CONSULTATIONS.

Consultations should be encouraged in difficult and protracted cases, as they give rise to confidence, energy, and more enlarged views in practice. On such occasions, no rivalship or jealousy should be indulged: candor, justice, and all due respect should be exercised towards the physician who first attended; and, as he may be presumed to be best acquainted with the patient and his family, he should deliver all the medical directions, as agreed upon. It should be the province, however, of the senior consulting physician to propose the necessary questions to the sick.

The consulting physician is never to visit without the attending one, unless by the desire of the latter, or when, as in sudden emergency, he is not to be found. No discussion of the case should take place before the patient or his friends; and no prognostications should be delivered which were not the result of previous deliberation and concurrence. Theoretical debates, indeed, should generally be avoided in consultation, as occasioning perplexity and loss of time; for there may be much diversity of opinion on speculative points, with perfect agreement on those modes of practice which are founded, not on hypothesis, but on experience and observation. Physicians in consultation, whatever may be their private resentments or opinions of one another, should divest themselves of all partialities, and think of nothing but what will most effectually contribute to the relief of those under their

care,

If a physician cannot lay his hand to his heart, and say that his mind is perfectly open to conviction, from whatever quarter it may come, he should in honor decline the consultation.

All discussions and debates in consultations are to be held secret and confidential.

Many advantages may arise from two consulting to

gether, who are men of candor, and have mutual confidence in each other's honor. A remedy may occur to one which did not to another; and a physician may want resolution, or a confidence in his own opinion, to prescribe a powerful but precarious remedy, on which, however, the life of his patient may depend: in this case, a concurrent opinion may fix his own. But, when such mutual confidence is wanting, a consultation had better be declined, especially if there is reason to believe that sentiments delivered with openness are to be communicated abroad, or to the family concerned; and if, in consequence of this, either gentleman is to be made responsible for the event.

The utmost punctuality should be observed in consultation-visits; and, to avoid loss of time, it will be expedient to establish the space of fifteen minutes as an allowance for delay, after which the meeting might be considered as postponed for a new appointment.

INTERFERENCES.

Medicine is a liberal profession; the practitioners are, or ought to be, men of education; and their expectations of business and employment should be founded on their degrees of qualification, not on artifice and insinuation. A certain undefinable species of assiduities and attentions, therefore, to families usually employing another, is to be considered as beneath the dignity of a regular practitioner, and as making a mere trade of a learned profession; and all officious interferences, in cases of sickness in such families, evince a meanness of disposition unbecoming the character of a physician or a gentleman. No meddling inquiries should be made concerning them, nor hints given relative to their nature and treatment, nor any selfish conduct pursued that may, directly or indirectly, tend to weaken confidence in the physicians or surgeons who have the care of them.

When a physician is called to a patient who has been under the care of another gentleman of the Faculty, before any examination of the case he should ascertain whether that gentleman understands that the patient is no longer under his care; and, unless this be the case, the second physician is not to assume the charge of the patient, nor to give his advice, excepting in instances of sudden attacks, — without a regular consultation; and if such previously attending gentleman has been dismissed, or has voluntarily relinquished the patient, his practice should be treated with candor, and justified so far as probity and truth will permit; for the want of success in the primary treatment of the disorder is no impeachment of professional skill and knowledge.

It frequently happens that a physician, in incidental communications with the patients of others, or with their friends, may have their cases stated to him in so direct a manner as not to admit of his declining to pay attention to them. Under such circumstances, his observations should be delivered with the most delicate propriety and reserve. He should not interfere in the curative plans pursued, and should even recommend a steady adherence to them, if they appear to merit approbation.

DIFFERENCES OF PHYSICIANS.

The differences of physicians, when they end in appeals to the public, generally hurt the contending parties; but, what is of more consequence, they discredit the profession, and expose the Faculty itself to contempt and ridicule. Whenever such differences occur as may affect the honor and dignity of the profession, and cannot immediately be terminated, or do not come under the character of violation of the special rules of the Association otherwise provided for, they should be referred to the arbitration of a sufficient number of members of the Association, according to the nature of the dispute; but neither the subject

matter of such references, nor the adjudication, should, if it can be avoided, be communicated to the public, as they may be personally injurious to the individuals concerned, and can hardly fail to hurt the general credit of the Faculty.

DISCOURAGEMENT OF QUACKERY.

The use of quack medicines should be discouraged by the Faculty, as disgraceful to the profession, injurious to health, and often destructive even of life. No physician or surgeon, therefore, should dispense a secret nostrum, whether it be his invention or exclusive property: for, if it is of real efficacy, the concealment of it is inconsistent with beneficence and professional liberality; and, if mystery alone gave it value and importance, such craft implies either disgraceful ignorance or fraudulent avarice.

CONDUCT FOR THE SUPPORT OF THE MEDICAL
CHARACTER.

The esprit du corps is a principal of action founded in human nature, and, when duly regulated, is both rational and laudable. Every man who enters into a fraternity engages by a tacit compact not only to submit to the laws, but to promote the honor and interest, of the association, so far as they are consistent with morality and the general good of mankind. A physician, therefore, should cautiously guard against whatever may injure the general respectability of the profession, and should avoid all contumelious representations of the Faculty at large, all general charges against their selfishness or improbity, or the indulgence of an affected or jocular scepticism concerning the efficacy and utility of the healing art.

FEES.

General rules are adopted by the Faculty in every town, relative to the pecuniary acknowledgments of their pa

tients, and it should be deemed a point of honor to adhere to them; and every deviation from, or evasion of, these rules should be considered as meriting the indignation and contempt of the fraternity.

Gratuitous services to the poor are by no means prohibited the characteristical beneficence of the profession is inconsistent with sordid views and avaricious rapacity. The poor of every description should be the objects of our peculiar care. Dr. Boerhaave used to say they were his

best patients, because God was their paymaster.

It is obvious, also, that an average fee, as suited to the general rank of patients, must be an inadequate compensation from the rich (who often require attendance not absolutely necessary), and yet too large to be expected from that class of citizens who would feel a reluctance in calling for assistance without making some decent and satisfactory remuneration.

EXEMPTION FROM CHARGES.

All members of the medical profession, together with their families, should be attended gratuitously; but visits should not be obtruded officiously, as such civility may give rise to embarrassments, or interfere with that choice. on which confidence depends.

But distant members of the Faculty, when they request attendance, should be expected at least to defray the charges of travelling.

Omission to charge, on account of the wealthy circumstances of the physician, is an injury to the profession; as it is defrauding, in a degree, the common funds for its support, when fees are dispensed with which might justly be claimed.

VICARIOUS OFFICES.

Whenever a physician officiates for another by his desire, in consequence of sickness or absence, if for a short time only, the attendance should be performed gratuitously