An Inaugural Essay on Scurvy
An inaugural essay on scurvy. : Submitted to the examination of the Rev. John Ewing, S.T.P. provost, the trustees, and medical faculty of the University of Pennsylvania, on the 22d day of May, 1798, of the degree of Doctor of Medicine. / By John Claiborne, of Virginia, member of the Philadelphia medical and chemical societies.
Background
John Claiborne
John Claiborne was born in Brunswick County, Virginia, in 1777 (1). He became a doctor in 1798 after studying medicine at the University of Pennsylvania and subsequently practiced medicine. He came from a politically active family, succeeding his father, Thomas Claiborne, as a representative of Virginia’s 17th district in the Ninth and Tenth Congresses from 1805 to 1808 (1).
Medical Education in Early America
The medical school of the University of Pennsylvania was the first medical school established in the US (2). Its accreditation process was a departure from the typical process at the time when students traditionally completed extended apprenticeships to become trained physicians (3). John Morgan, the founder of the school, based the curriculum and structure on Edinburgh Medical School, where he had studied medicine (4). The Edinburgh model required students to take three years of classes followed by a public defense of a thesis (5). A near-identical curriculum can be seen in the 1767 rules of the school, which stated that qualifications for an MD included three years of medical education following a Bachelor’s Degree and a public defense of a written thesis (6).
Material Analysis
Metadata and Provenance
The thesis was printed in 1798 in Philadelphia by Stephen C. Ustick. John Claiborne was the first owner, followed by William Scott. After that, it was in the possession of William Pepper from 1874 to 1947 before it was finally donated to the University of Pennsylvania.
Substrate and Format
The book’s substrate is paper, which has visible chain lines, indicating that it was made using a wireframe. However, after the main thesis, there are many blank pages in the back, which are smooth and lack visible chain lines – held up in the light, it looks to be wove paper, indicating that the book was most likely rebound at one point. The pages have all yellowed from age. There is also an extra leaf of different wove paper before the title page, one of which has a simplified title page before the very detailed one. These leaves are the same material as the flyleaf and endpaper. Little blue threads can be seen amongst the darker paper, and the material is thicker and smoother than the printed paper.
The format of the thesis is a codex. The bibliographic format is quarto, as each letter for the folio has 4 leaves. Signatures include [A]⁴ B-E⁴ F² (F2 verso blank). There are an additional 16 blank leaves after the thesis (after F2). The codex is small and thin, just larger than palm size. The text takes up most of each page.
Binding
The codex is bound. There is a high possibility the thesis was bound after it was submitted, as there is a variety of papers in the codex. Most likely, it was kept together as an unbound pamphlet and then bound by Penn after donation when it entered the general catalog and was in the stacks. It has a blank brown hardcover. The binding seems to be mid-century and far newer than the actual thesis. On the spine, it says “SCURVY, CLAIBORNE.” There is also a little pocket on the inside of the back cover for lending purposes, indicating that it was in the general library before being moved to the rare book collection.
Textual Analysis
Paratexts
There are 2 dedications and an introduction, all of which are written by the author. There is a dedication to Benjamin Rush and Robert Walker, who were most likely Claiborne’s instructors in medical school. Before the printed title page is a handwritten title page with a shortened title, author, date, and location.
The book has page numbers centered at the top of each page, starting from page 10 to the end. Before, some pages have Roman numerals to indicate pages, but only for page 4 and page 8, as these have text from the previous page continuing to the back of the leaf. There is no table of contents, but there is a clear title page, followed by dedications, then an introduction, then the actual body of the thesis (“Essay on Scurvy”). Folio signatures are printed at the bottom center of the first page of each folio. There are also references and footnotes within the text itself.
Content
Claiborne’s thesis on scurvy is well organized. Following the title page and dedications, he wrote a small introduction.
This is followed by the main body of his research. His first section is ‘History.’ Here, he writes about the history of the disease, especially the course of the disease in an afflicted individual. He goes into detail about the various signs and symptoms of scurvy, giving descriptions of what it looks like and how it presents. This section feels as though it was written from a medical perspective as if watching a patient in the hospital.
The next three sections are about causes. First, ‘Remote Causes’ is concerned with general situations and environmental factors that may lead to an individual developing the illness. Claiborne wrote a list of seven remote causes. Second, ‘Predisposing Cause’ is a short section, one paragraph describing how an individual might become predisposed to developing scurvy, which Claiborne summarizes as “debility” or generalized weakness. Third, ‘Proximate Cause’ is concerned with the specific mechanism of action of the disease. Here, he summarizes the theories found in the literature at the time, as the specific vitamin deficiency responsible for scurvy had not been identified at the time.
The final section is titled ‘Cure.’ Within this section, Claiborne lists various treatments that have been recorded to improve the condition of an individual with scurvy, such as purges, diuretics, and tonics. At the time of publishing, the medically accepted cure for scurvy, an intake of vitamin C, had been identified but not realized as the proper solution. Claiborne mentions citric acid but does not emphasize its importance above other interventions. Interestingly, at the end of this section, he recommends interventions such as “cheerful company” and “exhilarating passion,” stating that a proper cure requires a doctor to regard “equally…body and mind.” This holistic mindset is in striking contrast to the biomedical perspective modern medicine espouses, though this holistic concern with the individual’s mental state has regained importance in recent years. This concern with factors outside biomedical causes and cures most likely reflects the lack of development in medical sciences and the dependence on working with only what the doctors could see.