PORTLAND, Maine — Dr. Jeremiah Barker’s new book, all about his life as a country doctor in Maine, is finally out. The hefty tome is hitting bookstores after a lengthy publication delay of roughly two centuries. Even so, it seems right on time.
Barker practiced medicine in the days of yore, before any understanding of microbiology, when bleeding and strong laxatives were still common treatments. Still, his book is relevant today as it chronicles Barker’s honest efforts to alleviate suffering and treat his patients as best he could. The book also shows a physician struggling to understand how epidemic disease was spread — and how it could be stopped. Though he knew comparatively little by today’s standards, Barker’s work mirrors that of modern-day doctors, striving to deal with the overwhelming, and constantly changing, coronavirus pandemic.
Barker’s “Diseases in the District of Maine 1772-1820” was supposed to go to print in 1820, the year Maine became a state. But for unknown reasons, it never happened. Instead, the prestigious Oxford University Press published the 500-page book late last year. It’s the culmination of 30 years of off-and-on work by another Maine physician, Dr. Richard Kahn of Rockport.
“In 1990 and 91, my wife and I transcribed the whole manuscript,” Kahn said. “The Maine Historical Society gave me a copy.”
The handbound, partially handwritten book had been in the society’s vaults since the 1940s, when it was donated by Barker’s descendants.
After transcribing it, Kahn spent years going over the text again and again, annotating it, writing copious footnotes. Barker’s antiquated medical terms, tools and medicines had to be explained and translated into 21st-century language. Kahn even discovered and cited each medical journal and book Barker referenced in his vast writings. Kahn also researched Barker’s biography, explaining his place in the context of medical history.
“When I first saw this manuscript, I knew it was quite unusual,” Kahn, 80, said. “You don’t usually find records like this from non-elite physicians — what he read, who he was conversing with — I thought it was pretty amazing.”
Barker was born in Scituate, Massachusetts in 1752. He learned the medical trade as an apprentice, without going to college. Barker came to Maine in 1779 as a navy surgeon with the ill-fated Penobscot Expedition. The campaign’s complete failure at Castine is remembered as a low point in the American Revolution, but Barker stayed on. He first set up shop in Gorham and later in Portland’s Stroudwater neighborhood.
Barker retired to Gorham in 1818 and died in 1835. He’s buried, next to three of his five wives, in Stroudwater.
Throughout Barker’s career, successive epidemics swept through Maine. Tuberculosis, then known as consumption, was the leading killer in colonial America. Its cause was unknown. Yellow fever, typhus, diarrhea, smallpox and food poisoning were also common culprits.
“Epidemics devastated populations physically, socially and economically, and then just as suddenly receded,” Khan writes.
In one passage from his manuscript, Barker recalls how one fever swept through an entire household in 1790. Its symptoms, to the modern ear, sound like a virus. But in Barker’s time, such things were unknown.
Still, he was clever enough to suspect it was transmitted through “noxious air in the sick rooms” — not unlike COVID-19.
“When sick rooms have been properly ventilated, and cleanliness particularly observed, the disease has often not been communicated,” Barker wrote.
His career straddled a seismic shift in medical thinking. At the start of Barker’s doctoring, and for many previous centuries, physicians believed maladies were caused by an imbalance of the body’s “humors.” Bloodletting, induced vomiting and enemas were usual courses of action. But by the end of his active days, under influence of the Enlightenment, medicine was turning to a more scientific approach.
In one passage, Barker writes of a 16-year-old sawmill worker who suffered from an unknown type of paralyzing palsy.
“I drew a pint of blood from the paralytic arm and evacuated his bowels,” Barker said. “After 15 bleedings and as many [laxatives] the palsy was removed and his limbs were readily restored to their usual activity.”
Years later, Barker was using more modern but still experimental treatments of alkali-infused water. In September 1806 he took out a six-column ad in a local paper advertising his alkalies’ efficacy.
“He included the names of at least 33 philosophers and physicians, as well as references to books and journal articles to bolster his arguments,” Kahn said.
Kahn warns against judging Barker for not knowing then, what we know now. Barker’s ad and shift in practices show a doctor striving to stay current, and to understand more about what he doesn’t yet know. It’s a trait also evident in the meticulous casebooks he kept, detailing treatments of various patients, drawing conclusions as to what worked, what did not — and why.
In that regard, Khan said, Barker has much in common with modern-day physicians.
“Knowledge changes, information changes. What we think is the best treatment changes. Certainty is unattainable in medicine,” Kahn said. “That’s something a lot of people don’t grasp — patients and clinicians.”
Kahn sees parallels to today’s search for a coronavirus vaccine in what Barker did 200 years ago. We know more now but there’s still much to learn.
“There’s no fixed truth,” Kahn said. “We’re always doing the best we can, with the information available.”
Dr. Richard Kahn’s book about Barker is available at the Maine Historical Society and a talk he gave on the subject is archived here.