Understanding America’s Unhealthy Beginnings: 1826.

Posted on | February 6, 2023 | Comments Off on Understanding America’s Unhealthy Beginnings: 1826.

Mike Magee

Historians of 19th century America have well-documented that, as compromised as our population’s health was at the birth of our nation, it deteriorated markedly between 1830 and 1860. Those clearly at greatest risk were enslaved Blacks, forcibly relocated native Americans, and subjugated women. But entitled white male citizens also experienced significant declines in life expectancy.

Extreme levels of depravation multiplied in a nation loosely governed, expanding westward geometrically, and hampered by scientific ignorance and aggression. But one additional factor, largely ignored by most historians, that further complicated matters for early Americans, was that our nascent states oversight of their individual medical communities evaporated during this period. Leaders simply threw up their hands and gave up.

At the birth of our nation, there were fewer than 300 individuals in the 13 British colonies who had any formal education or certification as physicians. The first experimental hospitals and medical schools arrived in Philadelphia shortly before the Declaration of Independence and concentrated on housing the insane and managing primitive herbal apothecaries. The concept of a professional nursing force was still 70 years away.

Those few physicians who did exist in the various colonies had begun to organize themselves at the time of the American Revolution. This contrasted with licensure and oversight in Europe which was more “state directed.” Their motives in the American colonies, according to sociologist Tracey Adams , were to use “their influence to acquire status, and win legislation granting them the power to self-regulate.”

The medical society in Philadelphia was a tight knit club of elite European trained physicians who dreamed of bringing sophisticated medical education to the New World. In 1765, they first admitted students at the College of Philadelphia, officially launching the first medical school which would become the University of Pennsylvania in 1791. Other schools would appear, with their physician instructors collecting proprietary fees that augmented their practice incomes.

As the former colonies transformed into a loosely linked group of independent minded states, public sentiment initially supported the professionalization of their caregivers. State legislatures united around the need to respond to public appeals to address illness and injuries on the one hand, and the health professionals desire to purge themselves of unqualified practitioners on the other. With medical schools of varying quality now appearing side by side with medical societies, it was up for grabs whether degrees or licenses or both would be required to hang out a medical shingle.

But in the first few decades of the 19th century poor performance and lack of scientific acumen, as revealed initially in the response to the Yellow Fever epidemic in 1793 in Philadelphia, caught up with American medicine before it ever officially had a chance to launch.

As one historian explained, “The long political shadow of President Andrew Jackson inculcated a reverence for the wisdom of the common man and cast a skeptical eye on experts and authorities who they deemed more likely to protect their own interests than those of the average citizen. Concurrent to this anti-intellectual trend, others began to explore alternative methods for understanding the laws of nature, founding philosophies and professions that would ultimately find their place alongside mainstream medicine.”

According to Elaine Breslau, professor of History and author of Lotions, Potions, Pills, and Magic: Health Care in Early America: “After independence the character of the physician changed. They lost their special social status. Few went to Europe to study and thus they were cut off from advances on the other side of the Atlantic. Fewer still came from the educated population. Standards of medical education in this country declined dramatically. Minimally-trained doctors opened their own medical schools as moneymaking ventures encouraged by a growing commercial and acquisitive social climate.”

It was during this period, when Jackson was campaigning against “a monopoly of government by elites,” that the common adage took hold that “doctors take the fee while nature makes the cure.” Beginning in 1826 in Illinois, states began to repeal the laws they set up to sanction the unlicensed practice of medicine. By 1855, fifteen other states had followed suit establishing the young nation as a “Wild West of Medicine.”

As historians have noted, during this period “many physicians simply pursued their vocation as best they could and were generally free to ply their trade in whatever fashion they chose.” As for the patient in mid-19th century America, as historian John Heller noted, every day Americans at the time “remained indifferent to progress in pathology, new germ theories of disease, or…primitive ideas that ascribed ills to the influence of the stars, provided they were relieved of their pain and freed from the bonds of sickness.”

It took 50 years for Illinois to reverse its course and establish a Board of Medical Examiners in its state. Other states quickly followed suit. What reversed their course? As one historian suggested, “Licensing laws and state medical boards reappeared beginning in the 1870s with the ostensible intent of correcting what the hidden hand of the marketplace had failed to resolve.”