A narrative of medicine in America

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HX64096688 R151 .M91 A narrative of medic

Prefatory Note

This book is not a systematic history ; it is a narrative of medicine and doctors. My object has been to take some of the conspicuous American physicians of each era in their proper sequence, to tell the story of their lives and their doings, and thus to illustrate the whole by a series of pictures, as it were.

Very many men, dear to Dryasdust and others, are unnamed ; very many events are unchronicled ; but I hope the story will show to laymen as well as to physicians something of the meaning of medicine and of the life of its votaries.

It has always seemed to me that of such meaning popular conception was of the dimmest. The lawyers have their great names well known to all readers of history; the famous clergy of the past are household possessions; great statesmen, insignificant monarchs, gallant soldiers and sailors, and even traitors, scoundrels, and fools, are immortalized by writers; but of the doctors, few know or seem to care. Even their professional offspring neglect them, and will tell you that it is only the science of to-day which really counts; as though we could divorce ourselves from the past, as though we could understand truly our present or make progress without a knowledge of that past, as though we ourselves were not part of history.

So, after a fashion, I have in these pages attempted to call back to life one little group of men. They tell their own story, and if that story point a moral, it is for you, kind reader, to decide and benefit.

In the development of the theme it has seemed best, for reasons that must be sufficiently obvious, not to bring the

8 PREFATORY NOTE.

narrative down to the present time. It stops practically with the Civil War, or about the middle of the last century. Certain fugitive chapters are added : on Ether, on the American Medical Association, and on some Modern Tendencies.

It has been decided also to omit long lists of authorities, although a few are quoted. An extensive search and study of original documents has not been attempted, but such works as came readily to hand were used, and for no little material of the earlier chapters I am indebted to Dr. Francis R. Packard's exhaustive and scholarly " History of Medicine in the United States" (to the year 1800) recently published. Practically all the authorities consulted are to be found noted in the volumes of the Index Catalogue of the Library of the Surgeon-General's office at Washington.

I thank, too, most cordially the Executive Committee of the Boston Medical Library for the courtesy of special privileges extended to me; Dr. Francis H. Brown, of Boston, for the use of manuscript, not yet published ; and Dr. Malcolm Storer, of Boston, for valuable advice in revision.

J. G. M.

Some Tendencies in Modern Medicine 472

Introduction

Throughout history the man of action comes first; the fighting male, with his fists, his club, his battle-axe, and his sword. After him the poet, telling of his deeds. Then, after a long interval, the philosopher and the man of science.

So Achilles had his Homer, but no Plato or Hippocrates. Reason and science do not belong to the days of legend. The history of medicine does not depart from the history of the people. The brilliant genius — the man before his time — is but the best example of his time.

The meaning of science has always been understood by the chosen few, and the inductive method is as old as history; but legendary Rome did not produce a Galen, nor medisevalism a Thomas Huxley.

When we come down to the history of medicine in America, we must remember ^^' ' ^r three hundred years after its discovery " -^ was but a fringe on the bor-

ders of civilization. There were many men of action here in those early days; there were beginning to be some few poets to tell the story; there were fewer men of science. Indeed, men of science were little known in that Old World whence we came. One reads of doctors, — what we should call "practitioners," — but scientists were few. They were not liked. There were many theories and systems, but, after all, such things interest us no more than the creeds of that time. That Van Helmont taught the doctrine of " Spiritual Vitalism" is of no more importance to-day than that Calvin preached " Predestination." And if such was the case in learned Europe, we must look for little in the wilderness.

Let us, then, glance briefly at the conditions, political and scientific, which obtained especially in that island which the early immigrants called home, to see on what the American medicine of the seventeenth and eighteenth centuries had to build.

With the seventeenth century in England began the unfortunate and futile Stuart dynasty which for a hundred years, with two brief intervals, fought the losing fight with the people and the growing spirit of political freedom. The feeble, pedantic James, the shifty, unfortunate Charles I., the cynical trifler Charles II., the bigoted James II., and the dull and foolish Anne illustrate the degenerate Stuart family, little qualified to understand or deal with a proud and progressive people; while the remarkable episode of Cromwell's Commonwealth and the revolution of William and Mary but accentuate the failings of those others.

Party succeeded party, and the religious intolerance of the one provoked the religious intolerance of the other: Church of England prelate, Presbyterian and Roman Catholic, persecuted, each in his turn ; but, through it all, constantly there were coming to the front real men, and with it all there was developing that intellectual freedom of which we now boast.

Then suddenly we plunge into that curious, unreal eighteenth century, with its stupid kings, its shrewd politicians, and its microscopic literature. A century of mediocrity in politics it was, almost down to our Revolutionary days, except for the cyclonic Chatham. Cards and port ruled in England, and the tired dilettanteism of good society.

To all those folk America meant little more than Zambesi land, except so far as it provided comfortable sinecures for well-born scalawags; and when the storm of 1775 burst upon the realm, George Washington was to Englishmen Ijut an obscure backwoods colonel, and Benjamin Franklin a seven days' wonder for fools, although a solace to the wise.

A time of political incubation we are apt to think those centuries : for the old country as well as for the new.

Not altogether darkness for science, though, was the seventeenth century in England. The brilliant Harvey was born there in 1578, and midway in the reign of the foolish James, in 1616, while " Stenie" was being made a Duke of Buckingham, the great physician was teaching the true functions of the heart and the circulation of the blood. As truly as any man, perhaps, was he the father of physiology. And with Harvey we couple his famous contemporary, Rene Descartes, who was the first to show, as Huxley says, that vital phenomena, like all the other phenomena of the physical world, are, in ultimate analysis, resolvable into matter and motion.

In that century, too, Sydenham and Locke lived and taught. Sydenham, the father of rational medicine, who was the first to show us moderns the value of observation and the study of symptoms ; and Locke, student of physical as well as of mental phenomena.

On the Continent, towards the end of the seventeenth century, lived Hoffmann, of Halle, and Boerhaave, of Leyden. Hoffmann, the first to attack the teaching of Galen and the humoral theory; Boerhaave, brilliant student, teacher, philosopher, inexhaustible man of science, tireless collector, and prophet of the best thought of his day.

Sydenham lived through the civil wars and died the year after the revolution of 1688. Boerhaave, born in 1668, lived well into the eighteenth century and died in 1738, in the reign of George 11.

So Boerhaave's life covered much of two centuries, and brings us down through the dawn of modern science.^

* Whatever may be said for or against the genius and scientific attainments of Sydenham and Boerhaave, there can be no doubt that their influence was for the good of many generations of physicians in Europe and America.

Of medicine in the eighteenth century a vast deal might be written and of the men who made it.

In that century of memoir writing and salon philosophy, Linnaeus, following the thoughts of Kircher and Leuwenhoek, was considering the parasitic origin of disease, and Plenciz was teaching that every disease has a specific infective agent.

Such were the most distinguished men of medical science known to us in those early days prior to our own Revolution, if we omit the Hunters, Pott, and other such who belong rightly to a later time.^ The age was not a great age, perhaps, for scientific progress, as we reckon progress ; but progress there was.

Those men were struggling out of an Egyptian darkness. There was no applause from colleagues and an admiring world. Painfully, often in secret, against prejudice and passion, against conservatism and the traditions of ages, mostly, those pioneers worked; so that, to one reading the ancient records, the wonder is not the smallness but the greatness of their deeds.

Such men were the great men, the lonely teachers. Slowly and feebly their light penetrated to those others, the humble doctors of the day. To them and mankind

' Books required to be read by the candidates for examination (Massachusetts Medical Society, established June, 1808). Anatomy : Cheselden and the Edinburgh system. Physiology : Haller, Blumenbach, Bocrhaave, and Cullen. Chemistry: Chaptal and Woodhouse. Materia Medica and Pharmacy : Duncan's Dispensatory ; Massachusetts Pharmacopoeia ; Lewis or Murray's and Cullen's Materia Medica. Surgery: Benjamin Bell's System; do. on Ulcers and on Lues Venerea; John Hunter on Lues Venerea; do. on the Blood and on Gun-Shot Wounds ; Desault or Boyer on the Diseases of the Bones. Obstetrics : Burns's Anatomy of the Gravid Uterus ; on Abortion, Denman or Smellie. Pathology and Therapeutics: Cullen's First Lines and Nosology; Darwin's Zoonomia; Van Swieten's Commentaries; Sydenham by Wallis; Jackson on Fevers; Rush's works; Saunders on the Liver; Currie on Waters; Underwood on the Diseases of Children ; Pemberton on Diseases of the Abdominal Viscera.

came little fresh hope. For generations men were born and fell sick and died with small help from Harvey and Sydenham, Locke and Boerhaave. That was the pity of it; and that, perhaps, more than any one thing, marks those days and these. To us the good thing presently is known; to those men it was brought only after years.

One good thing, however, came to England out of the East, some fifty-four years before our Bunker Hill. Inoculation for smallpox, a practice older than history, was carried by Lady Mary Wortley Montagu and taught to Englishmen : the bravest and worthiest thing ever yet done by women teaching medicine.

There were other men — some of them very distinguished in their time — and other measures. Wiseman and Cowper in England and Le Dran in France advanced the art of surgery. But enough has been said to illustrate the kind of times in which men were living and the kind of science which then prevailed.

Now, about a hundred and twenty years after the first American voyage of Columbus, one began to find scattered along the northern shores of the New World some feeble, struggling colonies, where Englishmen dwelt, attempting to establish permanent homes and a system of government. Their story and their measure of success it is needless here to tell. Suffice it only to name those stations of theirs where civilization first took on some form of vigor and where doctors found their work.

There was Virginia, with its bold John Smith and the pretty legend of Pocahontas, — all in the time of James I., whose reign is made memorable for us by the discourses of Harvey. Virginia, a great colony of vast estates, with a rough, wholesome life and a frontier hospitality; with its negro slavery, its tobacco, its Crown governors, its House of Burgesses, and its Elizabethan Society; changing little, save for increase in number of men and in wealth, down to Revolutionary days : the colony of

Washington, Jefferson, Henry, Marshall, and Light- Horse Harry Lee.

Early in the reign of Charles I., and before the English civil wars, came the first settlements in the Carolinas to the South (long futile), and at the same time, far to the north, the Plymouth Colony and the planting of Massachusetts Bay ; with Maryland soon after and Connecticut and Rhode Island, all in quick succession, and before active civil fighting in England. In Cromwell's day little colonizing was done; then came the restoration of the Stuarts in 1660, with a consequent renewal of emigrations and a bountiful bestowal of American Crown lands through the latter years of the century. The North had been occupied and the South had been occupied, so now came the seizing and settling of the Middle Colonies, New York, Pennsylvania, and New Jersey.

Rough work, much of this, little calculated as yet for the advancement of medical science. Thus that seventeenth century in America came to an end : the seaboard taken and securely held by our vigorous ancestors, civil liberty established, and the country prepared for the prosperous material development known to the last two generations of our colonial days.

To those two generations in the eighteenth century life grew more calm and the Old World more near. Not that there was lack of action. French and Indians on the frontier continued a recurring warfare, the echo of greater battles fought beyond the sea. And out of it all grew constantly, for our ancestors, a wider experience, a closer touch with Europe, a sense of increasing strength and importance, an independence of thought, and an intolerance of control leading at last to political freedom through the American Revolution.

For the purpose of this narrative we divide roughly the colonial days of America into two eras, and those eras correspond with the two centuries of which I have told :

the seventeenth century, a time of colonization, struggle, and privation, when a footing was being made on these shores ; the eighteenth century, when towns were building and farms were planting, when commerce was beginning to thrive, and schools and colleges were appearing in the land.

So we must expect to find the medical history of the one era quite distinct from that of the other. At first the practice, remote and inadequate, of Elizabethan England was brought here ; then, with the succeeding century and the upgrowing of generations of American-born men, came a wider knowledge, better general education, and the first feeble attempts to combine the wisdom and teaching of the Old World with the changed experience of the New.

A NARRATIVE

OF

MEDICINE IN AMERICA.

Chapter I

THE SEVENTEENTH CENTURY. COLONIAL MEDICINE.

The Englishmen brought their doctors with them when they came to settle Virginia, and the Jamestown of 1607 had three members of the faculty. Thomas Wotton,^ Surgeon-General of the London Company, came out with the expedition which sailed from England on December 19, 1606, — a most uncomfortable season we must suppose. " Chirurgeon" Captain John Smith calls him, and ranks him with the " Gentlemen" of the expedition. Gentlemen surgeons were little known to our ancestors three hundred years ago. Those ancient surgeons were barbers first, and " gentleman barber" sounds strangely even to modern ears.^ Now, Wotton was a surgeon certainly, but beyond the name and fact we know no more.

It is of some interest to consider for a moment what this surgeon and " Gentleman Adventurer" — the first of

^Roswell Park, following Stith, calls him " Woolton." I knownot why.

" It was an ancient custom for the patient, when being bled, to grasp firmly in his hand an upright pole, in order to stimulate the flow of blood. As the pole was apt to become stained, a white linen band was twisted about it, and it was hung outside the door of the barber's shop. Our patriots have added a blue to the red and white stripes.

his kind to visit these shores — stands for in American medicine. The adventure was beset with hazard and hardship of a kind unknown to our modern world. It was an association of bold and roving spirits, joined together for an attack upon the distant, fearsome wilderness. The life was of the hardest and the recompense unknown. The voyage itself entailed a weariness and distress now almost inconceivable. So let us believe that the surgeon of the little fleet was a man of high heart and vigor, worthy predecessor of that long line of resourceful, able men who have honored American science.

The year 1606 was the third year of poor James; the penal laws against papists were being passed, and the plague was in London. Harvey had not yet announced his great discovery. Indeed, the world was very young. Earlier comers to Virginia, under Raleigh, had had no surgeon with them. Cause and efifect we may not find in this; but misfortune, hardship, and disease so thinned their ranks that no permanent settlement was made. John Smith's adventurers, with their Wotton, fared better. Perhaps he " signified."

A pleasant speculation, all this, no doubt; but Wotton was the first of our pioneer doctors, and we must make the most of him.

Besides Wotton, the surgeon, other doctors came to these shores. With the " First Supply" followed " Doctor" Walter Russell, perhaps a man of science and holding a degree. Doubtless, Wotton returned to England, leaving to Russell all the medical cares. Two colonies claim the latter, for in June, 1608, Captain Smith, with a small company of fourteen, explored the Chesapeake. Among them went Russell, and so came to Maryland and the " Eastern Shore."

In the story Smith tells of the first medical aid given to Englishmen in the land. A few days later " it chansed our Captaine taking a fish from his sword (not knowing her condition) being- much of the fashion of a Thornback, but a long tayle hke a riding rodde, whereon the middest is a most poysoned sting, of two or three inches long, bearded like a saw on each side, which she strucke into the wrist of his arme neare an inch and a halfe : No blood nor wound was seene, but a little blew spot, but the torment was instantly so extreme, that in foure houres had so swolen his hand, arme and shoulder, we all with much sorrow concluded his funerall, and prepared his grave in an Island by, as himselfe directed : yet it pleased God by a prescious oyle Doctor Russell at the first applyed to it when he sounded it with the probe (ere night), his tormenting paine was so well asswaged that he eate of the fish to his supper, which gave no less joy and content to us than ease to himselfe, for which we called the Island Stingray Isle after the name of the fish."

That story and these notes you will find to be typical of the times. The professional life of a few distant colonial doctors is too obscure to be dignified with the name of history and an extensive narrative ; mostly they played their humble parts with hundreds of others, and are consigned to a blameless oblivion.

In this same year 1608 Anthony Bagnall, " Chirurgeon," sailed with Smith upon the Chesapeake; but of him and Russell, as of Wotton,^ we hear little. Three adventurous spirits, let us believe, they appear to us out of the mists of those early days, and disappear.

Then came Dr. Lawrence Bohun in 16 10, and Dr. John Pott in 1624, temporary governor in 1628.

In the histor}^ of medicine great names stand forth and mark events, but in the early history of American science great names are lacking and great events as well. So the

' Toner mentions " Dr. James Woolton" as Surgeon-General of the colony in 1607. Probably he means that Thomas Wotton, " Chirurgeon," of Captain Smith's narrative.

interest to us is not so much in the men and what they did as what kind of men they were and what the hfe they led.

In Virginia we find them coming in scattered ships, rarely, adventurous, often returning home; then infrequently to settle, to take up the life of the wilderness, to bear their part with other pioneers, humble, little honored in history. Names dear to Dryasdust but of small moment to others.

But whatever the individual merits of the early Virginia doctors, they made a beginning of one good work, the completion of which still lies heavily upon us. They stirred up the Assembly to pass laws regulating medical practice. This was in 1639, when the Legislature of the colony was but twenty years old, the year before the summoning of that famous Long Parliament of Charles I. ; and further laws they passed in 1661, the year after the restoration of Charles II. Of what value these laws may have been it is impossible now to say, but they were needed sadly enough.

Throughout the colonies quackery flourished luxuriantly with little let or hindrance. The gi'eat distances, the infrequent needs of the people, the lack of any high medical standard, and the loose methods and credulity of most of the regularly licensed men gave an opportunity to what we pleasantly call " irregular practitioners" such as to this day the country has not outgrown.

That first law, passed on October 21, 1639, was "an act to compel physicians and surgeons to declare on oath the value of their medicines."

So Virginia was the first to tiy some feeble beginning of reform ; and to one glancing back over those early chaotic days Virginia must be remembered for these two facts: that thither came the first surgeon, Wotton, whom we know ; and that there first the law demanded better things.

Now, there is something good for which we may remember that fooHsh James in whose reign Harvey taught. He it was who issued patents to the London Company for the South and to the Plymouth Company for the North; and, having remembered this, we need think of him no more.

To Virginia came the two surgeons and Dr. Russell ; but not until 1620, thirteen years later, was the science of Europe brought to Plymouth in Massachusetts Bay. Dr. Samuel Fuller was the bearer of that science, — a man of some moment, let us believe ; versatile, devoted, a true Pilgrim in the land. Some few words about this ancient Fuller must be said, because he stands for a type notable in those early New England days, and because the practice of the man illustrates well the science of the times in which he lived. The light we get upon him is not veiy clear. Patience, faith, and imag'ination are needed to project one's twentieth-century \'ision into the mind of a simple, credulous countiy doctor of the seventeenth century.

Samuel Fuller was a church deacon — no sinecure in those days, but the important business of life. Dr. Green ^ guesses that he would have preferred the title " Deacon" to that of " Doctor." Very likely. Indeed, there is no evidence that he held the JNI.D., — a rare distinction here in that centurv\; so "Deacon Fuller" he doubtless was. The story of that first winter in Plymouth needs no telling here, but we must believe that there was enough practice for Deacon Fuller and his faithful wife. He was the first physician in New England, for some time the only one, and, most happily for the community otherwise so sad and stricken, he had brought a scanty stock of drugs. He came here, then, among the^ first, already

* S. A. Green, A Centennial Address. Medical Communications to the Massachusetts Medical Society, 1881.

grown mature, practised for thirteen years, and died. His wife was taught his work in some rough sort, — to act as midwife at least, — and both together served their neighbors well.

It was told with pride that Deacon Fuller's medical duties took him even to Salem and Charlestown, and that his opinion was held in high esteem by Governor Endicott. Many of the people were afflicted with " scui"vy and other distempers" peculiar to their hard circumstances, and Deacon Fuller went among them and " met with great success in his practice."

Hard, constant physical work, long hours, heat and cold ; all that, as well known now as then, we must believe he bore. Besides, he did some farming and wrestled long in prayer.

We cannot help surmising what the mental state could be of those ancient doctors when they planned their curious remedies. In all seriousness. Sir Kenelm Digby wrote to the younger John Winthrop this recipe; it illustrates the times and minds of men in 1656 :

" In the mean time let me tell, you of an easy medicine of mine owne that I have seene do miraculous cures in all sorts of vlcers and in mending soddainly broken bones wch I conceive it doth by carrying awaye by vrine the ichorous matter that infesteth such maladies ; and then nature healeth and knitteth apace, when nothing hindereth her. It is this : Beate to a subtile pouder one ounce of Crabbes eyes (in latin called oculi cancorum) then put upon it in a high glasse (because of the ebullition) fore ounces of strong vinegar. It will instantly boyle up, extremely : let it stand till all be quiett — then strain it through a fine linon — and of this liquor (wch will taste like dead beere without any sharpness) give two spoonfuls att a time to drink three times : and you shall see a strange effect, in a weeke or two."

Just one more and we need not worry ourselves further with such. This is from the receipt-book of John Wadsworth, of Duxbury :

" This Receipt cost me fifty pounds by count, and I pray yt you would not expose the same without good fee : this for a canser proves exelant, and if in time apphed will cure a canser humor. Take 3 frogs and put ym into a deep airthen Basen and power upon them as much swete oyel as will cover them, put ym into a hot oven and let ym stand a quarter of an houre : then turn off the remaining oyel and dip tow in it and apply to the canser ; and for a plaster you must take the yolkes of 2 eggs. Burnt Allow, I oz. Boal armonick, i oz., Bay salt one half oz. Bruse all to a fine pouder and mix up with yr yolkes of eggs and apply in form of a plaster to the sore every 3d day. Give a portion of a spoon of salts to cool the hete of the Blood ; this alwaise will carry off a canser humor if timely applied : the person must make them constant Drink canser roots tea. . . . We may att sartain times apply a tode cutt in two to the wound two or three times a week the nature of yr tode is such yt will draw out the sharp hot canserous and pysonous and if you proseded in this matter you may cure any canser." ^

These two dreary recipes feebly illuminate several phases of ancient practice. The absolute ignorance of the nature of cancer and its diagnosis, as well as of the action of the proposed remedies, is not surprising; but the credulity of the writers is amazing and carries us very far back into the dark ages. Whatever the preposterous practices of our ancestors during the past two centuries, the best of them certainly have not trusted blindly to their own remedies nor, like quacks, boasted their virtues.

And then that paying fifty pounds for a secret remedy ! The remedies are curious and amusing, if you choose, but

" Francis H. Brown, M.D., The Practice of Medicine in New England before the year 1700, in manuscript.

they show us how far removed as yet was medicine from science.

Truly that was an era of barbarism, though it struggled towards the light. Harvey was living and Descartes. The truth was being sought, but as yet, for us in rude America, crudeness and error reigned.

So Deacon Fuller died. The records note two other facts. For near a hundred years the births of children were supervised by women — midwives they called them. Some sort of skill, perhaps, they had. And largely medicine was held in part the work of ministers, and statesmen took a hand. The Massachusetts exodus was thoughtfully prepared. In planning emigration, the clergy sought to learn their duty to the body as well as to the soul. " Medical missionaries" would be our term. Highly trained and scholarly the records call them ; doubtless they were, but we have gleaned some knowledge of the science of that day. The statesman, trained in medicine, who interests us most was John Winthrop, Jr., who was born in 1605 and in 1657 became Governor of the New Haven Colony. Harvey's contemporary almost, he studied medicine before his coming here, perhaps with that great master. Of good repute in science, let us think, because he became a founder of the Royal Society.

It is hard to say what may have been the medical service and value of Winthrop to the colonists, but it would seem that, like Endicott and Winslow, the latter of whom is also reckoned among the doctors, he Avas rather a Board of Health and a general supervisor than a constant active practitioner, summoning other physicians in time of stress and taking their advice.