American Medicine: Off On The Wrong Track From The Beginning.

Posted on | February 10, 2023 | 2 Comments

Mike Magee

When your focus is on the History of Medicine, it is natural to think that every story will center on the rise of the Medical profession, or the hospital industry, or breakthroughs in pharmaceuticals. But the reality is, as sociologist Paul Starr suggested, “The development of medical care, like other institutions, takes place within larger fields of power and social structure.”

In early colonial times, the original British colonies were rural and small-town oriented. The absence of good roads, mechanized travel, and long distance communications reinforced a pressing need for self-reliance. Seeing a doctor, if one was available and competent, meant a day of travel, and a day away from farm chores. To survive, let alone thrive, required a wide range of skills, confidence, and a willingness to confront death and disease at every turn. Large scale success was rare, and nearly always the result of a willingness to enslave, dislocate and subjugate fellow humans, with religion and politics providing some moral cover.

England was the model for colonial physicians back then. Physicians in Britain were a small grouping of the elite and privileged, who had been accepted into the Royal College of Physicians and clustered around London. Between 1771 and 1833, that body offered fellowship to only 168 men, all graduates of either Oxford or Cambridge. Even so, their power flowed solely from their aristocratic patients whose patronage was never assured.

These chosen few “observed, speculated, and prescribed” and “declined to work with their hands.” That was left to the surgeons who were only a few decades separated from having been lumped together in the same guild with butchers. And last came the apothecaries, mixers of cures and potions, allowed to both retail and wholesale their concoctions. All three groups of practitioners could prescribe, but only the physicians could charge for advice.

There was no reason a British physician of the day would stoop so low as to join colonial practitioners who existed on a level with surgeons and apothecaries. Lacking status and knowledge grounding, medicine and religion often intermingled in the New World. New Jersey was the first colony to form a provincial medical society in 1766. Its first president was a physician and minister, and after a decade of existence, six of the thirty six loyal members were “pastor-physicians.”

At the beginning of the 19th century, only 200-300 individuals had legitimate training and certification as physicians. But more than ten times that number claimed to be “doctors.”

As Paul Starr recounted, “Botanic practitioners and midwives were probably the most numerous of lay therapists, but there were also uncounted cancer doctors, bonesetters, innoculators, abortionists and sellers of nostrums. Many were itinerant and moved freely into and out of various trades.”

At the same time, therapeutic confusion in our new nation contrasted with scientific advances in Europe following the French Revolution. Clinical findings were now cross-referenced with autopsy results, allowing physicians to track for the first time signs and symptoms to specific disease entities. And doctors, with the aid of the first primitive stethoscope in 1816, were touching patients and moving from hands-off observation to hands-on examination.

But American society was already deeply committed to individualism, self-actualization, openness to magical cures, and anti-elitist values. As Medical Historian Richard Skyrock PhD wrote, “the most hopeful period in the history of medicine was one in which the (American) public looked to medicine with the least hope.”

Comments

2 Responses to “American Medicine: Off On The Wrong Track From The Beginning.”

Art Ulene
February 15th, 2023 @ 11:36 am

Once again… still… you delight me with your knowledge, your insights and your writing skills. Thanks for sharing this with me. Keep ’em coming…. Art

P.S. I don’t care what you say: I’m still going to keep calling myself “Doctor”.
Mike Magee
February 17th, 2023 @ 9:09 am

Thanks, Dr. Art Ulene! Best, Mike