No. 171. IN ASSEMBLY, February 28, 1832. REPORT Of the committee on medical societies and colleges. Mr. Milledoler, from the committee on medical societies and col- leges, REPORTED: That the subject of the medical profession, involving the interests of an useful and extensive class of our fellow-citizens, and intimately connected as it is with the safety and comfort of every individual in the community, claims the serious consideration of this honorable body. From the circumstances, that much of the science embraced in the study of medicine, and almost all of its practical application are ne- cessarily unintelligible to such as have not made them special sub- jects of investigation, it happens that the unreflecting and superficial are inclined to doubt the claims of the profession to respect and con- fidence, and manifest an indifference to its concerns proportionate to their improper estimation of its utility. This indifference however, always decreases as society progresses in knowledge and refine- ment. In our own country, pervaded as it is by a spirit of general inquiry, we may certainly anticipate the time when correct views of this, shall not lag behind the advance of knowledge in other subjects of inte- rest and importance to the community. At present, an evil of great magnitude prevails, in regard to the medical profession, arising out of its peculiar character, which tends to introduce and perpetuate abuses in it. Many intelligent and influential members of society, who properly appreciate its practical value, are nevertheless apt to [A. No. 171.] 1 2 [Assembly suppose that inasmuch as they are unacquainted with its details, they are not competent to form a correct and independent opinion as to the best mode of regulating it, in order to elevate its character and promote its usefulness. This idea produces a disinclination to re- flect on a matter of this kind, and renders them liable to be unduly influenced by the representations of such as are active in fore- stalling opinions in favor of measures for personal advantage, al- though such measures may interfere with the rights of others, and the dignity and prosperity of the profession. These thoughts have been forcibly impressed upon the mind, in ad- verting to the existing laws of this State, regulating the practice of physic and surgery. The attention of the committee has been di- rected thereto, by the memorial of the medical society of the city and county of New-York, who petition this Legislature for an alte- ration of the law, particularly as it refers to medical education. This memorial is entitled to consideration, inasmuch as this society repre- sents the regular profession of that city and county, consisting of nearly four hundred members ; for it must be remembered that the present statute compels every physician and surgeon to join the medical society of the county in which he resides, and that the pe- nalty for neglect, is the forfeiture of his professional privileges. There is another reason why impor tance should be attached to the petition, arising out of the circumstance, that in such a locality, where many of the profession are congregated, the defects of the present system, are likely to be best understood, most strikingly illustrated, and most deeply felt. The committee do not howev- er, intend to confine their attention solely to the subject of medi- cal education, but shall propose such alterations of the existing laws, as shall in their opinion tend to promote the interest of medi- cal science, the honor of the profession, and to accord with the dig- nity of the State. The committee wrould also wish to impress upon the minds of this honorable body, that much of the difficulty of this subject is rather imaginary than real. The same manly sense and intelligence which enable us to form just opinions as to the best modes of regulating other brashes of industry and useful occupations, can be applied with equal effect to the profession of medicine. We need only in- quire, how shall the public good be promoted in legislating on this subject ? And how shall the rights of physicians be equalized and No. 171.] 3 protected ? To the first question we would answer: by securing to the public the greatest possible amount of medical skill and acquire- ment. This is to be accomplished by insisting upon an adequate quantity of time to be devoted to the study of medicine, and a prop- er test of the qualifications and attainments of those who would be introduced to the community as the guardians of their lives and health. To the members of the profession, every proper induce- ment should be offered to stimulate them to excellence ; every unne- cessary obstacle should be removed, that might impede their pro- gress, and every facility afforded them of gaining a correct public opinion of their merits. Whatever legislative acts shall in any measure contribute to the above results, shall in the same degree tend to the public welfare. The answer to the second inquiry is equally obvious. The privileges of those, who, in accordance with legal acquirements, have expended their time and money in pre- paring themselves for the important relations to society, which, as physicians, they have assumed, are to be protected against monopo- lies in their professional avocations. This is not only due to them, but also to the public; for experience has ever confirmed the rule, that if any branch of trade or any occupation be advantageons to the community, the more free and general the competition, it will al- ways be the more so. It is to be remarked however, that the medi- cal profession should not be exposed to a legalized competition, with such persons as have not undergone the necessary labors, or made the necessary sacrifices, in order to prepare themselves for a consci entious discharge of its incumbent duties. Having premised this much, we shall be more particular, and shall proceed frankly to state some of the defects of the present laws in reference to the medical profession. And in the first place would protest against that act by which quackery is legalized within the bounds of this State. The committee would not recommend any se- vere or positive enactments against this miserable system of igno- rance, fraud, and cupidity ; for they are satisfied that the general intel- ligence of the community, is the only safeguard against its deceptions. And although there are many even in this enlightened age who sometimes suffer their admiration of the wonderful to get the better of their sense and judgment, yet the progress of knowledge, and the increase of rational science shall in time, Lanish from society the belief in medical magic and witchcraft, and it shall share the fate of other follies, that are rapidly passing away. But your committee would inquire whether it comports with the dignity of this State, to to give character to such a system by continuing in its statute book an act to encourage it ? So long as the State government recognizes the learned profession as legitimate, legislates for its interest?, and defines its requirements, does it not also, by legalizing quackery, commit an act of injustice to those of its citizens, who, in good faith, enter the said profession, accord with the laws for its regulation, and make great sacrifices for the attainment of such knowledge as shall enable them to perform with honor to themselves, and advantage to the public, the duties which it embraces ? We would ask for the re- peal of the act alluded to, and make the request not only injustice to the medical profession, but for the credit of the government whose good faith and intelligence are implicated in the mode in which it shall legislate on this subject. The attention of this honorable body is also directed to that por- tion of the Revised Statutes which compels members of the profes- sion to join, within a limited time, the medical societies of the coun- ties in which they respectively reside, and in case of their neglect so to do, they are to be deprived of the professional privileges which, as regular physicians, had previously been guaranteed to them. It is now too late to complain of this law as harsh and op- pressive. Nor would we investigate the motives, or impugn the wis- dom of those, who by their exertions, accomplished this sacrifice of the dignity and freedom of their profession. The intention of the law has been answered, and although obnoxious to them, yet have the physicians of the State, like good citizens, accorded with its in- junctions. But not to dwell on this point, it is respectfully suggested whether, whilst this act continues in force, the State should not pro- ceed a step further and limit the medical societies in the ; mount of charges which, in the form of initiation fees and yearly dues, they impose upon those who offer themselves for membership. In the city and county society of NewT-York the initiation fee is ten dollars, and that society has the same right, by altering its by-laws, to charge any higher amount, that it has to demand this sum. By recognizing a principle of this kind we may subject a portion of our fellow-citi- zens to an unequal and burdensome taxation. For this power may be so abused as to present the spectacle of the civil authority, on one hand, forcing men into the medical societies, and these societies, on the other, excluding them by exorbitant demands. Between the two, private rights may be trampled upon ; an aristocracy of medi- cal wealth set up in a free government, supported and encouraged by a democratic State. It is confidently expected that the members 4 [Assembly No. 171.] 5 of this Legislature shall not hesitate to correct an evil, as offensive to their feelings as men, and abhorrent to their principles as politi- cians, as it is subversive of private rights, and opposed to the spirit of our liberal institutions. There remains another important subject, which we would sub- mit to this Legislature, and request for it a candid consideration. Reference is made to the present system of medical education. At the period when the idea of a State college originated amongst us, the degraded circumstances of the profession, the high literary, per- sonal and professional character of the gentlemen applying to be formed into a faculty, and, above all, the modesty of their demands, all tended to justify its introduction. A memorial was addressed to the Regents of the University, in the year 1791, praying that Sir James Jay, Samuel Nicoll, William Moore, Nicholas Romayne, Ben- jamin Kissam, Samuel L. Mitchell, Richard S. Kissam, Samuel Bard, John R. B. Rodgers and William Hammersley, be incorporated into a college of medicine, with the privilege of recommending to the University for medical degrees such of their students as, in the pre- sence of the Regents., shall pass, with credit, the several examina- tions which are appointed in the most celebrated universities in Eu- rope, &c. The memorialists observe, ci that they ask no salaries or emoluments of the Regents or the public. They rely solely on their own industry and success. Neither do they wish for an exclusive right to teach : let any man teach who will: your memorialists are not unwilling to enter into a competition that must necessarily tend to promote literature and the public good." So much for the pre- tensions of men whose names have done credit to their State and Country. At the period mentioned above, medical science in this State was very limited, and the means and inducements to cultiva*" it but small. These gentlemen having accompli' foreign instruction, by their sn^' acquiring information, nc solicited the dignified ofl numeration for their k whom it could not othe proposed college met elapsed before the F forming an institution Not to pursue the New-York, through 6 Assembly after the resignation of the faculty, in the year 1826, and the ap- pointment of the new professors, the laws of the State have exclu- ded all competition with the latter. And this has happened when the days of ignorance have passed, and the circumstances of the medical profession have been entirely changed. Knowledge and experience are now no longer confined to the few. Many have drank deeply at the fountains. Aspirants are ready to contend for professional honois, and eager for the race. The arm of the law alone with- holds them from competition. And how, it may be asked, shall our country take her stand among the nations of the earth for her contri- butions to science, if the cold touch of government shall wither the buds of talent, and paralyze the efforts of struggling genius? The existing law of the State, as far as regards medical science, produces this effect to the full extent. Let us analyze it, and discover its principles. A number of gentlemen are appointed as Regents of the University, of whose number but one belongs, at present, to the medical profession. This board is empowered to select a small number out of this profession and appoint them professors of medi- cine, in the only tw7o incorporated medical colleges within the State. It is thus virtually said to the remainder, these persons thus select- ed, are placed at the head of the profession. They hold their situ- ations for an indefinite time. From them the students of medicine in this State must derive their instruction, if they wish to shorten their term of study by one year, or to connect the honorary de- gree with the license to practise. This last bounty produces the effect of creating a monopoly of public teaching. As a further be- nefit conferred upon these institutions, the students are required to attend two full courses of each of the professors. Now in the ap- pointment of these gentlemen, inasmuch as under the present sys- ' 1"'i«ments are held out to other members of the profession ^lic lecturers, the Regents must of ne- by their general notoriety, riends, or else by the re- rofession, to whose judg- inions in matters of this ed in this way, by those ental circumstances, or f medical men often manual dexterity as a nown by the name of when his knowledge nvey instruction with No. 171.] clearness and effect to the minds of others. Another may have ac- quired a reputation from a successful practice, in some one branch of the profession, and may hence be appointed to teach another re- quiring much talent and experience, and which may be far removed from his ordinary sphere of operations, and for which he may not be at all calculated. Again, if the urging influence of a man's overweening vanity pushes his claims beyond his merits, it is probable that he shall be appointed a professor, in the case of a vacancy, rather than another whose manly pride, often the concomitant of a truly great mind, for- bids the sacrifice of self-respect to inordinate attempts at personal ag- grandizement. If the appointment to t-he few honors of the pro- fession, depends in a great measure upon the influence of a few me- dical men, who may chance to be among the Regents, we would re- mark that it is a difficult and trying situation to be placed in ; and it is due to them, as well as the public, that they should be afforded a criterion by which to judge correctly of the capability of those whom they would select for the responsible stations of public in- structors of youth in medical science. Having thus noticed the difficulties to which the appointing pow- er is subjected under the present arrangement, we shall next con- sider what advantages it confers upon those selected from, and pla- ced at the head of the profession. And in the first place, there is indirectly conferred upon them large pecuniary emolument, which they are privileged to receive for tickets of admission to their lec- tures. It matters not what may be their character as teachers, in a large city like New-York, possessing so many local advantages, in- dependent of their instructions, a class of one hundred and fifty or two hundred students can always be collected. Every member of the class pays from $15 to $20 to each of the professors for his ticket, which yields a very respectable income. Moreover, these gentlemen engross a large portion of the piivate instruction of medi- cal students. These youth are induced to entei' their offices from one or more of the following considerations : 1st. If we become students of the professors, when we apply for degrees, the risk of rejection will not be so great as if we belong to other offices. This feeling is known to prevail extensively, and is very natural with young men, particularly when it is understood that the examinations are held in private, and conducted by the profes- sors themselves. 7 8 [ Assembly 2d. If these physicians are recognized by authority as the most ca- pable of teaching publicly, we can derive more information from their private instructions than from other members of the profession. 3d. There is more credit attached to the student of a professoi', than to those educated by others. Here then is another fruitful source of emolument presented ; for it must be remembered that every private student pays as an office fee from $250 to $300 to the professor. Moreover, the fact of the appointment of these gentlemen, produces an impression on the pub- lic mind, that they possess superior skill and experience in those branches of the profession which they undertake to teach. This in- troduces them to a large share of lucrative practice. Now when it is considered, that all these advantages may be unworthily obtained, and inconsiderately and gratuitously bestowed, is it not intolerable that they should also be secured by an exclusive monopoly? An act will be presented to the Legislature, acccompanyingthis re- port, which contemplates liberalizing the medical profession as it re- spects its system of education, opening the door to competition, and removing the most odious feature of the present system, to wit, an exclusive State patronage of individuals. There is nothing of selfish design in this act. Its object is gene- ral, and its tendency it is believed, shall be to raise the character of the profession, and to afford talent and genius, now depressed, an opportunity of being publicly manifested. It seeks not to withdraw the patronage and rational support of the government from its scien- tific institutions. The professors in these must always enjoy supe- rior advantages over external competitors. There is much of digni- ty attached to their offices, emanating as they do from the highest literary authority of the State. They have facilities to aid them in their duty provided at the public expense. They already have the start of rival lecturers. Their foundation has been laid, and super- structure erected. Time has been given them to improve and adorn the work of their hands. The Regents of the University have made character for the professors, by the act of their appointment. Other teachers must establish reputation for themselves, which must be real and not factitious. If, then, professors, possessing such ad- vantages, should require the aid of an exclusive monopoly to sus- tain them against competition, would the institutions over which they are placed, be creditable to the State cherishing them, or to the Regents, the guardians of their interests ? No; 171. 9 The proposed modification of the system of medical education is more in accordance with the democratic character of the State, than the present arrangement. By the latter, the honors, and a large por- tion of the emolument and patronage of the profession, are conferred upon a privileged few. Its tendency is to collect around these indi- viduals personal and interested friends, to whom, whatever can be spared of unappropriated dignity and profit is extended, for which the last are expected to pay in an active support of those enjoying the monopoly. Hence men may always be found to support exclusive pri- vileges, and ready to protest against opening the profession to com- petition. They will be more determined in this opposition by the consideration that if any of the professorships shall become vacant, all the college influence will be exerted in bringing forward those who have gone the full length in supporting the existing order oi things. The chances of drawing these literary prizes will there- fore be greater in proportion to the degree of servility and want of independence of the candidates. It is to be distinctly understood that the remarks made in this report, have reference to abuses grow- ing out of the existing system of medical education in this State, and are not to be considered as personal, or as alluding to any set of in- dividuals. But to proceed. It is believed that the act submitted, will, if passed into a law, be highly instrumental in promoting medical sci- ence. At present no rivalry is tolerated. In the process of time, those to whom is granted the exclusive right of teaching, feeling secure in their situations, and not being stimulated to exertion will become careless and sluggish. The youth who derive their ed- ucation from such sources, will be subjected to stale and common- place lectures; will imbibe partial and contracted views, or re- ceive deficient instruction. In the mean time, those of the pro- fession, who might have become learned physicians and eloquent teachers, being offered no opportunities, sink into an obscurity na- ture never designed for them, and which has only become their lot, by a necessity imposed upon them by the enactments of the public authorities. Finally, the State Medical Colleges will be much benefitted by a liberal act, though it may interfere with the interests of indi- viduals, w'ho may not be able to compete with external talent.- Should it happen that professors are appointed, who, upon trial, are [A. No. 171.] 10 [Assembly found not calculated for public teachers, wheiybrought to me test o! a comparison, from a consciousness of inferiority, or induced by the persuasion of friends, they would resign situations in which they ndither do credit to themselves, nor advance the interests of sci- ence. The Regents'of the. University might then appoint succes- sors from amongst those whose reputation as public lecturers row generally known, would reflect credit upon the institutions to which they might be transferred. There would thus be presented a pros- pect to cultivated talent of advancement to the highest literary and professional honors. All reasonable men would be satisfied with such an arrangement, for they could entertain no jealousy of those upon w'hom the dignity of a professor was deservedly bestowed.- The Regents of the University would then be superintendents of institutions of which they might justly boast. The medical pro- fession would have at its head men whom it would delight to honor ; and the State, when asked further ornaments, among others of her distinguished sons, might point to them and say, " these are my jewels." The committee have prepared a bill, w hich they ask leave to in- troduce.