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Licensed to Practice

The Supreme Court Defines the American Medical Profession

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.

About the Author

James C. Mohr is the College of Arts and Sciences Distinguished Professor of History and the Philip H. Knight Professor of Social Science at the University of Oregon. He is author of Doctors and the Law: Medical Jurisprudence in Nineteenth-Century America and Radical Republicans in the North: State Politics during Reconstruction, both published by Johns Hopkins.

Reviews

"The tale told by Professor Mohr is not a dry sequence of facts, but is instead an evocative page-turner. Mohr’s description of the characters in this tale is massively evocative and filled with palace intrigue and scheming worthy of Henry II... To learn the fascinating details I refer you wholeheartedly to this marvelous depiction."

- Howard Wainer - Journal of Medical Regulation

"Mohr presents a thoroughly researched and eminently readable account of the times, people and circumstances that led to the passage of the West Virginia licensing law and its subsequent legal challenges... Reading this fascinating and personal history of a watershed moment in physician regulation encourages one to dig deeper into the history of medical regulation."

- John Harris - Social History of Medicine

"In sprightly prose Mohr explains how the practice of medicine came to be licensed. His archival sleuthing has unearthed a complex drama involving personalities, ideas, and interests."

- Jeffrey Kahana - Journal of American History

"Mohr clearly explains the rationale for opposing licensing and makes it easy to understand why for over a decade legal authorities remained confused and unconvinced by the decision. This book will be a useful case study for historians attempting to make the case for the contingent nature of change to non-historian policy makers."

- Joel D. Howell - Bulletin of the History of Medicine

"Licensed to Practice covers a lot of ground... [James C. Mohr] provides a definitive account of Dent, makes an important contribution to the history of medicine in the United States, and offers an interesting study of regulation in the Progressive era."

- The Federal Lawyer

"Licensed to Practice is a valuable contribution to the history of US medicine and public health. Mohr frames the unique features of the West Virginia law and its subsequent legal history. He presents new information on the individuals involved."

- West Virgina History

"Mohr’s book does a superb job presenting not just the history and the legal debates leading to Dent, but also offers well-thought-out criticisms of the consequences of the Supreme Court’s Dent decision for issues such as the medical malpractice system and the policing of physician competence post-licensure. He manages to present all of this, including the rather arcane and complex legal issues in an accessible and easily-understood manner even for those who are not steeped in constitutional law or historical research."

- Kennedy Institute of Ethics Journal

"Mohr’s effective blending of engaging narrative with cogent historical analysis makes this book a useful resource for historians of medicine, legal historians, as well as those interested in social history. But the book is also appealing to medical, legal, and regulatory professionals seeking a historical perspective on medical licensing, its impact on practice, and the implementation of public health in the United States."

- Journal of the History of Medicine and Allied Sciences
Johns Hopkins University Press
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