the flourishing and character of early american medical journalism, i797-1860

16
The Flourishing and Character of Early American Medical Journalism, i797-1860 JAMES H. CASSEDY N E of the significant innovations of late eighteenth- and early nineteenth-century medicine was the ap- pearance of the medical journal as a specialized form of publication separate from such existing communi- cation media as the generalized transactions of learned societies and the often slow-appearing proceedings of medical societies. * Published much more regularly and frequently than such organs, medical journals brought a new element of timeliness to the dissemination of medical information, one that invigorated and greatly accelerated the processes of medical change. Wherever estab- lished, moreover, the journal, like the medical school and the medical society, and more than the society proceedings, became a locus of medical influence and authority as well as a measure of medical pro- fessionalism in the community. Over the years a number of historians have carefully identified, counted, and classified the various kinds of nineteenth-century Ameri- can medical journals. 2 Others have examined the detailed histories of 1. For the European beginnings of medical and scientific periodical literature, see David A. Kronick, A History of Scientific and Technical Periodicals, id ed., Mctuchen, N.J., 1976. 2. Among the best of these surveys are Myrl Ebert, "The rise and development of the Ameri- can medical periodical, 1797-1850," Bull. Med. Lib. Ass., 40: 243-276, 1952;John Shaw Billings, "The medical journals of the United States," Boston Med. Surg.J., 100: 1-14, 1879; John Shaw An earlier version of this paper was presented in April 1978 at the New York meeting of the Organization of American Historians. My study is based principally upon an examination of a cross section of America's pre-Civil War medical journals, regular and irregular alike, but chiefly those that lasted three or more years. No attempt is made here to deal with the closely related history of the periodical transactions or proceedings of medical societies. C 1983 BY THE JOURNAL OF THE HISTORY OF MEDICINE AND ALLIED SCIENCES, INC. ISSN 0032-5O4J VOLUME 38 PACES 135 TO I5O [ 135 ]

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The Flourishing and Characterof Early American Medical Journalism,

i797-1860

JAMES H. CASSEDY

N E of the significant innovations of late eighteenth-and early nineteenth-century medicine was the ap-pearance of the medical journal as a specialized formof publication separate from such existing communi-cation media as the generalized transactions of learnedsocieties and the often slow-appearing proceedings of

medical societies. * Published much more regularly and frequently thansuch organs, medical journals brought a new element of timeliness tothe dissemination of medical information, one that invigorated andgreatly accelerated the processes of medical change. Wherever estab-lished, moreover, the journal, like the medical school and the medicalsociety, and more than the society proceedings, became a locus ofmedical influence and authority as well as a measure of medical pro-fessionalism in the community.

Over the years a number of historians have carefully identified,counted, and classified the various kinds of nineteenth-century Ameri-can medical journals.2 Others have examined the detailed histories of

1. For the European beginnings of medical and scientific periodical literature, see David A.Kronick, A History of Scientific and Technical Periodicals, id ed., Mctuchen, N.J., 1976.

2. Among the best of these surveys are Myrl Ebert, "The rise and development of the Ameri-can medical periodical, 1797-1850," Bull. Med. Lib. Ass., 40: 243-276, 1952;John Shaw Billings,"The medical journals of the United States," Boston Med. Surg.J., 100: 1-14, 1879; John Shaw

An earlier version of this paper was presented in April 1978 at the New York meeting of theOrganization of American Historians. My study is based principally upon an examination of across section of America's pre-Civil War medical journals, regular and irregular alike, but chieflythose that lasted three or more years. No attempt is made here to deal with the closely relatedhistory of the periodical transactions or proceedings of medical societies.

C 1983 BY THE JOURNAL OF THE HISTORY OF MEDICINE AND ALLIED SCIENCES, INC.

ISSN 0032-5O4J VOLUME 38 PACES 135 TO I5O

[ 135 ]

136 Journal of the History of Medicine : Vol. 38, April 1983

certain individual journals. Strangely enough, however, scholars havebeen backward in incorporating the history of medical journalism intothe general history of American medicine. They have done little, eitherto attempt a characterization of early American medical journalism as awhole, or to examine its functioning as a key aspect of Americanmedical professionalism and institutional development.3 This paper isa limited preliminary effort to set forth some of the broader elements ofthis complex story, one which deserves far greater scholarly attention.4

The nineteenth-century United States provided particularly fertilesoil for medical journals. In fact, the establishment of the Medical Re-pository in New York in 1797 was followed, in the next five or sixdecades, by a veritable flood of additional periodicals devoted to thisfield of knowledge. Myrl Ebert, some years ago, plotted the launchingof new health-related journals during this period, decade by decade.According to her figures, 7 were established between 1797 and 1810; 8more from 1810 to 1820; 32 in the following decade; 63 in the next; and94 from 1840 to 1850; a total of 204. Of these, 15 were dental, 12 werehomeopathic, 27 were botanical, 35 were eclectic, and the rest repre-sented regular or orthodox medicine.s At the end of another quarter-century or so, according to John Shaw Billings in 1879, the overall totalhad more than doubled to 547. Billings broke this figure down into 250

Billings, "Literature and institutions," in E. H. Clarke, et al., A Century of American Medicine1776-1876, Philadelphia, 1876, pp. 291-366; Henry B. Shafcr, "Early medical magazines inAmerica," Ann. Med. Hist., n.s., 7: 480-491, 1935; Frank Luther Mott, A History of AmericanMagazines [vol. I], 1741-1850, New York, 1930; and Frank Ludier Mott, A History of AmericanMagazines [vol. II], 1850-1865, Cambridge, Mass., 1938. Other useful general articles includeVictor Robinson, "The early medical journals of America founded during the quarter-century'797-1822," Med. Life, 36: 553-585, 1929; and Joseph Garland, "Medical journalism in NewEngland, 1788-1924," Boston Med. Surg.J., 190: 865-879, 1924.

I have not attempted to compile my own independent figures on the numbers of the variousspecies ofjoumals. The homeopadis alone supported some forty-eight different journals between1835 and 1866. "American homeopathic periodicals," Am. Homeopathic Rev., 6: 458—467, 1865—66. "New medical journals," Boston Mai. Surg J., 46: 325, 1852.

3. Neither Shyrock, Rothstein, Duffy, nor, to the best of my knowledge, other general his-torians of American medicine have given any significant attention eidier to the introduction andspread of medically related journals or to their influential roles. Packard briefly cites variousjournals here and there and discusses dieir proliferation in Missouri and California for a fewpages, but he has no overall chapter on American medical journalism. Miller discusses medicaljournals briefly as one aspect of the overall medical publication scene in mid-nineteenth-centuryAmerica. Genevieve Miller, "The nineteenth century medical press," in John B. Blake, ed.,Centenary of Index Medicus 1879—1979, Bethesda, Md., 1980, pp. 19—30.

4. J. X. Corgan, "Non-medical functions of the Nashville Journal of Medicine and Surgery,1851-1861,"^. Tenn. Med. Ass., 70:168-170, 1977, suggests some further broad areas of medical

journalism that merit extended historical study.5. Ebert, (n. 2) passim.

Cassedy : Early American Medical Journalism 137

regular medical journals, 58 pharmaceutical and dental journals, 124popular health journals, and 115 representing the various therapeuticsects.6

Regular physicians of mid-century America, of course, could neverunderstand where the support came from that permitted the creation ofthe many Thomsonian, homeopathic, or eclectic journals, in additionto their own orthodox periodicals. One commentator facetiously sug-gested that the only readers of such journals were the various sectarianeditors themselves. Subscription figures which might verify that opin-ion are not at present available. However, the implication it conveys,that Jacksonian democracy demanded an outlet for every theory, wasnot an exaggeration. As one regular put it: "when each man and wom-an has a Journal to be the exclusive organ of their individual opinionson medicine, the millennium will be near at hand."7

Medical journals came upon the scene only slightly later in Americathan in Europe. Most American periodicals long failed to match thosein the Old World in originality and quality, but they outdid them inquantity. In fact, the rapid early proliferation of new medical journalswas in its day thought of as a peculiarly American phenomenon, or atleast one whose scale was not approached in Europe. By 1850, it wasreported that the United States had roughly twice as many regularmedical journals as were then published in Great Britain. Some indi-viduals predicted, moreover, that the United States was "in a fair wayto exceed, not only any but all other nations put together" in thenumbers of such periodicals.8

Daniel Drake saw this phenomenon as part of the general spawningof all kinds of instruction and communication media, a process thatwas essential in a free society. Journalism, he asserted, "is an American

6. Billings, "Medical Journals of the United States," (n. 2).7. "Homeopathic journals," Boilon Med. Surg.J., 46: 121, 1852; "New medical journals," (n.

8. "New medical journals," Med. Exam., n.s., 1: 417, 1845. Similarly, by 1842 the UnitedStates had more newspapers than all of Europe combined. P. L. Simmonds, "Statistics of news-papers in various countries,"_/. Statist. Soc. Land., 4: 120, 1841-42. Daniel Dralce counted fifteenBritish journals, "which gives one for every 1,830,000 inhabitants; while in this country, there isone for every 715,000." Daniel Dralce, "On the origin and influence of medical periodical litera-ture; and the benefits of public medical libraries," in his Discourses, Delivered by Appointment, beforethe Cincinnati Medical Library Association, January gth and 10th, 1852, Cincinnati, 1852, pp. 82—83.While no single European medical journal provided die model for the American journals, severalexerted great influence upon the latter and upon American medical ideas generally. Among tliesewere the Annales d'hygiene et midicine legate of Paris, and John Forbes's British and Foreign MedicalReview.

138 Journal of the History of Medicine : Vol. 38, April 1Q83

—a republican—propensity." In addition, however, he felt that theexplosion was a natural outgrowth of America's federal system, fos-tered by the jealousies, aspirations, and loyalties of every region andstate, all of which demanded medical journals to go along with theother institutions rising in their capitals or principal cities.9

Before 1820 medical journals were published almost exclusively inurban centers along the Eastern seaboard, chiefly the Northeast. Un-derstandably, Philadelphia, New York, and Boston also continued insubsequent decades to produce large numbers of journals, includingmany of the most influential ones.10 In the later antebellum decades,medical journals began to appear as well in the trans-Allegheny region,where even much smaller communities were vying aggressively forsocial, political, and commercial advantage. Observers like Drake con-sidered it a sign of social and medical maturity when that region provedable, in 1842, to support as many as three regular medical journals atthe same time. By 1848, however, such periodicals were being pub-lished in eight different cities of the region.n In the two decades beforethe Civil War, more than fifteen separate regular journals came intoexistence in Kentucky alone, while St. Louis readers during that sameperiod had their choice of four regular medical journals, one dentaljournal, and ten irregular or sectarian journals.12

Since the economic, demographic, and urban development of thedeep South came somewhat later, the medical institutionalizing of thatregion was accordingly delayed. As late as the mid-i84OS Erasmus D.Fenner observed that no medical journals were then being publishedsouth of Louisville. However, within a few years several such periodi-cals had been launched. Designed as frankly regional organs, they weredevoted alternatively to building up the new sectional medical schoolsand to the elucidation of a peculiarly "Southern" medicine concernedwith uniquely "Southern" diseases, including those peculiar to blacks.By i860 most Southern cities could boast one or more medical journals

9. However, Drake regarded the proliferation of medical schools as the primary immediatestimulus to medical journals. Drake, (n. 8) pp. 84-86.

10. Samuel D. Gross listed seventeen regular journals that existed in Philadelphia alone be-tween 1804 and i860. See his "Medical literature of Philadelphia," N. Am. Med. Chimrg. Rev., 4:412-413, i860

11. D. [i.e., Daniel Drake], "Western periodicals," West. J. Med. Surg., y. 472-474, 1842;Review, ibid., 3d ser., 1:42, 1848.

12. Edgar Erskine Hume, "Early Kentucky medical literature," Ann. Med. Hist., n.s., 8:324—347, 1936; Irwin H. Pizer and Harriet Steuernagel, "Medical journals in St. Louis before1900, background," Bull. Missouri Hist. Soc., April, 221-256, 1964.

Cassedy : Early American Medical Journalism 139

of one variety or another. Charleston supported five assorted medicalperiodicals during the interval between 1803 and i860. However, aftera much later start in this sort of journalism, Louisiana saw ten suchjournals come into being within its borders at least briefly between1839 and 1861, most of them in New Orleans.13 Many of these jour-nals, sectarian and orthodox alike, subsequently were early casualtiesof the Civil War; along with other Southern intellectual enterprises,Southern medical journalism suffered more from that upheaval thanthe Northern.14

Like other types of periodicals, the publication of medical journalsduring these decades was greatly advanced by innovations in printing,while their distribution was enormously expedited by the advent of thesteamship, the railroad, and the telegraph. Distribution time was re-duced from a matter of months to one of weeks or days, between 1830and 1850. As a result, by the latter date, according to Drake, "even thevillage surgeon now cuts according to the newest fashion of some greattransatlantic operator; and when two country physicians meet for con-sultation in the log cabin of a backwoodsman, they discuss the propri-ety of a practice, which, but thirty days before, had been professed by aProfessor in . . . Europe."15

Medical publishers and editors could appreciate such improvementsbecause they were, among other things, businessmen. The health-related journals they conducted were business enterprises as much asthe nineteenth-century American proprietary medical schools were.Running the journals thus involved medical professionals in the eco-nomic problems of small businesses as much as in the intellectual as-pects of a learned profession.

As a business venture, the typical medical journal was a small,mainly local operation, run on a shoestring. It was likely to have had,on an average, somewhere between 400 and 700 subscribers.16 The

13. "Introductory address," New Orleans Mcd.J., i:\, 1844—45. See also Joseph loor Waring,"History of medical journalism in South Carolina,"J. South Carolina Med. Ass., 51: 185-191,'955; William Dosite Postell, "Erasmus Darwin Fenner and the beginnings of medical literature inLouisiana," Ann. Med. Hist., 3d ser., y. 297-305, 1941; Kay Olschner, "Medical journals inLouisiana before the Civil War," Bull. Med. Libr. Ass., 60: 1—13, 1972.

14. For a summary of the circumstances which caused even some of the most respectedjournals to fold during the war, see "Editorial valedictory," N. Am. Med. Chirurg. Rev., 5:1125-1126, 1861.

15. Drake, (n. 8), pp. 72-73.16. A decade or so after the Civil War this was still essentially the case. Billings noted in 1876

that "the number of subscribers to the greater number of our journals is small, the issue being, for

140 Journal of the History of Medicine : Vol. 38, April 1983

Medical Repository got by with hardly 300 subscribers for several years,while the St. Louis Medical and Surgical Journal never had over 500 in thetwelve years prior to 1855. The country's leading scientific journal,Benjamin Silliman's American Journal of Science, never exceeded a cir-culation of 1,000 up through 1847. In fact, a regular run of over 1,000was a great success for any periodical. Thus, the 50,000 circulationreported by the Water-Cure Journal around 1850 was a highly excep-tional accomplishment, matched only by Harper's, Godey's Lady'sBook, and a tiny handful of other American magazines.17 The weeklyBoston Medical and Surgical Journal was reputed in 1845 to enjoy a "widecirculation in every part of the country," but it did not begin to ap-proach such a figure. Nor did the highly regarded American Journal ofthe Medical Sciences, though observers reported somewhat enviouslythat it was consistently "well sustained, and must be a source of profitto both Editor and Publishers."18

Smallness in journal circulation was seemingly assured by the com-bination of a fierce sectionalism, with a widespread antimonopolisticsentiment, and the highly competitive nature of most medical enter-prise. Medical journals normally came into being in American regionsor communities following the accumulation there of a substantialnumber of physicians and usually after the doctors' organization inmedical societies and medical schools. Journals were sometimes orga-nized by one or more enterprising individual physicians. Occasionallythey were stimulated by the medical societies or were offshoots ofpublishing houses, bookstores, or related enterprises. Many were es-tablished under the sponsorship of particular medical schools, while in

many, less thin a thousand, and, for some, hardly five hundred copies." John Shaw Billings,"Literature and institutions," (n. 2). p. 340.

17. Godey's journal boasted 70,000 by 1850 and 130,000 by i860. Among the literary peri-odicals, The North American Review averaged around 3,000 during this period. See Mott, Historyof American Magazines, (n. 2), 1: 199, 514, and passim; editorial, "New volume," St. Louis Med.Surg.J., ly. 1, 1855; and "Preface," Am.}. Set., 50: 1847. For details about the Water-Cure Journal,the American Phrenological Journal, and other ventures of die publishers Fowlers and Wells, seeMadeleine B. Stem, Heads and Headlines: The Phrenological Fowlers, Norman, Okla., 1971.

18. "American medical journals," New YorkJ. Med., 5: 138-141, 1845. Unfortunately, myresearches in the journals were totally fruitless so far as unearthing circulation figures for thesetwo journals, and almost equally so with respect to most of the other antebellum periodicals that Iinvestigated. Equally frustrating was the fact that none of the comprehensive historical surveysthat I consulted (i.e., those by Ebert, Billings, Shafer, and odiers) include specific data oncirculation. Some such information must be available, though it may well require a great deal ofeffort to locate it. Since some nineteenth-century publishers were short-lived, their records maynot have survived. However, local searches should be undertaken in order to unearth whatevermay remain.

Cassedy : Early American Medical Journalism 141

certain other instances journals drew from the expertise of medicalschool faculties without becoming overtly partisan organs.19

Probably half or more of the journals had direct faculty connectionsat one time or another, though these affiliations were often transitoryand easily dissolved. Moreover, since the medical schools themselveswere often run on the most precarious of financial bases, they could notoften provide any substantial security for their journals. In 1842 allthree of the Ohio Valley journals were attached to medical schools, butnationwide only five of fourteen regular journals reported to be inexistence three years later were considered as organs of medicalschools. In the case of irregular or sectarian journals, there was alsosome variation in such sponsorship, though one historian believes thatclose relationships with sectarian schools were "customary."20

The launching of a medical journal presumed at least some advancecalculation of the economic considerations and risks. More or lesshardnosed publishers surveyed the potential market, determined sub-scription rates that were competitive (usually between $1.50 and $5.00per year), made arrangements with local printers, got what advertisingthey could, and occasionally even paid for original contributions.21

Even with only a modest subscription list, much of it stimulated bylocal allegiances, and even when run for publicity or scientific pur-poses, a journal must have been reasonably expected to turn a profit, orat least not to lose money.

As it turned out, however, antebellum medical journalism had asfew successes as did the general world of American magazines.22 In1879 Billings published statistics showing that there had been a shock-

19. Billings, "Literature and institutions," (n. 2), passim.20. Drake, (n. n ) ; "American medical journals, "(n. 18), pp. 138—141; F. C. Waite, "American

sectarian medical colleges before the Civil War,"Bw//. Hist. Med., 19: 148-150, 1946.21. The Western Journal of the Medical and Physical Sciences in 1828, at least, offered $1.00 per

page, but apparently did not long continue this offer. In any event, as was the case with certainother journals, such payments did not involve much expense since the editor (Drake) himselfwrote much of the original material. Similarly, the American Journal of the Medical Sciences an-nounced in 1827 (Vol. 1, Advertisement) that "all articles . . . will be liberally paid for," butnothing further about such payments was mentioned in subsequent volumes. Yet anotherjournalthat at one time or another paid for contributions was the American Journal of Science. See Mott,History of American Magazines, (n. 2), 1: JOJ. However, in 1852, Drake could think of "scarcelyone" that compensated its contributors. Drake, (n. 8), p. 84. The Buffalo Medical Journal was longmainly filled with contributions of two capable individuals, die editor (Austin Flint) and FrankHastings Hamilton. See "Report of the Committee on Medical Literature," Trans. Am. Med.Ass., 1: 266, 1848.

22. In 1852 Drake asserted that "very few of the whole afford any profit to their publishers, andstill fewer any compensation to dieir Editors." Drake, (n. 8), p. 84.

142 Journal of the History of Medicine : Vol. 38, April 1983

Birth and Death Statistics of American Medical Journals, 1797-1878

TABLE I

Years, Both Inclusive Regular Homoeopathic Botanic EclecticBegun Closed Begun Closed Begun Closed Begun Closed

I797-18021803-1807

I808-1812

1813-1817

1818-1822

1823-1827

1828-1832

1833-18371838-1842

1843-1847

1848-1852

1853-1857

1858-1862

I863-1867

1868-1872

1873-1877

1878

Total

2

2

61

71311

12

12

1721

21

3218

3130

13250

5

2

14

1410

14

5727

351522

24

2

196

3310

4513681

53

2

1

510

5479

43

1

76

31

1

19

2

562

31

19

1

44555611

1

42

2

48

436

71

35

ingly high mortality rate among such journals (see Tables 1 and 2).Large numbers of them had struggled for a single issue or two, failed togain or maintain a substantial subscription list, lost money, and weregiven up. Many others followed suit after a year or so of publication.

The failures of so many periodicals might well have been anticipated,given the intense competition for a very limited readership. The ordi-nary regular medical journal could count on obtaining readers onlyfrom among physicians, and then chiefly those in a relatively smallgeographical area. Some 40,000 regular physicians were reported in the1850 census, and there were perhaps half again as many unreportedirregulars. Many of these, however, by all accounts had virtuallystopped reading medical literature after they completed their originalmedical schooling. The state of Missouri—which may or may nothave been typical—had something over 1,300 practicing physicians in

Cassedy : Early American Medical Journalism 143

TABLE 2

RegularHomoeopathicBotanic, etc.EclecticPopularPharmaceuticalDentalReprints

5> ^°/"S G

247 16305321

124

25

33

13

214

91169

431

167

187

198

10

3

620

1

1

21

8

46

22

361

61

22

5

17

910

4

39595

12

539

788

72

Sowrtr<r John Shaw Billings, "The Medical Journals of the United States," Boston Medical andSurgical Journal, too: 1-14, 1879.

1855, but an interested editor complained that less than half of themsubscribed to any medical periodicals.23

Apart from such problems, medical periodical publishers encoun-tered a host of difficulties, most of them similar to those of othermagazine publishers. High printers' costs were major reasons for fail-ures, particularly such direct costs as making plates for illustrations andthe indirect costs brought about by shifts to steam presses and otherexpensive new equipment. At another level, subscribers were notori-ously unwilling to renew after making their initial subscriptions, whilethere was constant wrangling over who was to pay postage. Slowpostal deliveries in some areas lost other subscribers. Finally, since fewperiodicals enjoyed strong institutional support, many were vulner-able to local fiscal dislocations, and others collapsed during the nationaleconomic crises of the thirties and forties.24

The significant thing is that, for all this, health-related journals con-tinued to multiply. Despite the infinite difficulties and demonstrablypoor financial prospects, new periodical ventures kept springing up

23. Editorial, "New volume," St. Louis Med. Surg.J., ly. 1, 1855.24. For further elaboration of these problems, see Mott, History of American Magazines, (R. 2) 1:

119-121, 197-211, 340-342, 512-525; n: 1-26.

144 Journal of the History of Medicine : Vol. 38, April

irrepressibly out of the fertile intellectual, medical, and social soil ofantebellum America, in defiance of the laws of supply and demand.Clearly, such journals had an importance to medical men that tran-scended economic considerations.

It should be presumed that most or all founders and editors of ante-bellum medical journals were, at least by their own lights, genuinelymotivated by scientific considerations—by the desire to advance themedical profession through the promotion and dissemination ofknowledge. At the same time there were wide differences of opinion asto just which segments of medical knowledge and information wereworthy of being disseminated. As a result, the medical journals becamethe most conspicuous if not also the most important manifestations ofnineteenth-century medical variety and medical sectarianism. Ortho-dox and sectarian journals alike were thus essentially partisan organs.None pretended to represent or incorporate the entire- spectrum ofcontemporary medical viewpoints. Rather, each served as a mouth-piece for one or another particularized set of medical ideas.

In fact, in what was clearly a golden age of medical wrangling, manyjournals of the period virtually owed their very existence to their iden-tification with some special medical controversy, viewpoint, or enthu-siasm. This meant favoring contagionism or advancing anticontagion-ism; defending orthodox medicine or tearing it down; advocating newtherapies or supporting a sect which repudiated previous therapeuticpractices. Editorial impartiality, perhaps more often than not, wassacrificed to editorial dogma. Some editors and their writers made littleattempt to disguise their antagonisms to individuals or institutionsassociated in some way with other medical viewpoints. Their columnsalternated from condescension to sarcasm, from enthusiastic advocacyto bitter invective, all with the aim of discomfiting or defeating medicalfoes.25

Within this framework of conceptual bias and competition, thehealth-related journals performed a valuable information function. Inthe case of orthodox journals, this typically included disseminatingoriginal research articles or case reports by native American authors;reissuing or abstracting significant European articles or those fromother American journals; and providing book reviews that were reallylong summaries and extracts. The journals also often published notices

2 j . The role of the medical journals, both in reflecting and in promoting this censoriouscontroversialism, deserves further examination.

Cassedy : Early American Medical Journalism 145

of medical school enrollments, summaries of bills of mortality, reportsfrom local dispensaries or hospitals, obituaries, and other matter.Some carried advertisements for medical schools, books, or instru-ments, and some, not only sectarian organs, published letters fromtheir readers. Certain journals inserted editorials, communicationswhich drew readers' attention to medical issues or community needsand sought to promote the unity and morale of the profession, at leastof the like-minded part of it.26

In format and style, the quality of antebellum medical journals leftmuch to be desired. The popular health journals tended to be the mostattractive in these respects, but they too frequently suffered from repe-tition, loose generalization, and pompous writing. Sectarian journalswere generally characterized by the prominence of their editorialpuffery, the monotonous columns of testimonial letters, and the one-sided accounts of local medical controversies, the whole poorly printedupon the cheapest paper. Professional medical journals of the regulars,by contrast, usually manifested at least some air of scientific objectiv-ity, though the results were all too frequently pretentious and prosaic,with such heavy doses of dry technical material as to deter all but themost diligent of medical readers. Some also assumed certain of the badtraits of other American periodicals of the day, which foreigners foundto be "filled ad nauseam with high-flown figures and dazzlingornaments."27

Medical journals were equally criticized for deficiencies in content.Scientific contributions by American authors in particular, though rel-atively few in number to start with, were frequently found to be super-ficial, badly written, derivative, or otherwise inferior. Those that wereoriginal tended, as an American Medical Association committee re-ported in 1848, to be quickly picked up and reprinted by competingjournals. There could be no thought of any real advance in Americanmedicine, the committee agreed, without serious attention to this sit-uation. This meant ensuring "the stern exclusion of unworthy articles

26. There was, of course, wide variation amongjoumals with respect to format, content, kindsof features included, and so on. Further investigation of these differences using systematic contentanalysis techniques would be useful. Such analysis, applied to the whole range of nineteenth-century American health-related periodicals, would among other things facilitate the scholarlyprocess of sorting and classifying them with respect to scientific, professional, educational,sectarian, and other factors.

27. Simmonds, (n. 8). John B. Blake, "Literary style in American medical writing," J. Am.Mtd. Ass., 216 (1): 77—80, 1971, provides a short but valuable analysis of the literary style andcontent of the nineteenth-century American medical journals.

146 Journal of the History of Medicine : Vol. 38, April IQ83

from Medical Journals [and] the substitution of original for parasiticalauthorship."28

Another major weakness of the journals lay in their book reviewsections. Reviews were often as lengthy as original articles, and just ascarelessly written. Not infrequently they were composed chiefly oflong extracts from the books being reviewed, and as such were hardlymore than filler material. At the other extreme were the routine shortbook notices which did not even pretend to be analytical. Composedtypically of four or five "lines of meaningless praise," this type ofreview was easily done and noncontroversial, but it did no one anygood. Only in the mid-fifties did American publishers begin to protestthe almost total lack of constructive criticism. And only then did someeditors begin to acknowledge their responsibility to elevate the reviews.At the very least, as Sanford Hunt pointed out, they had an obligationto pay serious attention to native American medical and scientific au-thors and to indicate how they could improve.29

With such basic shortcomings, few of the orthodox medical journalsof this country commanded very widespread respect before 1850, evenamong American readers. The one solid and consistent exception wasthe American Journal of the Medical Sciences. In fact, by 1847, with whatwas perceived as the decline of such leading British periodicals as theMedical-Chirurgical Review and the British and Foreign Medical Review,some Americans began touting the Philadelphia journal as "by far themost valuable now published in the world." One admirer opined that" The Edinburgh Medical and Surgical Journal is n o t t o b e c o m p a r e d t o i t . . .we know of no French or German, and still less Italian or Spanishmedical periodical that we would exchange for the American."30

In the 1850s a number of other American journals began to approachthe Philadelphia journal in quality. Native observers took pride in thefact that the journals were including substantially more original contri-butions. But foreign recognition of this improvement was another

28. As a result of such extensive journalistic borrowing, the Committee concluded, in OliverWendell Holmes's ironic words, that it seemed as if "the ring of editors sit in each other's laps,with perfect propriety and great convenience it is true, but with a wonderful saving in the articleof furniture." "Report of the Committee on Medical Literature," (n. 21), pp. 256, 288.

29. "Reviews of medical books," Buffalo Med.J., 12:316-317, 1856-57.30. In the mid-l84OS the Medical-Chirurgical Review was affected by the death of its long-term

editor, James Johnson, while John Forbes, the influential editor of the British and Foreign MedicalReview, was forced from this post by medical conservatives who accused him of disseminatinghomeopathic and other unorthodox therapeutic views. See review in South. Med. Surg.J., n.s.,_j:467-468, 1847.

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thing; European journals seldom took notice of American medicalarticles, let alone reprinting them the way the American journals did.L. N. Dugas sorrowfully remarked in 1856 that American medicalperiodical literature was "entirely unknown in foreign countries,"with the conspicuous exception of the readers of the Dublin MedicalPress. English editors were reported to regard the American journals asunreliable sources of information because of the well-known Americanpropensity for exaggeration. Incensed by this report, Dugas expendedmuch energy during the decade before the Civil War trying to interestthe American Medical Association in sponsoring a truly national medi-cal journal, one that would have the stature to make native medicalaccomplishments better known abroad.31 These efforts proved decid-edly premature, and it was not until 1883 that the Association's annualpublished transactions were transformed into a journal.

Whatever merit and distinctive character the various health-relatedjournals achieved could usually be attributed to their editors. Then asnow, those individuals carried on the day-by-day labors of solicitingcontributions, reading manuscripts, assigning reviewers, selecting ma-terial from other journals, and ferreting out miscellaneous news of theprofession. In performing these tasks, they often led chameleon-likeexistences. They were not only intellectuals but administrators, notmerely medical politicians but businessmen.32

The editors came from diverse backgrounds. Editors of regular med-ical journals were invariably physicians; those of sectarian or healthimprovement journals were sometimes laymen. Politically, many ed-itors were Whigs, but some supported other parties. Most tended toreflect the conventional morality closely. Regular editors tended tocome from the middle class, but at least a few, including David Hosackand John C. Warren, were among the wealthiest persons ofJacksonianAmerica, even though they did not always use their wealth to sustaintheir journals when they faltered. Editors of irregular journals, on theother hand, more often appealed to popular medical prejudices, gen-erally championed the rising segments of society, and sometimes madethe most of current antielitist and anti-intellectual sentiments. Hardly

31. See editorials in South. Mcd. Surg.}., n.s., 12: 574-576, 1856; ty 645-648, 1859; 16:154-'57.473-474, i860. Drake had called for such a journal even earlier. Drake, (n. 8), pp. 87-88.

32. A great deal remains to be done in further identifying these men, analyzing their back-grounds and their work as editors, and assessing their place in nineteendi-century Americanmedicine. This article suggests some of die matters that deserve further study.

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any of the editors ever received direct income for their labors unlessthey were also owners of the periodicals. As late as 1878, no more thanone or two individuals were known to be receiving salaries as editors.33

In personality, certain of the medical editors—Nathaniel Chapman,Bennet Dowler, Orson Fowler—by all accounts apparently belongedto the same colorful and forceful journalistic breed as newspaper ed-itors James Gordon Bennett and Horace Greeley. Others, notably IsaacHays, were quiet, unassuming, and professional. Some used their jour-nals extensively to publish their own ideas; others acted vigorously onbehalf of one or another of the medical schools of the day. Someconfined their efforts to the largely passive act of taking in communica-tions or news from local medical society meetings; others used theireditorial chairs much more energetically to conduct extensive corre-spondence and to carry on a far-flung search for material.

Typically, the editors of the pre-Civil War health-related journalswere hardworking individuals who spent long hours trying to maketheir periodicals succeed. And some consciously aspired to a high levelof journalism. However, given the prevailing conditions of antebellumAmerica, high standards were almost impossible to maintain. In addi-tion, few, if any, of the editors thought of themselves as professionaljournalists, not even those who remained editors for any length oftime. Hays, John D. Godman, John Eberle, and John Bell collectivelyedited at least eighteen different health periodicals at one time or an-other during this period, but they also busily taught and carried onprivate practices.34 Samuel Latham Mitchill's energies went into poli-tics, chemistry, geology, and innumerable other interests in addition tothe Medical Repository. Orson Fowler long kept as busy reading skullsand lecturing on health reform as editing the American PhrenologicalJournal. R. T. Trail's hydropathic establishment took as much rime ashis Water-Cure Journal. Samuel Forry may well have worked himself todeath in 1844 trying to get a major book written along with his editorialtasks on the New York Journal of Medicine.3S

Daniel Drake fitted his editorial duties into a heavy load of medicalteaching, research, and practice, along with a host of scientific and civic

33. Billings, "Literature and institutions," (n. 2), p. 342; Drake, (n. 8), p. 84.34. George Daniels, who counted seventeen journals as having been edited by one or another

of these four physicians, did not list John BcW'sJoumal of Health. George Daniels, American Sciencein the Age of Jackson, New York, 1968, pp. 17, 237.

35. Forry's contemporaries saw him as "a martyr to severe study . . . over-worked by labori-ous investigations." Sec "Death of Dr. Samuel Forry," Boston Med. Surg.J., 31: 346, 1844-45.

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pursuits. Drake also traveled widely in the Ohio and Mississippi val-leys collecting material for his studies of the diseases of the region.During those months on the road, he prepared what he called "travellingeditorials" as a means ofkeeping in touch with his readers. Where otherwandering editors, in the letters they sent back to their journals, com-mented at great length upon European medical institutions, Drakeused his trips to observe his native America and describe its expandingmedical scene.36

Most individuals did not remain editors long enough to achieve anyparticular journalistic reputation either for their periodicals or them-selves. But there were exceptions. Of the Medical Repository's threeoriginal editors, Edward Miller continued as editor for fifteen years andSamuel Latham Mitchill for over twenty. Isaac Hays was sole editor ofthe American Journal of the Medical Sciences for over forty years, from1827 to 1869, and then co-editor with his son until 1879.

Another well-known and highly durable medical editor was J. V. C.Smith, who directed the weekly Boston Medical and Surgical Journal fortwenty-two years, from 1834 to 1856. A fellow editor, Charles A. Lee,thought that Smith was "admirably" suited for medical journalism.Together with his training in medicine, Smith took to his work anacquaintance with the sciences, "a peculiar tact; great industry andperseverance; [and] a kind and amiable disposition, which seems toshield everything but downright quackery." Less charitably than Lee,Ezra Hunt argued that these tolerant qualities of "Alphabet Smith"turned the Boston journal in the 1830s and 1840s into a veritable "re-ceptacle" of dubious material, since Smith was never known to rejectan article. Hunt believed that during those years the journal steadilydeclined in its influence among the regular profession, even thoughlarge numbers continued to read it. He thought that it was only afterSmith's departure in the 1850s that the periodical regained its "hon-orable" name.37

The wonder was, of course, given the devastatingly high mortalityrate of thejournals, that any mid-century physicians at all would want

36. Emmet Field Horine, "Daniel Drake and the origin of medical journalism west of theAllegheny Mountains," Bull. Hist. Med., 27: 217-235, 1953.

37. "American medical journals," (n. 18), pp. 138-139; [Hunt], "The medical world. Ajour-na] of universal medical science," Buffalo Med. J., 12: 312-315, 1856-57. Hunt thought thatSmith's conduct of a later journal demonstrated outright quackery. Ibid., p. 312. See also JosephGarland, "Jerome Van Crowningshield Smith," New Engl. J. Med., 283: 303-304, 1970, andJoseph Garland, "The New England Journal of Medicine, 1812-1968," J. Hist. Med., 24: 125-139, 1969.

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to become involved in such precarious enterprises. However, ante-bellum America had no shortage of individuals willing to take theserisks. As Billings observed, a few years later, it was "as useless to advisea man not to start a new journal as it is to advise him not to commitsuicide." The prevailing motivation behind such rash undertakings,Billings thought, was not the scientific spirit. Nor was it the urge "fordirect profit, but as an indirect advertisement, or—and this is morecommon—the desire to have a place in which the editor can speak hismind and attack his enemies without restraint."38

Whatever their motivations and longevity, the physician-editors col-lectively occupied one of the best possible positions for influencing andbringing about professional change in the American medical commu-nity. Through their journals they were the strategic conductors in thiscountry for the dissemination of the latest European medical advances.They publicized the need for new hospitals, quarantine facilities, andother medical institutions in their towns and cities. Within their parti-san limits, in their editorials and reviews, they were among the sharpestcritics of current medical practices and among the most tireless advo-cates of original research by Americans. The editors were, more oftenthan not, Baconians par excellence who made information gatheringand data collecting—through correspondence, questionnaires, reports,and the like—synonymous with early nineteenth-century medicalprogress. And at least some of them took seriously the tasks of tryingto elevate medical literacy and keeping alive the tradition of the physi-cian as a learned man.39

National Library of MedicineBethesda, Maryland

38. Billings, "Medical journals of the United States," (n. 2), p. 2.39. Again, further detailed analysis of the journals will be necessary to determine to what

extent given editors actually did exercise these various techniques for influencing medical devel-opment.