Medicine Of Jacksonian America
Author: Kathy Mandusic McDonnell
One of the basic concerns of any people or society is that of health, a matter which often supersedes other concerns since the conquest of the wilderness, the advance of civilization, and the preservation of society depends upon the survivability of people. From the earliest settlements at Jamestown and Plymouth, people suffered from the diseases of new environments, causing them to seek new remedies and practices to combat those illnesses. Poor sanitation, inadequate medical facilities, deficiency of medical knowledge, and the conflict between professional and self-proclaimed physicians also compounded health care well into the nineteenth century. However, by the 1830s, medicine stood at a watershed--in the growing professionalization of the practice, in the discoveries and applications of new medications and techniques, and in the knowledge of the human body. While future generations would surely benefit from the medical discoveries of the age, citizens of Jacksonian America faced the uncertainties and fears of a life filled with contagious diseases, periodic epidemics, poorly trained physicians, potentially dangerous cures, and generally unhealthy conditions.
Sanitation and Public Health
Foremost among the causes of poor health was the lack of knowledge about sanitation. People did not realize the connection between unsanitary conditions and sickness. Consequently, they tossed garbage and human wastes into streets and yards. Even animal carcasses were a common sight on the streets, such as in Vincennes in 1808. To combat the growing problem of rubbish in public areas, town governments began to pass health ordinances. The Madison, Indiana, council approved an ordinance in 1824 which charged the town marshal with the duty of monitoring the removal of waste from the streets. During the cholera epidemic of 1832 and subsequent months, supplemental regulations required inspection of lands and streets, removal of garbage and waste from the front of all dwellings, and the imposition of fines for lack of compliance. Despite these moves, public health throughout Indiana was still largely neglected.
Insects were common pests which contributed to the poor health of settlers. Mosquitoes were especially numerous around swamps and decaying vegetation. Recognized as pests these insects were not suspected, however, as the cause of malarial fevers:
The mosquitoes are a terrible plague here . . . on warm days here the air in the woods is filled with them. When night comes on, they swarm about the house and yard where people are working, and torment one to such a degree that it grows unbearable . . . They give no peace even in bed at night, and one has to cover the face and hands, even if it is warm.
(The Schramm Letters, p. 61)
William Oliver, who set out in December 1841 to spend eight months in Illinois, also commented on the wide variety and large numbers of insects:
Among the novel discomforts of the West, that of insects is one of no trifling character. The whole earth and air seems teeming with them, and mosquitoes, gallinippers, bugs, ticks, sandflies, sweat-flies, houseflies, ants, cockroaches, &c, join in one continued attack against one's case.
(Eight Months in Illinois, 1843, pp. 76-77)
In this dirty and pest-ridden environment, the Indiana pioneer invited further afflictions by poor eating habits. Most foreign observers felt Americans were great gluttons who tended to eat "huge quantities of poorly prepared food with the manners and charm of certain barnyard animals" (Pessen, Jacksonian America, pp. 20-21). Dr. Daniel Drake of Cincinnati believed that people of the interior valley at too many foods prepared through "vicious modes of cooking" (Diseases of the Interior Valley, 1850, 1:654). In the American Democrat (1838), James Fenimore Cooper remarked that
Americans are the grossest feeders of any civilized nation known . . . food is heavy, coarse, ill- prepared and indigestible . . . The predominance of grease in the American kitchen coupled with the habits of hasty eating and of constant expectoration, are the cause of the diseases of the stomach so common in America. (p. 208)
Americans also consumed an inordinate amount of tobacco and alcohol. Whiskey, brandy, and rum were standard drinks at militia musters, election days, most celebrations, and the daily meal table. In fact, the average per capita consumption of distilled liquors during the 1830-1836 period was nearly 5 gallons (Rorabaugh, Alcoholic Republic, p. 238).
Personal hygiene was careless at best. Linens were rarely changed at inns and taverns, meaning that bed vermin were common. Travelers often found little water for bathing. Some doctors, like William Buchan, warned men to take care of their health by bathing frequently, avoiding strong drink, and regulating their diets. Daniel Drake even felt that cholera was linked to poor personal hygiene.
The lack of concern about public health and sanitation resulted in much sickness. Summer through fall months, aptly known as the "sickly season," saw outbreaks of malarial fevers or "ague," typhoid (then called typhus), dysentery, milk sickness (trembles or slows), as well as cholera and smallpox which caused added panic and dread. Winter and spring months brought measles, pneumonia, colds, tuberculosis (called consumption), pleurisy, scarlet fever, erysipelas, and whooping cough. Calvin Fletcher reported in his diary that his entire family was sick with the measles in January 1836 (Diary, 1:300-303). Besides the cholera epidemics which hit Indiana in 1833 and again in 1849, fevers were probably the worst and the most frequent afflictions. In the town of Vevay in 1820, one in six died of bilious fevers; in Indianapolis in 1821, one in twelve residents died of fevers, though nearly nine-tenths of the population were afflicted! In addition to illnesses, accidents and assorted mishaps--burns, bites, injuries-- endangered the health of the settlers and often proved to be fatal if the injured was far from the doctor's care.
The Philadelphia Sentinel says that New York has a greater variety of physicians than any other city in the world. The Sentinel enumerates them thus: Regulars, Irregulars, Broussaisans, Sangradoarians, Morissonians, Brandrethians, Beechitarians, Botanics, Regular Botanics, Thomsonians, reformed Thomsonians, theoretical, practical, experimental, dogmatical, emblematical, magnetists, eclectical, electrical, diplomatical, homeopathians, rootists, herbists, florists, and quacks!!
(Indiana Journal 5 November 1836)
Although early nineteenth century doctors tried desperately to combat illness without the benefit of antibiotics, anesthesia, or proper equipment, they inadvertently contributed to the settler's ill health. Not only were early doctors unaware of germs and contagion, but they failed to associate unsanitary conditions with disease. Practitioners classified disease on the basis of similarity of symptoms and employed the same treatment for illnesses showing like manifestations. Harsh or "heroic" treatments, such as powerful drugs and bloodletting which altered their symptoms of the patient, were hailed as effective cures by the scientific or medical school trained doctors (known as the "orthodox" or allopathic physicians). Working without the benefit of the germ theory (formulated in 1865) and forced to perform operations on conscious patients, the Indiana practitioner of the Jacksonian era was limited in the treatment of various illnesses, surgery, and obstetrics.
The general practice of medicine or "physick" in 1836 was based upon humoral pathology, formulated in Greece in the 4th century B.C. by Hippocrates; he maintained that the human body contained four humors: blood, phlegm, yellow bile, and black bile. Diseases occurred when one these fluids was in excess, or "out of balance." As the body temperature increased, the ill humor separated from the others so the body could eliminate it. Physicians helped the patient either by raising the body temperature with drugs to help "cook the ill humor" or by assisting to expel it through bloodletting, purges or laxatives, emetics or pukes, and sudorifics or perspirants. The body was then rebuilt through the use of tonics.
Bloodletting was probably the most common therapy of the early nineteenth century, two types of which were employed: general, known as venesection or phlebotomy; and localized. Some people believed that the patient should be bled until unconscious or "syncope." By using a lancet, ten to twelve ounces of blood were drawn at one time, and the process was often repeated for an average of fourteen ounces of blood for ten consecutive days. The practice of venesection (cutting open a vein) was popular with
Indiana doctors, such as Dr. Lawrence Johnson of Rossville who performed 43 venesections between June 1837 and February 1838, as well as with eminent physicians like Drake and John Eberle. For local affectations, such as stomachache or headache, other modes of bloodletting were employed: the application of leeches to the affected part; or scarification, which entailed the use of a scarificator (a small brass box approximately two inches square which held small knives and which when released by a trigger, produced a series of lacerations on the skin) and small cupping glasses.
Once the patient was bled, the doctor proceeded to expel the system's remaining ill humors by the use of cathartics, emetics, diuretics, and sudorifics. Cathartics or purgatives, powerful laxatives used to cleanse the bowels, were given with great frequency. Probably the most used, and most abused, was chloride of mercury or calomel. Other cathartics used were jalap, gamboge, senna, manna, salts, rhubarb, castor oil, cream of tartar, and aloes. Emetics were used to cleanse the stomach or cause vomiting. The most commonly used medicines were ipecacuanha, tartar emetic, antimonial wine, and lobelia. Diuretics such as balsam copaiva were used to promote the discharge of urine, and sudorifics or diaphoretics such as tartar emetic, nitrous powders, antimonial wine, and spirits of nitre were used to promote a free and copious perspiration (John Gunn, Domestic Medicine, 1835, pp. 610-629).
The application of blister plasters was another way of cleansing the system. These were usually made of mustard or Spanish flies (cantharides) which were powdered and mixed with liquids to make a plaster. The compound caused great irritation to the skin; when blisters discharged the pus, much of the harmful matter supposedly was expelled. Once cleansed of its irritants, the body could be restored to health by the use of tonics. Arsenic, mercury, lime, copper, iron, and nitric acid frequently were used as components of the various restorative solutions and compounds.
Because surgery also was handicapped by the absence of the germ theory and anesthesia, physicians performed operations only when necessity demanded. Those physicians facing complicated operations usually found themselves ill-equipped and ill-prepared, thereby limiting their surgery to setting fractures, treating wounds and luxations, amputating limbs, removing abscesses and tumors, relieving hydrocele (collection of water in the scrotum), and trephining or perforating the skull to remove pressure. Extraordinary operations such as Ephraim McDowell's ovariotomy in 1819 and Dr. John Richmond's Caesarian section in 1827 were rare; both of these operations were "firsts" for doctors of the trans-Appalachian frontier.
Operating upon conscious patients also limited the surgery performed by physicians. To reduce pain during surgery, patients recited psalms or took opium, water of nightshade, whiskey or brandy; in some cases, tight straps were placed above the incision, or loud noises were used to divert attention. With the absence of hospitals in rural areas and insufficient room at the doctor's house for full care and recovery, surgery was usually performed at the patient's home. Most operations occurred during the day, though when circumstances demanded, surgery could be performed at night by candlelight.
Obstetrics was another field hindered by the physician's ignorance of anesthesia and antiseptics. Moreover, it was still somewhat limited by female prudery and opposition to male midwives and their orthodox practices. Even though Caesarian operations were known, they were rarely performed during the first half of the nineteenth century. Of the women who had Caesareans, few survived because of the danger of infection. In cases of difficult or protracted labor, various methods such as embryotomy and amputation in utero were used to facilitate the delivery, thereby sacrificing the child's life to save that of the mother. Embryotomy consisted of decapitating the fetus, perforating the skull and emptying its contents by the use of the perforator, crotchet, and blunt hook. Other doctors amputated the limbs of the fetus in utero and then delivered the child piecemeal (see William Lindsay journal, Richmond, Indiana, 30 November 1839, pp. 11-26).
The forceps were perfected in 1740 when Benjamin Pugh introduced the pelvic curve to the cumbersome straight forceps invented by Peter Chamberlen the Elder (1560-1631). Since forceps reduced the number of embryotomies, prejudice against the use of male midwives or physicians gradually dissipated in the late eighteenth century. By the 1840s, parturition (or the birthing process) was almost exclusively in the hands of males in both America and England. The forceps also eased the delivery of the child during protracted labor. With their use, William Dewees, an author of a midwifery book, felt the hooked crotchet should be employed only when immediate delivery of the child was necessary; now, every effort was to be made to save the child's life.
Nevertheless, in cases where the fetus was turned in the uterus and presented an arm or foot, either embryotomy or amputation was still considered necessary to save the mother's life. Had doctors been aware of the germ theory and anesthesia, more Caesarian operations could have been performed, saving both the mother and child.
Medical Training and the Rise of Alternative Methods
Medical training ironically contributed further to the ill health of the early settlers. Formal education was limited to those practicing orthodox medicine; however, many physicians never attended medical school, studying instead for three years as apprentices under practicing physicians. Those who received a medical education suffered from the colleges' low educational standards and the lack of clinical facilities, anatomical specimens, research libraries. Admission was open, terms were short, and graduation requirements were minimal. (Indiana did not have a medical college until 1841-1842 when the Indiana Medical College of LaPorte opened.) The absence of adequate training and the seemingly barbarous conditions employed by early physicians led to severe criticism of the profession, although it was sometime before the profession became regulated. Consequently, many patients sought the milder forms of treatment offered by dissenting medical sects, which preached "self- help" methods and advocated an end to the use of harsh drugs and bloodletting. As a result, serious diseases requiring professional help were often treated by the layman.
The largest "irregular" sect and opponent to orthodox medicine was the Thomsonians, or Botanics, founded by Samuel Thomson, a poor New Hampshire farmer. Thomson's major objective was to establish a simple system of botanic cures, free from the technical language of doctors and administered by the common man (New Guide to Health or Botanic Family Physician, 1822). According to Thomson, illness had only one cause-- the loss of the body's heat. Heat represented life:
Our life depends on heat; food is the fuel that kindles and continues the heat. The digestive powers being correct, caused the food to consume; this continues the warmth of the body, by continually supporting the fire.
(New Guide to Health, 1825, p. 8)
Therefore, by restoring the body's heat, disease could be cured. A medicine was employed to open the obstruction in the bowels, allowing free perspiration and restoring digestion:
All disease is caused by clogging the system; and all disease is removed by restoring the digestive powers, so that the food may keep up that heat on which life depends.
(New Guide to Health, 1825, p. 9)
Thomson's system consisted of a regular course of six botanic medicines, given in numerical order, beginning with the cleansing of the system and ending with its restoration with tonics. The average person could obtain his own botanic medicines, administer the remedy, and be his own physician. Thus, Thomsonianism had great appeal to the "common man" of Jacksonian America who wanted to end elitism in the medical world. The patient no longer had to be "doctored to death" or spend large sums of money for physicians' services; botanics were widely advertised and dispensed both wholesale and retail.
Another group of irregulars of dissenters were the homeopaths, founded by Samuel Christian Friedrich Hahnemann (1775-1843) who proclaimed that "like cures like." Hahnemann believed that the drug causing symptoms of a certain sickness in a healthy person could also cure the same illness in a sick person. For example, cinchona, if administered to a healthy person, caused the symptoms of malaria; therefore, cinchona would cure these symptoms in a malarial victim. This German physician also believed drugs were to be diluted since large doses of drugs hid their true essence. Homeopathy never gained midwestern support until after the 1830s.
Self-help suggestions were also obtained through a variety of domestic medical books containing both orthodox and botanic cures. The most popular home remedy books were William Buchan's Domestic Medicine or Treatise on the Prevention and Cure of Diseases by Regimen and Simple Medicines, originally published in Edinburgh in 1769, and John C. Gunn's Domestic Medicine or Poor Man's Friend, published in Knoxville, Tennessee, in 1834. Some of these books were written for those people denied access to a physician, while others specifically attacked the medical profession. A few authors, like Gunn, believed their manuals obviated the need for a physician even in amputation cases.
Besides the advice given in these books, people had at their disposal a variety of packaged nostrums or patent medicines which promised to cure anything from the common cold to scarlet fever. Most were not "patented" cures but merely concocted by the person whose name was attached. Over thirty-five patent medicines were available to the Indianapolis public, including Gardner's Celebrated Vegetable Liniment for sprains, bruises, scalds, wounds, and ringworms; Swaims Panacea; LaMott's Cough Drops; Burnham's Drops for cure of dyspepsia, influenza, colds, pains, and bowel complaints; and Dr. Linsey's Vegetable Tonic and Efficacious Remedy against fever and ague.
Despite criticism from sectarian practitioners and some authors of domestic medical books, doctors and patients generally believed that everything possible was being done to combat disease in the face of insurmountable odds. Usually, as the most educated man in the community, the doctor received great respect from his patients. The number of patients was often indicative of society's attitude toward the physician. Although not everyone in the community believed or trusted orthodox medicine, doctor's account books indicate a fairly large reliance upon medical treatment. Dr. Jabez Percival of Lawrenceburg visited about 120 different families in 1836. Rossville's Dr. Lawrence A. Johnson had over 60 patients in eight months while another local doctor reported 297 in 1840. A few people seemed to frequent the doctor for almost every ailment. Louella Case of Patriot, Indiana, wrote:
We have a good, sensible, and gentlemanly physician next door to whom I now apply for every headache that lasts over noon so you see I will not let sickness get hold again, and whose medicine is such as I do not fear to take it, though not homeopathic.
(Case to Dr. Levi Bartlett, Kingston, N.H., 2 June 1847, Case Papers, Indiana Historical Society)
Men, women, and children used the doctor's services for a variety of reasons, including child- birth, ague, colds and other catarrhal affections, inflammatory diseases, scurvy, broken bones, toothaches, skull fractures, hydrocele, cancer, amputation, cholera, and kidney and bladder infections. It is likely, however, that most persons waited until illnesses became serious before approaching the doctor for treatment.
From journals and doctors' account books, information about the various diseases treated by a physician can be obtained. Bleeding was performed in all cases of inflammation or fever; quinine was dispensed for ague; blister plasters for pleurisy, catarrhal affections and cholera; and vermifuges for worms. Catheters were passed in cases of kidney and bladder infections. Analysis of Dr. Lawrence A. Johnson's account books reveals that during a period of eight months the Rossville physician dispensed vermifuges 4 times; quinine or ague medicine, 17; toothdrops, once; febrifuge medicine, 8; and blister plasters, 13. He performed 43 venesections, extracted a splinter from the cornea of the eye, operated on a man's finger, assisted in 5 accouchement cases and treated one case of scurvy. Another local doctor cupped or scarified 56 times, performed 33 venesections, pulled 6 teeth, assisted in 33 parturition cases, passed on catheter, set two broken. bones, extracted 3 placentas, and lanced 9 times. During the year 1840, this same physician dispensed quinine 198 times; vermifuges, 23; rheumatism medicine, once; and cough drops, 13. Dr. Jabez Percival of Lawrenceburg dispensed over 200 cholera plasters during the cholera epidemic of 1832. He also treated several kidney and bladder infections. Dr. Lindsay of Richmond visited persons with broken limbs, skull fractures, hydrocele, cancer, and tetanus; several of the tetanus and cancer cases resulted in amputation. In addition, most doctors acted as their own pharmacists, making their own pills and compounding their own medicines to meet the needs of their patients.
Despite relying on medical services, Americans saw their health steadily deteriorate. Health hazards and the absence of proper sanitation, physicians' lack of accurate medical knowledge, and the abundance of quacks and domestic "self-help" books all contributed to the fragile existence of early nineteenth century Americans. By mid century, medicine had entered an age of "improvement, progress, and reform." Medical institutions were emerging to provide a more scientific approach to medicine. Physicians were now engaged in clinical teaching and research in hospitals. New instruments were introduced to assist doctors in their diagnoses. New channels for communicating between physicians and for disseminating medical information-- journals, societies--were established. But, as in the case of agriculture and economics, Indiana was characterized more by conservatism and maintaining the status quo than by the growing reform movement in American medicine.
Seasonal Chart of Diseases
||diseases of the bone
|apthae or thrush
(Taken from Drake, A Memoir on the Trembles; Buchan, Domestic Medicine; Gunn, Domestic Medicine; Eberle, A Treatise of the Practice of Medicine.)