Connecticut's Heritage Gateway

Health in Connecticut

By Christine Brendel Scriabine, Guilford, Connecticut

The search for a longer and healthier life was one of the factors that impelled Englishmen to leave the land of their birth and come to the New World. Despite the fact that by modern standards the death rate in the American Colonies was shockingly high, most historians have found that the colonists lived healthier lives than their English brothers. While America had few trained physicians, this deficiency was more than offset by other factors that promoted health and longevity. Such factors included the availability of wood for heating—in England firewood had become scarce and expensive; the addition of significant amounts of animal protein to the diet—in England ordinary people only ate meat a few times a year; the lowering of population densities—crowded England had long been plagued by epidemic diseases; and the opening up of new soils not contaminated by human parasites or disease organisms. The health of early American society is best gauged by its astonishing growth. By the end of the Colonial Period the society had reached a point of almost geometric natural increase.

The fact that Connecticut's people enjoyed good health relative to their English brothers does not mean that they were not deeply and justly concerned about the issue or that they enjoyed good health or long lives by our contemporary standards. In the seventeenth century epidemics spread widely over New England. For both the colonists and the Indians, measles and smallpox were ever present and often fatal dangers. An outbreak of diphtheria ravaged the colony in 1659, and influenza quickly spread in 1647. Even by 1800 the average life expectancy in the United States has been estimated at only thirty-two years and over 46 percent of children died before the age of nine.

The first colonists sought medical care from their clergy whose education had included some medical training; from the few physicians who had emigrated to America; and from midwives. Many treated themselves. Some familiarity with herbal remedies was considered to be a vital part of a housewife's store of knowledge.

The colony considered medical care for its citizens to be a governmental responsibility. The General Assembly of Connecticut issued its first medical license to a Thomas Lord in 1652, and his fees were regulated by the legislature. He was also granted an annual salary for caring for the indigent sick. In the Colonial Period licensed physicians were, as a rule, tax exempt and freed from military and other civic duties.

In early Connecticut physicians had few resources at their disposal to treat the seriously ill patient. The germ theory of disease was unknown, and even at the end of the Colonial Period medicine was still heavily influenced by the writings of Hippocrates (460-370 B.C.). Theories of the origin of disease were still in the humour and miasma stage, and public health measures were confined to street and privy cleaning and quarantines. The treatment of disease tended to be heroic: purging; emetics; diuretics; blistering; cold baths; bleeding; sweating; and large doses of mercury and quinine. Physicians often killed rather than cured. The only effective medicines they had were opium, foxglove (for dropsy) and chinchona bark (for malaria). The highlights of medical progress during this period were the introduction of the stethoscope and the first use of inoculation for smallpox in the 1720s. Vaccination was first used in America in about 1798.

Despite the generally low state of the practice of medicine in early Connecticut, there were exceptional practitioners and areas of progress. In 1765 Jared Potter, a leading physician, published one of America's earliest statistical studies in the Philosophical Transactions of the Royal Society. His subject was smallpox inoculations. In 1766 the physicians of Litchfield banded together to found the first medical society in Connecticut. Their purpose was to promote medical knowledge and to rid the profession of quacks. Even in the eighteenth century there were unscrupulous physicians claiming to have found cancer cures. To determine who was a quack was not always easy. There were few schools or texts to be used to impose medical orthodoxy. There were no medical schools in the American Colonies before the mid-eighteenth century (the University of Pennsylvania) and none in the state before 1810 (Yale). Eighty percent of the physicians were taught by the apprentice system. Hospitals did not exist in New England until the founding of Massachusetts General in 1811 and also were not available to be used as institutions for training or weeding out the unfit.

The health care situation began to improve in the post-Revolutionary period. A medical society was established in New Haven in 1784, and a state society was chartered in 1792. The New Haven society issued licenses to practice, but these had no legal status. Towns also started to become involved in improving the health of the citizens. In 1792 the New Haven town meeting empowered two doctors to set up an inoculating hospital for smallpox and to prevent ships from landing diseased passengers. New Haven subsequently enacted sanitary reforms including provisions for the removal of putrid fish and shellfish from creeks and wharfs and regulation of the operations of slaughterhouses. A board of health was created to enforce these laws. Other towns followed. At the state level the legislature passed a law that required physicians to have some college study, to serve two years of apprenticeship, and to pass examinations given by the medical societies if they wished to use the courts to collect professional debts.

Some progress was also being made in the advancement of knowledge needed to treat disease. The most significant innovation was Edward Jenner's use of vaccination for smallpox. This treatment became known in Connecticut in 1799 and was immensely popular by 1803. In these early years of the nineteenth century Connecticut's physicians contributed to the advancement of medical knowledge. Nathan Strong, Jr. wrote the first brochure on spotted fever in 1810. Elisha North wrote the first book on epidemic cerebro-spinal meningitis in 1812 and founded the first eye infirmary in the United States in New London in the same year. Nathan Smith, a professor of surgery at Yale, wrote two influential books, one on typhus and the other on the pathology and treatment of bone necrosis. William Beaumont, who was born in Lebanon, Connecticut, but served as an army surgeon all over the country, made nineteenth-century America's foremost contribution to physiology in his work on the physiology of digestion.

While medical knowledge began to advance in the beginning of the nineteenth century, life remained precarious. Communicable disease remained a major cause of death. T.B. was the most common and deadly communicable disease. Up to the 1870s it caused 1/5 to 1/8 of all deaths in New England. It took a terrible societal toll as 45 percent of its victims were young adults between twenty and forty, and 60 percent were women. Yellow fever was also a major health problem. It reached American ports in 1794 and killed sixty-four people in New Haven in that year. In 1798 it killed eighty-one in New London. Epidemic dysentery was a more regular visitor to Connecticut towns. It found its primary victims among the young and the old. Children were also the primary victims of diphtheria, scarlet fever, scarlatina, whooping cough, and meningitis. There were no known ways to prevent or cure these diseases. For those females who survived childhood, the next major hurdle was childbirth. With no anesthesia or antiseptics, childbirth was a major danger to life. Among the older in the population, endemic malaria was the infectious disease that claimed many and weakened others. Respiratory diseases killed some of the young but harvested the old.

The modern major killers—heart attack, stroke, cancer, and accidents—also claimed their victims. Despite the fact that they lacked contemporary Americans' favorite tools of destruction, the automobile and the handgun, many early nineteenth-century Connecticut citizens were still claimed by accidents. Drowning was the most common cause of accidental death in a state where almost all of the population lived near water and many went to sea. Lightning was the next most common cause in the days before lightning rods and when many worked outdoors. Many died in farm and lumbering accidents, with a number claimed in accidents involving horses and carts. Fires and scaldings killed a great many children in a period where hearths were open and heating stoves unguarded. For those injured, gangrene was a constant problem and lockjaw ever a possibility.

In the first half of the nineteenth century response to illness and incapacity involved the development of a number of Connecticut's institutions. In 1806 Dr. Nathan Strong and Professor Benjamin Sillman were appointed by Yale to explore the founding of a medical school. They worked with the state medical society which had been given power by the state to grant medical degrees, and in 1810 an act for the incorporation of the Medical Institution of Yale College was passed. A two-year program was prescribed for college graduates and a three-year course for others. The first M.D. degrees were issued in 1814. Medical learning required an institution in which to treat patients, and in 1826 a General Hospital Society was incorporated to raise money for a hospital in New Haven. The New Haven Hospital, designed by Ithiel Town, was opened in 1833 as one of the nation's earliest hospitals.

The institutionalization of medical education was only one facet of the desire to provide better and more comprehensive care for the ill and unfortunate. In 1817 the American School for the Deaf was opened in Hartford. This pioneering institution was founded by Dr. Mason F. Cogswell, a Hartford physician whose daughter was deafened by spotted fever in infancy. The lack of facilities to educate her led Cogswell to appeal to the General Association of the Congregational Church to conduct a survey of deaf persons in the state. The survey indicated the need for a school for deaf children. A group was formed, and the Reverend Thomas Gallaudet was sent to France to study methods of teaching the deaf. Money was raised, a state appropriation secured, and in April 1817 an institution was opened in West Hartford for the teaching of the deaf that still operates today as the American School for the Deaf. It was the first of its kind in the country. The Mystic Oral School is of somewhat later origin but also grew out of a father's desire for better education for his deaf child. About 1830 Jonathan Whipple of Mystic was troubled because his son, a bright lad, had been born deaf. As far as he knew no one had ever taught a deaf child to speak, but Jonathan decided to try. He succeeded, and in 1869 opened the Whipple Home School for the Deaf at Ledyard. This school became a pathfinder in developing methods to teach deaf children to speak. In 1872 the General Assembly granted it state aid, and in 1921 the state took over the institution. Connecticut was thus the birthplace of both major schools of thought on the education of the deaf. The followers of Gallaudet concentrate on the development of signing and those of Whipple on speech as the primary mode of communication with the hearing world.

The care of the insane had been a governmental issue in Connecticut since the seventeenth century, but the humane treatment of the insane and retarded grew out of the same reform impulses that prompted the founding of institutions for the teaching of the deaf. In 1699 a Connecticut law made the relatives and estates of the insane or mentally deficient person liable for his support, and in 1727 the legislature authorized confinement of the neglected insane in workhouses when not cared for by a relative and not fit to go at large. In 1793 the General Assembly ordered towns to confine the criminally insane in a suitable place and in 1797 forbade the towns to confine the insane in jails or workhouses. An 1824 law compelled the towns to confine dangerous persons. All of these laws were aimed at protecting society, not at helping the unfortunate. The state also did not provide the facilities needed for the towns to enforce the law. Most of the harmless insane were kept at home and were a dreadful drain on the energies of their relatives. Large numbers also wandered around the state half-clothed, wretched, and ill treated. Those who were incarcerated were often treated like animals. This situation led Dr. Eli Todd, a native of New Haven, to found the Hartford Retreat in 1821. Todd based his treatment, not on the punishments and harsh regimes that had previously prevailed in the institutions for the insane, but on gentleness, sympathy, and constructive occupation of the patients. His results impressed those who were studying mental illness, and his methods were spread over the nation by those staff members trained at the Retreat.

Despite the fact that the state and towns subsidized the treatment of some indigent patients at the Retreat, the facilities there were inadequate to meet the needs of growing numbers of indigent insane. In 1868 the Connecticut State Hospital at Middletown was opened. The hospital at Norwich was completed in 1904, and in 1933 the Fairfield State Hospital at Newtown received its first patient.

The state also began to provide funds for the education of the blind at the New England Institute for the Blind in Boston. The state did not build its own institution for the blind until 1893 when it created the Connecticut Institute and Industrial Home for the Blind in Hartford. The first institution in Connecticut for the education of the retarded was established by Dr. Henry M. Knight at Lakeville in 1859, and the state authorized money to educate children there.

The science of medicine began to advance at a faster pace by the mid-nineteenth century. One of the greatest advances of this period was the invention of anesthesia which aided modern surgery. A state resident, Horace Wells, played a role in this dramatic achievement. In the 1840s Wells, a Hartford dentist, became interested in the potential of nitrous oxide to deaden pain during the extraction of teeth. He experimented with the gas on patients, and in 1845 felt he was ready to demonstrate the possibilities of the gas to a medical audience. He gave a demonstration at the Harvard Medical School, but something went wrong and in the middle of the procedure the patient began crying in pain. Wells was humiliated and his audience unconvinced. Morton's demonstration of the value of ether followed shortly, and Well's pioneering work has been substantially forgotten.

The late nineteenth century saw enormous strides taken in the advancement of medicine. The great pioneers of modern medicine such as Pasteur and Semmelweis introduced concepts that made the progress that has taken place since possible, but at the end of the nineteenth century in Connecticut one third of the population was still dying before the age of twenty and contagious disease was still the major public health problem. In 1900 the T.B. death rate in the state was 187.4 per 100,000; syphilis 5.3; typhoid and paratyphoid 30.6; diphtheria 34.6; whooping cough 15.9; meningococcal infections 5.9; and measles 20.8. The only vaccination known was that for smallpox. The mosquito vector for disease was not yet known, and malaria was still endemic in the Northeast.

One of the reasons why the T.B. rate was so high in this period was that the great surge of immigrants in the late nineteenth century had crowded Connecticut's industrial cities and living conditions were at a low ebb. The state responded to the health threat posed by T.B. by creating the State Tuberculosis Commission and public T.B. sanatoria. Three sanatoria were opened in 1900, another in 1913 and a fifth in 1919. Major permanent sanatoria were built at Uncas-on-Thames near Norwich, at Laurel Heights near Shelton, at Underdliff near Meriden and at Cedarcrest in the towns of Wethersfield and Newington. The Commission waged an increasingly effective fight in the location and treatment of T.B. patients.

The Catholic Church sought to meet the health needs of the state's newer citizens by the creation of church-affiliated hospitals in which the overwhelmingly Catholic immigrants would feel more comfortable. The first Catholic hospital in the state was Hartford's St. Francis, opened in 1897 and staffed by the Sisters of St. Joseph of Chambery. St. Raphael's in New Haven was opened shortly after the turn of the century.

The mental health of the public also became a major concern at the beginning of the new century, and a major movement in the field was founded in Connecticut.

In 1908 Clifford W. Beers, a New Haven resident and former mental patient, published A Mind That Found Itself. Shortly thereafter Beers and others founded the Mental Hygiene Movement which was based in New Haven. This movement worked for the community prevention of mental illness, to improve treatment of the ill, and to disseminate information on the subject. The leaders of the movement believed that there was not a sharp border between the sane and insane and that intervention when problems began to arise would prevent lapses into serious illness. This intervention could take place in an outpatient setting. Many of the ideas that Beers introduced have become a part of prevailing medical orthodoxy.

Medical progress in the twentieth century in Connecticut has almost been too rapid to record. One of the most notable advances on the institutional level was the opening of the University of Connecticut Medical School in Farmington which graduated its first class in 1971. The medical school with its 200-bed John N. Dempsey Hospital has provided the state with its second major teaching complex. A movement that had its American origins in the state in recent years has been the hospice movement for the terminally ill. The Connecticut Hospice, incorporated in 1971 and located in Branford, serves over 1,000 patients and their families. While the care of the terminally ill is undergoing major institutional changes, the care of the mentally ill and mentally retarded is being dramatically deinstitutionalized. Since the 1950s the census of patients at mental hospitals has been dramatically reduced owing to the introduction of effective psychotropic drugs.

The epidemiology of fatal disease has also been greatly altered in this century. Epidemic contagious diseases have been virtually eliminated as causes of death. Heart disease (37.9%), cancer (23.9%), cerebrovascular disease (7.6%) and accidents (4.1%) are the major causes of death in Connecticut in the 1980s. Fifty-two percent of all accidental deaths are the result of motor vehicle accidents and are the leading cause of death in the 15-34 age group. The median age at death for the state's citizens is 73.9 years.

Since 1900 an equally dramatic change in the state's demographical picture has taken place in the area of births and infant mortality. In 1900 the birth rate was 22.6 per thousand, and the infant mortality rate was 171.3 per 100,000. In 1980 the birth rate was 12.5 per thousand and the mortality rate 7.5 per 100,000.

Connecticut currently enjoys a lower mortality rate than the country as a whole due in good measure to the availability of health care. The state is currently being served by over 12,000 physicians and over 37,000 registered nurses. In the past two decades public health programs, particularly in the area of cardiovascular disease, have been effective. Despite an aging population, mortality in this area is declining. The rate of cancer death, however, is still rising, as the population ages and prolonged exposure to pollution and occupational risks continues to take a mounting toll.

For Further Reading

Clark, George L. A History of Connecticut: its People and Institutions. New York, 1914.

Connecticut, Department of Health Services. Connecticut Health Bulletins.

Connecticut, State of. One Hundred and Thirty-Third Registration Report, 1980. Hartford, 1980.

McKee, Linda Ann. "Health and Medicine in Connecticut," Unpublished Ph.D. Dissertation, University of New Mexico, 1971.

Kuslan, Louis I. Connecticut Science, Technology and Medicine in the Era of American Revolution. Hartford, 1978.

Stein, Walter R. The Evolution of Medicine in Connecticut. New Haven, 1915.

Van Dusen, Albert E. Connecticut. New York, 1961.

* Entry under revision.