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This chapter examines the culture of mid-century medical education. It focuses on the four contexts of learning—lectures, hospital wards, anatomical dissection, and medical thesis—including the ways in which they helped create continuity in the physician's identity. First, it examines the rhetorical power of lectures and intellectual implications of anecdotes. Next, it describes students' experiences of hands-on medicine in clinics and wards. It then discusses the fascination with anatomy and anatomical dissections and how understanding human anatomy exemplified the flourishing of orthodox medicine. Finally, the chapter discusses the medical thesis, illustrating how the expression of orthodoxy was tied to each student's personal engagement with it.

In the mid-nineteenth century, thousands of southern men pursued orthodox medicine as their career. This chapter examines the factors that influenced southern men as they made their decision to become doctors, stressing issues of gender and family. It also describes the competition among medical schools in recruiting students and apprentices. The chapter also discusses schools' struggles in reforming their curriculum and defining themselves as distinct intellectual realms.

This chapter recounts the emergence of orthodox medicine. Medical care and medical education emerged as a scientific enterprise in the last quarter of the nineteenth century, with the help of the advances in germ theory, anti-septic techniques, hygiene, anesthesia, and surgery. By the turn of the twentieth century, orthodox medicine succeeded in eliminating a number of unconventional therapies, challenging philosophy-based practices through “evidence-based medicine” (EBM). Biomedicine treated disease as a biochemical phenomenon that could be classified into discrete categories of causation using standardized, objectified, and technologically validated biochemical treatments and mechanisms. This led to the evolution of clinical trials, such as the blind or masked (placebo) assessment; the double-blind, placebo-controlled randomized clinical trial (RCT); and the so-called Cochrane Collaboration, which incorporated meta-analysis to support RCT's predictions.

This chapter explores the identities physicians shaped for themselves against the larger backdrops of southern landscapes, race, and Christian faith. First, it describes the way in which physicians acted as social ethnographers and critics by writing medical topography, one of the canonical texts of orthodox medicine. This is followed by physicians' writings on slavery and orthodox generalizations about African American disease. Finally, the chapter describes how nineteenth century practitioners expressed their Christian faith through their writings, shedding light on the religious faith's importance in physicians' work.

This chapter examines several medico-legal issues insofar as they have a religious dimension or implicate the religious liberty of the persons seeking or refusing treatment. The chapter is organized as follows. Section II summarizes the law concerning medical treatment, contrasting the position of adults, adolescents or teenagers, and infants. Section III considers the underlying assumptions represented in the disputes between the law and certain religionists who spurn conventional medical treatment in favour of exclusive reliance upon prayer or other spiritual cures. The premises which form the central tenets of conventional or orthodox medicine — reliance upon rationality, insistence upon the scientific method, the need for empirical evidence — have recently been challenged, not only by some devout religionists, but by also a raft of ‘alternative’ health practitioners. Section IV discusses two examples of these broader themes. The chapter concludes with some observations on the extent to which a liberal state accommodates the wishes of believers when they seek to determine their own or their children's health.

This chapter examines the early state of health care and the medical profession in America. It considers the problems faced by the medical profession in the nineteenth century, suggesting that physicians unwittingly encouraged alternative modes of treatment that successfully undermined the orthodoxies of humoral medicine. It explores the variety of factors that led to doctors' loss of prestige and authority and the challenges they encountered, from scientifically inclined laymen to the mass of people who drew on their own domestic medicine to African Americans who opposed them as surrogates for the slave master. It also highlights the tensions and conflict between medicine and the public and discusses the role of orthodox medicine in the health of the population, the role of doctors in the area of mental health, and the impact of proprietary medical schools on American medicine.

This chapter describes the wholesale abandonment of medical licensing in the antebellum years due to the collective efforts of practitioners and supporters of Thomsonianism, an extremely popular school of botanical medicine. The Thomsonians waged their triumphant struggle to preserve freedom of therapeutic choice in explicitly constitutional terms, even though they conducted it entirely outside of court. Their campaign thus offers one of the most striking examples of a successful popular constitutional movement in American history. This chapter analyzes the rhetoric the Thomsonians used in their successful battle against medical licensing, demonstrating that the antebellum American commitment to freedom of therapeutic choice was based on notions of not only bodily freedom, but also economic freedom, freedom of conscience, and freedom of inquiry.

This epilogue provides a brief overview of the major advances in American medicine in the modern period, and how such advances have been challenged by a newly energized alternative medicine movement. The 1890s ushered in a new era in American medical history and a sharp break from the old following the establishment of the first endowed graduate program in medicine at Johns Hopkins University in Baltimore, an institution that focused on the advancement of laboratory-based science and evidence-based clinical trials. Medicine was finally disconnected from the older methods of learning, teaching, and practice. The new medical school model enabled physicians to regain their important place in American life with a new well-defined role as leaders in disease treatment and prevention. This chapter also discusses the strides made by American medicine by the 1950s, such as the decrease in death from infectious diseases with the help of antibiotics, along with the increase in life expectancy and the sharp divide between orthodox medicine and alternative medical techniques.