Lotions, Potions, Pills, and Magic: Health Care in Early America by Elaine G. Breslaw (review)

Many histories chronicle American medicine’s transformation from its chaotic and disorganized beginnings into “scientific medicine” in the late nineteenth and twentieth centuries.¹ By synthesizing secondary sources in a tightly packed two hundred pages, Elaine Breslaw resists retelling this triumphalist narrative and instead focuses much needed attention on medicine and health in America before the Civil War.

Breslaw’s narrative is not a cheery one. While she examines the many sides of the “American experience” of healthcare and medicine, it is the role of the doctor that drives the story. Breslaw condemns the medical profession in her synthesis, attributing the decline of healthcare in the nineteenth century to the practices of orthodox medicine. She argues that “the medical profession in America failed to improve health and often became a stumbling block to advances in medicine” (4). Breslaw’s argument depends upon and expands Ronald Numbers’s essay, “The Fall and Rise of the American Medical Profession” (1985), focusing specifically on the “fall” and the reasons American medicine declined in status in the eighteenth and nineteenth centuries.

Breslaw ranges over a wide variety of topics in ten chapters. The first two chapters describe the impact of disease on native, slave, and European populations. Smallpox and the practice of inoculation play a large role in this early story. In both chapters, Breslaw notes that medicine, particularly doctors, could offer very little to those who were sick, beyond relieving their pain. She also argues that a growing conflict within the medical profession, between traditional and experimental treatments, which often involved lay people, “would eventually lead to a loss of faith” in medicine (41). Still, Breslaw acknowledges that doctors continued to hold a place of esteem in American society before 1800. Alongside doctors, there were a variety of medical practitioners that she describes as a “shadow health system,” and a growing market in self-help medicine that helped fill the need for medical care (52).

Breslaw identifies challenges to the medical profession as early as the Revolutionary War. According to her account, the Revolutionary War did little to enhance the respect for physicians in America, as medical services during the war were disorganized and fraught with tension. Physicians and medical personnel in the war struggled to improve the situation in the face of a Congress that did not prioritize health; this governmental indifference continued in the nineteenth centuries when public health problems arose with the growth of cities. Local governments responded to epidemics as they arose, but the federal government implemented no standardized public health measures.

Breslaw notes that the expansion of the American nation after the war continued to undermine the status of physicians, as the lack of doctors on the frontier forced settlers to rely on themselves for healthcare. In addition, African Americans distrusted doctors both because they sometimes used slaves in medical experiments and because they were part of a system that supported slavery itself. Breslaw also describes how doctors tried to push their practice and authority into childbirth and the treatment of the mentally ill, but she demonstrates their limited success in both areas during the eighteenth and nineteenth centuries. In a familiar narrative, Breslaw finds that the final straw came with the rise of sectarian medicine in the early nineteenth century, and the rejection by many patients of heroic and depletive measures in therapeutics, pushing orthodox physicians to the margins of medical care in America. Ineffective remedies and poor training of orthodox practitioners, coupled with the anti-intellectualism of nineteenth-century America and the rejection of European “science,” contributed to the fall of medicine. In her epilogue, Breslaw briefly describes the rise of orthodox medicine again in the late nineteenth century, with the establishment of Johns Hopkins University in the 1890s.

Breslaw does well incorporating strands from some of the best medical histories available to weave...