The practice of medicine was not always the respected and trusted profession that it is today. In fact, much of what took place prior to and even during the 19th century was that of unproven, ineffective, or even fraudulent medical practice, often referred to derogatorily as “quackery.” The turning point for medicine as a legitimate science or “scientific medicine” only took place through the revolutionary advancements by European scientists and physicians in the 19th century and beyond. This century of medical revolution took place due to two concurrent advancements:
1) A growth in medical theory, improvements in chemistry and laboratory techniques and equipment, and the expansion of knowledge that eventually furthered the profession; and
2) Overall improvements in the daily practice of medicine in the field, particularly in terms of the replacement of the old ideas of infectious disease epidemiology with the sciences of bacteriology and virology.
Health science encompasses a broad spectrum of medical, health, diet, and fitness sciences which when viewed as an entire whole are very holistic. The broadness of this field often makes it a difficult subject area to teach and learn. As a result, an excellent starting place to teach and learn the subject of health science is to first obtain a background in the history of medicine and medical practice.
In an ongoing effort to provide the best healthcare resources, compiled below is a study guide to the historical aspects of healthcare as well as references and related links. This resource is meant to provide students, teachers, and healthcare history enthusiasts in general with valuable research information.
Scientific Medicine, Alternative Medicine, and Quackery
It is worth noting that, during the 19th century the theoretical side of medicine was termed “scientific medicine” while the daily practice of medicine within society could be more accurately described as the less scientific and more non-traditional “alternative medicine” such as homeopathy or, in severe cases of malpractice and fraud, as “quackery.” Supposed medical practices of the 19th century included Thomsonianism, phrenology (skull morphology), mesmerism, electropathy, and hydropathy. While some were readily accepted while others were not, over time the different practices adopted each other’s traits in order to reduce confusion and gain overall acceptance of the general public.
Scientific Revolution vs. Romanticism in America
The scientific revolution, although rapid in terms of the entire history of humanity, was slow to unfold. This slowness was due to both the medical conservatism in Europe at the time, in which new breakthroughs in pre-existing science were resisted with suspicion, as well as the American Romanticism philosophical movement. In revolt to the Age of Reason, Romanticism arrived in America from Europe between 1812 and 1861. Romanticism emphasized sensitivity, feelings, and the supernatural over the rational empirical thought. In America, Romanticism mixed with the Jacksonian democracy of the 1820s and 1830s, which resulted in religious evangelicalism unique to the United States. The result was an egalitarian America that viewed professions that were traditionally based on class, such as doctors, lawyers, and politicians, with great disdain, distrust, and overall repulsion. In an effort to level the playing field for all, professions that formerly required a professional license were now open to all to practice. This view, when combined with the removal of professional standards of practice, led the people of the U.S. to alternative medicine and even quackery. The corresponding birth of the patent of “medicines” in the United States also took place during this time. Many of these “medicines” were in reality nothing more than alcohol laced with other drugs and botanicals.
Improved Drugs, Research, and Techniques
At the beginning of this century, scientific medicine consisted of heroic medicine: all diseases were believed to be the result of fluid excess, with the cure of purging, vomiting, bleeding, and blistering prescribed in order to restore the natural balance of a given individual. During this time, surgery was always a last resort, as it was extremely painful and often deadly: the only available early anesthetics were opium and alcohol. By the 1840s, drugs such as chloroform, nitrous oxide, and ether began to be used by high society as social drugs – drugs that were eventually used in surgery. With the introduction of anesthetics, the often extremely intense pain of surgery was removed. This pain-free state allowed for longer and more complex operations.
In addition, U.S. physicians were also expanding their medical knowledge during this time period, stressing the study and determination of a diagnosis over the indiscriminate procedures involved with heroics. Three U.S. doctors encouraged this shift in medical thought and practice early on. The first doctor, Dr. Daniel Drake, attempted to standardize medical practice in 1819 when he founded the Medical College of Ohio in Cincinnati. The second doctor, a U.S. Army doctor by the name of Dr. William Beaumont, took advantage of a tragic situation to study the structure and function of the digestive system: he studied the stomach wound of a military patient. This wound would not heal, so Beaumont studied the workings of the stomach through this opening and in 1833 was able to publish a work on the chemistry of digestion entitled Experiments and Observations on the Gastric Juice and Physiology of Digestion. The third doctor, Dr. Samuel Gross, lectured at the Jefferson Medical College in Philadelphia, specifically on improved surgical techniques, from his book entitled A System of Surgery; Pathological, Diagnostic, Therapeutic, and Operative.
Sanitation and Subsequent Cures
Although the improvement of medical drugs, research and techniques improved the practice of medicine during the 19th century, by far the most basic and greatest medical advancement of this century was that of the realization of the benefits of sanitation. For example, in 1847, Hungarian physician Ignaz Semmelweis (1818–1865) suggested that physicians should be required to clean their hands before assisting women with their childbirths. Yet, due to the skepticism of the time, the discovery of Semmelweis was not widely accepted by his peers until nearly twenty years later, with the discoveries of Joseph Lister, a British surgeon who proved the principles of antisepsis with regards to wound treatments in 1865. Further, the discoveries made by French chemist and microbiologist Louis Pasteur (1822-1895), who invented pasteurization with French physiologist Claude Bernard (1813-1878), that linked microorganisms with disease, supported the work of Semmelweis and further revolutionized medicine with the confirmation of germ theory. Semmelweis’ sanitation suggestion, which predated the germ theory of disease, eventually became a requirement that resulted in a dramatic decrease in the number of women who died from child bed (puerperal) fever as a result of a recent childbirth. By the 1880s, U.S. surgeon Dr. William Mayo began practicing antiseptic surgery. Also in this century was the development of cures for some endemic infectious diseases began to take place, for the most part, a decline in the most lethal of the diseases was due more to improvements in sanitation, public health, and nutrition than to actual medicine.
Scientific Method, Disease Identification, & Genetics
It was Claude Bernard who set the foundation for the establishment of the scientific method in medicine. In 1865 he published An Introduction to the Study of Experimental Medicine. However, it would not be until the following century that the application of the scientific method to medical research would produce numerous key developments in medicine, including great advances in pharmacology and surgery.
In terms of disease identification, Pasteur and Prussian physician Robert Koch (1843-1910) – the latter of whom was awarded the Nobel Prize in 1905 – together founded the science of bacteriology, which later on would be grouped with other scientific branches such as mycology, parasitology, and virology under the more broad science categorization of microbiology. Koch was also famous for the discovery of the tubercle bacillus in 1882 as well as the discovery of the cholera bacillus one year later. In 1884, with German bacteriologist Friedrich Loeffler (1852-1915), Koch developed the four criteria designed to establish a causal link between a given causative microbe and a disease, which came to be called Koch’s postulates.
The second half of the 19th century was also a time for genetic discoveries. In 1859 English naturalist Charles Darwin (1809-1882) published The Origin of Species. Just a few years later, in 1865, Austrian Augustinian monk and scientist Gregor Mendel (1822–1884) published his books on pea plants and heredity, which would later become known as Mendel’s laws and the foundation of genetics, along with the controversial and later rejected eugenics movement.
Women and Medicine
The 19th century leader of women in medicine was British nurse, writer, and statistician Florence Nightingale (1820-1910). Nightingale, who became known as “the Lady with the Lamp” for her night visits to her patients, showed the then male dominated profession that hygiene and nutrition were the critical keys to the reduction of patient mortality. In 1859, Nightingale published Notes on Nursing, which became required reading for all nursing students. In 1860, Nightingale set up the St Thomas’ Hospital, the first secular nursing school, with English physician Elizabeth Blackwell (1821–1910) and became the first woman to formally study, and subsequently practice, medicine in the United States, during a time when the a master-apprentice model of instruction was common. By 1861, a professional nursing school was established within the United States in New York City and others soon followed throughout the nation, both during and after the American Civil War, when the need for hospitals skyrocketed.
The Role of the Church, Science, and Psychiatry
During the 19th century and early 20th century, medicine was closely related to the church, both within the United States and throughout Europe. However, technology and science soon replaced any religious authority. Mental health research began with the mentally ill in the lunatic asylums of the 18th and 19th centuries, which led to the recognition of the science of psychiatry. German psychiatrist Emil Kraepelin (1856-1926) is deemed to be the founder of modern scientific psychiatry. In the United States, it was not until after the Civil War and really not until the end of the 19th century that scientific medical advances began to catch up with the needs of society. For example, the casualties of the American Civil War, its hospitals, and the new bacteriology theories gradually resulted in critical changes in the medical practice and profession, which eventually led to today’s cutting-edge U.S. medical and pharmaceutical industries.
Online References and Additional Resources