As a nurse for more than 25 years, I’ve seen my share of changes in medical care. From starched white uniforms, paper files, and long hospital stays to casual scrub suits, electronic records, and one-day surgeries, change has characterized the medical and nursing professions. But, as I began my quest to learn about 19th century medicine, nothing prepared me for the difference between then and now.Eleanor Sullivan

            Let’s start with what diseases were called. You might not recognize these today. According to a mortality schedule, the causes of death in Tuscarawas County, Ohio in 1850 included dropsy, flux, canker, apoplexy, spasms and my favorite, “no opening.” Other than the last one (I can only guess at that!), here’s what we call those diseases today:

Dropsy—edema, usually from cardiac failure

Flux—diarrhea caused by dysentery

Canker—inflammation caused by infection (remember, no antibiotics existed then)

Apoplexy—unconsciousness caused by a stroke



Internal Causes

The cause of disease, it was believed, was inside the person. Those who became ill were weak. Or unclean. Or they sinned and God brought on their illness to punish them. Remember Job of the Bible? God tested him. With that example in mind, religious folks admonished the sick to admit their sins and ask God for forgiveness. But what if they didn’t get well? I guess God wasn’t satisfied with their confession.

External Causes

The outdoors brought on many illnesses, according to 19th century Americans. The night air was filled with miasmas, poisonous, foul-smelling, dark-colored vapors that held malevolent power. Mists rose from the ground (or more likely, stagnant water) like wicked sprites to creep over the land and threaten the populace with their toxic fumes.

Nineteenth century Americans lived in fear of the miasmas. The solution was to keep inside with tightly-closed windows no matter how hot it was. (I wonder how many died of heat stroke instead.) Miasmas weren’t everywhere, though. Some locales were known for them and travelers were admonished to take care to avoid any place where they saw fog.

Blood letting, Purging, and Puking

Because illness was believed to result in internal weakness (or sin) or that the external environment had invaded the body, aggressive treatment was designed to rid the body of its noxious incursions. Blood-letting, purging, and puking were the preferred treatments.

Blood letting relieved excess blood and returned the flow to normal, it was thought. This was such an accepted belief that the reason women were believed to have fewer illnesses is because they bled regularly. To relieve pressure in the blood, the doctor lanced a blood vessel and often used glass cup to produce a vacuum to draw the blood out. Blood-sucking leeches might also be used. Often the patient would faint from the blood loss, assuring the patient and the doctor that the treatment was indeed successful.

The goal of purging was to evacuate the bowels, another way of ridding the body of unwelcome invaders. If a cathartic, using such body-damaging medicines as mercury (called calomel), wasn’t successful, enemas would be given until the body had been flushed of all contaminants.

Puking was induced by several means. Ipecacuanha root (known today as ipecac) crushed into a powder or lobelia bark, also powdered, were administered in a tincture. If nothing else was available, warm salt water could induce vomiting. Again, every bit of disease must be eliminated from the body.

Herbs and Homeopaths

Medical treatment in the unsettled parts of America (and most of the country was unsettled in the early 19th century) was especially arduous, albeit they were often spared the rigorous administrations of medical doctors (licensed as early as 1811 in Ohio). Care often fell to a local midwife who administered herbal substances. Recipes were handed down through families and communities and often helped. My character, Adelaide, is a midwife and herbalist in 1830s Ohio.

Homeopaths also treated 19th century patients. Homeopathy was promoted by a German physician, Samuel Hahnemann in the 18th century. Hahnemann observed that cinchona bark, used to treat malaria, induced symptoms of malaria. Thus, he surmised that inducing symptoms with highly diluted preparations would cause the patient’s own vital force to expel the disease. He called this the law of similars. There is no scientific evidence that the treatment was effective. Again, patients were spared energetic medical treatments and may have recovered on their own. The leader of Zoar, Joseph Bimeler, who appears in my stories, was trained in homeopathy in Germany before emigrating to America.

In the end, the people who survived were sturdy stock. Many of us owe our good health to our robust ancestors. Thank goodness for them!


Cover her body by Eleanor SullivanMy latest book is Cover Her Body, A Singular Village Mystery. In a strict, religious society in 1830s rural Ohio, a 16 year-old girl is murdered because she’s pregnant, but the only person who suspects it wasn’t an accident is a young midwife, who puts her own life in danger when she tries to find the killer. Cover Her Body the first in a new series of historical mysteries based on the lives of my ancestors who lived in Zoar, Ohio in the early 1800s, a town that exists today. Graven Images releases next year.




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