“Disease, Science, and Religion in the Worlds of the Puritans”
Francis J. Bremer
Let me start with a personal note. In May I underwent a triple bypass operation, during which my chest was opened, my heart put on bypass, one artery replaced with another, two other arteries replaced by veins. This was not possible when my father died of coronary heart disease in 1992. In 1914 my maternal grandfather, an animal trainer, died horribly of septic meningitis as a result of wounds inflicted on his spine by a lion during a circus act in Binghamton New York. Penicillen had not been discovered.
I say all this to remind you that medical science has constantly evolved through the efforts of men and women from ancient times to today to better understand the human body, its maladies, and how to cure them. When people talk about the puritans and medicine it is easy to make them the object of ridicule and congratulate ourselves on how much smarter and more “scientific” we are. I don’t plan to do that this evening. Instead, I hope to examine the struggle against physical disease and mental affliction by men and women of the seventeenth century as a chapter in the long and still continuing effort to achieve healthy minds and bodies.
Let ‘s start with the challenges faced by those people.
It is difficult to diagnose disease at a remove of four centuries, but we can be fairly confident that illness experienced by seventeenth century men and women included smallpox, syphillus, measles, malaria, plague, dysentery (referred to as the bloody flux), congestive heart failure (which they termed dropsy), tuberculosis (called consumption), and stones in the urinary tract. Puritans were no different from their non-puritan contemporaries in suffering from these maladies and in how they responded to them. Thus, in dealing with how such diseases were treated, much of what I will be discussing was not uniquely puritan but rather experiences, beliefs, and practices shared by most people of that time.
To whom did those people turn to for help?
Beyond the household, a variety of practitioners helped cope with medical needs – Physicians diagnosed and prescribed; apothecaries prepared medications; and surgeons performed amputations, let blood, and removed bladder stones. With rare exceptions, none of these professions was open to women. On the other hand, child birth and the treatment of infant diseases were the exclusive realm of midwives. In London these distinctions were commonly observed, and a physician might be a graduate of the Royal College of Physicians. Throughout the rest of England and in the colonies the distinctions were blurred and many referred to as “doctors” were individuals who had served what was in essence (if not formally) an apprenticeship under someone who had learned his medical skills in a similar way. Still others acquired knowledge of disease and treatment from books. There was no medical curriculum as such at Oxford and Cambridge, but those who proceeded to a degree might very well have read classic works by Hippocrates and other ancients, which is why university trained ministers were often called upon to treat illnesses.
However it was acquired, medical understanding at the start of the seventeenth century was rooted in the concept of bodily humors formalized by the Greek physician Galen in the second century. According to this theory, human health was the result of the balance of four bodily humors or elements – yellow bile, blood, phlegm, and black bile. Each of these was associated with a quality, cold, heat, moistness, and dryness. Disease resulted from an imbalance of the humors and treatment involved restoring the humors by means such as purging and blood letting. In this view there were no specific diseases and illness did not come from anything outside the body — from bacteria for instance -- but from forces within.
While these theories dominated medical thought at the start of the seventeenth century, new ideas, mostly from the continent, were beginning to challenge, or at least modify them. The Swiss physician Paracelsus had argued that diseases were distinct, with specific causes. He was a practicing astrologer and alchemist, but what is of most relevance to our focus is his emphasis on close observation of disease symptoms, for which he is often referred to as the “father of toxicology.” He advocated the use of minerals and chemicals in the treatment of disease. Many of his disciples who were similarly engaged in alchemical experiments were responsible for developing methods for processing chemicals used in medical treatments.
Rejecting overarching theories of disease while somewhat reflecting the Paracelsian approach, the English puritan physician Thomas Sydenham (who fought in the Parliamentary army against Charles I before resuming studies at Oxford), utilized an eclectic approach that focused on the close bedside study of diseased patients to find patterns and to carefully record the effect of various attempts to combat the illness. Later referred to as the “English Hippocrates” his major works included The Method of Curing Fevers and Observations of Medicine.
The seventeenth century is noted for advances that were made in understanding the human body, which we would assume are an important part of our story, but we would be mistaken. William Harvey published his treatIse on the circulation of the blood in 1628. The Italian Marcello Malpighi used a microscope to discover capillaries. These and similar discoveries in anatomy would eventually prove of value to medicine, but did little to alter medical understanding and practices of the time.
Puritans are often denigrated by modern writers for believing that disease was “providential,” in other words that God inflicted disease on individuals as a punishment for their sin and that prayer and other spiritual tools were means of combatting it. But this was a common understanding. Harvey himself believed that it was a spiritual force that animated the blood. Robert Boyle, one of the great scientists of the period, believed in the truths of Christianity and supported programs to spread it to the natives of America.
In 1936 the sociologist and historian Robert Merton argued that there was a strong causal connection between puritanism and the scientific revolution, including developments in medicine. He argued that puritanism encouraged scientific research as a means of exploring God’sinfluence on the world, thus providing religious justification for scientific research. While some have attacked his thesis as being too broad, others have pointed to the puritan background of many of the members of England’s scientific Royal Society as proof of the argument. But whether they were more inclined to value science than their non-puritan contemporaries, puritans believed that religion and science were in harmony – the mysteries and operations of the creation could not contradict, but only enhance our knowledge of the creator. It was not until much later that the two realms of knowing were perceived as being in conflict.
While they saw the hand of providence in the visitation of disease on a person or a community, most puritans and non-puritans believed that God worked through natural causes in bringing that about, and that doctors as well as other carers were his agents in curing those whom he wished to recover. It is notable that their providential views did not prevent Luther and Calvin, as well as other Protestant leaders, from using medicines when suffering from disease. The chronically ill John Calvin even dedicated a book to his physician. The puritan clergyman William Perkins, who distinguished between lawful and unlawful medicine, and condemned the use of astrology and witchcraft as illicit, urged those who were ill to solicit help from learned and experienced physicians.
Let’s turn our attention to New England, and the men and women who tended to the sick in those colonies.
The neat distinction between licensed physicians, apothecaries, and surgeons that characterized the care available to some in London was meaningless in the English countryside and in New England as well. Throughout the seventeenth century there were less than half a dozen identifiable physicians in New England who had formal university medical training. Most of those who were identified as doctors were medical practitioners who were either self-taught or those who learned by working with a more experienced doctor. Those who had spent time in or graduated from university may well have acquired some medical knowledge, which is why we frequently see New England clergymen ministering to the physical as well as spiritual needs of their congregations.
Calling upon one of these practitioners was not the first things that was normally done if one became ill, however. The starting point for medical care in seventeenth century New England, as it is in most cases today, was home remedies. In addition to ordering rest and hydration, wives and mothers tended the sick with concoctions prepared from the medicinal herbs grown in their gardens. In his New Englands Rarities, the traveler John Josselyn wrote that within the kitchen gardens “some of the popular medicines of the Old World were planted” and he named about fifteen herbs which were used in contemporary English medicine. Many may have consulted the period’s most popular manual for domestic concerns, Gervase Markham’s 1613 The English Housewife, Containing the inward and outward Virtues Which Ought to Be in a Complete Woman, as her skill in Physic, Chirurgery, Cooking. Another manual that was designed for a lay audience and was well known in New England was The English Physician (1652) by the noted herbalist Nicholas Culpepper. In addition to such printed guides were family notebooks. John Winthrop carried with him a commonplace book of his father’s which is catalogued in the Winthrop Papers as “Medical Recipies.” The first part consists of copies of remedies taken from a number of 16th-century sources, among them Jean Fernel's "booke of the generall methode of curinge of feavers," Christof Wirsung'sPraxis Medicinae Universalis, John Banister's edition of Johann Wecker's A Compendious Chyrurgerie, andother works.
In addition to planting well known English herbs, the colonists also learned from the natives the medicinal use of sassafras, birch bark, white hellebore, and tobacco. Josselyn’s New England’s Rarities also dealt with the Physical and Chyurigal [Surgical] Remedies Wherewith the Natives Constantly Use to Cure their Distempers, Wounds, and Sores.
If home remedies were insufficient to effect a cure, colonists worked their way up the medical ladder in search of assistance. The local pastor or deacon might have earned a reputation for healing and be called upon for advice. Beyond that one might seek a local doctor or even someone noted throughout the region. A sense of this can be gathered by looking at some seventeenth century practitioners.
The first individual credited with being a doctor in early New England was Samuel Fuller, a deacon of the Pilgrim congregation. While his role as a deacon of that church in Leiden likely included visiting and comforting the sick, there is no evidence that Fuller studied medicine in any way or was referred to as a doctor before his arrival in Plymouth. His medical training likely came during his journey to America. At the time it was customary for ships to have a surgeon serve as a member of the crew. On the Mayflower that person was Giles Heale, who had served a surgical apprenticeship in London and been admitted to the Guild of Surgeons in 1619. A qualified surgeon, Heale attended the sick on the Mayflower’s journey to America and until the ship returned to England. Fuller likely assisted and learned from him during this time.
Supplementing what he learned from Heale, Fuller would have had access to medical books that William Brewster brought with him to the colony – in particular Timothy Bright’s A Treatise wherein is declared the sufficiency of English medicines for cure of all diseases (1615). Over time Fuller acquired medical books and tools of his own, as indicated in the inventory of his estate which included “physic books” and a “surgeon’s chest with the things belonging to it,” and refers to a medical volume he had lent to Roger Williams.
Nathaniel Morton, who had nothing good to say about any of the settlers of Plymouth or Massachusetts, labelled Fuller as a “quaksalver” in his New England Canaan (1637), but Plymouth’s governor William Bradford memorialized Fuller as the colony’s “surgeon and physician … [who] had been a great help and comfort to” the colonists. Fuller’s skills and usefulness were attested to when Bradford dispatched him in 1629 to Salem in response to a request from John Endecott requesting medical aid for that community. The colonists were evidently suffering from scurvy, and though Fuller and others recognized the efficacy of citrus (thus, in a 1621 letter Plymouth’s Edward Winslow recommended lemon juice be taken by those who journeyed to America) there was none available in the region. Shortly thereafter he again visited Massachusetts to lend his medical skills. We don’t know how successful Fuller’s efforts were on either occasion. Fuller died in Plymouth while treating his fellow colonists during what was likely a smallpox epidemic in 1633.
Recognizing a need for qualified medical practitioners, Massachusetts John Winthrop devoted considerable effort to persuading his “loving friend” William Gager, of Little Waldingfield in England’s Stour Valley, “skilled in the art of surgery,” to emigrate to New England. Gager joined the Winthrop fleet, was chosen deacon of the Charlestown church, but died between April and December 1630 while treating those who were ill.
While one could question how successful practitioners such as Fuller and Gager were, they were trusted by their fellow colonists. At the same time, New Englanders were not gullible, and were quick to take action against those who claimed to be skilled in curing diseases with no reputation to support such claims. In 1631 the Massachusetts authorities found Nicholas Knopp guilty of “taking upon him to cure the scurvy by a water of no worth nor value which he sold at a very dear rate,” and sentenced him to pay a fine or to be whipped if he failed to do so.