The 1900s Medicine and Health: Topics in the News

DEVELOPMENTS IN THE MEDICAL PROFESSION

Numerous individuals of varying skills and qualifications practiced medicine in the 1900s. Although the American Medical Association (AMA) had been founded in 1848, it remained a weak organization for more than fifty years. Because few physicians attended the group's annual meetings, the AMA did not expand beyond its bases in the East and Midwest. Internal disagreements further hindered the group's efforts to address the major medical concerns of the era, such as the relatively poor quality of medical education, the rise of physician specialization, and competing health philosophies. By 1900, however, the AMA had begun an intense period of reform designed to enhance the organization's standing across the nation. A Special Committee on Reorganization was created to offer recommendations on improving the AMA. The committee advocated strengthening the AMA's ties to state and local medical societies. By the end of the decade, the AMA had achieved significant growth. The group, which had only 8,400 members in 1900, had grown to more than 70,000 by 1910. With its newly increased rolls, the AMA began to exert greater influence in public health issues. For example, the AMA vigorously supported the 1906 Pure Food and Drug Act and other pieces of legislation, and sought to limit the amount of patent medicine sold to the public. By the end of the decade, the AMA had grown into one of the nation's most influential professional associations. It was able to shape the American health system for decades. It began to take on responsibilities such as setting standards for medical practices, granting admission into the profession, reprimanding doctors for misbehavior, and advocating policies to ensure the public's health.

Health care in the 1900s was further enhanced by greater diversification in the membership of the American medical community. African Americans had a long history of participating in the medical profession before the beginning of the twentieth century. James Derham is widely regarded as the first black physician in American history. Born into slavery, Derham learned his medical skills from his owner, Dr. James Kearsley Jr., a prominent doctor. After being sold to Dr. Robert Dove of New Orleans at the end of the Revolutionary War (1776–83), Derham continued his studies and eventually developed a thriving practice. In 1837, James Smith became the first African American to earn a medical degree, which he received from the University of Glasgow in Scotland. A decade later David Smith became the first black person to graduate from an American medical school. In 1864, Rebecca Lee became the first black woman to earn a medical degree when she graduated from the New England Female Medical College (now the Boston University School of Medicine).

Despite such advances, relatively few blacks were able to enter the medical profession until after the conclusion of the Civil War, in 1865. Several medical schools dedicated to educating former slaves were founded around that time, the earliest being Howard University in Washington, D.C., in 1869. By the turn of the century, more than a dozen medical schools for blacks were operating in Louisiana, Tennessee, North Carolina, Kentucky, Maryland, and Pennsylvania. Only four of these institutions, which graduated a vast majority of the nation's black physicians prior to 1920, survived until 1910. Black doctors of the era kept informed on contemporary issues through their own professional organization, the National Medical Association, which continues to thrive.

Despite being restricted by segregation, blacks in medicine in the 1900s accomplished several major achievements. Black hospitals were

opened to care for patients who had been refused treatment at white health-care facilities. Two of the most prominent of these black hospitals were the Lincoln Hospital in Durham, North Carolina, (founded in 1901) and Mercy Hospital in Philadelphia (founded in 1907). Among the most noteworthy African American physicians of the period included George C. Hall, Benjamin Covington, and Daniel H. Williams, who developed a means to suture (stitch) ruptured spleens in 1904. Black doctors of the era had few white patients, and black students were refused admittance to many established medical schools until after World War II (1914–18).

The Mother of Anesthesia

Dentist William Morton of Boston first demonstrated the use of anesthetics to sedate patients during surgery in 1846. For the next fifty years, surgical patients received anesthesia mainly from medical students or doctors with little training in the potentially lethal procedure. By the end of the century, nurse Alice Magaw was one of the first individuals to practice anesthesiology full-time. Magaw performed the procedure on more than fourteen hundred patients during her career, mostly for Drs. William W. and Charles H. Mayo (1861–1939). Between 1892 and 1906, she authored several important articles explaining anesthesia for doctors across the nation. A true pioneer for women in medicine, Magaw was so well respected that Dr. Charles Mayo proclaimed her the "mother of anesthesia."

Like African Americans, women faced a difficult struggle to attain a medical education in the late nineteenth century and early twentieth century. Most Americans believed women were emotionally unfit to assume the role of doctor. Americans widely believed that women were too physically and intellectually weak to participate in any endeavor outside the domestic sphere. Still, some women were able to enter the field. In 1850, the Women's Medical College of Pennsylvania was established, and it graduated its first class of eight women the following year. By the 1890s, women could attend some of the same medical schools as their male counterparts. Some medical schools admitted women to their ranks only due to financial necessity. In 1890, for example, Johns Hopkins University was in dire straits and announced a unique plan to improve its economics: The school would accept women for medical education if wealthy female patrons would donate $500,000 to the university endowment. Other colleges followed the Johns Hopkins example and permitted the enrollment of female medical students. Female doctors comprised approximately 5 percent of the nation's physicians in 1900. Nearly seven thousand female

doctors were practicing medicine in 1900; one hundred of those were black. Most female physicians of the early 1900s operated private practices that served a largely female clientele.

Despite their small numbers, female physicians of the era were able to make significant contributions that benefited all people. Extraordinary women doctors of the early twentieth century include: Dorothy R. Mendenhall, who demonstrated in 1901 that Hodgkin's disease (a type of cancer) was not a form of tuberculosis; Mathilde A. Evans, an African American who founded the first hospital for blacks in Columbia, South Carolina; and Martha Wollstein, who conducted early studies of polio (along with Simon Flexner) in 1907. Despite these accomplishments, and those of thousands of other female physicians, male doctors were slow to fully accept women doctors as equals. Nevertheless, by the end of the twentieth century women comprised 50 percent of all medical students in America and held many of the nation's most prestigious medical posts.

Human Research Subjects in Medicine

A hotly debated subject during the early 1900s revolved around the issue of using human subjects for medical experimentation. The term for using living humans or animals for study is "vivisection." Those opposed to the procedure (known as antivivesectionists) objected to procedures that did not offer a direct benefit to the human or animal subject's health. Several pieces of legislation advocating legal limits on animal and human research were proposed, but they were defeated. The issue ignited much controversy, as arsonists destroyed a New Jersey facility that bred research animals. The controversy raged throughout the twentieth century. Antivivesectionists proclaimed that the procedures were cruel to animals and the humans used for experimentation. They clashed with doctors who have argued in favor of animal testing and the use of corpses in the study of anatomy.

As more and more people were trained as physicians, medical education became more rigorous. The AMA voted in 1900 to strengthen the requirements necessary to become a physician. The association advocated requiring four years of training for their new members. In 1906, the AMA and other concerned grouped banded together to form the Council on Medical Education, which was charged with inspecting and rating medical schools. The committee reported that 20 percent of the nation's centers for medical education were inadequate. In 1907, Abraham Flexner (1866–1959) was hired to write a detailed analysis on the state of American medical education. He spent several years in the field and issued a scathing report in 1910. He stated that many medical schools were in horrendous condition. Laboratories and surgical rooms were often filthy, medical libraries were often bare, and many medical professors did little class instruction. Flexner then convinced the Rockefeller Foundation to donate $50 million to fund those medical schools that functioned satisfactorily. Poor medical institutions around the United States were closed and well-run schools were strengthened through Flexner's efforts.

MAJOR DISEASES OF THE 1900S

Many diseases that raged throughout the early 1900s and destroyed countless lives have been cured and largely forgotten by contemporary Americans. The most prevalent and insidious maladies of the era included pellagra, plague, tuberculosis, and yellow fever.

Pellagra is a terrible disease that is rare today, even in developing countries, but it was a major problem in the United States during the early 1900s. Caused by poor nutrition, pellagra results specifically from a lack of nicotinamide (a B vitamin), which causes inflammation of the skin (dermatitis), diarrhea, dementia, and often death. Unknown in America during the nineteenth century, pellagra was first noticed in several rural southern regions in 1902. By 1908, the disease had spread so quickly that Columbia, South Carolina, hosted a National Conference on Pellagra. By 1924, pellagra had been identified in thirty-six states, with more than 90 percent of all cases located in just nine southern states.

Pellagra was most prevalent in the southeastern United States, where many people's diets consisted mainly of fatty meats, cornmeal, and molasses. The disease spread as new corn milling techniques, which caused many vital nutrients to be removed, were gaining widespread acceptance. Residents in insane asylums often were afflicted with pellagra because their diet was extremely heavy in mass-produced cornmeal. Rural citizens who ground their own corn, on the other hand, were much less likely to have deficient diets and develop pellagra.

Many physicians and scientists worked valiantly to halt the spread of pellagra, but they remained largely unsuccessful for several decades. One of the primary reasons for the pellagra epidemic was the reaction of southern

political, cultural, and business leaders. They were embarrassed by their region's poverty, which contributed to the disease. Only continued public outcries for action forced these officials to take a strong stance against pellagra. The epidemic lasted until the 1940s. During that time, pellagra is said to have appeared in more than three million Americans and caused approximately one hundred thousand deaths.

Bubonic plague was another disease that threatened Americans during the early 1900s. Known since biblical times, the plague had been stricking various regions around the world for more than fifteen hundred years. In the early 1900s the disease, which is caused by the Yersinia pestis bacillus and spread to humans by fleas from infected rats, hit twice San Francisco. In 1900, a dead Chinese worker was discovered in the basement of the Globe Hotel. Quickly, twelve blocks of the city's popular Chinatown district were quarantined as police surrounded the area and searched for infected people. Only twenty-two plague victims were discovered, however, as many Chinese immigrants hid from the authorities out of fears of deportation. This initial San Francisco bubonic plague epidemic lasted until 1904. The community was divided between medical officials, who insisted the disease was widespread, and the city's political and business communities, who denied the existence of the plague. They feared news of the disease would deter tourists and consumers from visiting San Francisco. It was not until 1903, when more than one hundred confirmed cases of the disease had been reported, that the state's elected representatives took action. Newly elected Governor George C. Pardee, a physician sympathetic to issues affecting public health, began an extensive campaign to eradicate the disease from San Francisco. He authorized the demolition of decaying buildings that housed the rats that spread the plague. Although these efforts were largely successful, the 1906 San Francisco earthquake created excellent conditions for the plague to reappear. Several cases were confirmed in 1907, but the city's officials had learned from their previous mistakes with the earlier outbreak. Federal, state, and local officials and community leaders quickly banded together to aggressively battle the plague.

Typhoid Mary

Irish immigrant Mary Mallon (C. 1870–1938) spent most of the early 1900s working as a cook for several wealthy New York families. During much of this period, Mallon was infected with typhoid fever, a horrible disease that causes inflammation of the intestines, coughing, fever, abdominal pain, and diarrhea. Although she never came down with symptoms herself, Mallon was a carrier who spread the fever wherever she went. She was directly responsible for three deaths and fifty-three cases of the disease, and she may have been responsible for as many as fourteen hundred cases of typhoid in Ithaca, New York, in 1903. Mary Mallon was America's first identified carrier of typhoid. She gained international notoriety for spreading sickness and earned the infamous nickname "Typhoid Mary." She finally was persuaded to enter a hospital in 1907, and remained there until 1910. In 1914, hospital officials built a cottage for her at the Riverside Hospital in the Bronx, where she was quarantined for life. She died in 1938.

Another ancient disease that caused much concern in the early 1900s was tuberculosis. It is caused by a bacterial infection contracted by humans either from inhaling the bacteria or by eating meat from infected animals. The common symptoms of tuberculosis include coughing, fatigue, and weight loss. The bacteria most frequently attack the lungs. When an infected person coughs, the tubercles (nodules the body forms around the bacteria as a defense mechanism) burst and particles are expelled or released. People infected with tuberculosis can carry the disease for months or years. Little could be done for those afflicted with the disease in the early 1900s. The primary treatment consisted of rest and good nutrition, which only the wealthy could afford. The disease was a major American health crisis and accounted for more than 10 percent of all deaths from disease in 1908.

Public health efforts against tuberculosis began as early as 1889, when the New York City Board of Health recommended disinfecting the homes of people suffering from the malady. In 1904, scientists, doctors, and concerned citizens gathered in Philadelphia to form the National Association for the Study and Prevention of Tuberculosis. Led by Lawrence Flick, the group campaigned tirelessly to inform the public about the medical and financial costs of tuberculosis. They told how families could be devastated if an infected parent became too sick to work. Orphanages across America were filled with children whose parents had succumbed to the dreaded disease. One of the most effective means of raising awareness of the disease was through the sale of stamps called Christmas Seals. Journalist Jacob Riis (1849–1914) first advocated selling these stamps to raise funds to combat tuberculosis in 1907. The idea gained widespread acceptance in communities throughout the United States, as money poured in to pay for educational and health programs. Still, tuberculosis remained prevalent in America until the 1940s.

It took decades of heroic efforts from thousands of people before tuberculosis could be defeated. The strategies for eliminating tuberculosis became a model for other public health crises during the century. The fight against this disease demonstrated that the combined efforts of health officials, elected representatives, and enlightened citizens could be used to confront a major health scare effectively. The National Association for the Study and Prevention of Tuberculosis continues its efforts in the new millennium as the American Lung Association.

Yellow fever was another disease that had caused panic throughout the world for generations. Producing ghastly symptoms, yellow fever had resulted in many deaths. Victims suffer from headaches, fever, liver damage, and internal bleeding. Liver damage can cause jaundice, and internal bleeding results in a discharge from the nose and mouth, bloody stools, and black vomit.

Yellow fever outbreaks caused mass panics throughout the nation, as communities feared the rapid and unpredictable spread of the disease. Quarantines were established, better sewer and water treatment facilities were built to reduce the mosquitoes' habitat, and public health boards were established to deal with afflicted citizens. In 1881, Carlos Finlay first proposed the theory that mosquitoes were the agents of the dreaded sickness. By 1900, Finlay was advising the federal government as a member of the U.S. Army Yellow Fever Commission, which had been organized to combat the disease during the Spanish-American War (1898). The last yellow fever outbreak in the United States occurred in New Orleans in 1905. By the end of the decade, the nation's federal, state, and local governments were dedicated to controlling the mosquito population through extensive use of pesticides and other toxic chemicals. While these tactics solved the yellow fever problem, the heavy use of chemicals would cause further health problems later in the century.

Medical Quacks

Among the biggest medical problems of the early 1900s were hucksters and con men who traveled throughout the country selling tonics and elixirs that promised to cure nearly every known disease, pain, and sickness. One of the most famous cure-alls was "Mary's Wonderful Stomach Remedy," which was sold to relieve appendicitis, gallstones, liver problems, and stomach ailments. The "remedy" was composed only of olive oil and salt. Many of the other tonics sold in the early 1900s contained large quantities of alcohol and opium. Writer Samuel Hopkins Adams was one of the leading voices crusading against this medical quackery. In 1905, he published a famous article in McClure's magazine that exposed these fraudulent cures to the public. The American Medical Association also spoke out against these phony physicians and their fake cures with some success. Many hucksters were driven out of business, but the problem of quack medicine lingered throughout the decade.

Hookworm was another aggressive disease that debilitated citizens in the early 1900s. Most common in the rural South, the hookworm thrived in unsanitary conditions such as those present in outhouses. The parasite often would infect people who walked through larvae-filled soil in bare feet. Those afflicted developed such symptoms as dry hair, ulcerated skin and feet, protruding shoulder blades and stomachs, and diminished physical and mental energy. These symptoms contributed to the cultural stereotype of the barefoot, lazy, and slow-witted Southerner. Hookworm was eventually eradicated through the efforts of Charles Wardell Stiles (1867–1941), a zoologist who noticed similarities in hookworm diseases suffered by animals and people. He announced the causes of the ailment and outlined a plan to defeat hookworm. In 1909, industrialist John D. Rockefeller (1839–1937) donated $1 million to fund the Rockefeller Sanitary Commission, which aided hundreds of thousands of hookworm sufferers. By 1914, hookworm had been banished from most states.