THE ROLE OF THE "DISTRICT" AS
A UNIT IN OR-
GANIZED MEDICINE IN OHIO1
By ROBERT G. PATERSON, PH.D.
Use of the "district" as a
basic unit of medical organization
and administration is, historically, the
oldest in the State. It ante-
dates the county, city and state medical
societies. A "district" in
the sense in which it is used here
includes within its area two or
more counties. From 1811 to 1902 the history of
medical organi-
zation in Ohio is full of the trial and
error method in attempting
to find a satisfactory unit or units as
the basis for local organiza-
tion.2
Broad Outline of Developments
Beginning in 1811 and continuing to
1833, known as the le-
gal period of organization, the laws of
the State established medi-
cal districts in the then existing
counties. "The first of Ohio's
eighty-eight counties (Washington) was
established in 1788. The
last revision in the boundaries
(Auglaize, Logan) was made in
1888, exactly one hundred years
later."3 By 1833 there were
seventy counties in the State.
Population was sparse and scat-
tered. The 1830 census showed 937,903
population. Physicians
were few in number and likewise
scattered. Roads and transpor-
tation were primitive. So it was natural
for the State legislature
to adopt the district as the basis for
the establishment of local
boards of censors, the prime purpose of
which was to license
physicians to practice within the State.
The law of 1812 went
one step further when it provided for a
State medical convention
to be composed of representatives from
each of the five medical
districts. From 1811 the number of
districts grew from five until
in 1833 there were twenty-two districts
set up. After the repeal
1 While the period set for discussion
covered the years 1885-1858, it was thought
best to treat this subject as a complete unit from 1811
to 1940.
2 See Guy Thompson, District Medical
Organization in Ohio. Thesis, M.A., Ohio
State University, Columbus, Ohio, 1987.
3 R. C. Downes, "Evolution of Ohio
County Boundaries," Ohio State Arch-
aeological and Historical Quarterly (Columbus, 1887.), XXXVI (1927), 340ff.
(367)
368
OHIO ARCHAEOLOGICAL AND HISTORICAL QUARTERLY
of all such laws in 1833 physicians had
no means of congregating
in meetings other than those of local
scope. The first of these was
the Cincinnati Medical Society organized
in 1819.
In 1835 the first form of voluntary
State medical organiza-
tion was created. It was known as the
"Ohio Medical Conven-
tion." The present Ohio State
Medical Association rightly traces
its origin to this date. The convention
continued to 1851 when it
was merged with the Ohio State Medical
Society organized in
1846. At first members of the State
convention were listed in-
dividually from counties. By the time
the State society was or-
ganized, Ohio had been divided into 83
counties. Population had
increased to 1,980,329 in 1850. Physicians also
had increased in
number. Transportation and the means for
travel had improved
vastly. Roads and canals had been spread
in every direction
throughout the State.
Since the State meeting occured but once
a year there was a
growing demand upon the part of
physicians for some medium
through which they could gather together
more frequently to dis-
cuss their professional problems. These
media took two forms--
the county medical society and the
district medical society. One
of the earliest considerations before
the State society was the mat-
ter of determining what should
constitute an auxiliary society. In
1857 it was deemed necessary to
incorporate in the constitution of
the State society a provision which
sought to improve reports
from the local societies both district
and county. With variations
this attitude was continued until 1902 when all district societies
were excluded as auxiliaries and the
county form was adopted as
the sole unit of organization.
Legal Period of District Medical
Organization
A more detailed examination of the legal
period of district
medical organization reveals a number of
interesting develop-
ments and merits attention at this
point.
Dr. Samuel Prescott Hildreth of Marietta
was elected to the
House of Representatives from Washington
County in 1810.
Almost immediately after taking his
place in the General As-
OHIO MEDICAL HISTORY, 1835-1858 369
sembly he introduced a bill seeking to
give the State some measure
of control over those individuals who
sought to heal the sick. In
a preamble to the bill4 it is
stated, "Whereas the practice of physic
and surgery is a science so immediately
interesting to society that
every encouragement for its promotion
should be given, and every
abuse of it, so far as possible
suppressed."
The law, effective January 14, 1811, divided the
State into
five medical districts. A board of three
medical censors or exam-
iners, members of which were named in
the law, was provided in
each of the five districts. The boards
were to meet on the first
Monday of June and November at
designated centers, viz: Cin-
cinnati, Chillicothe, Athens,
Zanesville, and Steubenville. Exami-
nation of the membership of these five
district boards reveals
some illustrious names in the annals of
medical history in Ohio.
They are as follows:
District 1. Joseph Canby, Richard
Allison, Daniel Drake.
District 2. Edward Tiffin, Alexander
Campbell, Joseph Scott.
District 3. Leonard Jewit, Eliphas
Perkins, Samuel P. Hildreth.
District 4. John Hamm, John J. Brice,
Robert Mitchell.
District 5. George Wilson, John
M'Dowell, Thomas Campbell.
At the very next session of the General
Assembly, the law of
1811 was repealed and a new law5 enacted,
effective February 8,
1812. Again we find a preamble stating "Whereas well
regulated
medical societies have been found useful
in promoting the health
and happiness of society by more
generally diffusing the knowl-
edge of the healing art, and thereby
alleviating the distress of
mankind." Seven districts were
created and out of these seven
districts there was created by law a
State society styled "The
President and Fellows of the Medical
Society of the State of
Ohio." The law listed one hundred
and twenty physicians
throughout the State who were to
constitute the society. Places
of meetings of the district
representatives were designated as Cin-
cinnati, Chillicothe, Athens,
Zanesville, Steubenville, Warren and
Dayton. Meetings were to be held on the
first Monday in June.
These district societies were empowered
to elect not less than
4 Ohio Laws, Statutes, etc., Acts,
9 Assemb., 1810-11 (IX), 19.
5 Ibid., 10 Assemb., 1811-12 (X), 58.
370 OHIO
ARCHAEOLOGICAL AND HISTORICAL QUARTERLY
two, nor more than three,
representatives to the State society
which was to meet in Chillicothe on the
first Monday of Novem-
ber. A quorum of ten members was
required for this State
meeting.
On November 2, 1812, there
gathered at Chillicothe five dele-
gates from the first and second
districts. These hardy souls were:
Daniel Drake, Cincinnati, and Joseph
Canby, Lebanon, from the
first district; Samuel Parsons,
Franklinton; and John Edmiston
and Joseph Scott, Chillicothe, from the
second district. It is not
clear at the present time whether the
other five districts actually
appointed delegates. If they did the
delegates failed to make their
appearance. Even Hildreth, the author of
the first law, did not
attend. Since the law specified a quorum
of ten members no con-
vention was held.
At the next session of the General
Assembly this law was
repealed and a return6 made
to the law of 1811. Between 1813
and 1821, the General Assembly amended,
repealed and enacted
the law on three7 separate
occasions.
On February 26, 1824, the General
Assembly passed a new
law8 entitled "An Act to
Incorporate Medical Societies for the
Purpose of Regulating the Practice of Physic
and Surgery in this
State." It repealed the law of 1821
and remained in force, with
minor amendments, until 1833 when it,
too, was repealed. Again,
we find the pious preamble to the effect
that "whereas, well reg-
ulated medical societies have been found
to contribute to the dif-
fusion of true medical science, and a
correct knowledge of the
healing art."
With the rapid growth in population of
the State and the in-
crease in the number of counties, which
now numbered seventy, it
became necessary to divide the State
into twenty medical districts.
The counties comprising each district
were enumerated and the
names of physicians constituting each
district medical society were
given. With variations this method was
continued by the General
Assembly until 1833 when all such laws
were repealed.
6 Ibid., 11 Assemb., 1812-13 (XI), 28, Jan. 19, 1813.
7 Ibid., 15 Assemb., 1816-11 (XV), 195, Jan. 28, 1817; 16 Assemb.,
1817-18 (XVI),
105, Jan. 30, 1818; 18 Assemb., 1819-20
(XVIII), 162, Feb. 22, 1820.
8 Ibid., 22
Assemb., 1823-24 (XXII), 142.
OHIO MEDICAL HISTORY, 1835-1858 371
Thus dosed the first period of medical
organization in Ohio.
Regulation through legislation had
proved a dismal failure. It
was not until 1868 that a return to this
method is to be noted and
the law then enacted was so weak in its
effects that in 1896 the
General Assembly finally set up the
present form of regulating
the practice of medicine.
Voluntary Period of District Medical
Organization
Between 1833 and 1835, the physicians
throughout the State
had no means by which they could gather
together for discussion
of their professional problems except
for the few local medical
societies which existed. In 1835 the
organization of "The Medical
Conventions of Ohio" on a voluntary
basis was effected. These
continued until 1851. Membership in these conventions was open
to all regular physicians throughout the
State on an individual
basis. This situation continued to exist
until 1846 when the Ohio
State Medical Society was organized.
The Ohio State Medical Society soon
became a delegated
body and scores of local medical
societies sprang up either as
auxiliary to or independent of it. A
study of the Transactions
of the Ohio State Medical Society reveals
that one of the earliest
considerations before it was the matter
of auxiliaries. From its
auxiliaries, the State society drew its
strength and it constantly
promoted local organization. It
frequently found reason to quar-
rel with its component societies and in
many cases refused to ad-
mit a local society because its
constitution did not embrace some
code of ethics which was deemed
essential.
The development of the constitution of
the Ohio State Medi-
cal Society gives an insight to the
story of district societies. The
first formal recognition of the need for
a plan for auxiliaries is
found in a report9 of the
committee on a new constitution and
code of by-laws and a plan for the
organization of auxiliary so-
cieties. This plan which was adopted May
16, 1848, was:
Associations desirous of becoming
auxiliary, must furnish to the Com-
9 Ohio State Medical Society, Transactions
. . . from Its First Organization in
1846 to the Close of Its Last Session in 1850, with
Addresses and Essays (Columbus,
1850), 5.
372 OHIO ARCHAEOLOGICAL
AND HISTORICAL QUARTERLY
mittee on Medical Societies a copy of
their Constitution and By-Laws, and
a list of their members. The Committee
will report thereon, a majority vote
of the Society, admitting as members the
President and Secretary, ex-officio,
together with one delegate for every ten
members the proposed auxiliary
society may consist of. Delegates will
present to the State Medical Society,
such papers, etc., etc., as the
Association they represent may select, copies
of which they will deposit with the
Committee on Publication.
In questions of a general nature
affecting the profession of the State,
should the yeas and nays be demanded,
the delegates, on producing the indi-
vidual authority of each, may vote by
proxy for absent members of the
State Medical Society, who are also
members of the Same Association with
the delegate.
Auxiliary Societies will, so far as
possible, contribute to the furtherance
of the objects of the State Medical
Society, by selecting from their own
archives such original papers, essays,
reports, and especially statistics, as
they may deem of sufficient value, on
every subject connected with medical
science.
In 1850 a listing of auxiliary societies
showed the following:
1849. Hamilton County Medical Society
.................Auxiliary No. 1
1849. Warren County Medical Society of
Lebanon .......Auxiliary No. 2
1849. Clark County Medical
Society....................Auxiliary No. 3
1849. Lancaster Medical Institute
.......................Auxiliary No. 4
1849. Preble County Medical Society
...................Auxiliary No. 5
1850. Meigs County Medical
Association................Auxiliary No. 6
1850. Wayne County Medical Association...............Auxiliary
No. 7
1850. Richland County Medical &
Surgical Society .......Auxiliary No. 8
1850. Medical Association of Adams,
Brown & Clermont.Auxiliary No. 9
1850. Stark County Medical Society
....................Auxiliary No. 10
1850. Erie County Medical Society
.....................Auxiliary No. 11
In 1857, it was deemed necessary to
incorporate in the Con-
stitution of the Ohio State Medical
Society something which
would improve reports from the local
societies. From the first,
auxiliaries had been requested to submit
annually a "catalogue"
which included a list of its members,
papers and similar informa-
tion. The local societies were very
dilatory in complying with
this request and the State secretary
reprimanded them every year
in his report. Even after the amendment
of 1857 the reports were
unsatisfactory. The State secretary frequently changing
each
year, appears not to have performed his
work very well.
The State society was still recognizing
district societies in its
OHIO MEDICAL HISTORY, 1835-1858
373
constitution as late as 1891. The State
secretary in 1893 pointed
out that the work of the county
societies was anything but satis-
factory. He lamented the general
inactivity of the county societies
and gave the impression that they were
losing the position of im-
portance which the State society had
hoped for them. He said:
Why this state of lethargy or inactivity
or lack of interest in the county
societies? The fact is very prominent
that the county societies, which are
least active, are located within the
boundaries of flourishing district societies.
Without hastening to condemn the
district societies, for their success must
be prima facie evidence that they are
supplying a real demand in medical
society work, we must conclude that they
are depriving the county societies,
if not also the State Society of the
interest that should be taken by them.10
This struggle between the county,
district and State society is
to be noted each year until in 1902
when the State society changed
its constitution to comport with that of
the American Medical
Association. Article III of the
constitution read: "Component
societies shall consist of those county
medical societies which hold
charters from this Association."
The adoption of this provision
marked the downfall of district medical
societies in Ohio.
So far as can be ascertained the
district medical societies
which were organized in Ohio and which
were represented in the
Ohio State Medical Society by delegates
were:
The Medical Association of Adams, Brown
and Clermont,11
was organized Jan. 21, 1847. This was the first district medical
society in Ohio and was the first such
auxiliary of the State so-
ciety. It continued as such until 1884
when it disappeared from
the rolls of the State society. One
cannot be sure if the organiza-
tion was really active until 1884 or if
the State secretary was
careless in preparing his reports.
Records do not reveal the organization
of another district
medical society in the State for
seventeen years when there was
organized, April 12, 1864, the Union
Medical Association of Co-
lumbiana, Mahoning, Portage, Stark and
Carroll counties.12
This society was composed of physicians
of the "old school"
10 Ohio State Medical Society, Transactions
(Columbus, 1851-1904), 1893, 7-8.
11 Lancet-Clinic (Cincinnati, 1842-1916), VII (1848), 285.
12 Brant and Fuller, pub., History
of the Upper Ohio Valley (Madison, Wis.,
1891), II, 161.
374
OHIO ARCHAEOLOGICAL AND HISTORICAL QUARTERLY
or what is termed by them "regular
practice" and from the origi-
nal faith and practice it never
departed. A committee of five was
appointed in 1866 to effect an
organization of county societies in
the counties composing the union. This
is the only instance that
was found where such an action was taken
by a district society.
It continued as an auxiliary of the
State society until 1902.
The Union District Medical Association
was organized Oc-
tober 22, 1867. This society is unique
in Ohio in that it included
counties in both Ohio and Indiana. At
first it included Union
County (Indiana) Medical Society and
Butler County (Ohio)
Medical Society. Later Fayette and
Franklin counties (Indiana)
and Preble County (Ohio) were added.
This society never be-
came an auxiliary of the State society.
Delegates were sent to
the State meetings in both Ohio and
Indiana. On April 27, 1939,
it held its 142d semi-annual meeting at
Eaton, Ohio.13
The Central Ohio Medical Society was
organized June 14,
1869. This society became an auxiliary
of the Ohio State Medi-
cal Society July 1, 1869. It met
quarterly and drew most of its
membership from Columbus and vicinity.
From the record the
society existed as a paper organization
after 1896. The last meet-
ing of which we have record was a joint
session with the North-
western Ohio Medical Society in 1903.
The Northwestern Ohio Medical
Association was organized
about 1869. The actual date of
organization of this body is ob-
scure. It was admitted as an auxiliary
of the Ohio State Medical
Society in 1869 and continued as such
until 1902. In 1892 it as-
sented to Article 3, Section 10, of the
State Constitution and thus
was allowed to continue as a component society.
In that year, the
list of members which appeared in the Transactions14
numbered
255. The State society had only 428
members at this time. How-
ever, this statement should be qualified
by saying that there were
probably incomplete returns of the State
society's membership
from local societies. The last official
trace of the society is in
1903.
The Union Medical Association of
northeastern Ohio was
13 Ohio State Medical Journal (Columbus, 1905- ), XXXV
(1939), 636.
14 Ohio
State Medical Society, Transactions, 1892, 18.
OHIO MEDICAL HISTORY, 1835-1858 375
organized about 1870. Again, the actual
date of organization of
this society is obscure. It was admitted
as auxiliary of the Ohio
State Medical Society in 1870. The
membership was drawn from
nine counties in northeastern Ohio and
does not seem to have ex-
ceeded 250 at any one time.15
The Miami Valley Medical Society was
organized June 13,
1877. This society drew its membership
from Clermont, Hamil-
ton and Warren counties at the time of
organization. Later it
extended its area to include Butler,
Clinton, Greene and Highland
counties. In 1901 the society had a membership of only ninety-
seven members when there were 1228 physicians in
the counties
comprised in the district.16 The
society existed as late as 1907
when the thirtieth annual meeting was
held at Loveland, Ohio,
October 8.
The North Central Ohio Medical Society17
was organized
March 31, 1881, at Mansfield, Ohio,
largely through the active
efforts of Dr. Robert Harvey Reed. It
was accepted as an
auxiliary of the Ohio State Medical
Society in 1881 and con-
tinued as such until 1902. Its
membership was never large, not
exceeding 100 in the best years.
The Southwestern Ohio Medical -Society18
was organized
August 31, 1889, at Cincinnati and
included twenty-four counties
in its area from southwestern Ohio.
Meetings were held twice a
year. Its membership numbered around
100. It never became an
auxiliary of the Ohio State Medical
Society. The date it ceased
to function is shrouded in obscurity.
The Eastern Ohio Medical Association19
was organized in
1892. This society embraced Belmont,
Columbiana, Harrison and
Jefferson counties. It was admitted as
an auxiliary of the Ohio
State Medical Society in 1894 and
remained as such until 1902.
Its membership never exceeded 100.
In addition to the district societies
listed there were a number
of others organized about which data are
fugitive. These were:
15 Ibid, 1901, 473.
16 Lancet-Clinic, XCVIII (1907), 336.
17 Mansfield Herald April 7,
1881.
18 Lancet-Clinic, LXII (1889), 257-8.
19 Columbus Medical Journal (Columbus, O., 1882-1916), XIII (1894), 65-72.
376
OHIO ARCHAEOLOGICAL AND HISTORICAL QUARTERLY
The Northern Ohio District Medical
Society was organized
sometime in the early '90's. This
society was probably a combi-
nation of the three district societies
in the northern part of the
State and seems to have been designed to
promote a legislative
program.
The Muskingum Valley District Medical
Society was or-
ganized in the later '80's. This society
became an auxiliary of the
Ohio State Medical Society in 1886 and
disappeared as such after
1891.
The Midland Medical Society of Fayette
and Adjoining
Counties was rejected by the Ohio State
Medical Society and
never appears in any lists.
It is doubtful if the Delamater Medical
Association of
Norwalk and Vicinity comes within the
definition of a "district
society." The Transactions show that it was admitted as an
auxiliary of the Ohio State Medical
Society in 1859 and dropped
in 1870.
Very little can be learned of the
Athens, Morgan and Wash-
ington Medical Association. It appears
to have been the second
district society to become an auxiliary
of the Ohio State Medical
Society. This was in 1855. It was
dropped from the rolls in
1884.
Nothing was learned about the origin of
the Northeastern
Ohio Medical Association. It was
admitted as an auxiliary of
the Ohio State Medical Society in 1870. It disappeared
from the
rolls in 1892.
The Southeastern Ohio Medical
Association was admitted as
an auxiliary of the Ohio State Medical
Society in 1890. It was
dropped from the rolls in 1892.
Facts relative to the Ashtabula, Lake
and Geauga Medical
Society are difficult to obtain. It was
active in the middle '90's.
Thus we find the period 1846 to 1902 filled with
the activities
of physicians organized on a district
basis. Unfortunately, the
records are difficult of access or do
not exist. There are physicians
in Ohio still alive who have knowledge
of one or more of such
organizations and what a contribution
these men could make to
OHIO MEDICAL HISTORY, 1835-1858 377
medical history in Ohio if they would
set themselves to the task
of detailing such histories.
After 1902 the "district" came
back into use by the Ohio
State Medical Association as a basis for
membership in the
"Council." The struggle
between the "county society" and the
"district society" was
resolved by using the "county society" as
the basis for membership in the State
association and the creation
of the House of Delegates as the
legislative body representing
county societies. The component county
societies were then
grouped into districts for the purpose
of creating a Board of
Directors of the State association which
is known as the "Coun-
cil" with one representative from
each of the districts, of which
there are eleven at the present time.