In this sweeping biography, Elaine G. Breslaw examines the life of Dr. Alexander Hamilton (1712–1756), a highly educated Scottish physician who immigrated to Maryland in 1738. From an elite European family, Hamilton was immediately confronted with the relatively primitive social milieu of the New World. He faced unfamiliar and challenging social institutions: the labor system that relied on black slaves, extraordinarily fluid social statuses, distasteful business methods, unpleasant conversational quirks, as well as variant habits of dress, food, and drink that required accommodation and, when possible, acceptance. Paradoxically, the more acclimated he became to Maryland ways, the greater his impulse to change that society and make it more satisfying for himself both emotionally and intellectually. Breslaw perceptively describes the ways in which Hamilton tried to transform the society around him, attempting to re-create the world he had left behind and thereby justify his continued residence in such an unsophisticated place.

Hamilton, best known as the author of the Itinerarium—a shrewd and insightful account of his journey through the colonies in 1744—also founded the Tuesday Club of Annapolis, promoted a local musical culture, and in his letters and essays, provided witty commentary on the American social experience. In addition to practicing medicine, Hamilton participated in local affairs, transporting to Maryland some of the rationalist ideas about politics, religion, and learning that were germinating in Scotland's early Enlightenment. As Breslaw explains, Hamilton's writings tell us that those adopted ideas were given substance and vitality in the New World long before the revolutionary crises.

Throughout her narrative, Breslaw usefully sets Hamilton's life in both Scotland and America against the background of the major political, military, religious, social, and economic events of his time. The largely forgotten story of a fascinating, cosmopolitan, and complex Scotsman, Dr. Alexander Hamilton and Provincial America illuminates our understanding of elites as they navigated their eighteenth-century world.