By good fortune, the American Medical Association held its annual meeting in New Orleans one week following the 1903 LSMS meeting. The AMA architects of the plan for state medical associations were in attendance and assisted the LSMS in drafting a new constitution and bylaws reflecting the reorganization of the Society. In 1904, the LSMS celebrated its 25th annual meeting, and six officers, six Congressional District representatives, and 40 parish representatives constituted the first House of Delegates. General attendance at the annual meeting itself grew from a low of 20 in the 1890s to more than 300 in 1905.
Between 1909 and 1912 codified rules for the operation of the House of Delegates were adopted and refined as the new Constitution and Bylaws were amended. The House of Delegates would consist of delegates elected by both component Parish and District societies, the representatives of the Congressional Districts to be known as Councilors, and the President and Secretary of the Society as ex-officio members. A Chairman of the House of Delegates and a separate Secretary of the House of Delegates would also be elected and were added to the list of Society Officers.
The first House of Delegates under the newly amended Constitution and adopted rules convened on May 4, 1909 and consisted of 38 members in attendance. During this meeting, officers of the Society were first elected by the House of Delegates in a written ballot.
From 1912 forward, the membership of the House of Delegates continued to grow coinciding with the population growth in the state, membership in component societies, and formation of new Congressional districts. Over the years, the primary focus of the annual meetings shifted to the consideration of business by the House of Delegates and away from the presentation of scientific papers. The issues facing the practice of medicine and the laws regulating the practice have become more and more complex. And the agenda of the House of Delegates has expanded accordingly.