Lecture Two: Colonial Medicine

The Social Contract of Profession

1. The State of Massachusetts allows the Medical Society of ... A monopoly over the practice of Medicine
2. Rationale: Because consumers are unable to judge quality, medical services cannot be a market commodity; it is in the public interest to allow a self-policing independent profession

American Medical Profession

1. England
   • Physicians (RCP)
   • Surgeons (RCS 1745)
   • Apothecaries
   • Barbers
   • Chemists/Druggists
   • Scottish doctors
   • Quacks
   • Licensed Midwives
2. Colonies
   • Doctors
   • Healers

First Wave of Professionalization

1. 1760-1840: The Doctor as Midwife
   • The rise of forceps delivery
   • Who is a real doctor?
   • How do the real doctors get the gift of profession?

Forms of Medical Training

1. College and medical training (very rare)
2. College (30% of 18th century Massachusetts practitioners)
3. Edinburgh
4. Apprenticeship (7 years in UK, max of 5 MA; 36% of 18th century Massachusetts practitioners)
5. Family (20% of 18th century Massachusetts practitioners)
6. Informal - "social medicine"

Diseases in Colonial America

1. Epidemic
   • Smallpox, Diptheria, Scarlet Fever, Measles
   • versus European: typhus (typhoid), plague, dysentary, influenza, consumption
2. Endemic
   • worms, itch, burns
   • versus European: the stone, gout, melancholia

Cotton Mather (1663-1728)

1. Mather is not a doctor, so why is he writing a medical text?
2. Prosperity: soul or health?
3. Health as the most important temporal prosperity
4. Consider Mather's spiritual-physical analogies
5. Consider Mather's view on the relation of spiritual to the physical
6. Mather's rhetorical method and appeal to authority

Mather's Diseases of the Eye

1. Moral Diseases: Envious, haughty, unchaste
2. The centrality of tears
3. Eyes as danger portals: last to form, first to go
4. The grace of blindness
5. Eye cures
   • Spectacles
   • Eyebright
   • Celandine
   • copperas
   • oysters
   • betony (nose)
   • millipedes

Mather and Boylston VS. Douglass and the Doctors

1. Smallpox, deadliest of the childhood diseases: 90% infected, 20-30% case mortality
2. Boston in 1721:population of 10,700, ~6,000 cases and 850 deaths, (of 242 inoculated, 6 deaths)
   • Sources of intellectual authority - old wives (slave?) tales
   • Sources of political authority - justices, select-men, town meetings
   • Sources of propriety - who speaks for God?
   • Sources of acrimony - newspapers
   • Underlying tensions?

Life Expectancy Data