Mark Essig


By most historical accounts, the years around 1900 witnessed the triumph of the expert, as the Jacksonian era's egalitarian suspicion of specialized knowledge was replaced by a respect bordering upon awe. "[T]he last third of the nineteenth century saw the virtual overthrow of effective resistance to specialization," John Higham has written. "By 1920... America had embraced the specialist and sanctified the expert with an enthusiasm unmatched elsewhere." Physicians often occupy a starring role in this narrative of triumphant expertise. After half a century of professional disarray, doctors at the turn of the twentieth century built a remarkably powerful and prestigious professional organization and won control over education, licensing, drug distribution, and other aspects of medical practice.2 An older school of medical history attributed the profession's new social power to scientific advances: as the effectiveness of medicine increased, so did its social authority. More recent histories have pointed out that medicine's advances in cultural authority preceded and outstripped therapeutic advances. By this account, a few notable medical and scientific breakthroughs - including a vaccine for rabies and a drug for syphilis - convinced the public that medicine was worthy of respect even when its claims to therapeutic authority were suspect. "Bolstered by genuine advances in science and technology," Paul Starr writes, "the claims of the professions to competent authority became more plausible, even when they were not yet objectively true; for science worked even greater changes on the imagination than it worked on the processes of disease." Medical authority, in other words, depended largely on good public relations.