Final answer:
The intense competition in medical practice during the preindustrial era was due to the lack of formal medical standards and certifications, which allowed anyone to practice medicine, leading to a variety of primitive and sometimes harmful treatments. The role of spiritual healing and social inequalities also contributed to the fragmented medical field.
Step-by-step explanation:
Medical practice was characterized by intense competition in the preindustrial era for several reasons. Notably, anyone could practice medicine, as there were no formal standards or certifications required to do so. This lack of regulation meant that medical procedures were often primitive and non-standardized, which led humans to rely on a range of remedies from folk medicine to more harmful practices like bloodletting. Additionally, without the germ theory of contagion or advances like antibiotics and vaccines available, people often turned to clergymen and spiritual healing during epidemics, with some levels of resistance from religious authorities towards certain medical procedures. Social and racial factors also played a considerable role, as there was profound inequality in access to healthcare, notably for African Americans, who either used folk medicine or were barred from practicing by laws, further fragmenting the medical field and fostering competition among practitioners. Moreover, without powerful professional organizations like the American Medical Association, which was founded but initially had limited influence, there was little to no standardization in practices, leading to a proliferation of quack doctors and a desperate need for effective treatments.