AN ANALYSIS OF MEDICINE'S PROFESSIONAL SUCCESS
To analyze the structure of the market for medicine we must ask how the nature of the medical "commodity" determines, at least in part, the size of the market, the typical modes of exchange, the intensity and variety of competition, and the attitudes of the public authorities toward regulation. Secondly, we must ask how changes in the nature of the commodity affected the chances of success of the professional entrepreneurs who were attempting to unify and control the medical market.
The first and most obvious fact to consider is that the market for medicine is based on a vital and universal need: its potential for expansion is therefore unlimited, at least in principle. The general ideological climate of Western societies has favored the functions medicine claims to serve; the value of individual life, rooted in the Judaeo-Christian religious tradition, and individualism in general, have formed one of the strongest ideological dimensions of the post-feudal world. However, the actualization of this potential depended, for medicine, on factors other than the possible size of the market.
To begin with, the paying clientele in the nineteenth century was still quite narrow. But with more people becoming moderately affluent, and the already affluent getting richer, the perception that the practice of medicine was profitable to at least some physicians encouraged entry into the field.1 The appearance of a market in urban centers, and, particularly in America, in rural areas as well,2 set in motion the mechanisms for the standardized production of producers outlined in the preceding chapter. In England, the main problem was to tie the serious forms of training that the "lower branches" -- surgeons and apothecaries -- were organizing in their schools and teaching hospitals to a title of uniform prestige. In America, the absence of restrictive corporate monopolies, such as that of the British Royal College of Physicians, permitted an unbridled expansion of the supply of physicians. Proprietary schools, with requirements as lax as their curricula were brief, proliferated in the first two-thirds of the nineteenth century, rapidly substituting their diplomas for the license which medical societies had granted in most states since the eigh-