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Lecture notes of 12 pages for the course BIOL373 at UW (bio notes)
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Orthodox NotesMedical Education. “Orthodox” or “regular” medical practitioners included those who had
received recognized training in an apprenticeship, medical school, or both. Medical education
was available at only a handful of institutions in the United States. The University of
Pennsylvania began offering medical degrees in 1765, but eighteenth-century Americans had
no other alternatives except apprenticeship or study in Europe, primarily Edinburgh, London, or
Paris. Harvard University offered medical lectures as early as the 1780s but did not offer full
medical degrees until 1810. Yale Medical School began offering degrees in 1818. American
medical education generally did not include laboratory science other than anatomical dissection
until midcentury. Students could acquire their degrees after as little as two sixteen-week terms,
mostly spent listening to lectures. Clinical training was not a standard part of medical education
until the late nineteenth century, but many (if not most) medical graduates supplemented their
education by apprenticing themselves to established practitioners.
Humoral Theory. The practice of medicine prior to the discovery of bacteria in the 1880s was
governed by an understanding of the body that had prevailed for two thousand years. According
to humoral theory, first articulated by the Roman physician Galen, the human body was
composed of four humors, or fluids: blood, phlegm, black bile, and yellow bile. Every individual
had his or her own unique balance of the four humors. Physicians believed that all the leading
causes of death in the antebellum period, the endemic (“ever-present”) diseases such as
tuberculosis, influenza, pneumonia, dysentery, typhus, and malaria, resulted from a single
general cause: imbalance of the humors. Such an imbalance could result from internal factors,
such as teething, puberty, menstruation, worry, or overexpenditure of energy. External factors,
such as a change in diet or exposure to miasma (bad air, foul smells, fumes), could also
provoke imbalance and lead to disease.
THE SURGEON OF THE FLEET
Cadwallader Cuticle, M.D., an Honorary Member of the most distinguished Colleges of
Surgeons both in Europe and America, was our Surgeon of the Fleet. Nor was he at all blind to
the dignity of his position; to which, indeed he was rendered peculiarly competent, if the
reputation he enjoyed was deserved. He had the name of being the foremost Surgeon in the
Navy, a gentleman of remarkable science, and a veteran practitioner.
[N]othing could exceed his coolness when actually employed in his imminent vocation.
Surrounded by moans and shrieks, by features distorted with anguish inflicted by himself, he yet
maintained a countenance almost super naturally calm; and unless the intense interest of the
operation flushed his wan face with a momentary tinge of professional enthusiasm, he toiled
away, untouched by the keenest misery coming under a fleetsurgeon’s eye. Indeed, long
habituation to the dissecting-room and the amputation-table had made him seemingly
impervious to the ordinary emotions of humanity. Yet you could not say that Cuticle was
essentially a cruel-hearted man. His apparent heartlessness must have been of a purely
scientific origin.
, But notwithstanding his marvellous indifference to the sufferings of his patients, and in spite
even of his enthusiasm in his vocation , . , Cuticle, on some occasions, would effect a certain
disrelish of his profession, and declaim against the necessity that forced a man of his humanity
to perform a surgical operation.
Source: Herman Melville, White Jacket; Or, The World in a Man-of-War (New York: Harper,
1850).
Treatment. Standard treatments for disease were driven by a desire to restore the balance of
the humors. Physicians generally saw such physical manifestations as vomiting, diarrhea, or
blood loss as signs of the body attempting to restore its own balance. The physician’s job was to
start that process or help it along. Standard treatments for most diseases therefore included
bleeding by using the lancet or leeches, purging by using emetics to induce vomiting or
diarrhea, and cupping, the application of a heated glass to the individual’s back to raise blisters
that were subsequently drained. From the late eighteenth century to the 1830s the practice of
“heroic” therapeutics prevailed. Heroic therapeutics simply meant practicing the standard
medical treatments to extremes, such as bleeding a patient until he fainted, or purging her to the
point of causing extreme weakness.
Prestige of Doctors. The practice of medicine had never been a highly regarded or remunerative
profession in the United States, but doctors experienced a dramatic decline in prestige in the
1830s. This development had at least two causes. First, the 1820s and 1830s were years of
rapid population growth, which led to increasing population density in urban areas. Endemic
diseases had long been the leading causes of death, but in an age without adequate water or
sewage systems, urban crowding resulted in major epidemics of yellow fever, typhoid fever, and
typhus that provoked waves of panic throughout the early nineteenth century. Then, in 1832, a
new and more frightening disease appeared. Cholera was a depletive disease with a high
mortality, meaning that it struck swiftly, caused massive fluid loss through diarrhea and vomiting,
and killed rapidly. A person could leave his house perfectly well in the morning and be dead by
afternoon. Traditional medical treatments were devastating under these conditions because they
exacerbated dehydration and hastened death. Doctors found themselves helpless in the face of
an epidemic with a mortality rate of more than 50 percent. People lost faith in heroic treatments
that, with epidemics raging, seemed ineffective in comparison to the amount of misery they
caused. Second, a climate of anti-authoritarianism characterized the period. Many people
viewed doctors as un-American because they monopolized information and tried to establish
standards that would lead to an exclusive profession of the educated elite. Patients began to
turn in large numbers to people who could provide gentler alternatives to traditional medicine.
American Medical Association. One of the ways that physicians responded to their declining
prestige was to form an association to try to enhance their professional status. Local and state
medical societies already existed throughout the country, but in 1847 orthodox physicians joined
forces to form the American Medical Association (AMA). The founders of the AMA had two
major goals. First, they sought to define the boundaries of legitimate medical practice by
drawing up a code of ethics that urged physicians not to consult with sectarian or other lay
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