PHILADELPHIA COUNTY MEDICAL SOCIETY. 
N. E. Cor. Thirteenth and Locust Sts., 
Philadelphia, Penna. 
Jamks C. Wilson, M.D., President. 
T. B. Schneideman, M.D., Secretary. 
Dear Doctor : 
As a member of a constituent society represented in the American 
Medical Association, your attention is asked to a matter in which 
every such member has a measure of personal responsibility. You 
will find the history and present status of the question at issue set 
forth in the annexed report of the delegates of the Philadelphia 
County Medical Society, made on their return from the last meeting 
of the xVmerican Medical Association, held in San Francisco in 1894. 
In this connection we would call your attention to the following 
salient points: 
1. The Code of Ethics—the moral and organic law of the American 
Medical Association—as is well known, not only prohibits physicians 
from employing secret nostrums, but declares that “ in any way to 
promote the use ’’ of such nostrums is reprehensible. 
2. The advertising of such nostrums in the Journal of the American 
Medical Association, which is taking place, is certainly an attempt 
to promote their use. The Association appears, therefore, at least 
tacitly to permit the Editor and Trustees of its official journal to 
transgress, in the conduct of the Journal, the law laid down for our 
guidance as physicians. 
3. The attention of the Association having been called to the in- 
consistency of its course in this regard, resolutions were unanimously 
adopted at the Detroit (1892) meeting, instructing the Trustees of 
the Journal in future to respect this prohibition of the Code in the 
discharge of their trust. 
4. Thereupon the Trustees appear to have evaded this command by 
adopting as their governing policy the rule “ That an advertisement 
of a proprietary medicine shall be accepted in the discretion of the 2 
Committee when the proprietors thereof shall furnish the complete 
formula.” The advertisement of secret nostrums in the Journal con- 
tinuing, the Trustees have, presumably, become accessory to the 
secrecy, inasmuch as complete formulae of the preparations referred 
to are not published. Plainly, persistence in the present course 
results in an abrogation by indirection of a fundamental provision of 
the Code, which should either be strictly enforced or frankly repealed. 
The contention of the Trustees that without the income derived 
from this particular class of advertisements a deficit would result, does 
not in any way meet the ethical issue; nor does the precedent of other 
journals, including the organ of the British Medical Association, 
furnish a justification for the course adopted. 
The question under consideration is not one of money but of morals; 
the American Medical Association cannot afford to sell its honor 
under any circumstances or for any price. But would not the apparent 
financial sacrifice entailed by an honest and hearty observance of the 
spirit and letter of the Code of Ethics in the conduct of its journal 
be compensated by an increase of subscriptions thereto, brought 
about by higher respect and enthusiasm for it on the part of members 
of the constituent societies ? 
Do the members of your Society—County or State—desire the 
continuance of the present policy ? If not, it is hoped that the sub- 
ject will be discussed by you at an early meeting, and formal action 
taken upon it. 
Hoping to be promptly advised of your action, 
We remain sincerely yours, 
(Signed) 
Charles H. Thomas, M.D., 
James Tyson, M.D., 
Richard J. Phillips, M.D., 
S. Solis-Cohen, M.D. 
Committee appointed by the Philadelphia County Medical Society 
to carry out the recommendation in the following report. 
March 11, 1895. REPORT 
OF THE 
DELEGATES REPRESENTING THE 
PHILADELPHIA COUNTY MEDICAL SOCIETY 
IN THE 
AMERICAN MEDICAL ASSOCIATION. 
The undersigned, delegates to the American Medical Association, 
who attended its meeting held in San Francisco, June 5-8, 1894, 
respectfully report: 
The general character, attendance, and work accomplished by the 
meeting have already been laid before the members in detail in the 
Journal of the Association. 
The questions as to revision of the Constitution, By-laws, and Code 
of Ethics of the Association were decided adversely to any change, 
but are likely to be reopened by amendments introduced at that meet- 
ing, and in this way to come before the approaching meeting of the 
Association. 
In the matter of the policy of the Journal with reference to objec- 
tionable advertisements, your delegates endeavored to carry out the 
expressed will of the Society, and believe that all was accomplished 
in bringing the matter to the attention of the Association that it was 
possible for so small a delegation to accomplish. 
At the meeting of this Society, May 23, 1894, the following reso- 
lution was adopted: 
Resolved, That the Philadelphia County Medical Society instructs its dele- 
gates to San Francisco to co-operate with the delegation of the Pennsylvania 
State Medical Society in bringing before the Judicial Council the questions 
relating to the conduct of the Association Journal, and that Dr. Edward Jack- 
son be designated to represent this Society before the Judicial Council, with 
power to obtain the assistance of other members of the American Medical 
Association. 
The attention of the delegates of the Medical Society of the State 
of Pennsylvania being called thereto, a committee to represent that 
Society, composed of Drs. Edward Jackson, John T. Carpenter, and 
Lewis H. Taylor, was appointed. These delegates, representing the 
County and State societies, then prepared the following statement, 
which was submitted to the Judicial Council: 4 
The undersigned, appointed to represent the Medical Society of the State 
of Pennsylvania and the Philadelphia County Medical Society, respectfully 
submit to the Judicial Council of the American Medical Association : 
That the Code of Ethics of the American Medical Association in the 
chapter “ Of the Duties of Physicians to Each Other and to the Profession at 
Large,” Article I., Section 4, declares it is “ reprehensible for physicians to 
give certificates attesting the efficacy of patent or secret medicines or in any 
way to promote the use of them.” 
That the use of such secret medicines has been promoted by their adver- 
tisement in the Journal of the American Medical Association, and that the 
American Medical Association at its meeting in 1892 adopted the following 
resolution: 
“ Resolved, That the attention of the Trustees of the Journal of the Ameri- 
can Medical Association be directed to the fact that the Code of Ethics pro- 
hibits all commendatory mention or advertisement of secret preparations, 
and that said Trustees are hereby instructed to respect said prohibition in 
the future conduct of the official journal of this Association.” 
At the meeting of the Association in 1893 the Trustees of the Journal re- 
ported that they had instructed the editor that “ when the editor is in doubt 
about the character of an advertisement he shall refer the same to the Com- 
mittee on Advertising, and that an advertisement of a proprietary medicine 
shall be accepted in the discretion of committee when the proprietors thereof 
shall furnish the complete formula.” 
This action led members of the Association to hope that such advertise- 
ments would be stopped. Nevertheless the advertisements of such secret 
medicines continue to be published. See advertisements in the issue of May 
5, 1894, of Labordine, page ii.; Antikamnia, page iii.; Perpcena, page xxii., 
and others. 
Either the rule reported by the Trustees has not been enforced, or it was 
framed and intended to permit the continued violation of the Code of Ethics 
and expressed will of the Association. 
If the proprietors of secret medicines have furnished complete formulas 
of the same, these formulas have not been published. The medicines remain 
secret, and the Trustees of the Journal have become not merely promoters of 
their use, but partners in the secrecy. 
Furthermore, that in the Journal for April 7, 1894, advertising page vii., 
appears an advertisement of the American Physicians’ Sanitarium Associa- 
tion, offering to “ treat and cure all forms of narcotic and alcoholic inebriety,” 
and promising “ 250 shares ($100 each) reserved to issue free to phy- 
sicians sending THE first 250 patients (one share for each patient sent). 
All stock received at par in payment for treatment charges.” 
It is submitted that such use of the Journal of the Association in opposi- 
tion to the purposes and organic laws of the Association constitutes a breach 
of trust on the part of the Trustees of the Journal, and should be so declared 
by the proper tribunal, viz., your honorable body. 
(Signed) Edward ’Jackson, M.D., 
John T. Carpenter, M.D., 
Lewis H. Taylor, M D., 
For the Philadelphia County Medical Society and the Medical 
Society of the State of Pennsylvania. With this were submitted marked copies of the Journal of the 
Association containing the advertisements specifically complained of. 
The Trustees of the Journal were heard in their own defence, your 
committee being at the same time present and permitted to speak be- 
fore the Council. 
The Judicial Council, however, failed to secure a quorum and take 
action on the matter until after the adjournment of the Association; 
and although there is reason to believe that the decision arrived at 
has been communicated to the Trustees of the Journal, it has not 
been given to your representatives, nor, so far as we know, has it been 
published to the Association. 
The annual report of the Trustees of the Journal of the American 
Medical Association, in addition to the statement of the work of the 
Trustees for the past year, contained the following defence of the pol- 
icy they have pursued with reference to advertisements, which is sub- 
stantially similar to that made by the Trustees before the Judicial 
Council: 
“ During the entire existence of the Journal no question has presented 
greater difficulty or afforded your Board more embarrassment than to dis- 
criminate as to what may be considered as proper matter for its advertising 
pages. The policy adopted was, that having entered upon the business of 
publishing a journal, we would be governed by the same rules followed by 
those considered reputable who were engaged in the same business. The 
British Medical Journal, representing an association with similar purposes 
and aims, was particularly indicated as a standard. 
“ Beyond insertion of the advertisements, the Journal has scrupulously 
avoided any expression which could be interpreted as an indorsement of the 
advertisers, believing the owners of the Journal—the profession—were capable 
of discriminating as to what would serve their interests. 
“After the meeting of the Association in 1893 the Trustees resolved that 
an advertisement of a proprietary medicine shall be accepted in the discre- 
tion of the committee when the proprietors thereof shall furnish the complete 
formula. 
“ This course has since been our governing policy. The Board asserts that 
it has complied with the letter of the law in demanding that a formula of all 
secret and proprietary remedies should be submitted to its committee before 
being advertised in the Journal, but it would direct your attention to the 
fact that had the apparent intention of those who censure our action been 
established we would be obliged to present you to-day a considerable financial 
deficit. However desirous the Board might be to comply with the wishes of 
some members of the Association, it could not forget that under the present 
Constitution of the organization the members of the Board were the only 
parties legally responsible for obligations incurred, and they had too much 
confidence in the sense and justice of this body to believe it would demand 
they should ‘make bricks without straw,’ and discard a source of support 
utilized by other reputable journals. 6 
“No advertisements have been inserted in the Journal which do not find 
place in such publications as the British Medical Journal, Boston Medical and 
Surgical Journal, New York Medical Record, New York Medical Journal, and 
The Medical News.” 
When this report had been submitted to the Association on the sec- 
ond day of its meeting, to the motion to approve it, Dr. Jackson 
moved an amendment “ That the report be received, that thanks be 
tendered the Trustees for their efforts in behalf of the Journal, that 
the other suggestions be adopted, but that the Association does not 
approve the policy of the Trustees with regard to advertisements.” 
This amendment was laid on the table by a vote of 86 ayes to 83 
nays. On a later date of the meeting Dr. Jackson introduced the fol- 
lowing : 
Whereas, The interests of the Journal of the Association require that it 
should command the confidence of the members of the societies in affiliation 
with this Association; and, 
Whereas, The Journal of the American Medical Association has continued to 
publish unethical advertisements, like those of “Antikamnia,” “ Labordine,” 
and other secret nostrums, and that of the American Physicians’ Sanitarium 
Company, offering one hundred dollars’ worth of stock to physicians sending 
it patients; and, 
Whereas, The Trustees of the Journal have defended such a course on the 
ground that the money from such advertisements was needed to publish 
such a journal as they thought creditable to the Association ; 
Resolved, That the various State medical societies in affiliation with this 
Association are hereby requested to inform this Association whether their 
members approve the policy of admitting such advertisements to the pages 
of the Journal of the American Medical Association. 
A motion to lay this upon the table was lost by a vote of 102 ayes 
to 113 nays, and, after discussion, the resolution was referred to the 
Judicial Council. What the decision of the Judicial Council has been 
upon the case presented, or what action it will take with reference to 
the above resolution referred to it, we do not know. The action of the 
Association, however, in adopting the report of the Trustees is an ap- 
proval of the course the Trustees have pursued, and a fair assumption 
of responsibility for the same. Criticism of the Trustees as trustees 
for this course should, therefore, be regarded as ended. 
Whether the American Medical Association, however, can, when its 
attention has been fully drawn to the inconsistency between its Code 
of Ethics and its practice, continue in such a course is an entirely 
different matter. From the expressions of opinion by individual 
members present at the meeting ; from the difference between the vote 
of approval of the report of the Trustees and with reference to laying 7 
on the table the resolution later offered, it seems to us that the mem- 
bers of the Association are beginning to appreciate the illogical and 
false position in which the Association places itself by depending for 
the support of its Journal on the advertisement of a class of prepara- 
tions that it denounces in its Code of Ethics; and we believe the 
appreciation of this aspect of the case must extend and increase. 
Your delegates at San Francisco were met with the statement that 
only in the State of Pennsylvania had the policy of the Journal with 
reference to advertisements been adversely criticised.1 If the ques- 
tion is to be considered and discussed, it should be free from any 
personal or sectional bias ; it is important that affiliated medical socie- 
ties in other parts of the country should be induced to consider the 
subject and take action upon it. 
We would therefore suggest, if the Philadelphia County Medical 
Society has that real interest in the subject which justifies the placing 
upon its delegates of the ungracious office they had to perform at 
San Francisco, it prepare a brief statement of the objections to allow- 
ing the advertisement of nostrums in the Journal of the American 
Medical Association, and send this statement, Avith a request to con- 
sider the subject and take action thereon, to the various State and 
county medical societies throughout the country. 
We believe that if the constituent societies clearly express their 
disapproval of the policy in question, the American Medical Associa- 
tion and its Trustees will frankly accept the decision so reached, and 
that the object Avhich this society seeks will be accomplished—the im- 
provement and elevation of the Journal of the American Medical 
Association to a position where not only in its scientific and literary, 
but also in its ethical excellence, it shall lead rather than follow other 
medical journals, and so shall command the full respect and support 
of the whole profession. 
(Signed) 
Edward Jackson, M.D., 
J. H. W. Chestnut, M.D., 
John B. Roberts, M.D., 
G. Benson Dunmire, M.D. 
1 Resolutions disapproving the publication ot nostrum advertisements in the Journal of the 
American Medical Association have been passed by at least two other State societies, namely, 
those of Missouri and of Texas. The American Pharmaceutical Association passed a resolu- 
tion approving the action taken by the American Medical Association at Detroit, and con- 
veying its thanks for the same.