Past and Future History

In 1868, 12 physicians met in a colleague's office to once again establish a medical society that would promote medical science and uphold the ethics of medicine. After the failure of three previous medical societies, the future of the Sacramento Society for Medical Improvement must have seemed uncertain indeed. Medicine and the medical profession were on the brink of tremendous change, but the problems facing physicians seemed insurmountable. Being an american physician in the later 19th century held little prestige, and intense competition and hostility between individual physicians made collective action almost impossible. The California Medical Society, founded in 1856 by the Sacramento and San Francisco medical societies, was moribund until 1870. Licensure laws were non-existent and the abilities of many who called themselves physicians were questionable.

Medicine itself seemed powerless in 1868. Much of the biomedical science we take for granted today was not known or part of medical practice at that time. Physicians had little knowledge about the causes of disease, and they applied a limited pharmacopoeia of opium, alcohol, quinine, and other often dangerous drugs to treat their patients' symptoms. Cholera decimated Sacramento in 1850; but it was not until 1883 that Robert Koch discovered Vibrio cholerae. Medical research took place in Europe, not America, although it was U.S. Surgeon General John Shaw Billings who established the first ongoing catalogue of the medical literature, Index Medicus, in 1879. Surgery was also a hazardous affair in 1868. Anesthesia was already in wide use after William Morton's demonstration in the Ether Dome of the Massachusetts General Hospital in 1846; however, infection took many lives after the operation. In 1867, Joseph Lister published the antiseptic method of surgery, but it took 20 years before this method gained general acceptance in the United States. Public health measures held the greatest promise for combating the ravages of disease, and Sacramento physicians helped establish the first public health department in California.

A closer examination of the activities of our founding members is instructive on how they addressed the problems of their day. They became professional and civic leaders, serving as Presidents of the Sacramento and California Medical Societies, officers of the Sacramento City and State Boards of Health, Surgeon General of California, City Health Officer, Superintendent of the County Hospital, State Commissioner of Lunacy, Director of the State Library, President of the Board of Education, Superintendent of Public Schools for the City and County of Sacramento, Mayor of Sacramento, State Senator, and Secretary of State for California. In addition, the founders included a patron of the founding of Mercy Hospital, a President of the California Academy of Science, a trustee for the grant establishing Stanford University, and the President of the California State Medical Society who cast the deciding vote to admit women physicians to membership. These medical society founders set an example for civic leadership rarely matched by today's physicians.

Compared to the difficulties faced by the founders of the Sacramento Society for Medical Improvement, we have much to celebrate. The life expectancy of person born today is twice that of a person born in 1868. The United States is now the world leader in biomedical research, and high standards in medical education and practice established by the efforts of medical societies have made American medicine the most technologically advanced and sought after in the world. Today, physicians are held in high regard in the United States, and our profession receives levels of public support for medical education, biomedical research, health care facilities, and health care services that would astound the founders of our medical society.

However, we cannot take our history for granted. Many new challenges and opportunities face our profession. Advances in genetics, neuroscience, and information technology are profoundly influencing how our society defines health and well-being, and the practice of medicine has to address new demands from the public for quality and service. Our leading health problems, such as obesity and violence, defy existing biomedical solutions and require a return to public health approaches. We also face a crisis in how to finance medicine as health care costs threaten to overwhelm budgets of both government and businesses.

Unfortunately, physicians are less involved in our communities as our biomedical tools have become more powerful. Ensconced in our offices and hospitals, we become isolated from public debate and feel besieged by the demands of our society. Thus, physicians need to once again commit ourselves to civic leadership like our founders and to actively participate in public discourse on health. To this end, the SSVMS Board of Directors will be addressing how to promote physician civic involvement this year. Sacramento is the site of the California Medical Association (CMA) annual meeting this March, just as it was for the CMA's first meeting in 1856. Next month, on April 28, is the annual CMA Legislative Day. These meetings provide opportunities for member participation and input. I hope you will be inspired by what you read in this historical issue and commit to make some history of your own!

richard.pan@ucdmc.ucdavis.edu