CONSTITUTION AND BY-LAWS OF THE / jjUabtlplpo Count" IfiiMral lotittq TOGETHER WITH THE CODE OF ETHICS. X PHILADELPHIA: T. K. AND P. G. COLLINS, PRINTERS. 1853. ( I P5P5c 5 185 CONSTITUTION. ARTICLE I. TITLE OF THE SOCIETY. The title of this Society shall be The Philadelphia County Medical Society. ARTICLE II. OBJECTS OF THE SOCIETY. The objects of this Society shall be, the advance- ment of knowledge upon all subjects connected with the healing art; the elevation of the character, and the protection of the proper rights and interests of those engaged in the practice of medicine, and the study of the means calculated to render the medical profession most useful to the public, and subservient to the great interests of humanity. ARTFCLE III. MEMBERS OF THE SOCIETY. Sect. 1. To entitle a person to membership in this Society, he must be a citizen of the County of Phila- delphia, a graduate of a respectable medical school, a 4 licentiate of some approved medical institution, or a regular practitioner of at least fifteen years' standing —and of good moral and professional reputation. Sect. 2. Any Physician who shall procure a pa- tent for a remedy, or instrument of surgery, or who sells or deals in patent remedies or nostrums, or who shall enter into a collusive agreement with an apothe- cary to receive pecuniary compensation or patronage for sending his prescriptions to said apothecary, or who prescribes a remedy without knowing its compo- sition, or who shall hereafter give a certificate in favor of a patent remedy or instrument, shall be dis- qualified from becoming or remaining a member. ARTICLE IV. ELECTION OF MEMBERS. Sect. 1. Every candidate for membership shall be proposed in writing, at a stated meeting, by three members. Sect. 2. All propositions for membership shall be referred to the Censors, who shall inquire into the character and standing of the persons proposed, and report as to their eligibility for membership at its next stated meeting, when a ballot shall be gone into, and if two-thirds of the ballots deposited shall be in favor of the candidates, thejr shall be declared duly elected. Provided, That no candidate shall be balloted for unless his name has been furnished to the members of the Society by the Secretary in the notice for the 5 meeting at which the ballot upon his admission is to be taken. Sect. 3. No candidate for membership who is re- jected shall be again proposed within twelve months thereafter. Sect. 4. Candidates for membership shall be bal- loted for in the following manner: The presiding offi- cer shall appoint two tellers; by one of whom each member present shall be supplied with a slip of paper, on which to write the names of the candidate or can- didates for whom he intends to vote, and no member present shall be excused from voting unless by con- sent of the Society. The second teller shall collect the ballots, and the same being counted by himself and colleague, they shall announce the result by sim- ply stating the number of votes deposited for each candidate. Sect. 5. A member elect, before being admitted to the full privileges of membership, shall subscribe to the Constitution and By-Laws of this Society; pay an admission fee of one dollar; be presented at one of the meetings, and make the requisite declaration. Sect. 6. When a member elect is presented for ad- mission into this Society, the presiding officer shall address him as follows :— Having been duly elected a member of the Phila- delphia County Medical Society, do you solemnly declare that, so long as you shall continue a member of the same, you will comply with all its laws and regulations, and use your best endeavors to promote its object? ? 1* 6 ARTICLE V. CERTIFICATE OF MEMBERSHIP. Every member shall receive a Certificate of Mem- bership, signed by the officers of the Society, in the words following:— This is to Certify that was admitted a Member of the Philadelphia County Medical Society, on the day of A. D. 18—. President. Attest, | Vice-Presidents. Recording Sec. \ Censors. ARTICLE VI. CENSURE AND EXPULSION OF MEMBERS. If any member shall violate the laws or regulations of this Society, upon a charge against him being pre- sented to the Censors, it shall be their duty to notify the accused member of the same; and if, after a due investigation, they consider the charge to be sustained, they shall report the case, with their decision, to the Society at its next stated meeting; notifying the ac- cused member of the time when the said report is to be made. If the accused member shall fail to come forward and exculpate himself, he shall be repri- manded or expelled by a vote of two-thirds of the members present. But no vote for the reprimand or 7 expulsion of a member shall be taken, excepting at a stated meeting, at which not less than twenty-four members are present, and of which meeting due notice has been given. ARTICLE VII. OFFICERS OF THE SOCIETY. Sect. 1. The officers of the Society shall be a Pre- sident, two Vice-Presidents, a Recording Secretary, an Assistant Secretary, a Corresponding Secretary, a Treasurer, and five Censors. Who shall be elected by ballot, at the Annual meeting in January, and shall serve for one year, or until their successors are elected. Sect. 2. The President shall not be eligible for two consecutive terms. Sect. 3. Nominations for Officers and Delegates shall be made at the stated meeting in October, and no member shall be put on nomination who is in arrears for the annual assessment. ARTICLE VIII. DUTIES OF OFFICERS. Sect. 1. The President shall preside at the meet- ings of the Society, preserve order, and perform such other duties as custom and parliamentary usage re- quire. At the close of his term of office, he shall deliver a public address. Sect. 2. The Vice-Presidents shall, when called upon, assist the President in the performance of his 8 duties, and during his absence, or at his request, one of them shall officiate in his place. Sect. 3. The Recording Secretary shall keep cor- rect minutes of the proceedings of the Society, which, when approved by the Society, he shall fairly tran- scribe in a book to be kept for that purpose. He shall receive from members their initiation fee and annual contributions, and pay the same over to the Treasurer. He shall have charge of all papers belonging to the Society, other than those appertaining to the office of Treasurer and Corresponding Secretary. Sect. 4. It shall be the duty of the Assistant Se- cretary to give due notice of all meetings of the So- ciety ; and he shall furnish, in the said notice, the names of the candidates for membership to be balloted for. Sect. 5. The Corresponding Secretary shall con- duct the correspondence of the Society. Sect. 6. The Treasurer shall receive all moneys belonging to the Society, and disburse the same as directed by a warrant, signed by the President of the Society, and countersigned by the Recording Secre- tary. Sect. 7. It shall be the duty of the Censors to inquire into the character and standing of all candi- dates for membership, and report as to their eligibility at the next stated meeting; to investigate any dis- agreement which may occur between members, and endeavor to restore harmony, if possible. When a member is charged with an infringement of the laws of the Society, it shall be the duty of the Censors fully and impartially to investigate the same, and, if 9 they deem it to be well founded, to report the case to the Society at its next stated meeting, together with their decision. ARTICLE IX. MEETINGS of the society. Sect. 1. The stated meetings of the Society shall be held on the third Wednesdays of January, April, July, and October. Sect. 2. For the transaction of the ordinary busi- ness of the Society, twelve members shall be a quorum. For the election of officers, members, and delegates, or for altering the constitution, twenty members shall be a quorum. For the reprimanding or expulsion of a member, twenty-four members shall be a quorum. Sect. 3. Meetings for discussion shall also be held on the second Wednesday of each month, from Sep- tember to April inclusive, at 7 J o'clock in the evening. Sect. 4. Special meetings may be called by the President, whenever requested, in writing, by eight members of the Society. ARTICLE X. FUNDS OF THE SOCIETY. Sect. 1. An assessment of not more than one dol- lar upon each member shall be made, annually, at the meeting in January. Sect. 2. Any member refusing to pay the amount of his assessment, when applied to for the amountHby the Treasurer, shall be reported to the Society as 10 delinquent; and in case payment be not made within six months thereafter, he shall forfeit his right of membership. ARTICLE XI. CODE OF ETHICS. This Society adopts as a part of its regulations, binding upon all its members, the Code of Ethics adopted by the State Society. ARTICLE XII. ELECTION OF DELEGATES. The Delegates to the National Medical Association and to the State Society shall be elected annually, at the stated meeting in January, by ballot. Provided, however, that, by the unanimous consent of the mem- bers present, the election may be made viva voce. ARTICLE XIII. AMENDMENTS. This Constitution shall not be altered or amended, unless the proposed alteration or amendment be made, in writing, at one stated meeting, and receive the assent of two-thirds of the members present at the subsequent stated meeting. 11 BY-LAWS. ARTICLE I. ORDER OF BUSINESS. Sect. 1. The stated meetings of the Society shall be held at half-past three o'clock, P. M.; at which hour the President, or in his absence one of the Vice-Presidents, shall call to order. In case of the absence of the President and both Vice-Presidents, a chairman pro tempore shall be appointed. Sect. 2. At stated meetings, the business shall be conducted in the following order:— 1. The Recording Secretary shall register the names of the members present. 2. The minutes of the last stated, and all subse- quent meetings, shall be read. 3. New members shall be introduced. 4. Stated business, if any, of the meeting shall be considered. 5. Unfinished business shall be taken up. G. Reports of officers and committees shall be heard. 7. Propositions for membership shall be received. 8. New members shall be balloted for. 12 9. Written communications shall be received. 10. Oral communications shall be received. 11. New business may be introduced. 12. Adjournment. ARTICLE II. ELECTIONS. Sect. 1. No member shall be allowed to vote at any election who has not paid up regularly his annual assessments. Sect. 2. In the election for delegates to the State Society, the several portions of the county shall be equitably represented, as far as practicable. ARTICLE III. APPOINTMENT OF SPECIAL COMMITTEES. All special committees, excepting when otherwise ordered by a vote of the Society, shall be nominated by the presiding officer, subject to the approval of the Society. ARTICLE IV. AUDITORS. Three Auditors shall be appointed by the Presi- dent, at the stated meeting in October, who shall examine the Treasurer's accounts, and report upon the same at the stated meeting in January. 13 ARTICLE V. RESIGNATIONS. All resignations of membership shall be made in writing, and accompanied with a certificate from the Treasurer that all dues to the Society have been satis- fied. But no member shall be permitted to resign while charges are pending against him. ARTICLE VI. ORDER. The Society shall be governed by the usual rules of order of legislative assemblies. ARTICLE VII. AMENDMENTS. These By-Laws may be altered or amended at any time, by a vote of three-fourths of the members pre- sent at a stated meeting. 2 15 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 ne- glect. 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 inspire 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, 16 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 physicians are admitted in their professional visits, should be used with discretion, and with the most scrupulous regard to fidelity and honor. The obliga- tion of secrecy extends beyond the period of profes- sional services;—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 imperatively required to do so. The force and necessity of this obligation are indeed so great, that professional men have, under certain circum- stances, 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 useless anxiety to the patient, tend to diminish the authority of the physician, and render him liable to be suspected of interested motives. § 4. A physician should not be forward to make gloomy prognostications, because they savor of em- piricism, by magnifying the importance of his ser- vices in the treatment or cure of the disease. But he should not fail, on proper occasions, to give to the 17 friends of the patient timely notice of danger when it really occurs; and even to the patient himself, if ab- solutely necessary. This office, however, is so pecu- liarly alarming 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 resigned in their last mo- ments. The life of a sick person can be shortened not only by the acts, but also by the words or the manner of a physician. It is, therefore, a sacred duty to guard himself carefully in this respect, and to avoid all things which have a tendency to dis- courage 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. § 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- 2* 18 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, ac- companied by a sincere interest in the welfare of the person to whom they are addressed. Art. II.—Obligations of patients to their phy- sicians. § 1. The members of the medical profession, upon whom is enjoined the performance of so many im- portant and arduous duties towards the community, and who are required to make so many sacrifices of comfort, 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 intri- cate of the sciences, the world ought not to suppose that knowledge is intuitive. § 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 professional obligations. A patient should, 19 also, confide the care of himself and family, as much as possible, to one physician; for a medical man who has become acquainted with the peculiarities of con- stitution, habits, and predispositions, of those he attends, is more likely to be successful in his treat- ment 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 supervene on the slightest accidents. It is of still more importance 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 uncertainty and imperfection with which it has been reproached. § 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 secrecy. Even the female sex should never allow feelings of shame or delicacy to prevent their dis- closing the seat, symptoms, and causes of complaints peculiar 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 20 might have been readily prevented had timely inti- mation 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 suppose that the rules prescribed for them may be disregarded, and the consequence, but too often, is a relapse. Patients should never allow themselves to be persuaded to take any medicine whatever, that may be 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 prescriptions may appear to be, it often hap- pens 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 21 him—and when he does receive them, he should never converse on the subject of his disease, as an observation may be made, without any intention of interference, which may destroy his confidence in the course he is pursuing, and induce him to neglect the directions 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 con- jointly they are very likely to be productive of disas- trous 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 physi- cian is able to apportion his time in such a manner as to prevent an interference of engagements. Patients should also avoid calling on their medical adviser unnecessarily during the hours devoted to meals or sleep. They should always, be in readiness to receive the visits of their physician, as the detention of a few minutes 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 services rendered him by his physician; for these are of such a character, that no mere pecuniary acknow- ledgment can repay or cancel them. 22 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 honor, 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 un- wearied diligence, he resorts to every honorable means of enriching the science, he should entertain a due respect for his seniors, who have, by their labors, 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- ard of moral excellence are required, than the medi- cal; and to attain such eminence, is a duty every physician 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 compen- sate for the want of correct moral principles. It is also incumbent upon the faculty to be temperate in all things, for the practice of physic requires the unremitting exercise of a clear and vigorous under- 23 standing; and, on emergencies, for which no profes- sional man should be unprepared, 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 crea- ture. § 3. It is derogatory to the dignity of the profes- sion to resort to public advertisements, or private cards, or handbills, inviting the attention of indi- viduals affected with particular diseases—publicly offering advice and medicine to the poor gratis, or promising radical cures; or to publish cases and ope- rations in the daily prints, or suffer such publications to be made; to invite laymen to be present at opera- tions, to boast of cures and remedies, to adduce certi- ficates of skill and success, or to perform any other similar acts. These are the ordinary practices of empirics, and are highly reprehensible in a regular physician. § 4. Equally derogatory to professional character is it, for a physician to hold a patent for any surgical instrument or medicine; or to dispense a secret nos- trum, whether it be the composition or exclusive pro- perty of himself or of others. For, if such nostrum be of real efficacy, any concealment regarding it is inconsistent with beneficence and professional liberal- ity ; and, if mystery alone give it value and import- ance, such craft implies either disgraceful ignorance or fraudulent avarice. 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. 24 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 en- titled 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 dis- tant member of the faculty, whose circumstances are affluent, request attendance, and an honorarium be offered, it should not be declined; for no pecuniary obligation ought to be imposed, which the party re- ceiving 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 25 him temporarily to withdraw from his duties to his patients, and to request some of his professional breth- ren to officiate for him. Compliance with this request is an act of courtesy, which should always be per- formed with the utmost consideration for the interest and character of the family physician, and when ex- ercised for a short period, all the pecuniary obligations 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 considered 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. 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 honors 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- . 3 26 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 requested by the patient. But no one can be con- sidered as a regular practitioner or a fit associate in consultation, 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 anatomy, physiology, pathology, and organic che- mistry. § 2. In consultations, no rivalship or jealousy should be indulged; candor, 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 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 pro- per 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 prognostications should be delivered, which are not the result of previous deliberation and concurrence. 27 § 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 physician if he is sent for in an emergency, when the regular attendant is out of the way, and similar explanations 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 consult- ation 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 others, and to be an ample reason for the relin- quishment of any present occupation. But, as pro- fessional 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 con- sidered 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 con- siderable distance, in which latter case he may ex- 28 amine 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 may be much diversity of opinion concern- ing speculative points, with perfect agreement in those modes of practice which are founded, not on hypothesis, but on experience and observation. § 7. All discussions in consultation should be held as secret and confidential. Neither by words nor manner 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 attend- ants—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 considered as decisive; but if the numbers be equal on each side, then the decision should rest with the attending 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 de- plored, 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 prevent the adoption of this course, it must be left to the patient to select the physician 29 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 farther 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 attendance of two physicians might be objectionable to the patient, the member of the faculty whose assistance 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 honora- rium may be reasonably expected. § 10. A physician who is called upon to consult, should observe the most honorable and scrupulous regard for the character and standing of the practi- tioner in attendance; the practice of the latter, if necessary, should be justified as far as it can be, con- sistently with a conscientious regard for truth, and no hint or insinuation should be thrown out which could impair the confidence reposed in him, or affect his reputation. The consulting physician should also carefully refrain from any of those extraordinary at- tentions or assiduities, which are too often practised by the dishonest for the base purpose of gaining applause, or ingratiating themselves into the favor of families and individuals. 3* 30 Art. V.—Duties of physicians in cases of inter- ference. § 1. Medicine is a liberal profession, and those admitted 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 indirectly tend to diminish the trust reposed in the physician 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. Indeed, such visits should be avoided, except under peculiar circumstances; and when they are made, no particular inquiries should be instituted relative to the 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 31 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 candor and regard for truth and probity will permit; for it often happens that patients become dissatisfied when they do not experience 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 resign 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 circum- stances, courtesy should assign the patient to the first who arrives, who should select from those present, any additional assistance that he may deem neces- sary. In all such cases, however, the practitioner who officiates should request the family physician, if there be one, to be called, and, unless his farther attendance be requested, should resign the case to the latter on his arrival. § 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 recovery of the regular attendant, and with the con- sent of the patient, to surrender the case. 32 [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 neighboring patient who is under the regular direction of another physician, in consequence of some sudden change or aggravation 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 absolutely necessary with the general plan of treat- ment ; to assume no future direction, unless it be expressly desired; and, in this last case, to request an immediate consultation with the practitioner pre- viously employed. § 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 physi- cian can never be supported as an exclusively benefi- cent one; and it is defrauding, in some degree, the common funds for its support, when fees are dispensed 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. 33 Art. VI.—Of differences between physicians. § 1. Diversity of opinion and opposition of interest, may, in the medical as in other professions, some- times occasion controversy and even contention. When- ever 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 members of the Medical Society of their County, to the Censors. § 2. As peculiar reserve must be maintained by physicians towards the public, in regard to profes- sional matters, and as there exist numerous points in medical ethics and etiquette through which the feel- ings of medical men may be painfully assailed in their intercourse with each other, and which cannot be understood or appreciated by general society, neither the subject-matter of such differences nor the adjudi- cation of the arbitrators should be made public, as publicity 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 fa- culty, in every town or district, relative to pecuniary acknowledgments 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. 34 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 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 labors 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 poi- sons 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- 35 mortem examination, it is just, in consequence of the time, labor, and skill required, and the responsi- bility 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 dis- pensed 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 presenting valid claims for gratuitous services; but neither institutions endowed by the public or by rich individuals, societies for mutual benefit, for the insur- ance of lives or for analogous purposes, nor any pro- fession or occupation, can be admitted to possess such privilege. Nor can it be justly expected of physicians to 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 pensions, 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, 36 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 to entertain a just appreciation of medical qualifications; to make a proper discrimi- nation between true science and the assumptions of ignorance and empiricism—to afford every encourage- ment and facility for the acquisition of medical edu- cation—and no longer to allow the statute-books to exhibit the anomaly of exacting knowledge from phy- sicians, under a liability to heavy penalties, and of making them obnoxious to punishment for resorting to the only means of obtaining it. LIST MEMBERS OF THE PHILADELPHIA COUNTY MEDICAL SOCIETY. D. Francis Condie. George B. Wood. Isaac Hays. Samuel Jackson. Henry Bond. Samuel Jackson (Prof.) Alfred Stille\ John Bell. G. Emerson. N. C Reid. Charles M. Griffiths. Amos W. Griffiths. M. M. Reeve {deceased). Henry S. Patterson. Henry Y. Smith. R. J. Levis. Henry F. Leib. George G. Chamberlaine. Henry G ibbonsQremovcd from John Neill. the Stale'). Francis West. Anthony E. Stocker. Wm. Byrd Page. Isaac Parrish (deceased). George W. Norris. George Fox. Wilson Jewell. Thomas S. Reed. Jacob Huckel. Samuel Lewis. 4 John F. Meigs. David H. Tucker (removed from the State). Robert Foster. William Mayburry. Thomas F. Betton. Thomas Hobson (deceased). James A. McCulloh. Frederick A. Martin (re- moved from the County). Joseph Warrington. 38 James W. Leiper (deceased). Isaac Remington. William H. Tingley. John M. Pugh. Washington L. Atlee. William Curran. Francis G. Smith. D. Paul Lajus. Joseph Carson. Thomas H. Yardley. Robert P. Thomas. Moses B. Smith. J. Dickinson Logan. James Bryan. Wm. B. Wilson (deceased). 0. H. Costell (deceased). i/Abm. Helffenstein. */ M. C. Shallcross. Lawrence Turnbull. W. H. Gominger. Jacob Bowman. John D. Griscom. C. H. Bibighaus. Benjamin H. Coates. John Dawson (removed from William Keller. the State). John C. Wall. Joseph Klapp. Samuel Chamberlaine. William H. Klapp. Richard Clements. William R. Grant (deceased). Anthy. Bournonville. Charles D. Meigs. William Ashmead. R. La Roche. J. H. B. McClellan. Richard H. Townsend. Lewis Rodman. Hugh L. Hodge. Edward Hallowell. Benjamin S. Janney. J. Wilson Moore. William Pepper. William Henry. Albert Fricke. Edward Hartshorne. Colin Arrott. G. W. Patterson (deceased). G. Moehring. W. H. Gillingham. William Darrach. John Wiltbank. Joseph R. Bryan. William Gregg. N. L. Hatfield. Ellwood Wilson. David C. Skerrett. Edgar Janvier. Philip De Young. Amos Pennebaker. Robert K. Smith (removed Frederick Crowley (dec'ed) from the County). Levi Curtis. James M. Greene. William W. Gerhard. W 39 Thomas D. Mutter. J. Brookfield. Henry Ilartshorne. Ir John Rhein. R. M. Huston. Paul B. Goddard. William H. Gobrecht. John H. Ingham. John F. Lamb. Robert A. Given. J. M. Thatcher (deceased). John D. Bryant. Aug. C. Bournonville* William Notson. C. Campbell Cooper. J. F. Trenchard. K. F. Leake. ^Joseph Pancoast. Arnold Naudain. S. Harris (deceased). Edward H. Watson. William D. Stroud. Isaac Comly. William L. Knight. William R. Bullock (re- moved from the State). Gavin Watson. James Ash. William N. Johnson. Theophilus E. Beesley. James V. Emlen. James Aitken Meigs. William V. Keating. George Stewart. S. Littell. S. Stewart. J. D. Stewart. Geo. L. Newbold. Alfred L. Kennedy. ■ John K. Mitchell. D. Hershey. J. W. Jones. F. Scoffin. J. F. Gayley. S. L. HoUingsworth. Benjamin S. Deacon. Jacob S. Zorns. Henry H. Smith. G. Herman Robinett. W. R. Wright (resigned). James M^ Corse. Owen Osfler. Charles Neff. J. H. Handy. Edwin Fussell. James E. Rhoads. Thomas F. Azpell. David Gilbert. A. S. McMurray. ^ Silas S. Brooks. J. B. Biddle. John H. Weir. Paul Swift. Francis V. Greene. <- John De Lacy. J. H. Worthington. AVilliam Gardiner. Thomas J. Turner. 40 James L. Tyson. James V. Patterson. J. Conry. William N. Hamilton (re- moved from the State). 0. Jones Wistar. Robley Dunglison. Geo. J. Zeigler. Joshua W. Ash. S. C. Huston. Samuel Murphey. William H. Hooper. ,/J. Henry Smaltz. Thomas Bond. William F. Patterson. Tracy E. Waller. L. P. Gebhard. Lewis H. Gebhard. Z. Ring Jones. Addinell Hewson. i, James J. Levick. W. S. W. Ruschenberger. L. M. Service. T. M. Drysdale. William Harris. R. H. Lee. Charles Wittig. Robert Q. Shelmerdine. J. Gibbons Hunt. William Gallaher. William H. Squire. Robert C. Shelmerdine. S. W. Mitchell. Morton Stille. Antrum Foulke. John S. Rohrer. J. Coleman Morgan. Theodore Ashmead. Franklin Bache. Robert Bridges. Charles Evans. William Keith. J. L. Ludlow. Charles Neff. J. A. Whartenby. J. S. Crowly. James F. Crabb. John F. Cunningham. Henry Deitrich. Horace Evans. D. S. Gloninger. William H. Keim. William Hunt. M. M. Levis. Caspar Morris. J. R. Paul. James Smith. F. W. Sargent. • F. R. Shunk. W. H. Squire. E. Wallace. Caspar Wister. B. B. Wilson. W. S. Zantzinger.