By Arnold Melnick, DO, FACOP
This is 1946. This is the Waldorf-Astoria Hotel in New York. This is the Annual Meeting of the ACOP. This is Arnold Melnick, a lowly intern at Osteopathic Hospital of Philadelphia, with a burning desire to become a pediatrician, who chiseled two days off to try to learn some pediatrics at this meeting.
But wait a minute! I looked at all the ballrooms like this and couldn’t find the ACOP. Finally, I found a small, side Conference Room with a small table in the corner. The 15 or so ACOP members around that table were the 1946 ACOP Annual Meeting.
I sat through an afternoon with no additional pediatric knowledge but with an improved understanding of the ACOP organization. As soon as the meeting ended, Helen Hampton, who was President, approached me with a pile of papers and asked, “Will you be good enough to review these tonight and give a brief summary at tomorrow’s session?” So my brief discussion the next day on the brand new field of child development became only the second educational presentation at an ACOP Annual Meeting. That was 70 years ago and the start of a 70-year love affair between me and ACOP.
Seventy years ago, pediatricians usually limited their practices to infants under one year of age. The reason: infectious diseases overwhelmingly predominated their practices and there were no anti-infective medications or antibiotics. (That accounts for the famous picture of the doctor sitting by the bedside of a dying child, painted in 1887 by Sir Luke Fildes.) Actually he had little to fight the illness – except kindness, sympathy and support. Ultimately, as the specific drugs appeared in the 40s, the upper age of our practices rose to 12 years (where it was when I entered practice), then to 16 and today it varies from 21 to 25.
Thanks! Today, I appreciate being invited to give the Watson Memorial Lecture and especially being the only person to give it three times. I know I have slowed down, but it didn’t take me long to realize that I was not expected – being almost 95 and not having seen a patient in almost 40 years – to give the latest treatment of premature infants or discuss the newest cardiac drugs. I was invited because I am the only living member who has lived through 70 years of ACOP activity. So I’ll try to give you my view of many salient happenings in those 70 years – and throw in a few comments on key things that I think took us from…
Rejection and Discrimination to Recognition and Acceptance
When I was in medical school in the 40s, we faced a deadly plague – called “the draft board.” Medical students and graduates were all subject to being drafted into the medical branches of the armed forces. But DOs were declared “quacks” by the AMA, and the medical services (whose medical decisions understandably followed AMA standards) refused to grant us commissions in their medical corps. And that also meant that osteopathic students had no deferments and had to face draft board actions. I survived by virtue of a repeated 4-F classification (physically unfit for military service – vision).
However, the general policy brought agony to us and we chafed at the discrimination. But in retrospect, there was what I believe was a positive effect. Massive numbers of practicing MDs were drafted, leaving their neighborhoods bereft of adequate medical services. As a result, those “stranded patients” almost had to go to a DO. Many of those patients learned that DOs were “regular doctors” (so did their friends and neighbors) and many remained with the DOs after the war. This created a steady stream of thousands of patients for DOs and the pool of “osteopathic “patients grew exponentially, forming a basis for continued and increasing influence.
I believe this was a major tactical error on the part of the AMA – they literally chased patients to osteopathic physicians – unconsciously, of course. Thereby, we developed a larger cadre of osteopathic supporters than any advertising or publicity could possibly have created. So much so, that DOs accidentally reaped a huge impetus in public recognition and acceptance.
At the time of my internship, there were only two osteopathic residencies in Pediatrics and they were in California. So when I finished my internship, I went into what was then called General Practice. That was the route all previous DO pediatricians had taken. I also did what they did – I arranged to study Pediatrics at the feet of practicing pediatricians. This time, however, three of us exerted pressure on PCO and on Dr. Bill Spaeth (Department Chair) to set up a preceptor-type training program for us. The other two candidates were Otto Kurschner, a classmate of mine, and Thomas Santucci – that’s Tom, Senior – all friends and colleagues. ALL BECAME CHIEFS!!!
Our program was the start of long-term training programs for the College and proved to be a forerunner of many other pediatrics training programs in our profession, set up by the previously trained pediatricians.
Our routine was to work under Bill, Jim Purse and Harry Breitman in the twice-weekly Pediatrics Clinic, with occasional lectures thrown in, plus hospital rounds almost daily – sometimes there were as many as six pediatric patients in the pediatric wards. And we were involved with examination and care of all infants in the Nursery. After five years, we also earned the degree Master of Science in Pediatrics from the College, plus becoming eligible for ACOP certification, both of which all three of us achieved.
Meanwhile, I was in private practice, limiting myself after my first year to Pediatrics. Let me tell you about “practice”. First, “doctors” at that time essentially consisted of “neighborhood physicians” and “specialists.” When I started, the neighborhood physicians or “general practitioners” usually opened offices in their homes and serviced overwhelmingly that particular locale. “Specialists” were either located at the local area hospital or occasionally had a centrally-located office.
In the 40s, a routine office visit cost $2, with an occasional additional charge of $1 for injections, such as vaccines – and we only had DPT and DT vaccines to offer. House calls – the now almost-forgotten time when doctors packed their “doctor bags” with all their equipment, and went to the patient’s home because the patient was too sick to get to the office. The charge: $3 – and let me tell you – that extra few dollars a week for house calls were very helpful to physicians’ incomes.
Lest you wonder about just $2 for an office visit, allow me to paint you a picture of what things were like back then: Large Hershey bar… 5 cents, Good steak dinner… $2.50 to $3.00, Daily newspaper… 3 cents, Postage for a simple letter… 2 cents, Average middle-class (row) home… $4,500, Average new car… $1,200 AND gasoline was just 15 cents a gallon.
Plus consider these facts:
- There were only eight or nine TV stations in the entire U.S.
- No credit cards, no computers
- Some outdoor plumbing was still around
- Cell phones were only in the comic strips
And, for doctors:
- Most doctors (non-specialists) held “office hours” – no appointments – so “walk-ins” were the mode of operating offices
- There were no antibiotics or anti-infectives – thus the bedside doctor
- As for medications: Your PDR today contains more than 3,500 pages of drugs. My 1947 PDR was a “massive” 380 pages
- My annual tuition at Temple University (1937-42) was $200, but when I went to PCO a couple of years later, it was $400 a year.
- So, a $2 office visit was right in line with the 1940s
Let me try to delineate some of what I consider 10 of the highpoints of ACOP’s progress – adding occasionally some important steps to our wide acceptance:
- Over the early 40s, we had a couple of irregular ACOP newsletters, minor in the scheme of things, but we had no official publications. They were simply eight mimeographed pages about twice a year. (Does anyone remember mimeograph?) Within a couple of years of joining, I began to edit and publish The Bulletin of Pediatrics on a regular basis – several times a year, but still mimeographed. For a few years, Ross Laboratories took over the task of the actual publishing and mailing. Our publication grew in the 1990s, under AOA Management, into a printed bulletin and was re-named PULSE. This newsletter continued on a regular basis to improve until today – in its excellent form – under the editorship of Rob Locke.
- The degree Fellow of the American College of Osteopathic Pediatricians began as a sort of reward for each ACOP President, as they didn’t receive even expenses during their terms. This distinction became a significant permanent badge of honor. Eventually, it was expanded to serve as a distinguished service award without so naming it. In this new century, we converted to what most organizations had done – made it a sign of specialty certification. All previous holders’ awards were renamed Distinguished Service Awards.
- William Spaeth, then a Past-President of ACOP, recognized early on that, because of our small number of members and who were spread all over the country, there should be regional divisions of the ACOP, labeled according to geography. As there were clusters of ACOP members – small clusters – in the Philadelphia, Los Angeles and Chicago areas, the initial recommendation was to establish the Eastern Association of Osteopathic Pediatricians, the Mid-Western Association of Osteopathic Pediatricians and the Western Association of Osteopathic Pediatricians. This made it easier, with our limited membership, to hold educational sessions for the pediatricians in those areas – a rare opportunity in those days.
As I recall, the Eastern Association held three meetings a year, with programs tailored to the members’ desires and needs. They were well attended, offering more education than would have been available in just one national meeting. And we had great opportunities to learn, and even a chance for some of the younger members to become officers. The Western group had always had meetings with educational sessions – even before ACOP was founded – and I presume they continued with their programs.
This went on for about five years. Lest anyone feel that this was a minor thing, remember that back then, DOs could not attend any outside specialty lectures because of discrimination – and this was a boon educationally to our specialists.
- Around the same time, the AOA began running specialty Supplements to its Journal and invited ACOP to participate – one of the first. I was appointed Editor and continued to serve in that capacity for the life of Supplements – about five years. This was another recognition of ACOP by AOA as the true representative of the pediatric specialty – important because over time, we in ACOP had felt that such recognition was not forthcoming. Plus, it gave a number of our leading members an opportunity to be published in a legitimate medical publication.
- Somewhere in the 30s or 40s, the Kansas City College of Osteopathic Medicine and the Jackson County Osteopathic Association began co-sponsoring what was known as the Annual Child Health Conference. It grew in size and importance through the years. Its purpose was to provide consultative services for the many rural DOs in surrounding areas and offering some pediatric training to their students and to “local” DOs. Remember that in those days, most MD specialists would not consult with DOs – the AMA had officially declared that “voluntary association with DOs was contrary to the AMA Code of Ethics” – a ruling that persisted for many years. There were no pediatricians at KCCOM, so the practitioners were stymied. It was most successful and went on for years. DOs would come from 300-400 miles away with their problem patient(s) to consult with the guest pediatricians at the Conference. Other DOs would come just to learn as cases were examined and to listen to the guest lecturers. Another example of the profession’s creating education for itself – a necessity.
In 1953, ACOP became associated with the Conference, convening its first annual Conference on Pediatric Education there. ACOP had been moving in the direction of studying pediatric facilities and pediatric education in the profession, and this was a convenient and worthwhile place to begin. In 1954, for example, representatives of five of the six osteopathic colleges and 11 major osteopathic teaching hospitals took part in the CPE.
Key pediatricians at the Conference over the course of years were Leo Wagner and F. Munro Purse, both of Philadelphia, subsequently joined by a number or other osteopathic pediatricians from around the country. Attendance in some years reached 1,000 doctors, but eventually it folded as KCCOM developed its own faculty of pediatricians. It was a noteworthy run, both for offering great pediatric care for problem patients in the mid-west and providing many educational opportunities for the DOs. Many students and young DOs either added to their pediatric knowledge or were stimulated to choose Pediatrics as a specialty. It was a grand landmark in Osteopathic Pediatrics!
- Over the years, many of our wives accompanied their husbands to our meetings, and sometimes had their own activities – mainly socializing and sight-seeing. In 1957, ACOP officially established an Auxiliary. Their annual dues were just $2. A splendid experiment that went on for only five years, then disappeared. There have been no attempts to revive it.
- Over the years 1940 and 1950, there had been numerous talks, conferences, suggestions and complaints between the California Osteopathic Association and the California Medical Association regarding status of recognition. Primarily, the COA wanted to achieve equality of status, while CMS wanted to get rid of “those osteopaths” In May, 1961, both sides agreed upon “The Merger.” The terms essentially were: DOs were to obtain an MD degree and license on payment of $65, and the College of Osteopathic Physicians and Surgeons was to be renamed the California College of Medicine (and grant MD degrees only). The DOs who joined CMA were assigned to a single geographical district, regardless of where they practiced. It has been estimated that about 2000 DOs chose to join the CMA, leaving behind a small coterie of DOs.
These loyal DOs formed the Osteopathic Physicians and Surgeons of California, which has grown in size and strength and now represents that state. Eventually, the ban on osteopathic physicians was voided by the state Supreme Court – and California continues to grow as an osteopathic state, even having two new osteopathic colleges – Touro and Western University.
“The Merger” created some division of opinion in the other states, with a minority seemingly wanting to mirror California. But a large majority of the osteopathic profession resisted and they prevailed. I believe strongly that the hoopla of the merger and subsequent events contributed to the strength and growth of the osteopathic profession, instead of weakening us.
For a full description of the entire merger situation, read Norman Gevitz’ wonderful history of our profession, The DOs:Osteopathic Medicine in America or Robert Bomboy’s The Golden Anniversary History of the ACOP.
- No discussion of highlights would be complete without a word about the Annual Meeting of 1990 – the 50th anniversary of ACOP. It was held in St. Thomas, under the presidency of Mike Ryan. It not only featured an outstanding program and a wonderful vacation spot, it produced the landmark 50th Anniversary History by Robert Bomboy – the first published history in the life of ACOP.
- Over many preceding years, both the ACOP and the American College of Osteopathic Obstetricians and Gynecologists independently wanted out of meeting at AOA’s annual meeting, and even had some discussions with each other regarding a joint meeting. It came to fruition in 1959 when the two met together, with an attendance of 175 physicians and 50 spouses, and a splendid program, featuring, even at this early date, several nationally-known MD speakers. Harold Finkel, who had become a specialist in convention exhibits, taught the ACOOG about the potential revenues — and the joint meeting ran successfully for about five years. Another step in our growth!
- In the 1970s, the ACOP realized that it could not continue using only volunteer physician-officers to manage ACOP. So, we hired Esther Martin, quite experienced in organizational management, as our first Executive Secretary. From that point on, we continued with professional management, much to our benefit. Esther Martin was succeeded by Theresa Goeke, then David Kushner, and then we came under the care of AOA management. They produced our first printed newsletter – named PULSE – and on a regular schedule. For several years now, we have successfully had Ruggles Corporation as our management company, with Stewart Hinkley as our Executive Director – with mutual benefit.
As I end my 70 years of ACOP observation, I must add two additional progress notes of importance. First, this meeting – a combination of educational programs of ACOP and AAP – is certainly a great forward step. And forthcoming soon, the new ACGME, combining graduate education efforts of both professions, holds hope of great progress for DOs and MDs alike.
There it is. Ten salient features that I feel were significant points in the 70 years that I have observed – and been active in – ACOP. There are many, many more people and events that could have been recalled and may be important or significant to other members. But these are mine.
I would be pleased to answer questions or hear your comments at the end of my lecture.
I have taught public speaking periodically throughout my career, One thing I always emphasized, “Don’t end your talk with a mumbled ‘thank you’ and sit down. If you want to thank the audience, make it meaningful.”
So, thank you for inviting this old man for a final crack at an ACOP program. And thank you for honoring me three times as the Watson Memorial Lecturer. And thank you for being willing to listen to this old man’s overview of the last 70 years of ACOP. And above all, I thank you because all this makes me feel young again! ACOP, I love you!