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could never agree as to treatment. We use here the qualifying phrase, "if such circumstances should ever occur," because there are no doctors now who avowedly reject either "the accumulated experience of the profession," or "the aids actually furnished by anatomy, physiology, and organic chemistry"; and none, except the homeopathic fraternity, whose practice is based avowedly on "an exclusive dogma," and even of the homeopaths, it may be gravely doubted whether their practice is based so exclusively on the dogma of similia similibus curantur as they pretend it is.
The most fundamental reason which makes it incumbent on the regular profession to refuse professional fellowship to physicians who claim to belong to other and different schools, is to be found precisely in this fact, that they have deserted from our ranks, have chosen to march under alien flags, have violated our discipline, and proclaimed to the world their own superior claims to the world's confidence, and especially to the world's patronage. Upon this reason is based the rule in regard to consultations of the Royal college of physicians of London, which is in these words:
"While the college has no desire to fetter the opinion of its members in reference to any theories they may see fit to adopt in connection with the practice of medicine, it nevertheless considers it desirable to express its conviction that the assumption or acceptance by members of the profession of designations implying the adoption of special modes of treatment is opposed to those principles of the freedom and dignity of the profession which should govern the relations of its members to each other and to the public. The college, therefore, expects that all its fellows, members, and licentiates, will uphold these principles by discountenancing those who trade upon such designations."
In the great republic of medicine opinion is free. If a man in the treatment of diseases exhibits medicines not commonly used, does that make him an irregular? not at all. If a man treats diseases in accordance with some particular theory of their essential nature, does that make him an irregular? not at all. Within the ranks of the regular profession a man may entertain whatever theories of diseases he pleases; and in the treatment of diseases he may employ whatever medicines he pleases; and in the administration of medicines he may give whatever doses he pleases, and still no one will think of denouncing him as an irregular. He may be regarded as eccentric, or unsafe, or ignorant, but not as irregular. Amongst regular physicians there are eccentric, and unsafe and ignorant men. Amongst irregular physicians there are doubtless men who are not eccentric, who are not unsafe, and who are not ignorant.
Hahneman, the father of homeopathy, notwithstanding his eccentric doctrines-his doctrine of similia similibus curantur-his doctrine of dynamization and infinitessmial doses, and his doctrine of the fundamental pathological importance of psora-lived and died a member of the regular medical profesion, and nobody dreamed of turning him out. The followers of Hahneman became irregulars when they, of their own
free will and accord, cut themselves off from the fellowship and discipline of the profession, and adopted for themselves a distinctive sectarian designation—a patent trade mark.
A little different is the history of the eclectics. They had their origin in the movement started two or three generations ago by Samuel Thompson, who denounced all the learning of the schools, tabooed all mineral medicines, and treated all the ills that flesh is heir to by lobelia, stimulation and steam. Being withal a thrifty man, this mode of treatment he patented, and this patent he peddled industriously through several states, selling the privilege of using it, together with a little book of instructions, for the sum of twenty-five dollars. A great many doctors were made by this summary process. They were commonly called steamers. A few of them still survive in remote rural neighborhoods, and some of these have been admitted to membership in the Eclectic State Medical Association. These people being engaged in the practice of medicine naturally began to read other medical books besides Thompson's little manual. As they read their ideas expanded; some of them began to write books themselves; and finally they assumed the name of botanics, and began to build up medical colleges. They made large use of the indigeneous materia medica, refrained from the employment of mineral remedies generally, and even amongst vegetable remedies denounced all the more powerful as dangerous poisons. The more these botanics taught and studied medicine the more their conception of its powers and resources widened. They began to use the feruginous tonics, and some of the salts of potash; and then they began, surreptitiously at first, to use that class of vegetable remedies which they had before denounced as poisons, such as the various preparations of opium, and the cinchona alkaloids. While this process was going on amongst them they became known as eclectics; and under this new name the same process of growth and appropriation has continued until now. All of their college bred men are in virtual agreement with the regular profession in their theory and practice of medicine, and in their materia medica. The name eclectic, by which they are still known, has degenerated into a trade mark, and even as such is unveracious and misleading. The men engaged in the practice of medicine who apply it to themselves say virtually to the people: We have something to offer you in the treatment of your diseases very different from anything you can get from members of the regular profession. But when they say this they say something that has hardly a shadowy vestige of truth left in it.
Having thus lost everything distinctive in the way of principles, and in the way of remedies, in the very nature of things they must cease to exist. As a matter of fact they are dying out. Their colleges are less numerous and less prosperous than before the war, and the number of their practitioners is continually diminishing, at least in Alabama, and in the south generally.
In the meantime, however, they remain ethically irregular—are ethically irregular for the very reason they separate themselves from
the regular profession by retaining a distinctive designation, and by practicing medicine under a trade mark.
But is this the sort of irregularity contemplated by the law? Evidently not so. Misled, just as the general public is, by imperfect information, the makers of the law were unquestionably under the impression that eclectics and homeopaths pursue systems of practice; that are different in some essential way from that pursued by the regular medical profession-different in pathological doctrines, or in the treatment of diseases, or in the remedies employed, or in the manner of their administration. Since the foregoing argument was written the American Medical Association has taken action in regard to the issue presented by the adoption at its New Orleans session of the following preamble and resolutions:
Whereas, Persistent misrepresentations have been and are still being made concerning the provisions of the Code of Ethics of the American Medical Association, which many, even in the ranks of the profession, are led to believe-as, for instance, that the Code excludes persons from professional recognition simply because of difference of opinion on doctrines-therefore
Resolved, First, That Clause I, Article IV, of the National Code of Medical Ethics, is not to be interpreted as excluding from professional fellowship on the ground of difference in doctrine or belief those who in other respects are entitled to be members of the regular medical profession. Neither is their any other article or clause in the said Code of Ethics that interferes with the most perfect liberty of individual opinion and practice.
Second, That it constitutes voluntary disconnection or withdrawal from the medical profession proper to assume a title indicating to the public an exclusive or sectarian system of practice, or to belong to an association or party antagonistic to the general medical profession. Third, That there is no provision in the National Code of Medical Ethics in anywise inconsistent with the broadest dictates of humanity, and that the article of the Code which relates to consultation can not be correctly interpreted as inderdicting under any circumstances the rendering of professional services whenever there is pressing or immediate need of them; on the contrary, to meet promptly the emergencies of disease, or accident, and to give a helping hand without unnecessary delay is a duty fully enjoined on every member of the profession, both by the better and the spirit of the Code. But no such emergencies or circumstances can make it necessary or proper to enter into formal professional consultations with those who have voluntarily disconnected themselves from the regular medical profession in the manner indicated by the preceding resolution.
REMARKS ON THE ORDINANCE IN RELATION TO FEE BILLS.
The ordinance in relation to fee-bills was passed at the annual session of the Association held in Birmingham in 1877.
In order that it may be fairly understood, the argument which was submitted in connection with it by Dr. Jerome Cochran is here appended:
There is hardly any other question in connection with the practice of medicine that has more frequently led to the disturbance of professional harmony than the question of medical fees.
The principle of commercial competition, which has been accepted in so many of the departments of human industry and enterprise, as pcrfectly legitimate in the regulation of prices, has been held by the learned professions of all ages and countries as dishonorable and degrading. In the medical profession, especially, it has always been regarded as in the highest degree disreputable for physicians to seek to acquire popular reputation and to attract practice by offering to the community the inducement of low fees; and this, too, not because physicians have thought it to be legitimate to speculate in human suffering, and to convert the hopes and fears of their patrons into instruments of extortion. On the contrary, it has always been a maxim of the profession that the poor also were entitled to the benefit of their ministrations as well as the rich; and the physician's skill has never been rated at inflexible. fixed prices like commodities that are sold in the market. "The poor," says Boerhaave, “are the best customers, because God will be the paymaster;" and amongst all of the older writers on medical ethics, we find that any compensation which a physician receives, is mentioned rather as an honorarium freely bestowed, then as a debt collected. Indeed, it has been the rule with some of the most illustrious members of the profession never to make out bills, or to fix any specific price upon services. This is said to have been the case with Sir Astley Cooper, the most suceessful of English surgeons; and with Von Graefe, the great German occulist, recently deceased; both of whom were accustomed to leave the question of compensation to be settled by the gratitude and generosity of their patients.
I quote here, as entirely suited to the object I have in view, a paragraph from the very excellent code of ethics adopted by the New York State Medical Society in 1823, as follows:
"The fees for the compensation of medical services are regulated by the value of currency and the price of necessaries in different countries and cities; by the customs approved and established among experienced and reputable practitioners, and sometimes by a recorded rate of charges such as individuals belonging to any trade or profession adopt by general consent. It must be recollected, however, that this last mode has been forbidden physicians and surgeons, in their corporate capacity, by a resolution of the State Medical Society of New York, in the year 1817. This is in conformity to the common law of England, according to which services rendered by advice cannot constitute a pecuniary debt, and much less in the medical profession, which "is too honorable," said a chief justice of that country, (Lord Erskine) "to be subjected to a defined rate of charges." It follows, from this, that medical services are not legally entitled to remuneration, except for the
employment of time, medicines and personal labor in attending upon the sick. But public opinion in a civilized nation, and among the more enlightened classes of society, will always highly estimate and liberally compensate medical services."
The principle here stated as the common law of England, became, of course, the common law of the English colonies in America, and remained the common law in many of these colonies after they became States of the American Union. We Americans, however, are a progressive people, and in the course of time many of the antique fashions and conservative principles of our English ancestors were thrown aside, this amongst the number. Medical colleges multiplied apace in the land, and the multiplication of colleges led, very naturally, to the multiplication of doctors, and the declension of the standard of qualification. Not to go into the details of this retrogressive movement, it is sufficient to say that the evil influence at work soon went far towards the degradation of a liberal profession into a trade; and led, amongst other things, to enactment by most, perhaps by all, of the states, of statute laws enabling doctors to collect medical bills in the courts according to the rates of charges common in the localities where the practice is done. For myself, although the declaration will no doubt appear eccentric to the members of this Association, I have no hesitation to avow my own preference for the old common law system, as being much nobler than the system of our American Statutes. As Sir Benjamin Brodie has expressed it, "Medicine is one of the noblest of the professions, but the worst of all possible trades;" and whatever has a tendency to assimilate medicine to the level of the trades, has a tendency to demoralize it.
But this, although illustrative of the principles upon which our discussion must proceed, is still somewhat of a digression. Let us return to the subject more immediately in hand.
The rule at present in force in this country in relation to medical fees is that contained in Article VII of the Code of Ethics of the American Medical Association. It is in the words following:
"Some general rules should be adopted by the faculty, in every town or district, relative to pecuniary acknowledgments from their patients; and it should be deemed a point of honor to adhere to these rules with as much uniformity as varying circumstances will admit."
The language of this section seems to be advisory, rather than mandatory. This is true, also, of all the provisions of the code of ethics, the measure of obligation being always expressed by 'ought,' or 'should' never by 'must' or 'shall.' Shall, indeed, occurs once or twice in the code; and 'must' about three times; but only in subordinate clauses and to avoid circumlocution.
The object of the code seems to be to make a statement of principles, which are of obligation, not simply because they have been endorsed by the profession, although this endorsement goes for something too, but chiefly because of their inherent propriety and righteousness.