C69?c 1851 COLLEGE OF PHYSICIANS, PHILA CHARTER. 1851 NATIONAL LIBRARY OF MEDICINE Washington Founded 1836 U. S. Department of Health, Education, and Welfare Public Health Service >r/' ^l '-> CHARTER, ORDINANCES AND BY-LAWS OF THE COLLEGE OF PHYSICIANS j CHARTER, ORDINANCES AND BY-LAWS COLLEGE OF PHYSICIANS PHILADELPHIA. PHILADELPHIA: T. K. AND P. G. COLLINS, PRINTERS. 1851. CS77C //S7 The College was instituted in January, 1787, and incorporated in March, 1789; the Ordinances and By-Laws were revised and finally adopted July, 1840; since which time various additions and amend- ments have been made to them, all of which are incorporated in the present revised editon. Approved, November 1851. CONTENTS. CHARTER,.......5 ORDINANCES AND BY-LAWS, Chap. I. Of Officers and their Duties, - - - 10 II. Of Members and Membership, - - - 12 III. Of Meetings and Order of Business, 15 IV. Of Committees, - - - - 17 V. Rules of Order, - * - - 18 VI. Summary of Transactions, - - - 21 VII. Committee of Publication, - - - 22 VIII. Of the Library, - - - - 23 IX. Of the Museum, - ... 24 X. Code of Medical Ethics, - - - 25 XI. Of the Revision and Enactment of Ordinances and By-Laws, - - - - 50 LIST OF MEMBERS, ---... 51 OFFICERS, 1852,......55 CHARTER. An Act for the Incorporation of the College of Physicians of Philadelphia. 1. Whereas, the Physicians of Philadelphia, influ- enced by a conviction of the many advantages which have arisen from literary institutions, have associated themselves under the name and title of The College of Physicians of Philadelphia : 2. And whereas, the objects of this College are to advanpe the science of medicine, and thereby to lessen human misery, by investigating the diseases and re- medies which are peculiar to this country; by observ- ing the eifect of different seasons, climates, and situa- tions upon the human body ; by recording the changes which are produced in diseases by the progress of agriculture, arts, population, and manners ; by search- ing for medicines in the American woods, waters, and in the bowels of the earth; by enlarging the avenues to knowledge from the discoveries and publications of foreign countries; and by cultivating order and uni- formity in the practice of physic: 3. And whereas, the said College of Physicians have prayed us, the Representatives of the Freemen of the Commonwealth of Pennsylvania, that they may 6 be created a body politic and corporate, forever, with such powers, privileges, and immunities as may best answer the laudable purposes which the members thereof have in view; wherefore, to assist and encou- rage the said College of Physicians, in the prosecution and advancement of useful knowledge, for the benefit of their country, and of mankind, 4. Be it enacted, and it is hereby enacted, by the Re- presentatives of the Freemen of the Commonwealth of Pennsylvania, in General Assembly met, and by the authority of the same, That the members of the said College of Physicians, that is to say, John Redman, John Jones, William Shippen, Jun., Adam Kuhn, John Morgan, Benjamin Rush, Samuel Dufneld, Ge- rardus Clarkson, George Glentworth, Thomas Parke, James Hutchinson, Robert Harris, John Carson, Ben- jamin Duflield, William W. Smith, John Foulke, Sa- muel Powell Griffitts, William Clarkson, William Cur- rie, Benjamin Say, Andrew Ross, John Morris, Nathan Dorsey, James Cunningham, Caspar Wistar, Jun., Michael Lcib, and John H. Gibbons, be, and the same persons are, and shall be, a body corporate and politic in deed and in name, by the name and style of " The College of Physicians of Philadelphia," and, by the same name, they and their successors are hereby constituted and confirmed one body corporate and politic in law, to have perpetual succession, and to be able and capable to have, hold, and enjoy any goods and chattels, lands, tenements, rents, hereditaments, gifts, and bequests, of what nature soever, in fee sim- ple, or for term of years, life or lives, or otherwise; 7 and also to grant, sell, alien, assign, or let the same lands, tenements, and premises, according to the na- ture of the respective grants and bequests made to the said corporation, and of the estate of the said corpo- ration therein ; provided, that the amount of the clear yearly value of such real estate exceed not the sum of five hundred pounds, lawful money of this common- wealth. 5. The said corporation be, and shall be forever hereafter, able and capable in law, to sue and be sued, plead and be impleaded, answer and be answered unto, defend and be defended, in all or any courts of justice and other places, in all manner of suits, actions, complaints, pleas, causes, and matters of what nature or kind soever; and that it shall and may be lawful to and for the said corporation, forever hereafter, to have and use a common seal, and the same seal, at the will and pleasure of the said corporation, to break, change, alter, and renew. 6. For the well ordering of the said corporation and its affairs, there shall be, at all times hereafter, the following officers of the same; that is to say, one President, one Vice-President, four Censors, a Secre- tary, and a Treasurer, who shall be chosen, annually, from amongst the Fellows of the said College of Phy- sicians, on the first Tuesday in the month of July, for- ever hereafter, or within one calendar month after the same day, in any year; and that John Redman be the present President of the said College; John Jones, the present Vice-President; William Shippen, Jun., Adam Kuhn, Benjamin Rush, and Samuel Duffield, 2* 8 the present Censors; Samuel Powell Griffitts, the pre- sent Secretary; and Gerardus Clarkson, the pre- sent Treasurer of the said College : and shall be and remain the President, Vice-President, Censors, Secre- tary, and Treasurer, respectively, of the said College, until they be superseded by a new election to be made by the Fellows of the said College as aforesaid; and all vacancies by death, resignation, or otherwise, which shall at any time hereafter happen in any of the said offices, may be filled by a special election, to be holden so often as occasion shall require. 7. The authorities and duties of the officers of the said corporation, who are hereinbefore mentioned, and of any others which the said corporation shall see fit to appoint, the times of meeting of the said corpora- tion, the admission of members, and the other con- cerns of the said corporation, shall be regulated by the by-laws and ordinances of the said corporation, heretofore made or to be made, touching the premises. 8. Provided always, That no by-laws nor ordi- nances of the said corporation, hereafter made, shall be binding upon the officers or members thereof, un- less the same shall be proposed at one regular meeting of the said corporation, and enacted and received at another, after the intervention of at least thirty days. And that no sale, or alienation, or lease for above three years, of any part of the real estate of the said corporation, shall be valid, unless the terms and nature of such sale or lease be proposed at a previous meet- ing of the said corporation. Signed by order of the House, Richard Peters, Speaker. 9 Enacted into a law, at Philadelphia, on Thursday, the twenty-sixth day of March, in the year of our Lord one thousand seven hundred and eighty-nine. Peter Zachary Lloyd, Clerk of the General Assembly. ORDINANCES AND BY-LAWS. CHAPTER I. OF THE OFFICERS AND THEIR DUTIES. 1. The officers (as required by the Charter) shall be a President, a Vice-President, four Censors, a Se- cretary, and a Treasurer, to be chosen annually, by ballot, on the first Tuesday in July, or within one ca- lendar month thereafter. 2. The President shall maintain order at the meet- ings of the College, and shall sign all orders on the Treasurer, duly passed by the College. He shall have power to call special meetings at his own discretion; and it shall be his duty to call them, when requested in writing by six Fellows. He shall not discuss any question while in the chair, unless it be a question of order; and shall have no vote, except when his vote may be necessary to decide a question. 3. The Vice-President shall perform the duties of the President in the absence of the latter officer, or at his request when present. In the absence of both the President and the Vice-President, a chairman shall be appointed viva voce. 11 4. The Censors shall inspect the records and exa- mine the accounts of the College, and report thereon at the stated meeting in July. They shall take cog- nizance of all charges of a breach of the regulations of the College, preferred against a Fellow, and shall con- sider and determine the same, and report thereon to the College; provided that, in cases where a Censor is one of the parties concerned, the charge shall be referred to a committee of three, to be chosen by bal- lot, who shall act as censors pro hac vice. 5. An appeal from the decision of the Censors to the College, in these cases, shall always be reserved. 6. The Treasurer shall collect and receive all the moneys due to the College, and pay them only upon the order of the President, or other officer who may have presided at the meeting at which the appropria- tion was passed; and these orders shall be his vouchers for his expenditures. He shall present annually a statement of the finances of the College, at the stated meeting in June, and at such other times as the Col- lege shall direct. 7. The Secretary shall keep correct minutes of the proceedings of the College, and record them in a book provided for the purpose. He shall keep a list of the Fellows and Associates, on which he shall note the date of the election of each; the time of his death, resignation, or loss of membership, and the residence of Associates. He shall cause to be inserted, in a book provided for the purpose, the biographical no- tices of deceased Fellows presented to the College. He shall receive and preserve all books of records, 12 and papers belonging to the College, provide certifi- cates of membership, and perform such other duties as are appropriate to his office. He shall be, ex officio, a member of the Committee of Publication. He shall also act as Librarian. CHAPTER II. OF MEMBERS AND MEMBERSHIP. 1. The College shall consist of Fellows and Asso- ciates. 2. The Fellows shall be practitioners of medicine, of good character in their profession, residing within the city and incorporated districts of Philadelphia, and who are over twenty-four years of age. 3. The Associates shall be distinguished practi- tioners of medicine, residing without the limits above mentioned. 4. No person who gives his support to any system of practice, which is sustained by efforts to weaken or diminish public confidence in the science of medicine or in the medical profession, or who, by advertisement announces his claim to superior qualifications in the treatment of diseases, or of a particular disease; or who holds a patent, or part of a patent for a surgical instrument; or gives a prescription to any apothecary, which he refuses to give to other apothecaries; or who 13 deals in secret medicines, or publicly recommends them, shall be considered eligible as a Fellow or Asso- ciate of the College. And, any Fellow or Associate who may be hereafter so engaged, shall forfeit his right to membership, on the fact being reported by the Censors. But an appeal from the decision of the Censors is permitted, as in other cases. 5. Candidates for Fellowship may be proposed in writing, at any stated meeting, by three Fellows. They shall be balloted for only at the stated meet- ings in January, April, July, and October; when, if four-fifths of the Fellows present vote in their favor, they shall be pronounced duly elected; provided, that no election for a candidate shall be gone into, unless there be present at least twenty Fellows. 6. The names of the persons proposed as candidates for Fellowship shall not be placed on permanent record, unless the said candidates shall be actually elected; and, in the case of the rejection of any candidate, the paper containing his nomination shall be destroyed immediately after the meeting, at which he is balloted for, has adjourned. 7. No person elected a Fellow shall be deemed a member of the College, until he shall have subscribed the ordinances and by-laws, and paid his initiation fee; and if he omit the signing and payment above mentioned for three months, his election shall become void. . 8. The initiation fee shall be fifteen dollars, payable at or before the signing the ordinances and by-laws, and the annual contribution shall be five dollars, pay- 14 able at the stated meeting in July. To all annual contritions that shall remain unpaid after the meet- ing in October, ten per cent, shall be added. 9. Any Fellow who shall decline the payment of his annual contribution for two successive years, shall forfeit his membership. Provided, however, that if any Fellow shall be absent from Philadelphia, on pub- lic service in the Army or Navy of the United States, for twelve months or more, at any one time, a deduc- tion shall be made from the amount of his annual con- tributions, corresponding to the duration of his ab- sence. 10. No Fellow who may reirove from the city of Philadelphia, and Incorporated Districts, shall, in consequence of such removal, forfeit his Fellowship, but he shall be exonerated from the payment of the annual contributions. 11. No Associate, who may come to reside within the limits described in Chapter II. Sect. 2, shall be admitted to a Fellowship in the College, without being elected and introduced in the manner prescribed for the admission of Fellows. 12. The number of Associates shall not exceed forty, ten of whom shall be foreigners. 13. Associates shall have the privilege of attending the meetings of the College, but shall take no part in the transaction of its private business. 14. The signing of the Constitution adopted in 1788, shall be deemed a subscription to the ordinances and by-laws of the College, in force for the time being. 15. Every Fellow of the College shall receive a certificate of membership according to the annexed 15 form, having the seal of the College affixed thereto, and signed by the President, Vice-President, and Censors, and countersigned by the Secretary, ^Sos, Preeses, Vioe-Pr&ses, Censoresque Collegii Medi- corum Philadelpkiemis, omnibm ■ad quos hsec per- venerint, mlutem. Testamur tirum doctum et medicinse peritum, nostri Collegii Socium «—■--- adscriptum fuisse, omnesque ejus honores et privilegia, jure riteque comecutum esse. In cujus reijidem hisee Uteris, Collegii sigillo munitis, nomma. nostra subjici- mus. Datum Philadelphia, Anno Domini 18 Pt V. Prseses, Secretarius, CHAPTER IIL OF MEETINGS* 1. The Stated Meetings shall be held on the first Tuesday in every month; from October to March in- clusive, at 7 P. M.; and from April to September in- 3 16 elusive, at 8 P. M. At which hours precisely,- or 0,3 soon thereafter as a quorum, which shall consist of seven Fellows, shall have assembled, the meeting shall be organized. 2. At stated meetings, the following shall be the order of business: 1st. The minutes of the preceding meeting shall be read for approval or correction. 2d. Newly elected Fellows may be introduced. 3d. Committees shall report. 4th. Motions and observations respecting the pri- vate business of the College, may be made. 5th. Written communications may be received. 6th. Verbal communications may be made. 7th. Miscellaneous business may be transacted. 8. At the stated meetings in January, April, July, and October, the balloting for Candidates for Fellow- ship may be gone into,, after the second item of busi- ness has been transacted, provided there are present at least twenty Fellows. 4. At the stated meeting in June, the Treasurer' and the Library Committee shall present their annual reports, and the President shall nominate the standing committee On the Library, and a committee on Me- teorology and Epidemics. 5. At the stated meeting in July, after the third item in the order of business shall have been dispatched, the Censors and Committee on the Museum shall present their annual reports; the annual appropriation for the library shall be made; and the officers of the College for the ensuing year shall be elected ; after 17 which, the business of the College shall proceed in the usual order. 6. At the stated meeting in November, the Com- mittee of Publication shall be elected. 7. At the stated meeting in February, the report on Meteorology and Epidemics shall be made. 8. At special meetings, no business shall be trans- acted except that for which the said meeting has been called. CHAPTER IV. OF COMMITTEES. 1. The following shall be the mode of appointing Special Committees, excepting when otherwise ordered by a vote of the College. The President shall nomi- nate one member, who shall be chairman of the com- mittee, and considered responsible for the due perform- ance of the duties enjoined on the committee. The chairman shall nominate the second member, the se- cond the third, and so on, until the number agreed on shall be completed. 2. Committees shall report at the meeting imme- diately succeeding their appointment, unless it may be otherwise determined by an order or by-law of the College; and failing to make a final report at the proper time, unless a satisfactory reason therefor be 18 given, they shall be discharged, and the matter drop- ped or referred to another committee, as the College shall determine. 3. All reports shall be made in writing, and signeci by a majority of the committee. CHAPTER V. RULES OF ORDER. 1. No question shall be considered open for discus- sion, except when brought forward by motion duly made and seconded, and then distinctly stated by the presiding officer. The name of the mover of each motion to be entered upon the minutes. 2. Every motion shall be reduced to writing by the mover, if the presiding officer or any Fellow request the same. 3. Any Fellow may call for the division of a ques- tion, provided it comprehends two distinct proposi- tions. A motion to strike out and insert shall be deemed indivisible; but a motion to strike out shall not preelude either amendment or a motion to strike out and insert. 4. The mover, with the consent of the seconder, may withdraw any motion previously to its amendment, commitment, or to the question upon its final passage being put by the presiding officer. 19 5. When a Fellow speaks, he shall stand up, ad- dressing himself to the presiding officer, and confining himself strictly to the question under consideration. 6. No Fellow shall be interrupted while speaking, except by a call to order. 7. The presiding officer shall decide all questions of order, unless an appeal be made to the College, in which case the person appealing shall first state his reasons for appealing, and then the presiding officer his reason in support of his decision, but no further debate shall be allowed. 8. No Fellow shall be allowed to speak more than twice upon the same question, without permission being granted him by the College. 9. Whilst a question is under consideration, no mo- tion shall be received excepting to adjourn, to lay the subject upon the table, to postpone, to refer to a com- mittee, or to amend; which several motions shall have precedence in the order in which they are named. 10. A motion for adjournment shall always be in order, except when the College is voting oh another question, or while a Fellow is speaking. 11. A motion to amend an amendment is in order, but not one to amend an amendment to the amend-* ment. The question on the amendment shall be de«- cided before that on the main question. 12. No motion shall be received to postpone the motion under discussion for the purpose of introducing a substitute. 13. A motion for postponement shall preclude 3* 20 commitment, and one for commitment shall preclude amendment, or a decision to the original question. 14. Motions for postponement, to lay upon the table, and for adjournment, shall always be deter- mined without debate. 15. A motion that has been negatived, cannot be again brought forward at the same meeting, excepting upon a motion to reconsider. 16. No question shall be reconsidered, excepting on the motion of two Fellows, who voted with the ma- jority when the question was decided, and submitted at the meeting at which the same was discussed. 17. When a blank is to be filled, the question shall be first taken on the largest sum, greatest number, and remotest period. 18. Two Fellows may demand the yeas and nays on any question which is not required to be decided by ballot, and have them entered upon the minutes. The presiding officer in s-uch cases shall always vote last. 19. No order shall be taken upon the report of any special committee, excepting to refer it back to the committee, to lay it upon the table, or to obtain the sense of the College in relation to the resolutions ap- pended thereto. 20. The presiding officer shall not discuss any sub- ject while in the chair, but may assign his reasons on deciding a question of order. He shall have no vote excepting on a ballot, or upon a call for the yeas and nays. 21 CHAPTER VI. SUMMARY OF TRANSACTIONS. 1. There shall be published, at the termination of every three months, or as soon thereafter as circum- stances will permit, a summary of the transactions of the College; comprising, 1. All written communica- tions presented to the College, which the publishing committee may select, or the publication of which may be directed by the College. 2. A statement of all facts relating to the Science of Medicine, Surgery, or Obstetrics, communicated verbally to the College by its Fellows: and 3. An abstract of all discussions upon subjects of general interest which shall take place at the meetings of the College, and such other of its transactions, the publication of which may be deemed expedient and proper. 2. The numbers of the said Summary of Transac- tions shall be furnished to each Fellow and Associate of the College without charge. 22 CHAPTER VII. COMMITTEE ON PUBLICATION. 1. At the stated meeting of the College in the month Of November, annually, there shall be elected, (due notice of which election shall be given by the Secre- tary,) a committee of three Fellows, to be denominated the Committee of Publication. 2. The duty of the said committee shall be to decide Upon, and prepare for publication the matter to be in- serted into the numbers of the Summary of Transac- tions ; and to superintend generally their publication. 3. The Secretary of the College, who shall be ex officio a member of the committee, shall attend to the distribution of the numbers of the Summary to the Fellows of the College. 4. The Fellows shall have the privilege of reporting for publication the verbal communications and remarks presented by them at the meetings of the College. 5. No paper read before the College shall be pub- lished, otherwise than in the Summary of Transac- tions, as having been so read, without the consent of the majority of the Fellows present at the reading thereof,—this consent to be expressed by vote. 23 CHAPTER VIII. OF THE LIBRARY. 1. The committee on the Library shall consist of three Fellows to be appointed by the President of the College at its stated meeting in June. The commit- tee shall attend to the increase and preservation of the Library ; and shall carry into effect all such regu- lations pertaining thereto as may be adopted by the College, and shall report upon its condition at the stated meeting in June. 2. At the stated meeting in July, the College shall appropriate such a sum as may be deemed compatible with its funds, for the use of the Library for the en- suing year. 3. At the close of the stated meetings, and at such other times as the Library Committee shall direct, each Fellow, upon applying to the Librarian, shall be allowed to take out any book or set of books, except- ing such as, from time to time, the Library Committee may designate; and may retain the same until the next stated meeting. The Librarian shall enter, in a register kept for the purpose, the title of the books taken out, with the name of the Fellow by whom, and the date at which they are taken out. 4. If any Fellow shall detain the book or books de- livered to him by the Librarian longer than one month, 24 he shall pay a fine of twenty-five cents for every month the book or books are so detained. 5. If a book be lost by a Fellow, he shall either re- place it, or pay double the value thereof, or of the Set of books to which it belongs. 6. At the stated meeting in May, all the books shall be returned to the Library, to enable the Library Com- mittee to make their final report. CHAPTER IX. OF THE MUSEUM. 1. At the stated meeting in July, there shall be elected a Curator, and Committee of three Fellows, who shall be denominated the Committee on the Mu- seum. 2. The duty of the Curator shall be to prepare and set up such pathological specimens as the Committee on the Museum shall deem worthy of a place in the cabinet. He shall be, ex officio, a member of said committee. 3. The Curator shall label, and keep a correct cata- logue of the specimens presented to the Museum, with the name of the donor ; and, as far as practicable, a record of the case from which the specimen was de- rived. 4. The Committee on the Museum shall have a 25 general supervision of the Cabinet, and shall present, annually, in the month of July, a report of its condi- tion. CHAPTER X. CODE OF MEDICAL ETHICS. OF THE DUTIES OF PHYSICIANS TO THEIR PATIENTS, AND OF THE OBLIGATIONS OF PATIENTS TO THEIR PHYSICIANS. Art. I.—Duties of physicians to their patients. § 1. A physician should not only be ever ready to obey the calls of the sick, but his mind ought also to be imbued with the greatness of his mission, and the responsibility he habitually incurs in its discharge. Those obligations are the more deep and enduring, because there is no tribunal other than his own con- science to adjudge penalties for carelessness or neg- lect. Physicians should, therefore, minister to the sick with due impressions of the importance of their office; reflecting that the ease, the health, and the lives of those committed to their charge, depend on their skill, attention, and fidelity. They should study, also, in their deportment, so to unite tenderness with firmness, and condescension with authority, as to in- 26 spire the minds of their patients with gratitude, respect, and confidence. § 2. Every case committed to the charge of a phy- sician should be treated with attention, steadiness, and humanity. Reasonable indulgence should be granted to the mental imbecility and caprices of the sick. Secrecy and delicacy, when required by pecu- liar circumstances, should be strictly observed; and the familiar and confidential intercourse to which phy- sicians are admitted in their professional visits, should be used with discretion, and with the most scrupulous regard to fidelity and honor. The obligation of se- crecy extends beyond the period of professional ser- vices ;—none of the privacies of personal and domestic life, no infirmity of disposition or flaw of character observed during professional attendance, should ever be divulged by the physician except when he is im- peratively required to do so. The force and necessity of this obligation are indeed so great, that professional men have, under certain circumstances, been protected in their observance of secrecy by courts of justice. § 3. Frequent visits to the sick are in general re- quisite, since they enable the physician to arrive at a more perfect knowledge of the disease, to meet promptly every change which may occur, and also tend to preserve the confidence of the patient. But unnecessary visits are to be avoided, as they give use- less anxiety to the patient, tend to diminish the au- thority of the physician, and render him liable to be suspected of interested motives. §4- A physician should not be forward to make 27 gloomy prognostications, because they savour of em- piricism, by magnifying the importance of his services in the treatment or cure of the disease. But he should not fail, on proper occasions, to give to the friends of the patient timely notice of danger when it really oc- curs ; and even to the patient himself, if absolutely ne- cessary. This office, however, is so peculiarly alarm- ing when executed by him, that it ought to be declined whenever it can be assigned to any other person of sufficient judgment and delicacy. For, the physician should be the minister of hope and comfort to the sick; that, by such cordials to the drooping spirit, he may smooth the bed of death, revive expiring life, and counteract the depressing influence of those maladies which often disturb the tranquillity of the most re- signed in their last moments. The life of a sick per- son can be shortened not only by the acts, but also by the words or the manner of a physician. It is, there- fore, a sacred duty to guard himself carefully in this respect, and to avoid all things which have a tendency to discourage the patient and to depress his spirits. § 5. A physician ought not to abandon a patient because the case is deemed incurable ; for his attend- ance may continue to be highly useful to the patient, and comforting to the relatives around him, even in the last period of a fatal malady, by alleviating pain and other symptoms, and by soothing mental anguish. To decline attendance, under such circumstances, would be sacrificing to fanciful delicacy and mistaken liberality, that moral duty, which is independent of, and far superior to, all pecuniary consideration. 28 § 6. Consultations should be promoted in difficult or protracted cases, as they give rise to confidence, energy, and more enlarged views in practice. § 7. The opportunity which a physician not unfre- quently enjoys of promoting and strengthening the good resolutions of his patients, suffering under the consequences of vicious conduct, ought never to be neglected. His counsels, or even remonstrances, will give satisfaction, not offence, if they be proffered with politeness, and evince a genuine love of virtue, accom- panied by a sincere interest in the welfare of the per- son to whom they are addressed. Art. II.— Obligations of patients to their physi- cians. § 1. The members of the medical profession, upon whom is enjoined the performance of so many import- ant and arduous duties towards the community, and who are required to make so many sacrifices of com- fort, ease, and health, for the welfare of those who avail themselves of their services, certainly have a right to expect and require, that their patients should entertain a just sense of the duties which they owe to their medical attendants. § 2. The first duty of a patient is, to select as his medical adviser one who has received a regular pro- fessional education. In no trade or occupation, do mankind rely on the skill of an untaught artist; and in medicine, confessedly the most difficult and intricate of the sciences, the world ought not to suppose that knowledge is intuitive. 29 § 3.. Patients should prefer a physician whose habits of life are regular, and who is not devoted to company, pleasure, or to any pursuit incompatible with his pro- fessional obligations. A patient should, also, confide the care of himself and family, as much as possible, to one physician, for a medical man who has become ac- quainted with the peculiarities of constitution, habits, and predispositions, of those he attends, is more likely to be successful in his treatment, than one who does not possess that knowledge. A patient who has thus selected his physician, should always apply for advice in what may appear to him trivial cases, for the most fatal results often super- vene on the slightest accidents. It is of still more im- portance that he should apply for assistance in the forming stage of violent diseases; it is to a neglect of this precept that medicine owes much of the uncer- tainty and imperfection with which it has been re- proached. § 4. Patients should faithfully and unreservedly communicate to their physician the supposed cause of their disease. This is the more important, as many diseases of a mental origin simulate those depending on external causes, and yet are only to be cured by ministering to the mind diseased. A patient should never be afraid of thus making his physician his friend and adviser ; he should always bear in mind that a medical man is under the strongest obligations of se- crecy. Even the female sex should never allow feel- ings of shame or delicacy to prevent their disclosing the seat, symptoms, and causes of complaints peculiar 30 to them. However commendable a modest reserve may be in the common occurrences of life, its strict observance in medicine is often attended with the most serious consequences, and a patient may sink under a painful and loathsome disease, which might have been readily prevented had timely intimation been given to the physician. § 5. A patient should never weary his physician with a tedious detail of events or matters not apper- taining to his disease. Even as relates to his actual symptoms, he will convey much more real information by giving clear answers to interrogatories, than by the most minute account of his own framing. Neither should he obtrude upon his physician the details of his business nor the history of his family concerns. § 6. The obedience of a patient to the prescriptions of his physician should be prompt and implicit. He should never permit his own crude opinions as to their fitness, to influence his attention to them. A failure in one particular may render an otherwise judicious treatment dangerous, and even fatal. This remark is equally applicable to diet, drink, and exercise. As patients become convalescent, they are very apt to sup- pose that the rules prescribed for them may be disre- garded, and the consequence, but too often, is a re- lapse. Patients should never allow themselves to be persuaded to take any medicine whatever, that maybe recommended to them by the self-constituted doctors and doctresses, who are so frequently met with, and who pretend to possess infallible remedies for the cure of every disease. However simple some of their pre- 31 scriptions may appear to be, it often happens that they are productive of much mischief, and in all cases they are injurious, by contravening the plan of treatment adopted by the physician. § 7. A patient should, if possible, avoid even the friendly visits of a physician who is not attending him —and when he does receive them, he should never converse on the subject of his disease, as an observa- tion may be made, without any intention of interfer- ence, which may destroy his confidence in the course he is pursuing, and induce him to neglect the direc- tions prescribed to him. A patient should never send for a consulting physician without the express consent of his own medical attendant. It is of great importance that physicians should act in concert; for, although their modes of treatment may be attended with equal success when employed singly, yet conjointly they are very likely to be productive of disastrous results. § 8. When a patient wishes to dismiss his physi- cian, justice and common courtesy require that he should declare his reasons for so doing. § 9. Patients should always, when practicable, send for their physician in the morning, before his usual hour of going out; for, by being early aware of the visits he has to pay during the day, the physician is able to apportion his time in such a manner as to pre- vent an interference of engagements. Patients should also avoid calling on their medical adviser unneces- sarily during the hours devoted to meals or sleep. They should always be in readiness to receive the 32 visits of their physician, as the detention of a few mi- nutes is often of serious inconvenience to him. § 10. A patient should, after his recovery, enter- tain a just and enduring sense of the value of the ser- vices rendered him by his physician; for these are of such a character, that no mere pecuniary acknowledg- ment can repay or cancel them. OF THE DUTIES OF PHYSICIANS TO EACH OTHER, AND TO THE PROFESSION AT LARGE. Art. I.—Duties for the support of professional character. § 1. Every individual, on entering the profession, as he becomes thereby entitled to all its privileges and immunities, incurs an obligation to exert his best abilities to maintain its dignity and honour, to exalt its standing, and to extend the bounds of its usefulness. He should, therefore, observe strictly, such laws as are instituted for the government of its members;__ should avoid all contumelious and sarcastic remarks relative to the faculty, as a. body; and while, by unwearied diligence, he resorts to every honourable means of enriching the science, he should entertain a due respect for his seniors, who have, by their labours, brought it to the elevated condition in which he finds it. § 2. There is no profession, from the members of which greater purity of character, and a higher stand- 33 ard of moral excellence are required, than the medi- cal ; and to attain such eminence, is a duty every phy- sician owes alike to his profession, and to his patients. It is due to the latter, as without it he cannot command their respect and confidence, and to both, because no scientific attainments can compensate for the want of correct moral principles. It is also incumbent upon the faculty to be temperate in all things, for the prac- tice of physic requires the unremitting exercise of a clear and vigorous understanding; and, on emergen- cies, for which no professional man should be unpre- pared, a steady hand, an acute eye, and an unclouded head may be essential to the well-being, and even to the life, of a fellow creature. § 3. It is derogatory to the dignity of the profession, to resort to public advertisements or private cards or handbills, inviting the attention of individuals affected with particular diseases—publicly offering advice and medicine to the poor gratis, or promising radical cures ; or to publish cases and operations in the daily prints, or suffer such publications to be made;—to invite lay- men to be present at operations,—to boast of cures and remedies,—to adduce certificates of skill and success, or to perform any other similar acts. These are the ordinary practices of empirics, and are highly repre- hensible in a regular physician. § 4. Equally derogatory to professional character is it, for a physician to hold a patent for any surgical in- strument, or medicine; or to dispense a secret nostrum^ whether it be the composition or exclusive property of 5 34 himself, or of others. For, if such nostrum be of real efficacy, any concealment regarding it is inconsistent with beneficence and professional liberality; and, if mystery alone give it value and importance, such craft implies either disgraceful ignorance, or fraudulent ava- rice. It is also reprehensible for physicians to give certificates attesting the efficacy of patent or secret medicines, or in any way to promote the use of them. Art. II.—Professional services of physicians to each other. § 1. All practitioners of medicine, their wives, and their children while under the paternal care, are enti- tled to the gratuitous services of any one or more of the faculty residing near them, whose assistance may be desired. A physician afflicted with disease is usually an incompetent judge of his own case; and the natural anxiety and solicitude which he experi- ences at the sickness of a wife, a child, or any one who, by the ties of consanguinity, is rendered pecu- liarly dear to him, tend to obscure his judgment, and produce timidity and irresolution in his practice. Under such circumstances, medical men are pecu- liarly dependent upon each other, and kind offices and professional aid should always be cheerfully and gra- tuitously afforded. Visits ought not, however, to be obtruded officiously; as such unasked civility may give rise to embarrassment, or interfere with that choice on which confidence depends. But, if a distant mem- ber of the faculty, whose circumstances are affluent, 35 request attendance, and an honorarium be offered, it should not be declined; for no pecuniary obligation ought to be imposed, which the party receiving it would wish not to incur. Art. III.— Of the duties of physicians as respects vicarious offices. § 1. The affairs of life, the pursuit of health, and the various accidents and contingencies to which a medical man is peculiarly exposed, sometimes require him temporarily to withdraw from his duties to his patients, and to request some of his professional bre- thren to officiate for him. Compliance with this re- quest is an act of courtesy, which should always be performed with the utmost consideration for the inte- rest and character of the family physician, and when exercised for a short period, all the pecuniary obliga- tions for such service should be awarded to him. But if a member of the profession neglect his business in quest of pleasure and amusement, he cannot be con- sidered as entitled to the advantages of the frequent and long-continued exercise of this fraternal courtesy, without awarding to the physician who officiates the fees arising from the discharge of his professional duties. In obstetrical and important surgical cases, which give rise to unusual fatigue, anxiety and responsi- bility, it is just that the fees accruing therefrom should be awarded to the physician who officiates. 36 Art. IV.— Of the duties of physicians in regard to consultations. § 1. A regular medical education furnishes the only presumptive evidence of professional abilities and ac- quirements, and ought to be the only acknowledged right of an individual to the exercise and honours of his profession. Nevertheless, as in consultations the good of the patient is the sole object in view, and this is often dependent on personal confidence, no in- telligent regular practitioner, who has a license to practice from some medical board of known and ac- knowledged respectability, recognized by the Ameri- can Medical Association, and who is in good moral and professional standing in the place in which he resides, should be fastidiously excluded from fellow- ship, or his aid refused in consultation, when it is re- quested by the patient. But no one can be considered as a regular practitioner, or a fit associate in consulta- tion, whose practice is based on an exclusive dogma, to the rejection of the accumulated experience of the profession, and of the aids actually furnished by ana- tomy, physiology, pathology, and organic chemistry. § 2. In consultations, no rivalship or jealousy should be indulged; candour, probity, and all due respect should be exercised towards the physician having charge of the case. § 3. In consultations, the attending physician should be the first to propose the necessary questions to the sick; after which the consulting physician should have the opportunity to make such farther inquiries 37 of the patient as may be necessary to satisfy him of the true character of the case. Both physicians should then retire to a private place for deliberation; and the one first in attendance should communicate the directions agreed upon to the patient or his friends, as well as any opinions which it may be thought proper to express. But no statement or discussion of it should take place before the patient or his friends, except in the presence of all the faculty attending, and by their common consent; and no opinions or prog- nostications should be delivered, which are not the result of previous deliberation and* concurrence. § 4. In consultations, the physician in attendance should deliver his opinion first; and when there are several consulting, they should deliver their opinions in the order in which they have been called in. No decision, however, should restrain the attending phy- sician from making such variations in the mode of treatment, as any subsequent unexpected change in the character of the case may demand. But such variation, and the reasons for it, ought to be carefully detailed at the next meeting in consultation. The same privilege belongs also to the consulting physi- cian if he is sent for in an emergency, when the regular attendant is out of the way, and similar expla- nations must be made by him at the next consultation. § 5. The utmost punctuality should be observed in the visits of physicians when they are to hold consul- tation together, and this is generally practicable, for society has been considerate enough to allow the plea of a professional engagement to take precedence of all 38 others, and to be an ample reason for the relinquish- ment of any present occupation. But, as professional engagements may sometimes interfere, and delay one of the parties, the physician who first arrives should wait for his associate a reasonable period, after which the consultation should be considered as postponed to a new appointment. If it be the attending physician who is present, he will of course see the patient and prescribe ; but if it be the consulting one, he should retire, except in case of emergency, or when he has been called from a considerable distance, in which latter case he may examine the patient, and give his opinion in writing and under seal, to be delivered to his associate. § 6. In consultations, theoretical discussions should be avoided, as occasioning perplexity and loss of time. For there maybe much diversity of opinion concerning speculative points, with perfect agreement in those modes of practice which are founded, not on hypothe- sis, but on experience and observation. § 7. All discussions in consultation should be held as secret and confidential. Neither by words nor man- ner should any of the parties to a consultation assert or insinuate, that any part of the treatment pursued did not receive his assent. The responsibility must be equally divided between the medical attendants,—they must equally share the credit of success as well as the blame of failure. § 8. Should an irreconcilable diversity of opinion occur when several physicians are called upon to con- sult together, the opinion of the majority should be con- 39 sidered as decisive; but if the numbers be equal on each side, then the decision should rest with the attend- ing physician. It may, moreover, sometimes happen, that two physicians cannot agree in their views of the nature of a case, and the treatment to be pursued. This is a circumstance much to be deplored, and should always be avoided, if possible, by mutual concessions, as far as they can be justified by a conscientious regard for the dictates of judgment. But, in the event of its occurrence, a third physician should, if practicable, be called to act as umpire; and, if circumstances pre- vent the adoption of this course, it must be left to the patient to select the physician in whom he is most willing to confide. But, as every physician relies upon the rectitude of his judgment, he should, when left in the minority, politely and consistently retire from any further deliberation in the consultation, or participation in the management of the case. § 9. As circumstances sometimes occur to render a special consultation desirable, when the continued at- tendance of two physicians might be objectionable to the patient, the member of the faculty whose assist- ance is required in such cases, should sedulously guard against all future unsolicited attendance. As such consultations require an extraordinary portion both of time and attention, at least a double honorarium may be reasonably expected. § 10. A physician who is called upon to consult, should observe the most honourable and scrupulous re- gard for the character and standing of the practitioner in attendance: the practice of the latter, if necessary, 40 should be justified as far as it can be, consistently with a conscientious regard for truth, and no hint or insinua- tion should be thrown out which could impair the con- fidence reposed in him, or affect his reputation. The consulting physician should also carefully refrain from any of those extraordinary attentions or assiduities, which are too often practiced by the dishonest for the base purpose of gaining applause, or ingratiating them- selves into the favour of families and individuals. Art. V.—Duties of physicians in cases of inter- ference. § 1. Medicine is a liberal profession, and those ad- mitted into its ranks should found their expectations of practice upon the extent of their qualifications, not on intrigue or artifice. § 2. A physician, in his intercourse with a patient under the care of another practitioner, should observe the strictest caution and reserve. No meddling in- quiries should be made—no disingenuous hints given relative to the nature and treatment of his disorder; nor any course of conduct pursued that may directly or in- directly tend to diminish the trust reposed in the phy- sician employed. § 3. The same circumspection and reserve should be observed when, from motives of business or friend- ship, a physician is prompted to visit an individual who is under the direction of another practitioner. In- deed, such visits should be avoided, except under pe- culiar circumstances; and when they are made, no particular inquiries should be instituted relative to the 41 nature of the disease, or the remedies employed, but the topics of conversation should be as foreign to the case as circumstances will admit. § 4. A physician ought not to take charge of, or prescribe for a patient who has recently been under the care of another member of the faculty in the same illness, except in cases of sudden emergency, or in consultation with the physician previously in attend- ance, or when the latter has relinquished the case, or been regularly notified that his services are no longer desired. Under such circumstances, no unjust and illiberal insinuations should be thrown out in relation to the conduct or practice previously pursued, which should be justified as far as candour, and regard for truth and probity will permit; for it often happens, that patients become dissatisfied when they do not ex- perience immediate relief, and, as many diseases are naturally protracted, the want of success, in the first stage of treatment, affords no evidence of a lack of professional knowledge and skill. § 5. When a physician is called to an urgent case, because the family attendant is not at hand, he ought, unless his assistance in consultation be desired, to re- sign the care of the patient to the latter immediately on his arrival. § 6. It often happens, in cases of sudden illness, or of recent accidents and injuries, owing to the alarm and anxiety of friends, that a number of physicians are simultaneously sent for. Under these circumstances, courtesy should assign the patient to the first who ar- rives, who should select from those present, any addi- 6 42 tional assistance that he may deem necessary. In all such cases, however, the practitioner who officiates, should request the family physician, if there be one, to be called, and, unless his further attendance be re- quested, should resign the case to the latter on his ar- rival. § 7. When a physician is called to the patient of another practitioner, in consequence of the sickness or absence of the latter, he ought, on the return or re- covery of the regular attendant, and with the consent of the patient, to surrender the case. [The expression, "Patient of another Practitioner," is understood to mean, a patient who may have been under the charge of another practitioner at the time of the attack of sickness, or departure from home of the latter, or who may have called for his attendance during his absence or sickness, or in any other man- ner given it to be understood, that he regarded the said physician as his regular medical attendant.] § 8. A physician, when visiting a sick person in the country, may be desired to see a neighbouring patient who is under the regular direction of another physi- cian, in consequence of some sudden change or ag- gravation of symptoms. The conduct to be pursued on such an occasion is to give advice adapted to pre- sent circumstances; to interfere no farther than is ab- solutely necessary with the general plan of treatment; to assume no future direction, unless it be expressly desired; and, in this last case, to request an imme- diate consultation with the practitioner previously em- ployed. 43 § 9. A wealthy physician should not give advice gratis to the affluent; because his doing so is an injury to his professional brethren. The office of a physician can never be supported as an exclusively beneficent one; and it is defrauding, in some degree, the com- mon funds for its support, wrhen fees are dispensed with which might justly be claimed. § 10. When a physician who has been engaged to attend a case of midwifery, is absent, and another is sent for, if delivery is accomplished during the attend- ance of the latter, he is entitled to the fee, but should resign the patient to the practitioner first engaged. Art. VI.— Of differences between physicians. § 1. Diversity of opinion, and opposition of inte- rest, may, in the medical, as in other professions, sometimes occasion controversy and even contention. Whenever such cases unfortunately occur, and cannot be immediately terminated, they should be referred to the arbitration of a sufficient number of physicians, or a court-medical, or, where both parties are Fellows of the College, to the Censors. § 2. As peculiar reserve must be maintained by phy- sicians towards the public, in regard to professional matters, and as there exist numerous points in medi- cal ethics and etiquette through which the feelings of medical men may be painfully assailed in their inter- course with each other, and which cannot be under- stood or appreciated by general society, neither the subject matter of such differences nor the adjudication of the arbitrators should be made public, as publicity 44 in a case of this nature may be personally injurious to the individuals concerned, and can hardly fail to bring discredit on the faculty. Art. VII.— Of Pecuniary acknowledgments. Some general rules should be adopted by the facul- ty, in every town or district, relative to pecuniary ac- knowledgments from their patients; and it should be deemed a point of honor to adhere to these rules with as much uniformity as varying circumstances will admit. OF THE DUTIES OF THE PROFESSION TO THE PUBLIC, AND OF THE OBLIGATIONS OF THE PUBLIC TO THE PROFESSION. Art. I.—Duties of the profession to the public. § 1. As good citizens, it is the duty of physicians to be ever vigilant for the welfare of the community, and to bear their part in sustaining its institutions and burdens: they should also be ever ready to give counsel to the public in relation to matters especially appertaining to their profession, as on subjects of medical police, public hygiene, and legal medicine. It is their province to enlighten the public in regard to quarantine regulations,—the location, arrangement, and dietaries of hospitals, asylums, schools, prisons, and similar institutions,—in relation to the medical police of towns, as drainage, ventilation, &c.,—and 45 in regard to measures for the prevention of epidemic and contagious diseases ; and when pestilence prevails, it is their duty to face the danger, and to continue their labours for the alleviation of the suffering, even at the jeopardy of their own lives. § 2. Medical men should also be always ready, when called on by the legally constituted authorities, to enlighten coroners' inquests, and courts of justice, on subjects strictly medical,—such as involve ques- tions relating to sanity, legitimacy, murder by poisons or other violent means, and in regard to the various other subjects embraced in the science of Medical Jurisprudence. But in these cases, and especially where they are required to make a post-mortem exa- mination, it is just, in consequence of the time, labour, and skill required, and the responsibility and risk they incur, that the public should award them a proper honorarium. § 3. There is no profession, by the members of which eleemosynary services are more liberally dispensed than the medical, but justice requires that some limits should be placed to the performance of such good offices. Poverty, professional brotherhood, and certain of the public duties referred to in the first section of this article, should always be recognized as present- ing valid claims for gratuitous services; but neither institutions endowed by the public or by rich indi- viduals, societies for mutual benefit, for the insurance of lives or for analogous purposes, nor any profession or occupation, can be admitted to possess such privi- lege. Nor can it be justly expected of physicians to 46 furnish certificates of inability to serve on juries, to perform militia duty, or to testify to the state of health of persons wishing to insure their lives, obtain pen- sions, or the like, without a pecuniary acknowledg- ment. But to individuals in indigent circumstances, such professional services should always be cheerfully and freely accorded. § 4. It is the duty of physicians, who are frequent witnesses of the enormities committed by quackery, and the injury to health and even destruction of life caused by the use of quack medicines, to enlighten the public on these subjects, to expose the injuries sustained by the unwary from the devices and preten- sions of artful empirics and impostors. Physicians ought to use all the influence which they may possess, as professors in Colleges of Pharmacy, and by exer- cising their option in regard to the shops to which their prescriptions shall be sent, to discourage drug- gists and apothecaries from vending quack or secret medicines, or from being in any way engaged in their manufacture and sale. Art. II.— Obligations of the public to physicians. § 1. The benefits accruing to the public, directly and indirectly, from the active and unwearied benefi- cence of the profession, are so numerous and import- ant, that physicians are justly entitled to the utmost consideration and respect from the community. The public ought likewise lo entertain a just appreciation of medical qualifications ;—to make a proper discri- mination between true science and the assumptions of 47 ignorance and empiricism,—to afford every encourage- ment and facility for the acquisition of medical educa- tion,—and no longer to allow the statute books to exhibit the anomaly of exacting knowledge from physicians, under liability to heavy penalties, and of making them obnoxious to punishment for resorting to the only means of obtaining it. FEES. The following Table of Charges being founded on a just consideration of the professional services which the Fellows of the College are called upon to perform, it will be considered a duty on their part to conform to it, whenever the circumstances of their patients are not such as clearly to forbid it. For a single visit or advice, in a case in which no further visits are required, ..... $5 to 10 This is not intended to apply to those cases in which the physician is considered the regular medical attendant of the individual or family. For each visit, in a case in which the physician is in re- gular attendance, or for advice at his office, . 1 to 2 Every necessary visit on the same day to be charged, whatever may be their number, at the same rate. When detained, for each hour, . . . .3 For a visit at a time appointed by the patient or his friends, durfng the day time. . . . . 2 to 5 For written opinion or advice to a patient, . . . 5 to 20 For a visit at night, after ordinary bed-time, . . 5 to 10 For a first visit as consulting physician . .5 48 For each subsequent visit as consulting physician, in the $2 same case, ..•••"" For each visit of attending physician, when in consultation, 2 For a visit as consulting physician during the night 10 In visits to distant patients, one dollar to be be charged for every mile beyond two from the residence of the phy- sician, in addition to the ordinary charge, and $2 addi- tional for crossing the river Delaware. An extra charge may be discretionally made for travel- ing at night, or on account of the badness of the roads, or the inclemency of the weather. For an opinion involving a question of law, For a post-mortem examination, in a case of legal inves- tigation, ...... For a post-mortem examination made at the request of the family or relatives of a deceased person, For a certificate of the state of health of an individual, For vaccination, For re-vaccination, . For a case of midwifery, For the application of the forceps, For the operation of turning, For the operation of ernbryulcia, For any indisposition in the mother or child, after the tenth day from confinement, the charge for attendance as in ordinary cases requiring medical treatment. But when any serious ailment occurs in either mother or child within the ten days, a charge is to be made for each visit as in other cases of disease. For reducing fractures, and the first dressing, For reducing recent luxations, For reducing old luxations, . For removal of stone from the bladder, For amputation of a leg or arm, For amputation at the shoulder or hip-joint For amputation of a finger or toe, For the extirpation of large tumours, For the extirpation of other tumours, For trepanning, For the operation for cataract, 10 to 50 25 to 50 5 to 15 5 5 2 to 5 10 to 40 10 10 to 20 20 10 to 20 10 to 30 50 100 to 300 50 100 to 200 10 50 to 100 10 to 50 50 to 100 75 to 150 49 For other operations on the eye and its appendages, $10 to 50 For the operation for aneurism, subclavian, carotid, femoral, . . . . . . 100 to 200 For the operation for strangulated hernia, . . 50 to 100 For the operation for hare-lip, . . . 20 to 50 For the operation for fistula in ano, . . 20 to 50 For fistula in perineo, . . . . 50 to 100 For the operation for haemorrhoids, . . . 20 to 50 For the palliative operation for hydrocele, . . . 5 to 10 For the operation for the radical cure of hydrocele, . 20 to 30 For the operation for vesico-vaginal, or recto-vaginal fistula, 50 to 100 For the operation for phymosis and paraphymosis, . 5 to 20 For the introduction of the catheter, in ordinary cases, . 1 to 2 For the introduction of the catheter, in cases of obstruction, 10 to 20 For division of stricture of the urethra, . For the operation for artificial joint, For the operation of tracheotomy, For the operation for imperforate anus, vagina, &c, For the Caesarian operation, For the reduction of hernia by taxis, For extirpation of the tonsils, For the introduction of the stomach pump, in cases of poisoning, . . . . . . 10 to 30 For the removal of foreign substances lodged in the pha- rynx or assophagus, .... For the reduction of prolapsus ani, For examination per anum or vaginam, . For the introduction of a pessary, For the introduction of a seton, or forming an issue, For tapping for ascites, In all Surgical cases, the charge for subsequent attend- ance to be in proportion to the time occupied and the trouble incurred. It is recommended that in all cases of gonorrhoea and syphilis, a retaining fee of from $10 to 25 be required in advance, the subsequent charge being graduated by the amount of the after attendance in each case. Physicians should present their account at least an- nually, or as much oftener as they may deem proper. 7 10 to 50 20 to 100 20 to 50 10 to 30 100 10 to 50 10 to 20 10 to 50 5 to 10 5 to 15 5 5 10 to 20 50 CHAPTER XI. OF THE REVISION AND ENACTMENT OF ORDINANCES AND BY-LAWS. 1. No new nor amended ordinance or by-law (see the last clause of the Act of Incorporation), shall be binding on the Officers or Members of the College unless it shall be proposed in writing and subscribed by five Fellows, at one stated meeting, and enacted or passed at another, after the intervention of at least thirty days, nor unless it shall be passed by a majority of two-thirds, when there are not less than twelve Fellows present. 2. When it shall be in order for the College to act on an ordinance or by-law, it shall be announced by the Secretary to the Fellows in their notices. FELLOWS AND ASSOCIATES OF THE COLLEGE OF PHYSICIANS OF PHILADELPHIA * Denotes deceased Fellows. 1 Resignation of Fellowship. Forfeiture of Fellowship. (A.) Associates. (N. R.) Non resident Fellows. * John Redman, * John Jones, * John Morgan, * William Shippen,Jr., * Adam Kuhn, t Benjamin Rush, * Gerardus Clarkson, * Stmuel Duffield, * Thomas Parke, * James Hutchinson, * George Glentworth, * Abraham Chovet, * Andrew Ross, * William W. Smith, * James Hall,' f William Clarkson, * William Currie, * Benjamin Say, * Samuel Powell Griffitts, * Benjamin Duffield, || J. Morris, * John Carson, * John Foulk, || Robert Harris, * Nathan Dorsey, * John R. B. Rodgers, * Caspar Wistar, Jr., * James Cunningham, * Charles Moore, * Michael Leib, * John II. Gibbons, * Nicholas B. Waters, * Benjamin Smith Barton, * Nicholas Way, * James Tilton, (A.) * Isaac Senter, (A.) * Thomas Redman, * William M'llvaine, * Plunket F. Glentworth, * Hugh Hodge, * Peter Ptenaudet, (A.) || Charles Caldwell, * John Cumming, * Thomas C. James, * William Annan, f Adam Seybert, * William Patterson, (A.) * William Boys, * David Hosack, (A.) * Lewis J. Jardine, * Joseph P. Minnick, * Thomas T. Hewson, * John C. Letsom, (A.) Nathaniel Chapman, * Joseph Parrish, * Henry Neill, * Samuel Bard, (A.) * Samuel Stewart, 52 * Joseph Woolens, * Tsaac Cleaver, || William P. C. Barton, f Edwin A. Atlee. * John Moore. * Samuel C. Hopkins, John Wilson Moore, * Samuel Emlen, * John C. Otto, Elijah Griffiths, Jacob Bigelow, (A.) John Ruan, Joseph Hartshorne, Henry Bond, Robert M. Huston, John Bell, (N. R.) Hugh L. Hodge, Charles D. Meigs, George B. Wood, Rene La Roche, Benjamin H. Coates, John K. Mitchell, * Thomas II. Ritchie, Lewis P. Gebhard, William Darrach, * "" villiam S. Coxe, Franklin Bache, Daniel Drake, (A.) George Fox, Charles Lukens, || Edward Y. Howell, Theophilus E. Beesley, * Simon A. Wickes, Caspar W. Pennock, (N. R.) William W. Gerhard, Thomas Stewardson, Jr., (A. William Ashmead, Reuben D. Mussey, (A.) P. Ch. A. Louis, (A.) || Revnell Coates, John Marshall Paul, (N.R. Joseph Pancoast, Isaac Hays, John Rodman Paul, Charles Noble, D. Francis Condie, Squire Littell, Thomas D. Mutter, Isaac Parrish, John Revere, (A.) David Rutter, Frederick A. Vandyke, John T. Sharpless, Anthony Bournonville, W. S. W. Ruschenberger, U. S. N. Samuel Jackson, Robley Dunglison, Jacob Randolph, Joseph Carson, Joseph Warrington, James H. Bradford, (N.R.) Thomas S. Kirkbride, Geo. W. Norris, Francis West, Benjamin D. Neill, Rush Vandyke, Edward Peace, Frederick Turnpenny, Geo. Cheyne Shattuch, (A.) George M'Clellan, William D. Brinckle, William Pepper, Edward Hallowell, Theodoric R. Beck, (A.) Samuel Calhoun, William H. Klapp, Caspar Morris, Frederick S. Eckard, (A.) Carter N. Berkeley, Joseph Peace, William S. Zantzinger, David C. Skerrett, W. Poyntell Johnston, Henry H. Smith, Peter Parker, (A.) Charles Evans, Caspar Wistar, Benjamin W. Dudley, (A.) Nathan R. Smith, (A.) John Hubbard, (A.) Thos. Sewall, (A.) 53 Gotthilf Moehring, Robert C. Bridges, John D. Griscom, Meredith Clymer, (N. R.) John Ware, (A.) * Amos Twitchell, (A.) John J. Reese, Thomas Dillard, Paul B. Goddard, Alfred Stille, J. Forsyth Meigs, John Wiltbank, Henry S. Patterson, William B. Page, Lewis Rodman, George L. Newbold, Charles R. King, (N. R.) David IL Tucker, (N. R.) T. R. Brinckte, * Samuel G. Morton, Francis G. Smith, || Mahlon P. Hutchinson, N. D. Benedict, (A.) Benjamin S. Janney, Alexander Wilcocks, * Victor L. Godon, Thomas F. Betton, Morris C. Shallcross, William R. Grant, * Joshua M. Wallace, Washington L. Atlee, John Neill, Henry Gibbons, (N. R.) J. C. Warren, (A.) Samuel D. Gross, (A.) Richard D. Arnold, (A.) Anthony E. Stocker, Edward Hartshorne, J. Dickinson Logan, G. Emerson, Jonathan Knight, (A.) Alexander II. Stevens, (A.) J. M'Naughton, (A.) John L. Atlee, (A.) Moreton Stille, Caspar Wistar, Robert A. Given, Joseph Klapp, Samuel Jackson, Samuel Lewis, Justus Dunott, J. R. Greene, U. S. N. Samuel L. Ilollingsworth, J. L. Ludlow, William V. Keating, J. K. Mason, J. Pereira (London), (A.) Robert Christison (Edin- burgh), (A.) B. R. Welford (Virginia), (A.) Edmund Lang, Thomas S. Reed, * William B. Wilson, Richard H. Townsend, Isaac Remington, John R. Tuft, E. R. Mayer, William R. Bullock, R. P. Thomas. John B. Biddle, James P. Levick, Henry E. Drayton, Bernard Henry, Wilson Jewell, Joseph Leidy, Ellwood Wilson, Henry Hartshorne. m OFFICERS OF THE COLLEGE, 1852. President. GEORGE B. WOOD, M. D. Vice-President. CHARLES D. MEIGS, M.D. Censors. HENRY BOND, M.D. JOHN WILSON MOORE, M.D. SAMUEL JACKSON, M.D. GEO. W. NORMS, M.D. Secretary. D. FRANCIS CONDIE, M.D. Treasurer. JOHN RODMAN PAUL, M. D. Curator. JOHN NEILL, M. D. NATIONAL LIBRARY OF MEDICINE NLH D320b730 5 NLM032067305