Contrary to popular belief, the most significant health problems facing early Americans were not epidemics but the daily activities pursued in the New World.

Of course, disease was a problem. The low-lying coastal areas on which the colonists settled were mosquito-infested, and malaria was a serious and often fatal malady. So, too, was dysentery, usually referred to as the "bloody flux" by colonials. Smallpox, diphtheria, yellow fever and the many childhood diseases -- mumps, measles and whooping cough -- were loathsome but not widely devastating, largely because colonists were isolated and rural.

The most significant threat to the health of the colonists was themselves. They ate poorly: too much meat and too few vegetables was the rule. They ate like pigs: John Adams, while attending the Continental Congress in Philadelphia, wrote his wife Abigail of one of his more beloved meals of "ducks, hams, chickens, beef, pig, tarts, custards, creams, jellies, fools, trifles, floating islands, beer and wine."

This excessive eating was often accompanied by excessive drinking. Since many of the meats were cured with salt, things went better with fluids, particularly spirits, which were easily made. Therefore, drunkenness was not an infrequent complaint.

Colonial superstitions regarding medicine were slow to erode. Settlers carried over with them an English medicine chest of ideas that had little foundation in rationality. The doctrine of signature to which they adhered predated Hippocrates. Based on the religious belief that God had provided men with cures that were related to the environment in which they lived or the ailment with which they suffered, colonists feverishly looked to the flora and fauna of America for remedies.

Thus, they found a root that they appropriately named rattlesnake root, located as it was in areas where the reptiles abounded. While a few of these cures were effective, most were insults to their intelligence, as for example, the idea that walnut shells would relieve concussions (a cracked shell for one's cracked cranium), and that earthworms would eradicate jaundice (as the worm turns, so turneth the color of the skin).

Some of the remedies prescribed bore no relation to the doctrine of signature but were derived from the widely held notion of European medicine that the worse tasting the potion, the more likely the cure. With this thought in mind, Puritan leader Cotton Mather suggested that urine and dung be applied for medicinal purposes. These, Mather remarked in a classic understatement, were remedies "hardly to be paralleled."

In general, American doctors and hospitals lent neither prestige nor cures to colonial medical problems. Hospitals often arose from poorhouses and were therefore viewed with condescension by middle and upper-class families. The doctors were a motley lot, unfortunately bearing The greatest threat to the health of American colonists came not from diseases but from their own poor health habits.

little resemblance to their counterparts in England. Three divisions of medical practitioners typified English society during the 17th and 18th centuries: physicians, surgeons and pharmacists. All three were organized into guilds or unions, but only the physician carried prestige.

The physician was university-trained, usually at the University of Edinburgh in Scotland. The only one of the three practitioners to be called "doctor," the physician served the upper classes in a role that would parallel the "internist" specialty in America today.

Below the physician was the surgeon. Seldom the product of a university education, the surgeon was more akin to a skilled craftsman such as a barber or tailor, having been trained through apprentice methods. Until 1745, English surgeons belonged to a union that included barbers. With this type of training, it is little wonder that a South Carolina missionary complained in 1751 that he was under the "severe hand of the surgeon."

Called "mister," the surgeon amputated limbs without anesthetics, cleansed wounds with concoctions that had as much bite as Drano and repaired broken legs and arms with splints that were as utilitarian as galvanized iron pipes.

The pharmacist was the low man. Also trained by apprenticeship, he sometimes made potions but usually sold and prescribed already packaged drugs. He examined patients in a cursory fashion; nevertheless, he had a large following from a population that had already begun to put its faith in over-the-counter drugs.

In the first two centuries of the colonies' existence, few English physicians came to practice. This was understandable; the wilderness environment offered this refined profession more liabilities than assets. Given this trend, the people who practiced medicine in the colonies were apprentice-trained pharmacists and surgeons who expropriated the title "doctor" in the absence of the physician.

When the university-trained physician finally did come to America, he had a difficult time competing with the surgeons and pharmacists. He was therefore forced to become like them, since American patients preferred to go to one practitioner rather than three. Although trained physicians campaigned for licensing of medical providers, for education and for the building of hospitals, they were unable because of their numbers to break the hold of the quacks on their profession. By 1775, only 5 percent of the 3,500 practitioners were MDs.Thomas V. DiBacco is a historian at American University.