During the late 1700s, American physicians saw a great many illnesses, most of which were still little understood. Physicians were often called upon to treat both common ailments and epidemic diseases, such as small pox, tuberculosis, consumption, yellow fever, malaria, cholera, diphtheria and pneumonia. The general practitioner either treated symptoms such as fever and convulsions or chose to attack the “root” of the matter by adjusting the body’s balance or humors through such remedies as bleeding, purgatives, and sweating.

In the early 1800s, a shift in how physicians treated patients began in Paris and spread to America. This change was due to a new philosophy among French doctors that advocated patients needed to be carefully examined, not just observed, and autopsies should be performed routinely in order to study the pathology of disease. The French method was written about in American journals and soon medical students were enrolling in courses in Paris. By 1830 the French ethic had taken hold in America and the result was a chronicle of specific symptoms and diseases that dispelled the previously held notion of humors as the cause of illness.

Just as medical diagnoses were changing, so were the feelings among Americans regarding licensing and policing of the profession. The first colonial medical society was established in New Jersey in 1766. Its purpose, and those that followed it, was to ease tensions among local physicians and set fee structures. It was not long, however, before these societies were asking their local colonial governments to set up examinations and licensing requirements. The first licensing board was established in New Jersey in 1772. The Revolutionary War slowed progress temporarily, but most states were able to establish licensing procedures by 1830.

In the late 1840s conditions for patients and physicians had improved. Innovations in instruments such as the stethoscope, pulse watch, clinical thermometer, and hypodermic needle were direct results of the French method of treatment. Likewise, the area of drugs had shown a vast improvement including the introduction of morphine, ether anesthesia, strychnine and quinine. New institutions like the American Medical Association, established in 1846, helped physicians create a distinctly American medical profession. The combined result of this period was an increased interest in medicine in general and a new interest in specialization. The stage was set for ophthalmology to emerge in the “modern” era of medicine.