During the late 1800s, many advances in medical knowledge and technology resulted in dramatic changes to many areas of the profession. The two major advances were the acceptance of the germ theory of disease and the use of anesthesia during surgery. These two discoveries, in combination with continued research of the human body and the development of specialized tools, led to major transformations in our concepts of illness, methods of treatment, and hygienic practices at the turn of the 20th century.
Medical practice during most of the 19th century was carried out in private homes or occasionally in a private doctor’s office. During the Industrial Revolution, hospitals in large cities had a reputation for being dirty. Many people contracted diseases from staying in the hospital because doctors did not know how disease spread. Therefore, those that could afford it called a doctor to their homes. Doctors usually worked in a wide geographic area, and were expected to treat everything from toothaches to stomach aches, fevers, and sick livestock. As the century progressed, knowledge of specific parts of the body increased, specialized tools and procedures were developed, and gradually, doctors became specialized in broad areas of medicine.
In the 1800s, most doctors traveled by foot or horseback to patients’ homes. In this practice, a physician was limited in the number of tools and drugs he could use to those items that could fit in a hand-held case or saddlebags. It is understandable that the quality of care might be poor due to the combination of limited tools and the expectation of the doctor to treat a wide variety of aliments. Examinations and treatment were also done in a patient’s home. Examinations could include general observation of the patient’s body, the use of a stethoscope to the chest, lungs, and digestive track, or the analysis of blood or urine. A popular treatment was bleeding. There were many ways to bleed a patient and it was often done repeatedly over a short period of time. A single blood-letting could consist of 12 ounces, which is about 6% of an adults total volume of blood. (See a video about bleed tools here.) Other principle treatments included specific diet instructions, rest, baths, massage, blistering specific areas of the body, sweating, enemas, purging through use of diuretics and emetics like ipecac, and prescriptions such as anti-inflammation creams or herbal pills.
Surgery could also be carried out in a patient’s home. Anesthesia was not widely used until the end of the century, so most surgeries were limited to surface areas of the body and a patient’s tolerance of pain. Early anesthesia consisted ether or chloroform, and carried some risk of asphyxiation. An additional risk in this type of surgical setting is infection. In the United States, anti-septic was not common until the turn of the century, so the risk of infection from any surgery was high.
Like today, 19th century doctors usually charged their patients per procedure. They may have charged more for emergency evening visits or charged less for the treatment of a child. One major difference from doctors of today is that 19th century doctors were not often paid with cash, but rather “in kind” with whatever produce, services, or goods were available to the patient. This was especially true for rural or frontier doctors.
Find out about 20th century doctors, dentists, and surgeons by clicking on the “Doctors and Dentists Offices” link under the Exhibits tab.