Storming the Bastille of Orthodoxy

After describing orthodox medicine and its alternatives in early America, this chapter discusses the rise of country’s earliest medical licensing laws, in the late eighteenth and early nineteenth centuries. These schemes strove to exclude unorthodox practitioners from the medical profession. American arguments for freedom of therapeutic choice were born in opposition to these original licensing systems. The chapter examines in detail the medical liberty advocacy of Benjamin Rush, an influential Founding Father who was also the most prominent American physician of the early national period. The chapter analyzes the genesis during this time of various strains of medical freedom rhetoric that would persist, to varying degrees, throughout American history.

Horticultural therapy.

Horticulture has been a therapeutic activity ever since human populations began to plan, create and nurture gardens for pleasure as well as for food production. The sensory stimulus and relaxation that tending plants or being in the presence of nature brings has long been known to have positive effects on mind and body. During the Middle Ages, the gardens cultivated in the grounds of monastery hospitals were used not only for the production of medicinal plants, but also for the purpose of cheering melancholy patients (McDowell, 1997). Historically the use of gardening as a therapy dates back to the 1700s when documentation showed a correlation between patients in mental institutions (known as insane asylums) who engaged in gardening activities showed improvements in their physical and mental health (Porchey, 2007). In 1798, Dr Benjamin Rush, a signer of the Declaration of Independence and while a professor of medicine and clinical practice at the University of Pennsylvania, reported that gardening improved the conditions of mentally ill patients (Park-Brown et al., 2010). It was observed that 'digging in the soil seemed to have a curative effect on the mentally ill' and sought to encourage patient participation in such activities (Olszowy, 1978).

Chapter 1

Barker discusses the causes, frequency, and treatment of insanity, with references to contemporary articles and authorities on mental illness such as Benjamin Rush, Philippe Pinel, and Thomas Arnold. Case presentations include delirium, suicide, and problems associated with use of ardent spirits. A case of frenzy alternating with dejected behavior would today be called bipolar disorder or manic depression. Treatments include diet, bloodletting, blisters, mercurials and salivation, cathartics, cold baths, and other modalities.

“Alkaline Doctor” and “A Dangerous Innovator”

In 1795 Barker read Lavoisier’s chemistry, experimented on tainted meat made edible by soaking in alkalis, and began using alkaline therapy such a limewater. He wrote about this to Samuel Mitchill and Benjamin Rush, telling them that he had been called a “dangerous innovator.” A brief history of the acid/alkali debates of the seventeenth and eighteenth centuries includes information about Otto Tachenius, John Colbatch, Hermann Boerhaave, George Ernst Stahl, William Cullen, Joseph Black, and Antoine Lavoisier. Barker wrote about his experiments, azotic air (nitrogen), and his difficulty understanding the mechanism of this apparently successful therapy. His results were published in the Medical Repository, beginning a correspondence with Samuel Latham Mitchill, professor of chemistry at Columbia University. Contributors to the discussion of alkalis included David Hosack, Thomas Beddoes and James Watt, Humphry Davy, and Matthew Carey. Comments by Charles Rosenberg, John Harley Warner, Lester King, and others help us make sense of medical science and the acid/alkali battle.

Obtaining and Sharing Medical Literature, 1780–1820

The quest for timely medical literature was a concern for elite as well as rural physicians in the United States, as evidenced by comments from Drs. Benjamin Rush of Philadelphia; Benjamin Vaughan of Hallowell, Maine; and Lyman Spalding of Portsmouth, New Hampshire. It was the focus of an 1800 correspondence about the new cowpox (vaccination) between Barker and John G. Coffin of Boston who, in 1823, would found and edit the Boston Medical Intelligencer, precursor to the Boston Medical and Surgical Journal, now the New England Journal of Medicine; smallpox inoculation is also discussed. Topics include obtaining and sharing medical books and journals, the importance of both personal correspondence and newspapers for dissemination of medical information, problems with and for booksellers, medical nationalism, and publishing by subscription.

Diseases in the District of Maine 1772 - 1820

This previously unpublished primary source allows modern readers to reimagine medicine as practiced two hundred years ago by a rural physician in New England through his case histories, correspondence, biographical sketches, and personal commentary. Throughout his fifty-year practice, beginning with a preceptorship in Hingham, Massachusetts, Jeremiah Barker documented his constant efforts to keep up with and contribute to the medical literature in a changing medical landscape, as practice and authority shifted from historical to scientific methods. He performed experiments and autopsies, became interested in the new chemistry of Lavoisier, risked scorn in his use of alkaline remedies, studied epidemic fever and approaches to bloodletting, and struggled to understand epidemic fever, childbed fever, cancer, public health, consumption, mental illness, and the “dangers of spirituous liquors.” He corresponded with luminaries such as Benjamin Rush, Samuel Mitchill, and Lyman Spalding, and he published several articles in the first US medical journal, the Medical Repository. Perhaps many rural physicians practiced at this level, but few such written records have survived. Barker’s rare transcribed manuscript, never before published, is presented in its entirety with extensive annotations, a five-chapter introduction to contextualize the work, and a glossary to make it accessible to twenty-first-century general readers, genealogists, students, and historians.

The Old Medicine and the New: Why Did Barker Write This Manuscript, for Whom Was It Written, and Why Was It Not Published?

This section begins with a very brief overview of early medical philosophies leading up to Barker’s time, when science was developing an important place in American intellectual life. There was a gradual increase in the cultural authority of “regular” medical education by preceptorship, didactic medical school lectures, and medical licensure, as opposed to self-help or domestic medicine, sectarian medicine, the Thomsonians, homeopaths, and others. William Cullen, Benjamin Rush, and John Brown influenced medicine at the end of the eighteenth century. Pierre Louis in Paris, who had become a major influence on American medicine during the first third of the nineteenth century, believed that “medicine is a science of observation” and a “rigid method” is essential for medicine to improve. Careful case reports, necessary for practice and teaching, were facilitated by the numerical method. The Physician’s Case Book, published by Allen & Ticknor, Boston, in 1832, was an attempt to help physicians to record and organize their case reports. Possible reasons Barker failed to publish his manuscript include finances, competition from other books, and the rapidly changing medical beliefs during the first third of the nineteenth century. A comparison is made to Noah Webster’s 1832 decision to abandon the revised edition of his 1799 book on epidemics.