Enforcing Medical Licensing in Illinois: 1877-1890

Today, physicians are perhaps the most regulated professionals in the United States, but in 1870, almost all of them were unlicensed. In most jurisdictions, anyone could hang up a shingle and practice medicine. Only the Dakota Territory and Ohio required physicians to register with local authorities. Between 1870 and 1900, the practice of medicine changed dramatically, and by 1900, almost every state passed some type of medical licensing. The medical licensing statutes passed over this 30year period gave medical examination or health boards increasingly broad authority to determine who could become and remain a physician. The Illinois Medical Practice Act of 1877 and Illinois State Board of Health interpretations of their statute became important models for numerous states. The Illinois act created allies of organized regular and irregular physicians and broadly interpreted the powers entrusted to a medical board. Other states paid attention to the Illinois board’s prosecutions and mimicked its actions. Medical licensing boards’ enforcement powers forced fundamental changes in medical school curriculums, purged unlicensed ignorant practitioners and outright frauds, reduced the number of non-medical school graduates, marginalized midwives, revoked the licenses of abortionists, and unified the best organized of both regular and irregular medical practitioners. When physicians lobbied state legislatures for these medical practice acts, organized physicians (both regular and irregular) were the primary advocates for these laws. Organized regular and irregular physicians battled each other in state legislatures and crafted compromises that, while objectionable to both groups, forced these physicians into an uneasy marriage. Both the organized regulars and irregulars argued that licensing laws would eliminate unqualified practitioners and prevent unqualified quacks from harming innocent patients. Many regular physicians also believed they would directly benefit from medical licensing laws by eliminating the irregulars. These predictions — at least in the short term — were wrong. Medical boards licensed numerous irregular physicians, and both groups ultimately enforced these laws in ways that managed competition between organized physicians (both regular and ir-