Texas Medicine Chronicles a Century of Medical History
Cover Story - July 2005
By Marilyn Baker
Texas Medicine has rolled off the presses for 100 years, an amazing feat in the capricious world of periodicals. Yet it almost became a historical footnote, buried in old minutes. Only "rash action," led by Ira C. Chase, MD, Fort Worth, and W.B. Russ, MD, San Antonio - perhaps spurred by the recalcitrant 29th Texas Legislature - gave it life.
It happened in 1905, Einstein's "miracle year," when Schaudinn and Hoffmann also found the causative organism of syphilis; Einhorn synthesized novocaine, a substitute for cocaine; and Carrel sutured blood vessels, paving the way for organ transplantation. Freud spoke out on sex, and Crile performed the first modern blood transfusion. Gorgas was attacking yellow fever in Panama.
In Houston that spring, doctors waited in line to be "x-rayed" at the State Medical Association of Texas - today's Texas Medical Association - convention.
Science was marching on, but scientific measures the association supported were failing at the state Capitol. Departing president F.E. Daniel, MD, Austin, told delegates that "our anatomical bill" to obtain cadavers for medical students had been "ridiculed outrageously, laughed at, and overwhelmingly defeated in the Senate." Being ignored were other concerns, like improvements in the Board of Medical Examiners and creation of the long-sought board of health. Diploma mills were rampant, and fields of pseudo-medicine were flourishing.
Surprisingly, talk of an association journal overshadowed these pressing issues at the Houston convention. Two years earlier, the federation of medicine had been strengthened, making the county society the basic unit, and a House of Delegates had been assembled. Membership had jumped from 368 to 2,436, almost half the state's doctors, by meeting time in April 1905. The reorganization laid a strong foundation for a journal, and Dr. Chase, who ran the association's daily affairs from Fort Worth, pleaded that the officers could not "mobilize the profession for any campaign" without a means of inspiration and information. "Personal solicitation is impossible. Mails are expensive and letter writing is impractical. … The solution," he said, "is to be found in the establishment of a State Journal."
He offered 10 lofty goals, including intercommunication and publishing the House of Delegates Transactions while fresh; professional unification; educating the profession and laity; having advertisers pay for councilors' travel and association clerical help; and setting aside "a goodly sum" for legislative and educational reforms, libraries, museums, hospitals, and other "monuments to our beloved profession."
"Look before you leap," Dr. Daniel protested, urging continuation of the annual volume of Transactions , with its minutes and 120 medical papers. He pointed out that "journalizing" was tried in the 1880s and considered a failure.
As editor of his own Texas Medical Journal - the de facto association journal - Dr. Daniel perhaps had a bias, but history was on his side. Since President T.J. Heard, MD, Galveston, first envisioned a journal in 1870, TMA had favored cooperating with other journals rather than undertaking the direct expense. Its voice had been heard through publications such as the Galveston Medical Journal . Other private publishers had attempted journals, some still in existence, but Dr. Daniel's 20-year-old publication - as historian Pat I. Nixon, MD, describes it - was the "most pretentious and prolonged editorial effort."
Like Dr. Daniel, two-thirds of the delegates initially were thought to oppose a journal, but they heard a persuasive argument from Drs. Chase and W.R. Thompson, Fort Worth, coeditor of another small journal. They recommended launching a journal under the direction of a Board of Trustees that was being established at the meeting. Further, they said, it must be "absolutely free and untrammeled by fear of subscribers or avarice of advertisers" and not limited to the horizon of individual ownership.
Dr. Russ, the first Board of Councilors chair and an associate editor of Dr. Daniel's journal, embraced the idea. "If the time has not arrived for the establishment of a journal it will never arrive …," he declared. "I prophesy that within two years no amount of work will enable us to maintain the interest of the very men we most need. … Your councilors would insist upon a journal."
Without a dissenting vote, the delegates approved a motion to proceed by Holman Taylor, MD.
Dr. Daniel was not happy. Although he did not vote against the journal, he wrote "Rash Action of the House of Delegates," a scathing three-page editorial in his own journal the following month, charging that the matter had been railroaded through the House of Delegates.
Three months later in July 1905, 3,700 copies of the Texas State Journal of Medicine were printed in Austin. Dr. Chase was editor-in-chief, assisted by 15 associate editors from the Board of Councilors districts. The new Board of Trustees, serving as the Board of Publication, announced that the journal would be "a potent factor" in elevating standards and safeguarding life and health and would offer only "helpful and ethical" advertising.
Prominent names in Texas medicine were among the bylines: Jno. S. Turner, MD, superintendent of the North Texas Hospital for the Insane; A.C. Scott, MD, Temple, cofounder of the Temple Sanitarium, later known as Scott and White, and a future TMA president; and E.H. Cary, MD, Dallas, a future TMA and American Medical Association president who was active in Texas medical school issues. Frank D. Thompson, MD, Fort Worth, in "Medico-Legal Lessons From an Alleged Fracture of the Forearm," reported on his use of radiography to prove there had been no fracture.
In the issue also were Sir William Osler's famous good-bye speech to the United States medical profession, the association's membership roster, the first installment of the 1905 House Transactions , the Board of Medical Examiners' April questions, and an ethics tale by "Thomas Esculapius."
And, two journals, including the one coedited by Dr. W.R. Thompson, a member of the Board of Trustees, announced their discontinuation.
Publication of the new journal was quite an accomplishment. Just a year earlier, John T. Moore, MD, then-association secretary and a future president, and for 29 years the Board of Trustees' chair, reported there had been no typewriter in the secretary's office. He advised purchasing a "first-class machine."
Luckily, telegraph lines smoothed the way for financial success, as did a guaranteed readership of 3,000. All preferred advertising was "practically sold by wire within a week after the first advertising announcement, and the entire 16 pages practically secured before a type was set for the first time," proclaimed an editorial. The journal also was supported by $1 of the $2 association dues.
TMA-endorsed legislation soon took a favorable turn. Dr. Nixon attributed it to the legislative committee's efforts and Dr. Chase's editorial work. In 1906, the anatomical bill previously ridiculed by the legislature became law, and, in 1907, the governor signed the One-Board Medical Practice Act. The pure food and drug and State Board of Pharmacy bills, supported by the association, also became law.
There was another bonus - of sorts. In May 1906, Dr. Daniel wrote that the journal had been a gratifying success. "Much credit is due Dr. Chase, the indefatigable secretary-editor, for this success, but he nearly worked himself to death and has lost much avoirdupois and embonpoint - that fascinating rotundity that so well matched his bewitching little blonde Van Dyke beard."
A Long and Productive Era
Through the new journal, Dr. Chase wrote frankly on subjects from physicians' income to a recipe for a political funeral, and yellow fever to the pure milk supply. In 1908, for example, an article addressed a serious problem, "The Unsuspected But Dangerously Tuberculous Cow," with photographs of the poor culprits in the pasture.
Advertising often was a blessing and a bane, particularly because of unrestrained patent medicine claims. Part of Dr. Daniel's opposition to a state medical journal was his charge that "the Chicago octopus," the Journal of the American Medical Association ( JAMA ), would control other journals and that its advertising was not always clean.
Dr. Russ, active in AMA affairs, fought vigorously against "dirty" advertising. In 1907, the AMA Council on Pharmacy and Chemistry was established, and although Dr. Chase carefully followed high standards for the Texas State Journal of Medicine , he discontinued certain ads because the council proved some claims fraudulent. Some patent medicines had been carried in JAMA , but it soon conformed with new guidelines as well.
In 1910, Dr. Chase returned full time to private practice and was succeeded by Dr. Taylor, who moved to Fort Worth with a salary of $1,800 a year and a promise of income from 25 percent of all new advertising over 26 pages. He also aggressively covered timely concerns - Ehrlich's painful Salvarsan treatment of syphilis in 1910, an understanding in 1915 that protein deficiency led to pellagra, and the ethics of fee splitting. Of the three-year-old Workmen's Compensation Act, in 1916, he wrote, "The law is fine for the employer, good for the working man, questionable for the doctor, and disastrous to the lawyer."
A few kind words in the face of criticism, especially from Dr. Daniel, came from Olin West, MD, editor of the Journal of the Tennessee State Medical Association . "You can't make a touchdown without getting a few knocks on your way to the goal line," he advised. "As I see it, the score is already 40-0 in favor of the Texas Journal . Stiff upper lip, all sphincters tight, head up, tail over the dash-board - shoot 'em a few! Your Journal is all right. It does not suffer by any comparison that is fair to make."
In 1916, Dr. Taylor left his office to command the First Battalion of the Third Texas Infantry in France. Dr. Chase returned as editor pro-tem, facing the 1918 influenza epidemic, including 11 obituaries of stricken colleagues in the November issue. He complained about women's suffrage in Texas in 1918, but predicted it would lead to better public health and education. In 1919, he lamented that carpenters and brickmasons were paid $8 to $11 per day - more than the average doctor.
Dr. Taylor returned from war in April 1920, with a salary of $5,000, to more provocation, like the Sheppard-Towner bill in 1921, which TMA considered partial socialization of medicine. With the appearance of veterinary chiropractors in this era, he was direct: "That ignoramuses should trifle with the health of a horse or a hog is an outrage; that is property. If chiropractors are wise they will confine their malpractice to humans; it is safer."
As Dr. Nixon observed later, "The Journal was at once the spokesman and the teacher of the medical profession in Texas."
Higher expenses hurt during World War I, particularly the doubling of paper costs, and the number of pages had to be reduced. The War Industries Board also required the use of lightweight paper. Facing a deficit, Dr. Taylor obtained a dues increase to $5, with $2 going to the journal, for 1917. By 1927, the allocation was $3, remaining there until 1964.
By 1932, the Great Depression stressed the country, membership and advertising were down, and staff salaries were cut by 10 percent. The recurring fear of state medicine was intensifying, which Dr. Taylor declared a "menace to the health and welfare of our people and to the practice of scientific medicine."
From the first issue, the journal carried important scientific advances like the "Scott needle" and radiography in legal defense. In 1936, it published the discovery of the adverse effects of surgical glove powder by May Owen, MD, who would in 1960 become TMA's first woman president; and journals of the 1930s and 1940s reported on blood and plasma advances by renowned Texas investigators Drs. E.E. Muirhead, Joseph M. Hill, and C.T. Ashworth, and Sol Haberman, PhD. Some of their work, like Dr. Hill's freeze-dried plasma, proved invaluable in World War II battlefields.
"War Medicine the Responsibility of the Medical Profession," said the lead editorial in the January 1942 journal, which featured several articles pertaining to the war and aviation. Dr. Taylor noted that it had "never been necessary to force the medical profession to serve in the Army or elsewhere."
In May, he wrote "All Set for Houston," observing that the annual convention would be carried out as published. An AMA official present commended the 1942 papers saying he never neglected the " Texas State Journal ." Restrictions from 1943 to 1945 limited TMA meetings, forcing the annual session to be downsized or abandoned after the journal announced meetings, and in 1945, after it had published the full program. One-third of TMA members by mid-1943 had been called to war, with more also evident on journal obituary pages. Texas doctors felt threats to private practice from the Wagner-Murray-Dingell bill in Congress, which the journal continued to address.
In 1945, Harriet Cunningham, a trained journalist, joined Dr. Taylor's staff as assistant editor; she became managing editor in 1952. The journal covered the medical profession's collision with health care proposals from President Harry Truman, Sen. Claude Pepper, and others.
Dr. Chase died in 1934. He was a visionary who had been a staunch advocate for the state journal, its first editor, and the 1922 TMA president. Dr. Taylor died of a heart attack in 1947 at a banquet in his honor in Fort Worth. He had served the association as secretary and editor for 37 years. Together, the two physician secretary/editors had dedicated more than four decades to the journal.
An Era of Modernization
In 1948, the association moved to Austin, initiating plans to build a new contemporary structure on North Lamar Boulevard. The journal staff began a pattern of routine design updates and readership surveys.
The January 1949 issue exhibited a dramatic departure from the past, sporting a cover redesign with a bright blue border, a new typeface, and a logo of a star with the rod of Aesculapius in its center. It earned a rave review from a professional editors' group. "MD's in Texas are alive , says your new format," the judges wrote. "Medicine is looking forward, not backward. … There's proof that Texas doctors have the stuff it takes to fight the onward march of Socialism …" Over the next decades, the journal would receive numerous professional awards for editorial excellence, including the Sandoz award in medical journalism.
In 1950, trustees chose a new association management model based on professional expertise. Without a physician on the staff, the board in 1951 also named an anonymous Journal Advisory Committee of six Austin physicians to guide scientific matters and select scientific material. Meeting regularly with staff, the committee was aided by a system of confidential statewide peer reviewers that would grow from 150 to more than 350.
Meanwhile, the Korean Conflict presented new challenges. When doctors were slow to answer the call to war, the journal soon covered a "doctor draft." Worries about socialized medicine continued.
Most articles in the 1950s were aimed at private general practitioners, the predominant membership. Space aviation was evident, as were a medical history series and articles on public relations. Polio also was a concern. The journal began "Drug Notes," a column on pharmaceuticals from The University of Texas College of Pharmacy.
Advertising grew phenomenally following the 1954 appointment of C. Lincoln Williston as executive secretary. He quickly sought to increase association income. The welcome growth of advertising, however, posed certain problems, the most difficult being the balance of advertising and editorial ratios. With sometimes heavy, colored paper stock and color illustrations, foldouts, cutouts, and other gimmicks, there was talk that the journal looked like a "Sears catalogue."
New guidelines on standards were issued. Interspersing ads with editorial material was discussed and at first rejected, but in 1965 and 1966, gradually allowed. Attitudes also changed toward certain advertising. In 1955, the trustees stopped accepting new contracts for beer or alcohol ads, and in 1967 they voted to end cigarette ads.
A more flexible format change had been planned for 1960, with more white space and color, and a new editorial trend was evident as the journal considered accepting more scientific articles for the growing number of specialist members. These modifications were being implemented when Ms. Cunningham died of cancer in 1960 after having set meticulous standards.
During this era, medical care for the aged was a dominant topic. The association supported voluntary programs in the fight against socialized medicine, and there were concerns about physicians' public image. Guest editorials often sounded militant, with titles like "Choose Your Weapons."
In July 1962, Marilyn Baker was named managing editor and Rae Vajgert, assistant managing editor.
The journal had fertile ground for material in the 1960s, including the growing TMA annual session, with first pick on manuscripts. Having the National Aeronautics and Space Administration (NASA) and military aviation facilities in Texas, plus rapidly expanding medical schools, added to opportunities. In addition, long-feared government health care programs came to bear on medicine with passage of Medicare and Medicaid. Topics of heightened public interest, such as air pollution, an antismoking campaign launched in 1964 by the U.S. surgeon general, polio vaccination campaigns, pesticides, drug abuse, and medical aspects of the Vietnam war, were in the journal.
A new cover and page design debuted in January 1964. Alternating monthly in deep gold, muted aqua, brown, and olive green, the clean-cut cover included a significant change from the past - the removal of advertising from the cover. Technical and format changes, including typography, were made. A staff study showed the news section had changed from a collection of items to more statewide news and reporting of local events rather than repeating nationally released information. Association inserts, such as the membership directory, were removed, primarily because of cost. The colorful and embellished obituaries of earlier years became shorter and written in a crisper journalistic style. As membership grew, they would be condensed to a few lines.
A New Name
May 1966 marked a historical change when the journal name was simplified from the Texas State Journal of Medicine to Texas Medicine . With another new design in May 1967, cover illustrations changed with each issue to reflect content.
The early 1970s saw hints of new technology in physicians' offices and future state requirements. In 1971, Donald H. Brandt, MD, Denison, wrote about the practical applications for the computer in the physician's office. In 1972, a news item reported that R.D. Haines, MD, Temple, chair of the Committee on Continuing Education, had mailed a letter with a form, asking that TMA members voluntarily report continuing medical education (CME) activities for their membership files. Years later, in 1995, CME would be a prerequisite for periodic state registration of a license. During the 1970s, the state CME accreditation program was established through the journal department.
By late 1972, the Journal Advisory Committee's name was changed to the Scientific Publication Committee, with members' names published in the masthead. Preceding them were the unsung Austin physicians who served anonymously, arriving often after evening hospital rounds to meet with staff. John P. Vineyard, MD, Austin, was the first public chair. Joseph M. Abell Jr., MD, Austin, became chair in 1973, followed by C.W. Daeschner, MD, Galveston, in 1977. In 1981, the Board of Trustees appointed Richard D. Cunningham, MD, Temple, and Edward S. Reynolds Jr., MD, Galveston, as cochairs of the newly renamed Editorial Committee. Dr. Cunningham later became the sole chair.
Texas Medicine has always striven for excellence in content, thus acceptance and rejection rates of scientific manuscripts often were a concern, with the normal rejection rate approximately 30 percent. In 1980, the Editorial Committee developed stricter standards. By this point also, 51 percent of manuscripts were from the state's medical schools and health science centers, with fewer from the TMA annual session. In 1978, Dr. Daeschner solicited material for a "What's New" series. Among contributing authors was Michael DeBakey, MD, Houston, in January 1980, on "What's New In Surgery: The Aortocoronary-Artery Bypass Operation."
Landmark events have been covered, and in January 1964, the journal published the dictation of physicians at Parkland Memorial Hospital in Dallas after they had treated the assassinated President Kennedy, the wounded Governor John B. Connally, and the alleged assassin. It has been a much-referenced issue.
In 1966, the journal covered Austin physicians' response to The University of Texas at Austin tower shooting and the follow-up studies of the incident's medical aspects by Governor Connally's blue-ribbon committee.
After the devastating attacks on New York City and Washington, D.C., on Sept. 11, 2001, Texas Medicine published a special supplement in January 2002, "Physician Protocols & Patient Information on Biological Agents," a reproducible bioterrorism toolkit for physicians and their patients.
Texas Medicine also has been a vehicle for heady dreams.
In the December 1963 "Space Medicine Beyond the Moon," Hubertus Strughold, MD, of the USAF School of Aviation Medicine, at Brooks Air Force Base in San Antonio, predicted travel to the moon and deeper into the planets, noting that science must find ways to sustain earthlings. Wernher von Braun, PhD, offered similar optimism in a 1967 journal article, hoping that the "cabin in the sky" would solve petty problems between nations.
In June 1968, David M. Mumford, MD, Houston, wrote a prescient editorial, "Cell Fusion of Mice, Men, and Molecules," in which he said space exploration and nuclear development had claimed the lion's share of public and budgetary attention, but "the quickening advances in molecular biology may yet win the day as the great scientific nova of the 20th century."
Ms. Baker's final issue as editor was in January 1983 and Ms. Vajgert became editor that month. In 1986, John A. Mangos, MD, San Antonio, became chair of the Editorial Committee.
Among topics in this era were antismoking legislation in Texas and a new syndrome called acquired immune deficiency syndrome (AIDS). In 1986, a series of articles on practice management was published. For the first time, in September 1987, an issue was published in two sections, one containing the Texas cancer plan and guidelines for optimal cancer care. The impact of the computer revolution was evident with the citing of available online databases. Texas Medicine was in six major indices and available through the databases.
A new look and format was adopted in January 1986 to change the journal from the stark, high-tech look of the 1970s to a comfortable human appearance.
Becoming a Magazine
The late 1980s again was a time for rethinking TMA's future, including Texas Medicine , the association's most visible program.
A readership survey revealed that 91 percent of members and 42 percent of nonmembers read Texas Medicine , but physicians between ages 31 to 35 read it less often. Consultants recommended continuing efforts to make the publication more attractive to them. No single specialty now dominated the association, and national and specialty journals were serving specific clinical needs.
As a result of the studies, in 1990, the Board of Trustees made another historic decision, voting to refocus Texas Medicine as a newsmagazine to better serve all specialties. A small journal section was retained for solicited manuscripts on topics of broad interest and of specific pertinence to Texas.
The magazine's Editorial Committee was restructured to reflect the makeup of TMA membership in May 1990. Glen Journeay, MD, Austin, was named chair.
Ms. Vajgert and her staff implemented the magazine format in July 1990, featuring a cover story on animals in research and a yellow-tinted peer-reviewed journal section. As Ms. Vajgert wrote, "In 1905, the entire Index Medicus was published in one volume about the size of a modern medical dictionary." By 1990, she said, with clinical material readily available, it took more than a yard of shelf space.
The last full journal, the June 1990 issue, carried an illustration of the new TMA building being constructed at 401 West 15th Street in Austin near the Capitol, and an editorial, "Bricks, Mortar, and History," by TMA Executive Vice President Bob Mickey.
The managing editor of the journal penned a tribute to Ed Triggs, graphic designer for more than 25 years, who was completing his service to the journal. As Ms. Vajgert wrote, Mr. Triggs had given the journal character and professional form. Over the years, he had stimulated much discussion with his geometric symbolism, although once a conservative older gentleman MD felt a new title font was "too hippie." The design soon was modified by the gracious designer.
In September 1990, Ms. Vagjert retired, having served 30 years with TMA. Succeeding her was Kathryn Trombatore, who continued to develop and enhance the new magazine format, including a new cover design.
Jean Pietrobono became the magazine's managing editor in 1993 and served until December 1998, when she moved to New York with her family. She was succeeded by Larry BeSaw who joined the staff as associate editor in 1995. In 1999, his title was changed to editor, and long-time staff member Shari Henson became managing editor.
John C. Jennings, MD, Galveston, was appointed chair of the Editorial Committee in 1998.
Snapshots of the magazine since 1990 reveal a lively delivery of news on the issues of the day, from medical liability to biomedical research, and the return of age-old diseases.
In 1990 Texas Medicine began offering physicians CME credit for reading articles published in special symposia issues, taking a prescribed quiz, and completing a self-assessment form. Among the topics have been end-of-life issues, adolescent health care, and patient safety. Texas Medicine is the only state medical journal to offer such a service.
In May 2004, the Board of Trustees changed the Editorial Committee to the Editorial Board and streamlined membership to nine members. A recent reader survey had shown similar responses to previous studies - that readers had little time and wanted a wider variety of shorter stories. In June 2004, the publication unveiled its newest makeover to reflect those needs.
Rash Action 100 Years Later
Texas Medicine in March 2005 targeted the year 2040, and through the eyes of a demographer saw the likelihood of an older, sicker, poorer, and more ethnically diverse population and its dramatic impact on health care. A book review by a former president reminded readers of the 1918 flu pandemic.
In April, the magazine reported on the new medical climate in Texas following major tort reform; commented on science versus politics, particularly regarding stem cell research; and reminded physicians not to sit idly by and let the legislature pass bills without their voices being heard.
Dr. Chase would have been proud. He had predicted in 1906 that the field of the association would be incomprehensible in 100 years. He was right on mark by many measures. Texas Medicine 's average monthly press run now is 35,000 copies.
Earthlings have reached the moon, and their robots have surpassed it. Molecular biology became one of the greatest stories of the century, integral to modern medicine. Einstein's "miracle year" work ultimately affected medicine directly, as did that of many journal authors.
In 2005, science was still controversial in legislative halls, and old familiar topics like workers' compensation and the Texas State Board of Medical Examiners were on the legislature's agenda.
One thing was different. The Texas State Journal of Medicine had filled a void in the vast space called Texas, and now Texas Medicine magazine is sent to legislators - all due to the "rash action" of a young House of Delegates in 1905.
Marilyn M. Baker, CAE, a former editor of Texas Medicine , also served as director of the TMA Division of Medical Information, which comprised several departments, and the Office of Strategic Planning.
Texas Medicine Editors
Ira Carlton Chase, MD, 1905-1910
Holman Taylor, MD, 1910-1947
Harold Williams, MD, 1948-1950
Tod Bates, MD, 1950-1951
N.C. Forrester, 1951-1952
Harriet Cunningham, 1952-1960
Ruth Trahan, 1960-1962
Marilyn Baker, 1962-1983
Rae Vajgert, 1983-1990
Kathryn Trombatore, 1990 -1993
Jean Pietrobono, 1993-1998
Larry BeSaw, 1998-
July 2005 Texas Medicine Contents
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