Medicine in Virginia, 1607-1699 Part 4

A study of the drugs in use and the occasions of their utilization makes manifest the great part that freeing the body from corrupting matter played in the treatment of disease. The theorists and clinical physicians of the century placed such faith in the humoral doctrine that, on the basis of this predilection, much of the opposition to cinchona, or quinine, in a period greatly troubled by malaria, can be explained. Cinchona, discovered in Spanish America and known in seventeenth-century Europe, had demonstrable effects in the treatment of malaria but, because it was an additive rather than a purgative, physicians rejected it on theoretical grounds. Its eventual acceptance later revolutionized drug therapeutics, but this revolution did not affect seventeenth-century Virginia.

The emphasis that the contemporary medical men placed upon the purging of the body--the vomiting, sweating, purgings of the bowels, the draining, and the bleeding--cannot be considered irrational or quaint.

In the light of observation and common sense, to purge seemed not only reasonable and natural but in accord with orthodox doctrine as well.

Observation revealed that illness was frequently accompanied by an excess of fluid or matter in the body, as in the case of colds, respiratory disorders, swollen joints, diarrheas, or the skin eruptions that accompanied such epidemic diseases as the plague or smallpox.

Common sense dictated a freeing of the body of the corrupt or corrupting matter; drugs were a means to this end.

The use of drugs for vomiting, sweating, and other forms of purging seems excessive in the light of present-day medical knowledge, and at least one seventeenth-century Virginia student of medicine also found such use of drugs by his contemporaries open to criticism. In the opinion of the Reverend John Clayton, Virginia doctors were so p.r.o.ne to a.s.sociate all drugs with vomiting or other forms of purging that they even thought of aromatic spirits as an inferior "vomitive." He concluded that these physicians would purge violently even for an aching finger: "they immediately [upon examining the patients] give three or four spoonfuls [of _crocus metallorum_] ... then perhaps purge them with fifteen or twenty grains of the rosin of jalap, afterwards sweat them with Venice treacle, powder of snakeroot, or Gascoin's Powder; and when these fail _conclamatum est_."

The list of drugs used was extensive and each drug had a considerable literature written about it explaining the various sicknesses and disorders for which it was a curative. Libraries of the Virginia physicians and of the well-to-do laymen usually included a volume or two on the use of drugs. Among the most popular plants, roots, and other natural products were snakeroot, dittany, senna, alum, sweet gums, and tobacco.

Dittany drove worms out of the body and would also produce sweat (sweating being another popular method of purging the body of disease-producing matter). The juices of the fever or ague-root in beer or water "purgeth downward with some violence ... in powder ... it only moveth sweat." (Following Galen's system of cla.s.sifying by taste, this root was bitter, therefore thought dry. The physician would administer such a drying agent when attempting to reduce excess moistness in the body--and thus restore normal body balance, in accord with contemporary humoral theory.) Snakeroot, another of the popular therapeutics, increased the output of urine and of perspiration; black snakeroot, remedying rheumatism, gout, and amenorrhea, found such wide usage during the last half of the seventeenth century that its price per pound in Virginia on one occasion rose from ten shillings to three pounds sterling. Although King James I of England saw much danger in tobacco, others among his subjects attributed phenomenal curative properties to it. One late sixteenth-century commentator on America recommended it as a purge for superfluous phlegm; and smokers believed it functioned as an antidote for poisons, as an expellant for "sour"

humors, and as a healer of wounds. Some doctors maintained that it would heal gout and the ague, act as a stimulant and appet.i.te depressant, and counteract drunkenness.

The full significance of these drugs in the medicine of the period can be better appreciated by reference to a prescription for their use, in this instance a remedy for rickets, thought typical by historian Thomas Jefferson Wertenbaker:

Dip the child in the morning, head foremost in cold water, don't dress it immediately, but let it be made warm in the cradle & sweat at least half an hour moderately. Do this 3 mornings ... & if one or both feet are cold while other parts sweat let a little blood be taken out of the feet the 2nd morning.... Before the dips of the child give it some snakeroot and saffern steep'd in rum & water, give this immediately before diping and after you have dipt the child 3 mornings. Give it several times a day the following syrup made of comfry, hartshorn, red roses, hog-brake roots, knot-gra.s.s, petty-moral roots; sweeten the syrup with melosses.

But drug therapy was not always as simple as that recommended for rickets, although the evidence is that in Virginia the high cost of importing the rarer substances inclined local physicians toward the less elaborate compounds. Venice treacle, recommended by the Reverend Clayton's imaginary purge enthusiast consisted of vipers, white wine, opium, licorice, red roses, St. John's wort, and at least a half-dozen other ingredients.

Because their use was so extensive in Europe and because many brought a good price, any discussion of drugs in seventeenth-century Virginia should take note of the efforts in the colony to find locally the raw materials for the drugs both for use in Virginia and for export. The London Company actively supported a program to develop the drug resources of the New World, and the hope of finding them had originally been one of the incentives for the colonization of Virginia. Even as early as the sixteenth century, authors and promoters in England of the American venture had held up the promise of a profitable trade in drugs--sa.s.safras, for example--as a stimulus for exploration and colonization. Sa.s.safras had market value as it was widely used in cases of dysentery, skin diseases, and as a stimulant and astringent; French warships searching for loot off the sh.o.r.es of the New World had often made it the cargo when richer prizes were not to be had.

Like gold, sa.s.safras diverted labor during the crucial early period at Jamestown from the tasks of building and provisioning. Sailors and settlers, both, took time off to load the ships with the drug which would bring a good price in England.

The belief that the exporting of drugs would prove profitable for the colony in Virginia and for the Company may explain why two apothecaries accompanied the second group of immigrants who arrived in 1608. Someone had to search out and identify possible drugs, and a layman could not be expected to perform a task requiring such specialized knowledge. The apothecaries could further serve the new settlement by helping to supply its medicinal needs.

Before the drug trade in Virginia could be developed, and at the same time adapted to the over-all needs of the colony, attention had to be given to the use of drugs to meet the immediate needs of the settlers.

Dr. Bohun, who had brought medical supplies in 1610 and soon found them exhausted, turned resourcefully to an investigation of indigenous minerals and plants. He investigated earths, gums, plants, and fruits.

A white clay proved useful in treating the fevers (the clay of the Indians used for "sicknesse and paine of the belly"?); the fruits of a tree similar to the "mirtle" helped the doctor to face the epidemics of dysentery.

The colonists also needed a wine which could be produced cheaply and locally. Many of them, accustomed to beer and wine regularly, complained of having to rely upon water as a liquid refresher.

According to one of their number, more died in Virginia of the "disease of their minds than of their body ... and by not knowing they shall drink water here." One enterprising alchemist and chemist offered to sell the London Company a solution for this problem: the formula of an artificial wine to be made from Virginia vegetables.

After the colony seemed no longer in danger of perishing from its own sicknesses--or going mad from having to drink water--the Company urged the settlers to develop an active trade in medicinal plants, in order to help cure the diseases of England and the financial ills of the Company. The London Company, in a carefully organized memorandum, advised the colonists what plants had export value and how these plants should be prepared for export:

1. Small sa.s.safras rootes to be drawen in the winter and dryed and none to be medled with in the sommer, and it is worthe 50 lb. and better per tonne.

2. Poccone to be gotten from the Indians and put up in caske is worthe per tonne 11 lb. 4. Galbrand groweth like fennell in fashion, and there is greatest stoare of it in Warriscoes Country, where they cut walnut trees leaste. You must cut it downe in Maye or June, and beinge downe it is to be cut into small peeces, and brused and pressed in your small presses, the juice thereof is to be saved and put into casks, which wilbe worthe here per tonne, 100 lb. at leasts. 5. Sarsapilla is a roote that runneth within the grounds like unto licoras, which beareth a small rounde leafe close by the grounds, which being founde the roote is to be pulled up and dryed and bounde up in bundles like f.a.ggotts, this is to be done towards the ende of sommer before the leafe fall from the stalk; and it is worthe here per tonne, 200 lb. 6. Wallnutt oyle is worth here 30 lb. per tonne, and the like is chestnutt oyle and chec.h.i.n.kamyne oyle.

The Company's plan for the gathering, storing, and shipping of drugs was supplemented by a project indicating foresight and an early form of experimental research for the development of new products. In 1621 it planned thorough tests of an earth sent from Virginia in order to determine its value as a cure for the flux. In addition, the Company planned to test all sweet gums, roots, woods, and berries submitted by the colonists in order to ascertain their medicinal values.

In regard to the sale and dispensing of drugs in Virginia, whether found locally or imported, frequent references to the apothecary supplies and utensils in the possession of Virginia physicians lead to the conclusion that they were usually their own druggists.

As has been noted, the sale and dispensing of drugs usually culminated in their use--in accordance with the theory of the period--as means of purging the body. Drugs, however, did not have a monopoly in this greatly emphasized aspect of medical practice because the clyster (purging of the bowels, or enema) and phlebotomy (bleeding of the vein) could be used as well. These two methods might be cla.s.sified as mechanical in nature as contrasted with the essentially chemical action of the drugs.

Moliere, in his seventeenth-century satires on the European medical profession, ridicules the excessive use of the clyster. The popularity of the phlebotomy then is attested to by the notoriety of this technique today. (Rare is the schoolboy who does not think that George Washington was bled to death.) There is no reason to doubt that the clyster and phlebotomy enjoyed as wide usage in colonial Virginia as in Europe, but the evidence surviving to prove this a.s.sumption is slight.

Dr. Blanton, the historian of medicine, could find only meager references to the use of clyster (or glyster) and he sums them up as follows:

Among the effects of Nathaniel Hill was '1 old syringe.' In York County records we find that Thomas Whitehead in 1660 paid Edmond Smith for '2 glysters.' George Wale's account to the estate of Thomas Baxter in 1658 included a similar charge. George Light in 1657 paid Dr. Mode fifty pounds of tobacco for 'a glister and administering.' John Clulo, Francis Haddon and William Lee each presented bills for similar services.

The survival of such meager evidence for what was probably a common practice indicates the difficulties confronting the historian of medicine. Nor has Dr. Blanton been able to find, as a result of his research, any more evidence of phlebotomy although, again, its utilization must have been widespread. Blanton sums up his evidence for bleeding as follows:

Dr. Mode's bill to George Light includes 'a phlebothany to Jno Simonds' and 'a phlebothany to yr mayd.' Dr. Henry Power twice bled Thomas Cowell of York County in 1680, and Patrick Napier twice phlebotomized 'Allen Jarves, deceased, in the cure of a cancer of his mouth.' Colonel Daniel Parke in 1665 rendered John Horsington a bill for 'lettinge blood' from his servant; and we find Dr.

Jeremiah Rawlins and Francis Haddon engaging in the same practice.

The horoscope often determined the proper time for bleeding and notations have been found in an early American Bible recommending the days to, and not to, bleed. Although medicine today looks askance at astrological medicine and bloodletting, it remains difficult to explain the widespread popularity of such practices unless the patients enjoyed some beneficial results, psychological or physical.

Drug therapeutics, clysters, and bloodletting did by no means exhaust the seventeenth-century physician's treatments and remedies. The works of European painters of the century remind us of uroscopy or urine examination. One of the outstanding paintings ill.u.s.trating the technique is by artist Gerard Dou who has the young doctor intently examining the urine flask while taking the pulse of a pretty young lady. Unfortunately, such revealing pictorial representations of life and medicine in colonial Virginia do not exist.

On the other hand, in Virginia, the Reverend John Clayton displayed a distinct flair for the scientific method in his a.n.a.lysis of urine. It is safe to a.s.sume that his techniques were of a higher order than those usually a.s.sociated with uroscopy. Clayton, not satisfied to practice just the art of observation, utilized the science of comparative weights hoping to find diseases distinguished by minute variations in the specific gravity of the liquid. He thought he could find manifestations of "affections in the head" by his careful weighing and study; manifestations not uncovered by visual observations alone.

In Gerard Dou's painting, it is to be remembered, the doctor not only examined the urine but also took the pulse--another common practice.

This is not surprising insomuch as Galen--the great and ancient authority--had written enough to fill sixteen books on the subject of "pulse lore." Despite the facts that physicians centuries later continue to take the pulse, they would not find the theories behind the seventeenth-century practice acceptable. Galen's deductions have since been described as fantastic, and his attempt to a.s.sociate a specific type of pulse rate with every disease futile. Yet the Virginia physician, when he did take his patient's pulses, certainly did not lose his or her confidence by gravely considering the mysterious palpitation.

The physician with his many techniques and remedies did not restrict himself solely to the illnesses of the sane for--contrary to popular belief today--some effort was made to treat and cure the mentally ill.

America's first insane asylum was not established until 1769, but the insane had received, even before this, medical attention. If the case did not respond to treatment and took a turn toward violence, confinement under conditions that would now be considered barbarous often resulted. Before this extreme solution of an extreme problem recommended itself, however, the mentally ill might be purged. The intent was to relieve the patient of insanity-producing yellow and black bile. The belief that this type of sickness would respond to conventional treatment, however, did not completely dominate the theories on insanity; some seventeenth-century authorities considered insanity not an illness but an incurable, disgraceful condition.

One of the fullest accounts of a case of insanity in seventeenth-century Virginia describes the plight of poor John Stock of York who kept "running about the neighborhood day and night in a sad distracted condition to the great disturbance of the people." The court authorities ordered that Stock be confined but provided such "helps as may be convenient to looke after him." The court, in a sanguine mood, antic.i.p.ated the day when Stock would be in a better condition to govern himself.

HOUSING OF THE SICK

If the doctor, surgeon, or nursing persons could come to the patient's home, little advantage could have been obtained in the seventeenth century by moving the patient. The need did arise, however, to care for persons outside the home. For example, an individual without family or close friends might find it more convenient to move in with those who would care for him on a professional basis, or newly arrived immigrants and transients might need housing.

Quite in harmony with the needs of the period were the men and women willing to take in a sick person in order to supplement their incomes.

Illness forced one colonial Virginian to offer in 1686 to grant his plantation and his home to the person who would provide a wholesome diet, washing, and lodging for him and his two daughters. The beneficiary was also to carry the sick man to a doctor and to pay all of his debts. It is probable that the man provided these services only on this particular occasion, but by such special arrangements the century housed its sick. The number of ill persons provided for by relatives under similar arrangements or even without any compensation, must have been even greater in a period without hospitals and nursing homes.

On occasions, in the seventeenth century, the physician took the patient into his own home, but not always without some reluctance. Dr.

Wyndham B. Blanton, in his search of the Virginia records for this century, found an interesting account of Dr. George Lee of Surry County, Virginia, who in 1676 had an unfortunate experience in letting accommodations to a pregnant woman. Living in a house she considered open and unavoidably cold, and having only one old sow for food, the sick and feverish woman pleaded with the doctor to take her to his home for the lying-in period. The doctor argued that the house could be made warmer, suggested that neighbors bring in food, and protested that he had only one room fit for such occupancy and that he and his wife used it. Dr. Lee said he would not give up the room for anyone in Virginia.

Offering the opinion that the room was large enough for her, Dr. Lee, and his wife, the expectant mother had her servant take her by boat to Lee's where she remained, taking great quant.i.ties of medicine, until she delivered. The doctor then had to bring suit to collect his fees.

Another example of a medical man's housing the sick, is that of a surgeon promised 2,000 pounds of tobacco and "cask" if he cured the blindness of a person he had housed--but only modest compensation if he failed. The same surgeon received 1,000 pounds of tobacco in 1681 by order of the vestry of Christ Church parish for keeping "one Mary Teston, poore impotent person."

Much earlier, Virginia had what some authorities consider to be the first hospital built in America. While the colony was still under the administration of the London Company (1612), a structure was erected near the present site of Dutch Gap on the James river to house the sick. The hospital, which had provisions for medical and surgical patients, stood opposite Henrico, a thriving outpost of the settlement of Jamestown.

Evidence that the building was primarily designed for the sick and was not simply a public guest house is to be found in the statements of contemporaries. One described it as a "retreat or guest house for sicke people, a high seat and wholesome air," while another wrote that "here they were building also an hospitall with fourscore lodgings (and beds alreadie sent to furnish them) for the sicke and lame, with keepers to attend them for their comfort and recoverie." The use of the word "hospital," which had then a general sense, does not indicate any similarity to a present-day hospital as does the other information.

Nothing more appears about this establishment for the sick and wounded, and it may well have been destroyed during the Indian uprising of 1622.

Plans for similar inst.i.tutions in each of the major political and geographical subdivisions of the colony came from the London Company.

Unlike the Henrico structure, these buildings bore the name "guest house" and were to harbor the sick and to receive strangers.

Specifications called for twenty-five beds for fifty persons (which was in accord with custom in public inst.i.tutions); board part.i.tions between the beds; five conveniently placed chimneys; and windows enough to provide ample fresh air.

The Company repeatedly recommended and urged the construction of these guest houses not only as a retreat for the sick but also as a measure to prevent illness among the newcomers. In addition, the guest houses, if they had been built, would have saved the old settlers from being exposed to the diseases of the new arrivals who were taken into private homes. The colonists always had some excuse for delaying construction, and the Company in 1621 entreated to the effect that it could not "but apprehend with great grief the sufferings of these mult.i.tudes at their first landing for want of guest houses where in they might have a while sheltered themselves from the injuries of the air in the cold season."

That the London Company should have had the Henrico hospital built during its administration and made plans for the guest houses can be explained by the situation existing during the earlier days of the colony. The Company, engaged in a commercial venture and realizing by its own statement that "in the health of the people consisteth the very life, strength, increase and prosperity of the whole general colony,"

had sufficient reason to shelter and care for the colonists. Also, during the early days the number of incoming colonists was high relative to the number settled and with lodging to give or to let. The Company, in addition, knew that new arrivals fell victim most easily to seasoning and other maladies, and needed protection from the elements.

Finally, the Company had to fill the void created by the absence of religious orders which, during prior European colonization and occupation of distant lands, had provided shelter and care. These hospitals are no longer mentioned after the dissolution of the London Company, nor were any other comparable measures taken during the century to inst.i.tutionalize care for the sick.