Diploma Mill: The Rise and Fall of Dr. John Buchanan and the Eclectic Medical College of Pennsylvania by David Alan Johnson (review)

The heart of Diploma Mill is the engaging tale of a medical scoundrel in post–Civil War Philadelphia. Arriving from Scotland in the early 1850s, John Buchanan in 1860 joined the faculty of the Eclectic Medical College of Philadelphia (EMC), a school founded ten years prior, and soon became its dean. There were eight medical schools in Philadelphia in 1860 vying for students including two rival eclectic medical colleges. Sometime in the 1860s Buchanan began or greatly expanded the profitable practice of selling medical diplomas. In 1867 Buchanan obtained a charter for the American University of Philadelphia, ostensibly to train African Americans in medicine. (He courted newly enfranchised African Americans throughout his time in Philadelphia, especially during an unsuccessful run for the state legislature.) In a time of racial violence, this second school never got going as an educational institution. It, too, became a diploma mill with a more generic and appealing name than EMC. Buchanan ran a large business, selling diplomas to individuals with or without any formal medical training in the United States and Europe. Buchanan's two schools were not the only diploma mills in the nation, but they were the largest and most audacious at the time.

When Buchanan began selling diplomas, there was no medical licensing in the United States, and anyone, regardless of qualifications, could practice medicine and claim to be a doctor. The diplomas had no legal status. Some buyers wanted one to place M.D. after their names. Others, as Johnson argues, were concerned that new medical practice laws on the horizon might limit practice to those with an M.D. In fact, most state laws accommodated eclectics and homeopaths, and grandfathered in those practicing without a degree.

Johnson, who was the lead author of a history of the Federation of State Medical Boards, places Buchanan and the EMC in the context of growing professionalization in medicine, educational improvements in leading medical schools, and the early push for state medical licensing. Illinois passed what became a model law in 1877, requiring an examination for all candidates for a license, not just a registration of doctors. The Illinois State Board of Health had the right to list schools whose graduates were not eligible to take the examination. EMC was on the list.

A slick self-promoter, Buchanan countered increasing criticism from other physicians and the press in the 1870s by bravado, blaming others, and, if necessary, bribery. When the state tried to close his school in 1872, Buchanan sued and won on a technicality. Finally, in 1880, John Norris, a zealous newspaper reporter for the Philadelphia Record, with the help of his editor and approval of the state's attorney general, gathered evidence of fraud including letters from Buchanan offering to sell diplomas to Norris's fake inquirers. Facing trial and in debt for borrowed bail, Buchanan had the chutzpah to stage his own death by apparently jumping off a post-midnight ferry from Philadelphia to Camden, New Jersey. Norris and newsmen in Detroit tracked him down in Canada. Even after the closing of his schools in 1880, and his time in the state penitentiary, Buchanan was not through with medical chicanery. With a mysterious woman he claimed was his illegitimate daughter, he moved to New York and ran a successful patent medicine business.

In this highly readable biography, Johnson treats Buchanan more as a cunning rascal than as a grave danger to society. His pursuit of sources on Buchanan and eclectic medicine is thorough. However, for historical background on regular medicine, he often cites textbook histories of medicine, rather than fully engaging with recent literature on medical practice and growing professionalism in the nineteenth century.

As Johnson argues, the Philadelphia diploma mill scandal likely contributed to arguments for state licensing laws, but...