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SECTION III.
CHAPTER V.
THE AMERICAN MEDICAL ASSOCIATION.
The organization and facilities of the American Medical Association were placed at the command of the Medical Department of the Army even before the United States entered the World War. The following history of the war service of this body, as it concerned the Medical Department of the United States Army, is based on a special report by the editor of the Journal of the American Medical Association.`
The American Medical Association is the comprehensive organization of the medical profession of the United States. It is nonsectarian, including in its membership legally qualified practitioners of medicine, without regard to the medical school from which they graduated, who do not support or practice or claim to practice any exclusive system of medicine. This membership is composed of the more than 81,500 members of its "constituent State associations" in the 48 States and in the District of Columbia, Hawaii, the Isthmian Canal Zone, the Philippine Islands, and Porto Rico. The unit of organization is the component county medical society, of which there are over 2,000. Each member of these county branches has equal rights and responsibilities in the organization which he exercises himself or delegates to elected representatives. The county units in each State or Territory unite in the constituent State association for that jurisdiction which is governed by a house of delegates, the members of which are the representatives elected by its several component parts. In turn, these delegate bodies of constituent State branches select those who represent them in the house of delegates of the American Medical Association its
governing body.
In a word, in the American Medical Association, the United States Government had a thoroughly democratic, nonsectarian, voluntary organization of physicians, which included specialists in every branch of medicine as well as general practitioners, and in which practically two-thirds of the legally qualified active practitioners of medicine in the country held membership.
FACILITIES.
When the United States recognized that a state of war with Germany existed, the association already had tendered its organization and its facilities to the Medical Corps of the Army, of the Navy, and of the United States Public Health Service to cooperate in every way for the winning of the war.
These facilities were unique. They included information regarding the members of the medical profession which was not to be found elsewhere. This information consisted of complete records of the membership of the organization; in fact, of all licensed physicians and of other medical data compiled from various
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sources, including matters relating to the professional and social standing of individual physicians. Especially, at the association headquarters, there were:
(a) A card-index record of all medical students of the United States showing their preliminary education, the medical schools which they were attending, and the schools at which each of the years of the medical course was taken. This covered the seven years preceding the war.
(b) A biographic card index of physicians, giving, in addition to the student record, information concerning the school of graduation, licenses held, hospitals in which they had served as internes, the places at which they had engaged in practice, etc.
(c) A record of the membership of recognized special medical societies and associations, as well as the names of those who had registered in the various sections of the Scientific Assembly of the American Medical Association. These records provided information regarding the specialty in which each physician was interested or to which he limited his practice. This information was supplemented by statements from physicians themselves regarding their specialty. These data were available and were valuable in making selections of men for any special or particular service.
(d) A personal file containing a vast amount of personal information concerning physicians in the form of newspaper clippings and reports from various sources. It had been assembled during the 12 years preceding the war.
(e) A file in the propaganda for reform department of the journal containing a most complete list of quacks, irregular practitioners, cults, ‘pathies, etc. This file was begun in 1907.
It will be appreciated that the association had just the data needed by the War Department to show the general character, education, and standing of the individual both as a physician and as a man, and this information was made available to and was utilized by the Surgeon General of the Army.
THE PERSONNEL DIVISION.
From the beginning of the war, the Personnel Division of the Surgeon General’s Office, as a routine procedure before taking action on the applications, forwarded to the American Medical Association the names of applicants for commission in the Medical Reserve Corps, thus availing itself of the association’s records. These names were forwarded almost daily, often over a hundred a day. When received, the names were card indexed and the cards distributed among specially trained clerks, who looked up the information concerning each individual. If any data were found which called in question the professional or personal character of any of these applicants, the information was transmitted to the Surgeon General. In addition to these routine investigations special investigations were, on request, made by the association officers. These were conducted by asking the president and the secretary of the county medical society (within whose jurisdiction the subject of the investigation resided) and one to four other physicians of known professional standing in that community for data concerning the physician about whom information was requested, if necessary. These requests were repeated, or additional letters were sent to others. Then when three or four responses were received at the association’s headquarters they were assembled and the information forwarded to the Surgeon General’s Office.
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WAR WORK OF THE JOURNAL.
War was declared April 6, 1917. The journal for April 7 contained four editorials in which it was stated that war was certain. These editorials emphasized the needs of the Army and of the Navy for medical officers, and called on the medical profession to be ready to respond. The following week it published the facts relative to the number of graduates available from medical colleges, and emphasized the importance of maintaining the supply of physicians through the medical schools. In the journal for April 21, 1917, a call was issued to the profession of the United States, through the county societies, to supply the Army with medical officers. In that issue were printed 65,000 blank forms for making application for commission in the Medical Corps, as well as in the Medical Reserve Corps; and the announcement was made that the association was prepared to send pamphlets, circulars, and other information regarding the medical service of the Army and of the Navy.
In addition to other information regarding the Reserve Corps, the journal on April 28, 1917, published the first list of medical examining boards. On May 26 it again published application blanks-this time 67,000. (Incidentally, within two weeks 1,300 applications were received in the Surgeon General’s Office on blanks taken from the journal.)
From this time the journal carried on a propaganda to build up the Reserve Corps and in other ways to cooperate with the Surgeon General`s Office of both the Army and the Navy.
Especial mention is made of the “Medical mobilization and the war” department of the journal. This first appeared in the issue for April 14, 1917, and in each succeeding number during the period of the war. It included a great variety of medico-military articles.
One of the announcements which was of most effect in stimulating volunteers for the Medical Corps was that listing the names of physicians who accepted commissions. The first of these lists appeared in the issue for June 2, 1917, and others were published practically each week thereafter throughout the period of the war. Not infrequently the announcement of duty which accompanied the names in these lists was the first notice of his “orders,” which was received by the medical volunteer.
In connection with this work there naturally was a large amount of correspondence. Since the beginning of the war the association officers answered, both by letter and by publication, thousands of questions relative to the service, thus relieving the offices of the Surgeon General of this burden. Besides the application forms (132,000) contained in the journal, the association printed and sent out about 135,000 additional forms, or a total of nearly 267,000.
DIRECT PERSONAL APPEAL TO PHYSICIANS.
In May, 1917, a proposition was submitted to the Surgeon General of the Army providing for a personal appeal to all physicians under 55 years of age. The plan was indorsed by the Surgeon General, and an officer of the Medical Corps was assigned to the association office to represent the Surgeon General and to supervise the work. The work was begun on May 28, 1917, and completed about the end of October. The association, in addition to supplying biograph-
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ical data from its files and records, did the necessary printing connected with the work and furnished other facilities. However, this work was conducted ostensibly by the central division of the War Department, in Chicago, which means that the association’s part in this enterprise was unknown.
The proposition as outlined and as carried out required the sending of a circular letter to every physician on the association list under 55 years of age. This letter presented the privilege of applying for a commission in the Medical Reserve Corps, and was signed by the medical officer in charge as representing the Medical Corps. A card was in closed, with a return franked envelope, on which the recipient was asked to give certain information regarding himself; for example, his social conditions, and especially whether he would apply for a commission at that time, or later-in the latter case, when? An application blank and all the necessary information, including a list of examining boards, also was in closed. To those physicians who did not answer, a second letter was addressed. All told, including the first letter and the “follow-up,” 68,597 letters were sent out; and up to the time the medical officer was relieved from this duty returns had been received from 34,479 physicians.
In his final report to the Surgeon General the officer in charge stated that in following this work and noting the number of applicants for commissions in the Medical Reserve Corps a marked increase in these applicants reported from the different States had been noted immediately following the mailing of letters to the physicians of those States. This increase followed the mailing of both the first and second letter. The American Medical Association not only placed its files at the disposal of the Surgeon General’s Office for this work, but rearranged its card system from time to time for their convenience, furnished all materials other than the franked envelopes, did all the printing, and rendered every possible assistance in a most admirable manner.
In addition to this effort to increase the Reserve Corps, the association’s plant printed a large amount of material without cost to the Government. Besides the 270,000 application forms already mentioned, the following items are cited: 5,500 reply post cards for a survey of medical students relative to their relationship to the selective service law; 85,000 circular letters regarding the Medical Reserve Corps; over 120,000 lists of examining boards for Medical Reserve Corps applicants; 140,000 envelopes for use in circularizing physicians; 85,000 reply cards; over 60,000 circulars giving information concerning the Medical Reserve Corps; over 26,000 miscellaneous pamphlets and circulars relating to the mobilization of the National Army and especially of the medical profession. In a word, from the beginning of the war all the facilities of the association, including its biographical information, its printing plant—everything—
were at the disposal of the Surgeon General’s Offices, and every aid possible was rendered.
SURGEON GENERAL’S APPRECIATION.
As regards this point, the following letters from the Surgeon General, dated February 22, 1918, bear witness. The first is addressed to the chairman of the board of trustees; the second, to the secretary of the association:
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THOMAS McDAVITT, M. D.,
Chairman Board of Trustees, American Medical Association, St. Paul, Minn.
DEAR DOCTOR McDAVITT: In answer to your letter dated February 14, 1917, I am very glad to acknowledge the great service which the American Medical Association has given, with and without solicitation, to me personally and to the Office of the Surgeon General, in the solution of the important problems of preparedness for war and of the medical and surgical care of our boys in training camp and field by the Medical Department of the Army.
Through the officers, the journal, and educational propaganda distributed by the American Medical Association, we have secured thousands of officers of the Medical Reserve Corps. The Office of the Surgeon General and the Medical Department of the Army still need your aid and support.
Permit me to thank you, and through you the other trustees and officers of the association, for the valuable help already rendered and for the acceptable offer of a continued life service.
Very truly yours,
(Signed) W. C. GORGAS,
Surgeon General, [T. S. Army.
Dr. ALEX R. CRAIG,
Secretary American Medical Association, 535 North Dearborn Street, Chicago, Ill.
DEAR DOCTOR CRAIG: It gratifies and affords me pleasure to acknowledge the great services rendered by the American Medical Association, to me personally and to the Office of the Surgeon General, in organizing the Medical Department of the Army for the efficient care of our soldiers in training camp and field.
Since April, 1917, the board of trustees, the officers at the Chicago headquarters, the journal, and all the machinery of the American Medical Association have been important and distinctive factors through which many thousands of physicians have been influenced to apply for commissions in the Medical Reserve Corps; medical officers have received valuable instruction by means of special articles printed in the journal and also through literature distributed in pamphlet form from the office; and in other ways too great to enumerate here.
The spirit of service expressed by the officers and members of the American Medical Association in so many helpful ways, in the work of preparation for war and for actual surgical and medical care of our soldiers in war, evidences a patriotism and devotion to country which is a credit to the American medical profession.
I accept and thank you and through you the other officers of the association for the offer to continue the same services of the association to the Medical Department of the Army as long as may be.
Very truly yours,
(Signed) W. C. GORGAS,
Surgeon General, U. S. Army.
Under date of April 3, 1918, the Surgeon General of the Army addressed the American Medical Association submitting a memorandum of a plan for the utilization of the organization and machinery of the association, in addition to the activities of the other bodies, viz., the Medical Section of the Council of National Defense and the different sections and organizations of the American Medical Association, for the purpose of securing future increment to the Medical Reserve Corps and for keeping the numerical strength of the corps up to the requirements of the service. This plan contemplated a close cooperation between the Office of the Surgeon General and the officials of the American Medical Association through the officials of the different State and county medical societies and through the different section organizations of the American Medical Association. On receipt of this communication, the war committee convened in Chicago, April 16, 1918, and by formal action undertook the task assigned to it by the Surgeon General of the Army, and issued a statement announcing its action and declaring its confident anticipation of the hearty,
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active, patriotic cooperation of all physicians for the successful accomplishment of the task. Immediately a call was issued for a conference of the secretaries of the constituent State associations which was held at the headquarters of the association in Chicago on April 30, 1918.
At this conference, 38 constituent State associations were represented by their secretaries or an accredited alternate. The secretary of the Minnesota State Medical Association and chairman of the board of trustees, was elected chairman of the conference, and the entire day was devoted to the discussion of how the organized medical profession could be utilized effectively for the winning of the war, and specifically how the American Medical Association, its constituent State associations, and their component county societies could assist in enrolling the required increments for the Medical Corps of the Army and Navy. On the adjournment of the conference the secretaries of the State associations returned to the several States with the determination to coordinate the forces of the organized medical profession in their States with other agencies working with similar objects.
To determine to what extent the medical profession in various parts of the country had met its responsibility to the Government the war committee published in the journal for June 1, 1918, a survey or honor roll of the medical profession of the United States. This survey presented under each State a table which showed important facts regarding each county in the State; the area, population, total number of physicians, number of women physicians, number of physicians under commission in the Army and in the Navy. In addition to this table there were published for each State, under the counties and post offices, the names of all physicians of the State who had accepted commissions in the Medical Reserve Corps of the Army and Navy, or who were in active service in the Medical Department of the federalized National Guard. The published list did not include the names of the members of the regular Medical Corps, those who had been commissioned in the Reserve Corps but who had not accepted their commissions, or those who were serving as contract surgeons. This honor roll proved effective in stimulating applications for commissions in the Medical Reserve Corps.
SUPPORT OF MEDICAL EDUCATION.
By the time this country entered the World War the reforms among medical colleges had made such progress that for several years most of the medical graduates had benefited from improved conditions in medical schools, such as higher entrance requirements, more skilled teachers, better laboratories and laboratory equipment, better clinical material, and greatly improved methods in medical teaching.
The council on medical education of the American Medical Association, in addition to the information it had collected, rendered other important services to the Government, which are briefly enumerated as follows:
(a) When the selective service law was enacted it made no provision for the exemption of medical students. In the medical students` register the council had the home addresses of the majority of students enrolled during 1916-17, and was able by direct correspondence to secure reliable information showing the proportion of students who would be taken by the draft. The data col-
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lected had much to do with the provision made later, whereby drafted students were permitted to enter the enlisted reserve corps and to remain in medical colleges until they completed their medical training.
(b) Only such students were eligible for admission to the enlisted reserve corps as were enrolled in “well-recognized” medical colleges, which were defined as those recognized by the majority of State medical licensing boards. The only information immediately available by which it could be decided which colleges were so recognized was that published by the council on medical education of the American Medical Association in the State board statistics, based on reports signed by the various State board officers.
(c) The council’s files of information in regard to medical colleges were also placed at the disposal of the Surgeon General, and the secretary of the council cooperated in inspecting and furnishing reports to the Surgeon General regarding a number of medical schools.
(d) The council’s files of information in regard to standards of preliminary and medical education likewise were utilized by the Surgeon General. This information included also a list (compiled by the council) of hospitals considered in position to furnish acceptable internships.
CONSTITUENT STATE AND COMPONENT COUNTY BRANCHES.
In addition to the foregoing activities, which were conducted in the main from the headquarters of the association, the component State medical associations and their constituent county medical societies, beside the cooperation they accorded the American Medical Association, instituted and carried on many measures within their several jurisdictions. These branches of the American Medical Association, through their cooperation with various agencies, many of which were independent of the organization of the American Medical Association, contributed to the success of measures which were undertaken with the object of mobilizing the medical profession and of placing the organization and personnel of the profession at the service of the Government for the winning of the war.
REFERENCES.
The American Medical Association’s War Service, by George H. Simmons, editor, Journal of the American Medical Association. On file, Historical Division, S. G. O.
