Profound Science and Elegant Literature. Stephanie P. Browner

      Introduction:

      What’s a Doctor, After All?

      What’s a doctor, after all?—A legitimized voyeur, a stranger whom we permit to poke fingers and even hands into places where we would not permit most people to insert so much as a finger-tip, who gazes on what we take trouble to hide; a sitter-at-bedsides, an outsider admitted to our most intimate moments (birth, death, etc.), anonymous, a minor character, yet also, paradoxically, central, especially at the crisis . . . yes, yes.

      —Salman Rushdie, Shame, 1983

      The profession to which we belong, once venerated on account of its antiquity,—its various and profound science—its elegant literature—its polite accomplishment—its virtues,—has become corrupt, and degenerate, to the forfeiture of its social position, and with it the homage it formerly received spontaneously and universally.

      —Minutes of the First Annual Meeting of the American Medical Association, 1847

      The world of illness and pain is a foreign land we would rather not visit. We distance ourselves from the sick, and those we anoint as official healers carry the burden of our most ambivalent feelings about the shame and pleasure of living in material, mortal bodies.¹ We may wish to think of the healer as a minor character in our lives, one who lingers in the wings and makes only brief appearances. But we also turn to healers in moments of great need, hoping that they, along with their expertise, wisdom, language, and therapies, will return us to the land of the healthy. Inevitably, then, in every portrait of a doctor, nurse, shaman, or lay healer, we hear a culture negotiating who should have the duty and privilege of entering the sick room, listening to the patient’s story, attending the ailing body, and witnessing at the deathbed.

      Medical practice in the United States has two traditions—folk and professional.² Throughout the eighteenth and nineteenth centuries, the divide between the two was not rigid. A family might call in a lay healer on one occasion and a “regular” on another, and practitioners turned often to the pharmacopoeia and therapies of their competitors.³ But there were important differences. Folk healers typically identified themselves with the political rhetoric of health reform, populism, egalitarianism, untutored and independent thinking, democracy, and a free market. Professional medical men, by contrast, identified themselves with advances in medical science, specialized education, and the notion of a guild. In the first decades of the nineteenth century, as a national culture began to emerge, these differences erupted into lively public battles and professional medicine lost much of its prestige. Historians agree that in 1850 professional medicine was at its nadir and “appeared to be coming apart at the seams.”⁴ State licensing laws were repealed in the 1830s and 1840s, competition was fierce in a crowded, deregulated market, and regulars were often branded as aristocrats bent on establishing a healthcare monopoly. One New York newspaper suggested that medicine “should be thrown open to the observation and study of all,” and that “the whole machinery of mystification and concealment—wigs, gold canes, and the gibberish of prescriptions” that kept regulars in business should be destroyed.⁵

      Fifty years later the battles were over, and regulars had, in large part, won the veneration they had so coveted in 1847 when they founded the American Medical Association (AMA) in an effort to recover the “homage” the profession had “formerly received spontaneously and universally.” Four lavish oil paintings testify to the prestige accorded the professional doctor by the final decades of the nineteenth century: Thomas Eakins’s 1875 The Gross Clinic, his 1889 The Agnew Clinic, Robert C. Hinckley’s 1893 commemoration of the first surgery under ether, and John Singer Sargent’s 1906 commissioned portrait of the four world-renowned doctors who were leading medical studies at Johns Hopkins Medical School.⁶ Folk healers, of course, continued to practice, and as late as 1900 more dollars were spent promoting patent medicines than on advertising any other consumer product.⁷ But the question of prestige had been settled, and by 1910, with support from the Carnegie Foundation, most small, proprietary medical schools, including many that trained “irregulars,” had been shut down and foundation money was flowing to elite schools. In fact,