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Modern Medicine in the 19th Century
Modern medicine, as it’s practiced today, seems sleek, elegant, and highly advanced, especially when compared to the practice of medicine in times past. Even as recently as the 19th century, the modern medical practices of the era seem barbaric, crude, and pretty unbelievable.
The Greek physicin, Hippocrates is said to be the father of medicine, giving us the Hippocratic Oath more than 2,000 years ago. it is still pledged today by graduates of medical schools in the Western world. With that long history before it, it was the 19th century before scientific medicine, recognizable today, became a burgeoning industry in the United States (US). In the 1800s, human anatomy could be studied without fear of moral or religious retaliation. This advance in medical education led to breakthroughs of understanding as well as disease prevention and treatments that allowed more people to recover from once-fatal injuries and illnesses, spurring a population explosion that had dramatic effects on urbanization and industrialization of the emerging nation.
Bloodletting was one practice instrumental to modern medicine in the 19th century although the actual procedure was conducted by barbers, not physicians. The traditional red and white striped pole associated with barbershops even today was developed during this time. The red stripe represents the blood being drawn to treat a very large number of maladies and the white stripe represents the tourniquet used to control the letting of the blood. Even the pole is representative of the medical procedure, representing the stick a patient squeezed to dilate the veins for optimum benefits. Bloodletting was used as both treatment and prevention.
One noted proponent of bloodletting was Benjamin Rush, who considered the state of the arteries to be the key to health. His signature is on the US Declaration of Independence and one of his most famous associates was George Washington, who developed a throat infection he believed was caused by inclement weather. Washington asked to be bled heavily, thus ensuring a speedy recovery. Treatment didn’t work as expected however; after being bled of almost four pounds of blood (more than 3.5 pints), Washington died. The official cause of his death is throat infection.
Calomel was another favored remedy of Dr. Rush. This white, odorless powder, also known as mercury chloride, induced vomiting when ingested. Calomel’s purgative effect was used to release impurities from the body and hasten recovery from whatever ailment the patient was suffering. Along with impurities, calomel also relieved the patient of teeth and hair when large doses were administered.
The 19th century was a time of war and unrest in the US as well as Europe. One benefit of war, in any age, has been the advancement of medicine, as wounds sustained on the battlefield have to be treated immediately and under unique circumstances. Experimentation and adaptation have always been the norm in the war zone hospital and some of the most life-saving innovations employed throughout history were the result of injury on the front lines. One surgeon of note, Ambroise Pare, became an expert at treating gunshot wounds in Napoleon’s army but breakthroughs in controlling bleeding, infection, and pain were developed on 19th century battlefields as well.
Alternative Medical Practices
Experimentation led to some interesting adaptations off the battlefield, too. In its fledgling state, modern medicine relied on a few standardized treatments, such as bloodletting and calomel, but alternative medical practices were also being tested.
Homeopathic medicine emerged during the 19th century and is still in use today. This form of treatment, using the law of similars, involves treating symptoms with dilute formulations chosen because they cause the same symptoms as the affliction under treatment.
Samuel Thomson taught himself to use flowers, roots, and other parts of the plants he found growing in the wilds of his native New England and eventually established a do-it-yourself system of home medicine that gained enormous popularity during the 1800s. So popular was his system that traditional doctors sued him in an effort to stop the sale of his patented formulations that were being used by an estimated million Americans. Legal proceedings against this Thomsonianism system of medicine caused such an uproar that the medical system in operation at the time was eventually reformed, political debate raged along party lines (Federalist and Republican) as to whether or not Thomson should be allowed to practice medicine, and headlines frequently carried the latest developments to readers throughout the new nation.
Two other alternative medical practices of note were mesmerism and hydropathy. Proponents thought each one was based on solid medical knowledge but critics claimed them to be quackery, along with Thomson’s herbal medicine and the homeopathic movement. German physician and astrologer Franz Anton Mesmer developed a system of medicine he called animal magnetism that was said to incorporate the influence of the moon and planets to rid the body of disease. His method, mesmerism, is a form of therapeutic hypnosis and from his name comes the word mesmerize, meaning to transfix or hypnotize. Hydropathy, a therapy that relies on the controlled application of water to the internal and external body, is practiced today as hydrotherapy.
Women’s health issues of the 19th century can be summed up by this statement: “It was commonly believed that most physical ailments of women were caused by their sexual organs or mental disorders, resulting in painful, sometimes lethal treatments.” Perhaps the biggest problem with medical care for women of 19th century America is that almost all doctors were men. These poor doctors could simply not relate to the very real mental and physical demands of reproduction on a woman’s body and many were uncomfortable with the prospect of delving too intimately into the delicate nature of the female body.
The term, female hysteria, was created during the 19th century to describe sexual dysfunction in women. Hysteria is a term attributed to Hippocrates, taken from the Greek word (hustera) for uterus. It was Hippocrates’ understanding that lack of sexual intercourse caused a woman’s uterus to become light and dry, conditions which caused it to rise upward within the body, compressing her diaphragm, heart, and lungs in such a way that led to madness and suffocation. To relieve female hysteria, physicians of the 19th century used genital massage, vibrators, and water spray to the point of orgasm to relieve a female patient’s distress.
Great strides were made on mental health treatments in the 19th century. Mental patients were no longer thought to be wild animals deserving of public scorn and ridicule but deserved organized treatment instead. As a result, mental asylums were designed to provide safe, long-term housing and care of the mentally insane segment of the population. Although this new code of “moral treatment” of the insane was tremendously more humane than previous measures, care for the mentally ill was not perfected in the 1800s.
Dr. Benjamin Rush led the way to establishing humane and innovative ways of treating the mentally ill at the Pennsylvania Hospital where he worked. His method of compassionate care required intelligent, sensitive attendants who spent friendly time with patients who were no longer kept in restraints. He advocated small facilities that felt more like home than an institution but he also relied on bloodletting, calomel, baths of extreme temperature fluctuations, spinning boards, and tranquilizer chairs.
Dorothea Dix, a schoolteacher from Boston, became concerned about the treatment of mentally ill prisoners when she began teaching Sunday school lessons in a local prison. Her interest led to prison reforms that included safer, more humane treatment for mentally ill prisoners. Under her direction, 32 state hospitals for the criminally insane were established between 1841 and 1881.
Under the leadership of Rush, Dix, and other like-minded advocates for the mentally ill, the moral treatment movement saw an impressive number of recoveries in the early part of the 19th century. As the asylum system was adapted around the nation and abroad, however, larger and more impersonal institutions became the norm, along with overcrowding and cursory care. The recovery rate declined by the end of the century as isolation, abuse, and overcrowding became the norm.
Public Health Movement
Until the 19th century, the miasma theory of disease was believed to be the basis for all epidemics, where illness was spread as a result of poisoned air. The germ theory, however, was gaining ground within the medical community. In 1854 London, a tainted public water well was identified as the source of a cholera outbreak devastating the city, thereby shifting focus from the air to other elements of everyday existence. As a result, the modern public health movement began, with an emphasis in cleaning up the public water supply.
Sewer systems were developed and more sanitary latrines replaced waste buckets. Garbage collection systems were organized and waste was incinerated or hauled to a centralized landfill instead of allowing it to rot where it stood. Water purification systems were designed, along with drainage plans for standing water that drew mosquitoes and led to malarial outbreaks.
Once the significance of the germ theory was more clearly understood and measures were undertaken to address the entire realm of sanitation and a clean, healthy environment, the public health movement was in full swing. Its two initial goals were to prevent illness instead of cure it once it occurred and to deal with the environment on a population level rather than on an individual patient or epidemic basis.
In 1765, the University of Pennsylvania School of Medicine in Philadelphia was founded; it was the first medical school in the US. Today, the Association of the American Medical Colleges lists 130 schools that grant medical diplomas and the American Association of Colleges of Osteopathic Medicine lists 28 accredited for granting doctor of osteopathy diplomas.
Even today’s number of medical schools in the US seems small compared to the 400+ schools operating in the 19th century. There was no standardization in curriculum, admissions, or any other factors governing a medical education during the 1800s, leading the industry to grow wildly and uncontrollably. Enrollment was more often akin to a fraternal organization than an educational facility. Some medical schools were little more than diploma mills, handing out medical degrees to anyone willing to pay the price. Claims of quackery were abundant.
To streamline the medical education of America’s doctors, the American Medical Association (AMA) was created in 1847. It was chartered with the responsibility of self-regulation of the medical profession, including regulating the coursework required of every facility in the US claiming to be a medical school. By 1910, the number of US medical schools had dropped to 148; by 1930, there were only 76. Also in 1910, Abraham Flexner, an educator working under the auspices of the Carnegie Foundation, released his report (the Carnegie Foundation Bulletin Number Four), that called for higher standards for admission and graduation and strict adherence to scientific protocol in American medical schools. Many medical schools in the US and Canada did not meet the standards described in the Flexner report, which also claimed there were too many schools training too many doctors.
As a result of the Flexner report, schools were closed or consolidated and admissions standards were raised significantly. A collaboration of the AMA, Carnegie Foundation, and the Rockefeller Foundation developed the framework, including standardized admissions and graduation requirements, curriculum, and scientific protocol, under which all American medical schools operate today.
One unfortunate result of the Flexner report was that admission to medical school in the US was limited to male students only. While this gender-based restriction had once been the norm, Oberlin College had been accepting female medical students since 1833, as had Vassar and Pembroke Colleges, both of which were private schools.
The doctors and medical educators at work in the 19th century were surely on the cutting edge of technology, always looking for breakthroughs and new developments that would take the medical profession to a higher level of accuracy and achievement. That has been the nature of medicine throughout time. Even though some of the most innovative procedures of the 19th century seem antiquated and perhaps even a bit silly by today’s standards, it almost boggles the mind to try to envision the medical profession as it will be two hundred years from today.