The origins of medical theory and practice in this nation extend
further than the settlement at Jamestown in 1607. Jamestown was a seed
carried from the Old World and planted in the New; medicine was one of
the European characteristics transmitted with the seed across the
Atlantic. In the process of transmission changes took place, and in the
New World medicine adapted itself to some circumstances unknown to
Europe; but the contact with European developments in theory and
practice was never--and is not--broken.
Because of this relationship between European and American medicine, an
acquaintance with seventeenth-century European medicine makes it
possible to give additional support to some of the information in the
early sources about medicine in colonial Virginia. In addition,
knowledge of the European background allows reasonable speculation as
to what happened in Virginia when the early sources are silent.
In discussing the background for American medicine it is not necessary
to make a firm distinction between England and the rest of Europe. As
today, science--in this case, medical science--frequently ignored
national boundaries. The same theories relative to the structure of the
body (anatomy), to the functions of the organs and parts of the body
(physiology), and to other branches of medical science were common to
England and Europe. Medical practice, like theory, varied but in detail
from nation to nation in Western Europe.
Seventeenth-century Europe relied heavily upon ancient authority in the
realm of medical theory. The European and colonial Virginia physician,
surgeon, and even barber (when functioning as a medical man)
consciously or unconsciously drew upon, or practiced according to,
theories originated or developed by Hippocrates (460-377 B.C.) and
Galen (131-201 A.D.). Hippocrates is remembered not only for his
emphasis upon ethical practices but also for his inquiring and
scientific spirit, and Galen as the founder of experimental physiology
and as the formulator of ingenious medical theories. Most often
Hippocrates was studied in Galen's commentaries.
No longer do scholars or physicians scoff at the ancient authorities
who dominated medical thinking for so many centuries. The
seventeenth-century physician striving to reduce the frightful inroads
that disease made into the colony at Jamestown may have been
handicapped by the erroneous doctrines of the gossamer-fine _a priori_
speculation of Galen, but the physicians to a large extent practiced
according to a science rather than to superstition and magic--because
the voluminous writings of Galen survived the centuries. Nor would the
European physician, or his Virginia counterpart, have demonstrated the
same appreciation for close observation if Hippocrates had not still
been an influence.
In the realm of pathology (the nature, causes, and manifestations of
disease) the humoral theory, with its many variations, was extremely
popular. The humoral doctrines stemming largely from Hippocrates were
made elaborate by Galen but were founded upon ideas even more ancient
than either thinker and practitioner. As understood by the
seventeenth-century man of medicine, the basic ideas of the humoral
theory were the four elements, the four qualities, and the four humors.
The elements were fire, air, earth, and water; the four qualities were
hot, cold, moist, and dry; and the four humors were phlegm, black bile,
yellow bile, and blood. From these ideological building stones a highly
complex system of pathology developed; from it an involved system of
treatment originated. In essence the practitioner of the humoral school
attempted to restore the naturally harmonious balance of elements,
qualities, and humors that had broken down and caused disease or pain.
The seventeenth-century, however, witnessed in medicine the trend,
manifest then in so many fields of thought, away from an uncritical
acceptance of the authority of the past. It also saw a defiant denial
of ancient authority among those more radically inclined, such as the
disciples of the sixteenth-century alchemist and physician, Paracelsus.
Although some of his practices and teachings were based on the
supernatural, Paracelsus stressed observation and the avoidance of a
mere system of book-learning.
Practice lagged behind new scientific theory in medicine but Virginia
must have felt at least the reverberations caused by the clash of the
ancient and the new.
An important new school of medical theory was the iatrophysical or
iatromathematical (_iatros_ from the Greek--physician). This medical
theory--as is the case with many scientific theories-was borrowed from
another branch of science. The seventeenth century, the age of Isaac
Newton, Galileo Galilei, Gottfried Wilhelm von Leibnitz, Rene
Descartes, and other giants of physical science, was a period of
remarkable progress in the field of physics. It is not surprising then
that theorists in the field of medicine, noting the truths discovered
by conceiving of nature as a great machine functioning according to
laws that could be expressed in mathematical terms, should have
attempted to explain the human body as a machine.
William Harvey (1578-1657), whose name looms great in the history of
seventeenth-century medicine, explained the circulation of the blood in
mechanical terminology. To Harvey, working under the influence of the
great physicists, the heart was a mechanical force pump and the blood
was analogous to other fluids in motion. How many physicians,
practicing in the same intellectual environment as this Englishman,
must have carried the mechanical analogy to the extent of thinking of
the teeth as scissors, the lungs as bellows, the stomach as a flask,
and the viscera as a sieve?
The iatrochemical school existed alongside the iatrophysical. Whereas
the iatrophysical thought primarily in terms of matter, forces, and
motions, the iatrochemical thought chemical relationships were
fundamental. One of the founders of this school, the Dutch scientist
Sylvius (1614-72), explained diseases chemically (an approach not
completely unlike the humoral of Galen) and treated them on the basis
of a supposed chemical reaction between drug and disease. Another
leading figure in the iatrochemical school, Thomas Willis (1621-75),
was an Englishman. These two advocated the use of drugs at a time when
their respective nations were developing great colonial empires rich
with the raw materials of pharmacology.
However, it would be an error to think of the medicine of the period,
either European or Virginian, only in terms of rational or scientific
theories. Treatment was too often based on magic, folklore, and
superstition. There were physicians relying upon alchemy and astrology;
the Royal Touch was held efficacious; and in the _materia medica_ of
the period were such substances as foxes' lungs, oils of wolves, and
Irish whiskey. Nor should it be forgotten that many of the sick never
saw a medical man but relied upon self-treatment.
With theories from the ancient authorities and from experimenting
scientists to draw upon, the practicing physicians could deduce
therapeutic techniques or justify curative measures, but the emphasis
on theory brought with it the danger of ignoring experience and
abandoning empirical solutions. Aware that many of his fellow
physicians tended to overemphasize theory Thomas Sydenham (1624-89),
who received his doctorate of medicine from Cambridge University,
recommended personal experience drawn from close observation. He
scoffed at physicians who learned medicine in books or laboratory, and
never at the bedside. His study of epidemics, his emphasis on geography
and climate as casual factors in the genesis of disease, make this
Englishman's views and practices especially relevant to the medical
history of Virginia where geography and climate did play such important
roles in the life of the colony.
The history of surgeons and surgery during the century is less
distinguished than that of the physician and his practice. Surgery
produced no individuals of the stature and significance of Sydenham nor
any revolutionary theories as important as Harvey's. Dissections were
made but the knowledge acquired was not applied; amputation was common
but not always necessary or effective.
Battle wounds and injuries lay in the province of the surgeon. While
the surgeon was primarily concerned with the military, using mechanical
force (cutting, tying, setting, and puncturing) in his treatment of
body wounds and injuries, physicians on the Continent and in England
also filled these functions. For example, physicians in Italy sometimes
performed surgical operations they considered worthy of their dignified
positions, and in England the licensed physician could practice
surgery. On the other hand, surgeons licensed by Oxford University were
bound not to practice medicine. Both in France and in England surgeons
and barbers held membership in the same guild or corporation, and
physicians considered them of inferior social status. The American
frontier tended to reduce such professional and social distinctions.
In Europe and England, where medical education was institutionalized to
a far greater extent than in colonial Virginia, education explains much
of the difference in social status between physician and surgeon. The
surgeon learned by apprenticeship to an experienced member of his guild
while the physician had to meet certain educational and professional
requirements, depending upon local or national law. The best medical
education of the period could be had at the great centers of Leyden,
Paris, and Montpellier. Cambridge and Oxford also offered a degree in
medicine.
Englishmen preferred to study medicine abroad--according to a recent
study made by Phyllis Allen and printed in the _Journal of the
History of Medicine and Allied Sciences_--because a better education
could be obtained there in the same number of years. The Doctorate of
Medicine required fourteen years of undergraduate and post-graduate
study at Oxford; the Cambridge requirement was similar. Despite reforms
during the seventeenth century, education at these universities
remained dogmatic and classical. Students usually found their studies
dull and their social life stimulating. The more enterprising students
could find the new ideas of the period in books not required in their
course of study. Cambridge, Oxford, and the Royal College of Physicians
all licensed physicians who had survived their education, met certain
professional requirements, and passed an examination.
That physicians in England did possess a high social status as well as
more extensive formal education is evidenced by a precaution taken by
the Virginia Company, to avoid causing displeasure among men of rank,
in preparing letters patent. The Company requested of the College of
Heralds, in 1609, the setting "in order" of the names of noblemen,
knights, and Doctors of Divinity, Law, and Medicine so that their
"several worths and degrees" might be recognized when their names were
inserted on the patents. Surgeons received no mention.
On the other hand, physicians and surgeons in England might well have
come from similar social backgrounds and even on occasions from the
same families. When there were three or four sons in the family of a
country gentleman, he might have followed the custom of keeping the
eldest at home to manage and eventually inherit the estate. The second,
then, would be sent to one of the universities in order to follow a
profession such as that of physician, lawyer, or clergyman. The third
might be apprenticed to an apothecary, surgeon, or a skilled craftsman.
This practice should be borne in mind when former medical apprentices
are found in high offices in Virginia; their origins were not always
humble.
Although the physician enjoyed the greatest social and professional
prestige, he received the most verbal abuse and criticism. Perhaps the
most damaging and galling satire of the century flowed from the pen of
the French dramatist, Moliere, who had a medical student--not
completely fictitious--swear always to accept the pronouncements of his
oldest physician-colleague, and always to treat by purgation, using
clysters (enemas), phlebotomy (bloodletting), and emetics (vomitives).
These three curative measures followed the best Galenic technique:
releasing corrupting humors from the body. Moliere's _Le Malade
Imaginaire_ confronted the audience with constant purgings and
bleedings, and the caricature was not excessive.
The diseases of the century did not allow for the inadequacies of the
physician, and imparted a grim note of realism to the satire of the
dramatist. Infant mortality was high and the life expectancy low.
Hardly a household escaped the tragedy of death of the young and the
robust; historians have sensed the influence omnipresent death had upon
the attitudes and aspirations of the European and American of earlier
centuries. School children today learn of such a dramatic killer as the
bubonic plague, but even its terrible ravages do not dwarf the toll of
ague (malaria), smallpox, typhoid and typhus, diphtheria, respiratory
disorders, scurvy, beriberi, and flux (dysentery) in the colonial
period.
England, and especially London with its surrounding marshes, suffered
acutely with the ague during the century. Englishmen arriving in the
New World were well aware of the dangers of this disease and made some
effort to avoid the bad air, and the low and damp places. In 1658 the
ague took such a toll that a contemporary described the whole island of
Britain as a monstrous public hospital. Unfortunately, Thomas Sydenham,
whose prestige in England was great and whose works on fevers were
influential, paid scant tribute to cinchona bark (quinine) which was
known but thought of, even by Sydenham, as only an alleged curative
offering too radical a challenge to current techniques. According to
humoral doctrine, fever demanded a purging, not the intake of
additional substances.
Unfortunately, public hygiene and sanitation enlisted few adherents.
Epidemics of the seventeenth century have been judged the most severe
in history. In Italy physicians ahead of their times proposed the
draining of marshes and pools of stagnant water, and recommended the
isolation of persons with contagious diseases. But it was the great
London fire of 1666 that rid that city of its infested and infected
places, not an enlightened municipality.
Therefore Virginia, a colony of seventeenth-century Europe, started
life burdened with a heritage of deadly and widespread disease and
inadequate medicine. Not only did the ships that brought the settlers
to Jamestown Island bring surgeons and medical supplies but also
medical problems frequently more serious than the men and supplies
could cope with.
The European or Englishman, however, did not originate the practice of
medicine in Virginia for the Indian had had to struggle with the
problems of disease and injury long before the seventeenth century.