JOHN H. KNOWLES, M.D.
The following Bicentennial Essay is the eighth in a series that has been appearing periodically, surveying how we have changed in our 200 years.
On the eve of the Revolution, there were 2.5 million people in colonial America. Virginian William Byrd wrote, "It was a Place free from those three great Scourges of Mankind —Priests, Lawyers, and Physicians." Divine aid was considered more important than that of the physician. Only through God's grace could one escape disease or survive its attack. In The Angel of Bethesda, the first general treatise on medicine written in the colonies, Cotton Mather advised in 1724, "Lett us look upon Sin as the Cause of sickness."
Average life expectancy at birth was 34.5 years for men and 36.5 years for women. Fifty percent of deaths occurred in those under ten years of age. Infectious diseases decimated the population. Smallpox and yellow fever were most feared. Tuberculosis, cholera and dysentery, typhoid, diphtheria, measles and mumps were ever present. Malaria was as common in New England as on the Southern plantations. In 1721, almost half the population of Boston caught smallpox, and more than 7% died. Yellow fever wiped out 10% of the population of Philadelphia in 1793.
Scurvy, scrofula and scabies were common among the poor. Bathing was rare: one Quaker lady noted in her diary in 1799 that she withstood a shower bath "better than I expected, not having been wett all over at once, for 28 years past." Body lice were omnipresent, as was the disease they carried—typhus fever. Frequent births and poor obstetrics accounted for the high mortality in mothers; the death rate among black women served by midwives was lower than among whites served by physicians. Mental illness was seen as the work of the devil: the village idiot was either derided or tolerated, while the more violent were shackled and jailed.
There were 3,500 medical practitioners in the colonies when the Revolution began, of whom fewer than 200 held degrees from medical schools. One writer noted that "with a few, honorable exceptions in each city, the practitioners were ignorant, degraded and contemptible." Quacks abounded. In the North, ministers and magistrates doubled as physicians, while in the South, planters and their wives cared for the slaves. Some of these individuals brought status to the profession. The people viewed the medical profession in general, however, with a mixture of fear, comtempt and amiable tolerance. There simply was little that doctors could offer, and their cures were sometimes worse than the diseases that afflicted people.