For written advice

For rising at night, and a visit

For a first visit in consultation

For subsequent visits in the same case

For rising at night, and a visit in consultation

In visits to distant patients, one dollar to be charged for every mile beyond the limits of the city, in addition to the ordinary charges.

An extra charge may be discretionally made for travelling at night, or on account of the badness of the roads, or the inclemency of the weather.

For an opinion involving a question of law

For a post mortem examination in a case of legal investigation
For vaccination

For re-vaccination

For an ordinary case of Midwifery

$5" 20 5" 10

5

1 " 2 515

5" 20 25

5

2 " 5

For the application of the forceps, or for turning, an addition of
For any indisposition in the mother or child, after the tenth day of
confinement, the charge for attendance as in ordinary cases requiring
medical treatment.

10" 20

5" 10 5" 30

In all Surgical cases, the charge for subsequent attendance to be according to the time occupied, and the trouble incurred.

24. Physicians should present their accounts at least annually, or as much oftener, as they may deem proper.

25. A physician should not give advice gratis to those who are able to make compensation; for it is defrauding, in some degree, the common funds for the support of the profession, when fees are dispensed with which might justly be claimed. The poor, however, of every description, ought to be deemed the objects of kindness and attention; and to them gratuitous services should be rendered with promptness and alacrity. In the consideration of fees, let it ever be remembered, that though mean ones from the affluent are both unjust and degrading, yet the characteristical beneficence of the profession is inconsistent with sordid views, and avaricious rapacity. To a young physician, it is of great importance to have clear and definite ideas of the ends of his profession

of the means for their attainment, and of the comparative value and dignity of each. Wealth, respectability, and independence, with all the benefits resulting from them, may be the ends, which he holds in view; and they are interesting, wise, and laudable :-yet knowledge, benevolence, and active virtue, the means to be adopted in their acquisition, are of still higher estimation. And he has the privilege of practising an art, even more intrinsically excellent in its immediate than in its ultimate objects. The former, therefore, have a claim to uniform pre-eminence.

26. Physicians should avoid the practice of suffering vaccination. to be treated as a mere incident or make-weight in charging for other services, or of performing it for a very small reward. By so doing, they diminish the popular respect for this important operation, and produce a temptation, in their own minds, to despatch it with too great an economy of trouble, and, in particular, to omit journalizing the cases, which should never be neglected.

27. Whenever a physician officiates for another, who is sick or absent, the fees for attendance shall accrue to the physician for whom his office has been performed; with an observance, always, of the utmost delicacy towards the interest and character of the professional gentleman previously connected with the family.

28. Members of the profession, together with their wives and children, should be attended gratuitously, by any one or more of the faculty residing near them, whose assistance may be required. For, as solicitude obscures the judgment, and is accompanied with timidity and irresolution, medical men, under the pressure of sickness, either as affecting themselves or their families, are peculiarly dependent on each other. But visits should not be obtruded officiously; as such unasked civility may give rise to embarrassment, or interfere with that choice on which confidence depends. Distant members of the faculty, when they request attendance, should be expected to defray the charges of travelling. And if their circumstances be affluent, a pecuniary aknowledgment should not be declined; for no obligation ought to be imposed which the party would rather compensate than contract.

Dr. H. H. Smith, through Dr. J. R. Paul, presented, for the Library of the College, a copy of his work, entitled, "Minor Surgery-or Hints on the every day duties of the Surgeon."

Dr. B. H. Coates presented, for the Library, a "Copy of the Transactions of the Historical and Literary Committee of the American Philosophical Society, at its Centennial Anniversary, 1843."

A communication was received from the Royal Medical and Chirurgical Society of London, acknowledging the receipt, from the College, of a copy of the last edition of the United States Pharmacopoeia.

The "ANNUAL REPORT ON SURGERY," was read by Dr. PARRISH, as follows:

In a field so extensive as that of Surgery, and one so crowded with industrious and ardent labourers, there must be an annual harvest of rich and useful products. To bring these together, and to compress them into a condensed and comprehensive form, adapted for future use, is the object of these annual communications.

Your Committee cannot pretend, however, to do more, than to glance at some prominent topics, which appear to possess sufficient interest and novelty, to claim a passing notice. In our last annual report, we discussed, at some length, the subject of introducing a tube into the Colon, with a view of exhausting the air, in cases of tympanitis, or for the more effectual administration of enemata, in intestinal obstructions, &c. This practice has been applied, also, to cases of strangulated hernia, and, within the past year, a case has been reported, in the London Lancet, in which it is said to have been successful. The patient was a female, aged fifty-one years. She was very corpulent, and had been ruptured for twenty-four years. By some accident, strangulation of a large portion of intestine took place, at the femoral ring-the constitutional symptoms were severe and threatening, and a resort to the operation seemed inevitable; to this, however, the patient would not consent. Under these circumstances, the elastic tube of the stomach pump was passed up, through the rectum, to the distance of twelve inches. A syringe was attached, and two quarts of warm water slowly injected. When about one-half the quantity was thrown up, a gurgling was distinctly heard in the tumor, and it gradually became less tense. On removing the syringe the water was allowed to run off; after which, it was re-applied, and efforts made to exhaust the air. In a few minutes, the tumor began to yield, and by keeping up gentle pressure upon it, the contents were returned into the abdomen, to the immediate relief of the patient. The case occurred under the care of Charles Colambell, Esq., of Lambeth, England, and is reported in the London Lancet, for April 29th, 1845.

An account of a new method of treating burns and scalds, has recently been announced by Lisfranc, which, from its simplicity, and from the ease with which the remedy is attainable by all classes, is worthy of trial. It consists in saturating dossils of lint or charpie, with a solution of common salt, of medium strength, and applying them, over lint lightly covered with cerate or lard, next to the burn, so that the abraded surface may imbibe the solution by degrees. It is asserted, that very soon after the application, the local pain diminishes, or ceases altogether, and

that the subsequent healing of the part is insured in a shorter time, than by any other means. In slight burns, in which simple redness and elevation of the surface occur, it is said to subdue the inflammatory symptoms in twenty-four or forty-eight hours; while, in the more severe forms of burn, attended with serous or sero-purulent effusion, ulceration, &c., from five to eight days will be required to produce the like result. It is only in the first or inflammatory stage, that the solution of chloride of sodium is applicable-after the separation of the eschars, it is decidedly injurious, as it impedes the process of granulation. Your committee have had no opportunity of testing the efficacy of this practice by individual observation, but mention it as a matter worthy of trial, and calculated, if it should prove true, to exert an important influence on surgical practice, in a very extensive class of accidents. Dr. Rhind, of Edinburg, has recently proposed, as a remedy for burns and scalds, a solution of gum arabic; repeated coats of it being applied so as to form a complete covering to the injured parts. The solution is to be used at about the warmth of 96°, and, as gum is a bad conductor of heat, it is said not to cool down the system by evaporation, like an ordinary cool fluid, while, at the same time, it does not preclude an exposure to moderately cool air. Before applying the gum, the skin should be freed from all oily matters, and two, three, or four applications should be made, at intervals of five or ten minutes.

Dr. Houston, of Dublin, has recently urged the application of nitric acid to hæmorrhoidal tumors, as a means of cure, which he considers superior to any other method. His plan is, to apply the acid to the surface of the tumor, by means of a piece of wood, cut into the shape of a dressing case spatula; this is dipped into the acid, and then rubbed upon the tumor, until a greyish-white colour is produced; which is an evidence of its due action. If a superficial slough alone is desired, one application will prove sufficient; if a more deep one, several touches should be made, in quick succession. After the application of the acid, the parts should be lubricated with olive oil, and returned within the sphincter, the patient put to bed, and an opiate administered. Dr. Houston states, that the pain is smart and burning at first, but goes off in two or three hours, after which, a general uneasiness is felt about the anus, with a slight sense of heat, fulness, and throbbing, for a few days. On the third or fourth day, a purgative should be administered, when the bowels will generally be moved without pain, or prolapse of the rectum. After this, Dr. Houston declares that the cure progresses rapidly, and without disagreeable symptoms.

The use of black pitch has also been recommended as a remedy for hæmorrhoids, in their less aggravated form, as well as for fistula

in ano, and other indolent inflammations in the vicinity of the Dr. Wardleworth, of Manchester, states, that he has derived great advantage from the use of the following formula: Take of black pitch, one drachm; powdered gum acacia, two drachms; mix, and divide into xx pills--two to be taken every night. These pills operate as a gentle aperient, and are supposed to act as an agreeable stimulant to the capillaries and exhalants of the intestinal canal, and especially to the portal veins, thereby relieving that sluggish action, upon which the dilatation of the hæmorrhoidal veins is supposed to depend. In cases connected with functional disturbance of the liver, Dr. Wardleworth recommends the combination of blue mass with the pitch. He considers, from an extensive trial of this remedy, that it is far superior, as a medicinal agent, to Ward's paste, so celebrated in the cure of piles, and he urges a trial of it, upon the profession, in preference to an empirical remedy.

Within the past year, a new article has been added to our list of remedies, for the treatment of enlarged tonsils, and other morbid growths, occurring in different parts of the body. This preparation is an iodide of zinc, made by the action of iodine upon zinc, without the aid of any extraneous substance. A plate of zinc is placed over a jar or vial, and the iodine sprinkled over it. In a short time the iodide is deposited in the vessel, in the form of a semi-fluid, deliquescent substance, which is said to possess great efficacy in promoting the absorption of morbid growths. Dr. Goddard, of this city, has used the remedy extensively, within the past year, and reports very favourably of its effects. He informs us, that it appears to possess the peculiar property, when applied to an enlarged gland, of inducing a rapid absorption, by a sort of shrivelling process, and not by the formation of a slough. Like the chloride of zinc, it does not spread to the surrounding healthy structure, and, hence, may be used without the fear of injury from being swallowed.

Dr. Goddard conceives it to be well adapted, as an application to fungous or hæmmorhagic tumors, in which extirpation might prove dangerous, and in which even the use of escharotics is apt to be followed by troublesome and exhausting bleeding-an opinion which he has confirmed by a limited experience. The article is applied pure, by means of a camel's hair pencil, or a piece of sponge, secured to the end of a suitable handle-it is held on for a short time, and repeated every two or three days, until the object is accomplished. The application is followed by a pungent smarting, which continues for twenty or thirty minutes, but by no other inconvenience.

Should more extended trials establish the efficacy of this remedy, a great object will be attained, especially in those cases of enlargement of the tonsils caused by repeated attacks of inflammation in