上部 主权专业
引言 专业主权的社会起源
1.M.I.Finley,The Ancient Economy (London:Chatto&Windus,1973),57;N.D.Jewson,"Medical Knowledge and the Patronage System in 18th Century England,"Sociology 8 (September 1974),369-385;Theodore Zeldin,France 1848-1945,vol.1,Ambition,Love and Politics (Oxford:The Clarendon Press,1973),23-42.
2.David K.Shipler,"Life for Soviet Women All Work,Little Status," New York Times,August 9,1976.
3."American versus European Medical Science,"Medical Record 4 (May 15,1869),133.
4.见 Steven Lukes，“Power and Authority，” in A History of Sociological Analysis，ed.Robert Nisbet and Tom Bottomore （New York：Basic Books，1978），642。
5.Hannah Arendt,"What is Authority?" in Between Past and Future (New York:Viking,1961),93.
6.那些遵循马克斯·韦伯传统的权威分析家们有时倾向于强调合法性而不提依赖。韦伯本人指出，下属服从权威有很多原因，包括无助和对权威所拥有的权力的恐惧。但他把合法性作为分析的组织原则，并在他的权威类型的理论模型中特别排除了其他因素，如无助感。见Max Weber，Economy and Society，ed.Guenther Roth and Claus Wittich （New York：Bedminster Press，1968），I：214。我和韦伯的不同在于，我将依赖加入模型，并强调依赖和合法性之间的张力。Peter Blau提出在依赖条件的基础上发展另一种权威类型学的想法。参见他的文章，“Critical Re-marks on Weber’s Theory of Authority，”American Political Science Review 57 （June 1963），305-316。
7.Lukes，“Power and Authority，”640.Lukes在此总结了Carl Friedrich的想法。
8.Ibid.,640.
9.在这方面，可参见Marcia Millman，The Unkindest Cut （New York：William Morrow，1977），Chap.9。
10.通过对依赖性和合法性予以同样程度的强调，我旨在唤起人们对权威关系中的矛盾心理的关注，这一点在更理想化的解释中，尤其是在对传统型或超凡魅力型权威的解释中往往被忽略。关于权威的情感层面，参见Richard Sennett，Author-ity （New York：Knopf，1980）。
11.许多关于医学专业和医患关系的研究工作只集中在治疗功能上。对医生的行政管理作用的分析可参见Deborah Stone，“Physicians as Gatekeepers：Illness Certifi-cation as a Rationing Device，”Public Policy 27 （Spring 1979），227-254。
12.Weber，Economy and Society，I：53；另见编者们对翻译Herrschaft之困难的讨论（ibid.，61-62），以及韦伯对权威统治和经济权力统治的区分（按照他们的译法）（ibid.，III：941）。
13.Lukes将我称作“文化”和“社会权威”的东西描述为“凌驾于信念的权威”和“凌驾于行为的权威”。然而，他又把凌驾于信念的权威定义为将权威概念化的三种方式之一，另外两种方式分别是惯例的权威和强加的权威。这种分类似乎很不成功。Lukes倾向于将权威的不同方面当作另一种的模型。
14.转引自Arendt，Between Past and Future，123。
15.这种三分法—集体的、认知的、道德的—不属于任何一位作者，但我认为这涵盖了有时甚至冗长的属性清单中的主要内容。对于试图定义一个专业之本质的尝试，参见Ernest Greenwood，“Attributes of a Profession，” Social Work 2 （July 1957），44-55；Morris L.Cogan，“Toward a Definition of Profession，” Harvard Educational Review 23 （Winter 1953），33-50；Talcott Parsons，“The Professions and Social Structure，” in Essays in Sociological Theory，rev.ed.（Glencoe，Ill：Free Press，1954），34-39。关于一种有影响力的发展模型，见Harold L.Wilensky，“The Pro-fessionalization of Everyone？” American Journal of Sociology 70 （September 1964），137-158。批判性的评论可参见Terence J.Johnson，Professions and Power （London：Macmillan，1972）。
16.Johnson，Professions and Power；另 见 Eliot Freidson，Profession of Medicine （New York：Dodd，Mead，1970）。
17.例如，参见Richard H.Shryock，Medicine in America：Historical Essays （Balti-more：Johns Hopkins University Press，1966），以及William G.Rothstein，American Physicians in the Nineteenth Century：From Sects to Science （Baltimore：Johns Hopkins Press，1972）。在Rosemary Stevens，American Medicine and the Public Interest （New Haven，Conn.：Yale University Press，1971）中，科学造成了专门化，而这又成为该专业内政治冲突的焦点。按照她的叙述，专业未能应对专门化的挑战—即对更加协调的组织和筹资的需求—构成了其未能满足公众利益的原因。
18.对于为获得权威的斗争及其与变动的社会组织的关系，有一个很好的叙述，参 见 Thomas L.Haskell，The Emergence of Professional Social Science （Urbana，Ill.：University of Illinois Press，1977）。
19.Eliot Freidson,Professional Dominance:The Social Structure of Medical Care (New York:Atherton,1970),117.
20.帕森斯的经典论述可参见The Social System （Glencoe，Ill.：Free Press，1951），Chap.10。
21.见Robert K.Merton and Elinor Barber，“Sociological Ambivalence，” in Socio-logical Theory，Values and Sociocultural Change，ed.Edward A.Tiryakian （New York：Free Press，1963），91-120。
22.见Freidson，Profession of Medicine，esp.Chap.7。
23.Magali Sarfatti Larson,The Rise of Professionalism (Berkeley:University of Cal-ifornia Press,1977),14.
24.如果公司在监管外部订约人时遇到严重的信息问题，并且怀疑这些订约人有不同的目的，或者是重组劳动过程的障碍，他们就会有强烈的动机将其直接纳入自己的组织。见Oliver E.Williamson，Markets and Hierarchies：Analysis and An-titrust Implications （New York：Free Press，1975），以及Stephen Marglin，“What Do Bosses Do？”Review of Radical Political Economics 6 （1974），60-112。
25.关于医生在道德行为立法中的作用，见 James C.Mohr，Abortion in Amer-ica：The Origins and Evolution of National Policy，1800-1900 （New York：Oxford University Press，1978）；James Reed，From Private Vice to Public Virtue：The Birth Control Movement and American Society Since 1930 （New York：Basic Books，1978）；Linda Gordon，Women’s Body，Women’s Right：Birth Control in America （New York：Penguin，1977）；and David Pivar，Purity Crusade：Sexual Morality and Social Control （Westport，Conn：Greenwood，1973）。
第一章 民主文化中的医学（1750—1850）
1.Oliver Wendell Holmes,"The Position and Prospects of the Medical Student,"in Currents and Counter Currents in Medical Science (Boston:Ticknor and Fields,1861),316.
2.财富方面日益不平等的证据，见James A.Henretta，The Evolution of American Society，1700-1815 （Lexington，Mass：Heath，1973），103-106，以及Edward Pessen，Riches，Class and Power Before the Civil War （Lexington，Mass：Heath，1973），31-45。Pessen试图通过证明美国存在严重而稳固的财富集中来推翻托克维尔的“平等主义论点”，但他的证据并没有回应托克维尔关于美国文化的更大更复杂的论点。
3.Alexis de Tocqueville，Democracy in America，tr.Henry Reeve （New York：Schocken，1961），II：211.关于对年龄的尊重程度下降的一系列显著证据，见David Hackett Fischer，Growing Old in America （New York：Oxford University Press，1977），77-112。关于杰克逊时期的一般政治历史，见Arthur M.Schlesinger，Jr.，The Age of Jackson （Boston：Little，Brown，1945）。
4.William Buchan，Domestic Medicine，or the Family Physician...，2nd ed.（Phila-delphia，1771），171.关于他的作品在美国的多个版本，见Francesco Guerra，Amer-ican Medical Bibliography，1639-1783 （New York：Lathrop C.Harper，1962），191。Francis Packard在1931年写道，他认为巴肯作品的使用频率比任何其他同类书籍都要高，而且将来也不会被超越。该书出版后立即获得成功，在巴肯生前销售了八万册，并被翻译成所有主要的欧洲语言（Dictionary of National Biography，III：180-181）。关于这本书的背景的详细叙述，表明William Smellie可能是共同作者，见 C.J.Lawrence，“William Buchan：Medicine Laid Open，” Medical History 19 （January 1975），20-35。John Blake对这一传统做了出色的描述，见“From Buchan to Fishbein：The Literature of Domestic Medicine，” in Medicine Without Doctors：Home Health Care in American History，ed.Guenter B.Risse，Ronald L.Numbers，and Judith Walzer Leavitt （New York：Science History Publications，1977），11-30。关于巴肯之前的医疗参考书，见 John Tennant，Every Man His Own Doctor，or the Poor Planter’s Physician （Williamsburg，1734），该书曾三次再版。巴肯之后受其影响的著 作，见 Alexander Thomson，The Family Physician：or，Domestic Medical Friend （New York，1802）；James Ewell，The Planter’s and Mariner’s Medical Companion （Baltimore，1813）；以及Blake，“From Buchan to Fishbein，”15-18。
5.Buchan,Domestic Medicine,x,vii.
6.Bernard Semmel,The Methodist Revolution (New York:Basic Books,1973).
7.John Wesley,Primitive Physic:Or an Easy and Natural Method of Curing Most Diseases (1791;reprint ed.,London:The Epworth Press,1960),6-27.
8.John C.Gunn，Domestic Medicine...（New York：Saxton，Barker and Co.，1860），141.冈恩的作品最初于1830年在诺克斯维尔出版，出了许多个版本，到第九版时，销量已超过十万册。见M.E.Pickard and R.C.Buley，The Midwest Pioneer，His Ills，Cures，and Doctors （Crawfordsville，Ind.：Banta，1945）。
9.Wesley,Primitive Physic,26;Buchan,Domestic Medicine,vii-ix.
10.Buchan,Domestic Medicine,58;Lester King,The Medical World of the Eight-eenth Century (Chicago:University of Chicago Press,1958),318-320.
11.Buchan，Domestic Medicine，328-329；另见Gunn，Domestic Medicine，383-384，他说癫痫一般在月圆之夜发作。
12.Keith Thomas,Religion and the Decline of Magic (New York:Scribner,1971).
13.Ibid.,85.
14.Charles E.Rosenberg,The Cholera Years (Chicago:University of Chicago Press,1962),esp.Chaps.2 and 7.
15.W.J.Reader,Professional Men:The Rise of the Professional Classes in Nine-teenth-Century England (New York:Basic Books,1966),16-21,31-43,48-54;S.W.F.Holloway,"Medical Education in England,1830-1858:A Sociological Analysis,"History 49 (1964),299-324.
16.N.D.Jewson，“Medical Knowledge and the Patronage System in 18th Century England，”Sociology 8 （September 1974），369-385；关于贵族庇护与专业化，见Ter-ence J.Johnson，Professions and Power （London：Macmillan，1972）。
17.Richard H.Shryock,Medicine and Society in America:1660-1860 (New York:New York University Press,1960),9-10.
18.Wyndham B.Blanton,Medicine in Virginia in the Eighteenth Century (Rich-mond,Va.:Garrett&Massie,1931),36,20,24,49.
19.J.M.Toner，Contributions to the Annals of Medical Progress in the United States，Before and During the War of Independence （Washington，1874），106.Samuel Haber讨论了“第一波专业化浪潮”，见“The Professions and Higher Education in America：A Historical View，”in Higher Education and the Labor Market，ed.Margaret Gordon （New York：McGraw-Hill，1974）。
20.David Cowan,Medicine and Health in New Jersey:A History (New York:Van Nostrand,1964),6-7.
21.John Morgan,Discourse on the Institution of Medical Schools in America (1765;reprint ed.,Baltimore:John Hopkins Press,1937),xvii;Whitfield Bell,John Morgan,Continental Doctor (Philadelphia:University of Pennsylvania Press,1965).
22.Charles Caldwell，The Autobiography of Charles Caldwell （Philadelphia：Lippin-cott，Grambo，1855），121-122；关于贵族与中产阶级的风尚，见Erving Goffman，The Presentation of Self in Everyday Life （Garden City，N.Y.：Doubleday，1959），33-34。
23.Benjamin Rush,"Observations on the Duties of a Physician,and the Methods of Improving Medicine;Accommodated to the Present State of Society and Manners in the United States," Medical Inquiries and Observations,2nd ed.(Philadelphia:J.Conrad,1805),390-391.
24.Richard H.Shryock,"Benjamin Rush from the Perspective of the Twentieth Century," Medicine in America:Historical Essays (Baltimore:Johns Hopkins Press,1966),237.
25.我对早期医学院的讨论依赖William F.Norwood，Medical Education in the United States Before the Civil War （Philadelphia：University of Pennsylvania Press，1944）。
26.William Rothstein,American Physicians of the Nineteenth Century (Baltimore:Johns Hopkins Press,1972),73.
27.Joseph Kett,The Formation of the American Medical Profession:The Role of Institutions,1780-1860 (New Haven,Conn.:Yale University Press,1968),14-30;Malcolm Sydney Beinfeld,"The Early New England Doctor:An Adaptation to a Pro-vincial Environment,"Yale Journal of Biology and Medicine 15 (December 1942),278.
28.John Duffy,A History of Public Health in New York City,1625-1866 (New York:Russell Sage Foundation,1968),65-66.
29.Rothstein，American Physicians，75-79.这里以及接下来的几段中，我借鉴了Rothstein的论点。
30.Henry B.Shafer,The American Medical Profession,1789 to 1850 (New York:Columbia University Press),221-222.
31.Reginald H.Fitz,"The Rise and Fall of the Licensed Physician in Massachusetts,1781-186o,"Transactions of the Association of American Physicians 9 (1894),1-18.
32.Daniel Drake,Practical Essays on Medical Education and the Medical Profession (1832;reprint ed.,Baltimore:Johns Hopkins Press,1952),91-93.
33.Karl Mannheim，Essays on the Sociology of Knowledge （London：Routledge and Kegan Paul，1952），200；关于早已被遗忘的那些论著中的美国民间医疗信仰的一些例子，见Bruno Gebhard，“The Interrelationship of Scientific and Folk Medicine in the United States of America since 1850，”American Folk Medicine，ed.Wayland D.Hand （Berkeley：University of California Press，1976），87-98。
34.James Still,Early Recollections and Life of Dr.James Still (1877;reprint ed.,New Brunswick,N.J.:Rutgers University Press,1973),77.
35.Pickard and Buley,The Midwest Pioneer,36.
36.Virgil J.Vogel,American Indian Medicine (Norman,Okla.:University of Okla-homa Press,1970),52-54;Otho T.Beall,Jr.and Richard H.Shryock,Cotton Mather:First Significant Figure in American Medicine (Baltimore:Johns Hopkins Press,1954),28,46;Wesley,Primitive Physic,24.
37.Robert J.T.Joy,"The Natural Bonesetters with Special Reference to the Sweet Family of Rhode Island," Bulletin of the History of Medicine 28 (September-October 1954),416-441.
38.Kett,Formation of the American Medical Profession,108.
39.Catherine M.Scholten,"'On the Importance of the Obstetrick Art':Changing Customs of Childbirth in America,1760 to 1825,"William and Mary Quarterly (Sum-mer 1977),427-445.
40.Gerda Lerner,"The Lady and the Mill Girl:Changes in the Status of Women in the Age of Jackson,"in The Majority Finds Its Past:Placing Women in History (New York:Oxford University Press,1979),15-30.
41.Mary R.Walsh，“Doctors Wanted：No Women Need Apply”（New Haven，Conn.：Yale University Press，1978），xiv，3-6，14-16.另见John B.Blake，“Women and Med-icine in Ante-Bellum America，” Bulletin of the History of Medicine 39 （March-April 965），99-123。
42.Richard H.Shryock,"Sylvester Graham and the Popular Health Movement,1830-1870,"in Medicine in America:Historical Essays,111-125.
43.Alex Berman,"The Impact of the Nineteenth-Century Botanico-Medical Move-ment in American Pharmacy and Medicine" (Ph.D.diss.,University of Wisconsin,1954).
44.Samuel Thomson,Narrative of the Life and Medical Discoveries of Samuel Thomson...to which is added An Introduction to his New Guide to Health,2nd.ed.(Boston,1825),43-44.
45.Ibid.,199-200.
46.Thomsonian Recorder 1 (December 15,1832),123.
47.Thomson,Narrative of the Life,41-42.
48.Thomsonian Recorder 1 (June 1,1833),376.
49.Thomson,Narrative of the Life,158;Ronald L.Numbers,"Do-It-Yourself the Sectarian Way,"in Risse,Numbers,and Leavitt,eds.,Medicine Without Doctors,50.
50.Thomsonian Recorder 4 (January 2,1836),106-107;(March 12,1836),187.
51.Ibid.,188.
52.Kett，Formation of the American Medical Profession，130.折衷派也有一个激进的传统。创始人伍斯特·比奇（Wooster Beach）编辑了一份杂志，他在其中谴责了“国王之术、神父之术、律师之术和医生之术”。
53.一些有限的量化证据，见Edward C.Atwater，“The Medical Profession in a New Society，Rochester，New York （1811-60），”Bulletin of the History of Medicine 47 （May-June 1973），221-235；尤其是在上层阶级中支持率下降的问题，见Rosen-berg，The Cholera Years，154-164。
54.Richard H.Shryock,The Development of Modern Medicine (New York:Knopf,1947);Michel Foucault,The Birth of the Clinic (New York:Pantheon,1973);Erwin Ackerknecht,Medicine at the Paris Hospital,1794-1848 (Baltimore:Johns Hopkins Press,1967);Owsei Temkin,"The Role of Surgery in the Rise of Modern Medical Thought,"Bulletin of the History of Medicine 25 (May-June 1951),248-259.
55.Shryock,The Development of Modern Medicine,249.
56.对这些发展的论述，见George Rosen，The Specialization of Medicine，with Particular Reference to Ophthalmology （New York：Froben Press，1944），and Stanley J.Reiser，Medicine and the Reign of Technology （Cambridge：Cambridge University Press，1978）。
57.Ackerknecht,Medicine at the Paris Hospital,Chap.13.
58.Jacob Bigelow,Modern Inquiries:Classical,Professional and Miscellaneous (Boston:Little,Brown,1867),144,230-311;Shryock,Medicine and Society in Ameri-ca,131-132;Charles E.Rosenberg,"The Therapeutic Revolution:Medicine,Meaning and Social Change in Nineteenth-Century America," in The Therapeutic Revolution:Essays in the Social History of American Medicine,ed.Morris J.Vogel and Charles E.Rosenberg (Philadelphia:University of Pennsylvania Press,1979),3-25;John Harley Warner,"The Nature-Trusting Heresy:American Physicians and the Concept of the Healing Power of Nature in the 1850's and 1860's,"Perspectives in American History 11 (1977-78),291-324.
59.Karl Mannheim,"The Democratization of Culture," in Essays on the Sociology of Culture (London:Routledge and Kegan Paul,1956),184-185.
60.1833年12月27日；转引自Thomsonian Recorder 3 （January 17，1835），127。
61.Perry Miller,The Life of the Mind in America (New York:Harcourt Brace&World,1965),102.
62.Henry Steele Commager,The Era of Reform,1830-1860 (New York:Van Nos-trand,1960),71.
63.Lee Benson，The Concept of Jacksonian Democracy （Princeton，N.J.：Princeton University Press，1961）.Benson写道，反共济会运动代表了“‘下层阶级’成员对乡村和城市‘贵族的激烈攻击’”。这种对秘密社团的攻击在医学上也有对应的表现。一个名为卡帕·拉姆达（Kappa Lamda）的不轻易吸收新会员的全国性兄弟会成立于1820年，被指控垄断了医学院和医院的高层职位。1838年，《纽约辉格报》（The New York Whig）发表了一篇揭露性文章，称其为“秘密的、黑暗的、难以捉摸的”。该俱乐部逐渐衰落，最终于1862年关闭。（Kett，Formation of the American Medical Profession，112）
64.关于商业阶层和中产阶级对法律的敌意，见Morton J.Horwitz，The Transfor-mation of American Law，1780-1860 （Cambridge：Harvard University Press，1977），140-159，以及Maxwell Bloomfield，American Lawyers in a Changing Society，1776-1876 （Cambridge：Harvard University Press，1976），44；Matthew A.Crenson，The Federal Machine：Beginnings of Bureaucracy in Jacksonian America （Baltimore：Johns Hopkins Press，1975）。
65.Schlesinger,Age of Jackson,134;James Willard Hurst,The Growth of American Law:The Law Makers (Boston:Little,Brown,1950),280.
66.转引自Harris L.Coulter，Divided Legacy：A History of the Schism in Medical吀ought （Washington，D.C.：McGrath Publishing，1973），Ⅲ：98。
67.见Rothstein，American Physicians一书的附录（332-343）。
68.转引自Coulter，Divided Legacy，95-96；另见Kett，Formation of the American Medical Profession，21-22。
第二章 市场的扩张
1.Karl Polanyi,The Great Transformation (Boston:Beacon Press,1957).
2.Judah v.M'Namee,3 Blackf.269 (Ind.,1833).
3.Wyndham B.Blanton,Medicine in Virginia in the Seventeenth Century (Rich-mond,Va.:Garrett&Massie,1930),250-259;Wilhelm Moll,"Medical Fee Bills,"Virginia Medical Monthly 93 (November 1966),657-664.
4.Pynchon v.Brewster,Quincy 224 (Mass.1776);Glover v.Le Testue,Quincy 225 (Mass.1770).
5.Ruth E.Peters,"Statutory Regulation of Lawyers'Fees in Massachusetts,New York,Pennsylvania,South Carolina,Tennessee,and Virginia from the mid-Seven-teenth Century to the mid-Nineteenth Century." (Unpublished paper,Harvard Law School,May 1975.)
6.New England Journal of Medicine and Surgery 14 （1825），50-51；转引自George Rosen，Fees and Fee Bills：Some Economic Aspects of Medical Practice in 19th-Century America （Baltimore：Johns Hopkins Press，1946），6。
7."Fees and Fee Bills,"Medical and Surgical Reporter 7 (December 7,1861),231-232.
8.Pray v.Stinson,21 Me.(8 Shep) 402;Peck v.Hutchinson,88 Iowa 320,55 N.W.511.
9.Barnes Riznik，“Medicine in New England，1790-1840.” （Unpublished manu-script，Old Sturbridge Village，1963），78-81.在确定债务时，Riznik调查了马萨诸塞州伍斯特县34名“典型”医生的遗嘱记录；26人在去世时有未清偿的债务，一半以上的人欠下了2500美元至10000美元的债务。
10.Riznik，Medicine in New England，1790-1890 （Sturbridge，Mass.：Old Stur-bridge Village，1965），24.这本小册子是作者1963年原稿的缩减版。
11.Richard H.Shryock,Medical Licensing in America,1650-1965 (Baltimore:Johns Hopkins Press,1967),31-32.
12.估算行医的必要投资很困难，因为许多开支是不确定的。许多医生从未上过医学院，或者即使上了医学院，也只上了一个学期，甚至一个学期的一部分；学徒期长短不一。因此，我给出的是费用范围，而不是单一的平均值。费用要素如下：
①三年学徒或诊室学习的费用。
②医学院两个学期（约26周）的学费和生活费。
③马和马车的费用。
④书籍、药品和设备的费用。
⑤投资于学徒期和医学教育的时间机会成本。
⑥投入资金的机会成本，假定正常的收益率为10%。
我的粗略估计如下：①每年50—100美元，乘以3；②150—300美元，取决于学校是在农村还是在城市；③200—300美元；④25—100美元；⑤150美元；⑥35—125美元。低估计值假设以最低的费用做三年学徒，没有正式的医学教育，书本和药品的支出很少（总计560美元）。高估计值按照费用较多的三年学徒期，接受过城市医学教育，图书馆和药品的开支较大来计算（总计1275美元）。显然，如果把住房费用和行医初期收入微薄的阶段养家糊口的需要计算在内，费用会更高。
学徒期和医学院费用的数据直接来自William F.Norwood，Medical Education in the United States Before the Civil War （Philadelphia：University of Pennsylvania Press，1944），393-395。对时间机会成本的估计假定一个无一技之长的20岁男性每年能够获得的收入，相比他作为学徒或待在医学院可能获得的收入，超出部分最多为50美元。
13.见Clarence H.Danhof，“Farm-making Costs and the‘Safety Valve’：1850-1860，”Journal of Political Economy 49 （June 1941），317-359。
14.U.S.Bureau of the Census,Historical Statistics of the United States,Colonial Times to 1970 (Washington,D.C.:Department of Commerce,1975),76 (1850 only);William Barlow and David O.Powell,"To Find a Stand:New England Physicians on the Western and Southern Frontier,1790-1840," Bulletin of the History of Medicine 54 (Fall 1980),386.
15.Riznik,Medicine in New England (1965),15.
16.Barlow and Powell,"To Find a Stand,"386-401.
17.严格来说，还有一个因素—由于当时交通的限制，医生的服务是“不可分的”。虽然一个贫穷的农村地区可能无法养活一名训练有素的医生，但可以想象的是，如果医生在现代汽车和公路的帮助下可以覆盖八个这样的地区，那么它就可以养活八分之一的医生。但是，由于当时的交通十分原始，社区没有机会选择一个训练有素、价格较高的医生的一小部分，而只能选择一个训练不足、价格较低的医生的全部服务。
18.Benjamin Rush,"Observations on the Duties of a Physician,and the Methods of Improving Medicine;Accommodated to the Present State of Society and Manners in the United States,"in Medical Inquiries and Observations (Philadelphia:J.Conrad,1805),390.
19.Richard Dunlop,Doctors of the American Frontier (Garden City,N.Y:Double-day,1962),129-130.
20.Boston Medical and Surgical Journal 15 (November 30,1836),273.
21.Ivan Waddington,"The Development of Medicine as a Modern Profession,"in A Social History of the Biomedical Sciences,ed.Massimo Piattelli-Palmarini (Milan:Franco Maria Ricci,forthcoming).
22.关于间接价格的一般讨论，见Gary Becker，“A Theory of the Allocation of Time，”The Economic Journal 75 （September 1965），493-517。
23.Rolla M.Tryon，Household Manufactures in the United States，1640-1860 （Chi-cago：University of Chicago Press，1917），243，11.另见Stuart Bruchey，The Roots of American Economic Growth，1607-1861 （New York：Harper&Row，1965），26-31。
24.这些数据摘录自Rosen，Fees and Fee Bills，15-16，其中有许多其他的收费表，同样可以说明问题。
25.对交通和机会成本的直接估计表明，出行成本在大约两英里处超过了基本咨询费。我对该数据的计算见“Medicine，Economy and Society in Nineteenth-Centu-ry America，”Journal of Social History 10 （Summer 1977），604-605。
26.Samuel C.Busey,Personal Reminiscences and Recollections...(Washington,D.C.,1895),157-158.
27.Thomas N.Bonner,Medicine in Chicago,1850-1950 (Madison,Wis.:American Historical Research Center,1957),200.
28.Ibid.
29.Rosen,Fees and Fee Bills,30,41.
30.O.Larsell,The Doctor in Oregon:A Medical History (Portland,Ore.:Binsford&Mort,1947),160.
31.U.S.Bureau of the Census，Historical Statistics，11-12.另见 Adna F.Weber，The Growth of Cities in the Nineteenth Century （New York：Macmillan，1899）。
32.American Medical Association,Committee on Social Insurance,Statistics Re-garding the Medical Profession (Chicago:American Medical Association,1916),38-39.
33.Victor C.Vaughan,A Doctor's Memories (Indianapolis:Bobbs-Merrill,1926),269.
34.铁路对带来远距离病人的作用，见Helen Clapesattle，The Doctors Mayo （Minneapolis：University of Minnesota Press，1941），348-353。关于医生与铁路的关系的进一步讨论，见第六章。
35.Samuel Hays，“Introduction” to Building the Organizational Society，ed.Jerry Israel （New York：Free Press，1972），9-10.关于改变运输成本的问题，见George Rogers Taylor，The Transportation Revolution （New York：Rinehart，1951），尤其是Allen Pred，Urban Growth and the Circulation of Information （Cambridge：Harvard University Press，1973）。
36.John Brooks,Telephone:The First Hundred Years (New York:Harper&Row,1976),65;Marion May Dilts,The Telephone in a Changing World (New York:Long-mans Green,1942),9.
37.Clapesattle,The Doctors Mayo,135-136.
38.Verlin C.Thomas,The Successful Physician (Philadelphia:Saunders,1923),146.
39.George Kessel，“Would Not Practice Without an Auto，”Journal of the American Medical Association（以下简称JAMA）50 （March 7，1908），814.
40.J.A.Bowling,"Testimony from the Southwest,"JAMA 46 (April 21,1906),179.
41."A Compilation of Automobile Statistics," JAMA 54 (April 9,1910),1273-1274.
42.H.A.Stalker,"The Automobile as a Physician's Vehicle,"JAMA 52 (March 7,1908),812.
43.C.A.Hibbert，“Transient Flat Life Requires Physician to Cover Wide Territo-ry，” JAMA 58 （April 6，1912），1080.对该话题的更多论述可参见Lewis Mayers and Leonard V.Harrison，The Distribution of Physicians in the United States （New York：General Education Board，1924），以及Michael L.Berger，“The Influence of the Au-tomobile on Rural Health Care，1900-1929，” Journal of the History of Medicine and the Allied Sciences 28 （October 1973），319-335.
44.Tryon,Household Manufactures,275-276,291-293.
45.Antonio Ciocco and Isidore Altman,"The Patient Load of Physicians in Private Practice,A Comparative Statistical Study of Three Areas," Public Health Reports 58 (September 3,1943),1329-1351.
46.Gerald N.Grob，Mental Institutions in America：Social Policy to 1875 （New York：Free Press，1973）.有关这些发展，另见David J.Rothman，The Discovery of the Asylum：Social Order and Disorder in the New Republic （Boston：Little，Brown，1971），以 及 Andrew T，Scull.Decarceration：Community Treatment and the Deviant—A Radical View （Englewood Cliffs，N.J.：Prentice-Hall，1977），15-40。
47.Michel Foucault,Madness and Civilization:A History of Insanity in the Age of Reason (London:Tavistock Publications,1967).
48.Grob，Mental Institutions in America，135.Grob援引了Samuel Woodward的抱怨，说他的收入大幅减少，因为他声称自己在私人诊所的年薪是5000美元。但如果他确实赚了这么多，那也是极不寻常的；按照当时的行业标准，这些是高薪职位。
49.监护人员在1844年成立了一个独立的专业协会，后来又回绝了美国医学会要求建立联系的尝试。见Grob，Mental Institutions in America，147-150。
50.关于1873年，见J.M.Toner，“Statistics of Regular Medical Associations and Hospitals of the United States，”Transactions of the American Medical Association 24 （1873），314-333；关于之后的情况，见U.S.Bureau of the Census，Historical Statis-tics，78；这一时期各州的调查报告，见“Twenty-five Years’ Growth of the Hospital Field，”National Hospital Record 7 （September 1903），23-27。
51.U.S.Bureau of the Census，Historical Statistics，41.关于家庭结构，见William J.Goode，World Revolution and Family Patterns （New York：Free Press，1963），70-76；Frank Furstenberg，“Industrialization and the American Family：A Look Backward，”American Sociological Review 31 （June 1966），326-337；and Edward Shorter，The Making of the Modern Family （New York：Basic Books，1975）。
52.Bernard Farber,Guardians of Virtue:Salem Families in 1800 (New York:Basic Books,1972),46;Richard Sennett,Families Against the City:Middle Class Homes of Industrial Chicago,1872-1890 (Cambridge:Harvard University Press,1970),79.
53.Henry Hurd,"The Hospital as a Factor in Modern Society,"The Modern Hospi-tal 1 (September 1913),33.
54.Morris Vogel，“Boston’s Hospitals，1870-1930：A Social History，”（Ph.D.diss.，University of Chicago，1974），188-199.另见John Modell and Tamara K.Hareven，“Urbanization and the Malleable Household：An Examination of Boarding and Lodg-ing in American Families，” Journal of Marriage and the Family 35 （1973），467-479。Modell和Hareven指出，1790年至1970年间，一人之家在总家庭中的比例从3.7%上升到20%。
关于英国的情况，参见Brian Abel-Smith，The Hospitals，1800-1948：A Study in Social Administration in England and Wales （Cambridge：Harvard University Press，1967），141。
55.Talcott Parsons and Renée Fox,"Illness,Therapy and the Modern Urban Fami-ly,"Journal of Social Issues 8 (1952),31-44.
56.New York Times,December 31,1900.
57.转引自Scull，Decarceration，15。
58.Dr.Henry B.Hemenway,"Discussion," Bulletin of the American Academy of Medicine 10 (1909),635.
59.S.W.F.Holloway,"Medical Education in England,1830-1858:A Sociological Analysis,"History 49 (1964),299-324.
60.Ibid.
第三章 专业权威的巩固（1850—1930）
1.Samuel Gross,The Autobiography of Samuel Gross (Philadelphia:Saunders,1893),I:93.
2.Arpad Gerster,Recollections of a New York Surgeon (New York:Paul B.Hoeber,1917),162.
3.J.Marion Sims,The Story of My Life (New York:Appleton,1889),116.
4.Anne R.Burr,Weir Mitchell:His Life and Letters (New York:Duffield and Com-pany,1929),43.
5.[Worthington Hooker]，“Report of the Committee on Medical Education，”Transactions of the American Medical Association 4 （1851），420-423.后来在1882年发表的一项研究涵盖了58所学院和自1825年以来毕业的39054名校友，给出了大致相似的比例：9.2%的人从事医学，21%的人从事神学，19.7%的人从事法律。截至1880年，医学院的学生拥有学士学位的人数少于法学院或神学院的学生。见Charles McIntyre，“The Percentage of College-Bred Men in the Medical Profession，”Medical Record 22 （December 16，1882），681。
6.Editorial,"American vs.European Medical Science,"Medical Record 4 (May 15,1869),133.
7.Fred B.Rogers,"General John Beatty (1749-1826):Patriot and Physician,"Bul-letin of the History of Medicine 32 (January-February 1958),39.
8.关于在国会任职的医生名单，见“Appendix，”in James G.Burrow，AMA：Voice of American Medicine （Baltimore：Johns Hopkins Press，1963），405-407；另见“Doc-tors in Government，”JAMA 163 （February 2，1957），361-364。
9.“The Pecuniary Condition of the Medical Profession in the United States，”Bos-ton Medical and Surgical Journal 4 （February 15，1831），9，引用了《基督教考官》（Christian Examiner）上的一篇文章。
10.Sims,Story of My Life,192.
11.Edward C.Atwater,"The Medical Profession in a New Society,Rochester,New York (1811-60),"Bulletin of the History of Medicine 47 (May-June 1973),229.
12.[Lemuel Shattuck,N.P.Banks,Jr.,and Jehiel Abbott],Report of a General Plan for the Promotion of Public and Personal Health (Boston:Dutton and Wentworth,1850),59.
13.Edgar Martin，The Standard of Living in 1860 （Chicago：University of Chicago Press，1942），394.1853年11月8日的《纽约时报》上刊登了一个“中等生活水平”的工薪族四口之家的预算，总支出为600美元。Martin说，律师和医生“在乡村地区似乎每年能获得1000美元左右的收入，在城市则为2000美元”，但没有提供来源或文献。这些数字似乎很高，至少对医生来说是这样。
14.U.S.Bureau of the Census,Historical Statistics of the United States,Colonial Times to 1970 (Washington,D.C.:U.S.Department of Commerce,1975),165.
15.Chester Wright，转引自Martin，Standard of Living in 1860，394。
16.M.E.Pickard and R.C.Buley,The Midwest Pioneer,His Ills,Cures,and Doctors (Crawfordsville,Ind.:Banta,1945),161.
17."A Legion of Leeches," Detroit Review of Medicine and Pharmacy 6 (January 1871),19.
18.B.Joy Jeffries,"Reestablishment of the Medical Profession [Part 2]," Boston Medical and Surgical Journal 118 (June 21,1888),613.
19.C.R.Mabee，The Physician’s Business and Financial Adviser，5th ed.（Cleveland：Continental Publishing，1901），170.Mabee在第185页引用了一份无法核实的纽约杂志，据说医生的平均收入不超过900美元。
20.D.W.Cathell,The Physician Himself (Philadelphia:F.A.Davis),1890 ed.,276;1905 ed.,379.
21.Editorial,"Does It Pay to Be a Doctor?"JAMA 42 (January 23,1904),247.
22.U.S.Bureau of the Census,Historical Statistics,168.
23.G.F.Shears，“Making a Choice，” Cosmopolitan 34 （April 1903），654.转 引 自Gerald E.Markowitz and David Karl Rosner，“Doctors in Crisis：A Study of the Use of Medical Education Reform to Establish Modern Professional Elitism in Medicine，”American Quarterly 25 （March 1973），83-107。
24.Cathell,Physician Himself (1890),80,83.
25.Ibid.(1882),34.
26.这个例子是Sartre的。见Erving Goffman，The Presentation of Self in Everyday Life （Garden City，N.Y.：Doubleday，1959），33。
27.Cathell,Physician Himself (1890),94.
28.Ibid.,97.
29.Ibid.,143.
30.Ibid.,242.
31.Gerster,Recollections,163.
32.Jeffries，“Reestablishment of the Medical Profession [Part 2]，”614；另见idem，“Reestablishment of the Medical Profession [Part I]，” Boston Medical and Surgical Journal 1118 （June 14，1888），589-593。
33.Cathell,Physician Himself (1890),148.
34.Charles Rosenberg,"The Practice of Medicine in New York A Century Ago,"Bulletin of the History of Medicine 41 (May-June 1967),225-228.
35.John Shaw Billings，Selected Papers （[Chicago]：Medical Library Association，1965），19l；William Rothstein，American Physicians in the Nineteenth Century （Balti-more：Johns Hopkins Press，1972），提出了这一论点。
36.W.J.Reader,Professional Men:The Rise of the Professional Classes in Nine-teenth-Century England (New York:Basic Books,1967),47.
37.Billings,Selected Papers,191.
38.Nathan Smith Davis,History of the American Medical Association,from Its Or-ganization to January,1855 (Philadelphia,1855),37-38.
39.S.Oakley Vanderpoel,in Alfred C.Post et al.,An Ethical Symposium (New York:Putnam,1883),37-38.
40.James Howard Means,The Association of American Physicians (New York:Blakiston,1961),10.
41.Mancur Olson，The Logic of Collective Action （Cambridge：Harvard University Press，1965）.我在这里放弃了“公共利益”一词，因为它只会造成混淆，尽管严格意义上是正确的。
42.George W.Corner,Two Centuries of Medicine:A History of the School of Med-icine,University of Pennsylvania (Philadelphia:Lippincott,1965),32-34;Cecil K.Drinker,Not So Long Ago (New York:Oxford University Press,1937),150-151.
43.Rush Van Dyke，Valedictory Address to Graduates of Philadelphia College of Medicine，1849 （Philadelphia，1849），9-10；转引自Henry B.Shafer，The American Medical Profession，1789 to 1850 （New York：Columbia University Press，1937），153-154。
44.Harvey Wickes Felter,History of the Eclectic Medical Institute (Cincinnati:Pub-lished for the Alumni Association,1902),39-42.
45.Chauncey D.Leake,ed.,Percival's Medical Ethics (Baltimore:Williams,1927),Appendix III,225-235.
46.Cathell,Physician Himself (1890),184-186.
47.Max Weber，Economy and Society，tr.Guenther Roth and Claus Wittich （New York：Bedminster Press，1968），I：56；III：164.对于相反阐释的评论和分析，见Peter Berger，“The Sociological Study of Sectarianism，” Social Research 21 （1954），467-485。
48.Sidney E.Ahlstrom，A Religious History of the American People （New Haven：Yale University Press，1972），472-487，1019-1029.另见David Edwin Harrell，Jr.，All Things Are Possible：The Healing and Charismatic Revivals in America （Bloomington，Ind.：Indiana University Press，1975）。
49.Richard Niebuhr,The Social Sources of Denominationalism (New York:Holt,1929).
50.Bryan R.Wilson,Sects and Society (Berkeley:University of California Press,1961),354.
51.关于一位支持者对顺势疗法学说的详细阐述，见Harris Coulter，Divided Leg-acy：A History of the Schism in Medical Thought （Washington，D.C.：McGrath Pub-lishing Co.，1973），esp.Chap.1。
52.Martin Kaufman，Homeopathy in America：The Rise and Fall of a Medical Here-sy （Baltimore：Johns Hopkins Press，1971）；Coulter，Divided Legacy，101-104.Coulter呈现的一些证据表明，顺势疗法者的收入比普通医生高。
53.Joseph Kett,The Formation of the American Medical Profession (New Haven,Conn.:Yale University Press,1968).
54.Coulter，Divided Legacy，204.最初发表于1842年的那篇经典的批评文章，见Oliver Wendell Holmes，“Homeopathy and its Kindred Delusions，”in Medical Essays，1842-1882 （Boston：Houghton-Mifflin，1892）。
55.Kaufman,Homeopathy in America,63-92.
56.Kett,Formation of the American Medical Profession,185-86;J.M.Toner,"Tab-ulated Statistics of the Medical Profession of the United States," Transactions of the American Medical Association 22(1871),155;JAMA 79 (August 23,1913),600.
57.H.R.Hopkins,in Post et al.,Ethical Symposium,184.
58.Donald E.Konold,A History of American Medical Ethics,1847-1912 (Madison,Wis.:State Historical Society of Wisconsin,1962),26.
59.New York Times,May 28,1873.
60.Kaufman,Homeopathy in America,93-109.
61.Coulter,Divided Legacy,328-391.
62.William Ely in Post et al.,Ethical Symposium,12.
63.Rothstein,American Physicians in the Nineteenth Century,304.
64.Lawrence M.Friedman,"Freedom of Contract and Occupational Licensing,1890-1910:a Legal and Social Study," California Law Review 53 (May 1965),494-497.
65.Ibid.,500-512.
66.Bonner,Medicine in Chicago,208.
67.有11个州只要求进行一场考试；10个州在通过考试和提交有效的文凭之间提供选择。“Laws Regulating the Practice of Medicine in the Various States and Ter-ritories of the United States，”JAMA 37 （November 16，1901），1318，这篇文章提供了有各州法律的表格。
68.Harold W.Eickhoff,"The Organization and Regulation of Medicine in Mis-souri,1883-190l." (Ph.D.diss.,University of Missouri,1964),36-40,82,116-122,145-148,274-276.
69.Perry H.Millard,"The Propriety and Necessity of State Regulation of Medical Practice,"JAMA 9 (October 15,1887),491.
70.T.A.Bland,"The Medical Trust,"The Arena 19 (1898),520-526;B.O.Flower,"Restrictive Medical Legislation and the Public Weal,"ibid.,781-809;Herbert Spen-cer,Social Statics (London:John Chapman,1851),372-395;Henry James,ed.,Letters of William James (Boston:Atlantic Monthly Press,1920),II:67.
71.129 U.S.114.另 见 Frances P.DeLancy，The Licensing of Professions in West Virginia （Chicago：Foundation Press，1938）。
72.170 U.S.189;Friedman,"Freedom of Contract and Occupational Licensing,"493ff.
73.John A.Wyeth,"President's Address,"JAMA 38 (June 14,1902),1555.
74.Rothstein,American Physicians of the Nineteenth Century,323.
75."Medical Education in the United States," JAMA 79 (August 19,1922),629,632-633.
76.A.T.Still,The Autobiography of A.T.Still (Kirksville,Mo.:self-published,1897),286-287;Eickhoff,"The Organization and Regulation of Medicine in Mis-souri,"185-200.
77.Edwin Franden Dakin,Mrs.Eddy (New York:Grosset and Dunlap,1929),115.
78.“The Organization of the Medical Profession，” JAMA 38 （January 1，1902），13.另见ibid.（January 25，1902），250-251；ibid.（February 1，1902），324-325；ibid.（February 8，1902），400；ibid.（February 15，1902），460-461；ibid.（February 22，1902），514-515；ibid.（March 1，1902），584-585。
79."Preliminary Report of the Committee on Organization," JAMA 36 (May 25,190l),1450.
80.对各州的分析，见J.N.McCormack，“An Epitome of the History of Medical Organization in the United States，”JAMA 44 （April 15，1905），1213-1218.
81.Burrow,AMA,49-51.
82.Richard Hofstadter,The Age of Reform (New York:Random House,1955),148-164.
83.F.H.Todd,"Organization,"JAMA 39 (October 25,1902),1061.
84.关于医疗事故诉讼的增加，见Andrew A.Sandor，“The History of Profes-sional Liability Suits in the United States，” JAMA 163 （February 9，1957），459-466。Sandor的数据只提到了上诉判决，因此很不确凿；但是，医生对诉讼关注度的增加似乎证明了他的观点。关于地方性法规，见Gramm v.Boener，56 Ind.497 （1877）以及Small v.Howard，128 Mass.131，35 Am.Rep.363 （1880）。关于医疗事故辩护基金，见“Organized Medical Defense，”JAMA 38 （January 4，1902），37，43；“The Var-ied Functions Possible in the County Medical Society，” JAMA 44 （March 18，1905），881-882；Walter L.Burrage，A History of the Massachusetts Medical Society，1787-1922 （Norwood，Mass：private printing，1923），452；Oliver Garceau，The Political Life of the American Medical Association （Cambridge：Harvard University Press，1941），103-104。
85.U.S.Bureau of the Census,Historical Statistics,76.
86.Lawrence Veysey,The Emergence of the American University (Chicago:Univer-sity of Chicago Press,1965);Joseph Ben-David and Awraham Zloczower,"Universities and Academic Systems in Modern Societies,"Archives of European Sociology 3 (962),71-75.
87.Annual Report of the President of Harvard College,1869-70,18;Annual Report of the President of Harvard College,1871-72,25-26.(https://www.daowen.com)
88.Frederick C.Shattuck and J.Lewis Bremer,"The Medical School,1869-1929,"in The Development of Harvard University,ed.Samuel Eliot Morison (Cambridge:Harvard University Press,1930),556-557;Hugh Hawkins,Between Harvard and America:The Educational Leadership of Charles W.Eliot (New York:Oxford Univer-sity Press,1972),60-61;Henry Bigelow,Medical Education in America (Cambridge:Harvard University Press,1871).
89.Annual Report of the President of Harvard College,1870-71,20.
90.Annual Report of the President of Harvard College,1879-1880,25,33-34;Shat-tuck and Bremer,"The Medical School,"560-561.
91.Corner,Two Centuries,142-151.
92.Martin Kaufman,American Medical Education:The Formative Years,1765-1910 (Westport,Conn.:Greenwood Press,1976),155-156.
93.Alan M.Chesney,The Johns Hopkins Hospital and the Johns Hopkins University School of Medicine,vol.I,Early Years,1867-1893 (Baltimore:Johns Hopkins Press,1943).
94.Simon Flexner and James Thomas Flexner,William Henry Welch and the Hero-ic Age of American Medicine (New York:Dover,1966);Donald Fleming,William H.Welch and the Rise of Modern Medicine (Boston:Little,Brown,1954).
95.见Markowitz and Rosner，“Doctors in Crisis，”95。
96.Mary R.Walsh,"Doctors Wanted:No Women Need Apply" (New Haven,Conn.:Yale University Press,1977),176-193.
97.Arthur Dean Bevan,"Cooperation in Medical Education and Medical Service,"JAMA 90 (April 14,1928),1173-1177.
98.见 Table I，“Statistics of Medical Colleges in the United States and Canada”，收录于美国医学会关于医学教育的年度报告，JAMA 37 （1901），758-759；39 （1902），568-569；41 （1903），452-453；43 （1904），504-505；45 （1905），566-567；47 （1906） 592-593；49 （1907），588-589；51 （1908），586-587；53 （1909），546-549。
99.Abraham Flexner,Medical Education in the United States and Canada,Bulletin no.4 (New York:Carnegie Foundation for the Advancement of Teaching,1910).
100.Ibid.,11.
101."Medical Education—Progress of Twenty-Two Years," JAMA 79 (August 19,1922),660-661;"State Requirements of Preliminary Education," JAMA 79 (August 19,1922),658.
102.Ernest V.Hollis，Philanthropic Foundations and Higher Education （New York：Columbia University Press，1938），211-217.Hollis估计，到1936年，各基金会对医学教育和研究的总投入为1.54亿美元。关于通才教育委员会的作用，见Daniel Fox，“Abraham Flexner’s Unpublished Report：Foundations and Medical Education，1909-1928，”Bulletin of the History of Medicine 54 （Winter 1980），475-496。
103.一些马克思主义者进一步认为，由于科学医学的意识形态功能，资本家对科学医学的成功有着显著的兴趣。见Howard Berliner，“A Larger Perspective on the Flexner Report，” International Journal of Health Services （1975），573-592，以及E.Richard Brown，Rockefeller Medicine Men：Medical Care and Capitalism in America （Berkeley：University of California Press，1978）。Berliner 在他“更广的视角”中首先指出，科学医学将身体视为一台机器，这一构想与其他资本主义观念听上去极其相似。然后，他将科学医学与细菌学革命之前的“对抗疗法”如放血，联系起来，最后提出，资本主义在这种医学的胜利中有利可图，因为它发挥了合法化和资本积累的不可或缺的功能。遗憾的是，许多人认为这是马克思主义，更遗憾的是，许多马克思主义者认真对待它。关于Brown著作的更多内容，见第六章。
104.Corner，Two Centuries，187.对一个临床教授来说，一个职位的平均价值“可能是”10000美元，“原因是它带来了业务”。Ross V.Patterson to Abraham Flexner，March 31，1909 （Flexner papers，Box 19，Library of Congress）.
105.Fleming,William H.Welch,177-178.
106.Hollis，Philanthropic Foundations，211-212.Brown，Rockefeller Medicine Men，将全职要求视为法人资本主义在医疗保健领域的“进入楔子”；不那么情绪化的讨论，见Fox，“Flexner’s Unpublished Report，”484-487。
107.Joseph C.Aub and Ruth K.Hapgood,Pioneer in Modern Medicine:David Linn Edsall of Harvard (n.p.:Harvard Medical Alumni Association,1970).
108.Fox,"Flexner's Unpublished Report,"489-490.
109.Rosemary Stevens,American Medicine and the Public Interest (New Haven,Conn.:Yale University Press,1971),116-120;J.A.Curran,"Internships and Resi-dencies:Historical Background and Current Trends," Journal of Medical Education 34 (September 1959),878-889.
110.Walsh,"Doctors Wanted:No Women Need Apply," 178-267;Carol Lopate,Women in Medicine (Baltimore:Johns Hopkins Press,1968);Flexner,Medical Educa-tion,178-179.
111.Numa P.G.Adam,"Sources of Supply of Negro Health Personnel:Section A:Physicians,"Journal of Negro Education 6 (July 1937),468.
112.Collier's Weekly,June 11,1910 (Flexner papers,Box 19,Library of Congress).113.Flexner,Medical Education,16,45-46.
114.Raymond Pearl,"Distribution of Physicians in the U.S.," JAMA 84 (April 4,1925),1024-1027.
115.American Medical Association,Committee on Social Insurance,Statistics Re-garding the Medical Profession (Chicago:American Medical Association,1916),38-39.
116.Samuel Hopkins Adams,"The Vanishing Country Doctor," with sequels,Ladies'Home Journal 40 (October 1923),23ff;ibid.(November 1923),26ff;ibid.41 (February 1924),31ff;William Allen Pusey,"The Disappearance of Doctors from Small Towns,"JAMA 88 (February 12,1927),505-506.
117.Lewis Mayers and Leonard V.Harrison,The Distribution of Physicians in the United States (New York:General Education Board,1924),47-48.
118.U.S.Bureau of the Census,Historical Statistics,76.
119.Louis S.Reed,The Healing Cults,A Study of Sectarian Medical Practice:Its Ex-tent,Causes,and Control (Chicago:University of Chicago Press,1932),1-4,24-26,50-54.
120.Selwyn D.Collins,"Frequency and Volume of Doctors'Calls Among Males and Females in 9,000 Families,Based on Nation-Wide Periodic Canvasses,1928-31,"Public Health Reports 55 (November 1,1940),1987-1988.
121.James Harvey Young,The Toadstool Millionaires (Princeton,N.J.:Princeton University Press,1961),167-170.
122.Sarah Stage,Female Complaints:Lydia Pinkham and the Business of Women's Medicine (New York:Norton,1979),89-90,105-106,130-131.
123.A[braham] Jacobi，“Proprietary Medicines，” JAMA 97 （September 29，1906），978.另见Richard C.Cabot，“The Physician’s Responsibility for the Nostrum Evil，”ibid.，982。
124.“Secret Nostrums and the Journal，”JAMA 34 （June 2，1900），1420.另见“Rela-tion of Pharmacy to the Medical Profession，”ibid.34 （April 21，1900），986-988；ibid.34 （April 28，1900），1049-1051；and sequels。
125.Edward Bok,"The Patent Medicine Curse," Ladies'Home Journal 21 (May 1904,18).
126.Samuel Hopkins Adams,The Great American Fraud (n.p.:Collier&Son,1905 and 1906),39.
127.Edward Bok,"Pictures that Tell Their Own Stories,"Ladies'Home Journal 22 (September 1905),15;Stage,Female Complaints,140,160-162.
128.Adams,Great American Fraud,60.
129.Ibid.,84.
130.Austin Smith,"The Council on Pharmacy and Chemistry,"in Morris Fishbein,A History of the American Medical Association,1847 to 1947 (Philadelphia:Saunders,1947),86.
131.Editorial,"A Great Paper Attempts the Impossible,"JAMA 58 (April 13,1912),118.
132.Jacob A.Goldberg,"The Advertising Physician," Hygeia 1 (August 1923),308-311.
133.Stage,Female Complaints,198.
134.R.V.Pierce,The People's Common Sense Medical Adviser in Plain English;or,Medicine Simplified,99th ed.[?] (Buffalo,N.Y.:World's Dispensary Medical Associa-tion,1918),379.
135.Smith,"Council on Pharmacy and Chemistry,"871.
136.Peter Temin,Taking Your Medicine:Drug Regulation in the United States (Cambridge:Harvard University Press,1979),Chap.2.
137.这段引文和以下其他引文都来自Rima D.Apple，“‘To Be Used Only Un-der the Direction of a Physician’：Commercial Infant Feeding and Medical Practice，1870-1940，”Bulletin of the History of Medicine 54 （Fall 1980），402-417。
138.Ibid.,412.
139.Erwin H.Ackerknecht,Therapeutics from the Primitives to the 20th Century (New York:Hafner Press,1973),128-136.
140.Rothstein,American Physicians of the Nineteenth Century,266.
141.Irving Fisher,Report on National Vitality:Its Wastes and Conservation,Bulle-tin no.30 of the Committee of One Hundred on National Health (Washington,D.C.:U.S.Government Printing Office,1909),7,66.
142.JAMA 60 (June 21,1913),1996.
143.Stanley J.Reiser,Medicine and the Reign of Technology (Cambridge:Cam-bridge University Press,1978),43,38.
144.Ibid.,68.
145.Shryock,Development of Modern Medicine;H.J.Parish,A History of Immuni-zation (Edinburgh:E.&S.Livingstone,1965).
146.John B.McKinlay and Sonja M.McKinlay，“The Questionable Contribution of Medical Measures to the Decline of Mortality in the United States，” Health and Society 55 （Summer 1977），405-428.在“医疗干预（化疗或预防）年份”列表中，McKinlays列出了1930年的白喉（类毒素）和1948年的伤寒（氯霉素）。他们写道，白喉和伤寒“在医疗干预之后，其死亡率的下降可以忽略不计”（421）。难道他们没有听说过白喉抗毒素或伤寒疫苗吗？
147.关于破伤风和白喉的证据，见Parish，History of Immunization，131，166-169；另见Edgar Sydenstricker，Health and Environment （New York：McGraw-Hill，1933）；C.-E.A.Winslow，Health Survey of New Haven （New Haven：[Community Chest] 1928），374-381。
148.John Lovett Morse,"Recollections and Reflections on Forty-Five Years of Ar-tificial Infant Feeding,"Journal of Pediatrics 7 (September 1935),324.
149.Thomas E.Cone,Jr.,History of American Pediatrics (Boston:Little,Brown,1979),138.
150."Discussion,"Minnesota Medicine 6 (July 1923),445.
151.这些言论见于Victor C.Vaughan，“The Promotion of Periodic Health Exami-nations by the Medical Profession，”AMA Bulletin 16 （March 15，1923），296.Vaughan在他的自传中对这些经历做了详细的描述，A Doctor’s Memories （Indianapolis：Bobbs-Merrill，1926），375-379，397-399。
152.Christopher Lasch，The Culture of Narcissism （New York：Norton，1979），228-229，以及idem，“Life in the Therapeutic State，”The New York Review of Books，June 12，1980，24-32。
153.R.G.Leland,"Income from Medical Practice," JAMA 96 (May 16,1931),1687-1691;U.S.Bureau of the Census,Historical Statistics,176;Maurice Leven,In-comes of Physicians (Chicago:University of Chicago Press,1932),20,105-106;Milton Friedman and Simon Kuznets,Income from Independent Professional Practice (New York:National Bureau of Economic Research,1945),67-68,84.
154.Friedman and Kuznets,Income from Independent Professional Practice,14-15.155.George S.Counts,"The Social Status of Occupations:A Problem in Vocational Guidance,"The School Review 33 (January 1925),16-27;George W.Hartmann,"The Prestige of Occupations,A Comparison of Educational Occupations and Others,"Personnel Journal 12 (October 1934),144-152.
156.Rothstein，American Physicians in the Nineteenth Century，他主张以下的观点，即明显有效的疗法解释了医学“从宗派到科学”的转变，但也提供了许多有说服力的证据来反对他自己的立场。治疗方法的创新似乎太少、太晚，没有办法解释宗派的衰落。Rothstein 强调，直到19世纪90年代，行医者仍漠视和抵制细菌学；然后是白喉抗毒素出现了，很快，这个专业就转变了。这个说法很难让人接受。尽管Rothstein 的书对医学会和医学宗派的分析具有启发性，是非常宝贵的，但他对转变的分析没有注意到社会中更广泛的变化。
对于第二种观点，见Jeffrey L.Berlant，Profession and Monopoly：A Study of Medicine in the United States and Great Britain （Berkeley：University of California Press，1975）。
157.Karl Polanyi,The Great Transformation (Boston:Beacon Press,1957),152.
第四章 医院的重构
1.关于美国和其他地方的医生、病人、医院之间关系的比较，见Milton I.Ro-emer and Jay W.Freidman，Doctors in Hospitals （Baltimore：John Hopkins Press，1971），49-61。关于更多对本章极有用的一般性比较研究，见William Glaser，“American and Foreign Hospitals：Some Sociological Comparisons，”in The Hospital in Modern Society，ed.Eliot Freidson （New York：Free Press，1963），37-72，以 及Glaser被忽视的卓著，Social Settings and Medical Organization：A Cross-National Study of the Hospital （New York：Atherton，1970）。关于截至1885年的跨国比较而言，见Lewis S.Pilcher，“On the Organization of the Surgical Staff in General Hospi-tals，”Annals of Surgery 2 （1885），389-408。
2.本章的分析处理的是普通医院，而不是精神病院，除非在二者的对照有启发意义的地方。
这一章的形式与1976年至1977年间我所撰写和流布的内容几乎相同，并构成了我1977年提交的哈佛大学博士论文的一部分。从那时起，出现了一些关于医院的优秀新作。尤其参见新著David Rosner，A Once Charitable Enterprise （Cam-bridge：Cambridge University Press，forthcoming），以及Morris Vogel，The Invention of the Modern Hospital：Boston，1870-1990 （Chicago：University of Chicago Press，1980）。我看到了David Rosner的部分写作草稿和Morris Vogel论文的未发表版本；因此只引用了这些。另见 Charles E.Rosenberg，“Inward Vision and Outward Glance：The Shaping of the American Hospital，1880-1914，” in Social History and Social Policy，ed.David J.Rothman and Stanton Wheeler （New York：Academic Press，1981）。我注意到这本著作时已经太晚了，以至于在此未能使用。
3.组织的历史社会学在很大程度上仍是一个未经发展的学科，或者至少是未经整合的学科。关于法人企业结构的变化，见Alfred Chandler，The Visible Hand （Cambridge：Harvard University Press，1977）。关于大学的历史，见Lawrence Vey-sey，The Emergence of the American University （Chicago：University of Chicago Press，1965）。
4.“共同体的”和“相关的”是帕森斯对韦伯术语Vergemeinschaftung和Verge-sellschaftung的翻译，这对术语又来自Tonnies。见Max Weber，The Theory of Social and Economic Organization （New York：Oxford University Press，1947），136-139。
5.John P.Davis,Corporations,ed.Abram Chayes (1905;reprint ed.,New York:Capricorn Press,1961),xix.
6.George Rosen，“The Hospital：Historical Sociology of a Community Institution，”in Freidson ed.，The Hospital in Modern Society，10.另见Rotha Mary Clay，The Medi-eval Hospitals of England （London：Methuen，1909），143-157。
7.David J.Rothman，The Discovery of the Asylum （Boston：Little，Brown，1971），42-43.“衍生的”和“设计的”这两个词出自John Thompson and Grace Goldin，The Hospital：A Social and Architectural History （New Haven，Conn：Yale University Press，1973）。
8.Henry Sigerist,"An Outline of the Development of the Hospital,"Bulletin of the History of Medicine 4 (July 1936),573-581.
9.Rothman，Discovery of the Asylum，3-29，180-205；关于支持从家庭救济转向救济院的论点，见 Philadelphia Board of Charities，“Report of the Committee...”（1827），esp.23-30；[Josiah Quincy]，“Report of the Committee on the Pauper Laws...”（182），9；and John Yates，“Report of the Secretary of State…”（1824），939-963；再版于The Almshouse Experience：Collected Reports （New York：Arno Press，1971）。关于后来的改革，见Robert H.Bremner，From the Depths：The Discovery of Poverty in the United States （New York：New York University Press，1956），46-57。关于从救济院到城市医院的转变，见 Robert John Hunter，The Origin of the Philadelphia General Hospital，Blockley Division （Philadelphia：Rittenhouse Press，1955）；Douglas Carroll，“History of the Baltimore City Hospitals，”Maryland State Medical Journal 15 （January 1966），87-90；（February 1966），46-48；（March 1966），75-78；（April 1966），65-68；（（May 1966），83-85；（June 1966），101-103；（July 1966），17-19；（August 1966），69-71；（September 1966），105-108；（October 1966），89-96；（November 1966），103-111。
Rothman 将救济院与监狱和精神病院联系在一起，并认为其发展的动力在于杰克逊时代的改革者对改造依附者、罪犯和精神病患者的热忱。但正如他自己所承认的那样，转向救济院救济的目的同样是为了通过禁绝穷人的家庭救济来对贫困产生威慑力。赞许救济院的报告显然关注的是它们对救济院外的穷人的影响，而不是对救济院内的穷人的影响。在取消家庭救济的同时，各州也在迫使移民社区为穷人和病人建立自己的机构。惩罚穷人和限制公共支出方面的利益似乎足以解释救济院的流行，因此，Rothman强调康复是发展救济院的动机，似乎把他的论点延伸得太远了。
10.Leonard K.Eaton,New England Hospitals,I790-1837 (Ann Arbor:University of Michigan Press,1957).
11.Benjamin Rush,Medical Inquiries and Observations,2d ed.(Philadelphia:J.Conrad,1805),I:276;John E.Erichsen,On Hospitalism and the Causes of Death After Operations (London:Longmans,1874);James Y.Simpson,"Our Existing System of Hospitalism and Its Effects," Edinburgh Medical Journal 15 (December 1869),523-532;W.Gill Wylie,Hospitals:Their History,Organization,and Construction (New York:Appleton,1877),57-66.
12.Nathaniel I.Bowditch，A History of the Massachusetts General Hospital to Au-gust 5，1851，2nd.ed.with continuation to 1872 （Boston：The Trustees，1872），3-9；Morris Vogel，“Boston’s Hospitals，1870-1930：A Social History.” （Ph.D.diss.，Uni-versity of Chicago，1974），12-18.在1868年圣路易斯城市医院收治的病人中，超过五分之四的人要么单身要么丧偶；只有17.3%的人已婚。Board of Health，Second Annual Report （St.Louis，1869），19.
13.Francis R.Packard,Some Account of the Pennsylvania Hospital (Philadelphia:Engle Press,1938),9.
14.History of the Reading Hospital,1867-1942 ([Reading,Pa.]:The Reading Hos-pital,1942),5.
15.Allan Nevins and Milton Halsey Thomas,eds.,The Diary of George Templeton Strong:The Turbulent Fifties,1850-1859 (New York:Macmillan,1952),92.
16.Hyman Grinstein,The Rise of the Jewish Community of New York,1654-1860 (Philadelphia:Jewish Publication Society of America,1945),155-159,187-188.
17.Robert W.Downie,"Pennsylvania Hospital Admissions,1751-1850:A Survey,"Transactions and Studies of the College of Physicians 32 (1964),25.
18.George Worthington Adams,Doctors in Blue (New York:Collier Books,1961),101-151.
19.Elizabeth C.Hobson，Recollections of a Happy Life （New York：privately print-ed，1914），77-114；对州慈善援助协会中的女士们的描述来自它的第一份年度报告，引自M.Adelaide Nutting and Lavinia L.Dock，A History of Nursing （New York：Putnam，1907），II：370。
20.Jo Ann Ashley,Hospitals,Paternalism,and the Role of the Nurse (New York:Teachers College Press,1976),20.
21.Frederick F.Cartwright,The Development of Modern Surgery (London:Arthur Barker,1967),12-22.
22.Helen Clapesattle,The Doctors Mayo (Minneapolis:University of Minnesota Press,1941),297-338,407,432.
23.S.E.Crocker,"The Invalid in Home and Hospital,"National Hospital Record 2 (March 1899),7-9.
24.Vogel，“Boston’s Hospitals，” 140.布里奇波特市的数字引用自Commission on Hospital Care，Hospital Care in the United States （New York：Commonwealth Fund，1947），545。U.S.Bureau of the Census，Hospitals and Dispensaries：1923，3.
25.林肯医院的早期历史出自Fitzhugh Mullan，White Coat，Clenched Fist：The Po-litical Education of an American Physician （New York：Macmillan，1976），117-121。
26.Vogel,"Boston's Hospitals,"36,15-18;"Children's Hospital,Papers and Clip-pings,1869-1879,"Countway Library,Harvard Medical School.
27.Florence Nightingale,Notes on Hospitals,3rd ed.(London:Longman,Roberts and Green,1863),51-52.
28.Niles Carpenter，Hospital Service for Patients of Moderate Means （Washington，D.C.：Committee on the Costs of Medical Care，1930），23.这些数据基于对隶属美国医院协会的建筑师的调查，他们被要求报告他们在1908、1918和1928年所设计的医院中的床位数。
29.关于病人的早期义务，见Thomas G.Morton，A History of the Pennsylvania Hospital，1751-1895 （Philadelphia：Times Printing House，1895），210；Sidney Gold-stein，“The Social Function of the Hospital，” Charity and the Commons 18 （May 4，1907），162；Talcott Parsons，The Social System （Glencoe，Ill.：Free Press，1951），428-447。
30.S.S.Goldwater,"The Cost of Modern Hospitals," National Hospital Record 9 (November 1905),39-48.
31.Frank Tucker,"The Financial Problem of New York's Hospitals,"Charities 12 (January 2,1904),27-32;"What the Managers of the Hospitals Have to Say About Their Financial Problem,"ibid.,32-46;"Press Comment...,"ibid.,83-85.
32.David Rosner,"Bedside Business:The Transformation of Brooklyn's Hospitals During the Progressive Era."(Unpublished manuscript,Harvard University,1977.)
33.E.H.Lewinski-Corwin,The Hospital Situation in Greater New York (New York:Putnam,1924),121,130.
34.U.S.Bureau of the Census,Hospitals and Dispensaries:1923,4.
35.Albert R.Lamb,The Presbyterian Hospital and the Columbia-Presbyterian Med-ical Center,1868-1943 (New York:Columbia University Press,1955),22-24;Vogel,"Boston's Hospitals,"126-129.
36.Herbert D.Howard,"The Managers and the Superintendent,"National Hospi-tal Record 6 (December 1902),10.
37.J.M.Toner,"Statistics of Regular Medical Associations and Hospitals of the United States,"Transactions of the American Medical Association 24 (1873),314-333;E.H.L.Corwin,The American Hospital (New York:Commonwealth Fund,1946),7.
38.Henry S.Stark,"Hospital Reform in a New Light,"National Hospital Record 10 (February 1907),18-19.
39.Lewis S.Pilcher,"On the Organization of the Surgical Staff in General Hospi-tals,"Annals of Surgery 2 (1885),399.
40.关于医院任命的价值的讨论，见 Michael M.Davis and C.Rufus Rorem，The Crisis in Hospital Finance （Chicago：University of Chicago Press，1932），78-89。
41."The Medical Profession and the Hospitals," Medical Record 45 (January 6,1894),16.
42.Henry C.Burdett,Pay Hospitals and Paying Wards Throughout the World (Phil-adelphia:Presley Blakiston,1880),73;George W.Gay,"Abuse of Medical Charity,"Boston Medical and Surgical Journal 152 (March 16,1905),300;E.W.Cushing,"The Physician and the Private Hospital Patient," ibid.,311;"Private Patients'Liability,"National Hospital Record 8 (October 1904),6.
43.H.D.Niles，“Our Hospitals，” JAMA 38 （March 22，1902），759-761；Bayard Holmes，“The Hospital Problem，”ibid.47 （August 4，1906），320.霍姆斯是1895年芝加哥市长竞选中社会党派的候选人。
44.A.L.Beahan,"Hospitals in the Smaller Towns," Buffalo Medical Journal 41 (1901),187;Laura Lane,"The Individual Private Hospital,"National Hospital Record 10 (July 1907),37ff.
45."Hospitals and General Practitioners," National Hospital Record 10 (March 1907),9;Arpad G.Gerster,"System of American Hospital Economy,"National Hos-pital Record 9 (January 1906),17-19.
46."The City Hospital Issue,"Cincinnati Medical News 1 (November 1944),326-327;Dr.R.Lincoln Graham,"History of the Decay of Medical Opulence,"The Medi-cal Economist,publication of the Federation of Medical Economic Leagues 3 (February 1915),40;S.S.Goldwater,"The Extension of Hospital Privileges to All Practitioners of Medicine,"JAMA 84 (March 28,1925),933-935.
47."Article 3—Need for More Hospitals," National Hospital Record 8 (November 1904),26;Albert J.Ochsner and Meyer J.Sturm,The Organization,Construction and Management of Hospitals (Chicago:Cleveland Press,1909),563.
48.Rosner,"Bedside Business";Corwin,Hospital Situation in Greater New York,45,177;Davis and Rorem,Crisis in Hospital Finance,81;"Hospital Service in the United States," JAMA 98 (June 11,1932),2073;"Hospital Service in the United States,"JAMA 102 (March 31,1934),1014.
49.Roemer and Friedman,Doctors in Hospitals,36-39.
50.Cleveland Hospital Council,Cleveland Hospital and Health Survey (Cleveland:The Council,1920),858,863;Oswald Hall,"The Stages of a Medical Career,"Ameri-can Journal of Sociology 53 (March 1948),331.
51.Oswald Hall,"The Informal Organization of the Medical Profession,"Canadian Journal of Economics and Political Science 12 (February 1946),30-44;Hall,"Stages of a Medical Career,"327-336.
52.Glaser,"American and Foreign Hospitals,"54
53."Hospital Service in the United States" JAMA 94 (March 29,1930),928;Max Sehan,Blacks and American Medical Care (Minneapolis:University of Minnesota Press,1973),72-73.
54.U.S.Bureau of the Census,Historical Statistics of the United States:Colonial Times to 1970 (Washington,D.C.:U.S.Department of Commerce,1975),78.
55.U.S.Bureau of the Census,Hospitals and Dispensaries:1923,25-26 (from Ta-bles 5 and 6).
56.Irving Fisher,"Private Patients in General Hospitals,"National Hospital Record 8 (June 1905),19-25.
57."The Hospital Superintendents on the Hospital Situation in New York,"Chari-ties 12 (February 6,1904),157-161.
58.S.S.Goldwater,"The United States Hospital Field," in Hospital Charities,ed.Henry Burdett (London:The Scientific Press,1906).
59.U.S.Bureau of the Census,Benevolent Institutions,1904,20.
60.George Wilson,"The Hospitals of the National [Capital]," National Hospital Record 9 (May 1906),12.
61.Vogel,"Boston's Hospitals,"83-84.
62.关于对爱尔兰人的排斥，见 Vogel，“Boston’s Hospitals，” 21-22；关于犹太人对非犹太医院的疑虑，见Grinstein，Rise of the Jewish Community of New York，155-159；这段来自俄罗斯犹太人的引文出自Yidische Gazaetten （April 1894），转引 自 Moses Rischin，The Promised City：New York’s Jews 1870-1914 （Cambridge：Harvard University Press，1962），104；Richard C.Cabot，Social Service and the Art of Healing （New York：Moffat，Yard，1909），4-8。
63.Hall,"Stages of a Medical Career,"330.
64.Johan Goudsblom,Dutch Society (New York:Random House,1967),32,124.
65.关于高等教育中种族关系的讨论，以及更广泛的思考，见Christopher Jencks and David Riesman，The Academic Revolution （Garden City，N.Y.：Doubleday，1968），chaps.8 and 9。
66.Glaser,Social Settings and Medical Organization,32-38,74-75.
67.Charles P.Emerson,"The American Hospital Field,"in Hospital Management,ed.Charlotte A.Aikens (Philadelphia:Saunders,1911),2;American Medicine:Testi-mony Out of Court (New York:American Foundation,1937),II:723-724.
68.Glaser,"American and Foreign Hospitals,"39-50.
69.关于医院管理的早期发展，见Michael M.Davis，Hospital Administration：A Career （New York，1929）。关于医生和行政人员之间不断变化的平衡，见Roemer and Friedman，Doctors in Hospitals，118-120；Robert N.Wilson，“The Physician’s Changing Hospital Role，”Human Organization 18 （Winter 1959-1960），177-183.
70.Charles Perrow,"Goals and Power Structures:A Historical Case Study,"in The Hospital in Modern Society,ed.Freidson,12-46;and idem,"The Analysis of Goals in Complex Organizations," American Sociological Review 26 (December 1961),854-866.
第五章 公共卫生的边界
1.C.-E.A.Winslow,"The Untilled Fields of Public Health,"Science 51 (January 9,1920),30.
2.关于公共卫生的方向变化，见Charles V.Chapin，“History of State and Munic-ipal Control of Disease，”in A Half Century of Public Health，ed.Mayzyck P.Ravenal （New York：American Public Health Association，1921），135-137；Barbara Gutmann Rosenkrantz，Public Health and the State：Changing Views in Massachusetts，1842-1936 （Cambridge：Harvard University Press，1972）；James H.Cassedy，Charles V.Chapin and the Public Health Movement （Cambridge：Harvard University Press，1962）；and George Rosen，A History of Public Health （New York：MD Publications，1958），Chap.7。
3.Charles Rosenberg,"Social Class and Medical Care in Nineteenth-Century America:The Rise and Fall of the Dispensary,"Journal of the History of Medicine and the Allied Sciences 29 (January 1974),32-54;Michael M.Davis,Clinics,Hospitals and Health Centers (New York:Harper and Brothers,1927).
4.George F.Shrady，“A Propagator of Pauperism：The Dispensary，” The Forum 23 （June 1897），425；施拉迪从《医学记录》上的一篇文章引用了前述说法；Ag-nes C.Vietor，“The Abuse of Medical Charity：The Passing of the‘Charity’ Hospital and Dispensary，”Boston Medical and Surgical Journal 140 （May 4，1899），419；Davis，Clinics，Hospitals and Health Centers，80-83。
5.Michael M.Davis,Jr.,and Andrew W.Warner,Dispensaries:Their Management and Development (New York:Macmillan,1918),42.
6.Ibid.，46-58；对诊疗所滥用的进一步研究的总结，见Davis，Clinics，Hospitals and Health Centers，53ff；W.S.Thayer，“On Some Functions of the Free Dispensary，”Boston Medical and Surgical Journal 168 （February 6，1913），185-188；玛丽·里士满在第四届医院院长协会年会上的评论，National Hospital Record 6 （March 1903），8-10。
遗憾的是，诊疗所和医生在自己的诊室仅仅作为救济或根据与当地政府的合同为穷人提供的医疗服务的相对份额，我们没有估计数值。因此，我们无法分辨诊疗所的发展是否意味着为穷人提供了更多的免费服务，还是意味着补贴性医疗服务从诊室和家庭中转移出来。如果诊疗所的增加代表免费服务数量的绝对增加，那么它是否也代表了人均服务的增加，或者它只是对穷人数量增加的一种反应？现有的数据看似并不能回答这些问题。
7.Committee on Inquiry into the Department of Health,Charities and Bellevue and Allied Hospitals,Report (New York,1913),532.
8.Editorial，“Too Many Schools，” National Hospital Record 6 （November 1902），33；关于诊所费用的增长，见Davis，Clinics，Hospitals and Health Centers，323-338。
9.关于这里所讨论的事态的最新回顾，见John Duffy，“The American Medical Profession and Public Health：From Support to Ambivalence，”Bulletin of the History of Medicine 53 （Spring 1979），1-22。
10.以下各段，除特别指出其他来源外，均借自John Duffy，A History of Public Health in New York City，1866-1966 （New York：Russell Sage Foundation，1974）；C.-E.A.Winslow，The Life of Hermann M.Biggs （Philadelphia：Lea&Febiger，1929）；Wade W.Oliver，The Man Who Lived for Tomorrow：A Biography of William Hallock Park，M.D.（New York：Dutton，1941）；Jonathan T.Deland，“Hermann Biggs’ Public Health Work and the Medical Profession：New York City and State，1889-1923.” （Unpub-lished B.A.thesis，Committee on History and Science，Harvard University，March 1976）。
11.Board of Health,Annual Report (New York,1893),12-13.
12.W.R.Ingle Dalton，letter，New York Times，November 24，1901.圣路易斯的7名儿童在接受了由市卫生局分发的受污染的白喉抗毒素后，刚刚死于破伤风（New York Times，November 19，1901）。1902年，国会通过了《生物制品管制法》，禁止在没有美国公共卫生局许可的情况下跨州销售此类产品。
13.Daniel M.Fox,"Social Policy and City Politics:Tuberculosis Reporting in New York,1889-1900," Bulletin of the History of Medicine 49 (Summer 1975),169-195;Hermann M.Biggs,"Sanitary Measures for the Prevention of Tuberculosis in New York City and their Results,"JAMA 39 (December 27,1902),1635-1638.
14.Samuel Hopkins Adams,"Tuberculosis:The Real Race Suicide," McClure's 24 (January 1905),234-249.
15.Duffy,Public Health in New York City,244.
16.Leonard P.Ayres,"What American Cities Are Doing for the Health of School Children,"The Annals 37 (March 1911),250-260;Annette Lynch,"Evaluating School Health Programs," in Health Services:The Local Perspective,ed.Arthur Levin (New York:Academy of Political Science,1977),89-92;Mary Ross,"Health Inventory:1934,"Survey Graphic 23 (January 1934),38-40.
17.Chapin,"History of State and Municipal Control of Disease,"140.
18.Cassedy,Chapin and the Public Health Movement,96,100.
19.Charles V.Chapin,How to Avoid Infection (Cambridge:Harvard University Press,1917),61-62.
20.C.-E.A.Winslow,The Evolution and Significance of the Modern Public Health Campaign (New Haven,Conn.:Yale University Press,1923),57,58.
21.Richard H.Shryock,National Tuberculosis Association 1904-1954 (New York:National Tuberculosis Association,1957),130,157-158,170.
22.Davis and Warner，Dispensaries （1918），12-17；Davis，Clinics，Hospitals and Health Centers （1927），15-17.注意后一本书书名用语的变化。
23.John C.Burnham,"Medical Specialists and Movements Toward Social Control in the Progressive Era:Three Examples," in Building the Organizational Society,ed.Jerry Israel (New York:Free Press,1972),19-30.
24.Stanley Joel Reiser,"The Emergence of the Concept of Screening for Disease,"Health and Society 56 (Fall 1978),403-425.
25.Ibid；James A.Tobey，“The Health Examination Movement，” The Nation’s Health 9 （September 1923），610-611，648.对于该信条的激昂陈述，见James A.To-bey，“A Layman’s View of Health Examinations，”Boston Medical and Surgical Journal 191 （November 6，1924），875-878。
26.J.H.J.Upham,"The State Medical Association and the State Board of Health,"AMA Bulletin 16 (February 1923),273.
27."Like Banquo's Ghost the Chicago Public Health Institute Will Not Down,"Illinois Medical Journal 58 (November 1930),313ff;New York Times,April 8,11,and 14,1929.
28.Davis，Clinics，Hospitals and Health Centers，357；George Rosen，“The First Neighborhood Health Center Movement：Its Rise and Fall，”American Journal of Pub-lic Health 61 （August 1971），1620-1637；John D.Stoeckle and Lucy M.Candib，“The Neighborhood Health Center—Reform Ideas of Yesterday and Today，”New England Journal of Medicine 280 （June 19，1969），1385-1390.Stoeckle和Candib试图为1960年代的街区卫生中心寻找先例，但他们没有明确指出早期的卫生中心主要不是提供医疗服务；他们的发起人发誓不会与当地医生竞争。另一方面，1960年代的项目试图在私人医生几乎消失的地区提供综合服务。
29.Hermann M.Biggs，“The State Board of Health，” New York State Journal of Medicine 21 （January 1921），7；另见 Victor C.Vaughan，“Rural Health Centers as Aids to General Practitioners，”JAMA 76 （April 9，1921），983-985。
30.Milton Terris,"Hermann Biggs'Contribution to the Modern Concept of the Health Center,"Bulletin of the History of Medicine 20 (October 1946),387-412.
31.Edward L.Hunt,"The Health Centres Bill of 1920,"New York State Journal of Medicine 21 (January 1921),2.
32.Greer Williams,"Schools of Public Health—Their Doing and Undoing,"Health and Society 54 (Fall 1976),501-502.
33.Rosenkrantz,Public Health and the State,179,182.
第六章 逃离公司（1900—1930）
1.关于工业医疗在美国的发展，见 Henry B.Selleck，with Alfred H.Whittaker，Occupational Health in America （Detroit：Wayne State University Press，1962），and T.Lyle Hazlett and William W.Hummel，Industrial Medicine in Western Pennsylvania，1850-1950 （Pittsburgh：University of Pittsburgh Press，1957）。
2.关于发展程度的综述，见C.D.Selby，“Studies of the Medical and Surgical Care of Industrial Workers，” Public Health Bulletin，no.99 （1919）；National Industrial Conference Board，Medical Care of Industrial Workers （New York：National Indus-trial Conference Board，1926）；and“Medical and Hospital Service for Industrial Em-ployees，”Monthly Labor Review 24 （January 1927），7-19。
3.Interstate Commerce Commission,Fifteenth Annual Report (Washington,D.C.:U.S.Government Printing Office,1902),58;C.B.Herrick,"The Railway Surgeon and His Work,"Transactions of the Medical Society of the State of New York (1898),214-219.
4.I.M.Rubinow,Social Insurance (New York:Henry Holt,1916),288-289.
5.Pierce Williams,The Purchase of Medical Care Through Fixed Periodic Payments (New York:National Bureau of Economic Research,1932);Jerome Schwartz,"Early History of Prepaid Medical Care Plans," Bulletin of the History of Medicine 39 (Sep-tember-October 1965),450-475.
6.Stuart D.Brandes,American Welfare Capitalism,1880-1920 (Chicago:Universi-ty of Chicago Press,1976).
7.Williams,Purchase of Medical Care,1-23.
8.Schwartz，“Early History of Prepaid Medical Care Plans”，报告称一些工人支持公司的医疗计划，见Brandes，American Welfare Capitalism中更彻底的分析。
9."Contract Practice," JAMA 49 (December 14,1907),2028-2029;Selleck and Whittaker,Occupational Health in America,61;Alice Hamilton,Exploring the Dan-gerous Trades (Boston:Little,Brown,1943),3.
10.National Industrial Conference Board,Health Services in Industry,Report no.34 (New York:National Industrial Conference Board,January 1921),15.
11."Medical and Hospital Service for Industrial Employees," Monthly Labor Re-view 24 (January 1927),7-19;National Industrial Conference Board,Medical Care of Industrial Workers;J.D.Hackett,Health Maintenance in Industry (Chicago:A.W.Shaw,1925).
12.美国医学会的医生们经常反对在职业病的情况中扩大赔偿范围，因为他们将之视为“是在向社会化或国家医疗方向发展”。Carey McCord，“The Present Status of Industrial Medicine，”AMA Bulletin 25 （January 1930），1-21.
13.关于企业家长制的衰落，见Brandes，American Welfare Capitalism。
14.Schwartz,"Early History of Prepaid Medical Care Plans,"455;Note,"Right of Corporation to Practice Medicine,"Yale Law Journal 48 (1938),346-351.
15.Lawrence G.Goldberg and Warren Greenberg,"The Emergence of Physi-cian-Sponsored Health Insurance:A Historical Perspective," in Competition in the Health Sector:Past,Present and Future,ed.Warren Greenberg (Washington,D.C.:Federal Trade Commission,1978),288-321.
16.John Kenneth Galbraith,Economics and the Public Purpose (Boston:Houghton Mifflin,1973),73.
17.Rubinow,Social Insurance,293.
18.Charles Henderson,Industrial Insurance in the United States (Chicago:Univer-sity of Chicago Press,1908),112-127.
19.在这一节中，我借鉴了George Rosen，“Contract or Lodge Practice and Its In-fluence on Medical Attitudes to Health Insurance，”American Journal of Public Health 67 （April 1977），374-378。
20.Anna Kalet，“Voluntary Health Insurance in New York City，”American Labor Legislation Review 6 （June 1916），142-154.关于兄弟会组织和互助会的详细描述，请参见Report of the Health Insurance Commission of Illinois，May 1，1919，118-124。
21.George S.Mathews,"Contract Practice in Rhode Island,"Bulletin of the Ameri-can Academy of Medicine 10 (1909),599.
22.James G.Burrow,Organized Medicine in the Progressive Era:The Move Toward Monopoly (Baltimore:Johns Hopkins University Press,1977),120-122.
23.Horace M.Alleman,"Lodge Practice," Pennsylvania Medical Journal 15 (De-cember 1911),223.
24.Mathews,"Contract Practice in Rhode Island,"602.
25.Ibid.,602-603,604.
26.“Contract Practice，” JAMA 49 （December 14，1907），2028-2029；“Contract Practice，” JAMA 57 （July 8，1911），145-146.1912年，美国医学会司法委员会的一份报告对会社执业给予了同情，但当时委员会的主席是亚历山大·兰伯特（Alex-ander Lambert），他的观点在医学专业中不具代表性。该报告是医疗保险辩论的前奏。见JAMA 60 （June 28，1913），1997-1998。
27.Mathews，“Contract Practice in Rhode Island，”600；Dr.J.K.Weaver，“Discus-sion，” Bulletin of the American Academy of Medicine 10 （1909），630-632.关于医学会对为兄弟会工作的医生的阻挠措施，后来的报告见“Lodge Practice and the Medical Society，” AMA Bulletin 16 （March 15，1923），290-292。强调政策差异的对各州医学会反应的全面考察，见Burrow，Organized Medicine in the Progressive Era，124-132。
28.Irving Howe，World of Our Fathers （New York：Harcourt Brace Jovanovich，1976），188.转引自Rosen，“Contract or Lodge Practice，”375。
29.Henry Keller,"Contract Practice,"The Medical Economist 1 (December 1913),143-149.
30.Williams,Purchase of Medical Care,290-91;Schwartz,"Early History of Pre-paid Medical Care Plans,"452-454.
31.Howe,World of Our Fathers,188.
32.Weaver,"Discussion,"631.
33.引用来自Helen Clapesattle，吀e Doctors Mayo （Minneapolis：University of Min-nesota Press，194），388，392。梅奥诊所的其他细节来自ibid.，339-535。
34.Ibid.;also C.Rufus Rorem,Private Group Clinics (Chicago:University of Chi-cago Press,1931),115-118.
35.Clapesattle,The Doctors Mayo,788;Walker Winslow,The Menninger Story (New York:Doubleday,1956),13-16.
36.American Medical Association,Bureau of Medical Economics,Group Practice (Chicago:American Medical Association,1933),13-17.
37.Rorem,Private Group Clinics,15-18.
38.AMA,Group Practice,14.
39.与拉塞尔·李的私人谈话，加利福尼亚，帕洛阿尔托诊所，1975年。
40.AMA,Group Practice,15.
41.Rorem,Private Group Clinics,13.
42.Clapesattle,The Doctors Mayo,531,534.
43.Michael M.Davis,Jr.,"Organization of Medical Service,"American Labor Leg-islation Review 6 (March 1916),18.
44.Rorem,Private Group Clinics,102.
45."Group Practice—A Menace or a Blessing,"JAMA 76 (February 12,1921),452-453.
46.Rorem,Private Group Clinics,19-20.
47.Veader Newton Leonard，“The Significance of Group Practice，”JAMA 76 （Feb-ruary 12，1921），421-426.Leonard还提到了另外两种类型—封闭式医院的工作人员和诊断小组—但在大多数关于团体执业的讨论中，这些都被排除在外。
48.Rorem,Private Group Clinics,26-31.
49.Rexwald Brown,"Group Medicine in Practice," AMA Bulletin 18 (December 1923),443-448.
50.Edward B.Stevens,The History of the Medical Group Management Association,1926-1976 (Denver:Medical Group Management Association,1976),22.
51.AMA,Group Practice,42.
52.Ibid.,40-42.
53.American Medical Association,Proceedings of the House of Delegates (1934),47.
54.Stephen Marglin,"What Do Bosses Do?The Origins and Functions of Hierar-chy in Capitalist Production,"Review of Radical Political Economics 6 (1974),62.
55.American Medical Association,Bureau of Medical Economics,Economics and the Ethics of Medicine (Chicago:American Medical Association,1935),49-50.
56.Alleman，“Lodge Practice，” 223；Burrow，Organized Medicine in the Progres-sive Era，127亦有引用。
57.AMA,Economics and the Ethics of Medicine,45.
58.Annual Report of the President,1880-81,29.
59.Edward Louis Bauer,Doctors Made in America (Philadelphia:Lippincott,1963),247-249.
60.Bruce Steinwald and Duncan Neuhauser,"The Role of the Proprietary Hospi-tal,"Law and Contemporary Problems 35 (Autumn 1970),818-820;E.H.L.Corwin,The American Hospital (New York:Commonwealth Fund,1946),29.
61.JAMA 92 (March 30,1929),1050.
62.Rosemary Stevens,American Medicine and the Public Interest (New Haven,Conn.:Yale University Press,1971),225-231,238-243.
63.在对临床实验室的讨论中，我完全依据William D.White，Public Health and Private Gain：The Economics of Licensing Clinical Laboratory Personnel （Chicago：Ma-roufa Press，1979）。
64.Ibid.,63.
65.George Unwin,Industrial Organization in the Sixteenth and Seventeenth Centu-ries (Oxford:Clarendon Press,1904),96.
66.Judy Barrett Litoff,American Midwives,1860 to the Present (Westport,Conn.:Greenwood Press,1978),76.
67.Commission on Graduate Medical Education,Graduate Medical Education (Chicago:University of Chicago Press,1940),132-133;Abraham Flexner,Medical Education in the United States and Canada (New York:Carnegie Foundation for the Advancement of Teaching,1910).
68.Stevens,American Medicine and the Public Interest,127-128.
69.Kenneth Arrow,"Uncertainty and the Welfare Economics of Medical Care,"American Economic Review 53 (December 1963),941-969.
70.E.Richard Brown,Rockefeller Medicine Men:Capitalism and Medical Care in America (Berkeley:University of California Press,1979),3-4,119-130,and else-where.
71.Ibid.，117-118.布朗引用了全国制造商协会和全国公民联合会的观点。他显然错把全国制造商协会从未通过的委员会报告作为其官方立场。全国公民联合会对医疗保险的谴责很激烈。见我在下部第一章的讨论。
72.Ibid.,113.
73.Joseph Schumpeter,Capitalism,Socialism and Democracy (New York:Harper&Row,1950),125-126.