Table of Contents

Foreword by John Harley Warner

Introduction:

Chapter 1. Jeremiah Barker: Background, Education, and Writings
Who was Jeremiah Barker?
Provenance of the Barker Manuscript
Description of the Barker Manuscript
The Medical Geography of the District of Maine, 1760-1830
Barker's Contribution to the Medical Literature of Northern New England
Articles Published by Jeremiah Barker
Yellow Fever in the District of Maine?
Conclusion

Chapter 2. Obtaining and Sharing Medical Literature, 1780-1820
Medical Information by Mail
The First United States Medical Journals & Medical Nationalism
Problems Encountered by Early Medical Journals
Newspapers as a Source of Medical Information
And Last but Not Least, Books
Conclusion

Chapter 3. The Old Medicine and the New: why Barker wrote this manuscript, for whom was it written, and why was it not published?
The Importance of Observation and Recording
Basics of Greek Medicine and Fever
Bloodletting: The Blood Was "Sizy and Buffy"
"Scientific Doctors" and the "Empirics"
More Competition: Domestic and Sectarian Medicine
Science, Institutions, Education, Framing Disease, and Cultural Authority
Case Reports and the Clinical Exam circa 1800
Recording Cases, Observations, and the Numerical Method
"Thus Sayeth Galen" Meets Cullen, Rush, and Brown
"Intelligible to Those Who Are Destitute of Medical Science"
Why Was Barker's Manuscript Never Published?
Rapidly Changing Medical Theory and Philosophy: Noah Webster
Conclusion

Chapter 4. "Alkaline Doctor" and "A Dangerous Innovator"
Lavoisier and the New Chemistry
The Acid/Alkali Debates of the Seventeenth and Eighteenth Centuries
Barker, Mitchill, Septon, and the Medical Repository
Barker's Use of Alkaline Therapy
Chemistry, Yellow Fever, and the Contagionist/Anticontagionist Battle
Barker the "Dangerous Innovator"
Conclusion

Chapter 5. Thoughts to Consider While Reading Barker's Manuscript
Presentism, Whiggish History, the Post Hoc Fallacy, Confirmation Bias
Holistic and Biomedical Models
Numerical Methods and Retrospective Diagnosis
Barker's Treatments, Therapeutic Efficacy, Bacon, and Confirmation Bias
Nature vs. Art in Medicine-Best Available Evidence and the Burden of Disease
Conclusion

The Jeremiah Barker Manuscript Volume One

MS V. 1, Chapter 1. Insanity and Temperance
Mental illness and problems associated with the use of ardent spirits

MS V. 1, Chapter 2. Early Maine Medical History Beginning in 1735
1780 Barker moves from Barnstable, Massachusetts to Gorham, District of Maine
Introduces his new community and physicians practicing in southern Maine
Introduces Rev. Thos. Smith's diary documenting diseases and epidemics, 1735-1780
1735 N.E. epidemic of cynache maligna, putrid sore throat, as described by Smith
Excerpt of Dr. John Warren's 1813 article on cynache maligna or throat distemper
Barker discusses illnesses of the 1740s including quinsy

MS V. 1, Chapter 3. Deaths Following Trivial Wounds and Childbed Fever
Barker's initial years in the District of Maine beginning 1780
1784-1785 unusual epidemic of serious wounds and death in men
1784-1785 unusual epidemic of childbed fever and deaths of women
Discussion focusing on women with childbed fever, deaths, autopsies, searching the literature and contacting medical peers for suggestions
Excerpt remarks on puerperal fever By Dr. Channing, 1817
Excerpt Dr. William DeWees on puerperal fever 1807

MS V. 1, Chapter 4. Throat distemper, Ulcerous Sore Throat, Scarlatina Angiosa, Cynache Maligna
1784: experience with throat distemper, other New England physicians and the literature
Excerpt on putrid sore throat by Hall Jackson (Portsmouth, New Hampshire), 1786
Joshua Fisher on throat distemper or scarlatina angiosa

MS V. 1, Chapter 5. Scarlatina Angiosa, Inflammatory Fevers, Hooping [Whooping] Cough, and Croup in Maine, 1797-1806
1796-1798 Scarlatina angiosa and the use of bloodletting and blistering
1802-1807 Scarlatina angiosa with many comments by other physicians
1805 example: 17 yo woman with Scarlatina angiosa bled, blistered, treated with alkalis
1774-1780 Barker's experience in Barnstable with quincy of croup, "a kindred disease"
1795-1806 "hooping cough"

MS V. 1, Chapter 6. Bloodletting for Palsy, Hemiplegia, and Other Neurological Events
Pneumonia in a minister who used his lancet on his parishioners prophylactically
Use of bloodletting in disease, prophylactically, and by native Americans
Excerpt on bloodletting among native Americans in "Travels in Canada and the Indian territories, between the years of 1760 and 1776." Alexander Henry, 1809
Hemiplegia and apoplexy
Excerpt of "Observations on paraplegia in adults" by Matthew Baillie, 1820
Excerpt of "Cases of Apoplexy with Dissection," by John C. Warren, 1812

MS V. 1, Chapter 7. Hydrophobia
Hydrophobia, cases and review of literature
Value of volatile alkalis to treat three people bitten by mad dogs

MS V. 1, Chapter 8. Anasarca, Ascites, Dropsy, and Foxglove
1786 move from Gorham to Stroudwater section of Portland
Cancer
Anasarca, ascites, hydrocephalus

MS V. 1, Chapter 9. Epidemic of Influenza, Cancer, and Tainted Veal
Influenza or Epidemic Catarrh
Reference to Noah Webster's History of Epidemic and Pestilential Diseases, 1799
Regarding Thomas Smith's and Barker's cases
Use of alkali after Barker's experiments
Barker communicated his ideas on the nature of fever, together with some practical observations on the use of alkalis in fever in 1795, to Mr. William Payne, Secretary of the Humane Society in New York, who gave the letter to Dr. Samuel Mitchill at Columbia College.

MS V. 1, Chapter 10. Letter to Samuel L. Mitchill in New York, May 30th 1798
The first page of a letter to Dr. Samuel Mitchill, subsequently published in the Medical Repository 1799, Vol. II No. II, pp. 147-152: "On the febrifuge Virtues of Lime, Magnesia and Alkaline Salts in Dysentery, Yellow-fever and Scarlatina Anginosa. In a Letter from Dr. Jeremiah Barker, of Portland, (Maine) dated May 30, 1798."
The Jeremiah Barker Manuscript Volume Two

MS V. 2, Introduction
Chapter opens with a letter dated 20 December 1831: Dr. Samuel Emerson, Kennebunk, Maine, having reviewed Barker's manuscript, recommends that it be printed
Barker's Introduction to Consumption

MS V. 2, Chapter 1. Frequency of Consumption in Women in Recent Years in New England
General comments on consumption; anatomy of respiration

MS V. 2, Chapter 2. Tracheal Consumption
General comments on tracheal consumption

MS V. 2, Chapter 3. Phthisis Pulmonalis, or Pulmonary Consumption
General comments on phthisis pulmonale, or pulmonary consumption

MS V. 2, Chapter 4. Consumption and the Deaths of Barker's Wives; Pneumonia
Cases of consumption beginning during Barker's pupilage
1775 Marries Abigail Gorham, age 25 with a history of chronic catarrh, hemoptysis; dies in 1790 after gradually increasing illness
1780 Lucy Garrett of Barnstable, chronic cough with blood, dies 1787
Discusses Ezekiel and Abner Hersey, their treatments and their illnesses
1790 marries Susanna Garrett, age 21 with chronic cough, dies of consumption 1793
1798 marries Miss Eunice Riggs, of Falmouth, age 25, cough with blood, dies 1799
1799 Barker claims he had been

About the Author

Richard Kahn (1940-) is an internist and medical historian who graduated from Rutgers University and Tufts University School of Medicine, where his interest in medical history began. After internship at Maine Medical Center in Portland, he spent two years in the U.S. Public Health Service, returning to MMC for an Internal Medicine residency. Practicing in Rockport, Maine, he has had teaching appointments at Tufts, Dartmouth, and the University of Vermont medical
schools. He has been active in several organizations devoted to medical history, most notably the American Association for the History of Medicine and the American Osler Society. He received the Osler
Society's Lifetime Achievement Award in 2017. Assisted by his wife Patricia, a medical librarian, Kahn began work on the Jeremiah Barker papers more than 30 years ago with the rediscovery of the Barker Manuscript at the Maine Historical Society Library, culminating at last in the publication of Diseases in the District of Maine 1772-1820.

Reviews

"Diseases in the District of Maine 1772-1820 is a well-written, wide-ranging, scholarly work. It will appeal to anyone interested in the day-to-day practice of family medicine in the formative years of the United States." -- Chris Derrett, British Society for the History of Medicine
"Historians of medicine who focus on the era of early modern medical practice--which I define as between Thomas Sydenham's patient-centered empiricism in the seventeenth century and the dawn of general anesthesia in 1846--will love this book... In addition to being a work of first-class scholarship, Kahn's book is a real page-turner. I could not put it down." -- Eric v.d. Luft, Ph.D., M.L.S., Watermark
"Richie Kahn's new book is a well-researched, enjoyable read." -- The Oslerian
"A remarkable and previously unknown source of diseases and medicine in early America. With meticulous research and sensitive prose, Dr. Kahn has set this treasure in its social, cultural, and scientific context, making it accessible, informative, and engaging for everyone." - Jacalyn Duffin, MD, PhD, Professor Emerita Queen's University, Kingston Canada
"After a publication delay of over 200 years, Diseases in the District of Maine is fully worth the wait. It offers a fascinating and at times dramatic immersion into medical practice in one part of the early American nation. Dr. Barker proves to be an earnest physician and amiable reporter; while Dr. Kahn ably helps out as a meticulous scholar and annotator." -Steven J. Peitzman, MD, FACP, Office of Educational Affairs, Drexel University College of Medicine,
Philadelphia, PA
"This immensely readable book is the result of Richard Kahn's determination to see Jeremiah Barker's notes and views on the practice of medicine in rural Maine 200 years ago recognised today. Barker's fifty years' journey shows his progression from apprentice to a master of his craft. Throughout, his case notes, with description of the patients and justification for his diagnoses and treatment, reveal an enlightened approach. He noted the characteristics of
his patients and their habits along with detailing the local climate and geography to inform his thoughts, particularly with regard to consumption. He believed himself to be a scientific physician and
his epidemiological observations led to him addressing life-style changes. This methodology was not that far from that of today and he can be considered a pioneer." -- Dr John W. K. Ward, FRCPEdin, FRCGP, Past-president of both the Osler Club of London and the British Society for the History of Medicine
"This is an extraordinary look at "ordinary" Maine physician Jeremiah Barker and his attempt to practice medicine at the turn of the 19th century. We see Barker practicing and writing his ultimately unpublished History of Diseases in the District of Maine amidst the rise and fall of medical theories and practices, the birth of medical journals in this country, and the attempt by orthodox medical practitioners to establish a seemingly rational therapeutics.
Complementing Laurel Thatcher Ulrich's contextualization of Maine midwife Martha Ballard in A Midwife's Tale, Kahn places Barker's own evolving theories, practices, and identity, along with the full and
annotated transcript of Barker's History of Diseases of the District of Maine itself, into historical context." - Scott Podolsky, MD, Professor of Global Health and Social Medicine, Harvard Medical School and Director, Center for the History of Medicine, Countway Medical Library, Boston, MA