The Frontier. Medicine in early America was random, diverse, and unspecialized. University-trained medical practitioners were rare in the colonies. Most doctors were surgeons, apothecaries, or barbers educated under the apprenticeship system. They could prescribe herbal remedies, pull teeth, lance a boil, and bleed or purge a patient. But they were helpless when faced with serious illnesses such as typhoid fever, smallpox, or dysentery. Often both doctor and patient relied on home remedies learned from Indians. The feverish patient seeking relief sometimes followed the Indian example of steam baths. Louis Hennepin treated one of his fellow priests with a potion made of the herb hyacinth. He noted that the Native Americans cured the fever of malaria with a medicine contrived by boiling cinchona bark, which contained quinine. He approved
of the European practice of sometimes bleeding patients to relieve pain.
House Calls. Historian William Smith in 1757 claimed that in regard to the quality and quantity of physicians in America, “Quacks abound like locusts in Egypt.” Indeed, for a young society colonial America had a high percentage of doctors. In one Virginia town in 1730 there was one physician for every 135 people. Even farmers living in rural areas could find treatment for illnesses. John Mitchell of Virginia was one of many itinerant physicians who traveled throughout the colonies earning a living. The abundance of untrained physicians and the lack of a colonial licensing system led to the widespread views that most doctors were quacks and that the sick might as well treat themselves. Clergymen often doubled as physicians because of their education. There were so many virulent diseases in America that it was convenient that the man who treated the sick could also pray for them and perform last rites. Particularly in the southern colonies mortality rates were high due to yellow fever, malaria, and hookworm, all of African origin. Diseases of European origin such as mumps, measles, and smallpox thrived in America as well, especially in the cities.
Disease Control. There was no truly organized medical profession in America until the end of the colonial period. Communities did, however, develop techniques to prevent and to combat disease. Cities such as Boston set aside places to quarantine the sick who had communicable diseases. (In the case of Boston an island in the harbor was used.) These were the infamous pest houses. The temporary residents of the pest houses were frequently inoculated for the smallpox. In some cases towns tried to improve community sanitation and clean-water standards.
Medical Community. The prevalence of homespun medicine and itinerant doctors began to change with the emergence of a class of physicians trained in European medical schools. The Philadelphia physician Thomas Cadwalader, for example, studied in London and then taught medical techniques at Philadelphia. He performed the first autopsy in America. His contemporary, John Lining of Charleston, South Carolina, graduated from the University of Edinburgh. Concerned with the high mortality rate of the South, Lining kept statistics on the correlation of disease with changes in the weather. He even observed and kept precise records on his own personal health. Another great physician of the early eighteenth century was the Bostonian William Douglass. Initially opposed to proponents of smallpox inoculation such as Cotton Mather, Douglass later contributed to the vast evidence showing that inoculation worked. Douglass was a leader in the formation of the short-lived Boston Medical Society. There were other medical organizations, such as at Charlestown, Massachusetts, but most did not last long. Their lack of longevity showed on the one hand the primitive nature of American medicine, but on the other hand the attempt to form such societies illustrated the birth pangs of the organized medical profession in America.
THE PENNSYLVANIA HOSPITAL
Benjamin Franklin involved himself in just about every aspect of colonial science and public concern, including the establishment of the Pennsylvania Hospital. Conceived in 1751 and opened the next year, the Pennsylvania Hospital was the first modern hospital in America. Before the hospital the sick and poor of Pennsylvania received what care they could from almshouses, workhouses, and houses of correction. For the first time in Pennsylvania they received free care from trained physicians. The hospital also cared for mentally ill patients. Perhaps because the hospital accepted wealthy patients, their medical standards and facilities were the best of the time on both sides of the Atlantic. Indeed, the mortality rate of Pennsylvania Hospital patients was 10 percent, half that of comparable European institutions. Franklin advertised the success of the hospital in Some Account of the Pennsylvania Hospital, published in 1754. Years later in his Autobiography (1868) Franklin wrote: “A convenient and handsome building was soon erected; the institution has by constant experience been found useful, and flourishes to this day.”
Raymond Stearns, Science in the British Colonies of North America (Urbana: University of Illinois Press, 1970);
Frederick Tolles, Meeting House and Counting House: The Quaker Merchants of Colonial Philadelphia, 1682–1763 (New York: Norton, 1948);
Usually, physicians are regarded as the guardians of health and lives, but what happens when healing conflicts with larger state aims? How do physicians reconcile their Hippocratic oath with a mandate of genocide? Like many other professional groups, doctors are simultaneously members of the social elite and public servants. As such, ruling authorities sometimes use them as agents to provide a legitimizing framework for actions taken by the state. At the same time, doctors are human beings, and as members of a particular society, they are equally susceptible to that society's prevailing social mores and climate. When a state adopts an exclusionary policy of hyper-nationalism, all of its citizens, doctors included, can find themselves on both sides of the divide. Whether as willing participants or as reluctant accomplices, physicians have become involved in the planning and implementation of mass murder in numerous countries.
In 1915 Ottoman Turk physicians conducted medical experiments, participated in mass deportations, and promoted a genocidal ideology that led to the widespread death of the Armenian population. Less than two decades later physicians in Nazi Germany perpetrated similar atrocities in a system that culminated in the Holocaust. Carnage also occurred when Hutu doctors turned against Tutsi patients during the Rwandan genocide. Similarly, an international tribunal charged Serbian doctors with war crimes for their role in ethnic cleansing in Bosnia and Kosovo. Even in situations not necessarily intended as full-scale genocides, doctors have lent their medical expertise in an effort to remove or restrict "undesirable" elements of the population. Medical personnel in Argentina, Bolivia, Chile, Iraq, and elsewhere participated in the torture and death of dissidents and enemies of the state. Additionally, in Britain, the United States, Norway, and Sweden physicians helped to carry out involuntary sterilizations as part of their country's eugenic policies.
Four theories offer differing perspectives to explain how physicians could come to endorse programs so seemingly at odds with their role as healers. The first theory argues that doctors do not abandon medical ethics to follow eugenic or genocidal policies; rather, they reinterpret those ethics to coincide with the dominant and prevailing agenda. Generally, this involves placing the health of the collective ahead of that of the individual. Doctors then become charged with cutting out socalled cancerous elements of the population the same way they would remove cancerous tumors from a sick individual. Physicians are often aided in their actions by state-sponsored propaganda campaigns. The Nazis were particularly effective in promoting this approach through films for public consumption, such as Victims of the Past (1937) and Existence without Life (1940–1941). These films were designed to convince the population that the elimination of mentally and physically disabled people was not only in their collective best interest, but actually merciful, and furthermore, as in the case of the film I Accuse (1941), often the desire of the patients themselves.
The second theory promotes the idea of participation via the "slippery slope," whereby transgressions of the medical, ethical, and societal moral codes begin on a small scale, gradually build on themselves, and eventually spiral out of control. For example, doctors do not start out by killing individuals for the purpose of medical experimentation. Rather, by first defining certain people as inferior and then subhuman, it eventually becomes acceptable to use them as scientific specimens without regard for their rights as human beings.
A third theory argues that physicians participate because they cannot find a way to excuse themselves from such activities without suffering grievous personal, professional, or bodily harm. Their actions are motivated by a fear of losing their license, profession, social standing, or even life. For example, according to one source, Iraqi doctors under Saddam Hussein's regime were ordered to cut the ears off torture victims or suffer the same fate themselves. In another case, doctors during the Third Reich often faced internment in a concentration camp if they failed to comply with state rules. This theory raises questions about individual agency and choice. Why, when faced with identical situations, do some physicians find a way to circumvent such rules, while others, seemingly, cannot?
Whereas the first three theories are predicated on the idea that (some) physicians accept, or at least do not actively resist, involvement in such programs, a final theory argues that other doctors aggressively seek to participate in genocidal or eugenic programs. Their motivations range from an opportunistic desire for personal or professional gain to an entrenched belief in the advocated exterminationist ideology. Such was the case with National Socialist physician Leonardo Conti. His early membership in the Nazi Party (he joined the SA in 1923) qualified him as a member of the Old Guard. Conti rose through the system to eventually become the senior ranking medical officer in the Third Reich. Additional Nazi physicians who found scientific opportunity in the suffering of others included: Karl Brandt, who, along with Phillip Bouhler, headed the euthanasia program known as T-4; Gerhard Kujath, whose film A 4½-Year-Old Patient with Microcephaly (1936–1937) was a product of the regime's euthanasia program for children; Josef Mengele, best known for his infamous twin experiments; Sigmund Rascher, who conducted hypothermia and cold-water testing in Dachau; Heinrich Berning, who starved numerous Soviet prisoners of war in the name of famine experimentation; Carl Clausberg, known for his sterilization and castration experiments; and Kurt Gutzeit, who injected Jewish children at Auschwitz with hepatitis.
SEE ALSO Eugenics
Dadrian, Vahakan (1986). "The Role of Turkish Physicians in the World War One Genocide of Ottoman Armenians." Holocaust and Genocide Studies 2:169–192.
Kater, Michael H. (1989). Doctors under Hitler. Chapel Hill: University of North Carolina Press.
Proctor, Robert (1988). Racial Hygiene: Medicine under the Nazis. Cambridge, Mass.: Harvard University Press.
Schmidt, Ulf (2002). Medical Films, Ethics and Euthanasia in Nazi Germany: The History of Medical Research and Teaching Films of the Reich Office for Educational Films/Reich Institute for Films in Science and Education, 1933–1945. Husum, Germany: Matthiesen Verlag.
Sirkin, Susannah (2003). "Accountability for Crimes against Humanity in Iraq." Published in "Human Rights Violations under Saddam Hussein: Victims Speak Out," Proceedings of Hearing Before the House Committee on International Relations' Subcommittee on the Middle East and Central Asia. Available from http://www.phrusa.org/research/iraq/testimony_112003.html.
Education and Training: College and medical school, possibly with specialty training
Salary: Varies—see profile
Employment Outlook: Good
Definition and Nature of the Work
Physicians, or medical doctors (MDs), diagnose and treat diseases, injuries, and other disorders. They also work to promote good health and prevent illness. Physicians often supervise other health-care workers, such as physician assistants, nurses, and technicians.
Most American physicians are involved directly in patient care. Only about a tenth of all physicians in the United States work in areas other than patient care, such as administration or research. The majority of the physicians who provide patient care have their own practices or are partners in group practices. Others work full time in hospitals.
About a third of the physicians providing patient care are general practitioners. They treat a wide variety of common health problems. When general practitioners discover illnesses or injuries that need special care, they refer patients to specialists. Family practitioners, who are general practitioners, concentrate on primary health care for the entire family.
The other two-thirds of the physicians providing patient care are specialists who work in one particular branch of medicine. There are about thirty-five major fields of specialization with more than fifty different subspecialties. Physician specialties described in this book include anesthesiologist, dermatologist, gerontologist, ophthalmologist, psychiatrist, and surgeon. Specialties in primary care, which are described in brief in the following paragraphs, are internal medicine, obstetrics/gynecology, and pediatrics.
Physicians who specialize in internal medicine are called internists. They diagnose and treat problems of the internal organs, such as the liver, heart, and lungs. They do not perform surgery. Internists manage and treat common health problems, such as infections, influenza and pneumonia, as well as more serious, chronic, and complex illnesses. Their patients range in age from adolescents to the elderly.
Obstetrician/gynecologists (ob/gyns) focus on women's health. Along with general medical care of women, ob/gyns care for women before, during, and after pregnancy. They monitor not only women's state of health, but also that of their developing fetuses. They deliver the babies and care for the mothers after they have given birth. Ob/gyns also diagnose and treat diseases of the female reproductive, urinary, and rectal organs and breasts. They may prescribe medications, suggest exercise regimens, or perform surgery.
Pediatricians provide health care for children from birth through adolescence. They chart the growth and development of children, provide immunizations, and diagnose and treat illnesses, injuries, and behavioral problems. Pediatricians may refer children to specialists.
Education and Training Requirements
Students who want to be physicians usually get bachelor's degrees in sciences, such as chemistry or biology. Medical schools look for students who are well rounded, so other courses and activities are important. Most medical colleges have four-year programs that lead to doctor of medicine (MD) degrees. A few medical schools offer combined undergraduate and medical school programs that last six rather than eight years. Internship and residency—on-the-job medical training at hospitals—last from three to eight years.
In every state, physicians must be licensed. Requirements vary, although all states require degrees from approved medical colleges and licensing examinations. In most states MDs must also serve one or two years of residency in hospitals before they can be licensed.
Physicians who want to work as general practitioners usually serve three-year residencies in general internal medicine. Those who want to become specialists serve three-year residencies in their chosen fields. Specialists also need additional practice in their fields before they can be certified by the appropriate specialty boards. Physicians who want to go into teaching or research earn master's degrees or doctorates in particular sciences, such as biochemistry or microbiology.
Getting the Job
Some newly licensed physicians start their own practices and work alone. Others share offices in group practices or join health maintenance organizations (HMOs). A small percentage of physicians take salaried jobs in hospitals, clinics, government agencies, or private industry. Professional associations and medical colleges can provide information about going into private practice or finding salaried positions.
Advancement Possibilities and Employment Outlook
Most physicians advance by expanding their practices. They can improve their skills in general medicine or in special fields. Some physicians advance by teaching or doing research. Others study business administration and become hospital administrators.
Employment of physicians and surgeons is projected to grow faster than the average for all occupations through 2014, largely because health-care industries are continuing to expand. New technologies permit more tests, more procedures, and new treatments for patients with conditions that were previously untreatable. The growing and aging population should generate demand for physicians as well. The greatest needs may be in the fields of family practice, geriatrics, internal medicine, pediatrics, and preventive care. Job opportunities should be good in rural and low-income areas; earnings potential may be lower.
Physicians generally work in clean, comfortable offices, clinics, or hospitals. Those who have their own practices can control some of their working conditions. Many physicians work long and irregular hours. They must be available to handle emergencies. Some physicians limit their hours or work in specialties that have few emergencies.
Physicians need high intelligence, good health, and self-discipline. They should be able to communicate with many kinds of people. They must have good business sense and the ability to organize the work of others. Their profession demands that they continue to study new developments in medicine throughout their careers.
Earnings and Benefits
Earnings vary widely depending on experience, skill, location, field of specialization, and other factors. In 2004 physicians who had been in practice for more than one year earned the following median incomes: general practitioners, $156,010 per year; internists, $166,420; ob/gyns, $247,348; and pediatricians $161,331. Physicians who had their own practices tended to earn more than salaried physicians.
Where to Go for More Information
American College of Physicians
190 N. Independence Mall W.
Philadelphia, PA 19106-1572
Self-employed physicians arrange their own benefits. For those who are salaried, benefits generally include paid holidays and vacations, health insurance, and retirement plans.
A physician working in public health focuses on diagnosing and improving the health of communities. Such physicians are dedicated to the prevention of illness, injury, and disability, and to the promotion of healthy behaviors and improved quality of life. They provide special knowledge, skills, and especially leadership to resolve public health issues. Public health physicians often have clinical and/or administrative roles in local or state health departments, federal or international health agencies, academic institutions, and notfor-profit and for-profit health and health care organizations. While physicians enter public health with different clinical backgrounds, many have formal public health training and hold specialty board certification in preventive medicine, the combined art and science of getting and keeping people healthy.
Teresa C. Long
(see also: Preventive Medicine )
physician, heal thyself proverbial saying, early 15th century, meaning that before attempting to correct others you should make sure that you are not guilty of the same faults. Originally biblical allusion to Luke 4:23, ‘And he said unto them, Ye will surely say unto me this proverb, Physician, heal thyself: whatsoever we have heard done in Capernaum, do also here in thy country.’
phy·si·cian / fiˈzishən/ • n. a person qualified to practice medicine. ∎ a healer: physicians of the soul.