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 gonorrhoea 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.