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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.
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