What It Was Like To Be Sick In 1884

Physicians still found it difficult to think of diseases as concrete, specific entities. Fevers tended to melt into each other; diphtheria and croup, even syphilis and gonorrhea, were often confused.

The availability of such new tools as the ophthalmoscope plus an avalanche of clinical information meant that no individual could hope to master the whole of clinical medicine as might have been done a half-century earlier. Coupled with the realities of an extremely competitive marketplace, this explosion of knowledge guaranteed that the movement toward specialization would be irresistible. Significantly, however, ordinary physicians remained suspicious of specialists, whom they saw as illegitimate competitors using claims to superior competence to elbow aside family physicians. In 1884 the handful of specialist societies already in existence were well aware of such hostility, and most adopted rules forbidding members from advertising their expertise in any way.

THERE WERE OTHER STRAWS in the wind indicating the directions in which medicine was to evolve. One was the gradually expanding role of the hospital. Though still limited almost entirely to larger communities, hospitals were playing an ever larger role in the provision of medical care to the urban poor. In 1873, when America’s first hospital survey was undertaken, it found that only 178 hospitals of all kinds (including psychiatric) existed in the United States; by 1889 the number had risen to over 700. Even in small towns, local boosters and energetic physicians were beginning to think of the hospital as a necessary civic amenity; by 1910 thousands of county seats and prosperous towns boasted their own thriving community hospitals.

America’s first few nursing schools provided another, if less conspicuous, straw in the wind. The movement for nurse training was only a decade old in the United States in 1884 and the supply of trained nurses and number of training schools pitifully small; the 1880 census located only fifteen schools, with a total of 323 students. But the first products of these schools (reinforced by a handful of English-trained administrators) were already teaching and supervising the wards in many of our leading hospitals. They were also beginning to provide a supply of nurses for private duty in the homes of the middle and upper classes.

Before the 1870s, both male and female nurses ordinarily had been trained on the job in hospitals or, even more informally, alongside physicians in the course of their private practice. But no matter how long they practiced or how skilled their ministrations, such individuals were inevitably regarded as a kind of well-trained servant. By the time of the First World War, the hospital and the nurses who staffed, taught, and trained in them had become a fundamental aspect of medical care for almost all Americans, not just for the urban poor.

Some aspects of medicine have not changed during the past century. One is a tension between the bedside and the laboratory. At least some clinicians in 1884 were already becoming alarmed at the growing influence of an impersonal medical technology. Even the thermometer could be a means of avoiding the doctor’s traditional need to master the use of his eyes, ears, and fingertips—and thus disrupt the physician’s personal relationship with the patient. Such worries have become a clichéd criticism of medicine a century later; the growth of technology seems to have created an assortment of new problems as it solved a host of old ones.

But whatever the physician’s armory of tools, drugs, and ideas, some aspects of medicine seem unlikely to change. One is death. Euthanasia was already a tangible dilemma in 1884—when the physician’s technical means for averting death were primitive. “To surrender to superior forces,” as one put it, was not the same as to hasten or induce the inevitable. “May there not come a time when it is a duty in the interests of the survivors to stop a fight which is only prolonging a useless or hopeless struggle?”

Some of our medical problems have not been solved so much as redefined; and some have changed only in detail. A century ago an essay contest was announced in Boston; its subject was the probability of a cure for cancer. No prizes were awarded.