Chapter 14 - Medical and Scientific Societies

I am an ardent believer in cooperative efforts in professional scientific work. The man of genius may make his most valuable contribution to human knowledge in isolation, detached from his fellows, but recognizing that I have no claim to this distinction, I have been a zealous, if not always an intelligent, worker in medical and scientific societies. This has been prompted by mixed motives, some selfish and some more or less altruistic. With the purpose of extending my own knowledge, I have sought association with men whose intellectual superiority I have recognized. In this particular I have been most fortunate in receiving instruction and continuing my pupilage. However, I have found it well to preserve a critical attitude under these conditions for I have heard much misinformation from the lips of reputedly great men. Error is not converted into truth by the stamp of authority. The processes of evolution are not arrested by the dictum of the late Mr. Bryan.

A simple organization from which I have drawn much pleasure, enthusiasm and information is the “Scientific Club” of the University of Michigan, formed m the early eighties and still functioning. It consists of twenty research workers, meets at the homes of members, devotes one hour to listening to and discussing the problems of the host, one hour to a lunch and two hours to smokes and good fellowship. It is not considered good form to leave without satisfactory explanation before the clock strikes twelve. The only official is the chief servant who is selected by lot and whose functions consist in notifying the members of meetings, keeping tally on attendance, and serving as custodian of the club property, limited to a jack knife and a corkscrew, which he must produce on demand. Alas! The corkscrew is now limited to the plebeian function of opening ginger ale bottles.

I can not say how much other members have profited by this simple organization but it has done much to broaden my intellectual horizon and make me appreciative of the research problems my colleagues had in hand. To hear Calvin Thomas talk on German literature; Edward Walter discuss the great treasures housed in the Bibliothèque Nationale; Henry Adams explain Chinese finance and transportation; Dean Worcester or J. B. Steere tell of explorations in the Philippines under Spanish rule; Albert Prescott unfold the fascinating story of the benzene ring; Moses Gomberg dwell upon the chemistry of carbon compounds; Edward Campbell speak of solutions of carbon in steel; William Hussey describe double stars; Charles Greene exhibit and explain the details of the structure of the first cantilever bridge; these and many more of like interest and value were treats to one whose chief occupation was the study of the effect of bacteria on guinea pigs, rabbits, monkeys, and the like.

No other agency has done more to stimulate productive scholarship in the University of Michigan than the Research Club which was organized in 1900. I will permit the historian of this club, Doctor Lombard, to tell the story:

“Up to the time of the founding of the Club, Michigan had been an excellent teaching College, a glorified High School, and a University only in name. Graduate work was too often only a prolongation of undergraduate studies. There was nothing to stimulate student, instructor, or professor to original investigation. Any research work that was done was the result of the initiative of the rare individual who found pleasure in such work, but who received little external encouragement. It is not strange that the men most interested in research felt the need of mutual support and that they must get together and help one another through their sympathy and interest in each other’s problems. Moreover, there were many problems involving the University as a whole, which they felt could only be solved through the coordinated action of the men who were interested in research work. Perhaps the most pressing of these was the way that the work of the graduate students was conducted, and the fact that a large proportion of the Faculty was doing no research work. Many of the older members of the Faculty were of course hopeless cases, but there was great concern lest the younger men, having nothing to stimulate them to original investigations, would slide into the teaching rut and stay there, as so many of their chiefs had done.

“The club was formed with the object of uniting, as set forth in the Constitution, ‘those members of the academic staff of the University who were actively engaged in research and to originate and support such measures as are calculated to foster and advance research.

“From the first it was recognized that the hope for the future depended on arousing the interest of the younger men. There were a number who had already shown promise through their work, and these were gradually taken into the club, but as Associate members (a class which was abolished in 1904)’. Why was a class of Associate members instituted ? Because the founders of the Club felt that if it was to accomplish anything, a lot of delicate questions would have to be handled without gloves, and that discussion would be more free if confined to the older men, whose sympathies were well known. Those of us who were present at the early conferences will recall that they were very interesting and enlightening.

“Certainly the Club was never at the beck and call of any coterie, but has sought to serve all who had like interests at heart. That it was not a close corporation, ruled by a few, and that all interests of the University devoted to research could have fair play is evidenced by the fact that twenty-two different men have served as President during the first twenty-five years (only Vaughan was President more than once, all feeling the need of his leadership during the first four years, after which he declined to serve). Moreover, forty-eight men have served on the Council, ten of these having been elected twice, and one three times. About thirty-five different departments of the University have been represented on the Council at different times.

Up to the organization of this Club, the Medical School was the only department of the University in which productive scholarship was officially recognized and encouraged and in this it was demanded; it was made an important factor in the selection of Faculty members and in promotions. The bulwark of Conservatism in the literary Faculty whose dean, John 0. Reed, although a teacher of physics, was opposed to reform and in this was supported by many venerable and lovable professors who believed that their highest function was to teach the elements to the masses of students. But the Research Club has made progress and now (1926) even the President of the University is a man distinguished for his contributions to biological sciences. In 1900 the membership of the club numbered twenty-four; in 1925, one hundred and twenty, with a showing of three hundred and sixteen original contributions during the twenty-five years.

I took an early and continuing interest in the local and state medical societies. In the eighties a meeting of the state medical society bore a close resemblance to a political convention; it was a contest for offices; there were contesting delegations; one year the Michigan Central Railroad carried free those named by its chief surgeon; sectional strife was in evidence; personal animosities were aired. I will have to admit that under these conditions I was one year elected president. However, the sting of this admission is somewhat relieved by the fact that I was opposed by the railroad surgeon. Now, the medical profession of the state, at least the intelligent part of it, is directing its energies to scientific work; its annual meetings are harmonious and enlightening and its journal is a credit to it.

The annual meetings of the American Medical Association in the eighties were of the same character as those of the state society, but on a larger scale. In my opinion, Doctor John H. Rauch, Secretary of the Illinois State Board of Health (1877-1891), was the John the Baptist of reform in medical education in this country. He exposed many diploma mills, causing a score or more of them to close temporarily, and urged the extension in time and improvement in the curricula of medical schools. But the low-grade medical schools had too much political influence at that time and Doctor Rauch was forced out of office. His elimination was followed by the rapid multiplication of low-grade schools and a decline in the intellectuality and morale of the profession. I know about the work of Doctor Rauch because some of his papers were written in my home in Ann Arbor and I assisted him in the collection of data. I may say, that medical education in this country reached its lowest ebb in the ten years following the elimination of Doctor Rauch.

In 1901 the Journal of the American Medical Association published statistics obtained from the schools themselves and although the data were presented in the best possible coloring, the revelations were most deplorable. In 1904 the American Medical Association appointed a Council on Medical Education. I had the honor of membership in this Council for many years, but I wish to say that the excellent work it did was principally due to Doctor Arthur D. Bevan, long its president, and Doctor N. P. Colwell, continuously its secretary. The Council had not the slightest legal authority, but it determined to ascertain the facts and to give them to the public, relying on their belief that inefficiency and fraud are best suppressed by exposure. The only legal support the Council had lay in the state boards of medical registration and licensure and these could not with good grace give the right to practice medicine to graduates of inferior schools.

During the school year of 1906-07 everyone of the one hundred and sixty medical schools in the United States was inspected and the results published. “At the lowest extreme were a few institutions which were actually selling diplomas; in a large number only didactic, lecture or recitation courses were given, sometimes by the one teacher who constituted the entire Faculty. Most of the schools had no laboratories save an old time dissecting room and occasionally an excuse for a chemical laboratory. One institution was found which turned out one hundred and five graduates in 1905, without having completed any laboratory work, not even dissecting, nor had they had the opportunity to see a single patient in either a dispensary or a hospital. Less than half the colleges had affiliations with either dispensaries or hospitals in which patients could be utilized for clinical instruction, and the schools were few, indeed, in which students had the opportunity to study patients in small clinics at the bedside or as clinical clerks.

On the publication of the first report of the Council on Education, there was great furor among those interested in low-grade schools. Most violent denunciations were hurled at the Council and its members. Then the Council asked the Carnegie Foundation to make an inspection of the medical schools, using an eminent educator who was not a medical man.

Mr. Abraham Flexner did this so thoroughly and impartially that all opposition was silenced; the poorest schools went out of existence; weak ones combined their resources; and now (1926) there are eighty medical schools, where there were one hundred and sixty (1904), sixty-four of which are departments of universities and among these some are unsurpassed in equipment and teachers. There has been in the history of education no parallel to this advance in professional training.

However, I must not paint this picture in too brilliant colors; nor must I give the Council unlimited credit for its accomplishments. The world had moved between 1877, when Doctor Rauch made his attempt to improve medical education, and 1904, when the Council was organized. In 1883 Doctor Rauch attempted to close a diploma mill known as the Boston Bellevue Medical College. This institution was charged with selling diplomas and degrees “to individuals grossly ignorant of any medical knowledge, and either with or without attendance upon its alleged courses of instruction.” The officers under this charge admitted everything of which they were accused, but claimed that they were not violating the postal laws by sending their literature through the mail. This matter was referred to a United States commissioner who rendered the following decision: “The state has authorized this college to issue degrees, and it has been done according to legal right.... The law makes the Faculty of the college the sole judges of eligibility of applicants for diplomas. There is no legal restriction, no legal requirement. If the Faculty chooses to issue degrees to incompetent persons the laws of Massachusetts authorize it. This is, therefore, not a scheme to defraud under the statute. The defendants are dismissed.” I think that this decision should be preserved as evidence of how our Federal Government protected its citizens from fraud in 1883!

There is a more serious side to this matter; in 1925 medical diploma mills were exposed in Missouri and Connecticut, owing to corruption of state boards of licensure, and in other states cult schools, osteopath, chiropractic, and the like, are pouring out annually numbers of men and women, who are feeding on the credulity of the people. There are ebbs and flows in the general intelligence of successive generations and so long as there is abundant pabulum charlatanism will continue. Jenner demonstrated the protective value of vaccination against smallpox by repeated demonstrations in the years from 1796 to 1800, but there were thousands of cases of smallpox among us in 1925. However I, at least, am not going to worry about this. Morbidity and mortality rates depend upon the intelligence of the people and each generation gets about what it deserves. It is the problem of pure science to interrogate nature and to discover truth; it is the function of medicine, engineering, law and other professions to demonstrate the useful application of these discoveries; and finally the acceptance of these discoveries and their applications depend upon the intelligence of the people. I know of no scientific discovery which has not ultimately benefited the masses, but through ignorance or for other reasons, too numerous and complicated to be discussed here, scientific advances may be ignored, misinterpreted and even converted into agencies of human destruction. The advantages that have come to the profession from the labors of the Council can not be blotted out whether the benefits to the people are lasting or temporary.

At the close of the last century most newspapers in this country carried advertisements of patent and proprietary so-called medicines and some of the manufacturers of these worthless and often harmful nostrums accumulated great wealth and influence. The American Medical Association began a crusade against these frauds. Their contents were determined and their worthlessness exposed. This good work soon received the support of the best publications, some of them at great financial loss, and this iniquity has been markedly curtailed, though not completely exterminated. Under the able management of Doctor George H. Simmons, supported by excellent men on the Board of Trustees, the Journal of the American Medical Association has become the most authoritative medical publication in the world. In my opinion, the best work done by the medical profession in the past twenty-five or thirty years is to be found in the moral and intellectual cleansing it has done in its own house; of course continued scrubbing will be necessary. The medical profession has on its own initiative closed its inferior schools, has raised the requirements for admission, has lengthened and strengthened the courses of instruction, has stimulated the betterment of hospitals, has endeavored to educate the laity in the prevention of disease and has encouraged more exact observation and research among its members. All of these advances have brought benefits to the people in lower morbidity and mortality rates, in an improved standard of health, and in the keener enjoyment and appreciation of life and in greater efficiency. That the intelligent laity appreciates these services is shown by the fact that medical education and research are now receiving both private and public support with a liberality unequalled in history. The names Pasteur, Lister and Gorgas are as familiar in educated society as are those of kings, mighty warriors and divines. In 1913 the American Medical Association conferred upon me its highest honor-the presidency. This token of appreciation of my work by my professional colleagues is highly prized.

In the eighties the sections of the American Medical Association were so barren in scientific interests that many special societies came into existence. In some of these I found most nourishing intellectual food. Of one of these, the American Association of Physicians, at first limited to one hundred members in the United States and Canada, I became a member in 1889, president in 1909 and honorary member in 1915. The annual meetings of this society were rich treats, affording abundant opportunity for the extension of my intellectual horizon; for having my own ideas confirmed or confuted; for crossing swords with the ablest men in my profession; for receiving and inflicting wounds; and for social intercourse of the highest character. Of the original members of this society only four (William T. Councilman and Frederick C. Shattuck of Boston, James C. Wilson of Philadelphia and William H. Welch of Baltimore) are now (1926) living. To these I extend my greetings; to the shades of the dead I bring votive offerings; to all I acknowledge my indebtedness.

A short time before the death of Doctor Oliver Wendell Holmes the Physiological Society, numbering then not more than ten or twelve, met in Boston. Through the kindness of the late Doctor Henry P. Bowditch, then professor of physiology in Harvard University, Doctor Holmes received the members of this society. We entered his home, two by two. Doctors Holmes and Bowditch stood in the library, and to the surprise of all, when each man was presented, Doctor Holmes knew something of his work. We marveled at the extent of his reading and at the tenacity of his memory. I went with Doctor Abraham Jacobi of New York. When he was presented Doctor Holmes spoke of Doctor Jacobi’s recent book on Diseases of Infancy. The next day Doctor Jacobi and I entered a street car, where we found Doctor Holmes immediately in front of us. The following conversation occurred between Doctors Jacobi and Holmes:

“Good morning, Doctor Holmes.”

“Pardon me, I do not know you.”

“I am Doctor Jacobi.”

“Do you reside in Boston?”

“No, I live in New York.”

“Are you a practitioner of medicine?”

I shall leave the reader to explain how Doctor Holmes knew so much about Doctor Jacobi in the evening and how he managed to forget it all the next morning. Doctor Jacobi and I suspected that Doctor Bowditch had something to do with the wonderful knowledge temporarily possessed by the Autocrat of the Breakfast-table at his reception. I admit that my chief use of Who’s Who and Men of Science is to inform myself of the achievements of an expected visitor, and the occasion having passed, my memory soon fades.

I was elected a member of the American Public Health Association in 1883 and then became acquainted with the great men who laid the foundations of preventive medicine in this country. The fruit of the work they did we are now enjoying. I occasionally hear a young sanitarian speak with some contempt of the qualifications of his predecessors; then I delight in telling him that if he and his generation do as well as those of whom he is speaking, the world will have cause to bless and honor his name. In the forty-five years that have passed since 1880, the annual death rate in this country has been reduced from above twenty to about twelve per thousand; that from tuberculosis has been halved; yellow fever has been swept from the Western Hemisphere; typhoid fever has been reduced to almost negligible figures; diphtheria has been largely robbed of its terrors; and the average of human life has been increased by about sixteen years. If the same pace in betterment in life conditions is maintained for the coming period of like duration, the death rate in 1970 will be between six and eight and the average man will live out the biblical allotment. It is dangerous to prophesy and the wise man avoids it; but I venture to predict that this achievement will not be reached.

For the American Public Health Association, I wrote in the early eighties the Lomb prize essay on “Healthy homes and healthy foods for the working classes.” This was an early attempt to popularize the recent improvements in house construction, ventilation, heating and the caloric values of foods, their economic selection and their scientific preparation. The essay contained daily menus of balanced rations costing from twelve to fifty cents. It was printed in several languages, was sold at cost, and to those who would not buy, it was given. Mr. Lomb endeavored to ascertain how widely it was read and what influence it had on those for whom it was intended. A copy was placed in the home of every working man in Paterson, New Jersey, and some weeks later a visitor called to find out how many had read it. The number of these was small. Those who bought it, read it; those to whom it was given, did not. The moderately well-to-do read it and often followed its advice. Doctor Irving Watson, of Concord, New Hampshire, reported that the essay was widely read by thrifty New Englanders and that there was only one objection to its teachings. “Those who lived on the fifty cent ration developed gout.” I think I can say without undue self laudation that this essay was a contribution to the popularization of the needs for a balanced dietary.

About the same time, the American Public Health Association appointed a committee on the practical investigation of disinfectants with Doctor Sternberg (later Surgeon General), as Chairman. The final report of this committee, constituting an octavo volume of one hundred and thirty-seven pages did much to establish differences between deodorants, preservatives and disinfectants and the findings therein given have not been materially modified by subsequent investigations. My part in this work was largely confined to the study of the germicidal action of mineral acids and mercuric chlorid.

When the United States Public Health Service was reorganized about 1903 and its splendid hygienic laboratory was opened, an advisory board of civilians was appointed and on this board I have continued from the time mentioned. The United States Public Health Service renders the people of this country a service which but few appreciate and about which most people know nothing. Its functions are devoted largely to the prevention of infections entering this country and their extension from one state to another. This service has charge of all rational quarantine stations and in more than one instance has kept Asiastic cholera, bubonic plague and other infectious diseases from landing on our shores. It has charge of interstate quarantine and its machinery is at the service of the state and local authorities when requested. The service is charged with the protection of the people in the manufacture and sale of all vaccines and serums while from its hygienic laboratory researches of the highest character and of the greatest value to the people are constantly coming.

To be a member of the International Health Board is in and of itself equivalent to receiving a graduate course in public health. This organization, supported by the Rockefeller Foundation, began operation about fifteen years ago in showing the people of the Southern States how they might eradicate hook-worm disease. This function was soon enlarged so as to include malaria. At first the Board paid for all this work, but now the people in the Southern States, having been convinced of the benefits thus secured for themselves, are bearing the costs. When the Board extended its demonstrations to nearly every part of the globe. It has made a special effort to eradicate yellow fever totally from the world and at this writing (February, 1926), it can be said that there has been no case of yellow fever in the Western Hemisphere since May, 1925. Recently (July, 1925) the Board has sent an expedition to West Africa to ascertain whether or not yellow fever exists on that continent, and if it does, to proceed with its extinction.

In the American Philosophical Society and the National Academy of Sciences I find it difficult to comprehend some of the papers presented by those whose researches lie quite beyond my own limited field of endeavor, but the effort is stimulating and beneficial. It gives me some comprehension, inadequate as it is, of the wide range of human knowledge and awakens dreams of the possibilities of human achievement. As I see it, one of the highest functions of man is to study the operations of nature in the construction, maintenance, and development of the universe, and to adjust the race to its environment. Man is a part, probably a small part, of creation, but even the smallest cog in a complicated mechanism has a function, the proper performance of which is essential to the harmonious working of the whole. Man, as a part of the great machinery of the universe, unlike the components of man-made machinery, is capable of self improvement and better adjustment. How far this capability is possessed by other components, I do not know, but there are reasons for believing that growth, or the spirit of the creator, pervades, animates and directs all things, whether they be material, intellectual or spiritual. Even the chemical elements are not inert, but are labile, are born and are modified by environment. Nothing in the universe remains indefinitely in a fixed state; growth characterizes all; even the stars are born, flash into activity, fade and die, their substance supplying material for other growths; some of these changes are recorded in astronomical time, some are measured in solar terms while others are counted in geological ages. Law governs the universe; it is inexorable; and the unfit is eliminated. Suns and planets and all things pertaining thereto, when they fail to keep progress with the great mechanism, are cast out as waste and their substances and energies are converted into agencies which no longer interrupt the harmonious evolution of the universe.