Making Doctors: Schools, Science, and Remedies

Episode Narrative

In the heart of the 18th century, a transformative shift was underway in North America. The world was awakening to new possibilities, even as the colonies remained deeply rooted in traditions that defined their daily lives. Medicine, a field vital to the survival and well-being of the communities, began a significant evolution. The year was 1765, and in Philadelphia, the winds of change blew strong as the first medical school in North America was founded. Known as the College of Philadelphia, this institution marked a monumental departure from the apprenticeship-based training that had long dominated medical education. For the first time, structured and formalized instruction would beckon to those aspiring to wear the mantle of physician.

This era was not just about classrooms filled with eager students; it was the dawn of an institutional landscape that would redefine medicine itself across the colonies. In 1767, King’s College, now recognized as Columbia University, fortified this emerging educational framework by establishing the second medical school on the continent. The realization that medical knowledge could be taught and standardized began to take root in a land still often dependent on its homegrown remedies and folk practices.

During this period, between 1700 and 1820, a burgeoning curiosity began to manifest in the realm of medical publications. The first American medical texts emerged, including a notable pharmacopeia and illustrations that revealed the inner workings of the human body. Each publication represented not just a step toward professionalization but a commitment to the betterment of health through knowledge and instruction. The enthusiasm for learning about medicine spread like a wildfire, igniting discussions among practitioners and scholars alike.

Yet, the world of medicine at this time was steeped in complexity. Prominent naturalists like John Bartram and Pehr Kalm ventured into the wilderness, conducting botanical surveys that documented both indigenous and European medicinal plants. Their work facilitated a valuable exchange of knowledge across the Atlantic, as they searched for cures rooted in the land and cultural practices. These explorations served as a bridge, connecting old world traditions with the new insights emerging in the colonies.

Despite this progress, medical practices in the colonies remained heavily influenced by venerable European traditions, particularly the humoral theory that framed bodily health in terms of balance and imbalance. The scientific discoveries unfolding in Europe echoed in North America, yet the stubborn adherence to ancient ideas lingered, casting a shadow over the promising developments of the time. Healing often occurred at home, led primarily by women. Remedies passed down through generations or pulled from domestic manuals provided the backbone of care for many families. The medical landscape was diverse, though professional physicians were scarce, particularly outside bustling towns.

In the year of 1764, another innovation emerged. Colonial practitioners began to employ the practice of “cooling,” a method intended to treat fevers by curtailing body temperature through cold baths or applications. This approach was seen as an American innovation, testifying to the unique medical identity forming within the colonies. As families navigated life and health challenges, their reliance on creativity and adaptation became essential features of their medical practice.

Although smallpox inoculation had been introduced from Africa and gained popularity in Boston during the early 1720s, it remained a topic of contention. Cotton Mather and Zabdiel Boylston were at the forefront of this movement, advocating for a process that was met with skepticism. As the century unfolded, the acceptance of this practice gradually grew, signaling a shift in attitudes towards new medical techniques, even amid fervent debates.

Throughout the late 1700s, the founding of hospitals represented another crucial step in the evolution of American healthcare. Urban centers like Philadelphia and New York began establishing their first hospitals. However, these institutions primarily served the poor and indignant, rather than acting as epicenters of medical innovation. It was a time marked by a mixed environment where trained physicians, self-taught practitioners, and quacks coexisted, often blurring the lines of legitimacy in medical practice.

During this colonial period, the absence of stringent medical licensing led to significant variability in practice. The first American medical societies emerged in 1766 with the formation of the New Jersey Medical Society, aimed at promoting professional standards and facilitating knowledge-sharing. Yet, their influence remained limited. Publications began appearing, but their reach was modest compared to their European counterparts. American journals would circulate, adding their voices to a growing discourse while grappling with the challenges of establishing credibility amidst a landscape of formidable tradition.

As practitioners sought to refine their craft, they often looked to local plants for remedies. Indigenous healing practices, employing plants like tobacco, sassafras, and ginseng, found their way into colonial medicine, creating a rich tapestry of healing rooted in both European and Native American traditions. The transatlantic trade of medicinal plants — including cinchona, used for malaria, and ipecac, used for dysentery — linked North America to global medical markets, further illustrating the intricate web of knowledge that was taking hold in this burgeoning nation.

Yet, the colonial health landscape was a paradox. Mortality statistics began to be collected in several cities, shedding light on the causes of death and the public health challenges that plagued early American society. However, record-keeping remained inconsistent, limiting the ability to draw comprehensive conclusions about health trends. The early attempts to regulate medical practice emerged as colonies sought to bring order to this chaotic realm, requiring practitioners to file diplomas with local authorities, but the enforcement was often lax, leaving the door open for a wide array of practices to continue unabated.

Among those at the heart of community health during this time were midwives, like the notable Martha Ballard. Active in the late 1700s, she played a crucial role in childbirth and women’s health, often chronicling her experiences in detailed diaries. These rare documents provide invaluable insights into domestic medical practice, as well as the realities of life for women during this turbulent time. The work of midwives showcased not only the importance of women in the medical sphere but also the blending of traditional practices with emerging new ideas.

As the late 1700s unfolded, the establishment of the first American pharmacopeia signified a turning point in standardizing medical practices and preparations for common remedies. This publication reflected the growing professionalization of pharmacy, echoing the desire for consistency amid the diverse practices that permeated society. The scattered medical libraries of the time, mostly private collections of physicians, spoke to the yearning for knowledge and a deeper understanding even as they limited access for many. The Countway Library, a significant medical library, would not arise until the 19th century, showing how much reliance still remained on personal collections and informal networks.

Throughout the 1700s, the lack of formal medical education created a landscape where medical practice could differ widely from one community to another. Some practitioners eagerly embraced the new scientific ideas flowing from Europe, while others remained tethered to traditional or superstitious remedies. This divergence underscored the transitional nature of American medicine, caught between the old world and a burgeoning new identity.

By the dawn of the 19th century, the fabric of medical practice in North America was enriched yet fraught with the complexities of its formative years. As America stood on the precipice of immense change, the medical field mirrored society's broader transformations. The advent of institutional medical education heralded a new age, one in which knowledge would slowly but surely replace ignorance and superstition. The biographical sketches of early American physicians reveal not only their struggles and triumphs but also the rich and sometimes tumultuous backdrop against which they worked.

America was increasingly looking towards its future. The foundational developments of the period — establishing medical schools, publishing vital texts, and fostering both local and international knowledge exchanges — laid the groundwork for a more structured approach to medicine. The first hospitals emerged to address pressing community needs, forging a connection to the broader urban landscape while highlighting the complexity of healthcare access during this time.

Reflections on this era invite us to consider the legacy of these early pioneers in medicine. What they achieved against the odds echoes throughout the centuries. Medicine, now a well-structured profession, stands as both an art and a science, carefully informed and grounded in history. Their journey reminds us of the importance of knowledge, adaptability, and community. It challenges us to question: how far have we truly come?

As we move through time, the roots established in those formative years continue to intertwine with our present. In the heart of every hospital and medical school today, one can feel the pulse of this rich history. Still, we stand before a horizon filled with questions and challenges, learning from the past as we navigate the present. The journey from home remedies and apprenticeship learned at the feet of older physicians to institutional education and the evolution of medical standards remains a powerful testament to human resilience, curiosity, and the desire to heal.

What stories will future generations tell about our own era? As we ponder this, we embrace the complexity of medicine, recognizing not just the triumphs but also the ongoing struggles for access, understanding, and improvement. The echoes of history remind us that every step — every treatment pursued, every degree earned — contributes to a collective narrative of growth, learning, and care that spans centuries and shapes the very essence of what it means to practice medicine.