The Triumph of the American Medical Association

The following is an excerpt from Divided Legacy Volume III: Science and Ethics in American Medicine: 1800-1914.

This remarkable maneuver was effected by a remarkable man, George H. Simmons, M.D., who between 1899 and 1910 guided the Association through a series of delicate political and ethical adjustments designed to reconcile the interests of the regular profes­sion with those of the proprietary medicine manufacturers.

Simmons possessed political abilities of giant proportions. Born in England in 1852, he emigrated to the United States at an early age and in 1882 was graduated from the Hahnemann Medical Col­lege of Chicago. For several years he was a homeopathic phys­ician in Lincoln, Nebraska, and one of a rather partisan hue. He altered his therapeutic views, however, in the late 1880s and in 1892 secured a degree from the Rush Medical College of Chicago. He returned to Nebraska to become secretary of the allopathic state medical society and also of the (allopathic) Western Surgical and Gynecological Society. At this time he founded the Western Medical Review which immediately adopted a pronounced anti-homeopathic stance.

When the AMA Board of Trustees in 1899 decided to appoint a new secretary and editor of the Journal, a number of candidates were examined, and at length Simmons was selected for the post.

He was General Secretary and General Manager of the AMA from 1899 to 1911 and editor of the Journal from 1899 to 1924. His obituary reads:

to tell the story of the services of Dr. Simmons as General Manager from 1899 to 1924 is, in fact, to tell the history of the AMA in that period. . .Unquestionably he was the greatest figure in his generation in the development of the American Medical Association and the profession which it represents.

At a 1924 testimonial dinner in honor of Simmons the speaker observed that the total number of subscribers to the Journal in 1900 was 13,078, while on January 1, 1924, it was 80,297: “the Journal has always been the chief source of financial income of the Association . . . [and] the present satisfactory status of organized medicine of the country, as represented by the American Medical Association, has been made possible by the reorganization of the Association [which was] mainly due to the leadership of George H. Simmons.”

Simmons immediately set himself to the task of finding a modus vivendi with the proprietary interests. The rules formulated in 1895 by the Board of Trustees had in no way resolved the problem, and the issue continued to be ventilated annually at the Association meetings. In 1900 P. Maxwell Foshay, editor of the Cleveland Medical Journal, published an important analysis of the problem. He observed that: “there being such a multiplicity of journals, few of them could live alone on their subscription receipts, and the pharmaceutical firms are appealed to for advertisements. . .So great has this abuse become that many drug houses. . .will not deal with a journal that does not, in its advertising contract, agree to publish, in addition to the advertisement in its proper place, and without extra compensation, certain advertising matter among its original articles or editorials.” Out of the 250 medical journals published, not a dozen made a rigid separation between advertise­ments and editorial matter.

Simmons approached the issue by way of a series of articles, published throughout 1900 in the AMA Journal, which examined all aspects of the proprietary problem and predicted the policy which the AMA was to pursue—namely, to ally with the manufacturers which disclosed their ingredients, whether or not the ingredients, the process, or the name of the medicine were patented or copy­righted. This distinction had been foreshadowed by a floor fight at the 1895 AMA meeting in which some members insisted that the Code only forbade the use of “secret” proprietaries. Simmons’ articles were summarized in a 1900 editorial which observed that “medical preparations, the composition of which is kept secret, should not have medical patronage” and noted: “the advertising pages of the Journal contain announcements that, according to the above, ought not to be there, but they will be eliminated from our pages on expiration of existing contracts unless they are made to conform with our requirements.”

Since the Code specifically enjoined the use of “patent or secret medicines,” the word, “patent,” had to be eliminated. In 1903 a new code was adopted, whose relevant article read:

It is equally derogatory to professional character for physicians to. . .dispense or promote the use of secret medicines. . .

By limiting the ethical ban henceforth to proprietary medicines which did not disclose their ingredients, the new Code legitimized the advertising, in the Journal, of any proprietary article whose manufacturer provided a pro forma listing of the contents—even though this rarely contained the information needed to duplicate the article precisely. In seconding the motion for adoption of the new code, Dr. Charles Reed of Ohio, a leading figure in AMA circles, congratulated the Association “on the fact that by adoption of this report we put an end to a controversial question which has disturbed our councils for many years (Applause).”

The adoption of this new policy was facilitated by the 1900 decision of the United States Pharmacopoeial Convention to accept the patented synthetic chemicals, Antipyrin and others, into the pharmacopoeia. The question had been raised at the 1890 revision but resolved in the negative. In 1900 the Vice-Chairman of the Committee on Revision stated: “Probably no instruction of the Convention caused more criticism than this; but it must be remem­bered that synthetic proprietary remedies were comparatively in their infancy in 1890. But, as is well known, the materia medica has been enriched, or cursed, with an enormous flood of prepara­tions of this character, and it will doubtless be necessary for the next committee to make a wise selection of synthetic remedies and introduce them into the next revision.” The step was taken by the new committee elected at this convention.

Having moved the line of battle to a more favorable location, Simmons in 1905 consolidated his position by establishing the AMA Council on Pharmacy and Chemistry. This was announced in an editorial whose tone makes clear the new slant of the AMA’s policy on proprietaries:

There is no more serious objection to a proprietary medicine per se (i.e., one protected by a copyright or by a trade mark) than to one that is protected by a patent; for example, one of the synthetic chemicals. . .It is acknowledged that the manufac­turer should be protected when he has originated something of value to the public or to the profession . . .

The physician has a genuine interest in certain of the proprietaries, “for they compose a part of the armamentarium which he is expect­ed to use. On them he often has to depend, or at least does depend, consequently on them rest his success and the health, sometimes the lives, of those who place themselves in his care …” While most of the proprietaries are not a credit to their makers, they have caught on with the profession, “finding not only full directions for use, but the names of the disease in which the remedies were in­dicated. All proprietary medicines, however, must not be classed as secret nostrums . . . there are plenty of honestly made and ethically exploited proprietary prescriptions that are therapeutically valuable and that are worthy the patronage of the best physicians.” The problem is to separate these good ones from the inferior products. “The Board of Trustees of the American Medical As­sociation has found the question most difficult of solution, and it has been before the Board at nearly every meeting for many years.” The 1895 rule proved very unsatisfactory: “No manufacturer would furnish a working formula, and yet, without this, it is impracticable, except in a very few instances, to verify the statements made regarding the composition of an article. Consequently the claims made by the manufacturers had to be accepted, which meant that the personal equation had to be considered in giving a decision, and this is not always a safe basis for sound judgment. It has long been recognized . . . that a secret nostrum cannot be changed into an ethical preparation by attaching to it an incomplete for­mula . . .”

The new solution, embodied in the Council on Pharmacy and Chemistry, was to set a standard for all medicines not accepted into the Pharmacopoeia and to issue a listing (the AMA’s New and Non-Official Remedies) of all proprietaries and other medicines which conformed to the new standard. Simmons himself was the most prominent and active member of the Council.

The standard itself was not overly exacting. Active ingredients were to be indicated, but not the vehicle or the flavorings. The “rational formula” of any synthetic compound had to be supplied. Rule 4 came in like a lion and went out like a lamb:

No article will be admitted whose label, package, or circular ac­companying the package contains the names of diseases, in the treatment of which the article is indicated. The therapeutic in­dications, properties, and doses may be stated. (This rule does not apply to vaccines and antitoxins nor to advertising in medical journals, nor to literature distributed solely to physicians).

Finally, the patented synthetics were accepted in full, the rule only requiring that the date of registration, patenting, or copyrighting be furnished.

The real issue was buried—that the physician should have a genuine, and not merely a pro forma, knowledge of his medicines. The initial charge against the proprietaries had been not only that they concealed their ingredients but that they were promoted as specific cures for specific diseases. This was the reason why pro­prietaries were in principle rejected by the homeopathic profes­sion. Therapeutics became slipshod when the physician had only to match his diagnosis with a name on a bottle. The publication of lists of ingredients in the AMA Journal or in the New and Non-Official Remedies did not supply this defect.

Thus the AMA allied with, and was conquered by, the patent medicine industry. The Council on Pharmacy and Chemistry had little or no impact on the prescribing of proprietaries and did not curtail the baneful advertising practices current in the profession, but it did find a new source of income for the American Medical Association. By agreeing to patronize proprietaries which disclosed their contents and purchased space in the New and Non-Official Remedies, the AMA bowed to the existing realities and turned them to profit.

The increased income was welcome in these years which were very much a time of trial and hardship for the allopathic profession. Conditions of practice were steadily worsening, with the average allopath earning only about $750 annually. Young physicians had the greatest difficulty getting started, being completely ostracized by those who were already established, especially if the young man was competent. The life expectancy of the physician was said to be the shortest of any professional man. The pneumonia rate among them was very high. About forty physicians were committing suicide every year, the principal causes being poverty and financial insecurity.

Physicians were compelled by large companies, and by organized groups of patients, to provide contract service at very low rates. The prevailing competition, moreover, made the fee bills in most cases null and void and reduced medical practice to a frenzied scramble for subsistence.

Thus the situation of the 1840s was repeating itself. On all sides it was pointed out that the cause of the profession’s difficult­ies was its overcrowded condition, the excessive number of medical schools and medical graduates, and the competition with “quack-ery.”

To the unprejudiced medical observer of the profession of al­most any locality, the truth is patent that very many of its members are persons of inferior ability, questionable character, and coarse and common fiber. The little esteem in which the profession is held by laity and government attests its unworth-iness. Patients whose number is legion throw themselves from its arms into the embrace of quackery, and we must admit that the support is often as effective in the one case as in the other. . .The influence of the profession is not felt in the conduct of government. Bills championed by its foremost mem­bers are pigeon-holed in the committee room. Just bills for compensation for medical services rendered to the public are not allowed; while those licensing quackery make triumphant pas­sage from the first reading to the governor’s signature . . . Unquestionably the cause of medical degeneracy lies in the educational requirements made for entrance to the profession, and hence the question resolves itself into one of medical col­leges, their number, their location, and their standards . . . At the present time there are altogether too many medical col­leges, and one of the greatest dangers which now threatens the medical profession in this country is found in just this fact. This is not due alone to the pouring into the profession each year thousands of illy-prepared men, with a lesser proportion, it may be, of those who are really fitted for their life work, but in the commercialism, the strife, the petty ambitions, and the general demoralization which go with these, including free dispensaries, free clinics, and free hospital service . . . 

And the cure lay in better organization which would limit the size of the profession by cutting down on the yearly influx of new members. This, in turn, would improve physicians’ incomes and thereby transform the medical profession into a force which pol­iticians would have to respect:

It is not a dignified comparison, that of the medical graduates to the output of a machine shop; but the same principles of political economy apply in a measure to both. Overproduction in either has its bad effects . . . We will apparently soon have little prospect of a satisfactory future for the American medical graduate . . .

So irrationally have medical schools been established in our large cities that it is recognized by sociologists and charity workers as one of the most potent causes at work to undermine the sense of economic independence and self-respect in the community. The clinics must be filled; hence the ability to pay of those seeking relief can not be questioned. The official of the railroad and the banker’s wife seek unquestioned the free medical services offered therein. Not alone are the laity pauper­ized; the young practitioner walks long and wearily in the borderland between inanition and starvation. My statements are fact, not fancy.

If the physicians of this county and Cuyahoga were organized as they should be with a uniform fee bill, having a black list and protective features, I could reply to the officers of that plant that the profession of the county had a fee bill, the terms of which I could not deviate from, and that if they did not want to pay my charges for services rendered, I did not have to do the work. As it is, if I do not accept the fees the company of­fers, the work will go to another physician, and the company knows it can get plenty of doctors to do their work for whatever they are willing to pay. What the medical profession needs is a leader, to take it out of the valley of poverty and humiliation, a Mitchell as the miners have, or a Morgan, as the trusts have.

An influential medical profession . . . will be the only possible successful bulwark against the multiform manifestations of quackery.

The medical profession has a power for good in the community which is not equalled by that of the clergy or the legal fraternity. Its power is, however, not exerted. It is dissipated by lack of concerted effort, and wasted by internal differences of opi­nion . . . Why is it that after 100 years of practice among the people, the educated and ignorant alike, our influence is so transient, so feeble, that the most absurd fad, the most hare­brained delusion, the most fantastic fraud that comes along spreads its pernicious poison among the people? . . . How loyal are the people to us, because of our single-mindedness and devotion to them in their sickness and affliction? How much weight has the opinion of the medical man in a public matter, and with what smiling indifference do not those who make the laws listen to his protests? There is something wrong here. . . One cause . . . stands out as first in importance. It is lack of organization.

There were two important differences between 1845 and 1900, however: the new financial resources of the American Medical Association and the doctrinal weakness of homeopathy. While the allopathic profession as a whole was relatively impoverished, its representative organization was prospering, and the political war chest contributed by the patent-medicine industry was to prove a decisive element in the forthcoming campaign. And the homeo­paths, against whom the campaign was to be waged, were a declin­ing movement instead of a rising one. While the members of the New School at this time were prosperous as individuals—in marked contrast to the allopaths—their representative body was poor, the movement was split in two and riddled by internal feuds, and the greater part of the homeopathic profession no longer adhered to the Hahnemannian laws.

As in the 1840’s the regular profession saw the New School as the key to the existing difficulties and the principal obstacle to a solution. In 1889 Horatio C. Wood had observed that protective legislation for the medical profession could never be secured until the homeopaths were eliminated. The charge was repeated over and over again that the hostility between homeopaths and al­lopaths was the principal obstacle to legislative progress. The ex­ample of the New York State Licensing Board was still fresh in mind—this had been secured only through the combined efforts of the two wings of the profession, and, even then, the legislature had greatly preferred the homeopathic bill.

Thus, as in the 1840s, the profession was confronted with a choice—to work against the homeopaths or to combine with them, and Simmons was perspicacious enough to see that a combination could now be effected on allopathic terms.

It was perhaps his years in Hahnemann Medical College and subsequently in homeopathic practice which opened his eyes to the inherent weakness and divisiveness of the New School and persuaded him that the appropriate course was to “kill the homeo­paths with kindness” instead of solidifying their ranks by con­tinuing the traditional antagonism.

But in order to move against the homeopaths, the AMA itself had to be strengthened. In 1900 it was a weak and unwieldy organization. The House of Delegates, which was the AMA’s legislative organ, was made up of representatives from all state, county, and city medical societies which cared to be represented, on the basis of a delegate for each ten members of the constituent society. With more than 1,500 members at each annual meeting, it was too large for effective work, and, furthermore, the hierarchical principle was not observed. Many of the large urban societies had more representation than their own and other state societies. Not only did this confuse the whole representation situation, but the urban societies were inclined to be more liberal and progressive in their medical policies than the county societies, more liberal than the AMA’s office in Chicago desired.

It may be assumed that Simmons gave thought to these prob­lems immediately after his appointment, since he had a Committee on Organization established, with himself as its secretary. This committee in 1901 presented a new constitution and bylaws to the Association, stipulating that henceforth the House of Delegates would be made up only of representatives of state societies, on the basis of one for each 500 members of the latter. This reduced the House of Delegates to a more manageable 150 members. At the same time it was recommended to the state societies that they divide into two parts: a general meeting and a house of delegates of not more than 50 or 75 members, with the county and city societies represented in the latter on the basis of one delegate for each 100 members.

The 1901 constitution and bylaws departed radically from the previous organizational principles of the AMA by abandoning the requirement that the constituent societies subscribe to the Code of Ethics. Furthermore, the model membership requirement pro­posed for the constitutions of county societies (which were the only “portals” of entry to the state societies) read as follows:

every reputable and legally qualified physician who is practicing or who will agree to practice non-sectarian medicine shall be entitled to membership.

Since the national Code of Ethics still retained the ban on consulta­tion with homeopaths, the above provision was a maneuver ena­bling the state and local societies to admit homeopaths and Eclectics while the national organization was pondering the momentous problem of altering the sacred and moss-encrusted consultation clause.

The provision that representation of county societies in the state society houses of delegates be on the basis of each 100 mem­bers or fraction thereof of the county Society had the additional beneficial effect of giving proportionately less representation to the large urban societies with several hundred members each. The overwhelming majority of county societies in the country possess­ed less than 100 members, many of them indeed having not more than ten or twelve members. The AMA Journal editorialized philo­sophically that this would encourage the urban societies to increase their membership.

While these structural changes were being made, all constituent societies were urged to recruit actively among the physicians in their jurisdictions. The Committee on Organization had reported in 1901 that the total membership in medical societies was only about 35,000 of the 110,000 allopathic physicians in the country. Hence these wayward regulars were the first objects of the recruit­ment effort.

The physician who willfully devotes his entire efforts to his patients or to his family, who isolates himself from his fellow practitioners, who neglects his political and social duties, who contributes no assistance to medical societies, and whose life is spent in his patients’ behalf and his own self-aggrandizement, no matter how conscientious are his efforts and how honest his intentions, is not only remiss in the discharge of his entire pro­fessional obligation, but his narrow existence has unfitted him for the discharge of some of the most sacred duties he owes his fellow men. When he fails to exert his influence for the eleva­tion of his profession and for increasing its sphere of usefulness, he cannot excuse his course with the plea that the demands made on him by his patients are paramount in importance to the duty he owes his profession.

The Journal noted in that same year that at least three-fourths of the state societies had appointed committees on organization which were “actively considering the problem of how to bring every phys­ician in the state into the state society or one of its branches. The important change made in its organic law by the AMA at its last session is only one of the events which is leading up to that much to be desired condition—a united profession in the Unit­ed States.” This was an allusion to the other object of the organ­izational effort—the homeopaths and Eclectics. Since the con­stituent societies no longer had to subscribe to the national code of ethics, they were empowered to recruit any homeopath or Eclectic who would agree to stop calling himself a sectarian and to cease proselytizing for homeopathic or Eclectic medicine. The Journal noted in 1902 that this policy was a success: “Already a consider­able number of those who had formerly practiced sectarian medicine have openly renounced allegiance to any school and have associat­ed themselves with regular societies.”

To put teeth into the organizational drive, the state societies were encouraged to appoint organizers, with their expenses or stipends paid by the society, to travel around and visit the county societies. Furthermore, the national headquarters in Chicago fielded a number of prominent medical figures who visited in turn all the state societies and did whatever was necessary to put back­bone into organizational efforts at this level. The 1901 report of the Committee on Organization hazarded the opinion that the adoption of these proposals gives “good reason to hope that in five years the profession throughout the entire country may be welded into a compact organization whose power to influence public sentiment will be almost unlimited, and whose requests for desirable legislation will everywhere be met with the respect which the politician always has for organized votes . . .”

In 1903 Laertus Connor reported on the success of the new policies in Michigan. The state medical society, of which he was president, had followed the AMA’s recommendation with respect to homeopaths, deciding to admit “every reputable and legally registered physician who is practicing or who will agree over his own signature to practice, non-sectarian medicine only, and to sever all connection with sectarian colleges, societies, and institu­tions” Twelve councillors had been appointed, each with a stip­end of $25.00 but paying their own expenses. “To not a few was it a revelation to observe so many men, without hope of personal gain, toiling through Michigan, during an entire year, in organizing branches to the state society.” These councillors were instrumental in the establishment of local societies where none had existed in the past. Furthermore, a state society medical journal was started. Connor observed that “the power of 1,700 united physicians in Michigan, as compared with that of 500 discordant ones, has indicated itself in many ways: (1) it has given a self-confidence to the Michigan profession heretofore unfelt in its ability to help its members, the outside profession, and the people. (2) It has spoken to the legislature and secured a more respectful answer, because it had votes, and because the chances were greater that it expressed larger truth. (3) As 600 members gathered in Detroit at its late meeting, the laity saw a vast concourse of physicians clear­ly trusting one another. It reasoned that if these learned men so evidently trust each other, we may trust them, so the people as rulers of the land had a lesson that the new profession, with modern organization, is certain to develop a profession in which ‘he that is greatest is the servant of all.’”

Michigan was only one example of a drive which was pursued all over the country. Homeopaths later reported that the pressure upon them to join was especially great in California.

The policy of opening the portals of the county societies to persons formerly regarded as quacks had to be explained to the more old-fashioned physicians who, for whatever reason, felt that the old policy was a good one and should be continued. Many of these were of the view that abandonment of the rule on consulta­tion meant that the Association had been wrong for 60 years; others were still fearful of the competition with homeopathy. At the 1901 Annual Meeting President Charles Reed gave the justi­fication for the proposed admission of homeopaths to the AMA. He first pointed out that fifty years earlier the sectarians had been proscribed and that this policy had been a failure:

As time passed, schismatic medicine grew apace, its colleges multiplied, its practitioners appeared all over the country, ex­emplifying that law that always makes the blood of the martyrs the seed of the church. Quackery of the most flagrant character was found everywhere, and society was unprotected from its ravages, while the inability of a voluntary chartered organization to enact and to execute plenary laws was reduced to a demon­stration . . .

The regular physicians had thereupon turned to their state legisla­tures but found that “the so-called irregular practitioners, under the stimulus of ostracism and the fostering care of public sympathy thereby induced, had become so numerous and so influential that in the majority of states nothing could be done without their coope­ration.” The regulars were hence compelled to cooperate with the sectarians in securing the passage of licensing-board bills. This has been done in California, Illinois, Colorado, New York, and else­where: “in the majority of such boards are to be found members of the American Medical Association engaged in issuing licenses to practitioners of exclusive dogmas, and sitting in consultation with sectarian physicians, not over a dose of medicine, but over the vastly more vital question of the qualifications of those who are to care for the sick of our Republic.”

While these laws have led to a vast improvement in the medical colleges and in the conditions of medical practice (he continued) they are at the same time in conflict with the Code of Ethics which makes it unlawful to “examine or sign diplomas or certificates of proficiency for, or otherwise to be especially concerned with the graduation of, persons whom [the examiners] have good reason to believe intend to support and practice any exclusive and irregular system of medicine.” For this reason the Code of Ethics should be altered. In any case, “it cannot be said that schools even of sectarian antecedents entirely ‘reject the accumulated experience of the profession,’ nor can it be said that, in a sectarian sense, they any longer possess an excuse for existence.” The effect of the new licensing laws has been a decline in the registration of sectarian physicians. In New York alone the annual registration of sectarian practitioners has diminished nearly ninety percent under the operation of that state’s present law. In Ohio many graduates of sectarian schools were making application to have their classification changed to “regular”:

Thus we observe the passing of Homeopathy and Eclecticism, just as did the calm scientists of Rome witness the passing of the “Humoralism,” the “Methodism,” the “Eclecticism,” and the “Pneumatic School” of that period; and just as passed the “Chemicalism,” the “Iatro-Physical School,” the “Iatro-Chemical School,” the “Brunonianism” and the dozen other “isms” of later epochs, each leaving its little modicum of truth as the memento of its existence. And let us felicitate ourselves that, with the passing of the particular sectarianism of the last century there is also the passing of its concomitant evils, such as existed in even greater degree in the time of Galen, who “found the medical profession of his time split up into a number of sects, medical science confounded under a multitude of dogmatic systems,” and, as if relating the effect of the cause, the historian continues, “the social status and the moral integrity of the physician de­graded . . . “

Here the affectation of superiority was merely window-dressing, for the gist of the message was in the last line. “Social status” and “moral integrity,” of course, meant earning power, these being the usual formulae in which the regular physicians discussed the dis­agreeable subject of the superior economic status of the homeo­paths. Dr. P. S. Connor, one of the AMA’s principal organizers, was more straightforward in a 1903 address to the Cincinnati Academy of Medicine, in which he said:

If there were no sectarian doctrines preached and no effort made to get business through the influence that we attach to sectarian­ism of one sort or another, we would need no code of ethics.

The purpose of the AMA’s campaign against the homeopaths at this time was to eliminate this branch of the profession as a prominent and visible alternative to regular medicine with its own organizational structure and its own social base. A 1904 editorial entitled “The Practical Object of Organization” was specific in this respect:

When discussing medical organization there is a point not yet clearly understood by all which should not be overlooked. The chief purpose of the reorganization of medical societies that has been progressing since 1900 is not simply the scientific advance­ment of medicine. This was well accomplished in the main by the older form of medical society independent of affiliation with other bodies. It was the disorganized state of the profession when called on to face political attack, to accomplish legislative reform, to protect itself from malpractice injustice, to speak with some show of authority on medical questions having a public or semi-public bearing, or to act for the whole medical profession, that necessitated a closer union for the promotion of the material welfare … to unite all eligible physicians in one organization that can speak with authority for the whole profes­sion whenever the welfare of the community demands or its own interests are threatened.

The subsequent course of events made it clear that the AMA took no interest in whether or not a physician practiced homeopathy provided that he did not call himself one, did not proselytize for homeopathy, and did not hold out the homeopathic system as a competing and superior mode of practice to what was offered by the regular profession. One homeopathic reaction to this was the following:

Our estimable “regular” friends, when law-making times come around, grow hot against the outside medical barbarians, the “sectarians,” and they do most fiercely strive to exterminate them from off the face of the earth. If you inform the people that you treat those who come to you according to Similia, so far as drugging goes, you are anathema with the “regular,” but if you get inside his fold, you can use any old treatment you please—be it an “electro-therapeutist,” a man of “suggestion,” or of “serums,” calomel, bleeding, anything, and be a “regular physician.” Curious, isn’t it? Looks as though the real thing at issue was the “recognition of the union” rather than the “welfare of the public.”

The 1901 meeting of the AMA, after adopting the new constitution and bylaws relieving the state societies of the obligation to sub­scribe to the national code of ethics, appointed a committee to revise the hallowed code itself. The new code developed by this committee was adopted by the Association in 1903, as mentioned above. No longer did the Code contain a ban on consulting with sectarians, but a new section read:

It is inconsistent with the principles of medical science, and it is incompatible with honorable standing in the profession for physicians to designate their practice as based on an exclusive dogma or a sectarian system of medicine.

The meaning of this was explained on several occasions by AMA spokesmen. Dr. J. N. McCormack, the leader of the organizational drive, wrote in 1903, on “Admission of Former Sectarians:”

Under the present plan of organization this is a question which each county society must decide for itself…As a matter of expediency it will usually be better not to invite persons about whom there is likely to be any dispute to the initial meeting. Their presence might interfere with the free consideration of the subject which its importance demands, or some injudicious person on either side might take or give offense. After the so­ciety is organized, it can decide whether or not it will consider the matter, then refer it to a committee to report at some future meeting or postpone it indefinitely. It will be found that the objections to the admission of these people are usually founded on a misconception of the provisions for it made in the by-laws. If legally registered and otherwise reputable, they are entitled to membership on condition that they have or will sever their connection with all sectarian organizations and come to us as citizens, not aliens. When so elected they are no longer homeo­paths or eclectics, but are promoted to be plain physicians like the other of us . . . Many of them are recognized as physicians of ability and as powers for good in the community, and if they are willing to meet the conditions of our invitation, made fair and honorable for them and us, and come into an organization in which they are hopelessly outnumbered, there seems every reason for accepting them, especially as in most sections they are so few in numbers as to be cut off from any society unless they join ours . . . [stress added]

President Reed alluded in the following terms to the AMA’s homeopathic policy:

The state recognizes no “schools” or “sects” but holds all to be equal and equally responsible. Therefore it would be greatly profitable to these physicians if they could meet together and harmoniously discuss such things as are of importance to the public welfare…I am advised, confidentially, that, in effecting the initial organization the sectarian question was discussed and equitably recognized; I am told, too, that I am at liberty to al­lude to it in a more or less indefinite way this evening, but that from now henceforth the man who shall bring the ancient theme into these counsels shall have his voice drowned by the derisive notes of a song that makes some reference to “the time of old Ramses” . . .

Reed went on to observe that what is important is not the thera­peutic system practiced but that every school compel its students to master the fundamental branches of “scientific medicine:”

When gentlemen, after having mastered these fundamental studies to the satisfaction of the state, entertain peculiar views upon purely subsidiary topics, they should be left to the exercise of the largest possible discretion…It must be remembered that opinions long held are surrendered slowly, and the more slowly when honestly entertained. In many cases it is necessary to demonstrate that the changed relation does not, after all, involve so much a surrender of conviction as, what the individual himself is surprised to discover, are his prejudices…As time moves on…we shall move on convergent lines until finally we shall arrive at the standpoint of complete abandonment to the spirit of truth, the standpoint of complete professional unity, the stand­point of complete devotion to the highest exactions of citizenship.

Dr. McCormack was quoted in 1911 as stating: “We must admit that we have never fought the homeopath on matters of principle; we fought him because he came into the community and got the business” (Journal of the American Institute of Homoeopathy, IV [1911], 1363).

Pursuit of “scientific medicine” and the encouragement of “scien­tific” standards in medical education meant intensified work in anatomy and physiology at the expense of pharmacology and thus only increased the incompetence of the average allopath of the day in matters therapeutic. This, in turn, meant increasing reliance on the offerings of the drug industry, whose advertising budget provid­ed most of the financial sinews of the AMA campaign. Thus the charmed circle was complete.

The homeopaths and their organizations were caught off guard by this onslaught, and it produced a crisis in the New School’s affairs throughout the whole of the decade. Initially many were tempted to accept the AMA’s offer and subsequently resigned from the allopathic societies after finding what the conditions of mem­bership really were:

I thought there would be an opportunity to discuss homeopathic principles and homeopathic remedies if I joined the county and national societies of the old school, and so put some leaven into the lump. I found, however, that I was counting without my host. Such discussions are not permitted, so I am coming back.

Kansas finds that the homeopathic profession is just waking up to the fact that those who by sophistry were induced to join the county and hence the allopathic societies, have been betray­ed. The boasted freedom which they were promised is not allowed . . .

Allopathic journals reported difficulties with the new homeopathic members. Some of them were expelled for refusing to relinquish their homeopathic affiliations.

The homeopathic societies passed resolutions condemning those who accepted the AMA’s invitation:

You well know that the AMA is using every effort to gain power and control. In this she will not be successful as long as we remain true to our system. It seems strange that the older school, which at one time could not find adjectives offensive enough to describe homeopathic physicians, and which heaped ridicule and sarcasm upon the system, should now almost bow to the profession in beseeching tones and ask us as individuals to join their societies. Why is this? They tell us it is in the interests of medical progress. It is not. It is in the interest of medical tyranny and medical usurpation, the control of homeoepathy and homeopathic institutions . . . We ought in this state [Maryland] to stand as one man against the common enemy . . .

The fawning and cringing attitude that men of this type adopt toward the old school is disgusting to any man who has a grain of self-respect in his makeup. A mere crumb of recognition, an invitation to an old school medical gathering or an intimation that he might be received into one of their societies if he re­nounces his homeopathic views, fills the heart of one of these wobblers with great joy, and he almost imagines that it is his superior medical attainment that has won him this distinction. Little does it occur to him that he is simply used for a “good thing” and that he is as much despised by his perverters as he is by all truehearted men.

In consultation with old-school practitioners all goes placidly until you speak of homeopathic methods. Immediately you lose caste. In place of interest being aroused towards you, or that which you represent, all is a silence. Their approval lasts so long as you acquiesce in their methods.

It was pointed out over and over again that instead of being the only homeopath in town, now, after joining the regular medical society, he was merely one more of the town’s doctors.

Despite the warnings, many went over to allopathy and stayed there. During these years the homeopathic state and local societies became progressively weaker through the desertions of many of their members to the competing camp. While homeopathy remain­ed relatively strong in the urban centers, it was slowly weakening elsewhere.

Simmons defended the AMA’s new policy with skill, employing all of the well-known arguments of the past six decades. When a member of the University of Michigan’s homeopathic faculty declared that this was an AMA “conspiracy” against the New School, the Journal responded:

[Homeopathy] . . . has flourished on its soi disant reputation of being a “new school” and inferredly a broader, better, and more liberal body of practitioners than the “old school,” whose alleged persecutions have been its best capital. The sudden wiping out of this stock in trade is naturally a blow to the invested [sic] interests of homeopathy—hence these tears. They mean that homeopathy has been existing on a name, that its progressive practitioners recognize the fact and that the higher principled among them, in fact, all who are worthy, are ready to honestly admit it…We could ask no better indication that the liberal policy is likely to be effective than just such utterances from those whose financial interests are involved in the continued existence of the sectarian schools and journals.

The low-potency trend played into the hands of this man who was capable of appreciating its political value. When a “high” lamented, in a homeopathic journal, that on a recent trip through the South and West, “everywhere the complaint was heard, ‘there are so few good prescribers,’ and that many of our doctors are resorting to every other means of cure rather than the prescribing of their own remedies,” the AMA Journal responded:

If the remarkable success of homeopathic institutions related by the author is due to the therapeutic skill of doctors who are resorting to every other means of cure rather than to the pre­scribing of their own remedies, it is poor logic which credits homeopathic treatment with the results. It does not appear to have occurred to the writer that the well-equipped colleges with competent instructors in other departments than therapeutics may have been a factor in inducing men, who thus obtain some scientific training, to adopt any means of cure which reasonably promises to be of benefit to the sick, even though it may not consist in the administration of infinitesimal doses. It is a favorable sign to find a faithful follower of Hahnemann who acknowledges the natural tendency of which most medical men are aware, and it causes us to renew our hope that the time is not so very distant when the believers in the efficacy of dilutions will cease to shut themselves up in a “school” and will become a part of the regular medical profession, the members of which are ready and anxious to employ any and every means which can be scientifically shown to have a favorable influence upon the course of disease.

The unending dilemma of the homeopathic movement—the policy conflict between the “highs” and the “lows”—prevented it from uniting on a common platform. Dr. Royal Copeland observed in 1912: “Imagine a political party attempting a campaign with no formulated expression of what it believed and stands for!” The continual dissension in homeopathic ranks made these physicians apathetic and uninterested in society affairs. They concentrated on their own practices, confident that, no matter what, the law of similars could never die.

Thus, in diametric contrast to the regular profession, the homeopaths were economically strong as individuals while their organizations were poor and weak. In 1909, when Dr. J. N. McCormack of the AMA reported that one-half of the regulars “live in rented houses worse than the skilled mechanic or laborer,” the Institute Journal commented: “not one half or one tenth of our physicians are living in the circumstances he portrays so vividly for his own school . . . The truth is the homeopathic profession is prosperous, courteous, and busy, too busy to indulge in strife, and the hundreds of locations that await the homeopathic phys­ician where there is practically no competition prove that the students of our medical schools have no time to think of discord.” A homeopathic periodical editorialized in 1910: “The average earning capacity of physicians of the ‘old school’ is much below the average earning capacity of homeopathic physicians . . .” This prosperity, however, did not mean a corresponding willing­ness to support the Institute or the local societies, or even to take thought for the future of homeopathy generally. Out of about 15,000 homeopaths in the United States and Canada, only about 2,000-3,000 were members of the Institute. Only about 4,500 were members of their state societies. In Pennsylvania, which was the center of American homeopathy, only about 700 of the 1,500 practitioners were members of the state society.

The homeopaths, it seemed, were too busy practicing medicine to countenance extensive involvement in medical politics. Min­nesota’s 175 practitioners were treating about 300,000 patients: the homeopaths thus had one-tenth of the physicians and one-eighth of the patients. A paper read before the Homeopathic Medical Society of Kansas and Missouri in 1910 noted that the homeopaths were living much better than the allopaths and had more work than they could easily handle, but they still refused to do anything for the Institute or for the profession. The Institute Journal wrote in 1912 that many physicians who had grown rich from homeopathy failed to introduce successors for fear of losing business: fifty of the writer’s acquaintances had retired well but left no one to fill their places; half of the homeopaths of New York state were not members of the Institute or of their state or local societies: “They never attend societies for fear some of their practice will get away . . . They are unknown except at their own crossroads, where they have generally the best practice.”

Part of the reason why so many retiring homeopaths failed to introduce successors was the diminishing supply of homeopathic graduates and the steadily increasing demand. The homeopathic colleges were not able to fill the openings available. The Institute’s Council on Medical Education reported in 1912 that while there was one allopath for every 640 persons in the country, the ratio of homeopaths to the population was only 1:5,333; furthermore, more than 2,000 homeopaths could be placed then and there. The Institute President stated in 1910 that they were now paying the price for decades of indifference:

We have listened willingly to the seductive voice of that inborn love of ease which is part of mortal man’s inheritance, and we are now paying the price of it in apprehension and worry, at least those who do care . . . Communities are demanding homeo­paths, and the Institute is unable to supply them—at a time when the Old School claims that the population cannot support its graduates … if the demands for homeopathic physicians are not met in due time, they will eventually cease; the people will be obliged to have recourse to other available agents . . .

The Institute in 1910 attempted to emulate the myriads of AMA councilors, who were so powerful an influence for medical organ­ization, by electing a Field Secretary to galvanize the whole profes­sion. The Secretary spent the next two years travelling about the country and reporting his observations:

The only danger I can see to our friends at and about Wil­mington [Del.] arises from the fact that they have reason to be quite content with things as they are…Their personal relations are cordial, nearly all appear to do well in a business way, their standing in the community is good.

I was deeply impressed, the short time I spent in New York, with the comparative hopelessness (I will not say indifference) of some of the older men there, who act as though “tired” out; but so far as I could see the younger men are outgrowing this lackadaisical state and are putting on their fighting gloves . . .

In the larger centers and in fields where homeopathy has been long established and is accepted for its full value, there lies a dangerous sense of security and an appalling sense of reckless indifference…He who sits comfortably in his easy chair in his smoking jacket enjoying a genuine Havana bought with the silver earned by means of a successful homeopathic prescription, grunting a “Cui bono?” when called upon to do his share toward the perpetuation of the homeopathic doctrine, and he who vain­ly asserts that “Similia is a mighty truth and cannot die, no mat­ter whether I get busy on its behalf or not!” letting it go at that, are likely to awaken some wintry morn to find themselves un­deceived. . .There is need for awakening all along the line . . .

We need greater enthusiasms and a clearer realization of the fact that it is a narrow and wholly selfish life which measures its success by the business prosperity of the individual and its horizon by the showing made by the ledger or the bank book on the last day of the year.

There was, even at this late date, some small hope of reversing the tide if the organizational effort had been continued. The Field Secretary reported at one point:

It is surprising to hear reports of trouble, of lack of interest, of indifference to everything concerning homeopathy, and then meet our men face to face and find that they respond readily to pleas for increased activity in behalf of the old faith . . .

In 1911, however, the Institute by a heavy majority voted against paying a permanent Field Secretary out of Institute funds. At the same meeting, the Institute voted against raising the annual dues from $5.00 to $7.00, a delegate observing: “I have sent in scores of applications for membership. I have worked hard. I can say that the $2.00 would have cut down one half of the number I have sent in. I am opposed to it.” In vain the Field Secretary urged:

When we bear in mind that the association representing the dominant majority in the medical profession has for at least two decades been in the field with an able organizer and capable assistants in every part of the country, with large pecuniary resources at their command, and that their work did not for many years produce sufficient visible results to attract general attention, it would not seem reasonable if we, with much more limited resources, should expect to see marked or immediate changes in the very brief period we have been in the field. Yet it is undeniable that there has been awakened all along the line renewed energy, . . . the school, if its energies are properly directed, is not yet ready to disband.

Shortly afterwards the Field Secretary died of pneumonia, and no other was elected.

The other possible source of revenue, from advertisements, was largely foreclosed to the Institute. The Institute started its own Journal in 1909, and by 1912 had an advertising revenue of $3,300. After considerable internal struggles the Institute decided not to accept unethical advertisements, and its advertising income remained small during this and succeeding years. The total annual budget of the Institute during this critical period was between ten and fifteen thousand dollars. The permanent en­dowment fund in 1912 contained a total of $400. It was ob­served at the 1912 convention that the allopathic drug firms and proprietary drug firms all bought advertisements and rented space, while only one homeopathic pharmacist did the same.