"In the early part of the nineteenth century, the fate of trained physicians became even worse. What few regulations had existed in the colonial period were swept away in the era of Jacksonian democracy, and medical practice became one vast free market. Moreover, during the second quarter of the century, deep doctrinal divisions appeared within the rank of trained physicians themselves. For the first third of the century, physicians had depended on a model of illness that called upon the use of drastic medical treatments such as bleeding or the administration of harsh laxatives and emetics. By the 1850, a new group of physician (including such luminaries as Oliver Wendell Holmes) rejected the use of this “heroic armamentarium” and earned for themselves the sobriquet of “therapeutic nihilists” inasmuch as they seemed to argue that anything a physician could do was probably ineffective and might be dangerous as well. Two other developments during the course of the century kept the social and professional status of medicine low. First, as the effectiveness of “heroic” medicine was called into question by some physicians themselves, there was a proliferation of healers who advocated new models of treatment. Thomosonians, botanics, and homeopath among others all developed “sets” of healing and claimed the title of doctor for themselves. These nineteenth-century sectarians flourished, perhaps in part because they tended to support relatively mild forms of treatment (bath, natural diets) instead of the “heroic” measures used by many doctors. Thu, regular physicians (those who had some semblance of formal training and who subscribed to the dominant medial model) found themselves in increasing competition with the sectarians, whom they considered quacks."