2. Knowledge of Medicine
^ top of page ^
Contemporary readers will find it difficult to imagine the state of knowledge
about medicine, disease, childbirth, and traumatic injury during the
nineteenth century. In the United
States the life expectancy for whites was approximately 40
years; for slaves, only about 20 years (
Life Expectancy; Mintz). The major causes of death in antebellum southern
states were malaria, yellow fever, cholera, and pneumonia (Holt 10). There were no X-rays, no aspirin or
penicillin, and no vaccines. No one knew about germs, the microorganisms
that cause many diseases and infections. There were no professional
nurses—women generally took care of the sick in their own
households—and no women doctors. Mental illness was regarded as
possession by devils or other supernatural beings; the afflicted were
sheltered within the family or housed in asylums. Becoming pregnant was
fearful news for women because they knew they might die in childbirth, or
afterwards of bacterial infections known as puerperal or childbed fever.
[2] Attended at home by midwives,
women in labor rarely saw an obstetrician, unless they belonged to the upper
classes. It was considered immodest for men to assist women in childbirth,
regarded as a natural process in God's
hands. Surgery was truly ghastly, usually performed by men with unwashed
hands and dressed in clothing soiled with blood and filth. Scalpels, saws,
clamps, needles, and other instruments were not sterilized. The patient
would be conscious, forcefully restrained on a table, and screaming in pain
throughout the procedure. The skillful surgeon also had to be a speedy
surgeon, working fast while hearing the agonized cries of his patient.
Opium, laudanum, and alcohol might be administered to dull the pain, but the
effect would not be sufficient to endure most operations. Afterwards,
infection invariably set in.
Though the stethoscope had been invented in France in 1816 by René Laënnec (1781–1826), it
was not adopted in English-speaking
countries until about 1850 (González-Crussi
158). Anthonie van Leeuwenhoek
(1632–1723) had used a simple microscope to observe the circulation
of blood corpuscles in capillaries (1673), describe
life in a drop of lake water (1674), and discover
mouth bacteria (1683), but the instruments he
designed were capable of only 266-fold magnification.
[3] Furthermore, the relationship of his
observations to theories about human physiology and disease were not
understood until the late nineteenth century. Lacking an understanding of
the causes of most diseases, physicians attempted to treat the effects
instead, relying on herbal medicines to combat pain, fever, infection,
poison, and hemorrhage. Many of these remedies had existed for centuries and
were delivered as potions, tinctures, enemas, purges, salves, poultices, and
teas. Fevers, for example, might be treated by chewing willow bark or
drinking a tea made from it; willow bark contains salicin, a chemical
similar to acetylsalicylic acid, or aspirin. Foxglove, a source of
digitalis, could strengthen the heart by helping to eliminate excess fluid
around it. Plant extracts also could promote coagulation of the blood and
help heal wounds. Learning to diagnose a patient's problem, determine a
correct medicament and dosage, and compound it properly was an important
skill of nineteenth-century physicians, who often also served as the
community's pharmacist.
Nineteenth-century physicians knew about the circulation of blood, discovered
in 1628 by William
Harvey, but they held various theories about what blood was
for. Some thought, following Hippocrates and Theophrastus, that the body contained a balance of four
"humors": black bile, yellow bile, phlegm, and blood. When diet,
bad air, or disease created an imbalance in these humors, people became
melancholic, choleric, phlegmatic, or sanguine. Others believed that the
soul governed all bodily structures, so health and disease reflected the
state of a person's soul. Given either theory, therapeutic bloodletting, or
phlebotomy, was thought to clear the body of toxins, or bad humors, and to
overcome imbalances caused by the passions and other disruptions to the
soul. Bloodletting involved placing leeches on the patient's body,
lacerating an artery in the temple or a vein in the neck or forearm, or
using a "scarificator," a spring-loaded device containing several
lancets, to scrape the patient's surface blood vessels. Almost 1.7 liters,
or 3 ½ pints, of blood were drawn from President George Washington before he died from a
throat infection in 1799. Sometimes bloodletting
once or twice a year was recommended to prevent disease in healthy people.
Cupping, still found in traditional Chinese medicine, used special heated glass cups on parts
of the body to produce a localized vacuum; this procedure was intended to
restore balance in the body's fluids, relieve pain, and remove toxins from
the blood.
The first half of the nineteenth century also was the age of phrenology, an
early effort to understand human psychology.
Dusenbery's journal reproduces a phrenological report made
by a traveling phrenologist known only as "Woodward." Developed by the German physician Franz Joseph Gall (1758–1828), phrenology was
extended to the United States
through the work of Gall's
collaborator, Johann Spurzheim
(1776–1832), and the American brothers, Lorenzo Niles
Fowler (1811–1896) and Orson
Squire Fowler (1809–1887). Phrenologists claimed to be
able to map the bumps on various regions of a person's skull and thereby
identify the individual's character traits. Phrenologists developed various
five- to nine-point scales for measuring the size of different parts of the
skull and used these measurements to evaluate from 27 to 35 personality
traits such as self-esteem, benevolence, mechanical skill, musical talent,
and so forth. Although it reflected an increasing desire to understand a
biological basis for human behavior, phrenology was eventually dismissed as
a speculative theory without any physiological evidence to support it. In
fact, Dr. V. H. Taliaferro, who would
later become dean of Atlanta Medical
College,
[4] denounced
phrenology as a pseudoscience, "cöequal in its ridiculous folly and
error with clairvoyance, mesmerism and witchcraft" (381).
Taliaferro's
scathing criticism appeared in the third issue of
The Medical Journal of North
Carolina in 1860.
As this sketch makes clear, medical science was largely inadequate to the
task of alleviating pain, forestalling infections after operations, curing
most diseases, or providing skilled nursing care until the mid-nineteenth
century and decades later in some areas. An understanding of germ theory and
the importance of aseptic and antiseptic surgical environments as well as
the development of ether, chloroform, and other forms of anesthesia would
transform medical practice in the latter half of the century.
To learn more about nineteenth-century medical instruments, click
here.
3. Medical Education in the United
States
^ top of page ^
Medical education in the United
States during the eighteenth and nineteenth century was
predominantly unregulated. Prior to 1765, when the
University of Pennsylvania Medical
School was founded, aspiring physicians could be educated in
at least two ways. They could travel to Europe, especially Edinburgh, London,
and Paris, to study medicine with
renowned physicians such as John
(1728–1793) and William
(1718–1783) Hunter and William
Cullen (1710–1790). Lacking the resources for study
abroad, other students might apprentice themselves to a local practicing
physician for a year or two, during which time they read with the doctor,
then rode with the doctor. That is, they studied their mentor's medical
books, then assisted him in his practice by making compounds and travelling
with him as he visited his patients. When the student was judged
sufficiently trained to practice medicine, the physician would issue a
letter outlining the young doctor's qualifications so that he could hang out
his own shingle. Sometimes a physician or groups of physicians would open a
medical school, providing for a fee instruction in surgery, medicine,
anatomy, and materia medica (the study of
therapeutic properties of plants, animals, and minerals, the forerunner of
modern pharmacology). The quality of these schools varied significantly,
depending on the competence of the physicians, and they rarely lasted for
long because they were not affiliated with a permanent institution such as a
hospital or a university.
As the population of the United
States grew, medical colleges began to be established in
cities large enough to support them. In Philadelphia, Benjamin
Franklin (1706–1790) and his long-time friend,
physician Thomas Bond
(1712–1784), established in 1751 the first
public hospital in the United
States, Pennsylvania
Hospital. In 1762
William Shippen, Jr.
(1736–1808), a young Philadelphia physician who had trained with John and William
Hunter in London and
who held a medical degree from the University of
Edinburgh in Scotland, began offering a series of lectures on anatomy and
midwifery. Together with surgeon John
Morgan (1735–1789), Shippen founded a medical school in 1765 that eventually became associated with the College of Philadelphia (later, the University of Pennsylvania). It was the
first true medical school in the United
States. Other medical schools quickly followed at King's College (now Columbia University) in 1767; Harvard College in
1782; and Dartmouth
College in 1797. The independent
College of Medicine of Maryland and
the College of Physicians and Surgeons of New
York City were founded in 1807.
Students received formal instruction through lectures and demonstrations,
supported by modest libraries and "cabinets," or collections of
drawings, models, skulls, and other artifacts. Occasionally students had
opportunities to dissect animals or gain clinical practice in nearby
hospitals. However, these schools had few entrance requirements and offered
no grades or laboratory work. By 1810 approximately
650 students were enrolled in these medical schools, 406 of them at the
University of Pennsylvania
(Rutkow 453).
Medical reform, however, was clearly on the minds of many practicing
physicians in the mid-nineteenth century, a time when too many quacks
pedaled nostrums to a credulous public. When the American Medical Association was founded in 1847, attending physicians sought to standardize medical
education, advance medical science, and establish a code of medical ethics
to benefit public health (
Founding of
the AMA). In 1850, a year after the
founding of the Medical Society of the State of
North Carolina, presiding member Edward Strudwick recommended that the Legislature require
prospective physicians to "furnish evidence of a sufficient general
education and of good moral character" before practicing in the State
(11). Strudwick further encouraged
cooperation among medical colleges throughout the nation to ensure that a
medical degree was not "too cheap and of too easy attainment" (12).
Both Dusenbery brothers received medical degrees from reputable medical
colleges, but neither likely required certification to practice in the state
of their choice.
[5]4. James Dusenbery at the
University of Pennsylvania
^ top of page ^
James Dusenbery had decided to become a
physician no later than his senior year at the University of North Carolina, when he chose as the topic of
his senior speech "The State of Medical Sciences in N.C." This speech
survives. It expresses the view that "The science of 'medicine' is not
only the most ancient, but the most grave and dignified, that has ever
engaged the attention of mankind." The speech reflects the growing
spirit of reform, condemning the quacks and charlatans—"those
useless members who have so long clogged and restrained [medicine's]
upward flight"—who were all too common in the nineteenth
century. After graduating from the University of
North Carolina in June 1842,
James returned to Lexington, NC, to study medicine with
physician
C. L. Payne.
[6]
Dr. Payne, mentioned in
Dusenbery's journal, was a family friend who
had attended the University of
Pennsylvania's Medical
Department in 1825–1826, but it is unknown whether he
earned the MD degree and, if so, where he earned it.
Though many medical schools of the period did not have entrance requirements,
the University of Pennsylvania did:
"The candidate must have attained the age of twenty-one years, have
applied himself to the study of Medicine for three years, and have been,
during that time, the private pupil, for two years at least, of a
respectable practitioner of Medicine" (
Catalogue 34). Though
James was twenty-one years old when he entered the University of Pennsylvania's Medical
Department in 1843, he evidently was
excused, for reasons that are unclear, from the requirement that he study
medicine for three years prior to admission, two of which as the private
pupil of "a respectable practitioner." Nevertheless, by November 1843
James was in
Philadelphia, together with 445 other
students, to take up the formal study of medicine.
According to the "Regulations of the Medical Department of the University,"
the medical lectures began on the first Monday of November and ended in mid-March (
Catalogue 33–37). Upon
paying a fee, students received a ticket admitting them to a particular
course of lectures. Students at the University of
Pennsylvania were required to take two complete courses of
lectures in anatomy, chemistry, surgery, the theory and practice of
medicine,
materia medica and pharmacy, obstetrics
and the diseases of women and children, and the institutes of medicine
(physiology, pathology, and therapeutics).
[7] In addition, every student had to attend one
course of clinical instruction in the Philadelphia Hospital, the Pennsylvania Hospital, or some other approved medical
institution. In these facilities, students had opportunities to assist with
the care of patients, observe surgical procedures, and understand the
effects of disease on living persons. Though laboratory work was minimal,
students also attended demonstrations in practical anatomy. Grades were not
given.
After two years of study by reading, lecture, and demonstration,
Dusenbery and his classmates could apply to
receive the MD degree. Upon application for this degree, every student
submitted to the dean of the Medical
Department, by February 1 prior
to graduation in June, an essay, or thesis,
"on some medical subject."
James submitted a thesis titled
"Empiricism" (
Medical
Graduates 19). The essay has not survived, but we know that the
thesis was assigned to a faculty member, who examined
James on it and on his knowledge of medicine
in March. These examinations took place at the homes of the professors
beginning on the last Monday of the academic year and appear to have been
oral examinations, each student being examined separately (
Medical Graduates 30). At a
subsequent meeting of the entire faculty, as each student's name was called,
faculty members had an opportunity to comment on the student's
qualifications; then they voted by ballot to determine whether or not the
student had passed and was entitled to the degree. Three negative votes
could fail a student, unless he elected to undergo a second examination
before the entire faculty, meeting in joint session.
The cost of a medical degree from the University
of Pennsylvania in the 1840s included the following
charges:
| Amount of Fees for Lectures in the University |
|
$120.00 |
| Matriculating Fee (paid once only) |
|
5.00 |
| Hospital Fee |
|
10.00 |
| Practical Anatomy |
|
10.00 |
| Graduating Fee |
|
40.00 |
| |
Total |
$185.00 [8] |
James Dusenbery, MD, graduated from the
University of Pennsylvania on April 4, 1845, and as he tells us at the end of
his journal, "I hung out my shingle in my native town of Lexington early in the month of June
[1845]." In about mid-January 1846 he went to Statesville, NC, to practice medicine. The
1850 census indicates that
Dusenbery was living in the home of physician
David Chambers, age 60, and
29-year-old P. B. Chambers, a farmer.
Returning to Lexington by 1852,
James
opened a drug store in partnership with
James P.
Stimson, sheriff of Davidson
County. According to occupational information included in
the 1860, 1870, and 1880 census,
James continued to practice medicine until shortly before
his death in 1886.
Although there is no record that
James
attended meetings of the North Carolina Medical
Society, R. L. Payne,
[9] son of
Dusenbery's mentor
C. L. Payne, reported on
"The Diseases of Davidson County" at its
annual meeting in 1861. After the county's epidemic
outbreak of dysentery from 1858 to 1860, Payne
concluded that he knew of "no disease which more effectually baffles the
skill of the physician than [dysentery] occurring in young subjects"
and recommended no treatment with great confidence (338). Typhoid fever,
yellow jaundice, and diphtheria also plagued Davidson County in the years leading up to the Civil War.
James likely prescribed and prepared
medicinal remedies to treat those affected by the outbreaks, but as
Payne reveals, there were no
standard treatments at the time.
5. Fayette Dusenbery at the University of Maryland
^ top of page ^
James Dusenbery's brother,
Edwin Lafayette Dusenbery, known as
Fayette, also became a physician. Though he
received his MD from the University of
Maryland, his medical education was similar to
James's.
Fayette graduated from the University of North Carolina in June
1845, the same month in which
James graduated from the University of Pennsylvania Medical Department. After a year
of study with
James in Lexington, NC,
Fayette enrolled in the University of Pennsylvania, where he was listed as a
matriculant for the 1847–1848 academic year. There he would have
attended a year of lectures in anatomy, chemistry, surgery, the theory and
practice of medicine,
materia medica and pharmacy,
obstetrics and the diseases of women and children, and the institutes of
medicine comparable to those that his brother
James had heard four years earlier. For unknown reasons,
Fayette left the University of Pennsylvania and completed the
second year of his medical education at the University of Maryland in Baltimore, enrolling there in 1848.
[10]
The College of Medicine of Maryland (now
the University of Maryland School of
Medicine) was founded in 1807 as the
first
public medical school in the United States. It originated as a medical
school, not a university, and represented the response to a riot. John B. Davidge (1768–1829), who had
received his MD in Glasgow,
Scotland, established a successful surgical practice in
Baltimore and in 1802 began giving private lectures in surgery,
midwifery, and anatomy. With James
Cocke (1780–1813), a Virginian who earned his MD from the University of Pennsylvania in 1804 and taught physiology, and John Shaw (1778–1809), who taught
chemistry, Davidge and his fellow
physicians offered lectures and anatomical demonstrations in 1807 in a small building Davidge had built as a school. When rumors spread that he
was dissecting a fresh cadaver, crowds destroyed the building and carried
off the cadaver, the body of a criminal.
[11] Though Davidge had not acted illegally, the threat from mobs
opposing dissection of human beings only served to strengthen the doctors'
resolve. That same year they succeeded in gaining from the Maryland legislature a charter to
establish the College of Medicine of
Maryland. For a few years, lectures were offered in the
professors' houses, but by 1812 a solid brick
structure was built for lectures and demonstrations. Davidge
Hall still stands today on the University of Maryland campus. When the college added
faculties in arts and sciences, law, and divinity in 1812, the institution became known as the University of Maryland.
Enrolling 190 students in 1848–1849, the University of
Maryland Medical Department was considerably smaller than the
department at the University of
Pennsylvania.
[12]
Reading Maryland's
Annual Circular and Catalogue
for this period gives the impression that this smaller size encouraged
greater attention to practical and clinical instruction, offered through the
Baltimore Infirmary. Founded in
1823, the 150-bed Infirmary served the city's poor and was managed by the
Daughters of Charity. Prospective
students were advised to complete three years' preparatory study and "a
course of systematic reading, under the direction of some judicious
practitioner, or in one of the private medical schools" (
Forty-Second Annual Circular
2). Most of the students enrolled in 1848–1849, like
Fayette, had been admitted after studying
with a practitioner, or preceptor; however, several students had taken a
year-long course of lectures, reading, and clinical instruction at the
Maryland Medical Institute, the Baltimore
Infirmary, and the Baltimore
Almshouse. It is not known how many students, like
Fayette, had already completed one year of
lectures at some other medical school.
[13]The academic year at the University of
Maryland began on the last Monday of October and concluded in
mid-March. As at the University of
Pennsylvania, students paid fees to receive tickets admitting
them to lectures on surgery, chemistry, materia
medica, anatomy, the theory and practice of medicine, and
obstetrics. Two courses/years of lectures in these subjects were required.
Additional required lectures in pathological and practical anatomy were
taken for only one year, during the second year of instruction. Though the
University of Maryland did not
require a year of clinical practice, as did the University of Pennsylvania, this omission may be the result
of clinical training being included in other courses. The course in surgery,
for example, included daily lectures and clinical instruction involving
patients from the Baltimore Infirmary.
Students would have observed amputations, the treatment of fractures, and
other major and minor surgical procedures. The theory and practice of
medicine likewise included daily lectures and clinical visits at the
Infirmary. Annually, up to eight
students were permitted to live at the Baltimore
Infirmary as clinical assistants for $80 a year (other
students lived in boarding houses for $3 to $4 per week). Even
without a year of required clinical experience, the Annual Circular expresses an intention "to give
a practical and intelligible course of instruction, calculated to
prepare the student for the emergencies of his future profession"
(Forty-Second Annual
Circular 11).
As was true at the University of
Pennsylvania, every candidate for the MD degree was required
to submit a thesis "on some subject connected with medical sciences"
and to "satisfy the Faculty, by appearing before them in a private
examination, of his fitness for receiving the degree of Doctor in
Medicine" (
Forty-Second
Annual Circular 19).
Fayette's thesis on "Cholera"
survives. The results of the
examination were determined by a majority vote of the medical faculty. A
medical education at the University of
Maryland was slightly less expensive than that offered at the
University of Pennsylvania:
| Amount of Fees for Lectures in the University |
|
$90.00 |
| Matriculating Fee (paid once only) |
|
5.00 |
| Clinical Ticket |
|
no charge |
| Pathological Anatomy |
|
5.00 |
| Practical Anatomy |
|
10.00 |
| Graduating Fee |
|
20.00 |
| |
Total |
$130.00 [14] |
Though
Fayette Dusenbery is listed among
the 68 graduates who received their MD degrees in March
1849, we know little about his medical practice after leaving the
University of Maryland. He
returned to Lexington, NC, and on
18 May 1852 married Caroline Amanda Summey (b. 1830). Though one
source places him in Tennessee
before moving to Georgia, no
additional information about his residence in Tennessee is available. The 1860
census indicates that he was a physician in Resaca, GA, living with his wife and his farmer father- and
brother-in-law, Peter and Peter A. Summey. When the Civil War broke out,
Fayette enlisted as a private in the 14th Regiment,
Georgia Volunteers, in 1861. He died in Richmond, VA, on April 25,
1862.
We know almost nothing about how
James
and
Fayette Dusenbery conducted their
medical practice. The best documentary evidence of what physicians did is
the fees they agreed to charge for various procedures. These medical charges
were set by county medical societies and published in local newspapers.
[15] The Rowan County [NC] Medical Society, for example, established
fees for house calls of various durations and distances from town, post
mortem examinations, bleeding, dressing wounds, administering injections,
surgical procedures, attending women in childbirth, prescribing medications
and giving injections, extracting teeth, and treating fractures, among other
procedures.
6. Medical Advances in Dusenbery's Lifetime
^ top of page ^
What improvement ever equalled that of the introduction of
chloroform, of anæsthetics? Pain abolished at one glorious sweep;
you know that even within your own memory, let cavillers say what they
please, it has become the recognized practice of all good surgeons in
America, Asia, Europe, to administer chloroform. Let no silly errors
persuade you to the contrary! (Skey
152–153)
London surgeon F. C. Skey puts the matter quite simply: the
introduction of anesthetics revolutionized and radicalized medicine in the
mid-nineteenth century. And readers of the first issue of
The Medical Journal of North
Carolina (1858) likely heeded
Skey's prescient
pronouncement. After Georgia physician Crawford
Long used ether to anesthetize a boy needing a cyst removed
from his neck in 1842 and Boston dentist William T. G. Morton successfully anesthetized housepainter
Gilbert Abbott with "letheon"
[16] in 1846, the idea of painless surgery captivated physicians
worldwide. In fact, Queen Victoria
requested chloroform from her physician for the delivery of her son
Leopold, giving anesthesia the
royal stamp of approval in 1853 (Fenster 168). Nitrous oxide ("laughing
gas"), chloroform, and ether arose as the choice anesthetics in the
1840s, replacing a slew of unreliable alternatives in pain
management—among them mesmerism, freezing, and alcohol. However, the
relatively quick acceptance of anesthesia in medical circles
worldwide—hospitals in New
York, London, and
Paris began administering ether
only months after Morton's success in
Boston—did not stop
surgeons from operating on conscious patients (Pernick 3–4). Anesthetics were generally reserved for
white women and children of the upper classes, whom surgeons considered
typically weak, intractable, and more easily anesthetized. "Average"
white men, African Americans, and women of "the humble and healthy
classes" were unlikely candidates for anesthesia because they
"supposedly needed less protection from pain" (Pernick 176–177).
War was another revolutionary force in medicine in the mid- to
late-nineteenth century. British
nurse Florence Nightingale, who led a
team of nurses for the British Army
during the Crimean War
(1853–1856), published
Notes
on Matters Affecting the Health, Efficiency and Hospital Administration
of the British Army upon her return in 1858, emphasizing the necessity of sanitary living conditions to
contain preventable disease.
[17]
American physicians took Nightingale's recommendations seriously,
particularly after the Civil War broke out in
1861. In fact,
The Medical Journal of North Carolina reprinted
selections of John J. Chisholm's
Manual of Military Surgery, which
encouraged Confederate soldiers to
mimic the "frequent ablutions of the English, who
washed their clothes in hot water, and chang[ed] their underclothes
twice a week" in the Crimea
(589). The U. S. Sanitary Commission,
which formed "at the beginning of the war, in the desire to meet and
avoid, for our army, the terrible evils which decimated the Crimean Army" (United States 1),
managed to decrease the disease rate by half in Union camps (Burns). The
Civil War also brought new knowledge
about human anatomy and new surgical procedures, and in 1867
Joseph Lister (1827–1912)
reported on his experiments using carbolic acid to sterilize instruments and
clean wounds, publishing his
"Antiseptic Principle in the Practice of
Surgery" in
The British Medical Journal. The theories of
contagion that fueled these "clean-ups" precipitated germ theory and
the discovery of microorganisms by Louis
Pasteur (1822–1895)—a discovery unlikely to
have influenced
Dusenbery's
practice.
In the 1850s women such as Elizabeth
Blackwell (1821–1910) and Marie Zakrzewska (1829–1902) began to practice
medicine, especially among women and children. Blackwell graduated from Geneva
College in New York
in 1849, becoming the first woman to obtain a
medical degree in the United
States, and Zakrzewska
received her MD from Cleveland's
Western Reserve Medical College in
1856. Women physicians were still not widely
respected in the 1850s, but the Civil War
gave women, particularly nurses, a chance to assert new authority and
command respect in the medical field and the public sphere. Just as
Nightingale became an indispensible
asset in British public health
reform, nurses such as Mary Ann
Bickerdyke (1817–1901), Clara Barton (1821–1912), and Sally Louise Tompkins (1833–1916)
commanded unprecedented respect for fearlessly caring for the wounded and
sick, oftentimes providing treatment when doctors were scarce. General
William T. Sherman famously claimed
that "Mother" Bickerdyke, who
assisted in amputating limbs and brewed barrels of coffee for Union soldiers, "ranked" him. When
Jefferson Davis outlawed private
hospitals in the Confederate States in
1861, he commissioned Tompkins as a captain in the Confederate Army so that she could continue her good work as
a public servant at the Robertson
Hospital in Richmond.
The commission paid off: the hospital's staff of six only lost 73 of the
1,333 men they cared for during the war (Burns).
Women still had few professional opportunities
outside the home after the war, and medical schools remained reluctant to
admit women as students.
Susan Dimock
(1847–1875), twice denied admission to Harvard's medical school, had to teach herself German and travel to Zurich in 1868 to
pursue her MD. However, attitudes were changing. The same year that
Dimock traveled to Zurich, the American Medical Association's Committee on Ethics strongly
encouraged the recognition of sufficiently educated and qualified female
physicians. The Association welcomed
its first female member, Sarah Hackett
Stephenson, in 1876 ("Our History").
Dimock was admitted to honorary
membership in the North Carolina Medical
Society in 1872.
It would have been difficult for
James
Dusenbery to have dismissed the myriad medical advances over
the course of his professional lifetime. Promoting his view that
micro-organisms caused disease, Pasteur
developed ways to prevent milk, beer, and wine from making people sick, a
process now known as pasteurization. Formal nursing programs were
established in the early 1870s, and a decade later vaccines were being
developed for rabies, anthrax, and chicken cholera. These and many other
developments created new knowledge in the field of medicine, knowledge
requiring extensive training of aspiring physicians through courses,
laboratory work, and practica. By the time
Dusenbery died in 1886, the
University of Pennsylvania, the
institution from which he had received his medical degree after attending
two years of lectures and writing a thesis, had expanded its curriculum to
three years, with examinations at the end of each year, considerable
laboratory work, and a full year of clinical experience working with living
patients.
[18]Notes
^1. The following essay is based primarily on three sources: lecture notes
from a history of medicine seminar offered by Dr. George F. Sheldon of the University of North Carolina at Chapel
Hill during the spring 2008
semester; a digital copy of the Catalogue of the Trustees, Officers, and Students of the University
of Pennsylvania, 1844–45 (Philadelphia: Bailey,
1845); and a photocopy of the Forty-Second Annual Circular and Catalogue of the Medical
Department of the University of Maryland, Session
1849–'50 (Baltimore: Woods, 1849).
^2. After realizing that doctors were transferring childbed fever from
cadavers to living patients in May 1847,
Ignaz Semmelweis
(1818–1865) ordered his staff at Vienna General Hospital to sanitize themselves before
deliveries by washing their hands in chlorinated water. Deaths from
childbed fever dropped drastically. Unfortunately, these practices were
not implemented widely at the time and the value of sanitization and
sterilization would be debated for decades to come (Waller
63–64).
^3. The typical magnification of today's optical microscopes, which use
refractive glass to focus light into the eye, is up to 1500x.
^4. Dr. Valentine H. Taliaferro
(1831–1887) had a long history with Atlanta Medical College, which was the earliest
forerunner of Emory University School of
Medicine. After serving as a surgeon in the Confederate Army, Taliaferro was named chair of women's
diseases in 1872, elected professor of women's
and children's diseases in 1874, served as dean
of the faculty in 1876, and became a member of
the board of trustees at the college in 1877.
Thereafter, he served on the Georgia State
Board of Health, holding a number of positions including
secretary and executive member (Martin 360–361).
^5. Although the Medical Society of North
Carolina elected a board of seven members in 1859 to regulate the practice of medicine,
North Carolina did not
require its physicians to be licensed by the Board of Medical Examiners
until 1921 (150 Years).
^6. Dr. C[harles] L[ee] Payne
(1798–1865), with whom Dusenbery later studied medicine. Payne represented Davidson County in the North Carolina General Assembly in 1844 and served as a Councilor of State in 1848. He was married to Mary Ann Lewis (1809–1887). They were the parents
of seven known children, only one of whom lived to adulthood.
^7. The faculty included Nathaniel
Chapman (physic and clinical medicine), Robert Hare (chemistry), William Gibson (surgery), William E. Horner (anatomy), Samuel Jackson (institutes of medicine),
George B. Wood (materia medica and pharmacy), Hugh L. Hodge (obstetrics and the
diseases of women and children), William W.
Gerhard (clinical medicine). For more information,
consult the Catalogue of the
Trustees, Officers, and Students of the University of Pennsylvania,
1844–45 (Philadelphia: Bailey, 1845), 8. The Health
Sciences Library at the University of North Carolina at Chapel Hill
houses Dr. Chapman's A
Compendium of Lectures on the Theory and Practice of
Medicine, also available online at Internet Archive. The library's copy includes
a patient note to "Dr. Fuller."
^8. See Regulations of the Medical
Department of the University,
Report on the Medical Department
of the University of Pennsylvania, for the Year 1845
(Philadelphia: Bailey, 1845), 31.
^9. Dr. R[obert] L[ee] Payne
(1834–1895), a student at the University of North Carolina during the 1852–1853 academic year and
a graduate of Davidson College,
followed his father into the medical profession, graduating from
Jefferson Medical College in
Philadelphia in 1857 and practicing in Lexington until his death—an
unusually violent death at the hands of Baxter
Shemwell ("Obituary" 132).
^10. Baltimore was home to
Fayette's uncle, Samuel B. Dusenbery (1800–1855), a
captain and quartermaster in the U.S.
Army. Originally from North
Carolina, he was married to Mary Ray Bowie (1814–1881) and moved to
Baltimore in about 1837; they were the parents of two children,
Mary Ray and Hamilton Bowie Dusenbery. Samuel B. Dusenbery died in New Mexico.
^11. In the early nineteenth century, only the corpses of executed
criminals could be used legally for dissection in anatomy laboratories.
Physicians considered the study of human anatomy essential, but they had
difficulty securing anatomical material for their lectures and
demonstrations, often using wax models and illustrations instead of
corpses. The physician's view that anatomical knowledge was necessary
for the informed practice of medicine was countered by horrific accounts
of people who were murdered so that their bodies could be sold, of
flagrant grave robberies, and of extreme measures some families felt it
necessary to take to guard the deceased for several weeks until the body
could no longer be used for dissection. Others opposed dissection on
religious grounds, believing that the human body needed to be inviolate
and whole on Judgment Day. The limited supply of corpses encouraged
body-snatchers, or "resurrection men," to steal bodies from
cemeteries and offer them for sale to unscrupulous physicians. Though
body-snatching was illegal, the law was difficult to enforce. Some
states considered the body "dust," worth less than the clothing,
shroud, or jewelry the deceased may have worn and which the
body-snatchers were careful to leave behind to avoid being charged with
theft. In 1832
England's Warburton Anatomy Act served to license
anatomists, allowed for dissection of donated and unclaimed bodies, and
set requirements for the treatment of corpses before and after
dissection. Many states in the United
States enacted similar laws in the 1830s. Sometimes the
dissections, especially in the South, were carried on outdoors during cool months to
lessen the overwhelming smell of putrefying flesh; elsewhere, separate
buildings or sections of buildings housed the dissecting laboratory. See
John B. Blake, The Development of American Anatomy
Acts,
Journal of Medical
Education 30.8 (1955): 431–39.
^12. The faculty included Nathan R.
Smith (surgery), William E. A.
Aiken (chemistry and pharmacy), Samuel Chew (therapeutics, materia medica, and hygiene),
Joseph Roby (anatomy),
William Power (theory and
practice of medicine), Richard H.
Thomas (midwifery and diseases of women and children),
George W. Miltenberger
(pathological anatomy and demonstrator of anatomy). For more
information, consult the Forty-Second Annual Circular and Catalogue of the Medical
Department of the University of Maryland, Session
1849–'50. (Baltimore: Woods, 1849), 2.
^13. Such students, by agreement among reputable medical schools, were
admitted ad eundem; that is, "at the same
rank" that they had enjoyed in a previous institution. So, for
example, Fayette Dusenbery, having
completed one year at the University of
Pennsylvania, was considered a "second-year" student
at the University of Maryland.
^14. See Forty-Second Annual
Circular and Catalogue of the Medical Department of the University
of Maryland, Session 1849–'50 (Baltimore: Woods,
1849), 19–20.
^15. The North Carolina Medical
Society was founded in 1799 and a
year later established a Board of Censors to determine who was qualified
to practice medicine in the state. A law establishing a medical board of
examiners was not enacted, however, until 1859;
it "allowed for physicians with a medical diploma and those swearing
under oath that they had practiced medicine prior to the bill to
register to practice within their county of residence." See
150 Years of Leadership: The
History of the North Carolina Medical Society's Pioneering Physician
Leaders (Raleigh: North Carolina Medical Society, 2004),
4.
^16. Morton's "letheon" was a
mixture of sulfuric ether and oil of orange, which masked the smell of
ether (Fenster 6).
^17. During the Crimean War,
the British Army's death rate from
preventable disease was seven times that from battle wounds. Before
Nightingale's intervention in
the filthy and rat-infested hospital barracks at Scutari, the death rate for British soldiers was said to be 60
percent; after Nightingale
literally cleaned up the place, the death rate dropped to 1 percent by
the end of the war (Joel 14–16).
^18. See Medical Class of 1889:
Historical Development of Curriculum, University of
Pennsylvania Archives and Records Center, n. d.
Craig's
Microscope, patented February 18, 1862. C. H. Wheeler &
Co., Boston, MA. For more information about this item, click here.
German valved glass
cupping set from the 1830s. For more information about this
item, click here.
Portrait of German
physician and developer of phrenology, Franz Joseph Gall
(1758–1828)
Phrenological
head (L.N. Fowler), modern facsimile. For more information
about this item, click here.
James Dusenbery condemns the "demon of quackery" in his senior
speech "The State
of Medical Sciences in N.C."
Announcement for medical study at the University of
Pennsylvania (1867–1868).
Address of
the Trustees Concerning the Medical Department of the
University of Maryland. Baltimore: John D. Toy, 1836.
Surgical kit,
used for amputations dating from the mid-1880s. For more information
about this item, click here.
Frontispiece portrait
of Susan Dimock. Memoir of Susan
Dimock: Resident Physician of the New England Hospital for Women and
Children. Boston: J. Wilson, 1875. For more information on
Susan Dimock, click here.
Saddle bag
containing vials of various medicinal compounds (dated 1892). For more
information about this item, click here.
