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11/16/24, 8:31 PMHistory - Article - medicine in the antebellum period

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medicine in the antebellum period       

As the 19th century began, Americans had witnessed many revolutionary changes in their lives, but medicine had not kept pace. Medical practices di!ered little from those of the 18th century. Citizens of antebellum America were faced with a life filled with diseases and epidemics, poorly trained doctors, unsafe cures, poor diet, and generally unsanitary living conditions.

Scientific medicine at the beginning of the century was heroic medicine. All diseases resulted from an excess of fluids, and the cure was to relieve the body of the excesses through bloodletting and purging. The basic scientific knowledge necessary to disprove such beliefs was slow to develop in America. The generation of men like Franklin and Je!erson, who dominated the intellectual life of the country from 1750 to 1800 and promoted scientific research, was largely gone by 1800. Besides, the country had little time and little use for such aristocrats as it was swept up in the Age of Common Man. As Alexis de Tocqueville commented, the combination of democracy and economic opportunity in the Jacksonian era placed an emphasis on profitable technology over basic science. As a consequence, medical science based on empirical research su!ered too.

Contributing to the stagnation of scientific advances in the 19th century was the philosophical movement that dominated American society: Romanticism. Romanticism came to America from Europe between 1812 and 1861 as a revolt against the Age of Reason. Rather than rational empirical thought, Romanticism emphasized feeling, sensitivity, and the supernatural. As this philosophy mixed with Jacksonian democracy in the 1820s and 1830s, it developed many uniquely American traits, one of them being religious evangelism.

By the mid-1800s, scientific medicine had taken a back seat to quackery. Scientific medicine was

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hampered by poor training, the continued practice of heroic medicine despite patient protests, and quarreling among the brightest physicians. Proprietary medical schools and their common practice of grave-robbing to obtain dissection specimens did little to improve the public's image of the medical profession.

These factors combined in the 1820s and 1830s with a wave of Jacksonian democracy, producing an egalitarian America with no use for aristocratic physicians. The public came to believe that anyone could cure the ill if they applied the common-sense principles promoted by quack doctors. Physician licensing, once commonplace, was abolished in most states in the 1840s, so anyone was free to practice. Scientific medicine was rapidly replaced by quackery such as hydropathy, patent medicines, phrenology, and mesmerism. When quackery became inextricably linked to the religious revivalism and social reform movements sweeping the country at mid-century, it was unstoppable.

Since the scientific community was doing little to improve medicine, and the public was rebelling against the painful and debilitating treatments of heroics, a void developed in medical treatment. With no organizing body or set of standards for physicians to follow, few could agree to what constituted appropriate practice. Lay health reformers and practitioners, filled with the millennial, democratic spirit, rushed in with theories of their own. Their treatments included water, electricity, manipulation of animal magnetism, and vegetable compounds. Many of the quack theories took on qualities of social reform and religious revivalism to become movements of their own. Each practitioner claimed to be from a specific "school" of medicine. The result was a wide selection of treatments for patients from which to chose. Almost all doctors were "general" practitioners, with very few specializing in one area, such as surgery.

Meanwhile, a new European movement began in Paris. French doctors who caught the spirit of their country's revolution did not feel confined by the writings of the "masters" and instead observed for themselves how patients reacted to disease. Dubbed the French Clinical School, it emphasized both clinical and pathological observations to determine treatments. Doctors collected statistical evidence such as temperatures and pulse rates. Diagnostics were stressed over heroics. Some 700 of the best American doctors traveled to France to study between 1820 and 1860. Yet despite the opposition of those who returned from abroad, heroic medicine continued to be practiced, and eventually the public developed a deep skepticism of doctors and an increased interest in quackery.

The United States produced some of the best surgeons, many of whom studied in France. The rigors of life on the frontier also stimulated the advancement of surgical techniques, as doctors living there o"en had no alternative to surgery, because they lacked drugs and access to the latest medical

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advances. Surgery was the last resort because it was o"en fatal and always painful. Performed with no regard for cleanliness, doctors wore filthy coats—o"en directly from the autopsy room to the operating room—with pride. This practice spread deadly infections like septicemia or gangrene. The only anesthetics were opium and alcohol. In the 1840s, chloroform, nitrous oxide, and ether began to be used as social drugs by the upper classes, and were eventually applied to surgery. Anesthetics removed the pain of surgery, allowing for longer, more complex and delicate operations.

Three doctors who emphasized diagnostics over heroics were especially influential. Dr. Daniel Drake lived most his life on the frontier rather than on the East Coast, where medical training was centered. Realizing that the frontier lacked adequate facilities to train doctors, he started the Medical College of Ohio in Cincinnati in 1819. He is best known for his exhaustive study Systematic Treatise on the Principal Diseases of the Interior Valley of North America. The work not only examined disease but detailed geography, climate, and frontier society. Dr. William Beaumont used an unusual method to study how the digestive system worked. An army doctor at Fort Mackinac, he encountered a patient with a severe stomach wound that would not heal. Beaumont used the opening in the unfortunate victim as a window into the gastrointestinal tract, and his 1833 work Experiments and Observations on the Gastric Juice and Physiology of Digestion explained the chemical process of digestion. The work of Dr. Samuel Gross to improve surgical techniques resulted in A System of Surgery; Pathological, Diagnostic, Therapeutic, and Operative, used by Gross in his lectures at the Je!erson Medical College in Philadelphia, and by many other medical schools.

This was also the era when women would start to gain a foothold in the medical profession. The prevailing stereotype at the time defined women as sympathetic and nurturing, making them ideally suited to care for children. Women had a long tradition as midwives and lay practioners, but they were not considered suitable for professional medicine, given their irrational and delicate sensibilities. During the 1840s, supporters of the training of female physicians received a boost from a controversy surrounding midwives and childbirth. Male doctors were starting to claim that only they had the medical training and the instruments (namely forceps) that could safely deliver a child. However, many doctors were accused of interfering too much in the process of delivery, sometimes injuring the mother or child (or both). Supporters of female medical training used the resultant backlash to argue that it was immoral for men to be involved in gynecological and obstetric practice. As a result, several schools started to allow women into their programs. In 1849, Elizabeth Blackwell graduated from Geneva Medical College in New York to become the first woman anywhere to receive a medical degree. Blackwell's achievement spurred further advances for women in the medical field, such as the establishment of women's medical colleges. The first such institution was the Women's Medical College of Pennsylvania, which opened in Philadelphia in 1850.

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In 1847 the American Medical Association (AMA) was established by Nathan Davis Smith, and for the first time a code of medical ethics and educational standards for physicians was published in an e!ort to improve and standardize medical practice. The AMA also launched an investigation into quack remedies in an e!ort to enlighten the public in regard to the nature and dangerous tendencies of such remedies. Soon many medical schools were also involved in standardizing medical education, and physicians were now engaged in clinical teaching and research in hospitals. New medical institutions were emerging to provide a more scientific approach to medicine, and new instruments were being developed to assist doctors in treating patients. The 19th century started out with a bleak outlook for American medicine, yet by mid-century it had entered an age of improvement and reform.

Further Information

John Du!y, From Humors to Medical Science: A History of American Medicine, 2nd ed. (Urbana: University of Illinois, 1994)

Paul Starr, The Social Transformation of American Medicine (New York: Basic Books, 1983).

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Record Information

From: Expansion and Reform, Third Edition

Series: Encyclopedia of American History

By: Malcolm J. Rohrbough

Published: 2017 [Last updated: 2018]

Record Type: Encyclopedia Entry

Tags

Alternative medicine Gender studies Medical ethics Medical school Midwifery Pejoratives physician

Pseudoscience Quackery Women in medicine

11/16/24, 8:31 PMHistory - Article - medicine in the antebellum period

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