ti n& B™S*^I I MEDICAL SOCIETY , I — I I COUNTY OF ERIE: TOGETHER WITH THE RELATIVE TO | LAWS OF THE STATE OF NEW YORK 1 ] I THE MEDICAL PROFESSION Axn a SYSTEM OF MEDICAL ETHICS. PUBLISHED FOR THE SOCIETY, IJ U FFALO: [• R I N T K. I) It Y J E VV E T T, THOMAS & CO. Commercial Ailverti'er Riiilrlings 1850. fk Q BY-LAWS OF THE MEDICAL SOCIETY OF THE COUNTY OF ERIE: TOGETHER WITH THE LAWS OF THE STATE OF NEW YORK RELATIVE TO THE MEDICAL PEOFESSION AND A SYSTEM OF MEDICAL ETHICS. PUBLISHED FOR THE SOCIETY. BUFFALO: PRINTED BY JEWETT, THOMAS & CO. Commercial Advertiser Buildings. 1349. BY-LAWS OF THE itteMcal Soctetg of tl)c Counts cif <&xh. The Medical Society of the County of Erie, by virtue of the statute in such cases made and provided, do hereby make, ordain, and declare the fol- lowing By-Laws, Rules and Regulations, for the better government of the members of the said Society, and for the purpose of carrying into execution the several purposes and objects of their incorporation; that is to say: ARTICLE I. Persons who may be Members.—This Society shall be known by the name of the Medical Society of the County of Erie. It shall consist of legally authorized practicing Physicians and Surgeons now residing, or who may hereafter come to reside in the county of Erie, and who have been admitted, or who shall be hereafter admitted members of said soci- ety, pursuant to the subsequent provisions of these by-laws, excepting such as shall be at any time expelled the said societ}T, pursuant to said by-laws, and the statutes of this state. ARTICLE II. Officers.—The Officers of the said Society shall be a President, Vice President, Secretary, Treasurer, Librarian, a Primary Board composed of three; and five Censors; the Censors to be severally designated and named in the ballot, as follows: examiner in anatomy, physiology and surgery, examiner in practice of medicine and obstetrics, examiner in chemistry and pharmacy, examiner in materia medica and botany, examiner in medical jurisprudence and pathology. The said Officers shall be chosen by ballot at the anniversary meeting, and shall hold their offices one year, and until others shall be chosen. And the said Society shall, once in four years, and as often as a vacancy shall occur, elect a delegate to the State Medical Society. ARTICLE III. Meetings. § 1.—The Medical Society of the County of Erie shall hold two regular meetings in each year, in the city of Buffalo. The annual meeting on the second Tuesday of January, and the semi-annual meeting 4 on the second Tuesday of June. Extra meetings may be appointed by a resolution of the Society, or called by the President, or in case of a vacancy in his office, by the Vice President, on application of five members. § 2. In case charges should be preferred against any member for mis- conduct in his profession, or of immoral conduct and habits, pursuant to the statute upon that subject, (Revised Statutes, part 1, chap, 14, Title 7). or for a violation of any of the laws regulating the practice of physic and surgery, the President, on such charges being presented to him, may call a special meeting without the application of five members, giving at least ten days previous notice in one or more of the newspapers printed in the county. § 3. Not less than five members shall constitute a quorum. ARTICLE IV. Order of Business. § 1.—As soon as the presiding officer shall have declared the meeting organized, the order of business shall be as follows: 1. Reading and correcting the minutes of the last meeting. 2. Reception of members. 3. Communications from abroad. 4. Reports of Officers and committees of this Society. 5. Appointment of committees. 6. The Oration. 7. Miscellaneous business. 8. Appointment of succeeding Orator. 9. Election of Officers. 10. Valedictory address by the President. 11. Adjournment. § 2. At all special meetings, the business for which the Society may be convened, shall be first considered. § 3. Every member, previously to his speaking, shall rise from his seat, and address himself to the President. § 4. When two or more members rise at once, the President shall name the one who is to speak. § 5. No question on a motion shall be debated or put, until the same be seconded. When a motion is seconded, it shall be stated by the Presi- dent, before debate, and every such motion shall be reduced to writing if any member desire it. § 6. If a motion is stated by the President, it shall be deemed to be in the possession of the Society, but it may be withdrawn at any time before amendment or decision. § 7. No member shall interrupt another while speaking, unless it be to call to order, or to correct a mistake. § 8. When a question is under debate, no motion shall be received unless 1. To amend. 2. To commit. 3. To lay on the table. 4. To postpone. 5. To adjourn. § 9. A motion to lay on the table shall be decided without debate. 5 § 10. A second amendment shall not be received until the previous one is disposed of, except with the consent of the mover of the first amendment. § 11. If the question in debate contains several points, any member may have the same divided in voting concerning the same. § 12. Every member shall vote upon a question put, unless excused by the Society. § 13. When a motion has been once put and decided, it shall be in order for any member who voted in the majority, to move for a re-consid- eration thereof, but no motion for re-consideration shall be received more than once, except by unanimous consent. § 14. A member called to order shall immediately sit down, unless per- mitted to explain, and the Society if appealed to from the decision of the President, shall decide on the call, but without debate. If there be no appeal, the decision of the President shall be submitted to. § 15. All motions shall be put in the order they are moved, except in filling blanks, when the longest time and largest sum shall be first put. § 16. Upon a division, the names of those who vote for or against a question or motion, shall be entered on the minutes. § 17. Whenever a report is received from any officer or officers of the Society, or from any standing or select committees, if the report be accom- panied with resolutions requiring the consideration of the Society, the question, on accepting the report, shall be considered distinct from that on the resolutions. § 18. All committees shall be appointed by the presiding officer unless specially otherwise directed by the Society, in which case they shall be appointed by ballot, and a plurality of votes shall prevail. § 19. In case of the absence of the President and Vice President, the Society shall appoint a President pro tempore. § 20. Select committees to whom references are made, shall in all cases report in writing, together with their opinions, signed by the Chairman. § 21. A committee shall be appointed at each regular meeting of the Society, whose duty it shall be to select some member who is present at the said meeting, \,o deliver an address at the next regular meeting of the Society; and such selection shall be forthwith made public, and be entered on the book of the Secretary. And if any member so selected shall fail to deliver an appropriate written address at the next regular meeting of the Society, he shall forfeit and pay to the Treasurer the sum of five dol- lars. Provided always that in case of disability to read the same, the manuscript shall be delivered in due time to the Society. ARTICLE V. Admission of Members. § 1.—Every Physician or Surgeon residing in the county of Erie, of temperate habits, good moral character, and legally authorized to practice physic or surgery in this state, who may hereafter wish to become a member of this Society, may be admitted by a vote of two-thirds of the members present at a regular meeting. § 2. It shall be the duty of every member to give all the information in his possession concerning the character and standing of every candidate proposed for membership. 6 § 3. No candidate shall be present until the question of his admission be determined by the Society. § 4. Every member when admitted, shall pay the Treasurer one dollar, sign the by-laws, and then be entitled to a certificate of membership. ARTICLE VI. Duties of Officers § 1.—President.—The President shall preside at all meetings, maintain order and decorum, decide all questions of order* subject to an appeal to the Society, and shall appoint all committees, unless otherwise directed by the Society. On all motions made and seconded, he shall state the question, and take the sense of the Society, and shall have the privilege of speaking thereon; and in case of a tie, shall be entitled to give a casting vote. The President shall, at the annual meeting, and at the end of each year after his election to office, deliver to the Society a dissertation on some appropriate subject, and in case of default in delivering the same, he shall forfeit and pay to the Society the sum of ten dollars. Provided always, that if the President shall duly cause to be presented to the Society a copy of his anniversary dissertation, he' may. if the Society deem proper, be excused from delivering the same; but he shall not be exonerated from the fine of ten dollars, for not composing and presenting such dissertation; and a copy of such dissertation so presented, shall be read by the Vice President, or President pro tempore. The President on receiving a certificate of approval from the Censors, in favor of any candidate for a diploma, shall endorse on said certificate that such diploma has been granted by him, and shall hand the same to the Secretary, to be by him filed and kept as part of the records of the Soci- ety; and for every diploma thus granted, the President shall exact the sum of five dollars from such candidate, which he shall forthwith pay to the Treasurer of the Society. The President shall give the notice in writing, required by statute, to Physicians and Surgeons residing in the county, who have not become members of the Society. In the absence of the President, the Vice President shall preside, and exercise the like powers. In the absence of the President and Vice President, the Society may appoint a President pro tempore. § -2. Secretary. —The Secretary shall record the proceedings, and have charge of all the papers of the Society. He shall read all letters and communications, shall keep the cabinet, attest all writings, notify all meet- ings by the authority of the Society or the President, and deliver to the Chairman of all committees, a list of the members composing the same, stating the object of the committee—shall note members absent and pres- ent at each meeting, and report the names of the absent, at the annual meeting, to the Treasurer. He shall likewise transmit annually to the State Medical Society, a copy of such proceedings as may be required by that body. He shall also record the name of every member, and the 7 time of his admission; and shall deliver all books and papers belonging to the Society, to bis successor in office, and do such other duties as the Society may direct. . He shall not permit any paper, book or record to be removed from the archives of the Society, but shall allow the same to be examined by every member. . . § 3. Treasurer.—The Treasurer of this Society shall receive and account for all monies that shall come into his hands by virtue of any ol the by-laws of this Society, and, also, for all monies that shall come into the hands of the President for the admission of members or licensing of students; which monies the President is hereby required forthwith to pay over to the said Treasurer, who shall account therefor, at the next annual meeting. No monies shall be drawn from the treasury, unless such sums, and for°such purposes as shall be agreed upon by a majority of the Society, at their annual meeting, and by a warrant for that purpose, signed by the President, or in case of his absence or death, by the Vice President. And it is furthermore made the duty of the Treasurer, to collect, by prosecution, or otherwise, all debts, dues and demands belonging to this Society, and which shall have been due more than three months. He shall also give security, to be approved and retained by the President, con- ditioned for the faithful management of the funds of the Society, and that he will account for and pay over, when lawfully required, all sums of money which may remain in his hands. And the Treasurer is furthermore required to deliver over to his suc- cessor in office, all monies, books and other property belonging to the Society. „ , ... § 4. Librarian.—The Librarian shall have charge of the library, appa- ratus and other property belonging to the Society; he shall make an alpha- betical catalogue of the same, designating the name of the donor of all such books or other property as may have been presented to the Society, and the value, whether received as a donation or purchased. Any member who is not indebted to the Society, and who resides within ten miles of the library, may have at any time two volumes drawn, in his own name, from the library, and retain the same one month. Any mem- ber residing over ten miles may draw and retain the same number of books three months; but all books must be returned on or before 2 o'clock of the dav of each regular meeting of the Society. The' Librarian shall also impose a fine of six and a quarter cents per week for every volume retained from the library after it is due. On the return of each book, the Librarian shall carefully examine the condition, and note any damage it may have received in the hands of the last drawer, and impose such fine as he may deem reasonable. If the book is materially injured, or lost, the Librarian shall assess the member by whom it was drawn, a sum sufficient to purchase another, or if the book belonged to a set of volumes, he shall require the drawer to pay for the whole set, at a fair and equitable price. If a member lend a book to any person not a member, or to any person not entitled to draw books from the library, be shall forfeit the value ol the volume. 8 Any member considering himself aggrieved by reason of any decision ot the Librarian, may appeal in writing, to the Society, at their next regular meeting. No book shall be drawn from the library by any member, until all fines or assessments due the Society, by said member, have been paid. The Librarian shall pay to the Treasurer all monies received by him, on account of fines. The Librarian shall, at each annual meeting of the Society, make a written report of the condition of the library and of the monies received and paid over by him, to the Treasurer, and shall faithfully deliver to his successor in office, all the books and other property belonging to the Society, which may be in his possession. § 5. Primary Board.—It shall be the duty of the Primary Board, whenever notified in writing by any member of this Society, to meet at such place as may be most convenient, and examine such person or per- sons as may apply. , If the examination is satisfactory, the applicant shall be furnished with a certificate of the fact, in the following form:— " We certify that we have faithfully examined A. B., of C-----, and that he has a good English academic education; we certify, also, that he has produced before us a certificate, (or ' certificates,' or an ' affidavit,' as the case may be. An affidavit made before a proper officer, may be received, when, for reasons which may seem satisfactory to the Board, a certificate cannot be obtained), that he has diligently studied the Latin and Greek languages during six months." (or that he is a graduate of a literary college.) " We farther certify that he has produced before us a certificate of good moral character." A ---- B ---- )■ Primary Board. C ---- ) Dated------- [Signed by at least two of the Board.] The Board shall, at each annual meeting, report to the Society the number of those who have applied, and the names of those to whom they have given certificates, and the Secretary of the Society shall make a record of the same. § 6. Censors.—The Censors, or a majority of them together assembled, shall carefully and impartially examine all students who shall present themselves for that purpose, and who are entitled to such examination, pursuant to the provisions of the statute of this state, upon that subject, and who shall moreover exhibit satisfactory evidence that they are of good moral character. For which examination the Censors shall receive no other compensation from each student than the payment of their expenses. The result of each examination, if approved by the Censors, shall be immediately reported to the President of the Society, under a penalty of one dollar for each omission. Three Censors shall constitute a quorum. For non attendance at an examination, after suitable notice has been given by the candidate, each delinquent shall pay to the Treasurer of the 9 Society a sum not less than three, nor more than five dollars, unless he can render a reasonable excuse, which shall be accepted by a vote of two- thirds of the members present at a regular meeting. Any officer of this Society neglecting or refusing to perform the duties of his office, and any committee neglecting to perform the duty assigned them., shall forfeit and pay to the Treasurer of this Society a sum not less than two, nor more than ten dollars. ARTICLE VII. § 1. Every member of this Society shall, at the annual meeting in Jan- uary, in each year, or within thirty days thereafter, pay to the Treasurer of this Society the sum of fifty cents, for the purpose of procuring a medi- cal library, apparatus, "tate of New York, shall continue to be a body politic and corporate, in fact and in name, and by that name shall be in law capable of suing and being sued, pleading and being impleaded, answering and being answered unto, defend- ing and being defended, in all courts and places, and in all matters ana causes whatsoever, and shall and may have and use a common seal, ana may change and alter the same at their pleasure; and that the paid society shall be composed of one member from each of the county societies in the state, elected by ballot at their annual meeting, who shall meet together at the time and place appointed by the said society for that purpose, and being met, not less than fifteen in number, may annually elect by ballot, a president, vice president, secretary and treasurer, who shall hold their offices for one year, and until others shall be chosen in their places. § 4. And be it further enacted, That the medical society of the state of New York, and also the medical societies of the respective counties, shall and may agree upon and determine the times and places of their meeting; and the time so agreed upon shall for ever thereafter be the anniversary day of holding their respective meetings; and it is hereby made the duty of the secretary of each of the county medical societies, to lodge in the office of the clerk of their respective counties, if not already done, a copy of all the proceedings had at their first meeting; and it shall also be the duty of the secretary of the medical society of the state of New York, in like manner, to lodge in the office of the secretary of this state, a copy of their proceedings had at their first general meeting; and the said clerks and secretary are hereby required to file the same in their respective offices, for which they shall each receive the sum of twelve and a half cents. § 5. And be it further enacted, That the members now composing the medical society of the state of New York, from each of the four great districts, shall remain divided into four classes, and one class from each of said districts shall go out of office annually. § 6. And be it further enacted, That it shall be the duty of the secretary of the medical society of the state of New York, whenever the seats of , any of the members shall become vacant, to give information of the same to the respective county societies, to the end that such county societies may supply such vacancy at their next meeting. § 7. And be it further enacted, That in case there shall be an addition to the number of members composing the medical society of the state, that in that case it shall be in the power of the said society, at any of their annual meetings, and as often as they shall judge necessary, to alter and vary the classes in such manner as that one-fourth of the members from each of the great districts, as near as may be, shall annually go out of office. § 8. And be it further enacted, That if the seat of any member of the medical society of the state of New York shall be vacated, either by death, resignation, or removal from the county, it shall be the duty of the medi- cal society of such county to fill such vacancy at their next meeting, after such vacancy shall happen. § 9. And be it further enacted, That the medical societies established as aforesaid, are hereby respectively empowered to examine all students who shall and may present themselves for that purpose, and to give diplomas 19 under the hand of the president and seal of such society, before whom such student shall be examined, which diploma shall be sufficient to empower the person so obtaining the same, to practice physic or surgery, or both, as shall be set forth in the said diploma, in any part of this state. § 10. And be it further enacted, That if any student who shall have presented himself for examination before any of the medical societies of the several counties of this state shall think himself aggrieved by the decision of such society, it shall be lawful for such student to present him- self for examination to the medical society of the state of New York; and if in the opinion of such society, the student so applying is well qualified for the practice of physic or surgery, or both, as the case may be, the president of said society shall, under his hand and the seal of such society, give to the said applicant a diploma, agreeable to such decision. § 11. And be it further enacted, That it shall and may be lawful for the several medical societies so established as aforesaid, at their annual meet- ings, to appoint not less than three nor more than five censors, to continue in office for one year, and until others are chosen, whose duty it shall be, carefully and impartially to examine all students who shall present them- selves for that purpose, and report their opinion in writing to the president of said society.1 § 13. And be it further enacted, That it shall and may be lawful for the medical societies of the respective counties of this state, and also the medi. cal society of the state of New York, to purchase and hold any estate, real and personal, for the use of said respective societies, Provided, such estate, as well real as personal, which the county societies are hereby respectively authorized to hold, shall tfot exceed the sum of one thousand dollars; and that the estate, as well real as personal, which the medical society of the state of New York is hereby authorized to hold, shall not exceed five thou- sand dollars. § 14. And be it further enacted, That it shall be lawful for the respect- ive societies to make such by-laws and regulations relative to the affairs, concerns and property of said societies, relative to the admission and expul- sion of members, relative to such donations or contributions as they or a majority of the members at their annual meeting shall think fit and proper: Provided, That such by-laws, rules and regulations made by the society of the state of New York, be not contrary to, nor inconsistent with the con- stitution and laws of this state, or of the United States; and that the by- laws, rules and regulations of the respective county societies shall not be repugnant to the by-laws, rules and regulations of the medical society of the state of New York, nor contrary to, nor inconsistent with the constitu- tion and laws of this state or of the United States. § 15. And be it further enacted, That the treasurer of each society, established as aforesaid, shall receive and be accountable for all monies that shall come into his hands by virtue of any of the by-laws of such societies, and also for all monies that shall come into the hands of the pres- ident thereof, for the admission of members, or licensing students; which monies the said president is hereby required to pay over to the said treas- urer, who shall account therefor to the society at their annual meetings; (1) Sec. 12 required licenses to practice to be given by State Medical Society; it has been abrogated by subsequent acts. 20 and no monies shall be drawn from the treasurer, unless such sums, and for such purposes as shall be agreed upon by a majority of the society at their annual meeting, and by a warrant for that purpose, signed by the president. § 16. And be it further enacted, That it shall be the duty of the secre- tary of each of the said medical societies to provide a book, in which he shall make an entry of all the resolutions and proceedings which may be had from time to time; and also the name of each and every member of said society, and the time of his admission, and also the annual reports relative to "the state of the treasury, and all such other things as a majority of the society shall think proper; to which book any member of the society may at any time have recourse; and the same, together with all books, papers and records which may be in the hands of the secretary, and be the property of the society, shall be delivered to his successor in office. § 17. And be it further enacted, That it shall be lawful for each of the said medical societies to cause to be raised and collected from each of the members of such society, a sum not exceeding three dollars, in any one year, for the purpose of procuring a medical library and apparatus, and for the encouragement of useful discoveries in chemistry, botany, and such other improvements as the majority of the society shall think proper. § 18. And be it further enacted, That any student who may receive a diploma from the medical society of this state, shall pay to the president thereof, on receiving the same, ten dollars; and for each diploma that a student may receive from the medical society of any county, he shall pay to the president thereof, on receiving the same, five dollars: Provided, That the students who have been examined previous to the twenty-sixth day of May, one thousand eight hundred and twelve, and were entitled to receive diplomas, but who have not received the same, shall not pay there- for, more than two dollars. 19. And be it further enacted, That the medical society of this state may elect by ballot, at their annual meeting, eminent and respectable physicians and surgeons residing in any part of this state, which persons so elected, shall be permanent members of the society, and entitled to all the privileges of the same: Provided, That not more than two such members shall be elected in any one year, and that they receive no compensation for their attendance, from the funds of the society.1 23. And be it further enacted, That it shall be in the power of the legislature to alter, modify or repeal this act whenever they shall deem it necessary or expedient. 24. And be it further enacted, That if there should not be a sufficient number of physicians and surgeons in any of the counties of this state to form themselves into a medical society, agreeably to this act, it shall be lawful for such physicians and surgeons to associate with the physicians and surgeons of an adjoining county for the purposes hereby contemplated. 25. And be it further enacted, That this act shall be, and hereby is declared to be a public act. —?-----------------------------—-------------------------------------— (1) Sees. 20, 21 & 22 revised and consolidated in title 7, cb. 14, part 1, vol. 1, p. 509 21 An act to amend an act, entitled "An act to incorporate medical societies, for the purpose of regulating the practice of physic and surgery in this stated Passed April 20, 1818. Chap. 206, p. 192. 3. And be it further enacted, That the state medical society shall annually elect not more than twelve nor less than six censors, any three of whom shall be a quorum for the examination of students. 5. And be it further enacted, That in those counties where the anni- versary meetings of any county medical society shall occur on the same day on which the court of common pleas shall meet, it shall be lawful for such society to alter the time of their anniversary meeting, to such day as a majority of the said society present, may think proper. 6. And be it further enacted, That each of the colleges of medicine in this state, may elect a delegate to represent their colleges, respectively, in the medical society of the state, who shall be entitled to all the privileges, and subject to the same regulations, as the delegates from the county medical societies. An act further to amend "An act to incorporate medical societies, for the purpose of regulating the practice of physic and surgery in this state." Passed April 13, 1819. Chap. 237, p. 308. 1. Be it enacted by the People of the State of New York, represented in Senate and Assembly, That it shall and may be lawful for each medical society in this state, to cause to be raised and collected from each practi- cing physician or surgeon, residing in the county or counties where such society is by law established, a sum not exceeding one dollar in any one year; which sum, when collected, shall be a part of the fund of said society, to be applied as directed by the seventeenth section of the act entitled "An act to incorporate medical societies, for the purpose of regulating the practice of physic and surgery in this state," passed April 10, 1813. An act to enable the county medical societies in this state to alter the time of holding their annual meetings. Passed April 23, 1823. Chap. 228, p. 281. 1. Be it enacted by the People of the State of New York, represented in Senate and Assembly, That it shall and may be lawful for any society, incorporated under the act entitled " An act to incorporate medical societies, for the purpose of regulating the practice of physic and surgery in this state," at any anniversary meeting of such society, to change the day of holding their annual meeting, to such other day in the year as may be more convenient: Provided, That two-thirds of the members present con- cur in voting for such change; notice of intention to move the same, having been first given at some previous regular meeting of the society. An act to amend an act, entitled " An act to incorporate medical societies, for the purpose of regulating the practice of physic and surgery in this state,"passed April lbth, 1813. Passed February 6th, 1845, by a two- third vote. Chap. 8, p. 9. 1. It shall and may be lawful for the medical society of this state, to elect annually such number of permanent members as they may, from time to time determine by their by-laws, not to exceed two annually from any one senatorial dis+-;ot. CODE 6F MEDICAL ETHICS. CHAPTER I. OF THE DUTIES OF PHYSICIANS TO THEIR PATIENTS. § 1. A physician should not only be ever ready to obey the calls of the sick, but his mind ought also to be imbued with the greatness of his mis- sion, and the responsibility he habitually incurs in its discharge. Those obligations are the more deep and enduring, because there is no tribunal other than his own conscience, to adjudge penalties for carelessness or neglect. Physicians should, therefore, minister to the sick with due impres- sions of their office, reflecting that the ease, the health, and the lives of those committed to their charge, depend on their skill, attention and fidelity. They should study, also, in their deportment, so to unite tenderness with firmness, and condescention with authority, as to inspire the minds of their patients with gratitude, respect and confidence. § 2. Every case committed to the charge of a physician should be treated with attention, steadiness and humanity. Reasonable indulgence should be granted to the mental imbecility and caprices of the sick. Secresy and delicacy, when required by peculiar circumstances, should be strictly observed, and the familiar and confidential intercourse to which physicians are admitted in their professional visits, should be used with discretbn, and with the most scrupulous regard to fidelity and honor. The obligation of secresy extends beyond the period of professional services; none of the privacies of personal and domestic life, no infirmity of dispo- sition or flaw of 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 tlis obligation are indeed so great, that professional men have, under certain circumstances, been protected in their observance of secresy, by courts of justice. § 3. Frequent visits to the sick are, in general, requisite, since they ena- ble the physician to arrive at a more perfect knowledge of the disease—to meet promptly every change which may occur, and also tend to preserve the confidence of the patient. But unnecessary visits are to be avoided, as they give useless anxiety to the patient, tend to diminish the authority of the physician, and render him liable to be suspected of interested motives. § 4. A physician should not be forward to make gloomy prognostica- tions, because they savor of empiricism, by magnifying the importance of his services in the treatment or cure of the disease. But he should not fail, on proper occasions, to give to the friends of the patient timely notice of danger, when it really occurs; and even to the patient himself, if abso- lutely necessary. This office, however, is so peculiarly alarming when exe- cuted 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 23 should be the minister of hope and comfort to the sick; that, by such cor- dials to the drooping spirit, he may smooth the bed of death, revive expir- ing 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 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; for his attendance may continue to be highly useful to the patient, and comforting to "the relatives around him, even in the last period of a fatal malady, by alleviating pain and other symptoms, and by soothing mental anguish. To decline attendance, under such circumstan- ces, would be sacrificing to fanciful delicacy and mistaken liberality, that moral duty, which is independent o", and far superior to all pecuniary con- siderations. § 6. Consultations should be promoted in difficult and protracted cases, as they give rise to confidence, energy and more enlarged views in practice. § 7. The opportunity which a physician not unfrequently enjoys of pro- moting and strengthening the good resolutions of his patients, suffering under the consequences of vicious conduct, ought never to be neglected. His counsels, or even remonstrances, will give satisfaction, not offence, if they be proffered with politeness, and evince a genuine love of virtue, accom- panied by a sincere interest in the welfare of the person to whom they are addressed. CHAPTER II. OF THE DUTIES OF PHYSICIANS TO EACH OTHER, AND TO THE PROFESSION AT LARGE. ARTICLE I. Duties for the Support of Professional Character. §. 1. Every individual, on entering the profession, as he becomes thereby entitled to all its privileges and immunities, incurs an obligation to exert his best abilities to maintain its dignity and honor, to exalt its standing, and to extend the bounds of its usefulness. He should therefore observe strictly, such laws as are instituted for the government of its members; should avoid all con- tumelious and sarcastic remarks relative to the faculty, as a body; and while, by unwearied diligence, he resorts to every .honorable _ means ef 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. ,/.!•, 8 2. There is no profession, from the members ot which greater purity of character, and a higher standard of moral excellence are required, than the medical;' and to attain such eminence is a duty every physician owes alike to his profession and to his patients. It is due to the latter, as with- out it he cannot command their respect and confidence, and to both, be- cause no scientific attainments can compensate for the want of correct moral principles. It is also incumbent upon the faculty to be temperate in 24 all things, for the practice of physic requires the unremitting exercise of a clear and vigorous understanding; and, on emergencies for which no pro- fessional 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 dignity of the profession, to resort to public advertisements, or private cards, or handbills, inviting the attention of indi- viduals affected with particular diseases—publicly offering advice and medicine to the poor gratis, or promising radical cures; or to publish cases and 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 reme- dies—to adduce certificates of skill and success, or to perform any other similar acts. These are the ordinary practices of empirics, and are highly reprehensible in a regular physician. § 4. Equally derogatory to professional character is it, for a physician to hold a patent for any surgical instrument, or medicine; or to dispense a secret nostrum, whether it be the composition or exclusive property of himself, or of others. For, if such nostrum be of real efficacy, any con- cealment regarding it is inconsistent with beneficence and professional lib- erality; and, if mystery alone give it value and importance, such craft implies either disgraceful ignorance or fraudulent avarice. It is also rep- rehensible for physicians to give certificates attesting the efficacy of patent or secret medicines, or in any way to promote the use of them. ARTICLE II. Professional Services of Physicians to each other. § 1. Ah practitioners of medicine, their wives, and their children while under the paternal care, are entitled to the gratuitous services of any one or more of jf the faculty residing near them, whose assistance may be desired. A phy- sician 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, a child, or any one who by the ties of consanguinity is rendered peculiarly dear to him, tend to obscure his judgment, and pro- duce timidity and irresolution in his practice. Under such circumstances, medical men are peculiarly dependent upon each other, and kind offices and professional aid should always be cheerfully and gratuitously afforded. Visits ought not, however, to be obtruded officiously, as such unasked civility may give rise to embarrassment, or interfere with that choice, on which confidence depends. But, if a distant member of the faculty, whose circumstances are affluent, request attendance, and an honorarium be offered, it should uot be declined; for no pecuniary obligation ought to be imposed, which the party receiving it would wish not to incur. ARTICLE III. Of the duties of physicians as respects vicarious offices. § 1.— The affairs of life, the pursuit of health, and the various accidents and contingencies to which a medical man is peculiarly exposed, sometimes require him temporarily to withdraw from his duties to his patients, and to request some of his professional brethren to officiate for him. Compliance 25 with this request is an act of courtesy, which should always be performed with the utmost consideration for the interests and character of the family physician, and when exercised for a short peiiod, all the pecuniary obliga- tions for such service should be awarded him. But if a member of the profession neglect his business in quest of pleasure and amusement, he can- not be considered as entitled to the advantages of the frequent and long- continued exercise of this fraternal courtesy, without awarding to the phys- ician 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. ARTICLE IV. Of the duties of Physicians in regard to Consultations.—§1. A regular medical education furnishes the only presumptive evidence of pro- fessional abilities and acquirements, and ought to be the only acknowledged right of an individual to the exercise and honors'of his profession. Nev- ertheless, as in consultations, the good of the patient is the sole object in view, and this 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, recognized by this association, and who is in good moral and professional standing 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 dogma, to the rejection of the accumulated experience of the profession, and of the aids actually fur- nished by anatomy, physiology, pathology, and organic chemistry. §2. In consultations no rivalship or jealousy should be indulged; can- dour, probity, .and all due respect should be exercised towards the physician having charge of the case. § 3. In consultations, the attending physician should be the first to propose the necessary questions to the sick; after which, the_consulting physician should have the opportunity to make such farther inquiries of the patient as may be necessary to satisfy him of the true character of the case^ Both physicians should then retire to a private place, for delibera- tion ; and the one first in attendance should communicate the directions ao-re'ed upon, to the patient or his friends, as well as any opinions which it may be thought proper to express. But no statement or discussion of it should take place before the patient or his friends, except in the presence of all the faculty attending, and by their common consent; and no opinions or prognostications should be delivered, which are not the result of pre- vious deliberation and concurrence. 8 4. In consultations, the physician in attendance should deliver his opinion first; and when there are several consulting, they should deliver their opinions in the order in which they have been called in. No deci- sion, however, should restrain the attending physician from making such variations in the mode of treatment, as any subsequent, unexpected change 26 in the character of the case may demand. But such variation, and the reasons for it ought to be carefully detailed at the next meeting in consul- tation. The same privilege belongs also to the consulting physician if he is sent for in an emergency, when the regular attendant is out of the way, and similar explanations must be made by him, at the next consultation. § 5. The utmost punctuality should be observed in the visits of physi- cians 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 occupation. But as professional engagements may sometimes interfere and delay one of the parties, the physician who first arrives should wait for his associate a rea- sonable period, after which the consultation should be considered as post- poned to a new appointment. If it be the attending physician who is present, he will of course see the patient and prescribe; but if it be the consulting one, he should retire, except in case of emergency, or when he has been called from a considerable distance, in which latter case he may examine the patient, and give his opinion in writing, and under seal, to be delivered to his associate. § 6. In consultations, theoretical discussions should be avoided, as occa- sioning perplexity and loss of time. For there may be much diversity of opinion concerning speculative points, with perfect agreement in those modes of practice which are founded, not on hypothesis, but on experience and observation. § 7. All discussions in consultation should be held as secret and confi- dential. Neither by words nor manner should any of the parties to a consultation assert or insinuate, that any part of the treatment pursued did not receive his assent. The responsibility must be equally divided between the medical attendants,—they must equally share the credit of £ success as well as the blame of failure. § 8. Should an irreconcilable diversity of opinion occur when several physicians are called upon to consult together, the opinion of the majority should be considered as decisive; but if the numbers be equal on each side, then the decision should rest with the attending physician. It may, moreover, happen, that two physicians cannot agree in their views of the nature of a case, and the treatment to be pursued. This is a circumstance much to be deplored, and should always be avoided, if possible, by mutual concessions, as far as they can be justified by a conscientious regard for the dictates of judgment. But in the event of its occurrence, a third physician should, if practicable, be called to act as umpire, and if circum- stances prevent the adoption of this course, it must be left to the patient to select the physician in whom he is most willing to confide. But as every physician relies upon the rectitude of his judgment, he should, when left in the minority, 'politely and consistently retire from any further delibera- tion in the consultation, or participation in the management of the case. § 9. As circumstances sometimes occur to render a special consultation desirable, when the continued attendance of two physicians might be objectionable .to the patient, the member of the faculty whose assistance is required in such cases, should sedulously guard against all future unsolici- ted attendance. As such consultations require an extraordinary portion 27 both of time and attention, at least a double honorarium may be reasona- bly expected. § 10. A physician who is called upon to consult, should observe the most honorable and scrupulous regard for the character and standing of the practitioner in attendance; the practice of the latter, if necessary, should be justified, as far as it can be, consistently with a conscientions regard for truth, and no hint or insinuation should be thrown out, which could impair the confidence reposed in him, or affect his reputation. The consulting physician should also carefully refrain from any of those extra- ordinary attentions or assiduities, which are too often practiced by the dishonest for the base purpose of gaining applause, or ingratiating them- selves into the favor of families and individuals. ARTICLE V. 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 or artifice. § 2. A physician, in his intercourse with a patient under the care of another practitioner, should observe the strictest caution and reserve. No meddling 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 diminish 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 prompted to visit an j, individual who is under the direction of another practitioner. Indeed, such visits should be avoided, except under peculiar circumstances, and when they are made, no particular inquiries should be instituted relative to the nature of the disease, or the remedies employed, but the topics of conversation should be as foreign to the case as circumstances will admit. § 4. A physician ought not to take charge of, or prescribe for a patient who has recently been under the care of another member of the faculty, in the same illness, except in cases of sudden emergency, or in consultation with the physician previously in attendance, or when the latter has relin- quished the case, or been regularly notified that his services are no longer desired. Under such circumstances, no unjust and illiberal insinuations should be thrown out in relation to the conduct or practice previously pur- sued, which should be justified as far as candor, and regard for truth and probity will permit, for it often happens that patients become dissatisfied when they do not experience immediate relief, and, as many diseases are naturally protracted, the want of succe s, in the first stage of treatment, affords no evidence of a lack of professional knowledge and skill. 8 5. When a physician is called to an urgent case, because the family attendant is not at hand, he ought, unless his assistance in consultation be desired, to resign the care of the patient to the latter immediately on his arrival. 28 § 6. It often happens, in cases of sudden illness, or of recent accidents and injuries, owing to the alarm and anxiety of friends, that a number of physicians are simultaneously sent for. Under these circumstances, cour- tesy 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, and, 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 practitioner, in consequence of the sickness or absence of the latter, he ought, on the return or recovery of the regular attendant, and with the consent of the patient, to surrender the case. § 8. A physician, when visiting a sick person in the country, may be desired to see a neighboring patient who is under the regular direction of another physician, in consequence of some sudden change or aggravation of symptoms. The conduct to be pursued on such an occasion, is to give advice adapted to present circumstances; to interfere no farther than is absolutely necessary with the general plan of treatment; to assume no future direction, unless it be expressly desired; and, in this last, to request an immediate consultation with the practitioner previously employed. § 9. A wealthy physician should not give advice gratis to the affluent; because his doing so is an injury to his professional brethren. The office of a physician can never be supported as an exclusively beneficent 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 who has been engaged to attend a case of mid- wifery, is absent, and another is sent for, if delivery is accomplished during the attendance of the latter, he is entitled to the fee, but should resign the patient to the practitioner first engaged. ARTICLE VI. Of differences between Physicians. § 1.—Diversity of opinion, and opposition of interest, may, in the medical, as in other professions, some- times occasion controversy, and even contention. Whenever such cases unfortunately occur, and cannot be immediately terminated, they should be referred to the arbitration of a sufficient number of physicians, or a court- medical. As peculiar reserve must be maintained by physicians towards the pub- lic, in regard to professional matters, and as there exist numerous 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 or appreciated by general society, neither the subject matter of such differences, nor the adjudication of the arbitrators should be made public, as publicity in a case of this nature may be personally injurious to the individuals concerned, and can hardly fail to bring discredit on the faculty*. 29 ARTICLE VII. Uf pecuniary Acknowledgments. § 1.—Some general rules should be adopted by the faculty, in every town or district, relative to pecuniary acknowledgments from their patients; and it should be deemed a point of honor to adhere to these rules with as much uniformity as varying circum- stances will admit. CHAPTER III. OF THE DUTIES OF THE PROFESSION TO THE PUBLIC. ARTICLE I. Duties of the Profession to the public. § 1.—As good citizens, it is the duty of physicians to be ever vigilant for the welfare of the community, and to bear their part in sustaining its institutions and burdens: they should also be ever ready to give counsel to the public in relation to mat- ters especially appertaining to their profession, as on subjects of medical police, public hygiene and legal medicine. It is their province to enlighten the public in regard to quarantine regulations,—the location, arrangement, and dietaries of hospitals, asylums, schools, prisons, and similar institutions, —in relation to the medical police of towns, as drainage, ventilation, &c,— and in regard to measures for the prevention of epidemic and contagious diseases, and when pestilence prevails, it is their duty to face the danger, and to continue their labors for the alleviation of the suffering, even at the jeopardy of their own lives. § 2. Medical men should also be always ready, when called on by the legally constituted authorities, to enlighten coroner's inquests and courts of justice, on subjects strictly medical,—such as involve questions relating to sanity, legitimacy, murder by poisons or other violent means, and in legard to the various other subjects embraced in the science of medical jurispru- dence. 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 public should award them a proper honorarium. § 3. There is no profession, by the members of which, eleemosynary services are more liberally dispensed, than the medical, but justice requires that some limits should be placed to the performance of such good offices. Poverty, professional brotherhood, and certain public duties referred to in section 1 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 persous wishing to insure their lives, obtain pensions, or the like, without a pecuniary acknowledg- 30 ment. But to individuals in indigent circumstances, such professional ser- vices 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 aud even des- truction of life caused by the use of quack medicines, to enlighten the pub- lic on these subjects, to expose the injuries sustained by the unwary from the devices and pretensions of artful empirics and impostors. Physicians ought to use all the influence which they may possess, as professors in Colleges of Pharmacy, and 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 and sale.