History

A Long Way Gone Essay


Each of which writings is smalllike the middle rib, but broad forwards, pointed and round, a long way gone essay resemblingtherein a half-moon, from whence it took the name. The uppermost writingsor divisions being bigger than the lowest the stalks rise above thisleaf two or three inches, bearing thesis branches of small long tongues, every one like the spiky head of the adder tongue, of a brownishcolour, which, whether i shall call them flowers, or the seed, i wellknow not which, after they have continued awhile, resolve into a mealydust the root is small and fibrous this hath essaytimes divers suchlike leaves as are before described, with so thesis branches or topsrising from one stalk, each divided from the other place it grows on hills and heaths, yet where there is much grass, for therein it delights to grow time it is to be found only in april and may. For in june, whenany hot weather comes, for the most writing it is withered and gone government and virtues the moon owns the herb moonwort is coldand drying more than adder tongue, and is therefore held to be moreavailable for all wounds both inward and outward the leaves boiledin red wine, and drank, stay the immoderate flux of women courses, and the whites it also stays bleeding, vomiting, and other fluxes it helps all blows and bruises, and to consolidate all fractures anddislocations it is good for ruptures, but is chiefly used, by mostwith other herbs, to make oils or balsams to heal fresh or greenwounds as i said before either inward or outward, for which it isexcellently good moonwort is an herb which they say will open locks, and unshoe suchhorses as tread upon it.

Yet each of theseleaves are at the least twice as large as the other, and nicked in thesame manner about the edges, of a greyish colour on the under side;the stalks are greater, and rise higher, with thesis such leaves setthereon, and greater heads at the top, a long way gone essay of a brownish colour, and out ofthem come small dark purple flowers, like the former, but greater theroot is black and long like the other, but greater also. It has almostneither scent nor taste therein, like the garden kind place it first grows frequently in gardens the wild kind growsin divers counties of this land, especially in huntingdon, innorthamptonshire, in the meadows there. As also near london, by pancraschurch, and by a causeway-side in the middle of a field by paddington time they flower about the end of june and beginning of july, andtheir seed is ripe in august government and virtues this is an herb the sun challenges dominionover, and is a most precious herb, little inferior to betony. Thecontinual use of it preserves the body in health, and the spirits invigour. For if the sun be the preserver of life under god, his herbsare the best in the world to do it by they are accounted to be both ofone property, but the lesser is more effectual because quicker and morearomatic. It is a friend to the heart, liver, and other principal writingsof a man body two or three of the stalks, with leaves put into a cupof wine, especially claret, are known to quicken the spirits, refreshand cheer the heart, and drive away melancholy. It is a special helpto defend the heart from noiessay vapours, and from infection of thepestilence, the juice thereof being taken in essay drink, and the writingylaid to sweat thereupon they have also a drying and an astringentquality, whereby they are available in all manner of fluxes of bloodor humours, to staunch bleedings inward or outward, lasks, scourings, the bloody-flux, women too abundant flux of courses, the whites, andthe choleric belchings and castings of the stomach, and is a singularwound-herb for all sorts of wounds, both of the head and body, eitherinward or outward, for all old ulcers, running cankers, and most sores, to be used either by the juice or decoction of the herb, or by thepowder of the herb or root, or the water of the distilled herb, orointment by itself, or with other things to be kept the seed is alsono less effectual both to stop fluxes, and dry up moist sores, beingtaken in powder inwardly in wine, or steeled water, that is, whereinhot rods of steel have been quenched. Or the powder, or the seed mixedwith the ointments the butter-bur, or petasitis descript this rises up in february, with a thick stalk about afoot high, whereon are set a few small leaves, or rather pieces, andat the top a long spiked head. Flowers of a blue or deep red colour, according to the soil where it grows, and before the stalk with theflowers have abiden a month above ground, it will be withered and gone, and blow away with the wind, and the leaves will begin to spring, which being full grown, are very large and broad, being essaywhat thinand almost round, whose thick red foot stalks above a foot long, stand towards the middle of the leaves the lower writing being dividedinto two round writings, close almost one to another, and are of a palegreen colour. And hairy underneath the root is long, and spreadsunderground, being in essay places no bigger than one finger, inothers much bigger, blackish on the outside, and whitish within, of abitter and unpleasant taste place and time they grow in low and wet grounds by rivers and watersides their flower as is said rising and decaying in february andmarch, before their leaves, which appear in april government and virtues it is under the dominion of the sun, andtherefore is a great strengthener of the heart, and clearer of thevital spirit the roots thereof are by long experience found to bevery available against the plague and pestilential fevers by provokingsweat. If the powder thereof be taken in wine, it also resists theforce of any other poison the root hereof taken with zedoary andangelica, or without them, helps the rising of the mother thedecoction of the root in wine, is singularly good for those that wheesemuch, or are short-winded it provokes urine also, and women courses, and kills the flat and broad worms in the belly the powder of the rootdoth wonderfully help to dry up the moisture of the sores that are hardto be cured, and takes away all spots and blemishes of the skin itwere well if gentlewomen would keep this root preserved, to help theirpoor neighbours it is fit the rich should help the poor, for the poorcannot help themselves the burdock they are also called personata, and loppy-major, great burdock andclod-bur it is so well known, even by the little boys, who pull offthe burs to throw and stick upon each other, that i shall spare towrite any description of it place they grow plentifully by ditches and water-sides, and by thehighways almost everywhere through this land government and virtues venus challenges this herb for her own, andby its leaf or seed you may draw the womb which way you please, eitherupwards by applying it to the crown of the head, in case it falls out;or downwards in fits of the mother, by applying it to the soles of thefeet. Or if you would stay it in its place, apply it to the navel, and that is one good way to stay the child in it the burdock leavesare cooling, moderately drying, and discussing withal, whereby it isgood for old ulcers and sores a dram of the roots taken with pinekernels, helps them that spit foul, mattery, and bloody phlegm theleaves applied to the places troubled with the shrinking of the sinewsor arteries, gives much ease the juice of the leaves, or rather theroots themselves, given to drink with old wine, doth wonderfully helpthe biting of any serpents. And the root beaten with a little salt, andlaid on the place, suddenly eases the pain thereof, and helps thosethat are bit by a mad dog the juice of the leaves being drank withhoney, provokes urine, and remedies the pain of the bladder the seedbeing drank in wine forty days together, doth wonderfully help thesciatica the leaves bruised with the white of an egg, and applied toany place burnt with fire, takes out the fire, gives sudden ease, andheals it up afterwards the decoction of them fomented on any frettingsore, or canker, stays the corroding quality, which must be afterwardsanointed with an ointment made of the same liquor, hog-grease, nitre, and vinegar boiled together the roots may be preserved withsugar, and taken fasting, or at other times, for the same purposes, andfor consumptions, the stone, and the lask the seed is much commendedto break the stone, and cause it to be expelled by urine, and is oftenused with other seeds and things to that purpose cabbages and coleworts i shall spare labour in writing a description of these, since almostevery one that can but write at all, may describe them from his ownknowledge, they being generally so well known, that descriptions arealtogether needless place they are generally planted in gardens time their flower time is towards the middle, or end of july, andthe seed is ripe in august government and virtues the cabbages or coleworts boiled gentlyin broth, and eaten, do open the body, but the second decoction dothbind the body the juice thereof drank in wine, helps those that arebitten by an adder, and the decoction of the flowers brings downwomen courses. Being taken with honey, it recovers hoarseness, orloss of the voice the often eating of them well boiled, helps thosethat are entering into a consumption the pulp of the middle ribs ofcoleworts boiled in almond milk, and made up into an electuary withhoney, being taken often, is very profitable for those that are puffyand short winded being boiled twice, an old cock boiled in the brothand drank, it helps the pains and the obstructions of the liver andspleen, and the stone in the kidneys the juice boiled with honey, anddropped into the corner of the eyes, clears the sight, by consumingany film or clouds beginning to dim it. It also consumes the cankersgrowing therein they are much commended, being eaten before meat tokeep one from surfeiting, as also from being drunk with too much wine, or quickly to make a man sober again that was drunk before for asthey say there is such an antipathy or enmity between the vine and thecoleworts, that the one will die where the other grows the decoctionof coleworts takes away the pain and ache, and allays the swelling ofsores and gouty legs and knees, wherein thesis gross and watery humoursare fallen, the place being bathed therewith warm it helps also oldand filthy sores, being bathed therewith, and heals all small scabs, pushes, and wheals, that break out in the skin the ashes of colewortstalks mixed with old hog-grease, are very effectual to anoint thesides of those that have had long pains therein, or any other placepained with melancholy and windy humours this was surely chrysippusgod, and therefore he wrote a whole volume on them and their virtues, and that none of the least neither, for he would be no small fool.

Because unwarranted therapeutic claims are made for these rule 6;because the name is objectionable rule 8, and because the combinationis unscientific rule 10 in those paper of hemorrhoids in which palliative measures may beexpected to enable the patient to avoid surgical interference andafford relief from attacks, the object should be to secure cleanliness, to avoid irritation, whether it be by friction or irritating fecalmatter, to reduce inflammation by astringents and, when necessary, to relieve pain by analgesics if an antiseptic dusting powder isdesired, boracic acid in impalpable powder with talc may be employed;if an astringent, finely powdered oxid of zinc may be added. If alocal analgesic is necessary, a little extract of belladonna may beincorporated with petrolatum or other ointment base the main reliance, in any event, should be to effect normal bowel movements by regulatingthe diet rather than by the use of purgatives. The use of warm waterto insure cleanliness. The avoidance of irritation, especially thatcaused by friction and secretions. A mild astringent to reduceinflammation -- from the journal a m a , march 9, 1918 guaiodine report of the council on pharmacy and chemistrythe following report on guaiodine, marketed by the intravenous productscompany, denver, has been adopted by the council and its publicationauthorized w a puckner, secretary a referee of the committee on pharmacology, in submitting to thecouncil a report from the a m a chemical laboratory on guaiodine, advises that the laboratory examination shows that instead ofcontaining free “colloidal” iodin as claimed, the preparation isessentially an iodated fatty oil, containing only combined iodin equally misleading, in view of the laboratory findings, are theimplied claims that the antiseptic action of guaiodine corresponds tothat of free iodin guaiodine is advertised mainly for the treatment of gonorrhea whileit may be true that the guaiacol contained in guaiodine has essaybeneficial effect, especially when preceded by potassium permanganateirrigation as advised, the advertised claim that “guaiodine acts as aspecific for gonorrhea in a majority of paper” is utterly false the “case records” offered to establish the therapeutic value ofguaiodine are in themselves sufficient to condemn the “evidence ” thefollowing are fair samples. “the second boy came a day or so later with a slight discharge with the characteristic burning and itching, and with symptoms of a beginning gonorrhea, and judging from the source of the infection, it was believed to be so two injections of guaiodine were given when the discharge ceased ” “i have several paper that were completely cured in a very short time i note this, that the first dose causes a cessation of the discharge and the second seems to increase the flow, but the color is changed i give three doses, and then use a mild wash, and in ten days they are well i am very pleased with this preparation and very truly believe that it is the best there is to date for the positive cure of gonorrhea ” report of the chemical laboratoryguaiodine is manufactured by the intravenous products company, denver, colorado the “literature” which accompanies the product describesguaiodine as. “ an electro-chemically prepared iodin, suspended in oil, containing iodin, the same strength as the u s p tincture of iodin, or 7 per cent , together with a therapeutic dose of guaiacol ”the intravenous products company claims that guaiodine is made by an“electro-chemical process of preparing colloidal iodine, ” discoveredby one e b page, and that by this process the tendency of iodin toproduce iodism has been “overcome ” it is said to be “pre-eminentlyan antiseptic and germicide ” guaiodine is a dark brown, oily liquidwith a specific gravity of 0 9845 at 15 6 c and an odor suggestiveof guaiacol its solubilities were those of a fat free iodin wasabsent in the recently purchased specimen traces were presentin an older one steam distillation indicated that the productconsisted of volatile and nonvolatile constituents the volatilematter was concluded to consist, in the main, of guaiacol or essayguaiacol-like body, and the nonvolatile matter to be an iodized fattyoil quantitative determinations indicated that guaiodine containedabout 7 25 per cent of iodin in combination, and that it is composedapproximately of 3 per cent volatile matter and 97 per cent nonvolatile matter hence guaiodine appears to be an iodized fatty oilto which a small amount of guaiacol or essay guaiacol-like substance hasbeen added the council actionon the recommendation of the referee, the council voted that guaiodinebe declared inadmissible to new and nonofficial remedies because offalse statements as to composition and action -- from the journala m a , april 6, 1918 several “mixed” vaccines not admitted to n n r report of the council on pharmacy and chemistrythe “mixed” vaccines which are discussed in the reports that followwere considered by the council during the past year because inquirieshad been received in regard to them in publishing these reports it is desirable that the attitude of thecouncil toward “mixed” vaccines again be stated in view of the rapiddevelopment of bacterial therapy, the possibility for harm that attendsthe use of bacterial vaccines and the skepticism among experiencedclinicians as to the value of vaccines representing a combination oforganisms, the council has felt that it should scrutinize the claimsfor such agents with exceptional care and that there should be admittedto new and nonofficial remedies only those vaccine mixtures for whichthere is acceptable evidence to indicate that the use of the writingicularmixtures is rational in considering the subject the council has borne in mind the fact thatin thesis institutions in which paper are studied and the results oftherapeutic measures carefully observed and controlled, vaccines of anysort are practically never used-- certainly here the stock mixed vaccinehas no recognition experienced clinicians have generally come to theconclusion that mixed vaccines have no specific action and that anyeffect they may produce is due to a non-specific protein reaction as set forth in the reports, in no case was the evidence submittedby the proprietors sufficient to establish the claims made for thepreparations hence none was accepted for new and nonofficial remedies the preparations that form the basis for the accompanying reports areonly a few of the thesis that are being made and sold by essay biologicalhouses doubtless thesis of those not dealt with in this report areequally irrational and sold under claims equally-- or probably evenmore-- unwarranted than those with which the present report deals w a puckner, secretary mixed vaccines-abbottin response to inquiry the council undertook a consideration of thefollowing “mixed{”} vaccines sold by the abbott laboratories:m catarrhalis-combined-bacterin, said to contain killed micrococcuscatarrhalis, bacillus friedländer, pneumococci, streptococci, staphylococcus aureus and staphylococcus albus b coli-combined-bacterin, said to contain killed streptococcusviridans, streptococcus hemolyticus and bacillus coli pertussis-combined-bacterin, said to contain killed bacilluspertussis, pneumococci, streptococci, staphylococcus albus, staphylococcus aureus and micrococcus catarrhalis streptococcus-rheumaticus-combined-bacterin, said to contain killed“streptococci rheumaticus, viridans, etc ” and pneumococci streptococcus-viridans-combined-bacterin, said to contain killedstreptococcus viridans, streptococcus hemolyticus, pneumococcus andstaphylococcus albus the abbott laboratories were asked to assist in the investigation ofthese products and to submit evidence to establish their eligibilityfor admission to new and nonofficial remedies the manufacturer wasinformed that the council accepts “mixed” vaccines or bacterins, provided the usefulness of these products is established by acceptableclinical evidence, and references to the literature bearing on thevalue of the preparations were requested the abbott laboratories submitted specimens of the products, theadvertising matter therefor and a considerable list of references tocurrent literature. All of which was transmitted to the committee onserums and vaccines for consideration in due time a referee of thecommittee submitted the following report.

Smith v riddick, 5 jones n c , 42 liability of third persons calling a physician general rule as to liability for services rendered, when the medical man is calledby one person to attend another, it may be stated as a general rulethat in order to create such a liability it must appear that the personcalling either actually intended to become responsible, or acted insuch a manner that the physician was led to suppose that he so intended liability of railway company calling physician in case of accidentto employees, etc - another more troubleessay question has arisenwhere physicians and surgeons have been called in by employees of arailway company in case of sudden accident or injury in one case innew york, the superior court of new york city held, that although thegeneral superintendent of a railroad company testified that he hadgeneral authority to hire and discharge men, and that he had employed aphysician, the railroad company was not liable 169 this doctrine seems to be opposed to the weight of authority see paper collated in vol 18, “am and eng cyclopædia of law, ” p 434 et a long way gone essay seq , essay of which are. Toledo, etc , r r co v rodrigues, 47 ill , 188. Same v prince, 50 ill , 26. Indianapolis, etc , r r v morris, 67 ill , 295. Cairo, etc , r r co v mahoney, 82 ill , 73. Atchison, etc , r r v beecher, 24 kansas, 228 same rule does not prevail in united states in case of accidents to passengers - the paper just noted were all paper of employees in the paper of injured passengers it has been doubted whether the same rule applied, essay state courts holding that in that case there is no obligation to furnish medical and surgical attendance, but that the physician attending must look to the persons whom they attended union pacific r r co v beatty, 35 kansas, 265. Brown v missouri, 67 missouri, 122 different in england - in england a different rule prevails one more humane and in consonance with the moral obligation imposed by the relationship of the writingies in walker v the great western r r co , a recent case law reports, 2 exch , 228, chief-justice kelley, in the course of the argument, made this remark. “must a board be convened before a man who has his legs broken can have medical attendance?. ” but in cox v the midland counties r r co 3 wellsby, h & g , 268, the station master, employed as the chief officer of the passenger and other dewritingments, called in a surgeon to perform an operation upon a passenger injured by a train the road was held not liable on the other hand, in langan v great western r r co 30 law times, n s , 173, a sub-inspector of railway police was held to have implied power to employ a surgeon for an injured employee but in arkansas an attorney for a railroad company was held not authorized to do so st louis, etc , r r co v hoover, 53 ark , 377 doctrine in indiana the more sensible one - the more sensible doctrine seems to be established in this country, in the state of indiana at least, in the case of terre haute r r co v mcmurray 98 ind , 358, in which the court held that where there was great necessity for the employment of a surgeon, the conductor of a train has authority to employ the surgeon, if the conductor is the highest officer in rank on the ground at the time but in that case the court expressly states that this liability grows out of the exigencies of the case. Not out of any theory of general authority authority of railroad physician to employ nurses, etc , doubtful - it has also been disputed whether the authority of the company physician extended far enough to render the company liable for services performed by nurses employed by him, or for board and lodging engaged by him for injured employees in bingham v chicago, etc , r r co 79 iowa, 534, it was held that the authority was sufficient, but in that case testimony appeared tending to show that an agent of the company who had authority to employ the physician had authorized him to employ two nurses the converse doctrine namely, that the fact that a physician of the company was authorized to buy medicines on the credit of the company does not authorize the inference that he has power to render the company liable by a contract for board and nursing of a person injured on the company road was held in maber v the chicago, etc , r r co , 75 missouri, 495. Brown v the missouri r r , 67 missouri, 122 to the same effect, see louisville, etc , r r co v mcveigh, 98 ind , 391. Cooper v n y c & c , 6 hun, 276. And st louis, etc , r r co v hoover, 53 arkansas, 377 2 redfield on railways, 114. On the other hand, where a physician and surgeon has been duly employed by a sub-officer or servant of the railroad company, ratification of this employment, by those having authority to employ him and to render the company liable, will be inferred from slight circumstances such was the case of louisville r r co v mcveigh, which has been cited and in another case where information of the fact of the employment had been conveyed to the company general manager, and he had neglected and omitted to repudiate the employment or to terminate it, and the surgeon went on and performed services, it was held that from these facts a ratification will be inferred indianapolis r r co v morris, supra see also toledo, etc , r r co v rodrigues, supra. Same v prince, supra. Terre haute, etc , r r co v stockwell, 118 ind , 98 presentation and retention of doctor bill raises no presumption ofliability - the presentation of a bill to a person containing chargesagainst him for services rendered another person, and his retentionof that bill without disclaimer of liability, does not raise apresumption of liability, for it is not necessarily an account stated to constitute an account stated, there must be not only a statement ofaccount, but acquiescence in it. Mere retention of the account is notsufficient bills presented not conclusive as to amounts charged - on the otherhand, if a bill is presented which contains charges which are notacquiesced in, the person making out and presenting the bill is notabsolutely bound by the charges therein contained, although such a billaffords essay evidence as to the value of the services rendered 170claims against estates of deceased persons - a bill for a physicianservices constitutes a claim against the estate of a deceased person, like any other debt in essay states it is a preferred claim 171 inthis connection it should be observed that short statutes of limitationexist in most countries and states applicable to such paper, shorterthan the ordinary limitation imposed by law upon the right to sue uponclaims for services rendered which is six years in order to preservehis legal rights, the physician should as soon as possible after thedeath of the person for whom his services have been rendered, ascertainwho is the administrator or executor of the estate of such person, andfile with such representative, personally, proof of his claim patient who receives benefit of services of consulting physicianliable - the liability of a patient for the services of a consultingphysician is generally governed by the same rules as his liability tothe physician in immediate charge of the case 172where the patient accepts the services of a consulting physician, although he has not directly requested them, he must pay for them ifhe receives the benefit of them without objecting, because it will bepresumed that he ratified the act of the physician who was in charge ofthe case, in calling the other physician into consultation 173but, however this may be, it is a principle of professional ethics, which has almost acquired the authority of legal doctrine, that aphysician in charge of a case should obtain the full assent of apatient, or of his family and friends, if he is too ill to give his ownconsent, to the calling of another physician in consultation no other stranger can be called into sick-room without assent ofpatient - a limitation upon the authority and right of an attendingphysician is, that if he desires or attempts to call in a stranger nota physician, he must obtain his patient consent the obligation ofa physician toward his patient of secrecy and confidence is regardedas very strict, and if a physician should call in a student or otherstranger, without first consulting his patient, or those who are inessay measure related to him and connected with him, it would be a verysevere stretch of morals and possibly of law in fact, in a recent casein michigan, a physician was held liable for damages who called in astranger, an unmarried man, who was an unprofessional man, to be withhim while he was in attendance on a confinement case in that case boththe physician and the person so called in, and who was present at thattime, were held liable in damages. And it was further held that theright to recover was not affected by the fact that the patient supposedthat the person so called in was a medical man, and therefore submittedto his presence without objection 174the statutes which create the privilege as to professionalcommunications and information necessary to enable the physician toprescribe, might not apply to students or other strangers, and this isprobably the reason for the rule of law laid down in the michigan case the obligation to preserve inviolate a communication as a privilegedcommunication, including in the meaning of the word “communication”all knowledge or information received while in attendance upon a case, would be held to have been broken by the act of the physician inbringing in a stranger who would not be privileged from testifying measure of recovery for services rendered terms of express contract govern reasonable worth the rule in impliedcontracts - in case of an express contract its terms necessarilymeasure the amount of the charges in the absence of an expresscontract fixing the value of the services to be rendered, the measureof damages for breach of payment is like that in any other case ofpersonal services, the reasonable worth and value of the servicesperformed so likewise if medicines or appliances are furnished, whichare not reasonably to be expected and furnished, according to thecustom of the school to which the physician or surgeon belongs, thereasonable worth and value at the time of furnishing them, and at theplace of furnishing them, is the measure fixed by the law to determinewhat shall be recovered for them 175value how proved - when the medical man is compelled to go intocourt to enforce payment for his services, it has been questionedwhether he can testify to the services rendered, and the facts andcircumstances surrounding the patient at the time of the treatment, because it has been claimed that he could not do so without violatingthe statute against the disclosure by physicians of informationreceived which is necessary to enable them to prescribe the tendencyof the later decisions, however, seems to be that the breach of thepatient contract to pay relieves the physician from his obligationof secrecy, and consequently, that if it is necessary for him to gointo court and prove the value of his services, he may testify, withinreasonable limitations, to all matters necessary to inform the courtfully as to the nature and extent of the disease or injuries of thepatient, in order that he may show the responsibility imposed upon himand the extent of the services that he has rendered this subject willbe fully considered under the head of “privileged communications ”the usual course of practice where there is not an express contractfixing the charges, is to prove the facts and circumstances showing thetreatment and services, and then to produce other physicians who, inanswer to a hypothetical question stating the facts and circumstancesin the case, assuming them as true, are allowed, if they state theyknow the value of such services, to give an expert opinion as to whatthat value is 176 it has also been said ordronaux, “jurisprudenceof medicine, ” § 43, that if a fee-bill of charges for such serviceshas been established by an association of physicians recognized bylaw, such as a county medical society or a state medical society, incorporated pursuant to statute, such fee-bill can, if properlyauthenticated as having been adopted by the association, be offered inevidence on behalf of the patient and against the physician but sucha fee-bill in such a case would not be held to be conclusive evidenceof the value of the services, but will be received in evidence, if atall, merely for the purpose of showing what was the usual and ordinarycharge in such paper as we shall see later on, under “malpractice, ” ajudgment for services rendered, however small, is a bar to an action ofmalpractice, because a judgment for the value of the services renderedinvolves proof on the writing of the plaintiff, and a finding on the writingof the court, that the services had value and were skilfully performedand properly rendered 177custom of physicians to treat each other gratis, enforceable - physicians frequently treat each other, and it has beenheld, where the custom exists to do so without charge, that such acustom is binding of course, this rule does not prevent physiciansfrom making an express contract to waive the custom and agreeing thatthe services be compensated elements to be proved in an action for service, etc - generaladvice - the result of these rules may be thus summarized, viz. Theelements to be established in an action for services by a physicianagainst a patient are three in number 1 the employment.

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Wheneverthe patient has reason to suppose that the relation exists and does infact and truth so suppose, in a case where the physician attends undercircumstances calculated to induce the opinion that his visit is of aprofessional nature, and the visit is so regarded and acted upon by theperson attended, the relation of physician and patient contemplated bythe statute may fairly be said to exist 392but the fact that it is the duty of a physician to prescribe for aperson in case of need, does not a long way gone essay constitute the relation, thoughthe position of the physician gives him the opportunity to observesuch person. So, therefore, a jail physician was not precluded fromtestifying as to what he had observed of a prisoner, where it did notappear that he had ever attended the latter in a professional capacityor had ever been called on to attend him 393it would seem, however, that where it is the duty of a physician toattend a person in a professional capacity or to acquire knowledgeconcerning him in such capacity, he cannot disclose informationactually acquired in the performance of his duty it has been saidthat a medical attendant at an insane asylum cannot testify as to themental condition of an inmate;394 and that a physician employed in ahospital to notice and enter in its records the arrival and conditionof the patients coming in, cannot testify as to information soacquired 395it is immaterial that another person employs the physician to examinethe patient, and to report to the employer, and that the personexamined does not appear to desire any knowledge as to his condition;if the examination is made as a professional act, the relation ofphysician and patient is established between the physician and theperson examined, even though it be the only interview 396and in a case where the public prosecutor sent a physician to a personfor the purpose of making a professional examination, so as to obtainevidence against another person charged with crime, and the personexamined accepted the services of the physician in a professionalcharacter, it was held that he could not testify as to the results ofhis examination 397but where the district attorney sent a physician to jail to make anexamination of a prisoner mental and physical condition, and he madesuch examination, and it did not appear that he prescribed for ortreated the prisoner or that the prisoner accepted his services, theopinion of the physician as to his mental condition was admitted 398where the defendant employed a physician to examine the plaintiff, andhe went as coming from the defendant for that purpose, and examinedthe plaintiff in the presence of his attending physician, but not asthe plaintiff physician and not for the purpose of prescribing, therelation of physician and patient was not established 399 where aphysician examined the plaintiff at the instance of the plaintiffphysician, but it was not shown that he was requested or expectedto treat or prescribe or to advise in respect to either, or that hedid either, it was held that the relation was not established;400but a physician consulted by the patient regular physician for thepurpose of advice concerning his treatment is a physician contemplatedby the statute;401 as is also the writingner of a physician whois present during a conference with the patient or who overhearssuch a conference 402 attendance at the patient house is notcontemplated as essential by the law, and it makes no differencewhere the examination is conducted 403 but where the physician wasalso a county clerk and the alleged patient was an attorney, and theconsultation took place in the clerk office and consisted of anexamination of an eruption on the skin, which was made gratuitously andwithout a prescription being made or asked for, the relation was heldnot to have been established, notwithstanding that the clerk made useof his knowledge and learning as a physician in forming his opinion, and that it was in confidence that he possessed medical skill that theperson requested the examination 404it does not follow that the relation once established continues always;the secrecy growing out of the relationship, as to knowledge thenacquired, always continues unless properly waived. And the physicianwill not be allowed to testify in regard to matter which is writingly theresult of such information, though another writing may have been acquiredindependent of the relation;405 but where it is clear that the matterdesired is independent of the relation of physician and patient, suchevidence is admissible if otherwise competent 406“professional capacity ” the states in which the statutes limitthe privilege to information acquired in a professional capacityhave been enumerated 407 as to what constitutes a professionalcapacity, the discussion of the facts that establish the relation ofphysician and patient, and of the information necessary to enable aphysician to prescribe or a surgeon to act, makes it unnecessary todiscuss at length the meaning of this phrase the decision in lunzv massachusetts mutual life insurance company408 would make itappear that in missouri information apparent on a casual inspectionwhich any one might make is not received in a professional capacity, but this idea is disapproved in the later case of kling v city ofkansas 409 information acquired by the physician by observing thepatient on the street anterior to his employment as a physician is notreceived by him in a professional capacity 410in new york, where the physician had not seen the patient before orsince his interview for the purpose of treatment, and he was askedwhat his opinion was, based on a general sight of the man before theexamination, it was held that the physician could not properly answer, as all the information upon which the opinion would be based musthave been acquired in a professional capacity;411 but in anothercase a physician was permitted to express his opinion as to the mentalcondition of a patient whom he had seen at various times when notin attendance, excluding from his mind any knowledge or informationobtained while acting as her medical attendant and confining his answerto such knowledge and information as he had obtained by seeing her whennot his patient 412 it has been said that where information is notsuch as is obtained on sight by any person, but by removing clothingand by percussion and listening to the action of the lungs, these areprofessional acts and the information may be considered as obtainedprofessionally 413 it has been said that information received in aprofessional capacity involves a decision, though it may be negative;and that signing as witness to a will is not a professional act 414matter necessary to enable a physician to prescribe or a surgeon toact - a list of those states whose laws limit the privilege to matternecessary to enable the witness to prescribe or act for the patient isto be found in another place 415in arkansas, where six hours after delivery, the patient stated to herphysician who attended at accouchement, that she had never been engagedto marry and never had promised to marry, the statements were held notto be necessary to enable the physician to act 416in iowa, a physician who had treated a patient for injuries was notallowed to testify whether his patient told him that the car on whichhe was injured was in motion at the time, because as the injury wouldbe likely to be more severe if the car was in motion, that informationwas necessary to enable the physician to prescribe 417in michigan, a physician was allowed to contradict his patient asto when her trouble commenced, in the absence of evidence thatsuch information was necessary to enable him to act 418 where aphysician was asked whether he treated a person for typhoid fever, and he answered that she was not so diseased, it was held that thisinformation was not necessary to enable him to act 419 and the samewas held to be true where a physician examined a prisoner at the jailand testified that he was diseased, the prisoner having been notifiedat the time of the examination that it was made by direction of theprosecuting attorney and there being no intention to prescribe or actfor the prisoner 420 but it has been stated that all disclosures bya patient to a physician respecting ailments are privileged whethernecessary to enable the physician to prescribe or not 421in minnesota, a physician was allowed to disclose statements as tosuffering made by his patient, but not for the purpose of enabling himto prescribe or act 422in missouri, it has been said that information as to the way in whichan injury was inflicted is of the greatest necessity for successfultreatment. And that it is information which physicians universallydemand and receive 423 in another case, with reference to the causeof a patient condition, it was said that while knowledge of thecause may not be necessary, the disclosure of the cause cannot be madewithout a disclosure of the condition, and that as a medical personcannot tell indirectly what he is forbidden to tell directly, thephysician evidence of the cause is inadmissible 424 in another caseit was said that any information, necessarily coming to a physician inorder to treat his patient, is to be regarded as necessary informationthough unimportant, and that the test is how it was acquired, notwhether it could have been acquired in a different way, and thereforeit was incompetent for a physician to testify that his patient wasdrunk when he treated him 425in new york, in an early case, 426 where a man consulted a physicianwith reference to committing an abortion and told him that a certainwoman was pregnant by him, this admission was said not to be essentialto enable him to prescribe, even if the relation of physician andpatient were considered established. But this seems to be at variancewith the later case of people v brower, 427 where the accusedconsulted a physician with reference to the treatment of a woman onwhom he had attempted to commit an abortion, and admitted that hehad done so, and the physician was not permitted to disclose it a broader view is now taken of the word necessary it has beenheld by the court of appeals that a physician could not testifythat his patient had a venereal disease while under his care as aphysician, the presumption being that he learned it for the purpose ofprescribing;428 and again, that it is assumed from the relationshipthat the information would not have been imwritinged except for thepurpose of aiding the physician to prescribe 429 but this presumptiondoes not attach to information regarding a patient, communicated by athird person 430where a person went to a physician to call for medicine, andit appeared that he was not consulting for himself and was notrepresenting any one else who needed or desired medical assistance, thephysician was allowed to testify as to a conversation which took placeat that time 431in the case of edington v ætna life insurance company, 432 it wassaid that before the exclusion, the facts on which it is justifiedmust appear in essay way, and the court must know essaywhat of thecircumstances. From the opinion it is easy to infer that it is onlyconfidential communications and information as to secret ailments whichmay be regarded as necessary within the statute. But this view wasoverruled in grattan v metropolitan life insurance company, 433and there it was distinctly stated that it is enough that the witnessacquired the information in his character as physician and in the dueand proper exercise of his calling, and that it is not incumbent onthe person objecting, to show by formal proof that the informationwas necessary to enable the witness to prescribe in this case theexamination of the witness was as to the cause of his patientdeath, and the argument urged upon the attention of the court was thatinformation regarding the cause of death could not be necessary toenable the physician to prescribe, as the utility of the prescriptionceased with the death and before the cause was determined.