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Old Red

Pioneering Medical Education in Texas

Texas State Historical Association

In Search of a Medical School

It was the moment the aged physician had long awaited. On March 30, 1881, the Texas Legislature voted to establish the University of Texas and a medical department to go with it. Almost a half century had passed since Ashbel Smith left a successful medical practice in North Carolina to pursue life in Texas. In 1837, with a medical doctorate from Yale and a year of medical study in Paris under his belt, Smith arrived at the invitation of soldier and statesman James Pinckney Henderson, befriended General Sam Houston, and was quickly appointed surgeon general of the army of the Republic of Texas. For the next fifty years, Smith followed his quest to establish educational and medical excellence in his adopted state. After decades of effort, Smith's dream of a first-class medical school in Texas had become a reality. "The Medical Department, when properly organized," the seventy-four-year-old Smith enthusiastically proclaimed, "will ... be the leading, paramount school of Medical Instruction of the great Southwestern region of the American Union." The future of the proposed medical school looked bright indeed, but many challenges still lay ahead before it would be established.

Medicine was an archaic enterprise throughout most of the nineteenth century. Traditionally taught as an art rather than as a science, medical expertise was most often acquired through trial and error on patients rather than in the medical laboratory. A physician's résumé consisted primarily of delivering babies, setting broken bones, prescribing drugs, and comforting the dying. Common plagues such as typhoid, pneumonia, tuberculosis or "consumption," and "the itch" were confronted with age-old medical "remedies" that included bloodletting, blistering, and a variety of potentially toxic potions. Patients who survived the sickbed often did so only because of a strong physical predisposition or luck rather than the doctor's care.

Insufficient medical training was part of the problem. In the mid-nineteenth century, almost anyone who aspired to study medicine could do so. School choice consisted of two categories: university or proprietary (privately owned). Both were seriously understaffed and offered a very basic curriculum, which was frequently taught by harried faculty who were poorly paid. Proprietary schools were commonly considered no more than "diploma mills." With enrollment fees often the sole resource for funding, these institutions welcomed almost any applicant who demonstrated the ability to pay the tuition and read and write. The least qualified of this lot were offered a medical degree by mail.

Many aspiring practitioners sidestepped the medical school route altogether. The apprenticeship system, prevalent for centuries, enabled young men to study the art of healing for a "winter or two" under the guidance of an established practitioner. While competent practitioners emerged from this shaky system, it primarily produced masses of unqualified physicians, quacks, and pretenders. By 1850 the respect of the medical degree had so declined that some medical leaders wished to do away with it completely. In the absence—or avoidance—of medical expertise, Americans in search of medical care explored other options. Many embraced the teachings of native sects or joined health cults such as those espoused by Sylvester Graham and Bronson Alcott that created a secular religion out of trends in hygiene, diet, and bodily discipline. Others consumed patent medicines by the gallon. Daly's Aromatic Valley Whiskey for Medicinal Purposes was a favorite, as was Old Sachem Bitters and Wigwam Tonic.

The best hope of young Americans for obtaining a respectable medical degree involved study abroad. Nineteenth-century European medical schools, especially those in France and Germany, strongly advocated progressive ideas and practices that left a profound influence upon their American pupils. At a celebrated Paris medical school, the École de Médicine, French physicians of international renown lectured and allowed students to accompany them on their hospital rounds. In addition to providing clinical commentary, these physician-teachers gave lectures on twenty-six medical topics, including anatomy, surgical pathology, therapeutics, diseases of women and children, and legal medicine. For American students like Ashbel Smith, the greatest contribution to come out of the Paris school was the concept that factual evidence was essential to accurate diagnosis. When a violent outbreak of cholera swept through Paris in 1832, Smith treated the sick, and in off-duty hours he performed autopsies to learn the nature of the disease. After the epidemic passed, Smith published a pamphlet that described in detail the symptoms, pathology, and treatment of the disease—all acquired through extensive study.

The Germans also made great strides in medicine. Research conducted in German medical laboratories proclaimed the dawn of modern-day bacteriology and its wholesale significance to antiseptic surgery and public health. Americans studying abroad embraced the innovative skills and philosophies espoused by European physicians and eagerly applied them in their own practices upon their return to the United States. German influence upon American medicine extended beyond theory and practice. German physicians in particular received their training within the university system. Here, education and scientific advances went hand-in-hand. Physicians interested in full-time teaching and research earned the respected identity of professors. While enlightened American medical educators began to adopt German principles as early as the 1850s, the Civil War postponed genuine progress until the 1870s.

Medical practice in America during the Civil War period was a profound mixture of good and bad. The first year of the war in particular highlighted the inherent disorganization and ineptitude of both Union and Confederate army medical departments. Ignorance regarding the spread of germs and bacteria caused infectious diseases to rage within the camps. Calomel, a cathartic, and tartar emetic were implemented wholesale. Regimental physicians refused to care for patients other than their own. Medical records were lost. Hospitals buckled under sudden onslaughts of the sick and wounded. The Confederate medical situation remained desperate throughout the war as the army struggled with an ever-dwindling supply of food, drugs, blankets, and other necessities.

The war also hastened medical advances. At the height of the conflict, the Union army contained approximately 11,000 physicians, while the Confederates boasted almost 6,000 medical enlistees. The best-qualified practitioners took examinations to become regimental surgeons. Many received their commissions from state governors. Experience on the battlefield in handling the knife, the saw, and the use of anesthesia (ether and chloroform) gave these physicians invaluable experience and proficiency regarding surgical care. Many began to appreciate the connection between microbes and disease. For instance, United States Surgeon General William Hammond introduced a sound system for classifying diseases, encouraged procedures to ensure better hygiene and sanitation, and demanded better record-keeping procedures as a means of improving performance. The Confederate medical situation also improved through the able leadership of Surgeon General Samuel Preston Moore, who made the best of debilitating shortages. Both armies benefited from the world's first ambulance corps.

The nursing profession also received a boost. Previously, few women of means and certainly no "lady" entered the profession. Hospital nurses came from the dregs of society, most of whom, according to nursing reformer Florence Nightingale, "were too old, too weak, too drunken, too dirty, too stolid, or too bad to do anything else." Nightingale's courageous and untiring efforts to alleviate suffering among the British wounded during the Crimean War (1854–56) laid the foundation of professional nursing. Upon her return to England, Nightingale established in 1860 the first secular nursing school in the world at St. Thomas' Hospital in London. These actions had a profound influence upon American women, both North and South. As the incredible carnage of the battlefield assailed their communities, women labored to alleviate the suffering around them. Union nurses Clara Barton and Mary Ann Bickerdyke as well as the Confederate Sally Louise Tompkins organized successful war hospitals in their respective regions. Programs that would teach viable nursing skills were at a premium. Many of the well-educated and administratively efficient members of the U.S. Sanitary Commission became the primary motivators behind the creation of postwar nursing schools. Invalid corps in both the North and South effectively utilized the restless energy of disabled soldiers for guard duty, nursing, and other tasks. Each of these wartime initiatives gave birth to progressive medical theories and practices.

The Civil War arrived before the German medical education principles of the 1850s firmly took hold in America. Not until after the Confederate surrender at Appomattox did many American universities begin incorporating the independent medical school into their systems. Once they did, the quality of American medical instruction improved dramatically. University regents raised admission standards, expanded curriculum, and lengthened academic terms. Newly constructed facilities featured fully equipped laboratories, libraries, and other tools for scientific teaching and research. Each of these academic innovations benefited the American medical profession.

Progressive-minded Texans soon took notice. Many aspiring physicians in Texas traveled east of the Mississippi to attend one of the university medical schools. Galveston newspapers in particular featured advertisements from the University of Louisville School of Medicine, the Medical Department of the University of Nashville, and New York Medical College. The academic successes of these schools captured the imagination of crusaders in the West. Before long, Texas reformers began agitating for a university medical school of their own.

This idea was not entirely new. During the days of the Texas Republic, President Mirabeau B. Lamar, a fierce advocate for public education, championed the insertion of a provision into the original state constitution of 1845 to establish a state university and medical department. Lamar's campaign quickly stalled and unfortunately remained on the legislative shelf for the next twenty years. However, a few minor attempts at medical education were made during the interim. One of particular note occurred in 1855 when Galveston physician Thomas Stanwood endeavored to make the most of the hanging of convicted murderer John Schultz. The Galveston News reported that, promptly after the criminal's execution, "the body was then immediately delivered into the hands of Dr. Stanwood who removed it to a convenient place for a hasty dissection" and anatomy demonstration for persons in attendance. The body, sans "cranium," was buried at the conclusion of Stanwood's lecture.

It was no accident that Stanwood chose Galveston for his efforts toward medical enlightenment. From its founding, Galveston occupied a central place in conversations pertaining to medicine and health in Texas. Pioneer physicians in the early decades of the nineteenth century praised the healthiness of the island city. According to Ashbel Smith, the invigorating island sea breezes combined with warm Gulf water for bathing made Galveston the ultimate health resort. "If you have any invalids," wrote Smith to a friend in 1839, "send them among us. An abundance of seafood—an atmosphere unrivalled for balminess and salubrity—and novelty of scenes and the excitement of a virgin country are at the command of the dyspeptic. For rheumatics and consumptives the climate is particularly genial." Smith's sentiments were echoed by a British diplomat on a visit to "the Island" (the shortened term for Galveston Island often used by locals and visitors) in 1841: "[P]estential [sic] diseases ... so common in the West Indies, [are] here unknown ... in a word the mildness and salubrity of the climate of this region has no equal in America."

Not everyone viewed Galveston through such a wholesome lens. Stephen F. Austin noted the coastal areas of Texas appeared far less healthy than those further inland. An 1837 visitor to the Island concurred, "the lower country, from the Trinity to the Colorado, is as sickly as the most unhealthful portions of Louisiana ... The country becomes healthier at any point as you recede from [the] gulf." By the 1840s, many individuals began to view Galveston not as a hub of health but a city teeming with pestilence. Swarms of mosquitoes plagued residents making it impossible to sleep without protective netting. Poor sanitation reigned and deadly diseases extracted heavy tolls, especially of children, each year. Citizens lived in fear of typhoid, smallpox, dengue fever—and the most dreaded of all—yellow fever. Prior to 1860, seven epidemics of "yellow jack" or "vomit noir" claimed over 2,300 lives. During the late summer of 1853, the disease caused an average of fourteen deaths per day. The most virulent epidemic gripped the Island in 1867, when over 1,150 succumbed out of the approximately 16,000 residents. Each repeated visit of "yellow jack" increased Galveston's reputation as a "sickly city."

Galveston physicians and caregivers confronted the epidemics with a limited therapeutic arsenal. As a rule, antebellum physicians followed a medical belief system based upon maintaining a bodily equilibrium. If illness or disease upset that delicate balance, attempts were made to restore it by means of "heroic" medical procedures. Copious bleeding followed by purging highlighted the list of therapies. In cases of yellow fever, physicians advocated the lancet, mustard baths, and purgatives as necessary tools in treating the disease. While disagreements arose concerning the proper dosage, Galveston practitioners adhered to the standard procedures.

Yellow fever outbreaks in Galveston fostered significant medical breakthroughs, however. During a severe yellow fever epidemic in 1839, Ashbel Smith utilized the long hours treating yellow fever patients to unravel mysteries surrounding the disease. No one knew the source of yellow fever or how it was transmitted. Many physicians believed the disease was contagious, spread directly or indirectly between individuals. Others maintained an attack of yellow fever resulted from "local" conditions such as climate, poor sanitation, and airborne effluvia. Smith supported the latter theory. He maintained meticulous medical case records and, to ultimately prove his point, operated on the bodies of nine yellow fever victims. In his report, Account of Yellow Fever in Galveston in 1839, the first medical narrative printed and published in Texas, Smith revealed a courageously intimate—and squirm-inducing—methodology. To prove yellow fever was not contagious, Smith freely handled diseased organs, liberally immersed his hands in black vomit and other bodily fluids, closely viewed and smelled them—even "repeatedly tasted the black vomit, when fresh ejected from the stomachs of the living." In each instance, the doctor's health remained unscathed.

To keep the disease away from Galveston, Smith recommended the city remove filth from the streets and fill in disease-producing marshlands around the Island. Many citizens embraced Smith's theories. As the 1839 epidemic waned, patient Lucy P. Shaw proudly noted: "We are fortunate in having an excellent physician, Doctor Smith ... I am perfectly well now and all our family are well, although we have had so many deaths in our house and the yellow fever has taken away a great many on the Island ... Dr. Smith is perfectly well and has never had any symptoms of the disease, and if it was contagious I think he would ... There are ten resident physicians on the Island ... but we think we have found the best." Other citizens remained skeptical that yellow fever could be controlled so easily. Until the identification of the yellow fever virus and the mosquito as the transmission source in 1902, frightened Galveston residents continued to support strict quarantine and sanitation procedures as the primary means of protection from the disease. Nevertheless, Smith's work in Galveston set a precedent for future research by medical pioneers in the realm of medicine and public health.

The ongoing threat of disease in Galveston also spurred the establishment of hospitals and good nursing care. No health care institutions existed on the Island before 1838. The situation changed with the onslaught of yellow fever epidemics. Many victims of yellow fever and other diseases were European immigrants newly arrived to the port city en route west. The surging caseload of indigent sick compelled Galveston officials to establish a hospital to care for them. The first hospital on the Island, the Galveston City Hospital, was a primitive affair. Located on the bay shore of the Island, approximately a mile and a half from the city, the hospital was little more than a wooden hovel. Charles Hooten, a visitor to Galveston in 1841, offered this picture: "[The hospital] stood alone in the desert dead, silent, and seemingly aloof from all living and active Christian sympathy." The illustration that accompanied Hooten's stark description of the hospital featured a small, wood-frame structure set among marshes and sand dunes on the bay side of the Island. In 1845 a larger and more accessible charity hospital was constructed on Ninth and Strand Streets. Three stories tall and capable of accommodating nearly one hundred patients, the new facility was a significant improvement over its predecessor.

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Excerpted from Old Red by Heather Green Wooten. Copyright © 2012 Texas State Historical Association. Excerpted by permission of Texas State Historical Association.
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