U.S. health care, History of medicine, Disease
Elaine Breslaw’s book provides a synthesis of scholarship on health care from the Columbian contact to the 1890s. Through ten chapters, the book integrates scholarship on such topics as the “demographic disaster of the early European–Indian contact, the treatment of and changing concepts of disease, childbirth practices, the training of medical personnel, food habits and nutrition, military medicine, alternative medical practices, and public health problems” (6).
Breslaw claims that her study also tackles the “fall” of American medicine, and particularly how the medical profession failed to incorporate scientific advances made in France and Germany when such knowledge contradicted American doctors’ theories of disease (4–5). In doing so, the medical profession not only failed to improve health, claims Breslaw, but “often became a stumbling block to advances in medicine” (4).
As a synthesis, Breslaw’s book succeeds in its aims. Although Lotions, Potions, Pills and Magic does not contain much new material for historians of medicine (and offers bibliographic essays for each chapter rather than endnotes), it does serve as a helpful starting place for historians unfamiliar with medicine and health in early America. For example, chapter 1, “Columbian Exchange,” offers an interesting portrayal of health challenges for both Native and European populations, offering an array of academic opinions on why so many Native Americans suffered and died upon contact with European diseases. Chapter 7, “Giving Birth,” begins with the ubiquitous story of Martha Ballard but also supplies interesting material on Native American birthing practices (114).
As to Breslaw’s tale of an American profession that fell from grace, I have several concerns. Two characterizations populate the text, one that depicts early American therapeutics as brutal and ineffective and the other that describes the medical profession as “unable to organize, retarded by a vast army of illiterate and incompetent medical personnel, stymied by American exceptionalism and superiority that precluded learning from European developments” (185). In Breslaw’s portrait of medical practice, patients endured brutal treatments (heroic therapeutics such as calomel and bloodletting) for decades because of their respect [End Page 782] for physicians, only to lose that respect and reject traditional medical treatment by the early nineteenth century. Thus, in this story, people found little benefit, yet continued to consult with traditional physicians, as many surviving physicians’ daybooks can attest.
Certainly, Breslaw’s emphasis on epidemics highlights the inadequacies of medical treatment in early America, but what of the day-to-day practice of medicine? John Harley Warner’s The Therapeutic Perspective: Medical Practice, Knowledge, and Identity in America, 1820–1885 (Cambridge, MA, 1986) demonstrates that there were sharp regional differences in medical treatment in hospitals, and recent scholarship provides further evidence that New England physicians in private practice never used heroic therapies to the extent of Benjamin Rush and his colleagues in Philadelphia.
The ineffectiveness of medical treatment in early America can also be questioned. Recent analysis of private practices in Massachusetts shows that with two common ailments for which patients regularly sought treatment from traditional physicians—constipation and pain—doctors provided effective treatment with mild-to-moderate cathartics and opium. As to the brutality of early American medicine, one has only to imagine the judgment of those, decades from now, reviewing the current treatments of cancer with chemotherapy to understand the dangers of judging the brutality of medical treatments of the past. Finally, Breslaw’s presentation of the early American medical profession as rejecting European advances ignores Warner’s arguments in Against the Spirit of System: The French Impulse in Nineteenth-Century American Medicine (Baltimore, 1998), a study that explores the rise of empiricism and the expectorant approach to medical treatment among New England physicians influenced by the Paris Clinical School.
In the epilogue, Breslaw appears to reveal her motivations for writing this book. She makes connections between the earlier physicians’ “nineteenth-century model of animosity and rejection of alternatives” and the modern U.S. health system’s “medical absolutism” that is “giving way to...