Fascinated by Fevers: Nathan Smith (1762–1829),Early American Doctor

Hayward OS Putnam CE . Improve, Perfect, & Perpetuate: Dr Nathan Smith and Early American Medical Education. Hanover, NH: University Press of New England, 1998.

See Donaldson GA . The first all-New England surgeon. Am J Surg 1978; 135: 471–9.

The four institutions were (to use their modern names): Dartmouth Medical School in Hanover, New Hampshire; Yale Medical School in New Haven, Connecticut; the Maine Medical College (no longer in existence) at Bowdoin College in Brunswick, Maine; and the University of Vermont Medical School in Burlington, Vermont. Other nineteenth-century faculty members (especially of a slightly later generation) taught in even more medical schools than Nathan Smith did. One small example, from Smith's own Dartmouth faculty later in the century: Edmund Peaslee was listed simultaneously as part of the faculty at five different institutions. See Reichle HS. Peaslee. In: Malone D, ed. Dictionary of American Biography. New York: Charles Scribners, 1934: Vol.14, pp. 370–1. See also Edmund R Peaslee, Alumni File, Dartmouth College Archives.

Smith N . A Practical Essay on Typhous Fever. New York: E Bliss and E White, 1824; Smith N. Observations on the pathology and treatment of necrosis. Philadelphia Monthly Journal of Medicine and Surgery 1827; 1:11–19, 66–7. Both articles have been reprinted more than once, first in Smith NR, ed. Medical and Surgical Memoirs. Baltimore: William A Francis, 1831:39–96, 97–121, respectively, and later—notably—in Medical Classics 1937; 1:781–819, 820–38, respectively. For the most complete list available of the works of Nathan Smith, see Chronological list of works by Nathan Smith. In: Hayward OS, Putnam CE (op. cit. ref. 1): 337–9.

Hayward OS Thomson EH , eds. The Journal of William Tully, Medical Student at Dartmouth 1808–1809. New York: Science History, 1977: 48.

See, for example, such letters from Ezekiel Dodge Cushing to his parents as those written on 15 February 1809, 30 October 1809, and 15 December 1809; Ezekiel Dodge Cushing Papers (Folder 1), Manuscripts & Archives, Yale University Library.

Council of the Medical Society of London, Minutes, 22 May 1797; microfilm copy in the Wellcome Library, London. See also: Nye RE. Nathan Smith's trip to Edinburgh: A waste of time? Dartmouth Medical School Alumni Magazine 1983; 8:24-7; Nye RE. Nathan Smith's time in London: A better investment? Dartmouth Medical School Alumni Magazine 1985; 10:12-15.

Nathan Smith to John Warren, 4 May 1797; J C Warren Papers, Massachusetts Historical Society.

Henry Bond to Nathaniel Wright, 11 July 1813; Mss. 813411, Dartmouth College Archives.

Nathan Smith's involvement in each of the four schools—beginning at Dartmouth in 1797, Yale in 1813, Bowdoin and the University of Vermont (UVM) in 1821 - is different, and this is not the place to attempt to present the whole story. But of singular importance and significance is Smith's having established schools where he did. Before 1797, the young United States had only three medical schools; all of them were situated in metropolitan areas. For Smith to conceive that a medical school might thrive in the relatively speaking backwoods town of Hanover, New Hampshire—and to make it come to pass—was far bolder and imaginative than we today can readily appreciate. His vision was that country boys who wanted to become doctors needed a country school, partly because they could not afford to go to the cities but partly because that was the best way to ensure that they would learn the kind of medicine most relevant to the country patients Smith wanted them to be prepared to treat. Rural training for rural students to become rural doctors for rural patients: The dream was bold, the intention deeply humanitarian, the success stunning. The second part of Smith's genius connected with establishing medical schools was to make sure each was not a simple proprietary school of the type so common later in the nineteenth century, but rather that it was associated with an already established institution of higher learning—however modest by modern educational standards. Dartmouth College, for instance, was only 25 years old, had three faculty members and only about 100 boys of uncertain preparation as students, but it nonetheless took itself seriously, had a board of trustees, and was establishing itself as the one place in northern New England where post-secondary education was being offered. For more on Smith's role at Yale, Bowdoin, and UVM, see Hayward OS, Putnam CE (op. cit. ref. 1):chs 11–13.

The family tree was first published as part of Putnam CE. Nathan Smith's long line, in DMS [Dartmouth Medical School] Alumni News & Notes 1999: 8–11; it was reprinted in Putnam CE. Nathan Smith's gift to Maryland. Md Med J 1999; 48:214-16. On the first post-Nathan generation, see also Hayward OS, Putnam CE (op. cit. ref. 1):253-60.

One of the bibliographies in Hayward OS, Putnam CE (op. cit. ref. 1) comprises the fullest list to date of the extant Smith-student notebooks and their locations; two more notebooks have been discovered since.

Goodhue was inaugurated as president of the newly chartered Berkshire Medical Institution, in Pittsfield, Massachusetts, on 23 December 1823. Williams SW. A Biographical Memoir of Josiah Goodhue, M.D. … Pittsfield, MA: Phineas Allen and Son, 1829, gives more on the man and the school. Also: Williams SW. Dr Josiah Goodhue, in his American Medical Biography, or Memoirs of Eminent Physicians. Greenfield, MA: L Merriam, 1845; and also Gibbons PD. The Berkshire Medical Institution. Bull Hist Med 1964; 38:45-64.

Josiah Goodhue to George Cheyne Shattuck, 4 March 1829; Shattuck Papers, Massachusetts Historical Society. The next four quotations also come from Goodhue's letter.

See, especially, Nathan Smith to Lyman Spalding, 25 August 1809; Mss. 801474.1, Dartmouth College Archives. Of related interest is the fact that Smith's most important unpublished work was an essay on cancer and “scirrhous affections”. Notable for the two dozen case reports it contains, the paper gives valuable insights into Smith's understanding of cancer. For a discussion of some features of his work in this area, see Oughterson AW. Nathan Smith and cancer therapy. Yale J Biol Med 1939;12:130-4. For Smith's paper, see Smith N. Dissertation of scirrhous & cancerous affections. Beinecke Rare Book and Manuscript Library, Yale University. (A typescript copy is in the Francis A Countway Library of Medicine, Harvard University.).

A T Lowe to O P Hubbard, 7 April 1879; Mss. 879257, Dartmouth College Archives.

Welch WH . The relation of Yale to medicine. Yale Med J 1901; 8: 141–2. Here Welch shows familiarity with one of two richly informative obituaries of Smith. See Knight J. An Eulogium on Nathan Smith, M.D. New Haven: Hezekiah Howe, 1829, reprinted in Smith NR (op. cit. ref. 4): 12–36.

Cushing H . The Ideals, Opportunities, and Difficulties of the Medical Profession. Hanover, NH: Dartmouth College, 1929: 37–8.

Shryock RH . Medicine in America: Historical Essays. Baltimore, MD: Johns Hopkins University Press, 1966: 221.

Cushing H . (op. cit. ref. 18):22.

Philip AP Wilson . A Treatise on Febrile Diseases, Including the Various Species of Fever and All Diseases Attended with Fever, 2nd American edn, with notes and additions by Nathan Smith, M.D., from the 3rd London edn of 1813. Hartford, CT: Cooke & Hale, 1816.

In his early notes, my late co-author on the Smith biography made reference to Smith's extensive editing of and contributions to the work by Wilson Philip, along with hints that Wilson Philip had known Smith and personally chosen him to be his American editor. I found no evidence to support this, and later learned Hayward himself had acknowledged in print how little Smith had done. See Hayward OS. The basis in Sydenham, Rush, and Armstrong for Nathan Smith's teaching. Ann Intern Med 1962; 56: 343–8.

Eaton LK . New England Hospitals: 1790–1833. Ann Arbor: University of Michigan Press, 1957: 173. Eaton relies in making this point on a letter from Nathan Smith to George Shattuck, 22 June 1806/1807 (both dates appear in the letter—one inside and one outside); Manuscripts & Archives, Yale University Library.

Moseley B . Observations on the Dysentery of the West-Indies, with A New and Successful Manner of Treating It. London: T Becket (from the 2nd edn), 1781.

Complete bibliographical citations on these notes and essays are given in the chronological list of works by Nathan Smith, in Hayward OS, Putnam CE (op. cit. ref. 1): 337–8.

Osler W . Some aspects of American medical bibliography. Aequanimitas (3rd edn). New York: McGraw-Hill (nd):302–3.

Welch WH . Introduction. In: Smith EA . The Life and Letters of Nathan Smith, M.B., M.D. New Haven: Yale University Press, 1914:[v].

Shryock RH (op. cit. ref. 19):221.

Smith DC . Medical science, medical practice, and the emerging concept of typhus in mid-eighteenth-century Britain. In: Bynum WF Nutton V , eds. Theories of Fever from Antiquity to the Enlightenment. London: Wellcome Institute for the History of Medicine, 1981 (Med Hist Supplement No. 1): 121.

Smith N . Practical Essay (op. cit. ref. 4):21.

Smith N . Practical Essay (op. cit. ref. 4): 22.

Smith N . Practical Essay (op. cit. ref. 4): 43–4.

Forrester JM . The origins and fate of James Currie's cold water treatment for fever. Med Hist 2000; 44: 57–74 gives a thorough discussion of the use of hydrotherapy in treating fevers. Whether Smith knew anything about the work of Currie (1756-1805) is not known.

Smith N . Practical Essay (op. cit. ref. 4):74.

Eliot G . Middlemarch. Harmondsworth: Penguin, 1985: 177.

Bynum WF Nutton V . Introduction. In: Bynum WF, Nutton V, eds (op. cit. ref. 29):vii. Bynum went even further in his own essay in that collection (Cullen and the study of fevers in Britain, 1769–1820), beginning it thus: “There is probably no clinical subject in the whole history of medicine with a more extensive literature than fevers” (p. 135).

Putnam CE . A feverish enterprise. Wellcome History 1997: 5.

Bynum WF . Science and the Practice of Medicine in the Nineteenth Century. Cambridge: Cambridge University Press, 1994: 192.