THE ^ffrl.^ CONSTITUTION AND BY-LAWS OF THE MONTGOMERY COUNTY, -.mr IHIH'IIII'B (OHIO,) MEDICAL SOCIETY; AND TEE CODE OF ETHICS OF THE AMERICAN MEDICAL ASSOCIATION. *? ( ) DAYTON: EMPIRE STEAM PRINTING HOUSE. 1857. OFFICERS FOR 1857. PRESIDENT, Julius S. Taylor, M. D. VICE PRESIDENT, C. McDermont, M. D. SECRETARY, J. C. Denise, M. 1). TREASURER, Joshua Clements, M. D. BOARD OF CENSORS, H. G. Carey, M. D. W. H. Lamme, M. D. J. C. Reevi:, M. D. LIST OF MEMBERS. Edmund Bartlett, M. D, Conrad Brodbeck, M. D. Thomas Brennan, M. D. 0. E. Barkalow, M. D. G. H. Bane,M. D. H. G. Carey, M. D. Oliver Crook, M. D. *James M. Crook, M. D. Joshua Clements, M. D. I. A. Coons, M. D. John Davis, M. D. J. C. Denise, M. D. *C. G. Espich, M. D. James C. Fisher, M. D. Michael Garst, M. D. Job Haines, M. D. H. F. Koehne, M. D. A. Koogler, M. D. J. D. Kemp, M.D. Wm. H. Lamme, M. D. W. B. McAroy, M. D. C. McDermont, M. D. J. C. Reeve, M. D. *John Steele, M. D. Edwin Smith, M. D. *Edmund Smith, M. D. Julius S. Taylor, M D. John Treon, M. D. *H. Van Tuyl, M. D. H Van Tuyl, M. D. A. G. Walden, M. D. Dayton. Miamisburg. Chambersburg. Dayton. Germantown. Dayton. Vandalia. Centreville. Franklin. Dayton. Carrollton. Miamisburg. Dayton; ^Deceased. HONORARY MEMBERS. W. M. Awl, M. D. E. Bantz, M. D. J. H. Ealey, M. D. Elias Garst, M. D. Isaac Kay, M. D. Nathaniel Strong, M. D. Henry K. Steele, M. D. L. D. Sheets, M. D. D. B. Van Tuyl, M. D. Columbus, Ohio. Davenport, Iowa. California. Springfield, Ohio. Centerville " Cincinnati, " Liberty, Indiana. South Bend, Indiana. NAMES PROPOSED FOR MEMBERSHIP S. G. Armor, M. D. J. L. Brenton, M. D. Dayton. CONSTITUTION. ARTICLE I. This Society shall be known as the Montgomery County Medical So- ciety, and its objects shall be the improvement of its members in scien- tific and professional knowledge—the association of the profession for purposes of mutual recognition and fellowship—the promotion of the character, interests and honor of the fraternity by maintaining union and harmony, and by aiming to elevate the standard of medical education. ARTICLE II. Sec I. Any regular practitioner of Medicine and Surgery may be- come a member of this Society, who, by his adherence to the Code of Ethics of the American Medical Association shows himself entitled to the confidence and fellowship of his medical brethren,and who by his gen- eral conduct and mode of life proves himself worthy of being a member of one of the learned and liberal professions. Sec II. The name of any person wishing to become a member of this society, shall be presented by a member at any quarterly meeting, but the question of his admission shall not be voted upon before the next quarterly meeting, when if he receive a vote of two-thirds of those pres- ent, he may become a member upon signing the Constitution and By-Laws. Sec III. Any member who shall violate any part of the Code of Ethics of the American Medical Association, or any article or section of this Constitution, or the By-Laws, may be suspended or expelled, as the Society may direct, he having been previously notified of the time when his case shall be acted upon. A vote of two-thirds of the members present shall be necessary for suspension or expulsion. ARTICLE III. Sec I. The officers of the Society shall be a President, Vice Presi- dent, Secretary, Treasurer, and Board of Censors, who shall be elected by ballot, at the annual meeting in January. A majority of all the votes cast shall be necessary to a choice. 8 Sec II. The duties of the President, Vice President, Secretary and Treasurer shall be those usually performed in Scientific and Literary Societies. It shall be the duty of the Censors to examine and report up- on all cases of professional and moral delinquency, as prescribed by the By-Laws. ARTICLE IV. The Code of Ethics of the American Medical Association shall be adopted by this Society as the guide for its members in their inter- course with their patients, with irregular practitioners, and with their medical brethren ; and every person signing the Constitution and By- Laws of this Society is looked upon as thereby pledging his honor to uphold and abide by the said Code. ARTICLE V. Any member of this Society removing from the county, or abandon- ing the practice of medicine, and who is still influenced by friendly feel- ings to the profession, and still maintains an honorable character in soci- ety, may become an honorary member, and the proper officers shall fur- nish him with a certificate of the fact, upon application. Any other duly qualified practitioner, on the nomination of a member of the society, may be elected an honorary member, upon receiving a vote of two thirds of those present at any regular meeting. ARTICLE VI. The meetings of this Society shall be held as follows: the annual meet- ing on the first Thursday of January, and the quarterly meetings on the first Thursdays of April, July and October, at 10 o'clock A. M. Regu- lar meetings may also be held on the first Thursday evening of any month not mentioned in this article ; and at all meetings six members shall constitute a quorum for the transaction of business. ARTICLE VII. No tax shall be levied upon the members of the Society, unless by a two-thirds vote of the members present at a regular meeting. ARTICLE VIII. This Constitution may be altered, added to or amended, at any quar- terly meeting, by a vote of two thirds the members present, if the intend- ed alteration has been presented to the Society in writing at any previous quarterly meeting. BY-LAWS. I. It shall be the duty of the President to provide for the reading of an Essay at every quarterly meeting, by appointing an Essayist, with an alternate, (with their consent,) the latter to be prepared to read in case of the absence of the former, and to succeed as principal for the next quarterly meeting in case the person first appointed principal has fulfilled his duty. If the duty of the essayist be performed by the alternate the former shall be continued to the next meeting and a new alternate ap- pointed. II. The following shall be the order for the transaction of business: 1. Reading and acting on minutes of previous meetings. 2. Reception ot new members. 3. Reading of Essays and remarks. 4. Reports of cases. 5. Reports of committees and miscellaneous business. III. The Censors shall take into consideration all complaints of breach of etiquette or violation of medical ethics, preferred by a mem- ber against any other member of the society. If upon examination they shall unanimously find no cause for action, the complaint shall be dis- missed and their action be final; but if any of the board think there is just cause of complaint they shall report upon the case at the next quarterly meeting and give notice to the parties concerned, of their intention. IV. In case a complaint is brought against a member of the board of Censors, the Vice President shall be, ex-officio, a member of the Board for the investigation of that case. V. The fee to be paid upon becoming a member of this society shall be one dollar. VI. These By-Laws may be amended, added to, or altered at any regular meeting of the society, by a vote of two-thirds the members pre- sent, ff notice of the intended change shall have been submitted to the society in writing at least one month previously; but the operation of any or all of these may be temporarily suspended by a majority of the members present at any meeting. 2 CODE OF ETHICS, OF THE AMERICAN MEDICAL ASSOCIATION. CHAPTER I. 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. Sec 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 more deep and enduring, because there is no tri- bunal other than his own conscience, to adjudge penalties for carelessness or neglect. 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 de- portment, so to unite tenderness with firmness, and condescension with authority, as to inspire the minds of their patients with gratitude, respect and confidence. Sec. 2. Every case committed to the charge of a physician, should be treated with attention, steadiness and humanity. Reasonable indul- gence should be granted to the mental imbecility and caprices of the sick. Secrecy and delicacy, when required by peculiar circumstances, should be strictly observed; and confidential intercourse, to which phy- sicians are admitted in their professional visits, should be used with dis- cretion, and with the most scrupulous regard to fidelity and honor. The obligation of secrecy extends beyond the period of professional services; none of the privacies of personal and domestic life, no infirmity of dis- position or flaw ot character observed during professional attendance should ever be divulged by him 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 circumstances, been protected in their observance of secrecy, by courts of justice. 11 Sec 3. Frequent visits to the sick are in general requisite, since they enable the physician to arrive at a more general knowledge of the disease —to meet promptly every change which may occur, and also tend to pre- serve 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 in- terested motives. Sec 4. A physician should not be forward to make gloomy prognos- tications, because they savor of empiricism by magnifying the impor- tance of his services in the treatment or cure of the disease. But he should not fail, on proper occasions, to give to the patient's friends time- ly notice of danger, when it really occurs, and even to the patient him- self, if absolutely necessary. This office, however, is so peculiarly 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 tranquility of the most resigned in their last moments. The life of a sick person can be shortened, not only by the acts, but also by the words and manners 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 discourage the patient and to depress his spirits. Sec 5. A physician ought not to abandon a patient because the case is deemed incurable, for his attendance may continue to be highly use- ful 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 lib" erality that moral duty which is independent of, and far superior to, all pecuniary consideration. Sec. 6. Consultations should be promoted in difficult or protracted cases, as they give rise to confidence, energy, and more enlarged,views in practice. Sec 7. The opportunity which a physican not unfrequently enjoys of promoting and strengthening the good resolutions of his patients suffer- ing under the consequences of vicious conduct, ought never to be ne glected- His counsels or even remonstrances will give satisfaction, not 12 offence, if they be offered with politeness, and evince a genuine love of virtue, accompanied by a sincere interest in the welfare of the person to whom they have addressed. Art. II. Obligations of Patients to their Physicians. Sec 1. The members of the Medical Profession, upon whom are en- joined the performance of so many important 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 pa- tients should entertain a just sense of the duties which they owe to their medical attendants. Sec. 2. The first duty of a patient is, to select as his medical adviser, one who has received a regular professional 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. Sec. 3. Patients should prefer a physician whose habits of life are regular, and who is not devoted to company, pleasure, or to any pursui incompatable with his professional obligations. A patient should also confide the care of himself and family as much as possible to one phy- sician; for a medical man who has become acquainted with the peculiar- ities of constitution, habits and predispositions of those he attends, is more likely to be successful in his treatment than one who does not pos- sess 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 dis- eases; it is to a neglect of this precept that medicine owes much of the uncertainty and imperfection with which it has been reproached. Sec. 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 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 makino- 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 fe- male sex, should never allow their feelings of shame or delicacy to pre- 13 vent their disclosing the seat, symptoms and causes of the complaint pe- culiar to them. However commendable a modest reserve may be in the common occurences of life, its strict observance in medicine is often at- tended with the most serious consequences, and a patient may sink un- der a painful and loathsome disease, which might have been readily pre- vented had timely intimation been given to the physician. Sec 5. A patient should never weary his physician with a tedious de- tail of events and matters not appertaining to his disease. Even as re- lates to his actual symptoms, he will convey much more real information by giving clear answers to interrogatories, than by the most minute ac- count of his own framing. Neither should he obtrude the details of his business, nor the history of his family concerns. Sec 6. The obedience of a patient to the prescriptions of his phy- sician 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 al- low themselves to be persuaded to take any medicine whatever, that may be recommended to them by self-conceited doctresses, who are so fre- quently 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 happens that they are injurious by contravening the plan of treatment adopted by the physician. Sec. 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 interference, which may de- stroy his confidence in the coursehe is pursuing, and induce him to neg- lect 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 con- cert, for although their modes of treatment may be attended with equaj success when employed singly, yet conjointly, they are likely to be pro- ductive of disastrous results. Sec. 8. When a patient wishes to dismiss his physician, justice and common courtesy require that he should state his reasons for so doing. 14 Sec. 9. Patients should always, when practicable, send for their phy- sician 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 prevent an interference of engagements. Patients should also avoid calling on their medical ad- viser during the hours devoted to meals or sleep. They should always be in readiness to receive the visits of their physicians, as the detention of a few minutes is of serious inconvenience to him. Sec 10. A patient should, after his recovery, entertain a just and enduring sense of the value of the services rendered him by his physi- cian; for these are of such a character that no mere pecuniary acknowl- edgment can repay or cancel them. CHAPTER II. Of the duties of Physicians to each other and the profession at large. Art. 1. Duties for the support of Professional Character. Sec. 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 ability to maintain its dignity and honor, to exalt its stan- ding, and to extend the bounds of its usefulness. He should therefore observe strictly such laws as are instituted for the government of its mem- bers; should avoid all contumelious remarks relative to the faculty, as a body and while, by unwearied 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. Sec 2. There is no profession from the members of which greater purity of character, and a higher standard of moral excellence are re- quired, than the medical; and to attain eminence, is a duty every phy- sician owes alike to his profession and to his patients. It is also incum- bent upon the faculty to be temperate in all things, for the practice of physic requires the unremitting exercise of a clear and vigorous under. standing; and, on emergencies for which no professional 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 creature. Sec 3. It is derogatory to the dignity of the profession to resort to public advertisements or private cards or handbills, in inviting the at. tention of individuals affected with particular diseases, publicly offering advice and medicine to the poor, gratis, or promising radical cures; or 15 to publish cases and operations in the daily prints, or suffer such public- ation to be made; to invite laymen to be present at operations—to boast of cures and remedies; to adduce certificates of skill and success, or to perform any other similar act. These are ordinary acts of empirics, and are highly reprehensible in a regular physician. Sec 4. Equally derogatory to a professional character, it is, for a physician to hold a patent for any surgical instrument or medicine or to dispense a secret "nostrum," whether it be the composition or exclusive property of himself or others. For, if such nostrum of equal efficacy, any concealment regarding it, is inconsistent with benevolence or liberality; and if mystery alone give it its value and importance, such craft implies either ignorance, or fraudulent avarice. It is also reprehensible for phy- sicians to give certificates attesting the efficacy of patent or secret medi- cines, or in any way to promote the use of them. Art. II. Professional services of Physicians to each other. Sec I. All practitioners of medicine, their wives and their children, while under their parental care, are entitled 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 experiences at the sickness of a wife, or child, or any one who by the ties of consanguinity is rendered peculiarly dear to him, tend to obscure his judgment, and produce timidity and irresolution in his practice. Wnder such circumstances, medical men are peculiarly dependent upon each other, and kind offices and professional aid should always be cheerfully and gratuitously afforded. Visits, however, ought not to obtruded offic- iously, as such unasked civility may give rise to embarrassments, or in- terfere with that choice on which confidence depends. But if a distant member of the faculty, whose circumstances are affluent, request atten- dance, 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. 111. Of the duty of Physicians as respects various offices. Sec 1. The affairs of life, the pursuit of health, and the various ac- cidents and contingencies to which a medical man is peculiarly exposed, sometimes require him temporarily to withdraw from his duties to his pa- tients, and to request some of his professional brethren to officiate for him —compliance with the request is an act of courtesy, which should always 16 be performed with the utmost consideration for the interest and character of the family physician, and when exercised for a short period, all the pecuniary obligations for such services shouTd 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 ol the frequent and long continued exercises of the 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 responsibility, it is just that the fees accruing there- from should be awarded to the physician who officiates. Art. IV. Of the duties of Physicians in regard to Consultations. Sec 1. A regular medical education furnishes the only presumptive evidence of professional abilities and requirements and ought to be the only acknowledged right of an individual to the exercise and honors of the profession. Nevertheless, as in consultations, the good of the patient is the sole^object in view, and is often dependent on personal confidence no intelligent regular practitioner, who has a license to practice from some medical board of known and acknowledged respectability, recog- nized by this Association, and who is in good mora] and professional stand- ing in the place in which he resides, should be fastidiously excluded from fellowship, or his aid refused in consultation, when it is requested by the patient. But no one can be considered as a regular practitioner, or a fit associate in consultation, whose practice is based on an exclusive doff- ma to the rejection of the accumulated experience of the profession, and of the a.ds actually furnished by anatomy, physiology, pathology, and organic chemistry. °J Skc. 2. In consultations, no riyalship or jealousy should be indulged-* • candor prob.ty and a, due respect should be esercfsed towards 2Tot sician having charge of the case. " ' Sec. 3 In consultations the attending physician should be the first to the^aTen. s mav b» °PP°r,Uni'y '° "^ •""■ fe"her «***« « liberation; and the one first in attendance !, P P'aCe f°r d"- tions agreed upon to the patien or h °frie^s /sTT"^'6 'he dire°- wbicb „ay be thongb. proper ,o express/rr-l;: :-Z= 17 of it should take place before the patient or his friends, except in the pre- sence of all the faculty attending, by their common consent; and no op- inions nor prognostications should be delivered, which are not the result of previous deliberations and concurrence. Sec 4. In consultations, the physician in attendance should deliver his opinion first; and when there are several consulting, they should de- liver their own opinions in the order in which they have been called in.— No decision, however, should restrain the attending physician from ma- king such variations in the mode of treatment as any subsequent unex- pected change in the character of the case may demand. Hut such va- riation, and the reason for it, ought to be carefully detailed at the next meeting in consultation. The same privilege belongs also to the consul- ting physician, if lie is sent for in an emergency, when the regular atten- dant is out of the way, and similar explanations must be made by him at the next consultation. Sec. 5. The utmost punctuality should be observed in the visits of physicians when they are to hold consultations together, and this is gen- erally 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 relinquishment, 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 for a reasonable period, after which the consultation should be consider- ed 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 he 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, under seal, to be delivered to his associate. : Sec. G. In consultations, theoretical discussions should be avoided, as occasioning perplexity and loss of time. For there may be much di- versity of opinion concerning speculative points with perfect agreement in those modes of practice which are founded, not on hypothesis, but on experience and observation. Sec. 7. All discussions in consultations should be held as secret and confidential. Neither by words or manner should any of the parties to a consultation assert or insinuate that any part of the treatment pursued did »ot receive his assent. The responsibility must be equally divided be- 18 tween the medical attendants—they must equally share the credit of suc- cess as well as the blame of failure. Sec. 8. Should an irreconcilable diversity of opinion occur when sev- eral physicians are called upon to consult together, the opinion of the ma- jority should be decisive; but if the numbers be equal on each side, then the decision should rest with the attending physician. It may, however, 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 circum- stance 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 occurence, 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 the pa- tient 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. Sec 9. When circumstances occur to render a special consultationde- sirable, the physician whose assistance is required in such cases, should sedulously guard against all future unsolicited attendance. As such con- sultations require an extraordinary portion of both time and attention, at 'east a double honorarium may be reasonably expected. Sec 10. A physician who is called upon to consult, should observe the most honorable and scrupulous regard for the character and stand- ing of the practitioner in attendance; the practice of the latter should be justified, as far as it can be consistently with a conscientious regard for truth, and no hint or insinuation should be thrown out, which could im- pair the confidence reposed in him, or affect his reputation. The consul- ting physician should also refrain from any of those extraordinary at- tentions or assiduities which are too often practiced by the dishonest, for the base purpose of gaining applause, or ingratiating themselves into the favor of families and individuals. Art. V. Duties of physicians in cases of Interference. Sec 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. Sec 2. A physican, in his intercourse with a patient under the care 19 of another practitioner, should observe the strictest caution and reserve. No meddling inquiries should be made; no disingenious hint be given rel- ative to the nature and treatment of his disorder, nor any course of con- duct pursued that may directly or indirectly tend to diminish the trust reposed in the physician employed. Sec 3. The same circumspection and reserve should be observed when, from motives of business or friendship, 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 circum- stances, and when they are made, no particurar enquiries should be in- stituted relative to the nature of the disease, or the remedies employed, but the topic of conversation should be as foreign to the case-as circum- stances will admit. Sec 4. A physician ought not to take charge of, or prescribe, for a patient who has been under the care of another member of the faculty in the same illness, except in cases of sudden emergency, or in consul- tation with the physician previously in attendance, 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 in- sinuations should be thrown out in relation to the conduct or practice previously pursued, which should be justified as far as candor and re- gard 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 treament affords no evidence of a lack of professional knowl- edge or skill. Sec 5. When a physician is called to an urgent case, because the family attendant is not at hand, he ought unless consultation is desired, to resign the care of the patient to the latter immediately on his arrival. Sec 6. It often happens in cases of sudden illness; or of recent ac- cidents or injuries, owing to the alarm and anxiety of friends, that a num- ber 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 necessary. In all such cases, however, the practition- er who officiates, should request the family physician, if there be one, to be called, and unless his further attendance be requested, should resign the case to the latter on his arrival. Sec 7. When a physician is called to the patient of another practi- 20 tioner in consequence of the sickness or absence of the latter, he ought, on the return or recovery of the regular attendant, and with the consent of the,patient, to surrender the case. Sec 8. A physician when visiting a sick person in the country may be desired to see a neighboring patient who is under the regular direc- tion of another physician, in consequence of some sudden change or ag* gravation of symptoms. The conduct to be pursued on such an occa- sion is to give advice adapted to the circumstances; to interfere no further than is absolutely 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 immediate consultation with the practitioner previously employed. Sec 9. A wealthy physician should not give advice, gratis, to the affluent; because his doing so is an injury to his professional brethern.— The office of a physician can never be supported as an exclusively beni- ficent one; and it is defrauding in some degree, the common funds for its support, when fees are dispensed with, which might justly be claimed. Sec. 10. When a physician, who has been engaged to attend a case of mid-wilery, is absent, and another is sent for, if delivery is accomplish- ed during the attendance of the latter, he is entitled to the fee; hut should resign the patient to the practitioner first engaged. Art. VI. Of differences between Physicians. Sec. 1. Diversity of opinion, and opposition of interest, may, in the medical, as in other professions, sometimes occasion controversy and even contention. Whenever such cases unfortunately occur, and can- not be immediately terminated, they should be referred to the arbitration of a sufficient nujnber of physicians, or a Court-medical. As peculiar reserve must be maintained by physicians toward the pub- lic, in regard to professional matters, and as there exist numerous points in medical ethics and etiquette, through which the feeling 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 adjudication of the ar- bitrators 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 Acknowledgements. Sec 1. Some general rules should be adopted by the faculty in every 21 town or district, relative to pecuniary acknowledgments from their pa- tients, and it should he deemed a point of honor to adhere to these rules, with as much uniformity as varying circumstances will admit. CHAPTER III. " 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. Sec. 1. As good citizens, it is the duty of Physicians to be ever vig- ilant for the welfare of the community, and to bear their part in sustain- ing 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 hos- pitals, asylumns, schools, prisons, and similar institutions, in relation to the medical police of towns, as. drainage, ventilation, etc.; 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 con- tinue their labors for the alleviation of the suffering, even at the jeopardy of their own lives. Sec. 2. Medical men shoule always be ready when called on by le- gally constituted authorities, to enlighten coroner's inquests and courts of justice, on subjects strietly medical, such as involve questions rela- ting to sanity, legitimacy, murder by poisons or other violent means, and in regard to the various other subjects embraced in the science of medi- cal jurisprudence. But in these cases, and especially where they are required to make a post mortem examination, it is just in consequence of the time labor and skill required, and the responsibility and risk they incur, that the community should award them a proper honerarium. Sec 3. There is no profession, by the members of which elemosyn- ary services are more liberally dispense, than the medical; but justice requires that some limits should be placed to the performance of such good offices. Poverty, professional brotherhood, and certain public du- ties referred to in section 1 of this chapter, should always be recognized as presenting claims for gratuitous services; but neither institutions en- dowed by the public or by rich individuals, societies for mutual benefit, for the insurance of lives, or for analogous purposes, nor any profession or occupation, can be admitted to possess such privilege. Nor can it be 22 justly expected of physicians to furnish certificates of inability to serve on juries, to perform military duty, or to testify to the state of health of persons wishing to insure their lives, without a pecuniary acknowledg- ment. But to individuals in indigent circumstances, such professional t services should always be cheerfully and freely accorded. Sec 4. It is the duty of physicians who are frequent witnesses of the enormities committed by quackery, and injury to health and even the de- struction 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 pretensions of artful empirics aud imposters. Phy- sicians ought to use all the influence they possess, ane professors of col- leges of Pharmacy, by exercising their option in regard to the shops to which their prescriptions shall be sent, to discourage druggists and apothecaries from vending quack or secret medicines, or from being in any way engaged in their manufacture or sale. Art. II. Obligations of the public to Physicians. Sec. 1. The benefits accruing to the public directly and indirectly, from the active and unwearied benificence of the profession, are so nu- 0 merous and important, that physicians are justly entitled to the utmost consideration and respect from the community. The public ought like- wise to entertain a just appreciation of medical qualifications; to make a proper discrimination between true science and the assumptions of ig- norance and empiricism, to afford every encouragement and facility for the acquisition of medical education, and no longer allow the statute books to exhibit the anomaly of exacting knowledge from physicians, under liability to heavy penalty, and of making them obnoxious to pun- ishment for resorting to the only means of obtaining it. EEE BILL. OF THE MONTGOMERY COUNTY MEDICAL SOCIETY. REVISED, APRIL, 1857. PRACTICE OF MEDICINE. For first visit in the city, . jf 0q " subsequent visits to^same case when once daily, each. 75 to 1 00 " '• twice or more dailj, " 50 to 75 For visits in country, first mile, each, $1 00 do " " each additional mile, (the second mile commencing at corporation line,) 25 to 50 do night visits 50 to 100 per cent additional may be charged. do detention with patient all night, 5 00 do do in daytime per hour, 50 do way call, 1 00 do consultation visit 5 00 do do in same case subsequently, 3 00 do office prescription and advice, 50 to 1 00 do written opinion, 3 to 5 00 do prescription for each additional case in family, 50 do opinion upon a case in which the physician may be subpoenaed, 5 00 do postmortem examination in cases of legal investigation,* 10 to 30 00 do certificate as medical examiner to Insurance Companies, 2 00 *It has been too much the practice of medical men to receive from the coroners, or the County Commissioners the remuneration for making post mortem examinations, and this has been invariably below the value of the services rendered. By the following it will be seen that it is the duty of the Court of Common Pleas, to fix the amount which shall be paid in such cases; it is Sec. V. of an Act passed March 16, 1852, "Regulating the fees of witnesses in civil and criminal cases," and is to be found on page 411, of Swan's Stat- utes Revised. . "That in all cases where a physician or ,«ur<;eon shall make a post mortem examination, at the instance of \}\<: coroner or other officers, said physician or surgeon shall be allow- ed such compensation for his services as the Court of Common Pleas of the prober county may direct." SURGERY. For reducing luxations, $5 to 15 00 do do do of the hip, 15 to 30 00 do adjusting fractures of the arm, 5 to 10 00 do do do do leg, 10 to 15 00 do do do do thigh, 20 to 30 00 do amputation of the fingers or toes, each, 5 00 do do through the metatarsal or metacarpal bones, 10 00 do do at the ankle joint, 10 to 20 00 do do of the leg or arm, 20 to 30 00 24 For amputation of tbe thigh, $30 to 50 00 do do at the shoulder joint, 10 to 50 00 do do do hip-joint, 100 00 do extirpation of mammary gland, 25 to 50 00 do do of- tumours, 5 to 50 00 tdo do of tonsils, each, 5 00 do do of polypus, 50 to 25 00 do ligature of large arteries, 20 to 40 00 do do of small do in recent wounds. 5 to 10 00 do paraocnticis abdominis, 5 to 10 00 do do thoracis, II) to 20 (K) do trephining, 20 to 30 00 do lithotomy, 50 to 100 00 do reducing hernia, per taxis, 5 to 10 00 do operating for hernia, 40 to 60 00 ilo do do cataract, 50 to 100 00 do do do hare-lip, 10 to "J5 00 do do do fistula in ano, 15 to 40 00 do do do hydrocele, 5 00 do do do radical cure of same, 25 to 40 00 do bronchotomy, 25 to 50 00 do administration of chloroform, 2 to 5 00 do oupping, 1 00 do vaccinnation, 50 to 1 00 do introducing catheter, I to 3 00 do establishing scton or issue, 2 to 3 00 do treating gonorrhoea, simple, (to be paid in advance,) •5 00 do do syphilis, (to be paid in advance,) 10 to 20 00 OBSTETRICS. For delivery in natural case?, under 5 miles distance, 5 to 10 00 do do in preternatural and instrumental crises, 10 to 30 00 do extracting placenta alone. 3 to 5 00 In protracted cases requiring over five hours detention, fifty cents per hour may be charged additional, and mileage may be added at a greater distance thjn five miles. In all surgical cases, mileage, subsequent attendance, dressing and medicines |are to be charged at the usual rates as in other cases. '%■ Aided by the foregoing bill the practitioner will be enabled to regulate his fees in cases of extraordinary detention or attendance, which must in the very nature of things occur When convenient the Physician should present his account for settlement within six months from the time of attendance, and in every instance to settle his claims by cash or note once a year. Gratuitous services to the poor are by no means prohibited; the characteristic benefic- ence of the ■profession is inconsistent with sordid views or avaricious rapacity. The Profession-) I Fees this day adopted shall be a standard by whicb in future our charges shall be regulated: and our honors as Physicians and Gentlemen ara hereby pledged to adhere to them firmly in all cases, except where charity or sonic equally honorable mo- tive may induce a departure therefrom.