The history of medicine in the United States encompasses a variety of approaches to health care in the United States spanning from the home remedies of the colonial days to the present formalization of modern biomedicine. This history also consists of systemic medical abuse inflicted onto marginalized communities as a result of eugenics and scientific racism, starting from the 18th century. The medical history in the United States also includes the work of midwives and nurses.
Colonial Era At the time settlers first came to the United States, the predominant medical system was humoral theory, or the idea that diseases are caused by an imbalance of bodily fluids.Jouanna, Jacques. 2012. "The Legacy of the Hippocratic Treatise The Nature of Man: The Theory of the Four Humours" in Greek Medicine from Hippocrates to Galen, edited by Philip van der Eijk, pp. 335-360. Boston: Brill. Settlers initially believed that they should only use medicines that fit in this medical system and were made out of "such things only as grown in England, they being most fit for English Bodies," as said in The English Physitian Enlarged, a medical handbook commonly owned by early settlers.Culpeper, Nicholas. 1666. The English Physitian Enlarged. London. However, as settlers were faced with new diseases and a scarcity of typical plants and herbs used to make therapies in England, they increasingly turned to local flora and Native American remedies as alternatives to European medicine. The Native American medical system typically tied the administration of herbal treatments with rituals and prayers.Robinson, Martha. 2005. New Worlds, New Medicines: Indian Remedies and English Medicine in Early America. Early American Studies (Spring): 94-110. Any Native American medical information that did not agree with humoral theory was deemed heretical by Spanish authorities, and tribal healers were condemned as witches.Kay, Margarita. 1987. "Lay Theory Of Healing In Northwestern New Spain" Social Science & Medicine 24(12): 1051-1060. In English colonies on the other hand, it was more common for settlers to seek medical help from Native American healers.
Disease environment
Mortality was very high for new arrivals, and high for children in the colonial era.Rebecca Jo Tannenbaum, Health and Wellness in Colonial America (ABC-CLIO, 2012)Henry R. Viets, "Some Features of the History of Medicine in Massachusetts during the Colonial Period, 1620-1770," Isis (1935), 23:389-405 Malaria was deadly to many new arrivals. The disease environment was very hostile to European settlers, especially in all the Southern colonies. Malaria was endemic in the South, with very high mortality rates for new arrivals. Children born in the new world had some immunity—they experienced mild recurrent forms of malaria but survived. For an example of newly arrived able-bodied young men, over one-fourth of the Anglican missionaries died within five years of their arrival in the Carolinas.Bradford J. Wood, "'A Constant Attendance on God's ': Death, Disease, and the Anglican Church in Colonial South Carolina, 1706-1750," South Carolina Historical Magazine (1999) 100#3 pp. 204-220 in JSTOR Mortality was high for infants and small children, especially from diphtheria, yellow fever, and malaria. Most sick people turn to local healers, and used folk remedies. Others relied upon the minister-physicians, barber-surgeons, apothecaries, midwives, and ministers; a few used colonial physicians trained either in Britain, or an apprenticeship in the colonies. There was little government control, regulation of medical care, or attention to public health. By the 18th century, Colonial physicians, following the models in England and Scotland, introduced modern medicine to the cities. This allowed some advances in vaccination, pathology, anatomy and pharmacology.Richard H. Shryock, "Eighteenth Century Medicine in America," Proceedings of the American Antiquarian Society (Oct 1949) 59#2 pp 275-292. online
There was a fundamental difference in the human infectious diseases present in the indigenous peoples and that of sailors and explorers from Europe and Africa. Some viruses, like smallpox, have only human hosts and appeared to have never occurred on the North American continent before 1492. The indigenous people lacked genetic resistance to such new infections, and suffered overwhelming mortality when exposed to smallpox, measles, malaria, tuberculosis and other diseases. The depopulation occurred years before the European settlers arrived in the vicinity and resulted from contact with trappers.Alfred W. Crosby, "Virgin soil epidemics as a factor in the aboriginal depopulation in America." William and Mary Quarterly (1976): 289-299 online; in JSTORJames D. Rice, "Beyond 'The Ecological Indian' and 'Virgin Soil Epidemics': New Perspectives on Native Americans and the Environment." History Compass (2014) 12#9 pp: 745-757.
Medical organization The French colonial city of New Orleans, Louisiana opened two hospitals in the early 1700s. The first was the Royal Hospital, which opened in 1722 as a small military infirmary, but grew to importance when the Ursuline Sisters took over its management in 1727 and made it a major hospital for the public, with a new and larger building built in 1734. The other was the Charity Hospital, which was staffed by many of the same people but was established in 1736 as a supplement to the Royal Hospital so that the poorer classes (who usually could not afford treatment at the Royal Hospital) had somewhere to go.John Salvaggio, New Orleans' Charity Hospital: A Story of Physicians, Politics, and Poverty (1992) pp. 7-11.
In the British colonies, medicine was rudimentary for the first few generations, as few upper-class British physicians emigrated to the colonies. The first medical society was organized in Boston in 1735. In the 18th century, 117 Americans from wealthy families had graduated in medicine in Edinburgh, Scotland, but most physicians learned as apprentices in the colonies.Genevieve Miller, "A Physician in 1776," Clio Medica, Oct 1976, Vol. 11 Issue 3, pp 135-146 In Philadelphia, the Medical College of Philadelphia was founded in 1765, and became affiliated with the university in 1791. In New York, the medical department of King's College was established in 1767, and in 1770, awarded the first American M.D. degree.Jacob Ernest Cooke, ed. Encyclopedia of the North American colonies (3 vol 1992) 1:214
Smallpox inoculation was introduced 1716–1766, well before it was accepted in Europe. The first medical schools were established in Philadelphia in 1765 and New York in 1768. The first textbook appeared in 1775, though physicians had easy access to British textbooks. The first pharmacopoeia appeared in 1778.Carl Bridenbaugh, Cities in the Wilderness: The First Century of Urban Life in America 1625-1742 (1938) pp 399-400Ola Elizabeth Winslow, A destroying angel: the conquest of smallpox in colonial Boston (1974). The European populations had a historic exposure and partial immunity to smallpox, but the Native American populations did not, and their death rates were high enough for one epidemic to virtually destroy a small tribe.Paul Kelton, Cherokee Medicine, Colonial Germs: An Indigenous Nation's Fight Against Smallpox, 1518–1824 (University of Oklahoma Press, 2015)
Physicians in port cities realized the need to quarantine sick sailors and passengers as soon as they arrived. Pest houses for them were established in Boston (1717), Philadelphia (1742) Charleston (1752) and New York (1757). The first general hospital was established in Philadelphia in 1752.Richard Morris Encyclopedia of American History (1976) p 806.Carl Bridenbaugh, Cities in the Wilderness: The First Century of Urban Life in America 1625-1742 (1938) p 401
Late 18th and 19th Century Late 18th Century
The Yellow Fever Epidemic of 1793 devastated Philadelphia, then the capital of the United States, leaving thousands dead and many more fleeing in terror. Contemporary theories, including those discussed in A Short Account of the Malignant Fever, attributed the outbreak to rotting coffee dumped at the city’s docks. Others blamed miasma—foul air supposedly emanating from decaying matter. The outbreak was likely introduced by refugees fleeing the slave revolt in Saint-Domingue (modern-day Haiti). These refugees, arriving by ship, may have carried the virus and its mosquito vectors into the bustling port city. The lack of proper sanitation in an overcrowded city exacerbated the problem, leading to rapid transmission.
The epidemic caused mass panic. Philadelphia’s population of roughly 50,000 saw an exodus of over 20,000 residents, including government officials such as George Washington. A Short Account describes scenes of abandoned bodies, overflowing graveyards, and homes left empty due to sudden deaths. Societal impact led to widespread discrimination, particularly against African Americans who were falsely believed to be immune and were often conscripted into caregiving roles under duress.
Medical responses were disorganized and contentious. Physicians like Dr. Benjamin Rush advocated aggressive bloodletting and purging, a common method, but largely ineffective treatment. Other doctors, such as Jean Devèze, opposed these methods. Ultimately, colder temperatures in November finally halted the outbreak, as the mosquito population declined.
Thomsonianism and eclectic medicine
In the 19th century the nation was flooded with medical sects promoting a wide range of alternative treatments for all ailments. The medical societies tried to impose licensing requirements in state law, but the eclectics undid their efforts. The most famous of the eclectics was Samuel Thomson (1769-1843), a self educated New England farm boy who developed a wildly popular herbal medical system.John S. Haller Jr., Medical Protestants : the Eclectics in American Medicine, 1825-1939 (1994) pp. 37-55 online. For a fully detailed history see John S. Haller Jr., The People's Doctor: Samuel Thomson and the American Botanical Movement 1790-1860 (2001). He founded the Friendly Botanic Societies in 1813 and wrote a manual detailing his new methods.Samuel Thomson, New guide to health, or, Botanic family physician: containing a complete system of practice, upon a plan entirely new; with a description of the vegetables made use of, and directions for preparing and administering them to cure disease; to which is prefixed A narrative of the life and medical discoveries of the author (1822 edition) online He promised that even the worst ailments could be cured without any harsh treatments. There would be no surgery, no deliberate bleeding, no powerful drugs. Disease was a matter of maladjustment in the body's internal heat, and could be cured by applying certain herbs and medicinal plants, coupled with vomiting, enemas, and steam baths. Thomson's approach resonated with workers and farmers who distrusted the bloody hands of traditional physicians.James O. Breeden, "Thomsonianism in Virginia." Virginia Magazine of History and Biography 82.2 (1974): 150-180 online. President Andrew Jackson endorsed the new fad, and Brigham Young promoted it to the new Mormon movement.Linda P. Wilcox, "The imperfect science: Brigham Young on medical doctors." Dialogue: A Journal of Mormon Thought 12.3 (1979): 26-36.
Thomson was a master promoter. He patented his system and sold licenses to hundreds of field agents who gained patients during the cholera outbreaks of 1832 and 1834. By 1839, the movement claimed three million followers and was strongest in New England.Daniel J. Wallace, "Thomsonians: The People's Doctors." Clio Medica 14 (1980): 169-86.