1783-1815: Science and Medicine: Overview

Assessment . The period 1783 to 1815 was a time of few great advances in medical science in America. In many ways doctors continued the crude medical practices of the colonial period, with some indications of new thinking regarding preventive medicine, mental disease, and public sanitation. The story of American technology, on the other hand, is much more dynamic, inaugurating an era of industrial revolution, mass production (interchangeable parts), and powered transportation, as well as extraordinary progress in learning about the geography, plants, animals, and native inhabitants of a nation that would double in area during this period.

Medical Science . At the time of the American Revolution, it is estimated, there were about thirty-five hundred medical practitioners in America, only four hundred of whom had formal training. After the war American medicine became more organized, with the establishment of new hospitals and medical schools. Prior to this period there were very few American medical schools (Dr. John Morgan had established the first one in 1765 at the College of Philadelphia), and many colleges were used as barracks or hospitals during the war. The few well-trained American physicians had been educated in the great medical schools of Europe, particularly Edinburgh, Scotland. The war disrupted communications with Europe, and this was especially felt by physicians. After the war there occurred a significant increase in the number of American medical schools, as well as the formation of state medical societies which established standards for licensing of physicians. Despite these changes, conditions remained primitive, and the new medical schools continued to propound dangerously outdated theories about the causes of disease.

Theory Versus Practice . Medical “theory” was in many respects caught up in old ways: folk cures, superstitions, God’s wrath as the cause of disease (rather than germs, poor sanitation, or mosquitoes). There was often a fatalistic attitude toward illness. If disease was caused by sin, then only God’s forgiveness—not a doctor—could help the victim. Many people simply blamed the weather or heredity: nothing could be done about it. And medical theory would be hampered by the age-old question of whether disease was to be viewed as a general problem which a single theory could explain in its entirety (for example, “humors” out of balance), or whether disease was specific (for example, lesions on a particular organ indicating a localized problem or particular disease). Early American medical theory was dominated by Enlightenment thinking, which valued unified theories over experimental evidence. By the end of this period new ideas from Paris were beginning to influence American physicians. Pure theorizing was out, or at least open to new scrutiny; true scientific research based on experimentation and observation was encouraged.

General Health and Life Expectancy . Despite the shortcomings of medical science, the picture was not entirely bleak. Compared to Europeans, Americans enjoyed relatively good health, largely because of the spar-sity of the population. Unlike Europeans packed in overcrowded, unsanitary cities (and thus more exposed to deadly epidemics), Americans lived primarily in rural areas. This started to change after the Revolution, as the United States began to develop cities of its own. Life expectancy was short, but that was mostly due to childhood diseases. Philadelphia records for the 1780s show that more than half of all reported deaths occurred before the age of ten. In Massachusetts and New Hampshire, according to 1789 data, the life expectancy was only 34.5 years for males and 36.4 for females. Once past the high risks of getting through childhood, though, one’s life expectancy increased significantly: after reaching the age of twenty, a man could expect to live to fifty-four and a woman to fifty-six.

Hospitals and Almshouses . Only a few hospitals existed before the Revolution, most notably in Pennsylvania. During the war there had been a great many temporary hospitals in colleges or private residences, but after 1783 there was an increase—slowly, and only in the major cities—in the number of permanent hospitals. New York Hospital officially opened in 1791 and Massachusetts General Hospital in 1811. More common were the almshouses (poorhouses) that provided shelter and medical care for paupers, orphans, and the insane. By 1815 every city in the United States had an almshouse, and they were busy: the records for New York City in 1809 show that the almshouse was taking care of 538 adults and 226 children, with 168 sick in its wards. The new city hospitals, which were intended not for the destitute but for the middle class, still did not have the confidence of the general population. Most people avoided them if they possibly could, and with good reason: they were unsanitary, overcrowded, and staffed by people who knew little of human anatomy or the real causes of disease. The hospitalized patient, it was said with some truth, was just as likely to die as to recover.

Epidemics . This was a period of great outbreaks of yellow fever, smallpox, typhoid fever, and influenza. Rapid population increases in the cities led to overcrowding, inadequate water and sewage systems, and increased risks of disease. The epidemics prompted pioneering work by physicians such as Benjamin Rush and the development of better public water and sanitation systems. Philadelphia, which suffered a devastating epidemic of yellow fever in 1793, was among the first cities to build a steam-powered waterworks, in 1802. Epidemics were the most obvious killers, but not the most lethal. Diphtheria took the lives of many children each year. Respiratory diseases such as tuberculosis killed thousands annually. Because they did not strike in terrifying epidemics, these diseases were not feared as much as smallpox or yellow fever. Gout, which caused swelling and deformity of the feet and hands, was not feared. Instead, gout was believed to be a result of good living—too much fine wine, rich food, and leisure time—and therefore a sign that a man was above the working class. The victim of gout often took a strange pride in being afflicted.

Vaccination . One of the few areas of significant medical progress was vaccination against disease, in particular the new idea of infecting a healthy person with cowpox disease to ward off the more deadly smallpox. This concept struck most people, including doctors, as insane. But the English physician Edward Jenner in 1796 proved that his “vaccine” did produce an immunity to smallpox, and Harvard professor Dr. Benjamin Wa-terhouse, with timely support from President Thomas Jefferson, made smallpox vaccination acceptable to a larger public and saved countless lives.

Childbirth . Obstetrics began to move into general practice, at least in the cities where there were more doctors. Childbirth had always been the domain of midwives because physicians (and the population in general) had a moral opposition to male involvement in female health issues. In rural areas, though, midwives typically delivered babies-and took care of more-general medical needs as well. Although the typical midwife was poorly educated and often unable to handle serious complications, she probably did less harm than theorizing male physicians.

Mental Health . It was common practice in colonial America to ignore people suffering from mental diseases. They often roamed free or were confined in prisons, where they were at the mercy of the other prisoners. At best they were sent to public almshouses with paupers and orphans. Only Williamsburg, Virginia, had a hospital for the insane, the Mad House, founded in 1768. Dr. Benjamin Rush of Philadelphia was a pioneer in this field, among the first to insist that those suffering from psychological problems deserved special treatment. Rush wrote the first work by an American on mental illness, Medical Inquiries and Observations, upon the Diseases of the Mind (1812). Rush believed psychological problems were caused by “pervading vascular tension,” and so could be cured by bleeding the patient. Still, in his genuine concern for those who suffered from mental illness, and his emphasis on humane treatment and the value of a trusting doctor-patient relationship, he is rightly considered the Father of American Psychiatry.

Technological Nation . Before the Revolutionary War American industry had been hampered by the colonies’ great distances, sparse population, high labor costs, lack of investment capital, and British restrictions on the export of technology. With the war now over, Americans could concentrate on the major technical obstacles that faced them: how to traverse the great distances of their new nation, how to increase agricultural yields, and how to compensate for labor shortages. In the glow of post-Revolutionary enthusiasm, enterprising Americans made remarkable progress. Most technological discoveries still came from Europe, but Americans were skilled in perfecting new ideas. The steamboat, for example, was not invented by Robert Fulton, but he made steam-powered transportation practical. Although the early United States was still predominantly agricultural, the shift to an industrialized society had begun, and the basis of technology changed from craftsmanship to science.

Drawbacks to Industrialization . The Industrial Revolution had started in England, and there was occasional public outcry against its dehumanizing effects. In the United States some people also worried about the effects of industrialization, such as slums or the development of a huge underclass of laboring poor. Thomas Jefferson wrote in 1784, “While we have land to labor then, let us never wish to see our citizens occupied at a workbench.” But even Jefferson had a small nail-making enterprise at Monticello, and most Americans welcomed industrialization as a means of establishing the new nation’s self-sufficiency—not to mention producing great wealth. The combination of southern cotton (now more easily produced because of Eli Whitney’s cotton gin) and northern industrial power temporarily united the regions of the new nation and set New England humming with the sound of waterpowered spinning and weaving. The mill machinery was operated mostly by women and children working twelve hours a day, six days a week. The first child labor law in the United States was not enacted until 1848.

American System . The period began in an age of craft production and ended on the verge of mass production. Eli Whitney, best known for his invention of the cotton gin, obtained a contract from the War Department in 1798 to manufacture four thousand muskets. At that time, all mechanical devices were made one at a time, with each part made individually and fitted to the connecting part. Challenged to devise a way to speed up the process, Whitney in 1800 invented a system of milling each part in quantity, then assembling the muskets from the interchangeable parts. Although he did not deliver on his promise until 1808, other inventors and industrial planners such as John Hall would put the theory into practice on a large scale and improve the concept. This “American system,” as it became known throughout the world, may be the greatest technological innovation in American history, since it provided the basis for modern mass production.

Canals . The great age of canal building began in this period with short canals such as the Sault Sainte Marie, which allowed ships to go between Lake Huron and Lake Superior. Only a mile long, the Sault Sainte Marie canal was the first in America with a lock, to raise or lower a vessel to the elevation of the next portion of its journey. Driven by the need to bring western produce to eastern ports, engineers and hordes of laborers worked to tame longer distances and greater heights, culminating in 1825 with the 363-mile Erie Canal in upstate New York. Canal building became a national craze for engineers, politicians, and investors, enriching or impoverishing states and investors who speculated wildly on them. Unlike the Erie, most canals lost money.

Exploration . While canals, roads, and bridges were being constructed in the “civilized” states along the eastern seaboard, explorers, traders, and settlers were moving further westward, to the Mississippi River and beyond. President Jefferson had considered exploring the Missouri River watershed even before the acquisition of the vast Louisiana Territory. After the purchase in 1803, government-sponsored expeditions—most notably that of Meriwether Lewis and William Clark—explored the vast reaches west of the Mississippi River. Although some of these expeditions were scientific in nature, they all had political goals as well: there was much to learn about the native inhabitants, land, animals, and climate of regions soon to be enveloped by the expanding nation. Many other expeditions were completely independent of the government, financed by businessmen looking for wealth. Robert Gray, sailing for a fur-trading company, discovered and named the Columbia River in 1792; John Jacob Astor’s American Fur Company, established in 1808, and other large corporations pushed relentlessly into America’s interior. Individual farmers and hunters such as Daniel Boone also drove the expansion, drawn westward by the seemingly unlimited economic possibilities of the North American continent.

The Future . Any age of technological achievement provides an important basis for the progress of the following age. Innovations in steam power forever changed ship transportation and provided the technological foundation for the great era of steam locomotives. The interest in canal building, begun in the 1790s, became a mania by 1815 but by the 1830s canals would be put out of business by the railroads. The American system of manufacturing interchangeable parts was later applied to everything from watches to sewing machines to automobiles, and factories became a familiar (and less welcome) sight all across the American landscape. The United States was well on the way to establishing itself as a powerful, self-sustaining nation, no longer reliant on Europe for government, learning, medicine, or manufacturing.