A CONVERSATION

WITH

ALEXANDER WILDER, M.D., F.A.S.

ON

MEDICAL FREEDOM.

Q. Dr. Wilder, as the author of an able and interesting "History of Medicine," which I have just had the pleasure of perusing, I would like to obtain your views on restrictive medical legislation. The advocates of this kind of legislation plead that it is demanded for the protection of life and health, for the welfare of society, and for the advancement of science. In regard to the first of these propositions, let me ask you whether you consider it true that the life and health of individuals are safer and better secured where statutes are in force that narrow the practise of the healing art to the representatives of two or three schools of medicine, or where a broader freedom obtains and every citizen is guaranteed the right to select whomsoever he desires to wait upon him in the hour of sickness, and each physician understands that he will be held responsible for his own acts?

A. The subject of medical legislation covers a wide field and invades not only the rights of persons in a professional matter but their rights as human beings. I wish, therefore, that the subject could be discussed by some one other than myself. I grew up from childhood with an intense hatred of oppression and love of fair play and fair opportunities for all. I believe heartily with Herbert Spencer that every individual has freedom, the right to do all that he wills, provided he infringes not on the equal freedom of any other person. It seems to me, therefore, that I am too decided and too radical

in my notions to give any but a positive reply, perhaps without due regard to the other side.

I do not think that stringent legislation which, under the pretext of regulating medical practise, aims or operates to confine it to the representatives of particular schools of medicine has the slightest advantage in regard to life and health over the freedom of every individual to select his own adviser, and of that adviser to give the aid desired. It would be an act of tyranny to force a person to take medicine if he did not believe in its efficacy, and it is equally such to compel him to do without advice and service where he does so believe. Until this American system becomes a paternal government or an Asiatic despotism, such wrongs are not to be countenanced.

Medical legislation as a general fact is but meddling and muddling whenever it interferes. It cannot be intelligent, and therefore cannot be just. For medical men seldom agree, and none of them are experts in matters of legislation; hence, it is not possible to obtain the requisite knowledge to legislate to any right purpose. The legislators who vote for such enactments are little else than dupes of those who seek them; and unfortunately medical men have a great pecuniary interest in disseminating exaggerated notions about infection and other matters. If there was no pecuniary interest involved, I do not believe that such legislation would be sought; and, indeed, medical men of the first class in their profession are seldom found seeking to obtain it.

The first of these statutes, the one enacted in Illinois about twenty years ago, I was told by a physician who took part in it, was passed and procured, not to elevate the practise or to drive off charlatans, but simply to make an office for Dr. Rauch.

Q. Is it not true that the independent practitioner is compelled to be far more careful than the physician who has a large and powerful medical organization behind him?

A. Yes; the practitioners who have no powerful medical organization behind them are sure to be held responsible as other physicians are not. It is a significant fact illustrating this statement that while criminal abortion is very general

physicians belonging to orthodox medical societies are seldom brought to answer for it. When they are called to account for alleged malpractice or mistreatment, their professional brethren generally swear them clear. But the slightest aberration or blunder on the part of the unprotected independent is very certain to be made the theme of general criticism and abundant exaggeration.

Q. Is it not true that the remedial agencies and procedures employed by liberal, progressive, and independent practitioners are, as a rule, far less dangerous than the drugs employed by the "regular" or old school of medicine?

A. Certainly; I am very positive in my conviction that the latter are far less dangerous. Any intelligent person will object to swallowing medicine when in health, because it will very probably do him injury; yet he is the same individual when ill, and will often suffer injury from it accordingly. Hence, he takes it in the hope of some incidental benefit compensating for the injury. My personal observation in early life in my own family and neighborhood made me apprehensive that the physician would prove more dangerous than the disease; and, indeed, one of my strongest reasons for studying medicine, beyond a passion for knowledge, was to be able to escape that peril. Nevertheless, it is hardly necessary for me to impeach the orthodox medical practise. Its history resembles the shifting of the kaleidoscope, in which the same material is presented constantly in different forms, but with no change in the articles themselves. The ablest and most learned members of the profession have often spoken in no doubtful terms. I will not quote William James or Oliver Wendell Holmes.

Five centuries ago, when polypharmacy was in vogue in most disgusting and extravagant forms, Paracelsus wrote: "Some poison their patients with mercury, and others purge or bleed them to death. There are some who have learned so much that their learning has driven out all their common sense; and there are others who care a great deal more for their profit than for the health of their patients." Dr. Ben

jamin Rush, a signer of the Declaration of Independence, was equally positive. "We have assisted in multiplying diseases," said he, "and we have done more: we have increased their mortality." Even Dr. Chapman of Philadelphia declared the physician who abandoned his patient to calomel "a vile enemy to the sick." Yet the same boast was made then as now that the art of medicine was more perfect than ever, and not to be improved.

If it is imagined that the blood-letting practise has disappeared, not to return, we have only to remember that there are recurrences of epidemic "fads" among medical men, like those of cholera. Bacteriology was a fad two centuries ago, and even now the leading medical journal of Great Britain is named The Lancet. No one will venture to call it a misnomer. "Monsieur Tonson" is very sure to "come again."

Meanwhile it is a fact easy to demonstrate that physicians of the homeopathic, eclectic, and other schools, practising medicine side by side with those denominating themselves regular and "the medical profession" par excellence, do not exhibit in their practise any such high percentage of deaths. I have scrutinized their books and interrogated them personally in order to be sure of the fact. One of them, who has had a large number of cases of pneumonia, has in forty years scarcely lost over one or two in a hundred; and in an epidemic of dysentery, which was very malignant and fatal, he had over seventy patients and all recovered. He is equally sure in small-pox, but never vaccinates. I could point at others. It is perfectly safe to pronounce the remedial agencies and procedures of the various schools of liberal physicians far more sure of good results and far less dangerous than those of their rivals; and another significant fact is that when they adhere faithfully to the formulas and treatment of the school to which they belong, not "going after strange gods," they leave no disease behind as a consequence of their medical treatment. To them, therefore, the emphatic words of Dr. Rush do not so forcibly apply: "Those physicians generally become the most eminent in their profession who soonest eman

cipate themselves from the tyranny of the schools of physic;" or the declaration of Sir Thomas Watson, that in order to become successful the physician must first forget what he has learned in college.

Q. Is it not true that wise and just regulations can be provided for the protection of the community in case of contagious or infectious diseases, for example, without any stringent laws that are applied and intended to apply so as to give favored schools of physicians a practical monopoly of the healing art?

A. In regard to the protecting of a community in the case of contagious diseases, it is my opinion that this business of contagion and infection is prodigiously overdone. Much of the danger supposed to exist is only in the fancy, which is, often from motives of self-interest, stimulated abnormally to the point of alarm. Our people are educated to consider themselves diseased or liable to disease when such is not the case. Employment at something useful, pure air, pure water, and wholesome diet are more effective as prophylactics and disinfectants than the various expedients that are vaunted and exhibited. The legislation with which we are infested seems to be devised for the advantage of sanitary officers rather than for the benefit of the sick, or even the health of the community. I have yet to learn where health boards and their regulations have served to any noteworthy degree to lower the death-rate.

Q. It is often asserted that, in States and communities where no strict laws and regulations are in force, impostors, mountebanks, and charlatans deceive the people and lead their patients to believe that they have received a medical education when this is not the case. This plea was put forward several years ago as one of the chief reasons for the enacting of a medical statute in Massachusetts. It was opposed by a proposition that a measure should be enacted requiring every physician engaged in professional practise to hang up his diploma, if he had one, and a certificate giving his qualifications or lack of qualifications, which should be signed by the proper