Healthcare

PHYSICIANS

In the History of Salisbury by John Dearborn pages 397-406 published in 1890 there is a listing of 24 physicians who practiced medicine in town.

One very notable Doctor was Joseph Bartlett who came to Salisbury at the age of 21 in 1772 and was the first permanent physician serving the town’s residents for 30 years. He grew an extensive practice and volunteered time to town office.

He was also the nephew of Josiah Bartlett of Kingston New Hampshire, a signer of the Declaration of Independence. Josiah Bartlett frequently visited his nephew and daughter as well who resided in town at Salisbury Heights.

THE DOCTOR’S KIT

On display in the Salisbury Historical Society Museum is the Doctor’s Kit.

The Doctor’s Kit of Remedies

The Physician had about 100 medicines available to him in the 1800’s. Many were herbal in nature such as Digitalis leaf, Basil, Camphor, Myrrh, Anise, Valerian, and Opium etc. Glaubus Salt or sal mirabillis (miraculous salt), a general all purpose laxative was common. Others were inorganic compounds such as Mercury.

The medicinal kit in our display case has small vials containing Strychnine, Digitalis leaf, Mercury and Herbal agents. Some are deadly powders!

The Physician would dispense these in small paper envelopes and the patients were instructed to take the medicine mixed in water.

Inorganic Mercury was a very popular treatment for many illnesses among New England Doctors at that time. Unfortunately, inorganic Mercury is highly toxic and many patients died from its use.

THE FOUR HUMORS

A Prevalent Theory of Medicine in early times

This theory was essentially unchanged from the synthesis of historical medical information provided by the Roman physician Marcus Aurelius in 200 AD!

Medicine in New England during this period was based on the Theory of the Four Humors:

Blood- Sanguine

Phlegm- Dull

Yellow Bile- Quick to Anger

Black Bile- Depressed

________________________________________________________________

INFECTION

Basic concepts of infection and transmission were not understood by New England Physicians at that time.

Childbed (Puerperal Fever) Fever was near epidemic because Physicians did not wash their hands and thus transferred infection from one patient to another.

In 1849, at Bellevue Hospital in New York, half of the women giving birth contracted Childbed Fever and eighty percent of those died.

It is interesting to note that the infection rate was much lower when midwives attended the delivery since they practiced superior personal hygiene and careful hand washing before each delivery.

________________________________________________________________

QUARANTINE

The concept of the Four Humors persisted through Colonial times but there were several forward thinkers exploring other approaches healthcare. One was prevention though at the time the causes of disease were not understood. One was Thomas Jefferson and another John Adams.

According to Jeanne Abrams in her book, regarding Thomas Jefferson:

Revolutionary Medicine, the Founding Mothers and Fathers in Sickness and In Health

“Contrary to many of his contemporaries, he was aware of the fact that certain diseases were communicable before symptoms occur and this awareness led him to promote preventative measures such as the quarantine for Yellow Fever. In 1825 he performed an achievement of paramount importance, the opening of the University of Virginia, of which he was not only the founder but also the principal designer”. As Abrams notes, the design of the buildings was such that it promoted both the physical and mental health of the students and prevented the spread of infectious diseases.

Also see:

Broadcast (Podcast)#5 Jeanne Abrams:

http://www.benfranklinsworld.com/

Jeanne Adams also discusses the prevailing major illnesses such as Smallpox, Malaria and Measles epidemics.

The procedure called Innoculation is also covered.

VARIOLATION/INNOCULATION

It is interesting to note that John Adams and his family were inoculated against smallpox via an incision.

Regarding the devastating outbreaks of Small Pox in New England, from the link below:

http://www.historytoday.com/elizabeth-fenn/great-smallpox-epidemic#sthash.01iqMSo2.dpuf

“Fearsome though it was, eighteenth-century Americans did not face smallpox unarmed. Even without an understanding of virology, they employed two weapons against the disease: isolation and inoculation. Isolation or quarantine simply meant avoiding contact between individuals sick with the disease and individuals susceptible to it. Bed linens and clothing might receive special handling. Done properly, quarantine could often halt further contagion. In the colonial period, isolation was used by colonists and Native Americans alike.

The second weapon – employed even after Edward Jenner’s discovery of vaccination in 1796 – was inoculation. Unlike vaccination, which utilised the cowpox virus, inoculation involved the deliberate infection of a susceptible individual with Variola virus, usually through an incision on the hand. For reasons that elude scientists to this day, inoculated smallpox was in most cases much less virulent than the ‘natural’ form of the disease. Survivors won lifelong immunity, just as they would from ‘natural’ smallpox, but mortality was notably lower.

There was, however, a catch: individuals under inoculation did come down with smallpox, and they were therefore fully capable of infecting others with the disease. Unless practised under strict quarantine, the operation was as likely to start an epidemic as to stop one. For this reason, inoculation was highly controversial in the English colonies, where smallpox outbreaks were comparatively rare. In England, however, the disease had long been endemic, and the procedure achieved wider acceptance. These combined factors meant that in the early stages of the American Revolution the British forces were far more likely than the Americans to have acquired immunity to the Variola virus”.

From the following website:

https://www.iaff.org/ET/Smallpox/What_is_the_history_of_smallpox_vaccination.htm

“What is the History of The Small Pox Vaccine?

The story of smallpox prevention — and its eventual eradication through immunization — is a long and compelling one.

For centuries, it was known that people who survived smallpox became immune to it. For that reason, nearly every culture tried to induce immunity in healthy individuals. The Chinese used tubes to insert powdered smallpox scabs into their nostrils. In Turkey, pus from lesions was scratched into the skin.

Eventually these methods — collectively known as variolation — reached Europe and the New World. There, as elsewhere, variolation had varying degrees of success. Some people became immune, but others contracted the disease and died or became the source of a new epidemic. Still, by the early 1700s, “do-it-yourself” smallpox inoculation had become widespread”.

EDUCATION FOR THE PHYSICIAN IN THE 1800’s

To Become a Physician…

”All a young man has to do is gain admittance to the office of a physician, have access to some medical books, see a patient once a month and attend lectures for three months” -New England Journal of Medicine 1846.

Many Physicians had less training than this.

A minority of Physicians had formal education, such as the University of Michigan Medical School in 1850.

The tuition, $5.00 per year, covered 2 years of education.
No college graduation was required.
Requirement was the knowledge of some Greek and enough Latin to read and write prescriptions.
The curriculum consisted of lectures only and the second year was a repeat of the first year.

BLOODLETTING

Removing various amount of blood from a vein had been used at least as early as 400 BC.

In the 1800’s in New England it was used to treat a variety of illnesses.

During childbirth, women were often bled into un-consciousness in an attempt to control the pain of childbirth.

George Washington had a severe illness characterized by fever, sore throat and cough. He was attended to by three Physicians, two older Physicians and one younger. The two older Physicians wanted to treat Washington with bloodletting. The younger Physician disagreed but was overruled. Washington was bled two thirds of his total blood volume in less than twenty four hours. He died shortly thereafter.

Salisbury Historical Society, New Hampshire

Preserving Our Town's History and Traditions

Healthcare