the sake of gaining practice, would probably deter those from pursuing it who might be so inclined. The adage, "dear at any price," would be applicable to physicians relying on this policy. This is well understood by the public. Few patients are disposed to select a medical adviser because he places a low pecuniary valuation on his services. Necessity alone would dictate a choice on this ground; and it is rarely the case that inability to pay the customary fees prevents patients from having the services of those whom they prefer. The code by no means interdicts deviations from the general rules according to varying circumstances. It is to the honor of the profession that the instances are few in which efforts for the relief of suffering and the preservation of life are withheld on account of inability to make an adequate pecuniary acknowledgment. The circumstances which lead physicians from sympathy to deviate from the general rules are often not apparent to others. Few persons outside of the medical profession are aware of the extent to which the services of its members are freely rendered, with but little or no compensation; hence, one reason for an exaggerated estimate of the incomes of those largely engaged in practice, and for the fact that the majority of practitioners, after a long professional career, leave but little property. The physician, from his intimate relations with his patients, comes to know often their limited re sources, of which, perhaps, others are ignorant; how can he add to their embarrassment and anxiety by exacting full payment for his services? A considerable proportion of those to whom these services are gratuitously rendered do not come to him in forma pauperis, but silently appeal to his benevolence. While it can not be assumed as a principle that the remuneration received from the affluent should be sufficient to compensate for services to those unable to make pecuniary acknowledgments, the fact that these

services are rendered in the cause of humanity should be considered as a reason for the ready and cheerful payment of fees by patients who have no claims on the charity of the profession.

A demand for exorbitant fees is not in accordance with this article of the code. When based on an assumption of extraordinary knowledge or skill, it is an imposition, and it is, of course, fraudulent if services have been falsified. An exorbitant fee can not be claimed on the score of the wealth of a patient. Such a patient may add to the fee an honorarium which, considering the services rendered by a physician to those unable to make pecuniary acknowledgments, may be accepted without compromising self-respect. Extraordinary services rightfully claim deviations from the general rules in respect of fees. Detentions or constant attendance, involving sacrifice of interests, unusual fatigue, or impairment of comfort, and visits requiring traveling and absence from home, are in this category. No one but the physician himself can place a valuation on such services, and it is his right to do this, provided there be an understanding before the services are rendered. If the expense of certain services be stated beforehand, patients or their friends can have no occasion for complaint, and thereby the risk of unpleasant feelings, and, it may be, a suit at law, will be avoided.

Inasmuch as it is the custom in this country, after medical services have been rendered, either for the patient to request to know the amount of indebtedness, or, if not requested, for a bill to be presented, it is unbecoming to leave the amount of pecuniary compensation to be determined by the party who has received the services. It is to be assumed that the services have a certain valuation, varying, of course, according to circumstances in particular cases. To decline to fix on any valuation, provided patients be affluent, is virtually

to appeal to their generosity, and this is certainly undignified. If the valuation by patients be higher than that of the physician, the difference is easily made up by an honorarium. The exceptions to the rule that the physician should determine the value of his services are in some instances in which the pecuniary resources of the patients are either unknown or known to be limited. For a physician to keep no account of medical services, relying on the voluntary contributions of his patients for his support, is not only unseemly, but derogatory to the profession. Medical as well as other services are entitled to compensation, whenever they are not charitably bestowed, and it is disreputable to place pecuniary acknowledgments in the light of a gratuity.

CHAPTER III.

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

ART. I.—Duties of the Profession to the Public.

SECTION 1. As good citizens, it is the duty of physicians to be ever vigilant for the welfare of the community, and to bear their part in sustaining its institutions 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 subjects of medical police, public hygiene, and legal medicine. It is their province to enlighten the public in regard to quarantine regulations—the location, arrangement, and dietaries of hospitals, asylums, schools, prisons, and similar institutions—in relation to the medical police of towns, as drainage, ventilation, etc.-and in regard to measures for the prevention of epidemic 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.

SECTION 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 subjects strictly medical-such as involve questions relating to sanity, legitimacy, murder by poisons 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.

SECTION 3. There is no profession by the members of which eleemosynary services are more liberally dispensed than by the medical, but justice requires that some limits should be placed to the performance of such good offices. Poverty, professional 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 testify to the state of health of persons wishing to insure their lives, obtain pensions, or the like, without a pecuniary acknowledgment. But to individuals in indigent circumstances such professional services should always be cheerfully and freely accorded.

Laudation of the medical profession by physicians for the public may not always be consistent with a proper degree of modesty, but laudation of the profession for its members is not only admissible, but it has a salutary influence. The more physicians are led to regard medicine in its humane and noble aspects, the more they are reconciled to its hardships, and the more they are incited to do all in their power to maintain its character and usefulness. The feeling that honor is reflected by membership of a profession which professes to be governed by the code of medical ethics conduces to a high moral tone, and it is in this way that the code is of great service. It is a beautiful feature of the code that it aims solely at the influence of its ethical rules on the mind, irrespective of any penalties. It is based on the principle that moral rectitude is promoted more by fostering upright sentiments than by the punishment of offenses.