Scholars working in the history of medicine are plentiful. Relatively few have focused on the history of medical regulation in the United States.

One the earliest was Richard Harrison Shryock (1893-1972), a former historian at Penn and Duke Universities. Yet even Shyrock’s Medical Licensing in America, 1650-1965 (Johns Hopkins Press, 1967) proves slightly disappointing upon closer inspection. The slim volume–at 120 pages it is really more of an extended monograph–signals its intent to provide nothing more than a useful but high-level overview of the topic.

Similarly, the first third of the book focuses on the colonial and antebellum period when regulatory efforts in medicine were predominantly conducted through medical societies rather than more clearly governmental function characterizing the rebirth of licensing laws after the Civil War.

The strongest sections of the book deal with the development of American medical education in the last quarter of the 19th century and first decades of the 20th century. Here Shryock addresses the intertwined nature of medical education reform and improvements with the advent of modern licensing laws.

The period covered by Shryock’s text stops just as medical regulation is moving toward a paradigm shift in the 1960s when discipline (and not simply examining and licensing) became a major focus of state medical board activity. Shryock acknowledges this in his reference to the research conducted by Robert Derbyshire, president of the Federation of State Medical Boards. Derbyshire’s contributions both as a scholar and a leader in medical regulation merit their own blogs so I’ll return to him in the the months ahead.

  I remember stumbling upon the photo of Dr. Hiram Hampton about 6-7 years ago. Two things stood out at the time. First, the juxtaposition of a medical handbag and a holstered revolver grabbed my attention immediately. Maybe Hiram posed as a pistol-packing physician strictly for the sake of a fun photo? Or perhaps the pose reflected a rough-n-tumble aspect to ca. 1900 Florida now lost to our modern perception of state for its beaches, bikinis, retirees and Disney World.

The second element that struck me was Hiram’s identification as a member of the Florida Eclectic Board of Medical Examiners. I had some notion of the various ‘schools’ or philosophies that characterized 19th century medicine in the United States…but the eclectics still puzzled me somewhat. They originated in the 1840s as a reaction to the more extreme aspects of the medical orthodoxy of the day–in particular, the “heroic” medicine on the early 19th century which drew so heavily upon toxic minerals (e.g., calomel) and bloodletting. Eclectic physicians saw themselves as reformers championing a milder, therapeutic regimen, usually a botanic or herbal-based medicine.

But rather than allow themselves to become slaves to any  medical “-ism” or orthodoxy, eclectic physicians vowed to embrace any and all therapeutic regimens and practices that placed a premium on letting nature take the lead in healing the human body. Thus, the term “eclectic” took hold as a sign of their medical open-mindedness and liberal intellectual spirit. Of course, what eclectics saw as a virtue, their critics attacked as evidence of intellectual softness–in essence, disparaging their lack of a rigid theory or philosophy for the practice of medicine.

It is perhaps this aspect of 19th century medicine (its speculative philosophy) that seems most alien to us today. In a way, however, it made perfect sense for the time. Because there was so little that could be demonstrably proven in medicine, practitioners tended to coalesce into schools or philosophies of medicine (e.g., allopathy, homeopathy, osteopathy, eclecticism) most of which featured deeply structured, intellectually-rigid principles.  Because physicians of the day remained captive to a limited scientific framework for adjudicating the best methods of diagnosis and treatment, medical disagreements of the era often degenerated into passionate, rancorous arguments that were largely speculative and ultimately non-provable—the nineteenth century equivalent of medieval theologians arguing over the nature of angels, i.e., whether they possessed a material or corporeal nature. The historian Owen Whooley characterized medicine during this period as an “exercise in philosophizing rather than scientific researching.”

Eclectic physicians triumphed often enough in these battles to gain legislative recognition. A number of state legislatures mandated that representatives from the various schools of medicine (e.g., regular, homeopaths, eclectics) serve on a composite medical board. In more than a dozen states, separate medical boards were established for licensing physicians identified with these various schools of medicine. Thus, Florida’s eclectic medical board and Dr. Hiram Hampton.

Florida disbanded its eclectic medial board by the 1920s after a scandalous turn of events in the issuance of licenses. But I’ll save that for another day.