A detail of a sketch of people transporting and caring for wounded people outdoors; covered wagons stand in the background.

The Anatomy Acts and the Social Contract

Dr. Dale Smith gave the 2014 James H. Cassedy Memorial Lecture today at the National Library of Medicine on “Anatomy Acts and the Shaping of the American Medical Profession’s Social Contract.” Dr. Smith is a Professor at the Uniformed Services University of the Health Sciences Department of Military and Emergency Medicine. Circulating Now interviewed him about his work.

Circulating Now: Tell us a little about yourself. Where are you from? What do you do? What is your typical workday like?

Dale-Smith-at-NLMDale Smith: I am a native Floridian who went to school at Duke University (BA) and the University of Minnesota (PhD). For 33 years I have been a faculty member at the Uniformed Service University of the Health Sciences in Bethesda, Maryland,—“America’s medical school.” As a faculty member I teach and write, I spend many days reading history and historical source material. There is a certain amount of administrative activity, committee meetings and such, but most of my time is spent either teaching or preparing to teach healthcare providers who will serve in the military medical departments.

CN: Can you tell us about the work you presented in your lecture, Anatomy Acts and the Shaping of the American Medical Profession’s Social Contract.”

DS:  Professor Shauna Devine of Western University and I are engaged in a multiyear study of the potential role of the Civil War experience in shaping the emerging American medical profession in the last third of the 19th Century; this is an early installment. Sociologists and political theorists have, since the 17th century, played with the idea of social contracts—implicit agreements between elements of society; current sociology has move away from the simple functionalism of a social contract but the way in which a profession establishes and changes its unique role is still important. Historians of medicine have long observed that a western consensus that permitted special social privileges to a “safe general practitioner” emerged in many countries from the mid-18th to the early 20th century. This consensus had several common components: public subvention of the education of medical practitioners, public capitalization of the physicians work space in hospitals, exemption from legal review of medical science based decisions in prophylaxis and therapy, and a limitation, under the control of the medical profession, on who enjoyed these privileges. One of the earliest components of this “Social Contract” was the provision of anatomical material for medical education and research, through anatomy acts—laws which made the bodies of (at least some of) the dead available for the profession to use. In the United States these provisions were made state-by-state and while some anatomy acts were passed before the Civil War (half of those passed were repealed), in general Americans were not supportive of special privileges for physicians before 1860. In virtually every northern state, legislation was introduced in the years immediately post war to provide bodies—licensure laws, public health boards, or some combination of special privileges; some passed some did not.

A sketch of people transporting and caring for wounded people outdoors; covered wagons stand in the background.
Citizen volunteers assisting the wounded on the battlefield at Sharpsburg, Maryland, Sept. 17, 1862.
National Library of Medicine #101409976

CN: How did you originally become interested in the History of Medicine?

DS: I became interested in the history of science as an undergraduate and moved to the history of medicine under the stimulus of the faculty at University of Minnesota—the principal reason was the larger social component of medical history (at the time the history of science was a subset of intellectual history). On graduation with my PhD the National Library of Medicine awarded me a grant to pursue my research at Minnesota and I joined the faculty there.

CN: What inspires you in your work? Have you ever made a discovery in your work that made you say “wow!”?

Formal photographic portrait of a man.
Dr. William Budd (1811–1880)
National Library of Medicine #B03865

DS: Discovery is fun and while working at Minnesota I discovered a long lost manuscript by the Victorian epidemiologist, William Budd; it was in the NLM collection catalogued as an anonymous manuscript on fevers (J Hist Med Allied Sci. 1980 Jul;35(3):318-9). The discovery was published a few years later by Johns Hopkins University Press (On the causes of fevers (1839) by William Budd.) and made a contribution to the understanding of both Budd’s and contemporary physicians’ ideas. In many ways, the understanding is more inspiring than the discovery, how are new ideas incorporated into practice, what makes one country, culture or time period different from another one, given the basic building blocks of human intellect are constant across time and place?

CN: How have the collections and resources of the NLM informed your work?

DS: NLM is itself part of the American support of the medical profession in the post Civil War era and its unparalleled collection of state and local medical journals offers the best insight we have to the collective activities of many medical communities in the nineteenth century. Because of the high acid content of nineteenth century paper many of these periodicals are crumbling on the shelves of local libraries, NLM’s systematic preservation efforts will conserve this heritage for future scholars and is increasingly making the resources available in electronic formats at the researcher’s desk. NLM has always been at the forefront in medical bibliography and the computerized versions of the Index Catalogue now provide a research tool in their own right as we can ask questions about how the bibliographers thought about various publications that reflect concerns of individual authors and the collective activities of societies.

Dr. Dale Smith’s presentation was part of our ongoing history of medicine lecture series, which promotes awareness and use of NLM and other historical collections for research, education, and public service in biomedicine, the social sciences, and the humanities.

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