Indeed, I think that the previous post was very accurate. I think that part of the challenge facing American medical care in the first half of the 19th Century was that America was still a very young nation. Translating effective health care to any people, not even mentioning all people, was still a challenge in the new nation. Another challenge was that American medical care was highly contingent and dependent on advances in Europe. The center of all Western health care was European, in nature. Ensuring that advances in research, technology, and administering health care in America faced an inevitable delay from its translation across the ocean and into America. As the previous thoughts suggested, from here, the dispersion from urban to rural area also became a challenge. Once the nation started to take form and establish its economic will within the nation and upon the world, one started seeing the establishment of research institutions and public facilities in America, and the movement of center from Europe to America became more of a reality.
Perhaps their biggest problem at that time was a lack of technology and medical knowledge. Scientists still didn't understand how disease was spread and were unaware of the existence of germs, so even trained doctors had little means of disease prevention, and little more than that to treat them.
Doctor Benjamin Rush, considered one of the nation's leading physicians and researchers in the early 1800s, prescribed Lewis and Clark's expedition healthy doses of "Rush's Thunderbolts", a laxative so powerful that sick men taking it would probably have been better off taking nothing at all.
Another large problem was access to trained doctors. In the small towns and rural areas where most Americans lived, the best you could usually hope for was a "country doctor", who was usually little more than a glorified nurse. First aid responders today have much more sophisticated knowledge and skill than most doctors of the time.