THE BTA''J:'US THE MEDICAL PROFESSION STATE OJP NEA¥ -YORK, HENKY H. PTFFARD, M. D. COLUMBIA UNIVFRRITV DEPARTMENT OF PHYSIOLOGY College of Physicians and Surgeons 437 west fifty ninth street NEW YORK NEW YORK: D. APPLKTON AND COMPANY, 1, 3. AND 5 BOND STEEBT. 1884. Md ^ :&U intljeCttpotlmgcrk CoUege of ^iipssiciang anb burgeons Xibrarp Digitized by the Internet Archive in 2010 with funding from Open Knowledge Commons http://www.archive.org/details/statusofmedicalpOOpiff THE STATUS OF THE MEDICAL PROFESSION STATE OF ]SrEW YORK. HENRY G. PIFFARD, M. D. NEW YORK: D. APPLETON AND COMPANY, 1, 3,:and 5 BOND STEEET. 188 3. THE STATUS OF THE MEDICAL PROFESSION" IN THE STATE OF E'EW TOEK. FIRST ARTICLE. From the Neio York Medical Journal for April IJj.^ 1883. Comparatively few are acquainted witli the history of the events that led to the movement which resulted in the formulation of the New Code of Ethics of the Medical Society of the State of New York. The writer of this considers himself fairly well informed on the subject, and will give what appears to him the facts pertaining to the subject. In doing this, however, he must be pardoned for certain apparent digressions, since, in order that the matter may be correctly understood, it will be necessary to go back to the times that precede the promulgation of the " Old Code." In New York the profession first became organized as a corporate body in the year 1806, and seventeen years later thought fit to lay down a set of rules for the government of its members. This action was deemed neces- sary in order to control some who appeared to regard medicine in the light of a trade rather than a profession, and who were regarded by their stricter brethren as medical freebooters rather than physicians. The result was the enactment in 1823 of the "System of Ethics of the Medical Society of the State of New York." This " system " or code inculcated two species of obligation, namely : those which the profession should bear to the public, and those which its individual members should hold to each other. This code was founded on and was an adaptation to local needs of an English work known as " Percival's Ethics." At this time there was little cause for uneasiness on the part of those who with propriety might be called " regu- lar physicians," namely : those who were graduates of medical schools, and those who, after strict examination, were " licensed" to practice the profes- 4 THE STATUS OF THE MEDICAL PROFESSION sion by the bodies having due authority thus to license — to wit, the county societies. During these years, however, an irregular sect had come up, outside the profession, and who were commonly spoken of as the " steam- doctors " and " herb-doctors." ■ These were men of no medical acquire- ments, and of varying degrees of honesty, who had embraced the doctrines of one Samuel Thomson, hailing from Xew England. Their chief thera- peutic reliance was on vigorous sweats with the free use of lobelia and the utter condemnation of mineral and certain other powerful drags. The clamor that they raised against the heroic treatment then practiced by the mass of the profession resulted in a most bitter feud, in which the laity, as is usually the' case, took an active interest. The State government was appealed to, and for nearly twenty years the strife was kept up, sometimes the profession and sometimes the quacks being ahead. In 1827, however, the profession gained a definite and substantial victory, the medical act of that year placing in their hands the supreme control and regulation of the practice of medicine in this State. At this time the State society had less power over the county societies than at present, and the suppression of quackery was A^rtually left in the hands of the county societies, each having jurisdiction in its own district. The war against the irregulars, just men- tioned, was kept up with more or less vigor in different localities. During the fourth decade of this century, however, a new form of irregularity ap- peared. I refer to the introduction of Hahnemannism or Homoeopathy ; terms which in those days were synonymous. This new form of heresy developed, not among the irregulars, but in the bosom of the profession itself. The ad- herents and advocates of the new doctrines were members in good standing of the county societies, and their brethren were unable to invoke the aid of the law to compel them to practice in accordance with the views and wishes of the majority. Another weapon, however, was brought into play, namely : social and professional ostracism. The public, as before, became interested in the quarrel. Many of the laity regarded the action of the majority as a species of oppression, and, as often happens, became partisans of the weaker party. During this decade the number of professed homoeopaths increased and their adherents and supporters multiplied. The heretics were still members of the county societies, and there was no easy way of ridding the societies of them — that is, against their will. At that time the only way in which a member could be expelled from a society, and prevented from continuing his practice, was through a direct application to the courts. The courts, however, were unable or unwilKng to give the societies the desired relief, feeling, perhaps, that they had no more rigbt to interfere in matters of professional than of religious heresy. The societies, nevertheless, pos- sessed one valuable franchise : They could prevent any new comer from practicing in their respective districts if they saw fit to do so. This af^ forded them the means, as they thought, of preventing the increase of homoeopathy by accessions from abroad. About the year 1842 the Orange County society, I believe, availed itself of this power ; and forbade a physi- IN THE STATE OF NEW YORK. 5 cian of homoeopathic tendencies from practicing in that county. Fearing that he would in like manner be prevented from practicing in the other counties of the State, he gathered his friends together and, without much difficulty, procured the passage in 1844 of a law that deprived the county societies of their powers in this respect. This law, moreover, went much further than this, as it repealed the penal clause of the act of 1827 and vir- tually permitted any who chose, whether educated or not, to practice medicine in this State. This permitted quacks of all sorts and descriptions to ply their vocation without fear of molestation. This condition of affairs was maintained for thirty years, and there can be little doubt that this was the direct result of the injudicious action of the Orange County society, in- dorsed as it was by the then general sentiment of the profession throughout the State. Homoeopathy now had free scope to extend its influence, and, as the evils of sectarian medicine were most keenly felt in New York and Pennsylvania, these States were among the foremost to consider how they might be averted. The result of this consideration was the birth of the American Medical Association. It seemed probable to this association that the most effective blow would be given to the new-born heresy, if the pro- fession as a whole combined against it. It seemed necessary that the homoeopaths as a body should be absolutely excommunicated from profes- sional recognition and intercourse, and that the public at large should know it. In the code of ethics, and especially in the " consultation " clause, this sentiment crystallized. It was thought that the public, knowing that con- sultations were forbidden, would be afraid to intrust serious cases to the care of a homoeopath who might be scores of miles distant from a colleague with whom he might consult. This action was, to say the least, exceed- ingly unwise as judged from a purely medico-political standpoint. In those days the chief therapeutic reliances of the profession were bleeding, purg- ing, puking, blisters, and salivation. In contrast to this the homoeopath offered medication that was not unpleasant to take, nor, apparently, dis- turbing in its effects. Is it a wonder, then, that many persons, finding themselves but trivially affected and yet desiring professional advice, pre- ferred the milder to the severer medication ? Happily recovering, they felt emboldened to trust even severer cases to the homoeopath. The general profession, however, were blind to the teachings of these every-day occur- rences, and it was not until Andral demonstrated in the hospitals of Paris that no treatment was preferable in certain diseases to the methods in vogue, that medical men awakened to the fact that in many cases they were doing their patients harm rather than good. In England, Sir John Forbes learned the lesson, and endeavored to teach it to his countrymen. The reward he reaped was the scorn and hatred of his peers, and, after his death, the virtual adoption of his views (expectant treatment) by a succeeding generation. He simply taught that entire absence of treatment was often better than the heroic methods practiced by his colleagues. During these years the homoeopaths, despite ^ THE STATUS OF THE MEDICAL PROFESSION tlie opposition of the profession, increased in numbers and in influence, and, excluded by the "code" from joining the existing medical corpora- tions, tbey applied to the State for authority to form corporations of their own. This they secured, with powers co-extensive and identical with those possessed by the older societies. Most of the older homoeopaths joined the new organizations, but there was still left a certain leaven of un- righteousness, which the majority desired to get rid of. This could hardly be accomplished under existing laws, as the societies had not the power to prune their membership, except through an application to the courts. This was felt to be an inconvenience, and the Legislature was applied to for relief. Through the exertions of Dr. Oliver White and others, a law was enacted, in 1866, which greatly enlarged the powers of the county societies in this respect. The law in question permitted them to frame by- laws (subject to the supervision of the State society) which would enable them to visit expulsion on any member who should be guilty of irregular practices. The term " irregular practices " was a little indefinite, but was commonly understood to include employing remedies or methods that in any way resembled or savored of homosopathy. In the year following the passage of the act, the Westchester Medical Society invoked its aid to enable them to get rid of an obnoxious member who was charged with "irregular practice of medicine." Apparently the gravest charge against the member was the admitted fact " that he has purchased globules of sugar of milk by the pound from the Homoeopathic Pharmacy in New York City," and " that he used these homoeopathic globules in his practice, to induce his children patients to take the medicine which he prescribed for them." On these charges he was expelled by the county society, and, on the member's appeal to the State society, the action of the county society was sustained. The expelled member, if he desired professional affiliation, was now forced to join the homoeopathic society. In this way the ranks of that body obtained occasional recruits. I do not mean that there were many formal prosecutions for the crime of giving the children a little candy, but the social and professional pressure was so great that many left the regular societies voluntarily, in order that they might obtain a little peace from persecution and be enabled to practice as they thought best. It is a curious fact that, while the regular societies excluded the use of cer- tain medicines and modes of employing them, the homoeopathic societies were really more. liberal in this respect, none of them, I believe, having formally adopted the exclusive tenets of Hahnemann, or declared that their members must practice exclusively in accordance with the doctrine of simi- lars. So far as I am aware, they never expelled any of their members who found that " confectionery " (" Zuckerwaaren," as the decision of a German court of justice recently tenned it) was not always sufficient, and who sup-- plemented it with a good dose of quinine or calomel. The homoeopaths, then, were, practically at least, less exclusive than their elder brethren. Many physicians, who, led by a spirit of inquiry, investigated the homoeo- IN THE STATE OF NEW lOBK ^ patliic system, found some apparently striking verifications of the doctrine of similars, forthwith fancied that in these consisted the whole science and art of medicine, and made use of them as occasion required. This led to their ethical condemnation, and forced them into the established homoeo- pathic organizations, in some instances long before they had any settled convictions on the subject. There is little doubt that the general effect of the " code " was, in many ways, to build up and strengthen the sectarian societies, not only by forcing men into them, but by exciting public sym- pathy in their favor, and thus aiding them politically. A house divided against itself can not stand, and a medical profession di^dded into hostile camps can not long retain the respect of the public, nor the good-will and assistance of the legislators. Going back some years, we witness the birth of still another medico- political organization. The old herb- and steam-doctors, some of whom had picked up a smattering of medical knowledge, began to form voluntary organizations for mutual protection. Before long, they too aspired to cor- porate powers and governmental recognition. The _ existing feud in the profession rendered this a comparatively easy matter. Under the title of " Eclectics" they secured the same chartered rights as the other societies. There is little doubt that at this time the homoeopaths aided the eclectics, believing that, by forming an alliance with them, they could prevent the regulars from in any way curtailing the corporate powers of either body. For obvious reasons an alliance of this sort could not be very long main- tained. The homcBopaths, as a rule, were educated men, while the vast majority of the eclectics were not. There was, however, another cause that tended to isolate the eclectics from the educated profession, and this was their code of ethics. Following the example of the regulars, the homoeo- paths adopted a code that was a verbatim copy of the American code, with the single exception of the consultation clause. The eclectics, however, adopted a code which in every important respect was the exact reverse of the American code. In their code they stated that it was proper for medi- cal men to hold patents on surgical instruments, to advertise in the papers, to invite laymen to operations, to practice with secret nostrums, etc. Such practices most medical men regard as eminently improper, but this did not alter the fact that these men were in the eye of the law fully as regular as the very elect. This position they never would have obtained had it not been for the existing feud between the regulars and the homoeopaths. We now had in the State of New York three medico-political bodies, each with co-ordinate powers and co-ordinate jurisdiction. The differences between them were essentially as follows : The first or older organization and the second one were at variance simply on the question of practical therapeutics, while on questions of general medical polity they thought alike. The third organization differed from the others, both on the ques- tion of therapeutics and medical polity. One might suppose that the State of New York was by this time sufficiently afflicted, but such was not the 3 THE STATUS OF THE MEDICAL PROFESSION ^ case. A few years later, still another body, claiming to possess certain special therapeutic advantages, obtained corporate privileges and govern- mental recognition. But this was not all ; the repeal of the penal clause of the act of 1827 permitted quacks and charlatans of every kind to come ta the State and deceive the unwary in any manner that they chose. Such was the condition of affairs up to 1874. At this time some one — I have never been able to ascertain who — introduced into the Legislature a bill ta regulate the practice of medicine in this State. This bill would appear on its surface to have been a desirable measure, but a careful study of it ought, at the time, to have revealed its true inwardness. If this bill was not origi- nally drawn by the eclectics, it was unquestionably manipulated by them during its passage tkrough the Legislature, and practically it turned over to them the licensing of every quack in the State who thought it worth while to pay them an examination fee of ten dollars. The majority of them, however, did not take even this trouble. They had enjoyed immu- nity for thirty years, and were not afraid to take the risks a little longer. As a matter of fact, the few prosecutions that were undertaken came to a lame and impotent conclusion. This, then, was the state of medical affairs in New York about the year 1876. There were, first, the regular profession, enjoying chartered rights that dated back for seventy years, and consisting of men who were gradu- ates in medicine, or licentiates (after examination) of the county societies; second, a sectarian offshoot from them, who were likewise educated men ; third, a sect growing up by itself, and slipping into corporate existence while the first and second were quarreling — an exceedingly small number of these men had received a medical education ; fourth, a sect that died almost at its birth ; and, fifth, the horde of miscellaneous quacks who set- tled in the State during the times when this could be done with impunity. All of these things were brought about during the period that the profes- sion were'under the guidance of the code of ethics of the American Medi- cal Association. Surely, if the object of this code were the suppression of quackery, its success can hardly be described as brilliant. How it is in other States, the profession there resident are the best judges. In what precedes and follows, I am speaking only concerning the State of New York. With quackery rampant to a degree never before witnessed in this locality, the problem to be solved was, What were the causes and what was the remedy ? Th.ese questions could certainly not be answered off-hand and without consideration. The problem was one that required careful and earnest study, if a correct solution was to be reached. This study was un- dertaken by the then officers and censors of the Medical Society of the County of New York, whom the law had constituted the guardians and protectors of professional honor and professional interests within their juris- diction. Almost the first conclusion at which this body arrived was, that the laws regulating the practice of medicine were palpably defective. With practically no law from 1844 to 1874, and after that a worse than no law, it IN THE STATE OF NEW YOliK. g was clear that, until an efficient statute was enacted, it would be impossible to expect much, if any, improvement in the affairs of the profession. At this juncture a gentleman who had acted as the legal adviser of the society offered to prepare a suitable bill, and endeavor to procure its enactment. His offer was accepted. A bill was prepared, and introduced in the Senate. This bill was referred to a committee, and an hour was assigned for its con- sideration. At the appointed time the advocates and opponents of the bill presented their views to the committee, which was represented solely by its chairman, Dr. Ray V. Pierce, of Buffalo, a noted medical advertiser, and a member, we believe, of the eclectic organization. The bill did not meet the approbation of the committee, was not reported favorably to the Senate, and did not become a law. The next attempt to secure suitable medical legislation was made by the State Medical Society. In 1880 it instructed ^ its Committee on Legislation to prepare a proper law and submit it to the Legislature. This was done, and the Medical Act of 1880 was the result. Prior to the passage of this act there were in the State upward of one hun- dred and fifty bodies that were competent to legitimize practitioners of medicine. The act in question reduced the number to thirteen. Of these bodies, two were eclectic, two wete homoeopathic, one was nondescript, and the rest pertained to the regular school. Within the past year two of these bodies have been declared illegally constituted, and their career has ended. In 1882 an attempt was made by the State society to reduce the number of licensing bodies to one. The bill which was drawn for the purpose of effecting this object did not become a law. The law of 1880 remains in force, and under it the entire responsibility in regard to the licensing and legalizing of practitioners in the State rests with the medical colleges of the State, while prosecutions for violation of the law may be undertaken either by individuals or the county societies. In New York County these prose- cutions have been numerous, and usually successful. Thus far but one flaw or serious imperfection in the law has been discovered — namely, that the penalty for perjury in connection with registration is not sufficiently severe. Shortly after its adoption, our Pennsylvania brethren procured the enact- ment in that State of a law identical in its main features with the New York law. That the New York law is all that is to be desired, or that it is the best medical act in this country, is far from being claimed. In fact, I believe that Illinois and North Carolina have better ones, both from a theo- retical and practical standpoint. From this resume of the medico-political situation it will be seen that, after a sharp fight with quackery, the profession obtained the upper hand in 1827 : that for several years it retained this control ; that in 1844 it lost its power, and failed to regain any of it until 1880 ; that even now it does not possess the full powers and privileges that it formerly enjoyed. IQ THE STATUS OF THE MEDICAL PROFESSION SECOND AETICLE.^ From the Nao York Medical Journal for April 28, 1883. In our last we presented the medico-political or legal relations of the profession. In this we will consider the medico-educational. The oldest of the existing medical colleges is the College of Physicians and Surgeons. This institution was chartered, not directly by the State, but by the regents of the university, in the year 1807. It was at that time virtually the same corporation as the New York County Society, or, in other words, the county society was constituted a medical faculty, with au- thority to teach and grant diplomas. The intimate relationship was not long maintained. The teaching body obtained independent powers, and was subservient, to a slight degree only, to the county society as such. The relationship, however, was not wholly dissolved, for, a few years later, when the college exhibited an unbecoming laxity in the granting of de- grees, the society exercised its powers and influence to break up these practices. Since that time there has been, so far as we are aware, no spe- cial scandal connected with the management of its affairs. As an alumnus of the institution, we feel pride in stating that it has, before all others, been careful in the exercise of its corporate powers. This statement, however, is not true of some other colleges that were in existence during the early part of this century. The granting of diplomas was so lax that the State declared they should no longer be a license to practice [" The degree of doctor of medicine conferred by any college in this State shall not be a license to practice physic or surgery," Act of 1827, Sec. 21]. Subsequent to this time several new colleges were organized, which, in their charters, obtained the right to make their diplomas licenses to practice. At the present time the diploma of every legally incorporated medical college in the State carries with it the license to practice. On the other hand, no medical college in this country or elsewhere issues a diploma which entitles its bearer to practice in this State, except with the approbation of one of the college faculties of this State. It matters not whether the candidate has drawn his inspiration from Gross or Buchanan, he must first satisfy a college faculty of this State of his fitness to practice before he can become a legally quaUfied practitioner in this State. As before noted, the entire responsi- bility concerning the qualifications of practitioners coming into the State IN THE STATE OF NEW YORK. W from without the State rests with the colleges. For the assumption of this responsibility they are entitled to exact a fee of twenty dollars in each case. Until recently there were thirteen colleges capable of exercising these powers. Of these, eight professed to teach non-sectarian medicine, located, four in New York city, one in Albany, one in Syracuse, one in Buffalo, and one in Brooklyn. Two taught homoeopathy, both located in New York ; two were of the eclectic persuasion, both in New York ; and one, the " College of Physicians and Surgeons " of Buffalo, was a nondescript. These col- leges all possess the power of granting the degree of doctor of medicine, and their diploma carries with it the license to practice in the State, after the graduate shall have complied with the registration law of 1880. The legal requirements for graduation are the same in all — namely, three years' pupilage with a legally qualified practitioner (not necessarily of this State), attendance on two full courses of lectures, the last of which in the college granting the degree, and the passage of a satisfactory examination in the seven principal branches of medical science. It is safe to say that the re- quirements in the matter of examination have not been identical in the thirteen institutions. As regards the regular colleges, there have been no public scandals connected with improper graduation of candidates, at least of late years. The same can be said of the homoeopathic colleges, but can not be said of either of the eclectic colleges. The " Eclectic Medical Col- lege " of New York has been very strongly suspected of issuing diplomas contrary to law. Suspicion was first directed toward the other eclectic in- stitution, known as " The United States Medical College," in consequence of the receipt by the officers of the New York County Society of a com- munication from the Illinois authorities asking the status of said college. The communication further stated that a person armed with a diploma of that institution had applied for a license to practice in Illinois, under cir- cumstances that led them to suspect that he had obtained his diploma ille- gally. This led the officers of the society to watch the college, and, on examination, they became satisfied that the college itself was not legally incorporated, and they instituted a suit against it. The Supreme Court of the State has, within the past few weeks, rendered a decision to the effect that the college was not legally incorporated, and hence that none of its diplomas are legal. In Erie County the same may be said. The College of Physicians and Surgeons of Buffalo stood on exactly the same footing as the United States College, and a similar suit against them has resulted in a similar decision from the Supreme Court. We have now but eleven medi- cal colleges, against thirteen of a year ago. How much further the shrink- ing process will extend it is impossible to foresee. " The mills of God grind slowly, yet they grind exceeding small," and the profession of this county may rest assured that, if they give their officers proper moral and financial support, illegal pr'actice and quackery of all sorts will be an ex- ceedingly haizardous pursuit. ^ It may, we think, be truthfully stated that, at the present time, quack- ;J2 THE STATUS OF THE MEDICAL PROFESSION ery * and unqualified practice prevail liere to a less extent than in any other State in the Union, with the exception of the States of Illinois and North Carolina. On the other hand, the States in which it flourishes most lux- uriantly are Massachusetts and Pennsylvania, the latter State claiming to be the banner State of the old code, while the former has a special code of its own that is, in some respects, even more stringent than that of the American Medical Association. If we turn now to the States of Illinois and North Carolina we find that in the former quackery flourished to an alarming extent just so long as the profession was actively aggressive to- ward sectarian medicine. As soon, however, as it joined hands with sec- tarianism for the purpose of putting down quackery, it then began to tri- umph over the common enemy. This joining of hands occurred when the Illinois State Board of Health was established, in which were representa- tives of the regular, the homoeopathic, and the eclectic schools. In North Carolina the case was somewhat different. In that State the profession had never allowed the subject of sectarianism to trouble them very much. If a homoeopath by sia.j chance settled among them, they very sensibly let him alone. They neither persecuted nor prosecuted him. They gave him no opportunity to play the martyr, or to parade his grievances in public. We have been curious to learn the outcome of this policy, and, on inquiry, have been informed that, of fourteen hundred physicians in that State, there are but six homoeopaths, and, so far as known, no eclectics. In contrast to this let us cite the neighboring county of Kings in our own State. Many years ago a gentleman of homoeopathic proclivities applied for admission into the county society. He was refused membership. He carried the matter to the courts, and obtained a decision in his favor. He did not join the Kings County Society, however, as in the mean time a homoeopathic society had been formed of which he became a member. By the continu- ance of the same policy the Kings County regulars succeeded in building up against themselves a pretty strong sectarian organization, and now re- joice in one homoeopath to about every six regulars, a larger proportion of homoeopaths than will be found, we believe, in any other portion of the United States. New York city has about one homoeopath to ten regulars. This digression aside, we return to the subject immediately under con- sideration, namely, the medico-educational status of this State. Of the eleven medical colleges, three may be placed in the front rank as regards importance and facilities for medical instruction. Banking with them are two colleges in Pennsylvania and one in Massachusetts. These six colleges compete for and obtain the patronage of the better class of students, the one in Massachusetts, however, possessing a higher standard for entrance than the others. One of the colleges of this State emulated the example of Harvard, and declared that it would require an examination of the student's, * Bj' quackery we here mean the practice of medicine by uneducated and legally un- qualified persons ; while by sectarian medicine, practice in accordance with some special method or doctrine. /A THE STATE OF NEW YORK. \^ fitness before permitting him to matriculate. This declaration was regarded by the profession at large as an indication that the faculty of the college were determined to elevate the standard of medical education in the State, .and in thi^ way contribute to the elevation and maintain the dignity and honor of the profession. We all know how the experiment terminated. After one year's trial the faculty reconsidered its resolution to require a preliminary examination, and resumed its former status. The two other colleges, however, have made some substantial advances ; one of them, by enlarging its building, adding laboratories, etc, has increased its facilities for teaching, and the other has materially lengthened its lecture course. At the present time the clinical advantages, the facilities for instruction, and the quality of instruction actually given in this city, are, we believe, unsurpassed by any to be found elsewhere in this country. The other col- leges in the State have, according to their opportunities, done well, and, in some respects, have shown a more progressive spirit than the metropolitan institutions. This, then, is the medico-educational status at present. What it will be in the future it is impossible to foresee. There are evidences, however, that thoughtful minds in the profession are looking and hoping for still greater improvement. This may take the shape of a single board of exam- iners, or the establishment of a medical college so largely endowed that the number of the students and of graduates will not be a material factor in the requiremeuts of the college, or possibly the State or the municipality may itself assume the prerogative, as in several European countries, of educating those who aspire to be physicians. These, however, are questions that do not appear to exact immediate settlement, nor is such settlement at present possible. 14: THE STATUS OF THE MEDICAL PROFESSION THIRD ARTICLE. From the Xew Yorl- 2Iedical Journal for May 5, 1883. Having considered briefly, but we believe accurately, the medico- political and medico-educational status of tlie profession in this State, we will now take up tbe question of its medico-etMcal position and require- ments. As already noted, tbe earliest attempt at etbical regulation in tbis State was tbe adoption of tbe System of Ethics of tbe Medical Society of the State of New Tort in the year 1823, long before any other State had thought it worth while to move in tbe matter. This code remained in force until 1880. About the year 1850 the " Code" of the American Medi- cal Association was also adopted by the State society, but without tbe repeal of the older code. The profession of the State were, therefore, under tbe guidance and governance of two distinct codes, the respective provisions of which were not altogether in harmony. Thirty-five years ago there were those who preferred the old State " System" to the "Code" of tbe American Medical Association ; but, as by the adoption of the Ameri- can Medical Association code there was a prospect of national unity on . tbe matter, they yielded their preferences, and consented to be bound by both, thus accepting a measure of etbical responsibility in excess of that borne by the profession in any other State in the TTnion. At this time there was no other organized section of tbe profession to question tbe pro- priety of tbis code, or to propose the adoption of another. A few years- later tbe homoeopaths became organized, and acquired chartered privileges. They were, as already stated, an outcropping from tbe general profession, and thought best to follow its example and adopt a code. This code was an almost exact transcript of the American code, with the exception of tbe paragraph relating to tbe question of consultations. On tbis point they differed from tbe older code as foUows : " A complete medical education, of which the diploma of a medical college is the formal voucher, furnishes tbe only presumptive evidence of professional acquirements and abilities. But tbe annals of the profession contain the names of some who, not having the advantages of a complete medical education, became, nevertheless, through their own exertions and abilities, brilliant scholars and successful practitioners. A practitioner,. IN THE STATE OF NEW YORK. \^ therefore, whatever his credentials may be, who enjoys a good moral and professional standing in the community, should not be excluded from fel- lowship, nor his aid rejected, when it is desired by the patient in consul- tation. No difference in views on subjects of medical principles or prac- tice should be allowed to influence a physician against consenting to a consultation with a fellow-practitioner. The very object of a consultation is to bring together those who may, perhaps, differ in their views of the disease and its appropriate treatment, in the hope that, from a comparison of different views, may be derived a just estimate of the disease and a suc- cessful course of treatment. " No test of orthodoxy should be applied to limit the freedom of con- sultations. Medicine is a progressive science. Its history shows that what is heresy in one century may, and probably will, be orthodoxy in the next. No greater misfortune can befall the medical profession than the action of an [influential association or academy establishing a creed or standard of orthodoxy or regularity. It will be fatal to freedom and progress in opinion and practice. On the other hand, nothing will so stimulate the healthy growth of the profession, both in scientific strength and in the estimation of the public, as the universal and sincere adoption of a platform Avhich shall recognize and guarantee : "1. A truly fraternal good-will and fellowship among all who devote themselves to the care of the sick. " 2. A thorough and complete knowledge, however obtained, of all the direct and collateral branches of medical science, as it exists in all sects and schools of medicine — as the essential qualifications of a physician. " 8. Perfect freedom of opinion and practice, as the prerogative of the practitioner, who is the sole judge of what is the best mode of treatment in each case of sickness intrusted to his care." The additional sections of the homoeopathic code so closely resemble those of the American code that they need not be quoted. They recognize the impropriety of advertising, of patenting surgical instruments, of prac- ticing with nostrums, keeping secret the nature and composition of medi- cines used, etc. A few years later, when the eclectics became organized, they also adopted a code — one that was likewise based on the American code, and differing from it mainly by reversing the intent of many of the most im- portant sections of the older code as follows : "Article III (^Eclectic Code). " Medical men have an undoubted right to bring themselves and their claims before the public by every fair and honorable means, as much as any other class of men. They may enter into general or special practice as they may consider best adapted to their interests or to their peculiar views ; they may introduce themselves to the notice of the public by printed cards or other publications, by public or private lectures, or by the publica- 1(3 TEE STATUS OF THE MEDICAL PROFESSION' tion of certificates of cures actually performed. Tlie presence of laymen at operations is by no means objectionable if botb patient and operator sliall consent, as it tends to make the skill and ability of tbe operator bet- ter known in the community, etc. " Article Y. " A medical man having invented any surgical instrument, or discovered ' any new or valuable medicine, it becomes his capital, and it is not unpro- fessional for him to obtain a patent for the same. ... A physician may employ, in his ovrn practice,, a medicine or compound known only to him- self ; it is his capital, and there is no authority in the land ■which can com- pel him to divide that capital among others by disclosing his remedy, save his own benevolence and philanthropy," etc. Such is the " Code " of a body of men who would never have received governmental recognition if the educated members of the profession had not been engaging in a bitter internecine warfare. This was the status of nominal etbics untU within a recent period. The regular profession and the two sectarian bodies each had its code of ethics, differing from the others in the manner that we have seen. Wbile the American code held sway over the great mass of the profession, sectarianism was increasing in power and influence. An evil which at its birth could have been easUy controlled by wise measures was, on the other hand, inju- diciously stimulated to an abnormal growth. For many years tbe American code had, in great measure, lost its vitality, and its edicts were not re- spected. One form of impropriety after another came to the surface, which, it appeared unable to rectify or control. Eminent members of the profes- sion began to violate not only its spirit, but its letter, and the corporate bodies of which they were members appeared unwilling or unable to sub- ject them to discipline. About fifteen years ago the Xew York Academy of Medicine did discipline one of its members for consulting with a homoeo- path. Their experience on that occasion led them, quite wisely, to refrain from a repetition of the experiment. A few more such attempts would un- doubtedly have led to the disruption of the Academy, and, in all proba- bility, to a forfeiture of its corporate privileges. The suspension of the late Dr. Gardner from his rights as a Fellow of the Academy undoubtedly acted as a partial restraint on the other members of that body, and more especially on those who were comparatively young in the profession, or without suf- ficient influence to shield them from prosecution. As a matter of fact, two Fellows of the Academy permitted it to be publicly understood that they consulted with homoeopaths, and would continue to do so as often as they pleased. Despite this fact, these members have never been brought to the bar of the Academy for discipline. In 1865 ethical affairs were in such a state in Xew York that the late Dr. Oliver White saw fit to send to the Comitia Minora of the county so- ciety a communication, from which I extract the following : " It is patent to IN THE STATE OF NEW YORE. J 7 Hs all, Mr. Chairman, and it is daily manifest, that members of our profes- sion, once occupying honorable positions in it, have lost their standing among us by their own disreputable, dishonorable, and empirical practices, in violation of all medical ethics ; and, insomuch as we are not permitted by the laws of the State to discipline or expel unworthy members from the county medical societies^ except through the courts ; and, insomuch as we deem it both just and proper that our county society should be the custo- dian of its own honor, and the conservator of its own morals — therefore do I earnestly entreat the Comitia Minora to draft a memorial to the Legisla- ture of the State, praying that honorable body to grant the county medical societies throughout the State relief from the oppressive disabilities afore- mentioned; and that the Comitia ask the approval of the society to the proposed action in this matter." The result of this action was the passage of the Medical Act of 1866, which gave the county societies almost plenary powers in matters of disci- pline. At the meeting of the county society, held June 4, 1866, a resolution was offered to the effect " that a committee of three be appointed to examine our list of members, and report the names of those whose connection wiLh the society should be dissolved, and also what steps should be taken to ac- complish this result." This resolution was referred, with others, to a com- mittee of five, which met and considered the matters referred to them. This latter committee reported at the September meeting of the society that they could not purge the roll of membership as proposed, and recom- mended that " no further action be taken upon the matter at present," and requested " to be excused from further deliberation." This was certainly a rather impotent conclusion of the effort to purify the morals of the profes- sion. Since then very little has been done iu the way of attempting to check violations of the code. This brings us to the year 1876, when the first open and bold proposal to repeal this code was made by Dr. J. Marion Sims, in his presidential address before the American Medical Association. From this address we extract the following : " Here common sense and common interests have silently, almost im- perceptibly, established a higher law that overrides the code and leaves it inert." " The code of ethics is violated every day, either willfully or ignorantly, not only by the rank and file, but by men high in the profession — men who are considered leaders, advanced thinkers, and workers." The proposition of Dr. Sims to abolish the code produced a profound sensation. Many thoughtful persons asked themselves whether the code as it existed, but unenforced, was doing any good, while others asked whether or not it was not doing absolute harm. It may be safe to say that by the majority Dr. Sims's proposition was looked on with disfavor. At all events, no action was taken in support of it by the association at the time. This is not surprising when we consider the composition of this body, ma de up 13 THE STATUS OF THE MEDICAL PROFESSION as it is of representatives from all parts of the country, very few of whom had examined the subject with any care. The hatred of sectarianism was so great that men seemed unable to calmly consider how it could be abated. Nothino- was done. Shortly after this the writer found himself, as an offi- cer of the county society, face to face with questions in ethics that must be met. The code was violated daily, both by those of high and low degree ; but discipline was rarely asked for, except to gratify some personal malice. The two most obvious violations consisted in mixed consultations, and a striving after notoriety through the medium of the public press. These evils the officers of the society found themselves powerless to combat. This may appear to be a strange statement, but the facts are as follows : In refer- ence to mixed consultations, the apparent spirit of the code was rendered nugatory by a change of base on the part of the homoeopaths themselves. Their State society adopted a formal resolution,* in which they declared that for the future they would not adhere to the exclusive doctrines of Hahnemann, but would use such other methods as individually they saw fit. A careful comparison of this resolution with the consultation clause of the code makes it clear that the homoeopaths had thus technically freed them- selves from the ban, and that it would be impossible to discipline a member of the county society who should consult with them. The second difficulty that embarrassed the Comitia was the matter of newspaper notoiiety which certain members gained through " interviews," and through certificates given in favor of certain mineral waters, etc. This was a new form of impropriety, against which there was no pro^dsion in the by-laws of the society, and the Comitia were, therefore, powerless to take official cognizance of the matter. The president of the society, how- ever, took on himself the burden of appealing personally to the offending members. Strange as it may appear, some of them referred him to the code of the American Medical Association, and claimed that their conduct was not only blameless, but praiseworthy. Curiously, an examination of this code appeared to support their claim. Under these circumstances, the Comitia had but one resource — namely, an appeal to the State society, in the hope that it would enact sach laws as would enable the county societies to effectually deal with the evils referred to. Such an appeal was made to the State society, at its session in 1879. It was disregarded, and no relief * Resolved, Tiat, in common with other existing associations which have for their object investigations and other labors which may contribute to the promotion of medical science, we hereby declare that, although firmly believing the principle similia similibus curantur to constitute the best general guide in the selection of remedies, and fully in- tending to carry out this principle to the best of our abihty, this beUef does not debar us from recognizing and making use of any experience, and we shall exercise and defend the inviolable right of every educated physician to make practical use of any estabUshed principle in medical science, or of any therapeutic facts founded on experiments and verified by experience, so far as, in his individual judgment, they shall tend to promote the welfare of those under his professional care." — Adopted by the Homoeopathic State Society, February, 18Y8. IN THE STATE OF NEW YORK. |9 was afforded by the State society. The Comitia, however, were not alto- gether discouraged, and requested the writer to correspond with the chair- man of the proper committee of the State society and ask him to make a personal investigation of the matters in question. A lengthy correspond- ence resulted. It was early conceded that the American code did not afford protection against the rapidly increasing certificate nuisance, and, if this ought to be stopped, some new and more effective rule must be adopted. The matter of consultations, however, presented much greater diflSculties in the way of settlement, as on it hinged the whole question of sectarian- ism and its influence for good or ill on the profession. The present writer's views on the subject were presented in the form of a letter under date of November 28, 1879. From this letter I shall now quote at some length: " The question " (of sectarianism) " is a grave one, and demands serious examination at the hands of the enlightened members of the profession, and never more so than at the present time. The subject must be looked at in its several aspects, and regarded from the standpoints of medical poli- tics, of doctrine, of utility, and of its present raison d'etre. "■ In respect to the medico-political aspect of the question, it may be stated that the existence of sectarianism in medicine is a great evil, perhaps the greatest that at present oppresses the profession, and tends to injure it in the esteem and respect of the public. The State has seen fit to recog- nize three kinds of practitioners, who are in the position of public antago- nists, each claiming that the general methods of treatment pursued by them are superior to those employed by the others, and each decrying and speaking in derogatory terms of the others. The public is not competent to decide to which of these the greatest measure of merit pertains; and, in the majority of instances, the choice of a medical attendant is the result of considerations that need not be entered into at present. The public, however, interests itself to a greater or less degree in the controversial ele- ments of the question, and the result is a certain distrust of and lack of confidence in all three. " The venerable Hufeland, nearly fifty years ago, in a very able essay on the subject, pointed out the evils that would result from sectarianism in medicine, and anticipated the statement made in the last paragraph. He wrote : ' Nothing is, on the whole, more prejudicial to our art, nothing tends more to diminish public confidence in it, than a x>ublic quarrel, and the public expression of a mutual depreciation of one another by its professors. All who have the honor of the art at heart must lament such open bicker- ings, and do all they can to prevent them. The public is only too disposed to interest itself and to find amusement in them. Has it not already come to such a length that our dissensions are paraded on the stage, just as in the time of Moliere ? And do we not feel that just as the estimate of our art in general decreases, so every one, to whatever party he may belong, loses somewhat ? ' . . . " If, now, it be granted that sectarianism is an evil, does it not behoove 20 THE STATUS OF THE MEDICAL PROFESSION the profession to consult together as to the best means to abate it? Be- fore, however, this question is answered, it will be necessary to consider ■whether the abatement of this evil would bring about others that were still greater. The correct solution of this necessitates an acquaintance with a large number of facts, pro and con, which must be duly weighed, and the probable effects of any change in the present status carefully estimated. The opinion that I have personally formed is, that a certain amount of tem- porary inconvenience would ensue, to be followed by advantages that would more than counterbalance it. . . . " If the abolition of legalized sectarianism is desirable, the methods of its accomplishment must be considered. To this end but two are known to me — namely, force and persuasion. Force has been tried, and has failed as regards the homoeopaths. The more severe the exclusive enactments against them, the more they have seemed to flourish. The American Medical As- sociation, in ] 847, by the enactment of the consultation clause in the code, thought, by thus throwing odium on them, that the people would sustain the profession and refuse to employ the homoeopath. In this the asso- ciation was mistaken. . . . The action of the association, therefore, by excluding the early homoeopaths from professional intercourse, simply caused them to unite the closer among themselves, each befriending and de- fending the other in time of need, and all uniting for the promotion of cer- tain common objects, more especially the acquisition of the confidence of the people, and the attainment of governmental recognition. The .measure of success that has attended their efforts we are all witnesses of to-day. It will, therefore, be readily granted that the policy of the association has not accomplished its object, i. e., the suppression of homoeopathy, and I seri- ously question whether a continuance of this policy will not prolong and aggravate the present evils. " Before, however, any other method be attempted, it is expedient that we should be accurately acquainted with the political and doctrinal status of the homoeopathy, not of 1847, but of to-day, and we should more par- ticularly regard the matter in its relations to the people and the profession of the State of New York. The homoeopaths of this State may be divided into two pretty sharply defined groups. One group holds that the propo- sition "similia" is of great service in the selection of drugs where these agencies are requisite in the treatment of disease. They respect Hahne- mann as a prominent promulgator of this doctrine. They reject, however, his theory of dynamization, they reject his peculiar views regarding the origin of chronic diseases, they reject his views as to dosage, and disbelieve or deny his statements concerning the eflficacy of infinitesimals.* The other group of homoeopaths pretend to hold strictly to all of Hahnemann's * " The homceopathy of to-day has also shaken fi'om its feet the dust of more than one worthless theory. Although within its ranks are still numbered some so-called high dilutionists, its leaders have long ceased to insist upon LnCnitesimal dosage as an essential principle of treatment." — Beaed, "Popular Science Monthly," February, 1883. IN THE STATE OF NEW YORK. 21 doctrines, and consider themselves his only genuine followers. An aggres- sive movement on the part of this latter party led the liberals to a counter- movement, which resulted in the adoption by their societies of the resolu- tion Ave have given above, and a decided split in their ranks, " The regular profession has now an opportunity of settling the homoeo- pathic difficulty in a very simple manner. Let it be understood that it is willing to receive into fellowship those who have practically abandoned Hahnemann's homoeopathy, on condition that they also abandon the name, calling themselves, and permitting themselves to be called, jjhysicians sim- ply. It is probable that during the first year or so but a small number would avail themselves of the opportunity of joining the county societies. Later they would come in more freely. This would result in a return to the State of the chartered rights now possessed by them, and the removal of sectarian and offensive titles from the hospitals, dispensaries, colleges, and journals now controlled by them." The above are the views that were held by me at the date that the above letter was written, and are in substantial accord, with those that I hold to-day. There is little doubt that, if this course had been pursued at that time, when the homoeopaths were in so badly demoralized a condition, to-day there would have been no organized body, in this county at least, occupy- ing an antagonistic attitude. The writer's position was, and is, that social and professional absolution be accorded to all who are willing to renounce exclusivism and unite with the main body of the profession. In the number of this Journal for April 7th, pages 372 and 373, Dr. Flint would appear to be willing to go even further, and accord professional recognition to all, whatever their belief or practice, provided only they dis- continued their connection with sectarian societies. 22 THE STATUS OF THE MEDICAL FEOFESSIOj^^ FOURTH ARTICLE, 'From tlie Xeic York Medical Journal for May S6, 1883. At the annual meeting of the Medical Society of the County of New- York, held Octoher 25, 1880, its Committee on Ethics made the following report : * ..." Almost without an exception, therefore, the work of the committee has been confined to complaints against members of the society for public adver- tising, or methods that are regarded as at variance with the spirit, if not the let- ter, of that portion of the American Code of Ethics embraced in Chapter 11^ paragraphs three and four. " The committee approached this well-known field of action, where an almost ineflfectaal skirmish has long been kept up, with feelings of great uncertainty as to what the result of their efforts would be, and with a desire to perform their unpleasant duty without giving unnecessary ofi'ense to any. The committee, al- though to some extent shielded from personal attacks by its official character^ has been unable in all instances to perform its duties without censure from indi- viduals with whom it has been in communication ; and in other instances, where requirements were made under the committee's interpretation of the law, it has encountered firm opposition. Previous to this committee's appointment, efforts had been successful in securing the withdrawal of physicians' mineral-water tes- timonials from the public press, hut it was well known to the committee that all attempts to suppress those still appearing in the medical journals had been in the main unavailing : indeed, these futile efforts were treated as an encroachment on the rights of those concerned. " The society, when appealed to on this subject at a meeting held April 22, 18T8, adopted a resolution clearly expressing its disapproval of the practice of giving certificates to be used in bringing to notice ' any drug, nostrum, mineral water, wine, or other proprietary article intended to be used as a medicine or remedy in disease, or to any patented instrument or appliance that is intended for medical or sui'gical use.' "This resolution, which, morally at least, had all the force of a by-law of the society, was at the time of its adoption brought to the notice of every member of the society. The effect, however, was not what had been expected, and the commercial pages of the medical press still teemed with advertisements of trade- marked preparations, etc., bearing the sanction of medical men. . . . " The committee, after mature deliberation, being encouraged by the success * I omit such portions of the report as have no bearing on the present question. IN THE STATE OF NEW YORK. 23 others had already attained, and fortified by the resolution of the society above alluded to, thought that it was clearly their duty to make another appeal to those who stiU considered tliat they had a right to give their sanction to the articles under consideratiou ia a manner objectionable to the profession in general. The committee, therefore, adopted the following at a meeting held January 7, 1880: '•Resolved, That, in view of the fact that these certificates are offensive to a ma- jority of the profession, and that their continuance is an injury to professional tone, the Committee on Ethics respectfully requests the gentlemen concerned to take measures to have them discontinued.' This resolution, together with that adopted by the society, was printed in the form of a circular, and copies of it were sent to all whose names had been reported to the committee, with a request that they would signify to the committee what course they intended to pursue in the matter. The total number to whom the circular was sent did not, perhaps, exceed two dozen. "As a result of this action, a very small number signified their intention to withdraw the objectionable testimonials, and the committee has been informed that they have done so. In a few instances, letters in vindication of certificate writing were received, but it is believed that the position assumed in defense is not tenable, for in the advertisement of lactopeptine, for instance, the virtues of the remedy are extolled in a manner rather to arrest the public eye than instruct the physician; and this of a preparation where the method of manufacture is kept secret, and where the copying of its name by any one would render him liable to prosecution. The indication of the constituents of this preparation does not relieve it from the objection held against trade-marked and proprietary articles. "The greater number to whom the circular was sent, however, failed to respond to the committee's request, and their certificates continue to appear. "It will thus be seen that the committee has advanced this work but little, for, so long as any member can permit of the publication of these certificates with impunity, the majesty of the codes of ethics is not maintained. And, now that the society has continued to experience defeat in this matter, it may be well, before entering the contest again, to inspect its position and strength. The com- mittee has, therefore, made a careful examination of that portion of the Ameri- can Code of Medical Ethics and of the System of Medical Ethics of the Medical Society of the State of New York bearing on this subject, and it seems to it that, although their provisions may have been sufficient for the time when they were adopted, a gradual transformation in the character of the abuses alluded to has taken place, and, instead of secret remedies, there has grown up the proprietary and trade-marked article, which requires the investment of a large amount of capital. Secrecy has ostensibly been removed as to the constituents of these goods, but their manufacture or imitation is successfully prevented by patents and trade-marks. That they owe their chief value to professional testimonials and skillful advertising may well be believed. The committee has failed to find anything in the codes referred to sufficiently explicit to give them plenary power to take further action. If, therefore, the society desires to prevent its members contributing to trade interests in the manner above alluded to, and thus injuring its own, it has ample power under the State statutory laws to make the resolu- tion of April 22, 1878, a by-law of the society. The experience of the committee leads it to believe that no other course will accomplish the end desired. . . . " In this connection, it may be pardonable for the committee to state that its 24 THE STATUS OF THE MEDICAL PROFESSION experience during the past year has, in a forcible manner, demonstrated the in- adequacy of the present codes of medical ethics to tlie existing demands of the profession. The code adopted by the American Medical Association thirty odd years ago has in many respects become obsolete ; what were deemed offenses then are no longer regarded in tlie same light. Per contra, the ingenuity of man has developed practices which were unknown when the codes, national and State, were established, and hence were unprovided for. The code of the Ameri- can Medical Association contains a mass of sentimental advice which, together with its moral platitudes and verbiage, would seem to suggest the necessity for its revision. Our own System of Medical Ethics, which the State society adopted iu 1823, and which has since been subjected to but few alterations, is, perhaps, even more obsolete than the code above alluded to. The profession is now in no sense guided by these codes ; nor does it seem desirable to hold it together either by the regulations that pertain to trades-unions, or by the moral platitudes of existing codes, but it rather requires for its wholesome government clear and business-like regulations, backed up by our ample statutory laws, leav- ing the matter of moral maxims and precepts, as well as personal manners, to the social conditions that surround the individual." This report was signed by Di's. Samuel Sexton (Chairman), James R. Leaming, W. M. Polk, J. D. Bryant, and Clement Cleveland (Secretary). The foregoing was printed, and distributed to the members of the society. At the annual meeting of the Medical Society of tlie State of New York, held February, 1881, the President of the society, in his Inaugural Address, called tlie attention of the society to the necessity for a change in the code of ethics, perhaps the need for an entirely new one. The committee to whom the President's address was referred reported the following resolution : " Resolved, That a special committee of five be appointed by the Presi- dent, to be designated a ' Committee on the Code of Ethics,' whose duty it shall be to consider the whole question of desirable changes in the code, and who shall present to the society, at the session of 1882, such sugges- tions on this subject as their observations and investigations may direct." This resolution was adopted by the society, and a committee of five was appointed. Of the personnel of this committee the following may be stated : Three of its members were chosen from among the older members of the society and the profession, and two from among those who had been in practice between fifteen and twenty years. Three of the members had been presidents of the society, and the other two had served on important standing committees. Three were from the northern, western, and middle portions of the State, and two from the city. Three were general prac- titioners, and two were specialists. From this it would seem that the va- rious interests involved had been carefully provided for. The committer gave the subject with which they were charged careful and laborious atten- tion during the year that was allotted to them. The views of the different members were in part elicited and circulated by correspondence, and the IN THE STATE OF NEW YORK. 25 ■views and feelings of many of the more prominent, and also of the more obscure, members of the profession were sought. After a pretty complete knowledge had been obtained of what appeared to be the prevailing senti- ment of the profession throughout the State, the committee, setting private business aside, devoted two entire days to the matters under consideration. The first conclusion arrived at was, that, if the profession of the State de- sired a code, one should be reported that should be clear and distinct in its meaning, and one that could be enforced when necessary. The second conclusion was that the code should contain nothing that was already pro- vided for by the laws of the State, or by such moral laws as all, whether ■Christian, Jew, or infidel, considered binding. This narrowed the matter to the formulation of such rules as seemed to the committee most likely to he in harmony with the sentiments of the thoughtful members of the pro- fession, and to conduce to the best interests both of it and of the public. The two most important sections of the code were, first, those relating to the matters which the Committee on Ethics of the New York County Society had brought to the notice of the profession, and, second, those which related to the question of consultations. In dealing with this mat- ter, the committee carefully examined the American code, and found, as had been pointed out by the New York County committee, that it did not fully cover the ground. They, therefore, added several supplementary clauses, which made the completed article read as follows : "It is derogatory to the dignity and interests of the profession for physicians to resort to public advertisements, private cards, or handbills, inviting the atten- tion of individuals affected with particular diseases, publicly offering advice and medicine to the poor without charge, or promising radical cures ; or to publish cases or operations in the daily prints, or to suffer such publications to be made ; or, through the medium of reporters or interviewers, or otherwise, to permit their opinions on medical or surgical questions to appear in the newspapers ; to invite laymen to operations ; to boast of cures and remedies, or to perform other similar acts. " It is equally derogatory to professional character, and opposed to the in- terests of the profession, for a physician to hold a patent for any surgical instru- ment or medicine, or to prescribe a secret nostrum, whether the invention or discovery, or exclusive property, of himself or of others. " It is also reprehensible for physicians to give certificates attesting the effi- cacy of patented medical or suigical appliances, or of patented, copyrighted, or secret medicines, or of proprietary drugs, medicines, wines, mineral-waters, health resorts, etc." We believe no open objection has been made to any of the provisions of the foregoing sections, except with reference to the matter of patenting ■surgical instruments. It is claimed by those who advocate the propriety of patenting instruments that there is really no difference between that and taking out a copyright on a book. Personally, we can not regard the mat- ter in that light ; for, if this be admitted, a parity of reasoning would in- dorse the propriety of patenting medicines. 2Q THE STATUS OF THE MEDICAL PROFESSION In tlie second important matter connected witli tlie revision of the code — namelv. tlie consultation question — the committee felt that the gravest responsibility rested on them. In dealing "with it, they believed that a cor- rect and lasting solution would alone be reached by discarding sentiment and their own personal preferences, and considering the matter from the stand-point of actual fact. It was perfectly well known that consultations between regular physicians and homoeopaths were of frequent occurrence. It was also perfectly clear that the disposition to prosecute and discipline offenders for this breach of the code had disappeared. The last case of discipline known to the committee was the Gardner case, fifteen years ago. It was also deemed probable that, since the homoeopaths, by formal resolution, had repudiated their " exclusive" position, and had thus escaped the letter of the code, convictions of ofienders would be exceedingly diffi- cult ; and that, if a society should convict a member and suspend or expel him, the courts would, on technical, if no other grounds, inevitably rein- state him ; and a society repeating such action would probably become amenable to the charge of contempt of court, with its attendant conse- quences, and possibly liable, also, in civil damages to the aggrieved party. It was almost morally certain that no prosecutions of this sort would be undertaken, except by some indiscreet person, for purposes of gratifying private malice. The heresy-hunters of a preceding generation had mostly disappeared, and there were apparently none left who felt it their duty to act as public prosecutors. It was perfectly clear to the committee that the restrictive clause of the code availed only with those who felt themselves in honor bound by its apparent spirit, while it left all others to do as they pleased, free from any anxiety as to the consequences. Under these circumstances the committee had but two courses before them — one of .which was the preparation of a consultation clause so care- fully and tightly drawn that escape from conviction would be impossible, or else to recommend the abolition of all restrictions on the subject, leaving the matter to the individual consciences of all those who were interested. If the first course had been adopted, there is not a shadow of a doubt that the courts would have pronounced it " contra honos mores,'''' and void. The people of the State, as well as the legislators, had already become suffi- ciently indignant against the profession for assuming an attitude that ap- peared to them bigoted, intolerant, and inhumane. The rule of the Ameri- can Medical Association was generally regarded " as iron-clad, admitting of no exception ; and cases almost without number were known to the com- mittee in which medical men had refused consultation assistance under cir- cumstances that laid them open to the gravest charges of inhumanity, the only excuse given being that the rules of their order forbade them doing otherwise. The code of the American Medical Association, in its true and intentional meaning, is rigid and inflexible ; no matter what mav be the occasion, a physician meeting or consulting with an " irre refer to the registry law as the "first step taken in this no-code move- ment." The no-code movement, as we understand it, originated in a reso- lution introduced by Dr. Roosa, at the meeting of the State society in 1882. This movement has gained a considerable following, but, so far as we are aware, not a single one of the supporters of this movement had any hand or part in the passage of the Act of 1880. We further say that of those who did give their time and exertions to the furtherance of this regis- try law, not a single one has since appeared as an advocate of the no-code- movement. " Levels all inequalities." Every citizen, before voting at a general elec- tion, must in this State register his qualifications; but we fail to see that this brings down the statesman to the level of the pot-house politician, or the learned and virtuous to the level of the ignorant and criminal. In one respect only, not in "all," does it level. Just so the medical law levels in, but one respect only, and in a very necessary respect, as it is the only- means by which the State or any one else can learn the number or the quali- fications of those who are legally authorized to practice within the borders of the State. The writer of this does not feel himself specially degraded by the fact that his name is on the same list with the names of physicians whom he may deem of inferior professional quality, any more than he does that his name goes on the same polling-list with those whom he regards as politically inferior. The sentence, "This class, though legally authorized in a roundabout way through diplomas and certificates of bodies incorporated under a gen- eral law, would never have been legally recognized and licensed but for this. registry law," etc., will bear a little analysis. It implies, first, that there- exists a class of practitioners who should never have been legally author- 50 THE STATUS OF THE MEDICAL PROFESSION ized to practice. With this sentimeut we agree heartily, but the reader should be made aware that the only incorporated bodies that granted these legal authorizations under " a general law " were the State and county so- cieties acting in accordance with powers granted them by various statutes passed between the years 1806 and 1874. The reader might also have been informed that the registry law of 1880 revokes these powers so long possessed by the county societies, and which they in so many instances grossly abused. In the portion of the sentence that we have quoted there is a curious contradiction. The writer admits that a certain " class " were legally authorized by certain " incorporated bodies," and then says that they " would never have been legally recognized and licensed but for this registry law." The fact is, the registry law did not legally authorize a sin- gle person to practice medicine who at the time of its passage was not al- ready legally authorized in virtue of earlier laws (with an exception to be noted in a moment). The terms of the act are sufficiently explicit, and no misconception of their import should have arisen in the mind of any one Avho had read them. To make this perfectly clear, we quote the words of the act, italicizing the portions that bear on the present question. A person shall not practice physic or surgery within the State unless he is twenty-one years of age, and either has been heretofore authorized so to do pur- suant to the laiDS in force at the time of his authorization^ or is hereafter author- ized so to do as prescribed by chapter seven hundred and forty-six of the laws of eighteen hundred and seventy-two, or by subsequent sections of this act. Every person now lawfully engaged in the practice of physic and surgery within the State shall .... register. After the passage of the act, graduates in medicine only could com- mence the practice of medicine in the State. The exception that we alluded to a moment ago is in the case of medical students who had been in prac- tice for ten years. These latter were accorded an exemption from some of the provisions of the act for a period of two years from the date of its passage. We doubt if there have been six persons in the entire State who availed themselves of this exemption. m THE STATE OF NEW YORK. 5| SEVENTH ARTICLE. From the New York Medical Journal for November 24, 1883. A FEW days before the meeting of tlie State society in February, 1883, a prominent bomoeopatMc physician of this city said to the writer that, if the society stood by the new code, he, and probably other members, would resign from the homoeopathic county society, and abandon their special designation ; but that, if the State society re-enacted the American code, thus showing that the old spirit of intolerance still dominated the profes- sion, he should not leave the homoeopathic society, fearing, with others, that it would be still necessary for the protection of their interests to keep up a separate organization. As soon as it was known that the old code had not been restored, and that the old-code party were in the minor- ity, this gentleman and two other well-known homoeopaths severed their connection with the homoeopathic society. A month later, four others in like manner resigned and abandoned their sectarian titles. It seemed probable that this break from the homoeopathic ranks would have greatly increased, and, in the writer's judgment, fully one half of the members of the homoeopathic society would have abandoned sectarianism had it not been that the old-code party made renewed efforts for supremacy, and im- pressed many with the belief that they would ultimately succeed in restor- ing the old code. The bold front and the assurance of success assumed by the advocates of the American code put an immediate stop to resignations from the homoeopathic organizations and delayed their disintegration. The months of February and March of the present year were devoted by the supporters of the old code to the perfection of an organization, the purpose of which was to restore, if possible, the old code in this State. Such an organization was formed, and its efforts during the year have borne fruit, as we shall see later. During the month of March, Dr. Austin Flint commenced a series of papers in this journal on "Medical Ethics and Etiquette," which were a commentary on the American code as viewed from the standpoint of its supporters. Of this commentary we shall examine but a single portion, that relating to the subject of consulta- tions. As we all know, the rule of the American Medical Association reads as follows : " But no one can be considered as a regular practitioner, or a fit associate in consultation, whose practice is based on an exclusive 52 THE STATUS OF THE MEDICAL PROFESSION' dogma," etc. ConcerniDg this, Dr. Flint says : " The foregoing section has of late been made the subject of much discussion. Of the entire code, this section alone has occasioned dissension." Dr. Flint is here mistaken. The new-code party, or, to speak more strictly, those who drafted the new code, were dissenters from the old for more reasons than this. When they found that prominent members of the profession, including many dignitaries of the American Medical Asso- ciation, were the direct promoters of quackery and the use of secret nos- trums, through the testimonials given in support of them, and when tliey found that the American- code was apparently unable to repress these abuses, they endeavored in the New York State code to find an effective remedy. An examination of this code, especially its first section, will show how this difficulty was met, despite the fact that an effort of the same kind encountered defeat at a recent meeting of the American Medical Association. This certification of the value of nostrums by prominent members of the profession we personally consider as one of the most un- fortunate developments of the last few years. It is true that some mem- bers of the profession in this city fell into the traps laid by cunning manufacturers, but the prompt action of the County Society checked the further extension of this evil. This was effected by the passage of a special resolution, as the Committee on Ethics found that the American code was defective on this point. When, in 1882, the attention of the American Medical Association was called to the abuse in question, its Judicial Council refused to make any provision for its abatement, fearing, perhaps, to cast any reflection on those of its prominent members who were, or who had been, advancing their own interests at the expense of the mass of the profession. The first section of the State code we per- sonally regard as the most important, and we would be perfectly willing to strike out all that follows if by so doing we could secure harmony on the questions now at issue. Dr. Flint further says : " The Avriter of these remarks is one of many who think that the code is here open to objection, not, however, in spirit or intent, but in phraseology." From this it would seem that Dr. Flint approves the sentiment or spirit of the consultation clause, but does not approve of the language in which it is clothed. Let us, therefore, con- sider these points. The intent of this clause appears to be the prohibition of consultations with certain persons in consequence of their methods of practice, founded on a belief in the value of a special exclusive dogma, together with the rejection of certain aids approved by the regular pro- fession. Dr. Flint, however, a little farther on, says that a practice based on an exclusive dogma is not valid ground for an objection to consulta- tion. " Any physician has a right either to originate or adopt an exclusive dogma, however irrational or absurd it may be." We must here confess our inability to reconcile the last two sentences that we have quoted. That Dr. Flint should say that he approves of the "spirit or intent" of the IN THE STATE OF NEW YORK. 53 restrictive clause in the code, and. a moment later say that the adoption of an exclusive doctrine is not valid ground for refusing to meet a practi- tioner in consultation, certainly appears to us discrepant and inconsistent. The code having forbidden consultation with certain persons, let us ascertain, if possible, what persons are intended. On this point Dr. Flint says : " At the time when the code was adopted by the American Medical Association, the irregular practitioners, so-called, were for the most part uneducated men, whose practice was not only based on an exclusive dogma, but professedly to the rejection of the accumulated experience of the pro- fession, and of the aids actually furnished by anatomy, physiology, patholo- gy, and organic chemistry. They were steam-doctors, or Thomsonians, botanical, or herb doctors, eclectics, and the like. A system of practice based on the dogmas of Hahnemann had not then secured a hold on popu- lar favor. A considerable number of those who became homoeopathic practitioners, as they are termed, were from the ranks of the medical pro- fession, and had received a regular medical education. Since the adoption of the code, this system has obtained a legal recognition. It has its societies, colleges, and journals. The homoeopathic practitioners are an organized class, distinct from the regular profession. They are candidates for practice on the ground of a radical distinction in their therapeutical system, and it is on this ground that patients elect their services. Mean- while, other systems in antagonism to the regular profession are com- paratively insignificant as regards the number of practitioners and of patients." Although the foregoing would seem to imply that the anathema of the