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Attitudes toward Change BECAUSE THERAPEUTICS was so central to both the professional iden­ tity and the daily tasks of nineteenth-century American physicians, the process by which it changed was inevitably complexand disturbing to them. Looking hard at the way they regarded change and at the place and meaning it held in their values and institutions helps make sense of that process. One key to understanding their attitudes toward change is to recognize how the structure of medical theory minimized the disruptiveness of permutations in therapeutic practice, a disruptiveness that the profession's institutions further mollified. Another is to see that most of the factors that molded the individual practitioner's decision on whether or not to bring change into his practice exerted dual actions. He derived incentives for both stability and innovation from sources of medical instruction such as schools, apprenticeship, textbooks, and societies and from the socioeconomic context of prac­ tice that sectarianism so strongly shaped. Such factors as medical sec­ tary and the institutions of medical education did not unidirectionally encourage either stasis or change in therapeutics but rather exercised both conservative and progressive influences. Medical tradition was a leading source of professional pride. The communal rituals at which physicians periodically reminded each other of the nature of their calling, such as orations presented at medical commencements and presidential addresses at society meetings, con­ ventionally began by recounting the distinction and responsibility a noble heritage conferred. In facing the trials of medical practice, phy­ sicians could take solace in the knowledge that they were participating in a tradition of ideas and behavior handed down for many centuries. Filiopietism pervaded professional rhetoric. The frequency with which Attitudes toward Change 163 American physicians' sons born in the late eighteenth and early nine­ teenth centuries received the given name Benjamin Rush is one re­ flection of aself-conscious attempt to perpetuate professional tradition. Veneration of tradition served a more fundamental purpose than the inflation of the medical ego. Its crucial importance for professional identity is illustrated by the function of medical history in nineteenthcentury America. Put simply, medical history and the values it dis­ played validated the regular profession's regularity. History placed phy­ sicians in a continuing lineage and affirmed the links with the past that gave them legitimacy. Orthodox physicians who wrote medical history used tradition as a professional tool to set themselves apart from the variety of alternative practitioners. Tradition also provided confidence in practice. Compounded ex­ perience since the time of Hippocrates attested to the propriety and efficacy of such treatments as bloodletting. The fact that medical ther­ apeutics in the early and mid-nineteenth century had in some respects changed little from that practiced over two millennia earlier was, one point of view held, not at all a mark of inferior practice; that therapies were antiquated simply meant that they had received the validation of centuries of trial. The support of tradition for a practice indicated that successive generations of eminent practitioners vouched for its effectiveness and that it was therefore worthy of the nineteenth-century physician's faith. At the same time, the orthodox profession was resolutely com­ mitted to progress. Physicians maintained that it was the regular profession's active efforts to advance medical knowledge and practice that distinguished its therapeutics from unthinking sectarian routine. "Conservatism is a principle worthy of all honor," a New Orleans physician urged, "but there is a principle paramount to it, and worthy of still greater honor—and that is, a manly and enterprising progressiveness ."1 Regular physicians claimed to be singularly deserving of public confidence by merit of their assurance that the profession would readily alter its practices if such change would bring about better care. Physicians were aware of sharing in an ideal of progress that per­ vaded both the culture of science and American society. The exhibition of progress in medical institutions was one source of pride in their profession, for it was a sign that they were keeping pace with the advancement of their science and their society. "There is but little that is stationary in the present epoch, and still less in the science of medicine. 'Progress' and 'change' seem stamped on every page of med­ ical literature," a Georgia physician asserted with satisfaction.2 The expectation of progress was an integral part of right professional think­ ing. 164 THE PROCESS OF CHANGE Tension between the profession'sloyalty to tradition and its com­ mitment to change in the name of progress was inevitable...


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