"Licensed to Practice" begins with an 1891 shooting in Wheeling,
West Virginia, that left one doctor dead and another on trial for
his life. Formerly close friends, the doctors had fallen out over
the issue of medical licensing. Historian James C. Mohr calls the
murder "a sorry personal consequence of the far larger and
historically significant battle among West Virginia's physicians
over the future of their profession."
Through most of the nineteenth century, anyone could call
themselves a doctor and could practice medicine on whatever basis
they wished. But an 1889 U.S. Supreme Court case, "Dent v. West
Virginia," effectively transformed medical practice from an
unregulated occupation to a legally recognized profession. The
political and legal battles that led up to the decision were
unusually bitter--especially among physicians themselves--and the
outcome was far from a foregone conclusion.
So-called Regular physicians wanted to impose their own
standards on the wide-open medical marketplace in which they and
such non-Regulars as Thomsonians, Botanics, Hydropaths, Homeopaths,
and Eclectics competed. The Regulars achieved their goal by
persuading the state legislature to make it a crime for anyone to
practice without a license from the Board of Health, which they
controlled. When the high court approved that arrangement--despite
constitutional challenges--the licensing precedents established in
West Virginia became the bedrock on which the modern American
medical structure was built. And those precedents would have
profound implications. Thus does "Dent," a little-known Supreme
Court case, influence how Americans receive health care more than a
hundred years after the fact.
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