Medicine

Medical beliefs and practices were eclectic in colonial North America. Their foundation was the ancient teachings of Hippocrates and Galen, a tradition known as “humoral-ism” because it explained human health and illness in terms of internal bodily balances and imbalances among the four “humors”: blood (sanguine), phlegm, yellow bile (choler), and black bile (melancholy). Illness was explained as a result of five types of external cause: invisible, particulate effluvia; contagion (direct physical contact with disease); changes in air temperature; earthquakes, comets and other extraordinary natural phenomena; and divine punishment for sin. Diagnoses according to the Galenic tradition were made on the basis of relations between heat and cold and dryness and moisture in the patient. Treatments (known together as “heroic medicine”) included bleeding, sweating, purges, and emetics of various kinds to restore an equilibrium of the humors.

Other important theories and practices, like “iatro-chemistry” (iatros is Greek for “physician”), overlapped and combined with Galenic traditions. According to the 16th-century philosopher Paracelsus, illness could be explained by chemical imbalances in human bodily fluids and could therefore be treated by the use of chemical remedies, minerals, and classical botanical drugs. An innovation of the late 17th century, known as “solidism,” located the essential physical imbalance not in bodily fluids but in the body’s solid conducting tubes, like blood vessels and nerves. Solidism laid the basis for the development of theories explaining illness as the result of excessive or deficient activity in the nervous system. Among elite practitioners there was a direct continuity between European and American physiology, culminating in the centrality of Scottish nervous theory to the program of the first American medical school at the College of Philadelphia (1765).

Another tradition in colonial medicine was arguably one of the most popular: astrology. English works, imported and reprinted in the colonies, offered advice on how to use astral “sympathies” and “antipathies” to aid healing by performing medical treatments under specific star signs. Anatomical texts served simultaneously as guides to midwifery, sex manuals, and handbooks of astrological physiognomy (the interpretation of facial characteristics). Almanacs, which reached a wide readership, retained astrological advice throughout the 18th century; for many, knowledge of the heavens remained a valuable medical strategy. For example, in the early 1760s Dr. James Greenhill of Virginia noted that one of his patients, an epileptic slave, suffered fits only when the moon was in Capricorn. Greenhill used vomiting, purges, electric shocks, blisters, and internal medicine on his patient in search of a cure. A second striking example of overlapping medical traditions is Cotton Mather’s support of smallpox inoculation in 1721. Mather evidently saw no inconsistency between championing the cause of inoculation and retaining the moral view that disease was ultimately caused by sin.

The scarcity of physicians and the cost of consulting them meant that the burden of healing often fell to men and women in the home. They treated their families, servants, and slaves; women were particularly important as midwives. Home healers were largely self-taught, learning from British texts on home medicine and by experience. They bought herbal remedies from apothecaries and also mixed their own. The major remedies included cathartics, diuretics and diaphoretics (to expel foul humors), and tonics (to stimulate the nerves). Other important healers included ministers and their wives. Slaveowners and African-American doctors both treated slaves. Native Americans recognized four main causes of illness—sorcery, spiritual aggression, taboo transgression, and natural causes—and relied on the healing powers of shamans.

Unlike New Spain and New France, British American medical practice lacked centralized organization. As a result, British colonial medicine was probably more individualistic and the traditionally elite class of physicians more open and varied, embracing as it did surgical and apothecarial duties. Decentralization had disadvantages, however. Unlike their Spanish and French counterparts, American physicians were unlicensed, unsalaried, and instead charged fees. Consequently, it was difficult to distinguish legitimate physicians from illegitimate “quacks.”

Moreover, institutions for the care of the sick were slow to emerge. By 1650 Spain and France had established a number of New World hospitals, while British America’s first, the Pennsylvania Hospital, was founded only in 1751. See also environment; science; yellow eever.

Further reading: Richard Harrison Shryock, Medicine and Society in America, 1660-1860 (New York: New York University Press, 1960).

—James Delbourgo