraged when you find that your neighbours are not acting in the same way towards you, and when they may even be despitefully using you. Though you may feel for a time hurt and aggrieved, never retaliate, and least of all by the methods which they have employed, else you sink at once to their level. Keep always in front of you" the passionate bright endeavour," and obey the golden rule that whatsoever you would that men should do unto you, even so do unto them. To forget a wrong is the best revenge.

It is only by keeping a high standard of duty and, consequently, of professional etiquette before you that you will win the respect and love of your patients and earn (what is much more difficult) the approval of your fellow practitioners.

Retiring from a Case.-Sometimes you may feel

that you and the patient are not en rapport. You instinctively feel that he has no confidence in you or in your treatment. If you feel that this is so, then your wise course is to speak out plainly and tender your resignation as his medical attendant; he himself may not have had the courage to dismiss you. On the other hand, he may protest that he had no intention of conveying such an impression to you or that he did not mean to offend you, and so on. Having made up your mind, however (for the doctor may lose trust in his patient as well as the patient in his attendant), keep to your resolution and you will find it the best in the end. Unless there is mutual confidence between patient and doctor, the case is most unsatisfactory to both and should be ended. Not only will you ultimately lose him as a patient, but he may exert a bad influence on other patients of yours, and so from every point of view it is at least diplomatic to act as I have indicated. No practitioner should ever allow himself to be insulted by a patient or even treated with contempt, and more especially when he feels that he has done everything in his power for the benefit of that patient. It is only consistent with the dignity which we owe to our profession and to ourselves that we courteously retire from further attendance on such a case. We must, of course, have made sure that the patient is not suffering from any disease of the mind, because some of these cases are exceedingly difficult to treat and their behaviour to their medical attendant is often highly insulting.

Where one's medical advice is not followed, is another reason why a medical man may feel it

incumbent to withdraw his services from a patient. In any case, however, he should intimate his intention, and state the reason for his doing so in writing. The importance of doing so is shown by such a case as the following: An ophthalmic surgeon had repeatedly urged a patient to have an injured eye removed, as he feared the onset of sympathetic ophthalmitis in the sound eye. His advice was not followed, but when the patient was taken to an hospital, another surgeon removed the eye, though too late to prevent total blindness supervening. The first surgeon had to pay £3,000 as punitive damages, as he had not made legal proof of his insistence on an operation.

CHAPTER IX

ETIQUETTE OF THE SICK ROOM; CONSULTATIONS; FEES; RENDERING ACCOUNTS, ETC.

Etiquette of the Sick Room.-On paying a first visit to a patient, it is usual to be received by the husband, wife or parent in a public room, when one receives a brief account of the illness. Do not allow this interview to be prolonged, as most of it will be gone over again with the patient.

On entering the sick room, you ought to shake hands with the patient and with any other relative who may be present and introduced to you. It is sufficient to bow to the nurse, but very injudicious on your part to take no notice of her, as well as being very impolite; to make a good impression on her may pave the way to your acquisition of future patients, as she often has very great influence.

Listen to the history of the case; ask any questions relative to it; make your examination thorough and complete; tell the patient what is the matter with him; give him a general prognosis; add a few words of general conversation; then shake hands with him, and, bowing to the others, you leave the room. You will probably require to give instructions to the nurse or attendant, who will have accompanied you out of the sick room. You do so in another room, where also you will write out a prescription if such has been required. Make your