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llUo

BY- LAW 5, :•

Extracts from the Medical Act,

gode of jladieal Sthieg

AND

TARIFF OF FEES

¥he J^eu3 BFunlmicli

MEDICAL SOCIETY.

SAINT JOHN, N. B.

J. & A. McMillan.

1891.

1 1

BY-I^AW^S.

Article I. — Meetings.

Section i. — The Regular Annual Meeting of
the New Brunswick Medical Society shall be
held on the third Tuesday of July, at lo a. m.
The place of meeting to be determined at the
previous annual meeting.

Section 2. — Special Meetings shall be called
by the President at his discretion, or upon the
written request of five members. Ten members
shall constitute a quorum at all meetings.

Section 3. — Due notice of such special meet-
ing shall be sent to each member. The business
to be transacted at such meeting shall be stated
in the notice, and no other business shall be
entertained at such meeting.

Article II. — Membership.

All persons who are duly registered under the
New Brunswick Medical Act of 1881 shall be
members of the New Brunswick Medical Society-.

(3) ■■

Article III. — Officers.

Section i. — The officers of the Society shall
be a President, a First and Second Vice-Presi-
dent, Secretary, Corresponding Secretary, Trea-
surer, and three Trustees.

Section 2. — The officers shall be elected at
the regular annual meeting, and shall hold office
for one year, or during the pleasure of the
Society. The officers respectively shall be cho-
sen by nomination and written ballot on receiv-
ing a majority of all the votes cast. In case of
a third ballot, the candidate having the fewest
votes shall not be in nomination, and on each
succeeding ballot the lowest candidate shaii be
dropped until an election is had.

Article IV. — Duties of Officers.

Section i. — The President shall preside at all
meetings. He shall decide all questions accord-
ing to parliamentary usage, and discharge such
other duties as devolve on a presiding officer.

Section 2. — In the absence of the President,

the First Vice-President shall preside and dis-
charge his duties. If both President and First
Vice-President be absent, the Second Vice-Pre-
sident shall preside. If neither of these officers
be present, the meeting shall elect a chairman to

preside.

Section 3. — The Secretary shall attend all
meetings of the Society, and keep a correct
record of the proceedings thereof. On the order
of the President, he shall issue notices for every

meeting.

Section 4. — The Corresponding Secretary
shall conduct the foreign correspondence of the
Society, and perform such other duties as per-
tain to his office.

Section 5. — The Treasurer shall have charge
of the funds of the Society, and render a finan-
cial statement at the Annual Meeting.

Section 6. — The Trustees shall have the con-
trol of all properties of the Society, and shall
submit a report of the same at each Annual
Meeting.

Section 7. — The Officers shall enter upon
their duties at the close of the meeting at which
they are elected.

Article V. — Funds of the Society.

Section :. — Each member shall pay One
Dollar ($1) annually to the Treasurer to defray
the expenses of the Society.

Section 2. — No member shall be allowed to
vote at any meeting unless his Annual Fee be
paid.

Article V. — Order of Business.

1. Reading of Minutes of previous Meeting or

Meetings.

2. President's Address.

3. Correspondence, Bills, etc.

4. Receiving Reports.

5. Election of Officers.

6. Reading of Papers and Relation of Cases.

7. Deciding place of Annual Meeting.

8. New Business.

ExtFa?t| ivom the Jlfledii^al ^(^\.

Hereinafter no person shall begin or enter
upon the study of Physic, Surgery, or Midwif-
ery, for the purpose of qualifying himself to
practice the same in this Province, unless he
shall have obtained from the Council of Physi-
cians and Surgeons a certificate that he has
satisfactorily passed a matriculation or rrelimi-
nary examination in the subjects specified in
Schedule B to this Act, or unless he has p^.ssed a
matriculation examination for an Undergraduate
Course in Arts and Science at some College in
Great Britain, Ireland, Canada, the United States
of America, or the Continent of Europe.

SCHEDULE B.

Uniform Stand of Matrictdaiion or Prelimi?iary

Examination established under this Act.

Compulsory —

English or French Langtmge, including Gram-
mar and Composition, and Writing from
Dictation. (7)

Arithnieiic, including Vulgar and Decimal
Fractions, and Extraction of the Square
Root.
Algebra, to the end of Simple Equations.
Geometry, first two Books of Euclid.
Latin, one Book, Translation, and Grammar.

Optional —

One of t/iQ following : History of England,
with questions in Modern Geography ;
French Translation ; German Translation ;
One Greek Book ; Natural Philosophy,
including Elementary Mechanics ; Hy-
drostatics and Pneumatics ; History of
New Brunswick; History of Dominion.

No candidate shall be admitted to such matri-
culation or preliminary examination unless he
shall have, at least fourteen days previous to
such examination, given notice to the Registrar
of the Council of his intention to present himself
for such examination, and transmitted to the
Registrar a certificate shewing that he has com-

!♦

pleted his sixteenth year, and shall before the
examination have paid a fee of five dollars to
the Registrar.

No person shall be entitled to have his name
entered on the Register of the Council, or to
receive a license to practice from such Council,
unless he shall satisfy the Council that he has
passed the matriculation or preliminary exami-
nation; that after passing such examination he
has followed his studies during a period of not
less than four years (one of which may be under
the direction of one or more general practitioners
duly licensed) ; that during such four years he
has attended at some University, College, or
Incorporated School of Medicine in good stand-
ing, courses of lectures amounting together to
not less than twelve months on General Anato-
my, on Practical Anatomy, on Surgery, on the
Practice of Medicine, on Midwifery, on Chemis-
try, on Materia Medica and Pharmacy, and on
the Institutes of Medicine or Physiology, and
one three months' course of Medical Jurispru-

dence ; that he has attended the general practice
of an Hospital in which there are contained not
les.s tnan fifty beds, under the charge of not less
than two Physicians,, or Surgeons, for a period
of not less than one year, oi two periods of not
less than six' months each ; that he has also
attended two three months' courses or one six
months' course of Clinical Medicine, and the
same of Clinical Surgery ; that he has, after ex-
amination in the subjects of the course, obtained
a degree or diploma from such University, Col-
lege, or Incorporated Medical School, if such
University, College, or Incorporated Medical
School, requires a four years' course in order to
the obtaining its diploma, or for want of such
degree or diploma that he has satisfactorily
passed an examination in the various branches
hereinbefore specified before examiners to be
appointed by the Council ; that he is not less
than twenty-one years of age ; that he has paid
to the Registrar of the Council a fee of ten
dollars; provided that the Council shall have

power, subject to the approval of the Gcvernor
in Council, to make such alterations in the fore-
going curriculum as may from time to time he
required ; provided also, that in the event of any
person applying for registration as a Practitioner
of any system of Medicine the registered Prac-
titioners of that system shall have the right to
appoint an examiner or examiners on the subjects
peculiar to that system, viz. : Materia Medica,
Pharmacy and Therapeutics, and if they shall
neglect so to do the Council shall have the power
to appoint such examiner or examiners.

The last preceding section shall not apply to
an/person in actual practice w^ho shall be entitled
to register under Section 38, and to receive a
license to practice under this Act on payment of
two dollars ; and notwithstanding the provisions
of such section, any person upon producing to
the Council conclusive evidence that he has
passed a matriculation or preliminary examina-
nation, such as is required by this Act for per-
sons beginning the medical studies in New

Brunswick, tliat he has, before graduating or
taking a diploma, studied for at least four years
in the manner provided in Section 12 of this Act,
or pursued what the Council shall deem an
equivalent course of study, and has passed a
final examination in the subjects of such course ;
or for want of such requisites, ^hall have fulfilled
such conditions as the Council may determine,
and shall pay a fee of ten dollars, shall be en-
titled to be registered and to receive a license to
practice.

No person shall be entitled to recover any
charge in any Court of Law for any Medical or
Surgical advice, or for attendance, or for* the
performance of any operation, or for any medi-
cine which he shall have both prescribed and
supplied, unless he shall prove upon the trial
that he is registered under this Act.

If any registered Medical Practitioner omit to
pay the annual fee required to be paid by the
Council under the fifth section of chapter thirty
of forty-fifth Victoria, before the Registrar

„

shall cause the Register of the names to be
printed or published in the Royal Gazette, as
provided in section eight of " The New Bruns-
wick Medical Act, 1881," the Registrar shall not
cause the name of such Practitioner to be printed
and published as aforesaid, and such Practitioner
shall thereupon cease to be denied a Registered
Practitioner ; but such Practitioner shall at any
time thereafter, upon paying such fee, be entlded
to all his rights and privileges as a Registered
Practitioner from the time of such payment.

Code of Medical Ethics.

OF THE DUTIES OF PHYSICIANS TO THEIR
PATIENTS, AND OF THE OBLIGATIONS
OF PATIENTS TO THEIR PHYSICIANS.

Art, \,— .Duties of Physicians to their Patients.

I. A physician should not only be ever
ready to obey the calls of the sick, but his mind
ought also to be imbued with the greatness of
his mission, and the responsibility he habitually
incurs in its discharge. Those obligations are
the more deep and enduring, because there is
no tribunal, other than his own conscience, to
adjudge penalties for carelessness or neglect.
Physicians should, therefore, minister tc the

;i5)

sick with due impressions of the importance of
their office ; reflecting that the ease, the health,
and the Hves 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 firmyiess^ and conde-
scension with authority y 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 indul-
gence should be granted to the mental imbe-
cility and caprices of the sick. Secrecy and
delicacy, when required by peculiar circum-
stances, should be strictly observed; and the
familiar and confidential intercourse to which
physicians are admitted in their professional
visits, should be used with discretion, and with
the most scrupulous regard to fidelity and
honor. The obligation of secrecy extends be-
yond the period of professional services ; none

of the privacies of personal and domestic life,
no infirmity of disposition or flaw of character
observed during professional attendance, should
ever be divulged by the physician, except when
he is imperatively required to do so. The force
and necessity of this obligation are indeed so
great, that professional men have, under certain
circumstances, been protected in their observance
of secrecy by courts of justice.

3. Frequent visits to the sick are in general
requisite, since they enable the physician to
arrive at a more perfect knowledge of the disease
— to meet promptly every change which may
occur, and also tend to preserve the confidence
of the patient. But unnecessary visits are to
be avoided, as they give useless anxiety to the
patient, tend to diminish the authority of the
physician, and render him liable to be suspected
of interested motives.

4. A physician should not be forward to
make gloomy prognostications, because they
savor of empiricism, by magnifying the impor-

tance of his services in the treatment or cure of
the disease. But he should not fail, on proper
occasions, to give to the friends of the patient
timely notice of danger when it really occurs ;
and even to the patient himself, if absolutely
, necessary. This office, however, is so peculiarly
alarming when executed by him, that it ought to
be declined whenever it can be assigned to any
other person of sufficient judgment and delicacy.
For the physician should be the minister of hope
and comfort to the sick ; that, by such cordials
to the drooping spirit, he may smooth the bed
of death, revive expiring life, and counteract the
depressing influence of those maladies which
often disturb the tranquility of the most resigned
in their last moments. The life of a sick person
can be shortened not only by the acts, but also
by the words 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 pati-
ent 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 symp-
toms, and by soothing mental anguish. To
decline attendance, under such circumstances,
would be sacrificing to fanciful delicacy and
mistaken liberality, that moral duty which is
independent of and far superior to all pecuniary
consideration.

6. Consultations should be promoted in difti-
cult or 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 promoting and strength-
ening 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 satis-

faction, not offence, if they be proffered with
politeness, and evince a genuine love of virtue,
accompanied by a sincere interest in the welfare
of the person to whom they are addressed.

Art. II. — Obligations of Patients to their

Physicians.

1. The members of the medical profession,
upon whom is enjoined the performance of so
many important and arduous duties toward the
community, and who are required to make so
many sacrifices of comfort, ease, and health, for
thf^ welfare of those who avail themselves of
their services, certainly have a right to expect
and require, that their patients should entertain
a just sense of the duties which they owe to
their medical attendants.

2. The first duty of a patient is, to select as
his medical adviser one who has received a re-
gular 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 regular, and who is not devoted
to company, pleasure, or to any pursuit incom-
patible with his professional obligations. A
patient should also confide the care of himself
and family, as much as possible, to one physi-
cian ; 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 in his treatment
than one who does not possess that knowledge.

A patient who has thus selected his physi-
cian, should always apply for advice in what
may appear to him trivial cases; for the most
fatal results often supervene on the slightest
accidents. It is of still more importance that he
should apply for assistance in the forming stage
of violent diseases ; it is to a neglect of this pre-

cept that medicine owes much of the uncertainty
and imperfection with which it has been re-
proached.

4. Patients should faithfully and unreservedly
communicate to their physician the supposed
cause of their disease. This is the more impor-
tant, as many diseases of a mental origin
simulate those depending on external causes,
and yet are only to be cured by ministering to
the mind diseased. A patient should never be
afraid of thus making his physician his friend
and adviser ; he should always bear in mind
that a medical man is under the strongest obli-
gations of secrecy. Even the female sex should
never allow feelings of shame or delicacy to
prevent their disclosing the seat, symptoms, and
causes of complaints peculiar to them. How-
ever commendable a modest reserve may be in
the common occurrences of life, its strict obser-
vance 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 physi-
cian with a tedious detail of events or matters
not appertaining to his disease. Even as relates
to his actual symptoms, he will convey much
more real information by giving clear answers
to interrogatories, then by the most minute
account of his own framing. Neither should ne
obtrude upon his physician the details of his
business, nor the history of his family concerns.

6. The obedience of a patient to the pre-
scriptions of his physician should be prompt
and implicit. He should never permit his own
crude opinions, as to their fitness, to influence
his attention to them. A failure in one par-
ticular may render an otherwise judicious treat-
ment dangerous, and even fatal. This remark
is equally applicable to diet, drink, and exercise.
As patients become convalescent, they are very
apt to suppose that the rules prescribed for them
may be disregarded ; and the consequence, but

too often, is a relapse. Patients should never
allow themselves to be persuaded to take any
medicine whatever that may be recommended to
them by the self-constituted doctors and doc-
tresses who are so frequently met with, and who
pretend to possess infallible remedies for ^he
cure of every disease. However simple some of
their prescriptions may appear to be, it often
liappens that they are productive of much mis-
chief, 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 aij observation may be made, without
any intention of inteiference, 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 con-
sulting physician without the express consent oi

2.3

his own medical attendant. It is of great impor-
tance that physicians should act in concert ; for,
although their modes of treatment may be
attended with equal success when employed
singly, yet conjointly they are very likely to be
productive of disastrous results.

8. When a patient wishes to dismiss his
physician, 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 inter-
ference of engagements. Patients should also
avoid calling on their medical adviser unneces-
sarily during the hours devoted to meals or
sleep. They should always be in readiness to
receive the visits of their physician, as the
detention of a few minutes is often of serious
inconvenience to him.

snsHi

lo. A patient should, after his recovery,
entertain a just and enduring sense of the
value of the services rendered him by his phy-
sician ; for these are of such a character, that
no mere pecuniary acknowledgment can repay
or cancel them.

OP^ THE DUTIES OF PHYSICIANS TO EACH
OTHER, AND TO THE PROFESSION AT
LARGE.

Art. I. — Dii for the support of Pro-
fessional Character,

I. Every individual, on entering the pro-
fession — as he becomes thereby entitled to all
its privileges and immunities — incurs an obli-
gation to exert his best abilities to maintain
its dignity and honor, to exalt its standings
and to extend the bounds of its usefulness.
He should, therefore, observe strictly, such
as are instituted for the government of its
members: — should avoid all contumelious and
and sarcastic remarks relative to the faculty,,
as a body ; and while, by unwearied diligence^
he resorts to every honorable means of enrich-
ing 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 every physician owes alike
to his profession and to his patients. It is due
to the latter, as without it he cannot command
their respect and confidence; and to both,
because no scientific attainments can compen-
sate for the want of correct moral principles.
It is also incumbent upon the faculty to be
temperate in all things, for the practice of
physic requires the unremitting exercise of a
clear and vigorous understanding; 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 dignity of the
profession to resort to public advertisements,
or private cards, or handbills, inviting the atten;
tion of individuals affected with particular dis-
eases — 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 cer-
tificates of skill and success, or to perform any
other similar acts. These are the ordinary
practices of empirics, and are highly reprehen-
sible in a regular physician.

4. Equally derogatory to professional char-
acter is it for a physician to hold a patent for
any surgical instrument or medicine, or to dis-
pense a secret nostrum^ whether it be the com-
position or exclusive property of himself or
of others. For, if such nostrum be of real
efficacy, any concealment regarding it is incon-
sistent with beneficence and professional liber-

,11

ality ; and if mystery alone give it value and
importance, such craft implies either disgraceful
ignorance or fi alent avarice. It is also
reprehensible for physicians to give certificates
attesting the efficacy of patent or secret medi-
cines, or in any way to promote the use of
them. 4»

Art. II. — Professiofial Services of Physicians

to each other.

* 1

I. All 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 the faculty residing near
them, whose assistance may be desired. A
physician afflicted with disease is usually an
incompetent judge of his own case; and the
natural anxiety and solicitude which he experi-
ences at the sickness of a wife, a child, or any
one who by the ties of consanguinity is ren-
dered peculiarly dear to him, tend to obscure

»vM.»;3rj

his judgment, and produce timidity and irreso-
lution in his practice. Under such circum-
stances medical men are peculiarly dependent
upon each other, and kind offices and profes-
sional aid should always be cheerfully and gra-
tuitously afforded. Visits ought not, however,
to be obtruded officiously; as such unasked
civility may give rise to embarrassment, or
interfere with that choice on which confidence
depends. But if a distant member of the
faculty, whose circumstances are affluent, re-
quest attendance, and an honorarium be offered,
it should not be declined; for no pecuniary
obligation ought to be imposed, which the
party receiving it would wish not to incur.

Art. hi. — Of the dtities of Physiciafis as
respects vicarious offices.

I. 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 with this request is an
act of courtesy which should always be per-
formed with the utmost consideration for the
interest and character of the family physician,
and when exercised for a short period, all the
pecuniary obligations for such service should
be awarded to him. But if a member of the
profession neglect his business in quest of pleas-
ure and amusement, he cannot be considered
as entitled to the advantages of the frequent
and long-continued exercise of this fraternal
courtesy, without awarding to the physician
who officiates the fees arising from the dis-
charge 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
therefrom should be awarded to the physician
who officiates.

Art. IV. — Of the duties of Physicimis in
regard to co7is2iltatio7is.

I. A regular medical education furnishes

the only presumptive evidence of professional

abilities and requirements, and ought to be the

only acknowledged right of an individual to

* the exercise and honors of his profession.

Nevertheless, as in consultations the good of

the patient is the sole object in view, and this

is often dependent on personal confidence, no

intelligent regular practitioner, who has a license

to practise from some medical board of known

and acknowledged respectability, recognized by

the Maritime Medical 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 ; candor, probity, and all
due respect should be exercised toward 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 con-
sulting physician should have the opportunity
to make such further inquiries of the patient
as may be necessary to satisfy him of the true
character of the case. Both physicians should
then retire to a private place for deliberation ;
and the one first in attendance should com-
municate the directions agreed upon to the
patient or his friends, as well as any opinions
which it may be thought proper to express.
But no statement or discussion of it should take
place before the patient or his friends, except

in the presence of all the faculty attending, and
by their common consent; and no opiyiions or
prognostications should be delivered, which are
not the result of previous deliberation and
concurrence.

4. In consultations, the physician in attend-
ance should deliver his opinion first ; and when
there are several consulting, they should deliver
their opinions in the order in which they have
been called in. No decision, however, should
restrain the attending physician from making
such variations in the mode of treatment, as
any subsequent unexpected change in the char-
acter of the case may demand. But such vari-
ations, and the reasons for it, ought to be
carefully detailed at the next meeting in con-
sultation. 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 ob-

served in the visits of physicians when they
are to hold consultation together, and this is
generally practicable, for society has been con-
siderate enough to allow the plea of a profes-
sional engagement to take precedence of all
others, and to be an ample reason for the relin-
quishment of any present occupation. But as
professional engagements may sometimes inter-
fere and delay one of the parties, the physician
who first arrives should wait for his associate a
reasonable period, after which the consultation
should be considered as postponed to a new
appointment. If it be the attending physician
who is present, he will, of course, see the
patient and prescribe ; but if it be the consult-
ing 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 writiiig and under seal to be delivered to
his associate.

6. In consultations, theoretical discussions

should be avoided, as occasioning perplexity
and loss of time. For there may be much
diversity of opinion concerning speculative
points, with perfect agreement in those modes
of practice which are founded, not on hypothe-
sis, but on experience and observation.

7. All discussions in consultation should be
held as secret and confidential. Neither by
words nor 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 ^tendants — they
must equally share the credit of success as well
as the blame of failure.

8. Should an irreconcilable diversity of opin-
ion 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 physi-
cian. It may, moreover, sometimes happen

I! I

that two physicians cannot agree in their views
of the nature of a case, and the treatment to
be pursued. This is a circumstance much to
be deplored, and should always be avoided, if
possible, by mutual concessions, as far as they
can be justified by a conscientious regard for
the dictates of judgment. But in the event of
its occurrence, a third physician should, if
practicable, be called to act as umpire ; and, if
circumstances 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 deliberation in the con-
sultation, or participation in the management
of the case.

9. As circumstances sometimes occur to
render a special co7isultation desirable, when
the continued attendance of two physicians
might be objectionable to the patient, the mem-

ber of the faculty whose assistance is required
ill such cases, should sedulously guard against
all future unsolicited attendance. As such con-
sultations require an extraordinary portion both
of time and attention, at least a double honor-
arium may be reasonably expected.

lo. A physician who is called upon to con-
sult, should observe the most honorable and
scrupulous regard for the character and stand-
ing of the practitioner in attendance ; the prac-
tice of the latter, if necessary, should be justified
as far as it can be consistently with a conscien-
tious regard for truth, and no hint or insinuation
should be thrown out which could impair the
confidence reposed in him, or affect his reputa-
tion. The consulting physician should also
carefully refrain from any of those extraor-
dinary attentions or assiduities, which are too
often practised by the dishonest for the base
purpose of gaining applause, or ingratiating
themselves into the favor of families and in-
dividual.

Art. V. — Duties of Physicians in cases of

interference.

1. Medicine is a liberal profession, and those
admitted into its ranks should found their ex-
pectations 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
disingenuous hints given relative to the nature
and treatment of his disorder ; nor any course
of conduct pursued that may directly or in-
directly tend to diminish the trust reposed in
the 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 individual who is under the direction
of another practitioner. Indeed, such visits
should be avoided, except under peculiar cir-

cumstances ; and when they are made, no par-
ticular inquiries should be instituted relative to
the nature of the disease, or the remedies em-
ployed, 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 regu-
larly notified that his services are no longer
desired. Under such circumstances, no unjust
and illiberal insinuations should be thrown out^
in relation to the conduct or practice previously
pursued, which should be justified as far as
candor and regard for truth and probity will
permit; for it often happens that patients be-
come dissatisfied when they do not experience
immediate relief, and, as many diseases are

naturally protracted, the want of success, in the
first stage of treatment, affords no evidence of
a lack of professional knowledge and skill.

5. When a physician is called to an urgent
case, because the family attendant is not at
hand, he ought, unless his assistance in con-
sultation be desired, to resign the care of the
patient to the latter immediately on his arrival.

6. It often happens, in cases of sudden ill-
ness or of recent accidents and injuries, owing
to the alarm and anxiety of friends, that a
number of physicians, are simultaneously sent
for. Under these circumstances courtesy should
assign the patient to the first who 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.

I'M
1^

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.

[The expression, '* Patient of another Prac-
titioner," is understood to mean a patient who
may have been under the charge of another
practitioner at the time of the attack of sickness,^
or departure from home of the latter, or who
may have called for his attendance during his
absence or sickness, or in any manner given it
to be understood that he regarded the said
physician as his regular medical attendant.]

8. A physician, when visiting a sick person
in the country, may be desired to see a neigh-
boring 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 circum-

stances ; to interfere no further than is absolutely
necessary with the general plan of treatment ;
to assume no future direction, unless it be ex-
pressly desired ; and, in this last case, 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 defraud-
ing, 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 attenfl a case of midwifery 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.

Art. VI. — Of Differences between Physicians,

1. Diversity of opinion and opposition of
interest, may, in the medical as in other pro-
fessions, sometimes occasion controversy, and
even contention. Whenever such cases unfor-
tunately occur, and cannot be immediately ter-
minated, they should be referred to the arbitra-
tion of a sufficient number of physicians, or a
couri-medicaL

2. As peculiar reserve must be maintained by
physicians toward the public, in regard to pro-
fessional matters, and as there exist numerous
points in medical ethics and etiquette through
which the feelings of medical men may be pain-
fully 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 arbi-
trators should be made public, as publicity in a
case of this nature may be personally injurious
to the individuals concerned, and can hardly fail
to bring discredit on the faculty.

Art. \\\.-~ Of Pecuniary Ackjiowledgments,

Some general rules should be adopted by
the faculty, in every town or district, relative to
pectmiary acknoivledg^nents from their patients ;
and it should be deemed a point of honor to
adhere to these rules with as much uniformity
as varying circumstances will admit.

OF THE DUTIES OF THE PROFESSION TO
THE PUBLIC AND OF THE OBLIGATIONS
OF THE PUBLIC TO THE PROFESSION.

Art. L — Duties of the Profession to the Public.

I. As good citizens, it is the duty of physi-
cians 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 rela-
tion to matters especially appertaining to their
profession, as on subjects of medical police,
public hygiene, and legal medicine. It is their
province to enlighten the public in regard to
quarantine regulations — the location, arrange-
ment, and dietaries of hospitals, asylums, schools,
prisons, and similar institutions — in relation to
the medical police of towns, as drainage, venti-
lation, etc. — and in regard to measures for the

I > i

I i

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 autho-
rities, to enlighten coroners' 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 regard to the various other subjects embraced
in the science of Medical Jurisprudence. But in
these cases, and especially where they are re-
quired to make a post-7norteni 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 liber-
ally dispensed than the medical ; but justice

requires that some limits should be placed to
the performance of such good offices. Poverty,
professional brotherhood, and certain of the
public duties referred to in the first section of
this article, should always be recognized as pre-
senting 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 ad-
mitted to possess such privilege. Nor can it be
justly expected of physicians to furnish certifi-
cates 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 ac-
knowledgment. 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 fre-
quent witnesses of the enormities committed
by quackery, and the injury to health and even

destruction of !'ife caused by the use of quack
medicines, to enlighten the public on these sub-
jects, 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 dis-
courage 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,

The benefits accruing to the public, directly
and indirectly, from the active and unwearied
beneficence of the profession, are so numerous
and important, that *' jians are justly entitled
to the utmost cor .ation and respect from the
community. The public ought likewise to enter-
tain a just appreciation of medical qualifications ;
to make a proper discrimination between true

it ,.

science and the assumptions of ignorance and
empiricism — to afford every encouragement and
facility for the acquisition of medical education
—and no longer to allow the statute-books to
exhibit the anomaly of exacting knowledge from
physicians, under a liability to heavy penaldes,
and of making them obnoxious to punishment
for resorting to the only means of obtaining it.

^mii of |^ee|.

1. Ordinary visit, 8 a. m. to 9 p. m. | i 00 to | 2 00

2. Ordinary visit, 9 p. m. to 8 a. m. 2 00 to 4 00

3. Each additional member of a

family in same house at same

t^"^e Half fee.

4. Detention per hour extra in day

^'"^^ I 00 to 200

5., Detention per hour extra at

"^S:ht 2 00 to 400

6. Detention whole day 2000

7. Detention whole night 25 00

8. Visit in consultation with an-

other Practitioner 5 00

9. Each subsequent visit in con-

sultation 2 00

10. Office consultation i 00 to 5 00

11. Visit on board vessel in harbor 5 00 to 10 00

12. Visit on boqrd vessel at wharf.. 2 50 to 5 00

13. Mileage after first mile 50 to i 00

14. Visit if called in passing 2 ootoafullfee

15. Consultation bv letter

(53)

00 to 3 00

1 6. Certificate of health, including

examination $ 2 oo to

17. Certificate of lunacy, including

examination 5 00 to

18. Medico legal opinion 20 00 to

19. Vaccination i 00 to

OBSTETRICS.

20. Natural labour, with ordinary

(one week) attendance 10 00 to

Detention per hour at usual rates.

21. Delivery by instruments, or

turning 15 00 to

22. Attendance removing placenta 5 00

23. For removing adherent pla-

centa 15 00 to

24. Attendance in labor with con-

vulsions 25 00 to

25. For attendance, labor com-

pleted 3 00 to

26. Cramotomy 25 00 to

27. Attendance, placenta praevia... 50 00 to

SURGERY.

28. Administering anaesthetic 2 00 to

29. Dressing simple wounds i 00 to

30. Introduction of catheter i 00 to

31. Opening abscess i 00 to

I 5 00

10 00

50 00

2 00

20 00

25 00

100

')•)

Auipiitatiojts.
52. Amputation fingers or toes,

^^^^'•i I 5 00

Zo' Amputation wrist, forearm or

^^"^ 20 00 to

34- Amputation shoulder joint 100 00

35- Amputation foot, anl^le or ieg.. 50 00 to

36. Amputation thigh 100 00

Zl> Amputation hip joint 200 00

38. Amputation breast

39. Amputation penis 25 00

40. Amputation tonsil 5 00 to

Resections.

41. Resection of shoulder, elbow,

or wrist joint

42. Resectionof hip, knee, or ankle

50 00
75 00

50 00 to 100 00

25 00

jomt

50 00 to 100 00
75 00 to 150 00

Dislocations.

43- Reducing dislocation of shoul-

der joint JO 00 to

44- Reducing dislocation of elbow. 10 00 to

45. Reducing dislocation of hip 25 00 to

46. Reducing dislocation of pha-

^a"§:es 5 00 to

47. Reducing dislocation of jaw.... 5 00 to

25 00
25 00
50 00

10 00
10 00

Fractures.

48. Setting fracture of phalanges... | 5 00

49. Setting fracture of wrist, arm,

forearm, or clavicle 20 00 to 5000

50. Setting fracture of jaw 15 00 to 3000

51. Setting fracture of leg 20 00 to 4000

52. Setting fracture of thigh 30 00 to 50 00

53. Setting fracture of patella 30 00 to 50 00

54. Setting fracture of ribs 5 00 to 10 00

55. Each dressing after first i 00 to 5 00

Ligation.

56. Ligating radial or brachial

artery 25 00 to 5000

57. Ligating tibial artery 30 00 to 60 00

58. Ligating femoral artery.. 100 00

59. Ligating carotid artery 100 00

60. Ligating subclavian or iliac 200 00 to 300 00

Miscellaneous.

61. Circumcision 15 00

62. Ligating hemorrhoids 25 00

63. Operation for treating hemor-

rhoids by injection 5 00 to 2500

64. Operation for fistula in ano 10 00 to 25 00

65. Aspirating bladder 5 00 to 2500

66. Lithotomy and lithotrity 100 00 to 200 00

41!

100

100 00

67. Division stricture of urethra

(divulsion) $ 15 00 to $3000

68. Division stricture of urethra

(urethrotomy) 25 00 to

69. Tapping hydrocele 5 00 to

70. Radical cure of hydrocele 10 00 to

71. Reducing strangulated hernia... 5 00 to

72. Operation for strangulated her-

nia 50 00 to

73. Trephining 50 00 to

74. Operation for club foot 20 00 to

75. Operation for hare lip 15 00 to

76. Operation for staphylorraphy.. 50 00 to

77. Tracheotomy, laryngotomy and

cesophagotomy 20 00 to

78. Removal of foreign body from

throat or oesophagus 5 00 to

79. Removal of nasal polypus 5 00 to

80. Use of stomach pump 5 00 to

81. Application of plaster jacket... 5 00 to

82. Castration 3000

83. Laparotomy 100 00

Diseases of Females.

84. Introducing and removing tam-

pon I 00 to 500

85. Introducing catheter i 00 to 2 00

50 00

50 00
30 00
20 00
25 00

86. Uterine and vaginal examina-

tion $ 2 oo to

87. Operation on vesico-vaginal

fistula 50 00 to

88. Operation on lacerated perin-

ceum (old) 25 00 to

89. Operation on lacerated cervix 50 00 to

90. Removal of uterine fibroids... 50 00 to

91. Treatment by electrolysis 3 00 to

92. Ovariotomy 200 00 to

Ophthalmic and Aural Surgery.

93. Extraction of cataract 50 00 to

94. Iridectomy 15 00 to

95. Enucleation 20 00 to

96. Strabismus 15 00 to

97. Lachrymal stricture 5 00 to

98. Removal of tarsal tumours ... 5 00 to

99. Correcting refraction 5 00 to

100. Catheterization of eustachian

tube (first operation) 5 00

loi. Politzerization 2 00 to

Venereal Diseases.

102. Venereal disease (first consul-

tation) 5 00 to

103. Venereal. disease (subsequent

consultation) i 00 to

$500

100 00

100

100 00

500

10 00

5 00

10 00

2 00

In cases of fracture, dislocation, amputation, resec-
tion, or other major operations, the fee specified above
shall not include more than two weeks' subsequent
attendance. Subsequent visits in such cases at the
usual rates.

In applying the above scale of fees, it is intended
that due consideration should be made for patients in
poor circumstances.

The above scale of fees does not include payments
to assistants.