First Do No Harm

The History of Medicine in America
The Settlers Arrive

There were two physicians on the Mayflower. One was Miles Standish, the commander of the Mayflower. He was an officer in the British army, a magistrate, an engineer, an explorer, an interpreter, a merchant, and a physician. Called the Hero of New England, Standish’s formal education was in the military and, like many physicians of the time, he picked up medicine in his daily life and by watching other physicians. He is described by many historians as a little man with a fierce temper. He was exceedingly brave and had no qualms about killing a threatening native.

It is ironic that this hero also practiced what medical historians call Heroic Medicine. Heroic medicine can be defined in many ways, but one definition I have a particular affinity towards is: the medicine prescribed is proportional to the fear of the disease. We will get back to this, you can bet.

Another physician among the pilgrims was Dr Samuel Fuller. We don’t know much about his education either, or his skills as a physician, but we do know he died during the first smallpox epidemic to hit the colonies in 1633.

We also know that Dr Fuller was a physician AND surgeon. Around this time most doctors were not surgeons and a lot of surgeons were not doctors. In fact, it was hard to tell a surgeon from a barber or at times a barber from a physician. They all practiced some form of medicine, so perhaps it is time to tell you of the prevailing medical theories at that time.

As one historian puts it, "the underlying theory on which much of Western medicine was based for almost a thousand years was pure bunk." [Zacks, Richard. An Underground Education, Doubleday, New York, New York, 1997]

Considering the numbers of patients this bunk killed, "bunk" might be putting it lightly. It all started in the Salerno School of Medicine that flourished around 1000 A.D. Its basic tenets were borrowed from the Greek concept of Four Elements which stated that everything in the universe was made up of four basic elements: fire, air, water, and earth.

To the scholars of that period, this made a lot of sense. Therefore, they concluded that the body contained four corresponding "humors:" blood (fire), phlegm (earth), black bile (water) and yellow bile (air).

It was the physician’s job to maintain a balance among these four humors. If a person had a cold (phlegm was considered cold) the doctor applied hot medicines, and even a diet of pepper. To make things even sillier, this school of medicine determined that each person had a dominant humor that made prescribing a very complicated mess. And though physicians for years, right up till they were proven wrong, claimed that medicine was based upon science, it had no connection whatsoever to science, and in fact, was a philosophy, unprovable and un-testable. At Salerno, the head of Philosophy also chaired the Medical Department.

The therapies practiced by these conventional physicians were bleeding, purging, either by emetic or by enema, blistering, and poisoning. Did I say poisoning? I meant prescribing medicines. The most popular medicine of the time being Calomel, a form of mercury.

An interesting aside is the fact that it was medicine’s love of the enema that led to surgery becoming a respectable profession. Previous to 1685, surgeons held little favor with anyone. If you wanted something cut off, you could attend a surgeon or a barber. If you wanted a little blood letting, you could attend a physician or a barber. Both the surgeon and the barber had that red and white pole outside their place of business telling the world Blood & Bandages R US!

You see, the early Catholic Church forbade physicians to perform surgery. If you’ll remember back to the story of Michelangelo, who "illegally" dissected cadavers to study anatomy, you’ll know that if it is illegal to open up a dead body, it was just as illegal to open up a living one. The human body was made in God’s own image and could not be violated thus. It was through this ban on surgery (and the study of anatomy) that barbers got the job. Barbers did everything from cutting hair to pulling teeth to removing gallstones. All without anesthesia. However, the Renaissance and Martin Luther’s split from the church brought forth a new class of surgeon who yearned for the prestige of regular physicians. They wanted to raise up their lot from their lowly status and surely separate their craft from that of the town barber. Physicians had high earnings during this time. Surgeons were simply lowly craftsmen, taking their orders from physicians. But this was all to change when King Louis the 14th of France needed a surgeon to examine his bottom.

Enemas? Did someone mention enemas? The French loved them. Some of the first "French postcards" involved an innocent session with an enema device (they were much spookier back then). King Louis seemed to have enjoyed his lot. Richard Zacks tells us that there were recorded over 2000 enemas administered to the good king in his 59 years on the throne.

Then one day, a bump on the Kings anus appeared. All the doctors were called in but none could cure it. The king called in a surgeon, Charles Francois Félix, who quickly diagnosed the problem as an anal fistula, and promised to return in six months to fix it—it seems he’d not had all that good luck working on the anuses of paupers, having allegedly sent quite a few to an early grave. 

This is just conjecture, but it is quite possible, and plausible, that the good king’s anal fistula was caused by all of his enemas. So Charles Félix might have very well had the physicians of his time to thank for this royal opportunity.

Felix showed up on November 18th, 1686, and with the king’s new bride looking on, the surgery took place. It was deemed a regal success, and the king showered Dr Félix with "money and titles," as Zacks puts it. That year was dubbed the Year of the Fistula and everyone celebrated the good doctor who became the toast of the town. Bottoms up!

This led to raising up the stature of surgery in France and as Zacks tells us, "Over the next century French surgeons exported worldwide many of their breakthroughs in surgical techniques."

In 1745, the Barber-Surgeon guild broke up, surgeons went one way, the barbers went another, taking their pole with them.

Back to the colonies…

Conventional medicine, or as we will refer to it from this point forward, orthodox medicine, at that time, did have competition. Your odds of actually seeing a physician (as a patient) in the early colonies were much greater the more wealth you owned. Many colonials never attended a physician in their entire life. And doctors weren’t even allowed to attend a childbirth, except as a witness. Birthing was a communal event.

In her article, "All American Girl," Susan Norwood writes: "The women of colonial times were usually pregnant and caring for their young children. The second generation of colonial women had an average of about eight children. Childbirth was a fearful time for them. Death was an issue not to be dismissed with each birth. Childbirth was a communal affair attended by midwives and neighboring women." [http://www.yale.edu/ynhti/curriculum/units/1997/3/97.03.05.x.html#b]

She also goes on to state that marriage was, in the colonies, a must for young women. Unlike life in Great Britain, in the young colonies women could now choose their husbands rather than submit to a prearranged marriage. She makes this interesting comment: "If a young girl did not marry, it was probably because she was needed at home to care for a sick family member…."

There were no hospitals. There were no care homes. Family members helped family members. This is where the practice of nursing began, in the home. This diminutive statement speaks volumes, for it hints of the other forms of medicine practiced in the early colonies.

If you pick up a modern day book on medicinal or aromatic herbs, you’ll see that a lot of them that we treat as common, came over here from Europe. Herbalism reached its first major peak in Europe in 1652 when Dr Nicolas Culpeper published his book, The English Physician, filled with some 300 herbs, drawings, and their medicinal uses. He is considered by many to be the father of alternative medicine. He is considered by the orthodox to be an uncritical quack and stargazer. However, please note that this was his second book. His first book was on midwifery and child care, called The English Midwife. This book did not earn him the reputation of a quack, for it did not clash with the scholarly and scientific tenets of medicine. The English Physician did clash. It refused to acknowledge blood letting and the earthly minerals that led to so many cures.

Today, about 50% of our medicines come from herbs, in some way or form. But Nick Culpeper’s effrontery was a slap in the face of the scholarly physician whose education told him that he knew everything and that anything outside of that education was sheer quackery.

It was during the renaissance that herbs were being studied and classified, though herbal preparations had been used for centuries. The father of medicine loved garlic and prescribed it for tumors. Anthropologists feel that even our cave dwelling ancestors had their herbal remedies. But it was the few hundred years leading up to Culpeper’s book in which herbs were studied and classified to great extent in Europe.

It is no amazing coincidence that Native American historians point out that at this same time, cultures in this land were doing the same thing. When the colonists befriended the natives, their "medicine cabinets" so to say, expanded with new herbal remedies the natives brought them from their new land.

In his book, Divided Legacy, Dr Harris L Coulter describes this "second doctrine" (there were 4 competing theories of medicine in the first half of the 1800s) as the "Indian Doctors." Even though many of the arriving colonists had brought their herbal medicines with them (and seeds to grow more), the main herbal movement in this country were some of the new herbals introduced to the colonists by the natives. Any physician from the orthodox camp who used an herbal preparation was labeled, besides a quack, a "botanical practitioner" or "botanics." Orthodox physicians who adopted the practices of any conflicting medical "theories" were also called "irregulars."

About the time of the Revolutionary War another short-lived school of medicine cropped up. It was called the Thompsonians, named after the physician Samuel Thompson who left behind his orthodox practice to develop a much simpler theory based upon steam baths and the Indian remedy: lobelia. If you take enough lobelia, it will make you vomit. Thus, Dr Thompson too believed in the purging, but refused to bleed his patients to death. Eventually (1840s) the Thompsonians would join with the botanics to form the Eclectic medical school.

You will have to wait till the next article in this series to learn of the fourth movement.

Now, apart from all these highfalutin theories, medical schools, and supposed laws of nature, lives the lowly patient. The populace. You will see later, when the orthodoxy falls out of favor, that these scholarly figures looked down upon the masses who were just not qualified to judge them. The common man and common woman could never possibly comprehend the world of conventional medicine. They had to be led by the hand and saved from all the quackery that abounded in this period.

In reality, the common person brought along from Europe a history of self care. Many home remedies used then and are still used today. Yes, some are quite laughable, but many existed and were passed on because they worked. Unlike the orthodox medicine of the colonies which bullied its way into peoples lives, home remedies worked. Midwifery worked. Yes, the death of a woman giving birth or the death of the newborn was always a possibility, but when something works, it is used. Orthodox medicine, on the other hand, continued to be used because it was scholarly. It did not matter how many people died under its use. The patient died from the illness, not from the care. This was the firm stand of orthodox physicians. A physician was not judged by his successes nor by his failures, but rather by his erudition, scholarliness, and his cultivation.

In fact, the first internationally known American was the famous Dr Benjamin Rush. I’ve quoted Dr Rush at our web site previously. He was the one who warned us, at the constitutional convention, that we needed to include in the Bill of Rights a Freedom Of Medical Care, or else one form of medicine might gather up enough political strength to push aside all other forms. Which is exactly what has happened, and you’ll see how it happened in this series of essays as we progress.

Dr Rush is sometimes called the Father of American Psychiatry. His image is on the seal of the American Psychiatric Association. He is one of the signers of the Declaration of Independence.

When it came to treating the mentally ill, Dr Benjamin Rush did something highly unorthodox: he listened to them.

Rush is much credited with the way in which we now treat the mentally ill. He listened, he took notes, he was a patient advocate, and recommended against beating them and locking them away in small, filthy cells.

However, and I don’t take this however too lightly, he also had this strange theory that mental illness could be shaken from a person. He devised chairs suspended from the ceiling; attendants swung and spun the mentally ill patient for hours. Then there was a Tranquilizer Chair he devised in 1811 that locked a person up tightly and cut off all light so as to deprive the patient of any visual sensations (not all too unlike the sensory deprivation tanks of today). The chair came with an opening below allowing the patient to evacuate his/her bowels and a caretaker to change the pan without disturbing the patient.

Furthermore, Dr Rush is credited with perhaps a thousand kills. No, this wasn’t his military career we’re talking about. It was his medical career. Dr Rush liked to bleed patients till they passed out. He purged them (making them vomit—he felt it was great for their circulation), and blistered them, and gave them mercury. Many historians feel that during the 1793 Yellow Fever epidemic, Dr Rush killed more people than the disease itself. And though he had to fight his way through clouds of mosquitoes to visit patients, he blamed the yellow fever outbreak on coffee dumped into the harbor and rotting.

All in all, disease and orthodox medicine took their toll in the early colonies. As written in Culpeper's preface (I have a facsimile of the 1826 edition before me), "Disease is undoubtedly the most fatal enemy of mankind." Add to it orthodox medicine, and you have a very rough beginning in the young, American colonies.

If you were born with diabetes, you did not live long. If an epidemic hit, you lived and died in terror. A minor cut could lead to an amputation. In fact, most accidents proved fatal, it was just a matter of time. Though midwives traditionally washed before assisting a birth, germs were not known and ludicrous theories of disease abounded. It would not be till we heard about Rudolf Virchow’s publication, Cellular Pathology in the last half of the 1800s that conventional medicine actually began helping patients. Prior to that, if you had the money to call in a physician, you could expect heroic medicine: "Their techniques were rooted in the notion that the way to exorcise one set of afflictions from a patient’s body was to subject it to a considerably more violent set of afflictions. The heroics were entirely on the part of the patient: for even the mildest ailments, one could expect to be bled, leeched, cupped, blistered, amputated, sweated, trepanned, scourged, and purged and flayed to the fare-thee-well." [Courter, Gay, Flowers in the Blood, iUniverse, Lincoln, Nebraska 2002]

This was our rough beginning. Those of you who have been through chemotherapy for cancer know the meaning of heroic medicine. Cancer drugs are today’s heroic medicines. And, still, anything outside of orthodox medicine is quackery. As you can see, the more things change, the more they stay the same.

* * *

We learned after the publication of this particular essay, something that we had suspected all along, but did not find the materials to prove, and that was, that 40% of the physicians in the early colonies were women. Midwives at this time were considered doctors. Healing was a practice that had been handed down to women, as there were none who had a formal education in medicine; there were few men who'd had a formal education in medicine either. We are very grateful to Gail Collins, the editor of the New York Times editorial page (the first woman to hold this position) for her book, America's Women: Four Hundred Years of Dolls, Drudges, Helpmates, and Heroines. She did the original research that opened our eyes to a lost history of women in medicine.

 

References and Further Reading:


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