LETTER 
OF 
A. Y. P. GARNETT, M.D., 
IN REPLY TO 
HENRY I. BOWDITCH, M. D„ 
OF BOSTON, MASS. 
Judd & Detweiler, Printers. Washington, D. C., November 22, 1887. 
To Dr. Henry I. Bowditch, Boston, Mass. 
My Dear Sir : I have the honor to acknowledge the re- 
ceipt of your kind favor of the 13th instant and to express 
to you my grateful appreciation of the complimentary terms 
in which you have manifested your commendation of my 
paper. In making this acknowledgment, if I were con- 
trolled alone by considerations of propriety and courtesy, I 
might very properly satisfy myself with the above brief re- 
sponse to your note, but a profound sense of duty which I 
owe to the American Medical Association, as well as to my- 
self as an humble member thereof, impels me to notice more 
at length the following paragraph, which appears in that 
letter: 
" Pardon me if I allude to another subject. I neither know 
nor care for your opinion upon the code question, but I 
rarely write to any member of the American Medical Asso- 
ciation out of my State without making some allusion to the 
unhappy bickerings that have arisen, which, in my opinion, 
need not have arisen in the profession. When an association 
will exclude from its membership such honorable and able 
men as Barker, Lomis, of New York ; the excellent, vener- 
able Dr. Hun, of Albany, and many others in various parts 
of the country, it certainly seems as if bigotry of the worst 
type had become rampant." 
As the expression employed by you in the beginning of 
the above paragraph admits of no doubt regarding the value 
that you may attach to any opinion I might advance and 
affords but little encouragement for me to embark in a dis- 
cussion with you on that question, I must crave your for- 
giveness for my obtrusiveness in calling your attention to 
what I propose to submit as a fair, truthful, and unprejudiced 
exposition of the subject-matter upon which we seem to dif- 
fer so widely. 2 
Permit me to premise my remarks by assuring you that 
the very frank manner in which you have been pleased to 
allude to my opinion has been received by me in the most 
amiable and friendly spirit. Cheerfully conceding to you, 
as I do, the prerogative which, in my judgment, rightfully 
belongs to one of the distinguished and honored fathers of 
the profession, 1 can therefore honestly claim to address 
you with feelings of reverential friendship, unclouded by 
the slightest shadow of irritation or resentment. 
Among the several objects set forth by the founders of the 
American Medical Association in 1847, when its organiza- 
tion was perfected, was one which declared that it is expe- 
dient, for the purpose of promoting the usefulness, honor, 
and interest of the medical profession in the United States, 
that it should be governed by one national code of ethics; 
and the present code, with a few slight modifications, subse- 
quently made, was then adopted. 
Dr. Hooper, in his address, as late as 1882, referring to 
the excellence of our code, used the following language: 
" Had the American Medical Association done nothing else 
than to adopt the code of ethics it would have been entitled 
to unending gratitude," whilst many of the wisest, most lib- 
eral, and distinguished members of our profession have also 
given expression to similar commendatory judgments of it. 
For thirty-five years have the beneficent influence and 
harmonizing effects of this code been exerted over the entire 
domain of our country, enfolding the hitherto scattered 
members of a common profession within the sphere of its 
authority and cementing them into one compact brother- 
hood, demonstrating its practical good by promoting love 
of profession, personal honor, integrity, and self-respect. 
'Tis true that many years previously, antecedent, 1 be- 
lieve, to our civil war, a fierce internecine strife had raged 
in the city of Boston touching the personnel of the delegates 
who were to represent Massachusetts in the American Medi- 
cal Association. In this controversy much " unhappy bicker- 3 
ing " was indulged in and very bitter personal animosity 
displayed, concerning which, I believe, you, my dear Doctor, 
can truthfully exclaim, " Quorum pars fui / " x 
It is needless for me to remind you how that contro- 
versy resulted and the consequences which followed the 
action of the association in declining to assume a partisan 
position by rejecting Dr. R. H. Storer as a delegate. From 
that period to the present date the majority of those who 
acted with you on that occasion have been hostile, I believe, 
to the American Medical Association and sullenly stood 
aloof, seemingly satisfied to occupy for the nonce a negative 
position, and whilst some of our hypercritical New York 
brethren who sympathized with you did not hesitate to ex- 
press dissatisfaction with the ethical feature of the constitu- 
tion no organized effort was made for the avowed purpose 
of rebelling against it and destroying the unity and good 
feeling which had existed for so long a period under its 
operation, until 1882, when the New York Medical Society 
formally seceded from the American Medical Association 
and adopted what they styled a new code of ethics. This 
action on the part of the New York Society had the 
effect of so unsettling the views of many upon the sub- 
ject of medical ethics that a large number of the profes- 
sion declared themselves in favor of abolishing all codes 
of medical ethics and inferentially permitting every man 
who wished it to play the role of a free lance in the 
profession of medicine. If no other mischief resulted from 
the lamentable and disastrous conduct of the new code or- 
ganization this alone should condemn it in the estimation 
of every true and honorable lover of our profession. 
In a spirit of liberality and generous concession the 
American Medical Association, in 1884, appointed a com- 
mittee of five (of which I had the honor to be a member), 
including such men as the late Dr. Austin Flint, of New 
York, and Dr. N. S. Davis, of Chicago, to review and 
prepare an authorized construction of its code of ethics. 4 
This duty was done chiefly by the two distinguished mem- 
bers above named and the work submitted at the follow- 
ing meeting of the association, when it was unanimously 
adopted. It will be seen by reference to this report that 
the broadest construction and most liberal and concilia- 
tory interpretation consistent with professional honor and 
a conservative policy was recommended, thus removing, 
in my judgment, even an equivocal pretext for the opposi- 
tion of any unprejudic^T mind, and yet the fight on the 
part of these malcontents still goes on. 
Germain to this subject it occurs to me that in an address 
delivered by you some years ago before the Rhode Island 
Medical Society you advocated the abolishment of all codes 
of medical ethics and planted yourself upon the oft-repeated 
and sophistical platitude that gentlemen needed no code or 
law requiring them to deal honorably with each other. In 
the abstract and as a general rule this may be true, but let 
me ask you if you have passed through the last quarter of a 
century with your eyes and ears closed ? 
Of what material do you find a large portion of the medi- 
cal graduates at this date composed? Under the pernicious 
stimulus and misdirected forces of progress do you not per- 
ceive the widespread demoralization and decadence of per- 
sonal integrity and honor? Do you not know, despite the 
restraining and coercive power of our existing codes of ethics, 
that professional success is often achieved by cunning tricks 
and by pursuing disreputable and dishonorable modes and 
methods? Are you willing that this class of men should be 
encouraged and multiplied by imposing no check upon their 
conduct? Instead of approaching,the civilization of to-day 
is fast drifting away from the Utopia of social perfection, and 
the day is far distant, I fear, when the mens sibi conscia recti 
shall so pervade society that it will be the only governing 
rule of our conduct towards each other. 
Your much boasted progress of moral ideas is all a sham 
and a delusion, a mere fictitious pretext for immoral practices- 5 
In the race between virtue and vice in this life do you not 
perceive, my dear sir, that the fleet-footed and ubiquitous 
Satan has far outstripped the tardy Bourbons of Christ, and 
that at this advanced period of so-called moral ideas men 
are only restrained from wrong-doing by the apprehension 
of some punitive consequences to themselves? 
I might here, if I were disposed to indulge in just criticism, 
enter into an analysis of the motives which impelled the 
leaders of this new-code movement in New York to declare 
war against the American Medical Association and to throw 
off the restraining influence of its authority. It is, however, 
so well known who would be the principal beneficiaries that 
were to reap the pecuniary rewards of such a licentious and 
meretricious construction of medical ethics that it is not 
necessary for me to do more than express my profound re- 
gret and astonishment that men of such high standing and 
well-merited distinction should have been so far tempted by 
the auri sacra fames as to embark in such a fratricidal con- 
flict. 
You say " when an association will exclude from its mem- 
bership such honorable and able men as Barker and Loomis, 
of New York, and the excellent and venerable Dr. Hun, of 
Albany," &c., let me ask you at what time and by what 
means did the American Medical Association ever exclude 
these gentlemen from its membership? On the contrary, 
did not they voluntarily withdraw from all connection with 
that body after having been prominent and distinguished 
supporters of the association for years ? Had the association 
at that time abrogated any of those principles promulgated 
at its organization or changed in any way the constitution 
and by-laws which these gentlemen had acknowledged and 
supported for years? Certainly not. 
Without availing themselves of their constitutional right 
to come into the association and there take such legal action 
as they desired to modify or abolish our code of ethics, they 
chose to attach themselves to a hostile organization, renounce 6 
all allegiance to the American Medical Association, and 
commence a system of warfare upon that body. 
As a matter of self-preservation, the American Medical 
Association at a subsequent meeting found it necessary, in 
order to distinguish friend from foe, to require each delegate 
before registering to declare his fealty to the association. It 
is not reasonable to suppose that the association would have 
been guilty of such supreme folly as to voluntarily admit 
into its councils a Trojan horse filled with declared enemies. 
To the deep regret of the entire membership of the Ameri- 
can Medical Association these prominent and able orna- 
ments of our profession, unwisely and without adequate 
cause, withdrew of their own volition and assumed the atti- 
tude of enemies. 
When you and I entered the profession of medicine such 
a thing as infanticide for the purpose of concealing crime 
was scarcely ever heard of-certainly not connived at or 
practiced by members of the regular profession ; not even in 
progressive and cultured Boston was such a crime known to 
be perpetrated or tolerated. How stands it now ? What 
have the investigations into the secrets of this heinous prac- 
tice in your own city developed? What have been the re- 
sults of your own observations concerning this matter and 
what the lesson taught by such observations? If the sta- 
tistics of this atrocious crime could be procured from the 
larger cities of the United States, with the names of the per- 
petrators in each case, do you think that it would justify the 
conclusion that because a man had M. D. attached to his 
name he must ex necessitate be a gentleman and a man of 
honor, and lienee needed no binding obligation to keep him 
in the path of professional rectitude? 
1 might multiply illustrations in support of my belief 
upon this subject almost ad infinitum, but forbear to do so 
lest I should weary you before calling your attention to 
another subject upon which there seems to be a decided dis- 
crepancy of sentiment between us. 7 
I refer to the organization and management of the Ninth 
International Congress. Having already extended this com- 
munication far beyond, I fear, the limits of your patience, I 
shall be very brief in presenting the facts connected with 
the unfortunate controversy which has produced so much 
disgraceful crimination and recrimination within the ranks 
of our profession upon the subject of this meeting. The 
action of the American Medical Association in 1884, when 
it met in this city, appointing a committee to attend the 
meeting of the International Medical Congress at Copen- 
hagen, as well as the position taken by that committee and 
its work, has so often been discussed that I will not vex your 
patience with a tedious repetition. By reference to these 
you will perceive that this committee of seven had power to 
elect its ov^n officers, add to its membership, perfect its own 
organization, and make all necessary arrangements for the 
meeting of the congress,thus constituted as a committee of 
arrangements, only,having no authority to nominate officers 
of the congress. When the chairman of this committee of 
seven presented his report at the next meeting of the Ameri- 
can Medical Association in New Orleans, one year only hav- 
ing elapsed, it contained an elaborate statement of what it 
had done, including the appointment of most of the officers 
and a perfected programme for the work of the congress, 
thus far exceeding the authority given it by the association. 
The association, after receiving and discussing this report, 
declined to endorse or accept that portion of it which in- 
cluded the appointment of officers, and subsequently recom- 
mitted (as it had a parliamentary right to do) the whole 
subject to a new and enlarged committee, composed of the 
original committee of seven, with the addition of one repre- 
sentative from each State, Territory, District of Columbia, 
the United States Army, Navy, and Hospital Marine Service. 
This new committee was given full powers to appoint the 
officers of the congress and to perfect the entire programme 
for its proceedings. 8 
During the discussion of the subject a resolution was 
offered in the association that all new-code men should be 
excluded from official position in the congress. This was 
voted down by a vote of 129 to 88. At the first meeting of 
the enlarged committee, in Chicago, several of those who 
belonged to the original committee of seven were present 
and participated in its proceedings. The question of dis- 
criminating against the new-code men came up and was in- 
cidentally discussed, and whilst it was evident that a major- 
ity of those present favored such discrimination no definitive 
action was taken. Meanwhile the medical journals of Bos- 
ton, New York, and Philadelphia who represented the new- 
code sentiment had commenced a bitter attack upon the 
association. A short time after the enlarged committee 
again met in the city of New York. No one of the original 
committee of seven was present. 
At this meeting it was found expedient to fill up as far as 
it was practicable to do so at that time the official positions 
of the congress, when it became necessary to decide finally 
the question of admitting as officers those who represented 
the new-code organization. It was argued that as these gen- 
tlemen in the cities of Boston, New York, and Philadelphia 
had inspired or permitted the attacks made by the several 
medical journals of those cities upon the American Medical 
Association, advocating its abolition, and declaring that it 
" had outlived its usefulness," attempting to destroy its in- 
fluence and discredit it with the medical profession of the 
country, the committee could not consistently with its own 
self-respect and the duty which it owed to the association so 
far insult that body as to appoint to office under its author- 
ity open and declared enemies. It, however, offered every 
honorable inducement to those who were less hostile to 
abandon their opposition to the association and accept prom- 
inent positions in the congress. This was unanimously de- 
clined and the order passed along the entire line to with- 
draw from all connection or affiliation with the Ninth Inter- 
national Medical Congress. 9 
Whilst many of those who were not new-code men, but 
who were included in the original list of officers appointed 
by the committee of seven, felt inclined, I believe, to remain 
in the congress, so peremptory were the demands and so 
fierce the hostility of the leaders that they had not the moral 
courage to follow the direction of their own inclinations, but 
finally yielded to the Mephistophelian whisperings of those 
implacable fomenters of discord. 
And here permit me to say that because the committee 
had been placed in a situation by the conduct of this new- 
code faction which compelled it to exclude them from 
official position in the congress non constat that they could 
not have participated in its proceedings by preparing papers 
for its scientific work and taking part in the discussions, 
they were not excluded from membership by any action of 
the committee. On the contrary, many of those who acknowl- 
edged their allegiance to the American Medical Association, 
such honorable gentlemen as my friends Kenloch, of Charles- 
ton, S. C., and Battey, of Georgia, were personally solicited 
to do so. 
Not satisfied with withdrawing from and refusing to aid 
or assist those upon whom the responsibility had been im- 
posed by their own act of receiving our foreign friends and 
making the congress a success, they commenced a systematic 
effort to defeat and destroy it at home and a clandestine and 
contemptible attempt to do so abroad. We have positive 
evidences that emissaries were persistently working with 
leading members of the profession in Europe to induce them, 
by misrepresentations, not to attend the congress, and even 
after its assembling here in Washington, in the presence of 
our foreign guests, malicious attacks, inspired, no doubt, by 
some of those who had been fighting the American Medical 
Association, were published in one of the daily journals of 
Philadelphia. 
Now, my dear Doctor, if you have taken the trouble to 
read this discursive and somewhat prolix epistle with an im- 10 
partial judgment you must acknowledge that " bigotry of 
the worst type " was a little more rampant on your side than 
on mine. 
In conclusion, permit me most respectfully and kindly to 
express the hope that' after so long a career of usefulness, 
enviable distinction, and merited honor, when those crepus- 
cular shadows of that eternal gloom by which you are soon 
to be enshrouded are fast closing around you, you may add 
a crowning glory to that career by proclaiming with patri- 
archal authority let there be peace, good will, and unity among 
professional brethren. 
With sentiments of the highest esteem and respect, 
I remain, most truly yours, 
Alex. Y. P. Garnett, M. D.