An Infamous First

History and pop culture love famous “firsts.” Some firsts are understandably famous: Neil Armstrong, Roger Bannister, Kamala Harris. Whether in science, sports, politics or any other field of human endeavor, there have always been trailblazers—brave souls meriting every accolade tossed their way

But what about more dubious firsts? Notable flops or failures? Sometimes even these manage to enter the popular imagination. The Dalton Gang, western outlaws of the 1890s, offer a great example. One of them had the brilliant idea for a daytime simultaneous robbery of two Coffeyville, Kansas banks. As you might guess, it wasn’t quite a Clooney-Pitt Ocean’s Eleven outcome.

Take the case of Dr. Nathan J. Aiken. We don’t know much about him. He was born ca. 1840 in New York state, may have taught school briefly and graduated from the Cincinnati College of Medicine and Surgery in 1865. He entered the historical record in September 1878 in Aiken v. State Board of Health [Illinois].

For several months prior, the Illinois State Board of Health had been sending Aiken letters warning about his “advertising” practices in local newspapers. The board warned Aiken against advertising his “specialties” and, if he persisted, the board might be forced to a finding of “unprofessional conduct” with a loss of his medical license. Aiken ignored the warning. The Illinois board responded by revoking his license; so…Aiken lawyered up and filed suit against the board.

Aiken v. State Board of Health isn’t particularly scintillating but it represents the first court case challenging the authority of a state medical board to revoke a license.  At that time, only about twenty states and territories had laws regulating the practice of medicine; and most of these were just registration laws mandating the person present to the county clerk for inclusion on an official registry of physicians. Illinois was one of only a few states where the board had the legal power to revoke a license.

Thus, it appears Dr. Nathan Aiken holds the unique and dubious distinction for a pair of infamous firsts: the first revocation of a license by a state medical board and the first legal challenge to a medical board’s authority to revoke a license.

The basis for revoking Aiken’s license—advertising—seems like a quaint relic of another era. To be clear, the board didn’t condemn all advertising—they had no objection to what they termed “legitimate” or “honest” advertising. What the Illinois board rejected were the practices of those physicians who “pretend that they can cure everything, and advertise the same….” Such ads stood out even as they vied for newspaper space with the era’s many ads for mail-order patent medicines like Hoofland’s German Bitters, Lydia Pinkham’s Vegetable Compound and Radway’s Regulating Pills.

Lydia Pinkham Pills

Though the ads specific to Aiken’s case haven’t survived, at least two of his newspaper ads from the period survive via the Chicago Daily Inter Ocean. One is a brief note listing his specialties but the other seems likely to have been reflective of what got him into trouble with the board.

     “Exclusively Diseases of Women,

And all office cases, successfully treated by

            Dr. Nathan J. Aikin,

                Offices, 134 Clark St.

    While family doctors wrongly undertake every case they can get (though

of course not able to properly treat certain diseases that should never be

entrusted to them), Dr. Aikin gives his whole attention to the cure of Cancers,

Catarrh, Lungs, Men, Women, Nervous and Special Diseases which belong to

office practice. His wide experience, skill and trustworthiness as a gentleman

in every respect, give a guarantee to all who want professional aid.”

The Illinois board’s views on advertising were not unique. They reflected many, if not most, physicians’ views on the subject as well as those of the American Medical Association. The AMA’s original Code of Ethics from 1847 addresses advertising by directly enjoining physicians from “promising radical cures,” “boasting of…remedies,” or “dispens[ing] a secret nostrum.” In the late 1860s, the AMA came down equally forcefully on physicians advertising themselves as “specialists”—something increasingly occurring with physicians we would recognize as specializing in ophthalmology and obstetrics/gynecology. Aiken appears to have run afoul on both counts if the ad above is any indication.

Aiken lost his case against the board. Indeed, the Illinois court’s ruling sounded themes and principles later reflected in the U.S. Supreme Court decision, Dent v. West Virginia (1889): legal acceptance of self-regulation within a profession by its members, deference to the decision-making of such professionals and the privileged position of medicine among professions. These themes largely shaped medicine and medical regulation for the century that followed.

And Dr. Aiken? Well, his life story didn’t get much better after his infamous firsts in 1878. He relocated to Michigan and was a defendant in an 1886 criminal trial for manslaughter stemming from the death of a patient in an abortion case. Then he moved to California, gained a medical license and apparently thrived for a while despite periodic legal troubles starting with an extortion case. He later committed suicide (poison) in route to San Quentin prison. A press report identified him as a “notorious abortionist” convicted for using the U.S. mail to solicit criminal abortion.

Sources:

Seventh Annual Report of the State Board of Health of Illinois, 1885

Chicago Tribune, November 2, 1878

The Morning Call [San Francisco, California] June 10, 1894

The views expressed are those of the author and do not reflect those of the Federation of State Medical Boards.

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