The “Angelical Conjunction” Revisited: Another Look at the Preacher‐Physician in Colonial America and the Throat Distemper Epidemic of 1735‐1740

Much has been written on the development of the medical profession in America. By most accounts one significant event in that development, in its pitting colonial lay practitioners against preacher-physicians, was Boston's smallpox inoculation controversy of 1721. Some historians of the event have highlighted what they see as the Reverend Cotton Mather's courageous advocacy of inoculation in the face of the strong disapproval of William Douglass and the "hidebound forces of traditionalism" (Schmotter 23).(1) Others have argued that it provided a venue in which physicians could portray the proponents of inoculation, preacher-physicians, as inept and as having as their primary motive the desire to maintain control over the life of the community (e.g., Blake 69-70; Hawke, "Douglass's Summary" 50-54)(2) This article does not quarrel with either interpretation. Moreover, it assumes the narrative that flows from both, namely, that during the first half of the eighteenth century, the preacher-physician that had dominated medical practice during the previous century gave way to the increasingly professional lay practitioner. Where it differs is in its suggestion that any conclusion drawn from an assessment of the smallpox inoculation controversy, alone, may be misleading if not measured against events surrounding the throat distemper epidemic. That is to say, historical accounts of the inoculation controversy, in focusing on the acrimony between preacher-physicians and lay physicians and in their silence on the following event, imply that the two groups were never reconciled and that the former never again played a major role in medical affairs. A closer look at the throat distemper epidemic suggests something quite different, namely that by 1735 relations between preacher-physicians and lay physicians were, once again, harmonious and that preacher-physicians, though diminished in number and in proportionate representation within the profession, continued to play a leading and highly respected role in medical care. A few European-trained physicians accompanied the first settlers to British North America. The Virginia Company, for example, paid Lawrence Bohun to care for the Jamestown planters, but others came of their own accord, seeking a better life (Duffy, The Healers 19). Once the hardships of colonial planting became as obvious as the absence of prospects for professional prosperity, however, trained practitioners stopped coming. In the absence of such professional migration, those in the colonies with any medical knowledge, though usually acquired in a less formal manner, stepped forward to fill the breach (Hawke, Everyday Life 85; Shryock 9-10). Two points need to be made to keep this apparently negative assessment in context. First, European university training in the seventeenth century did not necessarily produce a more competent medical practitioner than those prepared in the colonies. The doctor of medicine degree at Oxford, for example, might have taken 14 years of university-level attendance, but it required no more than a knowledge of ancient authors, especially Galen. Lectures in "physic," anatomy, botany, and chemistry were perfunctory, and there was no practical instruction (Stevens 16; Duffy, The Healers 17). As the English physician, Thomas Sydenham, put it, one might as well send a person to Oxford to learn shoe making as to become a medical practitioner (King 24-27).(3) Second, though they were differently trained, by the end of the colonial period the ratio of medical practitioners to population in the colonies was not far out of line with that of Great Britain. The ratio in the colonies has been estimated at 1 to 600, as a whole, 1 to 350 in New York City, and 1 to 135 in Williamsburg, Virginia. In England, estimates range from 1 to 400 in London to 1 to 250 in the provinces (Hawke, Everyday Life 73-74; Stevens 14; Shryock 13; Watson 2). In sum, medical care in Colonial America was as good as it was in England. …