The Historiography of Early American Medicine

    I AM half inclined to be very angry with you,” wrote John Adams to Dr. Benjamin Rush in 1805, “for destroying the anecdotes and documents you had collected for private memoirs of the American Revolution. From the memoirs of individuals the true springs of events and the real motives of actions are to be made known to posterity.”1 Such letters and expressions of frustration could have been penned in Charleston or New York as well as in Boston and Philadelphia. With an uncertain yet promising future, the new nation needed also a history of its own. The fragments and documents of that past were scattered throughout the states and in England, too. Collecting and publishing details of a special person’s life served the then important needs of creating, then preserving, the past, and of setting examples for posterity to emulate. These motives, among others, inspired Mason L. “Parson” Weems to write in 1800 his celebrated life of George Washington. Literature highlighting the qualities of exemplary leadership and service to country embraced also retrospective discourses on the importance of the medical profession to a developing country.

    Reviews of the state of medicine in early America were produced exclusively by doctors, including James Potter of Connecticut (1781) and David Ramsay of South Carolina (1801). Written by local leaders of the profession, some of whom enjoyed a national reputation, these works do not contain many references to specific counterparts of earlier times. In The Rise, Progress, and Present State of Medicine . . . (1792), Dr. Benjamin Waterhouse of Massachusetts captured the spirit of this genre by observing that improvement in medicine derives from the “examples of the Eminent, who have gone before us,” and that continued service depends on the “hope of being able to preserve to our fellow creatures, that greatest of blessings, ‘A Sound Mind in A Sound Body.’” While these men sought to identify their profession with the ideals of republicanism and to inspire their colleagues, the authors themselves became subjects of the first generation of medical historians. With anecdotes and some documentation as sources, and individuals as subjects, the first, and still abundant, form of American medical history—biography—took shape during the first decades of the nineteenth century.

    Between 1828 and 1874, the writing of American medical history was done by the eminent, seeking information about their historical counterparts. That all of these doctor-authors perceived a shortage of information about their subjects is evident in their published works. Dr. Ebenezer Alden advised the readers of his Early History of the Medical Profession in Norfolk County, Massachusetts (1853) that the “recorded materials for such a purpose . . . are indeed scanty; and information obtainable from tradition [memory-oral tradition] is becoming everyday more vague.” Alden evidently did not believe in the existence of vast, undiscovered sources. He had been able to identify the “names of but few” early doctors, and “of these we know but little.”

    The appearance of the medical biographies with a national scope by Drs. James Thacher (1828), Stephen West Williams (1844), and Samuel D. Gross (1861) documented the lives of over three hundred practitioners from the preceding two centuries. Acknowledging the difficulties that he encountered while collecting scattered data for Contributions to the Annals of Medical Progress . . . Before and During the War of Independence (1874), Dr. Joseph M. Toner nevertheless established notable precedents. By sending out hundreds of questionnaires and clipping obituaries from newspapers he amassed some 4,000 biographical notes. When he estimated the number of doctors in the country in 1776 at 3500, the calculation revealed the inadequacy of existing biographical collections. Toner, like some of his predecessors, relied also upon the published works of Thacher, Williams, and Gross. The frequent use of these volumes by other writers indicates the emergence of a corpus of standard reference works on the subject(s). Toner’s files swelled with thousands of names as the search for biographical information continued in a manner suggesting the possibility of widespread systematization of the procedures involved. Others, like Dr. Oliver Wendell Holmes, shared his concern about retrieving medical historical data, but feared in addition the possible loss of documentation for disease in early America. Given the preponderance of biographical subject matter and the approach of the centennial celebration, we are not surprised to learn that the next form of medical history writing concentrated on groups of doctors in medical societies, schools, and states—institutional history.

    Collecting and disseminating biographical data on early American doctors continued during the period 1876–1931, and the efforts of those involved were aided by the creation of specialized journals and the willingness of previously established journals to publish historical accounts of medicine and its practitioners. While the journals offered great potential, that potential was not tapped until later. So, the most influential published results of the period appeared in book form. The first and perhaps most ambitious work in this group is that by Drs. Edward H. Clarke, Henry J. Bigelow, Samuel D. Gross, T. Gaillard Thomas, and John Shaw Billings, A Century of American Medicine, 1776–1876 (1876). Published earlier in the American Journal of the Medical Sciences, the essays represented the most comprehensive treatment of medical practice, anesthesia, surgery, obstetrics and gynaecology, and medical literature and institutions throughout the country. Activities and personalities at the state level, in Massachusetts and Virginia in particular, received most of the attention. Dr. Samuel A. Green’s History of Medicine in Massachusetts: A Centennial Address . . . (1881) preceded the works of Drs. Thomas F. Harrington, The Harvard Medical School (1905); Walter A. Burrage, A History of the Massachusetts Medical Society (1923); and in 1930, turning full circle, Henry R. Viets, A Brief History of Medicine in Massachusetts. Dr. Wyndham B. Blanton initiated his multivolume treatment of medicine in Virginia with the first volume covering the seventeenth century in 1930, followed by The History of Medicine in Virginia in the Eighteenth Century (1931).

    These works are representative of those published during the period in that they are collections of biographies and offer analytical sections on medical practice, epidemics, life styles, and the social role of the doctor. They were soon regarded as valuable reference works and were joined by two other pioneering efforts: Dr. Francis R. Packard’s two-volume History of Medicine in the United States (1931) and Louis C. Duncan’s Medical Men in the American Revolution (1931). To these works we should add sections on the medical profession included in the hundreds of town and country histories produced by historical societies throughout the country.

    By the 1930’s, then, the names of hundreds of practitioners were known for each state, as were the outlines of state and local societies, the development of licensing regulations, medical schools, the time and place of early epidemics, and the rudiments of actual medical practice. The last form of American medical history writing—the analytical—emerges during the 1940’s as a result of the availability of standard reference works with individual, local, state, and national scope, and the kinds of questions raised by newly trained scholars, in particular those authors with nonmedical academic training.

    Historical journals and professional historians would make significant contributions to the development of systematic approaches to the history of medicine in early America. Of the many writers involved in the analytical approach, two stand out as early advocates, charting new terrain, asking new questions, and offering to others suggestions for future research in neglected areas. While better known for works published later in their careers, two articles by Richard H. Shryock and Whitfield J. Bell, Jr., both of whom received their doctorates in history, represent the shift toward more systematic collection and analysis of information. “Medical Sources and the Social Historian,” American Historical Review (1936), by Shryock, and Bell’s “Suggestions for Research in the Local History of Medicine in the United States,” Bulletin of the History of Medicine (1945), invited students and scholars of early American medicine to explore such topics as the social context of medical practice, popular conceptions of disease and health, specialization of practice, effectiveness of therapy, small as well as large institutions, and the visible leaders as well as their nearly invisible average counterparts.2 In order to produce a successful study of these topics, the student must endeavor to overcome the provincialism, both theoretical and methodological, imposed by traditional disciplinary boundaries.

    A need implicit in the articles by Shryock and Bell, and in other works of the analytical genre, is the cooperation of trained historians and experts from the allied health professions. The topics cited earlier require also the discovery and exploitation of new sources and the introduction of techniques, such as statistics and computers, to examine data not otherwise amenable to traditional modes of investigation. The difficulty of determining the effectiveness of the colonial physician’s therapies is representative of the source and methodological problems confronted. Innovative and practical reference works were needed to accommodate a growing interest in these new studies and in the older works mentioned above. The publication of bibliographical guides to the sources for early American medicine during the 1960’s, including those by Francisco Guerra (1962), Genevieve Miller (1964), and the on-going National Library of Medicine’s annual index, now provide quick, reliable access to a variety of published sources, and, through them, primary documents.3 The ideas, techniques, and data present in recent scholarship have facilitated research in neglected areas, improved communication among writers of medical history, and enhanced interdisciplinary efforts.

    All of the sources and phases of the historiography of early American medicine—the biographical, the institutional, and the analytical—are present in this volume of papers. Opportunities like that provided by the Colonial Society of Massachusetts for historians, both amateur and professional, to meet and exchange information and ideas are rare. One hopes that, as the contents and format of this volume reveal, such gatherings can be quite productive. This volume contributes to future scholarly efforts in another important way by demonstrating the limitations of some sources and techniques, and by suggesting the need for more documentation on familiar topics.