c u l t u r e s
s y m p t o m s
Early 19th Century American Medical Worldview
Medicine in the United States in the first half of the nineteenth century was characterized by the view that bodies were constantly interacting with the surrounding environment. Health was a product of ensuring that one's body maintained a proper equilibrium with itself and with the environment around it. Two perspectives on the body were particularly important in nineteenth century America: first, all parts of the body were related to each other, and second, the inputs and outputs of the body were central to its proper functioning.
Both doctors and patients viewed their bodies as a collection of parts intimately connected to one another. In this manner, concepts of health and disease were understood as related to the entire body, not to particular areas. A patient record from a carpenter in Cincinnati noted that "his eyes sympathize with his stomach and bowells" [sic] by becoming infected "when much nausea of stomach obtains" (1). As a result, illnesses were rarely understood to have a specific source, and treatments targeted a person's entire body. In addition, medical thoughts also believed that health was determined by a proper regulation of the body's inputs and outputs. On this view, equilibrium was the most important element of health. If a person was unhealthy, it meant the body lost its proper balance of input and output.
Because illness was marked by disequilibrium, medical treatments were designed to help the body re-achieve its proper balance by prompting the release of bodily elements including blood, urine, defecation, and perspiration. These therapies worked because drawing out these elements of the body helped to restore the proper cycle of input and output. One of the central treatments was the practice of bleeding. By drawing excess blood from the system, patients and doctors believed that the force of illness would leave the body, just as steam would leave baked bread through the slits a baker cut in the top before backing. As Conevery Bolton Valencius notes, bloodletting was both regular and a form of relief: "many people expected blood to be drawn and experienced bloodletting as pleasurable; it relieved pain and drew strength away from gripping illness" (2). Other treatments were similarly targeted at restoring equilibrium to the body. Physicians prescribed drugs like calomel (a mercury compound) as a purgative, opium to moderate diarrhea and relieve pain, and camphor to induce perspiration. These drugs worked by producing strong reactions influencing the inputs and outputs of the body by inducing vomiting, stopping diarrhea, and prompting sweating.
These treatments were considered effective because they had a noticeable effect on the body. If a treatment did not remove blood, induce sweating or the like, then it did not work. Patients expected and often demanded from their physicians aggressive treatments in order to be sure that they were cured. The bodily releases offered physical proof of medical treatment. This was important because it clearly demonstrated that some therapy had been performed, and that a patient was not a victim of quackery. In addition, the releases could be used to gain further diagnostic insight. Based on the qualities of the discharges--smell, consistency, color--more could be learned about the illness.
Sickness was understood to come from the environment. People recognized that certain areas were healthier than others, and were particularly aware of miasmas that influenced health. A miasma can be generally understood as a foul air that gives rise to illness. Whereas pure air was clean and rejuvenating, miasmas were putrid, heavy, and sickening. In rural areas, miasmas often arose around still water swamps and in cities around heavy concentrations of people. Miasmas arose in the sweltering heat of the summer as well as the dank cold of winter. Whoever came into contact with a miasma was at great risk for becoming ill. Overall, miasma was a very flexible concept that expressed the general concerns people in the nineteenth century had about becoming sick from environmental factors.
Illness was also often associated with immorality. Because health was achieved through maintaining a body's equilibrium, sinful living was a way to lose this balance. In addition, people who lived in dirty and unsanitary conditions exposed themselves to harmful miasmas regularly. The victims of major cholera epidemics in 1832 and 1849 were widely believed to have been sinners who left themselves open to the disease by drinking alcohol and living in squalid conditions (3).
When a person became ill, they were most likely to be treated at home first by their family. If the illness did not get better or respond to home therapies, a doctor would be called to the house to administer treatment. People only went to hospitals if they could not afford medical treatment or they had no family to support them. In rural areas, families might have to wait long periods for a traveling physician to provide care. Physicians charged fees, and the amount and quality of care an individual was able to receive was often based on their ability to pay.
Most physicians did not have particularly high status in America during this period. Most treatments could be performed at home, doctors had few tools, and they were not able to offer many treatments that were significantly more effectively than home remedies. In addition, physicians rarely had enough business to be full-time doctors, and most had secondary occupations such as farming as well. Several other types of practitioners were also part of the medical community including midwives, nurses, pharmacists, and family members.
There was little medical infrastructure in America at the beginning of the 19th century. Only a handful of medical colleges and hospitals existed, and practically all patients were seen by doctors who made house calls. Doctors were trained through a two-year apprenticeship without formal education requirements. Some elite doctors attended college and studied in Europe before returning to America; however, these physicians were the exception rather than the rule, and concentrated in large coastal cities. Federal and state governments had very little impact, passing few laws that regulated medical practitioners and providing little funding.
1. Case of W. Griffith, Aet. 37, Carpenter, August 11, 1837, Male Medical Casebook, 1837-8, Cincinnati General Hospital Archives (as quoted in Rosenberg, 1987, 76).
2. Valencius, 2002, 62.
3. Rosenberg, 1962.
Bibliography for Further Reading
Rosenberg, Charles. The Care of Strangers: The Rise of America’s Hospital
System. Baltimore: Johns Hopkins University Press, 1987.
Rosenberg, Charles. The Cholera Years: The United States in 1832,
1849, and 1866. Chicago: The University of Chicago Press, 1962.
Ulrich, Laurel. A Midwife’s Tale: The Life of Martha Ballard, Based
on Her Diary, 1785-1812. New York: Vintage Books, 1990.
Valencius, Conevery Bolton. The Health of the Country: How American
Settlers Understood Themselves and Their Land. New York: Basic Books,