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