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<div class="portal" style='float:right; width:35%'>====Related DailyHistory.org Articles===={{#dpl:category=Medical History|ordermethod=firstedit|order=descending|count=12}}</div>Regular physicians in California did not have to pair the state’s licensing law with a public health measure. But they were significantly aided because the California Board of Health had been created the year before the licensing law was passed. Even though physicians did not piggy-back the state’s licensing on the creation of the board of health, members of the Board of Health in California strongly advocated on behalf of licensing as an essential component of public health. The board members’ support for licensing was unsurprising because all of the members of the board were Regular physicians. What was surprising was the state Regulars’ willingness to compromise with Irregulars. In many states, Regular physicians proposed laws that clearly sought to limit the influence of Irregulars, but in California, the leaders of CSMS fairly early on were committed to compromising with Irregulars. The leadership of CSMS and the Board of Health in California never sought to eliminate Irregulars. The Regulars’ willingness to compromise encouraged the state’s Irregulars to quickly support the law and overcame any objections in the legislature.
Admin moved page When were doctors first licensed in California? to When were doctors first licensed in California
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[[File:Annual_announcement_of_lectures_at_Toland_Hall,_Medical_Department_of_the_University_of_California,_San_Francisco,_California_(1874)_(14597726398).jpg|thumbnail|left|350px|Toland Hall, Medical Department of UC San Francisco 1874]]
In the 1870s, physicians across the United States pushed state legislatures to implement medical licensing. At this time, all doctors in the United States were unlicensed.<ref>Portions of this article were originally part of the following work: Sandvick, Clinton. <i>Licensing American Physicians: 1870-1907</i>, Dissertation, University of Oregon, 2014</ref> Additionally, the United States was composed of a crazy patchwork of physicians from different sects competing with each other. The three largest sects were regulars (traditional M.D.s), homeopaths, and eclectics (a mixture of Thomsonians and disaffected regulars). Eclectics, homeopaths , and other non-M.D. physicians were often referred to as irregulars. These sects represented completely different approaches to medicine.
By the 1870s, regular physicians were committed to regulating medicine. They believed that state licensing was a necessary first step to control the medical marketplace. Initially, regular physicians sought to use licensing to prevent homeopaths and eclectics from practicing, but in states such as California, they quickly realized that they would need to work together if they wanted the state legislature to create medical licensing.
====Stumping for Medical Licensing====
In 1870, the Legislature created a California State Board of Heath Health with the goal of looking “after the vital interest and physical condition of the people.” The Board was composed of seven physicians from Sacramento and five doctors from other parts of the state. The legislation did not bar Irregulars from serving on the board nor did it require it. Still, all of the members of the inaugural board were Regulars. One of the chief responsibilities of the Board was to propose bills to the legislature that could improve public health.<ref> Logan, Thomas, “Report of the Permanent Secretary”, <i>First Biennial Report of the State Board of Health of California for the Years 1870-1871</i> (Sacramento, D.W. Gelwicks, State Printer, 1871), 16-17, http://books.google.com/ebooks.</ref>
In 1874, Thomas Logan, one of the most prominent members of the CSMS and the permanent secretary of the California State Board of Health, began an earnest effort to enact medical licensing in California. Logan made a strong case at the 1874 California Medical Society meeting that it was crucial for physicians to began to assert control “over admission to its ranks.” He also argued that the disputes among the sects not only appeared to be “useless and unseemly” to the public, but they were counterproductive because these disputes “prevented or defeated all efforts to obtain legislation that would have … protected the people against medical frauds and ignorance.”
This conflict had weakened an already diminished profession. “Physicians of moral worth and personal dignity” were reduced to opposing any measure that would allow them to be categorized as a physician along with the numerous “shams and frauds” littering their profession. Logan argued that as long “as the demand” for licensing “is made irrespective of all so-called schools of medicine” the Legislature would be unable to “refuse.” Logan called on the CSMS to support a regulatory bill that would create an independent board of medical examiners that would license all applicants and criminalize the practice of medicine without a license.<ref><i>Transactions of the Medical Society of the State of California During the Year 1873 and 1874</i>, (Sacramento, H.A. Weaver, Printer, 1874): 49-61, http://books.google.com/ebooks.</ref>
Logan was not the only person calling for the creation of medical licensing in California. The <i>Los Angeles Herald</i> advocated on behalf of medical licensing on July 31, 1874. The editorial asked why ship pilots were required to secure licenses while physicians “were permitted to practice medicine without written evidence of their right to kill or cure the human family[.]” The editors argued that , unlike lawyers, “the ignorance and efficiency of the quack doctor” were not apparent until “one or more lives have been sacrificed.” The Herald demanded that the state of California needed to require physicians to get a license in order to “suspend operations” by “these murderers.”<ref> “Show Your Diplomas,” <i>Los Angeles Herald</i>, Volume 2, Number 103, July 31, 1874, 2.</ref>
====Proposing a Medical Licensing Law====
Logan’s bill was not the only one presented that year. The San Francisco Medical Society also proposed a similar law, but that one authorized the creation of a “Board of Medical Examiners.” This board would be composed of seven practicing physicians who would be responsible for evaluating diplomas and conducting a “critical examination” of all medical licensing applicants. If an applicant presented a valid diploma and passed the licensing exam, the board would confirm the identity of each applicant to ensure that they were not practicing under an assumed name. The <i>Sacramento Daily Union</i> questioned whether it was necessary for every physician who wanted to practice in the state. The <i>Union</i> argued that it would be inappropriate for a select group of California physicians to question the judgments of American medical schools and “the Medical Colleges of Europe.” The editors of the Union believed that California lacked physicians who possessed either the skill or credibility to question these august institutions. They argued that California would be better served if they relied on these schools to furnish “evidence of competency” for the prospective physicians.<ref> “Legislation Against Quackery,” <i>Sacramento Daily Union</i>, Volume 1, Number 232, Nov. 12, 1875: 2.</ref>
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====Passing Medical Licensing====
====Efforts to Amend the Licensing Law====
One of the most consistent problems faced by licensing laws was that as soon as they were passed, special interest groups immediately sought to amend them in the next legislative session. Sometimes these amendments were proposed by Regular or Irregular medical societies, but often they were proposed to benefit a class of medical specialists who were disadvantaged by the existing law. There was a wide range of amendments proposed in states around the country to help itinerant physicians, unrecognized specialties, or some other group. California was no different.
Even though the law was passed with overwhelming support from the state’s Regulars and Irregulars, Ira Oatman, Chairman of the Committee on Medical Legislation for the California State Medical Society, fought tooth and nail “to defeat” subsequent legislation that upset the original compromise. Oatman often worked with several other state medical societies to defeat any and all proposals to amend the licensing law from the Regular society. In 1878, Oatman was faced with multiple bills that sought to upend the state’s law. There were so many proposed alterations and amendments to the licensing, and Oatman admitted that he struggled to keep abreast of all the proposals. Oatman’s struggle was not unique. After licensing laws were passed, legislators constantly sought to tinker with them.'
The California law not only required examinations of all applicants, the new law explicitly, but it created separate Regular, Eclectic, and Homeopathic boards. Each of these boards was explicitly tied to the state board for each sect. Additionally, the medical societies retained the right to change the members without interference from the governor’s office. This effectively prevented any additional medical sects from creating their own medical examining boards, thereby establishing a medical cartel among the three dominant sects. Additionally, the law was altered to give the medical societies more money for examinations. Physicians who submitted false diplomas would be fined an additional fifteen dollars by the board. The examining boards also were required to refuse certificates to any applicant accused of unprofessional conduct. Finally, itinerant vendors were required to pay for one-hundred dollars licenses if they wanted to sell any “drugs, nostrum, ointment or appliance of any kind intended for the treatment of disease.” <ref><i>Laws Regulating the Practice of Medicine in the State of California, Passed April Third, 1876, and April First, 1878</i>, (San Francisco, A. L. Bancroft , and Company, 1878): 7–11, http://books.google.com/ebooks.</ref> Essentially, Oatman and the CSMS were successful in achieving almost everything they wanted from the 1878 amendments. Additionally, the 1878 bill enabled more rigorous enforcement of the licensing law.
One of the implications for the 1878 amendments was that non-graduates who had not presented themselves for an exam in 1876 had another opportunity in 1878. The Board of Examiners for the Medical Society of the State of California began advertising in newspapers providing notice to non-medical school graduates that they needed to take a medical examination to procure a license. One of the advertisements in the Sacramento Daily Union announced that all non-graduates had to go to San Francisco for the examinations. The examining board did not bother to schedule exams for Sacramento. The advertisement indicated that the board informed applicants that it would question physicians about why they had failed to take the earlier exam.<ref> “Important to Physicians,” <i>Sacramento Daily Union</i>, Volume 7, Number 67, May 8, 1878, 2.</ref>Allowing non-graduate physicians to apply for licenses even though they had failed to do so prior was a small compromise for California’s Regulars in order to achieve their primary goals.
===Conclusion===
Essentially, the three dominant medical sects got what they wanted. All three sects were officially recognized by the state and were given control over the medical marketplace. It also set a precedent that would extend throughout the country over the next 30 years. The three medical sects often worked together to create licensing in order to freeze out physicians they believed were substandard. This cooperation would ultimately lead to a breakdown of these sects and their combination during the early 20th century. <div class="portal" style='float:left; width:35%'>====Related Articles===={{Mediawiki#dpl:LongerAdcategory=Medical History|ordermethod=firstedit|order=descending|count=10}}</div>
====References====
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