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W Avontague Cobb, MD
THE PURSUIT OF EXCELLECE Project Arcturus W. Montague Cobb, MD Washington, DC
This issue of the Journal is dedicated to the memory of W Montague Cobb, MD, who served as Editor from 1947 through 1977 and as Editor Emeritus until his death on November 20, 1990. The Publication Committee requested that one ofDr Cobb's previous works be printed in this issue. To commemorate his diligent work and tireless efforts for the NMA, it is appropriate to reprint Dr Cobb's 1964 presidential inaugural address, which clearly demonstrates his far-reaching vision, his love for the NMA, and his concern for quality health care delivery for black Americans.
WITH MALICE TOWARD NONE, WITH CHARITY FOR ALL Some of the richest prose in the English language has been given us by an immortal President who did not have better than the equivalent of a second grade education. To begin this message today I can find no better or more timely theme than the closing lines of Lincoln's Second Inaugural Address. "With malice toward none; with charity for all; with firmness in the right as God gives us to see the right, let us strive on to *Originally presented as the President's Inaugural Address at the 69th Annual Convention of the National Medical Association, Washington, DC, August 2-6, 1964. Reprinted with permission from the Joumal of the National Medical Association, September 1964, vol. 56, no. 3, pp 432-441. JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 2
finish the work we are in; to bind up the nation's wounds; to care for him who shall have borne the battle, and for his widow, and his orphan - to do all which may achieve and cherish a just, and a lasting peace, among ourselves, and with all nations." When President Johnson signed the Civil Rights Act into law on July 2, 1964, he brought to formal end a long and arduous campaign for social justice. The nation has remnant wounds, in the form of bitterness and hostility, which must be bound up. Many who bore the brunt of the battle sacrificed greatly and must be cared for. And because lives were lost, there are widows and orphans to be seen after. Above all else, the American heritage demands that we strive on to finish this work we are in, to achieve the just and lasting peace among ourselves and with all nations.
THE AMERICAN HERITAGE The American heritage is something which belongs to all citizens of the United States. It is something to which our Negro citizens have made especially vital contributions. Ours was the first nation in the history of the world to dare to declare as political doctrine the concept that all men are created equal. The ancient
civilizations of Egypt, Mesopotamia, the Orient, Greece and Rome, and those of Europe in medieval and recent times, accorded no recognition to the rights and aspirations of the common man. Even after the Declaration of Independence on July 4, 107
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1776, it required nearly a century, until July 21, 1868, to establish clearly that the presumption of equality of all men meant just what the Declaration stated. It was held at first that the Indians could not be included, because their neolithic culture was more primitive than the European. The Negroes were eliminated because they had been brought over as slaves and were obviously a lower order of creatures, not to be included in the family of man. Orientals were too few in number at first to present a problem, but they too were obviously a different sort, not embraced in the intent of the Declaration. Nevertheless, the problem was debated and fought over in every conceivable way until the issue was settled by the military victory of the North in the Civil War and the Fourteenth Amendment became the law of the land in 1868. This stated that all persons born or naturalized in the United States were citizens thereof and of the State wherein they resided and that no State might deny to any person the equal protection of the laws. A subterfuge to avoid compliance with the law was introduced. This held that citizens could be segregated and still be considered as having equal protection of the laws if provisions for them were separate but equal. Nearly another century was to pass before this dodge would be ruled invalid. During the ensuing 86 years every aspect of this question was debated, investigated and litigated. On May 17, 1954, the United States Supreme Court made a final determination of the matter. In its historic education decision the Court held that separate cannot be equal, and therefore, segregation in education was unconstitutional and must be abandoned with all deliberate speed. Two centuries may not be a long time for the maturation of a nation, but in the 188 years between 1776 and 1964, we have had the annealing force of seven major wars.* These have forced the most critical examination of our principles and creeds, so that when the Civil Rights Act became law on July 2, 1964, it might be said that the country surely knew what is was doing and that our strong, young nation had finally come of age. We have made clear once again that under our laws all men are equal. To us as individuals this has taken a painfully long time, but it is worth noting that when the tumult and the shouting have died, our country has never taken a backward step. July 4, 1776, July 21, 1868, May 17, 1954, and July 2, 1964, all represent great and progressive days of decision in our history. *
1812, 1847, 1861, 1898, 1917, 1941
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For the great distance still to be travelled in the march toward our declared goal of equal justice and opportunity for all, we cannot expect two centuries more. The United States has been catapulted into a position of world leadership. Our way of life is challenged by a different political ideology, backed by powerful military strength, which denies the freedom of the individual which we so highly extol. When we invite emerging nations to choose our way rather than our competitor's they regard our example critically. Time is running out on us in making our practices conform with our preachments. The American heritage must be made meaningful at home as well as abroad.
THE NMA ON THE AMERICAN SCENE The National Medical Association is an integral part of the American heritage. Formed in 1895, in its 69th year it is among the older group of medical associations of our country. The two medical schools which have contributed most of the members of our Association have been even greater seniority among our 87 medical schools. The Howard University College of Medicine, opened in 1868, was a charter member of the Association of American Medical Colleges. Howard and its sister school, Meharry Medical College in Nashville, Tennessee, founded in 1876, have graduated more than 7900 Negro physicians, considerably more than all other medical schools combined. These physicians, spumed by their white colleagues, denied elementary hospital facilities and opportunities for professional improvement until very recent years, have contributed to the health care of the American populace under handicaps which no other segment of the profession has had to suffer. We are proud of our contribution and bow our heads to no man in this respect. It is noteworthy that the history of the National Medical Association is marked by lack of bitterness in expressions against the lot of its members. The often quoted credo of the Association articulated by Dr Charles V. Roman in 1908, is worth repeating here. Conceived in no spirit of racial exclusiveness, fostering no ethnic antagonism, but born of the exigencies of American environment, the National Medical Association has for its object the banding together for mutual cooperation and helpfulness, the men and women of African descent who are legally and honorably engaged in the practice of the cognate professions of medicine, surgery, pharmacy, and dentistry.
THE NMA HAS ALWAYS COME IN PEACE This Association was formed because its members JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 2
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had no other course to pursue to secure meetings for professional improvement. As the opportunities have expanded, the NMA has been in the forefront of efforts to demolish racial barriers in health areas. Year by year the quality of the scientific program of the Annual Convention has improved, as have the number and scope of its scientific exhibits. The NMA initiated an official organ, the Journal of the National Medical Association, in 1909. The Journal was at first a quarterly. It became a bimonthly in 1939 and is now in its 56th volume. The Journal is the second oldest periodical of any nature published under Negro auspices, and it is naturally the oldest Negro medical periodical. In its pages have appeared more than half of the approximately 5100 titles by Negro medical writers. The Journal has an international circulation. It has extended the hand of cooperation to young African countries as a professional medium until they can get their own periodicals under way. Our Journal has regularly reported significant developments in the progress of medical integration and through several series of historical articles became a valued, source on the history of the Negro in medicine. In appearance and content the Journal has representative quality. With the ever increasing need for outlets for the writings of a growing number of physicians the Journal can look forward to performing even greater service with wider circulation as a medium for diffusion of medical knowledge and the expression of professional opinion. The National Medical Association has always been active in the war against discrimination. When what is now the Veterans Administration Hospital at Tuskegee, Alabama, was established in 1923, it had been the Government's intention to staff it with white personnel in the belief that enough Negro doctors of a competence to staff a hospital of this kind did not exist. The National Medical Association was one the prime forces which prevented this plan from being carried out. Until the year 1939, the American Medical Association's Directory of all physicians in the United States inserted the abbreviation "col" for "colored" after the name of every Negro physician in the country. The AMA did not desist from this insulting practice until after prolonged and strongly resisted representations by the National Medical Association through a committee headed by Dr Roscoe Giles of Chicago. The NMA has always identified itself with the people's interest. In 1946 it placed itself on record in favor of National Health Insurance through the testimony of its president, the late Dr Emory I. Robinson of JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 2
Los Angeles. In 1962 the House of Delegates of the National Medical Association endorsed the principle of medical care for the elderly through the Social Security system and reaffirmed its endorsement of "Medicare" in 1963. On January 22, 1964, President Clement and your President-Elect testified for the NMA in behalf of the King-Anderson bill before the House Committee on Ways and Means. When at a meeting of the AMA-NMA Liaison Committee in December 1963, President Annis of the AMA attempted to chide the NMA as being the only significant group of physicians to oppose the stand of the AMA against Medicare, he was told by NMA President Clement that the National Medical Association had endorsed Medicare because it believed the legislation would be the best thing for the American people and that opposing the AMA was not a consideration in the NMA position. In 1957 the National Medical Association, jointly with the NAACP and the Medico-Chirurgical Society of the District of Columbia, initiated the Imhotep National Conference on Hospital Integration. After a second year with multiple sponsors, the auspices were limited to three national organizations, the NMA, the NAACP, and the National Urban League, each of which was nationally respected and well known as to background, philosophy, and modus operandi. The premise of the Imhotep Conference was that in view of the existing injustice in hospital practices throughout the country and the progressive trend of legislation and judicial opinion for its elimination, it might be possible to expedite the process by bringing together for the meeting of minds, the controlling organizations in the power structure of hospital administration. The stated purpose of the Conference were four: 1. To bring together representatives of all the interests among hospitals, the public, the healing professions and government agencies, which are concerned with this problem. 2. To provide a complete, comprehensive picture of the situation throughout the country as it exists today through first-hand presentations from the various regions. 3. To evolve in the atmosphere of common understanding and cooperation so created, recommendations and programs of remedial action which may be made known to the American people with the aim of securing widespread public support for their implementation. 4. To make available, through publication of the 109
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Proceedings of the Conference in the Journal of the National Medical Association, and in reprint form, a compact, authoritative reference on the subject of hospital integration which may have value both as information and as guidance for continuing efforts in this field in all parts of the United States. The name of "Imhotep," the Egyptian who lived in about 3000 B.C. and was the earliest historical figure of importance in medicine, was chosen for two reasons. First, as a reminder that dark skin was associated with distinction in medicine before that of any other. Second, because "Imhotep" means "He who cometh in peace." In a time of emotional tension, the sponsoring organizations came in peace. Annually for seven years, the Imhotep Conference failed to secure attendance by representatives empowered to speak, from the great hospital powers, although they kept an eye obliquely on what was being done through different observers. The American Medical Association even sent a staff representative to the Fourth Imhotep Conference in May 1960, to take full stenographic notes on the proceedings. He seemed at first a bit embarrassed about his notebook but it was explained to him that nothing to be discussed was in any way secret and he was invited to sit-in on all workshops and committee deliberations. At the end of the meetings he was invited to comment for the AMA, but he stated he had no authority to say anything. He would merely transmit his report to his superiors. Of course, nothing was ever heard from them. Last year at the Seventh Imhotep Conference in Atlanta, there was a note of grim amusement in the fact that the FBI sent word to officials of the Conference after Congressman Adam Powell and Congressman John Dingell had been met separately at the airport to be brought to the meeting for their addresses, that the FBI had us covered all the time and everything would be all right. No protection had been requested because no one had deemed it necessary in the frame of reference in which the Conference had been projected. A new positive influence was manifest at this meeting, however, in the presence of the Archbishop of the Catholic Archdiocese of Atlanta, the Most Rev. Paul J. Hallinan. Archbishop Hallinan stated that he came especially to tell of the progress made in Atlanta and of the integration of the Catholic hospitals there. In view of the general smug and rigid complacency of the part of the hospital powers, can there be any wonder that many Negro professionals despaired of obtaining any meeting of minds in the highly acclaimed 110
voluntary way and decided that action through the courts and focus of public attention through such techniques as picketing was the only recourse. It is, therefore, especially noteworthy that after the picketing of the AMA Convention in Atlantic City in June 1963, by an independent group, and of the AMA headquarters in Chicago in July 1963 by the NAACP, in which your President and Immediate Past President participated, and, after the Fourth Federal Circuit Court of Appeals ruled on November 1, 1963, that the "separate but equal" clause in the Hill-Burton law was unconstitutional and outlawed racial bias in federally aided hospitals, the country's most eminent medical editor, Dr Morris Fishbein, in an editorial in Medical World News for December 20, 1963, called for just such a conference as Imhotep had been holding for seven consecutive years. Dr Fishbein said in part: This is a problem that must be met by the Council on Medical Education and Hospitals of the AMA, the Association of American Medical Colleges, the Joint Commission on Accreditation of Hospitals, the governing boards of all hospitals that function as communal hospitals with support from the public, the American Medical Association, the National Medical Association, the certifying boards in the specialties, and the various colleges of specialties. An attempt to solve this piecemeal will create greater chaos than exists even now. Experience indicates that the circumstances demand a national conference in which all of those concerned participate with a view to establishing a program for meeting the demands and the requirements for the nation as a whole.
The logic of the Imhotep rationale appealed to even higher influences, however. On July 27, 1964, HEW Secretary Anthony J. Celebrezze presided over an all day conference with representatives of six organizations, the American Medical Association, the National Medical Association, the American Dental Association, the National Dental Association, the American Hospital Association, and the American Nursing Association, to discuss expediting the elimination of racial bias in hospital practices and voluntary compliance with the implications of the recent court decisions and the Civil Rights Act. The Secretary had already issued on May 19, 1964, regulations with respect to Hill-Burton applicants implementing the Mose Cone Hospital court decision. At the HEW conference on July 27, the White House was represented by Mr Hohart Taylor, Associate Special Counsel to the President. The officials of HEW and the Public Health Service carefully set forth the JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 2
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implications of the law respecting hospital practices as affected by the Moses Cone decision and the Civil Rights Act. They made it crystal clear that there must be compliance with the law, but strongly urged that the influential organizations there represented voluntarily do all in their power to secure not only voluntary obedience to the letter of the law but go further so as to bring about voluntary compliance with its spirit, thus quietly making an end to hospital discrimination and rendering unnecessary the 10 years of tensions and litigation which have retarded implementation of the 1954 Supreme Court education decision. No stronger appeal for the voluntary way could have been made. In 1957 when the Imhotep Conference first made the same appeal to the same organizations no one could have predicted this course of events but God moves in a mysterious way His wonders to perform; He plants his footsteps in the sea And rides upon the storm. I say, God bless the memory of John Fitzgerald Kennedy. I say, God bless Lyndon Baines Johnson. Under the leadership of these two great presidents our nation has advanced further than ever before toward realization of the ideals of the American heritage. God save us all from forces which would turn the clock backward.
PERMANENCE OF THE NMA Through annual donations to the NAACP Legal Defense and Educational Fund, Inc, the United Negro College Fund, other organizations, and through its own scholarship program the NMA has further identified itself with the public interest. All activities recounted have contributed to a good image of the NMA in the public eye which cannot be bought and which the AMA might well envy. Obviously, the NMA takes a pardonable pride in its history and traditions, and in its accomplishments, however modest. The NMA also perceives a clear need for its activities and services in the foreseeable future. There seems to be a mistaken impression in many quarters that once the door of integration has cracked a bit, Negroes are going to abandon all the organizations they have built up with blood, sweat and tears over the years. Nothing could be farther from the truth. Certainly this is not true for NMA. The country needs independent national medical JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 2
organizations for the stimulation of diversity in thought, just as in other fields. Monolithic professional control and outlook always stultify progress. The National Medical Association was forced to be independent in its origins and for three score and nine years it has had to continue independent. It owes nothing to nor is it beholden to any other organization. NMA members, being of mature years and judgment, are free to join any other organizations open to them, but the NMA could not be expected to be a recruiting agent for any other body. The NMA bears no hostility to any other group. It can coexist peacefully with any. But it will not move in any directions not determined by its own deliberations. No better evidence could be presented of the vigor of the NMA than the fact that its 1964 membership is the largest in its history and its constituent societies continue to flourish in areas where membership in AMA county societies has long been open. Here in Washington where excellent relationships with the Medical Society of the District of Columbia exist, the financial membership of the Medico-Chirurgical Society of 212 stands as an all time high for a component group of the NMA at the time of the Convention. The NMA units in Baltimore, Philadelphia, New York, Cleveland, Chicago, and Los Angeles, to name a few cities, have shown no signs of dissolution. Nor has the election of NMA members to office in AMA county societies had any effect on NMA membership in those localities. Let no man be concerned then with whether there is any longer need for the NMA or Morehouse College or Fisk University or Howard University. These and their counterparts will survive indefinitely, contributing presently through the lines in which they have special experience and gradually adapting their services to the changing needs of changing times.
TACTICAL ANTIBIAS GOALS ACHIEVED What then are the greatest tasks facing the National Medical Association today? The main concern of the past 16 years has beein the antibias campaign. Since 1948 when the first break-throughs occurred in the registration of Edith Mae Irby at the University of Arkansas as the first Negro to be admitted to a southern medical school, and the Baltimore County Medical Society dropped racial bars, 23 southern medical schools have opened, and something has been done about AMA county society membership in every state except Louisiana, 11 Negro physicians having been elected presidents of county societies. 111
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The courts have established the principle of nondiscrimination in Federally aided hospitals. Through resolutions by key organizations such as the American Medical Association, the American Hospital Association, the Catholic Hospital Association of the United States and Canada, and the American Public Health Association, and through the established policy of the Federal Government in its own vast systems of health facilities, the elimination of racial discrimination in health care may be considered to have become declared national policy. It is reasonable, therefore, to regard the anti-bias goals of the past 16 years activity-to have been tactically achieved. Some tough bastions of resistance remain to be cracked and complete implementation of the principle will require detailed attention for unpredictable time. But while the clean-up operations proceed, it will be necessary for the NMA to focus major attention on new areas. If we liken the forces which have breached the walls of discrimination to the linemen on a football team, we may say that the linemen have made the holes. We now need fast backs and plenty of bench strength to run through the holes, lest they close. We do not have these backs in adequate number at the present time and they must be quickly developed. On every hand we hear today the cry for trained Negro personnel and the supply cannot meet the demand. The openings for Negro students in medical schools significantly exceed the number of qualified applicants to fill them. The National Medical Association has a definite duty to do all in its power to supply the deficit. This will require a new tooling-up and reorientation in philosophy as well as organizational method.
THE NEGRO GENE POOL All the recent surveys of the nation's manpower resources reveal that we are not producing trained personnel in the numbers needed for the complex operations of our modern life, automation notwithstanding. The surveys show that neither the institutional nor the human sources of talent upon which we have depended in the past can meet future demands. We must develop both people from new sources and additional institutions in which to train them. The greatest untrapped reservoir of talent in our nation is its Negro citizenry. Contrary to widely held opinion, the Negro is the most highly selected stock in our heterogeneous population. With the exception of the Puritans, who were unique in the number of 112
educated people who came over, the colonies were not populated by the elite of Great Britain. Benjamin Franklin repeatedly petitioned the Mother Country to stop using the colonies as a dumping ground for its unwanted, to stop shipping over the occupants of its prisons, its vagrants, and its prostitutes. No less an authority than Dr Louis B. Wright, Director of the Folger Shakespearean Library here in Washington, has stated that there is no need for newly rich Americans to hire genealogists to try to discover an aristocratic ancestry for them. They have not got it. The aristocracy came over only in small numbers as governors or administrators and after their tours of duty went home. Similarly, many of the groups of later immigrants from Continental Europe were fleeing persecution of one sort or another and included many individuals who were undersized, undernourished, and otherwise poorly endowed. In the early part of the present century the discovery of the large amount of feeblemindedness in the white population gave rise to the alarmist propaganda of the early eugenics movement, long since discredited. On the other hand, the Africans involuntarily conscripted for residence in this country were highly selected. The weak did not survive to embark from the African ports. The rigors of the voyage over, the so-called middle passage, further decimated the ranks, so that only the toughest survived to land on our shores. The uncompensated labor which our Negro "Old Americans" contributed to the building of our country also could not have contributed to the survival of the unfit. The work was hard, the hours were long, and the food, clothing, and shelter meager. Moreover, the large but undocumented quantity of white genes which were continuously infused into the Ante-Bellum Negro population, came essentially not from the lower strata of whites, but from the privileged upper levels. While modern genetics does not permit definite answers on the biological effects of this admixture, it must be considered to have improved the stock, because the majority group so commonly used to allege that any brilliant Negro owed his superiority to his white blood. Perish the thought that any new form of racism is being promulgated here. Having in my own bodily constitution genes from all three of the major divisions of mankind, Negroid, Caucasoid, and Mongoloid it is possible to regard this matter a bit JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 2
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more objectively than is possible for one who thinks he is all one thing or another and can become a psychiatric case upon the suspicion that he may harbor a few genes from another source even though they do not show. I wish merely to emphasize that the American Negro is one the sturdiest stocks in the world. How else can one explain the fact that in the few short years since competition in professional sports has been open, Negroes have risen to dominant positions in every field? To the Jesse Owens of track can now be added the Joe Louises of boxing, the Jim Browns of football, the Willie Mayses of baseball, and the Wilt Chamberlins of basketball. What is needed now is the same recognition and acceptance of Negro potential and achievement in intellectual and professional fields that has been accorded Negro athletes. The country and Negroes themselves need to realize that Negroes can do anything as well as whites in mental as well as physical areas. It would have a most salutary educational effect on the country and on the world, if Harvard, as the nation's No 1 University, were to choose a Negro as its next president. My classmate, in the eighth grade, high schools and college, the Hon William H. Hastie, Judge of the US Third Circuit Court of Appeals, would be eminently qualified. High school valedictorian, junior Phi Beta Kappa and president of the chapter at Amherst, where he is now a trustee, assistant solicitor of the Department of the Interior, dean of the Howard University Law School, civilian aide to the Secretary of War, governor of the Virgin Islands, and alumnus of the Harvard Law School, where he earned a coveted place on the staff of the Law Review, Judge Hastie has everything required in the way of professional background. It may be that he will be elevated to the Supreme Court before the Harvard presidency becomes vacant again, but there will be other qualified Negroes available by that time.
TALENT RECRUITMENT ESSENTIAL Just as the present crop of prominent Negro athletes sprang from an untapped talent pool in a very short time, so it is possible for a generation of intellectually able and well trained Negroes to be quickly developed if they are discovered young enough and are properly nurtured. It takes much longer to develop a mature scholar, scientist, artist or professional than it does an athlete. The goals and rewards are somewhat different and the process more difficult. Yet the needs of our JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 2
country today are such that all our latent talent must be discovered and developed. Here the National Medical Association can make a vital contribution. In order to accomplish this, however, certain revisions in our organizational structure are in order.
A NEW TOOLING-UP I have asked the House of Delegates to establish a permanent Council on Talent Recruitment of 15 members, nationally dispersed so that there would be at least one member in every region. It would be the function of this Council to locate and inspire young talent at every possible level - primary grades, junior and senior high school and college - and steer it toward medicine or a health career. Our principal target would be the gifted underprivileged who might otherwise fail to receive sufficient motivation. This Council would have the greatest flexibility in its procedure and should contrive to operate so as to involve every member of the NMA and the Women's Auxiliary in its program. An important aspect of the work of the Council would be to acquire a familiarity with all of the various auspices which are now looking for talented Negroes and the numerous agencies which have set-up financial aid for them in one way or another, so that the NMA activity would be coordinated with and be able to take advantage of other efforts and programs with same broad goal. An absolute essential for the success of the NMA program would be the establishment of real communication between our physicians and the youngsters they want to reach. The identification of the able young is not difficult. Any experienced public school teacher can readily point out the children of real potential whom they teach. Really getting through to them so as to inspire them to solid intellectual effort is very difficult, however. This will require endless time and patience. Our members and their wives will have to develop their own individual skills in this area. At the present time we are not doing anything as an organization about communicating from our middle class security to the disadvantaged young who are in the same situation from which we ourselves emerged a generation or two past or even experienced in our own youth. It is fairly easy to get an enthusiastic response to single mass efforts. I have often addressed high school groups on the opportunities and rewards of a medical career, sometimes with excellent audio-visual aids. The enthusiasm evoked is consistently excellent, but when 113
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the youngsters hear how long it takes to become a doctor, of the years of arduous study involved, without income, the interest wanes. When seed is planted by a good health careers meeting or program, nothing will come of it without patient, tedious, and often frustrating follow-up. But the material is there and can be motivated. No other agency can do the job in respect which the NMA can do and we must do it. To complement the work of the Council on Talent Recruitment, I am asking the House of Delegates to establish a new standing Council on Financial Aid. This would replace our present Scholarship Committee and vastly enlarge the scope of the activities. This new Council would not only administer our own NMA Scholarship Fund, but establish working relationships with bodies like the Ford Foundation, the National Scholarship and Service Fund for Negro Students, the US Office of Education, National Medical Fellowships, and so on, so that wherever the Council on Recruitment found talent and need the Council on Financial Aid would know where to find the money to support it. One group could hardly d4o both jobs. In the event of the acceptance of these recommendations, I have secured the consent of a number of distinguished laymen to serve as a National Advisory Committee to the NMA in this area. This committee would provide all the expertise which we do not have within our own membership.
THE PURSUIT OF EXCELLENCE Because we cannot overnight remove or change the poor environments in which we discover the talent we seek, we must implant the desire for the pursuit of excellence for its own sake. The solid satisfaction that springs from any achievement which the individual knows within himself is real, is a marvelous cushion against frustration. It is the surest technique for survival and eventual success for the individual or group lowest down. In the midst of the strife and turmoil which now swirl about us, we must see to it that our young recognize that despite slums, riots, and Mississippi, our country is further along the road to the realization of the ideal of equality of opportunity and freedom of the individual than it has ever been before. We must make them aware that they can participate in the great enterprise of accelerating further progress by the quiet pursuit of knowledge and understanding. We must encourage them to learn something about everything in the universe from supergalaxies to electrons and have fun doing it. Somewhere in this 114
range they will find something they like and to which their talents are suited. Our country cannot afford to have a new generation of young people grow up in ignorance because of the hate and violence which may seem to enmesh us. The national press and periodicals have printed enough about the Negro and frustration and hopelessness. The Negro needs to hear more about his intrinsic merit, his possibilities, and the new opportunities beckoning, because they are here. The United States is the land of promise for the Negro today. To excel in our modern world, however, more self-discipline to the pursuits of learning is necessary. The Negro may continue to have to be better than the best to obtain recognition. But frustration must be. met and displaced by self reliance and self-respect. Hence the pursuit of excellence as a goal, all kinds of excellence. The concept is as old as Socrates. It is still as good. Let us then apply our energies and resourcefulness to the task of finding our hidden talent and developing it. In the process we shall gain extra rewards in the acquisition of values and a sense of usefulness we had ourselves never before realized.
HOMO SAPIENS OR SANGUINIS? To those who say how can such an outlook be possible in the face of Mississippi and Harlem, I would say that what the country needs is a good course in anthropology. When Linnaeus in 1735 gave man the name Homo sapiens or wise man, he was an optimist. With equal justification he might have called him Homo sanguinis or bloody man. We know that prehistoric man was often a cannibal. When Cain killed his brother we had a fratricide in the first generation after the Creation. The historical portion of the Old Testament overflows with blood. No other animal is so suicidal in the generic sense of killing his own species. Man has steadily increased his efficiency at self-extermination until today we are all appalled at what might happen if the great powers would accidentally be set at war. Man was a killer of his fellows for countless millennia before he evolved civilizations, moral values and ethical systems. The latter lie like hardly more than a veneer over our much older bestiality. But the same brain which man has used for becoming more efficient at dominating, exploiting, and destroying his fellow, has also developed our higher JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 2
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perceptions and values. Man the beast is ever present, latent or apparent, in all segments of our society the world over. He must be controlled and submerged until man the spirit can be made ascendant over man the beast. In the nature of the case that will take a long, long time. And we must be just as patient and understanding with the confused thinking of the old families, the nouveau riche, and the suburban country club set, as we are with that of the market place. Man is still a young primate who has got hold of dangerous powers he has not yet learned how to manage properly, withal he is almost crowding all the other animals off the planet. The world's population explosion will be subject of a special session of this convention.
VISIT MEXICO It would do us all in the United States a great deal of good to make a visit to Mexico. It might make us more modest about ourselves. We have so long regarded ourselves as the showcase of democracy, that it will come as something of a shock to many to perceive that a next door neighbor has in a number of ways surpassed us. This neighbor has had the same problems as ours, but in worse degree and with less means to solve them. The United States had to secure its freedom by throwing off the yoke of only one foreign power, England, Mexico has had to get free of three, Spain, France, and in important ways, the United States. Be it remembered that Ulysses Simpson Grant, General of the Union Armies in the Civil War and two term President of the United States, in his memoirs wrote
of the Mexican War of 1847. "(I) to this day regard the war.. .as one of the most unjust ever waged by a stronger against a weaker nation." The United States has never had the clashes over the separation of church and state which have repeatedly convulsed Mexico. Slavery in the United States was essentially a regional affair, but a much better entrenched white landowner class virtually enslaved the Indian population for a longer time in Mexico. Education in the United States has had widespread public support from the beginning of our republic, but Mexico is only now wiping out illiteracy. As great a problem as poverty has been with us, it is almost nothing to that which has confronted Mexico, but they are making giant strides against it. Mexican national policy does not recognize a race problem. It would be political death for a candidate to seek office in Mexico through a racial issue. In the United States we have had only one war over internal issues and heated controversies have seldom led to more riots. Mexico has had to go through the throes of 100 revolutions. Yet Mexico has achieved stable government. It is proud of its independence. It has a contagious confidence in a great future. Its vibrant passion for progress fills the air on every hand in the capital, Mexico City. Through its ever present art and monuments, it reminds its citizens of its history. Race has been thrust out of the national picture. On every hand is evidence of the national effort to expand education and housing and wipe out poverty. The sheer beauty and concept of the mammoth
THE EDITOR'S PASSPORT
"The Editor stood 'fore the Heavenly Gate, His features pinched and cold He bowed before the Man of Fate, Seeking admission to the fold. 'What have you done?' St. Peter asked, 'To gain admission here?' 'I was the Journal's editor, Sir, 'For many a weary year.' The Pearly Gates swung open wide As Peter pressed the bell. 'Come in and choose your harp,' he cried; 'You've had your share of Hell'." JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 2
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housing project, the Nono Alco in Mexico City, of which the 15 000 apartments will house 100 000 people, are enough by themselves to convince that this country believes in itself and is going somewhere with amazing rapidity. I am no John Gunther to write an "Inside Mexico," but I have seen enough to know that they have more progress against the same problems with which we have not done too well. I say, go and see for yourselves. I intend to return as soon as possible to learn more about how they have achieved so much in so little time.
HITCH YOUR WAGON TO A STAR All we have said, Emerson expressed in his famous quotation, "Hitch your wagon to a star." The National Medical Association is pre-eminently fitted to inspire and lead our young people in the pursuit of excellence.
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Project Arcturus (the nearest familiar star) should be a major preoccupation of this association for indefinite time. As this message opened with lines from Lincoln, let it close with others from the first Great Emancipator. "It is rather for us to be here dedicated to the great task remaining before us, that from these honored dead we take increased devotion to that cause for which they gave the last full measure of devotion, that we here highly resolve that these dead shall not have died in vain; that the nation shall, under God, have a new birth of freedom, and that government of the people, by the people, for the people, shall not perish from the earth." Literature Cited 1. Council on Scientific Affairs. Autologous blood transfusions.JAMA. 1986;256:2378-2380. 2. Blundell J. Experiments on the transfusion of blood by syringe. Med Chir Trans. 1818;9:56.
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 2
I .....
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W Avontague Cobb, MD
THE PURSUIT OF EXCELLECE Project Arcturus W. Montague Cobb, MD Washington, DC
This issue of the Journal is dedicated to the memory of W Montague Cobb, MD, who served as Editor from 1947 through 1977 and as Editor Emeritus until his death on November 20, 1990. The Publication Committee requested that one ofDr Cobb's previous works be printed in this issue. To commemorate his diligent work and tireless efforts for the NMA, it is appropriate to reprint Dr Cobb's 1964 presidential inaugural address, which clearly demonstrates his far-reaching vision, his love for the NMA, and his concern for quality health care delivery for black Americans.
WITH MALICE TOWARD NONE, WITH CHARITY FOR ALL Some of the richest prose in the English language has been given us by an immortal President who did not have better than the equivalent of a second grade education. To begin this message today I can find no better or more timely theme than the closing lines of Lincoln's Second Inaugural Address. "With malice toward none; with charity for all; with firmness in the right as God gives us to see the right, let us strive on to *Originally presented as the President's Inaugural Address at the 69th Annual Convention of the National Medical Association, Washington, DC, August 2-6, 1964. Reprinted with permission from the Joumal of the National Medical Association, September 1964, vol. 56, no. 3, pp 432-441. JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 2
finish the work we are in; to bind up the nation's wounds; to care for him who shall have borne the battle, and for his widow, and his orphan - to do all which may achieve and cherish a just, and a lasting peace, among ourselves, and with all nations." When President Johnson signed the Civil Rights Act into law on July 2, 1964, he brought to formal end a long and arduous campaign for social justice. The nation has remnant wounds, in the form of bitterness and hostility, which must be bound up. Many who bore the brunt of the battle sacrificed greatly and must be cared for. And because lives were lost, there are widows and orphans to be seen after. Above all else, the American heritage demands that we strive on to finish this work we are in, to achieve the just and lasting peace among ourselves and with all nations.
THE AMERICAN HERITAGE The American heritage is something which belongs to all citizens of the United States. It is something to which our Negro citizens have made especially vital contributions. Ours was the first nation in the history of the world to dare to declare as political doctrine the concept that all men are created equal. The ancient
civilizations of Egypt, Mesopotamia, the Orient, Greece and Rome, and those of Europe in medieval and recent times, accorded no recognition to the rights and aspirations of the common man. Even after the Declaration of Independence on July 4, 107
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1776, it required nearly a century, until July 21, 1868, to establish clearly that the presumption of equality of all men meant just what the Declaration stated. It was held at first that the Indians could not be included, because their neolithic culture was more primitive than the European. The Negroes were eliminated because they had been brought over as slaves and were obviously a lower order of creatures, not to be included in the family of man. Orientals were too few in number at first to present a problem, but they too were obviously a different sort, not embraced in the intent of the Declaration. Nevertheless, the problem was debated and fought over in every conceivable way until the issue was settled by the military victory of the North in the Civil War and the Fourteenth Amendment became the law of the land in 1868. This stated that all persons born or naturalized in the United States were citizens thereof and of the State wherein they resided and that no State might deny to any person the equal protection of the laws. A subterfuge to avoid compliance with the law was introduced. This held that citizens could be segregated and still be considered as having equal protection of the laws if provisions for them were separate but equal. Nearly another century was to pass before this dodge would be ruled invalid. During the ensuing 86 years every aspect of this question was debated, investigated and litigated. On May 17, 1954, the United States Supreme Court made a final determination of the matter. In its historic education decision the Court held that separate cannot be equal, and therefore, segregation in education was unconstitutional and must be abandoned with all deliberate speed. Two centuries may not be a long time for the maturation of a nation, but in the 188 years between 1776 and 1964, we have had the annealing force of seven major wars.* These have forced the most critical examination of our principles and creeds, so that when the Civil Rights Act became law on July 2, 1964, it might be said that the country surely knew what is was doing and that our strong, young nation had finally come of age. We have made clear once again that under our laws all men are equal. To us as individuals this has taken a painfully long time, but it is worth noting that when the tumult and the shouting have died, our country has never taken a backward step. July 4, 1776, July 21, 1868, May 17, 1954, and July 2, 1964, all represent great and progressive days of decision in our history. *
1812, 1847, 1861, 1898, 1917, 1941
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For the great distance still to be travelled in the march toward our declared goal of equal justice and opportunity for all, we cannot expect two centuries more. The United States has been catapulted into a position of world leadership. Our way of life is challenged by a different political ideology, backed by powerful military strength, which denies the freedom of the individual which we so highly extol. When we invite emerging nations to choose our way rather than our competitor's they regard our example critically. Time is running out on us in making our practices conform with our preachments. The American heritage must be made meaningful at home as well as abroad.
THE NMA ON THE AMERICAN SCENE The National Medical Association is an integral part of the American heritage. Formed in 1895, in its 69th year it is among the older group of medical associations of our country. The two medical schools which have contributed most of the members of our Association have been even greater seniority among our 87 medical schools. The Howard University College of Medicine, opened in 1868, was a charter member of the Association of American Medical Colleges. Howard and its sister school, Meharry Medical College in Nashville, Tennessee, founded in 1876, have graduated more than 7900 Negro physicians, considerably more than all other medical schools combined. These physicians, spumed by their white colleagues, denied elementary hospital facilities and opportunities for professional improvement until very recent years, have contributed to the health care of the American populace under handicaps which no other segment of the profession has had to suffer. We are proud of our contribution and bow our heads to no man in this respect. It is noteworthy that the history of the National Medical Association is marked by lack of bitterness in expressions against the lot of its members. The often quoted credo of the Association articulated by Dr Charles V. Roman in 1908, is worth repeating here. Conceived in no spirit of racial exclusiveness, fostering no ethnic antagonism, but born of the exigencies of American environment, the National Medical Association has for its object the banding together for mutual cooperation and helpfulness, the men and women of African descent who are legally and honorably engaged in the practice of the cognate professions of medicine, surgery, pharmacy, and dentistry.
THE NMA HAS ALWAYS COME IN PEACE This Association was formed because its members JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 2
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had no other course to pursue to secure meetings for professional improvement. As the opportunities have expanded, the NMA has been in the forefront of efforts to demolish racial barriers in health areas. Year by year the quality of the scientific program of the Annual Convention has improved, as have the number and scope of its scientific exhibits. The NMA initiated an official organ, the Journal of the National Medical Association, in 1909. The Journal was at first a quarterly. It became a bimonthly in 1939 and is now in its 56th volume. The Journal is the second oldest periodical of any nature published under Negro auspices, and it is naturally the oldest Negro medical periodical. In its pages have appeared more than half of the approximately 5100 titles by Negro medical writers. The Journal has an international circulation. It has extended the hand of cooperation to young African countries as a professional medium until they can get their own periodicals under way. Our Journal has regularly reported significant developments in the progress of medical integration and through several series of historical articles became a valued, source on the history of the Negro in medicine. In appearance and content the Journal has representative quality. With the ever increasing need for outlets for the writings of a growing number of physicians the Journal can look forward to performing even greater service with wider circulation as a medium for diffusion of medical knowledge and the expression of professional opinion. The National Medical Association has always been active in the war against discrimination. When what is now the Veterans Administration Hospital at Tuskegee, Alabama, was established in 1923, it had been the Government's intention to staff it with white personnel in the belief that enough Negro doctors of a competence to staff a hospital of this kind did not exist. The National Medical Association was one the prime forces which prevented this plan from being carried out. Until the year 1939, the American Medical Association's Directory of all physicians in the United States inserted the abbreviation "col" for "colored" after the name of every Negro physician in the country. The AMA did not desist from this insulting practice until after prolonged and strongly resisted representations by the National Medical Association through a committee headed by Dr Roscoe Giles of Chicago. The NMA has always identified itself with the people's interest. In 1946 it placed itself on record in favor of National Health Insurance through the testimony of its president, the late Dr Emory I. Robinson of JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 2
Los Angeles. In 1962 the House of Delegates of the National Medical Association endorsed the principle of medical care for the elderly through the Social Security system and reaffirmed its endorsement of "Medicare" in 1963. On January 22, 1964, President Clement and your President-Elect testified for the NMA in behalf of the King-Anderson bill before the House Committee on Ways and Means. When at a meeting of the AMA-NMA Liaison Committee in December 1963, President Annis of the AMA attempted to chide the NMA as being the only significant group of physicians to oppose the stand of the AMA against Medicare, he was told by NMA President Clement that the National Medical Association had endorsed Medicare because it believed the legislation would be the best thing for the American people and that opposing the AMA was not a consideration in the NMA position. In 1957 the National Medical Association, jointly with the NAACP and the Medico-Chirurgical Society of the District of Columbia, initiated the Imhotep National Conference on Hospital Integration. After a second year with multiple sponsors, the auspices were limited to three national organizations, the NMA, the NAACP, and the National Urban League, each of which was nationally respected and well known as to background, philosophy, and modus operandi. The premise of the Imhotep Conference was that in view of the existing injustice in hospital practices throughout the country and the progressive trend of legislation and judicial opinion for its elimination, it might be possible to expedite the process by bringing together for the meeting of minds, the controlling organizations in the power structure of hospital administration. The stated purpose of the Conference were four: 1. To bring together representatives of all the interests among hospitals, the public, the healing professions and government agencies, which are concerned with this problem. 2. To provide a complete, comprehensive picture of the situation throughout the country as it exists today through first-hand presentations from the various regions. 3. To evolve in the atmosphere of common understanding and cooperation so created, recommendations and programs of remedial action which may be made known to the American people with the aim of securing widespread public support for their implementation. 4. To make available, through publication of the 109
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Proceedings of the Conference in the Journal of the National Medical Association, and in reprint form, a compact, authoritative reference on the subject of hospital integration which may have value both as information and as guidance for continuing efforts in this field in all parts of the United States. The name of "Imhotep," the Egyptian who lived in about 3000 B.C. and was the earliest historical figure of importance in medicine, was chosen for two reasons. First, as a reminder that dark skin was associated with distinction in medicine before that of any other. Second, because "Imhotep" means "He who cometh in peace." In a time of emotional tension, the sponsoring organizations came in peace. Annually for seven years, the Imhotep Conference failed to secure attendance by representatives empowered to speak, from the great hospital powers, although they kept an eye obliquely on what was being done through different observers. The American Medical Association even sent a staff representative to the Fourth Imhotep Conference in May 1960, to take full stenographic notes on the proceedings. He seemed at first a bit embarrassed about his notebook but it was explained to him that nothing to be discussed was in any way secret and he was invited to sit-in on all workshops and committee deliberations. At the end of the meetings he was invited to comment for the AMA, but he stated he had no authority to say anything. He would merely transmit his report to his superiors. Of course, nothing was ever heard from them. Last year at the Seventh Imhotep Conference in Atlanta, there was a note of grim amusement in the fact that the FBI sent word to officials of the Conference after Congressman Adam Powell and Congressman John Dingell had been met separately at the airport to be brought to the meeting for their addresses, that the FBI had us covered all the time and everything would be all right. No protection had been requested because no one had deemed it necessary in the frame of reference in which the Conference had been projected. A new positive influence was manifest at this meeting, however, in the presence of the Archbishop of the Catholic Archdiocese of Atlanta, the Most Rev. Paul J. Hallinan. Archbishop Hallinan stated that he came especially to tell of the progress made in Atlanta and of the integration of the Catholic hospitals there. In view of the general smug and rigid complacency of the part of the hospital powers, can there be any wonder that many Negro professionals despaired of obtaining any meeting of minds in the highly acclaimed 110
voluntary way and decided that action through the courts and focus of public attention through such techniques as picketing was the only recourse. It is, therefore, especially noteworthy that after the picketing of the AMA Convention in Atlantic City in June 1963, by an independent group, and of the AMA headquarters in Chicago in July 1963 by the NAACP, in which your President and Immediate Past President participated, and, after the Fourth Federal Circuit Court of Appeals ruled on November 1, 1963, that the "separate but equal" clause in the Hill-Burton law was unconstitutional and outlawed racial bias in federally aided hospitals, the country's most eminent medical editor, Dr Morris Fishbein, in an editorial in Medical World News for December 20, 1963, called for just such a conference as Imhotep had been holding for seven consecutive years. Dr Fishbein said in part: This is a problem that must be met by the Council on Medical Education and Hospitals of the AMA, the Association of American Medical Colleges, the Joint Commission on Accreditation of Hospitals, the governing boards of all hospitals that function as communal hospitals with support from the public, the American Medical Association, the National Medical Association, the certifying boards in the specialties, and the various colleges of specialties. An attempt to solve this piecemeal will create greater chaos than exists even now. Experience indicates that the circumstances demand a national conference in which all of those concerned participate with a view to establishing a program for meeting the demands and the requirements for the nation as a whole.
The logic of the Imhotep rationale appealed to even higher influences, however. On July 27, 1964, HEW Secretary Anthony J. Celebrezze presided over an all day conference with representatives of six organizations, the American Medical Association, the National Medical Association, the American Dental Association, the National Dental Association, the American Hospital Association, and the American Nursing Association, to discuss expediting the elimination of racial bias in hospital practices and voluntary compliance with the implications of the recent court decisions and the Civil Rights Act. The Secretary had already issued on May 19, 1964, regulations with respect to Hill-Burton applicants implementing the Mose Cone Hospital court decision. At the HEW conference on July 27, the White House was represented by Mr Hohart Taylor, Associate Special Counsel to the President. The officials of HEW and the Public Health Service carefully set forth the JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 2
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implications of the law respecting hospital practices as affected by the Moses Cone decision and the Civil Rights Act. They made it crystal clear that there must be compliance with the law, but strongly urged that the influential organizations there represented voluntarily do all in their power to secure not only voluntary obedience to the letter of the law but go further so as to bring about voluntary compliance with its spirit, thus quietly making an end to hospital discrimination and rendering unnecessary the 10 years of tensions and litigation which have retarded implementation of the 1954 Supreme Court education decision. No stronger appeal for the voluntary way could have been made. In 1957 when the Imhotep Conference first made the same appeal to the same organizations no one could have predicted this course of events but God moves in a mysterious way His wonders to perform; He plants his footsteps in the sea And rides upon the storm. I say, God bless the memory of John Fitzgerald Kennedy. I say, God bless Lyndon Baines Johnson. Under the leadership of these two great presidents our nation has advanced further than ever before toward realization of the ideals of the American heritage. God save us all from forces which would turn the clock backward.
PERMANENCE OF THE NMA Through annual donations to the NAACP Legal Defense and Educational Fund, Inc, the United Negro College Fund, other organizations, and through its own scholarship program the NMA has further identified itself with the public interest. All activities recounted have contributed to a good image of the NMA in the public eye which cannot be bought and which the AMA might well envy. Obviously, the NMA takes a pardonable pride in its history and traditions, and in its accomplishments, however modest. The NMA also perceives a clear need for its activities and services in the foreseeable future. There seems to be a mistaken impression in many quarters that once the door of integration has cracked a bit, Negroes are going to abandon all the organizations they have built up with blood, sweat and tears over the years. Nothing could be farther from the truth. Certainly this is not true for NMA. The country needs independent national medical JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 2
organizations for the stimulation of diversity in thought, just as in other fields. Monolithic professional control and outlook always stultify progress. The National Medical Association was forced to be independent in its origins and for three score and nine years it has had to continue independent. It owes nothing to nor is it beholden to any other organization. NMA members, being of mature years and judgment, are free to join any other organizations open to them, but the NMA could not be expected to be a recruiting agent for any other body. The NMA bears no hostility to any other group. It can coexist peacefully with any. But it will not move in any directions not determined by its own deliberations. No better evidence could be presented of the vigor of the NMA than the fact that its 1964 membership is the largest in its history and its constituent societies continue to flourish in areas where membership in AMA county societies has long been open. Here in Washington where excellent relationships with the Medical Society of the District of Columbia exist, the financial membership of the Medico-Chirurgical Society of 212 stands as an all time high for a component group of the NMA at the time of the Convention. The NMA units in Baltimore, Philadelphia, New York, Cleveland, Chicago, and Los Angeles, to name a few cities, have shown no signs of dissolution. Nor has the election of NMA members to office in AMA county societies had any effect on NMA membership in those localities. Let no man be concerned then with whether there is any longer need for the NMA or Morehouse College or Fisk University or Howard University. These and their counterparts will survive indefinitely, contributing presently through the lines in which they have special experience and gradually adapting their services to the changing needs of changing times.
TACTICAL ANTIBIAS GOALS ACHIEVED What then are the greatest tasks facing the National Medical Association today? The main concern of the past 16 years has beein the antibias campaign. Since 1948 when the first break-throughs occurred in the registration of Edith Mae Irby at the University of Arkansas as the first Negro to be admitted to a southern medical school, and the Baltimore County Medical Society dropped racial bars, 23 southern medical schools have opened, and something has been done about AMA county society membership in every state except Louisiana, 11 Negro physicians having been elected presidents of county societies. 111
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The courts have established the principle of nondiscrimination in Federally aided hospitals. Through resolutions by key organizations such as the American Medical Association, the American Hospital Association, the Catholic Hospital Association of the United States and Canada, and the American Public Health Association, and through the established policy of the Federal Government in its own vast systems of health facilities, the elimination of racial discrimination in health care may be considered to have become declared national policy. It is reasonable, therefore, to regard the anti-bias goals of the past 16 years activity-to have been tactically achieved. Some tough bastions of resistance remain to be cracked and complete implementation of the principle will require detailed attention for unpredictable time. But while the clean-up operations proceed, it will be necessary for the NMA to focus major attention on new areas. If we liken the forces which have breached the walls of discrimination to the linemen on a football team, we may say that the linemen have made the holes. We now need fast backs and plenty of bench strength to run through the holes, lest they close. We do not have these backs in adequate number at the present time and they must be quickly developed. On every hand we hear today the cry for trained Negro personnel and the supply cannot meet the demand. The openings for Negro students in medical schools significantly exceed the number of qualified applicants to fill them. The National Medical Association has a definite duty to do all in its power to supply the deficit. This will require a new tooling-up and reorientation in philosophy as well as organizational method.
THE NEGRO GENE POOL All the recent surveys of the nation's manpower resources reveal that we are not producing trained personnel in the numbers needed for the complex operations of our modern life, automation notwithstanding. The surveys show that neither the institutional nor the human sources of talent upon which we have depended in the past can meet future demands. We must develop both people from new sources and additional institutions in which to train them. The greatest untrapped reservoir of talent in our nation is its Negro citizenry. Contrary to widely held opinion, the Negro is the most highly selected stock in our heterogeneous population. With the exception of the Puritans, who were unique in the number of 112
educated people who came over, the colonies were not populated by the elite of Great Britain. Benjamin Franklin repeatedly petitioned the Mother Country to stop using the colonies as a dumping ground for its unwanted, to stop shipping over the occupants of its prisons, its vagrants, and its prostitutes. No less an authority than Dr Louis B. Wright, Director of the Folger Shakespearean Library here in Washington, has stated that there is no need for newly rich Americans to hire genealogists to try to discover an aristocratic ancestry for them. They have not got it. The aristocracy came over only in small numbers as governors or administrators and after their tours of duty went home. Similarly, many of the groups of later immigrants from Continental Europe were fleeing persecution of one sort or another and included many individuals who were undersized, undernourished, and otherwise poorly endowed. In the early part of the present century the discovery of the large amount of feeblemindedness in the white population gave rise to the alarmist propaganda of the early eugenics movement, long since discredited. On the other hand, the Africans involuntarily conscripted for residence in this country were highly selected. The weak did not survive to embark from the African ports. The rigors of the voyage over, the so-called middle passage, further decimated the ranks, so that only the toughest survived to land on our shores. The uncompensated labor which our Negro "Old Americans" contributed to the building of our country also could not have contributed to the survival of the unfit. The work was hard, the hours were long, and the food, clothing, and shelter meager. Moreover, the large but undocumented quantity of white genes which were continuously infused into the Ante-Bellum Negro population, came essentially not from the lower strata of whites, but from the privileged upper levels. While modern genetics does not permit definite answers on the biological effects of this admixture, it must be considered to have improved the stock, because the majority group so commonly used to allege that any brilliant Negro owed his superiority to his white blood. Perish the thought that any new form of racism is being promulgated here. Having in my own bodily constitution genes from all three of the major divisions of mankind, Negroid, Caucasoid, and Mongoloid it is possible to regard this matter a bit JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 2
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more objectively than is possible for one who thinks he is all one thing or another and can become a psychiatric case upon the suspicion that he may harbor a few genes from another source even though they do not show. I wish merely to emphasize that the American Negro is one the sturdiest stocks in the world. How else can one explain the fact that in the few short years since competition in professional sports has been open, Negroes have risen to dominant positions in every field? To the Jesse Owens of track can now be added the Joe Louises of boxing, the Jim Browns of football, the Willie Mayses of baseball, and the Wilt Chamberlins of basketball. What is needed now is the same recognition and acceptance of Negro potential and achievement in intellectual and professional fields that has been accorded Negro athletes. The country and Negroes themselves need to realize that Negroes can do anything as well as whites in mental as well as physical areas. It would have a most salutary educational effect on the country and on the world, if Harvard, as the nation's No 1 University, were to choose a Negro as its next president. My classmate, in the eighth grade, high schools and college, the Hon William H. Hastie, Judge of the US Third Circuit Court of Appeals, would be eminently qualified. High school valedictorian, junior Phi Beta Kappa and president of the chapter at Amherst, where he is now a trustee, assistant solicitor of the Department of the Interior, dean of the Howard University Law School, civilian aide to the Secretary of War, governor of the Virgin Islands, and alumnus of the Harvard Law School, where he earned a coveted place on the staff of the Law Review, Judge Hastie has everything required in the way of professional background. It may be that he will be elevated to the Supreme Court before the Harvard presidency becomes vacant again, but there will be other qualified Negroes available by that time.
TALENT RECRUITMENT ESSENTIAL Just as the present crop of prominent Negro athletes sprang from an untapped talent pool in a very short time, so it is possible for a generation of intellectually able and well trained Negroes to be quickly developed if they are discovered young enough and are properly nurtured. It takes much longer to develop a mature scholar, scientist, artist or professional than it does an athlete. The goals and rewards are somewhat different and the process more difficult. Yet the needs of our JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 2
country today are such that all our latent talent must be discovered and developed. Here the National Medical Association can make a vital contribution. In order to accomplish this, however, certain revisions in our organizational structure are in order.
A NEW TOOLING-UP I have asked the House of Delegates to establish a permanent Council on Talent Recruitment of 15 members, nationally dispersed so that there would be at least one member in every region. It would be the function of this Council to locate and inspire young talent at every possible level - primary grades, junior and senior high school and college - and steer it toward medicine or a health career. Our principal target would be the gifted underprivileged who might otherwise fail to receive sufficient motivation. This Council would have the greatest flexibility in its procedure and should contrive to operate so as to involve every member of the NMA and the Women's Auxiliary in its program. An important aspect of the work of the Council would be to acquire a familiarity with all of the various auspices which are now looking for talented Negroes and the numerous agencies which have set-up financial aid for them in one way or another, so that the NMA activity would be coordinated with and be able to take advantage of other efforts and programs with same broad goal. An absolute essential for the success of the NMA program would be the establishment of real communication between our physicians and the youngsters they want to reach. The identification of the able young is not difficult. Any experienced public school teacher can readily point out the children of real potential whom they teach. Really getting through to them so as to inspire them to solid intellectual effort is very difficult, however. This will require endless time and patience. Our members and their wives will have to develop their own individual skills in this area. At the present time we are not doing anything as an organization about communicating from our middle class security to the disadvantaged young who are in the same situation from which we ourselves emerged a generation or two past or even experienced in our own youth. It is fairly easy to get an enthusiastic response to single mass efforts. I have often addressed high school groups on the opportunities and rewards of a medical career, sometimes with excellent audio-visual aids. The enthusiasm evoked is consistently excellent, but when 113
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the youngsters hear how long it takes to become a doctor, of the years of arduous study involved, without income, the interest wanes. When seed is planted by a good health careers meeting or program, nothing will come of it without patient, tedious, and often frustrating follow-up. But the material is there and can be motivated. No other agency can do the job in respect which the NMA can do and we must do it. To complement the work of the Council on Talent Recruitment, I am asking the House of Delegates to establish a new standing Council on Financial Aid. This would replace our present Scholarship Committee and vastly enlarge the scope of the activities. This new Council would not only administer our own NMA Scholarship Fund, but establish working relationships with bodies like the Ford Foundation, the National Scholarship and Service Fund for Negro Students, the US Office of Education, National Medical Fellowships, and so on, so that wherever the Council on Recruitment found talent and need the Council on Financial Aid would know where to find the money to support it. One group could hardly d4o both jobs. In the event of the acceptance of these recommendations, I have secured the consent of a number of distinguished laymen to serve as a National Advisory Committee to the NMA in this area. This committee would provide all the expertise which we do not have within our own membership.
THE PURSUIT OF EXCELLENCE Because we cannot overnight remove or change the poor environments in which we discover the talent we seek, we must implant the desire for the pursuit of excellence for its own sake. The solid satisfaction that springs from any achievement which the individual knows within himself is real, is a marvelous cushion against frustration. It is the surest technique for survival and eventual success for the individual or group lowest down. In the midst of the strife and turmoil which now swirl about us, we must see to it that our young recognize that despite slums, riots, and Mississippi, our country is further along the road to the realization of the ideal of equality of opportunity and freedom of the individual than it has ever been before. We must make them aware that they can participate in the great enterprise of accelerating further progress by the quiet pursuit of knowledge and understanding. We must encourage them to learn something about everything in the universe from supergalaxies to electrons and have fun doing it. Somewhere in this 114
range they will find something they like and to which their talents are suited. Our country cannot afford to have a new generation of young people grow up in ignorance because of the hate and violence which may seem to enmesh us. The national press and periodicals have printed enough about the Negro and frustration and hopelessness. The Negro needs to hear more about his intrinsic merit, his possibilities, and the new opportunities beckoning, because they are here. The United States is the land of promise for the Negro today. To excel in our modern world, however, more self-discipline to the pursuits of learning is necessary. The Negro may continue to have to be better than the best to obtain recognition. But frustration must be. met and displaced by self reliance and self-respect. Hence the pursuit of excellence as a goal, all kinds of excellence. The concept is as old as Socrates. It is still as good. Let us then apply our energies and resourcefulness to the task of finding our hidden talent and developing it. In the process we shall gain extra rewards in the acquisition of values and a sense of usefulness we had ourselves never before realized.
HOMO SAPIENS OR SANGUINIS? To those who say how can such an outlook be possible in the face of Mississippi and Harlem, I would say that what the country needs is a good course in anthropology. When Linnaeus in 1735 gave man the name Homo sapiens or wise man, he was an optimist. With equal justification he might have called him Homo sanguinis or bloody man. We know that prehistoric man was often a cannibal. When Cain killed his brother we had a fratricide in the first generation after the Creation. The historical portion of the Old Testament overflows with blood. No other animal is so suicidal in the generic sense of killing his own species. Man has steadily increased his efficiency at self-extermination until today we are all appalled at what might happen if the great powers would accidentally be set at war. Man was a killer of his fellows for countless millennia before he evolved civilizations, moral values and ethical systems. The latter lie like hardly more than a veneer over our much older bestiality. But the same brain which man has used for becoming more efficient at dominating, exploiting, and destroying his fellow, has also developed our higher JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 2
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perceptions and values. Man the beast is ever present, latent or apparent, in all segments of our society the world over. He must be controlled and submerged until man the spirit can be made ascendant over man the beast. In the nature of the case that will take a long, long time. And we must be just as patient and understanding with the confused thinking of the old families, the nouveau riche, and the suburban country club set, as we are with that of the market place. Man is still a young primate who has got hold of dangerous powers he has not yet learned how to manage properly, withal he is almost crowding all the other animals off the planet. The world's population explosion will be subject of a special session of this convention.
VISIT MEXICO It would do us all in the United States a great deal of good to make a visit to Mexico. It might make us more modest about ourselves. We have so long regarded ourselves as the showcase of democracy, that it will come as something of a shock to many to perceive that a next door neighbor has in a number of ways surpassed us. This neighbor has had the same problems as ours, but in worse degree and with less means to solve them. The United States had to secure its freedom by throwing off the yoke of only one foreign power, England, Mexico has had to get free of three, Spain, France, and in important ways, the United States. Be it remembered that Ulysses Simpson Grant, General of the Union Armies in the Civil War and two term President of the United States, in his memoirs wrote
of the Mexican War of 1847. "(I) to this day regard the war.. .as one of the most unjust ever waged by a stronger against a weaker nation." The United States has never had the clashes over the separation of church and state which have repeatedly convulsed Mexico. Slavery in the United States was essentially a regional affair, but a much better entrenched white landowner class virtually enslaved the Indian population for a longer time in Mexico. Education in the United States has had widespread public support from the beginning of our republic, but Mexico is only now wiping out illiteracy. As great a problem as poverty has been with us, it is almost nothing to that which has confronted Mexico, but they are making giant strides against it. Mexican national policy does not recognize a race problem. It would be political death for a candidate to seek office in Mexico through a racial issue. In the United States we have had only one war over internal issues and heated controversies have seldom led to more riots. Mexico has had to go through the throes of 100 revolutions. Yet Mexico has achieved stable government. It is proud of its independence. It has a contagious confidence in a great future. Its vibrant passion for progress fills the air on every hand in the capital, Mexico City. Through its ever present art and monuments, it reminds its citizens of its history. Race has been thrust out of the national picture. On every hand is evidence of the national effort to expand education and housing and wipe out poverty. The sheer beauty and concept of the mammoth
THE EDITOR'S PASSPORT
"The Editor stood 'fore the Heavenly Gate, His features pinched and cold He bowed before the Man of Fate, Seeking admission to the fold. 'What have you done?' St. Peter asked, 'To gain admission here?' 'I was the Journal's editor, Sir, 'For many a weary year.' The Pearly Gates swung open wide As Peter pressed the bell. 'Come in and choose your harp,' he cried; 'You've had your share of Hell'." JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 2
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housing project, the Nono Alco in Mexico City, of which the 15 000 apartments will house 100 000 people, are enough by themselves to convince that this country believes in itself and is going somewhere with amazing rapidity. I am no John Gunther to write an "Inside Mexico," but I have seen enough to know that they have more progress against the same problems with which we have not done too well. I say, go and see for yourselves. I intend to return as soon as possible to learn more about how they have achieved so much in so little time.
HITCH YOUR WAGON TO A STAR All we have said, Emerson expressed in his famous quotation, "Hitch your wagon to a star." The National Medical Association is pre-eminently fitted to inspire and lead our young people in the pursuit of excellence.
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Project Arcturus (the nearest familiar star) should be a major preoccupation of this association for indefinite time. As this message opened with lines from Lincoln, let it close with others from the first Great Emancipator. "It is rather for us to be here dedicated to the great task remaining before us, that from these honored dead we take increased devotion to that cause for which they gave the last full measure of devotion, that we here highly resolve that these dead shall not have died in vain; that the nation shall, under God, have a new birth of freedom, and that government of the people, by the people, for the people, shall not perish from the earth." Literature Cited 1. Council on Scientific Affairs. Autologous blood transfusions.JAMA. 1986;256:2378-2380. 2. Blundell J. Experiments on the transfusion of blood by syringe. Med Chir Trans. 1818;9:56.
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