The Inevitable Hour: A History of Caring for Dying Patients in America

2 Medical Professionals (Sometimes) Step In

Medicine played a relatively minor role in nineteenth-century death and dying. Tuberculosis aside, most deaths arrived swiftly and suddenly, from accidents and especially from acute, infectious diseases, often before doctors arrived. The American Medical Association urged physicians not to abandon patients whose lives slowly ebbed from chronic, incurable disorders, but many continued to do so. Only the rare family could afford to hire a nurse. And the few hospitals that existed tried to keep mortality rates low, primarily by excluding patients believed most likely to die. Doctors The writings of family members and friends focus on the care they personally delivered to the dying. Some mention doctors, but many others explain why they had not obtained medical assistance. Some families simply could not afford a physician’s fees. Without telephones or automobiles, the task of summoning doctors often involved time and effort that could not be spared in emergencies. In a small Oregon town in 1877, when Henry Guernsey’s son Roy seemed to be choking, Henry tried to find someone to “go after the Dr.” Because no one was available, Henry “had to take a small boat and go over alone and . . . found it a pretty hard task.” As he wrote to his mother, he rowed eight miles “against the tide” to reach a doctor across the bay. When some travelers reached their destinations, they found that the doctor was away, often visiting other patients. Emily Hawley, the daughter of Michigan farmers , wrote in her journal that when her sister was very sick and the family “quite afraid,” her brother Henry went to get Dr. Chappell. Dr. Chappell, however, was gone, and the physician Henry next tried could not come until the next day. In many cases, doctors arrived after patients had died. After noting the various people who visited her neighbor Mrs. Archdale during the hours before her death in Arkansas, Nannie Jackson commented, “The Doctor never did come.” Recallc h a p t e r 2 Medical Professionals (Sometimes) Step In Medical Professionals (Sometimes) Step In 23 ing his life as a cattleman in southeast New Mexico in the 1880s, William G. Urton told an interviewer, “One could die or get well before a physician could attend any sickness on the ranch.” Skepticism about physicians further deterred many people from relying on them. Children’s illnesses frequently caused the greatest alarm, but they were especially likely to reveal the limits of doctors’ knowledge. Many physicians did not bother to learn about children’s health, assuming that mothers were competent to treat their own offspring. In 1840, Rachel Simmons beseeched her mother to come and help care for a sick baby. Although a Dr. Thompson had visited and given her calomel, he “did not think he could do much for a child so young.” Maria D. Brown decided to avoid physicians whenever possible after her daughter died of diphtheria in Iowa in 1862. As Maria later told her daughter-in-law, “With any fair treatment, she would have pulled through. But old Dr. Farnsworth gave her terrible doses of quinine and cayenne pepper. . . . After she was gone, I said to myself, ‘Never again! When the next trouble comes, it will be between me and my God. I won’t have any doctor.’” Maria soon faced a “pretty hard test”—three of her children sick with scarlet fever at one time—but remained true to her resolution. The divisions among practitioners helped to undermine confidence in their skills. Socalled regulars were challenged by groups such as the Thomsonians in the first part of the nineteenth century and by homeopaths and eclectics in the second. Physicians often blamed poor outcomes on delays in seeking medical attention, yet they were hardly immune to self-recrimination, especially for deaths that occurred early in their careers. Many physicians were painfully aware of the deficiencies of their medical educations. A large proportion of nineteenth-century medical schools were poorly funded commercial enterprises, staffed by part-time instructors; some even lacked laboratories and libraries. A 1906 survey conducted by the American Medical Association found that the quality of only half the schools could be considered acceptable. Dr. J. Marion Sims, later a famous surgeon , recalled that when he graduated from the Jefferson Medical College in Philadelphia in 1837, he “had had no clinical advantages, no hospital experience, and had seen nothing at all of sickness.” Summoned by a prominent community member to visit his very sick...