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Political tensions about the goals of the American Medical Association, and their expression to the membership and the laity, have existed since the Association was founded in 1847. The most important is the tension between serving and self-serving. One could call oneself a doctor and practise as such about as easily and as legally as one can be a ‘therapist’ in California. Periodic attempts were made by state medical societies to elevate medical school standards, but they were half-hearted and unsuccessful. Financial anxiety, intellectual restlessness and patriotic competitiveness combined happily to inspire the membership to agree that a journal be founded. The redoubtable Nathan Davis, chairman of the Board of Trustees, sent out a mailing of 40, 000 describing the proposed new journal; he reported at the 1883 meeting that he had received some 2, 000 promises of support, which in addition to the projected advertising revenue should support the publication cost.