History of medicine in the United States

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The history of medicine in the United States focuses on the work of trained professionals from colonial days to the present.

Colonial era[edit]

Disease environment[edit]

There was a fundamental difference in the human infectious diseases present in the indigenous peoples and that of sailors, explorers and settlers from Europe, Africa and Asia. Some viruses, like smallpox, have only human hosts and appeared to have never occurred on the North American continent before mass immigrations of the 16th and 17th centuries. The indigenous people lacked genetic resistance to such new infections, and suffered overwhelming mortality when exposed to smallpox, measles, malaria, tuberculosis and other diseases. The disease environment was very hostile to European settlers, especially in the Southern colonies. Malaria was endemic in the South, with very high mortality rates for new arrivals. Children born in the new world had some immunity --they suffered mild recurrent forms of malaria but survived.

Medical organization[edit]

The city of New Orleans, Louisiana, deserves special mention for contributing two important hospitals in the early 1700s. The first was the Royal Hospital, which had humble beginnings when it was built in 1722 as a small military infirmary, but grew to importance when the Ursuline Sisters took over the management of it in 1727 and made it a major hospital for the public, with a new and larger building built in 1734.[1] The other major New Orleans hospital was the Charity Hospital, which was staffed by many of the same people but was established in 1736 as a supplement to the Royal Hospital so that the poorer classes (who usually could not afford treatment at the Royal Hospital) had somewhere to go.[2]

In most of the American colonies, medicine was rudimentary for the first few generations, as few upper-class British physicians emigrated to the colonies. The first medical society was organized in Boston in 1735. In the 18th century, 117 Americans from wealthy families had graduated in medicine in Edinburgh, Scotland, but most physicians learned as apprentices in the colonies.[3] In Philadelphia, the Medical College of Philadelphia was founded in 1765, and became affiliated with the university in 1791. In New York, the medical department of King's College was established in 1767, and in 1770, awarded the first American M.D. degree.[4]

Smallpox inoculation was introduced 1716-1766, well before it was accepted in Europe. The first medical schools were established in Philadelphia in 1765 and New York in 1768. The first textbook appeared in 1775, though physicians had easy access to British textbooks. The first pharmacopoeia appeared in 1778. The number of physicians was small, and the national resources were stretched thin by the medical needs of the Revolutionary Army, where supplies and facilities were often inadequate.

Pest houses aimed at newly arrived infected sailors were established in port cities, notably Boston (171), Philadelphia (174) Charleston (1752) and New York (1757). The first general hospital was established in Philadelphia in 1752.

Women[edit]

The Woman's Medical College of the New York Infirmary. [Announcement, 1868-69].

Doctors[edit]

In 1849 Elizabeth Blackwell (1821–1910), an immigrant from England, graduated from Geneva Medical College in New York at the head of her class and thus became the first female doctor in America. In 1857 she and her sister Emily, and their colleague Marie Zakrzewska, founded the New York Infirmary for Women and Children, the first American hospital run by women and the first dedicated to serving women and children.[5] on women as medical doctors. Blackwell viewed medicine as a means for social and moral reform, while a younger pioneer Mary Putnam Jacobi (1842-1906) focused on curing disease. At a deeper level of disagreement, Blackwell felt that women would succeed in medicine because of their humane female values, but Jacobi believed that women should participate as the equals of men in all medical specialties.[6]

Nursing[edit]

Nursing became professionalized in the late 19th century, opening a new middle-class career for talented young women of all social backgrounds. The School of Nursing at Detroit's Harper Hospital, begun in 1884, was a national leader. Its graduates worked at the hospital and also in institutions, public health services, as private duty nurses, and volunteered for duty at military hospitals during the Spanish-American War and the two world wars.[7]

The major religious denominations were active in establishing hospitals in many cities. Several Catholic orders of nuns specialized in nursing roles. While most lay women got married and stopped, or became private duty nurses in the homes and private hospital rooms of the wealthy, the Catholic sisters had lifetime careers in the hospitals. The enabled hospitals like St. Vincent's Hospital in New York, where nurses from the Sisters of Charity began their work in 1849; patients of all backgrounds were welcome, but most came from the low-income Catholic population.[8]

Infant mortality[edit]

Infant mortality was the major component of life expectancy. Infant mortality was lower in America compared to other parts of the world because of better nutrition. The rates were higher in urban areas, and in Massachusetts statewide the rates increased as the state urbanized. Public health provisions involving sanitation, water supplies, and control of tuberculosis started showing effects by 1900. Public health conditions were worse in the South until the 1950s.

Infant Mortality Rate, for Massachusetts
Years Deaths under 1
per 1000 live births
1970 16.8
1960 21.6
1945-49 28.4
1935-39 43.2
1925-29 67.6
1915-19 100.2
1905-09 134.3
1895-99 153.2
1885-89 158.5
1875-79 156.3
1865-69 146.3
1855-59 122.9
1851-54 131.1

source: U.S. Bureau of the Census, Historical Statistics of the United States (1976) Series B148

Civil War[edit]

In the American Civil War (1861–65), as was typical of the 19th century, more soldiers died of disease than in battle, and even larger numbers were temporarily incapacitated by wounds, disease and accidents.[9] Conditions were poor in the Confederacy, where doctors and medical supplies were in short supply.[10] The war had a dramatic long-term impact on American medicine, from surgerical technique to hospitals to nursing and to research facilities.

The hygiene of the training and field camps was poor, especially at the beginning of the war when men who had seldom been far from home were brought together for training with thousands of strangers. First came epidemics of the childhood diseases of chicken pox, mumps, whooping cough, and, especially, measles. Operations in the South meant a dangerous and new disease environment, bringing diarrhea, dysentery, typhoid fever, and malaria. There were no antibiotics, so the surgeons prescribed coffee, whiskey, and quinine. Harsh weather, bad water, inadequate shelter in winter quarters, poor policing of camps, and dirty camp hospitals took their toll.[11]

This was a common scenario in wars from time immemorial, and conditions faced by the Confederate army were even worse. The Union responded by building army hospitals in every state. What was different in the Union was the emergence of skilled, well-funded medical organizers who took proactive action, especially in the much enlarged United States Army Medical Department,[12] and the United States Sanitary Commission, a new private agency.[13] Numerous other new agencies also targeted the medical and morale needs of soldiers, including the United States Christian Commission as well as smaller private agencies such as the Women's Central Association of Relief for Sick and Wounded in the Army (WCAR) founded in 1861 by Henry Whitney Bellows, and Dorothea Dix. Systematic funding appeals raised public consciousness, as well as millions of dollars. Many thousands of volunteers worked in the hospitals and rest homes, most famously poet Walt Whitman. Frederick Law Olmsted, a famous landscape architect, was the highly efficient executive director of the Sanitary Commission.[14]

States could use their own tax money to support their troops as Ohio did. Following the unexpected carnage at the battle of Shiloh in April 1862, the Ohio state government sent 3 steamboats to the scene as floating hospitals with doctors, nurses and medical supplies. The state fleet expanded to eleven hospital ships. The state also set up 12 local offices in main transportation nodes to help Ohio soldiers moving back and forth.[15] The U.S. Army learned many lessons and in 1886, it established the Hospital Corps. The Sanitary Commission collected enormous amounts of statistical data, and opened up the problems of storing information for fast access and mechanically searching for data patterns. The pioneer was John Shaw Billings (1838-1913). A senior surgeon in the war, Billings built the Library of the Surgeon General's Office (now the National Library of Medicine, the centerpiece of modern medical information systems.[16] Billings figured out how to mechanically analyze medical and demographic data by turning it into numbers and punching onto cardboard cards as developed by his assistant Herman Hollerith, the origin of the computer punch card system that dominated statistical data manipulation until the 1970s.[17]

After 1870 the Nightingale model of professional training of nurses was widely copied. Linda Richards (1841 – 1930) studied in London and became the professionally trained American nurse. She established nursing training programs in the United States and Japan, and created the first system for keeping individual medical records for hospitalized patients.[18]

World War II[edit]

Nursing[edit]

As Campbell (1984) shows, the nursing profession was transformed by World War Two. Army and Navy nursing was highly attractive and a larger proportion of nurses volunteered for service higher than any other occupation in American society.[19][20]

The public image of the nurses was highly favorable during the war, as the simplified by such Hollywood films as "Cry 'Havoc'" which made the selfless nurses heroes under enemy fire. Some nurses were captured by the Japanese,[21] but in practice they were kept out of harm's way, with the great majority stationed on the home front. The medical services were large operations, with over 600,000 soldiers, and ten enlisted men for every nurse. Nearly all the doctors were men, with women doctors allowed only to examine the WAC.[22]

Notes[edit]

  1. ^ Salvaggio, John. New Orleans' Charity Hospital: A Story of Physicians, Politics, and Poverty. 1992. Baton Rouge, Louisiana: LSU Press. p. 7-8.
  2. ^ ibid., p. 11
  3. ^ Genevieve Miller, "A Physician in 1776," Clio Medica, Oct 1976, Vol. 11 Issue 3, pp 135-146
  4. ^ Jacob Ernest Cooke, ed. Encyclopedia of the North American colonies (3 vol 1992) 1:214
  5. ^ "Changing the Face of Medicine | Dr. Emily Blackwell". Nlm.nih.gov. Retrieved June 29, 2011. 
  6. ^ Regina Morantz, "Feminism, Professionalism and Germs: The Thought of Mary Putnam Jacobi and Elizabeth Blackwell," American Quarterly (1982) 34:461-478. in JSTOR
  7. ^ Kathleen Schmeling, "Missionaries of Health: Detroit's Harper Hospital School of Nursing, Michigan History (2002) 86#1 pp 28-38.
  8. ^ Bernadette McCauley, Who Shall Take Care of Our Sick?: Roman Catholic Sisters and the Development of Catholic Hospitals in New York City (2005) except and text search
  9. ^ George Worthington Adams, Doctors in Blue: The Medical History of the Union Army in the Civil War (1996), excerpt and text search; Glenna R. Schroeder-Lein, The Encyclopedia of Civil War Medicine (2012) excerpt and text search.
  10. ^ H.H. Cunningham, Doctors in Gray: The Confederate Medical Service (1993) excerpt and text search
  11. ^ Kenneth Link, "Potomac Fever: The Hazards of Camp Life," Vermont History, (1983) 51#2 pp 69-88
  12. ^ Mary C. Gillett, The Army Medical Department, 1818-1865 (1987)
  13. ^ William Quentin Maxwell, Lincoln's Fifth Wheel: The Political History of the U.S. Sanitary Commission (1956)
  14. ^ Justin Martin, Genius of Place: The Life of Frederick Law Olmsted (2011) pp 178-230
  15. ^ Eugene E. Roseboom, The Civil War Era, 1850-1873 (1944) p 396
  16. ^ He also built the New York Public Library
  17. ^ James H. Cassedy, "Numbering the North's Medical Events: Humanitarianism and Science in Civil War Statistics," Bulletin of the History of Medicine, (1992) 66#2 pp 210-233
  18. ^ Mary Ellen Doona, "Linda Richards and Nursing in Japan, 1885-1890," Nursing History Review (1996) Vol. 4, p99-128
  19. ^ D'Ann Campbell, Women at War with America: Private Lives in a Patriotic Era (1984) ch 2
  20. ^ Philip A. Kalisch and Beatrice J. Kalisch, American Nursing: A History (4th ed. 2003)
  21. ^ Elizabeth Norman, We Band of Angels: The Untold Story of American Nurses Trapped on Bataan by the Japanese (1999)
  22. ^ Campbell, Women at War with America (1984) ch 2

Bibliography[edit]

Surveys[edit]

  • Beecher, Henry K., and Mark D. Altschule. Medicine at Harvard: The First 300 Years (1977)
  • Duffy, John. From Humors to Medical Science: A History of American Medicine (2nd ed. 1993)
  • Duffy, John. The Sanitarians: A History of American Public Health (1990)
  • Grob, Gerald M. The Deadly Truth: A History of Disease in America (2002) online
  • Kalisch, Philip A., and Beatrice J. Kalisch. American Nursing: A History (4th ed. 2003)
  • Leavitt, Judith W.. and Ronald L. Numbers, eds. Sickness and Health in America: Readings in the History of Medicine and Public Health (3rd ed 1997)
  • Reverby, Susan, and David Rosner, eds. Health Care in America: Essays in Social History (1979)
  • Shryock, Richard H. "The American Physician in 1846 and in 1946: A Study in Professional Contrasts," Journal of the American Medical Association 134:417-424, 1947.
  • Shryock, Richard H. "The Significance of Medicine in American History." The American Historical Review, Vol. 62, No. 1 (Oct., 1956), pp. 81-91 in JSTOR
  • Stevens, Rosemary A., Charles E. Rosenberg, and Lawton R. Burns. History And Health Policy in the United States: Putting the Past Back in (2006) excerpt and text search
  • Warner, John Harley, ed. Major Problems in the History of American Medicine and Public Health: Documents and Essays (2000)

To 1910[edit]

  • Bonner, Thomas Neville. Becoming a Physician: Medical Education in Great Britain, France, Germany, and the United States, 1750–1945 (1995)
  • Byrd, W. Michael and Linda A. Clayton. An American Health Dilemma, V.1: A Medical History of African Americans and the Problem of Race, Beginnings to 1900 - Vol. 1 (2000) online edition
  • Fett, Sharla M. Working Cures: Healing, Health, and Power on Southern Slave Plantations. (2002)
  • Flexner, Simon, and James Thomas Flexner. William Henry Welch and the Heroic Age of American Medicine (1941).
  • Haller Jr.; John S. Medical Protestants: The Eclectics in American Medicine, 1825-1939 (1994) online edition
  • Ludmerer, Kenneth M. Learning to Heal: The Development of American Medical Education (1985).
  • Ludmerer, Kenneth M. "The Rise of the Teaching Hospital in America," Journal of the History of Medicine and Allied Sciences 38:389-414, 1983.
  • Packard, Francis R. A History of Medicine in the United States (1931)
  • Parmet, Wendy E. "Health Care and the Constitution: Public Health and the Role of the State in the Framing Era," 20 Hastings Constitutional Law Quarterly 267-335, 285-302 (Winter, 1992) online version
  • Rosenberg, Charles E. The Cholera Years: The United States in 1832, 1849, and 1866. (2nd ed 1987)
  • Rosenberg, Charles E. The Care of Strangers: The Rise of America's Hospital System (1987)
  • Rosenkrantz, Barbara G. Public Health and the State: Changing Views in Massachusetts, 1842–1936 (1972).
  • Rosner, David A Once Charitable Enterprise: Hospitals and Health Care in Brooklyn and New York 1885-1915 (1982).
  • Vogel. Morris J. The Invention of the Modern Hospital: Boston, 1870-1930 (1980)
  • Young. James Harvey. "American Medical Quackery in the Age of the Common Man." The Mississippi Valley Historical Review, Vol. 47, No. 4 (Mar., 1961), pp. 579-593 in JSTOR

Civil War era[edit]

  • Adams, George Worthington. Doctors in Blue: The Medical History of the Union Army in the Civil War. (1952)
  • Bell, Andrew McIlwaine. Mosquito Soldiers: Malaria, Yellow Fever, and the Course of the Civil War. (2010)
  • Cunningham, H. H. Doctors in Gray: The Confederate Medical Service. (1958) online edition
  • Flannery, Michael A. Civil War Pharmacy: A History of Drugs, Drug Supply and Provision, and Therapeutics for the Union and Confederacy. (London: Pharmaceutical Press, 2004)
  • Freemon, Frank R. Gangrene and Glory: Medical Care during the American Civil War. (1998)
  • Green, Carol C. Chimborazo: The Confederacy's Largest Hospital. (2004)
  • Grzyb, Frank L. Rhode Island’s Civil War Hospital: Life and Death at Portsmouth Grove, 1862–1865. (2012)
  • Humphreys, Margaret. Marrow of Tragedy: The Health Crisis of the American Civil War (Johns Hopkins University Press; 2013) 400 pages; argues that care early in the conflict was better than has been portrayed.
  • Lande, R. Gregory. Madness, Malingering, and Malfeasance: The Transformation of Psychiatry and the Law in the Civil War Era. (2003).
  • Robertson, James I (ed). The Medical and Surgical History of the War of the Rebellion. Broadfoot Publishing Co, 1990-1992 reprint (7 volumes); primary sources
  • Rutkow, Ira M. Bleeding Blue and Gray: Civil War Surgery and the Evolution of American Medicine. (2005)
  • Schmidt, James M. and Guy R. Hasegawa, eds. Years of Change and Suffering: Modern Perspectives on Civil War Medicine. (2009).
  • Schroeder–Lein, Glenna R. The Encyclopedia of Civil War Medicine (2012)
  • Schultz, Jane E. Women at the Front: Hospital Workers in Civil War America. Chapel Hill, North Carolina: University of North Carolina Press, 2004.

Since 1910[edit]

  • Brown, E. Richard. Rockefeller Medicine Men: Medicine and Capitalism in America (1979).
  • Harvey, A. McGehee. Science at the Bedside: Clinical Research in American Medicine, 1905-1945 (1981).
  • Liebenau, Jonathan. Medical Science and Medical Industry: The Formation of the American Pharmaceutical Industry (1987)
  • Ludmerer, Kenneth M. Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care. (1999) online edition
  • Maulitz, Russell C., and Diana E. Long, eds. Grand Rounds: One Hundred Years of Internal Medicine (1988)
  • Rothstein, William G. American Medical Schools and the Practice of Medicine (1987)
  • Starr, Paul. The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry (1982)
  • Stevens, Rosemary. American Medicine and the Public Interest (1971) covers 1900-1970
  • Stevens, Rosemary et al. eds. History and Health Policy in the United States: Putting the Past Back In (Rutgers University Press, 2006) online

Primary sources[edit]

  • Warner, John Harley, and Janet A. Tighe, eds. Major Problems in the History of American Medicine and Public Health (2006), 560pp; readings in primary and secondary sources excerpt and text search

See also[edit]