Enforcing Medical Licensing in Illinois: 1877-1890

Today, physicians are perhaps the most regulated professionals in the United States, but in 1870, almost all of them were unlicensed. In most jurisdictions, anyone could hang up a shingle and practice medicine. Only the Dakota Territory and Ohio required physicians to register with local authorities. Between 1870 and 1900, the practice of medicine changed dramatically, and by 1900, almost every state passed some type of medical licensing. The medical licensing statutes passed over this 30-year period gave medical examination or health boards increasingly broad authority to determine who could become and remain a physician. The Illinois Medical Practice Act of 1877 and Illinois State Board of Health interpretations of their statute became important models for numerous states. The Illinois act created allies of organized regular and irregular physicians and broadly interpreted the powers entrusted to a medical board. Other states paid attention to the Illinois board’s prosecutions and mimicked its actions. Medical licensing boards’ enforcement powers forced fundamental changes in medical school curriculums, purged unlicensed ignorant practitioners and outright frauds, reduced the number of non-medical school graduates, marginalized midwives, revoked the licenses of abortionists, and unified the best organized of both regular and irregular medical practitioners. When physicians lobbied state legislatures for these medical practice acts, organized physicians (both regular and irregular) were the primary advocates for these laws. Organized regular and irregular physicians battled each other in state legislatures and crafted compromises that, while objectionable to both groups, forced these physicians into an uneasy marriage. Both the organized regulars and irregulars argued that licensing laws would eliminate unqualified practitioners and prevent unqualified quacks from harming innocent patients. Many regular physicians also believed they would directly benefit from medical licensing laws by eliminating the irregulars. These predictions — at least in the short term — were wrong. Medical boards licensed numerous irregular physicians, and both groups ultimately enforced these laws in ways that managed competition between organized physicians (both regular and irregular) and eliminated their unorganized or marginalized competitors. While the existing literature has focused on the battle between regular and irregular physicians, this dynamic needs to be re-evaluated. Organized regular and irregular physicians did not enforce these statutes to eliminate each other; instead, they prosecuted their unorganized and more marginal colleagues. While William Rothstein’s statement that “conflict between regular physicians and homeopaths and eclectics continued to be a dominant feature of the organized profession in the later years of the century” is certainly true, the shotgun marriage between the organized regular, eclectics, and homeopaths created an opportunity to eliminate physicians that each of the groups found unpalatable [1]. If anything, organized regulars and irregulars realized they shared common interests. These new medical regulations were not enforced in ways to settle sectarian disputes so much as to drive the out unorganized sects and fraudulent practitioners.