THE PRESIDENT'S ADDRESS, Delivered at the Third Annual Meeting of the Rocky Mountain Inter-State Medical Association, Held September 3d and 4th, 1901, Denver, Colorado. By CAREY KENNEDY FLEMING, M.D., Members of the Society: Denver, Colorado. On occasions of this kind it is the usual practice, in our older medical societies, to consider some medical topic. This has been so firmly established as to be almost a fixed rule. Probably the habit of following the line of least resistance may account for the making of addresses, to which no one is likely to take exceptions and in which all will be equally interested. In this comparatively new society of ours, which is composed of the most vigorous elements of the progressive and successful western states of this great country, originality rather than conventionality is in keeping with the conditions which surround us, for it may be as Colonel Roosevelt stated, in a recent speech at Colorado Springs, that "As the years go by this Republic will find its guidance in the West." No further apology will be offered for the nature of the discussion and suggestions offered at this time. Legislation applied to the requirements of the practice of medicine has never been a popular subject with the majority of the members of the profession, for the principal reason that physicians, as a rule, take little part or interest in local or legislative matters. The nature of a physician's duties renders it im practicable, if not impossible, for the active practitioner to enter politics or any other field demanding time and labor, while the nature and delicacy of his relation to his patients usually prevents him from resorting to a process of law even to collect his bills. Add to this an unfamiliarity with the ways of the law, the element of indifference which the successful middle-aged doctor feels toward the rest of the profession, and perhaps to the rest of the world, and in which he is not unlike the successful man in any other profession, and you have some reasons which may account for the absence of interest among physicians, in the subject of medical legislation. I do not wish to be understood to mean that physicians are not good citizens, or are not public spirited; far from it, for I believe no class of men are more loyal to human rights or more devoted to human interests than they. Staunch adherents to great principles may be silent, yet they in no way lose in strength and sincerity, and when the time comes for action, it is often the habitually silent man who speaks in the most pronounced terms, the inactive who becomes the fighting champion. Such men are reluctant to act, but when once aroused they become the more efficient for their long retirement. Relying upon these qualities of the men about me, I invite your attention to some of the conditions which face the medical profession of the United States to-day and to some suggestions for relief from the evils inherent in the present system of laws and surroundings. Many of the worst enemies of the medical profession in its position as a dignified and honorable body, are within the profession itself. Men who are honest in purpose, intensely earnest in their work, but who are lacking in mental equipment, or the training or the power of application necessary to enable them to keep pace with the company they choose, are found in every walk of life. The legal profession has its proportion, the ministry its quota, literature is crowded with the would-be writer of fiction, romance and history, and medicine with its would-be doctors. If these men without let or hindrance or protest crowd the profession, then must we cease to hope that the profession can in any real sense become what it ought to be, a learned profession. We all know that one incompetent man in the profession will do more to lessen the dignity of medicine in a community than ten competent men can do to build it up, so apt is the public to measure down to the poorest rather than up to the best. But this class of men are not so dangerous to our ideals as the men who, though competent so far as the knowledge of medicine is concerned, are lacking in qualities equally necessary to the dignified expression of the profession-honesty and integrity. Within the profession to-day are men whose adherence to the profession is but a cloak to hide practices as black and damnable as murder itself-men who masquerade in society as physicians and who with mock solemnity pose as upholders of the dignity of medicine, but whose real work is to shield the enemies of society. Without the arm of the law to enforce its standards, these men can and do defy the profession to harm them. I may also here refer to those quasi members of the profession, who while using the title of "Doctor" or "M. D.," at the same time adopt methods of advertising and practice that mark them enemies to the profession in its higher aims. These men feed upon the credulous and weak; they do it partly by assuming to be physicians, and partly by fighting the methods of legitimate medicine. There is no influence at work to-day that so belittles the dignity and standard of the profession as do these advertisers, nor is so difficult to suppress, identified as they are in the public mind with medicine as a science and a profession. But if there are these disturbing elements within the profession, they do not constitute the sole hindrance of the profession. The evils within the profession are largely due to evils. without. There are about us to-day many new schools of healing, Christian Science, Divine Science, Theosophy, as well as schools employing somewhat more tangible methods of treatment, osteopathy, hydropathy, etc. With the schools of mental and spiritual healers the profession has had little or no conflict, for it does not recognize the practice of these methods as in any sense related to the medical profession, and has heretofore not sought to class them with legitimate medicine even in legislation, but these schools have, while professing the highest qualities of which the human heart and head are capable, striven by means unworthy the most confirmed of sinners and worldlings to tear down and cast to the winds the learning and experience of ages, and have waged uncompromising war upon medicine and its devotees. If the teachings of these schools were new and coherent systems of philosophy, and the followers were serious students of the great problems of human advancement, mentally, physically and morally, we might hesitate and inquire closely as to our right as against a profession that so far overreaches us in its promises of health and happiness to mankind, lest we should for selfish ends block the greatest good to the greatest number. But when we know that these principles or dogmas are nothing but the cast-off garments of philosophy, gathered from the junk shops of the world and patched together by men and women with no conception of the fundamental laws of the universe, we are not justified in leaving the field. The duty of the profession under these conditions is to show to the world, by scientific methods, that these theories are erroneous. The grain of truth in the ton of chaff is that mind has a certain influence over the body, but that fact does not imply that the mind can under all conditions and circumstances control the body, nor that the body does not exist except in contemplation of the mind. The profession must convince the people that these theories are false. We owe another duty in this matter, the duty of protecting the weak and confiding from the impositions, whether sincere or dishonest, of those who seek from the zeal of conviction, or from covetousness and greed, to treat the most serious diseases by means wholly inadequate. This duty is one we owe as citizens; it is the function of every government to protect the weak, physically and mentally, from the strong. The schools of osteopathy and others we can consider in but one light, as fads and fakes. These are things that will pass away. The doctrine that you can not "fool the people all the time" I will in the end 'correct these follies. The profession should join with the state to prevent imposition, fraud and crime. Evils of this sort attach rather to the state and to society than to the profession, but unfortunately the government has not done its part in regard to these matters; perhaps the profession is also remiss. The presence in the profession of incompetent men is a result rather than a cause. The lack of high standards of ad mission to schools and admission to practice allows these inferior men to gain admission to the profession, and, until the standard is raised, this class will continue to come in. I believe that no man should be admitted to the practice of medicine who is not a graduate of a medical college of unquestioned standing, and only then after passing a thorough state examination. The legal profession in most states does not admit to the practice of law upon graduation from the best law schools of the land, but the applicant must pass satisfactory examinations, whether graduates or not. The standards for admission to medical colleges should be so high as to insure that those ad mitted are men educated in the true and higher sense and capable of becoming members of a learned profession. It must be evident, without saying, that the standards must be uniform throughout the United States. Nothing is more discouraging or annoying than the fact that to-day there are as many standards for license as there are states in the Union. Some, and perhaps many, of the states have fairly well established standards, but of the thirty-three or thirty-four who have good laws there are no two alike, and a man going from one state to another may find himself unable to comply with some minor detail of the state law. It is not unfrequent that a physician is compelled to change location and climate either for his own health or for the health of some member of his family. He may be a man well established in practice and advanced in years. Nevertheless, he is confronted with some restriction in the new state which is very vexing and which perhaps renders it impossible for him to continue the practice of his profession in his new place of residence. Uniform standards would at one stroke correct this, for it would be of no consequence where a man comes from; he can be allowed to begin the practice of his profession at once. A license to practice in one state would be sufficient license to practice in any state, with only the necessary supervision to determine that the license is genuine and had not been revoked. It may be objected here that high standards may discourage some young men from entering the profession. I believe the opposite result would ensue. There is nothing to-day more discouraging to the young men contemplating the study of medicine than the consciousness that in the profession are many undesirable men, and that while he is spending money, time and labor in fitting himself for his profession there are men getting enough surface polish to enable them to slip through their graduation and to enter the practice many years ahead of the really educated and properly equipped man. Most young men are anxious to get into life, and that impatience is greatly increased by the fact that with poor training many men succeed in getting their professions at an early age. This condition of haste will continue just so long as it is possible for such men to begin practice early, and it will be possible for such men to begin early just so long as the standards are low. We cannot hope to have a genuinely serious body of men in the profession until we have removed from the profession, as a science, every trace of the preparatory school and made it truly a society of |