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Signature of James L. Dusenbery and several photographs artistically combined.

The Dusenbery Brothers and Nineteenth-Century Medicine

Ilouise S. Bradford and Erika Lindemann

1. Nineteenth-Century Medicine

Both James Lawrence Dusenbery (1821–1886) and his brother Edwin Lafayette (Fayette) Dusenbery (1824–1862) became physicians after receiving their bachelor's degree from the University of North Carolina. The study and practice of medicine in the nineteenth century differs greatly, however, from what physicians know and do today. The sections that follow briefly describe the state of medical knowledge in the mid-nineteenth century, the options available for gaining a medical education, and the curriculum experienced by the Dusenbery brothers at the University of Pennsylvania and University of Maryland medical schools. [1]
To view a slide presentation of this information delivered by Erika Lindemann, click here.

2. Knowledge of Medicine

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Contemporary readers will find it difficult to imagine the state of knowledge about medicine, disease, childbirth, and traumatic injury during the nineteenth century. In the United States the life expectancy for whites was approximately 40 years; for slaves, only about 20 years (Life Expectancy; Mintz). The major causes of death in antebellum southern states were malaria, yellow fever, cholera, and pneumonia (Holt 10). There were no X-rays, no aspirin or penicillin, and no vaccines. No one knew about germs, the microorganisms that cause many diseases and infections. There were no professional nurses—women generally took care of the sick in their own households—and no women doctors. Mental illness was regarded as possession by devils or other supernatural beings; the afflicted were sheltered within the family or housed in asylums. Becoming pregnant was fearful news for women because they knew they might die in childbirth, or afterwards of bacterial infections known as puerperal or childbed fever. [2] Attended at home by midwives, women in labor rarely saw an obstetrician, unless they belonged to the upper classes. It was considered immodest for men to assist women in childbirth, regarded as a natural process in God's hands. Surgery was truly ghastly, usually performed by men with unwashed hands and dressed in clothing soiled with blood and filth. Scalpels, saws, clamps, needles, and other instruments were not sterilized. The patient would be conscious, forcefully restrained on a table, and screaming in pain throughout the procedure. The skillful surgeon also had to be a speedy surgeon, working fast while hearing the agonized cries of his patient. Opium, laudanum, and alcohol might be administered to dull the pain, but the effect would not be sufficient to endure most operations. Afterwards, infection invariably set in.
                                Microscope, patented February 18, 1862. C. H. Wheeler &
                            Co., Boston, MA. For more information about this item, click here.Craig's Microscope, patented February 18, 1862. C. H. Wheeler & Co., Boston, MA. For more information about this item, click here.

Instrument Collection, Health Sciences Library, University of North Carolina at Chapel Hill

Though the stethoscope had been invented in France in 1816 by René Laënnec (1781–1826), it was not adopted in English-speaking countries until about 1850 (González-Crussi 158). Anthonie van Leeuwenhoek (1632–1723) had used a simple microscope to observe the circulation of blood corpuscles in capillaries (1673), describe life in a drop of lake water (1674), and discover mouth bacteria (1683), but the instruments he designed were capable of only 266-fold magnification. [3] Furthermore, the relationship of his observations to theories about human physiology and disease were not understood until the late nineteenth century. Lacking an understanding of the causes of most diseases, physicians attempted to treat the effects instead, relying on herbal medicines to combat pain, fever, infection, poison, and hemorrhage. Many of these remedies had existed for centuries and were delivered as potions, tinctures, enemas, purges, salves, poultices, and teas. Fevers, for example, might be treated by chewing willow bark or drinking a tea made from it; willow bark contains salicin, a chemical similar to acetylsalicylic acid, or aspirin. Foxglove, a source of digitalis, could strengthen the heart by helping to eliminate excess fluid around it. Plant extracts also could promote coagulation of the blood and help heal wounds. Learning to diagnose a patient's problem, determine a correct medicament and dosage, and compound it properly was an important skill of nineteenth-century physicians, who often also served as the community's pharmacist.
German valved glass
                                cupping set from the 1830s. For more information about this
                            item, click here.German valved glass cupping set from the 1830s. For more information about this item, click here.

Instrument Collection, Health Sciences Library, University of North Carolina at Chapel Hill

Nineteenth-century physicians knew about the circulation of blood, discovered in 1628 by William Harvey, but they held various theories about what blood was for. Some thought, following Hippocrates and Theophrastus, that the body contained a balance of four "humors": black bile, yellow bile, phlegm, and blood. When diet, bad air, or disease created an imbalance in these humors, people became melancholic, choleric, phlegmatic, or sanguine. Others believed that the soul governed all bodily structures, so health and disease reflected the state of a person's soul. Given either theory, therapeutic bloodletting, or phlebotomy, was thought to clear the body of toxins, or bad humors, and to overcome imbalances caused by the passions and other disruptions to the soul. Bloodletting involved placing leeches on the patient's body, lacerating an artery in the temple or a vein in the neck or forearm, or using a "scarificator," a spring-loaded device containing several lancets, to scrape the patient's surface blood vessels. Almost 1.7 liters, or 3 ½ pints, of blood were drawn from President George Washington before he died from a throat infection in 1799. Sometimes bloodletting once or twice a year was recommended to prevent disease in healthy people. Cupping, still found in traditional Chinese medicine, used special heated glass cups on parts of the body to produce a localized vacuum; this procedure was intended to restore balance in the body's fluids, relieve pain, and remove toxins from the blood.
Portrait of German
                            physician and developer of phrenology, Franz Joseph Gall
                            (1758–1828)Portrait of German physician and developer of phrenology, Franz Joseph Gall (1758–1828)

Special Collections, Health Sciences Library, University of North Carolina at Chapel Hill

The first half of the nineteenth century also was the age of phrenology, an early effort to understand human psychology. Dusenbery's journal reproduces a phrenological report made by a traveling phrenologist known only as "Woodward." Developed by the German physician Franz Joseph Gall (1758–1828), phrenology was extended to the United States through the work of Gall's collaborator, Johann Spurzheim (1776–1832), and the American brothers, Lorenzo Niles Fowler (1811–1896) and Orson Squire Fowler (1809–1887). Phrenologists claimed to be able to map the bumps on various regions of a person's skull and thereby identify the individual's character traits. Phrenologists developed various five- to nine-point scales for measuring the size of different parts of the skull and used these measurements to evaluate from 27 to 35 personality traits such as self-esteem, benevolence, mechanical skill, musical talent, and so forth. Although it reflected an increasing desire to understand a biological basis for human behavior, phrenology was eventually dismissed as a speculative theory without any physiological evidence to support it. In fact, Dr. V. H. Taliaferro, who would later become dean of Atlanta Medical College, [4] denounced phrenology as a pseudoscience, "cöequal in its ridiculous folly and error with clairvoyance, mesmerism and witchcraft" (381). Taliaferro's scathing criticism appeared in the third issue of The Medical Journal of North Carolina in 1860.
                                head (L.N. Fowler), modern facsimile. For more information
                            about this item, click here.Phrenological head (L.N. Fowler), modern facsimile. For more information about this item, click here.

Special Collections, Health Sciences Library, University of North Carolina at Chapel Hill

As this sketch makes clear, medical science was largely inadequate to the task of alleviating pain, forestalling infections after operations, curing most diseases, or providing skilled nursing care until the mid-nineteenth century and decades later in some areas. An understanding of germ theory and the importance of aseptic and antiseptic surgical environments as well as the development of ether, chloroform, and other forms of anesthesia would transform medical practice in the latter half of the century.
To learn more about nineteenth-century medical instruments, click here.

3. Medical Education in the United States

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Medical education in the United States during the eighteenth and nineteenth century was predominantly unregulated. Prior to 1765, when the University of Pennsylvania Medical School was founded, aspiring physicians could be educated in at least two ways. They could travel to Europe, especially Edinburgh, London, and Paris, to study medicine with renowned physicians such as John (1728–1793) and William (1718–1783) Hunter and William Cullen (1710–1790). Lacking the resources for study abroad, other students might apprentice themselves to a local practicing physician for a year or two, during which time they read with the doctor, then rode with the doctor. That is, they studied their mentor's medical books, then assisted him in his practice by making compounds and travelling with him as he visited his patients. When the student was judged sufficiently trained to practice medicine, the physician would issue a letter outlining the young doctor's qualifications so that he could hang out his own shingle. Sometimes a physician or groups of physicians would open a medical school, providing for a fee instruction in surgery, medicine, anatomy, and materia medica (the study of therapeutic properties of plants, animals, and minerals, the forerunner of modern pharmacology). The quality of these schools varied significantly, depending on the competence of the physicians, and they rarely lasted for long because they were not affiliated with a permanent institution such as a hospital or a university.
As the population of the United States grew, medical colleges began to be established in cities large enough to support them. In Philadelphia, Benjamin Franklin (1706–1790) and his long-time friend, physician Thomas Bond (1712–1784), established in 1751 the first public hospital in the United States, Pennsylvania Hospital. In 1762 William Shippen, Jr. (1736–1808), a young Philadelphia physician who had trained with John and William Hunter in London and who held a medical degree from the University of Edinburgh in Scotland, began offering a series of lectures on anatomy and midwifery. Together with surgeon John Morgan (1735–1789), Shippen founded a medical school in 1765 that eventually became associated with the College of Philadelphia (later, the University of Pennsylvania). It was the first true medical school in the United States. Other medical schools quickly followed at King's College (now Columbia University) in 1767; Harvard College in 1782; and Dartmouth College in 1797. The independent College of Medicine of Maryland and the College of Physicians and Surgeons of New York City were founded in 1807. Students received formal instruction through lectures and demonstrations, supported by modest libraries and "cabinets," or collections of drawings, models, skulls, and other artifacts. Occasionally students had opportunities to dissect animals or gain clinical practice in nearby hospitals. However, these schools had few entrance requirements and offered no grades or laboratory work. By 1810 approximately 650 students were enrolled in these medical schools, 406 of them at the University of Pennsylvania (Rutkow 453).
Medical reform, however, was clearly on the minds of many practicing physicians in the mid-nineteenth century, a time when too many quacks pedaled nostrums to a credulous public. When the American Medical Association was founded in 1847, attending physicians sought to standardize medical education, advance medical science, and establish a code of medical ethics to benefit public health (Founding of the AMA). In 1850, a year after the founding of the Medical Society of the State of North Carolina, presiding member Edward Strudwick recommended that the Legislature require prospective physicians to "furnish evidence of a sufficient general education and of good moral character" before practicing in the State (11). Strudwick further encouraged cooperation among medical colleges throughout the nation to ensure that a medical degree was not "too cheap and of too easy attainment" (12). Both Dusenbery brothers received medical degrees from reputable medical colleges, but neither likely required certification to practice in the state of their choice. [5]

4. James Dusenbery at the University of Pennsylvania

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James Dusenbery condemns the demon of quackery in his senior
                            speech "The State
                            of Medical Sciences in N.C."James Dusenbery condemns the "demon of quackery" in his senior speech "The State of Medical Sciences in N.C."

Published by permission of Dorothy and William B. Hankins, Jr.

James Dusenbery had decided to become a physician no later than his senior year at the University of North Carolina, when he chose as the topic of his senior speech "The State of Medical Sciences in N.C." This speech survives. It expresses the view that "The science of 'medicine' is not only the most ancient, but the most grave and dignified, that has ever engaged the attention of mankind." The speech reflects the growing spirit of reform, condemning the quacks and charlatans—"those useless members who have so long clogged and restrained [medicine's] upward flight"—who were all too common in the nineteenth century. After graduating from the University of North Carolina in June 1842, James returned to Lexington, NC, to study medicine with physician C. L. Payne. [6] Dr. Payne, mentioned in Dusenbery's journal, was a family friend who had attended the University of Pennsylvania's Medical Department in 1825–1826, but it is unknown whether he earned the MD degree and, if so, where he earned it.
Though many medical schools of the period did not have entrance requirements, the University of Pennsylvania did: "The candidate must have attained the age of twenty-one years, have applied himself to the study of Medicine for three years, and have been, during that time, the private pupil, for two years at least, of a respectable practitioner of Medicine" (Catalogue 34). Though James was twenty-one years old when he entered the University of Pennsylvania's Medical Department in 1843, he evidently was excused, for reasons that are unclear, from the requirement that he study medicine for three years prior to admission, two of which as the private pupil of "a respectable practitioner." Nevertheless, by November 1843 James was in Philadelphia, together with 445 other students, to take up the formal study of medicine.
Announcement for medical study at the University of
                            Pennsylvania (1867–1868).Announcement for medical study at the University of Pennsylvania (1867–1868).

Special Collections, Health Sciences Library, University of North Carolina at Chapel Hill

According to the "Regulations of the Medical Department of the University," the medical lectures began on the first Monday of November and ended in mid-March (Catalogue 33–37). Upon paying a fee, students received a ticket admitting them to a particular course of lectures. Students at the University of Pennsylvania were required to take two complete courses of lectures in anatomy, chemistry, surgery, the theory and practice of medicine, materia medica and pharmacy, obstetrics and the diseases of women and children, and the institutes of medicine (physiology, pathology, and therapeutics). [7] In addition, every student had to attend one course of clinical instruction in the Philadelphia Hospital, the Pennsylvania Hospital, or some other approved medical institution. In these facilities, students had opportunities to assist with the care of patients, observe surgical procedures, and understand the effects of disease on living persons. Though laboratory work was minimal, students also attended demonstrations in practical anatomy. Grades were not given.
After two years of study by reading, lecture, and demonstration, Dusenbery and his classmates could apply to receive the MD degree. Upon application for this degree, every student submitted to the dean of the Medical Department, by February 1 prior to graduation in June, an essay, or thesis, "on some medical subject." James submitted a thesis titled "Empiricism" (Medical Graduates 19). The essay has not survived, but we know that the thesis was assigned to a faculty member, who examined James on it and on his knowledge of medicine in March. These examinations took place at the homes of the professors beginning on the last Monday of the academic year and appear to have been oral examinations, each student being examined separately (Medical Graduates 30). At a subsequent meeting of the entire faculty, as each student's name was called, faculty members had an opportunity to comment on the student's qualifications; then they voted by ballot to determine whether or not the student had passed and was entitled to the degree. Three negative votes could fail a student, unless he elected to undergo a second examination before the entire faculty, meeting in joint session.
The cost of a medical degree from the University of Pennsylvania in the 1840s included the following charges:
Amount of Fees for Lectures in the University $120.00
Matriculating Fee (paid once only) 5.00
Hospital Fee 10.00
Practical Anatomy 10.00
Graduating Fee 40.00
Total $185.00 [8]
James Dusenbery, MD, graduated from the University of Pennsylvania on April 4, 1845, and as he tells us at the end of his journal, "I hung out my shingle in my native town of Lexington early in the month of June [1845]." In about mid-January 1846 he went to Statesville, NC, to practice medicine. The 1850 census indicates that Dusenbery was living in the home of physician David Chambers, age 60, and 29-year-old P. B. Chambers, a farmer. Returning to Lexington by 1852, James opened a drug store in partnership with James P. Stimson, sheriff of Davidson County. According to occupational information included in the 1860, 1870, and 1880 census, James continued to practice medicine until shortly before his death in 1886.
Although there is no record that James attended meetings of the North Carolina Medical Society, R. L. Payne, [9] son of Dusenbery's mentor C. L. Payne, reported on "The Diseases of Davidson County" at its annual meeting in 1861. After the county's epidemic outbreak of dysentery from 1858 to 1860, Payne concluded that he knew of "no disease which more effectually baffles the skill of the physician than [dysentery] occurring in young subjects" and recommended no treatment with great confidence (338). Typhoid fever, yellow jaundice, and diphtheria also plagued Davidson County in the years leading up to the Civil War. James likely prescribed and prepared medicinal remedies to treat those affected by the outbreaks, but as Payne reveals, there were no standard treatments at the time.

5. Fayette Dusenbery at the University of Maryland

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James Dusenbery's brother, Edwin Lafayette Dusenbery, known as Fayette, also became a physician. Though he received his MD from the University of Maryland, his medical education was similar to James's. Fayette graduated from the University of North Carolina in June 1845, the same month in which James graduated from the University of Pennsylvania Medical Department. After a year of study with James in Lexington, NC, Fayette enrolled in the University of Pennsylvania, where he was listed as a matriculant for the 1847–1848 academic year. There he would have attended a year of lectures in anatomy, chemistry, surgery, the theory and practice of medicine, materia medica and pharmacy, obstetrics and the diseases of women and children, and the institutes of medicine comparable to those that his brother James had heard four years earlier. For unknown reasons, Fayette left the University of Pennsylvania and completed the second year of his medical education at the University of Maryland in Baltimore, enrolling there in 1848. [10]
The College of Medicine of Maryland (now the University of Maryland School of Medicine) was founded in 1807 as the first public medical school in the United States. It originated as a medical school, not a university, and represented the response to a riot. John B. Davidge (1768–1829), who had received his MD in Glasgow, Scotland, established a successful surgical practice in Baltimore and in 1802 began giving private lectures in surgery, midwifery, and anatomy. With James Cocke (1780–1813), a Virginian who earned his MD from the University of Pennsylvania in 1804 and taught physiology, and John Shaw (1778–1809), who taught chemistry, Davidge and his fellow physicians offered lectures and anatomical demonstrations in 1807 in a small building Davidge had built as a school. When rumors spread that he was dissecting a fresh cadaver, crowds destroyed the building and carried off the cadaver, the body of a criminal. [11] Though Davidge had not acted illegally, the threat from mobs opposing dissection of human beings only served to strengthen the doctors' resolve. That same year they succeeded in gaining from the Maryland legislature a charter to establish the College of Medicine of Maryland. For a few years, lectures were offered in the professors' houses, but by 1812 a solid brick structure was built for lectures and demonstrations. Davidge Hall still stands today on the University of Maryland campus. When the college added faculties in arts and sciences, law, and divinity in 1812, the institution became known as the University of Maryland.
Address of
                                    the Trustees Concerning the Medical Department of the
                                University of Maryland. Baltimore: John D. Toy, 1836.Address of the Trustees Concerning the Medical Department of the University of Maryland. Baltimore: John D. Toy, 1836.

Southern Pamphlet from Rare Book Collection, Wilson Library, University of North Carolina at Chapel Hill

Enrolling 190 students in 1848–1849, the University of Maryland Medical Department was considerably smaller than the department at the University of Pennsylvania. [12] Reading Maryland's Annual Circular and Catalogue for this period gives the impression that this smaller size encouraged greater attention to practical and clinical instruction, offered through the Baltimore Infirmary. Founded in 1823, the 150-bed Infirmary served the city's poor and was managed by the Daughters of Charity. Prospective students were advised to complete three years' preparatory study and "a course of systematic reading, under the direction of some judicious practitioner, or in one of the private medical schools" (Forty-Second Annual Circular 2). Most of the students enrolled in 1848–1849, like Fayette, had been admitted after studying with a practitioner, or preceptor; however, several students had taken a year-long course of lectures, reading, and clinical instruction at the Maryland Medical Institute, the Baltimore Infirmary, and the Baltimore Almshouse. It is not known how many students, like Fayette, had already completed one year of lectures at some other medical school. [13]
The academic year at the University of Maryland began on the last Monday of October and concluded in mid-March. As at the University of Pennsylvania, students paid fees to receive tickets admitting them to lectures on surgery, chemistry, materia medica, anatomy, the theory and practice of medicine, and obstetrics. Two courses/years of lectures in these subjects were required. Additional required lectures in pathological and practical anatomy were taken for only one year, during the second year of instruction. Though the University of Maryland did not require a year of clinical practice, as did the University of Pennsylvania, this omission may be the result of clinical training being included in other courses. The course in surgery, for example, included daily lectures and clinical instruction involving patients from the Baltimore Infirmary. Students would have observed amputations, the treatment of fractures, and other major and minor surgical procedures. The theory and practice of medicine likewise included daily lectures and clinical visits at the Infirmary. Annually, up to eight students were permitted to live at the Baltimore Infirmary as clinical assistants for $80 a year (other students lived in boarding houses for $3 to $4 per week). Even without a year of required clinical experience, the Annual Circular expresses an intention "to give a practical and intelligible course of instruction, calculated to prepare the student for the emergencies of his future profession" (Forty-Second Annual Circular 11).
As was true at the University of Pennsylvania, every candidate for the MD degree was required to submit a thesis "on some subject connected with medical sciences" and to "satisfy the Faculty, by appearing before them in a private examination, of his fitness for receiving the degree of Doctor in Medicine" (Forty-Second Annual Circular 19). Fayette's thesis on "Cholera" survives. The results of the examination were determined by a majority vote of the medical faculty. A medical education at the University of Maryland was slightly less expensive than that offered at the University of Pennsylvania:
Amount of Fees for Lectures in the University $90.00
Matriculating Fee (paid once only) 5.00
Clinical Ticket no charge
Pathological Anatomy 5.00
Practical Anatomy 10.00
Graduating Fee 20.00
Total $130.00 [14]
Though Fayette Dusenbery is listed among the 68 graduates who received their MD degrees in March 1849, we know little about his medical practice after leaving the University of Maryland. He returned to Lexington, NC, and on 18 May 1852 married Caroline Amanda Summey (b. 1830). Though one source places him in Tennessee before moving to Georgia, no additional information about his residence in Tennessee is available. The 1860 census indicates that he was a physician in Resaca, GA, living with his wife and his farmer father- and brother-in-law, Peter and Peter A. Summey. When the Civil War broke out, Fayette enlisted as a private in the 14th Regiment, Georgia Volunteers, in 1861. He died in Richmond, VA, on April 25, 1862.
We know almost nothing about how James and Fayette Dusenbery conducted their medical practice. The best documentary evidence of what physicians did is the fees they agreed to charge for various procedures. These medical charges were set by county medical societies and published in local newspapers. [15] The Rowan County [NC] Medical Society, for example, established fees for house calls of various durations and distances from town, post mortem examinations, bleeding, dressing wounds, administering injections, surgical procedures, attending women in childbirth, prescribing medications and giving injections, extracting teeth, and treating fractures, among other procedures.

6. Medical Advances in Dusenbery's Lifetime

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What improvement ever equalled that of the introduction of chloroform, of anæsthetics? Pain abolished at one glorious sweep; you know that even within your own memory, let cavillers say what they please, it has become the recognized practice of all good surgeons in America, Asia, Europe, to administer chloroform. Let no silly errors persuade you to the contrary! (Skey 152–153)
London surgeon F. C. Skey puts the matter quite simply: the introduction of anesthetics revolutionized and radicalized medicine in the mid-nineteenth century. And readers of the first issue of The Medical Journal of North Carolina (1858) likely heeded Skey's prescient pronouncement. After Georgia physician Crawford Long used ether to anesthetize a boy needing a cyst removed from his neck in 1842 and Boston dentist William T. G. Morton successfully anesthetized housepainter Gilbert Abbott with "letheon" [16] in 1846, the idea of painless surgery captivated physicians worldwide. In fact, Queen Victoria requested chloroform from her physician for the delivery of her son Leopold, giving anesthesia the royal stamp of approval in 1853 (Fenster 168). Nitrous oxide ("laughing gas"), chloroform, and ether arose as the choice anesthetics in the 1840s, replacing a slew of unreliable alternatives in pain management—among them mesmerism, freezing, and alcohol. However, the relatively quick acceptance of anesthesia in medical circles worldwide—hospitals in New York, London, and Paris began administering ether only months after Morton's success in Boston—did not stop surgeons from operating on conscious patients (Pernick 3–4). Anesthetics were generally reserved for white women and children of the upper classes, whom surgeons considered typically weak, intractable, and more easily anesthetized. "Average" white men, African Americans, and women of "the humble and healthy classes" were unlikely candidates for anesthesia because they "supposedly needed less protection from pain" (Pernick 176–177).
Surgical kit,
                            used for amputations dating from the mid-1880s. For more information
                            about this item, click here.Surgical kit, used for amputations dating from the mid-1880s. For more information about this item, click here.

Instrument Collection, Health Sciences Library, University of North Carolina at Chapel Hill

War was another revolutionary force in medicine in the mid- to late-nineteenth century. British nurse Florence Nightingale, who led a team of nurses for the British Army during the Crimean War (1853–1856), published Notes on Matters Affecting the Health, Efficiency and Hospital Administration of the British Army upon her return in 1858, emphasizing the necessity of sanitary living conditions to contain preventable disease. [17] American physicians took Nightingale's recommendations seriously, particularly after the Civil War broke out in 1861. In fact, The Medical Journal of North Carolina reprinted selections of John J. Chisholm's Manual of Military Surgery, which encouraged Confederate soldiers to mimic the "frequent ablutions of the English, who washed their clothes in hot water, and chang[ed] their underclothes twice a week" in the Crimea (589). The U. S. Sanitary Commission, which formed "at the beginning of the war, in the desire to meet and avoid, for our army, the terrible evils which decimated the Crimean Army" (United States 1), managed to decrease the disease rate by half in Union camps (Burns). The Civil War also brought new knowledge about human anatomy and new surgical procedures, and in 1867 Joseph Lister (1827–1912) reported on his experiments using carbolic acid to sterilize instruments and clean wounds, publishing his "Antiseptic Principle in the Practice of Surgery" in The British Medical Journal. The theories of contagion that fueled these "clean-ups" precipitated germ theory and the discovery of microorganisms by Louis Pasteur (1822–1895)—a discovery unlikely to have influenced Dusenbery's practice.
Frontispiece portrait
                            of Susan Dimock. Memoir of Susan
                                Dimock: Resident Physician of the New England Hospital for Women and
                                Children. Boston: J. Wilson, 1875. For more information on
                            Susan Dimock, click here.Frontispiece portrait of Susan Dimock. Memoir of Susan Dimock: Resident Physician of the New England Hospital for Women and Children. Boston: J. Wilson, 1875. For more information on Susan Dimock, click here.

North Carolina Collection, Wilson Library, University of North Carolina at Chapel Hill

In the 1850s women such as Elizabeth Blackwell (1821–1910) and Marie Zakrzewska (1829–1902) began to practice medicine, especially among women and children. Blackwell graduated from Geneva College in New York in 1849, becoming the first woman to obtain a medical degree in the United States, and Zakrzewska received her MD from Cleveland's Western Reserve Medical College in 1856. Women physicians were still not widely respected in the 1850s, but the Civil War gave women, particularly nurses, a chance to assert new authority and command respect in the medical field and the public sphere. Just as Nightingale became an indispensible asset in British public health reform, nurses such as Mary Ann Bickerdyke (1817–1901), Clara Barton (1821–1912), and Sally Louise Tompkins (1833–1916) commanded unprecedented respect for fearlessly caring for the wounded and sick, oftentimes providing treatment when doctors were scarce. General William T. Sherman famously claimed that "Mother" Bickerdyke, who assisted in amputating limbs and brewed barrels of coffee for Union soldiers, "ranked" him. When Jefferson Davis outlawed private hospitals in the Confederate States in 1861, he commissioned Tompkins as a captain in the Confederate Army so that she could continue her good work as a public servant at the Robertson Hospital in Richmond. The commission paid off: the hospital's staff of six only lost 73 of the 1,333 men they cared for during the war (Burns).
Women still had few professional opportunities outside the home after the war, and medical schools remained reluctant to admit women as students. Susan Dimock (1847–1875), twice denied admission to Harvard's medical school, had to teach herself German and travel to Zurich in 1868 to pursue her MD. However, attitudes were changing. The same year that Dimock traveled to Zurich, the American Medical Association's Committee on Ethics strongly encouraged the recognition of sufficiently educated and qualified female physicians. The Association welcomed its first female member, Sarah Hackett Stephenson, in 1876 ("Our History"). Dimock was admitted to honorary membership in the North Carolina Medical Society in 1872.
Saddle bag
                            containing vials of various medicinal compounds (dated 1892). For more
                            information about this item, click here.Saddle bag containing vials of various medicinal compounds (dated 1892). For more information about this item, click here.

Instrument Collection, Health Sciences Library, University of North Carolina at Chapel Hill

It would have been difficult for James Dusenbery to have dismissed the myriad medical advances over the course of his professional lifetime. Promoting his view that micro-organisms caused disease, Pasteur developed ways to prevent milk, beer, and wine from making people sick, a process now known as pasteurization. Formal nursing programs were established in the early 1870s, and a decade later vaccines were being developed for rabies, anthrax, and chicken cholera. These and many other developments created new knowledge in the field of medicine, knowledge requiring extensive training of aspiring physicians through courses, laboratory work, and practica. By the time Dusenbery died in 1886, the University of Pennsylvania, the institution from which he had received his medical degree after attending two years of lectures and writing a thesis, had expanded its curriculum to three years, with examinations at the end of each year, considerable laboratory work, and a full year of clinical experience working with living patients. [18]


^1. The following essay is based primarily on three sources: lecture notes from a history of medicine seminar offered by Dr. George F. Sheldon of the University of North Carolina at Chapel Hill during the spring 2008 semester; a digital copy of the Catalogue of the Trustees, Officers, and Students of the University of Pennsylvania, 1844–45 (Philadelphia: Bailey, 1845); and a photocopy of the Forty-Second Annual Circular and Catalogue of the Medical Department of the University of Maryland, Session 1849–'50 (Baltimore: Woods, 1849).

^2. After realizing that doctors were transferring childbed fever from cadavers to living patients in May 1847, Ignaz Semmelweis (1818–1865) ordered his staff at Vienna General Hospital to sanitize themselves before deliveries by washing their hands in chlorinated water. Deaths from childbed fever dropped drastically. Unfortunately, these practices were not implemented widely at the time and the value of sanitization and sterilization would be debated for decades to come (Waller 63–64).

^3. The typical magnification of today's optical microscopes, which use refractive glass to focus light into the eye, is up to 1500x.

^4. Dr. Valentine H. Taliaferro (1831–1887) had a long history with Atlanta Medical College, which was the earliest forerunner of Emory University School of Medicine. After serving as a surgeon in the Confederate Army, Taliaferro was named chair of women's diseases in 1872, elected professor of women's and children's diseases in 1874, served as dean of the faculty in 1876, and became a member of the board of trustees at the college in 1877. Thereafter, he served on the Georgia State Board of Health, holding a number of positions including secretary and executive member (Martin 360–361).

^5. Although the Medical Society of North Carolina elected a board of seven members in 1859 to regulate the practice of medicine, North Carolina did not require its physicians to be licensed by the Board of Medical Examiners until 1921 (150 Years).

^6. Dr. C[harles] L[ee] Payne (1798–1865), with whom Dusenbery later studied medicine. Payne represented Davidson County in the North Carolina General Assembly in 1844 and served as a Councilor of State in 1848. He was married to Mary Ann Lewis (1809–1887). They were the parents of seven known children, only one of whom lived to adulthood.

^7. The faculty included Nathaniel Chapman (physic and clinical medicine), Robert Hare (chemistry), William Gibson (surgery), William E. Horner (anatomy), Samuel Jackson (institutes of medicine), George B. Wood (materia medica and pharmacy), Hugh L. Hodge (obstetrics and the diseases of women and children), William W. Gerhard (clinical medicine). For more information, consult the Catalogue of the Trustees, Officers, and Students of the University of Pennsylvania, 1844–45 (Philadelphia: Bailey, 1845), 8. The Health Sciences Library at the University of North Carolina at Chapel Hill houses Dr. Chapman's A Compendium of Lectures on the Theory and Practice of Medicine, also available online at Internet Archive. The library's copy includes a patient note to "Dr. Fuller."

^8. See Regulations of the Medical Department of the University, Report on the Medical Department of the University of Pennsylvania, for the Year 1845 (Philadelphia: Bailey, 1845), 31.

^9. Dr. R[obert] L[ee] Payne (1834–1895), a student at the University of North Carolina during the 1852–1853 academic year and a graduate of Davidson College, followed his father into the medical profession, graduating from Jefferson Medical College in Philadelphia in 1857 and practicing in Lexington until his death—an unusually violent death at the hands of Baxter Shemwell ("Obituary" 132).

^10. Baltimore was home to Fayette's uncle, Samuel B. Dusenbery (1800–1855), a captain and quartermaster in the U.S. Army. Originally from North Carolina, he was married to Mary Ray Bowie (1814–1881) and moved to Baltimore in about 1837; they were the parents of two children, Mary Ray and Hamilton Bowie Dusenbery. Samuel B. Dusenbery died in New Mexico.

^11. In the early nineteenth century, only the corpses of executed criminals could be used legally for dissection in anatomy laboratories. Physicians considered the study of human anatomy essential, but they had difficulty securing anatomical material for their lectures and demonstrations, often using wax models and illustrations instead of corpses. The physician's view that anatomical knowledge was necessary for the informed practice of medicine was countered by horrific accounts of people who were murdered so that their bodies could be sold, of flagrant grave robberies, and of extreme measures some families felt it necessary to take to guard the deceased for several weeks until the body could no longer be used for dissection. Others opposed dissection on religious grounds, believing that the human body needed to be inviolate and whole on Judgment Day. The limited supply of corpses encouraged body-snatchers, or "resurrection men," to steal bodies from cemeteries and offer them for sale to unscrupulous physicians. Though body-snatching was illegal, the law was difficult to enforce. Some states considered the body "dust," worth less than the clothing, shroud, or jewelry the deceased may have worn and which the body-snatchers were careful to leave behind to avoid being charged with theft. In 1832 England's Warburton Anatomy Act served to license anatomists, allowed for dissection of donated and unclaimed bodies, and set requirements for the treatment of corpses before and after dissection. Many states in the United States enacted similar laws in the 1830s. Sometimes the dissections, especially in the South, were carried on outdoors during cool months to lessen the overwhelming smell of putrefying flesh; elsewhere, separate buildings or sections of buildings housed the dissecting laboratory. See John B. Blake, The Development of American Anatomy Acts, Journal of Medical Education 30.8 (1955): 431–39.

^12. The faculty included Nathan R. Smith (surgery), William E. A. Aiken (chemistry and pharmacy), Samuel Chew (therapeutics, materia medica, and hygiene), Joseph Roby (anatomy), William Power (theory and practice of medicine), Richard H. Thomas (midwifery and diseases of women and children), George W. Miltenberger (pathological anatomy and demonstrator of anatomy). For more information, consult the Forty-Second Annual Circular and Catalogue of the Medical Department of the University of Maryland, Session 1849–'50. (Baltimore: Woods, 1849), 2.

^13. Such students, by agreement among reputable medical schools, were admitted ad eundem; that is, "at the same rank" that they had enjoyed in a previous institution. So, for example, Fayette Dusenbery, having completed one year at the University of Pennsylvania, was considered a "second-year" student at the University of Maryland.

^14. See Forty-Second Annual Circular and Catalogue of the Medical Department of the University of Maryland, Session 1849–'50 (Baltimore: Woods, 1849), 19–20.

^15. The North Carolina Medical Society was founded in 1799 and a year later established a Board of Censors to determine who was qualified to practice medicine in the state. A law establishing a medical board of examiners was not enacted, however, until 1859; it "allowed for physicians with a medical diploma and those swearing under oath that they had practiced medicine prior to the bill to register to practice within their county of residence." See 150 Years of Leadership: The History of the North Carolina Medical Society's Pioneering Physician Leaders (Raleigh: North Carolina Medical Society, 2004), 4.

^16. Morton's "letheon" was a mixture of sulfuric ether and oil of orange, which masked the smell of ether (Fenster 6).

^17. During the Crimean War, the British Army's death rate from preventable disease was seven times that from battle wounds. Before Nightingale's intervention in the filthy and rat-infested hospital barracks at Scutari, the death rate for British soldiers was said to be 60 percent; after Nightingale literally cleaned up the place, the death rate dropped to 1 percent by the end of the war (Joel 14–16).

^18. See Medical Class of 1889: Historical Development of Curriculum, University of Pennsylvania Archives and Records Center, n. d.

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