Nineteenth-Century American Medicine: the Implications of Professionalism, Capitalism, and Implicit Bias

Nineteenth-Century American Medicine: The Implications of Professionalism, Capitalism, and Implicit Bias DISSERTATION Presented in Partial Fulfillment for the Requirements for The Degree Doctor of Philosophy in the Graduate School of The Ohio State University By Amy Gregg, B.A., M.A. Graduate Program in Comparative Studies The Ohio State University 2017 Dissertation Committee: Maurice E. Stevens, Advisor Robert A. Buerki Christine Ballengee-Morris Copyright by Amy Gregg 2017 Abstract An examination of the history of medicine and pharmacy uncovers evidence of struggles among rival groups of practitioners in the process of establishing modern professional standards. Within these struggles, there is unmistakable evidence of bias during the nineteenth century that privileged the perspectives of the wealthy elite of American society. Drawing upon critical race theory, and the process of racialization as described by Richard Delgado and Jean Stefancic, this dissertation explores the development of medicine and pharmacy in the United States during the nineteenth century with respect to their maturation as it relates to the struggle for authority between sectarian and allopathic practitioners. It focuses on the impact that implicit bias had on what was considered legitimate medicine and who was valued as an authentic physician. The work of Dr. Francis Peyre Porcher constitutes a significant illustration: Porcher’s fifty-year career as a medical practitioner, researcher, and influential writer represents a synthesis of his interests in botanic medicine and the most advanced medical practices of his day, which he learned from his studies at the Medical School of South Carolina and France’s Paris Clinic. The ensuing period from the late nineteenth century through the twentieth century effectively sidelined practices such as botanic medicine as industrialization and capitalism institutionalized medicine and pharmacy into large corporations. It is this dissertation’s primary purpose to demonstrate that from a social and cultural standpoint, implicit biases deeply influenced the process of medical professionalization during the nineteenth century; and thus must be acknowledged as having impact on how medicine and pharmacy are practiced, distributed, and received in modern American society. ii Acknowledgements I have many people to thank for their support throughout my graduate school experience, and the researching and writing of this dissertation. First, to my advisor, Dr. Maurice Stevens, a most remarkable scholar and educator, who inspired me to believe in my project and myself. It has been a privilege, Maurice. Thank you, Dr. Robert Buerki, for bringing me to The Ohio State University, teaching me all there is to know about pharmacy ethics, and for your dedicated and meticulous editorial work. It has been an honor, Dr. B. The final member of my committee, Dr. Christine Ballengee-Morris connected me to a part of myself that I had been missing for decades. Thank you, Christine, I am forever grateful. The graduate school experience can be intimidating, but if one is fortunate, there are people to help guide one through, Maurice, Dr. B., and Christine, you are wonderful mentors and I am one lucky graduate student. Tim Watson, Director of Graduation Services made sure all of my “I’s” were dotted and my “T’s” were crossed. Thank you, Tim! To the Assistant Dean of the Graduate School, Dr. Kathleen Wallace, thank you for your support and encouragement. Thank you to Dr. Gregory Higby and the American Institute of the History of Pharmacy for the financial support. To Robin Kipps of the Pasteur and Galt Apothecary at Colonial Williamsburg, thank you for your contributions to the Apothecary Chart and for the many hours we spent discussing the historical roots of pharmacognosy. iii To my mom, Pamela Welling Gregg, you have always believed in me even when I lost faith. This project would not have been produced without your constant, quiet confidence in my success. To my partner, Dr. Andrew P. Millar, your steadfast patience and our numerous conversations about health-care inequity solidified my convictions that this project needed to be completed. To my dad, Tom Gregg, thank you for giving of your time, so that I might have time to write. Thanks to the Watkins for their support. Dr. Curt Spear, thank you for walking with me through this journey and for yelling at me to “just finish!” To Dr. Terry Chappell, you are a pristine example of the best of who there is in American medicine. Thank you for intersecting healing with science. To Angel, Diane, Dave, and Rick, thanks for keeping me going. Writing a dissertation is a labor of love and conviction. It is an arduous task; however, the relationships, which are made along the way, are simply the best. This dissertation is the culmination of many years of learning, reading, experiencing, and researching American history, American medicine, and the fragility of the human condition, in a country, where health care is a privilege rather than a right. It is my hope that it contributes to the debate concerning health-care legislation. iv Vita Candidacy, Ph.D. Comparative Studies, The Ohio State University Nineteenth-Century American Medicine: the Implications of Professionalism, Capitalism, and Implicit Bias…………………………………………….2008 - 2017 Master of Arts, Comparative Studies, The Ohio State University ………2009 - 2017 Master of Arts, History, Miami University………………………………2000 - 2003 Bachelor of Arts, History, Northern Kentucky University………………1991 - 1995 Adjunct Professor Department of History • Northern Kentucky University………………...2013 - present Department of Women’s Studies Graduate Teaching Assistant (TA for Robert A. Buerki, PhD)……….2013 - 2015 School of Pharmacy • The Ohio State University Graduate Teaching Associate (Instructor of Record) Department of Comparative Studies • The Ohio State University……....2009 - 2013 Graduate Teaching Assistant (TA for Robert A. Buerki, PhD) School of Pharmacy • The Ohio State University………………………2011 - 2013 Graduate Teaching Assistant (TA for Philip Armstrong, PhD) Department of Comparative Studies • The Ohio State University……... 2008 - 2009 Adjunct Instructor Department of History • Wright State University……………………….2007 - 2008 Colonial Williamsburg Brickman Intern at the Pasteur and Galt Apothecary…………………...Summer 2016 Supervisor: Robin Kipps, Apothecary Director v Georgetown Historical Rice Field Association……………May 2005-September 2005 Historic Charleston Foundation…………………………...Summer 2003 Boone Hall Plantation………………………………………Summer 2003 Publications Amy Gregg, “Nineteenth-Century Materia Medica and its Multicultural Medicinal Connections,” The Journal of Civil War Medicine 15:4 (2011), pp. 172-78. Fields of Study Major Fields of Study: Department of Comparative Studies The History of American Medicine and Pharmacy, Pharmaceutical and Biomedical Ethics, American Indian Identity, Critical Race Theory, American Social History, Antebellum America and Civil War History, American Women’s History and Gender History vi Table of Contents Page Abstract . ii Acknowledgements . iii Vita . v Table of Contents . vii Chapter 1: Introduction . 1 Chapter 2: The Racialization of American Indians and the Denigration of Their Medicinal Practices . 23 Chapter 3: Slavery, the Civil War, and the Myth of the Lost Cause . 42 Chapter 4: Women, Nature, and the Sphere of Domesticity . 66 Chapter 5: Francis Peyre Porcher: A Nineteenth-Century Physician at the Intersection of Sectarian and Early Modern Practices . 92 Chapter 6: Growth, Institutionalism, and Corruption . 119 Chapter 7: Conclusion . 140 Appendix A: Francis Peyre Porcher, M.D. .155 Appendix B: The Medicinal Garden of the Pasteur And Galt Apothecary at Colonial Williamsburg . 162 Bibliography . .188 vii Chapter 1: Introduction The scholarship regarding American medicine is expansive and diverse in scope. Among the main areas of study are the different therapeutic approaches practiced by both nineteenth-century sectarian and allopathic physicians. The focus here is the acquisition of legitimacy and authority during the professionalization process of the nineteenth century by allopathic physicians. While no one questions that allopathic physicians gained medical authority during this period, the interesting point is how and why. Michel Foucault, Paul Starr, and Hans Baer have each examined the period in question and their work lays a foundation for this study of the process by which legitimacy was established within and between medicine and pharmacy. In The Birth of the Clinic, Michel Foucault identified the Paris School (1790- 1850) as the decisive moment in the shift of clinical attention from healing the individual sick patient to studying disease entities as the object of research.1 The impact of the Paris Clinic and its approach to medicine created a crisis in Antebellum America with respect to how disease was understood, how medicine should be administered, what determined therapeutic treatment, and who was a legitimate physician. The result of that crisis was a rupture in the framework of therapeutic medicine wherein physicians who had been 1 John Harley Warner, Against the Spirit of System: The French Impulse in Nineteenth- Century Medicine (Princeton, New Jersey: Princeton University Press, 1998), p. 369. 1 heavily schooled in botany and the phytomedicinal agency of plants were now educated in the art of dissection and the efficacy of chemicals. What then occurs is not an erasure of the former, but to use Jacques Derrida’s concept

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