Medical Care and Medical Education, 1825–1860

During the early nineteenth century, medical practice became professionalized and medical treatment standardized as medical school training became more popular and medical societies and journals were organized. Dispensary and hospital care increased with the growth in urban populations. Medical students became dissatisfied with the theoretical training in medical schools and turned to private courses from individual physicians and clinical instruction at hospitals and dispensaries. By mid-century, private instruction had become almost as important as medical school training. Because little progress occurred in medical knowledge during the first half of the nineteenth century, the quality of medical care remained low, although it became more standardized due to the greater popularity of medical school training. Diagnosis continued to be unsystematic and superficial. The physical examination consisted of observing the patient’s pulse, skin color, manner of breathing, and the appearance of the urine. Physicians attributed many diseases to heredity and often attached as much credence to the patient’s emotions and surmises as the natural history of the illness. Although the invention of the stethoscope in France in 1819 led to the use of auscultation and percussion, the new diagnostic tools contributed little to medical care in the short run because more accurate diagnoses did not lead to better treatment. Few useful drugs existed in the materia medica and they were often misused. According to Dowling, the United States Pharmacopoeia of 1820 contained only 20 active drugs, including 3 specifics: quinine for malaria, mercury for syphilis, and ipecac for amebic dysentery. Alkaloid chemistry led to the isolation of morphine from opium in 1817 and quinine from cinchona bark in 1820. Morphine was prescribed with a casual indifference to its addictive properties and quinine was widely used in nonmalarial fevers, where it was ineffective and produced dangerous side effects. Strychnine, a poisonous alkaloid isolated in 1818, was popular as a tonic for decades, and colchine, another alkaloid discovered in 1819, was widely used for gout despite its harmful side effects. Purgatives and emetics remained the most widely used drugs, although mineral drugs replaced botanical ones among physicians trained in medical schools because their actions were more drastic and immediate.