Midterm Essay - Less Democratic Medicine

Answer one of the following questions, using any of the assigned readings and your lecture notes as your chief source of evidence. Your answer should be between 2 and 5 pages (12 point font, double-spaced). You’ll be graded on the clarity of your essay and the use of specific examples or data as evidence.

2. Describe the development of the medical profession in the United States from the late eighteenth century to the 1920s. Consider changes in the requirements for education, professional identity, professional and cultural authority, and prestige.

Was medicine a more or less democratic profession in 1930 than it was in 1848?

·      Thesis: Medicine was less democratic in 1930 than 1848. (Beginning/end?)

·      19^th Century medicine à Chaotic, poor, unregulated

§  Allopathic – Poor technique and learning, heroic medicine, blood letting, purging, heroin + mercury treatment (MPHMPH 58,71,129)

§  Therapeutic medicine = helping the body’s natural healing abilities (MPHMPH 94)

§  Water cure – Basic level treatment, water consumption, water bathing (MPHMPH 129)

§  Thomsonianism – Humoral medicine, botany (MPHMPH 71)

§  Midwifery (MPHMPH 73-79, 181)

·      20^th Century medicine à Organized, standardized

§  AMA – Organization (MPHMPH 298-303)

§  Monopoly of health (MPHMPH 67, 277)

§  Educational requirements (MPHMPH 277)

§  Rise of public health

·      Define democracy: Oxford dictionary - Characterized by or favoring social equality; egalitarian; capable of being used, accessed, or enjoyed by anyone.
"democratic, adj. and n.". OED Online. September 2016. Oxford University Press. http://www.oed.com/view/Entry/49758?redirectedFrom=democratic (accessed October 22, 2016).

·      Social equality, Greater access à 1848 > 1930

§  More professionals à b/c more sects with different people (MPHMPH 277)

o   Different types of medical available to suit patient needs

§  More sects = more diversity, refer previous

§  “Cheaper” alternatives

§  More access b/c more professionals Rockfeller Foundation (MPHMPH 292)

Why can’t other medical practices exist along side allopathic medicine? à Prevention could also be connected to health

            American medicine prior to the 20^th century was a hodgepodge of medical sects. Different medical practices from midwifery to allopathy covered a variety of aliments. Yet the potency of medical treatment remained suspect. Often heroic medicine did more harm than good. Purging and bloodletting were two such detrimental practices performed by allopathic physicians. The mixed results tarnished the reputation of the medical establishment. However, the rise of public health began the process of regulating medicine. Efforts by governments to actively monitor and maintain the health of its citizens generated a solid political structure for the advancement of allopathic medicine. The connection between health and government paved way for administrative regulation of medicine. Allopathic medicine managed to gain a major footing using the American Medical Association (AMA) as a political tool. The AMA convinced states to require standardize education and examinations for the right to practice medicine with the ultimate goal of eliminating poorly trained physicians. The success in homogenizing medicine enabled allopathy, with its focus on specialization, to climb rapidly in the 20^th Century. This specialization of medicine thinned out its availability to the masses. Even those qualified for practicing medicine from an experience standpoint were barred from practice. The decrease of medical professionals made medicine considerably less democratic than it was in the past.

            The Oxford dictionary defines democratic as, “characterized by or favoring social equality; egalitarian; capable of being used, accessed, or enjoyed by anyone.”[1] Clearly then the efforts of AMA to regulate medicine and reduce the number of practitioners was not democratic. In comparison to 1930, 1848 was more democratic in terms medical care for three reasons: diversity of treatment, medication access, and access to care. The variety of medical treatments provided an equality of choice. Patients could go to a medical practitioner that suited their needs. Treatments of therapeutic medicine were more accessible for larger segments of the population. Unlike the pricy medication used in allopathic medicine, other sects of Thomsonianism and hydropathy use local, easily available cures. Standardization of the medical profession reduced the number of professionals available to the public. This, on top of a growing population, left large areas of the country without medical coverage. Access to care and affordability was curtailed for professionalism and profit.

            While allopathic medicine of the 20^th century was developed with restrictive access in mind, the 19^th century was catered to a multitude of medicine for all. Allopathic medical techniques such as bloodletting and purging catered to individuals desperate to see immediate results. Midwifery served pregnant females. Thomsonianism accommodated to the everyday rural layman with its use of natural botanic remedies. Water cure in similar fashion also provided for the common folk through the use of a readily available source, water. The vast number of medical treatments meant that there was something for everyone. The case of Elizabeth Drinker demonstrates this equality of medical choice. Worried for her daughter and son, Elizabeth calls upon Dr. Kuhn, Nancy Skyrin, Dr. Shippen, and John Perry.[2] The doctors performed bloodletting and administered laudanum as well as opium. If one technique failed to produce results another method was available on hand to try out. Having alternate options allowed Americans to enjoy a diverse assortment of medical care. Thus the diversity of medical care ran along parallel lines with population diversity.

            Access to medication was another issue. Heroic allopathic medicine relied on special medications such as laudanum and calomel. These imported medications were available in limited supply at drug stores. In rural areas the nearest drug store could be miles away, not to mention that the drugs themselves were quite pricy.[3] Other sects provided the benefit of using common or local substances. Thomsonianism is one such example. Founded in 1800 by Samuel Thomson, Thomsonianism advocated for a return to the understanding of the four humors and use of medical botany. Use of local plants allowed for cheap, nearby medication. In contrast, laudanum and calomel are chemically produced and are often dangerous if not fatal.[4] Another practice with a simple medication was hydropathy, also known as the water cure. In hydropathy, water is applied various ways from ice cold baths to fluid intake. The account given by Mary Gove Nichols attests to the power of water cure. She describes how the “sanative effects of cold water” were successful in treating fevers and hemorrhages.[5] Nichols also notes how “depletion by bleeding or purgatives is never required,” further highlighting the uselessness of pricy drugs.[6] For those less financially well off, these sects of medicine offered more affordable cures. Cheaper medication on hand meant that more people were capable of receiving medical treatment. Thus the affordability of treatment went hand in hand with equality of access.

            Access to medical care was greater in the 19^th century because of the numerous medical sects and an abundance of medical professionals. Many medical sects of did not require advance schooling and education. The practices of Thomsonianism and midwifery were based mostly on the experience of its practitioners.[7] Hydropathy was taught from books and could be practiced on the fly, though not recommended.[8] The lack of an education requirement, in addition to the lack of a standardized assessment, permitted an assortment of medical professions to flourish. This led learned, allopathic physicians to complain of overcrowding in medical care. Latching onto the public health frenzy of the progressive era, physicians used organizations like the AMA to push forth standards on medicine. The influence of the AMA is clearly evident in the Flexner report, which is titled “Educational Reformer Abraham Flexner Writes a Muckraking Report on Medical Schools, 1910.”[9] Prior to writing his report, Flexner had consulted with the AMA and the American Association of Medical Colleges (AAMC) about the new standards of modern medicine. In his report, Flexner decries the over production of physicians stating that the US physician population proportion is four to five times larger than that of Germany’s. He then goes on to say that the argument for lower quality medical schools defends, not “the poor boy,” but the self interest of poor medical schools.[10] His scathing criticism is aimed at incompetent and uneducated doctors. However, underneath this rational response to medical incompetence is the true motivation of monopolizing medical care under the banner of “modern medicine.” His push to end medical sectarianism by a “treaty of peace” is a foreshadowing for an attempt to ban opposing sects via legislation.[11] By then, state licensing boards were pushing for greater educational requirements going as far as to define the very practice of medicine. The Nebraska act stipulated that anyone practicing any form of medicine, whether it be through drugs or healing regimens, was subject to the provisions of regulatory law.[12] Unsurprisingly, the number of medical professionals fell and only well-organized sects of allopathy, osteopathy, chiropractic, and Christian Science remained. With the fall of sect diversity and the decrease in medical professionals, access to medical care dropped.[13]

            The increased standardization of medicine eliminated not only incompetents, but experienced medical practitioners as well. Thomson did not attend formal higher education and neither did Martha Ballard. Yet both were capable medical practitioners in their own right. The elimination of multiple opposing sects played into the hands of the AMA, which moved to monopolize health care.[14] Even though complete monopolization failed, allopathic medicine had become a major powerhouse setting strict requirements on education and licensing examinations. The rising standards and regulations resulted in a smaller, elite pool of physicians. This reduction of medical diversity occurred along side the rising cost of modern medical treatments and a decrease in practitioners. By 1930 the practice of medicine had become less about the equality of access and treatment, and more about the advancement of professionalism and scientific progress.

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[1] "democratic, adj. and n.". OED Online. September 2016. Oxford University Press. http://www.oed.com/view/Entry/49758?redirectedFrom=democratic (accessed October 22, 2016).

[2] John Harley Warner and Janet Ann Tighe, Major Problems in the History of American Medicine and Public Health: Documents and Essays (Boston: Houghton Mifflin, 2001), 58-60.

[3] Thomson notes that the “price of imported drugs is very high.” Refer to Warner and Tighe, 72.

[4] Ibid., 71-73.

[5] Ibid., 129-130.

[6] Nichols refers to price of drugs when mentioning how the spread of water cure would result in “drugs would be in discount.” Refer Ibid., 130.

[7] Thomson says he spent thirty years of study along with hands on practice. Martha Ballad’s diary indicates that she was involved in 797 births. Refer Ibid., 71, 78.

[8] Nichols practiced water cure on her own child after reading the Book of Health. She recommends careful application of water cure for later on. Refer Ibid., 129-130.

[9] The reference to muckraking clearly connects to the progressive movement that brought in a new level of government involvement into everyday affairs. Refer Ibid., 277.

[10] Ibid., 277-278.

[11] Ibid., 281.

[12] Any act of healing or treatment thus came to defined as medicine. Refer Ibid., 299.

[13] Noted in the Rockefeller Report about doctor shortages in rural America. Refer Ibid., 292-296.

[14] The AMA did not succeed in banning all its opponents. Other sects continued to survive, but majority of doctors, three quarters, came under the allopathic banner. Refer Ibid., 298-303.