Medicine

Early America

Much analysis of pre-nineteenth-century American medicine has centered on differences between the emerging medical profession in America and the established tradition practiced in Europe. While American medical structures were derived in some ways from their European predecessors, American physicians tended to define themselves in contrast to European doctors and men. This was most clearly articulated by Benjamin Rush, an elite physician and outspoken advocate for American medicine and masculinity. Identifying the vigor of American men with the vigor of the new nation itself, and encouraging American physicians to promote both, Rush advocated ideals of health that connected simple diets and avoidance of overstimulation with healthy American masculinity.

Although Rush was an influential figure, most physicians in early America lacked the social status and cultural authority that would later become central to the physician's masculine professional identity. Education, training, and extent of practice varied widely among American physicians, and the majority of them struggled to make a living. Like American men in other occupations, they derived much of their identity from local circumstances, such as their social and economic position in their families and communities. Beginning in this period, however, and continuing into the twentieth century, male physicians began extending their authority into the process of childbirth, gradually eclipsing the previously accepted authority of midwives.

The Nineteenth Century

In the early nineteenth century, American medicine reflected the antielitism characteristic of Jacksonian democracy, and a variety of physicians and other healers competed in an open marketplace. Both men and women articulated and promoted ideas about health, illness, and treatments for disease, often in explicitly gendered ways. Approaches to health and disease such as homeopathy and the “water cure” were described by their advocates and practitioners (often women) as gentle. In sharp contrast, however, was allopathic medicine, originally promoted by Benjamin Rush and the precursor of today's [Page 297]mainstream medicine. Consisting mainly of bloodletting, purgatives, and other aggressive therapies, it was commonly described as “heroic” and was an exclusively male domain until the mid–nineteenth century (the first woman graduated from an allopathic medical school in 1847).

As allopathic physicians sought to dominate the medical marketplace, they used their authority as men with expertise (as opposed to their later appeal to the cultural authority of science) to gain public authority. A number of them also began to present their opinions publicly, particularly in relation to issues of gender. Some physicians attempted to use biological arguments to support the “cult of domesticity,” which defined men as suited to public activity and authority and women as best suited to domestic work. One physician, for example, argued against higher education for girls because of excessive loss of nervous energy during menstruation. (Ironically, the sharp division between male and female worlds in this time period actually helped some women become physicians by allowing them to claim that only women could modestly and appropriately treat other women.) The masculine ideals that permeated allopathic medicine in the late nineteenth century also shaped perceptions of the emergent nursing profession, as nurses (female practitioners) were viewed as helpmates to (male) physicians, reflecting the influence of the cult of domesticity.

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