Lecture Four: Republican Medicine

After the Revolution, American was severed from the European seat of orthodox medical power.  American orthodox doctors were forced to establish their own schools, their own dogma, and their own leaders.  Much of what glued orthodox doctors together and led to copious research was the medical racial script, much of which was inscribed in the standard medical school curriculum North and South.  However, during the Republican period, Americans eschewed labels, rules, and favoritism.  This translated into an ideal that anyone who thought themselves to be a doctor could be, without any desire to regulate physician education or practice.  For instance, no states maintained licensing requirements despite an orthodox push to do so.  Alternative medical ideas flourished.  We will discuss how orthodox medicine responded and how the American School--researches focused on racial medicine--lofted America into some degree of intellectual independence.

Transcript

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We're going to talk about medicine a little bit in the early republic. And it's really important, like we mentioned before, to realize that once America became severed from England, the nidis of orthodoxy dissolved. What I mean by that is there were no more medical schools over there. There were no more British doctors who were basically the leading doctors, especially in the islands, but also in some of the colonies as well. Now it was up to the Americans and people like Benjamin Rush and some of the other doctors we had mentioned who were doing a lot of research on black bodies. And these were actually called the American School. They had their own name. And they published a lot prolifically, both in America and in Europe, basically dealing with research done on either slaves or even sometimes free blacks that were in poor hospitals. So this became the intellectual backbone of American medicine. And at the same time, Americans were creating medical schools, University of Pennsylvania being one of the earliest ones. The curriculum was borrowed largely from the European model. It was galenic initially, but then a transformation occurred. We already talked about how the Glenic theory of humors was already being challenged through experimentation and that sources of diseases and treatments were being discovered, herbs were being used in different ways than they had before. But what really happened that changed the nature of healthcare the most occurred in France around the time of the revolution. So right around their revolution, they developed a new healthcare system and a new methodology of care that essentially pushed the patient away. Now we talked about in galanic medicine, the patient was the primary methodology of determining both illness and treatment and resolution. What we meant by that was that the patient's symptoms are what brought them to a doctor. Symptoms were then looked at through the humoral lens, through experimentation and other modalities, certain herbs, diets, exercises, purging, bleeding, leeches were used to treat what was felt to be imbalances in the body, and the resolution of symptoms indicated cure. In other words, the doctor had to be completely cognizant of the patient because the patient was telling the doctor what was wrong and when things were getting better. Things changed in France. Part of the change was the invention of the stethoscope and also other techniques that allowed doctors to be more probing into the body, not the least of which were a plethora of dissections that allowed the doctors to understand the mechanisms of the body in ways that transcended the humoral lens. Foucault talks a lot about this in the birth of the clinic. And if anyone wants to read something interesting about modern medicine at that time, uh Foucault is the guy. And mostly because they removed the patient from the equation. If the vector moved from the patient to the doctor, with these changes, the vector shifted 180 degrees from the doctor to the patient. He writes in his book paradoxically, in relation to that which he is suffering from, the patient is only an external fact. The medical reading must take him into account only to place him in parentheses, since disease exists only beneath the patient gaze and must be mapped discreetly by the doctor. If one wishes to know the illness from which he is suffering, one must subtract the individual with his particular qualities. And then he goes on to say that symptoms faded from the physician gaze. Only signs, which are objective observations from the physical exam, especially with a stetoscope, mattered. And all pathologic manifestations would speak in a clear, ordered language. There'd be no variability, no nuance, no verging from what was objectively true. And I quote again, the clinical gaze is the gaze that burns things to their furthest truth, according to these new doctors and the new methodology. The humoral lens was blown up. The patient became peripheral. The patient's symptoms became less important than what the doctor discovered through the physical exam, especially with the stethoscope. Why this is important is because a lot of what medicine was back then was so patient-focused. And now all of a sudden the orthodox doctors were creating a methodology that was focused on objective truths. And that is a crucial piece of information that we will see repeated over and over, that there is a singular truth in medicine. And that truth could only be discovered by the doctor. Whatever the patient says is somewhat irrelevant. We'll see later that some of the orthodox doctors said it's even best not even to talk to patients, because talking to patients will only create confusion. What kind of confusion? The kind of confusion that is subjective, right? So patient may say, well, I'm feeling better, but the exam's no better, so the patient can't be feeling better. This is not a subtle change. This is dramatic. And we'll see a similar dramatic change occur in the turn of the next century, uh, uh in 1900, when Germanic um ideology and progressive ideology creates even a deeper um discounting of the patient and more of an objectivity that is determined to be an absolute truth. So this was a repudiation of slave medicine, of Native American medicine, of humoral medicine, and it became integrated into the experimentation that was even done on black bodies during this time period. Medical schools were set up with laboratories, um, medical schools were set up with anatomy labs, students were supposed to learn physiology, pathology, anatomy. This stuff was not done before. It seems pretty commonplace to most doctors now, but it was novel. There were a few problems that occurred in, particularly in America, um, that were unique to American medicine. Uh, for one, there were no regulations at all. Understand that under the New Republic, there was a very laissez-faire view of how people should live their lives. Um, there was uh little regard for authority, for dogma, for one right answer thinking. And orthodoxy became one right answer thinking. It became a dogma uh based on experimentation and the exam that really had no nuance. The patient was not able to give variability to what the doctor could discover on his own. I say his because there were no women doctors at this time. Um, but without regulations, how could you enforce it? So getting a there were no doctor's license during the early republic when um a lot of the Orthodox doctors felt it was crucial to have very well-trained doctors, there was a move to create licensing requirements in several states, and some of them did pass. But by 1820, they were all gone. They were all turned over. Um, the the new American world did not want to put restrictions, and if someone said they were a doctor, well, that was good enough just to say they were a doctor. Also, as we'll see in a later chapter, there were multiple forms of medicine that competed with orthodox medicine. Remember, slave medicine was still alive and well at this time, especially on plantations, and very often that's who plantation owners used were their slaves to help with health care, despite the laws that were passed to prevent such a thing. It just made too much sense for them not to do this. There were also other forms of medicine like homeopathy and Thompsonianism that we'll talk about later, which did share a lot with humoral medicine and rejected the notion of there being absolute truths and one right answer, and any form of medicine that separated itself from the subjective complaints of the patient. So, so orthodox doctors were fighting against these people. And it's again no trivial matter because orthodox doctors were in the minority. And secondly, it was pretty well known that when you were treated with an or by an Orthodox doctor, as George Washington's family could tell you, you had a good chance you weren't going to live. They were maximalists, they did a lot to you, often with the bleeding being significant and the purging too, which is when they give someone medicine to make them have copious diarrhea to try to normalize the abnormalities in the system, um, which sounds still very humoral because they were still treating people in a humoral way, even if they were diagnosing them with more specific diagnoses. Well, these were dangerous. They they made sick people die. So plantation owners knew this, um, but a lot of people stayed away from these doctors. We'll see, the homeopaths had a whole different philosophy that was much more minimalistic and patient-centric. So they were fighting them. So there were no licenses, anyone could practice medicine, and anyone did. And uh, as long as you were a white man, you could call yourself a doctor. That was the criteria back then. This is true with medical schools too. Even though places like the University of Pennsylvania and many other modern medical schools budgeted in this time, dozens of schools popped up. And most of these schools had no particular curriculum. You know, they didn't all do anatomy and physiology and give lectures. Some of them, you just had to pay money and you get a degree. It was as little as that. And the uh Orthodox doctors pushed hard against this. Um, and we'll we'll see that when we get to the chapter in the AMA, that one of the biggest uh incentives to create a centralized organization of Orthodox doctors was to push back against a medical education system that essentially was churning out doctors who were anything but orthodox, even though some of them considered themselves orthodox doctors. So this was building up during this time period. We had people like um Benjamin Rush, who were certainly um reputable doctors publishing, teaching, and then we had people like Joe Schmoe, who was probably walking around with a bunch of potions, a bunch of herbs, patents, patent medicines, um, telling you you had this or that and selling you a bill of goods. Um it's debatable which one was more dangerous to the patient. Uh, we we don't know. We know that the Orthodox doctors certainly were. Um, yeah, I mean to look a little bit closer at this idea, it's interesting to uh look at a single doctor, a guy named Nathan Davis. Nathan Davis was a doctor who um was uh from New York um and ultimately practiced in Chicago. He attended Rush Medical School, which was a school that uh practiced traditional orthodox medicine. Um and in 1849 he was establishing his medical practice. Um he uh also went to the Western New York Medical College for further treatment. He practiced medicine in Broome County, New York, and started the Broome County Medical Society. Um, and then the New York Medical Society, uh, which he used to forward campaigns to tighten licensing laws and educational requirements. It's important to know that a lot of societies popped up around this time. Uh every state had a medical society, and most cities had a medical society, and these medical societies were a bastion of orthodoxy. This is where the traditional Orthodox doctors came and complained and gathered together and tried to pass licensing laws and education laws. Um Nathan Davis said, and I quote, that from the very nature of things, it is impossible to build up a professional aristocracy in this country, unquote, given the proliferation of quackery and substandard medical requirements. He used the word quackery all the time. Quackery was anything that was not traditional orthodoxy. So to teach people in a way that was non-orthodox to Davis and other Orthodox doctors meant to threaten uh the actual um soul of medicine and the changes that were going on in Paris that he hoped to uh bring to the to this country. Why do I bring up Nathan Davis? Well, one of the reasons is that he was a traditional doctor. We talk about the the racial script. It's very unlikely in any of his um comings and goings that Nathan Davis ever ran into an African-American patient and certainly not a colleague. He was a northerner, he was certainly not a fan of slavery, um, although he worked with many, many Southern colleagues uh and he had no problem with them. He he was brought up with the racial script in the medical school curriculum that he attended. He likely um uh did uh dissections on black bodies. He learned about the difference, Nate, the different nature of blackness from whiteness, and many of the um, and he read many of the scholars of medicine from America who experimented on black bodies. But again, Davis, this was peripheral to Davis. Um it was something that united the medical field that they in the orthodoxy they all followed the same script. That that's crucial. There was uniformity, and Davis was a huge proponent of uniformity. He wanted everything to be the same in all the medical schools, and he insisted that um that they follow the orthodox script. So he was a pretty typical Orthodox doctor, really pushing, especially in New York and ultimately in Chicago, for reforms that would create licensing laws, and he found it impossible. He was frustrated. And again, the second reason to bring up Nathan Davis is he is the founder of the American Medical Association, he is the man who um to this day is credited with fine founding it, and interestingly, as we'll see later, he's also discredited uh by the AMA today because he is considered um a leader of what became a racially tinged organization. It was felt that Nathan Davis um was responsible for that. There's nothing I've read through his writings, I've gone to archives, there's nothing in his writings that would even suggest he had a racist bone in his body. But by saying that, we're repudiating the very fact that orthodox medicine at this time was racist because it followed the medical racial script. To us today, that's racist. To them back then, that was science. So I I always find it funny when people label this stuff as pseudoscience because it wasn't pseudoscience. They believed it. This was science. When Calhoun cited um the writings from these people, he was citing science. So that this was considered the norm back then. And Nathan Davis did encompass all that, but that doesn't mean he was a racist, but it does give us a window into the racial exclusion that was occurring um in American Orthodox medicine. So during the Republican period, it became extremely difficult for Orthodox doctors to find a foothold because of the competition, because of the huge number of medical schools that were teaching other things, because um there were no licensing laws allowing everyone to be a doctor, and because even though Davis never said it in his prolific writings, because the outcomes were so bad, it's really interesting because I've read a lot of things written by Orthodox doctors during this time period. Not one of them says that their orthodoxy led to bad outcomes. They are quite sure that if everyone practiced orthodox medicine, the outcomes would be good, despite the clear evidence that that was not the case. Um, despite the changes going on in France, despite the fact there was a lot of experimentation and research going on, most doctors still held tight to the use of herbs, diet, um, exercise purgatives, and bleeding to treat people. That hadn't changed. And until treatment changes, um, it doesn't matter what else you're doing, your outcomes are not going to be good. Also, with all their diagnostic techniques, they couldn't really figure a lot out. I mean, as a doctor, I know that simply having a stethoscope and an exam is not going to tell me a lot, especially when I've decided that anything the patient tells me is too subjective to even listen to. That really gets in the way of truly determining what's going on. So, if anything, this new change in medicine in the revolutionary period, the republican period, um probably led to worse outcomes than it had even before when things were more patient-centric. Um and this was a challenge because if orthodox medicine was not accepted by Americans, if there were alternatives that seemed to be better, if there was no law uh that would restrict who could be a doctor or what kind of medicine medical schools can teach, then what chance did Orthodox medicine have to really gain a foothold? It was a wild, wild west of healthcare back then. And there was no reason to think when Nathan Davis was tramping around New York in the 1840s and 50s that that anything was going to change. But let's credit Nathan Davis for helping spearhead the change. And he worked with other doctors, but most of whom actually were Southerners, because that was where the real bastion of orthodoxy was at the time, um, to come up with a solution. The solution was the American Medical Association, that we'll talk about next. Uh it was formed in 1847. It was um not much of anything for its first many decades, but its very existence and its agenda um did spark the radical changes that both um elevated orthodoxy to the forefront of medical care in this country and essentially eradicated all other forms of medicine, as well as promoting a racial script that maintained um the complete exclusion of African Americans from the healthcare system. So we will get into that on the next talk.