In April 1748, the pastor Johann Boltzius wrote a despairing letter to his supervisor Gotthilf Francke in Halle, Germany. A strange condition had appeared in Boltzius's small community of Ebenezer, Georgia: people—mostly children—were eating raw corn and rice, dirt, ashes, and clay. Nothing could turn them from their appetite for these things; even sugar and honey could not compete. Parents, distressed by their powerlessness, could barely stand to look on as their children became bedridden, feverish, and unwilling and seemingly unable to eat anything of nutritional value. Boltzius interpreted the condition and its spread as a trial sent by God, whom he called on for aid. He also asked Francke to send advice from the physicians associated with the charitable Francke Foundations and the medical university in Halle.Footnote 1
Christian Thilo, the local physician in Ebenezer, reported his observations of the peculiar distemper in a letter to Francke. Thilo described an eight-year-old girl whose strange eating habits had eventually led her to eat tobacco stalks. He could find no medicine that worked; the girl would eat nothing else. She died, and Thilo feared the younger brother, who had learned her habits, would soon follow her to the grave.Footnote 2
Francke responded to Boltzius a few months later with the advice of a physician named Johann Juncker, who had been one of Thilo's medical instructors at the university in Halle. According to Juncker, the described disease was not unknown, but called pica. Pica was not a corruption of the body but rather the sign of a corrupted appetite or desire. Because the corruption had to do with desire, medicine was unnecessary; instead, treatment should involve a bit of trickery: giving the patient the dirt—or whatever she most desired—secretly mixed with an unpleasant-tasting tincture of bitter apple or ox gall. This treatment would cure the disordered desire of the patient, particularly, Juncker added, in the case of children.Footnote 3
In 1750, two years after the original correspondence, Boltzius was still reporting cases of pica in his journal, suggesting that Juncker's remedy was never received, was disregarded, or was ineffective. Boltzius tried bribing children, going to their school and offering rewards to those who did not eat the dirt, charcoal, or raw rice. The children could not control their appetites when they were alone, though, and Boltzius remained frustrated. He wrote that he had circulated an article on a cure, which he had found in a London magazine and translated into German.Footnote 4
The Ebenezer community's encounter with pica is a story of the intersection of religion and medicine in the Atlantic world. For eighteenth-century Christians, the created order, including the individual body, served as a symbol of the spiritual world. Disorder in the physical world meant something was spiritually amiss; it drew attention to the soul of the sufferer—or to the spiritual state of the suffering community—and called for close observation in order to discern God's will. In the case of pica in Ebenezer, not only clergy but also trained medical practitioners made their diagnosis and treatment in terms consistent with a long-standing Christian conception of a corrupted will causing bodily disorder. They echoed the conflict described in Paul's letter to the Romans: “I can will what is right, but I cannot do it. For I do not do the good I want, but the evil I do not want is what I do.”Footnote 5 The human body, vitiated by the effects of original sin, was prone to sickness. Sickness thus demanded reflection on the state of the individual soul.
Sickness was a problem not only for the individual body but also for the social body. As the pica episode demonstrates, both the minister and physicians were committed to combatting illness within the community. In so doing, they relied on an empirical approach to medicine that involved detailed observation, wide reading, and hands-on treatment. Their efforts were motivated by their faith in providence: they saw medicine and medical knowledge as divinely given and were convinced that caring for the sick offered an opportunity to do God's work in the world. Medicine was a chance to rid both the individual and social body of physical and spiritual corruption. Survival meant further opportunities to spread God's kingdom on earth. With these high stakes, Christians read widely, sought help, and encouraged treatments.
The relationship of the soul to bodily health was a central point of dialogue between religion and medicine throughout the eighteenth century. Christians participated in important changes within medicine: they debated over the soul's role in bodily health, they used new medical theories and treatment, they relied on empirical approaches, and they engaged in medical print culture. Following Descartes and, later, Newton, the body had increasingly become seen as fully observable and like a machine. By the eighteenth century, the soul's role in maintaining health was placed into question by the new, mechanistic approach to medicine. Mechanism represented a major transformation from the empirical approach, which had roots not only in the scientific method of Francis Bacon but also in the emphasis on patient observation reaching back to the ancient Greek physician Hippocrates and his second-century transmitter, Galen. Even with the turn to mechanism, some continued to prefer and defend empiricism. The empirically-oriented physician Thomas Sydenham, for example, remained popular on both sides of the Atlantic.Footnote 6
There was a wide variety of theory, knowledge, and practice within eighteenth-century medicine, yet, despite recent attention to the importance of cultural and social context in unraveling this complex history of medicine, scholars continue to overlook the role of religion.Footnote 7 For many eighteenth-century men and women, including trained medical practitioners, clergy, and laity, their participation in medicine was motivated by religious beliefs and practices. They connected spiritual and physical health. They understood medicine and medical knowledge as providential gifts of God. They believed God called them to evangelize, which included helping and healing those in need. Some medical historians have dismissed religious involvement in medicine as non-scientific, or, indeed as anti-scientific.Footnote 8 Other scholars have offered simplistic or theologically-uninformed assessments, arguing that participation in medicine was a symptom of secularization or decline from Calvinist orthodoxy.Footnote 9
Studies of religion and medicine often mistakenly connect protestant medical intervention to the nineteenth century and the popularization of Arminian theology as developed by John Wesley and the Methodist denomination. Wesley was an eighteenth-century Anglican minister whose renewal movement led to Methodism, one of the most rapidly expanding denominations of the early American republic. Wesley was a proponent of Arminianism, a theology that responded to the Calvinist theology of predestination by emphasizing individual Christians’ responsibility to work toward their own salvation. In studies of the nineteenth century, scholars have seen a parallel between, on the one hand, the Arminian principle of individual striving toward holiness and, on the other hand, the emerging medical literature that promoted self-medication and individual regimen in the pursuit of health. But scholars have uncritically read the eighteenth century through the nineteenth, applying to the former an alien paradigm of Calvinist aversion to medical intervention and Arminian rejection of providence. Such a conclusion overlooks both Calvinist medical engagement and the strongly providential cast of Wesley's medical writings. It mistakenly assumes that a Calvinist commitment to predestination—the belief that humans have no agency in earning salvation—entailed a rejection of activity to better earthly existence, and that an Arminian assertion of agency in salvation precluded the discernment of divine direction in earthly events.Footnote 10
By examining three different communities—Calvinists, Lutherans, and Arminians—and their interactions with medicine, this essay argues that eighteenth-century protestants actively participated in the diverse medical debates and treatments of the era, and that this participation was motivated by their conceptions of providence. The puritan minister Cotton Mather interpreted the physical efficacy of smallpox inoculation in terms of its effect on the animal soul, created by God to serve as a mediator between God and the human body. He also saw the promotion of inoculation in Boston as a divinely-designed opportunity for Christian benevolence. The pietist pastors in Ebenezer, meanwhile, became frustrated with their university-trained physician's obsession with the soul and spirit-led medical treatment, particularly when it hindered the interventions they saw as vital to the community's survival and evangelistic goals. The pastors turned, instead, to their own observations, reading, and women's medical knowledge. The Methodist John Wesley's popular medical manual, Primitive Physic, finally, relied on a traditional providential understanding of the human, fallen in both soul and body. The manual stressed the divine origins of empirical medical knowledge and its missionary potential.
These communities exemplify the theological and geographical diversity within eighteenth-century transatlantic protestantism. Despite their important differences, they have in common people, ideas, and concerns, and, most importantly, a shared conception of God's providence. Providential belief was not antithetical to medical activity. Rather, it shaped all aspects of protestants’ medical involvement. Protestants interpreted the human body and soul as integrally-connected parts of God's providential creation. They believed medical knowledge and medicine were part of this created order, inviting humans to act as God's intermediaries in the work of healing. And they perceived in this work a significant opportunity to build God's kingdom.
I. Cotton Mather: Managing the Body and Soul, Devising the Public Good
When a smallpox epidemic threatened Boston in 1721, Cotton Mather had a plan. After living through several previous smallpox epidemics, Mather had learned of a possible treatment that would stall the disease and save hundreds of lives, particularly the lives of those most vulnerable to the non-endemic smallpox cycles of New England: previously unexposed children. Along with other prominent Boston clergy and the physician Zabdiel Boylston, Mather promoted a new procedure called inoculation. Mather had learned about inoculation both from his slave, Onesimus, who described the use of the procedure in West Africa, and from a report in the Royal Society's Philosophical Transactions by Emanuele Timoni, who witnessed the procedure in Turkey. Inoculation worked by taking live virus from the pustule of someone sick with smallpox and implanting it into incisions cut in the arms of a healthy person. The patient would generally develop a less virulent form of smallpox, which he or she usually survived with less suffering and scarring than in the normal form. The procedure stirred great controversy.Footnote 11
Mather's involvement in smallpox inoculation has been a central focus of scholarship on religion and medicine in eighteenth-century America. Scholars have characterized Mather as an important early American medical thinker—indeed, even a “first.” They have debated his medical knowledge and argued about whether his choice to support inoculation—a procedure that, at the time, had undergone little testing or analysis in the western world—was truly forward-thinking or merely overconfidence, proven correct in retrospect. Meanwhile, while some studies have focused on the “superstition” that marked other areas of Mather's career, for example, his involvement in the trials of accused witches in Salem from 1692–1693, others look to Mather's engagement in medicine to consider his emerging “enlightenment” and its significance for secularization or, at least, for the decline of puritan orthodoxy. The latter generally apply a false timeline to Mather's medical writings, suggesting that Mather's concrete advice on disease management usurped his earlier focus on the redemptive opportunity presented by disease. In fact, both themes dominate his medical writings throughout.Footnote 12
Mather's involvement in the inoculation controversy must be considered in the larger context of his providential belief. This belief influenced Mather's understanding of the human body and soul, his approach to disease management, and his conviction that medical care was a crucial component of Christian benevolence and community. Mather described all of his work and ideas on the topic of inoculation in terms of providence; although new visions of human benevolence were emerging in his time, Mather, along with many of his contemporaries, perceived medicine and benevolence as part of God's will for human work.Footnote 13
Mather understood physical sickness providentially. Like most Christians of his generation, he found the origins of sickness in the original sin of Adam and Eve. Physical health and spiritual health were intimately linked in his unpublished medical manual The Angel of Bethesda.Footnote 14 Mather saw more than a helpful analogy between, on the one hand, the medical terms of bodily sickness and treatment and, on the other, the spiritual understanding of sin and the work of repentance. Sickness was a symptom and reminder of human weakness and transience and an invaluable opportunity to encourage sufferers to reflect on their spiritual state and God's providential promise of salvation. By repenting and turning to God, sinners could heal their souls.Footnote 15
Mather also believed that a healthy soul was the first step to physical health. In this conviction, Mather relied on medical opinions gleaned from his vast reading. He described, for example, an “Eminent Lady” with a “Chronical Malady,” who was cured by turning “herself wholly to God.” He also cited George Cheyne, a popular physician in early eighteenth-century England and an influential advocate of regimen in the promotion of bodily health. In a chapter on healing the soul, Mather quoted a passage from Cheyne's Essay of Health and Long Life, which described the importance of the soul and right belief to bodily health:
The Love of God, as it is the Sovereign Remedy of all Miseries, so, in particular, it Prevents all the Bodily Disorders the Passions introduce; by keeping the Passions themselves within due Bounds; and by the unspeakable Joy, and perfect Calm . . . it gives the Mind, it becomes the most powerful of all the Means of Health and Long Life.
The soul that properly loved God was the center of somatic wellbeing. It controlled the passions, prevented sickness, and promoted long-term health.Footnote 16
Mather elaborated on the soul's role in bodily health in a chapter called “Nishmath-Chajim,” or the “Breath of Life” in Hebrew.Footnote 17 According to Mather, God created the Nishmath-Chajim as an intermediary between the rational soul and the body. The Nishmath-Chajim was akin to the lower soul of the animal world. It provided physical “Safety and Welfare,” manifesting itself as “A Meer Instinct of Nature.” Mather's prime examples were a nursing infant and mother, who do “Very Needful and Proper Things, without Consulting of Reason for the doing of them.”Footnote 18 Mather was not alone in his understanding of a mediating, animal nature; it had long been a central part of the natural philosophy of Christian Aristotelians, and was maintained by the Flemish physician Jan Baptista van Helmont—with whose work Mather was acquainted—and by the German physician Georg Ernst Stahl at the University of Halle.Footnote 19
The Nishmath-Chajim allowed Mather to incorporate mechanistic notions of the body within historic Christian conceptions of the soul's role in physical health. Mather accepted, in part, the contemporary iatrophysical figuration of the human body as machine, but he resisted a purely mechanical notion of the body's operation: “There are many Things in the Humane Body, that cannot be solved by the Rules of Mechanism.” Without rejecting mechanism, Mather perceived something else was at work in the body. He argued that the “Machin” of the body was regulated by the Nishmath-Chajim, whose “Faculties” and “Tendencies” were “imprinted” by God. The Nishmath-Chajim assisted when the “Engine” of the body faltered: “other Parts of the Engine Strangely putt themselves out of their Way that they may send in Help unto it.” The body, as machine, relied on the Nishmath-Chajim to correct disorder.Footnote 20
With the Nishmath-Chajim, Mather participated in contemporary religious and medical debates regarding God, the soul, and the origin of bodily motion. Mather posited that the Nishmath-Chajim was “the Strength of Every Part in our Body” and gave “Motion to it,” thus accounting for the “Origin of Muscular Motion.” Like others of his time, Mather questioned the explanatory power of Cartesian mechanism or Newtonian physics for the origin of bodily motion. In discerning the origins of motion, Archibald Pitcairne, George Cheyne's teacher at Edinburgh, had focused on the heartbeat and circulation and posited some divine intervention. Mather's reluctance to accept a fully mechanistic view of the body and his interest in the soul was not necessarily, as has been argued, an effort to buttress ministers’ place in the sick room; clergy and medical practitioners alike were interested in God's role in the human body.Footnote 21
Mather's smallpox writings reflect these debates within eighteenth-century medicine. In discussing smallpox in the Angel of Bethesda, Mather stressed not only repentance but also disease management. He introduced both themes with language from Job, whose “broken” and “lothesome” skin and “Wearisome Nights” were widely associated with smallpox in Mather's time.Footnote 22 Mather made vivid reference to Job's suffering and lament: “Lord, From the Sole of the Foot, even to the Head, there is no Soundness in me; nothing but putrifying Sores.” With Job, Mather situated the suffering of smallpox within a providential narrative of sin and a call for humble repentance and resignation to God's will. Yet Mather's providential narration did not end with sin and repentance, but with management. He identified smallpox as the “Adversary” of Job's account—a formidable force against which humans were powerless but which God controlled. Mather exhorted his readers to courage against this “Adversary,” exclaiming, “There is a way to Manage him!”Footnote 23 Mather used the Book of Job to stage smallpox as both an opportunity for repentance and a battle that required human management and intervention. This intervention required, nonetheless, God's direction and a properly repentant soul.Footnote 24
The soul's role in disease management was tied to the stomach, or bowels, which housed the Nishmath-Chajim. This would prove critical for Mather's defense of inoculation.Footnote 25 The stomach was the place of digestion and the home of the passions, which were, significantly, the main faculties Mather attributed to the Nishmath-Chajim—the “Main Digester.” As the lower soul, the Nishmath-Chajim was responsible for nourishment and the basic function of life. Because of its centrality to human life, the stomach, when disordered, represented the “Seat of our Diseases, or the Source of them.”Footnote 26 Medical treatment had to target the stomach, focusing on proper digestion and humoral balance. In describing smallpox treatment—even before he knew of inoculation—Mather stressed care of the stomach. Inducing vomit in order to remove “Morbid Matter” was a chief way to clear corruption, balance the passions, and diminish the disease within people.Footnote 27
In his attention to the stomach and the balance of the passions, Mather was influenced, on the one hand, by the writings of John Woodward, a controversial medical writer in early-eighteenth-century England, who saw the stomach as the origin of disease and the main target of treatment.Footnote 28 On the other hand, Mather combined this focus on the stomach with the ancient theory of medicine known as humoralism. Humoralism, which first developed under the Greek physician Hippocrates and had lasting influence into the nineteenth century, was a system of medicine that divided the body into four humors: yellow bile, black bile, phlegm, and blood. Maintaining the balance of these four humors was essential to bodily health. To do so sometimes required an evacuation—often in the form of bodily fluid. An excessive fever, for example, could signify that the body had too much blood and required bloodletting. The body also had its own natural defense mechanisms when diseased, as seen, for example in pus, vomit, or diarrhea. As humoralism developed over time, the humors came also to reflect aspects of an individual's temperament. An excess of black bile, for example, could make a person melancholy, but this was a two-way street: a person, could, by attending to or controlling her emotions—or passions—also affect her physical health.Footnote 29
For Mather, finding this emotional balance depended on the soul and on God. Comprehensive disease management demanded not only the physical intervention required to restore balance to the stomach and lower soul but also the religious reflection of the higher “Rational Soul.” The rational soul controlled the passions, the balance of which was essential to the health of the Nishmath-Chajim and the body more generally. Through reflection and “Serious PIETY,” the rational soul effected “Wonderful Influences” on the Nishmath-Chajim. The Nishmath-Chajim, in turn, successfully mediated the higher soul and physical body. With the Nishmath-Chajim, Mather bound piety and physical intervention closely together.Footnote 30
Mather focused on the stomach, home of the Nishmath-Chajim, when he differentiated the way corrupted matter spread in natural versus inoculated smallpox.Footnote 31 Mather believed that the former was acquired through the air, went directly to the blood in the lungs, pulsed quickly into the heart and, soon after, passed into the “Bowels.” The “Bowels,” which Mather seems to have understood broadly to include the stomach, represented the “Centre of the Citadel.” They housed the Nishmath-Chajim, which maintained the body as “machine” by balancing the passions, fighting off corruption, and restoring order. The speed with which naturally-acquired smallpox approached the bowels limited the opportunity for active response and survival.Footnote 32
Inoculated smallpox, however, was acquired through the skin. Based on physical observation and their understanding of the soul, Mather and others believed that acquiring smallpox through the skin affected the body's ability to fight off the corruption. Mather thought that inoculated smallpox worked more slowly and only approached “the Outworks” of the “Citadel.” By keeping corrupt matter away from the “Vital Powers,” they were better able to combat smallpox. The Nishmath-Chajim had time to order the body, to turn to piety and to God, and to balance the passions. It could then “oblige [the inoculated matter] to march out the same way as [it] came in.” Mather's metaphor alluded to how, several days after inoculation, pus ran from the incisions. He interpreted this running as a sign of corruption exiting the body. Though inoculated smallpox was not harmless, according to Mather it left no scars through which it could return, and the patient could be “sure of never being troubled with [smallpox] any more.”Footnote 33
In early America, the state of one's soul was reflected in the body; complexion reflected both the physical health achieved through balanced humors and the spiritual health reflected in right behavior.Footnote 34 Mather and others, including the minister Benjamin Colman, pointed to the relative lack of scars on inoculation patients compared to the common and often disfiguring scars suffered by those who survived naturally-acquired smallpox. They appealed to this widely-experienced and highly-visible evidence when promoting inoculation in print. These ministers interpreted scars as a visible sign of corruption beneath the skin. Colman argued that, when contracted naturally, smallpox scabs—together with the corruption they covered—prevented “free perspiration by the Pores,” and left a “foul mass upon” the body. In this scenario, Colman reasoned, the smallpox could return and lead to the “second fever,” which defined the confluent and more fatal smallpox. Inoculation incisions, on the other hand, released corruption and prevented scars and lingering corruption.Footnote 35 A clear complexion implied that the vital power of the body, the Nishmath-Chajim, together with the higher, rational soul, had successfully fended off corruption.
Like Mather and Colman, anti-inoculators also attempted to explain their position to the public with tracts that appealed to visible evidence of corruption in the body. John Williams, drawing on his own experience and observation of smallpox and inoculation, argued that the running of pus at the incision was not a sign of corruption leaving the body. Rather, it signaled the living and more venomous corruption physicians had foolishly inserted into the body. The corruption of inoculated matter was evident, Williams believed, in its smell, which some witnesses reported as “worse than ever they smelled.” Such a smell was “contrary unto nature.”Footnote 36
The observation of inoculation's effect in individual bodies—which was encouraged by the tradition of empirically-based medicine—affected how writers interpreted inoculation as an activity of God's providence within the broader social body. Williams saw inoculated matter as corrupt. While he did not interpret preventative medicine (like bloodletting or a purge) as against God's providence, he could not see the insertion of corrupt, inoculated matter as preventative or providentially ordained. Williams argued that, instead of preventing disease, inoculation actually spread disease and corruption; the incautious inoculated patient could, in fact, give the natural and more dangerous virus to her neighbors. “To have it brought to them by a voluntary Motion of their Neighbour,” Williams wrote, “is more hard to be born by their injured Neighbour, than if it came to them in or by the common way; (the Providence of God casting it where and when he will).”Footnote 37 In addition to introducing corruption to an otherwise healthy person, inoculation, in effect, intentionally introduced corruption into an entire neighborhood.
For his part, Mather interpreted the protests against inoculation as evidence of a community suffering from evil and corruption, determined to undermine a procedure that was providentially ordained to save lives and prevent suffering. After his house was targeted by a homemade grenade (that failed to trigger) at the height of the controversy, Mather described anti-inoculation protests as the work of the devil, who was attempting to undermine Mather's efforts on behalf of God for his community's welfare. He prayed for God's compassion “to a Town already under dreadful Judgments, but ripening for more,” and hoped that God would “yet appear to rescue and increase my Opportunities to do good, which the great Adversary is now making an hellish Assault upon.” Inoculation was, as Mather's journal repeatedly echoed, a “good devised.” Influenced by German pietists, Mather increasingly sought out God-given opportunities to engage in such Christian benevolence.Footnote 38 As his own son, Samuel, underwent inoculation, Mather outlined plans to recommend the procedure abroad in order to save more lives, believing that “a World of good may be done to the miserable Children of Men.”Footnote 39 The phrase “children of men” is a scripturally-laden reference to humankind's sinful nature and God's loving and redeeming intervention in times of distress.Footnote 40 Inoculation, in Mather's view, was the most recent example of God's providential care and guidance for human activity on behalf of others.
Mather defended and promoted inoculation as a God-given public good, as an effective way to assist a soul-driven body in maintaining health, and as an empirically-tested procedure that prevented and purged corruption in both the individual and social body. While Mather was certainly, as scholars have argued, motivated by his desire for authority and his confidence in his own expertise, his outspoken role in the inoculation debates also—and more importantly—reflected his engagement in the central questions animating his medical and Christian contemporaries. Mather responded to these questions not only by reiterating his commitment to the importance of repentance in sickness, but also by positing that active medical intervention in a proven form could actually assist the soul, or the Nishmath-Chajim, in fighting disease. Mather, his supporters, and his opponents appealed both to providence and to traditional medical emphases on observation and experience as they explained how physical symptoms signified internal corruption within the individual body. They extended these observations to their understanding of the spread and treatment of disease within the social body.
Both sides of the inoculation debate sought to comprehend God's providence in their response to smallpox. For Mather, inoculation was a gift of God to help his neighbors. For anti-inoculators, it dangerously introduced corruption and could inadvertently spread disease, which was not, they believed, God's plan. In the end, each side saw a central connection between the human soul and medicine, a connection defined by their efforts to discern providential direction in their efforts to devise good for suffering humanity.
II. Ebenezer, Georgia: Medical Networks and Debates in a Colonial Pietist Community
In February of 1738, the long-awaited physician Christian Thilo arrived in the German-speaking pietist settlement of Ebenezer, Georgia. Shortly after Thilo's arrival, he had an argument with the community's lead pastor, Johann Boltzius. The argument ended, according to Boltzius, with Thilo running into his room, laying on his bed, and throwing a fit. Boltzius, meanwhile, fell to his knees in the courtyard and prayed to God for mercy and wisdom before he called Thilo to him. Running outside, Thilo pulled off his wig, put his head to the ground, and, according to Boltzius, mumbled perverse things. Thilo ceased going to church services, suggested the ministers were idolatrous, dallied with married women, and offered nonsensical reasons for refusing medical treatment one day but allowing it the next. Boltzius reflected with disappointment: after two long years without a physician, “now arrives such worthless material to sadness and moans.”Footnote 41
Rumblings of Thilo's problems began even before he arrived in Ebenezer. His behavior and preparation shocked the men he met in London, his first stop, including important representatives from the Francke Foundations in Halle, the Society for Promoting Christian Knowledge (SPCK), and the Georgia Trustees. They reported that Thilo suffered miserably from a lack of provisions during his passage from Holland to England: he expected the voyage to be a mere twenty-four hours, not a full seven days. Further, they worried that Thilo—although well educated in the method of Georg Ernst Stahl under the instruction of Johann Juncker at the medical university in Halle—was unprepared in essential medical practices, including bloodletting and surgery. Alarmed by these reports, Gotthilf Francke sent a letter to the Ebenezer ministers explaining that Thilo suffered from hypochondria, both of the body and the spirit, which was worsened by problems on his journey. The ministers were to welcome him, nonetheless, with love and gentleness.
The Francke Foundations, the SPCK, and the Georgia Trustees were committed to the support of a missionary physician, recognizing the central place of physical care to the success of Christian mission in the colony. Thilo received preliminary provisions and a stipend as well as medicines free of charge; Francke opined that Thilo was a better physician for Ebenezer than one who sought honor, money, and good living.Footnote 42 In the end, Thilo lived in Ebenezer nearly thirty years, during which he was a constant source of frustration and distress. The Francke Foundations’ steadfast commitment to providing missionary medicine and Thilo's erratic behavior and professional choices, however, produced an extensive manuscript record that offers invaluable insights into the medical world of Ebenezer in the mid-eighteenth century.
As in Cotton Mather's inoculation-frenzied Boston, medical debates in Ebenezer revolved around conceptions of the soul's role in bodily health and the conviction that medicine and healing were crucial to Christian mission. The ministers’ writings demonstrate how, when disappointed in Thilo, they turned to both formal and informal medical networks in their earnest efforts to keep community members alive. They relied on their own minimal missionary medical training in Halle, empirical observations, networks of female medical knowledge, and articles from the popular press. Like Mather, the Ebenezer ministers interpreted their medical activity in terms of Christian mission. They embraced a pietist impulse to do good, convinced that a healthy body allowed the human soul to pursue its work in the world, to promote the kingdom of God, and to exemplify Christian piety in colonial America. While many historians have told the story of Mather and 1720s Boston, almost no one has examined the history of medicine in Ebenezer, despite its rich trail of sources.Footnote 43
Thilo's unusual treatment practices were grounded in a soul-oriented medicine, which had its origin in his training at the medical university in Halle and his exposure there to theoretical debates within medicine. Boltzius's frustration with Thilo's medical practice became apparent in Thilo's response to malaria, a disease that had repeatedly afflicted the Ebenezer community since its initial founding in 1734. Despite relocating to better land, the malaria outbreak of 1736 proved even worse, spreading widely among adults and children.Footnote 44 Reports were so dreadful that sponsors in Europe, who annually published the ministers’ journals for eager audiences, delayed publication of the 1736 journal until it could be prefaced with more encouraging news. Desperation was widespread, and some threatened to move away.Footnote 45 Ebenezer's stability and success were at risk.
The first record of the community's treatment strategies for malaria is from 1740. On May 29, Boltzius wrote Francke to thank him for medications and the advice of Halle physician Johann Juncker on the “Fieber-Kuchen,” or the hard knots that formed in the left side of the abdomen in those affected by malaria. Boltzius hoped Thilo would implement Juncker's treatment and prayed for God's blessing on the cure.Footnote 46
Boltzius continued by describing past advice the community had received for malaria treatment and his resulting debates with Thilo. Samuel Urlsperger, an important Ebenezer benefactor in Augsburg, had shared his physician's advice. The advice posed a problem, however: not only was the prescription difficult to fulfill with ingredients available in Georgia, but Thilo also refused to follow it, because it did “not seem to follow the method organica.” Boltzius explained that Thilo particularly objected to the use of “cortex peruvianus.” Frustrated, Boltzius concluded that he “certainly does not take an active interest in the patients.”Footnote 47
Boltzius's frustration and Thilo's response to “cortex peruvianus” and alignment with the “organic method”—which was associated with the medical practitioner Georg Ernst Stahl in Halle—reveal a theoretical debate over the place of the soul in medical practice and bodily health. In the eighteenth century the most effective treatment for malaria was the bark of the Cinchona tree (cortex peruvianus, or Jesuit's Bark), which contained quinine, but this treatment had its detractors, who feared that quinine's effect on fevers did not correspond with humoralism. As in Mather's Boston, humoralism was still an influential theory of medicine. Because of the focus on balance within humoralism, a medicine designed to reduce a fever (a main symptom of malaria) was expected to produce a corresponding form of evacuation. For example, bloodletting was thought to release the corruption causing the fever. Quinine was problematic because it did not have an evacuant, leading to the fear that the fever—or corruption—was simply suppressed and lingered within the body.Footnote 48 This fear echoed debates surrounding smallpox inoculation in 1720s Boston and the significance of the pus—or evacuant—observed to run from the site of implantation.
The theoretical debate over quinine in Ebenezer was shaped by professors at the medical university in Halle, and their approaches reflected different conceptions of the soul's role in bodily health. In the late seventeenth century, Friedrich Hoffman, an iatromechanist, experimented with quinine and concluded that it neutralized the acidity in the blood, which he interpreted as the cause of fevers. Hoffman's colleague, Georg Ernst Stahl, however, was wary of mechanism. Stahl favored the “organic method.” For Stahl—like Mather—the soul directed healing, and fever represented a normal release of corruption that should not be repressed. Because quinine prevented fever, Stahl and his students, including Johann Samuel Carl and Johann Juncker—Thilo's teacher—rejected its use in malaria treatment.Footnote 49
Carl, Juncker, and, eventually, Thilo, went beyond Stahl in emphasizing the soul's role in healing and, correspondingly, in promoting “gentler” and more selective treatment. In treating malaria, for example, Carl recommended gentle dietary measures to aid the soul in removing corruption. Thilo, meanwhile, avoided treatments such as bloodletting and relied “on the course of nature.” He also, according to Juncker, fixated on patients’ spiritual states. Juncker reported that while Thilo was still in Halle, he occasionally extended appointments several hours, seeking to ascertain the condition of his patients’ souls. In 1738, Boltzius reported that Thilo could change treatment mid-course, depending on “inspiration.”Footnote 50
Despite Thilo's formal medical training, Boltzius and his assistant minister, Israel Gronau, found his treatments and methods unreliable and they were spurred to involvement. Like Mather, they were influenced by wide reading, personal observations, and a providential sense of Christian mission centered on survival and the growth of God's kingdom. In the case of malaria, the Ebenezer ministers apparently used quinine despite Thilo's objections. Francke reprimanded them in 1743 and 1745, astonished at reports of quinine use. He warned the ministers with language grounded in humoralism and empirical observation: he argued that quinine “plugs” or “jams” fever and, despite appearances, left dangerous corruption beneath the skin. He also worried that quinine had aggravated the symptoms and sickness that the minister Gronau described himself suffering.Footnote 51
Even if the Ebenezer ministers did not appreciate the theoretical medical debates behind Thilo's treatment methods, they knew enough about medicine to understand Francke's humoral concerns. Nonetheless, when it came to the persistent diseases that threatened communal stability, they proved willing to intervene and try new treatments. Both ministers had received some medical training in Halle and used it, particularly when Ebenezer lacked a doctor in early years. Even after Thilo's arrival, the ministers remained highly involved. In light of Thilo's dislike of bloodletting, Gronau practiced it, and Boltzius dispensed medicines, because Thilo rarely used the medicines freely provided to him from Halle.Footnote 52 They also recruited the help of Johann Ludwig Mayer, a 1741 immigrant from Swabia, who favored the use of quinine in treating malaria.Footnote 53
The ministers were focused on their community's survival; the success of their God-directed mission in Georgia depended on their physical health. Ministering to a community originally made up of protestant refugees from Salzburg, they found, like the puritans and Separatists of New England, a symbolic pressure to survive and witness God's providential mercy on their mission. Disappointed in their physician's lack of active intervention and trying to care for as many as he could, Boltzius repeatedly turned to other networks of medical knowledge, including women. Although the only evidence we have of this from Ebenezer is in Boltzius's writings, it is important to remember that women as well as men participated in medicine and that, although certain conditions highlighted discretion, this participation was often joint and interconnected.
In July 1749, Boltzius wrote two letters to Henriette Rosine Goetze,Footnote 54 the mother-in-law of Gotthilf Francke, regarding the poor health of his wife, Gertraud Boltzius.Footnote 55 Boltzius wrote that he would have asked Thilo to submit a report, but Thilo was “rather inexperienced in women's conditions.” Boltzius diplomatically did not mention his dissatisfaction with Thilo, who had proven unreliable in treating Gertraud Boltzius. Early on, Thilo refused to treat or even see her; according to Boltzius, Thilo resisted bloodletting her, vaguely explaining that “the bloodletting must occur tomorrow and not today,” and he sent medicine with a child messenger rather than bringing it himself. Boltzius wrote to Goetze not only because he found Thilo's spiritual direction in medical treatment unpredictable, however, but also because he listened to his wife, who told him to contact Goetze.Footnote 56
Boltzius explained his active intervention in his wife's health was motivated by love—the love he and his children had for a “helpmeet” and mother given by God. He recognized that the outcome of Goetze's counsel would depend ultimately on God's mercy.Footnote 57 Nonetheless, he did his best to provide Goetze with detailed information regarding Gertraud Boltzius's condition in order to improve the chances for effective treatment. Gertraud Boltzius had read a book on medicine by David Samuel von Madai, Unterricht der bewehrten Hallischen Artzeneyen (Instruction Concerning the tried and tested medicines of Halle), which Goetze had included in a recent shipment to Ebenezer, and Johann Boltzius wrote Goetze requesting specific medicines based on his wife's reading.Footnote 58 Urged by his wife, he also detailed her longstanding health problems. These began around age 17 during her first childbirth, when she was “very damaged … by an unscrupulous midwife.” He described Gertraud's “distressful gynecological (hysterischen) incidents”Footnote 59 with care, hoping that such detailed observations would assist in a cure:
her stomach has become so weak through the many ebullitions of the blood that she feels almost every bit of bread and the lightest food, and must, after eating, if it can be said, vomit . . . Please excuse me for mentioning out of necessity yet one particular condition. She indeed has always had her menstrual period, but irregularly; for example, every 3 weeks, sometimes too much, sometimes too little.
Despite his discomfort with the level of detail, Boltzius hoped for Goetze's sympathy and assistance, and, “at the request of my helpmeet,” he did not want to omit vital information.Footnote 60
Boltzius's appeal underlines his dissatisfaction with Thilo and desire for active medical intervention, even if intervention required once again sidestepping professional networks of medical knowledge. Boltzius's account and its detailed observations reflect ongoing participation in traditional empirical- and humoral-based medicine. He and his wife hoped the details would allow for diagnosis and treatment. Unfortunately, Goetze died before she received the letters. Boltzius followed up with Francke, and in October 1750 Madai himself responded. Although unable to make a diagnosis based on Boltzius's account, Madai nonetheless suggested a treatment.Footnote 61
Gertraud Boltzius's sickness was not the only occasion in which Johann Boltzius alluded to a separate, or parallel, line of communication when it came to women's health and his perpetual disappointment with Thilo. During a 1750 epidemic, which has been variously identified as “Rothe Friesel,” scarlet fever, or measles, Boltzius rarely mentioned Thilo and instead relied on his own observations and readings and his wife's personal observations in trying to determine treatment.Footnote 62 Boltzius believed bloodletting to be the best treatment. He reported that “adults who have this scarlet fever say that there is an extraordinary movement of the blood as if it is wished to break out of all veins.” He wrote that the English said bloodletting was the best cure, and he noted that he had seen children regain health after suffering a nose bleed. Gertraud Boltzius, meanwhile, confirmed the overwhelming significance of blood by observing several women's experiences with the disease, including:
A grown girl had her first period during her paroxysm, but then it rose immediately to her breast as if it all wished to come out of her throat, and from this she suddenly died five weeks ago . . . A pregnant woman in her first months was brought into mortal danger by the extraordinary motion of the blood in her body. However, because the blood broke out and she aborted, she soon recovered.
Boltzius reported his wife's observations as further evidence of the need for bloodletting as well as for constant scrutiny in treatment.Footnote 63
Boltzius turned to women's medical knowledge not only because it corresponded with his own humorally- and empirically-based understanding of the human body and the effects of illness, but also because it furthered the opportunity for intervention that he saw as critical to Christian mission. Despite his struggles and differences with Thilo, which stemmed from Thilo's fixation on the soul's role in sickness, Boltzius nonetheless also perceived spiritual significance in the practice of medicine and healing of the body. He maintained a pietist-inflected perspective on good health: it represented a gift of God directed toward a spiritual end, to do God's work in the world. Medical treatment made it possible, as Jürgen Helm has argued, for the sick person to “redeploy the body again in a condition that facilitated it to achieve the will of God and further it in the world … [The body] served as ‘guest giver’ and suitable instrument of the soul. Because of this function, the body was necessarily worthy of preservation.”Footnote 64
Boltzius understood the healthy human body as a house for the soul, its spiritual work, and mission, and he grounded this conviction in a providential understanding of Ebenezer. He longed for his community's survival, hoping to continue God's work in Georgia and to serve as an example of God's blessing on missionary work. Francke had shared this vision in a 1743 letter, invoking language from Matthew 5:14–16: “May the Lord therefore allow Ebenezer to be a city on the hill, and be a light on a glowing candlestick. May he then also grant to all inhabitants grace, to allow their light to be shone, through a spiritual and Gospel-worthy transformation, above all to the European inhabitants in America.”Footnote 65
After the Rothe Friesel epidemic of 1750, Boltzius envisioned a charitable institution designed for Ebenezer's physical and spiritual health: a hospital. The 1750 epidemic had been particularly bad: in a two-month period at least thirteen children, or about 5% of Ebenezer's population, had died. Boltzius lost his oldest son, Samuel Leberecht, and his youngest daughter, Christiana Elisabeth.Footnote 66 He was heartbroken. He accepted the loss as God's will and hoped for future retrospective clarity, citing John 13:7 in the top margin of a letter to Francke: “What I do thou knowest not now; but thou shalt know hereafter.” Boltzius also dwelled on the sheer number of deaths among children in Ebenezer since its founding: “If all the children who were born and baptized sixteen years ago in old and New Ebenezer were still alive, how large our congregation would be!” In hope, Boltzius envisaged “a beautiful troop of chosen and transfigured children from the Ebenezer congregation … resplendent before God's throne,” but he also suffered acute grief.Footnote 67
In responding to the loss of children, Boltzius envisioned a “spacious sickbay,” which would provide protection for poor families in winter. When inhabitants became sick during this time, he wrote, “their quick recovery is hindered, and they also contract long-lasting sickness and consumption.” Although physicians and medicines were freely provided, such a sickbay would transform the experience of illness in Ebenezer: “much good would accrue from it to the congregation and the whole country under the influence of God's blessing.”Footnote 68
Ebenezer could not survive without children, and if Ebenezer did not survive, what did that mean for its providential call to serve as an example of renewed piety and protestant mission in America? Although Boltzius's sickbay never materialized, his vision of a congregation and country transformed by a benevolent institution—approved by God's providence—demonstrates the power he saw in the Christian commitment to medicine and care. Disappointed in Thilo and his fixation on soul-based medical care, Boltzius displayed his own deep desire to intervene actively among the sick. His concerns were both practical and providential. Far from centers of learning and medicine, he engaged—through correspondence, popular print, and conversation—the medical knowledge and treatments available and sought to act upon this knowledge with the urgency impressed by his situation. His writings illuminate both the medical debates within pietist academic medicine and the central protestant concern with providing physical relief in the hope of survival, spiritual renewal, and Christian mission.
III. John Wesley, Primitive Physic, and American Mission
In 1789, a new preface was added to the twenty-first edition of John Wesley's Primitive Physic, a medical manual first published in England in 1747. The 1789 edition was published in Philadelphia, and the new preface was written by Thomas Coke and Francis Asbury, bishops of the recently-formed Methodist Episcopal Church. They began their preface: “The grand interests of your souls will ever lie near our hearts, but we cannot be unmindful of your bodies.”Footnote 69 More than forty years after Wesley made bodily health a central part of his renewal movement within the Church of England, his writings on the subject remained central in the new American denomination he and his followers shaped.Footnote 70
Like Mather and Boltzius, Wesley's interest in medicine was tightly bound to contemporary medical debates and Christian reactions to them. Wesley believed that theoretical medicine had developed at odds with God's design for human health. Following Cheyne, Wesley emphasized the importance of piety in the maintenance and restoration of bodily health, and like Mather and Boltzius, he also saw a clear connection between Christian benevolence and mission and medical care. But he took this connection one step further, using this commitment to benevolence and evangelism to critique theoretical medicine, which had grown too complicated for the average sick person's participation. Wesley remained loyal to the empirical tradition and, like Mather and Boltzius, learned from wide reading and observation. Wesley sought to make medical knowledge widely available by printing an inexpensive medical manual; in this he surpassed Mather, and, indeed, all Christian authors on medicine of his time.
Wesley's Primitive Physic was immensely popular, with more than thirty-seven editions printed in the English language before 1859, including at least twenty-four editions published in America. According to the historian G. S. Rousseau, the book “was found in almost every English household, especially in those of the poor, usually beside the Bible.” Notes and alterations to surviving American editions suggest that the book was well used, shared, and passed on.Footnote 71
Primitive Physic and the general Methodist commitment to good health were important manifestations of Methodist theology in both eighteenth-century England and America.Footnote 72 Wesley's writings on medicine were premised on a providential understanding of the fallen human soul, the corresponding condition of sickness, the gift of medicine from God, and the place of medicine and treatment in the Christian mission to the larger community. Scholars, however, have overlooked the commitment to providence evident in Wesley and in the broader Methodist movement; this oversight results from the efforts of scholars—and nineteenth-century Methodists themselves—to distinguish Methodism from Calvinism through reference to the Methodists’ Arminian stress on human effort, action, and practice. Attending to how providential views shaped Methodist theology and writings on medicine highlights the important parallels in medical interest and practice between Methodists and other religious communities, including puritans and Lutherans. This is particularly important because some historians have termed Wesley's ideas as “Christian enlightened thinking,” implicitly binding his attention to medicine to modern enlightenment without acknowledging his dependence on historic and contemporary Christian understandings of providence and healing.Footnote 73
Wesley's interest in medicine was shaped by his participation in both formal and informal medical networks. From his own family history and the models set by other ministers, he knew medicine could serve as a useful parallel career for English clergy. His medical development was shaped by his time as a missionary in the colony of Georgia in 1736 and by his relationship with George Cheyne, who treated Wesley on his return to England. Cheyne's straightforward writings on diet and exercise and his attention to piety influenced Wesley just as they had Cotton Mather. In the 1740s, Wesley opened a medical dispensary in London that served the poor free of charge, but it was costly and difficult to operate effectively. He redirected his efforts, and in 1747 he published Primitive Physic, an accessible book on medicine that was inexpensively distributed to interested readers in London and beyond. Recognizing the value of print in Christian evangelism, Wesley joined the already expansive medical marketplace that had emerged in eighteenth-century England.Footnote 74
In the preface to Primitive Physic, which remained unchanged through over a century of new editions, Wesley articulated a story of sickness and healing that originated in the sin of Adam and Eve. Both sickness and healing were ordained by God as a result of humanity's sinfulness, and both were transmitted from generation to generation—the former by nature and the latter by education. Wesley told this story in providential cadences, explaining to readers the fall of humanity and the origins of sickness, God's gift of medical knowledge and its proper use, and the importance of making medicine available to everyone. Wesley's preface welcomed readers familiar with a traditional providential view of the origins of sickness in human sin, while also explaining medical education and action in providential terms. In so doing, the preface offered an important Christian commentary on the contemporary state of medicine in England.
Wesley argued that God had ordained medical knowledge, together with other expertise, to pass seamlessly from parent to child—similar, in a way, to original sin. Medicine was traditional: “every father delivering down to his sons, what he had himself in like manner received concerning the manner of healing.” God had ordained not only sickness, but also the human ability to accumulate and share knowledge for the promotion of cures and health. For Wesley, Native Americans offered an unadulterated example of this process; they passed knowledge to the next generation and participated in the foundational and God-ordained activities that prevented disease in the first place: exercise, diet, and temperance. These activities were key components of the physical regimen that, according to Cheyne, accompanied spiritual discipline and health. Only recently, Wesley wrote, had Native American temperance been corrupted, but their medicines, passed from father to child, remained “quick, as well as, generally, infallible.”Footnote 75
Wesley's preface detailed how medical knowledge was a part of God's providential plan to heal fallen creation. What might seem an “accident” was how the “Author of nature” taught fallen humanity the means of medicine: “doubtless numberless remedies have been … casually discovered in every age and nation.”Footnote 76 God's order shaped human experience and corresponding knowledge of medicine. As long as “physic was wholly founded on experiment,” Wesley wrote, it reflected God's created order and was oriented to “common humanity.”Footnote 77
From this description of God-designed medical practice, Wesley turned sharply to criticize what he considered the contemporary corruption of the process. This corruption included theoretical approaches to medicine, which, he added, made profit rather than Christian humanity the orienting motive of the medical profession. When “men of a philosophical turn” ceased to be “satisfied” with the experimental approach to medicine, they turned increasingly to “hypotheses” and “theories” as they “inverted” the “whole order of physic.” In so doing, these men forgot the simples—medicines consisting of a single ingredient—that had long dominated medical therapy in order to promote compound medicines, which contained multiple ingredients and came with complicated rules for use. Together with compound medicines appeared an ever-increasing supply of difficult books, which were inaccessible “for common people.” Medicine “became an abstruse science”—involving anatomy, natural philosophy, and even astronomy—and therefore “quite out of reach of ordinary men.” This theoretically-obsessed medical profession secured “honor and gain” and was territorial. Compound medicines, Wesley wrote, were designed “to swell the Apothecary's bill,” indeed, “possibly on purpose to prolong the distemper, that the doctor and he may divide the spoil.” Meanwhile, the rest of humanity was left “utterly cut off from helping either themselves or their neighbours.” Medicine had been diverted from the God-ordained method of experience and goal of helping others in need.Footnote 78
Wesley's intent in writing Primitive Physic was to return medicine to what he considered its providential design in experience-based knowledge oriented toward Christian mission to fallen humanity, including the most “common man.” Wesley cited others who wanted to “explode” from medicine “all hypotheses, and fine spun theories,” particularly Thomas Sydenham, George Cheyne, and physicians who avoided complicated compound medicines, such as Herman Boerhaave. But Wesley went further, attempting to make medical advice widely available to even the lowest classes. Common people could promote good health by following the straightforward and simple remedies Wesley provided as well as by eating temperately and exercising regularly. Wesley reminded readers, “above all,” however, of the importance of prayer, “that old unfashionable medicine.” It was prayer that turned humans away from their own fallen knowledge, away from the dangerous enticement of theory and medicine oriented to private gain, and that reminded them to “have Faith in God, who ‘killeth and maketh alive, who bringeth down to the grave and bringeth up.” By echoing Hannah's praise of God's faithfulness and power over humanity in 1 Samuel 2, Wesley reiterated to readers the importance of remembering and trusting in the ultimate arbiter over human health and sickness.Footnote 79
Within this trust in providence, Wesley was not against reading widely in medical literature and, with the goal of helping others, he participated actively in many of the scientific and medical developments of his time. Regardless of his rhetorical promotion of “ancient and contemporary ‘popular’ medicine,” Wesley, as historian Deborah Madden has shown, “adopted, elaborated and simplified those authoritative medical sources that were validated by leading contemporary physicians.” As new editions of Primitive Physic were produced, Wesley occasionally added notes and described new treatments. He began adding an asterisk, for example, if he had personally tried or observed a remedy, or he appended a note if he found a person's testimony particularly compelling. For example, under the third treatment option listed for the condition “The Bite of a Mad Dog,” Wesley wrote, “Mix a pound of salt, with a quart of water. Squeeze, bathe, and wash the wound with this for an hour. Then bind some salt upon it for twelve hours. N.B. The author of this receipt was bit six times by mad dogs, and always cured himself by this means.” Wesley was actively engaged in attaining medical knowledge, most famously in his use of a personally-built “electrical machine,” which he began using to treat patients in 1746. He used electricity to treat a variety of conditions, including deafness and obstructed menses. By 1760, he added a prefatory remark on the benefits of electricity as “far superior to all the other medicine I have known.” While Wesley's participation in the medical world was wide-ranging, he always wrote with clear and simple language that he couched in personal experience, and he stressed that the outcome of human medical activities relied, ultimately, on the “blessing of God.”Footnote 80
Wesley ended the preface with a citation of “a few plain, easy rules”—gleaned from Cheyne—which focused on the importance of balancing passions for the maintenance of bodily health. Like Mather, Wesley quoted Cheyne's admonition that “the love of God” assists in “keeping the passions themselves within due bounds.” Such love represented “the most powerful of all the means of health and long life.”Footnote 81 Following Cheyne, Wesley also argued that the passions were both animal and spiritual, and both influenced the physical body. Indeed, the passions motivated the body and its activity in a way similar to how gravity affects matter. In describing the relationship between body, mind, and soul in the post-Cartesian world, Cheyne had been influenced by contemporary Newtonianism, but his understanding of body and soul also held intriguing similarities to Georg Ernst Stahl's conviction of the soul's driving influence in healing the body. Unlike Stahl, however, Cheyne perceived the influence between body and passions as a “two-way street”: that is, Cheyne did not limit the direction of influence to soul on body. Influenced by John Locke, Cheyne believed external stimuli could have internal influences. Thus, as his treatment methods developed, he came to stress—as did Wesley—that “discipline of the body was an essential counterpart to discipline of the soul.”Footnote 82
This mutually influential interrelationship between soul and body remained the driving impulse behind the publication and distribution of Primitive Physic in the United States: “The grand interests of your souls,” Coke and Asbury had written, required attention to “your bodies.” The 1789 Primitive Physic was not the first appearance of the book in the United States, but it was the first from the newly-opened publishing house of the Methodist Episcopal Church: the Book Concern.Footnote 83 The Book Concern was founded in 1789 in Philadelphia as part of an effort to build Methodist community in the rapidly expanding denomination. In the United States, Methodist membership grew dramatically between the years of 1784 and 1791: from 15,000 to 76,000. Aware of both the opportunity and the dangers of this amazing growth in such a large geographic space, publication became a central focus of American Methodists. The opening pages of The Arminian Magazine, a Methodist periodical first published in the United States in 1789, reminded readers of the importance of publication efforts on the “extensive continent” of the United States. Popular print, including journals, hymns, poems, and letters, represented an opportunity to enunciate the doctrines of Methodists and to differentiate them from Calvinists on the one hand and Universalists on the other. It is significant that among the first books published by this new publishing enterprise were Primitive Physic and Imitation of Christ (by Thomas á Kempis), which represented the two sides of holistic care that Wesley himself had long identified as essential for every household and pastor.Footnote 84
Although early Methodist publications in the United States were not overtly theological, they contained nonetheless the central components of Methodist theology: human sinfulness, God's providential grace to all humans, and a mission to care—both physically and spiritually—for the sick and needy. In the early Methodists’ involvement in hospitals in England, they understood their work as an opportunity not only to heal physically, but also “to reclaim the souls of the sick.” Participating in charitable medical endeavors was, further, important for the healer, as it provided an opportunity for Christian usefulness. Medicine was a chance to engage once again in the human-to-human transmission of medical knowledge ordained by God as the healing counterpart to disease transmission. Primitive Physic became a way for Wesley to encourage widely the impulses of healing, evangelism, and spiritual growth, and the publication proved vital for Coke and Asbury in the development of the Methodist community in the United States.Footnote 85
Wesley's Primitive Physic offered an important critique of the contemporary medical world and theoretical medicine. Like other protestants of his time, Wesley articulated a Christian understanding of the soul's role in sickness and bodily health and the importance of medicine for Christian benevolence and mission. Primitive Physic was a work of practical piety, but its preface also taught fundamental theological principles of human sinfulness, charity, and—above all—God's providence over creation. For Wesley, medicine was tightly bound to God's providence and was most successful when pursued with attention to the providentially-ordained method of experience, the generational transmission of knowledge, and the goal of helping others both physically and spiritually. The enduring popularity of Primitive Physic in both England and the United States demonstrates the appeal and significance of Wesley's arguments and providential perspective in shaping early Methodist communities.
IV. Conclusion
Eighteenth-century puritans, Lutherans, and Methodists participated in an ever-changing and diverse world of medical knowledge. Contemporary debates on the nature of the human soul, spurred by emerging mechanistic and Newtonian conceptions of medicine and the body, demanded a response. Some protestants, like Wesley, joined these debates and responded forcefully and publicly to theoretical and profit-driven medicine. Wesley saw medicine as God's gift for fallen humans to share inter-generationally with the intent of Christian healing and evangelism. Other eighteenth-century protestants, like Mather, were less concerned with the increasing theorization of medicine and more focused on integrating traditional Christian conceptions of the soul within new mechanistic understandings of the body. Mather promoted smallpox inoculation, because, like Wesley, he felt a providential call to “do good” in the world. But, unlike Wesley, Mather was unaware or inattentive to the practical aspects of inoculation that affected its accessibility. For Mather, God's providence would see to inoculation's implementation for the good once introduced. For Wesley, God's providence required constant work on the part of Christians to make sure medicine truly reached the common good.
Boltzius, meanwhile, grew impatient with the missionary physician Thilo and his intensive, soul-focused medicine. Like Wesley and Mather, Boltzius read widely and felt a Christian duty to help those who suffered. He valued first-hand observations and experiences of symptoms and treatments as he pursued cures for his entire community, but, unlike Wesley, Boltzius did not contemplate his work and intervention as a response to the theoretical changes within larger eighteenth-century medicine—changes that were, nonetheless, exemplified by the frustrating Thilo, his medical education, and his practice. Like Mather, Boltzius sought to implement treatments and cures that would ensure his community's survival. Like Wesley, he actively worked to make sure these treatments were available to all, and—due to the small size of his community and the discrete nature of his mission—this direct intervention was often achievable in a way it was not in Mather's colonial Boston or in Wesley's wide readership.
These differences are important, but they also highlight a unifying theme among eighteenth-century protestants and their engagement with medicine. Although scholars have sought to define, differentiate, and limit this engagement based on soteriologies or stances on predestination, all early American protestants actively pursued medical care, disease prevention, and health management. They combined knowledge from their own humoral or empirical understandings of the body, from informal medical networks that included Africans and women, and from the burgeoning medical print culture in order to help the sick in the most effective and efficient way possible. They understood their interventions in terms of a Christian mission of benevolence, recognizing that physical care was closely linked to the spiritual renewal and rebirth of both the individual and the community.
Mather, Boltzius, and Wesley—along with their correspondents and contemporaries—are a crucial part of the story of eighteenth-century medicine. They have been overlooked because scholarship has assumed, based on caricatures of their theologies, that they could not have participated in the eighteenth-century transformations in medicine. Yet their focus on the soul's influence on bodily health was not a theological, anti-empirical Christian maneuver, but a serious participation in contemporary medical conversations based on observation and theory as well as religion.
Mather, Boltzius, Wesley, and their circles actively shaped the physical and medical worlds of their communities in concrete ways. Through treatments and writings they promoted medical care as an essential component of Christian benevolence and mission. Their ideas did not reflect a dawning Enlightenment or a decline of theological commitment but rather their contemporary medical world and deep-rooted Christian beliefs in God's providential direction over the human body, soul, medicine, and mission.
