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

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

§ 6. It often happens, in cases of sudden illness, or of recent accidents and injuries, owing to the alarm and anxiety of friends, that a number of physicians are simultaneously sent for. Under these 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.

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 neighbouring 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 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 benificent 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 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 professions, sometimes 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 public, 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 soci. ety, 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.

ART. VII.-Of 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 honour to adhere to these rules with as much uniformity as varying circumstances will admit.

CHAPTER III.

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

ART. I.-Duties of the profession to the public.

§ 1. As good citizens, it is the duty of physicians to be ever vigilant for the welfare of the community, and to bear their part in sustaining its institutions and burdens: they should also be ever ready to give counsel to the public in relation to matters especially appertaining to their profession, as on subjects of medical police, public hygiène, 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, ventilations, &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 labours for the alleviation of the suffering, even at the jeopardy of their own lives.

§2. Medical men should also be always ready, when called on by the legally constituted authorities, to enlighten coroners' inquests and courts of justice, on subjects strictly medical,-such as involve 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 required to make a post-mortem examina. tion, it is just, in consequence of the time, labour 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 persons wishing to insure their lives, obtain pensions, or the like, without a pecuniary acknowledgment. But to individuals in indigent circumstances, such professional services should always be cheerfully and freely accorded.

4. It is the duty of physicians, who are frequent witnesses of the enormities committed by quackery, and the injury to health and even destruction of life caused by the use of quack medicines, to enlighten the public on these subjects, to expose the injuries sustained by the unwary from the devices and pretensions of artful empirics and imposters. 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.

ART. II.-Obligations of the public to physicians.

§ 1. The benefits accruing to the public directly and indirectly from the active and unwearied beneficence of the profession, are so numerous and important, that physicians are justly entitled to the utmost consideration and respect from the community. The public ought likewise to entertain a just appreciation of medical qualifica. tions to make a proper discrimination between true 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 liability to heavy penalties, and of making them obnoxious to punishment for resorting to the only means of obtaining it.

NOTE. The committee on presenting this code, stated that justice required some explanatory remarks should accompany it. The members of the Convention, would not fail to recognize in parts of it, expressions with which they were familiar. On examining a great number of codes of ethics adopted by different societies in the United States, it was found that they were all based on that by Dr. Percival, and that the phrases of this writer were preserved, to a consider able extent, in all of them. Believing that language which had been so often examined and adopted, must possess the greatest of merits for such a document as the present, clearness and precision, and having no ambition for the honours of authorship, the Committee which prepared this code have followed a similar course, and have carefully preserved the words of Percival wherever they convey the precepts it is wished to inculcate. A few of the sections are in the words of the late Dr. Rush, and one or two sentences are from other writers. But in all cases, wherever it was thought that the language could be made more explicit by changing a word, or even a part of a sentence, this has been unhesitatingly done; and thus there are but few sections which have not undergone some modification; while, for the language of many, and for the arrangement of the whole, the Committee must be held exclusively responsible.

On the Employment of Ether by Inhalation in Obstetric Practice; with Cases and Observations. By PROTHEROE SMITH, M. D., Member of the Royal College of Physicians; Assistant Teacher of Midwifery at St. Bartholomew's Hospital.—(Lancet.)

The power of the vapour of ether, when inhaled, to diminish, or even to destroy sensation, and consequently pain, has been placed beyond doubt by the results of hundreds of surgical operations. Its safety in surgical cases may also be considered as established, espe cially when the administration of the ether is conducted with attention to the precautions indicated by experience. We may, I think, fairly consider that the instances in which ether will be administered before surgical operations, will be the rule-those in which it will be omitted, the exceptions. We may also, expect its use to be general in dislo cations, hernia, spasmodic strictures, &c. In the first two of these cases, it acts in a twofold manner:-1st, it relieves the pain; and 2ndly, it relaxes the muscles, whose contraction opposes reduction. We shall see that in midwifery, also it possesses the latter advantage, by its action upon the perinæal muscles.

Ether has been but little employed in painful medical cases; and yet it has already been proved to give instant ease from the agony of neuralgia, and from the horrible dyspnoea of spasmodic asthma. A case of colica pictonum, which had resisted the usual means for three days, was cured by ether. A case of puerperal mania was immediately and permanently relieved; and several cases of dysmenorrhoea have been recorded, in which this agent has acted like magic. Probably, many spasmodic diseases will be benefitted by inhalation of ether; and we may confidently expect many forms of intractable hysterical pains to yield to it. In a few cases published by M. Piorry, which appeared unfavorably affected by it, the ether was probably impure. It is not my intention, however, to discuss the effects of ether in medical and surgical practice.

But though the diseases, as hysteria and dysmenorrhoea, which are commonly regarded as belonging peculiarly to the obstetric practi. tioner, will probably derive very great benefit from the etherial treat. ment, I would proceed to the inquiry, whether its exhibition will ever be habitually employed in daily obstetric practice.

To answer this question, we may examine-1st, the á priori physiological probabilities; and 2ndly, the results of the cases in which ether has been tried.

Labour is a complex process, in which every part of the nervous system is concerned. Now ether affects, in succession, every por tion of the nervous system, unless we except the ganglionic.

In labour, the brain is in action, as is proved by the presence of thought and special sensation; so, also, the pons Varolii (or whatever the seat of pain may be) is also active-as are the cerebellum, the medulla spinalis, the medulla oblongata, and the ganglionic system. But though all these portions of the nervous system are concerned

in ordinary labour, they are not all necessarily, or, as it appears to me, advantageously so.

It is proved beyond a doubt, by cases of paraphlegia, that the pa. tient may be sensible, and yet feel no pain, though the uterus contract regularly. The same absence of pain is seen in puerperal convul. sions, in which unconsciusness is superadded: and in some cases of paraplegia, even the reflex actions of the abdominal muscles have been wanting, so that labour has been terminated by the efforts of the uterus alone. Cases have occurred in which the patient has been unconsciously delivered, without accident or apparent delay, when in a state of extreme intoxication.

Thus, then, of the usual nervous concomitants of labour, conscious. ness, pain, and spinal reflex action, may be wanting, and yet partu rition proceed uninterruptedly.

But though they may be absent, can they be artificially abolished without danger? Can this be accomplished by ether-and if so, is it justifiable on Christian principles? as I have frequently been asked.

I will answer the last question before entering upon the consideration of the others; because, if we have reason to believe that an attempt to relieve the pains of labour would be in opposition to the will of God, all discussion of the other questions must at once be abandoned.

I think it is obvious that the same principle which would lead us to view any attempt to remove the dreadful and dreaded pains of labour, as opposed to the Divine will, would induce us to neglect every means of relieving human suffering. Though from different motives we should, like the Turks, passively bear evils easily removable, as disease and suffering are alike dependent on the event which elicited the decree "In sorrow thou shalt bring forth." In fact, precisely the same objections have successively been made to most of the great discoveries and improvements in medicine. Some may remember that one of the great arguments against vaccination-and in the last century, against inoculation-was, that the practice was a presump. tuous contravention of the Divine will. With far more reason might the objection be urged to the practice of inducing premature labour, and still more strongly against that of destroying in utero a living foetus. And yet it is now universally admitted, that to risk the life of the mother by refraining from these operations is not only unjus tifiable, but highly criminal. Certainly, then, if it is justifiable to attempt the relief of pain, it is especially imperative upon us to do so in the most intense of all pain.

I am induced to offer these observations in the hope that they may satisfy the scruples of those who have opposed the employment of ether in ordinary cases of labour, from a feeling that its use is not justifiable on Christian principles. Time has often hallowed what science and advancing knowledge have proved to be but the offspring of habit and prejudice; and in support of this assertion, I would quote a recent publication of Dr. Simpson, in which he says, "The