Why were Eclectic Physicians in the United States divided on Medical Licensing
In June 1869, the Eclectic Medical Society of the State of New York and the Reformed Medical Association of the United States organized a committee to explore holding a nationwide convention for “Physicians belonging to the New School of Medicine.” After contacting various state medical societies and eclectic medical colleges, the New York committee proposed holding a convention in Chicago, Illinois in 1870. In the fall of 1870, eclectic physicians from throughout the country descended upon Chicago in order to create a national organization. Prof. R.S. Newton, a New York physician, informed his audience that “persons connected with the different branches of the profession” hoped their meeting would fail, but he asked the attending doctors to let “nothing but harmony and peace prevail.” While Newton’s congregation was quite small, he sought to create an organization that could represent the interests of an estimated ten thousand American eclectic physicians These physicians voted to create a new national organization, the National Eclectic Medical Association (NEMA).
For the rest of the Nineteenth Century, NEMA grappled with the growing wave of states passing medical licensing statutes. Unlike the American Medical Association, NEMA response to medical regulation was hampered its membership’s disagreement over who was an eclectic physician and their widely divergent views on medical regulation. The debate over medical regulation exposed the fissures within the eclectic community. The older physicians who had cobbled together Thomonsonians, disgruntled regulars and medical reformers to birth eclectic medicine in 1830s and 1840s were 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. Regulations that had discriminated marginalized and limited their practice rights. They viewed regulars with suspicion and distrusted their motives in advocating for medical licensing. Younger physicians, many trained by the original innovators, were not as hostile medical regulation. Unlike their older colleagues many of them were medical school graduates and they had little in common with the illiterate Thomsonnians who had aligned themselves with their teachers in opposition to medical regulation. These younger eclectics were concerned with legitimizing eclecticism than in expanding its definition to include uneducated and marginal medical practitioners. In order to legitimize eclecticism the second generation of eclectic physicians believed that they had to purge their uneducated colleagues. Instead of fighting regulation, they worked with regulars to pass nonpartisan legislation.
In 1884, the debate over medical licensing exposed these rifts in eclectic medicine. Two of their most respected physicians attacked each other mercilessly in an effort to shape NEMA’s policy. 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 made its muddled stance on medical licensing even hazier. Local and state societies were left to develop their own policies and they received mixed messages from NEMA. Whether or not NEMA could influence or shape the direction of medical legislation is unclear, but due to its befuddled position on licensing it abdicated any leadership position it may have played in this nationwide medical debate.
NEMA was the not first attempt by the physicians from the eclectic medical sect to create a national organization. In 1848, a group of physicians from the “Eclectic Reform School” met in Cincinnati at the Eclectic Medical Institute for the National Convention of Eclectic Physicians. By 1850, the National Convention had morphed into a new national organization, the National Eclectic Medical Association. It is perhaps unsurprising that in 1848, regular physicians formed the American Medical Association (AMA). Unlike the AMA, the first NEMA failed to survive. By 1856, the chairman of the Committee on the State and Progress of Medical Reform complained that an insufficient number of eclectic physicians were attending NEMA’s convention. During the organization’s last convention, the Vice-President of NEMA decried the “apathy manifested by Eclectics in not sustaining their organizations.”
It is unclear what killed NEMA, although Joseph Haller cited a cascade of problems that not only weakened NEMA, but reform medicine in general. During this time eclectic medicine was comprised of two disparate groups -- “eclectics and independent Thomsonians.” The eclectic physicians were comprised of graduates of both eclectic and allopathic medical schools. Like regular physicians, these educated physicians wanted to organized themselves into local, state and national organizations. On the other hand, the Thomsonians were often neither medical school graduates or well-educated. It would have been exceeding hard to organize them. Additionally, Haller has argued that the reform of medicine or eclecticism was undermined by both the Civil War and, ironically, the success of medical eclectics in eliminating legislation limiting their practice rights.
By 1870, attempts to revive medical regulation had begun in earnest. During the winter session of the 1866-67 of the Ohio legislature, a bill was introduced that required physicians to be examined by the Ohio State Medical Society and graduates of a medical school. While this and other bills proposed around the country in the 1860s were ultimately defeated, it became increasingly clear that eclectics would have to combat potentially hostile legislation in numerous state legislatures. During the 1870s, medical licensing laws were passed in several states including Texas, Alabama, Kansas, California and Illinois. But it was the passage and implementation of the Illinois Medical Practice Act starting in 1877 that created a split in the leadership of NEMA on medical licensing. This crack lead to an ongoing debate within NEMA for the next decade. Two NEMA physicians played an outsized role in these debates: Dr. John King (1813-1894) and Dr. Anson L. Clark (1836-1910). King was a pioneer in eclectic medicine and one of its most prominent practitioners. In 1838, King 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.” Ostracism did not prevent King from becoming a leader in the eclectic movement. After graduation, he traveled extensively and settled in Kentucky where he practiced medicine until 1849. He was integral to organizing the first National Convention of Eclectic Physicians and was named secretary at its first convention. Between 1849 and 1851 he served as the chair of Materia Medica at the Memphis Institute. In 1851, King joined the faculty at the recently founded Eclectic Medical Institute of Cincinnati (EMI) and King taught at EMI for the next four decades. While King was at EMI it became the leading eclectic medical school in the country. While King’s textbook Eclectic Dispensatory was discussed at the 1851 NEMA convention, he published most of his books on eclectic medicine after moving to EMI. Eclectic physicians throughout the nineteenth century extensively used his textbooks. He joined the second NEMA in 1872 two years after it was found and served as its president 1878-1879.
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 probably 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 he moved back to Chicago and in 1868 became a member of the faculty and later as dean at the Bennett College of Eclectic Medicine and Surgery. In addition to working at Bennett he worked as an editor at the Chicago Medical Times and a member of the Illinois General Assembly in 1871. Starting in 1877, he served on the Illinois Board of Health (hereinafter Board). During his fourteen years on the Board he served as both its treasurer and secretary. As member of the Board he was responsible for regulating the practice of medicine under the 1877 Medical Practice Act. Additionally, he served as the President of NEMA in 1880-1881 and the Illinois State Eclectic Medical Society in 1898. These two physicians personified the generation gap within NEMA and the split on medical licensing. At time of NEMA’s creation, American medicine was struggling with two competing ideas: a physician’s duty to protect the public and personal liberty. Many physicians were troubled by the potential expansion of state power over the medical system, but they were equally concerned about the potential danger created by unqualified and uneducated physicians. In an Illinois physician best highlighted the dilemma state medical regulation posed:
In our eagerness to do all that lies before, in our keen appreciation of the great desirability of accomplishing certain ends, we are in danger of losing sight of the distinction between things proper for State medical authority to do, and things which are desirable in themselves but belong in the domain of their proper.
Between 1870 and 1900, the medical profession was forced to consider abandoning an expansive notion of liberty and freedom in order to protect Americans from unorganized and incompetent medical practitioners. In 1873, NEMA began discussing the growing push for medical licensing in the United States. The organization passed a resolution in favor of 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” and medical diplomas were so “freely granted” that they had ceased to be “evidence of the scientific attainments” of their holders. 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 which were not in good standing with the Board. The NEMA resolution would have required all physicians to take medical examination. This resolution is surprising because so many eclectics were skeptical of medical licensing.
One of the most unconvinced eclectics was John King. In his presidential address in1879 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 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” which sought to elevate their own medical sect. King was most concerned with the efforts of regular physicians to regulate medicine because he believed their primary goal was to marginalize eclectic medicine. Instead of the elevating the medical profession, the state legislatures when they passed medical licensing and registration acts had violated the “spirit of justice” contained in the United States Constitution.
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 would still refuse to consult with irregulars and refer to eclectics as “ignorant conceited quack[s].” King did not believe that regulars would ever stop maligning and persecuting eclectics simply even if eclectic physicians qualified for medical licenses. King held that the regulars did not seek to protect humanity from charlatanism, but instead sought to legislate the irregulars out of existence. King’s views were supported by the thirty years of discrimination he had suffered had the hands of Old School who had maintained their rigid Code of Ethics. This Code barred regular physicians from consulting with irregular physicians or their patients. A state report issued by the New York delegation at the convention also emphasized the historical efforts made by regulars to degrade medical reformers. The report emphasized that regular physicians in the first half of the century had 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.
King’s conviction that medical regulation was simply a Trojan horse was probably reinforced by the actions of the Illinois State Board of Health in 1879 against his own medical college, EMI, fifteen days before the 1879 NEMA conference. On June 3, 1879 the Illinois State Board of Health determined that EMI was not medical school in “good standing.” Under the 1877 Illinois Medical Practice Act, the Board asserted it 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 medical examination to practice medicine in Illinois. According to the Board, EMI, the most prominent eclectic medical schools, was unacceptable because it insisted on “giving two full courses of lectures in one year” which would permit students to graduate in one year. At the beginning of the Board’s existence, instead of evaluating each school individual it sought to apply rather mechanistic standards to evaluate medical schools. In 1878, the Board determined that any medical schools which held “two graduating courses in one year” could not be found to be in good standing. While the Board’s criterion was not particularly sophisticated, it was straightforward. The Board could use the medical schools’ own literature to determine whether or not it satisfied their requirements. This criterion made it possible to cheaply evaluate hundreds of medical schools in the 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 in July 1879 stated 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.” The editorial chastised the “belligerence” of the EMI and asked the school to “gracefully yield” to Boards demands. The editorial went as far as to suggest that “students and preceptors to take note of the existing states of affairs.” At this time, Clark was one of only two editors listed on the Chicago Medical Times byline. Therefore, he was undoubtedly aware and in agreement with this editorial. Whether or not the Board’s actions against EMI were motivated by animus towards eclecticism is very difficult to determine. The mechanistic nature of the Board’s criterion would have complicated any attempts to punish just eclectic schools. Numerous allopathic medical schools were also asked to comply with the Board’s criterion. Still, the editorial’s suggestion that “students and preceptors” should take note of the current situation does imply another reason for the Clark’s strong support of the action against EMI. While Clark may have simply agreed with the Board’s position as an attempt to elevate medical education, it could be cynically noted that he potentially had a financial stake in the decertification of EMI. As a faculty member Chicago’s Bennett Medical College he might have benefited personally by steering students away from EMI or undermining its reputation.
Despite King’s jeremiad against medical licensing, various state eclectic medical organizations advocated on behalf of regulation in their legislatures. The Nebraska delegation even stated that they were concerned the state could pass medical regulations that were “too liberal.” They sought licensing that not only protected the public from harm, but advanced the reputation of eclectic medicine. The imposters who endangered the public often “assume[d] the name Eclectic” when they practiced medicine. The Kansas delegation believed that the passage of its state law had 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. Other eclectics were clearly 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 a “John Buchanan” in Philadelphia had not only claimed to be the President of NEMA, but was selling eclectic medical degrees. Even though his statements and actions were fraudulent, NEMA was concerned about the potential consequences of Buchanan’s actions for NEMA. As a direct consequence of Buchanan and other Philadelphia entrepreneurs’ traffic 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, believed that act had at least “temporarily” closed the most egregious diploma mills. Unsurprisingly, the allegations of Buchanan’s fraud encouraged members to discuss how diploma sales could be halted. At the same convention, a resolution was proposed to support the creation of State Boards that would end the traffic of fake diplomas and medicines, but only if they were ruled by all of the schools of medicine. During Dr. Milbrey Green’s address to the convention in 1880, he emphasized that NEMA, since 1873, had supported regulations designed to prevent “incompetent men” from receiving diplomas. Green acknowledged that the country had been flooded with fraudulent diplomas for allopathic, homeopathic and eclectic schools of medicine. He believed that it was critical for all physicians to unite against these practices because NEMA and state medical societies could not eliminate these problems on their own. Green’s statement was fairly clear, NEMA needed to support state legislation to eliminate diploma mills and the threat they represented 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 the eclectics did not want any “half-breed Eclectics here and shall be glad to slough them off.”
Other eclectic physicians argued that medical regulation could not only eliminate fraudulent practitioners, but improve, despite King’s assertions to the contrary, relations between various medical sects. The report from the Illinois delegation on the status of eclectic medicine at the 1880 convention stated that regulation had actually improved relations between the “Eclectic, Old-School or Homeopathic” schools of practice. Instead of discrimination, the report alleged that eclectics no longer reported “unpleasant encounters” with other competing physicians. This report suggested a brighter future for eclectics if they were willing to compromise their views on medical regulation.
Eclectics in a number of states were equally heartened by the fact that discriminatory legislation often failed in state legislatures. The year before, the Nebraska report stated that the legislatures would not pass discriminatory legislation. In 1880, the New Jersey report stated that it, Massachusetts, Ohio and Wisconsin had successfully defeated a bills proposed by the American Social Science Association designed to consolidate control under the Old-School medical societies. An 1873 constitutional amendment in Texas barred any legislation which discriminated against any sects of medicine. In Kansas, the recently approved medical practice act accidentally prevented the licensing of regular physicians. Under the statute, Kansas outsourced control of the medicine to the regular, eclectic and homeopathic medical societies. Unfortunately for the regular physicians, the state determined that their medical society did not have a legal charter and was barred from licensing physicians. The debate in favor of passing nonpartisan legislation continued at the 1883 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 would eliminate eventually AMA ethics rules that barred regulars from consulting with irregulars. Clark would have certainly agreed with Howe’s assessment because had Missouri adopted legislation similar to that in Illinois. In 1884, the Illinois Board even helped Missouri organize its own medical board. Members of the two boards often attended each other’s meetings. The similarities between the two states’ laws allowed Missouri members to model the principles Illinois used to “establish precedents and formulat[e] principles upon which to base decisions in the many difficult and delicate questions which continually present themselves.”
In 1884, despite the continued advocacy on behalf of nonpartisan medical regulation, NEMA altered its position on medical regulation after a spirited debate between King and Clark at the annual convention at the birthplace of eclectic medicine, Cincinnati. King’s and Clark’s previous statements to convention had already demonstrated that they fundamentally disagreed on the necessity and legality of medical regulation. These positions were a result of their very different experiences with medical regulation. King had witnessed eclectic physicians the dismantling of discriminatory state medical regulations -- laws that intentionally marginalized irregular physicians by creating a class system for physicians. While regular physicians generally received government recognition and were permitted to collect their fees, irregulars were excluded from these regulations. Clark was twenty years younger than King. 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 different positions to the membership. Their disagreement was not limited to medical legislation; in fact, the heart of their disagreement centers 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. Medical practitioners that King were viewed by him as his brothers in arms were seen by Clark as frauds and charlatans. They were not only arguing about medical legislation but who comprised the heart and soul of eclecticism.
King had consistently opposed medical legislation in any form throughout his career and his position never changed. King believed that eclectics who were lukewarm to licensing were essentially “traitors” because they have forgotten the sacrifice made by early eclectics to overturn the medical legislation propounded in the first of the century. Eclectics had an obligation to oppose medical regulation in any and all of its forms. In King’s address he 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 Constitution which guaranteed rights “equally.” Not only did licensing violate the Constitution, but it was ultimately a “system or spying, of oppression and of usurpation, fully equal to the Machavelian absolutism of certain European nations.” He 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, antirepublican, 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.
King’s opposition to medical regulation did not stop there. He also asserted that medical eclecticism itself was an expression of American freedom and 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 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.” King objected to the notion that only the state could adequately evaluate physicians and protect the public from fraudulent practitioners. Instead 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.
King fervently believed that Old School physicians could not be trusted to pass fair and equitable licensing acts. Regulars had 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 were openly in favor of medical regulation. While the regulars argued that they sought licensing “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 the 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 the state legislatures.
Additionally, the regulars were not interested in saving, but preserving their “vacillating, uncertain system” of medicine. According to King Old School medicine was on the ropes and the regulars were only advocating for medical licensing because 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 Old School medicine have been recently rejected. Over time a regular physician’s understanding of disease had endured 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 alterd 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 their waning strength.
Instead of protecting American lives, King also argued that medical legislation would ultimately 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 it was unnecessary to treat patients effectively. Medical legislation would not only prohibit numerous people from practicing medicine, but if a “farmer, grocer or other non-professional person” 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.
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 had faithfully executed their jobs as healers would be classified as criminals for the same work that had been previously lauded. The medical regulations in Illinois had deprived many physicians of their rights and driven 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 even the most reviled medical practitioners: nostrum peddlers. He pointed out the irony that regular physicians often promoted nostrums while condemning their sellers as quacks. If anything the hypocritical position taken by numerous Old School physicians simply underscored the collapse of their allegedly superior therapeutic system.
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 are premised on the idea that citizens were incapable of taking care of themselves and they 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 had existed for over hundred years without these government Boards. All of the functions granted to Boards of Health had been successfully handled 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.
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 focused his attention on the impact of the Illinois Medical Practice Act over its first five years, he also briefly attacked several of the key arguments advanced by King in his address. His primary goal was assuage his fellow physicians’ fears and demonstrate that the success of the Illinois law had benefited eclecticism in Illinois. Clark first noted that State had an interest in protecting the health and lives of its citizens. Therefore, he argued that protecting the lives of its citizens was part of its “police powers” and the state had an absolute right regulate these matters. King’s expectation that physicians should be exempted 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.
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 each 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 rights that the regular physicians were willing to grant them.
Clark did not have a 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 exclusive definition. Clark would not have seen an uneducated Thomosonian practitioner as a qualified physician, but King saw them as colleagues and equals. Clark believed that eclectic medicine’s principled stand for freedom had “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.” Clark was thrilled that the Illinois Medical Practice Act chased 1500 people out of 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. Clark did not believe that any of these individuals could be classified as eclectics. Clark argued that eclectics had to try and 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, had benefited from just, nonpartisan medical regulation.
King’s and Clark’s position on medical regulation demonstrated a fundamental rift in eclectic medicine. King believed that medical regulation was a continuation of the ongoing war between regular and irregular medicine. What he 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 the qualified eclectic physicians. King was heavily vested 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 their niche, eclectic physicians might be incorporated into allopathy if licensing succeeded. He was clearly concerned that eclecticism would not be able to maintain its separate identity and disappear.
Clark is 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 they were wrong. His attack on unorganized, uneducated and marginal practitioners confirmed his belief that medicine could not be effectively practiced by anyone. Education and training were essential for physicians and he simply did not want to be associated with traveling itinerants and illiterate herbalists. Eclecticism had 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 believed that the states had a responsibility to protect their citizens. Clark’s assessment of these individuals was undoubtedly 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. Clark had seen that medical licensing could protect prominent eclectic physicians from King’s rabble.
Interestingly enough, this same rift and generational gap 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 had 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.” 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.” Many regulars recognized that their understanding of medicine was changing and some of them 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 had defined their practice a century earlier. 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 and irregular physicians began see that they shared common interests.
After King’s presentation, NEMA 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.” In addition to thanking 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.” While the passage of this resolution might have suggested a major shift in NEMA’s official stance on licensing, the resolution was altered the next day. 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 means, 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 convention. 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 reforming physicians, eclectics needed to focus their energy on educating the public. If an educated patient foolishly chose to seek treatment from quacks, it was “their American right and privilege.”
King again addressed NEMA in 1886 about the dangers of medical licensing. His arguments had changed little from the 1884 debate. He reemphasized that physicians did not need a scientific education and 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 was opposed medical legislation. He believed that the Knights of Labor 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 Promptly” to fight medical legislation. Not only should eclectics unite with anyone who opposed medical legislation, they should “avoid and banish” dissenters. King argued that eclecticism faced extinction if they failed to organize themselves and fight.
In 1885, NEMA attempted to clarify it 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 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” which 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 their policy, they still did not advocate on behalf of anything. 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 1894, it was fairly clear that 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 had been consistently upheld. Ultimately, he was engaged in wishful thinking when he stated that the laws were unconstitutional. Additionally, while people had a right to choose their own physician, it was becoming increasingly difficult for patients to determine who was adequately qualified to treat them safely. King sought to preserve the free market of medicine just as many other people were becoming weary of it. Through their prosecutions, medical boards throughout the country demonstrated that the United States was plagued with dangerous and unqualified physicians. People were being killed by incompetents and malpractice laws did not protect them from being killed by their physician. King underestimated the threat faced by the general public because he worked so closely with quacks in the past.
At the end of the day, the failure of NEMA to clarify its stance on medical regulation may have hindered state and local eclectic medical societies combat partisan legislation. These societies would have been required to fend for themselves. NEMA’s official policy would have encouraged skepticism by eclectics, but it failed to provide them with any guidance. The local societies would have had to determine for themselves whether proposed regulations were potentially beneficial or undesirable. Additionally, it would have been much more difficult these societies to effectively lobby the state legislatures without alternative regulatory plans. Additionally, if local and eclectic societies adopted the resolves passed at the national convention they would have only muddled their position on medical legislation in their discussions with state legislators. Notwithstanding the shrillness of King’s address, he did make a legitimate point. Medical legislation did threaten the survival of eclectic medical sect. Over time, licensed eclectic physicians began to define themselves as physicians and not as eclectics. When AMA changed its policy and invited eclectic and homeopathic physicians into its organization, eclecticism lost much of its vitality. Eventually the distinctions between eclectics and allopaths disappeared and eclectics were folded into the outstretched arms of the AMA.