surgical testimony*";:oi".. an expert nature, it would do much to Dr. John Leeming, Chicago—My experience in the West con- elevate the so-called "expert testimony" from the position of firms the experience of the essayist, and is not in accord with disrepute which it now occupies. that of Dr.. Crafts. The. difficulty in ascertaining the condi- Dr. Richard DeWey, Wauwatosa—One point was not men- tion of the patient previous to the occurrence of the accident tioned by the essayist, namely, the suggestive effect of the has not been referred to. In cases where we can demonstrate injury itself upon the patient, and, even more, the suggestive the presence of structural lesions by actual measurement or by electrical there can be no of but effect of an examination of the patient by the. physician, espe- tests suspicion malingering, cially if the latter, asks him leading questions as to certain the difficulty we have to deal with is to exclude positive sham- symptoms. The symptoms complained of by these persons may ming, or what I call "involuntary simulation," in persons who not be genuine, and still may not be dishonest. I have observed have received a trivial injury and who claim to be suffering from The of the is more than once a tendency to regard as dishonest all symptoms very serious neuroses. nature injury which are of a subjective nature and which can not be proven frequently out of all proportion to its effects, and these effects by' objective means. Even in Cases where the question of do not.occur in cases where no litigation is pending. We should damages did not enter I have seen, as has every one experienced try to form a positive opinion regarding the true nature of in these matters, serious impairment of function without dem- these cases, and not hesitate to express it. onstrable structural lesions. Dr. Lambert Ott, in reply—Those who do. not believe there • is much in connection with accident cases Dr. J. G. Biller, Cherokee, Iowa—I have been unfortunate rascality in large cities, I would invite to a brief in enough in two or three instances to be imposed upon by per- spend period Philadelphia and watch the trials, and I am sure will become sons who claimed for injuries, and who at jury tney damages feigned convinced. the method of once recovered when the damages were paid. I recall the case My suggestions regarding trying these cases not be under our of a farmer whose reputation for honesty was excellent and may practicable present statutes, but if were I believe the results would be far whom I had known for years. He met with a railway accident, they adopted more and than the methods. 1 and I examined him, with the chief surgeon of the company, satisfactory just by present and in view of his which had evidently been have studied this class of cases closely in Philadelphia and symptoms, other cities and the distortion of prompted by his attending physician, we made a favorable re- large prevarication, facts, of extreme with no visible evidence of dis- port. The railway company paid him $7000, and a few days complaints suffering, turbed tissue, associated with a of trivial make after he had received the money the man was in town buying history injury, up the of fraud for the of mulct- cattle. We should have some definite way of getting at these complexus presented purpose I to that in the trial of cases. They are often a disgrace to the profession. In the ing corporations. regret say injury cases a amount of will often find case I have referred to we made a very thorough examination, involving large damages you the on the side of the with his but we were unable to obtain any definite proof that the symp- well-paid specialist plaintiff biased statements and substance to their side. toms were feigned. giving strength Large corporation's are more in the settlement of claims Dr. Herman Platteville, Wis.—So long as we cling just Gasser, against them than individuals and whenever it is shown that to our present indefinite method of defining pain as subjective they are justly liable they seek an amicable and fair settle- and it will be impossible to formulate any system objective, ment. Our courts in groan under the burden of that will lead us to definite conclusions. There is no such Philadelphia such cases and only recently a band of conspirators were ar- as and objective pain; there is only one kind, thing subjective rested and convicted for purposely meeting with accidents and and that is It is a It always has pain. psychical product. subsequently injury in order to extort from some basis for its In some instances feigning damages pathological production. street It is within the of the the lesion is discoverable; in others it is railway companies. power pathological easily medical procession to stamp out this not. The reader of the paper referred to an increased pulse- rascality by condemning the malignerer and all others to confine themselves as an indication of Bichat showed that compelling rate pain. long ago to the truth. this was a valuable sign as indicating the presence or absence of real injury or of pain. The significance of the pulse as an indication of health or disease can not be overestimated. If SAMUEL FULLER\p=m-\PILGRIM, DOCTOR AND we see a sick or injured patient whose pulse is good and DEACON. strong, no matter how badly he may claim to feel—he may even be in convulsions—still we can rest assured that there is 1. N. DANFORTH, A.M., M.D. no immediate danger. As regards the occurrence of symptoms, CHICAGO. and the of I recall the case feigned real, after receipt injuries, "The names of those which came over first, in ye year of a who fell into excavation while the girl an walking along 1620, and were the of God the first street. She was apparently not injured. Her relatives by blessing begin- sug- ers and a the foundation of all the Plantations that she to in a claim for She (in sort) gested ought put damages. soon and in and their afterwards began to complain of pain in various parts of the Colonies New England; families."1 William Brad- body, and this was subsequently followed by the devlopment of So reads the quaint caption of Governor mental disturbance. She was examined by a number of physi- ford's list of the passengers, appended to his cians, and all of them, with one exception, thought she was "History of Plimouth Plantation." Among the pas- hysteric. She finally recovered $2300 damages without the case sengers, we read the name of "Mr. Samuell Fuller, and going to trial, but this did not cure her, and she is still in a a servant caled . His wife was behind, very poor condition both mentally and physically. She had a child which came afterwards."2 Bridget Fuller, a nervous and the advice of her hysteric organization fool the wife of "Samuell," with a child who soon died, friends made it chronically active, and she is now a paying came over in the ship Anne, and landed at Plymouth in severe penalty. hence, both Samuel Fuller and his wife Dr. F. Savary do not think the sug- August, 1623; Pearce, Philadelphia—I are classed the "old comers" or the gestions made by Dr. Ott regarding the methods of trial in properly among as the forefathers included all those these cases can ever be carried out, for the simple reason that "forefathers," the physician has nothing to do with the judicial side of the who came in the first three ships; the Mayflower, the question involving the damages. The physician simply has to Fortune, and the Anne.3 Referring again to Bradford's decide whether the person is injured or not, and this is often a history, we read that "Mr. Fuller his servant dyed at very difficult question for the neurologist to answer. Having sea; and after his wife came over, he had tow children determined that the plaintiff is or is not suffering from a by her, which are living and growne up to years (1650) ; traumatic neurosis, either functional (which I do not believe but he dyed some 15. years agoe" (in 1633).4 With these in) or organic, then the evidence is given to the jury and the brief and quaint remarks, Bradford dismisses Samuel latter should make the award of damages. Fuller and his family.

Downloaded From: http://jama.jamanetwork.com/ by a University of Michigan User on 06/18/2015 Samuel Fuller's servant, William Butten (who was newly arrived colonists at "Naumkeag" (now Salem), probably a student-assistant), who died at sea, November in Massachusetts Bay, caused "by infection that grue 6, 1620, as recorded by Prince;5 and Bradford writes: amonge ye passengers at sea, it spread also among them "In all this viage ther died but one of ye passengers, a shore of which many dyed, some of ye scurvie, other of which was William Butten, a youth, servant to Samuell an infectious feaoure" (fever), "which continued some Fuller when they drew near ye coast."6 time amongst them, though our people," i. e,, at Ply- There can be no doubt, I think, of the correctness mouth, "through God's goodness escaped it."15 Lieut.- of Packard's statement that "the earliest practitioner Gov. Endicott of Naumkeag, having heard of Dr. Fuller wrote some un- of medicine in Massachusetts was Samuel Fuller, who of Plymouth, Gov. Bradford "for help, was among the on the in 1620."7 derstanding here was one that had some skill yt way & passengers Mayflower had It is also true, as stated that "he cured diverse of ye scurvie, and others of other dis- probably by Packard, & other means."16 held no medical diploma, nor was his position officially eases, by letting blood Accordingly, Dr. Fuller was sent to the where he attended recognized"—i. e., by the "merchant adventurers," who Bay colony, to the ailments of the and also took oc- were tbe financial backers of the pilgrims. Although, bodily settlers, casion to make some the form according to Palfrey, he came, from London, it is not explanations concerning that he had the of medicine system- of worship in use among the pilgrims, which removed likely pursued study on that As a He must have the company in some previous misunderstandings point. atically. joined pilgrim result of this writes to Brad- Holland, as states that he followed the visit, Gov. Endicott Gov. Palfrey occupa- ford. 1629: "I selfe much tion of a silk-weaver while the pilgrims lived in Leyden.8 May 11, acknowledge my bound to for kind love and care in Mr. But they were all compelled to accept such employment you your sending Fuller and much I am him satis- as could find in Holland, and found it hard among us, rejoyce yt by they they fied of outward forme of and up-hill work to earn even a scanty maintenance; in touching your judgments ye God's In the summer of 1630 Dr. Fuller Oact; this was one of the most reasons which worshipe."17 persuasive was to on account led them to cross the then unknown and found the again called Massachusetts Bay of the ocean, Win- so memorable in the annals of civil and great prevalence of sickness, occasioned, says Gov. tiny repi VAc, at But or no with or throp, by "ill diet sea." Therefore, on July 8, he religious liberty. diploma diploma, went to "and let some without "official" Fuller was practically Matappan (now Dorchester), recognition, 20 of these blood." On he was at and gladly recognized as the physician of the pilgrim people August 4, Salem, and a little later at still colony, and was even called in a similar capacity by Charlestown, probably Governor to the then infant of Massa- "letting blood" and discussing theology, for our good AVinthrop colony Doctor was as well in chusetts on several occasions. quite versed the theological Bay of the as was in medicine. Soon after On in to squabbles day he reaching Leyden 1611, according Goodwin,9 we find him "the sadd news here Fuller was chosen deacon in the church, and (in August?), writing pilgrim is that are sick and are dead. I here was from that time forward a trusted leader i.nd counsel- many many but to be at home. I can do them lor in all matters relating to the pilgrim church—spirit- lose time, and long no good, for I want drugs and things fitting to work ual, medical and secular. He also had a hand in the Ful- which in the of the with." Shortly, perhaps immediately, thereafter, negotiations resulted, purchase ler returned to Lieut.- as one of the for the Plymouth, accompanied by transports company Gov. Endicott. These visits of Dr. Fuller were across the as shown in the re- poten- Atlantic, correspondence in and the close corded Bradford.10 Goodwin states—I do not know tially instrumental initiating cementing by which from that time forward existed be- upon what authority—that Fuller was one of the first friendship "Board of tween the "Old Colony" and the Colony of Massachu- Assistants to the Governor of Plymouth setts colony, continuing in office many years."11 He was Bay. "assistant" in 1631. but this is based In January, 1631, Henry Harwood, "a goodly young probably conjecture man" from was taken to from a shal- upon rather feeble evidence. Boston, Plymouth wrecked on the and Dr. Fuller was The first record of his work occurs in lop Cape, obliged professional to "extend treatment to says Goodwin, 1621. when in a surgical him," August, scrimmage with the Indians the nature of the treatment is not "ther was 3. sore these home although specified. wounded; they brought This is the brief but of Dr. Samuel with them," i. e., to "& had their wounds suggestive history Plymouth, Fuller's life so far as drest & cured and sente home."12 This act of kindness professional I have been able to trace it. of the old records show had an excellent effect in the way of the friend- But, course, quaint winning us but an infinitesimal fraction of the work he of their In June or actually ship savage neighbors. July, 1622, did. We must him back and forth came the and two sent "Master picture traveling Charity Swan, ships by from to the settlements of Massachu- Thomas Weston"—from whom the suffered so Plymouth sparse pilgrims setts either on foot or in an or minis- much in them some 50 or 60 Bay, open boat; ill-usage—having men, to the manifold wants of the that and a undesirable crowd were. In fact tering pilgrims during very they they first terrible winter half their number and to have been a of interested (when died), appear gang tramps,, chiefly for or in without and succeeded in thirteen years afterwards; visiting their savage living work, they foisting whom a fatal themselves upon the for two months, neighbors, among fearfully epidemic raged pilgrims nearly for several years prior to and following the landing of making sad havoc with the ears of green corn, which and How must have stole and roasted and and the pilgrims puritans. primitive they devoured, night day, been his how limited his medical and to the great of the upon whifch practice; surgical damage growing crop, armamentaria; how few and incapable the nurses at his the pilgrims were so dependent for the coming winter. During their unwelcome sojourn at Plymouth several of command; what a lonely, isolated, depressing and dis.- their number became "sick and lame,"13 and these piriting condition of things, for a physician burdened they is left at Plymouth under Dr. Fuller's care, "although they with such grave responsibilities! It impossible for us as we are . to had a surgeon of their own," Mr. Salisbury.14 In physicians, situated to-day, apprehend the winter of 1628 an epidemic appeared among the or justly appreciate the poverty of knowledge and

Downloaded From: http://jama.jamanetwork.com/ by a University of Michigan User on 06/18/2015 methods by which he was environed. One can not help Peregrine AVhite—first-born of American pilgrim ba- questioning whether those bold, hardy, fearless and reso- bies,—and we know not how many other pilgrim babies— lute, yet self-denying and self-forgetting pilgrims, ever has descended to this day, as one of the few veritable realized what vast and momentous results hung upon the and genuine Mayflower relics. success or failure of their wonderful experiment of self- Dr. Fuller evidently did not believe that it was good government in church and state. Happily for us they for "man to be alone." as he was married three times. triumphed; but who can estimate the consequences to His first wife was Elsie Glascock, whom he must have civil and religious liberty, if they had failed! married in England, but we have no certain data; she But Dr. Fuller, as we have already seen, was also probably died in England prior to the removal of the Deacon Fuller, and he was quite apt to have a hand in pilgrim church to Holland. On April 30, 1613, he was the theological squabbles which were so common in pil- married in Leyden to "Agnes Carpenter, maid, of Wren- grim and puritan days. In 1611. while the pilgrim tham in England," daughter of Alexander Carpenter, church was still in Leyden, Deacon Fuller became in- but she did not live long, and, so far as I can learn, volved in an epistolary controversy with one Daniel left no children. May 27, 1617, he was married to Studley—whom an old writer calls "that hypocritical Bridget Lee, maid, of England, accompanied by "Joos" chameleon"—and said Studley18 "grinds his teeth Lee, her mother,23 the name "Joos" being the Dutch against Samuel Fuller, a Deacon of Master Robinson's recording-clerk's spelling of some English pronomen. company; whom with his friends he describes as being but what it was we can not now ascertain. Bridget ignorant idiots, noddy Nabalites, dogged Doegs, fair- Lee Fuller, as we have seen, did not accompany Dr. faced Pharisees, shameless Shemites, malicious Michia- Fuller in the Mayflower, but followed in the Anne in vellians"—rather a choice assortment of alliterative ex- 1623. bringing also their child, probably three or four pletives, from a "Ruling Elder" (Studley), to a Deacon years old; but this child died soon after they landed. (Fuller). It illustrates the fierce and uncompromis- Two other children, Samuel and Mercy, were born in ing spirit of the times. Plymouth. Dr. Fuller's wife, Bridget, survived him Deacon Fuller also had an eye to business, especially many years, and was highly respected in Plymouth. in the matter of the church collection, even in the She became quite famous as a nurse and midwife, and presence of distinguished guests, as shown in the follow- her services were much in requisition in this capacity. ing description, by Governor AVinthrop, of a church In the year 1633, says Bradford, "it pleased ye Lord service in Plymouth in 1632: "On the Lord's Day," to visite them" (the pilgrims), "with an infectious in the forenoon, "there was a sacrament which they did fevoure, of which many fell very sicke, and upward of partake in; and. in the afternoon Mr. Roger Williams 20. persons dyed, men and women besids children, and (according to their custom) propounded a question, to sundry of them of their ancient friends which had which the pastor Mr. Smith spake briefly; then Mr. Wil- lived in Holand; as Thomas Blossome, Richard Master- liams prophesied; and afterward the Governor of Pli- son, with sundry others, and in ye end (after he had mouth (Bradford) spake to the question; after him much helped others) Samuell Fuller, who was their sur- Elder (Brewster) ; then some two or three men of the geon and phisition, and had been a great help and congregation. Then the Elder desired the Governour comfort unto them; as in his facultie so otherwise, be- of Massachusetts (Winthrop) and Mr. (Rev. John) ing a deacon of ye church, a man godly and forward to Wilson to speak to it, which they did. When this was do good, being much missed after his death; and he ended, the Deacon, Mr. Fuller, put the congregation in and ye rest of their brethren much lamented by them, mind of their duty of contribution; whereupon the and caused much sadness & mourning amongst them; Governor and all the rest went down to the deacon's which caused them to humble themselves & seek ye seat, and put into the box and then returned."19 How Lord; and towards winter it pleased the Lord ye sick- this contribution business would have delighted the soul ness ceased. This disease allso swept away many of ye of old John AA'esley if he had been present! Indeans from all ye places near adjoyning, and ye spring According to Rev. Edward Everett Hale, Dr. Fuller before, espetially all ye month of May, there was such was one of the capitalists, or one of the "persons of a quantitie of a great sort of flies, like (for bignes) to largest means in the Leyden group of the emigrants";20 wasps or bumble-bees, which came out of holes in ye but Dr. Azel Ames, in his recent work, says that "the ground, and replenished all ye woods, and eate ye green good Doctor"-—Hale—"is clearly in error."21 * * * things, and made such a constante yelling noyes, as made But Dr. Ames concludes that Dr. Fuller was "one of the all ye woods ring of them, and ready to deaf ye hearers. Leyden chiefs, connected by blood and marriage with They have not by ye English been seen or heard before most of the leading families of Robinson's congregation. or since.* * * * He was active in the preparations for the voyage But ye Indeans tould them sickness would follow, and and doubtless one of the the negotiators for Speed- so it did in June, July, August, and ye cheefe heat of well."22 In fact, he commenced the voyage in the somer."24 Speedwell, but was transferred to the Mayflower after Thus died Samuel Fuller the pilgrim "phisition" the broke as Speedwell down, the prospects seemed to and deacon. It is much to, be regretted that we warrant the conclusion that there would be an increase can not know more of this pioneer physician of before a "pilgrims" long, and that physician would of the "Old His will seems to indicate that be a rather factor in the Colony." important ship's company. he was a teacher as well as a doctor and deacon, as he AVith characteristic Mistress Su- pilgrim forethought. directs that "Elizabeth Cowles, who was submitted to sannah White—sister of our Dr. her- Fuller—provided my education by her father and mother at Charlestown, self with a strong, solid, serviceable oaken cradle before to be returned to her parents;" and the same disposition leaving Leyden. and she took good care that the cradle to be made of "George Foster being placed with me by (as well as her brother the Doctor), was safe aboard the when at last she sailed from the old to *Bradford here describes a visitation of the cicada septendecem, Mayflower away or seventeen-year locust, the first account of its appearance in New the New Plymouth. This cradle, after having rocked England.

Downloaded From: http://jama.jamanetwork.com/ by a University of Michigan User on 06/18/2015 his still at ; and 21. The Mayflower and Her Log, by Azel Ames, M.D., 1901, p. 8. parents living Sagus" (now Lynn) 22. Ibid., p. 28. "AVidow Ring submitted to me the oversight of her 23. Arber: Loc. cit., p. 164. son Andrew." He vent to his affection for 24. Bradford: Loc. cit., p. 314. gives Roger 25. Goodwin: Loc. p. 379. Williams as follows: cit., "Whatsoever Mr. Roger AVilliams 26. Ibid., p. 380. is indebted upon my books for physic, I freely give him." 905 W. Monroe Street. We also find this curious bequest: "I give to the Church of God at Plymouth the first cow-calf that my brown cow shall have."25 AVhile there are some uncer- ENFORCEMENT OF MEDICAL LAWS DEPEND- tainties regarding this gift, when we realize that heifers ENT ON AN ORGANIZED PROFESSION. were then (1633) worth £13 in Plymouth, and that the T. J. HAPPEL, M.D. purchasing power of a pound sterling was four times SECRETARY TENNESSEE STATE BOARD OF MEDICAL EXAMINERS. greater than it is now, we shall see that the church might TRENTON, TENN. be for a on pardoned "indulging hope" of fruitfulness The question of medical legislation has been an open the of Deacon Fuller's brown cow after all. part one for a time sufficiently long for thinking men of the He left a library of twenty-seven volumes, says Good- profession to have become thoroughly conversant with win, but does not enumerate them. Dr. Azel Ames it, but every member of an examining board soon be- remarks: is "One surprised and amused that the comes aware of the fact that many physicians in states library of the good Dr. Fuller should contain so relative- having good laws by which to regulate the practice of ly small a proportion of medical works (although the medicine, know practically nothing about them. In number in print prior to his death in 1633 was not some cases a few of the best men of the profession great, while rich in religious works pertinent to his openly oppose medical legislation, laying down the function as a deacon" (Loc. Cit. p. 216) ; and then with broad proposition that every man should be allowed to provoking reticence, he fails to mention the "medical do as he pleases in this free land of ours, employing if works" which Dr. Fuller did possess. he wishes any one claiming to be a practitioner of medi- "Indications show that he was a man of intellect and cine regardless of qualifications. Others take the posi- good presence, it not being improbable that he was of tion that the possession of a diploma from a medical regular education. He is among the noblest and most college in so-called good standing and the registration of interesting of the pilgrims, and the regard of his de- this diploma should be the only requirement demanded scendants should secure him a fitting monument on that of them, taking the broad ground that the possession of sacred hill where he prayed, and now sleeps in a grave such diploma is proof that the holder of it is better of which 'no man knoweth.' Surely the zeal of his suc- qualified for his work than the average member of an cessors in the healing art might well provide some mem- examining board. orial of the good physician's excursions of mercy to the These are samples of the objections presented. This pestilential cottages of infant Salem, Dorchester and diversity of opinion among physicians regarding medical Boston."26 laws interferes much with their enforcement. "In union is is more to of In conclusion, I append a facsimile of the autograph there strength," applicable this condition of Dr. Fuller, for which I am indebted to that monu- things in medical legislation and the enforcement of mental work. "AVinsor's Narrative and Critical medical laws than any other possible thing. The old History is in the of the United States." In place of an initial capital adage, "doctors disagree." constantly flung of the medical when the enforcement of "F" he uses "ft," as was the frequent practice in those faces profession days. medical laws is urged. Violations of these laws are reported to the prosecuting attorney of the state or county, and he frequently replies that whilst Dr. M. desires the laws enforced, Drs. N. and P. do not want M f any such thing done and he is unwilling to enter upon the prosecution of the violators of medical laws. This is especially the case when the prosecuting attor- ney is a salaried officer. His compensation is neither REFERENCES. increased nor diminished by his enforcement of laws, 1. Bradford's History , Deane's edition, and as the enforcement of any laws, new ones especially, 1856. p. 447. and medical ones more particularly, may make him 2. Ibid., p. 448. enemies and hence lose him votes in his next 3. Chronicles of the Pilgrim Fathers of the Colony of Plymouth election, from 1602 to 1625, by Alexander Young, 1844, p. 352. he is too well satisfied to do as little work along such 4. Bradford's "History," p. 451. lines as In many instances these 5. A of New England in the form of possible. irregular Chronological History live in a Annals, by Thomas Prince, M.A. (Ed. 1736), p. 72. and non-registered, law-infracting physicians 6. Ibid., p. 76. country district where they control a class of voters, or 7. History of Medicine in the United States, by Francis Ran- in a to the class who dolph Packard, M.D., 1901, p. 16. city they belong advertising pay 8. Compendious History of New England, 1494 to 1697, by John the daily or weekly papers to exploit their wonderful Gorham Palfrey, 1884, i, 59. skill as and surgeons, and as a result it is 9. The John A. 34. physicians Pilgrim Republic, by Goodwin, 1895, p. a to 10. Ibid., p. 49. the part of business policy for the attorney let them 11. Ibid., p. 159. alone. These facts are set forth thus plainly that those 12. Bradford, loc. cit., p. 104. who desire so to do may understand some of the diffi- 13. Young's Chronicle (Winslow's Relation), p. 297. 14. Goodwin, loc. cit., p. 207. culties met with by examining boards in having medical 15. Bradford, loc. cit., p. 263. laws enforced. In other cases, a physician writes to the 16. Ibid., p. 264. board it that Dr. A. is the 17. Ibid., p. 265. notifying violating medical 18. The Story of the Pilgrim Fathers, 1606-1623, A. D., as told law. but that his name must not be used in prosecuting by Themselves. Their Friends, and Their Enemies, by Edward him as it would render him with Dr. A.'s Arber, F.S.A., 1897, p. 124. unpopular a that he can not to as ex- 19. The Story of the Pilgrims, by Morton Dexter, 1894, p. 296. friends, thing afford do he 20. New England Magazine, Sept. 1889. pects to fall heir to Dr. A.'s work when he is driven by

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