Capitalism and religion: how they changed the doctor-patient relationship

Catherine Thompson, Graduate Fellow-Humanities Institute at the University of Connecticut. Courtesy of University Communications.

Patients paid their doctors in corn, honey, shoes or saddles. One man built a coffin for a doctor’s relative

Sometimes Catherine Thompson feels like a detective as she sifts through diaries, journals, family correspondence, and physicians’ case books.

Thompson is examining the relationships between patients and physicians in early America from 1750 to 1850.

“I’m researching what kind of care people received for common ailments like headaches, fevers, coughs, and gastrointestinal problems — things that a primary care physician would handle today,” says Thompson, who is graduate fellow this year at the Humanities Institute in the College of Liberal Arts and Sciences at the University of Connecticut.

“It’s like detective work,” she said. “People didn’t just write about their illnesses in their diaries. Health matters are buried in between everything else.”

Patient journals indicate that during the 18th century, people sought relief rather than cures, Thompson said. “They basically wanted to get back to work, and the pain interfered with that. Only quacks - who went from town to town giving out potions - promised cures.”

Thompson, a doctoral candidate in American history, says her research focuses on an area that hasn’t been studied. “Historians of medicine have analyzed the transformation of American medicine into a profession, but no one has yet examined how the early stages of professionalization affected physicians’ interactions with patients,” she explained.

Thompson's research focuses on the urban area of Boston, the town of Worcester and Deerfield, Mass.

From about 1790 to 1820, orthodox physicians – those trained at a university or through an apprenticeship – practiced 'heroics,' characterized by purges and emetics, she said.

By the 1820s, 'heroics' fell out of favor with the public, and by 1830, it was rarely practiced.

“There were more choices within the medical community at that time,” she says. And by the early 19th century, people wanted cures – particularly urban middle class patients.

Relationship between patients and their doctors changed with the economic times. At first, “People didn’t pay in cash. For example, one physician gave medical services to a man, and also gave him a gun. The patient gave him a better gun in return. Patients paid their doctors in corn, honey, shoes or saddles. One man built a coffin for a doctor’s relative.”

But the rise of capitalism in the 19th century changed the patient-physician relationship.

In the urban areas, doctors were now paid in cash or promissory notes. And so, people were no longer tied up in a social and financial web with their physicians, and had the freedom to go to a variety of physicians and specialists.

Religious developments also influenced patient-physician relationships. In the 19th century, the emergence of liberal Protestants - such as the Unitarians in Boston - meant that some middle-class patients no longer believed that God tested the state of their faith with disease.

Others - such as orthodox Calvinists - were still more likely to only seek relief from pain, because they believed a cure was in God’s hands.

Thompson also examines the changing roles of physicians’ wives.

Doctors’ wives in the 18th century did auxiliary work, such as book keeping, putting out medicines, and growing herbs for medical purposes..

“In the 19th century, when the financial bonds weakened between physicians and patients, doctors’ wives served to strengthen the intimacy bonds between their husbands and their patients,” Thompson said. Wives’ roles became more social, particularly in the urban areas, where they engaged in social networking and bolstered their husbands’ reputations in the community.

Thompson's favorite part of the research is reading the diaries. “Many of the people seem very familiar,” she said. “Sometimes I’ll start reading a journal to find something I need, but I get so caught up in the person’s life I can’t put it down.”

Thompson, originally from Shreveport , La. , has a master’s degree in European history and literature from Louisiana State University, and a bachelor’s degree in biology from the University of Colorado .

Posted Nov. 7, 2008