Friday, May 28, 2010

Delayed Births - What a Concept!

Occasionally I come across terms that on the surface do not make sense to me. I ask myself, "What does that mean?" In most cases I find these words in old documents, but in a few cases I come across some them in fairly contemporary documents.

Delayed births was one such term that I encountered as I researched my relatives born around 1900. Taking the phrase literally, it made no sense to me. No woman in the midst of labor would want to delay the birth of a child unless there was a very compelling reason to do so. I wasn't even certain that doctors had the means to delay a birth at the beginning of the 20th century.

So what was a delayed birth? Birth certificates are a 20th century creation. Prior to about 1905 and in the United States, most births were recorded in church records and in some cases a county registry. In some instances, the only record of the birth was in a family Bible.

It wasn't really important to actually know when one was born until the advent of the Social Security Administration in 1935. In order to qualify for Social Security benefits at age 65, you had to have proof of age. So for those people who were born before the time that births were officially recorded, there was a mechanism put in place that permitted the county in which you were born to create a birth certificate for you - a delayed birth (certificate).

The applicant for a delayed birth certificate had to obtain affidavits from family and friends that attested to the date of birth and the place of birth. If all was in order, then the county clerk or county registrar issued a birth certificate.

Prior to the creation of birth certificates, there were towns and counties that maintained a birth registry. The physician who delivered the baby was responsible for filing the birth with the town clerk. Physicians occasionally did not file the birth for months and sometimes a year or more later.

One woman who I met at my first full-time job wanted to retire. She believed that she was born in 1907 but the physician when he registered her birth recorded the year as 1908. She was perfectly happy to claim her age based on the doctor who delivered her until she wanted to retire.

Anne and I remained friends until she died at age 93.

Thursday, May 27, 2010

Carnegie Hill Neighbors - On Waldron Farm Update

On January 31, 2010, I posted a blog about the misinformation that this website had posted. I sent an email message via the contact me link at the website.

The message I sent read:

On the page accessed from you refer to a Baron Resolved Waldron. This person is the grandson of Barent Nagel after whom he was named. Your Baron Resolved Waldron is actually named Barent Resolveert Waldron. It is not a title but a common given name. His father was Resolved (Resolveert) Waldron. Typical of the time in which Barent Waldron was born people were identified with a patronym. In this case, Resolved (Resolveert).

I couple of weeks ago, I received the following message:
Dear Ms. Kline,

Thank you for the corrections you sent to Carnegie Hill Neighbors regarding the names of two early residents of our neighborhood.

I compiled the history section on our website using a number of sources. The references you mention are taken from an article in our Carnegie Hill News in 1990, written by an elderly gentleman who was somewhat of a historian. He lived in a wooden house built in 1871 and had a treasure of old maps and historical information, much handwritten. Twenty years ago, we accepted what he wrote without reservation. With your incentive, I have checked the names on Internet sources and see that you are quite right.

Quite incidentally, the president of our organization now is of Dutch origin, and he said independently that your corrections make sense. We will have them made this week.

Can you tell us how you came to our website?

Thank you for your interest and corrections.

Barbara Coffey
I replied to the her message. The site was updated. However, a few errors still exist.

Part 5: American Medical Training before the 20th Century

In an earlier blog entry, I suggested that I would try to determine if there was some number of physicians who were in private practice, not associated with a medical school and had earned an LLD. This task is proving to be huge. However, as I was looking at how one became a physician in the United States prior to 1900, I have pretty much concluded that very few private practice physicians prior to 1900 took the time to study for an LLD degree.

Upon learning how one became a physician before 1900, I realized that many of the medical practitioners had no formal training at universities and colleges. The physicians included in Walter Graeme Eliot’s book were associated with schools like Columbia University and the University of Pennsylvania. Thus, the opportunity to pursue an LLD degree was readily available.

In Part 4 of this series, I mentioned that during the American Revolution of the nearly 3500 medical practitioners about 400 had medical degrees. The approximately 3100 had become medical practitioners through an apprenticeship. The quotation that I included in Part 4 from William Smith’s book, The History of New York, from First Discovery to the Year MDCCXXXII (1732), complains about the lack of regulation and licensing of doctors. This complaint was repeatedly expressed throughout the 19th century as well.

Prior to 1765, if you wanted to become a doctor, you either went to Europe to study or you studied under a local practicing physician. Typically you apprenticed for two years and then your preceptor would create a certificate or affidavit stating that you had completed your study and were qualified to practice medicine. The course of training at the Medical College of Philadelphia and at King’s College Medical School did not do much to improve the quality of doctors.

To graduate with a bachelor degree in medicine, the student served 2 years under a preceptor and attended one course of lectures for the duration of four months. The lectures were from 7 to 8 hours in length each day and covered material medica, physic, anatomy and chemistry. To graduate with an MD, the student served 3 years under a preceptor and attended 2 courses of lectures for the duration of four months each one year apart. The second course of lectures was a duplicate of the first course.

Admission to American medical schools from 1765 into the 19th century was based on who could afford to pay. Students purchased tickets to the various lectures. At the Medical College of Philadelphia, these were called Matriculation Tickets. There were no tests, no labs and little to no clinical experience as most medical schools were not associated with a teaching hospital let alone a hospital.

By 1850, there were 37 medical schools in the United States. None were regulated. Without the need of laboratories and clinics and the lack of regulation, medical schools were easy to set up. If marketed well, a medical school was a cash cow for the physician who owned one. So it is no wonder that by 1876 another 33 medical schools were established. In the succeeding 25 years the number of medical schools more than doubled by the addition of 86 facilities. Of the 156 medical schools in existence in 1900, only 74 were departments of colleges or universities.

During the first half of the 19th century, several states attempted to regulate medical practices but by the 1830s the statutes were amended to the point of being ineffectual or abolished entirely. In 1850, only three states had laws concerning the licensing of physicians.

To be continued: Part 6: Regulation of Medical Schools in the United States.

Harvard Medical School History: Looking Back and Looking Forward.
The History of Medicine in the United States by Francis Randolph Packard, MD. Philadelphia: J. B. Lippincott Company, 1901.
The Standard Medical Directory of North American 1902Chicago: G. P. Englehard & Company, 1902.

Wednesday, May 26, 2010

History Repeats Itself Again

I was listening to a Bruce Springsteen CD Saturday afternoon as I was doing things around the house. One of the songs was "My Hometown." As I listened to the words, I thought to myself, "this seems familiar."

The song tells of tensions running high in 1965 in his high school between blacks and whites. At the same time there are vacant stores in his hometown. The textile mill closed and the foreman says, "These jobs are going boys and they ain't coming back to your hometown." It is 2010 and I am hearing the same things; tension between blacks, whites and Hispanics and jobs going somewhere else.

Jobs were going overseas in 1965 but those jobs were mostly jobs held by textile workers. Most garments that we wear today are made elsewhere. As I recall, in the early 1970s, many of the garments we purchased  had a label that said, "Hecho en Mexico." Soon our garments were being manufactured in other Latin Americans countries like Honduras. Then, at some point, I noted that clothing was being made in Asian countries including Bangladesh, India, Sri Lanka, Viet Nam, and China. As time passed, other jobs went overseas, such as automobile, computer and electronics manufacturing. Today, China is the largest producer of many of the goods that we purchase including toys.

Forty-five years later, jobs are still going overseas and tensions are running high. This time the tension is mostly between Hispanic immigrants and whites in the states that border Mexico. As I watch the reactions of the people on both sides of the issue unfold, I am reminded of the period in American history in which a large number of Irish came to the United States.

It was 1847 when the Irish came to America in the first big wave of Irish immigrants. Between 1845 and 1847, a million people died in Ireland as result of the potato famine. Fleeing the specter of starvation, Ireland lost another million to the United States. In 1850, the Irish represented the largest foreign-born population at 43% and were concentrated in Boston and New York. Of these about a quarter settled in Boston, a decidedly Protestant city.

The Irish were not treated well in either New York or in Boston. They were highly exploited and preyed upon. They faced discrimination in both cities but more so in Boston. I find it interesting that people whose ancestors fled Europe to escape religious persecution in the 17th century, themselves became persecutors of the Irish primarily because they were Catholic.

An anti-Catholic sentiment brewed and resulted in the burning of Catholic convents and churches and the homes of Irish immigrants. Some Irish immigrants were killed by mobs. Violence against Catholics was not exclusive to Boston, but occurred in Philadelphia, Baltimore, St. Louis, New Orleans and Louisville. A militant anti-Catholic political party was formed and called the Know-Nothings.

The goal of this party was to end Irish immigration to the US and keep those who were already here from becoming naturalized citizens. The party was the strongest in Massachusetts when in 1854, every one of its candidates won political office including the candidate for governor. It was the outbreak of the Civil War that turned the nation's attention away from the Irish immigrants.

As I write this, I feel a sense of deja vu and frustration that we don't seem to learn from the past. I don't understand the violence and hatred since every person in North America is an immigrant, even the "native" Americans. We all sprang from someone who came from elsewhere.

Source: Irish Potato Famine, The History Place, 2000. Accessed May 26, 2010.

Part 4: MD with an LLD Degree or Is It LLD with an MD Degree?

I made an javascript:void(0)error in my last post. Maryland was not the location of one of the first four medical colleges in the United States.

The Medical College of Philadelphia (now the medical school of the University of Pennsylvania) was established in 1765. King's College (now Columbia University) in New York City established a medical school in 1768. Philadelphia and New York for many years were the centers of medicine in the American colonies.

Harvard College added a medical curriculum in 1782 followed by Dartmouth Medical College in 1797. The creation of medical schools in the United States in the first 75 years of the 19th century was rather slow. Between 1801 and 1825 only 12 more medical colleges were established. Over the next 25 years 22 more schools were established followed by 33 between 1851 and 1875. However, the pace accelerated in the last 25 years of the 19th century with the addition of 86 new medical colleges. According to page 13 of The Standard Medical Directory of North America 1902, as of 1899, there were 156 medical schools in the US with 24,119 students enrolled.

This book, as well as others, claimed that during the Revolutionary War, nearly 3500 people were medical practitioners but only about 400 had medical degrees. So with only four medical schools founded between 1765 and 1797, how were most medical practitioners trained?

A few went to Europe to study. Dr. Francis Packard writes in his book that from 1758 through 1788, 63 Americans graduated with a medical degree from the University of Edinburgh in Scotland (page 156). During this period, if you had the funds, you went abroad to study in London, Edinburgh, Paris and Leiden. Unfortunately, most colonists did not have the means, thus most medical practitioners were trained through an apprenticeship.

I found that there were no standards regarding what constituted proper medical training. The following quotations taken from or about the time clearly illustrates the point:

God heals and the doctor takes the fee. - Benjamin Franklin
Few physicians amongst us are eminent for their skill. Quacks abound like locusts in Egypt, and too many have recommended themselves to a full practice and profitable subsistence. This is the less to be wondered at, as the profession is under no kind of regulation. - William Smith (1732)
The Chicago Medical College (Northwestern University) by 1859 had introduced a more rigorous curriculum and graded courses, compulsory clinical and laboratory work and lengthened the duration of the program. In 1871, Harvard Medical School adopted a similar program followed by Syracuse Medical School. However, the problem continued throughout the greater part of the 19th century at which time medical societies such as the American Institute of Homeopathy (organized 1844), Association of American Medical Colleges (1890), National Confederation of Eclectic Medical Colleges (1871) and the Southern Medical College Association (1892) pushed for the establishments of higher standards.

To be continued in my next blog: American Medical Training before the 20th Century.

History of New York, from the First Discovery to the Year MDCCXXXII by William Smith. Albany, NY: Printed by Ryer Schermerhorn, 1814.
The History of Medicine in the United States by Francis Randolph Packard, MD. Philadelphia: J. B. Lippincott Company, 1901.
The Standard Medical Directory of North American 1902
. Chicago: G. P. Englehard & Company, 1902.

Tuesday, May 25, 2010

Part 3: MD with an LLD Degree or Is It LLD with an MD Degree?

In my last blog entry, I indicated that I would look at physicians in private practice and not employed by a medical school to see if some percentage of these physicians had also obtained an LLD. That task is proving to be more time consuming than I had hoped.

However, while I was exploring the answer to this question, I did come across some interesting facts.

As I constructed the spreadsheet from the information in Walter Eliot's book, "Portraits of the Noted Physicians of New York 1750-1900" and filling in the information missing in the book about these 199 physicians from other sources, I noted an interesting fact. Several of the earliest practicing physicians had gone to Europe to study. In particular, these men traveled to Edinburgh, Scotland to study medicine either after earning an MD degree or after serving an apprenticeship under a practicing physician.

So what was happening in medicine in the colonies in 1750? Well, for one thing there were no medical schools. The first medical school established in the North American British colonies was in Pennsylvania in 1765 followed by medical schools in New York and Maryland. With the addition of a medical curriculum at Harvard in 1782, there were only 4 medical colleges in the United States by 1800. Clearly, the American Revolution had an impact on the establishment of medical colleges.

So it is not surprising to me that the men in Walter Eliot's book who were practicing medicine the earliest had gone to Scotland for training. As times progressed, some of the men in the book went to London, Paris and Vienna for medical training beyond the training that they received in the United States.

I am a descendant of the "first physician" in New Amsterdam. As I looked for documentation that supported this claim, I found Hans Kierstede referred as a chirurgeon. As it turns out this translates to a surgeon, but not as we think of a surgeon today. Back then, there were three occupations that provided medical care. These were the physician, surgeon and apothecary. The surgeon was associated with the military and whose function was to amputate limbs. The apothecary mixed items to create medicines.

To be continued...

Wednesday, May 19, 2010

Part 2: MD with an LLD Degree or Is It LLD with an MD Degree?

I created a spreadsheet from the information included in Walter Eliot's book, "Portraits of the Noted Physicians of New York 1750-1900." Then I found other sources including the Journal of the American Medical Association, the New York Times, etc. to fill in the information missing from Walter Eliot's book.

The physicians included in the book were in most cases on the faculty of medical colleges primarily in New York. Some were medical directors of hospitals, while others authored books on a particular area of study. A few invented things of significance in the health care arena of the 19th century.

All of the physicians who obtained an LL. D. degree did so after earning the medical degree. However, all of these doctors continued in their pursuit of medicine after earning the law degree. Most of these doctors earned the law degree twenty years or more after receiving the medical degree. Nearly three quarters of the doctors earned the law degree between 1878 and 1899.

I find it very interesting that so many of these physicians were awarded an LL. D. degree in the 1890s. I do not know why but will see if I can find an explanation. Curiosity is getting the best of me. I am very interested in seeing if practicing physicians during this period who were not affiliated with a teaching school were getting LL. D. degrees as well.

What was the average age of these men when they earned their medical degree? My spreadsheet included the birth year as well as the year in which each earned his M. D. It was easy to add a calculation that provided me with the age  of each of the 199 men at the time each received his M. D.

The youngest was 19 years old. Most obtained the medical degree between the ages of 21 and 26. The peak age was from 22 through 24 years. These three ages represents 50% of the doctors in the book. The men who obtained an M. D. age 21 through 26 years of age represent 82% of all the physicians included in the book.

Things have changed from the 19th century to the latter part of the 20th century. I don't have the numbers but I have observations from having worked in the Bio-mathematics Department of the School of Medicine at UCLA in the late 1970s and observing my daughter and her medical school colleagues more recently/ It appears that most doctors receive the M. D. at age 26 years.

The physicians included in the book had areas of specialty for which each was noted. However, from what I have ascertained in my research, formal residencies that the current medical student face before being allowed to practice in a specialized area did not appear to exist during the period covered by the book. Working with a preceptor seems to be the way in which MDs in the 19th century entered specialized practices.

Tuesday, May 18, 2010

Part 1: MD with an LLD Degree or Is It LLD with an MD Degree?

A distant cousin recently forwarded an email message asking for help in providing information about his/her ancestors. This individual is a descendant of Walter Graeme Eliot who authored several non-fiction books. I recall that in 1900 he authored a book, "Portraits of Noted Physicians of New York 1750-1900."

My daughter is a medical student so I often notice finding family having some connection to medicine. I was certain that this book would be out of copyright, so I took a chance and searched on Google Books. Happily, I found the book.

Walter's father, Augustus Eliot, was an obstetrician/gynecologist in the second half the 19th century in New York City. Thus, I was not surprised to find that Walter had authored such a book and was thoroughly expecting to find something about his father in this book. Walter did not disappoint me. In fact, he dedicated the book to his father.

As I perused the book, I was struck at the number of physicians who had an MD and an LLD degree. Of the 199 physicians included in the book, forty-two had earned both degrees. That means that 21% of these physicians also had an LLD degree.

I asked myself whether the physicians earned the law degree after becoming a physician or the other way around. My next step is to go back and capture this information to analyze it.

Two of the physicians in Walter Eliot's book did not have an MD degree. Over the years as I researched my family history, I came across relatives who became doctors because they studied under another practicing physician. I then wondered when did this practice stop?

Both of these questions are fodder for another blog.

Tuesday, May 11, 2010

Mother's Day

On the morning of Mother's Day, I found an email that let me know that my daughter had posted a greeting on my Facebook wall wishing me a happy Mother's Day.

My daughter is an MD/PhD student at UCSF and had a date in the South Bay Saturday night. She stayed the night at our house and spent the next day, Mother's Day with us. The two of us went to my gym Sunday morning to workout. Later she asked me if I had looked at her Facebook wall. I told her that I had not.

We had a nice brunch and came home to watch Saturday Night Live with Betty White that my husband had recorded. My daughter left to go back to the city to teach a class that evening. At some point I thought about her question earlier that day. I looked at her wall and found a link to a song the she had performed in my honor. I listened to the song and it brought tears to my eyes.

A friend sent a link to another person who recorded and posted a song to his mother. I listened to both songs and would like to share each with you.

The song  from a son to his mother and the song from my daughter.

Tuesday, May 4, 2010

A Train Trip over the Sierra Nevada

This rainy season has been long, cold and very wet. The result is the snowpack in the Sierra Nevada this year is well above normal. Only a week ago, it was still snowing the the Sierra Nevada mountains. (Today, Mark Cowin, State Water Director, reported that the snowpack was 143 percent of normal.)

My sister planned a trip to Nevada for early May and would be spending a night in Reno. I thought a train trip from the Bay Area to Reno would be fun, relaxing and scenic given the amount of snow this year. Sunday I boarded the California Zephyr in Emeryville, CA for my trip across the Sierra.

I packed five bottles of wine in a suitcase to give to my Minnesotan sister and had a painting that belonged my mother that I wanted to give my sister. The painting was fragile and the suitcase was very heavy. I decided to carry the painting onto the train and check the suitcase.

The train out of Emeryville followed Interstate 80 and the northeastern portion of the San Francisco Bay. As the train traveled toward the east into the delta area, I saw the blue bay waters turn brown. As the train moved eastward, we left the bay waters and traversed farmlands. The train stops were very, very brief at the stops along the way until we arrived in Sacramento. Over 100 boarded the train at this stop. It was also designated a smoking stop to allow passengers who were smokers to get off the train and have a smoke.

A volunteer from the State of California Railroad Museum in Sacramento boarded the train at this stop. He provided interesting historical comments as the train moved between Sacramento and Reno. The train made a stop at a town called Colfax. The man from the Railroad Museum said that the town was named after Schuyler Colfax.

In February, I wrote about my relative, Schuyler Colfax. This is the same person for whom the town of Colfax was named. I took a picture of a statue that was near the train stop assuming that it was a statue of my relative Vice President Schuyler Colfax.

The trip across the Sierra Nevada was pleasant and the views beautiful. I left the train in Reno and waited for my suitcase that I checked in Emeryville to appear. All the suitcases were claimed but one. However that suitcase was not mine. The claim number on the tag was one different from my luggage claim number.

The agent at the station took a report, called the Emeryville station to see if my suitcase was still in Emeryville. After several minutes, he learned that the suitcase left at Reno belonged to a man who was traveling to Denver. Somehow in Emeryville, my bag was tagged to go to Denver and the man's suitcase was tagged to go to Reno. The agent was able to contact the conductor on the train to check for my suitcase in the Denver destination section of the baggage car. The bag was there and was taken off the train at Winnemucca, Nevada. Monday morning my suitcase was put on the westbound train from Winnemucca to Reno.

I picked up the suitcase Monday morning. However, I did buy a nightgown, some underwear and a blouse to use between Sunday night and Monday morning.

I flew back from Reno today and told the skycap at the airport to make sure that my bag made it on the plane to San Jose as the suitcase had been lost by Amtrak on my trip to Reno.