Colonial Medicine

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

American medical Profession England Physicians (RCP) Surgeons (RCS 1745) Apothecaries Barbers Chemist/druggists Scottish doctors Quacks Licensed midwives Colonies Doctors Healers – Martha Ballard

First Wave Professionalization 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 training College + medical training (very rare) College (30 % of 18th c. Mass pract) Edinburgh Apprenticeship (7 years UK, max of 5 MA; 36 % of 18th c Mass pract) Family (20% of 18th c Mass pract) Informal – “social medicine”

Diseases in colonial America Epidemic: Smallpox, Diphtheria, Scarlet fever, Measles Vs. European: typhus (typhoid), plague, dysentery, influenza, consumption Endemic: worms, itch, burns vs the stone, gout, melancholia

Consider: M’s spiritual- Cotton Mather, Physical 1663-1728 Analogies                                                                     Cotton Mather, circa 1700 Born February 12, 1663) Died February 13, 1728 (aged 65) Occupation Minister Consider: M’s spiritual- Physical Analogies M’s views on the relation of the physical to the spiritual M’s rhetorical method and Appeal to authority Cotton Mather, 1663-1728 Mather is not a doctor Why is he writing a Medical text? Prosperity: soul or Health? Health as the most Important temporal prosperity Image: http://en.wikipedia.org/wiki/File:Cotton_Mather.jpg

Mather’s diseases of the eye Moral diseases Envious, haughty, unchast The centrality of tears Eyes as danger portals – last to form, first to go The grace of blindness Eye cures Spectacles Eyebright Celandine copperas Oysters Betony (nose) millipedes

Mather and Boylston vs Douglass and the doctors Smallpox, deadliest of the child diseases: 90% infected, case mortality 20-30% Boston in 1721: popu. 10700, c. 6000 cases, 850 deaths (242 inoc., 6 deaths) Sources of intellectual authority – old wives (slaves?) tales Sources of political authority – justices, select-men, town meeting Sources of propriety – who speaks for God? Sources of acrimony – newspapers Underlying tensions?