Medicinal Development During The 17th-18th Century North America

In the 17th and 18th century colonial North America, medical development was more of an afterthought amidst the turbulence and instability of the New World. Sickness, convalescence, childbirth, contagion, and death were ubiquitous events in association with the colonies. Factors of gender, race, and class influenced how colonists experienced these events. The medical profession was one of significance and deference in times of turmoil, with many

If one were to be alive during the 1600s-1700s, the average life expectancy was under twenty-five years. Various factors served as a contestant for the battle against one’s period of existence, such as disease and contamination. Smallpox, malaria, tuberculosis, pneumonia, influenza, among many others, were prominent agents of death. Along with that, wells for drinking water were often contaminated by nearby privies and unpenned animals, causing may illnesses. To fathom the medical practices centuries ago, it is crucial to understand the everyday lifestyle of the average colonist differing based on region. New England was settled by people who traveled across the Atlantic Ocean to escape poverty, persecution, and to gain religious freedom for themselves - Separatists and Puritans.

On the other hand, the Chesapeake region, namely Virginia was colonized for purposes of financial gain. The Jamestown colony was founded with the intent to discover riches, treasures, and gold. Despite the differences in intention, the hardships endured by the colonists of the New England colonies were analogous to those of the Chesapeake region. The settlers did not know how to live in the rugged wilderness, largely in part due to lack of experience and understanding of the environment and its resources. They faced many hardships such as harsh, bitter cold winters and knowing little about how to hunt or grow food on the new soil. In short, little effort was spent on furthering the development of the medical field simply due to greater issues to fret over.

In colonial times, homes did not have bathrooms or running water - instead, chamber pots served as toilets, with the contents poured outside. Unlike modern North America where bathing daily is common, bathing was a rare occurrence in the colonies, as most people believed that a layer of dirt was necessary to protect the body from illness. Drinking water was often brackish and contaminated by the waste from both humans and animals. Hospitals, colleges, and medical societies didn’t begin to make an impact on the medical world until the mid-1700s (CITE SOURCE), so doctors would train apprentices and didn’t need any formal certification or proof of education to call themselves medically trained professionals.

A majority of illnesses were treated at home without the help of a doctor, and oftentimes health care responsibilities would be directed to the housekeeper, plantation mistress or mother in the household. The reason being simply that most families lived far away from physicians. A supply of medicinal herbs and perhaps a journal of remedies was kept in the home, but when they failed, the local barber was often the next resort. Barbers would often bleed patients or remove abscessed teeth. Another important medical professional at that time was the apothecary, who made and administered various medicines and often performed all the same duties as a doctor. The assistance of a doctor was usually saved last for extremely ill patients.

During the 18th century, there were three main classes of the medical field professionals in England: physicians, surgeons, and apothecaries. Physicians were considered to be the elite among the three, holding medical degrees from universities and mainly serving the upper class, while surgeons and apothecaries gained training through a traditional apprenticeship. Contrasting with colonial America, physicians often practiced medicine, surgery, and apothecary together as needed. As the colonies grew and prospered, some could afford to be trained at the universities abroad and earn their official medical degree.

In 17th century America, there was no place for professional differentiation along European lines. Practical urgencies and the lack of physicians led to a melting together of the different professions. Most were (ship) surgeons, barbers, or apothecaries. Maryland inventories tend to describe all these as “physicians,“ although academic credentials are suspect. Medics engaged in general practice, surgery, dentistry, and drug selling, just like the British rural surgeon-apothecaries did. Even by the end of the 17th century, there was no differentiation of services along European lines. Often the American surgeon-apothecaries also had to engage in other professions to make ends meet. In the colony, midwives handled the obstetrical work; only in difficult cases were physicians consulted. They kept this “monopoly” until the second half of the 18th century. Midwives also served as nurses, pediatricians and often helped lay out the dead. Their training was largely based on folklore and experience.

Midwives at this time were considered doctors, and 40% of the physicians in the early colonies were women. In her article, 'All American Girl,' Susan Norwood writes: 'The women of colonial times were usually pregnant and caring for their young children. The second generation of colonial women had an average of about eight children. Childbirth was a fearful time for them. Death was an issue not to be dismissed with each birth. Childbirth was a communal affair attended by midwives and neighboring women.' Many colonials never attended a physician in their entire life, and doctors were not allowed to attend childbirth, except as a witness since birthing was a communal event. There were no hospitals and no care homes, resulting in reliance on family and the beginning of nursing.

With all the concerns of diseases, contamination, and short life expectancy, there were various methods of treatment - some beneficial, but many caused more harm than good. Herbal remedies were a major resource of medicine during the time, with an abundance of the colonists’ knowledge on herbalism stemming from Native Americans. The indigenous people were proficient in plants, herbs, and their medical uses. When the colonists befriended the natives, their “medicine cabinets” also expanded with new herbal remedies the natives brought them from the New World, leading to the main herbal movement.

Herbalism reached its first major peak in Europe in 1652, when Dr. Nicolas Culpeper published, “The English Physician” which was filled with roughly 300 herbs, drawings, and their medicinal usages. Many consider him to be the father of alternative medicine, while others deemed him as an uncritical quack and stargazer. His views on medicine clashed with the scholarly and scientific tenets of the 17th century. For example, he loved to prescribe garlic for tumors. Any physician from the orthodox camp who used an herbal preparation was labeled a “botanical practitioner” along with a quack. Orthodox physicians who adopted the practices of any conflicting medical “theories” were also called “irregulars.”

The site that was chosen for the founding of a colony often affected the health of its occupants. The southern colonies had trouble with malaria due to the humid climate. Approximately five people died daily of yellow fever in the colony of Charles Town, South Carolina. Charles Town was a port, and ships coming in brought the disease to this colony. Colonial doctors did not know that there were viruses and bacteria smaller than the eye could see that could make people sick. Some of these organisms were in the rivers from which they drank. An example of this was in Jamestown, where the water was contaminated causing dysentery and typhoid fever.

At this time, it was believed that everything in the universe was made up of the Greek concept of Four Elements: fire, air, water, and earth. Scholars thus concluded that the body contained four corresponding “humors:” blood (fire), phlegm (earth), black bile (water), and yellow bile (air). The interaction of the four humors explained differences between age, gender, emotions, and disposition, changing with the seasons, times of day, and life span. A physician’s job was to maintain a balance between the four humors, and create a homogenous internal environment. For example, if one had a cold (phlegm), the doctor would apply hot medicines, and even a diet of pepper (CITE).

In colonial times, an apothecary practiced medicine as a doctor through apprenticeship and would provide medical treatment through house calls, prescribe medicine, perform surgery, and serve as man-midwives (CITE). Some of the ingredients that were used in colonial remedies are the basis for modern medications, including chalk for heartburn, calamine for skin irritations, and cinchona bark for fevers. Later on, it was discovered that cinchona bark contains quinine for malaria and quinidine for cardiac conditions. Treatments were generally expensive and so individuals frequently diagnosed problems themselves and compounded medications guided by tradition, folklore, or domestic medical books. Headaches were often treated by vinegar of roses, a remedy made of rose petals steeped in vinegar and applied topically (CITE).

In reality, the common person brought along from Europe a history of self care. Many home remedies used then and are still used today. Yes, some are quite laughable, but many existed and were passed on because they worked. Unlike the orthodox medicine of the colonies which bullied its way into peoples’ lives, home remedies worked. Midwifery worked. Yes, the death of a woman giving birth or the death of the newborn was always a possibility, but when something works, it is used. Orthodox medicine, on the other hand, continued to be used because it was scholarly. It did not matter how many people died under its use. The patient died from the illness, not from the care. This was the firm stand of orthodox physicians. A physician was not judged by his successes nor by his failures, but rather by his erudition, scholarliness, and his cultivation.

The first internationally known American known Dr. Benjamin Rush was considered to be the Father of American Psychiatry, with his image on the seal of the American Psychiatric Association. When it came to treating the mentally ill, Rush did something truly unorthodox - he listened, took notes, and recommended against beating them and locking them away in small, filthy cells. He’s highly credited with how the mentally ill are treated now. Despite his clear achievements, Rush also devised several questionable inventions and is credited with roughly a thousand kills (CITE).

He was the first to believe that mental illness was a disease of the mind, and not a possession of the demons, and in turn, thought that it could be shaken from a person. Rush designed two mechanical contrivances to aid in the treatment of the ill: a Tranquilizer Chair and chairs that suspended from the ceiling, which swung the patient for hours. The belief at the time was that 'madness' was an arterial disease, an inflammation of the brain. The chair was supposed to control the flow of blood toward the brain and, by lessening muscular action or reducing motor activity, reduced the force and frequency of the pulse. It locked the patient up tightly and cut off all light to deprive them of any visual sensations, and came with an opening below allowing the patient to evacuate his/her bowels and a caretaker to change the pan without disturbance.

Both of Rush's devices were supposed to exert an influence in some way to circulation, which was believed to be essential to the successful treatment of the insane. In actuality, they did neither harm nor good. In his medical career, he also believed strongly in bleeding, purging/elimination, blistering, and giving patients mercury to cure diseases. Bleeding was thought to reduce inflammation and tension in the blood vessels. Despite no evidence that bleeding worked, the practice persisted for centuries. To achieve elimination, powerful purgatives, laxatives, and emetics were used to produce diarrhea or vomiting. For blistering, a glass cup was heated over a flame and applied directly to the skin and it would normally seep fluid.

Although no one knew that bacteria and other disease-causing microbes existed, it was clear that they did know something in the body had to be eliminated. These approaches fit well with the medicinal use of plants to make one urinate, sweat, vomit, or salivate since herbs were common in the environment surrounding the colonies. The belief caused dissension in the medical community during the Yellow Fever outbreaks, diving the orthodox from the unorthodox. Dr. Philip Syng Physick supported Rush's belief and when both contracted yellow fever during the epidemic of 1793, Rush bled himself and his friend. Both men recovered, although it is clear today that the bleeding played no part in their survival. As written in Culpeper’s preface, “Disease is undoubtedly the most fatal enemy of mankind,” all in all, disease and orthodox medicine took their toll on the early colonies.

Dr. David Caldwell was an influential Presbyterian minister, teacher, and physician in 18th century Guilford County. He gained most of his knowledge as a physician from studying medical books, observing traveling doctors, and corresponding with Dr. Benjamin Rush. This knowledge was used to treat his Buffalo and Alamance congregations and other members of the community. American colonists in the 1700s did not understand disease as we do today. They were not aware of the underlying causes of sickness, such as viruses or bacteria. They only saw the symptoms, such as fever, coughing, or soreness. In the minds of the American colonists, the symptoms of a disease were the disease. Malaria was termed “intermittent fever,” Typhus “ship fever” or “camp fever,” Influenza “winter fever,” Smallpox “the bloody pox,” and Dysentery “bloody flux.” (CITE)

The connection between astrology and medicine was equally important throughout the 17th century. It was commonly believed that because stars and planets influenced all life on earth, health and disease were also dependent on them. Thus, treatment was not only based on one’s temperament, but also on astrological data. Surgery was limited to structural emergencies as fractures, amputations and “cutting for stone.” Surgeons also took care of skin conditions but played no role in internal medicine. The study of anatomy involved the occasional examination of the bodies of criminals or suicides. In Europe, structured programs involving dissection evoked strong resistance.

In a time where people could or would not always turn to a qualified practitioner, many relied on home remedies. Housewives, as well as other practitioners, often had herb gardens that provided medicinal ingredients. Everyone in the 17th century, regardless of sex, class, or status, would have some form of working knowledge of herbal medicine and how to use it.