The above letter undoubtedly voices the sentiments of the very small minority, who are not in favor of amalgamation. We publish it in order that both sides of the question may be placed before the members of the Association, and in order that we may not be accused of withholding the views of this aforesaid minority. We would like to say in reply, that the withholding of the acknowledgment of meeting, by the writer does not necessarily mean that he will not be served in one way or another. The Committee in charge of this matter is trying to carry out simply the ideas of the majority of the members of the Association. Therefore, it would facilitate matters a great deal if each member of the Association would acknowledge acceptance of service of notice, without causing undue trouble or annoyance. This refusal of acceptance of service by a member, simply means that the matter may be carried into the courts, and may bring about a large expense and litigation, which is absolutely unnecessary. Acceptance of service. does not necessarily take from the individual his right to vote as he feels in the open meeting of the Association to be held in the coming October. We do not think that the idea of amalgamation means abolition of the ideas for which the Association was organized; we simply are striving for the unity of our medical brethren within the State of New York. Of course, the members of the Committee, it goes without saying, are not selling the birthright, which they have inherited from the State Association; were they so doing, they would consider themselves traitors to the organization which they hope they represent. The idea of the Committee is simply to prepare themselves beforehand to carry out those plans which were agreed to at the meeting of the Association in 1904, when the members present unanimously voted for amalgamation. It seems to us that the refusal of acceptance of service and notification is puerile and absolutely beyond the idea of what medical men should consider the true fraternal spirit. Therefore, we are sorry that our correspondent sees fit to take such a gloomy view of the earnest work of our Committee.

THE DIAGNOSIS AND TREATMENT OF
ABDOMINAL PAIN.

In very valuable article in the Yale Medical Journal are reviewed the more common causes of abdominal pain, the means of recognizing them and of avoiding the usual errors. The author, Dr. John B. Deaver, emphasizes these generalizations as the results of a long experience:

Pain is probably the most constant of all symp

toms, no matter what the disease or where the pathological lesions are situated, and the abdomen is surgically the most important and the most extensive part of the human body. From the sudden stab of momentary indigestion to the chronic agony of cancerous disease, from the burning ache of gastric or intestinal perforation to the prostrating pain of ruptured extra-uterine pregnancy, through the whole gamut of abdominal disease, the surgeon's mind must run as he seeks here and there a note of hope from the discord of pain in the effort to snatch his suffering patient from the grave.

He insists upon the absolute necessity of attention to every detail, even the most trivial, before arriving at a conclusion, and condemns superficiality "of all other traits the one to be most avoided." Many surgeons are satisfied to arrive at one of two conclusions-i. e., to operate or not to operate, leaving the determination of what the operation shall be until after the abdomen is opened; holding that "if we do not know what is inside, what is the harm of cutting a hole to look through?" The most appalling disasters are the result of such teaching. While not believing that the exploratory operation is never justifiable, as many conditions demand it, still he believes a surgeon should be able to say with reasonable certainty whether after the abdomen is opened anything further can be done to relieve the patient's condition. Of all things, delay is to be avoided.

His most emphatic warnings are against the promiscuous use of opiates. "Pain is Nature's signal light of intra-abdominal mischief, and it is criminal to shroud it over with the foggy mist of opiates." "Opium is the most valuable drug in the pharmacopeia, but the most outrageously abused." "A physician who makes a practice of administering a hypo to his patient who complains of abdominal pain before he makes a conscientious, systematic physical examination of the abdomen and arrives at a diagnosis at least tentatively correct, is not worthy of the name. Yet such physicians, I regret to say, have not entirely passed away, for all the fools are not dead

yet."

The cause of pain in the abdomen is not always an easy matter to determine, and the surgeon who is widest in his experience and most painstaking and accurate in his examination and interpretation of the phenomena present will be least likely to err in his diagnosis, or, in case an error is made, will be less to blame than one who merely jumps at a conclusion without due reflection, or who confessedly makes habitual resort to an operation as a means of discovering the patient's ailment.

To call a patient a neuro who complains of pain in the abdomen, the cause of which is not easily to be discovered, is too often only a cloak W. for ignorance.

Pattison, Warren E., Westport, N. Y.
Potter, Irving W., Buffalo, N. Y.
Remington, Alvah C., Rochester, N. Y.
Rushmore, Edward C., Tuxedo Park, N. Y.
Stewart, Edith W., Hume, N. Y.
Stein, Sydney A., New York City.
Winter, Henry Lyle, Cornwall, N. Y.
Wheeler, David Everett, Buffalo, N. Y.

AMENDMENTS TO BY-LAWS OF THE NEW YORK STATE MEDICAL ASSOCIATION. These amendments were offered at the twentyfirst annual meeting of The New York State Medical Association, held in New York City, October 18, 1904, and to be acted upon at the next annual meeting, October 16, 1905.

Amend Article II. Duties of the Council, by striking out Sec. 1 and substituting therefor the following:

Executive Board and Finance Committee.Sec. 1. The Council in the interim between the annual meetings of The New York State Medical Association and the annual meetings of the Council and Fellows, shall be and is hereby constituted the Executive Board or Committee, both of The New York State Medical Association, and of the Council and Fellows, with full power and authority to put into effect the purposes of the Association as expressed in and limited by its charter, By-Laws and resolutions. The Council may select a Finance Committee from among its members, the sole power of which shall be to audit and authorize the payment of such bills as may have been theretofore incurred by order of the Council, or the Council and Fellows of The New York State Medical Association.

Amend Article II, Sec. 6. Action under Medical Laws and Employment of Counsel, by striking out Sec. 6 and substituting therefor the following:

Action under Medical Laws and Employment of Counsel.-Sec. 6. The Council may in the name of The New York State Medical Association, take action in any case of violation of the public-health law, subject, however, to the provisions of such law. The Council may in the name of The New York State Medical Association, employ an attorney at law to advise or act in any legal matter for The New York State Medical Association, upon such terms as the Council may determine.

Amend Article II, Sec. 7, by striking out Sec. 7 and substituting therefor the following:

7.

Defense of Suits of Alleged Malpractice.-Sec.

Any active resident member of The New York State Medical Association may apply in writing for defense, and the Association shall. through its Council, furnish the legal services of a duly qualified attorney at law, in any alleged civil malpractice action brought against him, the alleged cause of action for which, occurred subsequent to the time when such applicant became at member of The New York State Medical Asso

ciation, provided, however, that said applicant shall not be in arrears in the payment of dues for a period of more than three months from the first day of January, and that said applicant shall agree in writing not to settle, compromise, adjust or discontinue such action without the consent of The New York State Medical Association or its attorney, and renouncing his own, shall vest in The New York State Medical Association or its Council sole authority to conduct the defense of said suit, or to settle or adjust the same with the consent of the applicant, but neither the Council nor its attorney, nor any other person shall obligate The New York State Medical Association to the payment of any money awarded by verdict, decree or court, upon compromise or otherwise.

Amend Article II. Duties of the Council, Sec. 2, Meetings, by striking out the period at the end of the section, and adding the following:

and notice of each special meeting of the Council specifying the time and place of the meeting, and the business to be transacted, shall be mailed in a securely sealed, post-paid wrapper, addressed to the last-given address of each and every member of the Council, at least five days before the date of meeting.

Amend Article III. Duties of the Council and Fellows, by striking out Sec. 1 and substituting therefor the following:

Duties of the Council and Fellows.-Sec. 1. Duties. The general supervision, business management and control, together with the financial interests of The New York State Medical Association and its membership, are vested in the body known and styled the Council and Fellows, as limited, qualified and authorized by Section 5 of Chapter 452 of the Laws of 1900.

Amend Article III, Secs. 1 and 2, by striking out Secs. 1 and 2 and substituting therefor the following:

Meetings.-Sec. 2. The Council and Fellows shall meet annually. The annual and all other meetings of the Council and Fellows of The New York State Medical Association, shall be held at its office or place of transacting its financial concerns the City of New York, Borough of Manhattan. The annual meeting of the Council and Fellows shall be held on the third Monday in October in each year, beginning at 3 o'clock in the afternoon, and special meetings of the Council and Fellows shall be held at such other times, upon ten (10) days' notice thereof, as may be determined by the Council to be necessary or expedient, or upon the written request of twenty-five (25) members of the New York State Medical Association. One-half the membership of the Council and Fellows, shall constitute a quorum.

Amend Article IV, Sec. 5, by striking out Sec. 5 and substituting therefor the following:

Duties of Treasurer.-Sec. 5. The Treasurer shall receive and disburse all funds of The New York State Medical Association under the direction of the Council, or Council and Fellows, or

upon the audit of persons duly authorized by these By-Laws. He shall make a report at the annual meeting of the Council and Fellows upon the finances of the Association, and to the Council at such other times as the Council may require, and shall report upon the names of such members as may be delinquent in the payment of their dues. Any member who shall not have paid his dues on or before the first day of July in any year shall be considered a delinquent member, and a member not in good standing. The Treasurer shall collect the dues of non-resident members. Amend Article V. Sec. 9, by striking out Sec. 9 and substituting therefor the following: Committee on Nominations.-Sec. 9. The Committee on Nominations shall consist of a Chairman and ten members, two of which members shall be elected from the Fellows from each of the five District Branch Associations. It shall be the duty of this Committee to present to the Council and Fellows at its annual meeting a list of nominees for all elective offices of The New York State Medical Association, from which list the officers may be elected, unless otherwise ordered by a majority of the members present.

Amend Article VI. Meetings of the Association, by striking out Secs. 1, 2 and 3, and substituting therefor the following:

Annual.-Sec. 1. The New York State Medical Association shall hold a meeting annually to be called its Annual Meeting, in the City of New York and Borough of Manhattan, on the first Tuesday, following the third Monday in October in each year, at 9.30 o'clock in the forenoon, at its office or place of transacting its financial affairs, and the scientific or social sessions of such annual meeting shall be held at such place and hour as shall be selected by the Council and designated in the notice for such meeting, and The New York State Medical Association may hold special meetings at other times, places and hours in the City of New York and Borough of Manhattan. The notice for all meetings of The New York State Medical Association or the Council and Fellows shall be in writing, mailed in a securely sealed, post-paid wrapper, addressed to the last-given address of each and every member of The New York State Medical Association, which notice shall state the date, place and hour of such meeting. Notice of all special meetings shall be mailed to every member of the State Medical Association at least ten (10) days before such meeting, and shall state the date, place, hour and purpose of the meeting, and no other business at any special meeting shall be conducted except such as is stated in the call. The affidavit of mailing by the Secretary of The New York State Medical Association of such notice for the call of the meeting, shall be sufficient proof of the service of such notice upon each and every member, for any and all purposes.

Special Meetings.-Sec. 2. Special meetings shall be called by the President by order of the

The title preceding Sec. 5 should read: "Duties of District Branch Association Officers." Amend Article VII, Sec. 7, by striking out Sec. 7 and substituting therefor the following:

Treasurer.-Sec. 7. The Treasurer shall receive and disburse all funds of the Branch Associations, as hereinafter prescribed under the laws regulating the distribution of dues.

Amend Article VIII. County Medical Associations, by inserting between Secs. 2 and 3 the title: "Duties of County Association Officers."

Amend Article VIII, Sec. 6, by striking out Sec. 6, and substituting there for the following: Treasurer.-Sec. 6. The Treasurer shall receive and disburse all funds of the County Association of the County in which he resides.

Amend Article II, Sec. 4, by striking out Sec. 4, and substituting therefor the following:

Privileges of Members.-Sec. 4. Active. Resident active members shall have all the rights and privileges conferred by their respective County and District Branch Association. They shall be eligible to any office in the gift of the Association, shall be entitled to attend all meetings of the Council and Fellows, and shall receive all of the protection, benefits and support conferred by The New York State Medical Association except as herein qualified or limited, provided, however, that such active member's dues shall have been paid to the Treasurer of The New York State Medical Association on or before the first day of July in any year, and not otherwise. If at the time of the annual meeting of any County Association or District Branch Association a member shall not have paid his annual dues to such County or Branch Association, he shall not be counted as a basis of representation in The New York State Medical Association, nor shall he be

eligible for election as a Fellow, nor thereafter until he shall have discharged his indebtedness in full.

Amend Article IX. Membership, by striking out Sec. 5 and substituting therefor the following:

Privileges of Members, Non-Resident, Honorary and Corresponding.—Sec. 5. All members of The New York State Medical Association other than active resident members, shall only receive notice of all scientific meetings, and a copy of all publications of The New York State Medical Association.

Amend Article X. Dues. Sec. 3, by striking out Secs. 3, 4 and 6, and substituting therefor the following:

Payment of Dues.-Sec. 3. All dues shall be due The New York State Medical Association and payable on the first Monday of January in each year. Members resident in the State of New York shall transmit their dues to the Treasurer of the County Association in which they reside, or to the Treasurer of the District Branch Association if no County Association exists in the County wherein they reside. Nonresident members shall transmit their dues to the Treasurer of The New York State Medical Association.

Collection of Dues.-Sec. 4. On the first day of July in each year the names of all members who have failed to pay their indebtedness to The New York State Medical Association for the current year shall be omitted from all public accredited lists of members of The New York State Medical Association, and if at the close of the first day of the Annual Meeting of The New State Medical Association such dues still remain unpaid and in arrears, the name of such delinquent member shall be dropped from the official roll of members, and he shall be notified of his suspension from membership in The New York State Medical Association as soon as conveniently possible thereafter.

Distribution of Dues.- Sec. 6. The Treasurer of each County Association or District Branch Association shall pay to the Treasurer of the State Association monthly, all dues or other funds in his hands received from members, which the Treasurer of The New York State Medical Association is entitled to receive.

Amend Article XV. Amendments, by striking out Sec. 1, and substituting therefor the following:

Amendments.-Sec. 1. Amendments to these By-Laws shall be made only upon the affirmative vote of a majority of those present and voting at a regular annual meeting of the Council and Fellows, or at a regular annual meeting of The New York State Medical Association, provided that notice of such amendment shall have been presented in writing at the previous annual meeting of the Council and Fellows, or at the previous annual meeting of The New York State. Medical Association..

PRINCIPLES OF MEDICAL ETHICS. The American Medical Association promulgated as a suggestive and advisory document the following: CHAPTER I.

THE DUTIES OF PHYSICIANS TO THEIR PATIENTS.

Section 1.-Physicians should not only be ever ready, to obey the calls of the sick and the injured, but should be mindful of the high character of their mission and of the responsibilities they must incur in the discharge of momentous duties. In their ministrations they should never forget that the comfort, the health and the lives of those entrusted to their care depend on skill, attention and fidelity. In deportment they should unite tenderness, cheerfulness and firmness, and thus inspire all sufferers with gratitude, respect and confidence. These observances are the more sacred because, generally, the only tribunal to adjudge penalties for unkindness, carelessness or neglect is their own conscience. Sec. 2.-Every patient committed to the charge of a physician should be treated with attention and humanity, and reasonable indulgence should be granted to the caprices of the sick. Secrecy and delicacy should be strictly observed; and the familiar and confidential intercourse to which physicians are admitted, in their professional visits, should be guarded with the most scrupulous fidelity and honor.

Sec. 3. The obligation of secrecy extends beyond the period of professional services; none of the privacies of individual or domestic life, no infirmity of disposition or flaw of character observed during medical attendance, should ever be divulged by physicians, except when imperatively required by the laws of the State. The force of the obligation of secrecy is so great that physicians have been protected in its observance by courts of justice.

Sec. 4. Frequent visits to the sick are often requisite, since they enable the physician to arrive at a more perfect knowledge of the disease, and to meet promptly every change which may occur. Unnecessary visits are to be avoided, as they give undue anxiety to the patient; but to secure the patient against irritating suspense and disappointment, the regular and periodical visits of the physician should be made as nearly as possible at the hour when they may be reasonably expected by the patient.

Sec. 5.-Ordinarily, the physician should not be forward to make gloomy prognostications, but should not fail, on proper occasions, to give timely notice of dangerous manifestations to the friends of the patient; and even to the patient, if absolutely necessary. This notice. however, is at times so peculiarly alarming when given by the physician, that its deliverance may often be preferably assigned to another person of good judgment.

Sec. 6. The physician should be a minister of hope and comfort to the sick, since life may be lengthened or shortened not only by the acts, but by the words or manner of the physician, whose solemn duty is to avoid all utterances and actions having a tendency to discourage and depress the patient.

Sec. 7.-The medical attendant ought not to abandon a patient because deemed incurable; for continued attention may be highly useful to the sufferer and comforting to the relatives, even in the last period of the fatal malady, by alleviating pain and by soothing mental anguish.

Sec. 8.-The opportunity which a physician has of promoting and strengthening the good resolutions of patients suffering under the consequences of evil conduct ought never to be neglected. Good counsels, or even remonstrances, will give satisfaction, not offense, if they be tactfully proffered and evince a genuine love of virtue, accompanied by a sincere interest in the welfare of the person to whom they are addressed.

CHAPTER II.

THE DUTIES OF PHYSICIANS TO EACH OTHER AND TO THE PROFESSION AT LARGE.

Article I-Duties for the Support of Professional Character.

Section 1-Every one on entering the profession, and thereby becoming entitled to full professional fellow