Brian Altonen, MPH, MS

Domestic Medicine

As a Quaker with social respect and leadership skills, Ricketson had his advantages as a physician and writer of health and living practices.  He had the advantage of witnessing the impacts and effects of Cheyne’s book Essay of Health of Long Life published a half century before, and probably learned of Cheyne’s writing due to its possession by a fellow Quaker and one of his elders, or by way of exploring the household of one such elder when he was a child, like many curious kids tend to do.  However Shadrach learned about Cheyne’s book, it influenced him greatly, enough to define what his first book was going to be like.  Between 1800 and 1806, Ricketson took on the task of replacing whatever role Cheyne’s book was playing in the lives of American Colonists and fellow Quakers.  He used Cheyne’s book as the outline for his own writing.  Shadrach Ricketson’s purpose in life at this time was to replace Cheyne’s writings with something a little more fitting of the American lifestyle.  In addition, since he was a physician, Ricketson felt it was his obligation to add to this book several sections which review the most important more and social issues in medicine at the time.

The social and moral issues Ricketson had to deal with in his writings were those pertaining to the increasing strength of medicines being produced by apothecaries and chemists.  He also had to deal with the rising issue of opium misuse and abuse.  In the decades prior to the American Revolutionary War, the primary use of opium gum was as a medicine to stop severe spellso of diarrhea.  Of course, it had its calming, relaxing or even inebriating effects, which physicians often attributed or related to the ability of opium to also cease the intestines from resulting in bloddy discharges.  However, the opium was used due to its ability to prevent severe and bloody diarrhea, and save a life, not to alter the temperament or state of consciousness of whomever it was prescribed to.  Following the War, this purpose for taking opium was undergoing a significant change towards a more targeted and specific “nerve tonic” effect.   This new use did not abide by previous theories about when and how to use medications, and so the option for misuse and abuse of medication were begiining to significantly increase in moderately populated social settings.

Adding even more to this problem with misused medicines was the4 misappropriation of these methods of use, by physicians questionably trained and learned in their field of medicine.  No fully effective laws were ever developed to define specifically how one was to be a doctor during the Colonial era.  This problem with law and medicine still existed once the War was over.  Attempts were made several times to established laws which would define how a physician could be identified and allowed to practice in his home community.  But the low population sizes and lack of effective legal systems throughout the area that could establish and monitor such a thing when people are living so far apart from each otehr, made it difficult for law, judges and lawyers to regulate medicine being practices durign the early post-war years.  One of the best ways to monitor and perhaps regulate the practice of medicine was to form a society of peers who could remain in regular communication with each other and serve as each others’ method of surveying nearby communities to ensure that only the most correct and best forms of care were being provided, not a form of medicine based on the local concept of quackery or thie like, like the practice of care without a decent knowledge and training background, or the promotion of medicines that had a very poor reputation and at times were fatal.

Ricketson felt he had to deal with these issues as a part of his book.  This plan he made led him to rearrange Cheyne’s table of contents slightly to make room for this new issue in American medicine.  Ricketson had found the major differences he had to produce and promote in his writings.  By modifying the popular set-up of Cheyne’s book, and then adding to the content some important local and social issues in medicine and health practices themselves, Ricketsons satisfied the popular readership and gave reasons for his own peers to review his own writings.  This book form prevented the mockery, ridicule and attempts to ignore his writing that another heaily popular writer for the time was recceiving–the inventor of a highly popular Electric Curing apparatus, Elisha Perkin’s Metallic Tractors, invented  and popularized just across the border  in Connecticut, and heavily promoted in the New York urban areas by Elisha’s son Benjamin..

But there was still more of the problems that popular culture seemed to be producing that were out of control between 1790 and 1800.  One major avenue to earning money in medicine was to have a pharmacy or merchantile business that rapidly distributed all sorts of patent medicines about the local area.   A number of patent medicine became very popular due to these activities, and even some newly discovered herbal medicines were becoming the most widely used medicines for the time.  Many of the patent medicines that were marketed more effectively treated conditions that were common, and according to the promoter, not in need of a costly doctor’s visit to be effectively dealth with.  In this way such remedies as Hooper’s Pills, tonics and elixirs of life came to be primary income sources for their distributors, and valuable substitutes for a doctor’s visit according to their buyers. 

The use of Patent Medicines alone however was still not the most important and remaining social and cultural problem that Ricketson had to deal with through the writing of his book.  The most popular reading in medicine at this time was William Buchan’s Domestic Medicine.  This book had already lasted about one-third of a century by the time 1800 came around, and was still looking ajhead to another 20 or 30 years of continued popularity and improvement.  Ricketson’s book had this alternative source of knowledge to contend with.   Another book of the form and use demonstrated by Buchan’s writings was the new and locally popular writing of Joseph Townsend named Elements of Therapeutics, or a Guide to Health . . .   Promoted in its forward by William Buchan, this book was meant to add to the tradition that British writers of popular culture and medicine had already provided with the public in general, including those of the United States population.

It was the social and political results of the Revolutionary War that ultimately stirred in Ricketson’s favor after he published his book Means of Preserving Health, and Preventing Diseases . . .  the title on the spine for which appears simply as “Ricketson  //  On Health.”   To better understand Ricketson’s work and its meaning and application to the reader, a review of Cheyne’s, Buchan’s and Townsend’s writings have been provided.  The content, presentation and potential issues experienced on behalf of its readership present to us many reasons as to how and why Ricketson’s book became popular for important social and political reasons, not just a result of effective marketing.

George Cheyne

Cheyne’s testimonial to health and longevity consisted of the following sections (232 pages, excluding the Table of Contents and miscellaneous front pages):

• Introduction
• Of Air
• Of Meat and Drinking
• Of Sleeping and Watching
• Of Exercise and Quiet
• Of our Evacuations and Obstructions
• Of the Passions
• Miscellany Observations

Like we see with many of the early medical writings, there is a lot of experience-related writing that is provided by the text.  This small pocket-sized book is somewhat anecdotal.  Diseases are not described, just the lifestyle we have to live to prevent them or reduce their impact on day to day living experience.   Aside from this book, Cheyne has written on scurvy and two diseases with important dietary causes.   For longevity, he recommends “Exercise and Quiet”, even at the organ level within the body.  He writes: “The Organs of the body that are most used, always become the strongest, and therefore we may strengthen any weak Organ by Exercise.”  After spending 11 pages discussing Air, 60 pages on “Meat and Drink”, and 10 pages on “Sleeping and Watching”, his chapter on “Exercise and Health” is about 17 pages in length.  A number of times his phrases are somewhat “God-centered”, referring back to Adam and the eating of bread “from the sweat of his Brow”, symbolic of life, health, and work.   Even though this section is supposed to be devoted to exercise and rest, Cheyne reverts back to food time and time again.   By the time the third section of this chapter is rached, the focus is finally upon sports and exercise, followed by a section on the effects of labouring intensively upon the “Animal Oeconomy“.  Section 7 provides rules, the “Three Conditions of Exercise”, which are “upon an empty Stomach,” “not continued to downright lassitude, Depression of Spirits, or a melting Sweat.” and “Due Care is to be had after Exercise, to retreat to a warm Room, and proper Shelter from the Injuries of the Weather, left sucking into the wasted Body the nitrous particles of the circumambient Air, they should inflame the Blood and produce a Rheumatism, Fever or Cold“.   Following a period of intense exercise, he recommends a “Cold Bath . . . “under the Direction of God’s Holy Spirit“, likening this process to “the Immersion at Baptism.”  To perform the best exercise, one has to abide by his or her “Temperance” or else this process will inevitably “instead of a Remedy . . . become an Evil.”

Interestingly, there is one other religious overtone to this writing.  In Chapter 5, the discussion of “our Evacuations, and their Obstructions”, Cheynes begins by stating “The Three Principal Evacuations are, By Siege, by Water, and by Perspiration.  All these must be duly regulated, and in the Order of Nature, towards the preservation of Health, and the prolonging of Life.  * Oportet Sanorum Sedes esse figuratas”  (translated in the foot note as “* i.e. The Gross evacuations ought to be of such a Consistence in the Healthy, as to take the Impression of the Guts.”  Once again. diet and meals form the crux of most of the subsequent discussions and orations in this section.

In his discussion “Of the Passion,” Cheyne leaves the Body behind and begins to concentrate on that second part of the Body, the Soul.  The Passions is typically used to describe why people do things, seemingly without control of their “Animal” functions and without control of their emotions and physical state or being.     The following propositions are mentioned:

1. “Prop. I.  The Soul resides eminently in the Brain, where all the Nervous Fibres terminate inwardly, like a a Musician by a well-tuned Instrument. . . “
2. “Prop II.  [Soul and Body]  The Union of these two Principles in the Compound, Man, seems to consist in Laws pre-establish’d by the Author of Nature, in the Communications between Bodies and Spirits, Laws established for Spirits, in their Commerce and Actions upon one another.”
3. “Prop. III.  As Bodies are purely passive and are acted upon by the other Bodies, conformable to the settled Laws of Nature; in Spiritual Beings , on the Contrarym there is an active, self motive, self-determining Principle, by which it directs and manages itself with regard not only to its own self, and its own Sentiments; but also to its Actions and Influence on other Beings without it , and their Actions and Influence on it.   And this is the foundation of Liberty, or Freewill, in Rational and Intelligent Beings.”
4. “Prop. IV.  As in Bodies there is a Principle of Gravity or Attraction, whereby, in vacuo, they tend to one another,and would unite, according to  certain Laws and Limitations, established by the Author of Nature.  So there is an analogous Principle in Spirits, whereby they would as certainly, in their proper Vacuity, be attracted to, tend to, and unite with one another. . . .  And this is nothing else but what in Scripture is called CHARITY.”

How universal were these thoughts for the time?  Were they a part of Quaker Physician Dr. Ricketson’s philosophy?

In Cheyne’s “Rules of Health and Long Life, drawn from the Head”, the summary to the lengthy discussion of each of these propositions in the following pages (referred to a Corollaries), he notes sudden and acute passions are more dangerous than slow or chronical (according to the prior section, Corollary 3, the latter merely wears out, wastes and destroys the nervous system over time).  What Cheyne’s writings reminds us of is the notion that, in Colonial medical philsophy, most diseases can be related to or have a similar condition related to the Passions.  According to Cheyne, “The Diseases brought on by the Passions, may be cured by Medicine.”  This exemplifies one basic premise much of colonial medicine depended upon: the notion that diseases somehow relate to an influence each other, and the factors that initiated one disease can be eliminated, and yet the disease still progresses by transferring to other parts of the body.  In this way, the gout can precede the onset of rheumatism or vice versa.  The methods by which diseases were differentiated in 1720s Cheyne-like thinking were not as unique or distinct as they could be differentiated using a more scientifically detailed method of defining pathology.  With medical pathology pretty much still in need of significant development, in order for disease to isolated rather than correlated to each other, Cheyne’s simple four proposition model for the Passions might suffice.  A century later, a few years after Ricketson’s book was published, these philosophies would be totally outdated.  At the time of publication, some of them in part may still be a part of some religiomedical followings and philosophies.

William Buchan 

William Buchan’s book offered substantially more detail into the kinds of insight that may be provided by domestic medical guides.   This feature of Buchan’s writing was no doubt used to increase the demand and marketability of his book, to both the common person and even to some physicians, but in particular to those trying to learn medicine through some sort of self-apprenticeship or unlicensed, uncertified method of training pursued by physicians who lived in areas where legalities were at a minimum. 

First printed in 1769, several versions of this book were produced with minor changes along the way.  Due to its popularity, a publisher not necessarily censored by the author tried to adapt to the wants and needs of his readers by publishing this book in a five volume set due to the amount of material contained within the entire set of writings.   This did not suffice, however, as evidenced by the 1785 advertisement appearing in the 1797 Second Edition of this book.   Buchan apologized for the attempts made by a Dr. Duplanil of Paris in producing the five volume set, going on to state this this writings does indeed need more than a single volume perhaps to satisfy its readers.  Included in this was his statement reminding the readership of the purpose of this text:

“Although the Domestic Medicine was never intended to superceded the use of a physician, but to supply the place in situations where medical assistance could not be readily obtained; yet the uathor is sorry to observe, that the jealousies and fears of the faculty, have prompted many of them to treat this work, in a manner unbecoming the professors of liberal sciences; not withstanding, their injurious treatment, he is determined to persist in his plan, being fully convinced of its utility; nor shall interest, or prejudice, ever deter him from exerting his best endeavours to render the medical art more extensively beneficial to mankind.”

William Buchan’s book was no doubt focused on the lay person, not the physician.  This is probably why he never succumbed to the use of a nosology of diseases, in which each disease is related to all diseases as a whole and follows the classification system so much favored by logical scientists like Linne’s plant classification system.  Instead of the nosological method of Class, Order, Genus and Species for classifying diseases, Buchan divided the diseases in a fairly logical way, in a way comprehensible and manageable to some extent by the every day reader.  The detail of his book however may have made it less readible to some, especially those barely schooled in this basic sociocognitive skill.  The fact that there was much professional criticism, at least in Europe, about this text, and the many issues published including as well some advertising inserts by local physicians paying for the publication or the local printer (i.e. the five volume Paris edition), Buchan’s reputation as a medical writer did suffer.  Another well known British author and physician for the time, Tobias Smollett, did not favor Buchan’s writings that much, and on occasion had published his commentaries and criticisms about this work.

These professional and political disputes within the European part of the medical profession did not help in the marketing of British medical writers once these disputes neared their peak around the time of the Revolutionary War.  With the start of the Revolution, its long period of slowly progressive fighting between loyalists and patriots, British and Americans, led to still more nationalistic pressure on the potential marketing of Buchan’s work, if not currently, at least in the near future.  Such became the case following the Revolutionary War, for a number of features about Buchan’s work seem very unrelated to the entire American lifestyle.  With the Colonies now their own separately entity, and the reputation of Loyalty and Loyalists problematic if not preventive and even counter to local patriotism, publishers went back to publishing and distributing Buchan’s Domestic Medicine in the newly established Provinces/States following the War.   

More than likely there could have been some problems people had with Buchan’s writings, enough to prevent its successful marketability.  Such was not the case.  The knowledge source for this book, its origin, the people who benefitted from its purchases by United States people, included the author and British professions and industries as a whole.  This economic and political feature about Buchan’s work could have influenced individuals to prevent its success in the United States, were it not for the lack of an adequate textbook of the same nature produced by an American author. 

One of the most obvious limitations to Buchan’s writings was the limited amount of US or North American  knowledge it had to share.  This was made quite apparent in upcoming years when, as long as 20 or more years later, Buchan’s book made absolutely no mention of some of the American borne methods of healing, such as the use of very local plant medicines and the use of mineral, hot and cold water springs as a part of medical care.  To a New Yorker this lack of acknowledgement and ample promotion of these methods of healing was not only demeaning, but also not acclimated to the problems of meeting the special needs of North American born United States residents.

Countering this were attempts by local authors to publish and add to Buchan’s writings.  Still, with the publication of Buchan’s “First Charleston Edition” of this book, published in South Carolina in 1807, this lack of change in practice methods and practicality became even more apparent than in previous editions.  The publisher of this book had his own additions to the writing, but like the editor-publisher of the 1797 edition, Isaac Cathrall, managed to add little if any significant content to the text such as the more important culturally-sensitive topics of the United States, in particular the New York State region.   It is possible that Charleston was still very much English bred and borne in its behaviors and attitudes, even though the Carolinas were now their own states.  But the same couldn’t be said for another set of potential readers, New York State residents, especially those upstream from the City who were very appreciative and desirous of the use of their local resources for the promotion of health and well being.  Any typical New York and especially Hudson Valley residents during this time would probably desire to review such a book, and then following first glances search for evidence that there was change in favor of their beliefs and philosophy.  Such was not the case.  When we look for the mention of any mineral, hot or cold mountain spring waters use, something reminiscent of Saratoga Springs and the other local healing waters, we find instead a brief section in Buchan’s relaying messages of caution about and even strongly worded statements against the use of this form of healing.  In Chapter LVII of this book entitled “CAUTIONS CONCERNING COLD BATHING AND DRINKING THE MINERAL WATERS,”  we find that Buchan is not completely against this method of healing, but in instead fairly cautious, cautious enough to not say enough to promote and support the use of such healing practices.  To some readers, this did not provide at all the documentation needed to support or even be related to the medical happenings in New York for the time.   This version of Buchan’s medicine was valuable to some, but not at all New York-like in nature.

In later versions of Domestic Medicine, Buchan finally pays closer attention to the uses of Water and Mineral Springs as a part of the therapeutic process, but this process appears to be too little being done too late.  In an 1828 edition of Domestic Medicine, for example (this rendering published in Exeter), the sections on mothering and children (the second volume in the new and improved version of 1809 just reviewed) was followed by an 8-page chapter entitled “OF COLD-BATHING, IN FRESH AND SALT WATER; WITH REMARKS ON THE CASES IN WHICH THE WARM BATH IS MORE ADVISABLE.”   This is immediately followed by a 22-page chapter entitled “OF MINERAL WATERS.”  

At the beginning of this section on Mineral Springs, Buchan lists 24 mineral water sources, none of them from from London.  He then goes on to review several of these completely throughout the remaining 21 pages, never once touching upon the value of New York Saratoga waters or the like.  In fact, no American mineral, hot water or cold water spring is ever mentioned in this text.  One can imagine how this may have been taken by New York and especially Hudson Valley residents, who well before the  1809 edition was published had already learned to make extensive use of the springs in Ballston and Saratoga.  By the time the 1828 edition was published, cold mountain waters were a part of the everyday American cold water cure philosophy, so heavily promoted by William Currie since the late 1790s and early 1800s. 

No doubt the Livingstons even had something to say about this seeming anti-American feature about Buchan’s Domestic Medicine.   Evidence for such criticisms and comments however are hard to uncover, since such a piece of Hudson Valley Medical history is not expected to be easily found except in the form of some local documents such as personal communications and intellectual discussions.  About the same time that Buchan’s 1828 edition of Domestic Medicine came out, Livingston had just spent a significant amount of time and money documenting the chemistry of the waters near Ballstown and Saratoga, hiring a French Chemist to perform these tests.  This ultimately resulted in an article published in the same by the New York medical school in their regular trade journal.   A feature and practice seemingly in favor of Livingston;s medical pursuits, but not those of William Buchan, such as his book.

In an economical and cross-cultural sense, this was most certainly a sign of the post-war growth in self-sufficiency, self-promotion, and the attached desires for separation of the States from Europe, both economically and in terms of the overall intellect.  When it came to producing medicines, physicians came to favor our own instead of those that were European and Asian borne.  Evidence for this attempt to promote the local economy will come out even more in medicine in just a few years as one of the Livingstons went about developing his own answers to questions which members of the rapidly growing United States population had about the need and value of imports.  It is fo this reason that the fourth generation of Livingstons living in North America came to develop more effective means to meed the needs of the local growing populations, meeting the desires and demands for better domestic products of all sorts, ranging from fruit and vegetable crops, to much needed cattle and sheep raising methods, all of which had a direct link back to the growing need Americans had for treatments for climatic disease, a topic for the most part lacking in much of Buchan’s writings.

Reverend Joseph Townsend

Reverend Joseph Townsend’s book was more like that of William Thacher, a popular book during the same time, but one used primarily by physicians. The forward of this book meant to advertise the book was produced by none other than William Buchan, who just a couple of years earlier published the second edition of his own book on domestic medicine.  A little bit of Townsend’s background is needed to understand his value to both American and European cultures, along with the respect he was provided as both a theological and medical physician. 

Townsend’s most important writings pertained to caring for the poor.  Employed by the highest seats in the Catholic Church for some time, he was given the respect needed to be able to travel Europe extensive, writing a 3-volume set on these experiences in the late 1780s.  This work was followed by his work as a field observer during the wars in Europe taking place during the late 1780s and 1790s.  This resulted in his writing another book on the activities, perils and military events of this war, focusing at some point on the types of care being provided within the battlefield for wounded soldiers.   In 1797, Townsend produce the first volume of his work Elements of Therapeutics, or Guide to Health . . . .  This book did much the same as Buchan’s work, but had a more professional look to its contents, vocabulary and nosology.  Townsend’s writings were much like William Thacher’s book First Lines in the Practice of Physic.  Thacher himself was supported by both Colonial and American physicians, making Townsend’s book seem very much accomodating to either in both its make up and presentation.  The size of Twonsend’s book alone (612 pages, again excluding pre-body materials), made it something more like the Bible to many households at this time–a reference book often referred to, but not made for leisurely sit-down reading in just a few days.   The Table of Contents for Townsend’s book Elements of Therapeutics or a Guide to Health (2ed. 1802, David Carlisle Printer, Boston) was a nosology or taxonomy/classification tree of diseases similar to that of Thacher.  Townsend’s nosology consisted of 4 major Classes of Disease, each of which had 4 sub-classes referred to as Orders.  In the introductory chapter to the second edition of Townsend’s book, it is briefly mentioned that 5 Orders were allotted for this classification system, but instead he uses just 4, due to lack of need for the fifth.  The following are these Classes and Orders:

1. Class I  PYREXIAE:   “After cold shivering, a frequency of pulse, with increase of heat and thirst.”  Order I – Febres,  Order II – Phlegmasiae,  Order III – Exanthemeta,  Order IV – Hemorrhagiae
2. Class II  NEUROSES:   “Affections of sense and motion, disturbed; without either idiopathic pyrexia [fever], or topical disease.”   Order I – Comata,  Order II – Adynamiae,  Order III – Spasmi,  Order IV – Vesaniae
3. Class III  CACHEXIAE:   “A depraved habit of body; without pyrexia, and independent of neurosis, as original diseases.”   Order I – Marcores,  Order II – Intumescentiae,  Order III – Impetigines
4. Class IV  LOCALES:   “Morbid affections, which are partial”.  Order I – Dysaesthesiae,  Order II – Dysorexiae,  Order III – Dyscinesiae,  Order IV – Apocenoses,  Order V – Epiecheses,  Order VI – Tumours,  Order VII – Ectopiae,  Order VIII – Dialyses.

The details of this nosology (method of classifying disease) barely made Townsend’s work more understandable in many household settings around the time of its publication.  Townsend’s work was perhaps very meaningful to individuals residing in places where medical care seemed to be lacking or was poor, inadequate and maybe even fraudulent to some extent, but like Buchan stated about his own work, this book was not meant to serve as a replacement for local doctors, only as a source of information to common readers when it came to better understanding their mental and/or physical states of health.  In favor of the circulation of this book is the fact that it managed to explain in fairly simple language the nature of the various diseases people heard about from others and their doctors.  Its section on vaccinations attempted to increase the public’s trust in the method of preventing severe disease outbreaks (p. 113, Hemorrhagiae section).  Most of Townsend’s writings were in fact very informative and useful to most households, essentially making it the Bible in medicine for its time. 

For most diseases, Townsend notes there to be two major causes for Remote (something within or inherent to the body is responsible for the disease) and Proximal (something introeduced into the body or put in contact with the body that in turn causes the disease), a disease theory heavily promoted by Benjamin Rush of Philadelphia, a Revolutionary War Physician and at the time of Townsend’s writing one of the main writers for the Philadelphia medical and surgical journals in operation and a professor at the Philadelphia medical school.  Added to these two primary causes were “Predisponent Causes” for disease, the reasons why a body develops disease related to inherent lack of acclimation or ability to acclimate, and “Occasional Causes” those which were infrequent, of undefineable origin, and which could not be placed in other parts of this classifications system.  For Nervous system related diseases, in particulat emotional and mental health related problems, a different set of rules appear to be followed by Townsend, not clarified very well by his writings.

Summary

The review of these four books as precedents provides us with insights into how one might consider a family medical guide being marketed around the time Shadrach Ricketson’s book was being written for publication by Ricketson himself.  Cheyne’s book was obviously out of date by the 1800s.  Although very popular  during Ricketson’s childhood, it was not valuable rading material by the time he began to learn medicine  soon after the war.  Cheyne’s books was essentially too short, many of its ideas pretty much commonplace and common sense, and the book itself was too small and short in length, kind of similar to the many pamhlets then circulating with their own propsed remedies for various diseases.  Buchan’s book had its time of want and need in American medical history, which would still continue for years to come.  Still, Buchan’s lack of information valuable to colonial settings, their rural nature and to some extent fairly limited renderings of the up and coming interest in weather or climate and disease, made this writing  once  the American lifestyle became less British and more American in nature, following the winning of the War. 

Overall, winning the war against Buchan’s mother country didn’t really change the popularity of his book that much.  It did bring about some sensitive issues that the his new readership ow had to deal with regarding British thoughts and perspectives of things, now that the War was over.  The continued publication of this book primarily as a British style of writing and publication must have said to the most patriotic of readers in the United States that medical writers from Europe had little to offer to American culture, especially when it came to better understanding the local health issues and the ways to stay healthy based on the more modern methods that American physicians had begun to define.  For this reason, an American book or two had to be produced by a local author, someone who was capable of satisfying the needs of the lay people’s without offending too much the local aristocracy.  Fortunately and unfortunately for Townsend, as a non-Anglican writer his book was different, but too complex and lacking the topics needed to satisfy the American’s desires for the most local medical information.  As a result the major flaw with Townsend’s book is that he did not address specifically American health and population issues, like the people wanted.  This is why Townsend’s book is perceived by some historians in medicine as a potential reason for the subsequent popularization of other books and methods of healing about to be generated within this New York-New England setting.  For local doctors to successfully meet the public needs, they would have to produce succinct, detailed writings about medicine on how to treat or cure specific American-related illnesses.  These methods of healing would have to be based upon specific local , American-born remedies.  The books which consisted of these simpler methods were easy to define and would become some of the most popular readings in medicine over the next 30 to 40 years.     

These problems with the popular press in domestic medical book writing and publication are what provided Shadrach Ricketson the chance he needed to produce  a book like no other book on medicine written and published in the United States.  Right around the peak of his professional career, as Ricketson became heavily involved with his life as a  Quaker elder, religious leader, community spokesperson, natural theologian, scientist, epidemiologist and physician, he was able to produce a book that very much met his religious needs whilst continuing his community service and satisfying his professional wants and needs.  This is probably what led Ricketson to publish the book targeting the lay person and the members of his immediate community.  Unlike Townsend and Buchan, Ricketsons’ book makes use of some new findings and methods in medicine missed by the others, in particular those most important to Hudson Valley and Dutchess County residents, his neighbors.