Medicine in Virginia, 1607-1699.

by Thomas P. Hughes.

CHAPTER ONE

European Background and Indian Counterpart to Virginia Medicine

EUROPEAN BACKGROUND

The origins of medical theory and practice in this nation extend further than the settlement at Jamestown in 1607. Jamestown was a seed carried from the Old World and planted in the New; medicine was one of the European characteristics transmitted with the seed across the Atlantic. In the process of transmission changes took place, and in the New World medicine adapted itself to some circ.u.mstances unknown to Europe; but the contact with European developments in theory and practice was never--and is not--broken.

Because of this relationship between European and American medicine, an acquaintance with seventeenth-century European medicine makes it possible to give additional support to some of the information in the early sources about medicine in colonial Virginia. In addition, knowledge of the European background allows reasonable speculation as to what happened in Virginia when the early sources are silent.

In discussing the background for American medicine it is not necessary to make a firm distinction between England and the rest of Europe. As today, science--in this case, medical science--frequently ignored national boundaries. The same theories relative to the structure of the body (anatomy), to the functions of the organs and parts of the body (physiology), and to other branches of medical science were common to England and Europe. Medical practice, like theory, varied but in detail from nation to nation in Western Europe.

Seventeenth-century Europe relied heavily upon ancient authority in the realm of medical theory. The European and colonial Virginia physician, surgeon, and even barber (when functioning as a medical man) consciously or unconsciously drew upon, or practiced according to, theories originated or developed by Hippocrates (460-377 B.C.) and Galen (131-201 A.D.). Hippocrates is remembered not only for his emphasis upon ethical practices but also for his inquiring and scientific spirit, and Galen as the founder of experimental physiology and as the formulator of ingenious medical theories. Most often Hippocrates was studied in Galen's commentaries.

No longer do scholars or physicians scoff at the ancient authorities who dominated medical thinking for so many centuries. The seventeenth-century physician striving to reduce the frightful inroads that disease made into the colony at Jamestown may have been handicapped by the erroneous doctrines of the gossamer-fine _a priori_ speculation of Galen, but the physicians to a large extent practiced according to a science rather than to superst.i.tion and magic--because the voluminous writings of Galen survived the centuries. Nor would the European physician, or his Virginia counterpart, have demonstrated the same appreciation for close observation if Hippocrates had not still been an influence.

In the realm of pathology (the nature, causes, and manifestations of disease) the humoral theory, with its many variations, was extremely popular. The humoral doctrines stemming largely from Hippocrates were made elaborate by Galen but were founded upon ideas even more ancient than either thinker and pract.i.tioner. As understood by the seventeenth-century man of medicine, the basic ideas of the humoral theory were the four elements, the four qualities, and the four humors.

The elements were fire, air, earth, and water; the four qualities were hot, cold, moist, and dry; and the four humors were phlegm, black bile, yellow bile, and blood. From these ideological building stones a highly complex system of pathology developed; from it an involved system of treatment originated. In essence the pract.i.tioner of the humoral school attempted to restore the naturally harmonious balance of elements, qualities, and humors that had broken down and caused disease or pain.

The seventeenth-century, however, witnessed in medicine the trend, manifest then in so many fields of thought, away from an uncritical acceptance of the authority of the past. It also saw a defiant denial of ancient authority among those more radically inclined, such as the disciples of the sixteenth-century alchemist and physician, Paracelsus.

Although some of his practices and teachings were based on the supernatural, Paracelsus stressed observation and the avoidance of a mere system of book-learning.

Practice lagged behind new scientific theory in medicine but Virginia must have felt at least the reverberations caused by the clash of the ancient and the new.

An important new school of medical theory was the iatrophysical or iatromathematical (_iatros_ from the Greek--physician). This medical theory--as is the case with many scientific theories-was borrowed from another branch of science. The seventeenth century, the age of Isaac Newton, Galileo Galilei, Gottfried Wilhelm von Leibnitz, Rene Descartes, and other giants of physical science, was a period of remarkable progress in the field of physics. It is not surprising then that theorists in the field of medicine, noting the truths discovered by conceiving of nature as a great machine functioning according to laws that could be expressed in mathematical terms, should have attempted to explain the human body as a machine.

William Harvey (1578-1657), whose name looms great in the history of seventeenth-century medicine, explained the circulation of the blood in mechanical terminology. To Harvey, working under the influence of the great physicists, the heart was a mechanical force pump and the blood was a.n.a.logous to other fluids in motion. How many physicians, practicing in the same intellectual environment as this Englishman, must have carried the mechanical a.n.a.logy to the extent of thinking of the teeth as scissors, the lungs as bellows, the stomach as a flask, and the viscera as a sieve?

The iatrochemical school existed alongside the iatrophysical. Whereas the iatrophysical thought primarily in terms of matter, forces, and motions, the iatrochemical thought chemical relationships were fundamental. One of the founders of this school, the Dutch scientist Sylvius (1614-72), explained diseases chemically (an approach not completely unlike the humoral of Galen) and treated them on the basis of a supposed chemical reaction between drug and disease. Another leading figure in the iatrochemical school, Thomas Willis (1621-75), was an Englishman. These two advocated the use of drugs at a time when their respective nations were developing great colonial empires rich with the raw materials of pharmacology.

However, it would be an error to think of the medicine of the period, either European or Virginian, only in terms of rational or scientific theories. Treatment was too often based on magic, folklore, and superst.i.tion. There were physicians relying upon alchemy and astrology; the Royal Touch was held efficacious; and in the _materia medica_ of the period were such substances as foxes' lungs, oils of wolves, and Irish whiskey. Nor should it be forgotten that many of the sick never saw a medical man but relied upon self-treatment.

With theories from the ancient authorities and from experimenting scientists to draw upon, the practicing physicians could deduce therapeutic techniques or justify curative measures, but the emphasis on theory brought with it the danger of ignoring experience and abandoning empirical solutions. Aware that many of his fellow physicians tended to overemphasize theory Thomas Sydenham (1624-89), who received his doctorate of medicine from Cambridge University, recommended personal experience drawn from close observation. He scoffed at physicians who learned medicine in books or laboratory, and never at the bedside. His study of epidemics, his emphasis on geography and climate as casual factors in the genesis of disease, make this Englishman's views and practices especially relevant to the medical history of Virginia where geography and climate did play such important roles in the life of the colony.

The history of surgeons and surgery during the century is less distinguished than that of the physician and his practice. Surgery produced no individuals of the stature and significance of Sydenham nor any revolutionary theories as important as Harvey's. Dissections were made but the knowledge acquired was not applied; amputation was common but not always necessary or effective.

Battle wounds and injuries lay in the province of the surgeon. While the surgeon was primarily concerned with the military, using mechanical force (cutting, tying, setting, and puncturing) in his treatment of body wounds and injuries, physicians on the Continent and in England also filled these functions. For example, physicians in Italy sometimes performed surgical operations they considered worthy of their dignified positions, and in England the licensed physician could practice surgery. On the other hand, surgeons licensed by Oxford University were bound not to practice medicine. Both in France and in England surgeons and barbers held membership in the same guild or corporation, and physicians considered them of inferior social status. The American frontier tended to reduce such professional and social distinctions.

In Europe and England, where medical education was inst.i.tutionalized to a far greater extent than in colonial Virginia, education explains much of the difference in social status between physician and surgeon. The surgeon learned by apprenticeship to an experienced member of his guild while the physician had to meet certain educational and professional requirements, depending upon local or national law. The best medical education of the period could be had at the great centers of Leyden, Paris, and Montpellier. Cambridge and Oxford also offered a degree in medicine.

Englishmen preferred to study medicine abroad--according to a recent study made by Phyllis Allen and printed in the _Journal of the History of Medicine and Allied Sciences_--because a better education could be obtained there in the same number of years. The Doctorate of Medicine required fourteen years of undergraduate and post-graduate study at Oxford; the Cambridge requirement was similar. Despite reforms during the seventeenth century, education at these universities remained dogmatic and cla.s.sical. Students usually found their studies dull and their social life stimulating. The more enterprising students could find the new ideas of the period in books not required in their course of study. Cambridge, Oxford, and the Royal College of Physicians all licensed physicians who had survived their education, met certain professional requirements, and pa.s.sed an examination.

That physicians in England did possess a high social status as well as more extensive formal education is evidenced by a precaution taken by the Virginia Company, to avoid causing displeasure among men of rank, in preparing letters patent. The Company requested of the College of Heralds, in 1609, the setting "in order" of the names of n.o.blemen, knights, and Doctors of Divinity, Law, and Medicine so that their "several worths and degrees" might be recognized when their names were inserted on the patents. Surgeons received no mention.

On the other hand, physicians and surgeons in England might well have come from similar social backgrounds and even on occasions from the same families. When there were three or four sons in the family of a country gentleman, he might have followed the custom of keeping the eldest at home to manage and eventually inherit the estate. The second, then, would be sent to one of the universities in order to follow a profession such as that of physician, lawyer, or clergyman. The third might be apprenticed to an apothecary, surgeon, or a skilled craftsman.

This practice should be borne in mind when former medical apprentices are found in high offices in Virginia; their origins were not always humble.

Although the physician enjoyed the greatest social and professional prestige, he received the most verbal abuse and criticism. Perhaps the most damaging and galling satire of the century flowed from the pen of the French dramatist, Moliere, who had a medical student--not completely fict.i.tious--swear always to accept the p.r.o.nouncements of his oldest physician-colleague, and always to treat by purgation, using clysters (enemas), phlebotomy (bloodletting), and emetics (vomitives).

These three curative measures followed the best Galenic technique: releasing corrupting humors from the body. Moliere's _Le Malade Imaginaire_ confronted the audience with constant purgings and bleedings, and the caricature was not excessive.

The diseases of the century did not allow for the inadequacies of the physician, and imparted a grim note of realism to the satire of the dramatist. Infant mortality was high and the life expectancy low.

Hardly a household escaped the tragedy of death of the young and the robust; historians have sensed the influence omnipresent death had upon the att.i.tudes and aspirations of the European and American of earlier centuries. School children today learn of such a dramatic killer as the bubonic plague, but even its terrible ravages do not dwarf the toll of ague (malaria), smallpox, typhoid and typhus, diphtheria, respiratory disorders, scurvy, beriberi, and flux (dysentery) in the colonial period.

England, and especially London with its surrounding marshes, suffered acutely with the ague during the century. Englishmen arriving in the New World were well aware of the dangers of this disease and made some effort to avoid the bad air, and the low and damp places. In 1658 the ague took such a toll that a contemporary described the whole island of Britain as a monstrous public hospital. Unfortunately, Thomas Sydenham, whose prestige in England was great and whose works on fevers were influential, paid scant tribute to cinchona bark (quinine) which was known but thought of, even by Sydenham, as only an alleged curative offering too radical a challenge to current techniques. According to humoral doctrine, fever demanded a purging, not the intake of additional substances.

Unfortunately, public hygiene and sanitation enlisted few adherents.

Epidemics of the seventeenth century have been judged the most severe in history. In Italy physicians ahead of their times proposed the draining of marshes and pools of stagnant water, and recommended the isolation of persons with contagious diseases. But it was the great London fire of 1666 that rid that city of its infested and infected places, not an enlightened munic.i.p.ality.

Therefore Virginia, a colony of seventeenth-century Europe, started life burdened with a heritage of deadly and widespread disease and inadequate medicine. Not only did the ships that brought the settlers to Jamestown Island bring surgeons and medical supplies but also medical problems frequently more serious than the men and supplies could cope with.

The European or Englishman, however, did not originate the practice of medicine in Virginia for the Indian had had to struggle with the problems of disease and injury long before the seventeenth century.

INDIANS AND THEIR MEDICINE

Seventeenth-century Americans found the medical practices of the Indians interesting enough to include descriptions of them in their accounts of the New World. The att.i.tude of the authors of these early observations is a mixture of curiosity, wonder, and--on occasion--admiration.

Henry Spelman, one of the early colonists, wrote of Jamestown and Virginia as they were in 1609 and 1610. He described the manner of visiting with the sick among the Indians. According to Spelman, the "preest" laid the sick Indian upon a mat and, sitting down beside him, placed a bowl of water and a rattle between them. Taking the water into his mouth and spraying it over the Indian, the priest then began to beat his chest and make noises with the rattle. Rising, he shook the rattle over all of his patient's body, rubbed the distressed parts with his hands, and then sprinkled water over him again.

Like the colonist, the Indian tried to draw out blood or other matter from the sick or wounded person. The method often used for releasing the ill humor from a painful joint or limb must have caused considerable suffering but may have offered certain advantages in preventing fatal infection. If the affected part could bear it, the Indian thrust a smoldering pointed stick deep into the sore place and kept it there until the excess matter could drain off. Another technique for burning and opening had a small cone of slowly burning wood inserted in the distressed place, "letting it burn out upon the part, which makes a running sore effectually."

Still another method for treating a wound was for the priest to gash open the wound with a small bit of flint, suck the blood and other matter from it, and finally apply to it the powder of a root. A colonist in describing the practice wrote that "they have many professed phisitions, who with their charmes and rattels, with an infernall rowt of words and actions, will seeme to sucke their inwarde griefe from their navels or their grieved places." Judging by other accounts written during the century concerning Indian medicine, the powdered root may well have been sa.s.safras, of which there was an abundance in the Jamestown area. The priest dried the root in the embers of a fire, sc.r.a.ped off the outer bark, powdered it, and bound the wound after applying the powder.

Not only did the native American resort to a crude form of bloodletting but he practiced sweating as well--which was also common to seventeenth-century European medical practice. In Captain John Smith's description of Virginia it was noted that when troubled with "dropsies, swellings, aches, and such like diseases" the cure was to build a stove "in the form of a dovehouse with mats, so close that a fewe coales therein covered with a pot, will make the pacient sweate extreamely."

Before lighting his stove, the Indian covered his sweating place with bark so close that no air could enter. When he began to sweat profusely, the sick Indian dashed out from his heated shelter and into a nearby creek, sea, or river. An Englishman commented that after returning to his hut again he "either recover[s] or give[s] up the ghost."

The Indians, like Moliere's stage physician, believed in the value of the purge. Every spring they deliberately made themselves sick with drinking the juices of a medicinal root. The dosage purged them so thoroughly that they did not recover until three or four days later.

The Indians also ate green corn in the spring to work the same effect.

The Indian medicine man, like his European counterpart, frequently dispensed medicines or drugs. As has been the custom among many men in the medical profession, the medicine man would not reveal the secrets of his medicines. "Made very knowing in the hidden qualities of plants and other natural things," he considered it a part of the obligations of his priesthood to conceal the information from all but those who were to succeed him. On the other hand, the Indian priest showed his concern for the health of his people--and the similarity of his att.i.tude to that of present day practices--by making an exception to his canon of secrecy in the case of drugs needed in emergencies arising on a hunting trip and during travel.

According to one early eighteenth-century history of Virginia, the Indian in choosing raw materials for drugs preferred roots and barks of trees to the leaves of plants or trees. If the drug were to be taken internally it was mixed with water; when juices were to be applied externally they were left natural unless water was necessary for moistening. Whatever the drug and however utilized, the Indian called it _wisoccan_ or _wighsacan_, for this term was not a specific herb, as some of the earlier settlers thought, but a general term.

Besides sa.s.safras, medicinal roots and barks, the Indian believed in beneficial effects of a kind of clay called _wapeig_. The clay, in the opinion of the Indians, cured sores and wounds; an English settler marvelled to find in use "a strange kind of earth, the vertue whereof I know not; but the Indians eate it for physicke, alleaging that it cureth the sicknesse and paine of the belly." Insomuch as the Indian priest preferred to keep his professional secrets, the colonist was unlikely ever to learn the "vertue" of the clay.

If the Indian medicine man had not believed that his G.o.ds would be displeased--or his prestige lowered--by revealing the nature of the _wisoccan_ he prescribed, it would have been possible for the early Virginians to have drawn upon the Indian knowledge of, and experience with, the simples and therapies of the New World. (Perhaps the "vertues" of the clay would have cured the "paines" of the Jamestown bellies.) As it was, the settlers make little mention of a reliance upon the Indians for medical a.s.sistance.

CHAPTER TWO

Disease and The Critical Years At Jamestown