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27. Founding of The American Medical Association.


GUILDS were the means by which medieval craftsmen bound themselves together for mutual protection and regulation. As centuries passed, many guilds faded away. Early in the nineteenth century came a resurgence of desire, especially among professional men, to band themselves together, for solution of mutual problems and to control or to eliminate from their midst quacks, pretenders, and charlatans. From this desire grew a number of great voluntary medical organization or associations of national scope. Growing like vines, these associations not only sprang from roots in sectional and local organization, but, gathering strength, sent out new schools that mothered more local societies, uniting all into vigorous, progressive corporations.

One of the first of such organizations to be formed was the British Medical Association, founded July 19, 1832. The Pharmaceutical Society of Great Britain came into being in 1841. The American Medical Association followed, in 1847; the American Pharmaceutical Association was organized in 1852; and the German Aerzteverein in 1872. Preceding all of these was the organization of the United States Pharmacopoeial Convention in 1820, a movement toward establishment of standards for medicines at first undertaken entirely by medical men.

While tradition and experience had developed disciplines among practitioners of medicine in the Old World, no such controls were in effect in the mushrooming communities of North America. New nations were being carved out of the wilderness; and among those men who were doing the carving were many free thinking nonconformists-rebels against older disciplines. As the Colonies rounded out their first century and new generations of pioneers carried on, few aspirants to medical careers could afford to return to Europe for education; tutoring by preceptors was the rule-but there were no laws to prevent anyone with sufficient audacity from calling himself “Doctor” and from practicing his own particular style of medicine. There developed, about the time the new nation, knows as the United States of America, was created, a situation in medicine that became increasingly unsatisfactory; preceptor training was being abandoned in favor of short courses in medical schools operated for private gain. The quality of many of these schools deteriorated as competition for students – and for their fees-became more intense. In addition to evils arising from lack of educational standards, licensure of practitioners was controlled by the very schools that produced them. Thus it became increasingly apparent to wiser and more sincere medical men of the time that some drastic action would be necessary to curb evils existing in medical education and licensure, and to restore to New World medicine dignity that would deserve public respect.

Organization of The American Medical Association was neither a spontaneous development nor the result of a moment of inspiration. According to Fishbein, “birth of the Association followed travail of many months; the pains, the jealousies, and the love associated with its conception forecast the great career to be achieved by this extraordinary progeny.” It exemplified, too, courage and determination of medical men in a new world, without benefit of traditional institutions and backgrounds, to raise themselves to standards in keeping with highest professional ideals.

Rivalry among medical schools, resulting in reduced curricula and other short cuts, provided the irritant that stimulated practicing physicians of the early nineteenth century to associated action. The Faculty of the Medical College of Georgia proposed, in 1835, a convention of delegates from medical schools; but other schools of the Atlantic seaboard opposed the plan. First move toward a national medical convention was a resolution passed by the Medical Society of the State of New York, in February, 1839. However, due to lack of interest, nothing came of it. In 1844, in resolutions presented to the New York Society, Drs. Alexander Chapman and N.S. Davis attacked abuses in medical education and urged separation of licensing powers from teaching institutions. Referred to committee, these resolutions were subjected to further discussion and controversial debate at the 1845 convention of the Society. When, as the convention neared its close, it appeared that the subject of reform of medical education would be put over for still another year, Dr. Davis of Bringhamton, at the surging of Dr. Alden Marsh of Albany, introduced a resolution calling for a national convention of delegates from medical societies and colleges “in the whole Union,” to be held in New York City in 1846. The enthusiasm of young Dr. Davis prevailed over opposition; the resolution passed; and Drs. Davis, James McNaughton, and Peter Van Buren, were named to the committee to activate the plan.

Dr. Davis the channeled his enthusiasm into a promotional program that rivals today’s best techniques. By February, 1846, medical societies and colleges of medicine, with the exception of colleges in Boston and in Philadelphia, had responded favorably. The meeting date was set for May, 1846, in the hall of the Medical Department of the University of New York. This progress was not accomplished, however, without strong opposition, stemming mainly from jealousies among medical schools. Ironically, an address severely criticizing the New York State Medical Society and referring to the proposed convention as political play, was made by Professor Martyn Paine, of the faculty of the host college. Widely published, this address had one unexpected result; it turned Philadelphians from opposition to support of the convention.

The meeting in New York convened May 5, 1846, with 80 delegates present, representing sixteen states. Dr. Edward Delafield of New York was in the chair, and Dr. William P. Buel served as secretary. A nominating committee of one delegate from each state was appointed, and following its report, officers for the meeting were elected; president was Dr. Jonathan Knight of Connecticut, vice-presidents were Dr. John Bell of Pennsylvania, and Dr. Delafield; and secretaries, Dr. Richard D. Arnold of Georgia and Dr. Alfred Stille of Pennsylvania.

Then followed a most extraordinary move: Dr. Gunning S. Bedford, a colleague of Dr. Paine and a delegate from the host university, introduced a resolution asserting that, since the assemblage was representative of fewer than half the states and of less than a majority of the medical colleges, adjournment was in order. After a moment of stunned silence, delegates rejected the resolution by a vote of 71 to 2. The convention then settled down to work. A committee of nine, headed by Dr. Davis, was instructed to bring in recommendations regarding medical education. Reporting for the committee the following day, Dr. Davis presented four proposals.

“First, That it is expedient for the medical profession of the United States to institute a National Medical Association.

“Secondly, That it is desirable that a uniform and elevated standard of requirement for the degree of M.D., should be adopted by all the medical schools in the United States.

“Thirdly, That it is desirable that young men, before being received as students of medicine, should have acquired a suitable preliminary education.

“Fourthly, That it is expedient that the medical profession in the United States be governed by the same code of medical ethics.”

These proposals were accompanied by a recommendation that a committee of seven be appointed to study each proposal, and to report at a meeting to be held in Philadelphia, the first Wednesday in May 1847. Following adoption of these propositions, Dr. Davis introduced a resolution calling for separation of licensing functions from teaching institutions. Though highly controversial, Dr. Davis was able to have this proposal referred to committee. Dr. John H. Griscom requested a committee, also to report the next year, on registration of births, marriages, and deaths. The convention adjourned the evening of May 6.

The American Medical Association came into being at the convention in Philadelphia in 1847. Some 250 delegates, representing 40 medical societies and 28 colleges, and coming from 22 states and the District of Colombia, gathered in the hall of Philadelphia’s Academy of Natural Sciences, May 5, 1847. They were welcomed by Dr. Isaac Hays, chairman of the committee on arrangements. Dr. Knight was named temporary chairman. Members were named to a credentials committee and to a nominating committee. Permanent officers elected for the convention were; president, Dr. Jonathan Knight of Connecticut; vice presidents, Dr. Alexander H. Stevens of New York, Dr. George B. Wood of Pennsylvania, Dr. A.H. Buchanan of Tennessee, and Dr. John Harrison of Louisiana; and secretaries, Dr. R.D. Arnold of Georgia, Dr. Alfred Stille of Pennsylvania, and F. Campbell Steward of New York.

Several committee reports were disposed of and the group reaffirmed its stand on licensure. In addition, a controversial resolution, concerning requirements for preliminary education, was discussed and acted upon. These principles were to be reaffirmed, repeatedly, though many years were to pass before their aims were fully achieved.

Most important of the subjects to come before this assemblage was the report of the committee on a plan for organizing a permanent national association. The committee brought in a proposed constitution, embodying, as the basis of organization, the principle of representation. Active members of the Association were to be delegates from medical societies and medical degree-granting institutions, in accordance with a fixed numerical ratio. Purposes of the organization, set forth in the Preamble, were:

“…for cultivating and advancing medical knowledge; for elevating the standard of medical education; for promoting the usefulness, honor, and interests of the medical profession, for enlightening and directing public opinion in regard to the duties, responsibilities, and requirements of medical men; for exciting and encouraging emulation and concert of action in the profession; and for facilitating and fostering friendly intercourse between those engaged in t.”

Encouragement of formation of state and local medical associations was to be one of the organization’s primary aims, and delegate membership was shaped to this end. Committees were to be established to study problems related to medical sciences practical medicine, surgery, obstetrics, medical education, medical literature, and publications.

After considerable discussion, the proposed Constitution was adopted, May 7, 1847. The convention then resolved itself into The American Medical Association. Officers elected for the Association’s first year were: president, Dr. Nathaniel Chapman of Pennsylvania; vice presidents, Drs. Jonathan Knight of Connecticut, Alexander H. Stevens of New York, James Moultrie of South Carolina, and A.H. Buchanan of Tennessee; secretaries, Drs. Alfred Stille of Pennsylvania, and J.R.W. Dunbar of Maryland, and treasurer, Dr. Isaac Hays of Pennsylvania.

From this organizational meeting stemmed three further resolutions that helped shape the course of the Association for more than a century: one was aimed at abolition of quackery and nostrums; another, at prevention of sectional domination-no two consecutive annual meetings were to be held in the same city; and the third laid groundwork for development of the Association’s Principles of Medical Ethics. The group then selected Baltimore as the city in which the 1848 meeting would be held on the first Tuesday in May.

Significant of the importance of The American Medical Association, both to the profession in this new and growing country and to its relationships with physicians of other land, were remarks made by the Association’s second president, Dr. Alexander H. Stevens of New York, at the close of the 1848 meeting held in Baltimore.

“Our Association stands forth without a parallel in its high purposes, and its means of accomplishing them. May it prove an exemplar of similar organizations in our sister republics of the Western Hemisphere, and exhibit in a new form to our brethren in Europe, the easy adaptation of our institutions to the great end of promoting the happiness of mankind.”

The man who most deserves the title of architect and founder of The American Medical Association was Nathan Smith Davis. Not only was Dr. Davis responsible in large measure for bringing about organization of the Association; he devoted a half century of his lifetime to the Association’s development and to bringing to fruition the second principles embodied in its objectives.

Dr. Davis was born in a log cabin in Chenango County, New York, January 9, 1817. Offered choice between a farm career and a term of higher education, the young man at age 16 years began attendance at Cazenovia Seminary and study of medicine under Dr. Daniel Clark. Later he continued his studies under Dr. Thomas Jackson of Binghamton, and attended three courses of lectures at the Medical College of Western New York. At 20 years of age, in 1837, he began practice in Vienna, New York, moving to Binghamton five months later. Joining the Broome County Medical Society that same year was his first step into organization work. During the next ten years he wrote articles for various medical journals, taught medical students, and helped found Binghamton Academy. He was seated as Broome County delegate to the New York State Medical Society in 1844. His interest and activity in the state organization led to his role in formation of The American Medical Association.

In the spring of 1847, Dr. Davis moved to New York City, where, in addition to his practice, he became instructor in anatomy at the College of Physicians and Surgeons, gave lectures on medical jurisprudence, and became editor of a semimonthly medical journal, The Annalist.

In the summer of 1849, Dr. Davis accepted the chair of Physiology and Pathology at Rush Medical College in Chicago. Soon he was editing the Northwestern Medical and Surgical Journal, and writing History of the Medical Profession, from the first Settlement of the British Colonies in America to the year 1850, and, History of The American Medical Association from its Organization up to January 1855. He advocated many reforms in preliminary educational requirements and the Dean, Dr. Davis resigned from that faculty, joining several of his supporters to found the Medical Department of Lind College. This institution became Chicago Medical College in 1862, and Northwestern University Medical School in 1892.

Dr. Davis attended 47 of the first 50 annual meetings of The American Medical Association and was ever active in promotion of progressive projects. He served as the Association’s president both at the 1864 and at the 1865 meetings. In 1882, at the age of 65 years, Dr. Davis became the first editor of The Journal of the American Medical Association, a position he held until 1888.

Dr. Davis’ sons, Frank Howard Davis, and Nathan Smith Davis, Jr. both followed him into practice of medicine, as did two of his grandsons, John Davis Kales, and Nathan Smith Davis III. The “old doctor” was to help celebrate the fiftieth anniversary of the Association, and also of the Chicago Medical Society and of the Illinois State Medical Society, both of which he helped organize. On June 4, 1904, after walking home from a busy day at the office, Dr. Davis suffered a heart attack. The “old doctor,” well past his eighty seventh birth day, grew increasingly weaker, and died, June 16.

The weekly periodical, The Journal of The American Medical Association, under the editorship of Dr. Davis, first appeared in 1883. The Journal grew to become one of the largest and most influential publications of its kind in the world, ranking beside the British Medical Journal and the Deulsche Medizinische Wechenschrift. In 1889, English born Dr. George H. Simmons became its second editor. For many years, Dr. Simmons also was business manager of the Association. In 1924, he was succeeded by Dr. Morris Fishbein, an able and brilliant medical journalist who had joined the staff as assistant editor in 1913. In 1949, Dr. Austin Smith, formerly Secretary of the AMA Council on Pharmacy and Chemistry, took over the editorial held, continuing until January 1, 1959, when he resigned to become president of the Pharmaceutical Manufacturers’ Association. Dr. John H. Talbott, formerly Professor of Medicine of the School of Medicine, University of Buffalo, New York, succeeded Dr. Smith as fifth editor of The Journal.

The Association, which Dr. Davis was instrumental in bringing into being in 1847, was to experience many struggles and vicissitudes during the next dozen decades. Complete reorganization was effected in 1900-1901, after which growth was rapid. Chief accomplishments of The American Medical Association include:

1. A long and determined drive for higher educational standards for medical students. This, one of the first aims of the Association, was to make little headway until 1909, when the report of a study made by Dr. Abraham Flexner put half the medical diploma mills out of business and set new standards for the future of medical teaching in the United States.

2. A relentless fight against quacks and charlatans. The AMA Bureau of Investigation, founded in 1906, has been most effective in revealing facts concerning unethical and fraudulent practices and in providing regulatory bodies with evidence leading to conviction.

3. Influence for greater scientific accuracy and for more dependable therapeutic agents. The Council on Pharmacy and Chemistry, founded in 1905, and today known as the Council on Drugs, has been influential in developing new concepts of pharmaceutic integrity.

4. Establishment of The Journal, which has been the lifeblood and heart of the AMA. Exercising a powerful voice in behalf of better standards for medicine, The Journal today has the largest circulation of any medical periodical in a comparable field. In addition, the Association publishes 10 specialty journals and Today’s Health, a magazine for the public.

5. Growth, steadily, from some 250 physicians, who attended its founding meeting, to a membership that today totals approximately 180,000 physicians. The Association owns its own headquarters at 535 North Dearborn Street, Chicago, Illinois, modernized recently at a cost of more than $2.000.000.

6. Establishments, in 1963, of a Council of Medical Science, “to make available facts, data and medical opinions with respect to timely and adequate rendition of medical care to the American people.”

7. Long, relentless, and costly efforts to prevent government encroachment into the field of medicine. It has tried to show, forcefully and clearly, that politics and medicine do not mix.

8. Encouragement of medical research, As early as 1898, the AMA established annual Scientific Grants in Aid of Research. Well over one million dollars have been contributed for fundamental investigations made by selected medical institutions.

9. Broadening of the public’s knowledge and understanding of health. In addition to Today’s Health, addressed to the public, and AMA News, directed to physicians, the Association, for years, has employed every medium of communication to the people in developing interest in public health matters.

10. Fostership of public health facilities throughout the nation. Formation of state health departments was one of the earliest goals of the AMA; and it recommended creation of the United States Public Health Service, and, more recently, the Department of Health, Education and Welfare, within the United States government. The Association also urged use of reason and of understanding, rather than emotional blindness, in combating groups where policies, if followed, would have prevented even discovery of antitoxin, insulin, antibiotics, and many other valuable therapeutics Agents.

The American Medical Association gave birth to, and brought to maturity, many other constructive reforms and advancements, all of which are part of the printed record. Naturally, such an aggressive organization has been sued for recovery of several millions of dollars in damages. With the exception of one case, the suits brought to trial have been unsuccessful. In this one exception, damages awarded were in the amount of one cent.

The distinguished physician and teacher, Dr. William H. Welch, in his presidential address to the Association in 1910, epitomized the effectiveness of the organization, when he said:
“The Association has been from the beginning the great unifying force for the medical profession of this country, whose common interests it has been its chief endeavor to serve.”

THE PICTURE

Advancement of medical knowledge, improvement of medical education, embracement of medical ethics, and furtherance of public service-these were aims of The American Medical Association, organized May 7, 1847, by 250 delegates seated among exhibit cases and before ancient bones of a mastodon, Mammal Americanum, in the hall of The Academy of Natural Sciences of Philadelphia. Chairman Jonathan Knight welcomed Dr. Nathaniel Chapman, first president, and officers (foreground) as, after years of “pains, jealousies, and love,” they launched what became one of the world’s larger and greater medical bodies now in its second century of service both to the public and to the profession.

REFERENCES:

Ackerknecht, E.H. unpublished monograph.

Ackerknecht, E.H: A Short History of Medicine, New York, Ronald Press Co., 1955.

Fishbein, Morris: A History of The American Medical Association, Philadelphia, W.B. Saunders, 1947.

Garrison, F.H: An introduction to the History of Medicine, 4th Ed. Philadelphia, W.B. Saunders, 1929.

Major, R.H: A History of Medicine, Springfield, Illinois, Charles C. Thomas, 1954.