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About Historical Medical Art

The General Practitioner, circa 1865

Medical practice well into the latter part of the 19th Century offered very little by way of diagnosis or treatment. Even though many important discoveries in physiology, pathology and microbiology were occurring during this period, their application in general practice was not particularly widespread. Consequently, the public had divergent opinions of the physician. Some people considered them "quacks" and potentially harmful to those they treated. Others respected physician opinions and methods of treatment and sought them out.

Since money and goods were exchanged for services, practitioners became somewhat competitive and often allowed patients to dictate their own treatment in order to keep them satisfied.

Medical education varied considerably and few cities or states had licensure requirements. Some practitioners were entirely self-taught or simply self-proclaimed. Others undertook preceptorships with established physicians or attended medical schools.

Most medical schools of the era were proprietary, and in order to compete for students they kept their curriculum short. The academic year was frequently only two to four months long and degrees were offered after only one or two years. When some schools sought to expand their courses to accommodate the mounting scientific discoveries, they experienced a decrease in enrollment, losing students to schools that offered degrees in less time.

Toward the latter part of the century, more uniform educational and licensure requirements began forcing out proprietary schools and university-based schools began to evolve. Although the American Medical Association was established in 1847, it did not become an effective force in advocating improved medical education until the end of the century.

General practitioners of this era rarely had offices based in commercial buildings. Most practiced from their homes with single rooms for patient evaluation and treatment, while the majority of the time was spent traveling to patients' homes to render services at the bedside.

Those who accepted physicians generally considered them knowledgeable and a friend to the family.

The general practitioners had few scientific treatments to offer their patients. The basic premise of illness was that, regardless of its nature, the "poisons" or "bad humors" had to be extracted from the body. Acceptable methods of accomplishing this included bloodletting, by venous transection or applying leaches, blistering, sweating, inducing vomiting, using cathartics and occasionally allowing the patient outside to breathe fresh air.

The physician mixed chemicals with his mortar and pestle but, with the exception of emetics and cathartics, few were effective. Another notable exception was the use of foxglove (for its digitalis effect) to treat heart failure, known then as dropsy.

Diagnostically, the physician had few pieces of equipment in his armamentarium. The microscope reached medicine in the 1840's and was used to look at blood samples to determine anemia and at urine samples for any evidence of "pus."

Once determined, little could be done therapeutically. Feeling the patient for fever was considered important. The medical thermometer was invented in 1867 and it allowed physicians to determine if a patient was truly febrile, which by then had become known as a hallmark of inflammation. Again, however, once determined, little could be done to help the patient. A good physician palpated the patient's pulse but what information was gained had no treatment modality to go along with it. In 1816, Laennec invented the stethoscope. Most general practitioners had one as part of their equipment, and used it to osculate the chest. It added some to diagnostics, but little to treatment.

I have chosen 1865 as the year for Anne Crawford's depiction of the General Practitioner. It was a time when the actual practice of medicine was still relatively primitive. Several discoveries in physiology and the pathology of disease were advancing the science of medicine but not its ability to treat patients.

The physician in the rendering is doing one of the few diagnostic modalities he knows - taking the patient's pulse. On the table to the right are the instruments of his practice: a Laennec stethoscope, a knife and a large brass bowl for bleeding, a small glass and brass cup for blistering. He has a variety of chemicals and a mortar and pestle for mixing them. To the left are his medical books and a microscope. Since he is examining a female, it was appropriate for the time to have a female assistant present.