“All doctors have to put on a bold front. […] I am not ashamed to confess that I do not know it all. Probably never will. I do try to use the best things and methods that rational science has to officer. All medicine has much yet to learn.”
So writes Dr. Amos Betterman in his diary on March 20, 1868. Betterman was a “country doctor” practicing somewhere in northeast Ohio during a time period of much change in the medical profession. He began his medical training by “reading medicine” with a practicing doctor for 3 years. He prepared “simples” [common medication] for the doctor (since there was probably not a pharmacy nearby) and assisted him in procedures, often holding limbs while the doctor did the operation. In this time period, he remembered one routine job where they opened an abscess for a farmer at his kitchen table. The doctor had cleaned and sharped his lancet with the leather at the top of his boot and they had washed their hands AFTER the procedure. They had applied a flaxseed poultice to the wound, which was made with cotton that had been pulled from an old quilt. Betterman’s only formal training was the 2 courses of lectures he attended that were given by doctors. This was a very common way to become a doctor in the mid-1800s in America.
Dr. Betterman then began his own medical practice as a country doctor. In 1873 Betterman briefly discussed the difference between country doctors and “hospital work.” In his words a country doctor was “very cautious not to do harm.” Their main jobs were to fix broken bones, cuts, wounds, acute sickness, and attend child births. Hospital work, to him, seemed to be mostly surgery and perhaps trying new and risky treatments.
In his diary, Dr. Betterman talked candidly about the hardships of working in a rural setting- the difficult traveling conditions due to the weather and poor roads, trouble collecting bills, and the isolation he felt since it was difficult to keep up with medical news. It was hard work and long hours considering the time it took for him to travel to each patient, prepare his own medicines (sometimes gathering, drying or distilling particular ingredients), and making repeat visits. There are few other physicians nearby, so he wrote letters to other doctors if he needed another opinion on a case. He had only a few instruments, so he often improvised with the basic tools he had.
“It seems to me the psychologic side of my work is half the battle. If I can get people’s confidence, my medicine works better.”
As Dr. Betterman settled into his practice, he began to notice the significant changes occuring in the profession around him. In the 1870s, specialists were starting to emerge in Europe. These physicians had additional training in particular areas of medicine and could demand higher fees for less work. They were mostly seen in bigger cities. Over the next 20 years, American doctors would start traveling to Europe to become specialists as well.
By the 1890s, Dr. Betterman noted the increased use of laboratory tests to diagnose illnesses. Microscopy, blood examination, and urinalysis were becoming more popular. Although he was fascinated with the process and results of the new science, he also worried that physicians were losing touch with the human side of medicine and the importance of viewing each case in context of the particular patient. There was also a new drug store in his town, so the doctor was no longer making his own medicine, but using pre-made tablets. He found that his patients are “willing to pay quite well for my office treatments,” so he was traveling less and using his home office more- so much more that he planned to build a bigger office that had more space for the new diagnostic equipment that was now available.
Medical education had also undergone a big change since Dr. Betterman had “read medicine.” Betterman’s son was training to become a doctor at the University. His studies probably included much more science and anatomy work than his father had done. Admission and graduation standards were also tightening in American medical schools. It is also telling of the great change in medicine at this time that Dr. Betterman advised his son to take an internship and find work in a hospital rather than become a country doctor.
Dr. Betterman’s story has a happy ending. His new office building (built in 1894 with about 4 rooms) became the 50-bed community hospital by 1909. It had a staff of about 50 cooperating doctors, plus nurses and assistants. It attracted patients from the surrounding 50 miles, since there were no other big cities. The success of the hospital required the town to build a hotel and more restaurants. It was a great change for the small town and in many ways brought modern medicine to the residents there.