What It Was Like To Be Sick In 1884

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IN 1884 ALMOST three-quarters of America’s fifty million people lived on farms or in rural hamlets. When they fell ill, they ordinarily were treated in their own homes by someone they knew, someone who might not be a trained physician but a family member, neighbor, or midwife. Only a handful of smaller communities boasted hospitals, for they were still a big-city phenomenon. And in those cities, only the workingman and his family, the aged and dependent, the single mother, or the itinerant laborer would normally have received institutional care. For the middle class, a bed among strangers in a hospital ward was a last resort. Even within the working class of America’s rapidly growing cities, the great majority of patients too poor to pay a private physician never entered a hospital but instead received free outpatient care from dispensaries, from paid municipal physicians, and from hospital outpatient departments. The hospital was a place to be avoided—often a place in which to die—and not the fundamental element in medical care that it has become in the twentieth century.

Some of the ills Americans fell victim to a century ago were the same as those we still suffer from—bronchitis, rheumatism, kidney and circulatory ailments; others have become either uncommon, like malaria, less common, like syphilis, or entirely banished, like smallpox. Tuberculosis was by far the greatest single killer of adults; gastrointestinal ills were the greatest scourge among children. Both tuberculosis and the “summer diarrheas” reflect and document the grim realities of a society in which food was sparse for many, work exhausting, living conditions filthy, and sanitation and water supplies well suited to the spread of infectious disease.

Americans still lived in the shadow of the great epidemics. Yellow fever had scourged the lower Mississippi valley only a few years before, and the threat of cholera that had scarred Europe in the early 1880s was just lifting; there was little reason to anticipate that Americans would be spared the devastation of any nationwide epidemic until the onslaught of influenza in 1918. But every year, of course, they had to contend with the usual exactions of typhoid fever, syphilis, malaria, measles, smallpox, and diphtheria.

Life expectancy at birth was a little over forty for the population generally—a bit more than half of what it is today. For those born in large cities it could be much lower. In Philadelphia, for example, life expectancy at birth was 40.2 for white males and 44.8 for white females—and 25.2 and 32.1, respectively, for black males and females. But for those fit enough to survive the hazards of infancy and childhood, life expectancies were not radically different from those prevalent in the United States today. A forty-year-old Philadelphia could expect to live to 65 if a man and to almost 69 if a woman; for blacks the figures were 58.6 and 64. Younger people died of ailments such as measles, diphtheria, diarrheas, croup, and pneumonia. Although a smaller proportion of Americans survived to die of cancer and the degenerative diseases now so important, their experience with them (excepting apparently a much lower incidence of most kinds of cancer) was similar to ours of the 1980s. Older people suffered and died from roughly the same sorts of things they still do.

MOST AILMENTS were, in the terminology of the day, “self-limited.” In the great majority of cases a patient could expect to recover—with or without the physician’s ministrations. This was understood and acted upon; even the wealthy did not ordinarily call a physician immediately except in the case of severe injury or an illness with an abrupt and alarming onset. The decision to seek medical help would be made gradually; first a family member might be consulted, then a neighbor, finally perhaps a storekeeper who stocked drugs and patent medicines—all before turning to a doctor. Many housewives kept “recipe books” that included everything from recipes for apple pie and soap to remedies for rheumatism and croup. Guides to “domestic practice” were a staple for publishers and peddlers. It is no wonder that doctors a century ago were so critical of the care provided by what they dismissed as uneducated and irresponsible laymen.