**C207** Chap. 7th

After brief comments on Hippocrates, Celsus, Cullen, and others, Barker discusses “the unfortunate [John] Brown,” whose “excentric notions & heated imagination . . . fascinated a considerable number of physicians, both in Europe & America.” About 1788, when Brown’s Elements of Medicine first appeared in Maine to be read by physicians, lawyers, and divines, the lancet and other depleting means were replaced by stimulants, chiefly of spiritous liquors. People with pulmonary consumption seldom consulted physicians, preferring the stimulating plan to the lancet. Physicians also preferred the stimulating plan and rarely used the lancet until 1798, when Dr Rush’s Inquiry into the Causes and Cure of the Pulmonary Consumption, printed in 1793, was brought to Portland and read by Barker and others. But prejudice against the use of the lancet in consumption was strong, and the change didn’t take place until the beginning of the nineteenth century.

**C135** Chap. 6th

Barker relates some unusual cases such as empyema (pus between lung and chest wall) in a fifty-five-year-old minister who was treated, drained, and lived for an additional thirty-eight years. A president of the College of New Jersey (later Princeton University) who had long-standing lung symptoms wrote a letter stating that he was such a devotee of venesection that he bought himself a lancet for self-treatment. In 1811 Barker’s twenty-five-year-old daughter, Eliza, daughter of a consumptive mother, developed chest pain, hacking cough, fever, and wasting. She received standard treatment by a physician acquaintance but rejected her father’s and a consultant’s suggestion to be bled. Eliza deteriorated, finally agreed to be bled, and was cured after five months of symptoms. She married in June and was doing well twenty years later. In Barker’s opinion, prevention should focus on proper clothing for women for “If the breast is left open to facilitate the entrance of Cupid’s darts, it affords a more certain mark for the envenomed shafts of the grisly king of terrors” (Joseph Young, 1809).

Phthisis Pulmonalis, or pulmonary consumption.

Barker defines pulmonary consumption as a wasting disease with destruction of the lungs, explaining that the poor results of treatments by the ancients was due to medical instruction “destitute of anatomical knowledge.” He cites Thomas Reid and quotes David Ramsay, that from 1700 to 1800, thousands of dissections led to improved treatments. Barker’s experience includes his careful observations on consumption, having lost three wives and two children to the disease, when the nature of this disease was “involved in obscurity.” He knows that he had been called “an unskillful and unsuccessful practitioner in consumption,” but feels that he has learned from his own sad experience. He comments on consumption in pregnancy and parturition as well as in young females whose “customary evacuations” fail to take place, followed by a hectic fever and often death. “Exposure to evening air, in the parade of parties, and the ball room, clad in cobweb muslin, has laid the foundation for consumption in many fashionable young females, and consigned them to an untimely grave!” Phthisis pulmonalis frequently takes place in consequence of neglected pneumonia, influenza, and measles.

Consumption

This brief chapter begins with a letter dated December 20, 1831, from Samuel Emerson of Kennebunk, Maine, commending the manuscript, particularly the volume on consumption, and agreeing with the “necessity of copious and repeated bleedings.” Barker promises a history of consumptive diseases as they have appeared in Maine and some other parts of New England since 1768, to be preceded by a history of the disease back to Hippocrates by Thomas Young. He notes that earlier in the eighteenth century consumption made up only about one-tenth of the bills of mortality but by the close of the century, it appears to have made up one-fourth of all deaths. Several physicians in North America have made valuable observations on consumption, though chiefly in the middle and Southern states; Barker will provide results of his inquiries and observations as it has appeared in the northern and eastern parts of the Union. He remarks about some cures that have come about by what are called by some, “the efforts of nature.”

Chap. Hydrophobia.

Barker presents several cases of hydrophobia, or rabies, written by physicians in the United States and abroad, with two apparent “cures.” For example, Joseph Gallup of Vermont apparently cured a case of a twenty-eight-year-old male bitten in the arm by a dog known to be mad because other animals bitten by it had “died within 21 days, a dog, two hogs and a sheep, with all the symptoms of canine madness”; two other dogs on being taken sick were killed.

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.

Thoughts to Consider While Reading Barker’s Manuscript: Presentism, Whiggish History, and the Post Hoc Fallacy

The holistic tradition of Hippocrates and Galen ended in the nineteenth century with the arrival of disease specificity. Thus, the correction of imbalances provoked by noxious air, inappropriate behavior, the environment, air, water, food, emotions, exercise, rest, and evacuations gave way to the biomedical model, reductionist medicine, and positive scientific authority. By the late nineteenth century, medicine had incorporated Rudolf Virchow’s cellular pathology (1858), Joseph Lister’s surgical antisepsis (1865), Louis Pasteur’s bacteriology (1860s), and Robert Koch’s discovery of the tuberculosis germ (1880s). But John Harley Warner maintains that in Barker’s era, therapeutic action was an essential part of professional identity, as physicians struggled with skepticism regarding medical therapy and the relative merits of nature healing versus the need for therapeutics such as bleeding, purging, and mercurials. Charles Rosenberg emphasizes the importance to the physician–patient relationship of “exhibiting” a drug. To evaluate the validity of Barker’s knowledge and treatments, the twenty-first-century reader must avoid presentism, whiggish history, and the post hoc fallacy, and must consider confirmation bias. Was Barker using the best available evidence in 1820? Were his decisions evidence-based?

“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.

**C59** Chap. 4.

Barker describes cases of consumption during in his preceptorship as well as the loss to this disease of his own wives in 1775, 1794, and 1799, portraying his early “defective practice” that improved with the advancing state of medical knowledge succeeding years. He comments on the death of Dr. Ezekiel Hersey in 1770, of his preceptor, Dr. Bela Lincoln in 1774, and of Rev. John Hall, a missionary to the Indians, and presents a number of his other patients with consumption.