Licensed to Practice: The Supreme Court Defines the American Medical Profession by James C. Mohr (review)

Licensed to Practice describes the contentious and forgotten struggle to pass West Virginia’s physician licensing law in 1881. West Virginia was not the first state to deal with regulation of the medical profession, nor was it a center of medical science and learning, but its physician licensing law was recognized as a landmark at the time.¹ Perhaps more importantly, this law set the legal standard for health professions licensing for all states.

Mohr’s book makes an important and thoroughly readable contribution to the history of public health in the United States, particularly to the history of physician regulation. The national significance of West Virginia’s 1881 law is that its constitutionality was challenged in West Virginia and eventually sustained by the US Supreme Court in 1889. The decision, Dent v. West Virginia, established the precedent by which states are allowed to regulate the health professions. Twentieth-century histories of physician regulation, such as those by Henry E. Sigerist or Richard Harrison Shyrock made no mention of the West Virginia law or of the Dent decision. Mohr remedies this oversight with a thorough use of primary sources, including personal interviews with one of Dr. Dent’s descendants.

The story begins with the shooting of one West Virginia physician by another in 1891. This event is not essential to understanding the issues, but Mohr uses it as a literary device to personify the egos and animosities that were present. He seeks to answer the questions: “[I]f the constitutional authority to license physicians at the state level was so self-evident, why had the case come before the Supreme Court in the first place? Why had the case arisen when it did? Who were these defendants, what was the nature of their contention, and what lay behind the dispute” (viii, 216).

Mohr answers his questions by developing the personalities, beliefs, and ambitions of the West Virginians who sought to control medicine in the state in the latter part of the nineteenth century. He describes the considerable intellect and determination of Dr. James Reeves, the brother of Ann Reeves Jarvis of Mother’s Day fame. Dr. Reeves organized the Medical Society of West Virginia and was a national public health leader. He was a determined opponent of quackery and those whom he felt were unscientific medical practitioners.² Reeves authored and, as secretary of the board of health, enforced the 1881 West Virginia physician licensing law. Opposing Reeves were other physicians, such as former medical society president William Dent, his son Frank Dent, the plaintiff, and William Dent’s brother and future West Virginia Supreme Court justice, Marmaduke Dent, who argued the case. For them, the issue was the freedom to practice whatever kind of medicine the patient was willing to accept. Mohr’s history centers on the rich clash of egos and ideologies in nineteenth-century West Virginia, as it exposes ongoing fault lines in medical practice. The book reminds the reader of issues we still face. When is an alternative approach to medicine unscientific or even illegal? Who decides?

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. His book inevitably leads one to ask another question. Why did the complex issues around medical licensure that led to a landmark Supreme Court case arise and come to resolution in nineteenth-century West Virginia, a relatively rural state without a single medical school? Was it simply the strong personalities on whom Mohr centers his attention, or were there other elements of West Virginia society and culture, not present in the major urban centers or discussed by Mohr, that allowed this defining event to occur where it did?