in the exhibit

The Book in the Sickroom: A Tradition of Print and Practice By Charles E. Rosenberg

(all the notes in this essay are anchored - simply click the number to read the note and then click 'return' to resume reading.)

When I walk into my local mega-bookstore, I am always struck by the diversely abundant section called health. It includes advice on every aspect of the human condition from diet to incontinence - with titles devoted to an impressive variety of diseases, from depression to breast cancer, from eating disorders to lower back pain. Separate areas are organized around sexuality and addiction. In a medical era dominated by intensive specialization and complex technical procedures, this proliferation of do-it-yourself health books might seem a perverse novelty.

But it is far from that. Books and pamphlets aimed at helping men and women manage their bodies in health and disease have long been a marketable commodity. Since the beginnings of printing, readers have used the printed page to guide themselves in the preservation of physical and emotional health and in the management of their ills. The practice of popular medicine is an ancient, culturally central, and still vital reality - one that bears a complex and shifting relationship to the formal medicine of its generation. Many of us will, for example, have had our own lives touched by books as familiar as "Dr. Spock" or Our Bodies Ourselves.¹ Of the making of such books there is no foreseeable end.

A Golden Age of Popular Medicine

Nevertheless, America's late-colonial and antebellum years constitute a kind of golden age for such guides. It was a period when formally trained physicians could not begin to treat all the ills and anxieties Americans experienced - and when a great many were too poor or geographically isolated to routinely employ a trained physician. In these decades it was still assumed - as it had been since antiquity - that the bulk of medical practice would remain in uncredentialed hands. And it was assumed as well that those hands would often be guided by advice from a printed page.

The American history of such self-improving works begins with colonization itself. And it might be said to have arrived at a novel stage in the Civil War era of cheaper paper, printing, and binding, and with the related development of increasingly national markets. One of the characteristic aspects of popular medicine in this earlier period was the original dominance of British ideas and texts, a dominance displaced in the first third of the nineteenth century by the growing prominence and diversity of American authors and the elaboration of reader-specific genres - books crafted for particular segments of a literate yet economically and socially diverse market: inexpensive pamphlets simply listing remedies, longer more discursive guides to regimen and therapeutics, almanacs and other advertising designed to sell particular products, manuals crafted for women and focused on midwifery and children, and books aimed at understanding and managing the emotions, including a novel subgenre of books addressed in the 1840s, 50s, and 60s to the sexual needs and anxieties of a growing middle class. And the authors were as varied as their literary products; although the majority were written by male physicians, some were compiled by women, others by sectarian opponents of regular medicine.

Boundaries between lay and professional medical knowledge, social responsibilities, and authority remained indistinct. Throughout this period, for example, preventing illness was valued as much as skill in its treatment; every aspect of life could-it was hoped-be organized so as to minimize the risk of sickness. One need not be a doctor to manage diet, the emotions, sleep, or exercise, and prevailing medical ideas about the causation and treatment of disease could in their essence be understood by educated men or women. Nor did physicians have the benefit of the diagnostic aids that have become routine in the twentieth century; even the thermometer did not become an everyday part of medical practice until the last quarter of the nineteenth century. An experienced mother or grandmother could judge a fever or inspect a whitened tongue or bloodshot eye as well as any physician. Therapy too was relatively straightforward (if by late-twentieth-century standards far from efficacious). Most medical therapeutics consisted of administering drugs of one sort or another - while the bulk of what was termed surgery consisted of managing lesions on the body's surface. Laypersons in early national America would not ordinarily have attempted to undertake an operation to remove a bladder stone or to reduce a dislocated joint - but most practitioners would also have hesitated to undertake such demanding procedures. And many laypeople had some understanding of medical remedies as well - which were universally accessible to anyone who could gather herbs or pay the pharmacist or shopkeeper (for the selling of drugs was by no means limited to pharmacists). There were no restrictions on the purchase of opium and its derivatives, for example, or on the variety of routinely used cathartics and emetics based on highly-toxic mercury, arsenic, and antimony compounds. The vast majority of medical care was provided in the home - and was performed by individuals who did not think of themselves as physicians. The skills, knowledge, and responsibilities of laypersons and physicians overlapped; in some sense credentialed physicians were always consultants - with the primary caregiver a family member, neighbor, or midwife. ²

Families called upon a well understood repertoire of recipes and knowledge, much of it incorporating and preserving a centuries-old tradition of - often botanic - information.³ Much of this lore was passed on in the form of oral tradition or carefully preserved books of manuscript "receipts" - formulas for everything from curing rheumatism to tanning leather and making soap.

in the exhibit

But the colonists of North America brought books with them as well. The most important and widely read guides to health, regimen, and childrearing were transported like every other European cultural artifact across the Atlantic and soon reprinted in North America. The titles of some often-reprinted books tell us much about their content and their readers' motives: Luigi Cornaro's Discourses on a Sober and Temperate Life, John Armstrong's The Art of Preserving Health, George Cheyne's Essay on Health and Long Life, S. A. Tissot's Advice to the People in General, with regard to their Health, and Nicholas Culpeper's English Physician; and Complete Herbal.

These widely-owned texts displayed an extraordinary cultural tenacity. Nicholas Culpeper's works on botanic (and astrological) medicine were, for example, reprinted scores of times after their original compilation in seventeenth-century England; American editions of the 1820s still retained the author's astrological orientation.⁴ William Buchan's Domestic Medicine, first printed in 1769 in Edinburgh, went through scores of American editions and - though perhaps not as omnipresent as the Bible - was to be found everywhere in American homes before the Civil War.⁵ John Wesley's Primitive Physick, a compilation of recipes - many of them tested by the founder of Methodism himself - also circulated widely in both England and North America after its original English publication in 1747.⁶ It was reprinted as early as 1764 in Philadelphia. Aristotle's Masterpiece - an extraordinary seventeenth-century gathering of words and woodcuts relating to birth and generation - was also widely if often surreptitiously circulated in the colonies and new nation.⁷ Continuity with older healing traditions was clear and pervasive - as exemplified concretely in the preservation and survival of these omnipresent texts.

Moreover, many of the titles aimed at the domestic practitioner were not simply books to read and contemplate, but tools for everyday practice just as similar guides to legal procedure with their model forms for conveying land or writing wills were used to avoid the costs and inconvenience of consulting a trained lawyer.⁸ There was an undeniable market for such handbooks; and at least as early as 1734, a Tidewater physician published Every Man his own Doctor: Or, the Poor Planter's Physician, the first such American guide to domestic practice. Its rambling subtitle tells us a great deal about the author, John Tennent's, assumptions and intended market: Prescribing Plain and Easy Means for Persons to cure themselves of all, or most of the Distempers, incident to this Climate, and with very little Charge, the Medicines being chiefly of the Growth and Production of this Country.⁹

American Guides to Healing

Throughout the first century of American independence the writing and compiling, the publishing, and the use of books in domestic practice increased steadily - reflecting as it did technical, economic, and cultural change. Cheaper paper, transportation, binding, and printing meant larger and more accessible books, while subscription sales and national distribution meant a new kind of mass market in printed consumables. Books were also more likely to be illustrated by mid-nineteenth century; both physicians and drug manufacturers used illustrated books, broadsides, and advertising to promote their goods and services. These new technical and market realities were reflected not only in the expansion of such traditional genres as guides to regimen, collections of recipes, and manuals of midwifery - but also in the creation of new kinds of texts, one genre, for example, devoted to relatively candid discussions of sex and marriage, birth control and the "secret vice," another concerned with management of the mind and emotions. These books and pamphlets seem in retrospect to have been aimed at an expanding and increasingly urban middle-class, at men and women concerned with defining their social identity through an appropriate style of life.¹⁰

Most striking perhaps is the proliferation of general guides to health and healing - the majority modeled in some general or specific way on Buchan's Domestic Medicine. Buchan itself was reprinted in a variety of competing formats, with an assortment of accompanying texts.¹¹ Later editions included - variously - sections on hernia, electricity, vaccination, rescue from drowning, diet for the poor, and cold bathing. Even more significant was the development in the early nineteenth century of a crop of home grown guides to health and medical care. James Ewell's Planter's and Mariner's Medical Companion, which appeared in Philadelphia in 1807 and then frequently reprinted, was one of the earliest and most successful of such family manuals. In the middle third of the century, however, John Gunn's Domestic Medicine, or Poor Man's Friend displaced Ewell and Buchan as America's most popular general health guide. This more assertively indigenous text appeared in Knoxville in 1830, representing an energetic mix of mainstream medical teachings and frontier resourcefulness; its widespread sales imply Gunn's success in having gauged the needs and assumptions of his Western and Southern readers. Within a decade his Poor Man's Friend had been reprinted more than a dozen times in a variety of small towns and cities; and by 1860 it had evolved into a ponderous, ostentatiously-bound subscription book.¹² The salesmen who hawked such products were well aware that they faced a highly competitive marketplace; Gunn was only one among scores of authors whose books promised to bypass or supplement the physician's costly and possibly deleterious prescriptions.

in the exhibit

This remained a period in which the medical profession's control of practice was far from absolute. In antebellum America, a number of thriving medical sects disputed the intellectual legitimacy and social authority of the regular profession: many Americans were advocates of the Thomsonian (Botanic), Eclectic, Homeopathic, or Hydropathic systems of medicine. A proliferation of specialized texts articulating their characteristic doctrines accompanied the growth of these sects; all, not surprisingly, produced their own guides to domestic practice. Samuel Thomson, founder of an eponymous botanic medical sect, wrote one such as early as 1822, a New Guide to Health, which appeared in many subsequent editions and inspired scores of competitors over the next quarter-century. All claimed to provide cure through the use of herbal remedies and the avoidance of regular medicine's mainstays of bleeding and "unnatural" mineral drugs.¹³ Such botanic books and pamphlets proliferated until the 1860s; although not all claimed to be acolytes of Thomson's particular system all appealed to a well-established practice of botanic healing.

in the exhibit

in the exhibit

This tradition had been widely disseminated in colonial America - as it was in England and on the Continent. In more formal and costly guise, nineteenth-century herbals maintained a continuity with an older healing and natural history tradition, while at what might be termed the vernacular level, cheaply-printed pamphlets provided lists of remedies and their "indications." There were many competitors for this "low budget" niche as the new century advanced; the most widely reprinted - and presumably used - was John Williams' so-called Last Legacy to the People of the United States, or the Useful Family Herb Bill, published first in 1811 and reprinted dozens of times by mid-century.¹⁴ Americans with more pretensions - and dollars - could purchase full-length herbals "embellished" with cuts of medicinally useful plants. As early as 1801, the polymath Samuel Stearns compiled and published the first such domestically-oriented American manual: The American Herbal, or Materia Medica.¹⁵ In 1814 a New York competitor offered to subscribers A New and Complete Medical Family Herbal with plates available either hand colored or in black and white.¹⁶ By the 1830s, Americans could select among a variety of herbals, ranging from C. S. Rafinesque's Medical Flora of the United States¹⁷ to Wooster Beach's American Practice of Medicine, a generously illustrated three-volume guide to practice "on botanic principles."¹⁸

Homeopathic and hydropathic guides to preserving health began to appear in the 1830s and 40s and flourished through the antebellum years. Both systems assumed an oppositional role in defining their claims vis-…-vis regular medicine - with advocates of homeopathy and hydropathy emphasizing the unnatural and physiologically debilitating aspects of regular medical practice. Logically enough, devotees of such sectarian practice were often also committed to radical health-enhancing diets and modes of life - a style of physiological reform that paralleled and in part constituted a more general reform impulse in the antebellum North. This is the period, for example, in which Sylvester Graham wrote and published widely on diet and sexual reform as well as health and medical practice; we still eat Graham crackers, a vestige of Graham's comprehensive program of lifestyle management and control.¹⁹ It is not hard to elaborate parallels and interactions between the secular perfectionism of such health reformers and similar efforts in more traditionally visible areas of reforms such as abolition, temperance, and women's rights. Many of the women who attended the Seneca Falls women's rights convention in 1848 would, for example, have been familiar with Graham's works and hydropathic medicine, even if they were not themselves thoroughgoing converts.

From Marriage Bed to Cradle

Not surprisingly, the 1840s and 50s saw the publication of a flourishing subgenre of books and pamphlets aimed at women and at relations between the sexes. Ranging from the earnest and ingenuously didactic to the sly and marginally transgressive, such books promised a scientific understanding of the "physiology of generation" specifically and relations between the sexes generally.²⁰ Contraception was often a key theme in such books, clearly reflecting anxieties about the relationship between proliferation of children and the ability to maintain a reassuringly respectable style of family life in America's new urban settings.²¹ More conventional were the widely-available guides to women's diseases and health, to childbirth and infant management.

in the exhibit

Such guides had been popular in North America since at least the eighteenth century. Alexander Hamilton's Treatise on Management of Female Complaints, and of Children in Early Infancy was, for example, widely circulated and his work soon reprinted by competing American publishers.²² Hugh Smith's Letters to Married Women, on Nursing and the Management of Children, William Cadogan's An Essay upon Nursing, and the Management of Children, Michael Underwood's Treatise on the Diseases of Children, and William Buchan's Advice to Mothers had similar publishing histories in this period; popular English texts, they were soon reprinted by energetic and ambitious American booksellers.²³

By the first decade of the nineteenth century, Americans had begun to produce their own guides to child management.²⁴ As early as 1811 the first such text written by an American woman appeared; entitled The Maternal Physician, it is recognizable to modern eyes as a prototypical childrearing guide.²⁵ It has had scores of nineteenth- and twentieth-century successors; Benjamin Spock's best-selling Common Sense Book of Baby and Child Care was atypical largely in its extraordinary level of success.

in the exhibit

In antebellum America, however, such books often served as manuals of domestic midwifery, a function now ordinarily severed from that of infant care. Today babies may be raised at home, but they are almost always born in hospitals. We no longer assume that the average household should be prepared to take responsibility for managing childbirth and the mother's aftercare. In the first half of the nineteenth century, however, midwives and general practitioners (sometimes in fact working together) attended respectable women in their homes; only the urban, the "abandoned," and the poverty stricken would have contemplated a hospital delivery for their child. Alert authors and publishers were quick to provide printed aids for this recurrent domestic reality.²⁶

Restoring and Preserving Health

Families were, similarly, expected to provide medical care in every sort of ailment from acute fevers to chronic ills such as cancer, tuberculosis, and "dropsy." Again, booksellers were quick to provide advice in ordering the sickroom.²⁷

The home was important in maintaining health as well as treating disease. In generations unaware of the germ theory and of the nature and causation of disease generally, the maintenance of health was seen in aggregate - non-specific - terms. Every aspect of life demanded scrutiny and control. Diet, exercise, air quality, and sleep all could over time bring about sickness or preserve health. Books that examined life from this perspective had been written and circulated since the Renaissance; revised, reconsidered, and recycled versions of such conventional admonitions were widely read in the late eighteenth and early nineteenth century.²⁸ Formal treatises on regimen were explicitly and implicitly aimed at the "middling and affluent"; working men and women could hardly afford to alter the potentially pathogenic balance of diet, exercise, and sleep that circumscribed their lives.

But anyone could become a victim of their emotions - or passions as they would have been termed at the beginning of the nineteenth century. General treatises on the preservation of health always found room for discussion of the damage uncontrolled anger, lust, or fear could inflict on the body. All medicine was psychosomatic medicine in these generations; mind and body, sickness and health were all intricately and inextricably related.²⁹ And by the 1820s and 30s, a new framework for understanding human capacities and emotions had become enormously popular: this was phrenology, a doctrine linking the brain's localized anatomical structure with fundamental intellectual and emotional faculties and functions. In its most widely disseminated version, phrenology became synonymous with the notion that psychological "readings" could be made from the contours - "bumps" - on an individual's head. Phrenological guides to health and happiness, even phrenological periodicals and almanacs, had become extraordinarily popular by the mid-nineteenth century.³⁰ Not all antebellum authorities on management of the mind were longtime advocates of phrenology, but all appealed to a growing American desire to understand and control mental states; consistently enough, the first English language treatises entitled "mental hygiene" were written by Americans and appeared in the antebellum United States.³¹

These books and pamphlets reflect a remarkably coherent vision of health and the body - even if the options for preserving health and treating disease were shaped by the realities of class and education. Of course, gender did, as we have seen, create its own readership and thus its own subgenre of advice books. Modesty, tradition, and anxiety interacted to dictate that guides to diseases of women, childbearing, and child management would flourish. But aside from a long-standing tradition of German health advice, ethnic diversity was limited.³² Native American healing traditions were honored more by the primitivist invocations of sectarian and itinerant healers than by serious study or selective assimilation.³³ (A variety of hypothetical "Indian doctors" plied their trade throughout nineteenth-century America.)

More striking than this general uniformity of content was the growing diversity of forms assumed by popular medical advice in the first half of the nineteenth century. Guidance in the prevention and cure of disease continued to fill pamphlets and books as they had in the eighteenth century, but the first half of the nineteenth century saw an increasing proliferation of novel forms through which to accomplish the traditional function of disseminating health advice. These included specialized almanacs and periodicals, newspaper columns and advertisements, and advertisements and articles in general magazines. Every technical innovation in printing and engraving was soon employed in answering unending demands for medical information.

Continuity and Change

It is a pattern that has hardly changed. Not all of us are content to entrust our bodies to credentialed physicians and the institutions they staff and legitimate; lay people seek assurance, understanding, and ultimately some control over their own medical prospects. The very term "managed care" that has become so familiar in recent years embodies, on the other hand, a structured passivity; the patient is to be "managed" by experts and bureaucratic mechanisms in the patient's - and society's - presumed interest.

But as the tradition of popular health publication makes clear, men and women have always sought to manage their own care, sought to reduce costs and to participate in the prevention and treatment of their own ills. Changes in media and in the specific content of medical knowledge only underline this fundamental continuity of function. We can now access websites and email lists for every conceivable ill, and find support groups for sufferers and their families. And in an era of chronic disease we are, of course, deluged with advice about lifestyle as key to the avoidance and treatment of these long-term ills. As health has moved into the public sector, in addition, the desire to play an active role in health care has evolved in parallel; disease oriented advocacy and lobbying groups have flourished in the late twentieth century, providing a voice for American lay persons as well as health professionals. In an era of omnipresent television and mass journalism, of films and videos, of congressional health politics, the seemingly quaint popular medical books and pamphlets of colonial and antebellum America seem all the more alive and significant as they embody an ineradicable desire to predict and control their readers' biological future.



back to main page

see selections from the exhibition

Notes

1. Spock's guide to child care has been so widely used and influential that it soon became known by its author's name alone. For the first of many editions, see Benjamin Spock, The Common Sense Book of Baby and Child Care (New York: Duell, Sloan and Pearce, [1946]); Boston Women's Health Book Collective, Our Bodies, Ourselves: a Book by and for Women (New York: Simon and Schuster, 1973). return

2. And it should be recalled that the physician normally treated patients in their own homes, not in the institutional settings that we have come to accept as normal in the twentieth century. return

3. Not all of this lore involved drugs, nor was all of it retrievable from the printed page. Popular medicine also included knowledge of practice, how to dress cuts and wounds, for example, and how to manage the problems of infancy and early childhood. return

4. Culpeper's omnipresent seventeenth-century guide to English herbs - "fitted to the meanest capacity" - was reprinted as late as the 1820s; the first American edition appeared in Boston in 1708. For later editions: The English Physician Enlarged, Containing Three Hundred and Sixty-nine Receipts for Medicines made from Herbs (Taunton: Samuel W. Mortimer, 1826); Culpepper's [sic] Family Physician: The English Physician Enlarged, Containing 300 Medicines, Made of American Herbs, James Scammon, ed. (Exeter, N.H.: James Scammon, 1824). return

5. Buchan was probably the most widely read of such books, appearing in almost one hundred and fifty English language editions after its original publication. Its vogue waned after the 1820s, even though it is still often to be found in antiquarian bookshops. Charles E. Rosenberg, "Medical Text and Social Context: Explaining William Buchan's Domestic Medicine," Bulletin of the History of Medicine, 57 (1983), 22-42; C. J. Lawrence, "William Buchan: Medicine Laid Open," Medical History, 19 (1975), 20-35. return

6. A. Wesley Hill, John Wesley among the Physicians: A Study of Eighteenth-Century Medicine (London: The Epworth Press, 1958). return

7. Roy Porter and Lesley Hall, "Medical Folklore in High and Low Culture: Aristotle's Master-Piece," The Facts of Life: The Creation of Sexual Knowledge in Britain, 1650-1950 (New Haven and London: Yale University Press, 1995), 33-64; Janet Blackman, "Popular Theories of Generation: The Evolution of Aristotle's Works. The Study of an Anachronism," in: John Woodward and David Richards, eds., Health Care and Popular Medicine in Nineteenth Century England (New York: Holmes & Meier, 1977), 56-88. return

8. For an accessible picture of a family's practice in colonial Philadelphia, see Cecil K. Drinker, ed., Not So Long Ago: A Chronicle of Medicine and Doctors in Colonial Philadelphia (New York: Oxford University Press, 1937). For the English context, see, for example: Lucinda McCray Beier, Sufferers and Healers: The Experience of Illness in Seventeenth-Century England (London: Routledge & Kegan Paul, 1987); Dorothy Porter and Roy Porter, Patient's Progress: Doctors and Doctoring in Eighteenth-Century England (Stanford: Stanford University Press, 1989); Roy Porter, ed., Patients and Practitioners: Lay Perceptions of Medicine in Pre-Industrial Society (Cambridge: Cambridge University Press, 1985). return

9. The title page describes this as the second edition; a first edition seems not to have survived (Williamsburg and Annapolis: William Parks, 1734). Like many such prescribing manuals, Tennent's book concluded with a handy index to diseases and another to "ingredients" which, he emphasized, were of local growth. I am "content," as he put it, "to do all my Execution with the Weapons of our own Country," 58. return

10. For a survey of this literature, see Lamar Riley Murphy, Enter the Physician: The Transformation of Domestic Medicine, 1760-1860 (Tuscaloosa and London: University of Alabama Press, 1991). Still useful are Guenter Risse, Ronald L. Numbers, and Judith W. Leavitt, eds., Medicine without Doctors: Home Health Care in American History (New York: Science History Publications, 1977) and Anita C. Fellman and Michael Fellman, Making Sense of Self: Medical Advice Literature in Late Nineteenth-Century America (Philadelphia: University of Pennsylvania Press, 1981). return

11. There was an American reprint as early as 1772; in 1795 a Philadelphia publisher issued an edition "revised and adapted to the diseases and climate of the United States of America." Rosenberg, "Medical Text," 41. return

12. Gunn's text has been conveniently reprinted: Gunn's Domestic Medicine: A Facsimile of the First Edition with an Introduction by Charles E. Rosenberg (Knoxville: University of Tennessee Press, 1986). The title page notes that it was "expressly written for the benefit of families in the Western and Southern States" and contained "descriptions of the medicinal roots and herbs of the Western and Southern country, and how they are to be used in the cure of Diseases." return

13. Samuel Thomson, New Guide to Health; Or, Botanic Family Physician (Boston: Printed for the Author, 1822). return

14. It is not clear who "Dr." Williams was; his twenty-eight page pamphlet was "printed for the author" and bore only the pro forma imprint "United States." return

15. The subtitle reads: "Wherein the Virtues of the mineral, vegetable, and animal productions of North and South America are laid open, so far as they are known; and their uses in the practice of physic and surgery exhibited." (Walpole, N.H.: David Carlisle, 1801). return

16. Samuel Henry, A New and Complete American Medical Family Herbal, wherein, is displayed the true properties and medical virtues of the plants, indigenous to the United States of America (New York: Samuel Henry, 1814). Henry's volume includes a list of subscribers indicating whether they opted for hand-colored illustrations. return

17. Rafinesque, Medical Flora; Or, Manual of the Medical Botany of the United States of North America, 2 vols. (Philadelphia: Atkinson & Alexander, 1828; Philadelphia: S. C. Atkinson, 1830). return

18. The American Practice of Medicine: Being a Treatise on the Character, Causes, Symptoms, Morbid Appearances and Treatment of the Diseases of Women and Children, 3 vols. (New York: Betts and Anstice, 1832). Beach's book appeared in many subsequent editions and formats; all were illustrated with botanical plates. Jacob Bigelow's landmark American Medical Botany, Being a Collection of the Native Medicinal Plants of the United States, 3 vols. (Boston: Cummings and Hilliard, 1817-20) with its costly colored plates was not aimed at the domestic practice market, although it did contain information as to the medicinal properties of the plants described. return

19. See, for example, Stephen Nissenbaum, Sex, Diet, and Debility in Jacksonian America: Sylvester Graham and Health Reform (Westport, Conn. and London: Greenwood Press, 1980). For an exposition of Graham's medical views, see his Lectures on the Science of Human Life, 2 vols. (Boston: Marsh, Capen, Lyon & Webb, 1839). return

20. Frederick C. Hollick, who wrote a variety of treatises on marriage, midwifery, and the diseases of men and women, was, with the more respectable and even more prolific William A. Alcott, the most widely read of such authors offering advice in these vexed areas. Thomas Low Nichols and his wife Mary Gove Nichols also wrote at the margin of respectability, providing their readers a mixture of medical, lifestyle, marital, and sexual advice. return

21. For an introduction to such tracts, books, and pamphlets, see Janet Farrell Brodie, Contraception and Abortion in 19th-Century America (Ithaca and London: Cornell University Press, 1994). Also useful is David S. Reynolds, Walt Whitman's America: A Cultural Biography (New York: Alfred Knopf, 1995), Ch. 7, "'Sex is the Root of it all'; Eroticism and Gender," 194-234. return

22. This title is itself the Edinburgh professor's own revision for "family use" of his 1781 textbook on midwifery. The enterprising Isaiah Thomas changed his Worcester, 1793 edition to The Family Female Physician. return

23. The first edition of Smith's Letters appeared in London in 1767, the first American edition in Philadelphia in 1792. For further detail on this and other pre-1820 imprints, see Robert B. Austin, Early American Medical Imprints: A Guide to Works Printed in the United States, 1668-1820 (Washington, D.C.: USPHS, DHEW, 1961). return

24. See Joseph Brevit, The Female Medical Repository: To which is added, a Treatise on the primary diseases of infants: adapted to the use of female practitioners and intelligent mothers (Baltimore: Hunter & Robinson, 1810); Samuel K. Jennings, The Married Lady's Companion, or, Poor Man's Friend; in four parts. I. An Address to the Married Lady, who is the mother of daughters. II. An Address to the newly married lady. III. Some important hints to the midwife. IV. An essay on the Management and Common Diseases of Children (Richmond: T. Nicolson, [1808]). return

25. The Maternal Physician; a Treatise on the Nurture and Management of Infants, from the Birth until Two Years Old. Being the result of sixteen years' experience in the nursery (New-York: Isaac Riley, 1811). Although it was published anonymously by "An American Matron," the author is known to be Mary Palmer Tyler. It was reprinted in 1818. return

26. For an attempt to create a formal midwifery curriculum see Valentine Seaman, The Midwives Monitor, and Mother's Mirror: being three concluding lectures of a course of instructions on midwifery (New-York: Isaac Collins, 1800); for the variety of guides to domestic midwifery, see, for example, the oft-reprinted Kurzgefasstes Weiber-Buchlein, Welches sehr Nutzlichen Unterricht fur Schwangere Weiber und Hebammen ([Ephrata]: 1798). return

27. Robert Wallace Johnson, The Nurse's Guide, and Family Assistant; Containing Friendly Cautions to those who are in Health: With ample directions to nurses and others who attend the sick, women in child-bed, &c. (Philadelphia: Anthony Finley, 1818); J. S. Longshore, The Principles and Practice of Nursing, or a Guide to the Inexperienced: . . . Adapted to Families, Nurses, and Young Physicians (Philadelphia: Merrihew and Thompson, 1842); Anthony T. Thomson, The Domestic Management of the Sick-Room, Necessary, in Aid of Medical Treatment, for the Cure of Diseases. Revised, with additions, by R. E. Griffith (Philadelphia: Lea and Blanchard, 1845); Harriet Martineau, Life in the Sick-Room. Essays . . . With an Introduction to the American Edition, by Eliza L. Follen. Second American Edition (Boston: William Crosby, 1845). The terms "fevers" and "dropsy" are obviously anachronistic but reflect categories as understood in ante-bellum America. return

28. See, for example: S.A. Tissot, An Essay on Diseases incident to Literary and Sedentary Persons. . . . The Second Edition (London: J. Nourse, and E. and C. Dilly, 1769); George Wallis, The Art of Preventing Diseases, and Restoring Health, founded on Rational Principles, and adapted to persons of every capacity (New York: Samuel Campbell, 1794); A. F. M. Willich, Lectures on Diet and Regimen: Being a Systematic Inquiry into the most Rational Means of Preserving Health and Prolonging Life: . . . The 1st Boston, from the 2d London edition (Boston: Manning & Loring for Joseph Nancrede, 1800). For overviews and syntheses of such teachings, see Thomas Beddoes, Hygeia: Or Essays Moral and Medical, on the Causes Affecting the Personal State of the Middling and Affluent Classes, 3 vols. (Bristol: J. Mills for R. Phillips, 1802); John Sinclair, The Code of Health and Longevity: Or, a Concise View of the Principles Calculated for the Preservation of Health, and the Attainment of Long Life. . . . The Second edition, 4 vols. (Edinburgh: Arch. Constable & Co.; London: T. Cadell, W. Davies, and J. Murray, 1807). return

29. For examples of widely-read guides to psychic and physical health, see the works of George Cheyne, The English Malady; or, a Treatise of Nervous Diseases of all Kinds, as Spleen, Vapours, Lowness of Spirits, Hypochondriacal, and Hysterical Distempers, &. (London: G. Strahan and J. Leake, 1733) and Cheyne, The Natural Method of Cureing the Diseases of the Body, and the Disorders of the Mind Depending on the Body. . . . The Third Edition (London: George Strahan and J. & P. Knapton, 1742). And for an overview of such ideas, see C. E. Rosenberg, "Body and Mind in Nineteenth-Century Medicine: Some Clinical Origins of the Neurosis Construct," Bulletin of the Hisory of Medicine, 63 (1989), 185-97. return

30. The phrenological literature is enormous and reflects a widespread lay interest in managing and predicting psychological and emotional traits. See, for example, John D. Davies, Phrenology: Fad and Science. A 19th-Century American Crusade (New Haven: Yale University Press, 1955); David de Giustino, Conquest of Mind: Phrenology and Victorian Social Thought (London: Croom Helm, 1975); Roger Cooter, The Cultural Meaning of Popular Science: Phrenology and the Organization of Consent in Nineteenth-Century Britain (Cambridge, London, and New York: Cambridge University Press, 1984); Cooter, Phrenology in the British Isles: An Annotated, Historical Biobibliography and Index (Metuchen, N.J. & London: The Scarecrow Press, 1989). return

31. William Sweetser, Mental Hygiene: An Examination of the Intellect and Passions, designed to illustrate their influence on health and duration of life (New York: J. & H. G. Langley, 1843); Isaac Ray, Mental Hygiene (Boston: Ticknor and Fields, 1863). return

32. For a useful recent introduction to the German literature, see: David L. Cowen and Renate Wilson, "The Traffic in Medical Ideas: Popular Medical Texts as German Imports and American Imprints," Caduceus, 13 (1997), 67-80. In the colonial and early national years, German printing was largely an Eastern Pennsylvania enterprise. In the second half of the nineteenth century, mainstream English language guides - such as those by Gunn and E. B. Foote - were translated and published in German in such cities as Cincinnati and St. Louis. return

33. Samuel Thomson, for example, claimed to have learned much of his doctrine from Native American healers, including his use of steam-baths and the effect of certain herbs. return