Medical Protestants: The Eclectics in American Medicine, 1825-1939

1. The American Landscape

1 The American Landscape The antecedents ofAmerican medical practice exist not only in the richness of European science and medicine but in the ideologically murky challenges of the New World frontier. From these sources, American colonists inherited an optimism that enriched them beyond measure and expanded their lives. Europe favored scholarship and brilliance, exalted high standards, forfeited experience to logic, accentuated contemptuousness, and exuded, above all else, a certain literary flourish. The American frontier bequeathed fresh simplicity, openness, high-spiritedness, vigilance, social compassion, an assumption ofinnocence, and an indomitable belief in common sense and practicality. From these beginnings, American practice manifested a stubborn, unconciliatory attitude that dutifully complemented both its public and its more solitary musings. It was not British and surely not European-but neither was it simply a reflection of native abilities. Few returned from Europe without a higher opinion of its greatness, tempting many to adapt elements of Old World medicine and practice into New World surroundings. Nevertheless, for those Americans living close to the soil, unexpressed in arts and letters, there existed a widespread flowering of imagination that, while youthful in its aspirations, spoke with authority, optimism, and determination. 1 2 lvledical PTOtestants American Improvisation Learned doctors were a rare commodity in the early years of the colonies. "Physicians, like the upper classes in general, did not migrate overseas," observed Richard H. Shryock, "and for a long period no American towns were large enough to train such men on their own behalf."1 When William Douglass, M.D. (1691-1752), with his medical degree from Utrecht, the Netherlands, settled in Boston in 1718, he was the only practicing physician who could boast a university degree. Understandably then, over the course of American settlement, men and women served as general practitioners for themselves and their neighbors and obtained the status of "doctor" simply by assuming the responsibility of healer. People beyond the reach of established educational institutions and statutory regulations fended for themselves, and the lack of medical education worked as no barrier to those gifted few who could inspire confidence while serving community needs.2 Thus, guild titles seemed not to matter as the terms doctor, surgeon, and physician entered the American lexicon without the formal distinctions understood elsewhere. In effect, the sharp delineation between surgeon and physician on the Continent did not exist in the American landscape where doctors advertised themselves as practicing both physic and surgery, as well as midwifery and pharmacy. Moreover, farmers, women, indentured servants, and even slaves acquired reputations as local healers. In addition, countless hordes of itinerant pretenciP.rs beguiled the public with promises and plied their trade unencumbered by degrees, education, or regulation. In keeping with European tradition, many ministers assumed the dual role of healer of bodies and keeper of souls, a practice that, except for the cities, predominated until about 1750. Indeed, as Richard D. Brown explained, "even the most rational and learned individuals ... saw no clear boundary between physical and spiritual phenomena."3 Examples of this physician-minister tradition included Cotton Mather (1663-1728), who introduced smallpox inoculation in 1721; Henry M. Miihlenberg (1711-87) of Pennsylvania; and Jared Eliot (1685-1763) of Connecticut. In A Letter About a Good Management Under the Distemper of the Measles, at This Time SpTeading in the Country (1713), Cotton Mather recommended moderate treatment and good nursing; his book was in- 3 The American Landscape tended "for the benefit of the poor, and such as may want the help of able physicians."4 In this laissez-faire environment, do-it-yourself books abounded, as did a wide array of medical almanacs, which provided a rich source of domestic medicine, recipes, commonly employed remedies, popular herbals, patent medicines, veterinary medicine, and astrology (i.e., indications for the propitious seasons of the year for bleeding and cupping). More serious works written by Simon-Andre Tissot (1728-97) and William Buchan (1729-1805) became the successors to Gervase Markham, The English HouseWife (1636); Countess Elizabeth Kent, A Choice Manual ofRare and Select Secrets in Physick and Chyrurgery (1653); James Hart, Klinekeh; Or the Diet of the Diseased (1633); Humphrey Brooke, A Conservatory of Health (1650); and Thomas Cogan, The Haven of Health (1636), which stressed the efficacy ofmoderate diet and condemned violent purgings and indiscriminate bleedings.5 John Wesley (1703-91), the founder of Methodism, authored Primitive Physick (1747), which went through thirty-eight British and twenty-four American editions. For...