Who's a Quack?

What makes someone a quack? Is he or she actually doing something nefarious or just doing something you don't agree with?

When I first started reading medical history, I (foolishly) thought the line between a quack and a legitimate doctor were easily drawn. A quack is selling ridiculous medicines claiming to cure everything and bilking gullible people out of money, right? The real story isn't nearly so simple.

Quack or man with a different idea?

Before the 20th century, medical knowledge was very limited. Those proclaiming themselves legitimate doctors rarely knew anything more than those hawking patent medicines and traveling from town to town. Many doctors engaged in what was thought of as "quackish" behavior, including advertising and putting their name on proprietary remedies. Some quacks even trained at celebrated medical schools or had medical licenses. There really was little scientific evidence separating the two, so calling someone a "quack" became an easy way of targeting those you didn't agree with for one reason or another. So many people stood accused of quackery that the term lost any real meaning, though not its sting of opprobrium.  

Everyone felt okay excoriating quacks because all were sure they weren't one. Most of the time, those calling out quacks were those in the medical establishment who belonged to some organization or institution or who had trained in Europe. But sometimes, so-called quacks called out other quacks. What makes someone a quack? Is he or she actually doing something nefarious or just doing something you don't agree with?

When I first started reading medical history, I (foolishly) thought the line between a quack and a legitimate doctor were easily drawn. A quack is selling ridiculous medicines claiming to cure everything and bilking gullible people out of money, right? The real story isn't nearly so simple.

Before the 20th century, medical knowledge was very limited. Those proclaiming themselves legitimate doctors rarely knew anything more than those hawking patent medicines and traveling from town to town. Many doctors engaged in what was thought of as "quackish" behavior, including advertising and putting their name on proprietary remedies. Some quacks even trained at celebrated medical schools or had medical licenses. There really was little scientific evidence separating the two, so calling someone a "quack" became an easy way of targeting those you didn't agree with for one reason or another. So many people stood accused of quackery that the term lost any real meaning, though not its sting of opprobrium.  

Everyone felt okay excoriating quacks because all were sure they weren't one. Most of the time, those calling out quacks were those in the medical establishment who belonged to some organization or institution or who had trained in Europe. But sometimes, so-called quacks called out other quacks.

Many that the medical establishment labeled as quacks simply disagreed with the medical therapies that had been practiced for centuries, including blood letting. And they had good reason to do so as many of these traditional practices had hurt and even killed people rather than helped them. 

As doctors began to organize into professional organizations in the mid-19th century, one of the motivating factors was to protect people from quacks. These organizations created sharp divisions between "insiders" and "outsiders." But the ethical and moral grounds for this distinction weren't nearly so clear, despite claims to the contrary. The medical marketplace was competitive and what these organizations did do was give some doctors a competitive advantage by their membership and illusory claims at standards, although many people found these organizations elitist and, obviously, exclusionary: but that was the point. 

So maybe the better way to think of quacks, doctors, and medical history more generally is to think of the development of the profession as one with many ways to prosperity. Medical men of all kinds were competing for custom, recognition, and financial reward in his own way, each straining to seize the high moral ground in a vicious arena. Some opted for the individualism of the entrepreneur and others opted for the safety and security of the establishment. None were better than the other with the scientific evidence available at the time. Surely, there were a few people who did know that they were peddling nothing more than alcohol and herbs in a jar and wanted to make as much money as possible, but it may not be as many as is commonly portrayed in the literature of the heroic doctor.