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Acknowledgements and Bibliographical Note 77

European Background and Indian Counterpart to Virginia Medicine

EUROPEAN BACKGROUND

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 , to the functions of the organs and parts of the body , 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 consciously or unconsciously drew upon, or practiced according to, theories originated or developed by Hippocrates and Galen . 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.

In the realm of pathology 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 . 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, Ren? 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 , 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 , explained diseases chemically and treated them on the basis of a supposed chemical reaction between drug and disease. Another leading figure in the iatrochemical school, Thomas Willis , 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.

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 , 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 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.

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.

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 , smallpox, typhoid and typhus, diphtheria, respiratory disorders, scurvy, beriberi, and flux 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 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.

INDIANS AND THEIR MEDICINE

Seventeenth-century Americans found the medical practices of the Indians interesting enough to include descriptions of them in their accounts of the New World. The attitude of the authors of these early observations is a mixture of curiosity, wonder, and--on occasion--admiration.

Henry Spelman, one of the early colonists, wrote of Jamestown and Virginia as they were in 1609 and 1610. He described the manner of visiting with the sick among the Indians. According to Spelman, the "preest" laid the sick Indian upon a mat and, sitting down beside him, placed a bowl of water and a rattle between them. Taking the water into his mouth and spraying it over the Indian, the priest then began to beat his chest and make noises with the rattle. Rising, he shook the rattle over all of his patient's body, rubbed the distressed parts with his hands, and then sprinkled water over him again.

Like the colonist, the Indian tried to draw out blood or other matter from the sick or wounded person. The method often used for releasing the ill humor from a painful joint or limb must have caused considerable suffering but may have offered certain advantages in preventing fatal infection. If the affected part could bear it, the Indian thrust a smoldering pointed stick deep into the sore place and kept it there until the excess matter could drain off. Another technique for burning and opening had a small cone of slowly burning wood inserted in the distressed place, "letting it burn out upon the part, which makes a running sore effectually."

Still another method for treating a wound was for the priest to gash open the wound with a small bit of flint, suck the blood and other matter from it, and finally apply to it the powder of a root. A colonist in describing the practice wrote that "they have many professed phisitions, who with their charmes and rattels, with an infernall rowt of words and actions, will seeme to sucke their inwarde griefe from their navels or their grieved places." Judging by other accounts written during the century concerning Indian medicine, the powdered root may well have been sassafras, of which there was an abundance in the Jamestown area. The priest dried the root in the embers of a fire, scraped off the outer bark, powdered it, and bound the wound after applying the powder.

Not only did the native American resort to a crude form of bloodletting but he practiced sweating as well--which was also common to seventeenth-century European medical practice. In Captain John Smith's description of Virginia it was noted that when troubled with "dropsies, swellings, aches, and such like diseases" the cure was to build a stove "in the form of a dovehouse with mats, so close that a fewe coales therein covered with a pot, will make the pacient sweate extreamely."

Before lighting his stove, the Indian covered his sweating place with bark so close that no air could enter. When he began to sweat profusely, the sick Indian dashed out from his heated shelter and into a nearby creek, sea, or river. An Englishman commented that after returning to his hut again he "either recover or give up the ghost."

The Indians, like Moli?re's stage physician, believed in the value of the purge. Every spring they deliberately made themselves sick with drinking the juices of a medicinal root. The dosage purged them so thoroughly that they did not recover until three or four days later. The Indians also ate green corn in the spring to work the same effect.

The Indian medicine man, like his European counterpart, frequently dispensed medicines or drugs. As has been the custom among many men in the medical profession, the medicine man would not reveal the secrets of his medicines. "Made very knowing in the hidden qualities of plants and other natural things," he considered it a part of the obligations of his priesthood to conceal the information from all but those who were to succeed him. On the other hand, the Indian priest showed his concern for the health of his people--and the similarity of his attitude to that of present day practices--by making an exception to his canon of secrecy in the case of drugs needed in emergencies arising on a hunting trip and during travel.

Disease and The Critical Years At Jamestown

MOTIVES AND PROVISIONS FOR COLONIZATION

In 1606 King James of England granted a charter to Sir Thomas Gates and others authorizing settlements in the New World. In 1609 this charter was revised and enlarged, granting the privileges to a joint-stock company. Among the merchants, knights, and gentlemen holding shares in the company and among those particularly interested in the more southerly areas of North America, including Virginia, were a number of physicians. The instructions given to the first settlers reflect the general concern of the London Company for the health of the colony and perhaps the particular interest of the physicians. One of the physicians, John Woodall, took especial care to urge that cattle be sent to provide the settlers with the milk he considered essential to their health.

Not only did the Company wish to lessen the dangers of disease in the New World, but it also urged colonization as a means of reducing the plague in England. In 1609 the Company advised municipal authorities in London to remove the excess population of that great city to Virginia as the surplus was thought to be a cause of the plague. There was little danger of a surplus population during the initial years in Virginia.

Before the colonists, or the Company, however, had to be concerned with dangers from disease in Virginia, the colonists had to undertake an extremely difficult and unhealthy voyage across the Atlantic.

DISEASE AND THE OCEAN VOYAGE

Although these small ships carrying the first permanent settlers had a stopover in the West Indies for rest and replenishment, there had been debilitating months at sea and more than 100 emigrants to provide for in addition to the crews. With limited cargo and passenger space, water and food supplies could hardly satisfy the demand created by a hundred persons at sea for hundreds of days. Several of the emigrants died on the first voyage and the remainder disembarked poorly prepared for the new tests their constitutions would soon endure.

The sea voyage of these first settlers probably exacted no heavier a death toll and caused no more suffering because the ships went by way of the Canaries and the West Indies instead of by the more northerly route by-passing the islands. A contemporary described the advantages thought to be had from the stopover in the West Indies :

We came to a bath standing in a valley betwixt two hills, where wee bathed ourselves.... Finding this place to be so convenient for our men to avoid diseases which will breed in so long a voyage, wee incamped our selves on this ile sixe dayes, and spent none of our ships victuall.

Later voyages during the century took anywhere from two to three months. Despite the precautions taken by some, of a rest, in the West Indies to bring about "restitution of our sick people into health by the helpes of fresh ayre, diet and the baths," the trip aboard the pestered ships continued to exact a heavy death toll and to discharge disease and diseased persons. Benefits resulting from the stopover in the Indies were countered by the considerable exposure to tropical infections. One convoy carrying colonists to Virginia in 1609 and running a southerly course through "fervent heat and loomes breezes" had many of the crew and passengers fall ill from calenture . Out of two ships so afflicted, thirty-two persons died and were thrown overboard. Another of these ships reported the plague raging in her.

Irritated by frequent references to the unhealthy climate of Virginia and fearful that the bad publicity would increase the difficulties in obtaining colonists, officials of the London Company took pains to expose the part that the ocean voyage played in bringing about the deaths of newcomers. Musty bread and stinking beer aboard the pestered ships, according to a contemporary, worked as a chief cause of the mortality attributed falsely to the Virginia climate and conditions at Jamestown. In 1624 Governor Wyatt and his associates recommended to commissioners from England that "care must be had that the ships come not over pestered and that they may be well used at sea with that plenty and goodness of dyet as is promised in England but seldom performed." Others complained of the crowding of men in their own "aires," uncleanliness of the ships, and the presence of fatal "infexion."

Insomuch as seventeenth-century medical theory paid scant attention to sanitation and hygiene in the study of the causes of disease, it is surprising to find the early Virginian rightly recognizing the ships as sources of sickness. On the other hand, observation could not help but lead passengers to conclude that sickness, such as flux or dysentery, with which they had to suffer aboard ship, might have a causal relationship to the ship. To have related the transmission of the plague from epidemic centers in England via infected shipboard rats, and transmission of tropical fevers, as well, by the medium of shipboard water buckets infected with mosquito larvae from the tropics, was beyond the capacity of both medical theory and of first-hand observation.

Physicians or surgeons did ship aboard the seventeenth-century ocean-going vessels, but Doctor Wyndham B. Blanton, the chief authority on seventeenth-century Virginia medicine, concludes that most of them probably had poor educations and little more to recommend them than "a smattering of drugs, a little practice in opening abscesses and a liking for the sea." A seventeenth-century contemporary recommended that a ship's surgeon--surgeons went to sea far more often than physicians--be the possessor of a certificate from a barber-surgeon guild and be freed from all ship's duties except the attending of the sick and the cure of the wounded. The ship's surgeon, then, crossed the professional line between surgeon and physician, a line that necessity would soon force so many medical men to cross in America.

Throughout the century ship's surgeons abandoned their shipboard duties to settle in the Virginia colony, and there seems little reason to doubt that those remaining aboard ship took advantage of the opportunity when in port to help meet the medical needs of the colonists, thus supplementing the medical talent which had taken up residence in Virginia.

The labors of the ship's surgeon at sea, no matter how valiant, could not offset the miseries of the long sea voyage, and the sight of Virginia's coast greatly cheered all hands. After the foul air, crowded quarters, and inadequate provisions of the ship, many settlers must have reacted to the Virginia land as Captain John Smith did: "heaven and earth never agree better to frame a place for man's habitation." It is not surprising then that the first permanent settlers were somewhat less than careful when evaluating, against standards of health, the possible sites for settlement.

THE SELECTION OF SITES FOR SETTLEMENT

In a fairly extensive set of instructions "by way of advice, for the intended voyage to Virginia," the London Company, in 1606, took into account the part that disease and famine could play in the life--or death--of the colony. Probably knowing that the chances for survival of the Spanish conquistadors had been enhanced by their superhuman qualities in the eyes of the Indians, the Company urged that no information on deaths or sicknesses among the whites be allowed to the natives. More important, as the course of events was to demonstrate, was the advice not to:

plant in a low or moist place, because it will prove unhealthfull. You shall judge of the good air by the people; for some part of that coast where the lands are low, have their people blear eyed, and with swollen bellies and legs: but if the naturals be strong and clean made, it is a true sign of wholesome soil.

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