As many Europeans settled in North America, their settlements were quite spread out, roads were often poor and people were extremely isolated. Since America lacked long-settled cities, universities, formal medical training and hospitals were essentially unknown.
During the colonial era, doctors' education was informal. Most were literate, but some, particularly those raised outside of New England where primary schools were a part of almost every town, were not. A man who wished to practice medicine did not need any type of certification. Most did have a period of apprenticeship with an est…
