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American medical care Essay These early immigrants survived the harsh times and difficult American climate as well as the wilderness on primitive basic instincts. The early settlements were often ravaged by starvation and disease. During the colonial era, doctors education was informal. Most were literate, but some who were raised outside of New England were not. A man who wanted to practice medicine did not need any type of certification. Most did have a period of apprenticeship with an established physician, but even this was not a requirement. Up until the late 19th century, very few doctors had a college education. Medical facilities were unofficial. Most patients were treated in their homes. However, even the smallest towns had poorhouses, where needy people could live and receive limited medical care. The few hospitals that opened in North America during the colonial period were opened in places like Quebec and New Orleans. Public health was unknown in North America at this time. Towns and cities did not have boards of health except during times of epidemics. Because most places did not have public water or sewer systems, most Americans got their water from pumps and used outhouses until well into the 19th century. There was no trash collection so the streets became a breeding ground for all types of disease. There were a few attempts to influence public health. For example, when smallpox vaccinations were developed in the 18th century, many small town doctors had groups of people that had to stay quarantined for a few days to make sure they only developed a mild case of smallpox. Cures may have killed more people than the diseases themselves. The public developed a very skeptical attitude towards regular doctors. In the early 19th century, the do it yourself attitude of many Americans was popular. These people freely gave medical advice, emphasized the participant of the patient in his or her own treatment. However, other medical treatments were available also. Probably snake oil is best remembered. Andrew Taylor Still started the practice of osteopathy. Osteopathy incorporated bodily manipulations, similar to those seen in modern chiropractics. In osteopathy, these manipulations affected the magnetic flow of energy in the body. Osteopathy discouraged use of medicines, but did not forbid them. Another reaction against heroic medicine was homeopathy. A university-trained German doctor named Samuel Hahnemann started it. Heinemann said that doctors were giving their patients too much medicine. He believed that tiny amounts of drugs should be diluted in water before being given to a patient and that practitioners should take very thorough medical histories of each patient. Quackery was a way to fool people into believing they were being cured while making money from them. Quackery had even been licensed in London, but it was completely ignored by the America government for hundreds of years. Hydropathy was another special case. The healing power of water, hydropathy indicated the value of the rest cure, importance of having like-minded people around, the usefulness of light exercise and the fact that women who wore loose-fitting clothing generally felt better and had fewer physical complaints than the ones who did. Another special case is the entire issue of faith-only healing. While empirical evidence in favor of faith-only healing is lacking, anecdotal evidence suggests that some people who pray do experience spontaneous decrease of certain diseases. The late 19th century saw major changes in medicine in the United States. Medicine went from being medieval to incorporating many elements of modern science. The advances in chemistry, and biology had major impacts on medicine. As medical practitioners began to understand that the body was comprised of basic chemicals and not mysterious humors, effective treatments for diseases and injuries were developed. As medicine became more scientific, doctors needed both training and  licensing. In 1847, Dr. Nathan Davis founded the American Medical Association (AMA) in Philadelphia to help create professional standards for doctors and set minimal educational requirements. Medical colleges opened up across the country, increasing requirements from a few months without any college background to a number of years with a college degree. However, these colleges provided an extremely unpredictable level of medical education, with some of them a diploma and others provided a to notch medical education. As American cities exploded in size during the 19th century due to immigration from Europe, public health became more of an issue. With many hundreds of thousands of people living in cities: extremely crowded, unsanitary conditions; tuberculosis was often at epidemic levels in the cities. During the 19th century, people understood that TB was not caused by miasma, but was caused by bacteria. People with TB were sometimes sent out of the city to places in the country, where the cleaner air seemed to help their recovery. It was obvious that people needed clean water for drinking, and bathing. So cities started massive sewer projects to help bring clean water into the cities while removing wastewater from the city. Dead animal remains and garbage littered the street until the late 1800s when cities started sanitation crews to take the trash out of town and dumps to move the waste to. Many cities started dispensaries so the poor could receive treatment and medications for low cost. With the urban population explosion, the poorhouses (probably todays HMO Urgent Care) became even larger and harder to manage. With new medical advances, people needed to be in big cities to receive certain types of treatment. Americans began to build hospitals across the country in the 19th century.  The new hospitals were generally cleaner than the old poorhouses.