The
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.
Notes
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 AmericaÕs Hospital
System. Baltimore: Johns Hopkins University Press, 1987.
RosenbergÕs book charts the rise of the modern U.S. hospital system. The
first three chapters of this book provide a compelling summary of American
health care between 1800 and 1850.
Rosenberg, Charles. The Cholera Years: The United States in 1832,
1849, and 1866. Chicago: The University of Chicago Press, 1962.
This book describes three cholera epidemics and how their occurrence was
understood, experienced, and treated by the residents and physicians of
New York City. It explores the social status of medical practitioners
and the moral qualities of illness.
Ulrich, Laurel. A MidwifeÕs Tale: The Life of Martha Ballard, Based
on Her Diary, 1785-1812. New York: Vintage Books, 1990.
Ulrich provides an alternative perspective on American medicine by exploring
the life and activities of a midwife living in frontier Maine at the beginning
of the 19th century.
Valencius, Conevery Bolton. The Health of the Country: How American
Settlers Understood Themselves and Their Land. New York: Basic Books,
2002
Valencius explores the experiences of nineteenth century settlers in Arkansas
and Missouri. Of particular interest are her accounts of settlers' ideas
of health and its relation to the surrounding environment.