No seventeenth-century physician could function without a variety of
drugs (medicines) to dispense. Dr. Pott made special arrangements--for
example--to have a chest of drugs transported with him from England to
America, and the effectiveness of Dr. Bohun's "physicke" drew the
praise of the colonists. Drugs were essential to the physician and a
valuable commodity for export, as well. The subject of drugs must then
include a discussion of their use as medicines and their importance as
items of trade.
A study of the drugs in use and the occasions of their utilization
makes manifest the great part that freeing the body from corrupting
matter played in the treatment of disease. The theorists and clinical
physicians of the century placed such faith in the humoral doctrine
that, on the basis of this predilection, much of the opposition to
cinchona, or quinine, in a period greatly troubled by malaria, can be
explained. Cinchona, discovered in Spanish America and known in
seventeenth-century Europe, had demonstrable effects in the treatment
of malaria but, because it was an additive rather than a purgative,
physicians rejected it on theoretical grounds. Its eventual acceptance
later revolutionized drug therapeutics, but this revolution did not
affect seventeenth-century Virginia.
The emphasis that the contemporary medical men placed upon the purging
of the body--the vomiting, sweating, purgings of the bowels, the
draining, and the bleeding--cannot be considered irrational or quaint.
In the light of observation and common sense, to purge seemed not only
reasonable and natural but in accord with orthodox doctrine as well.
Observation revealed that illness was frequently accompanied by an
excess of fluid or matter in the body, as in the case of colds,
respiratory disorders, swollen joints, diarrheas, or the skin eruptions
that accompanied such epidemic diseases as the plague or smallpox.
Common sense dictated a freeing of the body of the corrupt or
corrupting matter; drugs were a means to this end.
The use of drugs for vomiting, sweating, and other forms of purging
seems excessive in the light of present-day medical knowledge, and at
least one seventeenth-century Virginia student of medicine also found
such use of drugs by his contemporaries open to criticism. In the
opinion of the Reverend John Clayton, Virginia doctors were so prone to
associate all drugs with vomiting or other forms of purging that they
even thought of aromatic spirits as an inferior "vomitive." He
concluded that these physicians would purge violently even for an
aching finger: "they immediately [upon examining the patients] give
three or four spoonfuls [of _crocus metallorum_] ... then perhaps
purge them with fifteen or twenty grains of the rosin of jalap,
afterwards sweat them with Venice treacle, powder of snakeroot, or
Gascoin's Powder; and when these fail _conclamatum est_."
The list of drugs used was extensive and each drug had a considerable
literature written about it explaining the various sicknesses and
disorders for which it was a curative. Libraries of the Virginia
physicians and of the well-to-do laymen usually included a volume or
two on the use of drugs. Among the most popular plants, roots, and
other natural products were snakeroot, dittany, senna, alum, sweet
gums, and tobacco.
Dittany drove worms out of the body and would also produce sweat
(sweating being another popular method of purging the body of
disease-producing matter). The juices of the fever or ague-root in beer
or water "purgeth downward with some violence ... in powder ... it only
moveth sweat." (Following Galen's system of classifying by taste, this
root was bitter, therefore thought dry. The physician would administer
such a drying agent when attempting to reduce excess moistness in the
body--and thus restore normal body balance, in accord with contemporary
humoral theory.) Snakeroot, another of the popular therapeutics,
increased the output of urine and of perspiration; black snakeroot,
remedying rheumatism, gout, and amenorrhea, found such wide usage
during the last half of the seventeenth century that its price per
pound in Virginia on one occasion rose from ten shillings to three
pounds sterling. Although King James I of England saw much danger in
tobacco, others among his subjects attributed phenomenal curative
properties to it. One late sixteenth-century commentator on America
recommended it as a purge for superfluous phlegm; and smokers believed
it functioned as an antidote for poisons, as an expellant for "sour"
humors, and as a healer of wounds. Some doctors maintained that it
would heal gout and the ague, act as a stimulant and appetite
depressant, and counteract drunkenness.
The full significance of these drugs in the medicine of the period can
be better appreciated by reference to a prescription for their use, in
this instance a remedy for rickets, thought typical by historian Thomas
Jefferson Wertenbaker:
Dip the child in the morning, head foremost in cold water, don't
dress it immediately, but let it be made warm in the cradle & sweat
at least half an hour moderately. Do this 3 mornings ... & if one
or both feet are cold while other parts sweat let a little blood be
taken out of the feet the 2nd morning.... Before the dips of the
child give it some snakeroot and saffern steep'd in rum & water,
give this immediately before diping and after you have dipt the
child 3 mornings. Give it several times a day the following syrup
made of comfry, hartshorn, red roses, hog-brake roots, knot-grass,
petty-moral roots; sweeten the syrup with melosses.
But drug therapy was not always as simple as that recommended for
rickets, although the evidence is that in Virginia the high cost of
importing the rarer substances inclined local physicians toward the
less elaborate compounds. Venice treacle, recommended by the Reverend
Clayton's imaginary purge enthusiast consisted of vipers, white wine,
opium, licorice, red roses, St. John's wort, and at least a half-dozen
other ingredients.
Because their use was so extensive in Europe and because many brought a
good price, any discussion of drugs in seventeenth-century Virginia
should take note of the efforts in the colony to find locally the raw
materials for the drugs both for use in Virginia and for export. The
London Company actively supported a program to develop the drug
resources of the New World, and the hope of finding them had originally
been one of the incentives for the colonization of Virginia. Even as
early as the sixteenth century, authors and promoters in England of the
American venture had held up the promise of a profitable trade in
drugs--sassafras, for example--as a stimulus for exploration and
colonization. Sassafras had market value as it was widely used in cases
of dysentery, skin diseases, and as a stimulant and astringent; French
warships searching for loot off the shores of the New World had often
made it the cargo when richer prizes were not to be had.
Like gold, sassafras diverted labor during the crucial early period at
Jamestown from the tasks of building and provisioning. Sailors and
settlers, both, took time off to load the ships with the drug which
would bring a good price in England.
The belief that the exporting of drugs would prove profitable for the
colony in Virginia and for the Company may explain why two apothecaries
accompanied the second group of immigrants who arrived in 1608. Someone
had to search out and identify possible drugs, and a layman could not
be expected to perform a task requiring such specialized knowledge. The
apothecaries could further serve the new settlement by helping to
supply its medicinal needs.
Before the drug trade in Virginia could be developed, and at the same
time adapted to the over-all needs of the colony, attention had to be
given to the use of drugs to meet the immediate needs of the settlers.
Dr. Bohun, who had brought medical supplies in 1610 and soon found them
exhausted, turned resourcefully to an investigation of indigenous
minerals and plants. He investigated earths, gums, plants, and fruits.
A white clay proved useful in treating the fevers (the clay of the
Indians used for "sicknesse and paine of the belly"?); the fruits of a
tree similar to the "mirtle" helped the doctor to face the epidemics of
dysentery.
The colonists also needed a wine which could be produced cheaply and
locally. Many of them, accustomed to beer and wine regularly,
complained of having to rely upon water as a liquid refresher.
According to one of their number, more died in Virginia of the "disease
of their minds than of their body ... and by not knowing they shall
drink water here." One enterprising alchemist and chemist offered to
sell the London Company a solution for this problem: the formula of an
artificial wine to be made from Virginia vegetables.
After the colony seemed no longer in danger of perishing from its own
sicknesses--or going mad from having to drink water--the Company urged
the settlers to develop an active trade in medicinal plants, in order
to help cure the diseases of England and the financial ills of the
Company. The London Company, in a carefully organized memorandum,
advised the colonists what plants had export value and how these plants
should be prepared for export:
1. Small sassafras rootes to be drawen in the winter and dryed and
none to be medled with in the sommer, and it is worthe 50 lb. and
better per tonne.
2. Poccone to be gotten from the Indians and put up in caske is
worthe per tonne 11 lb. 4. Galbrand groweth like fennell in
fashion, and there is greatest stoare of it in Warriscoes Country,
where they cut walnut trees leaste. You must cut it downe in Maye
or June, and beinge downe it is to be cut into small peeces, and
brused and pressed in your small presses, the juice thereof is to
be saved and put into casks, which wilbe worthe here per tonne, 100
lb. at leasts. 5. Sarsapilla is a roote that runneth within the
grounds like unto licoras, which beareth a small rounde leafe close
by the grounds, which being founde the roote is to be pulled up and
dryed and bounde up in bundles like faggotts, this is to be done
towards the ende of sommer before the leafe fall from the stalk;
and it is worthe here per tonne, 200 lb. 6. Wallnutt oyle is worth
here 30 lb. per tonne, and the like is chestnutt oyle and
chechinkamyne oyle.
The Company's plan for the gathering, storing, and shipping of drugs
was supplemented by a project indicating foresight and an early form of
experimental research for the development of new products. In 1621 it
planned thorough tests of an earth sent from Virginia in order to
determine its value as a cure for the flux. In addition, the Company
planned to test all sweet gums, roots, woods, and berries submitted by
the colonists in order to ascertain their medicinal values.
In regard to the sale and dispensing of drugs in Virginia, whether
found locally or imported, frequent references to the apothecary
supplies and utensils in the possession of Virginia physicians lead to
the conclusion that they were usually their own druggists.
As has been noted, the sale and dispensing of drugs usually culminated
in their use--in accordance with the theory of the period--as means of
purging the body. Drugs, however, did not have a monopoly in this
greatly emphasized aspect of medical practice because the clyster
(purging of the bowels, or enema) and phlebotomy (bleeding of the vein)
could be used as well. These two methods might be classified as
mechanical in nature as contrasted with the essentially chemical action
of the drugs.
Moliere, in his seventeenth-century satires on the European medical
profession, ridicules the excessive use of the clyster. The popularity
of the phlebotomy then is attested to by the notoriety of this
technique today. (Rare is the schoolboy who does not think that George
Washington was bled to death.) There is no reason to doubt that the
clyster and phlebotomy enjoyed as wide usage in colonial Virginia as in
Europe, but the evidence surviving to prove this assumption is slight.
Dr. Blanton, the historian of medicine, could find only meager
references to the use of clyster (or glyster) and he sums them up as
follows:
Among the effects of Nathaniel Hill was '1 old syringe.' In York
County records we find that Thomas Whitehead in 1660 paid Edmond
Smith for '2 glysters.' George Wale's account to the estate of
Thomas Baxter in 1658 included a similar charge. George Light in
1657 paid Dr. Mode fifty pounds of tobacco for 'a glister and
administering.' John Clulo, Francis Haddon and William Lee each
presented bills for similar services.
The survival of such meager evidence for what was probably a common
practice indicates the difficulties confronting the historian of
medicine. Nor has Dr. Blanton been able to find, as a result of his
research, any more evidence of phlebotomy although, again, its
utilization must have been widespread. Blanton sums up his evidence for
bleeding as follows:
Dr. Mode's bill to George Light includes 'a phlebothany to Jno
Simonds' and 'a phlebothany to yr mayd.' Dr. Henry Power twice bled
Thomas Cowell of York County in 1680, and Patrick Napier twice
phlebotomized 'Allen Jarves, deceased, in the cure of a cancer of
his mouth.' Colonel Daniel Parke in 1665 rendered John Horsington a
bill for 'lettinge blood' from his servant; and we find Dr.
Jeremiah Rawlins and Francis Haddon engaging in the same practice.
The horoscope often determined the proper time for bleeding and
notations have been found in an early American Bible recommending the
days to, and not to, bleed. Although medicine today looks askance at
astrological medicine and bloodletting, it remains difficult to explain
the widespread popularity of such practices unless the patients enjoyed
some beneficial results, psychological or physical.
Drug therapeutics, clysters, and bloodletting did by no means exhaust
the seventeenth-century physician's treatments and remedies. The works
of European painters of the century remind us of uroscopy or urine
examination. One of the outstanding paintings illustrating the
technique is by artist Gerard Dou who has the young doctor intently
examining the urine flask while taking the pulse of a pretty young
lady. Unfortunately, such revealing pictorial representations of life
and medicine in colonial Virginia do not exist.
On the other hand, in Virginia, the Reverend John Clayton displayed a
distinct flair for the scientific method in his analysis of urine. It
is safe to assume that his techniques were of a higher order than those
usually associated with uroscopy. Clayton, not satisfied to practice
just the art of observation, utilized the science of comparative
weights hoping to find diseases distinguished by minute variations in
the specific gravity of the liquid. He thought he could find
manifestations of "affections in the head" by his careful weighing and
study; manifestations not uncovered by visual observations alone.
In Gerard Dou's painting, it is to be remembered, the doctor not only
examined the urine but also took the pulse--another common practice.
This is not surprising insomuch as Galen--the great and ancient
authority--had written enough to fill sixteen books on the subject of
"pulse lore." Despite the facts that physicians centuries later
continue to take the pulse, they would not find the theories behind the
seventeenth-century practice acceptable. Galen's deductions have since
been described as fantastic, and his attempt to associate a specific
type of pulse rate with every disease futile. Yet the Virginia
physician, when he did take his patient's pulses, certainly did not
lose his or her confidence by gravely considering the mysterious
palpitation.
The physician with his many techniques and remedies did not restrict
himself solely to the illnesses of the sane for--contrary to popular
belief today--some effort was made to treat and cure the mentally ill.
America's first insane asylum was not established until 1769, but the
insane had received, even before this, medical attention. If the case
did not respond to treatment and took a turn toward violence,
confinement under conditions that would now be considered barbarous
often resulted. Before this extreme solution of an extreme problem
recommended itself, however, the mentally ill might be purged. The
intent was to relieve the patient of insanity-producing yellow and
black bile. The belief that this type of sickness would respond to
conventional treatment, however, did not completely dominate the
theories on insanity; some seventeenth-century authorities considered
insanity not an illness but an incurable, disgraceful condition.
One of the fullest accounts of a case of insanity in
seventeenth-century Virginia describes the plight of poor John Stock of
York who kept "running about the neighborhood day and night in a sad
distracted condition to the great disturbance of the people." The court
authorities ordered that Stock be confined but provided such "helps as
may be convenient to looke after him." The court, in a sanguine mood,
anticipated the day when Stock would be in a better condition to govern
himself.