SURGICAL PRACTICE

Much has been made of the lower status held by the surgeon as compared with that of the physician--during the seventeenth century. On the continent and in England, at this period, membership in separate guilds in part distinguished doctor and surgeon; in England, after 1540 and until 1745, surgeons held common membership with barbers in one corporate organization. In America, historians agree, the differences based on specialization of practice between surgeons and physicians soon tended to disappear, a superior education often being the only attribute or function of a physician not shared by the surgeon. Barbers held a unique position, but in performing phlebotomies, a minor operation, they retained a.s.sociations with health and disease. Both barber and surgeon shared a certain expertness with tools, as they do today.

Evidence abounds in the earlier records that the scarcity of medical men may have compelled surgeons in Virginia to practice internal medicine: surgeons prescribed medicine with the same frequency as doctors. The surgeons, however, did not abandon the treatment of wounds, fractures, and dislocations; notes on amputations during the century also exist.

Nor is it reasonable to a.s.sume that the isolated physician of the Virginia countryside would always insist upon referring a patient to a surgeon. Dr. Francis Haddon, who had a large practice in York County, Virginia, and who is not identified as a surgeon, left recorded the course of treatment for an amputation--cordials, a purge, ointments, and bloodletting--and a dismembering saw, as well.

Other recorded surgical treatments include care of dislocated shoulders; wounds in various parts of the body; sores of the feet and legs; cancerous ulcers in the instep; ulcers of the throat, and dueling wounds. One of the most unusual surgical measures of the period was the application of weapon salve for battle wounds; the salve was applied to weapon, not wound.

Surgery has long been a.s.sociated with the military, and much of the outstanding surgical work done in Europe during the fifteenth and sixteenth centuries was performed by military surgeons. Ambroise Pare (c. 1510-1590), remembered especially for the use of the ligature in amputations and the abandonment of the burning-oil treatment of wounds, held a position as a surgeon for the French army. Other surgeons of the period contributed to the improvement of medical practice by enlightened measures of quarantine to prevent contagious diseases from decimating armies.

Insomuch as the first settlers at Jamestown greatly feared attack from Indians and Spaniards and because the initial landings had the character of a military expedition, it is not surprising that the first two medical men to arrive, Will Wilkinson and Thomas Wotton, were surgeons. Captain John Smith on three occasions, it is to be remembered, emphasized the importance of the surgeon to pioneer settlers and explorers in the New World. When injured by the stingray in 1608, Smith's first thought was of his need for a surgeon and "chirurgery"; so the success of physician Russell's soothing oils came as a pleasant surprise. On a subsequent expedition he included the surgeon, Anthony Bagnall, rather than Dr. Russell, to treat the stingray wound; and in 1609 when he received the powder burn, he left Virginia "seeing there was neither chirurgeon nor chirurgery in the fort to cure his hurt."

Throughout the century surgeons rendered services to colonists engaged in fighting with, or defending themselves against, the Indians. When the Indian ma.s.sacre of 1622 occurred, costing the lives of more than 350 colonists in the settlements, it is possible that the two surgeons who sailed to Virginia with Dr. Pott in 1621 gave a.s.sistance to the wounded. In 1644, when a retaliatory attack on the Indians was made by the settlers because of a recent ma.s.sacre, the General a.s.sembly provided for a surgeon-general to accompany the militia, at public expense.

Again, later in the century, the General a.s.sembly gave evidence of recognizing the importance of surgical care for soldiers when it voted for supplying a surgeon with "a convenient supply of medicines & salves, etc. to the value of five pounds sterling for every hundred men" to each of eight forts planned to protect the settlements against Indian attacks. Throughout the last half of the century references were made to surgeons ministering to companies of soldiers or to various garrisons and forts. Judging by the consistent employment of surgeons for military duties, it would appear that the profession of surgeon during the century was much more intimately a.s.sociated with the military than was that of physician. The relationship between the surgeon and the military is similar to the early one between civil engineer and the army in Europe.

HYGIENE

The restoration of the patient to health is not the only important aspect of medical practice; the prevention of illness is also vital to the health of a community. Much more attention is given to preventive medicine in the twentieth century than in the seventeenth, but the value of cleanliness, fresh air, and quarantine was known. Hygienic measures taken, or recommendations made, by public authorities make clear the fact that the cause of disease was not commonly thought to be supernatural by the educated and responsible. Contemporary accounts make known the widespread disapproval of foul ships, crowded quarters, marshy land, stagnant air, bad food and drink, excessive eating, and exposure to a hot sun.

Lord De la Warr laid down regulations for Jamestown designed to eliminate the dangers of dirty wash water ("no ... water or suds of fowle cloathes or kettle, pot, or pan ... within twenty foote of the olde well"); and of contamination from sewage ("nor shall any one aforesaid, within lesse than a quarter of one mile from the pallisadoes, dare to doe the necessities of nature"). The order argued that if the inhabitants did not separate themselves at least a quarter of one mile from the palisaded living area that "the whole fort may be choaked, and poisoned with ill aires and so corrupt." The colonists by the same order had to keep their own houses and the street before both sweet and clean.

Any doubt that an awareness existed of the dangers of infection by contact, at least from diseases with observable bodily symptoms, should be dispelled by the quarantine measures taken by the colonel and commander of Northampton County in 1667 during an epidemic of smallpox.

He ordered that no member of a family inflicted with the disease should leave his house until thirty days after the outbreak lest the disease be spread by infection "like the plague of leprosy." Enlightened authorities in Europe took similar precautions.

CHAPTER FOUR

Education, Women, Churchmen, and The Law

THE PLACE OF WOMEN IN MEDICINE

Women played a part in treating and caring for the ill and distressed in a number of ways during the century. A few women dispensed medicine and enjoyed reputations as doctors, but it was in the field of obstetrics and as midwives that they made their most important contributions. Although women did what might be described generally as nursing, their contribution in this area was relatively insignificant when compared with the importance of the female nurse today. Any discussion of the place of women in seventeenth-century medicine should note the relationship between women, witchcraft, and medicine.

Although the references leave no doubt of the existence of female doctors and dispensers of medicines, the mention of them is infrequent.

Mrs. Mary Seal, the widow of a Dr. Power, for example, administered medicine to Richard Dunbar in 1700. The wife of Edward Good was sought out in 1678 to cure a head sore and another "doctress" impressed the Reverend John Clayton, who had some insights into medical science himself, with her ability to cure the bite of a rattlesnake by using the drug dittany. In the same year that Good's wife was sought to treat the head sore, a Mrs. Grendon dispensed medicine to an individual who had injured his eyes in a fight. The exact status of these women, however, is unknown; it is highly unlikely that the female practicing medicine enjoyed the professional standing of a Dr. Pott or a Dr.

Bohun--an old female slave also appears in the record as a doctor.

With medical knowledge limited and antisepsis unknown, the expectant mother of the seventeenth century fared better with a midwife than she would have with a physician. The midwife, whose training consisted of experience and apprenticeship at best, allowed the birth to be as free from human interference as possible and did not do a pre-delivery infection-producing examination.

Both the fees and the prestige of the midwife, judging by contemporary records from other colonies, were high. Unfortunately, the early Virginia sources throw little light on the activities of the midwife in this colony. Among the scattered references from Virginia records are found charges of 100 pounds of tobacco for the service of a midwife; the presence of two midwives a.s.sisted by two nurses and other women at a single birth; the payment of twelve hens for obstetrical services; and the delivery of a b.a.s.t.a.r.d child by a midwife.

Nursing duties were probably taken on by both men and women in addition to their regular occupations. The duties consisted not only of tending the sick--and there is no reason to believe this was done under the supervision of a physician--but also of burying the dead and arranging the funerals. While the patient lived, the nurse prepared food, washed linen, and did other ch.o.r.es to make the patient comfortable. When death came, the nurse was "the good woman who shall dress me and put me in my coffin," and who provided "entertainment of those that came to bury him with 3 vollys of shott & diging his grave with the trouble of his funeral included."

The medical ramifications of witchcraft have been suggested. One of the most interesting Virginia court cases of the century had as its princ.i.p.al subject a woman accused of the power to cause sickness. In an age when weapon salve was wiped on the weapon and not the wound, and when astrology was intimately a.s.sociated with the practice of medicine, it is not surprising to find, also, the witch and her power to cause disease. Goodwife Wright stood accused of such powers in the colony's general court on September 11, 1626.

Goodwife Wright had caused, according to her accusers, the illness of a husband, wife, and child out of a spirit of revenge; and she was able to prophesy deaths as well. The details of the case brought against this woman accused of witchcraft reveal the more bizarre medical practices of the time. Goodwife Wright expected to serve as the midwife but the expectant mother refused to employ her upon learning that Wright was left-handed. Soon after affronting Wright in such a manner, the mother complained that her breast "grew dangerouslie sore" and her husband and child both fell sick within a few weeks. With circ.u.mstantial evidence of this kind, suspicion had little difficulty in linking the midwife with the sicknesses.

Testimony revealed that on another occasion she had used her powers to counter the actions of another suspected witch. Having been informed that the other witch was causing the sickness, Wright had the ill person throw a red-hot horseshoe into her own urine. The result, according to witnesses was that the offending witch was "sick at harte"

as long as the horseshoe was hot, and the sick person well when it had cooled.

CHURCHMEN AND MEDICINE

Medicine was a.s.sociated in many minds not only with the powers of evil but also with the forces for good. The clergyman in colonial America often practiced medicine, and the layman in some localities of Virginia could turn to the local parson for medical a.s.sistance.

Throughout the early Christian era and the medieval period, medicine and religion had had a close relationship. The New Testament had numerous references to the healing of the sick by spiritual means, and a casual relationship between sin and physical affliction had been a.s.sumed by many persons for centuries before the seventeenth. The hand of G.o.d was still seen by many in physical phenomena, whether disease or the flight of a comet. Not only was there a supernatural relationship seen between the G.o.d of the church and disease, but also a natural one between medicine and the church clergy, for they had staffed the medical schools for centuries. It is not surprising, then, that the parson-physician was no stranger to the Virginia colony.

As early as 1619, Robert Pawlett, known to be a preacher, surgeon, and physician, came to Virginia. He was followed by other parson-physicians in Virginia and in other colonies. As late as the end of the eighteenth century, the wife of George Washington called on the Reverend Greene, M.D., for medical advice.

Among the most interesting in this long tradition of ministers who practiced medicine is the Reverend John Clayton whose activities have been noted. Other persons residing in Virginia and combining the role of clergyman with a considerable interest in medicine were Nathaniel Eaton, who had a degree in medicine, and John Banister who was an active naturalist. As a naturalist, he made an important study of the plants of Virginia (_Catalogue of Virginia Plants_) which added to the literature available for the dispenser of medicinal drugs. One of the founders of Presbyterianism in America, the Reverend Francis Makemie, who came to America in 1681 and died in Accomack County, Virginia, was described as a preacher, a doctor of medicine, a merchant, an attorney--and a disturber of government by the governor of New York.

LAW AND MEDICINE

Although the Crown did not follow the lead of the Company in providing care for the sick and unsheltered, the authorities after 1624 did have the state take an interest in medicine to the extent of pa.s.sing laws dealing with medical problems and situations. These laws were primarily concerned with the collection and charging of fees, but also provided for the censure of the physician or surgeon neglecting his patient.

On four occasions during the century the a.s.sembly attempted to regulate the excessive and immoderate rates of physicians and surgeons. The chief example used to convey the injustice of fees for visits and drugs was that many colonists preferred to allow their servants to hazard a recovery than to call a medical man. Although an inhumane att.i.tude, the colonists reasoned that the physician or surgeon would charge more than the purchase price of the servant.

The act of 1657-58 reveals this att.i.tude and throws some light on the medical practice of the century. (Similar acts had been pa.s.sed in 1639 and in 1645 and would be pa.s.sed in 1661-62.) By the will of the a.s.sembly, the layman had the right to bring the physician or surgeon into court if the charge for "paines, druggs or medicines" was thought to be unreasonable. The surgeon or physician had in court to declare under oath the true value of drugs and medicines administered, and then the court decided the just compensation.

The law went on to declare that:

Where it shall be sufficiently proved in any of the said courts that a phisitian or chirurgeon hath neglected his patient, or that he hath refused (being thereunto required) his helpe and a.s.sistance to any person or persons in sicknes or extremitie, that the said phisitian or chirurgeon shall be censured by the court for such his neglect or refusall.

The legislators also gave the physician or surgeon protection by providing that their accounts could be pleaded against and recovered from the estate of a deceased patient--suggesting that patients were not prompt enough in paying their bills (or perhaps did not survive treatment long enough to do so). Court records show that the medical men often took advantage of this provision for collection.

A measure enacted in 1692 indicated a more sympathetic att.i.tude on the part of the legislators toward the physicians and surgeons. While in the earlier acts preventing exorbitant fees the court had been ordered to decide upon just compensation, the later act allowed the physician or surgeon to charge whatever he declared under oath in court to be just for medicines. Nor did the act of 1692 make reference to "rigorous though unskilful" or "griping and avaricious" physicians and surgeons as had the earlier laws.

References by the colonial a.s.sembly to exorbitant fees were not without a basis in fact. The conventional charge for the physician's visit, according to Dr. Wyndham Blanton, was thirty-five to fifty pounds of tobacco and on occasions the physician, or surgeon, must have exceeded this fee. An approximate estimate of the value of these visits in present-day terms would be between twenty and twenty-five dollars. The cost of medical care was even greater when an unusually large amount of drugs was dispensed. It is not surprising that many masters did not provide the services of a physician or surgeon for their servants; nor that medical attention was given by persons without professional status. Although these charges seem high, it must be taken into account that because of the great distances between communities and even between homes, the physician or surgeon could make only a small number of visits each week.

County records give many examples of the fees of physicians and surgeons. Of 145 medical bills entered in the York County records between 1637 and 1700, the average bill was for 752 pounds of tobacco, or a little less than one laborer could produce in a year. Other fees were: 400 pounds of tobacco for six visits; 300 pounds of tobacco for three visits and five days attendance; 1,000 pounds of tobacco for twenty days of attendance "going ounce a weeke ... being fourteen miles"; and 600 pounds for twelve daily visits. At the time these charges were made, tobacco brought between two and three cents per pound, or the equivalent of approximately fifty cents today.

The surgeon administering the clyster or phlebotomy, those commonly resorted to "remedies," could be expected to charge thirty pounds of tobacco for the first and twenty pounds for the second. The surgeon, and the physician, often charged from twenty to fifty pounds of tobacco for a drug prescription.

In 1658, Dr. John Clulo presented a bill to John Gosling in York County which he itemized as follows (in pounds of tobacco):

For 2 glisters [clysters] 040 For a glister 030 For a potion cord.[ial] 036 For an astringent potion 035 For my visitts paines & attendance ...

For a glistere 030 For an astringent potion 035 For a cord. astringent bole 036 For a bole as before 036 For a purging potion 050 For a [cordial julep] 120 For a potion as before 036

Not only does Dr. Clulo's bill give examples of fees charged, but it supports the contention that the substance of medical treatment during the century was bloodletting, purging, and prescribing drugs.

Although the physicians of colonial Virginia did charge well for their services, it should be noted that they were in demand. Their patients, this would indicate, considered their services of great value, any subsequent protests notwithstanding.