From the beginning of written history, men of medicine have played an important role in civilization and society. Each of these minds brought new ways of thinking to their particular era through experimentation and discovery. The 19th century was an age of pioneering, exploration, and change. These things were thought to apply mainly to the areas of invention and the quest for land, yet the extent reached as far as the field of medicine. Advancement in American medicine took place in the 19th century, particularly in the old west. This scope includes both the native healer, and the frontier doctor who traded big, bustling cities for mining camps and ghost towns. The 19th century was a time when the face of western American medicine was changed forever, a time when medicine transitioned from a religious ritual to a skilled practice. The introduction of the frontier physician was a catalyst for the medical evolution in the west from medicine men to men of medicine.
Before pioneers began to move and settle out west, the Native Americans ruled the frontier. We find that in every tribe every person had a specific duty to perform. The tribal chief was overseer of every tribal affair, warriors fought battles for the tribe, women were responsible for cooking and raising children, and any ailment or injury was tended to by the medicine man. The life of the medicine man was probably the most trying and stress-filled of the whole tribe. The process of becoming a medicine man in itself was rigorous and challenging.
At around the same time every year, most North American Indian tribes would perform a certain ritual that served as a means of choosing who the next medicine man would be. This test was a grueling ordeal, lasting several days. All young braves would assemble at the great medicine lodge. After three or four days of fasting, praying, privation, and observing older medicine men in practice, the ambitious young men were then to undergo the last and most trying part of the test for greatness. Any man that passed this part of the test was thought to be immortal by the tribe. They would gather once again in the medicine lodge and place themselves in a reclining position. The overseers of this ritual would then pinch an inch or two of the pectoral muscle on each side of each brave. They would continue by thrusting a ragged knife through the flesh beneath the fingers. Overseers would also make lesions in several places on the shoulder muscle, the front part of the thighs, the legs and the forearms. Skewers where then passed through the newly made wounds and attached to cords by which the braves were raised off of the ground and left to hang for a period of time. They were lowered to have heavy weights, such as buffalo heads, attached to the skewers then raised again. The braves did not pass the test until they were torn loose by their own weight.
The Sioux had a more refined, but equally ruthless, process of testing ambitious braves. They passed skewers through the pectoral muscles, similar to the before mentioned process, and then fasten their victims to a strong sapling. The braves would then be raised to the tips of their toes. With head thrown back they were compelled to gaze at the sun from its rising to its setting. If one brave should happen to faint or fall before the sun set, he was forever disgraced as a man without medicine. Still there were always candidates for the position.
My research found no explanation for the necessity of these rituals. These rituals were probably a means for the brave to gain the respect of the tribe. Medicine men were thought to have been beings that were almost divine. They were supposed to be able to understand the workings of gods and spirits. Most likely, the severity of these rituals was to prove to the tribe and to the spirits that the medicine man had indeed earned his position. In order for medicine men to remember the importance of their role, rules for Native American medicine men were very structured and stringent. Native American tribal customs only allowed for a medicine man to lose six of his patients before he himself would be killed. Losing one patient would mean getting his teeth pounded in or his eyes plucked out.
Because Native Americans believed medicine and religion went hand-in-hand, the medicine man served a combined role of priest and doctor. Medicine men were called to do battle with the evil spirits from which sickness was thought to have originated. Armed with medicine pipe, herbs and various concoctions, medicine men entered into combat with evil forces and through dance and rituals, invited good spirits to enter into their herbal remedies. Some tribes performed rituals where medicine men would suck on the inflicted part of the body in order to drive out evil spirits. Ailments and injuries were treated by medicine men with the use of herbal and other natural remedies. Such remedies included crushed rattlesnakes, which were given to women to eat in order to speed the birthing process, sagebrush tea, was given to diarrhea suffers, and willow tea was given for stomach aches.
As the Native American medicine man continued practicing in the west, the pioneer physician moved into the frontier. According to John Walls, the west was "where pioneers carved their lives out of the earth and built cities from previously barren lands. With their hands and hearts, they staked their claim to a new way of life" (Wide Open Spaces). Often it was the quest for gold that brought many doctors westward. Most doctors who ventured out into the frontier were adventuresome, wealth-seeking young men from the East or from Europe. These men seemed to find a life of security in uncertainty. To them, their medical degree was the passport to a life of excitement in a new land, sometimes nothing more. There were men who set up practice with no medical knowledge or experience. These men treated patients solely on the basis of intuition. Only when education through colleges and universities improved were lay people discouraged from pretending to be doctors and setting up their own practices.
Some doctors traveled westward for their own health, believing that the air and climate out west would be better for their lungs. Many men who eventually practiced medicine, traveled out west not intending to be doctors at all, but decided on the profession when they saw in it an opportunity for a new start.
Most early frontier doctors were trained through apprenticeships. These young men would associate themselves with doctors as much as possible. Much like the present day, students learned through a "shadowing" practice. However, back then "shadowing" often meant sweeping floors, mixing medicine, and other menial chores; but they were also allowed to observe the physician at work and read medical books, thereby gaining first hand experience. The apprentice would continue this practice until the doctor was convinced of the student's proficiency. The student would then be given a certificate of practice to prove that he was a learned doctor. It was not until the new physician set up his own personal practice that he would discover how little he actually knew about medicine.
In his book entitled Doctors of the West, Robert F. Karolevitz summarizes the importance of the frontier physician:
Needless to say, if the Old West offered a fertile field of endeavor for any profession, medicine was it. It was a land of vigor and violence, where great physical exertion was commonplace and where even the slightest rebuff could erupt into a deadly showdown with six shooter or stiletto. It was a vast rugged expanse where drought, malnutrition and exposure to the harsh elements took a heavy toll. (47)
Harsh circumstances played a large role in new medical inventions and techniques. In most cases doctors had to come up with spur-of-the-moment devices. There are accounts of doctors wielding scalpels on kitchen and billiard tables and making surgical saws out of a thimble and the handle of a feather duster. There are even accounts of doctors using hollow poles to drain body fluids. According to Karolevitz, "Frontier doctors treated frontier people under frontier conditions. Amputations-with or without anesthesia-were extremely common. Tumors which a doctor could see or feel were sometimes operated for, but other internal disorders were often baffling to the physician who had neither the experience nor the equipment to accomplish a proper diagnosis" (52-53).
When it came to epidemics, even the most experienced and knowledgeable frontier physicians found themselves unprepared. Destructive epidemics such as cholera, smallpox, and measles, left many doctors helpless against the disparaging rampage of diseases through the west. Besides epidemics, physicians dealt with common injuries, cuts and respiratory problems, and eye injuries, which were common in mining towns. Ironically, doctors frequently treated cowboys, legendary of good horsemanship, for broken bones caused by uncooperative mounts. The frontier physician did what he could under the circumstances. The many ailments and diseases of the west provided a knowledge that couldn't be gained and most times couldn't be found in a textbook. For the most part it was the physician's ingenuity and instinct that enabled him to treat his patients. Samuel Levey writes in his book, The Rise of a University Teaching Hospital, "The frontier physician depended for the most part on art rather than the science of medicine in treating his patient." Treatments ranged form leeches to whiskey, and almost everything in between. Though, at times, some methods seemed to be cruel and unpleasant the pioneer physician brought a sort of confidence and new spirit to the west. His work was a tireless service to pioneer families; to them the frontier doctor became a symbol of hope.
As the art of pioneer medicine began to be practiced more in the west, Native Americans faced obstacles in their own medical practice. Before pioneers began to settle in the west, Native Americans primarily suffered from respiratory and digestive ailments. The white settlers brought diseases that rendered Native American medicine men treatments useless. As a result the growth of white civilization increased the need of physicians in the west, pioneer doctors became essential figures to the frontier.
This increased presence of medical figures in the west caused medical practices to become more refined. At the same time, education and requirements for becoming a doctor became more sophisticated. It was not until 1873, almost 70 years after the first physicians began to move west, that a board of medical examiners was established to make sure that all practicing physician were properly trained. This beginning of medical schools in the west, which helped in increase the quality of education for the frontier medical pupil. Some medical schools required students to complete five stipulations for graduation. The first requirement was that the graduation candidate had to be at least 21 years of age. The candidate was also required to have studied medicine for three years, which included two full years of medical lectures. The student was also to have participated in a course of anatomy before graduation. Before even being considered a worthy candidate for graduation the pupil was required to write a Medical Thesis. Even though these rules seemed stringent in writing, in practice they did not amount to much. The required two-year lecture period consisted of eight to ten months of actual study. Some schools only possessed a skeleton or a box of bones on which to practice anatomy. Supplies were inadequate. Nevertheless, new stipulations were a step in advancing the training of pioneer doctors.
Perhaps because of the "advanced and civilized" training of frontier doctors, many generally considered Native American medical technique to be inferior to their own practices. Yet, regardless of the general feeling of superiority, frontier physicians were intrigued by Native American medicine. And the same was true for native medicine men. Some were so interested in white frontier medicine that they became physicians.
Charles Alexander Eastman is an example of a Native American that became a frontier physician. Eastman was raised as a Woodland Sioux. At the age of 15, his father insisted that he leave his tribe to receive the white man's education. Eastman attended Knox College and there, sought to work toward a profession, which he could use to earn a good living while benefiting his people at the same time. Eastman decided on medicine, which according to him was, "the best way to be of service to my race" (Dr. Charles A. Eastman). He then attended Dartmouth and Boston University medical school where Eastman became a highly literate physician. After his extensive studies, he returned to his reservation to serve his fellow American Indians. Eastman had many achievements as a physician, and also happened to be the only doctor available to the victims of the Wounded Knee massacre in 1890. "His goal was to achieve understanding and sympathy for the Indian culture, which he believed would lead white society to treating Indians with respect, instead of the way they were" (Dr. Charles A. Eastman). Eastman spent the rest of his life trying to change the white man's perception of the Native Americans.
Even though frontier medicine is generally thought to be a male dominated issue, no account of the medical evolution in the west can be complete without including the role women played in that process. Women served in the medical field as doctors, nurses, and midwives. These women battled epidemics and built hospitals at the side of the most prominent male medical figures of the day. Women had a harder time starting their own practice because they were not allowed a formal education. Women were not allowed to attend the newly started medical schools, and therefore were not licensed doctors. Yet there were women who found a way to practice without a diploma, despite the requirements of the day. Finally, medical schools in the east allowed female enrollment, and in 1849 Elizabeth Blackwell became the first woman to receive a medical degree in the United States. This was a huge deal and despite the fact that most men opposed this change in society and made a determined effort to stop this new revolution, the effects of this women's movement were soon felt in the frontier. Initially pioneer women cared little about acquiring a diploma; to them it was a piece of paper that entitled them to practice what they already knew through instinct. However, when rules for practicing medicine became more stringent, many women clamored into medical schools to obtain a degree. Women practicing in the medical field, at one time accepted by male doctors, were met with opposition and jealousy once they received their degrees. Despite hardship and prejudice many women pursued medical degrees and received them. By 1870, just 20 years after women were allowed to attend medical school, there were about 600 female doctors with degrees in the United States. This number was astounding for the day. Female doctors primarily treated women and children because most men thought it debasing to ever receive treatment from a "woman doctor". Through skillful work, female doctors proved to be as competent and knowledgeable as their male contemporaries.
Some women realizing they could go anywhere in the medical profession, became nurses. They, too, were mistreated. Female nurses usually received the worst insult and resentment from male doctors. Nursing duties entailed menial chores such as cleaning chimneys and mopping floors. Nurses were mistreated by male doctors and many times became targets for foul language and sexual harassment. Yet, the humility of the position attracted many women. Even Calamity Jane, one of the old west's most colorful and notorious characters, served as a nurse for a period of time. The Deadwood Pioneer, a frontier newspaper, wrote about her skill: "The man Warren, who was stabbed on lower Main Street Wednesday night, is doing quite well under the care of Calamity Jane... There's lots of humanity in Calamity, and she is deserving of much praise for the part she had taken in this particular case" (Qtd In Karolevitz).
Behind every good man, there's a great woman and this can be seen in the role that doctors' wives played. These women would be called upon to treat patients when their husbands were not present. Louise Abigail Mayo, the wife and mother of the founders of the Mayo Clinic, learned medicine by working side-by-side with her husband. She became experienced enough to prescribe remedies and treat fractures while her husband was away. Women proved that where medicine was concerned, there was no such thing as a weaker sex.
The introduction of the physician into the western frontier changed the American view of medicine. These men and women made large advancements over a short span of time. Nearly 80 years after the introduction of the frontier doctor, medicine in the west transitioned from a sacred privilege to a finely tuned skill. Such advancements were not made by Native American medicine men that had been practicing in the west for centuries before the first pioneer. Neither the physician nor medicine man had first-hand experience with patients before beginning a practice on their own. Both groups used indigenous techniques to cure illness, but the reason for the physician's success was neither in his training nor in the implementation of learned techniques. The difference was that frontier doctors never rested in their quest for medical knowledge. Native medicine men were largely content with the knowledge passed on from ancient ancestors and did little to change their practices or to modernize their culture. Native American medicine men depended upon revelation by spirits in order to heal disease. The goal of the frontier physician was to "treat not the disease, but the man."(Doctors of the Old West) These pioneers explored the depths of medical knowledge, and changed the western American perspective of medicine in the process. The men of medicine that the 1900s produced were people who revolutionized their era by searching, thinking, and finding answers to some of the most stupefying medical questions that the world had seen up until that time. In harsh circumstance and disease these men and women delved in to the challenge and found an opportunity to learn and create new inventions. These physicians made an indelible impression on frontier civilization and society and influenced medicine in ways which are still seen today.
Works Cited
"Dr. Charles A. Eastman." Native Author. 1996. 22 April 2002. http://www.kstrom.net/isk/stories/authors/eastman.html
Karolevitz, Robert F. Doctors of the West. New York: Bonanza Books, 1967
Levey, Samuel. The Rise of a University Teaching Hospital. Chicago: Health Administration Press, 1996.
Walls, John. "Wide Open Spaces." Texas Tech. University. 2001. 22 April. 2002 http://www.ttuhsc.edu/pages/news&pub/sum00-1.html