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Annual 6 Chapter 1
 

Relicensing Central European Refugee Physicians in the United States, 1933-1945
by Eric D. Kohler

Between 1933 and 1941, approximately 240,000 Jews found sanctuary from Nazi persecution in the United States. The history of this migration has usually been presented as an unusual success story, in which an illustrious company of refugees bested economic adversity, overcoming xenophobia and antisemitism, to emerge as a major force in American culture and science.1 But only a tiny minority of refugees found rapid employment as scholars and artists,2 and only a slightly larger minority of skilled workers-for example, bakers-made a rapid economic adjustment.3 For the vast majority of refugees, adjustment proved difficult as businessmen and professionals tried to start a new life. In large cities, small towns, and rural areas they faced the harsh conditions of the depression.4

Only one group among the obscure refugees arriving from Nazi Europe in the United States during the 1930s and early 1940s collectively succeeded in escaping the loss of status that generally accompanied emigration. These were the physicians.5 There were 3,097 of them (61.2 percent of the 5,056 immigrant physicians admitted to the United States between 1933 and 1940); they were relicensed in 15 American states.6 The statement "once a doctor, always a doctor"7 proved valid for these refugee physicians and, more important, they bested the system twice. First, they entered the country despite immigration laws written to discourage entry;8 second, they were the only refugees who could again collectively become what they had been, despite considerable opposition from the native medical establishment.

The refugee physicians succeeded in the United States because of the doctrine of states' rights: requirements for a license to practice medicine were different in each of the 48 states. Indeed, had the refugee physicians come a decade sooner in the early 1920s, they would have faced far more favorable conditions. First, they would have benefited prior to I July 1924 from a provision in the 1917 Immigration Act that granted preferential nonquota visas to physicians.9 Second, they would have been received by an American medical elite whose claim to elevated professional status frequently rested on training in Germany and Austria-those countries had been the model for the reform of American medical education between 1906 and 1920.10 Finally, the refugee physicians would have arrived at a time when only seven states required American citizenship for medical licensure.11 The refugees arrived, however, in the 1930s, not the 1920s. Yet it was precisely during the decade following 1924 that the professional situation for immigrant physicians in the United States changed radically. Paradoxically, this change was primarily due to the triumph in this country of the Central European model of university-controlled medical education.

Under that model, access to medical training required the possession of an academic high school diploma, that is, the Abitur (in Austria, the Matura) from the Gymnasium. Obtaining that document required intellectual ability and family finances. Although university education was cheap in Central Europe, the Gymnasium training that was its prerequisite was not. To provide it, a family had to pay tuition and book money, and also dispense with the potential earnings of the child for more than a decade beyond the normal departure age from school.

Although economically biased, this system was blind toward race, religion, and gender. The Abitur or Matura was an entitlement to study; success in two oral examinations administered by a medical faculty was the primary condition for licensure to practice medicine. Considering their middle-class background and their commitment to education, as well as the social barriers that excluded them from other careers, it is not surprising that in January 1933 German Jews, who were only I percent of the German population, provided 15.7 percent of Germany's 51,007 physicians.12 Similarly, in Austria 186, 000 Jews, most of them concentrated in Vienna, provided some 2,000 physician. These Central European physicians constituted more than half of the estimated 15,000 Jewish physicians in continental Europe.13

By the 1930s American medicine, aided by some major foundations, had adopted half of the scientifically superior Central European medical education system. By that time American medical education required the same kind of expensive, massive preliminary preparation as its European counterpart. Effectively it was closed to all but those who could afford ten years of study beyond high school.14

Yet while American medical education had imported the European economic preconditions for study, it had not copied the indifference toward the individual applicant found in Europe. Because of the highly decentralized nature of American primary and secondary education, and the vast differences in the quality of primary and secondary school preparation, admission to medical study was not an entitlement conveyed by an Abitur, or Matura, or even a college degree. Rather, it depended on the ability of an applicant to pass muster of a committee or a dean of the medical school.

As the number of medical schools shrank from 131 to 81 between 1910 and 1930, admission became a highly competitive affair refereed by deans and admission committees generally belonging to the ruling group of white, Anglo-Saxon Protestants, the so-called WASPs, whose prejudices worked against four groups: Jews, Italians, women, and blacks.15 Indeed, between the end of World War I and the end of World War II, most private Eastern colleges and universities adopted informal quota systems aimed at limiting their Jewish enrollments.16 In the medical schools this discrimination reached its high point in the middle and late 1930s; that is, it coincided with the influx of refugee physicians from Nazi Germany, Austria, and Czechoslovakia.17 Since over 70 percent of the medical refugees were Jews, their mere presence would reinforce institutionalized medical antisemitism.

Denied entry into American medical schools, Italian and Jewish victims of this discrimination began studying abroad, primarily in England, Scotland, Germany, and Italy.18 With more than 9,000 Americans studying abroad between 1930 and 1936, the American medical establishment, fearful of this competition, embarked on a campaign to devalue foreign medical credentials.19 Within a decade the German or Austrian medical degree, once the cachet of superiority, became the badge of the second-rate.20

The success of this campaign can be measured by its results. In 1940 only 15 American states continued to permit foreigners and Americans with foreign medical credentials, Canada excepted, to take licensure examinations.21 Of those states, five deliberately discouraged such persons from applying.22

These restrictions were imposed by 48 sovereign licensing boards. Usually composed of gubernatorial appointees drawn from the ranks of the practicing physicians in the state, board members were chosen less for professional distinction than for geographic equity or, more important, their relationships with the incumbent governor. Generally these boards met three times a year for two purposes: (1) examining candidates for medical licensure; and (2) chastising fellow physicians who had run afoul of anti-abortion and narcotic abuse statutes. Between meetings the chief executive officer of the boardsometimes a bureaucrat with a medical degree-exercised its authority.

The professional fates of most refugee physicians were thus determined by the bureaucrats who headed the medical licensing boards. Of these 48 chiefs, the most important were Harold Rypins in New York, Walter Bierring in Iowa, Thomas Crowe in Texas, Herbert Platter in Ohio, and Charles Pinkham in California. They wieldedtheir power for very long periods of time. 23 Moreover, these officials frequently enjoyed a professional prestige and a legislative influence that imparted the force of law to their decisions; rarely were they challenged in the courts.

Obviously, during the worst depression in American history, the boards had a vested interest in keeping out potential competitors. Hence, they began adopting measures to deny licensure to all foreign medical graduates. In the case of Americans with foreign medical degrees, the boards, taking their cue from a March 1933 resolution of the American Medical Association (AMA), began to demand that the applicants produce licenses to practice from the countries granting their diplomas or that they complete their senior year in an approved American medical school. Since European nations rarely licensed noncitizens and virtually no American medical school accepted transfer students, these conditions in effect barred Americans with foreign medical diplomas from practicing in the United States.24 To keep out refugee physicians, who had usually obtained both their diplomas and their licenses before the Nazis had come to power, many boards began to demand full American citizenship-some five years away for most immigrants-as a precondition to relicensure.

Nonetheless, it was the good fortune of the refugee physicians that the rise in this country of competing schools of medical thought during the nineteenth century had politicized licensure. As a result, requirements not only varied between states, but were also far more flexible than in Europe.25 Further, since the influx of refugee physicians was modest until autumn 1938, when Germany revoked the medical licenses of all physicians defined as Jews under the Nuremberg racial laws, the number of immigrant physicians had been small while their prestige had been high.26 Basically, there were three types of early immigrant physicians: (1) major figures of academic and clinical research, who had been ousted from their positions on medical faculties and hospital staffs in Germany during 1933- 1934 and in Austria during 1938; (2) students who were attempting to enter medicine at the time the Nazis came to power, and who realized that they had no chance to become physicians in the new Germany; and (3) small-town practitioners, primarily from western and southern Germany, who had watched their practices evaporate under the pressure of party-sponsored boycotts.

The majority of medical refugees settled in four states-California, Illinois, Ohio, and New York-none of which required American citizenship for a medical license. Also, in these states the refugee physicians often had settled relatives who were frequently descendants of earlier waves of Jewish immigration.27

Noncitizen refugee physicians could be relicensed in certain American jurisdictions, at least in part, as the result of two local conditions unconnected to the refugee physicians. First, there was racism. California and Texas, for example, had substantial noncitizen minorities of Orientals and Mexicans, and "Anglo" physicians did not care to treat them. Accordingly, the state licensing authorities were happy to grant licenses to physicians, generally from these minorities, who would render such care. Second, in some states competing schools of medical thought-the allopathic or regular, the homeopathic, the eclectic, and the osteopathic 28-had produced deadlock among their adherents over the right to issue or deny licenses, resulting in compromises that limited the powers of the boards. Where those fights had been especially bitter, as in Massachusetts, Illinois, Indiana, and Colorado, medical boards were weak; hence the issue of a few refugee physicians, the vast majority of whom had perfectly good training, quickly became secondary. But even where existing local conditions did not automatically favor the refugee physicians, the decisions to grant licenses were based less on the law than on the arbitrary application of the law.

In California, Dr. Charles Bradley Pinkham, a Stanford University graduate with a New York homeopathic degree, was the key figure in medical licensure. For 30 years he served as secretary-treasurer of the State Board of Medical Examiners. Pinkham, who also served as president of the Federation of State Medical Boards in 1930, had good Republican political connections, a trenchant writing style, and a talent for publicizing his achievements in prosecuting charlatans. He was a legalistic physician- bureaucrat who enjoyed making the rules he enforced.29

Pinkham believed in the slogans "Buy American" and "Educate American," and he would gladly have barred all foreign medical degree holders, refugees and Americans alike, from licensure in the Golden State.30 Nonetheless, he could not keep out refugee physicians by requiring American citizenship for licensure. California, after all, was home to a large Oriental minority, which had been prevented since 1882 by federal law from obtaining American citizenship.31 Thus Dr. Pinkham's dilemma: to require American citizenship for the California license would have denied the state's Oriental population access to medical care from the one group-their fellow Asianswilling to treat them. Moreover, based on his experiences in prosecuting Chinese herbalists for unlicensed practice, Dr. Pinkham could anticipate that requiring citizenship of Oriental licensure candidates would inevitably result in a successful court challenge, if only because in the past, plaintiffs in these cases had won since they "employ[ed] the highest powered attorneys."32

Unable to bar refugee physicians, Pinkham used the AMA campaign against licensing American foreign medical graduates to discourage them. In autumn 1933 the California Board of Medical Examiners became one of the first in the country to demand as prerequisites for licensure that foreign medical graduates obtain licenses from the countries granting their diplomas as well as serve a one-year rotating internship in an AMA-approved hospital. 33 Added to the state's Business and Professions Code in spring 1935, these requirements barred licensure to younger refugee physicians who had earned their medical degrees after the Nazi takeover and were, therefore, ineligible for German licensure on account of their race. Older refugee physicians with German, Austrian, or Czech licenses remained eligible for relicensure in California. This practice had the unconstitutional effect of granting rights to certain refugee aliens with foreign licenses that were denied to American citizens with foreign medical credentials.34

Nonetheless, for five years these rules remained unchallenged, until one victim, an American with a Basel medical degree, successfully sued the board; as he described it, he mustered the bravery "for lack of an alternative."35 Thereafter, pressured by the office of the attorney general, which had consistently opposed board policy toward foreign medical graduates, the board changed its approach in two ways.36 First, so long as refugee physicians already in the state met the degree and the rotating-internship requirements, they were treated fairly. Indeed, after the outbreak of World War II, when the verification of German and Austrian credentials became virtually impossible, such applicants were even given the benefit of the doubt on unverifiable credentials and on what constituted rotating internships.37 Second, the board ensured that it would only license foreign degree holders already in the state by obtaining legislative passage on a new exclusionary tactic previously adopted in Texas and Ohio. This stratagem, enacted into law during spring 1941, modified reciprocity procedures by permitting future licensure of foreign medical graduates only to the extent that their countries would license California physicians.38 Thereafter, among the Central European refugee physicians only graduates of Czech medical faculties qualified for licenses in the Golden State.39 Indeed, in the case of a world-renowned neurologist who had been brought to California by one of the state mental hospitals, but who had not fulfilled Pinkham's requirement of a rotating internship in an AMA-approved hospital, it took until 1946, three years after Pinkham's death, for the state to grant him a license.40

These ploys had several effects on the physician refugees. First, the rotating-internship requirement, which involved uncompensated work for a year, made qualification for a California license a luxury few could afford. Those who did complete the requirement (for example, Thomas Mann's personal physician) supported themselves from the sale of valuables brought out of Germany, used money borrowed from sponsor relatives, or lived off their wives' earnings, often obtained in menial jobs.41 Accordingly, a count of identifiable refugee physicians in the California section of the 1950 American Medical Directory shows only 175 German and Austrian degree holders, about 1 percent of the 16,673 physicians in the state.42 The physicians hurt most by these policies were younger medical graduates, who completed their training and received their degrees under the Nazis, but who no longer qualified for the German license, the Approbation. As one of them put it:

When I learned that I was ineligible for a California license, I looked at a map for the nearest state where I would be treated like anyone else. That was Colorado, and I've been here for the better part of the past 50 years.43
Several conditions were present in Colorado and in its capital, Denver, "the Jerusalem of the Rockies," to make the state relatively hospitable to refugee physicians.44 First, Colorado had a politically influential Jewish community.45 Second, owing to its dry mountainous climate, Denver was headquarters to two tuberculosis hospitals of national significance: the National Jewish Hospital and the Jewish Consumptives Relief Society (JCRS). Their need for medical personnel constituted a strong argument for keeping the state open to the refugee talent that in an earlier age had founded these hospitals and made them national institutions.46 Third, Colorado was unique in the intermountain West because it had its own four-year medical school. This fact alone did not necessarily foster openness, but it prevented medical schools in other states from turning Colorado into a private licensing preserve where Boards of Medical Examiners looked askance at physicians not entitled to wear a certain school tie.47

Further, in Colorado, licensing was organized so as to prevent domination of the process by long-tenured physician-bureaucrats like California's Dr. Pinkham. Since 1915 licensure in the Centennial State had been the province of a unified board of nine medical examiners on which, by gentlemen's agreement, two members were always osteopaths.48 Appointed to six-year terms by the governor, members generally rotated through two terms, the most senior of them assuming the presidency during the last year in office, after which, by custom, they would leave the board.

By the start of the refugee influx during the mid-1930s, the osteopaths of Colorado were fighting a successful action to retain their strength on the board, despite their shrinking numbers.49 Moreover, their rivals, the allopathic "regulars," were fiercely independent and poorly organized.50 Further, miserly state appropriations for board operations and the reluctance of practicing regulars in the state to fund the activities of the board through payment of annual registration fees, a practice common in other states, left the board with other battles to fight.51 Accordingly, the matter of licensing refugees, most of them interns at Denver's two Jewish TB hospitals and headed for practice in Denver, never became an issue. Moreover, Colorado did not require an unpaid internship of one year at an AMA-approved hospital as a precondition to licensure if the applicant could prove that the condition had been previously fulfilled. Finally, the state's popular two-term governor, Edwin C. "Big Ed" Johnson, had little respect for the medical profession:

I find the medical profession filled with men very jealous of their particular School, without much brotherly love for their fellow Doctors, yet ready to make every sacrifice for their fellow men in general. I get quite a kick out of them.52
However, it must be added that until March 1935, Colorado was not the most hospitable place for refugee physicians to relocate. Indeed, in late 1934, when the first two German Jewish refugee physicians, then interns at JCRS, applied for licenses, they were warned not to make the attempt, since they "would never be licensed so long as Dr. Locke was on the Board of Medical Examiners."53 The reference was to the Denver homeopath John Galen Locke, the Grand Dragon of the Ku Klux Klan in Colorado, whose appointment to the board had been one of the last official acts of Governor Clarence Morley, a member of the Klan.54 Fortunately for the two refugee physicians involved, Dr. Locke died in March 1935. With his departure, generosity replaced bigotry on the board. The spirit of this generosity was the board's most dynamic member, Dr. Nolie Mumey.

"Surgeon, historian, builder, cabinetmaker, inventor, poet, printer, businessman, silversmith, and aviator," Dr. Mumey was a short, squat, and homely man who thrived on four hours of sleep a night.55

Despite a penchant for living well, Mumey had strong sympathy for the underdog.56 Having encountered professional prejudice as one of Denver's first surgical specialists, he had no use for intolerance. As he had spent 1931 as a postgraduate in Vienna, he understood the professional qualifications of the refugee physicians. Moreover, as a member of the highest-paid specialty in medicine-even in the depth of the Depression, an ambitious, skilled, and board-certified surgeon could earn $75,000 per year-Dr. Mumey personally had little to fear from licensing refugee physicians.57

Nonetheless, few refugee physicians took advantage of Dr. Mumey's Jerusalem. Within the extensive refugee physician information network, both in German-speaking Europe and in the United States, none of the available literature mentioned Colorado's liberal licensing laws.58 Thus the 1950 American Medical Directory shows only 25 identifiable refugee Austrian and German physicians in Colorado.59 Five older refugee physicians settled there. Two did so because their sons had obtained internships in Denver's two Jewish tuberculosis hospitals. The third went because his brother-in-law, the president of the Colorado May Company stores, one of the country's first and most successful conglomerate department stores, insisted that he leave Germany and come to Denver.60 The other two were eminent pathologists hired by National Jewish Hospital.61 The vast majority, however, owed their presence in Colorado to internships completed at Denver's two Jewish TB centers.

Between 1940 and 1945, two additional constraints also operated to prevent more refugee physicians from seeking Colorado licensure. First, the helpful Dr. Mumey left the board in 1940 at the peak of the refugee physician influx into the United States. With his departure, Dr. Ralph S. Johnston, a man with a very different perspective, became the dominant figure on the board. Where Mumey was an urbane Denverite whose supurb reputation would keep patients flocking to his office for 63 years, Johnston came from La Junta, a southeastern Colorado town of 7,200, where the Atchinson, Topeka, and Santa Fe Railroad was the major employer.

In the railway towns of the intermountain West, physicians struggled economically, regardless of their professional standing. There, having the contract to treat railway employees was a prize of great value; if the railway men liked a contract physician, they would bring their families for private treatment. In such places the issue of who got the railway medical contract would occasionally be settled by fistfights among the physicians.62

Since he was from that environment, Johnston's attitude toward refugee physicians seeking Colorado licenses was hardly as generous as Dr. Mumey's. He once told one of them, "Why should we Americans give licenses to bloody foreigners?" It was thus not surprising that the Colorado Board of Medical Examiners yielded to pressure from the State Medical Society as soon as Dr. Mumey left, and henceforth required foreign medical graduates to pass a National Board of Medical Examiners (NBME) examination. This examination was extremely taxing and constituted a stumbling block for older physicians, whose basic science education lay in the distant past.63 The results were significant: few refugee physicians were licensed in Colorado between mid-1940 and 1945. Possibly because of his role in adopting the NBME requirement, Dr. Johnston was elected president of the State Medical Society for the year 1942.

Second, restrictive hospital privileges in Colorado limited the influx of refugee physicians. Hospital privileges were far more important in the United States than they had been in Central Europe. There hospitalization was a matter of referral; once a patient went into a hospital, the referring physician surrendered that patient's care to the attending hospital medical staff. IntheUnitedStates,however,a hospitalized patient continued to receive care from his or her primary physician. In Denver, apart from Beth Israel and St. Anthony's, both small hospitals on the city's less than fashionable west side, and the specialized Jewish tuberculosis centers, none of the large Protestantaffiliated hospitals wanted Jews as staff physicians or as patients, except for refugees associated with established society physicians.64 Extremely limited hospital admission privileges remained therefore a problem for refugee physicians until a large Jewish hospital, General Maurice Rose Memorial Medical Center, was opened in 1948.

Washington was the only other western state, alongside California and Colorado, to license refugee physicians. Since Washington had no medical school before 1946, its 1919 licensure law was loose, requiring only a degree from a recognized medical school and a year of hospital internship. Only 17 refugee physicians went there, and those who did generally filled hospital internships no one else wanted. Finally, the state's director of licensure, a non-physician, Dave Cohn, was willing to substitute internship experience for statutory requirements that all applicants for medical licenses complete at least their senior medical school year in an American institution. Since the numbers were so small, the State Medical Society took no action until after World War II, when it successfully pressured the legislature into adopting a discriminatory statute.65 That legislation survived until the wife of a refugee physician, herself a graduate of the Vienna medical faculty, successfully challenged it in 1957.66

In Texas, like California, the medical needs of a large and rapidly expanding minority underclass of Mexicans historically militated against an American citizenship requirement for medical licensure.67 Although less than 25 refugee physicians were licensed in Texas, many of them recent German medical graduates, their presence aroused notice. Economically the state was depressed, and as one member of the State Board of Medical Examiners put it, "every one of them [that is, refugee physicians], unless he has an uncle with a big store, is starving in the practice of medicine."68

Accordingly, in March 1939 the Texas legislature responded to pressure from the State Medical Association and amended the Medical Practice Act to require full American citizenship for a license to practice in the state. Directed primarily against Mexican physicians who were "practicing across the state line at their will and pleasure," the new law further required that reciprocity be limited to physicians from jurisdictions that license Texas medical graduates, thus eliminating refugee physicians who had previously been eligible for licensure.69 More important, when a Mexican physician, Dr. Manuel Garcia-Godoy, who practiced in Jaurez and occasionally hospitalized patients in neighboring El Paso, challenged the amended law, a Travis County district court upheld the statute in a precedent-setting decision.70

In Illinois bitter historic disputes over licensure among the representatives of the state's various medical sects had resulted in a series of court battles that had cost the regular Illinois Medical Society its influence over licensure. 71 In 1917, the legislature had even transferred the licensing authority of the State Board of Health to a newly created Department of Registration and Education, which now acquired, aside from the authority to supervise teachers colleges, the power to license physicians, well diggers, horseshoers, beauticians, barbers, dentists, and real estate agents.72 Worse, during 1921- 1922, the new department's second head, "Colonel" William Henry Harrison Miller, a former schoolteacher turned hack politician, besmirched the integrity of Illinois medical licenses by selling them to anyone willing to pay him for one.73

Under a new Illinois licensure law of 1923, applicants graduating from medical school after the adoption of the law were required to complete a one- year hospital internship. The examination of those seeking medical licenses, however, was vested in a board of five physicians subordinated to the State Department of Education, and the ultimate power to issue medical licenses remained with an educational bureaucracy which, unless threatened by legislative interference or a lawsuit, was free to create its own rules concerning admissibility to medical practice.74

Dr. Otto Saphir, a shrewd Viennese pathologist who had arrived in the United States in 1923 and who was interested in rescuing threatened Central European Jewish physicians, noticed the loopholes in the Illinois medical licensure statutes. Dr. Saphir, who practiced at Michael Reese Hospital in Chicago, an institution that had been founded with German Jewish money in the nineteenth century, created places for refugee physicians at the hospital. Under a plan adopted in late 1935 and implemented early the following year, a dozen German refugee physicians, providing they could obtain entry into the United States, would be given one-year appointments to the Reese medical staff, thereby enabling them to overcome the principal obstacle to licensure in Illinois, the one-year hospital internship. Indeed, two of the dozen slots were reserved for recent German Jewish medical graduates who had been denied the chance to complete their training in Germany.75

Starting in 1937, when the refugee influx began to include a larger proportion of older physicians, the wily Saphir moved one step further. Recognizing that the Illinois licensure statute said nothing about the content of a hospital internship, he created unpaid "externships" at Reese for the older physicians. For a year these exiled physicians-Reese quickly dropped the adjective refugee-made their way through the hospital's wards under the guidance of American colleagues. Thereafter, armed with appropriate certificates from Reese, the physicians qualified without challenge for relicensure in Illinois.76

Saphir's hunch that the law was on his side was repeatedly vindicated. In 1941 the Illinois General Assembly passed a bill making American citizenship a prerequisite for medical licensure. Although the proposal easily passed in both legislative houses, Governor Dwight Green vetoed the bill on advice from his attorney general, who held that the measure was unconstitutional.77 Subsequently, when Dr. Leopold Schultz, a German refugee physician with more than 20 years' professional experience, sued the Illinois Department of Education and Registration for denying him a license on the ground that his application was incomplete-the documents in question had been confiscated by the Gestapo-an appellate court found in favor of the physician on the ground that "insisting on a regulation without regard to circumstances, which is more exacting than the commonly accepted rules of evidence under which the courts operate daily, is an arbitrary and unreasonable requirement."78

In a similar case, licensure was denied to an internationally known ophthalmologist from Luxembourg, who arrived in Chicago in 1941 after the German occupation of his country, because his application had arrived late and incomplete. On the advice on a Chicago internist, the family physician of his sponsor, the ophthalmologist sued and won the right to take the licensure exam. Arriving in Springfield to take the test, the physician was greeted by his examiner with these words: "So you're the fellow who sued. Well you've already learned the first lesson about life in this country: With a good lawyer, you can get anything you want."79

Indiana was another state with no citizenship requirement for medical licensure. It is difficult to explain what made this bastion of the Ku Klux Klan so liberal toward refuge physicians-perhaps it was the chronic shortage of physicians. That it remained so liberal during the 1930s can probably be explained by three local conditions. First, the State Board of Medical Examiners was constructed in such a way that it was unable to unite against virtually anything, refugee physicians included. Second, the state needed physicians. In 1931 it had one physician for every 795 persons, and its single medical school advertised that its obstetrics service was "ten times larger than required by state boards."80 Third, almost no refugee physicians went to Indiana, probably because of the extremely poor information available to refugee physicians once they arrived in the United States.

Thus one refugee pathologist ended up in Indiana because a hospital there offered him a position for which there were no other candidates, and the local coroner, a chiropractor by training, needed a properly trained medical examiner to do autopsies.81 In another case, a young man landing in New York with a fresh German medical degree was informed that at his age, given the economic difficulties then facing his fellows in New York, he ought to consider some profession other than medicine; certainly there would be nothing available for him in the Empire State. Desperate, he wrote to a medical school classmate, whose American relations had brought her to northern Indiana. By return mail he received an offer of an internship at a Catholic hospital in Lafayette. From there he went to the southern part of the state, where he established a successful practice. Writing to the medical refugee assistance service that had advised him to abandon medicine, he informed its counselors that he was doing well and that Indiana had more room for refugee physicians. The reply he received was a classic example of Eastern provincialism: "Thank you, and where is Indiana?,"82

As in Indiana and Illinois, the licensure statutes of Massachusetts were compromises written into law by politicians caught between the internecine bickering of rival nineteenth century medical sects.83 Unlike the Illinois statute, the Massachusetts licensure law of 1893, one of the oldest in the nation, was so weak that it was rarely challenged in the courts.84 Under this law, graduates of any legally chartered medical school, including diploma mills, were entitled to take the licensure examination as many times as they needed to pass.85 Moreover, throughout the 1930s the state was home to the last Class B medical school in the United States, the Middlesex Medical Academy, located on what is now the campus of Brandeis University.86 Under these conditions, the State Board of Medical Examiners was highly politicized, not to mention corrupt, with its membership consisting almost entirely of the political friends of the current governor. Obviously, the board had virtually no contact with organized or academic medicine in a state with no less than three superb medical schools, one of which was internationally renowned.87 This lack of communication worked to the advantage of the refugees. Thus, in 1938, when the State Medical Society adopted a resolution demanding full American citizenship for medical licensure in Massachusetts, the plea fell on deaf ears.88

Still, not many refugee physicians settled in Massachusetts. Those who did tended to be specialists, "often older men of outstanding ability with international reputations," who usually affiliated with the Harvard, Tufts, or Boston University medical faculties.89 For the less eminent, who could not depend on faculty associations, appointments, or consultation fees to earn a living, the state was not a particularly attractive place to settle, since its licensing procedures were so shabby as to preclude reciprocity with any other state.90

In September 1938 the German government revoked the licenses of all Jewish physicians; thereafter, the steady stream of medical emigrants turned into a mass exodus. This increasing influx of refugee physicians led states, which had previously admitted them to practice, to prevent licensure through the imposition of statutory or regulatory citizenship and/or internship requirements.91

Iowa led the way in this effort to exclude refugee physicians. In October 1938, the Iowa Department of Public Health bowed to pressure from the State Medical Society and made American citizenship a requirement for a license to practice.92 Of course, the board was not averse to such a change. The head of the board, Dr. Walter L. Bierring, a Des Moines internist who was a major figure in both the American Medical Association and the Federation of State Licensing Boards, had argued since 1933 that there were simply too many physicians per patient in the United States.93 Finally, a major court case, Craven v. Bierring, in which the latter had prevailed over a dentist whose crime had been to advertise discount dentures, left Bierring a power unto himself.94 Accordingly, his decision to close Iowa to refugee physicians met with little protest.95

In Ohio, the secretary of the medical board, Dr. Herbert Morris Platter, a Columbus dermatologist with close connections to the State Medical Society, was ill disposed toward all refugee physicians. Forced by law to accept their medical credentials, Platter originally sought to discourage them by demanding additional course work in American history, civics, and college English, subjects obviously not included in European premedical studies. One victim of this pettiness took an American history course and, in good Prussian fashion, has kept his examination bluebook until today as proof of compliance with the Ohio rules.96 Another Ohio ploy after mid-1939 was to deny reciprocity to refugee physicians with New York licenses.97 Thereafter Dr. Platter refused licenses to foreign-trained physicians on the ground that the countries where their degrees had been earned would not license Ohio-trained physicians. One victim of this gambit actually returned to the University of Cincinnati to earn the degree he had already obtained at the Universities of Vienna and Basel.98

It must be mentioned, however, that Dr. Platter was enough of a politician- he ran Ohio licensure for 48 years-to make unavoidable concessions. In 1940, when he attempted to obtain legislation requiring American citizenship as a prerequisite for Ohio licensure, he was narrowly defeated in the state legislature by a strong effort mounted from Jewish Hospital in Cincinnati, an institution whose staff included some of the most respected names in Ohio medicine. Thereafter, if and when pressure was applied from Jewish Hospital, or from other hospitals needing refugee specialists under conditions of wartime emergency, Platter would bend and issue the license.99

In Virginia, the only state of the Confederacy to license refugee physicians, medical licensure was historically a relaxed process for two reasons. First, the state attracted few medical graduates from outside its immediate borders. Second, by the 1930s the state was experiencing a serious physician distribution problem. While its major cities-Richmond, Roanoke, and Norfolk- had a ratio of one physician to approximately 450 to 500 patients, statewide the number stood at I to 937.100 Well before the exodus of Jewish physicians from Nazi Germany, rural Virginia was increasingly underserved by a rapidly aging group of medical practitioners.101

Nonetheless, generosity in licensing refugee physicians came very slowly. The first two medical refugees to appear before the Virginia Board of Medical Examiners in June 1938 were denied permission to take the state licensure examination on the ground that their credentials were imcomplete.102 The following year the board amended its bylaws to exclude refugee physicians completely.103

Within another twelve months, however, the Virginia board reversed itself. By summer 1940 it was clear that some of the poorer hospitals in the state had vacant internships that recent American medical graduates were unwilling to fill. Moreover, economic expansion, the result of orders flowing into the Norfolk and Newport News naval yards, further strained the available medical services. Finally, by June 1940 a state Committee for the Resettlement of Emigre Physicians, whose members came from the leadership of the medical establishment in Virginia, began pressuring the board to act. Assuring the board that it would bring before it "no more than ten or twelve applicants [for licensure] a year," the committee further promised that "it intended to search out for these emigres such isolated rural localities ... as might be in need of medical service ... not now supplied."104 Accordingly, the board amended its bylaws again to permit the licensing of a few selected refugees fortunate enough to have found patrons within the Virginia medical establishment.105

The most important patron was Dr. Philip St. Leger Moncure of Norfolk. Like Dr. Mumey of Colorado, Dr. Moncure was a surgeon and of Huguenot descent. From 1930 through 1946, he served as vicepresident of the State Board of Medical Examiners. A balding septuagenarian, Dr. Moncure, again like Dr. Mumey, had strong sympathies for the underdog. Practicing in the poorer parts of Norfolk, he never billed impoverished patients. As chief of surgery at St. Vincent de Paul Hospital, Moncure saw the refugee physicians, particularly those whose degrees had been recently acquired, as a means to two ends. First, they could fill internships at St. Vincent's that could not be filled otherwise. Second, they could serve as physicians needed in Virginia's underserved rural areas. Accordingly, Dr. Moncure became the moving spirit behind the board's 1940 policy reversal in favor of licensing refugee physicians.106

Dr. Moncure's help did not stop there. Thus, when one recently licensed refugee physician expressed his anxiety that he would be assigned to some remote part of Virginia after considering himself settled in Norfolk, the old surgeon advised him to find a nearby location before one further away was found for him. When the refugee physician asked whether doing so would violate the letter of the agreement he had signed to practice in an underserved rural area, Moncure replied: "Sign it son, it's all unenforceable!"107 Maryland also had no citizenship requirement for medical licensure. Unlike cities in Virginia, however, the city of Baltimore had a large Jewish population and Johns Hopkins University, a world-class medical facility. Nonetheless, few refugees were ever licensed by the Board of Medical Examiners in Maryland. As the State Medical Society, or Medical and Chirurgical Faculty, appointed the board,108 it was not surprising that without persons like Dr. Moncure or Dr. Mumey, this board was unsympathetic toward refugees and downright hostile toward Americans with foreign medical credentials. The board, therefore, lumped the two together in an effort to discredit both.109

Unable to obtain a ruling from the Maryland attorney general to bar noncitizens from taking the state medical licensing examination, the Board of Medical Examiners soon developed another approach to discourage refugees from seeking medical licenses.110 It ruled that all candidates for Maryland licenses must have their credentials verified by the schools that had granted their degrees. Whereas in Colorado, Illinois, Massachusetts, and New York, study books, diplomas, and licenses to practice from foreign jurisdictions sufficed to prove the qualifications of a candidate, Maryland demanded documentation that was almost impossible to procure from Nazi Germany.111 It is not surprising that some 65 refugee physicians, many of whom had applied for licensure in Maryland the previous autumn, were barred from taking the state examination in July 1939 on the ground that the board had not received verification of their credentials from their European universities. When asked how long these applicants would have to wait before receiving permission to take the examination, the secretary of the board, Dr. John T. O'Meara, a Baltimore internist, responded that permission might never be forthcoming.112

In neighboring New Jersey, an attempt by the State Medical Society to exclude refugee physicians from licensure failed. Without a medical school and located in the shadow of the major medical teaching centers in New York City, the state's northern urban hospitals were not attractive places for a diminished number of American medical graduates who could afford to be selective about where they would do their internships and residencies. Accordingly, during the 1930s the hospitals of Newark and Jersey City became increasingly dependent on foreign medical graduates, including refugees, to fill otherwise vacant junior medical staff positions.

Nonetheless, in 1939 the State Medical Society convinced the legislature to enact a bill requiring that all interns in New Jersey hospitals be American citizens. Although passed into law, this requirement was never enforced because the attorney general ruled that the measure was simply unconstitutional, and the Newark and Jersey City hospitals complained that this measure would deprive them of their primary source of interns.

But even licensure did not guarantee a hearty welcome from medical colleagues in New Jersey. In one farming community, where there were more than enough German refugees to require the services of an immigrant physician, the first such physician was denied hospital privileges for the better part of a decade and eventually departed in disgust. His quadrilingual successor, a refugee from the Russian revolution, fared better, probably because of his linguistic abilities in Italian, the ancestral tongue of the town's majority. With a large number of Italian patients in his practice, a denial of hospital privileges-especially for someone with a 20-year-old New Jersey medical license-would have resulted in some embarrassing questions for the medical staff of the local hospital.113

New York was the state that never closed its doors, and more than two- thirds of the medical refugees settled there. In the Empire State, licensure had since statehood in 1792 been the prerogative of the Regents of the University of New York, an artificial creation that included during the 1930s only one physician.114 Moreover, as the historic American port of immigrant debarkation, New York City, and especially its borough of Manhattan, had always been home to large numbers of unassimilated ethnic minorities who preferred physicians who spoke their language.

Refugee physicians benefited from the fact that New York was home to many victims of the antisemitic, anti-Italian admission policies adopted by American medical schools after World War I. New York was the only state in the country where, because so many had been forced to study medicine abroad, licensure of foreign-trained physicians was never an issue. Also, unlike most other states, New York did not make a virtually unpaid year of internship a precondition for admission to its examination.

Nor was the AMA argument that foreign medical training was distinctly inferior to the American version credible in New York. Manhattan was the medical center par excellence for an older generation of prestigious medical specialists whose claim to preeminence rested on credentials obtained in Berlin, Leipzig, and Vienna. In New York, it was obvious that the only difference between the supposedly superior quality of the pre-World War I European degrees of established Park Avenue specialists and the allegedly inferior training imputed to the European degrees of the refugee physicians was time and circumstance.

Keenly aware of these pressures operating in the Empire State, the man in charge of medical licensure in New York, Dr. Harold Levi Rypins, kept the state open to holders of foreign medical credentials. The Harvard-trained son of a prominent Milwaukee rabbi, Rypins also had a personal stake in this policy of openness. As the author and editor of what was then and still is the best-selling guide to medical licensure exam questions, he could not help but benefit from the increased royalties produced by the sale of his books to refugees taking the licensure examination. Nonetheless, when he was attacked for his policy of generosity, Rypins responded that "there were no international boundaries in science generally, and certainly none in medicine."115

Until 15 October 1936, foreign medical licenses more than five years old could be "indorsed" into New York licenses upon passage of an English language proficiency examination.116 Thereafter, owing to pressure from the State Medical Society, which resented the refugee physicians crowding into Manhattan, passing an English language competency examination as well as the regular state licensure examination was required. Since most refugee physicians entered the United States after autumn 1938, the vast majority of the expatriate physicians had to face written and oral examinations testing their competency in English, as well as the nation's toughest four-day written medical examination, again in English. It was thus not surprising that the initial failure rate was 70 percent and higher.117

Failure to pass the examination frequently forced a significant number of refugee physicians to work at menial jobs-dishwashing and waiting tables- before taking the examination again. As in California, the wife of the physician often kept food on the family table by working, often at unskilled or semiskilled jobs, while the physician prepared for the next encounter with a horrendously difficult examination in one of the few states left in the country where he could be relicensed to practice.118 Still, it is a testimonial to the persistence and fortitude of the refugee physicians that so many of them passed the New York licensure examination. Many of them were people well into middle age and beyond; the two oldest, both Viennese, were relicensed at age eighty.

On balance, the states that accepted refugee physicians invariably got more than they gave. Although in the 1930s and 1940s people were less litigious than they are today, my research now covering 15 states has not revealed a single record of a malpractice suit against one of the refugee physicians. Moreover, all of these physicians, regardless of age, displayed an incredible stamina and dedication to their profession. For many, - retirement came only with physical incapacitation or death. As the daughter of one of them wrote, "My father died at 94; he practiced until he was 87, when he could no longer comfortably climb the steps of Manhattan's brownstone houses."119 The secretary of the Suffolk County Medical Society noted in the obituary for another refugee physician, who on the day of his death at age 86 had seen 25 patients: "He was unable to refuse a patient no matter at which time of day or night. [Still] he kept himself up-to- date with the advances of medicine until the last day of his life."120 Although American society continues to pay significant lip service to individual initiative and merit, the good fortune of the relicensed physicians came from no merit of their own. Rather, they benefited from the historical anomalies and inconsistencies that existed within 48 separate systems of medical licensure. Left to itself, most of American medicine would gladly have followed the pattern set elsewhere in the Western world: It would have surrendered to its worst instincts and prevented the refugee physicians from ever practicing their profession again. This did not take place because the system of medical licensure lacked central control and could be challenged in the courts. But within this system, credit must also be given to individuals like Rypins, Mumey, Saphir, and Moncure, who had the strength of character to stand for what they considered to be right, regardless of the prejudices and pressures of their peers. That these men occasionally prevailed over other men like Pinkham, Bierring, and O'Meara, enriched American medicine through the presence of the refugee physicians from Central Europe.

NOTES

This article is a revised version of a lecture delivered at the Simon Wiesenthal Center, Los Angeles, 2 April 1987.

1. See Laura Fermi, Illustrious Immigrants (Chicago, 1971 ed.); and Anthony Heilbut, Exiled in Paradise: German Refugee Artists and Intellectuals in America from the 1930s to the Present (New York, 1983).

2. See Jarrell C. Jackman and Carla M. Borden, eds., The Muses Flee Hitler: Cultural Transfer and Adaptation, 1930-1945 (Washington, 1983).

3. "Volunteer Spotlight," The American Israelite (Cincinnati, 20 Oct. 1988): A-23.

4. See, for example, Lola Zahn, "Als Emigrantin in Frankreich und in den USA," Beitrfige zur Geschichte der deutschen Arbeiterbewegung 24, no. 6 (1982): 867-82; Arthur D. Goldhaft, The Golden Egg (New York, 1957), pp. 232-62; Joseph Brandes and [Rabbi] Martin 1. Douglas, Immigrants to Freedom: Jewish Communities in Rural New Jersey since 1882 (Philadelphia, 1971), pp. 319-30; Helen Epstein, Children of the Holocaust (New York, 1979), pp. 325-26; Gertrude Dubrovsky, "The Rural Experience of Jews in Farmingdale, New Jersey," in New Jersey's Ethnic Heritage, ed. Paul A. Stellhorn (Trenton, 1978), p. 43; and Eric Kohler interview with Mrs. HM, Vineland, NJ, 23 Aug. 1986.

5. See Michael Dobkowski, ed. Tile Politics of Indifference: A Documentary History of the Holocaust and Its Victims (Washington, 1982), pp. 411-26; Frances Henry, Victims and Neighbors: A Small Town in Nazi Germany Remembered (South Hadley, MA, 1984), pp. 134, 184; and P. D. Kent, The Refugee Intellectual: The Americanization of the Immigrants of 1933-1941 (New York, 1953), pp. 125-29.

6. The states were Maryland, Virginia, New York, New Jersey, Ohio, Massachusetts, Maine, Illinois, Indiana, Iowa, Texas, Colorado, Califor- nia, South Dakota, and Washington. See David L. Edsall, M.D., "The Emigre Physician in American Medicine," Journal of the American Medical Association [hereafter cited as JAMA] 114 (23 Mar. 1940): 1071; David L. Edsall, M.D., and Tracy J. Putnam, M.D., "The Emigr6 Physician in America, 1941," JAMA 117, no. 22 (29 Nov. 1941):1883; and Kathleen M. Pearle, Preventive Medicine: The Refugee Physician and the New York Medical Community, 1933-1945 (Bremen, 1981), p. 14.

7. Heinz Hartmann, M.D., Once a Doctor Always a Doctor: The Memoirs of a German Jewish Immigrant Physician (Buffalo, 1986).

8. See Herbert A. Strauss, "Jewish Emigration from Germany: Nazi Policy and Responses, Part 2," Leo Baeck Institute Yearbook 26 (1981): 343-47; Dobkowski, Politics, pp. 259-61; and Michael C. LeMay, From Open Door to Dutch Door: An Analysis of U.S. Immigration Policy Since 1820 (New York, 1987), pp. 38-102.

9. 39 Stat. 876.

10. Between 1870 and 1914, some 15,000 Americans studied medicine in Germany and Austria. See John S. Haller, ft., American Medicine in Transition, 1840-1910 (Urbana, 1981), p. 217; Paul F. Starr, The Social Transformation of American Medicine (New York, 1982), p. 113; and E. Richard Brown, Rockefeller Medicine Men: Medicine and Capitalism in Amer- ica (Berkeley, 1979), pp. 135-91.

11. See American Medical Directory, 13th ed. (Chicago, 1931), passim.

12. Jacob R. Marcus, The Rise and Destiny of the German Jew (Cincinnati, 1934), Appendix 1; Institute of Jewish Affairs, Hitler's Ten Year War on the Jews (New York, 1943), p. 7; and W. F. Mimmel, "Die Ausschaltung rassisch und politisch missliebiger Arzte," in Arzte int Nation- alsozialismus, ed. Friedolf Kudlin (Cologne, 1985), p. 62.

13. On Austria, see Yehuda Bauer, My Brother's Keeper: A History of the American Jewish joint Distribution Committee, 1929-1939 (Philadelphia, 1974), pp. 224-25; Saul S. Friedman, No Haven for the Oppressed: United States Policy Toward Jewish Refugees, 1938-1945 (Detroit, 1973), p. 39; "Foreign Letters," JAMA 112, no. 24 (17 June 1939): 2546; and M. Leo Wulman, M.D., "The Tragedy of the Jewish Physician in Central Europe," Medical Leaves 3, no. 1 (1940): 58-64.

14. Haller, American Medicine, pp. 217-33; Starr, Social Transformation, pp. 116-27; E. Richard Brown, Rockefeller Medicine Men, pp. 135-91; and Lester S. King, M.D., American Medicine Comes of Age, 1840-1920, Ameri- can Medical Association (Chicago, 1984), pp. 83-95.

15. Starr, Social Transformation, pp. 124-25.

16. Marcia Graham Synott, "Anti-Semitism and American Universities: Did Quotas Follow the Jews?" in Anti-Semitism in American History, ed. David A. Gerber (Urbana and Chicago, 1986), pp. 233-71; Dan Oren, Joining The Club: A History of Jews and Yale (New Haven, 1985), p. 152; Frank Kingdon, "Discrimination in Medical Colleges," The American Mercury 61 (Oct. 1945): 392-93; Walter Hart, "Anti-Semitism in N.Y. Medical Schools, " ibid. 67 (July 1947): 55--63; and Edward N. Saveth, "Discrimination in the Colleges Dies Hard," Commentary 9 (Feb. 1950): 115-21.

17. Saveth, "Discrimination," pp. 115-21.

18. During the period 1929-1934, that is, during the depths of the Great Depression, the average annual net income of American physicians was $4,081, some four times the average earnings of gainfully employed workers. During the period 1930-1933, some 4,371 Americans studied medicine abroad; for the period 1930-1936, the figure was 9,365. Starr, Social Transformation, p. 143; and George Rosen, M.D., Tile Structure Of American Medical Practice, 1875-1941, ed. Charles E. Rosenberg (Phila- delphia, 1983), p. 76.

19. Pearle, Preventive Medicine, p. 34.

20. Rosen, Structure, p. 78.

21. Edsall, "Emigre Physician in American Medicine," p. 1071.

22. "Regulations Governing Licensing of Foreign Physicians in Ohio," Ohio State Medical journal 35, no. 1 (Jan. 1939): 95; Eric Kohler interviews with LF, M.D., Denver, 8 Jan. 1985, and JH, M.D., Chicago, 9 June 1985. See also Baltimore, Medical and Chirurgical Faculty Library: Charles T. Le Vinness, III (Assistant Attorney General for the State of Maryland) to John T. O'Meara, M.D. (Secretary, Maryland Board of Medical Examiners), 12 Sept. 1938; and "Medical Examiners Trying to Help Foreign Graduates," Baltimore Sun, 11 July 1939.

23. Of this quintet only Rypins, whose 13-year career as Secretary to the New York Board of Medical Examiners was cut short by his death at age 47, did not enjoy a lengthy tenure in office. Dr. Crowe reigned over licensure in Texas for 33 years; Platter administered the rules in Ohio for 48 years; Bierring exercised authority over licensure in Iowa for 45 years; and Dr. Pinkham dominated California licensure for 30 years.

24. Rosen, Structure, p. 78. See also Sacramento, California State Archives, Office of the Secretary of State, Minutes of the Board of Medical Examiners of the State of California, [hereafter cited as Bd. Med. Exam. Calif.], F:3760/22, 2 Mar. 1933, pp. 5349ff.

25. Starr, Social Transformation, pp. 44-45.

26. Of the 5,056 immigrant physicians entering the United States between 1933 and 1940, 3,217 or 63 percent, came between 1938 and 1940. Of the 3,217, 2,433 or 75 percent, were considered Jews. See Edsall and Putnam, "Emigre Physician in America, 1941," pp. 1881-88.

27. Strauss, "Jewish Emigration from Germany," pp. 343-47. The tendency of Jews from southern and western Germany to emigrate to the United States during the second half of the nineteenth century can probably be explained by a rising birth rate within their ranks. Accordingly, as Jewish families grew during 50 years of relative tolerance, general European peace, and an improving public health technology, their older children would be packed off to the New World to make room at home for their younger siblings.

28. Allopathy, or "regular" medicine, was founded on the theory that the best method of treating disease was the rapid elimination of its symptoms, generally through surgery or the ingestion of harsh, frequently toxic drugs that had no effect when taken in health. Homeopathy eschewed harsh therapies, including surgery, preferring instead the administration of small quantities of drugs designed to produce the symptoms of illness in a well person. Eclecticism, or Thomsonism, rejected bloodletting and harsh purgatives in favor of botanical remedies that induced sweating and vomiting in the patient. Osteopathy originally believed that most illness originated in lesions arising in the displacement of the bones. Chiropractic limited that theory to dislocations along the spinal column. Norman Grevitz, The DO's: Osteopathic Medicine in America (Baltimore, 1982), pp. 7-18.

29. "Charles B. Pinkham," (Obituary), California and Western Medicine 61, no. 2 (Aug. 1944): 119; Sacramento, California State Archives, Office of the Secretary of State, Governor James N. Gillette Collection, Box 1081: Pinknam to William Lovdal, 20 June 1910; Who's in California (San Francisco, 1929), p. 394; and Bd. Med. Exam. Calif., F:3760/24, 2 Jan. 1935, pp. 5750ff.

30. Bd. Med. Exam. Calif., F:3760/22, 2 Mar. 1933, p. 5352.

31. U.S. Statutes at Large, 47th Congress, Sess. 1, Ch. 117-20 (1882), pp. 5861.

32. Bd. Med. Exam. Calif., F:3760/30, 13 July 1941, p. 7803.

33. Ibid., F:3760/22, 13 July 1933, p. 5429.

34. Cal. Adm. Code 2193C. On unconstitutionality, see Bd. Med. Exam. Calif., F:3760/23, 18 Oct. 1934, p. 5739; and Leo v. Board of Medical Examiners, 97 P.2d 1046 (California 1940).

35. Leo v. Board of Medical Examiners, 97 P.2d 1046 (California 1940). Also Eric Kohler telephone conversation with Sidney D. Leo, M.D., 26 July 1986. Ironically, of the 83 persons taking the California licensure examination in April 1940, Dr. Leo obtained the highest score. "Sixty-seven of 83 Taking Medical Examinations Pass," Los Angeles Times, 15 Apr. 1940.

36. Bd. Med. Exam. Calif., F:3760/30, 20 Oct. 1941, 7937-39. Also, California and Western Medicine 50, no. 4 (Apr. 1939): 310f.

37. Bd. Med. Exam. Calif., F:3760/30, 20 Oct. 1941, pp. 7940-44.

38. Ibid., F:3760/31, 1 Mar. 1942, p. 8117.

39. Ibid., F:3503/648, Applications for Licensure File (file of EB, M.D.).

40. Case of Dr. JF, Bd. Med. Exam. Calif., F:3760/31, 28 July 1942, p. 8336.

41. Letter to Eric Kohler from Mrs. VW, widow of EW, M.D., Los Angeles, 4 Oct. 1984. Also Eric Kohler interview with EFS, M.D., Piedmont, CA, 16 Nov. 1984.

42. American Medical Directory, 18th ed. (Chicago, 1950), pp. 383-513.

43. Eric Kohler interview with LF, M.D., Denver, 8 Jan. 1985.

44. This description of Denver comes from Manuel Laderman, Rabbi Emeritus, Hebrew Educational Alliance, Denver. Letter to Eric Kohler, 14 May 1986.

45. " 'Big Ed'Johnson: Portrait of an Ally," Intermountain Jewish News (Denver), 16 May 1986.

46. Ida Libert Uchill, Pioneers, Peddlers, and Tsadikim: The Story of the Jews in Colorado (Boulder, 1957), pp. 249-58.

47. In neighboring Wyoming in 1950, 40 percent of all practicing physicians held degrees from Nebraska or Illinois medical schools.

48. Denver, Colorado State Archives, Governors Papers, Johnson Papers, Box 26910: Harvey T. Sethman, M.D., Executive Secretary, Colorado State Medical Society, to Governor Edwin C. Johnson, 28 Feb. 1936.

49. [bid.: Rodney Wren, D.O., to Governor Johnson, 27 Feb. 1936.

50. Vardry A. Hutton, M.D., "Current Activities of the State Board of Medical Examiners," Rocky Mountain Medical journal 34 (Mar. 1937): 183-86.

51. Colorado Board of Medical Examiners, Directory of Licentiates (1942), p. 4; Denver, Colorado State Archives, Records of Board of Medical Examiners, Box 13754.

52. Denver, Colorado State Archives, Governors Papers, Johnson Papers, Box 26895: Johnson to Reginald B. Weiler, 22 June 1935. On Johnson, see R. D. Lamm and D. A. Smith, Pioneers and Politicians: Ten Colorado Governors in Profile (Boulder, 1984), pp. 125-35.

53. Eric Kohler interviews with JW, M.D., and RW, M.D., Denver, 6 and 8 Jan. 1985.

54. Lamm and Smith, Pioneers, pp. 110-22. On Locke, see Robert A. Goldberg, Hooded Empire: The Ku Klux Klan in Colorado (Urbana, 1981), pp. 15-16, 94.

55. Claire Cooper, "Dr. Mumey Finds Time to Be Honored," Rocky Mountain News, 29 May 1978. Also, Eric Kohler interview with Mrs. Norma Mumey, 1 Apr. 1985.

56. Norma L. Mumey, Nolie Mumey M.D. (Boulder, 1987), pp. 173-74; Pasquale Marranzino, "Surgeon Helps in Austria," Rocky Mountain News, 17 Jan. 1957. On the lifestyle of the physician, one acquaintance recalled: "Mumey, who grew up in Louisiana, used to wear planter's hats and drive the biggest Cadillac available. Short as he was, it always looked like the hat was piloting the car." Information given to Eric Kohler by Laurence T. Greene, Jr., M.D., Laramie, WY.

57. Eslie Asbury, M.D. to Eric Kohler, 27 Jan. 1987.

58. Jewish Immigrants of the Nazi Period in the USA, ed. Herbert A. Strauss, vol. 3, part 2 (New York, 1982), p. 70. A survey for the years 1934-1940 of the New York Aufbau, the newspaper for the refugees, which often ran articles of special interest to physicians, disclosed no information on medical relicensure in Colorado.

59. American Medical Directory, pp. 521-36.

60. Eric Kohler interview with WT, son of RT, M.D., Denver, 7 Jan. 1985. The American uncle was a nephew of David May, the company's founder. On May and his still-extant holding company, see Uchill, Pioneers, Peddlers, and Tsadikim, pp. 98-101.

61. Eric Kohler interview with Mrs. WS, widow of WS, M.D., Denver, 10 Jan. 1985; also LF, M.D. interview, 8 Jan. 1985.

62. Interview with BJS, M.D., Laramie, 7 June 1986.

63. "Medical Licensure Statistics for 1938," JAMA 12, no. 17 (29 Apr. 1939): 1720; and Denver, Colorado State Archives, Colorado Medical Examiners Papers, Box 13754: "Proposed Changes in the Colorado Medical Practice Act," n.d.

64. Eric Kohler interviews with LL, M.D., Denver, 12 July 1984, and GH, M.D., Denver, 10 Jan. 1985.

65. Revised Code of Washington Annotated Session Laws 1947, pp. 781-83.

66. Kirschner v. Urquhart, 310 P.2d 261 (Washington 1957).

67. Texas State Medical journal 34, no. 10 (Feb. 1939): 660. Also Lawrence A. Cardoso, Mexican Emigration to the United States, 1897-1931 (Tucson, 1980), pp. 71-143.

68. JAMA 114, no. 16 (20 Apr. 1940): 1583.

69. Texas State Medical journal 34, no. 10 (Feb. 1939): 660. Also Austin, Texas State Archives: Minutes of the Texas State Board of Medical Examiners, 19, 20 and 21 June 1939, p. 304.

70. JAMA 113, no. 16 (14 Oct. 1939): 1495.

71. People v. Schaeffer, 1924, 310 111. 574, 142 N.E. 248 (1924); People v. Love, 298 111. 304 (1921). Also Kenneth H. Schnepp, M.D., "Medical Licensure in Illinois: An Historical Review," Illinois Medical journal 150, no. 3 (Sept. 1976): 224-29, 248.

72. Schnepp, "Medical Licensure," p. 234.

73. Ibid.

74. Springfield, Illinois State Archives, Office of the Secretary of State, No. 556-1: "Proceedings [of] the Medical Practice Act Commission [of Illinois]", Chicago, 16 Apr. 1958, pp. 7-8. See also Illinois Blue Book, 19411942, pp. 101-2.

75. Chicago, Michael Reese Medical Center Archives: Staff Minutes, p. 517, Memo from Dr. Herman Smith to Dr. Otto Saphir, 22 Nov. 1935, "Medical Staff: Immigrant Physicians." Also, Sarah Gordon, ed., All Our Lives: A Centennial History of Michael Reese Hospital and Medical Center, 1881-1981 (Chicago, 1981), pp. 119-20.

76. Interview with Mrs. OK, widow of OK, M.D., 6 June 1985.

77. Springfield, Illinois State Archives, Governor Dwight Green Papers, No. 101.30: Barrett to Green, 28 June 1941.

78. People ex rel. Schutz v. Thompson, 59 N.E.2d 494 (1945).

79. Interview with CL, M.D., Chicago, 6 June 1985.

80. American Medical Directory, 12th ed. (Chicago, 193111, p. 2040.

81. Eric Kohler interview with LB, M.D., Santa Fe, 28 Sept. 1986.

82. Eric Kohler interview with WL, M.D., Terre Haute, IN, 28 Oct. 1986.

83. Walter P. Bowers, M.D., "The Massachusetts Board of Registration in Medicine," New England Journal of Medicine 213, no. 1 (4 July 1935): 1-5.

84. Edward A. Knowlton, M.D., "Some Problems in Medical Licensure of Massachusetts," Proceedings of the Annual Congress of Medical Education and Licensure (1937), pp. 63-65.

85. Stephen Rushmore, M.D., "Some Proposed Changes in the Massachusetts Law as 11t Relates to Medical Practice", New England Journal of Medicine 203, no. 20 (14 Nov. 1940): 808-9.

86. Graduates of Class B medical schools were ineligible for licensure in most states.

87. Knowlton, "Problems," p. 63; and Proceedings of the Council of the Massachusetts Medical Society, 5 Feb. 1941.

88. Proceedings of the Massachusetts State Medical Society, 5 Oct. 1938, p. 44.

89. Ibid., 5 Feb. 1941, p. 35.

90. Knowlton, "Problems," p. 63; and Boston, Commonwealth of Massachusetts, State Archives, Office of the Secretary of State: Commonwealth of Massachusetts, Board of Registration in Medicine, Minutes of the Board of Registration in Medicine, 13 Dec. 1944, "General Rules and Requirements."

91. Edsall, "Emigre Physician in American Medicine," p. 1071; also Edsall and Putnam, "Emigre Physician in America, 1941," pp. 1881-88.

92. Journal of the Iowa Medical Society 28, no. 10 (1938).

93. Walter L. Bierring, "Social Dangers of an Oversupply of Physicians," American Medical Association Bulletin 29, no. 2 (Feb. 1934): 17-18.

94. Craven v. Bierring, 269 N.W. 801 (1937).

95. "Transactions of the Special Session of the House of Delegates of the Iowa State Medical Society," Journal of the Iowa State Medical Society 28, no. 10 (1938): 507.

96. "Regulations Governing Licensing of Foreign Physicians in Ohio," Ohio State Medical journal 35, no. I (Jan. 1939): 95. Also, interviews with LF, M.D., Denver, 8 Jan. 1985, and JH, M.D., Chicago, 9 June 1985.

97. Edsall, "Emigre Physician in American Medicine," p. 1071; and interview with Mrs. MS, widow of MS, M.D., Lima, OH, 7 Oct. 1984.

98. Telephone interview with ER, M.D., Cincinnati, 19 June 1985.

99. Interview Dr. Anonymous, 6 May 1986.

100. Figures from American Medical Directory, 12th ed. (Chicago, 1931), pp. 1577ff.

101. Ibid.

102. Richmond, Archives of the Commonwealth of Virginia: Proceedings of tile Medical Examining Board of Virginia, Minutes, 22 June 1938, p. 4.

103. Ibid., 21 June 1939, p. 4.

104. Ibid., 18 June 1940., p. 3.

105. Ibid., 13 Dec. 1939, p. 4, and 18 June 1940, p. 3.

106. Joseph Schechner, M.D., It Came to Pass (Unpublished autobiography, n. d.), pp. 126-32.

107. Ibid., p. 132.

108. Baltimore, Medical and Chirurgical Faculty Library: Transactions of tile Medical and Chirurgical Faculty of the State of Maryland (Baltimore, 1936), pp. 96-97.

109. Ibid.: Guy Steele, M.D. to Walter Wise, M.D. (Secretary of the Medical and Chirurgical Faculty), 17 Apr. 1937.

110. Ibid.: Charles T. Le Vinness, III (Assistant Attorney General for the State of Maryland) to John T. O'Meara, M.D. (Secretary, Maryland Board of Medical Examiners), 12 Sept. 1938.

111. "Medical Examiners Trying to Help Foreign Graduates," Baltimore Sun, 11 July 1939.

112. Ibid.

113. The town was Vineland, NJ, where I grew up. Eric Kohler interview with Dr. AJF, Los Alamitos, CA, 12 Aug. 1984.

114. Pearle, Preventive Medicine, p. 20.

115. Harold L. Rypins, M.D., "Why License Foreigners?" Medical Economics (Feb. 1937): 29-31.

116. Pearle, Preventive Medicine, p. 18; idem, "Arzteemigration nach 1933 in die USA: Der Fall New York," Mediziniiistorisches jalubticil 19, nos. 1-2 (1984): 112-37.

117. Howard Fox, M.D., F. Leslie Sullivan, M.D., and David Haller, M.D., "Status of Foreign Physicians," New York State Medical Journal 43 (15 Jan. 1943): 128.

118. Helmut Pfanner, Exile in New York (Detroit, 1983), pp. 79-80.

119. Mrs. HW, daughter of EA, M.D., to Eric Kohler, 2 Aug. 1984.

120. Information from Mrs. IG, daughter of AL, M.D., to Eric Kohler, 19 Feb. 1985.

Chap 2

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