IN THE LAND OF MIKE MAGEE
Healthcare entrepreneurs today tend to overestimate themselves and are surprised when their creations fall short of expectations due to a lack of connection to funders or regulators with legal authority. But Medicine is not fair, and genius is not so common.
What else can you infer from the thousands of references and citations to Philadelphia doctor Benjamin Rush and his wild ideas on how to heroically cure yellow fever in 1793, but you’ve probably never heard of Dr. John Henry Rauch? The former signed the Declaration of Independence, but directly or indirectly contributed to the unpleasant deaths of many. The latter saved millions and helped the AMA and AAMC find their way out of their post-Civil War professional wilderness.
B. Born in Lebanon, PA in 1828, he received his medical degree from the University of Pennsylvania, then opened a practice in Burlington, Iowa. He was there in 1850, where the Iowa State Medical Society was born, and with their encouragement he published (just five years after Iowa statehood) the epic Medical and Economic Botany of Iowa, which listed 516 species, comprising 23% of the known flora. . of the state today.
Two decades later, he was on the ground in Chicago on October 8-10, 1871, when 3.3 square miles of Chicago burned to the ground, killing 300 people, and managed the city’s medical emergency. At that time he was well acquainted with the outbreak and disaster, for he had attained the rank of lieutenant colonel in the Union army as assistant medical director of the famous army of Virginia during the Civil War.
Knowing this, it is not surprising that in 1966 he focused on cemeteries, publishing a 68-page pamphlet, “Indoor Intervals in Populated Cities and Their Effects on Health and Epidemics.” In it he informs the astonished public on page 48 that “…no grave can be dug to a greater depth than five feet most of the year, and in fact few or none are dug deeper than four feet without coming. water…”
His appointment as the city’s first sanitation director followed a year later and brought forth a strikingly futuristic vision that linked Chicago’s ecology and environment to human health. And by 1876, as the new president of the now 4-year-old American Public Health Association, he was ready to make perhaps his major contribution as a unifier of the House of Medicine.
As historians of the Federation of State Medical Boards recount, “The individualism and antiregulatory climate of the Jacksonian era, combined with the democratization of medicine … contributed to the wholesale collapse of medical regulation in the first half of the 19th century.” Illinois led the way in 1826 in eliminating all medical licensing requirements. Over the next decade or two, fourteen other states followed suit. Into this void stepped a relatively small group of physician activists focused on mobilizing their colleagues under the banner of a new organization in 1847, the American Medical Association. Striving for both autonomy and authority, they created a schism by trying to label a wide range. of self-proclaimed herbalists, homeopaths and eclectic practitioners as “irregular doctors”.
The public didn’t seem particularly impressed. As John S. diseases under the influence of the stars, provided they are freed from their pain and released from the fetters of disease.’
Entering this highly politicized professional struggle was John Henry Rauch, head of their newly formed Illinois State Board of Health in 1977. He focused on the mediation of the dispute, which was complex. Competing schools of medicine varied widely and multiplied at an alarming rate. Rauch identified only 24 in his state, which he deemed “ineligible for licensing.” Additionally, the rate of progress in medical science was unprecedented at the time, and medical schools such as Johns Hopkins, Harvard, and the Universities of Pennsylvania and Michigan demanded consistently high standards of medical education and licensure. And finally, the need for government control and standards in an increasingly industrialized and urbanized landscape in the wake of Rockefeller and Carnegie abuses was now attracting popular support.
In 1878, Rauch set the standard by engineering the passage of the Illinois Medical Practice Act of 1877 with the first requirement that licensure be available only to those graduating from “approved schools” with new high standards, both pre-medical and medical. education. 3,600 doctors in the state did not graduate from any medical school. Within a year of the law’s adoption, 1,400 of them were gone. This for the first time linked the interests of medical schools and state licensing boards with the public medical societies that bridged the gap.
Three years later, most states re-adopted medical licensing. In 1890, two events reinforced the developing national sentiment. First, Rauch organized and convened the National Confederation of State Medical Examining and Licensing Boards, convening its first national conference at that year’s AMA annual meeting. Its purpose was clearly stated to apply “uniform standards” to medical schools and licensing boards. Second, a new organization, the AAMC, with 22 medical school members, is focused on raising the standards of medical education. Initially agreeing on “a curriculum of two terms not occurring in the same year”, by 1905 they adopted a 4-year curriculum.
With Rauch’s encouragement, by the time his death was announced in the British Medical Journal at the age of 65, 27 states had established medical licensing and examination boards. Individual states continued to jealously support their jurisdictions and resisted standardized reciprocity among all states. Instead, they mirrored each other’s programs, which required medical licensure through a “satisfactory” medical degree and examination by a state medical board.
In another five years, the AMA would establish its Board of Medical Examiners, and the AMA and AAMC would align with each other on general reforms in medical education spanning the next century, but beginning with Abraham Flexner’s 1910 report. But without Rauch they would have fallen short.
As historians of the Federation of State Medical Boards have rightly reminded us, “Voluntary associations like the AMA and AAMC, while potentially influential, lacked the authority to push for the necessary changes. The only remedy was legislative. …As a duly constituted legal body regulating the practice of medicine within each state or territory, state medical boards were prepared to do what others could not.”
Mike Magee MD is a medical historian and CODE BLUE. Author of Inside the Medical Industrial Complex.