Born in Republican America, with its emphasis on democratic decentralization, the AMA was floundering in the late 1800's, with few doctors latching their sails to its agenda. Most orthodox doctors remained fully independent, many graduated from poorly regulated schools without any firm curriculum, and the medical landscape was dominated by non-orthodox providers. In this vein, the AMA shifted course in the late 1800's, increasing its funding stream, starting a journal, and gravitating towards a more top-down Progressive model of care. Part of its shift required certain compromises and a restructuring of its code of ethics, enabling stronger relationships with the growing pharmaceutical industry that led to more ads and increased revenue, and permitting the inclusion of homeopaths into its orbit if they adhered to certain orthodox precepts. Where the AMA did not bend is in its medical racial script, as it turned its back on the growing orthodox African American medical profession.

The very landscape of organized medicine is being altered by corporate takeovers. Whether in long term care, hospitals, or large groups, corporations are taking charge and offering "perks" that enhance the wealth of institutions, their leaders, and many specialist doctors, but take one more step in decimating primary care and focusing more on profits than patients. Andy and Alan will explain why what these corporate vultures sell is appealing but ultimately dangerous and often lethal.

Excluded from the AMA and from orthodox medicine, African American doctors had to find their own way in the late 1800's. Virtually no African American doctors existed in the early century, but that changed in the Civil War, especially with the advent of Howard University and then a sprinkling of other medical schools that trained black doctors. How the African American medical community grew and prospered by essentially engineering an alternate medical landscape is something often overlooked by medical historians, and yet is crucial to understand white orthodoxy, the medical racial script, and the posturing of the AMA. Ironically, most African American doctors upheld the most foundational tenants of orthodoxy and worked well with white doctors, but were shunned by organized medicine, medical schools, and remained excluded from most medical institutions.

While we view traditional medical care as the norm, it was not always that way. Throughout most of the 1800's Americans chose alternative providers more frequently than orthodox doctors; their outcomes were better, their ideas based on common sense, their focus patient oriented, and even their fees lower. One of the primary goals of the AMA was to snuff out alternative philosophies, especially homeopathy. We will discuss these alternative ideas and how they impacted the medical landscape.

With orthodox medicine in disarray, with no standards of education, and with alternative medical philosophies ruling the roost, several prominent orthodox doctors came together to forma national organization to represent the needs of orthodoxy, the American Medical Association (AMA). Founded in 1847 largely by Nathan Davis, the AMA had several goals: To promote licensing requirements, to standardize education, and to provide a collective where all orthodox doctors could gather. Although formed as a democratic union of orthodox doctors, the organization from the start sought to stamp a unifying dogma upon its members and the nation, one that included the medical racial script. In fact, the script helped to congeal doctors under a single rubric of medical science, one shared by doctors North and South. Weak from the start, the AMA hobbled along for many decades before emerging as the predominant Progressive force in American healthcare, one destined to change the system into the one we know today.

After the Revolution, American was severed from the European seat of orthodox medical power. American orthodox doctors were forced to establish their own schools, their own dogma, and their own leaders. Much of what glued orthodox doctors together and led to copious research was the medical racial script, much of which was inscribed in the standard medical school curriculum North and South. However, during the Republican period, Americans eschewed labels, rules, and favoritism. This translated into an ideal that anyone who thought themselves to be a doctor could be, without any desire to regulate physician education or practice. For instance, no states maintained licensing requirements despite an orthodox push to do so. Alternative medical ideas flourished. We will discuss how orthodox medicine responded and how the American School--researches focused on racial medicine--lofted America into some degree of intellectual independence.

Starting in the colonial period and crystalizing during the Republican Period, American doctors differentiated themselves from their European colleagues and from non-traditional healers by instituting a medical-racial script. We'll discuss what the script is, how it helped American healthcare and its white male doctors to establish legitimacy, and the toll it took on the African American community. The script will be woven throughout this course. Nothing more united white male doctors, helped grow the American medical infrastructure and academic foundation, and imprinted on American medicine its enduring stamp than the script. As we study the nidus of the AMA in the mid 1800's, the Progressive rise of orthodox medicine in the early 20th century, and the consolidation of modern orthodoxy, the script emerges as an often covert but powerful catalyst to the health care system we know today.

I will be presenting a series of lectures on the history of American Health Care through 1920. These lectures are interesting in how they lay a framework for the system we have today. The first lecture explores our colonial origins. How did the American healthcare system and its doctors change from their European mentors? What about the American landscape fermented something unique in the colonies regarding the practice and study of medicine?