Making 'Medical Hall': Dr. John Archer, medical practice, and apprenticeship in early America, 1769-1820.

摘要

In "Making Medical Hall," I examine the shape and texture of late eighteenth century American medical practice. The primary aim of my dissertation is to provide a study of medical work, examining how patients, local context, and social networks shaped the medical education and practices of Dr. John Archer of Harford County, Md., his sons, Thomas, Robert Harris, John Jr., James, George Washington, and his 45 students. Archer trained his students at his home "Medical Hall," and taught medical practice through a mixture of intensive reading in standard medical works, study of medical theories and practices Archer had learned in Philadelphia as a student at the College of Medicine, and hands-on experience with the many patients he served in the county. The medical careers of Archer's apprentices are illustrative of the opportunities and pitfalls that faced doctors as they struggled to find a medical living, and the ways in which local context and social networks contributed towards becoming a successful medical practitioner at the end of the eighteenth-century.My study offers a counterpoint to the scholarly work which focused on the growth of a medical "profession" in the nineteenth-century, casting for the roots of the profession in the perceived darkness of the seventeenth- and eighteenth-century medicine. This scholarship has neglected the rich dynamics of daily practice, the local contexts within which medical practices were situated, the multitude of practitioners other than doctors available for care, and the economic structures of medical practice. Because of the dominance of the professionalization narrative, historians have also neglected the primary form of medical education in the seventeenth- and eighteenth-centuries, the apprenticeship. Instead, we have origin stories about the first medical schools, which trained only a handful of practitioners in this period, because scholars believed that the roots of the profession could only be found in formal institutions of education. Apprenticeship structured how medical practitioners understood disease and illness, therapeutics, and patients, all within a context that was not directed towards professionalization, but to making a medical living.This dissertation has four substantive chapters and an introduction and conclusion. Through an analysis of numerous case histories and medical ledgers from the Archer family, I tell a layered story of medical work, including how this family of doctors practiced, how John Archer taught his students on the bodies of his patients, how knowledge was generated in rural Harford County, how medical practice fit into the larger economy, and how his students created and used social networks in their pursuit of medical practices.