The Secret Kappa Lambda Society of Hippocrates (And the Origin of the American Medical Association's Principles of Medical Ethics)

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HISTORY OF MEDICINE

The Secret Kappa Lambda Society of Hippocrates (and the Origin of the American Medical Association’s Principles of Medical Ethics)

Charles T. Ambrose

Department of Microbiology, Immunology, and Molecular Genetics, University of Kentucky, Lexington, Kentucky

This paper relates the neglected history of an idealistic, secret medical fraternity that exist - ed briefly in Lexington, Kentucky, during the first half of the 19th century. It was created for students in the Medical Department at Transylvania University, the fifth U.S. medical school, founded in 1799. One goal of the fraternity was to counter the widespread dissension and often violent quarrels among doctors that characterized American medicine of that period. And to that end, it was among the first to promote Thomas Percival’s code of medical ethics in this country. Branches of the fraternity were established in Philadelphia and New York City, where members became influential in local medical politics but in time encountered hostility from rival physicians. The secret character of the fraternity branches was publicized and maligned during an anti-Masonic movement in this country in the 1830s, which soon led to the demise of the Philadelphia group. The New York branch remained active through the 1860s. Members of both branches were among those who, in 1847, established the American Medical Association and devised its Principles of Medical Ethics.

INTRODUCTION EARLY SECRET COLLEGE FRATERNITIES Recorded histories about specific top - ics are often deficient in some small detail In the United States, the first student or incomplete due simply to space limita - fraternity was Phi Beta Kappa, established tions. An example is the origin of the at the College of William and Mary in American Medical Association (AMA). Williamsburg, Virginia, in 1776. During its So several versions of a subject need be early years, the fraternity had an oath of perused to gain an accurate interpretation. secrecy and a special handclasp or grip [1]. The following essay relates some little Some histories state that in this country, it known particulars about an early 19th cen - was “the sole society of its kind for 50 tury secret medical fraternity whose years” [2]. Indeed, other secret Greek-letter greater significance lies in its members fraternities followed from 1825 to 1827 at who helped found the AMA. Union College, Schenectady, New York,

To whom all correspondence should be addressed: Charles T. Ambrose, M.D., Department of Microbiology, Immunology, and Molecular Genetics, College of Medicine, University of Kentucky, Lexington, KY 40536. E-mail: [email protected]. †Abbreviations: AMA, American Medical Association. 45 46 Ambrose: The Kappa Lamda Society

(ΚΑ , ΣΦ , ∆Φ ) and in 1832 at Hamilton est”) was promoted in eastern cities. College, New York ( Α∆Φ ). Also, in 1832, George Washington and John Adams each the first of two secret societies was formed contributed $100 and Aaron Burr, $40. at Yale: Skull and Bones; the other, Scroll Pledges totaling $10,000 were obtained and Key, appeared in 1842. [3]. An editorial in the Journal of the However, the distinction of being the American Medical Association in 1905 second secret college society in the United noted that “the little school at Lexington States (after ΦβΚ ) must go to the Kappa grew with phenomenal rapidity to a posi - Lambda Society of Hippocrates, estab - tion second to none in the United States” lished at the Department of Medicine at [4]. For a decade during the 1820s, Transylvania University in Lexington, Transylvania University was “ranked Kentucky, in 1819. This fact is little appre - among the leading institutions of higher ciated today for several reasons: the ΚΛ learning” in the Union. Indeed, Jefferson Society in Lexington survived for less than favored sending students there rather than a decade, although branches established in to Harvard. At Transylvania, they would several eastern cities continued for several be imbued with “more of the flavor of the more. But its members greatly influenced old cast,” meaning a more democratic out - the early character of a later important insti - look, while at Harvard they would return tution, the American Medical Association. from Cambridge as “fanatics and Tories” The story of the ΚΛ Society and the AMA [5] (see note [6]). begins with Transylvania University and its The Civil War impoverished the small Department of Medicine, founded in 1799. colleges in the South, causing many to fold. In order to survive, Transylvania merged with the small church-funded Kentucky TRANSYLVANIA UNIVERSITY University in 1865. In the same year, a new “Transylvania” means “the country land grant college, the Agriculture and across the woods” and was the name given Mechanical College, was added to to the lands bordered by the Ohio, Transylvania’s campus. Also the College of Cumberland, and Kentucky rivers — that the Bible was included in the mix, all of part of present day Kentucky that original - which came to be known as Kentucky ly was the western extension of Virginia. University for the next four decades. In 1780, the General Assembly of Virginia In 1878, the A&M College moved deeded 8,000 acres of escheated land “in from the Transylvania campus to a nearby the County of Kentuckee” for “a Public site in Lexington and later was renamed the School.” The adjective “escheated” University of Kentucky. The Bible College referred to lands previously owned by also separated and became the Lexington British subjects who were no longer legal - Theological Seminary. Now divested of ly allowed to own them. Another 12,000 these two academic partners, the acres were added later to help fund “the Transylvania campus resumed its old name maintenance and education of youth.” The of Transylvania University and over the public school was named Transylvania next century attained its present reputation Seminary and became the first institution as a highly regarded, small liberal arts uni - of higher learning west of the Alleghenies. versity (see note [7]). Instruction began in 1785. In 1792, Kentucky became the 15th state. In 1798, the seminary’s name was changed to TRANSYLVANIA’S DEPARTMENT Transylvania University [3]. OF MEDICINE A fundraising campaign for the new In 1799 the trustees of Transylvania seminary/university (“a lamp in the for - University inaugurated a Medical Ambrose: The Kappa Lamda Society 47

Figure 1. Left: Medical Department Building, Transylvania University, circa 1840. Right: Matriculation and library ticket, 1824 to 1825. Figures used courtesy of Transylvania University.

Department [3]. This became the fifth (or el to Europe to purchase entire private seventh, see note [8]) medical school orga - libraries of medical works, anatomical nized in the United States but indisputably preparations, and the newest scientific the first west of the Alleghenies. Early instruments. In 1828, the Transylvania United States medical schools were com - Medical Library held over 3,000 volumes. monly called “Departments” or (Figure 1). At the time, Transylvania was “Institutes” of Medicine. The first had the “best endowed medical school in been established by the University of America” and had “one of the best Pennsylvania in 1765 followed by King’s [libraries] in the country” [13]. The library College in New York City in 1767 (or and museum of anatomical and scientific 1764), Harvard University in Cambridge items are still intact and on display today in 1783, and Dartmouth College in New at the university (see note [14]). Hampshire in 1797 [9]. (The Medical Transylvania’s Department of Institution of Yale College was created Medicine remained preeminent in trans- around 1810 [10].) Appalachia for two decades, from the Students were admitted to Tran- 1820s through the 1830s. However, in the sylvania’s Department of Medicine begin - mid-19th century, steam navigation caused ning in 1800 and taught initially in precep - inland Lexington to be eclipsed economi - torships with the four or so faculty at hand. cally by two nearby cities on the Ohio During the first decade or so, lectures were River — Cincinnati and Louisville. In given irregularly to small classes of stu - 1837, the Louisville Medical Institute was dents, numbering 20 or so. The academic opened with a class of 80 students. It year was only four months long. A formal became the University of Louisville‘s curriculum was not in place until the win - Medical Department in 1848 [13]. In the ter of 1819. The first class then included 1840s, enrollment at Transylvania’s 39 students. By 1825, the department had Medical Department began to decrease. 281 students, its peak number. The aver - Dissatisfaction within the Transylvania age enrollment in the 14 medical schools medical faculty, notably with the lack of of this period was 147 [11], although the bodies for dissection, led several members University of Pennsylvania then had 440 in the fall of 1850 to move to Louisville medical students [12]. and form the Kentucky School of In the early 1800s, several large dona - Medicine. In 1908, the two medical tions allowed Transylvania faculty to trav - schools in Louisville merged. In 48 Ambrose: The Kappa Lamda Society

Lexington, Transylvania’s last class of delay in starting regular class work nine doctors completed their studies dur - stemmed from discord with local practi - ing the 1856 to 1859 term. tioners and among the small medical fac - Throughout its nearly six-decade ulty. Doctors in the community were wary existence (1799 to 1857), Transylvania’s of the new medical college, fearing it Department of Medicine enrolled 4,358 would churn out rival physicians compet - students and graduated 1,881 physicians. ing for paying patients. Even within the In the antebellum South and Southwest of Department of Medicine conflicts arose; this country, the majority of trained physi - one led to a duel in 1818 involving three cians were medical graduates of professors (see note [17]). Numerous pro - Transylvania [3]. fessional and academic disputes were spread by pamphlets and anonymous let - ters to the local newspapers and disrupted ORIGIN OF THE SECRET the academic calm. KAPPA LAMBDA SOCIETY At the same time, a physician in The ΚΛ Society of Hippocrates was Philadelphia wrote that his medical col - founded by Dr. Samuel Brown (1769 to leagues “lived in an almost constant state 1830), the first Professor of Theory and of warfare, quarreling, and even worse … Practice of Medicine and also Professor of street fights” [18]. Indeed, there was not a Chemistry at Transylvania’s new city or town in the whole nation “where Department of Medicine. He was born in doctors were not at each other’s throats” Virginia and had obtained his medical [19]. The cause was competition for pay - training in Philadelphia and Scotland. The ing patients. renowned American surgeon, Dr. Samuel The vulgar deportment of his medical Gross, described Brown as “a beautiful colleagues both in Lexington and else - type of man [with] a magnificent physique where led Brown, the idealist and dreamer, … a thorough gentleman in manner and to inoculate his Transylvania students address.” To others he was eloquent, against such unworthy conduct through learned, benevolent, liberal, and idealistic his lectures, correspondence, and conver - — but a dreamer, some said [15]. sations. An acquaintance wrote that Brown In 1802, while students were being “sought by all means — by precept and taught mainly by preceptors, Brown was example — to sustain the dignity, vindi - occupied vaccinating 500 Lexingtonians. At cate the honor, and raise the status of the the time, physicians on the East Coast were profession” [15]. still debating the safety of this procedure. In 1819, with 39 restless students now Only two years earlier, Benjamin Waterhouse attending regular medical lectures, per - had obtained the first cowpox vaccine in forming human dissections, and occasion - America and had immunized seven members ally robbing graves, Brown may have of his Boston household [16]. thought that a student fraternity might rein In 1803, Brown founded the in their rowdiness and instill some profes - Lexington Medical Society. It seems to sional decorum. He gave the new fraterni - have been for the benefit of the medical ty a mysterious name: the Kappa Lambda students, since the February minutes only Society of Hippocrates. Secrecy was a listed them, some 15 in number. The notable feature of it. He may have felt that October minutes concerned renting a a secret symbol and a secret password meeting place and purchasing “candle, would make the fraternity more appealing candlestick, and snuffers.” to spirited youths and that a badge and As noted above, a formal medical goals would help form a professional bond curriculum began in 1819. Part of the among them. The December 1822 minutes Ambrose: The Kappa Lamda Society 49

of the K Λ Society listed 128 members, “friendly and brotherly feelings between including one from Ireland. practitioners,” and 4) to establish branches The significance of the two Greek let - of the ΚΛ Society in all states of the Union. ters in the society’s name was never dis - Nothing of lasting significance appears closed publicly, but recall that Brown also to have transpired in Lexington’s chapter of taught chemistry. The Greek letter Kappa ΚΛ . It remained active for less than a is thought by some to represent the Greek decade and faded from history a few years word “crystal,” “ κρυσταλλοζ .” The sim - after Samuel Brown retired and left plest crystal is the cube, and this was the Lexington in 1825. The Transylvania symbol adopted by the society as its Medical Journal (1828 to 1852) was edited emblem — indicative of purity and primi - by members of the Department of tiveness. Indeed, the word “primitive” was Medicine, but it had no connection with the a secret password to be used during intro - society. However, the spirit of the ΚΛ ductory conversations to identify a mem - Society survived in its branches, which ber. The word was also inserted (often flourished for a time in several East Coast somewhat forced) in documents of the cities. society — e.g., “the great primitive Author of nature” or “the triumph of primitive nature.” The Greek letter Lambda had no KAPPA LAMBDA SOCIETY particular significance except “to lead BRANCHES AND MEDICAL ETHICS astray the uninitiated in their conjectures” Chapters of ΚΛ were established in [20] (see note [21]) ( Figure 2 ). Philadelphia and New York City. Others The fraternity badge was a square (like were started in Baltimore, Washington, a cube) on which was inscribed the words and possibly elsewhere, but little or noth - “Virtue, Science, Friendship, and ing about them has been preserved. In Harmony.” The four goals of the society Philadelphia, the chapter was called the were 1) to promote medical science, 2) to “ΚΛ Society of Aesculapius,” while in communicate reports of interesting cases New York City it became the “ ΚΛ of diseases and important discoveries in Association of the United States.” A med - the science of medicine, 3) to cultivate ical society with lofty goals was desper -

Figure 2. Left: Certificate of membership in the ΚΛ Society. Right: Brass seal of the ΚΛ Society. Figures used courtesy of Transylvania University. 50 Ambrose: The Kappa Lamda Society

ately needed in these two cities because of book, published in 1803. But very likely the chronic dissension among doctors. In these ideas had been absorbed during the Philadelphia, Benjamin Rush had written preceding decades by many other medical before his death in 1813 that “nothing students at Edinburgh, including two could exceed the malice of rival authors Americans — Benjamin Rush and Samuel except the rancor of rival physicians” [22]. Brown. But the rancor in the City of Brotherly Rush (1745 to 1813) received his for - Love apparently subsided somewhat with mal medical training in Edinburgh in the the advent of the ΚΛ Society, one of 1760s. He is remembered today with some whose local founders was Dr. René de la dismay for his aggressively bleeding and Roche (1795 to 1870). He wrote of the purging patients suffering from yellow medical profession there that “soon after fever and other febrile illnesses. But establishment [of the ΚΛ Society], harmo - among his more worthy medical contribu - ny — comparative harmony at least — tions were his Lectures on the Medical was restored among its members.” The Jurisprudence of the Mind . Published in explanation for this success may relate to 1810, this was the first review of medical an 1822 document from the ΚΛ Society in ethics in America. Rush speculated that Philadelphia which reads, “… we have professional rivalry (“this peculiar profes - adopted such parts of the [book] Medical sional depravity”) was due to physicians’ Ethics of the illustrious Doctor Percival, as isolation — an isolation which could be are adapted [applicable] to the state of the relieved by physicians holding “frequent profession in this country.” The parent social and convivial meetings” [22]. organization in Lexington had published Samuel Brown’s medical education in extracts from Percival’s Code in 1821 and Philadelphia with Rush in 1792 and in sent them to its branches in Philadelphia Edinburgh the following year gave him a and New York City [23]. double dose of Scottish medical ethics and In the English-speaking medical etiquette. Brown was undoubtedly respon - world, Percival’s small book, titled sible for a Lexington press publishing Medical Ethics, or, A Code of Institutes extracts from Percival’s book in 1821 and and Precepts , became the manual for for the society distributing copies to its future medical ethicists. He had compiled two branches in Philadelphia and New it in an effort to prevent the perennial dis - York City, as noted previously. agreements among the medical staff at the The need for some socializing force in Manchester Infirmary. the profession, as well as a forum for set - Thomas Percival (1740 to 1804) had tling medical disputes, was milling around trained in medicine at Edinburgh and in the minds of various American physi - absorbed the ideas of two Scottish philoso - cians. Daniel Drake had concluded that the phers who taught there — John Gregory only solution to such conflicts was to and David Hume. Gregory (1724 to 1773) establish a neutral body — some impartial espoused “common sense medical ethics,” medical association — which would arbi - which seeks, among others things, to dis - trate disputes and elevate the level of tinguish the physician’s duty from his per - social intercourse among physicians [19]. sonal interests. David Hume (1711 to So the ethical ideas of Gregory, 1776) stressed the importance of “cooper - Hume, Percival, and Rush were likely in ation in societies” to “achieve natural Brown’s thoughts when he established the needs” — i.e., mutual happiness. ΚΛ Society in 1819 [Figure 3]. This soci - Cooperation implies cordial relationships. ety might have been more visible in the These views were incorporated into the history of American medicine had not its medical ethics and etiquette in Percival’s branches in Philadelphia and New York Ambrose: The Kappa Lamda Society 51

Figure 3. The harbingers of medical ethics and etiquette in the United States. Figure 3a (left) from Leake CD. Percival’s Medical Ethics . Baltimore: The William and Wilkins Company; 1927. Figure 3b (center) from Corner GW. The Autobiography of Benjamin Rush . Princeton University Press; 1948 (used with permission). Figure 3c (right) used courtesy of Transylvania University.

City been destroyed by jealous, uninitiated Suspicious neighbors assumed that he had physicians. Nonetheless, the society’s been abducted and drowned in Lake influence would later be expressed in Ontario when a decomposed male corpse another organization, the AMA. floated ashore near the mouth of the Niagara River [24]. Morgan’s book about the Masons was DEMISE OF THE published but aroused little excitement or KAPPA LAMBDA SOCIETY interest compared with the mystery of his The demise of the two ΚΛ branches disappearance. No other crime of the peri - seems related to an alleged murder in od garnered so much coverage in the western New York State. William Morgan northern newspapers. The lingering noto - was an occasional stone mason who lived riety of his supposed murder seeded a in Batavia, New York. It’s not known latent hostility to Freemasonry. An anti- whether he was ever admitted to member - Masonic hysteria swept over the country ship in any Masonic organization, but he and soon touched other secret societies. acquired enough knowledge to write a Phi Beta Kappa was one so affected. book purporting to reveal the secrets of the As noted previously, it originated as a Masonic Order. Efforts were made to pre - secret society and developed chapters at vent its publication, including arson at the several East Coast universities. In 1831, shop printing the book. One day in the Harvard chapter “removed the require - September 1826, Morgan was jailed ment for secrecy” in response to the anti- briefly for a trivial debt. When released Masonic fervor. All ΦΒΚ chapters soon that evening, four men were observed assumed the purely honorary character shoving him into a yellow carriage. familiar to us today. Other Greek-letter Morgan was never seen alive again. fraternities relaxed their shields of secrecy. 52 Ambrose: The Kappa Lamda Society

But at Yale in 1832, the ultra-secret society affiliated with Rutgers College in New Skull and Bones was founded — perhaps Jersey. Animosity became focused not as a contrarian response of students there only on the ΚΛ trustees, but on other ΚΛ to the prevailing anti-Masonic, anti-secre - members of the medical establishment. cy sentiment. An article “stigmatizing” the ΚΛ Meanwhile in Philadelphia, the secret Society and listing 17 New York members nature of the local ΚΛ branch was was published in The American Lancet in revealed to the general public during a fac - 1830. Two so-named were not members ulty fracas at Jefferson Medical College. and initiated libel suits that dragged on for In 1829, one of its professors, Francis some years [15, 20]. In 1839, a collection Beattie, was fired. He had said unkind of essays appeared entitled A History of things about the school’s founder, George the New York Kappa Lambda Conspiracy . McClelland, father of the future Civil War Its caustic critique of the society included general. Dr. McClellan sued Dr. Beattie. a poetical “epitaph,” of which the follow - During the trial, it was disclosed that ing are but a few lines. Beattie was supported by a secret medical Here lies the Kappa Lambda wight [25], fraternity, the city’s ΚΛ Society of Begot by Selfishness and Night. Aesculapius. A flurry of charges and It was a thing of craft and guile, counter-charges appeared in rival medical Which bowed and smiled, and wronged the while. journals — one claiming that both the Through dark and sinuous paths, by stealth. University of Pennsylvania and the It crawled to office, [&] gathered wealth. Philadelphia Hospital were now dominat - ed by ΚΛ members. The unfavorable pub - The epitaph concludes … licity soon led to the demise of the Exposed at length, to truth’s pure ray, Philadelphia ΚΛ branch [15]. It raved, writhed, withered, [&] passed away. One tangible reminder of the Philadelphia branch resides in the few libraries still preserving the North THE IDEA OF AN AMERICAN American Medical and Surgical Journal , MEDICAL ORGANIZATION which was edited by ΚΛ members from 1826 until 1832. In 1830, while defending Contrary to the epitaph, the New York Beattie, the journal sought to preempt bad ΚΛ Association did not pass away in 1839 publicity about the secret society in but survived until 1862. During its waning Philadelphia by being the first to discuss years, there appeared in New York City the the ΚΛ branch there. The article added first stirrings of a more durable organiza - parenthetically that ΚΛ had “a very excel - tion, the future American Medical lent branch in New York City” [15]. Association. In the late 1840s, at meetings So it was inevitable that the northern in New York City and Philadelphia, physi - branch would soon come under scrutiny. cians began addressing the country-wide By then, the ΚΛ membership in New York issues of medical education, certification, City had grown to include many physi - and licensure along with the pressing cians with the best hospital and academic problem of professional etiquette and appointments, the president of the College ethics. The latter problem had led to the of Physicians and Surgeons, and some of creation of the ΚΛ Society in 1819. But its trustees. In the mid-1830s, the trustees why in 1846 to 1847 were the other issues “brought charges” against the Physicians finally being discussed at a national level? and Surgeons faculty for some now forgot - It was primarily a matter of econom - ten fault. Many professors resigned in ics. Competition for paying patients had protest and established a medical school become fierce with the mushrooming Ambrose: The Kappa Lamda Society 53

numbers of doctors in the Union — regu - University to draft resolutions on various lar physicians and non-regular healers, the matters facing American medicine. These latter including homeopaths, herbalists resolutions, intended for further discussion (Thompsonian doctors), Eclectics, empir - and adoption at a later meeting in ics, and quacks. It was estimated that in Philadelphia, included mainly a national the 1840s, the proportion of medical prac - medical association, medical education titioners per population in the United and licensure, and a uniform code of med - States was five times greater than in ical ethics. France [26]. In 1800, there were 343 grad - uates from the four then-well-established United States medical schools. In 1840, THE FOUNDING OF THE there were 30 or so medical schools, from AMERICAN MEDICAL ASSOCIATION which 6,849 new physicians came that year [12]. In 1850, there were 42 regular In May 1847, representatives from 40 medical schools with 17,213 graduates medical societies and 28 medical schools that year. Added to these between 1820 convened in Philadelphia and approved and 1850 were the thousands who the establishment of the American emerged from the 30 or so United States Medical Association. Delegates to the ear - schools of homeopathy, Thomsonianism, lier meeting in New York City had includ - and Eclecticism [27]. This intense rivalry ed two prominent members of the New for gainful patients was reflected in the York ΚΛ branch: Drs. Edward Delafield precarious incomes of most practicing and Alexander H. Stevens. From the now- physicians of the period. defunct Philadelphia branch came Drs. This competition was the cause of John Bell and Isaac Hays, who co- much of the hostility and many of the authored the report on medical ethics, fights among American physicians. Again, which was unanimously adopted. The offi - these were the concerns that led Dr. cial code of conduct adopted was pat - Samuel Brown to form the ΚΛ Society in terned largely after Percival’s Code, pre - 1819, to adopt Percival’s Medical Ethics serving “to a considerable extent” his in 1821, and to send copies that same year phrases but also inserting elsewhere “the to the society’s two branches in New York words of the late Dr. Rush” [30]. City and Philadelphia. The Preamble of the AMA’s Other American groups besides the Constitution stated the purposes of the ΚΛ Society had been receptive to organization, which included “fostering Percival’s ideas. In 1808, the Boston friendly intercourse between those engaged Medical Association used precepts from in [the medical profession]” [31]. This Percival's second chapter concerning rela - wording is very similar to one of the origi - tionships among physicians in its rules nal goals of the ΚΛ Society — that of titled the Boston Medical Police [28]. In bringing about “the cultivation of friendly 1823, the New York State Medical Society and brotherly feelings between the practi - appropriated nearly the whole of tioners of different districts and states” [32]. Percival’s Code. And in 1832, the Medico- Chirurgical Society of Baltimore issued A System of Medical Ethics based on THE INFLUENCE OF THE KAPPA Percival’s little book [29]. Boston’s rules LAMBDA SOCIETY ON THE AMA were adopted by 11 other state medical This essay suggests that the ΚΛ societies between 1817 and 1842. Society contributed in particular to one area In May 1846, delegates from 16 of the of greatest concern to the AMA delegates, 26 United States met at New York namely the Principles of Medical Ethics. As 54 Ambrose: The Kappa Lamda Society

ΚΛ 3. Wright JD, Jr. Transylvania: Tutor to the early as 1821, members in the West . Lexington, Kentucky: Transylvania Lexington had seeded Percival’s Code to its University Press; 1975, pp. IX-X & 1-175. branches, whose Philadelphia members in 4. Editorial. History of the medical department turn proposed the Code to the AMA con - of Transylvania University. JAMA 1905;44: 1856-7. vention in 1847. 5. Jefferson T. Letter to Joseph C. Cabell, Jan. Also, one goal of the ΚΛ Society was 20, 1820. In: Ford, P.L., ed. T he Writings of incorporated in the AMA’s Preamble as Thomas Jefferson . Vol. 12. New York: G.P. noted above. “The cultivation of friendly Putnam's Sons; 1905:154-5. 6. Thomas Jefferson was an ardent advocate and brotherly feelings” was included in for public education and felt that the lands the minutes of an 1822 meeting of the ΚΛ in the west belonged to all the people and Society in “the Medical College of not to land speculators. He had opposed the Transylvania University,” as recorded by privately owned Transylvania Company, which had purchased lands between the Henry Miller. He was the 43rd member in Cumberland and Kentucky Rivers from the the society’s list for that year; soon after - Cherokee Indians in 1775 and sold parcels wards, he was a Transylvania medical to settlers [34]. His Land Ordinance of 1787 graduate and in 1859 the 13th president designated other lands beyond the Alleghenies to support education. It is like - of the AMA. He practiced obstetrics in ly that Jefferson promoted the Virginia leg - Kentucky and taught at the Medical islature's grant in 1780 of escheated lands Institute of Louisville University. for a “Public School” in “the County of Whether he was a delegate to the 1846 to Kentuckee.” 7. Famous early 19th century alumni of 1847 meetings in New York City and Transylvania University included Henry Philadelphia leading to founding the Clay, Stephen F. Austin, Cassius M. Clay, AMA is unknown. In addition to the ΚΛ Jefferson Davis, and two United States vice presidents: Richard M. Johnson, and John members cited above, there were eight C. Breckinridge. other members from Philadelphia [33]. 8 A scrupulous scholar might argue that Four presidents of the AMA were ΚΛ Transylvania's Department. of Medicine was members: Drs. A.H. Stevens (the 2nd, not the fifth medical school founded in this country but the seventh or eighth because of 1848), G.B. Wood (9th, 1855), H. Miller several others established in the late 18th cen - (13th, 1859), and S.D. Gross (20th, tury [9]. 1) In Philadelphia in 1765, medical 1868). faculties existed at both the University of In conclusion, the early focus of the Pennsylvania and the College of Philadelphia. ΚΛ In 1791, these two schools merged under the Society on medical ethics and profes - name of the former. 2) In New York City a sional courtesy and the subsequent role of medical department was established in 1792 its members in founding the AMA suggest at Queen's College (later Rutgers College). a debt owed by the American medical pro - Teaching here was “suspended before 1800,” resumed when the school was reorganized, fession to this forgotten secret medical but ceased in 1828. 3) A short-lived medical society. school was also founded at The College of William and Mary in 1779; it granted only one Acknowledgements: The assistance of Ms. degree —an honorary one in 1782. Concern B.J. Gooch, University Archivist of for priority rankings here pales in the knowl - Transylvania University, in preparing this edge that North America's first medical school paper is gratefully acknowledged. was founded in Mexico City nearly a century before, in 1578 [35]. REFERENCES AND NOTES 9. Fishbein M. The organization is conceived. In: A History of the American Medical 1. Phi Beta Kappa, A Handbook for New Association 1847 to 1947 . Philadelphia: Members . New York: The United Chapters W.B. Saunders Company; 1947, pp. 19-26. of Phi Beta Kappa; 1948:5-10. 10. Burr HS. The founding of the medical insti - 2. Greek-Letter Societies and College tution of Yale College. Yale J Biol Med Fraternities. In: The Encyclopedia 1933;6:333-40. Americana . Vol. 13. New York: Americana 11. Rothstein WG. Medical education 1825- Corporation; 1938:401-2. 1860 In: American Medical Schools and the Ambrose: The Kappa Lamda Society 55

Practice of Medicine . Oxford: Oxford 21. When this paper was presented as a talk at University Press; 1987:51. April 2005 meeting of the American Osler 12. Norwood WF. Medical education in the Society, Dr. Charles G. Roland, a member United States Before 1900. In: O'Malley and former president, made the astute sug - CD, ed. The History of Medical Education . gestion that the two Greek letters might also Berkeley: University of California Press; have referred to the first letters in Kentucky 1970:463-99. and Lexington, respectively. 13. Norwood WF. The Schools of Kentucky. In: 22. Haakonssen L. Benjamin Rush: medical Medical Education in the United States ethics for a new republic. In: Medicine and Before the Civil War . Philadelphia: Morals in the Enlightenment: John Gregory, University of Pennsylvania Press; Thomas Percival and Benjamin Rush . 1944:289-303. Atlanta, Georgia: Rodopi; 1997:219. 14. The Special Collections and the Museum at 23. Ingen PV. Remarks on “Kappa Lambda, elf Transylvania University represent time cap - or ogre?” and a little more concerning the sules of 19th century medicine and science. society. Bull Hist Med 1945;45:513-38. The Special Collections hold 1,772 theses 24. Vaughn WP. The Morgan affair and Its conse - written by medical graduates, 1,800 19th quences. In: The Anti-masonic Party in the century medical books, and over 800 such United States 1826-1843 . Lexington, Kentucky: books printed before 1800 [36]. The University Press of Kentucky; 1983:1-9. Museum contains numerous wax models 25. “Wight”: This is an Old Saxon word mean - (anatomical and pathological) plus “philo - ing a contemptible creature, often supernat - sophical apparatus” made in the early 19th ural or preternatural in nature. Oxford century, such as planetaria, Magdeburg University English Dictionary . Vol 10. spheres, electrostatic machines, a Lucernal Oxford: Oxford University Press; microscope, an Archimedes screw, etc. [37]. 1937:2426. 15. Leake CD. What was Kappa Lambda? Ann 26. Fishbein M. The first annual session. In: A Med Hist 1922;4:196-206. History of the American Medical 16. Hopkins DR. Princes and Peasants: Association 1847 to 1947 . Philadelphia: Smallpox in History . Chicago: University of W.B. Saunders Company; 1947, pp. 41-47. Chicago Press; 1983:380. 27. Cassedy JH. Medicine and the Westward 17. Duels date back to antiquity (Achilles and movement. In: Medicine and American Hector, David and Goliath) and were still Growth 1800-1860 . Madison, Wisconsin: common in 19th century Europe and University of Wisconsin Press; 1986:60-93. America, as any encyclopedia will describe. 28. Burns CR. Reciprocity in the development of In this country not only politicians Anglo-American medical ethics, 1765-1865. (Hamilton vs. Burr, Henry Clay vs. John Proc. XXIII International Congress History Randolph, Andrew Jackson vs. numerous of Medicine. London; 1972, pp 813-9. opponents) but doctors also engaged in this 29. Kolaja J. Historical development of medical often fatal exercise. As noted in the text, a ethics in the United States. World Med J. local example involving three Transylvania 1954;1:155-7. professors occurred in 1818, when Dr. 30. Leake C. Code of ethics of the American Benjamin Dudley challenged Dr. Daniel Medical Association. In: Percival's Medical Drake to duel (see note [38]). Drake Ethics . Baltimore: Williams & Wilkins; declined (as later he would other challenges 1927:218-238. in Cincinnati), but his honor at Transylvania 31. Fishbein M. A permanent national associa - was defended by a colleague, Dr. William tion. In: A History of the American Medical Richardson. Dudley's bullet severed Association 1847 to 1947 . Philadelphia: Richardson's femoral artery, and the latter W.B. Saunders Company; 1947:30-4. would surely have bled to death had not 32. Miller H. Minutes of “a meeting of the ΚΛ Dudley rushed over to the victim and, after Society of Hippocrates…” Dec. 11, 1822. asking his permission, applied his thumb University Archivist, Transylvania over the groin, allowing time for a ligature University, Lexington, Kentucky. to be fixed in place. “The two men were 33. Mayo WP. Kappa Lambda Society. In: life-long friends from that moment” [3]. Medicine in the Athens of the West . 18. Ellis JH. Medicine in Kentucky . Lexington, McClandan Publishing Co.; 1999:64-89. Kentucky: Kentucky University Press; 34. Randall WS. Thomas Jefferson: A Life . New 1977: pp 43-44. York: Henry Holt and Company; 1993:708. 19. Flexner JT. Genius on the Ohio: Daniel 35. The Encyclopedia Americana . Vol. 18. New Drake. In: Doctors on Horseback . New York: York: Americana Corporation; 1938, 760. Dover Publications, Inc.; 1937:151-214. 36. Catalogue of the Transylvania University 20. van Antwerp LD. Kappa Lambda: Elf or Medical Library. Lexington, Kentucky: Ogre? Bull Hist Med 1945;17:330. Transylvania University Press; 1987:635. 56 Ambrose: The Kappa Lamda Society

37. Brown LA. Early Philosophical Apparatus moves he made through six medical at Transylvania College (and Relics of the schools. He founded the Medical College of Medical Department) . Lexington, KY: Ohio at Cincinnati in 1819. A year later he Transylvania College Press; 1959:117. was expelled from its faculty even while he 38. The most famous physician in the Ohio was the presiding officer of the meeting. Valley during the first half of the 19th cen - Once Drake met one of the College's pro - tury was Daniel Drake (1785-1852) — cre - fessors on the street. As they approached the ative, charismatic, but also somewhat con - professor said, “I do not propose to step tentious. He taught at Transylvania during aside for a fool.” Drake replied, “I will” and three different periods. His restless combat - stepped aside [19]. iveness was reflected in the 11 academic