Sunday, March 1, 2015

"Doctor, I'm Sick," or Medical Practice in Eighteenth Century America By Shirley Martin
     Believe me, you wouldn't want to be sick in eighteenth century America.
    In my time travel romance, "Dream Weaver," the hero--Christian--is a doctor in 1762. In preparation for writing this romance, I read as much as possible about medicine in the eighteenth century.
    Let's start with a few basics. The average life span was thirty-five years, the death rate appalling. Very few people lived to the advanced age where cancer or heart disease manifested themselves. Only a very high birth rate allowed America to grow. The average married woman had seven children.
    Infection was the most common cause of death. Most doctors at this time recognized the value of cleanliness. Although those little, squiggly "animals" under a microscope were fascinating to watch, no one connected the bacteria with infection. The germ theory lay far in the future.
    In the eighteenth century, a pregnant woman was considered sick and indisposed for nine months. She was to avoid dancing and exercise, not to mention sex, for the duration.(One wonders how often this last proscription was observed.) Post childbirth infection was a feared complication of giving birth. Here again, cleanliness, or lack of it,was an important factor. Very few people in rural areas could afford doctors' fees, and someone other than a doctor performed delivery, often not bothering to wash their hands first.
    Since so many people couldn't afford doctors' fees, quacks abounded "like the locusts of Egypt." In colonial America, anyone who wanted to practice medicine could do so. Most doctors were trained as apprentices. However, American medical students considered the medical school in Edinburgh, Scotland, to be the premier source of a medical education. The courses there included anatomy, surgery, chemistry, pharmacy, and theory. American students in Edinburgh were conscientious scholars and spent long hours every day in the study and discussion of medicine. In 1765, the College of Philadelphia became the first medical school in America. Students had to give their thesis for a medical degree in Latin. Thereafter, America required a more stringent background for the practice of medicine.
    Amputations had a high mortality rate, and fractures of the vertebrae were considered fatal. We've all heard the term "bite the bullet."  It means to endure what you have to endure. More crudely, it means put up and shut up. If you've ever visited a historical fort and seen the bullets with the teeth marks, you might be able to imagine the agony of a patient having his leg sawed off without benefit of an anesthetic.
    Apothecaries in Europe and America sought Indian herbal medicine for many diseases. Sassafras tea was prescribed for infection and rheumatism, besides moths and bedbugs.
    Back then, many people who lived near poorly-drained areas suffered from the ague, what we now know as malaria. They believed that a miasma from the swamps caused this disease. It would be a long time before people realized that mosquitoes caused this malady. Yet strangely, the remedy then is the same as what is used today--Peruvian bark, today's source of quinine.
    Warfare has always advanced surgery. Gunpowder forever changed the strategy and tactics of warfare and also the problem of wound treatment. With gunpowder, casualties greatly increased. Most likely, because of the high casualty rate, doctors were forced to ignore advice on cleanliness. Sickness, not battlefield wounds, caused over 90% of the deaths in America during the Revolution. The conditions in the medical hospitals and field hospitals were appalling--dirty straw to lie on, lice, filth, wounds left untended for days. No wonder so many men died.
    The one great contribution of eighteenth century medicine was the development and practice of smallpox inoculation. In the early stages of this practice, many doctors and clergymen strongly opposed this practice, considering it against the will of God. Over time, the practice became accepted, and by the end of the Revolution, the entire American army had been inoculated. Thanks must go to George Washington for this for he recognized the value of smallpox inoculation.
    Inoculation was the first step in a process that virtually eliminated smallpox worldwide. Later, Edward Jenner developed smallpox vaccine, using the crusts from cowpox to prevent smallpox.
    In the latter part of the eighteenth century, a Virginia gentleman spent hours riding over his plantation, inspecting his property, marking trees and making notes. It was a cold, rainy and blustery December day. Later, he ate his evening meal without changing out of his wet clothes. Within a day, he developed a fever and a sore throat. A firm believer in bloodletting (a common remedy at the time), he asked his overseer to draw some blood. His condition worsened, and eventually three doctors attended him. They drew even more blood, until half of his blood was drawn. Besides that, the doctors purged him and gave him an emetic to induce vomiting. Finally, he asked them to just leave him alone. And shortly after, George Washington died quietly and at peace. 
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