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Scientific Medicine

Asthe 19th century began, Americans had witnessed many revolutionary changes in their lives, but medicine had not kept pace. Medical practices differed little from those of the 18th century. The foremost practitioner of the time was Benjamin Rush, a believer in the Enlightenment era's philosophy of natural law. In this rational system, the body was a machine, and all disease was one disease—an overstimulation of nerves and blood. The cure for overstimulation was "heroic" medicine: bleeding, blistering, purging, and vomiting to restore the natural balance.

Bleeding was usually the initial treatment. It consisted of venesection (opening up a vein), scarification (using a spring-loaded instrument to produce a series of small cuts), or cupping (placing a warmed glass cup over a cut which filled with blood as the pressure inside dropped). Blistering involved placing hot plasters onto the skin to raise blisters, which were then drained. The most common purgative was Calomel, a form of mercuric chloride which worked as a laxative in small doses, but usually was prescribed in large doses to purge the system.

Rush wrote extensively on heroic medicine and his work influenced many physicians who continued to practice heroic medicine despite its unpopularity with patients.

Chapter 1. Benjamin Rush's Medical Inquires and Observations.

While doctors in the U.S. relied on Rush's work, a new movement began in Paris. French doctors who caught the spirit of their country's revolution did not feel confined by the writings of the "masters," and instead observed for themselves how patients reacted to disease. Dubbed the French Clinical School, it emphasized both clinical and pathological observations to determine treatments. Doctors collected statistical evidence like temperatures and pulse rates. Diagnostics were stressed over heroics. Some 700 of the best U.S. doctors traveled to France to study between 1820 and 1860. Despite the opposition of those who returned from abroad, heroic medicine continued to be practiced and eventually the public developed a deep skepticism of doctors and an increased interest in quackery.

The United States produced some of the best surgeons, many of whom studied in France. The rigors of life on the frontier also stimulated the advancement of surgical techniques, as doctors living there often had no alternative to surgery because they lacked drugs and access to the latest medical advances.

Surgery was the last resort because it was often fatal and was always painful. Performed with no regard for cleanliness, doctors wore filthy coats—often directly from the autopsy room to the operating room—with pride. This practice spread deadly infections like septicemia or gangrene. The only anesthetics were opium and alcohol. In the 1840s, chloroform, nitrous oxide, and ether began to be used as social drugs by the upper classes, and were eventually applied to surgery. Anesthetics removed the pain of surgery, allowing for longer, more complex and delicate operations.

Three doctors who emphasized diagnostics over heroics were especially influential. Dr. Daniel Drake lived most his life on the frontier, not on the east coast where medical training was centered. Realizing that the frontier lacked adequate facilities to train doctors, he started the Medical College of Ohio in Cincinnati in 1819. He is best known for his exhaustive study, Systematic Treatise on the Principal Diseases of the Interior Valley of North America. The work not only examined disease, but detailed geography, climate, and frontier society. Dr. William Beaumont used an unusual method to study how the digestive system worked. An Army doctor at Fort Mackinac, he encountered a patient with a severe stomach wound that would not heal. Beaumont used the opening in the unfortunate victim as a window into the gastrointestinal tract, and his 1833 work Experiments and Observations on the Gastric Juice and Physiology of Digestion explained the chemical process of digestion. And the work of Dr. Samuel Gross to improve surgical techniques resulted in A System of Surgery; Pathological, Diagnostic, Therapeutic, and Operative, used by Gross in his lectures at the Jefferson Medical College in Philadelphia, and by many other medical schools.

Illustrations from William Beaumont's Experiments and Observations on the Gastric Juice and the Physiology of Digestion.

Despite these widely-recognized efforts to further the knowledge of doctors, by mid century scientific medicine took a back seat to quackery. Scientific medicine was hampered by poor training, the continued practice of heroic medicine despite patient protests, and quarreling among the brightest physicians. Proprietary medical schools and their common practice of grave robbing to obtain dissection specimens did little to improve the public's image of the medical profession.

These factors combined in the 1820s and 1830s with a wave of Jacksonian democracy, producing an egalitarian America with no use for aristocratic physicians. The public came to believe that anyone could cure the ill if they applied the common-sense principles promoted by quackery doctors. Physician licensing, once commonplace, was abolished in most states in the 1840s so anyone was free to practice. Scientific medicine was rapidly replaced by quackery such as hydropathy, patent medicines, phrenology, and mesmerism. When quackery became inextricably linked to the religious revivalism and social reform movements sweeping the country at mid century, it was unstoppable.

Alternative medical practices dominated until the end of the century. However, the overwhelming casualties of the Civil War forced the profession to systematically study the cause of disease and infection. In Europe between 1840 and 1870, studies conducted by Ingnaz Semmelweis (on the contributions of unclean procedures to "childbed fever"), John Snow (on the relation between contaminated water and the spread of cholera), Louis Pasteur (who disproved the theory of "spontaneous generation" of germs), and Joseph Lister (who advocated antiseptic surgery), served as the genesis for bacteriology. The germ theory was slow to be transmitted to the United States, however. It was not until the late 1880s that American surgeon Dr. William Mayo began practicing antiseptic surgery in his clinics in Rochester, Minnesota, and won converts among colleagues.

But these studies in the scientific basis of disease combined with improved medical education to make "scientific medicine" the predominate philosophy by the end of the century. Alternative medicine was still practiced, but was often combined with scientific medical principles.

Illustrations from Beaumont, William. Experiments and Observations on the Gastric Juice and the Physiology of Digestion. Plattsburgh: F. P. Allen, 1833. From the 1959 facsimile edition. MCO

Drake, Daniel. A Systematic Treatise, Historical, Etiological and Practical, on the Principal Diseases of the Interior Valley of North America. New York: Burt Franklin, 1971 facsimile of 1850 edition. MCO

Gross, Samuel D. A System of Surgery; Pathological, Diagnostic, Therapeutic, and Operative. Philadelphia: Henry C. Lea, 1866.

Rose, Jacob Servoss. The Reformed Practice of Medicine: Based Upon the Principles of the Chrono- Thermal System Practiced by the Celebrated Dr. Dickson of London. New York: W. H. Graham, 1845.

Rush, Benjamin. Medical Inquiries and Observations. Philadelphia: J. Conrad & Co., 1805.

Barbara Floyd, University Archivist, University of Toledo

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Last Updated: 1/3/12