MEDICAL ETHICS.

Dr. Aikenhead.

639

"That two books, to which are appended copies of these resolutions, and of the proposed bye-laws, shall be deposited, the one at Messrs. Simms and Dinham's, the other at the Reading Rooms of the Medical Society, and that any members of the profession who enrol their names and professional titles in the same, prior to November the 18th, shall become ipso facto members of this Association; provided, nevertheless, that any three gentlemen so enrolled, may, at the first meeting of the Association, demand a ballot on the admission of any one whose name appears in the list."

Are we not as well educated as the clergy, and is not Moved by W. C. Williamson, Esq., seconded by our position in life really as valuable as theirs? (Hear, hear.) I grant that the soul of man is superior to his body, but a great deal may be said about his body too. (Hear, hear.) I do not object to the clergyman getting £200; it doubtless is his due. But why should not the medical officer get £200 also? And here let one fact be mentioned without stating where it occurred :-A poor woman had typhus fever. The medical man considered that she was not in a condition to receive the clergyman's visits, and could not advise him to go. But she got better, and then she had a desire to see him. His answer was, "No, no; it is fever. I shall not go; I might take it home." (Hear, hear.) No one present would grudge a clergyman his fair salary, (hear, hear,) but it ought to be remembered, in comparing the two cases, that a medical man has not any such privilege as this. No. The board of guardians would say to the medical officer, if he hesitated on the score of contagion, "Sir, we pay you for these duties, and we expect you to perform them." And, is not the clergyman paid also? But no Board interposes its dictum to command obedience in his case. (Hear, hear.)

MEDICAL ETHICS.

MANCHESTER MEDICO-ETHICAL ASSOCIATION.

Moved by J. G. Harrison, Esq., seconded by Dr. Browne.

"That the first meeting of the Association be held in the Law Society's Room, on Thursday, the 18th of November, at six o'clock in the evening, when the members will determine on the general laws, and elect the officers of the Association; and that the Honorary Secretary be instructed to give to each member three days' notice of such meeting."

Moved by G. Southam, Esq., seconded by J. Bent, Esq.

"That a report of this meeting be forwarded by the Honorary Secretary, to the Medical Periodicals, with a request for its insertion."

After votes of thanks had been severally passed to the Provisional Committee, Honorary Secretary, and Chairman, the proceedings of the evening, which had been conducted with the greatest unanimity and good feeling, were terminated by upwards of thirty gentlemen enrolling their names as members of the Association.

A large and influential meeting of the members of the profession, convened by public advertisement, was held at the Law Society's Rooms, Manchester, on Thursday evening, the 28th ult., to receive the report of the Provisional Committee, appointed August 4th, to frame laws and regulations for the government of a Medico-Ethical Association. The chair was taken by Dr. J. L. Bardsley, and after the report had been read, the following resolu- PROPOSED BYE-LAWS OF THE MANCHESTER MEDICOtions were unanimously passed.

Moved by J. Windsor, Esq., seconded by R. T. Hunt, Esq. "That the principal objects of the Association be, to frame a code of etiquette for the guidance of its members; to decide upon all questions of usage or courtesy in conducting medical practice; to support the respectability and maintain the interests of the profession; to promote fair and honourable practice; to correspond with bodies or individuals in other parts of the kingdom on any matter touching professional interests, and by its moral influence and the exercise of a judicious supervision, to prevent abuses in the profession."

Moved by W. Wilson, Esq., seconded by D. Noble, Esq. "That all medical practitioners resident in Manchester, or within twenty miles of that city, who possess a degree, diploma, or license from any legally constituted corporate institution in the United Kingdom, or from any foreign university, requiring residence or examination to obtain its diploma, and who shall be admitted in pursuance of such rules as may be hereafter adopted, shall be members of the Manchester Medico-Ethical Association."

ETHICAL ASSOCIATION.

SECT. I.-Disqualifications for Membership. Any practitioner who may act in opposition to the principles involved in the eight succeeding laws, shall not be eligible to the membership of this Association; and if already a member, he shall, on infringing the same, be liable to expulsion.

1.-No member shall practise, professedly and exclusively, homœopathy, hydropathy, or mesmerism. 2.-No member shall by advertisement, circular, or placard solicit private practice.

3.-No member shall be the proprietor of, or in any way derive advantage from, the sale of any patent or proprietary medicine.

4. No member shall give testimonials in favour of any patent or proprietary medicine, or in any way recommend their public use.

5.-No member, who may keep an open shop, shall sell patent medicines, perfumery, or other articles than pharmaceutical drugs and preparations.

6. No member shall enter into compact with a druggist Moved by S. Crompton, Esq., seconded by R. Flint, Esq., to prescribe gratuitously, and at the same time share in

the profits arising from the sale of the medicines.

7.—No member, being a graduate in medicine engaged in general practice, shall hold the office of physician to any public institution.

8.-No member acting as medical officer to a public

institution, or poor-law union, or as district vaccinator, shall abuse the privileges of his appointment to the injury of his fellow practitioner.

SECT. II.-Code of Etiquette.

1.-No member shall, on any pretext, meet in consulta<tion persons practising medicine, who do not possess one or more of the qualifications enumerated in No. 2, of the general laws.

2.—No member shall meet in consultation any medical practitioner who may be inadmissible, by the operation of the bye-laws, (Section first,) as a member of this Association.

3. No member shall meet in consultation any practitioner who has been expelled this Association,

4. When a senior practitioner is called upon to meet his junior in consultation, for a second opinion, it shall be competent for the former to represent the propriety and advantage of obtaining the assistance of a more experienced practitioner, but if the patient specially desire to have the opinion of any qualified member of the profession, even though a junior, it is the duty of the practitioner in attendance to acquiesce.

5.-When two practitioners attend in consultation, and the period of meeting having been fixed, one of the two neglects punctuality, thus wasting the time of the other, the latter shall be expected to wait ten minutes, and then visit the patient.

6.-In consultation, the graduate in medicine practising as physician, is entitled to the precedence of the general practitioner.

7.-In consultation, the practitioner last called in is entitled to precedence, (except in the case provided for by rule six ;) at the same time it is submitted that, should the latter be a junior, the greatest delicacy and consideration should regulate his conduct.

assistant or servant of another to attend to an accident or other emergency in a family to whom both are equally strangers, the former shall be entitled to take charge of the case throughout; but if the family should communicate their previously-formed intention of employing the latter, he shall be remunerated according to rule eleven, and resign the case.

13.-When a practitioner is called in on emergency by a family usually attended by another, he shall, when the emergency is provided for, send for the ordinary medical attendant, and after one consultation, resign the case into his hands, but be entitled to charge the family for his services.

14.-When a practitioner is called in to attend at an accouchement for another, and completes the delivery, he shall, with the exception provided for in rule ten, be entitled to receive the fee; but when the delivery is not completed on the arrival of the pre-engaged accoucheur, the case shall be immediately resigned to him, and the fee equally divided.

15. When a practitioner is consulted by a patient whom he has previously attended as the officiating friend of another, during sickness, or absence from home, he shall enquire whether the patient has determined on changing his medical attendant; if so, he will be justified in taking charge of the case; if not, and the question be simply one of preference between the two practitioners, he should decline attendance.

16. When a patient is not satisfied with the treatment of the officiating friend left in charge, and wishes to have another opinion, the second practitioner called in shall stand in the relation of physician or consulting surgeon.

17.—When a practitioner is ill or absent from home, and the patient wishes to have a medical man of whom he knows something, rather than the officiating friend of whom he knows nothing, the practitioner so selected shall be entitled to act according to rule thirteen.

8. When a practitioner attends for another, or in consultation with another, and it appears necessary to 18.-When a practitioner has officiated for another, change the treatment, it should be done with the most and the ordinary practitioner has resumed his attendance scrupulous care, to avoid reflecting on the previous treat-upon a case, the former shall on no pretext make friendly ment; which in no instance should be openly condemned. calls upon the patient, unless justified by previous per9. When a practitioner is consulted by a patient sonal intimacy. already under the care of another, he shall on no account interfere with the case, but shall request a consultation with the gentleman previously in attendance. If, however, the latter refuse this, or if the patient insist on dismissing him, and a communication to that effect be made, the practitioner last consulted will be justified in taking charge of the case.

10. When during sickness, affliction, or absence from home, one practitioner has entrusted the care of his practice to a professional friend, the latter shall not make any charge to the former, or to the patients for his services, but shall in all things be locum tenens of the absentee.

11. In all other cases where a practitioner is requested by another, or any member of his establishment, to act for him, the former shall be entitled to compensation at the hands of the latter, unless some previous arrangement has been made by the parties; the fee to be regulated by the circumstances of the case, but in no instance to be less than half-a-crown.

19. While this Association does not propose to interfere with the medical relief part of friendly societies of artizans and operatives, it enacts, at the same time, that no member, being a candidate for the office of surgeon to a club or friendly society, shall, by canvassing, treating, or other undue familiarity, solicit the votes of its members.

20." When a diversity of opinion, or opposition of interest, occasions controversy and contention' between medical practitioners, the matter in dispute shall be referred to another physician or surgeon, as the case may be; but neither the subject matter of such reference, nor the adjudication, should be communicated to the patient or friends, as they may be personally injurious to the individuals concerned, and can hardly fail to hurt the general credit of the faculty."-Percival's Medical Ethics.

21.-"Officious interference. It frequently happens that a medical man may have the case of another practitioner stated to him in so direct a manner, as to render it difficult to decline any attention to it. Under such 12-When a practitioner is called upon by the circumstances, his observations should be delivered with

GENERAL RETROSPECT.

the most delicate propriety and reserve. He should not interfere in the curative plans pursued, and should even recommend a steady adherence to them, except in cases where either artful ignorance imposes on credulity, or neglect, or rashness, threatens the patient with imminent danger."-Ibid.

22.-"When a practitioner is called as a witness in any trial, he should be careful to avoid acting as a partizan, and for this purpose should, if possible, previously consult with any other medical practitioner who may be engaged on the same or opposing side as to the medical facts of the case; but this shall not prevent in any way the courteous statement of his own private opinion concerning them."-Beck and Smith.

SECT. III. On the Adjudication of Disputes. 1.-All charges of non-observance of the bye.laws, or breach of the code of etiquette, brought by one member against another, shall be decided by the Council.

2.-In case of a dispute arising between a member of the Association, and a qualified medical practitioner who is not a member, on any point of etiquette, the latter shall be invited to name a medical friend, who, in conjunction with two others, one nominated by the member, and the other by the council, shall constitute a "court medical" to judge and decide on the case, and their decision shall be final.

3.-In case a dispute arising between qualified practitioners who are not members, but who may both request the interference of the Association, the council shall have power to adjudicate in such manner as, under the circumstances, may seem most desirable.

Note. The term practitioner in these bye-laws includes all grades of medical men when not otherwise specified.

General Retrospect.

ANATOMY AND PHYSIOLOGY.

ON THE NERVES OF THE SHEATHS OF THE ROOTS
OF SPINAL NERVES.

641

superior roots, of short extent, are so poorly provided with nerves, that sometimes I have failed to find any, but which at present appears a matter of little moment. The nerves of the sheaths do not wholly belong to the system of vegetable life, (the organic nervous system,) but also, in part, to the cerebro-spinal system. The fact is completely beyond dispute, for I have two or three times succeeded in following nerves clearly arising from the root, and curving upwards, to arrive at the sheath of the motor nerves. Sometimes the nerves, having gained the sheath, proceed upwards; sometimes they descend; sometimes they may be followed to the inside of the dura mater; at other times they remain outside of it. In most cases I have succeeded in finding but one ramification of the nerves; once I have seen a nervefibres, mount and divide into two portions, one of filament, consisting of nearly eight or ten primitive which continued its course, whilst the other descended towards the periphery, forming an arch, such as is observed to be the termination of nerves, in numerous cases."

ON THE PULSE OF THE AGED.

By Dr. Pennock.

Physiologists, generally, have considered it as an established fact that the frequency of the heart's action diminishes in advanced age; and no one had called the correctness of this view in question until Leuret and Mitivié, in 1832, whilst engaged at the hospital of Salpêtrière, Paris, in observations relative to the pulse of the insane, were astonished to find that the pulse of 34 sane women in good heath, whose medium age was 71 years, presented the average of 79 beats observations, and to institute an inquiry as to the relative

in a minute. This fact induced them to make further

frequency of the pulse of the young adult and that of the aged. On the same day, at the same hour, and under analogous circumstances, the pulses of the young men at the veterinary school at Alfort, and those of the old men in good health at the Infirmary at Bicêtre were examined. The number of the veterinary students was 110, that of the aged men 27; the average age of the students was 21 years, that of the aged men was 71 years. The result of this examination proved that the medium pulse of the young men was 65 per minute, that of the aged was 73. Temperature 320 Fahr.

M. Pappenheim addressed a note to the Academy of Sciences, which was read at their sitting on the 13th of August, respecting the sheaths of the roots of spinal nerves, and the necessity of taking into consideration Dr. Pennock has also instituted a series of observathe existence of their small nerves in drawing conclu- tions in the Philadelphia Hospital, Blockly, on the pulse sions from any experiments on recurrent sensibility. and respiration of the aged inmates in the adjoining The author stated that he had rendered himself certain Infirmary. The number of persons whose pulse is of the existence, both in the horse and dog, of small reported is 170 men, and 203 women, being an aggregate nerves on the sheaths of the anterior roots of the spinal of 373, the ages of the men being between 50 and 90' nerves, a matter which had been doubted by some years, those of the women from 50 to 115 years. The anatomists. From numberless observations, on all results obtained are exhibited in tables. Table A. parts of the human body, he had become persuaded is derived from the observation of the pulses of 170 that nerves would be found wherever arteries were met men, the aggregate of whose ages is 10.895, and that with. "Now, on the anterior roots of a spinal nerve, of the pulsations 12,211. The respirations were counted an artery is found; at its side are nerves, but their | in 146 instances, the total number of inspirations being number, structure, origin, and situation, are not always the same. I find, too, as does M. Magendie, that the inferior nerves, on the anterior roots of which sensibility has so clearly been observed, have the greatest number of nerve-fibres in their sheaths, whilst the

3045. The medium age was found to be 64.09 years; the medium pulse 71.83 per minute; the medium respiration 20.51; the ratio of respiration to pulsation as 1 to 3.51. Table B. is derived from the observation of the pulse of 203 females, the aggregate of whose

MEDICAL INTELLIGENCE.