BY-LAAV S, RULES AND REGULATIONS OF THE DISTRICT MEDICAL SOCIETY FOR THE COUNTY OF/SUSSEX. PUBLISHED BY ORDER OF THE SOCIETY. NEWTON, N. J., PRINTED BY B. B. EDSjlLL & GO., “SUSSEX REGISTER” OFFICE. 1867. BY-LAWS, i - - '■ * * RULES AND REGULATIONS OF THE DISTRICT MEDICAL SOCIETY »« » FOR THE COUNTY OF SUSSEX. PUBLISHED BY OEDEB OF TIIE SOCIETY. NEWTON, N. J., PRINTED BY B. B, EDSALL & CO., “SUSSEX REGISTER” OFFICE. 18.(37- BY-LAWS ANI) RULES OF ORDER OF THE DISTRICT MEDICAL SOCIETY FOR THE COUNTY OF SUSSEX. REVISED JUNE 18th, 1867. Article 1. This Society shall be styled “The District Medical Society for the County of Sussex,” and shall he composed of at least five persons, residents of said county, and holding the degree of M. D., according to the act incorporating “ The Medical Society of New-Jersey,” which took effect on the fourth Tuesday of January, 1866; provided, that any person who was a member in good stand- ing of this Society prior to the passage of said act, shall retain his membership. Art. 2. The officers of this Society shall consist of a President, a Vice President, a Secretary, and a Treas- urer, who shall hold their offices for one year and until their successors shall have been elected. Art. 3. The President shall perform all the customary duties appertaining to. that office in voluntary societies, and such others as may be hereinafter prescribed. He shall open the annual meetings of the Society with an es- say upon some subject connected with the medical science or art, or a written clinical report of disease. 4 Art. 4. In the absence of the President, the Vice Pre- sident shall perform all his duties; when both these offi- cers shall be absent, a President pro tempore shall be ap- pointed. Art. o. The Secretory shall keep minutes of each meet- ing, and record them, when approved, in a book of records, and shall perform all the customary duties of a Secretary, and such others as may be herein prescribed. He shall send to the Recording Secretary of the State Society, on or before the third Tuesday of May annually, a certificate containing the names and post office address of each mem- ber of this Society, and the names of the persons ap- pointed to represent it in the Medical Society of New Jersey. Art. G. The Treasurer shall collect all the moneys due this Society, and disburse the same, agreeably to its or- ders, as certified by the presiding officer. He shall keep in a book for that purpose, a regular account of his re- ceipts and disbursements, and report the same, together with the balance between them, at the annual meeting, or oftener, if the Society demand, and shall deliver to his successor all books, papers or moneys, in his hands, as the property of the Society. lie shall, either personally or by the hands of the delegates, pay to the Treasurer of the vState Society, on or immediately before its annual meet- ing, the amount assessed by it upon this Society, giving said assessment precedence over all other appropriations. Art. 7. The annual meetings of this Society shall be held at Newton, on the second Tuesday of June, at the hour and place designated by the Society. Occasional meetings shall be called by the President upon the writ- ten request of three members, or when ordered by the Society. Notice of the time and place of every meeting, signed by the President and Secretary, shall be published in the county papers for two weeks previous to the meeting. Art. 8. All the officers of the Society shall be elected by ballot, by a majority of those present ; but if, on the first ballot, no one shall have a majority of the votes for any office, the highest two shall remain on nomination, to be balloted for. Art. 9. Every member, on his admission, shall pay an initiation fee of two dollars, and in each subsequent year such sums as a majority of two-tliirds present shall assess upon the members. Aut. 10. Five members shall constitute a quorum. Art. 11. One member shall be appointed at each annual meeting, to hold office .until the appointment of his suc- cessor, who shall furnish in writing to the Chairman of the Standing Committee of the State Society, on or be- fore the first day of May, annually, whatever information may be attainable within the bounds of this Society, re- lative to the subject matters of the report of said Stand- ing Committee. Art. 12. Two or more members shall be annually, ap- pointed to make a written report to the Society, at its next annual meeting, of the prevalent diseases of the'different seasons, and their requisite treatment, and of such other interesting facts pertaining to medical science as they may have learned. Art. 13. An essayist shall be annually appointed, whose subject shall be assigned to him by the Society; and his essay shall be read at the annual meeting or at a special meeting called for the purpose. It shall be a point of honor with all the members to prepare themselves for a full discussion of the said subject at the time of the read- ing of the essay. Art. 14. If any member inexcusably absent himself from any meeting, or neglect any duty assigned to him, he shall be fined one dollar. Art. 15. If the reporter to the State Society, or a dele- gate thereto, inexcusably neglect his duty, he shall be fined five dollars. Art. 16. Certificates of membership, signed by the Pre- sident and Secretary, shall, when required, be issued to those entitled to them. Art. 17. No one shall be entitled to a certificate of membership or to a vote on any question, while in arrears to the Society. 5 6 Art. 18. The Society, by a vote of three-fourths pre- sent, may suspend or expel a member; provided, that such member shall have had due notice of, and a fair opportu- nity for defence against, the charge preferred. Art. 19. It shall be considered censurable and dishon- orable for a member to hold professional intercourse with any resident practitioner who wilfully neglects to apply for membership in this Society, or who has been justly re- fused admission, or with any irregularly bred pretender to medical science, or any expelled member of any affiliated society, or to violate the code of ethics of this Society, or its fee bill, or to disclose such of its confidential proceed- ings as have reference to the professional character and standing of any of its members. Art. 20. The Code of Ethics of the American Medical Association, and the Fee Bill of this Society shall be a part of these By-Laws. Art. 21. No member shall prescribe for any person, or his family, who refuses or persistently neglects to pay for professional services that shall have been rendered to him or bis family, by another member, provided that he shall have received written notice of such refusal or neglect, from the member thereby defrauded. Art. 22. It shall be deemed censurable and highly de- rogatory to professional character, for a member in any way to further the use of means for preventing concep- tion, or, without counsel, to prescribe any emmenagogue, where the fact of pregnancy may or ought to be suspected, or to neglect to use any available means of resuscitating the suspended animation of a new-born infant. Art. 23. Any member who shall undertake any obstet- rical operation or any other interference with gestation, which will probably destroy the viability of the foetus, without the sanction of another practitioner recognized by this Society, shall be publicly expelled from it; provi- ded, that if the circumstances of the case were, in the Society’s judgment, incompatible with obtaining such sanction, he shall not be so expelled. Art. 24. The delegates of this Society to any Medical 7 Society or Convention shall have power to fill vacancies in their delegation, and this rule shall be embodied in their certificate of delegation. Art. 25. The rules of order in general use in public as- semblies shall govern this Society, except as otherwise spe- cified in the By-Laws. Art. 26. The following shall be the order of business at the annual meeting, viz: 1. Calling the roll. 2. Reading of the minutes of the last annual and the intervening meetings. 3. President’s opening exercise. 4. Recess. 5. Collection of dues. 6. Reports. 7. Volunteer communications. 8. Making appointments. 9. Miscellaneous business. 10. Election of officers. 11. Adjournment. The roll shall also be called at the beginning of all spe- cial meetings. This order may be suspended by the So- ciety. Art. 27. These By-Laws may be amended by a majority of two-thirds of those present at any annual meeting or meeting called expressly for that purpose. CODE OF ETHICS OF THE NATIONAL MEDICAL ASSOCIATION ; ADOPTED ALSO BY THE MEDICAL SOCIETY OF NEW-JERSEY, AND THE DISTRICT MEDICAL SOCIETY FOR THE COUNTY OF SUSSEX. Art. I.—Duties for the suppoi't of professional character. § 1. Every individual, on entering the profession;, as he becomes thereby entitled to all its privileges and im- munities, incurs an obligation to exert his best- abilities to maintain its dignity and honor, to exalt its standing, and to extend the bounds of its usefulness. He should, there- fore, observe strictly such laws as are instituted for the government of its members; should avoid all contumeli- ous and sarcastic remarks relative to the faculty, as a body; and while, by unwearied diligence, lie resorts to every hon- orable means of enriching the science, he should enter- tain a due respect for his seniors, who have, by their la- bors, brought it to the elevated condition in which he finds it. § 2. There is no profession, from the members of which greater purity of character, and a higher standard of mo- ral excellence are required, than the medical; and to at- tain such eminence, is a duty every physician owes, alike to his profession and to his patients. It is due to the lat- ter, as without it he cannot 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 upon the faculty to be temperate in all things; for the practice of physic requires the unremit- 9 ting exercise of a clear and vigorous understanding; and, on emergencies, for which no professional man should be unprepared, a steady hand, an acute eye, an unclouded head, may he essential to the well-being, and even to the life, of a fellow creature. § 3. It is derogatory to the dignity of the profession to resort to public advertisements or private cards or hand- bills, inviting the attention of individuals affected with particular diseases, publicly offering advice and medicine to the poor gratis, or promising radical cures; or to pub- lish cases and operations in the daily prints, or to suffer such publications to be made; to invite laymen to be pre- sent at operations, to boast of cures and remedies, to ad- duce 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 phy- sician. § 4. Equally derogatory to professional character is it, for a physician to hold a patent for any surgical instru- ment or medicine, or to dispense a secret nostrum, whether it be the composition or exclusive property of himself or of others. For, if such nostrum be of any efficacy, any concealment regarding 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. Art. II.—Professional services of physicians to each other § 1. All practitioners of medicine, their wives and their children, while under the paternal care, are entitled to the gratuitous services of any one or more of the faculty re- siding near them, whose assistance may be desired. A physician afflicted with disease, is usually an incompetent juage of his own case; and the natural anxiety and soli- citude which lie experiences at the sickness of a wife, a child, or any one who by the ties of consanguinity, is ren- dered peculiarly dear to him, tend to obscure his judgment, and produce timidity and irresolution in his practice. Un- 10 fler such circumstances medical men are peculiarly depen- dent upon each other, and kind offices and professional 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 circum- stances are affluent, request attendance, and an honorarium be offered, it should not be declined; for no pecuniary ob- ligation ought to be imposed which the party receiving it would not wish to incur. % Art. III.—Of the duties of physicians as respects vica- rious 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 tempo- rarily 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 con- sideration for the interest and character of the family phy- sician, and when exercised for a short period, all the pe- cuniary obligations for such service should be awarded to him. But if a member of the profession neglect his busi- ness in quest of pleasure and amusement, he cannot 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 phy- sician who officiates. Art. IV.—Of the duties of physicians in regard to con- sultations. § 1. A regular medical education furnishes the only presumptive evidence of professional abilities and acquire- ments, and ought to be the only acknowledged right of an individual to the exercise and honors of his profession. Nevertheless, as in consultations the good of the patient 11 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 this association, and who is in good moral and professional standing in the place in which he resides, should be fas- tidiously excluded from fellowship, or his aid refused in consultation, when it is requested by the patient. But no one can be considered a regular practitioner, or a fit asso- ciate in consultation, whose practice is based on an exclu- sive dogma, to the rejection of the accumulated experience of the profession, and of 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 op- portunity to make such further inquiries of the patient as may be necessary to satisfy him of the true character of the case. Both physicians should then retire to a private place for deliberation; and the one first in attendance should communicate the directions agreed upon to the pa- tient or his friends, as well as any opinions which it may be thought proper to express. But no statement or dis- cussion of it should take place before the patient or his friends, except in the presence of all the faculty atrend- ing, and with their common consent: and no opinions or prognostications should be delivered, which are not the re- sult, of previous deliberation and concurrence. § 4. In consultations, the physician in attendance should deliver his opinion first : and when there are several con- sulting, they should deliver their opinions in the order in Which they have been called in. 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 de- mand. But such variation, and the reason for it, ought to be carefully detailed at the next meeting in consulta- 12 lion. The same privilege belongs also to the consulting physician if he is sent for in an emergency, when the reg- ular attendant is out of the way, and similar explanations must he made by him at the next consultation. § 5. The utmost punctuality should be observed in the visits of physicians when they are to hold consultation to- gether, and this is generally practicable, for society has been considerate enough to allow the plea of a professional engagement to take precedence of all others, and to be an ample reason for the relinquishment of any present occu- pation. But, as professional engagements may sometimes interfere and delay one of the parties, the physician who first arrives should wait for his associate a reasonable period, after which the consultation should be considered as post- poned to a new appointment. If it be the attending phy- sician who is present, he will of course see the patient and prescribe; but if it be the consulting one, he should retire, except in cases of emergency, or when he has been called from a considerable distance, in which latter case he may examine the patient, and give his opinion in writing adn under seed, to be delivered to his associate. § 6. In consultations, theoretical discussions should be avoided, as occasioning perplexity and loss of time ; for there may be much diversity of opinion concerning spec- ulative points, with perfect agreement in those modes of practice, which are founded, not on hypothesis, but on ex- perience and observation. § 7. All discussions in consultation should be held as secret and confidential. Neither by words nor manner should any of the parties to a consultation assert or in- sinuate, that any part of the treatment pursued did not receive his assent. The responsibility must be equally di- vided between the medical attendants—they must equally share the credit of success as well as the blame of failure. §. Should any irreconcilable diversity of opinion occur when several physicians are called upon to consult to- gether, the opinion of the majority should be concidered as decisive; but if the numbers be equal on both sides, then the decision should rest with the attending physi- cian. It may, moreover, sometimes happen that two phy- sicians cannot agree in their views of the nature of a case, 13 and the treatment to be pursued. This is a circumstance much to be deplored, and should always be avoided, if pos- sible, by mutual concessions, as far as they can be justi- fied by a conscientious regard for the dictates of judg- ment. But, in the event of its occurrence, a third physi- cian should, if 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 phy- sician relies upon the rectitude of his judgment, lie should, when left in a minority, politely and consistently retire from any further deliberation in the consultation, or par- ticipation in the management of the case. § 9. As circumstances sometimes occur to render a spe- cial consultation desirable, when the continued attendance of two physicians might be objectionable to the patient, the member of the faculty whose assistance is required in such cases, should sedulously guard against all future un- solicited attendance. 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 practitioner in attendance; the practice of the latter, if necessary, should be justified as far as it can be, consistently with a conscientious regard for truth, and no hint or insinuation should be thrown out which could impair the confidence reposed in him, or af- fect his reputation. The consulting physician should also carefully refrain from any of those extraordinary atten- tions or assiduities which are too often practiced by the dishonest for the base purpose of gaining applause, or in- gratiating themselves into the favor of families and indi- viduals. Art. 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 qualifications, not on intrigue or artifice. § 2. A physician, in his intercourse with a patient under the care of another practitioner, should observe the strict- est 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 physician employed. § 3. The same circumspection and reserve should be ob- served when, from motives of business or friendship, a physician is prompted to visit an individual 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 an- other 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, tinder such circumstan- ces, no unjust and illiberal insinuations should be thrown out in relation to the conduct or practice previously pur- sued, which should be justified as far as candor ajfcl regard for truth and probity will permit; for it often happens that patients become dissatisfied when they do not experi- ence immediate relief, and as many diseases are naturally protracted, the want of success, in the first stage of treat- ment, affords no evidence of a lack of professional knowl- edge and skill. § 5. When a physician is called to an urgent case, be- cause the family attendant is not at hand, he ought, un- less 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 cases of sudden illness, or of recent accidents and injuries, owing to the. alarm and anxiety of friends, that a number of physicians are si- multipieously sent for. Under these circumstances, cour- tesy should assign the patient to the first who arrives, who should select from those present any additional assistance 14 that he may deem necessary. In all such cases, however, the practitioner who officiates should request the family physician, if there he one, to he called, and, unless his fur- ther attendance be requested, should resign the case to the latter on his arrival. >5 7. When a physician is called to the patient of an- other practitioner, in consequence of the sickness or ab- sence of the latter, he ought, on the return or recovery of the regular attendant, and with the consent of the pa- tient. to surrender the case. § 8. /V physician, when visiting a sick person in the country, may he desired to see a neighboring patient who is under the direction of another physician, in conse- quence of some sudden change or aggravation of symp- toms. The conduct to be pursued on such an occasion is to give advice adapted to present circumstances; to inter- fere no further than is absolutely necessary with the gen- eral plan of treatment; to assume no future directions, unless it he expressly desired; and, in this last case, to re- quest an immediate consultation with the practitioner previously employed. § 9. A wealthy physician should not give advice gratis to the affluent; because 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 sup- port. when fees are dispensed with which might justly be claimed. § 10. When a physician who has been engaged to attend a case of midwifery, is absent, and another is sent for, if delivery is accomplished during the attendance of the lat- ter, he is entitled to the fee, but should resign the patient to the practitioner first engaged. Art. VI.—Of differences between Physicians. § 1. Diversity of opinion, and opposition of interests, mav, in the medical as in other professions, sometimes oc- casion 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 of physicians, or a court-medical. 15 16 g 2. As peculiar reserve must be maintained by physi- cians towards the public, in regard to professional matters, and as there exist numerous points in medical ethics and etiquette through 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 in- jurious to the individuals concerned, and can hardly fail to bring discredit on the faculty. Art. VII. Of pecuniary acknowledgments. Some general rules should be adopted by the faculty in every town or district, relative to pecuniary acknowledg- ments from their patients; and it should be deemed a point of honor to adhere to these rules with as much uniform- ity as varying circumstances will admit. FEE BILL OF THE DISTRICT MEDICAL SOCIETY FOR THE COUNTY OF SUSSEX. ADOPTED JUNE 18th, 1807. OFFICE AND MISCELLANEOUS BUSINESS. Verbal advice in office is discretionary with the practitioner. Advice by letter, discretionary, Opinion in Medical Jurisprudence, $5 00 Certificate as family physician, in life insurance, 1 00 Certificate for beneficial societies, 1 00 Dividing gums, 0 50 Leeching, besides leeches, 1 00 Cupping, 1 00 Venesection, 1 00 Vaccination of one person at office, 1 00 Additional for other persons on one account, 0 50 Secondary do., 1 00 Besides fees for all visits, and mileage in addition, if practitioner choose to charge it. Examination of chest, 1 00 “ “ womb or rectum, 1 00 Specular examination of ditto first time, 3 00 “ “ “ subsecpiently, 1 00 Instrumental examination of eye or ear, 1 00 Application to or minor operation on throat, eye, or ear, 1 00 Application to womb or rectum, besides fee for spe- cular examination, 1 00 18 Application of galvanic battery, 1 00 Introduction of issue or seton, 2 00 Removing foreign body from pharynx, nose or ear, 1 to 5 00 Excising uvula, 2 00 “ each tonsil, 5 00 Opening an abscess, 1 00 to 5 00 Gonorrhoea, first prescription, besides medicine, 5 00 Syphilis, “ “ “ “ 10 00 The last two payable in advance. Applying a truss, 1 00 Post-Mortem, 10 00 “ if the subject is exhumed, 40 00 These charges apply only to cases demanded by the friends of de- ceased or the public authorities. When physicians and friends both de- sire a post-mortem, the fees are left discretionarj-. Catheterism, 1 00 Use of stomach pump, 10 00 Production of full general amesthesia, 5 00 “ partial or local “ 1 00 GENERAL PRACTICE. Ordinary visit, $1 00 If the distance exceeds a mile, add per mile, 0 25 Visits in haste or under peculiar circumstances, to be charged higher. Prescriptions for other patients in a family, at same time, each, 0 50 Visits after 10 o’clock, P. M., and before sunrise to be double. Attendance all night, 2 00 to 5 00 Detention beyond time for ordinary visit, between sunrise and 10 o’clock P. M., per hour, 1 00 Visit in small-pox to be double. Consultation visit, 5 00 Subsequent “ 2 50 Mileage in consultations discretionary. The attending physician is privileged to charge the consultation fee. MIDWIFERY. Ordinary obstetrical case, 6 00 Delivery of placenta only, 6 00 Attendance in abortion, 6 00 Laborious attendance over six hours, additional per hour, 1 00 Version, forceps, or vectis, 10 00 Extreme preternatural or instrumental case, 20 00 19 Twins, 10 00 Consultation in obstetrics, (mileage discretionary,) 6 00 Visit when called too late, half prie6, (mileage discretionary.) SURGERY. Simple fracture of Humerus, 10 00 “ “ Ulna and Radius, 10 00 “ “ Femur, 20 00 “ “ Tibia and Fibula, 15 00 “ “ Olecranon or Patella, 10 00 “ “ Radius, (Colles,) 10 00 “ “ Fingers or Toes, 3 00 “ « Clavicle, 10 00 “ “ Lower Jaw, 10 00 “ “ Nose, 5 00 Luxation of Femur, 20 00 “ Knee, 10 00 “ Patella, 5 00 “ Ankle, 5 00 “ Humerus, Elbow, or Wrist, 5 00 “ Jaw, 5 00 “ Fingers and Toes, 3 00 Luxations or fractures of both limbs to be in proportion. Compound ditto, one-half more than simple, besides the dallv dressings to be pro- portionate to injury. Subsequent visits in simple fractures to be charged at the rates for ordinary visits. Amputations and all other surgical operations shall be regulated by the fee bill of the State Society, which bill is also to be considered as the maximum rate of charge in all cases, whilst the specifications in the bill of this So- ciety shall be considered as the minimum. The rates for all persons not directly or indirectly re- sponsible under the laws of the State, or for members of their families, shall be discretionary with each practitioner. An Eleemosynary Institution maintained by the public authorities is not to be served by contract, except it em- ploy a resident physician, but is to be considered as a sin- gle family, and charged accordingly. No member shall make any contract for his professional services with an individual, or private firm, or corporation, by the day, week, month, or year, nor on any terms incon- sistent with this fee bill. Any number of visits in a day shall be charged at the foregoing rates, since cases requiring extra visitations in- volve unusual responsibility, and the extra visits must generally be made at inconvenient hours. The rates for medicines furnished shall be discretionary with each practitioner. It is earnestly recommended to each practitioner to pre- sent his bills for professional services, at least once in six months. 20