Americans in the 1800s and early 1900s sought unconventional methods such as the use of botanical drugs, steam baths, cold water therapy, magnetic healing, homeopathy, osteopathy, chiropractic, and naturopathy for the treatment of ailments (Wharton, 2003). Doctors were not readily available and most care was provided by family in the home. The use of blood-letting, induced vomiting, purging of the bowels, and the ingestion of drugs such as calomel were the types of conventional treatments utilized during this era, which were dangerous and ineffective making patients worse than better (Wharton, 2003). As the 19th century was ending, treating the whole person started to become the focus of care. The interconnection of self, others, nature, and spirituality; the focus of protecting, promoting and optimizing health and wellness; and the incorporation of integrative modalities/complementary and alternative modalities evolved into the practice of holistic nursing (Dossey & Keegan, 2016).
History of Holistic Nursing
Life in early America was filled with sickness, and scientific knowledge was minimal. Living conditions were unsanitary and resources were limited. Medical theory was based on the belief that sickness was related to the body out of balance (Jankin, 2014). The methods taken to correct the body’s balance during this time were inhuman and painful, often causing more harm than healing. Studies have shown Americans have always been independent and cost conscience, preferring home remedies and treatment which allow them to render care to themselves instead of doctor’s visits (Jankin, 2014).
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The push to move Westward greatly affected the ability to care for the sick, due to the lack of modern resources, few physicians and the remoteness of settlements. Holistic medicine and nursing were the typical means of caring for the sick and injured during the expansion westward of America in the 1800s. A doctor did not accompany the Lewis and Clark Expedition on their journey westward (Kovak, 2018). The Farmer’s Almanac, newspapers, cookbooks, health, and military manuals were among the resources available for medical information (Kovak, 2018). A potpourri of Army medicine, Indian medicine, and frontier home remedies successfully saw the expedition through their journey with the loss of only one man (Historical Collections and Archives (2003).
The entry into the 20th century brought the discovery of penicillin and the medicinal use of opium and heroin. Penicillin was a profound revolution and changed the course of treatment of infection in the modern age. Opium and heroin were readily available, and the sale was ungoverned by law. The widespread, unsupervised use of opium and heroin is considered a contributor during this era of many unintended addictions, overdoses and deaths (“Heroin History: 1900s”, n.d.). The use of both these drugs dramatically affected society in completely different manners, one for the good and one for the worst.
Holistic Healing 1800-1880
The Lewis and Clark Expedition is a prime example of the use of holistic healing methods during the 1800-1880 era. Lieutenant William Clark served as the camp doctor during the expedition and received instruction in medical treatment from Dr. Benjamin Rush prior to departing for the West. Clark was encouraged to question the use of Indian medicine techniques and remedies available on the frontier during their travels and was given 11 rules to follow for preserving health (“Discovering Lewis & Clark: Benjamin Rush”, n.d.). These rules included resting when fatigued, fasting with hydration for fever, purging “the Rush Thunderbolt pill” when early signs of illness occurred, wearing dry, warm clothes, limiting spirit (alcohol) use, medicinal doses of molasses or sugar and maintaining one’s feet with cleanliness, dry socks and good shoes (“Discovering Lewis & Clark: Benjamin Rush”, n.d.). The expedition proved successful due to the selection of healthy, strong, experienced Corps, pure luck, the kindness of strangers and the Indian presences of Sacagawea and her son, in addition to the trusting relationship between the Corps, Lewis and Clark (Kovak, 2018).
Constantine Hering’s contribution during this era is certainly mentionable as well. Hering is known as the “Father of Homeopathy” in the United States and founded the first schools where homeopathy was taught (Eliopoulos, 2018). The basic principle of homeopathy and Hering’s Law of Cure is “the body’s own healing process is activated to cure illnesses naturally” (Eliopoulos, 2018, p.354). His methods and the Hering’s Law Assessment Tool (HELAT) have been utilized in recent studies to measure the response of individuals to homeopathic therapy and has proven to show promise as a reliable means for measuring the clinical outcomes of homeopathy (Brien, Harrison, Daniels, & Lewith, 2012). Like Florence Nightingale and her beliefs, Hering devoted his practice to educating others about the benefits of homeopathy and holistic healing.
By the end of the 19th century, medicine and nursing theories were changing. Florence Nightingale led the way with her theories of holistic nursing and her continuous efforts to educate on the importance of health prevention measures and prevention education (Dossey & Keegan, 2016). The arrival of Pastor Theodor Fliedner, a German Lutheran minister, to Pittsburgh, Pennsylvania, with four nurse-deaconesses preceded the opening of the first nursing schools in America. These four deaconesses under Pastor Fliedner’s direction trained other individuals in care of the sick and started the movement to educate American nurses in 1849. The Pittsburgh Infirmary is considered the first real school of nursing in America (“American Nursing: An Introduction to the Past”, n.d.).
Holistic Healing 1900-1949
With the turn of the new century, the discovery of penicillin by Alexander Fleming in 1928 and the ease of access to heroin again spurred rapid changes in holistic healing. Gaynes (2017) acknowledges the discovery of penicillin had both an immediate and profound impact on the world and is credited with changing the course of medicine. Penicillin trials began on mice in the early 1940s. Between 1941 and 1942, Howard Walter Florey, Norman Heatley, and Ernst Boris Chain performed a series of clinical trials involving 170 patents, which resulted in evidence that penicillin could have a positive effect on bacterial infections without toxic side effects (Lobanovska & Pilla, 2017). They immediately realized the impact this could have on the wounded during the war.
In June 1941, penicillin was brought to the United States by Florey and Heatley seeking assistance with mass production (Gaynes, 2017). They met with Charles Thom, the principal mycologist of the US Department of Agriculture, who is recognized as identifying the P. Chrysogenum strain. This strain was found in the mold of a cantaloupe and produced six times the penicillin as the original strain discovered by Alexander Fleming (Gaynes, 2017). While in America, the group sought pharmaceutical companies to help mass produce penicillin. Florey administered the first trials in military hospitals in Africa in 1942 and penicillin proved to be effective on both fresh and infected wounds (Lobanovska & Pilla, 2017).
Opium and heroin were used for medical and recreational purposes between 1900-1949. “Heroin History: 1900s”, (n.d.) discusses the use of morphine during the war for the control of the wounded soldiers’ pain and relates the use to addiction for many of these soldiers after the war ended. These soldiers had free access to morphine during the war and after, because it did not require a physician to prescribe, their use continued. The addiction became known as “the soldiers’ disease” (“Heroin History:1900s”, n.d.). In the United States, laudanum, a form of liquid opium, was used in abundance and was the drug of choice for women. In larger western cities opium dens were prevalent (“Heroin History: 1900s”, n.d.). The widespread use of both opium and heroin without supervision lead to addiction in epidemic proportions and the overdose of many. Mothers even gave laudanum to their babies for the treatment of colic. The end results were sometimes fatal.
During this era, the public’s perception of heroin was very benign. The Bayer Pharmaceutical company actually marketed heroin as being non-addicting and a treatment for morphine addiction. Heroin was also approved by the American Medical Association in 1906 for general use (“Heroin History: 1900s”, n.d.). Kolodny, et al., (2015) compared the current opiate crisis to America’s first epidemic, which at its peak reached 4.59 opioid-addicted individuals per 1,000 persons. With the discovery and implementation of penicillin and the revolutions made in public health, which reduced diseases commonly treated with opium; the development of other pain medications such as aspirin; stricter drug laws; and the realization of the true effects of morphine, the addiction tide turned and began to decrease (Kolodny, et al., 2015).
Changes in Healthcare Practices
Holistic theories and philosophy of healthcare practices from 1800-1949 changed dramatically. This time frame is considered the first era of medicine. Medicine was becoming more scientific and assumptions were made that health and illness were physical in nature (Dossey & Keegan, 2016). Practitioners began to focus on combining medical treatment, drug therapy, and technology to provide cures (Dossey & Keegan, 2016). A person’s consciousness was not considered a major factor in health or wellness, but merely a by-product of the chemical, anatomic and physiologic aspects of the brain (Dossey & Keegan, 2016). With the change in theories and philosophy, so came change to healthcare practices.
Florence Nightingale’s contribution is well known. Nightingale is considered the founder of Holistic Nursing. Her principles of holism, which included unity, wellness, and the interrelationship of human beings and their environment, are the foundation of her philosophy for caring for the sick and wounded (Dossey & Keegan, 2016). Nightingale’s concern for the basic needs of a human being and consideration of all aspects of their environment, which include clean air, water, food, and housing, transformed healthcare practices (Dossey & Keegan, 2016). The simple practice and education on the importance of handwashing were revolutionary. Nightingale is well known for her innovations and advances in the practice of healthcare, but prior to Nightingale, Ignaz Semmelweis, a Hungarian doctor, gained recognition as the “Father of Hand Hygiene”. Semmelweis noticed an increase in post-delivery infections and mortality rates on the maternity ward after doctors who had performed an autopsy and then proceeded to the maternity ward for deliveries without washing their hands. Mandatory hand washing was implemented, and the rate of infections and deaths drastically decreased (“The Global Handwashing Partnership”, n.d.). Loudon (2013) the mortality rate fell from 13.3 per 1000 births to 12.7 per 1000 births.
Healthcare practices were again transformed when Joseph Lister, known as the “Father of Antisepsis”, translated the germ theory of disease into a near universally adopted system of preventative surgery (Glass, 2014). Lister’s interest in preventing nosocomial infections led him to conclude not only were his antiseptic principles important in the surgical theatre but on the patient wards as well. He believed the unhealthy atmosphere on hospital wards could be improved with judicious hand washing and instrument sterilization (Glass, 2014). Lister remained focused on patient safety and improved infection-free outcomes throughout his career. Each advancement in the prevention and spread of disease can be accredited in part to handwashing.
Changes in Health/Longevity
The discovery of penicillin and a better understanding of the relationship between humans and infectious germ-causing organisms helped increase the life expectancy of individuals and improve their overall physical and environmental health. Achievements in Public Health, 1900-1999: Control of Infectious Diseases (1999) determined the public health action of the 20th century, which were based on the identification of microorganisms as the cause of infectious diseases in the 19th century, is a direct contributor to the increase of life expectancy and the improvement in health conditions. Advancements in sanitation, hygiene, the discovery of penicillin, and the implementation of childhood vaccinations are credited for these changes (Achievements in Public Health, 1900-1999: Control of Infectious Diseases, 1999). The first era of medicine is known for its role in the furtherance of scientific technology. Its concern for how the environment affects human health and is recognized as the foundation for today’s surveillance and control of infectious diseases.
During the 20th century deaths from infectious diseases in the United States greatly decreased. Achievements in Public Health, 1900-1999: Control of Infectious Diseases (1999) contributes the decrease to the decline in infant and child mortality as well as the increase in life expectancy by 29.2 years. Deaths during the 1900s were related to three major disease processes, pneumonia, tuberculosis (TB), and diarrhea. Child and infant mortality equated to 30.4% of all deaths during this period (Achievements in Public Health, 1900-1999: Control of Infectious Diseases, 1999). Public health departments came into existence as well and much progress was made in public education and prevention activities such as sewage disposal, water treatment, food safety, and hygiene practices (handwashing).
Lindsay, Merrill, & Hedin (2014) denote the “First Public Health Revolution” occurred between 1880-1920, where history substantiates the greatest increase in life expectancy took place. Lindsay, Merril, & Hedin (2014) further validate the cause for this rise as directly related to the control of infectious diseases, improvement in sanitary conditions, safer food, and other nonmedical social advancements. The life expectancy at the beginning of the 19th century for a white male was approximately 39 years, as a result of the betterment in nonmedical determinants of health, and advancement in healthcare, the life expectancy by the late 1940s had risen to 60 years (Lindsay, Merril, & Hedin, 2014). Changes for the better in health and longevity during the first medical era can certainly be attributed to the theories and philosophies of holistic medicine and nursing, which are founded on treating the person as well as the contributing environmental conditions.
Changes in the Holistic Healer
1800-1949 saw numerous changes in the holistic healer. The early healers of this era were mothers, caretakers, spiritual healers, clergy and individuals with little or no formal medical education. Their education on treatment came from the Farmer’s Almanac, cookbooks, and home remedies passed down from other family members. Few doctors were present in the early 1800s’ America (Kovac, 2018). The first formal nursing schools were established, and technological advances provided a means for formally trained medical doctors to incorporate evidence-based practice into their treatment.
Realizing the importance of providing good patient care, Dr. Joseph Warrington began to instruct individuals interested in nursing. To assist in his instruction, Warrington wrote what is considered an early example of nursing practice text, “The Nurse’s Guide Containing a Series of Instruction to Females who wish to Engage in the Important Business of Nursing Mother and Child in the Lying-In Chamber' (“American Nursing: An Introduction to the Past”, n.d.). Dr.Warrington’s instructions were among the first formal training programs for nurses. The Nurse Society of Philadelphia utilized this text for training their nurses and employed about 50 during 1839-1850, who went into patient’s homes to provide care (“American Nursing: An Introduction to the Past”, n.d.). The efforts of these nurses founded the practice of modern-day home health nursing.
The need for nurses heightened during the Civil War. Some 20,000 men and women served to care for the sick and injured (“American Nursing: An Introduction to the Past”, n.d.). The abundant need for nurses provided the rationale for the development of formal training. As a result, the Women’s Hospital of Philadelphia offered a six-month training program and graduated its first class in 1869 (“American Nursing: An Introduction to the Past”, n.d.). Hospital-affiliated courses began to spring up with similar offerings shortly thereafter. It was now apparent there was an official need for professionally trained individuals to provide care for the sick and injured.
The first schools of nursing were based on Florence Nightingale’s theories and philosophies. In 1873, three schools opened in the United States: the New York Training School at Bellevue Hospital, the Connecticut Training School at the New Haven Hospital, and the Boston Training School at Massachusetts General Hospital (“American Nursing: An Introduction to the Past”, n.d.). The success of these three schools ushered in a new age of training and education in the nursing field and set the standard for future schools to follow. By the early 1900s, some 400-800 schools were in operations and the educational period, which was once six months, had extended to two- and third-year programs (“American Nursing: An Introduction to the Past”, n.d.). Education standardization changed the quality of the nursing healthcare provider.
The training that doctors received in the early 1800s bears little resemblance to modern day education. The training consisted of lectures with no hands-on clinical applications. A minimal requirement was needed for entrance, and it was not until 1905 a high school diploma became mandatory. Final exams were not required nor were medical licensure issued (Cardinal & Kaell, 2017). The doctors of this era lacked any real formal education and were considered quacks.
'The History of Johns Hopkins Medicine” (n.d.) chronicles the history of John Hopkins University School of Medicine which debuted a new model of education with its opening in 1893. This model would change the future of medicine and how doctors received their training. Rigid requirements were put in place for entrance into the program. The curriculum included an emphasis on the scientific method, bedside teaching and research became a part of the instruction elevating the standard of a physician’s medical education (“The History of Johns Hopkins Medicine”, n.d.). This was the dawn of a new era in professional training.
Cardinal & Kaell (2017) declare the advancements during the 20th century as the most important developments in medical education history. The models established during this period would continue to evolve and graduate successive generations of competent, well-trained physicians who were grounded in scientific based practice. In addition to formal lecture and scholarly teaching, doctors were taken to the bedside for their education (Cardinal & Kaell, 2017). The theories and philosophies of treating the patient in a holistic manner were merged with new discoveries in technology and science. The standards in education and training established at this time set the foundation for modern day medical schools.
Conclusion
In conclusion, the history of holistic nursing in the United States from 1800-1880 and 1900-1949 has been recognized as providing the greatest contributions to the improvement of the health and welfare of the American public. During the early 1800s, medical treatment was performed in the home by mothers and family members. The public had little faith in what was considered doctors with formal training and sought alternative medicine rather than visiting a physician. The use of botanical drugs, steam baths, cold water therapy, homeopathy, and naturopathy was chosen over medical doctors.
1800-1880 was an era of rapid change in holistic nursing. The expansion westward created new challenges as evident by the Lewis & Clark Expedition. Clark used an array of frontier remedies, Indian treatments, and medical instructions given to him prior to the journey to treat the injured and sick. The introduction of formal training in nursing began during this era and under Florence Nightingale’s influence, the first schools of nursing opened. Her theories of holistic nursing became the founding philosophies for these schools.
The era between 1900-1949 continued to advance how holistic nursing and healing is taught and administered. The discovery of penicillin, improvements in public health and welfare at the turn of the 20th century marked this period as having the greatest impact on today’s society. Scientific advancements, standardization of the formal education for doctors and nurses, along with the better understanding of infectious disease-causing organisms revolutionized the development of holistic nursing and healing. Changes in healthcare practices are a direct result of these discoveries and realizations.
Each individual contributor, each new discovery, each advancement in medical science, and each change in nursing theory and philosophy during these eras has provided the foundation for the development of holistic nursing practice in modern day. Our ancestors of the 19th and 20th century brought change to holistic nursing through the realization of the need for expanding their knowledge. The Code of Ethics for Nurses with Interpretive Statements (the Code), Provision 9 encourages use as nurses to promote and restore health, do our due diligence to prevent illness and injury, and remove pain and suffering from our patients while within the holistic milieu of healing the world (American Nurse Association, 2015). This statement from the Code encompasses the philosophy of holistic nursing and healing and if not for the pioneers in the medical and nursing fields would not be possible.
References
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