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 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 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.

ART. VII.-Of Pecuniary Acknowledgements.

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, 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 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 postmortem 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 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 inedicines, to enlighten the public 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.

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 qualifications;-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.

Part Fourth.

MEDICAL INTELLIGENCE.

FOREIGN.

1.-Report on the present state of knowledge respecting the Surgical, Medicinal, and Obstetrical application of the Vapour of Ether. By the EDITOR. (Ranking's Half-Yearly Abstract.)

Dr. Ranking deems the introduction of this new remedy into practice, and the various experiments that have been performed with it of suffi cient importance to deserve a special report. He has, therefore, drawn up one which will be read with interest. As we cannot make room for the whole of it, we will only give the following extracts. He begins thus:

"The introduction of a new remedy, or a new means of obviating the many undesirable events contingent upon the practice of medicine and surgery, is always regarded in a different light by different members of the profession.— There are some among us, on the one hand, who, contented to move along in the mental "jog-trot" to which they have been long accustomed, look with suspicion or dislike on any innovation upon the ancient opinions with which they have enfolded themselves. These are the men who ridiculed and opposed the introduction of the stethoscope, and who will continue to ridicule and oppose anything else which they had not "dreamt of in their philosophy," and which either threatens to interfere with the usual routine of their thoughts, or necessitates a greater amount of intellectual application than they are capable of devoting to it. There is, on the other hand, another equally mischievous, perhaps, but far more interesting class of practitioners, whose imagination is apt to lead them to expect something great of every chimera which a busy age is continually forcing upon the attention. These men take up mesmerism, homœopathy, and such-like vagaries; become positive as to the curability of incurable diseases; and alternately blow hot and cold upon every medicine with an impossible name, which is ushered into notice by the inventive genius or needy exchequer of the practical pharmacopolist. Between the priggish contempt of novelties exhibited by one class of medical practitioners, and the injudicious favouritism of the other, it is seldom that any new suggestion for the benefit of mankind meets with that dispassionate judgment which the public has a right to expect from those who constitute themselves the guardians of its health; and it is generally not until the lapse of a considerable time that its merits or demerits can be ascertained with anything like certainty.

"The introduction of the inhalation of ether, for the purpose of annihilating pain in surgical operations, and of depriving even the dreaded process of parturition of its pangs, has not been exempted from the ordinary fate of novel propositions in medicine, although it must be allowed that the objectors to the value of this agent form the minority of those who have been led to reflect upon its applicability. Still there have not been wanting, in every locality, some over-cautious or over-timid persons, who are haunted with the idea of the danger which must attach to means so extraordinary, and who look upon an ether inhaler as almost a synonym for apoplexy or asphyxia. These individuals, however, as we have said, are few in number, and their opinions are, therefore, of little consequence as respects the estimation of the agent; the real danger tó which it is exposed arises from the precipitate encomiums of its friends, and the reckless manner in which it appears to be made use of, without reference to, and by persons utterly incapable of judging of, the normal or diseased physical peculiarities of the patient.

"In the following report it will be our endeavor, as far as present experience of its effects will allow, to place the inhalation of ether as an anodynic and medicinal agent in a just light; laying before the reader an analytical digest of those communications upon the subject which appear to us to be most worthy of confidence."

He continues his report under the following heads:-1, Historical Notices; 2, Preparation, Application, Physiological Action, &c.; 3, Its Application to Surgery; 4, to Practical Medicine; and 5, to Obstetrical Practice. It seems that the inhalation of sulphuric ether was used. many years ago, as is shown by literary references, but Dr. R. does not think this "as in any degree derogating from the honor which is in common justice to be accorded to the American gentlemen, who at the close of the last year, brought this subject prominently before the medical world." In regard to the comparative claims to the discovery set up by Jackson and Morton, he thinks it "evident that the idea was Dr. Jackson's; the merit of applying that idea belongs to Dr. Mortin." As our readers have seen so much about the application of ether to surgery and general practice, we shall confine ourselves to what he says under his last head, viz:

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V.-Application of Ehter Vapour to Obstetrical Practice.

'Many circumstances conspire to render the application of ethereal vapour to the purpose of annihilating the pangs of childbirth the most interesting feature in the history of the discovery; but at the same time, from the number of points to be taken into consideration, in a process so complex as that of parturition, it is, of all the applications of the agent, that concerning which it is the most difficult to arrive at satisfactory conclusions. We have not to determine merely whether the inhalation of ether is capable of suppressing the pain which accompanies parturition, but we have to take note also of other conditions which complicate the problem. The action of ether upon the fœtus, and upon the general economy of the mother; whether the insensibility which paralyzed the voluntary muscles would not likewise abolish the contractility of the uterus and abdominal muscles--were all so many novel questions which it was neces sary to elucidate. It required, we think, no small courage to take the first step in solving a problem so important; a problem in which to err would not have been to commit a mere physiological blunder, but, in point of fact, to sacrifice the two lives, the preservation of which was confided to our care. It would be premature at the present time, to make any decided observations as to the general applicability of ether to midwifery; but if it should appear, on further examination, that it is a safe proceeding in that important department of medicine, to Professor Simpson, as the first to make the experiment, the profession

and the public will be not less indebted than to the original discoverers of the process itself.

"The communications respecting the application of ether vapour to midwifery, which, in point of number, rank next to those devoted to its use in surgery, consist, for the most part, in the narration of individual cases. We shall recapitulate these as nearly as possible in the rotation in which they appeared. "24. The first to be noticed is a pamphlet by Professor Simpson*, containing the subjoined cases, which we slightly abridge.

"The first is that of a female in her second confinement, whose pelvis was so contracted as to have rendered craniotomy necessary in her previous labor. Contrary to the advice of her medical attendant, she did not make him aware of her pregnancy until nearly her full time, so that it was too late to have recourse to the induction of premature labor. The labor-pains commenced on the 19th, and in the evening Dr. Simpson caused her to inhale the ether vapour. As she afterwards informed him, she almost immediately came under its influence; but as her insensibility was doubtful, it was continued for twenty minutes before turning was commenced. The operation was performed, and a full-sized still-born child was extracted.

"On questioning the patient after her delivery, she declared that she was quite unconscious of pain during the whole period of turning and extracting the infant, and only became fully aware of her situation by hearing the noise caused by preparing a bath for the restoration of the child; she quickly regained her full consciousness, and talked with gratitude and wonderment of her delivery and her insensibility to the pains of it. On the fifth day after delivery ⚫ she was dressed, and her convalescence was rapid and uninterrupted.

"The next two are forceps cases. One was brought into the Royal Maternity Hospital, in strong labor, early on the morning of the 3rd of February. It was her second confinement. At her first accouchement (seven years before) she had been delivered by instruments, in Ireland, and had been informed by the attendant practitioner that artificial delivery would be similarly required at her future labors. Dr. Simpson saw her between ten and eleven o'clock, a. M. The os uteri was well dilated, the membranes ruptured, and the pains extremely strong and frequent; but the large head of the child seemed not to enter fully into the brim, and was little affected by the powerful uterine contractions under which the patient was suffering. By three o'clock her pulse had risen to above 125 beats a minute, and it appeared to the medical officers present that it would be improper to allow the ineffectual and exhausting efforts of the patient to be longer continued. She was then, at the request of Dr. Simpson, brought under the influence of ether. Dr. Moir, with great skill, applied the long forceps upon the head of the child. He subsequently was obliged to use strong traction during the pains that followed, and becoming temporarily fatigued with his efforts, Dr. Simpson supplied his place. After the head fully passed the brim, the forceps were laid aside, and one or two uterine contractions finished the delivery. The child was large and strong, and cried vigorously soon after it was expelled. During the whole of this severe operation the patient appeared quiet and passive. The cries of her child speedily roused her from her etherized state, and she subsequently assured Dr. Moir that she had felt comparatively little or no pain during the whole operation and delivery.

"The other case was seen by Dr. Simpson, in consultation with Dr. Graham Weir. The patient was advanced in lite, and it was her first confinement.— The waters had escaped early, and the anterior lip of the uterus had subsequently been forced down in a very swelled and oedematous state before the head of the infant. After this obstruction was overcome, the child's head speedily descended upon the floor of the pelvis; but it was there impeded in its further progress by the narrow transverse diameter of the outlet. Under the compression of the converging tuberosities of the ischia, the bones of the fœtal

*Notes on the Inhalation of Sulphuric Ether in the Practice of Midwifery.