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be called to order in afternoon session when a quorum is not pres


RULE 2. In the absence of the President and Vice-Presidents, the meeting may elect any Fellow present to act as President pro tempore.

RULE 3. When a motion is under debate, no motion shall be received except motions to adjourn, to lay on the table, for the previous question, to postpone, to refer, or to amend, which several motions shall have precedence in the order in which they are enumerated in this rule.

RULE 4. A motion for the previous question shall not be entertained unless the same be seconded, and supported by at least four additional Fellows present.

RULE 5. Motions to adjourn, to lay on the table, and for the previous question, shall be decided without debate.

RULE 6. During the afternoon sessions, a motion to adjourn shall be in order at any time, except while a member has the floor, and such motion shall be decided without debate.

RULE 7. Every Fellow present at a meeting shall vote on all questions in morning sessions, unless excused from voting by the President, with the consent of the Association.

RULE 8. The ayes and nays on any question, when called for by five Fellows present, shall be decided without debate, and shall be recorded in full in the minutes.

RULE 9. After a question has been decided in morning session, except one of indefinite postponement, any two Fellows who voted with the majority may, at the same or at any subsequent morning session of the same meeting, move for a reconsideration thereof, without which no discussion of such question shall be allowed.

RULE 10. Every Fellow shall have the right to speak once on any question under consideration, but not oftener, unless by permission of the Association.

RULE 11. All questions of order not provided for in these rules shall be determined in accordance with the rules of order embodied in Cushing's "Manual of Parliamentary Practice."


SEC. 1. These By-Laws shall go into effect at the annual meeting of the Association in November, 1884.



SEC. 1. Amendments, alterations, or additions to these ByLaws may be made by a three-fourths vote of the Fellows present and voting at a regular annual meeting; provided that notice of such amendments, alterations, or additions shall have been presented in writing at the regular annual meeting immediately preceding.

SEC. 2. These By-Laws, or any Article, or any Section of any Article thereof, may be temporarily suspended at any morning or afternoon session of any regular meeting, during such session only, and then only by a three-fourths vote of the Fellows present and voting.



ART. I.-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 mission, and the responsibility he habitually incurs in its discharge. These 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 impressions of the importance of their office; reflecting that the ease, the health, and the lives of those committed to their charge, depend on their skill, attention, and fidelity. They should study, also, in their deportment, so to unite tenderness with firmness, and condescension 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. Secrecy 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 discretion, and with the most scrupulous regard to fidelity and honor. The obligation of secrecy extends beyond the period of professional

1 Taken from the "Transactions of the American Medical Association."

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 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 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 tranquillity 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 circumstances, would be sacri

ficing 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 difficult 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 strenghtening 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 offense, 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 the 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 regular professional education. In no trade or occupation do mankind rely on the skill of an untaught artist; and in medicine, confessedly the most difficult and intricate of the sciences, the world ought not to suppose that knowledge is intuitive.

§ 3. Patients should prefer a physician whose habits of life are regular, and who is not devoted to company, pleasure, or to any pursuit incompatible with his professional obligations. A patient should, also, confide the care of himself and family, as much as possible, to one physician for a medical man who has become acquainted with the peculiarities of constitution, habits, and predispositions of those he attends, is more likely to be successful in his treatment than one who does not possess that knowledge.

A patient who has thus selected his physician should always apply for advice in what may appear to him trivial cases, for the

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