From the colonial period to the 1820s, a profession of medicine existed only in a fragile and nebulous way. As late as 1776 there were perhaps 3,500 more-or-less recognizable "doctors" in the thirteen colonies, but only a tenth held a medical degree. Most of the many practitioners were highly individualistic healers. Those few who tried to distinguish themselves by education and qualification, however, turned to others of the same kind to try to establish a working identity. They always hoped for social recognition. But in a time when a physician functioned largely on the basis of personal authority, a social identity as a professional was usually a secondary consideration for him and his patients.
becoming a practitioner
Many women practiced healing, but none would have been accepted as a professional at that time. Moreover, men claiming professional competence relentlessly displaced women from the mid–eighteenth century to 1830. In the cities, even midwives were losing out to male physicians.
The colonists brought with them the customs of rural practice in England. In London and other cities there were, from medieval times, formal guilds of physicians (learned people), surgeons (especially trained in manual procedures), and apothecaries (specialists in the chemistry and dispensing of medicines). But in the countryside and the colonies, all practitioners, no matter how trained, had to serve as general practitioners and acquired the identity, earned or not, of "doctor."
By the middle of the eighteenth century, the training of doctors by an apprentice system was well established. Recognized physicians (most famously Dr. John Redman of Philadelphia) took numerous students whom they exploited and instructed in a family setting. Young men who later became leading figures typically after apprenticeship went to Europe, especially to Edinburgh, for further training and a formal degree. More than a hundred physicians had returned from Edinburgh by 1800.
In 1765 John Morgan and other young physicians with Edinburgh degrees persuaded the trustees of the College of Philadelphia to open the first medical school in North America. Others followed in New York and Boston. After the War of 1812, proprietary schools began to appear.
establishing a profession
Meantime, local groups of medical men had already begun to organize before 1763. Like other professionals, they wished to gain special social recognition for their roles and to exclude others and control competition. They issued "fee bills," trying to set charges for standard medical procedures. Usually, local groups had only temporary successes. A medical society for a whole colony, New Jersey, was formed in 1766. It was the only colonywide society to survive the American Revolution. The attempt of John Morgan to found an intercolonial medical society in the late 1760s was unsuccessful; the group became simply another local organization in Philadelphia.
Formal licensing by government entities was first simply an endorsement of some person or another as someone with recognized qualifications as a healer. Only in the 1760s and 1770s did colonies respond to consumer concern as well as pressure from leading practitioners to use a license as a requirement rather than just an endorsement. New York passed a law for New York City in 1760. In New Jersey beginning in 1772, practitioners had to be examined by two judges to be permitted to practice.
As the decades passed, in the developed states it became customary to let the state medical society examine candidates and issue licenses (for a fee). And as medical schools were chartered, graduation often automatically entitled the graduate to a license without examination. As yet, enforcement was very weak—except that unlicensed practitioners found it difficult to collect fees in court.
As states that once belonged to France or Spain came into the Union, the highly regulated systems of licensing that had existed did not carry over very well. Furthermore, these states, and Louisiana particularly, suffered from often unseemly competition between the French and Anglo-American practitioners, so that a unified medical community did not exist.
Insofar as there was a medical profession, then, the formal institutions of medical organizations and medical schools, both utilized for licensing, were fundamental. By 1800 nine states had state medical societies. Six more appeared before 1820, and after that, midwestern and southern state societies formed. The Revolutionary War had interrupted the functioning of the medical schools, and in 1800 there were schools only at the University of Pennsylvania in Philadelphia, Columbia in New York City, Harvard in Massachusetts, and Dartmouth in New Hampshire. Over the years, only about 250 students had graduated from those schools. By 1829, over 4,000 students had graduated from American medical schools. Since a cheap and easy medical education, including a formal degree, was available by the 1820s, the institution of apprenticeship began slowly to diminish as a source of trained medical practitioners. Daniel Drake of Cincinnati in 1832 asserted, only partially inaccurately, that a license without a degree was a "certificate of inferiority."
A number of physicians in Revolutionary America and the new nation were members of the intellectual elite of the North American colonies and the new nation, contributing—like Alexander Garden of South Carolina, after whom the gardenia was named—to natural history. But their medicine remained practice oriented. Virtually all innovation came from Europe. The first medical journal, the Medical Repository, was not founded until 1797, and it included many matters that were not strictly medical, including perhaps the last major defense of the phlogiston theory, by Joseph Priestley, a refugee then living in Pennsylvania. By 1822, twenty-two more medical journals had been established. Most were short-lived, but they helped establish a community within which there was a growing consensus on what a medical practitioner should do, however much their actions varied in detail and application.
By the nineteenth century, there was a sufficient professional community that it could become the object of dissent and even competition. As early as 1811, Samuel Thomson of New Hampshire began to establish a botanic medicine movement as an alternative to "regular" medicine. He was able to patent his system in 1813, and he published his New Guide to Health in book form in 1822. Thomson also sold rights to purchasers to practice according to his system and join in "Friendly Societies" with other purchasers. After 1830 other sects, particularly the hydropaths, with their water cure, and homeopaths also began to compete with the regulars in the United States. Insofar as the botanics and the later sectarians criticized the heroic practice of the regulars who bled and purged their patients, they helped draw lines of contestation that stimulated profession formation even more than the usual empirics and quacks who abounded.
Rothstein, William G. American Physicians in the Nineteenth Century: From Sects to Science. Baltimore: Johns Hopkins University Press, 1972.
Shafer, Henry Burnell. The American Medical Profession, 1783–1850. New York: Columbia University Press, 1936.
Shryock, Richard Harrison. Medicine and Society in America, 1660–1860. New York: New York University Press, 1960.
John C. Burnham