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Pre-1900 INTRODUCTION In the United States, as in most of the rest of the world before the modern era, methods of treating illness were long rooted in local custom and belief. Until the start of the 20th century, really, there was no firmly established class of profes- sional physicians, or even a convincing scientific model of health and illness. The medicine practiced in one region or by one group could be quite different from the medicine practiced elsewhere. Moreover, a range of new systems created by innovators who promised cures, and, in many cases, produced satisfied customers, arose at different times and places over the course of the 19th century. Not all of these alternatives lasted. Meanwhile, the standard medical system that eventually came to dominate the scene was still a century away. The “regular” doctors who operated in the 1800s employed much the same methods as those used by their predecessors in the 1700s or even earlier. Medical Mélange Nineteenth-century “irregular” doctors, or those pursuing alternatives to what then passed as “conventional” medicine, advocated a wide variety of approaches. There were magnetic healers, hydrotherapists, sellers of electrical shock equip- ment, makers of sham medicines, and more. Patients were urged to seek fresh air away from the cities or to recreate at hot spas, if one could afford it. There were mesmerism and spiritualism to address emotional concerns there were diets of whole grains and simple vegetables to improve digestion and there were homeo- pathic remedies containing tinctures of substances that caused symptoms similar to those of the very disease one wished to cure. Some of the characters behind these varied methods might be referred to as quacks, whereas many of them were dead serious and staked their lives and careers on the truth of their approach. In many communities, laypersons combined folk customs with information gathered from almanacs and popular reference works to treat injuries and dis- ease. At the same time, regular doctors, so-called, were trained through a mix of informal teaching and practical apprenticeship. What medical schools existed in the mid-19th century were, as often as not, business enterprises organized for the profit of the professors who managed them. Students, typically from middle-class or working families, were asked to pay to attend lectures of doubtful value. Even after the founding of the American Medical Association (AMA) in 1847, formal