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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