they agree sufficiently to take joint charge of the case, then the consulting physician must justify and uphold, so far as he can conscientiously do so, the practice of his associate, and must abstain from any hints, insinuations or actions which might in any way impair the confidence which the patient reposes in him, or affect his reputation. He must refrain from an extraordinary attentions or assiduities calculated to ingratiate himself in the patient's favor to supplant his associate.

SEC. 4. In consultations the attending physician should first put the necessary questions to the patient. After this the consulting physician should make such additional inquiries and examinations as may be needed to satisfy him of the true nature of the case. But he should avoid making a parade of examining the patient more thoroughly than had been done before, rather suggesting to the attending physician wherever it is possible, to make whatever examinations he desires, then making them himself. Both physicians should then retire to a private room for deliveration.

SEC. 5. In consultations the attending physician should deliver his opinion first; and, when there are several consulting physicians, they should express their opinions in the order in which they have been called in. Should an irreconcilable diversity of opinion occur, when more than two physicians meet in consultation, the opinion of the majority should be regarded as decisive; but, if the number be equal on each side, the decision should rest with the attending physician. If two physicians, in consultation, cannot agree they should call in a third to act as umpire. If this be not practicable the patient must be requested to select the physician in whom he is most willing to confide. The physician who is left in the minority should, without any illfeeling, retire from the consultation and from any further participation in the management of the case; and, in justice to the physician thus retiring, the fact of his difference from his associates should, in the presence of all the physicians attending, be explained to the patient as his reason for withdrawing from the case.

SEC. 6. The attending physician should communicate to the patient or his friends the directions agreed upon in the consultation, as well as any opinion which it may be thought proper to express. But no statement or discussion should take place before the patient or his friends, except in the presence of all physicians attending, and by their common consent. And no opinions or prognostications should be delivered which are not the result of previous deliberation and concurrence. No decision arrived at in a consultation is to be regarded as restraining the attending physician from making such variations in the treatment as any subsequent change in the case may demand. But such variation, and the reason for it, ought to be carefully noted at the time, and detailed at the next meeting in consultation. The same privilege belongs also to the consulting physician, if he is sent for in an emergency when the attending physician is out of the way; and similar explanations must be made by him at the next meeting.

SEC. 7. Sometimes a special consultation is desirable in cases in which the continued attendance of two physicians might be objectionable to the patient. The consulting physician, in such a case, should sedulously avoid all further unsolicited attendance. Such consultations require an extraordinary outlay of time and attention, and, at least, a double honorarium may be reasonably expected.

SEC. 8. The consulting physician cannot, with propriety, take exclusive charge at any time of the patient in whose case he has been called in consultation without the consent of the attending physician; except in cases provided for by the third sentence of Section and by the fourth sentence of Section 5, of this article.

Article V.-Duties of Physicians in Cases of Interference

SECTION 1. Medicine is a liberal profession, and those admitted into ranks should base their expectations of success upon the extent of their qualifications, not upon intrigue artifice. A physician should not allow himself to feel envious or jealous of a brother practitioneer. The distinction which one successful physician wins is shared by the whole profession. Nor should a physician suffer himself to feel illwill towards another who may come into his neighborhood and appears likely to take a share of the business which he has hitherto enjoyed. Such feelings are inconsistent with the beneficent and liberal nature of the profession. Liberality and true generous fraternity in thought, word and deed will unite the interests of all the members of the profession, and will so exalt the estimation in which it is held in the community that, confidence being increased, business will likewise increase; and to physicians will be accorded the position which, of right, should be theirs, that of confidential family advisers in all matters pertaining to the care of the body in health no less than in sickness.

SEC. 2. The physician, in his intercourse with a patient who is under the care of another practitioneer, should observe the strictest caution and reserve. No meddling questions should be asked in any interview for business or friendship, no disingenuous hints thrown out relating to the nature and treatment of his disorder; nor should the patient be allowed to converse upon these topics. No course of conduct should be pursued which might, directly or indirectly, tend to diminish the trust reposed in the physician employed.

SEC. 3. A physician should not take charge of a patient who is, or has recently been, under the charge of another practitioneer 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 has been regularly notified that his services are no longer required. Under such circumstances no unjust or illiberal remarks should be made or insinuations thrown out in relation to the treatment pursued by the previous physician. Nor should the physician permit the patient unreasonably to find fault with his predecessor, for patients often become dissatisfied with their attention on account of the mere duration of a case which no degree of professional knowledge or skill could have shortened.

SEC. 4. In cases of accident or sudden emergency one or more physicians are often sent for by alarmed friends. Courtesy should assign the patient to the first of these that arrives; and he should select from those present such additional assistance as he may deem necessary. But he should also request the family physician (if there be one) to be sent for, and on his arrival, resign the case into his hands. The practitioner of the patient, when he arrives, should take the place of any one called in his absence. "The practitioner of any patient" is the man whom he has in any way given to understand that he regards him as his medical adviser, or who would now be in charge of the case were it not for his absence, sickness or other disability.

SEC. 5. In a sparse population, a physician, when visiting a sick person, may be desired to see, in an emergency, a neighboring patient, who is under the regular charge of another physician. The conduct to be pursued on such an occasion is to give advice adapted to present circumstances; to interfere as little as possible with the general plan of treatment; to assume no further direction of the case unless it be expressly desired; and in the latter case to request an immediate consultation with the practitioner previously employed.

SEC. 6. A wealthy physician should not give advice gratis to the affluent, because his so doing is an injury to his professional brethren. The office of the physician can never be supported as an exclusively

beneficent one, and it is defrauding, in some degree, the common fund when fees are disposed with which might justly be claimed.

SEC. 7. When a physician who has been engaged to attend a case of midwifery is absent, and another is sent for, if delivery is accomplished in the absence of the former, the latter is entitled to the fee, but he should resign the patient to the practitioner first engaged.

Article VI.—Of Differences Between Physicians

SECTION 1. Diversity of opinion and opposition of interests may, in the medical, as in other professions, sometimes occasion controversy and even contention. When such cases occur and cannot be immediately termiated, they should be referred to the arbitration of a sufficient number of physicians or a court medical.

Article VII.-Of Pecuniary Acknowledgments

SECTION 1. Some general rules should be adopted by the physicians in every town or district relative to pecuniary acknowledgment from patients. These should be adhered to by physicians as uniformly as circumstances will permit. They serve, likewise, as a standard to which appeal may be taken in case of doubt or dispute.

SEC. 2. Members of the medical profession have been so uniformly in the habit of attending, gratuitously, the indigent sick, and, in general, of answering every call promptly and without a question as to whether they are to receive remuneration therefor, that many persons seem to think they have a right to demand the services of physicians, and do, in fact, call upon them freely, and neglect or refuse to render any pecuniary equivalent, although abundantly able to do so. They impose upon one physician in this way until they have exhausted his patience, and then call upon another; and thus, in the course of a few years, make the circuit of the profession in their neighborhood. It is proper for the physicians of a community to make a list of the names of such individuals, and to demand, before visiting those whose names are on it, adequate security that their honorarium will be paid.

PART III

The Reciprocal Duties and Obligations of Physicians and the Public Article I.-Duties of Physicians to the Public

SECTION. 1. As good citizens, it is the duty of physicians to be vigilant for the welfare of the community and to bear their part in sustaining its institutions and burdens. They should be always ready to give counsel to the public in relation to matters appertaining to their profession, as for example, 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, arrangements and dietaries of hospitals, asylums, schools, prisons and similar institutions; in relation to the medical police of towns, drainage, ventilation, etc., 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 suffering and the saving of life, even at the risk of their own lives.

SEC. 2. Physicians should always be ready, when called on by the proper authorities, to enlighten coroners' inquests and courts of justice on matters strictly medical, such as involve questions relating to insanity, legitimacy, or sudden and violent deaths, 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 post-mortem examinations, it is just and right, in consequence of the time, labor and skill required and the responsibility and risk they incur, that the public should award them more than a mere consulting fee.

SEC. 3. There is no profession, by the members of which eleemosynary services are more freely dispensed than they are by physicians; but justice demands that some limits should be placed to the claims upon such offices at their hands. Poverty, professional brotherhood, the benevolent and scantily remunerated occupation of the individual patient, and certain of the public duties referred to in Section 1 of this Article, 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 purpose, nor any profession of 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, or perform military duty, or to certify to the state of health of parties wishing to insure their lives, obtain pensions or the like, without a pecuniary acknowledgement. But to indigent persons such professional services should always be cheerfully and freely accorded.

Article II.-Obligations of the Public to Physicians

SECTION 1. The benefit accruing to the public, directly and indirectly, from the active and constant labors and beneficence of the medical profession are so numerous and important that physicians are justly entitled to the utmost consideration from the community. The public ought likewise, to entertain a just appreciation of the proper qualifications of a practitioner of medicine; to make a due discrimination between true science and the assumption of ignorance and empiricism; to afford every encouragement and facility for the acquisition of medical education, and not to allow the provisions of their statute books or of the prospects of their chartered institutions to interpose any obstacles to the attainment of the fullest knowledge of every branch of medical science, or in any way, to restrain the most entire freedom of thought, investigation and action in matters appertaining to the practice of medicine.