r ordinary
circumstances, neither the state nor the patients can oblige him to
exercise his profession at all; but, if once he has taken a case in
hand, he can be justly held not to abandon it till he has given his
patient a fair opportunity of providing another attendant; even the fear
of contagion cannot release him from that serious obligation.

The duties arising from the physician's twofold contract, with the
state and with his patients, are chiefly as follows:

1. He must acquire and maintain sufficient knowledge of his profession
for all such cases as are likely to come in his way. No Doctor has the
right to attempt the management of a case of which he has not at least
ordinary knowledge. In matters of special difficulty, he is obliged to
use special prudence or ask for special consultation. The courts justly
hold him responsible for any serious injury resulting from gross
ignorance; in such cases they will condemn him for malpractice. I would
here remark that, in an age in which the science of medicine is making
such rapid progress, every Doctor is in duty bound to keep up with the
improvements made in general practice, and in his own specialty if he
has one.

2. A second duty is that of proper diligence in treating every single
case. Many a patient suffers injury to health or even loses his life in
consequence of a Doctor's neglect. Gross negligence is an offence that
makes him punishable by the court, if it results in serious injury. But
even if such injury cannot be juridically proved, or has been
accidentally averted, the moral wrong remains and is to be settled with
the all-seeing Judge. Still, in ordinary ailments, no one is obliged to
take more than ordinary trouble.

3. A third duty of the physician is to use only safe means in medical
and surgical practice. He has no right to expose his patient to needless
danger. What is to be thought of the use of such remedies as will either
kill or cure? They cannot be used as long as safer remedies are
available and capable of effecting a cure; for neither Doctor nor
patient has a right to expose a human life to unnecessary risk. But when
no safer remedies are going to effect a cure, then prudence itself
dictates the employment of the only means to success. In such a case,
however, the patient, or his parents or guardian, should, as a rule, be
informed of the impending danger, so that they may give or refuse their
consent if they please. For, next to God, the r