What did it mean to be a “trained doctor” in the 18th century?

At the end of the 18th century, there were perhaps 4,000 people in America who called themselves doctors, 400 of them with formal training and 200 with actual medical degrees. In rural areas, most people acted as their own doctors, with the help of popular self-help books designed to make basic medical knowledge available to the ordinary person. The term “quack,” applied to a self-trained healer, was not considered insulting.

Southern Folk Medicine,1750-1820, by Kay K. Moss, provides a fascinating overview of the varieties of medical treatments in that era, and of the varieties of people who provided them. All of them trained or untrained, shared the same understanding of the human body: the ancient theory of humors, developed by Hippocrates in the 4th century BC. Illness was believed to arise from an imbalance in the body’s four humors, or fluids—blood, phlegm, yellow bile, and black bile—and was treated both by diet and by “heroic” methods aimed at depleting one or more of these humors. Bleeding, purging, vomiting, sweating, enemas, and the application of blistering plasters were the means to this end, and were applied singly or more often in combination to nearly every complaint from sore throat to cancer. Bleeding was also thought of as a general health measure, and was regularly performed on healthy people. A lancet or “fleam” for bloodletting, for use on livestock as well as on human patients, was part of the medical equipment of every household.

Backcountry healers also drew on a long list of folk medicines, collecting “receipts” (recipes) from books, neighbors, Native Americans, and slaves. William Lenoir of North Carolina reported that “Colo. Koons says a woman on New River had been a long time helpless with the Rheumatism, and was advised to have fat Lightwood knobs [pieces of resinous pine typically used for kindling] split up fine & boiled in a pint of new milk till it came to half a pint and drink as much of it as her Stomac would bear & by the Experiment she got entirely well in a short time. (NB Suppose the same to be good for a horse.)” Some popular ingredients would make a modern reader blanch: animal and human dung were used in a number of recipes, including medicines for hernias and cataracts. Others, however, have since been shown to have genuine medicinal properties, particularly as antibiotics and anti-inflammatories, and are still in use in modern herbal medicine.

What difference would it have made to the patients of Dr. Elijah Bettis Jr., a backwoods farmer with at most two or three years of medical apprenticeship, if he was or was not a “trained medical doctor?” Quite possibly, none at all. But he may have had a store of opium and “Peruvian bark” (the bark of the chinchona tree, the primary source of quinine,) the miracle drugs of the 18th century. And with luck, he may have been exposed to a little of the new medical knowledge of that century: an understanding of the importance of hygiene, of the importance of vegetables in the diet, of the value of smallpox inoculation, and, most important, of effective surgical methods based on a close study of anatomy. Simple as these ideas may seem to us, they were an important first step toward the modern world.

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