Sovereignty in Medicine

It would not be considered a bold statement to proclaim that the institution of medicine has progressed a great deal over the course of a mere few centuries. Its earliest roots would be found in physicians that would go an entire year without ever seeing a single patient. Such a prestigious career was once the occupation of well-educated paupers who were forced to find other means of income to support their families. If a twenty-first century physician were told to buy a farm, they would most likely laugh or be extremely insulted. Sovereign really is the watchword when the topics of medicine are brought into discussions. Everyone in healthcare, and every living being strives for autonomy- for freedom to do as one wishes. Medicine has come from a time where surgeons would strike their patients to render them unconscious. Due to adventurous medical explorers, we now possess anesthesia (“Accidental Inventions,” 2008). Record keeping and evidence-based practice would ultimately follow.

Advancements in aseptic technique would decrease mortality rates, radically (Bellis, 2013). As stated before, there is a specific ideology that stands true about every discipline. As is the case with any institution, it will advance over time. In other words, given a long enough timeline and something will change from what it was to what is will become. “Modern medicine is one of those extraordinary works of reason: an elaborate system of specialized knowledge, technical procedures, and rules of behavior” (Starr, 1982, p. 3).

In the beginning, the agrarian culture did not accept physicians as they are accepted today. To these early adopters, all forms of illness could be treated in the home. The similarity to their early modality of thinking is impressive, especially when one considers how much of the healing process takes place after an appointment with a physician. However, eighteenth century America had a strong bias toward modern healthcare, which was still in its infancy. Communication between the patient and physician was a magnificent issue, as the telephone was linked, primarily, between the physician and the pharmacist. Essentially, this meant that patient communication was almost non-existent, as far as the telephone was concerned (Starr, 1982). Another inhibitor of patient and physician interaction was the lack of transportation. The earliest physicians worked for free, and to a greater extent, suffered the cost of transportation, out-of-pocket. By stark contrast, a practicing surgeon was paid for his or her services- no question. Drawing on other physicians of the time, not included in Starr’s work, one may find this trend of service-for-free more common than before, in the chronicles of Dr. Jackson:

The physician, who worked in Pittsburgh, then Philadelphia, during the late nineteenth and early twentieth centuries, was rarely paid by his patients; his only request was that he be allowed to keep what he called the “fbdy,” short for “foreign body” (Cappello, 2011).

Noble and intrepid Dr. Chevalier Quixote Jackson would go on to invent and perfect tools for foreign body extraction until his last days.

Still, where was the sovereignty of the physician and the medical establishment during this time? To begin, William Buchan’s publication placed medical treatment in the hands of the layperson, thus causing the contradiction to physician autonomy, or sovereignty. Medical advice can be a dangerous piece of knowledge if not explicitly conveyed by a person with medical training. Physicians who took to private practice upheld a monopoly over a specific geographical area, causing a conflict between doctors (Starr, 1982). This territorial battle was discouraging to most physicians, largely in part because it hindered their ability to climb he status ladder. Doctors would also find that they were not developing the power that they had hoped. As the occupation grew larger, the fact remained that most physicians were not very educated, and took to teeth pulling, taking up jobs as a pharmacist and other odd jobs, often reserved for a commoner. The construct of the physician at this time was that of a person who was trying desperately to attain a level of social status, such as the English model of a physician (Starr, 1982). Ultimately, there was no dominion, control, autonomy or power for the physician. It would take much more than a title to convince a population that a physician was as necessary as air. The profession would take a giant leap forward when Johns Hopkins University made effective the minimum mandatory college degree before being accepted to the university (Starr, 1982). This invoked the American Medical Association (AMA) to reform all other medical schools.

The corporatization of the medical industry would only be possible after a series of scientific breakthroughs. In no particular order, several pieces of instrumentation made it possible for the collaboration of multiple physicians to share information collectively. One such example of this communal observation is the x-ray as well as the electrocardiograph. The discovery of ether was monumental. The stethoscope made possible for the listening of internal organs, thus allowing an onslaught of sound to be interpreted and lead to a diagnosis (Starr, 1982). The otoscope and the laryngoscope were major instruments in the inspection of the esophagus and ears. As microbiology was taken more seriously, it led to specific advancements in the treatment of diseases caused by specific bacteria (Starr, 1982). The more tools a physician had at his or her disposal, the more accurate the diagnosis would be. In summation, the enhancement of science opened the medical industry to the birth of the hospital. With this new advent would come greater salaries, for physicians, than ever before. All the while the AMA had been hard at work, prohibiting the disparaging rhetoric and unfounded accusations of physicians by pharmaceutical companies. Alas, the inevitable corporatization would find its place in the hospital and manufacturing companies.

When discussing hospitals, it is illustrated that most hospitals were designed for the poor. As such they were called almshouses. Translated, it means a charitable house, which, in this case, is quite apt as the poor were the majority of the hospital’s census. Alas, as this timeline continued, the impoverished were no longer the majority census and the first hospitals were taking root. Only the privileged and or wealthy were privy to mental health. The first hospitals were used for isolation, the indigent and travelers. In other words, they were used for those who had no home or were very ill.

Why were physicians opposed to corporate enterprise in medicine? One need not travel too far into Starr’s text to receive a compelling answer. “For a surgeon or physician to accept a position with a manufacturing company was to earn the contempt of his colleagues.” This quote is not that of Paul Starr, but of Alice Hamilton, a physician, muckraker, and leader in the occupational health filed of the period (“Changing the Face of Medicine | Dr. Alice Hamilton,” n.d.). One can propose that as industry grew, workers were prone to more accidents. Why did medical corporate enterprising grow? The growing need for the staffing of so-called “railroad surgeons” became essential. This cascaded into other industries as well, such as coal mining and lumber. Indeed, it seems practical and necessary to have skilled medical personnel on the premises, even though it was frowned upon for physicians to be practicing this type of corporate medicine. Be that as it may, these positions offered physicians steady employment, where elsewhere, the institution of medicine was becoming corrupt. In the opening of chapter six, Starr (1982) states, “so many of its practitioners saw themselves—beleaguered by unscientific sectarians and quacks who preyed on the credulous sick; by druggists who plagiarized their prescriptions and gave free medical advice to customers; by too many of their own profession…” (p. 198).

In conclusion, physicians wanted to make an honest living working for a company. This was the advent, where physicians saw the approaching age of collegiality. Though their peers may have found work as a private physician, other occupations were still very lucrative. Thus, the need to go where the money was is a logical modality. This is where they found sovereignty- in the wards of hospitals, in emergency rooms, in operating rooms, and on-site at manufacturing facilities. To think outside the box would be to say that this occupation never deserved to be put into place. Imagine it all removed. Would we be better off if everything else progressed, but medicine remained stagnant and unnecessary? How could society benefit? Culturally, our Eastern neighbors do not subscribe to the same radical approaches that Western medicine does. So, who is better off? Perhaps American medicine has much to learn, and a long way until it reaches a point of status-equality and less emphasis on sovereignty, rule, power, control, authority, and dominance.

 

References

Accidental Inventions. (2008). Accidental Invention of Ether Anesthesia. Retrieved May 22, 2013, from http://www.vat19.com/brain-candy/accidental-inventions-ether-anesthesia.cfm

Bellis, M. (2013). History of Antiseptics – Ignaz Semmelweis. History of Antiseptics – Ignaz Semmelweis. Retrieved May 22, 2013, from http://inventors.about.com/library/inventors/blantisceptics.htm

Cappello, M. (2011). Chevalier Quixote Jackson: Foreign Bodies. Foreign Bodies. Retrieved June 6, 2013, from http://protomag.com/assets/chevalier-quixote-jackson-foreign-bodies

Changing the Face of Medicine | Dr. Alice Hamilton. (n.d.). U.S National Library of Medicine. Retrieved June 6, 2013, from http://www.nlm.nih.gov/changingthefaceofmedicine/physicians/biography_137.html

Starr, P. (1982). The social transformation of American medicine. New York, NY: Basic Books.

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