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16-04-2015, 04:10

Medicine

The practice and study of medicine in the second half of the 18th and early 19th centuries experienced some changes, while still remaining firmly rooted in tradition. Although the number of doctors with formal medical schooling increased, most practitioners simply served an apprenticeship with a doctor or were self-taught. There were also few specialists; the majority of doctors were surgeon-apothecaries: individuals who mixed medicines, treated illness, and even on occasion performed operations. Female midwives delivered most babies, and often they were responsible for medical care when the expense of a doctor was either not called for or too high for the patient. By 1812 midwives were being replaced by male doctors as the medical profession began to organize itself and medical training in a college and hospital became more frequent.

In the 18th century the predominant European-American theory of medicine found its roots in the ancient humoral thesis. This theory held that an imbalance in the natural humors of the body caused all illness. Doctors typically sought to purge the patient of whichever humor was in excess. Medicine was slow to move away from this theory because few doctors did medical research; doctors were too busy treating patients, and the general population had moral objections towards using human bodies for research.

By the second half of the 18th century, there was some change. Medical men began to study anatomy, pathology, and physiology, even if they had to use stolen cadavers to do so. Doctors also began to change their approach to illness. They started to view DISEASE AND EPIDEMICS as different from each other, which, in turn, required different treatments. The most important step in this development was the establishment of hospitals and medical schools. The first hospital was built in Philadelphia in 1752, and the associated medical school opened at the College of Philadelphia (now the University of Pennsylvania) in 1766. Prior to the opening of this school, colonial Americans had to go to Europe for their formal medical EDUCATION. Following the success in Philadelphia, New Yorkers started a medical department at King’s College (now Columbia University) in 1768. The REVOLUTIONARY War (1775-83) put plans at other schools on hold, but, by 1799, Harvard, Dartmouth, and Transylvania University had medical programs of their own.

There were also a few advances made in the area of surgery during this time, mostly in the fields of obstetrics and gynecology. John Bard, in 1759, and John King, in 1818, successfully treated extrauterine pregnancies. Ephraim McDowell, in 1809, performed the first ovario-tory. There may have been other advances, however, we have no record of them. Surgeons focused more on the practice of medicine and often did not seek publication of their procedures.

Public health issues also played an important role in society. A community’s ability to protect itself from contagious disease was vital to its survival. Most cities had ordinances related to quarantining outbreaks of a contagious disease and the inspection of incoming vessels. The major outbreaks of yellow fever in the years after 1793 brought the need for public health standards to the forefront. The problem with yellow fever was that it did not behave in the same way as other contagious diseases, leaving officials baffled as to the best way to combat the disease. Debates over the origins of yellow fever intensified in the 1790s and continued throughout the 19th century.

Another disease that had a major impact during this era was smallpox. Before the invention of vaccines, doctors tried to prevent epidemics of contagious diseases such as smallpox using a treatment called inoculation, or variolation. This treatment involved the doctor collecting pus from an infected patient and injecting it into a healthy one. As a result, healthy patients contracted a milder case of smallpox from which they had a better chance of surviving. The survival rate increased from 20 percent to 95 percent. While this method of treatment appeared in the North American colonies in the early 18th century, it became more prominent in the Revolutionary War. At the outset of the war smallpox epidemics were again on the rise, but with the spread of inoculation, including within the CoNTINENTAL ARMY, the impact of the disease decreased.

During the Revolutionary War, the SECOND CONTINENTAL CONGRESS set up a medical department for the Continental army. While it achieved some success, especially in dealing with hygiene and smallpox, it was plagued with problems. The first head of the army medical department was Dr. Benjamin Church. He turned out to be a British spy and was dismissed from service. Dr. John Morgan, who had helped establish Philadelphia’s medical school, was appointed to replace Church in October 1775.

But he became embroiled in controversy as he wrangled over policy and authority with his longtime rival, Dr. William Shippen, Jr. Shippen replaced Morgan in January 1777, only to be charged with war profiteering. Shippen resigned in 1781. Throughout the war these political problems only made the shortage of supplies and personnel more difficult.

The foremost doctor of this time was Benjamin Rush. Rush gained fame as a revolutionary, reformer, and medical man. He served as a regional director in the army medical corps, and sided with Morgan in the jurisdictional disputes. As a doctor, Rush was an important teacher at the medical school in Philadelphia and wrote extensively on medicine. Rush clung to the “heroic” theory of disease, and because of his support and influence it continued as the dominant approach to disease in the United States. The heroic theory was rooted in the humoral theory of disease. Rush believed that all diseases could be tied to one problem, vascular tension. The differing levels of tension in the small capillaries of the body resulted in the symptoms manifested by the patient. This meant that the only cure was bloodletting and purging. The heroic theory of disease was slowly replaced by new theories formulated by Rush’s students in the 19th century. Ironically it is the emphasis that Rush placed on observation while teaching his students that led them to discard his theory.

Rush also had a huge impact on the treatment of mental illness. The abandonment of supernatural causes for insanity shifted the condition from the realm of religion to the realm of medicine. If there were natural causes for mental illness, then there had to be natural cures. This development in the conception of psychological derangement began in Europe and had crossed the Atlantic by the mid-18th century. The Eastern Lunatic Hospital in Williamsburg was the first separate institution devoted to the insane. The founders of the Philadelphia Hospital hoped that they could treat and cure the insane, and by 1796 they had built a separate wing to house only those with mental illness. Other communities and states built asylums in the following decades. Europeans emphasized “moral treatment” which separated the individual from his family and provided a rigid schedule and disciplined habits. Following the leadership of Rush, doctors in the United States believed that a medical treatment should accompany this separation. Using his heroic theory of disease, Rush not only advocated bloodletting and daily purges but also other procedures that almost sound like torture. He wanted the patient restrained by being strapped in a chair and then have cold water and ice applied to the head and warm water placed on the feet.

Beyond the European-American population, Native Americans and African Americans developed their own medical practices with a more holistic approach. Neither group separated the spiritual from the physical world. While this left them open to criticism from European Americans, it also meant that they treated social and physical symptoms. Both groups, too, relied heavily upon plants and herbs. Native Americans experimented over centuries to determine what types of plants might help in the context of the North American environment. African Americans were relative newcomers to the continent, but their experiences in Africa, where the environment had some similarities to the American South, helped them to seek out local cures. Distinctions between male and female practitioners, which increased in this period in European-American society, also had little meaning for either African Americans or Native Americans.

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