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Teaching topical history, the history of art, architecture, or medicine, is different from regular history in which you teach about the events that occurred in a set geographical location over a prescribed period of time, such as early modern Europe, North American borderlands, etc. In those courses the instructor weaves a tapestry from the events, culture, geography, and famous people within a defined time and place. Instead, with topical history, you grab a single thread from the long tapestry of history and follow it forward through different locations, different cultures, and different times, noting the changes.
I have chosen a short period on that long thread on the topic of the history of medicine, 1830-1860, the time of the Republic of Texas and early statehood; the location, the Texas frontier. I plan to discuss the practice of medicine in the days before the Civil War spurred changes that would revolutionize the field and gave rise to the medical profession we know today.
The rural population of the United States during the antebellum era had little experience with well-trained medical professionals, and those experiences were often frustrating and expensive. The public felt, quite correctly, that heroic therapy—which can be captured perfectly in the words of historian Volney Steele, "bleed, blister, and purge"—offered by many mainline physicians was detrimental to their health. The harsh life of average rural Americans included frequent episodes of trauma [End Page 133] and broken bones. Most suffered from some degree of chronic pain and arthritis. Unfortunately, contemporary physicians could do little to halt the course of most acute diseases other than comfort the family and perform an occasional surgery. Table-top surgery did not become practicable until after the Civil War. Appendicitis usually resulted in death.1
Imagine a small town in East Texas. The town is a cluster of dwellings at a crossroads or a ford on a river with a water source nearby, such as a stream or spring. The roads are terrible—mere ruts through the forest— with no pavement, no gravel, no drainage ditches. There is a small store, perhaps a blacksmith shop, a church and a school. Most of the dwellings are "dog trots," two single-room log cabins connected by a long open porch between the rooms. Perhaps a well is in front, and a kitchen is out back of the house along with a shed for the animals with their pens near the house and a privy out back—hopefully, away from the well. Behind the house is ten to fifty acres of cleared land plowed by the husband and a yoke of oxen or perhaps a mule. There is a cow and calf in the pen next to the house for milk. Also nearby is a smoke house to cure and store pork for the year and another shed for a corn crib.
Such a home would have been occupied by a family consisting of a husband and wife, with three to eight children, and perhaps a grandparent, or brother, or sister. The members of this family would have had a life expectancy of between thirty-five to fifty years. The most common causes of death, in order, were infectious diseases, trauma, and childbirth. Trauma was caused by falls, broken bones, and cuts from axes.
Sanitation was poor, and so was personal hygiene. Badly placed outhouses and animal shelters built uphill or upstream contaminated drinking water from wells and streams. Typhoid fever and diarrhea were endemic and frequent causes of death, especially in infants and small children. Half of the children would die before they reached ten years of age, primarily from infectious diseases like whooping cough, diphtheria, polio, and dysentery. Episodic epidemics such as cholera or smallpox were periodic threats. Malaria caused intermittent fevers and was a chronic and recurrent malady. Tuberculosis (TB) was a primary cause of death in urban areas and among the educated.2
A woman could expect to become pregnant about every two years...