#
I 
s/A.
f/r
Hi
/
/ errs
iv  QLl luU  *-v-\^/i  W)-1
 
          y
       '  SYSTEM  OF  ETHICS



C_>»*-wL»/-*L^^^CL^>      op THB
  C^—Uu—^^    .  Ir  .    -

/^P£^^%x
WASHINGTON
    WASHINGTON:

JUCOJi GIDKO.V, JR., PKINTKU.
IS37. 

•   \

        OFFICERS
%

  THE ASSOCIATION.   ;k m\
FREDERICK MAY, President.
NOBLE YOUNG, Secretary.
HARVEY LINDSLY, Treasurer.

         Counsellors.
ALEXANDER McWILLlAMS.
HENRY HUNTT.
THOMAS SEW ALL.
N. P. CAUSIN.
J. C. HALL.  _



        1**1 
REGULATIONS.
   1. The meetings of this Association shall be held on the
first Monday in May, annually, at 12 o'clock M., at such
place within the City of Washington as may be designated
by the President, and on its own adjournments.  At each
meeting any number not  less than five shall constitute a
quorum.
   2. The officers of this Association shall consist of a Pre-
sident, a Secretary, a Treasurer, and five Counsellors, who
shall constitute a  Standing  Committee for  the purposes
hereafter mentioned ; and who shall be elected by ballot,
by a majority of the members present at the stated meet-
ing in  May in each year.
   3. The President shall preside at all meetings of the
Association and of the  Standing Committee.  In his
absence a chairman shall be chosen  from the members
present.
   4. The Secretary shall keep a record of the proceedings
of the Association and of those of the Standing Committee.
He shall give notice of both  stated and special meetings of
the association, by advertising the same at least three times
in one of the public newspapers ; and  shall send a written
or printed notice  of all meetings of  the Standing Com-
mittee to each of its members.  The  Treasurer shall col-
lect all assessments, and disburse the same  on the order
of the  President ;  and, at the stated meeting in May, he
shall render to the Association an account of all the funds
received, with the vouchers for his disbursements.
  5. It shall be the duty of the Standing Committee to
attend to and decide on all matters which regard the honor 
4
and interest of the Association ; and especially all infringe-
ments of its regulations, which may come to their know-
ledge ; and to require special meetings of the Association
when they may think proper.   In all cases, however, an
appeal may be made from the judgment of the Committee
to the Association.  This committee may fill any vacancy
in the number of counsellors, or in the office of Secretary,
until the  next stated meeting of the Association.
  6. Should  the  Standing Committee find any member
guilty of a wilful violation of the rules of the Association,
they shall immediately call a special meeting  of  the so-
ciety, to whom they shall report the facts and the evidence
adduced; and should their decision be confirmed by two-
thirds of the  members present, the person  accused shall
be expelled from the Association.
  7. The Standing Committee shall assess  the  amount
required  for  the contingent  expenses of the Association
equally upon  all the members ; provided the amount of
such assessment shall in no one year exceed the  sum of
two dollars ; and if any one shall refuse or neglect for the
period of two years to pay his assessment, his connection
with the  Association shall thereupon cease ; and the Sec-
retary shall inform the members of the same by a circular
tiote ; and the assessment left unpaid shall become a charge
against .the association.
  S. The Standing Committee shall, at the stated meeting
in May, submit to the Association all their acts and  pro-
ceedings  during the preceding  year.
  9. Special  meetings of the Association  may  be called
by the President, when required by the Standing Com-
mittee or on the written application of three members of
the society.   Meetings of the  Standing Committee shall
be called  at  the  discretion  of the  President or  on the
written application of two of its members.
  10. If any member becomes acquainted with the con-
duct of another, which he considers a breach of the rules
and regulations of this Association, it shall be his duty to 
o
make it known to the Standing Committee;  who  shall
inquire into the case  and decide upon the same as they
may think proper.
   11.  The members  of this Association shall  charge for
their professional services the fees in the following table,
subject, however, to  the several rules contained in this
code relative to the same :
For visit and prescription, -
    First consultation visit,      ...
    Do.   do. beyond the limits of the city,
    Each subsequent consultation visit,
    Venesection or extracting a tooth,
    Prescription,venesection,dressingawound,
       and extracting a tooth at the physician's
       house,    -.....
    Visit and passing the catheter or bougie,
    Do.  often repeated,  -
    Visit, for every mile from the centre of
       the city in addition to ordinary fee,  -
    Rising in the night and advice at physician's
       house in addition to ordinary fee,*
    Do.  and visit,  -
    Do.  and consultation visit, -

    Attendance at patient's house during the /
       night,......C

    Case of gonorrhoea,    -
    Case of syphilis, -
    Case of midwifery in the day,
    Do.  if any part of the attendance be in
       the night,     -
    Capital operations, as amputating  large ~)
       limbs,  lithotomy, trepanning, or ex->
       cision of large tumors,              )
    Reducing fractures or luxations,  fistula in
       ano,  tapping for dropsy,   -
    Amputating fingers  and toes, ruducing
       hernia, excision of small tumors,
    Stitching recent wounds, opening  abces-
       ses, introducing seton or issue,  -
    Each subsequent dressing,
    Vaccination,     -
Dolls.
  * The night ia this table is considered as beginning at 10 o'clock
P. M-, and ending at sunrise. 
t'i
  The foregoing table is intended to state the lowest fees
which shall be demanded, subject, however, to the deduc-
tion hereafter mentioned. And it shall in all cases be the
duty of every practitioner to increase them in proportion
to the importance of the case, the responsibility attached
to it, or the extraordinary detention  and attendance re-
quired.   It is not, however, designed to prevent gratui-
tous services to those who are incapable of making remu-
neration without distressing themselves or families.   But
when the physician believes that the patient  cannot afford
to pay  the regular fees, and yet is  able to make some
compensation, he may make such deduction as the circum-
stances  of the patient require.
  12. No one shall omit to charge every visit on account
of the number made in one day j and whenever more than
three daily visits are made after obstetric cases, they shall
be charged as in ordinary cases.
  13. When a physician engaged to attend a case of mid-
wifery is absent and a second delivers the patient, the lat-
ter  shall receive the fee and relinquish the patient to the
first.  If he arrive before the patient is delivered, the se-
cond shall resign the patient to the first.   In cases where
the child is delivered and not the placenta, the whole fee
is to be charged,  but if both be delivered before the ar-
rival of the  physician, he may charge half or the whole
fee  according to the circumstances.   In cases where a con-
sulting physician is called in, both the attending  and con-
sulting  physician  shall  charge at least the ordinary fee
for delivery; but when the latter is not detained in attend-
ance, he should only charge the usual fee for consultation.
  14. It shall be the duty of every  member of this Asso-
ciation to present all accounts, and to  endeavor  to obtain
a settlement of the same at least once  in every year.
  15. No member of this Association shall  make a con-
tract to  attend an  individual or a family by the year  or
on any  other terms than those authorized by these regu-
lations. 
7
  16. No member of this Association shall consult with,
or meet in  a professional way, any  practitioner of this
city who is not a member thereof.
  17. All applications for membership shall be made in
writing to the President.
  18. All resignations of members shall be made in writ-
ing to the President, by whom they shall immediately be
laid  before  the Standing Committee, who  shall either
notify each member of the Association, or call a meeting
of the society as they may think proper.
  19.  All propositions for repealing, altering,  or amend-
ing these regulations  shall be made  in  writing at the
stated meeting in May, and shall be  acted  on at an ad-
journed meeting, which shall not take place until at least
one month from that at which the proposition  was made;
and it shall  then require the concurrence of  two-thirds of
the members present for its adoption.
  20 Every practitioner at the time of becoming a mem-
ber of this Association shall sign the following obligation,
viz: The undersigned do approve of the regulations and
system of Medical Ethics adopted by the Medical Asso-
ciation of Washington, and do agree  on their honor to
comply with the same. 
8
wm,®u©&&  ifiniis^
              CONSULT AT IONS.

  Consultations should be encouraged in difficult and pro-
tracted 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 phy-
sician who first attended; and as he may be presumed to
be the  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  con-
sulting physician  to  propose the necessary questions to
the sick.
  The consulting  physician should propose the times of
his  subsequent visits, and  decide upon the propriety of
discontinuing his attendance; but he is never to visit with-
out 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 pa-
tient or his friends; and no prognostications should be de-
livered which  were not the result of previous delibera-
tion and concurrence.  Theoretical debates, indeed, should
generally be avoided in consultation, as occasioning per-
plexity 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 hy-
pothesis,  but on experience and observation.  Physicians
in consultation, whatever may  be their private resentment
or opinions of one another, should divest  themselves of 
9
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 confi-
dence  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 concur-
rent opinion may fix his  own.   But when  such mutual
confidence  is wanting,  a  consultation had better  be  de-
-clined, especially if there is reason to believe that senti-
ments 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 consul-
tation  visits; and to avoid loss of time, it will be expe-
dient to establish the space oi fifteen minutes, as an allow-
ance for  delay, after which, the meeting might be consid-
ered 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 oi assiduities and attentions,
therefore, to families usually employing another, is to be 
10
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 charac-
ter 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 pur-
sued that may directly  or indirectly tend to weaken  con-
fidence in the physicians or surgeons who  have the  care
of them.
   When a physician is  called to a patient  or family that
has been under the care of another gentleman of the fac-
ulty, before any  examination of the case, he should ascer-
tain 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 pro-
bity and truth will permit; for the  want of  success in the
primary treatment of the disorder, is no impeachment of
professional skill and knowledge.
   W hen a physician  is called to a patient in  a case of emer-
gency, he should, on the arrival of the family physician
or of the one who may have been previously called in,
relinquish the patient to the latter.
   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. 
11
      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 profes-
 sion, and expose the faculty itself to contempt and ridi-
 cule.  Whenever  such  differences occur,  as  may effect
 the honor and dignity of the profession and cannot imme-
 diately be terminated, or do  not  come under the charac-
 ter 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 Asso-
 ciation, 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 pub-
 lic, 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 mys-
 tery alone give it value  and importance, such  craft  im-
 plies either disgraceful ignorance, or fraudulent avarice.

CONDUCT  FOR  IHE   SUPPORT  OF  THE
           MEDICAL  CHARACTER.

  The esprit du  corps is a principle of action, founded in
human nature, and when duly regulated, is  both rational
and  laudable.   Every man  who enters into a  fraternity, 
12
engages, by a  tacit compact, not only to submit  to the
laws, but to promote the honor, and interest of the Asso-
ciation, 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 con-
cerning 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 honer to ad-
here to them; and every deviation  from,  or evasion of
these rules, should  be  considered as meriting the indig-
nation and contempt of the fraternity.
  Gratuitous services to the poor are by no means pro-
hibited;  the characteristical beneficence of the profession
is inconsistent with sordid views and avaricious rapacity.
  It is obvious also that an average fee, as suited to the
general rank of patients, must be an inadequate compensa-
tion from the rich, (who often require attendance not ab-
solutely necessary) and yet too large to be expected from
that class of citizens, who would feel a reluctance in  call-
ing for assistance without making some  decent and satis-
factory remuneration.

      EXEMPTION  FROM   CHARGES.

   The clergymen of the City and all members  of the
 medical profession within it,  together with their families,
 should be attended gratuitously; but visits should  not be
 obtruded officiously, as such civility may give rise  to em-
 barrassments, or interfere with that choice on which con-
 fidence depends. 
13
  But distant members of the faculty, when they request
attendance,  should be expected  at  least to defray the
charges of travelling; and such  of the clergy as are quali-
fied by their fortunes or incomes to make a reasonable re-
muneration  for medical  attendance, are not  more privi-
leged than any  other order of patients.
  Omission to  charge on account of  the wealthy circum-
stances of the physician is an injury to the profession, as
it is defrauding in a degree the common funds for its sup-
port,  when  fees are dispensed with which might justly be
claimed.

          VICARIOUS  OFFICES.

  Whenever a physician officiates for another by his de-
sire, in consequence of sickness or absence, if for a short
time  only,  the attendance should be  performed gratui-
tously as to the physician, and  with the utmost delicacy
towards the  professional character of the gentleman pre-
viously connected with the patient.

                  SENIORITY.

  A regular and  academical education furnishes the only
presumptive evidence of professional  ability, and is so
honorable and beneficial that it gives a just claim to pre-
eminence among physicians at  large, in proportion  to the
degree in which it may be enjoyed  and improved.   Ne-
vertheless, as industry and talents may furnish exceptions
to this general  rule, and this method  may be liable to diffi-
culties in the  application,  seniority among practitioners
of this city  should be determined by the period of public
and acknowledged practice as  a physician or surgeon in
the same.   This  arrangement being  clear and obvious, is
adapted to remove all grounds of dispute amongst  medi-
cal gentlemen;  and it secures the regular continuance of
the established  order of precedency. 
14
  We, the undersigned, do approve  of the Regulations
and System of Medical Ethics adopted by the Medical
Association of the City of Washington, and do agree, on
our honor, to comply with the same.
                            Thos. J. Boyd,t M. D.
                            W. B. McGruder, M. D.
                            L. Orsborne,t M. D.
D.
D.
D.

D.
D.
Fred. May, M. D.
Alex. McWilliams,
George W. May, M.
Wm. Jones, M. D.
H. Huntt, M. D.
Joseph  Lovell,* M.
Nath. P. Causin, M.
Richmond Johnson,
Thomas Sevvall, M.
Thos. C. Scott,* M.
Thos. Henderson,! M. D.
Harvey Lindsly, M. D.
N. Young,  M. D.
Jas. C.  Hall, M. D.
Thos.  Miller, M. D.
Alex. McD. Davis, M. D.
Joseph  Borrows, M.  D.
H. N. Waters, M. D.
Fred.  Dawes,t M. D.
H. F.  Condict, M. D.
Henry  Haw, M. D.
J. Waring,! M. D.
Wm. Baker, M.  D.
B. J Miller,* M. D.
R. T. Barry, M.  D.
B. King, M. D.
Geo. R. Clarke,t M. D.
Albert Dornian, M. D.
Mor. Forrest,t M. D.
J. G. Coombs, M.  D.
Chas. McLean,! M. D.
M.  L. Weems, M.  D.
B. Washington,! M. D.
J. A. Kearney, Surgeon.
C. McCormick,! M. D.
Jas. Hagan,! M. D.
J.  M. Foltz, M. D.
G. B. McKnight, M. D.
Sam. Jackson, M. D.
A. J. Schwartze,! M. D.
T. D. Jones, M. D.
Wm. Drain, M. D.
J.  M. Roberts, M. D.
B. Randall, M. D.
J. M. Thomas,* M. D.
J. M. Munding.
* Deceased.       ! Absent from the city. 
 
NLM009888586