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Purging, emetics and bloodletting were common remedies; surgery consisted of "cutting for stone" and amputations. With no anaesthesia, the best surgeons were the ones who could cut, hack and saw most rapidly, aided by the strongest assistants to hold the patient down. Herbs and plants were extensively used in treatment. Governor John Winthrop of Massachusetts Bay prescribed a paste of wood lice, while Cotton Mather—who together with Zabdiel Boylston brought inoculation to the colonies in 1721 to prevent serious cases of smallpox—condemned the use by Boston physicians of "Leaden Bullets," to be swallowed for "that miserable Distemper which they called the Twisting of the Guts." By the early 18th century, there were only two drugs known to be specific: cinchona bark for malaria, and mercury as an antisyphilitic agent. Dr. Benjamin Rush of Philadelphia (one of four physicians to sign the Declaration of Independence) used bloodletting so extensively that even his colleagues marveled at the survival of his patients. Thomas Jefferson said in 1807, "The patient ... sometimes gets well in spite of the medicine."
The apprentice system of medical education held sway.
The apprentice might pay the master £100 annually for as long as seven years until he "qualified" to practice on his own. By the mid-18th century, more formal training began to take hold. In 1765, after a tour of medical centers in London, Paris, Padua and Edinburgh, John Morgan persuaded the College of Philadelphia to set up the first American medical school. The prototype of the British voluntary hospital was established with the founding of the Pennsylvania Hospital in 1751, the New York in 1771 and the Massachusetts General in 1811, moving the care of the sick poor and the teaching of medical students out of the almshouses. With the founding of the first mental hospital, the Virginia "insane asylum" at Williamsburg, shortly before the Revolution, the mentally ill began to be moved from jails and almshouses to state-sponsored, more humane institutions. Early on, the great cost of mental illness precluded voluntary efforts to cope for people of ordinary means.
The institutionalization of a loosely organized profession grew with the founding of state medical societies, teaching hospitals and medical schools. Largely because of the devastation caused by infectious diseases, local communities were forced to form boards of health, which established quarantine measures and tried to provide for sanitary engineering. Infectious disease was thought to be the result of noxious vapors emanating from decaying animal and vegetable matter. Therefore, in addition to isolating feverish individuals, much of the health boards' time was spent attempting to improve sewage and garbage disposal.