Great thoughts: early Vermont medicine

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(Host) Commentator Nils Daulaire reflects on the life and work of Nathan Smith, an early Vermont doctor who greatly influenced many of today’s progressive ideas about medical care.

(Daulaire) Patient’s rights. Health care irrespective of ability to pay. Dignity for the sick. Informed consent. All modern terms, but with deep roots right here in Vermont.

In the 1780s, Nathan Smith was a young apprentice bonesetter, the lowest rung on the informal medical care ladder of those days. He took his work and himself seriously, and the fellows who hung around the local tavern loved to tease him.

Summoned one evening to treat an injury at the inn, Smith found, in one of the inn’s better beds, a goose with a broken leg. But the apprentice turned the game around by treating his patient with great dignity, setting its leg with care, and insisting on bed rest and a diet of fine cornmeal. His lifelong reputation for being nobody’s fool was established when his bill “for professional services” arrived at the inn the next day.

Not long afterwards, Smith – a poor boy from Chester, Vermont – became only the fifth person to graduate from the newly founded Harvard Medical School. Despite opportunities for lucrative practice in the bustling cities, Smith went home to the settlements of the upper Connecticut River Valley, to care for his poor and rough-mannered neighbors. Having ridden for hours to perform emergency surgery, he would often stay for days among strangers, attending personally to his patient’s recovery.

In those days, doctors who didn’t know what to do often felt compelled to do something anyway. The cure was often worst than the disease. Working among his practical and independent Vermont neighbors, Smith developed a new philosophy of patient care based on experience and compassion.

He had the courage to do as little as possible, unless he felt certain that what he did would be of real help. Given a choice of treatments, he always recommended the one that was less painful for the patient. Over the years, Nathan Smith pioneered a new, patient-centered approach to medicine. Even more radically, he believed in his patients’ competence to make choices about their own care.

Yet no one better appreciated the country’s need for more doctors – or did more to meet it. Smith founded medical schools at Dartmouth College, the University of Vermont, Yale University, and Bowdoin College. When these projects required public money and political support, he won them by donating his own land or money to get things started. As a still greater gift to generations of Vermonters and all Americans, Smith imbued his students with ideals of kind and tireless service to the sick and needy.

It’s not hard to imagine what Dr. Smith would make of today’s crises in health care coverage, malpractice, and cost recovery. His essential attitudes toward medicine and society were reflected in his daily work.

There had been an explosion, and when Smith arrived, after the usual twenty-mile horseback ride, he saw that there was no choice but to amputate the leg of his patient, a poor laborer. When it was done, the sympathetic and appreciative crowd asked what he would charge. Smith said, “Fifty dollars,” and the crowd quickly collected the sum. Nathan Smith gave the money to his patient and rode back home.

Dr. Nils Daulaire is president of the Global Health Council, headquartered in White River Junction, Vermont. Learn more about VPR’s Great Thoughts of Vermont commentary series.

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