"Modern observers accustomed to thinking of the medical profession as prestigious technically effective and highly paid are sometimes shocked to learn that it was none of those things in the nineteenth century. On the contrary, much of its history during that century was an uphill struggle to attain jut those attributes. Whereas European physicians entered the modern era with at least the legacy of well-defined guild structure-structures that took responsibility for teaching, maintained the right to determine who could practice, and exercised some control over the conduct an craft of the profession-American physicians did not. Because of its history as a colony, the United States attracted few guild-trained physicians, and consequently a formal guild structure never developed. Healing in this country started out primarily as a domestic rather than a professional skill (women and slaves often developed considerable local reputations as healers), and therefore anyone who claimed medical talent could practice-and for the most part could practice outside of any institutional controls of the sort that existed in Europe. It is true that some early colonies did establish different fee structures for “trained” as opposed to “folk” doctors, but these regulations were not supported by “enabling” legislation. “Trained” physicians had the right to charge more, but there were no regulatory mechanisms by which they could enforce their higher fees or, ore importantly, deny others the right to practice medicine. From the earliest days of the medical profession in this country, therefore, physicians wanted effective licensing laws that would do for them what the guild structures had done for their European colleagues, namely, restrict the competition."