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his profession and and to his patients. It is due to the latter, as without it he
can not command their respect and confidence, and to both, because no
scientific attainments can compensate for the want of correct moral principles.
It is also incumbent on the faculty to be temperate in all things, for the
practice of physics requires the unremitting exercise of a clear and vigorous
understanding; and in emergencies, for which no professional man should be
unprepared, a steady hand, an acute eye, and an unclouded head may be
essential to the well-being, and even to the life, of a fellow-creature.

§ 4. — It is derogatory to the dignity of the profession to resort to public
advertisements, or private cards, or handbills. Inviting the attention of in-



900 NATIONAL MEDICAL SOCIETIES.

dlviduals affected with particular diseases — publicly offering advice and medi-
cine to the poor gratis, or promising radical cures; or to publish cases and
operations in the daily prints, or to suffer such publications to be made; tj
invite laymen to be present at operations; to boast of cures and remedies; to
adduce certificates of skill and success, or to perform any other similar acts.
These are the ordinary practices of empirics, and are highly reprehensible in
a regular physician.

§ 5. — Equally derogatory to professional character is it for a physician to
hold a patent for any surgical instrument or medicine, or to dispense a secret
nostrum, whether it be the composition or exclusive property of himself or
others. For, if such nostrum be of real efllcacy, any concealment regariHng
it is inconsistent with beneficence and professional liberality; and if mystery
alone give it value and importance, such craft implies either disgraceful
ignorance or fraudulent avarice. It is also reprehensible for physicians to
give certificates attesting the efficacy of patent or secret medicines, or in any
way to promote the use of them.

Article II. — Professional Services of Physicians to Each Other.

§ 1. — All practitioners of meiicine, their wives, and their children while
under the paternal care, are entitled to the gratuitous services ot any one
or more of the facult.v residing near r.hem, whose assistance may be desired.
A physician afflicted with disease 's usually an incompetent judge of his own
case; and the natural anxiety and solicitude which he experiences at the
sickness of a wife, a child, or any one who, by ties of consanguinity, is
rendered peculiarly dear to him, tend to obscure his judgment and produce
timidity and irresolution in his practice. Under such circumstances medical
men are peculiarly dependent upon each other, and kind offices and profes-
sional aid should always be cheerfully and gratuitously afforded. Visits ought
not, however, to be obtruded officiously; as such unasked civility may give
rise to embarrassment, or interfere with that choice on which confidence
depends. But if a distant member of the faculty, whose circumstances are
affiuent, requests attendance, and an honorarium be offered, it should not be
declined; for no pecuniary obligation ought to be imposed, which the party
receiving It should wish not to incur. V

Article III. — Of the Duties of Physicians as Respects Vicarious Offices.

§ 1. — The affairs of life, the pursuit of health, and the various accidents and
contingencies to which a medical man is peculiarly exposed, sometimes
require him temporarily to withdraw from his duties to his patients, and to
request some of his professional brethren to officiate for him. Compliance
with this request is an act of courtesy, which should always be performed
with the utmost consideration for the interest and character of the family
physician, and when exercised for a short period all the pecuniary obligations
for such services should be awarded to him. But if a member of the profes-
sion neglect his business in quest of pleasure and amusement, he can not be
considered as entitled to the advantages of the frequent and long-continued
exercise of this fraternal courtesy, without awarding to the physician who
officiates the fees arising from the discharge of his professional duties.

In obstetrical and important surgical cases, which give rise to unusual
fatigue, anxiety, and responsibility, it is just that the fees accruing therefrom
should be awarded to the physician who officiates.

Article IV. — Of the Duties of Physicians in Regard to Consultations.

§ 1. — A regular medical education furnishes the only presumptive evidence
of professional abilities and acquirements, and ought to be the only acknowl-
edged right of an individual to the exercise and honors of his profession.
Nevertheless, as in consultations the good of the patient is the sole object
in view, and this is often dependent on personal confidence, no intelligent
regular practitioner, who has a license to practice from some medical board
of known and acknowledged respectability, recognized by the Association, and
who is of good moral and professional standing in the place where he resides,



AMERICAN MEDICAL ASSOCIATION. 907

should be fastidiously excluded from fellowship, or his aid refused In con-
sultation, when it is requested by the patient. But no one can be considered
as a regular practitioner or a fit associate in consultation whose practice is
based on an exclusive dogma, to the rejection of the accumulated experience
of the profession, and the aids actually furnished by anatomy, physiology,
pathology, and organic chemistry.

§ 2. — In consultations, no rivalship or jealousy should be indulged; candor,
probity, and all due respect- should be exercised toward the physician having
charge of the case.

§ 3. — In consultations the attending physician should be the first to propose
the necessary questions to the sick; after which the consulting physician
should have the opportunity to make such further inquiries of the patient as
may be necessary to satisfy him of the true character of the case. Both physi-
cians should then retire to a private place for deliberation; and the one first
In attendance should communicate the directions agreed upon to the patient
or Ijis friends, as well as any opinion which it may be thought proper to
express. But no statement or discussion of it should take place before the
patient or his friends, except in the presence of all the faculty attending.
and by their com"mon consent; and no opinions or prognostications should be
delivered which are not the result of previous deliberation and concurrence.

§ 4. — In consultations, the physician in attendance should deliver his opin-
ion first; and when there are several consulting, they should deliver their
opinions in the order in which they have been called. No decision, however,
should restrain the attending physician from making such variations In the
mode of treatment as any subsequent unexpected change in the character of
the case may demand. But such variation, and the reasons for it, ought to
be carefully 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 regular attendant is out of the way, and similar explanation must
be made by him at the next consultation.

§ 5. — The utmost punctuality should be observed In the visits of physicians
when they are to hold consultations together, and this is generally prac-
ticable, for society has been considerate enough to allow the plea of a pro-
fessional engagement to take precedence of all others, and to be an ample
reason for the relinquishment of any present occupation. But as professional
engagements may sometimes Interfere and delay one of the parties, the physi-
cian who first arrives should wait for his associate a reasonable period, after
which the consultation should be considered as postponed to a new appoint-
ment. If it be the attending physician who is present, he will, of course,
see the patient and prescribe; but If it be the consulting one, he should retire,
except in case of emergency, or when he has been called from a considerable
distance, in which latter case he may examine the patient, and give his opin-
ion in writing and under seal, to be delivered to his associate.

§ 6. — In consultations, theoretical discussions should be avoided, as occa-
sioning perplexity and loss of time. For there may be much diversity of
opinion concerning speculative points, with perfect agreement in those modes
of practice which are founded, not on hypothesis, but on experience and
observation.

§ 7. — All discussions in consultation should be held as secret and confi-
dential. Neither by words nor manner should any of the parties to a con-
sultation assert or insinuate that any part of the treatment pursued did not
receive his assent. The responsibility must be equally divided between the
medical attendants — they must equally share the credit of success as well as
the blame of failure.

§ 8. — Should an Irreconcilable diversity of opinion occur when several physi-
cians are called upon to consult together, the opinion of the majority should
be considered as decisive; but If the numbers be equal on each side, then the
decision should rest with the attending physician. It may, moreover, some-
times happen that two physicians can not agree in their views of the nature
of a case and the treatment to be pursued. This Is a circumstance much to
be deplored, and should always be avoided, if possible, by mutual concessions,
as far as they can be justified by a conscientious regard for the dictates of
judgment. But in the event of its occurrence, a third physician should. If



908 NATIONAL MEDICAL SOCIETIES,

practicable, be called to act as umpire; and, If circumstances prevent the
adoption of this course, it must be left to the patient to select the physician
in whom he is most willing to confide. But, as every physician relies upon
the rectitude of his judgment, he should, when left in the minority, politely
and consistently retire from any further deliberation in the consultation, or
participation in the management of the case.

§ 9. — As circumstances sometimes occur to render a special consultation
desirable, when the continued attendance of two physicians might be objec-
tionable to the patient, the member of the faculty whose assistance is required
In such cases should sedulously guard against all future unsolicited attend-
ance. As such consultations require an extraordinary portion of both time
and attention, at least a double honorarium may be reasonably expected.

§ 10. — A physician who is called upon to consult, should observe the most
honorable and scrupulous regard for the character and standing of the prac-
titioner in attendance; the practice of the latter, if necessary, should be justi-
fied as far as can be, consistently with a conscientious regard for truth, and
no hint or insinuation should be thrown out which could impair the confi-
dence reposed in him, or affect his reputation. The consulting physician
should also carefully refrain from any of those extraordinary attentions oX
assiduities which are too often practiced by the dishonest for the base pur-
pose of gaining applause, or ingratiating themselves into the favor of families
and Indiviiuals.

Article V. — Duties of Physicians in Cases of Interference.

§ 1. — Medicine is a liberal profession, and those admitted into its ranks
should found their expectations of practice upon the extent of their qualifica-
tions; not on intrigue or artifice.

§ 2. — A physician, in his intercourse with a patient under the care of an-
other practitioner, should observe the strictest caution and reserve. No
meddling inquiries should be made — no disingenuous hints given relative to
the nature and treatment of his disorder; nor any course of conduct pursued
that may directly or indirectly tend to diminish the trust reposed in the physi-
cian employed.

§ 3. — The same circumspection and reserve should be observed when, from
motives of business or friendship, a physician is prompted to visit an indi-
vidual who is under the direction of another practitioner. Indeed, such visits
should be avoided, except under peculiar circumstances; and when they are
made, no particular inquiries should be instituted relative to the nature of the
disease, or the remedies employed, but the topics of conversation should be
as foreign to the case as circumstances will admit.

§ 4. — A physician ought not to take charge of or prescribe for a patient
who has recently been under the care of another member of the faculty 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 been regularly notified that his services are no longer desired.
Under such circumstances, no unjust and Illiberal insinuations should be
thrown out in relation to the conduct or practice previously pursued, which
should be justified as far as candor and regard for truth and probity will
permit; for it often happens that patients become dissatisfied when they do
not experience Immediate relief, and, as many diseases are naturally pro-
tracted, the want of success, in the first stage of treatment, affords no evi-
dence of a lack of professional knowledge and skill.

§ 5. — When a physician is called to an urgent case, because the family at-
tendant is not at hand, he ought, unless his assistance in consultation be
desired, to resign the care of the patient to the latter immediately on his
arrival.

§ 6. — It often happens in case of sudden Illness, or of recent accidents and
Injuries, owing to the alarm and anxiety of friends, that a number of physi-
cians are simultaneously sent for. Under these circumstances, courtesy should
assign the patient to the first who arrives, who should select from those pres-
ent any additional assistance that he may deem necessary. In all such cases,
however, the practitioner who olBciates should request the family physician,



AMEllICAN MRDTCAL ASSOCIATION. 909

if there be one, to be called, and, unless his further attendance be requested,
BhouUl resign the case to the latter on his arrival.

§ 7. — When a physician is called to the patient of another practitioner, In
consequence of the sickness or absence of the latter, he ought on the return or
recovery of the regular attendant and with the consent of the patient, to sur-
render the case.

(The expression " patient of another practitioner," is understood to mean
a patient who may have been under the charge of another practitioner at the
time of the attack of sickness or departure from home of the latter, or who
may have called for his attendance during his absence or sickness, or in any
other manner given it to be understood that he regarded the said physician
as his regular medical attendant.

§ 8. — A physician, when visiting a sick person in the coimtry, may be
desired to see a neighboring patient who is under the regular direction of
another physician, in consequence of some sudden change or aggravation of
symptoms. The conduct to be pursued on such an occasion is to give advice
adapted to present circumstances; to interfere no further than is absolutel>
necessary with the general plan of treatment; to assume no future direction
unless it be expressly desired; and, in this last case, to request an immediate
consultation with the practitioner previously employed.

§ 9. — A wealthy physician should not give advice, gratis to the affluent; be-
cause 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 midwifers
Is absent, another is sent for; if delivery is accomplished during the attend-
ance of the latter, he is entitled to fee, but should resign the patient to tho
practitioner first engaged.

Article 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 ter-
minated, they should be referred to the arbitration of a sufficient number ot
physicians or a court-medical.

§ 2. — As peculiar reserve must be maintained by physicians toward the
public, in regard to professional matters, and as there exist numerous points
in medical ethics and etiquette though 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.

Article VII. — Of Pecuniary Acknowledgment.
Some general rules should be adopted by the faculty, in every town or dis-
trict, relative to pecuniary acknowledgments from their patients; and it should
be deemed a point of honor to adhere to these rules with as much uniformity
as varying circumstances will admit.



OF THE DUTIES OF THE PROFESSION TO THE PUBLIC, AND OF
THE OBLIGATIONS OF THE PUBLIC TO THE PROFESSION.

Article I. — Duties of the Profession to the Public.
§ 1. — As good citizens, it is the duty of physicians to be very vigilant for
the welfare of the community, and to bear their part in sustaining its institu-
tions 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 sub-
jects of medical police, public hygiene, and legal medicine. It is their
province to enlighten the public in regard to quarantine regulations; the



910 NATIONAL MEDICAL SOCIETIES.

location, arrangement, and dietaries of hospitals, asylums, schools, prisons,
and similar institutions; in relation to the medical police of towns, as drain-
age, ventilation, etc. ; and in regard to measures for tlie prevention of epi-
demic 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 subject strictly medical — such as involve questions relating to sanity,
legitimacy, murder by poison 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 post-mortem
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 ofSces. Poverty, pro-
fessional brotherhood, and certain of the public duties referred to in the first
section 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 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 tes-
tify to the state of health of persons wishing to insure their lives, obtain
pensions, or the like, without a pecuniary acknowledgment. But to Indi-
viduals in indigent circumstances, such professional services should always bo
cheerfully and freely accorded.

§ 4. — It is the duty of physicians, who are frequent witnesses of the enormi-
ties committed by quackery, and the injury to health and even destruction
of life caused by the use of quack medicines, 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 prescrip-
tions shall be sent, to discourage druggists and apothecaries from vending
quack or secret medicines, or from being in any way engaged in their manu-
facture and sale.

Article II. — Obligations of the Public to Physicians.
§ 1. — The benefits accruing to the public, directly and indirectly, from the
active and unwearied beneficiaries of the profession, are so numerous and im-
portant 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 be
tween 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 a liability to heavy penalties, and of mak-
ing them obnoxious to punishment for resorting to the only means of obtain-
ing it.

EXPLANATORY DECLARATIONS.

Whereas, Persistent misrepresentations have been and still are being made
concerning certain provisions of the Code of Ethics of this Association, by
■which many in the community, and some in the ranks of the profession, are
led to believe those provisions exclude peisons from professional recognition
simply because of differences of opinions or doctrines; therefore,

1. Resolved, That clause first, of Art. IV, in the National Code of Medical
Ethics, is not to be interpreted as excluding 'from professional fellowship, on
the ground of difllerences in doctrine or belief, those who in otlier respects



AMERICAN MEDICAL ASSOCIATION. 911

are entitled to be members of the regular medical profession. Neither Is there
any other article or clause of the said Code of Ethics that interferes with the
exercise of the most perfect liberty of Individual opinion and practice.

2. Resolved, That it constitutes a voluntary disconnection or withdrawal
from the medical profession proper, to assume a name indicating to the
public a sectarian, or exclusive system of practice, or to belong to an associa-
tion or party antagonistic to the general medical profession.

3. Resolved, That there is no provision in the National Code of Medical
Ethics in any wise inconsistent with the broadest dictates of humanity, and
that the article- of the Code which relates to consultations can not be correctly
interpreted as interdicting, under any circumstances, the rendering of profes-
sional services whenever there is a pressing or immediate need of them. On
the contrary, to meet the emergencies occasioned by disease or accident, and
to give a helping hand to the distressed without unnecessary delay, is a duty
fully enjoined on every member of the profession, both by the letter and the
spirit of the entire Code.

But no such emergencies or circumstances can make It necessary or proper
to enter Into formal professional consultations with those who have volun-
tarily disconnected themselves from the regular medical profession, in the
manner indicated by the preceding resolution.

N. S. DAVIS, of Chicago.
A. Y. P. GARKETT, of Washington.
H. F. CAMPBELL, of Augusta, Ga.
AUSTIN FLINT, of New York.
J. B. MURDOCK, of Pittsburg.
On motion of Dr. Brodie the resolutions were unanimously adopted.
On motion of Dr. Keller, It was unanimously agreed that the resolutions
be added as an explanatory addendum in all future publications of the Code.

AMERICAN ACADEMY OF MEDICINE.— Organized in Philadel-
phia September 6, 1876.

OBJECTS. — Its objects are to bring those who are alumni of both classical
and scientific schools into closer relations; to encourage study in classical and
scientific Institutions before taking up the study of medicine; to broaden medical
Bclence and elevate the profession.



Online LibraryMedical Society of the State of New York (1807- )Medical directory of New York, New Jersey and Connecticut (Volume v.3) → online text (page 126 of 128)