Whence it follows, that the mean period of relapse is something less than eight months and a week; and that the chances are as seven to one that extirpation either proves fatal at once, or is followed by reproduction within twelve months. And that the mean duration of life is not increased by operating is shown by the records collected by M. Leroy d'Etiolles. From the first series of these facts, comparing the duration of life after the sixth year in persons operated on and not operated on, the subjoined table may be formed:

Whence it follows, that the commencement of the sixth year of a cancerous disease will be reached by 13.2 per cent. only of those operated on, by 29.7 per cent. of those who have not been submitted to the knife.

It were needless to adduce more proofs of the melancholy fact, that extirpation of cancerous growths with the knife can neither be regarded as a means of cure, nor of prolonging existence; and to our minds the conclusion is irresistible, that, excepting under very peculiar circumstances, such as the threatening of immediate death for incontrollable hemorrhage, or complete occlusion of the rectum in carcinoma of that viscus, the surgeon who cares for his own reputation and the real welfare of his patient should refuse to subject him to the danger and torture of an useless operation.

The other methods of ablation will not detain us. Cures have been effected by the enucleation of tumours by caustics (and for this purpose the chloride of zinc is perhaps the best and safest), and even by the induction of sphacelus by inoculation of the matter of hospital gangrene. But the experiments have not been conducted on a sufficiently large scale to warrant any satisfactory conclusion; and, while better and less hazardous means are in our power, we should hesitate long before advising a course so painful.

Here, for the present, we must pause with the remark, that in all that precedes we have given a mere epitome of the author's views. These seemed to us so just, that we found no ground for cavil or criticism. Our analysis is avowedly meager and dry, but we believe it will be found

accurate.

In our next Number we shall hope to accompany our readers through the remainder of this truly valuable work, and help them to form a closer acquaintance with this formidable disease in the various organs and tissues which it infests.

ART. IX.

Déontologie Médicale, ou des Devoirs et des Droits des Médecins dans l'Etat actuel de la Civilisation. Par le Docteur MAX. SIMON.-Paris, 1845.

Medical Deontology; or, the Duties and Rights of Medical Practitioners. By Dr. MAXIMILIAN SIMON. 8vo, pp. 590.

MEDICAL ethics have never attracted so much attention from laymen as medical theology. The opinions of physicians on questions of faith have generally been held to be of doubtful orthodoxy; their morals have usually been found unimpeachable. Trustworthy as men, they have absurdly enough been deemed irreligious. In this respect, however, they have but endured the common fate of all philosophers. From the earliest period the student of nature has been thought little better than an infidel; and, doubtless, this popular belief in one sense has always been well founded. How is it possible to imagine that Anaxagoras, Epicurus, Hippocrates, Socrates, or other like-minded men, ever expressed an earnest faith in the mythology of their age? Or can it be supposed that the modern geologists (holding the cosmogonical opinions they avow) participate in the popular belief as to the creation of the world? The Dean of York, although wrong alike in his theology and his philosophy, is true to the instincts of the ignorant multitude whose sentiments he expresses. Philosophy will ever war with mere dogmas, and medical science is philosophy par excellence.

And yet we venture to assert that there is not a more truly and sincerely pious, nor a more earnestly moral class of men than our own much calumniated profession. It ill becomes any profession to laud and magnify itself; but the avowal and defence of truth should not and shall not be sacrificed to the paltry fear of being thought vainglorious; or of being considered as emulous of those canting knaves who use religion as a cloak for pride, ignorance, or avarice. The cultivators of medicine, equally at least with the members of any other profession, may, without usurpation, to use the words of Sir Thomas Browne, assume the honorable state of a Christian, and we dare assert that none disgrace that honorable name less than medical practitioners.

If proofs of these assertions were wanting, they could not be more amply or aptly supplied than by the book before us. We subjoin an example, and we do this with the most perfect confidence that none but the most narrow-minded bigots can fail to recognize in it the pith and essence of Christ's teaching,-the marrow of that new law of mutual love which he left to mankind.

"With the man who is responsible to God alone for his decisions and actions regarding a thing so precious as human life, the thought of God should be ever present. A philosophy through which the sap of this fruitful thought does not circulate will be powerless to guide the physician at all times in the midst of the numerous quicksands he must meet with in the exercise of his profession. Medicine may be traced to God through the sympathy which the appearance of suffering awakens in us; but as a science of so high origin it only completes its work by asking from charity its love and its devotion. The physician who takes

the light of this dignified philosophy as the guide of his conscience may fail, but his fault will only be imputed to the imperfections of science. Understanding the dignity of human nature and the profound objects of life, he will devote himself entirely to the study of a science which can influence so decisively the individual destiny of men. Prudent and circumspect, he will not be seen to adopt hastily those unripe theories which sometimes pass over a generation like a destructive epidemic. In those cases, in which both theory and experience refuse their teaching, he will adopt the method of a prudent expectant treatment. To whatever rank of society he may belong, the sufferer will be his brother by the double relationship of pain and hope. Beneath the most hideous rags of misery he will recognize the indelible marks of the sufferer's heavenly origin, and with tender solicitude heap upon him the most devoted attentions. If in practice he meets with one of those difficult cases in which one means only can save the patient, and the use of those means may destroy his practice, if it fail, he will know how to do his duty, and endanger his reputation and success. Good and kind to all, he will not use his amenity of language as a privilege to gain wealth or rank. He will be aware that suffering spiritualizes a man, if the expression may be permitted, and gives for the moment to the most unpolished natures a delicacy and sensibility which rudeness of manner deeply hurts. He will be as affable and agreeable at the truckle-bed of the poor as in the perfumed boudoir of the rich; and thus both fulfil a rigorous duty and secure the action of those curative agents which science may direct.

"But conscience abandoned to her own guidance may stumble in the dark paths along which she might lead us: she is accessible to passion, and is led by fantasies, as is every power not attached to something fixed and immovable. It is necessary to mount higher and find a surer guide; it is necessary to ascend to that Christianity itself which affords infallible instructions suited to every station of life-to that Christianity which, expressing its doctrines in the one word CHARITY, is wonderfully allied to a science of which the essential object is the solace of human suffering. The men who have left behind them the most glorious names in the history of our science, Bayle, Van Helmont, Stahl, Sydenham, Boerhaave, Hoffman, Van Swieten, Winslow, Esquirol, &c., have well understood that it is in Christianity only the physician should seek that light and strength of which he has need, to maintain him equal to his difficult mission." (Introduction, p. 24.)

M. Simon at the outset, thus takes the sublime morals of Christianity as the fundamental principles of his medical ethics. Christian morals are beyond all controversy, whatever may be thought of Christian dogmas. DEONTOLOGY is a word adopted from Bentham, who used it to signify morals, or the science of duties. M. Simon uses it in the double sense of duties and rights, observing that the true meaning of the root of the word, deor from dei, oportet, warrants this double use of the term. Doubtless all duties are reciprocal; the rights of medical practitioners are the duties that society and individuals owe to them, as their duties to society and individuals are the dues or rights of the latter. A general view of these duties and rights is given in a lengthened introduction; it is a recapitulation, in fact, of the contents of the work.

M. Simon divides his subject into four books. The first treats of the duties of practitioners to themselves and to science; the second of their duties to the sick; the third of their duties to society; and the fourth of their rights, or, in other words, the duties of society and of the sick to them.

In treating the subject of the first book, he first inquires what motives ought to guide a practitioner in the cultivation and practice of his profes

sion? Our author well observes that the liberal professions sink lower and lower in public estimation. Medical practitioners, in particular, are full of complaint of the little honour and regard shown them by society. We should, however, be inclined to doubt whether the present generation croak more or in a more melancholy strain than the last; or whether the profession is really in less esteem than formerly. M. Simon believes this decadence to be real, and thinks the reason thereof is manifest enough. Few practitioners are guided by the principle of action which can alone secure them the regard and esteem of society. They are not devoted to the common interests, but to their own. They live out of society, and not for society; so society owes them nothing, except a watchful guardianship that they shall not under the sacred garb of the profession act the medical Tartuffe, and destroy rather than restore. There is nothing new under the sun; men are always equally selfish; the object of desire may differ, their greediness is ever the same.

Not long ago we happened to turn over several volumes of the earlier medical journals, and we were struck with the identity between the croaker of the existing and the last generation. In the earlier years of the present century medical reform was vigorously agitated by Sir Joseph Bankes, Dr. Beddoes, Dr. Harrison, and others. Much discussion was excited, the colleges were disturbed from their slumbers, the ultima Thule of the profession aroused. And what was the great characteristic of the discussion? Utter, barefaced selfishness. The London College of Physicians sent advertisements to the political journals, denouncing Scotch graduates as illegal practitioners; the King and Queen's Colleges of Physicians of Ireland answered the call for reformation by complaints regarding the encroachments of surgeons and apothecaries, and by a demand for further monopoly and more restrictive powers. Then as to the general practitioners, Dr. Beddoes, in his commonplace book (date 1808) observes, "the quantities of medicine ordered drive people to quack medicines. People can drop the latter when they please, but verecundia erga medicum makes them keep on longer with the former than either their stomach or their purse can well endure. To rescue the public from the stomach part of this evil, it will be proper to enact that the apothecary shall charge for more draughts than he supplies, as used to be the case with post-horses in France." In 1803, a country surgeon writes to a journal, "It is a melancholy consideration that whilst almost every class of men are in a state of improvement, the Faculty are certainly going retrograde; I speak to their revenue; competition has reduced the profession to the lowest ebb, consistent with comfortable support. . . . . . In short, such is the state of the country practitioners, that empiricism must soon supersede science, if every facility is not afforded him to procure information!" Complaints were loudly uttered not long ago against the drenching system; but, bad as it still is, we are sure that never did it flourish less than at this moment.

There is more hope, then, of a moral regeneration of the profession than croakers will allow; and there is the more hope, because the selfish are beginning to discover that a thorough devotion to professional science and duty is the surest, if not the shortest, way to wealth and esteem. They even doubt the wisdom of those public advisers who speak of the incomes

of quacks as so much taken from the pockets of regular practitioners. Although we think M. Simon too enthusiastic, we would not despise the high moral feeling which demands this devotion for the sake of virtue and for the love of God. But the incentive of a personal advantage to be obtained is a true and right incentive. How does the Wise Man incite to the love and pursuit of wisdom or virtue? By describing the advantages. she can confer. "Length of days are in her right hand in her left hand are riches and honour." Our author's sentiments are as follow:

:

"Follow the physician in imagination through all the situations in which the requirements of his laborious profession place him; follow him to the palace of the rich, or to the hut of the pauper; among the poor artisans who want air, or the peasants who have that alone; follow him amid the epidemics which decimate the populations around him; amid the contagion whose deadly miasm he may absorb at every pore; to the courts of justice, where his scientific words may advance or injure the most important interests of society, or of the individual; in short, follow him in the numerous directions where his office necessarily calls him, and you will always find him surrounded by the most imperious obligations. Now, the abstract idea of duty and the absolute principle of moral obligation are alone able to maintain him constantly in strength for his duties. He only who directs his conduct by this higher motive will make art equal to science, and know not the hesitations of devotedness which are nourished from sources less pure. The man who submits to this moral regimen contracts a habit of virtue-of self-denialwhich will render his duty easy whenever it shall be opposed to his own numerous passions." (p. 53.)

The duties of medical instruction and authorship are to be regulated, our author thinks, by the same high principles of unselfish devotedness. The greater his influence, and the wider his sphere of action, the more incumbent it is upon the teacher to purify the sanctuary of his conscience, and generously expel every interested motive. In medical science false ideas and crude theories may easily develop a dangerous method of treatment. Vanity, pride, avarice should be so chastened as not to obscure and deform the scientific page. M. Simon might have referred to a tribe of crawling scribblers, whose vocation is the pursuit of a miserable notoriety by the publication of unmitigated falsehoods. These men report cases they never witnessed, assert cures they never performed, record facts that never occurred. We promise ourselves some day the pleasure of impaling a few specimens of these creatures on our critical pens, and placing them with outstretched wings in our bibliographical museum.

What is the effect of medical studies and practice on the morals of the practitioner? M. Simon thinks they have a baneful effect. The pursuit of descriptive and pathological anatomy familiarizes the practitioner with man in a state of degradation. The majesty of death teaches him nothing, and affects him not; the corpse before him is a "subject," and nothing more. The infirmities of diseases and the nudities of death are necessarily ever present with him, and life only appears as a veil thrown over them. If the feelings thus excited are not counterbalanced by an abiding conviction of the dignity of human nature, the tender sympathy and the nobler instincts of humanity will be injuriously weakened, and with them the mental powers themselves. An impudent cynicism is excited, a looseness of language and deportment follows, and the student becomes the Don Juan of the dissecting-room.