THE PRACTICE OF DOMESTIC MEDICINEDURING THE COLONIAL PERIOD

L. G. Eichner, M.D.

This is a continuation of a presentation tothe History Club in November 2003

INTRODUCTIONIn the 1700s life expectancy was about 35years. Of course, that takes into account thehigh number of infant deaths. But only 35years of life was expected because of thestate of medical practice at that time, alongwith unchecked epidemics, an ignorance ofprinciples of contagion and sanitation, andthe regular ravages of smallpox, typhoid,yellow fever, measles, and the variety of fe-vers and fluxes—another term for diarrhea,or dysentery. Lice flourished, since bathingwas considered by many to be dangerous.

Injuries, sickness, and death were gener-ally viewed fatalistically—at least philoso-phically—as a manifestation of God's will.There was a morbid interest in illness anddeath that for many provided a break in theroutine of everyday life and material forconversation. Funerals were a social func-tion.

There are only a few written reports of howthings were in those days. The Amish, forexample, had written reports of buggy acci-dents and barn fires.

Many families lost children to disease, andgrim evidence of this can be found in localcemeteries. In one cemetery I visited youcould see families or areas in which childrenand infants had been ravaged by some dis-ease, and all because of woefully inadequateconditions. A high mortality existed withpregnancies and deliveries because onlyrelatives or midwives were available. Very

little was written about perinatal—care dur-ing pregnancy and delivery—problems. Phy-sicians in those times would examine thedead and then go right from there, withtheir dirty hands, to the delivery room orarea for the delivery of children. Purple sep-sis ran rampant.

It was hard to find an adult with a full setof teeth. Dental extractions and the settingof broken bones were performed by whoeverwas available.

In this geographic area, Quakers were con-sidered by outsiders to be a healthier thenaverage breed and were noted for their lon-gevity. During ill health, work generallywent on as usual. The urgency of the harvestand the scarcity of labor were motivatingfactors. Rarely did farmers send themselvesto bed while they were still able to work.You had to be really ill in those days to stopworking.

EARLIEST PRACTITIONERSThe chief medical person of the time was thehousewife, of whom there was no shortage.She was armed with a stock of superstitiousfolk remedies, family tales, Indian lore, andhomegrown herbs. Herb gardens were com-mon. She cared for the family andneighbors. She might have had access tonewspapers, almanacs and medical hand-books similar to the Merck Manual of today.There was a variety of English patent medi-cines available at drug and apothecarystores, plus local concoctions. During theWar, privateers provided British medicines,which were supplemented by ingenious

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American counterfeits, which I feel can beconsidered forerunners of today's genericdrugs.

Because of the uncertainty of medicine,quacks were numerous and, at least, suppliedemotional support. That's important. Theymay not have known anything but consolingsomeone was half the battle. The Welsh set-tlers in the Great Valley had a heritage ofmedical practice from Wales, where sur-geons, by the way, were separated from bar-bers in 1745. There were also Welsh wiz-ards—sounds like a clan of some type—whoemployed magic. In Valley Forge, a doctor,Abijah Stevens, was a self taught surgeon andpractitioner who had no formal trainingwhatsoever.

PHYSICIANSBy 1776, the colonies had 3000 to 4000 indi-vidual practitioners of medicine, 300 to 400of which had M.D. degrees and were usuallyin urban areas. These physicians with de-grees were, for the most part, postgraduatesof the University of Edinburgh in Scotland,which was a model for the first two medicalschools established in America during the co-lonial period.

Philadelphia was better supplied with phy-sicians than any other town. Between 1740and 1775, about 82% of them had studied inEurope and most had degrees. The supply ofphysicians in Pennsylvania was comparableto provincial England and a surprising num-ber were in country towns. The 300 to 400physicians were largely unlicensed as licen-sure procedures existed only in Europe. In1772, New Jersey passed a law for licensureexams to be conducted by the supreme courtof the state, but it was not fully implemented.

ECONOMIC ASPECTSThe cost of such care was not inexpensive,but even members of the laboring class couldafford it. Most physicians earned £100 to£200 annually—today £.55 equals $1.00—and were able to accumulate £500 of prop-erty. Some doctors accepted token paymentsfrom the poor and charged the rich higherfees, a longstanding English custom and one

which continued until recent years. A be-nevolent gesture was the Pennsylvania fund-raising drive to finance smallpox inoculationsof the poor, which was actually beneficial forall. If you cut down on the amount of small-pox of all, it was better for everybody.

FORMAL TRAININGTwo medical schools were established duringthe colonial period: the Medical Departmentof the College of Philadelphia—later the Uni-versity of Pennsylvania—in 1765, and KingsCollege—later Columbia University—in NewYork City in 1768. By 1776, only 51 degreeshad been conferred by these schools. Classeswere suspended because of the War. TheMedical College of Philadelphia was foundedby two prominent physicians named JohnMorgan and William Shippen, names I knowyou've probably heard. These men assumedimportant roles during the RevolutionaryWar but became adversaries in the processand never did reconcile their differences.

School was of two years duration, runningfrom November to June of each year. Thefirst year consisted of pre-clinical subjects inthe liberal arts, with mathematics, naturalhistory, a working knowledge of Latin, andpreferably French as well—somewhat similarto a pre-med course of today.

The second year included subjects in thefollowing order: anatomy, materia medica—the use of medicines, botany, chemistry,physiology, pathology, and clinical medicinewith instruction, lectures, and, at the Collegeof Philadelphia, demonstrations with pa-tients at nearby Pennsylvania Hospital.

At the end of the second year, an examina-tion for the bachelor's medical degree wasgiven. This was followed by an additionalthree years of study and practice, which ledto a stiffer exam, a written exam in Latin,and a thesis which had to be defended beforethe faculty, much like with the Ph. D degreeof today.

APPRENTICESMost of the practicing physicians weretrained solely as apprentices' assistants—theywere called "doctor's boy"—and were ac-

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corded the same rights as those with collegetraining. They were almost universal in NewEngland. One of the first three professors ofHarvard Medical School, John Warren, ofBunker Hill fame, came from their ranks.Some even began their apprenticeships at theage of fifteen. According to Dr. BenjaminRush of Philadelphia fame, the only prereq-uisite was the ability to stand the sight ofblood.

After three to six years of apprenticeship toa physician, a certificate of proficiency wasawarded and recipients could begin to prac-tice medicine. Their strength was in the de-velopment of the practical bedside approachunder the eye of a father figure that is stillvery important today, but that we don't al-ways have now.

In cities such as Boston, New York, andPhiladelphia, apprentices were permitted tosit in on medical lectures. One element oftraining for physicians were cadavers or bodyparts snatched from graves for dissection.Usually, they were bodies of criminals, pau-pers, or an occasional soldier, which led tostern disapproval from General Washington.The bodies were secured at night on ceme-tery forays and those involved were known asnocturnal "Resurrectionists"—an appropriateterm. As an alternative, wax molds of bodiesor body parts with veins and arteries injectedwith wax became popular in Boston and evenwere observed by John Adams, second Presi-dent.

DRUGGISTS AND APOTHECARIESAn emerging profession in colonial Americawas that of druggist and apothecary entre-preneur. The druggists were only in the larg-est cities and prepared drugs for physicians.Apothecaries were far more numerous andwere found in large towns as well. Often theowners were physicians and, if the establish-ment was large enough, they might employ achemist to prepare the prescriptions. Theseshops were identified by signs showing a pes-tle and mortar and were very common.When I was in medical school, proper train-ing in pharmacy was the use of the pestle andmortar. The first written prescription was by

a physician, Abraham Chovet, from Philadel-phia, just prior to the Revolutionary War. Inaddition to prescription items, over-the-counter preparations made up of secretremedies were sold to many people and wereknown as "sovereign remedies" or "sure spe-cific." Shades of the medical hawkers of alater period, and to some extent today.

Even at the time of the colonial period, asin the present, concern was voiced aboutphysician-owned apothecaries. Dr. JohnMorgan felt the combination of apothecaryownership and physician was not in the bestinterest of curing patients, a situation whichhas been addressed in recent years.

HOSPITALSHospitals first appeared in America early inthe 18th century. They were basically built toconfine those with contagious diseases dur-ing epidemics, and were located primarily inseaport towns such as New York City, Phila-delphia, Newport, Rhode Island, andCharlestown, South Carolina.

Later in the 18th century, the almshousewas established solely for the poor of the cit-ies, since those better off financially chose tobe treated in their homes. These almshouseswere the first institutions to provide continu-ous care and were organized as acts of charityby individuals and occasionally by colonialgovernments. Their upkeep rested with thelocal governments. They had a multitude offunctions: care of the destitute and sick, asorphanages, for criminal incarceration, andfor confinement of the insane. The first onewas in Philadelphia, organized by WilliamPenn in 1713, and was originally started fordestitute Quakers. It's hard to believe thatthere were destitute Quakers.

The next type of hospital was the voluntaryhospital—a necessity for the growing and in-creasingly organized middle class, which de-manded better care than was given at alms-houses. They were generally started by phil-anthropic gifts with ongoing operations fi-nanced by voluntary contributions and pa-tients' fees—similar to today. The first suchhospital was Pennsylvania Hospital at 8thand Spruce Streets in Philadelphia, which

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was co-founded in 1751 by Dr. Thomas Bondand Benjamin Franklin, for "the inhabitationof strangers."

However, New York Hospital, founded in1775, was the first American hospital afterthe War to use systemized instruction withmedical students.

MEDICAL LITERATUREAt the onset of the Revolutionary War,American medical literature consisted of onemedical book by the professor of surgery atKing's College on the treatment of woundsand fractures. There were also reprints ofthree other medical works and twenty pam-phlets. There was a death of printed infor-mation at this time.

THEORIES AND PRACTICESThe first theory in medical practice in the co-lonial era—or preceding it, really—was a Gre-cian theory of humours, based upon bodilyfluids—blood, phlegm, black bile, and yellowbile. These must remain in balance for goodhealth. An excess was relieved by bleeding,purging, and sweating. A deficit was replen-ished by rest, diets, and medicinals.

Later on, in the 17th century, the humourtheory was replaced by one of acidity/alkalinity/saltiness/tension and relaxation.

This was followed, in the 18th century, bythe concept of nerve irritation, which couldalter bodily fluids and lead to illness. This ledto a massive and complex classification ofdiseases—a textbook. The symptoms werematched to the text to achieve the diagnosis.

A unity theory was proposed by a Scots-man, John Brown, who felt that good healthdepended upon a proper balance of nervestimulation to muscles and a blood vessel re-sponse. It is well known today that nervestimulation to muscle and blood vessel re-sponse does occur in some situations. Exces-sive stimulation triggered muscular spasm,which led to disease. Too little stimulationresulted in weakness and atony. This theoryprevailed at the time of the Revolution.

TREATMENTThe treatment for excessive nerve stimula-

tion with fever and infection was bleeding,purging, and vomiting, plus alcohol and diet.Local irritant stimuli were treated with skinblistering, oral mercury, and medicinals viathe mouth or rectum. Excessive irritabilitywas removed by bloodletting, generally up toone quart daily, or every second day. It wasthought at that time that the body containedtwelve, not six, quarts of blood. Lancing wasconsidered as important as today's ther-mometer is in the home. Even lay peopleused it. One physician stated that he neversaw a failure from bloodletting. It was saidthat George Washington had nine quarts ofblood drawn in twenty-four hours—if that'spossible—because of his pneumonia. So hedidn't die of pneumonia. He was bled out. Nowonder he died.

When I was a teenager, I knew of a druggiston Arch Street at the foot of the BenjaminFranklin Bridge, who advertised and soldleeches. This form of treatment followed theuse of bloodletting of the colonial days.

There's also some other things for treatingexcessive tissue irritability: blistering,counter-irritants, cataplasms—also calledpoultices, formentation—applications of hotmoist substances such as flannel with hot wa-ter, clysters—rectal administration of medi-cations, and so forth.

When tissue irritability was decreased, theattempt was made to build up nervous energyby administering anodynes such as opiumand laudanum, cathartics, purgatives, rube-facients—substances to irritate or redden theskin—stimulants and diet.

Medications used for tissue irritability wereanodynes, antiarthritics, antidysenterics suchas ipecac, blackberry wine, opium—a goodbowel blocker, antipyretics—also called febri-fuges because they reduced fever, and emet-ics to get rid of stomach illness—ipecac to in-duce vomiting. Often they would give youthese medications until your vomitus wasclear. Until you were laid out, almost. Theyhad medications to relieve muscular spasmand salivation. You could hold mercury inyour mouth until you stimulated saliva and,of course, stomach irritation—if you sur-vived. Sudorifics and diaphoretics produced

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perspiration and sweat. Sweatbaths, bor-rowed from the Indians, were also used forthis purpose.

You've all heard of diuretics. That's an inthing with medicine today too. In fact, it isconsidered the number one medication forhypertension. Diuretics were to increase theurine flow in dropsy—the old term for edema,or tissue swelling. Each illness was felt tohave a characteristic urine. Check the urine.It goes way back east. They even found diabe-tes by tasting urine and by continuing totaste urine to follow the course of the illness.

Bloodletting, purging, and blistering wereused with any of the above. You could com-bine these things. And there was a diet of rec-ommended diuretic drinks: barley water, flaxseed tea, and watery gruel. The body mightalso be exposed to cool water and air to re-lieve fever. We do that today.

EPIDEMIC DISEASESSmallpox was the principal disease of thecentury and the only one with a proven pro-phylaxis—preventive treatment. During thewinter of 1777, General Washington orderedall soldiers and nearby civilians—these couldhave been the campfollowers, I don't know,but there certainly were enough of them—tobe pox-proofed. Only one in a thousandfailed to recover from the procedure. That is-n't bad, really, considering the alternative.

A non-seriously-ill donor would supplyclear serum from an early vesicle, which wasopened with a toothpick and scooped up witha quill. Then the recipient's skin would bescratched and the material introduced. Thisis similar to the way it's done, even today.These procedures were used until cowpoxwas discovered in 1798.

Typhus was also known as hospital or jail fe-ver because that's where you usually acquiredit. It was caused by an organism known as aRickettsia, a small little fellow—neither a vi-rus nor a bacteria—introduced into the bodyby the bite of a louse. Dr. Rush suspectedthat the louse was involved. The lice weretransferred from hospitals and militarycamps by blankets or clothing. Contributing

factors were considered to be the lifestyle ofthe colonists, poor health and diet, fatigue,the use of linen rather than woolen clothingin summers—heavier material was harder forthe louse to move through. Particularly sus-ceptible were drunks, convalescents, andblack people.

The characteristic lesion was petechiae-redspots which you've all seen, I'm sure—whichappeared diffusely on the skin. It was consid-ered an excessive stimulation disease andemetics were the usual therapy. Blacks wereconsidered to be particularly susceptible, be-cause their health conditions were poor. Theywere mistreated, of course, as slaves andtherefore their health problems were morerampant.

Typhoid, called malignant bilious fever, wasconsidered by some to be a disease like ty-phus, but with unknown differences in symp-toms and signs such as diarrhea and rose-colored spots on the chest and abdomen. Itwas spread by contaminated excreta, food,clothing, and bedding.

Dysentery—diarrhea and flux—was laterfound to be caused by the same organism asTyphoid. It was caused by drinking contami-nated water, eating bad food, exposure tocold air, and sleeping in wet clothing.

Diphtheria and scarlet fever were consideredto be the same disease. They were thought tobe from an "infection of the air," and notfrom other infected people. The treatment forsuch excessive stimulation was bleeding, likeGeorge Washington had. This was frequentlysublingual—beneath the tongue. They madeincisions underneath the tongue. The nexttime you stand in front of the mirror, turnyour tongue up, and see these little veins—that's what they used. A gargle of alum, dis-solved in honey and sharp vinegar, could beadded.

Colds included influenza or catarrh. Theywere thought to be caused by close contactand corrupt air, animal droppings, perspira-tion, stale clothes, unturned bedsheets,

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closed rooms, and a lack of exercise. Some ofthese things are apropos today.

get—they used it way back then—and used ituntil relatively recent years.

Yellow fever, also called The Great Sickness,The American Plague, Barbados Distemper,or Bilious Plague, was a virus carried by themosquito, Aedes aegypti. One epidemic oc-curred on Front Street in Philadelphia. It wasa frequent problem in seaports and southerncamps.

Prophylaxis consisted of a variety of meas-ures, including heating vinegar in bowls toproduce fumes to discourage mosquitos, theoral use of tobacco—cigars in the mouths ofwomen and children must have been a prettysight—handkerchiefs infused with vinegar orcamphor, chewing garlic and putting garlic inpockets and shoes, and also cleaning areaswith gunpowder—that would cure yellow fe-ver for sure, if you exploded.

A sensible step for those who could affordit, was to shift their residence outside the cityof Philadelphia to higher ground, such asFairmount Park. If you've ever taken a tourof the mansions of Fairmount Park, you'llhear how, in the summer, people would moveto the mansions of Fairmount Park to getaway from the low-lying city of Philadelphiaand from disease.

Dengue, also called "breakbone" fever, was ofviral origin and was also transmitted by themosquito, Aedes aegypti. The disease is char-acterized by severe back, hip, and leg pain.This became more prominent in World WarII at Fort Bragg, North Carolina, when it wascalled Fort Bragg fever, and young troopswould be incapacitated with it.

Malaria, called intermittent fever—and thatsort of describes it—was related to bad air inthose days because of the association withthe "exhalations of marshes." It was distin-guished from yellow fever and dengue by theperiodic onset of chills and high fever. Ifyou've ever seen anybody suffering from ma-laria, what they go through is something youwill never forget. Again, mosquitoes were thevector and carried the organism, Plasmo-dium. The therapy, quinine bark, was on tar-

Venereal Disease was a very vague subject atthat time. It was conveyed by European sol-diers; something they shared with us. Thetreatment was oral saltpeter and sumac root,or a mixture of salts and turpentine.

Consumption, or tuberculosis, was not un-derstood at the time and was one of the worstdiseases that could befall anyone. It wasmore common in women and I don't know ifit was because women were more of the care-taker type and therefore more associatedwith disease and people who were sick. Idon't know.

Dental deterioration was extremely common.Rotten teeth were pulled by anyone who wasavailable. Herbs were used as well, especiallywith associated gum infections. These rottenteeth would cause gum infections or gingivi-tis. They'd try to put something on it and tryto make it feel better. It was awfully painfulto yank the rotten teeth out of the gums.They would use herbs for that.

Stress has always occurred in times of uncer-tainty, and it was also manifested in 1774 and1775. At that time it was related to awaitingthe results of a petition to the King with re-gards to a possible reconciliation—or war. InPhiladelphia a large number of cases of apo-plexy—loss of consciousness—were reported.Even a member of Congress, PeytonRandolph, was affected. Suicides, in fact,during the colonial period were not uncom-mon, and were usually accomplished byhanging.

That is my story of a period of time known asthe Revolutionary War in colonial times.Philadelphia was a hotbed of medicine inthose days and still continues to be.

Comment: A hundred years from now, themedicine we have today will look OK.Reply: I envision no surgery being done, not

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as we know it today. We'll be treated exter-nally. Radiation will be used. You won't haveto have an operation for gall bladder or re-moval of the appendix. Cancer will be im-proved upon. Also, obstruction of the bowels.I just think that's what's going to happen.There are good days ahead.

Comment: Regarding the history of anesthe-siology. During the Revolutionary War, ifthere was surgery, they would just use alco-hol. The first use of an anesthetic was duringthe Civil War. Alcohol was the first anes-thetic.Reply: Yes, it was easier to just get themdead drunk. A dentist used the first anes-thetic.

Question: How did they figure out thatsomething abnormal in the body was causingsmallpox. They figured out that germs werecausing it, but the germ theory wasn't devel-oped until much later. How did they connectthe dots?Reply: They didn't. It took people like LouisPasteur to get that going. Air and vapors-humours as they called it—was what theythought caused it. Or divine intervention.

Comment: With smallpox, they observedthat the dairy girls did not get it. That's howthey made that connection and developedcowpox.Reply: It was the Dutch that invented micro-scopes, but it takes a while to connect things.In the San Gabriel Mountains in California,there's a nature trail you can take featuringnative herbs. It's amazing what the Indiansknew—far more than the white man. Whatthey knew about illness was just by observa-tion.

Question: The Chinese believe in yin andyang. This kind of ties into, maybe, those"humours." If so, is there a good basis for yinand yang?Reply: I don't know enough about it, but I doknow that they are opposing forces and Iknow that some people believe in it andblend Chinese and American medicine. The

use of acupuncture, for example. We have aphysician at the hospital who performs acu-puncture. Is it a cult? I don't know. Some-times it takes a while to establish whethersomething works or not. I don't know. Itseems to be an idea that's been around forcenturies. It must work for the Chinese sothere's probably something to be said for it.

Comment: I ran into an interesting storyabout the dissection of cadavers. It wasfrowned upon, but occasionally, it was legal.A building was built in Baltimore specificallyfor the purpose of dissecting cadavers; builtconveniently next to a large cemetery. Thenocturnal resurrectionists would steal thebodies from the graves and put them in bar-rels of whiskey to preserve them, presuma-bly, until they could be smuggled into theback door of this place and be used by thephysicians. And what happened to that whis-key? It was sold to the poor people. That'show we got the term rot-gut whiskey.Reply: Speaking of preservatives, I can re-member the cadavers we had in medicalschool. I don't know what they were pre-served in—maybe methyl alcohol or formal-dehyde and something else. It was so strongthat our fingers would shrivel. And thefumes. . . .

SOURCE

C. Keith Wilbur. Revolutionary Medicine: 1700-1800. Chester, CT.: The Globe Pequot Press,1980.

Dr. L. G. "Skip" Eichner's relatives came to theUnited States through the port of Baltimore. Theywere German. One later served in the Civil War.Skip received his medical degree from ThomasJefferson Medical College in 1954. This waspresented at the April 25, 2004 meeting of theTredyffrin Easttown History Club. It was tran-scribed by Bonnie Haughey.

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