Medical America in the Nineteenth Century: Readings from the Literature

Introduction

INTRODUCTION Many towns at the beginning of the nineteenth century cared for their sick poor in small infirmaries attached to the local almshouse. Needless to say, the medical and nursing care dispensed in these institutions was usually inadequate. This, coupled with the often squalid conditions under which patients were kept, soon became one of the issues in a general humanitarian crusade of the midcentury years. A safe generalization is that hospitals were founded for a variety of reasons beside their principal function of caring for sick and injured patients. They were the objects of charity, Christian and otherwise; they became, in the later nineteenth century, centers for specialized varieties of diseases and treatments; and finally, hospitals were important as centers for medical research and the training of medical students. As early as 1769, Samuel Bard of New York remarked that "the nature of diseases, and the practice of medicine cannot be taught but in a public hospital." As more and more American physicians returned from study trips in England, and particularly in France, they brought back the conviction that medical research and education was properly placed in large hospitals. The examples of Laennec and Louis in Paris influenced the thinking of many of their American students.1 The average nineteenth-century physician, practicing before about 1885, probably did not have much direct contact with hospitals or their problems. The modern hospital as the primary center for dispensation of medical care is a much more recent phenomenon. In 1873 one survey revealed only 178 hospitals in the United States. Thirty-two were established between 1826 and 1850 and thirtynine more between 1851 and 1860. The greatest rise in the number of hospitals occurred in the twentieth century and was related to increasing urbanization and 1 See Erwin H. Ackerknecht's comprehensive book, Medicine at the Paris Hospital, 1794-1848 (Baltimore:The Johns HopkinsPress, 1967); and the charmingessay by William Osier, "The influence of Louis on American medicine," Johns Hopkins Hosp. Bull 8 (1897): 161-67, reprinted in An Alabama Student (New York: Oxford University Press, 1908), pp. 189-210. 233 234 HOSPITALS to those technical advances in surgery, radiology, and laboratory diagnosis, that make the hospitals the essential centers of medical practice.2 There is an interesting, and fairly obvious, relationship between surgeons, hospitals, and hygiene. A number of leading surgeons, such as Stephen Smith and Willard Parker in this country and John Simon in England, were sanitarians of note. The surgeons were also the logical ones to be interested in proper hygiene and design of hospitals, and some of the large surgical texts contained chapters on hospital construction.3 W. Gill Wylie, in discussing the history of hospitals in 1876, specifically pointed to the fact that some of the professors of hygiene and surgery take up the construction of hospitals as a part of their course for students. Under the rubric hospitalism, a term introduced in 1869 by James Y. Simpson in England, surgeons discussed erysipelas, septicemia, pyemia, and hospital gangrene.4 But more than widespread post-operative infection was at issue for those who strove for hospital reform. In the early 1860's a large city hospital such as Bellevue in New York was usually over-crowded and grossly unclean. A sensational case in the spring of 1860 served to focus renewed attention on the conditions at Bellevue. A young Irish woman gave birth on a Sunday night. The following morning the infant was found dead next to the mother, who had been too weak to prevent rats from devouring the baby's nose, upper lip, toes, and half of the left foot.5 The introduction of anesthesia was of great importance in changing the primary locus of surgical operations from the kitchen table to the hospital operating room. Yet Simpson, and others too, could easily show that amputations performed in large city hospitals resulted in a much higher mortality than those done in the relative isolation of the country surgeon's practice. Although advance was made in surgical technique, much went for naught, because the crowdJoseph M. Toner, "Statistics of hospitals in the United States, 1872-1873," Trans. AMA. 24 (1873): 314-33; E. H. L. Corwin, The American Hospital (New York: Commonwealth Fund, 1946), p. 6. 3 E.g., J. R. Martin, "On Hospitals," in A System of Surgery, T. Holmes, ed., 4 vols. (London: Parker, 1860-64) 4: 983-1037. James Y. Simpson, Hospitalism, Its Effects on the Results of Surgical Operations, etc., Edinburgh: Oliver and...