Q&A with David A. Johnson – Diploma Mill: The Rise and Fall of Dr. John Buchanan

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July 8, 2019 – We welcome David Alan Johnson to our blog, here to answer some written questions about Diploma Mill: The Rise and Fall of Dr. John Buchanan. The book chronicles the bizarre history of the Eclectic Medical College of Pennsylvania (EMC). Founded in 1850 professing lofty goals, it collapsed into spectacular disgrace 30 years later — a scandal of Ponzi proportions, in an era (the 19th Century) when American medical personnel often had little training and even less regulation.

David A. Johnson serves as senior vice president at the Federation of State Medical Boards. His published works on various aspects of medical regulation and its history have appeared in Bulletin of the History of Medicine, Social History of Medicine and the Journal of Medical Regulation. He is the lead author of Medical Licensing and Discipline in America: A History of the Federation of State Medical Boards.

You can find our guest online at ArmchairHistorian.blog and @DaveArlingtonTx Twitter.

THE HISTORY AUTHOR SHOW: In the ten years before the mid-1870s, America suffers through the Civil War, the impeachment of President Andrew Johnson, and a deep economic panic. How does the profession of medicine evolve from 1850 when the Eclectic Medical College opens its doors, to the period in Diploma Mill where this scandal breaks?

David A. Johnson: We’re talking about a fundamental change happening between 1850 and 1880. Keep in mind, when Buchanan joined the EMC in 1860 the practice of medicine was virtually unregulated in every state. Anyone could treat illness. Few people practicing as physicians had a medical degree. For most Americans, medicine was essentially folk medicine—something experienced at home as practiced by a family member or friend or someone accepted by the local community as knowledgeable on things like herbal remedies. There was an immense psychological distance traveled in terms of people’s experience of medicine and healing from that reality to one just a few decades later when medicine had become a distinct profession slowly squeezing out the lay practitioner.

THAS: In your Preface, you write about coming across a 1923 reference to Dr. John Buchanan’s diploma scandal as a way of comparing a similar scheme at the time. They even use the term “Buchanan diploma.” How is it that something so infamous had been forgotten until you wrote Diploma Mill?

David A. Johnson:  One word – embarrassment. John Buchanan and the Eclectic Medical College represented an acute embarrassment to medicine as a fledgling profession and medical education at a time when medicine was just on the brink of major advances through people like Lister and Pasteur…work bringing us bacteriology as a major new field in medicine. Buchanan and the EMC were embarrassing reminders of the not-so-distant realities of what passed for medical education in some quarters. They were the black sheep relatives everyone has that you’d just as soon forget about and certainly not acknowledge. The fact that Buchanan operated out of Philadelphia—the undisputed center of American medicine in the nineteenth century—made it all the worse!

THAS: The cover of Diploma Mill features an illustration called “The Philadelphia Physician Factory.” Did you always intend for that to be the face your book showed the world, or did you have runners up for that position?

David A. Johnson: While researching I’m always watching for possible photos and images to use because, to be honest, some stories don’t seem to leave behind much in the way of possible illustration materials. I didn’t run into that problem with Diploma Mill! The cover illustration first appeared in 1880 as a cartoon in the American humor magazine Puck. When I shared the image with my publisher (Kent State Univ. Press), they immediately flagged it for the book cover.

At one point I considered titling the book, Bogus Dr. John and having the cover features a side-by-side set of the only two known images of John Buchanan. One was from the frontispiece to a book he wrote in the 1860s where he looked rather stylish, even dapper with his longish hair and mutton chop whiskers. The other is an image created at the time of his capture when he had altered his appearance during his flight from justice. He did a fair job with hair cropped short and dyed black, side whiskers shaved. That may have helped him avoid capture for the nearly four weeks he was on the run.

THAS: I first learned about the plague of unregulated, barely trained doctors when reading about Theodore Roosevelt’s crackdown on quacks as one of New York City’s police commissioners in the 1890s. Not only did training vary wildly, and schooling certainly wasn’t guaranteed, but it seemed as if anyone could hang out a shingle and call himself “doctor.” Who was Dr. John Buchanan that he decided, basically, “Hey, I’m going to take all those little individual frauds and make money cranking out fake M.D.s wholesale”?

David A. Johnson: I think Buchanan got caught up in the transition period when states begin shifting medicine from the domestic activity I mentioned earlier to one carried out by licensed physicians. Suddenly, physicians had to present a diploma or at the very least some evidence of medical education. The diploma became the gateway credential to the licensed practice of medicine. I don’t believe Buchanan joined the EMC with any intent to engage in dubious practices. It is my belief that once Buchanan started down this path it simply proved too lucrative to abandon.

THAS: Say I’m a Gilded Age man who’s aware that I can get a medical degree from this crooked college. What’s it going to cost me in terms of what I might earn later as a physician, and just how would I have gotten word about the criminal enterprise?

David A. Johnson: In terms of pricing the diplomas, Buchanan proved savvy. When dealing with a potential purchaser in person, he often declined to set a price, instead forcing the buyer to make known what the diploma was worth to him. That’s an effective negotiating tactic even today for the leverage it provides. Consequently, pricing for a degree was variable, not fixed, depending upon what the market would bear. He generally sold diplomas for $25 to $50 but also much higher sums. Within the Philly area, I’m sure it was common knowledge that a medical degree could be had for the right price but Buchanan also advertised the school in newspapers and journals throughout the US and even in Europe. For the European trade, he usually had a local agent as a middle man. His ads were framed in such a way that the intent was to get the buyer to begin a correspondence…it appears the majority of Buchanan’s sales went through the U.S. mail. That was ultimately his downfall as a change to federal law in the 1870s meant that he could be prosecuted on felony mail fraud charges.

THAS: Was everyone who purchased a fake diploma incompetent, or were some of them like infamous forger Frank Abagnale, Jr., who faked his way through everything from flying an airliner to acting as chief resident pediatrician?

David A. Johnson: Dean, your question brings up a critical point. On the one hand, there were individuals who never stepped foot in Philadelphia, paid Buchanan for a diploma and brought little or no real medical knowledge or expertise to treating patients. But having said that, for the first decade or so after its opening in 1850, the EMC operated as a completely legitimate institution graduating physicians with medical education not too different from that being offered in most medical schools. So the physicians holding an EMC diploma represented a diverse group—this included physicians seeking a medical degree to legitimize themselves at a time when the evolving expectation was that medicine should be restricted to those with a bona fide medical education…but this diverse group also included people who were outright frauds simply looking to monetize whatever they could from unsuspecting patients impressed by a medical diploma.

I always try to keep in mind the diversity of these EMC “graduates.” In fact, I ran across some info recently showing an 1868 EMC graduate who relocated to Maine and passed that state’s licensing exam in 1902. Apparently, he learned a little something at EMC and along the way in the decades that followed!

THAS: You start Diploma Mill after Dr. Buchanan’s disgrace, mentioning that being indicted was nothing new to him and laying out his criminal past. From a narrative perspective, why start the book there rather than take the reader along with his descent into infamy?

David A. Johnson: I considered a traditional linear narrative but ultimately chose to go with a structure that opens with a key moment—Buchanan ostensibly standing at the railing of a ferry boat contemplating a jump into the Delaware River that would end his worldly legal problems. I wanted to give readers a dramatic opening that would leave them wondering, “What happened to this guy? How did he get to this point?”—in essence, creating a “hook” with the intent of bringing the reader along for what follows which is then a more traditional linear story unfolding across more than thirty years.

THAS: You write in Diploma Mill, quote, “The Eclectic Medical College of Pennsylvania presents the researcher with numerous contradictions and false leads in attempting to recreate its story.” How did you go about overcoming those challenges?

David A. Johnson: I can tell you with 100% assurance that there is no way John Buchanan’s story could have been retrieved from the past and retold today without the internet and Google Books—at least not in the shape and form I did with Diploma Mill. The materials I drew upon were so scattered—sometimes in places that had no obvious connection the events of the story—that only the power of a deep search engine could find this stuff. The Google Books initiative that imaged so many primary source materials, including old newspapers and nineteenth century medical journals, really proved invaluable. Ultimately, I found material buried in archives in Philadelphia, New York, Washington DC, Indiana and elsewhere. And archival staff—they are the unsung heroes of history writing!

THAS: I always remind myself not to condescend to people in the past for not knowing things, because they can’t be blamed for that. (There’s surely plenty we don’t know today that people two centuries from now will think obvious.) But malice is another thing entirely.  Just how many of these fake doctors did EMC unleash on an unsuspecting public?

David A. Johnson: It is impossible to know for sure. When authorities raided Buchanan’s offices at the EMC in June 1880, they could account for about 1,500 students through the school’s records; yet the documents they confiscated indicated at least 3,000 diplomas going out the door. Even this is probably a vast under estimate. The Philadelphia Record finally estimated 10,000 diplomas issued and/or sold over three decades.

Think of it this way. Buchanan joined the school in 1860; and illicit sales of diploma began, I believe, soon thereafter—by1867 at the latest. He had a good fifteen-year run. I would conservatively estimate he sold diplomas for at least $100,000 during that period—perhaps 2-3 times that amount. Converting historical sums like this is tough but let’s just say, he managed to main a residence and a private office in Philly, another residence in New Jersey and apparently still provide financial support to his parents.

Keep in mind, this would’ve been in addition to what he earned from his medical practice. When he died in 1906, he left behind an estimate valued at $30,000-$40,000 even after it had been depleted by the woman who worked as his business partner in patent medicines starting in the mid-1880s.

THAS: Dr. Jacob Rosenzweig treated (or mistreated) a patient named Alice Bowlsby. What does that scandal within a scandal tell readers about the wider story they’ll find in Diploma Mill?

David A. Johnson:  No story—regardless of subject matter—takes place in a vacuum. Even the medical aspects of Diploma Mill did not. The Rosenzweig case is a great example. It was an abortion manslaughter case from August 1871 that created an absolute media frenzy. New York newspapers labeled it the “trunk murder” because of how Rosenzweig tried to dispose of the young woman’s body. It’s not clear what Rosenzweig’s medical qualifications were but he did possess a medical diploma from (guess who?) John Buchanan and the EMC! He became the poster child for the dangers presented by questionably educated and trained physicians whose major qualification seemed to be a dubiously earned medical diploma.

THAS: James C. Mohr, author of Licensed to Practice: The Supreme Court Defends the American Medical Profession, writes, “Diploma Mill is both a scholarly gem and a fun read.” With so much tragedy, people might think it’s one tale of botched treatment after another. That’s not the case. There are a lot of bizarre twists and turns like a novel to keep readers interested. For example, tell us a little bit about the faked suicide which really seems stranger than fiction.

David A. Johnson: Yeah, there are some bizarre twists in this story—a faked suicide, a séance, a manhunt across international borders. It seemed like I was telling my wife every other day, “You’re not gonna believe what I just found!” Buchanan’s faked suicide was his version of something known fairly well in those days as the “drowning dodge.”

Apparently faking a death by drowning was—not common obviously—but something not wholly unique either. In Buchanan’s case, he prepared everything reasonably well. He secured an impostor to make the jump from a ferry crossing the Delaware River right before a key court date. He identified the key spot in the river where the impostor could jump and swim to a waiting skiff. Faking his death by suicide was going to allow him to skip town and still see the money he put up for his bail returned to his estate.

What tripped him up was that he’d make his preparations a little too well…he made too many inquiries in setting up the scheme. So within 24-36 hours everyone –including police and the newspapers—were working under the assumption that Buchanan wasn’t really dead. Even the eye witnesses he had arranged began to falter in their testimony. After all, it’s one thing to testify to a death everyone believes and quickly accepts; it’s another to commit perjury about a supposed death when the story unravels publicly in the newspapers.

THAS: You write, quote, “In a way, individuals like John Buchanan, rather than being the sole or even primary targets of legal and regulatory authorities … served as the means to a greater end, a mechanism for bringing to heel the larger group of” untrained, barely trained, or incompetent people practicing dangerous medicine. What would you say to the notion that Buchanan’s audacious, industrialized criminal enterprise helped create the critical mass need for the public to demand reform?

David A. Johnson: I can’t trace an exact cause and effect but it doesn’t seem coincidental that as Buchanan’s activities received more attention in the 1870s the states began either enacting or amending laws that specified graduating from a “reputable” or “respectable” medical school. In essence, adding a qualifier in front of medical school so that not just any medical diploma would suffice. There were at least forty different schools that operated (albeit some briefly) which were later categorized as fraudulent based upon their diploma issuance practices. There’s no doubt in my mind that Buchanan and the EMC put a spotlight on this activity…and with it a call for reform.

THAS: You start Part Three, “Fall,” with a chapter titled, “John Norris and the Philadelphia Record.” At this point, Diploma Mill reminded me of All the President’s Men or some other thriller focused on dogged journalism. Introduce readers to the Record‘s editor, Mr. Norris, and make your pitch for why they ought to read about his forgotten role in bringing down the forgotten fraudsters of EMC.

David A. Johnson: John Norris and the Philadelphia Record underscore the value of a strong free press in this country’s history. In January 1880, Norris and the Record’s owner William Singerly met secretly with the Pennsylvania attorney general. Keep in mind, by 1880, the EMC had been operating either partially or completely as a diploma mill for well over a decade…and after the failed attempt by the state legislature to shut down EMC in 1872, it was almost as if the authorities just threw up their hands and said, “We give up!” Singerly pledged the money for a sting operation against Buchanan and EMC; Norris was the inside man who handled the details of the operation that resulted in criminal charges that finally stuck against Buchanan.

I wish Norris had left some type of journal or diary because he seemed like an incredibly driven man—a lifelong newspaper man who already operated as city editor for Record by age 24. Norris seemed to have a crusader’s zeal—he loved investigative journalism and had no fear in taking on big targets. He was an immensely talented man who later worked for both Joseph Pulitzer and William Randolph Hearst. That’s an astounding resume!

THAS: In his day, Dr. John Buchanan sullied not just the reputation of the medical profession, but of Philadelphia. He was able to slink out of the public eye and the history books until you forced him to face up to what he did in Diploma Mill. How would you like readers remember his legacy today and maybe apply a more skeptical eye to rooting out corruption?

David A. Johnson: I think Buchanan and the EMC offer a wonderful cautionary tale about the excesses that inevitably arise from unbridled capitalism and a complete lack of regulation. There’s a reason so many pundits and historians are reminding us about the excesses of the 19th and early 20th century and the socio-political pushback that resulted in the Populist and Progressive movements. John Buchanan and the EMC are perfect examples of the excesses of that period—including its avarice and willingness to endanger the public in the pursuit of monetary gain.

THAS: In closing, let me ask you to make your pitch: Why should readers pick up Diploma Mill and follow the spectacular, scandalous collapse of John Buchanan and the EMC?

David A. Johnson: I think Diploma Mill serves up a juicy slice of 19th century American life. Sure there’s the medical piece but there are secondary characters and side stories that feature spiritualism, political intrigue, a race riot, an abortion manslaughter case, a state senate investigation, several criminal trials, a crusading newspaper man and more…and the best part? It’s all true.

THAS: David A. Johnson, thank you so much for sending me a copy of Diploma Mill: The Rise and Fall of Dr. John Buchanan, and for dragging this infamous fraudster out of the pages of history where he has been hiding for a century. I enjoyed watching justice be served on him and the many fake doctors he enabled. I hope readers will feel the same way as they read your book. It’s part medical thriller, part true-crime drama, and all enjoyable

David A. Johnson: Thank you, Dean. It’s been a pleasure. I hope followers of the History Author Show will enjoy reading Diploma Mill as much as I enjoyed researching and writing it!