Preface to Researchers
The following details, including all the web-pages that following in some chronological fashion, are compiled from research and teaching notes I have taken over a 30 year period, and then pulled together for classes and essays, but mostly for personal gratification to get a sense of a tradition in life that few historians try to pull together as sociological historians interested in an integrated history of medicine, not just a series of essays with little interactions between the players of each story being retold.
The pages in this section (aside from this page), are rich in documentation, mostly from the local writers, with hundreds of images pulled from the microfilm of the Poughkeepsie Journal in total. If I have the time, and can find the opportunity to pull similar items from several other local newspapers for New York, such as Hudson or Troy, NY, these will be added as well once that opportunity arises. Half the task of good history work is finding the documents that are needed to pull together a valuable story of this important piece of local history. The other half is writing about your findings and your interpretation of their meaning and value as a historian. All the research and evaluation process gets accomplished during the time it takes to pull these important pirces of evidence of the past together, which is such a tedious process that it is not unusual to realize the conclusion long before the bulk of the documentation and recategorization process is complete.
Like other pages filled with primary source reference material, it is recommended this entire page and its series be downloaded by individuals or special interest groups in need of this valuable collection and summary I have produced of the evidence out there for our local medical history. The publishing world in general has demonstrated to me that they feel there is limited value to this kind of work, which is a unfortunate state of being for this important piece of American history. There are few out there trying to pull together this kind of information in a way that is complete in its authenticity and ability to demonstrate a piece of Americana which has for the most part been told and retold partially and inaccurately, often according to some agenda that is out there. During my 30 years of teaching medical history I have found that medical history speaks for itself given a full and concise collection of all of its events, dates, people, and contents. It is better to peruse the actual documents than to simply read someone’s subjective interpretation of things (even my interpretations at times often fall into this category), for which reason the evidence is compiled and now being placed on the web.
Introduction
This next section of my blog consists of a detailed evaluation of the medical profession in New York, with most of the details focused on Dutchess County. Over the years, historians have found it easiest to document the history of medicine as an urban study, and so many studies of colonial and the new post-colonial medicine are focused on the urban practices and professions. A fairly exceptional book was published back in the 1960s on medicine in both the urban and rural setting–Aesculapius Comes to the Colonies. This is the best published source for historians to peruse on Colonial Medicine, however it requires a meticulous review due to the amount of detailed information provided, typically presented in a form that consists of one county per chapter of the book.
The second major reference is James Thacher’s 2 volume biographies of medicine work, with most of the republished copies bound together as a single book. This adds additional information to the researcher’s review of any colonial and post-colonial topics, and since it is an early 19th century piece has a certain sense of authenticity. The problem with this book is its indexing. It requires a tedious review of the entire contents, plenty of note-taking, and then review and redistribution of the notes taken in order to make some sense of everything that has been shared by Thacher. This is more a book of many professional biographies than a book many to be a easily researchable publication. Parts 1 and 2 are different in their approach, with Part 1 using the biographical approach and Part 2 using a regional or topical approach. This only adds to the complexity of all that can be pulled from these books by a writer searching for background. (Once I find my notes on the two, these will be web-published as well.)
The First “Doctors”
There were few laws in place during the colonial and early post-colonial years to define the rights to practice medicine. To determine whether or not someone had the knowledge and skills required for this profession, the individual either had to demonstrate proof that he or she was trained in some official setting like a medical school in Europe, a hospital that taught medicine, of under the guidance of another physician qualified to provide some sort of apprenticeship training. In the local communities, the most common way someone learned medicine without leaving the immediate area was as an apprentice, and as the threats of skirmishes with the French and Indians, and the possibility of battles on land or at sea beginning to take form, learning medicine as an assistant to a military physician or surgeon was another way in which these skills could be learned.
Once the Revolutionary war commenced, medicine became something that was learned by serving as a Surgeon’s Assistant. The ongoing impacts of the war on local communities eliminated whatever methods of training were being provided by the only medical school in the region—King’s College in New York City. Two major series of events ensued due to the war that had a significant influence on how physicians would become socially accepted and peer-supported as practitioners of surgery and medicine. First, it was unofficially decided by social, government and political leaders that some form of background and clinical experience had to exist for an individual to be able to promote himself or herself as a skill practitioner in this field. Second, mountebanks, charlatans and other “quacksalvers” were no longer the only options one often had. Even though these “quacks” seemed to be growing in number and were absolutely no different from many of the regular doctors at times, some efforts were being made to officially watch over these practices. If a doctor from Germany was going to promote his miracle cure, he was only going to be allowed to do so under supervision of the right authorities and experts in the same practice.
For nearly a century this was pretty much performed by unofficial practitioners engaged in such forms of medical practice as simple herbalism, midwifery and even curees and zieckentroosters–‘visitors or consolers of the sick’. Practitioners who claimed to be physicians or chirurgeons (surgeons) and who have some form of experience in these fields through either an apprenticeship and/or some formal schooling in these fields, had to be tested for their knowledge and skills by someone associated with the colonial governor’s office. Even though a number of simple laws were composed restricting the practice of medicine somewhat by King James, there were nor any good laws written regulating the practice of medicine until well after the Revolutionary War was over. During the 1790s, specific Acts or Laws were established defining these requirements and how to interpret one’s ability to practice medicine, surgery, or both.
This period in early American medical history led to the publication of one of the most commonly quoted criticisms of the medical profession for the time. According to Chief-Justice William Smith Jr. in his The History of the Province of New York: From Its Discovery to the Appointment of Governor Colden in 1762 (New York, NY: New-York Historical Society, 1829; Reprinted in 2 vols., edited by Michael Kammen; Cambridge, MA: Harvard University Press, 1972), the later period of colonial history years was riddled by physicians not at all trained in medicine within an official university or hospital setting. The only place such training could really happen in significant amounts was Europe. This led William Smith Jr., to write:
‘Few physician amongst us are eminent for this skill. Quacks abound like locusts in Egypt, and too many have recommended themselves to a full and profitable practice and subsistence. This is the less to be wondered at as the profession is under no kind of regulation. Loud as the call is, to our shame be it remembered, we have no law to protect the lives of the King’s subjects from the malpractice of pretenders. Any man at his pleasure sets up for physician, apothecary, and chirurgeon. No candidates are either examined or licensed, or even sworn to fair practice.’
Although this statement about the condition of medicine is commonly quoted, the accuracy of its explanations provided by past historians are somewhat questionable. There in fact is considerable evidence that the bulk of these problems were more European-derived than Colonially-borne, as evidenced by Chapter 13 of The History of New York State (Dr. James Sullivan (ed.), Lewis Historical Publishing Company, Inc., 1927). In a review of the various published description of this problem by the local newspapers, we find that many if not most of these practitioners with questionable claims and skills were pretty much foreign trained migrants into the area. For example, in 1753 the Independent Reflector referred to these individual were described as “quacks and pretenders” creating “dismal havock” within the medical field based on a social point of view. Another newspaper, The Weekly Postboy, noted in an editorial the need to denounce and eliminate these “foreign quacks who had dared to intrude on the preserves of the native sons,” calling them “Scandalous interlopers” and “vile Quacks and base Pretenders.” In this case, loyalty and patriotism were superceded by the revenues generated by these advertisements made these claims important contributors to the publisher’s income.
Still further evidence for these consumer battles are found in Griffenhagen’s review of Patent Medicines. Marketing agents were very effective at providing potential patients with valuable substitutes for highly costly physicians and their seemingly highly dangerous ways of treatment at times. The promotion of European Patent medicine did little to improve the local economy and much to impact the needs and desires of foreign trade derived products, at a time when the war itself had made many such endeavors costly and at times economically impractical for some communities. If the European manufactured balsams and tonics could not make their way to the New York region, then at least their creators or inventors such as French, Prussian, and German physicians could.
These local practice problems led Dr. John Bard of New York and his Weekly Society of Practitioners to meet regularly, and by May of 1753, produce an article that was published in the Independent Reflector entitled “Heads of an Act to Regulate the Practice of Physic in New York.” In this article, the Provincial Assembly was advised to take whatever actions were needed to demonstrate their support for regular physicians against their unfair competitors—the “quacks”. The Law that resulted was summed up in this article and states the following:
“[All] the physicians, surgeons, apothecaries in the Province are to be licensed by a board consisting of the four eldest members of His Majesty’s Council, the judges of the Supreme Court, the representatives of the city of New York and of the Assembly, our Mayor and Recorder for the time being, or any seven of them, with the assistance of two physicians and two surgeons by the majority of them elected. Until after examination and licensing, no one shall practice. Examination shall be public.”
For the first time, attempts were being made to prevent individuals from becoming practitioners with questionable trade skills. The next attempt to add to this movement against “quacks” was a second action taken by the Provincial Assembly of New York City, which begins with:
“Where many ignorant and unskillful persons in physick and surgery in order to gain a subsistence do take upon themselves to administer physick and practice surgery in the City of New York to the endangering of the lives of many of their patients; and many poor and ignorant persons inhabiting the city, who have been persuaded to become their patients, have been great sufferers thereby; for preventing such abuses for the future, be it enacted, et cetera”
This 1760 New York statute was the first statute designed specifically to regulate the practice of medicine. It was successfully approved by the Council and signed and approved by the Lieutenant-Governor that same year, and required that an individual be examined by a board representative of the principal provincial and city departments before being allowed to practice medicine or surgery. Although this act formed in the city of New York had limited applications to rural county settings of the colony, there were limited provisions available to determine if these legal actions could be implemented locally. So, dealing with such issues within the Hudson Valley setting remained a local issue to be contended with, mostly by local Justices of Peace and the local courts.
Even within the New York City setting, this Act was hard to enforce. Whenever attempts were made to examine the skills of a physician, or review his history of study and apprenticeship, these could only be performed on new doctors for the most part, and could only be enforced if an individual lacked the permission of the board of examiners to be practicing medicine. Those practicing without such a claim, could only be penalized as much as five pounds for their offense, which was not always an effective deterrent for it did not prevent the recommencement of such practice elsewhere in the colonies. The next government Act pertaining to medical practice in New York wouldn’t be written and passed until after the Revolutionary War.
Smith’s statement about “Quacks” is more a reaction of the profession and its many political and social changes then taking place than it is a consequence of social and political events taking place within the medical profession. When interpreted in the context of medicine and politics at the time of its publication (1829, just a few years into the popularization of various types of “reformed medicine” heavily popularized within the Valley setting), Smith’s comment can be interpreted as a result of public criticisms and discontent felt about the practice of medicine in general, by many regular physicians as well as by the people. Evidence for this social discontent with medicine is demonstrated by the rapid increase in popularity of alternative medical practices then being promoted, such as Indian Root doctoring and the rapidly growing profession of Thomsonian medicine. It is also important to note that when Smith’s History of the Province of New York was printed, some of the influences of Jacksonianism were still at a peak, resulting in the popularization of such local publications as “Be Your Own Lawyer” (the title of a book published locally by a Poughkeepsie author) and the traditional Jacksonian method of practicing medicine: “Be your own physician”. These beliefs along with the common teachings of many “Reformed” or non-traditional physicians and industries then blossoming within the Hudson Valley really helped to set the stage for Smith criticisms of “quackery” in general, and in a way that was very much in favor of the chief competitors (regular MDs) more so than the peoples’ needs, as time would soon tell following the War. In the minds of the professionally trained doctors of the Hudson Valley, these events provided the profession with a reason to begin establishing its own professional group capable of regulating others making claims about their medical, surgical and apothecary skills.
Societies during the Revolution
During the Revolutionary War, the traditional Colonial physician or surgeon learned his or her specific either by way of attending a European school with classes devoted to this skill, one of the few universities in the Colonies then teaching important medical classes (Yale, Harvard, Princeton) and/or by engaging in some form of apprenticeship. For the military trained physician or surgeon, serving the local hospital or military ship, the War offered a golden opportunity for learning medicine as an apprentice, a position that by then was referred to as Surgeon’s Mate. Prior to the war, surgery and medicine were still viewed as distinctly different skills for the most part, like they were during the 16th century and prior. But since their teachings, particularly within university or college settings were often quite similar with regard to knowledge and practical skills, by the time the Revolutionary War began, these two types of positions were often similar in their training and differentiated more by the place of practice than by any formal series of trade-related definitions. In the case of the local Fishkill Hospital for example, when we review the history of two physicians serving at the Regimental level, James Thacher and Physician Cornelius Osborn, we find that each were required to practice similar skills, ranging from the steps needed to initiate and inoculation, to those required to induce the vomit or result in a sweat, to the surgeon’s ability to perform such procedures as surgically removing embedded arrows and musket balls, correcting exposed compound fracture bones, excising a largely swollen infected wound, or amputating a days old wounded appendage afflicted by gangrene. A review of Thacher’s diary suggests that he was required to engage more in the local battlefield setting dealing with various military medical needs, whereas government documents seem to suggest that Osborn served more as a bedside doctor working within the hospital setting, at times engaged as well in various administrative and/or quartermaster skills and activities.
Following the War, this similarity of the two professions—medicine and surgery—facilitated the merging of their teachings into a single form of medical education provided within the medical school setting. This took place with the recommencement of the older medical school facilities located in New York and Philadelphia. In just a few years, attempts would be made to produce other programs in New York, in the Fallkill area, and in the local states of Massachusetts and New Jersey. By this time, two things about medical training underwent significant change. First, the number of years of engagement was reduced from 6 or 7 years, a length of time typical of an English-based apprenticeship contract, to 3 or 4 years. Secondly, the idea of engaging in an apprenticeship beginning during your pre-teen to earliest teen years was eliminated from the American medical education system. In exchange for these early years of apprenticeship, the student was required to demonstrate a better knowledge base developed through engagement in the local lecture series provided on specific medical topics.
With each year that passed, we find this requirement attend lectures or classes to be more and more essential to obtaining a license approved by the local government for engaging in such a profession. Between 1783 and 1796, it was the availability of these opportunities that seemed to define how many physician would be available to practice in a given area, and what sorts of training they could obtain that would be locally and regionally accepted as adequate methods for learning medicine.
New York City
In 1792, An act was passed by the New York Assembly and Senate intended to deal with medical activities engaged in by “ignorant and unskillful persons.” This Act pertained just to the New York City and County area, those who “presumed to administer physic and surgery within the city and county of New York, to the detriment and hazard of the Citizens themselves.” To be allowed to practice medicine, they had to provide evidence to the city pertaining to their medical education and practice skills. This act also for the first time provided a time-frame pertaining to just how much training an individual had to engage in to learn medicine—three years:
“[No one] should practice physic or surgery within said city before he shall have both attended the practice of some reputable physician for two years, if a graduate of a college, or for three year if not a graduate, and been examined, admitted, and approved by the Governor, Recorder, or any two of them, taking to their aid three respectable physicians with whom the candidate had not ‘lived to acquire medical information.'”
The penalty for not abiding by the rules stated in this Act included a fine of seven pounds for practicing “without a testimonial of qualification”. In addition, this person found to be practicing illegally could not recover these rights to practice by any legal process. Since this act was not retroactive, its provisions were not applicable to practitioners coming from other States, or those already with a degree of Doctor of Medicine from an American college or university. For those who did not immediately qualify for exemptions, and were accused of being in violation of the act, could still uncover ways to avoid the consequences of the act and continue practicing due to the leniency clause that required they be put on probation, and/or be called before the mayor and recorder if they required a much faster manner of obtaining their licensure.
This first passage of an Act to control and define the requirements for the practice of medicine had a major impact on the development of the training of physicians for the next couple of years. By 1796, it led to the initiation of attempts to produce a state-wide Act concerning the practice of medicine in New York. This statewide Act would be the first to impact how physicians were defined from that point on in Dutchess County history.
Brian Altonen, MPH, MS 