Frequently there is more Danger from the Physician, than from the Distemper … but sometimes notwithstanding the Male Practice, Nature gets the better of the Doctor, and the Patient recovers.20
Healing as a Commodity
The dangers of the “Male Practice” lay not so much in the gender of its practitioners as in the economics of their situation. The early American regular doctors were not, in most cases, men of wealth and status like the British physicians they took as models. Their survival depended on their ability to convince large numbers of people that healing was a commodity—and that it was well worth paying for. This required that the act of healing become, first of all, tangible and discrete—so you could see what it was you were paying for—and, second of all, quantifiable, so you could be convinced to pay various amounts of money for various “amounts” of healing.
Herein lies a contradiction that haunts regular medicine to this day: healing is not something that can easily be bent into such a form. The medical care which we all recognize without question as a commodity today—something produced by an “industry,” bargained for by unions, and paid for by “consumers” (often, with the same credit cards that buy airplane tickets, restaurant meals, and shoes)—is a far cry from the more ancient and holistic notion of healing. Healing cannot be made discrete and tangible; it involves too many little kindnesses, encouragements, and stored-up data about the patients’ fears and strengths (all the things trivialized today as “bedside manner”). It cannot be quantified: the midwife does not count the number of times she wiped the parturient woman’s forehead or squeezed her hand. Above all, it cannot be plucked out—as a thing apart—from the web of human relationships which connect the healer and those she helps.
So the problem faced by the early regular doctors (which we might call the congenital defect of commercial medicine) was not merely to convince people that they had something beneficial to sell, but to convince people that they had some thing at all to sell. John Morgan discovered this in his campaign to bring the British distinction between physicians and druggists to colonial America. He tried to persuade his own clients to pay for his services separately from the drugs he prescribed (it was customary at the time for one bill to cover both). But the patients balked: drugs were one thing, but what were his “services”? Why pay for advice, or for visits from a man who should be concerned about you anyway? Unable to sell himself, Morgan had to be content with selling drugs.
The late-eighteenth-century regular doctors’ solution to this quandary was a system of therapeutics which came to be known as “heroic” medicine—in reference to the drastic measures employed by the doctor (though it might as well have referred to the heroism required of the patients). The point was to produce the strongest possible effect on the patient, of any kind, as if the physician were competing with the disease to see which—the disease or the physician—could produce the most outrageous symptoms. Thus there could be no question but that the doctor was doing something: something visible, tangible, and roughly measurable.
Unfortunately for the health of the young republic, the heroic approach contained an inherent drift toward homicide. Since the point was to prove that the treatment was more powerful than the disease, it followed that the more dangerous a drug or procedure, the more powerful a remedy it was presumed by most doctors to be. For example, blisters (induced by mustard plaster, etc.) were a common treatment for many diseases. In an 1847 paper a physician observed that extensive blistering frequently had a disastrous effect on children, sometimes causing convulsions, gangrene, or even death. He concluded from this that blisters “ought to hold a high rank” in the treatment of diseases of childhood!21
The most common regular remedies were bloodletting and purges which consisted of “cleansing” through vomiting, laxatives, and enemas. Bloodletting, which was still favored by many physicians well into the twentieth century, was used for every possible ailment, including accidental injuries, malaria, puerperal fever, discomfort in pregnancy, and anemia. It was not a matter of a fingerprick. Many physicians in the early nineteenth century bled until the patient fainted or pulse ceased, whichever came first. During the great yellow fever epidemic of 1793, Dr. Rush achieved Transylvanian excesses. According to his biographer:
Toward the end of the epidemic Rush drew from seventy to eighty ounces from a patient in five days, and in some cases much more. Mr. Gribble, a cedar-cooper on Front Street, lost 100 ounces in ten bleedings; Mr. George, a carter, was bled the same quantity in five days; and Mr. Peter Mierken, 114 ounces in five days.22
Historian Rothstein cites the following anecdote:
I remember that a horse kicked me once as Dr. Colby was passing the house. I was not injured much, yet mother called in the doctor, and he at once proceeded to bleed me—I presume on general principles. I had seen my mother bled a great many times. The doctor would always bleed her sitting up in bed, and when she would faint and fall over in the bed he loosened the bandages. The doctor had me sitting upon the bed, and when a small quantity of blood escaped, I shut my eyes and fell over on the bed. I remember he told mother that he never saw any one so speedily affected by bleeding. This was the only time I was ever bled.23
Laxative purges were usually accomplished by the administration of calomel, a mercury salt. Like bloodletting, calomel was considered an all-purpose remedy, something which no conscientious doctor would omit, no matter what the patient’s problem. It was used in large doses for acute problems like fevers and in small daily doses for chronic diseases; it was used for diarrhea, for teething pains—anything. It was, however, poisonous—probably no less poisonous than the arsenic “tonics” then in vogue. Long term use caused the gums, the teeth, and eventually the tongue and entire jaw to erode and fall off. According to Rothstein, physicians knew of these side effects, but they did not let the knowledge inhibit them. During a cholera epidemic in St. Louis, physicians ran around with the calomel loose in their pockets and simply dosed it out by the teaspoonful.24
It is impossible to calculate the harm done by late-eighteenth- and early-nineteenth-century regular doctors. William Cobbett, who witnessed the rise of heroic medicine under Rush’s leadership, described the new therapeutics as “one of those great discoveries which are made from time to time for the depopulation of the earth.”25 But heroic medicine did accomplish something: it gave the regular doctors something to do, something activist, masculine, and imminently more salable than the herbal teas and sympathy served up by rural female healers. Some of the regular doctors achieved considerable wealth and came, like Rush, to hobnob with statesmen and merchants and gentlemen farmers. The patrician dream—that healing would be restricted to the regulars and that their ranks, in turn, would be restricted to “gentlemen”—gleamed bright in the early decades of the new century. Between 1800 and 1820, the organized forces of regular medicine were able to get seventeen states to pass licensing laws restricting the practice of medicine. In most cases local and state regular medical societies were given the power to grant licenses; in ten states the unlicensed practice of medicine was made punishable by fine or imprisonment.26
It was a premature move on the part of the regular doctors. There was no mass support for the idea of medical professionalism, much less for the particular set of healers who claimed it. Furthermore, there was simply no way to enforce the new licensing laws: the ubiquitous lay healers could not be just legislated out of practice. Worse still, for the “regulars,” this early grab for medical monopoly inspired a radical health movement which aimed not only at foreclosing the patrician ideal, but at reclaiming healing from the marketplace.
The Popular Health Movement
Whether out of respect for the regular doctor’s presumed education or for his sex, many thousands of ordinary Americans had had some exposure to regular (heroic) medicine by the early eighteen hundreds. In the thirties, things had gone so far that calomel was said to have replaced butter on the bread of frontier families.27 Some kind of public reac
tion to the hazards—and the pretensions—of regular medicine was inevitable. In the twentieth century, such a reaction would probably have taken the form of consumer organizations lobbying, through familiar channels, for stiffer regulation, “quality control,” etc. But in the early nineteenth century, there were no channels to contain the reaction. Outrage against regular medicine mounted into a mass movement against medical professionalism and expertism in all forms—the “Popular Health Movement.”
Small farmers and shopkeepers, independent artisans, and, in all cases, their hard-working wives provided the constituency for the Popular Health Movement. These were people who had a tradition of self-reliance and independence that went back to the first rock-filled farms in Plymouth Colony. It was to secure this tradition that their fathers and grandfathers had fought in the Revolutionary War. But now, in the early eighteen hundreds the forces of the Market were grinding free citizens down to a condition of dependency and in some cases servitude. In the cities, the factory system was sweeping up skilled artisans and reducing them to the status of mere “wage-slaves.” Meanwhile, depressions and financial manipulations by the banks were proving to small farmers and storekeepers that hard work was no longer a sufficient guarantee against ruin. Everywhere, class divisions were deepening. The urban upper class flaunted the latest fashions from London—as if there had never been a war of independence. The ideals of “liberty, equality, and fraternity” were still in the air, but that air was now polluted with the unfamiliar smells of factory smoke and foreign perfumes.
Out of these changes and upsets came the two movements—the “workingmen’s movement,” composed of small farmers, artisans, and workers in the early factories, and the women’s movement—which converged in the Popular Health Movement of the eighteen thirties. These movements were as American as Davy Crockett or Betsy Ross, respectively, but each was in its own way profoundly subversive. Without any help from Karl Marx (who was only about twelve at the time) the workingmen’s movement came to the conclusion that all their problems stemmed from the capitalist system. Society, in their analysis, was divided into a working class, which produced all real wealth, and the “parasitical” upper class which lived off the labor of others. It was this latter class, the propertied class, which now seemed to control the courts, the legislatures, and other institutions of society; and this, in the minds of these early American radicals, was a violation of the principles of the Declaration of Independence, if nothing else. “What distinguishes the present from every struggle in which the human race has been engaged” declared workingmen’s (and women’s) leader Fanny Wright, “is that the present is, evidently and openly and acknowledgedly, a war of class, and that this war is universal.…”28
It was easy to guess which side doctors would be on in the coming class war. The regular doctors’ claims to educational superiority were particularly irksome to working-class people. Men who worked fourteen-hour days complained that they had no time left over for reading or discussion, and no money to finance their children’s educations. The absence of free public schooling meant that working-class children grew up semiliterate, unprepared for anything but manual labor, while sons of the propertied class enjoyed the kind of classical education which led to gentlemanly professions. Members of the workingmen’s parties sensed the emergence of a European-style aristocracy composed of the big property owners and the “nonproducing thinkers.” With equal fervor, they denounced “King-craft, Priest-craft, Lawyer-craft, and Doctor-craft.”
The women’s movement (and by this we mean something broader than the suffrage movement—suffrage did not become the central issue of feminism until mid-century) came to the problem of medicine from a different direction. With the rise of the Market, women began to find themselves in a monosexual world cut off from that of men, and frequently confined to home and church. Even working women found themselves by and large segregated into an all-women’s world, like that of the early New England mill towns. Left to themselves, activist women of the early nineteenth century drew on each other’s energy and inspiration to organize hundreds of benevolent associations, charitable institutions, and mutual-support groups. This “feverish congregation of women in extra-familiar groups,” as historian Mary Ryan describes it, provided a setting for the later emergence of the suffrage movement and the abolition movement.29
Within the developing female subculture, women inevitably discovered their common aversion to heroic medicine and began to grope for alternatives. Elizabeth Cady Stanton tells in her autobiography, for example, how an early encounter with male medicine reinforced her feminist consciousness. Her four-day-old infant (one of seven children) was found to have a bent collarbone:
The physician, wishing to get a pressure on the shoulder, braced the bandage round the wrist, “leave that,” he said, “ten days, and then it will be all right. Soon after he left I noticed that the child’s hand was blue, showing that the circulation was impeded.30
Stanton removed the bandage and tried a second doctor, who bandaged the infant in a slightly different way. Soon after he left, she noticed that the baby’s fingers had turned purple, so she tore off his bandages and sat down to devise her own method of bandaging the bent collarbone:
At the end of ten days the two sons of Aesculapius appeared and made the examination, and said all was right, whereupon I told them how badly their bandages worked, and what I had done myself. They smiled at each other, and one said, “Well, after all, a mother’s instinct is better than a man’s reason.” “Thank you, gentlemen, there was no instinct about it. I did some hard thinking before I saw how I could get pressure on the shoulder without impeding the circulation, as you did.”… I trusted neither men nor books absolutely after this, either in regard to the heavens above or the earth beneath, but continued to use my “mother’s instinct,” if “reason” is too dignified a term to apply to a woman’s thoughts.…31
From swapping medical horror stories, women’s circles moved on to swapping their own home remedies and from there to seeking more systematic ways to build their knowledge and skills. There were “Ladies’ Physiological Societies,” where women gathered in privacy to learn about female anatomy and functioning—something like the “know-your-body” courses offered by the women’s movement in the nineteen seventies. There were popular lecturers, like Mrs. A. Nicholson, who gave presentations of female hygiene. Masses of women, many of whose husbands were involved in the workingmen’s parties, were drawn into these nascent feminist health activities at a time when the demand for female suffrage had scarcely been raised. At this time in history, according to medical historian Richard Shryock, the health and feminist movements were “indistinguishable.”32
Feminism, class struggle, and the general social ferment of the twenties and thirties all came together in one figure, Fanny Wright. Fanny Wright was an outstanding intellectual leader of the workingmen’s movement; she was also a woman and a feminist. Her revolutionary vision was shockingly radical: not only must the “parasitic classes” be overthrown, but the family must be abolished if human beings were to be liberated. Child raising must be lifted out of the private family and collectivized so that all children would receive the finest education from infancy on. Sex must be freed from the inhibiting clutches of economic and familial dependency to make way for free love. To the establishment newspapers, she was “the Great Red Harlot,” perhaps as much for her unconcealed affair with socialist Robert Owen as for her political ideas. Yet, according to historian Arthur Schlesinger, “Her followers adored her. Hard-handed mechanics and workers crowded the halls when she lectured, and pored over copies of the Free Enquirer [the newspaper she edited] in flickering light late into the evening.”33 Five years before the Grimke sisters flaunted patriarchal rule by speaking out on abolition, Fanny Wright was thrilling audiences with the news of imminent cataclysm:
… The priest trembles for his craft, the rich man for his hoard, the politician for his influence … From the people—ay! from the people, a
rise the hum and stir of awakening intelligence, enquiry and preparation.34
Fanny Wright helped focus the workingmen’s movement on the subject of education and the control of knowledge. The problem, as she saw it, was not just to make education more available but to free it of class prejudice. What Americans now had was “a false system of education, stolen from aristocratic Europe.”35 If the working class was to achieve its goals, it would need to create a new kind of education, in fact, a new culture, of its own—one which was not handed down to the people by the “professional aristocrats.” As an example, Fanny Wright established a people’s “Hall of Science” in the Bowery district of New York which offered, among many other services, public instruction in physiology.36
While Fanny Wright was inciting people to think for themselves, and while mutterings against sex and class injustice were gaining volume in parlors and factories and public places, a poor New Hampshire farmer was piecing together the healing system which would become the main basis of the working-class and feminist alternative to regular medicine. Samuel Thomson had watched his wife suffer and his mother die in the hands of regular doctors. Outraged by the violent effects of regular medicine, he began to reconstruct the folk medicine he had learned as a boy from a female lay healer and midwife named Mrs. Benton:
The whole of her practice was with roots and herbs, applied to the patient, or given in hot drinks, to produce sweating which always answered the purpose … By her attention to the family, and the benefits they received from her skill, we became very much attached to her; and when she used to go out to collect roots and herbs, she would take me with her, and learn me their names, with what they were good for.…37
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