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VOLUNTARY ASSOCIATIONS AND THE RISE OF THE PROFESSIONS

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1VOLUNTARY ASSOCIATIONS AND THE RISE OF THE PROFESSIONS Before the first decades of the eighteenth century, medical practice as a professionalendeavor was unknown in the American colonies. Self-medication, folk and herbalhealing, midwifery by knowledgeable women of the community, be it rural or urban,were the rule. A few places had the advantage of ministers who also practicedmedicine. Fewer still could avail themselves of the handful of practitioners who hadbeen trained in the newly-founded English hospitals (only the French and Italianuniversities taught medicine). The absence of an organized medical profession imposed no great burden on thecolonists before 1700. Accidents and childbirth aside, life in North America wasextraordinarily healthy. Because there was so little communication between ruralsettlements, epidemic diseases, even when they swept the coastal cities, seldom spreadto the countryside. But the rise of the market economy in the colonies after 1700brought with it an alarming deterioration of public health: infant mortality doubledbetween 1670 and 1760; in rural New England, two-thirds of the men born before 1700could expect to live past the age of 60, but less than half of those born after 1700 wouldhave that life expectancy (Hall 1983, 109). In the eighteenth century, colonial towns andcities were devastated by periodic epidemics of smallpox, while increasingly crowdedliving conditions brought with them the often fatal diseases associated with poorsanitation. Even so, disease and increased mortality did not in themselves encourage thedevelopment of organized medicine or public health measures. As the Boston riots ofthe 1720s against efforts to introduce smallpox inoculation suggest, many colonistsclung to a medieval fatalism about death and disease, resisting the perfectionist ideas of2the Enlightenment, which asserted that people could improve their health -- along withtheir social, economic, and political circumstances. The rise of medical profession wouldstem from forces other than the objective need for medical services. Despite the paucity of trained physicians and popular resistance to medicalintervention, the number of individuals claiming to be practitioners of "physick andsurgery" dramatically increased between the beginning and the end of the eighteenthcentury. In Massachusetts, for example, the number of doctors increased more than 30percent every decade between 1700 and 1790, while the general population increasedonly 24 percent over the same interval (Christianson 1980, 54). In Connecticut, thenumber of doctors in practice increased by 400 percent between 1756 and 1790, whilethe general population of the state increased by only 63 percent in the same period. Asa result of these trends, the ratio of physicians to population in Massachusetts wentfrom 1:1000 in 1700 to 1:417 by 1780; in Connecticut, from 1:1452 in 1756 to 1:752 by1790. (In modern America, the ratio of physicians to population is 1:8000!). The stunning increase in the number of physicians over so short a period of time wasdue in large part to the fact that setting up as a doctor required no formal training. Nordid the colonial governments attempt to exert any regulation over individuals whoclaimed to possess medical skills and presumed to practice upon the unsuspectingpublic. As the field became more and more crowded, the physicians responded muchas the "shoomakers of Boston" had more than a century earlier, by petitioning theirlegislatures for permission to incorporate medical societies. The earliest efforts in the colonies to organize medical societies date from the 1730s.Boston physicians evidently formed an unincorporated association in the hope ofexchanging medical information and publishing a journal -- an organization along the3lines of England's Royal Society, but more narrowly devoted to medical concerns.Mention was also made of registering regular medical practitioners throughout theprovince, but no formal requests for such powers were ever made to the GeneralCourt. In 1749, a "Society of Gentlemen" was formed "for the weekly discussion ofMedical subjects." It met periodically and then disappeared. The first formal petition to create a medical society was made by Connecticutphysicians in 1763. While the preamble of the document made pro forma references tothe blessings of health and the hazards of quackery, the core of the proposal was arequest for what amounted to monopoly privileges. The incorporators --andcomparable groups in other counties -- would possess exclusive privileges to examineand license physicians. Their enforcement power would consist of their ability to barnon-certified practitioners from using the courts to recover monies owed for medicalservices. This was no small matter, particularly because payment for any services thathad been rendered to a deceased patient would have to be recovered through legalclaims against his or her estate and approved by the probate court. Besides running up against the colonists' almost inborn suspicion of monopolies, aswell as their doubts about interfering in providential events such as epidemics, thephysicians faced a peculiarly difficult problem in justifying the grant of extraordinaryprivileges to themselves. Few physicians in Connecticut at this time were collegegraduates (not that the colleges' classical and scriptural curricula would have enhancedtheir skills as healers). Virtually all had been trained as apprentices in a system with noagreed upon standards of knowledge or skill. Not surprisingly, the proposal failed togain approval.4Memorial to the General Assembly of the Colony ofConnecticut (1763) To the Honourable General Assembly of the Colony of Connecticut to be Held at New Haven thesecond Thursday of October next -- The Memorial of us the Subscribers Physicians in the said Colony Humbly sheweth Thatwhereas life is the most desirable of all Sublunary Enjoyments and Health so Invaluable aBlessing that without it in some Degree Life is [of] little Worth And that the Promoting ofMedical Knowledge among Physicians is the Necessary and direct means to Restore Health andeven Preserve Life and is of great Importance as it will Render The Practice of Physic more safeand Servicable to the Patient And at the same time yeald more Satisfaction and Honour To theProfession -- And whereas more than one hundred years have already passed away since the Planting [of]this Colony and Nothing has


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