AgeographerwhowasaskedtodescribethetidesofMassachusettsBay，wouldhavetorecognizethecircumstancethattheyarealimitedmanifestationofagreatoceanicmovement。Toconsiderthemapartfromthis，wouldbetolocalizeaplanetaryphenomenon，andtoprovincializealawoftheuniverse。TheartofhealinginMassachusettshassharedmoreorlessfullyandreadilythemovementwhich，withitsperiodsofebbandflow，hasbeenraisingitslevelfromagetoagethroughoutthebetterpartofChristendom。ItspractitionersbroughtwiththemmuchoftheknowledgeandmanyoftheerrorsoftheOldWorld；theyhavealwaysbeenincommunicationwithitswisdomanditsfolly；itisnotwithoutinteresttoseehowfarthenewconditionsinwhichtheyfoundthemselveshavebeenfavorableorunfavorabletothegrowthofsoundmedicalknowledgeandpractice。
Thestateofmedicineisanindexofthecivilizationofanageandcountry，——oneofthebest，perhaps，bywhichitcanbejudged。
Surgeryinvokestheaidofallthemechanicalarts。Fromtherudeviolencesoftheageofstone，——arelicofwhichwemayfindinthepracticeofZipporah，thewifeofMoses，——tothedelicateoperationsofto-dayuponpatientslulledintotemporaryinsensibility，isaprogresswhichpresupposesaskillinmetallurgyandinthelaborsoftheworkshopandthelaboratoryithastakenuncountedgenerationstoaccumulate。Beforethemorphiawhichdeadensthepainofneuralgia，orthequininewhicharreststhefitofanague，canfindtheirplaceinourpharmacies，commercemusthaveperfecteditsmachinery，andsciencemusthaverefineditsprocesses，throughperiodsonlytobecountedbythelifeofnations。Beforethemeanswhichnatureandarthaveputinthehandsofthemedicalpractitionercanbefairlybroughtintouse，theprejudicesofthevulgarmustbeovercome，theintrusionsoffalsephilosophymustbefencedout，andthepartnershipwiththepriesthooddissolved。Allthisimpliesthatfreedomandactivityofthoughtwhichbelongonlytothemostadvancedconditionsofsociety；andtheprogresstowardsthisisbygradationsassignificantofwide-spreadchanges，asarethevaryingstatesofthebarometeroffar-extendedconditionsoftheatmosphere。
Apart，then，fromitsspecialandtechnicalinterest，mysubjecthasameaningwhichgivesacertainimportance，andevendignity，todetailsinthemselvestrivialandalmostunworthyofrecord。A
medicalentryinGovernorWinthrop’sjournalmayseematfirstsightamerecuriosity；but，rightlyinterpreted，itisakeytohiswholesystemofbeliefastotheorderoftheuniverseandtherelationsbetweenmanandhisMaker。Nothingshedssuchlightonthesuperstitionsofanageastheprevailinginterpretationandtreatmentofdisease。Whenthetouchofaprofligatemonarchwasacureforoneofthemostinveterateofmaladies，whenthecommonsymptomsofhysteriawereprayedoverasmarksofdemoniacalpossession，wemightwellexpectthespiritualrealmsofthoughttobepeopledwithstillstrangerdelusions。
LetusgobeforethePilgrimsoftheMayflower，andlookattheshoresonwhichtheyweresoontoland。Awastingpestilencehadsothinnedthesavagetribesthatitwassometimespiouslyinterpretedashavingprovidentiallypreparedthewayforthefeeblebandofexiles。CottonMather，who，nexttothewitches，hatedthe“tawnies，““wildbeasts，““blood-hounds，““rattlesnakes，“
“infidels，“asindifferentplaceshecallstheunhappyAborigines，describestheconditionofthingsinhislivelyway，thus：
“TheIndiansinthesePartshadnewly，evenaboutaYearorTwobefore，beenvisitedwithsuchaprodigiousPestilence；ascarriedawaynotaTenth，butNinePartsofTenyea’tissaidNineteenofTwentyamongthemsothattheWoodswerealmostclearedofthoseperniciousCreaturestomakeRoomforabetterGrowth。“
Whatthispestilencewashasbeenmuchdiscussed。Itisvariouslymentionedbydifferentearlywritersas“theplague，““agreatandgrievousplague，““asoreconsumption，“asattendedwithspotswhichleftunhealedplacesonthosewhorecovered，asmakingthe“wholesurfaceyellowaswithagarment。“Perhapsnodiseaseanswersalltheseconditionssowellassmallpox。WeknowfromdifferentsourceswhatfrightfulhavocitmadeamongtheIndiansinafteryears，——in1631，forinstance，whenitsweptawaytheaboriginalinhabitantsofwholetowns，“andin1633。Wehaveseenawholetribe，theMandans，extirpatedbyitinourownday。Theword“plague“wasusedveryvaguely，asinthedescriptionofthe“greatsickness“foundamongtheIndiansbytheexpeditionof1622。Thissamegreatsicknesscouldhardlyhavebeenyellowfever，asitoccurredinthemonthofNovember。Icannotthink，therefore，thateitherthescourgeoftheEastorourSouthernmalarialpestilencewasthediseasethatwastedtheIndians。Asfortheyellownesslikeagarment，thatistoofamiliartotheeyesofallwhohaveeverlookedonthehideousmaskofconfluentvariola。
Withoutthepresenceorthefearoftheseexoticmaladies，theforlornvoyagersoftheMayflowerhadsicknessenoughtocontendwith。AttheirfirstlandingatCapeCod，gauntandhungryandlongingforfreshfood，theyfounduponthesandyshore“greatmussel’s，andveryfatandfullofsea-pearl。“Sailorsandpassengersindulgedinthetreacherousdelicacy；whichseemstohavebeenthesea-clam；andfoundthatthesemollusks，liketheshellthepoettellsof，rememberedtheiraugustabode，andtreatedtheway-
wornadventurerstoagastricreminiscenceoftheheavingbillows。
Inthemeantimeitblewandsnowedandfroze。Thewaterturnedtoiceontheirclothes，andmadethemmanytimeslikecoatsofiron。
EdwardTilleyhadliketohave“sounded“withcold。Thegunner，too，wassickuntodeath，but“hopeoftrucking“kepthimonhisfeet，——aYankee，itshouldseem，whenhefirsttouchedtheshoreofNewEngland。Most，ifnotall，gotcoldsandcoughs，whichafterwardsturnedtoscurvy，whereofmanydied。
Howcanwewonderthatthecrowdedandtempest-tossedvoyagers，manyofthemalreadysuffering，shouldhavefallenbeforethetrialsofthefirstwinterinPlymouth？Theirimperfectshelter，theirinsufficientsupplyofbread，theirsaltedfood，nowinunwholesomecondition，accounttoowellforthediseasesandthemortalitythatmarkedthisfirstdreadfulseason；weakness，swellingofthelimbs，andothersignsofscurvy，betrayedthewantofpropernourishmentandprotectionfromtheelements。InDecembersixoftheirnumberdied，inJanuaryeight，inFebruary，seventeen，inMarchthirteen。
Withtheadvanceofspringthemortalitydiminished，thesickandlamebegantorecover，andthecolonists，saddenedbutnotdisheartened，appliedthemselvestothelaborsoftheopeningyear。
Oneofthemostpressingneedsoftheearlycolonistsmusthavebeenthatofphysiciansandsurgeons。InMr。Savage’sremarkableGenealogicalDictionaryofthefirstsettlerswhocameoverbefore1692andtheirdescendantstothethirdgeneration，Ifindscatteredthroughthefourcrowdedvolumesthenamesofonehundredandthirty-
fourmedicalpractitioners。Ofthese，twelve，andprobablymanymore，practisedsurgery；threewerebarber-surgeons。AlittleincidentthrowsaglimmerfromthedarklanternofmemoryuponWilliamDirely，oneofthesepractitionerswiththerazorandthelancet。HewaslostbetweenBostonandRoxburyinaviolenttempestofwindandsnow；tendaysafterwardsasonwasborntohiswidow，andwithatouchofhomelysentiment，Ihadalmostsaidpoetry，theycalledthelittlecreature“Fathergone“Direly。Sixorseven，probablyalargernumber，wereministersaswellasphysicians，oneofwhom，Iamsorrytosay，tooktodrinkandtumbledintotheConnecticutRiver，andsoended。Onewasnotonlydoctor，butalsoschoolmasterandpoet。Onepractisedmedicineandkeptatavern。
Onewasabutcher，butcallshimselfasurgeoninhiswill，aunionofcallingswhichsuggestsanobviouspleasantry。Onefemalepractitioner，employedbyherownsex，——AnnMoore，——wastheprecursorofthatintrepidsisterhoodwhosecauseithaslongbeenmypleasureandprivilegetoadvocateonallfittingoccasions。
OutsideofthislistImustplacethenameofThomasWilkinson，whowascomplainedof，is1676，forpractisingcontrarytolaw。
Manynamesinthecatalogueoftheseearlyphysicianshavebeenassociated，inlaterperiods，withthepracticeoftheprofession，——
amongthem，Boylston，Clark，Danforth，Homan，Jeffrey，Kittredge，Oliver，Peaslee，Randall，Shattuck，Thacher，Wellington，Williams，Woodward。ToutonwasaHuguenot，BurchstedaGermanfromSilesia，LunerusaGermanoraPole；“PighoggChurrergeon，“Ihope，forthehonoroftheprofession，wasonlyPeacockdisguisedunderthisalias，whichwouldnot，Ifear，proveveryattractivetopatients。
Whatdoctrinesandpracticewerethesecolonistslikelytobring，withthem？
TwoprincipalschoolsofmedicalpracticeprevailedintheOldWorldduringthegreaterpartoftheseventeenthcentury。ThefirstheldtotheoldmethodsofGalen：itstheorywasthatthebody，themicrocosm，likethemacrocosm，wasmadeupofthefourelements——
fire，air，water，earth；havingrespectivelythequalitieshot，dry，moist，cold。Thebodywastobepreservedinhealthbykeepingeachofthesequalitiesinitsnaturalproportion；heat，bythepropertemperature；moisture，bythedueamountoffluid；andsoastotherest。Diseaseswhicharosefromexcessofheatweretobeattackedbycoolingremedies；thosefromexcessofcold，byheatingones；andsooftheotherderangementsofbalance。Thiswastrulytheprincipleofcontrariescontrariis，whichill-informedpersonshaveattemptedtomakeouttobethegeneraldoctrineofmedicine，whereasthereisnogeneraldogmaotherthanthis：diseaseistobetreatedbyanythingthatisprovedtocureit。ThemeanstheGalenistemployedwerechieflydietandvegetableremedies，withtheuseofthelancetandotherdepletingagents。Heattributedthefourfundamentalqualitiestodifferentvegetables，infourdifferentdegrees；thuschicorywascoldinthefourthdegree，pepperwashotinthefourth，endivewascoldanddryinthesecond，andbitteralmondswerehotinthefirstanddryintheseconddegree。Whenwesay“coolasacucumber，“wearetalkingGalenism。Theseedsofthatvegetablerankedasoneof“thefourgreatercoldseeds“ofthissystem。
GalenismprevailedmostlyinthesouthofEuropeandFrance。ThereadersofMolierewillhavenodifficultyinrecallingsomeofitsfavoritemodesoftreatment，andtheabundantmirthheextractedfromthem。
TheseGalenistswerewhatweshouldcall“herb-doctors“to-day。
Theirinsignificantinfusionslostcreditafteratime；theirabsurdlycomplicatedmixturesexcitedcontempt，andtheirnauseousprescriptionsprovokedloathinganddisgust。AsimplerandbolderpracticefoundwelcomeinGermany，dependingchieflyonmineralremedies，mercury，antimony，sulphur，arsenic，andtheuse，sometimesthesecretuse，ofopium。WhateverwethinkofParacelsus，thechiefagentintheintroductionoftheseremedies，andwhateverlimitswemayassigntotheuseoftheselong-trustedmineraldrugs，therecanbenodoubtthatthechemicalschool，asitwascalled，didagreatdealtowardstheexpurgationoftheold，overloaded，andrepulsivepharmacopoeia。WeshallfindevidenceinthepracticeofourNew-
Englandphysiciansofthefirstcentury，thattheyoftenemployedchemicalremedies，andthat，bytheearlypartofthefollowingcentury，theirchieftrustwasinthefewsimple，potentdrugsofParacelsus。
Wehaveseenthatmanyofthepractitionersofmedicine，duringthefirstcenturyofNewEngland，wereclergymen。Thisrelationbetweenmedicineandtheologyhasexistedfromaveryearlyperiod；fromtheEgyptianpriesttotheIndianmedicine-man，thealliancehasbeenmaintainedinoneformoranother。ThepartnershipwasverycommonamongourBritishancestors。Mr。Ward，theVicarofStratford-on-
Avon，himselfanotableexampleoftheunionofthetwocharacters，writingabout1660，says，“TheSaxonshadtheirblood-letters，butundertheNormansphysicke，begunneinEngland；300yearsagoeittwasnotadistinctprofessionbyitself，butpractisedbymeninorders，witnessNicholasdeTernham，thechiefEnglishphysicianandBishopofDurham；HughofEvesham，aphysicianandcardinal；Grysant，physicianandpope；JohnChambers，Dr。ofPhysick，wasthefirstBishopofPeterborough；PaulBush，abachelorofdivinitieinOxford，wasamanwellreadinphysickaswellasdivinitie，hewasthefirstbishopofBristol。“
“AgaininKingRichardtheSecond’stimephysiciansanddivineswerenotdistinctprofessions；foroneTydeman，BishopofLandaphandWorcester，wasphysiciantoKingRichardtheSecond。“
Thisalliancemayhavehaditsshareincreatingandkeepingupthemanysuperstitionswhichhavefiguredsolargelyinthehistoryofmedicine。ItiscurioustoseethatamedicalworkleftinmanuscriptbytheRev。CottonMatherandhereaftertobereferredto，isrunningoverwithfolliesandsuperstitiousfancies；whilehiscontemporaryandfellow-townsman，WilliamDouglass，reliedonthesamefewsimpleremedieswhich，throughDr。EdwardHolyokeandDr。
JamesJackson，havecomedowntoourowntime，asthemostimportantarticlesofthemateriamedica。