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By Fritz Ehlotzky

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Bartlett seemed only slightly concerned over his expulsion, but, as explained to a special committee of the Massachusetts legislature to whom he appealed, the prohibition on consultation had destroyed his livelihood. The effects and influence of my expulsion have been highly injurious to my character and prospects. Medical gentlemen have refused to consult with me, and 1 have lost prospective practice. My degree from Harvard has been of no service to me since my expulsion. I have no right which any loafer might not enjoy.

Since almost all physicians did the same sort of things, consultants were ordinarily potential competitors. The general practitioner today sees, of course, little danger in referring cases demanding specialized knowledge to another physician; the functional differentiation of the profession within the past century has defined, and thus limited the specialist's activities ([18], pp. 223--253, reprinted in [I 2], pp. 58-59). Thus, because o f the horizontal structure o f nineteenth-century medicine, when one physician consulted another, he was dealing with s o m e o n e w h o had an i m m e d i a t e self-interest in disparaging his care o f the patient.

36. : 1789, "Observations on the Duties of a Physician, and the Methods of Improving Medicine. : 1815, Medical Inquiries and Observations, Vol. I, pp. 251~o4, M. Carey, Philadelphia. 37. : 1831, ,4 Manual of Jurisprudence. compiled from the best medical and legal worlc~: comprising an account of" The Ethics o]" the Medical Profession, 11. The Charter and Statutes Relating to the Faculty; and II1. All Medico-legal Questions, with the latest discussions. ]'or the use o f barristers, solicitors. magistrates, coroners, and medical practitioners, Renshaw and Rush, London.

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