j&tie protection Against QuacI^ei1iJ 
by ? 
Charles F. j. Lehlbach, M. d. 
BEING THE 
PRESIDENT’S ADDRESS 
AT THE 
SEVENTY-SECOND ANNUAL MEETING 
OF THE 
Essex Qisfepidfe Medical Seciefey, 
id 7 
HELD IT NEWARK, N. J., APRIL 3, 1888. 
NEWARK, N. J.: 
The Advertiser Printing House, 
i888. ADDRESS. 
Once only, but cncc too often, was this Society 
called upon, during the past year, to pay the last 
tribute of friendship and esteem to a departed brother, 
—Dr. Wm. O’Gorman, whose memory we cherish. 
And it would be, on my part, an inexcusable neglect, 
were I to omit here the mention of the name of another 
recently departed brother, once an active member of 
this Society, though not officially connected with it, for 
nearly a quarter of a century—since the organization 
of Union County—as Dr. O’Gorman, an honored 
fellow of the Medical Society of our State—Dr. Lewis 
A. Oakley, whose honest, open, genial face and voice 
always reflected manliness of thought, courage of 
conviction, and readiness to do the right. 
While it is my duty, according to the Constitution of 
the Society, to read to you an Address, I beg of you 
not to consider it a slight, on my part, if what I shall 
say will not be in the form of an exhaustive disserta- 
tion on some purely scientific subject. If I shall 
deviate from the ordinary custom in this respect, I do 
it in the hope that I will be forgiven for any short- 
comings, more readily, as the solider courses of the 
scientific, literary bill of fare, at this meeting, have 
been amply provided for by others. The few thoughts 
to be presented to your consideration on the general 4 
subject of State Protection Against Quackery will l>c not 
entirely untimely, perhaps, in these times, when “free 
trade or protection" begin to loom up as battle cries of a 
near presidential election, and when recent occurrences 
in this County have had a tendency to call renewed 
attention to the subject. 
The earliest cases of difficult labor of which, as far 
as 1 know, any record exists, date back four thousand 
years, more or less. We read in the Thirty-fifth 
Chapter of Genesis, in the account ol Jacob's Journey 
to Ephrath, that “ Rachel travailed and she had hard 
labor; and it came to pass, when she was in hard labor 
that the mid-wife said unto her. fear not; thou shalt 
have this son also; and it came to pass as her soul was 
in departing (for she died) that she called his name 
B^n-oni; but his father called him Benjamin.” 
Two important facts are obvious in this short narra- 
tive : first, that in a protracted, hard case of labor, in 
which the mother died, the child was saved; second, 
that there was a mid-wife in attendance and that she 
knew enough of her business to enable her to console 
poor dying Rachel that the child would be safe. 
The next case we find in the Thirty-eighth Chapter of 
Genesis, where the accouchement of Tamar is described 
as follows: 
“ And it came to pass in the time of her travail, that, 
behold, twins were in her womb,—and it came to pass, 
when she travailed, that the one put out his hand: and 
the mid-wife took and bound upon his hand a scarlet 
thread, saying, this came out first. And it came to 
pass, as he drew back his hand, that, behold, his brother 
came out: and she said, How hast thou broken forth ? 5 
this breach be upon thee. Therefore his name was 
called Pharez. And afterward came out his brother 
that had the scarlet thread upon his hand; and his 
name was called Zarah.” 
Short and concise as this narrative is, handed down 
to us from a time antecedent to Ramses the Great, 
whose embalmed and mummified body, recently dis- 
covered, now forms one of the chief curiosities of the 
Museum at Bullack, its obstetric significance is of 
interest in more than one point. In the first place, it 
must be noticed that the mid-wife in attendance, when 
labor commenced, had knowledge enough to enable her 
to diagnose twins; and secondly, when there was an 
arm-presentation of the one, while taking precautions 
to establish the right of primogeniture, she was wise 
enough to make no vain and ignorant efforts to hasten 
delivery by either pulling at the arm or by trying to 
push it back by force until the arm would be nearly 
torn off the shoulder, but she waited, good mid-wife as 
she was, until, by the contractions of the womb, the 
head of the second child was driven down upon the 
breech and legs of the first, nature thus accomplishing 
spontaneous version by force applied from within. 
Time and place now change. Genesis has been 
followed by the Exodus--on to the Prophets and the 
Kings—to a new dispensation ; empires have arisen 
and fallen; there has been a long night of mediaeval 
darkness, when, amidst the ruins and decay of old, 
dying civilizations, the Arabs alone uphold the beacon 
of what is left of science and art. Columbus redis- 
covers a New World—probably the oldest —and tri- 
umphant democracy begins its march in the steady 
process of evolution in the mighty experiment of self- 6 
government. But, though the times may have changed, 
though the place of the scene may have shifted from 
the land of the Canaanites and the Hittites to the 
land of the New Jerseyites—still it is the old, old 
story—a woman in the pangs of labor; a wife in 
travail, with the mid-wife at her side. And it came to 
pass, as the waters broke, that the child, as in the case 
of Tamar, put out its hand; and the mid-wife, being a 
sensible woman, knowing her business, recognizing a 
shoulder presentation, knowing that, there being no 
twin, to allow for the hope of spontaneous version, the 
child must be turned to save it and the mother, sent for 
assistance. The result of the assistance thus sent for 
was a tragedy—the after-play, enacted on the last day of 
last week in our Court House, almost a farce. 
The shocking, disgusting details of the wanton sacri- 
fice of a woman and a child on the altar of legalized 
quackery, I need not here repeat. They were more 
than amply reported in the papers. And, that 1 may 
do full justice to the officers of the State, whose duty it 
is to protect society against the results of criminal 
ignorance, 1 call your attention to the verbatim report 
of the remarks of the judge, sentencing the criminal. 
He said, as is reported in the Newark Daily Advertiser : 
“The Grand Jury of this county indicted you for man- 
slaughter in causing the death of Mrs. Kutan through care- 
lessness, negligence and ignorance, and aftet a fair trial the 
traverse jury found you guilty. With the justice of this 
verdict the Court is satisfied, and it only remains to pro- 
nounce the sentence which the law imposes. In determin- 
ing what that sentence should be the Court has considered 
that the killing was necessarily without malice ; for, had it 
been otherwise, your crime would have been murder. The 7 
jury considered that you were actuated doubtless by good 
motives ; that if you had known the right would gladly 
have hurried it. Your crime was ignorance ; you hold 
yourself to be a person skilled in obstetrics, and you 
voluntarily undertook a duty which you were incompetent 
to perform. As the result of your ignorance and incompe- 
tence the life entrusted to you was lost, and the law holds 
you accountable. One who claims to be a surgeon is bound 
to bring to bear competent skill and information, and if by 
reason of his ignorance or wrant of skill death ensue, he is 
guilty of a crime, and only by the punishment of such 
crimes can the public be protected, and those who are 
ignorant and unskillful made to understand that they can- 
not with impunity trifle with human life. 
The sentence of the Court is that you be imprisoned at 
hard labor in the County Penitentiary for the term of six 
months.” 
How truly this sentence embodies the essence of the 
object of punishment in such cases! How directly it 
states that the object of the punishment is not retalia- 
tion upon the criminal, but the protection of Society! 
“ Only by the punishment of such crimes can the public be 
protected]' says the learned Judge; “ and those who are 
ignorant and unskillful made to understand that they can- 
not with impnnity trifle with human life." 
But how can you reconcile with this principle laid 
down by the learned Judge the fact that when it was 
in the Law’s power to protect Society against the 
criminal ignorance of this particular offender for a term 
of even ten years, the law deemed its duty done by 
protecting Society for a paltry six months against kill- 
ing by ignorance—just for the term of a somewhat 
prolonged summer vacation ? 
Here then is an illustration of the insufficiency of 8 
legal provisions to protect Society against the dangers 
of quackery. During the last twenty-five years we 
have witnessed laws upon laws passed, amended and 
re-amended, to provide for registration of those properly 
qualified to practice medicine, so as to enable the public 
to distinguish between those who are qualified, and those 
who are not. But in almost all cases, when attempts 
have been made to bring to trial and punishment, 
according to the provisions of the law, persons who 
practice medicine without legal sanction, such attempts 
have been generally abortive, or have turned into a 
farce. The disinclination of law-officers to institute 
vigorous prosecution in such cases, the disinclination of 
grand juries to indict, the disinclination of petit juries 
to convict, and the disinclination of judges to inflict 
more than nominal punishment in such cases, may be 
attributed, less to any willful neglect of duty, than to 
certain erroneous conceptions as to the real object of 
such laws, which pervade not only our halls of justice, 
but Society generally. Some of the provisions of our 
statutes, under the latent influence of such false concep- 
tions, have had a tendency rather to legalize quackery 
than to protect Society against it. 
What can be more ridiculous, for instance, than the 
provision of the law still, I think, in force, that the 
illegal practice of medicine, if only continued for a 
certain number of years, shall constitute the person so 
practicing a legal practitioner! Nothing illustrates 
more forcibly than this, the idea that right and wrong, 
crime and virtue, sin and saintliness, are but relative 
terms, as the world goes; aye, the very persistence in 
wrong-doing, crime and sin, may evolutionize the 
sinner into a saint, provided he has succeeded in wrap- 
ping himself up in saintly surroundings. 9 
It will hardly be necessary to appeal to the exper- 
ience of the members here assembled, to bear out my 
own, when, in conversation with friends and the public, 
in every-day life, this question is broached.: “ Why,” 
we are generally accosted, “ why don’t you doctors 
bring these fellows before the courts ? Why don’t 
your profession try to protect itself against these 
quacks ?” 
Herein lies one of the popular, erroneous conceptions 
referred to. It is assumed, if not theoretically—prac- 
tically, at least—by the public generally, by legislators 
and by those who administer the laws, that the object 
of laws regulating the practice of medicine is to protect 
the medical profession. Protect the Medical Pro- 
fession ! It —the most comprehensive, the most pro- 
gressive, the noblest of sciences! Protect the sun 
against the passing moon, defend the stars against the 
fleeting clouds, shield the unbroken, eternal roll of the 
ocean’s waves against dame Partington’s broom. Do we 
want, do we need, protection ? When the great Physician 
was once reproached that he ate with publicans and 
sinners, he said: “ They that be whole need not a 
physician, but they that are sick.” The weak and the 
sick are they who need protection, who need the 
physician, who need protection against the pretenders, 
against the ignorant quacks, to whom Job exclaimed: 
“Ye are forgers of lies, ye are all physicians of no 
value.’’ 
The public mind, once disabused of this erron- 
eous conceit that the regulation of the practice of 
medicine has anything to do with the special interests 
of the medical profession, our legislators once brought 
to a clear understanding of the fact that whatever they 10 
deem necessary to enact in this respect should be 
completely disassociated from any idea of class legis- 
lation, from any suspicion of protecting the practice of 
medicine in a business view, and that the sole object of 
such regulation must be in the interest of the public 
and of the public alone, and those upon whom devolves 
the duty of executing and administering the laws 
once brought to appreciate fully the weight of respon- 
sibility imposed upon them for the public good and 
welfare—the way will be cleared for a better under- 
standing of the main question : 
How far should the State, by law, protect its citizens 
against the perils of quackery, by regulating the 
practice of medicine? 
It is necessary here to bear in mind that prohibitory, 
protective, preventive or regulative legislation never 
fulfills its object unless public opinion is educated up to 
a point where prohibition, protection, prevention and 
regulation will be accomplished by the voluntary act of 
the community alone without any legislation whatever, 
based only upon strong public opinion. Until this 
point is reached, prohibition does not prohibit, protec- 
tion does not protect, prevention docs not prevent 
and regulation does not regulate. The effect of all 
attempts at real or imaginary reforms by strong pro- 
hibitive or regulative legislation, unsupported by the 
moral force of public opinion, is worse than useless, 
because, on account of the impossibility of execution, 
it must tend to bring all law' into contempt. Whatever 
laws you please to pass to prohibit the practice of 
medicine by unauthorized j>ersons, pretenders and 
quacks, you will not succeed in stopping the practice, 
as long as there are knaves to be found in the world 11 
eager to impose upon the public, and fools to believe 
them. Particularly is this the case in this country 
under our form of government, which is both repub- 
lican and essentially democratic—government Irom the 
bottom up, not from the top down—where, in spite of 
all evanescent tendencies to stronger, more centralized, 
paternal rule, and the disposition to seek relief from 
everv little passing evil through some kind of hasty, 
experimental legislation, the good old Jeffersonian 
maxim still holds good that that government is the best 
which governs least. And may this spirit of freedom 
and independence in the average American citizen 
grow and grow stronger, in these days of pageantry 
and adulation of dead and dying emperors. 
Personal liberty, involving the right of every Ameri- 
can citizen, of every American man or woman, to 
pursue what study he or she pleases; to follow what 
trade, occupation, vocation or profession seems to 
each most agreeable and promising most success in 
life, will only be abandoned when the edifice reared by 
the fathers of 1776 shall have been leveled to the 
ground, and State-Socialism and Communism shall have 
taken its place. The cobbler may get disgusted with 
his last and turn to preaching, the driver of canal mules 
may in his long meditative meanderings prepare his 
mind eventually to drive bulls and bears in Wall street, 
the mason may tire of his hod and trowel and fly to 
medicine to do justice to his ambition—it is their right 
to do so; or the cobbler, the mule-driver and the hod- 
carrier may combine their forces and, if they are smart 
enough to obtain the influence of some politicians, get 
a charter for a medical college, and embark in the 
profitable busines of selling diplomas, which, duly 12 
registered in our Court Houses, will enable other cob- 
blers, mule-drivers and hod-carriers to freely distribute, 
for good cash, the blessings of whatever medical 
knowledge they may have been able to scrape 
together. 
If, on the one hand, then, there can be no restriction 
from the pursuit of the study and practice of medicine, 
still less can any legislative regulation interfere with 
the right of ownership of every American man or 
woman to their own bodies and souls, unless by due 
process of law’ convicted of crime or declared insane. 
And this right to ownership of the body implies the 
right of choosing whatever physician of body or soul, 
or w hatever mode of treatment, when that body is sick. 
The American citizen, when sick, has a right to get 
well, or not, as he pleases, by powder or blister, by pill 
or by prayer. If he falls in the hands of a quack, so 
much the worse for the patient; if, by bad luck, the 
quack falls in the hands of the law, so much the worse 
for the quack ; but, on the whole, there seems to be 
really no possibility of protecting American Society 
by legal enactments. 
And here, disagreeable as it may appear, and however 
fervently we might wish that it were otherwise, it must 
be stated as a fact difficult of denial, that the possession 
of a Doctor’s diploma, however satisfactory it may be 
in the eyes of the law, as a matter of formality, fur- 
nishes no positive proof that the owner is really a phy- 
sician of proper qualification. Fortunately, or unfor- 
tunately—that depends upon our optimistic or pessi- 
mistic proclivities—the State of New Jersey is one of 
the exceptional States of the Union having no School 
or College of Medicine within her borders. The 13 
industry of turning the raw material of the annual crop 
of medical students into the fully burnished, polished 
manufactured article, duly labeled “ M. D.” is one of 
the very few industries which New Jersey has neg- 
lected. Hence we are thrown upon a, so to say, free- 
trade market. Luckily a corner has never occurred in 
it; the supply has always been fully up to the demand, 
—in quantity at least, and in quality the profession of 
New Jersey, probably occupies as high an average as 
that of any other State. But, no matter; the State of 
New Jersey, having no educational institution, char- 
tered by the State, authorized to grant diplomas, 
except that under certain conditions the State Medical 
Society may grant them on recommendation of the 
district societies, the candidate having previously passed 
an examination—the law at present regulating the 
practice of medicine is broad enough to let in the grad- 
uates of every college in the land, wild-cat and all and of 
every college or university of foreign countries (whose 
diploma would not even constitute a license to practice at 
home) by simple registration of a copy of the diploma, 
with no authoritative power vested in any body to 
verify its authenticity, its genuineness, or to decide 
regarding the identity of the person whose name it 
bears, with the person presenting it. 
While we must acknowledge that the facilities for 
medical education offered by the regular colleges of 
the United States, at the present time, on an average. 
have not kept, could not keep, full pace with the 
exceptionally rapid advances, if not to say, new depart- 
ures, which medical science has made within our gen- 
eration, it would be unphilosophical to allow this to let 
us look despairingly or even doubtfully at the coming of 14 
a better state of things. When we see three and four 
years graded courses in a number of the oldest schools 
of the country, with the courses extended from four 
and five to full seven months, take the place of the old 
two full courses, one a repetition of the other; when 
we see fully-equipped and well-conducted laboratories 
and widely extended clinical work take the place of the 
former “ reading medicine with a preceptor; ” when 
we sec in those of the schools of American medicine 
which have given tone and respectability to American 
medical education, an almost rivalry to present the 
smallest number of graduates in proportion to the 
number of matriculants, indicating a higher standard 
of requirements needed to pass examinations; when 
we see the old oral examinations give way to written 
examinations, which test more fully the medical knowl- 
edge of the candidate, as well as his literary culture; 
when we see large numbers of graduates obtaining and 
taking advantage of hospital positions, acceptable to 
but proportionately limited numbers thirty years 
ago, on account of the much smaller number of 
hospitals, and taking advantage of the clinical facilities 
offered by polyclinical and post-graduate schools and 
when entrance examinations will before long be made 
obligatory in most schools of any pretension, surely 
there is no cause for despondency, but rather cause for 
rejoicing that the voluntary efforts, both of faculties 
and students, are, if slowly, still surely testifying to a 
steady and healthy and a more complete development 
of medical education, and to a growing appreciation of 
the just demands which society has a right to make of 
the medical profession, though the latter spurns the 
assistance and protection of the State, and though the 15 
State permit quackery full sweep, dealing with it even 
most leniently when caught in and convicted ol crime. 
It might be claimed that a more strict law of regis- 
tration of diplomas, limiting their legal value to certain 
colleges of acknowledged repute and standing, with 
Boards of Health, or some other body of officials, 
authorized to verify them, and then to proceed with the 
prosecution of all offenders, would protect Society. 
Efforts in this direction have been often made, but as 
often failed. In several of the States, within the last 
few years, such attempts have been made, and appar- 
ently, at least, with some degree of success, in driving 
some of the more notorious individuals engaged in 
illegal practice from one State into another. But the 
real protection of the public against quackery thereby 
amounts to little. The fight between quackery and the 
legitimate, honorable practice of medicine, if fight there 
be, must go on in the future as it goes on to-day, as 
it has gone on in the past, leaving the final decision to 
the slowly-working influences of advancing intelli- 
gence, education and enlightenment. 
And is this all? I hear you ask. Is there, indeed, no 
way by which the State may, if not protect its citizens, 
at least throw some kind of warning signal around the 
places of danger? Is there no way in which society 
may protect itself without, on the one hand, apparently 
creating a favored class, and on the other, interfering 
with the freest exercise of individual liberty ? 
I think there is, and though I shall offer you no fully 
detailed and matured plan, I hope that the suggestions 
about to be made and which will close these remarks 
will tend at least to draw attention to the subject, and 16 
lead to fuller discussion of its possibilities hereafter, and 
perhaps in other places. 
The State of New Jersey in its Laws providing for 
and regulating its system of public education—while on 
the one hand providing for the supply of properly 
educated teachers through a system of Normal Schools, 
the graduates of which have by proper examination 
shown their fitness to teach, has, on the other hand, 
provided for a further supply by providing for exam- 
inations of such persons, who may offer themselves as 
teachers; and no local Board has power to appoint as 
teachers any but those found competent by formal legal 
examination. This does not prevent those in charge of 
private, semi-private or parochial schools, or any indi- 
vidual from employing any person as teacher whom 
they may choose; nor does this interfere with the right 
and liberty of any citizen of the State to devote him- or 
herself to the duties of teaching provided he or she can 
get pupils. The State, and through it the Boards of 
Education and School Trustees assume the control only 
of those directly under their charge. 
Now, not exactly analogous, but somewhat similar at 
least, in my plan would be the relation of the physician 
to the State. The latter should, in no way, assume to 
exercise any control over medical practice, but it should 
provide some means, by which those of its citizens in 
need of medical aid would be enabled to know who are 
competent to practice or not, or, to express it yet 
better, at least to give to those who wish the public to 
know that they consider themselves competent to prac- 
tice, an opportunity to prove their qualification before 
a State Board of Examination, which should be rigid, 17 
strict, impartial and thorough—not limited to the 
evidence of diplomas or certificates but to the results of 
a strict and full examination. 
The public, on the other hand, would thereby have 
this protection: that they would not unknowingly 
employ the medical services of any one not officially 
qualified, except by their own voluntary act, and the 
responsibility of whatever results would be thrown 
upon themselves. With a State Board of Examination, 
properly constituted, there would be no fear of par- 
tiality or injustice. Any one in possession of a diploma 
or other authorized document entitling him to practice 
could continue to do so, as he does now, but, in order 
to insure its citizens as far as possible against the perils of 
quackery, in the absence of any educational institutions 
of medicine under its control, the State should give to 
those who wish, the opportunity of becoming Licentiates 
of the State. Quackery flourishes, not on account of the 
desire of the people to employ ignorant or incompetent 
pretenders, but because, under present relations, it is 
difficult for the public to distinguish the true from the 
false. There should be nothing to hinder the adoption 
of a plan like this, as far as the community and the State 
are concerned. The public certainly would have no 
objection to be furnished with an official guarantee of 
proper capacity of at least a part of the persons prac- 
ticing medicine in the State, while the State would 
undoubtedly be glad to be rid of the present useless, 
cumbersome statutes. 
If any further inducement would be needed for 
practitioners of medicine, particularly for the younger 
members just entering the profession, to apply for 
examination for a State license, it would be the simple 18 
and just provision of the law, that the testimony of no 
physician should be accepted in any of the Courts, as 
that of an expert, unless he be a State licentiate, and 
that no township, town, city or county in the State, 
authorized to appoint or employ practitioners of medi- 
cine, in their capacity of physicians, to render services 
as such, for emolument or pay, or not, should appoint 
or employ such practitioner unless the same be duly 
licensed by the State. This would be an incentive for 
every young graduate to excel in real worth, to look 
upon the necessity of real acquirements in medical 
science and art as the chief means of accomplishing 
success, rather than upon mere social accidents or 
political affiliations, such as under existing circum- 
stances often seem to be the ruling powers. 
The greater opposition to the plan here suggested in 
outline, would, I fear, primarily at least, come from the 
profession itself, particularly those more advanced in 
years. It might be hard for many of us to brush away 
the cobwebs that may have accumulated in memory’s 
recesses, shutting out and darkening the light that once 
illuminated all the details of the elementary branches 
of our science. It might not be easy to many of us, 
perhaps, to come fully up to the requirements of an 
examination in minute modern pathological investiga- 
tion. Yet still harder would it be, undoubtedly, for 
some of us to relinquish ambition: to be obliged to 
resign ourselves to the sad conviction that we have 
ceased to advance, that we arc but landmarks of the 
past, that we arc no longer marching in the front, or 
with the body of the army, but stragglers in the rear. 
All this cannot be helped; it must be borne. 
But to the young men in the profession, those whose 19 
good fortune has placed their active entrance into it in 
an age of unprecedented new discoveries, opening up 
worlds of new truths that had been hidden for ages, to 
them I would appeal to unfurl the banner once again 
that shall lead us on to a higher professional life, that 
shall lead on to a truer appreciation of our science on 
part of the community, and that shall protect the 
people against quackery by giving them an opportunity 
to distinguish the wheat from the chaff. Unfurl that 
banner with its motto, “VOLUNTARY State EXAMINA- 
TION ! ”