History of Medicine (United States)

The history of American Medicine has been relatively short, as compared to European Medicine, but has had a global impact despite that brevity. This article focuses on the development of the professional practice and education of physicians in the USA. It it includes some background on the popular traditions of healing arts by both the Native Americans and the early European and African immigrants, whose remedies, in part, became incorporated into medical practice. Early American Medicine was characterized not only by diverse roots, but also the important position that medical doctors held in the economy of port cities like New York, in determining the safety of allowing ships to dock and unload. In the 19th century, as compared to European countries like England and France, Medicine in the USA was largely unregulated and marked by an enormous range of practices and practitioners. The lack of standards in medical education sparked a reaction in the early 20th century by a coalition formed by philanthropists and the American Medical Association, and the requirements for obtaining a medical degree became more, rather than less, stringent than in most other western countries. The rise of technology after World War II, along with increasing financial support of medical research and education, brought the level of academic medicine in the USA to an equal or superior level with any other country in the world. Along with this success, there has been an ongoing struggle to reach provision of universal healthcare to patients, and to blend the art of medicine along with science in the education and training of physicians.

The Columbian Exchange

The "Columbian Exchange" is the term historians use for the transfer of plants, andimals and diseases between the Eastern and Western Hemispheres. In medical terms the most important pattern was the transfer of diseases into the New World, usually by sailors or explorers. Most of the impact took place before 1600.

AS the human population of North America had been separated from European, African, and Asian disease environments for over 15,000 years, there was a fundamental difference in the human infectious diseases present in the indigenous peoples and that of new arrivals. Some viruses, like smallpox, have only human hosts and appeared to have never occurred on the North American continent before the 16th and 17th centuries. This not only meant that the indigenous people lacked genetic resistance to such new infections, and suffered overwhelming mortality --often over 50% or 90%--when exposed.

but-in the port cities, especially, even the immigrant population was subject to epidemic illness when ships arrived carrying ill passengers. Since the wealth of the port was dependent on the docking of ships, but the life of the inhabitants was dependant on quarrentine of sick pasengers, there was strong financial support of public health in cities like New York.

Medicine in Colonial Era

Disease conditions

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.

In the southern colonies malaria was endemic, 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.

Practice

The first medical society was organized in Boston in 1735. Many young men went to Europe for medical training; 41 were trained at the University of Edinburgh in Scotland before 1775. 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.

Hospitals

Pest houses 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.

19th Century

The slave south

Fett (2002) argues there was a stark difference in medicine between the slave community and the white community. The slaves had a "relational vision of health" that encompassed the entire community, the land, animals, herbs and plants, and imbued all with spiritual power. They believed many illnesses were spiritual crises manifested in the body. Their "spiritually enlivened landscape" of special herbs, plants, creeks and animals held spiritual power to heal or harm, and it was the job of the black nurses, midwives, herbalists, and conjurers to do the healing. Slaves believed some illnesses were caused by conjuration and the only remedy was to go to a conjurer. By contrast the white physicians hired to care for the slaves rejected the slave outlook as superstition and instead used science to define slave "soundness" as measured by their ability to work on the plantation.

Urban conditions

Public health conditions were poor in most cities, with cholera and yellow fever epidemics a major threat. During the Civil War, about one-third of the 600,000 deaths were due to combat, and two-thirds to disease.

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:
1851 to 1970: 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: Historical Statistics of the United States" (1976) Series B148

Early modern medicine and human biology

Organizations of like-minded physicians

Association of American Physicians (AAP) developed in 1886. "At the time of the first meetings of the AAP, emerging sciences of anatomy, chemistry, germ theory, and physics had the potential to revolutionize the practice of medicine (Figure 4). Nonetheless, in the United States the practice was unscientific, anecdotal, and unregulated with MD degrees being given by more than 800 storefront medical schools."(reference for quote:Snyderman R. AAP Presidential Address: The AAP and the transformation of medicine. [Addresses. Historical Article] Journal of Clinical Investigation. 114(8):1169-73, 2004 Oct. UI: 15489965)

20th Century

Medical financing

see Medicare, Medicaid

Bibliography

Surveys

• Henry K. Beecher and Mark D. Altschule. Medicine at Harvard: The First 300 Years (1977),
• John Duffy. From Humors to Medical Science: A History of American Medicine (2nd ed. 1993)
• John Duffy. The Sanitarians: A History of American Public Health (1990)
• Judith W. Leavitt and Ronald L. Numbers, eds. Sickness and Health in America: Readings in the History of Medicine and Public Health (3rd ed 1997)
• Susan Reverby and David Rosner, eds. Health Care in America: Essays in Social History (1979)
• Richard H. Shryock, "The American Physician in 1846 and in 1946: A Study in Professional Contrasts," Journal of the American Medical Association 134:417-424, 1947.
• Richard H. Shryock. "The Significance of Medicine in American History." The American Historical Review, Vol. 62, No. 1 (Oct., 1956), pp. 81-91 in JSTOR
• John Harley Warner, ed. Major Problems in the History of American Medicine and Public Health: Documents and Essays (2000)

To 1910

• Thomas Neville Bonner, Becoming a Physician: Medical Education in Great Britain, France, Germany, and the United States, 1750–1945 (1995)
• W. Michael Byrd 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
• H. H. Cunningham; Doctors in Gray: The Confederate Medical Service. (1958) online edition
• Sharla M. Fett. Working Cures: Healing, Health, and Power on Southern Slave Plantations. (2002)
• Simon Flexner and James Thomas Flexner. William Henry Welch and the Heroic Age of American Medicine (1941).
• John S. Haller Jr.; Medical Protestants: The Eclectics in American Medicine, 1825-1939 (1994) online edition
• Kenneth M. Ludmerer. Learning to Heal: The Development of American Medical Education (1985).
• Kenneth M. Ludmerer, "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)
• Wendy E. Parmet, "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
• Charles E. Rosenberg. The Cholera Years: The United States in 1832, 1849, and 1866. (2nd ed 1987)
• Charles E. Rosenberg. The Care of Strangers: The Rise of America's Hospital System (1987)
• Barbara G. Rosenkrantz, Public Health and the State: Changing Views in Massachusetts, 1842–1936 (1972).
• David Rosner, A Once Charitable Enterprise: Hospitals and Health Care in Brooklyn and New York 1885-1915 (1982).
• Morris J. Vogel. The Invention of the Modern Hospital: Boston, 1870-1930 (1980)
• James Harvey Young. "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

Since 1910

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