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 …showed first 75 words of 533 total…

…showed last 75 words of 533 total…self-reliance, the public developed a very skeptical attitude towards regular doctors. In the early 19th century, the spirit of Jacksonian democracy was common across America, which further heightened the "do it yourself" attitude of many Americans. Irregular medical sects were popular worldwide in the 19th century, but they were particularly common in the United States. These sects, while they freely gave medical advice, emphasized the participant of the patient in his or her own treatment.