THE CONSTITUTION AND BT - LAWS OF THE C1MK COUIIiTY MEDICAL ISSOSIAffll TOGETHER WITH A TABLE OF FEES. AND L^L^'0lCAU I8KW 0 HNFORD IJNlVERSnt OOIDIE OF MEDICAL ETHICS. ADOPTED January 2(5, 1 . —ALSO — AN ADDRESS DELIVERED BY F. R. PAYNE, M, D. PUBLISHED BY THE SOCIETY. MARSHALL, ILLINOIS; SUTTON & ENGL TRS.—MESSENGER OFFICE. 1867. THE CONSTITUTION AND BY-LAWS OF THE CLAEK CGCKTY MGBICAL ASSOCIATION. TOGETHER WITH A TABLE OF FEES. AND CODE OP E1XIICS. ADOPTED S20, 1867, —ALSO—s AN ADDRESS DELIVERED BY F. R. PAYNE, M.D. fji hushed nr the society. MARSHALL, ILLINOIS: SUTTON & ENGLISH, PRS.—MESSENGER Fj'IC''\ 1867. COKTSTlXtJTlOlsr. Art. 1. This society shall be called the Clark County MedioaL Association. Art. 2. This society shall hold four stated meetings annually, called annual and quarterly. The annual meeting shall be held the first Wednesday, of January, and the quarterly meetings the first Wednesdays of April, July, and October. Art. 3. This society may adjourn from day to day, but shall meet at all regular or called meetings, in Marshall, Illinois. Art. 4. For the election of officers at the annual meeting, or elec* tion of members to the Society, seven shall constitute a quorum, but for other purposes, five members shall constitute a quorum. When the President has declared the meeting opened, the order of business shall be as follows: 1. Reading of the minutes of the last meeting, and correcting the same, if necessary. 2. Calling the roll of members. 3. Appointment of the usual Committees, and Treasurer’s report. 4. President’s Address. 5. Report of Committees, and questions relative to taxation. 6. Reading of such papers (essays, etc.,) as have been directed by the Society. 7. Report of cases and other communications from the members of the Society. 8. Election of officers. 9. Miscellaneous business, motions, resolutions, notices, &c. 10. Each member, 'when speaking, shall rise and address the President, and when called to order by any member, shall set down. 11. On questions of order, the members shall have the right of appealing from the decision of the President to a vote of the society. SECTION I, SECTION II. Aijt. 1. The officers of this society shall be a President, Vice President, Secretary and Treasurer, and five Censors, chosen by ballot at the annual meeting, and shall hold their offices for oue year, and until successors shall have been chosem Aut.2. Vacancies may be tilled at any regular lneeting, or the President may appoint Censors pro-tcmpore in case of absence; Aijt. 3. Delegates to represent this society in the State Society, and National Association, shall be chosen at the annual meeting in January. SECTION III. DUTIES OF OFFICERS, Art. 1. It shall be the duty of the President to preside at all meetings, to preserve order, regulate debates, put questions, give tlie easting vote, call special meetings, and perform such other duties as may hereafter be assigned to him. Art. 2. He shall appoint the Chairman of all Committees, un- less otherwise ordered by special resolution, and deliver before the Society, at the expiration of his term of office, a dissertation on some appropriate subject, or in ccse of necessary absence, send the same to the society at the time aforesaid, and for neglecting or refusing to comply with the same, shall forfeit and pay to the Society the sum of two dollars, which may be returned by a vote of two-thirds of the members present, at the next meeting of the society, if satisfactory excuse be rendered. Art. 3. He shall also appoint one of the members to deliver a public address at the annual meeting of the society, and a business committee of three, to select subjects for essays and reports. He shall also appoint the chairman for the standing committees, (except the committee of publication,.)—each chairman having the right to select two members to assist him in the discharge of the duties as- signed him. Art. 4. The Vice President shall perform all the duties of the President in his absence, and if neither arc present, the society shall appoint a President pio-tem. Art. 5. It shall be the duty of the Secretary to keep a faithful record of all the proceedings of the society, keep a 1st of all the members, and preserve the books, papers, essays, and communica- tions belonging to the soceiety. Art. I!. The Secretary shall, also, at each meeting, report to the society a list of delinquents, and keep a record of fines unpaid, with the reason therefor—shall preseet a copy of the reason to. the mem- bers fined, and a 1st of all to the treasurer. He shall manage the corr spondence of the society, and make a report of the same at the meetings of the society, and perform such other duties as may bylaw be assigned to him. Art. 7. The Treasurer shall receive and disburse the funds of the socie ty. He shall keep a true account of all moneys received, and pay them out, by vote of a majority of the members present, at any stated meeting, and report the same at each regular mee ting of tha socie ty, and at the dose of his official term, shall de liver to his suc- cessor the records of his office, and all the moneys belonging to the society. Art. 9. It shall be the duty of the Censors to examine the cre- dent als of persons applying lor membership, and subject such appli- cants to examination when deemed necessary, and report the same to the society, at the'r earlic st convenience. Art. 9. The approbation of three censors shall be requisite to present an intlividual for admission. SECTION IY. Art. 1. Any Physician approved by the censors, having made application for admission to the society, and received the votes of two- thirds of the members present at any regular meeting, on paying his MEMBERS. initiation fee of $0,00 and signing the constitution, shall be admitted to full membership. Art. 2. The expenses of the society shall be defrayed by sub- scription, or equitable tax, to be assessed at the annual meeting of the society. Art. 3. Every member residing within twenty miles of the place of meeting, who shall fail to attend at least one of the stated meetings during the year, shall be fined one dollar. The society may remitthe fine on satisfactory reason being given for non-attendance. Art. 4. Any member who shall refuse to pay the taxes and fines regularly imposed upon him, when requested by the proper officer, for two years in succession, shall be suspended from membership, nor shall he be restored till he pay all arrears due from him, and an en- trance fee of one dollar. Art. 5 At each meeting, one or two subjects shall be selected by the society for discussion. Art. 6. Every member is expected and reqested to give a written or oral report, of all important cases that lie may treat during the in- terval of meetings, also any valuable fact he may find recorded in Medical journals. Art. 7. No member shall be permitted to give the names of per- sons who may apply for membership, except to the censors, or mem- bers of the society; and in no case shall the rejection of an applicant be made public. Art. 8. Members shall be liable to censure, suspension, fine or expulsion, for wilful neglect of the rules of the society, or flagrant violations of professional etiquette or honor. A vote by ballot of two- thirds of the members present shall be required to expel. Art. 9. When a motion is made to expel a member, it shall be done at a regular meeting, and the charges brought against him shall be reduced to writing, and a copy furnished immediately by the Sec- retary to the accused, who shall be allowed until the next meeting to prepare his defence, at which time the motion shall be considered and decided upon. LA.'WS- Art. 1. The code of “Medical Ethics” adopted by the “American Medical Association, ” in May, 18-17, is hereby declared to he the Code of Medical Ethics of this society, and as such, is binding on all its mcnil >ers. Art. 2. When two or more members rise at once, the President shall name the member who is first to speak. Art. 3. No person shall speak more than twice on the same ques- tion without leave of the society, nor more than once, until every member choosing to sp ak, shall have spoken. Art. 4. No question, oil a motion, shall be debated or put, until the same shall be seco ided. When a motion is seconded, it shall be stated by the President before debate, and every such motion shall be reduced to writing, if any member desire it. Art. 5. After a motion is stated by the President, it.shall be deemed to be in possession of the society, but it may be withdrawn at any time before amendment or decision. Art. 6. No member shall interrupt another while speaking, un- less it be to call him to order, or, to correct a mistake. Art. 7’ When a question is under debate, no motion shall be received, unless, 1st, to amend it; 2d, To commit it; 3d, To lay it on the table; 4th, To postpone it; 5th, To adjourn. Art. 8. A motion to lay on the table shall be decided without debate. Art. 9. A motion to adjourn shall always be in order, and shall be decided without debate. Art. 10. A second amendment shall not be received until a pre- vious one is disposed of, except with the consent of the mover of the first amendment. Att. 11. If the question in debate contaiu several points, any member may have the same divided in voting. Art. 12. Every member shall vote upon a question put, unless excused by the society. Art. 13. A member called to order, shall immediately sit down unless permitted to explain, and the society, if appealed to, from the decision of the President, shall decide on the call, without debate.— If there be no appeal, the decision of the President shall be submit- ted to. Art. 14. When a question has been put and decided, it shall be in order for any member who voted in the majority to move for a re- consideration thereof; but no motion for reconsideration shall be re- ceived more than once, except by unanimous oonsent. Art. 15. All motions shall be put in the order they are moved, and shall be reduced to writing, if required by any member. Art. 16. Any member who shall have attained the age of sixty years, shall be exempt from taxes and fines, and penalties for non- attendance. Art. 17. No member shall engage in manufaoluring, vending or using, in his practice, any nostrums, patent or secret medicine, or holding consultations with known quacks or imposters. Art. 18. Any of the above laws may be suspended for a specific purpose at any of the stated meetings of the society, by a vote of two-thirds of the members present. Art. 19. These By-Laws shall not be altered or amended except at an annual meeting, after notice of such intention shall have been given at some previous meeting. Art. 20. There shall be en annual aseessment of fifty cents upon each member, to dafray the incidental expenses of the sooiety. TABLE OF, FEES. All bills clue when services are rendered and cease to be necessary, and must be settled either by note or cash January and July of each year. We, whose names are appended, pledge ourselves to be gov- erned by the following Fee Bill. Constitution, By-Laws, and Code of Medical Ethics. We further agree that we will not attend a patient who is able, yet refuses to pay his bill, and that we will report quar- terly the names of this class of customers, that all medical men in the community may become familiar with their names and govern them- selves accordingly: MEDICAL FEE BILL. Visits in town, per day, $ j Each subsequent visit, same day, • • * Prescriptions at office, ordinary cases, Irom 50 to L UU Visit in the country, one mile, 2 00 Each additional mile Natural case of obstetrics, within four miles, 7 uu Call visits in country, • * ® Unnatural labor with false presentation, •••••••••*•• Twins, 00 t0 J* 00 Instrumental delivery, Jr Removing adhered afterbirth, ° * Abortion, same as full time, 7 00 Council fee, exclusive of mileage, • • • • • 5 00 Night visits, 50 pr cent additional, and if very bad weather 100 pr ct. SURGICAL FEE BILL. Amputation of Ilip joint, 00 Amputation of thigh, Amputation of leg, * 00 Amputation of arm, • • • • • • " ™ Amputation of fingers and toes, from 00 to 1° Reducing fracture thigh, ■•••••• 00 Reducing fracture leg, from $10 00 to 20 00 Reducing fracture fore arm, •••••• 00 Reducing dislocation shoulder, from $5 00 to 10 00 Reducing dislocation hip joint, from $10 00 to 40 00 Reducing dislocation knee, Reducing dislocation elbow, from $10 00 to 20 00 Reducing Hernia by taxis, 00 Reducing Hernia by operation, 50 00 Tapping for Hydrocele, * ”0 Tapping for Acities, ••;••• in above for radical cure charged additional. Operation for Hair lip, 20 00 Exercising Tonsils, • • 10 00 Lancing abscess, from oO cte to 2 00 Introducing Catheter, 2 Extracting Teeth, 50 Bleeding * For attending Coroner’s inquests and all cases where legal testimony will be required, from $20 00 to 30 00 CODE OIF MEDICAL ETHICS. OF THE DUTIES OF PHYSICIANS TO THEIR PATIENTS, AND OF THE OBLIGA- TIONS OF PATIENTS TO THEIR PHYSICIANS. CHAPTER I, Art. 1.—Duties of Physicians to their Patients. § 1. A physician should not only he ready to obey the calls of the sick, but his mind ought also to he 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 isno tribunal other than his own conscience to adjudge penalties lor care- lessness or neglect. Physicians should, therrehive, mini star to the sick with due impressions of the importance of their office; reflecting that the ease, the health, and the fives 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 conde- scension with firmness, as to inspire the minds of their patients \Vith gratitude, respect, and confidence. § 2. Every case committed to the charge of a physician should he treated with attention, steadiness, ard humanity. Reasonable indul- gence should he granted to the mental imbecility and caprices of the sick. Secrecy and delicacy, when required by peculiar circumstances, should he strictly observed; and the fanvfiaraml confidential intercourse to which physicians are admitted in their professional visits, should be used with discretion, and with the most scrupulous regard to fidelity snd honor. The obligation of secrecy extends beyond the period of professional services; none of the privacies of personal and domestic life, no infirmity of disposition or flaw of character observed during profess'onal attendance, should over 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 cer- tain circumstances, been protected in their observance of secrecy by courts of justice. § 8. Frequent visits to the sick are in general reqn;s‘te, since they enable the physician to arrive at a more perfect knowledge of the dis- ease—to meet promptly every change which may occur, and also tend to preserve the confidence of the patient. Rut unnecessary visit's are to he avoided, as they give us 1 -ss anxiety to the patient, tend to di- minish the authority of the physician, and render him liable to be sus- pected of interested motives. § 4. A physician should not he forward to make gloomy prognos- tications, because they savor of emp’ricism, by magnifying the impor- tance of lids s WiceS in the treatment or cure of the disease. Rut lie should not fa‘1, on proper oeasions, to give to the friends of the patient timely notice of danger when it rea ly occurs; and even to the patient himself, when it is absolutely necessary. This office, however, is so peculiarly alarming when executed by him, that it ought to be de- clined whenever it can be assigned to any other person of sufficient judgement 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 smsoth the bed ofdeath, revive expiring life, and coun- teract the depressing influence o' those maladies which often disturb the tranquility of the most resigned in their last moments. Tbe 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 discourage the patient and to depress his spirits. § 5. A physician ought not to abandon a patient because the case is deemed incurable; (or his attendance may’continue to be highly use- ful to the patient, and comlorting to the relatives around him,even in the last period of a fatal malady, by alleviating pa5n and other symp- toms, and bv soouiing mental anguish. To decline attendance, under such circumstances, would be sacrificing to fanciful delicacy and mis- taken 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 "ot unfrequently enjoys of promoting and strengthening the good resolution of his patients, suffering under the consequences of vicious conduct, ought never to be neglected. His counseis, or even remonstrances, will give satisfac- tion, not offence, if they be proffered with politeness, and evince a genuine love of virtue, accompanied by a sincere interest in the wel- fare of the person to who n they are addressed. Art. II.— Obligations of Patients to their Physicians. § 1. 1 be memb3rs of tbe medical profession, upon whom is en- joined the performance of so many important and arduous duties to- wards the community, and whoare required to make so many sacrifices of comfort, ease, and health, for the welfare of those who avail them- selves 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. § A. The first duty of a ; atient 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. § 3. Patients should prefer a physician whose habits of life are reg- ular, and who is not devoted to company, pleasure, or to au.y pursuit incompatible with his professional obligations. A patient should, also, confide the care of himself and family, as much as possible, to one physician, for a medical man who has become acquainted with the peculiarities of constitution, habits, and predispositions, of those he attends, is more likely to be successful iu his treatment, than one who does not possess that knowledge. A patient who has thus selected his physician, should always apply for advice in want may appear to him tr vial 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 ofamental origin stimulate thosedepend- ing on external causes, and yet are onlv 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 disclosing the seat, symptoms, aud causes of com- plaints 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 might have been readily prevented had timely intimation been given to the physician. § 5. A patient should never weary his physician with a ted'ous detail of events or matters uot appertaining to his disease, Even as relates to his actual symptoms, he will convey much more real infor- mation by giving clear auswers to interrogatories, than by the most minute account of his owa 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 prescription of his physician should be prompt and implicit. He should never permit his own crude opinions as to their fitness, to iufluence his attention to them. A failure in ono particular m iv render an otherwise judicious treat- ment dangerous, and even fatal. I bis remaik is equally applicable to diet, drink, and exerc;se. As patients become convalescent, they are -y apt to suppose that the rules prescribed lor them may be disre- garded, 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 pre- tend to possess infallible remedies lor the cure of evervdisease. How- ever simple some of their prescriptions may appear to be, it often hap- pens that thev are productive of much mischief, and in all cases they are injurious, by contravening the plan of treatment adopted by the physician. § 7. A patient, should, if possible, avoid even the friendly visits of a physician who is not attending him—and when he does receive them, he should never converse on the subject of his disease, as an observation may bemfde, without ary intention of interfeience. 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 cons&nt of his own medical attendant. It is of great importance that physicians should act in consort; for. although their modes of treatment may be attended with equal success when employed singly, yet conjointly they are very likely to be productive of disastrous results. $ 8. When a patient wishes to dismiss his pnyisician, justice and common courtesy require that he should declare his reasons for so doing. §9. Patients should always, when practicable, send for their physician in the morning, before his usual hour of going out; for, by being early aware of the visits he has to pay during the day, the physician is able to apportion his time in such a manner as to prevent an interlerence 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, entertain a just and en- during sense of the value of the services rendered him by his physi- cian; for these are of such a character, that no mere pecuniary ac- knowledgement can repay or cancel them. CIHPTER IT. OF THE DUTIES OF PHYSICIANS TO EACH OTHER, AND TO THE PROFES- SION AT LARGE. Art. 1. Duties for the supi>ort of professional character. § 1. Every individual, on entering the profession, as he becomes thereby entitled to all its privileges and immunities, incurs an obliga- tion to exert his best abilities to maintain its dignity and honor: to exalt its standing, and to extend the bounds of its usefulness, lie should, therefore, observe strictly such laws as are instituted for the government of its members; should avoid ail contumelious and sar- castic remarks relative to the faculty, as a body; and while, by un- wearied diligentce, 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 standard of moral excellence are re- quired, than the medical; and to attain such eminence, is a duty ev- ery physician owes alike to his profession, and to his patients. It is due to the latter, »s 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 on the faculty to be temperate in all things, for the practice of physic requires the unremitting exercise of a clear and vigorous understand- ing; 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. § 3. It is derogatory to the diguity of the profession, to resort to public advertisements, private cards or band-bills, inviting the atten- tion uf individuals affected with particular diseases—publicly offering advice and medicine to the poor, gratis, or promising radical cures;— or, to publish cases and operations in the daily prints, or suffer such publications to be made; to invite laymen, to be present at operations, to boast of cures and remedies, to adduce certificates of skill and suc- cess, of to perform any other similar acts. These are the ordinary practices of empirics, and are highly reprehensible iu a regular phys- ician. § 4 Equally derogatory to professional character is it, fora phys- ici in 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 of others. For, if such nostrum be of real efficacy, any concealment regarding it is inconsistent with beneficence and professional liberality; and, if mystery alone g'ves it value and importance, such craft implies either disgraceful ignorance, or fraudu- lent 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. Aut. II.— Professional services of physicians to each other. § 1. All practitioners of medicine, their wives, and their children while under the paternal care, arc eu d 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 questi ns to the sick; aiter which, the con- sulting ■ hysic'an should have the < jportunity to make such further inquiiies of the patient as may be necessary tosalisfy him o the true char; cter of the case. Both physicians should then iet;re o a pri- vate plac for deliberation; and the one first in attendance should communicate the directions agreed upon, to the patient or his triends, as well as any opinions which it may bethought proper to express. But no statement or d'seussion of it should take place before the pa- tient or his friends, except in t he ; resence of all the faculty ai tending, and bv their common consent; and no opinions or prognostications should be delivered, which are not the result of previous delibera- tion and concurrence. 5 4. Jn consultations, the physician in attendance should deliver his opinion first; and where there are several consulting, they should deliver their opinions r> the order in which they have been called in. No decision, however, should restrain the attending physician from making such variatioDsin the mode of treatment, as any subsequent unexpected change in the character of the case, mt.y demand. But such variation, and the reasons forit, ought to be carefully detailed at the next meeting in consultation. The same privilege, belongs also to the consulting phyiscian, 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. JC. The utmost punctuality should be observed in the visits of physicians when they are to hold consultation 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 relinquishment of any present oc- cupation. But, as professional engagements may sometimes interfere and delay one of the parties, the physician who first arrives, should wait for his associate a reasonable period, after which, the consulta- tion should be considered as poslponed to a new appointment. If it be the attending physician who is present, he will of course see the patient and prescribe; bat if it be the consulting one, he should re- tire, except in case of emergency, or when he has been called from a considerable distance, in which latter case, he may examine the pa- tient, and give his opiu’on in writing and under seal, to be delivered to his associate. 5 6. In consultations, theoretical discussions should be avoided, as occasioning perplexity and loss of time. For there may be such diversity of opinion concerning speculative points, with perfect agree- ment in tho e modes of practice which are founded, not on hypothe- sis, but on exf erience and observation. § 7. All discussions in consultation, should be held as secret and confidential. ISl either 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 bis assent. The responsibility must be equally divided between the medical attendants,—they must equally share the credit of success, as well as the blame of failure. § 8. Should an irreconcilable diversity of opinion occur when sev- eral phv&iclans ave called upon to consult together, the opinion ofthe majority should be considered as decisive; but if the numbers be equal on each side, then the decision should rest with the attending physi- cian. 11 mo eover, sometimes happens, that two physicians cannot agree in their views of the nature of a case* and the treatment to be pursued. Th;s is a circumstance much to be deplored, and should always be avoided, if possible, by mutual concessions, as far as they can be justified by a conscientious regard for the dictates of judgement, But, in the event of its occurrence, a third physician should, if prac- ticable, be cu'led to act as umpire; and, if circumstances prevent the adoption of this course, it must be left to the patieDt to select the physician in whom he is most willing to confide. But, as every phy- sician relies on the rectitude of his judgement, he should, when left in the minority, politely and consistently retire from any further de- liberation in the consultation, or participation in the management of the case. § 9. As circumstances sometimes occur to render a special consul- tation 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 seduously guard against all future unsolicited attendance. As such consultations require an extraordinary portion both of time and“attention, at least a double honorarium may be reasonably expected. § 10. A physician who is called upon to consult, should observe the most honorable and scrupulous regard for the character and stand- ing of the practitioner in attendance; the practice of the latter, it nec- essary, should be justified as far as it can be, consistently with a con- scientious regard for truth, and no hint or insinuation shosld be thrown out which could impair the confidence reposed in him, or affect his reputation. The consulting physician should always carefully refrain from any of those extraordinary attentions or assiduities, which are too often practiced by the dishonest for the base purpose of gi ln- ing applause, or ingratiating themselves into the favor of families and individuals. Akt. Y.—Duties of Physicians in cases of interference. § 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 c artifice. § 2. A physician, in his intercourse with a patient under the care of another practitioner, should observe hestrictestcaufion and reserve. No meddling inquiries should be made; no disengenuous hints given relative to the nature and treatment of his disorder; nor any course of conduct pursued that may directly or indirectly tend to diroiuish the trust reposed in the physician employed. § 3. The same circumspection and reserve should be observed when, from motives of business or friendship, a physician is prompt- ed to visit an individual who is under the direction of another prac- titioner. Indeed, such visits should be avoided, except under pecu- liar circumstances; and when they are made, no particular inquiries should be instituted relative to the nature of the disease, or the rem- edies 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 attendance, or when the latter has relinquished the case, or been regularly notified that his services aro no longer desired. Under such circumstances, no unjust and illiberal insinuation should be thrown out in relation to the con- duct 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 experi- ence 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 casa, because the family attendant is not at hand, he ought, unless his assistance in con- sultation be desired, to resign the care of the patient to the latter im- mediately on his arrival. § 6. It often happens, in oases of sudden illness, or of recent acci- dents and injuries, owing to the alarm and anxiety of friends, that a Bomber of phvsician3 are simultaneously seut for. Under these cir- cumstances, 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 practitioner who officiates, should request the family physician, if there be one, to be called, ard, unless his further attendance be requested, should, resign the case to the latter on his arrival. § 7. When a physician is called to the patient of another practi- tioner, in consequence of the sickness or ibsence 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. § 8. A physic:?n, when visiting a sick jxu’son in the country,may be desired to see a neighboring patient who is under the regular direc- tion of another physician, in consequence o s me sudden change or aggravation of symptoms. The conduct o be pursued on such an occasion is to give advice adapted to present circumstances; to inter- fere no farther than is absolutely necessa y with the general plan of treatment; to assume no iOture direction unless it be expressly desired; and, in the last case, to request an immediate consultation with the practitionerprevious'y employed. § 9. A wealthy physician should not give advice gratis to the af- fluent; because b’s doing > o is an injury to bis professional brethren. rJ he office of a physician can never be supported as an exclusively benefitert one; and it is defrauding, in some degree, the common funds for its support, when fees are dispensed with which might justly be claimed. § 10 When a physician w ho has been engaged to attend a case of midwifery, is absent, and another is sent for, if delivery is accom- plished during the attendance of the latter, be is entitled to the fee, but should resign the patient to the practitioner first engaged. Art, YI—Of aiffernaes between Physicians. § 1. Diversity of opinion, and opposition of interest, may, in the medical, as in other professions, sometimes occasion controversy and even contention. Whenever .uch cases unfortu .ate\v occur, and can- not be immediately terminated, they should be referred to the arbi- tration of a sufficient number of physicians, or a court-medical. § 2. As peculiar reserve must be maintained by physicians towards the public, in regard to professional matters, and as there exist numer- ous points in medical ethics and etiquette through which the feelings of medical men may be painfully assailed in their intercourse with each other, and which cannot be understood c r appreciated by general society, neither the subject matter of such differences nor the abjudi- cation of the arbitrators should be made public, as publicity in a cas* ol this nature may be personally injurious to the individuals concerned, and can hardly fail to bring disorediton the faculty. Art. VTl.— Of pecuniary acknowledgements. Some general rules should be adopted by the faculty, in every town ordistrict, relative to pecuniary acknowledgements 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. CHAPTER III. OF THE DUTIES OF THE PROFESSION TO THE PUBLIC, AND OF THE OBLIGA- TIONS 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 vig- ilant for the welfaie of the community, and to bear their part in sus- taining its institutions and burdens; they should also ba ever ready to give counsel to the public in relation to matters especially appertain- ing to their profession, as on subjects of medical police, public hygiene and legal medicine. It is their province to enhghten 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 presentation 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 poisons or other violent means, and in regard to the -various other subjects embraced in the science of Medical Jurisprudence. But in these cases, and especially where they are required to make a post-mortem examination, it is just, in consequence of the time, labor and skill required, and the re- sponsibility and risk they incur, that the public should award them a proper honorarium. } 3. There is no profession, by the members of which eleemosynary services are more liberally dispensed than the medical, but justice re- quires 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 chapter, 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 insurance of lives or for analogous purposes, nor any profession 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 acknowledge- 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 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 and imposters. Physi- cians ought to use all the influence which they may possess, as pro- fessors in Colleges of Pharmacy, and by exercising their option in re- gard to the shops to which their prescriptions shall be sent, to discour- age druggists 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. 5 1. The benefits accruing to the public, directly and indirectly, from the active and unwearied beneficence of the profession, are so numerous and important, that physicians are justly entitled to the utmost consideration and respect from the community. The public ought likewise to entertain a just appreciation of medicel qualifica- tions;—to make a proper discrimination between true science and the assumptions of ignorance and empiricism,—to afford every encour- agement and facility for the acquisition of medical education,—and no longer to allow the statute books to exhibit the anomaly of ex- acting knowledge from physicians, under liability to heavy penalties, and of making them obnoxious to punishment for resorting to the only means of obtaining it. MEMBERS OF THE ASSOCIATION. NAMES. POST OFFICE ADDRESS. STATE. F. R. Payne, Pros., F. II. Jennings, Vice Pres., Marshall, 44 44 W. T. Beiscoe, Treas., J. D. Mitchell, Sec., R. F. WILLIAMS, 44 44 44 R. C. Pbewett, W. H. McNaby, Daniel Gard, 44 44 44 44 Martin Flennek, 44 44 N. S. Holmes, Nathan Spencer, 44 44 44 w. II. II. McCloud, 44 U J. C. Price, J. Rains, J. A. Patton, B. F. Witty, W. S. Goodell, J. M. McClary, J. W. Barlow, Ciias. Gorham, D. O. McCord, .... Westfield, Casey,...'... .... Clarksville, York, 44 44 44 44 44 44 44 44 44 S. Jumper, Y. Magahan, 44 44 44 44 J. Parcel, Jesse Comstock, ... .Westfield, 44 44 4 4 W. Tj. Goodell, 44 44 B. J. See, L. D. Pbewett, Castle Fin, 44 44 STXJX3E3NTTS. J. W. Briscoe, JA8. BLACKBURN, Robert H. Bradley, Wm. L. Martin, James B. Dolsox, J. L. Spencer, John H. Brown, -A. 1ST ADDRESS. DELIVERED TO THE CLARK COUNTY MEDICAL SOCIETY, BY THE PRESIDENT, F.. R. PAYNE, M. D., AT MARSHALL, ILLINOIS, ON TIIE 20th DAY OF FEB., 1867. PUBLISHED BY REQUEST OF THE SOCIETY. Gentlemen.— As many who are now present, were not here when this society was organized, it is probably expected that I make a few explanatory remarks. This is the first effort ever made to establish a medical so- ciety in Clark County, and we are extremely desirous that we so ar- range and perfect the organization, that it will be one of the perma- nent institutions of the county. Iu order to do this, it. will be neces- sary for each member to cultivate social and professional duties. We should all strive to subdue those vices, which injuriously affect the re- lationship of man to God, his neighbor or himself. Unprofessional and irrevolent conduct should be strictly avoided by every member, private piques and difficulties, it is hoped, will never enter our socie- ty.. It is expected that we will all avoid slander, backbiting, and ev- erything that tends to arouse the evil passions. We meet for a more noble purpose; the improvement of our minds in regard to the ascer- tained facts of our profession. When all of these scattered facts are collected together, whether they be as old as history, or as young as to-day, then will our. profession occupy a much higher position, even than it now does. Every physician ought to deeply feel the greatness of his mission, and the immense responsibility which he incurs in the discharge' of professional duties. We trust all will fully unite in the present effort to collect practical facts for the mutual benefit of the members of this society. It seems to be a, proposition fully established, that medical doctrines and theo- ries are only explanations of assumed facts, and consequently are not reliable.. In the practical departments of our profession, assumed or unascctairu d phenomena and relationship, cannot form a legiti- mate element of medical science. Our society, as we understand it, is organized for the purpose of collecting all facts and observations of each member, so that we may mutually profit by this combined ex- perience. It matters, not how well we may understand the location, seat, and pathology of disease, we are not able to deduce a remedy.. We may be familiar with the anatomical structure of every organ in the body, and physiologically understand their healthy functions; we may also be familiar with the chemical elements that may enter into the composition of every remedial agent, but still without experience, or a practical test, we cannot select a remedy that will remove the abnormal action and thus restore healthy physiological action. The science of life in all instances, and in all of its multitudinous depart- ments is entirely independent of these hypothetical explanations. It is a lamentable fact, that these theories have pervaded, and too often ruled, the practical departments of our profession, and have, in in many instances been the instruments of positive evil, when the the object was the erection of an engine of good. When we look back upon the his- tory of the profession, and witness the innumerable theories and hy- potheses which were dignified with the title of established truths, we can readily comprehend why the practical departments of medicine have not equaled the anatomical, physiological and pathological knowledge. We can now only refer to some of these theories. We find the vi- talists, chcmicalists, mechanicalists, Cullenism, Brownism, Brons- siaism, also a host of pathies, such as hydropathy and homnepathy.— This is only a few of the long heterogeneous list of medical hypothe- ses. Hippocrates now occupies a pre-eminent position in the profes- sion, yet he lived when it was in its infancy. Why was it that he se- cured so much regard among medical men? The reason is obvious.— He had no general doctrine or theory of disease, and all of his many contributions to our science, were based on experience and observa- tion. Cullen contended that the cold stage of a febrile disease was the cause of all subsequent phenomena. He assumed that the prima- ry cause was debility of the brain, caused by the action of epidemic, or any other poison. This weakened aetion resulted in functional derangement of all of the organs of the body, and more especially the action of the heart and arteries, thus causing spasm of the vessels. His tlieraputies were, of course, based upon this hypothesis, and were, by prejudice, or a love of his own peculiar dogmas, leading him into fatal practical errors. Surely the wildest dreamer in pathol- ogy, and the most superficial a priori reasoner, could rot have collect- ed a more perfect bundle of assumption and incongruities. I hav spoken of homeopathy, and freely admit, that this is one of the most successful and seductive humbugs of the nineteenth century, and in fact, of any age. The disreputable part of this theory or patliy, consists in the practical deception used by its votarb s in proclaiming to the public that they use infinitesimal doses, while at the same time, in all grave diseases, they use rational dos s of medicine. Let any man of this school locate in this, or any intelligent community, and strictly follow out their theory or doctrine; let them put twenty drops of laudanum in one pint of water, and then give ten drops of the mixture every fifteen minutes in a case of colic, how long would it require to secure, and justly merit, the scorn and contempt of the community? I have several letters in my possession from a Lading and learned homnepath, now residing in Albany X. Y., who has the honesty to state that he does not confine himself to tiie infinitesimal doses of his school. I am now ready to assert and let honest men decide, that no man, it matters not how great his learning, or how well he may be informed in regard to the principles of medicine, he will totally fail in any communiy, if he strictly adheres to the teachings and doctrines of that school of medicine. Do °s any man with a thimbleful of brains, suppose that one grain of quinine dissolved in one pint of water, and then give twenty drops every fifteen min- utes, would interrupt a congestive chill? This is the theory, but all men who practice it with success, use rational doses. They give for chills, arsenic; and all of their remedies are the most active, and in a concentrated form, consequently their doses seem small, when in real- ity, they contain equally as much as those of a regular practitioner. The theory ofhomoepathy is equally as absurd and ridiculous as that of the laxum and stridum of the methodists, or the spasms of Cullen. This theory will soon be borne to that ancient vault, where all false doctrines, pathies and isms rest. No man, or set of men, with these hypothetical crotches in their brains can be trusted, and especially when life is placed in jeopardy by their folly. A belief in any theor ry, not based on experience and observation, , disqualifies the physi- cian who holds it, and renders it impossible for him to be a faithful observer of disease. Our society was organized for the purpose of presenting the practical facts and experience of each member, that we may all profit thereby. During the last few years we "have had, in our county, a visitation of that terrible epidemic, denominat- ed Cerebro Spinal Miningitis, and it is hoped, that wc may, through this society, so compare notes, that if we are again called to treat this malady, we will be better prepared to arrive at more correct views in regard to its pathology and treatment. In presenting facts, and in truth through all the various profession- al duties we are called upon to perform, we should cherish feelings of deep responsibility; wc ought to remember that we are the arbiters of life and death,—the guardians of our race, from birth, through all the perils of infancy, youth, manhood and old age. The true physi- cian is the first and last friend of humanity,—the soother alike of the entrance and exit of life. This being true, how important it is, that we secure a truthful and reliable presentation of the combined experience of all the members of the profession. The sphere of a medical man is limited, he can attend to but few patients, consequetly, it is cruel and unprofessional for any physician to hold in secrecy, a remedy which he may have, by experience and through test, found to be pos- sessed of superior value in the cure of any disease, Had Dr. Jen- ner locked up in his own bosom, his invaluable discovery of the pro- tecting virtue of vaccine virus, he would have justly merited the scorn and contempt of all good men. So with a host of others who lrcve made valuable contributions to our science. Those men, who have by toil and perscverence, discovered important anatomical, pathological and practical truths, are justly entitled to, and will for all time to come, receive the lasting gratitude of our race. They will be held in kind remembrance as long as intelligence constitutes an element in the hu- man family. Every medical man should cultivate a spirit of sincerity and truth. The public can generally judge with tolerable accuracy the merit of members of other professions, but they are almost totally incapable of arriving at correct opinions in regard to the knowledge and ability of medical men. This enables unprincipled men, in many instances, to practice upon public credulity. They will boast of their newly discover- ed theory, by the aid of which, nearly all the ills to which flesh is’heir, may with ease and rapidity be cured. They wil boast of some secret and vaunted nostrum, and claim that it possesses matchless curative powers,—send out flaming hand-bills, filled with certificates extorted from the honest but unsuspecting public, and thus rob the community of their money and degrade the profession. As a rule we may all set it down as a fixed fact, that all journeymen or traveling doctors are imposters. Their object is not to relieve suf- fering humanity, but to fill their coffers through the instrumentality of deception and fraud. One of the grand objects of this society is to unite all of the medical men of the county, and by a combined effort arrest, if possible, the inroads of quacks and imposters. It is hoped that each member will carefully study the just, humane and noble principles embodied in the American Code of Medical Ethics, which has been adopted by the society, and published with the Con- stitution and By-Laws. In this way we can properly understand each other, and by a united effort accomplish much good. Every medical man should be strongly imbued with a sense of moral obligation. It is expected and demanded that all physicians be governed by justice, morality, and the pure principles of honor. The medical man is re- ceived into the bosom of private families, and oftentimes intrusted with matters of such a nature that if disclosed, would frequently plunge the parents, children, and relations into the most bitter and distressing agony. The physician who stands on the street corners and public places amusing the vulgar with a recital of the private diseases of his patients, degrades himself and the profession. Every man who engages in the practice of medicine, should observe in the sick room prudence, kindness, and delicacy of feeling, and never permit the privacy of the family circle to be dragged into public conversation. While these ob- ligations ought to be held sacred by every physician, he is in return justly entitled to consideration and respect from his patients, and the community. This duty on the part of patients amounts to more than the ordinary civilities of life. The entire time of the medical man is spent for the benefit of the afflicted, consequently he is entitled to pe- cuniary reward. Many entertain the idea that the charges of physi- cians are exhorbitant; but, we assert, and have no fears of successful contradiction, that there is no class of men who perform as great an amount of gratuitous labor as the physician, neither are there any who are so inadequately remunerated for their labor. In proof of this as- sertion, look for a moment at the financial condition of the families of Clark county physicians. In no instance where their time was ex- clusively devoted to the practice of medicine have they more than barely made a living, and when death closed their labors, their fami- lies are left almost destitute. The truth is patent to all, that medical men in this country, live from hand to mouth, and generally their li- abilities exceed their income. The reason of this is, that half, and oftentimes three-fourths, utterly refuse or neglect to pay their bills.— The true physician, who loves his profession and feels an interest in the welfare of his patients, has not the time to engage in speculations and other employments which would add to his income. When not engaged in the rounds of his professional calls, he ought to be collect- ing and storing away in his mind the recorded experiences and obser- vations of those who have gone before. In the sixteenth and part of the seventeenth centuries doctors made no charge, but left the amount of their fees entirely to the generosity of the patient. Dr. Radcliff, in the sixteenth century, cured Bentinek of diarrhoea and congestion of the brain. For tlxe service he was pre- sented with 500 guineas. The physicians of our day often cure such cases, for which they charge $1, and wait ten years for the pay. Dr. Radc liff cured the princess of Denmark’s son of a worm fit, when the child was three years old. For this great feat Queen Mary sent him 1000 guineas, and a diamond ring worth 1200 guineas. There is not an old practioner in this society who has not cured similar cases for two dollars. In these days when men are very sick; “God and the doctor, they alike adore.” But only when in danger; when health is restored, God is forgotten, and the doctor abused for asking compensation. It is true we have many noble exceptions to this charge of ingratitude on the part of patients. The receipt of Bulleyn’s, and a host of others, for the cure of dis- ease, for which they received enormous fees, are truly laughable.— Roasted mice, snails, rats, bats, egg shells, and bones, compounded into syrups, plasters, and pills, were proclaimed as certain cures for Colic, Rheumatism, Cancer, Piles, and in fact all diseases to which flesh is heir. For these foolish prescriptions, from ten to one thousand guineas were freely given by the patient. Some of the men of this age ought to have lived in the days of RadclifF, Phears, Sher- ry, Sloane, Garth, Littson, and a host of others. All the true physi- cians left their reward to be measured by the gratitude and justice of the patient. They prefered a system of gratuity to that of legal right. Under that system of finance we leave for the members of this society to determine how much they would realize for their labor annually.— We will briefly refer to one more point and then close these desultory remarks, which have been extended beyond the limits first intended. It is the duty of the public to justly appreciate medical qualifications and make, as far as possible, a true discrimination between true science and the sickening boasting of the ignorant empiric. Every facility possible, legal, and otherwise should be encouraged, which tends to facilitate the acquisition of medical knowledge and education. Our statute books in nearly all of the States contain provisions imperative- ly demanding a certain amount of anatomical knowledge, and fix heavy fines and even imprisonment for a failure on the part of the physician, who does not possess that information. At the same time another statute law will punish with the most severe and degrading penalties, a resort to the only means on earth by which they can gain the infor- mation thus demanded by the law. We respectfully submit these remarks to the conside. ation of the society, and take this opportunity of expressing to you all, my sincere thanks for the honor confered by electing me president. It shall be my aim and desire to discharge the duties of the office with imparti- ality. 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