The odd case of Charles Knowlton: Anatomical performance, medical narrative, and identity in antebellum America

Bulletin of the History of Medicine

Volumn 83, Issue 3, 2009, Pages 460-498

  Sappol, Michael ^a  

^a NATIONAL INSTITUTES OF HEALTH   (United States)

Author keywords

Anatomy; Bodysnatching; Case history; Charles Knowlton; Dissection; Freethought; Grave robbery; Medical pranks; Narrative; Professional identity

Indexed keywords

ANATOMY; ARTICLE; GOVERNMENT REGULATION; HISTORY; HISTORY OF MEDICINE; HUMAN; PUBLICATION; RURAL HEALTH CARE; SOCIAL BEHAVIOR; UNITED STATES;

ANATOMY; GOVERNMENT REGULATION; GRAVE ROBBING; HISTORY, 19TH CENTURY; HUMANS; PUBLICATIONS; RURAL HEALTH SERVICES; SOCIAL IDENTIFICATION; UNITED STATES;

EID: 73349118452     PISSN: 00075140     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Article

References (207)

1. Charles Knowlton, casebook (1840), in Boston Med. Surg. J., 1851, 45(6):111.
2. Stephen J. W. Tabor, "The Late Charles Knowlton, M. D.", Boston Med. Surg. J., 1851, 45(6):109-11;
3. "The Late Dr. Knowlton's Autobiography", Boston Med. Surg. J., 1851, 45(6):111-20;
4. "The Late Dr. Knowlton's Autobiography", Boston Med. Surg. J., 1851, 45(8):149-57. All three installments will be referred to as "Autobiography" hereafter. An earlier obituary appears in Boston Med. Surg. J., 1850, 42(9):187. The most detailed research on Knowlton is in Mary Lee Esty, "Dr. Charles Knowlton: A Biography" (unpublished manuscript, Ashfield Historical Society, ca. 1972);
5. and Janet Farrell Brodie, Contraception and Abortion in Nineteenth-Century America (Ithaca, N. Y.: Cornell University Press, 1994), pp. 69, 72-74, 77, 87-90, 93-105, 109-11, 133-38, 152-56, 167.
6. See also Helen Lefkowitz Horowitz, Rereading Sex: Battles Over Sexual Knowledge and Suppression in Nineteenth-Century America (New York: Knopf, 2002), pp. 70-85;
7. James Reed, From Private Vice to Public Virtue: The Birth Control Movement and American Society Since 1830 (New York: Basic Books, 1978), pp. 3-33;
8. Reed, "Charles Knowlton", in American National Biography (New York: Oxford University Press, 1999), 12: 829-30;
9. Norman E. Himes, "Charles Knowlton's Revolutionary Influence on the English Birth Rate", N. Engl. J. M ed., 1928, 199: 461-65;
10. and Robert E. Riegel, "The American Father of Birth Control", New Engl. Q., 1933, 6: 470-90.
11. "Autobiography" (n. 2), p. 109;
12. Charles Knowlton, "The Autumnal Fevers of New England", Boston Med. Surg. J., 1845, 32(4):69-73, quotation on p. 69.
13. Charles Knowlton, Fruits of Philosophy, or The Private Companion of Young Married People, 2nd rev. ed. (Boston: A. Kneeland, 1833), p. 2. Richard Carlile, Every Woman's Book; or What is Love? (London: R. Carlile, 1826) was the first book in English to describe methods of contraception in detail.
14. Indictment, Supreme Judicial Court, Bristol County, April 1832, Commonwealth of Massachusetts (Massachusetts State Archives). In various editions, Fruits of Philosophy probably sold several thousands of copies in North America and Great Britain before 1877. In an 1832 trial in Taunton, Massachusetts, Knowlton was fined $50, plus court costs of $27.50, for publishing an obscene book, and he was convicted on a similar charge in East Cambridge, Massachusetts, where he was sentenced to three months' hard labor. A third prosecution, at Greenfield, Massachusetts, was eventually dropped after the jury twice failed to agree. Knowlton's own trials were overshadowed by the four trials (1833-38) and conviction (1838) of the radical freethinker Abner Kneeland for publishing, quoting, and praising Fruits in the columns of his Boston newspaper, The Investigator, and, later, by the 1877-78 prosecution of Charles Bradlaugh and Annie Besant for publishing a revised English edition.
15. See Charles Knowlton, Two Remarkable Lectures Delivered in Boston, by Dr. C. Knowlton, on the Day of his Leaving the Jail at East Cambridge, March 31, 1833, where he had been imprisoned, for publishing a book (Boston: A. Kneeland, 1833);
16. Knowlton, A History of the Recent Excitement in Ashfield, Part 1 (Ashfield, Mass, 1834);
17. Stewart H. Holbrook, "The Father of Birth Control", American Mercury, 1946, 11: 605-7;
18. Parker G. Marden, "A Man Ahead of His Time", Dartmouth Alumni Magazine, 1967, 1: 21-23. In the aftermath of the Bradlaugh/Besant case, sales of Fruits skyrocketed;
19. Marden estimates that two million copies were sold. Knowlton was convicted of "violating the sepulchres of the dead" in 1824 in Worcester, Massachusetts.
20. Knowlton belonged to the Massachusetts Medical Society, which published the Boston Medical & Surgical Journal. His contributions were published between 1842 and 1846: "Gonorrhoea Dormientium", Boston Med. Surg. J., 1842, 27(1):11-15;
21. "Abscess of the Lungs", Boston Med. Surg. J., 1843, 28(19):369-73;
22. "Scirrhus of the Pancreas-Error in Diagnosis", Boston Med. Surg. J., 1843, 29(19):379-82;
23. "Erysipelas and Puerperal Fever", Boston Med. Surg. J., 1844, 30(5):89-95;
24. "That Pancreas, & C.", Boston Med. Surg. J., 1844, 30(12):233-36;
25. "Lumbar Abscess", Boston Med. Surg. J., 1844, 30(18):380-81;
26. "Autumnal Fevers" (n. 3);
27. "Quackery, & C.", Boston Med. Surg. J., 1846, 34(9):169-80;
28. "The Fillet in Breech Presentation", Boston Med. Surg. J., 1846, 34(10):194-95.
29. See, for example, Valentine Mott, Reminiscences of Medical Teaching and Teachers in New York (New York: Joseph H. Jennings, 1850);
30. E. H. Dixon, "Scenes in a Medical Student's Life- Resurrectionizing", The Scalpel, 1855, 7: 95;
31. S. W. Francis, Biographical Sketches of Distinguished Living New York Physicians (New York: Putnam, 1867);
32. J. Marion Sims, The Story of My Life (New York: D. Appleton and Co., 1884);
33. W. J. McKnight, The Pioneer Doctor: "Who Shinned the Nigger" or the Origin and Enactment of Pennsylvania's State Anatomical Law (n. d.; reprinted from the Brookville Republican, 1897; 1 March 1915).
34. For a fuller discussion
35. see Michael Sappol, A Traffic of Dead Bodies: Anatomy and Embodied Social Identity in Nineteenth-Century America (Princeton, N. J.: Princeton University Press, 2002), esp. pp. 47-57.
36. Joseph Leidy, Lecture Introductory to the Course on Anatomy in the University of Pennsylvania for the Session 1858-59 (Philadelphia: Collins, 1859), p. 7. For anatomy and medical authority
37. see Michel Foucault, The Birth of the Clinic: An Archeology of Medical Perception (1973; repr., New York: Vintage, 1975);
38. John Harley Warner, Against the Spirit of System: The French Impulse in Nineteenth-Century American Medicine (Princeton, N. J.: Princeton University Press, 1998);
39. Sappol, Traffic of Dead Bodies (n. 8);
40. Russell Maulitz, Morbid Appearances: The Anatomy of Pathology in the Early Nineteenth Century (Cambridge: Cambridge University Press, 1987);
41. John B. Blake, "Anatomy", in TheEducation of American Physicians: Historical Essays, ed. Ronald Numbers (Berkeley: University of California Press, 1980), pp. 29-47.
42. John P. Harrison, Oration on the Guidance of a Sound Philosophical Spirit in the Investigations of Medical Science. Read before the Cincinnati Medical Society, January 4, 1837 (Cincinnati: Truman and Smith, 1837), pp. 18-19.
43. Knowlton argued that botanical healers lacked anatomical knowledge and so could not accurately diagnose and cure their patients: "Quackery, & C." (n. 6), pp. 169-70.
44. Address of Valentine Mott, M. D., LL. D., Emeritus Professor of Surgery..., Before the Graduates of 1860 of the University Medical College of New York (New York: 1860), p. 12.
45. See Blake, "Anatomy" (n. 9). I argue in Traffic of Dead Bodies (n. 8) that there was a strong link between anatomy and professional medical identity. Every medical school offered a course of anatomy; every school had an anatomical scandal. For the public, the medical student was notoriously a dissector and the medical school was a site of dissections. The circulars of American medical schools published between 1800 and 1860 typically promised students ample opportunities to dissect. But not every school could deliver on its promises: dissectable bodies were sometimes scarce. Frustrated by the lack of anatomical opportunities in their formal schooling, many students engaged in illicit, extracurricular dissections. In Philadelphia and New York, places where bodies were more readily available, small nondiploma-granting schools sprang up that specialized in practical anatomy.
46. Certainly some students shirked anatomical training. And some became physicians through apprenticeship and never went to medical school. But most studied anatomy, and some dissected, and-as we know from their memoirs and letters and legal difficulties-some got caught stealing bodies. Often enough, apprentices did go on to attend medical school, motivated in part by the desire for more anatomical training.
47. Influential older histories, such as Richard Shryock's Medicine in America (Baltimore: Johns Hopkins University Press, 1966) and Paul Starr's The Social Transformation of American Medicine (New York: Basic Books, 1982), emphasize the nonscientific (and nonanatomical) character of antebellum medicine and play up a "crisis of authority." They rely mainly on the writings of physicians who lobbied for state medical licensure laws and who formed the American Medical Association. Those reformers complained that schools were loosening requirements in practical anatomy and that students lacked adequate anatomical training. But such critics had a vested interest in painting a dire picture: they wanted to make medical education more rigorous, but they also wanted to reduce the number of schools and restrict entry into the profession, to reduce competition for patients and students-and to establish their own authority as professional leaders through the advocacy of higher standards.
48. "Medical Education", N. Y. Med. Inquirer, 1830, 1: 130; italics in original.
49. J. V. C. Smith, Boston, to J. C. Warren, Boston, 16 May 1825 (J. C. Warren Papers, Massachusetts Historical Society). Smith worried that if pupils apprenticed to physicians "at home" could easily and legally get cadavers, the "anatomical theatres" would be put out of business. In other words, access to cadavers was a scarce resource that drew students to medical college.
50. Warner, Against the Spirit of System (n. 9).
51. See, for example, Roland Barthes, "Introduction to the Structural Analysis of Narratives", Image, Music, Text, trans. Stephen Heath (New York: Noonday Press, 1977), pp. 79-124;
52. Louis O. Mink, "Narrative Form as a Cognitive Instrument", in The Writing of History: Literary Form and Historical Understanding, ed. Robert H. Canary and Henry Kozicki (Madison: University of Wisconsin Press, 1978), pp. 3-23.
53. See, for example, W. J. T. Mitchell, ed., On Narrative (Chicago: University of Chicago Press, 1981);
54. Paul Ricoeur, "The Narrative Function", in Hermeneutics and the Human Sciences, ed. John B. Thompson (Cambridge: Cambridge University Press, 1981), pp. 274-96;
55. Wallace Martin, Recent Theories of Narrative (Ithaca, N. Y.: Cornell University Press, 1986);
56. Hayden White, The Content of the Form: Narrative Discourse and Historical Representation (Baltimore: Johns Hopkins University Press, 1987);
57. Mieke Bal, Narratology: Introduction to the Theory of Narrative (Toronto: University of Toronto Press, 1985).
58. Mark Currie, Postmodern Narrative Theory (London: Macmillan Press, 1998), p. 2.
59. To be clear, I am arguing that narratological analysis can help lay bare the formal properties of seemingly nonliterary genres, especially of the "true story." "Narrative becomes a problem only when we wish to give to real events the form of a story": Hayden White, "The Value of Narrativity", in Mitchell, On Narrative (n. 18), pp. 1-23
60. quotation on p. 4.
61. For medical narrative and narrative medicine
62. see Cheryl Mattingly and Linda C. Garro, eds., Narrative and the Cultural Construction of Illness and Healing (Berkeley: University of California Press, 2000);
63. and Kathryn Montgomery Hunter, Doctors' Stories: The Narrative Structure of Medical Knowledge (Princeton, N. J.: Princeton University Press, 1991). Narrative is equally crucial for the disease sufferer/patient.
64. See Sue E. Estroff, "Whose Story Is It Anyway? Authority, Voice, and Responsibility in Narratives of Chronic Illness", in Chronic Illness: From Experience to Policy, ed. S. Kay Toombs, David Barnard, and Ronald A. Carson (Bloomington: Indiana University Press, 1995), pp. 77-102;
65. Arthur W. Frank, The Wounded Storyteller: Body, Illness and Ethics (Chicago: University of Chicago Press, 1995);
66. Rom Harré, "Some Narrative Conventions of Scientific Discourse", in Narrative in Culture: The Uses of Storytelling in the Sciences, Philosophy and Literature, ed. Cristopher Nash (New York: Routledge, 1990), pp. 81-100;
67. Arthur Kleinman, The Illness Narratives: Suffering, Healing and the Human Condition (New York: Basic Books, 1988). For an overview of medical sect and sect formation in this period
68. see William Rothstein, American Physicians in the Nineteenth Century: From Sects to Science (Baltimore: Johns Hopkins University, 1972).
69. Frank, Wounded Storyteller (n. 21), p. 52: "narratives are... media for body-selves to express and reflexively monitor themselves... Bodies are realized-not just represented but created-in the stories they tell."
70. Performance (and performativity) has been at the center of a large body of anthropological, sociological, and cultural theoretical scholarship, most notably the works of Erving Goffman, Victor Turner, Richard Schechner, and Judith Butler. In this literature, performance has two overlapping senses: (1) a special sequestered enactment or demonstration, made before an audience that attends it with expectations about the conventions of performance, genre, venue, audience behavior, and so on; and more broadly, (2) any enactment or demonstration that has social, cultural, or political meanings and consequences. The term implies that social actions are staged with scripts, emplotments, and metaphorologies; have venues; require resources and skills; have social effects; are critiqued for effectiveness, and so on. In theater criticism, a crucial distinction is made between script and performance. Here, I treat the printed word as a performance on the page that sometimes aims to evoke oral storytelling.
71. For the anthropology of storytelling
72. see Richard Bauman, Verbal Art as Performance (1977; repr., Long Grove, I11.: Waveland Press, 1984) and A World of Others' Words: Cross-Cultural Perspectives on Intertextuality (Oxford: Blackwell Publishing, 2004).
73. Barbara Herrnstein Smith, "Afterthoughts on Narrative: Narrative Versions, Narrative Theories", in Mitchell, On Narrative (n. 18), pp. 209-32
74. quotation on pp. 228-29: "[P] articipation in the narrative transaction is sufficiently in the interest of each [narrator, listener] to win out over all currently competing activities for both of them."
75. For storytelling culture in nineteenth-century America
76. see Constance Rourke, American Humor: A Study of the National Character (New York: Harcourt Brace, 1931);
77. and Ann Fabian, The Unvarnished Truth: Personal Narratives in Nineteenth-Century America (Berkeley: University of California Press, 2000).
78. Michel Foucault, The History of Sexuality: An Introduction (1976; repr., New York: Vintage, 1990), p. 139.
79. Foucault, Birth of the Clinic (n. 9), p. 31: In the eighteenth and nineteenth centuries, there was a "presence of doctors[,] whose intersecting gazes form a network and exercise at every point in space, and at every moment in time, a constant mobile differentiated supervision" that operated on bodies and within them. Foucault argues that power marks the body and enforces the thinkable or unthinkable, that it doesn't merely coerce the body but constitutes it through a process of definition, internalization, and self-regulation (although these in turn are enforced by complex combinations of social rewards and punishments). This process proceeds top down, but also inside out and multidirectionally through the deployment of disciplinary methods like the dissecting cut and the medical "gaze", and institutions like the clinic. (I would add one other institution: the public.)
80. See also Foucault, Discipline and Punish: The Birth of the Prison, trans. A. M. Sheridan (1975; repr., New York: Vintage, 1979) and Power/Knowledge: Selected Interviews and Other Writings, 1972-1977, ed. Colin Gordon (New York: Pantheon, 1980).
81. "Autobiography" (n. 2), p. 111.
82. Ibid., p. 112.
83. For the history of the medical case history
84. see Julia Epstein, Altered Conditions: Disease, Medicine, and Storytelling (New York: Routledge, 1995);
85. Mary Fissell, "The Disappearance of the Patient's Narrative and the Invention of Hospital Medicine", in British Medicine in an Age of Reform, ed. Roger French and Andrew Wear (London: Routledge, 1991), pp. 92-109;
86. David Flood and Rhonda Soricelli, "Development of the Physician's Narrative Voice in the Medical Case History", Lit. M ed., 1992, 11(1):64-83;
87. Jonathan Gillis, "The History of the Patient History Since 1850", Bull. Hist. M ed., 2006, 80: 490-512;
88. Thomas Laqueur, "Bodies, Details and the Humanitarian Narrative", in The New Cultural History, ed. Lynn Hunt (Berkeley: University of California Press, 1989), pp. 176-204;
89. Harriet Nowell-Smith, "Nineteenth-Century Narrative Case Histories: An Inquiry into Stylistics and History", Canadian Bull. Med. Hist., 1995, 12(1):47-67;
90. Stanley Joel Reiser, "Creating Form Out of Mass: The Development of the Medical Record", in Transformation and Tradition in the Sciences, ed. Everett Mendelsohn (Cambridge: Cambridge University Press, 1984), pp. 303-16;
91. Guenter Risse and John Harley Warner, "Reconstructing Clinical Activities: Patient Records in Medical History", Soc. Hist. M ed., 1992, 5: 183-205;
92. and Steven M. Stowe, "Seeing Themselves at Work: Physicians and the Case Narrative in the Mid-Nineteenth-Century American South", Am. Hist. Rev., 1996, 101(1):41-79.
93. The Boston Medical & Surgical Journal's very existence was predicated on the forging of links between the urban medical elite and rural rank and file. It was formed in 1828 by a merger between J. V. C. Smith's Medical Intelligencer and the New England Journal of Medicine and Surgery, the organ of J. C. Warren, Jacob Bigelow, and other members of the Boston Brahminate. Smith, a middling, but ambitious, anatomy professor who also served as the port physician of Boston, became the Boston Medical & Surgical Journal's principal editor.
94. "Autobiography" (n. 2), p. 111.
95. Ibid., pp. 111-12. It is unclear whether his casebook contained cases other than Knowlton's autobiography. I have been unable to locate the manuscript.
96. Ibid., p. 111.
97. Ibid., p. 112.
98. Ibid..
99. G. Motherby, A New Medical Dictionary, or General Repository of Physic, 5 th ed. (London: J. Johnson et al., 1801), p. 417.
100. See also Knowlton, "Gonorrhoea Dormientium" (n. 6), pp. 11-15.
101. Knowlton, in Fruits (n. 4), pp. 10-11, argues that "irratibility [sic] of the genital organs" is the proximate cause in most young men, rather than "a seminal weakness", but that the larger cause is the unmarried state, which fosters "solitary toil and vulgar dissipation. "The cure, therefore, is marriage, which enables a man to "enjoy the society and assistance" of a woman.
102. "Autobiography" (n. 2), p. 113.
103. Ibid..
104. Ibid., p. 114.
105. In Wounded Storyteller (n. 21), pp. 64-73, Frank argues that patients narrate their experience in order to "reclaim the self" that has been broken down by disease and medicalization. In Frank's taxonomy of patient narratives, Knowlton's tale is part "quest narrative", part "restitution narrative" (an account of distressing illness and the path by which the patient is restored to health), and part "testimony. "
106. "Autobiography" (n. 2), p. 115.
107. Ibid., pp. 115-16.
108. The literature on shamanic healing is vast.
109. See, for example, Mircea Eliade, Shamanism: Archaic Techniques of Ecstasy, trans. Willard R. Trask (1951; repr., Princeton, N. J.: Princeton University Press, 1964; rev. ed. 1970);
110. Johannes Wilbert, Tobacco and Shamanism in South America (New Haven, Conn.: Yale University Press, 1987), esp. pp. 156-200;
111. Jay H. Bernstein, Spirits Captured in Stone: Shamanism and Traditional Medicine Among the Taman of Borneo (Boulder, Colo.: Lynne Rienner Publishers, 1997). Wilbert reports that the Warao of French Guiana believe that "dark shamans" frequent "the stench-filled Land of the Dead", sacrifice a human, and then bring the cadaver back into the land of the living (p. 170). Another structural similarity is that candidates for shamanism are often said to exhibit some social, sexual, neurological, or psychological abnormality or eccentricity;
112. see Eliade, pp. 3-66
113. and Bernstein, p. 150: "chronic illness is the most commonly named factor predisposing a person to become a [shaman]."
114. Foucault, Birth of the Clinic (n. 9), p. 196; Foucault's emphasis.
115. Charles Knowlton, Elements of Modern Materialism; Inculcating the Idea of a Future State, in Which All Will Be More Happy, Under Whatever Circumstances They May Be Placed, Than If They Experienced No Misery in This Life (Adams, Mass.: Oakey, 1829), p. 371;
116. see also pp. 341, 377, 447.
117. "Autobiography" (n. 2), p. 117.
118. Ibid., pp. 116-17.
119. Ibid., p. 117.
120. Linkages between bodysnatching and blackness frequently occur in nineteenthcentury anatomical narrative. Sometimes the story features a bodysnatcher who has stolen the body of a black person. (Poor people, black people, immigrants, and Indians disproportionately and involuntarily supplied courses of anatomy until well into the twentieth century. See David C. Humphrey, "Dissection and Discrimination: The Social Origins of Cadavers in America, 1760-1915", Bull. N. Y. Acad. M ed., 1973, 49: 819-27; Steven Robert Wilf, "Anatomy and Punishment in Late Eighteenth-Century New York", J. Soc. Hist., 1989, 22: 507-30.) Sometimes reference is made to the darkening of skin color that occurs after decomposition (after the initial death pallor, which lightens the skin). Sometimes the bodysnatcher is a black person. For the racial coding of the cadaver, bodysnatching, and dissection
121. see Sappol, Traffic of Dead Bodies (n. 8), pp. 44-46, 85, 87-89, 97, 107, 253-59;
122. and Robert L. Blakely and Judith M. Harrington, eds., Bones in the Basement: Postmortem Racism in Nineteenth-Century Medical Training (Washington, D. C.: Smithsonian Institution Press, 1997).
123. "Autobiography" (n. 2), p. 117-18.
124. Ibid., p. 118.
125. Ibid..
126. Ibid..
127. Ibid., pp. 118-19.
128. Ibid., p. 119.
129. Ibid..
130. Ibid., p. 120.
131. Ibid., p. 149.
132. Ibid..
133. Ibid..
134. Ibid., p. 150.
135. Ibid..
136. The quoted phrase achieved wide circulation in Thomas Southwood Smith's pamphlet, The Use of the Dead to the Living. From the Westminster Review (Albany: Websters and Skinners, 1827). For popular responses to medical bodysnatching and dissection in Britain and America
137. see John B. Blake, "The Development of American Anatomy Acts", J. Med. Educ., 1955, 30: 431-39 and "Anatomy" (n. 9);
138. Ruth Richardson, Death, Dissection and the Destitute (London: Routledge, 1987);
139. and Sappol, Traffic of Dead Bodies (n. 8).
140. Charles Knowlton, "Anatomy" (Hanover Medical Institute, 1823), Dartmouth College Library Archives, p. 8. After 1950 donation by physicians and other middle-and upper-class persons became the dominant source of bodies for anatomy classes.
141. See Richardson, Death, Dissection and the Destitute (n. 64);
142. Sappol, Traffic of Dead Bodies (n. 8).
143. "Autobiography" (n. 2), p. 151.
144. Frederick G. Howes, History of the Town of Ashfield, Franklin County, Massachusetts From its Settlement in 1742 to 1910 (Ashfield, Mass.: Published by the town, 1910), p. 368.
145. "Autobiography" (n. 2), p. 152.
146. For a sample of anatomical arguments
147. see Knowlton, Elements (n. 46), pp. 73-189.
148. Ibid., p. 17: "The moderns know nothing about spirits... it is probable they never would have thought of such things were it not for what has been handed down from men of ancient times, whose active brains were not clogged by an overstock of scientific knowledge. Had the ancients known as much as the moderns about the laws and properties of matter... it is probable they never would have invented, never would have had any use for, the word spirit."
149. The scholarship on Paineite radicalism and freethought is vast.
150. See, for example, E. P. Thompson, The Making of the English Working Class (London: Victor Gollancz, 1963);
151. and Sean Wilentz, Chants Democratic: New York City and the Rise of the American Working Class, 1788-1850 (New York: Oxford University Press, 1986). For Knowlton and radicalism
152. see Esty, "Dr. Charles Knowlton" (n. 2) and Reed, Private Vice to Public Virtue (n. 2), pp. 3-33.
153. "Autobiography" (n. 2), p. 155. Knowlton, in History of the Recent Excitement in Ashfield, Part 1 and Part 2 (n. 5), details the nasty religious politics and medical competition of his region and his legal difficulties arising from the publication of Fruits of Philosophy.
154. Esty, "Dr. Charles Knowlton" (n. 2), pp. 15-16.
155. Knowlton, Fruits (n. 4), p. 12.
156. "[I]t is... a matter of necessity that I give an anatomical description of certain parts." On pp. 12-14, Knowlton discusses mons veneris, the clitoris, nymphae, orifice of the urethra, the hymen, vagina, uterus, Fallopian tubes, and ovaries, and explains the physiology of human reproduction, citing seventeenth-, eighteenth-, and nineteenth-century authorities. Robert Dale Owen, Moral Physiology; or, A Brief and Plain Treatise on the Population Question (New York: Wright & Owen, 1831).
157. Knowlton, Fruits (n. 4), p. 34.
158. Although Richard Carlile's Every Woman's Booh; or What is Love? (n. 4) was the first book in English to describe specific methods of birth control, including the use of condoms and sponges, Carlile had no medical expertise or credentials.
159. Knowlton, Fruits (n. 4), p. 6;
160. Esty, "Dr. Charles Knowlton" (n. 2), pp. 17-18.
161. For rural physicians and the difficulties of medical practice in this period
162. see Steven M. Stowe, Doctoring the South: Southern Physicians and Everyday Medicine in the Mid-Nineteenth Century (Chapel Hill: University of North Carolina Press, 2004) and "Seeing Themselves at Work" (n. 30). For New England physicians, see Barnes Riznik, "The Professional Lives of Early Nineteenth-Century New England Doctors", J. Hist. Med. All. Sci., 1964, 19: 1-16;
163. and Gerald Grob, Edward Jarvis and the Medical World of Nineteenth-Century America (Knoxville: University of Tennessee Press, 1978), esp. pp. 29-56.
164. In the 1830s and '40s, the economy of northwestern and central Massachusetts was boosted by the coming of canals and railroads, which made commerce between New York, Albany, Boston, and southern New England more feasible. Although the area was mainly rural, the numerous streams provided a source of power for mills, and there was some industrial development.
165. Howes, History of the Town of Ashfield (n. 68), p. 366.
166. Ibid., p. 163;
167. Address by George D. Crittenden... Before the Pocumtuck Valley Memorial Association (Deerfield, Mass.: Pocumtuck Valley Memorial Association, 1905), p. 21.
168. Esty "Dr. Charles Knowlton" (n. 2), pp. 36, 39-40;
169. Address by George D. Crittenden (n. 82), p. 21;
170. Speech of Dr. Charles Knowlton, in Support of Materialism, Against the Argument of Origen Bacheler, the Great Goliah, and Champion of the Cross in 1836 (Philadelphia: Society of "Free Enquirers", 1838);
171. Address of Dr. Charles Knowlton, Before the Friends of Mental Liberty, at Greenfield, Mass... (Boston: J. P. Mendum, 1845).
172. Esty, "Dr. Charles Knowlton" (n. 2), pp. 18, 24. In the late 1840s, Knowlton ran for office on the Free Soil party ticket and was elected to the state legislature (but did not serve);
173. Esty, p. 40.
174. Howes, History of the Town of Ashfield (n. 68), p. 163;
175. Address by George D. Crittenden (n. 82), p. 21.
176. Knowlton, "Gonorrhoea Dormientium" (n. 6), pp. 11-15;
177. quotation on p. 14.
178. Knowlton also discusses gonorrhœa dormientium in Fruits of Philosophy (n. 4), pp. 10-11, without acknowledging his own experience.
179. Knowlton, "Gonorrhoea Dormientium" (n. 6), p. 11;
180. "Erysipelas and Puerperal Fever" (n. 6), p. 89.
181. Esty, "Dr. Charles Knowlton" (n. 2), p. 41.
182. Last Will and Testament of Charles Knowlton, M. D., written 26 May 1847 (typed transcription, Ashfield Historical Society);
183. Greenfield, Mass. Probate Court, March 1850, Appraisal of Charles Knowlton's Property (transcribed in Lawrence R. Dame Collection, Pocumtuck Valley Memorial Association Library, Deerfield, Mass.).
184. "Autobiography" (n. 2), p. 110. 91.
185. Fabian, Unvarnished Truth (n. 26), p. 42.
186. Marcel Mauss, The Gift: The Form and Reason for Exchange in Archaic Societies, trans. W. D. Halls (1950; repr., New York: Norton, 1990).
187. Ruel Smith to Smith Robertson, Rochester, New York, 21 May 1841, Robertson Family Papers, Collection 243, Folder 1, Smith Robertson Papers, Division of Rare and Manuscript Collections, Cornell University Library, in Major Problems in the History of American Medicine and Public Health: Documents and Essays, ed. John Harley Warner and Janet A. Tighe (Boston: Houghton Mifflin, 2001), pp. 96-97.
188. For homosociality
189. see Eve Kosofsky Sedgwick, Between Men: English Literature and Male Homosocial Desire (New York: Columbia University Press, 1985). According to Sedgwick, the term "homosociality" in history and the social sciences "describes social bonds between persons of the same sex" (p. 1), which often form around some symbolic or actual exchange of women among men. In anatomical narratives, homosocial bonds among male students tend to form around transactions with cadavers, rather than transactions with women.
190. Sims, Story of My Life (n. 7), pp. 128-29.
191. The twentieth century's formalized genre of case presentation decisively differentiated itself from casual storytelling. In the nineteenth century, there was less distance between the two (both of which had a pronounced autobiographical element).
192. See Stowe, "Seeing Themselves at Work" (n. 30), pp. 59-65.
193. "Autobiography" (n. 2), p. 110.
194. As mentioned in footnote 33, Knowlton did not keep a running account of cases. If his casebook contained cases other than his autobiography (which is uncertain), they were for use in writing his Boston Medical & Surgical Journal contributions. In "Gonorrhoea Dormientium" (n. 6), p. 12, Knowlton states that he took "no notes of cases" and wrote from memory.
195. Esty, "Dr. Charles Knowlton" (n. 2), p. 187: "his articles have always confirmed the favorable opinion of his scientific attainments." The reference to "writing from the margins" echoes Ann Fabian's discussion of nineteenth-century American "beggar" narratives;
196. Unvarnished Truth (n. 26), p. 11. Knowlton, like Fabian's beggar-authors, came from the economic, social, and cultural margins as the son of a poor farmer, an odd-looking person, a gonnorhœa dormientium sufferer, and a grave robber.
197. Knowlton, "Fillet in Breech Presentations" (n. 6) and "Erysipelas and Puerperal Fever" (n. 6). William Potts Dewees (1761-1841) wrote several authoritative texts on obstetrics and midwifery, most notably A Compendious System of Midwifery... (Philadelphia: Lea and Blanchard, 1824).
198. Oliver Wendell Holmes, The Contagiousness of Puerperal Fever (Boston, 1843; reprinted from New Engl. Q. J. Med. Surg., 1843, 4: 25-60).
199. Stowe, in "Seeing Themselves at Work" (n. 30), esp. pp. 47-51, shows the same dynamic at work in Kentucky case histories published in an 1836 issue of the Transylvania Journal of Medicine.
200. Knowlton, "Erysipelas and Puerperal Fever" (n. 6), p. 93.
201. Knowlton, "Abscess of the Lungs" (n. 6), p. 373, and
202. "Autumnal Fevers" (n. 3), p. 70.
203. "Autobiography" (n. 2), p. 10.
204. Stowe, in Doctoring the South (n. 79), argues that medicine's "abstract traditions"-its scientific pretensions-conflicted with the demands of practice in small, insular communities of the rural South. The insistence on medicine's filiation with "science" shaped the rural doctor's healing identity in medical school, but it set him intellectually apart from his patients, even as he tried to forge an intimate connection with them. Even so, orthodox medical men maintained a commitment to "scientific" medicine, kept casebooks with clinical narratives, contributed to medical journals, attended meetings of medical societies, and so on. A similar dynamic was at work in Knowlton's career in rural Massachusetts-but his commitment to science helped him gain a clientele: his patients favored "scientific" practitioners and perhaps even wanted healers who stood intellectually "above" them and who were respected by colleagues. But they also wanted treatments that "worked" and resorted to botanical healers and other alternative healers when that seemed cheaper or more expedient, or when orthodox medicine failed, as it often did. Stowe, in "Seeing Themselves at Work" (n. 30), pp. 43-44, footnote 4, emphasizes that failure was a vital issue in the case history literature of rural physicians and acknowledges that medical practice in the rural South and rural North had "many similarities."
205. Rita Charon, "To Build a Case: Medical Histories as Traditions in Conflict", Lit. M ed., 1992, 11(1):115-32, quotation on p. 115.
206. Charon argues that doctors and patients "are engaged in deep conflict about meaning and purpose" (p. 116), but her article supports a somewhat different conclusion: close reading of the medical case history reveals a complex set of dialectical tensions that include collusion as well as conflict, physician/patient empowerment/disempowerment, and understandings and misunderstandings.
207. In "Autumnal Fevers" (n. 3), pp. 69-70, Knowlton argues that, although it "seems to be the fashion" to call it typhus or typhoid fever, "remittent fever" is the better diagnosis.