‘Diploma Mill’

In April 1871 The College Courant, which was something like the Inside Higher Ed of its day, reprinted an article that had run a short time earlier in The Philadelphia Press, one of the city's numerous papers. Typical of the era, it carried a long string of subheadlines, many ironically phrased: “The Ideal ‘American University’ Discovered at Last -- A Paradise for ‘Practical Men’ … Degrees for Everybody -- D.D., L.L.D., M.D., and All the Rest of Them.”

The institution in question was known as the American University of Philadelphia. Like the University of Pennsylvania, it was home to a medical school. And while that was about as far as any resemblance extended, the potential for confusion was obvious. Indeed, it was built into the lesser known university’s business model.

AUP occupied a three-story building only recently restored from a “dusty, begrimed, and forsaken” condition, “externally weather-beaten, its numerous windows an object for the dexterous aim of small boys.” The university had a faculty, of sorts. “The professors are a motley set in appearance,” the article said, “evidently got up like the figures in the milliner’s window, for show, and just as intelligent in appearance, and spend their time principally in lounging on the doorsteps.” What the campus did not seem to have was a student body.

For a sufficiently motivated M.D. candidate, it seems, attending lectures and taking exams were optional. The dean “named $40 as the price at which the coveted sheepskin could be procured” by the undercover reporter visiting his office as a prospective candidate. That comes to about $800 today -- not exactly pocket change, though still a bargain by any standard. The university also generated revenue from its medical museum, open to public visitors for a fee. “In the center of the room,” the reporter noted, “are three glass cases, in each of which is a life-size nude wax figure, two males and one female, perfectly true to nature in every particular, in lascivious attitudes.” About half of the other exhibits were dedicated to “certain organs of the male and female which are not so displayed in the museum of any regular and respectable medical institution in the country.”

Be that as it may, the educational enterprise held charters, legitimately issued by the state of Pennsylvania. That gave the institution a thin veneer of legitimacy while peddling its wares through discreetly worded advertisements in British and American journals. Meanwhile, the University of Pennsylvania was inundated with mail from people eager to take up on the offer of advanced degrees, home delivered, at a reasonable prices. Readers of The College Courant must have sympathized with their colleagues at Penn -- “for every one knows that its name has suffered somewhat by the false belief that it is a party to such transactions.”

Most white-collar criminals facing such unwelcome exposure would probably abandon the grift, or at least start running it from a different city under a new alias. Not so with the improbable figure whose career unfolds in David Alan Johnson’s Diploma Mill: The Rise and Fall of Dr. John Buchanan and the Eclectic Medical College of Pennsylvania (Kent State University Press). The author is a senior vice president at the Federation of State Medical Boards. (Some of the passages quoted above appear in the book, but curiosity sent me to check out the original article from The College Courant, available here.)

Buchanan was an impressive rogue -- immoral but skillful, shameless but energetic. Born in Scotland in the late 1820s (much about his early life is unclear) he was established in private practice as a physician in Philadelphia no later than 1859. He joined the faculty of the Eclectic Medical College of Pennsylvania the following year. Johnson says Buchanan possessed the qualities of “the adept conversationalist, the knowledgeable man of medicine and the successful salesman,” along with “an unflappable demeanor under pressure.” The press coverage that began in 1871 snowballed into legislative hearings and lawsuits; it was bad publicity of the self-replicating sort. Yet it did not stop him. The mill remained in operation until 1880, churning out thousands of degrees along the way.

His, then, was a Gilded Age success story, at least until the police finally raided the operation, seizing not just a printing press but also half a ton of blank diplomas. Faced with trial and the likelihood of a long stay in prison, Buchanan hired someone to impersonate him and fake his own suicide by jumping into a river (this fooled almost no one) while he escaped, briefly, to Canada. It was not the only development in his story lurid and improbable enough to read like chapters from one of the era’s penny dreadfuls.

Johnson is willing to characterize Buchanan as a sociopath: not just an especially colorful specimen from the golden age of quacks, but one whose fraud showed a callous disregard for human life on a very large scale. But Johnson also makes a case for understanding Buchanan as someone who simply exploited a corrupt and dysfunctional situation. He made it worse, but he didn't create it.

Just how nonprofessionalized, unregulated and fractious an enterprise medicine was in Buchanan’s time is difficult to imagine now. The chief qualification for practicing it was success in getting other people to call you “Doctor.” The requirements for opening a medical school were equally rigorous.

“From a socioeconomic perspective,” Johnson writes, “America’s medical marketplace remained ‘open’ and highly competitive. At that time, the notion that an elected official or some designated officer of the state should be empowered to restrict a citizen’s ability to engage in his or her chosen trade struck many Americans, and perhaps most physicians, as an infringement of fundamental rights and an unwarranted government intrusion. In any case, such governmental action was not yet possible, since large portions of the country, especially west of the Missouri River, lacked sufficiently developed state or territorial governments to enforce such powers.”

Equally moot was the notion of medicine as a field of expertise that could demand its practitioners absorb some minimum amount of established knowledge. As with religion, medicine had its sects, built around distinct and competing doctrines. One, for example, relied on herbal drugs only and believed that the combination of heavy sweating and emetics would speed along the healing process. Doctors trained in European medical schools might deride this as the “steam and puke” cure, but from this distance it is not obvious that their own use of arsenic-based medications and bleeding was greatly preferable.

The Eclectic Medical College seems to have started out in 1850 as a bona fide educational institution, training adherents to a self-described “eclectic” movement willing to use proven techniques without regard to the dogmas behind them. It received a charter from the state, though in the absence of oversight at any level that did not mean much. (Likewise for the American University of Pennsylvania, which was spawned a few years later in a dispute among the eclectics too complicated to go into here.) And while Buchanan might be cast as a villain who hijacked the eclectics' schools, Johnson avoids the melodramatic course and posits a number of likely factors involved in the drift toward criminality. At the start of the Civil War, many of those enrolled were Southerners who quit their studies to return home and fight -- so an occasional honorary degree to a wealthy individual probably helped keep the school afloat. Buchanan also made an attractive offer to prospective students who expected to take two yearlong courses of lectures necessary for a degree: they could save $20 if they paid the tuition for both up front. And there was a ready market for diplomas among practicing doctors who, after all, had obviously learned the art of healing along the way.

From one cut corner and slippery slope to the next, a criminal enterprise took shape. The sheer egregiousness of Buchanan's racket must have heightened the demand for greater professionalization and state intervention, although that is perhaps not the only lesson to take away from his story. Another would be that corruption has a way of feeding on itself until it's too big to ignore.