The Lifestyle of Early 19th Century Southern Physicians
During the time that William Graham practiced medicine, southern rural physician’s treatment of patients, bedside manner, acquisition of patients, and financial compensation were remarkable different from those of physicians today. Doctor’s were usually only called when a person was very sick and the members of the patient’s family could no longer help with the sick person’s recovery. The doctor would also rarely see these patients in his office. Instead, most of the healthcare services at this time were administered at the patient’s house (5).
After finishing medical school in Philadelphia, Graham traveled to Abingdon and began seeing patients at their homes. While Graham lived in Abingdon, he advertised his willingness to treat “citizens of Abington and its vicinity” (pg. 116), which implies that he also treated patients in Washington County. Washington County between 1810 and 1820 had a population of approximately 12,000 people. However, this relatively small number of people was spread over a rather large area. Abingdon and the surrounding county during this time period was 566 square miles, which would have been large distance to cover over horseback if Graham was making a house call (6).
Upon entering a home a physician was supposed to take note of “ his patient in terms of sex, race, and habit, an assessment of the patient’s basic constitution and temperament” (5). After the physician made a mental note of the physical appearance and general disposition of the patient, he would then take the pulse of his patient. When Graham first visits William Moore, a 70-year-old man who had difficulty breathing and a severe headache, Graham made the comment that “he had a high inflammatory fever [and] a full strong and corded pulse” (pg. 123).
Physician also tended to analyze the stool of their patients. The “color, consistency, and odor” of the stool were all observed, and the doctor used this in the diagnosis and treatment of their patients. When Graham’s fellow medical student, Mr. Hyckenbottom was ill with typhus, Graham mentions that he had “discharged several stools of dark-yellow feculent matter” (pg. 88) which were analyzed and used in prescribing medicine for his condition.
Doctor’s were also concerned with the flow of blood throughout the body, and at this time, they felt that most diseases were a result of poisoned blood (5). Doctors frequently employed blood letting to help purge the body of this tainted blood. Doctor Chapman, one of the physicians that mentored Graham in Philadelphia, was one of its biggest proponents and proclaimed, “the lancet is called for in language loud and unequivocal…this is the flag which nature holds out for success” (pg. 100). While older physicians might have been advocates of therapy that involved aggressive bloodletting, Graham seemed to think that “the lancet must be used with great caution” (pg. 100).
However, Graham does report using this procedure to treat William Moore, whose “most violent symptoms were relieved [and] his pulse became soft and natural” (pg. 124) after the bloodletting treatment.
Starting a practice as a new physician was not the easiest of tasks since towns were usually very small. Rural physicians were generally treating family, friends, or the slaves of family and friends. After giving the patient medicine or performing a surgery, physicians would often spend a good amount of time just praying and exchanging stories with the patient and their family (5). For this reason developing solid bonds with patients and a good reputation were of the utmost importance for a physician. In his initial attempt to start a practice, Graham “ found the people of the village but little disposed to encourage him” (pg. 119). To generate business, Graham posted an advertisement, stating that “he has just received from Philadelphia a general assortment of Drugs and Medicines which he will sell on the most reasonable terms” (pg. 116). Although Graham was a well-educated doctor, business proved to be very slow at first. Fortunately for Graham, he eventually seemed to have gained the approval of General Francis Preston and his family, who Graham states “treated [him] with the utmost kindness and cordiality” (p. 119). Through this connection, he was called to treat the family of Mr. Miles, whose wife and children were “all sick with a bilious fever” (pg. 119). Although Graham successfully cured all but one of the children, who unfortunately passed away, the family was unable to compensate him; however, this experience helped to build up the reputation of Graham in the community.
In the early 19th century, a doctor’s income often came from supplemental revenue sources, such as teaching and inheritances. Almost every doctor during this era had a unique experience when it came to enterprising and practicing medicine. A professor teaching in Baltimore during this time reported earning up to $4,000 annually solely from students paying to hear his lectures. Some professors would also hold private practices, and it is speculated that a popular physician “could expect to earn at least ten thousand dollars in a good year and his less popular colleagues well over five thousand annually” (1). In the case of Graham, it is unclear how he supplemented his income. The only instances in the diary of Graham being compensated occurs towards the end of the transcript when he was paid 75 dollar for cutting off a patient’s finger which “he thought was a great deal of money” (pg. 122) at the time. However, we can speculate that he must have been relatively well off due to his correspondence with his father. Graham’s father, Edward Graham, was professor of Mathematics and Natural Science at Washington College and had run into financial difficulties. In 1819, “the professor wrote an importunate letter to his young physician son asking that the latter send him aid at once” (2), suggesting that William Graham was wealthy enough to loan his father money at the time. While Graham’s annual salary is not clear from reading the diary, “he seems to have become successful as a doctor” (3) during his time in Abingdon. However, for reasons unknown, Graham decided to stop practicing medicine in Abingdon and pursed a career as a gold prospector. In 1829, he started the Lexington Mining Company, a fairly successful enterprise that eventually came to an end six years later due to “a desolating tornado along the Atlantic coast” (3).
By: Patrick A. Oley
- Bonner, Thomas. Becoming a Physician. The Johns Hopkins University Press: Baltimore, 1995; pp 61-100.
- Chrenshaw, Ollinger. General Lee’s College: Rise and Growth of Washington and Lee, Volume 1. Unpublished Typescript: Lexington, 1973; pp 173-174.
- Davis, Curtis. Chronicler of the Cavaliers: Three More Letters from and to William Alexander Caruthers, M.D. (1802-1846). The Virginia Magazine of History and Biography. 1949, 57, 55-66.
- Holman, Andrew. Gentlemen, Irregulars, and Eclectics: Who practiced medicine in Nineteenth-Century Rockbridge County, Virginia. Proceedings of the Rockbridge Historical Society. pp 45-50.
- Stowe, Steven. Seeing Themselves at Work: Physicians and the Case Narrative in the Mid-Nineteenth-Century American South. The American Historical Review.1996, 101, 41-79.
- U.S. Census Bureau: Selected Historical Decennial Census Population and Housing Count. http://www.census.gov/population.html (accessed 5/17/12).
- William Alexander Graham, “A Narrative  of Graham’s Journeys, Medical Training and Career 1816-1819 in Lexington, Va., Abingdon, Va., and Philadelphia,” pp. 100-122, Washington and Lee University Library, Special Collections.