Physicians with medical degrees and scientific training began showing up on the
American landscape in the late colonial period. The University of Pennsylvania opened the first medical college in 1765 and the Massachusetts Medical Society (publishers of today's New England Journal of Medicine), incorporated in 1781, sought to license physicians. Medical schools were often opened by physicians who wanted to improve
American medicine and raise the medical profession to the high status it enjoyed in
Europe and in England. With scientific training, doctors became more authoritative and practiced medicine as small entrepreneurs, charging a fee for their services.
In the early 1800s, both in Europe and in the United States, physicians with formal medical training began to stress the idea that germs and social conditions might cause and spread disease, especially in cities. Many municipalities created "dispensaries" that dispensed medicines to the poor and offered free physician services. Epidemics of cholera, diphtheria, tuberculosis, and