Enter the Physician: The Transformation of Domestic Medicine, 1760-1860.

Enter the Physician: The Transformation of Domestic Medicine, 1760-1860. By Lamar Riley Murphy (Tuscaloosa, Alabama: University of Alabama Press, 1991. xxi plus 312 pp.).

In Enter the Physician, Lamar Riley Murphy attempts to change our understanding of the way in which domestic health care was separated from the practice of medicine. Murphy focuses her analysis on popular discourse about health and disease from the late eighteenth and early nineteenth centuries. Her grasp of the materials under examination and her assessment of the discourse provide a noteworthy resource for any researcher in the field of nineteenth-century American medicine. The depth of her understanding of these materials is best illustrated in her notes and an impressive bibliographic essay at the end of the work.

As a result of her formidable assessment of varied works including domestic health manuals, sectarian tracts, domestic advice books, and medical journals, Murphy constructs a new model for explaining the evolution of domestic medical care. Murphy asserts that the American approach to domestic care evolved through several stages during the century from the American Revolution to the Civil War. At first physicians and domestic practitioners saw their roles as complementary. While orthodox physicians and lay people asserted a subordinate role for the domestic caretaker, they also accepted independent diagnosis and treatment by both patients and domestic caretakers. In the second stage, professionalization efforts aimed at defense against sectarian attacks from Thomsonians, Grahamites, and others spurred orthodox physicians to more precisely delineate the responsibilities of the physician and those of domestic caretakers. By the middle of the nineteenth century the weight of discourse tilted toward a careful separation of duties: physicians diagnose and treat diseases, domestic caretakers (mothers and wives) manage preventive strategies.

Within her discussion of this changing model of domestic care, Murphy corrects some earlier historical misconceptions about the relationship between orthodox physicians and domestic caretakers. She directly challenges Paul Starr's assertion that medical professionalization efforts caused doctors to be hostile to domestic practices. Instead she clearly demonstrates that physicians were more concerned with eliminating sectarian competitors than with halting self-care. The most interesting historiographic discussion in the work revolves around the question of why some sectarian ideas were more acceptable to orthodox physicians than others. Murphy proposes that sectarian doctrines which matched the regular physicians' efforts to define treatment as the sole responsibility of specially trained medical experts and prevention as the responsibility of domestic and lay practitioners encountered the least resistance. Her argument is convincing.

As a result of her focus on discourse, Murphy adopts a topical approach to her subject; this gives rise to both the strengths and weaknesses of the work. Murphy organizes her assessment around types of discourse, treating domestic health manuals, sectarian tracts, domestic advice books, hygiene texts, school or textbooks as separate topics. This allows her to carefully examine and compare similar arguments and identify within the writing of very distinct authors the same basic theme. But Murphy herself identifies a key problem with this approach, in noting that the materials are examined "... in rough chronological order" (Preface, p. xv). While much of the imprecision in chronological order is a result of the nature of the debate she is examining, the division of the discussion by type of discourse rather than date of publication, makes it difficult to judge the validity of some of her conclusions about the pattern of change. We do not know, for example, how William Andross Alcott's different works on domestic organization, physiology, and so on were related over time because discussions of each type of work come in separate sections of the book. The author implies both a numeric and chronological shift which is difficult to confirm or refute based on the topical approach.

Her topical categories also appear to have limited her discussion of several important works relevant to her study. In Murphy's discussion of the first stage of domestic medicine she deftly incorporates the diaries and letters of actual domestic practitioners. This important element of her analysis is lost in her examination of the mid-nineteenth century as she shifts her focus to another type of discourse. I am also puzzled by the brevity of her discussion of two widely read reformers: Sarah Hale and Catherine Beecher. While Murphy mentions Hale's cookbooks and her reform efforts in Godey's, this examination is superficial. Similarly, in her discussion of Beecher she analyzes only Physiology and Calisthenics. Murphy does not discuss in any detail Letters to the People on Health and Happiness, A Treatise on Domestic Economy, or The American Woman's Home. Without such a discussion, the implication that domestic reformers were as eager as orthodox physicians to place authority for treatment in the hands of doctors rather than mothers is not clearly proven.

Despite these reservations, I found the work to be challenging and stimulating to my thinking about nineteenth-century health reform. I congratulate Murphy on an interesting and engaging effort to transform our understanding of this period. Her skilled weaving of differing threads and historical approaches provides us with a new and important picture.

Jacqueline S. Wilkie Luther College