Sunday, July 24, 2016

The History of Medicine: 1800 – 1850


“Nearly all men die of their medicines, not of their diseases.” Moliere

The Revolutionary war is ended, a new century is begun, our first president has passed away and we are the freest society in the modern world. So, what are your options if you become ill?

If you lived in the cities your first choice is probably conventional medicine, which we will refer to as "regular medicine" in this article. As to physicians practicing this form of medicine, we shall call them "regulars." Regular medicine at that time was based upon the theory of the Four Humors. We’ve touched this theory in our first article on the history of medicine, The Settlers Arrive. At the turn of the century, many regulars began flirting with some of the newer theories of medicine imported from Europe, and still, none of these were based upon science. Regular medicine of this time, though deemed the best science of the age, was more a philosophy or art than a true science. One movement to which Dr Benjamin Rush  was a leader, attempted to refine all diseases into one disease, while other movements categorized diseases in hot and cold, acid and alkaline categories. Many of the papers published by physicians from this period were philosophical in nature, promulgating theories, which like most theories, easily found both proponents and evidence to back them up while ignoring all evidence to the contrary; that is, until another theory came along.

This same critique of medicine in 1800 being top heavy with theory was made by contemporaries. In a widely quoted excerpt, Thomas Jefferson criticizes basing treatment of disease on "some fanciful theory of corpuscular attraction, of chemical agency, of mechanical powers, of stimuli, of irritability accumulated or exhausted, of depletion by the lancet and repletion by mercury, or some other ingenious dream, which lets him into all nature's secrets at shorthand." He specifically scored the disciples of "Hoffman, Boerhaave, Stahl, Cullen, (and) Brown...." Historians suggest that Rush was omitted only because he was a personal friend. [Barnebeck, B, Destroying Angel: Benjamin Rush, Yellow Fever and the Birth of Modern Medicine]

The number of medicines available to regular physicians of the period was just starting to grow. There were probably fewer than 100 medicines used; a firm number is hard to pin down since the first American pharmacopoeia was not published until 1820. However, Rush was of the opinion that large number of medicines was due to “nosology;” or giving names to diseases; the more diseases, the more names.

Today there are some 13,000 drugs in our pharmacopoeia, though a physician will normally administer no more than 100 different pharmaceuticals in her/his lifetime. Most physicians stick to right around 30 different drugs prescribed during their entire career.

The Pharmacopoeia of 1820 consisted mainly of herbal medicines, with few inorganic compounds, such as calomel (mercury), a favorite among regulars. Though herbs have been dropped from today’s Pharmacopoeia, approximately 40% of those drugs listed today are related to herbs in some way, whether synthetics or derivatives.

According to some historians, the regulars’ main focus was on making a living and monopolizing medicine. In the early 1800s, this plan almost worked.

Despite the push of the regulars to monopolize, you still had options during at the start of the 19th century. One option, which is egregiously overlooked in most history books, was to attend a midwife. Midwives of the time did a lot more than just help deliver babies. They practiced a form of medicine that had been handed down for centuries from mother to daughter, family to family.

Midwifery thrived during times of war because doctors were conscripted into military service. In fact, were you to take a course in women’s studies today, you’d learn how women have always progressed during times of war when the men are off fighting. World War II brought many women into the workforce; some of them even became pilots who ferried planes about the country. It was during the Vietnam War that women moved into management positions for the first time. It was during the Civil War that women were first allowed to nurse the sick and wounded. It was after the Civil War that one female physician was decorated with the Medal of Honor.

Nursing during this period, for the most part, was a male vocation. An interesting historical side note is that during the Yellow Fever epidemic in the late 1700s, black slaves were hired out as nurses, because those who had lived in Africa were immune to the disease. [ ]

One learned midwifery either from her mother or as an apprentice to a midwife. During the Revolutionary War, midwives performed every service any physician of the period could offer, and though the end of the war reined in many midwifery practices, it wouldn’t be long before England attacked the US in the War of 1812 and again their services would be required throughout the cities and countryside. However, Gail Collins, in her book America's Women: Four Hundred Years of Dolls, Drudges, Helpmates, and Heroines, points out that with the end of conflict, the influx of doctors back into society left midwives with little to do beyond delivering babies. Doctors set out to build up their practices, and offered new life saving techniques, such as delivering babies with the help of forceps that had been popularized in England. As the population of doctors grew, so did their desire to put midwives out of business and take over their practices. Collins tells us that in, “Philadelphia, twenty-one women listed their professions as midwife in the 1815 city directory; by 1824 there were only six.” [In our References and Further Reading section at the end of this article is a link to a superb paper on women in medicine.]

Ironically, if you read up on midwifery, you’ll hear that doctors and modern hospitals could guarantee a sterile environment where babies could be successfully delivered with little chance of infection to the mother. However, it was midwives of this period whose personal hygiene and habits of washing before a delivery that separated their practices from those of the physicians.

Anytime a hand or instrument was inserted into a woman’s body, she was in danger of becoming infected, with fatal results. Childbed, or puerperal, fever became epidemic at times in the nineteenth century, particularly in hospitals, where a single doctor could carry infection from one patient to the next. Hospitals were the delivery rooms of the urban poor, and in 1840 at Bellevue in New York, almost half the women giving birth during the first six months of the year contracted the fever. Eighty percent of them died. [Collins]

Another option of the period were the Indian Doctors, or as they were also known, botanical practitioners; herbalists, to be exact. Regular physicians referred to them as “irregulars." Though the name, Indian Doctor would imply that they picked up their knowledge from the natives, much of what they knew had been brought with them from the Old World. It is an interesting historical fact that herbalism in the old world and in the new world among our natives grew and flourished at approximately the same time.

Two other options of this period were hydropathy and the Thomsonians. Hydropaths believed in the curative powers of water, which, in retrospect, we realize brought a needed bit of personal hygiene into the picture, while the Thomsonian movement put medicine into the hands of the common man. The movement was founded by Samuel Thomson “after six doctors called in to help his seriously ill wife prescribed six different treatments.” [Collins] Thomsonians believed that laypeople could treat themselves better than any physician with a little help from nature’s botanicals.


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