The State of Pathology in the British Colonies of North America *

"Pathology" during the 17th and 18th centuries, both in Great Britain and the Continent and in the British colonies of North America, was by no means the well-defined division of medicine that it later became. The name, to be sure, had long been in use (at least since the time of Galen) to signify, rather loosely, the nature of disease.12 It is in the broader sense of the word (i.e., including concepts of causes and development of diseases as well as pathologic anatomy) that I would now like to consider the state of Pathology in the British colonies. By considering the diseases and epidemics noted as prevalent, current ideas on etiology and pathogenesis, erroneous though they were, and the reports of autopsies, I hope that a picture may emerge, even though fragmentary and incomplete, of the state of pathology along the Atlantic seaboard during the 17th and 18th centuries. For some aspects, such as etiology, to be sure, the available material offers us but little of value; disease incidence also may seem to occupy too much of our attention. In all branches of pathology, we may expect to find that knowledge in the young colonies was perforce more crude than in the leading European countries of the same decades. For much of the period under consideration, practically the only persons holding an M.D. were those who had emigrated from Europe, and colonial medicine was learned by the apprentice system, or often by clergymen, government officials, and others, from books and from personal experience. In the last half century of the period more and more sons of the well-to-do flocked to Edinburgh and London and a few to continental schools; and it was only in the decade before the Revolution that a few medical schools were formed in the colonies themselves. If a practitioner received any medical training at all, other than from his own mistakes, it was as an apprentice, perhaps for as much as six or eight years, to an established practitioner. This was, and still is, a good way to learn how to care for the sick, as far as the application of current medical knowledge is