Revolutionary Medicine: The Founding Fathers and Mothers in Sickness and in Health

Epilogue: Evolutionary Medicine

« 231 » Epilogue Evolutionary Medicine Without health we enjoy nothing. —Dolley Madison to Anna Cutts, April 8, 1812 Not only were America’s founders political actors on the stage of the eighteenth-century world, but on multiple levels they contributed to advancements in American medicine, illustrating the complex links between politics and health. This was perhaps most visible in the manner in which intellectual leaders like Washington, Franklin, Adams, Jefferson, and Madison used their positions to influence public health and disseminate knowledge about better health practices to their families , communities, and citizens in the nation at large. Their numerous personal encounters with illness and loss made them acutely sensitive to issues surrounding medical practices and disease. Certainly they all believed that the health of the individual and the health of the community were closely intertwined, and that a democratic government and individuals could work together productively to promote the health of all Americans. In other words, they viewed common progress as the best measure of individual progress. As prominent medical historian Charles E. Rosenberg has observed, “There is nothing more fundamental in the history of American health care than the mixture of public and private. . . . It has long been assumed that the state has some role— and an interest—in protecting the health of its citizens generally and of providing at least minimal care for the helpless and indigent.”1 In the face of terrifying ubiquitous threats of diseases of their era, such as smallpox, cholera, yellow fever, and typhoid, these extraordinarily civic-minded founders often acted not only with personal 232 « Epilogue courage but also with admirable self-sacrifice in order to carry out their political responsibilities and help their neighbors and fellow citizens safeguard their individual and collective health. Franklin’s lifelong effort to reduce the incidence of smallpox through education about the benefits of inoculation and his scientific health experiments, Washington ’s campaign to inoculate his soldiers against smallpox and to provide them with a healthier military camp environment, Adams’s concern for isolating potential carriers of disease and caring for maritime sailors through the creation of the Marine Hospital Service, and Jefferson’s crusade to make smallpox vaccine more readily available to the American public are just a few examples of their momentous public health activities. Imbued with republican ideas, they all believed that helping to ensure the health of American citizens was not only an admirable humanitarian ideal but a practical way of fostering productivity by increasing the population and growing the economy. Moreover, the government could play a vital role in the process by engaging in health intervention when appropriate. In 1734, when Franklin reprinted the popular self-help medical manual , Every Man His Own Doctor, he was reflecting the medical milieu of the age. Of course, doctors were called in by those who could afford them when deemed necessary, but most farmers, planters, household heads, and their wives were familiar with symptoms of many contemporary diseases and at least basic medical treatment for everyday ills and medical emergencies. As we will see below, not until the late nineteenth century were American physicians able to fully consolidate their elite professional status. Today Americans almost always consult a doctor for maladies such as bacterial and viral infections, high fevers, and serious diseases such as diabetes and cancer, which our forebears would have at least initially treated themselves.2 Almost all of America’s founders, most notably Franklin, Jefferson, George and Martha Washington, Abigail Adams, and Dolley Madison, were at times medical practitioners themselves, dispensing home remedies and informal medical advice, and in the case of Washington and Jefferson even performing medical procedures , such as inoculation for their families and slaves. Abigail, Martha , and Dolley, often at great personal risk, worked tirelessly to nurse family members and neighbors, setting an example for their entire Evolutionary Medicine » 233 communities. Certainly medical care at the time was part of everyday “women’s work.” Some of the founders, especially Jefferson, even took what we would term today a more holistic approach to medicine. His underlying medical belief was based on a philosophy of vis medicatrix naturae, that the human body possessed a natural tendency to heal itself—if physicians and the patient would only refrain from derailing that process with invasive heroic measures. Some of the medical practices followed or suggested by the American founders in this study appear ludicrous to modern ears. As Enlightenment scholar Peter Gay...