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 Professionalization1760-1840

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

Cotton Mather

                                                                   

Cotton Mather, circa 1700

Born February 12, 1663)

Died February 13, 1728 (aged 65)

Occupation Minister

Cotton Mather, 1663-1728

Mather is not a doctorWhy is he writing aMedical text?

Prosperity: soul or Health?

Health as the most Important temporalprosperity

Consider:M’s spiritual-PhysicalAnalogies

M’s views on the relation of the physical to the spiritual

M’s rhetoricalmethod andAppeal to authority

Image: http://en.wikipedia.org/wiki/File:Cotton_Mather.jpg

Mather’s diseases of the eye

• Spectacles• Eyebright• Celandine• copperas

• Oysters• Betony (nose)• millipedes

Moral diseasesEnvious, haughty, unchastThe centrality of tearsEyes as danger portals – last to form, first to goThe grace of blindnessEye cures

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?