Lotions, Potions, Pills, and Magic: Health Care in Early America

Conclusion

>> 185 Conclusion The medical profession teetered on the edge of the abyss by the mid-nineteenth century. American doctors, often caught up in their own desire for preservation as a profession and clinging to outmoded therapies, proved to be doing more harm than good. They unwittingly encouraged alternative modes of treatment that successfully undermined the orthodoxies of humoral medicine. Although the cholera epidemics of the antebellum period demonstrated the futility of the physician’s medicine, it did not bring forth any radical changes in theory, only a slight moderation of previous therapies . Unable to organize, retarded by a vast army of illiterate and incompetent medical personnel, stymied by a belief in American exceptionalism and superiority that precluded learning from European developments, there was little that doctors could do to recapture their earlier prestige and authority. And yet, even in the colonial era, at the peak of respectability, doctors faced opposition in many forms—from scientifically inclined laymen to the mass of people who drew on their own domestic medicine to African Americans who opposed them as surrogates for the slave master. Thus tensions and 186 > 187 the medical practice of others. When those standards of education and social position declined in the following century, so too did the status of the physician. Colonial America benefited from an unusually healthy lifestyle because of the cheapness, variety, and abundance of food as well as the easy availability of alcoholic drinks. They not only had a longer life expectancy than their Old World forebears, but they were taller and the women more fertile. Both black and white, enslaved and free, rich and poor no longer suffered from famines. Shortages of food were usually temporary and seasonal, and did not affect long-range nutrition. Some physicians objected to that abundance, concerned that too much food led to sloth and poor health, but such advice was generally ignored. Although diets were not balanced in modern terms, the sheer quantity overcame the poor quality of many foods that had been preserved in sugar or salt. Although the quality of food deteriorated even more in later years and alcoholic consumption increased, the abundance continued to support a relatively healthy population. The growth of urban areas and increasing immigration of poor people with inadequate access to food in the nineteenth century began to undermine those healthful conditions. Orthodox medicine played only a minor role in the health of the population except in those cases when heroic remedies, as in the case of George Washington, contributed to death. The few laymen of those earliest years who found particular therapies objectionable were small in number and had no interest in undermining the role of the physician, merely correcting what they considered to be questionable treatments in certain circumstances. Such objections did create some tension between laymen and the professionals but it was not enough to weaken the authority of orthodox medicine. Even Cotton Mather’s dispute with the medical establishment and successful inoculations for smallpox in the 1720s did not damage the image of the local doctors. Nor did the colonial physician see any threats from domestic or folk medicine . All shared a common framework for explaining disease and ill health. The practices of the folk were, for the most part, complementary not competitive . Confidence in the doctor’s skills and knowledge led many nontraditional and domestic healers to accept and practice the same kind of medicine as the professional and doctors were willing to learn from them. The belief that they could cure was the most potent medicine in anyone’s medicine bag. Nonetheless, the early American doctor plied his trade among only a small proportion of the population-–the affluent and the destitute. They tried to expand their reach as male midwives by appealing to the more leisured class of women and convincing them that childbirth was a medical problem . The majority of the population, however, continued to rely on home 188 > 189 There were a small number of doctors with such authority in this early period, but their ideas had extraordinary influence in continuing the incarceration of the mentally ill and the application of depletion therapies taken from Benjamin Rush’s peculiar theories. The emphasis on the somatic element in treating insanity also continued in different guises. Rush’s gyrator certainly has an offspring in the later electric shock treatments. Custodial care may have had its advantages in keeping the insane in a safer environment , and at best kept fed and sheltered, but did little to aid...