Centenary celebrations afford a natural occasion for comparisons of the old and the new. The century which has elapsed since the Northern Medical Association of Philadelphia was founded in 1846 was one in which most aspects of civilization changed with unprecedented rapidity, and medicine was no exception to this rule. Hence the contrast between the status and activities of the American physician in 1846 and in 1946 involves much that may seem unusual to the modern observer.
The glance backward may also reveal some things which are of more than antiquarian interest, for certain problems persist even through a century of change. The most commonly aired grievance of American physicians during the 1840's, for example, was the difficulty of collecting fees. "It runs me almost crazy," wrote a successful practitioner about 1840, "to think that with hundreds upon hundreds due me professionally I find the greatest difficulty in raising a
SHRYOCK RH. THE AMERICAN PHYSICIAN IN 1846 AND IN 1946A Study in Professional Contrasts. JAMA. 1947;134(5):417–424. doi:10.1001/jama.1947.02880220001001