Fractured confidence: Origins of American medical malpractice, 1790-1900
De Ville, Kenneth Allen
Hyman, Harold M.
Doctor of Philosophy
By the 1840s medical men felt they were in the midst of an unprecedented malpractice epidemic. For the first time, American patients began to sue their physicians on a wide scale. Focusing on mid-century this dissertation describes, explains, and analyzes the origins of American medical malpractice. Patients sued their physicians in the 1840s because of immediate social, medical, and technological developments. The anti-status, anti-professional sentiment of the Jacksonian period antagonized the lay public. Americans had a long tradition of home remedies and had little patience with doctors who demanded respect and privilege but offered few cures. Intra-professional competition also generated conflict and many medical men incited suits against fellow practitioners. Dramatic advances in several areas of medicine crated unrealistic expectations in both physicians and patients and blurred standards of care. However, these immediate causes would not have engendered widespread suits without fundamental cultural changes. Many Americans changed their views on divine providence in the first half of the nineteenth century. This transformation allowed individuals to seek earthly causes for their misfortunes, assign blame, and demand compensation. At the same time a variety of forces combined to make Americans dramatically more concerned about their physical well-being. Finally, the erosion of traditional community customs inhibiting litigation and a transformation in individualism allowed patients to attack their physicians in court. These cultural developments did not cause malpractice suits, but without them widespread litigation would not have been possible. Malpractice law in the early part of the nineteenth century was in flux. American judges and lawyers relied on British precedents but altered them. Many scholars have claimed that legal relationships evolve from status-based responsibilities to contract-based responsibilities. I argue that this process occurred in malpractice law but was ultimately incomplete. The patterns set in the first half of the century continued through 1900. Many of the inciting causes of the 1840s disappeared. However new technological, social, professional, and legal factors arose to take their place. Most importantly, the underlying cultural trends that made the suits possible continued to develop and provided an increasingly hospitable social environment for malpractice suits.
American history; Law; History of science