THE MEDICAL PROFESSION 
 
 AND THE 
 
 COMMONWEALTH. 
 
 By FRANK WINTHROP DRAPP^R, M.D. 
 
 The Annual Discourse delivered before the Massachusetts Medical 
 Society, June 8, 1892. 
 
 BOSTON : 
 
 DAVID CLAPP & SON, PRINTERS, 115 HIGH ST. 
 1 8 9 2. 
 
Digitized by the Internet Archive 
 in 2017 with funding from 
 
 University of Illinois Urbana-Champaign Alternates 
 
 https://archive.org/details/medicalprofessioOOdrap 
 
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 J) 75 m 
 
 
 A 
 
 THE MEDICAL PROFESSION AND THE 
 COMMONWEALTH. 
 
 Mr. President and Fellows 
 
 of the Massachusetts Medical Society : 
 
 The father of modern lexicographers defines a 
 physician as “ one who professes the art of healing.” 
 This definition, even with its evident limitations, 
 accords with the popular idea of the doctor’s proper 
 place in the world’s affairs; he is of value as a 
 prescriber of remedies for sickness. His character- 
 istic business is the cultivation of therapeutic skill. 
 To this end, medical education is largely directed, 
 with its clinical features made prominent. To the 
 attainment of this result, hospitals lend their aid 
 and specialties have been organized in such num- 
 bers and variety as to confound the traditions of 
 conservatism. All this preparation and special- 
 ism fairly represent the current notion that the art 
 of medicine, rather than medical science, is the 
 physician’s specific domain. How to defy success- 
 fully and to conquer effectively the foe of the 
 household, — this is held to be the main purpose 
 of our profession, our chief reason for being. 
 “ They that be whole need not a physician, but they 
 that are sick.” 
 
 But while the medical and surgical practitioner 
 illustrates in his clinical round of duty his prin- 
 cipal function, there are other relations in his 
 
 \ 
 
 A 
 
4 
 
 THE MEDICAL PROFESSION 
 
 experience to which his profession necessarily ex- 
 poses him. Some of these are imperative and can- 
 not be evaded; others are voluntary but are full 
 of noble possibilities; all of them, properly used, 
 give increased value and dignity to our professional 
 vocation. In the discharge of the distinguished 
 dut}' which places me in your presence at this time, 
 I shall endeavor to make clear the true attitude 
 which our profession should maintain toward some 
 of these external conditions. I ask your indulgent 
 attention to a study of the relations which, as phy- 
 sicians, we hold toward the Commonwealth. 
 
 Our obligations to the State derive added signi- 
 ficance from the circumstances attending the incor- 
 poration of the Society of which we are the Fellows. 
 Our organic existence began in the troublous times 
 at the close of the revolutionary war, when the 
 more hopeful felt sure that they saw the dawn of 
 an independent nation, but did not dream of the 
 difficulties and delays that were to postpone for 
 nearly a decade the establishment of constitutional 
 government. The seat of military operations had 
 been carried southward, leaving IS T ew England 
 without serious apprehension of the further presence 
 of hostile forces. Yorktown was the point upon 
 which, during the early autumn of 1781, attention 
 was centred, and here the war reached its trium- 
 phant climax. Meanwhile, here in Massachusetts, 
 civil affairs, though still unsettled, had begun to 
 take permanent shape. For a year, the people 
 had been living under a constitution of their own 
 devising, an instrument of solid framework, the 
 
AND THE COMMONWEALTH. 
 
 
 prototype and model of many others constructed 
 after it. 
 
 It was at this time, when the national government 
 was in revolutionary instability and our own Com- 
 monwealth was in its infancy, that a few medical 
 men, chiefly resident in Boston, saw the desirability 
 of an association that should bring qualified prac- 
 titioners into closer relations for their own benefit 
 and for the good of the public. No doubt there 
 was ample ground for this feeling. The exigen- 
 cies of the war then closing had called many Mas- 
 sachusetts physicians into the public service, where 
 they met associates from other States and, with 
 them, by the intercourse thus available, were stim- 
 ulated to discuss the needs of the profession and 
 were led into a community and cohesion of in- 
 terests not possible otherwise. Out of this oppor- 
 tunity and experience grew a purpose to secure 
 order in place of medical chaos. Medical know- 
 ledge was limited and the facilities for obtaining 
 it were difficult; more difficult in New England, 
 indeed, than in other sections of the country. 
 There were already many pretenders and knaves 
 who made easy prey of the credulity of humanity. 
 There was no standard of medical knowledge or 
 of fitness to assume the responsibilities of medical 
 practice. Recognizing these conditions, the pub- 
 lic-spirited founders of our Society resolved to 
 come into closer union for the common good. 
 
 The preliminary deliberations which led to our 
 incorporation are not matters of record ; we simply 
 know their results. But these results are sug- 
 
6 
 
 THE MEDICAL PROFESSION 
 
 gestive of the bond of attachment which, at this 
 time, existed between the State and the better 
 class of medical men and which has never been in 
 serious peril since. The very name of our asso- 
 ciation is one evidence of this. Our fathers might 
 have looked across the sea and found an appro- 
 priate title in some w Medico-Chirurgical” society 
 or " Academy of Medicine ” or " College of Phy- 
 sicians,” which could be translated to the new 
 world. But this would not have been in harmony 
 with their purpose; their purpose was to make a 
 ” body politic and corporate ” which should estab- 
 lish “ a just discrimination ” between educated 
 practitioners and ignorant pretenders in medicine, 
 a purpose that had in view the welfare of the 
 community in its broadest sense. They therefore 
 asked the General Court to give permanent ex- 
 pression to this object by granting the name of 
 the Commonwealth to the new guild and by be- 
 stowing corporate privileges that should corres- 
 pond therewith. That request was granted and 
 we are the Massachusetts Medical Society, broader 
 than medical sectarianism, abhorring exclusive- 
 ness, loyal ever to the State’s highest interests, 
 proud of the charter which, bearing the historic 
 names of John Hancock and Sam Adams in at- 
 testation of its validity, the State bestowed upon 
 us in 1781, the first document of the kind granted 
 under the constitution. The commonwealth thus 
 became our alma mater. She gave her name to 
 our newly created body; she endowed us with 
 valuable rights; and she bestowed other encourag- 
 
AND THE COMMONWEALTH. 
 
 7 
 
 ing assistance and recognition. If she did not 
 actually rock the infant " body corporate ” in the 
 w cradle of liberty,” she contributed an added flavor 
 of legality and dignity to our first proceedings by 
 loaning the " county court-house in Boston” as 
 the place of meeting for Doctor Holyoke and his 
 thirty fellow-founders, and placed us under new 
 obligations of gratitude later by permitting meet- 
 ings of the society in the state-house and in other 
 public buildings belonging to the State. 
 
 Such was the beneficent and disinterested aim 
 of our fathers in founding this association; such 
 the gracious and helpful attitude of the Common- 
 wealth in aiding that foundation. It is becoming 
 in us, the heirs and beneficiaries of the endowment 
 thus established, to ask how the aim of its creators 
 has been fulfilled during all the years of the cen- 
 tury now drawing to its close; to what degree the 
 prosperity of the State has been advanced by the 
 Fellows of this organization; and what are our 
 present duties to the public in the discharge of the 
 trust which our organic charter imposes. The little 
 company of physicians which assembled in the 
 county court-room near Scollay square, in No- 
 vember, 1781, has by normal growth become a 
 multitude so large that it requires an entire block 
 of buildings to supply the needs of its anniversary 
 meetings, outgrowing all less adequate accommo- 
 dations. Keeping pace with the progress which 
 has made Massachusetts a leader in all things that 
 make for the highest civilization, our organization 
 holds and has long held the highest rank as the 
 
8 
 
 THE MEDICAL PROFESSION 
 
 representative of the best type of scientific and 
 practical medicine. It is true that it does not 
 include, nor has it ever included, in its fellowship, 
 all those who by education and personal character 
 have been entitled to avail themselves of its priv- 
 ileges. Undoubtedly there are many practitioners 
 who ought to be on our rolls of membership but 
 who are content to remain as medical gentiles- 
 Any stud} r of the relations of physicians to the 
 commonwealth should not omit these from its 
 scope. It is their misfortune, as well as their 
 fault, that they neglect the invitation to affiliate 
 with the only incorporated association which rep- 
 resents in the largest sense the principles which 
 should be dear to every educated medical man. 
 But I remember that what I have to offer to-day, 
 while it may apply comprehensively to all who use 
 the title and perform the functions of physicians, 
 is addressed especially to a body which for more 
 than a hundred years has stood for the best that 
 is attainable in medical science and art, and it is 
 therefore peculiarly appropriate that the physician 
 whose relation toward the commonwealth we are 
 to discuss should be the physician who is also the 
 Fellow of this society. It is likewise fitting that 
 the commonwealth concerning which we speak in 
 this connection should be the one to which we owe 
 allegiance as citizens and the one from which we 
 derive our chartered rights as Fellows. 
 
 Massachusetts, in founding its constitutional 
 government in 1780, established three co-ordinate, 
 yet independent, departments; and ordained that 
 
AND THE COMMONWEALTH. 
 
 9 
 
 the legislative, the executive and the judicial func- 
 tions should be forever distinct. This three-fold 
 distribution of organic powers and duties in the 
 State invites consideration of our relations, as 
 physicians, to each of the fundamental depart- 
 ments, and leads us to ask what has been accom- 
 plished and what remains to be done in directions 
 wherein the commonwealth and the medical pro- 
 fession are mutually concerned. 
 
 I. To what extent, then, in the first place, has 
 the State, through its General Court, as its legis- 
 lative department, enacted laws that are of parti- 
 cular interest to the members of our profession as 
 a class? An inspection of the public statutes will 
 be rewarded with the discovery of the following 
 requirements, exemptions and prohibitions, in force 
 at the present time: 
 
 " Practising physicians,” with a few other equally 
 fortunate public servants, are exempt from enrol- 
 ment in the militia. 
 
 w Able and discreet men, learned in the science 
 of medicine ” are to be appointed medical exami- 
 ners in each county. 
 
 " A physician who has attended a person during 
 his last illness ” must furnish, for the purposes of 
 registration, certain specified facts relating to the 
 patient and his illness. 
 
 " Physicians” shall make a monthly report of 
 the births at which they were present, the penalty 
 for neglect being double that for delinquency in 
 the matter of death certificates. 
 
10 
 
 THE MEDICAL PROFESSION 
 
 " A physician shall give ” immediate written 
 notice of all the cases of such diseases under his 
 care as the local sanitary board declares to be 
 dangerous to the public health, and again the 
 penalty for neglect is substantial. 
 
 Under carefully devised provisions and restric- 
 tions, " any physician or surgeon ” may have the 
 dead bodies of certain paupers, " to be by him used 
 within the State for the advancement of anatomi- 
 cal science”; and, in similar fashion, he may have 
 the dead body of an executed murderer; but if he 
 " willfully digs up, disinters, removes or conveys 
 away a dead body ” without authority, or w buys, 
 sells, or keeps for sale, the dead body of a human 
 being,” he shall be punished by imprisonment or 
 fine. 
 
 ]STo insane person shall be committed to a lunatic 
 hospital except upon the certificate of ” two phy- 
 sicians ” having special qualifications and comply- 
 ing with specific requirements ; and in each of the 
 State lunatic hospitals, “an educated female physi- 
 cian shall be appointed assistant physician.” 
 
 When the estate of a deceased person is insol- 
 vent, w the necessary expenses of his last sickness” 
 stand as a preferred claim before all other debts; 
 while if the insolvent debtor be living, " all debts 
 due to physicians for medical attendance on him 
 or his family ” are third in the order of priority. 
 
 " Practising physicians and surgeons regularly 
 licensed ” are in the list of persons exempt by law 
 from serving as jurors; but they are not excused 
 from any of the requirements which pertain to 
 
AND THE COMMONWEALTH. 
 
 11 
 
 witnesses in courts of law, nor have they any 
 special privileges if misfortune overtakes them and 
 a judgment for debt is to be executed. 
 
 Among the ” twelve reputable citizens ” to whom 
 the law accords an invitation to be present at the 
 hanging of a condemned murderer, ” a physician 
 or surgeon ” is especially included. 
 
 w A physician or surgeon ” is mentioned in the 
 list of the officers to be appointed by the Governor 
 for the administration of affairs at the state prison 
 and the reformatory prison for men; while the 
 reformatory prison for women has, according to 
 the statute requirements, a staff almost wholly 
 composed of women, including the ” one physician” 
 whose term of service is " during the pleasure of 
 the Governor and Council.” 
 
 Such are some of the statutory privileges and 
 obligations which to-day apply to Massachusetts 
 physicians. It cannot have escaped your notice 
 that the obligations far exceed the privileges. 
 When we have mentioned exemption from jury 
 and militia duty, some preferment of the claims of 
 physicians against insolvent estates, the rarely 
 used permission to dissect dead bodies, together 
 with the happily infrequent opportunity of attend- 
 ing a judicial hanging, we have included all the 
 essential benefits which the commonwealth bestows 
 on medical practitioners. It is not a long list of 
 special indulgences, nor a very valuable one. 
 
 Another feature of these statutes invites a word 
 of comment. Is it just and equitable, on the part 
 of the State, to exact gratuitous service and to 
 
12 
 
 THE MEDICAL PROFESSION 
 
 punish us by a heavy fine for non-compliance? 
 This is a question which has exercised the minds 
 of medical men who were entirely free from any 
 purely mercenary bias. Take the matter of death 
 certificates, for example; the determination and 
 proper formulation of the cause of a death is a 
 work requiring professional skill and judgment. 
 It is not the easy task which it appears to be; and 
 those who have to do with the registration of 
 deaths know the truth of this, for they see numer- 
 ous instances of failure and blundering in this 
 seemingly simple matter. I doubt not that many 
 of my audience have met with difficulty, again and 
 again, in the satisfactory framing of a death-certi- 
 ficate, and have done some severe medical thinking 
 in order to comply with the statute requirement. 
 And this service the State exacts as a formal 
 matter, without any return consideration; more 
 than this, it makes neglect or refusal to obey the 
 law forthwith a crime of the same grade and with 
 similar penalties as the passing of a toll-bridge 
 without paying the legal toll, or the wilful suffer- 
 ing of one’s sheep, swine or fowl to trespass on 
 his neighbor’s land, or public indulgence in profane 
 cursing and swearing. And the same reasoning 
 applies to the requirement that every physician 
 shall give immediate notice in writing, over his 
 own signature, of every case of small-pox, diph- 
 theria, scarlet fever, or any other disease which 
 his local board of health declares to be dangerous 
 to the public health and which he is called upon 
 to visit, the penalty for disobedience in this in- 
 
AND THE COMMONWEALTH. 
 
 13 
 
 stance being not less than fifty not more than two 
 hundred dollars. Let me not be misunderstood. 
 I am not desirous for a moment of arguing that 
 the State is wrong in requiring from physicians 
 this service concerning the living and the dead; 
 I regard the registration of vital statistics and of 
 infectious diseases as fundamentally indispensable 
 to all sanitary administration, and to take any 
 position of apparent hostility to it or to suggest 
 any course of conduct that would impair its value 
 and completeness would show a deplorable lack 
 of wisdom. Nor am I pleading for the principle 
 of remuneration for all service rendered; for I 
 believe that every intelligent and public-spirited 
 physician, recognizing that his contributions to 
 registration will aid in maintaining and promoting 
 the public health and general welfare, would not 
 be stimulated to better or readier obedience of the 
 statutes if, for each certificate, he received a small 
 fee. On the other hand, he is not inspired to do 
 his duty more punctually through fear of fines 
 which, like the Quaker guns of Manassas, are 
 meant rather to intimidate than to destroy. Yet 
 the criticism remains true, that there is an obvious 
 want of equity in the fact that the State makes an 
 unrequited requisition upon physicians for medical 
 facts which they alone can supply at an expense 
 of time and knowledge, and threatens them with 
 punishment as petty criminals if they neglect or 
 refuse to heed the requisition promptly. If a 
 penalty in connection with registration is to be 
 exacted at all, it would be more worthily attached 
 
14 
 
 THE MEDICAL PROFESSION 
 
 to wilfully false and fraudulent certificates, to 
 certificates that try to cover criminal abortion 
 under the disguise of septic peritonitis, or that 
 conceal suicidal pistol-shot wounds under the 
 euphemism " rupture of blood-vessels and hemor- 
 rhage,” or that attempt to mislead by calling a 
 suicide by laudanum a death by coma. 
 
 This matter, indeed, is not an important one; 
 but it is worth while to mention that the common- 
 wealth has shown some inconsistency by recogniz- 
 ing that the services of physicians do have a value, 
 trivial in degree, yet real in fact, when applied to 
 observations and reports requiring no special skill 
 to make them. For if a physician reports punc- 
 tually to the clerk of his city or town a correct list 
 of all children born therein during the month next 
 preceding, at whose birth he was present, he shall 
 receive for this purely clerical duty a fee of 
 twenty-five cents for each birth so reported ; while 
 neglect to report such list is punishable by a fine 
 not exceeding twenty dollars. It is notorious that 
 the registration of births in Massachusetts is de- 
 fective, even under this legislation which has pro- 
 vided a hope of reward and a fear of punishment 
 as the double incentive to the faithful discharge of 
 a public duty. 
 
 The critical student of the public statutes who 
 searches for any evidence therein that the com- 
 monwealth through its legislature has ever set up 
 any standard of education or skill on the part of 
 medical men, will find little in existing laws to 
 reward him for his inquiry. In a few instances, 
 
AND THE COMMONWEALTH. 
 
 15 
 
 the general court has provided that special, though 
 purely relative, qualifications shall be requisite in 
 certain contingencies. Generally, however, the 
 members of our profession are mentioned under 
 their generic title simply, as ” physicians ” or 
 w physicians and surgeons,” and the undoubted 
 intent is to include under this term all who pub- 
 licly announce themselves to be practitioners of 
 the art of medicine and undertake to treat sick or 
 injured persons, either for reward or gratuitously. 
 There is no attempt in the statutes to classify or 
 to define "physicians,” to declare by legislative 
 act who may practise medicine and who shall not, 
 to protect the people from the evil doings of igno- 
 rant pretenders, to establish a standard which 
 would exclude both fools and knaves. Massa- 
 chusetts has ever been hospitable to all sorts and 
 conditions of men, and she welcomes with a reck- 
 less graciousness any who choose to pass her open 
 door. She knows no sects, no schools, no differ- 
 ences among physicians; all doctors are alike to 
 her and, according to the assembled wisdom of 
 her law-givers, they can safely be left to take care 
 of themselves according to the principles of the 
 common law. There is no distinction, either 
 natural or arbitrary, which our statutes recognize, 
 to mark the fraudulent pretender from the educated 
 and trustworthy practitioner. To the citizens of 
 this State, there is absolutely unrestricted liberty 
 in the choice of their medical attendants when 
 they are ailing or are injured, a full realization of 
 the very opening words of the constitution of the 
 
16 
 
 THE MEDICAL PROFESSION 
 
 commonwealth, that w the end of the institution, 
 maintainance and administration of government is 
 to secure the existence of the body politic, to pro- 
 tect it, and to furnish the individuals who compose 
 it with the power of enjoying in safety and tran- 
 quillity their natural rights and the blessings of 
 life.” 
 
 This attitude of Massachusetts, allowing unre- 
 stricted freedom in the practise of physic, has 
 exposed the State to much criticism. It has given 
 rise to the impression that her present policy of 
 non-interference with medicine has always pre- 
 vailed, and that she is now simply carrying forward 
 a traditional rule of conduct in obstinate indiffer- 
 ence to the lessons of experience learned in other 
 and younger communities. This inference is incor- 
 rect. Long before any of the modern devices for 
 statutory regulation of medical practice were an- 
 nounced, long before many of the commonwealths 
 which are now taunting us had been staked out in 
 the primeval wildernesses of the west and north- 
 west, Massachusetts saw the need of controlling 
 the pretensions and active arrogance of charlatanry 
 within her borders and the clear duty of bestow- 
 ing her recognition upon reliable men and women. 
 As early as 1619, the colonial legislature enacted 
 a law concerning ” Chirurgeons, Midwives, Phy- 
 sitians,” which forbade all " persons whatsoever 
 imployed at any times about the bodyes of men, 
 women or children, for the preservation of life or 
 health ... to presume to exercise or put 
 forth any act contrary to the known approved Pules 
 
AND THE COMMONWEALTH. 
 
 17 
 
 of Art, . . . without the advice and consent of 
 
 such as are skillfull in the same Art,” upon such 
 w severe punishment as the nature of the fact may 
 deserve”; and the act has this quaint codicil, that 
 the law w is not intended to discourage any from 
 all lawfull use of their skill, but rather to incour- 
 age and direct them in the right use thereof.” 
 Does any statute of the many relating to medical 
 practice, which the present generation has wit- 
 nessed in various states of the Union, show a 
 better spirit? 
 
 But we need not look beyond the words of our 
 own charter of incorporation to find full evidence 
 that long ago the State discriminated sharply be- 
 tween those who merited confidence and those 
 who deserved to be restrained. The whole docu- 
 ment, from its preamble to its conclusion, is filled 
 with the flavor of this wholesome feeling. But 
 that which applies itself chiefly to our purpose in 
 this regard is the remarkable sentence which, like 
 a strong back-bone, is built solidly into the very 
 middle of the charter: — 
 
 And whereas it is clearly of importance, that 
 a just discrimination should he made between such 
 as are duly educated and properly qualified for the 
 duties of their profession , and those who may igno- 
 rantly and wickedly administer Medicine , whereby 
 the health and lives of many valuable individuals 
 may be endangered , or perhaps lost to the com- 
 munity : 
 
 u Be it therefore enacted by the authority afore- 
 said, That the president and fellows of said socie- 
 2 
 
18 
 
 THE MEDICAL PKOEESSION 
 
 ty, or other such of their officers or fellows as they 
 shall appoint, shall have full power and authority 
 to examine all candidates for the practice of physic 
 and surgery, who shall offer themselves for exami- 
 nation, respecting their skill in their profession.” 
 
 This placed a premium on proper qualifications 
 and proved fitness. It established a standard and 
 made our society the keeper of that standard, and 
 if with the recently accepted Bill of Bights in 
 popular remembrance, it did not forbid the prac- 
 tice of medicine by those who neglected or failed 
 to become licentiates under this charter, it never- 
 theless gave the community, what it had not had 
 before, a chance to have its medical practitioners 
 classified according to their worth and learning. 
 It was a most responsible function to place upon 
 this young society of physicians, but the trust was 
 adequately fulfilled then and is to-day being ful- 
 filled; and the men and women who possess the 
 letters testimonial of the censors of the Massachu- 
 setts Medical Society attesting their demonstrated 
 and approved knowledge and fitness need no fur- 
 ther passport to the full confidence of the people 
 and no better certificate to distinguish them from 
 those who “ignorantly and wickedly administer 
 medicine.” 
 
 But Massachusetts, through its legislature, did 
 not stop here. It supplied in our charter a standard 
 by which it strove to distinguish the genuine coin 
 from the counterfeit, and it created the agency for 
 the application of this standard to all who wished. 
 Subsequent enactments strengthened and con- 
 
AND THE COMMONWEALTH. 
 
 19 
 
 firmed this aim. The act of incorporation of 1781 
 was altered in 1803, the better to ” effect the im- 
 portant and desirable purposes for which it was 
 designed.” The limit to the number of fellows, 
 previously set at only seventy as its maximum, 
 was removed; the councillors were created; and a 
 board of censors was provided who were to ex- 
 amine candidates, and to give to such as were 
 successful in their examination a certificate of 
 approbation and of their license to become prac- 
 titioners in medicine or surgery; " after three 
 years of approved practice in medicine and sur- 
 gery, and being of good moral character, and not 
 otherwise,” these licentiates were to be eligible for 
 the higher honor of becoming Fellows. By this 
 same act, district societies were allowed to be 
 organized for purposes of medical improvement, 
 and each district was endowed with the additional 
 function of sharing with the censors-at-large the 
 authority to examine and admit candidates for the 
 regular practice of medicine. In 1831, the provi- 
 sion that required three years of probation for 
 licentiates before they were admitted as Fellows 
 of the Massachusetts Medical Society, was re- 
 pealed. 
 
 These various enactments, designed specifically 
 for the organization and development of this 
 society, but having the fundamental purpose also 
 to improve the character of the medical profession 
 in general in this commonwealth, do not complete 
 the catalogue of statutes which the legislature has 
 made for the regulation of medical practice. 
 
20 
 
 THE MEDICAL PROFESSION 
 
 Broad as our charter was, in its permissive provi- 
 sions, it was not in the least useful as prohibitive 
 legislation. We might admit all duly qualified 
 practitioners to our ranks, we had no control over 
 the disqualified pretender who cared little for the 
 privileges which the Massachusetts Medical Society 
 offered. This weak negative side in the then cur- 
 rent statutes came at length to be seen, and in 
 1818 a law was passed which was designed to 
 remedy this defect. It is of interest to us that 
 the State continued to turn to this Society to aid 
 in the fulfilment of its purpose. The statute pro- 
 vided that every person practising physic or sur- 
 gery in Massachusetts, without having received a 
 medical degree from some college or university, 
 or without being licensed by some medical society, 
 or college of physicians, or by three Fellows of the 
 Massachusetts Medical Society to be designated 
 in each county by the Councillors, should not have 
 w the benefit of law for the recovery of any debt, 
 or fees, accruing for his professional services”; 
 and every licensed practitioner was required to 
 deposit a copy of his license with the clerk of the 
 town where he resided. Just a year later, the 
 general court modified its predecessor’s work and 
 enacted that no person entering the practice of 
 physic or surgery after a specified date should be 
 entitled to the benefit of law for the recovery of 
 any debt or fee for his professional services unless, 
 previously to rendering those services, he had been 
 licensed by the regularly appointed censors of the 
 
AND THE COMMONWEALTH. 
 
 21 
 
 Massachusetts Medical Society or had been grad- 
 uated a Doctor of Medicine in Harvard University. 
 
 This law, it will be observed, distinctly recog- 
 nized the principle of the regulation of medical 
 practice, and this was the only good purpose 
 which it served. It had two ludicrously weak 
 features; it did not provide any punishment for 
 failure or neglect to procure the required license, 
 and while it presumptively made the way of the 
 irregular practitioner a difficult one in the matter 
 of collecting his fees, it left him perfectly free to 
 do what no reputable physician ever does, it left 
 him free to take his pay in advance. Neverthe- 
 less, the law was so satisfactory and acceptable in 
 its working, that it was re-affirmed in all its main 
 features in the Revised Statutes of 1836, seven- 
 teen years later, this Society being still designated 
 by name as the authority to manage the machinery 
 of examination and licensing; but there was this 
 important modification, — the courts were no longer 
 closed to such unlicensed physicians as sought 
 legal help in the collection of their fees. The 
 penalty for neglecting to secure a license was still 
 missing, and the only express reward for compli- 
 ance with the law was the privilege of dissecting 
 dead bodies acquired in accordance with well de- 
 fined conditions and restrictions still extant. This 
 anomalous statute (vox et preterea nihil) remained 
 in force without amendment until 1859, when it 
 dropped out of sight in the general revision of the 
 laws made by the legislature of that year. Since 
 its disappearance from the stutute book there has 
 
22 
 
 THE MEDICAL PROFESSION 
 
 been nothing unlawful in ” ignorantly and wickedly 
 administering medicine ” to the people of Massa- 
 chusetts in violation of any statute; the principles 
 of the common law are the only safeguard. 
 
 Meanwhile, during this period of thirty years, a 
 wave of legislative virtue has swept over the land 
 with reference to the regulation of medical prac- 
 tice. One State after another has passed restric- 
 tive laws of greater of less stringency hut with 
 the single aim of discouraging quackery. How 
 effective these laws have been in accomplishing 
 their purpose, or how zealously they are executed, 
 in the various communities, we are not now con- 
 cerned in determining; the suggestive fact is that 
 Massachusetts stands almost alone in her attitude 
 of toleration. Of one result of this state of affairs 
 we all are clearly aware. The action of neighboring 
 States, near and more distant, in requiring irreg- 
 ular practitioners to move on and to stand not 
 upon the order of their going, has brought to our 
 too hospitable territory a horde of medical pre- 
 tenders who have not been slow in discovering the 
 advantages of an asylum here. Moreover, the 
 unlimited freedom which characterizes medical 
 practice has encouraged the growth of a native 
 variety of charlatans and adventurers; the weeds 
 are not all of exotic stock, some of them are in- 
 digenous and have been permitted to grow in rank 
 luxuriance. It is safe to state that never in the 
 history of the commonwealth has such a wide 
 variety been offered to her people in the matter of 
 choosing a medical counsellor in time of sickness, 
 
AND THE COMMONWEALTH. 
 
 23 
 
 and that never has the class of charlatans been so 
 numerous or so haughty. 
 
 And what a motley company they are, these 
 disreputable parasites upon the medical profession ! 
 They offer to the curious student of anthropology 
 a great diversity of types, ranging all the way from 
 the long-haired male Indian medicine-man to the 
 short-haired female Christian scientist; creatures 
 with " natural ” and supernatural powers, extraor- 
 dinary owners of superior intellects who find no 
 difficulty in the problem of curing incurable dis- 
 eases; bio-chemists, nature-pathists, mesmerists, 
 vivopaths, psychopaths, botanic healers, magnetic 
 healers, — a great procession of social pests with 
 labels designed to captivate the unwary and the 
 credulous. 
 
 But these people who boldly affect superiority 
 by announcing themselves openly as irregular 
 practitioners, and by assuming an eccentric or 
 distinctive title in proof of it, are not the worst 
 representatives of their class. The charlatans 
 who are most harmful are those who deliberately 
 and fraudulently take on the simple designation 
 of ” physician,” and so far as any outward sign is 
 concerned are not to be distinguished by the pub- 
 lic from the best and noblest members of our pro- 
 fession. It is possible that this variety of irreg- 
 ular practitioners shows, in their method of mak- 
 ing a living out of the public, a higher degree of 
 shrewdness than their fellows of the former class, 
 because in their use of professional titles, the pre- 
 fix, " Doctor,” and the suffix, "M.D.” are in no 
 
24 
 
 THE MEDICAL PROFESSION 
 
 respect different in their external application, from 
 those employed in a genuine way by right. 
 
 Then, there is another form of medical fraud 
 which manifests itself in the shape of w medical 
 institutes.” These are evidently business enter- 
 prises simply, and the management being in the 
 hands of several persons, who are always an- 
 nounced as distinguished, successful and trust- 
 worthy exponents of medical science, the victims 
 of disease read the obvious lesson that in a multi- 
 tude of such counsellors there must be safety. 
 
 But however we may classify and differentiate 
 these people, they all have certain characteristics 
 in common; there is nothing beneficent in their 
 motives or actions; they are to the last degree 
 mercenary; they are busy obtaining money under 
 false pretences; they add nothing to the common 
 stock of knowledge; they contribute nothing to 
 the social welfare; they are a constant menace to 
 the public health. They defile the columns of 
 the daily press and of the religious weekly journals 
 with disgustingly suggestive notices of their 
 pretensions and insinuating invitations to walk 
 into their parlors. They make open solicitations 
 through their advertisements to the victims of 
 lustful practices to add crime to imprudence, and 
 they cover with the thinnest disguise their public 
 and defiant announcements that they will commit 
 unlawful acts and will take all risks of detection 
 and exposure. It. is openly declared that, dis- 
 guised as female practitioners of medicine, they 
 conduct houses of prostitution. They deface all 
 
AND THE COMMONWEALTH. 
 
 25 
 
 accessible surfaces with their bold and lying 
 promises, and offend good morals by their too open 
 allusions to unmentionable subjects. Like jug- 
 gling fiends, they take advantage of every form of 
 human misery to raise hope where hope is vain, 
 and they wickedly and cruelly draw the last pos- 
 sible dollar from their credulous victims, who get 
 small comfort from the fact that payment has been 
 made in advance for the wretched disappointment 
 of unfulfilled agreements. If in such a case death 
 comes to the relief of these double sufferers, the 
 ignorance of the only physician recognized by the 
 statutes in such a relationship is attested by the 
 manner in which the required certificate of the 
 cause of the death is executed, sometimes unintel- 
 ligibly, sometimes fraudulently, covering a crime 
 under the name of an innocent disease, and always 
 raising a doubt and question of the value of such 
 data for the purpose of vital statistics. 
 
 Can it be possible that Massachusetts, which 
 has long defended its claim to the possession of 
 superior wisdom in the care of all matters pertaining 
 to public health and public morality, is willing to 
 tolerate this state of affairs indefinitely? Is not 
 her indifference reprehensible? And have not we, 
 as physicians, remained far too quiescent under 
 these growing evils? Have we not evaded a duty 
 while we maintained a neutrality? Ought we not 
 now to speak out boldly and persistently until 
 some effective measure has been adopted to con- 
 trol and suppress the fungous growth of quackery? 
 It is to legislation, supported by an enlightened 
 
26 
 
 THE MEDICAL PROFESSION 
 
 public sentiment, and rendered fruitful by an 
 energetic enforcement, that we must look for the 
 real remedy, legislation that shall be practical 
 without being cumbrous or needlessly burdensome. 
 This is not the occasion for outlining the details 
 of such legislation; whether the statute should 
 supply a method of registration administered by 
 some already established board, like the State 
 Board of Health; or should require examination 
 and license through the agency of a purely 
 medical board; or should be framed upon the 
 model of the English law which forbids the false 
 and fraudulent use of any name, title or description, 
 implying that its user is a physician or surgeon, 
 when he has not been educated or licensed as 
 such, — all these matters may safely be left to 
 legislative wisdom. But the main point is that 
 the commonwealth should afford to its citizens 
 some guarantee that the persons who are permitted 
 to practise medicine are trustworthy by virtue of 
 education. Above all, let it be understood and 
 insisted upon that this guarantee, with its attendant 
 conditions and penalties, is not a matter into 
 which sectarian medicine enters in any degree. 
 Let there be an avoidance of all differences rela- 
 ting to schools of practice. Let not the smoldering 
 embers of medical contention be drawn out of the 
 ashes and fanned into life for the gratification of 
 controversialists. Let it be remembered that this 
 is not a question of therapeutics or of medical 
 ethics, but a question of medical education, with 
 the fundamental purpose of excluding from medi- 
 
AND THE COMMONWEALTH. 
 
 27 
 
 cal practice those who are unfit for it through 
 ignorance or wickedness. 
 
 But, some will say, how does this matter con- 
 cern the Massachusetts Medical Society, as a 
 society? Why need this organization trouble 
 itself to take any part in securing legislation 
 against quackery? Are we not in the possession 
 of an indefeasible charter, with ample protection 
 of our rights and privileges as physicians? Do 
 we not enjoy, as a Society, the respect and con- 
 fidence of the community? Does not the public 
 recognize in this association a body of medical 
 men and women offering ample evidence of the 
 trustworthiness and intelligent skill that are de- 
 sired? If any educated physician in Massachusetts 
 wishes to acquire the privileges of this recognition, 
 by entering this fellowship, is not the way easy 
 and the method simple? Why need we, an old 
 and honored body of regular physicians, fret about 
 quackery? Do not the charlatans give us new 
 and profitable business by their blunders? Why 
 should we meddle with the inherent right of every 
 individual to choose his adviser in case of injury 
 or sickness? Will not the prudent man make 
 seasonable inquiry and select the best; and cannot 
 we wisely leave this decision without dictation, 
 sure that in the long run the fittest will survive? 
 Why need we ask to have new burdens and re- 
 strictions placed upon us? 
 
 From the point of view of expediency and pro- 
 priety, as they apply to this Society, this purely 
 selfish and pharasaical course of reasoning is clearly 
 
28 
 
 THE MEDICAL PROFESSION 
 
 correct. This organization will do well to maintain 
 its independent attitude. It has no wish for a re- 
 newal of the legislation which formerly made it the 
 sole censor of medical practice in this State. It is 
 content to attend to its own affairs. It has no 
 ambition to pose as a monopolist in medicine. It 
 sets an example in medical tone, and in its tradi- 
 tions and present aim, cordially favors the highest 
 attainable development in medical education and 
 medical practice, but it has seen the mischief and 
 disappointment which have attended attempts 
 made, in its name, to influence and procure medical 
 legislation. But this view does not absolve us, 
 its individual members, from grave responsibility 
 regarding questions of public welfare. We are 
 citizens of the commonwealth as well as physi- 
 cians; and, as citizens, jealous of the good name 
 of Massachusetts, ashamed of her false position in 
 the matter now under discussion, we have the 
 right and the duty to protest that some remedy 
 should be applied to eradicate the evils which I 
 have tried to describe. We ought to do all in our 
 power to secure some practical process of sifting 
 which shall afford to the people an assurance that 
 the State is unwilling to trust the lives and health 
 of her inhabitants to charlatans and adventurers. 
 We ought to insist, and insist again, that it is not 
 for ourselves, or to promote our own interests, that 
 we wish the State to interfere, but that it is in be- 
 half of the thousands in her population who, 
 through lack of knowledge or discrimination, 
 become the victims of chicanery and fraud. We 
 
AND THE COMMONWEALTH. 
 
 29 
 
 ought to demand that protection for the classes of 
 people that do not and cannot protect themselves. 
 If professedly intelligent and cultured persons 
 choose to demonstrate their wisdom in a peculiar 
 fashion, by amusing themselves with the mind- 
 cure, and Christian science and hypnotism, and 
 other genteel fads, it should be with the distinct 
 condition that it is without the State’s approval of 
 their folly. The strong desire shown by a certain 
 class of individuals in this community to imitate 
 and emulate their prototypes in ancient Athens in 
 eagerness " to hear and to tell some new thing ” 
 offers no excuse for indifference, for human life 
 is in the balance as the material upon which the 
 novelty is to be tried as an experiment. 
 
 In this matter, we can take a useful lesson from 
 the very class of pretenders who are under our 
 study. The lesson is that if we would accomplish 
 anything with the legislature, there must be har- 
 monious, energetic, associated action. Let there 
 be but a whisper of an intended purpose to obtain 
 legislation to regulate medical practice, and the 
 swarm of charlatans, grown bold by its very numeri- 
 cal strength in Massachusetts, begins to organize 
 for defence. The whole body comes to the rescue 
 with a zeal and enthusiasm born of a resolve to 
 ensure self-preservation. They raise funds, the 
 manner of whose distribution it would not be re- 
 spectful to intimate. They secure able counsel in 
 the persons of eloquent lawyers or popular clergy- 
 men, who talk long and well of personal liberty 
 and the rights of man. They publish a newspaper 
 
30 
 
 THE MEDICAL PKOEESSION 
 
 of their own, which gives information of every 
 movement of their "enemy”; and, by methods 
 easily imagined, they convert to their views the 
 newspapers which others publish and which derive 
 from the advertisements of quackery a revenue 
 not to be despised. And so it happens that the 
 petitioners for legislation, only half prepared for 
 effective action, usually representing a small 
 coterie and a divided sentiment, have gone down 
 again and again before this numerous and power- 
 ful alliance of falsehood and fraud, and have been 
 given leave to withdraw. It is evident that this 
 experience will be repeated until we realize the 
 extent and the strength of the force which has 
 intrenched itself in our midst, and until we emulate 
 it in enthusiasm, sacrifice and persistency. 
 
 Is it not extraordinary that Massachusetts has 
 always been so ready to legislate in an endless 
 variety of directions affecting the life and well- 
 being of her population, and is reluctant to inter- 
 fere with uneducated and unfit practitioners of 
 medicine? The general court has provided for 
 the inspection of nearly everything that enters in- 
 to domestic administration, and has ordained 
 proper penalties for frauds and adulterations; wq 
 have ample protection in the matter of milk and 
 vinegar, chocolate and nails, gas and leather, con- 
 fections and drugs ; but none against the charlatan. 
 Massachusetts licenses her auctioneers and her 
 pedlers, her pilots and her publicans, her pawn- 
 brokers and her warehouse-men, her dentists and 
 her druggists; she places even clergymen and 
 
AND THE COMMONWEALTH. 
 
 31 
 
 lawyers under regulations, but no difference exists 
 in her esteem between the educated physician and 
 the fraudulent healer which an adjacent State has 
 spewed out upon our soil. We have statutes for 
 the protection of lobsters and smelts, rabbits and 
 partridges; but for sick people, the State oilers no 
 defence against quackery. 
 
 Let not medical men say that it is useless to 
 seek a remedy from the legislature, that charlatan- 
 ism has become too firmly rooted here to be eradi- 
 cated by any means, however drastic. Repeatedly 
 it has been demonstrated that measures of reform 
 have been successfully accomplished with the aid 
 of our profession in shaping and guiding legisla- 
 tion. Take a single illustration, the evolution of 
 the methods prescribed for the commitment and 
 treatment of the insane. As late as 1827, an act 
 was passed by the Massachusetts legislature 
 which included every excited lunatic with “ rogues, 
 vagabonds, common beggars, and other idle, dis- 
 orderly and lewd persons,” and provided for his 
 incarceration in a jail or house of correction until 
 he was “ restored to his right mind.” This barba- 
 rity continued until the State, in 1832, heeding 
 the representations of physicians, established the 
 first lunatic hospital at Worcester. For many 
 years after this, the process of commitment 
 continued to be a purely legal one, without any 
 required medical examination. But the protests 
 of physicians again prevailed. In 1844, the legis- 
 ture passed an act which recognized, for the first 
 time, that insanity was a disease, whose diagnosis 
 
32 
 
 THE MEDICAL PKOFESSION 
 
 required medical knowledge, rather than legal 
 acuteness. In 1862, it was enacted that for the 
 commitment of an insane person to a lunatic hos- 
 pital, “ the evidence and certificate of at least two 
 respectable physicians ” should be required as a 
 preliminary to establish the fact of insanity. Some 
 modifications have been made in the amount and 
 character of the medical evidence in these cases, 
 but the recognition of the true nature of insanity 
 and of the propriety of placing its humane treat- 
 ment in the hands of physicians, rather than in 
 those of the keepers of jails, was due to the labors 
 of such men as Bell, Wyman, Kay and Jarvis. 
 This result shows the effects which medical men 
 may accomplish at the State House if only their 
 efforts are rightly directed and persistently exer- 
 cised. Other examples of this force might be 
 cited. The statutes relating to the public healthy 
 to the registration of vital statistics, to compulso- 
 ry vaccination, to the use of subjects for anatomi- 
 cal study, to the investigation of deaths by vio- 
 lence, are all memorials of the intelligent zeal of 
 medical men in shaping and obtaining wise legis- 
 lation. What physicians have accomplished in 
 the past is an augury and proof of what they may 
 now accomplish in the attainment of statutory 
 regulation of medical practice. And not in this 
 direction alone. There are other matters wherein 
 wholesome laws are needed. I have only to sug- 
 gest the desirability of legislation for the more 
 effectual prevention of the spread of contagious 
 diseases, including syphilis; for less barbarous 
 
AND THE COMMONWEALTH. 
 
 33 
 
 methods in the punishment of convicted murderers; 
 for better dwellings for the poor; for medical in- 
 spection of schools; for the compulsory establish- 
 ment of a local health-board in every town. In 
 these, and other similar directions, the educated 
 physicians of Massachusetts have it in their power 
 to bring about salutary reforms. It is a power that 
 is not sufficiently appreciated by us, its possessors. 
 It is a power which may find its correct exercise in 
 various ways: in the open and candid expression 
 of opinion as we meet our acquaintances and 
 clients; or in properly formulated memorials to 
 the general court; or in attendance and spoken 
 testimony at hearings before legislative commit- 
 tees; or even in service in the law-making body 
 itself. It is to the credit of our Society that its 
 members have shown their willingness to interrupt 
 their professional labors and to respond to the call 
 of their neighbors to represent them in the legis- 
 lature. It is an honorable service, and nearly 
 every session has found, included in its rolls, the 
 names of reputable physicians, members of this 
 Society, who have given intelligent and faithful 
 attention to legislative problems, the satisfactory 
 solution of which has been largely due to their 
 wise counsel and to the experienced judgment 
 derived from their medical training. 
 
 II. But the true test of the value of laws lies 
 in their faithful execution and judicious applica- 
 tion. Let us inquire, now, concerning the rela- 
 tionship of our profession to the Commonwealth’s 
 executive department. 
 
 3 
 
34 : 
 
 THE MEDICAL PKOFESSION 
 
 In two instances, Massachusetts has selected its 
 supreme executive magistrate, the Governor, from 
 the medical profession and from the fellowship of 
 this Society. Governor John Brooks was elected 
 in 1816 and continued in office, by annual re- 
 election, until 1823. He was a practising physi- 
 cian, and became a Fellow of the Massachusetts 
 Medical Society in 1786. He undoubtedly received 
 high political recognition on account of his servi- 
 ces as an officer during the revolutionary war, for 
 he held the rank of Major at the battle of Bunker 
 Hill, and, later, was in command of a regiment 
 and was held in high esteem by Washington. It 
 does not appear, however, that his medical know- 
 ledge acted to discredit his reputation, or to limit 
 his efficiency, as a Governor; for his long service 
 in that office is good proof of the manner in which 
 he commended himself to the people’s favor. His 
 standing as a physician is attested by the honorary 
 degree of Doctor of Medicine which Harvard Col- 
 lege bestowed upon him in 1810, six years before 
 political success lent adventitious lustre to his 
 name as a medical man. It is further attested by 
 the fact that he was chosen in 1808 to deliver the 
 annual discourse before this Society, and by his 
 election to the presidency of the Society in 1823, 
 as soon as he was excused from farther service as 
 Governor of the State. He was greatly attached 
 to this organization, and gave good proof of his 
 interest in its welfare by bequeathing to it his en- 
 tire medical library. 
 
 Governor Brooks was succeeded in 1823 by 
 
AND THE COMMONWEALTH. 
 
 35 
 
 another physician, Dr. William Eustis, who died 
 in office in 1825. He, too, like his predecessor, 
 had a reputation derived from his military ser- 
 vices in the war of the revolution ; but his services 
 here were distinctly in the line of his profession, 
 for he was associated with Dr. John Warren and 
 Dr. William Damage in the care of the wounded 
 after the battle of Bunker Hill, he himself being 
 the senior surgeon of the staff. Although he had 
 studied medicine with Dr. Joseph Warren, who is 
 better known by his title of Major General, it does 
 not appear that Dr. Eustis ever took a medical 
 degree. He remained in the army surgical staff 
 till the close of the war. He joined this Society 
 in 1785. He evidently had ambition to shine in 
 other orbits than that of the plodding practitioner, 
 for besides being governor of Massachusetts he 
 was, earlier, a member of congress, a secretary of 
 war and a minister resident at the court of the 
 Netherlands. 
 
 These two physicians appear to have satisfied 
 the desire of the people for governors having 
 medical training and experience, although tradi- 
 tion suggests that, since the time of Eustis, other 
 medical men have not been reluctant to assume 
 the cares of the office if the opportunity appeared 
 auspicious for their ambition. But it should be 
 stated that long before Brooks and Eustis, long 
 before our Society was conceived, Massachusetts 
 had in her colonial history two other governors who 
 were primarily magistrates, but who knew enough 
 of medicine to add materially to their usefulness 
 
36 
 
 THE MEDICAL PROEESSTON 
 
 and esteem. Governor Edward Winslow w was 
 skilled in the practice of physic ” and made his 
 therapeutic attainments materially advantageous 
 to the colonists of Plymouth and to their aborigi- 
 nal neighbors as well. Governor John Winthrop, 
 too, added to his other claims to the gratitude of 
 the settlers of the Massachusetts Bay Colony, a 
 practical acquaintance with drugs and their uses, 
 which made his public functions all the more bene- 
 ficent. His. double service to his people was 
 recognized by his venerated pastor, Rev. John 
 Cotton, who described him as a " help for our 
 bodies by physick, for our estates by law”; thus 
 fixing his place as an ideal medicodegal practi- 
 tioner. His son, John Winthrop, Governor of 
 Connecticut, was an educated physician. 
 
 The second office in the gift of the people of 
 Massachusetts, that of lieutenant-governor, has 
 been held by three members of this Society, David 
 Cobb (who presided as a judge when he was not 
 practising medicine), Henry Halsey Childs and 
 Elisha Huntington. 
 
 The executive council of the commonwealth has 
 had many medical representatives in its member- 
 ship in the course of its history. They have done 
 excellent service in advancing the interests of our 
 profession whenever occasion offered. This was 
 especially the case in 1877, when the assistance of 
 the late Dr. William Cogswell was of great value 
 in the reform of the methods for conducting in- 
 vestigations of deaths by violence. 
 
 In municipal administration, our profession has 
 
AND THE COMMONWEALTH. 
 
 37 
 
 shown its adaptability for public affairs in numerous 
 instances. Repeatedly, medical men have demon- 
 strated their acceptability in the office of mayor 
 and in various subordinate positions in city and 
 town government. When we read, a few months 
 ago, in the obituary notice of one of our oldest 
 and most esteemed associates, that he had served 
 continuously for forty years as the keeper of the 
 records of the town in which he lived and died, 
 we had good proof that his capability and fidelity 
 were recognized by his fellow citizens. So, too, 
 we may recall the admirable services of our 
 brethren in the conduct of school-administration 
 and in the interests of free education under the 
 fostering care of the commonwealth. 
 
 Again, in the management of the public institu- 
 tions belonging to the State, medical men have 
 found a congenial field for the exercise of their 
 wise judgment and executive ability. Ever since 
 the establishment of the first lunatic hospital by 
 the State in 1832, at Worcester, the boards of 
 trustees of these and similar foundations have 
 welcomed the acquisition and assistance of phy- 
 sicians as an essential element of their success. 
 The credit for the progressively humane methods 
 in the treatment of the dependent wards of the 
 State in hospitals for the insane must be divided 
 between the able medical superintendents of those 
 asylums and the medical men in the boards of 
 government. If one desired a demonstration of 
 the executive ability of physicians, let him com- 
 pare the State Almshouse at Tewksbury, as it is 
 
38 
 
 THE MEDICAL PROFESSION 
 
 to-day, with its scandalous condition before 1876; 
 its discipline, its tine hospital service, its freedom 
 from abuses, are in sharp contrast with the methods 
 and results which characterized its management 
 before a physician took charge of it under the 
 authority of the legislature. 
 
 Why should not the executive efficiency of men 
 trained as physicians be utilized still further in 
 our public institutions? In India, the governor- 
 ship of jails and the position of medical officer 
 are combined in the one person of a medical man, 
 whose united functions result in great advantage 
 to the institutions and economy to the State. 
 Doctors of medicine who can manage great hos- 
 pitals, can govern penal reformatories; and con- 
 victs, as well as lunatics, would be none the worse 
 if their full sanitary supervision were in the hands 
 of specially trained officials. Who can doubt that 
 the discipline of a convict prison would be im- 
 proved if it were manifest that judicious care were 
 taken to maintain the health of the inmates by the 
 humane and practical methods of medical resident 
 officers? By the gradual education of junior 
 medical officers in this service, a supply of execu- 
 tive officials would be at the disposal of the State 
 for the management of its correctional institutions 
 in a proper and acceptable manner 
 
 There is one chapter of the Massachusetts laws 
 whose administration has always been an agreeable 
 duty for the members of our profession. The 
 statutes relating to the public health have been 
 especially interesting to medical men, and the in- 
 
AND THE COMMONWEALTH. 
 
 39 
 
 telligent practical application of them has always 
 had its best agents among physicians. Ever since 
 the board of health of Boston, ninety years ago 
 this summer, fitted up an observation hospital on 
 Noddle’s Island and invited Dr. Benjamin Water- 
 house and other physicians to demonstrate upon 
 the patients therein the immunity from small-pox 
 infection which Jenner’s recently discovered opera- 
 tion of vaccination bestowed;, nay, ever since Dr. 
 Boy 1st on, nearly a century earlier, fearlessly and suc- 
 cessfully acted as the champion of variolous inocu- 
 lation, and showed it, in the face of bitter prejudice 
 and opposition, to be a means of protection against 
 the justly dreaded aud disgusting scourge which 
 had swept periodically through the community, 
 Massachusetts has found among her physicians the 
 most zealous advocates of sanitary legislation, and 
 the most faithful servants in executing her enact- 
 ments. To the public, this paradox has always 
 been a mystery. Why medical practitioners should 
 desire earnestly to hinder or control the spread 
 of disease, when their livelihood and material 
 prosperity depend on its presence, and their 
 reputation for skill and success is directly re- 
 lated to its prevalence, is a problem which the 
 ordinary intellect is unable to solve. The 
 reason is that the vulgar apprehension has not 
 grasped the difference between a vocation and 
 a trade. The enterprising tradesman is not ac- 
 customed to place obstacles in the way of the 
 successful development of his business, and he 
 cannot understand why physicians do not follow 
 
40 
 
 THE MEDICAL PROFESSION 
 
 his example. But we are not engaged in the pur- 
 suit of a trade, and our methods are on a higher 
 plane than those of mercantile or of mechanic in- 
 dustries. We look to the welfare of humanity as 
 our first and fundamental object, and the practi- 
 tioner who forgets this and seeks primarily the 
 gains which are the objective reward of diligence 
 is not true to the high purposes of his profession. 
 The majority of physicians follow the more un- 
 selfish course and are therefore ready always to 
 aid and to adopt measures which will protect the 
 people from preventable suffering. It is, there- 
 fore, not surprising that they are earnest allies of 
 the State in the administration of sanitary laws. 
 I refer, of course, to the statutes relating to muni- 
 cipal sanitation in its broadest sense, including 
 those enactments, to which I have already alluded, 
 requiring the service of physicians in giving in- 
 formation concerning the presence of infectious 
 diseases and the registration of births and deaths. 
 
 And what a comprehensive array of enactments 
 affecting the public health the statute books of 
 Massachusetts present! The silence and indiffer- 
 ence of the State with regard to curative medicine 
 is in the sharpest possible contrast with the num- 
 ber and variety of laws relating to preventive 
 medicine. There would almost seem to be a de- 
 sign in this, an evidence of a purpose, however 
 chimerical, to make our profession a superfluity, 
 needing no legislative regulation, by abolishing 
 through manifold acts of the general court the 
 diseases which call into exercise our therapeutic 
 
AND THE COMMONWEALTH. 
 
 41 
 
 skill. However this may have been, the authority 
 with which the legislature has endowed municipal 
 boards of health in this commonwealth is extra- 
 ordinary. 
 
 Recall, for a moment, the almost bewildering 
 array of laws which are at this moment in force, 
 designed to promote health and resist the encroach- 
 ments of disease. The board of health of your 
 city or your town has the power, under the statutes, 
 re-inforced by decisions of the Supreme Court, to 
 interfere with personal and property rights in the 
 most arbitrary fashion, if only the interference is 
 in the name of the public health. It may remove 
 sick persons from their homes and from the care 
 of their friends and family physician, and place 
 them in hospitals specially provided; or it may 
 depopulate a neighborhood, and leave the patient 
 in sole and isolated possession of it. It may turn 
 back travellers who come from w infected places ” 
 across the boundary line of adjacent States, and 
 may detain at quarantine those who come by sea 
 from other ports. It may forcibly break open and 
 enter any house in search of baggage, clothing or 
 other articles supposed to be infected with diseases 
 dangerous to the public health, and may take pos- 
 session of other premises for the safe keeping and 
 storage of such articles. It may call unpleasant 
 attention to your dwelling by placing danger sig- 
 nals upon it if infectious disease has unhappily 
 entered there. It may forcibly enter any building 
 or premises for the purpose of examining into and 
 destroying, removing, or preventing a nuisance, 
 
42 
 
 THE MEDICAL PROFESSION 
 
 source of filth or cause of sickness; and it may, 
 in like manner, in its own way, but at the cost of 
 the owner, remedy undrained land on which stag- 
 nant water stands. It may compel you to abandon 
 the conveniences of the ancient cess-pool and privy 
 vault on your grounds and, at considerable ex- 
 pense to you, connect your dwelling with the pub- 
 lic sewer. It may surprise you by a declaration 
 that a disease which you have not deemed to be 
 formidable is hereafter to be classed as " danger- 
 ous ” to the public, and that every case under your 
 observation is to be reported, and the method of 
 disinfection at the termination of the case is sub- 
 ject to its approval. It may vacate and close 
 dwellings which it deems unsuited for habitation 
 and may prohibit the exercise of any offensive 
 trade outside the limits which it assigns. It has 
 control of the cemeteries in which your dead are 
 buried, it licenses the undertakers who have charge 
 of the burial, and it stands in the way of a burial 
 until the medical certificate of the cause of the 
 death is satisfactory in form and substance. 
 
 This epitome of the powers with which every 
 local board of health in Massachusetts is clothed, 
 gives but a hint of the profusion and force of the 
 laws which, since the establishment of the first 
 board in 1799, the State has enacted. Substantial 
 penalties are attached in case of their violation, 
 and it would seem that every sanitary emergency 
 and exigency had been anticipated. And it is 
 worthy of remark that, with all this array of 
 authority at their command and with the judicial 
 
AND THE COMMONWEALTH. 
 
 43 
 
 officers of the State under an obligation to render 
 executive aid in case of need, the boards of health 
 have never acted in an arbitrary or unjustifiably 
 severe manner. Too often, indeed, sanitary ad- 
 ministration has been characterized in some com- 
 munities by deplorable laxity and shiftlessness, 
 rather than by offensive zeal. The cause of this 
 inertia lies in the lack of a genuine public spirit 
 which should support and compel the enforcement 
 of the laws. If our people would show for sani- 
 tary precautions and regulations the sympathetic 
 interest which is deserved, the authorities who 
 administer the health laws would not be indifferent. 
 Wherever a city or town has provided for its 
 people a proper local board of health, with an in- 
 telligent, energetic medical man as its executive 
 officer, the result has been satisfactory, because 
 physicians, better than the ordinary citizen, know 
 what can be accomplished as well as what is 
 needed. 
 
 There is an impression that the State Board of 
 Health is endowed with an authority similar to, if 
 not greater than, that of local boards. This is an 
 error. The functions of the State board are largely 
 advisory; its powers as a purely executive body, 
 to make orders and enforce them, are quite limited 
 and are inferior to those of the local board of 
 health of the smallest town in the State. It has 
 authority to make investigations concerning the 
 causes of disease, to diffuse sanitary information 
 among the people, to conduct experiments relative 
 to the disposal of sewage, to recommend measures 
 
44 
 
 THE MEDICAL PROFESSION 
 
 for the prevention of the pollution of the water 
 supplies of cities and towns, and to advise persons 
 or corporations concerning proposed water supplies 
 or plans for sewage-disposal, its recommendations 
 and advice being a preliminary requisite before 
 legislative action. It has special duties assigned 
 to it with reference to the adulteration of foods 
 and drugs, and may, by its agents, bring offenders 
 to trial. Without doubt, the fact that the field of 
 its operations is comprehensive, untrammelled by 
 municipal limits and embracing whole communities 
 and large territories, adds value to its conclusions 
 and recommendations by relieving them of local 
 or sectional influences. It is a pleasure to ac- 
 knowledge publicly that, in all its investigations, 
 the board has had the hearty co-operation and 
 assistance of the members of this Society. 
 
 But the cynic will ask, of what use is all this 
 cumbrous, expensive and complicated sanitary ma- 
 chinery ? Of what value has it been to the State? 
 Do not epidemic diseases prevail just as they did 
 before all this legislation was piled up for our 
 admiration? Has not pandemic influenza stalked 
 defiantly around the world again and again in the 
 last three years, without the least hindrance from 
 any source? Do not scarlatina and diphtheria 
 enter our households and take possession in spite 
 of all precautions, official and personal, devised to 
 bar them out? Do not the children die by hun- 
 dreds in August, and the grand-parents perish by 
 the score in March, just as they did a century ago? 
 Has tuberculosis been controlled? 
 
AND THE COMMONWEALTH. 
 
 45 
 
 To all such pessimistic questioning, full answer 
 has been made in the impressive address to which 
 you listened three years ago , 1 and in the thought- 
 ful essay 2 of last evening. It is unnecessary for 
 me to add to their authoritative statements. But 
 it is not improper to remind the sceptic that the 
 general mortality rate has been made to diminish; 
 that the average duration of life has been appre- 
 ciably increased; that in communities which use 
 vaccination with reasonable fidelity, small-pox is 
 rare enough to be a luxury; that typhus fever, 
 once so common, is now a genuine medical curios- 
 ity, and to most physicians is as unfamiliar a 
 subject for Ira” clinical study as a case of the 
 plague. Is it of no consequence, moreover, that 
 dwelling-house architecture has followed the ad- 
 monitions of physicians and sanitarians and that 
 ventilation and drainage are no longer left to 
 chance? Is it of no importance that the water- 
 supplies of the State are more carefully protected 
 from pollution than ever before, and that every 
 new supply is critically tested in all its relations, 
 physical, chemical and biological, before it is 
 accepted? Is it of no significance that the men 
 and women of to-day find in athletic exercise and 
 out-door recreation the surest road to robust 
 health? These are some of the queries that are 
 suggested by doubts of the unbeliever in sanitary 
 teachings aud practice. To you, who have always 
 been in harmony with the progressive spirit in 
 
 1 The Annual Address for 1889, by Dr. H. P. Walcott. 
 
 2 The Shattuck Lecture for 1892, by Dr. J. F. A. Adams. 
 
46 
 
 THE MEDICAL PROFESSION 
 
 Massachusetts which is embodied in her health 
 laws, obstructive criticism will appear unworthy 
 of serious reply. Preventive medicine looks to 
 the future hopefully. Many of its problems will 
 be solved by the trained bacteriologist whose 
 greatest achievements are still before him. Public 
 sentiment will approve more stringent methods 
 in the preventive management of communicable 
 diseases. Tenement blocks for the poor will be 
 better adapted to their purposes. And in all 
 measures — scientific, practical, administrative — the 
 commonwealth, in the future as in the past, will 
 look to us and our successors as its best allies and 
 most efficient ^agents for the protection of the 
 people from harmful influences affecting life and 
 health. 
 
 There is one other department of the State’s 
 affairs to which I wish to refer briefly, because in 
 its administration our profession has been con- 
 spicuous. I allude to that chapter of the Public 
 Statutes entitled " Of Medical Examiners.” The 
 Massachusetts law relating to inquests is no longer 
 on trial as a questionable innovation; it has passed 
 the experimental stage and is now as permanent 
 and stable as any part of the judicial system of the 
 commonwealth. The practical experience of fifteen 
 years has demonstrated that the legislature of 
 1877 enacted a law of exceptional value, thoroughly 
 adapted to fulfil the purposes for which it was 
 designed. In all this period, only two material 
 amendments have been made, and neither of these 
 modified the essential principles and methods pecu- 
 
AND THE COMMONWEALTH. 
 
 47 
 
 liar to the original statute; one of these changes 
 simplified the disposal of the bodies of strangers 
 found dead, and the other required publicity of the 
 official records of medical examiners. In all its 
 main features, then, the new Massachusetts method 
 of conducting inquests has remained without 
 modification since it was put upon trial; and, as a 
 piece of experimental legislation, radically de- 
 parting from traditional and familiar usages, it has 
 accomplished most gratifying and successful re- 
 sults. And the reason for this is easy to com- 
 prehend. When the general court of 1877 de- 
 termined that the venerable but discredited and 
 abused system of investigating violent deaths by 
 means of coroners and their juries had outlived its 
 usefulness in Massachusetts, it was under an obli- 
 gation to substitute a legal mechanism that should 
 be simple, practicable, economical and trustworthy. 
 And this it did with such consummate success as to 
 challenge admiration. It provided a procedure 
 that accomplished the desired end promptly and 
 without friction. It differentiated the purely 
 medical elements of the inquiry from those which 
 were essentially judicial. It created a medical 
 officer whose sole function it should be to deter- 
 mine, in any case of mysterious or violent death, 
 the anatomical proofs of unlawful acts entering 
 into the cause of death; and it made his conclu- 
 sions upon this purely medical question the basis 
 for further inquest-proceedings by judges trained 
 in the methods of taking and sifting evidence and 
 required to solve the problem of accountability in 
 
48 
 
 THE MEDICAL PROFESSION 
 
 the case. The initial stage, then, of the inquest 
 is always the medical determination of the cause 
 and manner of the death, and for this determination 
 the law provides ample resources. 
 
 It is obvious that the responsibility resting on 
 the medical examiner in the discharge of such a 
 duty is not of a trivial character. In simple cases, 
 even, where his observations are but confirmatory 
 of evidence clearly established beforehand, he can- 
 not regard his task as a slight one. Suppose a 
 person to have been murdered by a pistol-shot 
 wound in the presence of witnesses; the tracing 
 of the missile through the dead body, with accurate 
 study of its course, direction and lesions in the 
 various organs and tissues, made and described in 
 such a manner as to be clearly intelligible to a 
 jury and creditable to the witness, is an exercise 
 which calls forth the best activities of the medical 
 mind. But such instances are not those which test 
 the merits of our Massachusetts system of inquests 
 most conclusively. The highest evidence of its 
 value is found in the mysterious cases in which 
 there is entire want of such information as may 
 furnish a correct guide to the examiner in his pro- 
 ceedings; or in cases wherein the facts are pur- 
 posely and wilfully concealed, or falsely stated, 
 with the intent to cover a crime. A young, un- 
 married woman dies suddenly in the office of a 
 physician, to whom she has gone for advice and 
 treatment; if the medical examiner believes the 
 doctor’s ready statement and his circumstantial 
 account of the affair, he will call the cause of the 
 
AND THE COMMONWEALTH. 
 
 49 
 
 death " heart failure ” and demonstrate his own 
 failure in the discharge of a delicate duty; but if 
 he recognizes his obligation as a public officer, 
 standing between the community and the commis- 
 sion of crime, he will push his investigation beyond 
 the voluntary statements of interested persons, 
 and he may be rewarded by finding that the fatal 
 issue was the result of an abortionist’s manipula- 
 tions upon a pregnant womb, admitting air to the 
 blood-vessels and causing a death by unlawful 
 violence. Such an instance illustrates the possi- 
 bilities for usefulness and efficiency which our 
 system offers; it shows that to the qualities of 
 ability, discretion and learning, which the statute 
 requires of medical examiners, there may properly 
 be added a wholesome incredulity in doubtful 
 cases, a conservative agnosticism which refuses to 
 believe that which is not demonstrated. 
 
 That the Massachusetts method of conducting 
 these inquiries is acceptable is shown by the entire 
 absence of real criticism, as well as by the cordial 
 approval of jurists who have studied its details. 
 It has commended itself to the authorities of other 
 States, who find in it the indications of a great ad- 
 vance in comparison with the clumsy and inverted 
 coroner system. It is quiet in its operation. It 
 does not, by the exercise of noisy authority, upset 
 and demoralize households overshadowed by re- 
 cent grief. Its results are certain and tangible. 
 It secures for use at trials for homicide the testi- 
 mony of trained men well fitted by experience to 
 be witnesses. It has absolutely eliminated all 
 4 
 
50 
 
 THE MEDICAL PROFESSION 
 
 scandal and sensationalism from inquest proceed- 
 ings. It has saved money to the county treasuries, 
 at the same time affording better service to the 
 people. Incidentally, it has gathered a large 
 amount of valuable medico-legal observations in 
 the transactions of the society conducted by the 
 medical examiners, and it has supplied material for 
 a full annual course of practical study in legal 
 medicine to the students of the Harvard Medical 
 School. 
 
 The credit for suggesting and initiating the re- 
 form which has wrought these results, and for 
 framing the legislative bill whose enactment made 
 the reform practical, belongs to a single member 
 of the Suffolk bar . 1 The credit for making the 
 change an accomplished fact belongs largely to a 
 few representative members of this Society, who 
 persistently and effectively urged the arguments in 
 its favor, and, in the face of determined opposition, 
 convinced the legislature that a new method of 
 inquests was imperatively needed. But the credit 
 of making the law itself, once enacted, a success, 
 rests with the medical men who have been com- 
 missioned to administer it. Left to the care of a body 
 of selfish, reckless or weak men, appointed indis- 
 criminately, this law would have quickly fallen into 
 disrepute. But it has not been so left. The corps 
 of medical examiners in commission to-day repre- 
 sents a selection made with care by the executive 
 of the State. From the time of the first appoint- 
 ments down to the present, the office has been 
 
 1 Theodore H. Tyndale, Esq. 
 
AND THE COMMONWEALTH. 
 
 51 
 
 kept out of the demoralizing influences of partisan 
 politics, and for this the community should be 
 cordially grateful. The large quota which this 
 Society has supplied to the present ranks of this 
 useful corps 1 contains jsome of the best representa- 
 tives of the medical profession in Massachusetts; 
 the same is true of the recent past, and when I 
 recall to your minds the names of Hosmer, and 
 Cogswell, and Russell, and Winsor, among the 
 dead, who while living served in this relation, you 
 will not marvel that the law has been administered 
 successfully, for it has been administered by con- 
 scientious medical men striving faithfully to per- 
 form their duty. In the last fifteen years, these 
 medical examiners, drawn largely from the Massa- 
 chusetts Medical Society, have investigated the 
 circumstances of more than twenty thousand 
 deaths, and it is not an exaggeration to say that 
 no method has yet been suggested by which this 
 great medico-legal service could have been dis- 
 charged so efficiently, with proper guarantees for 
 the protection of the interests of society and the 
 administration of justice. 
 
 From this allusion to a special medico-legal 
 function of great responsibility which our Fellows 
 are discharging acceptably, the transition is easy 
 to a consideration of the relationship which our 
 profession, in general, bears to the judicial depart- 
 ment of the commonwealth. 
 
 III. To state the proposition broadly, the 
 medical man finds himself in a court of justice 
 
 Sixty- four out of seventy- three. 
 
52 
 
 THE MEDICAL PROFESSION 
 
 under the same exigencies which occur to the 
 ordinary citizen, service on the jury alone ex- 
 cepted. He is either a plaintiff seeking reparation 
 for alleged wrong, or a defendant meeting a charge 
 of wrong-doing, or a witness summoned to testify 
 in an issue to wdiich others are the parties. Al- 
 though these are the three varieties of necessity 
 which take him, as they take others, out of the 
 routine of daily life, and subject him to novel ex- 
 periences more or less unpleasant, he is conscious 
 that his vocation as a physician places him in a 
 peculiar attitude unlike that of the layman. And 
 it is these peculiarities characterizing our position 
 in court that I now ask you to consider with me. 
 
 As a plaintiff, appealing to the judicial depart- 
 ment of the State to settle the issues of a quarrel 
 or to determine the money value of imputed 
 wrongs, or to solve for him other problems of a 
 similar nature, involving the law of contract, or tort, 
 or trespass, the physician is a spectacle of extreme 
 rarity. I think it can be claimed with confidence 
 that medical men, whatever their other character- 
 istics may be, are not noted for litigiousness. 
 They do not readily engage in contention. They 
 are generally too busy to find in the behavior of 
 their fellow-men the occasion for law-suits. Al- 
 though there is a certain hypersesthesia which is 
 said to apply to the profession in connection with 
 the subject of medical etiquette, this never finds 
 its way to the gates of the temple of justice; and 
 in the ordinary affairs of life the doctor of medicine 
 is seldom found on the hither side of the abbre- 
 
AND THE COMMONWEALTH. 
 
 53 
 
 viatecl Latinism which in the court docket stands 
 as a low barrier over which the parties to a suit 
 defy each other. If litigation brought into being 
 by physicians were the only business which en- 
 gaged the attention of juries or equity sessions, 
 the courts would have long vacations and the 
 practitioners of law would find other more pro- 
 fitable employment. The doctor in court as a 
 plaintiff, then, need not detain us longer. 
 
 But with the doctor in court as a defendant, 
 strenuously bending his energies and using his 
 resources to resent an imputation upon his skill 
 and care, the case presents a theme of serious 
 interest, for it concerns the whole domain of our 
 legal rights as medical practitioners. Most of the 
 suits in which physicians are the defendants are 
 actions instituted by former patients to recover 
 damages for alleged malpractice. The fact sug- 
 gests, at the very outset, some consideration of 
 the obligations which the law imposes on physi- 
 cians and surgeons in their treatment of the sick 
 and injured persons who employ them. 
 
 To the medical man as he stands in the presence 
 of a person who has summoned him for professional 
 aid and counsel in time of suffering, the law says: 
 " You were under no obligation to respond to the 
 summons which called you to this bedside. This 
 person had no lawful claim upon you for your 
 services. However strongly selfish interest, ex- 
 pediency, prudence, or humanity may have urged 
 you hither, you had the right to decline the call 
 and to remain at home in comfort, if you so 
 
54 
 
 THE MEDICAL PROFESSION 
 
 desired. But having responded, and having under- 
 taken the care of this case, you have assumed 
 certain obligations which the law fully recognizes, 
 and which you cannot avoid, except at the risk of 
 losing both money and reputation. 
 
 " Your obligation is that of an implied contract 
 which, though less formal and specific than an 
 express contract executed in writing, is not less 
 binding it its nature. 
 
 "You must continue in attendance here, and 
 may not abandon the case or desert the patient 
 without reasonable cause, or without allowing suffi- 
 cient time for the procurement of other attendance. 
 
 "In undertaking the medical care of this person, 
 you shall attend upon him with reasonable dili- 
 gence and skill, and you will be answerable to him 
 for any want of ordinary care, diligence and skill 
 which results in his injury. 
 
 "Under the obligations of the implied contract, 
 in accordance with which you are employed, you 
 do not warrant or insure that all the results of 
 your attendance shall be satisfactory, that there 
 shall be a perfect recovery, or that your treatment 
 shall effectually stand in the way of unexpected 
 complications. 
 
 "Your judgment relative to the application of 
 certain remedies or modes of treatment may err, and 
 the law will not hold you responsible for ill results 
 growing out of errors of judgment. But you en- 
 gage, under the law, to treat this case in such a 
 way that any injury which the patient suffers, in its 
 course or subsequently, cannot reasonably be 
 
AND THE COMMONWEALTH. 
 
 55 
 
 traced to a neglect of competent and ordinary care 
 and skill on your part as its proximate cause.” 
 
 Such are the principles established by the com- 
 mon law as the intangible environment of the 
 medical or surgical attendant for his guide and 
 control under the usual circumstances of his em- 
 ployment. They are the rules which underlie and 
 govern those actions of tort wherein the claim is 
 set up that negligence and unskilfulness on the 
 part of the medical attendant have caused injury 
 and distress to his patient, and that money will be 
 the proper remedy to heal the wrong imputed to 
 him. And it is reassuring to record the fact that 
 these rules and principles, however difficult they 
 may seem to be as practical guides, have been in 
 effect a shield rather than a menace to the inter- 
 ests of defendant physicians, and that the cases 
 are fortunately few in number in which it can 
 be said that unjust and unfounded verdicts have 
 been returned by juries upon the issue of impu- 
 ted negligence and unskilfulness; where verdicts 
 against the defendant have been recorded, the 
 testimony has usually left little question that the 
 decision was right, because the negligence charged 
 was really inexcusable on any reasonable ground. 
 
 But while this is true concerning the issue of 
 suits for damages, it is also true that the law 
 interposes no obstacle in the way of initiating such 
 suits. Let us suppose that the medical attendant 
 has done all that the law requires in the care of 
 his case, that he has to the best of his ability used 
 ordinary and reasonable skill and diligence and 
 
56 
 
 THE MEDICAL PROFESSION 
 
 has avoided all measures that could be criticised 
 as experimental, he may nevertheless, through 
 circumstances and conditions over which he has 
 no control, find himself a defendant in an action 
 of tort brought by his patient. Perhaps the dis- 
 located shoulder which he has reduced months 
 ago, with proper attention to all surgical details, 
 persists in giving pain and in refusing to resume 
 its mobility. Perhaps the fractured femur is re- 
 stored to duty with a permanent and irremediable 
 though unavoidable shortening. Perhaps the 
 broken forearm, when taken out of the splints, 
 has an uncomely deformity in spite of the most 
 assiduous care. Or, in a puerperal case, perhaps 
 the woman on her recovery finds that she has a 
 disgusting leakage of urine through a fistula in 
 the vesico-vaginal septum, and she remembers that 
 the doctor used forceps to deliver her; but she 
 forgets that she consented to their use only after 
 hours of ineffectual labor, during wdiich the child’s 
 head lay low down, without progress, pressing 
 upon the very spot that is now the seat of her 
 misery. In any of these events, whatever has 
 happened out of the ordinary course, it is easiest 
 to blame the attending physician for it; and the 
 next step is equally easy, the initial step in the 
 proceedings for what is called " getting satisfac- 
 tion.” However clear the attendant’s conscience 
 may be that he is not blameworthy; however 
 positive his memory may be that he has done 
 nothing and has omitted nothing in his attendance 
 that was in violation of the soundest teaching and 
 
AND THE COMMONWEALTH. 
 
 57 
 
 the tests of experience, these will not save him 
 from the trouble and expense of defending him- 
 self against the charge of negligence and unskil- 
 fulness as it is formulated and openly made in 
 court. The story is an old and familiar one. 
 Too often the motive that initiates the suit and 
 urges it forward is a most unworthy one, and is 
 scarcely to be distinguished from the wickedness 
 of blackmail. Too often it is nurtured and stimu- 
 lated by lawyers more hungry for plunder than 
 ambitious for a good name. Too often it is encour- 
 aged by the unfriendly words and actions of pro- 
 fessional rivals. Sometimes, no doubt, a suit is 
 well founded and the complainant really believes 
 in the justice of the complaint, and is candid in 
 accusing the physician of carelessness; but such 
 apparently well-founded instances are exceptional, 
 as we all know, and they cannot bear comparison 
 with the number of suits brought with discreditable 
 motives. Over these prosecutions, the physician 
 is powerless to bring any control ; however strong 
 his defence may be, he cannot prevent a trial, with 
 all its annoyances, risks and costs, except by 
 adopting the course of paying money to settle the 
 claim out of court, — a course which any self- 
 respecting medical man will not adopt, though 
 sorely tempted to escape thereby all the wretched 
 miseries of a jury trial. 
 
 This constant menace of unjust lawsuits which 
 every physician, and especially every surgeon, has 
 constantly before him, as the law is now practised, 
 is an evil which we may properly criticise and 
 
58 
 
 THE MEDICAL PROFESSION 
 
 denounce. There is one remedy for it which 
 might well have general application; if every com- 
 plainant of the class we are considering were re- 
 quired, upon initiating the suit, to demonstrate his 
 sincerity in the justice of his cause by filing a 
 sufficient bond, with sureties, to indemnify the de- 
 fendant physician for all the costs of the trial if 
 the jury should give a verdict unfavorable to his 
 claim, we should hear far less of these iniquitous 
 suits than we now do. 
 
 It has often been suggested that, in view of 
 their liability to unwarranted claims for malprac- 
 tice, medical men would do well to organize co- 
 operative defence unions for their own protection. 
 Such a suggestion has much to make it attractive, 
 and it has actually borne fruit in England in a 
 flourishing and fully equipped association pre- 
 pared to assist its members when they are brought 
 to bar as the victims of irritable, or avaricious, or 
 depraved human nature. The way is so easy for 
 ungrateful or unprincipled convalescents to institute 
 charges, and it is so burdensome and costly to re- 
 fute such charges, that a medical defence union 
 appeals to the imagination very strongly as a real 
 relief. But while such a fellowship might serve 
 to deter the unscrupulous from bringing suits 
 against physicians, in such suits as are pressed to 
 trial, the appearance of a medical defendant backed 
 by the money and the sympathy of a numerous 
 company of his professional brethren might have 
 a reactionary effect upon jurymen, who are notori- 
 ously ready to render verdicts against corporations 
 and corporate interests. 
 
AND THE COMMONWEALTH. 
 
 59 
 
 But the incivilities of the so-called civil suits 
 which we have been studying do not exhaust the 
 opportunities offered to physicians to become de- 
 fendants in legal proceedings. There is a kind 
 or a degree of negligence and unskilfulness which, 
 while offering no bar to an action of tort, is suffi- 
 cient ground for the State’s interference and may 
 become a subject of investigation on a criminal 
 charge. It is when the death of a patient is 
 charged to the carelessness or ignorance of the 
 attending physician that the machinery for crimi- 
 nal prosecutions is set in motion for his discipline. 
 All law-writers use nearly identical terms in their 
 definition of the degree of dereliction which con- 
 stitutes criminal malpractice; and this general 
 definition is so tersely expressed by Mr. Bishop 
 in his work on Criminal Law that I quote it: "If 
 a person, whether a medical man or not, profess 
 to deal with the life or health of another, he is 
 bound to use competent skill and sufficient atten- 
 tion ; and if he cause the death of another through 
 a gross want of either, he will be guilty of man- 
 slaughter.” 
 
 It is, then, that degree of malpractice which the 
 law characterizes as " gross ” which renders the 
 practitioner liable to punishment under a criminal 
 charge. As in the law of civil malpractice, so 
 here, definitions hardly define; for the term 
 " gross ” conveys a relative and not an absolute 
 meaning, and in many cases where a man’s liberty, 
 or possibly his life, depended on the decision, a 
 real difficulty might easily arise in applying it. 
 
60 
 
 THE MEDICAL PROFESSION 
 
 When we remember that such a decision is to 
 come from twelve unenlightened and perhaps 
 prejudiced jurymen, we may well contemplate 
 with something akin to awe the immunity of med- 
 ical men, and feel a sense of gratitude that all 
 deaths are not made the subject of judicial in- 
 vestigation. On the other hand, however arbitrary 
 the criminal law may be in theory, the leading 
 cases which are reported demonstrate that, in 
 practice, medical defendants under the accusation 
 of criminal negligence have been dealt with 
 leniently. 
 
 Chief Justice Parsons, in his charge to the jury 
 in the notorious Thomson case, said there was no 
 reasonable doubt that the patient had died by the 
 unskilful treatment of the prisoner and that the 
 latter’s ignorance was very apparent; but that if 
 the prisoner acted with an honest intention and 
 expectation of curing the deceased by his dosing, 
 although death, unexpected by him, was the con- 
 sequence, he was not guilty of either murder or 
 manslaughter. The defendant’s acquittal followed 
 promptly. This statement of the law served as a 
 precedent in Massachusetts for seventy-five years. 
 It has been somewhat modified within the past 
 ten years, the Supreme Court having set aside a 
 convicted charlatan’s reliance upon it ; in this 
 latter case, it was decided that a verdict of guilty 
 was correct because the death, which followed the 
 prolonged swathing of ajwoman’s body with flan- 
 nels saturated with petroleum, was the result of 
 reckless and foolhardy presumption judged by the 
 
AND THE COMMONWEALTH. 
 
 61 
 
 standard of what would he reckless in a man of 
 ordinary prudence under the same circumstances. 
 
 But it is incomprehensible that any individual 
 in my present audience can have any personal or 
 direct interest in these legal decisions concerning 
 homicidal malpractice. The judicial history of 
 Massachusetts contains no mention of any repu- 
 table medical man in the position of a defendant 
 indicted for the destruction of his patient’s life 
 through gross carelessness or reckless and fool- 
 hardy presumption. Such an exhibition is mo- 
 nopolized by the representatives of quackery. 
 
 Let us turn, then, to a far more familiar relation- 
 ship between medical men and the courts of law, 
 that sustained by physicians as witnesses. Rightly 
 considered, the function of a medical witness 
 establishes one of the most dignified and honor- 
 able positions in the service of the commonwealth 
 which a member of the medical profession can 
 discharge. That the function has been abused 
 and has experienced a measure of disrepute, is 
 quite true. That there are certain features of it 
 which are deplorable and most unsatisfactory is 
 also true. But it is likewise true that, with all the 
 criticism and disparagement of which it has been 
 made the subject, medical evidence will continue 
 to be an indispensable element in judicial proceed- 
 ings, and the medical witness, if he be properly 
 equipped for his service, if he be duly appreciative 
 of the real responsibilities which rest upon him, 
 and if he studiously avoid certain well-defined 
 errors and evils which have grown up in connection 
 
62 
 
 THE MEDICAL PROFESSION 
 
 with medical testimony, has it in his power on 
 every occasion to command the respect of all who 
 observe him, and to be, in the court of justice as 
 in the sick-room, the representative of sound learn- 
 ing and of manly deportment. 
 
 It has been customary, in treating of medical 
 evidence, to classify medical witnesses as of two 
 distinct varieties, according to the assumed 
 character of their testimony ; they are regarded as 
 ordinary witnesses if they testify to facts, and as 
 expert witnesses if they express opinions or under- 
 take to interpret facts. This purely arbitrary dis- 
 tinction has had a mischievous tendency affecting 
 every medical witness, hampering his usefulness 
 on the witness-stand and opening the way to faulty 
 practices. The differentiation of facts from opin- 
 ions is of service practically, so far as physicians 
 are concerned, in establishing a basis for remuner- 
 ation and in impressing juries favorably by creating 
 a presumption of superior attainments on the part 
 of so-called experts. But if we recall the usual 
 methods under which medical witnesses are em- 
 ployed, we shall see how artificial is such an attempt 
 at classification. The truth is that nearly every 
 piece of medical testimony is a composite of facts 
 and opinions in which the facts largely predomi- 
 nate. But they are medical facts, the correct de- 
 termination and statement of which require medical 
 knowledge, skilled training, and a special aptitude. 
 In a trial for homicide, for example, the medical 
 examiner who describes the post-mortem appear- 
 ances observed at the autopsy is dealing with 
 
AND THE COMMONWEALTH. 
 
 63 
 
 anatomical facts, and the correct inference of the 
 cause and manner of the death rests, as an incident 
 only, on these many ascertained data, the fruit of 
 his observation. So, too, when the chemist ex- 
 hibits to the jury the arsenical mirror which is the 
 result of his analysis of suspected organs or rem- 
 nants of food, he is submitting, not opinions, but 
 incontrovertible facts. When Professor Wood, in 
 a recent capital trial in a neighboring State, de- 
 scribed the methods and stated the results of 
 hundreds of micrometric observations of blood- 
 globules recovered by him from stains upon 
 clothing worn by the accused, and testified that 
 his observations were consistent with the view 
 that the stains were made with human blood, he 
 was giving medical facts. When Professor Austin 
 Flint testified that in his microscopic and chemical 
 examination of the material found under the finger- 
 nails and on the clothing of a degraded criminal 
 accused of the murder of a woman and the muti- 
 lation of her body, he detected crystals of tyrosine 
 and other substances which must have come from 
 no other part of the intestinal tract than that found 
 cut open in the victim’s abdomen, he was giving 
 an indisputable physiological demonstration of 
 objective facts, which fastened the guilt of the 
 homicide upon the prisoner. When Professor 
 Jeffries Wyman, in the memorable case which so 
 engrossed public interest in this community in 
 1850, established by his evidence the identification 
 of a mutilated human body, the work that he did 
 was not guess-work, but was again a demon- 
 
64 
 
 THE MEDICAL PROFESSION 
 
 stration based upon accurately observed anatomical 
 material. 
 
 These are illustrations of the highest type of 
 medical testimony, commonly called expert, but 
 really an extraordinary grade of ordinary testi- 
 mony relating to facts. The same principle is 
 seen in the numerous civil suits growing out of 
 imputed negligence, whereby accidental injuries 
 result. The testimony of medical men connected 
 with these cases is largely directed to the descrip- 
 tion of symptoms and conditions of a purely 
 physical and objective character; to the establish- 
 ment of the proof of genuine lesions and the 
 elimination of what is subjective or feigned; to 
 the reasonable connection of well-ascertained 
 causes and effects. Even in the comparatively 
 rare cases in which a medical man answers purely 
 hypothetical questions, and gives his opinion upon 
 assumed facts, of which he has no personal proof, 
 the examination does not end with this exhibition 
 of the expert’s technical office, but wanders away 
 into the various regions of medical knowledge 
 pertinent to the questions at issue; the hypothe- 
 tical recedes from view and the actual becomes 
 prominent. 
 
 Conversely, the physician who responds to a 
 subpoena as an ordinary witness, without any inti- 
 mation that his testimony will extend beyond 
 simple matters of fact, is generally asked some 
 questions when on the witness-stand which call for 
 the expression of an opinion; and this entitles him 
 to recognition and remuneration as an expert. 
 
AND THE COMMONWEALTH. 
 
 65 
 
 He may evade the dilemma by declining to answer 
 the questions, and may, for his reward, have a 
 mercenary element imputed to his motives. Or he 
 may take the risk of personal embarrassment by 
 attempting to formulate on the spot opinions on 
 difficult issues adroitly presented. In either event, 
 the fact remains that a purpose has been shown to 
 use him as a medical expert when his call to court 
 gave no suggestion of such a purpose. 
 
 The conclusion, then, which I wish to draw 
 from these considerations is that all medical testi- 
 mony is of the nature of skilled service, and de- 
 serves appreciation as such. The State has no 
 right to place the usual low value on evidence 
 which, though denominated w ordinary,” implies 
 under every possible contingency an adequate 
 degree of learning, skill and training in medicine. 
 It has been held repeatedly that knowledge, in 
 science or art, is its possessor’s capital, accumu- 
 lated through years of study and application; and 
 that neither the commonwealth nor any individual 
 can make any lawful requisition upon that capital 
 without substantial reimbursement. This is the 
 well-recognized and universally applied rule 
 governing the employment of medical experts, 
 who go to court to state opinions with facts. 
 Why should not the same rule attach to the ser- 
 vices of surgeons and physicians who, heeding the 
 peremptory summons, respond as witnesses to give 
 evidence of clinical facts, of physical appearances, 
 the presence or absence of signs and symptoms, 
 and all those other matters the correct observation 
 5 
 
66 
 
 THE MEDICAL PROFESSION 
 
 ancl description of which require a definite amount 
 of knowledge, the fruit of much patient study 
 or long experience? The demand which in the 
 name of the commonwealth is made upon medical 
 men, wasting their time in tiresome delay, in- 
 terrupting their professional routine of duty, 
 subjecting them to disagreeable and irritating 
 experiences, extorting from them facts acquired 
 under the confidential relations of the sick-room, 
 is not one which, under prevailing conditions, is 
 answered with cordiality. It is among the un- 
 pleasant incidents of professional life. It reminds 
 us that of all departments of our practical work, 
 the medico-legal service is the only one which we 
 cannot control, or evade, or transfer to others. 
 The call of a judicial summons is imperative, and 
 physical disability will alone excuse its neglect. 
 When, therefore, we consider the nature of the 
 testimony which the medical witness will impart, 
 its indispensable value in determining disputed 
 questions, and the degree of technical knowledge 
 required for its correct presentation, we do not 
 exceed propriety if we ask that the State shall in 
 some way provide fit methods for the adequate 
 reward of such involuntary service, or shall place all 
 purely medical testimony in the relation now held 
 by expert testimony and subject to the ordinary 
 customs of preliminary adjustment and agreement. 
 
 One other feature of medical testimony solicits 
 attention; it relates to the deportment of the wit- 
 ness in court. The ideal medical witness possesses 
 these qualities: his demeanor is dignified and un- 
 
AND THE COMMONWEALTH. 
 
 67 
 
 constrained; he has large stores of well-seasoned 
 knowledge; he is quick in apprehension, firm and 
 immovable in his convictions, but conservative and 
 judicial in reaching them; he has a retentive 
 memory, a reserved courage and an imperturbable 
 temper; he is terse, direct, clear and concise in 
 statement, and especially is an adept at translating 
 every technical term into words and phrases clearly 
 intelligible to every juryman; he abhors garrulity, 
 flippancy and trickery; he aims to be candid and 
 strives to be impartial, disinterested and free from 
 bias. 
 
 Sometimes, though very rarely, one sees a phy- 
 sician on the witness-stand who represents faith- 
 fully all these requirements; he is the object of 
 our emulation and envy. Much more commonly, 
 however, medical testimony illustrates character- 
 istics quite in contrast with the ideal. The 
 physician whose methods on the witness-stand 
 we do not desire to copy is garrulous, affected, 
 pedantic, flippant, ready to engage in controversy, 
 dogmatic, and above all saturated with partisan- 
 ship. Of all these faults, the last is the most 
 common and conspicuous and the one which has 
 brought the greatest reproach on medical men as 
 witnesses; it is this which has led judges on the 
 bench to disparage and belittle medical experts; 
 which has caused writers on jurisprudence to dis- 
 credit their value; and which, in practice, has 
 induced juries to ignore their testimony altogether 
 in trying to reach a verdict. But while admitting 
 that partisanship is a too common element of medi- 
 
68 
 
 THE MEDICAL PROFESSION 
 
 cal evidence, I insist that it is an evil for which 
 medical men should not be held responsible. It 
 is the unavoidable and legitimate fruit of the con- 
 ditions under which the modern practice of the law 
 is pursued. The physician in the sick-room does 
 not exhibit the disposition here depicted; but place 
 him under the novel and subtle influences of the 
 court-room and he becomes another creature. In 
 this new relation, he inevitably finds himself 
 subject, in greater or less degree, to peculiar temp- 
 tations. For nearly all that is objectionable in the 
 exhibitions of partisanship made by medical wit- 
 nesses, I blame the methods under which such 
 experts are employed; the system, and not the 
 witness, is at fault. A case, for example, occurs 
 which offers an opportunity for the use of medical 
 testimony. You receive a politely insinuating 
 invitation from the counsel, to serve as an expert. 
 You do not inquire very closely into the grounds 
 that have determined the selection; you feel com- 
 plimented, at all events, and you consent to be 
 retained. Now, having fully committed yourself 
 to the service of your employer, your independence 
 is almost necessarily laid aside. You are expected 
 in preparing for the trial to develop all the ele- 
 ments in the case favorable to your employer’s 
 side only. The advocate consults with you, nour- 
 ishing in you a controlling partiality, and doing 
 all in his power to stimulate a cordial interest in 
 his client’s cause. The witness thus appproaches 
 the trial, expert chiefly as a partisan medical ad- 
 vocate. Against the insidious influences which 
 
AND THE COMMONWEALTH. 
 
 69 
 
 promote this surrender of mental equipoise, few 
 physicians could successfully defend their judg- 
 ment. Ordinarily, the exigencies of his service, 
 his sympathy with the client’s claim, his sense of 
 obligation to fulfil an implied contract, all draw 
 the medical witness from a judicial independence. 
 
 Then at the trial itself, still more compulsory in- 
 fluences encompass him. He now finds himself in 
 the arena, marshalled with others to defend his own 
 side, to defeat the opposing side. He is harassed 
 by the technical limitations of the rules of evi- 
 dence. Through the inability of lawyers to 
 conduct acceptably an examination on medical 
 subjects, he is made inadvertently to state views 
 which, under other circumstances, he would not 
 think of supporting. The leading questions with 
 which the cross-examination bristles ensnare him 
 into unexpected and embarrassing corners, out of 
 which the easiest way lies through extraordinary 
 expositions of medical knowledge. Professional 
 pride compels him to defend stoutly his position, a 
 retreat from the ground being deemed worse than 
 the blunder which took him there. First, last and 
 always, he is to shape his course with the single 
 aim of helping to win a verdict favorable to his 
 side, and of earning thereby the dollars which are 
 his reward for faithful service. 
 
 It is cause for regret that the English and 
 American methods of employing medical experts 
 have fallen away so far from the primitive practice. 
 Under the Roman law, the physician in court as 
 an expert witness held a relation of exceptional 
 
70 
 
 THE MEDICAL PROFESSION 
 
 honor and responsibility; he was amicus curias, 
 an independent and unprejudiced interpreter of 
 medical facts. He was summoned to instruct the 
 court and jury in matters of which they had, pre- 
 sumably, an imperfect knowledge. His duty was 
 to aid in establishing the whole truth. In such 
 a position, a physician occupied an office of honor. 
 He was chosen because of his fitness; he truly 
 represented his profession. And in still more 
 recent times, even down to the present period, the 
 system in vogue in France and Germany is far 
 in advance of our own in securing the end which 
 the theory of medical expert testimony designs. 
 Either under the German plan which provides for 
 official experts, or under the French method which 
 leaves the choice and employment of the expert to 
 the discretion of the court, the medico-legal re- 
 sults are admirable and in striking contrast with 
 the procedures with which we are familiar, and 
 which permit a suitor to come into court with a 
 company of medical Hessians enlisted to defeat 
 his opponent. 
 
 Now, what can be done — and this is the one 
 important question for consideration — to modify, 
 or, if need be, to revolutionize these unsatisfactory 
 methods? Without pausing to review the various 
 propositions that have been made from time to 
 time for accomplishing this end, I remark at the 
 outset that, as may readily be inferred from what 
 has been presented, the first thing to be desired is 
 the removal of the medical witness from the influ- 
 ences and temptations of partisanship; he must be 
 
AND THE COMMONWEALTH. 
 
 71 
 
 lifted far above the plane of bias. This is the 
 corner-stone on which the entire new structure 
 must be built, if the evils of which we complain at 
 present are to be eliminated. Other provisions are 
 mainly correlative and subordinate details growing 
 out of this. 
 
 To secure this end, the best way, because it is 
 the most in accord with American notions of fair- 
 ness, is that which would provide that the medical 
 expert in any action at law, civil or criminal, 
 should be the choice of the two parties interested 
 in the litigation; or, in the event of their disagree- 
 ment or neglect, the choice of the court . 1 Grant 
 this primary principle, and all other secondary 
 questions and exigencies will find comparatively 
 easy adjustment. The advantages of such an in- 
 novation, both theoretical and practical, are too 
 plain to be mistaken. Theoretically, such a plan 
 would secure experts in fact as well as in name, 
 since it would obviously be for the interest of all 
 concerned that the best available medical judg- 
 ment should be obtained upon technical questions 
 involved in the issue on trial. Instead of the 
 present deplorable exhibitions, so amusing to 
 lawyers, so discreditable to our profession, so 
 subversive of justice, we should see a true repre- 
 sentative of medical science, selected because he 
 is recognized as such, appearing in court as the 
 interpreter of the medical data established in the 
 
 1 The practicability of this method was demonstrated by the New 
 Hampshire Supreme Court in a case which occurred during the prepara- 
 tion of this discourse. 
 
72 
 
 THE MEDICAL PROFESSION 
 
 evidence. We should see him the impartial ex- 
 ponent of the most recent authoritative advances 
 in science, as well as of the settled principles 
 which are the fruit of long experience. We 
 should see him, with the same judicial indepen- 
 dence which the presiding justice himself must dis- 
 play, passing judgment, without fear or favor, on 
 matters which legitimately fall to his office as an 
 expert. There would be little danger that this 
 altogether honorable function would fall into un- 
 worthy hands under such a system; the man 
 chosen would, from the necessities of the case, be 
 well known as the possessor of knowledge fitting 
 him to comprehend and to elucidate the points 
 presented in the testimony. The man of pro- 
 nounced and peculiar views, the man of hobbies, 
 would not be sought; his judgment is already 
 discounted. 
 
 In practice, the expert thus selected would 
 make such investigations as the case demanded, 
 would listen to all the testimony, and at the proper 
 time would report his conclusions, either as oral 
 evidence or, preferably, in the form of a written 
 statement. Here w r ould occur au opportunity for 
 professional distinction. The name of medical 
 expert, instead of conveying with it a questionable 
 flavor, would become a term of good repute, at- 
 tracting rather than repelling the master-minds 
 in our profession ; while the many-sided questions 
 presented in legal suits and actions would offer 
 occasions for medico-legal reports such as have 
 made Germany and France confessedly the leaders 
 in forensic medicine. 
 
AND THE COMMONWEALTH. 
 
 73 
 
 But at just this point, the typical barrister, with 
 a gesture and in tones familiar to those of us who 
 have ever served as witnesses, says: "Stop a mo- 
 ment! I object!” And when asked to state his 
 objection, he replies: "I object because such a 
 scheme would interfere with the constitutional right 
 of the individual citizen to defend his life, person, 
 property or character by producing ' all proofs that 
 may be favorable to him.’ I object because when 
 I undertake to prosecute a suit at law or when I 
 am engaged to defend a client, I wish to know 
 precisely what the evidence favorable to my cause 
 is to be; I have no intention of remaining wholly 
 ignorant of the medical conclusions up to the time 
 of the expert’s appearance in court. Moreover, 
 I object because I will not waive my control over 
 all accessible proofs that will aid my purpose. I 
 am in court theoretically to see that justice is ad- 
 ministered; but I am here in reality to do what I 
 can to win a verdict for my client, and I wish, in 
 order to secure that end, to employ all lawful 
 means, including medical evidence of my own 
 choosing; and if this evidence is skilfully warped 
 and stretched to meet well the exigencies of my 
 claim, it will be so much the more useful and ac- 
 ceptable.” This is the lawyer’s view of the matter; 
 and it is this spirit which has hitherto stood as an 
 insuperable obstacle in the way of a much needed 
 reform of the present methods. It is a purely 
 selfish spirit held by a large part of the legal pro- 
 fession, but repudiated by a few conspicuous and 
 honorable exceptions. It will continue to offer 
 
74 
 
 THE MEDICAL PROFESSION 
 
 objections to the advent of better procedures, 
 however fully it may have been demonstrated that 
 they are entirely feasible and satisfactory in prac- 
 tice. 
 
 Meanwhile, we as physicians have a plain re- 
 source. When required to discharge the duty of 
 medical witnesses, let us diligently aim to illus- 
 trate a high standard. Let us avoid well-recog- 
 nized errors to the utmost of our ability. Let us 
 decline to act simultaneously as medical advocates 
 and medical witnesses. Let us endeavor to give 
 our testimony with the same candor and the same 
 independence which would characterize our state- 
 ments if instead of the peculiar environment of a 
 court of justice, we were in the presence of an 
 audience of friendly, but critical, medical asso- 
 ciates. Difficult as such a duty is, it is not im- 
 possible of performance. 
 
 IV. This review of the relationship which our 
 profession holds toward the commonwealth will be 
 incomplete without some reference, in conclusion, 
 to a still higher obligation resting on us. It is the 
 obligation of loyal citizenship, involving duties 
 superior to any of those which I have undertaken 
 to discuss. Men sometimes speak of citizenship 
 as a privilege, to be used or laid aside with easy 
 indifference. Properly considered, it is much 
 more than this; it is a living trust, a priceless 
 heritage, involving duties as well as rights. In 
 the presence of educated physicians, there is no 
 need to emphasize this. They recognize their 
 obligation and their opportunity, — their personal 
 
AND THE COMMONWEALTH. 
 
 75 
 
 obligation of earnest loyalty, their opportunity, 
 through the place they hold in the community and 
 in the household, to raise the level of civic virtue 
 by precept and example. To them, the service to 
 the State which the best type of citizenship pre- 
 sents is not expressed in political zeal, in greed 
 for office, or in an active partisanship which in 
 medical men is always especially offensive and 
 objectionable. It means, on the other hand, abso- 
 lute independence of all machine methods in 
 politics. It leaves practical politics to ” profes- 
 sional ” politicians, but it never fails or omits to 
 register its convictions through the agency of the 
 ballot. It is found in sympathy with all reason- 
 able methods of moral and social reform, but 
 avoids impracticable radicalism and sensationalism. 
 It stands for popular education and defends the 
 public schools from all assaults, overt or insidious, 
 that would impair their usefulness and freedom. 
 It insists on fidelity and honesty in official station. 
 It aims to aid in shaping a healthy public opinion 
 upon all matters pertaining to the welfare of society 
 and the elevation of mankind. It protests against 
 the fastidious indifference which too often marks 
 the attitude of educated men toward civic affairs. 
 When the nation’s life is assailed, it is found at 
 the front represented by such men as Derby and 
 Otis, and Sargent, and Hooker, and Bell and Ly- 
 man, adding new lustre to the proud title of 
 Massachusetts volunteers. 
 
 Fellows, these closing years of the nineteenth 
 century are making an extraordinary record of 
 
76 
 
 THE MEDICAL PROFESSION. 
 
 progress in all that pertains to the science and the 
 art of medicine. The brilliant, almost audacious, 
 achievements of modern surgery and the benefi- 
 cent triumphs of rational and preventive medicine, 
 inspire our admiration and stimulate our zeal. In 
 the rapid movements of our noble profession along 
 all the lines of advanced development, we find it 
 difficult to keep our leaders in sight; star-eyed 
 science certainly does not encourage loitering on 
 the part of her votaries. But while we strive to 
 keep in touch with this spirit of progress in all 
 that belongs to our domain as physicians, let us 
 not forget the claim which the commonwealth may 
 properly make upon us as citizens. Let us seek 
 earnestly, each in his own community, to illustrate 
 the highest ideals of loyalty and fidelity. So may 
 we, in a double sense, as physicians and as citi- 
 zens, discharge our duty to humanity.