Eighteenth Century Medicine in Perspective
By Marjory E. Wienkop — 5th PA Regt.
Much has been said about the horrors, negligence, and somewhat medieval state of medicine during the American Revolution, but sometimes we forget to view it in the context of the times and within the limits of supply.
Many of the things we view as non-existent during this period, such as anesthesia, had actually been discovered or were on the verge of discovery. Operations were not done without at least an anodyne, or pain-killer, unless supply was exhausted. Doctors had many variations of opium compounds in liquid and solid forms including laudanum, a very popular spirit. William Brown's Parmacopoeia Simpliciorum of 1778 alone contains twelve variations of opium compounds. These were used whenever available. Some doctors and dentists still used hyoscyamine, or henbane, a hold-over from medieval times, in liquid and vapor states as the narcotic for surgery. Curiously enough, ether had already been discovered by the Swiss-German physician Paracelsus in the sixteenth century, and Joseph Priestly experimented with nitrous oxide, or laughing gas, by 1772, yet credit for the introduction of anesthesia into surgery would be given to Dr. Horace Wells of Hartford, Connecticut in 1844.
Part of the lack of medical advance was due to the unwillingness of the "learned" men of medicine (i.e., those that had attended medical schools of universities) to accept discoveries by non-diplomaed individuals. Theirs was a tight circle and physicians sought to maintain a degree of mystique. This is one reason physicians wrote and sometimes spoke in Latin, so the common person wouldn't be privy to their secrets. As a consequence, these physicians tended to be somewhat close-minded to outside discoveries. For example, scurvy, caused by a lack of vitamin C and a great bane of seamen and soldiers alike, was treated by the schooled physicians with something called "elixer of vitriol," consisting basically of sulfuric acid brewed with spirits of wine, aloes, myrrh, and English saffron. Most physicians realized it produced little effect, but continued to use it anyway, despite the fact that it was known that citrus fruit, fresh vegetables, scurvy grass (Cochlearia officinalis), beer made from young spruce tree shoots, and even pickled sauerkraut (used by Dutch sailors) made significant anti-scorbutics. But these were simple cures and preventatives; anyone could find them. There was no mystique. Frequently, physicians and apothecaries made compounds of a dozen or more ingredients that had no physically curative effects. They were no more than placebos or possibly even harmful to the patient.
Because the Europeans had easier access to medical schools in London, Edinburgh, and Paris, among others, more of them were diplomaed than in America, where the only medical school that existed was the Philadelphia Medical College. Only those with money and influence could afford to go overseas. As a result, less than three hundred out of the 3,500 physicians in America in 1775 were medical school graduates. The remainder were apprenticed to practicing physicians for three to seven years. When these physicians determined that their charges were capable of setting out on their own, the neophyte doctor was presented a document written by his mentor attesting to his credentials. There was, however, no unifying standard for being a qualified physician. Some doctors that volunteered for the military admitted that they hadn't the knowledge or experience to cope with what they were faced with.
On the other hand, many of the homegrown physicians had the benefit of a variety of herbal curatives learned from country folk healers and Native American Indians that the European doctors were not aware of or tended to ignore for reasons previously stated. These cures, however, actually had beneficial properties. Many of those medicinals still used today, such as aspirin (salicylic acid), derived from the salicin found in black willow bark, came from such humble sources. [As a note: there were herbalist physicians in Europe who were the followers of Galen of Pergamom (131-200 A.D.) whose chief opponents were the followers of Paracelsus (1493-1541 A.D.) who advocated chemical and mineral medicines. Debates raged continuously within the Medical Colleges as to who was right and who was wrong.]
The modus operandus of the time was to cure sickness and injury by observing the response of outward symptoms to pharmocological and/or mechanical stimuli. That is, a physician would apply a curative or a succession of curatives to, say, some swelling or irritation and observe which one produced a positive response. If one did, then that item or procedure would likely be repeated on every similar case that came the doctor's way, whether the underlying cause was the same or not.
Bacteria and other microbes had already been discovered in the seventeenth century, and one Athanasius Kirchner (1601-1680) insisted that these "beasties" he saw in his early microscope were the cause of infectious disease. He was discredited by his colleagues because their less-than-perfect instruments could not detect the organisms. It would not be until 1850 that studies of the pathologic nature of bacteria (and on a relatively large-sized bacteria of anthrax in horses and sheep at that) would be made.
As can be seen, pharmacology had not made great strides. Surgery was, however, advancing. Medical schools were no longer in fear of the church for violating corpses and dissecting them for study. Illustrated systematic textbooks of anatomy were being produced in the early eighteenth century. Stephen Hales (1677-1761) demonstrated the dynamics of blood circulation by stressing the capillary system. Giovanni Battista Morgagni (1682-1771) disposed of the ancient humoral theory of a simple morbid cause for all disease. The well respected English physician and teacher John Hunter (1728-93) performed a new method of closing off an aneurism, thus preserving the limbs of thousands of soldiers from amputation. Frenchman Pierre Fauchard (1678-1761) is considered the father of modern dentistry. He presented, in organized form, a treatise that covered the entire field of dentistry — anatomy, morphology, anomalies of tooth decay and prevention, as well as creating advanced dental prosthetics. The list of surgical advances during this period is long.
People have and will always trust physicians because we believe them to be thoroughly educated in the aspects of medicine and they will heal us to the best of their abilities and knowledge. We will endure painful treatments because they say it is necessary. It was the same then as it is now. Yes, there were still horrors in medicine during the eighteenth century, but in comparison to the previous century, it was truly an Age of Enlightenment, and we must view it in that perspective. In fact, consider this: The technological wonders of today's medicine will, in twenty or fifty years, seem just as archaic as those discussed here, as surgical procedures become non-invasive and virtually painless. Congenital diseases and defects may be prevented by gene manipulation. Cancer may not only be cured, but prevented. And each age will be more wondrous than the next.
Marjory E. Wienkop is an artist and dental technician and portrays a Regimental Surgeon with the Fifth Pennsylvania Regt.
Sources used in this work:
Brown, William. Pharmacopoeia Simpliciorum., Steiner & Cist, Phila. 1778.
Clark, Bigelow, Gross, Thomas, Billings. A Century of American Medicine., Burt Franklin, NY. 1876.
Duffy, John. The Healers: The Rise and Fall of the Medical Establishment., McGraw-Hill, NY. 1976.
Griggs, Barbara. Green Pharmacy — A History of Herbal Medicine., Viking Press, NY, NY. 1981.
Lust, John. The Herb Book., Bantam Books, NY., 1974.
Lyons, Albert S., M.D. Medicine: An Illustrated History., Harry N. Abrams Inc., Pub., NY. (?)
Ring, Malvin E., D.D.S. Dentistry: An Illustrated History., Harry N. Abrams Inc., Pub., NY. 1985.