20
Social History of Alcohol and Drugs, Volume 24, No 1 (Winter 2010)
“HE IS AN EXCELLENT DOCTOR IF
CALLED WHEN SOBER”: TEMPERANCE,
PHYSICIANS AND THE AMERICAN
MIDDLE CLASS, 1800-1860
SCOTT C. MARTIN
Abstract. During the early nineteenth century, many American physicians
abandoned the personal and professional use of alcohol. This change in
SUDFWLFHUHÀHFWHGWKHJURZLQJLQÀXHQFHRI%HQMDPLQ5XVKDQGWKHWHPSHUDQFHPRYHPHQW,WDOVRVWHPPHGIURPGRFWRUV¶GHVLUHWRDWWDLQPLGGOHFODVV
VWDWXVDQGUHVSHFWDELOLW\IRUWKHSURIHVVLRQ'UXQNHQLQFRPSHWHQWGRFWRUV
GLPLQLVKHGSXEOLFFRQ¿GHQFHLQDQGHVWHHPIRUSK\VLFLDQV%\DGYRFDWLQJ
WHPSHUDQFHSK\VLFLDQVFRQ¿UPHGWKHLUDFFHSWDQFHRIPLGGOHFODVVYDOXHV
and cemented their class status. Dr. Thomas Sewall, a temperance advocate and successful physician, illustrates how an anti-alcohol stance could
UHKDELOLWDWHDGRFWRU¶VSXEOLFLPDJH$QRWKHUFRQFHUQZDVSK\VLFLDQV¶UROH
in promoting intemperance in women through the prescription of alcohol
for female illnesses. Though doctors eventually abandoned strict temperance, they retained the gender norms that underpinned it, continuing to
prescribe drugs differentially for women
In 1819, a Pennsylvania newspaper published a humorous poem entitled “The
Doctor and the Lady.” It recounted the story of a physician who, “when all his
GDLO\ODERUVZHUHIXO¿OO¶G+LVSDWLHQWFXU¶G±VRPHWLPHVKLVSDWLHQWNLOO¶G´
enjoyed a “generous glass of wine” with his dinner. After a particularly exhausting day of battling “fever, cough and gout,” the doctor “his usual dose
ventured to exceed” by consuming two bottles of wine. While “fairer visions
GDQF¶GEHIRUHKLVH\HV´WKHGRFWRUUHFHLYHGDFDOOWRDWWHQGDVHYHUHO\LOOODG\
Leaving his glass to “succor sovereign beauty,” the bibulous physician made
KLVKRXVHFDOOEXWIRXQGKLPVHOIWRREHIXGGOHGE\GULQNWRSUHVFULEHIRUKLV
unconscious patient:
But mindless of the tenets of his tribe,
That ever urges something to prescribe,
A certain dizzy swimming in his head
$GPRQLVK¶GKLPKH¶GEHWWHUJRWREHG
0RUWL¿HGE\KLVVHOILQGXFHGLQFDSDFLW\WKHGRFWRUSURFXUHGDSHQDQGLQN
IURPDVHUYDQWDQG³ZLWKVRPHKXPLOLW\LQVFULE¶Gµdead drunk¶´RQDSLHFHRI
paper. Instructing the servant to give the note to his mistress, he promised to
Scott C. Martin is Professor of History and American Culture Studies and Chair of the
History Department at Bowling Green State University.
SHAD (Winter 2010): 20-36
Martin: Temperance, Physicians and the American Middle Class, 1800-1860
21
return the next day to care for his patient.
At the appointed time old Galen came,
And trembling stood before the injur’d dame;
When she with down cast look and pallid hue,
,QIDOWHULQJYRLFHH[FODLP¶G³¶7LVYHU\WUXH
“But by the faith that you to woman owe,
ear Doctor, never let my husband know.”1
Though intended to poke fun at both physicians’ professional hauteur and
women’s exaggerated image as moral exemplar, this amusing vignette points
WRVRPHWKLQJPRUHVLJQL¿FDQWWKHLQWHUUHODWLRQEHWZHHQLQFUHDVLQJFRQFHUQ
about excessive drinking by doctors, the medical profession’s embrace of
WHPSHUDQFH DQG PLGGOHFODVV YDOXHV GXULQJ WKH ¿UVW KDOI RI WKH QLQHWHHQWK
century, and physicians’ anxieties about their role in promoting a shocking
transgression of those values, namely, female intemperance. As physicians attempted to consolidate and elevate their professional standing and reputation
in the decades before the Civil War, the medical bungling of inebriated doctors proved a substantial obstacle. Central to physicians’ desire to improve
their professional lot was their inclusion in the rapidly coalescing American
PLGGOHFODVVPHPEHUVKLSLQZKLFKKDGDOUHDG\EHVWRZHGVLJQL¿FDQWVRFLDO
HFRQRPLFDQGFXOWXUDOEHQH¿WVRQSUDFWLWLRQHUVRIRWKHUOHDUQHGSURIHVVLRQV
law, education, and the ministry. Temperance represented a primary tenet
of middle-class ideology, making it essential that physicians adopt sobriety
themselves, and avoid producing intemperance in others, particularly women,
through their medical practice. Middle-class aspirations, the concomitant
necessity of defending their profession against charges of intemperance and
LQFRPSHWHQFHDQGWKHJURZLQJLQÀXHQFHRIPHGLFDOWHPSHUDQFHZULWLQJE\
Benjamin Rush and others, led American doctors to enlist almost en masse in
the war against drunkenness. Medical endorsement of temperance principles
DQGSUDFWLFHVERWKVLJQDOHGDQDI¿QLW\IRUPLGGOHFODVVYDOXHVDQGDOORZHG
doctors to distance themselves from the excesses of heroic medicine most
SUREOHPDWLF IRU ERXUJHRLV PRUHV 6SHFL¿FDOO\ LW UHPRYHG IURP SK\VLFLDQV
the stigma of responsibility for iatrogenically induced female intemperance
during a period when emerging gender roles, especially among the middle
class, depicted women’s drinking and anyone who promoted it, as monstrous
and disgusting.
My book, Devil of the Domestic Sphere: Temperance, Gender and MiddleClass Ideology, 1800-1860, examined the role of middle-class formation and
ideology in shaping physicians’ responses to temperance. Devil also noted
KRZPLGGOHFODVVLGHDVDERXWJHQGHU¿JXUHGLQPHGLFDOSURQRXQFHPHQWVRQ
WHPSHUDQFH5HYLVLWLQJWKHFDVH,KDGPDGHDQGUHYLHZLQJHYLGHQFHWKDWGLG
not make it into the book along with new material that came to light since
LWVSXEOLFDWLRQ,UHDOL]HGWKDWPRUHQHHGHGWREHVDLGDERXWGRFWRUVDQGWHPSHUDQFH ,Q SDUWLFXODU WKH UROH RI FODVV IRUPDWLRQLQ WKH DVFHQGDQFH RI WKH
temperance movement, which was an organizing theme for the book, seems
SDUWLFXODUO\LPSRUWDQWLQWKHFDVHRISK\VLFLDQV+HUH,ZRXOGGLIIHUHQWLDWH
22
Social History of Alcohol and Drugs, Volume 24, No 1 (Winter 2010)
P\DUJXPHQWIURPWKDWRI-RVHSK*XV¿HOGZKRVHSymbolic Crusade: Status
Politics and the American Temperance Movement reinvigorated temperance
KLVWRU\ LQ WKH HDUO\ V *XV¿HOG SDLQWHG WHPSHUDQFH UHIRUP DV WKH UHVSRQVHRIEHOHDJXHUHGHOLWHVZKRKDGORVWVRFLDOLQÀXHQFHDQGSUHVWLJHZLWK
the democratization of American society in the early nineteenth century. By
FUHDWLQJLQ*XV¿HOG¶VYLHZDVRFLDOSUREOHPZKLFKGRFWRUVPLQLVWHUVHGXcators and others of the old elite could address, these groups hoped to bolster
WKHLUÀDJJLQJDXWKRULW\Devil took a different tack, viewing temperance as
an effort by prosperous or aspiring citizens both to respond to a genuine probOHPDQGWRGH¿QHWKHLURZQYDOXHVDQGLGHQWLW\LQWKHUHODWLYHO\ÀXLGVRFLDO
milieu of the early nineteenth century. My analysis did not intend to discount
RWKHUH[SODQDWLRQVRIWKHULVHRIWKHWHPSHUDQFHPRYHPHQWHLWKHU*XV¿HOG¶V
(though it has been questioned by others) or those that emphasize the reform’s
links to the Second Great Awakening and anti-immigrant sentiment. Rather,
,ZDQWHGWRKLJKOLJKWWKHG\QDPLFVRIPLGGOHFODVVIRUPDWLRQDQGFRDOHVFHQFH
that animated much temperance enthusiasm. Physicians, whose professional
and social standing was intertwined in unique ways with their use of alcohol,
provide a striking example of the importance of class in temperance reform.
,QDGGLWLRQWKHH[SHULHQFHRISK\VLFLDQVZLWKWHPSHUDQFHXQGHUVFRUHVDQRWKHUIRFXVRIWKHERRNWKHLPSOLFDWLRQVDQGFRQWLQXLQJLQÀXHQFHRIWKHPLGGOH
class gender ideology that underpinned temperance reform. Physicians, like
other temperance advocates, imbibed much of this ideology, and it continued
WR LQÀXHQFH WKHLU PHGLFDO SUDFWLFH ORQJ DIWHU WKH\ DEDQGRQHG WHPSHUDQFH
This article will extend the arguments made in Devil of the Domestic Sphere,
exploring further American doctors’ abandonment of the medical and recreational use of alcohol during the antebellum years, highlighting the medical
and socio-cultural factors in this development, and suggesting ways in which
some aspects of temperance inspired gender ideology persist in medicine to
the present day.2
PHYSICIANS AND TEMPERANCE IN THE EARLY NINETEENTH CENTURY
Between 1800 and 1860, American doctors altered dramatically their personal
consumption and professional use of alcohol. Once considered an essential
part of the materia medicaDOFRKROIHOOLQWRGLVIDYRUXQGHUWKHLQÀXHQFHRI
Benjamin Rush (1745-1813). Perhaps better known for his pioneering medical
work and Revolutionary patriotism, Rush also helped to found the temperance
movement through his publication of An Enquiry into the Effects of Spirituous
/LTXRUVRQWKH+XPDQ%RG\DQGWKHLU,QÀXHQFHRQWKH+DSSLQHVVRI6RFLHW\
in 1784. Though Rush did not condemn the moderate use of fermented beverages, he asserted that distilled liquors are not necessary to health, and can
be injurious. Early in the new century, physicians seized upon Rush’s work
to support their claims that the intemperate use of liquor threatened to undermine the physical and moral health of American society. On Rush’s authority, for instance, an 1813 address on intemperance to Connecticut churches
Martin: Temperance, Physicians and the American Middle Class, 1800-1860
23
warned that physicians agree that “intemperate drinking has a direct tendency
to ruin health and shorten life.” Further west in Ohio, the Chilicothe Association for Promoting Morality and Good Order quoted Rush to highlight the
moral danger of drinking. Rush, the Association reminded readers in 1815,
had “known many men and women of excellent characters and principles”
who had been “betrayed by occasional doses of gin and brandy into a love of
OLTXRUV´ODWHUVXFFXPELQJWR³WKHLUIDWDOHIIHFWV´7KURXJK5XVK¶VLQÀXHQFH
even lay temperance advocates warned against the effects of using liquor as
medicine. Many men and women, John James Bound echoed Rush in 1820,
whose “moral characters in other respects stands unimpeached,” have “inadvertently brought on this disorder [intemperance]” through a “too free” use
of alcoholic beverages intended to “raise their spirits and add to their bodily
strength.”3
With the growing acceptance of Rush’s doctrines, other reformers felt con¿GHQWUHSURYLQJSK\VLFLDQVZKRVWLOOXVHGRUSUHVFULEHGDOFRKRO$QDQRQymous 1831 pamphlet, The Devil Turned Doctor, used a dialogue in verse
EHWZHHQ6DWDQDQGDIDUPHUWRFRQGHPQWKHXVHRIDOFRKRODVPHGLFLQH,Q
it, Satan employs all the arguments previously used by medical advocates of
alcohol to ensnare his unsuspecting victim, promising strength, good spirits,
DQGLPSURYHGGLJHVWLRQDVWKHEHQH¿WVRIGULQN
1RZ,KDYHLQWKLVERWWOHJRW
That which will make you warm when you’re hot;
Twill make you warm when you are cold,
And if faint-hearted make you bold…
When you are wet twill make you dry, –
$QGDWLWVWRXFKGLVHDVHZLOOÀ\
Satan dismisses the farmer’s objection that many condemn liquor, asserting
that when “rightly used” his “medicine” improves and prolongs life. Predictably, the farmer begins to drink, loses his farm, his life, and his soul, as Satan
returns at the end of the poem to conduct his spirit to Hell. Though this poem
was not directed at the medical profession per se, few physicians could have
missed the implications of this unsubtle likening of liquor-dispensing doctors
WRWKHGHFHLYLQJDUFK¿HQG4
The increasing pressure from the temperance movement to adopt an antiliquor stance had two major effects on American doctors. First, doctors began
to heed admonitions to “speak out, and reiterate former assertions – that there
is no case in which ardent spirit is indispensable, and for which there is no
substitute,” thereby denying the claim that alcohol is necessary for treating
disease. As the century progressed, doctors in all parts of the United States
acknowledged the dangers of alcohol, and began to advocate temperance or
abstinence to their patients. A committee of the Philadelphia Medical Society,
for instance, declared in 1829 that ardent spirits produced greater susceptibility to disease, along with a train of other potential woes such as delirium trePHQV,QThe Journal of Health and Recreation, a Philadelphia medical
journal, cited an article by one Dr. Caldwell, who warned that “the common,
24
Social History of Alcohol and Drugs, Volume 24, No 1 (Winter 2010)
external evidences of drunkenness, however odious and disgusting,” paled
before the mental derangement intemperance caused: “[it] gives to the inferior
portion of the brain supremacy over the superior, depresses morality and intellect below appetite and passion,” and reduces men to the level of brutes. A
year later the same journal noted approvingly that Philadelphia’s prestigious
College of Physicians had declared itself opposed to the consumption of ardent spirits, as medicine or beverage.5
Doctors elsewhere followed suit. The Boston Medical and Surgical Journal attributed a large measure of disease to intemperance, observing wryly
that physicians “as a profession, have received great praise from philanthroSLVWVIRURXUGLVLQWHUHVWHGVHOIVDFUL¿FHLQMRLQLQJWKHJHQHUDOFUXVDGHDJDLQVW
RXUEHVWSDWURQDQGWKXVFXWWLQJRIIWKHPRVWSUROL¿FVRXUFHRIRXUVXSSRUW´
Always practical, the unnamed physician who authored the piece consoled his
IHOORZSUDFWLWLRQHUVWKDWSURPRWLQJWHPSHUDQFHPLJKWEHEHQH¿FLDO¿QDQFLDOO\
for doctors after all, for temperate patients paid their bills more readily than
drunken ones. Dr. E. H. Barton of New Orleans struck a more serious note,
pressing on his readers the “unquestionable facts” that liquor created “almost,
if not quite all, our criminals and paupers, and more than half our taxes,” in
addition to corrupting public morality and undermining public health. Clearly,
by the mid-1830s at least, medical opinion had turned against the prescription
of alcohol as medicine.6
The second effect of the temperance movement’s pressure on physicians,
which was linked to this changing medical opinion, lay in doctors’ reconsideration of their own drinking. During the antebellum decades, American
doctors increasingly took their own medical advice by swearing off alcohol
themselves. As with the physician in the anecdote related above, doctors became embarrassed their own lapses in sobriety, and the damage they did to
WKHLUSURIHVVLRQ¶VUHSXWDWLRQ,QWHPSHUDQFHQRWHG7KRPDV6HZDOOZKRPZH
will encounter again, “is a rock on which many of our profession have foundered; a whirlpool into which many of them have been drawn.” Concerned
medical men had recognized early in the century that the “arduousness and
irregularity” of medical practice exposed physicians “peculiarly to the vice
of intemperance”: doctors’ “exposure to the vicissitudes and inclemencies of
the season,” and the “interruption of his hours of repose” furnished an excuse
for invitations to drink. Well-meaning patients and their families often urged
doctors weary from extensive travel on foot or horseback and exposure to the
elements in the course of their visits to the homes of the sick to imbibe spirits
WRLQYLJRUDWHERG\DQGPLQG,QWKH8QLWHG6WDWHVH[SODLQHG'U'DYLG+Rsack in 1830, “the fashion of drinking, urged upon the physician by misplaced
hospitality, and erroneously supposed to be necessary in counteracting fatigue
and exposure to cold and night air,” had led many physicians to fall victim “to
the vice of intemperance.” Physicians not only planted “the seeds of intemperance and death” by prescribing alcohol for patients, but were “themselves
the victims of their errors, even in larger proportion than they made victims
Martin: Temperance, Physicians and the American Middle Class, 1800-1860
25
of others.” One physician observed ruefully in 1853 that every doctor in Natchez thirty years ago “who as in the habit of tippling… has long since been
numbered with the dead! Only two of them, who were comparatively temperate, lived to be gray.” So prevalent were drunken doctors that intemperance
did not necessarily harm a doctor’s practice or reputation. During his medical
school days, Dr. John Bell recalled hearing “good, moral, and otherwise intelligent persons assert,” that “Doctor C. prescribed as well drunk as sober…
[and] that they would rather have him than Doctor D. to prescribe for them,
even though he were drunk.” As the perils of alcohol for patient and doctor
alike became clear, physicians changed their ways, altering their consumption
and prescriptive practices.7
MEDICINE, TEMPERANCE AND THE MIDDLE CLASS
Not coincidentally, physicians’ embrace of temperance coincided with the
medical profession’s efforts to solidify the respectability and middle-class
status of its members. Beginning around 1830, American doctors set about
constructing a professional “character,” with “the purpose of raising doctors
LQSXEOLFHVWHHPDQGFUHDWLQJVROLGDULW\ZLWKLQWKHSURIHVVLRQ´,QWKHDQWHbellum era, when popular respect for doctors was “at its lowest point, and
mistrust of medicine at its highest,” medical educators and advocates deemed
it essential that doctors embody the virtues and qualities which elevated professions such as law and the ministry in public estimation. Prominent physicians and medical school professors urged their colleagues and students to
cultivate earnestness, temperance, classical learning, and industry, to protect
and extend the good reputation of their profession. All these traits, but parWLFXODUO\WHPSHUDQFH¿JXUHGSURPLQHQWO\LQWKHDGYLFHERRNVDLPHGDW\RXQJ
men who inhabited or aspired to the middle class, that proliferated during the
1830s.8
Temperance recommended itself to doctors for two reasons. First, it removed an obstacle to professional competence; as the story of the impaired
physician that began this article suggests, drunken doctors could not attend
adequately to their patients. Second, and perhaps more importantly, advocating and adopting temperance principles attested to the staunch middle-class
respectability of doctors as a group. By the early 1840s, prominent physician
and reformer Daniel Drake could assert proudly that a change had occurred.
We can remember when it was sometimes said of a practitioner – “he is an excellent doctor if called when sober.” The reproach of intemperance can no longer be
ODLGWRWKHGRRURISK\VLFLDQV7KH\DUHHYHU\ZKHUHWKHHI¿FLHQWLQVWUXPHQWVLQ
the great moral revolution now going on.9
Drake described accurately the zeal with which the medical profession embraced temperance by the 1830s and 1840s. Physicians contributed to the
movement in a number of ways. Medical men had long played leading roles
in the establishment and support of temperance societies and institutions. A
doctor was among the three founders of one of the earliest documented tem-
26
Social History of Alcohol and Drugs, Volume 24, No 1 (Winter 2010)
perance societies, established in upstate New York in the early nineteenth cenWXU\3K\VLFLDQV¿JXUHGSURPLQHQWO\LQWKHHVWDEOLVKPHQWRIWKH0DVVDFKXVHWWV6RFLHW\IRUWKH6XSSUHVVLRQRI,QWHPSHUDQFH066,DVZHOO$PHHWLQJ
of concerned citizens in 1811, which included respected doctors R. D. Mussey
DQG-RVHSK7RUUH\OHGWRWKHIRXQGLQJRIWKH066,ZKLFKEHFDPHWKH0DVsachusetts Temperance Society in 1833. A warm relationship between physiFLDQVDQGWKH066,FRQWLQXHGRYHUWKH\HDUVLQWKH6RFLHW\¶VDQQXDO
report noted approvingly of the “ground being taken by several medical societies in different part of the country” regarding temperance, reserving special
SUDLVHIRUWKH0DVVDFKXVHWWV0HGLFDO6RFLHW\,Q3HQQV\OYDQLDWRRSK\VLFLDQVDVVXPHGOHDGHUVKLSSRVLWLRQVLQWHPSHUDQFHRUJDQL]DWLRQV,QIRU
instance, one of four vice presidents and eleven of thirty six managers of the
Pennsylvania Society for Discouraging the Use of Ardent Spirits were medical doctors.10
Medical doctors who embraced temperance engaged in institution building
LQDYDULHW\RIZD\V,QDGGLWLRQWRRUJDQL]LQJWHPSHUDQFHVRFLHWLHVSK\VLcians supported the establishment of asylums for chronic inebriates as well.
A Committee of the Connecticut Medical Society recommended in 1830 that
instead of “sending a drunkard to the “work-house for punishment, we would
have him sent to an asylum for reformation.” Medical men urged that drunkards could not be cured without some measure of control and compulsion, and
WKDWDV\OXPVZRXOGEHQH¿WWKHGULQNHUVWKHPVHOYHVWKHLUIDPLOLHVDQGVRFLHW\
DWODUJHE\UHGXFLQJWKHGHPDQGVRQFKDULW\DQGDOPVKRXVHV,I³LQIDFW´'U
Samuel Woodward asked in 1838, “intemperance in general cannot be cured
without restraint, and can be cured with it, – what is obviously the duty of the
community towards the intemperate?” Dr. John Francis emphasized the neFHVVLW\RIWKH1HZ<RUN6WDWH,QHEULDWH$V\OXPDWLWVRSHQLQJLQ,QOLQH
with medical opinion, the New York State legislature had granted the asylum
power to “receive and retain all inebriates who enter said asylum, either voluntarily or by the order of the Committee of any habitual drunkard.”11
Doctors also contributed to temperance reform by authoring articles, pamphlets and books for their peers and the educated lay public. As we have
already noted, numerous physicians noted that drinking seemed to make
patients more susceptible to a variety of illnesses, ranging from cholera to
yellow fever. Other medical men focused on the moral and intellectual, rather
than the physical toll of intemperance. Dr. R. D. Mussey, for instance, penned
a well-known essay during the 1830s, which informed his fellow practitioners
and the general public that “alcoholic excitation” weakened and “perverted”
the “reasoning powers and moral sense,” degrading the “noblest attributes of
human nature” by producing “indecent, profane, idiotic, or pugnacious garrulity.”12
,QDGGLWLRQWRGLVVHPLQDWLQJPHGLFDORSLQLRQVRQGULQNLQJSK\VLFLDQVDOVR
wrote general temperance tracts and pamphlets that owed their impact as much
to sensational rhetoric and imagery as to the medical professions’ social status
Martin: Temperance, Physicians and the American Middle Class, 1800-1860
27
and emerging middle-class morality. Elaine Frantz Parsons perhaps overstates
the case in arguing that “medical discourse on inebriety in the nineteenth century derived from more than it contributed to the popular temperance discourse.” She is close to the mark, however, in recognizing that much medical
ZULWLQJ ³ODUJHO\ GUHVV>HG@ XS GULQN GLVFRXUVH LGHDV LQ VFLHQWL¿F ODQJXDJH´
,QDFFRUGDQFHZLWKWKHLUPLGGOHFODVVDI¿OLDWLRQDQGVHQVLELOLWLHVGRFWRUVRIten emphasized the damage intemperance did to families. Charles Jewett and
Daniel Drake, both ardent temperance advocates, exemplify this trend. Of all
“on whom the dreadful effects of this vice may fall,” Drake lamented in 1828,
“none are so injured as a wife and children: – the wife especially, for whose
VLWXDWLRQZKHQWKHKDELWLVFRQ¿UPHGWKHUHLVLQJHQHUDOQRUHPHG\´-HZHWW
RSWHGIRUPRUHOXULGGHVFULSWLRQV,QDQZRUNGLUHFWHGDWFKLOGUHQ-HZett detailed harrowing scenes of child abuse committed by drunken parents,
all illustrated with engravings. One picture represented “a scene which has
often been witnessed in manufacturing villages: a drunken father driving his
children away to the mill, where they are made to work” for money he spends
at “taverns and grog-shops.” Another depicted a “hard-hearted man” holding his “little boy by the hair with one hand, while the other is raised to give
KLPDEORZ´DVKLV³DQ[LRXVPRWKHU´DWWHPSWVWRVDYHWKHODG,QERWKFDVHV
the physician-authors addressed a largely middle-class readership likely to
respond to their appeals and their claim of middle-class authority.13
The temperance movement gratefully embraced physicians’ efforts, seeing
LQWKHPVFLHQWL¿FDQGPHGLFDOFRQ¿UPDWLRQRIWKHLUPLGGOHFODVVPRUDOSUHdilections. The Temperance Volume, a compilation of temperance pamphlets
published by the American Tract Society in 1834, contained a number of references to doctors’ condemnation of drinking. A national circular directed at
families leaned heavily on medical opinion, quoting Drs. Mussey, Drake, and
other lesser-known physicians to make their case against strong drink. The
Rev. Edward Hitchcock also invoked doctors’ opinion, noting that “it is important then to remark, that physicians have decided that alcohol is a powerful
poison.” Another contributor to the volume asked pointedly why “should not
WKHRSLQLRQRISK\VLFLDQVVXI¿FHRQWKLVSRLQW",IZHWDNHWKHLUDGYLFHRQZKDW
will cure us when sick, why not also as to what will injure us when well?”14
,W PHULWV QRWLFH KHUH WKDW PHGLFDO UHQXQFLDWLRQ RI DOFRKRO VHHPHG WR UXQ
counter to the practice of “heroic medicine” that medical historians tell us
ÀRXULVKHGEHWZHHQURXJKO\DQG7KLVVFKRRORIPHGLFDOSUDFWLFH
popularized (ironically) by Benjamin Rush, emphasized drastic measures
such as bleeding patients, inducing vomiting, diarrhea or profuse sweating, or
administering large doses of powerful drugs such as calomel and laudanum.
,QPDQ\LIQRWPRVWFDVHVWKHVHWDFWLFVSURYHGKDUPIXOUDWKHUWKDQEHQH¿FLDO
to patients. Alcohol, long valued for its calming, pain-killing, sleep-inducLQJDQGIRUWLI\LQJTXDOLWLHVZRXOGVHHPWR¿WZHOOZLWKKHURLFSUDFWLFH,Qdeed, many physicians did prescribe a glass of wine or porter for a variety
of ailments. Over time, however, the disadvantages of prescribing an article
28
Social History of Alcohol and Drugs, Volume 24, No 1 (Winter 2010)
regarded by the respectable public as injurious, if not evil, outweighed any
SRWHQWLDOWKHUDSHXWLFEHQH¿WV0DQ\SK\VLFLDQVWKHPVHOYHVPD\KDYHEHFRPH
convinced of the insidious nature of drink, imbibing, as they did, the rhetoric and ideology of middle-class temperance. Whatever the etiology of their
change of heart, once doctors became convinced of the therapeutic and social
DGYDQWDJHVRIRSSRVLQJGULQNLQJWKH\KDSSLO\SURYLGHGVFLHQWL¿FDQGPHGLFDO
support for the temperance movement. 15
THOMAS SEWALL AND THE REDEMPTIVE POSSIBILITIES OF TEMPERANCE
The career of Thomas Sewall, a physician who became prominent in the temSHUDQFH PRYHPHQW H[HPSOL¿HV PDQ\ RI WKH WUHQGV RXWOLQHG DERYH ZKLOH
also demonstrating, through admittedly unusual circumstances, the value of
temperance principles for physicians seeking middle-class status. Born in
Maine in 1787, Sewall received a medical degree from Harvard in 1812, and
VXEVHTXHQWO\VWXGLHGEULHÀ\ZLWK%HQMDPLQ5XVKDWWKH8QLYHUVLW\RI3HQQsylvania. With a keen, inquisitive intelligence, a penchant for research, and a
facility for writing, Sewall seemed destined for a promising career as a phyVLFLDQDQGPHGLFDODXWKRU3UDFWLFLQJLQ,SVZLFKDQG(VVH[0DVVDFKXVHWWV
GXULQJWKHWHHQVKHPRYHGVWHDGLO\WRZDUGWKHSURIHVVLRQDOVWDQGLQJ¿QDQFLDO
prosperity and social recognition coveted by so many of his peers. Sewall became a fellow in the prestigious Massachusetts Medical Society, maintained
D UHVSHFWDEOH DQG SUR¿WDEOH SUDFWLFH PDUULHG LQWR WKH GLVWLQJXLVKHG &KRDWH
family, and involved himself in the public affairs of his community. Sewall’s
journey into the middle class hit a substantial roadblock, however, in the form
of a prosecution for body snatching in 1819.16
/LNHPDQ\SK\VLFLDQVDQDWRPLVWVDQGPHGLFDOVFLHQWLVWV6HZDOO\HDUQHG
IRU VFLHQWL¿F LQTXLU\ LQWR WKH VWUXFWXUH DQG IXQFWLRQV RI WKH KXPDQ ERG\
Such inquiry required the dissection of cadavers, a practice proscribed by
law. Some doctors and medical students purchased cadavers from a variety
of shady sources; others, like Sewall, procured them personally. Sewall’s
pursuit of medical knowledge through dissection unluckily came to the attenWLRQRIWKHORFDODXWKRULWLHVLQ,SVZLFKDIWHUWKH\OHDUQHGWKDWHLJKWJUDYHVKDG
been robbed months earlier. Unsurprisingly, this gruesome discovery elicited
shock and outrage from the distressed relatives of the dead and the community at large. The “late extraordinary scene,” lamented a local clergyman,
left mourners “doubly bereaved” of their “deceased relatives and friends…
their sorrows in parting with them at death not only called up afresh but aggravated and increased.” Outraged residents subscribed the enormous sum of
WR¿QGWKHSHUSHWUDWRUDQGDQLQYHVWLJDWLRQUHYHDOHG6HZDOODVWKHFXOprit, resulting in his trial for the desecration. Despite retaining the illustrious
'DQLHO:HEVWHUDVKLVDWWRUQH\6HZDOOZDVFRQYLFWHGDQG¿QHG:LWK
his legal and professional positions in Massachusetts irretrievably damaged,
and bourgeois respectability proving elusive, Sewall departed, resettling in
Washington, DC, to start afresh. Sewall’s efforts to change his luck proved
Martin: Temperance, Physicians and the American Middle Class, 1800-1860
29
spectacularly successful: once in Washington, he helped to establish medical
education at Columbian College (later George Washington University), servLQJDV3URIHVVRURI$QDWRP\DQG3K\VLRORJ\XQWLOKLVGHDWKLQ,QDGGLtion, Sewall authored a number of medical works, and served as the personal
physician for three presidents. 17
How did he achieve this remarkable retrieval of medical authority and
bourgeois respectability? Though it did not produce his reversal of fortune,
Sewall’s gravitation toward and eventual championing of temperance reform no doubt helped. Sewall’s decision to support the anti-liquor cause may
KDYHEHHQLQÀXHQFHGE\KLVEURWKHULQODZ'U5HXEHQ'0XVVH\DQROGHU
respected, and staunchly middle-class physician who had been waving the
temperance banner since the teens. Consistent with the trend among other
physicians, Sewall adopted temperance principles and urged them on his colOHDJXHVDQGVWXGHQWV,QDFRPPHQFHPHQWDGGUHVVWRWKHJUDGXDWLQJFODVVRI
Columbia College’s medical students in 1827, Sewall exhorted his erstwhile
charges to practice a variety of middle-class virtues including veracity, compassion, religiosity, and gentility. Prominent among these laudable qualities
was the observation of “strict temperance in the use of ardent spirits,” adding
WKDWWKHUH³LVQRVXEMHFWJHQWOHPHQRQZKLFK,ZRXOGHQWUHDW\RXZLWKPRUH
HDUQHVWQHVVWKDQXSRQWKLV´/LNHQLQJLQWHPSHUDQFHWRDGDQJHURXVUHHIRU
maelstrom that threatened to sink the ship of sobriety, Sewall implored his
audience to shun ardent spirits both to assure their professional competence
and to solidify their positions as moral pillars of the community:
Universal temperance is incumbent on you, not merely as essentially requisite
to preserve your minds in that unclouded state, which may render you equally
able at all times to pronounce on the cases you may be called to investigate, but
EHFDXVHLWLVDYLUWXHZKLFK\RXZLOORIWHQ¿QGLW\RXUGXW\WRLQFXOFDWHRQ\RXU
patients, and which you will enforce with but little effect, if it is not regularly
H[HPSOL¿HGLQ\RXURZQFRQGXFW18
,Q DGGLWLRQ WR H[KRUWLQJ KLV LPPHGLDWH FLUFOH WR DEMXUH WKH SRLVRQHG FXS
Sewall, like other physicians, also devoted energy to promoting the formal
temperance movement. By 1830, Sewall’s growing renown as a physician
recommended him to deliver an address to the Washington City Temperance
Society. Terming intemperance “the most alarming evil that ever infested human society,” Sewall proceeded to rehearse many of the arguments and ideas
that rapidly were becoming staples of the middle-class indictment of liquor.
,QWHPSHUDQFH KDG DIÀLFWHG ³HYHU\ FODVV RI VRFLHW\« FRUUXSWHG RXU PRUDOV
impaired our intellect, and enfeebled our physical strength” and represented
an “individual, social and national evil… affecting our personal independence
DQGKDSSLQHVVRXUQDWLRQDOZHDOWKDQGLQGXVWU\´,QHQXPHUDWLQJDOOWKRVH
with a responsibility to combat drinking – the clergy, the civil authorities,
parents, women – Sewall reiterated the exhortation to the medical community
KH¿UVWDUWLFXODWHGLQKLVFKDUJHWR&ROXPELD&ROOHJH¶VJUDGXDWLQJFODVV,W
was “time the profession should have an opportunity to exonerate itself from
30
Social History of Alcohol and Drugs, Volume 24, No 1 (Winter 2010)
the charge, under which it has long rested, of making drunkards.” Claiming
IRUSK\VLFLDQV³DVWDWLRQLQVRFLHW\ZKLFKJLYHV\RXDFRPPDQGLQJLQÀXHQFH
on this subject,” Sewall urged his medical colleagues to raise their voices and
“speak out boldly… exert an agency in this matter, which will bring down the
blessings of unborn millions upon your memory.”19 Presumably, their bold
voices and the resulting agency they exerted would yield social and economic
EHQH¿WVLQWKHSUHVHQWDVZHOODVWKHJUDWLWXGHRISRVWHULW\
Sewall’s particular contribution to combating this monstrous evil was a description of the effects of alcohol on the “moral, intellectual, and physical constitution of man,” drawn, presumably, from his experience in medical practice.
Though Sewall’s account of the moral and intellectual consequences of drinking added little to the denunciations of other commentators, his discussion of
alcohol’s impact on the liver, brain, and particularly the stomach, proved to be
a valuable weapon in the battle against intemperance. Sewall later expanded
his work on the physiology of alcohol-damaged organs to produce one of the
PRVWZLGHO\GLVWULEXWHGDQGPRVWLQÀXHQWLDOWHPSHUDQFHSXEOLFDWLRQVRIWKH
antebellum years. Continuing during the 1830s his work on the devastation
caused by liquor to the stomachs of chronic drunkards, Sewall came to the
attention of Edward Delavan, the Albany merchant, philanthropist, and temperance reformer. By 1840, Delavan had already become a major benefactor
RI WKH WHPSHUDQFH PRYHPHQW ODYLVKLQJ RQ WKH ÀHGJOLQJ$PHULFDQ
Temperance Union in 1836, and reportedly subsidizing the production and
dissemination of approximately 36 million temperance tracts and other pubOLFDWLRQV ,I 'HODYDQ VDZ LQ 6HZDOO D YDOXDEOH FROODERUDWRU LQ WKH VWUXJJOH
against drink, Sewall no doubt recognized the Albany temperance zealot as
DIDFLOLWDWRUIRUH[WHQGLQJKLVLQÀXHQFHDQGFHPHQWLQJKLVUHVSHFWDEOHPLGGOH
class status.20
Delavan lauded Sewall’s 1841 publication, The Pathology of Drunkenness,
or the Physical Effects of Alcoholic Drinks with Drawings of the Drunkard’s
Stomach, which had been published as letter to Delavan. Sewall’s frank prose
and vivid drawings illustrating the damage caused to the stomach by chronic
intemperance provided reformers with graphic, not to mention ghastly, evidence of the pernicious effects of strong drink. Delavan must have been quite
taken with Sewall’s work, and its possibilities as temperance propaganda, for
he contributed a foreword to the 1841 publication, commissioned a color lithograph of the eight line drawings that accompanied the text, and used his temperance periodicals, the Temperance Recorder and the Enquirer to promote
Pathology and defend it against any detractors. The American Temperance
Union, still beholden to Delavan as a major benefactor, considered Sewall’s
plates so important that it recommended that they “should receive the special
attention of all temperance lecturers, and be hung up in all suitable places of
public resort.” Delavan facilitated this goal by funding the production of a
lithograph of Sewall’s eight drawings of stomachs ravaged by alcohol, and
distributing 150,000 copies of it to schools, prisons, hospitals and poorhouses.
Martin: Temperance, Physicians and the American Middle Class, 1800-1860
31
The widespread dissemination of the lithograph, in conjunction with the professional celebrity generated by the publication of Pathology of Drunkenness,
which was subsequently translated into German, established Sewall’s “reputation both at home and abroad as an original investigator.” With this development, Sewall secured the middle-class status he had nearly lost. He would be
remembered as the respectable physician who produced pictures of drunkards’
stomachs to aid the temperance cause, rather than the unscrupulous quack
ZKRUREEHGJUDYHVWRVDWLVI\KLVRZQPRUELGVFLHQWL¿FFXULRVLW\ 21
PHYSICIANS AND MIDDLE-CLASS GENDER IDEOLOGY
,QHQGRUVLQJDQGSUDFWLFLQJWHPSHUDQFHERWKSURIHVVLRQDOO\DQGSHUVRQDOO\
doctors necessarily confronted issues raised by the emergence of new middleclass gender roles, and by the more general discussion of women’s place in
American society. Gender roles, and especially the nature and function of
women, elicited much attention from middle-class ideologues and moralists.
,QWHPSHUDWH ZRPHQ SUHVHQWHG D SUREOHP IRU PLGGOHFODVV WKRXJKW DV WKH\
seemed to contradict a social, domestic, and political order based on strictly
differentiated gender roles that assigned virtue, not vice, to women. Drunken
women evoked particular concern among doctors, particularly those who aspired to the middle class, as well, because they feared that medical ineptitude
KDGFUHDWHGDJRRGO\SHUFHQWDJHRIIHPDOHLQWHPSHUDQFH,QWKHHDUO\V
'U - & /HWWVRP D %ULWLVK SK\VLFLDQ ZKRVH ZRUN FLUFXODWHG LQ WKH 8QLWHG
States, charged that physicians produced female intemperance by prescribing
DOFRKROIRUDYDULHW\RIDLOPHQWV/HWWVRPQRWHGWKDWVRPHYLFWLPVRIDOFRKRO
“are often those of the most delicate part of the female sex, whose habits of
intemperance are not unfrequently [sic] introduced by those who should have
been the guardians of their health.” American temperance crusaders picked
up this theme, employing emerging middle-class understandings of women as
frail, nervous creatures to explain careless doctors’ frequent recourse to alcohol as a tonic for female ailments. “Vast mischief has resulted to mankind,”
the Baltimore Temperance Society scolded
from the employment of certain cordial medicines in the form of tinctures. They
are often prescribed by physicians when the system being exhausted by disease,
both body and mind are puerile and capricious, and hence the easy victims of a
vicious habit. This is apt to occur especially to delicate, nervous females, whose
unpleasant sensations are always temporarily relieved by the excitement which
is produced.
'U+DUYH\/LQGVOH\HFKRHGWKLVVHQWLPHQWXUJLQJWKDW³PRUHIHPDOHGUXQNards are made by this means than by any other.” She is
only taking medicine, and this too by the advice of her physician! Her conVFLHQFHLVSDFL¿HGDQGVKHGRHVQRWNQRZIRUVKHGRHVQRWUHÀHFWWKDWVKHLV
GULQNLQJDUGHQWVSLULW±WKHEDUHLGHDRIZKLFKZRXOGSUREDEO\¿OOKHUZLWKDSprehension and alarm. 22
32
Social History of Alcohol and Drugs, Volume 24, No 1 (Winter 2010)
/LQGVOH\¶VIHDUWKDWLQFRPSHWHQWGRFWRUVZRXOGWXUQXQVXVSHFWLQJZRPHQLQWR
GUXQNDUGVFLUFXODWHGEH\RQGPHGLFDOOLWHUDWXUH¿QGLQJLWVZD\LQWRSRSXODU
WHPSHUDQFH¿FWLRQ,Q¶V³&RQIHVVLRQVRID)HPDOH,QHEULDWH´WKHXQIRUtunate protagonist begins drinking wine on a doctor’s advice as she recovers
from “great debility” occasioned by a previous disease. The wine relieved the
“sensations of weariness, languor, and faintness at the stomach,” under which
she had long labored, but became a necessity even after her health improved.
³<HW , GLG QRW GUHDP RI GLVFRQWLQXLQJ P\ PHGLFLQH RQ WKH FRQWUDU\ , ZDV
gradually increasing the quantity… as its effects were less perceptible.” Predictably, disaster follows, as the unnamed woman attempts to stop but cannot.
Her husband leaves her after she accidentally kills her young daughter with
an overdose of laudanum administered while she was drunk. The story ends
with her discovery that her husband has died in Europe, leaving her desolate
DQGDORQH,QDYDULDWLRQRQWKLVSORWOLQHDQRWKHUWHPSHUDQFHWDOHThe
Drunkard’s Daughter, relates the destruction of a family when a doctor prescribes wine for an ailing wife whose husband falls off the wagon because of
the presence of alcohol in the house.23
,Q WKH ZDNH RI WKHVH FRQFHUQV DERXW WKHLU SXEOLF UHSXWDWLRQ SURIHVVLRQDO
competence, and personal responsibility for female intemperance, American
physicians in large numbers (though by no means unanimously, for many
doctors of the older school continued to see the merits of alcohol in medical
practice) abandoned the private and medical use of alcohol. A 1980 examination of the use of beverage alcohol as medicine by Sarah Williams sheds light
on this transition. Williams’ argument that formally trained physicians prescribed alcohol much less than their irregularly trained colleagues dovetails
with the point made here about the importance of social class, since precisely
those physicians who received formal training in medical schools were those
most likely to aspire to middle-class status. Throwing their weight behind the
middle-class push for temperance reform, many status conscious doctors by
the 1840s advocated total abstinence as the wisest course both for their profesVLRQDQGWKHODUJHU$PHULFDQVRFLHW\LWVHUYHG,QWKHSURFHVVWKH\DOWHUHGWKH
treatment prescribed for women, avoiding the use of medications containing
alcohol whenever possible. By the 1830s, for instance, doctors had distanced
themselves from the practice of prescribing ale or porter for nursing mothers,
attributing the persistence of using alcohol to fortify mother’s milk to “the
well-meant but mistaken motives” of “female attendants.”24
THE LEGACY OF MEDICAL TEMPERANCE
,IPHGLFDOUHSXGLDWLRQRIDOFRKROUHSUHVHQWHGDYLFWRU\IRUPLGGOHFODVVWHPperance reform, the triumph was short-lived. By the 1850s, many states had
moved toward prohibitory legislation, at the urging of upper- and middle-class
temperance supporters, who had come to view alcohol abuse as a vice primarily of workers and immigrants. By the eve of the Civil War, however, many
of these efforts to proscribe liquor had failed, prohibition having run afoul of
Martin: Temperance, Physicians and the American Middle Class, 1800-1860
33
either state judiciaries or local voters. As prohibitory energies waned, medical
interest in temperance reform per se DSSHDUVWRKDYHÀDJJHGDVZHOOJLYLQJ
way to physicians’ efforts to determine the etiology and optimum treatment
for chronic inebriety. By the late 1850s, doctors were solidly ensconced in
WKHPLGGOHFODVVDQGFRXOGSXUVXHWKHVHQDUURZHUVFLHQWL¿FDQGSURIHVVLRQDO
issues without the necessity of championing temperance quite so forcefully
to demonstrate their social respectability. Moreover, the events of the 1860s
undermined many of the gains made by the temperance movement, in the
medical profession as elsewhere in American society. The American Civil
War produced death, disease and physical agony on an unprecedented scale.
)HZQHZHI¿FDFLRXVWUHDWPHQWVKDGEHHQDGGHGWRWKHmateria medica, and
H[LVWLQJ GUXJV WKDW GLG SURYLGH VRPH EHQH¿WV VXFK DV ODXGDQXP RU FKORURform, were often in short supply. By all accounts, the Civil War accelerated
alcohol use as both psychological balm and physical painkiller among many
groups of Americans, doctors included, setting the stage for another round of
reform in the 1870s.25
,URQLFDOO\ HYHQ SK\VLFLDQV¶ FRQFHUQ DERXW WKH GDQJHUV RI SUHVFULELQJ DOcohol for women did not eliminate the specter of female addiction produced
by doctors. Here the example of physicians illustrates the longevity and conWLQXLQJ LQÀXHQFH RI WKH JHQGHU LGHRORJ\ WKDW HPHUJHG IURP WKH DQWHEHOOXP
WHPSHUDQFHPRYHPHQW0HGLFDOZRUULHVDERXWIHPDOHLQWHPSHUDQFHUHÀHFWHG
middle-class gender ideology, which could not countenance drunken women.
Though doctors no longer advocated wine or alcoholic tinctures for female
illnesses, they continued to diagnose and treat women’s ailments using the
culturally-mediated notions of gender that emerged among the middle class
during the early nineteenth century. By the latter part of the century, opiates
rather than alcohol had become the drug of choice for dosing women who
H[KLELWHGV\PSWRPVRIK\VWHULDQHUYRXVQHVVRUUHSURGXFWLYHGLI¿FXOWLHV$V
David Courtwright has demonstrated, the typical opium addict during the late
nineteenth century was a middle-class, middle-aged woman, who became habituated to the drug iatrogenically. This pattern of disproportionate medical
recourse to anesthetic or psychotropic drugs to treat female “problems,” based
largely in middle-class notions of gender, persists, in altered form, to the presHQWGD\,QWKH8QLWHG6WDWHVDVZHOODVHOVHZKHUHLQWKH:HVWZRPHQDUH
much more likely than men to be prescribed psychotropic medications such
DVWUDQTXLOL]HUV$UHSRUWIURPWKH1DWLRQDO,QVWLWXWHRQ'UXJ$EXVH
for instance, noted that women were, “in some cases,” 55 percent more likely
to be prescribed abusable drugs. Research has also shown that women are at
“increased risk for nonmedical use of narcotic painkillers and tranquilizers.”
The recurrence of medical concerns about women’s susceptibility to chemiFDOGHSHQGHQF\¿UVWZLWKDOFRKROWKHQRSLDWHVDQGQRZSV\FKRWURSLFGUXJV
indicates that there may not only be cycles of American temperance reform,
as Jack Blocker noted, but also cycles of gender-based American iatrogenic
addiction. 26
34
Social History of Alcohol and Drugs, Volume 24, No 1 (Winter 2010)
Bowling Green State University
[email protected]
ENDNOTES
1. ³7KH'RFWRUDQGWKH/DG\´Washington Reporter, March 22, 1819, 1.
2. Scott C. Martin, Devil of the Domestic Sphere: Temperance, Gender and Middle-Class
Ideology, 1800-1860 'H.DOE 1RUWKHUQ ,OOLQRLV 8QLYHUVLW\ 3UHVV HVS -RVHSK
*XV¿HOGSymbolic Crusade: Status Politics and the American Temperance Movement (Urbana:
8QLYHUVLW\RI,OOLQRLV3UHVV)RURWKHUSHUVSHFWLYHVRQWKHRULJLQVRIWHPSHUDQFHUHIRUP
see Jack S. Blocker, Jr. American Temperance Movements: Cycles of Reform (Boston: Twayne
Publishers, 1989). For discussions of gender and temperance after the period covered by Devil,
see Elaine F. Parson, Manhood Lost: Fallen Drunkards and Redeeming Women in the Nineteenthcentury United States (Baltimore: Johns Hopkins University Press, 2003), Catherine G. Murdock,
Domesticating Drink: Men, Women and Alcohol in America, 1870-1940 (Baltimore: Johns HopNLQV8QLYHUVLW\3UHVVDQG/RUL5RWVNRIILove on the Rocks: Men, Women and Alcohol in
Post-World War II America (Chapel Hill: University of North Carolina Press, 2002).
3. Intemperance. An Address to the Churches and Congregations of the Western District of
)DLU¿HOG&RXQW\ (Hartford: Peter B. Gleason, 1813), 12; Address of the Chilicothe Association
for Promoting Morality and Good Order, to Fellow Citizens, on Profane Swearing, the Violation
of the Sabbath, and the Intemperate Use of Ardent Spirits (Chilicothe: John Andrews, 1815),
12; John James Bound, The Means of Curing and Preventing Intemperance (New York: Charles
Baldwin, 1820), 6. The American Tract Society reprinted Rush’s Enquiry in The Temperance
Volume: Embracing the Temperance Tracts of the American Tract Society (New York: American
7UDFW6RFLHW\2Q%HQMDPLQ5XVKDQGKLVLQÀXHQFHRQWHPSHUDQFHUHIRUPVHH:LOOLDP
J. Rorabaugh, The Alcoholic Republic: An American Tradition (New York: Oxford University
Press, 1981), 39-46. A number of classic works on temperance touch upon physicians’ conversion to alcohol reform during the early decades of the nineteenth century, though not its class
GLPHQVLRQV6HHIRULQVWDQFH,DQ57\UUHOOSobering Up: From Temperance to Prohibition in
Antebellum America, 1800-1860 (Westport: Greenwood Press, 1979), 89-91, and Mark Edward
/HQGHUDQG-DPHV.LUE\0DUWLQDrinking in America: A History (New York: Free Press, 1987).
4. The Devil Turned Doctor. A Poem, (New York: Robert Nesbit, 1831), 5.
5. Rev. Marcus E. Cross, The Mirror of Intemperance, and History of the Temperance Movement3KLODGHOSKLD-RKQ7/DQJH³2QWKHXVHDQG$EXVHRI$UGHQW6SLULWV´Journal
of Health-DQ³&DOGZHOORQ,QWHPSHUDQFH´Journal of Health and Recreation 4 (Nov, 1832): 88; “College of Physicians,” Journal of Health and Recreation 4 (1833):
292-94. For more on the alcohol problems with which antebellum Philadelphia physicians grappled, see Matthew Warner Osborn, “A Detestable Shrine: Alcohol Abuse in Antebellum Philadelphia,” Journal of the Early Republic 29 (2009): 101-32.
6. -³,QWHPSHUDQFHDQG'LVHDVH´Boston Medical and Surgical Journal 15 (Nov 30, 1836),
261; E. H. Barton, M.D., A Discourse on Intemperance, and of the Applicability of Stimulants in
a Warm Climate, delivered before the New Orleans Temperance Society (New Orleans: T. Rea,
1837), 13.
7. Thomas Sewall, M.D., A Charge Delivered to the Graduating Class of the Columbian College, D. C., at the Medical Commencement, March 22, 1827 (Washington: Duff Green, 1828),
9; 7KH7HPSHUDQFH&DXVH)URPWKH8QLWHG6WDWHV5HYLHZIRU-DQXDU\3DPSKOHW¿OHLQ
College of Physicians, Philadelphia), 5; David Hosack, M. D., Dr. Hosack’s Address Delivered
%HIRUHWKH1HZ<RUN&LW\7HPSHUDQFH6RFLHW\0D\ (New York: John P. Haven, 1830),
10; Samuel A. Cartwright, M. D., “Hygenics of Temperance,” Boston Medical and Surgical Journal 48 (June 1, 1853), 373; John Bell, M. D., An Address to the Medical Students’ Temperance
6RFLHW\RIWKH8QLYHUVLW\RI3HQQV\OYDQLD)HEUXDU\ (NP, 1833), 6.
8. 5HEHFFD-7DQQHQEDXP³(DUQHVWQHVV7HPSHUDQFH,QGXVWU\7KH'H¿QLWLRQDQG8VHVRI
Professional Character Among Nineteenth-Century Physicians,” Journal of the History of Medicine and Allied Sciences 49 (1994), 252, 257. For more on doctors and antebellum temperance
Martin: Temperance, Physicians and the American Middle Class, 1800-1860
35
in general, see James H. Cassedy, “An Early American Hangover: The Medical Profession and
,QWHPSHUDQFH´Bulletin of the History of Medicine 50 (1976): 405-13. On the disUHSXWDELOLW\ RI$PHULFDQ GRFWRUV GXULQJ WKH HDUO\ QLQHWHHQWK FHQWXU\ VHH 5RQDOG / 1XPEHUV
“The Fall and Rise of the American Medical Profession,” in Sickness and Health in America, ed.
-XGLWK/HDYLWWDQG5RQDOG1XPEHUV0DGLVRQ8QLYHUVLW\RI:LVFRQVLQSUHVV2Q
advice manuals, see Karen Haltunnen, &RQ¿GHQFH0HQDQG3DLQWHG:RPHQ$6WXG\LQ0LGGOH
Class Culture in America (New Haven: Yale University Press, 1982).
9. Daniel Drake, “Physiological Temperance Society,” Boston Medical and Surgical Journal
26 (Mar 23, 1842), 114.
10. /HEEHXV$UPVWURQJThe Temperance Reformation (New York: Fowler and Wells, 1853);
Massachusetts Temperance Society, The Physiological Effects of Alcoholic Drinks, from the British and Foreign Medical Review of Dr. Forbes; with Documents and Record of the Massachusetts
Temperance Society, illustrating the Origin of the Temperance Reformation, and Its Progress in
the State of Massachusetts (Boston: Massachusetts Temperance Society, 1848), 2, 43-47; Fourteenth Annual Report of the Massachusetts Society for the Suppression of Intemperance, with
Resolutions Passed at a Public Meeting Held November 5, 1827 (Boston: N. S. Simpkins and Co.,
1827), 4; The Anniversary Report of the Managers of the Pennsylvania Society for Discouraging
the Use of Ardent Spirits. Read on the 7th0D\DQG2UGHUHGWREH3XEOLVKHGE\WKH6RFLHW\
(Philadelphia: Henry H. Porter, 1831), 4.
11. Report of a Committee of the Connecticut Medical Society respecting an Asylum for IneEULDWHVZLWKWKH5HVROXWLRQVRIWKH6RFLHW\DGRSWHGDWWKH$QQXDO0HHWLQJ0D\ (New
Haven: Hezekiah Howe, 1830), 8; Samuel B. Woodward, M. D., Essays on Asylums for Inebriates (1838), in Nineteenth-Century Medical Attitudes Toward Alcohol Addiction ed. Gerald Grob
(New York, Arno Press, 1981), 24-25; Ceremonies, Etc. New York State Inebriate Asylum. Binghamton, New York (New York: Wynkoop, Hallenbeck and Thomas, 1859), 24-51, 175.
12. 5'0XVVH\³(VVD\ RQ$UGHQW 6SLULWV DQG ,WV 6XEVWLWXWHV DV D 0HDQV RI ,QYLJRUDWLQJ
Health” in Temperance Prize Essays HG5'0XVVH\DQG+DUYH\/LQGVO\:DVKLQJWRQ'XII
Green, 1835), 19.
13. Elaine Frantz Parsons, Manhood Lost: Fallen Drunkards and Redeeming Women in the
Nineteenth-Century United States (Baltimore: Johns Hopkins University Press, 2003), 9; Daniel
Drake, M. D., A Discourse on Intemperance; delivered at Cincinnati, March 1, 1828, before the
Agricultural Society of Hamilton County, and subsequently pronounced, by Request, to a Popular
Audience&LQFLQQDWL/RRNHUDQG5H\QROGV'U&KDUOHV-HZHWWThe Youth’s Temperance Lecturer (Boston: Whipple and Damrell, 1840), 24, 20. See also Drake’s An Oration on the
Intemperance of Cities: Including Remarks on Gambling, Idleness, Fashion, and Sabbath-BreakLQJ'HOLYHUHGLQ3KLODGHOSKLD-DQXDU\ (Philadelphia: Griggs & Dickinson, 1831), and
Jewett’s Speeches, Poems, and Miscellaneous Writings, on Subjects Connected with Temperance
DQGWKH/LTXRU7UDI¿F (Boston: John P. Jewett, 1849).
14. National Circular, Addressed to the Head of Each Family in the United States in The Temperance Volume, Embracing the Temperance Tracts of the American Tract Society (New York:
American Tract Society, 1834): 139-43; Rev. Edward Hitchcock, Argument against the Manufacture of Ardent Spirits. Addressed to the Distiller and Furnisher of the Materials in The Temperance Volume, 211; Rev. C. P. M’ilvaine, D. D., Address to the Young Men of the United States, on
Temperance in The Temperance Volume, 250.
15. See Paul Starr, The Social Transformation of American Medicine (New York: Basic Books,
1982), 30-59; and John S. Haller, American Medicine in Transition, 1840-1910 (Urbana: UniverVLW\RI,OOLQRLV3UHVV
16. %LRJUDSKLFDOGDWDRQ6HZDOOFRPHVIURP+RZDUG$WZRRG.HOO\DQG:DOWHU/%XUUDJH
American Medical Biographies (Baltimore: The Norman, Remington Co., 1920), 1037; History of the Medical Society of the District of Columbia, 1817-1909 (Washington, D. C.: The
Society, 1909), 148, 222; Michael Sappol, $ 7UDI¿F LQ 'HDG %RGLHV$QDWRP\ DQG (PERGLHG
Social Identity in Nineteenth-Century America (Princeton: Princeton University Press, 2002);
&KULVWRSKHU %HQHGHWWR ³µ$ 0RVW 'DULQJ DQG 6DFULOHJLRXV 5REEHU\¶7KH ([WUDRUGLQDU\ 6WRU\
RI %RG\6QDWFKLQJ DW &KHEDFFR 3DULVK LQ ,SVZLFK 0DVVDFKXVHWWV´ New England Ancestors 6
(2005), 31-34, 45. On the grave-robbing incident, see also Suzanne Shultz, Body Snatching:
The Robbing of Graves for the Education of Physicians in Early American History (Jefferson:
36
Social History of Alcohol and Drugs, Volume 24, No 1 (Winter 2010)
McFarland, 1992), 51-52.
17. Robert Crowell, $ 6HUPRQ 'HOLYHUHG LQ ,SVZLFK 6HFRQG 3DULVK -XO\ 2Q WKH
2FFDVLRQRI5HLQWHUULQJWKH&RI¿QV:KLFK+DG%HHQ5REEHGRIWKHLU&RQWHQWV (Andover: Flagg
and Gould, 1818): 38, iv; Sappol, Dead Bodies, 13, 330; Medical Society, 148. The history of the
District of Columbia Medical Society claims that Sewall cared for three presidents, but he is not
PHQWLRQHGLQ/XGZLJ0'HSSLVFK0'The White House Physician: A History from Washington
to George W. Bush-HIIHUVRQ0F)DUODQGDQG&RPSDQ\6HHDOVR$0/DVVHNHuman
Dissection; Its Drama and Struggle6SULQJ¿HOG7KRPDVRQ6HZDOO¶VVXEVHTXHQW
career.
18. Sewall, Charge Delivered to the Graduating Class, 9, 10.
19. Thomas Sewall, MD, An Address Delivered before the Washington City Temperance SociHW\1RY (Washington, DC: William Greer, 1830), 4, 5, 20.
20. Sewall, An Address, 6. Material on Edward Delavan is drawn from William Rorabaugh’s
HQWU\LQ$PHULFDQ1DWLRQDO%LRJUDSK\DYDLODEOHRQOLQHDWKWWSZZZQ\VPQ\VHGJRYDOEDQ\
ELRVGHFGHODYDQDQEKWPODFFHVVHG1RYHPEHU
21. See, for example, Delavan’s Defence of Doctor Sewall’s Work on the Pathology of Drunkenness (Albany: Temperance Recorder, 1843); and Collection of Documents which appeared in
the Public Papers, in relation to Dr. Sewall’s Drawings of the Human Stomach, &c. (Albany,
1843); Thomas Sewall, The Pathology of Drunkenness, or, the Physical Effects of Alcoholic
Drinks with Drawings of the Drunkard’s Stomach. A Letter to Edward Delavan, Esq. (Albany,
1842); “Seventeenth Anniversary of the American Temperance Union,” Journal of the American
Temperance Union 7 (June 1843), 82; Kelly and Burrage, Medical Biographies, 1037.
22. -&/HWWVRP0'History of Some of the Effects of Hard Drinking6L[WKHGLWLRQ/RQdon: W. Darton and Co., 1791), 1; The Constitution and Address of the Baltimore Temperance Society; to which is added An Address, delivered before the Society, by N. R. Smith, M.D., Professor
of Surgery in the University of Maryland%DOWLPRUH-'7UR\'U+DUYH\/LQGVO\
$Q(VVD\RQWKH2ULJLQDQG,QWURGXFWLRQLQWR0HGLFDO3UDFWLFHFFRI$UGHQW6SLULWV´LQ
0XVVH\DQG/LQGVO\Temperance Prize Essays, 171-72. On gender ideology and temperance,
see Martin, Devil of the Domestic Sphere, and Holly Beckley Fletcher, Gender and the American
Temperance Movement of the Nineteenth Century (New York: Routledge, 2008).
23. >,VDDF)6KHSDUG@³&RQIHVVLRQVRID)HPDOH,QHEULDWH´LQ-RKQ:&URZOH\HG
Drunkard’s Progress: Narratives of Addiction, Despair, and Recovery (Baltimore: Johns Hopkins University Press, 1999), 71-72; Mrs. J. Thayer, Picnic Tales Number Three. The Drunkard’s
Daughter (Boston, William S. Damrell, 1842), 15.
24. Sweetser, Dissertation on Intemperance, 56; Reuben Dimond Mussey, M. D., An Address
on Ardent Spirit, read before the New-Hampshire Medical Society, at their Annual Meeting, June
5, 182713/LQGVO\³(VVD\´0DFQLVKAnatomy of Drunkenness, 14; Sarah
Williams, “The Use of Beverage Alcohol as Medicine, 1790-1860,” Journal of Studies on Alcohol
41 (1980): 543-66. On holdouts among the medical profession who continued to use liquor, see
Cassedy, “Hangover,” 407.
25. Blocker, American Temperance Movements, 71-72, Cassedy, “Hangover,” 413. For discusVLRQVRIWKH0DLQH/DZLWVUDPL¿FDWLRQVDQGXOWLPDWHGHPLVHVHH%ORFNHUAmerican Temperance Movements,,DQ57\UUHOOSobering Up: From Temperance to Prohibition in Antebellum America, 1800-1860 (Westport: Greenwood Press, 1979), 252-323.
26. David T. Courtwright, Dark Paradise: A History of Opiate Addiction in America (Cambridge: Harvard University Press, 2001), esp. 36-37. “Prescription Drugs: Abuse and Addiction,”
1DWLRQDO ,QVWLWXWH RQ 'UXJ$EXVH 5HVHDUFK 5HSRUW 6HULHV 1,+ 3XEOLFDWLRQ 1XPEHU (August, 2005), 6 (available at ZZZGUXJDEXVHJRY3')553UHVFULSWLRQSGI. On the impact of
JHQGHURQLDWURJHQLFDGGLFWLRQDQGGUXJDEXVHVHHDOVR'DYLG+HU]EHUJ³µ7KH3LOO<RX/RYH&DQ
Turn You On’: Feminism, Tranquilizers and the Valium Panic of the 1970s,” American Quarterly
-RQDWKDQ00HW]O³µ0RWKHUV/LWWOH+HOSHU¶7KH&ULVLVRI3V\FKRDQDO\VLV
and the Milltown Resolution,” Gender and History 15 (2003): 228-255; and Andrea Tone, “Tranquilizers on Trial: Psychopharmacology in the Age of Anxiety,” in Medicating Modern America:
Prescription Drugs in History ed. Andrea Tone and Elizabeth Siegel Watkins (New York: New
York University Press, 2007): 156-79.