History of medicine in New York : three centuries of medical progress /

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Ex ICtbrta

SEYMOUR DURST

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Chapter 1

S has been narrated in a preceding chapter, the organization of the present Medical Society of the State of New

York primarily grew out of a movement of the physicians of Saratoga county in 1796 and following years. However, a brief recapitulation is necessary to the continuity of the present narrative.

Toward the end of the eighteenth century, a number of members of the medical profession assembled in Saratoga county, intent upon the legal regulation of the practice of medicine through the establishment of a corporate body, empowered to grant or refuse license to practise. After repeated meetings without definite result, in November, 1805, at Saratoga, was held a meeting when definite action was taken by the adoption of a resolution inviting the co-operation of the physicians of the adjoining counties of "Washington and Montgomery, and urging ' ' the necessity of adopting some vigorous measures for the suppression of empiricism, and the encouragement of regular practitioners;" also reciting that ' ' the evil calls loudly for the united efforts of aU who sincerely wish to remove from that valuable science (of medicine) the imputation of quackery, under which, from the ignorance of some of its professors, it not unjustly labors. ' ' Drs. William Patrick, John Sterns and Grant Powell were constituted a committee of correspondence to forward the purposes expressed in the resolution.

At an adjourned meeting on January 16, 1806, a memorial to the legislature was adopted, and a committee aj)pointed to take it in charge. Dr. Asa Fitch, of Washington county; Dr. John Sterns, of Saratoga county, and Dr. Alexander Sheldon, of Montgomery county. The committee appeared before the legislature a^t its next session, and under most favorable conditions, one of its own members, Dr. Alexander Sheldon, being speaker of the House. In the second place, the committee rose above the trammels which obligated it, viz. : to procure legislation confined to the three counties which it directly represented; for it assumed the responsibility of making its cause general, and extending throughout the State the operations of the desired legislation.

The committee presented its memorial, accompanying it with an explanation of its reasons for desiring enlargement of the legislation originally contemplated. Reference was made to a committee consisting of William Livingston and Isaac Sargeant, of Washington county; Gurdon Huntington, of Otsego county; John Ely, of Greene county, and Joel Frost, of Westchester county — a majority being physicians. When the incorporating bill was reported to the House, it was vigorously supported by the speaker, the committee, and several other members.

However, a powerful opposition developed, which threatened its defeat by a large majority, '^notwithstanding all the exertions and political influence of its friends the danger to which the tranquillity of the State would be exposed by the incorporation of forty distinct associations of physicians, was so great, that but feeble hopes were entertained of its success." At this critical moment, the bill found its most potent advocate in Hon. William W. Van Ness. ''Perhaps the pre-eminent powers of his eloquence were never exerted with better effect. He refuted the arguments of the opposition, portrayed the benefits to the profession and the public in such glowing colors and with such energy and zeal, that the opposition became feeble, the friends to the bill increased, and from that moment a successful issue was rendered certain." The "Act to Incorporate Medical Societies for the Purpose of Regulating the Practice of Physic and Surgery in this State," passed April 4, 1806.

Considering that at the outset only the creation of county or district societies was sought for, it is not surprising that county societies should have been given powers coordinate with those of the State Society in the matter of licensing practitioners. On the other hand, the State Society was clothed with commanding importance and well-defined supremacy, inasmuch as it could override the action of a county society, and license a candidate whom the latter had rejected. It was evidently intended, however, that, while the State and county societies were created by the same instrument, each should in itself be independent ; and that the action of the former should not be dependent upon that of the latter. This seems worth noting, for some three-quarters of a century later, question arose as to the relationship between the State and the county societies, and the independence of the State organization was somewhat impugned. At the outset, the movement contemplated regulation of practice only within the northeastern counties of the State; but under discussion it broadened in scope, and eventually its provisions were made to embrace the entire State, under the Act of the Legislature of April 4, 1806. This was the first legislative recognition of a medical society in the United States.

Legislation is as much a matter of growth and development as is for instance, invention. In the Act of 1806 a brave attempt was made to remedy a great ill ; but when its provisions came to be applied, its deficiencies became manifest. Accordingly, an amendatory Act was applied for, and was passed April 3rd, 1807. The new law contained a number of provisions whose novelty is particularly interesting. Article I. provided for a new classification of members from the various districts, and for such succession and rotation of representatives from the county societies to the State Society as to bar a monopoly of influence. This was an important measure, and introduced a feature that was to remain prominent for many years. The penal clause in Article Y. remedied a fault in the original bill, but imposing upon an unlicensed practitioner a penalty of five dollars for every month he thus practised, one-half the sum to go to the informer.

Toward the end of Article V. appear some provisions which bear semblance to the modern ''rider," and which were not accurately construed by the State Society members having the legislation in hand; probably they were the handiwork of an unrecognized sinister purpose. One of these obnoxious provisions freed from penalty any apothecary or person administering medicine who does not follow the practice of medicine as a profession. This left an apothecary free to prescribe almost at liberty; and many unlicensed practitioners opened drug stores (many not deserving of the designation), and prescribed over their counters. Under the same protection of the new law, traveling quacks evaded penalties under the pretence that they did not practise medicine as a profession, because at inter\^als they were otherwise employed, and only served out medicines when they found themselves in a new neighborhood where the people did not know even the ordinary popular remedies. The most seriously defective clause in the Act practically nullified the effectiveness of the law as a penal measure. This, the last clause, provided that nothing in the Act was to be construed to debar any person from using or applying, for the benefit of any sick person, any roots or herbs, the growth or product of the United States. This not only gave the herbalists C'yarb doctors" they were usually styled), all necessary authority for their calling ; but afforded them what in modem phrase would be "endorsement" by the State. The abuses growing out of this pernicious legislation were manifold; and the victims of the charlatan were numerous, and not alone the most illiterate among the people.

The original by-laws of the Medical Society of the State of New York give a clear idea of the intention of its founders. Certain features deserve special attention because of their emphasizing a policy different from that of other State medical societies of that day ; and because of the stress they laid upon the ethical relationships which should exist between physicians, and the high standards which it was hoped they would maintain. It is unnecessary to give at length the particular provisions of the by-laws, but it is well to epitomize the rules reflecting the moral and professional spirit of the body. These provided :

That the president, at the annual meeting, and at the end of each year after his election, shall deliver a dissertation on some appropriate subject; and in default shall forfeit to the Society the sum of twenty-five dollars.

That a majority of the Censors may perform the duties of the full number and they may examine students separately if they deem it expedient.

That a student, when found qualified to practice physic or surgery, or both, before receiving his diploma shall sign a declaration in the following words: "I, A. B., do solemnly declare. That I will honestly, virtuously and chastely conduct myself in the practice of physic and surgery, with the privilege of exercising such profession I am now to be invested; and that I will with fidelity and honor do everything in my power for the benefit of the sick committed to my charge."

Prescribing the form of the diploma in Latin; and also a form in English, if a candidate should so request.

That each member of the Society present to the Society all proper information respecting the geography and topography of his county, together with an historical account of the diseases which prevail at any season of the year; and communicate all such information in his power which may contribute to the public good, or advance the knowledge of the healing art.

Providing for a correspondence committee of not less than five nor more than seven members, to correspond, in their joint or individual capacity, with the literary societies and men eminent for knowledge, and present to the Society such communications as they may deem proper.

Recites that it is inconsistent with the dignity of the medical profession for physicians and surgeons in their corporate capacities to arrange and fix professional charges; and provides that any member violating the rule be expelled from the society, after conviction, and forever after be debarred from membership.

That any member convicted of any serious offense against the laws of the State or of the United States, or who may be guilty of gross immorality, or who shall have improper pretensions to any specific or nostrum, or who shall be repeatedly guilty of improper conduct in the duties of his profession or his behavior in the Society, may be expelled at any anniversary meeting, upon a two-thirds vote of members present, after a fair and impartial trial.

The concluding article of the by-laws, relating to the obligations of the various county societies is well worth reproducing in full, as it led to various difficulties between them and the State Society, as narrated in another chapter of this work. The text of the article is as follows:

And be it further ordained by the authority aforesaid, that any county medical society who (sic) shall neglect to perform all such acts as may be required to be done by them, by the law incorporating medical societies, or any other law in the State relative to the science of medicine, or who shall do any acts which shall be considered derogatory to the honor of the medical profession, or who shall oppose or neglect to comply with the by-laws of the said Society, every such county medical society shall be admonished touching any such proceeding; and if it be deemed necessary for the public good, that from the improper conduct of any such county medical society, their corporate rights should for a time be suspended, then and in such case it should be lawful and just for this said Society to make application to the honorable Legislature for such purpose.

Among the difficulties growing out of the too general provisions of previous laws, was doubt as to whether County Medical Societies had such corporate powers as to enforce the prosecution of unlicensed practitioners, and the same doubt existed to some degree as to the powers of the State Medical Society in such cases. Accordingly, a bill to determine the legal status of both State and County Medical Societies, became a law on April 10, 1813. This Act recognized existing medical societies, and provided for organization of others in counties where such did not exist. It gave to the County Medical Societies full corporate powers, and similarly to the State Medical Society. It provided for proper organization, and for the meetings of the various societies, and prescribed the duties of officers. It was enacted that **the members now composing the Medical Society of the State of New York from each of the four great districts, shall remain divided into four classes from each of said districts, and shall go out of office annually." These great districts were as follows: Southern District — Counties of New York and Westchester ; Middle District — Counties of Greene, Columbia, Dutchess, Ulster, Delaware, Orange; Western District — Counties of Oneida, Madison, Herkimer, Oswego, Cayuga, Jefferson, Chenango, Ontario, Lewis, Otsego; Eastern District — Counties of Essex, Schoharie, Saratoga, Clinton, Albany, Montgomery, Washington.

The Act also contained the following provision, which was to have a far-reaching effect upon the organization of the State Medical Society in subsequent years :

That the Medical Society of this State may elect by ballot at their annual meeting, eminent and respectable physicians and surgeons residing in any part of the State, which persons so elected shall be permanent members of the society, and entitled to all the privileges of the same; Provided, that not more than two such members shall be elected in any one year, and that they shall receive no compensation for their attendance from the funds of the Society.

That it shall and may be lawful for the several medical societies so established as aforesaid, at their annual meetings, to appoint not less than three nor more than five censors, to continue in office one year and until others are chosen, whose duty it shall be carefully and impartially to examine all students who may present themselves for that purpose, and report their opinion in writing to the president of the said society.

That if any student who shall have presented himself for examination before any of the medical societies of the several counties of this State shall think himself aggrieved by the decision of such society, it shall be lawful for such student to present himself for examination to the Medical Society of the State of New York; and if in the opinion of such society the student so applying is qualified for the practice of physic or surgery, or both, as the case may be, the president of such society shall, under his hand and the seal of such society, give to the said applicant a diploma, agreeable to such decision.

The foresight of the founders of the New York State Medical Society was not mistaken. The three most important movements for the uplift of professional life in America had their origin in them. These are so important in the History of Medicine in America as well as here in New York, that a special chapter has been devoted to them, and ' ' New York as a Pioneer in Professional Movements." They were the establishment of the National Pharmacopoeia, the movement for which was begun in 1818, the formulation of a code of medical ethics, and the organization of the American Medical Association.

The State Medical Society performed no more monumental work than in formulating its system of medical ethics. That its early members held to a high standard of professional and personal behavior, is evident from facts narrated in its Transactions, and expressions contained in the early presidential addresses and special papers read before the body. It was evidently felt, however, that a code of ethics was desirable, to serve as a guide in cases of doubt, and as a manual of instructions to young practitioners. Accordingly, a committee was appointed consisting of Dr. James R. Manley and Dr. John H. Steele, both of whom became presidents of the society, and Dr. Pascalis. This report was made to the society in February, 1823, and unanimously adopted. The most notable feature of this admirably written instrument is its noble spirit of professional honor in the relation of physicians to each other, to their patients, and to humanity at large — a monument to the lofty aims of its authors and those whom they represented. It omits no danger that besets professional life, nor suggestion as to their avoidance. It is also interesting to note that a reading of this code of 1823 and that of the American Medical Association of 1847, makes it clear that the latter was in large measure founded upon the former — a fact not surprising when it is recalled that the American Medical Association owed its beginning to the State Society of New York. In its essentials, the New York Code remains the basis, as it was the origin, of that which to this day has governed the profession throughout the entire United States. However, after the lapse of thirty years, differences arose in the State Society, and which led to the formulation and adoption of a new code. Nor was this the end ; for out of it came a rupture between the Society and the American Medical Association, which was destined to continue for nearly a quarter of a century.

At an early day, the Society came to the realization that many of its members who had entered into the practice of medicine under the old regime, when study under a physician and examination before a committee of a medical society were sufficient for a license, would wish for the degree of Doctor of Medicine. Manysuch, during long years of practice, had kept themselves constantly abreast of what was latest and best in medical progress, and were eminently fitted to bear the degree. For sake of these, who under the conditions of their student days were unable to procure it, the Society, at its annual meeting in 1826, sought the privilege of presenting each year to the Board of Regents of the University of New York, the names of certain such physicians, with the request that they be granted the Honorary Degree of Doctor of Medicine. The memorial was framed by Dr. T. Romeyn Beck, chairman of a committee appointed for the purpose. The text of the Regents' response is not in evidence, but its purport is discernible through subsequent notes in the Transactions of the Society. It is evident that the Regents considered it either improper or inadvisable to confer the degree on all nominated by the Society, but they intimated that if the Society would each year present the names of such as they would wish to receive it, their action would probably be favorable. On February 8, 1827, a committee of the Society, to whom was referred a communication from the Regents, reported it as deemed necessary to consider age as a requisite, as well as professional standing, and fixed the age as forty -five years, which would imply a good many years of practice.

At the annual meeting in 1828, the president of the Society related that, on its request, the Regents had conferred the honorary degree of Doctor of Medicine upon the following named, duly nominated by the Society at its last meeting: John Onderdonk, New York; Jonathan Eights, Albany; Laurens Hill, Oneida; James Stevenson, Washington; Thomas Fuller, Otsego, and Gain Robinson, Wayne. These six men, the first to receive the honorary degree, were distinguished members of the Society; two of them later became its president, and all were widely known for their medical skill and liberal education. It is to be noted that they were selected from different parts of the State, presumably to avoid an implication that personal influence had governed their selection.

The subject of improved medical education continued under discussion in various medical societies throughout the country, and in 1844 the Medical Society of the State of New York returned to the subject with greater persistence. Two resolutions were presented, one by Dr. Alexander Thompson, of Cayuga county, the other by Dr. N. S. Davis, of Broome county, with reference to the necessity for a higher standard of qualifications on the part of candidates for licenses to practise. At the close of the debate, which developed conflicting ideas to such an extent that the entire subject was about to be postponed to the next annual meeting, Dr. Alden March, of Albany, suggested privately to Dr. Davis that possibly concert of action could be commanded in a National Medical Convention. Dr. Davis, a new member of the Society, unaware that any previous attempt had been made to assemble such a body, at once arose and submitted the following preamble and resolution :

Whereas, It is believed that a National Convention would be conducive to the elevation of the standard of medical education in the United States; and whereas, there is no mode of accomplishing so desirable an object without concert of action on the part of the medical colleges, societies and institutions of all the States; therefore

Resolved, That the New York State Medical Society earnestly recommend a National Convention of delegates from medical societies and colleges in the whole Union, to convene in the City of New York, on the first Tuesday in May, in the year 1846, for the purpose of adopting some concerted action on the subject set forth in the foregoing preamble.

The following named were constituted a committee to carry the purpose into effect: Dr. N. S. Davis, Dr. James McNaughton, of Albany, and Dr. Peter Van Buren, secretary of the State Society. A circular issued by the committee, and correspondence growing therefrom, shows favorable responses from societies, colleges and individuals throughout the country, with these exceptions: The Medical College in Boston, and the two oldest colleges in Philadelphia, declined to take part in the proposed convention; the then recently organized Pennsylvania College of Philadelphia promised to send delegates ; and delegates were pledged from medical societies and colleges in Maine, New Hampshire, Connecticut, New Jersey, Delaware, District of Columbia, South Carolina, Georgia, Mississippi, Louisiana, Tennessee, Kentucky, Ohio, Indiana and New York.

On May 5, 1846, in accordance with invitation by the Medical Society of the State of New York, delegates and members of the profession assembled in the Hall of the Medical Department of New York University, to the number of nearly one hundred, representing societies and colleges in sixteen States — New Hampshire,

Vermont, Massachusetts, Rhode Island, Connecticut, New York, New Jersey, Pennsylvania, Delaware, Maryland, Virginia, Georgia, Mississippi, Indiana, Illinois and Tennessee. The following officers were elected: Dr. Jonathan Knight, of Connecticut, president; Drs. John Bell, of Philadelphia, and Edward Delafield, of New York City, vice-presidents; Drs. Richard D. Arnold, of Georgia, and Alfred Stille, of Philadelphia, secretaries.

An abortive attempt was made to adjourn the convention si7ie die, on the ground that the meeting had ''failed in a representation from one-half of the United States, and from a majority of the medical colleges." Resolutions were adopted, declaring it expedient to organize a National Medical Association ; that a uniform and elevated standard of requirements for the degi'ee of M.D. should be adopted by all medical schools; that young men before being received as students of medicine should have acquired a suitable preliminary education ; and that the profession should be governed by the same code of medical ethics.

On May 5, 1847, delegates assembled in Philadelphia, to the number of nearly two hundred and fifty, representing more than forty medical societies and twenty-eight colleges in twenty-two States and the District of Columbia. By this body were laid the real foundations of the American Medical Association, in suitable provisions for the perpetuation of the organization, and for the instructional purposes contemplated. All measures were adopted with practically no opposition, except that ' ' recommending to all colleges to extend the period employed in lecturing from four to six months," and this eventually was accepted.

The year 1857 marked the semi-centennial of the Society, and in view of its many large accomplishments during the half century of its existence, it occasions some surprise that so little attention was given to the event. The only formal celebration seems to have been the semi-centennial address delivered by the president. Dr. Alden March, on February 4th, in the capitol at Albany. His effort was of real merit. He reviewed the progress of science and industry during the preceding half centur>% and very properly made much of the fact that medicine had kept pace with the other arts and science in the way of progress.

After the celebration of its semi-centennial, the New York State Medical Society continued to be the most important factor in the American Medical Association for many years. When the meetings of the National Association were held in New York, there was always a record attendance, and members of the profession from New York continued to be prominent in the councils of the national body. Unfortunately these friendly relations were destined to be rudely disturbed.

For several years in the later seventies, some dissatisfaction had been expressed at the meetings of the Medical Society of the State of New York with the code of ethics which was then supposed to rule the conduct of members of the regular medical profession. The discussions culminated at the annual meeting in 1881 in the appointment of a committee who drew up a new code of ethics to be substituted for the one then in force. Their recommendation was adopted by the State Society in February, 1882, but met with considerable opposition from many of the county societies.

In June, 1882, the American Medical Association at its annual meeting held in St. Paul, refused to receive the credentials of the delegates from the Medical Society of the State of New York or to admit them to its proceedings because of the adoption of the revised code of medical ethics by the State Society. The old code had been accepted for over thirty years and had come to be considered as one of the fundamental laws of the American Medical Association. This was the beginning of a rupture in the formal relations between the American Medical Association and the New York State Society which was destined to last for nearly a quarter of a century.

The adoption of this ''no-code" resolution and the failure of all attempts to secure the readoption of the old code, or at least some formal legislation that would forbid consultation on the part of members of the society with irregular medical practitioners, or with those practising on a sectarian basis, finally led to so much dissatisfaction that the formation of a new organization was suggested by those who wished to maintain their affiliation with the American Medical Association. It was realized, however, that with the constitution of the State Medical Society as it then was and with the membership as determined by it, it would be practically impossible to obtain any legislation of such a nature as would bring about a reunion with the national body.

Great care was taken to learn the sentiments of the members of the medical profession in New York State, with regard to the question of the national code, the new code and the abrogation of all codes. A personal canvass was made of all physicians of the State, which resulted as follows : For the National Code, 2,547 ; for the New Code, 1,040; for No Code, 239; Unclassified, 34; total, 3,860. It was apparent from these figures that there was a majority of the New York State Profession for the National Code over the whole number of committed and uncommitted, moreover, there was a majority of more than two-thirds for the National Code over the New Code and a nearly two-thirds majority for the National Code over the ''New Code," ''No Code," and "Unclassified" combined. As the result of this canvass, it was resolved to form a new organization. The New York State Medical Association was accordingly organized in February, 1884, and held its first annual meeting the next autumn.

The rival State medical organizations continued to exist side by side in New York for about twenty years. During the later years of the nineteenth century sentiment throughout the medical profession of New York State was, that the maintenance of two State medical organizations was without any proper reason. A new generation of physicians had come into practice since the events which had brought about the disunion, and among them especially opinions in favor of the reunion of the two State organizations began to be expressed freely and frequently. A rather anomalous condition developed in New York City, which was a sign of the feeling on the part of many members of the profession that the reasons for disunion were not so important as had seemed, and that many of the older reasons for separation from the national body had lost their weight. Many New York City physicians belonged to both their County Medical Society and their County Medical Association.

This state of affairs could scarcely continue for long. If the members of the medical profession could belong to both organizations, then the differences between them were surely not essential, and the reasons for separation had evidently lost their weight. It was in the New York county organizations, therefore, that the movement for reunion took form and gradually gained the strength necessary to bring about the fusion of the two State organizations. Owing to legal difficulties, mainly dependent upon the indefinite character of certain of the early by-laws of the medical organizations, the actual accomplishment of reunion was delayed longer than had been expected. It was completed, however, in time for the celebration in a compact body by the medical profession of New York State, of the Centenary of the foundation of the New York State Medical Society in 1906.

The friendly relations of the New York State Society to the National Association were soon re-established. Such distinguished men as Dr. Joseph Bryant and Dr. A. Jacobi were elected presidents of the American Medical Association, and within ten years New York came to occupy the old place of prominence in the councils of the national body. When after forty years of interval the American Medical Association held its annual meeting in New York, in June, 1917, though we were in the midst of many diverting interests because of the war so recently declared, it was clear that the old wounds had been healed and that a new era of professional cooperation was thoroughly under way.