Medical practice in the Chesapeake and Mid-Atlantic regions, 1769-1820

Melissa J. Grafe Institute of the History of Medicine Johns Hopkins University My research into the 18th-century medical practices of the Archer family of Harford County, Maryland had led me unexpectedly to Philadelphia. With the generous support of the PACHS fellowship, which gave me the funding for a month to research at multiple archives, and the support and advice of the PACHS executive director Babak Ashrafi and his assistant Bonnie Clause, I started my search at the University of Pennsylvania’s Rare Book and Manuscript library on the sixth floor of the Van Pelt library. Dr. John Archer was the first medical graduate from the College of Philadelphia (later the University of Pennsylvania), and four of his sons and many of his students attended the University of Pennsylvania near the end of the 18th century. Archer’s medical education in Philadelphia shaped the way he practiced in Harford County, just as knowledge obtained through the bodies of his patients in Harford County, many of them friends, relatives, and neighbors, altered the way he applied this medical knowledge. I had located one of John Archer’s medical ledgers, dating from 1775-1783, and a clinical notebook containing his notes from studying under Dr. John Morgan, at the manuscript library earlier in the year, and now had the time to work on these items. The medical account ledger forms the basis of the first chapter of my dissertation, which examines how Archer’s medical work was shaped by local context. I entered everything from the ledger, which included names, places, medical services offered and dates of service, and payment (or more often non-payment) for Archer’s help, into a database to analyze later. I also examined the notebook, which detailed what Archer learned under Morgan through lectures and the types of cases he saw. Through the help of public services specialist John Pollack, I gained access to the Shaw and Shoemaker database, which offers a digital version of thousands of early American imprints from 1800 to 1820. Using keyword searches, I was able to find over a dozen references to Archer, his sons, and students, in dissertations, early medical works, and government documents. While I came back to the University of Pennsylvania often throughout my month, my priority was to examine manuscripts related to the Archer family or medical education in Philadelphia in the 18th century at several archives. I spent a week at the College of Physicians, transcribing and photographing a notebook attributed to John Archer Jr. with his notes on Benjamin Rush’s lectures in 1797. I also paged through the minutes of the College, and discovered another Harford County physician’s correspondence concerning the use of electricity in medicine, which was later published in the College’s Transactions. Joan McKenzie, the technical services librarian, was extremely kind, and I was grateful for access to the collection, which is now open by appointment only. Between Christmas and New Year’s, I went to the Historical Society of Pennsylvania, trying to find correspondence between Archer and other doctors in Philadelphia, including Dr. Robert Harris, his brother-in law. I had no luck in this area, but found one of Dr. John Morgan’s medical ledgers, useful in comparison to John Archer’s ledger, and also examined the medical school notebooks of Drs. William Martin and James Anderson, who both attended Penn contemporaneously with Archer’s sons. Reading through the notebooks helped me better understand when and why certain medicines were used, and illuminated some of the guiding principles behind medical theory at this period. While the Historical Society’s collections are extraordinary, I found the navigation of the library catalog confusing at times, and I feel that when I visit again, I will consult a curator ahead of time. The following week, I went to the University of Pennsylvania archives, which is currently located in the Franklin fieldhouse, to search for information on the Archer family and to develop a list of Harford County medical students attending the University to compare with my list of Archer students. Using the online finding aids, I found that the archives had the dissertations of some of Archer’s students and sons, tickets for admittance into medical lectures for John Archer Jr. and another Harford County physician, William Dallam, and alumni files for Archer and his family. In George Monro’s dissertation, I found an inscription written to John Archer, and discovered that Monro was a “kinsman” to Archer. Nancy Miller, the archivist, directed me to the General register of medical students, which listed who attended lectures, often with the state; and the University of Pennsylvania’s Trustee’s minutes, which outlined requirements for a medical degree. I also compiled a list of Penn. dissertations on croup, as John Archer had become known for his cure of croup and the dissertations would be helpful in seeing how others had interpreted Archer’s cure. On the advice of Bonnie Clause, the PACHS executive assistant to Babak Ashrafi, I made time in my final week for the Pennsylvania Hospital Archives. The original Pennsylvania Hospital still exists, housing the earliest and probably best collection of medical imprints in its historical library, as well as records of the hospital dating from the mid-18th century. Stacey Peeples, the curator-archivist, was fantastic in guiding me through the collections, and great with answering my questions. I spent more time at the hospital than I expected, examining the Board of Manager minutes, book of patient admissions, medical staff information, case books, and attending manager reports. Archer and his students all spent time at the Pennsylvania Hospital attending clinical lectures, and this research enabled me to build a picture of what medical practice in this hospital looked like, what types of patients Archer encountered, and the illnesses he attended. I want to thank the Philadelphia Area Center for the History of Science and the consortium institutions for this wonderful opportunity to visit multiple places for research purposes, instead of being tied to one. I was able to weave together different strands of research to develop an idea of what medical education in Philadelphia might have looked like in the late 18th century, through medical notebooks, ledgers, hospital records, and case notes. I found myself many times thinking, “Well this now makes sense,” as I compared what I was reading in a manuscript to notes on something else I had just researched a few days before. For example, the fact that John Archer had very little exposure to pregnant women in the hospital (which did not admit them) or in his medical training reflected in his medical practice, where he helped deliver less than ten women from 1775-1783, as I discovered in my analysis of his medical ledger at the University of Pennsylvania. Instead of getting one side of the picture, I had many angles to choose from, which is the best type of research I can think of.