A COURT OF MEDICINE AND SURGERY. 
A. B. CHOATE. 
The remark is frequently made, " A doctor buries his mis- 
takes in the grave and no one is the wiser; " or as someone 
has put it, " Physicians of all men are most happy : what- 
ever good success soever they have, the world proclaims it; 
what faults they commit, the earth covers them." No 
doubt there is some truth in this, - how much doctors only 
know. 
The difference in this respect between the practice of law 
and that of medicine and surgery is very marked. In the 
practice of law the client's case is formally stated by his attor- 
ney in writing; this statement is filed in court and becomes 
a public record. Corresponding to this formal, written, pub- 
lic record is the doctor's diagnosis, frequently nothing more 
than a mental conclusion, without even the publicity of 
spoken words. In a lawsuit there is an opposing attorney 
who writes out and files his diagnosis of the same cause, in 
which he takes issue with his opponent on one or more of 
the most vital points in the case, and represents it to be a 
case materially differing from that stated by his opponent, 
demanding entirely different treatment. 
In medicine there is nothing of this kind whatever. As a 
rule, no other doctor is allowed to see the patient or know 
anything whatever about his condition or treatment. It is a 
serious breach of professional etiquette for another physician 
to attempt to know or say anything adverse concerning a 
brother physician's treatment of the case, even if certain that 
there has been a mistake in diagnosis and treatment which 
will cost the patient his life. If the physician first called can 
retain the confidence of the patient, or of his friends in case the 
patient succumbs, he conducts the case in strictest privacy 
to the end. Whether that end be the grave or a prolonged 
life of misery, not a breath of adverse criticism by any other 
physician is tolerated. No opportunity for intelligent criti- 
cism of a physician's or surgeon's work is furnished. Is it 
any wonder that different schools of medicine succeed equally 
well although proceeding upon diametrically opposite theories ? 
211 212 
THE ARENA. 
The jealousy with which a patient is protected from inter- 
ference by more than one doctor at a time suggests the truth 
of the following : 
See, one physician like a sculler plies, 
The patient lingers and by inches dies; 
But two physicians, like a pair of oars, 
Waft him more swiftly to the Stygian shores. 
Quite likely such would be the result if two physicians 
were allowed to squabble over the same patient unrestrained; 
but all this is different in law. Opposing counsel come into 
an open court, presided over by one especially learned in the 
law and competent to give intelligent criticism, and there in 
the light of public criticism each endeavors to sustain the 
position he has taken; each seeks to expose a flaw in the 
work of the other ; nothing is hidden or covered up ; whether 
it be an error in the diagnosis or subsequent treatment of the 
case, it is held up to public view. An intellectual battle 
between the opposing counsel is conducted with weapons con- 
sisting of the keenest wit, the most biting sarcasm, and the 
soundest logic. After hearing both sides the judge decides 
the various points discussed, and in so doing sometimes takes 
occasion to censure one of the attorneys for his ignorance or 
negligence, and terminates the case by requiring the defeated 
client to pay to the successful one an arbitrary sum of money 
in addition to all his costs and disbursements as partial com- 
pensation for being wrongfully brought into court. The 
vanquished attorney may then leave the court room in dis- 
grace, fortunate if his fertile brain is sufficient to the task of 
squaring himself with his client who has been a witness to 
the whole proceeding. 
At first thought, the freedom of physicians and surgeons 
from this severe criticism seems an advantage on the theory 
of O'Reilly, - " Be silent and safe; silence never betrays 
you." But is it not, in fact, a great disadvantage to the 
really efficient practitioner? Does not this freedom from 
just and intelligent criticism have the effect of placing the 
quack and the pretentious ignoramus on a level with the 
conscientious and scientific practitioner? 
But what is of much greater importance, is it not due to 
the public that some means should be furnished whereby the 
physician of real merit, as well as the quack and pretender, 
may be known ? Is it to the best interest of the sick 
and suffering that they should be imposed upon, and the A COURT OF MEDICINE AND SURGERY. 
213 
results of ignorance or carelessness be allowed to bear fruit 
in death or a miserable existence, while the ignoramuses who 
work the imposition are permitted to continue their depreda- 
tions in the name of science, under the cover of secrecy ? 
Is it best that the only verdict to be pronounced in case of 
death caused by an ignorant blunderer shall be the libellous 
one, " God touched him and he slept " ? Such a verdict is 
either a libel on God or an undue laudation of a blundering 
quack. To the layman this seems unjust, not only to the 
physician and surgeon of real merit, but also to the general 
public. 
Why should there not be a court of medicine and surgery 
similar to a court of law? Of course the general practice 
of medicine could not be done in any public manner; but 
why should not all hospital work, or at least all clinics, be 
conducted in a manner similar to the trial of a lawsuit? 
Why should not every hospital and medical college be estab- 
lished under state license and state regulation, as such insti- 
tutions now are in nearly all parts of Europe ? Then estab- 
lish the office of clinical judge. Employ a competent 
physician and surgeon to fill the office and preside at each 
hospital at the expense of the state. Create the office also 
of state physician. When a case is brought to the hospital 
or prepared for a clinic, require the physician in charge of 
the patient, as well as the state physician, to file with the 
clinical judge a written diagnosis of the case. Make it the 
duty of the state's physician to know and make a record of 
every step taken in the treatment of the case, together with 
his criticism of the manner in which it is conducted. In no 
case should the state's physician interfere in the least with 
the management of a case or of a clinical operation, except 
to call upon the clinical judge to prevent any error likely to 
result in death to the patient; the judge's decision should be 
final, and absolutely control without delay or argument. At 
stated periods have a calendar made up of discharged cases, 
which should be indicated by number only, and in the pres- 
ence of all who desire to attend have each case thoroughly 
discussed by the state's physician first presenting his criti- 
cisms, and the physician or surgeon who operated the case 
defending his work, the clinical judge to decide all points of 
disagreement between them and make a record of his decision. 
Do as adversaries do in law - 
Strive mightily, but eat and drink as friends. 214 
THE ARENA. 
One of the chief advantages of such a court would con- 
sist in making clinical work more effectual for students. 
Clinical operators would not be able to play to the galleries 
so freely as they do now. Some superficial impostors would, 
of course, have their business ruined, and opportunities 
would be less for quacks to pose before the public as com- 
petent physicians and surgeons by reason of having their 
names on hospital staffs and as one of the faculty of a uni- 
versity or college, while no careful, conscientious, efficient 
physician or surgeon would have anything to fear. 
It has been proposed to promote some legislation along 
these lines at the meeting of the legislature of Minnesota 
this winter, and this paper is written for the purpose of calling 
out discussion and fair criticism of the plan. Many details of 
the above proposed plan have not been touched upon, which 
would be necessary to avoid minor objections that will 
arise; but since the writer is not a physician or surgeon, it is 
quite probable that some serious difficulties have been over- 
looked that will arise in the minds of physicians. Of 
course nothing but condemnation and opposition can be 
expected from every empiric and impostor in the country ; 
but the animus which prompts their opposition will be gener- 
ally recognized and their opposition discounted accordingly. 
Just criticism from competent professional men, as well as 
laymen, will be received with pleasure.