Preserving Individualism in the Organizational Society: "Cooperation" and American Medical Practice, 1900-1920

No man here needs to be told the meaning of this term. The world of the twentieth century is a commentary upon it; the advancement of mankind is an illustration of it. . . . Gentlemen, the world has found that there are tasks which one man cannot do alone; the day of isolated individual labor is forever gone. There are also tasks in our world of medicine which no man can accomplish alone. . . . Cooperation! What a word! Each working with all, and all working with each. Can any one doubt that we shall win our battle against low standards, indifferent laws and deadly disease, if all work as one. ¹

This enthusiastic passage from a 1915 medical society presidential address framed one of the most conspicuous watchwords of the early twentieth century. “Cooperation” in an amoral, technical sense meant, simply, “association”: several individuals or groups working together, or combining their material resources, toward the same objective. But among those who urged each other to cooperate, the word also conveyed a sense of morality—in two ways. First, it contrasted favorably with the suspect merits of “competition”; and second, “cooperation” connoted “good” association (for example, a voluntary campaign of social “uplift”) rather than “bad” association (a monopolistic cartel or a radical labor group). The moral connotation helped to popularize the term and made it a persuasive watchword in the organizing efforts of early-twentieth-century commercial and professional associations. ² It also helped make the tighter organization of complex enterprise a virtuous objective.

Yet American businessmen and professionals had to reconcile the attraction of “cooperation” with three other, less high-minded but equally long-standing ideas—individualism, competition, and specialism. Physicians, especially, found such reconciliation difficult. While early-twentieth-century practitioners, to judge by their rhetoric, understood and generally agreed with those who preached “cooperation,” their familiar professional world, which was individualistic and highly competitive, pulled them in a different direction. For the most part, they perceived the emergence of specialism in this light as well, and not as a summons to cooperate.

“Cooperation” in medicine (or any other enterprise) could take at least three different forms. First, it could mean forming a new membership association of previously unaffiliated individuals or firms (“associational cooperation”). The association’s purpose would be to advance and protect its members’ interests by various means, including political influence and education. A second form of cooperation could occur when some public issue or cause aroused the interest of two or more associations sufficient for them to combine their efforts on behalf of the cause. Such issue-centered coalition building amounted to a kind of “social cooperation” among interest groups. Finally, a third kind of “bureaucratic cooperation” was manifest whenever an enterprise enabled constant association of its work staff—including professionals—and directed their collective efforts in such a way that the quality or efficiency of production (of goods or services) promised to surpass what the workers could otherwise achieve as individuals working alone.

The medical profession’s initial cooperative vehicle was the membership association, and here early-twentieth-century physicians resembled other professions and commercial groups. Medicine would follow its own course, however, in dealing with the realities of competition and specialism. Although other sectors of American enterprise moved to a more formal unity in cooperative work organizations by the 1920s, medical practitioners did not. One reason was that they were ultimately able to accommodate an increase in specialism without abandoning the tradition of individualistic competition. The other was that the “cooperation” watchword proved double-edged: it could be the cutting edge of change, but it also could also fortify the status quo. Thus, physicians found they could use their cooperative membership associations to block those who wished to move, finally, to cooperative practice.

In this essay, I attempt to show how two organizational components of medicine—medical associations and medical practice ³ —used the popular watchword “cooperation” to advance their interests and protect themselves against those who were promoting a more tangible form of “cooperation” in the medical workplace—organized group practice. I argue that...