I recently ran across an edition of the Journal of the American Veterinary Medical Association from 1921 which contained a few tidbits that I found interesting concerning the distinction between scientifically trained veterinarians and their “empirical” competitors. Such documents are always entertaining for the dramatic difference in tone and cultural perspective between then and now, and for the insight into how things were different and, sometimes, how they were the same. The entire issue is available on Google books.
Merillat LA. Some notes on the comparative study of veterinary medicine in France and the United States. Journal of the American Veterinary Medical Association 1921;58(11):64-73.
The author apparently spent two years working with French veterinarians during the First World War, and he has nothing but praise for the high standards of scientific training and expertise among them, which he seems to consider better than the contemporary standards in the U.S. The passage of particular interest here is the following.
There are no veterinary laws in France as we know them in our several States. Anyone may practice, but the nongraduate is under such restrictions as to the particular disease he may treat and the drugs he may prescribe that the activities of the empirical practitioner are somewhat curbed. I say “somewhat” advisedly, because quackery is not unknown in France. In my travels in the rural districts I made a special effort to gather some information in this respect, and found that almost every community supported its handy horse and cattle doctor. The fact that all of the regular veterinarians were at the front may have intensified the situation and may have made it appear more grave than under normal peace-time conditions. I fear, however, from information thus obtained and that gathered by living almost a year in the home of a leading veterinarian of Paris, that the situation as regards empiricism is far from satisfactory to the practicing veterinarian, and I am also assured that the condition in Holland, Belgium, Germany and Italy is no better. In these countries empiricism and the patent-medicine industry thrive uncurbed. Judging from advertisements in the lay press and periodicals, it is legal to sell nostrums regardless of contents or of the effects claimed for them. Thus the veterinary practitioner, after having made this splendid preparation to practice, is little protected against cheap opposition. Then it appears that medical enormities and superstitions are practiced more among ‘the European laymen than among the more intelligent American.
The one feature in which the French veterinarian differs most from us in this respect is the way he has been able to dignify his calling and separate himself from the empiric. Here we are still classed with the lowest type of charlatan, while in France everyone knows that the veterinarian and the quack belong to two entirely different categories of individuals. Here we fight the quack to rid ourselves of an undesirable companion, while in France no complaint is entered so long as the quack does not overstep his legal domain. The French practitioner looks on cheerfully as if rather satisfied to be rid of the uncanny and gruesome jobs he might be called upon to do if the quack were not in existence. This I think explains the status of the quack situation in Continental Europe.
First, of course, we note the natural and relaxed use of the term “quack,” which today would never find its way into any official publication of the AVMA. While the haughty and paternalistic attitude of the medical mainstream in the early 20th century is deservedly a thing of the past, we have perhaps become too democratic in banning any sort of pejorative characterization of useless or nonsensical treatments. I suspect the successful anti-trust litigation pursued by chiropractors against the American medical Association in 1976 may explain this to a significant degree. In any case, “quack” is now a much rarer term, for better or worse.
We also see the beginnings of the desire for American veterinarians to be seen as scientists and professionals, which of course required emulating the kind of scientific training and methods the author so admires in his French colleagues. ” Here we are still classed with the lowest type of charlatan, while in France everyone knows that the veterinarian and the quack belong to two entirely different categories of individuals.” Certainly today, veterinarians are pretty respected and trusted as a profession, but one of the dangers of not being vigilant in maintaining a high scientific standard for our clinical practices is that of becoming indistinguishable in the public eye from “charlatans.” Embracing unproven methods and a anecdote-based epistemology is a sure way to dilute the credibility we have earned as a profession through our dedication to progress and sound science.
There’s a bit of unselfconscious ethnocentrism in the statement ” medical enormities and superstitions are practiced more among the European laymen than among the more intelligent American” that we can afford to think of as quaint since it is so obviously not an attitude that would be acceptable today.
And finally, there’s the discussion of the relationship between mainstream, scientific veterinary medicine and the alternatives, unscientific folk practices, patent medicines, and so on. On one hand, there is an obvious sense of resentment at the idea of veterinarians undergoing rigorous scientific training only to be in competition for patients with untrained lay people who are allowed to sell whatever nostrums they like regardless of their usefulness. And in contrast is the picture painted of an almost idyllic division of labor between the scientific practitioner and the quack. The situation in France is described as one in which the laws allow unscientific, or “empirical” veterinary practices so long as they are confined to domains not reserved for “real” veterinarians. What sort of restrictions are in place is not stated, but one can imagine it might be a system analogous to the veterinary practice acts of the states, in which the “practice of veterinary medicine” is limited to veterinarians, and debates then ensue as to what this encompasses.
In California, for example, performing chiropractic on animals is considered veterinary medicine, so it is required to be done by licensed chiropractors but only under the “direct supervision” of licensed veterinarians. This really only amounts to an exam by the vet within the last year and a referral for chiropractic, but occasionally I am able to catch a case in which a patient comes to our hospital for chiropractic only but I find a serious disease that requires real treatment during my “pro forma” exam of the patient, so I am able to steer them towards real therapy.
Today, the position of the AVMA and other professional veterinary lobbies seems to be that they don’t care what kind of treatment is offered or whether it has any scientific legitimacy so long as only veterinarians are allowed to offer it. This seems a total abdication of any responsibility for protecting the public from quackery and a bit of crass protectionism to me. Granted, there are political considerations since a fair number of veterinarians believe in CAM treatments, so the kind of direct condemnation of them found in this old article wouldn’t be politically possible these days. Still, the article clearly demonstrates that much the same sort of conflict that exists today, between legitimate medical practices based in science and “empirical” practices based in folklore or personal intuition, existed nearly a century ago. The more things change, the more they stay the same.