THE STATUS 
OF 
THE MEDICAL PROFESSION 
IN THE 
STATE OF NEW YORK. 
BY 
IIEtfRY (4. PTFFARD, M. D. 
NEW YORK: 
I). APPLETON AND COMPANY, 
1. 3. and 5 BOND STREET. 
1 884. THE STATUS 
OF 
THE MEDICAL PROFESSION 
IN THE 
STATE OF NEW YORK. 
BY 
HENRY G. PIFFARD, M. D. 
NEW YORK: 
D. APPLETON AND COMPANY, 
1, 3, and 5 BOND STREET. 
188 3. THE STATUS OF 
THE MEDICAL PROFESSION 
IN THE 
STATE OF NEW YORK. 
From the New York Medical Journal for April 14, 1883. 
FIRST ARTICLE. 
Comparatively few are acquainted with 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 he 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 New 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 drugs. 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 virtually left in the hands of the county societies, each having 
jurisdiction in its own district. The wrar 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 Ilahneinannism 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 unwilling to give the societies the desired 
relief, feeling, perhaps, that they had no more right 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 wras 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 6 
THE STATUS OF THE MEDICAL PROFESSION 
the opposition of the profession, increased in numbers and in influence, 
and, excluded by the “ code ” from joining the existing medical corpora- 
tions, they 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 homoeopathy. 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 termed 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 eider brethren. 
Many physicians, who, led by a spirit of inquiry, investigated the homoeo- IN THE STATE OF NEW i ORE 
7 
pathic 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 divided 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 steain-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 homoeopaths, 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 THE ST A TUS OF THE MEDICAL PROFESSION 
8 
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 to 
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 hill to 
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 through 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 werehinder 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 ? These 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 YORK. 
9 
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 w ere eclectic, two were 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 flawr 
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, l 
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 182V : 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. 10 
THE STATUS OF THE MEDICAL PROFESSION 
SECOND ARTICLE.” 
From the New 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, 
hut 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 
qualified 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. 
11 
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 practice and quackery of all sorts will be an ex- 
ceedingly hazardous pursuit. 
It may, we think, be truthfully stated that, at the present time, quack- 12 
ery * and unqualified practice prevail here 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 any 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. lie 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. Ranking 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 
* By 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. 
THE STATUS OF THE MEDICAL PROFESSION IN THE STATE OF NEW YORK. 
13 
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 this wray 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 
requirements 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. THE STATUS OF THE MEDICAL PROFESSION 
14 
THIRD ARTICLE. 
From the New York Medical Journal for May 5, 1883. 
Having considered briefly, but we believe accurately, the medico- 
political and medico-educational status of the profession in this State, we 
will now take up the question of its medico-ethical position and require- 
ments. 
As already noted, the earliest attempt at ethical regulation in this State 
w’as the adoption of the System of Ethics of the Medical Society of the 
State of New York in the year 1823, long before any other State had. 
thought it worth while to move in the matter. This code remained in 
force until 1880. About thq year 1850 the “ Code” of the American Medi- 
cal Association was also adopted by the State society, but without the 
repeal of the older code. The profession of the State were, therefore, 
under the 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 
the American Medical Association; but, as by the adoption of the Ameri- 
can Medical Association code there was a prospect of national unity on 
the matter, they yielded their preferences, and consented to be bound by 
both, thus accepting a measure of ethical responsibility in excess of that 
borne by the profession in any other State in the Union. At this time 
there was no other organized section of the profession to question the pro- 
priety of this code, or to propose the adoption of another. A few years 
later the homoeopaths became organized, and acquired chartered privileges. 
They were, as already stated, an outcropping from the 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 the 
paragraph relating to the question of consultations. On this point they 
differed from the older code as follows: 
“ A complete medical education, of which the diploma of a medical 
college is the formal voucher, furnishes the only presumptive evidence of 
professional acquirements and abilities. But the 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. 
15 
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 wdiich 
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- 16 
THE STATUS OF THE MEDICAL PROFESSION 
tion of certificates of cures actually performed. The presence of laymen 
at operations is by no means objectionable if both patient and operator 
shall consent, as it tends to make the skill and ability of the 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 own 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 professiop had not 
been engaging in a bitter internecine warfare. 
This was the status of nominal ethics until 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. While 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 easily controlled by wise measures was, on the other hand, inju- 
diciously stimulated to an abnormal growth. For many years the 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 New 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 thq 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 186,5 ethical affairs were in such a state in New 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. 
17 
us 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 with 
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 in 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, made up 
o 18 
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. 
Nothing 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 notoriety 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 provision 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 such 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, That, 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 ability, this belief 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 established 
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, 1878. IN THE STATE OF NEW YORK. 
19 
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 difficulties 
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 Ilufeland, 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 public 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 1 847, 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 efficacy of infinitesimals.* The 
other group of homoeopaths pretend to hold strictly to all of Hahnemann’s 
* “ The homoeopathy of to-day has also shaken from 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 infinitesimal dosage as an essential 
principle of treatment.”—Beard, “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 we have given above, and a decided split in their ranks. 
“ The regular profession has now an opportunity of settling the homoeo- 
pathic ditliculty 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, physicians 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 PROFESSION 
FOURTH ARTICLE. 
’ From the New York Medical Journal for May 26,1883. 
At the annual meeting of the Medical Society of the County of New 
York, held October 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 II, 
paragraphs three and four. 
“ The committee approached this well-known field of action, where an almost 
ineffectual 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 offense 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, 
1878, 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 surgical 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 still considered that they had a right to give their sanction to the articles 
under consideration in a manner objectionable to the profession in general. The 
committee, therefore, adopted the following at a meeting held January 7, 1880: 
1Resolved, 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 the 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 the 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 in 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 a3 personal manners, to 
the social conditions that surround the individual.” 
This report was signed by Drs. Samuel Sexton (Chairman), James R. 
Learning, 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 the State of New 
York, held February, 1881, the President of the society, in his Inaugural 
Address, called the 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 committee 
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 
eonclusion 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 
be 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 surgical 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. 26 
THE STATUS OF THE MEDICAL PROFESSION 
In the second important matter connected with the revision of the code 
—namely, the 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 offenders 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 bonos 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 may be the 
occasion, a physician meeting or consulting with an “irregular” was liable 
to discipline. IN THE STATE OF NEW YORK. 
27 
The committee, therefore, deemed it both useless and unwise either to 
retain the rule of the American Medical Association or to recommend the 
adoption of a stricter one. 
The medico-political aspect of the question also received consideration, 
and from two points of view. In the first place, the effects of the exclusive 
attitude of the profession on the homoeopathic question were duly weighed, 
and it was the unanimous opinion that the consultation clause of the code 
of the American Medical Association had, more than any other one agency, 
assisted the homoeopaths to obtain their present position in the estimation 
of the public, and the abolition of this clause was the first step to be taken 
if it were desirable that the people should again estimate medical men 
according to their individual merits, rather than as upholders of this or 
that doctrine. In the second place, those who had interested themselves 
to obtain legislation on medical subjects intended to improve the status of 
the profession of the State were frankly informed that no relief might be 
expected from the Legislature so long as the profession was at war within 
itself. When intestine differences were healed, the State would be only 
too glad to do what it could to elevate and improve the material condition 
of medical men; but, so long as there were factions, the State would take 
no action that might perhaps aid one to the detriment of the other. These 
reasons alone should, in the writer’s judgment, have been sufficient to de- 
cide the question at issue, but there were others which appeared to the 
committee to be even weightier. The relation of the profession to the 
welfare of the community was an element that could hardly be overlooked. 
To exemplify this point briefly, it may be assumed that the only instance 
in which a homoeopath would desire or ask for a consultation with a regu- 
lar would be when in the treatment of a given case he had exhausted 
his own resources, and the patient still remained uncured. Under these 
circumstances, duty to his patient certainly demanded that he should seek 
advice and counsel from such sources as in his judgment would be best 
able to supply them. To this end he solicits the aid of a Thomas, a Flint, 
or a Sayre, believing that their larger experience in certain departments 
may throw a clearer light on the pathology of the case, or may enable 
them to suggest a more successful method of treatment than the one pre- 
viously pursued. If, now, these gentlemen believe that their own methods 
are not superior to those commonly pursued by homoeopaths, or that their 
skill is less than that of the physician who seeks their aid, they certainly 
have valid excuse for declining a consultation. If, on the other hand, the 
consultant has reason to believe that his experience or skill may contribute 
somewhat to the recovery of the patient, it would certainly seem that his 
duty to the individual, and, in a wider sense, to the community, was per- 
fectly clear. To the performance of this duty there has heretofore been 
but one obstacle—the consultation clause of the American code. 
Still another aspect of the question presented itself—namely, the right 
of a society to lay down any restrictive rules for the guidance of its mem- THE STATUS OF THE MEDICAL PROFESSION 
28 
bers which interfered with the free exercise of their talents and abilities in 
the pursuit of their calling. It may be conceded that there exists in every 
organized body a necessity for certain rules and regulations relative to its 
organization and continuance; and it may be contended that individual 
members should yield some of their personal rights, if the general body to 
which they belong will be benefited thereby. The present question, how- 
ever, does not appear to fall within either category, as it certainly will not 
be claimed that, if A (regular) consults with B (homoeopath), C (regular) 
is injured thereby, or that the fellow-members of A and C receive any det- 
riment as a body from the action of A. We, therefore, fail to see any good 
reason why A should be restricted in the matter of consultation when either 
his sense of duty or his inclinations or interests are at stake; and a rule 
that does so restrict him belongs to the class of rules which American citi- 
zens have always regarded as opposed to that liberty of action which is re- 
ferred to in the Declaration of Independence, and guaranteed by the Con- 
stitution of the United States. It is a rule utterly opposed to the principles 
that underlie the National and State governments of this country. 
The foregoing may be regarded as among the moral aspects of the ques- 
tion, and those which most certainly should be the first to be considered; 
and the committee were of the unanimous opinion that ordinary morality 
and the welfare of the community demanded that the old rule should be 
abolished, and the matter of consultation left to the good sense and con- 
science of each qualified practitioner. 
The question of expediency next demanded attention, and more espe- 
cially in its relation to the sectarian bodies. Would the proposed action aid 
them to maintain their antagonistic attitude ? Or, on the contrary, would 
it not, by removing the chief excuse for their existence, tend to their gradu- 
al extinction?* The committee were unanimously of opinion that such 
would be the effect of the contemplated action.f It must not be supposed, 
however, that the committee overlooked the relations which the State socie- 
ty bore to the American Medical Association. On the contrary, these were 
considered most carefully and exhaustively; but since much misapprehen- 
sion exists as to the relationship between this body and the various societies 
which are represented in it, we briefly state the facts: 
The American Medical Association is a voluntary and self-constituted 
body, without charter or any form of incorporation, amenable to no other 
authority than its own will, and without power to exercise authority over 
any other body. At the time of its organization it adopted certain rules 
by which its future membership should be regulated, which rules have, 
* The doctrinal changes that had occurred in both the homoeopathic and regular 
schools during the past fifteen years were so great, and in such converging lines, that 
there was no longer any sufficient raison d'etre for the continuance of societies whose co- 
herence depended on dogmatic or doctrinal peculiarities, their only real bond of union 
being one of political defense against the aggressive attitude of the regular profession. 
\ The very decided confirmation of this opinion by recent events will be shown later. IN THE STATE OF NEW YORK. 
29 
from time to time, been amended and changed. The association indicates 
the kind of societies from which it will receive delegates,* and the terms on 
which said delegates will be admitted.f The acceptance of these terms by 
the various State and other societies simply permitted them to be repre- 
sented, and to take part in the proceedings of the association. 
The association is also composed in part of what are known as “ perma- 
nent members,” namely, persons who once or oftener have served as dele- 
gates, and who, in virtue of this fact and an annual payment of five dollars, 
become entitled to assume the designation.\ The permanent members, 
however, do not enjoy equal powers and privileges with the delegates. 
They are entitled to seats, and, in a qualified sense, are allowed a voice in 
the proceedings. They can not, however, give practical force to any views 
that they may hold on topics under discussion, inasmuch as they are not 
permitted to vote. It will, therefore, be seen that the practical manage- 
ment of affairs is taken out of the hands of the older and more experienced 
members and left to the judgment of those who are younger, many, if not 
most, of whom visit the association for the first time ready to become the 
veriest clay in the hands of some wily and adroit manipulator.* 
It will be seen from the foregoing that the American Medical Associa- 
tion is not in any sense a confederation of State and dependent societies, 
united by mutual pledges to each other, as is the case with the States form- 
ing the Federal Union, but simply a body composed of such societies as 
find it to their inclination or interest to conform, for the time being, to cer- 
tain rules and regulations. If, therefore, a State society should place itself 
in a position that would prevent further continuance of its connection with 
the association, such action can not be considered as a secession in the same 
sense as a withdrawal of States from the Union would be. It is not a vio- 
lation of any promise or pledge, but simply the severance of a connection 
which, in this instance, the committee believed was at the present time, and 
under present circumstances, a source of injury to the profession of the 
State. 
* These are permanently organized State medical societies, and county and district so- 
cieties entitled to representation in the State societies. 
f The adoption of the association’s code of ethics. 
At one time a single payment of five dollars and attendance on a single meeting of 
the association were the only requirements for permanent membership. 
* The constitution of the New York State Society is essentially different. In this body 
the delegates, in accordance with the statutes of the State, are elected for four years, one 
fourth of the total number being elected annually and one fourth retiring. At every meet- 
ing, therefore, there will be those who are serving in their fourth year, others in their 
third, and others in their second, while but one fourth of the entire number of delegates 
can by any possibility be men without experience in society matters. In addition to the 
delegates, the permanent members constitute an important factor in the society. They 
are chosen from among such delegates as have served three out of their four years of ser- 
vice, and the number that may be elected annually is limited by the statutes of the State. 
Permanent members have both voice and vote. 30 
THE STATUS OF THE MEDICAL PROFESSION 
In the light of these facts and conclusions, the committee decided to 
report the following for the consideration of the State society: 
“ Members of the Medical Society of the State of New York, and of the medi- 
cal societies in affiliation therewith, may meet in consultation legally qualified 
practitioners of medicine. Emergencies may occur in which all restrictions 
should, in the judgment of the practitioner, yield to the demands of humanity.” 
As the subsequent sections of the State code have not been specially 
criticised, we will not quote or make further allusion to them. 
After the committee had agreed on their report, the question of pub- 
lishing it in advance of the meeting was considered. The committee would 
have been glad to give, it the fullest publicity, but they were without au- 
thority so to do. It would have been contrary to custom, and an act of 
disrespect to the society, for any of its committees to give to the public a 
contemplated report in advance of its presentation to the body that had 
ordered it. It was thought proper, however, to show it to some of the ex- 
officers of the society, and especially to those who, it was supposed, might 
have opposite views to those of the committee. The writer was responsible 
for the use of but a single copy in this manner. It was shown to an ex- 
president of the society, who, in a letter received the following day, com- 
mented on it as follows : 
“ If the spirit of the new code, which is proposed, and the spirit of the 
resolution which you read to me as unanimously adopted by the Royal Col- 
lege of Physicians of London, had governed the profession forty years ago, 
homoeopathy would never have attained an elevation, in the opinion of any 
of the educated or cultivated portion of the community, as an antagonistic 
school in medical science. Both the profession and the public would have 
been saved much evil.” IN THE STATE OF NEW YORK. 
31 
FIFTH ARTICLE. 
From the New York Medical Journal for June 2, 1883. 
After the committee had agreed as to the report that should be made 
to the society, it directed that it should be printed in advance of the meet- 
ing, in order that it might be placed in the hands of those present at the 
earliest possible moment after its reception by the society. This was done 
that each and every member might have an opportunity to carefully con- 
sider its contents and prepare himself to offer objections to it if he saw fit 
to do so. The report was printed with the lines numbered, to facilitate 
reference when it came under discussion. It was presented at the morning 
session of February 6, 1883. It was duly received, the printed copies were 
distributed to the members, and the subject was made the special order for 
the evening session. During the day, and up to the time of its formal con- 
sideration, the code was the chief subject of conversation, and it is safe to 
say that it was looked on by the members from all sections of the State as 
a very decided improvement on the American code, and one that, in its 
practical operations, would accomplish much good for the profession in the 
State. The members present were apparently almost unanimous in its 
favor, the leading comment being that the change was one that should have 
been made years before. 
At the evening session, the report of the committee having been read, 
Dr. Agnew moved that it be discussed seriatim. Dr. Roosa moved, as an 
amendment, that it be discussed as a whole, which was ordered. Dr. 
Roosa, taking the floor, then said : * 
If the society will bear with me in a few remarks, I will at their close offer a 
substitute for this report. I recognize the character of the gentlemen who have 
made this report. Without exception, they are the honored servants of this so- 
ciety ; without exception, they have had peculiar opportunities to learn the will 
of the profession in this State with regard to the code of ethics. I also recog- 
nize, Mr. President, the very great difficulty under which this distinguished com- 
mittee has labored, for I remember that behind them are the traditions of a pro- 
fession that believed it was necessary to bind each other with very strong legal 
bonds in order to prevent harm. I remember that they saw the traditions which 
* The extracts from the discussions are taken from the official record as published in 
the Transactions of the Society for 1882. 32 
THE STATUS OF THE MEDICAL PROFESSION. 
were thought to be as obligatory as those of the Mosaic code, and necessary in 
order to promote righteousness among medical men. I therefore see their diffi- 
culties, and I honor the result of their labors. I believe that it presents a great 
advance over anything which has been offered to our profession up to this time. 
But my objection to this report is that it contains nearly every one of those 
things which in the progress of time have become distasteful to the profession of 
our day. I believe that it contains in it the very intrinsic objections which we 
constantly make against the code which I hold in my hands—this sentimental 
code of our forefathers, which tells us how our patients should behave toward 
us, and which enters into such innumerable details as to the relations we sustain 
to our fellow-men that it is impossible to believe that the authors of it thought 
the medical profession was entitled to any discretion in the management of its 
own professional affairs. I think that, if the committee had fully studied the 
sentiment of the profession of the Empire State, they would have wiped out the 
code of ethics from its beginning to its end. I believe they would have left such 
matters to be settled by the individual discretion and wisdom and the good faith 
of each man in affiliation with this society. 
After further remarks, Dr. Roosa offered the following substitute for the 
report of the committee : 
The Medical Society of the State of New York, in view of the apparent senti- 
ment of the profession connected with it, hereby adopt the following declara- 
tion, to take the place of the formal code of ethics, which has up to this time 
been the standard of the profession in this State. 
With no idea of lowering, in any manner, the standard of right and honor in 
the relations of physicians to the public and to each other, but, on the contrary, 
in the belief that a larger amount of discretion and liberty in individual action, 
and the abolition of detailed and specific rules, will elevate the ethics of the pro- 
fession, the medical profession of the State of New York, as here represented, 
hereby resolve and declare that the only ethical offenses for which they claim 
and promise to exercise the right of discipline are those comprehended under the 
commission of acts unworthy a physician and a gentleman. 
Resolved, also, That we enjoin the county societies, and other organizations in 
affiliation with us, that they strictly enforce the requirements of this code. 
Dr. H. G. Piffard, of New York, moved that the substitute be referred 
to the Standing Committee on Ethics, to be reported upon next year. The 
motion was lost. 
Dr. Squire, of Elmira, then spoke to the subject, and was followed by 
Dr. Van der Poel, who said: 
Let us for a moment see where we stand. The special committee upon the 
code of ethics, after consultation, have presented this report for adoption. That 
report is objected to upon the one hand by Dr. Roosa, because, liberal as we 
have made it, it does not go as far as he thinks it should, and we have placed 
restrictions upon ourselves which Dr. Roosa wishes to have swept away. On 
the other hand, Dr. Squire thinks that we have swept away too much of our 
restrictions in some directions, and that we have not swept enough away in 
others. Now, let me state what was the spirit which governed us in making up 
this code as presented in this report. We reached the conclusion that it would 
be impossible to affect the relations of man to man, or the gentlemanly conduct IN THE STATE OF NEW YORK. 
33 
and behavior between man and man. We can not make a man a gentleman un- 
less ho is made so by nature; it is utterly impossible to bind men in these rela- 
tions by any code of medical ethics. For that reason we left these things out of 
our report. Every one of Dr. Squire’s references relate to conduct between man 
and man, and, as we believe that no written restrictions can affect the moral 
character of the man, we simply say that, in our opinion, we should govern our 
conduct in consultations as we have indicated in the report. Dr. Roosa goes 
further than we do, and he wishes to restrict the medical profession only by 
those influences which are comprehended under the bonds “ worthy of a physi- 
cian and gentleman ” ; and says that it is utterly useless to make any obligation, 
and that it should be left to the moral decision of each practitioner, and if you 
choose to consult with any man, you are perfectly at liberty to do so. I think 
the time has come when consultation should be made vastly more liberal than it 
has been. I have grown up with all the prejudices and tendencies of a man edu- 
cated at the time I was, and during my entire life-time I have not consulted 
directly or indirectly with a homoeopath, and therefore I can speak without fear 
or favor. But, for a few years past, I have been somewhat removed from active 
practice, and I have looked over the question a little more dispassionately ; and 
it has struck me, as well as others, that our position in this respect was painfully 
narrow and restricted. If we can break down those barriers and show up the 
homoeopaths to the public, and break down the barrier which enables them to 
get sympathy from the public, and leave it openly with the conscience of every 
gentleman to go or not to go as he sees fit, I think it would be a very great 
advance. There are many physicians from the country here at this time, and 
doubtless they will support me in the statement that the instances are not few in 
which there are two physicians in a village—one a homoeopath, and the other a 
regular physician, using the ordinary expression. The homoeopathic physician, 
perhaps, has a severe case of sickness, and it becomes necessary to have consulta- 
tion and advice, and the circumstances are such that he can not send away to get 
such consultation and advice. Now, it seems to me to be cruel and heathenish, 
although I have done it myself over and over again, to hang upon a miserable 
code of ethics and say I can not go. Such cases, I believe, should be left to the 
decision of the gentlemanly feeling and instinct of the man. 
The present writer then took the floor and objected to Dr. Roosa’s sub- 
stitute, fearing that it would be generally interpreted as removing all restric- 
tions on the conduct of medical men and lead to the most unbridled license, 
and, in fact, to an ethical status equivalent to that of the eclectics. 
Dr. Frazier, of Camden, said: 
Now, upon the one hand the laws of this State say that certain men are 
physicians, and make them so by law ; and here we have simply an effort made 
to make our laws comply with those of the State of New York. By not doing 
so, we give to other physicians who do not belong to our school a very great 
advantage in permitting them to say, in different neighborhoods: “ We are prac- 
ticing according to the laws of the State of New York, but these men will not 
meet us in consultation according to the laws of the State under which we all 
practice.” That has been the argument which they have used, and which makes 
them strong, and which makes us appear stubborn and weakens us. I have 
always been of opinion that we should be permitted to meet these men if the 34 
THE STATUS OF THE MEDICAL PROFESSION 
permission could be placed in proper language; that is, if we could be permitted 
to consult with them without making it obligatory that we should do so. 
Dr. H. D. Noyes, of New York, said: 
I have been looking for something which would explain to me what it was 
that gave rise to this system of rules which we know under the name of the code 
of ethics, hut I have not heard whence it came. It seems to me it must have 
had a beginning in controversies and animosities and peculiar conditions, which 
have to a large extent, or, perhaps, entirely, been abolished. The present status 
of the medical profession is one in which there is a high sense of personal dig- 
nity, and feelings of propriety among its members in their relations to the pub- 
lic and to each other. At the same time we all know that a considerable class 
of men—both those who are called regulars and those who are irregulars—are 
prone to do things improper and unworthy of gentlemen. Now, the code of 
ethics, as it stands, is doubtless intended to meet the latter class of men, but I 
think that our influence in controlling them is absolutely nugatory. I do not 
believe that the old code of ethics has amounted to anything in the way of re- 
strictions upon them. Every physician can call to mind instances of flagrant vio- 
lation of both the spirit and the letter of the code by men who h ave not been 
called to account. I well remember the feeling of surprise which came over me 
when the American Medical Association met in the city of New York in 1854, 
and I first read what is known as the code of medical ethics. I never was 
more struck with astonishment than with that document. It seemed to be 
saying things which were both humiliating and unnecessary, even at that time. 
I am sure that the sense of this meeting is for the abolition of that code as it 
now stands. . . . 
. . . My feeling throughout my professional life has been, first, to study what 
my duty is to humanity, and, second, to consider what my duty is to the profes- 
sion. It has been with me a strong desire, and continues now, to see wherein 
professional honor and propriety can be sustained, and, in deciding with refer- 
ence to consultations. I must say that I have uniformly refused to consult with 
so-called irregulars. At the same time I have done so under the feeling that I 
was entitled to protest against it. I shall vote in favor of the substitute. 
Dr. E. M. Moore, of Rochester, said: 
I have had the same wonder which Dr. Noyes has expressed as to where such 
a code as theirs (American Medical Association code) could have come from, and 
I took pains at one time to investigate in that direction as to how we could have 
had such a wonderful composition. It was really copied almost verbatim from 
a treatise written by Dr. Samuel Percival in 1760, in accordance with the condi- 
tion of society presented in England at that time, which was entirely aristocratic, 
governed by the law which regulates the relations existing between patron and 
client. 
About seven or eight years ago this subject came up in the American Medical 
Association. It began to be doubted whether it was all right. I received at 
that time a letter from Dr. N. S. Davis, of Chicago, the father of the associa- 
tion, to whom this matter had been referred, and I gave him my views upon the 
question, calling attention to the fact that Dr. Percival wrote the article over a 
century ago, and expressed the opinion that we had entirely outgrown such 
swaddling clothes. At the next meeting of the American Association the com- IN THE STATE OF NEW YORK. 
35 
mittee brought in their report, and it was to the effect that the code of ethics 
was so excellent that it should be maintained. ... I am willing to strike it all 
out and leave the regulation of our conduct to the unwritten law, for we have 
uniformly failed to apply the rules of discipline under any code or system of 
ethics by which we have been governed. . . . 
Additional remarks were made by Drs. Mosher, Wight, Squibb, and 
Gray. It is a curious fact that not a single speaker defended the propriety 
of the consultation clause of the old code, or attempted to advocate the 
merits of this instrument as a whole. Many, however, thought it would 
be better to defer the decision of the question until after it had been 
brought to the notice of the American Medical Association. The majority 
thought otherwise, and the vote showed 52 in favor of immediate action to 
18 opposed. Immediately after the vote, Dr. Roosa gave notice that at 
the meeting in 1883 he would move the adoption of his “substitute.” 
On the writer’s return to the city, the almost universal expression of 
opinion was in favor of the action of the State society, the adverse criti- 
cisms being very few in number. On the day of his return he was met in 
the street by a well-known physician, who asked concerning the ethical 
situation. On being informed, he said : “ I suppose, then, I can call in a 
homoeopath if I want to.” I replied that I saw no reason why the rule 
didn’t work both ways, but inquired why he wanted a homoeopath. He 
replied that he had a very severe case of scarlet fever under his care, and 
that the family were very anxious, and desired a homoeopath in consulta- 
tion ; and added that, in all probability, if he did not have the homoeopath, 
the family would discharge him and employ the other. He stated that, 
rather than lose the family, he would have the consultation, provided he 
could not be disciplined therefor. This gentleman is now enrolled as one 
of the supporters of the old code. 
The publication of the action of the State society permitted the medical 
press throughout the country to criticise it, and this they did in a manner 
that was not altogether in harmony with that spirit of Christian charity 
that the old code was supposed to be founded on. If the fasehood, hatred, 
and malice displayed by some of the advocates of this code are to be re- 
garded as its legitimate fruits, God forbid that it should ever again be the 
supreme medical law in this State. The change in the code was a matter 
that affected the profession of this State only, and was not the business or 
concern of any one outside the State. The State society, with perfect delib- 
eration, and with its eyes open, resigned from the American Medical Asso- 
ciation,* because it believed that the consultation rules of that body were 
both morally and politically wrong, and that further acquiescence in them 
* The severance of this connection was exactly similar in principle to that which oc- 
curs when a member, for reasons that seem satisfactory to him, severs his connection 
from a medical society by resignation. It is neither an act of secession, nor an act of re- 
bellion, terms which have been used in this connection by those who should have known 
better. 36 
THE STATUS OF THE MEDICAL PROFESSION 
would be to perpetuate the evils that had already accrued from their ob- 
servance. 
The medical press of the country, in dealing with the action of the 
State society, with few exceptions, failed to discuss the question on its 
merits. Few, if any, sought to ascertain the real motives and reasons which 
rendered the change necessary or desirable ; few even discussed the effect 
that the change would have on the affairs of the 'profession in this State. 
Fow appeared to recognize the fact that it was the duty of the State society 
to watch over and protect the interests of the profession rather than to 
leave them to the tender mercies of the American Medical Association. 
On the contrary, the majority of the press assumed to view the subject 
in a light which reflected most seriously on the intelligence or honesty of 
the profession in this State. One of the most prominent charges, and one 
which, after it had been first enunciated, passed current as truth from one 
journal to another, was the statement, wholly unverifiable by facts, that this 
movement had been initiated and engineered solely by specialists from 
sordid motives.* The large vote (fifty-two to eighteen) by which the origi- 
nal change was made indicates either that the great majority of the profes- 
sion in this State are specialists, or else that a very considerable number of 
general practitioners were of but one mind in this matter. 
It may be asked why the State society did not first apply to the Ameri- 
can Medical Association before taking this action on its own account. To 
which we may reply that, in the first place, it did not desire to carry a 
domestic affair into the councils of that body, to inflict its own views on 
the profession of other States, to make any attempt to proselyte in ground 
that was as yet unprepared, or to meddle with the affairs of those beyond 
its jurisdiction. Secondly, it knew the history of the American Medical 
Association too well to expect for a moment that it would listen to any 
propositions looking toward the liberalization of the profession. Almost 
from the beginning of the history of that association its practical manage- 
ment and the dictation of its policy have been in the hands of one man— 
one who is commonly spoken of as the “ Father of the Association,” and 
who, so long as he retains his power, will continue to use it, as he has used 
it in the past, as an obstacle to the scientific and political advancement of 
the profession and the welfare of the people. For evidence on this point, 
* All of the New York specialists who had anything whatever to do with the matter, 
or voted on the question, were members of the New York Academy of Medicine, which 
was under the governance of the American code. The action of the State society in no 
wise affected the ethical status of that body, which is competent to adopt any by-laws that 
it chooses, or any code of ethics that it desires. These members of the State society, 
therefore, who voted for the change simply gave freedom to those who were not members 
of the Academy without releasing themselves in any manner from the Academy’s code ; 
nor have they, during the past eighteen months, made any effort, or organized any move- 
ment, to change the ethical status of the Academy. It will be seen, therefore, that the 
specialists were not governed by the sordid motives that have been ascribed to them. 
They, less than any one else, have been affected by the change. IN THE STATE OF NEW YORE. 
37 
we need but to cite the latest ethical ordinance adopted by that body—one 
which clearly showed the animus of the controlling element of the associa- 
tion, and exhibited its ever-readiness to meddle with the domestic affairs of 
the individual States. We refer to the action that was recently taken in 
reference to the University of Michigan. 
At home, the action of the State society was discussed more temper- 
ately. The two most important medical journals of this city approved the 
change, while one or two others of minor influence were opposed. The 
profession of the State as a whole gave the matter but limited considera- 
tion, but as a rule a favorable one; the old code was pretty generally re- 
garded as dead, and the recent action was simply the interment of its re- 
mains. A few months later Dr. E. R. Squibb circulated throughout the 
profession of the State, in his personal organ, “ The Ephemeris,” a protest 
and an argument against the change. This action was the first incitement 
to dissension and trouble in the State, and we can not but regard it as ill- 
judged and in bad taste. Dr. Squibb is not a practitioner of medicine, and 
has not for many years been placed in a position that would enable him to 
have a practical knowledge of the questions at issue ; and, even if he had, 
he should have left the discussion to those whom it immediately concerns. 
As a recognized member of the profession, however, he had a perfect right, 
of course, to discuss the matter; but it would have been better, we think, 
if he had done so in one of the public medical journals, in which his views 
and opinions might have received reply. As it was, he of necessity had 
the entire argument to himself, and was enabled to give his personal views 
the widest distribution that he chose. 
A journal in a neighboring city, with even less motive, endeavored to 
excite dissension among the members of the county societies in this State, 
and incited them to seditious action, urging them not to accept the edict of 
the State society, but to adhere to the American code, apparently unaware 
that such action by the county societies would be absolutely null and void. 
Our Southern friends also, with great unanimity, censured the profes- 
sion of the State, and even suggested that the malcontents form a new 
State society, forgetting the old rule in physics that two bodies can not 
occupy the same space at the same time. The distance which separated 
them from us and the different conditions which surrounded them are suffi- 
cient reasons for a misapprehension on their part of the propriety and neces- 
sity of our action. We think, howrevcr, that they might have been a little 
more charitable in the expression of their views. They frankly charged us 
with desiring to affiliate with the lowest quacks and charlatans, just as in 
the old antebellum days they charged every abolitionist and opponent of 
slavery with the desire to marry his daughter to a “ nigger.” Long accus- 
tomed as they were to the idea that slavery of the body was right and 
proper, it may take them some years before they understand why it is that 
we in the North are unwilling to longer accept the slavery of the mind of 
which the old code represented the bonds. 38 
THE STATUS OF THE MEDICAL PROFESSION 
Shortly after the meeting of the State society in 1882, an attempt was 
made to bring up the matter of the code in the New York Academy of 
Medicine. Notice was given that the action of the delegates from the 
Academy who had voted for the new code would be submitted to the Acad- 
emy for its approval or the reverse. This was done by the friends of the 
old code who hoped to secure an expression of opinion adverse to the action 
of its delegates. At the meeting of the society at which the question was 
to be considered, Dr. Austin Flint, Sr., first claimed the floor, and, in a few 
brief but eloquent words, urged that the question be not brought up in that 
body, and moved that all action on it be indefinitely postponed, on the 
ground that the scientific interests of the association were too important to 
be hazarded by the introduction of medico-political questions of this char- 
acter. This action was regarded by the opponents of the old code as almost 
a pledge that the question would not be raised again. The}’ preferred to 
abide by rules and by-laws which were distasteful to them, and to gauge 
their conduct in accordance with ordinances regarded as oppressive rather 
than to risk the future harmony and welfare of the Academy. During the 
succeeding months the advocates of the State code rested on their oars, 
but the supporters of the American code were busily engaged in manufac- 
turing opinion throughout the country adverse to the action of the State 
society. The most active agencies in this direction were the “ Medical 
News ” and the “ Ephemeris,” both of which endeavored to incite sedition 
in the county societies, urging them to repudiate the action of the State 
society, and to instruct their delegates to vote for the repeal of the State 
code. 
Thirty or more of the county societies followed this advice, and in- 
structed their delegates to vote for the repeal of the State code. The 
societies that took this action were only those entitled to a limited number 
of delegates, and the aggregate vote thus obtained hardly counterbalanced 
the votes of two or three of the more populous counties. In none of the 
larger counties was this action taken. It is true that Kings County, enti- 
tled to twelve delegates, did at one meeting instruct its delegates, under 
the urging of Dr. Squibb, to vote for the repeal of the State code, but this 
action was rescinded at a subsequent meeting of the society. 
In New York County, it being the year for the election of delegates, 
upward of forty nominations were made at the September meeting. Of 
these candidates I do not recollect the names of more than two or three who 
belonged to the old code party. From the forty nominees, twenty-four 
(the number prescribed by law) were to be selected. At the election in 
October, the entire number elected were men opposed to the old code. 
This was not in consequence of any special electioneering, as from the code 
standpoint it mattered little which of the forty (with two or three excep- 
tions) were elected. Those elected owed their election to the fact that 
they were suitable persons for the position, and were sufficiently popular. 
One or two of the unsuccessful candidates were men equally suitable and IN THE STATE OF NEW YORK. 
39 
personally popular, but, their pronounced position in favor of the old code 
being known, they polled a very small vote. 
After this, very little thought or attention was given to the code in this 
city, much less, in fact, than in other parts of the country, our neighbors 
appearing to be really more solicitous about our welfare than we were our- 
selves. Ethical matters slumbered, and it was not until the stated meeting 
of the county society in January, 1883, that the question was again opened. 
At this meeting, Dr. L. A. Sayre moved that the delegates of the society 
be instructed to vote for the repeal of the State code. After discussion, 
this motion was lost. Not satisfied with this expression of opinion on the 
part of the society, the old code advocates procured the calling of a special 
meeting for the announced purpose of obtaining a vote on the question. At 
this meeting the question of instructing the delegates was again raised, and 
amotion to that effect was lost by a vote of 60 yeas to 147 nays. THE STATUS OF THE MEDICAL PROFESSION 
40 
SIXTH ARTICLE. 
From, the New York Medical Journal for October 6, 1883. 
The seventy-seventh annual meeting of the Medical Society of the State 
of New York convened February 6, 1883, and was opened with the inaugu- 
ral address of the President, Dr. Harvey Jewett, of Ontario County. From 
this address I extract the following: 
At the annual meeting in February, 1881, this society appointed a committee 
of five, from among the most distinguished medical gentlemen of the State, to 
consider and revise the old code of medical ethics which had governed our 
action for nearly forty years. In conformity with the instructions given this 
committee, they presented their report at the annual meeting in 18S2. At the 
same time a substitute was offered to this effect: that we abolish all restrictions 
relative to the practice of medicine, as superfluous and unnecessary in the pres- 
ence of the unwritten or higher law, leaving all ethical questions to be settled by 
the gentlemanly instincts of the profession. The report of the committee, as 
well as the substitute, was printed and placed in the hands of all members of the 
society who desired a copy, that they might examine and vote deliberately and 
understandingly upon the changes reported for their consideration and adoption. 
After a general discussion, in which all present had an opportunity to express 
their views, the report of the committee was adopted by a large majority. The 
new code has not been received by the profession or the medical press, in this 
and in other States, with cordiality or favor, but, on the contrary, by the most 
outspoken and emphatic opposition. The county societies, at their first meet- 
ings, expressed their surprise at and disapproval of the new code adopted by a 
majority of their representatives, as unbecoming the dignity of the profession, 
and as revolutionary in its nature and “ disorganizing in its tendency.” A year’s 
consideration, a calm and dispassionate discussion of the matter, have greatly 
modified the views of the profession in reference to the objectionable measure, 
and I trust a more conservative sentiment exists to-day than at the time of its 
adoption. 
The American Medical Association, at its annual meeting at St. Paul, in June, 
1882, refused admission to the delegates from the Medical Society of the State of 
New York, because they failed to recognize some of the provisions of the old 
code which had controlled their action for so many years, and had taken the 
liberty to substitute what was deemed a more progressive and liberal spirit in 
reference to established rational medicine as it exists at the present time. The 
objectionable clause in the new code consists in the sion of consultation IN THE STATE OF NEW YORK. 
41 
with any legally qualified practitioner of medicine as not derogatory to the in- 
terest and dignity of the profession, in cases of emergency, or where such aid is 
required upon the broad ground of common humanity. 
The advocates of the new code assert that this is merely permissive; that no 
one is under obligation, expressed or implied, to meet an irregular practitioner 
in consultation, unless he prefers to do so; but in certain cases it would be illib- 
eral, inhumane, and contrary to the spirit of the age, to withhold professional aid 
because of “ difference of opinion in creed or belief.” The attention of the so- 
ciety at this meeting is directed to a consideration of the merits of this subject, 
to confirm, modify, or abolish the new code, as'in their wisdom and judgment 
they may deem most conducive to the welfare, dignity, and interests of the medi 
cal profession of the State of New York. 
At the conclusion of the President’s address the standing committees of 
the society were announced, and after that communications from county 
societies, as the first order of business, were called for. The following were 
presented: 
Medical Society of the County of Westchester, ) 
Katonah, February 3, 1883. ) 
To the State Medical Society : 
The following action was taken by the society at its annual meeting in 1882: 
Resolved, That this society reaffirm its loyalty to its parent body, the Ameri- 
can Medical Association, and thus declare its adherence to the code of ethics pro- 
scribed by that body as a guide in practice. It strongly deprecates the action of 
the State society, and maintains that such action is as unworthy as it is revolu- 
tionary; and that the adoption of such a code under such circumstances could 
result only in confusion and dishonor. 
Resolved, That these resolutions be submitted to the State Medical Society at 
its next annual meeting through our regular delegates. 
Carried. Affirmative, 28; negative, 2. 
(J. G. Wood, Secretary pro tem.) 
J. Francis Chapman, Secretary. 
Rochester, N. Y. 
At the annual meeting of the Monroe County Medical Society, held in the 
Common Council chambers at Rochester, N. Y., May 31, 1883, it was 
Resolved, That it is the sense of the Monroe County Medical Society that the 
code of ethics be repealed, and that the secretary notify the Medical Society of 
the State of New York of the action taken. 
William F, Sheehan, 
Secretary of the Monroe County Medical Society. 
Oswego, N. Y., January 31, 1883. 
To the New York State Medical Society : 
At the annual meeting of the Oswego County Medical Society, held in Oswe- 
go, June 13, 1882, the following resolution was adopted, and the delegates to the 
next meeting of the New York State Society were instructed to bring the same 
before the society: 
Resolved, That, in regard to ethics of consultations, the true rule of our pro- 
fession is that, while we should be free to visit the sick under all circumstances 
and under whosever care, it is unworthy of us to call in consultation any but 
regular practioners. p. M. DowDj salary. 42 
THE STATUS OF THE MEDICAL PROFESSION. 
After the transaction of some farther business, Dr. E. R. Squibb, of 
Kings County, offered the following: 
Whereas, The Special Committee on the Code of Ethics, in its report at the 
last annual meeting, recommended a change in one part of the code which was 
more in the nature of a revolution than of a revision, and, therefore, may be 
more radical than was expected or desired by the constituency of this society; 
and, 
Whereas, That report was adopted at a session wherein only fifty-two mem- 
bers voted in the affirmative, and thus legislated for the entire profession of the 
State on a subject of vital importance in a direction which may not have been 
anticipated or desired by the profession at large; therefore, 
Be it resolved, That all the action taken at the annual meeting of 1881, in re- 
gard to changing the code of ethics, be repealed, leaving the code to stand as it 
was before such action was taken. 
Resolved, That a new Special Committee of five be nominated by the Nomi- 
nating Committee of the society, and be appointed by the society to review the 
code of ethics, and to report at the annual meeting of 1884 any changes in the 
code that may be deemed advisable. 
Resolved, That the report of the committee be discussed at the meeting of 
1884, and be then laid over for final action at the meeting of 1885. 
These resolutions were made the special order for the evening session. 
At this session the society went into committee of the whole, and Dr. 
Squibb opened the discussion, maintaining that the action of the last an- 
nual meeting upon the subject of the code of ethics was contrary to the 
plan of the organization of the society, and to the letter and the spirit of 
self-government by majority rule, and, therefore, ought to be reversed. 
Dr. Squibb then went on to claim that the code of ethics was a part of 
the constitution of the society, and analogous to the constitution of the 
State, and that any amendments to be made in it should first be approved 
by the county societies. 
Dr. Roosa, then taking the floor, said: 
The Medical Society of the State of New York, as one of its inherent rights, 
has the power to make its own by-laws, and, by statute law, it has the right to 
call to the bar any county society which may refuse to cause its by-laws to con- 
form to those of the State Medical Society. The argument, under the circum- 
stances under which we meet to-night, is utterly absurd. What has happened? 
It is true that instructed delegates have come here from several county societies, 
and it is also true that from these very counties have come men who have been 
made permanent members, and who are entirely at variance with the instruc- 
tions given to the delegates. It is a most unwarrantable doctrine that the city 
of New York, with its nearly two millions of people, and nearly two thousand 
regular physicians, that the county of New York, representing a constituency 
something like that of twenty counties in this State, is not to have her full and 
proportionate voice in the discussion and decision of any question which comes 
before us here. Because she has the misfortune to be a city, and a large city, is 
her vote to be counted only equal to that of Alleghany ? I believe that this so- 
ciety is of one accord that the argument of Dr. Squibb is not sufficient for it, and IN THE STATE OF NEW YORK. 
43 
that the State society is prepared to-night, whatever it may have been on pre- 
vious occasions, to settle this question for itself, without referring it back to the 
counties. The State society undertook this action of revising the code, not as 
has been charged very frequently during the year, not at the suggestion of spe- 
cialists, not by any arrangement beforehand. If there ever was a spontaneous 
convention on the face of the earth, if there ever was a convention which repre- 
sented its constituents, it was the annual meeting of the Medical Society of the 
State of New York in 1882, and it has been equaled in the annals of this society 
only by the immense meeting of to-night. At that meeting this society not only 
passed the revised code, but, without caucusing or consultation with any person 
as to whether they could or would support it, it passed a resolution much more 
radical, which had not been presented to any person, except one, before it was 
offered to this society at that meeting. That meeting of the society did repre- 
sent its constituency perfectly well, and so does the meeting of the society to- 
night. There was no unfair action of any kind in the meeting of last year, what- 
ever may have been the statements from any source. It was an open discussion, 
and the distinguished gentleman who has opened the debate had his full say, and 
he was unable to convince even one third of the meeting that his views were 
correct. It is assumed in the argument of the gentleman that we have such a 
union with the American Medical Association that we are compelled to ask that 
association before we make any change in our by-laws. Perhaps that question 
has been sufficiently answered ; and a large number are present to-night who did 
not hear the discussion which took place this morning on that part of the sub- 
ject. Let us understand ourselves distinctly. We recognize no allegiance to 
the American Medical Association except that of fraternal relations, and in case 
they refuse to admit our delegates, as they refused to do last year, this relation 
is dissolved. That association is not an incorporated association. If we ever 
subscribed to its code, we repealed that subscription last year. The American 
Medical Association has not taken a position in the medical world to be com- 
pared with this society of which we have the honor to be members. There is 
no secession in this business. There is no States rights in our action. If the 
union of these States was no more than that which exists between the American 
Medical Association and this State Medical Society, there never would have been 
a rebellion. There would have been no need of one. Each State would have 
been independent, as we are now of the so-called National Association. The 
gentleman lays great stress on the adjective “ revolutionary.” Revolutionary 1 
We are not afraid of that word. All the advances in the world have been made 
by revolutions; but revolutions are never revolutions except as they are mouth- 
pieces of the people, and a revolution in this society will never be successful 
unless we represent the voice of the medical profession of the State of New 
York. Not of us in New York can any charge of misrepresentation be made. 
The county of New York comes up here with its hands untied and without fet- 
ters, and any member is at liberty to vote as his conscience may dictate. The 
county ot Kings, thanks to great effort in opposition to the gentleman who has 
just spoken, is also unfettered upon this floor. But, I am sorry to say, I am 
addressing some gentlemen who never had an opportunity to listen to arguments 
on the side of those of us who believe that an advance of the profession will be 
most effectually promoted by our assistance to the resolutions offered to-night, 
and they come up here bound and directed as to what they shall do. I consider 
these instructions as utterly illegal; and, when I had the honor to be president 44 
THE STATUS OF THE MEDICAL PROFESSION 
of this society, I ruled that these instructions were invalid, and one gentleman 
from New York violated his instructions, and he was never disciplined, although 
he was threatened. No, Mr. President, not upon us can any charge of revolu- 
tion be fastened except that which is similar to what has emancipated many a 
country, and which will emancipate the State of New York. The few other 
arguments which have been advanced against the new code are easily answered. 
It has been assumed by the friends of the old code that we have played com- 
pletely into the hands of the homoeopaths and the eclectics, if consultation with 
any class of legally qualified practitioners be allowed. Now, if you are not will- 
ing to trust the ex-presidents of this society, who, with very few exceptions, are 
entirely in favor of this expression of freedom in consultation, and the commit- 
tee, not of specialists, but of a majority of general practitioners who drew up this 
code—if you are not ready to trust them as to whether we are going to surren- 
der in any such way, then I have misunderstood this society. 
It has also been said that this is a medical question, and that it can not be in 
any manner understood by men outside of the medical profession. If this was 
a question as to the value of iodide of potassium, or sulphide of calcium, or the 
sulphate of quinine as agents for controlling the symptoms of disease, then none 
except men like ourselves, who have received a medical education and have had 
experience in its practical application, are competent to decide it. But it is not 
a question of drugs or drugging. It is a question of ethics, a question of man’s 
rights, his relations to his brother man, and his entire conduct toward the people 
of this community. The entire sentiment and conduct of the people is against 
this restricted trades-union clause in the American Medical Association code, and 
they have a right to their opinion, and are competent to give an opinion upon 
this question. The old code of our profession has made us the laughing-stock of 
educated men. We claim for ourselves, not the privilege of affiliating with 
quacks, but of giving our advice wherever it is asked for. 
If we act simply as benefactors to our own kind, no matter if we stand alone 
for the next hundred years, we shall be right, and the Medical Society of the 
State of New York can afford to smile at those who refuse it fellowship. 
Dr. H. G. Piffard, of New York, then said: 
I desire to throw a little light upon one point raised by the gentleman from 
Kings. He drew an analogy between the constitution and by-laws of this so- 
ciety and the constitution and laws of the State. His special effort is to show 
that the code of ethics was virtually the constitution of this State society, and 
that it could not be altered except by the consent of the constituencies from 
which the society is recruited. This view, I think, is erroneous. The code of 
ethics we have adopted is, and always has been before, regarded as a by-law 
simply. The gentleman from Kings County seems to think that we derive our 
authority from county medical societies, that we have no authority over them, 
and that our by-laws are subject to their revision, instead of their by-laws being 
subject to the revision of the State Medical Society. In that the gentleman is 
absolutely mistaken. He quotes from a certain law enacted in 1813, which gives 
us the power to make certain by-laws, and also gives county medical societies 
power to make certain by-laws, but he overlooks the fact that in 1866 another 
law was passed which enabled the State society to control the by-laws of county 
societies. ... In other words, county societies are amenable to this society, not 
this society amenable to the county societies. . . . IN THE STATE OF NEW YORK. 
45 
Dr. H. R. Hopkins, of Erie, then addressed the Committee of the 
Whole* 
Dr. Didama, of Onondaga County, next spoke. Referring to the Ameri- 
can code, he said : 
. . . This code is the one which we adopted on condition of representation 
in the American Medical Association. If we repeal it, then we have no rightful 
representation in that association. It was repealed by a few, but their action 
was not the expression of the great mass of the profession of this State, only 
fifty-three persons voting one way, and they did not represent the opinion of 
four or five thousand regular practitioners of medicine in this State. There is a 
little complaint that our delegation—which was sent after our secession, if you 
choose to call it so, our cutting ourselves loose from the American Medical As- 
sociation—was not received with respect and open honor. But I think every 
fair-minded man must allow that the association could have done nothing else. 
They were hound to reject the delegates sent from a society which had repudiated 
the code of ethics established for the government of the entire profession. The 
question is, Are we, the medical profession of the State of New York, prepared, 
to cut ourselves loose from the American Medical Association? 
Dr. Didama further stated that he considered a consultation with a 
homoeopath, with a person who believed in the efficacy of the so-called di- 
lutions, as conniving at a fraud, f In closing, he said : 
With this I shall end, saying that a consultation with certain persons is de- 
rogatory to the medical profession, and that it is derogatory because those who 
do it are simply perpetrating a fraud. ■ 
Dr. Rochester, of Erie County, then spoke : 
I arise with a full consciousness and appreciation of the soberness of this dis- 
cussion to-night, and I hope that anything which I may say will be entirely free 
from personality. We have to look to common sense in this matter. I have 
been looking over this paper (State Code), and I have not seen any line of it 
which tells us what is to be gained by this proposed modification, except that 
broad humanity requires us to meet everybody who calls upon us. This I would 
say is simply a reflection on the medical profession throughout the length and 
breadth of the land, for there is no emergency, no casualty, no case of distress or 
anxiety to which medical men do not always go under any circumstances, with- 
out expectation of reward or remuneration. . . . Now, sir, I am a permanent 
member of the American Medical Association, and I have been for a long time 
a permanent member of that body, as I am of this society, and I am proud of it, 
and I should be sorry to give it up. But I will say if this new code passes I will 
give up my membership in the State Medical Society sooner than my permanent 
membership in the American Medical Association. . . . 
Referring to mixed consultations, Dr. Rochester said : . 
We meet, we talk, but do not agree in therapeutics, very likely not in diag- 
* As Dr. Hopkins’s remarks have already been published in full in the columns of the 
“ N. Y. Med. Journal,” they are here omitted. 
f See “N. Y. Med. Journal” for August 18, 1883, pp. 177, 178. 46 
THE STATUS OF THE MEDICAL PROFESSION 
nosis, and the people are satisfied; but how is it with the patient? Does the 
patient get any benefit? Not at all. We say we can not see anything to do dif- 
ferent from what is being done, and if we did suggest anything it would not be 
carried out. It is impossible for any such thing to take place. We can not do 
it without degrading ourselves. We maintain, then, our first position—that we 
are kind, generous, and liberal to all those who call upon us, and always have 
been, and I do not see any possible advantage which can come from this modifi- 
cation. Perhaps we are mistaken. Now, we know that while they are carry- 
ing these colors they are giving the very drugs that regular practitioners do, ex- 
cept that sometimes they give a little more. 
Dr. Seymour, of Rensselaer County, then spoke to the question, but 
his remarks were too voluminous to be given in full, and will hardly bear 
condensation. We must, therefore, refer the reader to the official report. 
Referring, however, to certain members of the profession residing in a 
neighboring county, he said: “ This thing will not do, and if you come up 
here to strengthen the hands of these men against us, we will arraign you 
before this society, and kill you off professionally; and, if you are backed 
up by your confreres, we will twist their necks off too. That cock will not 
crow.” During Dr. Seymour’s remarks he was interrupted by the receipt 
of a telegram from Dr. L. A. Sayre of New York. Relative to this tele- 
gram Dr. Seymour said: “ It is, perhaps, under the circumstances, hardly 
in order, but Dr. Sayre’s name was mentioned, and then it was stated that 
he had met with homoeopaths, and confirmed the new code, and violated 
the old code, and I took the liberty of sending a telegram to Dr. Sayre, 
telling him that the charge had been made ; and I understood that a letter 
proving the charge would be read at this meeting, and called upon him to 
vindicate himself, and I got this telegram from some one in his house: 
‘ Dr. Sayre has been confined to his bed for two weeks, and it is impossible 
for him to be moved at present. He says: “ I saw in consultation Dr. 
Baldwin, who was treating the patient most heroically all through. He 
had not diagnosed the case, and afterward I learned that he was a homoeo- 
path, although from what I saw of him no one would suspect that he was. 
He was at the time using hypodermic injections of morphine, and in no 
respect carrying out the principles of Hahnemann.” ’ ” 
Dr. Seymour further said: “ Once or twice in ray life I have violated 
the code myself, and been to consult with homoeopaths—once in a case of 
placenta praevia, where the woman was bleeding to death. After I had 
righted things up, and got the woman so I thought she would live, I turned 
around to this homoeopathic gentleman and said to him, ‘You have abun- 
dant time now to consult with one of your own kind, and I will not trouble 
you any further.’ For this consultation I was condemned, and I had to 
vindicate myself upon the principle of humanity.” 
This concluded the arguments on the question before the society. After 
some parliamentary skirmishing, the question was taken on Dr. Squibb’s 
resolutions. The result of the vote showed 99 ayes to 105 nays, and the IN THE STATE OF NEW YOltK. 
47 
resolutions were declared lost. To carry them would have required a two- 
thirds affirmative vote, which in the ballot cast would have been 136. 
The result of this ballot exhibited one fact with great distinctness— 
namely, that the majority of the representatives of the profession of this 
State were not in favor of a restoration of the old code.. It had been re- 
peatedly predicted by the hostile press outside the State that the action of 
the State society of the previous year would be reversed at this meeting. 
The vote showed, only too clearly, that, despite the exertions that had been 
made in behalf of the old code, and despite the abuse that had been heaped 
on us from without, the profession of the State were thoroughly convinced 
of the evil effects of the code in the past, and were not going to submit to 
them in the future, even at the expense of loss of representation in the 
American Medical Association. 
Subsequent to the announcement of the vote, Dr. Roosa moved the 
adoption of his “substitute,” which, on motion, was laid over until 1884. 
Dr. J. G. Adams entered a protest, as delegate from the New York Academy 
of Medicine, against the action of the State society. This protest was 
clearly an impropriety if offered in behalf of the Academy, and should not 
have been received as an expression of the Academy’s feelings and views, 
inasmuch as a majority of the delegates of the Academy who Avere present 
voted with the majority. It may further be stated that the Academy had 
not expressed its views on the subject, and, as a curiosity in the matter of 
society by-laws, it may stated that the members of the Academy have 
no direct voice in the selection of the delegates that are supposed to 
represent them, either in the State society or in the American Medical 
Association. 
On the second day of the session the Committee on Legislation made 
its report, and during its discussion the question of ethics was incidentally 
revived. The committee having asked for an appropriation of five hundred 
dollars, for the purpose of procuring legal assistance, with the view to de- 
sirable legislation, Dr. Hopkins, of Buffalo, spoke in favor of the motion to 
adopt the report, to which Dr. Van de Warker, of Onondaga County, replied 
as follows: 
I did have great hopes for the cause of medical education in this State, not- 
withstanding the fact that nearly every attempt this State ha3 made to regulate 
the practice of medicine has been a terrible failure—so terrible that, if medical 
men attempt to make laws, it is to be hoped that they will be such laws as will 
be of benefit to the profession. The law of 1880, which legalized every quack, 
was a deplorable failure, and the law of 1874, which gave the medical societies 
of this State certain powers, was another terrible failure, and, every time this 
society has attempted to dabble in medical law at all, the profession at large has 
deplored the fact. 
Dr. Sturgis: I would ask the gentleman from Onondaga if any effort has 
been made in his county to prosecute illegal practitioners? 
Dr. Van de Warker: An Indian doctor rode through our principal streets 
the other day, adorned with war paint and feathers, and he registered in the 48 
THE ST A TUS OF THE MEDICAL PROFESSION 
Clerk’s office, and is now considered a legalized practitioner, and be stands on 
the same footing with the other members of the profession. 
Dr. Sturgis: lias any attempt been made to prosecute illegal practitioners in 
your county ? 
Dr. Van de Warker: Prosecution was not attempted in my county. . . . The 
legislation of 1880 was not to protect the regular practitioner, but to protect 
quacks, just as the code indorsed last night was not for the regular profession, 
but for quacks. 
Dr. Sturgis: I do not think tbe gentleman can speak fairly of a point which 
has not been tried in his own county, and in which he has not had any experi- 
ence. At all events, what he states is at variance with what has been the ex- 
perience of the Medical Society of the County of New York, and the same is good 
for every county medical society in the State. When that law passed, the physi- 
cians of New York made up their minds to make a fair trial of it, and to deter- 
mine wherein it was deficient, and to try to remedy its defects. We went to our 
county medical society and told them that the question was simply one of money, 
and that we needed money to employ legal counsel. We said to them, If you 
will give us your support, we will carry out the provisions of the law. The re- 
sult has been that sixty suits have been brought, and in only three has the socie- 
ty failed to establish its case, and in every offense the man has been fined and 
driven out of practice. We got hold not only of irregular practitioners, but we 
have our hands on the throat of one of the colleges of this city. When the gen- 
tleman says that the law of 1880 protects quacks and protects irregular practi- 
tioners, he makes a mistake. 
Dr. Smith (Secretary of the Society): There is an opinion, widely prevalent 
in the medical profession of this State, that the mere fact of registration in the 
county clerk’s office makes a man a legally qualified practitioner. It does no 
such thing. The law requires the legally qualified practitioner in his registration 
to state the authority under which he claims to be qualified, and a person who 
has no legal right to practice medicine, if he registers under the law of 1880, 
will often furnish evidence in the statement he makes in his registration that he 
is not legally qualified; so that that law, instead of protecting quacks, often 
causes them to furnish proof whereby they can be convicted of practicing ille- 
gally. 
The introduction of the questions relating to the law of 1880 into the 
code controversy, by the supporters of the old code, was irrelevant and un- 
called for, as it had no bearing on the real issues under discussion. One 
may, perhaps, excuse words spoken hastily in the heat of debate, but we 
can not so readily overlook misstatements made in the calm seclusion of the 
sanctum. The following references to the law of 1880 are taken from the 
“Ephemeris” for May, 1883, pp. 279 and 280 : 
“ The law entitled An act to regulate the licensing of physicians and sur- 
geons, passed May 20, 1880, through the efforts of the New York County Medi- 
cal Society,” etc. (italics our own). 
The fact is that the New York County Society had nothing whatever 
to do with this law. It was passed through by the efforts of a committee 
of the State society appointed for the purpose, and the entire expense of its 
passage, amounting to a little less than fifty dollars, was borne by the State IN THE STATE OF NEW YORE. 
49 
society. The committee itself was composed of one member from Albany, 
one from Kings, and one from New York counties. 
“This authorizing and licensing registry law, which, seen now in the light of 
more recent action, appears as the first public step taken in this no-code move- 
ment, levels all inequalities, and .ranks the best names in the profession with 
those qualified for no profession and undeserving of recognition, whoso lack of 
qualifications must be all the more dangerous to the public welfare for being 
legally authorized and licensed. This class, though legally authorized in a 
roundabout way, through diplomas and certificates of bodies incorporated under 
a general act, would never have been legally recognized and licensed but for this 
registry law, and the harm done by thus recognizing a large number will far 
overbalance the good of preventing the registry of a few, or the prosecution of a 
few who may be so incautious as to register fraudulently.” 
With reference to the foregoing, we are compelled to say that we do 
not remember to have ever read two consecutive sentences in which were 
to be found so many errors as to fact, and. language so well calculated to 
lead to false inferences. If the writer in the “ Ephemeris ” had taken a 
little care to ascertain the facts, he could hardly have had the hardihood to 
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, cr 
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 sentiment we agree heartily, bnt 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 
who 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 laws 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. IN THE STATE OF NEW YORK. 
51 
SEVENTH ARTICLE. 
From the New York Medical Journal for November 1883. 
A few days before the meeting of the State society in February, 1883, 
a prominent homoeopathic 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 wrould 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 wrere 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 ST A TUS OF THE MEDICAL PROFESSION 
dogma,” etc. Concerning 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 they 
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 writer 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 
code was directed as much, if not more, against the various nondescript 
practitioners of the time as against the homoeopaths, the wording of the 
code itself would almost to a certainty indicate that it was specially in- 
tended to prevent consultations with the latter, as none of the other prac- 
titioners had even the pretense of an exclusive dogma. Dr. Flint, howT- 
ever, is, we think, in error when he states that these practitioners had not 
at that time acquired much hold on popular favor. As early as 1844 
they had acquired sufficient hold to enable them to secure the repeal of 
the most important section of the Medical Acts of 1827, which, as we have 
already shown, opened wide the gates of the State to all forms of quackery. 
Dr. Flint says: “ Since the adoption of the code, this system ” (homoe- 
opathy) “ has obtained a legal recognition.” This legal recognition we 
believe to have been the direct consequence of the code, and that it 
would never have been obtained except for the occurrences that grew out 
of the operations of the code. This is, of course, purely a matter of 
opinion, but in the present instance is based on a careful and extensive 
reading of the controversial literature of those days. 
Continuing his commentary, Dr. Flint says: “ It is fair to conclude 
that the framers of the code had no feeling of illiberality, and no intention 
to interfere with the practice of medicine, under any circumstances, in the 54 
THE ST A TVS OF THE MEDICAL PROFESSION 
cause of humanity. The code declares explicitly that in consultations the 
good of the patient is the sole object in view, and enjoins against declin- 
ing consultations on the score of fastidiousness. The restrictions of the 
code are in no wise inconsistent with the demands of humanity in cases of 
emergency. In saying that certain practitioners are not to be considered 
as regular or fit associates in consultation, it is neither said nor implied 
that a physician should not -see a patient, even with these practitioners, 
when humanity requires him to do so. The tenor and spirit of the code 
throughout are opposed to any act of professional inhumanity. Moreover, 
in particular cases the physician must be the judge of his duty in this 
regard.” 
The view of the code here taken is certainly a novel one, and one 
that, so far as we are aware, has never before been publicly advanced. 
Certainly the American Medical Association has never given its official 
sanction to this explanation of its consultation clause, nor has any other 
society, when called on to enforce the code, accepted such from delin- 
quents as a sufficient excuse for their misdoing. It must therefore be 
considered as a purely personal view, and as such does honor to its pro- 
mulgator. Divested of unnecessary verbiage, it simply means that the 
American code permits consultations with homoeopaths in emergencies, and 
when demanded by the dictates of humanity, and makes the individual 
practitioner the judge of the necessities and proprieties of the case. 
Let us compare this with the consultation clause of the State code, the 
first sentence of which reads as follows : “ Members of the Medical So- 
ciety of the State of New York, and of societies in affiliation therewith, 
may meet in consultation legally qualified practitioners.” The second 
sentence is in antithesis to, and an explanation of the first, and reads as 
follows: “ Emergencies may occur in which all restrictions should, in the 
judgment of the practitioner, yield to the dictates of humanity.” It will 
be noted that this code neither obliges, recommends, or encourages con- 
sultations with homoeopaths; it simply permits them under circumstances 
which are specified, and leaves the conscience of the individual physician 
interested to act as the judge of the necessities of the case. In what re- 
spect, we may ask, does this code differ from the American code as inter- 
preted by Dr. Flint? We believe the veriest hair-splitter would find great 
difficulty in establishing even the minutest difference between the spirit 
and intent of the one code and the spirit and intent of the other. And 
yet this difference, whatever it may be, is the nominal cause of the hostile 
attitude of two important portions of the profession. What reason is 
there, then, for any further prolongation of the contest ? None whatever, 
so far as the merits of the case are concerned, unless perchance Dr. Flint’s 
interpretation of the code should prove not to be the correct one. There 
can be no question as to the truth of the assertion that until within a very 
recent period the American code has almost universally been interpreted 
as absolutely forbidding mixed consultations, under every and all circum- IN THE STATE OF NEW YORK. 
55 
stances, the individual practitioner not being permitted to use the slightest 
discretion in the matter, except at the risk of professional animadversion. 
Humanity or emergencies found no place in the bosom of the heresy- 
hunter, whose special delight, apparently, was to detect some unfortunate 
practitioner whose heart had gained the better of his prudence. The 
issue here is plain. Either the old and orthodox interpretation of the 
code must be accepted, or else the one offered by Dr. Flint. In the latter 
event it certainly seems to us preferable to accept the phraseology of the 
State code, the meaning of which is clear and distinct, than to cling to the 
American, the language of which apparently permits of the most opposite 
interpretation. Dr. Flint, however, believes that consultations with homoe- 
opaths should be forbidden for reasons which we find for the first time 
stated. He says: “ The true ground for refusing fellowship in consulta- 
tions, as in other respects, is a ‘ name and an organization distinct from 
and opposed to the medical profession.’ ” . . . “ It is to be hoped that the 
body from which the code emanated—namely, the American Medical 
Association—will adopt such modifications in the phraseology of this sec- 
tion as will place restrictions on consultations, not on the ground of 
doctrines or forms of belief, but on separation from and avowed antago- 
nism to the medical profession.” . . . “ If homoeopathic practitioners 
abandon the organization and the name, provided they have received a 
regular medical education, there need be no restrictions on consultations 
other than those belonging to other portions of the code, whatever thera- 
peutical doctrines they may hold.” 
It would appear from the foregoing that Dr. Flint’s main objection 
to the homoeopaths, from the consultation aspect, is the fact that they 
have formed medical associations outside those of the regular medical 
profession, and not in affiliation with them, and that, as a consequence of 
this, they should be denied professional recognition, and their patients 
should be denied the advantages of regular advice when such is needed. 
It does not appear even that emergencies or the calls of humanity would 
permit an evasion of the rule. In other words, the homoeopathic practi- 
tioners are to be denied recognition, and their patients punished simply 
because they have established separate organizations. We believe the 
existence of separate sectarian organizations to be a great evil—one of the 
greatest that at present afflict the body medical—but we are not disposed to 
hold up the homoeopaths to utter condemnation on account of their exist- 
ence, when the medical profession itself is mainly the cause of their exist- 
ence. We have already shown that the homoeopaths did not leave the 
regular societies voluntarily and for the purpose of organizing separate 
societies, but, in fact, were forced out of the established bodies. A recent 
writer,* commenting on this very point, says: 
“ But there is, according to Dr. Flint, still a disqualifying cause which 
should exclude homoeopaths from consultations, and this is the assumption 
* Dr. Thomas Hun, in “An Ethieal Symposium,” New York, 1883, pp. 60, 61. 56 
THE STATUS OF THE MEDICAL PROFESSION 
of a name and organization distinct from and opposed to the regular 
profession. There is undoubtedly force in this objection, but, if we look 
at the history of the rise and growth of homoeopathy in this country, 
the objection will be weakened, if not invalidated. Surely the doctor is 
old enough to remember the persistent efforts made in the beginning 
by the homoeopathists, when as yet they had no organization, to be ad- 
mitted into our county medical societies, or in the case of members of the 
societies who adopted homoeopathy to resist expulsion. The numerous 
suits unsuccessfully brought before the courts to compel the societies to 
admit or retain them sufficiently attest that, if they now have a distinct 
organization, the fault is not on their side. We thrust them out of doors, 
and now it comes with a bad grace from us to give as a reason for refusing 
fellowship with them that they are not in our house.” 
We have no hesitation, therefore, in asserting that Dr. Flint’s proposi- 
tion savors neither of justice nor propriety, and that some better excuse 
must be devised for excluding homoeopaths from consultation when the 
demands and needs of the sick render such consultations desirable. 
While Dr. Flint’s commentary on the code was being published in the 
columns of this journal the supporters of the American code sought to 
effect an organization of the physicians of this State in opposition to the 
State society, and with the avowed purpose of resisting any modifications 
of the code that did not originate with the American Medical Association. 
A vigorous canvass of the State was made in behalf of this organization, 
and numerous signatures were obtained to a paper pledging its signers to 
stand by the American code. This action necessitated the formation of 
another association, one opposed to the re-enactment of the old code. 
This latter body forwarded to each member of the regular profession of the 
State a postal-card bearing on its back the following words: “ I, the un- 
dersigned, am opposed to the present code of ethics of the American 
Medical Association, and approve of the use of all honorable means to pre- 
vent its re-enactment in the State of New York.” The majority of those 
who signed this declaration and mailed the card back to New York simply 
attached their signatures and addresses. Many, however, added a few 
words of comment. All of the cards that were returned to the city came 
under the eye of the writer, and from them we have copied the following 
words of comment: 
“ and all other codes, as thirty years adherence to it has proved its useless- 
ness.”—S. F. McF. 
“ and so is the County Medical Society as a body.”—R. L. 
‘“I am strongly in favor of the abolition of all codes, considering any code 
unnecessary for the guidance of a gentleman, and useless for the restraint of 
others.”—T. C. W. 
“I think that the old code was a good one when adopted, but there are 
reasons why it should now be rejected.”—S. P. S. 
“ I have practiced my profession since 1845, and do not hesitate to say that IN THE STATE OF NEW YORK. 
57 
I do not recall the time or instance when the old code governed the conduct of 
men of good sense or repute.”—E. Y. K. 
“ I would much rather prefer no code at all. But, being obliged to choose 
under existing circumstances, I say, emphatically, give me the new code.”—M. 
G. P. 
“I heartily indorse this card. Had the same position been taken twenty 
years ago it would have been better for the people and the profession.”—J. R. 
“The more liberty we have, the greater amount of good we can do.”—L. B. 
“I regard the new code as a most unfortunate and unwise substitute for the 
old code. Abolish the whole thing.”—J. M. N. K. 
“I have protested against it for eighteen years, and will do all in my power 
to aid in its overthrow.”—0. II. A. 
“I believe in each physician practicing medicine according to the dictates of 
his own conscience.”—F. W. 0. 
“Hope wo will succeed. New York can afford to be not represented at the 
American Medical Association. If we make a bold stand I think we will win 
—we have the right side, any way. I am for no code."—R. F. 
“After obeying and carefully observing the rules of the old code for many 
long years, I have become strongly opposed to it, and am in full accord with the 
new code; and am willing to do what little I can to maintain it in the State of 
New York. 
“I see its opposers are working hard, almost moving heaven and earth to 
bring about its repeal; but I do not think they can succeed. ... It (the 
American code) is not in accord with the spirit of the age; it is against the 
common-sense law of the land, and the best sentiment of all classes of society.” 
— W. B. A. 
“ I think a code of ethics for the medical profession as unnecessary as a book 
of etiquette for a true gentleman.”—H. F. B. 
“ An unwritten code is as binding to an honorable, honest man, and a writ- 
ten code, however stringent or liberal, will have no influence over the conduct 
of any others.”—II. A. B. 
“ I prefer not to be tightened up by any code; shall in the future do as I 
have done in the past—uphold the dignity and honor of my profession, in my 
own way, to the best of my judgment.”—J. R. B. 
“and I am opposed to the pretentious and hypocritical old code of the New 
York State Medical Society.”—L. C. / 
“ The new code does not cause irregulars to rejoice, nor does it encourage 
a single wrong; the new code is legal; it is the voice of the age. It is prog- 
ress.”— S. J. P. 
“ Most heartily.”—F. W. A. 
“ In the name of humanity, decency, and liberal progress, Amen! ”—H. L. 
“ I did not approve of the change, but, since it has been done, would not 
torn back.”—C. S. P. 
“I would prefer no code, but, if we must have one, let it be liberal.”—0. 
C. F. 
“ believing no code as effective as any code.”—J. II. F. 
“because it can’t be lived up to in actual practice. We must meet irregu- 
lars, and, if gentlemen, we must treat them as such.”—P. Iv. S. 
“ I am in favor of free consultations.”—J. T. L. 
“Patients first, ethics next, and liberal opinions all the time.”—C. M. McL. 58 
THE STATUS OF THE MEDICAL PROFESSION 
“I am in favor of the present code of ethics of the American Medical Asso- 
ciation, and approve of all honorable means to effect its re-enactment in the 
State of New York, hoping that we may soon have it amended in a way that 
will leave all at liberty to council with all whom they please, and not admit (as 
the present code does) that the Legislature is competent to say with whom it is 
proper and right to meet in consultation. A code of medical ethics should 
ignore all sects in medicine.”—L. B. 
The foregoing comments certainly indicate a wide diversity of feeling 
on the questions involved in the present discussion, and the different stand- 
points from which they are viewed. 
The next important event in connection with the code controversy 
occurred at a meeting of the New York Academy of Medicine in April last. 
This body, by virtue of its charter, is entitled to representation in the 
State society. Its by-laws, however (unlike those of the county societies), 
are not subject to the revision of the State society. The Academy has 
generally been regarded as the peculiar stronghold of the conservatives, it 
being claimed that they possessed a large majority in that body. Some 
question having arisen as to the right of the Academy to representation 
in the American Medical Association after the exclusion of the New York 
State society, it seemed important to the old-code party to place the 
Academy distinctly on record as a supporter of the American code. At a 
meeting of the Academy, held on the 19th of April, Dr. Austin Flint, Jr., 
introduced a series of resolutions disavowing sympathy with the action of 
the State society, and pledging the Academy to renewed allegiance to the 
code of the American Medical Association. The Committee on Admis- 
sions of the Academy was also directed to report for membership only 
such persons as would pledge themselves to support the old code. The 
resolutions were adopted by a large majority, obtained by the very simple 
expedient of assembling the old-code members by means of a secret 
circular, and without notice of the proposed action to the other side. The 
detailed proceedings of this meeting of the Academy have obtained a very 
wide publicity, and need not here be rehearsed. It was at this meeting 
that Dr. Flint, Jr., first appeared as the virtual leader of the old-code 
element, and indicated that the policy to be pursued would be characterized 
by the fortiter in re, rather than the suaviter in modo. In other words, 
opposition was to be overcome by brute force, rather than by an appeal to 
argument and reason. This, indeed, was so thoroughly characteristic of 
the methods that for years have prevailed in the American Medical Asso- 
ciation itself that we need not be surprised at anything that is done in 
its name. The effect of this action in the Academy was not all that was 
hoped by its supporters. Instead of strengthening the old-code party in 
this city, it distinctly weakened it. Many gentlemen whose bias was in 
favor of the old code, and who were willing to vote for its restoration, 
recoiled at the means that the leaders of their party seemed disposed to IN THE STATE OF NEW YORK. 
59 
adopt, and declined to follow them farther. This was most conclusively 
shown a few months later. 
The American Medical Association met early in June, and when the 
members assembled they found themselves confronted with an order from 
the Judicial Council, notifying them that they would not be permitted t» 
register and take part in the proceedings of the meeting unless they 
signed a pledge of fidelity to the code of ethics. This pledge termi- 
nated with the words: “ I will use my best efforts to maintain the same, 
and in testimony whereof, I hereunto affix my name.” A careful exami- 
nation of the constitution and by-laws of the association fails to discover 
any authority for this action of the Judicial Council. It was a pure assump- 
tion on their part, for which they possessed no warrant whatever. This 
action of the council does not surprise us; in fact, nothing that this body 
should do, or attempt to do, would surprise us. We were, however, im- 
measurably surprised that any of the members of the association were 
willing to be thus deprived of their liberty of action, or to deprive their 
fellow-members of theirs. We believe that the majority of the signers 
could hardly have been aware of the full intent of the pledge they were 
singing, as it virtually binds them to use their best efforts to maintain 
forever, without change, the present code of the American Medical Asso- 
ciation. 
We see in this act of the Judicial Council and of the association a 
striking example of the dangers that beset every uncliartered and irre- 
sponsible body; a clique, once getting into power, hold the members at 
their mercy, and are enabled to trample on their rights at any moment, 
without fear of being held accountable, either as individuals or as an asso- 
ciation. Not so in a chartered society, even with by-laws identical with 
those of the American Medical Association. Such a society would have 
been compelled to admit its regular members, irrespective of signing or 
not signing such a pledge. Doubtless the old-code members of the New 
York Academy of Medicine would be very glad to exclude from the meet- 
ings such of its members as do not approve its present code and by-laws * 
but they know such an attempt would prove futile. In a chartered society, 
every member knows, or can readily learn, his rights, and neither a ring, 
clique, nor even a majority in the society, can deprive him of them against 
his will. In an unincorporated society, however, anything may be done 
that at any time a majority approves, and there is no redress for those 
who may be injured thereby. For instance, in the American Medical 
Association a majority could, by mere vote, pass a resolution expelling all 
members who are opposed to them, and the expelled members would not 
be able to defend, or regain, their rights through an appeal to the courts. 
In fact, something very like this was done a few years ago. The writer 
attended a meeting of the association in 1865, and paid his fee of five 
dollars, which at that time entitled him to life-membership, without further 
payment of dues. A few years later he, in common with other members 60 
THE STATUS OF THE MEDICAL PROFESSION 
■who had joined the association on similar terms, was informed that his 
life-membership would be forfeited unless he maintained it by a further 
annual payment of live dollars. This was a most unmistakable breach of 
contract, and violated the commonest principles of honesty and morality. 
The instance is cited simply as an example of the many arbitrary acts of 
the association, and to show how any act may be done by any voluntary, 
unincorporated society. Despite these facts, there are those who desire to 
see the incorporated societies of this State subjected to the control of such 
a body. We can hardly believe that the gentlemen holding these views 
have given any very careful consideration to the subject. In common with 
the majority of the profession, we approve of the existence of a national 
medical association, but it should be one devoted to scientific pursuits only, 
and should not attempt to interfere with medical politics in any manner. 
If the American Medical Association would reorganize on such a basis, 
New York State, we believe, would be unanimous in its support. If it con- 
tinues as it is, its existence is but a question of a very few years. 
The refusal of the American Medical Association to permit those who 
did not approve its code to participate in the proceedings of the Cleveland 
meeting, thereby preventing any discussion of the subject, has proved to 
be one of the most valuable allies to the cause of the New York State 
code. It was generally supposed that the advocates of the American code 
in this State would endeavor to secure desirable modifications at the 
Cleveland meeting, and many signatures were obtained to the old-code 
papers in consequence of this impression. The warrant for this belief was 
the fact that Dr. Flint in his commentaries had expressed his dissatisfac- 
tion with the code, as already shown in the present paper, together with 
the peculiar wording of the papers sent for signatures. In fact, many 
signatures were obtained on the express representation that a change of the 
code would be attempted by the members from New York. No such at- 
tempt was made, and some of the old-code signers, now fully appreciating 
the fact that no change may be expected by the association, and not ap- 
proving the code as it stands, have withdrawn their support and influence, 
and have given them to the State code. We believe that a majority of the 
old-code supporters gave their signatures not from a fondness for the old 
code, but from a belief that all changes in it should originate with the 
association. Many have the idea that the association possesses some sort 
of jurisdiction over the profession of the State, and that resistance to its 
by-laws is a species of rebellion against constituted authorities. This idea 
is an absolutely false and mistaken one. The association has no more 
jurisdiction over the different State societies than the American Gynae- 
cological or the American Dermatological Society has. Moreover, there is 
no process by which it could obtain such jurisdiction. No single State in 
the Union could give it a charter that would enable its power to be exerted 
beyond the limits of the State granting the charter ; while the best that the 
United States could do would be to grant a charter the jurisdiction of IN THE STATE OF NEW YORK. 
61 
which would be coextensive with the District of Columbia. Congress has, 
for instance, the power to establish a medical college within the limits of 
the District, and to make the diplomas of the college licenses to practice 
within that area, but it does not possess the power to make them valid in 
any State in the Union. Such power exists solely in the respective States. 
The profession of this State, and of other States as well, should remem- 
ber that they are not doctors by divine right, or the grace of God, but 
simply through the will of the various State Legislatures. It is this 
which gives them a legal right to call themselves “ doctors,” and permits 
them to practice their profession. The Constitution of the United States 
guarantees a certain amount of freedom in the exercise of religious privi- 
leges, but it makes no such guarantees as regards the exercise of the legal, 
medical, or any other profession or trade. These rights the States reserved 
at the time of the formation of the Union, and since then have never 
yielded their prerogative to the national authorities. The action of the 
New York State society has been likened to the action of the Southern 
States at the commencement of the late “ unpleasantness.” It should be 
remembered that at the time of the formation of the Union the various 
States entered into a compact with each other, and that their secession was 
a breach of that compact. The Medical Society of the State of New York, 
however, never formed any compact, or entered into any contract with the 
American Medical Association or with any of the other States, nor, so far 
as we are aware, did any other State. There is therefore no analogy 
between the relations of the various States to the Union and the purely 
voluntary relation of the different State societies to the American Medical 
Association. The latter can, at any time it chooses, and for any cause, 
refuse to admit the delegates from any of the States. In like manner any 
of the State societies can sever its existing connection with the American 
Medical Association whenever it deems it to be to the interest of the pro- 
fession of the State to do so. 
In 1882 the New York society considered that it was better to relin- 
quish its connection with the American Medical Association than to con- 
tinue the connection, subject to the objectionable by-laws of the latter 
body. The association, on the other hand, thought it would be better to 
dispense with the representatives from New York than to alter its by-laws. 
This it had a perfect right to do, and no one, so far as we are aware, has 
found any fault with it for so doing. The only power possessed by the 
association is of a moral nature ; legal power it has none. We should 
therefore judge its actions by the moral standard alone. The repudiation 
of its financial contract with its early permanent members, and the recent 
refusal to admit certain of its members, who under its by-laws were entitled 
to admission, should be sufficient to place the seal of condemnation upon 
the association, judged by the standard we have alluded to. 
During the summer months there was an apparent cessation of active 
operations by both parties. Early in October, however, Dr. Fordyce Bar- 62 
THE STATUS OF THE MEDICAL PROFESSION 
ker, the president of the New York Academy of Medicine, sent to each of 
the members a recommendation that the by-laws of the Academy be altered 
in certain respects. The Academy came into existence by virtue of a char- 
ter from the State granted in the year 1847. This charter conveyed cer- 
tain rights and privileges, none of them, however, of a medico-political na- 
ture. The Academy, shortly after its organization, assumed such powers, 
and, through its moral influence, exercised them for many years. The 
alterations of the by-laws proposed by Dr. Barker involved a repudiation 
of its former political aspirations, and the resumption of a purely scientific 
status, as contemplated in its original charter. To accomplish this end it 
would be necessary for the Academy to repeal its allegiance to the Ameri- 
can code. This would require a three-fourths vote of its members. When 
the matter came to a decision, it was found that a three-fourths vote was 
not in favor of the repeal of the code, but, to the surprise of many, there 
was a very decided majority in favor of such action. The Academy there- 
fore stands to-day as adverse to the old code, but without power to repeal 
it, while the minority who are in favor of the old code have no power to 
enforce it against the wishes of a stronger adverse sentiment. This is cer- 
tainly an anomalous state of affairs, which can not continue for any great 
length of time. 
For some months it had been claimed by the supporters of the old code 
that the general sentiment of the profession in this city was in favor of 
the re-enactment of the American code. It was asserted that a majority 
of the County society were in favor of such action. The test was made at 
the annual election of officers in October. On this occasion both parties 
brought to the polls their full voting strength. On counting the votes, 
it was found that there were 220 in favor of restoring the old code, and 
375 opposed to so doing. It seems quite certain that the old-code associa- 
tion had secured, early in the spring, a sufficient number of supporters to 
give them hopes of success. When the matter came to a vote, however, 
both in the Academy and in the County society, the result showed that 
there had been many breaks from the old-code ranks. Many gentlemen, 
who in the spring had hastily signed the old-code papers, on careful 
examination of the subject reconsidered their action. Many others re- 
garded the occurrences that took place at the April meeting of the Acade- 
my of Medicine a sufficient ground for withdrawing their sympathies 
from the leaders of the majority on that occasion. A still greater num- 
ber, however, we are satisfied, abandoned the fortunes of the old-code 
party in consequence of the failure of the leaders of that party to even 
attempt to secure changes in the American code that so many of their 
followers considered desirable. 
We may, I think, consider the code question as definitely settled, in 
this city at least, so far as regards the restoration of the code of ethics 
of the American Medical Association. The County society, the only 
body that can legitimately consider the question, at the last election, as IN THE STATE OF NEW YOliK. 
63 
on every previous occasion on which the matter has been brought for- 
ward, distinctly expressed its sentiments in opposition to the old code. 
It is true that the question can hardly be said to have reached a final 
solution in the Academy of Medicine. This body, with a limited member- 
ship, possesses but a limited influence on the mass of the profession, 
and it is of very little practical consequence which way it is there 
decided. The liberals, it is true, are in the majority, and will, without 
the slightest doubt, remain so, and may expect accessions both from the 
ranks of the present conservatives and from among those who in the 
future become members. As we have already shown, the code has been 
for many years practically in abeyance in the Academy, so far as its 
enforcement was concerned, and there is but little likelihood that its 
vitality will ever again be tested in that body. Such being the case, we 
are perfectly willing that those who profess to admire the code should 
continue to wear it as an ornament and a phylactery. 
Before closing this series of papers, one or two questions of impor- 
tance require notice. As we have already shown, certain of the county 
societies of this State repudiated the action of the State society in the 
matter of the code, and declared that they would stand by the old code 
and retain it among their by-laws. 
It has been thought by some that such action on the part of the county 
societies would forfeit their title to representation in the State society. 
Such, however, is not the case. There is no provision in any of the statutes 
by which the State society is empowered to deny the county societies the 
right of representation, no matter how rebellious they may be as regards 
the edicts of the former body. The only way in which the State society 
can defend itself in the matter is by a direct application to the Legislature 
to have the charters of the offending societies revoked, as provided for in 
Sec. 2 of Article V of the by-laws of the State society. There is little doubt 
that, in the present state of public opinion, if such application were made 
to the Legislature, the request of the State society would be promptly 
granted. The county societies, however, should be aware that any code 
or by-laws they adopt contrary to the wishes of the State society are ab- 
solutely illegal and null and void. The importance of this matter suggested 
to the writer the advisability of obtaining the opinion of legal counsel con- 
cerning it, and to this end we submitted the following question: What will 
be the effect if a county medical society adopts a by-law which is not in 
accordance with the ordinances of the Medical Society of the State of New 
York, or which does not receive the approval of said State society ? The 
answer to this question was as follows : 
“ By the provisions of Sec. 14 of the Act of 1813 (Chap. 94), it is made 
‘lawful for the respective’ (county) ‘societies to make such by-laws .... 
as they shall think fit and proper, provided .... that the by-laws .... 
shall not be repugnant to the by-laws, rules, and regulations of the Medical 
Society of the State of New York.’ 64 
THE STATUS OF THE MEDICAL PROFESSION. 
“And, by the provisions of Sec. 1 of Chap. 445 of the laws of 1866, it 
is declared to be ‘lawful for any county medical society in this State .... 
to establish such rules and regulations for the government of its members 
as they may deem tit, provided the action of such societies receive the 
sanction of the said State medical society.’ 
“ I am, therefore, of opinion that any such action on the part of a county 
society would be null and void and of no effect; in other words, as the 
law stands, the county societies can not adopt a by-law such as is sug- 
gested by the question, and any attempt to do so would be idle and of no 
avail.” ' 
We here leave the question of the codes and the status of the profession, 
with the statement that we have endeavored to be accurate as to facts, 
logical as to inferences, and moderate but candid in the expression of 
opinion. We can not but hope that the whole matter will receive a speedy 
solution, and one that will commend itself to the great majority of the pro- 
fession in this State. The lew York Medical Journal, 
A WEEKLY REVIEW OF MEDICINE. 
Published by 
D. Appleton &. Co. 
Edited by 
Frank P. Foster, 
M. D. 
Tiie New York Medical Journal, now in the nineteenth year of its 
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condensed form in which the matter is arranged, it contains more reading- 
matter than any other journal of its class in the United States. It is also 
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than is the case with other weekly journals. 
It has a large circulation in all parts of the country, and, since the pub- 
lishers invariably follow the policy of declining to furnish the Journal to 
subscribers who fail to remit in due time, its circulation is bona fide. It is 
largely on this account that it is enabled to obtain a high class of contrib- 
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better part of the profession ; a consideration which has not escaped the 
notice of advertisers, as shown by its increasing advertising patronage. 
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