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State Medical Society

State Medical Society

In compliance with the request of a number of physicians in different parts of the State, and in view of the meeting of the National Society to be held in San Francisco in May 1871, the State Board of Health, as the only organization representing in any degree the profession in the State, hereby invite all regular practitioners in California to meet in San Francisco on

Wednesday, October 19th

for the purpose of reorganizing the State Medical Society. Local Societies and Medical organizations of all kinds are request to send delegates.

H. Gibbons, President

T. M. Logan, Secretary.

Pursuant to the above call from the State Board of Health, the meeting to reorganize the State Medical Society of California convened in the hall of the Young Men's Christian Association in San Francisco on the 19th and 20th of October 1870. At the request of Dr. Gibbons, Dr. Logan delivered the address of welcome: [55]

Gentlemen: In consequence of the part I have taken, as the executive of the only organization representing, in any degree, the profession of the State, in calling you together, it becomes my privilege, as well as my duty, to thank you sincerely for this your cordial response. Fourteen years ago, in association with the lamented Cooper, who was the leading spirit of the occasion, I officially signed the call, as Corresponding Secretary of the Medical Society of Sacramento, for a Convention in that city, to inaugurate the scheme which we are now assembled to resuscitate. The objects for which the State Medical Society was formed did then, as they do now enlist my warmest interest and command my active cooperation; and, judging from the intelligent - many of them old familiar - faces around me, I have reason to believe that I entertain these views and professions only in common with you all. . .

Upon conclusion of Dr. Logan's address, Dr. A. B. Stout, who played such a prominent role in the extinction of the former State Society, came forward with the motion "that this Convention organize itself into a State Medical Society." The motion was immediately approved and the original Society was thus reborn at the behest of its former despoiler, and without a whisper of dissent.

Drs. Logan of Sacramento, Gibbons of San Francisco and Shurtleff of Stockton were appointed as a committee to draft a constitution, an assignment they promptly discharged by recommending that the Constitution of the old Society be adopted. Their recommendation was approved unanimously.

Dr. Logan was then unanimously elected President. Dr. Stout was elected as Treasurer, and Drs. Nixon of Sacramento and Gibbons, Jr., of San Francisco as Secretaries.

Throughout the proceedings, emphasis was on the amicable and brisk conduct of business. When Dr. Hoffman of San Diego offered the following resolution, controversy over "the woman question" was avoided through a parliamentary maneuver by Dr. Stout: [56]

Resolved, That all persons, of either sex, who possess the qualifications prescribed by the Constitution may become members of this society.

On a motion by Dr. Stout, the motion was laid on the table, indefinitely.

When a member from the interior, in the course of remarks, referred to the profession in San Francisco as bearing the reputation of being divided into hostile cliques, Dr. H. Gibbons, Sr., requested the privilege of correcting the error. He argued that the great body of physicians of the city were in perfect harmony. He added, no doubt with Dr. Stillman in mind, that as a matter of course, among so many there are bound to be a few growlers who take pleasure in giving a bad name to medical organizations.

Dr. Gibbons pronounced the meeting for reorganizing the State Society to be a complete success. He characterized the proceedings as entirely harmonious and marked by a high degree of professional spirit. About eighty doctors were enrolled as members. Many others who were not able to attend signified their wish to become members. Therefore, the meeting was adjourned until 1 May 1871, the day before convening of the San Francisco Meeting of the American Medical Association, at which time they had an opportunity to join the State Society.

***

A. M. A. Meeting in San Francisco, 2-5 May 1871

In the opinion of Dr. Gibbons, the atmosphere of the meeting was distinguished by the gracious hospitality extended by the San Francisco hosts to their visiting brethren from the east. As predicted by Dr. Stillman, there was a busy schedule of sight-seeing for the guests including visits to medical and cultural institutions, and views of the awesome scenery of San Francisco Bay during a lengthy excursion aboard the steamer Antelope.

When officers of the Association for the ensuing year (1872) were selected, Dr. Thomas. Logan was chosen First Vice President. This placed him in the line of succession so that at the Annual Meeting for 1872, he was elected President of the A. M. A. for 1873.

Topics on the agenda of the San Francisco meeting ranged from medical education to ethical matters, including quackery and abortion, but no significant issues were settled.

Unfortunately, the President of the A. M. A., Dr. Alfred Stillé (1813-1900), Professor of the Theory and Practice of Medicine at the University of Pennsylvania, chose an unfortunate theme for his Annual Address. According to Dr. Gibbons' sarcastic resumé of the President's remarks: [57] [58]

Dr. Stillé canvassed pretty fully the question of Women Doctors, and administered to the sex a merciless castigation for their attempts to rise to a level with man in intellectual pursuits. He proved conclusively that the female mind was vastly inferior to that of man, and that women are incapable of studying and practicing medicine with success, or of attaining to distinction in any pursuit which requires mental force. His strictures on this topic were highly relished by a portion of the audience, while others were perplexed to comprehend how such an inferior animal could be the mother of man.

We include the following excerpts from President Stillé's comments in order to reinforce the point that it was not unusual for arrogant men in the highest echelons of the profession to deride the endowments of women: [59]

In every department of active life man excels woman, excels her even in things for which she is esteemed most fit. In the arts of design, in painting and sculpture, no woman, albeit the artist's career has always been open to her, has ever risen far above mediocrity; while men have excelled women in not a few employments which are regarded as essentially feminine. In the art of cookery, for example, no woman ever occupied the first rank; and in more than one capital, male hairdressers and dressmakers set the fashions in which court ladies and city dames contend for the palm of beauty. . . .

Women may possibly become persuasive preachers, or even safe practitioners of domestic medicine; but learned and subtle divines, great lawyers, scientific physicians - never. To reach such eminence, a knowledge of principles is necessary, a power of eliminating the essential from the accidental, of distinguishing plausible falsehood from genuine truth, and that power has been denied them. It seems very probable that if woman could be made fully to comprehend the difficulties of a professional career, and the vastness and complexity of medical science and art, she would be less eager to become a physician. . . .

If, then, woman is unfitted by nature to become a physician, we should, when we oppose her pretensions, be acquitted of any malicious or even unkindly spirit. . .

After Dr. Stillé's Address, a controversial amendment to the Association's Constitution, proposed by Dr. Hartshorne of Pennsylvania at the previous Annual Meeting, was called up for consideration: [60]

Resolved, That nothing in this Constitution shall be so construed as to prevent delegates from colleges in which women are taught and graduated in medicine, and hospitals in which medical women graduates in medicine attend, from being received as members of this Association.

Dr. Nathan Davis, the chief parliamentarian of the meeting, pointed out that the net result of this amendment would be to admit delegates from female colleges, whether male or female, to the meetings of the Association. It would, in essence, legitimize the admission of qualified women to the A. M. A. on an equal basis with men - and Dr. Davis was firmly opposed to this eventuality.

In the heated debate which followed, Dr. Gibbons' response to the demurrer of Dr. Davis is memorable: [61]

I am surprised at so good a logician as Dr. Davis resorting to the ad captandum bugbear of female suffrage. The question is not, Shall women study and practice medicine? We can not settle that question. They are doing it in spite of us, and the more we oppose them, the greater their determination and their success, and the stronger the public sympathy for them. The question is, When a woman has had a regular medical education, and has received a well-earned diploma, shall we treat her with the same courtesy as a man, or shall we trample her under foot merely because she is a woman? I don't understand why the idea of a female delegate in this body is so terrifying. We have ladies here now, as spectators, by special invitation, and the members appear satisfied. This is the first time I ever spoke publicly on this question. But standing here on the verge of the continent, outside of the vortex of excitement, and surveying dispassionately the course of events in America and in Europe, I am satisfied that, in our opposition to female doctors, we are only damming up the stream to increase its power. Public sentiment is more and more against us. Our best policy is to accept the situation. In view of the future, I wish to place myself on the record in favor of the amendment. Let women study and practice medicine if they will. It is a matter of taste. We can not help it. . .If a woman is smart enough to compete with me in practice, let her do it. I will show her fair play, just as I do a man.

After an animated discussion of about two hours, a motion to postpone indefinitely was carried: yeas, 85; nays, 25.

In concluding our reference to the first meeting of the A. M. A. on the Pacific Coast, we must reluctantly report that some of the medical profession in San Francisco misbehaved during the meeting, thus preserving the city's reputation for divisive "cliques and coteries." Dr. Gibbons' mail from delegates to the recent meeting contained references to "disorder and want of harmony as a feature of the sessions of the Association lately held in San Francisco."

Dr. Gibbons, as usual, rose to the defense of the local profession, insisting that although some of the doctors refused to participate in the reception of the visitors, the welcome was on the whole extremely cordial. He maintained that "the physicians of the city and State vied with each other in perfect harmony of feeling and action, for the purpose of honoring and entertaining their guests."

Dr. Gibbons conceded that a disreputable publication did appear during the meeting, denouncing the Association and falsely asserting that a large number of the most eminent medical men in town were hostile to it - statements which our faithful apologist dismissed as false, mendacious and malignant.

In spite of Dr. Gibbons' impression that perturbations in the San Francisco medical community during the A. M. A. meeting were minor and inconsequential - one might say within the normal range for the universe in question - they were sufficient to evoke from President Stillé the following rather stern letter to Dr. Gibbons: [62]

I sincerely trust that the late meeting may have some influence in promoting union among the members of the Profession in your city, and at the same time in showing those of them who kept aloof that their conduct has done more to lower them in the opinion of their visitors than they can readily estimate. The people of San Francisco have lived so isolated a life until the railroad was opened, that some of them seem to have forgotten that they belong to the family of civilized man, and are expected to conform to the usages and courtesies of older communities.

***

Evolution of the California State Board of Medical Examiners

Our ultimate objective in tracing the revival of the San Francisco and State Medical Societies is to provide background for an assessment of their role in the establishment of a State Board of Medical Examiners in California, as urged by the American Medical Association.

It is surprising to learn that Dr. Gibbons actually had little interest in this issue. In January 1870 he wrote an editorial in the PMSJ entitled "Legislation against Quackery:" [63]

A bill has been introduced in the California Legislature by Mr. Naphtaly, similar to the law of Ohio, Minnesota and some other states, prohibiting persons from practising medicine without the diploma of a medical College, or a license from a State Board of Examiners. . . The subject is a fit one for legislation, provided legislation can be made effectual. It is well, however, that the movement is not made by physicians.

Also in January 1870, Dr. Stillman disavowed interest in Mr. Naphthaly's bill before the Legislature. Unaccountably, in view of his contempt for the organization, Stillman assigned to the American Medical Association the task of determining standards and, through subordinate associations in each State, conferring the medical diploma. He addressed the topic in his usual incisive manner: [64]

A Bill is before the State Legislature which has for its object the regulation of the practice of medicine. Its details are unknown to us, nor do we care to know them. . .

The American Medical Association has for more than twenty years been laboring to. ..raise the standard of medical education, but without success. . . When the Association addresses itself to the work of establishing its own standard of medical qualifications, and shall confer its own title upon its members, with subordinate associations in each State, then it will have taken the only available road out of the wilderness. . .

Then the A. M. A. may ask for legislative protection only to punish all such as assume its title without its authority. This, it seems to us, is all the legislation that should ever be asked for by the medical profession.

Meeting of State Medical Society, April 1873

As indicated by the above editorials, an antiquackery law had already been under consideration in the California Legislature for several years when the Third Annual Meeting of the California State Medical Society convened in April 1873. It was at this meeting that Professor John F. Morse introduced the following Resolution, the only proposal regarding a Board of Medical Examiners to be considered by either the San Francisco and or the State Medical Society until the 1875 meeting of the State Medical Society: [65]

Resolved, That the State Medical Society of California, desiring to see some system adopted by which a high and liberal standard of medical education and graduation may be secured, have heard with great pleasure that our State University contemplates the organization of an independent Board of Medical Examiners, and we do hereby express the hope that such a Board may be appointed, on a foundation so independent, that, upon their certificate of graduation, a diploma of the University will be granted and conferred , irrespective of the school or source of instruction in which the applicant has been educated.

This resolution was similar to the proposal to establish a Board of Medical Examiners made to the Board of Regents of the University of California by the Faculty of the Medical Department of the University of the Pacific in 1870. As we have already noted, when the proposal was adopted temporarily by the Regents in c. April 1873, it caused much confusion and ill-will.

Approval of Dr. Morse's Resolution by the State Medical Society would keep open the question of a State Board of Medical Examiners appointed by the Regents of the University of California with the sole power in the State to conduct final examinations and award the M. D. degree. If such a Board were established, both Dean Cole's Medical Department and the Medical College of the Pacific would thereby be divested of important prerogatives.

It is important to note that the State Board of Medical Examiners as proposed by Dr. Morse did not address the issue of licensure of all physicians in the State. That being the case, his Resolution failed to deal with the major problem agitating the public and physicians in California, i. e., "irregular" doctors and quackery.

After a lengthy discussion, the State Society declined to approve the Resolution, deeming it "premature." It was, therefore, on motion, laid upon the table for one year.

Meeting of San Francisco Medical Society, c. June 1873

A few months later at the meeting of the San Francisco Medical Society, Dr. Morse again campaigned for his version of a State Board of Medical Examiners. He made the argument that control of examinations and graduation by an independent Board of Examiners would raise the standard of medical education and enhance the value of the M. D. degree. He concluded by introducing the following Resolution which was similar to that tabled at the State Society meeting: [66]

Resolved, That in the opinion of the San Francisco Medical Society, there should be a competent, independent State Board of Medical Examiners, whose duty it should be to carefully examine all persons who claim the proper qualifications, and who desire to obtain a diploma of regular medicine; and that to such applicants as pass this examination and receive the endorsement of the aforesaid Board of Examiners, there should issue a diploma from the highest possible State authorities, irrespective of any conditions except the thorough qualification of the applicant, as attested by the Board of Examiners.

After discussion, the San Francisco Medical Society adopted the Resolution and commended it to the consideration of the several medical associations throughout the State.

Meeting of State Medical Society, April 1874

Encouraged by the support of the San Francisco Society, Dr. Morse reintroduced his Resolution a year later on 16 April 1874 at the Fourth Annual Meeting of the State Society, again recommending the institution of a State Board of Examiners not connected with any medical school, which should have the exclusive authority to conduct final examinations and confer degrees. [67] [68]

This was the third time within a year that Dr. Morse had proposed his Resolution to a medical society. Dr. Beverly Cole saw plainly that implementation of the proposal would significantly limit his authority as Dean of the Medical Department of the University of California, and would be a coup for the Medical College of the Pacific whose Faculty had originally proposed the measure to the Board of Regents of the University. Thoroughly incensed at the repeated introduction of this threatening Resolution, Cole attacked it with great severity, declaring it to be impracticable and preposterous. He also reflected harshly on Dr. Morse, personally.

Dr. Morse responded in his usual earnest and persuasive manner and it was evident from the frequent applause which he elicited that he had with him the sympathies of the audience.

But when Dr. Gibbons saw that Dr. Cole's intemperate language was becoming a needless embarrassment to the Society, he adopted a standard stratagem for controlling unruly debates. He offered a substitute Resolution calling for further study of the issue:

Resolved, That it is desirable that there should be a uniform system of examinations for the Degree of Doctor of Medicine, apart from the institution of teaching, so that the Diploma shall be awarded to all competent candidates, and that the profession and society at large shall be secured against the possibility of the degree of Doctor of Medicine being conferred upon unworthy or incompetent individuals.

Resolved, That a committee of five be appointed by the Chair, to prepare and present at the next meeting of the society some plan by which the said object can be accomplished.

Dr. Morse accepted the substitute, and it was adopted unanimously. The committee of five was appointed to included Drs. Morse, Gibbons and Logan. There the matter rested. The committee never reported.

Separation of teaching from qualifying examinations and credentialing was a lost cause. It was an abortive attempt to plant a British tradition in stony ground. Dr. Cole was correct. The proposal was impracticable and not in his interest - nor in that of the Medical College of the Pacific. Had the proposal been implemented, medical education in California would have been politicized, as was the administration of the University of California itself after the departure of President Gilman. [69]

Dr. Morse's Resolution would not have received so many hearings but for the wide personal influence of Dr. Morse. He doubtless would have continued to press for its adoption had he not become seriously ill during the fall of 1874. He died on 31 December. It was his last crusade.

Meeting of the State Medical Society, April 1875

Dr. Thomas Logan, Secretary of the State Board of Health, was also Chairman of the Society's Committee on State Medicine and Public Hygiene in California. In his Committee Report, Dr. Logan referred to the Society's past failure to adopt the Resolution of Dr. Morse, and pointedly refrained from proposing further consideration of it.

He further reported that he had been called upon by the California Legislature, as the Chief Sanitary Officer of the State, to prepare a bill for presentation to the next Legislature, looking specifically to the prevention of the practice of medicine and surgery by unqualified persons.

In response to these instructions, Dr. Logan drafted a statute for establishment of a State Board of Medical Examiners with the responsibility to determine the validity of the Medical Degree of every physician practicing medicine or surgery in California. In preparing the statute, he drew upon the text of measures being enacted by other States for the same purpose, including Nevada and New York.

Dr. Logan concluded his Committee Report by appending a copy of his proposed bill bearing the following title: [70]

An Act For the Better Protection of the Sanitary Interests of the People against Fraud and Imposture in the Practice of Medicine land Surgery.

After a free discussion of the Act and related issues, the Society appointed a three-member Committee on Legislation which drafted a bill that was laid before the Legislature. Members of the Committee lobbied for adoption of its provisions, some but not all of which were included in the final version of the legislation. [71] [72]

Final Bill to Regulate Medical Practice in California, April 1876

A bill to regulate medical practice was finally approved by the Legislature on 3 April 1876. The following is a summary of its main provisions: [73] [74]

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