Why were Eclectic Physicians in the United States divided on Medical Licensing?

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As states adopted medical licensing and registration laws during the 1870s, Irregular physicians faced a dilemma. Irregulars understood that Regulars originally advocated on behalf of licensing as a way to eliminate Irregulars, but many of them agreed with the overall goals of licensing. The proliferation of unqualified medical practitioners concerned many Homeopaths and Eclectics. Eclectics were especially apprehensive because fraudulent doctors often passed themselves off as Eclectics. This further marginalized the weakest and smallest major medical sect. Eclectics were disquieted that Eclecticism’s affiliation with outright frauds could undermine their standing as physicians.

Unlike Homeopaths, Eclectics did not practice a unified system of medicine. Eclectics were composed of a mixture of lonely local practitioners, botanic physicians, reformed Regulars, and graduates of Eclectic medical schools. The very name “Eclectics” accurately described the differing medical practices of its members. Sometimes, Eclectics in the National Eclectic Medical Association (NEMA) did not even appear to agree on who was a legitimate Eclectic physician. While Homeopaths could draw on their unified medical system to assemble a more coherent and coordinated approach to medical licensing. Eclectics lacked this cohesion when medical licensing became a defining issue. Homeopaths demonstrated their unity and influence when they effectively blocked medical licensing in two of their strongholds, New York and Massachusetts, until the 1890s.[1] Homeopaths’ influence was derived not only from their larger numbers but also the nature of their patients. Urban and wealthy Homeopathic patients helped their physicians lobby in state legislatures on their behalf.

In contrast, Eclectics were in more precarious position. While they lacked the power to block legislation, they worked with Regulars and Homeopaths to help craft potentially beneficial medical licensing laws. Many Eclectics understood that medical licensing could improve Eclecticism’s standing in the medical community by eliminating frauds who hid under their moniker. Eclectics faced a stark choice: cooperate with Regulars to draft helpful licensing or attempt to block licensing and risk further marginalization. Eclectics were increasingly torn on how to proceed with medical licensing.

Even though Homeopaths had more influence in state legislatures than Eclectics, they were faced with many of the same choices. In states where Homeopaths could kill licensing, they did, but in most states, they were forced to compromise with Regulars on licensing. In many ways, the debate within Eclecticism mirrored the debate in Homeopathy, but the Eclectic debate is noteworthy because leaders within the movement publicly attacked each other in their battle over licensing.

The passage and implementation of the Illinois Medical Practice Act created a major rift in the leadership of the National Eclectic Medical Association over the issue of medical licensing. While many Eclectic physicians were concerned with licensing in other states, in Illinois the Eclectics worked with Regulars to create the Illinois Board of Health and establish medical licensing in the state. Eclectics also served on the joint mixed State of Board of Health. Dr. Anson Clark was not only the Eclectic representative on the Illinois Board of Health but the editor of a leading Chicago Eclectic journal and a future president of NEMA. The willingness of Illinois’ Eclectics such as Clark to align themselves with the state’s Regular physicians rankled the older members of NEMA. These older members were much less willing to cooperate with Regulars on either regulation or public health than younger physicians such as Clark. Clark’s actions angered many of the older members because he openly advocated for a unified medical board instead of establishing separate boards for each of the sects.

NEMA had focused on combating the new wave of licensing that began in the 1860s. Throughout that decade, unsuccessful licensing bills popped up all over the country. During the 1866-67 legislative session, for example, a bill was introduced that would require physicians to be examined by the Ohio State Medical Society and be graduates of a medical school. Ohio was the heart of Eclectic medicine, and this bill represented a serious challenge to Eclecticism.[2] It became increasingly clear to organized Eclectics that they would have to combat potentially hostile legislation across the country. The wave of medical licensing laws in the 1870s demonstrated that their concern was legitimate. However, it was the passage and implementation of the Illinois Medical Practice Act that forced open a crack in NEMA’s leadership and led to an ongoing debate over licensing within the group for the next decade.

The passage of the Illinois law forced NEMA grapple with a wave of new laws modeled after the Illinois law. Unlike the American Medical Association, NEMA’s response to medical regulation was hampered by its membership’s disagreement about what constituted an Eclectic physician was and its members’ widely divergent views on medical regulation. The debate over medical regulation exposed the fissures within the Eclectic community. The older physicians, who cobbled together the Thomsonians, disgruntled Regulars, and medical reformers to give birth to Eclectic medicine in the 1830s and 1840s, were a discordant group and predisposed to oppose any type governmental regulation. These medical reformers had fought hard to eliminate medical regulation in the first of half of the century. They believed that state regulations discriminated, marginalized, and limited their practice rights. They viewed Regulars with suspicion and distrusted their motives in advocating for medical licensing.

The younger generation of Eclectic physicians was not as hostile to medical regulation despite being trained by the original Eclectics. Unlike their older colleagues, many of them were Eclectic medical school graduates. They had very little in common with the illiterate Thomsonians who aligned themselves with Eclectics in opposition to medical regulation in the first half of the century. This younger generation was more concerned with legitimizing Eclecticism than expanding its definition to include uneducated and marginal medical practitioners. The second generation of Eclectic physicians believed that they had to purge their uneducated colleagues from their ranks to legitimize Eclecticism. Instead of fighting regulation, they often worked with Regulars to pass nonpartisan legislation.

Eclectics realized that Regulars needed Irregular support to pass licensing laws, and they knew that discriminatory legislation often failed in state legislatures. Between 1870 and 1880, Eclectics reported to NEMA that state legislatures were unwilling to discriminate against Irregulars. A Nebraska report stated that its legislatures would not pass discriminatory legislation. Massachusetts, Ohio, and Wisconsin successfully defeated bills proposed by the American Social Science Association designed to consolidate control under the old-school medical societies. Even with these hopeful signs, medical licensing made Eclectics anxious.

The debate over licensing within the NEMA sparked an outright war between two of its most prominent members: Dr. John King and Dr. Anson Clark. While both physicians sought to downplay the severity of the clash, it is clear from their rhetoric that their battle represented a serious dilemma for NEMA. The tenor of the debate suggested that both physicians believed they were fighting for the soul of the Eclectic movement. King and Clark attacked each other mercilessly to shape its policy. King opposed any type of medical regulation, while Clark worked on the Illinois Board of Health with Regular physicians to regulate the practice of medicine in the state. This heated debate created confusion with NEMA and spawned an awkward and ambiguous policy towards medical regulation. Instead of presenting a united front and crafting a coherent policy, NEMA muddled its stance on medical licensing. NEMA sent mixed messages and left local and state societies to develop their own policies on licensing. Whether NEMA could influence or shape the direction of medical legislation is unclear, but because of its befuddled position, it abdicated any leadership position it might have played in this nationwide medical debate when these laws were first being pushed through state legislatures.

John King was a pioneer in Eclectic medicine and one of its most ardent devotees. In 1838, he graduated from the Reform Medical School of New York founded by Wooster Beach (1794-1868) in 1827. As a graduate of the Reform Medical School, King ensured that he would be ostracized by the medical establishment as a “charlatan and quack.”[3] After graduation, he traveled extensively and settled in Kentucky where he practiced medicine until 1849. He helped organize the first National Convention of Eclectic Physicians, and the attendees elected him secretary at the convention. Between 1849 and 1851 he served as the chairman of Materia Medica at the Memphis Institute. In 1851, King joined the faculty at the recently founded Eclectic Medical Institute of Cincinnati (EMI) and taught there for the next four decades. During his tenure, EMI became the leading Eclectic medical school in the country. King established himself as one of the leading writers of Eclectic textbooks, such as the Eclectic Dispensatory, and published most of his books on Eclectic medicine while at EMI. Eclectic physicians throughout the nineteenth century extensively used King’s textbooks in their medical schools. He joined the second iteration of NEMA in 1872 and served as its president from 1878-1879.

Anson Clark was born in Massachusetts in 1836, but he moved to Cook County, Illinois, when he was five years old. He graduated from EMI in 1861 and likely attended King’s classes as a student. During the Civil War, he worked as a surgeon in the 127th Illinois Volunteer Infantry. After the war, Clark moved back to Chicago and in 1868, became a member of the faculty and later its dean at the Bennett College of Eclectic Medicine and Surgery. In addition to working at Bennett, he served as an editor at the Chicago Medical Times and a member of the Illinois General Assembly in 1871. Starting in 1877, Clark served on the Illinois Board of Health. During his fourteen years on the board, he served as both its treasurer and secretary. As a member of the Illinois board, he was responsible for regulating the practice of medicine under the 1877 and 1887 Medical Practice Acts. Additionally, Clark served as the president of NEMA in 1880-1881 and the Illinois State Eclectic Medical Society in 1898.[4] These two physicians were from different generations of Eclectics and they represented NEMA’s split on medical licensing.

In 1873, NEMA began discussing the growing push for medical licensing in places such as Texas. The organization passed a resolution for requiring “every person” hoping to practice “medicine, surgery or obstetrics” to pass a comprehensive examination covering “the fundamental sciences, comprehending a course of study necessary for the acquirement of a full knowledge of the science of medicine in all its branches.” NEMA believed that an examination was necessary because the general public could not determine “the scientific attainments of medical practitioners” as medical diplomas were so “freely granted” they had ceased to be “evidence of the scientific attainments” of their holders.[5] Additionally, Eclectics could pass this exam as easily as Regulars and Homeopaths. This resolution went far beyond the goals of the Illinois Medical Practice Act. It required an examination of non-graduates and graduates of medical schools that were not in good standing with the board. The NEMA resolution would have required all physicians to take the medical examination. This resolution is surprising because so many Eclectics were skeptical of medical licensing.

King, however, was not just skeptical about medical licensing; he was adamantly opposed to any medical licensing regulations. In his presidential address of 1879 at the NEMA conference in Cleveland, he attacked medical regulation generally. King argued that like religion, medicine did not require county, state, or federal regulation. Instead of outsourcing medical licensing to the state, each school of medicine should be responsible for regulating themselves. King believed that these laws did not protect the public and that they were an insult to the intelligence of the American people. King stated that the proposed regulatory schemes would not advance medicine or science; instead, they were simply the work of “bigoted scheming minds” that sought to elevate their own medical sect. King was most concerned with the efforts of Regular physicians to regulate medicine because he considered their primary goal was to marginalize Eclectic medicine. Instead of elevating the medical profession, he believed that when the state legislatures passed medical licensing and registration acts they violated the “spirit of justice” in the United States Constitution.[6]

Not only did medical regulation undermine Eclectic medicine, King felt that Regulars would continue to discriminate and torment Irregular practitioners. Even after Eclectic physicians had complied with the Regulars’ “legal enactments,” Regulars still would refuse to consult with Irregulars and refer to Eclectics as “ignorant conceited quack[s].” He could not imagine that Regulars would ever stop maligning and persecuting Eclectics, even if Eclectic physicians demonstrated that they were qualified for medical licenses. King held that the Regulars did not seek to protect humanity from charlatanism, but instead sought to legislate the Eclectics out of existence. Thirty years of discrimination by Regulars convinced King that Regulars could not be trusted to treat Eclectics fairly. A state report issued by the New York delegation at the 1879 convention supported King’s claims by emphasizing the historical efforts made by Regulars to degrade medical reformers. The report remarked that Regular physicians in the first half of the century secured medical regulations that criminalized medical practice for Irregular physicians. Additionally, Regulars were accused of actively seeking to drive Irregulars from the medical practice by encouraging former Irregular patients to sue their physicians.[7]

The actions of the Illinois State Board of Health in 1879 against King’s own medical college, Eclectic Medical Institute (EMI), reinforced his belief that medical regulation was simply a Trojan horse to help Regulars destroy Eclecticism. Fifteen days before the 1879 NEMA conference, the Illinois State Board of Health determined that EMI was not a medical school in “good standing.” The Illinois Board of Health had the power to determine whether a medical school was in “good standing.” Graduates of medical schools in good standing did not have to take a medical examination to practice medicine in Illinois. According to the board, EMI, the most prominent Eclectic medical school in Illinois, was unacceptable because it insisted on only “giving two full courses of lectures in one year.” At the beginning of the board’s existence, instead of evaluating each school individually, it sought to apply rather mechanistic standards to evaluate medical schools. In 1878, the board determined that any medical school that had “two graduating courses in one year” was not in good standing. While the board’s criterion was not particularly sophisticated, it was clear-cut. The board could use the medical schools’ own literature to determine whether it satisfied their requirements. This criterion made it possible to cheaply evaluate hundreds of medical schools in North America and Europe.

Clark not only served as a member of the board that decertified EMI, but he explicitly approved of the board’s action. A Chicago Medical Times editorial by Clark in July 1879 stated that the board was simply “striving to make medical education more thorough, more comprehensive and more fully in accord with the progressive spirit of the times.”[8] The editorial chastised the “belligerence” of EMI and asked for the school to “gracefully yield” to the board’s demands. The editorial went as far as to suggest that “students and preceptors to take note of the existing states of affairs.”[9] Yet, Clark was one of only two editors listed on the Chicago Medical Times byline. Therefore, he probably wrote the editorial and even if he did not, he agreed with this editorial.

Illinois board’s action against EMI most likely was not motivated by animus to Eclecticism, and Clark’s support for the board undermined King’s claim. Also, the mechanistic nature of the board’s criteria would have complicated any attempts to punish only Eclectic schools. The board also asked numerous Allopathic medical schools to comply with the board’s criteria. Still, the editorial’s suggestion that “students and preceptors” should take note of the current situation did imply another reason for Clark’s strong support of the action against EMI. While Clark simply may have agreed with the board’s position as an attempt to elevate medical education, he also may have had a financial stake in decertifying EMI. As a faculty member of the competing Bennett Medical College in Chicago, he might have benefited by steering students to Bennett.

Despite King’s attack against medical licensing, various state Eclectic medical organizations advocated on behalf of regulation in their legislatures. The Nebraska delegation even stated that it was concerned that the state might pass medical regulations that were “too liberal.” It sought to license that not only protected the public from harm but advanced the reputation of Eclectic medicine. The Nebraska delegation also was concerned that charlatans often “assume[d] the name Eclectic” when they practiced medicine. [10] The Kansas delegation conjectured that passage of its state law enhanced the reputation of Eclectic physicians and “confidently believed” that it would spur growth in the state organization. Instead of aiding the Regular school, the Kansas report indicated that medical regulation was “a great discomfiture” to them.[11] Other Eclectics clearly were willing to forget past actions by Regulars and compromise with them if they could secure non-discriminatory legislation.

During the next convention in Chicago in 1880, several members raised legitimate concerns about the reputation of Eclectic medical education. In 1880, NEMA became aware that John Buchanan, one of the ringleaders of a large and notorious diploma mill in Philadelphia, listed serving as the president of NEMA as one of his chief credentials. Even though his statements and actions were fraudulent, NEMA justifiably was concerned that Buchanan’s claims could undermine faith in NEMA. As a direct consequence of Buchanan and other Philadelphia entrepreneurs’ trafficking in medical degrees, the Pennsylvania legislature passed a medical registration act two years later designed to end this unsavory practice. Benjamin Lee, a prominent Regular physician from Philadelphia, argued that act had at least “temporarily” closed the most egregious diploma mills.[12]

Buchanan’s fraud encouraged members to discuss how diploma sales could be halted. Members proposed a resolution at the convention to support the creation of state medical boards that would end the traffic of fake diplomas and medicines. The proposal dictated that their support was contingent on the boards’ beginning to be governed by the major medical sects. During Dr. Milbrey Green’s address to the convention in 1880, he emphasized that since 1873, NEMA supported regulations designed to prevent “incompetent men” from receiving diplomas. Green acknowledged that the country had been flooded with fraudulent diplomas from Allopathic, Homeopathic, and Eclectic schools of medicine. He stated that it was critical for all physicians to unite against these practices because NEMA and other state medical societies could not eliminate these problems on their own.[13] Green’s statement made it clear that NEMA needed to support some type of state legislation to eliminate diploma mills. He also underlined the threat they posed to Eclectic medicine. In Wisconsin, the state Eclectic society agreed with Green and helped pass a medical licensing act that required physicians to possess a medical school diploma. The Wisconsin report stated that Eclectics did not want any “half-breed Eclectics here and shall be glad to slough them off.”[14]

Other Eclectic physicians argued that medical regulation not only might eliminate fraudulent practitioners but improve relations between various medical sects. The report from Anson’s Illinois delegation stated that medical regulation in the state thawed relations among the “Eclectic, Old-School or Homeopathic” physicians. Instead of discrimination, the report stated that Eclectics no longer reported “unpleasant encounters” with other Regular physicians.[15] When Regulars served side by side with Eclectics and Homeopaths, it made it more difficult for Regulars to demonize them. The Illinois report suggested a brighter future for Eclectics if they were willing to compromise their views on medical regulation.

Whether licensing immediately ameliorated relations between Regulars and Irregulars is debatable, but mixed licensing boards gave these physicians an opportunity to meet each other as colleagues and equals. Clark stated that he did not feel threatened by the Regular physicians he worked with on the board. Where King saw enemies, Clark recognized physicians who were quite similar to himself. They were medical school graduates, who were deeply involved with medical education, active in their medical societies, and published in medical journals. These values and goals were shared also by organized, educated Eclectics and Homeopaths.

While medical licensing was not necessarily a fait accompli in 1880, it was becoming clear that state legislatures were becoming more inclined to pass these regulations especially if they were tied to sanitation reform. As Eclectics continued to debate the merits of licensing, the crawl toward nationwide licensing continued in the 1880s. While the 1870s was defined by these early efforts to pass any type of medical practice acts, in the 1880s, physicians, medical societies, and the newly created medical licensing boards often sought both to implement these laws and strengthen the newly created medical regulations. In states where legislatures passed registration laws, medical societies immediately attacked these regulations as ineffective and useless. Additionally, after tying together boards of health and medical licensing, Regulars created a strong argument in favor of licensing and expanding their power. Doctors effectively had turned medical licensing from an economic to a public health issue.

As state supreme courts around the country began to rule in favor of licensing laws, opponents were forced to double down against their passage. If state courts refused to invalidate licensing, then the only way to stop licensing laws was to prevent their progress in state legislatures. These early court decisions placed additional pressure on opponents of licensing within the National Eclectic Medical Association (NEMA). The debate in favor of passing nonpartisan licensing legislation continued at the 1883 NEMA annual convention in Topeka, Kansas. The president of NEMA, Andrew Jackson Howe, openly advocated the creation of “organized and efficient Boards of Health” as long as the “rules adopted” were equitable. Howe cited the creation of the Missouri Board of Health as an example of acceptable nonpartisan medical regulation. He even believed that this type of legislation eventually would eliminate the American Medical Association ethics rules that barred Regulars from consulting with Irregulars.[16] Eclectic opponents of medical licensing became more vocal and boisterous in their opposition. Organized Regulars already had demonstrated that they needed Irregular support in most states to pass licensing, and the opponents of these laws in NEMA continued the attack to convince NEMA’s membership to oppose these laws and not compromise with Regulars.

In 1884, despite the continued advocacy by leadership on behalf of nonpartisan medical regulation, NEMA’s position on medical licensing was in flux as John King and Anson Clark debated the topic at the annual convention in Cincinnati, the birthplace of Eclectic medicine. King’s and Clark’s speeches at the convention demonstrated that they not only disagreed fundamentally on the necessity and legality of medical regulation but represented the fundamental split within NEMA. They had very different experiences with medical regulation up to this point in their careers. King had taken part, along with his older Eclectic colleagues, in the dismantling of discriminatory state medical regulations in the 1840s and 1850s. These earlier laws were passed by Regulars, and they were intentionally meant to marginalize Irregular physicians. King was sickened by the fact that Eclectics were now working with Regulars, who he believed still wanted to eliminate Eclectics and Homeopaths. On the other hand, Clark was twenty years younger than King and was not involved in this struggle. Clark may have been against discriminated by Regulars during his career, but he still believed that he could successfully compromise with them and elevate the medical profession.

At the 1884 convention, both King and Clark were invited to present their views on licensing to the membership. Their disagreement was not limited to medical legislation; the heart of their disagreement centered on the definition of Eclectic medicine. While King maintained an expansive definition and deemed numerous uneducated and marginal practitioners as medical Eclectics, Clark’s definition limited Eclecticism to his organized and educated colleagues. Numerous Eclectic medical practitioners, viewed by King as his brothers-in-arms, were seen by Clark as frauds and charlatans. They were arguing not only about medical legislation but about who comprised the legitimate heart and soul of Eclecticism. In many ways, this definitional debate was limited to the Eclectics. While Homeopaths were threatened by licensing, they did not have the same problems defining Homeopathy. Unlike Eclecticism, Homeopathy was the product of a single physician. As long as Homeopaths agreed to follow Samuel Hahnemann's medical system, they automatically knew who was a Homeopath and who was not. On the hand, Eclectics were defined by their diversity. Medical licensing threatened this diversity because licensing was designed to eliminate medical practitioners who did not fit a certain mode. Medical licensing was beginning to coalesce around the notion that doctors needed to have a medical degree from a certain type of institution. Any physician who failed to attend the right type of institution risked being marginalized or eliminated.

King consistently opposed medical legislation in any form throughout his career and his position never changed. King was convinced that any Eclectics who were even just lukewarm to licensing were “traitors” because they have forgotten the sacrifice made by early Eclectics to overturn the medical legislation propounded in the first half of the century.[17] He felt Eclectics had an obligation to oppose medical regulation in all its forms. In his address, King made several provocative arguments in opposition to licensing -- arguments that were focused on undermining the growing support for medical licensing in NEMA. He attacked medical regulations and claimed that they were “despotic” enactments that violated the United States Constitution, which guaranteed rights “equally.” Not only did licensing violate the constitution, but it was also ultimately a “system or spying, of oppression and of usurpation, fully equal to the Machiavellian absolutism of certain European nations.”[18] King declared that American civil rights grew “out of the Constitution” and that any effort to eliminate these rights would establish a precedent for future deprivations. Even medical registration (the least onerous type of licensing) was described by him as “disgraceful, detestable, anti-republican, and in opposition to that Amendment of the Federal Constitution intended to prevent caste monopoly.” He simply could not understand why physicians who had practiced “20, 30 or 40 years” should be compelled to register with the state.[19]

John King’s opposition to medical regulation did not stop there. He also asserted that medical Eclecticism itself was an expression of American freedom and that any type of regulation would undermine the concept and practice of Eclecticism. In King’s mind, Eclecticism represented not just freedom from the dogmatic views of the Old School, but mental freedom that could only be preserved if “destructive legislation” was defeated. He thought that medical regulation could weaken the strength of reformed medicine by limiting the freedom of its practitioners. Not only were individual physicians’ rights curtailed by medical legislation, but licensing laws would prevent the general public from seeking treatment from whomever they desired. The public wanted the same freedom in selecting their physician as they did in picking “their religion” or “their tailor.”[20] King objected to the notion that only the state could evaluate physicians adequately and protect the public from fraudulent practitioners. Instead of relying on the state, the public should be permitted to evaluate physicians on their own. King assumed that malpractice law could more than adequately protect the public from incompetent or unqualified physicians. The ability of citizens to sue their physicians, King argued, gave them sufficient enforcement power to ensure public health. [21]

King fervently believed that Old School physicians could not be trusted to pass fair and equitable licensing acts. Regulars used medical legislation in the first half of the century to marginalize and attack Irregulars, and King believed that the current push for licensing was no different. He stated that only Regulars and their proxies favored medical regulation. While Regulars argued that they sought to license “to protect the people,” King did not believe that the people shared their concern. The demand for medical legislation did not come from common citizens, but from Regulars and their proxies. The Regulars were not trying to protect the public’s health and welfare; they simply sought to create a medical monopoly.

The public, according to King, was in a much better position to protect its health and welfare than state legislatures. Additionally, Regulars were interested in preserving their “vacillating, uncertain system” of medicine. According to King, Old School medicine was on the ropes and the Regulars were advocating only for medical licensing while they still possessed some credibility. While Regulars may have sneered and jeered at Irregulars from a distance, King argued that they had adopted Irregular medicine over the past forty years. Previous theories and hypotheses considered essential parts of the Old School, especially heroic medicine, had recently been questioned or even rejected. Over time, Regular physicians’ understanding of disease underwent dramatic changes. King attempted to chart the changes in Old School medicine. First, he stated that disease was believed to be caused by “certain conditions of the fluids of the system.” Later Regulars altered this dogma and became convinced that disease was caused by “conditions of both the fluids and solids.” King declared that their understanding of disease was again being replaced by the “names of bacteria, bacilli, micrococci, microbes, or minute vegetable formulation in the fluids, in the solids, or in both.” The existence of competing sects of medicine was, in King’s mind, “prima facia evidence of the fallibility of regular practice” and a demonstration of the Regulars’ questionable reputation. King believed that only medical regulation could preserve the Regulars’ waning strength.[22]

King also argued that medical legislation, instead of protecting American lives, ultimately would imperil public health because it would prevent talented individuals from entering the practice of medicine. King stated that many successful physicians had practiced without diplomas and that it was unnecessary to have one in order to treat patients effectively. Medical legislation not only would prohibit numerous people from practicing medicine but if a “farmer, grocer or other non-professional people” discovered “a cure for cancer,” licensing would bar them from sharing their cures. While King did not disparage medical graduates, he stated that “too much legal importance has been given to it” because a medical degree cannot ensure that an individual was a “safe and successful medical practitioner.” Medical students were not exposed to any educational material that could not be learned from a textbook. King did not believe that a broad education in math, science, anatomy, chemistry, “microscopic germs,” and dead languages would benefit physicians. It was not uncommon for “illiterate men” to have a rare gift for treating the sick, but licensing laws would prevent them sharing their gifts with humanity.[23]

The biggest tragedy in King’s mind was that honest, hardworking physicians and their families’ very survival was threatened by the specter of medical regulations. People, King stated, who faithfully executed their jobs as healers, would be classified as criminals for the same work that previously had been lauded. The medical regulations in Illinois deprived many physicians of their rights and drove them from their homes. King cited the fact that almost two thousand “Irregular” physicians had been forced out of Illinois by medical licensing as evidence that licensing was targeting their kind. Instead of praising the efforts of the Illinois board to eliminate the least educated and the most unorganized physicians, he castigated them for destroying the lives of thousands of able physicians. King even went out of his way to defend the most reviled medical practitioners: nostrum peddlers. Nostrum peddlers sold medicines and potions that not only possessed little medicinal value but could be dangerous. He pointed out the irony that Regular physicians often promoted nostrums while condemning their sellers as quacks. If anything, the hypocritical position was taken by numerous Old School physicians simply underscored the collapse of their allegedly superior therapeutic system.[24]

Finally, King claimed that ultimately “[r]estrictive laws are enacted” to generate revenue for the government. When the government grants special privileges or licenses to some, but not others, it is a form of “indirect taxation.” As an indirect tax, it was antithetical to both the Constitution and American principles of freedom because it was essentially feudal in nature. These taxes were premised on the idea that citizens were incapable of taking care of themselves and needed a “master or law to take care of him.” King then extended the same objection to boards of health. He stated that the nation successfully existed for more than one hundred years without these government boards. All of the functions granted to boards of health had been handled successfully by local medical societies and local government authorities. Americans were more than capable of taking care of themselves without these indirect taxes or unnecessary boards.[25]

Unlike King, Clark’s statement on medical legislation was brief and tightly focused. Clark believed that if Eclectics failed to embrace medical regulations, Eclecticism’s very existence would be endangered. While he directed his attention on the impact of the Illinois Medical Practice Act over its first five years, Clark also briefly attacked several of the key arguments advanced by King in his address. Clark’s primary goal was to assuage his fellow physicians’ fears and demonstrate that the success of the Illinois law benefited Eclecticism in the state. Clark first noted that the state had a legitimate interest in protecting the health and lives of its citizens. Therefore, he argued that protecting the lives of its citizens as part of its “police powers” and that the state had an absolute right to regulate these matters. King’s expectation that physicians should be exempt from government regulations was untenable, especially if their actions were found to “be detrimental to the welfare of the people composing the commonwealth.” Clark essentially acknowledged that the state had broad powers to regulate medicine. [26]

Next, Clark stated that the “venomous” Eclectic objections were ultimately counterproductive and “shortsighted.” While King claimed that Allopathy was collapsing, Clark acknowledged a readily apparent reality: Eclectics were vastly outnumbered by Regulars. In most states, Eclectics comprised only one-sixth to one-twelfth of the total number of physicians in the state. Eclectics were a fairly small minority, and they needed protection from the state to elevate their standing and protect their sect. In lieu of fighting each and every law regulating medicine, Clark believed that Eclectics needed to organize and secure the rights that Regular physicians were willing to grant them.[27]

Clark did not have the same benevolent view of the Irregular rabble that King lionized. Clark thought that the illiterate medical savants described by King were frauds, incompetents, and “medical mountebanks.” King believed that these uneducated medical men were Eclectics, while Clark maintained a much more exclusive definition. Clark would not have seen an uneducated Thomsonian practitioner as a qualified physician, even though King saw him or her as a colleague and equal. Clark believed that Eclectic medicine’s principled stand for freedom “allowed frauds to fill our nest with more dirt and rubbish than all the decent ones could clear out.” The uneducated physicians were not allies in a war against the Regulars, but threats to the reputation of organized and educated Eclectic physicians. Unless the Eclectics purged their ranks of this “rubbish,” they could not be “respected.”[28]

Clark was thrilled that the Illinois Medical Practice Act chased one-thousand-five-hundred people from their medical practices. Instead of weeping for the displaced families, Clark was comforted that these individuals were forced to either abandon medicine or go to medical school. He maintained Eclectics were not harmed by the board’s crackdown on itinerant physicians who lied about their skills in dishonest advertisements.[29] Clark did not believe that any of these individuals could be classified as Eclectics. Clark argued that Eclectics actively had to secure their rights as qualified medical practitioners. If they simply opposed all medical legislation, then Eclectics faced a precarious future. If they cooperated with other organized and educated physicians they could ensure their survival. Clark believed that Illinois and Missouri were outstanding models for Eclectics because qualified practitioners, whether Allopath, Homeopath, Eclectic, benefited from just, nonpartisan medical regulation.

King’s and Clark’s positions on medical regulation demonstrated the fundamental rift in Eclectic medicine. King believed that medical regulation was a continuation of the ongoing war between Regular and Irregular medicine. What King saw as a last desperate attempt by the enfeebled Regulars to preserve their status and legitimacy, Clark viewed as an opportunity to unite organized, educated medical practitioners and elevate medical Eclecticism. King was unwilling to compromise on medical legislation, but Clark believed it was the best hope for helping qualified Eclectic physicians. King was vested heavily in the success of Eclecticism. He was recognized as a pioneer and leading scholar for the movement. He had educated numerous physicians, including Clark, during his long career, and he understood that medical legislation could potentially unite medicine. Instead of occupying its niche, Eclectic physicians might be incorporated into Allopathy if licensing succeeded. King clearly was concerned that Eclecticism would not be able to maintain its separate identity and ultimately disappear.

Clark was less concerned with preserving Eclecticism. He was a full generation younger than King, and he was willing to compromise with Allopaths and Homeopaths on licensing. He did not hate the Regulars; he simply believed that their medical system was fundamentally unsound. His attack on unorganized, uneducated, and marginal practitioners confirmed his belief that medicine could not be effectively practiced by everyone. Education and training were essential for physicians, and Clark simply did not want to be associated with traveling itinerants and illiterate herbalists. Eclecticism accepted these individuals in the past, and he sought to eliminate their presence in Eclecticism and medicine. If medical societies could not purge the ranks of quacks and charlatans, then he thought the states had a responsibility to protect their citizens. Clark’s assessment of these individuals undoubtedly was shaped by his own experiences as a practicing physician and his work on the Illinois board. The Illinois board conducted quasi-judicial hearings to punish physicians for misconduct and ethical violations. In 1880, the Illinois board prosecuted two physicians for practicing under aliases who assumed the identity of a prominent professor at Bennett Medical College, Clark’s employer. The Bennett faculty asked the board to prosecute the physicians and ultimately the charlatans’ medical licenses were revoked. [30] Clark had seen that medical licensing could protect prominent Eclectic physicians from King’s rabble.

Interestingly enough, this generational gap also was appearing among the Regulars. Local and state Regular medical societies were forced to work with organized Irregular practitioners to secure legislation. These interactions softened their attitudes on Irregular practitioners. The president of the Illinois State Medical Society argued for this approach at the society’s annual meeting shortly before the act was passed in 1877. While he demanded passage of a medical licensing law to protect the public from unqualified practitioners, he conceded that Eclectic and Homeopathic practitioners were, like Regular physicians, “devoted to their patients and profession.”[31] He advocated détente between Regulars and Irregulars in Illinois and argued that the medical society should pass “wise and impartial legislation,” which recognized only “well-educated men” but debarred incompetents, “whether regular or irregular.” [32]

Many Regulars recognized that their understanding of medicine was changing, and some were beginning to acknowledge that the Old School profession did not have a monopoly on effective medicine. By 1884, most Regulars had rejected the heroic therapeutics that defined their practice a century earlier, even if they were still being taught in Regular medical schools. Organized Regular and Irregular physicians were beginning to resemble each other more than at any other time in United States history. While King still identified with the uneducated rabble, organized and educated Regular, Eclectic, and Homeopathic physicians began to see that they shared common interests.

In a democratic vote, NEMA sided with King and agreed to publish ten thousand copies of King’s address to sell to Eclectics around the country. The association also unanimously approved a resolution thanking King for “his able and scholarly address.”[33] In addition to recognizing King for his contributions, NEMA changed its official stance on medical legislation. It passed a strong resolution stating “[t]hat while the National Eclectic Medical Association is in favor of elevating the standard of Medical Education, it is opposed to all medical legislation.”[34]

While the passage of this resolution might have suggested a major shift in NEMA’s official stance on licensing, the resolution was altered the very next day. Instead of being a meaningful shift of its position, NEMA’s adoption of an outright opposition to licensing looked increasingly like a token of appreciation and respect to King for his contributions to Eclecticism. A motion to insert “class” in front of “medical legislation” was adopted by NEMA. This change rendered the entire resolution meaningless. NEMA may have opposed “class medical legislation,” whatever that meant, but it failed to state what it did support. Did it support non-class legislation or no regulation at all? NEMA had not changed its position as much as guarantee its ambiguity.

King failed to attend the next national convention because his wife was ill, but he sent a letter to be read at the conference. Again, he emphasized his opposition to any form of medical regulation. He stated that any Eclectics who supported medical legislation had “dough-faces and cowardly hearts.” They had chosen to “lick the hands” of the Regulars who sought to “annihilate them.” Instead of reforming physicians, Eclectics needed to focus their energy on educating the public. If educated patients foolishly chose to seek treatment from quacks, it was “their American right and privilege.” [35]

In 1886, King again addressed NEMA about the dangers of medical licensing. His arguments changed little from the 1884 debate. He reemphasized that physicians did not need a scientific education and that it was inappropriate for medical boards to test them on this material. Uneducated physicians had advanced medicine in all three medical branches, and King believed that patients did not care if their doctor was an expert in science. King also proposed forming medical societies composed of Irregular physicians and anyone else who opposed medical legislation. He believed that the Knights of Labor, the largest national labor union in the United States at that time, could be used as an appropriate model for these new organizations, because “medical men, after all, are but laboring men.” He asked Eclectics to “Organise [sic] Promptly” to fight medical legislation. Not only should Eclectics unite with anyone who opposed medical legislation, but they should also “avoid and banish” dissenters. King argued that Eclecticism faced extinction if they failed to organize themselves and fight.[36]

In 1885, NEMA attempted to clarify its position on medical regulation. It passed three separate resolutions addressing licensing. The resolutions claimed that it was still opposed to “Partisan Legislation,” but in favor of the board of health, as they were “not empowered to act prejudicially to any class of physicians.” The final resolution stated that NEMA favored “testing the constitutionality of laws” that discriminated against Eclectics. The resolution adopted the previous year, which opposed “all class medical legislation,” remained the official policy of NEMA. While the new resolutions were clearly an effort to clarify its policy, they still did not advocate on behalf of anything. [37]

While King and Clark were not able to materially alter NEMA’s official stance on medical licensing, Clark’s vision for medical licensing ultimately became reality. By King’s death in 1894, medical licensing had become a permanent feature of American life. King’s complaints that medical licensing laws violated the Constitution were widely rejected. While courts occasionally expressed some skepticism about the merits and necessity of licensing, they universally held that the state had a strong interest in protecting the health and welfare of citizens under its police powers. Even in 1884, King would have been aware that these laws were consistently upheld. Ultimately, he was engaged in wishful thinking when he stated that the laws were unconstitutional. King sought to preserve the free market of medicine just as many other people were becoming weary of it. Noted historian and Eclectic physician, Alexander Wilder, highlighted the shifting Eclectic position. By 1901, Wilder noted that even if Eclectics had “suffered persecution and resisted it manfully” at the hands of Regulars, they were not against licensing if it focused solely on “practitioners who follow methods and procedures that are not embraced in their category” instead of on Eclectics.[38] King’s concerns ultimately were dismissed, and the Eclectics gradually moved towards Clark’s position. King, however, was proven prescient in the end because when Eclectics accepted licensing, they gradually lost their distinctiveness and identity as a unique medical sect.

References

  1. Martin Kaufman, Homeopathy in America: The Rise and Fall of a Medical Heresy, (Johns Hopkins Press, 1971), 145.
  2. Transactions of NEMA 1869-70 (1872): 13, http://books.google.com/ebooks
  3. Eclectic Medical Journal, 1894, Vol. LIV, No. 2: 57-8, http://books.google.com/ebooks.
  4. “The Eclectic News,” The Eclectic Medical Journal 1898 (July, 1898): 449, http://books.google.com/ebooks; Harvey Wickes Felter, History of the Eclectic Medical Institute Cincinnati, Ohio: 1845-1902, (Alumnal Association of the Eclectic Medical Institute, Cincinnati, 1902), 177, http://books.google.com/ebooks; H. G. Cutler, ed., Physicians and Surgeons of the West, Illinois Edition, (American Biographical Publishing Company, 1900), 238-240, http://books.google.com/ebooks.
  5. Transactions of the National Eclectic Medical Association for the years 1879-1880 (1880): 14-15, http://books.google.com/ebooks.
  6. Transactions of NEMA 1879-1880: 14-15.
  7. Transactions of NEMA 1879-80: 91-92.
  8. The Chicago Medical Times, 1879, Vol. XI, No. 4: 181-182, http://books.google.com/ebooks.
  9. The Chicago Medical Times, 1879, Vol. XI, No. 4: 181-182, http://books.google.com/ebooks.
  10. Transactions NEMA 1879-80 (1880): 86.
  11. Transactions of NEMA 1879-80 (1880): 77-78.
  12. Transactions of the American Medical Association 1882 (1882): 385, http://books.google.com/ebooks.
  13. Transactions of NEMA 1879-80 (1880): 2-63.
  14. Transactions of NEMA 1881-82 (1882): 82-83.
  15. Transactions of NEMA 1880-81 (1881): 8.
  16. Transactions of NEMA 1883-84 (1884): 50.
  17. Transactions of NEMA 1884-85 (1885): 181.
  18. Transactions of NEMA 1884-85 (1885): 178-79, 187.
  19. Transactions of NEMA 1884-85 (1885): 178-79, 186-87.
  20. Transactions of NEMA 1884-85 (1885): 15-16.
  21. Transaction of NEMA 1884-83: 178-181.
  22. Transactions of NEMA 1884-85 (1885): 180, 182-83.
  23. Transactions of NEMA 1884-85 (1885): 177, 180, 183-85.
  24. Transactions of NEMA 1884-85 (1885): 183, 190-91.
  25. Transactions of NEMA 1884-85 (1885): 190-191.
  26. Transactions of NEMA 1884-85 (1885): 174-75.
  27. Transactions of NEMA 1884-85 (1885): 174-75.
  28. Transactions of NEMA 1884-85 (1885): 175-76.
  29. Transactions of NEMA 1884-85 (1885): 175-76.
  30. Annual Report State Board of Health of Illinois 1880 (1881): 5-7.
  31. Transactions of the Twenty-Sixth Anniversary Meeting of the Illinois State Medical Society, 1876 (Chicago, 1876): 196, http://books.google.com/ebooks.
  32. Transactions of the Twenty-Sixth Anniversary Meeting of the Illinois State Medical Society, 1876 (Chicago, 1876): 196.
  33. Transactions of NEMA 1884-85 (1885): 29.
  34. Transactions of NEMA 1884-85 (1885): 31.
  35. Transactions of NEMA 1884-85 (1885): 22.
  36. Transactions of NEMA 1886-87 (1887): 167-74.
  37. Transactions of NEMA 1885-86 (1886): 10.
  38. Alexander Wilder, History of Medicine. A Brief Outline of the American Eclectic Practice of Medicine, (New Sharon, Maine, 1901), 775.
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