Charlatanism IN COLORADO. BY JESSE HAWES, M.D., GREELEY, COLO. {Reprint from the " Transactions" of the State MedicbL Society far. 188yf) CHARLATANISM IN COLORADO. Jesse Hawes, M.D., Greeley. Mr. President and Gentlemen:- While the chronicles of charlatanism are an amusing study for the curious, they seriously merit the meditations of the thoughtful. Toward charlatanism the attitude of public sent- iment is an enigma. In a dark alley of the city, a human life is sacrificed by the hand of another; from the victim's pockets a few dollars are taken. Public sentiment is hor- rified and calls for vengeance upon the author of the mur- der. In the dark chamber of sickness a human life is sacri- ficed ; from his estate he by whose hands he fell receives a few dollars. Public sentiment manifests sorrow and moans at what it calls " a mysterious dispensation of Divine Provi- dence." In anger, fatal leaden bullets are dealt into the bowels of a man in health. The author of the crime is sought as a candidate for the gallows. Compound cathartic pills are poured with fatal results in- to the bowels of a man writhing with peritonitis. The au- thor of the crime, for such an act is a crime, is sought as a candidate, mayhap, for city physician. Under my observation, have fallen some of the following cases: Stealthily was arsenic administered to an elderly person by a young relative, till death was the result. Open- ly, with bluster and brow-beating, was podophyllin adminis- tered in grain doses, many times daily, to one stricken with enteric fever, until death was as certain as in the former case. Public sentiment said that to restrain the first person would be legal, but to restrain the second would be an abridgement of civil liberty. Sixty miles from Denver, down the Platte, Charley Egan gave his " chum " a quickly fatal dose of strychnia,and, in fear of the punishment that was certain to follow, he committed suicide. About the same distance from Denver, an oily, plausable, soft-handed man, who, in his whole life, had never given a month's study to the action of drugs, gave a 2 babe of ten days, morphia sulphate, one twentieth grain, and it became as dead as an Egyptian mummy. Did that man commit suicide? Not yet. He received for his prescription two dollars, and, in parting from his patron, he was saluted with a kindly, " Good morning doctor." In a drunken row, perhaps in self-defense, in a town on Clear creckTa man drove a fatal bowie-knife into the bowels of an assistant. Public sentiment had no hesitation in pro- nouncing the act as unlawful'. To a town on Clear creek there came a rotund, red-faced, red-haired man, whose life had been passed in the shambles. From boyhood he had been known in an Illinois town as an unlettered butcher. He bought a little book of medical receipts, a silk hat, a fashionable suit, and joined the Pikes Peak army. In this town on Clear creek he plunged a bis- toury into an inguinal hernia with deadly effect, and the act was not deemed unlawful, for there was no law nor public sentiment prohibiting such a man from using a bistoury under the guise of being a physician. Say you these comparisons are unjust? Only to those who have given the subject no thought does it appear so. Of the two classes of fatal cases named, neither died of disease, neither by accident; both met a death that might and should have been avoided ; but of the evils named, public senti- ment only calls for the repression of the one and has called repression of the other, Since the organization of Colorado as a territory, up to the year T 881 ,many and repeated attempts have been made for the repression of charlatanism. From a careful inquiry, I esti- mate that not less than a dozen bills have been presented to the various legislatures, and by legislators claiming, and doubtless with truth, to represent public sentiment, have they been defeated. At the legislative session preceding the last, a statute was enacted with which we are all fa- miliar. A consideration of charlatanism, and of the means by which to hold it in check, implies a consideration of medi- cal laws and reasons for and against such laws. As one of the Medical Examining Board, appointed under the provis- ions of our Colorado statute, your reporter has had a rare opportunity to observe the great necessity of such a law, as well as to note its results, and with a zeabborn of con- victions, I gladly enter into a discussion of the subject as- signed me by our presiding officer. For me to place before this body of thoughtful, educated, honorable medical men, reasons why charlatanism should 3 be checked, why fraud should be frustrated, why deception should be denounced,would be a work of supererogation; but, trusting that my words may fall under the observation of men who do not see in quackery its deception, fraud, and sometimes even the wanton sacrifice of human life, I may be pardoned for considering, quite at length, the subject of charlatanism, and the need of repressive legislation, before speaking of charlatanism in Colorado. It is well known that laws regulating the practice of med- icine, have, for a long period, been recognized by the most enlightened states of Europe as absolutely necessary to the protection of their people. The same protection by similar laws have been extended to the citizens of many of the states of our Union. That there are some honest and intelligent men who deny the right of a state legislature to enact such laws, and oth- ers who, not denying the right, honestly doubt the wisdom of their enactment, is apparent from the past history of medi- cal legislation, not only in Colorado, but in other states of the Union and in other countries. That in this the State arrogates to herself no unwarranted power is the opinion of our best educated and most worthy citizens, is the opinion of the most learned portion of the medical profession, is the opinion of candid and thought- ful statesmen, as enunciated in the saying of Lord Beacons- field, " The health of the people is the first duty of the statesman." The limits of the province of government ex- clude no good work, and the state would be doing less than its duty should it permit its citizens to be the dupes of im- posters, when, by reasonable laws, it were possible to afford them protection. The accidents and diseases of man in all ages have called for aid, relief and comfort, and those to whom it has been the peculiar province to pi offer these, have, in the main, been rewarded by the gratitude of the sufferer, and the sin- cere regard of friends. So universal has this been in all conditions of society, that about the peculiar office of the physician there has been cast, when remembering such kindnesses, a vestment of respect and kindly regard that is rarely bestowed upon any other profession or occupation. This especial regard is often coveted, for the benefits it may confer, by ignorant and assuming schemers for base and sel- fish purposes. It should be the object of a law that the latter class should be, by a qualified board sifted out and restrained 4 from pursuing a course that often might be dangerous and sometimes fatal to those whom they treated. Notj-profes- sional persons are rarely to able form as just an esti- mate of the scientific attainments and professional worth of physicians as they are to appreciate the merits and de- merits of other men. By carefully observing the works of citizen tradesmen, and even some of the professions, intel- ligent men are able to form a moderately just estimate of the person, and the extent to which he has acquired his trade or profession. Our good civil engineers give us the most practical ditches, railroads, canals, tunnelsand bridges. The structures of our best architects do not fall. It is pos- sible to judge of the astronomer by observing the accuracy of his estimates. It is even possible, in some of the more crude departments of surgery, to judge of the merits of the surgeon by the result he obtains; but, in the department of medicine proper, it is well known to all physicians, that only a physician ( and he only after considerable investigation ) can judge of the merits of another physician. Hence, since ignorant or unprincipled men in the practice of medicine could do so much injury without public detection, it is wise, and the part of good statesmanship, to create a body equal to the occasion, upon whom shall be conferred the impor- tant charge of detecting and casting out so far as possible such counterfeits. In procuring the passage of the Colorado law, physicians were the most active agents. That physicians more than others should be leaders in such a reform is obvious, since under their observation, more than that of any one else, comes a knowledge of the injuries and deaths, chargeable to malpractice. Another cause, and that a prominent incentive, is a de- sire on the part of respectable physicians to render the pro- fession of medicine more worthy of respect by pruning from that body its unworthy members. The sister profes- sion of law, as a profession, holds a higher position, solely from observing an inexorable rule that no one can be ad- mitted to the bar until he has shown a proper acquaintance with the law. So also the clergy of certain religious bodies rank higher in a scholarly sense, as a body, than physicians, because those churches demand that all their clergy must be educated as well in letters, in the arts and sciences, as in theology. In those portions of the old world where the practice of medicine is subjected to state control, and where a high or- 5 der of classic and scientific education is essential to the degree of M. D., the profession, as a body, is not relatively demeaned, but is the peer of any. In marked contrast are some men regarded by the public as a part of the profes- sion, in those states demanding by their statutes no profes- sional or other attainments. It is not drawing upon the imagination to state that claiming to be physicians are per- sons whose education would not have secured for them as teachers a second grade certificate; whose mathematical ig- norance would render them unsafe accountants; whose ig- norance of the language they had spoken from cradle to manhood would have driven them covered with ridicule from the position of a public speaker, whether at the bar or in the pulpit. These men have brought derision upon a profession to which, like parasites, the better portion of the medical profession desire to be rid. To recapitulate, the incentives of medical men in urging a law are several. They, more than any one else, are cogn- izant of the evils it could remedy. In the absence of re- strictions imposed by law or by custom, the standard of their profession suffers much, and a laudable professional pride demands their earnest action. Their more perfect knowledge of the evils of medical ignorance places them under a moral obligation to suppress it. Conscious that no legal enactment can be effective, no matter what laws you may enact, no matter what power you may confer upon public officers, unless an intelligent interest shall be created in the minds of the people, we deem it proper, first, to discuss the various objections to a law, and show their want of force; second, to present a few of the many certainties upon which to-day the practice of medicine is based ; third, to point out the evils wrought by uneducated practitioners, which, in a measure, would be remedied by a proper statute. In all countries where beneficial sanitary and medical laws have been enacted, there has been, to a greater or less extent in their beginning a repudiation of such laws, their originators and their custodians; and to this repudiation there has been added ridicule and taunts and sarcasm ; but when the most scrupulously prepared returns of vital sta- tistics have shown their benefits, such ridicule and opposi- tion have been silenced, and replaced by commendation and support. The opposition in Colorado has been less, per- haps, than in any state where such a law has been enacted. It has come from various sources. The most out-spoken, 6 however, has been manifested by the class of petitioners particularly legislated against, and by a few of their per- sonal friends. Such opposition, however, was to be expect- ed, and its absence would have been much more remark- able than its existence. As a rule medical counterfeits are accepted by a greater or less number of persons in every community, not as coun- terfeits, but as genuine. Such friends are not easily con- vinced of their error. While they would regard any law restraining incompetent practitioners as wise, when applied to the stranger, or to the mere acquaintance, applied to the case of their own professional attendants, they become oppressive, of the nature of a persecution, and will be treated as such. From a few persons in Colorado and elsewhere, slight opposition has come from a feeling that it was class legislation, and in opposition to the spirit of our national ideas. In a certain sense it is class legislation, only such, however, as has been found necessary to secure fit persons for responsible places, just as our school laws are examples of class legislation, when they demand that only certain persons can be employed as teachers. Who these law favored persons are is to be determined by the County Superintendent of schools after a rigid examination. Indeed quite a similarity exists between the two laws of our State, as is shown in the comparison below : School Law. Persons wishing to teach must un- dergo an examination for certificate. If not sufficiently educated certificate is denied. If sufficiently educated certificate granted. Without certifi- cate, may teach in certain places, pri- vate families, etc. Medical Law. Persons wishing to practice medi- cine are required to go before an Ex- amining Board for certificate. If not educated in medicine certificate is de- nied. If educated in medicine certi- ficate granted. Without certificate, may practice in emergencies. From this point a difference exists ; we have yet to hear of any person or class of persons who have highly valued and championed the cause of the ignoramus who offered himself as a teacher, crying that a great injustice and loss was entailed upon pupils by a cruel and unreasonable law, that demanded teachers to be educated. We have yet to listen to a wail of sorrow, demanding the appointment as professor of mathematics in the educational halls of our state, men, whose mathematical flights never extended beyond the counting of their fingers. But as a curiosity to be handed down in history, such a wail, such a demand has been made by a few, for the recognition of the savage and ignoramus in any medical law. 7 When, however, men are persuaded that human life and health are things of value, as is education, it is to be expect- ed that citizens will be as solicitous in regard to the attain- ments of their medical attendants, as to the attainments of their teachers. It has been stated with much clearness and force that there are many people who have lost all faith in those per- sons who are recognized by the public as physicians, even the most eminent, and have faith in some irregular practi- tioner, perhaps even the most ultra charlatan. Now to say to these people, you shall not consult whom you choose, and if you will not be treated by a licensed physician you shall not be treated at all, does not seem right. It has been urged that, " If a man believe he can be helped, when sick, by any one, whether licensed or not, he will think himself injured and deprived of his rights, if forbidden to consult that person, as he virtually would be by our law." The facts, however, in such a statement are only given for one side. The object of law is to protect society. Laws are framed to do this with as little interference with individual liberty as possible. If it narrows slightly individual choice, this is only a minor evil. Many laws do the same thing. Laws regulating legal practice, laws regulating our schools, do the same thing. Our mining laws, land laws, and stock laws do the same thing. In fact, most laws imply that the choice of a few is restricted for the good of the greater number. An apathy, in its results almost equivalent to an opposi- tion, is found among those who would place no restrictions upon any one. Their motto is, " let every alleged physi- cian stand or fall from his own success." This doctrine, carried out to its legitimate results in other directions, would change our State into an Elysium for con- fidence men, swindlers and highwaymen ; for these enter- prising citizens would hardly fail to stand by their successes. It has been sneeringly asserted that educated medical men wished the law in order to protect themselves ; that it is the project of a trades-union. The answer is that the chief ob- ject of a statute is to protect life, and prevent suffering, es- pecially among those members of society, whose opportuni- ties of information in regard to the status of medicine and medical men, are limited. Such persons are easily credu- lous towards any pretences of a medical character. None better than physicians themselves, know how utterly void of truth this statement is, and that per contra, the law does 8 not revert to their pecuniary benefit. For nothing is more certain than that by charlatans, a large number of patients have been made worse, and not a few well persons have been made ill; a considerable number of each of these classes, have ultimately become patrons of physicians. Harvard's witty poet, philosopher, physician, himself a most pronounced believer in the value of a thorough medical education, and a believer in the value of medical treatment, once said, " Laying aside opium and quinine, wine and an- aesthetics, if the whole materia medica, as now used, (by all who use them, quacks in addition to physicians), could be sunk to the bottom of the sea, it would be all the better for mankind, and all the worse for the fishes. Throwing out of consideration physicians and their rela- tion to the law, its primary intention should be to protect society, and no one familiar with the spirit of the medical profession would regard it otherwise. In this connection, as showing the soul of the medical profession, we beg leave to incorporate into this paper, a portion of the code of ethics of the American Medical Association, to which the great body of American physicians have subscribed: " It is derogatory to professional character for a physician to hold a patent for any surgical instrument, or medicine," (Code of Ethics, chap. 2, art. I, sec. 4), and membership in this great representative body is denied any physician, whose conduct is so selfish and unprofessional. The profession that would not permit the patenting of valuable surgical instruments, or appliances, nor the patent- ing of ether, chloroform, quinine, or a thousand other valu- able remedies, that pecuniarily, could have been made as valuable as the sewing machine, or telephone; the profes- sion that would not conceal vaccination ; who, in a century, have lessened the amount of disease more than one-half; who have battled more than all other professions for the prevention of disease, by sanitary laws, could illy afford to tarnish their record of the past by advocating a selfish law for the present. Barring possibly, the clerical profession alone, no other profession, trade, or occupation has tinted its past or present more deeply with unselfishness, and good will to man. A few have declared an opposition to the enactment of any law that shall recognize medicine as a science, or even ap- proaching the condition of a science. It is a public misfortune, that flippant, inconsiderate writers have written upon the subject of medicine, and 9 worse still, some who have known the least, have written the most. If one might place any reliance upon their shal- low utterances, we might doubt whether the present age were not behind the ages that have long ago passed. In substantiation of these statements, we need only to re- fer to the sneers that frequently appear in our daily and weekly journals. Within the last year the question has been asked, even by a few journals of our own State, " Is medical treatment of any value to the patient ?" and when a well known, talented lady writer, commenting upon the death of our assassinated chief magistrate, (The Spent Bul- let, by Gail Hamilton), derided and belittled the claims of medicine and surgery, many whose calm judgment should have reminded them that searching for a lost bullet is as small a portion of modern surgery, as it is of modern gunnery, were prepared to believe the claims of scientific medicine an empty boast. It is somewhat tiresome to reiterate the truths in regard to the status of medicine, yet, truths there are, that give to it a lofty rank among the kindred sciences for completeness and precision ; mindful that all matters mundane possess an element of uncertainty, and careful to make no absurd claim for our profession, we state only what an attentive in- vestigation will corroborate, most positively, when we as- sert that there is no occupation or pursuit of man, except- ing mathematics, and the pursuits based strictly upon that science, which surpasses medicine in the certainty of its re- sults. Many critics of medicine are pleased to dwell upon its uncertainties, as if that were its chief characteristic. It is not difficult for a determined cynic to sneer. He can point out that in law, with the whole science narrowed down to a question of right or wrong, an eminent, learned and con- scientious judge will have his decisions reversed by a judge equally eminent, learned and conscientious; that Christian theologians are not all of the same opinion; that in geo- logical studies different conclusions are arrived at by the most eminent students of that science; that even in chemistry teachers are not in perfect accord upon all questions. Such minds would ask us to throw aside all things concerning which any question could be raised. The opinion of an educated physician whether given upon the spur of a moment or after careful consideration, is characterized by as much of certainty as that of the learned jurist, the theologian or the geologist, under the same circumstances. 10 We stated above that, except mathematics and the pur- suits based strictly upon that science, there is no pursuit of man which surpasses medicine in the certainty of its results. Examine the reasons for the statement. Medicine is based upon a knowledge of anatomy, physiology, their deviations, and remedies for such deviations. Anatomical knowledge can be acquired with as much certainty as geography or geology, for, while the student of geography often acquires his knowledge of that sub- ject from the observations of others, the anatomist may not only avail himself of the observation of others, but may again and again view and carefully examine and work over the object of study? The rivers of the globe are not better defined than are the arteries of the body. The " arms of the sea" and the " bowels of the earth " may perhaps be inaccessible to the geographer; but no such hindrance can thwart the student of the body. The " backbone of the continent" is calling for prospectors to lay bare its many secrets, but its prototype of the body has been studied in all its minutiae. Physiology is based largely on chemistry, " the exact science," and physics, and well-studied phenomena. The actions of the solids and fluids, the functions of muscles and nerves, membranes and glands have been studied from nearly all possible standpoints, in nearly all lights, and the settled facts of such study are the integral parts of which physiology is composed. Thousands of eyes, thousands of educated, careful and thoughtful minds have been observing and describing the deviations from normal structures and normal functions of the body; and, sought after by chemists, microscopists and electricians, very much of disease that formerly was an im- penetrable mystery has been freed of its obscurities, and placed clear and legible before those who desire to observe. An equal advance has been made in demonstrating the ac- tion of remedies, in making clear their effects, and how and w hy. In the past twenty years, scores of studious experi- menters, profound reasoners, have been engaged in making clear the action of remedies. It is but a slight exaggera- tion to state that nearly every important remedy that is used has been placed under observation; and that to-day we have definite knowledge how each of them effects, if they have any effects upon, the principal muscles, arteries, and nerves of the body. If they have been found to have any effect upon the liver, spleen, kidneys, stomach or 11 brain, they have been questioned and cross-questioned, like the witness upon the stand, until all material facts have been brought out. Medicine has not yet attained the limits of its growth, (and the same thing can be said of chemistry, of geology, of geography, of physics). New remedies will be discov- ered, new means of alleviating human suffering will be brought out, and so long as sickness and accident and death shall be a law of our being, so long will advancement in medicine be made; but were no advancement to be made from this day forward, enough of facts have been gathered to place medicine, as a science, by the side and in the far front rank with other sciences, which, in a great measure, are exact. It would far exceed the scope of this paper to enter into the details by which the actions of a large number of rem- edies have passed from reasonable conjecture to positive knowledge ; but, as illustrating a method for the benefit of readers who are not physicians, a single example will be given. A half century ago, whether a given remedy when administered, increased or diminished the quantity of cere- bral blood could only be conjectured; it could not be proved. The accompanying cut shows an instrument used in determining the effect of remedies upon the blood vessels of the brain : No. no5«. 13 The instrument is a hollow tube, the upper part of glass, the lower part of metal; it is open at the top, and closed at the bottom with a very thin sheet of rubber; a screw is cut upon the lower portion, by which it can be tightly screwed into an opening made into the skull of an animal. When securely fastened into the skull, the tube is filled with a colored liquid to the point zero (°). If a remedy increasing the quantity of blood in the skull be administered, the col- ored liquid will be observed to rise; if an opposite remedy be given it will fall. With such a means it is easily possible to decide whether any remedy increase or diminish the quantity of cerebral blood. This instrument also teaches another truth, viz: that in the human body only appreciable doses give appre- ciable effects ; infinitesimal doses of most medicines give no result; when results follow such doses they are only due to the influence of the mind upon the body. The knowledge thus gained is of practical value. Some diseases consist essentially of an increased or diminished quantity of cerebral blood, and the positive knowledge gained from this source renders the treatment of such con- ditions as rational as the use of water in the extinguishing of flames. With the cephalo-hermatometer, cardiograph, the myo- graphion, the kymographion, the manometer, Marey's tym- panum and lever, with a multitude of similar ingenious, mechanical and electrical instruments, by many chemical analyses, the action of a vast number of remedies upon the different organs of the body have been positively de- termined, and, when all factors are considered, the practice of medicine is characterized by a certainty scarcely believed by non-professional persons, and little suspected by the un- educated cheats and frauds who counterfeit the profession and assume the name of physician. It is a source of pleasure to thus make plain the certain- ties of medicine. It is a source of regret that the scope of this paper does not permit us to speak of the many similar and equally conclusive means of demonstrating the certain- ties of therapeutics, that a public, who are so often treated to tirades against our profession, might obtain a clearer view of its foundation in science and in reason. We have discussed the principal objections urged against the State's supervision of the practice of medicine, and have shown their weakness. Having devoted so much to a dis- cussion of charlatanism and its repression, without respect 14 to locality, we will consider it with reference to our own State, placing before you specimens of its work and speci- mens of its workers, each their own commentary. Patients or their friends are not necessarily aware of the name of the remedies they introduce into their bodies; cer- tainly they cannot be expected to know their effect; what- ever is given is usually accepted, and, in cases involving surgical procedure, the decision of the attendant as to pro- cedure, and the result, is accepted as final. In surgical practice if an error be committed, few are the patients capable of measuring its extent; and of medicine proper, it is less easy to judge than of surgery. Many and fatal errors, and many that are undiscovered by the patients, are directly chargeable to the ignorance of medical pretenders. Without doubt, many homicideshave unconsciously been committed by charlatans in Colorado. An unsavory col- lection of such cases have been, by request, brought to the author, and since personal incidents are more impressive than general statements, three cases are below produced. A friend cautions me to write with care, lest I disseminate an incorrect idea concerning mal-treatment of patients. Let me not be misunderstood: the errors I mention weie not committed by physicians, but by charlatans, and we only lay bare the misdeeds of villains, who assume the role of physicians,as they should be, were their authors to assumethe role of clergyman, prophet, priest or king. Such errors as I re- cord have never been committed by men who have learned the profession of medicine, and never will be. Case i. In one of our prosperous, rushing mining towns, Dr. was called to visit a man suffering from a rupture in the groin ; he made a hasty examination and pronounced it a " gathering abscess;" a poultice was applied for a day, and then the lancet was used ; of course, death ultimately resulted. An explanation relieving himself from any pos- sible blame, and satisfactory to spectators and friends, was made by the attendant. With no shadow over his profes- sional reputation, no diminution of his practice, he contin- ued his ministrations to the afflicted, performing now and then an occasional homicide; but, unable to comply with the re- quirements of the present law, he sought another and more congenial sphere of usefulness without the boundary lines of the Centennial State. A medical gentleman in the southern portion in our State furnishes the following: Case 2. A lady in confinement was attended by a neigh- boring quack ; by unwarranted violence he produced an in- version of the uterus, (uterus turned inside out). The in- 15 jury was detected neither by the quack nor by the patient; a continuous loss of blood resulted, clots were permitted to be retained, to decompose, to poison, and death was the last scene in the first act of the tragedy. A physician was call- ed to make a post-mortem, which cleared up the flagrant malpractice. Believing that a statement of the facts would be followed by another tragedy, he wisely or unwisely, made no mention of the prime cause, but attributed death only to the blood poisoning. The sorrowing friends to this day are unconscious of the crime which ignorance committed, and only to the author were the real facts made known by him who performed the post-mortem. We premise a narration of the third case by stating to non-professional readers that experiment has shown that con- vulsions may be due to an increased quantity of blood in the brain, or to a deficiency of blood; if due to an excess, one remedy might be appropriate ; if due to a deficiency, another ; but it is evident that a substitution of one remedy for the other, in a given case, would be the worst possible treatment. It is the province, then, of a medical attend- ant in a case of convulsions, before giving any remedy, to decide correctly whether an excess or a deficiency exists, and to administer according to the condition, not to pre- scribe the one or the other because of the two; one may be of benefit in one form of convulsions. Case 3. A child of a few months was attacked by a dis- ease, of which convulsions was a symptom. An examina- tion showed an excess of blood in the brain. (The soft spot on the top of the head was very much protruded; a condi- tion always found in cerebral congestion). A remedy that would be beneficial in convulsions due to a deficiency of blood was administered to control the convulsions, and death quickly followed. A non-professional observer could form no opinion from the result as to whether it was due to the original disease or the remedy. The stricken parents consoled themselves with the thought that every thing was done that could be, but if the attendant, at a later period, acquired the medical knowledge he should have possessed, he would then know that the worst thing possible was done for his little patient. These cases are a few of the considerable number that have come to the knowledge of the author, and are here brought forward, only to show in its true light the subject under consideration. We come next to consider who are embraced in the class under consideration ; what do they know of medicine ; or rather to what extent are they ignorant of medicine? Much 16 very pointed testimony has been elicited before our State Board of Medical Examiners. By the provisions of the statute creating the board, meetings have been held at stated periods. At each of these meetings gentlemen and ladies have presented themselves for examination, who desired to practice in Colorado, although they had never pursued a regular course of medical study. To each of these persons ten (io) or more written questions were presented, to which answers were required in writing. These written questions and answers are placed on file by the Secretary. In addi- tion to the written questions, verbal questions and answers formed a part of the examination. It is required that not less than seven-tenths of all an- swers should be correct; persons whose average is below this are required to pass another examination satisfactorily, before a license can be granted. All questions are intended to be only such as any practitioner should know, and a stand- ard lower than the one adopted would, in effect, ren- der the law of no value. While it is believed there is noth- ing taught in a regular course of medical study that is not necessary, and that whoever has not had such training is at a disadvantage, (for there are certain branches of study like Auscultation in Physical Diagnosis, that almost certain- ly cannot be well learned except by the aid of a teacher), it is believed that this feature of the law is wise. Of the per- sons who have been so examined, more than fifty (50) per cent, have been rejected. For the purpose of showing the class, who, previous to the passage of the law, were in practice in Colorado, but who have been refused a certificate, and now are prohibited from practicing, below is given a sample of the questions asked, and their answers as written by the candidate. To the au- thor it certainly seems that if heretofore any non-profes- sional citizen of Colorado has had any doubt as to the ne- cessity of a law to protect the citizens of our State, such doubts can no longer be entertained. The amount of in- jury that might be wrought by these men, and remain un- detected, is left to your computation. The incorrect answers as given are but a tithe of the whole number in possession of the Board ; but the few given have been selected at random, and are a fair sample of the many others. In some answers the original spelling is pre- served in its native rugged strength. For the benefit of non-professional persons, I have added correct answers or comments: 17 Question Asked. Answer given by appli- cant for certificate. Correct answer or com- ments. How many cranial nerves are there? Three: optic, brachial, and illiacfemeral. There are twelve : olfac- tory, optic, motor oc- uli, pathetic, trifacial, abducentes,facial,audi- tory, glosso-pharyngeal pneumogastric, spinal accessory, and hypo- glossal. The brachial is not a cranial nerve, and there is no nerve named the iliac(not illiacjfemoral. Give the anatomy and physiology of the uter- us and ovaries ? The uterius is suspended in the upper pelvis by philopium cords, the fundius upward, the oss uteri down. The ovaries conduct the male germ of life to the uteries. The uterus (not uterius) is not suspended in the upper pelvis. Fallo- pian, not philopium. Not correct. To what ribs do the lungs extend in front, below the nipple? To the twelve ribs. Another answer : To the tenth ribs. Between the sixth and seventh. What is the nornial length of the virgin uterus? Six to eight inches. Three inches. This person claimed to make a specialty of diseases of the uterus. What is the principal se- cretion of the stomach in health? Acids and alkalies. The gastric juice is acid, but alkalies are not se- creted by a healthy stomach. What is the normal tem- perature of the body ? 90° F. F. A prolonged temperature of 90° F. would be surely fatal. What is the normal spe- cific gravity of urine ? 78. Normal specific gravity of urine is about 1,025. What is the chemical test for albumen ? Don't exactly know, but could find it in the chemistry. A physician should know this, for a work on chemistry might not always be readily found What effect do medici- nal doses of ergot have on the muscular tissue of the uterus at full term, labor having commenced ? Relaxes it. Contracts it. Action of lobelia-gene- ral stimulant or seda- tive ? Valuable stimulant. Lobelia is a powerful sedative. 18 Question asked. Answer given. Correct ans. or comment. Its dose to a child ten days old, depressed by vomiting, and how of- ten ? Three drops tinct. lobelia every ten minutes, for two hours, if depres- sion continue that time Very active emetic; would be the worst treatment possible. Such treat- ment would kill a child Dose of morphia sulphate for a child ten days old and how often ? One-twentieth of a grain every two hours. First dose would kill; second dose unneces- sary. Name the chemical con- stituents of the human body. In tissue we have nucleus cels; they consist most- ly of elasticity, exten- sibility and porosity; the chemical composi- tion of musels is hard to tel, but is close con- ection with the areola tissue, bind vesels and nerves. The answer bears every mark of an uneduca- ted person. What is endo-cervicitis ? Endo cervicitis is deep- seated inflammation of the urethra. Endo cervicitis is inflam- mation of the lining membrane of the neck of the womb. The urethra belongs to another organ. What is the difference be- tween version and flex- ion of the uterus. They both mean the same thing. They are entirely differ- ent. What is the difference between version and flexion of the uterus ? I practice botannical, and therefore do not know any such diseases. This person made a spec- ialty of diseases of the uterus. When would you use chloral in labor? When the pains are suffi- cient, but no progress is made. The result would be there would be neither pain nor progress; such a course would do much harm and no good. Name conditions during labor, indicating chlo- ral, chloroform, or ether. Give chloral or chloro- form when pains cease from exhaustion or ex- treme prostration. The very worst treatment that could be adopted. Treatment of post par- tum hemorrhage. Use the tampon. Almost certain death. In what position should the leg be placed in fracture of the patella ? Semi-flexed. It should be straight; never flexed. The position of the fore- arm in fracture of olec- ranon process? Flexed. The worst position pos- sible. What are the pathologi- cal lesions in typhoid fever ? Tongue has thin coat. Answer is almost irrele- vant ; the characteris- tic lesion (diseased part) is in the bowel. 19 Question asked. Ansiver given. Correct ans. or comment. What is pneumonia ? It affects the lungs. The answer gives no in- dication of how it af- fects the lungs. What tissues are chiefly involved in acute ar- ticular rheumatism ? The deep tissues. Answer very indefinite. Name the organs found in the thoracic cavity. Liver, hart, loungs, stom- ack, splen and pan- creas. Note the spelling. Liv- er, stomach and pan- creas are not found in the thoracic cavity. How many forms of con- sumption are common- ly recognized? Several; coughing with- out expectoration is one. Most authors recognize three: tubercular, fi- broid, and caseous. Describe some of the pathological conditions that produce dropsy, general and local ? It is caused by the dry- ing up of secretions, and stopping up the pours. Answer means nothing. At what points on the chest are the different valves of the heart most clearly heard. They are all heard near the collarbone. Entirely incorrect. In an early stage of pleu- ritis, what sound is heard that is due to friction ? Crepitant rale. Pleuritis never causes crepitant rale. Do we have bony union in all cases of trans- verse fracture of the patella ? Usually we do, but some- times cartilaginous. We never have bony union. What is cystitis ? Cystitis is inflammation of the prostate gland, causing mucus iu the urine. Cystitis is inflammation of the bladder. Pros- tate is not a part of the bladder. What is the surgical treatment of nose bleed? Ligate an artery in the neck; the name I have forgotten. Ligating any artery in the neck would do no good, but harm. What is varicocele? A lymphatic tumor of the neck. Dilation of the veins of of the spermatic cord, (In the scrotum.) In a case of peritonitis (inflammation of the bowels) would it be advisable to administer a brisk cathartic ? Yes, it would be very excellent treatment. No, it would be the worst possible treat- ment. In a case of psoas abscess where would you look for its origin ? At the knee. Psoas abscess has its or- igin in the lower por- tion of the backbone, above the level of the hips. 20 There, gentlemen, make a copy of that, and preserve it as a curiosity connected with this year of enlightenment, one thousand, eight hundred and eighty-three. In addition to the number who have been rejected after examination, we place below for your inspection a few more that have been winnowed out of the list of persons claim- ing to be physicians. The members of this class have never presented themselves for examination ; although de- void of medical education, they were not so devoid of sense as to come before the Board and display their ignorance. To obtain the list, a circular was sent by the author to some reliable citizen of each county. The circular request- ed the names of those who had been practitioners, or had offered their services as such, previous to the establishment of the law ; but who had either discontinued practice or left the state after its passage. Information was sought in regard to their subsequent history, as throwing some light upon their probable professional worth. The persons select- ed have been taken at random and are a fair representation of the hundred or more of their class. After discontinuing their profession, most them of returned to the employments they had formerly pursued, and with the intricacies of which, they were more familiar. 1. Discontinued practice-is prospecting in southern Colo- rado. 2. Left the State under the following circumstances: He was called to attend a case of labor; placenta retained ; to remove it, the patient was raised to an erect posture and thoroughly shaken, actually jolted. The patient died quickly. The " doctor " was twice soundly thrashed by the patient's friends, and given a specified time to leave the town and State. 3. Discontinued; is practicing fortune-telling, and is a fe- male clairvoyant. 4. Left for parts unknown. 5. Discontinued; present occupation unknown. 6. Discontinued ; works as section hand on railroad. 7. and 8. Discontinued. 9. Discontinued ; works as carpenter. 10. Left the State; went west to practice. 11. Left the State ; is now practicing in Indian Territory. 12. 13, 14, 15, 16, 17 and 18. Went into other branches of business in Colorado. 19. Removed to Kansas; when last heard from was driving a mule team. 21 20. Driven by cruel fate from the the practice of medicine in Colorado, he removed to Oregon, and when last heard from was preaching. Doubtless as much of a fraud in religion as in medicine. 21. Moved to Iowa; is practicing there. 22. 23, 24, 25, 26 and 27. Discontinued practice or left the State. 28. Is now in practice in Arizona; before leaving the State he wrote to a member of the Board with whom he was quite intimately acquainted, and offered a handsome sum for a blank certificate such as the Board issue to medical graduates. He stated that he was in practice in the extreme southwestern portion of the State, over five hundred miles from Denver; that he would forge the names of the Board and risk detection-a risk he esti- mated as extremely small at a place so distant from the State capital. He also offered an equal amount for a diploma from any recognized medical school, its date and to whom issued, being immaterial; he explained that he could erase the original date and name, and supply them as he deemed best. To the member ad- dressed, the transaction seemed rather questionable, and was not sanctioned. The letter containing the request is in the possession of the Board. A careful computation of those who left the State or dis- continued practice, rather than undergo an examination, places their number at about one hundred. Another chapter should be written concerning men who are practicing under the ten year-clause. A medical friend mentioned meeting one, during the past year, in consulta- tion : The case was typhoid fever, with a very high tem- perature ; he had been giving chiefly tr. ferri chloride in one-half teaspoonful doses every two hours, and mentioned that the patient needed a tonic ; that he was trying to " brace him up." Now, a stiff iron rod often makes a good " brace ;" but, alas, in this case, the poor patient was like Mark Twain's jumping frog, and the verdict of a coroner's jury would have been, " too much metal." Another gave, to restore the menses, tincture guaiac one- half pint daily ; her case was by him pronounced consump- tion, due to the cause he was combatting. The patient died in less than a week; not from consumption, not from amenorrhcea, but from the effects of a valvular disease of the heart. I once made a post mortem for one of this class, and when we found the patient had died from abscess of the 22 kidney, and found a renal calculus the cause of all the mischief, he uttered an exclamation of wonder and said that must be a new disease, for he had never heard of such a thing before. In the vocabulary of these gentlemen there must be a great number of new diseases, if their ignorance of diseases constitutes them as new. It is well to mention these things; it were better to make them impossible. There are in the United States eighteen colleges where a diploma can be purchased with as much ease as brass jewel- ry can be at an auction store. kh|re are, in addition to these corporations, more than a scare against which the same charge can be made, and a jury would bring in the Scotch verdict of " guilty, but not proven." The children of these institutions are neither few nor cursed with bash- fulness. In other States men have taken the diplomas of deceased physicians, and changed the name to correspond. Men who have been about a college for a few weeks, and have read enough of medical works to use their terms with ease, have been willing to commit perjury, making affidavit to having really possessed a diploma, and lost it, rather than bear the shame of having their true status known to ac- quaintances. The labors of the Colorado Examining Board have unearthed several curious specimens of these pseudo- medical men. Gentlemen, in this paper I have placed before you a fair portrayal of charlatanism in Colorado; the portrait is not a creation of my imagination, it is not an exaggeration of the real, is not even a representation of the whole evil as it exists. A knowledge of the means that have been taken to check the evil is familiar to each of you, and while there can be found upon the outskirts of our profession, self- styled advanced thinkers, long haired philosophers, swag- gering oracles, or weak-eyed, squeaky-voiced conservators of medical mysteries, who cry, " Hold! hold! any legis- lation concerning the practice of medicine must be per- nicious, and a trammel to the advance of science." The great body of the profession, its best and noblest represen- tatives, supported by the best class of our citizens, with good reason, demand that we, as citizens, battle longer, stronger and with greater earnestness against the vampire, that like its prototype, sucks the life blood from its sleeping, un- suspecting victims. In this matter our army and our navy have given us an example. Save in the urgent times of great wars our sail- 23 ors and soldiers in their days of sickness and wounds are placed only under the care of men thoroughly grounded in the principles of their science and art. And it is an utopian dream to hope the day may come when the citizens of our State shall be deemed so precious, their lives shall be trust- ed only to men, who, by years of devotion to study, by the aid of clinical teachers, shall be the peers of our military and naval medical corps. And for the honor of the profession to which we belong, may we all see the time- Jo carefully shall the State guard its interests, so high shall be our professional standard of ex- cellence, that to be a practitioner in Colorado, shall be an unquestionable guarantee of professional ability, learning, and skill. Let me thank you for your attention.