call, that the number of the delegates amounted to about four hundred and fifty. The measures which have already been entered upon, and the spirit which has been manifested, clearly indicate, that the great object for which the Association was formed, "the elevation and advancement of our common calling" will be rigorously and steadily prosecuted. The recurrence of this festival of the profession from year to year, I fully believe, will be marked by real advances in all the interests of medical science. And now, I ask, is it too much to expect of the stable and well-informed in the community, that they will give their countenance to the objects at which we aim? While we are thus struggling together to elevate the standard of medical education, and to rid our noble, profession of the abuses which impair its honor and its usefulness, we have a right to demand of the community, which is to be especially benefitted by these efforts, a cheerful and active support. Whether this shall be given us, will depend upon the men of influence in every profession and occupation in our land. It is to them that we make our appeal, and we believe that it will not be made in vain. CHAPTER XII. INTERCOURSE OF PHYSICIANS. * THE object of this chapter is to notice some points in relation to the intercourse of physicians, which the community ought to understand, and to correct some prevalent errors, which tend to destroy the harmony of the profession, and to impair its usefulness. Mistaken notions are very prevalent, even among thinking and judicious men, both in regard to the object of consultations, and the principles by which they should be regulated. These notions sometimes exert a very injurious influence, and the patient is deprived of the benefit to which he has a right, from the combined wisdom of those who consult upon his case. What then is the main object of a consultation, is an important inquiry. It seems to be considered by many as the chief object of a consultation to decide the question, whether the patient will die or recover. We hear ignorant people talk about a jury of doctors,' and they ask what they gave in,' as if * I have placed in the Appendix the Code of Medical Ethics adopted by the American Medical Association, in which the reader will find concisely stated the rules and principles, which I have endeavored to illustrate in this and in some of the other chapters of this work. a sort of verdict was to be pronounced of a decisive, almost a binding, character, in regard to the result of the case. The same erroneous ideas are, to some extent, to be found among sensible and well informed people, though they are expressed in a different way. Let me not be understood to say, that the question, whether the patient will probably recover, should not come up for consideration at all. But it is certainly a gross error to suppose, that the decision of this question is a principal object of the consultation. It is in fact a merely incidental object, and it is profitable only as it may have some bearing upon the treatment, as it sometimes does, though much less often, and to a less extent, than is commonly supposed. Sometimes, I may say often, nothing like a decision of this question can be arrived at. Farther developments in the progress of the case must be waited for before this can be done. Neither is it the object of a consultation to have the physician who is called in prescribe to the attending physician what he shall do; though this is often considered to be the object, especially when the consulting physician is much older than the one who is in attendance upon the case. Dictation is certainly very far from being consulta tion. Again. It should not be among the objects of the friends of the sick, in calling a consultation, to obtain the opinion of the physician who is called in upon the course of treatment which has been pursued. He has nothing to do with the past, except so far as it will aid him in discovering the true nature of the case, and in fixing upon the course to be adopted at the present time. He steps out of his province altogether, if he says anything to the friends in regard to what has been done. This general rule applies not only to criticisms upon practice, but to all expressions of approba tion also. The patronizing air, with which some physicians utter their commendations of the course, which has been pursued by the attending practitioner, is a most flagrant insult. It generally involves an unwarrantable and ridiculous assumption of superiority. It is a common trick resorted to by the dishonorable, to impress upon the bystanders an idea of their greatness. The friends of the sick often put the consulting physician in an awkward position, by the inquiries which they make of him in regard to the measures which have been pursued. If he really approves of them all, of course there is no difficulty. But suppose that he does not-that he cannot say with truth, that if he had been called to the case at the first he should have adopted precisely the same course. What answer shall he make then to the inquiries put to him? Shall he reply to them fully and frankly? By no means. It would be cruel both to the friends of the patient and to the physician to do so. He has no right to take such a course, unless there be gross and palpable malpractice, which the good of the patient and of the community requires should be exposed. This is the only case which can justify such a measure. Where there exists merely that difference of opinion, which results from the various individual notions and preferences and doctrines of physicians, all such inquiries of the friends of the sick should not be replied to. There are also some exceptions to the rule in its application to expressions of approbation. If for example an older and well-established physician, on being called in to the patient of a junior member of the profession, sees that the propriety of the course, which has been pursued, has been called in question by some of the friends or by busy bodies, it is his duty to volunteer in the defence of that course if he can conscientiously do it. Older physicians often have such opportunities of doing essential service to meritorious young men. It is only such cases as I have mentioned, which form the exceptions to the rule laid down. The general practice of remarking upon what has been done cannot be too severely reprobated, as opening a wide door for cunning intrigue and ungenerous insinuation. The honorable physician desires no such privilege, but the dishonorable prize it highly, as one of the means of inflicting their base wounds upon the reputation of their competitors. Such physicians are ever ready to answer the inquiries of friends and neighbors, about the previous treatment, in every case to which they are called. They commonly prefer to do this in a corner, rather than openly. Whenever they see that a stab can be given to the professional character of any competitor they do it, and often so stealthily, that it is not seen. A word, a look, a mere movement of the head may do it, and perhaps oftener does it than any tangible expression of opinion. An open show of the weapon that inflicts the wound the cunning and dishonorable physician most studiously avoids. In this connexion I may remark, that the bandying about of the opinions of this and that physician, in regard to different cases, by their partizans, is one of the chief causes of the jealousies and quarrels among the members of our profession. If the friends of the sick would ask simply for the result of the consultation, instead of endeavoring to obtain the opinions of each physician in regard to the various points of the case, it would manifestly shut out all opportunity for intrigue at such times. And it is to this result alone that they have any right under ordinary circumstances. When a consultation is held, it is expected that |