ERIC H. CHRISTIANSON

The Medical Practitioners of Massachusetts, 1630–1800: Patterns of Change and Continuity *

CONFRONTED with the formidable task of discussing the highlights of the history of the medical profession in Massachusetts up to 1869, Dr. Oliver Wendell Holmes reminded his Lowell Institute audience that the “medical history of eight generations, told in an hour, must be in many parts a mere outline.”1 Yet, here I am with less than one hour to cover the period 1630–1800, a span of time coterminous with the seven generations of Drs. Clark of Boston that began with Dr. John Clark (1598–1664). Acknowledging his temporal limitations, Holmes expressed more frustration with the paucity of information about his subjects. The hardworking, intelligent country practitioner, he remarked, “more especially deserves the gratitude of his own generation, for he rarely leaves any permanent record” detailing his career. Earlier, in 1853, medical biographer Dr. Ebenezer Alden of Randolph also concluded that the early history of medicine in Massachusetts “is involved in great obscurity.”2 Though hardly obscure, the well-educated and geographically stable Clark dynasty does illustrate some important trends. The general impressions, however, of early medical practitioners suggested by such atypical individuals or families conceal from our view the diverse composition of, and changes in, the profession to which they belonged.

In order to provide a reliable representation of the medical world we have lost, scholars have advised the prospective historian-biographer to provide also an informed social and intellectual context for such an endeavor, thus avoiding the provincial character of most local history of medicine. To achieve balance in such a project requires a discussion not only of the most visible, but also, in the words of Professor Bell, the “hundreds of practitioners in towns and villages . . . who formed the bulk of the profession, provided most of the medical care, and gave the profession its prevailing tone.”3 The need for such comprehensive studies of the identity and demographic patterns of colonial doctors has been recorded in the literature of the field for decades.4 One systematic approach that holds the promise of rendering the obscure more visible and providing balance at the same time is collective biography or prosopography.5

Collective biography requires many kinds of sources already familiar to demographer and historian alike: the histories of towns, counties, and institutions; vital data; church registers; and court records. In addition to these sources, for this paper a computer permitted further exploitation of techniques developed by historical demographers to reconstruct families down through the generations and by social historians to analyze town and group characteristics.6 With these aids, the researcher can develop perspectives based on more representative data than could be compiled otherwise. Unfortunately, the limits imposed by time and by the titles of other papers in this symposium prevent detailed discussion of many biographical and demographic characteristics of this paper’s subjects. While Holmes complained about the dearth of information concerning early American doctors, he did not conduct an extensive investigation of then available records. The rich sources mentioned above provide much information for an in-depth study of colonial doctors. With the partial reconstruction of their lives complete, it is possible to study over time the increase of doctors, the patterns of individual and group distribution, their educational experiences, and some of the possible effects of these features on the organization of medical practice.

scope, qualifications, and definitions

An important objective of this study is to determine with some measure of certainty the number of practitioners throughout the state at different times. In such a study one could argue for the inclusion of all mothers and fathers as part-time practitioners, for, indeed, the family assumed the immediate responsibility for the health of its members. One could also assume that all ministers exhibited the “Angelic Conjunction”—the healer of spirit and body—but I have included only those noted in the records for their expertise.7 Most medical men were readily identified by their titles. Herein lies the principal reason for the omission of female practitioners. Vital records of towns and the like rarely mention “midwife,” “doctoress,” or “nurse” before the names of women who might have acted out the functions of one of these three categories. As Professor Jones demonstrates elsewhere in this volume, court records promise to help determine the identity of female practitioners, who remain most elusive subjects for study.8 Unlike urban Britain, which also experienced change in this regard, but resembling the customs in the provincial towns, the basis of separating “physician,” “surgeon,” and “apothecary” proved inoperative in the colonies as early as the 1620’s.9 Even with the advent of such agencies of urban culture as The Boston Directory in 1789, this nomenclature did not usually correspond with the appropriate British function. In effect, these conditions produced a hybrid, a general practitioner, a “physician,” some of whom also had expertise in a specialty like surgery or obstetrics.

“It was not customary,” wrote Dr. Samuel A. Green in 1881, during the colonial period “to address or speak of a physician by the title of doctor ... perhaps because so few had diplomas.”10 His use of the term “physician” reflects both late nineteenth-century definitions as well as the nomenclature of the British medical hierarchy throughout the colonial period. To his knowledge, the earliest date at which the appellation “Doctor” appeared in Massachusetts is 1668. And yet the logbook of the Mayflower in 1620 indicates that Samuel Fuller was “Dr. Fuller,” although he did not have a diploma either.11 Not until the proliferation of medical schools during the nineteenth century granting thousands of diplomas did “physician” become generally equated with the recipient of the M.D. Nowhere in colonial America did there exist effective restraints on the use of the title of “Doctor” or uniformly accepted qualifications for who could practice. Not all of the contents of “this attic full of institutions,” as Daniel Boorstin describes the formal agencies of the English medical hierarchy, were involved in the transit of culture to the New World, but early settlers were certainly aware of them.12 Dr. John A. Raach points out that most New Englanders immigrated from English counties, such as Norfolk, Suffolk, and Essex, with a high concentration of M.D.’s and men with other types of formal training.13 The first groups coming to New England sought to avoid the disaster of Jamestown by including individuals with skills necessary for a successful community, like male and female practitioners who would provide health care for a rural, working-class society. And in an environment that encouraged multiple careers, virtually all doctors were engaged also in other income-producing activity.14

Nearly two-thirds (874, or 63.8 percent of the 1370 during 1700–1792) of the men either styled themselves or were referred to in the records as “Doctor.”15 In England at that time, for example, Peter Laslett observes that some parish clerks and ministers “were more generous in distributing titles to their entries and it would be foolish to expect any rigorous consistency.”16. My findings, however, suggest that, with more than marginal consistency, the use of titles in the colonies, where their availability to ordinary people was limited and highly prized, even the title of “Doctor” was perhaps considered by many to be preferable to no title at all. The freedom with which these men employed, and were granted, the title of “Doctor” is one important reason that this study seeks to include as many as the records reveal. Only then can we appreciate the action of reformers, who, after 1750, would focus much of their effort on the indiscriminate use of the title “Doctor.” For the period 1630–1800 nearly 1600 doctors were identified from a wide variety of sources, both printed and archival. The primary focus is on the 1370 medical inhabitants of some 268 Massachusetts towns and eleven counties during the period 1700–1792.

growth

The richness and accessibility of the state’s early historical records yield an unanticipated number of doctors exhibiting, as a group, an equally impressive rate of growth. During the period 1700–1790, the number of doctors increased by 32.4 percent every ten years, while the general population increased by only 24.3 percent over the same interval. Throughout the seventeenth century the ratio of doctors to population remained stable at about 1:1,000. But because the subgroup of doctors doubled more rapidly than did the general population over the next century (26.8 years for doctors and 37.4 years for the total population), the ratio increased steadily from 1:1,000 in 1700 to its high of 1:417 in 1780.17 And though comparisons with other areas are employed with much reservation, the figure for 1780 might indicate that in Massachusetts, among all states, we find the highest concentration of medical men.18

Since the 1870’s, researchers have come to rely upon Dr. Joseph Toner’s estimates for the number of practitioners during the American Revolution.19 Assuming the population to be 3,000,000 in 1776, Toner suggests the figure of 3500 doctors with a ratio of 1:800 [1:857]. In 1960, Professor Shryock arrived at a ratio of 1:600 based on a smaller population of 2,000,000.20 Using either approximation, or the mean figure, in 1776 Massachusetts contained about ten percent of the population, and with 643 doctors, nearly twenty percent of all doctors in the new republic.

1. Dr. John Clark (1598–1664). Painted in Boston about 1664 by Augustine Clement or his son Samuel. Courtesy Boston Medical Library.

2. Map of Massachusetts in 1800, showing the counties. Franklin and Hampden Counties were not created until 1811 and 1812, respectively. From Carey’s General Atlas (Philadelphia, 1816). Courtesy Harvard College Library.

3. Articles of Indenture of Joseph Lemmon, Jr., to Dr. Zabdiel Boylston of Boston, 18 May 1736. Courtesy Boston Medical Library.

4. Letter from Dr. Cotton Tufts of Medford to Dr. Joseph Warren in Boston 22 July 1774. Tufts seeks Warren’s advice for relieving rheumatic pains in a boy of twelve or thirteen years of age. Courtesy Boston Medical Library.

5. Dr. Cotton Tufts (1731–1815). Painted by Benjamin Greenleaf in 1804. Tufts was apprenticed to his brother Simon in Medford. He began to argue for the establishment of a state medical society in 1765, and, after it was organized in 1781, Tufts served as its fourth president, from 1787 to 1795. Courtesy Boston Medical Library.

6. Clinical notes of Dr. John Perkins (1696–1781). This 1750 note concerns the successful treatment of a woman who had convulsions at the time she delivered her baby. Another physician, Dr. Thomas Boylston (1715–c. 1771), served as her obstetrician. From Perkins’s unpublished ms “Observations Medical & Chirurgical.” Courtesy Boston Medical Library.

According to Toner, the geographical distribution of the 3500 doctors in 1776 produces a ratio of 1:800 for the cities and 1:1,000–1:1,200 in the countryside. There are several observations claiming an “urban surplus” of doctors, but Toner argues that all ratios are probably too high because so few towns had populations greater than 5,000. Once certain occupational thresholds are reached, towns with populations as small as 1,000–2,000 should also be considered “urban.”21 So for the present study an arbitrary selection of towns with more or less than 1,000 inhabitants in 1765 and 1790 produces results that conflict with earlier estimates.22 For example, in 1765 the ratio of doctors to population in towns over 1,000 in 1:1,035, rn the smaller towns 1:557. And the results for 1790 are nearly identical: for towns over 1,000 the ratio is 1:954, and for smaller towns it is 1:588. There were, of course, cities with more than 1,000 with high ratios in 1790, like Great Barrington in Berkshire County (1:683), Easton in Bristol County (1:488), Worcester (1:419), and Boston (1:563, almost the same as in 1765). For Massachusetts, at least, country towns probably contained more medical practitioners than the cities. The ambiguous nature of a “surplus” or “shortage” of doctors will be discussed later. With these general characteristics of the doctor population as background, we can investigate other features of the observed growth patterns, specifically their origins, distribution, and educational experiences.

other features of growth

As might be expected, Europe produced less than ten percent of all colonial Massachusetts practitioners. The great migrations of the seventeenth century, however, contributed almost one-third of the early-period doctors, while only 3.9 percent were Europeans by birth during the next century.23 The geographical mobility in the decades following the initial settlement of New England is indicated by fifty-three doctors in the later period who immigrated from bordering provinces.24 With immigration high after 1750, nearly ten percent of the state’s doctors were recent arrivals in search of patients.

Among the native-born, most were from the eastern counties that were more densely populated and consistently produced more medical men than the developing regions of Worcester, Hampshire, and Berkshire; Suffolk, Middlesex, and Essex together account for one-half of the 1370. Regardless of time or location, one-fourth of the medical inhabitants of the counties came from other Massachusetts counties or from outside Massachusetts. Doctors seem to have been less geographically stable than the general population, and their movement as a group after they started to practice reached thirty-four percent; by 1760 one-quarter (24.2 percent) of this mobility was among counties. Dr. Giles Firmin, perhaps the first practitioner to note the social impact of this instability, complained to Governor John Winthrop in 1639 about those who “range from place to place on purpose to live upon the country.”25 Those men without apprenticeship experience or college attendance moved throughout the century significantly more often than did their trained counterparts.26

For the entire 170-year period, no more than twenty-five percent (421/1,600), attended college, received a degree, or attended lectures in Europe, New England, or another colony. But after 1750 Harvard and Yale college graduates found medical practice much more attractive than earlier in the century (26.1 percent increase).27 This trend reached its peak also in the 1760’s when forty-six percent (71/153) of all the beginners had attended college. Indicative of rapid growth within the ranks of the college graduate doctor is that 46.9 percent of all graduates who entered medicine did so between 1751 and 1780.

Similarly, less than one-third of all doctors during the period 1630–1800 served apprenticeships of at least one year’s duration, but during the eighteenth century almost thirty-six percent (488/1370) were apprentice-trained, an increase of twenty-six percent over the previous century. Consistent with other changing patterns, after 1750, apprentice-trained men increased by twenty-eight percent relative to the earlier period. In spite of their numerical strength, these men were never to comprise more than one-half of all beginners in each decade. A college education or a preceptorship represented but two of a large selection or combination of possibilities. Most of these categories of experience, however, such as inoculating in a smallpox hospital, acting as surgeon or surgeon’s mate in a military campaign, or caring for the needy in the poorhouse were virtually closed to those without a degree of some kind or apprenticeship experience.28 Granted, these experiences are rather limited prior to 1700, but one agency of practical experience, the medical family, provided training throughout the colonial period.

Recruitment from within the ranks of the professional family accounts for a substantial number of the 1600 doctors during 1630–1800. Of the 149 seventeenth-century doctors, seventeen percent were joined and then succeeded in practice by one or more sons. In the eighteenth century nearly twenty percent (271/1369) of all practitioners either came from (15.7 percent), or married into (4.1 percent), medical families. Within this group with medical fathers we encounter the dynasties, the fifty-two families, including that of Dr. John Clark, who perpetuated the traditions of the healing arts for three or more generations. The appearance and distribution of multi-generational medical families is similar to the patterns for the larger group. For example, over one-half (fifty-eight percent) of the 215 with medical fathers flourished in Essex, Middlesex, and Suffolk counties, and nearly two-thirds (63.4 percent) first began to practice after 1750, with the per decade high during the 1750’s, when they constituted almost one-fourth (33/133) of all the beginners.

Unlike the larger group of medical men whose fathers were not also practitioners, families of three or more generations of doctors were geographically stable and well trained. In the older counties like Middlesex, where the general mobility of doctors might reach forty percent after 1750, or the rapidly developing newer counties such as Berkshire, created in 1761, where mobility surpassed eighty percent, the mobility rate for the multigeneration group rarely exceeded fourteen percent. While fewer medical family doctors attended college than the larger group, all of them were apprentice-trained, which means that forty-four percent of all the apprentice-trained were members of medical families. In these families, fathers provided in lieu of college credentials practical training for their sons and bequeathed to them land, medical supplies, books, and a ready-made clientele. These kinship and professional ties provided adequate protection for years, and they seem to have grown stronger when challenged by an ever increasing number of mobile itinerants.

Medical families or dynasties exhibit features similar to the larger groups of apprentice-trained and/or college-graduate men, primarily voluntary geographical stability or calculated movement (which usually brought them back to the towns of their birth), and a high incidence of apprenticeship training, then the predominant form of professional education. Relationships established through family ties and educational experiences also produced an informal network of communication between similarly qualified or like-minded individuals living miles apart. News concerning the job market passed quietly within this tight-knit medical patronage system. After 1750 the infiltrations of the rapidly expanding group of mobile interlopers into this network had important implications for the strategy and effectiveness of medical reformers well into the nineteenth century.

implications

In the last few years, scholars, including Professor Brown, have argued that the modernization of American society gained momentum after 1760.29 Processes of change long at work, and later accelerated by the events of the Revolutionary era, produced a breakaway from some traditions and a reaffirmation of others. Alarmed by altered surroundings, some contemporaries warned others of the possible loss of close personal ties and the virtues of rural life. And, like the experiences of other groups in this pluralistic society, tensions between coexisting and often opposed forces of modernization and tradition within the medical profession were accentuated also by changing economic and demographic realities.

A changing environment in which shortages of available land, uncertain opportunities, and multiple careers were common might have stimulated “upwardly mobile, achievement-oriented” individuals to try their hand at doctoring their neighbor’s complaints after home remedies had failed or if the local doctor was unavailable.30 Unwilling to have their career choices limited by regulations or time-consuming and expensive training, these individuals displayed little deference toward their betters. One alarmed observer noted the strained economic conditions and dislocation of people in Massachusetts following the Treaty of Paris in 1763. As a result of these circumstances, he added, more men were unemployed, and “having poor Stomachs to return to the Stall or plough from whence they came; some of them commence quacks and call themselves Doctors.”31 With the vast majority of doctors coming from nonmedical families, especially farming, and with less than ten percent of them sons of men with college educations, it seems reasonable to assume that medical practice was an attractive alternative to the sons of those farmers who did not have enough land to distribute among all their offspring, and who could not afford either to send them to college or to pay apprenticeship fees, or who refused to do so.

Apprenticeship instruction had long been the most traditional form of training apothecaries and surgeons in England and her colonies even in the presence of expanded educational and career opportunities. Some scholars have identified conditions in America that they feel contributed to the declining vitality of this pedagogical technique during the eighteenth century. Among these writers, Bernard Bailyn did not restrict his analysis to the apprenticeship patterns of any particular occupational group, but concluded that generally “evidence of its decline was as clear in its internal characteristics as it was in quantitative decrease.”32 Such a decline is attributable to a societal tendency to transfer the burdens of some vocational training from within the home to external agencies. To apprentices, he argues, the old obligations to formal training were “archaic entanglements,” obstacles in the path of independence. To its defenders, the substance and function of the medical apprenticeship indeed experienced flux, and its prospects were unclear, but not futile. Another writer suggests that the war of the American Revolution weakened the system as regularly trained men entered medical service to treat soldiers and sailors, only to be rivaled in their absence by the untrained intruder answering the demands for medical services;33 even some Tory doctors were allowed to remain.34 During the 1770’s a large number of untrained beginners did appear, for in that decade we find 219 men first starting to practice (sixteen percent of 1370), of whom only forty-two percent had served at least an apprenticeship. But the results of the present study reveal that in spite of the documented intrusion of untrained practitioners into temporarily vacant practices (and most were forced to leave once the absent incumbent came home from war), the apprenticeship system for medicine grew stronger, not weaker, in the eighteenth century.

A demand for medical services certainly did exist, whether or not the practitioner had credentials, throughout the colonial period, and such conditions encouraged some to seek access into the medical profession via traditional means, while others skipped the formalities, and, to paraphrase Tammany Hall sachem George Washington Plunkitt, they “seen their opportunities and they took’em.” Town selectmen actively sought resident bone-setters, midwives, and physicians, and offered subsidies of land and/or money to those who promised to “[live] among us Some years.”35 True, the wandering individual, male or female, or uprooted family was always suspect of becoming a burden to the town’s taxpayers, but in these circumstances a mobile doctor regardless of training might not have been unusual or socially undesirable.

The mobility of self-taught doctors, one source of their obscurity in the records, suggests that frequent movements represent ventures not of success but of repeated failure to compete successfully with established and trained counterparts.36 This movement is documented well into the nineteenth century.37 Before 1800, physical dispersion and smaller average size of communities in America, argues Daniel Calhoun, allowed a “large proportion of doctors to enjoy a monopoly on practice” in some communities.38 If not a monopoly, some doctors did enjoy a thriving practice, but long before the turn of the century they evidently could not meet the needs of all the potential patients in the community. Even today, observes Rashi Fein, with legal restrictions on medical practice, there exist no wholly acceptable criteria for an “oversupply” or “shortage” of medical personnel.39 The respected doctor could create a demand for his services as healer and preceptor, but for early Massachusetts or colonial America as a whole we have perspectives only on the ability of the population to consume his services. With widespread demands for medical services on record, it might be imprudent to conclude that because of their mobility or large numbers a “surplus” of doctors did exist.

Even in the presence of a flourishing self-doctoring tradition in early America, and the willingness of towns to attract resident doctors with varying degrees of skill and experience, those with a proven commitment to learning, and with at least the potential of contributing to the stability of the community, would receive their deference and prevail over the less-polished and self-taught.40 Seen, however, from the perspective of the geographically stable and trained men in towns and cities, something had to be done, wrote one defensive Dedham practitioner in 1764, to “prevent the intrusion of every ignorant drone that assumes the title of doctor” into their ranks.41 The tone of his remarks signals a jolt, a discontinuity, a realization that what had worked in the past to control competitors might not work in the future. A major issue of strategy for such reformers, the conservators of tradition and arbiters of change, became how they could best suppress “this Herd of Empiricks who have heaped such intolerable contempt on the Epithet Country practitioner.”42 Their concerns would not develop into a general social campaign against untrained mobile doctors, but rather an intragroup clash for local control and legitimacy.

As cracks appeared in the structures of the deferential social order (what some recent studies refer to as an “ascriptive” social order), many groups sought to strengthen its weak points, others to create another order based on acquired expertise. In the decades after 1760 the altered milieu brought forth political parties, county bar associations, interest groups seeking protective legislation for their members, societies offering restricted membership to those who wished, according to Professor Cassedy, to “be or act as learned men,” and voluntary associations created by reform-minded individuals.43 Even with a growing, more concentrated population, and the spread of urban culture throughout the area, the vestiges of an isolated world-view persisted. Most of the groups, especially the voluntary associations, which included medical societies, achieved their goals more effectively at the local, rather than at the state or national, level.44 And while the rhetoric of republicanism indeed stimulated the formation of groups dedicated to national purpose and to the completion of the unfinished revolution, its phrases and ideals also elevated the individual to new levels of self-esteem; a nation of individuals might oppose the formation and activity of restricted groups whose very composition and intent ran against the grain of individual rights. In these circumstances the health of individuals and their right to be protected from alleged incompetents became an issue that doctors tried to support themselves, although they did not try very hard to secure legislative sanctions.

Perhaps united only by disputed titles and qualifications for practice, doctors composed not one group but many—some that shared communalities of interest and background yet espoused conflicting goals. Granted the existence of overlapping membership, multigenerational medical families and apprentice-trained or college-educated doctors tended to offer solutions to problems that would preserve their own self-interest. The appearance of new institutions, such as the Massachusetts Medical Society in 1781 and the Harvard College-Harvard Medical School connection after 1783, were received with ambivalence throughout the state.45 Those who had relied upon the apprenticeship system for local control might balk at the possibility of basically academic qualifications for practice and a centralized medical authority in Boston. Doctors near to, and distant from, Boston would argue with the state society during the 1780’s and 1790’s for the right to determine on their own the appropriate duration of the apprenticeship in order to promote response at the local level.46 Local groups tended to overestimate the strength of the Boston medical establishment, which itself was experiencing a bitter controversy between the state society and the new medical school at Cambridge. And while many desired to expand upon the basic virtues of the apprenticeship as a medium of self-improvement, doctors in the most rural areas began to acknowledge that the system was itself, because of the insularity of the pupil-mentor framework, rather limited as an educational tool or agency of control over entry into practice.47

Emerging from long-existing relationships between mentors and pupils, generations of family ties, and colleagues in practice, county medical societies like the Berkshire Medical Association created in 1787 or the Middlesex Medical Society in 1788 also restricted membership largely to medical men, but offered the practicing self-taught doctor an opportunity to improve himself by associating with trained men and their pupils.48 Lectures would supplement the basic pupilage for those who could not travel to Boston or Cambridge, and these local societies certified their own pupils. The intense bickering and one-upmanship that plagued Dr. William Douglass’s efforts to create a stable Boston Medical Society in 1735 would have to be overcome by more realistic attempts based on compromise as well as commitment to improved medical services.49 Such realistic arrangements, argued Dr. Benjamin Waterhouse in 1791, would best promote the the interests of the Faculty by reducing destructive bickering among doctors and improving the general level of practice.50

Inclusive local societies would act as a buffer between the extremes of rampant individualism and centralized or distant control. The primary purpose for creating the limited membership state society in 1781, complained one western member-correspondent, had been to eliminate the untrained doctor; but the efforts of the Massachusetts Medical Society had not by 1784 in “the least degree prevented the Increase of Empirics.”51 Perhaps Calhoun is correct in observing that immigrants to larger towns and cities knew or remembered local isolation as a standard even while “they sought to work out a life appropriate to the city.”52 Yet medical immigrants to larger communities, or those who grew up in them, also sustained their bickering in new surroundings. Respectability for the profession, declared an orator in 1787 to the members of the Berkshire Medical Association, “could never be attained so long as we are activated by the meanness of jealousy and opposition to each other.”53. Even with modest hopes for the future success of their efforts, local groups recorded Pyrrhic victories and the state society would, by 1803, be forced to reevaluate its tactics and to expand its membership to represent more realistically the demographic realities of medical practice in the state. In these circumstances we can better understand why some reformers were frustrated and driven to define the self-taught as adversaries, as if “to vindicate their own uncertain worth by assaulting those around them.”54. Only in the distant future would the medical profession achieve that collective individualism expressed as “You are as good as I, and let us help one another.”55

The medical settlement of Massachusetts was essentially over by 1790, though not every town could boast of a resident doctor, but demographic and social realities had decentralized medical authority and training throughout the state. True, the American Revolution had brought together men of varying degrees of experience and had inspired them further, but these changes were set in motion during the 1750’s. A balance between control and personal freedom would, in these circumstances, produce a tenuous compromise at best. These eighteenth-century developments established a framework for the clash between sectarians or regulars and proprietary or college medical school graduates so characteristic of the following century.56. There was both change and continuity in the composition and organization of the medical profession during 1630–1800. But the inertia of traditions and the apparent success of the self-taught doctor reduced the options available to medical reformers in their responses to a more rapidly changing social and intellectual context.

* Speaker

1. David Hawke, The Colonial Experience (Indianapolis, 1966), 255.

2. Evarts B. Greene and Virginia D. Harrington, American Population before the Federal Census of 1790 (New York, 1932), 6.

3. John M. Murrin, “Review Essay,” History and Theory: Studies in the Philosophy of History, 11 (1972), 248.

4. Ibid., 256, fn. 63.

5. Ibid., 256.

6. Carl Bridenbaugh, Cities in the Wilderness: The First Century of Urban Life in America, 1625–1742 (New York, 1955), 6, 143, 303.

7. Carl Bridenbaugh, Cities in Revolt: Urban Life in America, 1743–1776, Oxford paperback ed. (New York, 1971), 5, 216.

8. James T. Adams, New England in the Republic, 1776–1850 (Boston, 1926), 54.

9. The articles on religion and the 1795 vote on the calling of another constitutional convention did not receive a two-thirds vote but were declared accepted nonetheless. See Allan Nevins, The American States during and after the Revolution, 1775–1789 (New York, 1924), 181. In the gubernatorial elections between 1780 and 1789 the voter turnout ranged between nine and thirty-two percent. See R. R. Palmer, The Age of the Democratic Revolution: A Political History of Europe and America, 1760–1800, 2 v. (Princeton, N.J., 1959), I, 227–228, fn. 19; and J. R. Pole, Political Representation in England and the Origins of the American Republic (New York, 1966), 542.

10. Delegates from coastal and island counties voted 102 to 19 in favor of the new Constitution, while those from inland counties voted 128 to 60 against. See Samuel Eliot Morison, The Maritime History of Massachusetts, Sentry ed. (Boston, 1961), 39–40.

11. Greene and Harrington, Population, 18; Bureau of the Census, Historical Statistics of the United States, Colonial Times to 1970, 2 vols. (Washington, 1975), i, 29.

1. John A. Schutz and Douglass Adair, eds., The Spur of Fame: Dialogues of John Adams and Benjamin Rush, 1805–1813 (San Marino, Calif., 1966), 44.

2. As their later writings clearly reveal, Shryock and Bell followed up many of their own suggestions. Between the two of them, however, more ideas were produced than they alone could tackle. Some of the topics identified by them as significant and worthy of in-depth investigation became scholarly monographs, such as John Duffy’s Epidemics in Colonial America (Baton Rouge, La., 1953) and John B. Blake’s Public Health in the Town of Boston, 1630–1822 (Cambridge, Mass., 1959).

3. Francisco Guerra, American Medical Bibliography, 1639–1783 (New York, 1962); Genevieve Miller, Bibliography of the History of Medicine of the United States and Canada, 1939–1960 (Baltimore, 1964).

1. John B. Blake, ed., Education in the History of Medicine (New York, 1968), 114, 121, For a 1904 rationale for medical history, see: Henry E. Sigerist, “Medical History in the United States: Past—Present—Future: A Valedictory Address,” Bulletin of the History of Medicine, 22 (1948), 47–64. Although a 1956 symposium was charged to explore whether medical history can “illuminate current problems and issues in medicine,” its published proceedings show that it did not do so: lago Goldston, ed., On the Utility of Medical History (New York, 1957). In 1969 Genevieve Miller reported on reasons for the disappearance of medical history from medical school curricula in: Bulletin of the History of Medicine, 43 (1969), 259, 344, 444, 553. Participants in an unpublished symposium on “The Implications of Current Trends in Medical Education for the Teaching of Medical History” at the American Association for the History of Medicine annual meeting in Montreal, Canada, 3–5 May 1972, blamed the chasm between historians and practitioners (including students) of medicine at least partly on an unwillingness among scholars without M.D. degrees to adapt their scholarship to the emotional, cognitive, attitudinal, and intellectual needs of medical students, and on the rapid compression of medical curricula. Newly evolving approaches to the overall problem were only lightly sketched by Stanley Joel Reiser in “The History of Medicine Program at Harvard,” Bulletin of the History of Medicine, 46 (1972), 190–191.

2. Lester S. King, “Why Celebrate?” Journal of the American Medical Association, 236 (1976), 40.

3. Thomas S. Kuhn, The Structure of Scientific Revolutions, 2nd ed. (Chicago, 1970), 1.

4. Jonathan Swift, Gulliver’s Travels. See Gulliver’s visit to the Academy of Lagado on his voyage to Balnibarbi, in any standard edition. Gulliver’s medical training was among the best obtainable in the late seventeenth century. After a four-year apprenticeship to a London surgeon, Mr. James Bates, he studied physic for another two and a half years at Leyden, but before Boerhaave was appointed professor there in 1701. Electing a career as a ship’s surgeon, Gulliver had already spent over ten years at sea before he landed on Lilliput in 1699.

* After taking his A.B. in History at Oberlin College, Dr. Brown earned his A.M. and Ph.D., also in History, at Harvard. He is now Professor and Chairman of the History Department at the University of Connecticut at Storrs. His recent books that complement this paper include: Revolutionary Politics in Massachusetts: The Boston Committee of Correspondence and the Town (1970); Modernization: The Transformation of American Life, 1600–1865 (1976); and Massachusetts: A Bicentennial History (1978).

1. The population figure of 300,000 is an estimate of the combined populations of Massachusetts and Maine. According to Historical Statistics of the United States, Colonial Times to 1970, part 2 (Washington, D.C., 1975), 1168, the population was 267,000 in 1770. Assuming a growth rate of 2.5 percent per annum the population would have exceeded 300,000 by 1775. Robert V. Wells, author of The Population of the British Colonies in America before 1776 (Princeton, N.J., 1975), estimates the population at between 310,000 and 320,000 in 1775 (personal letter, 9 March 1979). James Potter, in “Growth of Population in America, 1700–1870,” in D. V. Glass and D. E. C. Eversley, eds., Population in History (Chicago, 1965), 638, puts the population at 339,000 in 1775, but his estimate projects an annual growth of over three percent. Comparison of birthrates and longevity is with English and European populations, although it is generally believed that natural increase was greater in New England than elsewhere in Anglo-America in the seventeenth century and that life expectancy was greater in the eighteenth century as well. See: Daniel Scott Smith, “The Demographic History of Colonial New England,” Journal of Economic History, 32 (1972), 165–183, esp. 165–170; Maris A. Vinovskis, “Mortality Rates and Trends in Massachusetts before 1860,” Journal of Economic History, 32 (1972), 184–213, esp. 195–202.

2. Kenneth A. Lockridge, Literacy in Colonial New England (New York, 1974), 98–99.

3. The rising popularity of almanacs during the course of the eighteenth century was partly based on their agricultural utility. Surviving almanac-diaries commonly include information on planting and harvest dates and yields. Almanacs also facilitated “moon farming,” a system of agricultural practices calculated according to the phases of the moon. See also: Robert A. Gross, “The Problem of Agricultural Crisis in Eighteenth-Century New England: Concord, Massachusetts, as a Test Case,” paper presented at American Historical Association Meeting, Atlanta, Ga., 29 Dec. 1975; Gross, “Minutemen in a New Nation: Concord, Massachusetts, in the 1790’s,” revised manuscript of a paper presented at the Historical Deerfield Conference on New England Towns in the Early National Period, 8 Dec. 1973.

4. John Clive and Bernard Bailyn, “England’s Cultural Provinces: Scotland and America,” William and Mary Quarterly, 3rd ser., 11 (1954), 200–213.

5. Keith Thomas, Religion and the Decline of Magic (New York, 1971).

6. David E. Stannard, The Puritan Way of Death (New York, 1977), ch. 4, “Death and Dying.”

7. From stone of Seth Sumner, Milton, Mass., 11 Nov. 1771. Quoted in Dickran and Ann Tashjian, Memorials for Children of Change: The Art of Early New England Stonecarving (Middletown, Ct., 1974), 245.

8. 29 Feb. 1730, Barnstable, Mass. Recorded by author.

9. Although there was conflict between some aspects of science and Protestant belief in the eighteenth century, medicine and theology were compatible; indeed Cotton Mather, a leading divine, was an advanced medical thinker (Perry Miller, New England Mind: From Colony to Province [Boston, 1961], 443). A few physicians were privately skeptics in religion, but medicine itself was a Christian profession. See: Whitfield J. Bell, Jr., The Colonial Physician and Other Essays (New York, 1975), 20–21. The existence of God was said to be demonstrated by scientific knowledge.

10. Christianson has found evidence of 149 practitioners in the colony before 1700, and one-half of them continued their activities after that date. He dates the substantial increase in the medical corps from the mid-eighteenth century (see Eric H. Christianson, “The Medical Practitioners of Massachusetts, 1630–1800,” below, 49–67).

11. Virgil J. Vogel, “American Indian Influence on the Pharmacopeia,” American Indian Culture and Research Journal, 2 (1977), 3–7; and Vogel, American Indian Medicine (Norman, Okla., 1970), 41–45. J. Worth Estes notes the use of Indian therapies and native American plants in “Honest Dr. Thornton: The Path to Rebellion,” in George E. Gifford, Jr., ed., Physician Signers of the Declaration of Independence (New York, 1976), 73–74.

12. William G. Rothstein, American Physicians in the Nineteenth Century: From Sects to Science (Baltimore, 1972), 36–37.

13. Christianson, “The Medical Practitioners of Massachusetts, 1630–1800.” J. Worth Estes notes that the medical experience of a Leicester, Massachusetts, cleric was by no means unusual since it was commonly expected that a minister would “fill both the medical and religious needs of his parish” (“Honest Dr. Thornton,” p. 71, see n. 11).

14. Whitfield J. Bell, Jr., considers the Boston-Philadelphia comparison below. See his “Medicine in Boston and Philadelphia: Comparisons and Contrasts, 1750–1820,” 159–184.

15. The American Antiquarian Society’s copy of William Buchan, Domestic Medicine: or, a Treatise on the Prevention and Cure of Diseases by Regimen and Simple Medicines, 14th ed. (Boston, 1793), contains a pasted-in newspaper remedy. Buchan’s Domestic Medicine was first published at London in 1769.

16. Eric H. Christianson, “The Medical Practitioners of Massachusetts, 1630–1800” (below, 49–67), has found that the self-taught “doctor” was most common. Douglas L. Jones, “Charity, Medical Charity, and Dependency in Eighteenth-Century Essex County, Massachusetts” (below, 199–213), demonstrates that people who became town charges often received treatment from the most learned physician in their locale.

17. According to the Oxford English Dictionary (Oxford, 1933; reprinted 1961), VIII, 929, the term “placebo” first appeared in a medical dictionary in 1811. Since dictionaries have typically lagged behind current usage, it would not be surprising if the term was in use among eighteenth-century medical practitioners; certainly the concept was known.

18. Joseph F. Kett, The Formation of the American Medical Profession: The Role of Institutions, 1780–1860 (New Haven, 1968), 5.

19. John M. Murrin, “The Myths of Colonial Democracy and Royal Decline in Eighteenth-Century America: A Review Essay,” Cithera, 5 (1965), 53–69.

20. Quoted in James H. Stark, The Loyalists of Massachusetts and the Other Side of the American Revolution (Boston, 1910), 386.

21. Biographical sketches in E. Alfred Jones, The Loyalists of Massachusetts: Their Memorials, Petitions and Claims (London, 1930), 140–142, 179–181, 233. (See Philip Cash, “The Professionalization of Boston Medicine, 1760–1803,” below, 69–100.—eds.)

22. First series given in 1765 by William Perkins. Albert Matthews, “Notes on Dr. William Perkins (1737–1797),” PtMications of the Colonial Society of Massachusetts, 20 (1917–1919), 10–17.

23. Philip Cash, “The Professionalization of Boston Medicine, 1760–1803” (below, 69–100), notes that military service often provided supplementary medical training. Cash also describes the shift in political influence from Tory to Patriot physicians. In his Medical Men at the Siege of Boston (Philadelphia, 1973) Cash estimated that some 140 “doctors” served the revolutionaries at Boston. The social characteristics and medical training of most of these men (sixty-nine percent) are unknown. Among the forty-three whose careers could be discovered Cash found that they were mostly young men from Massachusetts (twenty-six years of age on average), and possessed of limited medical experience. Less than half had attended college. Presumably the ninety-seven others whose careers could not be traced were even less well educated.

24. Walter Muir Whitehill, “Early Learned Societies in Boston and Vicinity,” in The Pursuit of Knowledge in the Early American Republic: American Scientific and Learned Societies from Colonial Times to the Civil War, Alexandra Oleson and Sanborn C. Brown, eds. (Baltimore, 1976), 151–173.

25. Information on the early purposes and membership is drawn from Massachusetts Medical Society, Medical Papers Communicated to the Massachusetts Medical Society, To Which Are Subjoined Extracts from various Authors, containing some of the Improvements, which have lately been made in Physic and Surgery (Boston, 1790), Evans no. 22661; Kett, Formation of the American Medical Profession, 15.

26. Massachusetts Medical Society, Medical Papers (see n. 25).

27. Ibid., iii–iv.

28. Ibid., vii.

29. Ibid., vii.

30. On the continuing vitality of popular medicine see: Guenter B. Risse, Ronald L. Numbers, and Judith Walzer Leavitt, eds., Medicine without Doctors: Home Health Care in American History (New York, 1977).

* Dr. Christianson, who is currently Assistant Professor of History at the University of Kentucky, Lexington, received his A.B., A.M., and Ph.D. degrees in History from the University of Southern California. His research and teaching encompass the history of science, medicine, and several of their branches. He is now working on a study of the Medical Department of Transylvania University at Lexington.

1. Medical Essays (Boston, 1911), 312, 352–353.

2. The Early History of the Medical Profession in Norfolk County, Massachusetts: An Address before the Norfolk District Medical Society, May 10, 1853 (Boston, 1853), 6.

3. Whitfield J. Bell, Jr., “A Portrait of the Colonial Physician,” Bulletin of the History of Medicine, 44 (1970), 497–517.

4. Certainly one of the first to recommend this approach is Bell, “Suggestions for Research in the Local History of Medicine in the United States,” Bulletin of the History of Medicine, 17 (1945), 460–476.

5. An excellent discussion of this technique is Lawrence Stone, “Prosopography,” Daedalus, 100 (1971), 46–79. Though not a computerized study, Steven Shapin and Arnold Thackray, “Prosopography as a Research Tool in the History of Science: The British Scientific Community, 1700–1800,” History of Science, 12 (1974), 1–28, demonstrate persuasively the analytical potential of collective biography. The pioneer effort to employ computer analysis of collective biography in American medical history is Barnes Riznik, “The Professional Lives of Early Nineteenth Century New England Doctors,” Journal of the History of Medicine and Allied Sciences, 19 (1964), 1–16. One exceptionally solid project examining demographic aspects of an occupational group is Harry S. Stout, “University Men in New England, 1620–1660: A Demographic Analysis,” Journal of Interdisciplinary History, 4 (1974), 375–400.

6. Two fine works in this area are Peter Laslett, The World We Have Lost (London, 1965), and Robert A. Gross, The Minutemen and Their World (New York, 1976). Unless otherwise noted, the charts and other statistical material in this paper are taken from my doctoral dissertation, “Individuals in the Healing Arts and the Emergence of a Medical Community in Massachusetts, 1700–1792: A Collective Biography” (University of Southern California, 1976).

7. Among others, the Reverend Dr. Cotton Mather discussed the importance of the rninister-doctor especially in the absence of trained individuals in developing regions. Robert Heller argues that the problems of health care in rural areas during the eighteenth century are a “mirror image of the situation in the developing countries” of the Third World (“ ‘Priest-doctors’ as a Rural Health Service in the Age of Enlightenment,” Medical History, 20 [1976], 361–383). (See Richard D. Brown, “The Healing Arts in Colonial and Revolutionary Massachusetts,” above, 35–47.—eds.)

8. In my attempt to reconstruct the composition of the first Boston Medical Society (1735– c. 1741), I discovered that Ezekiel Hersey, a pupil of Dr. Hugh Kennedy of Scotland, was inoculated for smallpox. Kennedy had to visit a patient out of town, so a nurse was summoned to care for Hersey. Because he was only a pupil, not an apprentice, Hersey was sued by his mentor for the nurse’s fees. The nurse, Sarah Melendy, gave her deposition and it can be profitably perused in the Court Files of the Superior Court of Suffolk County, Mass., February 1736/7, ccxc, 92–97.

9. For developments in England during a later period, see Joseph F. Kett, “Provincial Medical Practice in England, 1730–1815,” Journal of the History of Medicine and Allied Sciences, 19 (1964), 17–30.

10. History of Medicine in Massachusetts (Boston, 1881), 15.

11. Henry R. Viets, A Brief History of Medicine in Massachusetts (Boston, 1930), 11–12.

12. The Americans: The Colonial Experience (New York, 1958), 229.

13. A Directory of English Country Physicians, 1603–1643 (London, 1962), 12–14.

14. Gloria L. Main, “Inequality in Early America: The Evidence from Probate Records of Massachusetts and Maryland,” Journal of Interdisciplinary History, 7 (1977), 559–581.

15. Example-Title Styled at Death, abstracted from my dissertation (n. 6):

Title	N	% of total
Medical	861	62.8
Medical & other	13	.9
Esquire	20	1.5
Deacon	1	1
Other	42	3.1
Missing*	433	31.6
Totals	1370	100.0%

*Includes also those individuals for whom no title exists in the records.

16. Laslett, The World We Have Lost, 266.

17. I wish to thank Professor J. Worth Estes, m.d., of the Boston University School of Medicine, for this observation based on my original growth-rate figures.

18. While there are no comprehensive analyses for other areas with which to compare the results of the present study, two scholars have estimated that during the period 1607–1800 New Jersey had 300 medical inhabitants and Virginia 927 (David L. Cowen, Medicine and Health in New Jersey: A History [New Brunswick, 1964], 8; Wyndham B. Blanton, Medicine in Virginia in the Seventeenth Century [Richmond, 1930], 260–297, and Medicine in Virginia in the Eighteenth Century [Richmond, 1931], 313).

19. Contributions to the Annals of Medical Progress and Medical Education in the United States Before and During The War of Independence (Washington, D.C., 1874), 105–106.

20. Richard H. Shryock, Medicine and Society in America, 1660–1860 (Ithaca, 1962), 12.

21. Richard D. Brown, “The Emergence of Urban Society in Rural Massachusetts, 1760–1820,” Journal of American History, 61 (1974), 29–51.

22. Eric H. Christianson, “The Emergence of Medical Communities in Massachusetts, 1700–1794: The Demographic Factors,” unpublished paper read at the 50th Annual Meeting of the American Association for the History of Medicine, 13 May 1977, Madison, Wisconsin. The selection of towns includes Attleborough, Becket, Billerica, Boston, Boxford, Bridgewater, Brookline, Charlton, Chilmark, Great Barrington, Medford, Newbury, Northampton, Pittsfield, Plymouth, Rehoboth, Salem, Taunton, Tyringham, and Worcester.

23. Also see J. Worth Estes, “Therapeutic Practice in Colonial New England,” below, 289–383; and the Appendix to C. Helen Brock, “The Influence of Europe on Colonial Massachusetts Medicine,” below, 101–143.—eds.

24. Helpful observations on mobility during the eighteenth century in several locations are found in Gross, 90–91 (fn. 6), and Philip J. Greven, Jr., Four Generations: Population, Land, and Family in Colonial Andover, Massachusetts (Ithaca, 1970), 156–157, 162–163, 254–256.

25. T. H. Breen and Stephen Foster, “The Way to the New World: The Character of Early Massachusetts Immigration,” William and Mary Quarterly, 30 (1973), 189–222.

26. Christianson, “The Emergence of Medical Communities in Massachusetts, 1700–1794” (see n. 11).

27. Similar figures for the antebellum period are presented in Riznik (n. 5), 1–13, and in Charles McIntyre, “The Percentage of College-Bred Men in the Medical Profession,” Medical Record, 22 (1882), 681–684.

28. Christianson (n. 22).

29. Richard D. Brown, Modernization: The Transformation of American Life, 16001865 (New York, 1976), 74–121.

30. The quote is from James A. Henretta, The Evolution of American Society, 1700–1815 (Lexington, Mass., 1973), 209. The problem of how difficult it is to determine the efficacy of learned and home remedies is discussed in my article “The Description and Treatment of the Fly-Blown Ear: An Aspect of Science and Medicine in Colonial America,” The Melsheimer Entomological Series, 26 (1979), 1–12.

31. Nathaniel Ames, Jr., “An Elegy On the Death of the Late Dr. Ames,” in An Astronomical Diary, or Almanack, for . . . 1765 (Boston, 1764), n.p.

32. Education in the Forming of American Society: Needs and Opportunities for Study (Chapel Hill, N.C., 1960), 30–31.

33. Rhoda Truax, The Doctors Warren of Boston, First Family of Surgery (Boston, 1968), 85.

34. Viets (n. 11), 94–95, observes that in Boston the loyalist physicians did not fare well, but away from the hub of activity the loyalist might be watched carefully but tolerated.

35. In 1738, after ten years without a resident doctor, Northampton, along with four other neighboring towns, jointly extended an offer of £200 to Hezekiah Porter of Farmington, Connecticut, provided that he “lived among us Some years” (Northampton Town Records quoted in James Russell Trumbull, History of Northampton, Massachusetts [Northampton, 1902], II, 85–86).

36. Christianson (n. 6), 161–163, 168–171.

37. Riznik (n. 5), 3–6; William Barlow and David O. Powell, “To Find a Stand: New England Physicians on the Western Frontier, 1790–1840,” unpublished paper delivered at the 50th Annual Meeting of the American Association for the History of Medicine, 13 May 1977, Madison, Wisconsin.

38. Professional Lives in America: Structure and Aspirations, 1750–1850 (Cambridge, Mass., 1965), 55. Professor Estes demonstrates elsewhere in this volume that in New England doctors in large communities recorded a higher patient load than did their country counterparts and made more money, and that their therapies differed to some extent. Also, in another article (“ ‘As Healthy a Place as Any in America’: Revolutionary Portsmouth, N.H.,” Bulletin of the History of Medicine, 50 [1976], 536–552) he describes the greater longevity among residents of smaller towns than among their city counterparts. Few practitioners in either situation became wealthy from their patients’ fees, but it may be that inhabitants of larger towns, where mortality rates were higher, might have required greater medical attention and yielded more professional income. The city doctor, in effect, might not have to wait as long to collect fees from his deceased patients’ estates. On the other hand, it is possible that rural doctors received over a longer period of time a constant but modest income from their patients. A “surplus” of doctors in the countryside might then be heightened by their patients’ greater longevity.

39. The Doctor Shortage: An Economic Diagnosis (Washington, D.C., 1967), 5–8.

40. An excellent anthology covering the vitality of the self-help tradition in American history is Guenther B. Risse, Ronald L. Numbers, and Judith Walzer Leavitt, eds., Medicine without Doctors: Home Health Care in American History (New York, 1977). Henretta (n. 30), 111, stated that a deferential society persisted in New England and that the masses deferred to the leading families. Such customs might also explain the apparent success of medical family members in driving out the mobile interloper. “It could be said that the advent of universal literacy [in post-1760 New England] would have increased both the unity of men and their contentiousness, in a paradox typical of the modernization of attitudes” (Kenneth A. Lockridge, Literacy in Colonial New England: An Inquiry into the Social Context of Literacy in the Early Modern West [New York, 1974], 29).

41. Ames, “An Elegy . . .” (n. 31).

42. This quote is from the famous “Graph Iatroon” letter announcing in March 1765 the formation, without realization, of a medical society composed of doctors living around, but not in, Boston (Walter L. Burrage, A History of the Massachusetts Medical Society with Brief Biographies of the Founders and Chief Officers, 1781–1922 [1923], 3–4).

43. “Medicine and Learned Societies in the United States, 1660–1865,” in Alexandra Oleson and Sanborn C. Brown, eds., The Pursuit of Knowledge in the Early American Republic: American Scientific and Learned Societies from Colonial Times to the Civil War (Baltimore and London, 1976), 261–278.

44. Richard D. Brown, “The Emergence of Voluntary Associations in Massachusetts, 1760–1830,” Journal of the Volunteer Active Reserves, 2 (1973), 64–73.

45. One need only peruse chapters II, III, and X in Burrage (n. 42), to capture the flavor of ambivalence.

46. The manuscript collection pertaining to the early history of the state society contains dozens of letters written by members from all over the state making suggestions about educational qualifications for competent practice (b.ms.b.75.1, Boston Medical Library, Francis A. Countway Library of Medicine).

47. In 1755, young Bostonian William Jepson, a former pupil of Dr. Silvester Gardiner, enumerated the “many disadvantages attending a seperate [sic] way of study” in the bylaws of a group composed of recent apprenticeship graduates for the purpose of continuing their training throughout their careers (uncatalogued Silvester Gardiner Papers, Francis A. Countway Library of Medicine).

48. One of the rules governing the Berkshire Medical Association, which was located in Stockbridge, indicates the willingness of some regularly trained men to join forces with the opposition: “Any person residing within the limits of this county, and pretending to practice physic and shall refuse ... to become a member ... he shall be treated with entire neglect” (manuscript records of the Berkshire District Medical Society, 1785–1864, Berkshire Medical Institution, Pittsfield, 3–27).

49. For a detailed discussion of that ill-fated group, see Christianson (n. 6), 155–161.

50. The Rise, Progress, and Present State of Medicine, Delivered at Concord July 6, 1791, before the Middlesex Medical Association (Boston, 1792), 28. Such discord was “highly detrimental to the Profession” and provided the “chief Root from whence these very Empiricks spring” (Burrage [n. 42], 3–4).

51. Israel Atherton to M.M.S., Lancaster, 20 October 1789 (b.ms.b.75.1 f72, Boston Medical Library, Francis A. Countway Library of Medicine).

52. Calhoun (n. 38), 55.

53. Berkshire District Medical Society Records (n. 48), 5, 10.

54. Michael Zuckerman, “The Fabrication of Identity in Early America,” William and Mary Quarterly, 34 (1977), 183–214.

55. The motto coined by Theodore Parker in 1848 and quoted in Michael Kammen, People of Paradox: An Inquiry Concerning the Origins of American Civilization (New York, 1973), 57.

56. Two works detailing these developments are Joseph F. Kett, The Formation of the American Medical Profession: The Role of Institutions, 1780–1860 (New Haven, 1968), and William G. Rothstein, American Physicians in the Nineteenth Century: From Sects to Science (Baltimore and London, 1972).

* After obtaining his B.S.Ed, at Gorham State Teachers College in Maine, Dr. Cash completed his studies in History at Boston College, where he earned his M.A. and Ph.D. degrees. He is now Professor of History at Emmanuel College in Boston, where he was Chairman of the Department for nine years. His other contributions to colonial medical studies include a chapter on Dr. Oliver Wolcott of Litchfield, Connecticut, in Physician Signers of the Declaration of Independence (1976), and a book on Medical Men at the Siege of Boston, April, 1775–April, 1776: Problems of the Massachusetts and Continental Armies (1973).

1. The use of the term “professionalization” in this paper may not conform to some contemporary sociological models. It is used as a term of practicality or convenience. By it I mean an increased sense of awareness of common goals and common aspirations on the part of Boston’s trained medical practitioners (physicians) of this era. This was demonstrated primarily in increased cooperation, attempts to improve medical training, and in attempts to gain greater control over the dispensing of medical services. It also involved the founding of two medical societies and a medical school. I recognize that there was a medical profession in Boston before 1760 and that the process of professionalization continued after 1803.

2. For developments in Philadelphia at this time see Whitfield J. Bell, Jr., “Medicine in Boston and Philadelphia: Comparisons and Contrasts,” below, 159–184.—eds.

3. In analyzing the professionalization of Boston medicine between 1760 and 1803 I have considered as “physicians” only those practitioners of medicine who had undergone at least a medical pupilage or apprenticeship and who were engaged in medical practice for at least five years, including any military medical service. Admittedly, this definition is somewhat arbitrary and not wholly in keeping with contemporary usage. However, these limitations are more than offset by the fact that it provides for far greater clarity and precision of usage and allows for a systematic analysis of that element among the variegated purveyors of medical service in eighteenth-century America who would evolve into the modern doctor. So far I have been able to identify and confirm forty-seven men who meet these criteria and who were members of the Boston medical community between 1760 and 1798, although in several instances the fact of their pupilage or apprenticeship must be inferred from substantial but indirect evidence. Undoubtedly there were others who practiced in Boston during this time and who meet the above criteria, but whom I have not been able to identify or confirm. However, it is unlikely that they would seriously alter the professional profile that I have drawn. I have listed these men in Appendix I together with pertinent data as to their college education, medical training above the apprenticeship-pupilage level, military medical experience, and religious and political affiliations. In identifying and listing these men I have used 1798 rather than 1803 as the cutoff date in order to avoid including such people as James Jackson and John Collins Warren who really belong to the next generation and next era of Boston medicine. The fourteen physicians who were practicing in Boston in 1760 were: Thomas Bulfinch, Jr.; Benjamin Church, Jr.; John Clark rv; Nyott Doubt; Silvester Gardiner; Joseph Gardner; James Lloyd; Thomas Mather; James Pecker; John Perkins; Nathaniel Perkins; William Lee Perkins; John Sprague; and Miles Whitworth, Sr. The twenty-one who were active at the opening of 1775 were: Samuel Adams, Jr.; Thomas Bulfinch, Jr.; Benjamin Church, jr.; Samuel Danforth; Silvester Gardiner; Joseph Gardner; Ebenezer Hunt; Charles Jarvis; John Jeffries; Thomas Kast; James Lloyd; James Pecker; John Perkins; Nathaniel Perkins; William Lee Perkins; Isaac Rand, Jr.; John Sprague; Joseph Warren; Miles Whitworth, Sr.; Amos Windship; and Thomas Young.

4. By 1760 Boston was a city in deep economic, social, and political trouble because of the residue of bitterness left over from the monetary struggles of the 1740’s and early ‘50’s, the serious economic and human losses sustained in the last two colonial wars, and the growing competition for markets offered by commercial rivals both large and small and near and far. Between 1760 and 1764 the city was ravaged by the greatest of many fires during the colonial era and then further disrupted by a major smallpox epidemic. Over the next decade a generally depressed economy and bitter political struggle punctuated by military occupation beset the city until the news of Lexington and Concord must have come as psychic relief. See James T. Adams, Revolutionary New England, 1691–1776 (Boston, 1923), 138–416; Carl Bridenbaugh, Cities in Revolt: Urban Life in America, 1743–1776 (1955; rpt. ed., New York, 1971); Samuel G. Drake, The History and Antiquities of Boston, the Capital of Massachusetts and Metropolis of New England, from its Settlement in 1630 to the Year 1770 (Boston, 1856), 637–784; Albert B. Hart, ed., Commonwealth History of Massachusetts, 5 v. (New York, 1927–1930), II and III; James A. Henretta, “Economic Development and Social Structure in Colonial Boston,” William and Mary Quarterly, 22 (1965), 75–92; Gerald B. Warden, “The Distribution of Property in Boston, 1692–1775,” Perspectives in American History, 10 (1976), 81–130; Gerald B. Warden, Boston, 1689–1776 (Boston, 1970), 127–143; William B. Weeden, Economic and Social History of New England, 1620–1789, 2 v. (Boston, 1890), II, 637–767; Justin Winsor, ed., Memorial History of Boston, Including Suffolk County, 1630–1880, 4 v. (Boston, 1880–1881), III, 1–67, 119–175. For the permanent population of Boston during this period see Lemuel Shattuck, Report to the Committee of the City Council Appointed to Obtain the Census for Boston for the Year 1845 (Boston, 1846), 3–5, 54; Bridenbaugh, Revolt, 5, 216, 497, fn. 328:1.

5. For doctors in the colony as a whole see Eric H. Christianson, “The Medical Practitioners of Massachusetts, 1630–1800: Patterns of Change and Continuity,” above, 49–67.—eds.

6. John Langdon Sibley and Clifford K. Shipton, Sibley’s Harvard Graduates, 17 v. so far (Cambridge, Mass., 1873–), viii, 90–92.

7. The thirteen who had studied in Europe were: Thomas Bulflnch, Jr.; Benjamin Church, Jr.; Samuel Danforth; Nyott Doubt; Silvester Gardiner; Charles Jarvis; John Jeffries; Thomas Kast; James Lloyd; Samuel Marshall; John Perkins; William Lee Perkins; and Williams Smibert. Of these, only Smibert (Edinburgh m.d., 1762) had not studied in London.

8. They were Thomas Bulfinch, Jr., and Williams Smibert (Edinburgh), and John Jeffries (Aberdeen). William Lee Perkins may have earned a medical degree but where or when is uncertain, and it is quite possible that he received it after leaving Boston in 1776.

9. See C. Helen Brock, “The Influence of Europe on Colonial Massachusetts Medicine,” below, 101–116, and its Appendix, 117–143.—eds.

10. See Brooke Hindle, The Pursuit of Science in Revolutionary America, 1735–1789 (Chapel Hill, N.C., 1956).

11. The exceptions were Thomas Kast, who was born in Boston but whose father had emigrated from Germany; John Linn, an incorporator of the Massachusetts Medical Society, who came from Pennsylvania and soon returned there; Williams Smibert, who very likely was the son of the Edinburgh-born painter John Smibert, who had emigrated to Rhode Island with Bishop Berkeley’s party in 1728; and Thomas Young, whose father had emigrated from Ireland to Ulster County, New York, where Young was born and raised.

12. Josiah Bartlett, “An Historical Sketch of the Progress of Medical Science in the Commonwealth of Massachusetts, being the Substance of A Discourse Read at the Annual Meeting of the Medical Society, June 6, 1810, with Alterations and Additions to January 1, 1813,” Massachusetts Historical Society Collections, 2nd ser., 1 (1814), 106–109; John B. Blake, “The Medical Profession and Public Health in Colonial Boston,” Bulletin of the History of Medicine, 26 (1952), 218–230; John B. Blake, “The Inoculation Controversy in Boston, 1721–1722,” The New England Quarterly, 25 (1952), 489–506; John B. Blake, “Smallpox Inoculation in Colonial Boston,” Journal of the History of Medicine and Allied Sciences, 8 (1953), 284–300; John B. Blake, Public Health in the Town of Boston, 1630–1822 (Cambridge, Mass., 1959), 52–88; Bridenbaugh, Revolt, 328–329; John Duffy, Epidemics in Colonial America (Baton Rouge, La., 1953). 103; Frederick G. Kilgour, “The Rise of Scientific Activity in Colonial New England,” Yale Journal of Biology and Medicine, 22 (1949–1950), 122–138; Joseph M. Toner, “History of Inoculation in Massachusetts,” Massachusetts Medical Society Publications, 2 (1867), 153–190; Ola E. Winslow, A Destroying Angel: The Conquest of Smallpox in Colonial Boston (Boston, 1974).

13. In March 1761, Silvester Gardiner, then the most distinguished physician in Boston, offered to construct a private inoculation hospital on a remote part of the Common near where he had earlier built a hospital for the British fleet in New England waters, but nothing came of it. In 1763, Thomas Bulfinch, Jr., Joseph Gardner, and Joseph Warren, who only recently had finished his training with James Lloyd, joined in an unsuccessful effort to secure permission to build a private inoculation hospital in or near Boston. See Boston Records Commissioners’ Reports, 16, 51–52; John Cary, Joseph Warren: Physician, Politician, Patriot (Urbana, Ill., 1961), 21; silvester Gardiner, “To the Freeholders and Other Inhabitants of the Town of Boston, in Town Meeting Assembled, March, 1761,” Massachusetts Historical Society Proceedings, ser. 1, 4 (1858–1860), 324–328; Maurice Bear Gordon, Aesculapius Comes to the Colonies: The Story of the Early Days of Medicine in the Thirteen Original Colonies (Ventnor, N.J., 1949), 89–90; Samuel Abbott Green, History of Medicine in Massachusetts: A Centennial Address Delivered Before the Massachusetts Medical Society At Cambridge, June 7, 1881 (Boston, 1881), 78; Henry R. Viets, A Brief History of Medicine in Massachusetts (Boston, 1930), 79.

14. Blake, “Inoculation,” 291; Boston Post-Boy and Advertiser, 26 March 1764; Boston Records Commissioners’ Reports, 16, 116–117; Cary, Joseph Warren, 22; Esther Forbes, Paul Revere and the World He Lived In (Boston, 1942), 75–76.

15. Bartlett, “Progress,” 108; Blake, “Inoculation,” 291–292; Boston Post-Boy and Advertiser, 27 February – 25 June 1764; Cary, Joseph Warren, 21–22; J. Worth Estes, Hall Jackson and the Purple Foxglove: Medical Practice and Research in Revolutionary America, 1760–1820 (Hanover, N.H., 1979), 16–21; Green, Massachusetts, 74–76; Massachusetts Gazette and Boston News-Letter, 8 March 1764; Toner, “Inoculation,” 180–184.

16. Blake, “Inoculation,” 291.

17. Blake, “Inoculation,” 292–295; Blake, Public Health, 92–96; Toner, “Inoculation,” 204, fn. 38.

18. Warren Papers, ii (1756–1799), Massachusetts Historical Society; Edward Warren, The Life of John Warren, M.D. (Boston, 1874), 21–22.

19. Certificate of Attendance by James Lloyd at two Courses on Midwifery by William Smellie, BMS Miscellany, Countway Library, Harvard Medical School; Edwin M. Jameson, “Eighteenth Century Obstetrics and Obstetricians in the United States,” Annals of Medical History, new ser., 10 (1938), 413–432; “Notice of the Late James Lloyd, m.d.,” New England Journal of Medicine and Surgery, and the Collateral Branches of Science, 2 (1813), 127–130; Shipton, Sibley’s, xii, 184–193; James Thacher, American Medical Biography, 2 v. in 1 (Boston, 1827), i, 359–376; Henry R. Viets, “James Lloyd,” DAB, xi, 332; Viets, Massachusetts, 72–74; Henry R. Viets, “The Medical Education of James Lloyd in Colonial America,” Yale Journal of Biology and Medicine, 31 (1958–1959), 1–14. See also a letter from Lloyd’s son, James, to James Thacher, dated 16 September 1829, inserted into a volume of Thacher’s American Medical Biography, inscribed to Dr. Edward Reynolds and now in the Countway Library, Harvard Medical School.

20. Ledger of James Lloyd, 1758–1778, Countway Library, Harvard Medical School. (See J. Worth Estes, “Therapeutic Practice in Colonial New England,” below, 289–383.—eds.)

21. Cary, Joseph Warren, 20; Shipton, Sibley’s, xii, 188–189; Thacher, Biography, I, 364; Viets, Massachusetts, 73–74, 86, 91–92. Ironically, by the late 1760’s Lloyd’s practice was so large that he could no longer be effective in carrying out his training reforms. See Shipton, Sibley’s, xviii, 188–190.

22. Albert Matthews, “Notes on Early Autopsies and Anatomical Lectures,” Colonial Society of Massachusetts Publications, 19 (1916–1917), 273–290; Frederick C. Waite, “The Development of Anatomical Laws in the States of New England,” New England Journal of Medicine, 233 (1945), 716–725.

23. Boston Gazette and Country Journal, 25 November 1765; Bridenbaugh, Revolt, 409; Cary, Joseph Warren, 33; E. Alfred Jones, The Loyalists of Massachusetts: Their Memorials, Petitions and Claims (London, 1930), 179–181, 233–234; Edward B. Krumbhaar, “Early History of Anatomy in the United States,” Annals of Medical History, 4 (1922), 282; Albert Matthews, “Notes on Dr. William Perkins (1737–1797),” Colonial Society of Massachusetts Publications, 20 (1917–1919), 10–17; Shipton, Sibley’s, xvii, 188–190. Jones mistakenly dates the Jeffries lectures as 1765, although he also credits the 1765 lectures to Perkins. See above.

24. Krumbhaar, “Anatomy,” 182.

25. Samuel F. Batchelder, Bits of Harvard History (Cambridge, Mass., 1924), 157–158; Bartlett, “Progress,” 105; Henry K. Beecher and Mark D. Altschule, Medicine at Harvard: The First Three Hundred Years (Hanover, N.H., 1977), 27; Cary, Joseph Warren, 31, 32, fn. 25; Matthews, “Autopsies,” 285–289; Thomas E. Moore, Jr., “The Early Years of the Harvard Medical School: Its Founding and Curriculum, 1782–1810,” honors thesis, Harvard University, 1952, 19–20; Francis R. Packard, History of Medicine in the United States, 2. v (New York, 1931; Hafner rpt., 1963), i, 430; Warren, John Warren, 23–26, 226–233.

26. Boston Post-Boy and Advertiser, 30 January 1764. Also see Green, Massachusetts, 76–77; Harvard Corporation Records, ii, 182, Harvard Archives, Pusey Library; Thomas F. Harrington, The Harvard Medical School: A History, Narrative, and Documentary, 1782–1905, 3 v., ed. James Mumford (New York, 1905), I, 32; Massachusetts Gazette and Boston News-Letter, 2 February 1764; Josiah Quincy, The History of Harvard University, 2 v. (Boston, 1860), ii, 480–482.

27. Quincy, Harvard, ii, 530–531.

28. Lawrence A. Cremin, American Education: The Colonial Experience, 1607–1783 (New York, 1970), 397; I. Bernard Cohen, Some Early Tools of American Science (Cambridge, Mass., 1950), 9–10.

29. Bartlett, “Progress,” 116; Boston News-Letter, 20 December 1770; Harrington, Harvard, i, 32–33; Harvard Corporation Records, ii, 350–351, 375–376, Harvard Archives, Pusey Library; Thomas E. Moore, Jr., “Early Years of the Harvard Medical School, 1782–1810,” Bulletin of the History of Medicine, 27 (1953), 530–531; Quincy, Harvard, ii, 212–213.

30. Harvard Corporation Records, ii, 378, Harvard Archives, Pusey Library. The “Reverend Dr. Erskine” continued to be a benefactor to Harvard until at least 1798. See Harvard Corporation Records, iii, 260, 307, 329–330, 396, 434, 438, 459, and iv, 535, Harvard Archives, Pusey Library.

31. Batchelder, Bits, 158; Francisco Guerra, American Medical Bibliography, 1639–1783 (New York, 1962), 533, 567, 647–651; Massachusetts Gazette and Boston Post-Boy and Advertiser, 14–28 November 1764; Massachusetts Gazette and Boston Weekly News-Letter, 12 January 1775.

32. They were John Clark vi, William Eustis, Martin Herrick, John Homans Samuel Tenney, Thomas Welsh, and Miles Whitworth, Jr. See Harvard University Quinquennial Catalogue of Officers and Graduates, 1636–1930 (Cambridge, Mass., 1930), 194–195; Viets, Massachusetts, 99.

33. The prime mover in the attempt to found a colonywide medical society in 1765 was Dr. Cotton Tufts of Weymouth, later a major force in the early years of the Massachusetts Medical Society. One of the physicians who gave him considerable support was a Joseph Gardner who Burrage says practiced in Milton and Dorchester. However, it seems likely that this was the Joseph Gardner who was a prominent physician in Boston at this time and who also was a leader in the early years of the Massachusetts Medical Society. No other Boston physician seems to have played a significant role. See Walter L. Burrage, A History of the Massachusetts Medical Society, with Brief Biographies of the Founders and Chief Officers, 1781–1922 (Norwood, Mass., 1923), 3, 62.

34. Boston Chronicle, 7 January 1768.

35. Burrage, Society, 21–22; Philip Cash, Medical Men at the Siege of Boston, April, 1775. April, 1776: Problems of the Massachusetts and Continental Armies (Philadelphia, 1973).

36. James T. Adams, New England in the Republic, 1776–1850 (Boston, 1926), 3–108; Forbes, Revere, 196–352; Allen French, The First Year of the American Revolution (New York, 1934); Hart, Commonwealth, iii, 1–354; M. A. DeWolfe Howe, Boston: The Place and the People (New York, 1903), 87–122; Allan Nevins, The American States during and after the Revolution, 1775–1789 (New York, 1924); Winsor, Boston, iii, 67–188.

37. The physicians known to have been practicing in Boston in 1776 include: Thomas Bulfinch, Jr.; William Clark; Samuel Danforth; Joseph Gardner; Ebenezer Hunt; Charles Jarvis; Thomas Kast; James Lloyd; James Pecker; John Perkins; Isaac Rand, Jr.; and John Sprague (part-time).

38. This included the thirteen members of the newly founded Boston Medical Society plus Thomas Bulfinch, Jr. See Burrage, Society, 19.

39. See William C. Wigglesworth, “Surgery in Massachusetts, 1620–1800,” below, 215–247.—eds.

40. Burrage, Society, 52–53, 55, 292; “Samuel Danforth,” Boston Medical and Surgical Journal, 1 (1828–1829), 17–21; Harvard Corporation Records, III, 148–149, 151, Harvard Archives, Pusey Library; Moore, “Years” (article), 537; Thacher, Biography, ii, 264–265; “Experiments on the Waters of Boston by Dr. Feron,” Warren Papers, ii (1780–1785), Massachusetts Historical Society; Warren, John Warren, 190–242, 418–420.

41. Bartlett, “Progress,” 111–112, 120–121; Beecher and Altschule, Harvard, 25; Burrage, Society, 13–15; Hindle, Pursuit, 263–268, 285–287, 290–292, 297–298, 357–358; Moore, “Years” (article), 534–535; Viets, Massachusetts, 104; Warren, John Warren, 233–237.

42. Beecher and Altschule, Harvard, 27; Boston Evening-Post and General Advertiser, 10 November 1781; Bulfinch to Boston Medical Society, 24 September 1780, Warren Papers, II (1780–1785), Massachusetts Historical Society; Burrage, Society, 19; Ephraim Eliot, “Dr. Ephraim Eliot’s Account of the Physicians of Boston,” Massachusetts Historical Society Proceedings, ser. 1, 7 (1863–1864), 181; Oscar and Mary Handlin, Commonwealth: A Study of the Role of Government in the American Economy: Massachusetts, 1744–1861, rev. ed. (Cambridge, Mass., 1969), 97; Harrington, Harvard, I, 77–79; Moore, “Years” (article), 533; Warren, John Warren, 222–225.

43. Boston Evening-Post and General Advertiser, 10 November 1781.

44. Beecher and Altschule, Harvard, 29; Eliot, “Account,” 181–182; Green, Massachusetts, 101–102; Harrington, Harvard, i, 77–79; Independent Chronicle and Universal Advertiser, 6–20 December 1781; James Jackson, A Eulogy on the Character of John Warren, M.D. (Boston, 1815), 14–15; Moore, “Years” (article), 534; Shipton, Sibley’s, xviii, 664; Thacher, Biography, ii, 258.

45. Beecher and Altschule, Harvard, 28; Burrage, Society, 16–19; Handlin, Commonwealth, 97; Joseph F. Kett, The Formation of the American Medical Profession: The Role of Institutions, 1780–1860 (New Haven, 1968), 14; Viets, Massachusetts, 103, 106.

46. For a list of the thirty-one incorporators, see Burrage, Society, 16.

47. Bartlett, “Progress,” 113–114; Beecher and Altschule, Harvard, 25, 28, 537, fn. 21; Burrage, Society, 1–75, 280–281, 301–313, 350–354, 388–400, 416–418; Joseph E. Garland, “Medical Journalism in New England, 1788–1924,” Boston Medical and Surgical Journal, 190 (1926), 865–879; Handlin, Commonwealth, 97, 208–209; Kett, Formation, 14–15, 24; Harold and James Kirker, Bulfinch’s Boston, 1787–1817 (New York, 1964), 224; Massachusetts Medical Society, Miscellany, i, Countway Library, Harvard Medical School; Warren, John Warren, 242.

48. By 1815 the library of the Massachusetts Medical Society contained about 4,000 volumes. See Kirker, Bulfinch’s, 224.

49. Burrage, Society, 463–467.

50. Burrage, Society, 44, 463–467.

51. Beecher and Altschule, Harvard, 27–28; Eliot, “Account,” 183–184; Lloyd to Massachusetts Medical Society, 5 November 1788, b.ms. c. 75.2, Countway Library, Harvard Medical School; Shipton, Sibley’s, xii 192–193; Viets, “Lloyd,” DAB, xi, 332.

52. Rhoda Truax, The Doctors Warren of Boston: First Family of Surgery (Boston, 1968), 88.

53. See Harvard Corporation Records, iii-v, passim, Harvard Archives, Pusey Library.

54. Beecher and Altschule, Harvard, 40–45; John B. Blake, Benjamin Waterhouse and the Introduction of Vaccination: A Reappraisal (Philadelphia, 1957); Cohen, Tools, 102–103; Jeanette E. Graustein, “Natural History at Harvard College, 1788–1842,” Cambridge Historical Society Publications, 38 (1959–1960), 73; William Coolidge Lane, “Dr. Benjamin Waterhouse and Harvard University,” Cambridge Historical Society Publications, 4 (1909), 5–22; Packard, Medicine, i, 433–445; William Roscoe Thayer, “Extracts from the Journal of Benjamin Waterhouse,” Cambridge Historical Society Publications, 4 (1909), 22–27; Josiah Charles Trent, “The London Years of Benjamin Waterhouse,” Journal of the History of Medicine and Allied Sciences, 1 (1946), 25–40; Josiah Charles Trent, “Benjamin Waterhouse (1754–1846),” Journal of the History of Medicine and Allied Sciences, 1 (1946), 357–364; Henry R. Viets, “Benjamin Waterhouse, m.d.” DAB, xix, 529–532; “Death of Benjamin Waterhouse, m.d.,” Boston Medical and Surgical Journal, 35 (1846–1847), 206.

55. See William Frederick Norwood, Medical Education in the United States before the Civil War (Philadelphia, 1944; Arno rpt., 1971).

56. Beecher and Altschule, Harvard, 31, 34; Burrage, Society, 19; Harrington, Harvard, i, 275; Moore, “Years” (article), 545–546; Packard, Medicine, i, 305–306; Barnes Riznik, Medicine in New England, 1790–1840: A Report Prepared by the Department of Research, Old Sturbridge Village (Sturbridge, Mass., 1963), 105–106; Warren, John Warren, 287–295.

57. Samuel Eliot Morison, Three Centuries of Harvard, 1636–1936 (Cambridge, Mass., 1936), 164–167, 174; Shipton, Sibley’s, xvi, 253–265. Willard was inducted into the Harvard presidency on 19 December 1781. See Harvard Corporation Records, iii, 134–136, Harvard Archives, Pusey Library.

58. Beecher and Altschule, Harvard, 29; Eliot, “Account,” 181–182; Green, Massachusetts, 101–102; Harrington, Harvard, i, 77–79; Independent Chronicle and Universal Advertiser, 6–20 December 1781; Jackson, Eulogy, 14–15; Kett, Profession, 72; Moore, “Years” (article), 534; Morison, Centuries, 168; Packard, Medicine, i, 430; Shipton, Sibley’s, viii, 664–665; Thacher, Biography, ii, 258.

59. Warren was elected Professor of Anatomy and Surgery on 22 November 1782; Waterhouse, Professor of the Theory and Practice of Physic on 24 December; and Dexter, Professor of Chemistry and Materia Medica on 22 May 1783. Warren and Waterhouse were inducted in an impressive ceremony on 7 October 1783. Dexter, who was unavoidably absent at this time, was inducted in a lesser ceremony on 16 October. See Harvard Corporation Records, iii, 160–163, 171, 178, 180–181, Harvard Archives, Pusey Library; Harvard Overseers’ Records, iii, 257–260, Harvard Archives, Pusey Library.

60. Martin Kaufman, American Medical Education: The Formative Years, 1765–1910 (Westport, Conn., 1976), 26.

61. Cohen, Tools, 73–80; Graustein, “Natural History,” 69–71; Harvard Corporation Records, iii, 171, Harvard Archives, Pusey Library; Hindle, Pursuit, 342–343; Moore, “Years” (article), 537–538; Moore, “Years” (thesis), 86–89.

62. Bartlett, “Progress,” 118; Beecher and Altschule, Harvard, 43; Cohen, Tools, 100–103, 113–123; Graustein, “Natural History,” 70–71; Harvard Corporation Records, iii, 307–308, iv, 472, 488, 495, 514, 535–536, 603, Harvard Archives, Pusey Library; Kett, Profession, 72–73; Lane, “Waterhouse,” 7–13; Moore, “Years” (thesis), 71–73; Morison, Centuries, 171–172; Benjamin Waterhouse, The Botanist, being the Botanical Part of A Course of Lectures on Natural History ... Together with A Discourse on the Principles of Vitality (Boston, 1811). Waterhouse gave his lectures on natural history first in 1786 and 1787 at commencement time at Brown University, where he served as an unsalaried professor of natural history and on the Board of Fellows. See J. Walter Wilson, “The First Natural History Lectures at Brown University, 1786, by Dr. Benjamin Waterhouse,” Annals of Medical History, 3rd ser., 4 (1942), 390–398.

63. See John C. Greene, “The Boston Medical Community and Emerging Science, 1780–1820,” below, 187–197.—eds.

64. Adams, Republic, 109–229; Hart, Commonwealth, iii, 341–357; Howe, Boston, 123–221; Kirker, Bulfinch’s; Marjorie Drake Ross, The Book of Boston: The Federal Period, 1775–1837 (New York, 1961); Walter Muir Whitehill, Boston: A Topographical History, 2nd ed. (Cambridge, Mass., 1968), 47–72; Winsor, Boston, iii 189–216.

65. Burrage, Society, 21–22; Lemuel Shattuck, The Vital Statistics of Boston (Philadelphia, 1841), xii–xvii; Winsor, Boston, iii, 168, fn. 2.

66. See Appendix II.

67. See Appendix II.

68. They were William Spooner, who received his M.D. from Edinburgh, and John Clark vi, who studied midwifery in London. Charles Williams Windship received his M.D. from Glasgow in 1797, but does not appear to have practiced in Boston in or before 1798.

69. They were: Samuel Brown; Nahum Fay; John Fleet, Jr.; William Dix; and William Ingalls. Brown, who had a tragically short career, dying in 1805, won the Humane Society prize for his excellent account of the Boston yellow-fever epidemic of 1789. Fleet was one of the first two graduates of the Harvard Medical Institution and was later appointed its first assistant (to John Warren in 1793). He also was the first consulting physician to the Boston Dispensary as well as recording secretary and librarian of the Massachusetts Medical Society. Ingalls became a distinguished professor of anatomy and surgery at the Brown medical school.

70. Harvard Corporation Records, iii, 358–359, 361, Harvard Archives, Pusey Library; Samuel Eliot Morison, “Dr. Amos Windship (1745–1813, H.C. 1771),” Colonial Society of Massachusetts Publications, 25 (1922–1924), 141–171; Shipton, Sibley’s, xvii, 673–679.

71. Beecher and Altschule, Harvard, 34; Burrage, Society, 19; Harrington, Harvard, I, 275; Harvard Corporation Records, III, 186, 191–193, 195, 236, Harvard Archives, Pusey Library; Memorial of the President and Fellows to the General Court, 5 February 1784, State House Archives, House File No. 1405; Moore, “Years” (article), 555–556; Morison, Centuries, 171; John Warren to Overseers of the Poor of the Town of Boston (tentatively dated 1789, should be dated 1784), Warren Papers, iii (1786–1795), Massachusetts Historical Society.

72. Bartlett, “Progress,” 113, 118–119; Burrage, Society, 51–52, 54, 303–306, 369; Eliot, “Account,” 183–184; Handlin, Commonwealth, 97, 208–209; Harvard Corporation Records, iii, 155–159, 215–217, 223–224, 426, Harvard Archives, Pusey Library; Hindle, Pursuit, 291; Kett, Profession, 14–15, 24, 72; Massachusetts Medical Society Documents, Miscellaneous, I, Countway Library, Harvard Medical School; Moore, “Years” (thesis), 100–102; Warren, John Warren, 285–287.

73. Handlin, Commonwealth, 129.

74. See the letter from Lloyd’s son, James, to James Thacher, dated 16 September 1829, inserted into a volume of Thacher’s American Medical Biography, inscribed to Dr. Edward Reynolds and now in the Countway Library, Harvard Medical School.

75. John Warren, Lectures on Anatomy, 1783–1812, Countway Library, Harvard Medical School.

76. There is a notebook in the Countway Library, Harvard Medical School, entitled “Theory and Practice of Midwifery.” There is no indication as to who the author or owner was, but it may well have been John Clark vi. It consists of a rather extensive course of thirty-six well-organized but simplified (as compared to those of the London teachers of obstetrics) lectures on midwifery such as would have been very useful to the type of medical student then in Boston.

77. The first two dispensaries were founded in Philadelphia in 1786 and New York in 1790. The Boston Dispensary was opened in 1796 and incorporated in 1801. See Bartlett, “Progress,” 127; Blake, Public Heallh, 239; Columbian Centinel, 14–21 December 1796; Leonard K. Eaton, Early New England Hospitals, 1790–1833 (Ann Arbor, Mich., 1957), 21–22; [William R. Lawrence], A History of the Boston Dispensary By One of the Board of Managers (Boston, 1859), 1–48; Warren, John Warren, 236.

78. Blake, Public Health, 166–167, 229.

79. Bartlett, “Progress,” 123–124; Blake, Waterhouse, 46–47; Blake, Public Health, 181–182; Boston Records Commissioners’ Reports, 35, 133–134; James Jackson Putnam, A Memoir of Dr. Jackson ... (Boston, 1906), 228–229; “Report of the Board of Health, December 16, 1802,” Boston Medical and Surgical Journal, 145 (1901), 445; Warren, John Warren, 404–406.

80. Bartlett, “Progress,” 124; Blake, Waterhouse, 64; Columbian Centinel, 22 December 1802.

81. Bartlett, “Progress,” 113–114; Burrage, Society, 58–59, 68–74, 418–419; Kett, Profession, 15; Putnam, Jackson, 244–246.

* Dr. Brock took her B.A. and M.A. in Natural Sciences, and her Ph.D. in Structural Materials in Animals, at Cambridge University. Her teaching and research at the University of Glasgow, where she is in the Department of the History of Science, span modern zoology and the life and work of James Douglas and his pupil William Hunter.

1. Cotton Mather, Magnalia Christi Americana (London, 1702), Book i, ch. ii, 7.

2. F.R. Packard, The History of Medicine in the United States, 2 v. (New York, 1931), i, 3–4

3. Francis Bacon, Novum Organum, Book ii, aphorism 52. (1620; from the translation by Joseph Devey, 1853).

4. Charles Webster, The Great Instauration: Science, Medicine and Reform 1626–1660 (London, 1975).

5. New Englands First Fruits (1643), quoted from S. E. Morison, The Intellectual Life of Colonial New England (New York, 1956), 31.

6. Irene Parker, Dissenting Academies in England (Cambridge, 1914).

7. S. E. Morison, “Charles Morton’s Compendium Physicae,” Colonial Society of Massachusetts Publications, 33 (1940), 117.

8. Albert Matthews, “Comenius and Harvard College,” Colonial Society of Massachusetts Publications, 21 (1919), 146–190.

9. Catalogus Librorum Bibliothecae Collegij Harvardini Quod est Cantabrigiae in Nova Anglia (Boston, 1723).

10. Boston Post-Boy and Advertiser, 30 January 1764.

11. Josiah Quincy, History of Harvard University, 2 v. (Cambridge, Mass., 1840), ii, 480–482.

12. Idem; Oliver Letterbook, ii, Andrew Oliver to Peter Oliver, Boston, 20 August 1770, Massachusetts Historical Society.

13. R. S. Wilkinson, “The Alchemical Library of John Winthrop Junior (1606–1676), and His Descendants in Colonial America,” Ambix, 2 (1963), 33–51.

14. J. H. Tuttle, “The Libraries of the Mathers,” Proceedings of the American Antiquarian Society, 20 (1910), 269–356.

15. G. E. Littlefield, Early Boston Booksellers (Boston, 1900).

16. Silvester Gardiner, uncatalogued papers, Countway Medical Library, Boston.

17. John Hartshorn, Diary (1752–1756), Countway Medical Library, Boston.

18. Samuel Adams, Diary (1769), New York Public Library.

19. Francisco Guerra, American Medical Bibliography, 1639–1783 (New York, 1962).

20. Silvester Gardiner, uncatalogued papers, Countway Medical Library, Boston. An unsigned letter to Captain Kirkwood, 15 November 1755, asking for a wooden leg to be procured in London.

21. See the Appendix.

22. For the extent of bleeding, purging, and other remedies, see J. Worth Estes, “Therapeutic Practice in Colonial New England,” below, 289–383.—eds.

23. Cotton Mather, The Angel of Bethesda. ms at the American Antiquarian Society, Worcester, Massachusetts, edited by G. W. Jones and published by American Antiquarian Society and Barre Publishers, Worcester, Mass. (1972).

24. Carl Bridenbaugh, Cities in the Wilderness (New York, 1955), 88; Nathaniel B. Shurtleff, Records of the Governor and Company of the Massachusetts Bay in New England, 12 v. (Boston, 1853), ii, 278–279.

25. Sir George Clark, A History of the Royal College of Physicians of London, 2 v. (Oxford, 1966).

26. Charles Webster, The Great Instauration: Science, Medicine and Reform 1626–1660 (London, 1975).

27. J. Woodward, To Do the Sick No Harm (London, 1974).

28. C. Bridenbaugh, Cities in Revolt (New York, 1955), 5; B. B. Mitchell and P. Deane, Abstract of British Historical Statistics (Cambridge, 1962).

29. For a detailed review of medical charity, see Douglas Lamar Jones, “Charity, Medical Charity, and Dependency in Eighteenth-Century Essex County, Massachusetts,” below, 199–213.—eds.

30. Josiah Bartlett, “A Dissertation on the Progress of Medical Science in the Commonwealth of Massachusetts,” Communications of the Medical Society of Massachusetts, 3 (1810), 240.

31. P.M. Rattansi, “Paracelsus and the Puritan Revolution,” Ambix, 2 (1963), 23–32.

32. G. H. Turnbull, “George Stark, Philosopher by Fire,” Colonial Society of Massachusetts Publications, 38 (1949), 219–251; R. S. Wilkinson, “George Starkey, Physician and Alchemist,” Ambix, 2 (1963), 121–152.

33. Boston Gazette, 19 June 1744.

34. R. S. Wilkinson, “New England’s Last Alchemists,” Ambix, 10 (1962), 128–138.

35. A.J. B. Gilsdorf, “The Puritan Apocalypse: New England Eschatology in the Seventeenth Century” (Ph.D. thesis, Yale University, 1965).

* Dr. Warden earned his B.A., M.A., and Ph.D. degrees in History at Yale University. A Lecturer at Boston University, he is especially interested in the development of history curricula in schools and in colonial legal history. He directs the activities of the Cambridge Historical Society and is the author of Boston, 1689–1776, published in 1970.

1. See Anthony Giddens, Capitalism and Modern Social Theory: An Analysis of the Writings of Marx, Durkheim and Max Weber (Cambridge, Eng., 1971), 101–102, 158–160, 203–204, 234–238.

2. See David D. Hall, The Faithful Shepherd: A History of the New England Ministry in the Seventeenth Century (Chapel Hill, N.C., 1972).

3. See Charles Warren, A History of the American Bar (Boston, 1911), and Anton-Hermann Chroust, The Rise of the Legal Profession in America (Norman, Okla., 1965).

4. See Neil R. Harris, The Artist in American Society, 1790–1860 (New York, 1966).

5. See Brooke R. Hindle, The Pursuit of Science in Revolutionary America, 1735–1789(Chapel Hill, N.C., 1956), and Raymond P. Stearns, Science in the British Colonies of America (New York, 1970).

6. For early attempts at corporate organization in other colonies, see Sidney Shindell, The Law in Medical Practice (Pittsburgh, Pa., 1966), 3–4.

7. For resistance to corporate privileges, see G. B. Warden, Boston, 1689–1776 (Boston, 1970), 102–126. During discussion, the question arose about the documentation for my argument that the medical profession did not develop in colonial Boston. There is none, and my inferences are based on the absence of such documentation in the valuable work of other scholars and in my own extensive research in the Boston newspapers, town meeting reports, General Court records, and manuscript collections of the Massachusetts Historical Society, State Archives, Boston Public Library, and Suffolk County Court House. The professional consciousness of the town’s physicians was so minimal that, to the best of my knowledge, there was never even any demand for medical organization, as there was for the clergy, merchants, and lawyers. For a differing view, and for a discussion of the later organization of Boston’s physicians as a professional association, see Philip Cash’s paper, above, 69–100.

8. See C. H. S. Fifoot, History and Sources of the Common Law: Tort and Contract (London, 1949), 157–158. During the discussion at the conference, Eric Christianson confirmed the extensive number of court cases against doctors in the legal records he has examined.

9. See Warden, Boston, 102–104, 127–129.

10. See Josiah Quincy, Jr., Reports of Cases Argued and Adjudged in the Superior Court of Judicature of the Province of Massachusetts Bay, between 1761 and 1772, ed. Samuel M. Quincy (Boston, 1865), 224–226.

11. See John B. Blake, Public Health in the Town of Boston, 1630–1822 (Cambridge, Mass., 1959).

The Medical Profession in Colonial Boston 153

12. For data on obstetrical deliveries by physicians in Boston, see J. Worth Estes, “Therapeutic Practice in Colonial New England,” below, 289–383.—eds.

13. See Perry Miller, The New England Mind: From Colony to Province (Cambridge, Mass., 1953), 345–366.

14. See Edmund S. Morgan, The Challenge of the American Revolution (New York, 1976), 88–95.

15. See Warden, Boston, 214–217.

* After earning his A.B. in History at Dickinson College, Dr. Bell took his A.M. and Ph.D. in History at the University of Pennsylvania, where he wrote his dissertation under the direction of Richard H. Shryock. Now the Executive Officer and Librarian of the American Philosophical Society at Philadelphia, he has made many contributions to colonial medical history, including John Morgan: Continental Doctor (1965), and The Colonial Physician and Other Essays (1975).

1. Andrew Burnaby, Travels through the Middle Settlements in North-America (2nd ed., London, 1775; Ithaca, N.Y., n.d.), 53–54; Robert Treat Paine, Diary, Sept.–Nov. 1751; Paine to Joseph Palmer and Richard Cranch, 26 Sept. 1751, Paine Papers (Massachusetts Historical Society); John Adams, Diary and Autobiography, ed L. H. Butterfield and others (Cambridge, Mass., 1961), II, 116, 150.

2. Daniel Coxe to Benjamin Rush, 16 May 1791, Rush mss, xxvii, 11 (Library Company of Philadelphia); Walter Charming to Benjamin Smith Barton, 29 Sept. 1811, Barton Papers (American Philosophical Society); Thomas Jefferson to Rush, 13 Oct. 1808, facsimile in Martin Meyerson, Gladly Learn and Gladly Teach (Philadelphia, 1978), 51. Jefferson expressed the same opinion in similar terms to Dr. Barton, 22 June 1807 (Boston Public Library). The records of the Pennsylvania Hospital, 1795–1820, show four or five English medical students enrolled there, in addition to a number from the West Indies and a few from Canada.

3. John F. Fulton and Elizabeth H. Thomson, Benjamin Silliman, 1779–1864: Pathfinder in American Science (New York, 1947), 23–32, 95–100; Harold J. Burr, “Jonathan Knight and the Founding of the Yale School of Medicine,” Yale Journal of Biology and Medicine, 1 (1929), 327–343.

4. Thomas Cooper, An Address delivered before the Medical Board of S. Carolina, at Columbia, December, 1821 (Columbia, S.C., 1821), 4. Cooper considered the professors of the University of Pennsylvania Medical School, Dr. Physick excepted, as undistinguished in abilities and undignified in professional conduct.

5. Population figures are conveniently collected in Evarts B. Greene and Virginia D. Harrington, American Population before the Federal Census of 1790 (New York, 1932). On the comparative growth of the cities in the colonial period see Carl Bridenbaugh, Cities in Revolt: Urban Life in America, 1743–1776 (New York, 1955).

6. Whitfield J. Bell, Jr., John Morgan, Continental Doctor (Philadelphia, 1965), 22–23.

7. On some of those mentioned here see Kenneth and Anna M. Roberts, trans. and eds., Moreau de St. Méry’s American Journey, 1793–1798 (New York, 1947).

8. Dr. Samuel A. Green, “Medicine in Boston,” in Justin Winsor, ed., The Memorial History of Boston,... 1630–1880 (Boston, 1883), iv, 527–549; J. Thomas Scharf and Thompson Westcott, History of Philadelphia (Philadelphia, 1884), II, 1578–1685; Leonard K. Eaton, “Medicine in Philadelphia and Boston, 1805–1830,” Pennsylvania Magazine of History and Biography, 75 (1951), 66–75.

9. Joseph Carson, A History of the Medical Department of the University of Pennsylvania (Philadelphia, 1869), 52ff.

10. William Cullen to Benjamin Rush, 16 Oct. 1784, Rush mss, xxiv, 56 (Library Company of Philadelphia). Cullen had written John Morgan, 18 September 1768, that the Philadelphia school had “a better Chance for transmitting what can or should pass to Posterity than any College on this Side of the Water.” Ibid., 54.

11. John Morgan to John Warren, 21 Nov. 1776, in Edward Warren, Life of John Warren, M.D. (Boston, 1874), 128; James E. Gibson, Dr. Bodo Otto and the Medical Background of the American Revolution (Springfield, Ill., 1937), 260–261.

12. George W. Corner, Two Centuries of Medicine: A History of the School of Medicine, University of Pennsylvania (Philadelphia, 1965).

13. Edward Warren, John Warren, 225–227, et passim; Benjamin Rush to Warren, 12 Oct. 1782, in L. H. Butterfield, ed., Letters of Benjamin Rush (Princeton, 1951), I, 288–289; Henry K. Beecher and Mark D. Altschule, Medicine at Harvard: The First Three Hundred Years (Hanover, N.H., 1977), 29–31.

14. Winsor, Memorial History of Boston, IV, 26.

15. Pennsylvania Gazette, 11 Jan. 1770, quoted in Journal of the History of Medicine and Allied Sciences, 23 (1968), 108–110.

16. Warren, John Warren, 26; Albert Matthews, “Notes on Early Autopsies and Anatomical Lectures,” Colonial Society of Massachusetts Publications, 19 (1916–1917), 273–290.

17. Bell, Morgan, 137–140; Bell, “For Mutual Improvement in the Healing Art: Philadelphia Medical Societies of the 18th Century,” Journal of the American Medical Association, 216 (1971), 125–129.

18. Walter L. Burrage, A History of the Massachusetts Medical Society... 1781–1922 (privately printed, 1923), 16–21, 37–41, 77–81. George Hayward, then a student in Philadelphia, in a letter to John C. Warren, 28 Feb. 1812 (Warren Papers, viii, Massachusetts Historical Society), rejoiced in the defeat of efforts to establish a college of physicians in Massachusetts.

19. See Richard D. Brown, “The Healing Arts in Colonial and Revolutionary Massachusetts,” above, 35–47; Eric H. Christianson, “The Medical Practitioners of Massachusetts, 1630–1800,” above, 49–67; and Philip Cash, “The Professionalization of Boston Medicine, 1760–1803,” above, 69–100.—eds.

20. Burrage, Massachusetts Medical Society, 302–308.

21. Herbert Thoms, “The Medical Institution of Yale College and the Connecticut State Medical Society,” Connecticut Medicine, 24 (1960), 546–551.

22. Josiah Bartlett concluded his excellent historical Dissertation on the Progress of Medical Science, in the Commonwealth of Massachusetts (Boston, 1810) with an appeal for the removal of the medical school to Boston.

23. N. I. Bowditch, A History of the Massachusetts General Hospital (Boston, 1851), 3–9. See also the address of the medical professors, 5 Sept. 1810, in which similar views are expressed. A copy is in Warren Papers, vii, 2.

24. James Jackson, A Eulogy on the Character of John Warren, M.D. (Boston, 1815), 29.

25. George E. Ellis, Memoir of Jacob Bigelow, M.D., LL.D. (Cambridge, Mass., 1880), 15–16.

26. Henry R. Viets, A Brief History of Medicine in Massachusetts (Boston, 1930), 28.

27. Clifford K. Shipton, Biographical Sketches of Those Who Attended Harvard College [Sibley’s Harvard Graduates] (Boston, 1968), xiv, 551–552.

28. Whitfield J. Bell, Jr., “Portrait of the Colonial Physician,” Bulletin of the History of Medicine, 44 (1970), 504–505.

29. R. W. Innes Smith, English-Speaking Students of Medicine at the University of Leiden (Edinburgh, 1932), passim.

30. J. Rendall, “The Influence of the Edinburgh Medical School on America in the Eighteenth Century,” in R. G. W. Anderson and A. D. C. Simpson, eds., The Early Years of the Edinburgh Medical School (Edinburgh, 1976), 95–123. Henry Lloyd generously supported the foreign medical studies of his son James, 1750–1752. The family reckoned that the reputation he would gain thereby was worth seven to ten years of practice. Papers of the Lloyd Family, I (New-York Historical Society Collections, 69 [1926], 413, et passim).

31. “Dr. Warren was probably more self-taught than any man, who has undertaken a similar office, within the last two centuries. He had indeed the books of anatomists before him; but he had not like other great teachers of our day, in this country as well as in Europe, had the benefit of personal instruction from any of the great masters in the science” (Jackson, Eulogy on Warren, 15). But, Jackson continued, his mind on current developments in Boston, a medical education confined to the walls of a university was always deficient. “A medical school can never flourish except in a large town.... In 1810 he [Warren], with his colleagues, effected the extension of the medical lectures to this town [from Cambridge to Boston]; and since that time the correctness of his judgement has been abundantly demonstrated by the increased usefulness and increased prosperity of the Institution” (ibid., 16).

32. Whitfield J. Bell, Jr., “James Hutchinson (1752–1793): Letters from an American Student in London,” College of Physicians of Philadelphia, Transactions & Studies, 4th ser., 34 (1966), 20–25.

33. Also see C. Helen Brock, “The Influence of Europe on Colonial Massachusetts Medicine,” and its Appendix, above, 101–143.—eds.

34. Betsy C. Corner, William Shippen, Jr., Pioneer in American Medical Education (Philadelphia, 1951), 25ff., 73; Whitfield J. Bell, Jr., “Philadelphia Medical Students in Europe, 1750–1800,” Pennsylvania Magazine of History and Biography, 67 (1943), 17–18.

35. James Hall to Benjamin Rush, 4 March 1784, in W. S. W. Ruschenberger, An Account of the Institution and Progress of the College of Physicians of Philadelphia . . . from January, 1787 (Philadelphia, 1887), 17.

36. Walter Channing to George C. Shattuck, 20 April 1811, Shattuck Papers, III.

37. Appendix I to Philip Cash, “The Professionalization of Boston Medicine, 1760–1803,” above, 69–100. Walter Channing summarized the difference between Edinburgh and London in bold and certainly exaggerated terms. “In Edinburgh & throughout Scotland medicine is the grand object of pursuit. It is taught upon the most liberal plan. It is considered the most respectable, & far the most important branch of the art, & looks upon surgery as upon the apothecary as a necessary appendage to its system. But in London the thing is quite reversed, & I should think throughout England, as there is no surer way to eminence than the compilation or composition of a work on surgery, ornamented with some pretty pictures. Mr. Cooper is considered as knowing nothing of medicine, & a friend of mine, a very clever man heard him declare at table that he doubted how far medicine was a blessing to society.” Happily, Channing continued, in America a practitioner was not compelled to choose one specialty or the other. Medicine and surgery were “united, & we need not degrade one, to increase the reputation of the other.” Channing to George C. Shattuck, 20 April 1811, Shattuck Papers, III.

38. Burrage, Massachusetts Medical Society, 115.

39. Ebenezer Alden to George C. Shattuck, 19 Jan. 1812, Shattuck Papers, III. Dr. Henry I. Bowditch recorded Dr. Jacob Bigelow’s recollections (in advanced old age) of his Philadelphia professors. Rush and Wistar were kindly, the latter especially was warmhearted; both “received” the students. Physick, on the contrary, was “a savage,” who never invited them to his house and would not associate with them. Barton was “egotistical, a bad reader and speaker.” Rush, “enthusiastic and eloquent,” was a great believer in medicine and drugs, an “ultra practitioner,” who used to admonish his students, “we can have no reliance on nature, gentlemen. We must turn her out of doors in our practice, and substitute for her efficient art. The vis medicatrix naturae which Cullen taught is a delusion.” Vincent Y. Bowditch, Life and Correspondence of Henry Ingersoll Bowditch (Boston, 1902), II, 285.

40. Nathan Smith to George C. Shattuck, 22 Jan. [1807] (typescript), Shattuck Papers, I.

41. Ephraim Eliot, “Account of the Physicians of Boston,” Massachusetts Historical Society Proceedings, Ser. 1, 7 (1863–1864), 179, 180.

42. For the incidence of bleeding in two Boston practices see Table IV in J. Worth Estes, “Therapeutic Practice in Colonial New England,” below, 289–383.—eds.

43. Burrage, Massachusetts Medical Society, 26.

44. Oliver W. Holmes, “Additional Memoranda” [to Green’s “Medicine in Boston”] in Winsor, Memorial History of Boston, iV, 557; John Adems Paxton, comp., Philadelphia Directory and Register, for 1818; Boston Directory... (Boston, 1816). Bleeding was practiced little, if at all, in cases reported in the Boston Medical Commentaries, II, 39–40, 111ff., 145, 462–475. Holmes speaks with some surprise of a Boston physician whom he consulted in 1867, who carried two lancets with him at all times—he had never given up their use. Holmes, “Scholastic and Bedside Teaching,” in Medical Essays (Boston, 1899), 295.

45. General Alumni Catalogue of the University of Pennsylvania, 1922; Thomas F. Harrington, The Harvard Medical School (New York, 1905), III, 1449ff.

46. Joseph I. Waring, A History of Medicine in South Carolina, 1825–1900 (Columbia, S.C., 1967), 72.

47. Walter Channing to George C. Shattuck, [August 1808], Shattuck Papers, II; Channing to Benjamin S. Barton, 20 March [no year], Barton Papers.

48. W. Welch to George C. Shattuck, 31 May 1811, Shattuck Papers, III.

49. George Hayward to Benjamin S. Barton, 10 Sept. 1814, Barton Papers; Hayward to John C. Warren, 28 Nov. 1811, 28 Feb. 1812, Warren Papers, vii, viii.

50. Only one New Englander is listed on the roll of Rush’s “regiment of prentices,” as he called them, 1770–1812. James E. Gibson, “Benjamin Rush’s Apprenticed Students,” College of Physicians of Philadelphia, Transactions & Studies, 4th ser., 14 (1946–1947), 127–132.

51. Ellis, Memoir of Jacob Bigelow, 15–16; George C. Shattuck to Benjamin S. Barton, 9 Aug. 1807 (copy), Shattuck papers, I; Daniel Oliver to Barton, 20 May 1811, Walter Channing to Barton, 20 March [no year], Barton Papers.

52. Roswell Shurtleff to George C. Shattuck, 17 Dec. 1806; Shattuck to Shurtleff, 11 Jan. 1807, Shattuck Papers, I.

53. Shattuck to Shurlteff, 10 Nov. 1806, ibid.

54. Amos Twitchell to George C. Shattuck, 20 May 1808, Shattuck Papers, II; George Hayward to John C. Warren, 28 Nov. 1811, Thomas Foster to Warren, 14 Dec. 1811, Warren Papers, viii.

55. Benjamin Lynde Oliver to Benjamin Rush, 5 May 1808, Rush mss, xii, 57.

56. Leonard K. Eaton, “Charles Bulfinch and the Massachusetts General Hospital,” Isis, 41 (1950), 8–11.

57. Nathan Ryno Smith to George C. Shattuck, 21 Jan. 1823. A transcript of this letter, without reference to the location of the original, was given me by Miss Elizabeth H. Thomson, Department of the History of Medicine, Yale University.

* After studying Political Science at the University of South Dakota, Dr. Greene earned his M.A. and Ph.D. in History at Harvard, and he is now Professor of History at the University of Connecticut at Storrs. The author of two books on the history of evolutionary biology, he has also published, with John G. Burke, The Science of Minerals in the Age of Jefferson (1978), and is now completing American Science in the Age of Jefferson.

1. Joseph I. Waring, A History of Medicine in South Carolina, 1670–1825 (Columbia, S.C., 1964); Brooke Hindle, The Pursuit of Science in Revolutionary America, 1735–1789 (Chapel Hill, N.C., 1956), chs. 2–3; George E. Gifford, Jr., “Charleston Physician Naturalists,” Bulletin of the History of Medicine, 49 (1975), 556–574. The role of physicians in early American mineralogy is apparent in John C. Greene and John G. Burke, The Science of Minerals in the Age of Jefferson, Transactions of the American Philosophical Society, 68 (1978), part iv.

2. George W. Corner, Two Centuries of Medicine: A History of the School of Medicine, University of Pennsylvania (Philadelphia and Montreal, 1965); Whitfield J. Bell, Jr., The Colonial Physician and Other Essays (New York, 1975); George Gaylord Simpson, “The Beginnings of Vertebrate Paleontology in North America,” Proceedings of the American Philosophical Society, 86 (1943), 130–188; George E. Gifford, Jr., “Medicine and Natural History—Crosscurrents in Philadelphia in the Nineteenth Century,” Transactions & Studies of the College of Physicians of Philadelphia 4th ser., 45 (1978), 139–149.

3. Courtney R. Hall, A Scientist of the Early American Republic, Samuel Latham Mitchill 1764–1831 (New York, 1934); Christine Chapman Robbins, David Hosack, Citizen of New York (Memoirs of the American Philosophical Society, 62, 1964).

4. I. Bernard Cohen, Some Early Tools of American Science... (Cambridge, Mass., 1950); Jeanette E. Graustein, “Natural History at Harvard College, 1788–1842,” Proceedings of the Cambridge Historical Society, 38 (1959–60), 69–86; Henry R. Viets, A Brief History of Medicine in Massachusetts (Boston and New York, 1930), chs. 4–5; Edward Warren, The Life of John Warren, M.D.... (Boston, 1874).

5. Quoted in George P. Fisher, Life of Benjamin Silliman, M.D.. LL.D.... Chiefly from his Manuscript Reminiscences, Diaries, and Correspondence, 2 v. (New York, 1866), I, 19.

6. Benjamin Waterhouse, autobiographical ms at the Francis A. Countway Library of Medicine, Harvard Medical School. See also James J. Abraham, Lettsom: His Life, Times, Friends and Descendants (London, 1933), 360–361; Lloyd E. Hawes, Benjamin Waterhouse, M.D., First Professor of the Theory and Practice of Physic at Harvard and Introducer of Cowpox Vaccination into America... (Boston, 1974).

7. Sidney Willard, Memories of Youth and Manhood, 2 v. (Cambridge, Mass., 1855), I, 169.

8. Edward Warren, The Life of John Collins Warren, M.D. Compiled Chiefly from his Autobiography and Journals, 2 v. (Boston, 1860); James Jackson Putnam, A Memoir of Dr. James Jackson With Sketches of His Father Hon. Jonathan Jackson, and His Brothers... (Boston and New York, 1905); Walter L. Burrage, A History of the Massachusetts Medical Society with Brief Biographies of the Founders and Chief Officers, 1781–1922 (Norwood, Mass., 1923).

9. John Gorham to Benjamin Silliman, Boston, 20 Nov. 1809, and 28 Sept. 1810, Silliman Correspondence, Beinecke Library, Yale University. See also James Jackson, An Address Delivered at the Funeral of John Gorham, M.D.... (Boston, 1829). There is a good account of Gorham in Cohen, Some Early Tools of American Science ..., ch. 4.

10. John Gorham to Benjamin Silliman, Boston, 20 June 1811, Silliman Correspondence, Beinecke Library, Yale University.

11. Ibid.

12. Some Account of the Medical School in Boston, and of the Massachusetts General Hospital (Boston, 1824).

13. Warren, Life of John Collins Warren, I, 11, quoting J. C. Warren’s autobiographical notes.

14. John Collins Warren, A Comparative View of the Sensorial and Nervous Systems in Men and Animals (Boston, 1822). Appendix H consists of an “Account of the Crania of some of the Aborigines of the United States.” Alěs Hrdlička, in his Physical Anthropology: Its Scope and Aims, Its History and Present Status in the United States (Philadelphia, 1919), 31, describes Warren’s “Account” as being “remarkable for the systematic, technical descriptions of the specimens.”

15. George E. Ellis, Memoir of Jacob Bigelow, M.D., LL.D., Proceedings of the Massachusetts Historical Society, 17 (1879–1880), 383–467.I am indebted to RichardJ. Wolfe for letting me see a manuscript copy of his Jacob Bigelow’s “American Medical Botany,” 1817–1821 (Boston, 1979).

16. “Museum of Natural History,” New England Journal of Medicine and Surgery, 5 (1816), 189–191; see also 9 (1820), 311–313. See also Thomas T. Bouvé, Historical Sketch of the Boston Society of Natural History; With a Notice of the Linnaean Society, Which Preceded It, Anniversary Memoirs of the Boston Society of Natural History... 1830–1880 (Boston, 1880), 4–14.

* Dr. Jones earned his B.A. in History at Duke University. After studying Law at the University of Texas, he obtained his MA. in History there, and his Ph.D., in the History of American Civilization, at Brandeis University. Now Assistant Professor of History at Tufts University, he has just completed a fellowship at the Charles Warren Center for Studies in American History at Harvard. He has published several articles on the history of the law, poverty, and charity in colonial America.

1. William Bentley, The Diary of William Bentley, 2 vols. (Gloucester, Mass., 1962), II, 88.

2. These changes in Essex County are discussed in Douglas Lamar Jones, “Geographic Mobility and Society in Eighteenth-Century Essex County, Massachusetts” (Ph.D. dissertation, Brandeis University, 1975); also, see Philip J. Greven, Jr., Four Generations: Population, Land, and Family in Colonial Andover, Massachusetts (Ithaca, 1970). For a more focused discussion of poverty in Essex County, see Douglas Lamar Jones, “The Strolling Poor: Transiency in Eighteenth-Century Massachusetts,” Journal of Social History, 8 (1975), 28–54.

3. David J. Rothman, The Discovery of the Asylum: Social Order and Disorder in the New Republic (Boston, 1971); Gerald Grob, Mental Institutions in America (New York, 1973).

4. Rothman, Asylum, 3–6. One should also consult Albert Deutsch, “The Sick Poor in Colonial Times,” American Historical Review, 46 (1940–1941), 560–579.

5. For a fuller exposition of the religious concept of “affliction” and Puritan ideas of poverty and wealth, see Stephen Foster, Their Solitary Way: The Puritan Social Ethic in the First Century of Settlement in New England (New Haven, 1971), 124–129; and chapter five generally.

6. The Reverend William Bentley, Sermon No. 20 [undated], [p. 1]. The manuscript sermons of Bentley are located in the Archives of Tufts University, Medford, Massachusetts.

7. Bentley, Sermon No. 20, [p. 7].

8. Foster, Their Solitary Way, 134–144.

9. Jones, “The Strolling Poor,” 42–48; also see Hendrik Hartog, “The Public Law of a County Court; Judicial Government in Eighteenth Century Massachusetts,” American Journal of Legal History, 20 (1976), 282–329.

10. Petition and Acct. of Selectmen of Andover Abt Joshua Barker of Methuen, File Papers, 1761, Essex County Court of General Sessions of the Peace. Hereafter, references to the Essex Sessions Court will be only to the File Papers or to the Record Books. These materials are located in the Clerk’s Office, Salem Courthouse, Salem, Massachusetts.

11. Newbury v. Gloucester, File Papers, 1763.

12. Petition of the Selectmen of the Town of Marblehead, File Papers, 1752.

13. E. A. Holyoke, Leger-Book [sic], [vii], [No. ii], 1181, 1125, Holyoke Papers, Essex Institute, Salem, Massachusetts.

14. Petition of Andover for H. Long, File Papers, 1757.

15. Petitions of Tho. Rowell Etc. for Mary Flanders, File Papers, 1759; Petition of Town of Rowley, File Papers, 1769.

16. On these points, see Hartog, “The Public Law of a County Court,” 303–308.

17. Case of Mary Harris, Record Book, December Term, 1764, 37.

18. Massachusetts Acts and Resolves, ch. 17, 1758–1759, 178–179. On midwifery in early America, see Catherine M. Scholten, “ ‘On the Importance of the Obstetrick Art’: Changing Customs of Childbirth in America, 1760–1825,” William and Mary Quarterly, 34 (1977), 426–445; and Charlotte Gregg Borst, “Midwives in Early New England, 1620–1820: From Healer and Community Authority to Quack and Outsider” (M.A. thesis, Tufts University, 1977).

19. Case of Joan Reed, Record Book, February Term, 1717.

20. Petition of Selectmen of Haverhill, File Papers, 1765; Wenham Town Records (Wenham, Mass., 1930), III, 99.

21. For more general discussions of the categories of physicians and medical practitioners in early America, see Richard Harrison Shryock, Medicine and Society in America, 1660–1860 (Ithaca, 1962), 1–43; and Whitfield J. Bell, “Medical Practice in Colonial America,” Bulletin of the History of Medicine, 31 (1957), 442–453.

22. Among numerous examples, see the Case of Sarah Silver, File Papers, 1758.

23. Newbury v. Gloucester, File Papers, 1763.

24. Petition... of Andover Abt Joshua Barker..., File Papers, 1761.

25. Quoted in Henry Follansbee Long, “The Physicians of Topsfield, with Some Account of Early Medical Practice,” Historical Collections of the Topsfield Historical Society, 16 (1911), 7; also quoted in Bell, “Medical Practice in Colonial America,” 450–451, fn. 28.

26. The Holyoke ledgers and day books are in the Holyoke Papers; Amos Spofford’s book, April 1795, is a one-volume ledger, dated 1795–1804; and Nehemiah Cleaveland left three volumes of account books and six day books. All of these manuscript materials are located in the Essex Institute, Salem, Massachusetts.

27. DAB, ix, s.v. “Holyoke, Edward Augustus.”

28. Salem Town Records, 10 May 1749. Box 4 (1748–1775), folder 1, 22. This is a handwritten copy in the Essex Institute. For Holyoke’s participation, see, ibid., 16 May 1770. Box 4 (Oct 1768 – Oct. 1770), folder 8, 786–787.

29. See John Duffy, Epidemics in Colonial America (Baton Rouge, La., 1953), 127–128, 176–177; and Shryock, Medicine and Society, 91–95.

30. Jones, “The Strolling Poor,” 45.

31. Joseph B. Felt, Annals of Salem, 2 v. (Salem, Mass., 1849), II, 400–401; Rules and Orders for the Management of the Work House ... 1749–1798, v. 14, Public Welfare Department, Salem, Mass. Located in the Essex Institute. For a useful discussion of the workhouse in Salem in the very early nineteenth century, see Anne Farnam, “Uncle Venner’s Farm: Refuge or Workhouse for Salem’s Poor?” Essex Institute Historical Collections, 109 (1973), 60–86.

32. Overseers of the Poor. Miscellaneous, 1746–1832, Essex Institute. Most of the payments from the few records which remain went to Holyoke. He may have been the official physician to the poor, but no evidence indicates that this relationship was formalized with the town selectmen. Dr. Moses Little is recorded as receiving payments from the town in 1794 and 1795.

33. The sample years examined include, with the number of sick poor visited, the following: 1756 (55); 1761 (48); 1766 (39); 1771 (43); and 1776 (301). This information is taken from Leger-Book [sic], v. i, no. ii, 156; ibid., v. ii, no. ii, 233, 358; ibid., v. iii, no. ii, 477, and v. iv, no. ii, 628; ibid., v. [iv], no. [ii], 760, and v. [v], no. [ii], 885; and v. [vii], no. [ii], 1181, 1125.

34. Low mean ages of death for both lower-class men and women in two Essex County towns, Beverly and Wenham, occurred during the eighteenth century; see Jones, “Geographic Mobility and Society,” 47–52.

35. Generally, see Shryock, Medicine and Society, 100–105. For the Salem workhouse, see “Rules and Orders for the Management of the Work House,” 870, Salem Town Records. Box 4 (Oct. 1770 – Jan. 1773), folder 9.

36. Although the sample of Cleaveland’s patients is taken from the year 1784, it can be considered comparable to Holyoke’s because each year represented the early stages of medical practice for the two physicians.

37. For the daily caseloads of physicians in neighboring southern New Hampshire, see J. Worth Estes, “Therapeutic Practice in Colonial New England,” especially Table I, below, 289–383.—eds.

38. William Barlow and David O. Powell, “James Thacher’s American Medical Biography: The Sketch of Dr. Joseph Orne of Beverly, Massachusetts,” Essex Institute Historical Collections, 114 (1978), 213–221; see especially the letter from Orne to Holyoke, 218–220.

* Dr. Wigglesworth studied Sociology as an undergraduate at Harvard, where he also earned his M.D. degree. Although his primary activity is private surgical practice, he is an Instructor in Surgery at the Tufts University School of Medicine and has been studying medical history for the past ten years because he enjoys it.

1. Russell Leigh Jackson, The Physicians of Essex County (Salem, Mass., 1948), 42.

2. Thomas Franklin Waters, Ipswich in the Massachusetts Bay Colony (Ipswich, Mass., 1905), 83.

3. See C. Helen Brock, “The Influence of Europe on Colonial Massachusetts Medicine,” and its Appendix, above, 101–143.—eds.

4. Henry R. Viets, A Brief History of Medicine in Massachusetts (Boston, 1930), 11.

5. Henry E. Sigerist, A History of Medicine, (New York, 1951), I, 207.

6. Viets, Brief History, 2.

7. L. S. Bryan, “Blood Letting in American Medicine,” Bulletin of the History of Medicine, 28 (1964), 516–529; Ralph Major, A History of Medicine (New York, 1959), 53; Guido Majno, The Healing Hand (Cambridge, Mass., 1975), 417–418.

8. Ibid., 400; Allen O. Whipple, The Story of Wound Healing and Wound Repair (Springfield, Ill., 1963), 48.

9. L. M. Zimmerman and Ilza Vietz, Great Ideas in the History of Surgery (Baltimore, 1961), 96; Viets, Brief History, 3.

10. Richard Hardway Meade, An Introduction to the History of General Surgery (Philadelphia, 1968), 156.

11. For the professional education of later practitioners, see Eric H. Christianson, “The Medical Practitioners of Massachusetts, 1630–1800,” above, 49–67; Philip Cash, “The Professionalization of Boston Medicine, 1760–1803,” above, 69–100; and C. Helen Brock, “The Influence of Europe on Colonial Massachusetts Medicine,” above, 101–143.

12. Ralph Boas and Louise Boas, Cotton Mather: Keeper of the Puritan Conscience (New York, 1928).

13. Oliver Wendell Holmes, Medical Essays, 2 v. (Boston, 1892), II, 277–286. Viets’ Brief History, 48–49.

14. Viets, Brief History, 37–38; Walter L. Burrage, A History of the Massachusetts Medical Society... 1781–1922 (Norwood, Mass., 1923), 92–94.

15. Bernard Wolf Weinberger, An Introduction to the History of Dentistry In America (St. Louis, 1948), 3.

16. James G. Mumford, A Doctor’s Table Talk (New York, 1912), 252.

17. Uncatalogued manuscript notes, Edward Augustus Holyoke Papers, Essex Institute, Salem.

18. Therapeutic trial and error seem to have been infrequent; see J. Worth Estes, “Therapeutic Practice in Colonial New England,” below, 289–383.

19. Francisco Guerra, American Medical Bibliography, 1639–1783 (New York, 1962), 462–463.

20. J. Worth Estes, Hall Jackson and the Purple Foxglove (Hanover, N.H., 1979), 5–9.

21. Burrage, Medical Society, 1. (As Professor Cash points out, the Boston doctors did not form a permanent association until after the war; see above, 69–100.—eds.)

22. Baron [Gerhard] van Swieten, The Diseases Incident to Armies with the Method of Cure (Philadelphia, 1776), 81.

23. Ibid., 81–82.

24. William Northcote, Extracts from the Marine Practice of Physic and Surgery (Philadelphia, 1776), issued with van Swieten, note 22 above, 115.

25. Ibid., 115.

26. Ibid., 116.

27. John Jones, Plain Concise Practical Remarks on the Treatment of Wounds and Fractures (Philadelphia, 1776), 5–9. The first edition had been issued in the previous year.

28. Ibid., 21–24.

29. Ibid., 25–26.

30. Ibid., 30–44, especially 41.

31. Ibid., 44–56.

32. Ibid., 56–59.

33. Ibid., 56–57

34. Massachusetts Medical Society Documents, unpublished manuscripts, Countway Library of Medicine, Boston, 11, numbers 9, 26, 32, 42.

35. John Ashurst, “Surgery Before the Days of Anesthesia,” in The Semi-Centennial of Anaesthesia (Boston, 1897), 28–29; Whipple, Wound Healing, 68.

36. Whipple, Wound Healing, 31.

37. Ibid., 32.

38. Jones, Practical Remarks, 1. For a detailed discussion of the problems in practical surgery which the introduction of anesthesia would later alleviate, see Josiah Charles Trent, “Surgical Anesthesia,” Journal of the History of Medicine and Allied Sciences, 1 (1946), 505–514.

* A student of American Literature at Middlebury College, Dr. Cassedy earned his A.M. and Ph.D. in American Civilization at Brown University. As Historian at the National Library of Medicine in Bethesda, he is Editor of the Library’s annual Bibliography of the History of Medicine. He published his Demography in Early America in 1969, and is now completing a book on Medicine, Statistics, and National Growth in Nineteenth-Century America.

1. See, for example, Tables VI through IX in J. Worth Estes, “Therapeutic Practice in Colonial New England,” below, 289–383.—eds.

2. John Southerden Burn, The History of Parish Registers in England (London, 1829); James Christie, Some Account of Parish Clerks (London, 1893); James H. Cassedy, “Medicine and the Rise of Statistics,” in Allen G. Debus, ed., Medicine in Seventeenth Century England (Berkeley, 1974), 283–312.

3. John B. Blake, “The Early History of Vital Statistics in Massachusetts,” Bulletin of the History of Medicine, 29 (1955), 46–54; Robert Gutman, Birth and Death Registration in Massachusetts 1639–1900 (New York, 1959); R. R. Kuczynski, “The Registration Laws in the Colonies of Massachusetts Bay and New Plymouth,” Journal of the American Statistical Association, 7 (1900–1901), 65–73. These state registers recorded births and deaths in place of baptisms and burials. Apart from the vital statistics registers, of course, Massachusetts colonial officials were concerned with collective mortality as a phase of political arithmetic; royal governors were regularly instructed to furnish the Board of Trade in London with information on the numbers of births and deaths.

4. Annual bills of mortality were issued in Salem starting in 1768. Boston did not make provision for regular, printed bills until 1810. See Boston News-Letter, 1704 onward; Maris A. Vinovskis, “Mortality Rates and Trends in Massachusetts before 1860,” Journal of Economic History, 32 (1972), 185–190; John B. Blake, Public Health in the Town of Boston, 1630–1822 (Cambridge, Mass., 1959), 106–107, 213–215; Cassedy, Demography, 117–147.

5. Samuel Sewall’s records of this kind of information are particularly well known. “Diary of Samuel Sewall, 1674–1729,” Collections of the Massachusetts Historical Society, 5th ser., 6 (1879). For examples of local lists of deaths that were kept by women, see Mary F. Peirce, ed., Town of Weston: Births, Deaths and Marriages 1701–1850 (Boston, 1901). See Josiah H. Benton, Jr., Early Census Making in Massachusetts 1643–1763 (Boston, 1905); and James H. Cassedy, Demography in Early America: Beginnings of the Statistical Mind 1600–1800 (Cambridge, Mass., 1969).

6. While historians sometimes refer to these journals or registers as “bills of mortality,” this terminology can and does cause confusion. In the present context, therefore, I have deliberately distinguished between the private, unpublished mortality lists of the clergyman, and the public published documents which emulated the original London bills of mortality. Unlike a few Anglican and other parishes of Philadelphia and Charleston, South Carolina, the Massachusetts churches (Congregational as well as other) apparently never published their vital records in the form of broadside bills of mortality.

7. Edmund S. Morgan, The Puritan Family (New York, 1966); Ola Elizabeth Winslow, Meetinghouse Hill 1630–1783 (New York, 1952), 99; David E. Stannard, “Death and the Puritan Child,” in his Death in America (Philadelphia, 1975), 9–29. The symbols of death which adorned eighteenth-century gravestones were often the same as those which embellished printed funeral sermons and bills of mortality. See Allen Ludwig, Graven Images: New England Stonecarving and Its Symbols 1650–1815 (Middle-town, Conn., 1966); and Margaret M. Coffin, Death in Early America (Nashville, 1976). For a discussion of some of the possibilities in quantitative studies of New England gravestones, see Edwin S. Dethlefsen, “Colonial Gravestones and Demography,” American Journal of Physical Anthropology, 31 (1969), 321–333.

8. “Diary of Samuel Sewall,” 170.

9. Among the particularly useful publications are Blake, Public Health in Boston; John Duffy, Epidemics in Colonial America (Baton Rouge, La., 1953); Ernest Caulfield, A TrueHistory of the Terrible Epidemic Vulgarly Called the Throat Distemper (New Haven, 1939); Vinovskis, “Mortality Rates and Trends in Massachusetts”; R. S. Meindl and A. C. Swedlund, “Secular Trends in Mortality in the Connecticut Valley, 17001850,” Human Biology, 49 (1977), 389–414.

10. William B. Trask, ed., “Rev. Samuel Danforth’s Records of the First Church inRoxbury, Mass.,” New England Historical and Genealogical Register, 34 (1880), 84–89, 162–166, 297–301, 359–363.

11. Isaac Backus, “Bills of Mortality (1749–1805),” unpublished manuscript at Andover Newton Theological School.

12. Thomas Prince, A Sermon occasioned by the Death of the Honourable Mary Belcher (Boston, 1736), 10–12.

13. For a discussion of these interests, see Cassedy, Demography, 111–116, 172–179.

14. Ezra Stiles, “Deaths in Newport, R.I., 1760–1764,” New England Historical and Genealogical Register, 62 (1908), 283–291, 352–363; 63 (1909), 51–58. The original manuscript of this document is in the Rhode Island Historical Society.

15. Ezra Stiles, A Funeral Sermon, Delivered Thursday, July 26, 1787 (New Haven, 1787). Stiles appended extracts and analyses from Whittelsey’s records. Jeremy Belknap, The History of New-Hampshire, 2nd ed., 3 v. (Boston, 1813), iii, 178–188.

16. The first of these periodicals, New York’s Medical Repository (v. 1, 1797–1798), included several such contributions from clergymen in its early years. Boston’s Medical and Agricultural Register did not even bother to solicit these kinds of data from doctors, but concentrated on the clergy. Ibid., I, 1806–1807, cited in Blake, Public Health in Boston, 214–215.

17. Edward Wigglesworth, "A Table shewing the Probability of the Duration, the Decrement, and the Expectation of Life, in the States of Massachusetts and New Hampshire, formed from sixty two Bills of Mortality on the files of the American Academy of Arts and Science, in the ear 1789," <i>Memoirs, American Academy of Arts and Sciences,</i> 2, parts 1-2 (1793) 131-135; American Academy of Arts and Sciences, broadside dated 10 Nov. 1785, "Sir, The American Academy. . ." (Boston 1785). For a recent analysis of the merits and shortcomings of Wigglesworth's table, see Maris A. Vinoskis, "The 1789 Life Table of Edward Wigglesworth," <i>Journal of Economic History,</i> 31 (1971), 570-590. Among other things, the Academy's 1785 questionnaire asked that annual vital statistics submittd be entered on a standard form, upon which causes of death should be listed under any of sixty-eight different suggested disease terms.

18. While it seems certain that most returns were made by clergymen, it is not now possible to verify this since the original bills collected by the Academy in the 1780’s are no longer in the Academy’s files and have not been located in other repositories. At the same time, while a great many seventeenth- and eighteenth-century mortality journals of clergymen have been located and published by historical periodicals, I have not seen any by Massachusetts physicians reproduced in such publications.

19. Edward Augustus Holyoke, “A Bill of Mortality for the town of Salem, for the year 1782,” Memoirs, American Academy of Arts and Sciences, 1 (1785), 546–550 (includes the bill for 1783); Edward A. Holyoke, “On Meteorological Observations and Bills of Mortality,” ibid., 2, part 2 (1804), 58–61; Edward Augustus Holyoke, “An Account of the Weather and of the Epidemics, at Salem, in the County of Essex, for the year 1786,” Medical Communications, Massachusetts Medical Society, 1 (1787), 17–40 (includes bill of mortality for 1786).

20. J. Worth Estes, “As Healthy a Place as Any in America’: Revolutionary Portsmouth, N.H.,” Bulletin of the History of Medicine, 50 (1976), 536–552. Josiah Bartlett did not start keeping records of the births and deaths “within the limits of his practice” in Charlestown, Massachusetts, until 1789, while Lyman Spalding did not initiate his bills of mortality for Portsmouth, New Hampshire, until 1801. Jedidiah Morse, “Topographical Account of Charlestown (Massachusetts), with Bills of Mortality, Etc., Etc.,” Medical Repository, 2 (1799), 7–12; Lyman Spalding, “Bill of Mortality for Portsmouth, New Hampshire, for a.d. 1801,” Medical Repository, 5 (1802), 354.

21. Cassedy, Demography, 117–147, 274–304.

* Dr. Gifford obtained both his B.S. and M.D. degrees at the University of Maryland, and an M.A. in the History of Science at Harvard. A practicing psychiatrist, he is also Consultant to the Historical Collections at the Countway Library and head of the section on the History of Medicine in the Department of Socio-Medical Sciences at Boston University School of Medicine. A student of the history of natural history, he edited a book on the Physician Signers of the Declaration of Independence (1976).

1. J. J. Byrne, “Medicine at Plymouth Plantation,” New England Journal of Medicine, 259 (1958), 1012–1017; H. M. Dexter, “October Meeting 1889: Catalogue of Elder Brewster’s Library,” Proceedings of the Massachusetts Historical Society, 5 (1889), 37–85.

2. T. F. Harrington, “Dr. Samuel Fuller, of Mayflower (1620), Pioneer Physician,” Bulletin of the John Hopkins Hospital, 14 (1903), 263–270; Henry R. Viets, A Brief History of Medicine in Massachusetts (Boston, 1930), 8–18, 28; James Thacher, American Medical Biography, 2 v. (Boston, 1828), I, 266–267.

3. For an excellent account of medical practice in this era, see Joseph F. Kett, The Formation of the American Medical Profession (New Haven, 1968), 1–13. For other overviews, see Richard Harrison Shryock, Medicine and Society in America, 1660–1860 (Ithaca, 1962), 1–43; Gordon W. Jones, ed., The Angel of Bethesda by Cotton Mather (Barre, Mass., 1972), xxxi–xxxv; O. T. Beall and R. H. Shryock, Cotton Mather, First Significant figure in American Medicine (Baltimore, 1954), 19–33.

4. Quoted in Richard Harrison Shryock, The Development of Modern Medicine (New York, 1947), 19.

5. Fielding H. Garrison, An Introduction to the History of Medicine, 4th ed. (1929; rpt. ed., Philadelphia, 1960), 112; Malcolm Sydney Beinfield, “The Early New England Doctor: An Adaptation to a Provincial Environment,” Yale Journal of Biology and Medicine, 15 (1942–1943), 103–104; Edward Eggleston, The Transit of Civilization, from England to America in the Seventeenth Century (Boston, 1959), 50–58.

6. For information about the “doctrine of signatures” see: Garrison, History, 205, 206, 237; C. Mettler, History of Medicine (Philadelphia, 1947), 2, 201; Ralph C. Major, A History of Medicine, 2 v. (Springfield, Ill., 1954), I, 388–390; Maurice Bear Gordon, Aesculapius Comes to the Colonies (Ventnor, N.J., 1949), 3–4; Thomas J. Pettigrew, On Superstitions Connected with the History and Practice of Medicine and Surgery (London, 1844); Arturo Castiglioni, A History of Medicine (New York, 1947), 21, 449; Byrne, “Plymouth Plantation,” see note 1; Agnes Arber, Herbals: Their Origin and Evolution (Cambridge, England, 1938), 247–263; Eleanour S. Rohde, The Old English Herbals (New York, 1922), 1, 168–169, 231; Whitehead, “Indian Medical Exhibit,” 1–26; Harvey Wickes Felter, “The Genesis of the American Materia Medica Including a Biographical Sketch of’John Josseln, Gent’,” Bulletin of the Lloyd Library, no. 26, Reproduction series no. 8 (1927), 4; Beinfield, “New England Doctor”; Scott Buchanan, The Doctrine of Signatures (New York, 1938); Encyclopaedia Britanitica (Chicago, 1952), xx, 644.

7. Quoted in Arber, Herbals, 250–251.

8. Eggleston, Transit, 57.

9. Mettler, History, 200.

10. Rembert Dodoens (1517–1585), physician to the Emperors Maximilian II and Rudolph II, is best known today as a botanist. His Crydboeck (Antwerp, 1553) was assembled with other of his writings in a huge Stirpium historiae (Antwerp, 1583), which became a model for Gerard’s Herball, according to Castiglioni, Medicine, 441. Other references to Dodoens are in Arber, Herbals, 70, 76, 81, 83–86, 91, 122–126, 155, 162, 174, 176, 227–229, 232–234, 239, 255, 266, 277–280; Rohde, Herbals, 58, 83, 86, 93–98, 100, 103–104, 211–212, 230. According to Viets, Massachusetts, 21, “Gerard took most of his material from the great Latin herball of Dodoens, claiming it to be a work of his own.”

11. E. Kremers, “American Pharmaceutical Documents, 1643 to 1780,” Badger Pharmacist, no. 15 (1937). The original 1643 letter of Dr. Stafford is in the Boston Medical Library Collections, Countway Library.

12. Oliver Wendell Holmes, Medical Essays (Boston, 1911), 318.

13. Rohde, Herbals, 29, 83, 90, 116, 142–162, 213, 214; Arber, Herbals, 134–138, 174, 176, 233, 237, 284; Mettler, History, 211.

14. Garrison, History, 289.

15. Thomas O. Cockayne, ed., Leechdoms, Wortcunning, and Starcraft of Early England (London, 1864–1866).

16. Jerry Stannard, “Medical Botany,” in Joseph Ewan, ed., A Short History of Botany in the United States (New York, 1969), 147.

17. The idea was also promulgated by N. Culpeper. In the 1661 edition of his Physical Directory, the subtitle is Being an Astrologo-Physical Discourse of the Vulgar Herbs of this Nation: Containing a Compleat Method of Physick, Wliereby a Man May Preserve His Body in Health; or Cure Himself, Being Sick, for Three Pence Charge, with Such Things Only as Crow in England, They Being Most Fit for English Bodies’; see Arber, Herbals, 261.

18. Robert Turner, The British Physician (London, 1664), quoted in Arber, Herbals, 255. This idea was also espoused by Cotton Mather who was convinced that God had placed remedies in each part of the world where they were appropriate; see his Christian Philosopher, 136.

19. Eggleston, Transit, 68–69, 79; Garrison, History, 290.

20. Charles Whitehead, “The Indian Medical Exhibit of the Division of Medicine in the United States National Museum,” Proceedings of the U.S. National Museum, 67, n.d., article 10, 18–19.

21. John B. Beck, Historical Sketch of the State of Medicine in the American Colonies... (Albany, 1850), 35.

22. For information about Indian plant remedies, see “The Herb Spirit Healeth,” Clinical Excerpts, 5, no. 3 (1941), 67–76; Lloyd G. K. Carr, “Interesting Animal Foods, Medicines, and Omens of the Eastern Indians, with Comparison to Ancient European Practices,” Journal of the Washington Academy of Sciences, 44 (1954), 229–235; C. M. Cobb, “Some Medical Practices among the New England Indians and Early Settlers,” Boston Medical and Surgical Journal, 177 (1917), 97–105; William N. Fenton, “Contacts between Iroquois Herbalism and Colonial Medicine,” Annual Report of the Smithsonian Institution, 1941, 503–526; William N. Fenton, “Medicinal Plant Lore of the Iroquois,” New York State University Bulletin to Schools, 35, no. 7 (1949), 233–237; Leaman F. Hallett, “Medicine and Pharmacy of the New England Indians,” Bulletin of the Massachusetts Archaeological Society, 17 (1955), 46–49; John U. Lloyd, Origin and History of All the Pharmacopoeial Vegetable Drugs (Cincinnati, 1929); Henry A. Sigerist, A History of Medicine (New York, 1951), 1; H. W. Youngken, “Drugs of the North American Indians,” American Journal of Pharmacy, 96 (1925), 485–502; 97 (1926), 158–185, 257–271; Beinfield, “New England Doctor,” 99–132; W. T. Bradley, “Medical Practices of the New England Aborigines,” Journal of the American Pharmaceutical Association, 25 (1936), 146; Felter, “Genesis,” 4–64.

23. Bradley, “Practices,” 153.

24. Beinfield, “New England Doctor,” 114.

25. Quoted in Ewan, Short History, 146.

26. Glenn Sonnedecker, Kremers and Urdang’s History of Pharmacy, 4th ed. (Philadelphia, 1976), 152–158.

27. Peter Kalm, Travels into North America, 2nd ed., 2 v. (London, 1772), II, 268.

28. David L. Cowen, “The British North American Colonies as a Source of Drugs” (1966), quoted in Sonnedecker, History of Pharmacy, 152.

29. Felter, “Genesis,” 21.

30. Ibid., 23.

31. Ibid., 57–58.

32. Ibid., 27.

33. Kalm, Travels, i, 160.

34. Ibid., 337–338.

35. Ibid., 155–156.

36. Quoted in Ewan, Short History, 147.

37. Quoted in Beall and Shryock, Cotton Mather, 46.

38. Ibid., 46–47.

39. Ibid., 60.

40. Sonnedecker, History of Pharmacy, 161; Robert B. Austin, Early American Medical Imprints 1668–1820 (1961; rpt. ed., Arlington, Mass., 1977), 98; Francisco Guerra, American Medical Bibliography, 1639–1783 (New York, 1962), 76–77.

41. George Griffenhagen, “Bartholomew Browne, Pharmaceutical Chemist of Salem, Massachusetts, 1698–1704,” Essex Institute Historical Collections, 94 (1961), 19–27.

42. Edward Kremers, “A Drug List of King Philip’s War,” Badger Pharmacist, no. 25 (1939), 1–18.

43. William Salmon, Pharmacopoeia Londinensis (London, 1691), 175.

44. Buckner Hollingsworth, Flower Chronicles (New Brunswick, N.J., 1958), 20; Sonnedecker, History of Pharmacy, 153.

45. Sonnedecker, History of Pharmacy, 153.

46. David L. Cowen, “The Boston Editions of Nicholas Culpeper,” Journal of the History of Medicine and Allied Sciences, XI (1956), 157; Garrison, History, 375.

47. Cowen, “Boston Editions,” 158.

48. Ibid., 165.

49. Sonnedecker, History of Pharmacy, 161.

50. Mettler, History, 216.

51. John C. L. Clark, “The Famous Doctor Stearns,” Proceedings of the American Antiquarian Society, 45, part 1 (1935), 317–324; Guerra, Bibliography, 353, 357, 379, 385, 537, 715, 724, 729; Austin, Imprints, 192.

52. Clark, “Stearns,” 355.

53. Quoted ibid., 327.

54. Quoted ibid., 328.

55. Ibid., 376.

56. Austin, Imprints, 214–215; Guerra, Bibliography, 157–158; John Wesley, Primitive Remedies (rpt. ed., Beverly Hills, Calif., 1973).

57. For information about Cutler, see Brooke Hindle, The Pursuit of Science in Revolutionary America, 1737–1789 (Chapel Hill, N.C., 1956), 303, 313–314, 357; William Parker Cutler and Julia Perkins Cutler, Life, Journals and Correspondence of Rev. Manasseh Cutler. LL.D., 2 v. (Cincinnati, 1888); Ewan, Short History, 36, 38.

58. Cutler and Cutler, Life, I, 73.

59. Ibid., 82.

60. Ewan, Short History, 37; Mettler, History, 211.

61. Hindle, Pursuit, 263–273.

62. Cutler and Cutler, Life, I, 283.

63. Mannasseh Cutler, An Account of Some of the Vegetable Productions Naturally Growing in this Part of America (Boston, 1785), 491.

64. Cutler and Cutler, Life, ii, 259.

65. Ewan, Short History, 6, 37–38, 40, 47–48, 115; Cutler and Cutler, Life, ii, 287–288.

66. Ibid., fn. 291, 289; Ewan, Short History, 41, 89–90; Beall and Shryock, Cotton Mather, 16.

67. Cutler and Cutler, Life, ii, fn., 311–312; Ewan, Short History, 8, 39–40, 47, 115–116, 148.

68. Austin, Imprints, 183; Guerra, Bibliography, 120; Helen Gere Cruickshank, ed., John and William Bartram’s America (New York, 1957), 50–51.

69. Harold W. Rickett, Wild Flowers of the United States: The North Eastern States, 2 v. (New York, 1967), ii, 417.

70. Ewan, Short History, 35.

71. S. A. Green, A History of Medicine in Massachusetts (Boston, 1881), 56; Viets, History, 70.

72. William Douglass, A Summary, Historical and Political, of the First Planting, Progressive Improvements, and Present State of the British Settlements in North America, 2 v. (London, 1755), ii, 216.

73. Douglass, Summary, I, 449.

74. Beck, Historical Sketch, 37–70; Ewan, Short History, 33, 35, 36; John Tennent, “An Epistle to Dr. Mead concerning the Seneca Rattle-snake root,” Edinburgh Medical Essays and Observations, 6 (1743), 376.

75. Jones, Angel of Bethesda, xiv, xxxix.

76. David L. Cowen, “The Edinburgh Pharmacopoeia,” in The Early Years of the Edinburgh Medical School, ed. R. G. W. Anderson and A. D. C. Simpson (Edinburgh, 1976), 25–45.

77. “Letters of Samuel Lee and Samuel Sewall Relating to New England and the Indians,” Publications of the Colonial Society of Massachusetts, 14 (1913), 159; Sonne-decker, History of Pharmacy, 156.

78. Sonnedecker, History of Pharmacy, 172–173; Hindle, Pursuit, 26, 227, 282, 307, 316.

79. Sonnedecker, History of Pharmacy, 172–173.

80. Marion E. Brown, “Adam Kuhn: Eighteenth-Century Physician and Teacher,” Journal of the History of Medicine and Allied Sciences, 5 (1950), 163–177. Also see George E. Gifford, Jr., “Medicine and Natural History: Crosscurrents in Philadelphia in the Nineteenth Century,” Transactions and Studies of the College of Physicians of Philadelphia, 4th ser., 45 (1978), 139–149.

81. George E. GifFord, Jr., “Benjamin Waterhouse the Botanist,” Harvard Medical Alumni Bulletin, 44, no. 2 (Nov./Dec. 1969), 14–16.

82. J. Worth Estes, “Concordance to Dr. Waterhouse’s Hortus Siccus,” in Lloyd E. Hawes, Benjamin Waterhouse, M.D. (Boston, 1974), 17–28.

83. George E. Gifford, Jr., “Physician of Many Facets: Jacob Bigelow,” Harvard Medical Alumni Bulletin, 39, no. 4 (March/April 1965), 34–39. Also see George E. Gifford, Jr., “The Medical Botany of New England, 1782–1842,” Proceedings of the Cambridge Historical Society, 43 (1973–1975), 127–140.

84. See note 11 above.

* After taking his A.B. in Biology at Harvard, Dr. Estes earned an M.A., in Pharmacology, and his M.D. at the Boston University School of Medicine, where he is currently Associate Professor of Pharmacology and Experimental Therapeutics, and of Socio-Medical Sciences (section on the History of Medicine). His publications relevant to this symposium include a chapter on Dr. Matthew Thornton in Physician Signers of the Declaration of Independence (1976) and a book on Hall Jackson and the Purple Foxglove: Medical Practice and Research in Revolutionary America, 1760–1820 (1979).

1. See, for a discussion of one such rare example: Lester S. King, The Medical World of the Eighteenth Century (1958; rpt. ed., Huntington, N.Y., 1971), 310–315.

2. James Thacher, The American New Dispensatory (Boston, 1810).

3. The Kendall coefficient of concordance, W, was calculated as outlined by Siegel (Sidney Siegel, Nonparatnetric Statistics for the Behavioral Sciences [New York, 1956], 229–238). The median number of drugs administered to their patients by each of the four physicians was computed by probit analysis of the cumulated percent of patients treated with increasing numbers of drugs (J. T. Litchfield, Jr., “A Method for Rapid Graphic Solution of Time-Per Cent Effect Curves,” Journal of Pharmacology and Experimental Therapeutics, 97 [1949], 399–408). Life expectancies were calculated by the method of Sachs (Rose Sachs, “Life Table Technique in the Analysis of Response-Time Data from Laboratory Experiments on Animals,” Toxicology and Applied Pharmacology, 1 [1959], 203–227).

4. Frank C. Mevers, ed., Guide to the Microfilm Edition of the Papers ofJosiah Bartlett (1729–1795) (Concord, N.H., 1976), 7–17; Frank C. Mevers, “Josiah Bartlett: Dedicated Physician, Sterling Patriot,” in George E. Gifford, Jr., ed., Physician Signers of the Declaration of Independence (New York, 1976), 99–121. Also see Frank C. Mevers, ed., The Papers of Josiah Bartlett (Hanover, N.H., 1979), which supplements the microfilm edition.

5. D. Hamilton Hurd, History of Rockingham and Strafford Counties, New Hampshire (Philadelphia, 1882), 189; Louis C. Duncan, Medical Men in the American Revolution 1775–1783 (Carlisle Barracks, Penna., 1931), 407.

6. Howard A. Kelly and Walter L. Burrage, Dictionary of American Medical Biography (1928; rpt. ed., Boston, 1971), s.v. “William Aspinwall”; Philip Cash, Medical Men at the Siege of Boston, April 1775 – April 1776 (Philadelphia, 1973), 160.

7. Ibid., 163; Kelly and Burrage, Dictionary, s.v. “David Townsend.”

8. See Douglas Lamar Jones, “Charity, Medical Charity, and Dependency in Eighteenth-Century Essex County, Massachusetts,” above, 199–213.

9. Frank C. Mevers, ed., Microfilm Edition of the Papers of Josiah Bartlett (1729–1795) (Concord, N.H., 1976), frame 3075; J. Worth Estes, “‘As Healthy a Place as Any in America’: Revolutionary Portsmouth, N.H.,” Bulletin of the History of Medicine, 50 (1976), 536–552; Robert V. Wells, The Population of the British Colonies in America before 1776 (Princeton, N.J., 1975), 72, 76.

10. William B. Weeden, Economic and Social History of New England, 2620–1789, 2 v. (Boston, 1890), II, 745–768; Carl Bridenbaugh, Cities in Revolt: Urban Life in America, 2743–1776 (1955; rev. rpt. ed., New York, 1971), 89.

11. Lyman Spalding and Richard Thurston, Bills of Mortality for Portsmouth, New Hampshire (1801–1811, 1818–1820), 14 broadsheets, Boston Medical Library. The Spearman rank difference correlation coefficient shows no similarity between the rankings of monthly morbidity in Kingston from 1751 through 1787 and of monthly mortality in Portsmouth from 1801 through 1820.

12. Wecden, Economic History, ii, 473, 484, 753–759; Bridenbaugh, Cities, 89, 252; Timothy Dwight, Travels in New England and New York, ed. B. M. Solomon & P. M. King, 4 v. (Cambridge, Mass., 1969), I, 301.

13. Ibid., iv, 327.

14. J. Worth Estes, “An Account of the Foxglove in America,” Bulletin of the History of Medicine, 47 (1973), 394–408; Kelly and Burrage, Dictionary, s.v. “William Aspinwall”; James Thacher, American Medical Biography (1828; rpt. ed., New York, 1967), 91–95; Levi Bartlett, “The Memoirs of His Late Excellency Josiah Bartlett First Governor of the State of New-Hampshire,” in Mevers, Microfilm, see note 9, ms 22, frame 5155; Josiah Bartlett to Mary Bartlett, 2 October 1775, Microfilm frame 0190; Josiah Bartlett, “Itineraries,” ms, 28 November 1775, Microfilm frame 3364. Operative details of couching can be found in J. Worth Estes, Hall Jackson and the Purple Foxglove: Medical Practice and Research in Revolutionary America, 1760–1820 (Hanover, N.H., 1979), 6–9.

15. Estes, “As Healthy a Place,” see note 9; J. Potter, “The Growth of Population in America, 1700–1860,” in D. V. Glass and D. E. C. Eversley, eds., Population in History (Chicago, 1965), 638–639.

16. More precisely, Kingston suffered 12.7 ± 7.6 deaths per year, and Kensington 9.1 ± 6.5, during the years of Bartlett’s and Rowe’s practices, respectively. These figures are more directly comparable with those in Table VII.

17. Ernest Caulfield “A History of the Terrible Epidemic, Vulgarly Called the Throat Distemper, as It Occurred in His Majesty’s New England Colonies between 1735 and 1740,” Yale Journal of Biology and Medicine, 11 (1939), 219–272. See also the same author’s paper “Some Common Diseases of Colonial Children” in Publications of the Colonial Society of Massachusetts, 35 (1951), 4–65.

18. The Kendall coefficient of concordance, W, is 0.881, its chi-squared is 66.941, at P < 0.005. Spearman rank difference correlation coefficients result in identical conclusions.

19. Thacher, Dispensatory, see note 2, 330, 366; J. Worth Estes, “John Jones’s Mysteries of Opium Revealed (1701): Key to Historical Opiates,” Journal of the History of Medicine and Allied Sciences, 34 (1979), 200–209. Camphor, still used in liniments and, by mouth, as a carminative, can cause death associated with central nervous system stimulation (Robert Kopelman, Sanford Miller, Raymond Kelly, and Irving Sunshine, “Camphor Intoxication Treated by Resin Hemoperfusion,” Journal of the American Medical Association, 241 [1979], 727–728).

20. Estes, “Foxglove in America.”

21. Pearson product-moment correlation coefficients, r, were calculated to assess the degree of relationship among the four physicians’ uses of the active ingredients listed.

22. r=0.643, P<0.01.

23. r=0.239, P<0.05, and r=0.414, P<0.01, respectively.

24. r=0.072, P>0.05.

25. r=0.615, P<0.01, for Bartlett, and r=0.330, P<0.01, for Townsend.

26. r=o.336, P<0.01.

27. r=0.529.

28. r=0.750.

29. Jeremy Belknap, The History of New-Hampshire, 2nd ed., 3 v. (Boston, 1813), III, 73–94

30. Richard Harrison Shryock, Medicine and Society in America, 1660–1860 (Ithaca, 1962), 24.

31. Bridenbaugh, Cities, see note 10, 199.

32. See, for instance, K. Danner Clouser, “Clinical Medicine as Science: Editorial,” Journal of Medicine and Philosophy, 2 (1977), 1–7; also see other papers in the same issue of that journal.

33. Shryock, Medicine and Society, 51, 66.

34. William Heberden, Commentaries on the History and Cure of Diseases (1802; rpt. ed., New York, 1962), 5–7.

35. James McKittrick Adair, Medical Cautions . . . (London, 1787), 77; Levi Bartlett, “Memoirs,” see note 14, 22–24, frames 5155–5156.

36. [Henry Mellen], poem on title page ofJabez Dow, Bill of Mortality for Kensington, N.H. (Dover, N.H., 1802).

37. King, Medical World, see note 1, 32–44, 56–58, 103, 107, 120; Oxford English Dictionary and American Heritage Dictionary, s.v. “Empiric,” “Empirical,” “Science,” “Scientific.”

38. Sometime between 1800 and 1810 Dr. Jabez Dow (1776–1839) of Dover, New Hampshire, prepared a manuscript outline of the materia medica, probably intending to publish a book on the subject. His classification resembles that used by James Thacher, although their organizations differ, especially as to the subclasses recognized by each. Dow lists the “particular” drugs he thought to be the most efficacious in each class. The drugs recommended by Dow account for about two-thirds of the prescriptions actually administered by Bartlett, Rowe, Aspinwall, and Townsend, and for about eighty percent of the active ingredients employed by them. All together the five physicians were most consonant in the drugs they used the most often. When Thacher’s Dispensatory appeared, Dow was most enthusiastic about both its relevance to the practice of medicine and its tone: “For an American physician this work is in every respect superior to Duncan’s Dispensatory & supersedes the one published some years ago at Philadelphia (Murray’s El. Pharm. & Mat. Med.). . . . [Thacher has treated his subject in a way] calculated to induce a cool & impartial trial of such of these medicines as he may not have been previously acquainted with, which appears to be the only means by which new medicines get into immediate & general use among men of medical Science.” (Jabez Dow, “Materia Medica,” MS in Jabez Dow Papers, Boston Medical Library, 18 pp.: Jabez Dow to Dr. Joseph Burden, Tamworth, N.H., 11 August 1810, in “Manuscript No. 1,” MS Blank book in Jabez Dow Papers, Boston Medical Library, 84; George Wadleigh, Notable Events in the History of Dover, New Hanpshire [Dover, N.H., 1913].)

39. Shryock, Medicine and Society, see note 30, 52.

40. Samuel P. Griffits, J. Morris, John R. B. Rodgers, Caspar Wistar, Jun., William Clarkson, and Michael Leib, [“Return of the Diseases of the Patients of the Philadelphia Dispensary,”] Transactions of the College of Physicians of Philadelphia, 1 (1793), 2–42. Many more such data will be necessary before we can definitively retute the common assumption that historic therapeutic practices were inherently irrational, or even “humbuggery,” as exemplified in Hartwin A. Schulze, “Some Old Bizarre Medical Remedies,” Scientific Monthly, May 1935, 431–439. Comparable data for a military population may be found in Estes, Hall Jackson; see note 14, Table 4.

41. For the derivation of similar conclusions from different kinds of evidence, and for the historical development of the medical profession’s concept of the vis medicatrix naturae in America, see Charles E. Rosenberg, “The Therapeutic Revolution: Medicine, Meaning, and Social Change in Nineteenth-Century America,” Perspectives in Biology and Medicine, 20 (1977), 485–506; John Harley Warner, “‘The Nature-Trusting Heresy’: American Physicians and the Concept of the Healing Power of Nature in the 1850’s and 1860’s,” Perspectives in American History, 11 (1977–1978), 291–324.

42. Belknap, History of New-Hampshire, see note 29, iii, 171–174.

43. Levi Bartlett, “Memoirs,” see note 14, 24, frame 5156.

44. Josiah Bartlett to Benjamin Rush, 25 January 1783, Mevers, Bartlett Microfilm, see note 9, item 1616; Benjamin Rush to Josiah Bartlett, 23 February 1783, ibid., item 0634.

45. Levi Bartlett, “Memoirs,” see note 14, 25, frame 5156.

* Sources of the definitions: James Thacher, The American New Dispensatory (Boston, 1810); A. C. Wootton, Chronicles of Pharmacy, 2 v. in 1 (1910; rpt. ed., Boston, 1971); Louis S. Goodman and Alfred Gilman, The Pharmacological Basis of Therapeutics, 5th ed. (New York, 1975); Walter H. Lewis and Memory P. F. Elvin-Lewis, Medical Botany (New York, 1977); The Merck Index, 7th ed. (Rahway, N.J., 1960); American Heritage Dictionary; Oxford English Dictionary; John Woodall, The Surgions Mate (London, 1617); W. Lewis, The New Dispensatory (Edinburgh and London, 1786); J. Worth Estes, “John Jones’s Mysteries of Opium Reveal’d (1701): Key to Historical Opiates,” Journal of the History of Medicine and Allied Sciences, 34 (1979), 200–209. Unless a specific reference is included in the entry, modern information about a drug’s special pharmacological and toxicological properties can usually be found in standard texts, like that of Goodman and Gilman cited just above, unless no such information is readily available.

The Medical Practitioners of Massachusetts, 1630–1800: Patterns of Change and Continuity*

scope, qualifications, and definitions

growth

other features of growth

implications

The Medical Practitioners of Massachusetts, 1630–1800: Patterns of Change and Continuity *