The neighborhood focus of nineteenth-century medical practice

Nineteenth-century American life revolved around small communities and narrow personal contacts. Most Americans lived in rural villages and towns that were essentially isolated from each other, and even those who lived in the city lived in highly structured communities separated from each other by culture, ethnicity, and sometimes language. Because there were no adequate transportation and communication systems early in the century, there was little chance for relationships beyond one's immediate neighborhood. In these so-called walking cities, life revolved around the local church, school, and other small institutions. Government was a neighborhood responsibility watched over by the local ward boss, who, as part of the political machine, was able to attend to the needs of the community.

A strong neighborhood focus of necessity characterized nineteenth-century medical practice as well. For much of the century, New York City was a highly congested series of neighborhoods spread between the southern tip of Manhattan and Fifty-ninth Street. Before the introduction of electric trolleys and elevated railroad lines, the horse was the major means of transportation. Although the city's gentry owned private carts and wagons for transportation, most of the working people depended upon slow and undependable horse-drawn trolleys, which had to negotiate streets that were continually “torn up, blown up or dug up” for construction.