Am.  Jour.  Pharm. 
May,  1915. 
M  odem  M  c  die  inc. 
233 
The  greatest  single  mistake  has  been  the  belief,  common  in  the 
medical  profession  for  the  last  forty  years,  that  sanitary  reforms 
could  be  accomplished  by  the  passage  of  laws.  This  is  all  the 
stranger  in  view  of  the  fact  that  a  clear  and  definite  note  of  warning 
was  struck  early  in  this  period  by  one  of  the  leaders  of  medical 
thought  of  his  day.  In  1877,  at  the  Chicago  session  of  the  American 
Medical  Association,  Dr.  Stanford  E.  Chaille,  of  New  Orleans, 
presented  a  paper  on  "  State  Medicine  and  State  Medical  Societies," 
which  to  the  student  of  the  development  of  State  medicine  in  this 
country  must  ever  remain  as  one  of  the  clearest  and  most  far-sighted 
papers  ever  presented  before  the  association.  Discussing  the  neces- 
sity of  systematic  education  of  public  opinion  as  a  necessary  precedent 
to  the  enforcement  of  sanitary  laws,  Dr.  Chaille  says : 
"  It  requires  no  great  wisdom  to  enact  laws,  but  great  wisdom 
to  enact  on  many  subjects  laws  which  can  be  enforced.  The  history 
of  legislation  is  glutted  with  the  enactment  of  laws  which  not  only 
failed  to  accomplish  the  object  intended,  but  which  did  accomplish  a 
very  different  one,  often  bringing  the  object  sought  for  into  public 
contempt.  Rarely  do  writers  on  State  medicine  realize  the  truth  of 
the  lessons  taught  by  students  of  the  philosophy  of  lawmaking,  that 
there  is  a  class  of  subjects  in  regard  to  which  laws  can  be  enacted  in 
advance  of  public  opinion  without  fear  of  bad  results ;  but  that  there 
is  another  class  of  subjects  in  regard  to  which  no  laws  can  success- 
fully precede  their  public  sanction,  and,  if  enacted,  violation  and 
contempt  for  them  will  ensue.  Unfortunately,  to  this  class  belong 
such  subjects  as  the  regulation  of  the  practice  of  medicine,  com- 
pulsory vaccination,  registration  of  vital  statistics,  etc.,  and  their 
satisfactory  disposal  cannot  be  hoped  for  until  an  enlightened  and 
organized  medical  profession  exercises  its  influence  on  public 
opinion." 
In  spite  of  this  clear  statement  of  the  problem,  we  have,  as  a 
profession,  placed  far  too  much  confidence  in  legislative  enactment 
as  a  means  of  social  and  sanitary  improvement.  This  is  partially 
due  to  the  prevailing  popular  idea  that  the  passage  of  a  law  in  some 
way  accomplishes  something,  and  that  a  law  necessarily  contains 
within  itself  the  power  for  its  own  enforcement.  A  law  is  not  a 
force  and  never  can  be.  A  law  is  simply  a  rule  of  action,  a  state- 
ment of  the  way  in  which  a  force  acts  or  should  act.  Now  in  this 
country  the  only  possible  force  is  public  opinion,  the  will  of  the 
majority.    It  has  come  to  be  recognized  as  axiomatic  that  no  law 
