Doctors and Medicine in the Early 1800s

There’s a line from an old folk song, “I would not marry a doctor, they’re always killing the sick.” In 19th-century America, many people feared doctors and the medicines and treatments they used – or, you might say, inflicted – on their patients.

It was a time when dangerous diseases stalked the land, including smallpox, cholera, typhus, dysentery, yellow fever, scarlet fever, syphilis, measles, malaria, diphtheria, consumption (tuberculosis), influenza, and many more. In my first mystery, A Stranger Here Below, my main characters Gideon and True Stoltz survive a bout with influenza. Their infant son does not.

A young woman when healthy, and four hours before her death from cholera, circa 1831. Courtesy Wellecome Collection.

In the early 1800s, one in five children died before their first birthday. Most families lost at least one child to a diarrheal or respiratory illness. In New England in 1850, about 13 percent of children who reached age one perished before age five. Child mortality was worse the farther south and west you went. 

Overall, life expectancy in the 1830s was around 45 years. Epidemics of cholera, a bacterial disease, killed thousands, as did yellow fever, a mosquito-borne viral malady.

Surgery was rare. If someone developed appendicitis – called peritonitis back then – they were simply allowed to die. If they suffered a compound fracture, they had a fifty-fifty chance of surviving. Wounds were allowed to fester; “laudable pus,” or pus discharged freely from an injury, was thought to drain unhealthy “humors” from the body.

To balance the body’s humors, physicians used harsh drugs to induce vomiting, diarrhea, or sweating. A favorite was calomel, a mercury compound that brought on extreme cramping and diarrhea. Doctors treated a host of illnesses with calomel, including dysentery, a bacterial infection of the bowels; worsening the diarrhea that accompanied dysentery heightened dehydration, sometimes killing the patient. Calomel-caused mercury poisoning could result in teeth falling out, gangrene of the mouth, and death.

No one knew about bacteria, viruses, or parasites. The “germ theory of disease” wouldn’t gain acceptance until late in the century. People believed they got sick from inhaling miasmas, foul vapors that rose from swamps and rotting vegetation.

A person’s “constitution” referred to their body’s ability to resist disease. You could weaken your constitution by drinking alcohol, working in a stinking place like a tannery, living in a slum, or engaging in immoral practices such as fornication or masturbation. Longevity depended on “right living.” Some called disease “God’s flail,” brought down mercilessly upon sinners.

Because doctors thought of the human body as a collection of parts intimately connected to one another, they often prescribed treatments that targeted the entire body. They believed that balancing the body’s inputs and outputs helped maintain or restore health.

One popular practice was “bleeding.” A doctor would siphon off blood by opening a vein, usually in the patient’s arm, or by applying blood-sucking leeches to various body parts. (Doctors themselves were sometimes called “leeches.”) Draining excess blood caused the force of an illness to leave the body – like steam escaping through slits cut into a pie’s crust before it goes in the oven. Some people had their blood drawn regularly; they considered bloodletting pleasurable and believed it sharpened the intellect and warded off illness.

In “blistering,” doctors applied hot plasters or heated iron to the skin, raising blisters that were then punctured and drained. Gout, fevers, hysteria, and inflammation were treated using this technique.

Medical schools were few and rudimentary, and it was rare for a doctor to possess a medical degree. Almost all doctors were male, sometimes scorned for being “too stupid for the bar and too immoral for the pulpit.” Most began by apprenticing to another doctor, watching him treat patients and reading whatever medical books he might own. (Assuming they could read.) Or they just hung out a shingle. Few made their entire living from medicine. They might supplement their income by farming, running an apothecary, or treating horses and cows.

They charged a lot for their services, vile and violent though they might be. Some billed twenty-five cents a mile to travel to a patient. To avoid paying a doctor, or out of fear of what he might do, families consulted medical guides, diagnosed their own illnesses, and bought drugs (including many quack nostrums) from pharmacies or used herbal medicines made from plants gathered in nature or cultivated in gardens.

Many home remedies came from American Indian cultures. People also prayed to stay healthy, prayed even harder to get well when they got sick, and consoled themselves with the notion of a disease- and pain-free afterlife.

In my second mystery, Nighthawk’s Wing, Gideon suffers lingering effects from a concussion. He’s loath to go to Adamant’s doctor (also the county coroner), since “Doc Beecham would bleed him or burn him or dose him with some vile potion that would make him gag and puke.”

Instead, he turns to his wife, True, taught by her wise old grandmother to treat illnesses and injuries using wild plants. True prepares poultices and brews medicinal teas. She even stitches up a bad cut in Gideon’s face (in the third, not-yet-published mystery in the series), first washing her hands, soaking the thread in whiskey, and sterilizing her needle by holding its tip in the fire.

In the Jacksonian Era, surgeons often used spit to help get thread through the eye of a suturing needle. There are accounts of medical men sharpening their scalpels by scraping them on their boot heels. Hand-washing didn’t become a common practice for doctors until the 1850s.

Such doctors were good at “killing the sick.” Thanks to her gram, True is smarter than that.

(To learn more, read Health and Wellness in 19th-Century America, by John C. Waller; Dr. Műtter’s Marvels, by Cristin O’Keefe Aptowicz; and The Sick Rose: Disease and the Art of Medical Illustration, by Richard Barnett.)