Emergence of Professionalism in Late 19th and Early 20th Century America

The period between 1870 until the start of the first world war in 1914, or thereabouts, is often called the Progressive Era in America’s historical development (Gilmore, 2002; McGeer, 2003). It was a time of social upheaval, when many Americans living in the country were moving to the cities creating overcrowded conditions, when the industrial revolution took hold, creating an impoverished work force that included young children as well as adults, when several waves of immigration took place leading to city slums. Americans involved in creating the solutions to these severe problems came to be called the progressives because they believed that progress was possible and they were willing to work toward building a new America.

There were a number of radical solutions for solving some of the problems. Settlement houses were established, such as the one begun by Jane Addams in the inner city of Chicago, to provide food, clothing, education, and a sense of community to new immigrants. Labor unions, such as the International Workers of the World, lobbied to improve wages and working conditions. Child labor laws were passed to protect children who were in the workforce. Women campaigned for the vote. Asylums for the blind, deaf and mentally retarded were founded. And the individual states passed compulsory education legislation requiring all children to attend school.

It was in this progressive context, where many Americans felt responsibility for one another, that a new sense of professionalism emerged. Those, like Jane Addams, at first served as volunteers and reformers to provide services to those who needed them. The second generation of volunteers began to organize and develop specialty training, and lobby for salaries. For example, the volunteers in the settlement houses such as the Hull House in Chicago or the Henry Street Street Settlement in New York regrouped and called their activities “social work”. Settlement houses began to be replaced by mental health or guidance clinics, staffed by trained mental health professionals. In this cultural atmosphere of emerging professionalism, those members of the society who provided speech and language therapy began to think of themselves as members of a profession, and to start organizing themselves accordingly.

The emergence of professionalism in America

During this progressive era a number of professions were organized in the US —social work, medicine, special education. One primary issue for those with an itch to become “professional” was to decide who were to be members of the profession and who would be excluded. This involved creating standards and criteria for qualifications of its members.

Another issue dealt with by these early 19th century budding professions had to do with determining their nature and scope of practice. The notion of scope of practice is intertwined with another issue, one having to do with assuring monopoly over the domain marked off in the scope of practice. These dual goals of great concern for fledgling organizations have been talked about as “jurisdiction” (Abott, 1988) and “monopoly” (Brown,1992) of professional groups.

In order to gain a monopoly, professionals attempted to demonstrate that it was their members who had greatest expertise in the domain of contention. They did several things to establish themselves as experts. One main way was to carry out and disseminate experimental research. Organizations used knowledge of the research being done as a way to assess the competence of those seeking membership in the profession. So a big responsibility for new professionals was to find or create venues where research could be conducted, and where results could be disseminated. College and university programs were instituted, conventions were held, and journals were created so that the profession could identify those with expertise, exclude those without it, and maintain control over how and what constituted best practices.

In sum, among the many particular individual concerns of the new professional groups, there were four that seemed central to all. They involved the need to (1) determine qualifications for professionals; (2) identify a profession’s jurisdiction; (3) establish ways for obtaining monopoly over the activities that fell within the jurisdiction; and (4) carry out a scientific program to build a knowledge base for assessing professional expertise.

Among the professions that reorganized or formed themselves in this period were: medicine, special education, and speech correction. Each dealt with the four concerns in its own way.


In the mid 19th century, physicians in America had little status and required little training (Starr, 1982). The salaries were quite varied, with the physicians servicing the poor barely making a living and those serving the wealthy quite well-to-do.

There were also different factions, called “sects” by Paul Starr, (1982, p. 93), each having different philosophical groundings for their practices. The primary group of physicians, were conventional, or what Starr calls “orthodox” (Starr, 1982, chapter 3) who based their practices on natural philosophy and experimental science. Some of their remedies were quite extreme (called “heroic therapy” by Starr, p. 94) that involved bleeding, heavy doses of mercury, and other methods now judged lethal.

Homeopaths, a second sect, drew from the philosophies of German immigrant physicians. They believed that diseases could be cured by drugs which produce the same the symptoms in a healthy person. They also administered their drugs in small doses, believing that the more diluted the dose, the greater the effect. Homeopaths stressed the need for individual attention and for research on the effect of medication, thereby subscribing to the importance of scientific testing.

A third group called themselves the “eclectics.” They combined the herbal medicine practices of the homeopaths with the traditional approaches of orthodox medicine. They opposed the use of heroic therapy practices of the orthodox physicians. They were political reformers and took a strong, vociferous stance against the orthodox physicians.

All three groups wanted more status, higher salaries, greater authority, and credentialing, but they fought against one another’s efforts to achieve any of this. Eventually, they were able to work together to form the American Medical Association, becoming a single profession. In so doing, they addressed the four issues common to all groups working to achieve professional status: medical qualifications, scope of medical practice, monopoly of medical jurisdiction, and the creation and dissemination of medical science.

1. Medical qualifications.

Physicians of all persuasions who were lobbying their fellow physicians to organize into a professional organization were interested in legitimizing their themselves by establishing qualifications for medical practitioners. The American Medical Association was formed mainly for this purpose in 1847. The founders took as one of their main business items at the founding meeting the business of creating minimum requirements for medical training. In 1904, the AMA’s Council on Medical Education mandated a minimum standard for physicians that included four years of high school, four years of medical training, and passing a licensing test (Starr, 182, p. 117).

2. Jurisdiction of medical practice

In order to establish a scope for medical practice, physicians talked about their responsibilities in relation to other professionals. For example, the newly founded AMA stipulated in their 1903 code of ethics their relationship to the profession of pharmacy (Chapter 3, section 4):

It is the duty of physicians to recognize by legitimate patronage to promote the profession of pharmacy on the skill and proficiency of which depends the reliability of remedies, but any pharmacist who, although educated in his own profession, is not a qualified physician and who assumes to prescribe for the sick, ought not to receive such countenance and support. Any druggist or pharmacist who dispenses deteriorated or sophisticated drugs or who substitutes one remedy for another designated in a prescription, ought thereby to forfeit the recognition and influence of physicians.

3. Medical monopoly

To affirm that they were the ones in charge of the things they identified as within their jurisdiction, the founders of the AMA worked to identify and educate the public about those they considered unqualified to practice medicine. In 1849 the new organization established a professional board to analyze “quack remedies and nostrums” and to enlighten the public in regard to the nature and danger of such remedies and in the 1903 code of ethics they addressed, among other things what physicians should do about charlatans and about physicians who do not meet the standards of the orthodoxy. For example, in chapter 2, section 1 they say:

It is inconsistent with the principles of medical science and it is incompatible with honorable standing in the profession for physicians to designate their practice as based on an exclusive dogma or a sectarian system of medicine.

And in chapter 3, section 4, they elaborate:

It is the duty of physicians who are frequent witnesses of the great wrongs committed by charlatans, and of injury to health and even destruction of life caused by their treatment, to enlighten the public on these subjects and to make known the injuries sustained by the unwary from devices and pretensions of artful imposters.

4. Medical science.

Each of the three medical groups vying for professional authority had its own medical school and professional association by the mid 1880s. In 1883, American Medical Association began publishing the Journal of the American Medical Association which became the main publication venue for medical studies and the place to go to learn, teach, and display medical science.

Following a model forwarded by Johns Hopkins Medical School, medical schools throughout the country began shifting from a clinical curriculum taught by experienced practitioners to one that was based on scientific research taught by medical researchers. Medical students at Johns Hopkins were required to come with a college degree. The graduate curriculum at Johns Hopkins was rooted in basic science and laboratory study. Residencies were developed for advanced scientific training in a specialized area.

Special education

While there were a number of custodial and vocational programs for individuals with severe disabilities by the mid 1800s (Osgood, 1999), it was not until the 1890s that special education services began to be provided in public schools. These services were for less severely involved children—children who were then identified as “morons” or “backward children”.

A special class for “backward children” was first established in 1875 in Cleveland, Ohio, and then in 1896 in Providence Rhode Island. By 1902 the following school systems had opened classes for children who were identified by their teachers as being either “wayward” or “backward” (Chace, 1904; Tyor and Bell, 1984, Wallin, 1924).

By 1911, 99 cities were reported to have special classes and 220 cities with ungraded classes for backward children (Van Sickle, Witmer & Ayres (1911).

Special educators, like physicians, began organizing themselves into a profession during the progressive period, establishing their professional qualifications, their professional jurisdiction, how to maintain monopoly on their jurisdiction, and the scientific basis for their practices.

1. Qualifications of special educators.

The teachers of the first public school special education classes for backward children were trained as regular teachers, with an add-on, sometimes, of a workshop or course in specialized methods. In Boston, in this early period when special education classes were first formed, administrators favored hiring kindergarten teachers because of their training in working with beginning students. Lincoln, for example, describes the first special education teachers in Boston as:

Women of experience in their profession, acquainted with kindergarten methods, some of whom had been trained…at Barre [an institution in Massachusetts] and Mrs. Seguin’s school, while others had been sent by the Board to spend three months in residence at Elwyn [in Pennsylvania]… The teachers thus chosen wee practically allowed to act as their own judgment dictated. There was no requirement, scarcely even a suggestion, as to the result to be sought, or the methods to be used; the work to be done is very much the same as in state schools for the feebleminded (Lincoln, 1903, p. 84).

Later, formal courses were offered by university programs that then became required by state departments of education. In 1896, Lightner Witmer offered a three week summer course for teachers in training at the University of Pennsylvania ; in 1906 New York University offered a course on the “Education of Defectives”; and in 1908 Teachers College at Columbia University offered a course on “The Psychology and Education of Exceptional Children (Connor, 1976). A number of these courses were taught by Elizabeth Farrell, a special educator and administrator in New York City.

In 1910, A. A. J. Miller, an assistant superintendent of the Baltimore Public Schools presented a paper to the National Education Association outlining the ideal qualifications for special education teachers:

  1. training in a good normal school
  2. basic coursework in a variety of liberal arts and education subjects
  3. five years of approved experience in the grades
  4. superlative spiritual equipment

By 1929, there were 100 institutions of higher education in the USA that offered from 1 to 12 courses for the training of special education teachers (Connor, 1976, p. 369).

Throughout this phenomenal period of growth, special education teachers, like their colleagues who were also establishing their professions, felt a need for having standardized qualifications. This need was expressed in the founding document of the Council for Exceptional Children (called then the International Council for the Education of Exceptional Children). One of the three main aims of the new organization, formed in 1922, was: “to establish professional standards for teachers in the field of special education (Kode, 2002, p. 89).

Up to that time, the primary organizations for establishing credential requirements for special education teachers were the regional boards of education. These boards differed from one another. For example, in New York City in the early 1920s, teachers were required by the Board of Examiners to have three years teaching experience, and to pass a three part exam: written, oral and practical. The written exam consisted of two papers, one on methods of ungraded instruction and the other on principles of education. The oral exam evaluated applicants’ use of English and classroom management techniques. And the practical exam consisted of a demonstration of the ability to do basketry, play the piano, draw and sew (Kode, 2002, p. 76-77).

2. Jurisdiction of special educators.

The primary role played by special educators has been to teach children with special needs in the public schools system. While the teachers tend not to be involved in decisions about which children they will be teaching, in the early days of special education, around 1913, they sometimes worked in school-based psycho-educational clinics. In this case, the special educators extended their scope of practice from classroom instruction to doing diagnostic work as a member of a diagnostic team. The group members worked together to make decisions about special class placement and programming for individual children.

3. Monopoly of educational jurisdiction.

Since schools did their own hiring, the monopoly that special educators had over their practices were locally determined. Divisions of labor of professional duties that were being negotiated at that time can be examined by looking at the assignment of duties to the various members of a team in a psycho-educational clinic. The psychologists administered intelligence and other kinds of tests. The physician examined children for disease and recommended needed medical treatments. The social worker (volunteer visiting teacher) evaluated the home circumstances and counseled family members. Special educators evaluated children for their academic skills (from Kode, 2002, pp. 49-54, re Elizabeth Farrell’s clinic in the New York City Public Schools.)

4. Scientific basis for special educators’ practices

The first leaders of the special education movement, like other in the field of education at that time, were interested in increasing their status by creating a scientific basis for their practices. They were among those in the schools and institutions like Vineland Training Center, who established research laboratories and developed batteries for measuring the physical and mental status of students and residents. They joined others in the child study movement to create test batteries for evaluating students’ abilities and measuring their progress.

Elizabeth Farrell, for example, when establishing a scientific basis for placing New York City children in special classes, had the staff of her psycho-educational clinic carry out the following measures:

In order to disseminate their scientific findings to their members and to their affiliates, special educators began to have professional meetings and produce journals. There were journals that were affiliated closely with particular institutions, the most well known being the Vineland Institutions “Training School Journal.” There was also the Journal of Psycho Aesthenics (begun in 1896) that was issued by Association of Medical Officers of American Institutions for Idiots and Feeble-minded Persons (later to become the American Journal of Mental Deficiency) (Scheerenberger, 1983, p. 119).

The International Council for Educating Exceptional Children began holding annual meetings for educating special educators in the science and practice of the field in 1922. In 1942, the group inaugurated their journal, The Journal of Exceptional Children.

Speech correction

Like for their sister professions, practitioners and researchers in the field of “speech correction”, as it was then called, began to realize that it was time for them to get themselves organized. These specialists were situated in various disciplines, some of which already had professional identities and organizations. For example,

These professionals, along with a number of others, began to feel allied with one another, even though there was no one organization where they could express their commonalities and professional identities. Some began to meet together at the conventions of one parent profession, American Speech Association. There they worked their colleagues to create a specialty group. They were particularly interested in establishing their independence, creating a research base, and policing the field for quacks and charlatans (Kester, 1955). This core group, like those who organized professional groups that preceded them, worked to establish professional qualifications, practice jurisdiction, practice monopoly, and scientific grounding for those entering and working in the field of speech correction.

1. Qualifications for professional speech correctionists.

The constitution of the American Academy of Speech Correction, approved in 1926, stipulated the groups aim “to raise existing standards of practice among workers in the field of speech correction” (Anon, 1927, p. 312). Their first way of approaching this was to establish themselves as a clinical/academic elite, who would oversee the practices of those who did not qualify for membership in the academy. Only those who were doing research and who had higher academic degrees were eligible for membership in their organization. Acceptance of new members into Academy required the following (Anon, 1927, p. 313):

  1. Active present participation either in actual clinical work in speech correction or in administrative duties immediately concerned with supervision and direction of such work.
  2. Possession of an M.D., Ph.D., D.D.S., or of a Master’s degree, in the securing of which degree important work shall have been done in speech correction or some closely allied field such as psychology, phonetics, modern languages, mental hygiene, psychiatry, or medicine.
  3. Publication of original research in the form of a monograph, magazine article, or book.
  4. Possession of a professional reputation untainted by a past record (or present record) of unethical practices such as blatant commercialization of professional services, or guaranteeing of “cures” for state sums of money.

The membership in the Academy was restricted further by the stipulation in the constitution that no more than five new members can be inducted into the academy any one year (Anon, 1927, p. 312).

Thus, the Academy did not see itself as a group that represented practitioners (whom they called “workers in the field of speech correction”). Rather, the members of the Academy regarded themselves as a group who would, by example, raise professional standards. One of six stated aims was to “to make membership in our organization a coveted recognition of merit and in this way to furnish workers in the field of speech correction with a powerful incentive to greater achievements” (Anon, 1927, p. 312). Another statement of their advisory role was explicated in another of their aims” “to furnish this new profession with responsible and authoritative leadership” (Anon, 1927, p. 312).

Five years later the Academy opened up its requirements by voting for a new level of membership, the “Associate,” for which members need to have a Bachelors degree and to have completed three years employment in the field. They were not required to have a publication or a higher degree, like the original members were. Rather than have a single level of membership and give up their higher status, the group maintained most of the original criteria and established a for a higher level of membership—those they called “ASHA Fellows”. Fellows were required to have a higher level degree (MA or above) and to have published original research. Thus, the in 1930, the American Academy of Speech Correction became a two-tiered organization made up of Associates and Fellows, with different membership criteria for each. The hope of the organization was to require all speech correctionists to become members thereby raising the standards of the profession, as they aimed to do at the outset, and disqualifying those “quacks” and “charlatans” who had no education in the profession.

The Academy continued to hone their professional requirements and standards. In 1941 they established four levels of membership, three were related to employment standards and the fourth was an honorary level--the jolly good Fellow. Finally, the profession had in place a means for controlling the quality of practice. The membership levels were:

  1. Associates members were not yet ready for employment, except as apprentices.
  2. Clinical Members had completed their education and were qualified to practice, under supervision.
  3. Professional members were considered fully qualified to practice.
  4. Fellows, like professional members, were fully qualified to practice.

2. Jurisdiction of speech correctionists

In order to create professional jurisdictions it is helpful to have a conceptual model that determines what to lay claim to. It was not clear to the founders of speech correction and their colleagues, what group of conditions that they would be in charge of. For example, are they responsible for those whose communication disorders stem from retardation? What about those who wanted to improve the speech, but who had no speech problems? So, much of the activity of the early practitioners and founders of the profession was to establish a model and taxonomy of conditions that would fall within their jurisdiction.

The model they picked was a medical one, the taxonomy they devised was based on the biological-disease basis of speech-disorders. A nomenclature committee, set up in 1927 by the American Speech Correction Association, provided an outline and descriptions of the various conditions that speech correctionists were responsible for (Anon, 1927, p. 347). In the words of Sara Stinchfield, member and primary mover on the nomenclature committee:

The attempt is made in this arrangement to give the student an outline of practically all of the commonly found disorders of speech, such as appear in home, school, and speech clinic, and to so group them that they may come under one of seven main headings: dysarthria, dyslalia, dyslogia, dysphasia, dysphemia, dysphonia, or dysrhythmia…It was necessary for the committee on terminology to coin a number of new terms having old prefixes, frequently defining the older and better-known terms as synonymous with the coined ones (Stinchfield, 1933, p. 29).

The listing was extensive, over 100 different diagnostic categories, with more attention paid to naming the conditions than to describing, diagnosing, or treating them. The need for the listing was to indicate which conditions speech correctionists were responsible for. That is, this was the grouping of conditions that constituted their scope of practice.

Another effort to define the scope of practice made by the founding professionals and their colleagues, was to do prevalence studies. There was considerable activity by researchers and practitioners to find out how many people in a given institution had speech disorders and what types of disorders they exhibited. In this way, professionals were claiming responsibility for those they identify as needing their services.

3. Monopoly of speech correctionists’ over their jurisdiction.

The concern about identifying charlatans and ostracizing them from the field of speech correction was not only one held by the founders of the profession, but also by their predecessors. For example Potter (1882), Warren (1837), Werner (1881) and Zug (1881), all berated and exposed practitioners who either promised a quick cure, charged too much, or did therapy with little study or information about what is considered by established practitioners or scientists to be best practices.

Later, in the 1920s the profession’s founders reiterated their concerns about unethical practices of those who tried to pass themselves off as legitimate. The American Association of Speech Correction added to its 1926 constitution the following listing of what constitutes unethical practices:

It should be considered unethical:

  1. To guarantee to cure any disorder of speech.
  2. To offer in advance to refund any part of a person's tuition if his disorder of speech is not arrested.
  3. To make “rash promises,” difficult of fulfillment, in order to secure pupils or patients.
  4. To employ blatant or untruthful methods of self-advertising.
  5. To advertise to correct disorders of speech entirely by correspondence.
  6. To seek self-advancement by attaching the work of other members of the Society in such a way as might injure their standing and reputation. Reproaches or criticisms should be sympathetically discussed with the member involved.
  7. For persons who do not hold a medical degree to attempt to deal exclusively with speech patients requiring medical treatment without the advice of or the authority of a physician.
  8. To extend the time of treatment beyond the time when one should recognize his inability to effect further improvement.
  9. To charge exorbitant fees for treatment.

While there was little they could do to exert their monopoly over the practice and to ostracize those they considered unprofessional, since this was before credentialing and licensure, they did make an effort to apprise the public of their concerns.

4. Speech correction science

There were a number of ways that the founders in the field of speech correction used science to enhance their reputation and establish their knowledge base. They carried out studies of phonetics, did brain research, designed technologically sophisticated (for the time) devices to measure performance, embraced the psychological testing movement, and used and added to the developmental norms collected by those involved in the child study movement.

It was the science component of the field that was emphasized in university programs, and that formed the basis of newly developing university training programs. For example, Sarah T. Barrows, a phonetician, was among the first faculty members hired at the University of Iowa in the newly formed Department of Speech. The Quarterly Journal of Speech Education, the journal issued by the American Speech Association announced in a 1923 issue:

Among the first American universities to recognize the science of phonetics is the State University of Iowa, which has recently appointed Miss Sarah T. Barrows to a position in phonetics in the Department of Speech. Miss Barrows has studied with many of the foremost phoneticians of Europe, both in theoretical and instrumental phonetics. She is especially interested in comparative phonetics and has studied the sound systems of many different languages….opportunity will be offered for research work in some of the phonetic problems: interpretation of intonation curves, transliteration of dialects, application of phonetics to the teaching of reading. A clinic will be arranged for the improvement of speech difficulties… (Anon, 1923, p. 398).

Another way for the new profession to embrace science was to adopt the medical model when accounting for speech and treating speech disorders. This wholesale adoption is evidenced in the effort of the profession to standardize the diagnostic terminology and to used Latinized forms borrowed from medicine.

Finally, in 1936, the group began its own journal, the Journal of Speech Disorders. The journal provided the new organization with a venue for research and with a legitimacy that would, along with other activities, upgrade professional standards and accrue public and professional respect. Their aim was to develop uncontested jurisdictional control of the activities of the profession and to monitor the practices and police the qualifications of those carrying out those activities.


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