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Becoming a new doctor prior to 1861

Posted on Friday, April 28, 2017 at 12:01 am

Before the Civil War there were the country doctors. That institution went to the house, delivered the babies, healed the sick and (in the South) treated the slaves. This was the mainstay of medicine in this age. The country doctor earned less than $19,000 per year in today’s dollars, some of which was barter or payment in livestock. What was it like for the new doctor prior to the war? As medical students, they had experienced the four contexts of learning that was emphasized in medical school: lectures, hospital wards, anatomical dissections, and the written medical thesis. Each of these was supposed to prepare them for a lifetime of treating patients. In their lectures that not only provided information, the professor demonstrated how to explain and persuade others of their diagnosis. This is a time where medical schools and their students are just starting to revise their opinions on the complexity of nature. There is the start of a movement that doctors were to assist nature in its healing powers instead of using toxic medicines to intervene. It was a new age where doctors were expected to know when to act, not simply which procedure or drug to apply in each situation. Medicine was returning to more of an “art” that a “science.”

The clinics medical students went to for internships now provided, “a bedside view of diseases…more profitable, than the hearing of lectures.” Charleston’s Roper Hospital, Louisville’s Marine Hospital, and the Charity Hospital in New Orleans provided the medical student with the working poor, transients, the homeless, inmates of almshouses, and seamen to observe and practice their art. In the year 1850, 18,000 patients passed through the New Orleans Charity Hospital. Many of these medical students now witnessed complicated medical procedures that they had only previously read about. The reality of the textbook was there every day during their internship. Anatomy now provided the student with practical experience in seeing the complexities of the human body. By mastering anatomy, with the knife, saw, and trocar, the student learned about the skeletal structure, internal organs, and how muscles worked. They could now locate arteries and veins for surgical purposes. Medical school pamphlets described dissection as a journey into the “mysteries and intricacies of the human organism.”

The final piece was the medical thesis. What is fascinating is that these were the only piece of writing required in a student’s career. These were not intended to be deeply researched or to contain any new ideas/knowledge. They really contained much of what the student had learned in class, but focused upon a topic of choice. It was more of a retrospective look at knowledge learned during their two years of courses. Most of them took two months to write.

Professors gave their farewell lectures, gifts were exchanged between students and faculty, landlords were paid their final rents, and friends from school said good-bye. The new title “Doctor” was used by family upon their return home. After graduation the real work began. Many of these new “doctors” realized how little medical knowledge they had now that they were going to practice with live patients. Some of them now understood that they would have to have a “sensitivity” to their patients not taught in either their clinical or lecture work in school. His abilities were now going to be tested by his neighbors. One medical school professor asked a graduating student to tell him how to make chicken soup. The student gave his recipe. The doctor then explained why he asked, he wanted to know if the student would first explain that they had to kill the chicken. The professor explained, “Nothing is too trivial to be remembered by the practicing physician. School is over, now the hard lessons begin.”

In the South before the war, the new doctor sought a classic “plantation practice.” This was a practice where the country is good, the planters are wealthy, and society respectable.” A plantation with a sizable number of slaves meant a contract for a new physician for a period of months or even years. This meant a stable income and entry into the local society by an elite patron of the community. On the other hand, there were many new doctors that wandered the South seeking a community to settle in where they could earn a living. William Whetstone, MD wrote his mother in South Carolina that, “this country is too healthy to support one quack.”  Unfortunately, some new doctors actually depended upon the community’s bad fortune. One North Carolina doctor stated, “Sickness began to increase…and my calls came thick and fast until I had all the practice I could attend to.”

Areas that were booming in the 1840-1860’s were ripe for new doctors. One set up close to St. Louis, Missouri. These created openings for aggressive, skilled young doctors. In some cases, new doctors actually paid older doctors for the opportunity to “treat” some of their patients for a period of three years. This allowed a new Dr. Samuel Dickerson in Charleston, South Carolina, to become known in the city. There were hundreds of such “deals” cut with older physicians in large towns to enable new doctors to become known in larger markets. Sometimes doctors answered ads placed in newspapers by cities. Osyka, Mississippi advertised for a doctor. Answering the ad, the new doctor found out that the town sought, “a good obstetrician, one that will make himself useful as a leading citizen and must be a sound and active Baptist, strictly a temperance man, with personal skill and the experience to succeed.” Many new doctors had their work cut out in their new communities. Dr. Samuel Leland was appalled to see that “people, all wash both their hands and feet from the same basin, and have but one towel for the entire family.”

The lightning rod of the new doctor was the first patient in the community after he arrived. This first call placed the spotlight on the new doctor, as both curiosity and gossip would follow his patient’s treatment. If he gained a positive reputation, more patients would follow. Many times the first patients were such diseases as hemorrhoids or social diseases. First failures (deaths) always affected the doctor. Sometimes these incidents even appeared in writings years after the event. One of the doctors I portray as a reenactor, Dr. James Gaskill from Illinois, went to the funeral of his first patient who died in his unit during the war. This second lieutenant is mentioned in his personal diary the day that he died. His language indicates that he is very upset that he could not save this officer so he could go home to his family. The patients these new doctors saw sometimes had extreme news that they sought to have the doctor heal. A planter wrote the following note to the doctor in town, “Dr. Sir, I send for you in a case of emergency, I want you to come as soon as you can get here. My wife cannot live 24 hours without relief…I do not know anything I can do. I now call upon your skill.” It was the social, bedside manner that gave the new doctor his strength in the healing of the sick and comforting of the dying in this age. Just his ability to “name” the disease allowed him the power to seek to heal that illness in the community. Many of these doctors took copious notes in their casebooks that they kept. It is these casebooks that give us a glimpse into the medical treatment of this age. Dr. John Knox has this entry in his casebook for October, 1852.  “October 8, 1852 – Mary Dunlap was taken down with fever today. Ordered a dose of Calomel. October 9, 1852 – MD better – Quinine. October 10, 1852 – MD has cold feet & hands following fever. I left her Tulley’s Powder (a substitute for Dover’s Powders).” The detail in these books allowed a doctor over the course of years to draw “facts” about the effectiveness of his actions, adding to his success as a practitioner of the ages prior to germ theory. Perhaps the best thing said was by the brother of a new physician in 1849, “Read your works, study hard & be attentive. You are now a man.”

Your obt. Servant,
Surgeon T.T. Steinbach

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