Medicine in Virginia in Revolutionary Times GORDON W.JONES

[250 ]

Downloaded from http://jhmas.oxfordjournals.org/ at The University of British Colombia Library on July 13, 2015

jIRGINIA, far more than the New England colonies, was multiracial and multinational by the time of the Revolution. The peopling of the colony makes a fascinating study. The native American inhabitants whom the white man encountered in Virginia were members of the Powhatan Confederacy. The confederacy was a union of Algonquian nations which had migrated southward in relatively recent prehistoric times and they had displaced the original inhabitants of the Virginia Tidewater. If a history of the confederacy could exist, it would undoubtedly show a struggle for power between the various tribes and their neighboring Indians. The Powhatan Confederacy was a strong, warlike group of probably 10,000 people organized into various tribes, and at the time of white settlement it was under the direction of Emperor Powhatan. They far outnumbered the English during the early years of the Jamestown colony and presumably Powhatan did not worry about the newcomers. He believed that they would die off, or go away, or be so weak as to be easily eliminated at his discretion. Such he knew to have been the case wida the Roanoke Island settlers a generation before. Powhatan enjoyed the benefits of English trade, and the story of his daughter, Pocahontas, her marriage to the English settler John Rolfe, and her presentation in London at court is well known. While Powhatan enjoyed this peaceful coexistence, the Virginia colonists were the real beneficiaries. Initially, the colonists could not have survived without Powhatan's help. From the Indians they learned the cultivation of New "World crops, among them tobacco, which quickly became a cash crop. In 1622, four years after Powhatan's death and under the leadership of his brother, Opechancanough, the Powhatan Confederacy attacked several of the English settlements with the intention of driving out the white man. Some 350 or more settlers were killed, but by 1622 this was only about a quarter of the "white population. The Indian people were already suffering the effects of disease brought by the •white man. In addition, they now had

Jones : Medicine in Virginia in Revolutionary Times

251

1. Gordon W. Jones, 'Seventeenth century comparative medicine and its significance in Virginia history,' Va. Med. Monthly, 1964, pi, 298-304, 341-345, 386-390.

Downloaded from http://jhmas.oxfordjournals.org/ at The University of British Colombia Library on July 13, 2015

to contend with angry colonists who were determined to rid the Tidewater of its Indian population. Again in 1644 under the leadership of the now very aged Opechancanough, the confederacy launched a sneak attack on the settlers. They made a marvelously well-planned attempt to massacre all whites but, as was usual throughout Indian history, they gave up too soon. Opechancanough was captured and shot and the Powhatan Confederacy came to an end. The various tribes were now without unifying leadership and between peace settlements with the English, which usually meant giving up their land, and the ravages of disease, by the end of the seventeenth century only a handful of Indians remained in Virginia east of the Blue Ridge Mountains.1 Measles, smallpox, and perhaps typhoid, all deadly to the Indians, probably account for their weakened condition and inability again to become masters of their land. At the time of the Revolution, the Indians were no threat in the Tidewater, but in what is now West Virginia they still survived in tribal organization and were a potential menace. The English began their first serious and successful settlement of America in 1607 at Jamestown on the James River of Virginia. Once established at Jamestown they began to spread along the great tidal rivers of Virginia, replacing the Indians, conquering the new land in the same way as had their Anglo-Saxon ancestors a millennium before, when they invaded England and pushed the Britons out of the bottomlands and into the hills to the west. The parallel is striking. Their early mortality in Virginia was severe, but they came on in successive waves just the same, so desperate •was the situation at home. By Revolutionary times the English settlers were heavily concentrated in eastern Virginia and were looking eagerly toward the western parts. Still another invasion of Virginia began in the 1720s. Thousands of Germans from the Palatinate, driven out by the economic devastation in the wake of the French wars of 1683-89 and by the loss of religious liberties, had migrated to Pennsylvania in the late seventeenth century. William Perm had been quick to see these people as ripe for immigration and his agents had worked actively to promote Pennsylvania and its liberal religious policy. The new settlers in the early eighteenth century drifted westward from the less congenial and more expensive eastern part of Pennsylvania and discovered the old Indian trails which led down into the beautiful Shenandoah Valley of Virginia. These Germans arrived in Vir-

252

Journal of the History of Medicine : July 1976

2. Thomas Jefferson, Notes on the State of Virginia (London, 1787), p. 145. 3. Ibid., p. 140.

Downloaded from http://jhmas.oxfordjournals.org/ at The University of British Colombia Library on July 13, 2015

ginia in a flood after 1730. They farmed the rich northern part of the Shenandoah region and farmed, hunted, and traded with the Indians in the more southern reaches. To these Germans there were added many Scots and Scots-Irish, especially after the Jacobite rebellion of 1745. They, too, sought the rich, cheap lands. Not all the Scots-Irish immigrants entered Virginia by the Valley route. Hugh Mercer (1725-77) fled Scotland after the suppression of the 1745 Jacobite rebellion and settled in Pennsylvania where he practiced medicine for several years. During his service as a line officer in the French and Indian War he became friendly with George Washington and after the war moved south to Fredericksburg, Virginia, near Washington's home. There he opened an apothecary shop and again practiced medicine. When the Revolution broke out he left medical practice again to become a line officer. He died in action at Princeton in January 1777, a brigadier-general. Although the white people were in the majority, a large percentage of the Virginia population was from the black race. Black slaves were first brought into Virginia in 1619. These first slaves were eventually set free. The lifetime servitude of the black man did not begin until later in the seventeenth century. Great numbers of Negroes were imported both from the West Indies and directly from Africa. While scurvy was certainly rampant in the slaves, the Negroes probably brought other diseases with them. Virginia was thus a populous colony. Thomas Jefferson compiled population figures for Virginia for 1781. He reported that the total number of inhabitants was 567,614, of whom 259,230 were black slaves.2 By that year the number of Indians was insignificant. Very significant was the fact that there were only about 50,000 more whites than blacks. And the white majority included the largely non-slave-owning whites of the Shenandoah Valley. Jefferson suggested that an interpretation of the growth trends would indicate a probable Virginia population of 4,500,000 by 1862.3 It did not in fact reach that figure until the 1970s. Today the Virginia population is little greater than that of metropolitan Philadelphia. Since Jefferson's survey, Virginia has increased in population only eight times while the population of the United States as a whole has increased seventy times. In the eighteenth century Virginia was largely rural. There were a few towns—Norfolk, Williamsburg, Fredericksburg, Alexandria, and so on— but no cities comparable to Philadelphia. On large plantations there might

Jones : Medicine in Virginia in Revolutionary Times

253

4. 'Journal of Colonel James Gordon of Lancaster County, Virginia,' William and Mary Quarterly, 1st ser., 1902-03, 11, 98-112,195-205, 219-230, and 1903-04,12, 1-12. 5. William Byrd, The secret diary of William Byrd of Westover 1709-1712, ed. Louis B. Wright and Marion Tinling (Richmond, 1941). William Byrd, Another secret diary of William Byrd of Westover '739-174', ed. Maude H. Woodfin and Marion Tinling (Richmond, 1942). 6. Landon Carter, The diary of Colonel Landon Carter of Sabine Hall 1752-1778, ed. Jack P. Greene, 2 vols. (Charlottesville, 1965). 7. Isaac Weld, Jr., Travels through the stales of North America . .. during the years 179s, 1796, 1797, 2 vols. (London, 1807) 1, 156. 8. William Beverly, The history and present state of Virginia (London, 1705), Book rv, p. 68.

Downloaded from http://jhmas.oxfordjournals.org/ at The University of British Colombia Library on July 13, 2015

be several hundred people. More often the holdings were small and worked by one white man and a few slaves. The holdings of the Germans of the Valley were small and not commonly worked by slaves. Virginians tended to be isolated in the countryside. That isolation meant that they did not develop immunity to most infectious diseases. When the sons of those pioneers joined the Continental Army, measles, diphtheria, and other infectious diseases became rampant among them just as occurred also in the Civil War eighty years later. It is difficult to imagine ourselves in the medical world of Revolutionary Virginia. Our forefathers were in a medical environment certainly no more healthy than that of the least advantaged nations today. None of the vaccines or antibiotics which make modern life relatively disease free were available to Revolutionary Virginians. Their knowledge of the importance of sanitary measures was still some years in the future. Many contemporary documents testify to their poor health. An attentive reading of the diaries of James Gordon,4 William Byrd II,5 and Landon Carter6 gives one an overwhelming impression of a disease-ridden society. Isaac Weld remarked that 'The common people in the lower [eastern] parts of Virginia have very sallow complexions owing to the burning rays of the sun in summer and the bilious complaints to which they are subject in the fall of the year.'7 Not infrequently most of the people of a plantation, both master and servants, might be prostrated to the point of paralyzing agricultural operations for a time. Beverly, the early historian of Virginia, and a great apologist for the country, maintained that most of this illness was the fault of the patients themselves because of their tendency to work shirtless, lie nearly naked in the grass to cool off, drink cold water and milk when overheated, and so on.8 In my boyhood men were still warned against drinking water when overheated. Poor health began at birth. Infant mortality was high. When Cotton Mather of Massachusetts died in 1728 he was survived by only two of his fifteen children, not all of whom died in infancy. Summer diarrhea af-

254

Journal of the History of Medicine : July igj6

9. Carter, Diary (n. 6), p. 1034. 10. J. Worth Estej, "The health of revolutionary America,' Harv. Med. Alum. Bull, 1975, 49,16-21.

Downloaded from http://jhmas.oxfordjournals.org/ at The University of British Colombia Library on July 13, 2015

flicted many infants. Childhood was subject to many severe upper respiratory tract infections including diphtheria. Deaths of children were common. One would suppose that once a person had survived the rigors of childhood illnesses he might have reasonably expected a long life because of his superior hardiness. Such does not seem to have been the case; the diseases of adulthood were waiting. There are no longevity figures for the people of that era because no statistics were recorded. Searching the records of a number of prominent eighteenth century Virginians, I found the average age at death to have been fifty-four. These were men who had lived long enough to make their marks on society. The general life expectancy was undoubtedly much lower. Yet eighteenth century Virginians accomplished a great deal during their short lives. A man of sixty was considered to be quite old both by himself and by society. Probably few women lived to the menopause since, in addition to the diseases which affected their menfolk, they suffered the dangers of many childbirths. There is little information as to the rate and causes of maternal death in the eighteenth century. The vague term 'died in childbirth' was usually used. Carter described a case of obvious eclampsia.9 Puerperal sepsis, the bane of crowded cities in Europe, was apparently of little importance in Virginia because the scattered nature of the population discouraged its spread. But we may be sure that toxemia, hemorrhage, malpresentations, and maternal exhaustion from prolonged labors in childbirth took their toll. A study of one New Hampshire doctor's records showed that he claimed a stillbirth rate of two per cent.10 There is no record of his immediate postnatal mortality. Surely his premature births and low-birth-weight infants must have done poorly. In various eighteenth century writings there is frequent mention of infants dying in the first few days of life, too soon perhaps for 'cholera infantum' to have been a factor. The total mortality at or about the time of birth was probably twice the present-day figure. The childhood mortality was immeasureably greater. "Why did the men who survived infancy and childhood still die young? Only a relatively few of these vigorous men lived long enough to have their names appear in the Dictionary ofAmerican Biography. What were the diseases that killed those who were hardy enough to overcome diphtheria, measles, and tonsillitis? Did frequent bouts of bilious fever (malaria) so weaken them that they eventually died of it or of some intercurrent affection? Were they the victims of heart disease and stroke in a day when

Jones : Medicine in Virginia in Revolutionary Times

255

11. Adam Patrick, 'A consideration of the nature of the English sweating sickness,' Med. Hist., 1965,9, 272-279; and R. S. Roberts, 'A consideration of the nature of the English sweating sickness,' Mcd. Hist., 1965, p, 385-388. These speculations are not entirely satisfying. 12. S. M. Buckley and J. Casals, 'Lassa fever. A new virus disease from West Africa,' Ama.Jour. Trop. Mcd., 1970,19, 680. 13. Byrd, Diary . . . 1709-1712 (n. 5), p. 9. 14. Ibid., p. 10. 15. Medical Museum, 1804,1, 1-20.

Downloaded from http://jhmas.oxfordjournals.org/ at The University of British Colombia Library on July 13, 2015

nothing was known of hypertension or its treatment? Did their heavy diets contribute to an early demise? Was pneumonia, mentioned often enough, the 'old man's friend'? Did the tonsillitis of youth recur to ravage an aging system? George Washington died of a 'putrid sore throat.' Did the violent treatments of the day hasten the deaths of the middle-aged and aging? It is very difficult for the physician of today to sort out the diseases which afflicted people then. They may have experienced some diseases which have become totally unknown to us, extinct perhaps. The terrible English sweat of the sixteenth century apparently disappeared completely in the 1550s.11 On the other hand, there are highly fatal diseases, rare but not unknown today, and only recently discovered in some cases, which may have ravaged the Virginians. Lassa fever, for instance, has only recently been identified as a deadly virus infection spread by rats (and likely also by human contact) in Nigeria.12 This disease may possibly have come over from West Africa in the slave ships, dormant or active in the bodies of the slaves or the ships' rats. What was the disease which afflicted poor people generally and raged violently on the Eastern Shore of Virginia in the winter of 1709 and killed thirty people?13 And why did many people die with the gripes after drinking rum brought in by New England ships? Lead poisoning?14 Dr. John Mitchell of Urbanna, Virginia, may have encountered a now unknown disease in the winters of 1737, 1741, 1742 in the countryside about Urbanna. His patients were so intensely jaundiced that he diagnosed them as having yellow fever, but yellow fever was impossible in the winter. An analysis of Mitchell's report, published by Benjamin Rush long after Mitchell's death,15 makes typhus a possibility. However, Mitchell must have been well acquainted with jail fever. He did not consider it a possibility among these people living on remote plantations. Many of the patients died and he performed autopsies. Despite his bare-handed postmortems, Mitchell did not contract the disease. But this scientific physician did become so chronically and severely ill a few years later that he had to leave the colony. His illness was probably falciparum malaria.

256

Journal of the History of Medicine : July igj6

Though some of the diagnoses are obscure, most are plain enough. They are the diseases our parents and grandparents knew. The best source of information about the ailments of the time is the recently published Diary of Colonel Landon Carter of Sabine Hall 1752-1775. Carter "was very much

16. Carter, Diary (n. 6), p. 377. 17. Pathologist at the University of Virginia. Quoted very briefly in Medical Tribune, 1975. 18. Gordon W. Jones, "Thefirstepidemic in English America,' Va. Mag. Hist, and Biog., 1963, 71, 1-10.

19. Wyndham B. Blanton, Medicine in Virginia in the eighteenth century (Richmond, 1931), p. 257.

Downloaded from http://jhmas.oxfordjournals.org/ at The University of British Colombia Library on July 13, 2015

involved with the illnesses of his family, slaves, and neighbors. In his experience illness seemed to be a constant accompaniment of life. Death was expectable. The children seem to have been sick most of the time. Chicken pox and measles seem to have been less dangerous to white children than the complications of upper respiratory infections. Many respiratory infections must have been diphtheria. In March of 1770 many children in the vicinity of the Carter plantation died of'tumified throats.'16 The 'winter disorders' afflicted all ages, sexes, and races. Many came down with 'pleuritic pains' simultaneously; others had sore throats and painful ears. A rumor of the presence ofjail fever in the country was enough to create terror all about. Diphtheria, tonsillitis, mastoiditis, whooping cough, pneumonia, and typhus were mainly winter disorders. Tuberculosis was endemic and probably fairly common. According to Dr. Marvin J. Allison, tuberculosis was also endemic among the American Indians.17 Hints of its presence appear in Carter's diary. George Washington's half-brother Lawrence died of consumption, and it seems certain that George had it, at least as a youth. Typhoid fever, also more or less perennial, was endemic in Virginia and had been, ever since the first weeks in Jamestown.18 It was probably the 'seasoning sickness' that endangered great numbers of fresh immigrants. Governor Edward Nott died of it early in the century shortly after arriving to take up his duties. Equally common from the very first was the terribly painful and often deadly 'bloody flux.' Whether this was amoebic or bacillary dysentery cannot be ascertained. Probably both were present though perhaps the bacillary type was the more common. It ran a rapid course and was evidently perennial. Dysentery was particularly deadly among the soldiers of the Revolution. Going from body to body, it seemed to grow in virulence. Out of the armies of the war at least 70,000 died of disease,19 many

Jones : Medicine in Virginia in Revolutionary Times

257

20. P. V. Fithian, Philip Vickers Fithian: journal 1775-1776, ed. R. G. Albion and L. Dodbon (Princeton, 1934), p. 241. 21. Carter, Diary (n. 6), p. 635. 22. Ibid., p. 657. 23. Ibid., pp. 140-141.

Downloaded from http://jhmas.oxfordjournals.org/ at The University of British Colombia Library on July 13, 2015

of dysentery. The famous diarist Fithian died of it soon after enlisting.20 Intestinal worms, especially flatworms, were mentioned by Carter as occurring with astonishing frequency, particularly among his slaves. These parasites were more debilitating than deadly. Carter had many pungent descriptions of his slaves plagued with worms. 'Charlotte . . . an unconquerable fund of worms.' 21 'I gave him a mercurial purge which brought away abundance of worms and amongst them a tapeworm of enormous length.'22 Apparently calomel was the principal drug used, followed by rhubarb. And then the exhausted patient was revived with camomile tea. The 'King of Terrors,' as John Adams called smallpox, was an everpresent menace in all the world. It had been brought to America by the whites who seem to have had a certain degree of racial immunity. The mortality was high enough among the whites, but among the totally nonimmune Indians it had a devastating effect. Smallpox was endemic among Europeans in the eighteenth century. Probably because of the scattered population, it was sporadic in Virginia. Carter mentions it only a few times.23 Apparently none of the raging epidemics which struck larger centers like Boston and Philadelphia were known in Virginia. George Washington contracted his smallpox in Barbados. That experience was enough to make him very much aware of its dangers when nonimmune persons became concentrated in armies. He accordingly strongly urged inoculation of the Continental Army. In this attitude Washington differed from many of his fellow Virginians. Inoculation was intensely unpopular in Virginia. Mobs burned down the houses of more than one doctor who tried it. The House of Burgesses several times forbad variolation. There was so much public sentiment against this preventive infection that many Virginians were forced to go for smallpox inoculation to Maryland, where public policy was more enlightened. There was something to be said for the prejudice against inoculation. On a few occasions inoculated persons had been released by their physicians too soon and had spread true smallpox. To the dismay of the neighborhood, one John Smith (the record does not say whether he was a physician) variolated a number of people at Flats Bay, an area thought to have been a little southwest of Richmond where the wide

258

Journal of the History of Medicine : July 1976

24. Frances H. Mason, eA, John Morton and sons, merchants of London and Virginia (Richmond, 1937),

pp. 31, 38. 25. Carter, Diary (a. 6), p. 128.

Downloaded from http://jhmas.oxfordjournals.org/ at The University of British Colombia Library on July 13, 2015

Flat Creek enters the Appomattox, and let them 'go abroad too soon: so that the distempers hath spread in two or three parts of the country: some of the College yottfhs carried it to Williamsburg where two out of three have died.'24 We must wonder at the terror inspired by a disease that forced people by the hundreds to undergo inoculation, with its illness, clanger, and one per cent mortality, in order to prevent the ultimate horror of naturally acquired smallpox. When smallpox did occur, the patients were isolated as soon as possible. If available, immune persons were sent to wait on them. Sometimes patients were isolated and left to care for themselves, with food and wood supplied at the doorstep. Sometimes the shacks in which they suffered were burned after their recovery or death. There were a few 'pest houses' in the towns for smallpox patients where they presumably received better care. The importance of quarantine was universally recognized. Long before the germ theory was proven, folk vaguely understood an infectious process and discovered the value of burning fomites and of isolation. A few also learned the value of fomites in spreading smallpox among the Indians. Germ warfare is not a new idea. Smallpox and jail fever, or rumors thereof, seemed capable of creating panic. Dysentery, continued fever (typhoid), intermittent or bilious fever (malaria), all seem to have been accepted more or less as a part of life. The malarial fevers were apparently absent from Virginia before the English came. Very likely the English settlers brought with them what we know as benign tertian malaria caused by the plasmodium vivax strain, which is a relatively mild disease. We can assume that the terrible malarial illnesses of eighteenth century Virginia were due to the plasmodium falciparum strain, probably brought in by the Negro slaves. In September 1756 Carter noted the summer distemper: 'Above eighty of us, young and old, have felt the effects of the season.'25 The standard treatment for malaria was Peruvian bark (cinchona), but it often was without success. The Jesuit blessing was of greatly varying potency and evidently was not as efiective as when used for the milder strain in England. The yellowness of the patients indicated to them a severe stoppage of the bile, and it was considered more important to use purges and vomits to move the 'stopped up bile' downwards and upwards. Snakeroot was also used to promote sweats. Carter noted the

Jones : Medicine in Virginia in Revolutionary Times

259

26. Ibid., p. 506.

Downloaded from http://jhmas.oxfordjournals.org/ at The University of British Colombia Library on July 13, 2015

extreme cachexia, the swollen bellies, the utter misery, the convulsions, as well as the chills and burning fever. There were deaths. As mentioned before, Dr. John Mitchell did not see yellow fever as he supposed in the Urbanna region of Virginia. Apparently yellow fever was absent in Virginia before the days of independence. This seems strange in view of the fact that small epidemics of the terrible disease did occur in Charleston, Philadelphia, New York, and Boston. The diseases of malnutrition do not seem to have affected the folk of Virginia by Revolutionary times as they had in the early years of the colony in the previous century. Virginians were well fed. Carter mentioned the many vegetables which were available, so scurvy, pellagra, and beri-beri that had occurred in early Jamestown were no longer problems. However, deficiency diseases were found among the suffering armies of the day, just as was the sad case in the Civil War of the next century. The treatment of so many sick people kept their attendants busy. In general, treatments were vigorous. Few specifics were known. Jesuit's bark of varying potency was the only drug that we recognize as effective today. It was employed for any fever, not just bilious fever. Since its bitterness was considered its cardinal virtue, the bitter bark of certain local trees, such as dogwood, was used as a substitute for the sometimes hard to obtain Peruvian bark. But the mere use of bark and bed rest seemed too mild. All patients were purged with mercurials, jalap, senna, and rhubarb. Clysters were often used. Such depleting therapies were especially enforced if the patient had a 'full bounding pulse': the purge was used to get rid of the 'load of slimy phlegm in the stomach . . . and a fund of acrid bile seated in the passage below die orifice of the stomach.'26 The same patient received ipecacuanha and antimonials to get rid of the phlegm upwards as well. They thought mat there had to be a careful balancing of expectorants and purges. Milder laxatives, like rhubarb, were used in patients who were frail. But even a debilitated patient might be purged furiously with jalap if his bowels were stubborn. As mentioned before, Virginia snakeroot was used to promote sweating. Calomel was a salivant. Oil of juniper and cream of tartar were both considered to be fairly good diuretics. Every conceivable method, including heavy bleeding, was used to get rid of the noxious humors thought to be causing disease. Milder substances were also used. Hartshorn (ammonia water) was thought to stimulate. Similar in purpose was the pleasant lavender water.

260

Journal of the History of Medicine : July 1976

27. 28. 29. 30.

Ibid., p. 653. Ibid., p. 653. Blanton, Medicine in Virginia (a. 19), pp. 207-208. Ibid.

Downloaded from http://jhmas.oxfordjournals.org/ at The University of British Colombia Library on July 13, 2015

Horehound was a mild tonic. Valerian was thought to stimulate the nervous system, but in large doses it was very toxic. The value of an experienced physician lay in his abilities in diagnosis, prognosis, and treatment. Diagnosis was necessarily often approximate in the eighteenth century. Prognosis was an art, cultivated since the time of Hippocrates, an art that was acquired with age and experience. Treatment was largely a matter of skillfully balancing depletion and stimulation, with purges and expectorants on the one hand and cordials on the other. Carter not infrequently modified the harsh regime prescribed by his physician when he thought the purging had gone far enough.27 But, even in Carter's hands, a patient might vomit half a dozen times, go to stool as often all morning and then, sufficiently weakened, would be given camomile tea, or weak wine, or broth. Not quite all such treatment was farcical. To his satisfaction, Carter treated asthma with expectorants.28 I once saw an acute attack of asthma apparently relieved by a spontaneous vomiting spell. Doubtless some vagal stimulus was at work. Bleeding in our enlightened times has been used to relieve abnormally high central venous pressure widi the attendant pulmonary edema. Doubtless in times past an occasional pneumonia patient has obtained transient relief from bleeding. From such observations there perhaps arose die belief that any ill person widi a bounding pulse needed bleeding. And, at times, patients were bled to unconsciousness as a preliminary to surgery. I have been unable to find any evidence diat this was done in Virginia, however. Who administered these treatments? Who took care of die multitude of sick and miserable people in a rather scattered population of more than half a million? Who decided when to use jalap, mercury, ipecac, or the bark? There were about 500 physicians in Virginia in the eighteenth century. 29 Probably this means that by Revolutionary times diere were perhaps 300 practitioners. Blanton lists about 250 who served in the army or the navy. Not all of diem served all the time, and a certain number must have remained behind to take care of the civilians. After the war the physicians became more numerous. Of these 500 men only about 55 had M.D. degrees or had had training in a medical school.30 Among them were such once-noted men as John Gait,

Jones : Medicine in Virginia in Revolutionary Times

261

1774 thesis was De potionis frigidae in morbis febrilibus usu. Neither of these

doctors served in the Revolution according to Blanton's list.32 James Ramsay of Norfolk defended a thesis, De intermittentibus, in 1786 at the same time that James S. Gilliam discussed Diarrhoea. A medical school with a program similar to Edinburgh's had been started at Philadelphia at the University of Pennsylvania, but it was not until well after the Revolution that Virginians attended it. At first the theses at Philadelphia were in Latin, like William Stokes's 1793 paper on asphyxia. Later all papers 31. Gordon W.Jones, 'A Virginia-owned shelf of early American medical imprints,' Papers Bib. Soc. America, 1964, 58, 281-290. 32. Blanton, Medicine in Virginia (n. 19), pp. 403-408.

Downloaded from http://jhmas.oxfordjournals.org/ at The University of British Colombia Library on July 13, 2015

John de Sequeyra, Walter Jones, John Tennent, John Mitchell, James McClurg, William Brown, and John Leigh. De Sequeyra seems to have been the only one of this group who went to the University of Leyden. Except for Tennent, the rest attended Edinburgh after a preliminary education at William and Mary College in Williamsburg. Apparently most received M.D. degrees. Dr. John Mitchell did go to Edinburgh but where he received his degree is unknown. Some, like Gait, received additional training in London. A few went to Paris also. The physicians with degrees, or at least with some university training, formed the aristocracy of the profession in Virginia, had good practices, and were welcome everywhere socially. The other 450 gained their skills and ability to practice through apprenticeship to other physicians, often degree-holding ones, but not always. The apprenticeship-trained physicians usually practiced in the countryside; the university-educated physicians tended to settle in the towns. Many of the apprenticeship-trained physicians were able, worthy men. Peyton Grymes (1791-1878), who lived in Orange, Virginia, in the next generation was such a physician. He lived a long and prosperous life, and showed his interest in his profession by maintaining a very respectable library of the best medical works of the day.31 The men whc went to Edinburgh stayed there varying lengths of time, but the course of study was usually about three years. Each man on graduation had to defend a thesis. These theses, usually about thirty printed pages long, were written in Latin, which suggests that our physicians may have had a good classical premedical education in Virginia, perhaps by private tutor, perhaps in a school on a neighboring plantation like the one maintained by the Lees at Stratford, or at William and Mary College. William Ball's 1773 thesis was De tabe mesenterica; John Griffin's

262

Journal of the History of Medicine : July

33. Robley Dungluon, History of medicine from the earliest ages to the commencement of the nineteenth century (Philadelphia, 1872), pp. 152-136.

Downloaded from http://jhmas.oxfordjournals.org/ at The University of British Colombia Library on July 13, 2015

were in English. John Claiborne wrote forty-three pages on scurvy in 1798 and Henry Lockett wrote a long illustrated paper on the warm bath in 1801, in English. The 'learned physitians' of the time based their professional claims upon their thorough knowledge of theory. Experience and long practice merely added to this important asset. The troublesome fact was that many wellread and educated men of affairs, like Landon Carter and William Byrd II, were well versed in all this theorizing and did not hesitate to discuss Boerhaave and Cullen on equal terms with their doctor neighbors. Of all the 'systems' or theories known in the eighteenth century the systems of Boerhaave and Cullen were the most respected in England and America. Those of Hoffman and Stahl were not considered of consequence. Hermann Boerhaave was an eclectic. He accepted the early glimmerings of modern chemistry, but also embraced the doctrine of humors. He felt that the fluids of the body consisted of various particles adapted only to certain apertures and when they were forcibly sent through vessels too small various complaints were caused. Cullen discarded some of this and pursued a belief in the doctrine of spasm and debility. Rheumatism, for instance, was in his view due to a spasm of the muscles. He rejected the ideas of specific causative agents. He laid much stress on the natural healing power of nature, fomented by the nervous fluid and the vital principle. To him the brain was all-important.33 Among the fifty-odd men trained under these systems in Europe five busied themselves in professional investigation and writing. The sample is small, of course, but this is a surprisingly high percentage. If the same proportion applied today some 500 Virginia physicians would be actively writing. The earliest of the physician authors was John Tennent. He left Virginia about a generation before the Revolution, but his son served as a surgeon in the Continental Army. Tennent was a strange mixture of physician and near-quack. He was educated in Britain, where, no one knows, and came to Virginia in 1725 where he soon discovered the Indian remedy of snakeroot, the chief effect of which was to produce a sweat. He experimented with snakeroot and proclaimed it to be a cure-all. He 'gave his discovery to die people' and then demanded that the House of Burgesses pay him well for giving up the profits from his discovery so freely. A bemused legislature did pay him ,£100 only, to his disgust. To promote snakeroot

Jones : Medicine in Virginia in Revolutionary Times

263

Travels in Barbary and the Levant, Hiob Ludolfs Historia Aethiopica, Francis 34. Lawrence C. Wroth, William Parks printer and journalist of England and colonial America (Rich-

mond, 1926), pp. 50, 52. 35. John Mitchell, 'Dissertatio brevis de principiis botanicorum et zoologorum,' in Acta Physicomedica Academiae Caesarca Leopoldo Franciscanae, 10 vols. (Nuremberg, 1727-54), appendix to vol. 8,

pp. 187-224 (included is his 'Nova plantarum genera').

Downloaded from http://jhmas.oxfordjournals.org/ at The University of British Colombia Library on July 13, 2015

he wrote his Essay on Pleurisy, published at WiUiamsburg in 1736. He is thought to have been the author of Everyman his Own Doctor, published at WiUiamsburg in 1734.34 Many scoffed at Tennent and his snakeroot. To further promote it he went to England where he won the friendship of Doctors Mead and Monro. He defended himself quite intemperately in The Case of John Tennent published in London. In 1742 he published his Physical Enquiries, also in London. This was a fairly typical book for the period, emphasizing die effects of change of climate upon man, but lacking in substantial medical knowledge or new discovery, and was marred by his blasts at die opinions of other doctors and noted quacks. He died poor and ignored. A much more respected man was Dr. John MitcheU (1711-68). Unlike Tennent, he was Virginia born. He was educated at die University of Edinburgh and began practicing in Urbanna, Virginia, a Tidewater vUlage on die Rappahannock, in die early 1730s. As we have seen, he had an inquiring mind. Probably inspired by Alexander Monro of Edinburgh, Mitchell performed postmortems on his patients and kept careful notes on his findings. When we recall diat all kinds of dissections on human beings tended to be violendy opposed in the eighteendi century we marvel diat Mitchell had die courage, as weU as the interest, to perform autopsies. In 1804, Benjamin Rush published Mitchell's autopsy observations on die victims of what he considered yeUow fever. Very likely MitcheU's notes on odier autopsies were lost on his way to England in 1746 when his papers were seized by a French pirate. Like many of the physicians of the day, Mitchell had a strong interest in natural history. He searched for new plants wherever he went on his rounds in Virginia. His papers on his botanical and zoological observations were published in Germany,35 and he submitted an anatomical study of die opossum to the Royal Society. In 1744 die Royal Society pubh'shed in its Transactions his paper 'An essay upon the Causes of die different Colours of People in different Climates.' MitcheU wrote with die help of his imagination and his extensive personal library in Urbanna where, among medical books, were also to be found the books he referred to in this paper: Newton's Opticks, Thomas Shaw's

264

Journal of the History of Medicine : July 1976

Moore's Travels into the Inland Parts of Africa.36 His interest in the subject

was, of course, stirred by his observations on the many Negro slaves in eastern Virginia. In 1746 Mitchell left Virginia because of extremely poor health and went to England. There he finally gave up medicine and botany to become a cartographer. In 1755 he published the first edition of the most important map of America in the eighteenth century.37 Another Virginian, the little-known John Leigh, published in 1786 the prize essay An experimental Inquiry into the Properties of Opium. The paper is

first American pharmacopeia, Pharmacopeia simplicocorum et efficacorum in usum nosocomii militaris. It detailed fhe use of the simplest, cheapest, and

36. Gordon W. Jones, "The library of Doctor John Mitchell of Urbanna,' Va. Mag. Hist. Biog., 1968, 76, 441-44337. See Edmund Berkeley and Dorothy Smith Berkeley, Dr. John Mitchell, the man who made the map of North America (Chapel Hill, 1974).

Downloaded from http://jhmas.oxfordjournals.org/ at The University of British Colombia Library on July 13, 2015

quite modern in its careful attention to the details of his experiments with opium, but this work seems to be his only claim to fame. Perhaps the wealthiest and professionally most prominent writer-physician of Virginia was James McClurg, who had been a classmate of Thomas Jefferson at William and Mary College. He attended Edinburgh University where he defended his thesis De Calore in 1770. It was acclaimed by his contemporaries. He summarized in eighty numbered short sections all the actions of heat in and out of the body, its sources, its spread, and its importance. Later he studied in Paris and London. While in London he conceived and wrote his then-famous little book Experiments upon the human Bile (1772). He believed that bile was formed from 'putrefactive blood.' And all things that contributed to the putrefaction of the blood, such as hot climates, malaria, marshes, badly ventilated ships or dungeons, and so on, would be the causes of biliary disturbances. The book appeared in several languages. After his success in Europe McClurg returned to Virginia, settled at Williamsburg, and married. He later served in the Continental Army and also the navy. After the war he moved to Richmond, the new capital of Virginia, so that he might maintain his prominence in the center of Virginia affairs. William Brown, born in 1748 into a family with considerable medical tradition, studied at Edinburgh and returned to Alexandria, Virginia, where he became a prominent physician. As soon as the Revolution broke out he joined the army and served for five years. In addition to his duties as surgeon-general of the hospital of the Middle Department, he wrote the

Jones : Medicine in Virginia in Revolutionary Times

265

38

38. Bhnton, Medicine in Virginia (a. 19), p. 13a.

Downloaded from http://jhmas.oxfordjournals.org/ at The University of British Colombia Library on July 13, 2015

most readily available medicines. Before the end of the war he resigned from the army and returned to his practice in Alexandria. The vast majority of the educated medical practitioners did no writing. They were content to spend their lives, like most physicians today, treating patients in their offices or in their apothecary shops. Many physicians, educated or otherwise, practiced as apothecaries. It was profitable. Apothecaries, in their turn, practiced medicine. Wise female neighbors doubled as midwives and 'doctoresses.' On occasion the householder treated his own family with home remedies. And there were quacks, how many we cannot tell, but advertisements by the more notorious ones appeared in the Williamsburg newspaper. These eighteenth century physicians had a medical language all their own, of ancient lineage, which is often difficult for us to understand or appreciate. The terms 'biliousness,' 'bilious fever,' 'acrimony of the fluids,' and the like were bandied about liberally by all practitioners and accepted by their patients as impressive terms. The patients' families listened respectfully as their physicians described the ailments of dear ones according to the systems of Boerhaave or Cullen. No matter what the system or theory, no matter how much or how little was the practitioner's education, the actual methods of all were essentially the same. They ignored Cullen's advice against too much bleeding and bled their patients profusely. All of them were great believers in expectorants, diaphoretics, diuretics, and especially purges. Blisters, cuppings, plasters, setons were all used. Then carminatives and cordials were employed to restore the exhausted bodies. The patient might as well have gone to an empiric as to a 'learned physician.' Laymen thought themselves medically wise, too. Among the laymen the plantation owners were often busy medical practitioners. Some thought they knew all and had firm medical convictions. They often held the physicians in disdain. Landon Carter was only moderately respectful to his doctor, Walter Jones, whom he sometimes called to treat his family. Yet Walter Jones was sufficiently respected by others to be made one of the physicians-general of the army. William Byrd II was very much of the opinion that he knew more than the physicians and felt contemptuous of those he saw in Virginia. The laymen of Virginia were reinforced in their good opinion of their personal medical abilities by their ownership and avid reading of the best

266

Journal of the History of Medicine : July

Sceptical Chymist, Reconcileableness of specific Medicines to the Corpuscular Philosophy, and Usefulness of Experimental Natural Philosophy were repre-

sented in at least one copy each. Landon Carter owned William Smellie's work on midwifery. Many had the works of Hippocrates and Galen in Latin and Greek. John Mitchell owned Francis Clifton's English translation of parts of Hippocrates as well as the works of Richard Lower, Regner de Graaf, and Marcello Malpighi. An obscure Virginian named John Morris bought in 1763 a copy of the 1673 English edition of William Harvey's classic work on the motion of the heart and blood. The list of Virginiaowned medical and scientific works numbers over 400 separate titles. When we consider their extensive libraries we have little cause to wonder that the masters of plantations felt quite able to treat and nurse their 39. Gordon W. Jones, 'Medical and scientific books in colonial Virginia,' Bull. Hist. Med., 1966,40, 146-157.

Downloaded from http://jhmas.oxfordjournals.org/ at The University of British Colombia Library on July 13, 2015

medical works of England and Europe.39 Everyone who could read and afford books had them. Books were prized possessions as proven by the long lists of books which appear in the estate inventories to be found at the Virginia State Library. The numbers of books in a household varied from a dozen or so to several thousand. William Byrd II had a library to rival that of Cotton Mather of Boston or William Logan of Philadelphia. From 100 to 200 books would be a not unusual number in an affluent home. Of these in colonial times ten per cent to twenty per cent would be medical books. The percentage of medical books would naturally be higher in the libraries of physicians. In the years after die Revolution the popularity of medical works among laymen declined. James Monroe had only two purely medical books in his large library. Others demonstrated a similar lack of interest. Perhaps this indicates a lessened need for amateur medical practice as a result of a greater availability of more-or-less trained physicians. Among the pre-Revolutionary and Revolutionary libraries of Virginia there were a few simple self-help works like that of Tennent. John Wesley, the Mediodist preacher, published Primitive Physick or an easy and natural Method of curing most Diseases. It went through at least seventeen editions and was owned by more than one anxious Virginia householder. Similar in nature and popularity was Robert Boyle's Medicinal Experiments: or A Collection of Choice and Safe Remedies. . . . It, too, is full of the quaint, and remained popular long after its first appearance in 1692. But the taste of the large planters was far more sophisticated. They owned works by Thomas Willis, Thomas Sydenham, and the great works of Boyle. Boyle's

Jones : Medicine in Virginia in Revolutionary Times

267

40. American Archives, ed. Peter Force, 9 vols. (Washington, 1837-53), Jth ser., n, coL 497.

Downloaded from http://jhmas.oxfordjournals.org/ at The University of British Colombia Library on July 13, 2015

families and slaves. This plantation-master medical competence showed plainly in George Washington's insight, as commander-in-chief, into the medical problems of his army. His encouragement of inoculation was not his only evidence of concern. He gave constant attention to sanitation and to the burning of carcasses and filth. He kept an eye on the physicians and often did not like what he saw, especially the surgeons to the militia. He wrote Congress in late 1776 urging that surgeons be carefully screened. He called many of the regimental surgeons 'very great rascals.'40 He remarked upon their insubordination and constant bickering with the general hospital. He thought that they should be firmly subordinated to the director-general of the hospital. Washington was well recognized for his concern for the health of his troops. The plantation master wanted his people kept healthy, saved from smallpox, and he wanted each overseer to know his niche. A New England farmer or a Philadelphia merchant would not have had Washington's insight since neither would have been experienced in the long-time care of 200 slaves and dependents. Before the Revolution there were no general hospitals in Virginia. Occasionally certain buildings were designated by communities as pest houses for the care of persons with smallpox. Otherwise the only hospitals were the few-bed ones to be found on the great plantations for the care of slaves. Landon Carter had one. Physicians often housed patients in their spare rooms. If other states can claim the honor of having established general hospitals in colonial times Virginia does have the distinction of having built the first Lunatick Asylum in America. Authorized by the House of Burgesses in 1770, it was completed at Williamsburg in 1773. It was equipped with chains and locks and rooms for confining twenty or more 'idiots and lunatics' who had previously languished in county jails. Treatment was nonexistent and inmates in Virginia received the same stern care they did all over the civilized world. The American Indians were far more considerate of their mentally aberrant kin. Such was Virginia on the eve of the Revolution: a sickly people about half free, half slave, living mostly on plantations and small farms; a few small towns like Williamsburg, Richmond, Norfolk, Fredericksburg, Alexandria; and pioneers in the Valley and to the west. The west was still open to Indian raids, yet even so, sufficiently civilized and apparently safe to be able to afford such amenities as the healing springs of Bath, now

268

Journal of the History of Medicine : July 1976

41. Fithian, Journal (n. 20), pp. 125—126. 42. American Archives (n. 40), 4th sa., m, coL 48.

Downloaded from http://jhmas.oxfordjournals.org/ at The University of British Colombia Library on July 13, 2015

Berkeley Springs, West Virginia, where the well-to-do of Tidewater Virginia could go and soak away their infirmities.41 Virginia presented a pleasant enough society for the upper class and an endurable one for lesser folk. Their backbreaking toil was no different from that in the Old World, and there was always the chance of upward movement, except for the slaves. The only shadows were the constant threat of terrible infectious diseases, of economic disaster due to British policy, and war. "We tend to think of the war that did come in terms of a few hundred or a few thousand fighting men. It "was, in fact, a great struggle, one which sapped the strength of the thirteen colonies, caused a staggering inflation, caused great, now-forgotten suffering from illness and wounds among many diousands of soldiers. We have already noted the estimate that 70,000 men were killed by disease during the war. Misery was intense. On 6 August 1775, General Schuyler wrote to Congress from Ticonderoga, 'Out of 500 men that are here near a hundred are sick and I have not any kind of stores, although I forgot not to order them immediately after my appointment.'42 Dysentery, typhoid, malaria, typhus, all took their toll as in all the wars before the establishment of the germ theory and the work of Koch and Lister. The summertime miseries were multiplied in winter, with pneumonia added, just as in the Civil War eighty years later. Nearly 10,000 men left Virginia to serve in the Continental Army, more than from any odier colony except Massachusetts. Virginia also supplied a number of high-ranking medical officers, among them Doctors James Craik, George Draper, David Jackson, and William Brown. Except for die Battle of Great Bridge in 1775 Virginia was not directly affected by the war until 1779 when the British began making raids into Virginia. From that time on Virginia felt the war more and more until the final victory at Yorktown in the fall of 1781. Before 1779 Virginia took in a number of sick and wounded soldiers, most of whom were cared for in private homes. The necessity for large general hospitals was not evident until the military campaigns for die rich and populous state began and the number of casualties increased. It was soon discovered diat the wounded and sick did better in private homes. Thus, private homes continued to be used. The Governor's Palace in Williamsburg was used briefly as a hospital before it burned. French sick were at first cared for in a building of the College of William and Mary. Then the French built a hospital near

Jones : Medicine in Virginia in Revolutionary Times

269

4.3. Blanton, Medicine in Virginia (n. 19), p. 274. 44. Ibid., pp. 280-281, 283.

Downloaded from http://jhmas.oxfordjournals.org/ at The University of British Colombia Library on July 13, 2015

Williamsburg where sanitary conditions were good, but the mortality was the same as in American hospitals. The American hospital, the Vineyard,43 which like the French hospital has disappeared without a trace or record of its size, was also built outside Williamsburg. Many sick and wounded were cared for in large tents. Other hospitals were quickly built at Yorktown, Hampton, Portsmouth, Chesterfield Courthouse, Charlottesville, Fredericksburg, and Alexandria.44 They were all needed for the care of the thousands of sick and wounded American, French, and British soldiers, after the Yorktown surrender. Surgery during the American Revolution, as eighty years later during the Civil War, was at a low ebb. Men died from amputations with the same dreadful frequency. Men ill with dysentery and other infectious diseases were billeted next to the wounded. Typhus, typhoid, and dysentery spread readily. In the Southern armies malaria was a great problem, requiring requisitions for enormous quantities of Jesuit's bark. Fortunately for the American forces, the British were equally vulnerable to all such causes of death and debility. Benjamin Rush listed a number of observations made on troops during the Revolution. Young men under twenty were subject to the greatest number of camp diseases. Those over thirty or thirty-five had the fewest. Among the more resistant were Europeans serving the American forces. The Southern troops were more sickly than those of the North and New England. Southern troops sickened from want of salt provisions. 'I once saw a private in a Virginia regiment throw away his ration of choice fresh beef and give a dollar for a pound of salted bacon.' The principal diseases were typhus 'gravior and mitior of Cullen.' Men who came into the hospital with other diseases and wounds soon lost the characteristics of their other diseases, and suffered or died from typhus. Typhus was worse in winter, better in the fresh air of summer. Cold always made the contagion active. Rush shrewdly observed that the contagion was conveyed from hospital to camp by means of blankets and clothes. Black soldiers died of typhus even more readily than the whites. Those soldiers billeted in private homes usually escaped hospital fever and recovered soonest from their diseases. 'Hospitals are the sinks of human life in an army. They robbed the United States of more citizens than the

270

Journal of the History of Medicine : July 1976

Fredericksburg, Virginia

45. Benjamin Rush, Medical inquiries and observations, 4 vols. (Philadelphia, 1805), 1, 271-276.

Downloaded from http://jhmas.oxfordjournals.org/ at The University of British Colombia Library on July 13, 2015

sword.' Rush advised the abolition of hospitals for acute diseases and the treatment of the sick in private houses.45 The war made few permanent changes in the Virginia medical situation. After it was over the physicians and surgeons returned to their practices. They performed their treatments exactly as before. No discoveries came out of the War of Independence. Its major effect on medical education seems to have been to divert American medical students from Edinburgh to the University of Pennsylvania Medical School for their formal medical education. University-trained and apprentice-trained physicians increased greatly in numbers during the early years of the Republic. Laymen, if we may judge from the drop in the proportion of medical books in their libraries, placed their bodies more at the discretion of physicians than of their own personal judgments. Medicine continued to be practiced as it had been for centuries with the lancet, the purge, the expectorant, and the blister. Physicians still grasped at theories; the facts came only several generations later.

Medicine in Virginia in Revolutionary times.

Medicine in Virginia in Revolutionary Times GORDON W.JONES [250 ] Downloaded from http://jhmas.oxfordjournals.org/ at The University of British Colo...
1MB Sizes 0 Downloads 0 Views