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The Secret Kappa Lambda Society of Hippocrates (and the Origin The Secret Kappa Lambda Society of Hippocrates (and the Origin

of the American Medical Association's Principles of Medical of the American Medical Association's Principles of Medical

Ethics) Ethics)

Charles T. Ambrose University of Kentucky, cambros@uky.edu

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

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INTRODUCTION

Recorded histories about specific top-ics are often deficient in some small detailor incomplete due simply to space limita-tions. An example is the origin of theAmerican Medical Association (AMA).So several versions of a subject need beperused to gain an accurate interpretation.The following essay relates some littleknown particulars about an early 19th cen-tury secret medical fraternity whosegreater significance lies in its memberswho helped found the AMA.

EARLY SECRET COLLEGEFRATERNITIES

In the United States, the first studentfraternity was Phi Beta Kappa, establishedat the College of William and Mary inWilliamsburg, Virginia, in 1776. During itsearly years, the fraternity had an oath ofsecrecy and a special handclasp or grip [1].Some histories state that in this country, itwas “the sole society of its kind for 50years” [2]. Indeed, other secret Greek-letterfraternities followed from 1825 to 1827 atUnion College, Schenectady, New York,

YALE JOURNAL OF BIOLOGY AND MEDICINE 78 (2005), pp. 45-56.Copyright © 2005. All rights reserved.

45

To whom all correspondence should be addressed: Charles T. Ambrose, M.D., Departmentof Microbiology, Immunology, and Molecular Genetics, College of Medicine, University ofKentucky, Lexington, KY 40536. E-mail: cambros@uky.edu.†Abbreviations: AMA, American Medical Association.

HISTORY OF MEDICINE

The Secret Kappa Lambda Societyof Hippocrates (and the Origin of theAmerican Medical Association’sPrinciples 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 forstudents 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 andoften 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 ethicsin this country. Branches of the fraternity were established in Philadelphia and New YorkCity, where members became influential in local medical politics but in time encounteredhostility from rival physicians. The secret character of the fraternity branches was publicizedand maligned during an anti-Masonic movement in this country in the 1830s, which soon ledto the demise of the Philadelphia group. The New York branch remained active through the1860s. Members of both branches were among those who, in 1847, established theAmerican Medical Association and devised its Principles of Medical Ethics.

(ΚΑ, ΣΦ, ∆Φ) and in 1832 at HamiltonCollege, New York (Α∆Φ). Also, in 1832,the first of two secret societies was formedat Yale: Skull and Bones; the other, Scrolland Key, appeared in 1842.

However, the distinction of being thesecond secret college society in the UnitedStates (after ΦβΚ) must go to the KappaLambda Society of Hippocrates, estab-lished at the Department of Medicine atTransylvania University in Lexington,Kentucky, in 1819. This fact is little appre-ciated today for several reasons: the ΚΛSociety in Lexington survived for less thana decade, although branches established inseveral eastern cities continued for severalmore. But its members greatly influencedthe early character of a later important insti-tution, the American Medical Association.The story of the ΚΛ Society and the AMAbegins with Transylvania University and itsDepartment of Medicine, founded in 1799.

TRANSYLVANIA UNIVERSITY“Transylvania” means “the country

across the woods” and was the name givento the lands bordered by the Ohio,Cumberland, and Kentucky rivers — thatpart of present day Kentucky that original-ly was the western extension of Virginia.In 1780, the General Assembly of Virginiadeeded 8,000 acres of escheated land “inthe County of Kentuckee” for “a PublicSchool.” The adjective “escheated”referred to lands previously owned byBritish subjects who were no longer legal-ly allowed to own them. Another 12,000acres were added later to help fund “themaintenance and education of youth.” Thepublic school was named TransylvaniaSeminary and became the first institutionof higher learning west of the Alleghenies.Instruction began in 1785. In 1792,Kentucky became the 15th state. In 1798,the seminary’s name was changed toTransylvania University [3].

A fundraising campaign for the newseminary/university (“a lamp in the for-

est”) was promoted in eastern cities.George Washington and John Adams eachcontributed $100 and Aaron Burr, $40.Pledges totaling $10,000 were obtained[3]. An editorial in the Journal of theAmerican Medical Association in 1905noted that “the little school at Lexingtongrew with phenomenal rapidity to a posi-tion second to none in the United States”[4]. For a decade during the 1820s,Transylvania University was “rankedamong the leading institutions of higherlearning” in the Union. Indeed, Jeffersonfavored sending students there rather thanto Harvard. At Transylvania, they wouldbe imbued with “more of the flavor of theold cast,” meaning a more democratic out-look, while at Harvard they would returnfrom Cambridge as “fanatics and Tories”[5] (see note [6]).

The Civil War impoverished the smallcolleges in the South, causing many to fold.In order to survive, Transylvania mergedwith the small church-funded KentuckyUniversity in 1865. In the same year, a newland grant college, the Agriculture andMechanical College, was added toTransylvania’s campus. Also the College ofthe Bible was included in the mix, all ofwhich came to be known as KentuckyUniversity for the next four decades.

In 1878, the A&M College movedfrom the Transylvania campus to a nearbysite in Lexington and later was renamed theUniversity of Kentucky. The Bible Collegealso separated and became the LexingtonTheological Seminary. Now divested ofthese two academic partners, theTransylvania campus resumed its old nameof Transylvania University and over thenext century attained its present reputationas a highly regarded, small liberal arts uni-versity (see note [7]).

TRANSYLVANIA’S DEPARTMENTOF MEDICINE

In 1799 the trustees of TransylvaniaUniversity inaugurated a Medical

46 Ambrose: The Kappa Lamda Society

Department [3]. This became the fifth (orseventh, see note [8]) medical school orga-nized in the United States but indisputablythe first west of the Alleghenies. EarlyUnited States medical schools were com-monly called “Departments” or“Institutes” of Medicine. The first hadbeen established by the University ofPennsylvania in 1765 followed by King’sCollege in New York City in 1767 (or1764), Harvard University in Cambridgein 1783, and Dartmouth College in NewHampshire in 1797 [9]. (The MedicalInstitution of Yale College was createdaround 1810 [10].)

Students were admitted to Tran-sylvania’s Department of Medicine begin-ning in 1800 and taught initially in precep-torships with the four or so faculty at hand.During the first decade or so, lectures weregiven irregularly to small classes of stu-dents, numbering 20 or so. The academicyear was only four months long. A formalcurriculum was not in place until the win-ter of 1819. The first class then included39 students. By 1825, the department had281 students, its peak number. The aver-age enrollment in the 14 medical schoolsof this period was 147 [11], although theUniversity of Pennsylvania then had 440medical students [12].

In the early 1800s, several large dona-tions allowed Transylvania faculty to trav-

el to Europe to purchase entire privatelibraries of medical works, anatomicalpreparations, and the newest scientificinstruments. In 1828, the TransylvaniaMedical Library held over 3,000 volumes.(Figure 1). At the time, Transylvania wasthe “best endowed medical school inAmerica” and had “one of the best[libraries] in the country” [13]. The libraryand museum of anatomical and scientificitems are still intact and on display todayat the university (see note [14]).

Transylvania’s Department ofMedicine remained preeminent in trans-Appalachia for two decades, from the1820s through the 1830s. However, in themid-19th century, steam navigation causedinland Lexington to be eclipsed economi-cally by two nearby cities on the OhioRiver — Cincinnati and Louisville. In1837, the Louisville Medical Institute wasopened with a class of 80 students. Itbecame the University of Louisville‘sMedical Department in 1848 [13]. In the1840s, enrollment at Transylvania’sMedical Department began to decrease.Dissatisfaction within the Transylvaniamedical faculty, notably with the lack ofbodies for dissection, led several membersin the fall of 1850 to move to Louisvilleand form the Kentucky School ofMedicine. In 1908, the two medicalschools in Louisville merged. In

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 ofTransylvania University.

Lexington, Transylvania’s last class ofnine doctors completed their studies dur-ing the 1856 to 1859 term.

Throughout its nearly six-decadeexistence (1799 to 1857), Transylvania’sDepartment of Medicine enrolled 4,358students and graduated 1,881 physicians.In the antebellum South and Southwest ofthis country, the majority of trained physi-cians were medical graduates ofTransylvania [3].

ORIGIN OF THE SECRETKAPPA LAMBDA SOCIETY

The ΚΛ Society of Hippocrates wasfounded by Dr. Samuel Brown (1769 to1830), the first Professor of Theory andPractice of Medicine and also Professor ofChemistry at Transylvania’s newDepartment of Medicine. He was born inVirginia and had obtained his medicaltraining in Philadelphia and Scotland. Therenowned American surgeon, Dr. SamuelGross, described Brown as “a beautifultype of man [with] a magnificent physique… a thorough gentleman in manner andaddress.” To others he was eloquent,learned, benevolent, liberal, and idealistic— but a dreamer, some said [15].

In 1802, while students were beingtaught mainly by preceptors, Brown wasoccupied vaccinating 500 Lexingtonians. Atthe time, physicians on the East Coast werestill debating the safety of this procedure.Only two years earlier, BenjaminWaterhousehad obtained the first cowpox vaccine inAmerica and had immunized seven membersof his Boston household [16].

In 1803, Brown founded theLexington Medical Society. It seems tohave been for the benefit of the medicalstudents, since the February minutes onlylisted them, some 15 in number. TheOctober minutes concerned renting ameeting place and purchasing “candle,candlestick, and snuffers.”

As noted above, a formal medicalcurriculum began in 1819. Part of the

delay in starting regular class workstemmed from discord with local practi-tioners and among the small medical fac-ulty. Doctors in the community were waryof the new medical college, fearing itwould churn out rival physicians compet-ing for paying patients. Even within theDepartment of Medicine conflicts arose;one led to a duel in 1818 involving threeprofessors (see note [17]). Numerous pro-fessional and academic disputes werespread by pamphlets and anonymous let-ters to the local newspapers and disruptedthe academic calm.

At the same time, a physician inPhiladelphia wrote that his medical col-leagues “lived in an almost constant stateof warfare, quarreling, and even worse …street fights” [18]. Indeed, there was not acity or town in the whole nation “wheredoctors were not at each other’s throats”[19]. The cause was competition for pay-ing patients.

The vulgar deportment of his medicalcolleagues both in Lexington and else-where led Brown, the idealist and dreamer,to inoculate his Transylvania studentsagainst such unworthy conduct throughhis lectures, correspondence, and conver-sations. An acquaintance wrote that Brown“sought by all means — by precept andexample — to sustain the dignity, vindi-cate the honor, and raise the status of theprofession” [15].

In 1819, with 39 restless students nowattending regular medical lectures, per-forming human dissections, and occasion-ally robbing graves, Brown may havethought that a student fraternity might reinin their rowdiness and instill some profes-sional decorum. He gave the new fraterni-ty a mysterious name: the Kappa LambdaSociety of Hippocrates. Secrecy was anotable feature of it. He may have felt thata secret symbol and a secret passwordwould make the fraternity more appealingto spirited youths and that a badge andgoals would help form a professional bondamong them. The December 1822 minutes

48 Ambrose: The Kappa Lamda Society

of the KΛ Society listed 128 members,including one from Ireland.

The significance of the two Greek let-ters in the society’s name was never dis-closed publicly, but recall that Brown alsotaught chemistry. The Greek letter Kappais thought by some to represent the Greekword “crystal,” “κρυσταλλοζ.” The sim-plest crystal is the cube, and this was thesymbol adopted by the society as itsemblem — indicative of purity and primi-tiveness. Indeed, the word “primitive” wasa secret password to be used during intro-ductory conversations to identify a mem-ber. The word was also inserted (oftensomewhat forced) in documents of thesociety — e.g., “the great primitive Authorof nature” or “the triumph of primitivenature.” The Greek letter Lambda had noparticular significance except “to leadastray the uninitiated in their conjectures”[20] (see note [21]) ( Figure 2 ).

The fraternity badge was a square (likea cube) on which was inscribed the words“Virtue, Science, Friendship, andHarmony.” The four goals of the societywere 1) to promote medical science, 2) tocommunicate reports of interesting casesof diseases and important discoveries inthe science of medicine, 3) to cultivate

“friendly and brotherly feelings betweenpractitioners,” and 4) to establish branchesof theΚΛ Society in all states of the Union.

Nothing of lasting significance appearsto have transpired in Lexington’s chapter ofΚΛ. It remained active for less than adecade and faded from history a few yearsafter Samuel Brown retired and leftLexington in 1825. The TransylvaniaMedical Journal (1828 to 1852) was editedby members of the Department ofMedicine, but it had no connection with thesociety. However, the spirit of the ΚΛSociety survived in its branches, whichflourished for a time in several East Coastcities.

KAPPA LAMBDA SOCIETYBRANCHES AND MEDICAL ETHICS

Chapters of ΚΛ were established inPhiladelphia and New York City. Otherswere started in Baltimore, Washington,and possibly elsewhere, but little or noth-ing about them has been preserved. InPhiladelphia, the chapter was called the“ΚΛ Society of Aesculapius,” while inNew York City it became the “ΚΛAssociation of the United States.” A med-ical society with lofty goals was desper-

Ambrose: The Kappa Lamda Society 49

Figure 2. Left: Certificate of membership in the ΚΚΛΛ Society. Right: Brass seal of theΚΚΛΛ Society. Figures used courtesy of Transylvania University.

ately needed in these two cities because ofthe chronic dissension among doctors. InPhiladelphia, Benjamin Rush had writtenbefore his death in 1813 that “nothingcould exceed the malice of rival authorsexcept the rancor of rival physicians” [22].

But the rancor in the City of BrotherlyLove apparently subsided somewhat withthe advent of the ΚΛ Society, one ofwhose local founders was Dr. René de laRoche (1795 to 1870). He wrote of themedical profession there that “soon afterestablishment [of the ΚΛ Society], harmo-ny — comparative harmony at least —was restored among its members.” Theexplanation for this success may relate toan 1822 document from the ΚΛ Society inPhiladelphia which reads, “… we haveadopted such parts of the [book] MedicalEthics of the illustrious Doctor Percival, asare adapted [applicable] to the state of theprofession in this country.” The parentorganization in Lexington had publishedextracts from Percival’s Code in 1821 andsent them to its branches in Philadelphiaand New York City [23].

In the English-speaking medicalworld, Percival’s small book, titledMedical Ethics, or, A Code of Institutesand Precepts, became the manual forfuture medical ethicists. He had compiledit in an effort to prevent the perennial dis-agreements among the medical staff at theManchester Infirmary.

Thomas Percival (1740 to 1804) hadtrained in medicine at Edinburgh andabsorbed the ideas of two Scottish philoso-phers who taught there — John Gregoryand David Hume. Gregory (1724 to 1773)espoused “common sense medical ethics,”which seeks, among others things, to dis-tinguish the physician’s duty from his per-sonal interests. David Hume (1711 to1776) stressed the importance of “cooper-ation in societies” to “achieve naturalneeds” — i.e., mutual happiness.Cooperation implies cordial relationships.These views were incorporated into themedical ethics and etiquette in Percival’s

book, published in 1803. But very likelythese ideas had been absorbed during thepreceding decades by many other medicalstudents at Edinburgh, including twoAmericans — Benjamin Rush and SamuelBrown.

Rush (1745 to 1813) received his for-mal medical training in Edinburgh in the1760s. He is remembered today with somedismay for his aggressively bleeding andpurging patients suffering from yellowfever and other febrile illnesses. Butamong his more worthy medical contribu-tions were his Lectures on the MedicalJurisprudence of the Mind. Published in1810, this was the first review of medicalethics in America. Rush speculated thatprofessional rivalry (“this peculiar profes-sional depravity”) was due to physicians’isolation — an isolation which could berelieved by physicians holding “frequentsocial and convivial meetings” [22].

Samuel Brown’s medical education inPhiladelphia with Rush in 1792 and inEdinburgh the following year gave him adouble dose of Scottish medical ethics andetiquette. Brown was undoubtedly respon-sible for a Lexington press publishingextracts from Percival’s book in 1821 andfor the society distributing copies to itstwo branches in Philadelphia and NewYork City, as noted previously.

The need for some socializing force inthe profession, as well as a forum for set-tling medical disputes, was milling aroundin the minds of various American physi-cians. Daniel Drake had concluded that theonly solution to such conflicts was toestablish a neutral body — some impartialmedical association — which would arbi-trate disputes and elevate the level ofsocial intercourse among physicians [19].

So the ethical ideas of Gregory,Hume, Percival, and Rush were likely inBrown’s thoughts when he established theΚΛ Society in 1819 [Figure 3]. This soci-ety might have been more visible in thehistory of American medicine had not itsbranches in Philadelphia and New York

50 Ambrose: The Kappa Lamda Society

City been destroyed by jealous, uninitiatedphysicians. Nonetheless, the society’sinfluence would later be expressed inanother organization, the AMA.

DEMISE OF THE KAPPA LAMBDA SOCIETY

The demise of the two ΚΛ branchesseems related to an alleged murder inwestern New York State. William Morganwas an occasional stone mason who livedin Batavia, New York. It’s not knownwhether he was ever admitted to member-ship in any Masonic organization, but heacquired enough knowledge to write abook purporting to reveal the secrets of theMasonic Order. Efforts were made to pre-vent its publication, including arson at theshop printing the book. One day inSeptember 1826, Morgan was jailedbriefly for a trivial debt. When releasedthat evening, four men were observedshoving him into a yellow carriage.Morgan was never seen alive again.

Suspicious neighbors assumed that he hadbeen abducted and drowned in LakeOntario when a decomposed male corpsefloated ashore near the mouth of theNiagara River [24].

Morgan’s book about the Masons waspublished but aroused little excitement orinterest compared with the mystery of hisdisappearance. No other crime of the peri-od garnered so much coverage in thenorthern newspapers. The lingering noto-riety of his supposed murder seeded alatent hostility to Freemasonry. An anti-Masonic hysteria swept over the countryand soon touched other secret societies.

Phi Beta Kappa was one so affected.As noted previously, it originated as asecret society and developed chapters atseveral East Coast universities. In 1831,the Harvard chapter “removed the require-ment for secrecy” in response to the anti-Masonic fervor. All ΦΒΚ chapters soonassumed the purely honorary characterfamiliar to us today. Other Greek-letterfraternities relaxed their shields of secrecy.

Ambrose: The Kappa Lamda Society 51

Figure 3. The harbingers of medical ethics and etiquette in the United States. Figure3a (left) from Leake CD. Percival’s Medical Ethics. Baltimore: The William andWilkins Company; 1927. Figure 3b (center) from Corner GW. The Autobiography ofBenjamin Rush. Princeton University Press; 1948 (used with permission). Figure 3c(right) used courtesy of Transylvania University.

But at Yale in 1832, the ultra-secret societySkull and Bones was founded — perhapsas a contrarian response of students thereto the prevailing anti-Masonic, anti-secre-cy sentiment.

Meanwhile in Philadelphia, the secretnature of the local ΚΛ branch wasrevealed to the general public during a fac-ulty fracas at Jefferson Medical College.In 1829, one of its professors, FrancisBeattie, was fired. He had said unkindthings about the school’s founder, GeorgeMcClelland, father of the future Civil Wargeneral. Dr. McClellan sued Dr. Beattie.During the trial, it was disclosed thatBeattie was supported by a secret medicalfraternity, the city’s ΚΛ Society ofAesculapius. A flurry of charges andcounter-charges appeared in rival medicaljournals — one claiming that both theUniversity of Pennsylvania and thePhiladelphia Hospital were now dominat-ed by ΚΛ members. The unfavorable pub-licity soon led to the demise of thePhiladelphia ΚΛ branch [15].

One tangible reminder of thePhiladelphia branch resides in the fewlibraries still preserving the NorthAmerican Medical and Surgical Journal,which was edited by ΚΛ members from1826 until 1832. In 1830, while defendingBeattie, the journal sought to preempt badpublicity about the secret society inPhiladelphia by being the first to discussthe ΚΛ branch there. The article addedparenthetically that ΚΛ had “a very excel-lent branch in New York City” [15].

So it was inevitable that the northernbranch would soon come under scrutiny.By then, the ΚΛ membership in New YorkCity had grown to include many physi-cians with the best hospital and academicappointments, the president of the Collegeof Physicians and Surgeons, and some ofits trustees. In the mid-1830s, the trustees“brought charges” against the Physiciansand Surgeons faculty for some now forgot-ten fault. Many professors resigned inprotest and established a medical school

affiliated with Rutgers College in NewJersey. Animosity became focused notonly on the ΚΛ trustees, but on other ΚΛmembers of the medical establishment.

An article “stigmatizing” the ΚΛSociety and listing 17 New York memberswas published in The American Lancet in1830. Two so-named were not membersand initiated libel suits that dragged on forsome years [15, 20]. In 1839, a collectionof essays appeared entitled A History ofthe New York Kappa Lambda Conspiracy.Its caustic critique of the society includeda poetical “epitaph,” of which the follow-ing are but a few lines.

Here lies the Kappa Lambda wight [25],Begot by Selfishness and Night.It was a thing of craft and guile,

Which bowed and smiled, and wronged the while.Through dark and sinuous paths, by stealth.It crawled to office, [&] gathered wealth.

The epitaph concludes …

Exposed at length, to truth’s pure ray,It raved, writhed, withered, [&] passed away.

THE IDEA OF AN AMERICANMEDICAL ORGANIZATION

Contrary to the epitaph, the New YorkΚΛAssociation did not pass away in 1839but survived until 1862. During its waningyears, there appeared in New York City thefirst stirrings of a more durable organiza-tion, the future American MedicalAssociation. In the late 1840s, at meetingsin New York City and Philadelphia, physi-cians began addressing the country-wideissues of medical education, certification,and licensure along with the pressingproblem of professional etiquette andethics. The latter problem had led to thecreation of the ΚΛ Society in 1819. Butwhy in 1846 to 1847 were the other issuesfinally being discussed at a national level?

It was primarily a matter of econom-ics. Competition for paying patients hadbecome fierce with the mushrooming

52 Ambrose: The Kappa Lamda Society

numbers of doctors in the Union — regu-lar physicians and non-regular healers, thelatter including homeopaths, herbalists(Thompsonian doctors), Eclectics, empir-ics, and quacks. It was estimated that inthe 1840s, the proportion of medical prac-titioners per population in the UnitedStates was five times greater than inFrance [26]. In 1800, there were 343 grad-uates from the four then-well-establishedUnited States medical schools. In 1840,there were 30 or so medical schools, fromwhich 6,849 new physicians came thatyear [12]. In 1850, there were 42 regularmedical schools with 17,213 graduatesthat year. Added to these between 1820and 1850 were the thousands whoemerged from the 30 or so United Statesschools of homeopathy, Thomsonianism,and Eclecticism [27]. This intense rivalryfor gainful patients was reflected in theprecarious incomes of most practicingphysicians of the period.

This competition was the cause ofmuch of the hostility and many of thefights among American physicians. Again,these were the concerns that led Dr.Samuel Brown to form the ΚΛ Society in1819, to adopt Percival’s Medical Ethicsin 1821, and to send copies that same yearto the society’s two branches in New YorkCity and Philadelphia.

Other American groups besides theΚΛ Society had been receptive toPercival’s ideas. In 1808, the BostonMedical Association used precepts fromPercival's second chapter concerning rela-tionships among physicians in its rulestitled the Boston Medical Police [28]. In1823, the New York State Medical Societyappropriated nearly the whole ofPercival’s Code. And in 1832, the Medico-Chirurgical Society of Baltimore issued ASystem of Medical Ethics based onPercival’s little book [29]. Boston’s ruleswere adopted by 11 other state medicalsocieties between 1817 and 1842.

In May 1846, delegates from 16 of the26 United States met at New York

University to draft resolutions on variousmatters facing American medicine. Theseresolutions, intended for further discussionand adoption at a later meeting inPhiladelphia, included mainly a nationalmedical association, medical educationand licensure, and a uniform code of med-ical ethics.

THE FOUNDING OF THEAMERICAN MEDICALASSOCIATION

In May 1847, representatives from 40medical societies and 28 medical schoolsconvened in Philadelphia and approvedthe establishment of the AmericanMedical Association. Delegates to the ear-lier meeting in New York City had includ-ed two prominent members of the NewYork ΚΛ branch: Drs. Edward Delafieldand Alexander H. Stevens. From the now-defunct Philadelphia branch came Drs.John Bell and Isaac Hays, who co-authored the report on medical ethics,which was unanimously adopted. The offi-cial code of conduct adopted was pat-terned largely after Percival’s Code, pre-serving “to a considerable extent” hisphrases but also inserting elsewhere “thewords of the late Dr. Rush” [30].

The Preamble of the AMA’sConstitution stated the purposes of theorganization, which included “fosteringfriendly intercourse between those engagedin [the medical profession]” [31]. Thiswording is very similar to one of the origi-nal goals of the ΚΛ Society — that ofbringing about “the cultivation of friendlyand brotherly feelings between the practi-tioners of different districts and states” [32].

THE INFLUENCE OF THE KAPPALAMBDA SOCIETY ON THE AMA

This essay suggests that the ΚΛSociety contributed in particular to one areaof greatest concern to the AMA delegates,namely the Principles of Medical Ethics. As

Ambrose: The Kappa Lamda Society 53

early as 1821, ΚΛ members in theLexington had seeded Percival’s Code to itsbranches, whose Philadelphia members inturn proposed the Code to the AMA con-vention in 1847.

Also, one goal of the ΚΛ Society wasincorporated in the AMA’s Preamble asnoted above. “The cultivation of friendlyand brotherly feelings” was included inthe minutes of an 1822 meeting of the ΚΛSociety in “the Medical College ofTransylvania University,” as recorded byHenry Miller. He was the 43rd member inthe society’s list for that year; soon after-wards, he was a Transylvania medicalgraduate and in 1859 the 13th presidentof the AMA. He practiced obstetrics inKentucky and taught at the MedicalInstitute of Louisville University.Whether he was a delegate to the 1846 to1847 meetings in New York City andPhiladelphia leading to founding theAMA is unknown. In addition to the ΚΛmembers cited above, there were eightother members from Philadelphia [33].Four presidents of the AMA were ΚΛmembers: Drs. A.H. Stevens (the 2nd,1848), G.B. Wood (9th, 1855), H. Miller(13th, 1859), and S.D. Gross (20th,1868).

In conclusion, the early focus of theΚΛ Society on medical ethics and profes-sional courtesy and the subsequent role ofits members in founding the AMA suggesta debt owed by the American medical pro-fession to this forgotten secret medicalsociety.

Acknowledgements: The assistance of Ms.B.J. Gooch, University Archivist ofTransylvania University, in preparing thispaper is gratefully acknowledged.

REFERENCES AND NOTES1. Phi Beta Kappa, A Handbook for NewMembers. New York: The United Chaptersof Phi Beta Kappa; 1948:5-10.

2. Greek-Letter Societies and CollegeFraternities. In: The EncyclopediaAmericana. Vol. 13. New York: AmericanaCorporation; 1938:401-2.

3. Wright JD, Jr. Transylvania: Tutor to theWest. Lexington, Kentucky: TransylvaniaUniversity Press; 1975, pp. IX-X & 1-175.

4. Editorial. History of the medical departmentof Transylvania University. JAMA 1905;44:1856-7.

5. Jefferson T. Letter to Joseph C. Cabell, Jan.20, 1820. In: Ford, P.L., ed. The Writings ofThomas Jefferson. Vol. 12. New York: G.P.Putnam's Sons; 1905:154-5.

6. Thomas Jefferson was an ardent advocatefor public education and felt that the landsin the west belonged to all the people andnot to land speculators. He had opposed theprivately owned Transylvania Company,which had purchased lands between theCumberland and Kentucky Rivers from theCherokee Indians in 1775 and sold parcelsto settlers [34]. His Land Ordinance of 1787designated other lands beyond theAlleghenies to support education. It is like-ly that Jefferson promoted the Virginia leg-islature's grant in 1780 of escheated landsfor a “Public School” in “the County ofKentuckee.”

7. Famous early 19th century alumni ofTransylvania University included HenryClay, Stephen F. Austin, Cassius M. Clay,Jefferson Davis, and two United States vicepresidents: Richard M. Johnson, and JohnC. Breckinridge.

8 A scrupulous scholar might argue thatTransylvania's Department. of Medicine wasnot the fifth medical school founded in thiscountry but the seventh or eighth because ofseveral others established in the late 18th cen-tury [9]. 1) In Philadelphia in 1765, medicalfaculties existed at both the University ofPennsylvania and the College of Philadelphia.In 1791, these two schools merged under thename of the former. 2) In New York City amedical department was established in 1792at Queen's College (later Rutgers College).Teaching here was “suspended before 1800,”resumed when the school was reorganized,but ceased in 1828. 3) A short-lived medicalschool was also founded at The College ofWilliam and Mary in 1779; it granted only onedegree —an honorary one in 1782. Concernfor priority rankings here pales in the knowl-edge that North America's first medical schoolwas founded in Mexico City nearly a centurybefore, in 1578 [35].

9. Fishbein M. The organization is conceived.In: A History of the American MedicalAssociation 1847 to 1947. Philadelphia:W.B. Saunders Company; 1947, pp. 19-26.

10. Burr HS. The founding of the medical insti-tution of Yale College. Yale J Biol Med1933;6:333-40.

11. Rothstein WG. Medical education 1825-1860 In: American Medical Schools and the

54 Ambrose: The Kappa Lamda Society

Practice of Medicine. Oxford: OxfordUniversity Press; 1987:51.

12. Norwood WF. Medical education in theUnited States Before 1900. In: O'MalleyCD, ed. The History of Medical Education.Berkeley: University of California Press;1970:463-99.

13. Norwood WF. The Schools of Kentucky. In:Medical Education in the United StatesBefore the Civil War. Philadelphia:University of Pennsylvania Press;1944:289-303.

14. The Special Collections and the Museum atTransylvania University represent time cap-sules of 19th century medicine and science.The Special Collections hold 1,772 theseswritten by medical graduates, 1,800 19thcentury medical books, and over 800 suchbooks printed before 1800 [36]. TheMuseum contains numerous wax models(anatomical and pathological) plus “philo-sophical apparatus” made in the early 19thcentury, such as planetaria, Magdeburgspheres, electrostatic machines, a Lucernalmicroscope, an Archimedes screw, etc. [37].

15. Leake CD. What was Kappa Lambda? AnnMed Hist 1922;4:196-206.

16. Hopkins DR. Princes and Peasants:Smallpox in History. Chicago: University ofChicago Press; 1983:380.

17. Duels date back to antiquity (Achilles andHector, David and Goliath) and were stillcommon in 19th century Europe andAmerica, as any encyclopedia will describe.In this country not only politicians(Hamilton vs. Burr, Henry Clay vs. JohnRandolph, Andrew Jackson vs. numerousopponents) but doctors also engaged in thisoften fatal exercise. As noted in the text, alocal example involving three Transylvaniaprofessors occurred in 1818, when Dr.Benjamin Dudley challenged Dr. DanielDrake to duel (see note [38]). Drakedeclined (as later he would other challengesin Cincinnati), but his honor at Transylvaniawas defended by a colleague, Dr. WilliamRichardson. Dudley's bullet severedRichardson's femoral artery, and the latterwould surely have bled to death had notDudley rushed over to the victim and, afterasking his permission, applied his thumbover the groin, allowing time for a ligatureto be fixed in place. “The two men werelife-long friends from that moment” [3].

18. Ellis JH. Medicine in Kentucky. Lexington,Kentucky: Kentucky University Press;1977: pp 43-44.

19. Flexner JT. Genius on the Ohio: DanielDrake. In: Doctors on Horseback. New York:Dover Publications, Inc.; 1937:151-214.

20. van Antwerp LD. Kappa Lambda: Elf orOgre? Bull Hist Med 1945;17:330.

21. When this paper was presented as a talk atApril 2005 meeting of the American OslerSociety, Dr. Charles G. Roland, a memberand former president, made the astute sug-gestion that the two Greek letters might alsohave referred to the first letters in Kentuckyand Lexington, respectively.

22. Haakonssen L. Benjamin Rush: medicalethics for a new republic. In: Medicine andMorals in the Enlightenment: John Gregory,Thomas Percival and Benjamin Rush.Atlanta, Georgia: Rodopi; 1997:219.

23. Ingen PV. Remarks on “Kappa Lambda, elfor ogre?” and a little more concerning thesociety. Bull Hist Med 1945;45:513-38.

24. Vaughn WP. The Morgan affair and Its conse-quences. In: The Anti-masonic Party in theUnited States 1826-1843. Lexington, Kentucky:University Press of Kentucky; 1983:1-9.

25. “Wight”: This is an Old Saxon word mean-ing a contemptible creature, often supernat-ural or preternatural in nature. OxfordUniversity English Dictionary. Vol 10.Oxford: Oxford University Press;1937:2426.

26. Fishbein M. The first annual session. In: AHistory of the American MedicalAssociation 1847 to 1947. Philadelphia:W.B. Saunders Company; 1947, pp. 41-47.

27. Cassedy JH. Medicine and the Westwardmovement. In: Medicine and AmericanGrowth 1800-1860. Madison, Wisconsin:University of Wisconsin Press; 1986:60-93.

28. Burns CR. Reciprocity in the development ofAnglo-American medical ethics, 1765-1865.Proc. XXIII International Congress Historyof Medicine. London; 1972, pp 813-9.

29. Kolaja J. Historical development of medicalethics in the United States. World Med J.1954;1:155-7.

30. Leake C. Code of ethics of the AmericanMedical Association. In: Percival's MedicalEthics. Baltimore: Williams & Wilkins;1927:218-238.

31. Fishbein M. A permanent national associa-tion. In: A History of the American MedicalAssociation 1847 to 1947. Philadelphia:W.B. Saunders Company; 1947:30-4.

32. Miller H. Minutes of “a meeting of the ΚΛSociety of Hippocrates…” Dec. 11, 1822.University Archivist, TransylvaniaUniversity, Lexington, Kentucky.

33. Mayo WP. Kappa Lambda Society. In:Medicine in the Athens of the West.McClandan Publishing Co.; 1999:64-89.

34. Randall WS. Thomas Jefferson: A Life. NewYork: Henry Holt and Company; 1993:708.

35. The Encyclopedia Americana. Vol. 18. NewYork: Americana Corporation; 1938, 760.

36. Catalogue of the Transylvania UniversityMedical Library. Lexington, Kentucky:Transylvania University Press; 1987:635.

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37. Brown LA. Early Philosophical Apparatusat Transylvania College (and Relics of theMedical Department). Lexington, KY:Transylvania College Press; 1959:117.

38. The most famous physician in the OhioValley during the first half of the 19th cen-tury was Daniel Drake (1785-1852) — cre-ative, charismatic, but also somewhat con-tentious. He taught at Transylvania duringthree different periods. His restless combat-iveness was reflected in the 11 academic

moves he made through six medicalschools. He founded the Medical College ofOhio at Cincinnati in 1819. A year later hewas expelled from its faculty even while hewas the presiding officer of the meeting.Once Drake met one of the College's pro-fessors on the street. As they approached theprofessor said, “I do not propose to stepaside for a fool.” Drake replied, “I will” andstepped aside [19].

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