In 1800, all forms of medicine were practiced together. It wasn’t long before medical societies sprung up with the sole purpose of supporting one type of medicine over another.The Constitution of this Republic should make special provision for medical freedom. To restrict the art of healing to one class will constitute the Bastille of medical science. All such laws are un-American and despotic. . . . Unless we put medical freedom into the constitution the time will come when medicine will organize into an undercover dictatorship and force people who wish doctors and treatment of their own choice to submit to only what the dictating outfit offers. [Dr Benjamin Rush, at the Constitutional Convention]
In 1806 the first licensing laws were passed in the US, in New York, called the Medical Practices Act. This act allowed the state to license practitioners, which meant that only licensed physicians could recover their fees in courts. Unlicensed practitioners were fined $25.00 for practicing without a license. The New York Journal of Medicine candidly published the reasoning behind this new law: “the suppression of empiricism and the encouragement of regular practitioners.”
Empiricism: the application of observation and experiment, rather than theory, in determining something. This is, supposedly, the core of modern science.
It should be noted that when the first medical licensing laws were passed, legalizing only the practice of medicine based on the philosophy of the four humors, that this particular medicine had neither cured nor had it even palliated a single illness. In fact, if you pulled all of the nutritional and herbal medicines out of their pharmacopoeia, there wasn't a single medicine left that could help an ailing patient. Pharmaceutical medicine would have to wait exactly one hundred years from this first licensing laws before it cured an illness. Yet local governments, pressured by the physicians (not the citizens), tried to force bad medicine onto the populace.
America was still very young and many remembered the struggle for freedom and liberty. Many of these early Americans felt this kind of law to be unconscionable and far too restrictive on their rights and freedom. In 1807 the Medical Practices Act was modified to a point just short of its being repealed. The fine was dropped significantly, and the definition of an “irregular” physician was so defined as to hardly include anyone. Even a student of any of the competing practices did not fall under the parameters of this new definition.
Connecticut passed a similar law in 1832. The Thomsonians fought back and had it repealed in 1842. In 1827 the medical societies attempted to put teeth back into the New York laws, but in 1830, much of this new law was reversed, and by 1844 it was completely abolished. Even with laws on the books, the juries often took the side of the irregulars. Coulter’s book, Divided Legacy, tells us of a case in 1843 where a man charged with practicing homeopathy without a license was found guilty by a jury of his peers, but they fined him 3/4 of a cent for every infraction, and when the trial was over, they all donated their fees received for being on the jury to a local homeopathic society.
Early Americans still remembered the price of freedom, and were loath to relinquish theirs.
Massachusetts passed its first licensing laws in 1819, but they were repealed in 1835. Illinois passed their first laws in 1819, which were repealed in 1821, and then reinstated in 1825, but finally abolished the following year. Some of the strictest licensing laws were passed in Ohio in 1810 and in 1816. These were repealed in 1819, with new laws on the books by 1824, though these didn’t last ten years. In the South, where Thomsonians flourished, licensing laws were passed in Alabama restricting practices outside regular medicine, but in 1832 were modified to allow Thomsonians to practice and recover their fees in courts. Georgia passed medical licensing laws in 1825 and established the first Board of Examiners. In 1839 the law was revised to allow herbalists and Thomsonians to practice and in 1847 Georgia even established a Botanic Medical Board of Physicians along with laws allowing only those practitioners who had graduated from proper botanical schools to practice.
Throughout the 1820s and 1830s Delaware, Mississippi, Vermont, Indiana, Maryland, South Carolina, and Maine all repealed their licensing laws to allow irregulars to practice, and by 1850 Rhode Island, Pennsylvania, Virginia, North Carolina, Texas, Tennessee, Kentucky, and Missouri had never regulated medicine. In fact, by 1850 only Louisiana, Michigan, New Jersey, and Washington DC had laws concerning the licensing of regular physicians.
As you can see, the regulars held sway during the 1820s and 1830s. They influenced a lot of legislation, but because laws in any society represent the will of the people, public opinion won out and the network of medical societies collapsed as the competition built up a strong following.
Then something happened that nearly put a stake in the heart of regular medicine: the advent and spread of Homeopathy throughout the land.
The Early Development of MedicalLicensing Laws in the United states,1875-1900
The condition of the American medical profession at the close of the Civil
War was, in almost every particular, significantly different from that which
obtains today. The profession was, throughout the country, unlicensed and
anyone who had the inclination to set himself up as a physician could do so,
the exigencies of the market alone determining who would prove successful
in the field and who not. Medical schools abounded, the great bulk of which
were privately owned and operated and the prospective student could gain
admission to even the best of them without great difficulty. With free entry
into the profession possible and education in medicine cheap and readily
available, large numbers of men entered practice. Indeed in 1860 the census
data indicate that the country possessed over 55,000 physicians, or 175 per
100,000 population, almost certainly the highest number of doctors per
capita of any nation in the world.'
Competition resulted not only in a prolifefation of medical personnel but
in the growth of heterodox theories arising in opposition to standard
medical therapeutics. Regular medicine in the early nineteenth century relied
heavily on symptomatic treatment, consisting, in the main, of bloodletting,
blistering, and the administration of massive doses of compounds of mer-
cury, antimony, and other mineral poisons as purgatives and emetics,
followed by arsenical compounds thought to act as tonics. The therapeutic
regimen thus developed came to be known as "heroic therapy" and certainly
killed large numbers of patients unfortunate enough to undergo treatment at
the hands of its practitioners. Two sects--eclecticism and homeopathy-
successfully competed with regular medicine and were, between 1830 and
1850, in great part responsible for the repeal of medical licensing laws which
remained as legacies of the Colonial period and the earliest years of the
Republic.'
Eclecticism's principal theoretician was Samuel Thomson, originally a
New Hampshire farmer, who developed and patented a system of medicine
* The original version of this article was delivered at the Sixth Annual Libertarian Scholars
Conference, Princeton University, October, 1978.
in 1813 relying exclusively on botanical remedies, steam baths, and rest. He
completely repudiated the therapeutic arsenal of heroic medicine, attacking
bleeding, blistering, and the administration of mineral poisons as "instru-
ments of death," and injected much common sense into the care of the sick
and ailing. Most importantly, he provided an alternative to regular therapy
easily understood and eventually widely employed by the American public.'
An even greater threat to orthodox medicine was homeopathy, created by
Samuel Hahnemann, a German physician possessed of a formal and rigor-
ous medical education. Hahnemann's researches led him to conclude that
the most efficacious remedy for any ailment consisted in the administration
of a drug which, when tested in a healthy person, induced those symptoms
most closely approximating the symptomology of the disease. This law,
similia similibus curanfur, was the foundation-stone of homeopathic thera-
peutics. Equally revolutionary was the homeopathic theory of optimal dos-
age. Regular physicians had prided themselves on the strength and quantity
of medication administered, many believing that if ten grains of a substance
were thought beneficial, one hundred would likely prove ten times more
effective. Hahnemann, on the other hand, argued that extremely attenuated
and minute doses were far preferable to stronger ones, indeed, the more
attenuated, the better. He went so far as to recommend dilutions to the one-
decillionth of a drop of the original medication. Perhaps the most significant
contribution of homeopathy, however, and that which in turn contributed
heavily to its popularity among the public after its introduction in America
in 1825, was its stress on the natural healing powers of the organism itself.
Homeopathic physicians were strong proponents of fresh air, sunshine, bed
rest, proper diet, and personal hygiene for recuperation in an age when
regular medicine regarded these as of little or no value.
Nine years after the passage of Illinois' medical practice act, the President
of the Detroit Medical and Library Association, the largest local medical
society in Michigan, in a spirited plea for the enactment of similar legislation
in his own state, attempted a rough estimate of the financial effects of the
Illinois statute. Assuming that each of the three thousand physicians who
otherwise would have been practicing in Illinois had its law not been enacted
would have earned on the average $2,500 annually, the author calculates
that some $67,500,000 "have been saved" by the reduction in supply in the
space of nine years." Despite the inducement these figures served to Michi-
gan physicians to lobby more vigorously for equivalent legislation however,
they were unsuccessful in gaining an effective law until 1899, twenty-two
years after Illinois had passed hers.
The first state to require both a diploma in medicine and examination was
Florida. In 1889, the State Medical Society was successful in prevailing upon
the state legislature to enact a medical practice law which authorized the
appointment of medical examining boards for each judicial district to
examine all candidates "upon production of a medical diploma from a
recognized college."3~ Because of sectarian pressure, a state-wide homeo-
pathic board was established at the same time and, by separate legislation
ten years later, an eclectic examining board was also created.39 Curiously,
the Florida law provided that district examiners, that is, those appointed to
examine prospective orthodox practitioners, must themselves have been
graduates of "some medical college recognized by the American Medical
Association." Inasmuch as the AMA did not begin to classify and recognize
medical colleges until 1906, the Florida law seems to have anticipated the
activities of the Association in the area of medical education by some
seventeen years!An
Of the two requirements, physicians-with good reason-held that com-
pulsory examination was a more effective method of limiting the supply of
new practitioners than was the requirement that they present evidence of
holding an M.D. degree. In the absence of restrictions respecting the prolif-
eration of medical schools, their number had increased from sixty-five in
1860 to seventy-five in 1870, and to 100 in 1880. By 1900, there were 160
medical schools operating in the country, of which twenty-two offered
instruction in homeopathic medicine and nine in eclectic medicine.41 Gradu-
ation from a medical college, while it might well improve the technical
competence and enhance the qualifications of new practitioners, could not
serve as a basis of curtailing their supply, as could mandatory examinations
tailored to the number of applicants in any given year. In extolling the
benefits of compulsory licensing examinations, physicians openly referred to
the importance of curbing competition and establishing a more secure
economic environment in which to practice. Thus, Dr. John Roberts,
Professor of Anatomy and Surgery at the Philadelphia Polyclinic, in anaddress before the Medical Jurisprudence Society in 1884 observed:
Such an examination would weed out and keep out of the profession
those persons who, though ignorant of medical science, accept profes-
sional duties and emoluments, and thus increase the difficulty of an
educated physician gaining a livelihood. There are, undoubtedly, too
many physicians for the needs of the closely settled districts. Fewer
doctors, and better ones, would be a boon to most sections of the state.
The state examination would affect both ohjects.
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