The CMA was Born Here

The California Medical Association is holding its 2004 House of Delegates meeting in Sacramento during the second week of March. By amazing happenstance, the first meeting of the Medical Society of the State of California (later named the CMA) held its first meeting in the second week of March of 1856. The CMA was born here.

The history of the early years of organized medicine is fascinating and reminds us that the more things change, the more they remain the same. J. Roy Jones, MD, chronicled the history of early California medicine in several books including, The History of the Medical Society of the State of California, 1964 and Memories, Men and Medicine, 1950, published by the Historical Committee, Sacramento Society for Medical Improvement (dba Sierra Sacramento Valley Medical Society).

"BOYS, BY GOD, I BELIEVE I have found a gold mine." That's what James Marshall, a carpenter from Iowa was reported to have exclaimed as he held a pea-sized dollop of gold at a Coloma saw mill on January 24, 1848. In just two years, some 90,000 people made their way to California, reaching more than 300,000 by 1854.

The Gold Rush transformed Sacramento from a wilderness into the state's mining center. Gold seekers arrived overland, or by ship to San Francisco, and from there by boat to Sacramento where they outfitted themselves and headed for the gold fields, rivers and mines. The 1852 census listed El Dorado County as the state's most populated with 40,000, followed by San Francisco with 36,151; Yuba with 22,063; Nevada 21,363; Calaveras 20,192; Tuolumne 17,637; Sacramento 12,589 and Placer with 10,784. By comparison, Los Angles claimed 7,831 inhabitants.

Gold attracted doctors, too. Sacramento's 1851 City Directory listed 88. With that many physicians in one location, things were bound to happen.

In his first book, J. Roy Jones, MD, states that, "California's medical profession was in a deplorable state. Graduate physicians were held in low repute, to an extent that many deliberately concealed their titles. Some, yes many worked at menial tasks by preference; others, by compulsion. It was not because of servile labor that doctors were held in disrespect; honest, productive and faithful labor was and is praiseworthy, but rather owing to imposters and pretenders who, without moral or legal reason, took the title of doctor. These Doctors, with avaricious cupidity, deprived sick and dependent fellow citizens of their last bit of gold dust, and that for but a few professional visits."

As might be predicted, 32 physicians in Sacramento gathered together on May 2, 1850 under the leadership of Dr. J. D. B. Stillman to form the Sacramento Medico-Chirurgical Association. They elected Dr. John W. Bay, of Albany, New York, as President. Among others elected were Drs. John F. Morse, T. J. White, J. H. Briggs and Wakeman Byerly. Some of these men went on to lead the CMA and AMA.

They were organized, "for the cultivation of science; the promotion of honor, dignity and interest of the profession, and the separation of the regular from the irregular practitioners." Stillman was elected recording secretary and noted that three of the officers had been presidents of county medical societies in their home states.

Unfortunately, according to Jones, the lofty purposes of the organization were overcome by the difficulties and "bug-a-boos" of separating the regulars from the irregulars. Their efforts proved fruitless. Sometime in 1854 or 1855 the association was disbanded. Other Sacramento physician organizations came and went, including the Sacramento Medical Society and the Sacramento Pathological Society.

It was not until March 17, 1868 that the Sacramento Society for Medical Improvement (SSMI) was formed and our roots firmly planted. SSMI is still our legal name.

On June 22, 1850, physicians in San Francisco came together to organize their medical society. There they found the living and rental property expensive. They, too, faced a desire to weed out the irregulars and bring professionalism and collegiality to their organization. It did not seem unnatural, according to Jones, that the 23 founders of the society would immediately appoint a committee to develop and publish a fee schedule. The resulting furor, fed by newspapers, split the organization. Within the medical society, according to Jones:

"Humble laughter seemed lacking; moralists, for the moment were not needed; all should have kept their pipes in their mouths! Adjustments and conformity were nowhere to be found. So, doctors began dropping away from the organization, even some who had voted for the Committee's report. In consequence, after four months, San Francisco's first medical society surrendered to envy, rivalry, covetousness and the material."

In 1851, the San Francisco Pathological Society formed but, according to Jones, little information was available about the group that was listed in the city directory up to 1863. In November, 1853, the San Francisco Medical Society was reorganized. A chronicler at the time said it was, "Quack free and highly representative." Yet another medical society, the San Francisco County Medico-Chirurgical Associa-tion was formed in October 26, 1855.

On February 3, 1856, during all the fits, starts and confusion of Sacramento's and San Francisco's medical societies, the then-Sacramento Medical Society corresponding secretary, Thomas Logan, MD, wrote to E. S. Cooper, MD, corresponding secretary for the San Francisco Medico-Chirurgical Association and called for, "a convention in Sacramento on the 2nd Wednesday of March 1856 for the purpose of an interchange of opinion respecting the expediency of organizing a State Medical Society."

A notice, published jointly by the Sacramento and San Francisco societies, was placed in Sacramento and San Francisco newspapers announcing the convention. The advertisements carried the names of a credentials committee established to "prevent admission of improper persons." At a meeting with nearly 100 physicians present, the California Medical Society got its start on March 11, 1856.

Benjamin Franklin Keene, MD, of El Dorado County was elected as the first president of the state association, but would never complete his term. In the words of J. Roy Jones, "Death came as a rider in the night, September 5, 1856, to inform Dr. Keene his days were told, to enfold and perpetuate the esteemed gentleman that they might ride together toward the eternal awakening."

Several meetings were held over the next few years. However, like the early local societies, the state society had many problems of its own. The publication of a medical journal and the failure of members to pay their subscriptions put the organization into debt; arguments over advertising, women in medicine, and self-promotion took a toll, and there was general disharmony.

At the 1858 state meeting, Dr. Henry Gibbons, retiring president, gave his farewell speech. He didn't mince words.

"We are a heterogeneous mass; an array of incompatibles. No country in the world is supplied with physicians so diverse in character. The physicians of California know less of each other than the physicians of any other land; and they care less for each other. There is no fraternity. Every man is for himself, and he thinks the best way to raise himself is by treading down others. We live in continual war with each other; an internecine war, murderous and suicidal. It is elsewhere, but more so in California.

"I believe that this hateful practice of fault finding and abusing is much more prevalent among physicians than they are aware of. It is the result of habit rather than malice. It is often done thoughtlessly and unconsciously. Sometimes a wise look conveys the poison, or a French shrug, or a gentle whisper, with the affection of kindness.

"As critics we have as much feeling for our fellows as for the subject of an autopsy.

"Surgeons are worse in these respects than physicians proper. Young physicians are especially quarrelsome; as they grow older they grow wiser, unless they were fools from birth.

"One thing however is palpable; that no available remedy can be so effectual as the organizing and cherishing medical associations in every possible locality. This is one of the main purposes of the State Society."

According to Jones, "From 1858 to 1870 the State Medical Society lay in a lingering death." There were developing medical schools and competing medical journals. But the issue of slavery and the Civil War seemed to divide medicine even further and little progress was made in getting the state association up and running effectively.

The passage of legislation on March 18, 1870, creating the State Board of Health, was just what organized medicine needed. The legislation was written by Thomas Logan, MD, during his term as President of the AMA, and by Henry Gibbons, MD. Logan became the agency's Secretary, and Gibbons became its first President. When the AMA adjourned its 1870 meeting, delegates voted to hold the next one in San Francisco. The threat of a new state agency, the leadership of two highly respected physicians, one from Sacramento and the other from San Francisco, and the AMA headed for San Francisco got the state association into high gear.

The rest is history.

bsandberg@ssvms.org