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 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, animals 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 dependent on quarantine of sick passengers, 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. Nonetheless, in the United States the practice was unscientific, anecdotal, and unregulated with MD degrees being given by more than 800 storefront medical schools.

20th Century

Medical financing

see Medicare, Medicaid