PART EIGHT

NEW WORLD MEDICINE

“They have the Happiness to have very few Doctors, and those such as make use only of simple Remedies, of which their Woods afford great Plenty. And indeed, their Distempers are not many, and their Cures are so generally known, that there is not Mystery enough, to make a Trade of Physick there, as the Learned do in other Countries, to the great oppression of Mankind.”

ROBERT BEVERLEY

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Nature-Healing and Simple Remedies

THE AMERICAN EXPERIENCE hardly encouraged great work in the physical sciences. Even in the biological sciences the colonial period was barren of theoretical advance. But, in some fields of science which had become overgrown with dogmatic learning in Europe, the simplicity of American life as well as American naïveté proved fruitful in their own way. Medicine—including materia medica, or what was later called pharmacy or pharmacology—was one such field.

Natural history (especially botany) and medicine were closely connected in the 18th century. In those days the most commonly used medicines were botanical, and the most important treatises on botany were “herbals”—catalogs of common medicinal plants, telling where and how they grew and what they were good for. Nothing was more natural than that European-trained physicians, finding themselves in a new land with many unfamiliar plants, should seize the opportunity for botanical discoveries. Even laymen studied American flora in the hope of adding to medical knowledge.

In 1610, during the unhappy early years of the Jamestown colony, the Governor and Council wrote to the London Company about widespread sickness (“strange fluxes and agues”) and dwindling medical supplies. The company physician, Dr. Lawrence Bohun, looked for the possible medical uses of local plants. Among other things, he found in the gum of white poplar a balm which would “heale any green wound,” and he experimented with sassafras, which was common around Jamestown. Tobacco, from its first discovery, was of interest to Europeans for its medicinal possibilities. Harriot’s Briefe and True Report of the New Found Land of Virginia (1588) touted tobacco as a medicine which “purgeth superfluous fleame & other grosse humors, openeth all the pores & passages of the body: by which meanes the use thereof, not only preserveth the body from obstructions; but also if any be, so that they have not beene of too long continuance, in short time breaketh them: whereby their bodies are notably preserved in health, and know not many greevous diseases wherewithall wee in England are oftentimes afflicted.” It was claimed that smoking tobacco would heal gout and ague, cure hangovers, and reduce fatigue and hunger. The “Jamestown Weed” (datura stramonium), which modern medicine has proved to be sedative and antispasmodic when taken in small doses, and narcotic and poisonous when taken in larger doses, was praised for its “cooling” effect.

Robert Beverley in 1705 observed “the Planters abhorring all Physick, except in desperate cases”:

The Planters … have several Roots natural to the Country, which in this case they cry up as Infallible. They have the Happiness to have very few Doctors, and those such as make use only of simple Remedies, of which their Woods afford great Plenty. And indeed, their Distempers are not many, and their Cures are so generally known, that there is not Mystery enough, to make a Trade of Physick there, as the Learned do in other Countries, to the great oppression of Mankind.

It was two eminent English physicians who persuaded Mark Catesby to undertake the travels in 1710-19 which produced his Natural History of Carolina, Florida and the Bahama Islands, He found many therapeutic plants, including the May-apple, snake-root, ginseng, and witch-hazel. Among the most useful was the so-called “Tooth-Ache tree” whose “leaves smell like those of Orange; which with the Seeds and Bark, is aromatic, very hot and astringent, and is used by the People inhabiting the Sea Coasts of Virginia and Carolina for the tooth-ach, which has given it its name.” Even Dr. John Morgan, who was devoted to the ways of European medicine and hoped for the establishment in America of all the respectable rigidities of European medical training, could not overlook the peculiarly American opportunities:

We live on a wide extended continent of which but the smallest portion, even of the inhabited part, has yet been explored. The woods, the mountains, the rivers and bowels of the earth afford ample scope for the researches of the ingenious. In this respect an American student has some considerable advantages over those of Europe, viz. The most ample field lies before us for the improvement of natural history. The countries of Europe have been repeatedly traversed by numerous persons of the highest genius and learning, intent upon making the strictest search into everything which those countries afford; whence there is less hopes or chance for the students who come after them to make new discoveries. This part of the world may be looked upon as offering the richest mines of natural knowledge yet unriffled, sufficient to gratify the laudable thirst of glory in young inquirers into nature. The discovery must greatly enrich medical science…. How many plants are there, natives of this soil, possessed of peculiar virtues?

This natural-history emphasis among American doctors was encouraged not only by New World opportunities, but even by one of the ancient dogmas of European medicine, the doctrine of “signatures.” This dogma, expressed in the motto similia similibus (“like by like”—a doctrine which was to be curiously confirmed by the use of inoculation) implied that there was a necessary providential coincidence between the place where a disease occurred and the place where its remedy would be found. By the end of the 18th century some scientists were beginning to doubt this generalization, but it was so widely held that Benjamin Smith Barton’s Collections for an Essay towards a Materia Medica (1801-1804) described as “trite” the theory “that every country possesses remedies that are suited to the cure of its peculiar diseases … that the principal portion of indigenous remedies is to be found among the vegetables of the countries in which the diseases prevail.” Thus it was widely believed that the remedy for rattlesnake bite would probably be found on the same American terrain where the rattlesnake was found. And, sure enough, Polygala Senega (rattlesnake root) proved to be just the thing! Well might the Rev. Nicholas Collin, rector of the Swedish Churches in Pennsylvania and something of an inventor and natural historian, exclaim: “The bountiful Creator discovers his marvels in proportion to our wants … every country has native remedies against its natural defects.” Even when this ancient dogma was diluted into only a hypothesis or a suspicion, it still encouraged students of American diseases to take special interest in the plants the Creator had placed here.

In America trained physicians showed an impressive and fruitful interest in the American landscape, its climate, its peculiar plants and animals. In part this was, of course, only an effect of the close traditional association (not particularly fortunate on either side) of botany and medicine as European academic subjects. But in those days most scientists, other than mathematicians and astronomers, commonly began with medical training. Carl Linnaeus, the great Swedish botanist, had been trained in medicine, and Herman Boerhaave, the director of a botanic garden, dominated European medicine in the early 18th century from his professorship of botany and medicine at the University of Leyden. To his disciples a botanical garden was standard equipment for medical institutions. Even in the early 19th century, the College of Physicians and Surgeons in New York City still maintained a botanical garden for teaching purposes.

Many of the leading American naturalists in the provincial age had medical backgrounds. Some, like John Bartram and John Clayton, were self-educated, but Cadwallader Colden, for example, possessed a London medical education, and Benjamin Smith Barton, author of the first notable American treatise on botany (Elements of Botany, 1803), and professor of medicine at the University of Pennsylvania, had come to the subject through materia medica.

Especially in the South, where books and trained experts of any kind were scarce, the physicians—often the only persons of scientific training for miles around—became the leading botanical discoverers. The career of Dr. Alexander Garden, after whom the “Gardenia” was named, was a parable of the opportunities, temptations, and limitations of American life. During his thirty years as a physician in Charleston, South Carolina, he discovered many new species and genera and was perhaps the most accomplished American botanist of the age; but even he never produced a significant systematic work. His most important scientific writing was in his letters. Soon after arriving in Charleston in 1752 with a medical degree from Edinburgh, where his botanical interests had been stimulated in the University’s botanical gardens, he took up a correspondence with European naturalists including Linnaeus, and became acquainted with Americans like Colden, Clayton, and John Bartram, with whom he exchanged observations. Although energetic and imaginative, Garden’s diffuse interests tended to be focused mainly on the questions put to him by European scientists. “In Charleston we are a set of the busiest, most bustling, hurrying animals imaginable,” he complained, “and yet we really do not do much, but we must appear to be doing. And this kind of important hurry appears among all ranks, unless among the gentlemen planters, who are absolutely above every occupation but eating, drinking, lolling, smoking and sleeping, which five modes of action constitute the essence of their life and existence.” Linnaeus urged him to collect the fish, reptiles, and insects of Carolina, with the result that Garden’s name appeared more often than that of any other American in the famous twelfth edition of Linnaeus’ Systema Naturae. But Garden never became more than a devoted gatherer of the raw materials from which European scientists built their systems.

Dr. John Mitchell of Urbanna, Virginia, who had also been trained in Edinburgh, claimed twenty-five new genera of plants, which made him the rival of Garden as a botanical discoverer. He described to the Royal Society the life-cycle and reproductive mechanism of that peculiar American animal, the opossum, and he inquired into the environmental causes of differences of color in the human races. The first satisfactory map of British and French North America (1755), which was used at the Peace Conference of 1783 and was still standard at the end of the century, was his work.

The members of this far-flung circle of American physician-naturalists were held together by their collaboration and by their half-known and tantalizingly amorphous American subject-matter. The systematizing of their knowledge they left to their correspondents in England, France, Germany, Holland, and Sweden, while they threw their energy into collecting, describing, and interpreting the natural novelties of their New World.

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Any student of European medical education during the 17th and 18th centuries cannot fail to see the significance of this concrete and practical focus of the energies of American physicians. European medical learning, especially in the great University centers, was still enveloped in dogma. “Vitalists,” “iatrochemists,” and “iatrophysicists” argued with one another over which of their single causes explained all human health. With few exceptions, every eminent professor of medicine offered his own simplistic explanation of all bodily functions; every illness was supposed somehow to be another maladjustment of the general “system” of the body. Some attributed all diseases to disorder in the “humors,” others to disturbance of the bodily “tension,” and still others to even cruder doctrinaire causes. American physicians, if academically trained at all, had been trained in such dogmas, but the absence of American medical schools until 1765 removed them from the arenas of such tempting but fruitless debate. Later, as American medical education “improved,” more such medical dogmatists would be found on this side of the water. Perhaps the most famous of them was Benjamin Rush, who expounded a monistic theory of bodily tension and who had nearly unbounded faith in bleeding. The ultimate proof of his theory was that any patient who was bled long enough would eventually relax!

Even the most charitable historian cannot be impressed by the amount of useful knowledge at the disposal of those learned European Doctors of Physick in the 18th century. The rise of Newtonian physics, a grand new system, seemed to encourage doctors in their temptation to make a simple system of the body. It was not until the growth of pathological anatomy, stimulated by the work of Morgagni of Padua in 1761, that the classification, understanding, and successful remedying of specific diseases made significant progress in the European medical schools. Until well into the 19th century dogmas were so rigid, theories so doctrinaire, hands and instruments so germ-ridden, and “remedies” so enervating that the learned doctor often did less to cure than to kill the patient. If the American patient had no other advantage, he was lucky that so much learned error had not been brought to these shores.

The common medical treatments here did not cure any more effectively than those administered in the Old World, but they probably interfered less with the patient’s recovery. While the European physician frequently relied on extreme measures, which carried his simplistic dogma to its logical—if sometimes fatal—conclusion, the American amateur was more likely to let nature take its course. Instead of relying on ruthless emetics, purges, and bleeding (what medical historians have called “heroic” remedies), the self-trained practitioner was inclined to more timid and less damaging treatments.

The ministers in early Massachusetts, who were probably most familiar with the diseases of their community, were inclined to prescribe such wholesome and harmless treatments as rest, fresh air, and massage. The first medical publication of British North America was not written by a trained physician. A Brief Rule to Guide the Common-People of New-England How to Order Themselves and Theirs in the Small Pocks, or Measels, by Thomas Thacher, minister of the Old South (Third) Church in Boston, was published in January 1678 at the height of a smallpox epidemic. This broadside contained nothing new. It was apparently cribbed from the great English physician Thomas Sydenham—himself a pioneer in opposing “heroic” treatments—who had urged allowing “Nature to do her own work, requiring nothing of the Physician, but to regulate her, when she is exorbitant, and to fortifie her, when she is too weak.” The single sheet which Thacher composed was a simple list of thirty numbered items in lay language. “As soon as this disease therefore appears by its signs, let the sick abstein from Flesh and Wine, and open Air, let him use small Bear warmed with a Tost for his ordinary drink, and moderately when he desires it. For food use water-gruel, water-potage, and other things having no manifest hot quality, easy of digestion, boild Apples, and milk sometimes for change, but the coldness taken off.” Thacher freely confessed himself “though no Physitian, yet a well wisher to the sick,” but doctors even now agree that Thacher’s Brief Rule gave an adequate description of smallpox in nearly modern terms and offered a sensible regimen for the patient. It was a useful guide, perhaps even more useful than one by a learned doctor would have been. It was reprinted during the epidemics of 1702, and again in 1721.

In America it was not only the layman who inclined toward simpler, more common-sense treatments. The therapeutics of Virginia physicians in the 17th century was much simpler than that of their English contemporaries. Drugs, especially the exotic imported ones, were extremely expensive, and apothecaries skilled in elaborate concoctions were rare on this side of the ocean. Master pharmacists in Virginia sent their apprentices into the woods to find native remedies; most of their medicines were therefore simple, home-made, and less likely to disturb the healing course of nature. We cannot appreciate this simplicity until we have seen the indigestible concoctions of learned European doctors, which included human excreta, urine, and nearly everything else, mixed by complicated formulae. American physicians, especially the more learned of them, were not always free from such well-established practices: Governor Winthrop, for example, used to prescribe a paste made from wood lice. Cotton Mather reported to the Royal Society in London in 1724 that Boston physicians advised the swallowing of “Leaden Bullets” for “that miserable Distemper which they called the Twisting of the Guts.” On one occasion the prescription entered the lung of a patient; “from which … unhappy experiments, I think, I should endure abundant, before I tried such a remedy.”

Even the eminent 19th-century physician Dr. Oliver Wendell Holmes (the Autocrat of the Breakfast Table) though hostile to the Puritans, had to admit that the remedies of their clergymen-physicians were less harmful than those of their European contemporaries.

What has come down to us of the first century of medical practice, in the hands of Winthrop and Oliver, is comparatively simple and reasonable. I suspect that the conditions of rude, stern life, in which the colonists found themselves in the wilderness, took the nonsense out of them, as the exigencies of a campaign did out of our physicians and surgeons in the late [Civil] war. Good food and enough of it, pure air and water, cleanliness, good attendance, an anaesthetic, an opiate, a stimulant, quinine, and two or three common drugs, proved to be the marrow of medical treatment; and the fopperies of the pharmacopoeia went the way of embroidered shirts and white kid gloves and malacca joints, in their time of need. ‘Good wine is the best cordiall for her,’ said Governor John Winthrop, Junior, to Samuel Symonds, speaking of that gentleman’s wife,—just as Sydenham, instead of physic, once ordered a roast chicken and a pint of canary for his patient in male hysterics.

One of the best examples of the dangers of the overzealous physician was in the area of prenatal care. In the days before antisepsis, when the causes of childbed fever were still unknown, it was during prenatal examination that the physician was most likely to introduce infection. The crude statistics of deaths from puerperal sepsis in Virginia before 1860 show a much higher mortality rate among whites attended by doctors than among Negroes attended by midwives. Similarly, the amateur, personal, small-scale nursing of colonial Virginia seems to have been superior to that of the great English municipal hospitals, where the poor, the insane, and the sick were brought together and where the manners and morals of the nurses were proverbially corrupt.

The scarcity of professionals taught Virginians to do things for themselves. Crossing the back-country to a remote plantation or to survey their lands, they had to provide their own medical services: William Byrd, for example, had no physician on his expeditions. When traveling into the North Carolina borderlands in 1733, he was troubled by “an impertinent Tooth.” “Tooth-Drawers we had none amongst us, nor any of the Instruments they make use of. However, Invention supply’d this want very happily, and I contriv’d to get rid of this troublesome Companion by cutting a Caper.” Byrd simply tied a string from his tooth to a log, and capered about till the tooth came out.

On any large plantation there was almost daily need for the layman to act the doctor. The Virginia planter could no more afford to summon a doctor for the minor ailments of his slaves than a modern farmer can afford to call a carpenter every time his barn or his fences require minor repairs. Even on large plantations the owner commonly relied on himself, his wife, or the overseer for routine medical treatment and for more serious cases in an emergency. When William Byrd arrived at his plantation near Richmond in October, 1732 and learned of a fatal epidemic of dysentery raging in the neighborhood, he instructed his steward “to make use of the following Remedy, in case it shou’d come amongst my People. To let them Blood immediately about 8 Ounces; the next day to give them a Dose of Indian Physic, and to repeat the Vomit again the Day following, unless the Symptoms abated. In the meantime, they shou’d eat nothing but Chicken Broth, and Poacht Eggs, and drink nothing but a Quarter of a Pint of Milk boil’d with a Quart of Water, and Medicated with a little Mullein Root, or that of the prickly Pear, to restore the Mucus of the Bowels, and heal the Excoriation. At the same time, I order’d him to communicate this Method to all the poor Neighbors, and especially to my Overseers, with Strict Orders to use it on the first appearance of that Distemper, because in that, and all other Sharp Diseases, Delays are very dangerous.” George Washington commonly prescribed for the ills of his slaves, and in his own last illness it was his overseer, and not a doctor, who first treated him by bleeding. When Thomas Jefferson returned to Monticello from the White House one summer, he inoculated with his own hand seventy or eighty people on his plantations and he supervised his neighbors in the inoculation of another hundred-odd.

Much of the burden of doctoring fell upon the planter’s wife, who might be called out of bed at any hour of the night to deliver a baby or to care for the violently ill in the slave-quarters. The nursery for the infants of slave working-mothers was in her charge. “She takes great care of her negroes,” the Marquis de Chastellux wrote in 1781 of Mary Willing Byrd, widow of William Byrd III, “makes them as happy as their situation will admit, and serves them herself as a doctor in time of sickness. She has even made some interesting discoveries on the disorders incident to them, and discovered a very salutary method of treating a sort of putrid fever which carries them off commonly in a few days, and against which the physicians of the country have exerted themselves without success.”

It is not surprising to find medical guides for laymen among the commonest books in Virginia libraries. Every Man his own Doctor; or, the Poor Planter’s Physician (1734) attained vast popularity by prescribing “plain and easy means for persons to cure themselves of all, or most of the distempers, incident to the climate, and with very little charge, the medicines being chiefly of the growth and production of this country.” Benjamin Franklin published three editions of this book in Philadelphia (1734, 1736, 1737). The first pharmacopoeia ever printed in British America was Dr. William Brown’s thirty-two page pamphlet, which he put together in 1778, in the stringent days of the Revolution, to list the simplest, cheapest, and most available drugs.

The colonial situation, which sometimes bred a disrespect for learning, also encouraged distrust of the omniscient professional, who already was receiving his share of ridicule in Europe. The elder William Byrd distrusted doctors so much that he would not call one even in his last illness. His son, the famous William Byrd II, also preferred his own practical methods. And in Franklin’s Philadelphia people were handing about a pointed epigram of “The Advantages of having two Phisicians”:

One prompt Phisician like a sculler plies,

And all his Art, and skill applies;

But two Phisicians, like a pair of Oars,

Convey you soonest to the Stygian Shores.

Jefferson in 1807 was eloquent against the presumptuous dogmatism of the physicians:

Having been so often a witness to the salutary efforts which nature makes to re-establish the disordered functions, he [the wise physician] should rather trust to their action, than hazard the interruption of that, and a greater derangement of the system, by conjectural experiments on a machine so complicated & so unknown as the human body, & a subject so sacred as human life. Or, if the appearance of doing something be necessary to keep alive the hope & spirits of the patient, it should be of the most innocent character. One of the most successful physicians I have ever known, has assured me, that he used more bread pills, drops of colored water, & powders of hickory ashes, than of all other medicines put together. It was certainly a pious fraud. But the adventurous physician goes on, & substitutes presumption for knoledge. From the scanty field of what is known, he launches into the boundless region of what is unknown. He establishes for his guide some fanciful theory of corpuscular attraction, of chemical agency, of mechanical powers, of stimuli, of irritability accumulated or exhausted, of depletion by the lancet & repletion by mercury, or some other ingenious dream, which lets him into all nature’s secrets at short hand. On the principle which he thus assumes, he forms his table of nosology, arrays his diseases into families, and extends his curative treatment, by analogy, to all the cases he has thus arbitrarily marshalled together. I have lived myself to see the disciples of Hoffman, Boerhaave, Stahl, Cullen, Brown, succeed one another like the shifting figures of a magic lantern, & their fancies, like the dresses of the annual doll-babies from Paris, becoming, from their novelty, the vogue of the day, and yielding to the next novelty their ephemeral favor. The patient, treated on the fashionable theory, sometimes gets well in spite of the medicine.

From this side of the Atlantic, that Europe, which has taught us so many other things, will at length be led into sound principles in this branch of science.

While Americans seemed somewhat less vulnerable to complicated forms of quackery, their circumstances tempted them in the direction of nature-healing. The bookish cure-alls of the Doctors of Physick were sometimes replaced by the environmental cure-alls sensationally advertised in promotional literature: the New England air, the Virginia water, the Georgia climate. Where Nature was so generous, men easily expected too much of her.

The record of the age did not yet justify Dr. David Ramsay’s prophecy on the second anniversary of Independence that the arts and sciences “require a fresh soil, and always flourish most in new countries.” He was closer to the truth when he boasted of the success of amateur doctors whose common sense was accomplishing what academic learning had found difficult or impossible. “The pride of science is sometimes humbled on seeing and hearing the many cures that are wrought by these pupils of experience, who, without theory or system, by observation and practice acquire a dexterity in curing common diseases.”

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