The Healing Arts in Colonial and Revolutionary Massachusetts: The Context for Scientific Medicine *
BY the time of the American Revolution, Massachusetts was an old and populous colony. Most of its 300,000 inhabitants traced their descent and culture from the thousands of Pilgrim and Puritan immigrants of the 1620’s and 1630’s. High birthrates and unusual longevity in the seventeenth and eighteenth centuries resulted in a rapid rate of natural increase in the population.
Compared with other eighteenth-century populations, whether in the American colonies or elsewhere, the people of Massachusetts were relatively enlightened in the broad sense, as well as with reference to the intellectual culture of contemporary Britain. Literacy among both men and women exceeded the standard in England and perhaps even Scotland, the most literate country in the world.
Within this setting, what were the fundamental characteristics of treatment for sick people? Did Massachusetts reproduce the conditions of provincial England? And if it differed, to what degree did social and political circumstances in Massachusetts foster or hinder medical development? To answer these questions we must begin by exploring colonial attitudes toward illness. Here, though examples are drawn only from Massachusetts, they apply to New England generally and are not necessarily unique to the culture of seventeenth-and eighteenth-century Dissenters. The subject itself, attitudes toward illness, is neither simple nor static, and one can only sketch some of the salient themes; but in order to understand the emergence of scientific analysis and treatment of disease in colonial Massachusetts, it is necessary to begin with people’s beliefs about the nature of illness.
Tradition, of course, merged the natural and the supernatural in European as well as non-European cultures. Keith Thomas’s exploration of seventeenth-century England informs us that even the most rational and learned individuals, from Isaac Newton down to farm laborers and washerwomen, saw no clear boundary between physical and spiritual phenomena.
Lament me not as you pass by
As you are now, so once was I;
As I am now, so must you be;
All Flesh is mortal you may se.
Ultimately resignation led to positive acceptance, as the verse on Anna Russell’s marker declared:
Beneath this Marble Stone doth Lye
Two Subjects of Death’s Tyranny
The Mother who in this Close Tomb
Sleeps with the issue of her womb
Here Death deals Cruelly you see
Who with the Fruit cuts down the Tree
Yet is his Malice all in vain
For Tree and Fruit Shall Spring again.
Above all else, religion taught that illness and death were to be borne humbly and submissively as God’s judgments.
But resignation and submission to God’s will did not imply dumb passivity. Prayer was the first of the healing arts, practiced among all ranks and in all regions of the colony, but it was not the only one. God had given mankind intelligence, and people were duty-bound to use it. Consequently when seventeenth- and eighteenth-century people suffered injuries or took sick, they called the minister and, if they could afford it, the doctor. Prayers and potions (including mercury and opium), blessings and bloodlettings complemented each other as bedside rituals. Though the nature and extent of religious commitment varied among individuals, virtually everyone agreed that ministering to the spirit as well as to the body was central to the treatment of disease. When it came to the healing arts, clergymen and laymen saw no conflict between the science of medicine and religion.
This meant that for most people during the entire colonial period ministers served as both their pastors and physicians. Visiting the sick was one of a minister’s primary responsibilities—to lead prayer in the afflicted household, to pray with and over the sick person, and to recommend appropriate medical treatment. Except in Boston and Salem there was scarcely anyone, trained or untrained, whose sole occupation was medicine until the middle decades of the eighteenth century.
Collectively, the techniques of healing that clergy and laymen employed combined old English folk remedies and Indian therapies with up-to-date scientific techniques. These three elements in treatment coexisted during the seventeenth and eighteenth centuries, despite their diverse origins and assumptions. Massachusetts settlers, living in a quasi-frontier environment, showed some willingness to experiment with new remedies from the outset. By the beginning of the eighteenth century, if not sooner, practitioners had added some distinctly American products like sassafras to their assortment of routine prescriptions.
From the perspective of London- or Edinburgh-trained physicians, the popular, self-taught “empirics” were dangerous rivals—dangerous to the patients they treated and threatening to the emergence of medicine as a learned profession in Massachusetts. Because these elite physicians and the apprentices they trained could not conclusively demonstrate their own superiority to the public at large, their influence was limited, and they could not control colonial medical practice.
Yet after independence the new, republican Commonwealth of Massachusetts immediately created agencies of elite, scientific medicine, the Massachusetts Medical Society and the Harvard Medical School. Normally historians compare these developments with those in Philadelphia, and so ask why Boston lagged behind.
One must begin by setting aside the tempting notion that scientific medical institutions won legislative support because the medical treatment of the learned physicians was conspicuously better than popular medicine. As of 1780 or 1820, indeed even as late as the 1849 cholera epidemic, the merits of scientific medicine were open to reasonable doubt. Moreover, even if it was clearly superior it would not be surprising if people still clung to older, more familiar therapies as well as prayer. Certainly there was and remains much unscientific conservatism among physicians and laymen alike; and even in the twentieth century, despite the impressive record of scientific medicine, folk alternatives attract waves of popularity, even among legislators. Scientific medicine did not win approval simply on its merits in the 1780’s. To explain this new departure in republican Massachusetts one must look again at the colonial medical heritage.
Reference has already been made to the well-known hostility of trained physicians like William Douglass to the mere “empirics” and lesser practitioners who abounded in the Bay Colony, and to the fact that there were two streams of empirical medicine, one learned and the other popular. While these two were distinct, they were not wholly separate. For although Douglass and his professional colleagues were not disposed to learn from their inferiors, the common practitioners of the healing arts—clergymen, self-taught “empirics,” midwives, and ordinary people in general—were eager to learn from their betters, and if they could not afford sustained medical instruction, they did buy, borrow, and read popular medical books, and clip from the newspapers reports of new treatments.
What did clearly separate learned medical practice from its popular rivals was its social not its scientific characteristics. Degree-holding practitioners were largely confined to the port towns, especially before the Revolution, and their fees discouraged many ordinary people from seeking their treatment. Doctors trained through apprenticeship were more numerous and accessible, but it was the self-taught practitioners who were most numerous and commonly available.
By the mid-eighteenth century, however, this distinction was taking on a new significance that threatened the future of learned medical practice in Massachusetts. For the British-trained physicians who desired to imitate the hierarchical and monopolistic structure of the London medical professions—divided among physicians, surgeons, and apothecaries—were entering a larger social and political conflict that strained Massachusetts’s equilibrium. John Murrin has characterized this conflict as pitting the friends of Anglicization against defenders of the Puritan and popular traditions of Massachusetts. In medicine and law, in politics and in religion, royal officials and Atlantic merchants led a movement to bring Massachusetts institutions into conformity with Georgian England. The formal creation of a medical establishment modeled on that of London, complete with exclusive licensing procedures, a medical school, and a hospital—as was being introduced into Pennsylvania—could not be considered by itself because it coincided with the formation of the Massachusetts bar, the organization of an Atlantic merchants’ society, and an expansion of the Anglican presence, including the establishment of a missionary church adjacent to Harvard yard.
Yet paradoxically the fulfillment of revolutionary republicanism in the 1770’s and 1780’s did not destroy elite, scientific medicine; it promoted it in a distinctly American way. Here the warfare itself was crucial. For the war led to the exile of several leading Anglophiles, including notable physicians like Silvester Gardiner, John Jeffries, and Nathaniel Perkins, and it destroyed the political influence of those who remained.
The Revolutionary war had given learned physicians an opportunity to define their professional interests so that they coincided with the public good. In addition there was a utopian thrust to republican ideology that raised social expectations generally. In this context a variety of learned societies gained support in Massachusetts in the 1780’s and 1790’s, including: the American Academy of Arts and Sciences; the Massachusetts Historical Society; the Massachusetts Society for Promoting Agriculture; the Boston Athenæum; and the Salem East-India Marine Society—in addition to the Massachusetts Medical Society.
Like the founders of the other learned societies, the sponsors of the Medical Society had English models in mind from the beginning. Yet at the same time there were distinctly republican departures that grew out of Massachusetts’s experience. Although the members of the Medical Society had all been trained as physicians, only a few possessed medical degrees. The Society tried until 1803 to follow the Royal College’s rule of differentiating learned “fellows” of the society from mere licensees, but the effort failed, and the Society never even attempted to create the English distinctions between physicians, surgeons, and apothecaries. Nor did the Society press for an exclusive monopoly to practice medicine. Its powers of certification were limited to those who voluntarily chose to seek examination; and to make sure access was open, the General Court required the Society to examine everyone who volunteered, or face penalties.
Instead, the purposes of the Medical Society reflected the longstanding interest of practitioners at all levels to increase their store of knowledge. In 1785 the Society initiated creation of county committees of correspondence open to any individual or group of doctors who chose to participate. Five years later the Society began to publish a periodical, Medical Papers, which included gleanings from these committees of correspondence.
Until well into the nineteenth century scientific medicine in Massachusetts was necessarily more remedial and practical than inquiring and imaginative in its orientation. Both the Medical Society and the Harvard Medical School aimed first at bringing the healing arts as practiced in Massachusetts up to advanced European standards. This objective provided legitimacy in the republican social environment, and built on the strengths of Massachusetts society for supporting scientific medicine—its broad literacy, its commercial and urban development, and the improving spirit that was evident throughout the state. As a result, though the tension between learned medical practitioners and popular medical treatment persisted, and self-dosing would flourish through the nineteenth century, scientific medical institutions gained a secure place and a substantial following in republican Massachusetts.