( – promoted by buhdydharma )
Much has been made by teabaggers in the healthcare debate that we need to “return to the country our founders envisioned”. With all due respect to the founders who – as Enlightenment thinkers – got a lot of things right, this would be like asking Henry VIII for relationship advice.
The health care system at the time of the American Revolution was so bad that more soldiers died of disease than in combat:
It has been estimated that, during the American Revolution, 90 percent of the deaths occurring among the inexperienced, poorly clothed, poorly fed soldiers of the Continental Army, most of them country boys without previous exposure to communicable diseases, and 84 percent of those among the seasoned, disciplined British regulars were from disease.
Most physicians in Colonial America had little in common with their modern counterparts in terms of training, education and overall understanding of disease and how to treat it:
According to his background, training, and experience, therefore, a physician might blame mass outbreaks of disease on climate and season, unhealthy elements in the air, contagion, possibly caused by “animalcules,” or God’s determination to punish sinful man.
The average eighteenth century physician had little in the way of either equipment or understanding to aid him in distinguishing one specific disease from another. The concept of a standard body temperature had only been suggested, the body’s heat-regulating mechanism was not understood, and Fahrenheit’s recently developed mercury thermometer was not commonly used by physicians. The stethoscope was not invented until 1814, and although a “pulse watch” had been developed in 1707, it also was largely ignored by physicians, who preferred describing the pulse to counting it.
The reasoning underlying some eighteenth century diagnoses, however, may seem strange to us today. When a fever described as yellow fever responded to quinine, for example, rather than concluding that the fever was in reality malaria, the eighteenth century physician assumed that quinine must be effective against yellow fever. Since all fevers were regarded as stemming from the same physical unbalance, such a conclusion was logical. Rashes were not regarded as particularly significant in diagnosis, and differing symptoms appearing in patients believed to have the same disease might be brushed off as indicative merely of the conditions under which the illness was contracted.
Finally, the Army Medical Department 1775-1818 academic paper that I’m quoting from clearly states what the Colonial American health care “system” was:
The method of treatment upon which Rush insisted with increasing inflexibility called for a low diet, vigorous purges with calomel and jalap, and bleeding until the patient fainted. Rush apparently did not hesitate to remove a quart of blood at a time, or, should unfavorable symptoms continue, to repeat such a bleeding two or three times within a two- to three-day period, it being permissible in his opinion to drain as much as four-fifths of the body’s total blood supply. In time, Rush’s system and treatment became, in the words of a noted medical historian and physician, “the most popular and also the most dangerous ‘system’ in America.”
It wasn’t until the early nineteenth century that there were more than literally a few medical colleges in this country, and there were no minimum standards for what constituted medical education and there were no institutions that oversaw the licensing of doctors (something that promoted quackery in the mid-to-late nineteenth century, as this article in a 1910 issue of The Atlantic Monthly outlines: http://www.theatlantic.com/doc…
Our modern healthcare system as we recognize it is, in fact, mostly a product of the twentieth century, both in its science and organization. It reflects the complexities of using modern technology and mass manufactured pharmaceuticals to deal with communicable diseases and long-term illnesses in large, concentrated urban areas and with populations whose scope and diversity could not have been imagined in the age our founding fathers inhabited. Therefore, when fixing the problems in this relatively new, very modern system it may be better to look at more contemporary thinking and institutions than to look back to a time when medicine was little understood and poorly practiced.
Or, we could just go back to purging and bloodletting…