Chapter 1: Medicine in a Democratic Culture

This chapter looks at American medicine from 1760-1850.

Democracy -- Really "Equality" for All?
One of the first, key points Starr notes is that American democracy did not lead to equality for all when it came to wealth. Individuals began to view their fellow man is equal, they had the same status in society. But, the new capitalist economy led to new found concentrations of wealth and power. Particularly in larger cities where specific individuals began to gain more wealth and power.

Similar changes occurred in the medical professions. While physicians tried to retain their social power that allowed them a "monopoly of practice," most of the public did not allow them such power and insisted on maintaining their own "rights and judgement in managing sickness." Thus, there was a constant battle between medical professional's trying to maintain their autonomy (they wanted to practice medicine in their own way, controlling how patients approached and used medicine) and individual Americans who now tried to control what health care they were given.

Tension Within Medicine
Starr delves into how the struggle between physician autonomy and patients' independence effected three parts of medicine: medicine in individual households, medicine practiced by physicians, and medicine practiced by lay healers.

I found the section of lay healers the most interesting. Starr states that lay healers became the competitive counterparts of medical professionals; specifically, lay healers "saw the medical profession as a bulwark of privilege, and they adopted a position hostile to both its therapeutic targets and its social aspirations." Doctors were usually individuals from the upper class, while other medical practitioners (like lay healers) came from lower classes. Social differences, general mistrust of one another's medical practices, and other problems propagated animosity between physicians and lay healers. But, it was interesting that, as Starr points out, both groups oftentimes usd medical practices derived from one another. Then why the animosity?

To answer this question I looked at to different examples. First, I believe that some animosity may stem from the fact that medical professionals did not like women entering their field. Many women who wanted to practice medicine may then become lay healers instead; however, they would still harbor animosity against doctors they perceived to be prejudiced.

Second, I looked at the major lay health movement concerning the Thomsonians. Samuel Thomson started this movement, he began practicing as a lay healer and eventually got a patent to practice botanic medicine. He gained many followers, many of whom came from rural areas. The medicine he practiced were centered around the following principles: all disease is from one cause and can be removed by a remedy, cold is the cause and heat is the remedy. All bodies are composed of the four elements. To restore health, you must restore heat. Many doctors were against the Thomsonians, just like they were against lay healers.

Inititally, I was intrigued by the Thomsonians because I'd never heard of this movement before reading this book. After reading Starr's section about them, I realized they provide one of the best examples to depict the struggle between medical professionals and medical practitioners. First, Thomsonians show how lower class individuals were able to "rise up" and assert their new found "democratic" power equality. Most Thomsonians were from rural areas; so, I'm guessing they did not have a lot of money or education. Thomson's new way of medical practice provided a quick and easy way to quickly begin practicing medicine. Consequently, this new profession provided these individuals with a way to assert power over people they cared for. Therefore, they found a way to exercise the new "power" the democratic idea of equality gave them.

Thomsonians provided competition for physicians. Doctors were not expected to prove their credibility not only for their patients but in comparison to a newly conceived medical practice. Consequently, tensions arose between physicians and the Thomsonians as both groups tried to establish themselves.

A Redundant Cycle?
This is exactly what Starr states happened at this time. Medical professionals tried to retain their social power while other Americans used the idea of equality to substantiate their own individual power. In the end, this constant ba.ttle led to a redundant cycle betwen professionals and lay persons

Eventually, according to Starr, people began to realize that each individual could not become a physician. At the conclusion of this chapter he states "the nineteenth century was a period of transition, when the traditional forms of mystification had broken down and the modern fortress of objectivity had not yet been built." I'm intrigued to see what happens in the nineteenth century. Hopefully, people were not bogged down by their fascination with individual power and, at least some, brought peace and order to medicine.