History of Medicine

In this brief lecture, we will discuss the themes and trajectories of American Healthcare from its Colonial Origins to the Flexner Report of 1911, which constitutes the origins of our modern healthcare system.  

The first lecture explores our colonial origins.  How did the American healthcare system and its doctors change from their European mentors?  What about the American landscape fermented something unique in the colonies regarding the practice and study of medicine?

Starting in the colonial period and crystalizing during the Republican Period, American doctors differentiated themselves from their European colleagues and from non-traditional healers by instituting a medical-racial script.  We'll discuss what the script is, how it helped American healthcare and its white male doctors to establish legitimacy, and the toll it took on the African American com...

After the Revolution, American was severed from the European seat of orthodox medical power.  American orthodox doctors were forced to establish their own schools, their own dogma, and their own leaders.  Much of what glued orthodox doctors together and led to copious research was the medical racial script, much of which was inscribed in the standard medical school curriculum North and South.  How...

With orthodox medicine in disarray, with no standards of education, and with alternative medical philosophies ruling the roost, several prominent orthodox doctors came together to forma national organization to represent the needs of orthodoxy, the American Medical Association (AMA).  Founded in 1847 largely by Nathan Davis, the AMA had several goals: To promote licensing requirements, to standard...

While we view traditional medical care as the norm, it was not always that way.  Throughout most of the 1800's Americans chose alternative providers more frequently than orthodox doctors; their outcomes were better, their ideas based on common sense, their focus patient oriented, and even their fees lower.  One of the primary goals of the AMA was to snuff out alternative philosophies, especia...

Excluded from the AMA and from orthodox medicine, African American doctors had to find their own way in the late 1800's.  Virtually no African American doctors existed in the early century, but that changed in the Civil War, especially with the advent of Howard University and then a sprinkling of other medical schools that trained black doctors.  How the African American medical community gre...

Born in Republican America, with its emphasis on democratic decentralization, the AMA was floundering in the late 1800's, with few doctors latching their sails to its agenda.  Most orthodox doctors remained fully independent, many graduated from poorly regulated schools without any firm curriculum, and the medical landscape was dominated by non-orthodox providers.  In this vein, the AMA shift...

As the AMA gained power and scripted a plan to commandeer the medical system, it used its medical-racial script to leap on the progressive train, including an embrace of eugenics. Eugenics flowed from the medical racial script, and according to historians, was the secular religion of progressives.  It was deemed to be sanctified science, taught at all major universities, and penetrating the hearts...

The AMA grew up in a libertarian America, but chose to change its nature during a top-down Progressive America, where experts and scientifically based rules were determined to be crucial to any viable reforms.  Working with corporate foundations, Progressive reformers, and German-inspired Progressive academic doctors, the AMA shifted course and transformed into a top-down organization that sought...

Two of American medicine's pioneers, and co-founders of Johns Hopkins Medical School, represented a fork in the road.  William Osler, whose scientific humanism pushed back against a healthcare system teetering between commercialism and quackery, created a solution at Hopkins: clinical care, doctors as teachers, patients as teachers, an end to protocols and dogma.  He believed in patient centr...

Once the AMA and William Welch orchestrated an alliance of Progressive reformers, corporate interests, and state medical licensing agencies, it was time to sanctify the cogs of a new medical system.  That is what the Flexner Report is all about, a survey of US medical schools largely scripted by the AMA, conducted by a little known educator working for the Carnegie Corporation named Abraham Flexne...

Two pages of the Flexner Report condemned African American medial providers, hospitals, and patients to decades of struggle.  Relying on the AMA's medical-racial script, and playing into the atmosphere of Progressive eugenics, Flexner's chapter devoted to the African American medical situation flowed from what united white orthodox providers and fed the corporate impetus that would finan...

The first half of American Medical History ends at the Flexner Report, which entirely morphed American Healthcare into a monolithic corporate entity under the complete control of the AMA.  Every aspect of healthcare transformed, from education, to payment, to philosophy, to licensing, to dogma.  The Medical Racial Script, long unspoken and oft ignored, became the law of the land.  What are the rep...